The Dr. Hyman Show - Addressing The Root Cause Of Heart Disease

Episode Date: May 25, 2022

This episode is brought to you by BiOptimizers, Cozy Earth, and Rupa Health. Insulin resistance is a main driver of cardiovascular disease that we don’t hear enough about. Paying attention to our sugar and starch intake, eating plenty of healthy fats and vegetables, and getting enough exercise can all dramatically improve our insulin sensitivity and reduce our risk of heart disease and other metabolic issues.  For the next few weeks, I’ll be featuring in-depth episodes from my Longevity Roadmap docu-series. Today, we’re talking all about heart health. Throughout this episode, you’ll learn everything you need to know about preventing and treating cardiovascular disease from a functional perspective, from innovative testing to at-home lifestyle changes.  To get all of my longevity tips, sign up for my weekly Longevity newsletter at drhyman.com/longevity. In this series, I am joined by my colleagues at The UltraWellness Center: Elizabeth Boham, MD, MS, RD, Medical Director and Physician; Todd LePine, MD, Physician; and George Papanicolaou, DO, Physician. This episode is brought to you by BiOptimizers, Cozy Earth, and Rupa Health. BiOptimizers Magnesium Breakthrough formula contains seven different forms of magnesium, all of which have different functions in the body. There is truly nothing like it on the market. Go to magbreakthrough.com/hyman and use code hyman10 at checkout for 10% off your next order. Cozy Earth makes the most comfortable, temperature-regulating, nontoxic sheets on the market. Right now, get 40% off your Cozy Earth sheets. Just head over to cozyearth.com and use code MARK40. Rupa Health is a place where Functional Medicine practitioners can access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, and Great Plains. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com. Here are more details from our interview (audio version / Apple Subscriber version):  Why cardiovascular disease is not just about heart health (4:44 / 1:35) The true role of cholesterol in cardiovascular disease (7:58 / 4:35)  What causes inflammation? (12:53 / 9:40)  Are statin drugs effective for the prevention of heart disease? (14:28 / 11:21)  Habits to prevent heart disease (18:27 / 15:14)  The dangers of insulin resistance (20:23 / 17:00)  The importance of LDL cholesterol particle size (24:19 / 19:45)  What is insulin resistance? (31:47 / 27:18)  Markers of inflammation (35:55 / 31:21)  Four behaviors that reduce your risk of disease (49:54 / 45:44)

Coming up on this episode of The Doctor's Pharmacy. When it comes to heart disease, your diet and your lifestyle is the single most important thing. Acting now not only saves you later, but the things you need to do to prevent heart disease make you feel great and younger right now. Hey everyone, it's Dr. Hyman. I'm all about using food first when it comes to nutrition, but there's certain nutrients I recommend everyone supplement with because it's simply impossible

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Dr. Hyman and his team dive into the functional medicine approach to the biggest killer of our time, heart disease. Is cholesterol the enemy we've made it out to be? Is fat actually important for our health? What is the true cause of heart disease and how can we address it? You'll learn more in this episode. And to get all of Dr. Hyman's longevity tips and secrets, sign up for the longevity newsletter at drhyman.com slash longevity.

The biggest killer in the world is heart disease. But our traditional approach is pretty misguided and addresses the symptoms, not the causes. High blood pressure, high blood sugar, high cholesterol don't just happen out of the blue. There are signs of imbalance, of underlying dysfunction that can be fixed. We've all been told, you know, why are we seeing more cardiovascular disease? The number one killer worldwide is cardiovascular disease. And cardiovascular disease is not just about the heart. It's about the whole vascular system,

the whole endothelial system. The heart is the pump that pumps out to the arteries, goes to the small arterioles, then goes to the veins, then goes through the capillaries, and then back through the lymphatic system. And that whole system is intimately tied in with our health. It delivers oxygen, it removes waste, and when we get inflammation in that system or gumming up of the pipes, that's when we get cardiovascular disease. So our endothelium is one cell layer that lines the inside of our arteries.

