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Episode 617
The Doctor's Farmacy

What You Need To Know About Cholesterol Testing And Reducing Risk For Heart Disease

Open the Podcasts app and search for The Doctor’s Farmacy. If you’re viewing this site on your phone, you can just tap on the

Tap the subscribe button and new shows will be added to your library.

If you’re using a different device, our show is available on the following platforms.

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For years well-meaning doctors, echoed by the media, have emphasized what they have long believed is the intimate link between cholesterol and death by heart disease. If only it were so simple! You may hope that if you monitor your cholesterol levels and avoid the foods that are purported to raise cholesterol, you’ll be safe from America’s number-one killer. The truth is much more complex. Cholesterol is only one factor among many—and it’s not even the most important one—that contribute to your risk of getting heart disease.

In today’s episode of my series I’m calling Health Bites, I talk about why standard cholesterol testing is outdated and why cholesterol may not be the cause of heart disease.

This episode is brought to you by Thrive Market and Athletic Greens.

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I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

Show Notes

  1. Cleerly
  2. Sleep-hygiene blogs

Transcript Note: Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Narrator:
Coming up on this episode of the Doctor’s Farmacy.

Dr. Mark Hyman:
It’s not the high fat diet that causes abnormal cholesterol, it’s the high sugar diet we eat, which is about 60% of our calories or more as starch and sugar. 152 pounds of sugar and 133 pounds of flour per person per year. That’s a lot. It’s almost a pound a day, and that causes a really abnormal type of cholesterol.
Hi, everyone, I’m Dr. Mark Hyman. Welcome to the Doctor’s Farmacy, a place for conversations that matter. And today I’m bringing you a special feature of the Doctor’s Farmacy called Health Bites; to improve your health because taking small steps daily can lead to significant changes over time. And today we’re talking about cholesterol because it may not actually be the cause of heart disease. That’s a bold statement, Dr. Hyman. Well, listen up and you’ll hear why.
Now, we’ve all heard that the living long healthy life, heart disease free, and the key to that is lowering your cholesterol. But is that really true? The reality is, most of us have little understanding of our cholesterol levels in our blood, and the whole topic is way more complicated than that because there’s so many other factors involved than just cholesterol. In fact, even worse, the normal way we measure cholesterol now, the standard way is so outdated. It doesn’t actually check for what we need to be checking for, which is a particle number in size and the quality of your cholesterol, not just the weight of it, which is what normal tests do. When you put… Basically weigh it and you see how much cholesterol you have, but it doesn’t tell you anything about what it’s comprised of. It could be a thousand bad particles, or just 10 good particles and it’s the same weight, right? So what we need to know is a lot more about cholesterol. So what… Let’s get into it and get into the story of cholesterol.
So what is cholesterol? Well, it’s not a bad thing, it’s something your body makes. It’s a sturdy substance produced by the liver, and it does thousands of functions in your body. It lines every single one of your nerve sheets. It’s part of your cell membranes. And you’ve got 30 trillion cells, right? Without cholesterol they can’t function. It makes hormones, estrogen, progesterone, testosterone. A lot of your brain is made up of cholesterol. So, if you think cholesterol is the enemy, think again.
Now, what are the factors that actually affect your cholesterol, whether it’s good or bad? One of the biggest myths that we have is that abnormal cholesterol is because of fat, especially saturated fat. In fact, there was a huge review just published in the European Journal, I think of Cardiology, that really kind of debunked the idea that saturated fat was the boogeyman we thought it was. That’s not to say that for some subset of people, for example, like me, saturated fat may not be as good for you. Why? Because I’m what we call lean mass hyper-responder. I’ve got such low body fat, and I’m an athlete, and seem to have a weird anomalous response.
There’re also genetic problems with cholesterol that can be a factor, that are more serious. So yes, it’s a factor for some, but not in the way we thought with fat. In fact, it’s not the high fat diet that causes abnormal cholesterol. It’s the high sugar diet we eat, which is about, oh God, 60% of our calories or more as starch and sugar. 150 pounds of sugar and 133 pounds of flour per person per year. That’s a lot. It’s almost a pound a day. And that causes a really abnormal type of cholesterol. And that causes a cholesterol we’ll get into, that’s small, dense, and dangerous. Now, the type of fat you eat is also important. So, olive oil, avocados, nuts and seeds, fish oil; those are all great for your heart.
