Is High Cholesterol Really Catastrophic? Eminent cardiologist says “NO”

00:32:57
https://www.youtube.com/watch?v=I9TOMH332eA

Ringkasan

TLDRIn a conversation between the host and Dr. Aim Malhotra, they discuss newly published research on LDL cholesterol and its relation to heart disease, questioning traditional beliefs. Dr. Malhotra emphasizes that LDL cholesterol may not be a standalone risk factor, especially in metabolically healthy individuals, and highlights the significance of lifestyle factors like diet and insulin resistance. The discussion critiques the reactive stance of cardiology toward cholesterol management and suggests that a more holistic, patient-centered approach may be necessary. The host shares a personal experiment demonstrating unexpected LDL responses to a high-carb diet. The conversation stresses the importance of skepticism toward mainstream medical narratives and encourages an open-minded approach to understanding heart health.

Takeaways

  • 🔍 The relationship between LDL cholesterol and heart disease is complex.
  • 📊 New data suggests LDL may not be a significant risk factor for metabolically healthy individuals.
  • ⚖️ Lifestyle factors like diet and exercise play a crucial role in cardiovascular health.
  • 💡 Insulin resistance and inflammation are key contributors to heart disease risk.
  • 🔄 There is potential for reversing heart disease through lifestyle changes.
  • 🚫 Current medical narratives may oversimplify cholesterol's role in heart health.
  • 🔬 Research challenges the effectiveness of LDL reduction alone in preventing heart disease.
  • 😮 Personal experiments highlight surprising dietary impacts on LDL levels.
  • 📖 Awareness of media narratives is critical for understanding medical information.
  • 🌍 An open mind is essential for evolving traditional views in cardiology.

Garis waktu

  • 00:00:00 - 00:05:00

    The conversation begins with a focus on an upcoming publication regarding LDL cholesterol and heart disease, prompting a discussion about the current understanding of LDL cholesterol as a risk factor, particularly for metabolically healthy individuals.

  • 00:05:00 - 00:10:00

    Dr. Malhotra finds the newly published paper fascinating and consistent with existing literature, questioning LDL cholesterol's role as an independent risk factor for heart disease while discussing historical data from the Framingham study.

  • 00:10:00 - 00:15:00

    The dialogue highlights that understanding familial hypercholesterolemia (FH) requires a deeper investigation beyond just elevated LDL levels, citing that many individuals with FH do not develop heart disease, suggesting that additional factors like insulin resistance may play a critical role.

  • 00:15:00 - 00:20:00

    A key point raised is whether LDL is considered a major or minor risk factor. Previous systematic reviews indicate a lack of consistent correlation between LDL reduction and actual cardiovascular event reduction, emphasizing the need for context in interpreting LDL data.

  • 00:20:00 - 00:25:00

    As the conversation progresses, they discuss the appropriate time frame for studying the impact of diet on cardiovascular health and the importance of long-term follow-up in understanding the implications of LDL levels and diet on heart disease.

  • 00:25:00 - 00:32:57

    In closing, Dr. Malhotra encourages listeners to maintain an open mind about medical information, underscoring the complexity of heart disease and the potential limitations of mainstream narratives around cholesterol.

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Peta Pikiran

Video Tanya Jawab

  • What is the main topic of the conversation?

    The main topic is the newly published research on LDL cholesterol and its relationship to heart disease.

  • Why is the LDL cholesterol research considered controversial?

    The research questions the traditional view of LDL cholesterol as a primary risk factor for heart disease, especially in metabolically healthy individuals.

  • What alternative factors are discussed in relation to heart disease risk?

    Factors such as insulin resistance, hypertension, and lifestyle choices are discussed as having a greater impact on heart disease risk.

  • How do Dr. Malhotra's views challenge conventional cardiology?

    He suggests that LDL cholesterol may not be an independent risk factor and emphasizes the importance of overall health metrics rather than just cholesterol levels.

  • What dietary approach is supported in the conversation?

    A low-carb or ketogenic diet is suggested as potentially beneficial for metabolic health and heart disease.

  • How do cardiologists generally react to these new findings?

    Many cardiologists may initially react with skepticism due to established medical narratives around cholesterol.

  • What is the impact of lifestyle on cardiovascular health according to the discussion?

    Lifestyle changes, including diet and stress management, are seen as critical tools for reversing heart disease risk.

  • What personal experience does the host share regarding the research?

    The host shares a personal experiment involving Oreos to illustrate the surprising effects of a high-carb diet on LDL levels.

  • What should be the audience's takeaway from this conversation?

    The audience should maintain an open mind about evolving perspectives in medicine and challenge conventional wisdom on heart disease.

  • What message is conveyed about medical information and media narratives?

    There's caution against blindly accepting mainstream medical narratives, especially those influenced by commercial interests.

