Leading Cardiologist: Your Doctor Is WRONG About Cholesterol | Dr. William Davis

No, there's nothing else that tracks with "LDL" cholesterol, because it's not a real number. It's a fictitious number. It's obtained by something called the "Friedewald" calculation, the "LDL" cholesterol reducing franchise. Statin drugs, "PCSK9" drugs, all that stuff pay huge amounts of money. Just a few years ago, it wasn't uncommon for pharma to make many tens of billions a year. It's because it pays so well. That's where all the attention is focused.

Someone comes in and says, hey, I'm 52, and my dad dropped dead suddenly at 56 of a heart attack. Do I have that in store also? So we do a "CT" heart scan to generate a cardiac calcium score, and his score, let's say, is 400, which is a high score. And if you do nothing, a score of 400 yearly is 500, 25% higher. A year later, 625 or whatever. And every year you're close to dying. What if we put you on baby aspirin, a high dose of a cholesterol drug like "Lipitor," 40 milligrams, cut the fat and saturated fat in your diet, and had you exercise? How fast does that score go up? 25% per year. It has no impact whatsoever on that measure. The good news is... you, your family, your listeners have magnificent control over cardiovascular risk. And sadly, the last person to ask is the cardiologist or the general practitioner, the primary care doc, they don't know.

Doctor "Davis," as a cardiologist, what do you think is most important for us to be focusing in on when it comes to prevention of cardiovascular disease? Things like heart attack and stroke? "Jesse," such a huge topic and one that is so muddied and clouded by profit seeking behavior. Among my colleagues in healthcare, the healthcare system in general, pharmaceutical industry, the medical device industry, these are companies who have discovered over the last 50 years that heart disease is exceptionally profitable. That's why even though there's at least lip service being given to prevention, there really is no real prevention going on. Can you reduce heart disease by reducing your intake of saturated fats or total fat, or taking a statin cholesterol drug, or taking a baby aspirin or, no. It has no material impact on heart disease.

-- It's worse in the US, of course, where your local hospital adds an $85 million wing for cardiovascular care. Now, wait a minute here. Over 80 million Americans, just in this country alone, 80 million people take statin cholesterol drugs. You would think that heart attack, sudden cardiac death, need for angioplasty, stent implantation, bypass surgery would be slashed. No, it remains the number one source of revenue for the healthcare system and my colleagues. So there's lip service given to the nonsense. The real tragedy "Jesse" in all this is that while everybody's focused on those things, no one's paying attention to the real causes of heart disease, which are readily identifiable and readily correctable, but practically for free. That's the curse. That's also the blessing that you can have magnificent control over cardiovascular risk for all those heart events. But the last person you want to ask on how to do this is a cardiologist or your primary care doctor. Unless it's you.

- Well, I'm generalizing. Of course. There are some practitioners who are starting to see light and say things like these statin cholesterol drugs hardly really have any much impact at all. Doing things like cutting saturated fat. No, that doesn't work. Following a diet rich in healthy whole grains causes heart disease. So that's the stuff we're dealing with. Well, let's get into a lot of the nuance around this. Somebody who hasn't had a heart event yet, or vascular, whether it be heart attack, stroke, or beyond, let's talk about what they can do in the prevention realm to try and stack the odds in their favor to never have to go down that route. So one thing that helps is to take a big, thick, black magic marker and cross out your cholesterol values, the nonsense that is the prevailing standard for purporting to reduce cardiovascular or manage cardiovascular risk. Total cholesterol is a worthless value. "LDL" cholesterol is not even a real value. It's a fictitious value. It's obtained by a calculation, a very crude calculation that's about 70 years old, and it should have been discarded many years ago... There is a little bit of useful information in a cholesterol panel. The "HDL" cholesterol and the triglycerides actually do have a little bit of helpfulness, but they're often misinterpreted. So a high triglyceride level is often interpreted as a need for a statin drug, which is absurd. So let's cross out, let's forget those numbers. Let's instead do a better form of testing. This is called lipoprotein testing, that is characterizing, quantifying the particles in the blood, the proteins in the blood that carry not cholesterol, but lipids, fats. Those are called lipoproteins. And you'll see right away if you start doing lipoprotein testing, not cholesterol testing. Cholesterol testing emerged from 70 years old technology where they tried to, if you separate blood into its various protein fractions and you wanted to count each particle, well, in 1958, that was impossible. So what they did was say, okay, if we can't really quantify... all the various fractions of these lipoproteins in the bloodstream, let's choose one thing and measure that thing and use it as an indirect gauge of these particles. We could measure apolipoprotein B. We could measure apolipoprotein C3, we could measure triglycerides. Let's use cholesterol. They used cholesterol to crudely guesstimate the number of particles in the various fractions of bloodstream. Well, so it was known... The people who did this at the "NIH," "National Institutes of Health" knew this was a crude and indirect way, but over the years, it became construed as cholesterol is the cause of heart disease, and it is not. It was meant to be nothing more than a crude indirect marker for the actual particles that cause heart disease. And we've been able to measure those lipoproteins, "Jesse," for over 30 years. I've been doing that for 30 years. When you do that, when you discard cholesterol testing and do lipoprotein, the most common method now, it's changed, it's evolved over the years, but the most common method now is nuclear magnetic resonance "NMR", same as "MRI", except we're not putting your body... in the magnetic field. We're putting your plasma, the clear part of your blood, minus red blood cells. And we can quantify and characterize the lipoproteins. You're going to see right away... that two patterns emerge. When you look at these patterns in lipoprotein testing, it's "VLDL" particles, very low density lipoproteins, rich in triglycerides and small "LDL" particles. Small, low density lipoprotein particles, not "LDL" cholesterol. That's meant to guesstimate "LDL" particles, but the actual "LDL" particles. We'll focus on small "LDL". Why is small "LDL" an issue? Well, it's smaller. It's better able to penetrate into the walls of arteries. It's much more likely to be oxidized, much more likely. It's eight fold more glycation prone, that is, prone to be changed by glucose. So consuming anything that raises blood glucose, like grains, the amylopectin A of grains, raises blood glucose, which glycates small "LDL" particles. It also triggers the formation of small "LDL" particles. And small "LDL" particles persist in the bloodstream for about five to seven days, as compared to large "LDL" particles provoked by consumption of oils and fats, which lasts 24 hours. So with that one slice of pizza or bagel or multigrain bread triggers formation of small "LDL" particles and increases cardiovascular risk dramatically for about a week, just at one serving. So people say, I learned this lesson a long time ago. People said they'd start with, let's say, small "LDL". Number of 2000 nanomoles per liter, particle count per volume. Okay, we're gonna eliminate all wheat and grains. We're going to address nutrients that affect insulin resistance. Cause that's an amplifier or small "LDL". And so someone does this, and he comes back in a few months, and small "LDL" has dropped from 2000 to maybe 900. I say it's better, but it's not good. We want close to zero as possible. I say, are you doing the diet and everything? Yes, I am. Are you sure? Well, Friday is my bad day. I allow myself one slice of pizza every Friday. That's all it takes, "Jesse," to increase cardiovascular risk for a week long time period. Thereby, if you do it once a week, 52 weeks a year. So think about this. If that's true, by the way, there are now 55 studies, 55, not 5, 55 studies, that have demonstrated that small "LDL" quantification is dramatically superior to cholesterol testing.

-- If there's such evidence? This goes back 30 years. It's not brand new. 30. Why? Because the way to manage small "LDL" is through diet. Diet is spectacularly effective in eradicating small "LDL" and thereby much of the risk for cardiovascular disease. In other words, there's no pot of gold for the pharmaceutical industry. So there's no sexy sales rep in a mini skirt or three piece suit to tell the doctor, hey, no one's selling the diet, right? So even though the science has been worked out, no one's talking about it, no one's putting it to use. Let me make sure I have this correct. So coming back to that example, the pizza, having that once a week would elevate the small, dense "LDL" for a week. So there's potential there for threat from that over that week. Is there a continuum, though, for the person that's only having, say, that one piece of pizza on a Friday night versus somebody who is having pizza on a daily basis? Talk about that continuum. Because we always need to discuss good, better, best, and obviously not good as well. We want to give people the full continuum so they understand, based on decisions they're making with the diet and lifestyle, what the consequences are. So in that example I use, which is -- a fictitious example, but it reflects real life what happens in real life. So he goes from eating pizza and bagels and sandwiches every day and has small "LDL" of 2000 nanomoles per liter, part of the count per volume. He cuts it down to one slice of pizza a week. Now, his small "LDL" is 900. We're trying to get to zero. So it is better, it is less harmful to eat those kinds of things.

