The BIG MYTH Behind Heart Disease & What ACTUALLY CAUSES It! |Dr. Elizabeth Boham & Mark Hyman

the reason we're really looking at cholesterol is because it's one factor that influences somebody's risk of cardiovascular disease right [Music] welcome to the doctor's pharmacy i'm dr mark hyman it's a special episode of the doctor's pharmacy called house call and this episode is with my friend and colleague dr elizabeth bowham and we're talking about cholesterol and heart disease and what is the truth and what is fiction and what should we do when our doctor tells us to take a statin which every doctor pretty much does regardless of our age sex or whatever is going on it's the number one drug sold on the planet and we need to think about why and if it's actually good for us or what we actually should be doing about our cholesterol so dr baum is a incredible physician she's uh one of my good friends and has been working with me for 20 plus years now i guess it's a long time uh and she's one of the leaders in functional medicine in the world teaches all over the place now mostly from her house on zoom but uh really is is a part of the faculty the institute for functional medicine she's a huge contributor to the field and is what every doctor should be which is not only an md but 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 that 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 all right let's get right into it so cholesterol if you are a person in america and you've been to your doctor you likely have had your cholesterol checked and you probably have been told you need to get your cholesterol down and you might have even been told that you should be taking a drug called the statin uh so tell us what is this whole hullabaloo about cholesterol and statins and why should we even care about cholesterol and is it really the thing we should be worried about with heart disease oh such great questions i mean it's estimated that 50 of people in this country and in europe and 40 worldwide have what's considered elevated cholesterol and and obviously that you know for those 50 percent of people not all of them have to be really concerned about that cholesterol number it doesn't mean that all 50 of us have to be taking a medication to lower that cholesterol and so people come in all the time with those questions of is this 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 at cholesterol is because it's one factor that influences somebody's risk of cardiovascular disease right i like how you said one factor one factor exactly one piece of the puzzle and for a lot of people it's not even an important piece of the puzzle right but for it it is one piece of the puzzle especially for people who have a really high cholesterol very like familiar hypercholesterolemia genetic absolutely we're talking about ldls like in the 190s and we'll talk more about those numbers total cholesterol in the 300s you know there is a there is an association with vascular disease it can cause plaque buildup and that can cause if the plaque is built building up around the arteries around the heart that can cause a heart attack or in the arteries leading to the brain it can cause a stroke so for some people it's something that's very important for other people it's something that's giving us a lot of information potentially about their health and where do we need to focus and 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 confused what does this number mean do i really need to be worried so we're going to get deep into all 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 the most important one by the way because two-thirds of people who have heart attacks actually have pre-diabetes or diabetes and it's mostly undiagnosed that 70 percent of people who come in have pretty good cholesterol who have heart attacks about 50 percent have normal cholesterol and you know uh and and it's really striking that we're kind of like wondering about uh this this condition which is is actually not so cut and dried uh and i think absolutely i think i want to get into um the numbers let's talk about cholesterol because in my opinion and i've written a lot about this the test that you get when you go to your doctor is antiquated absolutely it's outdated it's not the cholesterol test you should be getting uh and it doesn't give you the right information to make a decision about what to do so you typically get your total cholesterol your triglycerides your hdl your h your ldl those are fine but tell us about what these numbers mean and what cholesterol tests we should be doing your doctor may not be ordering and that is available through quest or labcorp through your insurance absolutely so when you get your traditional cholesterol panel done your traditional lipid panel done you're they're they're giving you the the ldl cholesterol the hdl cholesterol the total cholesterol and and that's one piece of information like you said but we're missing a lot of information there so the the uh it's really important i love this analogy of the dirt and dump trucks so um dirt and dump trucks and think of think of all the dump trucks that are going around carrying dirt and we can make this analogy with cholesterol so think of your cholesterol like the dirt and the um the dump trucks are the particles carrying around your cholesterol so what we're learning is it's not just the amount of dirt somebody has that's important it's the amount of dump trucks that they have carrying around that dirt and that the size of the dump trucks are actually really important and so when you get a typical lipid panel done you know you're just finding out the amount of dirt that you have and how much of it is ldl and hdl and triglycerides and that's important and we will talk about that but what's even more important or at least as important right is the amount of dump trucks you have carrying around that dirt and what we're learning is that or what we've learned is that the the