It's Not Cholesterol. Inflammation Is What's Actually Causing Heart Disease

Why are we still so see seeing so many Why are we still so see seeing so many people with heart disease? [music] people with heart disease? [music] people with heart disease? [music] >> Yeah, it's still the number one killer >> Yeah, it's still the number one killer >> Yeah, it's still the number one killer around the world, not just here. And around the world, not just here. And around the world, not just here. And it's still the number one killer in it's still the number one killer in it's still the number one killer in women who, you know, they think that women who, you know, they think that women who, you know, they think that it's breast cancer. No, no, it's [music] it's breast cancer. No, no, it's [music] it's breast cancer. No, no, it's [music] this is it. this is it. this is it. >> I concluded that one of the root causes, >> I concluded that one of the root causes, >> I concluded that one of the root causes, Mark, was this was this flawed Mark, was this was this flawed Mark, was this was this flawed hypothesis that [music] we should have hypothesis that [music] we should have hypothesis that [music] we should have low-fat diets to prevent heart disease. low-fat diets to prevent heart disease. low-fat diets to prevent heart disease. Cardiovascular disease is an Cardiovascular disease is an Cardiovascular disease is an inflammatory [music] process that it's inflammatory [music] process that it's inflammatory [music] process that it's not just about cholesterol, but there's not just about cholesterol, but there's not just about cholesterol, but there's ongoing inflammation, ongoing inflammation, ongoing inflammation, >> chronic stress, [music] loneliness, >> chronic stress, [music] loneliness, >> chronic stress, [music] loneliness, isolation, bad sleep, those things are isolation, bad sleep, those things are isolation, bad sleep, those things are huge in heart disease. huge in heart disease. huge in heart disease. >> But we know that 80% [music] >> But we know that 80% [music] >> But we know that 80% [music] of cases of heart disease and diabetes of cases of heart disease and diabetes of cases of heart disease and diabetes may actually be preventable with diet may actually be preventable with diet may actually be preventable with diet and lifestyle. and lifestyle. and lifestyle. >> As part of our summer series, we're >> As part of our summer series, we're >> As part of our summer series, we're revisiting some of the [music] most revisiting some of the [music] most revisiting some of the [music] most important conversations we've had on the important conversations we've had on the important conversations we've had on the topics that matter most to our health. topics that matter most to our health. topics that matter most to our health. And few are more important than heart And few are more important than heart And few are more important than heart disease. Heart disease remains the disease. Heart disease remains the disease. Heart disease remains the number one cause of death worldwide. And number one cause of death worldwide. And number one cause of death worldwide. And yet, despite decades of research, yet, despite decades of research, yet, despite decades of research, millions of prescriptions, and billions millions of prescriptions, and billions millions of prescriptions, and billions of dollars spent on treatment, many of dollars spent on treatment, many of dollars spent on treatment, many people still are confused [music] about people still are confused [music] about people still are confused [music] about what actually causes it and what we can what actually causes it and what we can what actually causes it and what we can do to prevent it. For years, the do to prevent it. For years, the do to prevent it. For years, the conversation [music] around heart conversation [music] around heart conversation [music] around heart disease has focused almost entirely on disease has focused almost entirely on disease has focused almost entirely on cholesterol. But what if that's [music] cholesterol. But what if that's [music] cholesterol. But what if that's [music] only part of the story? In this only part of the story? In this only part of the story? In this compilation episode, you'll hear from compilation episode, you'll hear from compilation episode, you'll hear from Dr. Cindy [music] Guyire of the Ultra Dr. Cindy [music] Guyire of the Ultra Dr. Cindy [music] Guyire of the Ultra Wellness Center, Dr. Eric Toppel, and Wellness Center, Dr. Eric Toppel, and Wellness Center, Dr. Eric Toppel, and Dr. for Simhotra as they explore a Dr. for Simhotra as they explore a Dr. for Simhotra as they explore a different perspective on heart disease. different perspective on heart disease. different perspective on heart disease. [music] One that goes beyond cholesterol [music] One that goes beyond cholesterol [music] One that goes beyond cholesterol and looks at the deeper drivers of and looks at the deeper drivers of and looks at the deeper drivers of cardiovascular risk, including cardiovascular risk, including cardiovascular risk, including inflammation, insulin resistance, inflammation, insulin resistance, inflammation, insulin resistance, metabolic [music] dysfunction, metabolic [music] dysfunction, metabolic [music] dysfunction, lifestyle, and early detection. You'll lifestyle, and early detection. You'll lifestyle, and early detection. You'll hear why many experts now believe that hear why many experts now believe that hear why many experts now believe that heart disease often [music] begins heart disease often [music] begins heart disease often [music] begins decades before symptoms appear, why decades before symptoms appear, why decades before symptoms appear, why traditional testing can miss important traditional testing can miss important traditional testing can miss important [music] signs and that are warning [music] signs and that are warning [music] signs and that are warning signs, and how emerging science is signs, and how emerging science is signs, and how emerging science is giving us new tools to identify risk giving us new tools to identify risk giving us new tools to identify risk earlier than ever before. earlier than ever before. earlier than ever before. >> [music] >> [music] >> [music] >> And more importantly, you'll hear a >> And more importantly, you'll hear a >> And more importantly, you'll hear a message that is both practical and message that is both practical and message that is both practical and hopeful and that many of the factors hopeful and that many of the factors hopeful and that many of the factors driving heart disease [music] are within driving heart disease [music] are within driving heart disease [music] are within our control and that prevention remains our control and that prevention remains our control and that prevention remains one of the most powerful tools we have. one of the most powerful tools we have. one of the most powerful tools we have. So, let's dive in. So, let's talk about So, let's dive in. So, let's talk about So, let's dive in. So, let's talk about heart disease cuz we think we know all heart disease cuz we think we know all heart disease cuz we think we know all about heart disease. Oh, it's about heart disease. Oh, it's about heart disease. Oh, it's cholesterol and statins are the cure and cholesterol and statins are the cure and cholesterol and statins are the cure and if that doesn't work, you get a bypass if that doesn't work, you get a bypass if that doesn't work, you get a bypass and angoplasty and you know, if that and angoplasty and you know, if that and angoplasty and you know, if that doesn't work, you get a transplant. doesn't work, you get a transplant. doesn't work, you get a transplant. [laughter] That's sort of and then you [laughter] That's sort of and then you [laughter] That's sort of and then you know of course there's all the normal know of course there's all the normal know of course there's all the normal causes we know like diabetes and high causes we know like diabetes and high causes we know like diabetes and high blood pressure and high cholesterol but blood pressure and high cholesterol but blood pressure and high cholesterol but diabetes is a symptom. High cholesterol diabetes is a symptom. High cholesterol diabetes is a symptom. High cholesterol is a symptom. Smoking is a habit is a symptom. Smoking is a habit is a symptom. Smoking is a habit [laughter] [laughter] [laughter] and yet we're kind of missing the boat I and yet we're kind of missing the boat I and yet we're kind of missing the boat I think on a lot of the reasons we have think on a lot of the reasons we have think on a lot of the reasons we have heart disease and what we can do about heart disease and what we can do about heart disease and what we can do about it from a a more systems perspective. it from a a more systems perspective. it from a a more systems perspective. So, let's talk about um just what a big So, let's talk about um just what a big So, let's talk about um just what a big deal this is and and how few people deal this is and and how few people deal this is and and how few people actually are meeting the simple actually are meeting the simple actually are meeting the simple behaviors that will prevent heart behaviors that will prevent heart behaviors that will prevent heart disease. disease. disease. >> Yeah. Again, this is another one of >> Yeah. Again, this is another one of >> Yeah. Again, this is another one of those conditions that the debate is, those conditions that the debate is, those conditions that the debate is, well, it's in my family, so I'm doomed well, it's in my family, so I'm doomed well, it's in my family, so I'm doomed to get it. But we know that 80% of cases to get it. But we know that 80% of cases to get it. But we know that 80% of cases of heart disease and diabetes may of heart disease and diabetes may of heart disease and diabetes may actually be pre preventable with diet actually be pre preventable with diet actually be pre preventable with diet and lifestyle. And despite that really and lifestyle. And despite that really and lifestyle. And despite that really powerful message, fewer than 3% of the powerful message, fewer than 3% of the powerful message, fewer than 3% of the US population is meeting the core four US population is meeting the core four US population is meeting the core four basic characteristics that predict low basic characteristics that predict low basic characteristics that predict low risk. And it's a pretty low bar, Mark. risk. And it's a pretty low bar, Mark. risk. And it's a pretty low bar, Mark. >> What are those? What are those four >> What are those? What are those four >> What are those? What are those four things? things? things? >> It's not smoking. >> It's not smoking. >> It's not smoking. >> Okay. >> Okay. >> Okay. >> Getting the minimum recommended 150 >> Getting the minimum recommended 150 >> Getting the minimum recommended 150 minutes of exercise a week, eating in minutes of exercise a week, eating in minutes of exercise a week, eating in the top two quintiles of what's the top two quintiles of what's the top two quintiles of what's considered a whole foods diet, and considered a whole foods diet, and considered a whole foods diet, and having a healthy body fat percentage. having a healthy body fat percentage. having a healthy body fat percentage. Fewer than 3%. I still find that Fewer than 3%. I still find that Fewer than 3%. I still find that shocking. So, not too much body fat, shocking. So, not too much body fat, shocking. So, not too much body fat, eating pretty healthy, little exercise, eating pretty healthy, little exercise, eating pretty healthy, little exercise, and don't smoke. and don't smoke. and don't smoke. >> Simple things to do, but like >> Simple things to do, but like >> Simple things to do, but like >> we're not even there yet. >> we're not even there yet. >> we're not even there yet. >> 3%. >> 3%. >> 3%. >> Yeah. >> Yeah. >> Yeah. >> And and and >> And and and >> And and and what's really staggering is that, what's really staggering is that, what's really staggering is that, >> you know, not only do people not meet >> you know, not only do people not meet >> you know, not only do people not meet those habits, but that there there are those habits, but that there there are those habits, but that there there are some really other big factors that we we some really other big factors that we we some really other big factors that we we are just so bad at in America. Our whole are just so bad at in America. Our whole are just so bad at in America. Our whole society is set up to actually cause society is set up to actually cause society is set up to actually cause heart disease. heart disease. heart disease. >> Absolutely. >> Absolutely. >> Absolutely. >> What are those things that that really >> What are those things that that really >> What are those things that that really are these risk factors that are these risk factors that are these risk factors that >> besides cholesterol? >> besides cholesterol? >> besides cholesterol? >> Well, of course, it's inflammation. I >> Well, of course, it's inflammation. I >> Well, of course, it's inflammation. I mean, you and I were working together mean, you and I were working together mean, you and I were working together back at Canyon Ranch when that pivotal back at Canyon Ranch when that pivotal back at Canyon Ranch when that pivotal study came out. I think it's been 21 study came out. I think it's been 21 study came out. I think it's been 21 years ago. I remember that New England years ago. I remember that New England years ago. I remember that New England Journal of Medicine review paper, Journal of Medicine review paper, Journal of Medicine review paper, >> Peter Libby and Paul Ricker showing that >> Peter Libby and Paul Ricker showing that >> Peter Libby and Paul Ricker showing that cardiovascular disease is an cardiovascular disease is an cardiovascular disease is an inflammatory process that it's not just inflammatory process that it's not just inflammatory process that it's not just about cholesterol, but there's ongoing about cholesterol, but there's ongoing about cholesterol, but there's ongoing inflammation. And as you've talked about inflammation. And as you've talked about inflammation. And as you've talked about many times on this podcast, many times on this podcast, many times on this podcast, >> inflammation is not it's also a symptom >> inflammation is not it's also a symptom >> inflammation is not it's also a symptom that it can come from a lot of different that it can come from a lot of different that it can come from a lot of different places. Because in our paper, our local places. Because in our paper, our local places. Because in our paper, our local paper, when that article came back out, paper, when that article came back out, paper, when that article came back out, I don't know if you remember this, it I don't know if you remember this, it I don't know if you remember this, it said President Bush's doctors measured said President Bush's doctors measured said President Bush's doctors measured his CRP, which is the common marker of his CRP, which is the common marker of his CRP, which is the common marker of inflammation, inflammation, inflammation, >> and they don't know what to do about it. >> and they don't know what to do about it. >> and they don't know what to do about it. >> Right. Right. >> Right. Right. >> Right. Right. >> So, it's one thing to say, well, we know >> So, it's one thing to say, well, we know >> So, it's one thing to say, well, we know inflammation matters. It's another one inflammation matters. It's another one inflammation matters. It's another one entirely. entirely. entirely. >> Take aspirin. >> Take aspirin. >> Take aspirin. >> Take aspirin and a statin. Right. >> Take aspirin and a statin. Right. >> Take aspirin and a statin. Right. >> But it's another to say, well, what are >> But it's another to say, well, what are >> But it's another to say, well, what are the root causes of inflammation? the root causes of inflammation? the root causes of inflammation? >> Well, it's true. And and we there's a >> Well, it's true. And and we there's a >> Well, it's true. And and we there's a lot of them. Um, lot of them. Um, lot of them. Um, >> and some of the things that we don't >> and some of the things that we don't >> and some of the things that we don't >> typically think of as causing >> typically think of as causing >> typically think of as causing inflammation, we know infections and inflammation, we know infections and inflammation, we know infections and allergens, things like that, even toxins allergens, things like that, even toxins allergens, things like that, even toxins and bugs in your gut, and bugs in your gut, and bugs in your gut, >> but uh, stress causes inflammation. >> but uh, stress causes inflammation. >> but uh, stress causes inflammation. >> Absolutely. >> Absolutely. >> Absolutely. >> Lack of exercise causes inflammation. >> Lack of exercise causes inflammation. >> Lack of exercise causes inflammation. >> Yeah. >> Yeah. >> Yeah. >> Bad sleep causes inflammation. >> Bad sleep causes inflammation. >> Bad sleep causes inflammation. >> Loneliness and isolation cause >> Loneliness and isolation cause >> Loneliness and isolation cause inflammation. And those are inflammation. And those are inflammation. And those are >> pandemics. >> pandemics. >> pandemics. >> Yes. >> Yes. >> Yes. >> In America, chronic stress, loneliness, >> In America, chronic stress, loneliness, >> In America, chronic stress, loneliness, isolation, bad sleep. isolation, bad sleep. isolation, bad sleep. I mean those things are huge in heart I mean those things are huge in heart I mean those things are huge in heart disease and we often miss miss the boat disease and we often miss miss the boat disease and we often miss miss the boat on helping our patients really deal with on helping our patients really deal with on helping our patients really deal with those those those >> right >> right >> right >> so okay so the typical person comes in >> so okay so the typical person comes in >> so okay so the typical person comes in he's you know got a high cholesterol he he's you know got a high cholesterol he he's you know got a high cholesterol he or she is a high risk for heart disease or she is a high risk for heart disease or she is a high risk for heart disease maybe family history maybe family history maybe family history >> um typical doctor does sort of what >> um typical doctor does sort of what >> um typical doctor does sort of what workup and and what kind of treatments workup and and what kind of treatments workup and and what kind of treatments >> so typical doctor might measure a >> so typical doctor might measure a >> so typical doctor might measure a glucose and an A1C to look at their glucose and an A1C to look at their glucose and an A1C to look at their blood sugar status and they would do a blood sugar status and they would do a blood sugar status and they would do a standard cholesterol profile, which standard cholesterol profile, which standard cholesterol profile, which interestingly enough calculates your LDL interestingly enough calculates your LDL interestingly enough calculates your LDL cholesterol, the one we usually think of cholesterol, the one we usually think of cholesterol, the one we usually think of as being the lousy cholesterol, from a as being the lousy cholesterol, from a as being the lousy cholesterol, from a formula, doesn't even really measure it, formula, doesn't even really measure it, formula, doesn't even really measure it, and base most of the decisions on that. and base most of the decisions on that. and base most of the decisions on that. >> If they have symptoms, they might send >> If they have symptoms, they might send >> If they have symptoms, they might send them to a cardiologist for a stress test them to a cardiologist for a stress test them to a cardiologist for a stress test >> if they have chest pain. >> if they have chest pain. >> if they have chest pain. >> If they have chest pain, right, >> If they have chest pain, right, >> If they have chest pain, right, >> or shortness of breath on exercise, it's >> or shortness of breath on exercise, it's >> or shortness of breath on exercise, it's already kind of down the road, already kind of down the road, already kind of down the road, >> right? Um, but most doctors don't >> right? Um, but most doctors don't >> right? Um, but most doctors don't measure a C reactive protein because, as measure a C reactive protein because, as measure a C reactive protein because, as I mentioned before, it's like, well, I mentioned before, it's like, well, I mentioned before, it's like, well, what do we do? What do I do with it? what do we do? What do I do with it? what do we do? What do I do with it? >> What do I do with it? Oh, statin and >> What do I do with it? Oh, statin and >> What do I do with it? Oh, statin and aspirin. And then they're probably going aspirin. And then they're probably going aspirin. And then they're probably going to treat them with if they are to treat them with if they are to treat them with if they are pre-diabetic or diabetic, they're going pre-diabetic or diabetic, they're going pre-diabetic or diabetic, they're going to give them metformin or medications to to give them metformin or medications to to give them metformin or medications to lower blood sugar and probably a statin lower blood sugar and probably a statin lower blood sugar and probably a statin to control the cholesterol. Um, how to control the cholesterol. Um, how to control the cholesterol. Um, how often do they actually talk to them often do they actually talk to them often do they actually talk to them about those root causes such as diet and about those root causes such as diet and about those root causes such as diet and stress and sleep? Maybe not. Yeah, stress and sleep? Maybe not. Yeah, stress and sleep? Maybe not. Yeah, they're talking about this poly pill as they're talking about this poly pill as they're talking about this poly pill as a as a treatment, which is this combo a as a treatment, which is this combo a as a treatment, which is this combo com combo pill of an aspirin, a statin, com combo pill of an aspirin, a statin, com combo pill of an aspirin, a statin, and a blood pressure drug. and a blood pressure drug. and a blood pressure