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Hello Health Champions. Today I want to talk
about cholesterol, because the way we have been
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understanding and dealing with cholesterol in
the last 50 years is one of the greatest health
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disasters of all time. And there's this huge fear
factor about cholesterol. When people are changing
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their lifestyle and they're getting healthier
they're losing weight they're feeling better
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all their health markers are improving
except one, their doctors still scare them
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into abandoning their healthy lifestyle
and reverting to a low-fat diet because
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one marker LDL cholesterol is too high
in their opinion. And this is all because
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we have bought into the idea, without any
good evidence, that LDL cholesterol is bad
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cholesterol. What I want to help you with today
is to make an informed decision by understanding
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the true factors and what's really going on.
What we really want to get away from is the
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idea that if cholesterol is over 200, if your
total is over 200, then you get this automatic
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prescription for a statin drug. Or if your LDL is
over 100 that that should be some magical number
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that now you get a statin drug. Do statin drugs
lower cholesterol. Yes absolutely. They do,
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but we're going to talk about whether that is
actually a good thing we're going to answer
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what kind of cholesterol do they lower is that
something we actually want to lower. We're going
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to ask about heart disease does it actually help
lower heart disease and the answer is there is
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no good evidence of that. Recent studies actually
show the opposite that higher cholesterol actually
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is associated with lower all-cause mortality and
better cognitive function in your later years.
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Does it improve longevity. Does it help people
live longer and there is no good evidence to that
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either. What you do get for sure are side effects
and we're going to talk about that as well.
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So why then is there a standard prescription for
a statin even though there's no good evidence that
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it actually helps. Because there is something
called evidence-based medicine and the only
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evidence they're looking for is. Does it lower
cholesterol? Yes absolutely. And there's the
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assumption that cholesterol causes heart disease
and therefore it must be a good thing to lower it.
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And that's a false assumption. The other reason
is called standard of care that a doctor as long
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as he follows the standard of care which is to
prescribe a statin if your cholesterol is over 200
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you can't get in trouble if you hurt patients
as long as you follow the standard of care.
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The time you can get in trouble is if you step
outside of the standard of care and something
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happens. We want to get away from the idea of high
or low cholesterol and we want to start thinking
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balanced or unbalanced. Because 190 could be
unhealthy and 350 could be healthy. Now this is
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not to say that you should ignore your cholesterol
numbers. They still give you good feedback higher
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isn't necessarily better but higher isn't
necessarily bad either. We have to understand
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when to pay some attention. What are the numbers
to pay attention to we'll go over that. One thing
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we want to understand is we want to start fighting
we want to start addressing the true cause
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instead of the rescue attempt. So what do I mean
by that. If you come to a fire then there is
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probably some people from the fire department
there. Most of the time that you see a traffic
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accident or a fire there will be a responder.
There'll be an ambulance there'll be a firefighter
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and there's an association there and that's
just like we associate cholesterol with disease
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cholesterol with damage because cholesterol always
shows up at the accident site. Just like the first
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responders show up at the accident site. That does
not imply causation. That does not make the fire
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department guilty of the fire. It does not make
the cholesterol guilty of the damage. And if we
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start fighting cholesterol we are fighting
the wrong guy. That would be like setting up
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roadblocks for the fire department because there's
an association between fires and fire department.
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So what then is the real cause of heart disease
and plaques? And the real causes are inflammation
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a low-grade chronic inflammation which is
associated often with insulin resistance and or
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oxidative stress. All these three go hand in hand.
And here's what we want to understand there is a
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strong correlation between cardiovascular disease
and these three things there's a very very weak
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correlation between cholesterol and cardiovascular
disease. And to the extent that cholesterol
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is involved with cardiovascular disease it's to
the extent that it's associated with these three.
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So what we really want to understand is when is
cholesterol unbalanced and the indicators are
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increased blood glucose, increased blood
insulin, increased long-term glucose,
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called a1c, increased triglycerides,
decreased HDL high density lipoproteins,
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and an increased ratio of total cholesterol
to HDL. We also want to look at VLDL
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and we want to look at LDL size. Now one
of these by itself doesn't necessarily
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indicate anything and that's why we want to look
at the bigger picture. The first four I'll cover
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very quickly because I've done so many videos on
that increased glucose comes from eating sugar
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and processed carbs which trigger an insulin
response to combat that high blood sugar.