if you have small dump trucks so if you have a certain amount of dirt you could either have a few big dump trucks carrying around or a lot of small dump trucks carrying 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 actually more concerning that they can get into the artery lining more they can cause more plaque buildup they can get that that it can help that cholesterol get oxidized through oxidative stress it's much more dangerous so the size of those dump trucks you have carrying around your cholesterol is critically important yeah and something 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 uh you know the the number you get on your test is the weight of your cholesterol so it's milligrams per deciliter it's just basically the weight yep but it doesn't tell you if that cholesterol is made up of a thousand particles or a hundred particles right so you could have a cholesterol of 150 and it could be 5 000 particles or it could be 500 particles yep of cholesterol and that makes a huge difference in your risk of heart disease and you can't tell from a regular cholesterol test whether you have a lot of particles or whether they're big particles or small particles so i think about sort of like golf balls and beach balls you know beach balls are these big light fluffy balls that you can bounce and don't hurt anything and 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 dangerous 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 regular test you can have smaller large ldl smaller large hdl smaller large triglycerides and the triglycerides are a little different it's the big triglycerides that are a problem not the small ones but you can really get a sense from these newer tests what's really going on because i i've seen people with a cholesterol 300. their hdls which sounds terrible right because they're supposed to be under 200 their ldl might be 150 which sounds terrible because it should be under 70. their hdl is like 110 yep 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 this kind of cholesterol there's no evidence that these people are at risk of heart disease because they have large light fluffy particles they might have no small particles they might 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 well 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 all cardiologists study and i said you know peter i have these patients these little ladies they cholesterol is 300 and 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 you 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 test that your doctor does right right so you need something called what like particle size testing um it's telling us about those those things that are carrying around your cholesterol yeah so labcorp does nmr yep nmr quest does something called cardio iq which is similar and you can ask your doctor for these and you shouldn't stand for any other test but these tests and then absolutely they tell you so much so tell us how do you get a profile that is with these small dense dangerous hdl and ldl well you know it's interesting so there's there's a lot of lifestyle that impacts the size of your ldl particles right the size of those you know are they small and dense and dangerous or are they big and fluffy and not so dangerous i mean there's a there's always a genetic component right there's a genetic component but then there's our lifestyle and we know that that that uh metabolic syndrome where people are insulin resistant gaining weight around the belly they typically have lower hdl they typically have higher triglycerides but they also typically have more of these small dense ldls which are more concerning and so lifestyle makes a huge impact on the the 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 causes you to have the dangerous kind of that's true sad diet the standard american diet right that'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 it's the sugar that drives it and what does that do to the body that causes these particles and it actually leads to the high triglycerides the low hdl the small particles right it's that whole process of insulin resistance and it results in this really unhealthy pattern and so you know we sometimes get clues of 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 one you want higher and for for men you want it at least over 40 and for women at least over 50 and then if that triglycerides are i'm like 50 and 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 your cholesterol's hdl is 40 probably not optimal should be over 50. it really should it really should you're right here um and then the triglycerides you want at least under 150 or what would you say what's that there you go for triglycerides so if your triglyceride is over a hundred you're you're definitely flirting with danger and there are you know there's some genetics involved we'll talk about the genetics in a minute but but it is usually a sign of increased carbohydrate load like not and i don't mean broccoli i mean like flour and sugar absolutely right so so you know you can get some sense of if somebody has is prone to metabox syndrome insulin resistance with that but then the particle size testing also gives us a lot of information um the nmr for example gives you something called your insulin resistance score yeah so you can get a sense based on the analysis of the particles of cholesterol that you have how at risk you are for insulin resistance so it's just one more piece of the puzzle and i've seen people with a cholesterol i'm 150 yep who have like 2 000 particles of ldl which is should be under a thousand who have like 900 particles a small ldl which should be under 300 ideally probably less than 90 is perfect and you see that often and yet their doctor well your cholesterol is 150 it's fine you know and 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 highly 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 mentioned is that insulin resistance is the driver