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Teks
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Gulir Otomatis:
  • 00:00:00
    what you're about to hear is a
  • 00:00:01
    conversation between myself and Dr aim
  • 00:00:04
    Malhotra a famous consultant
  • 00:00:06
    cardiologist and close friend of Robert
  • 00:00:08
    F kennedy Jr who himself has been tapped
  • 00:00:11
    for a position in the new administration
  • 00:00:13
    i note that upfront to call out the
  • 00:00:15
    elephant in the room our conversation is
  • 00:00:18
    going to be centered around data that
  • 00:00:19
    colleagues and I have just published
  • 00:00:21
    around LDL cholesterol and heart disease
  • 00:00:24
    that will be controversial actually
  • 00:00:26
    republish it tomorrow morning as I
  • 00:00:28
    record this but it's going to make big
  • 00:00:30
    waves now if you haven't seen the video
  • 00:00:32
    covering those new data please do so
  • 00:00:34
    before or after watching this
  • 00:00:37
    conversation now the last thing I'm
  • 00:00:38
    going to say before we start the
  • 00:00:40
    conversation is that science and people
  • 00:00:42
    have something in common it's often the
  • 00:00:44
    most controversial samples that are the
  • 00:00:47
    most poorly understood so please keep an
  • 00:00:49
    open mind and now for the conversation
  • 00:00:52
    dr mahra thank you for taking the time
  • 00:00:54
    to speak with me i want to get right
  • 00:00:55
    into it i know you read our new paper
  • 00:00:57
    which releases tomorrow morning to the
  • 00:01:00
    public what was your reaction to reading
  • 00:01:02
    the paper it was fascinating um Nick I
  • 00:01:05
    mean really great work what you've done
  • 00:01:07
    i think for me also it it seems
  • 00:01:09
    consistent with what we already appear
  • 00:01:11
    to know at the very least there needs to
  • 00:01:14
    be a big question mark around the
  • 00:01:16
    original understanding dogma on LDL
  • 00:01:20
    cholesterol being a significant risk
  • 00:01:23
    factor of heart disease especially as
  • 00:01:24
    you've pointed out in people who are
  • 00:01:27
    otherwise metabolically healthy and when
  • 00:01:29
    you bring that into the equation you've
  • 00:01:31
    then got to ask yourself whether or not
  • 00:01:33
    it is truly an independent risk factor
  • 00:01:34
    for heart disease william Castelli
  • 00:01:36
    co-director of Framingham
  • 00:01:38
    1996 actually said looking at going back
  • 00:01:42
    over Framingham data that LDL
  • 00:01:44
    cholesterol unless it was above 300
  • 00:01:46
    milligrams per deciliter or 7.8 millles
  • 00:01:48
    per liter depending on which country
  • 00:01:50
    you're in and what units you use it had
  • 00:01:53
    essentially no value in
  • 00:01:56
    isolation in predicting heart disease so
  • 00:01:59
    it's very consistent with what we
  • 00:02:01
    already know Nick i think that's why
  • 00:02:02
    it's it's such a good paper thank you
  • 00:02:05
    but would you agree with this you just
  • 00:02:07
    mentioned LDL in isolation but I don't
  • 00:02:10
    think we've actually had a population of
  • 00:02:12
    people up until this point who as a
  • 00:02:15
    population isolate LDL as a risk factor
  • 00:02:18
    because we have generally in the
  • 00:02:19
    population metabolic dysfunction as a
  • 00:02:21
    background or we look towards familial
  • 00:02:23
    hyper cholesterolmia and it's talked
  • 00:02:26
    about as if it was just high LDL but I'm
  • 00:02:29
    sure you'd agree like FH is a lot more
  • 00:02:30
    also the ideology matters the cause like
  • 00:02:33
    if you're born with a very high LDL
  • 00:02:35
    because you have a broken lipid receptor
  • 00:02:37
    that's very different than a metabolic
  • 00:02:39
    response you're absolutely right so I
  • 00:02:41
    think there's two points to be made
  • 00:02:42
    there um so the first one in reference
  • 00:02:45
    to what you said yes this is the first
  • 00:02:46
    time I think this has been studied in
  • 00:02:48
    this way but interestingly uh David
  • 00:02:50
    Diamond and Paul Mason I don't if you
  • 00:02:52
    read that paper they did a review of
  • 00:02:54
    looking at statin trials specifically
  • 00:02:56
    what they found in subgroup analysis of
  • 00:02:59
    both primary and secondary prevention
  • 00:03:00
    statin trials which is very interesting
  • 00:03:03
    was that those subgroups that had normal
  • 00:03:05
    triglycerides and HDL got no benefit
  • 00:03:07
    whatsoever from the statin which is
  • 00:03:09
    which is interesting but also on FH H so
  • 00:03:13
    I was involved in some research looking
  • 00:03:15
    at FH uh with a number of international
  • 00:03:18
    scientists and this is an interesting
  • 00:03:20
    one so the the big headline for FH and
  • 00:03:22
    this is these are people I manage by the
  • 00:03:23
    way so I'll give you some examples of
  • 00:03:25
    what I found in my clinical practice
  • 00:03:26
    which also seems to be consistent with
  • 00:03:28
    the research okay is that in people with
  • 00:03:31
    FH 70% of women okay and uh unselected
  • 00:03:36
    and 50% of men with FH right genetically
  • 00:03:40
    high cholesterol will not develop
  • 00:03:42
    premature heart disease so the question
  • 00:03:44
    then is is there any factors that
  • 00:03:46
    differentiate those ones that do develop
  • 00:03:48
    heart disease versus ones that don't
  • 00:03:50
    when you look at the LDL they're the
  • 00:03:52
    same so LDL isn't the differentiating
  • 00:03:54
    factor they're obviously very high in
  • 00:03:56
    both of them but it's not the
  • 00:03:56
    differentiating factor what what is the
  • 00:03:59
    differentiating factors well insulin
  • 00:04:00
    resistance so type two diabetes
  • 00:04:03
    hypertension smoking obviously um
  • 00:04:06
    lipopro lipoprotein little a and
  • 00:04:10
    fibbrinogen so I've had many patients
  • 00:04:12
    come to me some of them by the way are
  • 00:04:14
    probably lean mass hyper respponders
  • 00:04:16
    right in their 50s but some of them are
  • 00:04:17
    true FH and I look at their insulin
  • 00:04:20
    resistance markers and I we go through
  • 00:04:21
    the history i say listen actually you
  • 00:04:23
    don't appear to be at high risk that
  • 00:04:26
    these people are fit and active but
  • 00:04:27
    they've been scared by their doctor that
  • 00:04:30
    their cholesterol LDL is so high like
  • 00:04:32
    250 300 like in similar to the people in
  • 00:04:34
    your study and uh they literally think
  • 00:04:37
    that you know they've got the fear of
  • 00:04:38
    death put into them and but they're a
  • 00:04:39
    bit reluctant they're a bit skeptical
  • 00:04:41
    and they want to get a second opinion so