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If this goes on over time then we get insulin
resistance and our a1c starts creeping up.
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And once we're insulin resistant now this glucose
is not accepted by the cells. The cells are
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resisting additional fuel and if the glucose
can't get into the cells now it gets converted
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into fat, which is the triglycerides that
circulate in the blood. Next we want to look at
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HDL and the ratio of total cholesterol to HDL
so this person has a total cholesterol of 286
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and it's supposed to be a 100 - 199 so that is
obviously very high so it's marked with a flag.
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But this in itself does not tell us if this is
good or bad the range goes from 100 to 199 and I
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would be a lot more concerned if your cholesterol
total was 100 than if it was 286. Then we look at
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his HDL cholesterol which is generally considered
protective and we want to see this above 39.
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And this person has 46 but is that high enough
it's above that threshold but is it enough to
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kind of offset the total cholesterol. So now we
look at the total cholesterol to HDL ratio and now
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we want to have zero to five. Again a lot of these
ranges are kind of ridiculous because there is no
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way a living human could get to zero. Zero or one
is not a good number because then you would have
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virtually no cholesterol in your body and that
is an essential nutrient. But this person has 6.2
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so that's above the range and what does that
mean and this is on most standard blood work
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so this is not anything unknown or out there. It
says please note you have half the average risk
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of heart disease if your ratio is about three and
a half and you have average risk of heart disease
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if your ratio is about five and this is from men
it's a little different for women but you get
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the idea. So based on this marker this person's
estimated heart disease risk is 1.3 times, 30%,
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higher than average. So that's not great and
this is based on one marker that I use. I'd
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like to see this ratio in the three to three
and a half range. Next marker is called VLDL,
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very low density lipoprotein, also known as
remnant cholesterol. And the range is between
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5 and 40 and this person is 16. so what does
that mean? This marker is very often overlooked
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but it's a great tool to look at to see where
you are on your insulin resistance journey. The
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way you get this is you take the total and you
subtract the other two. So it's just what's left
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over you subtract LDL and HDL and you're left with
VLDL. And I like to see this number between 15 and
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20. So this number of 16 is actually really really
good. To say that it should be anywhere between
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5 and 40 is a little bit ridiculous because
your body is not indifferent to if the number is
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eight times as high as the low number. So
what is this thing the VLDL cholesterol.
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It's a carrier. The purpose is to deliver dietary
fat to the cells, to the tissues. So this has some
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triglycerides and it has some cholesterol it
has a lot more triglycerides which are light
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and this is why it's called very low density. And
the purpose is to deliver the fat to the tissues
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and when it's successful then it quickly offloads
these triglycerides and the cells take them in
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and now this VLDL becomes an LDL a healthy normal
fluffy LDL. But if you're insulin resistant then
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the tissues resist the delivery of these nutrients
of this fat. And therefore if it's unsuccessful
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in delivering then it's going to linger it's going
to stick around in the bloodstream for a long time
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and the levels go up so when we measure them
they are much higher. So if you have a value
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of 35 or 40 then you're quite insulin resistant
because your tissues are resisting the delivery of
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fuel. Now let's talk about the really important
stuff that hardly anyone gets. 99% of people
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prescribing statins have no idea of what I'm
gonna tell you we said that the liver packages
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nutrients into certain vehicles for delivery and
one of those is the VLDL and if all goes well
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this quickly is converted into a normal healthy
fluffy LDL and then what happens is your liver
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wants to recycle this LDL. It wants to keep
it going so it has receptors and if this LDL
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is normal then this system works like a revolving
door. Very very quickly does the liver reabsorb it
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repackage it and put it out again and it
does this with VLDL's with LDL's with HDL's.
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With all the different types of cholesterol. They
are always appropriate whether they're high or low
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they're appropriate for what's going on in
the body. But what happens if you introduce
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some oxidative stress and some low-grade
chronic inflammation and some glycation.
