Is LDS Cholesterol Bad? What are the Risks of Statins?
Feb 10, 2021 Dr. Nadir Ali, an interventional cardiologist clears up confusion about LDL and answers questions like is LDL cholesterol really bad for us? Why does LDL cholesterol go up on a low carb diet? Are statins bad for you? Do statins prevent or cause heart disease? As a leading cardiologist in the high fat, low carb space, Dr. Nadir Ali has been paving the way in advocating that we should not fear high LDL cholesterol when other numbers are in line such as low triglycerides, low insulin and glucose, low inflammation, and high HDL cholesterol. Statins are commonly prescribed for elevated LDL cholesterol but as Dr. Ali discusses in this video, we may be treating high LDL all wrong. Statins have been shown to have significant side effects like cognitive and memory problems, fatigue, and muscle pain for many patients. Elevated LDL has been shown to be important for sex hormones, muscle function, cognition, and inflammation.
Dr. Morgan Nolte is a doctor of physical therapy and a board-certified clinical specialist in geriatric physical therapy. This video is for general informational purposes only. It should not be used to self-diagnose and it is not a substitute for a medical exam, cure, treatment, diagnosis, and prescription or recommendation. It does not create a doctor-patient relationship between Dr. Nolte and you. You should not make any change in your health regimen or diet before first consulting a physician and obtaining a medical exam, diagnosis, and recommendation. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. Zivli, LLC and Morgan Nolte, PT, DPT are not liable or responsible for any advice, course of treatment, diagnosis or any conclusions drawn, services or product you obtain through this video or site.
Transcript
0:00When I started putting patients on a low carb lifestyle, I noticed that their insulin levels
0:06went down, the blood sugar levels went down, their inflammation went down, their triglycerides,
0:13which is fat in the bloodstream went down. Their good cholesterol went up, but the LDL came up.
0:23So I needed to explain to myself many different aspects. Number one is that, is higher LDL bad.
0:32Number two, is that, why does the LDL actually go up?
0:38So every medical professional will agree that all the factors that I talked about is good
0:46for us. Weight loss is good for us, lower insulin and lower sugar levels are good for us.
0:54Triglycerides is good for us. High HDL is good for us. So when you are having so many beneficial effects, and yet the LDL is going up, should
1:06you focus on these? Or should you blame the LDL?
1:12There’s this huge cognitive dissonance that’s going on in people, because they think that they’re trying to live this healthy lifestyle and they see those other numbers improving.
1:21And they’re like, what’s wrong with my LDL? And their doctor says, you need to go on a statin.
1:26And they’re thinking I did this so I didn’t have to go on a medication.
1:32Can you help relieve some of this cognitive dissonance that we have around a fear of high LDL cholesterol?
1:38It’s very intuitive to implicate cholesterol in heart disease because when you look at
1:46a plaque, in other words, a blood vessel that has a buildup of, by the way, I refuse to
1:54try to call it as a fatty plaque because it tries to incriminate fat and cholesterol in
2:01the process. So I just want to honor it as a plaque. Okay. And what needs to ask a question is cholesterol in that process because it went in there to
2:14heal an injury. In other words, is it a fireman or did it go in there to create the fire?
2:23Is it an arsonist? Because I tend to believe that the the LDL cholesterol is a firefighter it’s gone there
2:31to help heal the blood vessel that is damaged from inflammation, from high blood pressure,
2:40from insulin resistance, from metabolic dysfunction.
2:45And that it’s really not the culprit that caused the plaque build up.
2:52All right, everybody, we have a really special guest today.
2:57Dr. Nadir Ali has agreed to share his time and his expertise.
3:03And I know that you’re going to get a ton of value from today’s episode. So Dr. Nadir Ali is a practicing interventional cardiologist in the Clear Lake and Houston
3:14community area for over 30 years. He has several years of experience in the low carbohydrate, high fat diet and the treatment
3:23of metabolic disease, diabetes, and heart disease, and also to improve the quality of
3:30cholesterol. Dr. Ali, thank you so much for being here with us today. Um, we did a little bit of offline chat so we could get this structured and organized
3:39and we wanted to start just with an introduction of who you are and why you went into cardiology.
3:46Well, it’s an honor for me to be here with you, Morgan.
3:52Uh, I perhaps become a cardiologist because my mother is a physician and every little
3:59kid growing up in India thinks that having a stethoscope means that you are a cardiologist.
4:07Um, and, uh, yeah, I think it has been a great, uh, profession for me.
4:17It’s been very fulfilling and I started out my cardiology career as a plumber.
4:23Um, by that, I mean that I trained as an interventional cardiologist and interventional cardiologist
4:32is someone who opens up blocked blood vessels of somebody’s heart.
4:38Like if somebody is coming in with a heat attach, or they have a severe blockage, you
4:43go from the blood vessel in the leg and you open it up with catheters under x-ray guidance.
4:51You put in balloons and open up the blockages, you put in stents.
4:56And I found myself, uh, being extremely good at doing that. So I guess it requires a kind of dexterity in your fingers, some judgment in how to open
5:09up these blood vessels, uh, and, uh, idea of how an anatomy of the heart is and imagination
5:18of how the heart is structured, because the x-ray picture is a two dimensional picture.
5:25So I find myself being extremely good at opening blood vessels of the heart.
