The BIG MYTH Behind Heart Disease & What ACTUALLY CAUSES It! Dr. Elizabeth Boham & Mark Hyman
Oct 5, 2020 The Doctor’s Farmacy with Mark Hyman M.D.We have all heard that the secret to living a long, healthy, heart disease-free life is lowering your cholesterol, but is that really true? The reality is, most of us have little understanding about our cholesterol levels in our blood and the whole topic is much more complicated than we thought. Moreover, the standard cholesterol testing is outdated because it doesn’t check for particle size and particle number, and this information is what is needed to tell what’s really going on with your cholesterol. In this episode, Dr. Hyman sits down with Dr. Elizabeth Boham to discuss why cholesterol is only one factor in determining your overall health. They also discuss the factors that influence your cholesterol and whether or not statin drugs are the most effective way to prevent heart attacks. Elizabeth Boham is a physician and nutritionist who practices functional medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. Dr. Boham has contributed to many articles and wrote the latest chapter on Obesity for the Rankel Textbook of Family Medicine. She is part of the faculty of the Institute for Functional Medicine and has been featured on the Dr. Oz show and in a variety of publications and media including Huffington Post, The Chalkboard Magazine, and Experience Life. Her DVD Breast Wellness: Tools to Prevent and Heal from Breast Cancer explores the functional medicine approach to keeping your breasts and whole body well. For more information, please visit drhyman.com/uwc This episode is brought to you by Perfect Keto. Right now, Perfect Keto is offering Doctor’s Farmacy listeners 20% off plus free shipping with the code DRMARK. Just go to http://perfectketo.com/drmark, and make sure you try their Nut Butters and Keto Cookies.
Transcript
0:00the reason we’re really looking at cholesterol is because it’s one factor that influences somebody’s
0:06risk of cardiovascular disease right [Music]
0:12welcome to the doctor’s pharmacy i’m dr mark hyman it’s a special episode of the doctor’s pharmacy called house call
0:18and this episode is with my friend and colleague dr elizabeth bowham and we’re talking about
0:24cholesterol and heart disease and what is the truth and what is fiction and what should we do when our
0:31doctor tells us to take a statin which every doctor pretty much does regardless of our age sex or
0:37whatever is going on it’s the number one drug sold on the planet and we need to think about why and if
0:43it’s actually good for us or what we actually should be doing about our cholesterol so dr baum is a incredible physician she’s
0:50uh one of my good friends and has been working with me for 20 plus years now i guess it’s a long
0:57time uh and she’s one of the leaders in functional medicine in the world teaches all over the place now mostly
1:03from her house on zoom but uh really is is a part of the faculty the institute for functional
1:08medicine she’s a huge contributor to the field and is what every doctor should be which is not only an md
1:15but she’s a registered dietitian and an exercise physiologist and i’m super jealous of all that uh we both went to cornell so we have
1:21that in common and uh it’s great to have you back on the doctor’s pharmacy list thank you mark it’s great to be here
1:27all right let’s get right into it so cholesterol if you are a person in america and you’ve been to your doctor
1:33you likely have had your cholesterol checked and you probably have been told you need to get your cholesterol down
1:39and you might have even been told that you should be taking a drug called the statin uh so tell us what is
1:46this whole hullabaloo about cholesterol and statins and why should we even care about
1:51cholesterol and is it really the thing we should be worried about with heart disease oh such great questions
1:57i mean it’s estimated that 50 of people in this country and in europe and 40 worldwide have what’s considered
2:05elevated cholesterol and and obviously that you know for those 50 percent of people not all of
2:11them have to be really concerned about that cholesterol number it doesn’t mean that all 50 of us have
2:17to be taking a medication to lower that cholesterol and so people come in all the time with those questions of is
2:24this cholesterol too high and how do i get it down do i need to get it down and and the reason we’re really looking
2:30at cholesterol is because it’s one factor that influences somebody’s
2:35risk of cardiovascular disease right i like how you said one factor one factor
2:40exactly one piece of the puzzle and for a lot of people it’s not even an important piece of the puzzle
2:46right but for it it is one piece of the puzzle especially for people who have a really high cholesterol very like
2:53familiar hypercholesterolemia genetic absolutely we’re talking about ldls like in the 190s and we’ll talk
3:00more about those numbers total cholesterol in the 300s you know there is a there is an association with
3:06vascular disease it can cause plaque buildup and that can cause if the plaque is built
3:11building up around the arteries around the heart that can cause a heart attack or in the arteries leading to the brain it
3:16can cause a stroke so for some people it’s something that’s very important for other people it’s something that’s
3:23giving us a lot of information potentially about their health and where do we need to focus
3:28and so i think it’s an important thing for us to talk about like what are all these numbers numbers mean right people are so
3:34confused what does this number mean do i really need to be worried so we’re going to get deep into
3:40all the things you should be thinking about if you want to prevent heart disease cholesterol being one of them one of them and maybe not
3:47the most important one by the way because two-thirds of people who have
3:52heart attacks actually have pre-diabetes or diabetes and it’s mostly undiagnosed
3:57that 70 percent of people who come in have pretty good cholesterol who
4:04have heart attacks about 50 percent have normal cholesterol and you know uh
4:10and and it’s really striking that we’re kind of like wondering about uh this this condition which is is
4:17actually not so cut and dried uh and i think absolutely i think i want to get into um the numbers let’s talk