- By the way, this is a little complicated. How do you get small "LDL" out of a slice of pizza? Well, any carbohydrate, whether it's glucose, sucrose, table sugar, high fructose corn syrup, or the amylopectin A of wheat and grains, which is a sugar molecule. So you consume any of those things, and the liver converts them to triglycerides, to fats. That's called de novo lipogenesis, making new fats. So sugar comes in liver convergence to triglycerides. Triglycerides are fats. And fats can't ride through your bloodstream by themselves because if they did, they would coalesce and cause infarct death of many tissues. Just like oil in your oil and vinegar, the oil coalesces into a layer. It would do the same thing in your bloodstream. So triglycerides, as a fat can't ride in the bloodstream by themselves. They have to be a ride on a protein particle, lipoprotein. So the liver puts the triglycerides into "VLDL" particles, very low-density lipoprotein. So sugar goes in hepatic or liver de novo lipogenesis converts it to triglycerides that the liver then packages as a "VLDL" particle. "VLDL" particles are very rich in triglycerides, and they interact with "LDL" particles and make them triglyceride-rich. And the "LDL" particle goes through a series of reactions, enzymatic reactions, that convert it to that small "LDL" particle. I tell you all that because -- once you understand that the starting point... is not fat, it's not bacon, it's not pork. It's things that the liver converts to triglycerides that create "VLDL" and that influence the composition of "LDL" particles. Now, this is really tough to try to explain this to a primary care doc, who just wants, oh, come on, what prescription do I write? Well, there is no prescription so what do you do to get rid of "VLDL" and thereby small "LDL"? Well avoid the inputs, the sugars that start the process. So no sugar, no high fructose corn syrup, other source of fructose. No amylopectin A of wheat grains and sugars. But you don't mean you don't have to limit fat, don't have to limit calories, eat all you want of the other things. So we limit the input and we address insulin resistance. That's the driver of cardiovascular risk, risk for dementia, breast cancer, type two diabetes, etcetera. How do you do that? Well, dress nutrient deficiencies common in modern people, not because of the diet, because the way we conduct our lives. So you and I are talking and we're indoors, we're not getting lots of sun all over our body surface area... We don't eat much liver, right? So we need vitamin D. If you want to drink water, you can't drink from the river. It's got sewage, it's got farm runoff and other garbage. It got “PFAS.” So we have to filter our water. Well, water filtration removes all magnesium, so we need to get magnesium, iodine. If you live away from the coast, the ocean, you're getting very little iodine in your food, livestock or plants. So you need to supplement iodine. And likewise, most modern people don't eat brain anymore and we can't eat all the fish we want because it's contaminated with mercury, shellfish with cadmium. So we supplement omega-3 fatty acids, so those four nutrients, when put together, synergize to minimize insulin resistance. Insulin resistance is an amplifier of that liver de novo lipogenesis that makes “VLDL” and small "LDL." So we're going to turn off insulin resistance. And by doing so, you also turn down inflammation... And one of the effects of this lifestyle is a reduction in abdominal visceral fat, fat encircling abdominal organs that is a major source for inflammation and insulin resistance. So we put this all together and you have magnificent control... over cardiovascular risk. And then more recently, We've added some strategies to manage a disrupted gastrointestinal microbiome because that's also a driver of insulin resistance and thereby “VLDL” and small "LDL." But put that all together. Now, imagine getting this from your primary care doctor or the cardiologist. You're not, you're not going to get it from them. It's -- too much to understand and learn. Two, there's no money in it. And so this is why I scream and yell because I see people paying all kinds of money. I have colleagues making millions of dollars a year by doing the wrong thing... And, by the way, often doing procedures that are unnecessary, often that's very, very common. Cardiology, gastroenterology, and the surgical specialties are among most corrupt specialties there are because of the money involved. If you're enjoying this episode, take a second and let me know by clicking like and subscribe below. Thank you so much. And now back to the show. Let's go over those four supplements again. Vitamin D, magnesium, iodine. What was the fourth one? And omega-3 fatty acids. Okay, let's start with iodine. This is a controversial one. A lot of people are scared to take it, including myself, at different points in my health journey. Talk about why we shouldn't be afraid... and how much we need to get. Can we get that all from food if we're supplementing how much? Basically, all things iodine. Iodine is endlessly fascinating, "Jesse." Iodine deficiency has been a plague on the human species... ever since we've walked this planet millions of years. If you go to Rome or Paris and go to the museums and see the artwork and statues, you'll see that a lot of them have goiters... They have enlarged thyroid glands on the neck from lack of iodine. So iodine deficiency has been a plague on human existence for generations, thousands of generations. Well, -- it's become clear that iodine is concentrated in the ocean and thereby in seafood, shellfish, and plants that come from the sea. So people who live coastally and fish maybe add seaweed, like they do, say, in Japan or coastal China, there's almost no goiters. There's no iodine deficiency in some parts of Japan, there's actually iodine toxicity. On the island of Hokkaido, for instance, where they eat a specific species of kelp of seaweed, and they get about 30,000 micrograms. The "RDA" for iodine is 150 micrograms per day for an adult. So they're getting 30,000 micrograms, and they have terrible problems with iodine toxicity, which is experienced as hypothyroidism. Your thyroid gland turns off, and so that's the opposite. But people who live closely tend not to have a problem with iodine, because livestock that graze on, say, grasses or other creatures that consume... seafood and seaweed, they have iodine in their -ecosystem. It's when you move into the interior, like the Midwest in the US, or the central provinces of Canada or the highland mountains of western Europe, this is where there's a lot of problems with iodine. And when you have a lack of intake of iodine, because you're not eating things closely, thyroid gland enlarges, you become hypothyroid. So iodine lack and iodine toxicities experience both as hypothyroidism. And this was a huge problem in the US about where I am right now. The Chicago, Michigan, Wisconsin, Illinois, Indiana, that area, about 30% of children had iodine deficiency. This impairs growth, it impairs "IQ", neurological development, and you can die of it. If our great grandma, if you said, hey, great grandma, tell me about goiters when you were a little girl, she would say, "Jesse," you wouldn't believe it. My next door neighbor died at age 13 of heart failure. My teacher had a goiter so big, she had to wear a special device to carry her thyroid glandg goiter. I mean, this is a horrible problem. And in 1924, it was figured out it was lack of iodine. Well, 1924, there's no Internet, there's no radio, there's no TV. A quarter of the us population was illiterate. How do you get this message to people? Well, the "FDA" said, well, everybody uses salt, let's put it in salt. And they had a campaign to encourage people to consume salt. And goiters disappeared for the most part. And then, of course, in the seventies, eighties, the "FDA" saw that there are some people who have hypertension and sodium retention problems, not recognizing it, that it's due to their dietary advice. When you say things like, cut your fat, eat more grains, everything in moderation, you cause sodium retention by the kidneys... But they didn't know that. And so they said, quit using all that salt. So guess what's coming back? Not quite as forcefully as it was in pass because the food system is globalized. We get avocados from Mexico, for instance. It's not as bad as it was, but we're seeing some reappearance of goiter and iodine deficiency, experienced often as fatigue, hair loss, dry skin, constipation, depression, and then at some point, enlargement of a thyroid. So, obviously, it's going to depend where you're living, your access to different foods that contain iodine. But in a practical sense, what is somebody to do to assess where they're at on that continuum with iodine? And then you mentioned the iodine being in salt. Is that something we should be consuming because I hear there are certain caking agents and different things in traditional salt. Basically, in a practical sense, how do we assess where we're at. And then what do we do to maintain that optimal range? What I'd like to say, "Jesse," is eat all the seafood and shellfish and seaweed you want, but we can't. It's contaminated. We have, as we all know, we've contaminated the oceans horribly. Not just microplastics, but other compounds and fish, coarse mercury, shellfish, cadmium. And those are long, persisting heavy metals. If you get cadmium from eating, say, clams, and you did that in the year 1998, it's still in your body. So it takes about 30 years for one exposure of cadmium to be reduced. 30 years. -- So I'd like to say eat all the seafood and shellfish and seaweed, but you can't. -- You could use iodized salt. There are some reservations about some of the anti-caking, it's probably not as big a deal as people make out, but it's very difficult to rely on. It did work as a public health maneuver. So there's no question that iodized salt does work. But one of the problems with iodized salt is it only works if you are a very enthusiastic consumer of salt. And that's because once you open the canister, the iodine volatilizes gases off in about four weeks. And so it does work if the entire family is going through the canister quite rapidly and everybody's salting like crazy. So it's not a real practical solution, even though it did work for many years. So the easiest solution is to get iodine as a supplement. Again, you can just buy very inexpensive kelp supplements, dried seaweed. The quantity is so small, there probably are some contaminants, but the quantity is relatively small. If you don't like that, you can get potassium iodide drops. The one thing I warn people about is there's a lot of nonsense going on with iodine, where there are some people saying things like, take mega dose iodine, which is complete, utter nonsense and very destructive, very harmful, because I've had many patients who took that crazy, nonsensical advice that has no... justification whatsoever, and they became iodine toxic... So the "RDA" recommended daily allowance in the US for iodine in adults 150 micrograms per day. How'd they get that number? They asked, well, how much iodine does an adult need and not have a goiter. Well, is not having a goiter the same as optimal or ideal thyroid function? I don't think so. I think it's probably more towards 300, 400 micrograms. Not real, real high, like some people are advocating 20,000 or 30,000, but 300, 400. And you get that from kelp tablets or potassium iodide drops. Close your ears to the nonsense about high-dose iodine. What those people are talking about and don't understand is when you take megadose iodine, for one thing, you can become iodine toxic starting at about 6000 micrograms per day and you become hypothyroid. So I had a very nice dietitian one time... She came to me and said, something weird is going on. I've gained 18 pounds. I'm sleeping 14 hours a day and I can't function. What's going on? I said, how much iodine are you taking?.. 6500 micrograms per day. And she became iodine-toxic. Her "TSH," that's the... primary thyroid test, ideally is about 2.0 micro units or less. The higher the "TSH" the more hypothyroid you are. Hers was 18. So she had made herself hypothyroid from a dose of iodine of 65. This happens all the time. So why are those people making claims like megadose iodine cures cancer... or diabetes? What they're doing is they're taking a dose of iodine that exceeds your gastrointestinal capacity for iodine absorption and thereby has an antimicrobial effect. So when you were a kid and you skinned your knee, what did mom put on your knee? Iodine, it's an antimicrobial. So you take a mega dose. What they're doing inadvertently is treating "SIBO" or at least colonic dysbiosis. That is the infestation of the small intestine with fecal microbe, which is extremely common. It's everywhere, even though it's not talked about, it's everywhere. That's what they're doing. Not recognizing that they're inadvertently treating "SIBO."

- You went exactly where I was gonna go. The fact of it's antimicrobial. Taking those high doses in. You're a big advocate and proponent of optimizing our gut microbiome. It's not just one input, one output. I mean, we have to consider all the different facets to doing something like that in the microbiome, get into more the detail how that would impact that. So we have a problem, "Jesse," a huge problem. The worst epidemic in the history of our species on this planet... And that is the ascent of fecal microbes that are supposed to stay in the colon. The colon is very happy with fecal microbes, E. coli, salmonella, pseudomonas, proteus, campylobacter, citrobacter. These are fecal. Like when you pass your number two in the toilet, you just passed out a whole bunch of fecal microbes. A lot of them. Well, modern people, because of overexposure to antibiotics... and probably a whole long list of other things. Glyphosate, other herbicides, preservatives in food that have antimicrobial effects in food, but in you, also emulsifying agents like polysorbate 80 in your ice cream. All these things conspire to have reduced the populations of healthy microbes in your colon. Well, healthy microbes help suppress those fecal microbes. So when you lose hundreds of species, trillions of healthy microbes, those fecal microbes over proliferate and then remarkably, they have the capacity to ascend into the small intestine, the 24ft of small intestine. So now many people have a total of 30ft, 24ft small intestine, 4 to 5ft colon of fecal microbes. Well, those fecal microbes only live for a few hours. When they die, they release some of their toxic components, such as endotoxin, that is crossed into the bloodstream. Small intestines, very permeable. That's where we absorb nutrients. So endotoxin from fecal microbes enters the bloodstream, endotoxemia. And that drives, for instance, insulin resistance. Hepatic de novo lipogenesis amplifies small "LDL." So endotoxemia from "SIBO," major cardiovascular risk. But it also does things like drive weight gain, especially in the abdomen. High blood pressure, risk for dementia, cognitive impairment, rosacea, psoriasis, eczema, depression, anxiety, fibromyalgia, sleep apnea... It's either an exaggerating amplifying agent or initiating factor in literally hundreds if not thousands of modern health conditions... not being addressed by most... doctors because the treatment there's no money to make from it. I've actually had conversations with gastroenterologists. I once had a conversation with an MD, PhD, gastroenterologist and PhD in biochemistry. So, pretty smart guy, right? I said, hey, how are you managing? I'm not testing his knowledge. How are you managing "SIBO?" Oh, I don't. Why not? -- If they have a question, I just say, go back to your primary care. Primary care doesn't know what "SIBO" is, has no idea what to do about it, or very, very few do. And so what I see is broad neglect. One of the great tragedies here is that while they're doing their colonoscopies, look for polyps as a risk for colon cancer. They're not addressing the real cause of colon cancer, which is a disrupted gastrointestinal microbiome. And very interestingly "Jesse," a disrupted oral microbiome. The science has gotten very strong that if you have bleeding gums, gingivitis or periodontitis that allows the proliferation of a species called fusibacterium nucleotum... that then enters the bloodstream when you floss or brush and colonize the colon where it grows a colon cancer. So if a gastroenterologist was truly serious about wanting you not to have colon cancer, yeah, maybe do the colonoscopy, but then talk to you about how you correct the gastrointestinal microbiome in general and then also assess you for the presence of fusobacterium in the mouth and then talk to you about ways to eradicate it. So you can see that a lot of this stuff, the science is progressing, bits and pieces from a variety of directions, but it's not being incorporated into common practice. Now if I could charge you $3,000 to get rid of your fusobacterium they would be first in line to do it.

