Heart Surgeon: Spike in Heart Deaths from Eating THIS Way w/ Dr. Philip Ovadia

is there anything that we can do to reverse atherosclerosis particularly of the coronary arteries yeah so reversal of atherosclerosis is a fairly controversial topic I'll say and a lot of it comes down to how are you measuring the AOS sclerosis so we can look at something like a coronary artery calcium scan which I think is the best screening test um for Athos scerotic heart disease and you know whether or not you can actually reverse coronary calcium whether you can lower Cor order calcium scores um is controversial but I've seen it happen in practice so it is possible um and then when you go beyond that and if you look at something like a coronary CT angiogram which is going to show you both soft plaque and calcified plaque you have more capacity it seems to reverse the non-calcified soft plaque than you do the calcified plaque so I do think think um reversal of heart disease is possible uh just conceptually I think that you know the body can heal itself so why wouldn't it be able to heal this damage when it can heal all other sorts of [Music] damage Today's Show with Dr Phil ldia who's by the way a cardiovascular surgeon and this is a phenomenal discuss probably one of the most comprehensive conversations we've ever had on all things cardiovascular and metabolic health I really really hope you enjoy this episode brought to you by myoscience nutrition because we're talking so much about the importance of metabolic Health you need to know about bourine hydrochloride this is a natural product that has been used in traditional Chinese medicine for the better part of 3,000 years what I love about berberine is it's a natural appetite suppressant and many of us derail our metabolic Health Quest and journey by consuming some junk food cooking cookies crackers treats and ice cream or even alcohol in the evening time and so bourine can be used to help curb those pesky evening food cravings in addition to supporting fasting physiology increasing ketones and helping to support overall metabolic health so you can save on this unique formulation known as the burine fasting accelerator over at myoscience decom that URL again is mxci nc.com myoscience with the X and be sure to use the code podcast at checkout so before we cut back to it with Dr philia I just want to say this is a phenomenal episode I really hope you enjoy it I think you'll find the show notes very helpful in this conversation we talk about cholesterol we talk about natural ways to reduce blood pressure how to optimize hormones we talk about potential problems with seed oils we talk about so much more definitely check out Dr Phil's book that I will link in the description below and without further Ado let's cut back to it and talk about all things cardiovascular disease prevention well Dr Phil it's great to be with you I know we've uh had conversations over the years about doing this together and here we are at metabolic Health Summit uh in Tampa Florida so Cardiology and cardiovascular disease unfortunately as you know the stats you know 630,000 people every year are dying from this very preventable disease and and as a cardiac surgeon you've seen many people on the operating table who probably shouldn't be there had they not made a lifelong of series of uh poor lifestyle choices so um how preventable is cardiovascular disease uh particularly in people who have a first-degree relative who might have high blood pressure or for example in my case my grandfather died of congestive heart failure at 74 didn't exercise ate a lot of processed food things like that so how preventable is this if we are at higher risk yeah that's a great question and I think ultimately most heart disease is preventable and I would say you know some of the statistics would suggest up to 90% uh of heart disease is preventable we've gotten this concept um that genetics are more important than they actually are and I think what we've lost sight of is within families it's not just genetics that get get passed down it's habits uh and these habits we know have a you know massive influence on our health we have the statistics 88% of the adults in the United States they're in not optimal metabolic Health um when you go back it's interesting in the cardiac literature um you know when you go to sort of the era before we were so focused on cholesterol there was a lot of interest in insulin resistance and it's relationship to cardiac disease Gerald Ren uh among others did a lot of this work and his studies suggest that up to 95% of patients with cardiac disease are insulin resistant and we know that insulin resistance is largely reversible so that tells me that a very large percentage of cardiac cases are preventable and quite honestly today you know I consider that every patient that ends up on my operating table is a failure of the medical system I'm not blaming the patient the patients gotten bad advice bad information um and you know a lot of times the patients are following the advice that they've been given by their Physicians but they're getting bad advice from their Physicians so I view it as a failure of the Health Care System almost each and every time a patient ends up on my operating table which is really unfortunate and part of that back advice is adhering to a lowfat diet you know we've been told over and over again for the past 60 years that fat is the problem and it's SOC calleded clogs the arteries of the coronary vessels and so forth and um why is that in your opinion now if if we know that majority of cardiovascular disease has some element of of insulin resistance how is the lowfat diet advice exacerbating this underlying problem for people yeah the problem with the low-fat dietary advice is it pushed people towards a a higher carbohydrate diet and a more processed diet and we now know I think the evidence is abundant that processed food and high carbohydrates are the two primary drivers of metabolic disease and metabolic disease and insulin resistance is the primary driver of heart disease so this focus on fat um which again has been thoroughly disproven you know dietary saturated fat as a driver of heart disease has been thoroughly disproven in the um in medical literature you know and even the American Heart Association and the dietary guidelines have removed the limits you know the suggested limits on uh saturated fat from the diet yet it's still a commonly held belief among practitioners and the general public that you know saturated fat in the diet is bad and low-fat diets are beneficial um what I look at is you know we've run this experiment to its completion as you said 60 years we've been giving the same advice you know lowfat diet um and it's failed miserably heart disease Remains the number one killer um we really haven't had a meaningful impact on the incidents of heart disease we've gotten better at keeping people with heart disease alive longer because we have things like Sten and bypass surgery that we can do more successfully but most of those people still end up dying of heart disease they just die later of heart disease and they're sicker in the process and quality life is not as good and all of that exactly so what is it about the heart and insulin resistance specifically that exacerbate the functional decline of the cardiac muscle and and maybe we can speak to the coronary