Michael "Mike" Albert, MD
@MichaelAlbertMD
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Co-Founder, Chief Medical Officer @accomplishhlth | Obesity & Cardiometabolic Medicine | Clinical Incretinology | Healthcare Futurist
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Carnivore MD no longer does Keto-Carnivore because he thinks it’s unhealthy—stemming from self-reported adverse effects of chronic nutritional ketosis.
You can’t make this stuff up. What a world.
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Diagnosed my first case of Trigeminal Neuralgia due to acute
#COVID19
. I’ve heard of ageusia and anosmia, but this is the first I’ve seen of CN5 involvement. It appears that the 🦠 hangs out in the cranial nerves? Anyone else seeing similar cases?
#medtwitter
#COVID4MDs
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Insurance broke me. I no longer do prior authorizations bc I do not have the time or patience. Congrats, Big Insurance. You have broken my spirit and denied patients access to necessary care.
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D1: Well, it happened. I developed symptoms last night, and I’m on self-isolation for a week. Started w/ dry cough and SOB and progressed 2 chest tightness. Pulse oximeter has me @ 98% on RA. We shall see...
Can I be tested? No! Still restricted testing in CA.
#COVID
ー19 🦠
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“Obesity is a choice” is the biggest misconception we tell ourselves and our patients. Read any of the genetics or neuroscience of obesity literature, and you would quickly rid yourself of this concept. Ignorance remains an obstacle to progress.
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A hill I’m willing to die on:
Physicians should not be providing lifestyle counseling. Physicians should be assessing, diagnosing, and treating/managing diseases.
Let RDs, health coaches, behavioral therapists, exercise physio, etc., provide preventive services & counseling.
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Wk 1: I have really struggled w/ how to share my experience on the
#frontlines
this wk. People young and old are dying. I have a wife and a baby. I risk my life every day when I walk in that room, and some of you still don’t get it.
#COVID19
#StayTheFHome
#SocialDistancing
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What’s wrong with healthcare. I can’t quite put my finger on it…🤔
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Obesity is one of the rare fields in Medicine where we accept treatments that are ineffective as adequate. Not only do we accept them, but we promote them. This would all be shocking, but many consider obesity a personal failure, so it’s clear most have no clue.
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Your friendly reminder that LDL causes atherosclerosis. This is the consensus among expert physicians and scientists. The only people questioning this are trying to justify a personal lifestyle choice. FYI: we don’t use “unequivocally” lightly in science.
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I don't know who needs to hear this, but INTERMITTENT FASTING IS NOT A DIET. 👍
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If you are an opioid-naive patient and receive an initial 10 day supply of opioids, there is a 20% chance you still be taking them at 1 year and a 10% chance you'll be taking them at 3 years. These drugs clearly start affecting your brain chemistry right away!!!!
@CDCgov
study
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Monthly cost of semaglutide treatment from around the world:
🇺🇸 $900-$1400
🇨🇦 $299
🇲🇽 $160
🇬🇧 $100
🇮🇱 $140 ($70 with insurance)
🇵🇱 $90 ($25 with insurance)
🇸🇦 $100
🇨🇿 $121
🇧🇪 $110 (free w/ T2DM)
Which one is not like the others?
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1/
#OBESITYSERIES
2: WHY COMMON OBESITY IS NOT A CHOICE
A large number of people, including physicians, believe that obesity is a consequence of a person's moral character or poor choices. The reality could not be farther from the truth. Let's jump in...
The following question will inform my next tweetorial:
Is obesity the consequence of making too many unhealthy choices, lacking discipline, or being lazy?
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🚨BREAKING: Semaglutide meets primary end-point in SELECT trial—reduces 3-point composite MACE by 20%.
All endpoints (CV death, non-fatal MI, non-fatal stroke) supposedly contribute to the demonstration of superiority vs. Placebo.
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If you still believe that obesity is SOLELY due to carb intake, you are ignorant of the science or do not care. Either way, you can unfollow me as I provide evidence-based information.
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Diet & exercise will not effectively treat obesity, a disease primarily regulated by subconscious parts of the 🧠. We can continue to develop novel diets & lifestyle txs (resulting in 0-5% wt loss LT) that appeal to a weak system, or we can start understanding obesity regulation.
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Some of the smartest physicians I know have no idea about the science of obesity. Obesity is not a choice. We still have so much work to do.
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Why are doctors always late?
Why are they always tired?
Why must they see >20 patients daily to keep the lights on?
It’s important to empathize with each other. Thanks for this powerful analogy,
@jjfitzgeraldMD
.