  • 00:04:43
    what do I do I organize CT coronagrams
  • 00:04:46
    for them and more often than not they
  • 00:04:48
    come back completely normal which means
  • 00:04:51
    that it reinforces that for them these
  • 00:04:53
    people some of these with FH especially
  • 00:04:56
    females that the if if cholesterol is a
  • 00:05:00
    problem for them if LDL is a problem for
  • 00:05:02
    them by your mid50s late 50s early 60s
  • 00:05:06
    you will see some degree of
  • 00:05:08
    aththeroscerosis and there is nothing
  • 00:05:09
    there Nick nothing yeah no my mom falls
  • 00:05:12
    into that category she's um MD PhD and
  • 00:05:15
    she's had high cholesterol all her life
  • 00:05:17
    but when she went low carb it went even
  • 00:05:18
    higher so lean mass hyper responder on
  • 00:05:20
    top of generally high LDL probably 160s
  • 00:05:24
    200 LDL most of her life um and then she
  • 00:05:27
    became a lean mass hyperresponder
  • 00:05:28
    several years ago ldl's in the 400s
  • 00:05:31
    she's having her 60th birthday actually
  • 00:05:33
    2 days today's uh April 6th her 60th is
  • 00:05:36
    on April 8th happy birthday mom um but
  • 00:05:39
    she wanted to know whether or not she
  • 00:05:40
    should go on a statin i said just like
  • 00:05:42
    get cardiac imaging you're a physician
  • 00:05:44
    you know you know what this means get a
  • 00:05:45
    CCTA zero plaque score no plaque and
  • 00:05:48
    that made the decision for her so you
  • 00:05:50
    know the high level truth I think that
  • 00:05:51
    we agree on is when you look at risk
  • 00:05:53
    factors like LDL and Apple B even if you
  • 00:05:56
    consider them a risk factor it's very
  • 00:05:58
    context dependent and to have a myopic
  • 00:06:00
    focus on that is problematic well yeah
  • 00:06:02
    that's true i agree and I think the
  • 00:06:04
    other thing to add in which is another
  • 00:06:05
    layer to trying to um really question
  • 00:06:10
    whether or not LDL is an independent
  • 00:06:12
    risk factor for heart disease and then
  • 00:06:14
    the degree of which it is so you know is
  • 00:06:16
    it a major risk factor is a minor risk
  • 00:06:17
    factor and myself and um in
  • 00:06:22
    2021 I always get the year wrong 2021 in
  • 00:06:24
    BMJ evidence-based medicine myself
  • 00:06:27
    Robert Dro and Michelle de logero second
  • 00:06:30
    author we did a systematic review which
  • 00:06:32
    has now been corrected to a review for
  • 00:06:34
    some reason because there was a bit of
  • 00:06:35
    backlash but we really looked at all the
  • 00:06:37
    randomized control trials looking at
  • 00:06:38
    statins the PCKS9 inhibitor drugs which
  • 00:06:42
    are very potent lowers of LDL
  • 00:06:43
    cholesterol and a zetami and there was
  • 00:06:46
    about 35 random ized control trials to
  • 00:06:48
    answer this question is there a
  • 00:06:49
    consistent relationship between the
  • 00:06:51
    reduction in LDL cholesterol Nick and
  • 00:06:54
    reduction in cardiovascular events
  • 00:06:55
    because you got to look at the other
  • 00:06:56
    side right because one is okay you've
  • 00:06:58
    got a biomarker that's got some
  • 00:06:59
    association with disease again context
  • 00:07:02
    dependent the next question is does
  • 00:07:03
    Loring it make any difference and we
  • 00:07:05
    found there was no consistent
  • 00:07:07
    relationship even from industry
  • 00:07:09
    sponsored trials where the data is
  • 00:07:11
    usually not independently verified so
  • 00:07:14
    the when you and then your paper now so
  • 00:07:16
    it's so good so strong so helpful that
  • 00:07:19
    it really reinforces this message of
  • 00:07:22
    course one of the things I want to ask
  • 00:07:23
    you which was interesting of course one
  • 00:07:25
    of the limitations is this one year okay
  • 00:07:28
    but my understanding reading the paper
  • 00:07:30
    is that the people enrolled had had
  • 00:07:32
    their LDL levels quite high at least
  • 00:07:35
    over 200 right um for a period of
  • 00:07:38
    several years is that correct yes so the
  • 00:07:40
    precursor paper to this um was a
  • 00:07:42
    baseline study where we had a match
  • 00:07:44
    population the Miami heart and what we
  • 00:07:46
    did is we compared plaque levels in
  • 00:07:48
    those two populations now at baseline
  • 00:07:51
    the average age of the participants was
  • 00:07:52
    about 55 in the keto group and they had
  • 00:07:55
    been keto for 4.7 years on average right
  • 00:07:58
    the end of this study it's 5.7 on
  • 00:08:00
    average this we were looking at a
  • 00:08:02
    one-year you know study but we still did
  • 00:08:05
    look at about you know 5 years after
  • 00:08:08
    they started keto and their LDL jumped
  • 00:08:10
    how do they compare to a match
  • 00:08:11
    population who is generally healthy and
  • 00:08:14
    what we actually found was there was no
  • 00:08:16
    increase in plaque in the keto group
  • 00:08:18
    versus the people with LDLs that were I
  • 00:08:22
    think the average levels at the baseline
  • 00:08:23
    were 277 for the keto group and 123 for
  • 00:08:26
    Miami heart right and that works out to
  • 00:08:28
    about 700 milligram per deciliter year
  • 00:08:30
    exposure actually the lean mass
  • 00:08:32
    hyperresponders were trending to have
  • 00:08:33
    less plaque it was a non-significant
  • 00:08:35
    difference but there was a trend towards
  • 00:08:36
    less plaque in the lean mass
  • 00:08:37
    hyperresponders so by the end of the
  • 00:08:39
    study 5.7 years on average everyone at
  • 00:08:41
    least two years keto yeah that's
  • 00:08:44
    fascinating I mean that adds adding
  • 00:08:45
    another layer that it's a reasonably
  • 00:08:47
    medium-term
  • 00:08:48
    you know that you haven't seen any
  • 00:08:50
    significant increase in LDL yeah
  • 00:08:52
    and yeah with the higher resolution CT
  • 00:08:56
    and geography we have now one year is
  • 00:08:58
    pretty standard i mean our PI Matthew
  • 00:09:01
    Budof is a um expert in cardiac imaging
  • 00:09:04
    and like he said this is an appropriate
  • 00:09:06
    time frame based on what other people do
  • 00:09:07
    based on the modern technology the fact
  • 00:09:09
    of the matter is of course we want to
  • 00:09:11
    follow them for 2 years 5 years but like
  • 00:09:13
    we don't have a time machine so check
  • 00:09:14
    back with me in 2030 and we'll have more
  • 00:09:16
    data these are where the data stand
  • 00:09:18
    right now and I think yes they're
  • 00:09:19
    preliminary but they're pretty
  • 00:09:21
    reassuring but I also want to be
  • 00:09:23
    respectful of your time and I have a few
  • 00:09:24
    more questions I definitely want to hit
  • 00:09:26
    um you're a cardiologist so you're
