The Doctor's Farmacy with Mark Hyman, M.D.
What Standard Cholesterol Testing Isn't Telling You
This episode explores the limitations of current cholesterol testing, the importance of understanding cholesterol carriers and particle size, the role of metabolic health and inflammation in heart disease, the impact of diet and lifestyle changes, controversies surrounding meat consumption and dietary recommendations, advanced testing for cholesterol particles, critiques of statin use, the examination of statins' impact on heart disease death rates, and the evaluation of statin effectiveness and risks.
Comprehensive testing provides a more complete picture of cardiovascular disease risk.
The current cholesterol test used by doctors is outdated and does not provide accurate information for making decisions about heart health. Lifestyle and inflammation play a role in heart disease. Particle size of cholesterol particles is important in assessing risk.
Diet plays a significant role in cholesterol patterns and heart disease risk.
The standard American diet high in carbohydrates and sugar leads to dangerous cholesterol patterns. Insulin resistance caused by a high-sugar diet results in unhealthy cholesterol patterns with low HDL and high triglycerides. Clues about unhealthy patterns can be seen in a standard lipid panel.
Metabolic health and inflammation contribute to heart disease.
Triglyceride levels should be under 150 to avoid danger. Many Americans are metabolically unhealthy, with a high percentage having prediabetes or diabetes. Inflammation and oxidative stress contribute to heart disease, particularly belly fat. Statin drugs have anti-inflammatory effects.
Microbiome imbalance and oxidative stress impact heart health.
Oxidative stress can be caused by various factors such as poor diet, inflammation, microbiome imbalance, toxins, and heavy metals. The microbiome in the gut and mouth can influence inflammation in the body and impact the risk of heart disease. Pendulum offers products to support gut health.
Diet modifications can effectively manage cholesterol patterns.
Research has shown that a low-fat, high-carb diet can increase levels of small LDL particles. High saturated fat diets mainly affect larger LDL particles. Low carbohydrate diets and weight loss are effective in lowering small LDL particle levels. Lifestyle changes are not predetermined by genetics alone.
Controversies exist regarding meat consumption and dietary recommendations.
Saturated fat is not consumed as a substance itself, but rather in the context of foods. There is controversy surrounding the effects of meat consumption on health. Nutritional epidemiology has limitations in determining dietary recommendations.
Advanced testing provides more information about cholesterol particles.
Assays such as cardio IQ and NMR measure individual cholesterol particles. Small LDL particles are strongly associated with heart disease risk. Total ApoB measurement is a powerful tool for assessing heart disease risk.
Statins have limitations and risks in preventing heart disease.
The data on statins has been manipulated to exaggerate benefits. Lifestyle changes can have positive side effects beyond heart health. The fear of cholesterol has led to an overemphasis on statin use. Individual discussions between doctors and patients often do not consider alternative plans.
Statins may not have had a significant impact on reducing death rates from heart disease.
Reduction in smoking prevalence and other factors have contributed to the reduction in heart disease death rates. Increased statin prescription did not correlate with a reduction in cardiovascular death or heart disease. Many patients at high risk for heart disease stop taking statins.
The effectiveness and risks of statin use should be carefully considered.
Statins are not very effective for primary prevention. Patients who tolerate the drug and don't experience side effects are more likely to be included in trials. Doctors should involve patients in decision-making and provide transparent information about statin use.
- The Limitations of Current Cholesterol Testing
- Understanding Cholesterol Carriers and Particle Size
- Metabolic Health and Inflammation in Heart Disease
- The Role of Microbiome and Gut Health
- Dietary Factors and Lifestyle Changes
- Controversies Surrounding Meat Consumption and Dietary Recommendations
- Advanced Testing for Cholesterol Particles
- Critiques of Statin Use and the Importance of Informed Consent
- Examining the Impact of Statins on Heart Disease Death Rates
- Evaluating the Effectiveness and Risks of Statin Use
The Limitations of Current Cholesterol Testing
00:00 - 06:52
- The current cholesterol test used by doctors is outdated and does not provide accurate information for making decisions about heart health.
- Comprehensive testing can provide a more complete picture of cardiovascular disease risk.
- Lifestyle and inflammation play a role in heart disease.
- Particle size of cholesterol particles is important in assessing risk.
- Statins are commonly used for high cholesterol treatment.
- Cholesterol is just one factor that influences the risk of cardiovascular disease, not the only factor.
- Two-thirds of people who have heart attacks have prediabetes or diabetes, which is often undiagnosed.
- The traditional lipid panel test only provides limited information about cholesterol levels and misses important details about particle size.
Understanding Cholesterol Carriers and Particle Size
06:34 - 12:58
- The amount of dump trucks carrying around cholesterol is important, as small dump trucks can cause more plaque buildup and oxidative stress.
