The TRUTH About Cholesterol and Heart Disease with Dr. Mark Hyman and Dr. Zach Bush

there is so much misinformation out there about cholesterol and heart disease that it may seem like an impossible topic to navigate but we're going to try to simplify it here for you when you stop producing cholesterol within every cell the cell membrane becomes rigid and in that lack of flexibility you age quicker statins poison our mitochondria these are the parts of the cell that are responsible for producing energy in the body it's so interesting to me that all of life comes down to really a single molecule and its transfer of light energy into the energy that your body would run on every year approximately 660 000 people in the united states die of heart disease contributing to one in every four deaths that makes heart disease the number one killer exceeding cancer now the most common type of heart disease is coronary artery disease which can lead to heart attack or myocardial infarction this disease is also highly related to stroke which results from blockage of the arteries to the brain which causes an additional 160 000 annual deaths in this three-part master class mash-up doctors zach bush and mark hyman take a close look at the physiology of heart disease its root causes and the conventional treatments that are commonly administered popular medicine has cast cholesterol specifically ldl low density lipoprotein better known as the bad cholesterol as the primary villain in causing atherosclerosis and heart disease and in response western medicine's answer to high levels of ldl has been the prescription of a class of pharmaceutical drugs known as statins statins are the second most prescribed drug in the united states the statins inhibit the body's endogenous production of cholesterol however if cholesterol was inherently bad for us why would our own cells produce it in section one dr zac bush deconstructs the cholesterol myth and explores the extensive functional role of cholesterol in the human body here's zach with is cholesterol the enemy in the 1970s we developed a fear of cholesterol we had started to see an uptick in cardiovascular disease and the like and we were pouring billions of dollars of infrastructure into building heart centers and and all of this around the country and we were starting to uncover in our scientific laboratories the mechanisms by which cholesterol forms plaques in the walls of arteries this correlation between cholesterol and the wall of the vessel and the presumably obvious connection to cholesterol in our diet began a journey into the corruption of our understanding of our food system that is now 50 years raging it has become so ingrained in us that is so difficult to pop any of us out of this rut of belief that cholesterol is the enemy cholesterol is the cause of heart disease so to get there i want to go on a bit of a scientific dive with you as to what cholesterol is and what are the critical roles it plays within the human body if you were to google the word cholesterol you're going to pop up with a whole series three pages of images that look like this some version of a clogged artery and so the whole understanding and belief of what cholesterol is is heart disease we don't want to think outside of the box of this pathology as to what cholesterol might do to us because we've built a multi-billion dollar in fact a near trillion dollar industry now over the last 40 years of all of the statin drugs that are blocking the ability of our body to make this cholesterol and so google and nobody else out there in the in the scientific milieu of what we call the pharmaceutical industry apparently wants us to know what cholesterol is because page after page it's heart disease it's heart disease it's death cholesterol is the enemy we need less cholesterol we need to decrease the amount of cholesterol in your bloodstream to save your life that's the dogma that's out there and let's take a look now at the reality the reality of the broken heart is not one of excess cholesterol it's as a it's actually a dysfunction within the flow state of the body and ironically the very thing that creates the ability of flow to happen through every one of your blood vessels that might actually be damaged to the point where you would have cardiovascular disease that flow state is actually allowed by cholesterol and so i need to take you on a bit of a journey to show you that everything we have vilified in this area of heart disease is actually the opposite these are the solutions that are in front of us and it begins with the roles of cholesterol within the biology this image here is showing you the structure of cholesterol it's rings of carbon and oxygen combined with a long chain of of carbons that look like a fatty acid and so there's a couple of different portions of this that behave differently in environments of water and oils the rings are what we call lipophilic they will bind to the oil type structures within a cell plasma cell membrane that would be the structure in the uh infrastructure of every single cell in your body and so this lipophilic ring structure binds to the phospholipid membrane and then the hydrophilic or water loving part will hang between the two membranes and in this it will create a more complex structure to the plasma membrane that will allow for some critical functions interestingly this cholesterol is built in every cell of your body cholesterol in the diet only comes from animal products meat dairy eggs the like and so as you start to consume cholesterol it has the option as shown here on the right side to absorb that cholesterol at the cell membrane level pull it into a liver cell for example process that into a number of different types of fats that would then be trafficked out to the body including cholesterol elements that whole process of absorption doesn't occur at all in a plant-based diet you absorb no cholesterol from your diet if you're only eating plants instead you produce all of that cholesterol necessary for all the cellular functions within each and every cell the molecule that that cholesterol begins with is called acetyl-coa and it turns out that this is actually the molecule that both glucose and fatty acids turn into in a single step when they enter a mitochondria we'll get that later in a later segment within this but it's interesting when you when you hear the word acetyl-coa maybe completely new to you maybe some ptsd from biology 101 or you've never heard it but i want you to remember it when we get to the glucose and carbohydrates because it turns out that sugars fats and cholesterols are all built from fundamental same building blocks in the body it's so interesting to me that all of life comes down to really a single molecule and its transfer of light energy into the energy that your body would run on acetyl-coa is then restructured into this complex structure that is called cholesterol and in its absorption or production within the cell it integrates into the double plasma membrane that would allow every cell to have its barrier the flexibility of this double double-walled cell is determined by how much cholesterol is integrated so if you have less cholesterol integrated into that cell wall it becomes rigid rather than fluid and flexible in its rigidity it ages faster and injures more quickly just like a muscle that loses its flexibility it is more likely to tear more likely to injure catastrophically and take you out of the game when you