Hello Health Champions. Today I want to talk
about cholesterol, because the way we have been understanding and dealing with cholesterol in
the last 50 years is one of the greatest health disasters of all time. And there's this huge fear
factor about cholesterol. When people are changing their lifestyle and they're getting healthier
they're losing weight they're feeling better all their health markers are improving
except one, their doctors still scare them into abandoning their healthy lifestyle
and reverting to a low-fat diet because one marker LDL cholesterol is too high
in their opinion. And this is all because we have bought into the idea, without any
good evidence, that LDL cholesterol is bad cholesterol. What I want to help you with today
is to make an informed decision by understanding the true factors and what's really going on.
What we really want to get away from is the idea that if cholesterol is over 200, if your
total is over 200, then you get this automatic prescription for a statin drug. Or if your LDL is
over 100 that that should be some magical number that now you get a statin drug. Do statin drugs
lower cholesterol. Yes absolutely. They do, but we're going to talk about whether that is
actually a good thing we're going to answer what kind of cholesterol do they lower is that
something we actually want to lower. We're going to ask about heart disease does it actually help
lower heart disease and the answer is there is no good evidence of that. Recent studies actually
show the opposite that higher cholesterol actually is associated with lower all-cause mortality and
better cognitive function in your later years. Does it improve longevity. Does it help people
live longer and there is no good evidence to that either. What you do get for sure are side effects
and we're going to talk about that as well. So why then is there a standard prescription for
a statin even though there's no good evidence that it actually helps. Because there is something
called evidence-based medicine and the only evidence they're looking for is. Does it lower
cholesterol? Yes absolutely. And there's the assumption that cholesterol causes heart disease
and therefore it must be a good thing to lower it. And that's a false assumption. The other reason
is called standard of care that a doctor as long as he follows the standard of care which is to
prescribe a statin if your cholesterol is over 200 you can't get in trouble if you hurt patients
as long as you follow the standard of care. The time you can get in trouble is if you step
outside of the standard of care and something happens. We want to get away from the idea of high
or low cholesterol and we want to start thinking balanced or unbalanced. Because 190 could be
unhealthy and 350 could be healthy. Now this is not to say that you should ignore your cholesterol
numbers. They still give you good feedback higher isn't necessarily better but higher isn't
necessarily bad either. We have to understand when to pay some attention. What are the numbers
to pay attention to we'll go over that. One thing we want to understand is we want to start fighting
we want to start addressing the true cause instead of the rescue attempt. So what do I mean
by that. If you come to a fire then there is probably some people from the fire department
there. Most of the time that you see a traffic accident or a fire there will be a responder.
There'll be an ambulance there'll be a firefighter and there's an association there and that's
just like we associate cholesterol with disease cholesterol with damage because cholesterol always
shows up at the accident site. Just like the first responders show up at the accident site. That does
not imply causation. That does not make the fire department guilty of the fire. It does not make
the cholesterol guilty of the damage. And if we start fighting cholesterol we are fighting
the wrong guy. That would be like setting up roadblocks for the fire department because there's
an association between fires and fire department. So what then is the real cause of heart disease
and plaques? And the real causes are inflammation a low-grade chronic inflammation which is
associated often with insulin resistance and or oxidative stress. All these three go hand in hand.
