Cardiologist Shares TRUTH About Cholesterol - What ACTUALLY Causes Heart Attacks

Heart disease is actually the number one killer of midlife women, but we seem to focus on cancer and other things, or we look at heart disease as a man's disease. Also, cholesterol, where does that tie in? There's a lot of conflicting information about cholesterol, and I've learned recently this goes back to the 70s, whether we need to pay attention to cholesterol, whether we need to ignore it, and what do we actually need to be testing for? And how do we know if we're in danger of heart disease? What do we need to be really watching? Today, I've got an amazing card cardiologist on Dr. Khan, and I'm gonna have him tell you a little bit about his background. Before I do that, I just want to share how I met him. Recently, I actually had spoken at an event that was recorded, and he heard me on the podcast and reached out to me and said, hey, I heard you. I checked out your podcast. You haven't had a cardiologist on it. Got my attention, because this is literally how my dad died. My dad died at age 49 of a heart attack. Now, his was very high triglycerides, very high blood pressure, and a lot of visceral fat, which you could see on him physically. So I want to put that out there. But I genetically have something called familia hyperlipidemia. Is that what it's called? I think that's what it's called when you're born with genetically high cholesterol, meaning I had high cholesterol even as a kid. No matter what, I've changed in my diet. It has been something I've chased and looked at for years and years and years. And even I've gone down the rabbit hole lately with what's true about cholesterol. Like, where do we need to not pay attention to it? Where do we need to care about it? And our statins prescribed, and what else can we be doing? So I invited Dr. Khan on the podcast today. Thank you so much for being here. I can't wait to chat.

I'm fired up. And first, you said you don't really qualify for my podcast. You have some odd views. But we've come to realize, as in any, you know, new relationship and conversation, there's like, a thousand bridges we agree upon. And.

Well, I didn't say you didn't qualify because of views. I said I was concerned because, well, your way of eating is very different. But we'll talk about that in a minute. Can you share a little bit about your background? And just who you are. And you have quite the list of credentials.

Yeah. I got two paths in life that converged to create the cardiology practice that I am now. I grew up in a home in suburban Detroit where we kept kosher. And Natalie, you know about that. But that meant I had to think for a minute, am I eating this? Am I not eating that? Is this on my menu or not on my menu? It wasn't a cheeseburger. We weren't an orthodox family. But this was the tradition and I have maintained it to this day. And when I arrived at University of Michigan 1977, oh my God, so many years ago, I got admitted to a program where you did undergrad and medical school combined in six years. It was wonderful because I knew I wanted to be a cardiologist since I was a little squirt. Just something about my upbringing. No doctors in the family. The only solution for my kosher rules were to eat from the salad bar. And within a year I was fully plant based. And now, 48 years later, nothing's changed. I've never had, I mean, you'll find other people, but in 48 years I haven't had dairy, I haven't had chicken, I haven't had fish, I haven't had foul, I haven't had pork, obviously. And I have eaten a lot of greens and beans. I had a girlfriend at the time who joined me in the dorm. She did the same thing. We've been married 44 years, we. So we're two, you know, almost 50 year vegans now. Do I have a few T shirts that have vegan jokes about, you know, we are a weird little click. Yeah. I want the listener to know, go and eat clean food and you'll do a good job. Just don't outsource your nutrition to a company or a restaurant or a fast food place if you can avoid it. The second path was getting into med school. Realizing I was a pretty good student, I ended up graduating number one from University of Michigan. 300 students stayed there as a resident and then went to Dallas, Texas to become a cardiologist. Incredible training. Very difficult city in the 1980s to eat. Plant based, vegan, whatever you want to call it. I like the word plant. Strong as just a general term. Ended up in Kansas City for a year. That's Casey Masterpiece barbecue sauce again. I ate so much okra and beans it was crazy just to survive and end up. And I've been in Michigan since, since 1990. I had 25 years as a cath lab stent doctor published 150 research papers, was a professor, and still am a professor at Wayne State University in Detroit. But 10, 12 years ago, I totally threw that all away, went back and got integrated medicine training, stopped going to the cath lab, started my own practice that exists now in two locations, suburban Detroit and Boca Raton, Florida license in about 20 states. So we do a fair amount of telemedicine. It's just really, really deep science and prevention. You pick the diet, you follow. I'm going to educate you about the science, but you pick the diet.

And what it's interesting is when, when he said that at the beginning that I wasn't going to have my podcast. I do want to have him on the podcast, but what I started looking at just from being the nutritionist in me and what I teach is right away when I saw vegan, I said, I don't like this. And what. So we've been, we've been texting back and forth. What I want to share with you today is whether you are a vegan or not a vegan. He is not going to try to convince you to be a vegan today. That's not the goal of the conversation. I, um. In fact, he does approve when I shared how I eat and what we're. What I'm doing. He's aligned with that. So what we're going to talk to you about today is more heart in general. Like, what are the warning signs? What do we need to be testing for? Where does cholesterol actually fall into this conversation? And how do we actually read these labs and understand what's going on and when, if ever, is a step statin appropriate and is there other options to it? And I'm going to go into this with telling him at the time of this recording right now, he has my labs in front of him and I'll tell you my total cholesterol, my total and someone who is not overweight. I'm lean, I'm eat as clean as possible in my view of cleanup as possible. My total cholesterol is 238 at the time of this recording, and my LDL is high. It's 171. So I'm being transparent, going to share and we're going to get into not just about my labs, but in general. But if you're listening, thinking you have high cholesterol, I'm telling you the baseline on mine first, so you know where we are. I do not have high triglycerides or high blood pressure. My dad had both when he died. But let's jump in. Joel, let's talk first about what goes on with heart disease. What do you see? And especially in women, what are you seeing?

Yeah, well, the topic of heart disease in women is actually fascinating. In men, largely. We're going to converse about smoking, high blood pressure, their lab values, their fitness or sleep. And we're worried about clogging arteries, having heart attacks. And men drop dead. A thousand people a day in the United States drop dead. Every 40 seconds somebody has a heart attack that's a man more than a woman. Now, it's clearly at risk for a woman, but the profile of somebody dropping dead is specifically unique to men more than women. Women present with fatigue, palpitations, shortness of breath, fatigue, back pain, arm pain, jaw pain. But there's years of asymptomatic heart disease before those typical and atypical symptoms present. But the reason I say women are fascinating, and I really do mean that, is because we've learned now that if you had preeclampsia in your 20s and 30s, in your 50s, you're more at risk for clogged arteries. If you had high blood pressure and prediabetes during your pregnancy, you're more at risk for heart disease. Like, there's special things about women. There's a very distressing situation called spontaneous coronary artery dissection. Scad, look it up, it's about 90% women. It mimics a heart attack. It can be terrible, it can occur and cause a heart attack. It's unique. It's hormonal and estrogen levels and how they affect the arteries. There's something called broken heart syndrome. A woman under tremendous stress, a divorce, a child dies, financial issues. That's the classic setting. And oh my God, they show up in the emergency room exactly like a classic heart attack. But you take them and you look at their arteries and they're clean. It's a massive emotional outpouring and adrenaline outpouring. So they're I just throwing a quick list, I would imagine.

Like, even when you look at how people have died from drug overdoses could be heart related. So it's not always saturated fat or cholesterol or clogged arteries. There's other reasons what I'm hearing that can create a heart attack.

But still for your audience in midlife, it's the age you start to develop clogged arteries and usually it's asymptomatic for a very long period. Pickleball travel, gym time, family life. The arteries are getting further and further and further. Diseased and you're at risk of showing up. I'm short of breath in my Pilates, having some unusual burning during my runs. I don't have the energy to do my workouts anymore. All that needs a good workout, but clogged artery. So we have to look. This is my number one message. There's a mammogram, there's a colonoscopy, there's a Pap smear. Where's the heart test when you're 45 to 50? And I want the women listening to write down the name of that test. We talk about it right now, a little later in our conversation. And ask your primary care doctor. I want this checkup and I want to do it again in about 10 years if it's normal. I want to keep an eye on my heart more than just the superficial way we deal with heart disease.