drug. >> Yes. Put it in the water. >> Yes. Put it in the water. >> Yes. Put it in the water. >> Just like give it to everybody. It'll >> Just like give it to everybody. It'll >> Just like give it to everybody. It'll prevent heart disease. I'm like, yeah. prevent heart disease. I'm like, yeah. prevent heart disease. I'm like, yeah. Okay. Well, why do we have high blood Okay. Well, why do we have high blood Okay. Well, why do we have high blood pressure? Why do we have an aspirin pressure? Why do we have an aspirin pressure? Why do we have an aspirin inflammation? Why is our cholesterol all inflammation? Why is our cholesterol all inflammation? Why is our cholesterol all screwed up? screwed up? screwed up? >> Yeah. And you know, it's really >> Yeah. And you know, it's really >> Yeah. And you know, it's really interesting. There's, believe it or not, interesting. There's, believe it or not, interesting. There's, believe it or not, there's a potential behavioral component there's a potential behavioral component there's a potential behavioral component for patients who go on a statin and for patients who go on a statin and for patients who go on a statin and their cholesterol is now normal. It's their cholesterol is now normal. It's their cholesterol is now normal. It's good. good. good. >> Oh, yeah. I I can eat my cheeseburger. I >> Oh, yeah. I I can eat my cheeseburger. I >> Oh, yeah. I I can eat my cheeseburger. I can eat my cheeseburg chicken. can eat my cheeseburg chicken. can eat my cheeseburg chicken. >> Isn't that interesting that people >> Isn't that interesting that people >> Isn't that interesting that people change their diet in an unhealthy way? change their diet in an unhealthy way? change their diet in an unhealthy way? Oh, yeah. When their numbers better. Oh, yeah. When their numbers better. Oh, yeah. When their numbers better. >> One of the worst things I ever read was >> One of the worst things I ever read was >> One of the worst things I ever read was there was a bunch of cardiologists there was a bunch of cardiologists there was a bunch of cardiologists advocating for selling statins over the advocating for selling statins over the advocating for selling statins over the counter at McDonald's and fast food counter at McDonald's and fast food counter at McDonald's and fast food restaurants. restaurants. restaurants. >> Oh my gosh. And I think I think they do >> Oh my gosh. And I think I think they do >> Oh my gosh. And I think I think they do sell even statins over the counter and sell even statins over the counter and sell even statins over the counter and like you know it's like it's like those like you know it's like it's like those like you know it's like it's like those commercials for the acid blockers like commercials for the acid blockers like commercials for the acid blockers like take some Pepsid cuz don't worry daddy take some Pepsid cuz don't worry daddy take some Pepsid cuz don't worry daddy you can eat your peppers and sausage you can eat your peppers and sausage you can eat your peppers and sausage just take and I'm like no don't eat the just take and I'm like no don't eat the just take and I'm like no don't eat the peppers and sausage. [laughter] peppers and sausage. [laughter] peppers and sausage. [laughter] >> Um so you know you kind of mentioned >> Um so you know you kind of mentioned >> Um so you know you kind of mentioned they do a sort of a cholesterol profile they do a sort of a cholesterol profile they do a sort of a cholesterol profile but there was a hint of a a subtext in but there was a hint of a a subtext in but there was a hint of a a subtext in that sentence where they really weren't that sentence where they really weren't that sentence where they really weren't measuring the right thing. Yeah. measuring the right thing. Yeah. measuring the right thing. Yeah. >> So, we tend to look at things that we're >> So, we tend to look at things that we're >> So, we tend to look at things that we're used to looking at used to looking at used to looking at >> that are easy to test and measure, but >> that are easy to test and measure, but >> that are easy to test and measure, but you know, one of the things that that I you know, one of the things that that I you know, one of the things that that I think people forget, and I think doctors think people forget, and I think doctors think people forget, and I think doctors honestly forget is we get trained in honestly forget is we get trained in honestly forget is we get trained in this panel of tests. this panel of tests. this panel of tests. >> Mhm. >> Mhm. >> Mhm. >> And it's your blood count and your >> And it's your blood count and your >> And it's your blood count and your metabolic profile and your cholesterol metabolic profile and your cholesterol metabolic profile and your cholesterol and we measure like a few things. Maybe and we measure like a few things. Maybe and we measure like a few things. Maybe it's 30, 40 things. Maybe if like it's a it's 30, 40 things. Maybe if like it's a it's 30, 40 things. Maybe if like it's a super fancy doctor, they'll measure a super fancy doctor, they'll measure a super fancy doctor, they'll measure a hundred things like and hundred things like and hundred things like and they think they're kind of checking they think they're kind of checking they think they're kind of checking everything. Oh, your tests are fine. everything. Oh, your tests are fine. everything. Oh, your tests are fine. Everything's great. You look good. And Everything's great. You look good. And Everything's great. You look good. And the truth is that they're missing a huge the truth is that they're missing a huge the truth is that they're missing a huge amount. There are literally tens of amount. There are literally tens of amount. There are literally tens of thousands of different molecules in your thousands of different molecules in your thousands of different molecules in your body all doing things all the time, body all doing things all the time, body all doing things all the time, every minute, every second. And we every minute, every second. And we every minute, every second. And we ignore most of them. And they we in fact ignore most of them. And they we in fact ignore most of them. And they we in fact we may ignore some of the most important we may ignore some of the most important we may ignore some of the most important ones. And when it comes to cholesterol, ones. And when it comes to cholesterol, ones. And when it comes to cholesterol, we've covered this on the podcast with we've covered this on the podcast with we've covered this on the podcast with Dr. Bow and we went really deep into Dr. Bow and we went really deep into Dr. Bow and we went really deep into this. We just should just do a quick this. We just should just do a quick this. We just should just do a quick refresher because um the test that most refresher because um the test that most refresher because um the test that most people get, not the one we get here at people get, not the one we get here at people get, not the one we get here at the Ultra Wellness Center, but the test the Ultra Wellness Center, but the test the Ultra Wellness Center, but the test that most people get is like an that most people get is like an that most people get is like an antiquated cholesterol test that doesn't antiquated cholesterol test that doesn't antiquated cholesterol test that doesn't really tell you a whole lot. And I I really tell you a whole lot. And I I really tell you a whole lot. And I I have a patient yesterday who was a have a patient yesterday who was a have a patient yesterday who was a classic example of that, right? Uh so classic example of that, right? Uh so classic example of that, right? Uh so tell us about and I'll tell you about tell us about and I'll tell you about tell us about and I'll tell you about his test in a minute but tell us about his test in a minute but tell us about his test in a minute but tell us about about your you know the new kind of about your you know the new kind of about your you know the new kind of testing that we're doing. It's not so testing that we're doing. It's not so testing that we're doing. It's not so new because we've been doing it for 20 new because we've been doing it for 20 new because we've been doing it for 20 years but [laughter] years but [laughter] years but [laughter] and the discovery that allowed for the and the discovery that allowed for the and the discovery that allowed for the testing was oh 50 years ago. testing was oh 50 years ago. testing was oh 50 years ago. >> Yeah. So so the focus has been on >> Yeah. So so the focus has been on >> Yeah. So so the focus has been on amounts of cholesterol but we want to amounts of cholesterol but we want to amounts of cholesterol but we want to know the quality of the cholesterol. So know the quality of the cholesterol. So know the quality of the cholesterol. So we know for example LDL that's typically we know for example LDL that's typically we know for example LDL that's typically labeled the lousy cholesterol. There's labeled the lousy cholesterol. There's labeled the lousy cholesterol. There's big fluffy puffy pattern a LDL big fluffy puffy pattern a LDL big fluffy puffy pattern a LDL cholesterol which is less easily made cholesterol which is less easily made cholesterol which is less easily made into a plaque in the artery less prone into a plaque in the artery less prone into a plaque in the artery less prone to inflammation and oxidative stress and to inflammation and oxidative stress and to inflammation and oxidative stress and rupture. So it's a less risky LDL rupture. So it's a less risky LDL rupture. So it's a less risky LDL whereas somebody could have small dense whereas somebody could have small dense whereas somebody could have small dense pattern B LDL and that's the really pattern B LDL and that's the really pattern B LDL and that's the really risky LDL. So quality matters and if you risky LDL. So quality matters and if you risky LDL. So quality matters and if you have two people with a calculated LDL of have two people with a calculated LDL of have two people with a calculated LDL of 130, one of them could all have pattern 130, one of them could all have pattern 130, one of them could all have pattern a low-risisk LDL and they're actually a low-risisk LDL and they're actually a low-risisk LDL and they're actually fine. somebody else could have lots of fine. somebody else could have lots of fine. somebody else could have lots of those dense particles that's not those dense particles that's not those dense particles that's not captured by the calculated LDL of 130. captured by the calculated LDL of 130. captured by the calculated LDL of 130. So the quality matters. The same is true So the quality matters. The same is true So the quality matters. The same is true for HDL. We've historically thought of for HDL. We've historically thought of for HDL. We've historically thought of HDL as being the good healthy HDL as being the good healthy HDL as being the good healthy cholesterol, but size matters there, cholesterol, but size matters there, cholesterol, but size matters there, too. Small HDL doesn't seem to be as too. Small HDL doesn't seem to be as too. Small HDL doesn't seem to be as able to cart out the bad LDL and get rid able to cart out the bad LDL and get rid able to cart out the bad LDL and get rid of it. So we want to know the quality of it. So we want to know the quality of it. So we want to know the quality and the size of both the HDL and the and the size of both the HDL and the and the size of both the HDL and the LDL. And we want to know what other LDL. And we want to know what other LDL. And we want to know what other remnant particles are floating around remnant particles are floating around remnant particles are floating around like very low density lipoprotein and like very low density lipoprotein and like very low density lipoprotein and intermediate density lipoprotein. And intermediate density lipoprotein. And intermediate density lipoprotein. And those don't show up on a typical panel. those don't show up on a typical panel. those don't show up on a typical panel. >> Yeah. So, so, so practically what you >> Yeah. So, so, so practically what you >> Yeah. So, so, so practically what you see is people come in with what it looks see is people come in with what it looks see is people come in with what it looks like a normal cholesterol. Like this guy like a normal cholesterol. Like this guy like a normal cholesterol. Like this guy yesterday has early dementia. His yesterday has early dementia. His yesterday has early dementia. His cholesterol I think was 160 something. cholesterol I think was 160 something. cholesterol I think was 160 something. >> Sounds good. >> Sounds good. >> Sounds good. >> Yeah. His LDL was I think under 100. >> Yeah. His LDL was I think under 100. >> Yeah. His LDL was I think under 100. >> His triglycerides weren't bad. his HDL >> His triglycerides weren't bad. his HDL >> His triglycerides weren't bad. his HDL was 39, which is kind of low. was 39, which is kind of low. was 39, which is kind of low. >> Um, but we looked at his particle >> Um, but we looked at his particle >> Um, but we looked at his particle number. Even though his his LDL like the number. Even though his his LDL like the number. Even though his his LDL like the regular dog, oh, that's a great 160. regular dog, oh, that's a great 160. regular dog, oh, that's a great 160. That's a great cholesterol. Uh, they That's a great cholesterol. Uh, they That's a great cholesterol. Uh, they missed the boat because his particle missed the boat because his particle missed the boat because his particle number was was like 1,500. It should be number was was like 1,500. It should be number was was like 1,500. It should be under 1,000. under 1,000. under 1,000. >> Wow. >> Wow. >> Wow. >> And his small particles, which should be >> And his small particles, which should be >> And his small particles, which should be like zero or less than 300 is, you know, like zero or less than 300 is, you know, like zero or less than 300 is, you know, you can live with, but you can live with, but you can live with, but >> anything over that is high. His was 900. >> anything over that is high. His was 900. >> anything over that is high. His was 900. Wow. Wow. Wow. >> So he was like and he was a skinny older >> So he was like and he was a skinny older >> So he was like and he was a skinny older guy was 84 years old and had you know guy was 84 years old and had you know guy was 84 years old and had you know lost muscle, belly fat, you know, lost muscle, belly fat, you know, lost muscle, belly fat, you know, underweight, over fat and he was underweight, over fat and he was underweight, over fat and he was pre-diabetic and that was driving some pre-diabetic and that was driving some pre-diabetic and that was driving some of his dementia. But they go, "Oh, your of his dementia. But they go, "Oh, your of his dementia. But they go, "Oh, your cholesterol is fine. Not an issue." cholesterol is fine. Not an issue." cholesterol is fine. Not an issue." >> And and we also look at a lot of other >> And and we also look at a lot of other >> And and we also look at a lot of other things besides. And by the way, you things besides. And by the way, you things besides. And by the way, you know, in 2021, no one should get their know, in 2021, no one should get their know, in 2021, no one should get their regular cholesterol panel. I mean, you regular cholesterol panel. I mean, you regular cholesterol panel. I mean, you you got insist from your doctor. You can you got insist from your doctor. You can you got insist from your doctor. You can get it from LabCore Quest. It's called get it from LabCore Quest. It's called get it from LabCore Quest. It's called NMR, Cardi IQ. Uh it's it's so important NMR, Cardi IQ. Uh it's it's so important NMR, Cardi IQ. Uh it's it's so important to do and and I guess you know the to do and and I guess you know the to do and and I guess you know the problem is most doctors won't know what problem is most doctors won't know what problem is most doctors won't know what to do with it once they find it. There's to do with it once they find it. There's to do with it once they find it. There's no drug for it. Like, oh, your LDL's no drug for it. Like, oh, your LDL's no drug for it. Like, oh, your LDL's high, we'll give you a statin. high, we'll give you a statin. high, we'll give you a statin. >> It's like we it's like we treat what >> It's like we it's like we treat what >> It's like we it's like we treat what we're what we can easily test and find, we're what we can easily test and find, we're what we can easily test and find, not necessarily what the right thing is. not necessarily what the right thing is. not necessarily what the right thing is. And and so with with heart disease, uh And and so with with heart disease, uh And and so with with heart disease, uh >> you know, it really is a metabolic >> you know, it really is a metabolic >> you know, it really is a metabolic issue. It's it's it's you know you could issue. It's it's it's you know you could issue. It's it's it's you know you could they shouldn't be called cardiologists they shouldn't be called cardiologists they shouldn't be called cardiologists they be you should be called they be you should be called they be you should be called cardioendoimmunologists cardioendoimmunologists cardioendoimmunologists right because it's all about the right because it's all about the right because it's all about the hormones including insulin all about the hormones including insulin all about the hormones including insulin all about the inflammation immune system inflammation immune system inflammation immune system >> and uh and you mentioned earlier that >> and uh and you mentioned earlier that >> and uh and you mentioned earlier that study by Paul Ritker and and Libby in study by Paul Ritker and and Libby in study by Paul Ritker and and Libby in which uh was sort of the beginning of which uh was sort of the beginning of which uh was sort of the beginning of the conversation a lot of the follow-up the conversation a lot of the follow-up the conversation a lot of the follow-up studies like the Jupiter trial they studies like the Jupiter trial they studies like the Jupiter trial they found that if patients had a high LDL found that if patients had a high LDL found that if patients had a high LDL but they didn't have a high CRP their but they didn't have a high CRP their but they didn't have a high CRP their risk of heart disease was negligible. risk of heart disease was negligible. risk of heart disease was negligible. But if they had a high LDL and a high But if they had a high LDL and a high But if they had a high LDL and a high CRP, that was the problem. So CRP, that was the problem. So CRP, that was the problem. So independent of inflammation independent of inflammation independent of inflammation may not be an issue. Most of us are may not be an issue. Most of us are may not be an issue. Most of us are walking around in a state of chronic walking around in a state of chronic walking around in a state of chronic stimulation. Your cortisol is elevated, stimulation. Your cortisol is elevated, stimulation. Your cortisol is elevated, your nervous system is stuck in go mode, your nervous system is stuck in go mode, your nervous system is stuck in go mode, and we wonder why we can't sleep or and we wonder why we can't sleep or and we wonder why we can't sleep or focus. And one thing I've been using focus. And one thing I've been using focus. 