4:23about cholesterol because in my opinion and i’ve written a lot about this the test that you get when
4:28you go to your doctor is antiquated absolutely it’s outdated
4:34it’s not the cholesterol test you should be getting uh and it doesn’t give you the right information to make a decision about
4:40what to do so you typically get your total cholesterol your triglycerides your hdl your h your ldl
4:46those are fine but tell us about what these numbers mean and what cholesterol tests we should be doing
4:52your doctor may not be ordering and that is available through quest or labcorp through your insurance absolutely so
4:59when you get your traditional cholesterol panel done your traditional lipid panel done
5:04you’re they’re they’re giving you the the ldl cholesterol the hdl cholesterol the
5:11total cholesterol and and that’s one piece of information like you said but we’re missing a lot of
5:17information there so the the uh it’s really important i love this
5:22analogy of the dirt and dump trucks so um dirt and dump trucks and think of
5:30think of all the dump trucks that are going around carrying dirt and we can make this analogy with cholesterol
5:36so think of your cholesterol like the dirt and the um the dump trucks
5:43are the particles carrying around your cholesterol so what we’re learning is it’s not just
5:49the amount of dirt somebody has that’s important it’s the amount of
5:55dump trucks that they have carrying around that dirt and that the size of the dump trucks are
6:00actually really important and so when you get a typical lipid panel done
6:05you know you’re just finding out the amount of dirt that you have and how much of it is ldl and hdl and
6:11triglycerides and that’s important and we will talk about that but what’s even more important or at
6:16least as important right is the amount of dump trucks you have carrying around that dirt and what we’re learning
6:22is that or what we’ve learned is that the the if you have small dump trucks so if you have a
6:28certain amount of dirt you could either have a few big dump trucks carrying around or a lot of small dump trucks
6:34carrying it around yeah and what we’re learning is that those small dump trucks if you have too many small dump trucks that that’s
6:41actually more concerning that they can get into the artery lining more they can cause more plaque buildup
6:46they can get that that it can help that cholesterol get oxidized through oxidative stress it’s much more
6:52dangerous so the size of those dump trucks you have carrying around your cholesterol is critically important yeah and
6:58something we look at all the time i mean the way i think about it is and i another way i kind of look at it is
7:04uh you know the the number you get on your test is the weight of your cholesterol so
7:10it’s milligrams per deciliter it’s just basically the weight yep but it doesn’t tell you if that
7:15cholesterol is made up of a thousand particles or a hundred particles right so you could have a cholesterol of 150
7:21and it could be 5 000 particles or it could be 500 particles yep of cholesterol and that makes a huge
7:29difference in your risk of heart disease and you can’t tell from a regular cholesterol test whether you have a lot
7:35of particles or whether they’re big particles or small particles so i think about sort of like golf balls
7:41and beach balls you know beach balls are these big light fluffy balls that you can bounce and don’t hurt anything
7:47and the golf ball is small but a hitch in the head will knock you out right and the golf balls are the things that are the small particles that are
7:52dangerous that bang up against the arteries and cause the plaque to develop and cause heart attacks so so you can’t tell that from a
7:59regular test you can have smaller large ldl smaller large hdl smaller large triglycerides and the triglycerides are
8:06a little different it’s the big triglycerides that are a problem not the small ones but you can really get a sense from
8:12these newer tests what’s really going on because i i’ve seen people with a cholesterol 300.
8:18their hdls which sounds terrible right because they’re supposed to be under 200 their ldl might
8:24be 150 which sounds terrible because it should be under 70. their hdl is like 110
8:30yep so they’re really high they’re skinny they’re healthy and i’m diabetes high blood pressure they don’t smoke they’re older often little ladies have
8:36this kind of cholesterol there’s no evidence that these people are at risk of heart disease because
8:41they have large light fluffy particles they might have no small particles they
8:46might have the perfect size and shape of all their cholesterol markers and their risk is really low and i remember talking to a colleague of
8:53well more of a mentor dr peter libby who’s the chief of cardiovascular medicine at harvard has written the textbook you know on heart disease at
8:59all cardiologists study and i said you know peter i have these patients these little ladies they cholesterol is 300
9:06and they have this and that like this was like 20 years ago like would you treat these people with a statin or drugs absolutely not
9:12you know there’s no evidence that these people are at risk even though the cholesterol is so abnormal so you can’t just go by the cholesterol
9:17test that your doctor does right right so you need something called what like particle size testing um it’s
9:25telling us about those those things that are carrying around your cholesterol yeah so labcorp does nmr
9:30yep nmr quest does something called cardio iq which is similar and you can ask your
9:35doctor for these and you shouldn’t stand for any other test but these tests and then absolutely they tell you so
9:41much so tell us how do you get a profile that is with these small dense dangerous hdl and
9:49ldl well you know it’s interesting so there’s there’s a lot of lifestyle that impacts the size of your ldl particles
9:56right the size of those you know are they small and dense and dangerous or are they big and fluffy
10:01and not so dangerous i mean there’s a there’s always a genetic component right there’s a genetic component but then
10:07there’s our lifestyle and we know that that that uh metabolic syndrome
10:13where people are insulin resistant gaining weight around the belly they typically have lower hdl they
10:19typically have higher triglycerides but they also typically have more of these small
