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