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You've seen these these patients who were and I seen these these patients who were and I seen these these patients who were and I I don't mean to stereotype people but I don't mean to stereotype people but I don't mean to stereotype people but like it was this kind of cohort of women like it was this kind of cohort of women like it was this kind of cohort of women who were probably in their 70s and 80s who were probably in their 70s and 80s who were probably in their 70s and 80s who were thin who were fit the ladies we who were thin who were fit the ladies we who were thin who were fit the ladies we see at Kenya Ranch who like exercise eat see at Kenya Ranch who like exercise eat see at Kenya Ranch who like exercise eat well don't smoke normal blood pressure well don't smoke normal blood pressure well don't smoke normal blood pressure no diabetes and their cholesterol is 300 no diabetes and their cholesterol is 300 no diabetes and their cholesterol is 300 and their HDL is 100 and their LDL is and their HDL is 100 and their LDL is and their HDL is 100 and their LDL is like I don't know maybe 150 or something like I don't know maybe 150 or something like I don't know maybe 150 or something and and their they have no small and and their they have no small and and their they have no small particles and they have all these large particles and they have all these large particles and they have all these large fluffy things and they're in really no fluffy things and they're in really no fluffy things and they're in really no risk for heart disease and they don't risk for heart disease and they don't risk for heart disease and they don't need a statin. Right. Right. need a statin. Right. Right. need a statin. Right. Right. >> I even asked Peter Libby who's the chair >> I even asked Peter Libby who's the chair >> I even asked Peter Libby who's the chair of cardiology at Harvard like do these of cardiology at Harvard like do these of cardiology at Harvard like do these women need a statin? They're like no women need a statin? They're like no women need a statin? They're like no they don't. We don't have any data to they don't. We don't have any data to they don't. We don't have any data to say that they do. And I'm like oh that's say that they do. And I'm like oh that's say that they do. And I'm like oh that's interesting. So we kind of have to be interesting. So we kind of have to be interesting. So we kind of have to be really personalized in our approach and really personalized in our approach and really personalized in our approach and that's the other feature of functional that's the other feature of functional that's the other feature of functional medicine not like one size fits all. medicine not like one size fits all. medicine not like one size fits all. Everybody gets the poly pill. Everybody Everybody gets the poly pill. Everybody Everybody gets the poly pill. Everybody gets a statin aspirin and blood pressure gets a statin aspirin and blood pressure gets a statin aspirin and blood pressure pill like no we have to sort of think pill like no we have to sort of think pill like no we have to sort of think about what's the cause and there heart about what's the cause and there heart about what's the cause and there heart disease is is a symptom. It's a disease is is a symptom. It's a disease is is a symptom. It's a syndrome. It doesn't there are many many syndrome. It doesn't there are many many syndrome. It doesn't there are many many causes. So let let's talk about this causes. So let let's talk about this causes. So let let's talk about this whole idea of metabolic health whole idea of metabolic health whole idea of metabolic health >> because uh you know we were chit >> because uh you know we were chit >> because uh you know we were chit chatting a little earlier and chatting a little earlier and chatting a little earlier and >> it's staggering to me as a physician >> it's staggering to me as a physician >> it's staggering to me as a physician just how poor our metabolic health is. just how poor our metabolic health is. just how poor our metabolic health is. [snorts] [snorts] [snorts] >> Uh so so how how healthy are Americans >> Uh so so how how healthy are Americans >> Uh so so how how healthy are Americans metabolically? metabolically? metabolically? >> Yeah. Not very. So, so a recent study >> Yeah. Not very. So, so a recent study >> Yeah. Not very. So, so a recent study was looking at the Nahannes data from was looking at the Nahannes data from was looking at the Nahannes data from 2009 to 2016 government surveys our 2009 to 2016 government surveys our 2009 to 2016 government surveys our blood tests and health records and blood tests and health records and blood tests and health records and everything right everything right everything right >> and trying to say well how many people >> and trying to say well how many people >> and trying to say well how many people are what we would call metabolically are what we would call metabolically are what we would call metabolically healthy and it if you're not familiar healthy and it if you're not familiar healthy and it if you're not familiar with for people who may not be familiar with for people who may not be familiar with for people who may not be familiar with that term it's sort of meeting the with that term it's sort of meeting the with that term it's sort of meeting the optimal numbers for a blood pressure optimal numbers for a blood pressure optimal numbers for a blood pressure less than 120 over 80 um HDL levels less than 120 over 80 um HDL levels less than 120 over 80 um HDL levels being in the high range a good range uh being in the high range a good range uh being in the high range a good range uh greater than 40 for men 50 for women um greater than 40 for men 50 for women um greater than 40 for men 50 for women um having triglycerides that are low um having triglycerides that are low um having triglycerides that are low um having a glucose that's less than 100. having a glucose that's less than 100. having a glucose that's less than 100. And they found that 12.12% And they found that 12.12% And they found that 12.12% of Americans of Americans of Americans >> 12.2% >> 12.2% >> 12.2% >> 12.2%. Thank you. 12.2% of Americans >> 12.2%. Thank you. 12.2% of Americans >> 12.2%. Thank you. 12.2% of Americans were metabolically healthy, were metabolically healthy, were metabolically healthy, >> which kind of means that almost 88% of >> which kind of means that almost 88% of >> which kind of means that almost 88% of Americans are metabolically unhealthy. Americans are metabolically unhealthy. Americans are metabolically unhealthy. And since 75% of people are overweight, And since 75% of people are overweight, And since 75% of people are overweight, there's another 13% there. there's another 13% there. there's another 13% there. >> Yes. It's like what are the what's >> Yes. It's like what are the what's >> Yes. It's like what are the what's what's going on with the skinny people? what's going on with the skinny people? what's going on with the skinny people? >> Well, and that's the interesting piece. >> Well, and that's the interesting piece. >> Well, and that's the interesting piece. Fewer than onethird of so-called normal Fewer than onethird of so-called normal Fewer than onethird of so-called normal weight people were metabolically weight people were metabolically weight people were metabolically healthy. So, that's another really healthy. So, that's another really healthy. So, that's another really important message. important message. important message. >> Wait, wait, wait, wait, wait, wait. Did >> Wait, wait, wait, wait, wait, wait. Did >> Wait, wait, wait, wait, wait, wait. Did you just say that twothirds of skinny you just say that twothirds of skinny you just say that twothirds of skinny people are metabolically unhealthy and people are metabolically unhealthy and people are metabolically unhealthy and have pre-diabetes like syndrome? have pre-diabetes like syndrome? have pre-diabetes like syndrome? >> Yes. >> Yes. >> Yes. >> Twothirds. >> Twothirds. >> Twothirds. >> That's mindboggling to me. >> That's mindboggling to me. >> That's mindboggling to me. >> Okay. So, that that means that what like >> Okay. So, that that means that what like >> Okay. So, that that means that what like 95% of Americans are [laughter] are men 95% of Americans are [laughter] are men 95% of Americans are [laughter] are men among like among like among like >> No, no, no. still the 88%. All right, >> No, no, no. still the 88%. All right, >> No, no, no. still the 88%. All right, >> but we're looking at how strongly it >> but we're looking at how strongly it >> but we're looking at how strongly it correlated with weight. correlated with weight. correlated with weight. >> That's so terrible. >> That's so terrible. >> That's so terrible. >> So just having a body mass index that's >> So just having a body mass index that's >> So just having a body mass index that's less than 25 is not a guarantee that less than 25 is not a guarantee that less than 25 is not a guarantee that you're metabolically healthy. you're metabolically healthy. you're metabolically healthy. >> So if you're a skinny sugar and bagel >> So if you're a skinny sugar and bagel >> So if you're a skinny sugar and bagel eater, don't think it's fine cuz you're eater, don't think it's fine cuz you're eater, don't think it's fine cuz you're skinny is basically the bottom line. skinny is basically the bottom line. skinny is basically the bottom line. [laughter] [laughter] [laughter] >> Exactly. Because foods have other >> Exactly. Because foods have other >> Exactly. Because foods have other impacts besides just what they do with impacts besides just what they do with impacts besides just what they do with cholesterol anyway. Foods directly cholesterol anyway. Foods directly cholesterol anyway. Foods directly impact the elasticity of the arteries, impact the elasticity of the arteries, impact the elasticity of the arteries, for example, which is another key play. for example, which is another key play. for example, which is another key play. You mean food is more than calories, You mean food is more than calories, You mean food is more than calories, Cindy? Cindy? Cindy? >> Food is information, Mark. You've said >> Food is information, Mark. You've said >> Food is information, Mark. You've said that for years. It talks to our genes. that for years. It talks to our genes. that for years. It talks to our genes. It talks to our systems. It talks to our systems. It talks to our systems. >> Yeah. >> Yeah. >> Yeah. >> Wow. So, you're talking about how the >> Wow. So, you're talking about how the >> Wow. So, you're talking about how the food impacts our metabolic health. And food impacts our metabolic health. And food impacts our metabolic health. And and and we're not really good at and and we're not really good at and and we're not really good at diagnosing metabolic dysfunction, right? diagnosing metabolic dysfunction, right? diagnosing metabolic dysfunction, right? >> I mean, 90% I mean, >> I mean, 90% I mean, >> I mean, 90% I mean, >> okay, one out of two Americans has >> okay, one out of two Americans has >> okay, one out of two Americans has pre-diabetes or type two diabetes. And pre-diabetes or type two diabetes. And pre-diabetes or type two diabetes. And if you look at this new study, I would if you look at this new study, I would if you look at this new study, I would argue that nine out of 10 Americans have argue that nine out of 10 Americans have argue that nine out of 10 Americans have some degree of pre-diabetes or type two some degree of pre-diabetes or type two some degree of pre-diabetes or type two diabetes. Like 90% of Americans. diabetes. Like 90% of Americans. diabetes. Like 90% of Americans. >> So >> So >> So when you look at that data and you also when you look at that data and you also when you look at that data and you also look at the parallel data that 90% of look at the parallel data that 90% of look at the parallel data that 90% of Americans with pre-diabetes are not Americans with pre-diabetes are not Americans with pre-diabetes are not diagnosed by their doctor, diagnosed by their doctor, diagnosed by their doctor, >> right? >> right? >> right? >> That's terrifying, especially because >> That's terrifying, especially because >> That's terrifying, especially because this is a 100% reversible, preventable, this is a 100% reversible, preventable, this is a 100% reversible, preventable, treatable condition. And it gets worse treatable condition. And it gets worse treatable condition. And it gets worse and worse over time and people just and worse over time and people just and worse over time and people just don't even know they have it. and don't even know they have it. and don't even know they have it. and doctors miss it because there's no pill doctors miss it because there's no pill doctors miss it because there's no pill to take. Oh, tech metformin. Well, to take. Oh, tech metformin. Well, to take. Oh, tech metformin. Well, that's not going to help, right? It's that's not going to help, right? It's that's not going to help, right? It's like and and so um what are the kinds of like and and so um what are the kinds of like and and so um what are the kinds of ways that we look at these patients ways that we look at these patients ways that we look at these patients differently? What are the tests that we differently? What are the tests that we differently? What are the tests that we do? What are the things that we really do? What are the things that we really do? What are the things that we really focus on when someone comes in with a focus on when someone comes in with a focus on when someone comes in with a risk of heart disease or they're risk of heart disease or they're risk of heart disease or they're concerned about heart disease? You know, concerned about heart disease? You know, concerned about heart disease? You know, what's our what's our approach? It's not what's our what's our approach? It's not what's our what's our approach? It's not just looking at the typical cholesterol just looking at the typical cholesterol just looking at the typical cholesterol and even CRP. and even CRP. and even CRP. >> Yeah. So, we would look at those, of >> Yeah. So, we would look at those, of >> Yeah. So, we would look at those, of course. We would also want to know what course. We would also want to know what course. We would also want to know what is somebody's insulin. Most doctors is somebody's insulin. Most doctors is somebody's insulin. Most doctors measure glucose but not insulin. measure glucose but not insulin. measure glucose but not insulin. >> I personally like to look at somebody's >> I personally like to look at somebody's >> I personally like to look at somebody's glucose trends over time because if you glucose trends over time because if you glucose trends over time because if you think about something that's think about something that's think about something that's preventable, you don't want to wait till preventable, you don't want to wait till preventable, you don't want to wait till they cross that threshold to they cross that threshold to they cross that threshold to pre-diabetes or diabetes. So even in the pre-diabetes or diabetes. So even in the pre-diabetes or diabetes. So even in the range of so-called normal glucose mark, range of so-called normal glucose mark, range of so-called normal glucose mark, um you know this somebody whose fasting um you know this somebody whose fasting um you know this somebody whose fasting glucose runs less than 85 is in a very glucose runs less than 85 is in a very glucose runs less than 85 is in a very different metabolic place than somebody different metabolic place than somebody different metabolic place than somebody whose fasting glucose is 95 to 99. even whose fasting glucose is 95 to 99. even whose fasting glucose is 95 to 99. even though they're both technically normal, though they're both technically normal, though they're both technically normal, that it's a spectrum of risk. And the that it's a spectrum of risk. And the that it's a spectrum of risk. And the farther along you mark that spectrum, farther along you mark that spectrum, farther along you mark that spectrum, the higher the risk of heart disease and the higher the risk of heart disease and the higher the risk of heart disease and diabetes. So, if somebody's glucose used diabetes. So, if somebody's glucose used diabetes. So, if somebody's glucose used to be 85 and then it was 91 and now it's to be 85 and then it was 91 and now it's to be 85 and then it was 91 and now it's 98, we're going to talk to that person 98, we're going to talk to that person 98, we're going to talk to that person right off the bat about all the things right off the bat about all the things right off the bat about all the things they need to put into place to prevent they need to put into place to prevent they need to put into place to prevent it from progressing because they're it from progressing because they're it from progressing because they're already on that spectrum. We also want already on that spectrum. We also want already on that spectrum. We also want to know insulin levels. Not just a to know insulin levels. Not just a to know insulin levels. Not just a fasting insulin, but sometimes the fasting insulin, but sometimes the fasting insulin, but sometimes the insulin response to food. Because the insulin response to food. Because the insulin response to food. Because the other thing that's emerged is insulin is other thing that's emerged is insulin is other thing that's emerged is insulin is a player. And way before somebody's a player. And way before somebody's a player. And way before somebody's blood glucose goes up, they might be blood glucose goes up, they might be blood glucose goes up, they might be pumping out tons of insulin to try to pumping out tons of insulin to try to pumping out tons of insulin to try to keep it in a good place. keep it in a good place. keep it in a good place. >> And insulin by itself contributes to >> And insulin by itself contributes to >> And insulin by itself contributes to inflammation and more weight gain around inflammation and more weight gain around inflammation and more weight gain around the middle the the middle that visceral the middle the the middle that visceral the middle the the middle that visceral atypose tissue. So we want to know their atypose tissue. So we want to know their atypose tissue. So we want to know their insulin both fasting and in response to insulin both fasting and in response to insulin both fasting and in response to a challenge. a challenge. a challenge. >> So wait wait wait. Are you saying it's >> So wait wait wait. Are you saying it's >> So wait wait wait. Are you saying it's sugar not fat that's causing heart sugar not fat that's causing heart sugar not fat that's causing heart disease [laughter] disease [laughter] disease [laughter] and sugar the the thing that's driving and sugar the the thing that's driving and sugar the the thing that's driving the insulin because fat doesn't cause the insulin because fat doesn't cause the insulin because fat doesn't cause insulin spikes? insulin spikes? insulin spikes? >> Well there is some I mean fat is a >> Well there is some I mean fat is a >> Well there is some I mean fat is a player. player. player. >> Fat by itself. You eat fat with other >> Fat by itself. You eat fat with other >> Fat by itself. You eat fat with other food it will but food it will but food it will but >> Yeah. >> Yeah. >> Yeah. >> Yeah. >> Yeah. >> Yeah. >> Yeah. And I would say I would say that >> Yeah. And I would say I would say that >> Yeah. And I would say I would say that quality of fat does matter and we can quality of fat does matter and we can quality of fat does matter and we can talk some more about that but I think talk some more about that but I think talk some more about that but I think fat plays a role with artery elasticity fat plays a role with artery elasticity fat plays a role with artery elasticity which is another component of vascular which is another component of vascular which is another component of vascular risk. risk. risk. >> Yeah. So fried foods, trans fats, >> Yeah. So fried foods, trans fats, >> Yeah. So fried foods, trans fats, refined oils, those are nasty and refined oils, those are nasty and refined oils, those are nasty and health. health. health. >> Absolutely. >> Absolutely. >> Absolutely. >> But but fat itself if it's made from >> But but fat itself if it's made from >> But but fat itself if it's made from whole food sources and nuts and seeds whole food sources and nuts and seeds whole food sources and nuts and seeds and avocados and might actually be and avocados and might actually be and avocados and might actually be beneficial. beneficial. beneficial. >> Actually beneficial. Yeah. >> Actually beneficial. Yeah. >> Actually beneficial. Yeah. >> So what you're talking about is is a set >> So what you're talking about is is a set >> So what you're talking about is is a set of diagnostic tests that are are so of diagnostic tests that are are so of diagnostic tests that are are so important but mostly ignored. So the the important but mostly ignored. So the the important but mostly ignored. So the the the particle size and number which the particle size and number which the particle size and number which >> nobody's doing and the second is not >> nobody's doing and the second is not >> nobody's doing and the second is not just measuring your blood sugar A1C just measuring your blood sugar A1C just measuring your blood sugar A1C >> which may be perfect >> which may be perfect >> which may be perfect >> and you may be in really bad trouble >> and you may be in really bad trouble >> and you may be in really bad trouble >> but measuring also insulin in response >> but measuring also insulin in response >> but measuring also insulin in response to drinking like a couple of Cokes, to drinking like a couple of Cokes, to drinking like a couple of Cokes, right? right? right? >> I I have a patient Cindy that I remember >> I I have a patient Cindy that I remember >> I I have a patient Cindy that I remember who was at super high risk for heart who was at super high risk for heart who was at super high risk for heart disease and she had disease and she had disease and she had >> uh I mean she looked like the Tasmanian >> uh I mean she looked like the Tasmanian >> uh I mean she looked like the Tasmanian devil. And she was just like a round devil. And she was just like a round devil. And she was just like a round apple ball like this and her belly was apple ball like this and her belly was apple ball like this and her belly was just like this big thing and I'm like just like this big thing and I'm like just like this big thing and I'm like this woman is in big trouble and she's this woman is in big trouble and she's this woman is in big trouble and she's inflamed. She's high heart disease, high inflamed. She's high heart disease, high inflamed. She's high heart disease, high blood pressure, diabetes and I'm like blood pressure, diabetes and I'm like blood pressure, diabetes and I'm like let's check her glucose tolerance test let's check her glucose tolerance test let's check her glucose tolerance test with insulin and this is you know this with insulin and this is you know this with insulin and this is you know this is like 20 plus years ago and no no one is like 20 plus years ago and no no one is like 20 plus years ago and no no one was like looking at this. Even today no was like looking at this. Even today no was like looking at this. Even today no one's looking at this. It's like so one's looking at this. It's like so one's looking at this. It's like so hard. I mean, it took 50 years from the hard. I mean, it took 50 years from the hard. I mean, it took 50 years from the time the guy said, "Hey, we should wash time the guy said, "Hey, we should wash time the guy said, "Hey, we should wash our hands before surgery for us to wash our hands before surgery for us to wash our hands before surgery for us to wash our hands." You know, McKinley died, our hands." You know, McKinley died, our hands." You know, McKinley died, President McKinley, because he got shot President McKinley, because he got shot President McKinley, because he got shot in the belly. And the doctor, Mc Bernie, in the belly. And the doctor, Mc Bernie, in the belly. And the doctor, Mc Bernie, stuck his finger in the wound to check stuck his finger in the wound to check stuck his finger in the wound to check it out without washing his hands, you it out without washing his hands, you it out without washing his hands, you know. So, that's like crazy. It took 50 know. So, that's like crazy. It took 50 know. So, that's like crazy. It took 50 years from the time the guy said, "Let's years from the time the guy said, "Let's years from the time the guy said, "Let's do a sk the stethoscope so we don't get do a sk the stethoscope so we don't get do a sk the stethoscope so we don't get lice jumping into the doctor's hair to lice jumping into the doctor's hair to lice jumping into the doctor's hair to start using the stethoscope because the start using the stethoscope because the start using the stethoscope because the