of this which is pre-diabetes metabolic syndrome and to some degree or another 88 of americans are metabolically unhealthy and have some degree of this 50 has pre-diabetes or type 2 diabetes like every other american has diabetes or pre-diabetes that's crazy 75 percent overweight and every one of those people is some degree of poor metabolic health so if this is true and what else does this diet do that 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 but 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 yes right so inflammation seems to cause everything these days from depression to cancer to heart disease diabetes to everything else so uh what is what is the cause of inflammation in these patients with insulin resistance so 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 belly when we get insulin resistant we gain more weight around our belly and we know that visceral fat or or weight around the belly the apple shape is more inflammatory it secretes all these inflammatory markers and increases inflammation in the body and so when people when they when we get them to when they help their weight around their belly goes down when we get that waist hip ratio better that inflammation goes down so basically what you're saying is is that fat around your belly is not just holding up your pants that it's an immunologically active organ yep it produces these molecules we call adipose cytokines you've heard of the cytokine storm with covid yep well it's that same chronic cytokine storm that's being released from these fat cells in your belly they're not just average i mean fat your legs or your butt it's not going to do that these fat cells in your belly are super inflammatory so then you get the inflammation which leads to oxidative stress which then causes what problem with the cholesterol right so when your ldl cholesterol gets oxidized and what is that um think of oxidative stress like excessive free radicals or rusting in the body but you know there's we're always making free radicals when in many different cellular processes in the body but when there's too many of them or you don't have enough antioxidants to squelch that oxide those those free radicals so if your diet's not rich enough in the polyphenols or those phytonutrients or your vegetables then then what happens is you get more oxidative stress and that oxidative stress can can can shift that ldl cholesterol and it's that oxidized ldl that's more damaging and more likely to cause plaque build up and and um that will lead to heart disease it's basically rancid cholesterol yep in your bloodstream that's the problem that gets oxidized which is like you said rusting or apple turning brown or your skin wrinkling from too much sun these are all signs of oxidatives but this happens inside of you and it leads to this inflammatory process this oxidative stress and that's what causes the heart disease and i you know some of the interesting studies i've seen like the jupiter study very big trial from harvard on heart disease fascinating to me that people had high ldl but no inflammation had very low risk yes people had high inflammation but 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 be focused on inflammation what's causing that and it may be that you know the statin drugs turns out the the benefits may not have a lot to do with cholesterol lowering but they're anti-inflammatory they're very powerful anti-inflammatory drugs which is quite a side effect yeah but but it actually works now there's a lot of better ways to get rid of inflammation besides taking statin drugs and so so when 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 from 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 how 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 looking at more than just those numbers we're looking at what are their markers of oxidative stress you know we can measure those we can measure oxidized ldl we can measure eight hydroxy deoxyguanosine and lipid peroxides all of these biomarkers that give us a sense of is there oxidative stress and by the way these kinds of tests are not 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 a deeper dive into the root causes into these diagnostic tests which are not available usually through your traditional doctor they 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 are excited to help people figure out how to look at their risk and design a strategy that's personalized for them using functional medicine and we see people from all over the world that the ultra wellness center doing like zoom consoles now so it's pretty easy to get get access you know and it's it's fascinating because there's so many pieces to the puzzle and so when you find somebody with high oxidative stress you ask that question why why is there high oxidative stress is it their poor diet is it is it you know inflammation is it their microbiome is it their microbiome you know is it a toxin heavy metals heavy metals like a toxin or something yes all this smoke that the wildfires in california that increases risk of cardiovascular disease absolutely absolutely so you know it's really important to think about all the different things that can lead to oxidative stress and inflammation and then try to tease out what is it for that individual person that we need to focus on so i think that's important for for some people and a lot of americans there's so much that's lifestyle related right but for some people their lifestyle is great and it's more um it's more toxin related that we really 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 much about how it influences inflammation in the body yeah you know um microbiome in your gut as well as microbiome in your mouth right and gingivitis and how much that we know we've known for years that that impacts risk of heart disease because of its inflammatory properties so those are important things that we need to really investigate and look at yeah so true you know i'm