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Triglyceride over HDL silent cardiovascular
risk factor this is part one we're going
to be doing part 2 next week and
how can you be doing that much on one
little ratio
you'll find out as we get there just a
couple of other
comments about other content that we
have available
previous topics vitamin K2 & cardiovascular
health
helping to clear the confusion in that
area how to prevent stroke with exercise
heart disease in women
falls and one of our most popular videos
over the past
few weeks has been can vitamin D lower
lower COVID-19
risk and how vitamin D impacts your
immune system
we slowed down on COVID-related
videos because of the over
politicization
I think that's the right word it
became
way too political
and we're not a political channel but
that one video has been very very
popular
recently if you want to
to get some information about yourself
if you want to find out do I have
insulin resistance
do I have plaque do I have diabetes
should I be taking supplements those
are all available on some webinars
some events that we're
working on right now and again
Aspen if you could Aspen and Sam if you
could go back and check with Michelle I
don't know that that sale is still going
on
if somebody clicks in on this I'll
certainly honor it though
the courses started to get an
uptick in interest in the courses
recently the courses are quick and easy
it's your own pace
an hour or so and you can end up
learning a little bit more about
or significantly more about insulin
resistance prediabetes cardiovascular
inflammation
plaque no more than the vast majority of
doctors
in that area just with an hour or two of
time
and we know those topics are important
because
they're the number one source of heart
attack which is the number one cause of
death
number one cause of strokes number one
cause of disability
so very important items
continuing to get interest in our
subscription
I talked regarding the book we've got
two books coming up now
the plaque book and I will just say
with a smile if you ever write a book be
careful about
doing a co-author I talked with or Todd
sent me an email the other day and
we were we were about ready to send it
in and
Todd looked at one more thing and
decided he wanted to go down
yet another it's not a bunny trail it's
a
it's a necessary item but it's like when
will this
thing ever get submitted
hopefully soon so
again check out the website we've
done a lot of work on it we're starting
to get a significant uptick
tick in interest and
activity there we're starting to migrate
our content from just the
YouTube channel it's hard to get
everything verbally
into writing and we actually uh
Chris actually published that
original more popular
video today on the website the one
about reversal 20 years reversal of
plaque my story I had actually wanted to
hold off
on publishing that blog yet
and and here's why that blog
that art that excuse me let me start
again
that video was popular enough to
create its own
Google
long tail keyword reverse
20 years plaque
you google that Google that term and
that's what will pop up
our video so I think we've had over 2
million views on it now
and again I didn't realize it was going
to be such a click bait when
that was one of my first videos I'd only
been doing the YouTube channel for a
month or so and it was a lark at that
time
but it was very well received I got very
hyper and wanted to
really do the blog article correctly
and do some edits the end of the day
it came out it is what it is and
if you go in and take a look let us know
we're planning on providing more content
which gives you a lot more detail on
how you can reverse your plaque
yes it's possible despite what many
cardiologists
say and it's not just on my channel I'm
not a goofy
YouTube doc making stuff up I used to
teach this stuff at Hopkins
I used to be an ER doc
real doc real information in fact it's
not just me
tell them to look it up on Harvard
Health I mean there are plenty of places
where they talk about
it is possible to reverse plaque and in
fact I have
a significant number of patients who've
done it now the real question is
is it practical to say I want to reverse
all of my plaque
in certain situations it is the real
practical goal that all of us can attain
though
is to stabilize stabilize that plaque
and reverse
your risk and we'll again we'll talk a
little bit more about that as that
information comes out today Ii want to
talk though about
triglyceride over HDL ratio it's a very
very important topic
there's been quite a few lives saved
looking at this specific item so
as soon as Aspen gives us the water bowl
on that we'll talk about triglyceride
over HDL ratio
so as you can see we're going back in
getting the
the website now populated with some of
the original information
making more information more
available to people in writing form as
well as
written form as well as as the videos
and this I have recently been able to
rewrite
the triglyceride over HDL video
added a lot of information to it and
again you'll see that
blog come up on the website
probably a couple of weeks hopefully we
won't
jump the gun on that one like we did on
this recent one
but here in studying the content to
prepare for
the written version I listened to some
interesting uh videos The Drive Peter
Attia
most of you a lot of people that watch
my channel have seen Peter Attiah
he's also a Hopkins grad he was he
started off in surgery in Hopkins and
his video that was his claim to
fame was a TED
Talk where he was talking about
getting called in as a surgery
resident to
see a lady I think he was going to have
to take her leg off
and diabetes the lady was over
overweight and he was
he was not treating her with
the patient effect
the patient concern that he
that felt he should have and here was
the thing he was blaming the patient
we often blame patients until you begin
to realize
that sometimes behavior is driven by
biology and in this case
there's a lot to be said about the
hormone theory of weight loss
in other words it's not that we get fat
because we eat more it's that we're
eating more
because we can't burn the energy that
we're eating
so we remain hungry if you
don't know what that means if that
sounds really weird
get the book Why We Get Fat and What
to Do About It Gary Taubes
it's a great book it helps you
understand a lot more about diet
again totally different topic but here's
the reason that I brought up
Peter Attia he made a pivot in his
life and started focusing all on
longevity
he's a great doc he's got a lot of good
good content
he did a series with Thomas Dayspring
who's a basically national and world