doctor used to put their head on the doctor used to put their head on the doctor used to put their head on the patient. So, it takes forever." And patient. So, it takes forever." And patient. So, it takes forever." And we've been doing it. So anyway, this we've been doing it. So anyway, this we've been doing it. So anyway, this woman, I did this test. I gave her this woman, I did this test. I gave her this woman, I did this test. I gave her this drink and it was the most shocking thing drink and it was the most shocking thing drink and it was the most shocking thing I'd ever seen. Uh, and it taught me so I'd ever seen. Uh, and it taught me so I'd ever seen. Uh, and it taught me so much about what we miss in medicine. Her much about what we miss in medicine. Her much about what we miss in medicine. Her blood sugar was perfect. Like 80 like blood sugar was perfect. Like 80 like blood sugar was perfect. Like 80 like and and she took the sugar drink and it and and she took the sugar drink and it and and she took the sugar drink and it was like perfect. Like was like perfect. Like was like perfect. Like >> like it never went over 110 after taking >> like it never went over 110 after taking >> like it never went over 110 after taking like the equivalent of two Coca-Cas. Oh, like the equivalent of two Coca-Cas. Oh, like the equivalent of two Coca-Cas. Oh, she's fine. Her A1C was perfect. Her she's fine. Her A1C was perfect. Her she's fine. Her A1C was perfect. Her insulin normally should be under five insulin normally should be under five insulin normally should be under five fasting and under like 25 or 30 after a fasting and under like 25 or 30 after a fasting and under like 25 or 30 after a drink. Her insulin was like 50 fasting. drink. Her insulin was like 50 fasting. drink. Her insulin was like 50 fasting. Wow. Wow. Wow. >> And like 250 after a drink. So her body >> And like 250 after a drink. So her body >> And like 250 after a drink. So her body was just pumping out insulin which was was just pumping out insulin which was was just pumping out insulin which was making her hungry, making her hungry, making her hungry, >> slowing her tablets, putting fat in her >> slowing her tablets, putting fat in her >> slowing her tablets, putting fat in her belly cells, which were basically belly cells, which were basically belly cells, which were basically inflammation factories inflammation factories inflammation factories >> and leading this perpetual cycle. And >> and leading this perpetual cycle. And >> and leading this perpetual cycle. And she was able to lose 50 lbs like that she was able to lose 50 lbs like that she was able to lose 50 lbs like that when we cut out starch and sugar. Uh, when we cut out starch and sugar. Uh, when we cut out starch and sugar. Uh, and I just feel like, you know, that and I just feel like, you know, that and I just feel like, you know, that that showed me so much because you can that showed me so much because you can that showed me so much because you can even do a normal glucose tolerance test even do a normal glucose tolerance test even do a normal glucose tolerance test and if you were super hyperinsulinemic, and if you were super hyperinsulinemic, and if you were super hyperinsulinemic, >> you're going to you're going to miss >> you're going to you're going to miss >> you're going to you're going to miss that patient's real problem. And you that patient's real problem. And you that patient's real problem. And you know it's interesting Mark because that know it's interesting Mark because that know it's interesting Mark because that scenario is also associated with that scenario is also associated with that scenario is also associated with that cholesterol profile we talked about with cholesterol profile we talked about with cholesterol profile we talked about with the small dense LDL and and and low HDL the small dense LDL and and and low HDL the small dense LDL and and and low HDL and the squelli that we usually link to and the squelli that we usually link to and the squelli that we usually link to diabetes fatty liver peripheral diabetes fatty liver peripheral diabetes fatty liver peripheral neuropathy all these other organs that neuropathy all these other organs that neuropathy all these other organs that are affected and it can happen with the are affected and it can happen with the are affected and it can happen with the high insulins alone before the sugars go high insulins alone before the sugars go high insulins alone before the sugars go up. up. up. >> Yeah. >> Yeah. >> Yeah. >> It's a metabolic imbalance. >> It's a metabolic imbalance. >> It's a metabolic imbalance. >> Yeah. So that's really the take-home >> Yeah. So that's really the take-home >> Yeah. So that's really the take-home here is that that heart disease is here is that that heart disease is here is that that heart disease is really a hormonal issue around insulin really a hormonal issue around insulin really a hormonal issue around insulin and insulin resistance and insulin resistance and insulin resistance >> and an inflammation issue. So let's talk >> and an inflammation issue. So let's talk >> and an inflammation issue. So let's talk about the the heart reduction because about the the heart reduction because about the the heart reduction because people say, "Well, that story's been people say, "Well, that story's been people say, "Well, that story's been told, you know, we've got statins, we've told, you know, we've got statins, we've told, you know, we've got statins, we've got this PC SK9 inhibitors, we're all got this PC SK9 inhibitors, we're all got this PC SK9 inhibitors, we're all good. Like what's the big deal? What good. Like what's the big deal? What good. Like what's the big deal? What should we worry about? It's just all should we worry about? It's just all should we worry about? It's just all about LDL cholesterol. What's new? I about LDL cholesterol. What's new? I about LDL cholesterol. What's new? I mean, what what should we be looking at? mean, what what should we be looking at? mean, what what should we be looking at? What should we be thinking about? And What should we be thinking about? And What should we be thinking about? And and and why why are we still seeing so and and why why are we still seeing so and and why why are we still seeing so many people with heart disease?" Yeah, many people with heart disease?" Yeah, many people with heart disease?" Yeah, it's still the number one killer around it's still the number one killer around it's still the number one killer around the world, not just here. And it's still the world, not just here. And it's still the world, not just here. And it's still the number one killer in women who, you the number one killer in women who, you the number one killer in women who, you know, they think that it's breast know, they think that it's breast know, they think that it's breast cancer. No, no, it's this is it. This is cancer. No, no, it's this is it. This is cancer. No, no, it's this is it. This is exciting because, exciting because, exciting because, >> uh, we do know the things that we've >> uh, we do know the things that we've >> uh, we do know the things that we've been reviewing for risk factors, but been reviewing for risk factors, but been reviewing for risk factors, but >> we have a way to now, uh, establish the >> we have a way to now, uh, establish the >> we have a way to now, uh, establish the risk. Are they really high risk without risk. Are they really high risk without risk. Are they really high risk without before they ever have heart disease, 20 before they ever have heart disease, 20 before they ever have heart disease, 20 years plus? Um and way we do that is we years plus? Um and way we do that is we years plus? Um and way we do that is we can get a simple lipid panel add uh the can get a simple lipid panel add uh the can get a simple lipid panel add uh the LP little Apo B so a little more than LP little Apo B so a little more than LP little Apo B so a little more than what is the standard lipid panel the L what is the standard lipid panel the L what is the standard lipid panel the L LP little A will be part of a lipid LP little A will be part of a lipid LP little A will be part of a lipid panel in the next year or two but anyway panel in the next year or two but anyway panel in the next year or two but anyway when we get that lipid panel which is when we get that lipid panel which is when we get that lipid panel which is again very inexpensive and we can also again very inexpensive and we can also again very inexpensive and we can also get a polygenetic risk score very get a polygenetic risk score very get a polygenetic risk score very inexpensive we can also get a heart inexpensive we can also get a heart inexpensive we can also get a heart clock right and we can get inflammation clock right and we can get inflammation clock right and we can get inflammation markers anyway Now you have the full markers anyway Now you have the full markers anyway Now you have the full stack with your records and you know and stack with your records and you know and stack with your records and you know and and you have somebody who is well before and you have somebody who is well before and you have somebody who is well before they've ever manifest heart disease and they've ever manifest heart disease and they've ever manifest heart disease and you say, "Oh wow, this person is really you say, "Oh wow, this person is really you say, "Oh wow, this person is really high risk for heart disease. What do we high risk for heart disease. What do we high risk for heart disease. What do we do?" Well, do?" Well, do?" Well, >> you get their LDL down, you know, not >> you get their LDL down, you know, not >> you get their LDL down, you know, not just to below 70, we go down to 20 or, just to below 70, we go down to 20 or, just to below 70, we go down to 20 or, you know, less than 30, right? We have you know, less than 30, right? We have you know, less than 30, right? We have so many ways to do that now. Uh we have so many ways to do that now. Uh we have so many ways to do that now. Uh we have these injectables that are against this these injectables that are against this these injectables that are against this PCSK9. We've got new drugs, five new LP PCSK9. We've got new drugs, five new LP PCSK9. We've got new drugs, five new LP little A drugs that are going to be out little A drugs that are going to be out little A drugs that are going to be out within the next year or so that are within the next year or so that are within the next year or so that are really potent. really potent. really potent. >> And we've had none of them. None until >> And we've had none of them. None until >> And we've had none of them. None until now. now. now. >> Yeah, we never had one. We always tell, >> Yeah, we never had one. We always tell, >> Yeah, we never had one. We always tell, well, too bad your LP little A is over well, too bad your LP little A is over well, too bad your LP little A is over 100. You know, nothing we can do. We're 100. You know, nothing we can do. We're 100. You know, nothing we can do. We're going to be able to change that and going to be able to change that and going to be able to change that and that's going to have a big impact. We that's going to have a big impact. We that's going to have a big impact. We can get o all the inflammation get all can get o all the inflammation get all can get o all the inflammation get all over it right in terms of bringing the over it right in terms of bringing the over it right in terms of bringing the inflammation down. Uh we've already seen inflammation down. Uh we've already seen inflammation down. Uh we've already seen how GLP1 drug do that before any weight how GLP1 drug do that before any weight how GLP1 drug do that before any weight loss. So that should work well in people loss. So that should work well in people loss. So that should work well in people who aren't even obese. And we've seen who aren't even obese. And we've seen who aren't even obese. And we've seen how that can prevent heart preserve how that can prevent heart preserve how that can prevent heart preserve ejection fraction heart failure which is ejection fraction heart failure which is ejection fraction heart failure which is half of all heart failure right GLP1s half of all heart failure right GLP1s half of all heart failure right GLP1s prevent that. So for heart disease we're prevent that. So for heart disease we're prevent that. So for heart disease we're seeing some really breakthroughs for the seeing some really breakthroughs for the seeing some really breakthroughs for the treatment particularly the new target of treatment particularly the new target of treatment particularly the new target of LDL that we have five different drug LDL that we have five different drug LDL that we have five different drug classes. Statins you've mentioned but classes. Statins you've mentioned but classes. Statins you've mentioned but the the PCSK9 we have three different the the PCSK9 we have three different the the PCSK9 we have three different ways to do that now. We got other new ways to do that now. We got other new ways to do that now. We got other new drugs that are coming. Uh just recently drugs that are coming. Uh just recently drugs that are coming. Uh just recently the CETP inhibitor worked really well on the CETP inhibitor worked really well on the CETP inhibitor worked really well on top of so we got we can stamp out top of so we got we can stamp out top of so we got we can stamp out inflammation. The other thing is we have inflammation. The other thing is we have inflammation. The other thing is we have a metric we never had before which is AI a metric we never had before which is AI a metric we never had before which is AI and by the way that also goes with and by the way that also goes with and by the way that also goes with Alzheimer's. You can do a retina AI Alzheimer's. You can do a retina AI Alzheimer's. You can do a retina AI exam. So I have a picture of the retina exam. So I have a picture of the retina exam. So I have a picture of the retina and you do AI on it and it tells you and you do AI on it and it tells you and you do AI on it and it tells you when you're going to have Alzheimer's if when you're going to have Alzheimer's if when you're going to have Alzheimer's if you're going to have Alzheimer's 5 to you're going to have Alzheimer's 5 to you're going to have Alzheimer's 5 to seven years in advance. The retina also seven years in advance. The retina also seven years in advance. The retina also tells if you're going to have heart tells if you're going to have heart tells if you're going to have heart disease or a stroke in advance. It will disease or a stroke in advance. It will disease or a stroke in advance. It will even tell if you're gonna um you know even tell if you're gonna um you know even tell if you're gonna um you know your calcium score of your heart your calcium score of your heart your calcium score of your heart arteries through your retina. It's arteries through your retina. It's arteries through your retina. It's remarkable and we should that should be remarkable and we should that should be remarkable and we should that should be widely available. It isn't yet, but it widely available. It isn't yet, but it widely available. It isn't yet, but it will be. We'll be doing smartphone will be. We'll be doing smartphone will be. We'll be doing smartphone retina checks someday, right? But um retina checks someday, right? But um retina checks someday, right? But um here's where we get um a real uh kick on here's where we get um a real uh kick on here's where we get um a real uh kick on a jump on this because if you are a jump on this because if you are a jump on this because if you are concerned about high risk and somebody concerned about high risk and somebody concerned about high risk and somebody you say 40 50 they have significant risk you say 40 50 they have significant risk you say 40 50 they have significant risk factors you can do a CT factors you can do a CT factors you can do a CT angio which is now becoming very angio which is now becoming very angio which is now becoming very inexpensive inexpensive inexpensive uh and you can look at inflammation in uh and you can look at inflammation in uh and you can look at inflammation in the artery I go through this in the book the artery I go through this in the book the artery I go through this in the book inflammations in the artery without a inflammations in the artery without a inflammations in the artery without a narrow okay so the the it basically It narrow okay so the the it basically It narrow okay so the the it basically It does AI of the fat around the artery and does AI of the fat around the artery and does AI of the fat around the artery and it and this is something that was it and this is something that was it and this is something that was developed in the UK and it's now getting developed in the UK and it's now getting developed in the UK and it's now getting ready for FDA approval. This is a big ready for FDA approval. This is a big ready for FDA approval. This is a big jump because we always were jump because we always were jump because we always were >> so this isn't the Clearly scan. This is >> so this isn't the Clearly scan. This is >> so this isn't the Clearly scan. This is something else. something else. something else. >> No, no, the clearly and the other ones >> No, no, the clearly and the other ones >> No, no, the clearly and the other ones in the US don't do this, but this is a a in the US don't do this, but this is a a in the US don't do this, but this is a a a Oxford University of Oxford spinout. I a Oxford University of Oxford spinout. I a Oxford University of Oxford spinout. I think it's called Carista. They're going think it's called Carista. They're going think it's called Carista. They're going to have that available soon. And I went to have that available soon. And I went to have that available soon. And I went through the data in the book. I mean, through the data in the book. I mean, through the data in the book. I mean, they've had multiple papers, but it's they've had multiple papers, but it's they've had multiple papers, but it's striking. If you have inflammation striking. If you have inflammation striking. If you have inflammation without a narrow, it's, you know, you without a narrow, it's, you know, you without a narrow, it's, you know, you you could have 15fold risk of a heart you could have 15fold risk of a heart you could have 15fold risk of a heart attack. So, that's when you use that as attack. So, that's when you use that as attack. So, that's when you use that as a metric, just like we were talking a metric, just like we were talking a metric, just like we were talking about the PTA 217 for Alzheimer's. about the PTA 217 for Alzheimer's. about the PTA 217 for Alzheimer's. >> We've got all these new things for >> We've got all these new things for >> We've got all these new things for cardiovascular. We are going to get a a cardiovascular. We are going to get a a cardiovascular. We are going to get a a grip on this and we got to, you know, grip on this and we got to, you know, grip on this and we got to, you know, ideally start early, but you know, the ideally start early, but you know, the ideally start early, but you know, the lifestyle factors work really well. This lifestyle factors work really well. This lifestyle factors work really well. This is the most preventable known of the is the most preventable known of the is the most preventable known of the three big age related diseases through three big age related diseases through three big age related diseases through lifestyle lifestyle lifestyle >> because even without a lot of the drugs >> because even without a lot of the drugs >> because even without a lot of the drugs like lifestyle plays a big role like you like lifestyle plays a big role like you like lifestyle plays a big role like you know I've seen data up to 90% by healthy know I've seen data up to 90% by healthy know I've seen data up to 90% by healthy diet, exercise, stress mitigation, diet, exercise, stress mitigation, diet, exercise, stress mitigation, sleep, right? sleep, right? sleep, right? >> Yeah. I mean that is that in the book I >> Yeah. I mean that is that in the book I >> Yeah. I mean that is that in the book I found all these studies that I was found all these studies that I was found all these studies that I was really struck by that are recent that really struck by that are recent that really struck by that are recent that show that if we practice the lifestyle show that if we practice the lifestyle show that if we practice the lifestyle factors that we've been reviewing with factors that we've been reviewing with factors that we've been reviewing with the details um that we we discussed that the details um that we we discussed that the details um that we we discussed that gets us 7 to 10 years of healthy aging gets us 7 to 10 years of healthy aging gets us 7 to 10 years of healthy aging without one of these age related without one of these age related without one of these age related diseases. I mean, who wouldn't want diseases. I mean, who wouldn't want diseases. I mean, who wouldn't want seven to 10 years of healthy aging just seven to 10 years of healthy aging just seven to 10 years of healthy aging just from the stuff we've been discussing from the stuff we've been discussing from the stuff we've been discussing without any, you know, magic potion or without any, you know, magic potion or without any, you know, magic potion or pill? Uh, so that's I think people don't pill? Uh, so that's I think people don't pill? Uh, so that's I think people don't know about that. I didn't know about know about that. I didn't know about know about that. I didn't know about that. It's really impressive. that. It's really impressive. that. It's really impressive. >> That's powerful. So, so, but you're >> That's powerful. So, so, but you're >> That's powerful. So, so, but you're saying that some of the advances in saying that some of the advances in saying that some of the advances in cardiology are more pharmacological that cardiology are more pharmacological that cardiology are more pharmacological that you're thinking are coming like the you're thinking are coming like the you're thinking are coming like the drugs that lower this genetically drugs that lower this genetically drugs that lower