And this endothelial layer is critical for our health. We want that endothelium working really well. And it needs to be able to relax to allow blood to get to all the different tissues in the body. And we know we can impact the endothelium. If the endothelium is not able to relax, that causes our blood pressure to go up. What we know is we start to see endothelial dysfunction and inability for that endothelium to relax even before, years before somebody actually goes on to have the diagnosis of hypertension. So, you know, it's important for that endothelium to be able to relax. And there's many things we can do that can help with that. We know, for example, that blueberries are amazing because they're rich in these anthocyanins, these phytonutrients that can contribute to improvement in the endothelium. And we know that when people have what's equivalent to one cup

of blueberries twice a day, within four weeks studies have shown that you can drop systolic blood pressure, that top number on your blood pressure, by as much as a blood pressure medication. There's many things that can be damaging to the endothelium. Oxidative stress, for example, we know can cause damage to that endothelial layer. We definitely know that inflammation is a trigger for damage to that endothelium. We know that that may be coming from the visceral adiposity. When people hold on to too much weight around their belly,

that weight around the belly is not just sitting there. It is an active endocrine organ. That means it's secreting inflammatory markers like interleukin-6 and tumor necrosis factor, which goes on and causes inflammation throughout the whole body. We know this because when men gain too much weight around their belly, they have a higher risk for erectile dysfunction. And erectile dysfunction is definitely caused by endothelial dysfunction. So we need that endothelial, those blood vessels to be able to relax. And that's really important for everything from prevention of erectile dysfunction to keeping your blood pressure

nice and low. And what we see with research is when men are able to lose the belly fat, they have improvements in erectile dysfunction. We see that all the time. The one thing that I need to tell everyone out there is that cardiovascular disease is not about cholesterol. Let me repeat that. Cardiovascular disease is not about cholesterol. Cardiovascular disease is about inflammation

in the setting of cholesterol. And the standard cholesterol test that a lot of doctors do is, in my opinion, pretty much worthless. You really need to look at a whole host of different things to look at a person's cardiovascular risk. So how are they going to potentially develop heart disease or cardiovascular disease down the road? You don't want to wait till you have blocked arteries in all your veins and you can't walk up a flight of stairs and say, oh, you've got heart disease now. What is cholesterol? What's it doing in our body? And how is it involved in heart disease? Well, cholesterol is not water soluble. So it can't move around our body freely.

It needs to be carried around. So it's carried around by proteins. They're called lipoproteins. So when you go to the doctor, everybody by now gets their lipid profile done at least once a year, and they hear the terms total cholesterol. They get LDL, which is your bad cholesterol, or HDL is your good cholesterol. Those are lipoproteins. So there's a low-density lipoprotein, which is LDL, which is considered a bad lipoprotein. And then there's HDL, which is a high-density lipoprotein, which is considered good. LDL carries cholesterol from your liver to parts of your body where the cholesterol is needed to do its work. HDL, the good cholesterol, carries cholesterol from the periphery of your body and cells that have used it back to the liver for disposal. That's LDL, that's HDL's job. That's why it's a good cholesterol. It carries cholesterol away once it's been used and gets rid of it. So where does the problem arise?

And why is LDL the bad guy? And honestly, it's not the bad guy. And we're going to talk about that in a second. The problem with cholesterol is that it has an affinity for inflammation. And if the endothelial lining of the blood vessel wall in any part of your body is inflamed, that creates an opening in that protective lining. The endothelial lining is the inner lining of a blood vessel. The blood vessel is like a pipe that's carrying water in your house. Well, your blood vessel carries blood throughout your body. The critical places those blood vessels have to be the healthiest are in your heart and in your brain.

If you have inflammation in the inner lining, it's almost like rust in a pipe. If you have rust on that endothelial lining, that's inflammation. And cholesterol, particularly LDL, has an affinity for that inflammation. And it will attach to the inflamed blood vessel wall. And it will actually enter in underneath that lining and begin to collect. And that's when it becomes a problem. When that happens, the immune system recognizes the cholesterol as a foreigner and creates an inflammatory response. And it sends these immune cells called macrophages to the site, and they begin to gobble up the cholesterol. And when they get big enough to the site, and they begin to gobble up the cholesterol. And when they get big enough, they die, and they form these things called foam cells.

And then these foam cells initiate an even more potent immune response. And that goes on day after day, month after month, year after year. First, it's on a microscopic level. But then is that what we call plaque begins to grow underneath the endothelial lining. It pushes into the blood vessel wall, and that begins to occlude the blood flow. And when that happens to the blood vessels that feed the heart, then you start to experience what we call ischemic heart disease. Your first symptoms may be chest pain with exercise, chest pain when you're under stress. What we experience is the most devastating outcome of having that plaque forming

is when it gets big enough that it cracks. And when it cracks, it causes a blood clot. And that blood clot will fill up the remaining space in the blood vessel. And that is a heart attack. And those can be lethal. And if they're not, they can create a great deal of disability for patients. That's why cholesterol has gotten the bad rap, because it's the last bank robber running from the bank. And that's the one that got seen. But that's not the problem. The problem is what happened first,

and that's the inflammation. So what causes inflammation? Lots of things. We're going to go back to lifestyle. And one of the most important things that causes inflammation are carbohydrates, particularly refined carbohydrates and sugars. And in the last 50 years, when we were living under the dogma of cholesterol is bad, our food industry started making low-fat foods. And to make low-fat foods tasty, you needed to add sugar, you needed to add salt, and you also needed to add fat. And the fat that was being used, which was thought to be safe, were vegetable fats, but they were highly processed. And when you highly process vegetable fats, they become inflammatory. So now you have sugar, you have inflammatory oils that are now coursing through our bloodstream, creating inflammation.