arteries and atherosclerosis I mean I think this is really confusing for a lot of people because you hear about this narrowing of the arteries and part of that is calcium and and cholesterol deposition and so forth so why is how is it that humans in physiology we haven't sort of figured out a way to better inate the the heart muscle so to speak and why are these arteries so susceptible to becoming uh uded or or narrowing or or clogged if you will yeah so um it's interesting when you look at the impact of insulin resistance on the blood vessels in general throughout the body um you know again we can demonstrate that they damage the blood vessels um why are the blood vessels in the heart more susceptible than perhaps blood V vels elsewhere um I think first it probably just has to do with a size issue um the blood vessels on our heart are some of the smallest arteries in our body um and they're serving a very important function uh you know so when a blood vessel in your leg especially a small blood vessel in your leg might get blocked up um you may not notice much effect from that uh but on the heart you know that blood supply is so vital uh and so I think that gets magnified when the blood vessels on the heart get damaged and get blocked up and that's why Athos scerotic heart disease is such a um impactful disease you know uh blood vessel disease atherosclerosis elsewhere you can live with you know it's going to impact quality but it doesn't tend to be lifethreatening in the same way that AOS scerotic heart diseases and for reference point for people if they're envisioning like a shoelace or a pen how big or small are the coronary arteries like what's a reference that we yeah so um we're really talking uh you know a couple of millimeters uh so you're talking like a a a spaghetti strand um you know is uh the coronary arteries the blood vessels on the surface of the heart that are then supplying the muscle of the heart with oxygen and it's usually those vessels that become included or clogged where you have to come in as a surgeon to then or the cardiologist will stent them or you do bypass is that really part of the pathophysiology correct yeah so AOS scerotic heart disease is the most common form of heart disease it's not the only one but it's the most common one and when most people are referring to heart disease that's what they're referring to and you know at its Essence atheros scerotic heart disease is a buildup of plaque in the arteries that will either slowly over time or sometimes quickly acutely um decrease the blood flow to the muscle of the heart and therefore decrease the oxygen supply to the muscle of the heart and then when you not getting enough oxygen to the muscle like any other muscle uh that is then going to start to damage the muscle and we would characterize that as an infar um yeah so it can either be if it happens suddenly and you completely cut off the blood supply that's going to be a heart attack a myocardial infarction if it happens slowly and you're kind of gradually reducing um you can get what we call esea uh which people will know as angena you know chest pains uh that aren't a complete loss of blood flow so you don't get you know dying of the muscle uh but the muscle can't meet its metabolic demands and obviously you know there are very high metabolic demands hands with the heart constantly beating uh so um that becomes a problem as well interesting and so is it the AIA that triggers the reduced cardiac output we hear about left ventricular hypertrophy in that and poor output and cardiac ejection fraction is it that the heart muscle is just not able to do its job is that leads to the atrophy that can be one of the consequences so you can start to get um you know what we call uh left ventricular dysfunction reduced e ejection fraction is another term that people will hear about uh but the actual function of the heart starts to diminish because again you it's that muscle isn't being supplied with enough oxygen and blood and energy to do what it's being called upon to do fascinating stuff so to summarize the the metabolic millu from insulin resistance is just causing vascular dysfunction throughout the body but we're seeing the manifestation of that more prominently in the heart because the vessels are very small and the heart is very metabolically active uh what comes to my mind is the importance of exercise if we think about exercise all of your muscles are getting blood flow including your heart so it seems like in addition to cutting out the processed foods and Seed oils and sugars and things like that exercise is wonderful for the heart and possibly keeping these arteries from becoming occluded or narrowed yeah so you know exercise has never really been shown to help uh prevent atherosclerosis um but that that doesn't mean that it's not beneficial and you know the way to think about it is the stronger your heart is to start with the more it's going to be able to tolerate um you know the decreased blood flow so as you're having decreased blood flow you're going to have more capacity to deal with that I guess is how I would put it um and it's like any other muscle you know the bigger it starts if it then starts to atrophy or weaken uh you know you're going to be able to tolerate that from a symptom atic standpoint but it doesn't really change the damage that's being done uh so you know exercise is certainly helpful and we know that things like building muscle can help protect your metabolic Health can help protect you from insulin resistance so in that sense it kind of indirectly is helpful in preventing atherosclerosis interesting there was a recent study I'm sure you came across it uh individuals who had angina went to a I think it was a just a hospital type setting they followed these people uh over years and they looked at their isometric leg strength and they found that people who had lower leg strength upon admission to the hospital for Angina lived much or sorry lower leg strength lived much shorter died from a future cardiovascular event compared to people who were stronger and in my opinion um that was probably related to their you know uh activity levels of daily living exercise and all that but if you have a weak muscle in the heart it makes sense that if you do have this narrowing that it's just going to be more vulnerable to Future challenges yeah exactly and and uh grip strength in a similar fashion has been shown to be one of the best predictors of uh not only lifespan but Health span you know Functional Health span um and the bottom line is the better you're able to maintain muscle as you age um the better you're going to deal with the aging process love that I want to get into blood viscosity and and more exercising diet specific things but you mentioned exercise does not reverse atherosclerosis um there's been some talk about proteolytic enzymes and fasting and autophagy and uh re uh daptin nib and Romas and all these different things uh what comes to mind or is there anything that we can do to reverse atherosclerosis particularly of the Corn arteries yeah so reversal of atherosclerosis is a fairly controversial topic I'll say and a lot of it comes down to how are you measuring the artherosclerosis so we can look at something like a coronary artery Calum scan which I think is the best screening test um for AOS scerotic heart disease and you know whether or not you