stop producing cholesterol within every cell the cell membrane becomes rigid and in that lack of flexibility you age quicker the yellow cholesterol that shows integrated throughout this plasma membrane is nowhere near the reality cholesterol is gathered throughout that whole cell membrane integrated at nearly every interval of a phospholipid to make more flexibility within that membrane in a healthy body as we age and as we gum up the enzymes that produce the building blocks for cholesterol as we go on drugs that prevent our ability to go in cholesterol we can't integrate as much cholesterol into that double membrane and they become rigid and so it is for that posse that we lose flexibility and flow state at the vascular level and in fact if we go on a drug that stops our ability to make cholesterol we ensure that in the years falling we will have more rigid blood vessels they may not have cholesterol plaques in the same way but they will certainly be rigid and for that we continue to have heart attacks the introduction of statin drugs have had no impact on the rates of decline of heart disease that was a different public health intervention that's improved that and we'll take a look at that in our later section but it's interesting to note that the lack of fluidity the lack of flexibility within your blood vessels guarantees continued cardiovascular disease in the face of a statin that's stealing away your flexibility the fluidity is also then joined by the protective capacity of that cell wall every cell wall is a firm barrier between the outside world and the extremely exquisitely controlled internal environment of the cell the cytoplasm within the cell is is monitored and cared for so carefully to make sure that the osmolality is right that the the salinity is right the amount right amount of electrolytes are in there that is hydrated that you have energy delivery in there it is kind of the holy of holies here protected within this double cell membrane if it does not have enough cholesterol it begins to leak the permeability goes up and so if a doctor comes and tells you he needs to put you on a drug that's going to gum up your ability to make cholesterol in every single cell of the body know that you're about to lose flexibility in every cell of the body and you're about to leak worse in every cell of the body and so we have a fundamental problem here with our understanding of cholesterol it is the the backbone of flexibility and and regenerative qualities in cell membranes and it is the barrier system that allows for a cell to protect itself the third and fourth mechanisms of cholesterol are extracellular outside of the cell and these get interesting one of them is bile salts and so the biosynthesis that happens from the liver that goes on to produce the liquid that is then secreted by the gallbladder and the pancreatic duct and everything into your small intestines every time you eat is the way in which we liberate nutrients and bioavailability of the the food that you just consumed we need the cholesterol production to allow for that bile salt to make the food that we eat bioavailable to us that is a phenomenally critical step in being nourished being fed by mother earth and if we go on a statin drug or some other drug that blocks our ability to put adequate amounts of cholesterol into that bile we start to diminish our nutritional capacity next up is steroid synthesis this happens throughout the endocrine system in multiple organs none of the steroids estrogen testosterone those are the common ones but also the less common ones understood vitamin d things like this are all dependent on the formation of cholesterol at the beginning of synthesis of those complex molecules you would not have any reproductive capacity if not for the gift of cholesterol we have demonized the very building blocks of the endocrine system when we told you that cholesterol was the problem all of that said the cross hairs of the whole statin movement and low cholesterol movement fall right here on the lipoproteins the lipoproteins are the elements in which we carry cholesterol throughout the body in the forms that might be familiar to you with your annual exams ldl cholesterol hdl cholesterol and the like those are descriptions of large protein and lipid structures that circulate throughout the body with great purpose you've probably been told that ldl cholesterol is the bad cholesterol we'll go into more detail later on this but it turns out that ldl cholesterol is actually made as an anti-inflammatory for your blood vessels by the liver hdl then recycles that cholesterol back to the liver once it's done its work as an antioxidant when you are put on a statin drug you are being given a drug that will take away your liver's capacity to make the one of the primary anti-inflammatory systems for your bloodstream the ironies could not run more deep we could not have the model more 180 degrees wrong than we do on cholesterol in the end it's critical for you to to take these bullet points forward i want you to write these down every time you go to an annual exam because one of these days your doctor is going to sit down and say there's too much cholesterol in your blood we should start you on a statin and you can pull it out and say okay doc that sounds reasonable but can you explain to me what's going to happen if i go on a statin drug and you take away every cell's ability to make cholesterol and i start to lose the flexibility of every cell wall and i start to to increase the permeability i lose the protective quality of every cell wall in my body 70 trillion human cells suddenly leaking and what what happens to my bile production when you decrease cholesterol in my bloodstream and my liver metabolism how do i get my nutrients out of my food if my bile is deficient in cholesterol how do i make my estrogen and testosterone how do i make my vitamin d without cholesterol if i lower my cholesterol with a drug that blocks my ability to make that in every cell of the body what is my life course going to be i may lower my cholesterol in my bloodstream but at what cost to the rest of my body if you're going to put me on a statin drug again lower my ldl my understanding is you just took away my main antioxidant for the blood vessel wall which is ldl cholesterol if you just repeat those bullet points back to your doctor he's going to sit there in silence because he forgot that all of those things were true i am telling you that we are so ingrained in this as physicians that we do not remember biology 101 from 25 years ago all we remember is the drug wreck came in last week and told us that this new super statin is more powerful than the other stat and you should try this one we are 25 years from remembering that cholesterol is a critical building block for so many functions that are are absolutely necessary to your thrive state remind them with this short bullet list and move forward to a life that says ask the deeper question which is why is cholesterol needed in my bloodstream if you see it elevated that's a warning sign that you are doing something in your lifestyle to create too much vascular stress and inflammation and you're demanding your liver to come and treat that with ldl cholesterol do not take away the workhorse do not take away the army that would resolve the inflammation that starts you on the course to a broken heart as we reconsider human condition we're going to have to devilify all of the building blocks for