5:32And I found myself being very disappointed in working in the office, seeing patients,
5:39because I found that working in the office, I am not able to help improve their lives.
5:46Their blood pressure got worse. Despite many blood pressure medicines, their diabetes got worse, they became more obese.
5:56I could reduce the cholesterol with medicines, but I was always a cholesterol skeptic.
6:02I didn’t think that cholesterol was really the culprit in heart disease.
6:07And I found that I would give patients cholesterol medicines and drop their cholesterol.
6:12And yet the heart disease would progress quite dramatically.
6:18And so I said, what am I doing for these people? I would rather let my colleagues take care of patients in the office and I wanted to
6:29spend more and more time in the cath lab. I was very good at doing that until I had a little transformation, but I don’t want
6:38to be talking. I want you to participate and structure the interview to your audience.
6:44Well, uh, I think that what you just said was a really important point.
6:49And I want people to hear that again. And you said that you prescribed statins for heart disease and their cholesterol came down,
6:58but their heart disease became worse. So we’re going to segue into the next thing here, but I wanted people to keep that top
7:06of mind as we move through this interview and I want you to kind of talk about your
7:12evolution as a cardiologist. Did you always, right now you run a website called eat mostly fats.
7:19Clearly you’re an advocate of a high-fat diet. And I want you to describe your evolution to the place where you are today with your
7:28nutritional recommendations, for people to prevent heart disease or to treat heart disease.
7:34Yes, so for the first 20 odd years of practicing as a cardiologist, I really had no personal
7:45issues with maintaining my weight. I was always very thin. I ride bikes a lot, almost like five to seven times a week, but right around the 2011-12
8:01timeframe, I noticed that I was gaining weight and I couldn’t understand why I had gone up
8:07to about 180 pounds. And my weight usually used to be around 150, sometimes to, 160s.
8:19And no matter what I tried, I could not lose weight. And I’m a pretty determined person.
8:25And I didn’t know why that was happening. So in that timeframe in 2012, there was a tour de France athlete by the name of Chris
8:35Froome. And Chris Froome has won the tour de France several times. And he, there was a, uh, magazine article that he was a low-carb athlete.
8:49So I started looking into low-carb lifestyle and low-carb medicine, and I found very little
8:57information and people that were gravitating towards that.
9:03There were some books by Gary Taubes. There was book by Robert Atkins, but there was not much else.
9:11And when I started working through the biochemistry of what happens to us, when you are on a low
9:19carb lifestyle, it started to dawn on me saying, Hey, why don’t I try that?
9:26And when I tried that, I found that within about a couple of months, I was down from
9:31180 to 160 pounds without really having to try. I felt satiated. I didn’t feel like I was going hungry.
9:40And then something clicked in my brain. I said, if it’s so easy for me to do and do something like this, why should I not try
9:51this in my patients? And then when I started trying that in people who are 70, 80, even 90 year old, I saw that
10:03they lost about 30 to 50 pounds over a six month period. I saw that they reduced their diabetic medications or got off of them.
10:12I saw several of them get off their wheelchair, drop their walkers.
10:17They had a reduction in their blood pressure medicines. So that was like a moment in which it was like a no look back moment.
10:28I said, I’ve done something wrong for the last 20 odd years.
10:34And now I should move forward by spending more time in the office and counseling patients
10:42and learning more and more about the low-carb lifestyle. And then it has evolved in the last seven to eight years.
10:51And there are many more facets that I have learned. And then, so that is, that is really my story.
10:58I think that that’s very relatable. My story is a little bit similar. I have two children and my oldest son is two and a half and my daughter is eight months.
11:07And I never had to work at losing weight until after I had my son. And then I did.
11:13Right? I wanted the baby weight off. And so then I really started looking into the science of weight loss and I figured it
11:19out for myself. And then I thought, Oh my gosh, this is so different. Same thing, low carb lifestyle, several different factors.
11:25Um, but I thought who’s teaching people this, you know, and so that’s really, that was the
11:30impetus for me for starting my business because I knew if I could help other people do this,
11:36I could help them prevent the need for a geriatric physical therapist. You know what I’m saying? They got rid of their wheelchairs and their walkers, and it’s just really beautiful to
11:44see that power of nutrition and lifestyle and preventative medicine. So that was a really cool story.
11:50Thank you for sharing. Um, kind moving on through the interview. I want to know some of, I want to dig into LDL cholesterol specifically.
12:00You have some really great YouTube videos out there on LDL. And I want to know why on a lower carb lifestyle diet, why does LDL sometimes increase?
12:13Because that’s a concern for some of my members. Yes. And, uh, that was quite challenging for me in the beginning because when I started putting
12:25patients on a low carb lifestyle, I noticed that their insulin levels went down, the blood
12:32sugar levels went down. Their inflammation went down, their triglycerides, which is fat in the bloodstream went down.
12:40Their good cholesterol went up, but the LDL came up.
12:47So I needed to explain to myself many different aspects. Number one is that, is high LDL bad.
12:56Number two, is that, why does the LDL actually go up?
13:01So every medical professional will agree that all the factors that I talked about is good
13:10for us. Weight loss is good for us, lower insulin and lower sugar levels are good for us.