And one study they did in Europe, which was hard to do, a randomized controlled trial on free living humans, but they basically gave one group… It was a 7,000 people. One group they gave them olive oil and told them to drink a liter a week. Another group they gave them about a 30 grams or a big handful of nuts every day. And they said, “Eat that.” They compared that to the low fat group. Well, what happened was they had to stop the study because the people in the low fat group were dying, and the people on the olive oil nut group were living and they had far less heart attacks and heart cardiac issues, and it was as good as taking any of the best cholesterol drugs. So what they found was that it’s not that… fat itself, it’s the type of fat. So saturated fat can be neutral, or for some, may be bad. And if you are a lean mass hyper-responder, it’s bad. If you’re an overweight diabetic person, it’s not necessarily bad. Trans fats, hydrogenous fats, process fats, refined oils, those are not great. But obviously whole food oils, avocados, nuts and seeds, extra virgin olive oil, certain kinds of other oils can be very, very helpful. And you should consume those and not be afraid of them. They’re not going to cause a problem.
So if the biggest problem with cholesterol is not fat, what is it? It’s sugar. It’s the sugar that you eat that converts into fat in your body. Your body has this process called lipogenesis, which basically turns sugar into fat, and it’s the worst culprit. And the worst of the worst is high fructose corn syrup, which is pretty much in everything. It’s ubiquitous and it should be banned. It’s really a dangerous substance. And in another Health Bite, we talked about fatty liver and high fructose corn syrup. And it’s in soda’s, juices, salad dressings, tomato sauce, sugar drinks like coffee drinks. I mean, it’s everywhere. So basically get rid of that. So the real concern isn’t the fat, it’s the sugar. And make sure you eat the right types of fat.
So what are the other factors that influence cholesterol? Genetics, environment, lifestyle. First of all, the real driver of heart disease, as I said, is not cholesterol, it’s inflammation. And inflammation makes cholesterol dangerous. And inflammation is caused generally by, in our lifestyle, too much starch and sugar, which causes imbalances in blood sugar and insulin. And that leads to free radicals, oxidative stress and inflammation. So that’s really the cause. And if you looked… For example, these studies where people walk into the emergency room with a heart attack, 75% are either diabetic or have pre-diabetes. Most of them who walk in have normal cholesterol. Almost nobody walks in has normal HDL or triglycerides, which is signs of this pre-diabetes metabolic syndrome. So we’re kind of barking up the wrong tree. So, in order to deal with your genetics, in order to deal with the risk of cholesterol, you’ve kind of got to look at what are the… all these factors.
So we know now that your environment plays a huge role. Exercise, your thoughts, your beliefs, environmental toxins, various latent infections. All these can play a role in your risk of cardiovascular disease. But you need to kind of take a big picture, look at your overall health and address everything that matters, not just your cholesterol. Medicine’s so focused on the things we can treat. You know, I mean just, “Oh, cholesterol, we can treat that. Let’s go to give them the statin. That’s the drug we have.” And then we forget about all the other things. But all the other things may be actually more important, including the rest of your diet, sugar and starch, stress, lack of exercise, environmental toxins. And even your microbiome, which is now understood to play a big role in your risk of cardiovascular disease. So you want to do some key tests. And we want to know about… And we’ll talk about some of the tests. We want to know about blood sugar and insulin. We want to know about inflammation. We want to know about your nutritional levels like folic acid and homocysteine. We want to know about your clotting factor. We want to look at your hormones. All of that gives us a much deeper look at what’s going on.
Also, in terms of inflammation, we really need to look at that because that’s what’s driving so much of heart disease. And again, it’s just the processed diet, sugar, starch, trans fats, too much, inflammatory fats, the sedentary lifestyle, too much stress, autoimmune diseases, food allergies, hidden infections, gum disease, even environmental toxins, mercury, all these things can drive heart disease. So we’ve got to deal with all of them. In a functional medicine, we look at all the factors, not just one. We want to look at all the factors that can cause disease. So we need a comprehensive workup.