life embrace them and understand their role in our recovery and ultimate regeneration okay in section one of this master class we learned that cholesterol isn't all bad it plays an integral part in the flexibility of the cell membrane and safeguards the integrity of the cell wall it enhances the bioavailability of the nutrients in our food and is essential for hormone synthesis lastly ldl is made by the liver to be an anti-inflammatory so if you're enjoying this master class be sure to check out dr zack bush's full commune course titled vital health at one commune zac bush and dr mark hyman's commune course hacking your healthcare at onecommune.com healthcare indeed high ldl levels are commonly associated with coronary artery disease but is this a correlation or are high ldl levels causal well in section two zack examines the physiology and root causes of cardiovascular disease and dives deep into how and why ldl develops into plaques that can clog our arteries and perhaps most importantly he examines the pitfalls of turning off endogenous ldl production with statin drugs here's zach with the physiology of cardiovascular disease as we mentioned last time in the 1980s with the new ability to measure fractionated cholesterol in the bloodstream we suddenly made these public health correlations between high ldl and the occurrence of cardiovascular disease and we made the assumption of causation here we're going to take a look at the physiology of vascular disease from start to finish and you get to see the role of cholesterol in it and realize just how we went wrong with our current narrative on cholesterol and our pharmaceutical attack on the whole cholesterol system with our statin drug history what we're going to show you here is the simple pathway of ldl cholesterol as it's produced cholesterol can be either absorbed from your gi tract as we mentioned in the last episode or synthesized in every single cell of the body and one of the big epicenters of synthesis of cholesterol within that cellular system is certainly the liver the liver cell called a hepatocyte produces a whole array of clusters of cholesterols that produce different effects within the human physiology critical among these is ldl which is the primary mechanism for anti-inflammatory action within the bloodstream and so imagine for a minute a healthy human being reaching for that first cigarette taking an inhalation of radioactive compounds and carcinogenic metabolites of the tobacco as it's burned in addition to the smoke itself and some of the caustic chemicals within that smoke that gets absorbed through the wall of the lung into the bloodstream those chemicals and radioactive isotopes go tearing through the bloodstream causing damage to that teflon lining the endothelium of our entire vascular system and in the ripping and tearing and destruction of that that force of the the toxins we see friability or the opportunity for non-fluid flow across those endothelial surfaces the blood pumps with that we get a sustained injury as the blood flow itself continues to do a secondary and tertiary injury on top of the tobacco smoke so we've disrupted that first law of thermodynamics or flow dynamics within that blood vessel with the cigarette smoke but then the normal physiology can continue that injury this is the beginning of cardiovascular diseases we know it and the way to snip it in the bud is ldl cholesterol production from the liver so we produce ldl cholesterol which is a lipoprotein as it's called it's a cluster of proteins and cholesterols that are bundled into a specific format that carry extra electrons and so we call this ldl reductase or the potential for ldl reductive activity which is the donation of electrons so as ldl is emitted into the bloodstream from the liver you have this deluge of anti-inflammatory warriors that go coursing through the bloodstream and when it finds an area of injury inflammation from that cigarette or the toxins in the food in the forms of herbicides and pesticides and the like done the damage the ldl can then travel in across the endothelial surface to deliver the electrons and in that delivery it does something called reduction it reduces the inflammatory positive charge within the wall of that damaged blood vessel in delivery of ldl and its electrons the the remnant of that lipoprotein is now called ldl oxidase or it's an ldl oxidant now it's got a positive charge to it and so it needs to be carried out of the tissue and it's done so by a portion of the immune system which are the monocytes that'll pick up that guy and carry it back into the blood vessel where it's picked up by hdl the quote-unquote good cholesterol hdl picks up the ldl remnant and carries it back to the liver where electrons are added back to that lipoprotein particle system and sent back into circulation as an antioxidant again and so there's this awesome recycling and regeneration of the army of antioxidants made by your liver in the form of ldl cholesterol in the next episode we're going to look into exactly how we came to demonize this ldl because from everything you've heard so far it's one of the most critical warriors against disease in the body as we move into that though i want you to take a pause and consider the ramifications of producing a drug and introducing a drug to the bloodstream that prevents the liver from making cholesterol which is exactly what the statins do they certainly prevent that same production of the cholesterol and all the other cells blocking all of the other important biologic mechanisms we've talked about but right now we're going to stay stay here within the vascular tree and imagine the consequences to blocking ldl production now imagine picking up that cigarette and that caustic material of the radioactive isotopes and the rest coursing through the bloodstream causing havoc to all that endothelial surface causing rough inflammatory reactions throughout and there's no army to treat the inflammation and so in the short-sighted effort to reduce ldl cholesterol in the bloodstream with the hope that it doesn't end up in the wall of the blood vessel to cause a plaque and heart disease we have short-circuited the entire biological process of repair within the endothelial system of our vascular tree it's a classic mistake of correlation rather than causation and in that we've created a multi-billion dollar industry of statin drugs that have now sold a couple hundred billion dollars of drug over the last 25 years uh just for a tour of a statin but then the whole statin category as a whole you're looking near a trillion dollars of income globally over the last 30 years certainly one of the most incredible blockbuster drugs of our time and it missed the mark for the simple mistake of correlation versus causation that would be an economic crisis if it wasn't such a biologic humanitarian crisis in that journey we have left two generations without the anti-inflammatory response system and they have suffered a life of increased inflammation and pain in their bodies and diminishing effects of the rigidity of of the blood vessel wall rigidity of the cells within their body rigidity of the muscle cells themselves the inflammatory consequences are huge and it undermines quality of life every time we take a step into the chemical codependence of western medicine we tend to undermine quality of life for short-sighted gains in the metrics of biology that are correlations not causations in this section i'm excited