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“I ate too much protein and that is why I have obesity” said no one ever.
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Exercise does not lead to meaningful weight loss. Stop this nonsense!
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🚨BREAKING: Novo Nordisk receives the first of its kind FDA approval of Wegovy (Semaglutide) for secondary prevention of cardiovascular disease in people with overweight and obesity.
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We do not need RCTs to appreciate the power of lifestyle interventions:
E.g., I made wholesale changes to my life:
-lost 30 lbs
-stopped 2 BP meds (and BP is 110/60-70s)
-symptoms of depression and anxiety are gone
-LDLc 127->79; HDL 42->48
Name a drug that could do this?
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1/
@PeterAttiaMD
suggests semaglutide makes his patients “fatter” due to his patients losing more lean body mass relative to fat mass (LBM:FM). He claims the data was generated by an in-house pre-post DEXA case series (unpublished). Let’s evaluate that claim…
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The Golden Obesity Therapeutic Triad:
◾️ appetite normalization
◾️ increased EE/fat oxidation
◾️ preservation of lean mass
It's wild to speculate, but I am confident obesity will be solved in our lifetime.
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As we rapidly accelerate toward this future of obesity, I would remind everyone that unless systemic changes are made which require changing fundamental structures of our society, this will be inevitable. Once people develop obesity, we have no evidence that the neurohormonal and
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1/ Is Obesity A CHOICE?
The thread 🧵. For starters, please answer the following question ⬇️
Yes
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No
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Unclear
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Treating obesity would be the single most impactful way to reduce the chronic disease burden in the US.
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Sources tell me that Tirzepatide is on track to be approved for chronic weight management and obesity before the end of the year and as early as October 2023.
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Respectfully, there is an entire profession who is already educated on nutrition, nutrition counseling, and medical nutrition therapy. It is our failure that we do not financially support their efforts to work with patients.
#RD
#Dietitians
BIG NEWS: The House of Representatives has passed my bipartisan resolution calling on medical schools, residency, and fellowship programs to provide nutrition education that demonstrates for providers the connection between diet and disease.
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Time Restricted Eating (aka intermittent fasting) is just (a structured form of) Calorie Restriction.
What’s your unpopular medical opinion that would land you in this position?
Drop it in this thread
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Anyone who raises money off the idea that they can solve obesity or chronic dz based on a microbiome analysis is lying. We have barely scratched the surface of our understanding of the gut. We need to crawl before we can walk or run.
SF poop-testing startup, once compared to Theranos, charged in $60M fraud scheme via
@SFGate
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‼️ If you have ever worked in a hospital and needed to prescribe Ondansetron (ODT) for patients leaving the hospital, oftentimes, it would be >$150, which at my safety net hospital was unreasonable for patients to pay. With
@costplusdrugs
they offer it for $6! Thanks,
@mcuban
🙏.
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If diet and exercise were the definitive treatment for obesity we would see it in the data. We’ve studied virtually all forms of dieting and exercising and none lead to same level of disease control as surgery or medication. How do you reconcile this fact? I know how I do.
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Yes, people have to stay on obesity meds forever.
Virtually all chronic disease meds have to be taken continuously and indefinitely.
I never hear people make similar comments of statins, autoimmune meds, BP Meds, or diabetes meds as a sort of “gotcha.”
Check yourself.
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A harsh reality is that adult obesity prevalence is nearing 50%, and very few healthcare providers and ZERO health coaches or personal trainers are formally educated on the science and management of obesity. It is an uphill battle to educate people.
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1/ STEP 4 Trial of Semaglutide for obesity treatment is a beautiful illustration of the physiology of body weight regulation. Let's explore it in this 🧵
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In obesity, eating less and moving more as a means to reduce BW assumes normal physiological conditions. But, obesity, by definition, implies disturbed physiology that will not respond normally to standard stimuli.
#OW2021
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FTC passed a non-compete ban but excluded non-profits (i.e., the new rule does not apply to non-profit health systems), which is a huge chunk of healthcare
FTC is moving forward in banning non-compete clauses today.
Physicians everywhere rejoice!
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1/ WHY INCREASING PHYSICAL ACTIVITY/EXERCISE SHOULD BE A GREATER FOCUS THAN LOSING WEIGHT:
I still think a weight-centric approach to managing chronic dz is the best approach, but if you are going to focus on ONE change in your life, I hope it is increasing PA.
[thread]
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I don’t know who needs to hear this, but diet & exercise is not an effective obesity treatment.