10:24dense ldls which are more concerning and so lifestyle makes a huge impact on the
10:31the size of those ldl particles and which part of your lifestyle what’s the biggest thing the diet your diet what do you what diet
10:39causes you to have the dangerous kind of that’s true sad diet the standard american diet right
10:44that’s the one that that you know that full of carbohydrates and sugar and refined and processed foods and lots of alcohol and you know
10:52it’s the sugar that drives it and what does that do to the body that causes these
10:57particles and it actually leads to the high triglycerides the low hdl the small particles right it’s that
11:04whole process of insulin resistance and it results in this really unhealthy pattern and so you know we sometimes get clues
11:12of that with a standard lipid panel right we sometimes get clues when somebody has a low hdl that’s the one the hdl is the
11:19one you want higher and for for men you want it at least over 40
11:24and for women at least over 50 and then if that triglycerides are i’m like 50
11:29and 60. i’m i’m i’m more aggressive than you yeah well that’s really true like what’s that optimal right what’s off
11:35your cholesterol’s hdl is 40 probably not optimal should be over 50. it really should it really should you’re
11:40right here um and then the triglycerides you want at least under 150 or what would
11:47you say what’s that there you go for triglycerides so if your triglyceride is over a hundred you’re you’re definitely
11:53flirting with danger and there are you know there’s some genetics involved we’ll talk about the genetics in a
11:58minute but but it is usually a sign of increased carbohydrate load like not and i don’t mean broccoli i mean
12:03like flour and sugar absolutely right so so you know you can get some sense of if somebody has is prone to
12:12metabox syndrome insulin resistance with that but then the particle size testing also gives us a lot of information
12:19um the nmr for example gives you something called your insulin resistance score yeah so you can get a sense based on the
12:26analysis of the particles of cholesterol that you have how at risk you are for insulin
12:31resistance so it’s just one more piece of the puzzle and i’ve seen people with a cholesterol i’m 150 yep
12:36who have like 2 000 particles of ldl which is should be under a thousand
12:42who have like 900 particles a small ldl which should be under 300 ideally
12:49probably less than 90 is perfect and you see that often and yet their doctor well your cholesterol is 150 it’s fine you know
12:55and and so you really can get duped by just looking at the total numbers if it’s 300 it might be fine if it’s 150 it might be
13:02highly dangerous to you right and it’s not so easy without looking at the specific test so it’s super important and so what you
13:08mentioned is that insulin resistance is the driver of this which is pre-diabetes metabolic syndrome
13:13and to some degree or another 88 of americans are metabolically unhealthy and have some degree of this 50 has pre-diabetes
13:21or type 2 diabetes like every other american has diabetes or pre-diabetes that’s crazy 75 percent overweight and
13:28every one of those people is some degree of poor metabolic health so if this is true and what else does this diet do
13:36that accelerates heart disease because we now know that it’s not just the cholesterol like i said you could have cholesterol 300 and be fine
13:44but there’s a special ingredient you need in order to cause heart disease what is that special ingredient so it’s inflammation and oxidative stress
13:50yes right so inflammation seems to cause everything these days from depression to cancer to heart disease diabetes to
13:57everything else so uh what is what is the cause of inflammation in these patients with insulin resistance
14:03so so a lot of times i mean there’s many things right but it’s our belly fat because we know that that fat around our
14:10belly when we get insulin resistant we gain more weight around our belly and we know that visceral fat or
14:15or weight around the belly the apple shape is more inflammatory it secretes all these
14:21inflammatory markers and increases inflammation in the body and so when people when they when we get them to when they
14:28help their weight around their belly goes down when we get that waist hip ratio better that inflammation goes down so basically
14:35what you’re saying is is that fat around your belly is not just holding up your pants that it’s an immunologically active
14:42organ yep it produces these molecules we call adipose cytokines you’ve heard of the
14:47cytokine storm with covid yep well it’s that same chronic cytokine
14:52storm that’s being released from these fat cells in your belly they’re not just average i
14:58mean fat your legs or your butt it’s not going to do that these fat cells in your belly are super
15:03inflammatory so then you get the inflammation which leads to oxidative stress which
15:09then causes what problem with the cholesterol right so when your ldl cholesterol gets oxidized
15:15and what is that um think of oxidative stress like excessive free radicals or rusting
15:21in the body but you know there’s we’re always making free radicals when in many different cellular processes in the body but when
15:28there’s too many of them or you don’t have enough antioxidants to squelch that oxide
15:34those those free radicals so if your diet’s not rich enough in the polyphenols or those phytonutrients or
15:39your vegetables then then what happens is you get more oxidative stress
15:44and that oxidative stress can can can shift that ldl cholesterol and it’s
15:50that oxidized ldl that’s more damaging and more likely to cause plaque build up and and um that will lead to heart disease
15:57it’s basically rancid cholesterol yep in your bloodstream that’s the problem
16:02that gets oxidized which is like you said rusting or apple turning brown or your skin
16:08wrinkling from too much sun these are all signs of oxidatives but this happens inside of you and it leads to this inflammatory
16:14process this oxidative stress and that’s what causes the heart disease and i you know some of the interesting
16:19studies i’ve seen like the jupiter study very big trial from harvard on heart disease fascinating to me that people had high
16:25ldl but no inflammation had very low risk yes people had high inflammation