13:18Triglycerides is good for us. High HDL is good for us. So when you are having so many beneficial effects and yet the LDL is going up, sure.
13:30Do you focus on these? Or should you blame the LDL?
13:37So I started investigating both the aspects. So let’s take the first one.
13:44Is LDL necessarily a bad molecule. So I would like to submit that LDL is actually a good molecule because these are the functions
13:55that the LDL does. That’s number one, it is a host defense mechanism.
14:02At this time, we have a Pandemic. To neutralize bacteria and viruses you need the LDL So it’s something that is fighting
14:10infections. Number two, it dampens inflammation. When the body’s inflamed, the earlier has several antioxidants through which it can
14:22dampen inflammation. Number three, it supplies the cholesterol to our ovaries and our testers to make estrogens
14:34and testosterone. It’s an extremely important hormone for us to have to maintain our strength, our muscle
14:45strength, it also supplies CoQ10 to our muscles.
14:52So many people don’t realize that coQ10 carried in the LDL.
14:58Many people also don’t realize that Coq10 comes from cholesterol.
15:03So the same pathway that’s making cholesterol also makes Coq10.
15:09And Coq10 is needed by our muscles for them to function well. So like for example, I always give the metaphor.
15:18If an engine does not have a spark plug, it cannot burn fuel.
15:24Similarly, if muscles don’t have Coq10, they cannot burn fuel.
15:32So by reducing LDL, you taking away so many of the beneficial effects for which the LDL
15:40molecule is designed. The next question you should ask yourself is that Why does the LDL go up?
15:52And the reason the LDL goes up is that a low-carb lifestyle is generally a little higher in
16:00animal protein and animal food. So I give the example of a vegan.
16:06You take a vegan, a vegan is not eating any cholesterol whatsoever because there is no
16:12cholesterol in plant food. And when the vegan doesn’t eat cholesterol, the body, the liver is forced to make cholesterol.
16:23So the liver makes about 300, sorry, 3000 milligrams of cholesterol every day in a vegan,
16:31it’s a very energy expensive task for the liver. The liver does not want to do that work.
16:39On the other hand, a person eating animal food is eating cholesterol.
16:44The cholesterol gets absorbed and the liver says, Hey, I’m happy. I can go on a vacation.
16:52So as you increase the intake of cholesterol, like let’s say you take a carnivore, somebody
17:01who is eating no vegetable food. And that carnivore is focusing on eating red meat on eating eggs with egg yolk.
17:11He’s eating a lot of cholesterol. So the liver stops making cholesterol.
17:18Since the liver stops making cholesterol, it doesn’t need to pick up the cholesterol from the bloodstream.
17:24And since it’s not picking up the cholesterol from the bloodstream, the LDL levels are going to go up.
17:34It’s a very simple experiment that was done by researchers. They took liver cells and they put them in nutrients media, media in which they were
17:46tried. And if you looked at nutrient media that did not have any cholesterol in it, the liver
17:58cells started making cholesterol. If on the other hand, you had the same liver cells in a nutrient media that had high cholesterol,
18:08the liver cells stopped making cholesterol.
18:14So the reason your LDL is going to go up is not because you’re making more cholesterol.
18:20You are eating more cholesterol. The liver stops making cholesterol. It doesn’t need cholesterol from the bloodstream.
18:27So it doesn’t pick it up from the bloodstream. And hence the LDL goes up.
18:34And I think that is perhaps the best way to explain that.
18:40The next level of question that we need to ask is that, is that high LDL bad?
18:45Yes. We will. We will get into that. If that’s where you want to go.
18:51I do want to go that way. I want to, I want your perspective on, you know, is the elevated LDL as it goes up, is
18:59it bad? Is there a cutoff or is it more a holistic picture of what is LDL doing in relationship
19:05to the HDL, the glucose, the insulin, the triglycerides, and all the other things.
19:11So will you kind of elaborate a little bit more and by the way, I love how in depth you’re going from a physiology standpoint.
19:17Cause I’m the kind of person that I hear something. And I say, well, why is that? Well, why is that?
19:23Well, why is that? So I really appreciate that you’re giving all of these little tidbits about why this
19:28happens, because that really, um, satisfies my intellectual nature.
19:33Well, I’m glad that you were saying that because many people accuse me of being so nerdy.
19:38No, I’m a nerd too. So we’ll see what the listeners think.
19:43So thank you for that nice comment. So you hit upon a really important aspect.
19:52And that is, that is the person who has low insulin, low triglycerides, high HDL, low
20:00inflammation markers yet having a higher LDL level is the same as a person who has a higher
20:08LDL level and has high sugars, insulin resistance, high triglycerides, low HDL.
20:16And I’d like to submit that they are two completely opposite people.
20:23A physician would agree that an uncontrolled type one diabetic is somebody who is at very
20:31high risk of heart disease. In fact, that’s one of the highest risk. So our type one diabetic is somebody who’s not making any insulin.
20:40And if they’re not given exogenous insulin, their sugar levels go up, their triglyceride
20:48levels go up, their HDL levels go down.
20:53And just because I want it to be interactive, I want to ask the audience to guess what happens to the LDL levels?
21:01Would it surprise them that LDL levels are actually on the low side?
21:06And I can tell another easy example that people can relate to. If you take a hundred diabetics age, 50 years of age and you weight match them with another
21:1750 people who are not diabetic, who will have a higher earlier.