can actually reverse coronary calcium whether you can lower coronary artery calcium scores um is controversial but I've seen it happen in practice so it is possible um and then when you go beyond that and if you look at something like a coronary CT angiogram which is going to show you both soft plaque and calcified plaque um you have more capacity it seems to reverse the non-calcified soft plaque than you do the calcified plaque so I do think um reversal of heart disease is possible uh just conceptually I think that you know the body can heal itself so why wouldn't it be able to heal this damage when it can heal all other sorts of damage now what I think is important for people to understand is the data that we have on coronary artery calcium scoring shows us that as long as you stop the progression of coronary artery calcium as long as it's not getting worse over time um that means that you're at a lower risk for a clinical event so you know for people who uh maybe got their first coronary artery calcium score and it's elevated and you know they're thinking this is sort of a death sentence um I try and give those people hope I want to empower them to understand that you don't even actually have to reverse the disease you just have to stop it from getting worse over time that's really important like if you forly smoked or Vaped just stop now and you may not reverse that cified plaque for example but you it's not going to progress exactly and same thing from a dietary standpoint you know if you've um had a poor diet ate a lot of processed food um and you've developed this coronary calcium changing those habits can stop it from getting worse and again sometimes we see reversal sometimes we don't but as long as we stop it from getting worse that gives you a very good prognosis I love that I think that's really empowering for people at what age should folks consider start doing this and is the CCTA is the acronym for this coronary calcium uh CAC coronary artery calcium scan and then CCTA coronary CT angiogram uh so two separate tests very important for people people to understand as well the coronary artery calcium scan is kind of the screening test it's an easy test to do takes literally about 5 minutes in a cat scanner no IV no die very low radiation exposure so it's a test that I encourage people to get early and then to repeat over time to follow this progression the coronary CT angram is a more detailed test you do have to put an IV in you it's a higher radiation exposure so it's a test that probably can't be done as often on people and so I kind of use that as the second level test um if we have reason to be especially concerned um maybe you have a very high CAC score or you're having symptoms of heart disease the CT angiogram becomes a better you know a great test uh from a practical standpoint you know people are always uh thinking or hearing about you know how blocked are my order iies are they 50% blocked are they 70% blocked um the CAC scan doesn't give you that information the CT andram does give you that information so again I usually tell people start with the CAC scan I think for men um you know probably in your 40s is a good place to start women tend to be about a decade behind men in terms of their development of heart disease so 50s is probably okay now if you have a strong family history if you know you're metabolically unhealthy you're insulin resistant you're overweight obese you might want to start earlier um the reality that I see today as a heart surgeon is younger and younger patients are ending up on my operating table it's really not that uncommon anymore that I have 30 and 40y olds on my operating table which tells you that they probably started forming plaque in their 20s uh and so you know there's probably a lot of people that need to be screened even earlier right with a CAC and would that be an annual thing I mean let's say again someone's beening fast food smoking poor sleep works the night shift whatever is this an annual thing or every 18 months or how long how frequently would you recommend follow-up testing yeah so it's going to depend on your situation you know and you know if you get that first one and you have a zero score which is what we all want um You probably can wait a number of years the older you are with a zero score the more meaningful it is so if you're 60 and you have a zero score that tells us that over the next 10 years you have about a 1% chance of having a heart attack very low so you know if you're in your 60s you get a zero score you could probably wait 5 to 10 years now if you're in your 30s and you get a zero score not as meaningful and you know those people I usually say we should probably recheck in like two or three years um and if you have a nonzero score now I want to track that over time and those are the patients that I'm often times getting annual scans on to see their progression over time because again we know that if you don't progress or you progress very slowly that's going to be a better situation than if you're progressing quickly okay so let's say how often do you see this clinically because I'm sure a patient seek you out because you're getting your work out there with your book and and podcast which is fantastic an individual have zero calcium score but say a high LDL cholesterol or high APO lipoprotein B how common would that be now that so many people are doing low carb or zarb yeah so um I do have a very specialty practice and I attract a lot of these people because this is the very controversial uh situation and at this meeting you know two great presentations by Dave Feldman Nick norwitz on this topic um so my practice is admittedly biased but I see it a lot now uh cuz the patients find me and they have a high LDL and they've been told by their doctor that's a dangerous situation but they're metabolically healthy they're not insulin resistant they have low inflammation markers and they have a zero CAC score and ultimately I think that conversation has to come around to um the amount of your LDL isn't the whole story the quality of your LDL cholesterol particles is very important in this and so that where we get into advanced lipid testing looking at particle sizes um perhaps looking at oxidative oxidized LDL versus you know non oxidized LDL uh that becomes part of the conversation um but ultimately I think we're accumulating more and more data that shows us that all high LDL isn't the same and yes sometimes high LDL is a problem uh but sometimes it isn't right well this is a very nuanced perspective and I think it's going to take mainstream medical doctors a long time to Grapple their head around this because I used to actually sell a test that was a competition for the Berkeley heart lab uh analysis that came out I think in 2006 you know the the LDL subfraction testing has been around for a long time and still it's I I often see people that I work with on a nutritional perspective their ldls High we have no apob no subfraction uh how many more decades do you think it's going to be before this Nuance perspective is going to make its way into clinical practice yeah I think it's still going to take quite a while because quite frankly doctors aren't educated about this you know prior to my self-education process around low carb and ketogenic diets and stuff uh quite frankly I was never taught about LDL subfractions and and understanding