  • 00:09:29
    obviously uh know many cardiologists how
  • 00:09:31
    would they most cardiologists react to
  • 00:09:35
    the idea now the evidence-based idea
  • 00:09:37
    that lean metabolically healthy insulin
  • 00:09:40
    sensitive people on a ketogenic diet
  • 00:09:41
    with LDLs of 200 300 400 500 uh or more
  • 00:09:46
    might not actually be a high-risisk
  • 00:09:47
    group for cardiovascular disease how
  • 00:09:49
    would they react cognitively emotionally
  • 00:09:52
    well it's a really good question i can
  • 00:09:54
    tell you that they probably first of all
  • 00:09:57
    just part of human nature their initial
  • 00:10:00
    reaction would be one of skepticism they
  • 00:10:02
    won't want to believe it you know these
  • 00:10:04
    things take time i've even seen that I I
  • 00:10:07
    thought there's been great progress in
  • 00:10:10
    the shifting of the paradigm of heart
  • 00:10:12
    disease away from focusing on LDL
  • 00:10:14
    cholesterol in part because of some of
  • 00:10:16
    the work I've been doing and getting a
  • 00:10:17
    lot of publicity on over the years m um
  • 00:10:20
    but recently what I found Nick and and
  • 00:10:22
    this is really important for the context
  • 00:10:23
    of what we are up against in terms of
  • 00:10:25
    the narrative that's why your paper's
  • 00:10:28
    important it's why it's so important
  • 00:10:29
    that we get some coverage on this and
  • 00:10:31
    I'm sure it's going to do very well it's
  • 00:10:33
    going to get a lot of certainly al media
  • 00:10:34
    and hopefully some mainstream media will
  • 00:10:36
    react to it and and and you know give
  • 00:10:38
    you some amplify the message but what's
  • 00:10:41
    happened in the last couple of years is
  • 00:10:44
    I've noticed there's been almost a
  • 00:10:45
    reemergence of an obsession and an an
  • 00:10:48
    extra fear around cholesterol and I
  • 00:10:50
    suspect that's also because of the
  • 00:10:52
    non-statin new cholesterol lowering
  • 00:10:54
    drugs they're getting pushed because
  • 00:10:55
    they're very lucrative drug industry
  • 00:10:57
    spend a lot of money on them so what
  • 00:10:59
    I've been finding and this is the reason
  • 00:11:00
    I find this is actually from my
  • 00:11:02
    interaction with patients who come to me
  • 00:11:03
    from sec for a second opinion or even
  • 00:11:05
    reading letters from other reputed
  • 00:11:07
    cardiologists in America
  • 00:11:09
    i have a lot of patients in the US and
  • 00:11:11
    in the UK where there is almost a a
  • 00:11:14
    reinforcement of this cholesterol
  • 00:11:16
    hypothesis like as in you know um unless
  • 00:11:20
    you get your cholesterol down you're
  • 00:11:22
    going to have a heart attack soon you're
  • 00:11:23
    going to die there's a lot of
  • 00:11:24
    misinformation unfortunately Nick within
  • 00:11:27
    the minds of cardiologists and this is
  • 00:11:30
    still based upon to a large degree as
  • 00:11:33
    well the the focus on the management
  • 00:11:36
    saying if you get your LDL as low as
  • 00:11:37
    possible you are massively reducing ing
  • 00:11:39
    a risk of a cardiovascular event yeah I
  • 00:11:42
    I have an interesting assessment of that
  • 00:11:44
    and I want to see your reaction to it i
  • 00:11:47
    think that's going to backfire very
  • 00:11:49
    strongly we have this you you just
  • 00:11:52
    alluded to it lower is better mantra
  • 00:11:54
    like really focusing on getting um LDL
  • 00:11:57
    cholesterol and apple be lower and lower
  • 00:11:59
    and lower and I think it is a reaction
  • 00:12:02
    to alternative points of view on the
  • 00:12:04
    pathogenesis of heart disease risk
  • 00:12:06
    factors that are important whether or
  • 00:12:07
    not people need to be treated and I
  • 00:12:09
    don't think any self-respecting
  • 00:12:11
    individual could stand behind the
  • 00:12:13
    statement lower is better as an umbrella
  • 00:12:14
    statement better with respect to what
  • 00:12:16
    cardiovascular outcomes how are you
  • 00:12:18
    lowering it because that's important But
  • 00:12:20
    my impression is conventionalists might
  • 00:12:23
    want to push a conservative narrative
  • 00:12:26
    because they don't want people you know
  • 00:12:29
    seeing an inch and taking a mile but
  • 00:12:31
    what I think is happening I want to see
  • 00:12:33
    if you agree is people even if they
  • 00:12:36
    don't understand the depths of
  • 00:12:38
    metabolism and cardiovascular health and
  • 00:12:40
    athoscerosis pathophysiology most people
  • 00:12:43
    can tell when they're being patronized
  • 00:12:44
    to and when you project a message of
  • 00:12:47
    lower is better that's all you need to
  • 00:12:48
    know here's a medication people get
  • 00:12:51
    pissed off yeah and they react and
  • 00:12:54
    what's more I think a lot of
  • 00:12:56
    conventional outlets including
  • 00:12:58
    cardiovascular journals are destroying
  • 00:13:01
    their credibility and the credibility of
  • 00:13:02
    the Associated establishment by putting
  • 00:13:05
    out what are effectively propaganda
  • 00:13:07
    pieces that can be very easily explained
  • 00:13:09
    so I can give specific examples but for
  • 00:13:11
    example did you see the um the what was
  • 00:13:14
    it in gemocardiology that there was that
  • 00:13:16
    cardiovascular imaging report of the man
  • 00:13:18
    with yellow nodules on carnivore no I
  • 00:13:21
    didn't see that it's interesting i'll
  • 00:13:23
    send it to you so it's a brief report
  • 00:13:25
    and um they present a case of a man in
  • 00:13:28
    his 40s that is the entirety of the
  • 00:13:31
    patient's description they don't give
  • 00:13:33
    his actual age they don't give any
  • 00:13:35
    genetic family or other history and then
  • 00:13:37
    they say he had been on a carnivore diet
  • 00:13:40
    for 8 months eating get this 9 lbs of
  • 00:13:46
    meat cheese and butter per
  • 00:13:49
    day per day and and the senior the first
  • 00:13:52
    author went on mainstream media news and
  • 00:13:54
    doubled down on that narrative that that
  • 00:13:56
    was the dietary intake and then they
  • 00:13:57
    said he had um basically cholesterol
  • 00:13:59
    oozing out of his skin and they showed
  • 00:14:01
    something or whatever right yeah and it
  • 00:14:03
    was just it read like a Monty Python
  • 00:14:05
    skin it was behind a payw wall so people
  • 00:14:07
    just kind of assumed maybe there was
  • 00:14:08
    more details i looked at it i posted
  • 00:14:10
    literally the whole thing on social
  • 00:14:11
    media i emailed the journal i emailed
  • 00:14:14
    the first author i even said to the
  • 00:14:15
    first author if you actually have data
  • 00:14:17