renowned lipidologist
now here's the quotes that they had
about
triglyceride and HDL
Peter says and I think it's about
five minutes into this
this podcast there are a few
things that humble me more
than my complete and utter buffoonery
when it comes to HDL lipidology again
Peter's a sharp guy he knows he knows
more about
HDL than I do but
clearly somebody that knows more than
both of us put together in that space is
a fellow named Thomas Dayspring and his
comment was very telling he said you
know what
that's true of all of us so
given the fact that HDL lipidology or
the study of
HDL or "good cholesterol" can be
such a dicey topic why would I
venture to go there because
I'm not so much it may sound like it a
lot of people may say
what I'm not an academician the
stuff that I talk about does get a
little bit geeky
I was at a faculty full-time at Hopkins
for a while but I never thought of
myself as
an academician I still don't my goal is
to save lives
and as you begin to look at
this concept this issue you can you
can begin to realize
that it can save lives one of the people
who talked about that is a fellow
named
Chuck Smith on the bottom right hand
corner Chuck's giving his presentation
to a group at Louisville we'll talk
about that in just a few minutes but he
talks about
how this understanding HDL
over triglyceride that ratio saved his
life
so a couple of other things that Attia
and Dayspring talked about in there in
episode 22 of the drive podcast
triglyceride over HDL ratio is five
times more predictive
than for heart attack risk and then LDL
that was seen in our a recent Framingham
study lipoprotein particles pass both
cholesterol and fatty acids around
like hot potatoes what
again that's an interesting concept that
you'll hear if you go there
that's not so much that may be a
little bit more
arcane stuff for academicians and we'll
skip over that let's make sure that we
learn basic
triglyceride over HDL
lipidology right now because it's really
more a diabetology
food nutrition issue than anything else
the basics of triglyceride and HDL
are critical to health
the complicated version sometimes just
isn't understandable so
or even actionable I did a simple video
on triglyceride over HDL ratio in 2017
the link is here on the page it's a
popular video I think there have been
about 60,000
views on that video
so let's go back and talk about some
of the basics what are triglycerides
tri meaning three
glycerin meaning the glycerin molecule
here
and there are three fatty acids
that link up to a glycerol glycerin
molecule
I won't go too deep in this this is not
going to last too long we'll get back to
the basics in a couple of minutes
but this is fat that's what
triglycerides are
now what are the appropriate
triglyceride levels once you get
over a hundred you need to be worried
and thinking about your triglycerides
one to two hundred
tend to be listed as normal or one to
two millimoles per liter for those of
you in the UK and
Europe and other parts of the world
using metrics
lower levels than 100 though or lower
levels than one millimole per liter
are optimum some disease states I mean
these can get really high some disease
states show triglycerides
over 500 or 500 milligrams per deciliter
in the US or 5.7 millimoles per liter
uh elsewhere I've got several patients
350 400 450
etc now that's triglycerides let's don't
get too much deeper into triglycerides
right now let's go back and talk about
HDL high density lipoprotein
many of you have heard of it
and heard it called "the good
cholesterol"
when those same people that call HDL the
good cholesterol
usually call LDL the "bad
cholesterol"
now I'm not going to go there
I've used that terminology in the past I
don't use it now
because we know a lot more about these
but again let's leave that topic for
later as well
the final L in LDL and HDL
stands for lipoprotein lipo means oil or
fat or wax
and protein means protein so what's
going on is
these are particles made up of
a protein and the fat cholesterol
wax oil and if you didn't have those
proteins that would help these oils
form a particle in your blood
you could get what's called emboli
you'd have to do is eat a salad with
with olive oil dressing and you could
get what's called a fat
embolus that would be a big blob of oil
olive oil in your blood that blob could
cause a heart attack or a stroke
because it would it could block
arteries
so that is the purpose of these proteins
the APO what they're called
apolipoproteins or the lipoproteins
that that make fats and oils form tiny
microscopic particles that are not going
to
cause what we call an embolus
or a blockage of your artery
so when you digest fats things like HDL
LDL
lipoproteins keep those fats in
a tiny
microscopic area so you don't get the
the emboli
or the blockage of your artery HDL
particles are considered to be
responsible for "reverse
cholesterol transport" and if you go deep
into some of these
some of the other videos you you begin
to hear that
this "reverse
cholesterol transport" or RCT
which you'll see referred to all over
the science
you see it referred to in this little
guy with the
with the wheelbarrow who's taking the
cholesterol away from the artery
you begin to listen and hear to some
hear some of the cutting edge HDL lipid
allergy and they're throwing this whole
RCT or reverse cholesterol transport
into question doesn't that shake the
whole issue regarding health
no the health the details of how
some of these things work are still in
debate they're still being argued they
can still be very confusing
but the basics of how they impact our
health
are still rock solid so hang on we'll
get there
HDL particles again was considered to be
responsible for
reverse cholesterol transport that's
where you're taking it from the arteries
back to the liver for the cholesterol to
be metabolized
will an improvement in HDL result in
better health
yes with a few exceptions where you have
problems with the HDL itself
not going to get into that topic right
now either but
higher HDL means better health
how it improves nitric oxide it
decreases
oxidase enzyme function decreases
adhesion molecules
decreases monocyte filtration you
know the immune system activity that's
attacking plaque possibly again improves
reverse
cholesterol transport now
why is there triglyceride in the blood
the most common reason for
elevated triglycerides is
prediabetes so now you're beginning to
to get to the basics of this
higher the triglycerides the more we're
concerned about prediabetes and or
full-blown diabetes
and the
lower the HDL the
more concern we have about just overall
health indicator
no matter what mechanisms and there