Is this a coronary artery scan?

Yeah. There is a CT scan that's already going to lose a couple of people. You lie in a stretcher, you go in a machine. Could be at a university, a local hospital, could be at a freestanding center. I don't own a CT scanner. You want a good one, you go in a tube. It's not claustrophobic. You hold Your breath for 10 seconds and you go home. I did it.

It was easy. Super easy.

And a computer reads it. And you want to come out with something called a coronary artery. Calcium score zero. For those of you that are watching, not listening, I always have a few little cutesies around. This is what the images actually look like. That's a breastbone up above. That's a backbone. Below those are the ribs. And calcium shows up white because it's a bone. The lungs are black, kind of boring. And the hearts, the gray blob in the middle. And the yellow arrows pointing to a heart artery called the widowmaker artery, the left anterior descending artery, one that gets clogged the most. And it's like a bone. It's supposed to be a soft, flexible, free of calcium structure. And you know this cost. This test was introduced in 1990. And there's 10,000 research studies and probably of the listeners right now that are 50 and above, I'm going to guess less than 5% have had this test. The price has come down from 150 to me, 1500 to maybe 150. $100. And insurance won't cover it. Except in Texas at age 50, wild.

That insurance doesn't pay for it.

Am I a zero? And 10 years later, am I still a zero? Or am I 142? I have yoga ladies. My neighbor across the street saw me two years ago. You know, 106 pounds, pool, yoga, pilates, pretty clean diet. And she wanted it and came back 244 and we've studied her more. She inherited that nasty little genetic cholesterol called lipoprotein A. We can talk about. Yeah, but you know, it's out there everywhere unless you test for it.

Okay, so, okay, let's talk about that coronary artery scan for a minute. And if someone's listening and they've done it and they're a zero. So I did it and I'm a zero. When do you read? Is it 10 years or is it three years? Is it five years? When do you retest for that?

Yeah, five to 10 years.

Five to 10 years.

Don't do it every year. There's. It's the same radiation exposure as a mammogram. Specifically 0.7 millisieverts. In my town, that's a very low dose. It's the same as a mammogram, but you don't need to do it yearly. Coronary arteries don't change that fast. Generally. My wife and her friend. I'll try and keep this generic. Went 10 years ago. They were both zeros. They're both very fit now, in their mid-60s. I urge them. My wife went back, stay to zero. The other woman went back and now was 200. Something happened to her in those eight to 10 years and we've intensified her program.

But okay, so what are the numbers? So zero is good, obviously. What is the range then? Is it like, does it can go up to a thousand or what? Where is the red flag? Where is the. We can reverse this. Where is this urgent?

Yeah, they're actually amongst these 10,000 research studies, there's quite a few involving men and women followed for 10 or 12 years. And there's a group that are zero and you hope they stay zero. But retest, don't retest quickly retest. They have a very low, maybe not zero, very low risk. Over 10 years of showing up in an emergency room, having a heart attack, having a stent, they still could get other cardiac problems. Atrial fibrillation, palpitations, congestive heart failure. They're not going to have heart attack. One to 100 is the next kind of segment that's often presented. It's a little different. 10 year risk, it's not high. Maybe it's less than 10% of those people have a problem. Definitely less than 10%. 100 to 400 is another cutoff. I have a lot of ladies over 400. I have a lot of ladies with great lifestyles that are in that two to 400 range. 400 to 1,000, then over a thousand. I've seen people up to six, seven, 8,000. It's a rarity. It's just bragging rights live and doing okay and sometimes it's amazing how well they're doing.

So it's not a death sentence if you have the higher number. It's just a warning.

Even that highest group, you look over 10 years, 20, 25% of them are going to show up in an emergency room, maybe 75% or not even at the highest level. And let me tell you, if you've got a calcium score of 112, this stuff's been going on for 6, 7, 8, 9, 10, 11 years. It's a slow, steady, silent, scary process. I was not going to use the word deadly because there's so much we can do nowadays. But the treatment program is so different if you're a 0 or 242. And that does touch on statins. No statins.

So before I ask about that, and I want to ask about the other two tests that people that, that I've heard you mention and that I have done one and I'm doing another one's the clearly, what is that? I know I paid a lot to do that extra test. Why is that different? And then what? The ultrasound for the heart that I know you ordered for me, that I'm going to be getting. What are those things?

So this is a quick backdrop. Mri, ultrasound, PET scanning have roles in medicine and in cardiology. They do not show hard arteries. There is. I wish we could use an MRI because there's no radiation. Maybe down the road, doesn't work. Now it's CT scanning. So you go for this calcium score because your mother had a bypass at age 62 and your brother just got a stent. And just typical example. And you come back 187. And I just sit down, discuss with you, there's disease. You know, we're not calling a fire alarm, but we got a problem. Let me tell you what the calcium score doesn't show. This is the conversation I'm going to have with that woman. I'm going to tell her, this test is great, but it doesn't tell me how narrowed your arteries are and it doesn't tell me how much of a second kind of plaque. One is called hard calcified bone, like, but One is called soft non calcified plaque. And there's a lot of it out there, particularly people like your father. Visceral, flat fat, triglycerides, low hdl, high blood pressure. We can't tell. And I tell them there is now available for about five years, a ct. We're going to up the game. If they want to, they're going to have an iv, they're going to get iodine, which is not radioactive, makes you feel warm for 20 seconds. You're in the same scanner, it's a little more radiation, maybe three, four times more. And you're going to go home with a band aid and you're going to get a report read by artificial intelligence software called Clearly. And you may pay cash for this because insurance coverage is spotty. It's getting better. But you will then know the same details that Elon Musk and Martha Stewart might know. Very wealthy people. You don't have to be uber wealthy. There's no better than a clearly coronary ct. Hand scrap. And then we can really make a plan. How aggressive, how frequent the follow up. Can we shrink the plaque? That's possible. And can we watch it improve? Rarely does that ever show so much disease that we're talking about referring for a stent or a bypass.

What's interesting is, so I had had that clearly done and when I told him my coronary artery scan was zero, he said, great. He looked at my labs. You then pulled up my clearly. And I don't know if you remember this, but you said, okay. But the clearly did not show zero. It showed a very small trace amount. So you said it was very mild. But still it gave me some indication that like you still have to pay attention to it.

Right? Because, you know, this is a concept that's very important. We have all kinds of literature, research and what are called online calculators. What's my odds of a heart attack in 10 years? Well, in your age, the conversation should be 3:30 years. And this is something American Heart association is talking about. You can go. There's an online calculator, be fun for you to do it, called Prevent, American Heart Association Prevent. And you put in various numbers, including your zip code, because the region in the country you live in has an influence on your risk of heart attack. Unfortunately, wealthier neighborhoods have lower heart attack rates and some urban neighborhoods that don't have sidewalks and safety. And you can calculate your 30 year risk of a heart attack. It's not perfect, but it is an interesting concept. So when you have little spots of soft plaque at your young age. Natalie, you know, we still don't want to ignore the fact that will slowly get worse if we don't create some plan.

So that's why that clearly is good. Because the coronary artist can almost give you a false sense of security if you're only looking at that and saying, oh, I'm good, I'm going to go.

Eat whatever that there is that psychological of support. Partly. People that are on the statin sometimes eat poorly. I'm on meds. It's a bad concept. And sometimes the results of these tests give them a reassurance. Now you asked and I just want to follow up. If you are an anti X ray person, there are some, including some cardiologists out there, you can do an ultrasound of the two arteries that feed your brain blood, the carotid arteries, but you want to do it special if you can find a way to do it. I helped you locate somebody in Scottsdale, do it for you called a carotid intimal medial thickness, but C I M t ultrasound, about 15 minutes. Literal radiation free ultrasound like you do on a gallbladder or a baby. And you can learn. I'm 52 and my arteries are like a 41 year old woman. Yep. My 40 year old son just did it. His arteries came out like a 30 year old and he has a cholesterol issue. So it was very helpful to know that. But it often comes out the other way. I'm 52 years old and they say marriages are like, I'm 69. It ticks me off. You got to dig deep. Why? Why? Why? And then you can see little bumps and soft plaque and you can do it in a year and watch them shrink or watch them get worse.