    on this patient and want to do a more
  • 00:14:18
    comprehensive report I will help you
  • 00:14:20
    write it i will do the leg work and if
  • 00:14:22
    you want to get genetic testing I will
  • 00:14:23
    pay for it at my expense no response and
  • 00:14:27
    that's a pattern there are more papers
  • 00:14:29
    like that and I just think they see that
  • 00:14:31
    and then they're like why would I trust
  • 00:14:33
    gem cardiology you're right i think I
  • 00:14:36
    think there are two other aspects to add
  • 00:14:37
    in in terms of the the reaction which we
  • 00:14:40
    have to acknowledge just head up just to
  • 00:14:41
    understand the psychology but also the
  • 00:14:43
    barriers to the truth one is um most
  • 00:14:46
    cardiologists most doctors have no
  • 00:14:49
    training or understanding of lifestyle
  • 00:14:52
    interventions to prevent and manage
  • 00:14:53
    heart disease okay zero so you know you
  • 00:14:57
    give a man a hammer and every problem is
  • 00:14:59
    a nail right so for them their only
  • 00:15:02
    approach to see a high LDL which again
  • 00:15:04
    they don't fully understand the data on
  • 00:15:06
    is um because they're just following
  • 00:15:07
    guidelines and a narrative that's being
  • 00:15:09
    pushed through propaganda right is that
  • 00:15:11
    they think they've got this drug and you
  • 00:15:13
    take this drug the second issue is and
  • 00:15:15
    this is a second barrier to to them
  • 00:15:18
    maybe speaking out even the ones that do
  • 00:15:20
    realize there may be an issue they would
  • 00:15:23
    be very reluctant to go against what
  • 00:15:25
    their peers and what the guidelines are
  • 00:15:28
    telling them because they know that that
  • 00:15:31
    is going to be potentially threatening
  • 00:15:32
    to their career and I say this as
  • 00:15:34
    someone as an example of of of being in
  • 00:15:37
    this space for you know almost 15 years
  • 00:15:41
    as soon as I wrote in the BMJ in 2013
  • 00:15:44
    that saturated fat doesn't cause heart
  • 00:15:45
    disease we've over overestimated I
  • 00:15:47
    didn't say completely overestimated
  • 00:15:48
    cholesterol as a risk factor we've
  • 00:15:50
    overmedicated people on stands right we
  • 00:15:52
    should be pushing low carb diets right
  • 00:15:54
    hit all those in one 800 you know
  • 00:15:56
    commentary piece that got peer-reviewed
  • 00:15:58
    and and uh press released became a big
  • 00:16:00
    news story i've had relentless threats
  • 00:16:03
    to my career ever since then i've lost
  • 00:16:05
    three jobs i went I carried on with the
  • 00:16:07
    campaigning um but that was what happens
  • 00:16:10
    so you you've got people one that don't
  • 00:16:13
    understand it two if they do understand
  • 00:16:14
    it are they going to speak out so but
  • 00:16:16
    listen the truth is the truth and
  • 00:16:18
    incrementally over time this ripple
  • 00:16:20
    effect and the more and more of this
  • 00:16:21
    sort of researcher gets out there and
  • 00:16:23
    the more advocates we have Nick powerful
  • 00:16:25
    advocates like yourself like Dave Felman
  • 00:16:27
    right like others like Malcolm Kendrick
  • 00:16:28
    in the space and Ravkco the more people
  • 00:16:31
    that speak out and articulate this with
  • 00:16:33
    the scientific evidence as you say the
  • 00:16:35
    harder it's going to be for them to
  • 00:16:36
    maintain this um this false paradigm
  • 00:16:40
    yeah i mean I'm reassured like I don't
  • 00:16:42
    need everybody to agree with me but I
  • 00:16:44
    think there's this idea that all of
  • 00:16:47
    mainstream medicine and all like
  • 00:16:49
    clinicians are pushing forward one
  • 00:16:52
    particular narrative and I can tell you
  • 00:16:53
    and I'm sure you could tell my audience
  • 00:16:54
    like on the back end like when I go
  • 00:16:56
    around and talk to my peers at HMS um
  • 00:16:59
    Harvard Medical School and like
  • 00:17:00
    residents and talk to them about the
  • 00:17:01
    research they're not like "Oh no
  • 00:17:03
    everybody needs a statin." They're like
  • 00:17:04
    "Oh this is interesting like I want to
  • 00:17:07
    learn more." So when you kind of like
  • 00:17:08
    remove the filter of social media I
  • 00:17:10
    think a lot of people are generally
  • 00:17:12
    curious and openminded because most
  • 00:17:13
    people just want to help their patients
  • 00:17:14
    nick you're right but I think that's a
  • 00:17:16
    very good point and I find the same
  • 00:17:18
    happens when I give talks and lectures
  • 00:17:20
    to doctors usually primary care
  • 00:17:21
    physicians or non-cardiologists very
  • 00:17:23
    open-minded and they're finding it
  • 00:17:25
    interesting not necessarily the same
  • 00:17:28
    with
  • 00:17:29
    cardiologists but it's a bit as Yeah you
  • 00:17:31
    would know better than me on that all
  • 00:17:33
    right my next question for you is um do
  • 00:17:36
    you think you can reverse heart disease
  • 00:17:39
    and I want to frame this in the context
  • 00:17:42
    of in our paper we had um six people
  • 00:17:44
    despite their extremely high LDL have a
  • 00:17:46
    decrease in total plaque score and one
  • 00:17:49
    with a decrease in non-calified plaque
  • 00:17:51
    volume as measured by the CCTA now even
  • 00:17:54
    though 6 out of 100 or one out of 100 is
  • 00:17:57
    not you know a high percentage the fact
  • 00:18:00
    that potentially we could have
  • 00:18:02
    regression of plaque despite those
  • 00:18:04
    levels do you think that could be
  • 00:18:07
    generalizable given underlying
  • 00:18:09
    physiology and do you think you can
  • 00:18:11
    reverse heart disease absolutely yes and
  • 00:18:13
    I'll tell you that not even that we can
  • 00:18:16
    we know it happens so the question is
  • 00:18:17
    what is the best what is the mechanism
  • 00:18:20
    or what are the mechanisms of how it
  • 00:18:22
    happens and what is the best you know
  • 00:18:25
    management plan in general for people
  • 00:18:28
    and obviously context dependent um so
  • 00:18:31
    the first thing to say is you have to if
  • 00:18:32
    you if you start from an understanding
  • 00:18:34
    and people can look up this paper uh in
  • 00:18:36
    2017 I'm sure you're aware of it
  • 00:18:38
    saturated fat does not cause the
  • 00:18:39
    arteries heart disease is a chronic
  • 00:18:40
    inflammatory condition that can be
  • 00:18:42
    improved by lifestyle changes right so
  • 00:18:44
    was me Rita Redberg Pascal my BMJ great
  • 00:18:46
    on sports medicine so if you start from
  • 00:18:49
    the understanding that the best un the
  • 00:18:52
    best um explanation for heart disease is
  • 00:18:55
    insulin resistance combined with chronic
  • 00:18:56