the advanced lipid panel so I think very few practitioners are you know well-versed and knowledgeable in this and you know the the the Health Care System wants broad guidelines that are easily applied and the reality of the situation is that for most people with elevated LDL cholesterol that's going to be combined with metabolic disease as I said earlier 90% of adults essentially are metabolically unhealthy so for most of the people with high LDL they have that very dangerous combination of metabolic disease and high LDL but I think it's incumbent on us as practitioners to also figure out who doesn't fit in that situation you know who are these people that have a high LDL but they are metabolically healthy they're not insulin resistant their particles look good and so those people there's really no reason there's no data that we have that shows that lowering their LDL is of any benefit and there may actually be some harm associated with that in some of the studies we look at I love that I'm glad you hit on the fact that there are a large subset of the population that have high LDL in addition to high triglycerides low HDL insulin resistance in those situations do you recommend statins or do you focus more on the insulin resistance and weight loss what is the best clinical track because that's as you mention very common yeah so and that's exactly the conversation I have with patients in that situation um yes you can take medications to lower your LDL there is going to be a small benefit and understand that that benefit is a lot smaller than it's purported to be um and you're exposing yourself to the risk of you know taking these medications or doing the dietary interventions you know you can say Okay lowfat diet it's going to lower my LDL but at what cost right you know uh the cost meaning hormone issues brain issues memory decline diabetes what's the the consequence of lowering Alo with say Statin um so with statins again the medications yes exactly you know we know over the lawn long-term for instance that stat in use more than 10 years increases your risk of developing insulin resistance and type 2 diabetes which are two primary drivers of heart disease so this is why I think the Staten data is so disappointing when you really look at it objectively you know again the absolute risk reductions in heart disease um for people taking statins over long periods of time are minuscule they're like 1% 2% 4% in the best studies secondary prevention and people have already had a heart attack um but of course as you know you're well familiar with and a lot of your audience is well familiar with um you know we manipulate the way that this data is conveyed to the public and to practitioners we use relative risk reduction instead of absolute risk reduction and it makes it look like there's a greater effect than there actually is so that's the conversation I have with patients I said yes you can take these medications you can expose yourself to the risk of the medications or or you can change the way you eat you can deal with the true underlying problem insulin resistance and that does cause a much greater magnitude reduction um and you know if you fix your insulin resistance and again you shift those lipid particles to the large fluffy healthy LDL particles now again you're in that situation where the medications aren't going to be any benefit so you don't have to worry about them and most people when they're given the option in that way they're like sign me up tell me what to eat you know I don't want to take a medication for the rest of my life yeah especially as you mentioned the absolute risk reduction is single digit percentage so we're talking about very very small do you think some of the benefits of statins are the indirect so-called pleotropic effects of anti-inflammatory and this and there's a million other ways to reduce inflammation you is that part of it yeah definitely so you know inflammation is a very important part of the development of heart disease um and uh so statins do have an anti-inflammatory effect but as you said there are much better ways to lower inflammation without taking on the risks of statins sure uh along the lines of statins and not to Pivot too much away I want to continue this trajectory a little bit um but I was really surprised when I started work with a medical doctor in Colorado work U seeing patients on a nutritional perspective in his office jar gillery and many of these patients had high lipids and high blood pressure and they were given beta blockers and thide diuretics which as you know also have the same consequence as the statins do in in exacerbating insulin resistance and I I thought that was just so perplexing to me that the very conditions that are being used probably for to to mask the symptoms that are manifesting from their insulin resistance IE high blood pressure were causing more insulin resistance so can you speak to the people right now because there's many people still prescrib thide Dix and and beta blockers um maybe having a conversation about looking at something like an ARB or calcium Chanel blocker or ACE inhibitor yeah and really two parts of that conversation CU again high blood pressure is a huge missed opportunity you know the vast majority of hypertension high blood pressure the root cause is insulin resistance metabolic disease again so instead of just you know using the medication putting a Band-Aid on the symptom let's look at that root cause uh and you know so again patients that come to me with high blood pressure um often times we're able to get them off their medic when we get them when we fix their insulin resistance when we get them metabolically healthy their blood pressure improves and you can usually reduce or eliminate the medication um but I would agree that you know there may be better medication options other Alternatives like um ACE inhibitors or arbs um Ace receptor blockade um that uh might have advantages over beta blockers over diuretics um and again most doctors they're not trained to think this deeply about it you know they have the guidelines and uh they're kind of checking boxes off on the guidelines and they're really uh quite frankly not knowledgeable enough and they don't have the time to think about all these things and that's that's where the systemic issues come into play again yeah I'm glad you mentioned that because many of these doctors are really well- intended but to get paid or reimbursed especially if they take Medicare you know they're spending hours and hours documenting and they're just so backed up and it's just incredible the documentation and things like that which is really really challenging so um the oxidation of LDL cholesterol uh do you like to look at the ox LDL panels I know Cleveland Hart and some others are coming up with this let's just say someone's a little scared you know they low carb their HDL is low or sorry the HDL is high triglyceride is low but LDL is a little high they're concerned about this do you look at L oxidation is that something that's clinically useful or do you yeah so I don't um I'm not a big fan of the ox LDL test uh and the reason is that it it tracks with your LDL the more LDL you have the you know the more oxidized LDL you're going to have so we run into the same situation where you know a patient will get tested for that their LDL is very high their Ox LDL by the you