this genetically determined lipoprotein called LP little determined lipoprotein called LP little determined lipoprotein called LP little A, which I've been checking for 30 A, which I've been checking for 30 A, which I've been checking for 30 years. Apo B, which I've been checking years. Apo B, which I've been checking years. Apo B, which I've been checking for 30 years. I read some article the for 30 years. I read some article the for 30 years. I read some article the other day that was like, there's this other day that was like, there's this other day that was like, there's this great new test that can be more great new test that can be more great new test that can be more predictive of your risk of heart attack predictive of your risk of heart attack predictive of your risk of heart attack than any other test. It's just than any other test. It's just than any other test. It's just discovered. I'm like, what is that? I'm discovered. I'm like, what is that? I'm discovered. I'm like, what is that? I'm like, look like they're the article. like, look like they're the article. like, look like they're the article. It's like Apo B. I'm like, oh god. I It's like Apo B. I'm like, oh god. I It's like Apo B. I'm like, oh god. I mean, you only you only need to get it mean, you only you only need to get it mean, you only you only need to get it once and then you can tell that if you once and then you can tell that if you once and then you can tell that if you need to check it out further, but you're need to check it out further, but you're need to check it out further, but you're getting at a a key point here is it getting at a a key point here is it getting at a a key point here is it isn't just that we have better, you isn't just that we have better, you isn't just that we have better, you know, more aramentarium of drugs, but we know, more aramentarium of drugs, but we know, more aramentarium of drugs, but we didn't know how to get the risk down. didn't know how to get the risk down. didn't know how to get the risk down. You know, we didn't know how to say this You know, we didn't know how to say this You know, we didn't know how to say this person's really high risk for person's really high risk for person's really high risk for aththeroscerosis aththeroscerosis aththeroscerosis because we didn't really have we didn't because we didn't really have we didn't because we didn't really have we didn't use the polygenic risk score. We didn't use the polygenic risk score. We didn't use the polygenic risk score. We didn't have as we do now, we're going to have a have as we do now, we're going to have a have as we do now, we're going to have a heart clock. We we are so there's a big heart clock. We we are so there's a big heart clock. We we are so there's a big debate out there as you probably know debate out there as you probably know debate out there as you probably know how low should we go on LDL should we how low should we go on LDL should we how low should we go on LDL should we pull out all the stops well if you look pull out all the stops well if you look pull out all the stops well if you look at all the data the lower you go the at all the data the lower you go the at all the data the lower you go the more protection but you don't want to more protection but you don't want to more protection but you don't want to necessarily give people you know necessarily give people you know necessarily give people you know zettoide and a statin and a injectable zettoide and a statin and a injectable zettoide and a statin and a injectable and all these things unless they really and all these things unless they really and all these things unless they really are high risk then you go for broke and are high risk then you go for broke and are high risk then you go for broke and you also get the LPA and you get the you also get the LPA and you get the you also get the LPA and you get the inflammation down we have ways that we inflammation down we have ways that we inflammation down we have ways that we can do that and we're going to keep can do that and we're going to keep can do that and we're going to keep having better ways. So, this is a having better ways. So, this is a having better ways. So, this is a striking uh it's a combination of who's striking uh it's a combination of who's striking uh it's a combination of who's at risk, the partitioning the risk, and at risk, the partitioning the risk, and at risk, the partitioning the risk, and having a better ways to work on that having a better ways to work on that having a better ways to work on that risk. Just to play devil's advocate risk. Just to play devil's advocate risk. Just to play devil's advocate because this conversation comes up all because this conversation comes up all because this conversation comes up all the time. You're a cardiologist, so your the time. You're a cardiologist, so your the time. You're a cardiologist, so your favorite organ is the heart. And so, favorite organ is the heart. And so, favorite organ is the heart. And so, your idea is get the LDL as low as you your idea is get the LDL as low as you your idea is get the LDL as low as you can, but your brain is made up of a lot can, but your brain is made up of a lot can, but your brain is made up of a lot of of of >> only in people who are at high risk. >> only in people who are at high risk. >> only in people who are at high risk. >> In people at high risk. Okay. So if >> In people at high risk. Okay. So if >> In people at high risk. Okay. So if you're really high, but like what what you're really high, but like what what you're really high, but like what what about the effects for example on the about the effects for example on the about the effects for example on the brain and cognitive function cuz the you brain and cognitive function cuz the you brain and cognitive function cuz the you know cholesterol is a big part of your know cholesterol is a big part of your know cholesterol is a big part of your brain and sex hormones which is what brain and sex hormones which is what brain and sex hormones which is what your testosterone is made from is your testosterone is made from is your testosterone is made from is cholesterol. So how do you kind of cholesterol. So how do you kind of cholesterol. So how do you kind of navigate that and what's the truth and navigate that and what's the truth and navigate that and what's the truth and what do we know? what do we know? what do we know? >> Yeah. I mean the statins are probably >> Yeah. I mean the statins are probably >> Yeah. I mean the statins are probably the most studied drug class uh of in the most studied drug class uh of in the most studied drug class uh of in history really. Some of the data that history really. Some of the data that history really. Some of the data that comes out of these big metaanalyses comes out of these big metaanalyses comes out of these big metaanalyses which say, "Oh, people don't get any leg which say, "Oh, people don't get any leg which say, "Oh, people don't get any leg cramps." That's not true. You and I know cramps." That's not true. You and I know cramps." That's not true. You and I know that's not true. People do get severe that's not true. People do get severe that's not true. People do get severe leg cramps where they can't even sleep leg cramps where they can't even sleep leg cramps where they can't even sleep at night, you know, uh and and all sorts at night, you know, uh and and all sorts at night, you know, uh and and all sorts of other, you know, leg uh and muscle of other, you know, leg uh and muscle of other, you know, leg uh and muscle related symptoms. Now with respect to related symptoms. Now with respect to related symptoms. Now with respect to cognitive and u uh sexual dysfunction cognitive and u uh sexual dysfunction cognitive and u uh sexual dysfunction the data really don't show a hit there the data really don't show a hit there the data really don't show a hit there at all and in fact um you know I think at all and in fact um you know I think at all and in fact um you know I think that uh we have some data to suggest the that uh we have some data to suggest the that uh we have some data to suggest the chances of having dementia uh in people chances of having dementia uh in people chances of having dementia uh in people and Alzheimer's as you know accounts for and Alzheimer's as you know accounts for and Alzheimer's as you know accounts for 70% of dementia that if you if you don't 70% of dementia that if you if you don't 70% of dementia that if you if you don't have the LDL lowered to let's say less have the LDL lowered to let's say less have the LDL lowered to let's say less than 100 less than 70 you're going to be than 100 less than 70 you're going to be than 100 less than 70 you're going to be at higher risk for dementia. So if at higher risk for dementia. So if at higher risk for dementia. So if anything the data support uh statins um anything the data support uh statins um anything the data support uh statins um and you know the data for what sexual and you know the data for what sexual and you know the data for what sexual dysfunction it's again some of that's dysfunction it's again some of that's dysfunction it's again some of that's vascular and it mo if it's vascular vascular and it mo if it's vascular vascular and it mo if it's vascular we're talking about athoscerata uh and we're talking about athoscerata uh and we're talking about athoscerata uh and that again is going to be uh ailarated that again is going to be uh ailarated that again is going to be uh ailarated with with with >> and it of course we don't have to just >> and it of course we don't have to just >> and it of course we don't have to just rely on statins a lot of people do have rely on statins a lot of people do have rely on statins a lot of people do have side effects from statins no matter what side effects from statins no matter what side effects from statins no matter what the group at Oxford keeps saying that the group at Oxford keeps saying that the group at Oxford keeps saying that everyone can take a statin and it's everyone can take a statin and it's everyone can take a statin and it's just, you know, it's mental if they just, you know, it's mental if they just, you know, it's mental if they can't that when I wrote a when I wrote can't that when I wrote a when I wrote can't that when I wrote a when I wrote an op-ed in the New York Times like a an op-ed in the New York Times like a an op-ed in the New York Times like a decade ago and I called out the diabetes decade ago and I called out the diabetes decade ago and I called out the diabetes from statins. Okay. Because if you take from statins. Okay. Because if you take from statins. Okay. Because if you take a very potent statin, you have a higher a very potent statin, you have a higher a very potent statin, you have a higher risk of developing type 2 diabetes, risk of developing type 2 diabetes, risk of developing type 2 diabetes, right? right? right? >> Yeah. >> Yeah. >> Yeah. >> Oh, did I get slammed by my cardiology >> Oh, did I get slammed by my cardiology >> Oh, did I get slammed by my cardiology colleagues for that? I think, well, wait colleagues for that? I think, well, wait colleagues for that? I think, well, wait a data, folks. I'm sorry. And over the a data, folks. I'm sorry. And over the a data, folks. I'm sorry. And over the years, we've seen many more reports years, we've seen many more reports years, we've seen many more reports about, you know, the potent statins, about, you know, the potent statins, about, you know, the potent statins, high doses where you get a higher risk. high doses where you get a higher risk. high doses where you get a higher risk. Yeah. And you know what? Most physicians Yeah. And you know what? Most physicians Yeah. And you know what? Most physicians are not keeping up with this. are not keeping up with this. are not keeping up with this. >> They're not watching their patients to >> They're not watching their patients to >> They're not watching their patients to see if they're glucose glycohemoglobin, see if they're glucose glycohemoglobin, see if they're glucose glycohemoglobin, you know, A1C or fasting glucose. And you know, A1C or fasting glucose. And you know, A1C or fasting glucose. And this is bothersome to me because that is this is bothersome to me because that is this is bothersome to me because that is a side effect of statins, particularly a side effect of statins, particularly a side effect of statins, particularly potent statins. So again, this is potent statins. So again, this is potent statins. So again, this is important because if we're going to important because if we're going to important because if we're going to lower LDL and pull out all the stops and lower LDL and pull out all the stops and lower LDL and pull out all the stops and you know high doses of rovite and you know high doses of rovite and you know high doses of rovite and crusttor or a torist lipur that could crusttor or a torist lipur that could crusttor or a torist lipur that could also raise the risk of that person also raise the risk of that person also raise the risk of that person developing type 2 diabetes we don't want developing type 2 diabetes we don't want developing type 2 diabetes we don't want to do that and we have cardiologists my to do that and we have cardiologists my to do that and we have cardiologists my colleagues they are you know really sold colleagues they are you know really sold colleagues they are you know really sold on statins and they basically ignore on statins and they basically ignore on statins and they basically ignore this this diabetes issue and did I ever this this diabetes issue and did I ever this this diabetes issue and did I ever take grief? No, take grief? No, take grief? No, >> I agree. I I agree with you. And I think >> I agree. I I agree with you. And I think >> I agree. I I agree with you. And I think I think there's there's um a concern I I think there's there's um a concern I I think there's there's um a concern I have around its effect on mitochondrial have around its effect on mitochondrial have around its effect on mitochondrial function and some of the data I've seen function and some of the data I've seen function and some of the data I've seen that even in people without muscle pain, that even in people without muscle pain, that even in people without muscle pain, even without elevated muscle enzymes, even without elevated muscle enzymes, even without elevated muscle enzymes, that there's mitochondrial damage on that there's mitochondrial damage on that there's mitochondrial damage on muscle biopsies. And for me, muscle biopsies. And for me, muscle biopsies. And for me, mitochondria are so key to healthy aging mitochondria are so key to healthy aging mitochondria are so key to healthy aging in the brain, in everything from in the brain, in everything from in the brain, in everything from Parkinson's to al to heart disease, Parkinson's to al to heart disease, Parkinson's to al to heart disease, diabetes. Diabetics have poor poorly diabetes. Diabetics have poor poorly diabetes. Diabetics have poor poorly functioning mitochondria. that maybe functioning mitochondria. that maybe functioning mitochondria. that maybe part of why it causes it. And so I I'm part of why it causes it. And so I I'm part of why it causes it. And so I I'm wondering, you know, some of these other wondering, you know, some of these other wondering, you know, some of these other drugs that are coming down the pike, drugs that are coming down the pike, drugs that are coming down the pike, even though some of them are expensive, even though some of them are expensive, even though some of them are expensive, maybe a better solution. maybe a better solution. maybe a better solution. >> Well, people that have the clearcut uh >> Well, people that have the clearcut uh >> Well, people that have the clearcut uh adverse effects, um you know, the the adverse effects, um you know, the the adverse effects, um you know, the the PCSK9 injectable drugs are a winner PCSK9 injectable drugs are a winner PCSK9 injectable drugs are a winner because they're potent and they have not because they're potent and they have not because they're potent and they have not been associated with diabetes, which is been associated with diabetes, which is been associated with diabetes, which is really interesting. really interesting. really interesting. >> They have not been associated with >> They have not been associated with >> They have not been associated with cognitive cognitive cognitive >> uh or other side effects. So most >> uh or other side effects. So most >> uh or other side effects. So most insurers cover that. Now we, you know, insurers cover that. Now we, you know, insurers cover that. Now we, you know, went through years where it was a went through years where it was a went through years where it was a because they were so expensive, the cost because they were so expensive, the cost because they were so expensive, the cost has come down. So as long as people uh has come down. So as long as people uh has come down. So as long as people uh have the right indication where they have the right indication where they have the right indication where they have significant side effects or they have significant side effects or they have significant side effects or they need to have their LDL substantially need to have their LDL substantially need to have their LDL substantially lowered, it's usually not a financial um lowered, it's usually not a financial um lowered, it's usually not a financial um stress for most people. stress for most people. stress for most people. >> So heart disease still lifestyle, but >> So heart disease still lifestyle, but >> So heart disease still lifestyle, but then there's a cocktail of other drugs then there's a cocktail of other drugs then there's a cocktail of other drugs in very high-risisk patients that you in very high-risisk patients that you in very high-risisk patients that you can detect early to figure out. can detect early to figure out. can detect early to figure out. And what about lipoprotein fractionation And what about lipoprotein fractionation And what about lipoprotein fractionation which is a lab test that we include as which is a lab test that we include as which is a lab test that we include as part of function health as well as apo part of function health as well as apo part of function health as well as apo and LPA something I've been testing for and LPA something I've been testing for and LPA something I've been testing for 30 years but you do you think that's as 30 years but you do you think that's as 30 years but you do you think that's as important because to me the particle important because to me the particle important because to me the particle number and particle size story is number and particle size story is number and particle size story is important and it's a sort of a clue that important and it's a sort of a clue that important and it's a sort of a clue that there's insulin resistance which is one there's insulin resistance which is one there's insulin resistance which is one of the biggest drivers of heart disease of the biggest drivers of heart disease of the biggest drivers of heart disease and all the other age related disease. and all the other age related disease. and all the other age related disease. >> Yeah. I mean I think it's um these mild >> Yeah. I mean I think it's um these mild >> Yeah. I mean I think it's um these mild potentially mild incremental potentially mild incremental potentially mild incremental information. I just don't see that it information. I just don't see that it information. I just don't see that it has nearly the impact of just zeroing in has nearly the impact of just zeroing in has nearly the impact of just zeroing in on LDL and LP little A and I do on LDL and LP little A and I do on LDL and LP little A and I do recommend everybody get an APO at least recommend everybody get an APO at least recommend everybody get an APO at least once uh and then you can figure out once uh and then you can figure out once uh and then you can figure out whether that needs to be further whether that needs to be further whether that needs to be further assessed. These other things you know assessed. These other things you know assessed. These other things you know that it's an additional expense. I just that it's an additional expense. I just that it's an additional expense. I just haven't seen the the value. But, you haven't seen the the value. But, you haven't seen the the value. But, you know, I have colleagues that are know, I have colleagues that are know, I have colleagues that are lipidologists that test every known lipidologists that test every known lipidologists that test every known particle to mankind, right? I just particle to mankind, right? I just particle to mankind, right? I just haven't I haven't really seen the haven't I haven't really seen the haven't I haven't really seen the benefit because it doesn't change benefit because it doesn't change benefit because it doesn't change usually to me. I got to know the usually to me. I got to know the usually to me. I got to know the person's risk person's risk person's risk >> and then I'm going to go after >> and then I'm going to go after >> and then I'm going to go after inflammation. I'm going to work on their inflammation. I'm going to work on their inflammation. I'm going to work on their lifestyle and if necessary, you know, lifestyle and if necessary, you know, lifestyle and if necessary, you know, get their LDL down as low as possible. get their LDL down as low as possible. get their LDL down as low as possible. So the the other things just don't have So the the other things just don't have So the the other things just don't have a for me a added uh value. U but I do a for me a added uh value. U but I do a for me a added uh value. U but I do know there are people that are you know know there are people that are you know know there are people that are you know wild and crazy on every particle small wild and crazy on every particle small wild and crazy on every particle small large dense you know you name it out large dense you know you name it out large dense you know you name it out there. Yeah. This episode is brought to there. Yeah. This episode is brought to there. Yeah. This episode is brought to you by Rose Nutrition Liposal NAD. you by Rose Nutrition Liposal NAD. you by Rose Nutrition Liposal NAD. Here's a real question. Why did two Here's a real question. Why did two Here's a real question. Why did two people the same age look and feel people the same age look and feel people the same age look and feel completely different? One has energy completely different? One has energy completely different? 