    inflammation right then of course
  • 00:19:00
    theoretically anything you do to combat
  • 00:19:02
    insulin resistance and chronic
  • 00:19:04
    inflammation will at the very least stop
  • 00:19:07
    the progression of heart disease but
  • 00:19:09
    also potentially reverse it
  • 00:19:10
    understanding that it's a dynamic
  • 00:19:12
    process we were led to believe for many
  • 00:19:14
    many years that it was a gradual
  • 00:19:16
    accumulation of plaque over time and it
  • 00:19:17
    was fixed and it would just increase but
  • 00:19:19
    we now know that isn't true the best
  • 00:19:22
    data I've seen but also the angiograms
  • 00:19:24
    I've seen with my own eyes Nick was uh
  • 00:19:28
    in India a cardiologist called
  • 00:19:30
    cardiologist called Satish Gupta he did
  • 00:19:33
    a study um called the Mount Abu open
  • 00:19:36
    heart trial which was essentially a
  • 00:19:37
    single center perspective observational
  • 00:19:39
    study where he took several hundred
  • 00:19:42
    patients okay this is really interesting
  • 00:19:44
    I mean this is it's mind-blowing
  • 00:19:46
    actually what what what he did and what
  • 00:19:48
    I saw myself and what were in his
  • 00:19:50
    results results is mind-blowing so he
  • 00:19:52
    took several hundred patients who had at
  • 00:19:53
    least moderate to severe obstructive
  • 00:19:55
    coronary artery disease that means the
  • 00:19:57
    stenosis was at least 50 to 70% okay
  • 00:20:00
    they were high risk for whatever reason
  • 00:20:02
    they didn't want to have a bypass or a
  • 00:20:03
    stent they wanted to manage through
  • 00:20:05
    alternative means he put them through a
  • 00:20:07
    healthy lifestyle program okay you ready
  • 00:20:09
    for it
  • 00:20:11
    lowfat high fiber 50 grams a day
  • 00:20:14
    vegetarian diet two 30 minute brisk
  • 00:20:17
    walks a day and something called Raj Yog
  • 00:20:20
    meditation for 40 minutes a day okay and
  • 00:20:23
    he put them on this lifestyle plan and
  • 00:20:25
    then he repeated their andrograms two
  • 00:20:27
    years later like gold standard coronary
  • 00:20:29
    invasive coronary okay completed their
  • 00:20:32
    andagrams two years later on an average
  • 00:20:34
    the the reduction in the stenosis was
  • 00:20:37
    about 18 to 20% so 70 became 50 50
  • 00:20:41
    became 30 for example which is huge huge
  • 00:20:43
    change in the plot right and of course
  • 00:20:46
    events were reduced as well and then he
  • 00:20:48
    did his own you know analysis of what
  • 00:20:50
    was it what what was the independent
  • 00:20:52
    factor or factors behind reversal and it
  • 00:20:56
    wasn't the diet it wasn't the exercise
  • 00:20:59
    the only independent factor for reversal
  • 00:21:02
    was actually the meditation 40 minutes
  • 00:21:04
    of meditation a day is there an
  • 00:21:06
    explanation for this yes we know that
  • 00:21:07
    chronic stress as a attributal risk for
  • 00:21:11
    heart disease is is now thought to be
  • 00:21:13
    equivalent to smoking 20 cigarettes a
  • 00:21:15
    day or being diabetic or hypertensive
  • 00:21:17
    and we know the the mechanism through
  • 00:21:19
    chronic inflammation and through
  • 00:21:20
    increasing clotting factors so
  • 00:21:22
    potentially that was what so the the
  • 00:21:24
    reason why this is fascinating is I
  • 00:21:27
    think all these things played a role and
  • 00:21:29
    my personal view is and this is my
  • 00:21:31
    hypothesis that if one was to pick a
  • 00:21:33
    diet that is likely to be the most
  • 00:21:35
    effective for insulin resistance and
  • 00:21:36
    chronic inflammation it's going to be a
  • 00:21:39
    low carb or ketogenic diet with
  • 00:21:42
    anti-inflammatory components in the food
  • 00:21:43
    and that's why I and I'm very happy for
  • 00:21:46
    people to contradict this or find a
  • 00:21:47
    better way but at the moment I seem to
  • 00:21:48
    think looking the literature you know as
  • 00:21:51
    a general default a low carb or
  • 00:21:53
    ketogenic Mediterranean diet seems to be
  • 00:21:55
    in my view the best dietary approach for
  • 00:21:57
    this so that needs to be then tested but
  • 00:21:59
    I think that the other component is is a
  • 00:22:01
    stress reduction and I'd be curious of
  • 00:22:03
    course I don't know whether there's
  • 00:22:04
    something you can look into is that the
  • 00:22:06
    the patients your participants in your
  • 00:22:09
    particular study i'm wondering what else
  • 00:22:11
    they were doing other than the diet in
  • 00:22:13
    terms of lifestyle i mean I think for
  • 00:22:15
    the most part the population tends to be
  • 00:22:17
    pretty active um but we don't have to my
  • 00:22:20
    awareness like detailed lifestyle
  • 00:22:22
    assessments so it would be interesting
  • 00:22:25
    to take a survey of that small
  • 00:22:27
    population which we could do post talk
  • 00:22:28
    those six people and see if they were
  • 00:22:30
    doing anything that made them stand out
  • 00:22:32
    but just to kind of summarize your last
  • 00:22:34
    point when you know another way to frame
  • 00:22:36
    this is when we're learning um you know
  • 00:22:39
    in our first year at at Harvard Met
  • 00:22:41
    about risk factors for cardiovascular
  • 00:22:42
    disease really you're saying maybe they
  • 00:22:45
    should have on their bullet points all
  • 00:22:46
    right LDL app insulin resistance and
  • 00:22:48
    then medical school itself
  • 00:22:51
    yeah i don't know probably I joke about
  • 00:22:53
    it but I mean you you can probably
  • 00:22:55
    empathize one of the worst hits I've
  • 00:22:57
    taken to my health has been as a
  • 00:22:58
    function of medical training which I'm
  • 00:23:01
    not even a medical resident right now
  • 00:23:02
    i'm finishing up my fourth year of
  • 00:23:03
    medical school but it is just ironic
  • 00:23:06
    that the training load almost requires
  • 00:23:09
    you to martyr yourself in terms of your
  • 00:23:11
    lifestyle and the reason I raise that is
  • 00:23:14
    because I think it can create an
  • 00:23:17
    underlying bias about the value of
  • 00:23:19
    lifestyle in medicine when you can't
  • 00:23:20
    live it yourself just because of the
  • 00:23:21
    training that's required very true very
  • 00:23:23
    true and that's actually something that
  • 00:23:24
    still exists um within medicine you know
  • 00:23:28
    I remember during the pandemic uh when
  • 00:23:30
    the whole thing was happening with COVID
  • 00:23:32
    and there was data coming out and it
  • 00:23:33
    looked pretty consistent that adver poor
  • 00:23:35
    metabolic health was also a risk factor
  • 00:23:37
    for poor COVID outcomes that was then
  • 00:23:38
    proven later on for example you had
  • 00:23:40
