Transcription
Major update in cholesterol screening guidelines, the first in nearly a decade. It is estimated that one in four adults have high LDL, the bad cholesterol.
One in four, about one in four adults in the U.S. have high LDL cholesterol. And now there are new guidelines emphasizing healthier lifestyle habits.
The new cholesterol guidelines are being called one of the biggest changes in decades. But what's the change, and why is it surprising so many people? Let's unpack it. Hi, I'm Dr. Eric Westman. Welcome to my channel where I review and debunk nutritional misinformation online. In this video, we're going to hear from Dr. Sil Dond. I've done some reacts videos of Dr. Don before. He's an internist and generally a pretty reasonable sort. And here he's getting bloody furious about this new cholesterol guideline. Let's see what he has to say.
I am so angry right now. I am furious at the new guidelines issued for cholesterol management by the American College of Cardiology, American Heart Association, and several other American organizations. They are doubling down on being hyperaggressive, focusing on the cholesterol number. And I have immense concerns as a doctor. I have for a long time with the way the medical profession is so focused on numbers. They're focused on medications like statins where, when you dive into the actual data, when you actually be a person of science, the actual benefits are nowhere near what you may be led to imagine. And my concerns are that, especially at the extremes of age, being hyperaggressive with fixing numbers is not a good thing.
So specifically, he's talking about fixing, monitoring, and fixing the total and LDL cholesterol. The LDL being the primary molecule that's in guidelines and and doctors and and are actually supposed to lower the cholesterol level based on these guidelines. And some doctors are even paid to do that, or or something is withheld if they don't have x% of their patients on medicines for certain levels of cholesterol. I kind of share Dr. Dan's concern, and I'm not one to be furious about many things, but the idea that you have to only use medication to help with heart disease and cardio-metabolic risk is going to be a theme here. So the traditional view is you have to use medications to achieve some sort of benefit for heart patients.
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I mean, think about this. Every cell in your body needs cholesterol. Your brain is 60% fat. But authorities are doubling down on this aggressive management of a number. Take a look at this here. These are some of the guidelines that they are emphasizing. And look at this here. In high-risk people, they want the LDL cholesterol to be less than 55. You got that? The LDL, quote unquote, bad cholesterol, less than 55. That is super aggressive. Has this been thought through? Have they studied people who are at the extremes of age, older people, what happens when you're hyperaggressive? Because these statistics, and I'll come to this in a moment, for statin medications, a fair number of people do have side effects. Let's look at some of the other recommendations.
Well, so before we leave LDL, I learned a while back doing a course of cholesterol myself that LDL and cholesterol, like Dr. D is saying, is a normal, in fact, essential thing in the body. LDL is not there to cause heart disease as its only reason. LDL is a molecule that lipid-soluble, fat-soluble molecule particle, if you will, that takes fat-soluble substances through the bloodstream, which is a water-soluble environment. So the liver packs on the fat-soluble substances for the VLDL, LDL generation, and LDL generation, and then fats-soluble vitamins are put on these particles and kind of trafficked around like trucks in the in the on a highway, so to speak. Chylomicrons are a different beast, but they take fat around the body, fat that you eat, and also fat-soluble substances, things like that. We don't talk much about chylomicrons, but the LDL being the only thing to think of when you think about heart disease risk and management.
Well, aside from smoking, high blood pressure, abdominal obesity, metabolic syndrome has now become a player in cardio-metabolic risk. And that doesn't look at LDL. It looks at triglyceride and HDL in the blood. And of all of these things, the traditional view was to focus on the LDL. But we in the nutrition space have concern about lowering an LDL particle down so low that it can't send around enough vitamins and nutrients in the bloodstream if you lower it with a medication, for example. So, yeah, I share some concerns here too.
Well, they want to focus on a blood test called lipoprotein, and that's okay. I'll talk about that more in a future video. That's a decent blood test. They also want to put more emphasis on coronary artery CT scannings. That's a CT scan to look for plaque buildup in the coronary arteries. Again, I'm okay with this, as long as it's not going to be used to suck more people into the medical industrial complex. As long as we've thought about false positives and also false negatives as well, it should be thought through if you're going to rely on a scan. But this is the part that really gets me. They are now really focusing on screening children. You got this? Screening children for high cholesterol. This would have been unthinkable a few decades ago. Only two or three decades ago, there wouldn't have been as much emphasis on this. And aside from the rare circumstances where, okay, you may have a genetic condition, they want universal screening. And the reason why this is more important is that the metabolic health of children in the United States, just like adults, has completely fallen off a cliff.
Yeah. So that's concerning to me that a guideline will reach beyond the solid substance of the research that's been done in adults and now into children. Rob Lustig, a professor, University of California, San Francisco, puts it this way: that you have to use medication if you eat bad food. That good food is medicine, but bad food requires medicine. So, you could argue that because the diet of these children is so bad, now we need to use medications to treat the diet. Of course, the alternate view of, and what I do in my practice and try to teach others through this channel, is that changing the food means you don't need the medicines, or you need less of them, or you may not need them at all. So, I'm I'm getting a little irritated, like Dr. maybe furious, at the end, that reaching into childhood now for these medicines is perhaps going too far.
