Transcription
Now, this is key, and I've got to tell you about this because there's a lot of misunderstanding about LDL. Most people, they all they know is LDL is a bad, bad cholesterol. And that's not true. Because if your body, if your macrophages were engulfing and eating up LDL, I'd be dead. LDL is part of your mechanism, which is the cholesterol is the mother molecule from which a lot of hormones in your body are made, and without that, you, you, you, you cannot survive.
It is the damaged LDL that's the problem. The macrophages don't devour normal LDL. They devour and eat up small, dense LDL, which is abnormal LDL, and then that's described as a foam cell. And you know that a foam cell is part of atherosclerosis. It's part of the plaque. The foam cells, when you open them up and look inside them, it's small, dense LDL. So why do I look at small, dense LDL? Because that's the clue. If you have small, dense LDL, then the next question is, why is my LDL small? What damaged it? That's a million-dollar question. So I know that basically, six, seven causes of small, dense LDL. And I'm going to be chasing them.
The first one I already mentioned to you is to do with insulin and glucose. If you have hyperinsulinemia, you almost certainly going to have high triglycerides, low HDL, small, dense LDL particles. So you're going to be chasing that insulin and that sugar, and you've got to get that down.
The next thing that I know that causes small, dense LDL is omega-6. You eat a lot of vegetable oils, almost guaranteed that those oils go to the normal LDL, displace cholesterol from it, take up its room over there, and now you've created a small, dense LDL. Cholesterol is gone and replaced it with that omega-6 on it. Omega-6 is pro-inflammatory. That's why none of my patients will eat vegetable oils.
The next thing, advanced glycation end products. What does that mean? These are when you cook your food at extremely high temperatures, and you're creating these unnatural molecules. It's not natural to have proteins, fats, and carbohydrates all at such high temperatures and dry heat that you combine them all into a molecule and expect the body to metabolize it. You evolved that way. Your body did not. The most your body was allowed to do is probably a fire or steam or cooking water, 100 degrees. But to go like these air fryers, for example, you know, I'm totally against air fryers because you're creating all these advanced glycation end products. When they get into the body, there are receptors to get rid of them because evolutionarily we've been barbecuing food, so we do have those receptors. But when we overwhelm them, these particles cause small, dense LDL, and that's going to then drive the macrophages crazy, and the atherosclerotic process is going to start as well.
The next thing is regular toxins. All these toxins that I'm talking about. But there's one in particular that I really don't like, and that's called LPS, lipopolysaccharides. Lipopolysaccharides are bacterial wall products. They get into your bloodstream from your gut. These are not bacteria, but the bacterial dead bacterial wall products. When LPS gets into your bloodstream, it makes small, dense LDL. LPS does damage in and of itself also to your glycocalyx and your lining because it's charged. It gets oxidized.
By the way, have you thought about this? How come if the LDL, oxidized LDL, is damaging the body, and if it's, if it's, how come only the arteries get damaged? How come the veins don't? It's because these bad molecules go from your liver to your lungs, and they get oxidized in your lungs. That's why you don't get atherosclerosis in your veins. How come you don't get atherosclerosis in a vein? Because the oxygen tension is different. And then when all that gets oxidized and comes back to the heart, the first place they're going to come to the heart is the left atrium, right? The four pulmonic veins coming back into your left atrium. And if there's a lot of inflammatory substrate inside your blood, you're going to get atrial fib because that's where atrial fib comes from. So this is a good point to tell you that today, the commonest cause of atrial fibrillation is not microstenosis. It's not hypertension. I'm finding that the commonest cause of atrial fibrillation is metabolic disease, and when I fix that, atrial fib goes away.
Then from the heart, the first branch is the coronary artery. So they're going to see the brunt of this oxidized LDL and other inflammatory molecules, and that's why you get coronary artery. Now, some of it will also go into your carotid. So you might get some disease in your carotid. But as it then goes to the rest of the body, the atherosclerosis goes away. You don't get it everywhere else. Diabetics get it because the whole body's metabolism is off, so they get peripheral vascular disease also. But when it comes to this metabolic endotoxemia, as we call it, the leaky gut, as we call it, these patients have a lot of coronary calcium. The highest coronary calciums that I'm noticing these days is not people who are smoking. It is in people who have a bad gut. And that's a whole separate workup that you need to do on them.