16:32but kind of okay cholesterol they were at risk and those with high cholesterol and high inflammation had the most risk so i think we have to
16:38be focused on inflammation what’s causing that and it may be that you know the statin drugs turns out
16:45the the benefits may not have a lot to do with cholesterol lowering but they’re anti-inflammatory
16:50they’re very powerful anti-inflammatory drugs which is quite a side effect yeah but but it actually works now
16:55there’s a lot of better ways to get rid of inflammation besides taking statin drugs and so so
17:01when you’re talking about people’s cholesterol you know how do you decide you know what to do for each patient how do you decide
17:07from a functional medicine perspective you know how to work these patients up to decide whether that should go on a drug or whether you just do lifestyle
17:13how do you how do you figure that out i mean it’s it is a complex process right where we’re taking a really detailed history and we’re
17:19looking at more than just those numbers we’re looking at what are their markers of oxidative stress
17:25you know we can measure those we can measure oxidized ldl we can measure eight hydroxy deoxyguanosine and lipid
17:31peroxides all of these biomarkers that give us a sense of is there oxidative stress and by the way these kinds of tests are
17:36not things you’ll typically get at your regular doctor you know at the ultra wellness center here in lenox massachusetts we we do functional medicine which takes
17:44a deeper dive into the root causes into these diagnostic tests which are not available usually through your traditional doctor
17:49they may not be interested in or know what to do or how to interpret even fasting insulin which they don’t even do so we really
17:55are excited to help people figure out how to look at their risk and design a strategy that’s personalized
18:01for them using functional medicine and we see people from all over the world that the ultra wellness center doing like zoom consoles now so
18:06it’s pretty easy to get get access you know and it’s it’s fascinating because there’s so many pieces to the puzzle
18:12and so when you find somebody with high oxidative stress you ask that question why why is there high oxidative stress
18:17is it their poor diet is it is it you know inflammation is it their microbiome is it their microbiome
18:23you know is it a toxin heavy metals heavy metals like a toxin or something yes all this
18:29smoke that the wildfires in california that increases risk of cardiovascular disease absolutely
18:35absolutely so you know it’s really important to think about all the different things that can lead to
18:40oxidative stress and inflammation and then try to tease out what is it for that individual person that we need to
18:46focus on so i think that’s important for for some people and a lot of americans there’s so much that’s lifestyle related
18:53right but for some people their lifestyle is great and it’s more um it’s more toxin related that we
18:59really need to work on that or or like you mentioned the microbiome is this is a is an area that’s fascinating we’re learning so
19:06much about how it influences inflammation in the body yeah you know um microbiome in your gut as well as
19:12microbiome in your mouth right and gingivitis and how much that we know we’ve known for years that that impacts
19:17risk of heart disease because of its inflammatory properties so those are important things that we
19:23need to really investigate and look at yeah so true you know i’m just thinking about you know how how we work with these
19:29patients so we look at all these diagnostic tests that may not be looked at we look at their overall cardiovascular risk their family
19:34history we may look at diagnostic tests we may send them for a heart scan look at calcium carotid ultrasound look at particle size
19:41look at inflammation markers oxidative stress markers the microbiome heavy metals we might look at other factors like
19:47homocysteine which looks at b vitamin status we look at lipoprotein and a bunch of other factors that give
19:53us a more rounded picture of what’s going on so we’re not just focused like a laser on cholesterol
19:59and the reason it seems to me that we are so hyper focused on cholesterol is we have a good drug to treat it right
20:06so it’s it’s all pharmaceutical driven whereas whereas when you look at the data two-thirds of all people entering
20:12into an emergency room with a heart attack have either uh pre-diabetes or diabetes and most of them are undiagnosed
20:18right so when when you say two thirds of heart attacks are from sugar not cholesterol issues
20:25and we’re just focusing cholesterol it seems like we’re missing the mark here we often are and we’re saying okay this is high i mean so
20:31many people come back with you know high on their on their lab work and it doesn’t necessarily like you said
20:37i mean it’s anything to be concerned about right um and then there’s so many people who come back without that h that high level and they’re and they do
20:44need to be concerned hey everybody it’s dr hyman thanks for tuning in to the doctor’s pharmacy i hope you’re loving this podcast it’s
20:50one of my favorite things to do and introducing you all the experts that i know and i love and that i’ve learned so much from
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21:33use to enhance my health and get healthier and better and live younger longer now back to this week’s episode
21:40statins have a role but let’s talk about the statins for a minute because it’s very controversial
21:46though you know like any drug there are benefits there are risks there are side effects
21:51and there’s the right patient for the job right so how do you come to sort of decide
21:56what you should do with a patient yeah i mean you really want to get a good detailed family history you know i think that there are some
22:02people who are at very high risk of a vascular disease and and for people who
22:08have a strong family history which means that if you have a first degree relative
22:14which would be a parent or a sibling who has had an early heart attack so for a man less than 55
22:20or a woman less than 65 that means they’ve had diagnosed heart disease because of
22:25plaque at an early age you know that those people who have that type of family history
22:31need to be more careful were they smokers were they very overweight do they have diabetes like what are the