Soaring rates of obesity, metabolic dysfunction, inflammation from poor lifestyle, processed foods, sugars, not active enough, sedentary children. I mean, we see this all around us. And the reason why this is so scandalous in many ways, and this links to what is happening in adults, is when you read these guidelines, they're so focused on numbers. They're focused on when to start statin medications and other medications to artificially bring down a number, but they're not focused on the bigger picture. And this is the whole problem with the medical profession these days. This is how far we've moved away from the spirit of Hippocrates, the father of medicine, approaching medicine holistically. Because nowadays, the number one reason for high cholesterol is insulin resistance. I've made lots of videos on this topic before. I will include some links down below. So, how could the top doctor associations, when they're reinforcing guidelines like this, how could they not even mention insulin resistance? How could they not even mention the fact that people, sadly, millions upon millions of people, are stuck in very poor lifestyles? They are addicted to comfort foods, processed foods, carbohydrates, insane amounts of carbohydrates being consumed every day, sugar intake through the roof.
Not one mention of this.
Well, it's finally made sense to me why, you know, if you have an organization that's built on a certain foundation of low-fat diets and LDL cholesterol management, that's what the foundation of the organizations are. They're going to stick to their their purpose, or the the organizational purpose, which is to cut the fat out of the food and lower the LDL and diminish or even not include other data beyond that. But it would be like going to a car dealership and and assuming that the VW dealer salesman is going to tell you about the BMW that's across the way. No, when you're on the dealer's floor, they're only going to talk about the car that they're selling. So, here we have organizations now that are selling health. Yeah, sorry. It may seem crass if you're a doctor hearing that we sell health, but we do. We talk about it, and they're selling health through medication treatment of LDL. That's what their purpose and foundation is. So, it's not the only way to do it. And there's always been a competing hypothesis through the years, going back to Professor Gerald Reaven at Stanford, metabolic syndrome and Syndrome X, and talking about triglyceride and HDL in the blood. And this is probably going to be the ultimate clash of paradigms at some point because you can now treat the metabolic syndrome and insulin resistance with a different drug. And so without regard to the cholesterol treatment, there's a new drug on the on the block that can lower heart attacks about the same amount as the statins can in secondary prevention that may overcome or dominate or or at least show that this other paradigm is equally as important and effective. So, yes, you know, I I just acknowledge that there are different ways to go about this, and these organizations think they're the only way, which is too bad that they they're not really scientific organizations. They're promoting a certain way of going about it based on a certain paradigm that they started with.
And this, my friends, is why we're in big trouble because the medical profession of today is hyperfixated on numbers. They are hyperfixated on medications like statins where, if you really want to be a true person of science, you will quickly find out when you dive into the data that a number needed to treat is very high. The odds of a statin medication actually helping you in terms of reducing the chances of a significant event or increasing your life expectancy are not that great at all. This is a great thing about AI. You can put the numbers in and you can see that if a statin was a sports team or a horse, you wouldn't bet on it. The odds are not great. So, I'm not saying that people who are on statins should immediately stop them. Of course, this is not direct medical advice. I want to understand what is wrong with these big shot authorities. You would think that cardiologists are smart people. They're looking at the whole picture, but they're not. They are fixated on numbers. They're fixated on drugs with minimal actual benefits, but they're not reinforcing what is really going to help people. And I don't live in fantasy land. I know that a lot of people won't listen to lifestyle advice, but I bet you if doctors were fully invested in this, in raising the health and well-being of a population, if at every visit they kept on emphasizing, "You need to cut back on sugar, you need to go for that extra walk," millions of people would listen. Many people wouldn't, but lots of people would, just like they did with smoking. But doctors are not fully invested in this, and how can they be anyway in the system which affords five minutes with every patient? It's all about prescriptions, prescriptions, looking at numbers, protocol following. And I believe that if change is going to come, because change is going to come, the system is going to implode. More and more people are waking up to the fact that doctors are not really being doctors. They are being protocol followers. They are increasingly acting like robots. They almost are writing a prescription as their patient is walking through the door. More and more people are realizing this, and they don't like what they're seeing. So, I believe change is going to come from the bottom up.