to give you a timeline of events that occurs from that initial vascular injury to the liver's response with ldl cholesterol through to the repair process or the failure to repair and the ultimate accumulation of plaque within the blood vessel wall and the event of cerebrovascular disease and stroke or coronary vascular disease and heart attack the journey begins at that blood vessel wall which again is called endothelium again we're going to picture this as a slippery teflon surface that's dynamic it's very adaptive to flow dynamics and changes of pressure when you go from sitting to standing massive changes have to happen in the muscles that surround your small blood vessels and the endothelium is extremely adaptable and flexible in its ideal use of cholesterol in those cell membranes of the endothelium so cholesterol causing that important viability flexibility within the vascular tree can then be injured by some sort of insult the most common injuries currently are the herbicides and pesticides in our food water and air systems if you've been following any of my work over time you know well the role of glyphosate which is a common chemical in herbicides worldwide glyphosate is a toxin that destroys the tight junctions the proteins that hold that whole endothelial lining in a coherent teflon-like barrier as glyphosate goes through your bloodstream it damages those protein structures causing rough surfaces to occur and leak across the blood vessel this leads to again uneven flow dynamics through that small blood vessel and the turbulent flow can lead to further shear forces and tears in the vascular tree so with that initial injury there comes an immune response this is when monocytes a specific type of white blood cell are called into this now sticky surface of the endothelium and they start to stick along there and their adhesion proteins on their surface will then bring them between two endothelial cells to now go into the wall of the blood vessel that monocytes role is actually to clean up the ldl cholesterol that's already entered the blood vessel ldl being an extremely small version of cholesterol lipoprotein is very quick to enter an injured source like a smart bomb the ldl cholesterol is the early responder even before you get that coarsening and destruction of the texture of the endothelium through vascular damage the ldl can find that early inflammatory center via a charge state remember i mentioned that the liver making ldl as a reductant or anti-inflammatory has added electrons that can then react to a positively charged source of inflammation and so the positive charge of damage brings in the negatively charged ldl cholesterol which can travel right across the cell membrane even if there hasn't been damage between the endothelium yet so you've got early responders as the ldl cholesterol to reduce the inflammation in an ideal environment the monocyte never gets called in because the ldl has already done its work but in the event that the monocyte gets called in because there's still a coarse you know repair process going on in the surface creating that adhesion event the monocyte travels in and will absorb the ldl cholesterols that are now the ldlo or oxidase oxidized ldl those are now positively charged and need to be returned to the liver to get recharged with electrons that ldlo being cleaned up by the monocyte is now safe from the environment it's not no longer oxidizing the environment but the monocyte needs to get back into the bloodstream and so it's picked up by a macrophage which is this extraordinary system of sweeper cells kind of the the waste management system of the tissue of the body will then pick up the monocytes and try to move them back into circulation via the lymph or via direct access through a damaged vascular wall in the event that there's poor dynamics and an accumulation of chronic injury in this space and you get an overwhelming amount of monocytes that can't be cleaned up quickly enough they can become pooled and they start to to become aged and in the aging of these these white blood cells they start to create what's called a foam cell which sort of like what happens with a joint when it starts to get osteoarthritis and starts to get larger with time the the blood vessel wall thickens the the foam cells or these damaged and aging monocytes that haven't been cleaned up quick enough by the body will start to call in fibroblasts and you get a thickening of the vascular wall just as you would be with a thickening of the knee joint in osteoarthritis and so in that chronic inflammatory state now you start to call in more and more ldl cholesterol to deal with all kinds of different levels of inflammation that are now happening between the interactions of monocytes the aged foam cells and these fibroblasts this is where you start to get these large cholesterol plaques but to blame it on the ldl is a lot like blaming war on the foot soldier it's never the private in the army that started the battle the private on the army in the trenches was always sent there to deal with some sort of large political upheaval that didn't get resolved through better mechanisms and so i see end-stage cardiovascular leaves or cerebral vascular disease as a war that never got resolved politically the political resolution should have happened at the regenerative state where you call in repair repair happens and you move on you go back to a completely brand new teflon shield there in the endothelium in a chronic inflammatory state you've worn down your reservoirs of response systems your antioxidants your amount of glutathione in the blood vessel whatever it is you've run out of those coping mechanisms and the the political system has failed and now you're just in full-out war and the body for all of its efforts is having a hard time figuring out how to regenerate in the context of a battle that just can't be cleaned up fast enough the battle proliferates gets bigger and bigger and bigger until you finally have that big cardiovascular event you have a heart attack as the plaque ruptures and creates a an immediate bloodstream reaction that clogs off the blood vessel acutely and you go from feeling well to sudden crushing chest pain sweating nausea massive heart attack risk of death that's the whole course of events that's happened and we've come back to this middle zone of ldl response as our moment of intervention for the pharmaceutical industry so the statin drugs are not helping resolve the initial inflammatory reaction it's it's blocking the soldiers from entering the field so the battle may never emerge into a war and so you may prevent a plaque from happening but you actually never improve the vascular status of that that cardiovascular system and so you have an aging vascular system that's no longer having a heart attack but is pumping more and more inflammation into the system due to the failure of those antioxidant soldiers that should be pouring in in the form of reductase reductant ldl and so this is a good example of you know stepping in midstream with a solution that creates the appearance of victory here we've left the inflammation untreated the individual continues to to go into a less and less functional status clinically even though their ldl may look perfect so these are the patients that show up in my clinic with an ldl cholesterol on a statin drug after 10 or 15 years that can't walk can't breathe well is in congestive heart failure has inflamed joints throughout