But you see, we ignored all that. We ignored the fact, the medical profession ignored the fact that there's even a thing called leaky gut because when you scoop them, you're not going to see it. These are bacteria that are wrong, or the food is wrong, causing inflammation, or there's toxins, but your gut is not right. Basically, your gut has become porous. And we have a lot of data now to show that if you chase that and you fix that, all of a sudden, the LDL particles become large again. So this is not just theory. I've been doing this for a few years now, looking at small, dense LDL. Not a few, many years. That after we fix the inflammation in the gut, lifestyle, and everything else, what happens to the small, dense LDL? The particles become big again. So the LDL size, which is measured in angstroms, 210, 213 angstroms, they become 224 angstroms. That's where you want them to be.
So when you look at the lipid panel, and you've seen these panels come across your desk, I'm sure they're pattern A. Oh, yeah. I got, I got LDL pattern A, and this guy's got pattern B. A is okay. B is bad. It's true. What are we talking about? We're talking about particle sizes. That's what determines whether it's pattern A or B. And you can only obtain that on the advanced lipid panel. The trouble is that you go to your regular doctor, and I'm not saying that they're bad or they don't. No, it's just, it's just the norm. They'll do a total LDL, total HDL, cholesterol, and triglyceride. That's it. So you don't know the characteristics of your LDL particles. All you know is that my LDL is 130, and therefore I have to be on a statin. The question is not that if your LDL is 130, what kind of LDL is it? What's your LDL particle size? You need a deeper dive. So you need to ask for the advanced lipid panel. If you're not asking for the lipid panel, you really have put the curtains on everything because you're not really understanding what's going on inside you.
It's not the total LDL. You know, the studies show that total LDL is a rather poor predictor of who's going to have a cardiovascular event. The, what we call the, the, um, hazard ratio is about 1.28, 1.29. That means this is 29% predictive that in the next 8 to 10 years, there's going to be a cardiovascular event. What carries an even higher predictive value is the triglycerides. It's 1.8. When you have a high triglyceride, you're going to have small, dense LDL particles. So your surrogate for a small, so a poor man's surrogate for a small, dense LDL is the triglyceride level. So you know, I've always said that you can look at the triglyceride to HDL ratio. When your triglycerides are high, you're going to have small, dense LDL particles. When your triglycerides are high, you have a metabolic reason as to why it's high. And it's usually insulin resistance because your fat cells are sending out a lot of free fatty acids, which are going to your liver. Your liver then processes it, puts out VLDL, which is very triglyceride-rich. And these triglyceride-rich molecules interact with the LDL, and your LDLs become small because they exchange that triglyceride. So you get small, dense LDL. So triglycerides are a very good clue.
So if your triglycerides are absolutely normal, and normal is not less than 150. Remember, we fudged a lot of the numbers. It's not 150, it's less than 100. That's normal. It's just that the population today has so much target that they just put the level at that, just like your liver enzymes. When I was in training, your liver enzymes more than 25 were abnormal. Now it's 45 because everybody's got a fatty liver. So they just bumped it up. Now, how daft is that? So we need to become more stringent, not more lax, if we want the population to be healthier. So I look for triglycerides less than 100. If it is more than 100, you should ask for the advanced lipid panel so that you can look at the particle sizes and then then say, "Oh my goodness, I got small, dense LDL particles." And then you look at the rest of the picture also, then try to figure out why you got small, dense LDL particles. And then your goal should be to develop large, fluffy, good LDL particles. And we know that those are very good. For example, I'll tell you myself, my LDL level is about 170, something large particles. Calcium score zero. Zero. So my triglycerides 80, HDL 75. That's what you want. You want a good high HDL and a nice low triglyceride. And then the LDL is going to take care of itself. You're going to have large, fluffy particles, and you can test for it. And then someone like me, you know, I'm going to test coronary calcium. My coronary calcium score being zero, I know I'm going to be okay. See, and metabolically I'm fine. My hemoglobin A1C is 4.9. That's what you want. Now, even if my hemoglobin A1C was about 5.5, I'll start worrying a little bit, and maybe I'll do more fasting, and maybe I'll reduce my visceral fat if I had that.