So one of the kinds of things that contribute, well, like we said, inflammation; and that’s why I want to look at C-reactive protein. That’s a really important test. We talked about that on another Health Bite, but C-reactive protein is a really good marker. Now what’s fascinating in a Harvard study, what they did was they took people who had risk for Gangapur heart disease. They looked at ones with high cholesterol, but normal CRP. So, high cholesterol but no inflammation, normal cholesterol but high inflammation, or high inflammation, high cholesterol. So obviously the worst group was the high cholesterol, high inflammation. What was interesting is, the group that had high cholesterol but no inflammation, didn’t have any real risk. But the group that had normal cholesterol and inflammation, they had a real risk. So it’s really more about the environment in which the cholesterol exists; if it’s inflammatory or not. The other big factor that drives it is metabolic syndrome, prediabetes.
And here’s the thing guys, I just sort of made this terrifying study not too long ago, maybe a couple months ago. Which said that… And get this, 93.2% of Americans are metabolically unhealthy. That means 6.8% of Americans are metabolically healthy. Now what does that mean? That means 6.8% Americans don’t have high blood sugar, high cholesterol, high blood pressure, haven’t had a heart attack or stroke, have not had a heart attack or stroke, and are not overweight. That means everybody else has one of those things. And almost all those things are caused by too much starch and sugar and insulin resistance. So this is really, really important.
There’s a few other things I would pay attention to, is, for example, your other factors that maybe play a role. What’s your cholesterol absorption? What… Production in your liver? We can do tests for that. We want to know what your methylation status is, B vitamins, homocysteine, very important to look at your cardiac risk. We want to look at certain genes that may be a factor, that affect your cholesterol metabolism or genetics. So there’s a lot of nuances. But for the most part, if you just cut out starch and your sugar, eat good fats, exercise and watch your inflammation, you’re going to be doing great.
So what should you be testing, and what are the right tests to do? Because when you go to the doctor, all you’re getting, typically, is your total cholesterol, your LDL, HDL, and triglycerides. That test should be left to the 20th century. Dr. Robert Krauss, one of the leading lipid researchers in the world, maybe 50 years ago now, developed a test to look at not only the cholesterol weight, because that’s what it measures, it’s just milligrams per deciliter of all these numbers, but looks at the quality. So he looks at them literally under an MRI machine.
So looking at your cholesterol under an MRI machine, you can see is a large fluffy particle which is safe, or is a small dense like golf ball. Is it a beach ball or a golf ball? Now beach ball hits you in the head, no problem. Golf ball hits you in the head, it’s problem. So same with cholesterol. These small dense particles are the ones that are what we call atherogenic particles; are ones that cause heart disease. And you can get small dense HDL, small dense LDL. Triglycerides, the opposite happens. They get big and fluffy filled with fat from the sugar, because sugar is what causes high triglycerides. So you can tell the quality of your cholesterol and you can map it out. And then you can see the degree of insulin resistance. So much more important. And that’s the test you should be asking for. It’s available at your doctor’s office or any lab. Labcorp does an MRI testing, Quest does Cardio IQ testing. Super, super important.
Now you also want to check for metabolic health. How do you do that? Well, most doctors just check your blood sugar. Not enough. I had a guy yesterday, for example, who was almost 400 pounds. Not diabetic. His cholesterol looked okay on a regular test, but not on the one I’d did. Blood sugar was maybe 104, a little high but not terrible. His insulin level was 108, should be under five. So 20 times normal. He was severely metabolically unhealthy. Had an insulin resistance. You can also check fasting insulin. That’s something I recommend you do every time you get your blood checked. A little more aggressive test is a glucose tolerance test where you measure blood sugar and insulin.
Now most doctors will just check sugar, not insulin. So you got to check insulin, fasting at one in two hours. And often, the sugar will stay fine, but the insulin goes high and it keeps the blood sugar normal until last minute. And then the blood sugar can’t keep… can’t be controlled anymore. And, so it’s going up and that’s when you get diabetes. But way before you get diabetes, you’re getting all these bad things happening that aren’t just pre-diabetes. I hate that word because, if you have pre-diabetes you get everything else. You get nerve damage, you get memory loss, you get heart disease and heart attacks, you get cancer, you get strokes. You don’t have to actually have diabetes, to get all those things.