there are multiple
that HDL does to impact health so then
you begin to see
why triglyceride over HDL
is an important ratio now triglycerides
can also become elevated in several
inherited diseases they're diseases
where
again our the individual the patient's
body just does not
metabolize triglycerides correctly
chronically high insulin stimulates
adipocytes and hormone-sensitive lipase
now why did I say that let's go back to
this original comment
high triglycerides tends to be
a sign of prediabetes now how does that
happen
now let's go back and repeat that
chronically high insulin which you get
from insulin resistance
high insulin stimulates adipocytes
and hormone-sensitive lipase
the hormone-sensitive lipase results in
the release of too many fatty acids and
fat cells
these excess fatty acids take
up space in the HDL
and LDL an enzyme called
cholesterol ester transfer protein CETP
facilitates the exchange of cholesterol
in large HDL
and large LDL with triglycerides
so here's what happens you eat a meal
you for a few minutes to a few hours
you'll have
VLDLs those are those very large
are very low density lipoproteins
they're very large particles
and they have a lot of triglycerides in
them
meanwhile because of your prediabetes
your hormone-sensitive lipase has been
stimulating
release of triglycerides so you've got
too many triglycerides
circulating
in your system hopefully that helps to
to start
understanding why triglycerides are
elevated with prediabetes
now here's the other piece and it's in
this slide from Dr. Dayspring Thomas
Dayspring
there's a CETP cholesterol ester
transfer
protein which takes cholesterol
out of the large LDL and out of the
large
HDL and transfers it back to
VLDL in exchange for
triglycerides now what happens then
that all might sound a little bit
complicated why are we going there for
it I'll tell you why
in just a minute in the next image it's
from the the patient charts that I see
time after time day after day example
after example
we'll see this on the labs
triglyceride-enriched HDL and LDL
are in turn metabolized by a liver
lipase resulting in
loss of the large HDL and LDL so in
other words
when the cholesterol is taking
taken out of large
HDL and large LDL
liver or hepatic lipase
metabolizes those large particles
now I said I was going to cover
something that
I see in the vast majority of my
patients as in over 90
of them this is a
a spectrum analysis of
HDL and LDL in patient blood
you see here on the vertical we have
total
lipoprotein mass so that's mass
and you see along the horizontal
we've got diameter so
same mass lower diameter you're going
to see
HDL same mass higher diameter
you're going to see LDL because
same mass lower diameter high density
lipoprotein
same mass higher diameter low density
lipoprotein that's how those were
originally named
using these techniques and they didn't
understand them originally what they
were before so that's why they had the
names HDL and
LDL using basically just a
a chart like this now what you should
have
in a healthy patient is large
fluffy HDL and large fluffy LDL
so you should have a smooth bell curve
on the HDL that peaks here
over the large green
image same thing on LDL but what we
classically see
in people with prediabetes is it looks
like a big
chunk of the HDL
bell curve has been
bitten out of it that where the red
where my red mark is
and that's exactly what we see over and
over and over again
so you see that there that this person
this patient's
HDL peak is way down here in the lower
levels so the HDL that they have are
still not so much the large healthy ones
the large healthy ones have had their
cholesterol taken out of them
exchanged by with CETP for
triglycerides and then the
liver lipase has metabolized those large
HDL particles now with the
bell curve with the LDL you don't see
that same impact on the bell curve where
it
looks like a shark came on came along
and bit a piece of that bell curve out
what you see is a shift of the bell
curve and
that's exactly what happened with this
patient they have what's called
docs tend to call it a B pattern meaning
the peak for their LDL curve is lower
it's in the more in the smaller
denser
ldl area and that's not where you want
that either
you don't want small dense LDLs you want
the large fluffy ones so hopefully that
helps
you begin to see excuse me
what I see all day every day
let me go back to text because this
patient
also had a little FH and we'll talk
about you know we'll
talk about that for just a second but
make sure I covered the details on the
on the script
decreased size of HDL is caused by
by this activity and the bell of the HDL
should again be
have a smooth bell curve here you get a
decreased size of LDL particles
instead of getting that bite taken
out of the
the bell curve you get a shift you
get in this
patient you have elevated triglycerides
216 and so when you look at it this
patient had
triglycerides of 216 and HDL of 34.
just to comment back to
people that are or have seen that
original video about triglyceride
over HDL Chuck for example said that
he had Chuck lost
about 50 pounds working with a
well-known
low-fat diet doctor Caldwell Esselstyn
after the loss of the 50 pounds he
had a heart attack
that's not that's not very common
most people weight is a major
determinant
and in most people weight is the major
determinant
so I'm not banging on Caldwell
Esselstyn I'm not
I'm not banging on or criticizing the
other docs that talk about low fat
if you can get that body fat down
that is for most people the most
important thing
but triglyceride over HDL is very
important as well
as Chuck found out for some people it's
the most important thing
Chuck said after his heart attack
he started looking at my channel he
discovered this concept this
triglyceride over HDL
he looked at his and his was between
five and seven
his triglyceride over HDL
if you're interested in Chuck's video
it's
there are a couple of versions of it on
the channel he was driving a Tesla when
his
heart attack happened he put the Tesla
in
autopilot and while he was reaching
in the back seat to get his
nitro but again another digression for
another time period
as you can see this patient's
triglyceride over HDL ratio is 216 over
34
or 6.4 at that point I recommend a goal
of one
and again if you go back to Chuck
Smith's
videos Chuck's HDL
is now down below one from a high
of five to seven when he had his heart
attack
now there's one other thing I mentioned
a few minutes ago this patient also has
an unusually high LDL
I've mentioned that many times we've
talked about
FH familial hypercholesterolemia
and that's why you tend to see such a
big area