And here's what we want to understand there is a strong correlation between cardiovascular disease
and these three things there's a very very weak correlation between cholesterol and cardiovascular
disease. And to the extent that cholesterol is involved with cardiovascular disease it's to
the extent that it's associated with these three. So what we really want to understand is when is
cholesterol unbalanced and the indicators are increased blood glucose, increased blood
insulin, increased long-term glucose, called a1c, increased triglycerides,
decreased HDL high density lipoproteins, and an increased ratio of total cholesterol
to HDL. We also want to look at VLDL and we want to look at LDL size. Now one
of these by itself doesn't necessarily indicate anything and that's why we want to look
at the bigger picture. The first four I'll cover very quickly because I've done so many videos on
that increased glucose comes from eating sugar and processed carbs which trigger an insulin
response to combat that high blood sugar. If this goes on over time then we get insulin
resistance and our a1c starts creeping up. And once we're insulin resistant now this glucose
is not accepted by the cells. The cells are resisting additional fuel and if the glucose
can't get into the cells now it gets converted into fat, which is the triglycerides that
circulate in the blood. Next we want to look at HDL and the ratio of total cholesterol to HDL
so this person has a total cholesterol of 286 and it's supposed to be a 100 - 199 so that is
obviously very high so it's marked with a flag. But this in itself does not tell us if this is
good or bad the range goes from 100 to 199 and I would be a lot more concerned if your cholesterol
total was 100 than if it was 286. Then we look at his HDL cholesterol which is generally considered
protective and we want to see this above 39. And this person has 46 but is that high enough
it's above that threshold but is it enough to kind of offset the total cholesterol. So now we
look at the total cholesterol to HDL ratio and now we want to have zero to five. Again a lot of these
ranges are kind of ridiculous because there is no way a living human could get to zero. Zero or one
is not a good number because then you would have virtually no cholesterol in your body and that
is an essential nutrient. But this person has 6.2 so that's above the range and what does that
mean and this is on most standard blood work so this is not anything unknown or out there. It
says please note you have half the average risk of heart disease if your ratio is about three and
a half and you have average risk of heart disease if your ratio is about five and this is from men
it's a little different for women but you get the idea. So based on this marker this person's
estimated heart disease risk is 1.3 times, 30%, higher than average. So that's not great and
this is based on one marker that I use. I'd like to see this ratio in the three to three
and a half range. Next marker is called VLDL, very low density lipoprotein, also known as
remnant cholesterol. And the range is between 5 and 40 and this person is 16. so what does
that mean? This marker is very often overlooked but it's a great tool to look at to see where
you are on your insulin resistance journey. The way you get this is you take the total and you
subtract the other two. So it's just what's left over you subtract LDL and HDL and you're left with
VLDL. And I like to see this number between 15 and 20. So this number of 16 is actually really really
good. To say that it should be anywhere between 5 and 40 is a little bit ridiculous because
your body is not indifferent to if the number is eight times as high as the low number. So
what is this thing the VLDL cholesterol. It's a carrier. The purpose is to deliver dietary
fat to the cells, to the tissues. So this has some triglycerides and it has some cholesterol it
has a lot more triglycerides which are light and this is why it's called very low density. And
the purpose is to deliver the fat to the tissues and when it's successful then it quickly offloads
these triglycerides and the cells take them in and now this VLDL becomes an LDL a healthy normal
fluffy LDL. But if you're insulin resistant then the tissues resist the delivery of these nutrients
of this fat. And therefore if it's unsuccessful in delivering then it's going to linger it's going
to stick around in the bloodstream for a long time and the levels go up so when we measure them
they are much higher. So if you have a value of 35 or 40 then you're quite insulin resistant
because your tissues are resisting the delivery of fuel. Now let's talk about the really important
stuff that hardly anyone gets. 99% of people prescribing statins have no idea of what I'm
gonna tell you we said that the liver packages nutrients into certain vehicles for delivery and
one of those is the VLDL and if all goes well this quickly is converted into a normal healthy
fluffy LDL and then what happens is your liver wants to recycle this LDL. It wants to keep
it going so it has receptors and if this LDL is normal then this system works like a revolving
door. Very very quickly does the liver reabsorb it repackage it and put it out again and it
does this with VLDL's with LDL's with HDL's. With all the different types of cholesterol. They
are always appropriate whether they're high or low they're appropriate for what's going on in
the body. But what happens if you introduce some oxidative stress and some low-grade
chronic inflammation and some glycation. If you get some sugars stuck on these LDL's now
they become damaged and when they're damaged or oxidized now they shrink. And this is why we're
talking about the size of the LDL and the bad LDL is the damaged LDL. But again, it's not the
LDL that it's bad, it's small and therefore it indicates that you have had some oxidative stress
and some inflammation and glycation. These are the real problems. The small LDL is just an indicator
of those problems. And here's one of the first big keys to understand. This healthy LDL fits into
the revolving door but this oxidized LDL does not when it's small and damaged now this receptor
doesn't recognize it. It doesn't fit into the system the liver cannot reabsorb this LDL.
