Dr. Nadir Ali - 'Do statins prevent or cause heart disease? Should LDL be called "bad" Cholesterol?'

[Music] my disclosures are that in a moment of weakness Jason Fong and Megan Ramos decided to include me as a part of IDM and the fasting method and if there is any statin police out there I want to make a disclosure that I am NOT giving individual medical advice and occasionally I do prescribe statins so you have seen this slide before fat and cholesterol are vacci substances they do not dissolve in blood our blood is Acuras of watery and in order to carry cholesterol it creates these lipoprotein particles that have an outer coat that dissolves in blood and they have identifying proteins that give it a functionality so I wanted to go over what functions the lipoproteins do and I thought one slide would be enough but what we need to recognize is that there is millions of years of evolutionary engineering behind creating these molecules so that they help us with host defense they fight bacteria they mop up bacterial products they modulate inflammation cholesterol is not a metabolic fuel you cannot burn it and it has to be removed and it's removed in the biliary tree it's the life of proteins that create a cholesterol balance when your cells are damaged cells need to be repaired and it's the life of protein molecules that do that so I thought one slide would be enough but it was not so I had to create a second slide to show that the cholesterol is important in processing or functionality of your insulin receptor depends on cholesterol because cholesterol rich domains give it the structure it needs to function our sex hormones the LDL surprise the raw materials for the sex hormones to be made it's a carrier for fat soluble vitamins Dave Feldman has talked about energy delivery it is the lipoprotein molecules that deliver energy the kakouton which is an important part of our muscle function is delivered through the lipoproteins and who knew that prevention of vascular calcification that Jeff was talking about is also modulated because cholesterol is involved in converting vitamin K 1 to K 2 which prevents vascular calcification so the question we should ask is that should I ampere with these lipoproteins in general or LDL or LDL in particular when millions of years of evolutionary engineering has given it so many different biologic functions that I have pointed out and this list by no means is complete what we need to recognize is that Nature has already done some of this for us and it has created a situation which is called a better lipoprotein emia in which the LDL is absent so we should think that a person with an absent LDL should live forever so when we look at a group of these individuals let's see what happens they have a failure to thrive they get recurrent infections they get blindness they get issues with regards to their neuromuscular function in other words movement disorders they get a fatty liver and instead of living forever they die in their third or fourth decade the that the lipoprotein molecules are important in supplying cholesterol to your nerves in carrying fat soluble vitamins in fighting infections but as it so happens we don't want to learn from nature's mistakes we want to do our own and that's why we started this era of statins and a new drug which is called pcsk9 and hopefully I'll have time to get into that now cholesterol is vitally important for us if you ate no cholesterol and you became a complete vegan your body will still make 300 3,000 milligrams of cholesterol every day 3 grams 3,000 milligrams there's a synthetic machinery that our body has to make cholesterol and while it's making cholesterol it also makes certain very important molecules that have biologic function now statins prevent cholesterol production very high up in the chain of this cascade so what we noticed is that isopentenyl is making us certain proteins called solano proteins that give us antioxidant protection it's converting vitamin K 1 to K 2 that prevents vascular calcification kakouton is important because it helps muscle function dalek all which is cholesterol precursor is helping us process the insulin receptor and cholesterol itself is involved in giving the membrane the integrity that it needs so I have been accused of being very nerdy and that was quite nerdy so how do i unpack this how do I be redundant so to reiterate the isopentenyl is involved in creating certain antioxidative enzyme that prevent free radical damage that the isopentenyl converts K 1 to K 2 so that vascular calcification is prevented that kakouton is involved in muscle function that dolly call is processing the insulin receptor and cholesterol itself is providing certain cholesterol rich domains so that receptors can function and here is an example of an insulin receptor the insulin receptor sits in caviola which is a cholesterol rich domain and in that cholesterol rich domain the receptor functions well because it has the structural integrity when you remove the cholesterol the insulin receptor does not function well as we shall see later now we talked about dalek all as a precursor for cholesterol production and dalek all is involved it takes the protein manufacturing machinery of the body and in that location where the insulin receptor is being made it attaches a sugar residue so that the receptor can function well so cholesterol is involved in every step of the way for processing of the insulin receptor at the level of the membrane it sits in a cholesterol rich domain the sugar residue is through Dalek halt or cholesterol intermediate and the pore through which the channel through which the body takes in sugar the glute 4 channel is also processed through the solano proteins made by cholesterol so is this all just biochemistry or is there any