under the curve for this patient for
LDL so this patient has a double problem
FH and prediabetes
triglyceride over HDL as I've said
many many times I've got
tons of patients with garden variety
FH familial hypercholesterolemia
they rarely get into any problems until
and unless
another major risk factor happens we've
got several videos on that
girl one patient who as a young woman
was smoking like several packs a day
had a problem needed had an event
found out that she had FH it was not
recognized at first by her primary care
doc
FH is rarely recognized first
and it's something that needs to be
recognized but
again as I've said before FH is not
something that
that tends to take us out initially like
most people think
it is something that decreases our
capacity and
most commonly the thing that takes us
out is
triglyceride over HDL ratio
associated with prediabetes and
diabetes
I've gone down a whole lot of bunny
holes thank you for your patience if
you're continuing to hang in there
let's just cover a couple of other
items related to this
one of them is remnant cholesterol many
people consider remnant cholesterol the
most
dangerous type of cholesterol particle
what is it it's also called the
triglyceride-rich lipoproteins TGRLs
it consists primarily of VLDL you know
we mentioned that a couple of times the
VLDL
and IDL very low density lipoproteins
and intermediate density lipoproteins
are very short-lived you eat a meal
and you see them for
half an hour a couple hours at most in a
in most healthy patients
how do you find that number it's very
simple
you take LDL and add HDL
and you subtract that from total
cholesterol
what remains is
remnant cholesterol you'll see a good
bit about remnant cholesterol with
oh Dave I always I keep forgetting
Dave's last name there's a felon
that does a lot of work on the Internet
about
remnant cholesterol (it's Dave Feldman)
it's not Aspen is it anyhow
remnant cholesterol particles appear
only briefly after a meal then
they're metabolized into other
lipoproteins by the breakdown of
triglycerides
in that particle this breakdown is
accomplished by lipoprotein lipase
lining the luminal surface the inner
surface
of the capillaries remnant cholesterol
is higher in
serum with those with cardiovascular
disease
15 milligrams per deciliter or above
now next week we'll talk about
other parts of triglyceride HDL ratio why
it's important
the optional triglyceride over HDL ratio
ethnicity you'll see when you start
looking up triglyceride over HDL that
there's a lot of focus on ethnicity I
have patients of
I've got patients from all over the
world many
ethnic groups yes you could say that
but no I would not use ethnicity as a
major guideline
and we'll talk about that some later how
can you
lower triglyceride and raise HDL
naturally
it's i've got people doing it all
the time just like Chuck did
changed his ratio from five to seven
down to less than one
most of that he did naturally there are
medications as well and we'll talk about
those
medications which improve triglyceride
over HDL
and the question does lowering carbs
does that improve triglyceride HDL
remnant cholesterol cardiovascular risk
again
all for next week we're not going to
show
either of these videos I'll tell you
what Aspen if you will go ahead and
give us the
the transition we'll go ahead and start
with questions and answers
I am just looking up something real
quick I was having a
senior moment about lean mass hyper
responder I'm still trying to find
Dave's last name he's a fellow that
talks a lot about remnant cholesterol
anyhow what I'll do I'm sure somebody
will help me with a fact check on that
and let's go to questions
Amer Al Gayar hi from Germany
and my question was where in germany
Bob Weis hi from North Georgia
Mountains Carsten Nielsen due to more red
blood cells with cardiovascular plaque
seem to cause blood clotting easier I
think
well yeah if you've got a lot of plaque
and if you
if plaque can be stable plaque alone is
not the problem
the more plaque you have the more likely
you are to have this issue
but the concern is having plaque and
then your immune system attacking it
that can cause
clots which if they go to the heart is a
heart attack if they go to the brain
it's a stroke
My Bjj I just found out recently what my
Bjj stands for Brazilian jiu-jitsu
thank you so much Bjj for your
participation and thank you for joining
today from Temecula
and Bart
Carsten
1957Kato good morning thank you again
Art Berry good morning Lake Ontario
New York San Francisco I think that was
My Bjj five dollar
super chat thank you so much Bjj
John Tocho good morning remember to
smash the likes and consider
joining Patreon thank you so much John I
appreciate that
the Patreon we appreciate the
donations we appreciate
we'd also recommend you know what why
don't you make a
contribution that contributes to your
own life as well
purchase the course come see me as a
patient
seeing me as a patient is expensive I
understand that and
it's not in a lot of people's budget but
as you know we have done a lot of work
to
make not only this free content but a
whole lot of content
like the courses which you
can get you where you need to be
My Bjj Labcorp's LP-IR looks at six lipid
metrics to estimate insulin sensitivity
yeah I've seen that one VLDL
particles LDL particles HDL particles
VLDL
size and LDL size HDL size what are your
thoughts on this lipid panel to estimate
IR
you know I don't think it's bad if you
if you go back and you look at what we
just talked about My Bjj
it's crystal clear that
I can tell a lot about somebody's carb
metabolism and whether they have
insulin resistance by looking at
HDL LDL
triglyceride VLDL you know those remnant
particles
that's why we went through what we went
through today so it's very interesting
I'm
very interested in a cholesterol panel
but not like most other docs are and for
the reasons that we talked about today
so
yes that's a helpful
those are helpful indicators now here's
my problem with it though
Quest has a similar index
these labs however don't share with you
exactly what they're looking at
and what they're making their decision
on and how they're making their
recommendation
so what I would rather do is look at the
actual numbers
and go over with them as with you as a
patient
look at my own numbers and see
exactly what's going on
thank you so much great question I
scored the ideal category for
for all six LP-IR markers without any
meds
Labcorp says I'm in the most insulin
sensitive group
also my triglycerides only 46 and HDL 74
those are some impressive numbers
triglyceride over hdl ratio is 0.62
yet my fasting blood glucose is often
100 to 110.