That's the critical piece. There are things that you can do to preempt heart disease. One of the big things that we're finding out is that the gut microbiome and leaky gut and also the oral microbiome are intimately tied in with cardiovascular disease. So if you have leaky mouth, leaky gut, you've got bacteria that are floating around your system, your immune system then reacts to these organisms and then potentially can cause inflammation that's then being expressed itself in the vasculature. It's in the brain. You're getting problems with memory, problems with brain fog, problems with shortness of breath.

All of those things contribute to heart disease. The use of statins in primary prevention, meaning that if a person does not have any known heart disease, the number needed to treat, you have to treat about 500 people to prevent one heart attack. So statins for primary prevention really have no role, in my opinion. Unfortunately, because of standard of care and protocols, et cetera, and also how we sort of look at heart disease, a lot of people are unnecessarily being put on statin medications. And these medications do have their role. If you have a person who has had heart disease or has had heart surgery or stents, there is good evidence that taking statins prevent secondary heart attacks and decrease

risk for stroke and further heart attacks. But for primary prevention, which is what they're being used primarily for, they really are dangerous medications. There's lots of side effects. Patients can develop muscle disease. I think about one in 10 people will develop a muscle injury. That's related to the fact that statins are actually poisonous to mitochondria. And then also, they increase a person's risk for insulin resistance and diabetes. So again, statins really, in my opinion, should not be used for primary preventive heart disease. I have had patients who have come to me with a history of heart disease and never have they had their microbiome in the gut looked at,

never had they had any type of testing done for increased intestinal permeability, which leads to metabolic endotoxemia, which is those gram-negative bacteria floating around in your blood. And then I also had some patients who've had heart disease that never had their oral microbiome looked at. The oral microbiome is really important. Lots of regular doctors don't even think about it. Even functional medicine doctors may not think about the oral microbiome because they're not dentists. And a lot of dentists actually don't think that the mouth is connected to the heart. So there are tests that you can do that look at the oral microbiome. And interestingly, various specific organisms are more tied in with cardiovascular disease, also autoimmune conditions like rheumatoid arthritis, and potentially even intestinal

cancers. So CoQ10 is the body's natural antioxidant. Our body produces CoQ10. And statin medications are actually called HMG-CoA reductase inhibitors. That stands for hydroxymethyl-CoA reductase inhibitors. And when this enzyme is blocked in the synthesis of cholesterol, you also block the production of CoQ10. CoQ10 is vital in the body for its antioxidant functions, and it's also vital because it also helps with mitochondrial function. So if a patient does need a statin medication,

pretty much any patient should also concomitantly be on Coenzyme Q10. You can also make an argument as people get older, their production or the natural production of CoQ10 can drop, and you can actually measure CoQ10 levels, but optimizing CoQ10 in patients over 50 is a good idea, but especially if patients are already on statins. High cholesterol is not a statin deficiency.

In fact, some studies aggressively treating high blood sugar, high cholesterol, and high blood pressure with medication to prevent disease in pre-diabetics actually made them worse. Don't get me wrong. Medication is often life-saving and critical when needed, but we're missing a big piece of the puzzle. Medications cover over the symptoms instead of addressing the underlying biology. And in the case of heart disease, that's inflammation,

insulin resistance, oxidative stress, which is rusting and free radicals, hormonal imbalances, and toxins, and lots more. Bad diets, lack of exercise, stress, environmental toxins, nutritional deficiencies, those are the things that lead to high cholesterol, high blood pressure, high blood sugar, and of course, heart disease. In fact, over 90% of all heart disease can be prevented with a

few simple habits. Staying your ideal body weight, exercising, not smoking, sleeping well, and eating a whole foods, nutrient-dense, plant-rich diet. Not a plant-based diet, a plant-rich diet, or what I like to call the pegan diet. But you may say, well, high blood pressure, diabetes, heart disease, they run in my family. Here's what the science tells us about genetic risk. Your genes load the gun, but the environment pulls the trigger. Your genes determine your predisposition, but not your destiny. In fact, 90% of chronic disease and unhealthy aging is caused by something called our exposome, not our genome. The exposome is the sum total of all our life inputs into our biology, our diet, first and foremost, that's most important, our activity, stress, sleep, our relationships, our connections,