know lab uh normals is high but as a percentage you know it's actually low uh when they have you know when they're not insulin resistant uh so I don't find oxldl ends up adding much uh above and beyond if you're looking at their particle sizes um now uh there is one Lab company that has a sort of indexed oxidized phospholipid test where they it's oxidized phospholipids um uh divided by apob so it's sort of controls for that a little bit that may be a better uh indicator But ultimately you know when you um if you combine um a advanced lipid panel and nmor panel that's going to show you your particle sizes you do an insulin level and some assessment of insulin resistance and that can be something like a hom IR calculation that can be the lipoprotein insulin resistance score lpir which I am a very big fan of um you know and you check some inflammation markers something like CRP that probably that gives me enough information um that I really don't necessarily have to go to the ox uh LDL test I like that because everything that you just mentioned are available in from Lab cor Quest you don't have to go to a boutique lab and spend $300 which is really fantastic what about uh iron you know we hear a lot about um Iron overload and and people have thick uh markers of increased blood viscosity you know hemoglobin hematocrit are elevated and all that what what weight do you uh consider that a risk factor and then do you ever recommend blood donation for folks yeah so um you know and this really looks at uh gets into fertin levels and fertin is a very interesting marker because fertin actually is measuring two things at once it's measuring your total body iron stores but it's also an inflammation marker it's what we call an acute phase reactant and it will go up with inflammation so when someone has an elevated fertin level you need to dig into you know is their fertin elevated because they have elevated total body iron or do they have inflammation or do they have both and um again that's going to lead you sort of down different Pathways um ultimately blood donation does reduce fertin we know that increased fertin is a risk factor for cardiovascular disease so if I have someone who has high fertin levels and we're pretty convinced that they don't have inflammation or they've addressed their inflammation um blood donation can be a useful tool uh in that situation but again it's not you know um I don't want to fall into the Trap of just saying High fertin go donate blood I want to make sure I want to figure out why is that fertin high yeah what's driving it yeah yeah that's really important I remember I took my labs I've been doing you know chem 24 and cbc's and just your standard blood work um a mentor taught me this in 2006 I happen to get some blood work after I got a cold and my fertin it looked as though I had hemocromatosis and of course you know the young naive uh overe exuberant Health Seeker in me was like okay I got to get this Gene test and this and my mentor said you're probably sick just rerun the test I was like okay and reran the test and sure enough it was back down to like 110 or whatever it was but it was like 500 so it really interesting to me to see the the acute phase reactant of ferian um being involved in immunologic responses after just like a seasonal cold yeah which was and you know that's a I think another good concept for people to keep in mind with layup testing in general you know it's Trends it's not necessarily A oneoff a onetime value you know I see the same thing with CRP testing C reactive protein another inflammation marker and people will come and their CRP is through the roof and then I'll be like well you know were you just sick did you get your blood work drawn after doing a very strenuous workout or you know an endurance event um I personally had the experience many years ago of you know my CRP usually runs pretty low and all of a sudden was high and you know again I'm going through that similar thing and I'm like oh I got badly sunburned like you know three days before um so you know uh with all of these markers you need to keep in mind context and you need to look at it overall and that's why I think narrowly focusing on just one marker is never a good idea like there is not one blood test that tells us everything that's going on in your body and that's one of the other criticisms I have about this sort of LDL Centric model we take people um that are doing for instance low carb ketogenic diets and we see all of these markers that move and what are considered a positive direction you know their hemoglobin A1c goes down their inflammation markers go down their insulin level goes down um and yet we get hyperfocused if one metric goes in what we consider to be the wrong direction their LDL cholesterol goes up and everyone freaks out and says you know basically I don't care that you've lost weight you're feeling better and all of your other markers look good because this one marker moved in this direction this diet must be killing you and you have to stop doing what you're doing it's wild it's just that dichotomous thinking you know we fall into these binary traps you know this is one thing is good or one thing is bad meat is bad all plants are good right these these conversations so yeah it's really important that we understand that um a little bit esoteric research suggests potentially that consuming linolic acid in the form of canola oil safflower oil maybe cotton seed oil may be increasing the susceptibility of LDL to become oxidized the so-called linolic acid LDL oxidation hypothesis um what are your thoughts on that yeah I think there's certainly some validity to that you know uh we have sort of the uh mechanistic studies that show this you know these polyunsaturated fatty acids are more susceptible to oxidation and that's going to be going on in our bodies um now you know what becomes tough to separate out is um you know uh kind of the question of what's the most dangerous part of processed food right we know processed food is bad and everyone wants to know well is it you know all the fake uh you know processed oils is it the processed carbohydrates is it the combination of it and in the end you know I kind of uh zoom out and say I don't know but I know that not eating processed food is good for you so eliminate the processed food and that's going to kind of eliminate all of the stuff at once you know again short of I guess you know drinking vegetable oil uh you know you're not going to get exposed to these vegetables and Seed oils in high quantities if you're not eating processed food uh and so that's why you know I try and keep the advice simple for people and my message is just eat whole real food first and foremost I love that and it seems that the the research is a little bit biased uh towards a plant-based diet when it comes to preventing cardiovascular disease and this um what would be your thoughts on that what yeah so I think plant-based diets have been shown to be better than standard American diets and again that's largely because some plant-based diets eliminate processed food now you can do a highly processed plant-based diet and I don't think that's going to be any better for you um but I think any diet that eliminates processed food is going to improve um you know your outcomes uh what's never been done is a plant-based a nonprocessed plant-based diet versus a