21:25So would it surprise you that the diabetic people will have a lower LDL and the non-diabetic
21:31people will have a higher LDL? Yes. That, that surprises me.
21:36Yeah. And yet these diabetic people are at greater risk of getting heart disease. Okay.
21:42So we started off with a type one diabetic who is uncontrolled. And I have several patients in my practice who came and said, I don’t want to have an
21:53abnormal blood sugar. I’m going to go on a low-carb lifestyle. I’m going to do intermittent fasting.
21:59And I’m going to have the same blood sugar that a normal person has.
22:06And believe it or not even type one, diabetics can achieve that goal.
22:12So when they achieve that goal, let’s see what happens to them. Their sugars come down, their triglycerides come down, their HDL goes up and their LDL
22:27rises dramatically. Right? So then you have to ask yourself, Hey, this person is maintaining normal sugars.
22:38They have excellent blood markers. Why are we blaming the LDL?
22:44Why would the body be so stupid and get everything normal?
22:49And yet the LDL go up, Right? The body is not stupid. I love that.
22:55You said that, but we assume that something’s wrong. So help us. There’s this huge cognitive dissonance that’s going on in people, because they think that
23:04they’re trying to live this healthy lifestyle and they see those other numbers improving. And they’re like, what’s wrong with my LDL?
23:10And their doctor says, you need to go on a statin. And they’re thinking I did this so I didn’t have to go on a medication.
23:18Can you help relieve some of this cognitive dissonance that we have around a fear of high LDL cholesterol?
23:24And I’m going to try my best. And I just want to make sure that when I talk about this, that people understand that there
23:34are a few unknowns that I don’t pretend to know everything.
23:39And I don’t want people to think that I have all the answers, but I will try to provide
23:46much clarity as Possible. So the first question that we know are grappling with after we have settled, some issues is
23:53that is the higher LDL bad. So we go to demographic data first.
23:59We are not going to go into clinical trials that have used statins yet. We are first going to go into the demographic data.
24:06So when you go into the demographic data, and you take 50,000 patients in Europe, followed
24:12in the Hunt Trial for 10 years. We took 50,000 patients followed for 10 years.
24:19And when you look at now, these people are not fasting. These people are not on a low carb diet.
24:26And when you look at cholesterol levels in men and you put them into high, low, and medium, I mean, high, medium, and low, there is actually a
24:38trend towards lower mortality, higher the cholesterol, which makes no sense.
24:47These people have high cholesterol and yet they are dying at a lower rate.
24:53And are we talking specifically LDL cholesterol here or total cholesterol?
24:58I’m glad you asked that question because what many people don’t realize is that as the cholesterol
25:06goes up, so does the LDL cholesterol, they have to follow one another.
25:13So roughly three fourths, two thirds to three fourths of your cholesterol is going to be
25:18LDL cholesterol, regardless, unless you are a very uncontrolled type one diabetic, then
25:26you’re not talking about this. But what I was also wanted to point out is that when you looked at the women in the Hunt
25:35Trial in women, it was extremely clear, higher, the LDL or higher the cholesterol, lower the
25:46mortality. Lower the cardiovascular mortality. I also need to plug in a couple of my heroes.
25:52One of them is [inaudible]. I mean, not say his name right, he’s a European, but great man.
26:00So he’s written a couple of cholesterol books and other one is Malcolm Kendrick from Scotland,
26:06an amazing man. Both of these people looked at about 16,000 patients.
26:14I may have the thousand patients a little wrong, a few thousand here or there.
26:1960,000 is a big number. They took 60,000 patients and they divided them into third tiles of cholesterol, you
26:28know, like top 20, second 20, the middle of 20, the lower 20.
26:35And they look at total mortality. And again, there is a surprise higher.
26:43The cholesterol lower the mortality higher, the LDL cholesterol, lower the mortality.
26:52How does that happen? This is a town of Leiden in Netherlands in that town they took people between 85 and
27:0295 years of age. And they followed them for 10 years and they divided them into high cholesterol over 250
27:11middle cholesterol, around 200 and a low cholesterol below 200.
27:18The people with the highest cholesterol had the lowest mortality and the lowest cancer
27:24risk and the lowest infection risk. Older people die of infections?
27:30Higher cholesterol was associated with lower pneumonias. The people with the lowest cholesterol had higher mortality, higher cancer risks, higher
27:42infections. And this study was followed for 10 years. Now I can give you several such examples.
27:49I bet. I want to give one more.
27:55Take world war II, Japan and take world war II. United States.
28:00The incidents of strokes in Japan was much higher compared to the United States.
28:06The cholesterol levels in Japan were two thirds of the United States. So they have lower United States was higher.
28:16As Japan became affluent, they started eating Kobi beef, Shashimi a lot of animal food.
28:26Their cholesterol levels started rising.
28:31What happened to the stroke rate? The stroke rates started falling off a cliff so that having a higher cholesterol, your,
28:43the stroke rate is coming down. Did we pause to think about it?
