Muscle for Life with Mike Matthews - Dr. Spencer Nadolsky on How Not to Die of Heart Disease

Episode Date: May 8, 2019

If you’re over age 65, you’re more likely to die from heart disease than any other cause. Why, though? Is it due to stress? Over or under exercising? Eating too much fat, cholesterol, and junk food? A bit of each or something else altogether? Scientists have been searching for answers to those questions for a long time now, but if there’s one culprit that has been fingered more than any other, it’s diet. For a couple decades now, we’ve been told by experts everywhere that saturated fat, cholesterol, and often just dietary fat in general increases our your risk of heart disease, full stop. This idea has been further bolstered by the promotion of the food pyramid, which tells us to get most of our calories from whole grains like pasta, cereal, and bread, and as few calories as possible from added fats like oils, butter, lard, and others. Is it really that simple, though? Is reducing our dietary fat intake really the best way to avoid heart disease? Frankly, while I’ve read enough to know there are some major holes in the “less fat = less heart disease” hypothesis, I’m not an expert on the topic, so I invited my buddy Dr. Spencer Nadolsky on the show to break it down. I caught him at a good time, too, because he’s currently studying for certification on this very topic and shares some great insights on the most current scientific understanding of how our diets actually affect our tickers. 6:16 - How was the food pyramid created? 8:30 - What are the different types of fats and how do they affect your cholesterol? 10:25 - Does eating cholesterol raise your cholesterol? 14:09 - If you usually eat no cholesterol and start eating cholesterol, will you have a jump in your blood cholesterol? Does that normalize over time? 15:49 - What’s the purpose of having two different types of lipoproteins? 18: 27 - What does endogenous and exogenous mean? 19:39 - What is familial hypercholesterolemia? 21:03 - What does the research say about the mediterranean diet? 23:41 - What kind of effect does the stearic acid in chocolate have on LDL? 26:27 - What foods should people limit their intake of? 28:24 - Have you seen doctors go to the dark side? 37:07 - At what number is our LDL cholesterol a risk of heart disease? 40:06 - How much red meat should we have? 43:52 - Any more advice you had on saturated fat? 43:42 - How many servings of butter should we have per day? 51:11 - Can eating poorly from a young age have irreversible damage to your body? 53:55 - Where can people find you and your work? Want to get my best advice on how to gain muscle and strength and lose fat faster? Sign up for my free newsletter! Click here: https://www.muscleforlife.com/signup/

Welcome, welcome to another episode of the Masterful Life Podcast. I am Mike Matthews, of course. And this time around, I'm talking with Dr. Spencer Nadolsky about heart disease. Why heart disease? Well, it is the number one killer in the world. And if you are over the age of 65, you are more likely to die from heart disease than anything else. And unfortunately, this trend is not getting better. It is only getting worse. Why though? Is it due to stress? Is it due to over or under exercising? Is it due to eating too much dietary fat, too much cholesterol, too much sugar, junk food, or maybe a bit of each of those things or something else altogether? Well, it is a tricky subject. Scientists have been searching for answers to

those questions for a long time now. But if there is one thing, one culprit that has been fingered more than any other, it is definitely diet. For at least a couple decades now, we have been told by experts everywhere that saturated pasta, cereal, and bread, and as few calories as possible from added fats like oils, butter, lard, and others. Well, is it really that simple? Is reducing our dietary fat intake really the best way to avoid heart disease? Of course, these days with high fat dieting being the thing, being so trendy, many people would say absolutely not and that it's all fake news and you should in fact eat as much dietary fat as you can and as little carbohydrate as you can. But is that really the answer? Well, frankly, while I have read enough to know that there are some major holes in the less fat equals less heart disease hypothesis and that eating more dietary fat

can absolutely increase the risk of heart disease in some people. I don't consider myself an expert on the topic and that's why I invited my buddy Dr. Spencer Nadolski on the show to break it down. And I caught him at a good time as well because he is currently studying for certification on this very topic. And in the interview, he shares some great insights on the most current scientific understanding of how our diets actually affect our kickers. This is where I would normally plug a sponsor to pay the bills, but I'm not big on promoting stuff that I don't personally use and believe in. So instead, I'm just going to quickly tell you about something of mine, specifically my fitness book for women, thinner, leaner, stronger. Now this book has sold over 150,000 copies in the last several years, and it has helped thousands of women build their best bodies ever, which is why it currently has over 1,200 reviews on Amazon

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Yeah, I know. As opposed to some other, I don't know. Everybody has a doctor in front of their name, I swear, on Instagram anyway. How's it going? Not bad. How are you doing, buddy? I'm still here. I'm still going. Good, good, good. I'm getting a lot of patients from you still, so keep up the good work there. Really? That's cool. Is that from...

I think an old podcast, maybe. I don't know. That's why we got to update it. That's the only reason for doing this, build people of money. That's right. No, it's great. I'm actually going to be, I'm working through a series of updates to muscle for life. There's gonna be some aesthetic updates and some content stuff. I'm going to be adding a resources. I'm probably going to pull books off the menu. It doesn't have to be on the menu and replace that with resources where I'm going to link to a bunch of people and things who, and that I like basically. So you're going to be on

there, my friend. Perfect. All right. So what are we talking about today? We're talking about cholesterol. Cholesterol, cardiovascular disease prevention. Let's dig into it. I've written a bit about this. I've spoken a bit about this, mostly in the context of just dietary fat intake. And I guess specifically just cautioning people against having saturated fat orgies, which is kind of the thing these days. But otherwise, I'm just going to listen to you and learn. Yeah. So if you go back in the history of diets, I don't know when you were in elementary school, but I remember, I think it was third grade, third or fourth grade when they had the big food

pyramid out and they said, eat a ton of basically bread and pasta and all the way in, that was the base of the pyramid. And all the way at the top was the tiny tip that basically said, just get very minimal amounts of this, the fat, oils, anything like that, nuts, butter, lard, whatever. Do you know how that, I don't know the story. Didn't, I think, what's her name? Denise Minger is her name? Death by Food Pyramid. She has a book. I think that's all about that, but yeah, there's a lot of cool stories. How did that come about? How was it at one point where it was like, yeah, just eat a bunch of pasta and bread. That'll be good for you. Well, I think, you know, with the obesity epidemic, I mean, it's all kind of aligned