meaning, purpose, toxins, microbes from outside and also in your gut, allergens, and lots more. The good news is we have control over almost all of it. Heart disease is the leading cause of death in the United States and also around the world. About 647,000 Americans die from heart disease every year. That's one in four deaths in America. Now, what most people and lots of doctors don't realize is that two-thirds of heart disease is caused not by fat or cholesterol, but by sugar and starch in our diet, causing a condition that's known as insulin

resistance. In fact, the central feature of almost all age-related disease, whether it's heart disease or cancer or diabetes or dementia, even muscle loss and what we call sarcopenia and even hormonal imbalances, is something called insulin resistance. And that happens when we consume boatloads of starch, like flour, bread, pasta, rice, and refined grains, and sugar. In fact, we eat an average of about 152 pounds of sugar per person, and 133 pounds of flour per person every year. This makes up about 60% of our calories, and it's killing us.

And it's making us age very, very fast. Now, the good news is that everything we discuss in this docuseries is focused on getting to the root causes of aging and none is more powerful than insulin resistance. And it is something we can completely reverse. Hey everyone, it's Dr. Mark. One of the most important tools I have for helping my patients optimize their health is testing. And that is why I love what Rupa Health is doing. Functional medicine testing can require placing orders with lots of different labs and it can kind of get really complicated for doctors and their patients to easily access results and keep track of everything. But Rupa Health has totally streamlined that process.

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You can check it out with a free live demo, with a Q&A, or create an account at rupahealth.com. That's R-U-P-A health dot com. Now let's get back to this week's episode of The Doctor's Pharmacy. Now years ago, I remember one of the top cardiologists at Harvard saying that if you found a group of 100 year olds with clean arteries, they would have one thing in common. They would be insulin sensitive, meaning that they could perfectly regulate their blood sugar with very little insulin. And this,

my friends, is the key secret of healthy aging. But the bad news, my friends, is that today in America, only 12% of Americans are metabolically healthy, meaning they are not insulin resistant. They are insulin sensitive, like those 100-year-olds with clean arteries. This is shocking. It should be headline news. That means that 88% of people are metabolically unhealthy,

including the 75% of Americans that are overweight and, get this, between 20 and 40% of normal weight people who are over fat, even if they're not overweight. What I like to call skinny fat, they are equally at risk of heart disease and aging and all the other complications that we see as people get older. Now, abnormal cholesterol, high blood pressure, and high blood sugar are all signs of not being metabolically healthy. This is even more important in the age of COVID-19 because the biggest risk factors

for serious disease and death with COVID-19 are being overweight, obese, or suffering from an age-related chronic disease. And these are all signs of being metabolically unhealthy. And this is also why we see such an alarming rate of heart disease. What's amazing about these particles is that we can really influence them with our lifestyle. So we can make our small, dense LDLs get bigger and fluffier. We can make our LDL cholesterol become less atherogenic. We can make your LDL particles be less concerning in terms of causing plaque production in your body.

And one of the best ways that we do that is by decreasing somebody's insulin resistance in their body, by pulling away the simple sugars, by removing the refined and processed foods. We can see the LDL particles get bigger and fluffier in size. And that's a wonderful thing we can measure. We measure it all the time with this NMR lipoprofile test. It's a really interesting test that tells us about the size of your LDL particles. Are they small and dense and therefore more at risk for causing heart disease and plaque? Or are they big and fluffy and less of a risk for your health? So it's good

if your cholesterol, if your LDL-C is a little bit high, we want to ask your physician, let's do some more testing. Let's look at the particle sizes of those LDL cholesterol. I want to see, do I have the small dense or do I have the big fluffy? If you have the big fluffy particles, they're less concerning. And if you have the small dense ones, you know it's time to say, I've got to make a change in my lifestyle. I've got to make some changes in my diet, my exercise program, and my sleep. I've got to work to make these LDL particles bigger in size, because many times we can. Sometimes when somebody's LDL cholesterol comes back very elevated, then it triggers us to look a little bit deeper.

There is a subset of our population, it's about one in every 250 people, who have something that's called familial hypercholesterolemia. And they have a genetic variation that prevents their body from getting rid of their LDL cholesterol as easily. So for that subset of patients, we might see their total cholesterol be almost 300 or higher. We'll see their LDL cholesterol be greater than 190. That's very high. That's not very common, but if you have those numbers that are higher like that, you want to ask that question, okay, you know, what's going on? Do I have familial hypercholesterolemia? Because we know that people who have this genetic variation have a much higher risk of heart disease.