Why? Obesity is driven by subcortical changes (below consciousness) leading to overeating. Telling yourself to eat less won’t make you “eat less” if it is not a willpower issue.
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I don't want to keep dunking on CarnivoreMD, but he keeps giving bad advice.
Babies should NOT eat honey or raw dairy. This is literally Pediatrics 101. It's the most basic stuff. You won't pass the intro med school classes w/ these answers. I don't know what to say at this pt.
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It is called “humanism in medicine.” I’ve cried with patients and families on a number of occasions, and I’m not embarrassed to admit it. We are taking care real people with real lives at stake. At the very least, it shows you care and understand the stakes.
Many doctors admit to crying at work. Probably still more have done so but been unwilling to admit it for fear that it could be considered unprofessional. However, it’s increasingly recognised as unhealthy for doctors to bottle up their emotions . . .
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Physical activity is arguably the greatest tool for weight loss maintenance, and more is better. ≥ 200 min/wk did not experience weight recurrence.
Famous study: Jakicic et al., 1999
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I hope no one believes the actors that put on 15-20 lbs of muscle in 6 weeks and have <10% BF are natural. You know that’s physiologically impossible, right? Right?!! It’s not brown rice, chicken, and broccoli. Please tell me you don’t believe it’s a “special”workout routine.
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GLUCOREXIA NERVOSA
If I’ve contributed nothing else to medicine, at least give me this: pathologizing clinically insignificant or subclinical glycemic excursions through the obsessive measurement of interstitial glucose levels such that it causes mental or physical harm to an
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Reminder: it is illegal for health coaches and trainers to provide meal plans or diets.
Also, they are not allowed to prescribe a way of eating for the purpose of treating a specific health condition.
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Carbs lead to obesity and type 2 diabetes when you ingest them as 🍕🍩🧁🍟🍬🍭🍨🍪...
...rather than 🥗🥔🌽🥕🥦🥬🫑🍎🍉🍌🍓🍇🍒🥒.
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CDC Updates Obesity Prevalence Data (based on BRFSS).
Things continue to trend in the wrong direction. Ten years ago no state had an obesity prevalence above 35%--now, 22 states with levels exceeding 35%.
Link:
Media Statement:
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Finished taking my Obesity Boards!
Happy to announce that after years of studying for the test, I can unequivocally say:
👉🏻carbs don’t make you fat
👉🏻fat doesn’t make you fat
👉🏻protein doesn’t make you fat
- - -
Consuming any of the three in EXCESS does!
#Caloricsurplus
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The family went to a summer birthday party, and Ozempic was all the talk among the private school parents. I observed quite a bit of drug-induced anorexia and sarcopenia among the affluent parents. Who is prescribing Ozempic to all these women? It’s malpractice.
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@MITCHELLEHRENBE
Yep, makes me wonder if SARS-COV-2 could remain dormant in nerve root ganglia like Herpes.
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FALSE NEGATIVE RATES W/
#SARSCoV2
RT-PCR TESTING
Day 1 - 100%
Day 4 - 67%
Day 8 - 20%
Day 21 - 66%
Authors conclude "tests for SARS-CoV-2 based on RT-PCR add little diagnostic value in the first 5 days immediately after exposure."
THIS NEEDS MORE ATTENTION!!!
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FTC is moving forward in banning non-compete clauses today.
Physicians everywhere rejoice!
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After many discussions with expert intensivists & immunologists, considering my review of the literature, and based on personal exp, causes of COVID19 deaths primarily fall into 1 of 3 categories:
1) cytokine storm
2) lack of ventilators
3) poor baseline health + ARDS
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First, obesity IS caused by genes (monogenic and polygenic forms of obesity; this is not debatable, it’s a fact). However…this debate is primarily about people talking past each other and trying to overemphasize one component. Data is pretty clear that the distribution in body
Obesity isn't caused by genes, or by lack of willpower.
There's three times more obesity today vs. a few decades ago, our genes and willpower are arguably the same.
It's all about the ultra-processed food environment. It was redesigned for profit.
Big Food caused the epidemic.
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1/ ENOUGH IS ENOUGH!!!
We can and should acknowledge that bariatric (metabolic) surgery is a superior intervention for the treatment of obesity. [thread]
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Adipocytes secrete over 600 proteins, all with various functions. I will let that sit for a bit...
>600 proteins. We have only just begun to comprehend obesity.
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I understand that many people and businesses have struggled during these times that is why I am grateful to announce that I accepted a faculty position
@CedarsSinai
where I will be leading the Obesity Medicine Program at the Weight Loss Center.