Let's come back to our iodine. Somebody taking a high dose of that orally. Talk more about what that would do... to the microbiome. It sounds like it would lead to "SIBO" and im sure other things. But for people that are taking those mega doses with the antimicrobial effect of that. What's happening down there? So when you have "SIBO," you have literally trillions of microbes and 30ft of gastrointestinal tract, colon, ileum, jejunum, duodenum, stomach, and esophagus, and mouth. Probably also what if I took a broad spectrum couple of antibiotics like let's say vancomycin with clarithromycin. Very broad spectrum. Well I would get rid of "SIBO" for a few weeks to months because they kill everything. They kill good microbes, they kill unhealthy microbes. And you would feel a little bit better for a few weeks to months. That's what iodine is. It's a broad, indiscriminate antimicrobial. So you're going to kill off all those fecal microbes in the small intestine and you're thereby, you'll say things like, oh, my fibromyalgia doesn't hurt as badly. My psoriasis seems to be receding for a few weeks because killing things off... does not mean good things will return. It usually means because you lost good microbes as well as bad microbes and good microbes suppress bad microbes. So... they all come back. Some of the good, but lots of the bad comes back. So all you've done is applied a temporary band aid because the effort to rebuild them, this is a work in progress. "Jesse," I don't have all the answers on how to rebuild a healthy microbiome, but the answers are clarifying gradually and there are steps you can take to recolonize with healthy microbes. All right. I'm sure we're going to get more into the microbiome later, but I want to stay with the supplements, the four that you talked about, and we've went into iodine. Let's move into the omega-3s and what you recommend for somebody dietary wise, and or supplements to get into that range, that's healthy. I think the clearest perspective on an adequate intake of omega-3 fatty acids, the "EPA" and "DHA" a measure called “RBC” omega-3 index. This came out about 15 years ago or so. All it is, is a measure of what proportion of fatty acids in the cell membrane is composed of omega-3s because they're a component of the cell membrane and all throughout your body. But we measure it specifically in the red blood cells as a surrogate for other -- body cells. So the average Americans “RBC” omega three-3 index is about 2.3%. That is about 2.3% of all fatty acids in the cell membrane are the omega-3s. - People who eat a lot of fish can get up to 3.7, 4.0, something like that. And the evidence tells us this, though, if you get to 6% or higher, the risk of sudden cardiac death drops off precipitously. If you get to 10% risk for heart attack, myocardial infarction and dementia drops off precipitously. So we've been aiming for about 10%. And so years ago, we measured everybody's “RBC” omega-3 index and tried to get to 10%. But what I found was if people were getting in the vicinity of 3000 milligrams to 3600 milligrams of the combination of "EPA" and "DHA" they would almost always get around 10%. So I stopped measuring it -- not to incur costs because if people took that dose of omega-3s. Now, the real way to get omega-3 is to eat brain and fish and shellfish. Well, no modern people want to eat brain anymore. You could. There are some risks nowadays, though, of what are called prion diseases like mad cow disease... because of some crazy farming practices. So most people don't want to. And it may not be as safe as it used to be and eating a lot of fish and shellfish, but we can once again, right, mercury and cadmium. So taking fish oil is just a convenient and safe workaround. It's not ideal, but it's a workaround for all the problems that humans have caused on the planet. I've heard some concern about rancidity when it comes to fish oil. I think its the fact that they oxidize so easily. How do you feel about that? And is there a specific brand you can recommend that's immune to that? This used to be a big problem... up until maybe ten years ago. You could go to the pharmacy... and you'd open the container and it stunk like dead fish. So oxidized omega-3s stink like dead fish. That's why dead fish stink. But since then, most companies have cleaned up. And so, for instance, there used to be a, I had a good friend who lived in Halifax, Nova Scotia, and he started a company called, was it called back then? I think it was called “Ascenta.” He sold his company since. But what they would do, and a lot of companies have adopted this, is they would not allow the omega-3s to be exposed to air, to oxygen. The whole thing was prepared encapsulated in nitrogen gas. So you can't get oxidation in nitrogen gas. Right. And so they have taken precautions. And then we have services like "ConsumerLab" that tests fish oil and other products for potency, contamination, etcetera. And very few brands now have a lot of oxidation. You can consult with "ConsumerLabs" as a subscription service or do a very simple thing, smell it. If your fish oil stinks, don't take it, change your brand. You want the least fish, it's going to smell a little bit fishy, but it should be a very kind of minimally unpleasant fishiness. Or you could go to triglyceride form, that is, when you eat fish, you're getting the triglyceride form, three fatty acids on a glycerol backbone. When they... process fish oil, they process it in ethanol and alcohol, and it breaks off those three fatty acids. So we call those ethyl esters because they replace the glycerol backbone with an "OH" group. -- That's what most fish oil is. But you can also buy fish oil where the triglyceride form is reconstituted onto a glycerol backbone once again. And that's, it's more expensive, it's less fishy. And that way -- it's usually liquid. You take it by the tablespoon or so and you refrigerate it to minimize oxidation. So oxidation used to be a problem. There are times in years past where you open it, it was so disgusting, you couldn't take it. That's pretty much gone by now. But use smell as your index. Good to know. They figured that out. And I think the dosage you recommended was 3000 milligrams of "EPA," "DHA" in combo. Do you lean more towards more "EPA" or "DHA?" I know a lot of these supplements. Now, you can get high "DHA," high "EPA." Or do you just like something that's a balance of the two? - Whenever in doubt, I say, do how it occurs in nature. And fish oil usually occurs in an "EPA" to "DHA" ratio of three to two. Most. Not always, but most. Now, here's a question. So it's "DHA" that provides cognitive benefits. The science is pretty good. There's a lot of sketchy science in the world of cognitive impairment and dementia. But the evidence in favor of "DHA" inclusion in the diet is quite good. It actually has been shown to slow or prevent cognitive impairment in the earliest phase. You got to do it preventively. Once you have established dementia, it doesn't do anything, but it's very good at preventing. That's the "DHA." The "EPA" does not play a big role because the brain is mostly "DHA." But there's also two pieces of evidence that show that "EPA" has substantial cardiovascular benefits. There's the "JELIS" trial. J-E-L-I-S from Japan, 19,000 participants. And "EPA" added to a fish-rich diet, seafood-rich diet in Japan had additional benefits. And then we have this... bit confusing “VASCEPA” study. That's the drug that the drug industry came out and tried to pretend that "EPA" is a drug. It's not a drug, it's an oil. - But they did a big study that showed that 4000 milligrams of "EPA" specifically reduced cardiovascular events by 25%. And so there is good evidence that "EPA" is necessary... I wouldn't get rid of one or the other. Now, here's the stupidity of “VASCEPA.” If you take “VASCEPA” pure "EPA" 4000 milligrams per day, but you want to prevent dementia, you have to take fish oil to get the "DHA." But... it's illustrative of the nonsense that comes from the pharmaceutical industry and my colleagues who say, oh, it's a prescription. It must therefore be superior. And you can actually see this in the marketing. You can't get “VASCEPA” in the health food store. That's their marketing pitch. Did I have that number right? The 3000 milligrams of the "EPA," "DHA," the combo of the two. Is that your recommended daily dose? Yeah. Yeah. The only exception to that is there's a genetic pattern called lipoprotein A. This is getting down to the weeds, so sorry, but there's a genetic pattern called lipoprotein A. These are people who tend to be very slender, very good at distance sports like marathon running and... triathlons and biking and swimming. They tend to be very smart. They tend to be very good at numbers. So you see a lot of accountants, mathematicians, physicists, electrical engineers with this genetic pattern... and so slender, long distance, right? Smart, and very high risk for heart disease, heart attacks at age 42. These are the people who, they say things like this, this marathon running, cause heart disease because this guy was slender, he was... five foot eleven and weighed 139 pounds and crossed the finish line, had a heart attack. - That's what confuses people. It's not the marathon running, it's the lipoprotein A that tends to select people, tends to cause people to seek out long-distance exercise. So, of course, the drug industry is working on a drug solution to this. But I would look at it differently, and they're going to charge you thousands of dollars, by the way, because it's a biologic, it's an injectable drug to treat this genetic pattern. But let's think about this for a moment. Okay? So people with lipoprotein A slender, ultra-fit, very good long distance exercise, and smart and very tolerant to deprivation of water and food. They can go extended periods without drinking or eating. Now, wait a minute, in a wild environment, not a modern world, but wild environment, these are people who can run faster, run longer, don't have to stop for food or water, and smart enough to outsmart their prey and other predators. I hear survival advantage. So here's a different question. What takes something that's a survival advantage and turns it into a cardiovascular risk? Here's what I saw. If you and I, without lipoprotein A, consume wheat, grains, and sugars, you get an explosion in small "LDL," high blood sugar, abdominal fat, all the stuff, high C-reactive protein, measures of inflammation. If a person with lipoprotein A skinny, fit, smart, cuts the saturated fat, eats more healthy whole grains, follows conventional advice. They have lethal levels of small "LDL," "VLDL". So you can have a five foot eleven, 139 pound guy who likes to run 7 miles on his off day, and yet he has an explosive quantity of small LDL and he's a type two diabetic. So... they're as prone, but more so to all the bad things that are being advocated in diet. I tell you all this because the only thing I found that works for reducing the -- atherogenicity or the heart disease causing potential of that gene is high dose fish oil, based on an old study called the “Lugalawa” study. In Africa, there are two tribes of the Bantus that are genetically related, but one lives right along this lake. That is teeming with fish. So they have a very -- fish rich diet. Breakfast, lunch, dinner. An inland population, but related, they intermarry lives too far, just a few miles, but too far to go every day for fish. So they eat very little fish, but they have the same genes for lipoprotein A. Well, the fish eating population, their lipoprotein molecule was much less likely to cause heart disease and they got about 5000 milligrams of "EPA" and "DHA" per day. Now, an example of an observational study, it can't prove cause and effect, but given the absence of any real strategy for lipoprotein besides wheat, grain, sugar elimination, insulin resistance reduction, I added high dose fish oil. And "Jesse," it works like a charm. It stops heart disease risk in the context of all those other things too. Wheat, grain, sugar elimination, all those nutrients that minimize insulin resistance inflammation. Then we add high dose fish oil to mimic the “Lugalawa” experience and it has worked. It has halted the progression of coronary heart and carotid disease. As you talk about upping the dose of fish oil, it gets me thinking about, which could be a total myth. This is something that used to be talked about more. I found the fact that when you take fish oil, you have to worry about your blood thinning. Within the doses that we're talking about here today, is that a concern at all? No, it's a misinterpretation by my colleagues who confuse blood thinning with correction of blood coagulation. When you take omega-3 fatty acids, there are improvements in your capacity to clot blood. For instance, a lot of modern people have high levels of a protein called fibrinogen, which is a clotting protein. So it's not uncommon for somebody with a big belly and pre-diabetic and high blood pressure and lots of small "LDL." They have a high level of fibrinogen, let's say 390 milligrams. You take fish oil, and it reduces fibrinogen. That's not blood thinning, that's correction of an abnormality, but it's interpreted as blood thinning. And so official, to my knowledge, there's never been ever a report of hemorrhage or bleeding from fish oil. Because I hear this a lot... from people. I'm going to have surgery, my gallbladder or whatever and the doctor said, the surgeon says, stop taking all fish oil. So I say to them, did they also tell you to stop eating fish and shellfish? No. In other words, it's very unclear thinking, "Jesse," but it does not thin the blood. It normalizes blood clotting. All right, important we get into that, though, it is still something that's being said. How do you feel about krill and cod liver oil? Those are another couple of supplements in that realm of fish oil that people are taking in our world. Do you feel like one is better than the other for different circumstances? Do you know a lot about the latter two? Yeah. So krill, there's nothing wrong with krill oil, and there's some advantages in it. The problem with krill oil is that the people who manufacture it and sell it are... guilty of mass misinformation. Spreading mass information. One of the things they say, for instance, is krill oil is 40 times more potent than fish oil. That is complete nonsense. What they're referring to is the astaxanthin component. Carotenoid in the krill oil has antioxidative properties. What's in fish oil that's antioxidative? Nothing that doesn't have an antioxidant. And so -- it's like saying "Jesse" has an apple farm and I have an orange farm. And I say my orange farm makes better oranges than your apple farm. -- You can't compare them. They're unrelated. So that's one issue. The false marketing of the krill oil industry. Now, the good news is there is "EPA" and "DHA" in krill oil, but at such small quantities that you have to literally take the entire bottle every day to achieve that 10% "RBC" omega-3 index level. So it's impracticality. It does have astaxanthin. I'm a big fan of astaxanthin. So that's great. Asaxanthin has great effects on body composition, body shape, it reduces your waist size, it has fabulous effects as an anti-inflammatory. But take it for the right reasons. Take it if you want to have better skin or better joint health, or reduce inflammation, or reduce abdominal visceral fat. But they replace fish oil with krill oil means you've fallen victim to the false marking of the krill oil industry. The cod liver oil is... nothing wrong with cod liver oil, except that there tends to be a contaminant. There was a lawsuit in California some years back because a lot of cod liver oil is contaminated by "PCBs." That's what it was. Polychlorinated biphenyls. I don't know if that issue has been fixed. The other reservation about cod liver oil is when you have a fixed ratio, vitamin A and vitamin D, and you want to alter one of them it's kind of hard to do that with cod liver oil. So I've never really been a fan of cod liver oil. Cause a lot of us use higher dose vitamin D, and it's hard to do that in cod liver oil without becoming hyper vitamin A exposure. Got it. And earlier you were talking about these omegas getting incorporated into cell membranes. This gets me thinking about from the other end of the spectrum, toxic oils, seed oils, or vegetable oils that are often talked about in the health world today. Talk about how you see those. Is this something that you totally avoid? Do you think this is being overblown? Because it seems to be something that's actually gaining momentum in our world lately. People saying that these oils are actually worse than sugar. So how do you feel about them? I think that's a bit of an exaggeration, but here's something to bear in mind. So we're talking about linoleic acid, the so called omega-6. Well, what if you were to completely avoid omega-6 linoleic acid? You would eventually die. It's an essential fatty acid. So you can't do away with omega-6 s or linoleic acid. Your body actually needs it. What we don't need is the excessive quantities being introduced through such things as corn oil, mixed vegetable oil, cottonseed oil, all this, as you point out, seed oils that are rich in linoleic acid. So that's where the overexposure comes from. But you still get some in extra virgin olive oil, avocado oil, the fat in meats and poultry. So you can't avoid them. But you cannot have the wild overexposure that comes from processed and ultra processed foods and fast food. So that's all we're trying to do but you still need them. Got it. All right, let's move into magnesium, another one of the supplements you recommended. Let's talk about there are so many different types of magnesium in supplement form. What type do you recommend, how much? And there's a lot of people, including myself, that like to take it before bed for its supposed help with sleep. I mean, that's very subjective. I can't say I've noticed a specific difference with sleep when I've done that but let's talk everything magnesium and how you feel about that as a supplement. Well, in an ideal world, "Jesse" and his family would get up in the morning, go to the river or stream and drink water. But we can't, right, it's got sewage, farm runoff, all kinds of other garbage in there. So you can't just drink that water. So you have to filter it. Either your city filters it, or maybe you filter or maybe both. And water filtration, you'll see it's an a water filtration system, extremely good at removing all magnesium. - The family gets up in the morning and you go hunt for wild plants that you know are safe. And wild plants are rich in magnesium. Cultivated, farm sourced produce is very low in magnesium.