carnivore diet for instance that that comparison has never been done um and then you know what happens in this uh sort of plant-based focused world is they say okay you know we've eliminated processed food our health got better and it has to be the meat that's part of that processed food right they um they don't separate out uh the fact that you know when someone goes to McDonald's and gets a hamburger um you know yes there's meat there but there's the bun and the fries and the soda and the toppings and you know that is never really separated out well in these studies that show benefits of plant-based diets really important point and especially considering the fact that Chris Gardner at all over at Stanford recently published that St study randomizing twins to either eat a healthy om nervous diet versus healthy plant-based diet and we just spent the last 10 minutes talking about how myopically focusing on LDL cholesterol is missing the boat but curious enough even though that was published in the New England Journal of Medicine that paper myopically focused on the LDL cholesterol um what would be your thoughts on that why why aren't we looking at body fat percentage changes waist circumference changes trist ride elevations the plant-based diet group versus I'm never you know any comments on that yeah I think the reason they don't look at it is cuz they don't want to know what that data is going to show you know LDL is a um serves that dual purpose of you know yes eating a plant-based diet versus a you know omnivorous diet is going to lower your LDL cholesterol and you know the assumption that we've now accepted in the mainstream is that that's going to lead to Better Health outcomes and I would argue that we really don't you know that contention isn't supported uh in the literature um but it's used as another vehicle to promote plant-based diets and you know we know that there are many non-health related reasons that plant-based diets are getting um you know pushed And So It just fits into the overall narrative and I think that's what continues this myopic focus on LDL cholesterol yeah uh what about the omega-3 index so Bill Harris has U popularized the use of quantifying the percentage of omega-3 fats as a percentage of fatty acids in cell membranes what do you think about that for preventing sudden cardiac death and and do you recommend people take omega-3 fats um yeah so I think the omega-3 index is important um but I think what gets misunderstood about it is that supplementing omega-3 isn't the best way to improve your omega-3 index it turns out that lowering your intake of Omega 6 um is a better way to improve your omega-3 index so um you know the data around omega-3 supplementation fish oil supplementation is really all over the place you know some studies show benefit other studies show harm uh and many studies are kind of neutral effect um so again it's and this is another concept that I think we see uh repeating itself in medicine you know we look at the level of a marker um and vitamin D is another good example and you say Okay low vitamin D definitely correlates with all sorts of disease dises um but that doesn't mean that supplementing vitamin D is going to eliminate these sources uh and I think if you can find ways to improve these markers through your diet and your lifestyle that's always going to be better than the supplementation approach well so many people are scared of the sun I mean that's a problem so it's like okay take the pill or go in the sun sun equals wrinkles skin cancer so I'm going to take the pill uh but we know that there's many other intangible benefits I mean it's very sunny outside I just went in the Sun for an hour and but cell therealist dermatologists and so yeah um what are your thoughts instead of supplementing with vitamin D get go exercise Outdoors yeah no definitely and again I think sun exposure is something that we've misunderstood uh you know and again ties into all of this one of the reasons that um the skin um is susceptible to damage from the Sun is when we have high concent ations of polyunsaturated fats in the cells of our skin and the subcutaneous you know the fat layer underneath there uh so again many people have had the experience and this hasn't been I would say scientifically validated but many people have had the experience that when they eliminate polyunsaturated fatty acids from their diet all of a sudden they don't sunburn anymore and they're able to better tolerate being out in the sun for hours and you know again that raises their vitamin D level and has has all sorts of beneficial effects uh so I'm a big fan of getting out in the sun I think it's certainly one of the pillars of good health uh and um I consider myself fortunate to live down here in Florida and to be able to get out in the sun most of the year that's awesome and so do you wear like a zinc sulfate you know natural sun block if you're going to be in the Sun for extended periods of times or are you not worried about that no I've really stopped using uh you know uh any sort of uh sunscreen load ions um you know I kind of I think I just have a a um very practical approach that if I feel like I'm getting to that point that you know you go inside or you put a shirt on or you know and you cover up uh but um again I've had that same personal experience of going from being a very easy sunb burer to now I can really be out uh for hours in the you know Midsummer midday Sun without sunb burning yeah that is so I've been hearing that from so many people and myself have experienced that as well um I would love to see a case study or a clinical trial on this because it's incredibly fascinating um one biomarker we haven't really talked about is triglycerides and there was this whole notion of looking at non-fasted triglycerides because in the postmill window you get this uh uh issue with uh hyper lipidemia and Hyper triglyceridemia specifically what do you think of triglycerides as a biomarker and maybe even how would you correlate higher triglycerides with in terms of how would you weight cardivascular risk we talked about LDL versus triglycerides where do you wait those two biomarkers yeah so I think triglycerides are a very important uh marker in most uh studies the triglyceride in most studies that look at both triglycerides and LDL in terms of their magnitude of risk triglycerides comes out as a higher magnitude risk factor than LDL cholesterol and you know there are confounders there because triglyceride Ides is one of our markers of insulin resistance you know insulin resistance raises triglycerides insulin resistance also is going to affect the quality of your LDL particles uh so um lowering triglycerides um by improving your metabolic Health definitely beneficial now it's interesting the um studies using drug therapy to lower triglycerides are not as clear and the main agent that we have uh from a drug standpoint to lower triglycerides is actually high does EPA Omega-3s um you know and um I would say the data on those uh Pharma agents has been mixed kind of unimpressive to be honest uh but you know I think when you lower your triglycerides by changing your diet changing your lifestyle improving your insulin resistance at the same time uh definite benefits there and uh highly encourage it so I think triglycerides are a great marker it's one of the main things I look at with my patients as well