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Bc most of the GLP1 skeptics don’t read the science & have never talked to a pt, let me break it down. Behavior is the manifestation of lots of complex neurobio. GLP1s dampen/shut off certain signals, thus making the pursuit of certain health behaviors easier & more accessible.
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These MDs have to stop embarrassing themselves. I do not know what you even call this, but it is not science.
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No diet has demonstrated type 2 diabetes reversal (A1c < 6.5%) without weight loss. In fact, weight loss is the mechanism by which A1c is improved over the long term as described by the ‘TWIN-CYCLE’ hypothesis.
How much weight loss is needed? ~15 kg per DiRECT trial
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If an individual physician sees 40+ patients daily, they are not providing healthcare.
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You did not develop obesity because of fruit.
You did not develop obesity eating a Mediterranean-style dietary pattern.
You did not develop obesity following the Dietary Guidelines.
None of these are true. This is either recall bias or willful misrepresentation.
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Seeing a lot of “longevity clinics” pop up.
At one point in time, we just called this primary care. Does primary care need a rebrand for millennials?
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Oprah: Do you have to be on it [obesity treatment] for the rest of your life?
Dr. Velasquez: Yeah…the data would support that. We have good trials showing that when these patients stop the medication, the disease comes backs.
Me [at home]: Yes! Evidence-based! 👏🏻👏🏻👏🏻
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Diet adherence naturally wanes with time. Why? Because as many people have pointed out this week, modern processed food options are generally more convenient and appealing, which is an almost irresistible combination for our primitive brains. 🧵
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My last thought on the
#SELECT
trial. Participants did not experience weight recurrence over 51 months. This provides strong evidence for the durability of incretin therapy for obesity. I’m actually unaware of any treatment that provides this level of durability.
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>80% of obesity-associated genes are located in the nervous system
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Obesity is now the LEADING modifiable risk factor for Alzheimer disease and related dementias
JAMA Neurology | JAMA Network
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We’ve stigmatized unhealthy weight for decades, and the problem only worsens.
Maybe we should stop considering it a personal failing and instead appreciate it as a product of Biology x Environment, as all the science indicates. Then we might be able to make progress on the
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People overestimate the health benefits from diets and underestimate the health benefits from physical activity (movement and strength training).
#GetMoving
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For my carbs "make you fat" and "give you diabetes" folks.
How come plant-based eating patterns (high in carbs) have long been used to prevent disease and remit diabetes?
Is it possible that carbs (like fats and proteins) only cause health issues in excess (kcal surplus)?
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I just received my Assistant Professorship of Medicine at UCLA. Thanks to everyone who supported my application!
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Internet folks: “I have been eating the ADA diet and it made me overweight/sick.”
Reality: you’ve been eating 🍕🍟🥞🍡🥨🥯 and never whole-plants
Also Internet: “Keto healed me and is the only reason my health and DM improved.”
Reality: you stopped eating 🍕🍟🥞🍡🥨🥯
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Obesity meds WON’T solve the obesity crisis. We cannot medicate and surgerize our way out of this. These tools will help reduce disease burden but will not solve anything. Instead, we need to remodel society and make it more equitable & health-focused—only then will it be fixed.
GLP-1s have the potential solve the obesity crisis and save our floundering healthcare system from hundreds of billions in costs.
But there's a major problem:
Most patients won't be able to get access.
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The single best advice I could give any person:
Eat your food and exercise as if it were Medicine; otherwise, you will have to take your Medicine as if it were food for the rest of your life.
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WITH LIFESTYLE INTERVENTIONS FOR WEIGHT LOSS:
▪️50% of lost wt is regained within 2 yrs
▪️80% is regained within 5 years
▪️~10% of people will be able to lose and maintain ≥ 10% wt loss at 10 years.
Lifestyle interventions alone are NOT effective LT treatments for the majority.
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An Absolute Tour De Force Summary of the Obesity Research Findings Resulting From the Strategically Focused Research Network (SFRN):
TLDR:
“Ultimately, the complexity of obesity involves interactions among large sets of susceptibility genes, epigenetic modifications, behaviors,
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My wife and I welcomed our 1st child into this world today. There is nothing that compares to this. I am at a loss for words, trying to cherish each moment, and feeling blessed that our daughter is entering a world where women are empowered like no other time in history.