Typically 80% to 90% less magnesium than wild plants. And so most of us don't anymore remember what plants are safe to eat, nor do you want to go out in the cold and dig for roots and gather plants. So no one really does. Very few people do that.

So we rely on magnesium supplementation to compensate for the deficiencies of water and plants, produce. Now, the form of magnesium, I think is a bit overblown. It does have an effect, and you can put this to use. For instance, magnesium citrate is better as a laxative. So if you have some constipation issues, irregularity issues, magnum citrate is a good one, but they are in multiple good forms. Magnesium chelate, magnesium malate, magnesium -- chloride. There's many good forms.

The key is to look at the quantity of magnesium, not the total weight. So if it's magnesium malate, the tablet may weigh like 1200 milligrams. But you just want the, I think it's 130 milligrams, something like that, of magnesium. So you want the so called elemental magnesium and you want on the order of about 400, 500 milligrams.

One of the advantages of all the things you and I have been talking about is so we get rid of grains, we thereby rid ourselves of phytates that bind magnesium and you poop it out. So no wheat, no grains. You don't bind magnesium anymore. Eating better food, like organic food, a little bit higher in magnesium. And so there's some advantages in what we're doing to amplify the benefits of magnesium and your retention of magnesium, because it's the most important thing you can do for bone health.

Magnesium is a major constituent of your bones. It's also a major player in heart rhythms and blood pressure. In my cardiology days, we'd have people on diuretics. People would be taking chlorothalidone or hydrochlorothiazide or lasix furosemide or others. And those diuretics cause massive loss of magnesium and potassium, too. And people would come in in cardiac arrest literally, or they'd be in the hospital for some other reason and they'd have a cardiac arrest. They'd have a very unstable heart rhythm. It's called torsades de pointes, or ventricular tachycardia. These are very dangerous heart rhythms that are often fatal.

Well, if somebody has that as quickly as possible, give them intravenous magnesium. In this case, magnesium sulfate. You can give megadose because there's no diarrhea. Oral magnesium gives you diarrhea, but you can give megadose intravenous because it doesn't go through the gastrointestinal tract. And you turn off those rhythms like that. Think about that. So magnesium, a lack of magnesium can be life-threatening.

How about pregnant ladies? If a woman has preeclampsia or eclampsia and is at risk for seizures and losing the baby and dying, what's the first treatment? Intravenous magnesium. How about a person with really bad migraine headaches so bad they go to the "ER" for painkiller medication and other meds? What's one of the first things they do? Intravenous magnesium.

So... what the healthcare system is good at doing is giving you acute, urgent care. They suck at the long-term healthy practice. What they should have done, all those situations is say, okay, we'll take care of the acute deficiency now, but you need to be aware that you should take magnesium in some form, magnesium, malate, chelate, whatever, every day so that this doesn't happen again. But that conversation almost never happens.

And do you find the timing a day really matters with magnesium coming back to taking it at night to help with sleep, is that something you do or have found with others that it's helpful? Some people do. I'd say maybe a third to a half of people will say that same thing. You're saying that is they take magnesium at night, or if they take it in the daytime, it makes them too sleepy. So it can be useful for, I don't understand why, but it does seem to apply to a lot of people.

Let's move into vitamin D and cross the fourth supplement off our list here. And obviously we can get vitamin D from getting proper sunshine. How do we with that variable? Obviously getting things in the natural form, like through the sun or through food, is preferable, and at least in our world. How does somebody know, obviously we can get tested and see what our vitamin D level is, but in a general sense, how does somebody know... how to balance that out with getting sunshine when they can, taking a supplement, and then coming back to what we talked about before the "RDA" versus an optimal dose of vitamin D to thrive. A lot to unpack, right?

So several things to know. So vitamin D is activated by exposure of the skin, of course, the sunlight. Well, a lot of us live at a latitude that the sun is too weak much of the year. You're like me, you -- work indoors, so it's bright and sunny where I am in suburban Chicago, but I'm not getting any vitamin D. And then when we go outside, you're a law-abiding citizen, you wear clothes. So a lot of your surface area is covered. And we start to lose the capacity to activate vitamin D in the skin. Typically after age 40, you start to really.

So this used to happen in my practice, for instance, these snowbirds, this was when I was living in Milwaukee, Wisconsin. People would come back and I'd say, let's check your vitamin D. They said, no, doc, no, no, look at me. They show me their dark brown... tan, right? And we check your vitamin D. It'd be 15 severe deficiency. So these are people in their seventies, typically. And so a lot of things to factor in. Ideally, you and I would spend our days outside in a "Speedo" bathing suit and get lots of vitamin D. By the way, kids who do that in a tropical climate, let's say you're a lifeguard in Honolulu. You would have a 25-hydroxy vitamin D that's the blood test of about 89, 85, 91 around there. Now, that's naturally obtained and physiologic. So that gives us a little bit of guidance at what is safe and what's not safe. So no one has problems from vitamin D. Being a lifeguard in Honolulu.

What other guidance do we have and what constitutes a healthy level of vitamin D? Well, one of the good things to be aware of is when you have lack of calcium in your bloodstream. Calcium is very critical. If you have low calcium, you can have seizures and die, have heart rhythm disorder and die. So the body maintains blood calcium very tightly in a very tight range. What does so by the parathyroid gland. Parathyroid, para, next to the thyroid. Little four of them right here and it produces a hormone called parathyroid hormone, or "PTH." So when blood calcium goes down a little bit, your parathyroid produce release more “PTH” to extract calcium from your bones, which is not good because if you do that too often, you get bone thinning and fractures.

So at what level of 25-hydroxy vitamin D is “PTH” maximally suppressed? About 50. 50, 55 nanograms per milliliter, telling us that it's that range where you have maximum bone health preservation. Another perspective, if we took thousands and thousands of people... and measured their 25-hydroxy vitamin D level and then watched them have cancer or not have cancer, at what level does the incidence, this is observational, so it's not real, real solid. But at what level of 25-hydroxy vitamin D does risk for cancer plummet? Ovarian, uterine, prostate, breast. 50 nanograms per milliliter.

What does the -- lab say is the reference range that your doctor interprets as the normal range? Typically 10 to 30. Why do they say that? It used to be 10 to 20, by the way. Well, here's what they do, they take a random population and they measure their 25-hydroxy vitamin D. We now know that the majority of people are deficient. So they take a population deficient and define normal from this deficient population. The easiest analogy is a story I often tell. So "Jesse" says to me, hey, what's the average weight of a woman in Chicago? So I say, well, I'm not sure. Let's get a scale and let's go to the nearest mall. And every woman walks by. We say, ma'am, could we weigh you and we weigh 1000 women, right? 1000 people later, we tally it up and say, okay, "Jesse," look at this the average woman weighs 176 pounds... plus or minus 25 pounds, two standard deviations. Should we interpret that as normal or ideal?.. Of course not. So if we measure weight in obese or overweight population, we're going to get this weird skewed number. That's what they did with vitamin D. So, and this is true, by the way, for not all, but many laboratory values, they're quoting... values obtained, reference ranges obtained from a diseased population. And so we don't pay attention to what the lab says about reference range. So what I've been doing is aiming for around 60 to 70 nanograms per milliliter. I've never seen any evidence of toxicity doing that.

Come back to calcium. You talked about how the body is regulating that within a really narrow range. That, like iodine, is another one of those controversial supplements. Most people saying to stay away from them. How do you feel about supplementing with calcium? And then we'll go from there.