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How we we don't talk about enough. How we we don't talk about enough. How we prepare our food matters, too. The prepare our food matters, too. The prepare our food matters, too. The warmer months are actually a great time warmer months are actually a great time warmer months are actually a great time to reset your habits. People are cooking to reset your habits. People are cooking to reset your habits. People are cooking more fresh meals. They're grilling. more fresh meals. They're grilling. more fresh meals. They're grilling. They're eating lighter, focusing on They're eating lighter, focusing on They're eating lighter, focusing on feeling better day-to-day. And one small feeling better day-to-day. And one small feeling better day-to-day. And one small but meaningful upgrade is paying but meaningful upgrade is paying but meaningful upgrade is paying attention to the cookware used attention to the cookware used attention to the cookware used regularly. 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If you're looking to upgrade your cookware, go to upgrade your cookware, go to upgrade your cookware, go to maidenware.com and use the code maidenware.com and use the code maidenware.com and use the code highman-hive for 10% off your first highman-hive for 10% off your first highman-hive for 10% off your first order. order. order. >> Yeah. So, I hear you on that. I think >> Yeah. So, I hear you on that. I think >> Yeah. So, I hear you on that. I think it, you know, sometimes more information it, you know, sometimes more information it, you know, sometimes more information isn't always better, but you know, what isn't always better, but you know, what isn't always better, but you know, what is the most important information? I is the most important information? I is the most important information? I think you cover that in your book. And I think you cover that in your book. And I think you cover that in your book. And I think, you know, we're going down the think, you know, we're going down the think, you know, we're going down the kind of the horsemen of the apocalypse, kind of the horsemen of the apocalypse, kind of the horsemen of the apocalypse, you know, the uh the the the heart you know, the uh the the the heart you know, the uh the the the heart disease, the cancer, the the dementia. I disease, the cancer, the the dementia. I disease, the cancer, the the dementia. I think diabetes is sort of all in there think diabetes is sort of all in there think diabetes is sort of all in there related, but you're talking about how related, but you're talking about how related, but you're talking about how there's kind of a newer with the there's kind of a newer with the there's kind of a newer with the advances in our diagnostics, whether advances in our diagnostics, whether advances in our diagnostics, whether it's imaging or retinal scans or new new it's imaging or retinal scans or new new it's imaging or retinal scans or new new ways we can measure dementia biomarkers ways we can measure dementia biomarkers ways we can measure dementia biomarkers we never had before, cancer, we'll get we never had before, cancer, we'll get we never had before, cancer, we'll get into in a sec, that these diseases can into in a sec, that these diseases can into in a sec, that these diseases can become more optional, like they're not become more optional, like they're not become more optional, like they're not inevitable. We have more agency than we inevitable. We have more agency than we inevitable. We have more agency than we ever had before given what we know now. ever had before given what we know now. ever had before given what we know now. And when you layer up what we're And when you layer up what we're And when you layer up what we're learning with a AI and using multimodal learning with a AI and using multimodal learning with a AI and using multimodal treatments, we're able to actually make treatments, we're able to actually make treatments, we're able to actually make a big dent if people really understood a big dent if people really understood a big dent if people really understood how to navigate this. And the sad part how to navigate this. And the sad part how to navigate this. And the sad part is that, you know, you spend your time is that, you know, you spend your time is that, you know, you spend your time thinking about what's coming. Most thinking about what's coming. Most thinking about what's coming. Most physicians are just trying to deal with physicians are just trying to deal with physicians are just trying to deal with the onslaught of what is and don't have the onslaught of what is and don't have the onslaught of what is and don't have the the bandwidth to actually apply this the the bandwidth to actually apply this the the bandwidth to actually apply this stuff until it kind of is way often stuff until it kind of is way often stuff until it kind of is way often decades later. And so I I I really decades later. And so I I I really decades later. And so I I I really appreciate you're sort of paying appreciate you're sort of paying appreciate you're sort of paying attention to, you know, what's happening attention to, you know, what's happening attention to, you know, what's happening and keeping your nose to the scent of and keeping your nose to the scent of and keeping your nose to the scent of where things are emerging because where things are emerging because where things are emerging because otherwise people just don't know and otherwise people just don't know and otherwise people just don't know and doctors like you said don't know and and doctors like you said don't know and and doctors like you said don't know and and the average person doesn't know. But the average person doesn't know. But the average person doesn't know. But this is such a hopeful message and and this is such a hopeful message and and this is such a hopeful message and and I'd love you to sort of unpack how you I'd love you to sort of unpack how you I'd love you to sort of unpack how you came to go from being a trained came to go from being a trained came to go from being a trained cardiologist cardiologist cardiologist who basically swallowed the gospel who basically swallowed the gospel who basically swallowed the gospel >> Yeah. to one who understands and has >> Yeah. to one who understands and has >> Yeah. to one who understands and has looked at the literature and has come to looked at the literature and has come to looked at the literature and has come to a different conclusion because it's not a different conclusion because it's not a different conclusion because it's not just that you're anti-drug or you're just that you're anti-drug or you're just that you're anti-drug or you're anti-medical care, anti the system. anti-medical care, anti the system. anti-medical care, anti the system. You're for the truth and for science and You're for the truth and for science and You're for the truth and for science and for an objective look at the facts. So for an objective look at the facts. So for an objective look at the facts. So the question I have is how did you go the question I have is how did you go the question I have is how did you go from being a trained cardiologist who from being a trained cardiologist who from being a trained cardiologist who believed in statins to one who started believed in statins to one who started believed in statins to one who started to question statins to one who's come to to question statins to one who's come to to question statins to one who's come to understand that our approach to understand that our approach to understand that our approach to cardiovascular might be a little bit cardiovascular might be a little bit cardiovascular might be a little bit misguided and we'll talk about what the misguided and we'll talk about what the misguided and we'll talk about what the right approach should be later but I I right approach should be later but I I right approach should be later but I I kind of want to start with unpack unpack kind of want to start with unpack unpack kind of want to start with unpack unpack the science for us because the science for us because the science for us because >> everybody listening has no heard if >> everybody listening has no heard if >> everybody listening has no heard if their cholesterol is high their cholesterol is high their cholesterol is high >> to take a statin. Sure. And if statins >> to take a statin. Sure. And if statins >> to take a statin. Sure. And if statins cause side effects, which they do for a cause side effects, which they do for a cause side effects, which they do for a lot of people, probably 20% get some lot of people, probably 20% get some lot of people, probably 20% get some muscle damage or some symptoms or muscle damage or some symptoms or muscle damage or some symptoms or increased risk of diabetes, you know, increased risk of diabetes, you know, increased risk of diabetes, you know, we'll talk about that data. There's we'll talk about that data. There's we'll talk about that data. There's still there's still a huge drive in our still there's still a huge drive in our still there's still a huge drive in our society for prescribing these and society for prescribing these and society for prescribing these and globally. globally. globally. >> Yeah, absolutely. So my interest in this >> Yeah, absolutely. So my interest in this >> Yeah, absolutely. So my interest in this came from really looking at the came from really looking at the came from really looking at the initially the obesity epidemic. So 2004 initially the obesity epidemic. So 2004 initially the obesity epidemic. So 2004 WHO announced it as an epidemic. You WHO announced it as an epidemic. You WHO announced it as an epidemic. You know, by 2010 I was in nine years know, by 2010 I was in nine years know, by 2010 I was in nine years qualified as a doctor. I was specialist qualified as a doctor. I was specialist qualified as a doctor. I was specialist registra in my cardiology training. Um I registra in my cardiology training. Um I registra in my cardiology training. Um I was seeing more people this viscerally. was seeing more people this viscerally. was seeing more people this viscerally. I'm very sensitive to I'm very sensitive to I'm very sensitive to how do I put it suffering around me if how do I put it suffering around me if how do I put it suffering around me if you like but also seeing my colleagues you like but also seeing my colleagues you like but also seeing my colleagues under more stress in the system and I under more stress in the system and I under more stress in the system and I was like hold on a minute this if we was like hold on a minute this if we was like hold on a minute this if we carry on down this trajectory the whole carry on down this trajectory the whole carry on down this trajectory the whole healthare system is going to collapse. healthare system is going to collapse. healthare system is going to collapse. We want to even manage people acutely if We want to even manage people acutely if We want to even manage people acutely if they are ill, right? I never thought they are ill, right? I never thought they are ill, right? I never thought that would happen and and ultimately that would happen and and ultimately that would happen and and ultimately that one of my own two of my own p two that one of my own two of my own p two that one of my own two of my own p two of my parents basically died because of of my parents basically died because of of my parents basically died because of failures in the system because the failures in the system because the failures in the system because the system's under so much stress, right? system's under so much stress, right? system's under so much stress, right? Never predicted that would happen. But Never predicted that would happen. But Never predicted that would happen. But that's where I started from. And when I that's where I started from. And when I that's where I started from. And when I looked into the issue of obesity, you looked into the issue of obesity, you looked into the issue of obesity, you know, I I I concluded that one of the know, I I I concluded that one of the know, I I I concluded that one of the root causes, Mark, if not the main root root causes, Mark, if not the main root root causes, Mark, if not the main root cause, was this was this flawed cause, was this was this flawed cause, was this was this flawed hypothesis that we should have low-fat hypothesis that we should have low-fat hypothesis that we should have low-fat diets to prevent heart disease, food diets to prevent heart disease, food diets to prevent heart disease, food industry exploited that increasing sugar industry exploited that increasing sugar industry exploited that increasing sugar intake, increasing refined carbohydrate intake, increasing refined carbohydrate intake, increasing refined carbohydrate intake. It became quite clear, there was intake. It became quite clear, there was intake. It became quite clear, there was a clear correlation between that change a clear correlation between that change a clear correlation between that change in guidance in the late 70s in the US in guidance in the late 70s in the US in guidance in the late 70s in the US and early 80s in the UK. Yeah. when the and early 80s in the UK. Yeah. when the and early 80s in the UK. Yeah. when the obesity epidemic started to then you obesity epidemic started to then you obesity epidemic started to then you know take its uh trajectory down the know take its uh trajectory down the know take its uh trajectory down the wrong way. wrong way. wrong way. >> Yeah. And I covered a lot of this in my >> Yeah. And I covered a lot of this in my >> Yeah. And I covered a lot of this in my book Eat Fat Be Thin which I sort of book Eat Fat Be Thin which I sort of book Eat Fat Be Thin which I sort of unpacked the whole history of how we got unpacked the whole history of how we got unpacked the whole history of how we got this lowfat craze led to this high sugar this lowfat craze led to this high sugar this lowfat craze led to this high sugar starch craze that then led to this starch craze that then led to this starch craze that then led to this dramatic rise in obesity which now of dramatic rise in obesity which now of dramatic rise in obesity which now of course we're treating with another drug course we're treating with another drug course we're treating with another drug the GLP1 agonist and you knowide and the GLP1 agonist and you knowide and the GLP1 agonist and you knowide and some glutenic and it's kind of crazy some glutenic and it's kind of crazy some glutenic and it's kind of crazy right just kind of flipped it upside right just kind of flipped it upside right just kind of flipped it upside down. down. down. >> Oh absolutely. So, so when I looked at >> Oh absolutely. So, so when I looked at >> Oh absolutely. So, so when I looked at that, started looking at the data and that, started looking at the data and that, started looking at the data and spending years and and and months and spending years and and and months and spending years and and and months and years looking at it and looking at years looking at it and looking at years looking at it and looking at different bits of data, I I was able to different bits of data, I I was able to different bits of data, I I was able to put it all together and I wrote a piece put it all together and I wrote a piece put it all together and I wrote a piece in the BMJ in 2013 called saturated fat in the BMJ in 2013 called saturated fat in the BMJ in 2013 called saturated fat is not the major issue, right? is not the major issue, right? is not the major issue, right? >> I read it. That's how I first came >> I read it. That's how I first came >> I read it. That's how I first came across it. across it. across it. >> Yeah. And that got a lot of attention, >> Yeah. And that got a lot of attention, >> Yeah. And that got a lot of attention, right? It was international news and right? It was international news and right? It was international news and British news and CNN international and British news and CNN international and British news and CNN international and whatever, you know, cuz obviously whatever, you know, cuz obviously whatever, you know, cuz obviously suddenly you've got a cardiologist suddenly you've got a cardiologist suddenly you've got a cardiologist busting this myth that we think butter busting this myth that we think butter busting this myth that we think butter has been bad for our cholesterol. But has been bad for our cholesterol. But has been bad for our cholesterol. But when I did that, okay, so what I looked when I did that, okay, so what I looked when I did that, okay, so what I looked at the data and it was very clear there at the data and it was very clear there at the data and it was very clear there was no clear association with saturated was no clear association with saturated was no clear association with saturated fat consumption and heart disease. So if fat consumption and heart disease. So if fat consumption and heart disease. So if that's true then and we know saturated that's true then and we know saturated that's true then and we know saturated fat raises LDL cholesterol, that means fat raises LDL cholesterol, that means fat raises LDL cholesterol, that means LDL cholesterol can't be that important. LDL cholesterol can't be that important. LDL cholesterol can't be that important. So and if LDL cholesterol or total So and if LDL cholesterol or total So and if LDL cholesterol or total cholesterol isn't that important as a cholesterol isn't that important as a cholesterol isn't that important as a risk factor, how does statins work? But risk factor, how does statins work? But risk factor, how does statins work? But I knew statins had a separate effect to I knew statins had a separate effect to I knew statins had a separate effect to lower cholesterol which is their lower cholesterol which is their lower cholesterol which is their anti-inflammatory and their anti- anti-inflammatory and their anti- anti-inflammatory and their anti- clotting. And I knew this even it's well clotting. And I knew this even it's well clotting. And I knew this even it's well known within cardiology circles. You known within cardiology circles. You known within cardiology circles. You know I trained as an interventional know I trained as an interventional know I trained as an interventional cardiologist and that means key heart cardiologist and that means key heart cardiologist and that means key heart surgery stances for example patient surgery stances for example patient surgery stances for example patient comes in we didn't even check their comes in we didn't even check their comes in we didn't even check their cholesterol maybe some of the thinking cholesterol maybe some of the thinking cholesterol maybe some of the thinking was a lower the better which we'll come was a lower the better which we'll come was a lower the better which we'll come on to as well so it doesn't matter what on to as well so it doesn't matter what on to as well so it doesn't matter what their cholesterol starting from um the their cholesterol starting from um the their cholesterol starting from um the lower your cholesterol the better in lower your cholesterol the better in lower your cholesterol the better in fact 2011 2011 a cardiologist one of the fact 2011 2011 a cardiologist one of the fact 2011 2011 a cardiologist one of the editors I think of the American journal editors I think of the American journal editors I think of the American journal of cardiology wrote an article which I I of cardiology wrote an article which I I of cardiology wrote an article which I I mentioned in my book a statree life mentioned in my book a statree life mentioned in my book a statree life which was entitled it's the cholesterol which was entitled it's the cholesterol which was entitled it's the cholesterol stupid right and what did he say in that stupid right and what did he say in that stupid right and what did he say in that He said, "You can be an obese diabetic He said, "You can be an obese diabetic He said, "You can be an obese diabetic smoker that doesn't exercise." Sounds smoker that doesn't exercise." Sounds smoker that doesn't exercise." Sounds crazy, but as long as your cholesterol crazy, but as long as your cholesterol crazy, but as long as your cholesterol is low enough, is low enough, is low enough, >> you're not gonna get a heart disease. >> you're not gonna get a heart disease. >> you're not gonna get a heart disease. >> You're not going to get heart disease. >> You're not going to get heart disease. >> You're not going to get heart disease. >> That's like >> That's like >> That's like >> like really. So, okay, I had to unpick >> like really. So, okay, I had to unpick >> like really. So, okay, I had to unpick that and and and what I what I also then that and and and what I what I also then that and and and what I what I also then did moving forward from 2013. That's how did moving forward from 2013. That's how did moving forward from 2013. That's how I got down this track realizing that our I got down this track realizing that our I got down this track realizing that our obsession with LDL lowering has has been obsession with LDL lowering has has been obsession with LDL lowering has has been a You looked at the saturated fat a You looked at the saturated fat a You looked at the saturated fat literature and you weren't impressed and literature and you weren't impressed and literature and you weren't impressed and data showed that it didn't seem data showed that it didn't seem data showed that it didn't seem >> both observational data and randomized >> both observational data and randomized >> both observational data and randomized control trials no benefit like in control trials no benefit like in control trials no benefit like in lowering it no association nothing lowering it no association nothing lowering it no association nothing >> right >> right >> right >> right and when you look at all the data >> right and when you look at all the data >> right and when