and it's nice because it's easy you know the the patient that has come to you that you know their practitioner will only order the sort of basic blood work you know the lipid panel uh and again they've ordered it because they're looking at the LDL and I'm looking at the triglycerides you know more so than the LDL yeah I think it's been incredibly fascinating and the fact that more Healthcare practitioners are actually encourage encouraging patients to not fast before looking at these lipid markers is interesting I was playing around in 2017 doing the Bulletproof Coffee and things like that and I found my triglycerides tended to increase pretty profoundly after and so having Bolis amounts of liquid fat was something that I changed my mind on as being heal Health promoting now if I had Parkinson's or was working with someone with Parkinson's that needed to be in a deep state of ketosis that would be a little bit different but um I think that the utility of non-fasted triglycerides as a indicator of insulin resistance which is driving everything we've been talking about is pretty interesting yeah and you know as we get more and more capabilities to monitor things on a continuous basis um certainly the continuous glucose monitor has become ubiquitous but you start to think about what other markers might be useful to uh to measure on a continuous basis and um you think about things like triglyceride or or maybe even free fatty acids even better uh you know ketones lactic acid levels um as the technology continues to evolve I think we're going to be able to understand a lot more about these dynamic fluxes in our body and what the effects of all these various things are on them and I am very optimistic about that because I think that then shows us the way you know uh when we can measure continuous glucose continuous ketone um you know continuous insulin levels uh and we see the effects of these dietary changes um that's going to lead us to uh the the true path uh to Better Health I I wholeheartedly agree I think apple is making some some progress there in other companies which are fantastic um I want to sort of close on hormones and I think it's important because a lot of women are going through menopause and one thing that you mentioned at the start is women are generally 10 years behind the men uh for as you can allude to shortly a lot of that is the hormonal shifts that occur through menopause um are you a big fan of of women after menopause getting on biodental hormones and things to help to prevent future carvas disease risk yeah so I would say that um you know it's interesting the the thinking on this you know and the shift so of course there was a concern um going back a number of years that things like hormone replacement may increase increase cardiovascular risk and that was based on some studies that were probably uh flawed um there's also the confusing factors of you know how are you replacing your hormones are you using bioidentical or are you using synthetic hormones I think clearly bioidentical hormones are better um I think um if you're having significant symptoms of you know menopause per menopause I'm a big fan of bioidentical hormones and I think we have the data now to inclusively say it's not increasing your cardiovascular risk at all and it very well may be decreasing your cardiovascular risk so um women shouldn't fear doing it uh and you know I would tell them that it primarily should be used basically to manage the symptoms of um uh of menopause and perimenopause um I wouldn't do it primarily to lower my cardiov vascular risk but that might just be a good side effect of It ultimately right so if one is having symptoms you know U hot flashes for example low energy low libido vaginal dryness all that consider hormones now what about for men because we know low testosterone is an independent risk factor for heart disease right yeah and you know what's interesting about the low testosterone data uh is again how much of that low testosterone is actually due to metabolic disease because one of the things that I've now started to see consistently in my male patients is when we improve their metabolic Health their testosterone goes up uh so it's another example of let's not just treat the number let's figure out why that number is low uh and if we can get to that root cause um that's you know going to have better effects than just treating the number with testosterone replacement therapy ultimately again I think similar to the conversation around women's hormones if you're having symptoms of low testosterone testosterone replacement can definitely be helpful I like I prefer before you go to that route if you can figure out why your testosterone is low if you have unrecognized metabolic disease which many men do uh let's fix that first and then let's see if your testosterone is still low and you're still having symptoms then yeah certainly I think trt can be helpful and again trt similarly there have been concerns that you know can it increase cardiovas vascular disease um I think well done trt is very safe um poorly done trt I think can get into those effects so for instance if you're running very high testosterone levels and that's going to increase your um hematocrit the concentration of red blood cells uh in your uh blood um that can get you into a situation where you're increasing your risk of cardio of blood clotting and cardiovascular disease so uh you just want to avoid that situation but if you're doing you know trt well and someone's monitoring you well and your levels are staying in the reasonable range not a not a concern right I think that's a really important qualification because many people are at high risk or um they're not addressing the root cause of why the trt is low and just hopping on trt and having the thickened blood and everything like that could be problematic so again uh this theme is recurring from fish whs to using fish will to lower trig threads to just masking metabolic dysfunction with giving hormones we got to address the root cause and that is metabolic syndrome and insulin resistance and it's Associated seila which is really important so the um reducing intake of processed foods junk Foods bakery Goods um are there any studies you know people that are going in for bypass is there certain foods that are commonly these people commonly eat that Sugar Sween beverages sodas smoking is can we pinpoint it down or is it just all the whole bucket of processed food that really is causing that yeah I think ultim ultimately you know the bucket of processed food um you know in the same way that U you know trying to villainize meat as you know one aspect of it I think trying to villainize you know one particular part of the diet becomes difficult you know can I really say it's sugar versus um you know the vegetable and Seed oils for instance so um I think elimination of processed food eating whole real food um that's really the uh sort of high arching highlevel concept uh that I put forward to my patients and um you know it's interesting in my heart surgery patients I'm now able to have that conversation with them you know and the conversation is that the heart surgery isn't fixing the underlying problem it's not addressing why you got here in the first place it's often times necessary life-saving you know can make the patient feel better can literally save their life in the