22:36other factors so i always look at that as well because you have to i remember my grandfather you know everybody in his family like i
22:41think he had nine siblings everybody had heart attacks in their 50s you know they all
22:47had bypasses heart attacks uh and they weren’t like significantly overweight but they were
22:53pretty high risk uh as a family and he was deaf so he couldn’t hear so he really he really couldn’t get a
23:00job like a white-collar job so he had a a blue-collar job which was basically loading
23:06new york times big bundles of new york times onto the trucks from the conveyor belt so he was constantly working
23:11out all day long and was very very strong and healthy and every night he would go out in queens and he would walk
23:17down the street and feed all the alley cats so he walked every night after dinner which we now know is a very good way to
23:22improve your health and he he didn’t really get heart disease until his 80s right right and they all got in
23:28their 50s so it’s and his diet wasn’t the best right but still even with simple simple
23:35lifestyle things that can make a big difference absolutely so right so you bring up a great point that genetics
23:41and family history is just one piece of the puzzle it’s not what makes all you know make us makes us make all the
23:46decisions in the world but we take that into account as well as all their other risk factors like you mentioned like type 2 diabetes
23:53and are they a smoker and you know so we really have to pay attention to all of those lifestyles high blood
23:59pressure you know a lot of high blood pressure is a big factor in heart disease but again high blood pressure is usually
24:04caused by the same thing which is insulin resistance so sleep apnea yeah it’s very very common yeah uh and
24:10and you know i just sort of recall a patient i’d love to hear any cases you’re you’re you’d like to share but i just
24:15remembered a patient i was about 50 years old and he came to see me he had a little bit of belly fat maybe 20 pounds overweight
24:21he had a heart attack had a stent and was freaked out you know at 50 years old to
24:27have his heart be at risk like that and he was on a pile of medications when
24:32i saw him he was on a statin a beta blocker blood thinner you know calcium the whole
24:38cocktail blood pressure pills you know pretty much everything um and i said well listen are you
24:44willing to sort make some changes and so he totally revamped his diet we got rid of all the junk out of his diet
24:50very very low sugar starch diet lots of good fats lots of fiber got them on some basic
24:56supplements you know b vitamins folate uh and and also
25:01fish oil um got him on exercise program and over the course of a year you know
25:07he lost i think i don’t know maybe he was more boy i think he lost almost 50 pounds he he was able to normalize all of his
25:14numbers and his blood sugar was high his insulin was high he wasn’t quote diabetic he was pre-diabetic
25:21and no one they completely missed it like they i mean it’s just staggering to me that after 30
25:27years that i’ve been doing this that the literature has been there that doctors don’t check for
25:33pre-diabetes on a regular basis which affects uh basically one out of every two americans
25:39or more and and and so you check that by measuring insulin a1c a glucose tolerance test with insulin there’s ways
25:45to look at it and then look at particle number particle size and and he lost the weight and he
25:52was able to reverse all of his numbers and he was able to get off all his medication including statins and
25:58his numbers were better off the statins than they were on it by fixing all these
26:03lifestyle factors and he’s been heart attack free for the last 20 years so i just yeah i think we we are so
26:10stuck in this paradigm of treating the symptom the cholesterol instead of the cause
26:16absolutely that’s critical that’s yeah you can store it you’ve had some patients too right so
26:22yeah so you know the first one you know i wanted to bring up the two cases i wanted to talk about today were people with this this
26:28in between cholesterol like where they were they really they really wanted to know what to do
26:34they weren’t crazy high risk but they were told they should go on medication and they came to me to say well is that the right decision or what
26:41else can i do so the first one was a 45 year old gentleman who um was told his cholesterol was too high
26:48he didn’t have a strong family history of heart disease and um but his total cholesterol was
26:54what 225 his good cholesterol’s hdl was 37 which is low
26:59too low 50 right his triglycerides was we’re 185 fasting which is high right
27:06and his ldls were 145. so you know his doctor said you know what i think you should start some medication
27:12and he said well you know what i want to see what else i can do so he came to see us which was great and
27:19because you know a lot of times with patterns like this we can make a huge change so we did that
27:25special we did an nmr lipo profile so we looked at those particle sizes and we saw that he had a lot of the
27:32small dense ldl particles his pattern they sometimes give you a pattern
27:37are you pattern a or pattern b pattern b being the more concerning you have too
27:43many small dense ldls and that’s what he had he had he looked like he had a high risk for insulin resistance which we
27:50knew even before we did the test but um because his waist dip ratio was too high his hdl was too low his
27:55triglycerides were too high so it was it was obvious but that test confirmed that right it said you have a
28:00high risk for insulin resistance based on your cholesterol panel and we also before you go there yeah i just want to
28:06point out because this is really a very easy cheap way to check to see if you have insulin resistance and it’s
28:12a far better predictor of your risk of heart attacks than your ldl which is your triglyceride
28:19to hdl ratio and this guy had a ratio about five right it’s over one not great if it’s
28:25over two you’re in trouble he was five yeah and that that pattern of high triglycerides low hdl is what
28:31you see in these patients with pre-diabetes even though they might have a normal cholesterol i mean his was 225 but i’ve
28:37seen people with you know a total of 150 triglycerides of 300 hdl of 29.