So that test is called CIMT ultrasound, is that correct? That's the one. But if you are listening here and you're 45 or older, you should get, I would say if you can do it, do a coronary artery scan. Highly recommended by a cardiologist here because like he said, insurance may not pay for it, but it is definitely worth it to see. And as you said, the prices come down quite significantly. So that helps. Before we talk about cholesterol, I want to talk about high blood pressure because that's, that's how my dad died and that's what a lot of people deal with. Help us understand the numbers. Like everyone hears the number. I don't think people really understand what they mean. What does, does low blood pressure have any danger? Do you want, where do you want to be help us with that and.

I'll introduce this topic with the idea. Before you buy a cold plunge, before you buy an imprisonment, before you buy a red light panel or whatever else you're going to get, spend 90 bucks on a blood pressure cuff for your home. When you put on your arm, you just hit a button. Sit on the couch with your feet on the ground. Do it relaxed a few times in a row, about three times in a row, a minute apart. And maybe make it blood pressure Sunday. I mean do it to educate maybe the family, include them in it. It's another silent disease. 18, 19, 20 million people a year around the world die of blood pressure related problems. Some of them are strokes and kidney failure. And ideal blood pressure is 110 over 75. Some people are in the 90s. That's not a disease if you're healthy, thin and athletic. It's pretty uncommon, but it's fine. But you know, the 145, 150s and office blood pressures are notoriously challenging.

Is the top number or the bottom number help us with that?

What do those systolic? Diastolic. Systolic is blood pressure as the heart beats. Diastolic is as the heart relaxes. They both have an influence. There are people, particularly elderly, their arteries get stiffened, just top numbers high. So 170 over 70, that causes disease. It causes the heart muscle to age, the heart muscle to thicken, get stiff. You can get congestive heart failure from just a stiff heart muscle due to high blood pressure. It's definitely a factor in damaging arteries. You know, 100,000 times a day. The first part of the body to get the blood pressure wave is the heart arteries. They're the first place that gets the blood that the heart attack. And 170 is more of a smack in the face than 110. And some of heart disease, that widowmaker is mechanical injury to the heart. So you know, check it out. 110 over 70 would be a really good number. You know, everything we do can influence it. Better sleep, address sleep apnea. Salt is controversial. The the mainstream cardiology opinion is lower salt is better, but it may actually be more magnesium, more potassium.

Do you think? I have a theory. Again, I'm not a doctor, so I'm just asking you. I have a theory that a lot of the salt conversation came because most processed foods are heavy in salt. So most when they talk about high sodium, I'm thinking of a heavily processed food diet. I am not thinking about a whole food diet where you're adding a little pink Himalayan rock salt.

I agree with you completely. And the latest literature in the last couple of weeks was maybe the emphasis should be if you have good kidneys, higher potassium, higher magnesium diet. That's lentils, that's apricots. That's, you know, whole grains. If you eat them, it's, you know, real food. It's not processed food. Yeah, but I remember being an undergraduate, University of Michigan, learning about these people called the fierce Yanomamo in South America class. And you go study them. They have, like, no salt in their diet, and their blood pressure is 90, and they're free of heart disease. So that's usually the throwback.

Yeah, I can tell you, I literally add salt to my water, like today, and I'm low blood pressure all the time, so it's like I can't even get it up. So it's. But I feel this. The. When you eat a heavily processed food diet, you're getting an unnormal amount of salt. You're getting a lot of it.

Read the package. Look at hospital food. You have a cup of vegetable soup at the hospital cafeteria, 1100 milligrams of sodium. You know, that's a whole day's supply for a heart patient. That's terrible. That's a topic to talk about on another day.

Okay, there. If you're finding value in this episode of Midlife Conversations, I would really appreciate it if you would hit that. That, like, button and subscribe. And when that little bell pops up, you want to hit that. That way you are notified of all new episodes so you don't miss a beat. Also, you subscribing and liking helps others find this content. And this allows me to keep growing, keep getting amazing new guests for you and to keep sharing. Okay, let's get into cholesterol. This one is a wild topic. Now I'm going to share that because I genetically have high cholesterol, I have gone down the rabbit hole in this my whole flipping life, starting as a teenager when a doctor wanted to put me on statins. This is years ago. I did statins, had the muscle aches. All the things stopped him after a couple weeks was like, never again. So I had been on a mission my entire life, playing with diet and studying apoa. Apob. Understanding what this all means. Does it matter? Does it not? What's interesting is when I was first texting with Dr. Connor, we were voice noting back and forth. I said to him, what's your stance on statins? Because if he had said, everyone needs to be on statins. Right. I was right away going to be like not my person here. But I loved what you shared. Can you let's. And you also mentioned to me because I said I kept sending him articles and research and saying what about this person? What about that? And he. What he said to me is, Natalie, this conversation about what causes cholesterol has been going on since the 1970s. So help us here share what you shared with me here.

I'll be real succinct, but it is interesting. You know, the first heart attack in the world was described in 1919. Now we do know mummies get X rays. They have calcium in their arteries. There's a interesting. If you're into interesting history OTC, the Iceman Otzi, he fell in a crack 5,000 years ago. And they found his body 20 years ago, perfectly preserved.

Wow.

He had heart disease. He actually had a genetic reason for heart disease. They actually did genetics. So there has been heart disease. But the first heart attack was described in 1919. It's not like this. An ancient disease in the frequency number one killer of men and women every 40 seconds, heart attack. That's a new finding. So after World War II, heart attacks, heart attacks, heart attacks country of Finland, heart attacks everywhere. Research started. You know, there's a famous study some people are aware of called the Framingham Study. And I'm going to go through this quick. We didn't know what caused heart attack. The, the reigning theory was it's just aging. It's nothing about our lifestyle. Lifestyle wasn't a word to many people. The Framingham Study, which is a community outside of Boston, everybody got poked and prodded in electrocardiograms and histories. And they. In 1961 they published a paper. I've read it recently. You could read it today. Everything in it rings true. There's too much heart disease and it's. They identified high blood sugar, high cholesterol and smoking as in that community, largely a white community, relatively comfortable economics outside of Boston as statistical features found much more common in people that had a heart attack and follow up. They started in 1948. So this is about 13 years of follow up than people that didn't have heart attack. Now there's always a question, do smokers do something different than non smokers? So there's something called multivariated. They try, but at the end of the day those are the big three. Some people criticize that. They didn't point out smoking with more emphasis. It took another decade for really smoking.

Most of my listeners probably don't smoke now. But they are confused about the is do I need to chase cholesterol or sugar or both.

So the other part of the story, and I won't go any further, is. And you know this, you brought up the name several times in our texts and phone calls. Is a researcher in Minneapolis was watching heart attacks all over the place occur in the late 40s, early 50s. Ancel Keys, he had already become very famous for research on starvation that was very important in World War II as they released Holocaust camp survivors. And he had done a lot of research on nutrition, the famous K ration that World War II soldiers carried his K for Ansel Keys that he discovered this perfect blend of calories. He saw this rise in heart attacks. He went and visited a colleague outside of Florence, a little town called Nicotera. If you're into trivia and the cardiologists, we don't have heart attacks. We don't see a heart attack a year. And it was like a lightning bolt. Wait, you're the. Your people. We're people. He brought some Harvard professors over and they asked questions. They were not seeing heart attacks in Italy. That started a very long process that's still ongoing into studying the Mediterranean diet, which actually was unknown as a word in America at the time. But Dr. Ancel Keys wrote three books with his wife Margaret, cookbooks for America that were bestsellers. And that's when we learned the term the Mediterranean diet, which still is a good platform to consider, you know, patterning your own diet after. And he launched a study in 1958 that the first conclusion was 1970. And he found pretty without question that the higher the saturated fat content of your diet, which is usually animal foods, could be coconut oil and palm oil. But the communities that were studied did not have much coconut oil or palm oil. So it was butter, cheese, lard, meat, and the rest.