You also want to check hemoglobin A1C. That’s your average blood sugar over six weeks. That’ll give you a good sense of things. C-reactive protein we talked about, homocystine to check the B vitamins. To check for oxidized cholesterol. You can do oxidized LDL, which is, is it rancid or not. Basically, rancid fat is what causes the problem. You look if your blood’s more thick and clotty. You can look for fibrinogen ferritin levels, lipoprotein A, another cardiac risk factor. It’s a genetic but plays a role. A certain genetic tests may be helpful. And there’s an imaging test. We do calcium scores, which can be helpful. But there’s a new test called Cleerly heart scan. It’s been put in the show notes. And, it’s a test that uses CT imaging, similar to what we do with a calcium score, but they also look at soft plaque, which is on the inside of the arteries, which is something that’s really hard to determine for most people. And that soft plaque is a really… is driving your risk for cardiovascular disease. So it’s a much more advanced test using artificial intelligence. I’d encourage you to check that out.
And so what do you do? Well, obviously it’s the things we all know. It’s eat good food. Whole foods, unprocessed diet. Eat the good fats, avocados, extra virgins, olive oil, fatty fish, lots of nuts and seeds, low starch sugar diet, obviously high fiber plant rich diet, lots of phytochemicals, lots of non-starchy veggies, lots of good quality protein found in beans, seeds, nuts, high quality regenerative raised or grass fed animal protein. Really important to get your diet straight.
You know, there was a… Studies sure 90% of cardiovascular disease could be prevented through healthy lifestyle. Not smoking, exercising and eating a healthy diet. Exercise also, super important. It’s super important to get your blood vessels healthy and exercise… They love exercise. So, 30 minutes of walking will help if you want to do nothing else. Strength training, really critical to help your metabolism. More exercise, obviously the better. Not crazy amounts, but good vigorous cardio three or four times a week, and good strength training program three or four times a week can make a huge difference.
Sleep, really important. If you don’t sleep, your risk of death is much higher. So, get good sleep, good sleep hygiene. We have rel… made a lot of blogs on that we can link to that. The right supplements make a difference. So, good multivitamin, fish oil, vitamin D. You can take extra fiber like PGX, which is great. If your cholesterol’s high, there’s different things you can use to help mitigate that. Herbally, like red rices. And then sometimes some people may need medication like statins or Zetia or Repatha. It’s very individual. I’m not opposed to medication, but it’s really the last resort.
So in terms of statins, they’re pretty ubiquitous. I’m cautious about them because they do cause mitochondrial injury. They can be linked to some other harmful effects like muscle injury and muscle damage that affects about 20% of people. They’re not the best drugs in terms of their efficacy. They have to treat a lot of people to get one…prevent one heart attack. I think 89 people to prevent one heart attack. Imagine if you had to treat 89 people with a bladder infection, to deal with one bladder infection, it wouldn’t be a very good drug. So they’re helpful in the right situation, but they’re not a panacea. And I think the key is to remember to look deep into the root causes. To understand that this is a complex issue. That there are many factors involved. To do the right tests. To clean up your diet and lifestyle. And then you’ll be okay.
Most, by the way, most of the heart disease today we exist and see, that we have today, we didn’t see a hundred years ago. I remember learning in medical school in John’s Hopkins, William Olser, one of the fathers of modern medicine, when they had a heart attack patient come in like 1910, everybody would come. The residents, the medical students, all the attendings. This is such rare, a rare case. Would be like seeing syphilis today. Everybody have to like run and see this one case of syphilis, you know. Because nobody’s ever seen a case before. And it was like that. And now it’s kind of pretty much the number one killer in the world. So, remember it’s something that we don’t have to get. It’s something we know what to do about. And it’s not just about cholesterol.
And I hope then you’ve learned a little bit more, maybe than you wanted to know, but that’s the story about heart and cholesterol for today. That’s it for today’s Health Bite. If you love this podcast, share with your friends and family. We’d love to hear from you. Leave a comment. Hope you help your own lipids and cholesterol and heart disease, and we’ll see you next time on the Doctor’s Pharmacy.

Narrator:
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.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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