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1/Bariatric surgery is often described as "barbaric" and "radical." I believe most of these polarizing opinions are derived from ignorance, so let's explore the science of bariatric surgery to better understand what is happening. 🧵
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May 2023 be the year we get rid of saying “obese people.”
People are not defined by their disease. We would never say the “hypertensive, cancerous person.” It’s a form of implicit bias that needs to be gone.
As an alternative:
“Man or woman with obesity”
“Person with obesity”
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ANY DIET THAT CAUSES WT LOSS WILL LEAD TO MEASURABLE ⬇️ IN BP.
This relationship is clear and has nothing to do with carb intake or InSuLiN.
For every 1 kg of wt loss, it is expected that BP will ⬇️by ~1 mmHg. Enough already! Our obsession with macros is almost pathological.
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Small plastics found in carotid atherosclerotic plaques were associated with a 4.5x higher hazard for adverse events.
Our environment is killing us!
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Amidst all the tragedy and suffering that our world has to offer, I hope to provide some positivity. On Feb 8th, we welcomed another member to the Albert clan, my daughter, Grace Katherine Albert. Seen with big sis in photo
#1
.
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Ppl argue about trivial things like macro ratios, food timing, and exercises for muscle hypertrophy.
The vast majority of people would benefit from consistently eating less ultra-processed food and more whole-ish food, while finding meaningful ways to move!
Do not overthink it!
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The Animal Origins of GLP1 🧵
--
The discovery of GLP-1 (Glucagon-like peptide-1) as a potential treatment for type 2 diabetes dates back to the early 1980s. At that time, researchers were exploring the role of gut hormones in regulating blood sugar levels. GLP-1 is a hormone
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There’s so much “balance your hormones” filth on TikTok. 🤢🤮
Just so we are clear: “balance your hormones” is an empty statement. It literally means NOTHING!
I might as well say: “we need to blockchain your microbiome from generative AI to fast-twitch your Dopamine-mediated
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It’s hard to take this comment seriously when you still sell ‘The Carnivore Code’ on Amazon despite the change of heart.
@MichaelAlbertMD
This is old news, been eating differently for 3-4 years now. Derek asked me about this and I shared the story. Would rather be honest about where I have shifted my perspective over the years.
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I desperately want to redefine the disease of obesity as a clinical syndrome described by its biological underpinnings rather than (exclusively) its anthropometric consequences.
Major criteria:
1) Appetite dysfunction
2) Insulin Resistance
3) Inflammation
Minor criteria:
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@CMichaelGibson
I have been in contact with one of the head MDs in Wuhan. He told me that in Dec, they were not wearing masks in the hospital, and a lot of the staff got COVID19. Then, leadership required masks for all workers and HCW transmission when to 0. They now wear masks 100% of the time.
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May 2024 be the year we stop referring to all GLP-1 meds as ‘Ozempic.’
Ozempic is the 3rd most effective FDA-approved incretin therapy, and it’s not even in the top ten based on the drug pipeline.
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So this received a lot of attention. I suspect my concerns resonated with many others. As an update, I am trying to find ways to conduct PAs (other than myself) bc I do not want my patients to miss out, but the whole system is frustrating, and the patient is the one that suffers.
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Federal Court Says Doctors Can’t Testify On NP’s Standard of Care

“Nurse practitioners cannot be held to same standard of care as doctors due to differences in their education and training…”
If they can practice independently, then they should be held to the same standards.
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People are struggling to understand this expert thread on obesity.
Obesity is both genetically and environmentally driven. The truth is that you are not absolved of personal responsibility, but there are aspects of your weight outside of your control.
It is proving difficult
“Obesity is genetic”
If you were just triggered, then this thread is for you.
If “but the human genome can’t evolve in a generation!” has passed your lips in the past few months, then this thread is for you.
🧬This is why obesity is genetic. And the environment is to blame.
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Stop conflating a disease with women empowerment and self-worth. Your body size does not determine your morality, individuality, or value as a person.
Even individuals with OB considered “metabolically healthy” are at increased risk of cardiovascular and metabolic diseases.
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➖You spend hundreds of thousands of dollars training to become a doctor
➖Countless nights studying
➖14,000+ hours of hands-on clinical training
Only to realize insurance companies make all the medical decisions for your patients.
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The Great Unifying Nutrition Fact:
Ultra-processed foods chemically engineered to overwhelm our primitive brains and promote overconsumption are bad for our health and promote disease.
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A lot of nutrition and fitness postering happens online when the reality is 99.9% of people would improve their health by finding some sustainable way to marginally increase unprocessed protein consumption, whole food plant consumption, and physical activity.
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