Several things to be aware of. So if your listeners are wheat and grain-free, they've eliminated the phytates, the phytates that bind calcium and other positively charged minerals like magnesium. So you get rid of the phytates because when you eat a burger with a bun or a sandwich or a bagel or whatever, pretzels, the phytates in the grains bind the calcium and you poop it out, you don't absorb it. When you get vitamin D, it enhances dramatically intestinal absorption of vitamin D. If you take steps to improve your microbiome, especially eradicate "SIBO" fecal microbes that block absorption of vitamin D, and you cultivate a return of healthy microbes like lactobacillus, bifidobacteria and others, you enhance calcium. So those of us following these kinds of lifestyle changes are hyper absorbers of calcium that you get from broccoli or kale or spinach and those kinds of things.

Another issue to be aware of, evidence out of, mostly Australia, New Zealand, where... this is observational. So it's not real solid, but it's concerning that people who take more than 500 milligrams of calcium all at once, so-called bolus dosing. So it's not getting, you're not getting a little calcium from broccoli, a little calcium from kale, a little calcium from maybe yogurt. In this case, you can take it as a bolus dose. So a lot of ladies will take, for instance, 1200 milligrams all at once. Well, that sudden burst of calcium has been associated with an increase in cardiovascular death. And so... it's a tough thing to prove, though -- if I said to the ladies in the audience, alright, we're gonna do a study, I'm gonna give you a tablet. It may contain a high dose of calcium. It may be a placebo. And I want to see -- if you're more likely to die. Well, no one's gonna do, it's unethical, no one would do it.

This happens over and over again when something bad could happen it's really tough to prove because you can't ethically do that to people, nor would people do it. And so we're left with this kind of indirect evidence that people who take more calcium appear to have, by the way, and calcium supplementation almost does nothing to increase bone density. It may have a modest effect in the first year, but not much after that. I would prefer to be a hyper absorber of calcium and get calcium from whole foods, from real foods, not ultra-processed foods, but whole foods like vegetables, those kinds of things.

All right, to make sure I have that correct, then if we're living a healthy lifestyle, we're going to absorb more calcium from the diet. Taking too much in supplement form in a bolus could be problematic. The other caveat to supplementation is it doesn't necessarily help the bones. Is calcium supplementation therefore fit in any dose for any specific population? Because I feel like, and you'd know better than me, this would have been a common recommendation by a family doctor, especially to women as they age, to maintain bone mass, to take calcium. Yeah, we know with good evidence that calcium supplementation may have a very modest effect in the first year of supplementation, but not much beyond that. But once again.

The crime here is that my colleagues pay attention only to calcium and often don't pay attention to the other things that really matter in preserving bone health. Magnesium. Big role restoration of lactobacillus reuteri a big role via oxytocin. Restoration of other healthy gut microbes, other lactobacilli, bifidobacteria species that enhance calcium absorption. How about exercising that stresses the axial spine and pelvis, that helps prevent -- osteoporosis and fractures? Maybe "K2." "K2" is a little uncertain. It does help for bone strength, not necessarily bone density. So if a woman takes vitamin "K2", let's say 180 micrograms of the "MK7" form of "K2" she won't see an improvement in her bone density on a "DEXA" but she'll have less fracture. So it's presumed that "K2" somehow strengthens bones, maybe via the collagen component, but it doesn't increase bone density. So just a little clarification of thinking.

Collagen... helps strengthen bones, though, once again, you won't see that in bone density testing. Bone density testing is a flawed method. It only tests stuff that adds the calcium in bone and mineralization of bone. It doesn't test for the strength of bone that has to change over time. There's going to be a replacement of bone density testing with bone strength testing, but issue for future. So -- reuteri a big... advantage in preserving bone density. Collagen, so why would collagen work? Well, bone is largely collagen. And most modern people lead a collagen free or reduced diet because, we've been told, cut your fat and saturated fat. So most modern people have abandoned consumption of brain and tongue and heart and stomach and intestines rich in collagen. And so most people don't want to eat those things anymore, sadly. So you can go to a collagen supplement where I would tell your listeners, don't fall for this nonsense talk of bone broth. So we now know bone broth that is prolonged boiling of the bones and the addition of vinegar to mobilize minerals. It does mobilize some minerals, like calcium, magnesium, but it also releases the lead. So bone is naturally a repository for lead. This is true in humans, it's true in animals. So when you boil it for extended period and add vinegar, it mobilize the lead. And the amount of lead in a liter or a quart of bone broth is approaching what the "EPA" would label toxic. So if you're consuming a lot of bone broth, you're getting toxic levels of lead. They're going to stick with you for decades. So I tell people -- it doesn't sound good, but make carcass, broth. Let's say you bake a chicken, you eat the drumsticks, eat some of the meat, and then save the skin, ligaments, tendons, and some of the bones and whatever else you have. Some of the meat, maybe if you have the liver or something, boil it for a limited period, maybe 4 hours, to release the meat and fat. -- Don't add vinegar, and you'll have maybe a little bit of lead, but you won't have the toxic levels of lead that occur in bone broth. That's true by the way, for both homemade and commercially made bone broth.

All right, really important. And is that as much of a concern if the animals are healthy, if it's like grass-fed, grass-finished cow that you're using the bones from, or pasture-raised chickens, how much of a concern is it with healthier animals? You know, sadly, no one's done that analysis and compared, so I'll bet you it's a little bit better in organic or pasture raised, but we have no proof of that.

Are you a fan of bone marrow, eating that periodically? Yeah. I mean, -- it's a real hard sell, "Jesse," to tell modern people eat bone marrow, get some brain, and get some thymus and liver. It's really tough. So very few people, some will do it, some will do such things. They inch their way into it, like get some ground liver and mix it with ground beef... and a lot of people do that. Some people have the courage to make some tongue, but it's a really tough sell. Buy sausage in casing, in real casing that has collagen in it. But because it is hard for modern people, they're squeamish. It's kind of hard to get these things sometimes. Last time I tried to buy heart at a butcher, I had to sign a release that I wasn't going to do evil things with it. No joke.

So I have this straight. Those white collagen powders, which is an element you'd find in bone broth, in that case, whatever they're doing to extract that and making that powdered supplement that won't be a problem with the lead. The times I've seen analyses, there has not been lead or other heavy metals. - But not all products have been tested, to my knowledge. So you have to be careful. -- I'm hoping "ConsumerLab" would be testing collagen for lead content, but so far, the analysis I've seen, there's been no lead, thank goodness.

But collagen is really interesting because here's an issue. People who cut their fat and eat more healthy whole grains or follow a diet, everything in moderation, typically have rise in blood glucose. So typical story, someone has a bowl of oatmeal, organic stone ground oatmeal, and skim milk, no added sugar, maybe a handful of blueberries, whatever. Their blood glucose goes from 90 to 155. Every time blood glucose exceeds 100, you glycate proteins irreversibly.

And one of the features of collagen in the body is very glycation prone. So every time your blood glucose from the bowl of ice cream or oatmeal or sandwich on whole wheat bread, your blood glucose goes above 100 and you glycate the proteins, but especially collagen in your skin. You have acceleration of skin aging, because when you glycate collagen, it cross links and then fragments, and then your body reabsorbs the collagen and you get dermal. Ladies get very concerned about this because they get dermal thinning and they get wrinkles. So anytime blood glucose exceeds 100, you're causing accelerated skin aging. You also glycate the collagen joints. The cartilage is mostly collagen, it's about 70% collagen. So you glycate the collagen in your knees and hips and joint cartilage, becomes brittle, breaks down, and you get arthritis, and eventually bone on bone arthritis, you glycate the collagen in your bones and you weaken the bones. So glycation, very important, fundamental process underlying many of the phenomena of aging. Every time blood glucose exceeds 100 but that becomes very important in collagen. So glycation is irreversible. You can't undo it. One of the great things is you can -- replace the collagen that was glycated by getting collagen. So we know with good evidence, including our own clinical trial, that when you ingest collagen, you increase dermal collagen, joint collagen, brain collagen, heart collagen, arterial collagen. So it's one of the occasional times that people are given a chance for a do over.

How do you feel about all the different types of collagen? If we really want to get in the weeds here, there's different types from different animals, different parts of animals. I know I've seen a supplement that had a number of different types within the powder that was contained there. How do you feel about that? Is there certain types to look out for or is this just becoming.

Is this too much for the average person? And we don't need to go that far. It's nonsense, "Jesse." So people say things like, oh, our collagen is type one, type three and type four. Well, it doesn't matter because people say things like this. Well, type one collagen is important for joints, so we're going to give you type one collagen. That's not how it works... So here's what really happens. You consume collagen, you break it down into both single amino acids, as you do when you eat an egg or a piece of beef. But there are also unique sequences in collagen. These are so called di and tripeptides. Two and three amino acid long sequences such as the "Gly-Pro-Hyp." Glycine, proline, hydroxyproline. That tripeptide is resistant to human digestion. We don't have the enzymes to break that sequence down. So single amino acids and di and tripeptides, and most of the di and tripeptides that remain intact, that go, for instance, to the skin where they trigger the formation of collagen. So it's not that collagen here goes to the joint or the skin, it's the di and tripeptides. So the greater the content of the di and tripeptides, those sequences, the better the results of the collagen at lower doses. I point that out because... if someone wants to take collagen, bovine, porcine or chicken sources, the effective dose is typically 20 grams. It's pretty hefty dose, but if you get a marine sourced, it can be effective at a lower dose. But it varies because marine is not one thing.

It could be a bony fish, could be a cartilaginous fish. They could have included the scales. So marine collagen is very variable. But there's evidence to suggest that marine source of collagen is roughly... the same effectiveness at a dose between 500 and 2500 milligrams. So much lower dose, about a 10th of the dose. But one of the problems we have in marine sourced is if you buy, let's say your wife buys a canister of marine sourced collagen in order to know what the dose is, we have to know what fish it came from, if it came from tilapia, if it came from haddock, if it came from shark.

And if you call the retailer, the manufacturer, they'll typically say, we can't tell you, it's proprietary. So I know because I talk to the manufacturers. So, for instance, in one of the things I created, we source our collagen from a japanese company called “Nitta Wellnex”. And they have evidence, several studies, to show that a dose of 1500, 2500 milligrams, so much less than the 20,000 milligrams, 20 grams... of bovine, we know that lower dose is effective, and I'm aware of that because we wanted to put it in a capsule form. You can't put bovine collagen in a capsule. You can, but you won't get enough. You can't put 20 grams big scoop into capsule form, but you can do it with marine source collagen.

How do you feel about gelatin? My wife and kids like to make these gummies very simple ingredients using gelatin, and they're delicious. They become pretty solidified.

How do you feel about that in relation to collagen? Gelatin is great. It also is a source of collagen. Unfortunately, no one's done a head to head comparison to see if one is better than the other, but it's a perfectly fine and safe thing to do. I just don't know if it'll generate the same kind of effects that... collagen will... For example, -- if you take 20 grams of bovine collagen every day and we do something called high resolution skin ultrasound, we measure the thickness of the dermis. A lot of ladies are very familiar with topical products that affect the epidermis, the external, but really don't do much for the dermal layer beneath. And it's the dermis, the dermal layer, where skin health and appearance is determined. Dermal layer is living and very active epidermis large and dead. So when, if you take collagen, and we were to do high resolution skin ultrasound over 90 days, three months, we'd see about a 6 to 7% increase... in the thickness of the dermis. And we would see evidence of collagen deposition because of those di and tripeptides not because of type one or type three.