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If you get some sugars stuck on these LDL's now
they become damaged and when they're damaged or
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oxidized now they shrink. And this is why we're
talking about the size of the LDL and the bad LDL
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is the damaged LDL. But again, it's not the
LDL that it's bad, it's small and therefore it
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indicates that you have had some oxidative stress
and some inflammation and glycation. These are the
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real problems. The small LDL is just an indicator
of those problems. And here's one of the first
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big keys to understand. This healthy LDL fits into
the revolving door but this oxidized LDL does not
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when it's small and damaged now this receptor
doesn't recognize it. It doesn't fit into
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the system the liver cannot reabsorb this LDL.
And therefore the numbers of small damaged LDL
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starts building up. And what was it that caused
the oxidative stress the inflammation and the
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glycation. It is sugar insulin resistance, food
allergies, stress, and the list goes on and on.
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All those things associated with chronic
disease. So now listen up very carefully.
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Here is the real cause of atherosclerotic
plaques. This oxidized LDL can do some damage.
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It damages the intima which is the inside lining
of the blood vessel. If you notice this yellow
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plaque it's not actually inside the lumen of the
blood vessel. That there are different layers
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of the blood vessel and the inside layer
is the intima, and then you have various
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different layers. So what this oxidized LDL does
it damages the inside layer and makes the gaps
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grow bigger and now this oxidized LDL, which is
tiny can slip through the crack and start getting
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into the wrong place. And now there's something
called a macrophage that starts following this
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bad guy in through that crack. And a macrophage
is something that eats something. That's a white
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blood cell sometimes it's called a phagocyte, it
goes by many different names but it's basically
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we're going to call it Pac-Man and this Pac-Man
its job is to go after and gobble up this LDL.
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Because the liver receptors cannot recycle it as
a healthy cell, this oxidized LDL is now treated
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as a foreign intruder. It's not part of
the friendly guys in your body anymore.
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And the only way to get rid of it is through your
immune system. So it's treated like a virus or a
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bacteria or a fungus or something we need to get
rid of. And when Mr. Pac-Man has gobbled it up,
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now it encloses this and it becomes
a foam cell. So it sort of protects
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the environment from this damaging cell, but
it becomes another problem in the process,
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because these foam cells now become the plaque.
So to really drive home the importance of looking
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at the big picture and the sizes let's
look at a couple of real live examples.
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We did one test on January 25th and we did another
one on April 5th that's a little over two months
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70 days we started off with a total
cholesterol of 297 which was flagged as high
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and 70 days later it is still high, but it's a
couple of points higher at 299. We look at LDL
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cholesterol which is traditionally considered bad
and that was 225 and the later test was still 225.
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So this guy was a patient who had been
doing some changes in his lifestyle, going
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doing low carb high fat diet, and let me tell
you his medical doctor was not impressed. He was
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asked very sternly or told to get on a statin
drug they said look it's not getting better.
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So then we ordered an NMR profile we had this
on both occasions which is where you measure
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the particle count which takes into account the
size of these particles. And now it starts looking
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even worse because we want this number to be
under a thousand and it is 3448. And now you
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may have noticed that this has my name on it
as the ordering physician so you're wondering
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why am I bragging about this case it just doesn't
look too hot. I mean this guy is in trouble right
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well once we look at the next step we look at
the change we see that his LDL particle count
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went down from 3 400 to 2 900. We had a change a
reduction in 455. A 15% reduction in the number
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of cells, but more importantly what
kind of cells which cells were reduced.
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So now we look at the small LDL count and that
went from 1653 to 1227. So what we see here
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is crucial, almost all of the reduction was the
small damaging oxidized LDL particles. The ones
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that caused the plaquing and the damage and
on this test we also get an average size of
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the LDL's and we want this to be over 20.5. So
this guy started off in January at 20.9. So even
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though his numbers didn't look too impressive they
were probably much much better than they were six
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months or a year earlier. We just don't have any
data on that and then we look at what happened
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in these 70 days and it climbed. The size average
increased from 20.9 to 21.3. And that may not look
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like a huge change but let's look at it one more
way. LDL particles can be called small pattern or
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large pattern and we see that on the first test
this person was already into the large pattern
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size and 70 days later he was further in it
doesn't look like a whole lot, but now let's
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look at this. They also give you what's called an
insulin resistance score and in January he was in
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the 57th percentile. That means there were still
57 percent of the population that were healthier
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than he was in this regard but 70 days later
he was in the 33rd percentile and he had made
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tremendous progress because what this means in
only 70 days he had passed 84 million Americans in
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terms of health. And this is why it's so important
to look at the big picture because if you only
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looked at the milligrams of total cholesterol and
LDL, it looked like he was making no progress but
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when we start understanding the big picture and we
actually measure now we're more interested in the
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direction he's going. Are we making progress
and can we monitor that continued progress.