well again there's nothing like looking
at the real data
in term and the direct data now
one thing I would say though just given
what you've told me so far Bjj
you even though you obviously have
some
excuse me some of what's called the dawn
effect
the dawn effect is when in the dawn the
early hours of the morning
many of us tend to get well all of us
tend to have our spike
of cortisol in the dawn in the early
morning so
all of us tend to have our
highest natural blood glucose levels
in the early morning like that so
even though you have some dawn effect
you obviously are managing it very very
well and I'm not too worried about that
if those are some of the biggest
glucose numbers you're seeing
I'm obviously very interested to see
or would be very interested to see what
your numbers are
after a challenge I said a few minutes
ago
those are often the highest numbers for
people natural numbers meaning
numbers that are not created by a
challenge and a challenge can be
in the lab as well as a challenge with
you know burgers and a coke or something
like that unfortunately
too many people in the US and other you
know other parts of the world
are challenging our pancreas our
metabolism with
Big Macs french fries super-sized
Coke you name it not only once a day
seven days a week three times a day 21
times a week
maybe four maybe five times a day you
get that kind of challenge on a regular
basis and you're gonna wear your
pancreas out
and your arteries My Bjj however I've
recently brought
my fasting blood glucose down to 90-93
by being in keto and depleting my
glycogen
yeah there are some things to do I will
tell you this a lot of people get
really really worried about their dawn
effect
if you're managing your carbs
and managing your blood glucoses during
the rest of the day
I'm not I have to often counsel
patients
don't be quite so concerned about a
morning blood glucose of 100
to 110 those are not dangerous levels
like
you know 180 200 for
somebody who's got significant
glucose metabolism problems and eating
obviously
sometimes the wrong stuff
excuse me maybe I will
starting to get in into the allergy
season for me so maybe a little bit of a
challenge there
Amer Al Gayar hi from Germany which
part of Germany Amer
be very curious to see good morning Dave
Murphy I hope you're doing well
Saarland Saarbruken
well thanks for letting us know and
gosh I was hoping someplace like
Berlin my German I probably
shouldn't have even asked thank you so
much for sharing anyway
Amer first it's at 5:00 pm
5 pm in Germany where my mary is
Dave Murphy 97 percent O2 sat
and 62 beats per minute Dave you're
cooking along doing well
Dave Feldman thank you so much C Lear
yes Dave Feldman goes
way deep into a lot of discussion about
lean mass hyper responders
and one of the things he talks about is
the remnant cholesterol that one of the
images that we use in our slides came
from one of Dave
Feldman's illustrations of remnant
cholesterol
and again that's the high triglyceride
cholesterol
in healthy people you don't see a whole
lot of them they'll happen a little bit
after a meal
and then they get cleared out Art Berry
my primary
provider tells me a stress test is the
"gold standard"
but after listening to your
channel I've scheduled a
CAC test thank you and thank you for
sharing that Art
unfortunately we've got way too many
people
saying that stress test is the gold
standard and
again don't believe me go to the you
know the Princeton
Longevity site just look it up
go to the go to
Google false positive false negative
stress tests and the
snippet that will come up the Google
snippet will come that comes up will say
what is one and a half million stress
tests
out of the six to eight million that are
done this year
or were done last year prior to COVID
one and a half million we know are false
positive or false negative
so you gotta ask yourself are you
feeling lucky
thank you so much Art I appreciate the
information oh we gotta
well we've got a lot of participation
here I'm gonna try to keep up here
Dr. McChord great topic today my latest
triglyceride over HDL was down to 1.06
that is excellent Dr. McChord thank
you so much for sharing that
and glad to hear it diet and lifestyle
are so very important I've been
supplementing two grams of fish oil
daily one gram of niacin daily and
rosuvastatin 10 milligrams
only three times a week thank you for
sharing that that's a
good set of numbers you've got
a couple of comments that I will just
respond to quickly out of this
fish oil does tend to help with
triglycerides and in fact if you look at
things like Vascepa
I'm blanking on the generic name for
Vascepa
it's the new fish oil on steroids
it actually does help quite a bit
with the triglyceride part of the
triglyceride over HDL
ratio Nancy Salvaggio Dave Feldman thank
you thank you Nancy thank you C Lear
you know they say word finding
is the first big and it is there's no
question you look at the science word
finding is the first
big concern symptom
for dementia early decline
so obviously I stay nervous about that
now a lot of people laugh at me when I
say that
I'm obviously not at a significant
level of dementia
and the other thing I'd have to
share
as well is I've had word finding
problems since I was in the fourth grade
so but
it's an irritation so thank you so
much for
the help there I appreciate it Nancy and
C Lear
Dave Feldman Feldman yep Gary Radke
Dave
Feldman exactly John Benda
hi Dr. Brewer recently lost 230 pounds
let me repeat that that's amazing D.
Brewer recently lost
230 pounds how recent I mean that's not
something you do in a month
going low carb my triglycerides went
from 133 to 74.
however my HDL only went from 33 to 37.