their body suffering from low back pain chronic memory loss poor sleep quality chronic pain of three or four different sources that individual is a factory of inflammation in all sorts of organ systems for the reason we took away their workforce we took away the antioxidant workforce of ldl through the statin drug that they've been on and so this is the mistake that we make over and over again in medicine is finding some biologic metric that we can measure causing a correlation then become causation and then creating a chemical intervention that disrupts a normal biologic process of regeneration to actually bring the problem from a single blood vessel to a whole system crisis by taking away that workforce the step of biology that is interrupted by the statin drugs is a single enzyme it's called hmg coa reductase and hmgla sits in the factory if you will that lives within every single cell of the body the factory is called the endoplasmic reticulum and just like any factory complex you've ever driven through with all kinds of huge buildings and all interconnected by little roadways and everything else the endoplasmic reticulum looks like that kind of jumble in the middle of the cytoplasm of the cell hugely busy protein synthesis all kinds of stuff happening in the endoplasmic reticulum it is the manufacturing center of the cell in the wall of that endoplasmic reticulum is hmg-coa reductase and that critical enzyme is the rate limiting step to make all cholesterol for all functions mentioned so far a single enzyme responsible for all forms of cholesterol that means once disrupted it's going to be leading to a failure of your ability to integrate cholesterol into every cell membrane of the body therefore creating flexibility resilience and regeneration creating a failure of cholesterol integration into those cell membranes and such undermining the permeability barrier of the cell wall therefore creating leaky cells all over your body interrupting bile production in the in the gut such that you're losing the bioavailability of nutrients that are critical for your regenerative healthy youthfying biology that's innate to you and finally disrupting that whole synthesis of biology of the steroid hormones on the back end so hmg coa reductase a critical step in all of those systems of bioregulation that are highly dependent on the downstream effects of cholesterol that hmg-coa enzyme that is stationary in the wall of the anaplasmic reticulum is the target for the statin drug the way in which the statin drug moves in there prevents it from working at all it gums up the system if it weren't for the regenerative quality of the body i believe that statin drugs would kill people in the matter of weeks the only reason they don't kill people that quickly is because your body is constantly making new new endoplasmic reticulum it's a constant building of the factories you're always scaling up if you will at the factory manufacturing level within your cells and so you're always building new mechanisms so there's short periods of time between your doses of statin or whatnot where there's new hmg coa reductase enzymes being integrated into the endoplasmic reticulum and you get a moment of cholesterol production and so fortunately when you come in on a statin drug to my clinic your cholesterol may have fallen from an ldl of 180 down to 75 but it's never zero and it's for this regenerative quality of biology that thank god is keeping up with the rate of injury or the rate of clogging of the hmg coa reductase by the statin drugs that you're taking every day and so for the regenerative quality they don't kill us quickly but instead we have the slow reduction in our quality of life that's obviously going to correlate with a drop in cholesterol production in every cell and every system within the body all right in section 2 we learned that endogenous ldl made by the liver is actually an antioxidant however the extensive inflammation of the vascular system allows for ldl particles to become lodged in the arterial walls of the endothelium where they can then become plaques this inflammation has myriad causes including smoking drinking chemicals in and on our foods and toxins in our air and water lack of sleep too much stress and a poor diet high in processed foods sugar or saturated fats can also contribute to systemic chronic inflammation so in section three dr mark hyman one of the world's most prestigious functional medicine doctors looks further into the root cause of cardiovascular disease he delves into the contributing factors that lead to the development of metabolic syndrome including high blood pressure high blood glucose levels and abnormal cholesterol all factors that are precursors for heart disease he addresses the efficacy of statins to treat atherosclerosis as well as associated side effects and he discusses the right kind of lipid panels that you should request in the different hdl ldl and triglyceride metrics that we should be considering in determining heart health if you are enjoying this master class be sure to check out dr zack bush's full commune course titled vital health at onecommune.com zac bush and dr mark hyman's commune course hacking your health care at onecommune.com healthcare without further delay here's mark hyman on heart health it's dr hyman back here with you ready to talk to you about one of the most mistreated chronic conditions in this country heart disease now the current way doctors treat heart disease is pretty misguided because they treat the symptoms not the causes to think we can treat heart disease by lowering cholesterol lowering blood pressure and lowering blood sugar alone is like mopping up the floor while we leave the faucet running as the sink overflows we have to deal with the cause of those problems not just suppress those numbers with drugs instead we need to ask what's causing the high blood pressure what's causing the high blood sugar or abnormal cholesterol in the first place spoiler alert these are not medication deficiencies it's not a statin deficiency or an insulin deficiency or or a blood pressure medication deficiency we have to treat these problems with medications but studies have increasingly shown that by reducing these risk factors there is very little benefit if at all for many people research shows that by changing your lifestyle you can have a more powerful intervention to prevent heart disease than any medication now since functional medicine is all about prevention we need to make sure that you're equipped to take responsibility of your health and track your risk for heart disease so we can intervene before anything ever develops the thing is that the approach to reversing heart disease is the same as preventing it so how does a functional medicine doctor interpret the tests that can help you understand your risk for heart disease they start with some basic lab tests we're going to start with the most basic but also the most controversial topic in medicine cholesterol there is so much misinformation out there about cholesterol heart disease that it may seem like an impossible topic to navigate but we're going to try to simplify it here for you statins these are the drugs used to treat high cholesterol are the second most commonly prescribed drug in the world one of the most common questions that functional medicine doctors get is should i be put on a statin now unfortunately the calculator that estimated the number of people that should be taking statins