Now, when you combine that with reuteri, like this is reuteri, my favorite microbe in the world and collagen and I also do hyaluronic acid. Hyaluronic acid, another example of something we've abandoned because it's rich in brain and skin and other organs. So we've lost collagen, lost hyaluronic acid. And most -- modern people live a diet of processed and ultra-processed foods get very little carotenoids. So I threw a carotenoid in there, astaxanthin, the same kind of astaxanthin that's in krill, and we got a 15% increase in dermal thickness. So it makes ladies crazy because they lose their wrinkles.

So is this all part of a supplement that people take internally? Part of a product? Yeah. Or you can just do like a lot of us do, make the reuteri yogurt and get those things individually. Collagen peptides, hyaluronic acid. The dose of hyaluronic acid is typically 120 milligrams. I'm a little skeptical about that, though. So if you ate a four ounce serving of sheep brain, how much hyaluronic acid would you get? About seven milligrams. So 120 is actually a very respectable dose. But hyaluronic acid is really interesting stuff, "Jesse," because most fibers come from plants, right, celery, tomatoes.

Hyaluronic acid is an example of a fiber that comes from animals, mostly brain and skin. So I see people doing this, oh, I'm gonna buy boneless, skinless chicken breast. Don't do that. You just throw away a source of hyaluronic acid and collagen. But here's the thing. Hyaluronic acid is a fiber, and it's a wonderful fiber because it causes proliferation of species that are very beneficial. These are species like Akkermansia, Faecalibacterium, Ruminococcaceae, Lachnospiraceae. It suppresses fecal microbes, the Proteobacteria and it strengthens the intestinal barrier. So hyaluronic acid, absent from the diet of almost all modern people, when added back, has magnificent effects, smooths the skin and acts as a fiber on your microbiome and introduces very favorable changes. So we do all those four things and you get huge benefits on skin, joint health... and even vaginal health.

All right, so hyaluronic acid, this is a topic I want to delve a bit deeper into. You mentioned brain, it would be found in, which is something most people aren't going to eat. It sounds like it's in skin of animals. If somebody is having skin on their meat, they're obviously going to get some there. But any other sources, things people can include to up that? Organs. And you can see the problem here. So thankfully, because most people don't want to consume organs or don't do so habitually, you can get it as an inexpensive supplement. It's very easy. It's -- very cheap, so it is easy to get. It does help maybe to have some skin, like when you have chicken or poultry or fish eat the skin. That that's an easy way to get some hyaluronic acid.

So what are the four again? Reuteri, hyaluronic acid, collagen. You mentioned four things we can take that help with the skin. And the carotenoid astaxanthin. A lot of carotenoids have beneficial effects on skin and joint and have anti-inflammatory effects. Carotenoids like lycopene, lutein, zeaxanthin, cryptoxanthin. I chose astaxanthin because, one, it has the most potent antioxidative, anti-inflammatory effects and it's been shown to reduce your waist circumference as well as generate very important effects in skin. So almost all carotenoids also protect you from sun damage because they inhibit an enzyme called matrix metalloproteinase in your skin. Let's say I get a sunburn. Well, I just fragmented and damaged my collagen... And the next thing that happens is that enzyme, matrix metalloproteinase is activated to clean it up. And that's why people get too much sun, get real crepey skin. That's from sun damage to the collagen and then resorption of the collagen by matrix metalloproteinase. Well, astaxanthin, as well as other carotenoids are inhibitors of matrix metalloproteinase. It blocks the absorption of collagen so here, what we're doing here is we're getting lactobacillus reuteri via oxytocin, stimulates collagen production in the dermal layer and other parts of the body. We're getting collagen, the building blocks for collagen via those di and tripeptides. We're getting hyaluronic acid, which is a wonderful effects on the microbiome and also increases moisture in the skin in the dermal layer. Also increases the lubricating fluid in your joints, synovial fluid. We get astaxanthin as a carotenoid, which turns off matrix metalloproteinase and has other anti inflammatory and body composition changing effects. Put it all together, "Jesse," and you get this huge combined effect on multiple aspects of health. Smoother skin, better joint health, better vaginal health, better reproductive health, and you're happier and you like people better and you're more generous. That's all via oxytocin and the reuteri.

Reuteri, "Jesse" is so interesting for so many reasons. So one interesting thing is it causes release of the hormone of love and empathy, oxytocin. I also call oxytocin the hormone of body shape and composition. That's true. But it also takes up residence. Very unusual in the small intestine. Most microbes take up residence in the colon, unless they're fecal microbes, in which case they do ascend. But reuteri is unique in that it naturally and normally colonize the small intestine. But almost everybody's lost it because it's very susceptible to common antibiotics. But you restore it, takes up residence in small intestine, 24ft of small intestine or produces bacteriocins. These are natural antibiotics, effective in killing fecal microbes... So all the people, by my estimation, in the US alone, 150 million people, that's a conservative estimate. And there's a rationale behind that. 150 million people have infestation of their small intestine by fecal microbes. Well, loss of reuteri is probably one of the reasons why that happened. Restoration of reuteri, because of small intestinal colonization bacteriocin production starts the process of eradicating them and pushing it back. What can you expect? You can expect your waist to start shrinking. You can expect some redness to start going away. You can expect a reduction in blood pressure, blood sugar, visceral fat, skin rashes, joint pain, depression, anxiety. So just the restoration of reuteri, "Jesse," is a hugely powerful advantage. Now we're going to amplify it with those so called co factors that are lacking in the modern diet. And the difference between what you're talking about now, using reuteri to attack "SIBO" in a healthy way, versus the iodine before, which is just like a nuke going down there and killing everything. This is more selective. And you mentioned all the additional benefits of reuteri as well.

Yes. So reuteri is what -- we call a keystone microbe. It's kind of like plankton in the ocean... Plankton, little tiny creatures that filter feeding creatures like whales and jellyfish rely on. They filter and that's how they live. What if plankton populations start to diminish as they have? By the way, we're going to start seeing die off of whales and jellyfish? Well, reuteri is the same way. If you don't have reuteri, it doesn't support the other, many, many other microbes. Restoring reuteri begins the process of restoring other healthy microbes. There's more to do. Fermented foods are very important... fibers, very important. But hyaluronic acid, this forgotten fiber. "Jesse," no one's talking about hyaluronic acid. It's one of those important things people can do for their microbiome as well as skin, joint and brain health.

All right, Doctor "Davis," a couple loose ends from earlier on in the conversation. I want to make sure we tie up vitamin K. I want to come back to that one, which is often found in supplements with vitamin D. You quickly touched on it, get more into the nuance there. Is that something we want to look for in a vitamin D supplement. And the way I understand it is the K. And we're talking about "K2" here. It helps bone, actually, sorry, not bone, but calcium deposit in the right areas of the body that we want it versus in unhealthy areas. So I'll have you talk about that. That's kind of a half truth. There's a lot of misinterpretation. One argument, for Instance, is that if you take vitamin D without "K2," you will calcify your arteries. That's utter nonsense. There's no basis for that.

What do we know it's true. We know that "K2" intake strengthens bones. It does not increase bone density, it only strengthens bones. So probably via a collagen mechanism, probably that evidence, mostly out of Japan where it was recognized that people who ate natto, which is fermented soybeans. It's disgusting. My mom was Japanese. She tried to feed us natto. It's disgusting. It looks like snot, but it's rich in "K2." In the "MK7" form of "K2" and the evidence is pretty good that it does increase bone strength, though, does not increase bone density.

Now, there was a study called the "Rotterdam" heart study, came out about 15 years ago where they did this. "Jesse," did you eat any cheese on Monday? You say, ah, I had two slices of cheddar cheese on my sandwich. How about Tuesday? I had some mozzarella cheese in my pizza. And we quantify how much "K2" are in those foods. Then I contact you in five years and I say, "Jesse," have you had a heart attack? You say, no, I haven't, or, yes, I have. And then we relate it back to that intake, that kind of study, observational, epidemiologic study. It's very sloppy. It is the basis for almost all dietary guidelines, by the way, that is, I say, "Jesse," what did you eat for breakfast on Monday? I had a bowl of oatmeal with a banana. What did you have for lunch? I had a bologna sandwich with mustard and cheese on two slices of whole grain bread. Would you have for dinner do that for five days? I contact you in five to ten years and I say, did you have colon cancer or heart disease or whatever?.. And then we try to relate it back to the five days of dietary questionnaire. Now wait a minute here in the years since you filled out that questionnaire, you got divorced and you drank too much and then you did a cleanse, then you fasted 14 times and then you went on a binge on an all you can eat vacation. Then you got depressed and you ate fast food for three months solid. In other words, all kinds of crazy stuff happens to humans and you're going to predict your future by five days of what you ate ten years ago? That's how they developed dietary guidelines. Well, that was the "Rotterdam" heart study and 4700 Dutch people. And they quantified presumptive "K2" intake via questionnaire and then they said people had greater "K2" intakes, had 57% reduced heart attack. So that's very bad evidence, very sloppy evidence. And so far in prospective studies, it's not held up. So it's probably not true.

But here's another aspect of "K2", so modern people have disrupted their gastrointestinal microbiome. Well, do microbes produce vitamins? They do. They produce the good microbes, not the fecal microbes, not the proteobacteria, but the ones you want. They produce vitamins "B1," "B2," "B3," "B5," "B7," "B9," "B12," and "K2." Isn't that interesting. So the apparent need for "K2" is probably really a reflection of dysbiosis in the colon or "SIBO" in the small intestine. So there's no harm in taking "K2," like maybe 180 micrograms of the "MK7" form, like natto. Or, by the way, fermenting with bacillus subtilis. It's not quite clear. So the microbe used to make natto is bacillus subtilis subspecies natto. But you can get bacillus subtilis. I have some fermenting on my kitchen counter right now. I got it from kombucha. I bought a kombucha that was made with bacillus subtilis and it makes a delicious sparkling soda out of juices. So it takes a juice... Sugary juice gets rid of the sugar because the microbes process the sugar, and you get an effervescent sparkling juice out of it. Takes about 60 hours at 90 degrees, by the way.

Now, one thing we don't know is what other strains of bacillus subtilis produce "K2." So I'm not sure I'm getting "K2" from that juice. At some point, I should do that. We should measure "K2" in it. But you can just do that also, so you don't have to buy an expensive supplement. But you can, there's no harm in doing it. But I'm a little bit skeptical, given what's known about "K2," that it has any cardiovascular benefits.

And you mentioned "MK7" being the form to look for. There are different forms. Are there any value to the other ones, or is "MK7" the only way to go? "MK4," "MK9," "MK10". That just refers to length of the tail on the molecule. They do have benefits also, but some of them, like "MK4," is very... short acting. You can take "MK4" but only provides an effect for about 3 hours. The “MK7” provides effect for about three days. So the “MK7” is just more resistant to metabolism... So if you're going to get "K2," you want to get the “MK7” form.

Okay, so bottom line, for somebody going out to buy vitamin D, do they want, if both options are there with "K2" or not, would you pick the "K2" one? I think if you're a woman at risk for osteoporosis, it's a modest advantage to get the "K2." But it's once again hard when you have a combination to alter the what if you prove to have a low vitamin 25-hydroxy vitamin D and you want to increase the D intake, you got to take the whole thing, right? You can't really adjust them individually, but beyond that, there's no harm in taking it with a "K2."

All right, another piece I want to come back to. Early in our conversation, we were talking about “LDL.” How traditional “LDL” testing, there's no value there. But the small particle, “LDL” there is value there. Do we know the physiology of that form of “LDL,” how it's causing cardiovascular disease? Or would you even say that it's causing it? Because... there is so much conflicting information in this realm, where there's people saying “LDL” is just an innocent bystander, when we have these plaques. There's people saying it's the only cause, that's more conventional thinking. And it sounds like you're somewhere in between. So I'll have you talk about physiology there with the small “LDL” and whats actually happening.