So he was a saturated fat person. He's the one who figured this out.

But I'll tell you the example. He. He visited Crete, which is an island in Greece. 40% of their calories that's higher than is recommended in Crete were from fat. They did not have heart attacks. In the 1950s and 60s, he visited Finland, an area called North Karelia. 40% of their calories came from fat. They had the highest heart attack rate in the world in the 1960, 40%. But it was butter, lard, cheese, sausage. In Finland. It was olive oil. Olive oil, olive oil. And these things just suggest patterns. You know, it wasn't a randomized study. You moved to Finland you moved to Crete. It always leads questions. Are the genetics different? Is the atmosphere different? One's a cold environment, one's a warm environment. And things like that matter for multiple, multiple sclerosis and other diseases. But it was just starting to build the case. Framingham and then many, many studies. We didn't have drugs, so this wasn't funded by drug companies. You know, Ancel Keys became the most hated man in America by a lot of the nutrition communities. There's a lot of misinformation. I'm. I'm his biographer along with some other people. So I'm pretty up on the topic. Not worth going down that path anymore. But out of that came the concept. Get your blood checked. I mean, everybody listening probably has had a pretty good blood.

I want to hear before you go more here because I know your stance and I'm gonna. And I want to come back to it in a minute. I want you to pretend for a minute like you're one of your colleagues that don't think this way. So you've got some other colleagues that there are believers that cholesterol doesn't matter, saturated fat doesn't matter. I've heard some of these, the conversations, right. And if you were, what is going on in their mind? Why do they say it has nothing to do with that? It's the sugar, it's the, it's the blood sugar that matters. It's the other. Help us understand where they are coming from. We're playing like debate in school when you're playing the other side for a minute.

So by its very nature, nutrition science is harder than pharmaceutical science. You got a drug, we put a thousand people on placebo. A thousand people on a drug. We study them for four years. We count something and we've got a pretty good ability to evaluate is it safe, does it work? You rarely ever do that in human nutrition sciences. Rare studies, prediment study, cord approved study. It's very hard to do. And there's often problems at the end of the day. There's break in the protocols. It can be done eight weeks, 16 weeks. That's one observation number two, and I hope people listening have heard the name Voltair Longo L O N G O PhD a researcher at University of Southern California. He's Italian born. I think he's the number one nutrition source in America. He is the number one most funded nutrition researcher in America. He talks about how difficult it is nutrition research, his field, and you got to look at everything. That's what the people on social media don't look at. You got to look at biochemistry. Does it possibly make sense that a higher blood cholesterol, whether it's genetic or comes from your diet like in Finland, could cause plaque? Of course, in 1910, they scoop plaque out of legs of humans and they found cholesterol in the plaque. They didn't find sugar, they didn't find triglyceride. They find cholesterol in the plaque. So at least it's biochemically possible. And many other foundations look at randomized studies. Look at epidemiology, which is the biggest conversation. We studied 200,000 people. There were five studies this week. We calculated that if they ate less red meat and ate more beans, the risk of cancer and heart disease would go down by 28%. There's all these studies this week, every week, but those are all what's called association studies. Is there something different about the bean eaters than there is about the beef eaters? Because they're not randomized. You know, the researchers do their best. You always got to check the funding of the study. Very interestingly, a few of the probing anti beef studies lately have actually been funded by the beef industry. The results didn't turn out the way they wanted. So. And then you got to look at case reports. You're a case report. You've got a very high cholesterol and have almost no atherosclerosis at your age. But keep. And then you got to look and let's not talk about environmental and animal rights and all, but Dr. Longo puts that in the structure. This is hard stuff. And cholesterol is one of 25 causes of heart disease. I checked my patients for in this lipoprotein A and TMAO and insulin resistance and nutrition levels and genetics and on and on. So the fact that you have a high cholesterol genetically 1 in 250 people are like you in this country, but you at this age have very little plaque is a wonderful thing for you, but it's what confuses so many of these critics. It's never one one. Not every smoker gets lung cancer.

I agree with you on a lot of things. So I'm not going to challenge that and I want to go deeper there. But I also want to make sure we don't smoke. Skip over, why do the doctors speaking out? I'm not talking about social media influencers. I'm talking about there's MDs, there's other cardiologists and you know, some of them that are saying stop paying attention to cholesterol and we only need to look at our blood sugar. Why are they saying that? Where is that coming from?

I have to say, you know, social media has changed. There's. There's monetary reasons, there's popularity reasons.

So you think it's not research based at all?

I'm going to give them the credit for being of high integrity. They're cherry picking. They're not.

Tell us what that means. Like, what are they looking at that's giving them this conclusion?

Well, they're not looking at 250 randomized studies put together called systematic reviews or umbrella reviews. It's a lot of work. I mean, you know, you have your passions and things you study. I know you work your tail off every week to provide quality to your audience. That's what I do. And most of it, other than my family time, it's research, it's reading, it's new articles, it's synthesizing.

So you would say that it's. They're taking a few studies, a few things, and they're saying this is the conclusion based on this. But you're saying they're omitting a lot of others that. I don't want to put words in your mouth, but is that what you're.

For example, without ripping, a doctor you introduced me to, I was unaware of Kat Shanahan, MD, in her book Dark Calories. At your recommendation, I actually read the book. She spent a fair amount of time. It's like a red flag. If you talk about something called the Minnesota Coronary Experiment, the story is there was this study that compared corn oil to butter. The data come out as expected. So they hid the data in the basement for a While, and then 2016, it got published. Turns out, I mean, so if you just listen to that story, you'd say, wow, you know, everybody loves a conspiracy. There's a conspiracy to hide the data, that butter's bad for you and corn oil is good for you, or some variation of it. It turns out. I'll just tell you, the study was done. Minnesota Coronary Experiment in psychiatric hospitals. Great place. People are there, we can change their diet. They aren't going anywhere. Turned out the study was done just as drugs like Haldol were coming on the market and people started getting released from psychiatric hospitals. So at the end of one year, 83% of the people in the study had been discharged. That wasn't the idea that they were supposed to be there for a decade. So when you have a study of thousands of people and 83% can't even complete the one year follow up. It's a very weak study in essence. Plus there was a lot of trans fats in margarine back then. Unfortunately, there's not too much good to say about the food industry. We have far fewer trans fats. So it's so nuanced that it's very easy to pick and present four or five studies. But I'm telling you, unfortunately there's thousands and it's just exhausting and hard. I don't know right now this is a wave coming back, but like you said, it's a wave that existed in the 60s and the 70s. And Dr. Dean Ornish used to debate.

Yeah.

Robert Atkins on national TV in the 80s. Two very different. So everybody loves a good debate, a good rock em sock em.

So my big awareness, I have read more studies than I can even believe how many studies I've read around this. Like I am, I have been consumed in this cholesterol topic and heart disease and what I have found when I dig deep enough and I like really listen to cardiologists on different sides and most cardiologists I find really more aligned with your thoughts around saturated fat and cholesterol than cardiologists that don't. But what I do find is there's a lot of commonalities and I want to talk about some of those first and then I want to get like more into labs and nuances because the commonalities that I found digging through research, talking to you listen just everything is almost actually all of them will say unprimarily and unprocessed. Natural food diets best, whether you're vegan or whatever or you're vegan or you're Paleo or you're. That doesn't. Or Mediterranean. Unprocessed, primarily natural, real foods are best. I'm also hearing pretty universal that the best fat source would be literally like olive oil, nuts and seeds. Is that accurate? That's what, that's what I'm finding.

So everything you just said is, you.

Know, I'm also hearing that being leaner and adding muscle and working out huge, getting your blood pressure down is huge. And then cholesterol. What I'm learning is very nuanced. And before we talk about the details on the cholesterol, blood sugar is pretty universal with everyone I've listened to or read that you do not want pre diabetes. You got to manage your blood sugar because if you don't, you do create more inflammation and, and you do create problems. I'm also hearing that trans fats Partially hydrogenated oil, all that bat oxidizes really quick. Not good. I'm also hearing whether you're vegan or not, if you're vegan and you have patients that are meat eaters or you're a, a carnivore doctor, you, there's still a universal thing about you do not want to overcook your meat. If, if you burn your meat, you're creating glycation which creates oxidation. Is that accurate? Help me with all these things.