was wrong whoops it recommended statins to far more people than it would help the new guidelines increase the number of people that are eligible for status by 30 now these guidelines were developed often with conflict of interest from the drug industry this is a huge issue because statins are not without side effects i mean if it was like vitamin c and you could take it no problem i would say don't worry but it is not free of side effects i'm going to suggest going to a website it's called www.thent.com that's number needed to treat which is looking at the real data around statins and cholesterol by independent scientists not ones who are funded by the drug industry and what they show is that not one single person will prevent a death from heart disease by taking a statin if you've not already had a heart attack and that you will need to treat 89 people who have elevated cholesterol who will take this statin for five years to prevent one heart attack and that means that 88 people who take the statin will get no benefit over five years now many who take that that with no heart benefit the 88 nine 88 or the 89 people they're going to have significant side effects including diabetes muscle pain sexual dysfunction cognitive function and more so it's not really a great drug if i had to treat 89 people with an antibiotic to cure just one person with a bladder infection that would not be a very good drug you see statins do something that we don't want in our life statins poison our mitochondria these are the parts of the cell that are responsible for producing energy in the body this is why the number one side effect is muscle pain it's like you just ran a marathon and your muscles hurt even in patients who have no muscle pain and whose tests of muscle enzymes are normal biopsy studies have shown that every person who takes statins gets muscle damage see statins can impair our ability to produce energy and they also knock out the pathway in their body that's responsible for producing some of our sex hormones yes your sex hormones are made from cholesterol now this may lead to low hormone levels like progesterone and testosterone and as we learned yesterday low testosterone levels are becoming the norm statins also may increase your risk of mild cognitive impairment or cognitive dysfunction are statins the only thing that can reduce your risk of heart disease not even close daily consumption of dark chocolate has been shown to reduce the risk of heart disease by 45 to 77 and the side effects are good it's yummy and a handful of nuts a day may reduce your risk by 20 to 30 percent drinking a liter of olive oil a week same thing about 30 as much as a statin i also want to emphasize that i'm not saying that statins are not suitable for some people but i'm saying is that you need to be educated on what to ask your doctor about and what additional tests you should get done prior to initiating any statin therapy you need to know your own body you need to know what your risk factors are you need to know what all your numbers are and you need to make an educated decision with your doctor only people at high risk for heart disease who've had a heart attack or people with genetic cholesterol disorders should take a statin so let's get into the weeds and talk about what different cholesterol measurements actually mean so you can be more informed if you're having a discussion with your doctor about cholesterol or statins all right cholesterol one of the biggest myths out there is that high cholesterol is the enemy in fact 75 of heart attacks occur in people with normal ldl cholesterol levels that is the number that doctors treat with statin so there may be something else that's driving heart disease see cholesterol becomes problematic when it's damaged by free radicals where it oxidizes or goes rancid this occurs when there's underlying inflammation in the body from things like a lack of exercise or high sugar starch diets or belly fat or stress or poor sleep or even environmental toxins thus the goal should always be to find the cause this is where functional medicine shines we are the cause finders like the medical detectives now this doesn't mean that cholesterol doesn't matter it just means that we need to take all of our risk factors into account and look at the person as an individual we don't just treat the ldl if it's high with a statin and forget about it right let's go through what a lipid panel tells us and let's talk about it a little more in detail most of the cholesterol panels that are done by your doctor are outdated and they don't tell you the real story i would demand the right test it's called an nmr test from labcorp or cardio iq from quest there is no other cholesterol test your doctor should run and by the way probably 99 of cholesterol tests to run are not these tests so the first number on a lipid panel is the total cholesterol now this number doesn't tell us much because it lumps together hdl and ldl we call the good and the bad cholesterol although it's a little more complicated than that and it doesn't differentiate between the particle number and particle size which we'll talk about in a minute it's so important that's the most important thing to know however ideally your cholesterol should be under 200 but again this matters less than the overall profile if your total is 300 but your hdl or good cholesterol is 100 and all the other numbers are great then you may not have to worry at all but if your cholesterol is 150 and your hdl is 30 then you're at super high risk of a heart attack now hdl is known as good cholesterol because it sweeps up like a vacuum cleaner all the cholesterol from the arteries and delivers it back to the liver for processing hdl should be over 50 for men and over 60 for women but unfortunately there's the possibility of having dysfunctional hdl meaning the hdl level you have looks okay but it's not working properly this is why we never look at one number we look at the entire person if we see an elevated hdl far above the goal range with high inflammatory markers which we'll discuss in a little bit then the good guy or hdl might not be as good as we thought ldl which has been coined the bad cholesterol should ideally be less than a hundred but again this is not the whole story there are many forms of ldl that are much less concerning than other forms the same for hdl and that's why it's essential for your doctor to do this nmr profile so let's look at the nmr lipid profile it's super helpful so what we'll look at here is we'll see the ldlp now this is something your doctor usually never measures ldlp is the number of particles as opposed to ldlc which is your cholesterol so this looks like your cholesterol is 98 which seems okay but your particle number is 1237. anything under 1000 is good so it's got a little more particles you also look at the hdl the triglycerides and the total cholesterol so you get an idea of what this normal range is but what we want to look at more is is this which is the actual size so you can see here you've got hdl particles which should be above a certain number you don't want a lot of the small particles so you can have ldl that looks like a normal lumber like it's under 100 but it's made up of almost 500 small particles that could be dangerous you want under 90 ideally and the size you look at of the particles we look at size of hdl ldl triglycerides all the numbers and we can tell what a person's risk is and they can have quote normal