Your Doctor Is Wrong About Cholesterol

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