- Regular cholesterol tests cannot determine the number or size of cholesterol particles, which affects the risk of heart disease.
- Small, dense LDL particles are dangerous and can cause plaque development and heart attacks.
- Some individuals with abnormal cholesterol levels may have low-risk profiles due to large, light fluffy particles.
- Particle size testing, such as NMR or CardioIQ, provides more information about cholesterol carriers.
- Lifestyle factors, particularly diet, impact the size of LDL particles. The standard American diet high in carbohydrates and sugar leads to dangerous cholesterol patterns.
- Insulin resistance caused by a high-sugar diet results in unhealthy cholesterol patterns with low HDL and high triglycerides.
- Clues about unhealthy patterns can be seen in a standard lipid panel, such as low HDL and high triglycerides over 100.
Metabolic Health and Inflammation in Heart Disease
12:30 - 19:20
- Triglyceride levels should be under 150 to avoid danger, and high levels are usually a sign of increased carbohydrate intake.
- Particle size testing can provide insights into insulin resistance and metabolic health.
- Many Americans are metabolically unhealthy, with a high percentage having prediabetes or diabetes.
- Inflammation and oxidative stress contribute to heart disease, and belly fat is particularly inflammatory.
- Fat cells in the belly produce adipose cytokines, which contribute to chronic inflammation.
- Oxidative stress can lead to the oxidation of LDL cholesterol, causing plaque buildup and increasing the risk of heart disease.
- Statin drugs have anti-inflammatory effects that may contribute to their benefits beyond cholesterol lowering.
- Functional medicine takes a personalized approach by considering factors such as oxidative stress markers and diagnostic tests not typically done by traditional doctors.
- High oxidative stress can be caused by various factors including poor diet, inflammation, microbiome imbalance, toxins, and heavy metals.
The Role of Microbiome and Gut Health
18:55 - 26:27
- Oxidative stress can be caused by various factors such as poor diet, inflammation, microbiome imbalance, toxins like heavy metals, and environmental factors like smoke from wildfires.
- Lifestyle plays a significant role in oxidative stress for many individuals, but for others, it may be more related to toxin exposure or microbiome imbalance.
- The microbiome in the gut and mouth can influence inflammation in the body and impact the risk of heart disease.
- Acromancia is a beneficial bacterial strain that strengthens and regulates the gut lining, and its presence is important for long-term health.
- Pendulum offers products containing live acromancia mucinophilia to support gut health.
- Cholesterol is a waxy substance present in all tissues of the body and has important functions.
- Cholesterol attached to different lipoproteins can be associated with higher or lower risk depending on the specific lipoprotein.
- Blood cholesterol levels do not distinguish individual lipoprotein particles, so measuring cholesterol alone does not provide meaningful information about specific components that are more prevalent in heart disease.
- Small LDL particles have distinct features that make them more toxic to arteries compared to larger LDL particles, including tighter binding to arteries and increased oxidation leading to inflammation.
- Normal cholesterol levels do not necessarily indicate low risk of heart attack; other factors such as triglycerides and HDL levels should also be considered when assessing cardiovascular risk.
- Lowering LDL particles is an important treatment goal for reducing cardiovascular risk. Lowering triglycerides or raising HDL alone does not have proven benefits.
Dietary Factors and Lifestyle Changes
26:00 - 34:08
- Lowering triglyceride or raising HDL does not have a proven benefit, while lowering LDL particles is the main goal for heart health.
- Statins can be effective in lowering small LDL particles, but may not be as effective as with large LDL particles.
- Research has shown that a low-fat, high-carb diet can increase levels of small LDL particles, which are less related to heart disease risk.
- High saturated fat diets raise LDL cholesterol levels, but mainly affect larger LDL particles rather than small ones.
- Low carbohydrate diets and weight loss are effective in lowering small LDL particle levels in individuals with high levels of this trait.
- There is a genetic component to these traits, and some people may require more intensive treatments if statins are not effective.
- Cholesterol numbers measure the weight of cholesterol, while looking at particles provides information on their number and size.
- The advice to cut saturated fat and increase carbohydrates may not be accurate, as combining saturated fat with starches and sugars is detrimental.
- Variation exists in the population regarding metabolic health and genetic predisposition to conditions like diabetes.
- Following a low carb diet can significantly reduce the prevalence of the atherogenic small LDL trait by up to 95%.
- Lifestyle changes, including diet modifications, can effectively manage these traits and are not predetermined by genetics alone.
Controversies Surrounding Meat Consumption and Dietary Recommendations
33:43 - 41:11
- Saturated fat is not consumed as a substance itself, but rather in the context of foods.