with that unintentionally maybe, but there's a lot of conspiracy theorists out there talking about the cereal companies and things like that. I haven't gone into all the different books and different theories in there, but basically one of the ideas was that, hey, we should probably have less fat since it has more calories per gram, really. And that's not as satiating as, you know, say carbohydrates and protein. It's still, that's an odd like you go okay sure but vegetables let's yeah we should probably have the vegetables at the base yeah i agree why don't we do fruits and vegetables at the bottom which are going to be even better than wheat products especially more highly processed wheat products going to be lower in calories higher in nutrients

you're going to get some insoluble fiber, blah, blah, blah. You know, it's interesting. Before we get into the fat stuff, I remember seeing that and going, well, I better eat just bowls of pasta and rice. And I did. I ate a ton of, it didn't matter because genetically I'm not predisposed to gaining much weight and pretty athletic when I was younger. But you can imagine maybe the effect on other people just eating huge bowls of pasta. Especially with no understanding of energy balance. It's just, yeah, this is what I'm supposed to be eating. This is what the doctors say.

Just eat all this shit. Bowls of cereal, bowls of pasta. Yeah. So you go back to then saying low fat, and then all of a sudden we kind of have the trend back to kind of a lower carb, higher fat approach. And it keeps going back and forth. Looking at heart disease, there's something called the lipid hypothesis. And now some people say that just eating fat in general is bad for your heart. And eating

saturated fat, you can imagine eating things like butter, anything that's solid at room temperature. You eat it, and it goes into your your blood and you can see it just kind of hardening again and it's hardening your blood vessels, right? That's kind of what, at least what I imagine. And that's what I think what my patients imagine now, now that I know it's a lot more complicated and a lot more detailed in how the digestion and how it truly affects you works. I don't know. Have you ever thought about that? Have you ever discussed that on your podcast? Because we can kind of go into it. A little bit, but I think it's worth going into. I remember I have an article on like how many grams of fat should you eat per day? And I recorded a podcast based on the information in the article. So I probably an expert in lipidology, the study of lipids, cholesterol and triglycerides and everything like that.

So it's really interesting because I don't think as a kid you really taught about how that works. You may have a physiology class and then maybe you go through college and maybe have some biology, physiology, pathophysiology. But in medical school, we learn it, but you forget it quickly when you go through all the other subjects. So when everybody says saturated fat, they just think this one term of type of fat. But actually, there's different types of saturated fatty acids. There's different types of polyunsaturated fatty acids, and there are different types

of monounsaturated fatty acids. I'm sure you've talked about that. The reason that they're either monounsaturated or polyunsaturated or saturated, it's the biochemical structure of it. There's double bonds in the structure. And if there's multiple double bonds, it's polyunsaturated. If there's just one double bond, it's monounsaturated. And if there are no double bonds, it's completely saturated. Now, we all just think, yeah, saturated fat's bad for you. But there's actually multiple different types of these saturated fatty acids, and they each have likely different effects on your health. And what we mostly think about is our cholesterol.

So most people think that eating saturated fat is going to elevate your cholesterol, but it does so in a very interesting way. I don't think anybody's ever talked about that with you. Have you discussed that at all? No. way. And I don't think anybody's ever talked about that with you. Have you discussed that at all? No, just hearing from people, a question, a more even basic question that I often get that you might want to quickly touch on is eating cholesterol going to raise my cholesterol? And is that bad? Like if I want to eat some eggs, is that a problem? Yeah, no, not necessarily. So it's an interesting thing. So okay, so we'll go through,

we call it the exogenous pathway of how you absorb cholesterol before we get into the saturated fat stuff. So when we eat things that contain cholesterol and things can contain both cholesterol and saturated fat, they're two different things. Cholesterol is not a fatty acid. And it's like a waxy substance, right? Yep. So a lot of people kind of confuse saturated fat and cholesterol. They're two completely different types of molecules. There's triglycerides and fatty acids that are used for energy. And then cholesterol is a different type of molecule

that's used for our membranes, used for our bioproduction, used for hormones. Each cell actually produces the cholesterol molecule, every cell in our body. However, we can also eat foods that contain cholesterol. So what it does is it gets into your intestines and then it actually gets absorbed and then gets put into these little particles called chylomicrons. They circulate our system. Your tissues take some of the fatty acids that are also in these chylomicrons and then they get reabsorbed into your liver. Now, it's interesting because when you eat things that contain cholesterol, not all of it necessarily gets absorbed. And then it's actually not the biggest component of the cholesterol that's in your intestines. The bile that goes in to actually break down the fats that we eat. I don't know,

do you know anything about bile? Bile is the thing that's made by a liver, goes out the gallbladder and helps us digest fat. It emulsifies the fat so we can absorb it. So that's actually the biggest component of cholesterol in our intestines. So when people don't think of that, so you eat a ton of cholesterol in your diet and it may not make as much of a difference because we also have this a ton of our cholesterol from bile acids. So it's just kind of a little aside thing there. Now, once you eat cholesterol, if you're absorbing more of that cholesterol, your liver can actually shut down production of more cholesterol that's kind of pushed out into the system. So that's why you don't necessarily see this huge change in cholesterol. Some people do.

When they eat more cholesterol, they see a big change, especially if you're vegan, if you're not used to eating cholesterol at all. And if you eat a lot of cholesterol, there may not be as much of a change when you start eating more of it. In the new dietary guidelines, people don't focus on it as much. It does make a difference. Some people will have big time changes in their serum, their blood cholesterol from eating more higher cholesterol containing foods. But a lot of people that are just eating a standard kind of diet that are eating foods that contain cholesterol, as long as you're not a vegan, you won't see as big of a change. And that's why research has shown, right, that like eating eggs doesn't increase the risk of heart disease or eating other forms of cholesterol, because it sounds like the body's feedback loops work pretty well here. Yeah, and eggs are a whole different

story. There may be something in the eggs that also change the absorption of the cholesterol too. So that's another thing we'll talk about when we get into the saturated fatty acids, because not only are these little components of the foods we eat matter, it's also the food constituents, the food matrices, they call it. What else is in the food, right? Yeah. It can change how we absorb it and change how we metabolize and the rates of gastric emptying, all these different things. An obvious example of that, right, could be the difference of high fructose corn syrup in like some pop tarts or fructose in an apple. Yep, exactly. Similar kind of analogy there. That's the dietary cholesterol.