That's worse. About two more minutes now or when you want to talk about, about that because that's so interesting and your audience probably isn't hearing it ever. Want to do it now?

Yes, let's do it now.

Yeah. So very conveniently, there's an abbreviation, AGE small S AGES that stands for advanced glycation end products, a very sciency word. But these are chemicals that get created in your body for two reasons and they literally age your body. They age your arteries, your nerves, your skin, your hair. You don't want wrinkles, pay attention right now. And we learned in the last 40 years that if you chronically run a high blood sugar, maybe you got a CGM on, maybe you've had lab testing or a glucose tolerance test. Remember, if you had prediabetes during pregnancy, you're at risk of it later in life. So get tested. That as your blood sugar stays up on average, your proteins and your fats become really like a frosted donut, sugar coated, it's called glycated. They don't work well, your arteries become stiff, your skin gets damaged, it leads to high risk of dementia, cancer, heart disease, kidney disease, pretty much anything you don't want. So control your blood sugar. Okay? The second reason you develop age is what nobody hears about. You take a breast of chicken, I could take a block of tofu, and you put it in a stew or a tagine, there's a fancy word. And you make a moist chicken based dinner for the family. The amount of age that can be measured. And there's a professor in New York who's the world expert on this. Helen Vlassara Greek, Maryland. You make very little ages. But what does America love to do? Take the chicken, put it on the barbecue, roast it, grill it. The any food that's high in fat and protein that you apply high heat to and frying is the worst. You create a, a God awful amount of these age compounds and we eat it for breakfast, lunch and dinner. Could be bacon. Bacon is the number one food on this. The level of age from Pan fried bacon is insane. But.

And what does age stand for again?

Advanced glycation end products. So there is a cookbook, there's a few out there, low age recipes. But get an instant pot, get a tagine, make stews, make chilies even. Here's a tip. You want to barbecue your chicken breast, you marinate it ideally in lemon juice, vinegar or black beer. These are all research studies.

Lemon juice, vinegar and black beer. Okay.

You don't have to do them all at once. Probably if you did them all at once, be a super package. You probably cut down the chemical reaction. The moisture helps and the acidity helps. And you.

Any vinegar, red. Red vinegar, white vinegar. Does it matter?

I got, I got to search it down.

Okay.

You create half the amount of these age. So. And there's very little, I hate to say it, in plant based foods. Tofu is an exception. Tofu is a high fat, high protein plant. You fry, barbecue your tofu, which is a pretty unusual thing to do. But tempura at a Japanese restaurant, you can create a lot of age because it's the same chemistry.

So this is another word, this comes into my obsessively digging. So a lot of times I'm not saying this is your feeling because I know where you are and you're a vegan. But, but there's a lot of times where people are bashing meat. They're talking about grilled or overly processed meat. So when you're doing like organic, natural and you're cooking it well, then it's not necessarily creating as big of a problem as when you're using the highly processed food. Like you even said, it doesn't matter how natural they're listing the bacon or the, the sausage. Stay away from it.

This is not a topic about grass fed being better than. I mean, obviously factory Produced meats has 1000 problems, only one of which is how poor quality.

And you're talking about the cooking method and the curing method where they're made.

In North Carolina with all the sewage and the infections and antibiotics and you know, just. And plus human, you know, tragedy of trying to work there. You know, it doesn't matter if it's that meat or grass fed, finished, regenerative farm meat, throw it on a barbecue, you have a chemical reaction called age.

So I'm a little human experiment here. And what he, doctor, what he knows is I had sent him my most recent labs, but I'd also sent him labs from four weeks ago that were dramatically different in some numbers, like mpo, we're Going to talk about what actual lab markers mean in a minute. But my, it was like an off the charts MPO and my everything had skyrocketed and when I looked back at why, like what was the difference? It was the meal I had the night before the test, which is interesting. And I had gone out to a restaurant and I had had like all the things on the menu and I had a steak that was definitely like more burnt on the outside. So this stuff's pretty immediate in your body. I can, I'm sensing that it's pretty immediate when you eat like a grilled mood or a food or fried food, it shows up pretty immediate. Is that accurate?

Yeah, it is both accumulative, but it, it's immediate too. Yeah. One meal changes your microbiome and your physiology and your life blood work. Yes.

So just to kind of wrap this up before we go on to the lab part, just best practices for meat. If you're having meat, you're going to say you want to make sure you're marinating it in lemon or vinegar. Obviously boiling, braising, cooking at a low heat is going to be way better than grilling or deep frying or curing or processing. Anytime you're doing that, you're creating the bigger issue which creates oxidative. So stress, something else. I don't know if I learned this from you. Maybe I did. I read so much. I'm not sure where it came from now, but I think it was you that if you are having meat or you happen to be having grilled, you want to make sure you're having a lot of vegetables, green leafy vegetables with it because it kind of counters that. Did I get that from you?

Take it from me.

Okay, I take it from you.

You've got the antioxidant to go with the oxidative stress. You have the anti inflammatory to go with the inflammatory stress.

So y', all, I've been literally like, I make sure now if I'm having meat, I'm having a big green salad. I'm taking my broccoli sprouts with it. I'm literally, I take my energy bits. Like I make sure I'm overpowering with greens and I'm also taking polyphenols with it. I'm like, I'm making sure to add that because I thought I didn't know if I got that from you or somewhere, but it made sense to me because antioxidants are countering the oxidative stress.

Can I give a broccoli cooking, please? Cooking Tip. Everybody pay attention. This is the coolest science. You know, everybody loves broccoli. A lot of people hate kale.

Some people hate broccoli. I love it.

Don't hate broccoli. You know, you've got the water boiling. You're going to steam some broccoli, and there's your broccoli head. Broccoli is like a glow stick. Remember those things we break? It has a chemical called glucoraphamin. Separately in the cell, there's an enzyme called myrosinase. But then this is all you need to know. There's a really good chemical in broccoli that can be made called sulforaphane. And question is, if you just dump that head of broccoli in the water, the enzyme gets destroyed right away. You won't make sulforaphane. Sulforaphane is anti breast cancer, kind of like food medicine. So you chop, chop, chop your broccoli on the, on the chopping block. Let it sit there for 20, 30 minutes. You've broken some of the cells up, releases that enzyme from the broken cells. The chemical reaction that would occur if you chewed raw broccoli. That's cool. Chew raw broccoli.

Yeah.

You can create a little chemistry set on your chopping block. Wait 20, 25 minutes, and then dump it all in your steamer. In your water, you'll have sulforaphane rich broccoli, which is super good. It's always a good food. But sulforaphane rich broccoli is a better food.

What about broccoli sprouts? Are you getting that from that?

Yeah. You don't normally cook broccoli sprouts, You Absolutely. As you chew broccoli sprouts, one of my favorites are broccoli microgreens.

Yeah, I eat a tight. I'm like cups of them a day.

We have a little organic farm by my house. We get broccoli micro.

Also helps if you're estrogen dominant.

Literally one of the best foods on the planet.

I mean, also helps with estrogen dominance. It helps you clear estrogen, so it helps with that pathway.

So D in it, Right?

Exactly. Yes.

Another, before we're done, we just got to talk about statins for two weeks.

Oh, yeah, we're going to talk about that right now, actually.

Going down, you know. Oh, we were talking about your lab values.

Yep. I want to talk about lab values and statins and where they fall in. So. Okay. Share your perspective on statins first. Do you feel they're over prescribed? Do you think there's Ever a case for them. What where do you fall on statins?