you look at all the data so that was the first sort of bit that I so that was the first sort of bit that I so that was the first sort of bit that I was okay was okay was okay >> some might even been protective like >> some might even been protective like >> some might even been protective like some of the dairy fat some of the dairy fat some of the dairy fat >> well we know now yes there is there is >> well we know now yes there is there is >> well we know now yes there is there is some suggestion that dairy fat could be some suggestion that dairy fat could be some suggestion that dairy fat could be protective absolutely so there's all protective absolutely so there's all protective absolutely so there's all that and then coming back to the LDL that and then coming back to the LDL that and then coming back to the LDL hypers hypers hypers >> by the way you're not alone on this I >> by the way you're not alone on this I >> by the way you're not alone on this I mean there was a major paper published mean there was a major paper published mean there was a major paper published by Darish Mazafarian from tus and others by Darish Mazafarian from tus and others by Darish Mazafarian from tus and others looking at butter and and actually looking at butter and and actually looking at butter and and actually showing that there really wasn't showing that there really wasn't showing that there really wasn't evidence that it was evidence that it was evidence that it was >> so Mark this is what's interesting that >> so Mark this is what's interesting that >> so Mark this is what's interesting that article I wrote because creates such a article I wrote because creates such a article I wrote because creates such a you know um a lot of headlines and and you know um a lot of headlines and and you know um a lot of headlines and and then backlash or whatever else that's then backlash or whatever else that's then backlash or whatever else that's when people like Darius started looking when people like Darius started looking when people like Darius started looking at this again so it was all really from at this again so it was all really from at this again so it was all really from the back of that BMJ piece it all came the back of that BMJ piece it all came the back of that BMJ piece it all came together so then everybody's like you together so then everybody's like you together so then everybody's like you know I know and at the time I was I was know I know and at the time I was I was know I know and at the time I was I was writing just a writing just a writing just a >> a commentary which was peer reviewed but >> a commentary which was peer reviewed but >> a commentary which was peer reviewed but I could have got it wrong I could have I could have got it wrong I could have I could have got it wrong I could have but I was like you know what there's but I was like you know what there's but I was like you know what there's enough here that for me at least to enough here that for me at least to enough here that for me at least to provoke the thoughts provoke the thoughts provoke the thoughts >> right >> right >> right >> and then it all get got proven that you >> and then it all get got proven that you >> and then it all get got proven that you know what I'd written had validity right know what I'd written had validity right know what I'd written had validity right which is good but the other aspect to which is good but the other aspect to which is good but the other aspect to this if we go back and you mentioned this if we go back and you mentioned this if we go back and you mentioned cholesterol so the so is chole so for is cholesterol so the so is chole so for is cholesterol so the so is chole so for is high cholesterol a risk factor for heart high cholesterol a risk factor for heart high cholesterol a risk factor for heart disease and is LDL cholesterol risk disease and is LDL cholesterol risk disease and is LDL cholesterol risk factor so you have to go back to square factor so you have to go back to square factor so you have to go back to square one right so these are the framingham of one right so these are the framingham of one right so these are the framingham of studies that uh you know started in studies that uh you know started in studies that uh you know started in Massachusetts in 1948 and went over Massachusetts in 1948 and went over Massachusetts in 1948 and went over decades looking at thousands of people decades looking at thousands of people decades looking at thousands of people where a lot of risk factors emerge for where a lot of risk factors emerge for where a lot of risk factors emerge for heart disease whether it's diabetes high heart disease whether it's diabetes high heart disease whether it's diabetes high blood pressure smoking for example now blood pressure smoking for example now blood pressure smoking for example now >> high cholesterol >> high cholesterol >> high cholesterol >> and high cholesterol right so you go and >> and high cholesterol right so you go and >> and high cholesterol right so you go and look back at the Framingham studies and look back at the Framingham studies and look back at the Framingham studies and what and the just to summarize it what and the just to summarize it what and the just to summarize it without complicating the situation too without complicating the situation too without complicating the situation too much William Castelli is a cardiologist much William Castelli is a cardiologist much William Castelli is a cardiologist and he published uh he was a co-director and he published uh he was a co-director and he published uh he was a co-director of Framingham and in 1996 he published of Framingham and in 1996 he published of Framingham and in 1996 he published in one of the cardiology major in one of the cardiology major in one of the cardiology major cardiology journeyings a summary of cardiology journeyings a summary of cardiology journeyings a summary of Framingham specifically looking at LDL Framingham specifically looking at LDL Framingham specifically looking at LDL cholesterol let's just let's just look cholesterol let's just let's just look cholesterol let's just let's just look at LDL because that is the so-called bad at LDL because that is the so-called bad at LDL because that is the so-called bad cholesterol and he said from Framingham cholesterol and he said from Framingham cholesterol and he said from Framingham Unless your LDL was above 7.8 8 mill Unless your LDL was above 7.8 8 mill Unless your LDL was above 7.8 8 mill moles which by the way I think in your moles which by the way I think in your moles which by the way I think in your units is probably 250 or 300 250 units is probably 250 or 300 250 units is probably 250 or 300 250 probably I think maybe we can look it up probably I think maybe we can look it up probably I think maybe we can look it up and calculate but let's just say for and calculate but let's just say for and calculate but let's just say for argument sake around 250 which is very argument sake around 250 which is very argument sake around 250 which is very very high by the way it absolutely had very high by the way it absolutely had very high by the way it absolutely had no it was useless as a predictor for no it was useless as a predictor for no it was useless as a predictor for coronary artis coronary artis coronary artis >> LDL LDL now why is that when you correct >> LDL LDL now why is that when you correct >> LDL LDL now why is that when you correct for triglycerides and HDL for triglycerides and HDL for triglycerides and HDL okay which by the way is a more okay which by the way is a more okay which by the way is a more important predictor of heart disease LDL important predictor of heart disease LDL important predictor of heart disease LDL loses its significance completely loses its significance completely loses its significance completely So then if that's true and I'm saying So then if that's true and I'm saying So then if that's true and I'm saying that means LDL isn't really a risk that means LDL isn't really a risk that means LDL isn't really a risk factor of heart disease and I believe factor of heart disease and I believe factor of heart disease and I believe with everything I know now that to be with everything I know now that to be with everything I know now that to be the case. Okay, let's let's unpick every the case. Okay, let's let's unpick every the case. Okay, let's let's unpick every part of it. Does lowering LDL part of it. Does lowering LDL part of it. Does lowering LDL cholesterol from diet or drugs, but more cholesterol from diet or drugs, but more cholesterol from diet or drugs, but more specifically drugs cuz they're the most specifically drugs cuz they're the most specifically drugs cuz they're the most potent ways of lowering LDL cholesterol, potent ways of lowering LDL cholesterol, potent ways of lowering LDL cholesterol, whether it's PCK9 inhibitors, whether whether it's PCK9 inhibitors, whether whether it's PCK9 inhibitors, whether it's statins, whatever. Is there is it's statins, whatever. Is there is it's statins, whatever. Is there is there a clear correlation? Is this dogma there a clear correlation? Is this dogma there a clear correlation? Is this dogma true that the lower the better? So true that the lower the better? So true that the lower the better? So myself and two cardiologists did a myself and two cardiologists did a myself and two cardiologists did a systematic review of the totality of systematic review of the totality of systematic review of the totality of drug industry sponsored trials by the drug industry sponsored trials by the drug industry sponsored trials by the way and some diet trials but many drug way and some diet trials but many drug way and some diet trials but many drug industry sponsored trials all of the industry sponsored trials all of the industry sponsored trials all of the randomized control trials on randomized control trials on randomized control trials on cholesterol-lowering drugs statins PCK9 cholesterol-lowering drugs statins PCK9 cholesterol-lowering drugs statins PCK9 blah blah was there a clear relationship blah blah was there a clear relationship blah blah was there a clear relationship as you lowered LDL in low-risk and as you lowered LDL in low-risk and as you lowered LDL in low-risk and high-risisk patients Mark okay over 30 high-risisk patients Mark okay over 30 high-risisk patients Mark okay over 30 studies studies studies >> was a relationship with lowering LDL and >> was a relationship with lowering LDL and >> was a relationship with lowering LDL and preventing cardiovascular events no preventing cardiovascular events no preventing cardiovascular events no >> even in high-risisk patients >> even in high-risisk patients >> even in high-risisk patients >> even in high risk it's nonsense it's >> even in high risk it's nonsense it's >> even in high risk it's nonsense it's nonsense. So the question then is nonsense. So the question then is nonsense. So the question then is >> why do we all so firmly believe >> why do we all so firmly believe >> why do we all so firmly believe >> so does that mean stat but then I said >> so does that mean stat but then I said >> so does that mean stat but then I said well of course statins have a role they well of course statins have a role they well of course statins have a role they do have a benefit from the from the RCT do have a benefit from the from the RCT do have a benefit from the from the RCT data which is small because I knew data which is small because I knew data which is small because I knew already they're anti-inflammatory and already they're anti-inflammatory and already they're anti-inflammatory and anti- clotting so it's nothing in my anti- clotting so it's nothing in my anti- clotting so it's nothing in my view listen I could be proven wrong here view listen I could be proven wrong here view listen I could be proven wrong here but the evidence at the moment looks but the evidence at the moment looks but the evidence at the moment looks very clear that there is no consistent very clear that there is no consistent very clear that there is no consistent relationship right it's definitely not a relationship right it's definitely not a relationship right it's definitely not a clear relationship so if even if it's a clear relationship so if even if it's a clear relationship so if even if it's a weak relationship mark let's just weak relationship mark let's just weak relationship mark let's just argument sake let's say there's a weak argument sake let's say there's a weak argument sake let's say there's a weak benefit lowering LDL. benefit lowering LDL. benefit lowering LDL. >> What else is going on? And what else are >> What else is going on? And what else are >> What else is going on? And what else are you ignoring? Right. you ignoring? Right. you ignoring? Right. >> Yeah. >> Yeah. >> Yeah. >> What else do statins do? They cause >> What else do statins do? They cause >> What else do statins do? They cause insulin resistance. Say one in 100 insulin resistance. Say one in 100 insulin resistance. Say one in 100 people get type two diabetes because of people get type two diabetes because of people get type two diabetes because of statins. statins. statins. >> One in two. >> One in two. >> One in two. >> One in 100. >> One in 100. >> One in 100. >> One in 100. >> One in 100. >> One in 100. >> Yeah. One in 100. So about 1 to 2% but >> Yeah. One in 100. So about 1 to 2% but >> Yeah. One in 100. So about 1 to 2% but one in 100. Some some studies say one in one in 100. Some some studies say one in one in 100. Some some studies say one in 50, right? Will get type two diabetes 50, right? Will get type two diabetes 50, right? Will get type two diabetes because of the statin. Probably because of the statin. Probably because of the statin. Probably reversible still, but not ideal, right? reversible still, but not ideal, right? reversible still, but not ideal, right? If you're on a stand drug. If you're on a stand drug. If you're on a stand drug. >> The second thing is look at the whole >> The second thing is look at the whole >> The second thing is look at the whole patient coming in. patient coming in. patient coming in. >> We have the illusion of protection. We >> We have the illusion of protection. We >> We have the illusion of protection. We have patients I used to see coming in have patients I used to see coming in have patients I used to see coming in and they thought my cholesterol is low. and they thought my cholesterol is low. and they thought my cholesterol is low. I can go and eat a McDonald's. It's I can go and eat a McDonald's. It's I can go and eat a McDonald's. It's fine. And they they're and they're fine. And they they're and they're fine. And they they're and they're getting more and more overweight, more getting more and more overweight, more getting more and more overweight, more insulin resistant. They're increasing insulin resistant. They're increasing insulin resistant. They're increasing their cardiovascular risk. They're not their cardiovascular risk. They're not their cardiovascular risk. They're not told the statin is going to give them a told the statin is going to give them a told the statin is going to give them a 1% benefit. I.e. more likely than not 1% benefit. I.e. more likely than not 1% benefit. I.e. more likely than not they're not going to benefit. So you they're not going to benefit. So you they're not going to benefit. So you could imagine that concept that the could imagine that concept that the could imagine that concept that the overall net effect of the way that overall net effect of the way that overall net effect of the way that statins are prescribed and the dogma statins are prescribed and the dogma statins are prescribed and the dogma around them in my view has been negative around them in my view has been negative around them in my view has been negative and has actually been one of the main and has actually been one of the main and has actually been one of the main reasons why we have got this pandemic of reasons why we have got this pandemic of reasons why we have got this pandemic of chronic disease. chronic disease. chronic disease. >> In 2011 I visited a farm in southern >> In 2011 I visited a farm in southern >> In 2011 I visited a farm in southern Spain and ate grilled seabbream Spain and ate grilled seabbream Spain and ate grilled seabbream harvested that morning from an 8,000 harvested that morning from an 8,000 harvested that morning from an 8,000 acre restored wetland estuary. 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If you're looking to upgrade your daily essentials, head to your daily essentials, head to your daily essentials, head to cozier.com/fimement cozier.com/fimement cozier.com/fimement and receive 20% off and receive 20% off and receive 20% off >> because we've overemphasized an index on >> because we've overemphasized an index on >> because we've overemphasized an index on LDL cholesterol and forgotten everything LDL cholesterol and forgotten everything LDL cholesterol and forgotten everything else. else. else. >> Absolutely >> Absolutely >> Absolutely >> right. >> right. >> right. >> Because there's a drug for it. It was >> Because there's a drug for it. It was >> Because there's a drug for it. It was interesting to me if there was a drug interesting to me if there was a drug interesting to me if there was a drug for insulin resistance that worked for insulin resistance that worked for insulin resistance that worked really well and we have metformin, but really well and we have metformin, but really well and we have metformin, but it's it's it's >> and it fixed insulin resistance, you >> and it fixed insulin resistance, you >> and it fixed insulin resistance, you know, everybody be prescribing it, but know, everybody be prescribing it, but know, everybody be prescribing it, but we don't even diagnose it in most people we don't even diagnose it in most people we don't even diagnose it in most people because we don't have a drug for it. because we don't have a drug for it. because we don't have a drug for it. Exactly. And it's it's stunning to me Exactly. And it's it's stunning to me Exactly. And it's it's stunning to me that you I was talking to the that you I was talking to the that you I was talking to the lab director at Quest Laboratories. He lab director at Quest Laboratories. He lab director at Quest Laboratories. He said, "What percent of your tests you said, "What percent of your tests you said, "What percent of your tests you get to come in are measuring insulin, get to come in are measuring insulin, get to come in are measuring insulin, which is, I think, one of the most which is, I think, one of the most which is, I think, one of the most important things you need to know about important things you need to know about important things you need to know about your biomarkers." your biomarkers." your biomarkers." >> Uh, and he was like less than 1%. And >> Uh, and he was like less than 1%. And >> Uh, and he was like less than 1%. And it's part of why I co-ounded this it's part of why I co-ounded this it's part of why I co-ounded this company, Function Health, to really look company, Function Health, to really look company, Function Health, to really look at a deep biomarker set around at a deep biomarker set around at a deep biomarker set around cardioabolic risk factors, including cardioabolic risk factors, including cardioabolic risk factors, including insulin, including LP little A, insulin, including LP little A, insulin, including LP little A, including something called Apo B, which including something called Apo B, which including something called Apo B, which I want to talk to you about. not just I want to talk to you about. not just I want to talk to you about. not just your total LDL, HDL, and triglyceride your total LDL, HDL, and triglyceride your total LDL, HDL, and triglyceride levels, but also particle number, levels, but also particle number, levels, but also particle number, particle size, inflammation markers, all particle size, inflammation markers, all particle size, inflammation markers, all the things that are often missed, but the things that are often missed, but the things that are often missed, but that are much better at giving you a that are much better at giving you a that are much better at giving you a holistic picture of your cardiovascular holistic picture of your cardiovascular holistic picture of your cardiovascular risk. And then you know where to risk. And then you know where to risk. And then you know where to intervene. And it and in what one of the intervene. And it and in what one of the intervene. And it and in what one of the studies that it was so interesting to me studies that it was so interesting to me studies that it was so interesting to me was actually from I think Scotland or was actually from I think Scotland or was actually from I think Scotland or Ireland was where they looked basically Ireland was where they looked basically Ireland was where they looked basically at a series of patients who came into an at a series of patients who came into an at a series of patients who came into an emergency room with a heart attack and emergency room with a heart attack and emergency room with a heart attack and they did glucose tolerance tests on they did glucose tolerance tests on they did glucose tolerance tests on everybody who came in with a heart everybody who came in with a heart everybody who came in with a heart attack and they found that twothirds attack and they found that twothirds attack and they found that twothirds either had diabetes or pre-diabetes. either had diabetes or pre-diabetes. either had diabetes or pre-diabetes. >> Yeah. >> Yeah. >> Yeah. >> Who had a heart attack. >> Who had a heart attack. >> Who had a heart attack. >> Yeah. >> Yeah. >> Yeah. >> That that was really the big driver. Now >> That that was really the big driver. Now >> That that was really the big driver. Now there's a subset of people have familial there's a subset of people have familial there's a subset of people have familial lipid disorders. you know, inherited lipid disorders. you know, inherited lipid disorders. you know, inherited genetic lipid disorders and not those genetic lipid disorders and not those genetic lipid disorders and not those people probably need to be treated more people probably need to be treated more people probably need to be treated more directly. But but