They have a 20 times increased risk of heart disease, and it happens at a much younger age. So they might start to develop heart disease in their 30s or 40s, as opposed to in their 60s or 70s or 80s. So if you have a family history of early heart disease, which means less than 55 for a man or less than 65 for a woman, so if you have aunts or uncles or parents or brothers who've had a heart attack at a young age, or if you have any signs of really high cholesterol, so your LDL being greater than 190, maybe you've got some cholesterol deposits around your eye called xanthelasmas. You can often see those.

Just by looking in the mirror, you'll see some bumps under the skin around your eye. And if your LDL cholesterol is more toward over 190 or your total cholesterol toward 300, and you have a strong family history of heart disease, many times in these situations, though lifestyle is critically important and can, again, decrease your risk of heart disease, but these are the patients that we take lowering their cholesterol much more seriously. And these are the patients that really may benefit from medication to lower their cholesterol. Plant sterols are the components of our plants that prevent the reabsorption of cholesterol from the gut. So plant sterols will bind to cholesterol within your intestines and prevent it from getting reabsorbed into your body.

Then the plant sterols will take the cholesterol out in your stool. As a result, they can lower cholesterol. You know, we know that two grams of plant sterols a day can lower LDL cholesterol by 10%. You can take plant sterols as a supplement, but you can also get them from lots of your food. So foods such as your beans, legumes, and nuts and seeds are naturally rich in these plant sterols. When somebody has a very high LDL cholesterol and we're having a hard time getting it down with changes in diet or we really focus on making sure they're getting a balance of their protein in their body. So not just relying on the animal sources of protein but pulling in more vegetable sources of protein. This

is where you can really get benefit from your beans and legumes and your nuts and seeds. They can help with providing your body with these plant sterols that help with lowering cholesterol. Vitamin B3 is also known as niacin, and niacin can have a positive impact on your cholesterol. It can lower triglycerides and lower LDL cholesterol and raise up the HDL cholesterol. Niacin, though, you really want to work with a provider when you're trying niacin as a supplement because you want to get a slow release niacin to help with some of the hot flashes it can cause or hot flushes in the body and too much too fast may not make you feel so good. So work with the

provider if you're gonna try niacin to help with improving your cholesterol levels. Fish oil can really help with lowering LDL cholesterol and lowering triglycerides and raising up that HDL cholesterol. Fish oil is phenomenal for so many aspects of our health but definitely has a good impact in terms of risk of heart disease. The VITAL trial showed that if people are eating less than one and a half servings of fish in a week, then if they take one gram of fish oil per day, they can decrease their risk of having a heart attack. For people eating a lot of fish, fatty fish especially, in a week,

they might not need the added fish oil. They may be getting enough from their fish, especially the wild-caught salmon, sardines. Those are great sources of your fish oil. You may wonder, should I take some extra fish oil? The people we definitely use fish oil supplements for are people with a high triglyceride level and low HDL cholesterol. Because fish oil can help with lowering those high triglycerides and increasing that good HDL cholesterol. Two to four grams of fish oil a day has been shown to have a real positive impact on improving your cholesterol levels.

Look for a good source of fish oil, one that's a good quality. And I always say keep your fish oil in the fridge. There's other sources of omega-3s like ground flaxseed that are great to add into your diet as well. Ground flaxseed is a great source of fiber and is also really rich in omega-3 fats that can improve your cholesterol profile. One ounce of nuts five times a week can have a really positive impact on your cholesterol. It also has been shown to decrease risk of heart disease,

to lower inflammation in the body. So nuts are a wonderful thing to add into your daily routine. So what is one ounce of nuts? That's like equal to 24 almonds or 15 walnut halves or 15 pecan halves. And you want to keep your nuts fresh. So what I always recommend, I get raw nuts and I keep them in my freezer. And that keeps them really fresh, prevents them from oxidizing. That's the best way to get those nuts into your daily diet. One of the number one causes of heart disease is insulin resistance.