And this is a little part you can tell. Sometimes I tell a little story before we get to it. This is a little part about my strong belief that cholesterol can't be ignored. It doesn't need to be over treated. It can't be ignored. When I was a cardiology fellow in Dallas, Texas and two gentlemen won the Nobel prize in medicine for discovering how we make cholesterol in our liver. Dr. Michael Brown and Joe Goldstein. Incredible experience to be there when that happened. We would take care as cardiology fellows of 9, 10 and 11 year olds. You probably got one gene from one parent that gives you a cholesterol over 300. That's called heterozygous familial hyperlipidemia 1 and 250. We were the referral center because these two Nobel Prize winners for children, they got it from both parents. That's called homozygous. Instead of one in 50, it's one in a million. And they only have one defect in their body. They cannot clear cholesterol out of their blood. So their cholesterol can be a thousand.

Wow.

And we had people getting bypass surgery, having angioplasty and their lifespan can be quite shortened. And now there are many strategies to deal with it, but we're talking in the 1980s. So you say, you know, you got a kid, that the only thing that God gave them a altered, you know, physiology is high cholesterol. You see what happens? It weighs on me and all. So the easiest philosophy, well, number one, the official way to do it is I meet with you, Natalie, I plug your numbers into the prevent calculator, I come up with what your 10 year or your 30 year risk is. I'm assuming you haven't had a calcium score and you haven't had a clearly see the angiogram. And based on that I whip out my prescription pad and I say, typically over the next 10 years you probably should take this medicine. I'll see you in a year. Maybe you'll learn about muscle aching and blood sugar patient and brain fog, all which are real. God forbid you get told to take CoQ10, a vitamin that helps safely use statins. Maybe they'll talk 30 years. That'd be quite unusual in 2007. This is really key. There was a proposal by a really great research foundation. Why don't we check people for heart disease before we write a statin? If only has clean arteries, we shouldn't be writing a prescription drug. We don't use chemotherapy on people without cancer. Why are we using chemotherapy called statins on people without atherosclerosis? It took 12 years, but in 2019, even the very conflicted American Heart association takes money from all kinds of crazy places they shouldn't take money from. Without question announced. If you have a calcium score of zero, that $100 easy test, there's no role for you to be on a statin unless you're a smoker, diabetic, a small group of people. So if you ask me in my clinic, I take women off statins because I ask them to get the testing. You know, Jane, your carotids are clean, your heart arteries are good. We've got a lot to do with exercise, diet and supplements, sleep and stress management and hormone replacement and all the things you can do with a midlife woman. We're stopping your statin and it's a joyful moment for me and I'm doing it really within property. Yeah. Now, if you had a large burden of disease in your heart arteries and thank goodness you don't, and you have a genetic problem and you know, your best diet and your best fitness didn't bring it around. I talked to you about the whole option. We can try niacin, we can try red yeast rice, we can try berberine, we can try bergamet. But if you want to have the least cost, quickest benefit, I'd put you on a mini dose, a microdose statin, five milligram, two and a half milligram, and there's a second drug, you add to it called Ezetimibe and you use them together scientifically. Been shown safest combination, most effective combination and also the most effective at keeping arteries clean. I've been doing that. I'm not brilliant, but I've been doing that for about 20 years. Just in the last six weeks, the Mayo Clinic published a paper. Every cardiologist should use this low dose combination. We'd save hundreds of thousands of lives.

And is that a daily combination or is that a few times a week?

There are people that take usually the second drug. It's called Ezetimibe or Zetia. Z E T I. I usually use that daily. It works in the intestines. It's not a statin, doesn't work in the liver, doesn't cause muscle aching. The statin I might use twice a week, three times a week, four times a week. It all depends. You'd be challenging if we needed to treat you and we don't because you know your cholesterol is over 300.

It's not over 300 right now. It's 238.

238?

Yeah.

Since you talked to me, it's dropped. I mean, it's amazing. I'm not taking credit for that. You didn't go back for that same meal. So there is, in my opinion, a very. It's called personalized medicine. Natalie's different than Jane's, different than Debbie different. And it's harder work to.

Why does your body. Okay, this is the big question, right? And I'm going to give you the social media influencer answer. And I'm going to ask the question from the cardiologist. I want to understand why your body produces cholesterol to begin with. And then why do people say that we need cholesterol for our brain and to protect us. And what happens if we remove the cholesterol? Do we create another problem?

Wonderful point. And some people argue, and I would argue that calling LDL cholesterol, the bad cholesterol, it's somewhat effective in describing a cholesterol panel to a patient. We used to call HDL cholesterol, happy cholesterol. But we don't say that anymore because a lot of Women have an HDL cholesterol. 110, 120, 130. They have heart disease. It's not protective. It can be damaging. So we don't say H is happy anymore. You want to be right in the middle for hdl, but LDL and all. So you need cholesterol for your cell membranes, for your brain growth. But what's the LDL cholesterol of a 2 month old. I have a 2 month old granddaughter right now, Natasha. She's growing like a weed. What's her LDL cholesterol? 25 or 30. And she's growing 30 faster and quicker than any time in her life, including her brain. She's coming along just great. And in fact, the data is you don't need a LDL cholesterol of 225 to fuel your membranes and your vitamin D and your sex steroids. Nobody has an LDL of 0. Even the most aggressively treated, serious sick heart patient lowers their LDL cholesterol or their apolipoprotein be another way to measure. But they don't go to zero. And I always will fall back. You can listen to Facebook and Instagram. These two Nobel Prize winners in 1977, before I got there, Joe Goldstein, Michael Brown said our research, which ended up winning them a Nobel Prize in medicine that's never been contested says that the baseline level of LDL a human needs is 25 milligrams per deciliter for all body functions. That's what an infant has. That's what animals in the wild have. That's what native populations living in jungles like the Yanomamo have 25 or 30. And actually that's kind of where cardiology is back to if you've had bypass stents, heart attacks and you're in big trouble, we're lowering your LDL to Brown and Goldstein levels. 50 years later. It's kind of fascinating. But you don't need that. I don't need that. I don't take a statin. I have calcium score zero. And a clearly study that's like yours, you know, trivial. I do a lot of other things. I don't take it. So we just. Some of the women listening probably can get off a statin. Work with your doctor, get the heart scan. But is there, is there nobody listening that could benefit from a statin? You know, it all depends who you are out there in Natalie. Jill.

I do doctors so quickly. When someone has a cholesterol that's even borderline, like there's some doctors I'd walk into with mine and they're going to go, you have to be on a satin. And they might even put me on blood pressure medicine when I don't need that. So why are they so quick to do this? Is this protecting themselves? What are they? What's the reasoning?

There's a bunch of they don't know how to talk to you about nutrition. Even recognizing there's a whole bunch of patterns of nutrition. With the Mediterranean diet being easy fallback, they probably don't have much to say about fitness. You know, there are a lot of unhealthy cardiologists. It's not an easy lifestyle. It's not an easy lifestyle. I mean, they should bring up smoking. Most people don't smoke anymore. And it's easy. You know, the numbers get better. You know, the numbers almost always get.

Better unless you haven't changed the lifestyle.

We don't fix the number. Translate. So this is a little sophisticated. There is something called number needed to treat. There's actually websites nnt how many 53 year old women with a cholesterol of 245 that have no known heart disease you have to treat with a statin to save one heart attack. It's an incredibly high number.

Wow.

Actually, if you get more sophisticated, how many women with a calcium Score of zero. Do you need to treat with a statin for one heart attack? It's an insane number and a lot of those women are going to have side effects. So you don't do it. But when you get down to the bypass and the stent and the calcium score is 500 patient, it's a more reasonable number.

That makes sense.

Might be 30. I'll tell you one last thing. I just want to throw this in. There are studies that follow people for 50 years for cholesterol, 15 years for cholesterol. But most of the cholesterol studies are four to five years. Drug companies just can't do a 15 or a 50 year study. When you look at low cholesterol over 50 years, you drop heart attack rate by 90%. There are people that are lucky to be born with a lower cholesterol. They have no problem, they just have less heart attacks. When you look at studies like the framium study over 15 years, it's kind of in the middle. The trials of drugs, they end at four to five years. It's not that much time and challenge. So you get these little benefits. And that's what social media attacks. It wasn't much but the conversation should be 20 or 30 or 40 year risk. It's hard to do though.