Well, I'm learning through my patients, and you may be one of them, that doing a calcium score, which is now included in the guideline, can be very helpful, and it's actually measuring the disease we're trying to treat. So, remember, cholesterol is not a disease. It's a risk factor at best, and even then, it's not a great one. And treating the cholesterol, as Dr. Don says, is not a huge effect, but it is an effect. And if a doctor thinks that's all they have, they're going to push it, push it hard. So, but people were coming into me being told by their doctors they needed beyond a medicine for their cholesterol level, but they showed me the calcium score being zero or very low, which means they don't have atherosclerosis. So, they may have lived 70 years without any atherosclerosis, and their doctor still wants to put them on a medicine. In fact, some doctors might credit the medicine for the fact that they didn't have atherosclerosis in the first place when they may have not have had it anyway, even without the medication. So, the interesting thing is, in my short time using calcium scores, and in my area, people have to pay out of pocket for their own, I found people who I wouldn't have predicted that they had heart disease, and they did. And I found people who I would have predicted they had it from their history, and they didn't. So, the only way that you can really know if you have it is to measure yourself rather than predicting. So, it's kind of like asking the weather people if it's going to rain right here in this spot. And the best, no, they don't know. They can't predict right here. But if you put your hand out the window, you can find out if it's raining right here. So, I'm afraid the idea of guidelines just being focused on the blood level and the treatment of that is to me now seeming kind of almost ridiculous. So, the incorporation of the calcium score, to me, is it's a great improvement. But but like Dr. Dond is saying, if a doctor now does a calcium score and finds you have a little bit of atherosclerosis, they may be finding that as a reason to put you on a medication. Now, stop, you know, if you do have some, you might choose a lifestyle change instead of medication. And that's the main kind of blinders that the organizations have, that only medicines can work. No, lifestyle change can work as well, and even other medicines can work. But don't automatically assume that there have been studies on because there haven't been on very low calcium score patients who are treated with medicines and aren't treated on medicines in a prospective way. So, don't let a doctor talk you into going on a medicine for a very low calcium score, you know, unless you've really thought it through. The so, the calcium score has almost revolutionized the ability to detect, in a preventive cardiology way, whether you have it or not. But what to do with that information is not clearly laid out yet in clinical trials. So, a lot of it is judgment at the moment. But there's even a group who will have in a publication that says if you have a calcium score of zero, you know, assuming there's no major other risk factor for heart disease, that you may or may not agree to be put on a medication to lower the cholesterol independent, you know, meaning the calcium score is more powerful as a predictor if it's zero than any other risk factor assessment in the blood. And if you're treated with a medicine to lower the cholesterol with a calcium score of zero, it really doesn't help. The early research is showing. So, anyway, the getting away from the blood levels and just treating that of the LDL and adding these other things is great, but as Dr. Don says, no mention of insulin resistance is, you know, still pretty backward.
And the medical profession, I hope you get your act together because look at what's happening every year. People are getting sicker. Prescriptions are going through the roof. The rates of illness are going up. What on earth, and I will say, what on earth are we doing as the medical profession? Why are we not holistic? Why are we not thinking every day? Is a medication really the answer? Is looking at a number really the answer? What are the true benefits? And importantly, what are the risks? When we're hyperaggressive about fixing a number, especially in older people, what are we doing here? Now, statin medications, when you look statistically, a fair number of people do have issues, including muscle weakness. They have muscle aches. There are other problems. Liver function tests can also become abnormal. Many of you watching may have had these problems happen to you, or you know people who've had these issues. So, why does the medical profession act like these drugs with minimal actual benefits statistically? Why are they the cure-all for the problem of high cholesterol, which is actually brought about mainly by insulin resistance, inflammation, and people loading their bodies up with the wrong foods?
Well, also in the weight loss context, there's one study, which means there need to be more studies. The hallmark of science is replication. One study is interesting, and you want to get it replicated. That the statins lower the same medicine that's being used massively popular for weight loss today. So, yeah, the study showed that the GLP-1 levels were lower if treated with a statin. It was a human trial and kind of ignored, but it would be interesting to see that repeated. What that would mean is that it would be harder for you to lose weight if you were on a statin medicine. And I I rarely touch the statins in the clinic unless people really want to get into a discussion about it because it's so almost sacredly held by the other doctors in my area. But I will talk about how it may affect the metabolism aside from its effect on LDL cholesterol.
So at some stage, the medical profession will need to come to its senses. But guidelines like this, which come out again and again. I mean, a similar thing happened with blood pressure. Makes me think, what on earth are doctors doing? Are we in this for the health and well-being of the population, or are we acting like robots looking at numbers, thinking about how many scripts we can hand out? There needs to be a big change, my friends, a complete revolution. And I believe it is going to come from the people who have had enough of this, watching people get sicker and sicker every year, more and more drugs, and clearly what we're doing right now is not working.
Yeah. So, in general, I I like Dr. Don and his internal medicine perspective. The new guidelines that came out from the cardiology organizations that really see medication as the only treatment for heart disease, or statins and bypass surgery as well. They have recommended that the LDL be driven down even lower than before, and they're now starting to recommend the calcium score. So, I have mixed reviews of this new guideline. There are other treatments than just drugs to lower LDL, target the insulin resistance and metabolic syndrome that Dr. Don's talking about. And I like the idea of the calcium score being used more frequently. If you don't have any evidence of atherosclerosis by a calcium score, and someone wants to put you on a drug for a disease that you don't have, I mean, this wouldn't happen in cancer treatment, oncology treatments. You wouldn't be put on chemotherapy if you didn't have a tissue diagnosis of cancer. So, it may be common sense to say, "Doctor, do I have any evidence of atherosclerosis, which is what you're treating me with that drug to prevent?" And if the doctor said, "Well, you know, everyone gets it." No, that's not true. So, not everyone gets it. You know, that's an over-exaggeration. So, anyway, great video by Dr. Don again. And the new cholesterol guidelines are just like what you would expect from organizations that are built on the low-fat diet and the reduction of LDL with medications. Doesn't mean it's the only way to do things.
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