So just to kind of sum it up, the amount of cholesterol that you eat kind of pales in comparison to the cholesterol that's actually contained in your bile that goes to digest the fat. There are people that absorb more or less dietary cholesterol. If you eat no cholesterol and you start eating cholesterol, you'll have a much bigger jump in general. Again, this is variable. You'll likely have a much bigger jump in your serum cholesterol, blood cholesterol, than if you were already eating a lot of cholesterol and started eating like double that. I guess in time, it would probably normalize though, right? Yeah, the curve kind of slows down. It's really interesting stuff. Some new studies just came out. There's a guy, Kevin Mackey, he's one of the lead researchers on this, just came out with a new

article, the meta regression of the LDL changes from eating dietary cholesterol. So one of the things I also want to talk about is that when we talk about blood cholesterol, when we measure it, we're talking about the cholesterol measured on these things called lipoproteins. The cholesterol can't circulate your blood without being contained on one of these proteins since it's not water soluble. So you don't just eat cholesterol. It doesn't just go into your blood and clog your arteries. It has to actually go on these proteins. It's like a transporter, right? And those proteins are actually, once they get down to the low-density lipoproteins,

those are the things that actually get stuck in your artery walls and start the atherosclerosis cascade. And that's the LDL cholesterol that many people listening probably heard. You probably heard LDL is just the bad quote-unquote in HDL, the high density is the quote unquote good. Exactly. And so, yeah, and that's the other thing. People think, oh, bad cholesterol, good cholesterol.

The cholesterol is the cholesterol. Like I said before, it's the molecule in it. It's really the lipoprotein that's probably harmful. So HDL, high density lipoproteins that carry that same cholesterol that can also be in an LDL particle or low density lipoprotein particle, it's the same cholesterol. So it's really the lipoprotein that is bad. So it might be a stupid question, but what's the purpose of having these two different type of lipoproteins? Something I guess I haven't answered for myself along the way. Again, this isn't an area that I've read that much about. I've given myself a

basic education on it to share the basic practical advice. They have different mechanisms. So like I said, when you recall from the exogenous pathway, when we eat foods and cholesterol and fats, they get carried on these chylomicron particles. They're similar to those LDL particles, but they're huge. They pass around in our blood and get muscles and fats, take up the triglycerides and things like that. And then they go back and get reabsorbed in the liver. The liver then can also push out these things called very low density lipoproteins. And those that go around in our blood, they get triglycerides taken off of them and they get smaller and smaller and then they turn into an LDL basically. Oh, okay. Low density lipoprotein. There is actually no purpose that we know of LDL other

than it's just kind of the garbage left over that just needs to go back to the liver to get recycled. So, with HDL, these things are transferring cholesterol and triglycerides all the time, but HDLs don't have that same purpose of delivering triglycerides to the tissues. They can deliver cholesterol to things like your adrenal glands if they need it for extra cholesterol to make hormones and things like that. But the HDL aren't like the other lipoproteins. We call it reverse cholesterol transport where they go into macrophages that have plaque atherosclerosis and start sucking up cholesterol from there. But they're not harmful as far as we can tell. They don't actually get into the artery walls and start the atherosclerosis. So that's kind of the difference there. I see. Okay. And obviously the problem would be is, okay, so if you are

eating too much of, in this case, it's like saturated fat, which then just necessitates more and more LDL molecules to process all of it. If you do that long enough, that's where you can have buildup that accumulates over time and so forth. of marketing or advertising gimmicks can match the power of word of mouth. So if you are enjoying this episode and you think of someone else who might enjoy it as well, please do tell them about it. It really helps me. And if you are going to post about it on social media, definitely tag me so I can say thank you. You can find me on Instagram at Muscle for Life Fitness, Twitter at Muscle for Life, and Twitter at Muscle for Life, and Facebook at Muscle for Life Fitness.

So I was talking about eating cholesterol in the endogenous pathway. And that just means in the body, so endo, inside. Yeah, so exogenous meaning taking in food, and then endogenous meaning it's already producing like the liver. The endogenous pathway, this is where the saturated fat makes the bigger difference. So it's not that we just eat saturated fat and for some reason our cholesterol goes up and then it clogs our artery like butter, you know, it's saturated. That's why oils like olive oil, monounsaturated, polyunsaturated, they're liquid at room temperature.

Usually the saturated fat like coconut oil and butter and lard, those are solid at room temperature. Usually the saturated fat like coconut oil and butter and lard, those are solid at room temperature. So it's not that you just eat these and then they harden up in our vessels and clog our arteries. The way they actually would increase risk of cardiovascular disease, or at least it's thought, is that they change the LDL receptor activity. So what that means is, you know, I talked about those LDLs kind of being like garbage, basically, left over after your liver made some very low-density lipoproteins and they get smaller and smaller as our body uses the triglyceride that's on them for fuel. Well, those LDLs build up in our system when our LDL receptors aren't working so well.

There can be people that have genetic causes for that. The familial hypercholesterolemia. Have you heard of that? I've heard of the term. So it's a condition where people can have a severely higher risk of cardiovascular disease earlier in life because they have some sort of genetic issue with usually their LDL receptor. There's a couple of different types, but in general, their LDL receptors aren't working so well. So they have, even at birth and throughout life, they have higher than average low-density lipoprotein particle numbers or cholesterol. So if those people are at risk, they have longer lifelong levels of that high LDL. If something were to decrease the LDL receptor activity, then that probably increases your LDL cholesterol that builds up in your body because you're not recycling it as well.