for the majority of directly. But but for the majority of directly. But but for the majority of people out there who are obese or have people out there who are obese or have people out there who are obese or have pre-diabetes or metabolic dysfunction, pre-diabetes or metabolic dysfunction, pre-diabetes or metabolic dysfunction, which is basically in America, 93% of which is basically in America, 93% of which is basically in America, 93% of Americans, that's what's driving Americans, that's what's driving Americans, that's what's driving probably most of the heart disease, not probably most of the heart disease, not probably most of the heart disease, not >> 100% >> 100% >> 100% >> butter or saturated fat or >> butter or saturated fat or >> butter or saturated fat or >> no LDL elevations. Well, something else >> no LDL elevations. Well, something else >> no LDL elevations. Well, something else to throw into the picture, right? So, to throw into the picture, right? So, to throw into the picture, right? So, you can make the argument, okay, Dr. you can make the argument, okay, Dr. you can make the argument, okay, Dr. Motra, you're saying there's no Motra, you're saying there's no Motra, you're saying there's no consistent relationship. It may be a consistent relationship. It may be a consistent relationship. It may be a benefit. Why not just lower your LDL? benefit. Why not just lower your LDL? benefit. Why not just lower your LDL? Okay, so 2016 and the reason we did this Okay, so 2016 and the reason we did this Okay, so 2016 and the reason we did this me and a number of international me and a number of international me and a number of international scientists looked at we decided to do a scientists looked at we decided to do a scientists looked at we decided to do a systematic review of observational data systematic review of observational data systematic review of observational data looking at people over 60 was there a looking at people over 60 was there a looking at people over 60 was there a relationship with LDL cholesterol and relationship with LDL cholesterol and relationship with LDL cholesterol and heart disease and the reason we did this heart disease and the reason we did this heart disease and the reason we did this by the way is another thing that was by the way is another thing that was by the way is another thing that was interesting from framing which wasn't interesting from framing which wasn't interesting from framing which wasn't well publicized is that when after well publicized is that when after well publicized is that when after people hit 50 years old as their people hit 50 years old as their people hit 50 years old as their cholesterol dropped their mortality cholesterol dropped their mortality cholesterol dropped their mortality increased. So we thought okay is there increased. So we thought okay is there increased. So we thought okay is there something you know because for it to be something you know because for it to be something you know because for it to be a risk factor for heart disease it a risk factor for heart disease it a risk factor for heart disease it should be consistent really across all should be consistent really across all should be consistent really across all age groups and both sexes right age groups and both sexes right age groups and both sexes right >> mortality >> mortality >> mortality >> for mortality yeah but even for heart >> for mortality yeah but even for heart >> for mortality yeah but even for heart disease as well right you that's a good disease as well right you that's a good disease as well right you that's a good point so we looked at was there first of point so we looked at was there first of point so we looked at was there first of all any association if you're over 60 all any association if you're over 60 all any association if you're over 60 with LDL cholesterol and heart disease with LDL cholesterol and heart disease with LDL cholesterol and heart disease right we found none okay interesting but right we found none okay interesting but right we found none okay interesting but what was surprising was there was an what was surprising was there was an what was surprising was there was an inverse association with LDL cholesterol inverse association with LDL cholesterol inverse association with LDL cholesterol and all cause mortality In other words, and all cause mortality In other words, and all cause mortality In other words, statistically, if you're over 60, the statistically, if you're over 60, the statistically, if you're over 60, the higher LDL, the less likely you are to higher LDL, the less likely you are to higher LDL, the less likely you are to die. So, what's the reasoning for that? die. So, what's the reasoning for that? die. So, what's the reasoning for that? Well, something that's been forgotten or Well, something that's been forgotten or Well, something that's been forgotten or missed or not discussed, cholesterol is missed or not discussed, cholesterol is missed or not discussed, cholesterol is has a very vital role in many functions has a very vital role in many functions has a very vital role in many functions in the body, including, you know, the in the body, including, you know, the in the body, including, you know, the brain, hormone production, but also the brain, hormone production, but also the brain, hormone production, but also the immune system. immune system. immune system. >> Mhm. >> Mhm. >> Mhm. >> And it's likely that that's where the >> And it's likely that that's where the >> And it's likely that that's where the protective benefit comes because older protective benefit comes because older protective benefit comes because older people are more vulnerable to dying from people are more vulnerable to dying from people are more vulnerable to dying from infections. And we also know there is an infections. And we also know there is an infections. And we also know there is an association. I'll use this word, an association. I'll use this word, an association. I'll use this word, an association, right? is definitely causal association, right? is definitely causal association, right? is definitely causal between low cholesterol and cancer. between low cholesterol and cancer. between low cholesterol and cancer. Again, it's probably related to the Again, it's probably related to the Again, it's probably related to the immune system. immune system. immune system. >> Yeah. I mean, I think I think the >> Yeah. I mean, I think I think the >> Yeah. I mean, I think I think the problem with this data though is I'll problem with this data though is I'll problem with this data though is I'll just push back a little bit is it's it's just push back a little bit is it's it's just push back a little bit is it's it's observational data and the data observational data and the data observational data and the data >> like from the Hawaii study show that you >> like from the Hawaii study show that you >> like from the Hawaii study show that you know you were older and you had higher know you were older and you had higher know you were older and you had higher cholesterol, you know, you're more cholesterol, you know, you're more cholesterol, you know, you're more likely to live longer than if your likely to live longer than if your likely to live longer than if your cholesterol is lower. But it may be cholesterol is lower. But it may be cholesterol is lower. But it may be because the people have low cholesterol because the people have low cholesterol because the people have low cholesterol or malnourished, have cancer, and other or malnourished, have cancer, and other or malnourished, have cancer, and other reasons. reasons. reasons. >> So, let me push back on that. So, we we >> So, let me push back on that. So, we we >> So, let me push back on that. So, we we accounted for that and we found actually accounted for that and we found actually accounted for that and we found actually no when you you count like time lag, you no when you you count like time lag, you no when you you count like time lag, you go back five or 10 years. No, it's not. go back five or 10 years. No, it's not. go back five or 10 years. No, it's not. It's not. That does happen, but it No, It's not. That does happen, but it No, It's not. That does happen, but it No, it's independently it does seem to be an it's independently it does seem to be an it's independently it does seem to be an issue. issue. issue. >> Okay. So, you sort of looked at all the >> Okay. So, you sort of looked at all the >> Okay. So, you sort of looked at all the data and you came up with this very kind data and you came up with this very kind data and you came up with this very kind of contrary opinion, which is that LDL of contrary opinion, which is that LDL of contrary opinion, which is that LDL isn't all it's cracked up to me. isn't all it's cracked up to me. isn't all it's cracked up to me. >> That statins work a little but not for >> That statins work a little but not for >> That statins work a little but not for the reasons we think. the reasons we think. the reasons we think. >> Meaning they lower inflammation and they >> Meaning they lower inflammation and they >> Meaning they lower inflammation and they may have other properties that may may have other properties that may may have other properties that may beneficial. We don't even know are beneficial. We don't even know are beneficial. We don't even know are called this pleotropic effects. So they called this pleotropic effects. So they called this pleotropic effects. So they for example they induce nitric oxide for example they induce nitric oxide for example they induce nitric oxide synthes which dilates your blood vessels synthes which dilates your blood vessels synthes which dilates your blood vessels and reduces inflammation and helps your and reduces inflammation and helps your and reduces inflammation and helps your lining of your blood vessels. All that's lining of your blood vessels. All that's lining of your blood vessels. All that's protective and so it maybe it stabilizes protective and so it maybe it stabilizes protective and so it maybe it stabilizes plaque and may help in those ways but it plaque and may help in those ways but it plaque and may help in those ways but it may not be the LDL lowering effect. In may not be the LDL lowering effect. In may not be the LDL lowering effect. In fact Paul Ritker from Harvard I remember fact Paul Ritker from Harvard I remember fact Paul Ritker from Harvard I remember he published trial I think it was the he published trial I think it was the he published trial I think it was the Jupiter trial where they show that if Jupiter trial where they show that if Jupiter trial where they show that if you if you had a high LDL but didn't you if you had a high LDL but didn't you if you had a high LDL but didn't have any inflammation you didn't have have any inflammation you didn't have have any inflammation you didn't have that significant a risk of having heart that significant a risk of having heart that significant a risk of having heart disease. But if you had disease. But if you had disease. But if you had >> interesting >> interesting >> interesting >> a high level of inflammation, high LDL, >> a high level of inflammation, high LDL, >> a high level of inflammation, high LDL, you had a much higher risk. So it was you had a much higher risk. So it was you had a much higher risk. So it was the inflammation that was really driving the inflammation that was really driving the inflammation that was really driving the heart disease. And that was really the heart disease. And that was really the heart disease. And that was really the seminal paper was in the New England the seminal paper was in the New England the seminal paper was in the New England Journal of Medicine over 20 years ago. I Journal of Medicine over 20 years ago. I Journal of Medicine over 20 years ago. I remember reading it by Paul Richtor and remember reading it by Paul Richtor and remember reading it by Paul Richtor and and his crew that really laid out how and his crew that really laid out how and his crew that really laid out how heart disease is not a plumbing problem. heart disease is not a plumbing problem. heart disease is not a plumbing problem. It's an immune problem It's an immune problem It's an immune problem >> 100%. It's a chronic inflammatory >> 100%. It's a chronic inflammatory >> 100%. It's a chronic inflammatory process exacerbated by metabolic risk process exacerbated by metabolic risk process exacerbated by metabolic risk factors or insulin resistance. And I factors or insulin resistance. And I factors or insulin resistance. And I wrote wrote wrote >> metabolic risk factors. By that you mean >> metabolic risk factors. By that you mean >> metabolic risk factors. By that you mean problems with your blood sugar and problems with your blood sugar and problems with your blood sugar and insulin insulin insulin insulin insulin insulin >> resistance and pre-diabetes. 100%. Uh >> resistance and pre-diabetes. 100%. Uh >> resistance and pre-diabetes. 100%. Uh and actually we published an editorial and actually we published an editorial and actually we published an editorial with two cardiologists I did in British with two cardiologists I did in British with two cardiologists I did in British own sports medicine in 2017 own sports medicine in 2017 own sports medicine in 2017 which was a very long title but it got a which was a very long title but it got a which was a very long title but it got a lot of publicity and more than a million lot of publicity and more than a million lot of publicity and more than a million downloads which was um uh saturated fat downloads which was um uh saturated fat downloads which was um uh saturated fat does not clog the arteries. Coronary does not clog the arteries. Coronary does not clog the arteries. Coronary artery disease is a chronic inflammatory artery disease is a chronic inflammatory artery disease is a chronic inflammatory condition which can be effectively condition which can be effectively condition which can be effectively managed with lifestyle changes. That was managed with lifestyle changes. That was managed with lifestyle changes. That was the title of this thing but it's all the title of this thing but it's all the title of this thing but it's all there people. It's free access. People there people. It's free access. People there people. It's free access. People can look it up and read it. But we can look it up and read it. But we can look it up and read it. But we talked that we've overdone the thing and talked that we've overdone the thing and talked that we've overdone the thing and wasn't just Dr. Mahhatra his opinion wasn't just Dr. Mahhatra his opinion wasn't just Dr. Mahhatra his opinion being controversial. The two my two being controversial. The two my two being controversial. The two my two co-authors were both editors of medical co-authors were both editors of medical co-authors were both editors of medical journals and cardiologists. Luis journals and cardiologists. Luis journals and cardiologists. Luis Redberg, editor of John Medicine and Redberg, editor of John Medicine and Redberg, editor of John Medicine and Pascal Meer, editor of BMJ Open. Pascal Meer, editor of BMJ Open. Pascal Meer, editor of BMJ Open. >> Why why is this not getting more play? >> Why why is this not getting more play? >> Why why is this not getting more play? Why why is still the dogma and the Why why is still the dogma and the Why why is still the dogma and the orthodoxy that if you have a high LDL, orthodoxy that if you have a high LDL, orthodoxy that if you have a high LDL, you take a statin? you take a statin? you take a statin? >> Do do you want my honest answer, Mark? >> Do do you want my honest answer, Mark? >> Do do you want my honest answer, Mark? >> Yeah. I mean, not all I mean I know >> Yeah. I mean, not all I mean I know >> Yeah. I mean, not all I mean I know doctors are usually very good-hearted. doctors are usually very good-hearted. doctors are usually very good-hearted. Sure. Sure. Sure. >> Very smart, well-intentioned. Don't want >> Very smart, well-intentioned. Don't want >> Very smart, well-intentioned. Don't want to hurt their patients. try to do what's to hurt their patients. try to do what's to hurt their patients. try to do what's in the best interest of their patients in the best interest of their patients in the best interest of their patients and follow the science. So why why are and follow the science. So why why are and follow the science. So why why are they not hearing about this? they not hearing about this? they not hearing about this? >> Okay, so let's go to the root cause of >> Okay, so let's go to the root cause of >> Okay, so let's go to the root cause of the problem even in society today. the problem even in society today. the problem even in society today. What's what's the big issue in health? What's what's the big issue in health? What's what's the big issue in health? We have commercial distortions of the We have commercial distortions of the We have commercial distortions of the scientific evidence. Who is behind that scientific evidence. Who is behind that scientific evidence. Who is behind that and who has more power and control over and who has more power and control over and who has more power and control over medical education, medical training, the medical education, medical training, the medical education, medical training, the media ever before? Big corporations in media ever before? Big corporations in media ever before? Big corporations in this case big farmer. And the level of this case big farmer. And the level of this case big farmer. And the level of this control and power mark has got to a this control and power mark has got to a this control and power mark has got to a level where it can be very easily and level where it can be very easily and level where it can be very easily and rationally not in an inflammatory way or rationally not in an inflammatory way or rationally not in an inflammatory way or overplaying it as as being tyrannical. overplaying it as as being tyrannical. overplaying it as as being tyrannical. What what what also happens with these What what what also happens with these What what what also happens with these big corporations in the way they exert big corporations in the way they exert big corporations in the way they exert their power is that they want to avoid their power is that they want to avoid their power is that they want to avoid conflict, right? They want to avoid the conflict, right? They want to avoid the conflict, right? They want to avoid the truth coming out. So there's a debate truth coming out. So there's a debate truth coming out. So there's a debate and discussion because ultimately people and discussion because ultimately people and discussion because ultimately people like myself, like you who are obsessed like myself, like you who are obsessed like myself, like you who are obsessed with the truth, who want to get it out with the truth, who want to get it out with the truth, who want to get it out to help patients when we speak and act to help patients when we speak and act to help patients when we speak and act from a place of of integrity and truth. from a place of of integrity and truth. from a place of of integrity and truth. It has a very powerful resonance with It has a very powerful resonance with It has a very powerful resonance with people and it can very quickly destroy people and it can very quickly destroy people and it can very quickly destroy all these other dogmas that people have all these other dogmas that people have all these other dogmas that people have created because of that power that that created because of that power that that created because of that power that that that the truth has. They want that that the truth has. They want that that the truth has. They want that conflict to remain latent, to remain conflict to remain latent, to remain conflict to remain latent, to remain hidden. So that, you know, Num Chomsky hidden. So that, you know, Num Chomsky hidden. So that, you know, Num Chomsky says the general public doesn't know says the general public doesn't know says the general public doesn't know what's happening and they don't even what's happening and they don't even what's happening and they don't even know that they don't know. know that they don't know. know that they don't know. >> That's right. >> That's right. >> That's right. >> Right. So a lot of these doctors and I >> Right. So a lot of these doctors and I >> Right. So a lot of these doctors and I agree are well intentioned, but they agree are well intentioned, but they agree are well intentioned, but they don't they're living, you know, in many don't they're living, you know, in many don't they're living, you know, in many ways they're living they're climbing up ways they're living they're climbing up ways they're living they're climbing up the wrong wall to success when it comes the wrong wall to success when it comes the wrong wall to success when it comes to helping patients to helping patients to helping patients >> because it's a drug companies that are >> because it's a drug companies that are >> because it's a drug companies that are are really calling the shots. So we are are really calling the shots. So we are are really calling the shots. So we are under a situation of tyranny. And the under a situation of tyranny. And the under a situation of tyranny. And the reason I call it tyrannical is because reason I call it tyrannical is because reason I call it tyrannical is because there are doctors that know this uh there are doctors that know this uh there are doctors that know this uh mark. There are a few doctors that kind mark. There are a few doctors that kind mark. There are a few doctors that kind of know this, but then they're less of know this, but then they're less of know this, but then they're less they're afraid to speak out. And only a they're afraid to speak out. And only a they're afraid to speak out. And only a minority of the doctors that know what's minority of the doctors that know what's minority of the doctors that know what's going on will then speak out. going on will then speak out. going on will then speak out. >> If you love that last video, you're >> If you love that last video, you're >> If you love that last video, you're going to love the next one. Check it out going to love the next one. Check it out going to love the next one. Check it out here.