not good taking 500 mg of niacin a few
times a week
any suggestions how to get my HDL up
well you already took
my first recommendation that was to
read up a little bit on niacin
I will tell you a lot of us
think that well here's the thing
500 of niacin a few times a week
may not get you there you may want to
try a little bit higher doses as in up
to two grams a day
that's certainly one thing some of the
other questions I would have would have
have to do with lifestyle
use of interval resistance training
high intensity intervals sleep
again deep deep subject
but a very important one HDL is
incredibly
important I hope that helps Beth Edens
good morning from North Carolina
Beth I am from South Carolina
Spartanburg
and we used to take day trips up into
the mountains there and my mother
is from Union County which is
real country a bunch of chicken farmers
her family are chicken farmers
and a wonderful group
not so many anymore but wonderful group
it's been a long time since I've seen
them and
I miss my family there
1957Kato talking about ethnicity and
triglyceride over HDL ratio
Latins have or suffer more from high
triglyceride is that true
you'll see a lot of science indicating
that
Hispanics Latinx
that ethnicity tends to have more
problems with triglyceride over HDL
ratio
and some would say specifically in the
triglyceride area
now here's one of the things that you
need to
to separate out and that's lifestyle how
much is lifestyle how much is
genetics how much of that matters
again on a person-by-person basis
you get you gotta get to that
question how much does that matter in
terms of
what causation may be
what really matters is how to fix it
but thanks it's a good question Dave
Murphy five
oh thank you Dave I appreciate that
another super chat
good to see the live again missed the
last couple of weeks flying to see the
kids
don't forget to like thanks again
Dave thanks for the super chat and
thanks for the reminder about likes
seeing you isn't as expensive as the
long-term costs of poor health
that you are helping correct thanks
thank you so much
Dave has shared a couple of times on the
channel that he's been a patient
I think he's also well he has he's also
shared that he lost 150 pounds
so you know Dave is like many others
gosh the vast majority of my patients
these days come from the YouTube channel
we're starting we're not completely
booked up
I can still see a few more probably
always would be able to see
a few more but
one of the things that often happens now
is I see patients so many patients come
in and they're like Dave they've
started listening to the channel they
started learning a whole lot
so the patients coming to me now are
extremely well informed
they often also are patients who
have ended up with some great numbers
and then you start saying well why do
you why are your glucose numbers looking
so good yet you're
you've got plaque and then since I've
begun seeing so many
YouTube channel patients I've now
learned to ask
did you lose 30 pounds sometime recently
and Dave's answer as he shared
with you guys is
no I lost 150 so fantastic work
so then the next question is
I'll see these patients and they'll say
yeah I've lost 30 pounds and I say well
you know what you've already done the
majority of the work you've done the
hard part you've saved yourself a couple
of decades
and it's very interesting what I hear
right after that
is yep Doc that might be true
but I know there's more that I can do
and guess what there's not a person that
I've heard say that that I would argue
with
yes there have there has always been
something more
that you can do thank you again Dave I
appreciate it
Saxgirl Hornboy five dollar super
chat thank you so much we appreciate it
these numbers make a difference
again we do some offshoring in
terms of some of the work
Aspen Sam Chris some of the folks
are from
the Philippines and so five dollars
goes a long way it may not seem like
much in
American dollars but it goes a long way
in terms of
helping move this channel ahead and
helping get this information
out to other people Saxgirl Hornboy how
much does the CIMT test
add to a recent calcium score
so if we can ever get that darn book out
we talk in depth about it but here's the
thing
both tests you know like like so many
ways of measuring plaque everything
has
its benefit and its risk the two three
of the best
are calcium score CIMT and a newcomer
to the block CT angiogram
computed tomography angiogram the thing
of the advantage about
CT angiogram is you get a picture a very
clear picture of where your plaque is
and what it looks like
Gerry Kurth shared one time that he
took his and
and taped it to his refrigerator door it
really helped him
think twice at snack time
the CIMT has a major advantage over the
calcium score in that
it tells you how much soft plaque
you have if any
the critical piece is not really so much
how
so much how much calcium have how
much
hard plaque you have the critical piece
the part that causes danger
is the soft plaque and that's what the
CIMT adds
to a recent calcium score I've gotten
to where so many people have come to me
with a CIMT
that was not well done because they went
to their local hospital or somewhere
else
I've gone to where I say you know what
if you're coming to see me just get a
calcium score
if you want otherwise we'll go ahead
and get started
and when it's time to get a proper CIMT
we'll do that
but again CIMT will give you clarity
regarding
soft plaque that you just won't get from
a calcium score
the downside of CIMT it can get messed
up so easily
it's not it's hard to standardize so you
need to be very careful where you get it
there we go Dr. McChord I've learned
another important
ratio to watch is ALT and AST
correlates with insulin
resistance
non-alcoholic fatty liver disease
endothelial dysfunction and
adverse cardiovascular events very true
you know Kevin you and I have talked
about it several times
I have done a couple of series on
non-alcoholic fatty liver disease it is
a big deal
it has become a major cause even of
liver cancer
and in fact I think it's in
females isn't it in females that it's
become a bigger issue than alcohol
not after fatty liver is a big deal and
thank you for bringing it up Dr.
McCord and ALT AST these are
very much related to that Jonathan Hull
hi Dr. B are you familiar with the
science and the relationship between
insulin resistance
and dementia what's your opinion oh I'm
so glad you asked that question yes
I am and I will
again I'll go down another bunny hole
and I think that this bunny hole is
very worthwhile I took the two-day
training
with Dale Bredesen you know Dale
wrote the book
The End of Alzheimer's and you know that
sounds very
aggressive I would just let you know
that if you go to the Alzheimer's
foundation that's their major ad
campaign right now too
the first Alzheimer's survivor is out
there
and so Dale's book publisher was the
one that pushed on that title
I think it's a great title I think I
think it's a great ad campaign for the
Alzheimer's foundation to have out there
there are
significant reversal components of
cognitive decline I've seen a reversal
of cognitive decline
in patients that we've dealt with now
how did I get interested in cognitive
decline again a friend
a friend and patient of mine read the
book
there was so much interaction
and so much overlap between insulin
resistance
and risk factors for cognitive
decline Alzheimer's
that he said Ford you got to do this and
in fact for a couple of years I was one
of the
providers for cognitive decline in
Dale's group we withdrew the focus
totally on cardiovascular work
we've thought many times about going
back in and
doing the insulin resistance component
of
the 39 holes in the roof that's the
Dale Bredesen work so let me just add
one other quick snippet
at the end of that two-day story Dr.