cholesterol but still be at high risk so this is a little sophisticated a little complicated i've written a lot about in the books there'll be reference materials about this but this is the test you want to do for your cholesterol there is no other test to do now this profile will break down the ldl to get the real scoop on what your actual risk for heart disease is see ldl has been termed the bad cholesterol however this isn't true of all ldl in the past we were only concerned with the ldl amount in fact it was a way it's the weight of your cholesterol but in that weight you could have for example a thousand small particles that are dangerous or you have a hundred large fluffy particles like beach balls that don't do anything and it's the same number you get on your regular blood test so just as a reminder in the past we're only concerned about the ldl amount but it turns out the number of particles and the size of those ldl particles has a much bigger predictive risk on your risk of heart disease so the small dense ldl is problematic they're like little dangerous bbs or golf balls that can damage arteries where you could have large big fluffy ldl and that's going to bounce off your arteries like a beach ball in addition someone with low ldl cholesterol could also have a high number of small ldl in other words you can say your ldl looks normal it's 70 but it's made up of all these small dense ldl particles which is super dangerous so you get a false sense security i've seen this over and over again where it looks like it's ideal or normal with a regular doctor looking at it when you peel the hood back and you go wait what's going on you'll see these small dense ldl particles and that's because these small dense particles can squeeze in between the arteries can actually cause inflammation and create the cycle of heart disease now as we said before the ideal value for ldl is less than 100 but it's more important to look at the total particle number that should be under a thousand and the small ldl particle number which should be less than 400 or even lower i've seen people less than 90. so the takeaway here is that measuring your ldl which most doctors do is just not enough you need to know what your ldl particle number is and you need to know the number of small particles or large particles and that will give you a much better idea of your risk of a heart attack so this test measures hdl and triglyceride size and particle number which matters a lot see small ldl in many particles along with the small hdl and large triglyceride particles and the triglycerides are a little different you want the large ones are not good that indicates pre-diabetes or type 2 diabetes and we're going to address that in the next video see in addition to the nmr profile there's also a test to see whether the ldl you have is damaged or not see oxidation is a term used when ldl becomes damaged and can cause harm to the artery walls and that causes plaque formation it causes narrowing our vessels and is one of the biggest contributors to heart disease we now have the technology to measure how much of our ldl is oxidized or rancid oxidized ldl of less than 60 is a sign of not an increased risk of heart disease the days of just running a normal lipid profile and prescribing a statin without examining all these other markers and more we'll learn about is really malpractice in my view it's outdated medicine so finding a doctor who can use these up-to-date tests who knows about these advanced tests is really essential and many conventional doctors are now using these because it's available through regular labs now everybody is obsessed with high cholesterol but the truth is that low cholesterol can also be a problem it can be problematic often more problematic than high cholesterol you see low cholesterol may lead to increased suicide attempts depression impulsive behavior just to name a few in fact when you have low cholesterol you're not making your hormones you're having any fat for your brain it's really important in fact women with low cholesterol have a 16 times greater risk for attempted suicide than women with normal cholesterol this is because cholesterol is the building block for our hormones and even some nutrients like vitamin d which are essential for mood stabilization 25 percent of cholesterol in our body is in the brain it's in the brain for a reason it's essential for coating our nerves so we can ensure we can send great messages across our our nerve cells and our nerve pathways so when it comes to cholesterol lower is not necessarily always better and lastly triglycerides are another important measurement you're going to find on a standard lipid profile triglycerides should ideally be under 100 or even under 70. most labs say under 150 is fine i don't think that's true triglycerides are often high because of a high carb diet that's starch sugar flour all that you can look at your ratio of triglycerides to hdl this is a ratio that's actually more predictive of heart disease than almost any other ratio on your cholesterol panel and again most people don't look at it this ratio should be under two some say under one meaning you're let's say your hdl should be 70 and your triglyceride should be 70. if your triglycerides are 140 and your hdl70 maybe it's okay but you still want lower triglycerides if it's over two you almost certainly have what we call carbohydrate intolerance that's right fat's not the issue fat doesn't cause the fat in your blood to go up it's the sugar and starch that screw up your cholesterol believe it or not processed carbs sugar even just starchy vegetables can be a problem eat a ton of potatoes and that tells you that you have carbohydrate intolerance and that's what's driving these abnormal blood tests so if you have extra belly fat or you're pre-diabetic or you have type 2 diabetes and you have elevated triglycerides and low hdl then you should definitely focus on eating a higher fat lower carbohydrate diet so now we've discussed blood cholesterol and lipids i want to emphasize that the standard lipid panel is outdated don't get it find a doctor who does the right test we always want to get only an nmr profile from labcorp or a cardio iq from quest that will help us find out what kind of ldl hdl triglycerides we have and it'll give us the right information to know what to do and we also want to know about inflammation in the body which that also can lead to more inflamed arteries and is actually the driver of heart disease in fact in studies they found that if you have a high level of inflammation even if you don't have high cholesterol you're at risk for heart disease and if you have a high level of cholesterol and no inflammation there's no risk of heart disease so it's really more important to look at the whole picture now let's talk about that marker of inflammation and this is a test that's been well studied in relation to heart disease it's called c rp or c reactive protein it's something made in your liver it's a marker of chronic inflammation so this test called crp or high sensitivity crp is a critical test to run for everybody but especially if you're worried about heart disease especially if you have elevated cholesterol which will help you calculate your actual risk for heart disease because as we just learned a conventional lipid panel alone is not enough to determine your risk in addition to crp homocysteine is another marker to look at for heart disease it can indicate