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So what would be the pros and cons of a statin
drug we know they lower cholesterol but now let's
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understand what type of cholesterol they actually
lower. So what does a statin drug do? It increases
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the number of receptors to reabsorb LDL particles.
That would seem like a good thing, right? Well
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the thing is that these healthy fluffy LDL
particles they fit into these receptors like
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we talked about. So if we take a statin then
we will see these numbers of LDL particles
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go down. We're going to see a dramatic decrease
of these fluffy LDL particles. But we also said
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if you remember that these small ones they are
not recognized by these receptors, so the stat
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drug will decrease total cholesterol but it
will only reduce the cholesterol that we want.
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It will not reduce the cholesterol that we're
trying to get rid of. The damaging cholesterol
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there is no change. These damaged oxidized LDL 's
can only go down if your immune system is working.
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And as we saw in the previous example your body
has a chance to do that if you reduce the level of
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oxidation so that there is less oxidized damage.
Now one point we could say in favor of the statin
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would be that if we reduce the LDL particles then
there is less total LDL out there to be oxidized,
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but the better idea obviously is to reduce the
actual root cause which is the oxidation, the
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insulin resistance and the inflammatory damage.
So let's talk about why these statin drugs do some
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damage as well the first question is - why does
the liver up regulate the receptor sites for LDL
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when we introduce a statin? Is that a good thing
or a bad thing? Well the statin blocks an enzyme
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called HMG-CoA Reductase and don't memorize the
name it's totally not important. But when we block
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that then we're stopping a process. The body made
that enzyme for a reason it wanted to accomplish
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something now we block it then the end product of
this pathway can't happen either and farnesyl pp
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was supposed to become cholesterol and CoQ-10. So
these are two very precious substances the body
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doesn't make unnecessary things. It wants these
things for a reason so the reason that the liver
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up regulates these receptor sites is that
when we block the production of cholesterol
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of an essential nutrient, then the liver perceives
a lack of cholesterol. It wanted that cholesterol.
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Cholesterol is very expensive to produce
everything in the body is expensive to produce.
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So when we block the production so there's less
of it the liver sense is a lack so now it kind
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of gets desperate and tries to reabsorb as much of
that cholesterol as possible, but again remember
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it can only reabsorb the normal, healthy LDL
the stuff we actually want to get rid of is not
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affected. The other precious nutrient CoQ-10 is
involved with 95% of all the energy production in
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the body. So when you block the pathway you reduce
CoQ-10 you reduce the overall energy production in
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the body as well. Which tissues would be the
hardest hits it's the body parts and tissues
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that use the most energy normally. So muscles use
a lot of energy because you have to move around.
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So statin drugs cause muscle fatigue muscle
pathology and weakness. And if you recall one
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really important muscle is called the heart and
we take the statin drugs because we're afraid that
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the cholesterol will block the artery and shut off
the oxygen delivery for energy production but now
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we take a drug that actually shuts off the energy
production and the delivery to the heart. So now
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the heart has to work harder and we often get
heart pathology like cardiomegaly and things
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like that. Another very hard working organ is the
liver so first we interfere with the production of
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cholesterol so it has to try even harder to make
and reabsorb cholesterol, and then we block the
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energy production to that. And then there's one
more place that uses more energy than any other
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and that is your brain. It's two percent of your
body weight uses 20% of all the energy in your
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body so let's take some statins so we block the
energy production to that as well. So you could
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take a statin drugs and you can interfere with
all of this or you could just stop eating sugar
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and get healthy. If you enjoyed this video
you should really take a look at that one next
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if you want to understand how the body works and
truly master your health. Thanks for watching