28:51So all these things are discrepant. Now it’s very intuitive to implicate cholesterol and heart disease because when you look at
29:04a plaque, in other words, the blood vessel that has a buildup of, by the way, I, I refuse
29:12to try to call it as a fatty plaque because it tries to incriminate fat and cholesterol
29:19and the process. So I just want to call it as a plaque. Okay. And one needs to ask a question is cholesterol in that process because it went in there to
29:33heal an injury. In other words, is it a fireman or did it go in there to create the fire?
29:42Is it an arsonist? And to me, that question is not settled.
29:49I think that I have a YouTube video that talks about LDL cholesterol. Is is a fireman?
29:56Is it a firefighter or an arsonist? Because I tend to believe that the LDL cholesterol is a firefighter it’s gone there to help heal
30:07the blood vessel that is damaged from inflammation, from high blood pressure, from insulin resistance,
30:16from metabolic dysfunction. And that it’s really not the culprit that caused the plaque buildup.
30:25And right now biochemical and scientific data is not conclusive, in proving cholesterol
30:33as a culprit, at least to my reading, at least to the reading of Dr. Malcolm Kendrick, at
30:40least to the reading of [inaudible].
30:45So in some ways I’m trying to build a narrative that talks about how paradoxical it is that
30:58as you become more insulin sensitive, that means you are getting healthier, how the LDL
31:05cholesterol goes up. More insulin sensitive, higher cholesterol mode, insulin resistant, lower LDL cholesterol.
31:16So one has a cognitive dysfunction, as we are talking about in trying to view the molecule
31:23as a villain and try to annihilate it.
31:29So the next step would be to move on and try to look at clinical studies that attempted
31:36to lower cholesterol and see how much benefit there was in lowering cholesterol in terms
31:43of protecting people from heart disease and strokes. So I want to pause here, give myself a chance to catch a breath, see what comments you have.
31:55Well, I thought that that whole is LDL the fireman or the arsonist was brilliant.
32:03And I think that, um, you know, it’s almost like wrong place, wrong time, you know, they’re,
32:11they’re looking into the plaque and they see the LDL and they, you know, assume that maybe
32:18that caused the plaque. And I know that you’re saying more evidence, more research needs to come of this, but from
32:24what you’ve read, you’re more in line with LDL was the firefighter trying to reduce the
32:32inflammation. So is that kind of where, by the way, I don’t want to get too off track because I do want
32:40you to go into the next realm of studies where you were talking about, we did lower LDL,
32:45here’s what happened with cardiovascular risks. So I want to come back to that, but is this really where the whole fear of LDL stems from?
32:54Or where does this stem from in the medical community? Why are so many physicians prescribing statins to lower LDL?
33:02When there is a significant body of research that says we don’t need to be fearful of LDL and it’s actually protective when other numbers are in line as well.
33:12Um, most physicians are ingrained. You know, there is group think group think makes your, uh, particular, uh, idea is already
33:25set in stone and proven, and you don’t need to prove it beyond any reasonable doubt.
33:31And if your foundation is weak and you start building more and more evidence on top of that, you’re going to go to the wrong ladder.
33:40Like Stephen Covey says, if your ladder is in the wrong place, climbing faster on that
33:46ladder is going to just get you to the wrong place faster. You need to make sure that your foundation is right, that you’re climbing the right ladder.
33:55So there is a lot of research that talks about how LDL is bad and how people have built one
34:05layer after another. And there are very few studies that are questioning the dogma that LDL may not be bad.
34:15So I don’t want the audience to get the impression that, Hey, we know for sure that LDL is not
34:22bad. We can prove it beyond a shadow of doubt, because that has not been looked into as carefully,
34:29because that question in many people’s mind is already decided and moot.
34:35And you should not even look into that. It’s only the advent of a low carb diet.
34:44It’s only the advent of, uh, grounds up improvement in people’s health.
34:50In other words, people are improving their health, not because the heart associations and the college of cardiology are improving their health it’s that people are taking critical
35:01thinking into their own hands and changing their lifestyle. And in the process of changing the lifestyle for the first time are educating physicians
35:13that, Hey, all these good things are happening to me.
35:19My LDL is going up. Can you please look into that? Can you please see if that is bad?
35:24Okay. So those are kind of the things like, for example, I have many patients, their LDL went
35:32up to 400, sometimes 600, sometimes 800, right?
35:40And you would say, man, these people have a genetic tendency to have high cholesterol.
35:48So we took a few of those. And we said for three weeks, you go on a completely vegan diet.
35:57Let’s see what happens to your LDL. Would it surprise you that in these people, the LDL cholesterol went down from the three,
36:06four hundreds down into the 100 range. And you said three weeks? In three weeks of a vegan diet.
36:13Okay. So the low cholesterol diet, the serum cholesterol and the blood, the LDL LDL, right.
36:21Went from 200 to 300 to 100 in three weeks of a vegan diet.
36:26Okay. Continue. I just had to get that math straight, But also they gained about
36:34Four to 10 pounds of weight, the triglycerides, which is the blood sugars went up a little
36:43bit. So, you know, bad things are happening to them yet, their LDL is going down.
36:50And all we are focusing on is that, Hey, you’re doing really good, but all of the statutory
36:56that’s happening is being missed. It’s a good point, perhaps, to not talk about the cholesterol reducing trials,
37:06I would like to do that. And then can we circle back around to saturated fat, fear of saturated fat for a fear of raising
37:15LDL and how maybe we’ve been a little bit misled in that arena after we talk about these
37:23studies. Sure. Okay. So go ahead and talk about the studies first. I think that’d be interesting to hear.