Makes total sense. So I want to talk about labs and then I'm going to come back to like what people can actually do, diet and supplement wise if they're not going a statin route. And I'll share what I'm doing too. That has made a big impact on mine. I want to talk about some main numbers here. So obviously when you go get a test, they do a total cholesterol, they do an ldl, they do an HDL and do a triglyceride. Can you just for people that don't fully know, explain sort of the difference between ldl, hdl, triglyceride and even that ratio that shows up?

Okay, so you know, the ability to measure total cholesterol is probably 80, 90 years old. So that's where actually that's where the studies still focus on. Even though when we treat, we're treating LDL cholesterol predominantly. Turns out that's why this basic panel is not good enough. If you really look at anybody's cholesterol panel, the basic panel, it'll say LDL calc. It's a calculated number. They don't directly measure it. It's a 50, 60 year old equation called the Friedman Wald equation. The most important number for treating a heart Patient is a calculated artificial number. It's not good enough, but you know, the total cholesterol is LDL cholesterol, which is low density lipoprotein. We learned that if we spin your blood, your lipids in your blood layer out based on their weight. And we called the low density, low density. And the high density triglycerides just float to the top. They look like cream if you spin your blood. And they're all what's called atherogenic. If you have a triglyceride of 1800 people are like that, you can develop clogging. If you have an LDL of, you know, 200, you could develop clogging. It's not necessary, but it's possible. And we thought if you had a low hdl, you could develop clogging. But it turns out this over 100 phenomenon in the last 10, 12 years looks like it's not so sweet either. So what you've had many times is there's something called an advanced cholesterol panel. We're talking 25, 30 bucks. Some people call it three letters. NMR, nuclear magnetic resonance Lipo profile. It actually measures one thing we can do, LDL particle number. It measures that LDL really accurately. Yep, much better than the calculated. And there are studies that if you want to go predict heart attacks 10 years down the road, the advanced lipid panel, 25 bucks works better. But primary care docs don't do it. I mean, I've ordered 50,000 of them. But primary care docs don't do it. It's just more data to deal with on a quick office visit.

Totally.

Lately there's two labs that are now stressed heavily. Everybody needs, your audience needs get a lipoprotein a cholesterol. And I'm going to be a little promotional here. If you're watching this on YouTube, that's how you spell it. Lipo protein A. Yeah, I wrote it's the only book on this topic out there. But that is a 25 blood test. You can have a really nice cholesterol panel and find out for me or somebody like me or just ordered on your own on the web that your parents gave you an extra cholesterol you had no clue on and really should be checked. At age 18 or 20, 25% of people, their liver allows them to make this 75% of. No, some never get heart disease. It came from mom, dad or both. But fortunately you don't have that double whammy. You don't have the high cholesterol and the high lipoprotein little A. A lot of people have both. It's a double whammy. This is really tough to treat, but if you want to know your current status, get this done.

Okay?

There are drugs. I hate to say there were drugs because there really isn't any diet or food fitness. Niacin, a B vitamin, helps, but cardiologists hate niacin. I don't.

They do. I take carton icin.

Yeah, I. Cardiologists typically say that's an old drug. From the 1970s we got newer.

What's wrong with it though? What's it going to do? Is it negative?

1970S, they did randomized long term studies that showed niacin B vitamin, which causes a bit of a flush feeling, lowers heart attack, lowers stroke, and you live longer.

And I like the flush feeling.

I like the question too. I take niacin. But when they started to combine niacin with statins, two studies suggested that didn't add benefit. They weren't particularly dangerous. And it just muddied the water.

It's not hurting anything.

It's just they're saying my niacin costs about 20 cents a day. So the pharmaceutical industry wasn't so excited about over the counter guys. And then the other blood test, remember I said too, it's called apart B, write down apo. But now capital B you got to do.

And there's two of those. There's APO B and APO B. A1. What's the difference?

There's APO A1. Okay, I order that. APOA1 is A, is the carrier of HDL cholesterol. Okay, I see some really nice doctors and patients want this test and they accidentally order APO A1 and they tell me it's fine and I look at it. I said, no, you didn't. You never had this check. So just write that down. Get that done. Lipo protein, little A. Every lab does it. Lab Corp. Quest Hospital doctor's office.

So I'm just looking at mine. Actually, maybe I have the wrong one because mine says APO A dash one. So that's the wrong thing.

Your most recent labs have both. That's why I was telling you your most recent lab say your lipoprotein a is less than 7. It's under lipoprotein markers.

Oh, I see. Okay, good. So I. Okay, that's. I was looking at the wrong thing. Oh, I'm really good. I'm really good there. I see it.

I'm showing you labs. I'm violating hipaa. Yeah, it's hard to read on the phone, but you do.

I see it. It's good.

Okay, you had apob and actually just recently. I mean, it's a test. Been available for four years. If you said too much stuff, give me one number to check if your APOB is low. You're good because it measures everything. Bad triglycerides, bad lipoprotein A, bad ldl. If your APOB is high, there's a few different reasons to could be high. So that's the latest trend. Ask your primary care doc or a lot of people are ordering labs online that they pay for cash. Make sure you do what you did. Natalie.

Joe, that vibrant test, that's the full heart panel. What about oxidized ox, LDL and mpo? Can you. Because the MPO was the one that put me on the state of the alarm when mine was super high that one time.

Well, you used to live in San Diego and there was a professor at the university. University, Daniel Steinberg. A blessed memory. I knew his son and he was a researcher extraordinaire and he developed a way to measure oxidized ldl. Rusted ldl. Other things you can glycate ldl, you know, from the advanced glycation end products and make it. But oxidized LDL seem to be worse than regular LDL. That trend has fallen off in the last 10 years that all of these particles we've talked about in some people can be dangerous to their blood vessels. So you can measure oxides, ldl, if you want. I mean, I follow the literature like crazy. There's very little new that says danger, danger. Be sure you get your oxidized LDL measured again. Major publication in the last three weeks definitively said forget about that stuff. Get your lipoprotein A and your apob and you've got a good foundation where you're at.

What about npo? What is that?

Well, that's your specialty. And you know, everybody agrees that inflammation is a factor in many diseases. Brain disease, but it's a factor in developing a heart attack, a clogging, a stroke. And we have many blood tests to ask the question, is my lifestyle creating an anti inflammatory milieu? I love that word. Or is my lifestyle or my dental health or my sleep apnea or my psoriasis or my eczema, is it creating internal inflammation? Or my lupus, my rheumatoid artists, my Sjogren's, all the autoimmune diseases you want, your high sensitivity C reactive protein. But you said mpo, myeloperoxidase It's a lab test created by the Cleveland Clinic. You showed me your lab values three weeks ago. You were like, I was freaking out.

I thought I was going to die.

Yeah, Cleveland Clinic. That is really, really bizarre. Fortunately, it appears to be lab error. Or that terrible meal.

It was just one meal. Or a lab error. Yeah, or. So what I learned about MPO was if you have a dental infection. So I went right to the dentist. If you have like an old root canal, a dental infection absolutely can raise your mpo. Also if you're living in mold. So if you have mold or heavy metal exposure. So and even just like a recent, like if you were staying someplace for a week, it could raise it. So it's an indicator that you want to recheck. In my case, mine was like not so high. It was 4200 and I was like sounding the alarms. It's not that anymore. It's normal.

But that's a paper. People that take melatonin at night have lower mpo. So if you need to do. I'm a fan of low dose melatonin. It's a cool little. Because people ask me, doc, what can we do to lower it? Well, like you said, eat clean, go to the dentist. There's a special X ray of your mouth called a cone. Cone beam teeth that can find hidden infection under your root canals. You have high inflammation. Sometimes it's worth, you know, the mouth and the heart are very tightly connected.