And that means you're probably at higher risk for heart disease. So in fact, saturated fat, like I said, there's multiple different types of saturated fatty acids, specifically the one that's in butter, the most common one, palmitic acid, seems to downregulate that LDL receptor activity. So then you get increased levels of LDL cholesterol in the blood because it just keeps building up because you're not recycling it as well. Polyunsaturated fats seem to increase the LDL receptor activity. So that's why you see people's LDL cholesterol levels decrease when they eat more polyunsaturated fats and monounsaturated fats. Polyunsaturated is the bigger one that seems to have a more positive effect.

Problem is, is that people look at some of these studies and the way that these studies are done, and they don't see much of a difference in risk. You know, that's why you see these studies. Well, saturated fat wasn't bad. Well, here it was bad. And it's a lot of back and forth. When they start teasing out the trials that have actually been done, it seems there is the most recent Cochrane meta-analysis that pooled all these studies together. The most recent Cochrane one showed that there is a decreased risk of cardiovascular events with reduced saturated fat and increased polyunsaturated fat.

I guess that kind of back up some of the research out there on the Mediterranean diet, right? Yeah, that's one of them. Now, some of these high-fat proponents will be like, well, you know, one of the studies called the PREDIMED study that actually recently got retracted and republished, but they didn't have differences in their LDL cholesterol levels between the two groups. This is like comparing a Mediterranean diet. Really, it's just olive oil and nuts versus a controlled diet. Differences in cholesterol, but they had a decreased risk of basically strokes.

So that's kind of one of these proponents of saying the cholesterol doesn't matter. But high fish, high nuts, seeds, that's kind of why the dietary guidelines are there to focus on those types of fats versus things like butter and coconut oil. The thing is, it's controversial because not everybody has these massive increases in LDL cholesterol. And if they're trying to focus on any type of diet, they probably have other healthy behaviors too. So even people that are chugging down bulletproof coffee and, you know, drinking butter in their coffee and doing all these other things, they probably have very low risk factors otherwise, because they're probably exercising and doing these other things.

It's going to be really hard to tell in the long run whether they truly have an increased risk, but based on the data we have right now, they probably are if all things else are being equal, like take two people. One person has the higher LDL from drinking butter. The other person doesn't. That person drinking butter with the higher LDL likely has a higher risk given everything else being equal. So the story gets a little bit more complicated, again, because it's not just that palmitic acid saturated fatty acid.

There's also the types of foods just like we talked about eggs and other cholesterol containing foods may not increase cholesterol the same way based on the food it's packaged in so and the same goes for saturated fat yes exactly so there's different types of saturated fatty acids as we palmitic acid in butter was one example what's another example yeah so like stearic acid in butter was one example. What's another example? Yeah. So like stearic acid, that's the one that people talk about. It's in chocolate and it actually has a neutral effect, not LDL. So do they know why? Is it understood yet or is working theories or?

Yeah. So that's actually something that I want to study more because I think it's interesting. Like I'm pretty sure it all had to do with LDL receptor activity. So something about that palmitic acid, I have no idea why. Why does that decrease LDL receptor activity? I don't know. And so people are talking about from an evolutionary standpoint, why would it do that? I'm not exactly sure, but. And you think, is it the stearic acid per se, or is it something else in chocolate that when it the stearic acid per se or is it something else in chocolate that when combined with stearic acid i think it's the stearic acid because it's

seen in other foods that contain stearic acid oh okay well yeah because you can get it in meat as well that's why people say well meat's not bad because it has actually meat has like mono insaturated fats in it as well of course even good sources of monoinsaturated fat have some like take an avocado it has a bit of saturated fat, doesn't it? Yeah, there's a little bit of saturated fat and even olive oil has a little bit of saturated fat. So that's why some people even say, oh, olive oil is bad for you. It's like, no, no, shut up. It makes me think of, I published an article recently on Most for Life on Tom Brady's diet. Oh, nice. Yeah. And then we have an article going on Most for Life on Tom Brady's diet. Oh, nice.

Yeah. And then we have an article going up any day now on the plant paradox, which is worse because you got to blame the scammy right-hand man, his life guru guy. That guy is an actual con man. I mean, Brady doesn't claim to even be an expert. He just says, hey, look, this is what I do. And he's following the advice of this quack and wouldn't believe that, of course, but he's following the advice of this guy. And he just says, this is what I do. It works for me. I don't know. I'm not an expert. Leave me alone. Whereas the plant-powered ox is a calculated scam. I can't stand it. I want to take them all down. I can't stand these quacks.

So there've been some studies looking at, say, like yogurt, cheese, and then versus butter. some studies looking at say like yogurt cheese and then versus butter each of these have different effects on ldl cholesterol levels simply because the food that they come in with changes the way either the absorption or there's something called a milk fat globule membrane i don't know if you've guys talked about that on your podcast at all some of these things that obviously change the way either the absorption of the way the palmitic acid affects it. So butter specifically doesn't have some of these calcium protein or the milk fat globule membrane. And so let's hypothesize that, hey, these other foods, yeah, they seem to not have that

effect. So they're probably beneficial. Whereas butter, I tend to have people minimize butter as much as possible. There can be some healthier things in it, but it's one of those things where you'd have to eat a lot of it to get any of those other healthier. What are some other foods that you tend to recommend people eat? Maybe not as little of as possible, but to limit their intake of? Generally coconut oil. Is that still super trendy? Because that was a big thing for a while. I'm going to check Google Trends while you're answering. I still have tons of people saying, but coconut oil is a healthy oil,

right? And I'm like, well, I don't think it's unhealthy. I don't think any of these things, I don't like to call anything unhealthy per se. I would just say we should focus on these types of foods. We know these eating patterns are associated with longevity. We can see it from an experimental basis. We can see it from observational studies as well. So probably eating these types of food pandas is probably the best. I don't know of any long-living tribes or areas out there that drink butter. I've never heard of it. It doesn't necessarily mean that it's wrong, but based on the evidence we have right now, it's probably not right. Well, and a lot of that came from Dave Asprey, right?

Yeah, I know. Who is an actual joke. The guy's actually a joke. So you can't listen to anything that guy says. He's laughing his way to the bank. You read his articles. I don't know if you've read some of his stuff. And you check citations.