So recall that the small “LDL” particle is initiated by consumption of anything that looks like sugar. So glucose, sucrose, fructose, and the amylopectin A of grains. The worst, by the way, is the amylopectin A of grains. So you eat those foods, sugars or grains... Your liver converts those sugars to triglycerides, packaged in a "VLDL" particle, a very low-density lipoprotein... That "VLDL" particle interacts with “LDL” particles, making them triglyceride enriched. And then that triglyceride enriched "LDL" particle goes through a series of what are called remodeling steps, enzymatic remodeling steps, that creates the small “LDL.” That small “LDL” because it's small, is better able to infiltrate into the walls of arteries. It's more adherent to structural tissues in the arterial wall. That small “LDL” is also more prone to oxidation, which makes it more dangerous, and to glycation, like we talked about. So it's glycoxidized small “LDL” particles... that infiltrate the walls of arteries. And that small glycoxidized “LDL” particle is very resistant to liver metabolism. That's because when an “LDL” particle is large, as occurs when you eat olive oil or pork, that large “LDL” has a protein called apolipoprotein B exposed on its surface, and the liver sees it clears it promptly within 24 hours. When the particle is small, the conformation that apolipoprotein B is partly concealed and the liver does not recognize it. So that small “LDL” particle goes around and around and around in your circulation, giving it lots of opportunity to take up residence in your arteries.

And once that small “LDL” particle enters the artery. It's very good at triggering inflammatory responses. And the process of insulin resistance, inflammation and endotoxemia from "SIBO" are amplifiers of that entire cascade. And so you can see now wait a minute, "Lipitor" and "Zocor" and all those they reduce “LDL” cholesterol, the marker for heart disease, and they worsen insulin resistance. So we contributed to a study years ago. One of the things we were doing years ago was tracking carnivorous calcium scores, because calcium occupies 20% of total atherosclerotic plaque volume. So you can use calcium as a very convenient dipstick or gauge of how much plaque you have. Well, so we're scanning people left and right and finding hidden heart disease silent. And people like you and me go into work, riding their bike, that stuff. And someone comes in and says, hey, I'm 52, and my dad dropped dead suddenly at 56 of a heart attack. Do I have that in store also? So we do a heart "CT" heart scan to generate a cardiac calcium score. And his score, let's say, is 400, which is a high score, normally zero. And we help publish these data if you do nothing, a score of 400 yearly is 500, 25% higher year later, 625 or whatever, 25% per year. And every year you're closer to dying, having a heart attack, sudden cardiac death. Right. Well, we did this. What if we put you on baby aspirin, a high dose of a cholesterol drug like "Lipitor," 40 milligrams, cut the fat and saturated fat in your diet, and had you exercise? How fast does that score go up? 25% per year. It has no impact whatsoever on that measure. Thats what led me down this path, "Jesse," because I started asking, well, if I got people freaking out on me what can we do? Well that's where vitamin D, huge effect calcium scores did this. Omega-3s, elimination of the small “LDL” particle via wheat, grain, and sugar avoidance. All those things came from... trying to figure out how to put a stop to the progression of heart disease.

For somebody right now that wants to see where they're at on that continuum of heart disease, is the "CT" scan of the coronary arteries the gold standard to assess? It is. It has been for about 30 years. When we first started doing this 30 some years ago, we got a lot of skepticism, but the science has become very clear. It is. So if I said your cholesterol is 240, are you going to die of a heart attack tomorrow in ten years? You have no idea. It's a lousy predictor. What other gauges there for your potential for heart attack? Well, the best by far is a coronary calcium score. If your score is zero, your risk for heart attack is virtually zero. I say virtually because this can sound crazy. I can't stop you from using methamphetamine... or crack cocaine. People do crazy things, right? But for all practical purposes, score is zero. Zero risk for heart attack and other cardiac events. What if your score is 700 and you allow it to go up 25% per year? Your risk is really high. You're virtually guaranteed you die or have a heart attack within five to six years. What if your score is 700, but you did vitamin D and eliminate wheat and grains and sugars, eliminate small "LDL" particles, and got omega-3s at a healthy level, got iodine, your thyroid, and address your SIBO" and your score is now 500. So it's a high score. Still, what's your risk for heart attack or death? Virtually zero. So you don't have to get back down to zero to be safe. You just have to keep it from going up like that, as it does on "Lipitor," baby aspirin, and low-fat diet.

And when it comes to that score, is that looking at hard and soft plaque? So critics who don't understand the science will say things like this, well, we don't care about hard plaque. We care about soft plaque. Well, calcium is an index of total plaque. My friend "John Rumberger," when he was at "Mayo Clinic," developed the science behind this. He showed that calcium is -- an indicator of total plaque in all its elements, soft elements, fibrous elements, calcified or hard elements. So it's a way to track total plaque. I will tell you this, though in the number of years back, I was trying to figure out a way to keep that from happening, make it do this instead. The first time it happened, a guy had a score of I think, 700. And then he came back and scores like 350. I said no way, no way... So I went back, put the scans up side by side. We measured cows because it's easy to see and quantify precisely, down to tenths, even a hundredth of a millimeter. But you can still see those soft elements, and you could see that the entire plaque had shrunk dramatically. And so I know we've done this over and over and over again. I published some of those data. You can reduce cardio calcium scores, and it has nothing to do with reducing cholesterol, has nothing to do with statin cholesterol drugs, has nothing to do with all those things they focus on, but it has to do with things like wheat, grain, sugar avoidance, vitamin D, all these things you're familiar with omega-3 fatty acid, iodine addressing your, your bowel floor.

All right, so a "CT" scan of the coronary arteries... can detect... soft and hard plaque, correct? Or total plaque, it's an index of total plaque. Which is just a total of the two together. Right? Like when you check your oil in your engine and -- it shows you have one inch of oil. Do you really have one inch of oil? No, you probably have four or five quarts of oil, right? So calcium is kind of the dipstick for total atherosclerotic plaque.

Okay, just to get into some nuance here, do you feel like the soft plaque is more dangerous than the hard plaque? Oh, there's no question. There are confirmations. There are shapes of atherosclerotic plaque that are more rupture prone. That's what we're talking about here. So in my cardiology days, one of the things we do is do something called intravascular ultrasound. What that means is you pass an ultrasound probe down into the coronary artery, and you map out its contours. You can see where the calcium was, you could see where the soft elements were, you can see where the cap was. You can see -incredible detail. And so there's no question softer plaque is more rupture prone than... plaque that has calcium in it. But -the truth of it is, and this comes from years and years and years of mapping people's arteries out. Plaque is a whole bunch of crazy things, and you'll have little calcium here, some fibrous elements here, some inflammatory. It's a whole mixture. It's a hodgepodge of things. So this notion of

We only want soft. The reason they say that is because they're trying to make the argument that even if you have a 30% blockage, that that justifies a several thousand dollars procedure to implant a stent or bypass your arteries. In other words, they're trying to make the argument they should bypass or stent just about anything, which is nonsense. So that comes from people who push for procedures. That's the blessing curse here.

Procedures are very good now. They're quite refined, but they also pay very well, and that is an incentive a lot of my colleagues cannot resist. And so they'll stent or bypass almost anything. That means a lot of procedures. It's hard to get a fix on this. There have been some analyses that suggest about 30% of all heart procedures are unnecessary. I think that's probably accurate, maybe a little more than that. But there's a lot because it pays so well, "Jesse." -- If it didn't pay so well, if you got paid $10 to put a stent in, no one would be putting in stents.

All right, so give me the bottom line on all this. What's the number we're looking for? And it sounds like this number does encompass soft and hard plaque. Yes. So calcium score is an index of total plaque, and you can reduce that score very easily. But a statin drug will, in fact, there's good evidence. Several clinical trials in which statin drugs actually accelerated the accumulation of calcium. My colleagues who apologize for the statin industry will say things, oh, that's proof that you're converting soft plaque to hard plaque. That is not true. There's no such evidence. That's just their speculation. To protect the pharma people. -- So what we do is we address the real causes vitamin D deficiency, liver de novo lipogenesis. That creates "VLDL" and thereby small "LDL" nutrients that, when put together, synergize to minimize insulin resistance and inflammation. And we address bowel flora so that we eradicate endotoxemia.

If you have coronary disease, you've got endotoxemia. If you've got a neurodegenerative disorder or... autoimmune condition, or irritable bowel syndrome, or depression, or suicidal impulses, or rosasia or psoriasis, or restless leg syndrome, or fibromyalgia, you have "SIBO" and endotoxemia virtually guaranteed. Now, what is the solution, "Jesse?" Well, I say, okay, "Jesse," were going to solve this by removing your small intestines surgically. You would say, well, you better be damn confident that strobuster. What if the solution was something that looks and smells like yogurt that you make in your kitchen? Well, you don't have to be quite so certain. And what if that same concoction that looks and smells like yogurt also smooths your skin, restores youthful muscle, increases your testosterone by 50% in older guys, restores vaginal moisture in older ladies, increases libido, preserves bone density, and makes you a better human being because you're more generous, you like people better, you have less social anxiety, and you accept the opinions of other people more readily. We don't have to be quite so certain. And that, by the way, what I'm talking about is making what I call "SIBO" yogurt. It's the combination of lactobacillus reuteri, lactobacillus gasseri. Those two colonize the small intestine produce bacteriocins. It used to also include bacillus coagulans for similar reasons. But we did a whole bunch of testing and found that bacillus coagulans in yogurt is not a reliable fermenting microbe. It requires a very specific environment where you control pH and osmolality and mineral content, which we don't do in yogurt. So we're going to drop the coagulans. I'm contemplating adding a third microbe. But right now, if all you do is ferment lactobacillus reuteri, lactobacillus gasseri, microbes you're supposed to have because your mom gave it to you when you pass through the birth canal and breastfed, but likely lost it because you took antibiotics ten years ago or whatever, you lost it now you're going to restore it. And one of the great effects is push back "SIBO" and reduce or eliminate endotoxemia. And we've gone into this in great detail. If people want to go back and listen or watch our previous conversations.

Before we leave this "CT" scan piece, obviously, a score of zero is what would be ideal. It sounds like we can always reverse back down to zero. But if we're coming down with our number, it sounds like that's a sign that we're, -- obviously making progress. But if you're somebody that had a score of 500 and you're down to 250 and you're maintaining there, do you feel confident that things are stable at that point? Yeah. --- What you're doing is stabilizing plaque. So heart attack, sudden cardiac death, people think of it as they think, oh, blocks getting worse and worse and worse and worse. That's not how heart attacks occur. Heart attacks occur from a minor plaque, maybe only blocks 30% of the diameter, that ruptures like a little volcano, and that triggers blood clot formation. And so that's how heart attacks occur. So when we have a drop in a cardio calcium score, we're achieving stabilization... and reduce the potential for plaque rupture. So when you have a score that's not changing or that's reduced the heart attack risk is virtually zero. Once again, I say virtually because I can't stop you from taking methamphetamine or crack cocaine. No, perfect. Important we get into the nuance there.