So it's important to understand what insulin resistance is. Every time you eat a meal, your body's blood sugar increases after that meal. And then the body responds by producing insulin. Insulin is that hormone that takes the food and gets it into the cells so you can use it for energy. Unfortunately, what can happen as we get older, or if we're not taking good care of ourselves, or if we're eating too many refined and processed foods, and we've even shown that some toxins can cause this as well, we can develop what's called insulin resistance. And that means that after our meal, our body has to produce a lot

more insulin to get the food into ourselves. So when somebody has insulin resistance, their insulin levels are actually high. They're much higher than they should be, but the body is not listening to that insulin as well. And so even though you're making a lot of insulin, the food, the nutrients aren't getting into the cells as well as they could. As a result, that high level of insulin causes us to gain weight around the belly, which is that really inflammatory visceral adiposity. High levels of insulin have been associated with heart disease. They've been associated with stroke. They have been associated with many types of cancer, including breast, prostate, and lung cancer.

And they've been associated with dementia. So what we want to really focus on, keeping our insulin sensitive, keeping our insulin in that normal range. You can ask your doctor to check a fasting insulin level. And most research has said less than 12 is considered normal for fasting insulin. We are a little stricter and we like to see that fasting insulin closer to five. And when I start to see somebody getting towards seven, nine, 10, definitely over 12, that's considered insulin resistance or prediabetes. Another word that's been used is metabolic syndrome. And so a high fasting insulin is one sign that you have metabolic syndrome or insulin resistance. There's other signs as well.

So if you're gaining too much weight around that belly, if your waist to hip ratio for a woman is greater than 0.8 or for a man greater than 0.9, that's a sign that you're gaining too much weight around the middle. And that's also a sign that you may have some insulin resistance or metabolic syndrome. If your blood pressure is starting to increase, that's also a clue that there may be a problem. And if your good cholesterol, that HDL cholesterol, is too low, if it's less than 50 for women or less than 40 for men, that's a sign that there's a problem with insulin resistance. If your triglycerides are too high, that's also a signal. And finally, if your blood sugar is

starting to get too high. So we can look at fasting blood sugar. We know if it's greater than 100, you're at risk for insulin resistance or metabolic syndrome. If somebody's greater than 125, they have type 2 diabetes. And that's what happens when you're greater than 125. But what we're learning is that when you're pre-diabetic, in those years before actually getting diabetes, when your blood sugar is starting to go up and you have all those other markers of insulin resistance, that high insulin, the weight gain around the belly, the low good cholesterol, the high triglycerides, the elevated blood pressure. We know that in those years, even before you get diabetes, your risk for all of the diseases that come along with insulin resistance, like cancer and heart

disease and stroke, are increased as well. So you don't want to just wait until your blood sugar starts to get too high. It's really important. Many times in conventional medicine, doctors don't want to just wait until your blood sugar starts to get too high. It's really important. Many times in conventional medicine, doctors don't have enough time with patients or enough tests are not done. And many times this is missed. I see it missed all the time. Patients, their blood sugar will be slightly high or starting to creep up and they don't realize how important it is to act at this time.

Because this is the time where you can really reverse the prediabetes. You can reverse the insulin resistance and prevent all of these diseases from occurring. So there are several markers of inflammation that we look at. One's called a CRP, one calls it homocysteine. And I say, I certainly can't make a decision or help you make a decision about whether you should come off your statin or take a statin unless I know how much inflammation you have in your body. So that will be two tests that I will get if they are not part of their profile. Then I will perform something called a nuclear magnetic resonance lipid profile. That is when we are able to look

at the actual molecular structure of the lipoproteins that go through your bloodstream and determine which ones you have. And when we do that, we're able to find other lipoproteins, and they've been researched, and they've been found to actually be more important markers of heart disease or risk for heart disease than LDL, total cholesterol, and low HDL. One of them is called your low-density lipoprotein particle number, and one's called your low-density lipoprotein size. The low-density lipoprotein particle number, and one's called your low-density lipoprotein size. The low-density lipoprotein particle number is really a measurement of how many LDLs you actually have. Not just the total, but how many individual LDL molecules do you have. The LDL size is

how big are those LDLs. So it's not just a total LDL. Now we're getting more granular. How many of them do you have and how big are they? And what we found is that the really small, dense LDLs, they're like missiles. They can penetrate into the endothelial lining where there's inflammation and build up very quickly. So you want larger LDL molecules because the big fluffy ones put you at lower risk for heart disease. And if you have big fluffy LDLs, that's going to be a favorable measurement and is going to be one step towards, hmm, your LDL may be high, but they're big and fluffy, and you have lots of them, and you have few of them. You want a low LDL particle number.

The fewer particles you have and the bigger they are, the lower risk you are. So if you have that profile, that's like one reason why you might not need to be on a statin, because it doesn't matter if the LDL is high. You have small ones, and you have fewer of them. You have big ones, and you have fewer of them. Okay. Then there's another marker. It's HDL size. You want your HDLs to be big. So even if you have a mildly low or low HDL, if we look at the size and they're big, that's really good because HDLs are like, we know what they do. They collect cholesterol and they take it to the liver for it to be disposed of. If you have small HDLs, then that's like having small dump trucks, and they can't really pack on a lot of cholesterol, and they're not very efficient at collecting it and driving it to the liver and getting rid of it.