just thinking about you know how how we work with these patients so we look at all these diagnostic tests that may not be looked at we look at their overall cardiovascular risk their family history we may look at diagnostic tests we may send them for a heart scan look at calcium carotid ultrasound look at particle size look at inflammation markers oxidative stress markers the microbiome heavy metals we might look at other factors like homocysteine which looks at b vitamin status we look at lipoprotein and a bunch of other factors that give us a more rounded picture of what's going on so we're not just focused like a laser on cholesterol and the reason it seems to me that we are so hyper focused on cholesterol is we have a good drug to treat it right so it's it's all pharmaceutical driven whereas whereas when you look at the data two-thirds of all people entering into an emergency room with a heart attack have either uh pre-diabetes or diabetes and most of them are undiagnosed right so when when you say two thirds of heart attacks are from sugar not cholesterol issues and 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 many people come back with you know high on their on their lab work and it doesn't necessarily like you said i 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 need 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 one 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 and i want to tell you about 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with a patient yeah i mean you really want to get a good detailed family history you know i think that there are some people who are at very high risk of a vascular disease and and for people who have a strong family history which means that if you have a first degree relative which would be a parent or a sibling who has had an early heart attack so for a man less than 55 or a woman less than 65 that means they've had diagnosed heart disease because of plaque at an early age you know that those people who have that type of family history need to be more careful were they smokers were they very overweight do they have diabetes like what are the other 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 think he had nine siblings everybody had heart attacks in their 50s you know they all had bypasses heart attacks uh and they weren't like significantly overweight but they were pretty high risk uh as a family and he was deaf so he couldn't hear so he really he really couldn't get a job like a white-collar job so he had a a blue-collar job which was basically loading new york times big bundles of new york times onto the trucks from the conveyor belt so he was constantly working out all day long and was very very strong and healthy and every night he would go out in queens and he would walk down 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 improve your health and he he didn't really get heart disease until his 80s right right and they all got in their 50s so it's and his diet wasn't the best right but still even with simple simple lifestyle things that can make a big difference absolutely so right so you bring up a great point that genetics and family history is just one piece of the puzzle it's not what makes all you know make us makes us make all the decisions in the world but we take that into account as well as all their other risk factors like you mentioned like type 2 diabetes and are they a smoker and you know so we really have to pay attention to all of those lifestyles high blood pressure you know a lot of high blood pressure is a big factor in heart disease but again high blood pressure is usually caused by the same thing which is insulin resistance so sleep apnea yeah it's very very common yeah uh and and 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 remembered 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 he had a heart attack had a stent and was freaked out you know at 50 years old to have his heart be at risk like that and he was on a pile of medications when i saw him he was on a statin a beta blocker blood thinner you know calcium the whole cocktail blood pressure pills you know pretty much everything um and i said well listen are you willing to sort make some changes and so he totally revamped his diet we got rid of all the junk out of his diet very very low sugar starch diet lots of good fats lots of fiber got them on some basic supplements you know b vitamins folate uh and and also fish oil um got him on exercise program and over the course of a year you know he 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 numbers and his blood sugar was high his insulin was high he wasn't quote diabetic he was pre-diabetic and no one they completely missed it like they i mean it's just staggering to me that after 30 years that i've been doing this that the literature has been there that doctors don't check for pre-diabetes on a regular basis which affects uh basically one out of every two americans or more and and and so you check that by measuring insulin a1c a glucose tolerance test with insulin there's ways to look at it and then look at particle number particle size and and he lost the weight and he was able to reverse all of his numbers and he was able to get off all his medication including statins and his numbers were better off the statins than they were on it by fixing all these lifestyle factors and he's been heart attack free for the last 20 years so i just yeah i think we we are so stuck in this paradigm of treating the symptom the cholesterol instead of the cause absolutely that's critical that's yeah you can store it you've had some patients too right so yeah 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 in between cholesterol like where they were they really they really wanted to know what to do they 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 else can i do so the first one was a 45 year old gentleman who um was told his cholesterol was too high he didn't have a strong