37:30Okay. So one has to realize before we talk about the studies that the studies are predominantly
37:37done, 95 plus percent, almost 99% of the studies are done by a pharmaceutical industry.
37:44The pharmaceutical industry gathers all the data. They hire physicians like me, they hire universities, they hire, uh, case managers who are collecting
37:56the data, the hire bio-statisticians, they hire ghostwriters to write the entire manuscript
38:02that is published. So if I were investing in a product, I want to portray it in the best light.
38:11And if I’m the only one who is privy to the data, then perhaps I may subconsciously think
38:22that, Hey, Mr X, who was on my drug had a bad event, but there is a reason to exclude
38:31him. There were few things that happened that were a little not right.
38:37And so that person should be excluded.
38:43There may also be some incentive to lie and pharmaceutical industries have lied in the past.
38:49Uh, that is the Vioxx scandal. Um, there are many other scandals with pharmaceutical industry that we can look at.
39:01So one has to give the fact that there is conflict of interest.
39:07So conflict of interest would be a broad that would encompass all these deficiencies in
39:14clinical trials. Another thing that we need to point out is that up until 2006, a company could do about
39:2310 different trials with a drug and publish the one that showed their drug in the best
39:30light and ignore the other nine. It’s only in 2006, that the US Congress came up with a requirement that if a company starts
39:40a clinical trial, that they have to register it and at least publish it online.
39:46Okay. So we have kind of established a conflict of interest here, but now we’re going to move
39:54on and say that the companies are honest. They are ethical, that they don’t fudge any data.
40:03That conflict of interest did not play any part in the results that were put out in the
40:09papers. So we are giving them the benefit of doubt, and we go to the best clinical trial that
40:17shows that statins help reduce heart related deaths.
40:24So I want to kind of pause here and talk about mortality. Mortality is a very robust endpoint.
40:29You, you are either dead or you’re not dead. How did that Sorry, that’s funny.
40:37I wrote best end point. You’re either dead or you’re not dead. It’s pretty black and white.
40:43And you know, you can fudge the harder docs a little bit, because hundred back means that there is a little elevation in your heart enzymes.
40:50You may not have EKG changes. One physician may say you’ve had a heart attack. The other physician may say, so in terms of robustness, the heart attack is not that good.
41:03And endpoint. Mortality is very good.
41:08So you take the best clinical trial. It was done in 1994. Uh, a company was collecting all the data.
41:14There was not as much oversight and it’s called the Forest Trial. The Scandinavian Simvastatin trial 4,000 odd patients were selected.
41:27Half of them were given a statin. Half of them were not given the statin and they were followed for five years.
41:36So if you were to figure out, and by the way, this is the best clinical trial that is, there
41:42has not been another trial that has shown a greater degree of benefit.
41:48That has not been another trial that has shown a greater degree of benefit.
41:54These people who are high risk people, these people had established heart disease. They either had bypass surgery, stents, or some other evidence of established heart disease.
42:04So they were at higher risk of events. And when you distill that information down, what it shows is that if you treated a hundred
42:13patients with the drug and also another similar a hundred patients without the drug that reduction
42:20in mortality at one year would be a little over half a percent, 0.6%.
42:32So if you told a patient that say, Hey, I’m going to put you on a drug. And by the way, it has about a 0.6% chance of reducing your cardiovascular mortality.
42:43Would that be an honest way of describing to them that the absolute risk reduction,
42:49the degree of benefit is small and would it surprise you that most physicians don’t understand
42:58that? And I think they look at that, but I feel like they neglect the other side of statins,
43:07right? So maybe there is a tiny, tiny, tiny, you know, reduction in mortality.
43:13But can you tell us about the other side of statins when, when physicians with good intentions,
43:19put a patient on a statin to reduce LDL, because they think that that’s important to do for
43:24this person’s health. What are some of the common side effects that you’ve seen in your practice with statins.
43:30So, yes, I’ve worked. 50% of my patients have some type of myopathy.
43:36They feel fatigued. They feel weak. They feel tired. The physicians who were statin proponents used to say that this is very small.
43:50The same physicians who said that this myopathy was very small, when a statin competitor came
43:56onto the market called PCSK9 inhibitor. Suddenly these physicians now have changed their tune.
44:02They say that the incidence of myopathy is somewhere in the range of 20, maybe even 30%,
44:11because now this new drug that is reducing LDL even more dramatically should be utilized.
44:17There is also memory and cognitive side effects. There are side effects in terms of erectile dysfunction because it reduces testosterone
44:28levels. The person comes and tells me, I feel fatigued.
44:33I feel tired. I feel mentally run down and most physicians are dismissive of that.
44:41They say you are getting older. The medicine has nothing to do with it.
44:47And it’s only when you bothered to listen to people that you will get this information.
44:54So I want to kind of progress a little further here and say that from 1994 to 2017, many
45:04more clinical trials have been done with the clinical trials that have shown a greater
45:12reduction in cholesterol. So we can take a trial that was done.
45:18I think in 2008, it’s called the Jupiter trial. It reduced the LDL cholesterol by almost over 50%, the Forest Trial reduced it by 25%.