But if you've got really big dump trucks, really big HDLs, they can collect more cholesterol, carry it to the liver, and have it removed. So your HDL size is also important. And finally, there's a really interesting marker that's gaining a lot of ground as being an important marker for heart disease, and it's called lipoprotein A, or LP little a. So LP little a is very much genetically programmed. So 90% of the people that have this LP little a, they have a gene for it. And there's some thought that this may have conferred for that population of people a lower risk of dying from injury because it helps blood clot. So evolutionarily, it may have

had a value at some point. But now, because of the diets that we have and the lifestyle we have, that what used to be an evolutionary advantage may now be a disadvantage when it comes to heart disease. So LP little a actually expresses itself very quickly. So by the time you're two years old, it's fully expressed and you're making a lot of Lp little a. By the time you're five, you're making a lot of this lipoprotein A. And what it basically is, is an LDL with an additional lipoprotein called APOA. It's fully expressed by age five to your adult level. So you're living with this really high LP little a, if you're inclined to do that genetically, for most of your lifetime. Knowing that value, we understand about that is that it increases your risk for heart disease fourfold, but nobody screens for it.

And so I will screen for an LP little a, because if that is, you know, really high number, even if everything else being equal, you're sort of on the borderline with your numbers, a high LP little a is going to really concern me. And I'm going to really want to work at changing your lifestyle and using that as leverage to have you do it. So what I've just talked about are different ways of looking at cholesterol. And I told you it's inflammation, but I just got done telling you that there are important cholesterol markers that we need to look at that increase your risk for heart disease. It's both. Inflammation is the genesis and cause of heart disease in that it creates an environment for cholesterol to create those plaques that create those blockages that create the diseases that cause heart attacks and strokes. So when it comes down to it, we need to be aware of those things

that will, in our life, that will create inflammation. And we also need to be aware that our doctors need to measure it appropriately. So when you come to me as a functional medicine doctor, I'm going to look at not just your total cholesterol and your LDL and your HDL, but the markers that identify risk more sensitively, as I've explained, those are LDL particle number, LDL particle size, LPL little a as your cholesterol markers. On the other side, and more importantly, is do you have inflammation going on in your body right now? And two of the really important markers that need to be included in your cardiovascular risk assessment when we're looking at our physiologic markers,

are CRP and homocysteine, because both of those are linked to increased risk for heart disease because they are markers for inflammation. I always start with the basics. If someone has a poor lifestyle, if their diet's not great, if they're not exercising, they're under too much stress, if they're not sleeping, if their nutrient levels are off, I start by focusing on those. And I do that aggressively. But there is a subset of patients that don't respond to that and that have a genetic problem. Maybe something called familial hyperlipidemia, which means you get really high cholesterol. And I have a patient right now who's just following all the advice I'm giving him,

and he's doing great. But he's one of those patients that needs a statin, and he's a very significant cholesterol absorber. So we actually can do tests now to see whether you're a cholesterol producer or you're a cholesterol absorber, if you're a hyperabsorber. So you absorb all the cholesterol and fat in your diet in a way that's not good for you, or maybe your liver just produces too much of it. And we can use things to help block the absorption of cholesterol, whether it's fiber or other factors, or we can use something to help block the synthesis of cholesterol in the liver, whether they're natural products or medications. So it's very personalized and individualized. There's not one size fits all. But the problem today is if anybody comes in with a cholesterol, an LDL of over, you know, 100 or 130, the doctor goes, you need a

statin, sort of one size fits all. And that's just not how to practice medicine. And we know this now. I mean, the medical profession understands this. The National Institute of Health has a whole department of precision medicine and precision health and precision nutrition. So we're understanding that this one size fits all medicine just doesn't make any sense anymore. But it takes a while to get it into practice. And functional medicine is the science of personalized medicine. It's the science of personalized nutrition

and personalized health. So everybody's different. I treat everybody differently. And I look at what their issues are, what their genetics are. And I push as hard as I can on the things that are the least toxic, the least harmful, with the least side effects.

Nobody's gonna die from improving the quality of their diet. The opposite is true. But some people may have adverse effects from drugs. So I use them, but I use them as a last resort, not as the first step. There's interesting technology available today that allows us to look at the quality and function of your blood vessels. And that's really cool. So we can see in real time, are they stiff? Are they pliable and soft? Or are they hardening? And if your arteries are hardening and stiff, it's not terminal.