I'm going to ask you about that in a minute. And then external things like toxins because I know you are a fan of looking at all of that. But I don't want to skip over the supplement. I want to share what I'm doing supplement wise for heart health. And I want you to chime in on what's being missed and if everyone can take these or what, what we should be looking at. I personally, I do niacin, I do Coq10, I do Bergamot, I do polyphenols and I do quercetin every single day. Those are I. And I'm also very aware of alkaline foods. So I eat a high amount of low glycemic fruits and vegetables, a lot of them because I want the antioxidants. And then as far as my fats, my main fat that I include in my diet is olive oil. I put olive oil on everything because of the polyphenols. And it's also a more heart healthy fat. I do not have more than 30% of my calories, no Way from fat at all. So I am not into that eat a 50, 60% fat. So I am. When I do have steak, for example, I'm having lean cuts of filet. And then I'm also watching how meat is being cooked. So based on what I just shared, where are those things like kind of use universal? Anyone can have those types of supplements. Is that not help us with those? I know I sent you a picture and you were like, I like them, but I wanted to make sure we.

Talk about niacin as an option. But don't tell your regular cardiologist. They won't be happy. Of course. Okay, tell them Jared. But there's a wonderful book, Niacin the Real Story. It's, you know, 450 pages by Dr. Abram Hofer that if you want to read about niacin, you don't have to do that talk about bergamot. Bergamot is a lemon looking citrus that grows in Calabria, Italy, the very bottom of the island. It's been associated with longevity and health and anti inflammation and people now prepare it in capsules and it can lower blood sugar and lower cholesterol. It's a natural treatment. It's quite safe for sure. You can add it to a statin. There are research studies. You can use it alone. Quercetin comes from onion, garlic, apples. It's a polyphenol antioxidant. It's a great supplement recently just described. It helps prevent gum recession if you're dealing with that. During COVID it was being used widely because it has some immune support for benefits. It's great for your endothelium. I have ladies that have Raynaud's, the white, red, blue, cold fingers. They do Coq 10 and Quercetin. Oh, their endothelium says this is great stuff. Don't use Listerine and Scope. Those antibacterial mouthwashes are very bad for your endothelium. And I've had women get rid of their Raynaud's by getting rid of their mouthwash. Crazy. Tell me what else was on the list.

So. Well, I think you hit all of them. As far as the oils that your favorite of olive oil, would that be your preference?

Absolutely. When you have science, use science. There is a little controversy amongst cardiologists in the plant based community. It's crazy. Olive oil is toxic. So in 2020 a paper was published and there have been others in Spain. This is one of the very rare Nutrition randomized studies. 1002 heart patients, not healthy volunteers for seven years had five tablespoons of olive oil a day or less than one teaspoon a day. They tried to keep them on path with a great Mediterranean diet, a low saturated fat Mediterranean diet. They stopped the study early. There were so many fewer heart attacks and hospital admissions in the high olive oil group. The group. And they looked at those CIMTs. The plaques were melting with the olive oil. I don't do five tablespoons a day. I do one good heaping tablespoon on my salad every day. I'm very picky about extra virgin cold pressed ice pressed. I'm buying from northern Israel right now to support a little farmer, but usually it's Italy.

No, I buy. I have very high quality olive oil too and. But I've used it for everything. I personally and I don't tell everybody to do this. I will prefer in my programs, for example, if somebody's adding fats to their diet, I list out the fats that they could use and I avocado oil, olive oil, nuts and seeds. I prefer for them using either coconut oil, butter or ghee over using trans fats or margarine or things like that. However, I don't personally eat saturated fat. I'm very aware of that. I don't add a lot of it, so I want to share that too. What are your thoughts in general about and other than meat itself? They know how you feel about that, but what do you. Your thoughts on the whole coconut oil trend? Tallow, which is from. What is your. What are your thoughts about that?

Put whatever you want on your skin. If you're a heart patient. I wouldn't include the two food products you mentioned in your diet. They are. I don't know the percentage for beef.

Tallow, very high saturated fat.

But Coconut oil is 85, 90% is number one in the world. There just isn't much research about coconut oil. There's one little group of people, 1200 people called Ketavins. They eat coconuts and they seem pretty healthy. It's such limited research.

So if you're not. If you're like my husband and you have no issues, you can really jack.

Up your coconut oil and your beef tallow. Just do a blood test in six or eight weeks. Yeah, some people are hyper responders. My cholesterol 180 went to 340. It happens.

Yeah. I'm a hyper responder. So my stuff very much. When I had a whole workup years ago, a cardiologist told me I'm one of those people that do not process saturated fat. Well, so that was unique for me. But, like, my husband can have as much as he want. Doesn't affect his numbers at all. So it's very individualized. I know I'm asking a lot of questions here, but I want to kind of wrap up with external factors, external things, like, how do you feel about, like, toxins? Do you think? I understand some people go, well, everything's toxic, but what are your feeling on, like, xenoestrogens and, like, all these. This extra stuff in our products and how that's affecting our hearts?

I think it's a huge issue. I think it's a huge issue in the obesity epidemic that leads to insulin resistance and hypertension and heart disease and shrinks your brain. There's all kinds of problems with obesity, and it's not fat shaming. It's just real. And I think it, you know, we can store no protein in our body. You know, you can build muscle, but you don't store protein you ate. You store a little bit of carbohydrate. You can store as much fat as you want. And a lot of these toxins get diluted in the body by being stored. Stored in fat. There's kind of this theory that you're protecting your health by maintaining an obese body status because you're diluting the toxins. And as you start to lose weight, they come out and you get, you know, reactions. So I think it's a big deal. And it. It's, you know, air quality. There's 8,000 research papers about air quality and poor health, including heart health and dementia. Get an air filter. Try not to live by a freeway if you can. Don't work as a truck driver. I mean, there's. There's issues that are difficult there, you know, including glade air fresheners, you know, those kind of things.

I unplug those anywhere I go, like when I see them plugged in.

Water quality matters. Have home water systems, if you can. Don't drink out of plastic bottles. But really, it's the plastics, the microplastics right now. Don't microwave plastic. Be careful about, you know, plastic wraps. As you're cooking for food, the whole gamut, you really do need to make these changes. There is this group of chemicals called phthalates. They're in a lot of women's cosmetics. They're in a lot of nail polish. They're on a lot of eyeliners. Unfortunately, the chemical names are uninterpretable. Dpb, dmp, depates. But just, you know, there's so much that's relevant. In the last two weeks, there was a worldwide study that 350,000 people a year die of heart disease due to phthalates from.

Oh, wow.

350,000 people because they're endocrine disruptors. You got a high exposure to phthalates, your thyroid gets impaired, your blood sugar gets impaired, your cortisol gets impaired. And down the road, you know, heart disease develops. So.

Wow.

The perk, you know, if you go to the dry cleaner. Do you clean my clothes in perc? Go find a nice green, organic, you know, dry cleaner. If you do that, you know, buy organic mattresses and sheets of furniture and carpet, you know, you could drive yourself absolutely crazy. But we are paying a price for modern convenience.

Wow. Wow. This was so helpful. Today. I know you. You can see patients in other states. Can you share a little bit about, like, how people can find you? Can they work with you and a little bit more about your books and just where they should go to learn more.

We are very kind. Yeah. I'm about 35 years into practice, but I'm. I'm actually not slowing down. I've added more hours lately because I'm just busy. Ten months a year in Michigan, two to three months a year in Boca Raton, but always doing telemedicine. New York, California, Texas, Florida, Pennsylvania, Arizona, Iowa, Illinois. You know, not every state. New Jersey, Connecticut, a lot of states. Okay. Because I am a solo practitioner. You go to Dr. Joel khan.com d, r, j, o e l k a h n dot com. There's a link. I have a weekly podcast. I have my clinic. I have blogs. There's a lot of free information.

Amazing.

Isn't as pretty as yours, Natalie. Jill. I need to update it, but it does the job. It functions pretty well.

Amazing. Thank you so much for today. Thank you.

I loved it. It was wonderful. And I just really hope. Get a calcium score, get the apob. Get the lipoprotein A. Make a chicken stew, not a chicken fried. I mean, these are. You know, watch your cosmetics. There's a lot of practical things we can all do.