And therefore the numbers of small damaged LDL starts building up. And what was it that caused
the oxidative stress the inflammation and the glycation. It is sugar insulin resistance, food
allergies, stress, and the list goes on and on. All those things associated with chronic
disease. So now listen up very carefully. Here is the real cause of atherosclerotic
plaques. This oxidized LDL can do some damage. It damages the intima which is the inside lining
of the blood vessel. If you notice this yellow plaque it's not actually inside the lumen of the
blood vessel. That there are different layers of the blood vessel and the inside layer
is the intima, and then you have various different layers. So what this oxidized LDL does
it damages the inside layer and makes the gaps grow bigger and now this oxidized LDL, which is
tiny can slip through the crack and start getting into the wrong place. And now there's something
called a macrophage that starts following this bad guy in through that crack. And a macrophage
is something that eats something. That's a white blood cell sometimes it's called a phagocyte, it
goes by many different names but it's basically we're going to call it Pac-Man and this Pac-Man
its job is to go after and gobble up this LDL. Because the liver receptors cannot recycle it as
a healthy cell, this oxidized LDL is now treated as a foreign intruder. It's not part of
the friendly guys in your body anymore. And the only way to get rid of it is through your
immune system. So it's treated like a virus or a bacteria or a fungus or something we need to get
rid of. And when Mr. Pac-Man has gobbled it up, now it encloses this and it becomes
a foam cell. So it sort of protects the environment from this damaging cell, but
it becomes another problem in the process, because these foam cells now become the plaque.
So to really drive home the importance of looking at the big picture and the sizes let's
look at a couple of real live examples. We did one test on January 25th and we did another
one on April 5th that's a little over two months 70 days we started off with a total
cholesterol of 297 which was flagged as high and 70 days later it is still high, but it's a
couple of points higher at 299. We look at LDL cholesterol which is traditionally considered bad
and that was 225 and the later test was still 225. So this guy was a patient who had been
doing some changes in his lifestyle, going doing low carb high fat diet, and let me tell
you his medical doctor was not impressed. He was asked very sternly or told to get on a statin
drug they said look it's not getting better. So then we ordered an NMR profile we had this
on both occasions which is where you measure the particle count which takes into account the
size of these particles. And now it starts looking even worse because we want this number to be
under a thousand and it is 3448. And now you may have noticed that this has my name on it
as the ordering physician so you're wondering why am I bragging about this case it just doesn't
look too hot. I mean this guy is in trouble right well once we look at the next step we look at
the change we see that his LDL particle count went down from 3 400 to 2 900. We had a change a
reduction in 455. A 15% reduction in the number of cells, but more importantly what
kind of cells which cells were reduced. So now we look at the small LDL count and that
went from 1653 to 1227. So what we see here is crucial, almost all of the reduction was the
small damaging oxidized LDL particles. The ones that caused the plaquing and the damage and
on this test we also get an average size of the LDL's and we want this to be over 20.5. So
this guy started off in January at 20.9. So even though his numbers didn't look too impressive they
were probably much much better than they were six months or a year earlier. We just don't have any
data on that and then we look at what happened in these 70 days and it climbed. The size average
increased from 20.9 to 21.3. And that may not look like a huge change but let's look at it one more
way. LDL particles can be called small pattern or large pattern and we see that on the first test
this person was already into the large pattern size and 70 days later he was further in it
doesn't look like a whole lot, but now let's look at this. They also give you what's called an
insulin resistance score and in January he was in the 57th percentile. That means there were still
57 percent of the population that were healthier than he was in this regard but 70 days later
he was in the 33rd percentile and he had made tremendous progress because what this means in
only 70 days he had passed 84 million Americans in terms of health. And this is why it's so important
to look at the big picture because if you only looked at the milligrams of total cholesterol and
LDL, it looked like he was making no progress but when we start understanding the big picture and we
actually measure now we're more interested in the direction he's going. Are we making progress
and can we monitor that continued progress. So what would be the pros and cons of a statin
drug we know they lower cholesterol but now let's understand what type of cholesterol they actually
lower. So what does a statin drug do? It increases the number of receptors to reabsorb LDL particles.