Sometimes the citations literally have nothing to do with even the claims like they're just citing random shit and assuming that no one's going to check it anyway mercola does that i've looked at some of his uh god that guy's one of the biggest quacks on this planet but uh uh have you talked about mercola on this podcast no no i, no. I don't know that much. I've seen some of his articles and I'm like, that's bizarre. And so I've only heard. Between him and Dave Asprey, I don't know who's a bigger quack, but Mercola is actually a doctor. So like I would call him worse. Dave Asprey is just trying to make some money. I mean, obviously Mercola is too, but I don't know. We take a Hippocratic oath and just, it's not cool to lose your integrity, lose your scruples. But. Random aside, have you seen that from the inside? I've always been kind of curious how that

works exactly. Like, have you seen someone go to the dark side? Not like good friends. Cause I would be like, I would be very upset, but, and I'd call them out too. It's, it's interesting. So nobody from my med school necessarily, but to see someone like that, and you know that they went through med school, they had to take their exams at one point. They were taught a certain way. At one point, someone jumps ship, right? They just decide that money is more important than integrity. Ben Greenfield, he's not a doctor, but I've been tweeting at him. He said vaccines cause autism. They do indeed cause autism.

And I was like, well, that's not true. Like, you got to actually back your claim up. And he actually what he did is he cited a Mercola article, ironically. Really? Yeah. At some point, because other people were saying, what? Ben Greenfield used to be so good. He did this and that.

I'm like, well, I don't know. At some point, he jumped ship. People turned crazy. I think it's mostly monetarily driven, although there may be a fame portion in there too. They like to have a bunch of followers and they like to polarize and polarize for the wrong. Integrity is more important to me than, you know, of course we all want to make a lot of money, but you basically sell your soul. So I don't know. I've never seen personal friends do it, but you see some of these people that are a little bit older than you that... I've met some guys that were like that. They were ones I can think of were pretty brazen. I remember one guy, I mean, yeah, he openly would say, I sell pills in a bottle. I don't know what's in there. He wasn't trying to pretend,

not that that's admirable, but I find that at least a little bit like hypocrisy is the most disgusting of traits in people. I mean, you have liars and hypocrites are just universally despised by everybody. But you can have someone, they're not going to be friends with them, but you can at least respect their honesty, right? So that guy, I remember, he was like, I have no idea what's in it. I don't care. I'm just making money. I'm like, okay. At least there's some honesty

there. At least he's not pretending like he's trying to help anybody and could probably, if I really dug into it, he could probably say something like, and it's always easy if you get into that rationalizing mindset, right? You'd be like, yeah, well, my pills do nothing. Yes, that's true. I think they were like weight loss pills, right? Okay. So my pills do nothing. But if it encourages people to, you know, to start dieting because they think the pill is going to help them as well, then I've helped some people. Of course you could say, yeah, that's true. But people like that, where they don't want that conversation to go is weighing. Sure. So there's been some construction,

there's been some help. That's true. But now you got to weigh it against all of the people that you've let down and all the money you've taken from them and how many people have been disappointed. And then they've given up on their weight loss journeys and maybe even rebounded and blah, blah, blah. So when you weigh it, you go, eh, nah, dude, your entire business is a net negative on society. You are taking from society. You are imposing negative on society. Like you are taking from society, you are imposing costs on society. So anyways, I've met some people that were a bit more like that about it. Just like, yeah, whatever. Fuck it, dude. I have multimillion dollar homes and cars and shit. And I have a private jet and you don't. So what else is there to say? Yeah. It's like, oh, good for you, man. I hope you can live with that. Ironically, that guy apparently now is having all kinds of health problems himself.

It's poetic justice. His body's all broken. Now he's all fucked up. So it goes around, comes around sometimes. It's probably all the weird stuff he put in his pills. Whatever else he was putting in his body. Yeah, the cocaine or whatever. Yeah, yeah, exactly.

Oh, man, yeah. So I don't know what we were talking about. We got on that via coconut oil. So I was asking like, what's another? And I guess that also, that was big on the MCT oil thing too. Coconut oil is a great source of that. I looked on Google Trends, coconut oil peaked. Let's see. It was March of 2014 was peak. And then it was pretty good there for a few years and now it's on a downswing, but it's still far more popular now than it was back in 2010. So yeah, it's still a thing for sure. Yeah. I get patients asking about it or diet templates that we don't mention coconut oil as a

healthy fat to eat. And they're like, what about coconut oil? I'm like, you can have it. It's just don't focus on it. Focus on the things that we know are good for you. Or just have something else unless you love it, I guess. But people ask me sometimes what to cook with. I'm going to cook with olive oil. It's a solid. You can't go wrong cooking with olive oil. No, you can't.

People worry about the smoke point of olive oil. And there's actually a recent study looking at the differences between coconut oil and olive oil or extra virgin olive oil and avocado oil. And extra virgin olive oil did a bang up job on not being oxidized. And I probably know the paper you're talking about because in the Tom Brady diet, that was one of the things that I was talking about there is as oils to cook with, because I think if I remember correctly, part of it was you can only cook with olive oil. And even then you have to watch out and make sure you don't overheat it and there were a couple studies i found where it was being used to fry food so it was getting abused and yeah they compared different oils and it barely had oxidized after getting pummeled over

and over i don't know 20 fryings or something and it was still perfectly fit for consumption frankly you know the reason people use the coconut oil is because with the biochemical structure with no double bonds, it doesn't get oxidized as readily as, say, polyunsaturated fats with multiple double bonds. Those are more readily oxidized. But the monounsaturated is the one, you know, like you said, olive oil, extra virgin specifically does very well. Well, especially considering we're not deep frying a hundred batches of food in a row

and then drinking the oil or just like stir frying some vegetables. Right, exactly. So if somebody comes to you, their cholesterol is high. Their blood LDL cholesterol is high and you want to get it down and you know it's not familial, it's not genetic. So what do you do? You look at their diet. A lot of them are doing paleo, bulletproof type of coffee.