midst of a heart attack um but it's still not addressing the underlying root cause and if we don't address the underlying root cause together with the heart surgery or putting the stent in um those patients still usually end up dying of heart disease uh like I said earlier so now uh I am better prepared to have that conversation with patients and while my primary goal is to keep people off my operating table um even if you end up on my operating table I want to keep you from coming back to the operating table and there's still a powerful opportunity to do that that's huge uh what percentage of these patients are morbidly obese or obese I mean there are a lot of skin fat on the inside skinny on the outside so-called tofy phenotype in these people that are that you're operating on yeah we do see that um you know the the perception again is or the misperception is that only obese people end up needing heart surgery and develop heart disease and that is certainly not true I operate on plenty of people that appear lean and again the common finding is they usually have a lot of visceral fat they're usually that kind of toofy uh thin on the outside fat on the thin thin on the outside fat on the inside like you said uh and when you look at their metabolic Health markers you see the metabolic disease there and do you actually see the ectopic lipid deposition in the heart when you're operating yeah so um you know uh epicardial fat the fat that's on the outside of the heart is another form of visceral fat you know we talk about the visceral fat usually in the abdomen but I see it on the heart as well uh and you know I can do comparisons between patients that I'm operating on their heart for non atheros scerotic reasons you know people maybe with a valvular problem or A congenital heart problem you know and comparing those hearts to the patients with AOS scerotic disease you can visibly see the difference you know I've I've posted this many times on social media you know that we definitely get that visceral fat covering of the heart uh and it sometimes it becomes a challenge to me as a surgeon to even find the blood vessels under all that fat you know that we're trying to do the bypass to so bad situation so do you suck it out I mean what do you do in that scenario uh no we actually kind of cut through it essentially to get to the blood vessels that are underneath wow so it becomes embedded in the heart muscle on top like a sheath it's on top yeah it's an outer covering essentially that crazy yeah so the body's just trying to to get it's just fat overload from probably conversion from sugar suar excess energy and it's just putting it everywhere is that what's going on yeah yeah that's pretty scary to think about that's that's happening to the liver and the pancreas in the heart I mean wow I mean I think if people could see that on an MRI what their food choices are doing that would probably motivate them to stop you think yeah I think so and I think Imaging for visceral fat again is another powerful tool that we now have available to us you know going back to the coronary artery calcium scan one of the things that's interesting is um you know the way way that the scan is done they'll get to the upper abdomen and we can see the liver and we can see fatty liver and we can see visceral fat depositions uh so um besides just getting your coronary artery calcium score um you know I always encourage my patients like I want to see the actual pictures and I think doctors should do this more look at the actual pictures because it's not just about your calcium score you know if you have a zero calcium score but I see a fatty liver and load of visceral fat like you're still in danger and we need to address this so the the CTCA is is looking at that anyways you might as well get the data as what you're saying exactly and unfortunately a lot of times the the uh Radiologists the doctors reading the study aren't looking at that because they're focused on you know the reason we got the test which was the coronary Ary calcium score but more and more I am seeing Radiologists uh kind of wake up to this fact and they mention fatty liver or you know increased visceral fat uh and again that can be another useful indicator of where you stand totally yeah if your body's getting the radiation you might as well get the report you know exactly um final question for you what about um kateed artery uh Med cred intimal media thickness C IMT what's the value there is there any um there's some but I don't think it's as good a test you know the the advantage of the cimt test is it's more easily report uh repeatable you know it can be done in the doctor's office um if it's done well I think it's an okay marker doesn't always correlate with what's going in the heart uh going on in the heart but um there is some correlation it can be an early indicator and like I said it's more it's even more easy to repeat that than getting another Cat Skin there's no radiation um but it's got to be done well it's hard to get a truly consistent repeatable cimt assessment uh so it can be a useful tool I still prefer the coronary artery calcium score though maybe if we have robots in the future that can not have human air in there we could have a reliable cimt fascinating stuff uh Dr Phil I think we could talk all day about all these different topics but you have a great book and a YouTube channel yourself um where can folks find your book yeah so uh stay off my operating table is the book widely available all the usual places and then iFix Hearts is where to find me can go to iFix hearts.com social media find me at iFix Hearts um my team and I work with people in all sorts of ways I have a private tele medicine practice that I work with people oneon-one we have coaching individual group coaching programs we have a ton of resources courses the book out there so just um you know my overall message to people is figure out where you stand from a metabolic Health standpoint Empower yourself to improve your metabolic health and that's going to allow you to stay off my operating table ultimately that's key I mean I love that you have this resource because there's many people that are frustrated with their own doctor and they don't know where to go and I think you know your platform is a great tool for them because they can actually get science-based advice and work with someone like yourself um so that they're not banging their head against the wall fighting whether or not they should be on a Statin or whatever else medication so um yeah would love I just love that you're sharing this content which is fantastic so appreciate you coming on the show this is fantastic thanks Mike we finally got it done I know we did a lot of great info shared thank you

Channel: High Intensity Health

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Keywords: artery clogging, artery clogging reversible, artery clogging foods you should avoid, clogged artery cleaning, low cholesterol meals, low cholesterol, low cholesterol foods, is cholesterol a myth, is cholesterol reversible, is cholesterol bad for you (real doctor reviews the truth), is cholesterol hereditary, is cholesterol really bad, is cholesterol good or bad, is cholesterol bad for you, artery plaque test, clear artery plaque, arterial plaque reversal naturally

Id: 3HxGlXUcVrU

Length: 61min 31sec (3691 seconds)

Published: Wed Feb 14 2024