45:32So there is almost a higher increase in LDL cholesterol.
45:38Now these pieces, Sorry, the drugs are getting better at reducing LDL.
45:43Is that what you’re saying from then, until now? Okay. They’re getting more potent, they’re getting better at reducing LDL.
45:51You reduce LDL more and if it’s the culprit, you should say, Hey, listen, I’ve already
45:57used the LDL. I should get a bigger impact on mortality.
46:04Would it surprise you that the impact and mortality in the Jupiter trial was wafer thin,
46:12about 0.2 or 0.3% or two years.
46:19So, I mean, I may be fudging the numbers a little wrong because I’m recalling out of
46:25memory, but it’s pretty much in the ballpark. Now, the new drug came on the market, which is the PCSK9 inhibitor.
46:33Now PCSK9 inhibitor can drop the LDL cholesterol to almost zero.
46:40So in this trial, it’s called the Four Year trial, that took 28,000 patients, 14,000 that
46:47got the PCSK9, 14,000 that did not get PCSK9.
46:53The LDL cholesterol here was reduced by over 60% of our 30 milligrams per deciliter.
47:03So when you compare 14,000 patients, you would expect that when you annihilated related LDL
47:10cholesterol, that you should have a dramatic increase of a dramatic reduction in people
47:18dying. So do you know what happened? The more people died in the group that got PCSK9 compared to the people who did not get
47:28PCSK9, it was not statistically significant.
47:33So I like to use the line of John Abrahamson that you may have heard from me.
47:38Yes. Dying of corrected Cholesterol is not a successful outcome.
47:44Right. And I’ve heard, I’ve heard too that sometimes these, um, cholesterol lowering drugs can
47:51overshoot and lower cholesterol too much and cause side effects. And do you have any experience of that?
47:59Where, how would somebody know if they are being over medicated for cholesterol and their
48:05cholesterol levels are low? We already talked about it’s important in sex hormones. So what are some side effects that we could see on these statins?
48:13We talked about cognitive impairment. We talked about muscle fatigue are those, you know, side effects of cholesterol levels
48:20that are too low or just of the statins themselves. Um, it could be a combination.
48:26Um, also another thing that we should point out is that there is very clear evidence that
48:33cholesterol reducing medicines do cause diabetes. They cause insulin resistance.
48:39Wow. There is also a lot of data on people with the new information about the PCSK9 inhibitors.
48:50And this is an important thing to get into. And I hope you don’t accuse me of being too nerdy.
48:56So PCSK9 is a molecule that our body elaborates, and it is a defense mechanism.
49:05When you get an infection, PCSK9 goes up and the reason PCSK9 goes up is that it’s says.
49:13I need to get the body ready for invaders. I need to get the body ready to fight inflammation.
49:22And one of the ways it does is that it comes in. Tell us a little bit, I want you to stop sucking up cholesterol from the bloodstream.
49:30So PCSK9 goes up, comes and tells the liver don’t pick up any cholesterol. I want cholesterol in the bloodstream to fight infections.
49:39Okay. So now we have established that. Was that clear or did I mess it, explaining that?
49:46I don’t think so, but here’s the deal. So I have an online course that teaches people how to lose weight.
49:52And many, many times my members are Morgan. I had to watch that masterclass like four times. One of them is how to lower insulin resistance.
49:59And so my members in my community are very used to me going very in depth, where they have to relisten to stuff.
50:04And I was just thinking, as you were speaking, I’m going to have to go back and relisten to this episode so that I can absorb things.
50:11And I’m going to have to have a Google window open a little bit so that I can do some research into this, all of this stuff that you’re talking about.
50:18Cause some of it’s new, even to me, which I love, I absolutely love learning. And I really appreciate the fact that you’re kind of going against conventional wisdom
50:27here and that we’re building this resource that somebody can confidently live with a
50:34high LDL cholesterol. If all of the other numbers that we talked about are going in the right direction, because
50:40I don’t want people to be afraid of something if they don’t need to be afraid of it. So let’s give them a little bit more, um, you know, arsenal here and let’s say, so what
50:49if they are concerned about cardiovascular disease? Maybe they have a family history, something like that.
50:55And LDL has historically been a marker for that. And we’re kind of talking about why maybe that’s not such a good thing.
51:02So, you know, as a cardiologist, what do you look at to determine someone’s risk for cardiovascular
51:08disease if it’s not LDL? So that’s an excellent segue.
51:15And we need to talk about people on a carnivore diet who have very high LDL levels as to what
51:21information we have for them. And where are the uncertainties? Because we want to be truthful.
51:29We don’t want to hype something without having the right background and foundation. But one of the things that is very important for people who are at risk of heart disease
51:42is to get a calcium score done. So a calcium score. Now we already talked about the other markers because I think that insulin resistance, diabetes,
51:52inflammation, high blood pressure, all of this get better with the low carb lifestyle
51:58and with fasting are important factors to address, right? Let’s say you have addressed all of those.
52:05What you need to do is to look at calcium scores. So let’s say I come up across a person, who’s got all the beneficial markers of insulin
52:15sensitivity and have a high LDL. I put them through a calcium score and a calcium score is checking calcium buildup up in the
52:25blood vessels of the heart and with the cat scan.