They're cooking everything in coconut oil. They're putting butter on their ribeyes. Here's an easy way to change it. You tell them switch all the butter, every coconut oil and butter that they have to basically only nuts, olive oil and av avocados, and maybe avocado oil. Have them switch their meats to a little bit of a leaner cut if possible. And then one other thing is soluble fiber. So things like oats, lentils, legumes, apples, those types of things, those actually bind up not only some of that dietary cholesterol

that you'll eat, but also some of that bile acid cholesterol that's also in your intestine. That's why I wanted to mention it is because, yeah, you could cut out the dietary cholesterol, but you're still going to have a ton of that cholesterol in your bile that just keeps getting reabsorbed and recirculated. And that's not necessarily a problem. But if you want to lower your cholesterol levels, your blood cholesterol levels, it'd be nice to lower that somehow. So soluble fiber sources may actually do that. So oats in general are probably the biggest one, beta-glucan. And you can also get soluble fiber from fruits and vegetables, of course,

another good source. Yep, apples. And then, you know, you can do psyllium husk if you really wanted to supplement with it. Glucomonin is another one, but I like to do it from oats and lentils, legumes and fruit. But so yeah, you do those two things. I've seen people go from an LDL cholesterol in the 200s down to the low 100s. It can have a major effect. How does that map in terms of risk for heart disease? Just as a doctor, you say you see that you see 220 or something. Yeah. So if your total cholesterol is 220, you want to look at the HDL cholesterol and stuff like that. So the LDL cholesterol, the level we want it, I mean, obviously for me, people might disagree. I want my LDL cholesterol as low as possible,

but most people are going to run around that 100 to 120, 130 level for LDL cholesterol as low as possible. But most people are going to run around that 100 to 120, 130 level for LDL cholesterol. I'd want mine closer below 100 for years if possible. Ideally for me, I'd like to be at under 80. For me, it's not going to happen. My genetics seem to have a slightly higher level. So once you get over that 190 milligrams per deciliter, that's where the doctors really want to throw you on a statin because that's the level shown to increase without any other risk factors. Actually at lower, even 130, 140, 150, 160, the higher you get, the higher risk. But at that 190, they're a little bit more scared because possibly have the risk of familial hypercholesterolemia and that puts you

at a higher risk but even if you don't you're still at a higher risk above that 190 so i think something just worth commenting on that what sucks is that's probably what happens in a lot of cases right is there's no talk about diet or making any of the changes you're talking about it's just like well you're on drugs now and these drugs drugs, like all drugs, have side effects. And we'll see where this goes. Yeah, exactly. And that's where a lot of these diet bloggers get really upset because the doctors don't have much time.

I think it's a system issue. The doctors don't have much time. They come in, they see your level there, and they go, all right, here's a script. First of all, I could change my cholesterol very quickly. There's a guy, Dave Feldman. He's a buddy of mine. He's kind of a cholesterol denialist, but that's okay. Because the cool thing he's done, and I've seen this with my patients, is that you can actually change your LDL cholesterol within just a day or two, just with massive changes

to your diet. And I'm actually going to do some more self-experimentation to me. I want to see how high I can get my cholesterol and then see how low I can get it. Because I think I can manipulate it based on that LDL receptor activity. So you're about to get fat is what's going to happen. You're going to be eating like five sticks of butter. Yeah, I'm going to drink butter basically. And then I'm going to cut out all cholesterol, all saturated fat. So it'll be interesting, but I think I can manipulate it within days. Okay. So if it's going to be within days, then whatever. You have like 9,000 calories of fat for over a few days.

Yeah. So the doctor comes in, sees your cholesterol super high, and you're doing a bulletproof coffee, or you're doing a paleo, and they're just like, here's a statin. You're probably not going to go back to the doctor. You're going to think that doctor is an idiot. The doctor is not an idiot necessarily. They just may not know enough about, you know, dietary differences. And they just figure everybody's kind of either has a poor lifestyle, not going to change or that they have a genetic cause for their high cholesterol. And so

that's why they just give you the script. That's not how they're supposed to do it. They're supposed to talk to you about things like hypothyroidism, birth control, all sorts of things can increase your cholesterol too, not just diet. So they should have a conversation with you. You should give it a good lifestyle try. I would not drink butter and coconut oil in your coffee. I mean, we see major changes with that. But yeah, like you said, they'll just throw you out of medicine and not have that discussion.

That will piss a lot of people off. With foods that contain saturated fats, so you mentioned a couple here, butter, coconut oil, generally kind of stay away from or just minimize your intake of. Meat, however, you mentioned earlier, may not be as bad. But then you said that you would recommend people if they need to bring their cholesterol down to eat leaner cuts of meat. What about for the average person who's listening who doesn't have necessarily any issues? But this is advice I personally

already follow. I eat, I'd say on a day-to-day basis, actually no butter and no coconut oil. I cook with olive oil. I get my fats from, I have some olive oil on a salad that I eat for lunch. I have some avocado and I mostly just kind of chicken for meat and I'll have some red meat, usually 90, 10 once or twice a week. I'll make a hamburger or something like that. Where are you at on, let's say red meat intake. That's really like the question these days, right?

Yeah. So if your cholesterol is fine and you're eating a stable amount of red meat, say you're eating beef once a day, even in your cholesterol is fine. Some would say, well, I guess it's not having an effect. Others would say, the vegans specifically, would probably say, hey, look, there's some epidemiological evidence, meaning they didn't do a long-term trial randomizing one person to meat, another person to no red meat. They've looked at the people that just have dietary patterns where they eat lots of red meat versus not. That's the kind of the evidence they have. There may be some suggestion of increased risk of eating

more red meat. Now they have to then tease it out into processed like hot dogs and bratwurst and things like that versus whole unprocessed say like beef jerky and shit. Yeah, exactly. Versus whole unprocessed, say like- Beef jerky and shit. Yeah, exactly. Versus a nice pasture-raised cow. And it seems that there is a less risk with those things that are eating unprocessed. Or less processed, right? Because I mean, obviously processed is something you just to put it in the store. Exactly. There are other things about the red meat that there may be. Maybe there's an issue.