family history of heart disease and um but his total cholesterol was what 225 his good cholesterol's hdl was 37 which is low too low 50 right his triglycerides was we're 185 fasting which is high right and his ldls were 145. so you know his doctor said you know what i think you should start some medication and 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 because you know a lot of times with patterns like this we can make a huge change so we did that special we did an nmr lipo profile so we looked at those particle sizes and we saw that he had a lot of the small dense ldl particles his pattern they sometimes give you a pattern are you pattern a or pattern b pattern b being the more concerning you have too many small dense ldls and that's what he had he had he looked like he had a high risk for insulin resistance which we knew even before we did the test but um because his waist dip ratio was too high his hdl was too low his triglycerides were too high so it was it was obvious but that test confirmed that right it said you have a high risk for insulin resistance based on your cholesterol panel and we also before you go there yeah i just want to point out because this is really a very easy cheap way to check to see if you have insulin resistance and it's a far better predictor of your risk of heart attacks than your ldl which is your triglyceride to hdl ratio and this guy had a ratio about five right it's over one not great if it's over two you're in trouble he was five yeah and that that pattern of high triglycerides low hdl is what you see in these patients with pre-diabetes even though they might have a normal cholesterol i mean his was 225 but i've seen people with you know a total of 150 triglycerides of 300 hdl of 29. i'm terrified for these patients absolutely total cholesterol is 150 and it's absolutely right right that's where we get really nervous because we know that's such a pro-inflammatory process and what we know about heart attacks especially sudden heart attacks right there's typically um it's it's you know i always sort of draw this picture for my patients of the inside of the artery and so often we think when somebody has a heart attack the plaque just keeps building building building building you know they're 50 blocked and then they're 90 blocked and then they're 100 blocked and they have a heart attack but what we know is that that sometimes you're only 30 blocked but if that's inflamed if that blockage is inflamed kind of like that can rupture and then cause a a significant blockage it's like a pimple popping that then your body protects by making a blood clot and your heart rate right and that that's really often what we see when somebody study somebody has a sudden heart attack right that that blockage is just ruptures and so it's often missed people aren't necessarily coming in with years of chest pain and you know shortness of breath those things that we see as people get older they just have a sudden rupture of that of that plaque so yeah those are the situations you get really nervous and a lot of times you see a lot of inflammation so um so we also did an oxidized ldl with him which which was high and concerning bran said cholesterol yep that's that rancid cholesterol so you know we really for him with all those signs of insulin resistance metabolic syndrome the diet for him was that really low glycemic diet we needed to work to lower those carbohydrates to lower the sugar you know we know that triglycerides really decrease when you cut out juices sugars alcohol they're basically fats that are made in the liver when you eat sugar and starch right they're not produced by eating fat nope nope sugar and you can really you can lower your triglycerides pretty quickly when you pull out the alcohol the juice the lots if some people doing too much fruit um flour and sugar flour and sugar absolutely sugar sugar sugar so when you cut that out you can bring your triglycerides down really pretty substantially pretty quickly so we really focused on lowering his carbohydrate load you know all the bad carbs right and um and we also focus on giving him more of the omega-3 fats because we know those omega-3 fats are really anti-inflammatory and they can 2-4 grams of omega-3 omega-3s a day can lower your triglycerides and raise up that hdl and this is fda approved as a drug absolutely which is fish oil which is a prescription that you can buy to lower your triglycerides and you can get it from food right like a can of sardines three ounces of sardines is about two grams has about two grams of the omega-3s in it that's what i'm having for lunch that's my favorite lunch sardines on a salad with some walnuts very heart healthy so we made that switch with his diet you know and and what was amazing and what i love to see is when in like three months we repeated that nmr lipo profile and he went from having the too many of the small dense ldls to having he was now considered pattern a he had more of the big fluffy ldls his hdl improved now it wasn't yet optimal but i think it got up to like 47 in three months his triglycerides came down to 120 so maybe not you know this was just three months of doing this we can see really quick changes in people'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 this 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 really bad at in medicine is personalizing care and there's no place that's more important to personalize your care than dealing with your heart attack risk and cholesterol because it's different for different that's very true and what i've seen i'm sure you've seen this over the years is people respond dramatically differently to the same diet so so typically we're told by the american heart association that we should have less than five percent of our diet is saturated fat although breast milk is 25 saturated fat so 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 diet because it's a building block for cholesterol and which is not