52:30So let’s say you are about 50 years of age. And if your calcium score is zero, that means there is no black buildup in the blood vessels
52:38of your heart. You have all of these other beneficial markers, insulin sensitivity, healthy liver, metabolically
52:46healthy. Then that zero calcium score predicts an extremely good 10 year heart disease outcome.
52:57That means the possibility of you having an adverse cardiac outcome is very low.
53:02In 10 years. You can also take it to the bank because now American Heart Association has come on board
53:09and says, if you have a zero calcium score, you don’t have any additional benefit from
53:15taking a statin. So people can find some comfort in that.
53:22Now let’s talk about where we don’t have certainty in our field.
53:27Now, several people are on a carnivore diet, a carnivore diet.
53:34In my mind, I have a part. I have a YouTube podcast that talks about optimal diet for humans.
53:40And I think as humans, we were designed predominantly to eat a carnivore diet. You would have to look into why our brain needs that kind of food what expensive tissue
53:49hypothesis is, so I’ll let you delve into that. But when you go on a carnivore diet and you’re fasting and you’re getting metabolically healthy,
53:58your LDL levels can go 300, 400, 500. I’ve seen seven hundreds.
54:05And the question those guys have is that, is that healthy? Can that damage me?
54:12And the answer to that is that I don’t know, and we should get that information and we
54:19should get that information perhaps by doing serial calcium scores, let’s say your calcium
54:26score is zero here. Your LDL is 300 to 400 and you have that higher LDL for several years and you redo your calcium
54:35score. And there is no increase in calcium. There’s no increase in plaque buildup that is going to provide us with the right answers.
54:44This information is just beginning to come out. And I have anecdotal information from one to three years up with people with higher
54:54calcium scores remaining zero, I have 90 year old women who have had a higher
55:01LDL all their life. And I have taken pictures of the blood vessels of the heart and found no blockages.
55:09So there’s plenty of evidence that higher LDL is perhaps not the culprit and that there
55:16may be several other factors that accompany high LDL, which may be causal.
55:24And the higher LDL may be just a red herring, But we got to admit that we don’t know for
55:32sure, because that is the honest way. And that we don’t have all the answers at this point.
55:40So I think that was an important aspect to get out to your audience because they don’t
55:46just want to hear the hype. Yeah.
55:51And I think we could go on and on, I have one more micro question and then I’m going to end it on a more personal question.
55:57So one of my members said that she didn’t want to go on a statin kind of a more traditional
56:02mindset here. And she was taking red rice yeast.
56:08And I challenged someone to say that 10 times out loud, if you’re driving in the car, listening to that red rice yeast.
56:14And I just wanted to get your opinion on that quickly. So red yeast rice. That’s it then.
56:19That is nothing but a statin because statins are products that are derived from fungi in
56:30yeast. So red yeast rice is a kind of a statin. It’s usually sold as a supplement.
56:36It’s unregulated. And if you want to take a red yeast rice, you might as well take a statin because it
56:43will have the same side effects and the same benefits. And so that, that was an easy answer.
56:48Red yeast rice. All right, well, that’s still hard to say 10 times in a row. Now this is a question you didn’t know that you’re going to get asked, but I decided to
56:56ask it anyways. And that’s, if you could list, what are you most proud of either personally or professionally?
57:02Um, you know, in the last 30 years as a cardiologist, what’s your proudest accomplishment? I don’t know.
57:09I find very hard to praise myself. It seems like awkward. I’m putting you on the spot.
57:19But I would say that, um, the ability to make yourself feel relevant by helping people is
57:31perhaps the greatest attribute a physician can have. And I feel relevant when I’m helping people.
57:38And I hope with what I’m doing that I’m hoping You are. And I think, I think the beauty of what we’re doing online as we can help so many more people
57:48who can do these videos and you do have a lot of great online resources, we’ll be sure to link those up, both in the show notes on the blog post for this and the YouTube video,
57:59but real quick, if people want to learn more about you, Dr. Ali, how can they find you? I think the best way that they can find some of the information that I have is going, is
58:10by going to our YouTube channels, uh, we have an Eat Mostly Fat YouTube channel.
58:15There’s a channel under my name Dr. Nadir Ali, MD So you will get about 50 plus videos
58:22that talk about various aspects of low-carb diet, offensive and resistance of fasting,
58:28of cholesterol, of, uh, statins and allow, uh, sleep and heart rate variability and resting
58:37heart rate. Because I want to make sure that on one hand we are treating with nutrition, with fasting,
58:44with exercise, but sleep and stress is also an important component that people need to
58:50address. The other way that you can get ahold of us is by contacting us with email that you’re
58:56going to list. I will, yep. So I would say those are the best ways to get ahold of us.
59:02All right. Well doctor, thank you so much for joining us. Thank you for sharing your expertise. I know that you’re a very busy man.
59:09Um, but my audience and doctors who listened to this other healthcare practitioners, I’m
59:14sure are going to come away just with, you know, feeling more empowered about elevated LDLs on a low lifestyle.
59:21I know I feel better about it. I feel like I have more information to share with my members and that’s the ultimate goal
59:28of this podcast and the YouTube videos that I put out there is just to empower people with better information.
59:34So thank you. Thank you. Thank you, Morgan. I was honored to be with you today. All right.
59:40Bye everybody. Bye.