problems with folate metabolism and when it's elevated it can be inflammatory an elevated homocysteine level is a risk factor for alzheimer's and heart disease cancer and much more it should be ideally between six to eight it's related to our levels of b6 and b12 and folate so if your doctors see a high homocysteine level they may put you on these supplements to help reduce the level but again most doctors don't test for it there's another set of markers for heart disease that are important order and they can be ordered through a conventional lab test it's called apob and apo a1 apob is an indicator of bad cholesterol or ldl apoe1 is a marker that's based on hdl which is the good cholesterol and the ratio of those is really important you can go one step further and look at the ratio of apob to a1 which gives us a much more accurate risk predictor than looking at either one alone in fact april bead a1 is one of the most accurate measurements for heart disease now it should be less than 0.8 here's the thing with april b to a1 apob is elevated not from eating fat is elevated from eating starch and sugar from having diabetes from having belly fat so you can see a theme here that the issue around heart disease is not fat it's sugar and starch it's diabetes it's not cholesterol it's triglycerides and hdl not so much ldl so there's another thing we should look at if you have a risk of heart disease it's called fibrinogen that's a marker for heart disease and this is a protein it's involved in clotting so we want to make sure that it's not too high see if it's elevated it's a marker of reduced blood flow of blood stickiness of blood more likely to clot so fibrinogen is a marker of blood flow or how thick or sticky your blood is and we want your blood flow to be smooth and undisturbed so that nutrients and oxygen can get in our tissues especially our brain and our heart without any issue and to make sure that the blood doesn't clot which is actually what causes a heart attack it's a blood clot ideally fibrinogen should be less than 300 if your fibrinogen is elevated you may have other elevated inflammatory markers like crp if that's the case you need to find the source of the inflammation and again for most people the source of the inflammation is belly fat is diabetes see fibrinogen gets lowered and people are often taking enough of the good fats too these are things like omega-3s from fish oil and when you address the causes of inflammation the fibrinogen comes down so even if you have elevated markers there's so much we can do to lower them all right now there's another marker that's a little hard to deal with it's called lp little a it's an important marker because it's genetically determined for the most part and it may be more problematic than even ldl and seems to be the new villain in heart disease if you have a family history of heart disease and your lipid panel shows elevated ldl then this is a must order test in fact i do it as screening on everybody as a cardiovascular risk assessment lp little a has more to do with genetics than it does with diet however there are natural therapies that can help lower your lpa and reduce your risk of ever developing heart disease in the first place ideally your lp little a should be less than 30. and one of the therapies that's been found to reduce lpa is niacin which is a b vitamin there are other therapies too that are natural now the last test i want to touch on here briefly is carotid intima medial thickness or cimt now this is an ultrasound test where you basically run almost on your neck and it looks like the plaque in the arteries in your neck which is associated with heart disease or cardiovascular risk this test is super important for at-risk people because we want to know how inflamed the vessels are and how much plaque you've created over time if we can get insight into what is going on in the vessels in your neck then we're also going to get a good idea what's happening in your heart or your brain since they're all connected and ideally if you're over 50 and you have a family history of heart disease or a lot of risk factors you should get another test it's called coronary calcium score it's a special high speed cat scan and it looks at the calcium around your arteries and this reflects inflammation and heart disease now i know that heart health testing can seem kind of overwhelming and a bit confusing but heart disease markers are one of the most controversial topics in medicine and it's difficult to navigate on your own so that's the reason i want you to work with a good practitioner who understands how these markers all work together they're going to be able to look at your entire biochemical picture and help you make an informed decision about what is going on with your health and not just focus on ldl we're so ldl centric we want to look at all these biomarkers and get a real picture of what's going on and combine that with all these other variables your family history your genetics and much more all right in the next video we're going to talk about metabolic syndrome or pre-diabetes or diabetes which has now become an epidemic in the modern world it affects one in two people and last but not least congratulations you've made it halfway through the course and you're well on your way to becoming ceo of your own health and getting the kind of health care that you need and that you want i hope you found this master class on heart health with dr zach bush and dr mark hyman informative and helpful now disease particularly heart disease can be really scary however once you understand the mechanisms of the human body and the true causes that lead to disease it is so much easier to adopt healthy behaviors that can lead to thriving and well-being increasingly medical science is discovering that our health is not predetermined by our genetics the emerging fields of epigenetics and the microbiome and neuroplasticity tell us that we can change in response to our behavior in our environment now as far as heart health there are myriad life choices you can make that maximize heart health and minimize the chance of disease understanding your body and how it works is essential to making the right lifestyle choices again if you are interested in going deeper be sure to check out dr zach bush's full commune course titled vital health at onecommune.com zac bush and dr mark hyman's commune course hacking your healthcare at onecommune.com healthcare that's all from the commune for this week my name is jeff krasnow hey thanks for watching if you liked this commune master class that i think you'll love this video right here so we've never seen 60 million year old soil we've never seen that little microbial intelligence so imagine the overwhelming experience of putting this liquid from freaking fossil dirt onto the surface of a gut and watch it in a petri dish begin to heal

Channel: Commune

Views: 308,401

Keywords: commune courses, commune, health, mark hyman, heart disease prevention, heart disease treatment, heart disease food diet, heart disease diet, reversing heart disease diet, prevent heart disease diet, reverse high cholesterol, how to lower my cholesterol fast, zach bush, plant based diet reverse heart disease, best diet for heart disease, high cholesterol foods to avoid, how to live longer than 100 years, healthy foods to eat, how to live longer life, mark hyman live longer

Id: R4Jzmj5X9xA

Length: 61min 59sec (3719 seconds)

Published: Tue Feb 22 2022