necessarily a bad thing i mean your cholesterol makes your hormones it makes the nerve coverings for your nerves it's part of your brain yeah i mean it's really important uh a lot of your hormones are made from cholesterol your sex hormones um and and what i found is you know depending on the person their responses are very different to diet yes and and i've talked to dr ronald prowse who'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 come to mind one was of a woman who was overweight who was clearly pre-diabetic whose triglycerides were 300 which is really high it should be under 70. her hdl was like 30 which is terrible her total was you know probably you know 2 50 60 was pretty hot should a lot of small particles a lot of overall particles just syndrome yeah and she struggled with with weight loss and diet so i put her on a high saturated fat diet i put her on basically butter and coconut oil and almost a ketogenic diet and it was striking she never could lose weight she dropped 20 pounds like that her cholesterol dropped 100 points her triglycerides dropped over 200 points her hdl went up 30 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 saturated fat was the cure for her cholesterol not the cause but another guy was this super fit mid-50s biker would bike 50 miles a day i'm super healthy and his his cholesterol wasn't great and he he had a genetic issue with his cholesterol and had this sort of more of these small particles and and and so i put him on i tried himself let's try just do more of a ketogenic diet see what happens or more essentially his cholesterol turned it terrible yeah so we had to totally change gears and get them off saturated fat i think we'll soon be able to do a test which is a cheek swab or a drop of blood measure genetics and figure out which one are you are you somebody who should be eating more fat and saturated fat or more carbohydrates or more of the right foods different kinds of fat we're not quite there yet but i think in functional medicine and here at the ultra wellness center we can on an individual basis really come to learn what is the right thing for this particular person yeah i think it's so important that's so important 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 our nutrition intervention and i think what you mentioned with the first woman the reason we saw such you saw such an improvement with the ketogenic diet is you lowered her insulin so much right so we know that the carbohydrates that you eat cause your insulin to spike so when your insulin is high and you can't lose weight because you're your insulin is high because it's causing you to put on weight around the belly when you change to a diet that doesn't cause your insulin to go up which is like a ketogenic diet i mean that's the extreme right you can do some some things in between too but then that insulin doesn't go up and that's when we can see huge benefits for some people in that situation it's really true i mean insulin you know for the most part and like the one 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 thing and and you know aside from getting the nmr particle test getting a measure of your fasting insulin really great if you can get an insulin test after you have a sugar load that's even better because by the time your 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 fasting and then two hours after a sugar load it's you know you see a little earlier but you know doing these tests for decades i just see this pattern over and over again you can have perfectly normal sugar perfectly i mean i had this one woman who was really overweight and she had a giant belly and clearly she was metabolic syndrome she had high triglycerides low hdl same pattern but when i measured her glucose tolerance test and her a1c perfectly normal like her fasting blood sugar was normal her average blood sugar was normal her one and two hour blood sugar test like normal like her fasting was in the 80s after it was like 110 but i measured her insulin now normal insulin should be under five it was over 10 kind of in trouble her fasting insulin was like 30. yep and then we did a sugar load and her insulin up to 200 to 50. yep and it should be under 30 after sugarload so she was like 10 times normal and it was keeping her blood sugar normal but it was driving all this weight gain and inflammation and abnormal cholesterol so you really have to dig 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 especially if you don't pull the carbohydrates you lost 50 pounds like that once you pulled the carbohydrates it's so easy i 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 biology which is what functional medicine really is about it's understanding each of our unique biology looking at things that traditional doctors don't look at at function at differences in the responses to different insults like diet and toxins and various things so we have a really different scope and you know at a cleveland clinic where i also work one of the leading doctors there cardiologist stan hazen has done incredible work look at the microbiome and how the environment and the gut can increase your risk of heart disease and how certain foods increase certain problems i and it's just fascinating to think you know here at the number one heart hospital in the world they're going wait a minute maybe we should be looking at poop right right and so the paradigm is breaking down right the the hyper laser focus on cholesterol which we're talking about today is is only one small part of the story and and and getting into the nuances is really 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 center 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 to come up with a personalized plan that can help determine their their best outcomes and reduce all these factors yeah so you know the second case i had she did not she was not at risk for insulin resistance significantly you know her insulin i don't really remember what