clinical relevance to this and the clinical relevance to this is coming from the Women's Health Initiative study 10,000 of these women were on statins 140 were not what happened the women that were in statins three years later the chances of beat them being a diabetic was a little close to 10% compared to 6% in women not taking statins a three point five percent difference if you were a Hispanic you are more susceptible to statin damage and the difference was not three point five percent it was five percent if you were a nation like me the difference was not three point five percent it was seven percent now we've talked about coq10 a lot the way I talk about coq10 is that it is the spark plug of an engine if the engine doesn't have spark plug it cannot burn fuel similarly for mitochondria I don't have Co Q 10 they cannot create usable energy which is called ATP and Co Q 10 is a cholesterol by-product so my fellow Texan dr. Lance Joan took ten patients who were on statins heated muscle biopsies here at blood work and he compared them to nine matched controls and out in the blue line what you're seeing is how the match controls performed and compared to that blue line the people who we're on statins had higher blood pressure higher sugars they had lower kakouton in their muscles they made less enzymes that prevented oxidative damage of free radical damage they were not able to generate the energy currency because they didn't have Co Q 10 and they were insulin resistant so dr. Lance Truman took 328 patients that present it to his office and we're on statins and he found that 50 of these patients complained that they were having myalgias that they were fatigued that they were having shortness of breath that they were having memory issues and he stopped their statins and when he stopped their statins majority of them improved in 28 these patients they had heart muscle dysfunction that he evaluated with an ultrasound of the heart called an echocardiogram when he stopped the statins 50% of these individuals improved the other 50% did not improve which means that statins physician of statins may not lead to improvement in everyone so it this is something that was not good information for the statin industry and what they did is to say hey let's go on offense and say that using statins will prevent mortality in people who have congestive heart failure heart failure is a situation in which the heart muscle is not pumping well so what they did is to compare people who had heart failure who were on statins compared to who we're not on statins and this is an unfair comparison because if you to bring me a patient with heart failure and they have high cholesterol I know they're going to live forever a proper way to compare is to see the group of people who are on statins if they are taking statins less frequently in the middle or taking it more than 75% of the time who does better and that's the comparison I did so if you were taking statins less frequently you are less likely to die in fact the highest mortality was there in the group that took the statins most of the time not just all cause mortality you were at greater risk of strokes you were at greater risks of getting her attacks in Japan the Japanese Society of Cardiology said that everybody with a cholesterol over 220 should get a statin so this is 41,000 patients who are on statins and as they take statins their cholesterol levels are reducing so you would expect that if your cholesterol level is coming down you should be at lower risk of dying but as you can see on the graph the lower your cholesterol greater the risk of all-cause matter mortality the greater the risks of cancers the greater the risks of strokes how does that make sense now in that same study we evaluated the number of diabetics so you would think that if statins are good for you as you reduce the cholesterol you should have a lower incidence of diabetes but as you can see as the cholesterol got reduced by the use of simvastatin that was the group that had the highest risk of being a diabetic now we said that the cholesterol intermediates are involved in preventing oxidative injury because the parental intermediates take the protein manufacturing machinery that we have and creates L&O proteins that prevent oxidative damage they also make some DNA repair enzymes that prevents injury to ourselves so that we don't get cancers so this is the function of the cholesterol intermediates so again the deception from the statin industry and the statin experts is that let's go on offense and say that statin use is associated with a reduced chance of having mortality if you have cancers so they took a Danish population 40 years in order all of them had cancers and they're comparing people who are known on statins to people who are on statins again this is an unfair comparison the reason is that if you have high cholesterol and you have cancers you have a better chance of survival and you would give cholesterol reducing medicines only to somebody who has high cholesterol not to somebody who has low cholesterol so similarly the comparison should be that somebody on low-dose middle those and high dose if cholesterol is beneficial in preventing them from dying the higher the cholesterol the lower should the higher the statin dose the lower should be your mortality but not so in this study if you were on the highest dose of cholesterol you had a much greater chance of all-cause mortality and also of cancer mortality compared to the low-dose cholesterol group now this is a study done in patients 65 years and older called an older population and I looked at that and I said what do you mean 65 is old but anyway there were 3,000 patients in each group the pravastatin used reduced cholesterol by roughly 33 percent they were followed for three