Transcription
I don't prescribe statins in my clinic, and I'm not alone. The more we learn about metabolic health, the more we see that statins don't deliver on their claim to be good for everyone with high cholesterol. But many folks watching this channel hear the message that in that case, they don't have to worry about heart disease. Is that true?
Keto patients burn fat for fuel, and as a result, their circulating fat called cholesterol shoots up, especially that LDL cholesterol. In fact, the first 6 months of a ketogenic diet, I don't let them check their cholesterol. But does that mean I don't worry about heart disease? Of course, I do. Let me show you how I think through this.
Step one is to reverse the insulin resistance. Simply start with the real problem, which is insulin resistance. That high total or LDL cholesterol in my ketogenic patients are not the villains. Think of these droplets of circulating fat as passengers in a car being driven by a much more dangerous force, which is high insulin.
Every doctor knows that heart disease and diabetes show up together in the patient's chart. So why do they get away with calling diabetes a risk factor as if it's a separate issue? The truth is they are both symptoms of the same underlying disease of an unhealthy metabolism. One that has been fueled by too much insulin for too long.
Here's how it works. When your blood sugars spike, you make insulin. When your blood sugars spike multiple times a day for the past decade, your insulin is chronically high. High insulin is profoundly inflammatory. And inside your blood vessels, you have a beautiful slippery gel coating the insides of your blood vessels called a glycoalix. Think of it as the teflon protecting your blood vessels, keeping everything flowing smoothly.
Inflammation from high insulin erodes on that lining. And once that teflon is worn off, those LDL cholesterol particles can get stuck in places where they do not belong. Those fatty droplets in the wrong places of your body spark an inflammatory reaction and this creates a sticky environment leading to the fat buildup we call plaque.
So what do I test instead of just looking at the LDL cholesterol? Well, I want to know what's the level of insulin resistance in my patient. And the best way to do that is an LPIR score, which stands for lipoprotein insulin resistance. Let's compare the LPIR score to the standard cholesterol panel. In this outdated test, we do a mathematical equation after stripping the cholesterol all from the particles carrying the fat around the body. Then we calculate the LDL or bad cholesterol from that number.
Instead of using the standard lipid panel, this NMR or LPIR score uses advanced math to measure how efficiently your body dishes out nutrients from those circulating fat particles and then how well it recycles it back into the liver. And this is a much more useful thing to understand. This measurement is directly and hugely impacted by insulin. This score predicts the future heart attacks better than any other metric I can measure.
For patients whose LPIR score on that NMR is less than 25, I assure them that their body recycles cholesterol efficiently, leaving them a very little chance that it ends up stuck inside those arteries. Maintaining this sexy LPIR score of less than 25 is no easy task. It begins with cutting your carbs down to 20 total daily grams and then moving your eating window of less than 8 hours to all before sunset.
And step two is to activate autophagy because what if you already have heart disease or if your LPIR score is not improving? This is where we go to the next level of healing and we need to lower your Dr. Bos ratio. Yeah, the Dr. Bos ratio is your glucose divided by your ketones and it simplifies the math for the glucose ketone index. This is an at-home test allowing you to see today's snapshot of how much insulin your body is making. You want a low Dr. Bos ratio first thing in the morning, meaning you want a low amount of insulin first thing in the morning. A ratio under 40 heals most deep metabolic problems like heart disease. But to get there, you need to lower the blood sugar and raise the ketones.
So, how do you do that? This is where I think the real work begins. So, don't mess around. Measure your blood with a prick of your finger each morning, first thing. Check your glucose and your ketones right as you wake up. Spoiler alert, if you have serious health issues and really want to move the needle, you will need to use some powerful tools like a sardine fast to get those numbers under 40. By day three of sardines, you will be well on your way to healing. And in my insulin resistant patients, this works far better than a 3-day water fast.
The goal of this work is to activate autophagy. And in Greek, this means to eat thyself. Yeah. Think of it as a cellular housekeeping. And in those high insulin patients, your cells are stuck in the growth mode. And the unhealthy cells grow right along with the healthy ones. This is where the real problem is. Autophagy will flip that switch from growing to repairing. So, your cells begin to clean house, eat up old, damaged parts, and the inflammatory garbage that's been building up for decades gets removed.
And ketones are only half the puzzle. Getting your morning fasting glucose under 100 is a struggle for my patients. But getting it to less than 80 is where I see patients reaching autophagy most days of the month. Don't be discouraged. This is a step-by-step process and your body will adapt to each improvement you achieve. That's the goal. That's good. This is how you get healthy. But if patients change too much at once, they often fall off the wagon. My entire channel is built around this keto continuum to guide you safely. For a step-by-step walkthrough, I wrote a book. I designed a course. You can find those in the description.
But let's focus on the worst-case scenario and that is step three bridging patients to safety and it's for the high-risk cases. There are folks who do everything right and their numbers are not showing that. Now this is important. I am not anti-medication. I am pro getting people healthy. For my high-risk patients, those who have already had a heart attack or a stent, we use a powerful tool to act as a bridge to safety while their body is healing.
So, what is my checklist for considering medication? Well, first have a clear evidence that you are not recycling those fats well. Proof that your LDL is hanging out too long in your circulation and becoming oxidized and very dangerous. In these serious cases, I consider two types of drugs. Number one is a zetoide and number two is a class of drugs called PCSK9 inhibitors.
Zetoide reduces cholesterol by binding to the cholesterol found in your bile. Yeah, it prevents your body from recycling the cholesterol that you naturally do within your intestines. In some patients, it lowers their numbers dramatically. PCSK9 inhibitors also really help. This is an injectable medication. See this closeup? This is the liver and this is an artery delivering fat back to the liver for recycling. Notice this liver is stuffed with fat and glycogen and triglyceride called a fatty liver. Chronic high insulin made that fatty liver. And as a consequence, the numbers of these LDL catchers mitts dwindles dramatically. There's just no more room in the liver for them. The protein PCSK9 is responsible for destroying those catchers mitts. Taking drugs like Rapatha stop this deterioration. With more catchers mitts on duty, the liver pulls a lot more LDL out of the bloodstream, often dropping it by 50 or 60%. And this provides a powerful safety net, buying us the time we need to reverse those underlying metabolic diseases for good.
To get right to optimizing your results, start with the next video to focus on the three steps to lower that stubborn blood sugar. I'll see you there.