So, the advanced lipid panel is an extremely valuable test to look to risk-stratify the patient, especially if they already got coronary artery disease. Look, if you already have coronary disease, if you already have coronary calcium, if you've already had stents, you absolutely have to do the advanced lipid panel. Unfortunately, across the world, many countries don't have that. But here in the United States, there's no excuse. It's available. You've got to tell your primary care provider or your cardiologist that you want to get that test done.
>> Let's come back to our list. Oh, that's where you were going. Actually.
>> You last.
>> Keep going.
>> Use the example there. I think there was six or seven different ones you were going to go through. LPS.
>> We finished that one. Continue.
>> Yeah. So, we know that the leaky gut causes small, dense LDL particles. Then toxins. Toxins cause low LDLs. Uh, the particles become very small. We know that the pathways have been worked out. One of the toxins that I'm particularly worried about are mycotoxins. Mycotoxins. I have seen a number of patients who have chronic low-grade inflammation in the body. It's because they have mycotoxins in them. So has the science caught up with this where I can definitely say to you that, hey, you know, Jesse, these people, they got coronary artery disease and coronary calcification definitely because of the mycotoxins? I don't have that data yet. But I do know one thing, that the particle sizes got better when we get rid of the mycotoxins. So the mycotoxins are detected on a urine sample. That urine sample contains all the toxins. That urine sample contains the following. It contains glyphosate and other herbicides and pesticides because if you have those in your body, they're not just taking a ride. Your body has never seen those before. It's an inflammatory reaction. It will react to those molecules. These molecules destroy your micro, your glycocalyx. They also affect your mitochondria. And by the way, everything at the end of the day, it's all about mitochondrial disease. That's the final step by which these things hurt you. It's your mitochondrial function.
So, these, these plastics, and the plastics are from phthalates, which are on your day-to-day household personal care products. They're not benign. Look, sometimes I have this very difficult conversation with my patients, and I have to tell them, look, stop using these body lotions. First of all, you don't have dry skin, so you don't need to be putting body lotion on you. You can't even pronounce the names of most of the chemicals that are in that lotion. So why are you putting it on your body? They all get absorbed. And the studies have been done that on average, when a lady wakes up in the morning, gets ready, goes to work, she's got at least 100 man-made chemicals on her. Now, this is not right. You think it's only on your face or on your makeup? It all gets absorbed. And these studies have been done. After the shower, immediately phthalate levels in the urine go up. That's been shown over and over again. You get out of the shower, you already have phthalates coming out in your urine. Phthalates, fortunately, have that's the plasticizer that makes the lotion nice and greasy. Okay, that's fine. But they're not normal particles, and they've been linked to inflammation, not only in animals but even in human studies. BPA, for example, which is a plastic, which is nowadays they're saying that they got rid of it because they don't line the cans with it, but they replaced it with BPS, which is just as bad. Nothing from a can. Don't eat anything out of a can. I don't eat anything out of a can. No good. They'll always substitute one for the other. So all these plastics have been shown, and the biochemical pathways have been well established to show how they cause inflammation in the body.