    hypertension you were 34 more times more
  • 00:23:42
    likely to be hospitalized or die from
  • 00:23:44
    COVID than if you were metabolically
  • 00:23:46
    healthy right yeah so and and you then
  • 00:23:48
    it's diabetes obesity all those things
  • 00:23:50
    and I remember there was a situation in
  • 00:23:52
    the middle of the pandemic early 2020 or
  • 00:23:54
    mid 2020 where one of the teaching
  • 00:23:56
    hospitals in the UK I don't know if you
  • 00:23:57
    remember this it was a big social media
  • 00:23:59
    thing bmj even wrote about it one of the
  • 00:24:02
    teaching officers of the UK were very
  • 00:24:04
    proud to announce that they were getting
  • 00:24:06
    a free crispy cream donuts like a
  • 00:24:09
    thousand crispy cream donuts for the
  • 00:24:10
    staff now the point is it's not just
  • 00:24:12
    that and I obviously objected to it and
  • 00:24:14
    I you know I made a fuss on social media
  • 00:24:16
    there was a huge you know back and forth
  • 00:24:18
    backlash you know lots of people joining
  • 00:24:19
    in and one of the things that was really
  • 00:24:22
    interesting to observe is a lot of these
  • 00:24:24
    doctors who found it funny that I was
  • 00:24:26
    saying that why this is not setting good
  • 00:24:28
    example in the middle of the BC epidemic
  • 00:24:30
    but also you're probably going to make
  • 00:24:31
    the risk your risk of COVID um outcomes
  • 00:24:34
    worse if you are and we actually do have
  • 00:24:36
    data showing that the people that had
  • 00:24:38
    very high glucose levels with type two
  • 00:24:40
    for example or Even non-diabetics who
  • 00:24:41
    came to hospital with high glucose had
  • 00:24:43
    worse outcomes so there's definitely
  • 00:24:44
    some evidence for that but in general it
  • 00:24:46
    wasn't sending good message people were
  • 00:24:48
    responding like jokingly like as if they
  • 00:24:50
    as if diet had no they were being very
  • 00:24:53
    explicit i mean I'm talking about people
  • 00:24:54
    who are diabetists and endocrinologists
  • 00:24:57
    they're thinking that diet has no role
  • 00:24:59
    to play in disease or very little role
  • 00:25:01
    to play in disease i mean I mean that's
  • 00:25:05
    what we're up against yeah no no free
  • 00:25:07
    crispy creams to incentivize
  • 00:25:08
    immunization it's like setting aside
  • 00:25:10
    your opinion on you know social
  • 00:25:13
    distancing whatever the pathophysiology
  • 00:25:16
    is clear the risk factors are clear poor
  • 00:25:18
    glycemic control insulin resistance
  • 00:25:20
    diabetes are high risk factors for poor
  • 00:25:21
    outcomes the fact that you would
  • 00:25:23
    incentivize people to get an
  • 00:25:25
    immunization by giving away free donuts
  • 00:25:27
    it's such a dysfunctional
  • 00:25:30
    like it's it's I don't see how people
  • 00:25:33
    can see that and think that that's okay
  • 00:25:35
    so what we would need obviously is like
  • 00:25:37
    a cultural shift where everybody sees
  • 00:25:38
    that every healthare practitioner sees
  • 00:25:40
    it and like this is not appropriate it
  • 00:25:43
    it just not but speaking about junk food
  • 00:25:46
    I wanted to ask your opinion on this in
  • 00:25:47
    case you hadn't heard of it um you know
  • 00:25:50
    let me frame this as you're a fire brand
  • 00:25:53
    of sorts you've definitely gotten your
  • 00:25:54
    name out there don't have trouble
  • 00:25:56
    putting your opinions out there which I
  • 00:25:57
    think is great um as as a general uh
  • 00:26:00
    point I am new to the scene new to the
  • 00:26:03
    social media scene and I've only been
  • 00:26:04
    putting effort into social media for
  • 00:26:06
    about like a year and a bit and my
  • 00:26:09
    emergence was we were doing this
  • 00:26:12
    research this is now our like 11th paper
  • 00:26:14
    on this topic but people weren't talking
  • 00:26:15
    about it they're like where's the data
  • 00:26:17
    i'm like I've shown you like 12 times
  • 00:26:19
    the meta analysis of RCTs and that we've
  • 00:26:22
    done on this particular topic like you
  • 00:26:23
    are ignoring it entirely so I wanted to
  • 00:26:25
    force a conversation so do you know what
  • 00:26:28
    I did at the beginning of 2024 is this
  • 00:26:30
    Oreo Oreo cookies yes yeah tell me a
  • 00:26:33
    little bit more about that cuz I
  • 00:26:34
    remember just I I superficially source
  • 00:26:36
    all the what was happening but it was I
  • 00:26:39
    was just like look first of all I don't
  • 00:26:41
    have many resources at the time I was
  • 00:26:42
    like a 27year-old you know medical
  • 00:26:44
    student but I'm like but I really want
  • 00:26:46
    to force this conversation how can I do
  • 00:26:47
    it so I'm like all right what do I have
  • 00:26:49
    i have brands i have an Oxford PhD i
  • 00:26:51
    have a Harvard Harvard Medical School
  • 00:26:53
    and I have social media not big on
  • 00:26:55
    social media but can I design an
  • 00:26:58
    experiment that is so provocative
  • 00:27:00
    everyone will have to talk about it and
  • 00:27:02
    so based on my understanding of the
  • 00:27:03
    lipid energy model which is the idea
  • 00:27:06
    behind the lean mass hyperpres this
  • 00:27:08
    population of people low carb high LDL
  • 00:27:10
    the leaner you are the higher your LDL
  • 00:27:13
    that is a graphic of the mechanism we
  • 00:27:15
    have paper that I'll post in the video
  • 00:27:17
    notes but that aside the physiology as I
  • 00:27:20
    understood it would predict that I could
  • 00:27:22
    reverse my high LDL by just adding carbs
  • 00:27:26
    to my diet it didn't have to be a swap
  • 00:27:28
    it could be a pure addition of carbs it
  • 00:27:29
    could be any carbs too so I'm like what
  • 00:27:32
    is the most viral worthy source of
  • 00:27:35
    carbohydrates and I'm like I think Oreo
  • 00:27:37
    cookies i can't think of something
  • 00:27:38
    that's like has a better brand for just
  • 00:27:40
    being delicious unhealthy than Oreo
  • 00:27:43
    cookies so I designed a crossover
  • 00:27:45
    experiment where I eat my baseline diet
  • 00:27:47
    i'd lock it in for 2 weeks get lipid
  • 00:27:49
    tests then eat Oreo cookies for about 2
  • 00:27:53
    weeks the dose was 12 cookies per day
  • 00:27:56
    which is about 100 g of carbs add it to
  • 00:27:58
    my diet diet was locked in this was not
  • 00:28:00
    a swap then um do a wash out period to
  • 00:28:03
    reset and go on 20 millig of crust um
  • 00:28:07
    for 6 weeks the statin phase was longer
  • 00:28:10
    because I wanted to give it you know a
  • 00:28:11
    fair shot and I went for the gorilla
  • 00:28:13
    dose of 20 milligrams i will also note
  • 00:28:15
    the senior author on that paper is a two