years what happened the people on pravastatin had 50 more cancers approximately it was statistically significant so Jeff showed his slide of having calcium in his led I'm sorry he doesn't have calcium in the led somebody else does he has a zero calcium score and the cholesterol converts vitamin K 1 to K to the prelate proneural intermediates and they activate an enzyme that prevents calcium deposition in the blood vessels of the heart so this is a VA study and the VA study was done in patients who were on statins not using frequently versus those who were using frequently when you see the people who are using statins a lot they had more calcification when they were followed at 4.3 years the progression of calcium was highest in the people using statins compared to the people who were not so for the sake of time I'm skipping some slides they are on my Twitter feed this is another compelling information you take smooth muscle cells these are cells that line the wall of the vessel and you grow them in a culture dish and you give them increasing amounts of the statin drug and what you're finding on the slide to the left of the screen here is that as the dose of statin increased more cells were dying now a picture is worth a thousand words and in this picture the arrows are pointing to the effects of statins that are killing the smooth muscle cells now I wanted to make sure that I have a few slides that showed animation so that you know that I can make good slides so here is a cell that is undergoing repair and as it undergoes repair it puts cholesterol out into the milieu the HDL which looks discoid in the beginning is there to pick up the cholesterol it becomes spherical and then it does this amazing thing it transfers the cholesterol from HDL to LDL the LDL takes the cholesterol it is then subsequently removed by the liver through the LDL receptor and the liver recycles the cholesterol and the protein this is an important biological but if you prevent that transfer which is happening through the C type enzyme you create something that medical profession medical professionals like a lot you are increasing your HDL you are reducing your LDL so that's what happened in this study so this is an illuminate trial about seven and a half thousand patients in each group the group to the left the HDL which is the good cholesterol is very high 83 the LDL is very low a cardiologist like me would salivate over this say this is so good why are you even coming to see me you don't need to come see me because you're gonna live forever what happened in this study with high HDL and lowered DL people died more people had cancer mortality more were hospitalized for heart failure more had infections and more had strokes so this is where I want to tell you how an industry-sponsored clinical trial is done 95% of studies that are done on statins are sponsored by the clinic by the industry and the industry plays the clinical side which is at the top of the slide about 400 sites in about 25 countries is a blockbuster study physicians like me at the side are paid by the industry the industry hires a team of experts called CAC central adjudicating committee they are paid by the pharmaceutical industry they hire a DSM a data safety and monitoring committee that's designed to protect the patient who pays them it's the pharmaceutical industry the FDA which is to approve new drugs a substantial portion of their budget comes from the pharmaceutical industry there's a revolving door between pharmaceutical industry and FDA you would think that medical journals that take these blockbuster studies that are going to make mega profit for the industry are they conflicted yes they are because when a blockbuster study is published millions of reprints are ordered that is extremely beneficial for the statin industry and for the medical journals you would think that American Heart Association and ACC are not conflicted but just go to one of their meeting and see the dominance of the industry a large portion of their budget comes from them you would think that physicians like me are not conflicted but they'll come and say doctorally we think that you are a pretty good opinion leader in your community you can speak why don't we give you about three thousand dollars five nights a month and why don't you go and tell your friends and your community that this is a good drug use it I urge you to go to ProPublica calm put the names of the physicians you will be shocked to see that some physicians are earning between a hundred to five hundred thousand dollars a year speaking for the industry and promoting their drugs so let's say that the pharmacy pharmaceutical industry the doctors who have done the study are completely ethical they're aboveboard they have done nothing wrong that the data is robust and you say come and show me the best study you have done that shows that statin is beneficial you got to go back to 1994 the Forrest trial about 4,000 plus patients in Scandinavia half of them given simvastatin half of them not given similar a turn at the end of five years the reduction in mortality was 0.6 percent per year that is the most robust endpoint mortality zero point six percent per year okay now it would be honorable for the doctors and the pharmaceutical industry to say yes this is a result but they pointed saying that there was a 42 percent reduction in mortality now I borrowed these slides from Malcolm Kendrick I've used them before I would appreciate that even if you have heard it before that you laugh let's say the Colorado lotto if you buy a ticket the chance of winning is one in fifteen million and I come and say I'm an expert at predicting who will win I'll increase your chances by winning by 50 percent how much is that realistically that is one point five and fifteen