28:43i’m terrified for these patients absolutely total cholesterol is 150 and it’s absolutely right right that’s
28:48where we get really nervous because we know that’s such a pro-inflammatory process and what we know about heart attacks
28:56especially sudden heart attacks right there’s typically um it’s it’s you know i always sort of
29:02draw this picture for my patients of the inside of the artery and so often we think when somebody has a heart
29:08attack the plaque just keeps building building building building you know they’re 50 blocked and then they’re 90 blocked and
29:14then they’re 100 blocked and they have a heart attack but what we know is that that sometimes
29:19you’re only 30 blocked but if that’s inflamed if that blockage is inflamed kind of like
29:25that can rupture and then cause a a significant blockage it’s like a pimple
29:31popping that then your body protects by making a blood clot and your heart rate right and that that’s
29:36really often what we see when somebody study somebody has a sudden heart attack right that that blockage is just ruptures and so
29:43it’s often missed people aren’t necessarily coming in with years of chest pain and you know shortness of breath those
29:49things that we see as people get older they just have a sudden rupture of that of that plaque so yeah those are the
29:56situations you get really nervous and a lot of times you see a lot of inflammation so um so we also did an oxidized ldl
30:03with him which which was high and concerning bran said cholesterol yep that’s that rancid cholesterol so
30:09you know we really for him with all those signs of insulin resistance metabolic syndrome
30:15the diet for him was that really low glycemic diet we needed to work to
30:20lower those carbohydrates to lower the sugar you know we know that triglycerides really decrease when you
30:26cut out juices sugars alcohol
30:31they’re basically fats that are made in the liver when you eat sugar and starch right they’re not produced by
30:37eating fat nope nope sugar and you can really you can lower your triglycerides pretty quickly
30:43when you pull out the alcohol the juice the lots if some people doing too much fruit
30:49um flour and sugar flour and sugar absolutely sugar sugar sugar so when you cut that out you can
30:54bring your triglycerides down really pretty substantially pretty quickly so we really focused on
30:59lowering his carbohydrate load you know all the bad carbs right and um and we also focus on giving him
31:06more of the omega-3 fats because we know those omega-3 fats are really anti-inflammatory and they can
31:132-4 grams of omega-3 omega-3s a day can lower your triglycerides and
31:19raise up that hdl and this is fda approved as a drug absolutely which is fish oil which is a
31:26prescription that you can buy to lower your triglycerides and you can get it from food right like
31:31a can of sardines three ounces of sardines is about two grams has about two grams of the omega-3s in it that’s
31:37what i’m having for lunch that’s my favorite lunch sardines on a salad with some walnuts
31:42very heart healthy so we made that switch with his diet you know and and what was amazing and
31:48what i love to see is when in like three months we repeated that nmr lipo profile
31:54and he went from having the too many of the small dense ldls to having he was now considered pattern
32:01a he had more of the big fluffy ldls his hdl improved now it wasn’t yet optimal but i think it
32:07got up to like 47 in three months his triglycerides came down to 120
32:12so maybe not you know this was just three months of doing this we can see really quick changes in
32:19people’s bodies with making these changes in lifestyle which is phenomenal yeah and i think one of the other thing i want to talk about
32:25this is a great case but you know you’re able to change his diet and improve things but you know one of the things that we’re
32:30really bad at in medicine is personalizing care and there’s no place that’s more
32:36important to personalize your care than dealing with your heart attack risk and cholesterol because it’s different for different
32:41that’s very true and what i’ve seen i’m sure you’ve seen this over the years is people respond dramatically differently
32:46to the same diet so so typically we’re told by the american heart association that we
32:52should have less than five percent of our diet is saturated fat although breast milk is 25 saturated fat
32:58so maybe we should ban breast milk according to the american heart association i don’t know about that but it’s really important to get saturated fat in your
33:05diet because it’s a building block for cholesterol and which is not necessarily a bad thing i mean your cholesterol makes your hormones
33:10it makes the nerve coverings for your nerves it’s part of your brain yeah i mean it’s really important uh a
33:17lot of your hormones are made from cholesterol your sex hormones um and and what i found is you know
33:23depending on the person their responses are very different to diet yes and and i’ve talked to dr ronald prowse
33:29who’s one of the world’s experts in cholesterol in this he says yeah there’s a lot of heterogeneity uh and i’ve seen this just two cases
33:35come to mind one was of a woman who was overweight who was clearly pre-diabetic whose
33:41triglycerides were 300 which is really high it should be under 70. her hdl was like 30 which is terrible
33:49her total was you know probably you know 2 50 60 was pretty hot should a lot of
33:55small particles a lot of overall particles just syndrome yeah and she struggled with with weight
34:03loss and diet so i put her on a high saturated fat
34:08diet i put her on basically butter and coconut oil
34:13and almost a ketogenic diet and it was striking she never could lose weight she dropped 20 pounds like that
34:20her cholesterol dropped 100 points her triglycerides dropped over 200 points her hdl went up
34:2530 points and you just like you just can’t get that result with a drug no and and so i did that with her and