And last piece with cholesterol, the small "LDL." Do we know for certain... if it's causative... when it comes to heart disease or does there need to be another insulting factor for it to... go to that site of injury and then progress things? Basically, just want to get to the distinction here, whether we think that it's part of the problem once there's already a problem. Or is the small particle "LDL" the actual initiator? It is the actual initiator. Well, I should say small "LDL" is a product of carbohydrate consumption, magnified by insulin resistance, inflammation, and endotoxemia. So that's why we address all those things. And then when you do that, small "LDL" typically drops from, say, 2000 nanomoles per liter to zero. So we're not talking about, like, oh, it's 30%, but no, most of the time, you've eradicated it. Now great things happen. So when you look at "LDL" cholesterol, does it have other things that occur with "LDL" cholesterol?.. No, there's nothing else that tracks with "LDL" cholesterol, because it's not a real number. It's a fictitious number. It's obtained by something called a "Friedewald" calculation. Small "LDL" if you have, let's say, 1800 nanomoles per liter. Small "LDL" what else is evidence that something's wrong? Well, your "HDL" is low, maybe 32. It's also abnormally small. You have too much "VLDL" and triglycerides. So high triglycerides. My definition of high, by the way, "Jesse," is anything above 60 milligrams per deciliter? The lab says 150. But you now know labs are full of nonsense a lot of time, because you can still have a fatal heart attack... from that triglyceride level at 130. So we aim for 60 milligrams or less. So small "LDL" co occurs with low "HDL," small "HDL", ineffective protection, more "VLDL", higher triglycerides, higher c-reactive protein, higher blood pressure, higher blood sugar, higher hemoglobin "A1C." In other words, small "LDL" doesn't occur in isolation. It occurs as part of a cluster of abnormal effects that magnify cardiovascular risk. "LDL" cholesterol occurs with nothing, nothing tracked except total cholesterol. But none of those other measures, nothing correlates with"LDL" cholesterol.

But it pays well. The "LDL" cholesterol reducing franchise, statin drugs, “PCSK9” drugs, all that stuff, pay huge amounts of money. And just a few years ago, it wasn't uncommon for farmer to make many tens of billions a year. And so that's because it pays so well. That's where all the attention is focused. Even though you see, the great thing about this, that's the bad news. The good news is you, your family, your listeners have magnificent control... over cardiovascular risk. And sadly, the last person to ask is the cardiologist or the general practitioner, the primary care doc. They don't know.

All right, Doctor "Davis", we're going to end on this. Earlier you talked about the spiking of blood sugar... and the glycation and the problems that brings. This gets me thinking about controlling blood sugar spikes with this new natural sweetener, I shouldn't say new, but something that's really blowing up in the natural health world, allulose. How do you feel about that for controlling blood sugar and controlling appetite as a "GLP-1" agonist... and then well flip into the drugs that are being used in that realm as well. Allulose, wonderful sweetener. I know of no ill effect. It may even actually amplify loss of subcutaneous fat. There are three compartments of fat. There's subcutaneous beneath the skin. So people with big buttocks or thighs, that's mostly subcutaneous. Then there's abdominal visceral fat. That's the fat in circles, the abdominal organs, a much more problematic form of fat because it causes insulin resistance and inflammation. And then there's this recently recognized process called ectopic fat. That's fat in other organs where they're not supposed to be like fat surrounding the heart, epicardial fat or pericardial fat. There's fat in the pancreas that can kill off your insulin producing cells, the beta cells. There's fat in your kidneys, which can give you kidney disease and hypertension. There's fat in your joints like hips and knees. And when that happens, it accelerates breakdown of your cartilage. So ectopic fat, very, very bad. Those are three kinds of fat. Allulose seems to have this peculiar ability to specifically target subcutaneous fat. Don't know why. - So it's a great sweetener, as is monk fruit, stevia is pretty good.

Now here's something that bear in mind for your listeners when you go wheat and grain free. People say, I have a sweet tooth. I say, no, you have a wheat tooth. I say that because it's the gliadin protein in wheat and related proteins and other grains like secalin and rye and horedin and barley and zein and corn, that upon digestion form opioids. These are four or five amino, kind of like collagen, but these are four or five amino acids, long, different structure, and they're resistant to human digestion and they cross into the brain where they have opioid effects, but they don't make you high. They stimulate appetite. So people who consume grains tend to have a much more of a sweet tooth. Also, another driver of sweet tooth is fungal overgrowth... in the colon and or in the small intestine. It's a weirdest thing. Fungi love sugar... That's why diabetics who have high sugar levels in their skin, their saliva, their urine, and they're everywhere typically have fungal infestation everywhere. Skin, groin, under the breasts and the hair and the ears. Because -- they're sugary and fungi love sugar. But somehow fungi have evolved to produce some metabolite. No one knows what metabolite that sends a signal to your brain to eat more sugar, so they somehow have evolved to produce a metabolite to direct your eating behavior -- If you go wheat and grain-free and then cultivate microbes like reuteri and get rid and also address the fungal overgrowth, you start to recognize you have magnificent control over appetite and the desire for sweetness almost goes away entirely. So in the early days of wheat belly, for instance, I had all these recipes for cornbreads and cheesecake and cookies and pies to replace all those things. We'd make it with stevia and monk fruit and those kinds of things. And as time goes on, for a lot of us -- we don't need that stuff anymore. Maybe once in a while, maybe at Thanksgiving or other holidays, or maybe you're having a football party and you want to serve something, but outside of that, or you have kids and grandkids who still expect those kinds of things. But for -- most of us, all those needs go away. But you're right, allulose, good sweetener, monk fruit, stevia, some others.

All right, now let's pivot into "Ozempic," semiglutide, these drugs that are exploding right now in the conventional realm to help with weight loss. Tragic, "Jesse." Horrible. The "FDA" should never have approved those awful class of drugs. Let's say your wife pays $12,000... for a year's worth of "Wegovy". She endures all the side effects, hopefully doesn't die of a bowel obstruction or something, but she loses 40 pounds. Of. Of the 40 pounds lost. Ten pounds is muscle. 30 pounds is fat. Now, ten pounds of muscle is a lot. Imagine ten pounds of ground beef on your kitchen table. It's a lot of muscle to lose. So she stops the drug after a year, because few people can afford that forever. She regains 32 to 34 pounds, almost nearly all fat, not the muscle. She's now more at risk for diabetes, heart disease, dementia, breast cancer than she was at the start because the pivotal thing here is the loss of muscle. So in the clinical studies, a couple dozen of them, between up to 50% of the weight loss is muscle. And we know with good evidence, when you lose muscle, your metabolic rate plummets. So for instance, the so called biggest loser study, they took a bunch of people who are graduates of the 8th season, like "Danny Cahill." I talked to him, he lost, he started 430 pounds, "Jesse," he lost 239 pounds in seven months. I mean, wow. By consuming 800 calories per day, which is torture, and exerting about 8000 calories. And he does, at the end of the show, he looked great. Good looking guy, look great, right? He leaves the show continues 2 hours a day, six days a week, exercise, strength, resistance and aerobic, and a low-calorie diet... regains the weight. "NIH" researchers studied those people who did this.All except one regained all the weight because the loss of muscle, they measured their metabolic rate. It dropped by 27% and the study ended after six years. And their metabolic rate was still low at six years. So it goes on for a long, long time. In other words, whenever you lose muscle, you guarantee that metabolic rate will drop, the rate at which you burn calories and you will regain the weight. So "GLP-1" agonists are just another spin on calorie reduction. We could call it "GLP-1" agonist, we could call it move more, eat less. -- We could call it lap-band or gastric bypass that shrinks stomach volume. They're all variations on the same theme, reducing calorie intake. And we know with good evidence, when you reduce calorie intake, you lose muscle, which in turn guarantees a drop in metabolic rate and weight regain.

Now, one thing I didn't mention to you was we did that little clinical trial for the skin and we did show the increase in dermal thickness. Ladies were happy they lost their wrinkles in three months, but they also lost a ton of abdominal fat, as much as eight and a half inches off their waist. And now here's the crazy thing, these ladies lost all this abdominal fat, but didn't lose weight. Well, how in the world can you lose tons of abdominal fat and not lose weight? Well, consistent with the animal evidence and what's going on around me with thousands of people increase muscle. So, for instance, me personally in my sixties. -- I hate going to the gym. I don't know about you, I hate going to the gym. So I go 15 minutes once a week. And when I did this, I gained 13 pounds of muscle and my strength increased by 50%. That's what we're seeing. People are regaining muscle. So the "GLP-1" agonist world reduces calorie intake because makes you not interested in eating. You lose muscle, reduce "BMR" metabolic rate, regain the weight, and you're less healthy than you are. I think we stumble on a way through a skin trial to preserve or increase muscle, specifically target abdominal fa. So this is kind of a new conversation I've been having, the ways to get control. So I tell people, don't worry about weight loss. Let's think of it instead as shape and body composition. Ladies say I don't want to look like "Arnold Schwarzenegger." Don't worry, you won't look like "Arnold Schwarzenegger." What we're trying to do is restoring the level of musculature you had in your twenties. That's what's happening. And of course, this is "Ozempic" face phenomenon. You lose your weight on the "GLP-1" agonist and you look like you're 10, 20 years older than because you lost subcutaneous fat, you lost muscle. We're seeing the opposite. We're seeing preservation of muscle, reduction of wrinkles, and people look 10 to 20 years younger. That's what we're seeing.

Well, let's end on this. Somebody who is overweight right now, they're metabolically unhealthy, somewhere on that spectrum between insulin resistant to type two diabetic. What are the high level points that are going to net them the most gains to lose weight and regain their metabolic health quickly. So it's what we've been talking about in its entirety. It's the diet. No wheat, no grains, no sugar, address those common nutrient deficiencies that altogether reduces insulin resistance and inflammation and facilitates loss of abdominal fat while not losing muscle. We're going to add lactobacillus reuteri, that via oxytocin causes a regrowth of lost muscle. So put it all together, get rid of "SIBO" because of endotoxemia. Endotoxemia is a big driver of insulin resistance and weight gain in the abdomen. So all that stuff in its entirety, and you can amplify the effect by going further, restoring those lost nutrients. Collagen, hyaluronic acid, and a carotenoid like astaxanthin. Now, you have huge effects on shape and body composition... So you might not lose weight because you gained muscle. So I've been asking people to get one of these bioimpedance scales, body composition scales you can get for as cheap as like $30 now... and measure your total fat and your, what's called fat-free mass. - That's muscle. And you can track because if you lose, let's say, 30 pounds and you want to lose 60, but of the 30 pounds, you also gained 15 pounds of muscle. The bioimpedance scale gives you a better index of that. Or look in the mirror, ladies, say this to me. I'm doing the yogurt. Doing all this and I gained eight pounds. What's going on? I tell them, well, look in the mirror. What do you see? Well, my waist is smaller, my buttocks and thighs are smaller, and my shoulders and arms seem firmer. My neck is firmer. They're losing abdominal fat, some subcutaneous fat, but while restoring or returning youthful muscle.

All right, that's perfect. We covered a lot in the conversation, so going really high level at the end, just to summarize, is great... And Doctor "Davis", we're going to link up your website, your social media, all your books, including "Super Gut", your latest book, in the show notes, and really enjoyed the conversation. Thank you. Same here, "Jesse." Thank you. Thanks for being so thorough. Now that you're done, you're going to want to stick around here and catch this other incredible episode. You don't want to miss it. I'll see you over there. Towards the end of college, I started developing "GI" upset with basically anything I ate. So I ended up becoming quite desperate and after trying a bunch of medications that didn't end up really working to keep me in remission or help my symptoms, tried a bunch of different diets -