You can influence that by the quality of your diet, by lifestyle, all the things we've been talking about can change your blood vessels from stiff and hard and at risk for damage to soft and pliable and fluid which keeps you healthy and free of heart disease. So we look at these tests like for example Endopat which is a machine that's non-invasive that looks at the vascular health. How is your blood vessels? Are they good? Are they bad? And this endopat test

can be done at your doctor's office. Again, many don't use this preventive technology, but it's a great way to see. And then you can alter your lifestyle and you can come back a month later and do it again and you'll see the change. And we see that very often. Well, if someone has poor blood vessel health, we know so much about how to get your blood vessels working better, which is to eat an anti-inflammatory diet, low starch and sugar, lots of plant-rich foods, lots of good quality fats, lots of nuts and seeds, what I call the vegan diet. It's something I've been talking about forever. It's the quality of our food matters more than the quantity.

What you eat matters more than how much you eat. And so focusing on the quality and upgrading the quality of your diet is so critical. And getting rid of all the junk, getting rid of all the flour and the sugar doesn't mean you can't ever have it, but it's just not a staple in your diet anymore. Exercise also has enormous benefits on your vascular health, on function. Saunas, who knew? But saunas actually increase your vascular health and can produce better vascular resilience and response. Increase something called your heart rate variability, which is a sign of the quality of your heartbeat.

Is it good or is it bad? Is it more risky for heart disease or less risky for heart disease? There's meditation, which also can affect your blood pressure and inflammation and oxidative stress and all the things that cause your blood vessels to not be happy. And then there's lots of nutrients out there. Fish oil is a great one. Curcumin is another one. Vitamin D, antioxidants, a whole list of plant derived compounds we call phytochemicals and also just nutrients play a huge role in your vascular health.

So we designed a comprehensive program to upgrade the quality of your vascular system in your blood vessels so you don't get heart disease. With the increasing interest in ketogenic diets and low carb diets, we're seeing a phenomenon that's pretty fascinating, which is the variability in individuals' response to different diets. Some people do really well on a lower fat diet and other people do really well on a higher fat diet. Some people do better with lower starch and sugar. Some people have more ability to manage starch and sugar. So I have a good ability to manage starch and sugar, but I've noticed, for example, when I have a high intake of certain types of fat, like saturated fat, my cholesterol goes really high. So there's this

phenomena called lean mass hyper-responder, which we're still studying and still learning about, which is people who are fit and healthy, when they jack up certain types of fat in their diet, it doesn't work so well for them. And we can actually do analyses that we do in our clinic here at the Cultural Wellness Center called DNA Diet,

where we can see how you respond to fat Ultra Wellness Center called DNA Diet, where we can see how you respond to fat, how you respond to carbs, and how you respond to different factors that regulate your eating behavior, how you respond to salt taste, and various kinds of bitter taste, and what actually you should be eating to maximize your genetic potential. When it comes to heart disease, your diet and your lifestyle is the single most important thing. Acting now not only saves you later, but the things you need to do to prevent heart disease make you feel great and younger right now. A very big European study called EPIC found that incorporating four simple behaviors can dramatically reduce your risk of developing heart disease by 90%. So not smoking, exercising three and a half hours a week,

eating a healthy diet, and maintaining a healthy weight. In fact, researchers in the EPIC study found that adhering to these four behaviors alone seemed to prevent 93% of cases of diabetes, 81% of cases of heart attacks, and 50% of cases of diabetes, 81% of cases of heart attacks, and 50% of cases of strokes, and also 36% of cases of all cancers. Now, there is no medication on earth that can do that. Of course, there is a role for medication in some patients. For some patients with significant genetic risk, or if they've already had heart disease

or a heart attack. But over time, by addressing the root causes, many people can come off these medications. Through lifestyle changes and addressing root causes, I have seen patients lose weight, get off all their medication, normalize their blood sugar, normalize their blood pressure and cholesterol, and even reverse congestive heart failure using functional medicine. Incorporating positive dietary and lifestyle changes can lead to miraculous results. You just have to implement the right strategies. So we'll see you next time for episode three, and thanks for tuning in. Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving

this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays.

Nothing else, I promise. And all you do is go to drhyman.com forward slash PICS to sign up. That's drhyman.com forward slash PICS, P-I-C-K-S, and sign up for the newsletter and I'll share with you

my favorite stuff that I use to enhance my health and get healthier and better and live younger, longer. Hi, everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database.

It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.