Bredesen walked up and said well Ford
what do you think
in terms of the course and
I sort of hesitated for because I didn't
know exactly how to say this it was
sort of a critical comment I said it was
great work
it was a great two days I learned a lot
and he looked at me and he said but what
and I said well
here's the concern I said you know I
don't know
what you think Dale you clearly know
that the insulin resistance prediabetes
is a big thing
and I would think that it causes at
least half
of Alzheimer's and he looked at me
funny and
and I said what and he said no I would
think it causes all of it
insulin resistance causes all
Alzheimer's and I said
really he said Ii said I tend to think
that too but I didn't think you did he
said oh yeah he said
if you look at the brain insulin is very
much involved and
we knew this insulin is very much
involved in actually
creating the biochemical process of
creating memory
because of that discovery there was a
lot of work in actually
having people inhale insulin snorting
insulin
that research didn't work but it still
doesn't have anything to do with the
fact that
insulin is involved with making memories
so if you so anyhow Dr. Bredesen's point
was
so even if you can't measure insulin
resistance in the body
we think it's going on and is a major
causative component
of memory loss in the brain
now what he didn't know and I didn't go
into it I mentioned it but
we didn't go into it it's the vast
majority of insulin resistance in the
body
is missed the vast majority of it over
90
of people that have insulin resistance
don't know so it's like
you're right major we're worried about a
a coronavirus pandemic we've had a major
cardiovascular
pandemic mostly driven by unrecognized
undiagnosed prediabetes
and it's not just causing the major
cause of it's not just the major cause
of death with heart attack it's not just
the major cause of disability with
stroke it's also the major cause of
dementia
so it's like it is a much bigger deal
than COVID-19 and pardon me for even
mentioning COVID-19 it's such a
political issue My Bjj per your
question when I do
a challenge with high carb meal I'm at
170
after one hour and about 130 140 after
two hours so yeah that's
the meals and the high carb meals is
obviously where
where I'm more concerned Bjj than your
about those your postprandial stuff your
post meal
glucose than I am about your
your 100 to 110 your dawn effect
that seems to clearly indicate insulin
resistance despite my LP-IR
score yeah see and that's another
point
you know you bring up another really
good point there are so many
"indicators" indices there's the
I'm blanking on Homa-IR
so many people seem to stay so focused
on Homa-IR
and the science behind that most Homa-IR
science focuses on a one-time shot
it's a ratio between blood glucose and
insulin
and here's the problem none of these
snapshots like Bjj just
just describe it you just nailed it the
snapshots do not
show the moving picture they don't tell
you the whole truth
you get a series of indicators from
Labcorp and they tell you you're fine
in reality you've got a big problem and
why did why did that happen
because you took a snapshot you didn't
take the full
you didn't watch the movie you didn't
challenge your
your metabolism with glucose
so you never saw the rest of it happen
again the vast majority of insulin
resistance
is just not being seen because that's
the kind of of advice
that the medical
the medical leadership is giving people
Jim Dandy you can try phosphatidylserine
at bedtime and see if it lowers your
overnight cortisol
thank you Jim Dandy and not exactly sure
what that
picture means it looks like the guy on
the monopoly we used to pay a little bit
of that
I'm not sure what he's doing Carlo Fusco
a question from Switzerland
well thank you for letting us know that
you're there how much does
this change the metabolic syndrome in a
prepubescent child or an adolescent
compared to an adult didn't quite I got
a little bit messed up on the English
does change
I will tell you this it was back
in World War II
they went you know when young men were
getting killed they began to see that
even very young men can have streaks
of plaque in their arteries
since then they've started looking I
mean that's what World War II we're
talking almost 100 years ago
since then there's been a lot of work to
look and find that you can
even start finding plaque fatty streaks and
arteries plaque
and kids that have just been born so
this process starts early it
is never too early to start focusing on
this issue
and unfortunately the vast majority of
my patients are
over 50 by the time they see me I have
seen several 20 year olds
and excuse me have applauded them and
their parents when their parents were
involved in getting them in to see me
Dave Murphy still having problems
getting a CIMT schedule in my area
CardioRisk says just keep checking
maybe a while
sorry Dave
it is what it is John B should Enduracin
improve triglyceride over HDL yes it
should
Enduracin is a wax matrix safe
form of no flush or low flush
niacin
I use it a lot
a lot of patients my patients have used
it
now niacin is one of the few it's the
only thing we know
prescription or otherwise which
tends to improve LDL HDL
triglycerides all of those things
it's a
it's a major actor now then you get into
a lot of studies about well
they didn't find an improvement in
cardiovascular experience
well not so fast
if you use laropiprant
that's a chemical that was given that
was added to
niacin to decrease the flush that you
get with niacin
that chemical impacted the
the effect of niacin
you look at others and that's again
not going to go down that bunny trail
but yes we talked about it a couple
times earlier
niacin two grams per day
sounds like a lot it is Jim Clark
what are your thoughts on
when to have your lipid levels run after
starting clean
keto I've heard to wait until weight
loss stabilizes then run them and not
before
well it depends on how hard it is for
you to get
get lipid labs
you know just the cholesterol panel and
the stuff that we showed on the
video earlier today
shouldn't be that hard it's not like it
takes a half-day like
an OGTT oral glucose tolerance or
insulin
survey but yes
I think the real question is how long
does it take them to stabilize
as I've well I didn't show you today
because that was a relatively new
patient's
chart I've got people that have had
they will continue the
going keto or low carb will tend to
have an impact on HDL
much quicker than LDL
depending on the amount of effect
we can start seeing effect within just a
couple of weeks
we will continue to see effect for
months down down the line usually to
have an impact on LDL
I've never seen that happen in less than
two to three months
and the vast majority will go on six
months or more but I will also tell you
this you can still
even though somebody has been on low
carb for
months I've got plenty of people on low
carb for years
that still have some of that impact on
those
those bell curves that I mentioned
earlier that big bite taken out of the
HDL
and the LDL moved over so those are not
always
assured of total reversal when you
change your lifestyle
but well we'll talk
we can talk about that further later if