- Whole fat dairy products, such as yogurt and cheese, may have heart health benefits unrelated to saturated fat.
- Meats are more complicated, with some saturated fats raising cholesterol levels.
- Increasing the size of LDL particles does not make them completely harmless.
- There is controversy surrounding the effects of meat consumption on health, including potential risks of type 2 diabetes and cancer.
- Nutritional epidemiology, which relies on population studies, is a major basis for dietary recommendations but has limitations.
- Observational studies on meat consumption may have confounding factors that affect the results.
- The speaker developed a test that measures the number of particles in the blood, including LDL and HDL particles.
Advanced Testing for Cholesterol Particles
40:46 - 48:41
- Assays used to measure particles in the blood, including LDL, HDL, and VLDL particles.
- The units used to measure these particles are nanomoles, not milligrams.
- Particle concentrations can be analyzed based on their size.
- The bioprotein fraction test, also known as cardio IQ, is a patented test that separates and counts individual particles in the blood.
- The cardio IQ test measures small LDL and medium LDL particles, as well as large HDL particles.
- Another method called nuclear magnetic resonance spectroscopy (NMR) is also used to measure these particles but does not separate or count them individually.
- Both tests are not widely used but have been adopted by an increasing number of physicians.
- Typical cholesterol tests only measure total cholesterol, LDL, triglycerides, and HDL levels.
- The test being discussed measures small, medium, or large LDL particles and the size of HDL and triglycerides.
- Small LDL particles are strongly associated with heart disease risk.
- ApoB is a protein found in both LDL and IDL particles and can be measured to assess heart disease risk.
- Elevated ApoB levels are usually associated with high levels of small LDL particles.
- Total ApoB measurement is a powerful tool for assessing heart disease risk but does not pinpoint the source of elevation.
Critiques of Statin Use and the Importance of Informed Consent
48:16 - 55:10
- The speaker discusses the importance of measuring interactions between the smile and the eye in evaluating and treating patients.
- Treating able be (presumably a medical condition) may not have the same rationale as treating small LDL, as they do not carry the same degree of risk.
- The speaker challenges the idea that statins are a panacea for preventing and treating heart disease, highlighting their risks and side effects.
- The data on statins has been highly manipulated to give the impression of a profound benefit.
- Ethical evidence-based medical practice is emphasized, along with giving patients alternative plans and considering lifestyle impacts.
- Lifestyle changes can have positive side effects such as well-being, happiness, better sleep, better sex, and weight loss.
- The fear of cholesterol in relation to heart disease has been exaggerated, leading to an overemphasis on reducing cholesterol through statins.
- Statins are widely prescribed and highly lucrative drugs with many vested interests involved.
- Shared decision making is advocated for in conversations with patients about treatment or investigation options.
- The speaker questions whether death rates from heart disease are actually decreasing and if statins are as effective as claimed.
Examining the Impact of Statins on Heart Disease Death Rates
54:51 - 1:01:24
- Death rates from heart disease started to increase in the 1920s and peaked around 19. Since 1970, death rates have started to drop.
- Reduction in smoking prevalence had the biggest impact on reducing heart disease death rates.
- Other factors that contributed to the reduction include emergency care and treatment of heart attacks, development of coronary care units, and the use of defibrillators.
- The reduction of trans fats in food supply may also have played a role.
- However, an analysis showed that increased statin prescription did not correlate with a reduction in cardiovascular death or heart disease.
- Most data on statins is from industry-sponsored studies, which may exaggerate benefits and minimize harms.
- Statins seem to be more beneficial for people who have already had a heart attack or severe blockages in their arteries.
- Taking statins religiously over five years may increase life expectancy by an average of 4.2 days.
- Many patients at high risk for heart disease stop taking statins within two to three years.
- Statins may not have had a significant impact on reducing death rates from heart disease in the population as a whole.
- Individual discussions between doctors and patients often do not consider this information.
Evaluating the Effectiveness and Risks of Statin Use
1:01:03 - 1:06:16
- Statins are commonly prescribed for primary prevention, but the data on their effectiveness is not very promising.
- Only 1 in 83 people taking statins for five years will have a death prevented.
- Patients who tolerate the drug and don't experience side effects are more likely to be included in trials, leading to biased results.
- The benefit of statins may be smaller or even non-existent when considering patients who experience genuine side effects.
- Doctors should be transparent about the uncertainties and biases surrounding statin use and involve patients in decision-making.
- For primary prevention, statins provide approximately a 1% benefit in preventing non-fatal heart attacks or strokes over five years, but there is no mortality benefit.
- When presented with this information, many patients would choose not to take statins.
- Ethical evidence-based medical practice and informed consent suggest that most people prescribed statins would probably choose not to take them.