Heme iron, it's a form of iron that may cause metabolic disturbances and may increase your risk of atherosclerosis i'm not completely convinced and that may be me saying that because i like red meat there's also have you heard of t-mow there's this molecule that may i feel like this isn't in connection to cancer or am i thinking of something else maybe i'm thinking of the wrong... You're probably thinking of the heterocyclic amines that... Yeah, from cooking, right? I guess it's burning.

Yeah, exactly. Like searing, really getting charred. T-mol is this trimethylamine anoxide molecule that is thought to increase when eating a lot of meat, and it may be associated with atherosclerosis. So eating more of it may somehow increase the rate of atherosclerosis. It's controversial though. There's a lot of it in fish and eating a lot of fish is good for you, blah, blah, blah, blah, blah. I'm not completely convinced that's an issue. But so the question is, is there something about red meat other than cholesterol and changes in LDL cholesterol that could increase your risk of atherosclerosis? These are just a couple things

that people think. But again, a lot of people that are pushing this are also plant-based eaters. Again, I like red meat, so it may be my bias that says, I don't know, I'm questioning it. But I think there probably is something to it. If it were me, I don't eat as much red meat anymore. I still eat it because I like it and tastes good. And I think the risk is relatively low and I have other low risk factors, but there may be something to those other things. Yeah. General advice would be don't follow the carnivore diet, but if you're going to have some red meat here and there and you're doing other things right, it's probably not a big deal. And if you really wanted to know, you can get some blood work done and then you would know, right?

I haven't done it myself. I want to do this, but you can actually check your TMAO levels. Just an interesting thing. But yeah, the carnivore diet, the thing is, say if you're 400 pounds, and for some reason, the carnivore diet, you're sitting there eating Pop-Tart, just eating crap all the time, and you just can't stop eating this yummy food. Buy into the carnivore diet, you're sitting there eating Pop-Tart, just eating crap all the time. You just can't stop eating this yummy food. Buy into the carnivore diet, you lose 200 pounds or 100 pounds or whatever, and you feel amazing and all of your other risk factors decrease. Well, then, you know, hey, who am I to say you're an idiot? That's probably a net positive. But for somebody that's someone like you or me that just decided

that we're going to do carnivore, probably not the best option. But yeah. Anything else with saturated fat that you had floating around that you want to touch on? You mentioned a couple of different types of saturated fats and they do different things in the body and different foods. I'd say if you get more fermented forms of dairy that contain saturated fat, yogurt, and cheeses, it's probably more beneficial than the butter. So if you're going to eat it, I would get it from yogurt and cheese as opposed to butter. A little bit of butter is not going to kill you. I'm not one of these like butter Nazis or whatever you want to call these low-fat

folks, but a little bit of butter on a little piece of bread once in a while, probably not the biggest deal. Yeah. What amount of intake for you would make you say, oh no, we need to slow down. So some people could have a few, maybe three or four servings a day and probably not have a huge effect, but I have a feeling sticking to around a serving or zero to one serving is probably fine. Okay. And a serving is what, like an ounce or something? One tablespoon. Yeah. I mean, what do you need that much butter anyway unless you're just pulling how much are you supposed to put in one of the bulletproof coffees so yeah i believe it was one to two tablespoons of grass-fed butter and you and i both know that do you a tablespoon they're probably grabbing that

freaking big spoon in your drawer that's not a tablespoon. Yeah, it's probably a tablespoon and a half. Yeah. So it ends up being three tablespoons. And then Dave Asprey, the Bulletproof people, they say to use their MCT oil, their brain octane oil. So most people use coconut oil though, because coconut oil does have some of these medium chain triglycerides. But I believe I'd have to look up the medium chain triglycerides in the brain octane oil. Most people use coconut oil, which will probably raise your LDL cholesterol more than specific MCT oil. I'd have to see if there'd been studies comparing the two. But so you can imagine three tablespoons of butter and then another two or three tablespoons of coconut oil. It's like 80 grams.

Yeah, let's see. Three. Yeah, that's like about 80 grams of fat in one little thing. And then take that. Then you go and eat a ribeye later. You melt some butter on it because you think it's good. Those are massive increases in your LDL cholesterol. Not something I would recommend. So pat a butter here and there, put it on your toast, or even if you wanted to put it on some steak or something like that, probably not the biggest deal. So when you're drinking it and just over consuming it, that's where you see these huge effects that I see in the clinic anyway. These bulletproof coffees, I actually don't run into this very much, but it sounds like you run into a bit more. Are people drinking just one of these a day or are some people drinking two?

It's usually one, but I caught flack on Twitter because I said this guy basically cut his cholesterol in half and lost 20 pounds or eight pounds or whatever it was from cutting out his bulletproof coffee. And people are like- That's the only change he made in his diet. Yeah. And they're like, how is that even possible? I'm like, well, it had like 400 calories in it. They're like, that doesn't make sense. I'm like, well, they weren't taking a tablespoon and taking a knife and flattening it out and then putting it in. And now they're probably dunking it in.

And it's just a massive fat bomb. And they're basically like, but that's supposed to replace breakfast, though. They shouldn't be eating on top of that. I'm like, I don't know. He didn't satiate him. So he had to eat sooner than later after drinking it. And so I just told him to cut that out, eat a normal breakfast like usual, instead of drinking the stupid coffee. And he lost eight pounds over like three months or whatever it was. There's a weight loss hack.

Just stop doing anything that is trendy or fad related period. That's the new fad diet is if it's recommended in a fad diet, don't do it. You'll lose weight. Yeah. Just stop listening to these idiots. The problem is it's hard to sell the truth. It's much easier to sell bullshit. It's much easier to say lectins kill you. So you have to pressure cook your beans before you eat them, than it is, say, you have to learn how to control your desires and you can't overindulge and you have to develop a healthy relationship with food, which means probably, I mean, I don't know if you'd agree with this, but means that you kind of have to not care that much about food. I don't know about you, but I'm that way myself. And in having worked with a lot of people who are super fit and

stay super fit, it's pretty common that they like food. They can eat a lot of food or not eat a lot of food. It doesn't really matter that much to them. They're not quote unquote addicted to anything. They don't really deal with cravings. They're just very well balanced, I guess. And I understand it. It can be hard to get there for some people, especially starting at a young age, we're introduced to these hyper-palatable, hyper-engineered foods. And then who knows? Do you think eating that way starting at a young age can mess your body up in ways that are irreparable or that are very hard to change? Kind of like how if a teenager smokes weed, it's worse.