  • 00:28:17
    author paper me and uh professor William
  • 00:28:19
    Cromwell i don't know if you know him
  • 00:28:21
    but he's a lipidologist over 30 years
  • 00:28:23
    experience i chose him because he's very
  • 00:28:25
    open-minded but he's also has
  • 00:28:27
    relationships to people that are
  • 00:28:28
    relevant in the space um he trained
  • 00:28:30
    Thomas Dpring uh in lipids who's
  • 00:28:33
    obviously very close to Peter so um
  • 00:28:36
    anyway he gave me input on how to design
  • 00:28:39
    it that's how we decided on the 20
  • 00:28:40
    milligrams of crust for six weeks anyway
  • 00:28:42
    I executed on the study and the
  • 00:28:44
    punchline was the Oreo cookies were
  • 00:28:46
    twice as powerful as the statin at
  • 00:28:48
    reducing my LDL the Oreo cookies dropped
  • 00:28:50
    my LDL by 71%
  • 00:28:53
    from 384 to 111 in 16 days the reason it
  • 00:28:57
    was 16 days not exactly 2 weeks 14 days
  • 00:29:00
    is because the drop was so dramatic at
  • 00:29:03
    14 days and we were doing weekly tests
  • 00:29:05
    so that was only the second what was
  • 00:29:07
    actually what what was the what was the
  • 00:29:08
    mechanism of the drop i'm curious
  • 00:29:10
    because the diet because of in general
  • 00:29:11
    like high sugar high carb diets will
  • 00:29:13
    give you high small dense LDL that
  • 00:29:15
    increases LDL so how come it dropped i'm
  • 00:29:18
    curious what was actually that dropped
  • 00:29:19
    it our understanding of the physiology
  • 00:29:21
    of the seed oil no no no so when you go
  • 00:29:26
    um low carb and you're very lean you
  • 00:29:27
    release more free fatty acids even than
  • 00:29:29
    someone with obesity or diabetes and the
  • 00:29:32
    spillover of the fatty acids goes to the
  • 00:29:33
    liver and then there's recirculation
  • 00:29:35
    whereby your liver exports more large
  • 00:29:38
    VLDLDL right and then there's a really
  • 00:29:41
    rapid turnover of the VLDLDL so your
  • 00:29:43
    baseline starting LDL was actually quite
  • 00:29:46
    high compared to most people yes on a
  • 00:29:48
    ketogenic diet although I will note if I
  • 00:29:50
    when I eat a standard American diet
  • 00:29:51
    before I went keto my LDL is about 90
  • 00:29:53
    like my LDL at at bas and what was it
  • 00:29:56
    what was it only on keto so are you a
  • 00:29:58
    lean mass hyperresponder then yourself
  • 00:29:59
    yes so my LDL fluctuates between 250 and
  • 00:30:02
    566 okay that makes me Okay now I
  • 00:30:05
    understand now makes sense i want to
  • 00:30:07
    move on because I want to be respectful
  • 00:30:08
    of your time my final questions for you
  • 00:30:10
    one one quick question though before you
  • 00:30:12
    answer sorry we can put this in what
  • 00:30:14
    happened to your triglycerides and HDL
  • 00:30:16
    when you ate the Oreo cookies so that's
  • 00:30:19
    really interesting hdl because of it
  • 00:30:21
    it's complicated and I know you have
  • 00:30:23
    like 2 minutes left so I I'll was stable
  • 00:30:25
    i think over time if I continued it
  • 00:30:27
    would have dropped that's the prediction
  • 00:30:29
    um the triglycerides went were stable or
  • 00:30:33
    went down most people wouldn't think our
  • 00:30:35
    model predicts that but it actually does
  • 00:30:37
    because in the acute setting 2 weeks I
  • 00:30:42
    remained insulin sensitive like you
  • 00:30:44
    don't get metabolic syndrome in 2 weeks
  • 00:30:47
    what happened was the relative
  • 00:30:49
    hyperinsulinemia while being insulin
  • 00:30:51
    sensitive was probably triggering my
  • 00:30:54
    lipoprotein lipase to be more active so
  • 00:30:56
    the fat had been cleared out of my blood
  • 00:30:57
    from the diet when I got the fasting
  • 00:30:59
    test so what's going to happen is the
  • 00:31:02
    leprop is going to pull extra
  • 00:31:03
    triglycerides out of the VLDL so my go
  • 00:31:06
    down and they did over the longer term
  • 00:31:08
    it would have gone up though obviously
  • 00:31:10
    as I accumulated like fat in my liver
  • 00:31:11
    became insulin resistant but it was all
  • 00:31:13
    predictive with the model now I I
  • 00:31:15
    generally rail against short-term
  • 00:31:16
    studies but short-term studies can be
  • 00:31:18
    useful when you're testing dynamic
  • 00:31:20
    systems which is what this is okay yeah
  • 00:31:22
    great i want to jump into a couple more
  • 00:31:25
    questions one you're good friends with
  • 00:31:28
    um RFK Jr do you one think he'll see
  • 00:31:32
    this paper listen to this conversation
  • 00:31:34
    and if he does what do you predict his
  • 00:31:36
    reaction will be listen I think first of
  • 00:31:38
    all he's obviously extremely busy man
  • 00:31:40
    doing lots of stuff at the moment it's
  • 00:31:42
    really important things um given the
  • 00:31:44
    fact that I am closely aligned with him
  • 00:31:46
    and uh I can communicate with him on a
  • 00:31:50
    regular basis part of this will
  • 00:31:52
    definitely be part of the bigger picture
  • 00:31:54
    i'm sure he it will come across um his
  • 00:31:57
    uh you know uh he will be aware of it
  • 00:32:00
    for sure we'll make sure that happens
  • 00:32:02
    and in general and with a with with a
  • 00:32:04
    broader perspective also looking at
  • 00:32:06
    shifting our current approach to
  • 00:32:07
    preventing and managing heart disease
  • 00:32:09
    for sure and this is 100% part of the
  • 00:32:11
    story excellent and with my last
  • 00:32:13
    question I want to ask is there anything
  • 00:32:14
    I should have asked you that I haven't
  • 00:32:16
    anything you want to say to my audience
  • 00:32:18
    no I think people just need to be keep
  • 00:32:20
    an open mind and realize that and have a
  • 00:32:22
    think about how they receive medical
  • 00:32:24
    information and uh the fact that most
  • 00:32:28
    stories in the mainstream media do not
  • 00:32:30
    actually fulfill criteria for accuracy
  • 00:32:33
    especially if they are sponsored by very
  • 00:32:35
    powerful vested interests so I think
  • 00:32:39
    yeah just keep an open mind that's all I
  • 00:32:40
    would say fantastic well thank you so
  • 00:32:42
    much for your time to my audience links
  • 00:32:44
    to the papers and associated videos are
  • 00:32:46
    going to be down below um with more
  • 00:32:48
    information thanks so much for taking
  • 00:32:50
    the time and I look forward to uh this
  • 00:32:52
    hitting the news streams tomorrow
  • 00:32:55
    awesome thanks so much
Tags
  • LDL cholesterol
  • heart disease
  • cardiology
  • metabolic health
  • lifestyle interventions
  • ketogenic diet
  • insulin resistance
  • cholesterol management
  • clinical research
  • medical skepticism