it was but it wasn't that concerning to me um but she uh was also concerned about her cholesterol you know she was 55 her doctor had just checked her cholesterol her ldl cholesterol was 160 um and so he was recommending some medication she didn't have a strong family history but when we looked deeper or when we you know her cholesterol also showed her triglycerides were okay at 90 her hdl was 55 again maybe not perfect but you know it was really that ldl cholesterol i was a little more concerned about we did we did particle size testing on her and she didn't have too many of those small dense ldls she was more pattern a more of the big fluffy ldls which made me happy to see and um but she's like you know what let's bring i want to bring down this ldl cholesterol and um so with her the focus in the diet was a little bit different you know she did she was about 10 pounds overweight so she wanted to lose some weight so we focused on that and then we also really focused on her protein because um because protein's really important as well when we're talking about cholesterol because there's some vegetable proteins that can help with lowering they can help with lowering that ldl cholesterol so beans and legumes nuts and seeds these are vegetable sources of protein that have plant sterols in them and they can help bind to the cholesterol in the gut and lower your ldl cholesterol and you know so when when i have a situation like this you know i really talk to them about balancing where they're getting their protein from more of that pegan diet right where they're getting some of their protein from a vegetable source like beans and legumes healthy forms of soy nuts and seeds and some other protein from 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 area to focus on so she with you know you know three months or so the weight came down and when we rechecked her we saw that ldl cholesterol come down to like 130 and so and her hdl even went up higher which was great to see so you know she had a nice improvement with shifting her diet but we just focused 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 not 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 in plants like plant cereals that come in beans and nuts and seeds and high fiber you can really have a big impact uh and and i think you know one of the things i like to use is is extra fiber as something called pgx which is basically from a root of a japanese vegetable called cognac it's not like the alcohol it's ko and jac and it's a fibrous root you can actually make a noodles out of it there's these shirataki noodles so you can have pasta in a sense but it actually is zero calories it's all fiber and it blocks the absorption of cholesterol from your gut so adding more fiber plays a huge role changing the quality of your diet increasing the good fats like olive oil or the the avocado oil and also improving the the overall content of phytochemicals in your diet all helps to reduce your risk dramatically and i think we'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 of 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 it selling lipitor at mcdonald's which i thought was insane but i think i think we really have to understand that heart disease is a complex disorder it's not just about cholesterol that from a functional medicine perspective we do much more detailed workups looking at inflammation oxidative stress looking at the particle size of number looking at even your gut heavy metal toxins other factors that relate to nutrition like homocysteine and and we get a really good sense of what's going on and and we then personalize the treatment and it's very very different approach to reducing your risk and i it's been so satisfying for me and i've had patients who've had heart attacks and then we follow them for 20 years and they're just great and they're healthy and they have no risk because they they really have changed the cause of 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 say heart disease is not a statin deficiency right right so uh thank you so much dr bohamlis for being on the dr pharmacy podcast if you've suffered from heart disease if you are having issues with cholesterol if you're concerned about it someone in your family's struggling with these issues i really encourage you to dig deeper don't just accept at face value that you should take a stat and cholesterol is the problem it's more often more complex and find a doctor or practitioner who can help you we're at the ultra wellness center here in linux massachusetts happy to help anybody we're doing mostly zoom and virtual consults now so we can take care of anybody from anywhere and it's just really satisfying to see how quickly people respond and fix these things and get off the medications and fix their numbers and more importantly they get better they feel better because i don't really care 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 medications are not benign uh and so i'm just so excited we got a chance to talk about this on the doctor's pharmacy uh you're just a wealth of information knowledge and i'm so excited that we get to do these house call podcasts and get people information about things that often they're struggling with and have questions 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 been 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 you fix your cholesterol and subscribe wherever you get your podcast and we'll see you next time on the doctor's pharmacy [Music] you

Channel: Mark Hyman, MD

Views: 997,758

Keywords: bad cholesterol, dr. mark hyman, good cholesterol, hdl cholesterol, health theory, heart disease, heart health, high cholesterol, how to live longer, how to lower cholesterol, ketogenic diet, ldl cholesterol, low carb down under, mark hyman, nadir ali, nutrition tips, personal development, self development, self help, self improvement

Id: 3mc7O-7BUZg

Length: 45min 24sec (2724 seconds)

Published: Mon Oct 05 2020