It messes with their brains in a way that you don't see in adults. Yeah, I'd say so. And there are some studies to suggest that what you're saying is there may be a more propensity to keep doing it, whether it's a psychological difference. But there are studies looking at brain changes. And that's what we talk about, like with obesity medicine is that, you know, people with obesity tend to have neural connections that are changed and the reward pathway can be dysfunctional, meaning they just have a higher propensity to keep going after those foods, similar to what

we'd kind of like an addiction state. But yeah, they truly, they have free will. It may drive them to eat more of those types of foods. It's interesting stuff. I, yeah. So ideally we'd get these things, minimize them as much as possible. They just taste so good. And it's probably just an argument for general abstinence. I think of quoted this couple of times because it just sticks in my brain. John Rockefeller Sr. didn't drink alcohol. And I forget who it was. Somebody asked him why. And he said that he can't become an alcoholic if he doesn't take the first drink. And he might've just been saying that for effect, but there's truth in that. And the more you stay away from those foods, the easier it is to not eat

those foods or something to be said for that. And even if you have good willpower or you have good self-control, it requires even energy to resist temptations like that. And so even for I myself, again, somebody who doesn't really care that much about food, if I eat, I mean, what's the most recent? There were some little Pop-Tart bites lying around. I tried it. Actually, it's gross. I don't even, it tasted like nothing.

Surprise. It tasted like nothing, like just sugar, actually. So those weren't good, but whatever. I don't know. Maybe chips or something. Again, there's been, who knows, tens, maybe even hundreds of millions of dollars of research put into just perfecting this little treat and that every bite is delicious as possible. I'm sure I'll enjoy it as much as the next person.

But by generally staying away from those foods, it never even pops into my head to eat a bunch of chips or something. You know what I mean? How does that with you? If I see that food, I get cravings for it. I'm like, hmm. something you know what i mean how does that with you if i see that food i get cravings for it i'm like hmm but sometimes if i'm dieting if i'm getting like really lean oh man i crave it a lot more but yeah i've run into that too i think that's just inevitable right i mean yeah if i'm steady though if i'm steady regular weight i can see it i'm just like nah i don't need it but some

people they just they can't stop whether it's an ingrained habit versus reward pathway dysfunction or a combination of the two, there's something going on there. Yeah. It's kind of weird for me is I can smell a food and actually get some sort of satisfaction from it and not have the desire to eat it. That's amazing. I don't think I could do that. It's actually weird.

Like I used to just to fuck with one of the guys that works with me, one of the guys who did the clean eating challenge, one who did it right. He's better now with food, but previously his diet was a joke. Basically, he would eat BMR during the week and those calories used to be like protein shakes and candy. I don't think any vegetables whatsoever, just an actual, about as bad as it could be. So then he could binge on the weekends. So it's BMR during the week to just explode himself on the weekends. Just to fuck

with him. I used to get donuts. I'd bring them in the office and put them in the toaster oven. So then the office was smaller. I mean, even current office would work, but you know, within 10 minutes, the entire office just smells like delicious donuts. And I thought it was funny. That's amazing. And for me, I just enjoyed it. It just smelled good to me. I was like, oh, this is good.

I had no desire to eat the donuts. It just was a nice aroma. That's awesome. Anyways, anything else on the topic at hand? I think we've touched on all the things that I thought we were going to talk about. Yeah, no, I think we're good. I just wanted to go into the mechanisms because people just think eating cholesterol saturated fat your arteries get clogged but it's really because

of these lipoproteins that carry those things get into your arteries and each of the cholesterol and dietary cholesterol and saturated fat they change your cholesterol based on different mechanisms so saturated fat decreases the recycling, eating cholesterol, may get more cholesterol into your serum by getting incorporated into the lipoproteins. But don't drink butter, don't drink coconut oil. You can enjoy them if you want. Keep them minimal. Focus on nuts, olive oil, avocados, and fish. Eat your soluble fiber, lentils, legumes, oats specifically, fruits. And that's probably not going to change. That's going to be the advice until we find some new, I don't know,

breakthrough type of food that just changes the game. Yeah. That's probably going to be it. Yeah. Really, right? I mean, and eat a bit of protein if you, especially if you're physically active, which you should be and train your muscles, get enough sleep and don't drink a bunch of alcohol.

Don't do a bunch of drugs. I don't know the simple things. Yeah. I think that's great advice. All right. Well, let's finish up with where people can find you and your work. And I know you're just about to launch a new exciting

company actually. So I want to let everybody know. Yeah. So Instagram is now my main place at Dr. Nadolski. That's D as in dog, R, N as in Nancy, A, D as in dog, O, L, S, K, Y. Go to his Instagram for the memes. For the memes. Yep. I love making some fun memes there. I'm on Facebook as well, Spencer, Dr. Spencer Novelski. And then the new business is rphealth.com. It's a sister company to Renaissance Periodization, combining dieticians and physicians for like a more of a medical nutrition type of therapy to help people lose weight. Awesome. And are you still working with patients? If anybody is like, I want this dude to be my doctor, is that even an option?

Kind of. I'm pretty booked up right now. So they'd probably have to email me and Get on the wait list of the old takeaway, the scarcity. Pretty much beg. You still are working with people. I am. I have like about 300 patients that I stick with. I don't want to go too much over that. So that's why I'm at least do you maintain a wait list? So if people are interested,

they can reach out. And then if they want to work with me, probably through RP health would be the way they would at this point. All right, man. Well, this was great. Thanks for taking the time and we'll have to schedule another one.

I enjoyed it. Yeah. Cool, man. We'll find a bunch of other things to talk about. Hey there. It is Mike again. I hope you enjoyed this episode and found it interesting and helpful.

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