Then the mycotoxins. Mycotoxins come because you either exposed to it every day, or you already have the mold in you. If you have the mold in you, you're constantly inoculating yourself with that mold. So I have found that many patients are mold toxic, and the symptoms that I get from them are, okay, I've fixed your heart, you're looking good now. Why are you still dragging your feet? Why are you still fatigued and tired? How come you have mental fog? How come you're just good for nothing, and by 3:00 in the afternoon, you're just taking a nap, even though you don't have sleep apnea, even though you slept 8 hours, you still have no energy whatsoever? How come you got all these rashes? How come you can't tolerate certain foods? How come your immune system is out of control? So you get every little cold that goes by, and you, you, you're getting it. And what's the skin rash all about? And how come your joints are hurting so much? So if, if you don't do a deep dive, you'll just chalk this down to, oh yeah, he's a little depressed. And look, that really bothers me because nobody willingly wants to be depressed or wants to be anxious all the time. But these toxicities are causing that phenotype as well. And I find that the moment we fix those, the patient feels so much better. I had a patient who came who couldn't even really walk from his car into the office. He was so fatigued, tired, weak. But once we identified his toxins in his body and got rid of them, he came running into the office about three months later, feeling absolutely exhilarated. So I think that the, the, the toxicities from the environment, particularly mold, as a cardiologist, I know I'm just getting into this, but I'm finding more and more of it. If they don't already have it in their sinuses or in their gut, they're exposed from home. Because you know that seven out of 10 homes have mold because they've either had water damage or some sort of black mold or some mustiness in their house, and they can smell it. We have a problem because we brought water into the homes into piping, and now we're going to get water damage. So take a deep history, you'll find out. Yes, I lived in a certain place that was very damp and very musty for two, three years, and then shortly after that, all my problems started. I, I'm having all these myriad of inflammatory symptoms right now. So we do want to identify them, and they are treatable. So it's not like you're just trying to identify them and say that, okay, I've identified it. No, they are treatable. And the way we, my approach against is an anti-inflammatory lifestyle, anti-inflammatory environment, anti-inflammatory diet, because your body does have the ability to get rid of these toxins. This includes heavy metals. See, nobody wants to talk about this, but it's everywhere. The water you drank this morning has mercury in it. The water you drank this morning also has birth control pills in it. There are estrogen-disrupting compounds everywhere. Are they not causing inflammation in the body? Yes, they are. So all these plasticizers, all these hormones in the environment, they all have to be fixed before the patient's inflammatory condition gets. So it's a very deep dive. It's a difficult thing to do because traditionally, all we've done is said, "Okay, you want a prevention program? Great. Here's a statin. Go home. That's it. And better make sure you take that statin, okay? Otherwise, you, I'm going to fire you." And that's been the, that's been what everyone's doing. But it's much deeper than that.
Coming back to LDL. Yep. We know that in general, it's not the culprit. It's the small dense that is the problem. We were going through a list, and I just want to make sure if there was anything else that we forgot to mention in that realm, things that create small dense out of LDL, making it problematic. There are a few congenital conditions that you are born with, but that's very rare. And the reason I didn't mention that is because many people say, "Oh, I was just born with that small." No, it's not the case. Um, no, basically, we covered them, right? They're all acquired, and they're acquired from the diet and toxins in our body and the deranged metabolism of our body, such as insulin and sugars that cause the small dense molecules. You see, I just want to throw this out to you. When you glycate a molecule like hemoglobin, that becomes hemoglobin A1C. It's glycated. Oh, it's high. It's running 6.9. You're glycating every protein in your body. So every enzyme in your body is glycated, including your LDL. So obviously, things are not going to work properly because everything's glycated. So the point there is that we want to make sure that all our cellular functions are good. One of the reasons why heat makes for better physiology is it releases what is known as heat shock proteins. The heat shock proteins brought on by heat go throughout the body, and they fix the three-dimensional and four-dimensional, I mean, three-dimensional configuration of all the cells and the proteins. It repairs all the proteins through heat shock protein production. So that's another mechanism by which sauna really helps you. So our physiology affects not just one part. It's not if you have bad LDL, you have bad just about everything in your body. Everything else is also out. It is not right.
>> Um, yeah.
>> If you enjoyed that clip, you're going to want to head over here and catch the full episode. I'll see you over there.
>> A lot of coronary artery disease is very silent. That plaque is silently sitting there in millions of people without them even knowing. And there are ways to find this out now. We have the technology. It's just not being done. And those.