34:32saturated fat was the cure for her cholesterol not the cause but another guy was this super fit
34:38mid-50s biker would bike 50 miles a day i’m super healthy and his his cholesterol wasn’t great and
34:46he he had a genetic issue with his cholesterol and had this sort of more of these small particles and and
34:52and so i put him on i tried himself let’s try just do more of a ketogenic diet see what happens or more essentially
34:58his cholesterol turned it terrible yeah so we had to totally change gears and get them off saturated fat i think
35:04we’ll soon be able to do a test which is a cheek swab or a drop of blood measure genetics and
35:09figure out which one are you are you somebody who should be eating more fat and saturated fat or more
35:14carbohydrates or more of the right foods different kinds of fat we’re not quite there yet but i think
35:19in functional medicine and here at the ultra wellness center we can on an individual basis really come to
35:25learn what is the right thing for this particular person yeah i think it’s so important that’s so
35:31important because what’s what’s really key with diet is personalizing it right that’s when we get the we get the most benefit from you know
35:39our nutrition intervention and i think what you mentioned with the first woman the reason we saw such you saw such an
35:44improvement with the ketogenic diet is you lowered her insulin so much right so we know that the carbohydrates
35:50that you eat cause your insulin to spike so when your insulin is high and you can’t lose weight because you’re
35:57your insulin is high because it’s causing you to put on weight around the belly when you change to a diet that
36:03doesn’t cause your insulin to go up which is like a ketogenic diet i mean that’s the extreme
36:08right you can do some some things in between too but then that insulin doesn’t go up and that’s when we can see
36:15huge benefits for some people in that situation it’s really true i mean insulin you know for the most part and like the
36:21one guy it wasn’t because he was so fit and there’s genetic variations but for most people out there it is really the most common
36:28thing and and you know aside from getting the nmr particle test getting a measure of your
36:33fasting insulin really great if you can get an insulin test after you have a sugar load that’s even better because by the time
36:40your blood sugar goes up you’re down the road way down the road yeah it’s a late stage phenomena you even have your blood sugar going up
36:46fasting and then two hours after a sugar load it’s you know you see a little earlier but you know
36:51doing these tests for decades i just see this pattern over and over again you can have perfectly normal sugar
36:56perfectly i mean i had this one woman who was really overweight and she had a giant belly
37:01and clearly she was metabolic syndrome she had high triglycerides low hdl same pattern but when i measured her
37:09glucose tolerance test and her a1c perfectly normal like her fasting blood
37:14sugar was normal her average blood sugar was normal her one and two hour blood sugar test like normal like her fasting was in the
37:2180s after it was like 110 but i measured her insulin now normal insulin should be under five
37:27it was over 10 kind of in trouble her fasting insulin was like 30. yep and then we did a sugar load and
37:33her insulin up to 200 to 50. yep and it should be under
37:3830 after sugarload so she was like 10 times normal and it was keeping her blood sugar
37:43normal but it was driving all this weight gain and inflammation and abnormal cholesterol so you really have to
37:50dig in in a different way than your traditional doctors are digging in absolutely those people can’t they have such a hard time losing weight
37:55especially if you don’t pull the carbohydrates you lost 50 pounds like that once you pulled the carbohydrates it’s so easy
38:01i feel embarrassed about it because you know it’s like what we’re telling people to do is so simple but when you understand the
38:07biology which is what functional medicine really is about it’s understanding each of our unique biology looking at
38:15things that traditional doctors don’t look at at function at differences in
38:20the responses to different insults like diet and toxins and various things so we have a really different scope and you
38:26know at a cleveland clinic where i also work one of the leading doctors there cardiologist stan hazen has done
38:32incredible work look at the microbiome and how the environment and the gut can increase your risk of heart disease
38:39and how certain foods increase certain problems i and it’s just fascinating to think you know here at the number one heart
38:44hospital in the world they’re going wait a minute maybe we should be looking at poop right right and so the paradigm is
38:51breaking down right the the hyper laser focus on cholesterol which we’re talking about today
38:56is is only one small part of the story and and and getting into the nuances is
39:02really important in order to really look at your risk and design the right program for you and that’s what you do here at the ultra wellness
39:07center it’s what we do we’ve been doing for decades and i think it gives people a chance if they’re concerned about their heart disease risk
39:13to come up with a personalized plan that can help determine their their best
39:18outcomes and reduce all these factors yeah so you know the second case i had she did not she was not at risk for
39:25insulin resistance significantly you know her insulin i don’t really remember what it was but it
39:31wasn’t that concerning to me um but she uh was also concerned about
39:36her cholesterol you know she was 55 her doctor had just checked her cholesterol her ldl
39:42cholesterol was 160 um and so he was recommending some medication she didn’t have a strong
39:47family history but when we looked deeper or when we you know her cholesterol also showed her triglycerides were okay
39:53at 90 her hdl was 55 again maybe not perfect but you know it was really that ldl