there are other questions
Bob Weis is a good idea to eat 15 grams
of fat
when taking meds to help meds primarily
fat-based be absorbed
yeah it probably is
I have not been that fastidious about
when I take my
supplements and maybe that's my bad
Dave Murphy I really like the Enduracin
brand of niacin that you recommend
I do too again it's wax-based so
wax matrix so you get a little dose here
a little does here a little less there
and you're not getting things like
laropiprant
other chemicals in there that's the one
we've tried Rugby
Rugby is also really good
but more patients do better
with Enduracin My Bjj I'm planning to
get a Kraft
survey to see what's going on with my
insulin I think that's a really good
idea
I suspect possible low levels of insulin
from years of endurance
training maybe I should have I have
low IR but low insulin
I'm confused about what you're saying
I think what you what you might be
talking about
Bjj is a maybe a stage 5
diabetic once you burn out your
pancreas even though you push
on your blood sugar levels you still
just don't create much insulin
I don't
I may be able to find that in a few
minutes and actually show you
some graphs which make a lot of sense
but let's go back and see if I can do
that in a minute let me cover one more
question and
Robert Thompson I drop a few pounds
when I chew
nicotine gum regain weight when I quit
is nicotine gum harmful
I don't think it is actually there there
was a whole
a whole book about whether or not
nicotine itself
alone is what causes tobacco problems
there's no question
tobacco causes problems there is some
question though regarding
how much of that's due to nicotine not
gonna go
any deeper than that let me see
if I can if we have a
chart yes okay
let me cover this I think it's Bjj that
had a question about
low insulin and if you look at
there's been what's called
five stages of diabetes
and there's also Kraft diabetes
profile where he talks about different
stages
and let me just show those of you who
may not understand and I hope this is
what you're talking about Bjj
so normal pattern of a Kraft
diabetes profile is this is
glucose by the way and it's bumping up
to about 120
then it comes down to 100 and then back
down to 80
and it started at 80 the insulin
is should start at five or less for
basal insulin
then it can pop up it really shouldn't
get beyond
50 they're saying 80 on this chart
and then it comes back down
with the first pattern
or the first abnormality you tend to see
is delayed
insulin response and that's because
there are two levels of insulin response
one is stored insulin in your pancreas
the other is
insulin that your pancreas makes in
response
so when that stored insulin
stored insulin is not there because
you're burning it up too much
it tends to peak later at hour
one hour rather than half-hour that you
see in a normal
insulin response the blood glucose
levels go higher
and they stay high longer as you
continue to go you'll see pattern
3a which is further delay it's taking up
to two hours to get a
peak of pardon me
it's taking up to two hours to get a
peak of insulin there and again as you
can see
we're getting blood sugar levels that
are peaking and staying up there
until that insulin peak comes up
then you get 4 where
you get significant hypercholesterolemia
and your
patients are even though they're pumping
out 150
200 250 levels of insulin
their blood sugars are still going way
high 200 250 that's because
they are their insulin receptors in
their muscle cells and their liver
liver cells are resisting that insulin
now what Bjj was referring to
is if you go in these patterns long
enough
your pancreas will just give out
it will not make insulin much longer I
mean it just
it makes it but very very small
levels
and this is what they're calling
pattern 5 insulinopenic
penia means not enough of and
again the pancreas is just not making
that much insulin
I hope that has been helpful
and let me go back to the channel
okay thank you very much I think that in
I thought that ended our question we had
a few others
Steve Mitchum I can't do
super John Tocho super chat five dollars
thank you very much
John Steve Mitchum I can't do super chat
excuse me I can't do super chat how else
can I donate
Patreon works PayPal
works and if you click on those you can
go
I think those will help you
find out how to do that and again as I
said before just buy
buy a course or see me as a patient
Dave Murphy CIMT is still needed if
you've had a CT angiogram
again the CIMT is the one that's
really helpful for understanding whether
or not you're
you've got a soft plaque
Dave as we've discussed I don't think
that's a major issue for you now so I'm
not in a huge hurry and I don't think
you need to be in a huge hurry to get a
CIMT
I'd be patient wait we routinely get
those once a year anyway
so wow
5.49 I guess that's Deutsch marks
it looks like pounds to me but Amer
whatever it is thank you so much
I appreciate that very very helpful
Cole Mctarmach I wonder if that's
Scottish
my wife has me watching outlander
recently
hi Dr. Brewer thanks for the great channel
I'm 23 and lean well
thanks for your interest Cole I'm
concerned since I have an HDL of 35 you
should be concerned that's not a good
HDL to have as well as a family history
of early cardiovascular disease
any tips as far as prevention
I think one of the biggest questions
Cole that I have
for you is what's going on what is
causing that low HDL
is it part of a
prediabetic problem as I've
mentioned before we start seeing plaque
forming in
20-year-olds 15-year-olds 10-year-olds
and we see prediabetes
one of the major growing groups for
prediabetes is teenagers
so I think that's the major question I
would
I would ask is what's going on what
first assess the situation
Saxgirl Hornboy did you get the Jim
Dandy's
phosphatidylserine cortisol comment if
not any thoughts
here's the thing I don't think I'm
gonna be able to speak to
whether or not phosphatidylserine
actually
I haven't reviewed the science and on
that in
over three years the time that I did
look at that whether or not
phosphate whether or not
phosphatidylserine
actually improved cortisol
I don't remember it knocking me out of
the park and
I don't routinely take
phosphatidylserine
I'm
I have but I haven't looked at the
science in the past couple of years
Beth Edens keto for one year and down
70 pounds congratulations
70 pounds is enough to change your
health
dramatically again save you a couple of
decades
of or more of healthy life STEMI CABGX3
STEMI is
it's a heart attack basically CABG
is a
coronary artery by a bypass graft times
three
at age 50 now 56 and found high
Lp(a) one of my questions Beth
would be
how high was that Lp(a) given what
I do you can imagine I've got
a lot of patients with it triglyceride
over HDL was 0.68 the cardiologist will
only focus
on LDL of 180 frustrating
I can understand that LDL of 180
is significant again as I mentioned
earlier
it makes me wonder a little bit about FH
but the the stuff you've done in terms
of your
own weight I think are huge and
big big deal for your health thank you
so much guys we've gone way over
an hour today
I appreciate the interest and we'll talk
to you next week

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