That would seem like a good thing, right? Well the thing is that these healthy fluffy LDL
particles they fit into these receptors like we talked about. So if we take a statin then
we will see these numbers of LDL particles go down. We're going to see a dramatic decrease
of these fluffy LDL particles. But we also said if you remember that these small ones they are
not recognized by these receptors, so the stat drug will decrease total cholesterol but it
will only reduce the cholesterol that we want. It will not reduce the cholesterol that we're
trying to get rid of. The damaging cholesterol there is no change. These damaged oxidized LDL 's
can only go down if your immune system is working. And as we saw in the previous example your body
has a chance to do that if you reduce the level of oxidation so that there is less oxidized damage.
Now one point we could say in favor of the statin would be that if we reduce the LDL particles then
there is less total LDL out there to be oxidized, but the better idea obviously is to reduce the
actual root cause which is the oxidation, the insulin resistance and the inflammatory damage.
So let's talk about why these statin drugs do some damage as well the first question is - why does
the liver up regulate the receptor sites for LDL when we introduce a statin? Is that a good thing
or a bad thing? Well the statin blocks an enzyme called HMG-CoA Reductase and don't memorize the
name it's totally not important. But when we block that then we're stopping a process. The body made
that enzyme for a reason it wanted to accomplish something now we block it then the end product of
this pathway can't happen either and farnesyl pp was supposed to become cholesterol and CoQ-10. So
these are two very precious substances the body doesn't make unnecessary things. It wants these
things for a reason so the reason that the liver up regulates these receptor sites is that
when we block the production of cholesterol of an essential nutrient, then the liver perceives
a lack of cholesterol. It wanted that cholesterol. Cholesterol is very expensive to produce
everything in the body is expensive to produce. So when we block the production so there's less
of it the liver sense is a lack so now it kind of gets desperate and tries to reabsorb as much of
that cholesterol as possible, but again remember it can only reabsorb the normal, healthy LDL
the stuff we actually want to get rid of is not affected. The other precious nutrient CoQ-10 is
involved with 95% of all the energy production in the body. So when you block the pathway you reduce
CoQ-10 you reduce the overall energy production in the body as well. Which tissues would be the
hardest hits it's the body parts and tissues that use the most energy normally. So muscles use
a lot of energy because you have to move around. So statin drugs cause muscle fatigue muscle
pathology and weakness. And if you recall one really important muscle is called the heart and
we take the statin drugs because we're afraid that the cholesterol will block the artery and shut off
the oxygen delivery for energy production but now we take a drug that actually shuts off the energy
production and the delivery to the heart. So now the heart has to work harder and we often get
heart pathology like cardiomegaly and things like that. Another very hard working organ is the
liver so first we interfere with the production of cholesterol so it has to try even harder to make
and reabsorb cholesterol, and then we block the energy production to that. And then there's one
more place that uses more energy than any other and that is your brain. It's two percent of your
body weight uses 20% of all the energy in your body so let's take some statins so we block the
energy production to that as well. So you could take a statin drugs and you can interfere with
all of this or you could just stop eating sugar and get healthy. If you enjoyed this video
you should really take a look at that one next if you want to understand how the body works and
truly master your health. Thanks for watching