39:59cholesterol i was a little more concerned about we did we did particle size testing on her and she didn’t have too many of
40:06those small dense ldls she was more pattern a more of the big fluffy ldls which made me
40:12happy to see and um but she’s like you know what let’s bring i want to bring down this
40:17ldl cholesterol and um so with her the focus in the diet
40:23was a little bit different you know she did she was about 10 pounds overweight so she wanted to lose some weight
40:28so we focused on that and then we also really focused on her protein
40:34because um because protein’s really important as well when we’re talking about cholesterol
40:39because there’s some vegetable proteins that can help with lowering they can help with lowering
40:44that ldl cholesterol so beans and legumes nuts and seeds these are vegetable sources of protein
40:50that have plant sterols in them and they can help bind to the cholesterol in the gut and lower your ldl cholesterol and you know
40:58so when when i have a situation like this you know i really talk to them about balancing where they’re getting their
41:04protein from more of that pegan diet right where they’re getting some of their protein from a vegetable
41:09source like beans and legumes healthy forms of soy nuts and seeds and some other protein
41:14from an animal source but maybe not you know more of as that condiment as you speak about so i think that’s a really important
41:21area to focus on so she with you know you know three months or so the weight came down and when we
41:27rechecked her we saw that ldl cholesterol come down to like 130 and so and her hdl even went up
41:33higher which was great to see so you know she had a nice improvement with shifting her diet but we just
41:39focused a little bit differently than we did with the first generation you know you’re right i think you bring up a lot of very important points it’s
41:44not just what you take out of your diet like sugar and is what you put in your diet yes and and using compounds that are naturally found
41:52in plants like plant cereals that come in beans and nuts and seeds and high fiber you can really have a big
41:58impact uh and and i think you know one of the things i like to use is is extra fiber as
42:03something called pgx which is basically from a root of a japanese vegetable called cognac
42:09it’s not like the alcohol it’s ko and jac and it’s a fibrous root you can actually
42:15make a noodles out of it there’s these shirataki noodles so you can have pasta in a sense but it actually is
42:22zero calories it’s all fiber and it blocks the absorption of cholesterol from your gut so adding
42:27more fiber plays a huge role changing the quality of your diet increasing the good fats like
42:33olive oil or the the avocado oil and also improving the the overall
42:40content of phytochemicals in your diet all helps to reduce your risk dramatically and i think
42:45we’re we’re really not uh focused on that in medicine we’re just like here take this drug we’ll see you later and then people often get a false sense
42:52of security so i’m taking my stat and i can have the fried food or i can go to mcdonald’s or i mean they were they were talking about
42:58it selling lipitor at mcdonald’s which i thought was insane but i think i think we really have to
43:04understand that heart disease is a complex disorder it’s not just about cholesterol that from a functional medicine perspective
43:10we do much more detailed workups looking at inflammation oxidative stress looking at the particle size of number looking at
43:16even your gut heavy metal toxins other factors that relate to nutrition like
43:21homocysteine and and we get a really good sense of what’s going on and and we then personalize the
43:26treatment and it’s very very different approach to reducing your risk and i it’s been so satisfying for me and i’ve
43:32had patients who’ve had heart attacks and then we follow them for 20 years and they’re just great
43:37and they’re healthy and they have no risk because they they really have changed the cause
43:42of their heart attack so taking a statin doesn’t change the cause of why your cholesterol is messed up that’s very true and i think it’s you know i want to
43:48say heart disease is not a statin deficiency right right so uh thank you so much dr
43:54bohamlis for being on the dr pharmacy podcast if you’ve suffered from heart disease if you are having issues with
44:00cholesterol if you’re concerned about it someone in your family’s struggling with these issues i really encourage you to
44:05dig deeper don’t just accept at face value that you should take a stat and cholesterol is the problem
44:10it’s more often more complex and find a doctor or practitioner who can help you we’re at the ultra wellness center here in
44:16linux massachusetts happy to help anybody we’re doing mostly zoom and virtual consults now so we can take care of
44:22anybody from anywhere and it’s just really satisfying to see how quickly people respond and fix these things and get off the
44:27medications and fix their numbers and more importantly they get better they feel better because i don’t really
44:32care about the numbers as much as how do you feel what’s your vitality energy and i think you know the side effects of these
44:38medications are not benign uh and so i’m just so excited we got a chance to talk about this on the
44:43doctor’s pharmacy uh you’re just a wealth of information knowledge and i’m so excited that we get
44:48to do these house call podcasts and get people information about things that often they’re struggling with and have
44:54questions about that are kind of obtuse but that in functional medicine we really do a powerful job in in fixing thank you mark so if you’ve
45:01been listening this podcast and you loved it please share with your friends and family on social media leave a comment we’d love to hear from you how
45:06you fix your cholesterol and subscribe wherever you get your podcast and we’ll see you next time on the doctor’s pharmacy
45:19[Music] you