million so in absolute terms that is 0.6 zeroes three so if I were a pharmaceutical industry I would sell my wares like this do you want to be a millionaire send me 50 bucks I will increase your chances by 50% this is no contract on the other hand if I were being honest this is what I would say that the pathetic desperate lonely doctorally can very minuscule II increase your chances of winning the Lord Oakley send me this much money you get the point so the truth is that you should always talk about absolute risk reduction never relative risk reduction so I don't want you to get bogged on by the slide I took a lot of time to prepare it and it has very useful information so in the LDL reduction line or showing the degree of reduction in LDL over time from 1994 to 2017 and on the Bott hallory benefit line is showing the degree of mortality benefit so the forest trial we've seen over five years three point three percent reduction but then 2004 was a landmark point in which the why ox trial came out when the why ox trial was evaluated it was found that Merck did data tampering the same company that did the forest study they also found that Merck had the data that showed that these people were having heart attacks what happened 88,000 patients had a heart attack roughly 40,000 patients died and when it came to light Merck paid five billion dollars in damages that's the first time that Congress put in guidelines that said that if you do a study you need to publish it because before that a company could do ten different studies hidden hide the nine and publish the one that showed benefit now that's when scrutiny started and if you look at the trial called the cards trial in diabetics thirty three percent reduction in cholesterol 1.5 percent reduction in mortality but that was before the clinical trial guidelines a similar trial was conducted right after clinical trial guidelines same group of diabetic patients similar reduction in collected cholesterol zero reduction in mortality the Jupiter trial this trial reduced cholesterol by over 50% the reduction in mortality was half a percent the fourier trial that I will show you reduce cholesterol by almost 60% it had 28,000 patients there was a slight increase in mortality so how did the mortality benefit miraculously disappear so I'm an Indian and I get very compassionate and when I get like that I talk very fast so I find that actually I have five more minutes so this is telling you what pcsk9 does and I don't know if they're doctors in this audience so I want to go over that the pcsk9 comes in and tells the body that something is happening let's down regulate the LDL receptor so let's remove the LDL receptor from the liver so that more LDL is there in the circulation why is it doing that it's an acute phase reactants in other words if you have an infection pcsk9 goes up the LDL is there as we have seen to fight infections to modulate inflammation to do cell repair and in a time of need provide energy but for whatever reason the people want to use pcsk9 inhibitor to remove the pcsk9 and as the pcsk9 has removed the LDL receptor is present on the liver and it mops up and takes away all the LDL so the LDL levels go very low with pcsk9 and with low LDL number perhaps all the beneficial effects of what LDL is doing also go away I refused to call LDL the bad cholesterol so what happened in this study this is the study on pcsk9 in 28,000 patients they dropped the LDL cholesterol to 30 milligrams per deciliter what they were more deaths in the group that got the pcsk9 I would think that this is what you should say that John Abrahamson said dying of correct corrected cholesterol is not a successful outcome pcsk9 was designed when humans were going through a nutrient depleted environment we had unpredictable fasting it was designed so that you would have the ability to fight infections that your body can be provided with energy it also has many other functions that I will not get into so the Big Pharma the food industry near hundred percent of cardiologists the american heart are telling us eat a processed vegan diet take statins take pcsk9 inhibitors they want to wipe the LDL and the pcsk9 out of our bodies should we do that and I'm using a nice tagline from dr. Mercola because he says take control of your health do your own critical thinking so when I prescribed a statin I think that I need to discuss with the patient the risks and benefits that's informed consent because should i view startings as might record mitochondrial toxins something that affect memory and cognition that cause vascular calcification that caused insulin resistance that from more oxidative injury that damage your muscles that most of the trials that have been done are conflicted by industry interest so I'm gonna use this and the next as my last slide and I think that as a physician I have a right to say this I think that physicians have abdicated their clinical responsibilities to their patients they are looking to key opinion leaders big pharma food industry various medical societies and they are failing to talk to their patients they seize their clinical thinking abilities so I think we should accept some responsibility that this is right that we are probably the first or the second leasing leading cause of death in the US and worldwide thank you [Applause] [Music]

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Keywords: Low Carb Down Under, LCDU, www.lowcarbdownunder.com.au, Low Carb Denver 2020, #LCD2020, #LowCarbDenver, Nadir Ali, @eatmostlyfatali, CVD, statins, LDL cholesterol, heart disease, cardiovascular disease, lipoproteins, HDL, dolichol, CoQ10, ATP, Pravastatin, Big Pharma, PCSK9 Inhibitors, Abetalipoproteinemia, Chylomicrons

Id: o_QdNX9etCg

Length: 31min 49sec (1909 seconds)

Published: Sat Jun 27 2020