3 Heart Experts Reveal What Really Prevents Heart Disease

21:25Most doctors measure glucose, but not insulin. I personally like to look at somebody's glucose trends over time, because if you think about something that's preventable, you don't want to wait till they cross that threshold to prediabetes or diabetes. So even in the range of so-called normal glucose mark, you know this. Somebody who's fasting glucose runs less than 85 is in a very different metabolic place than somebody who's fasting glucose is 95 to 99, even though they're both technically normal. that it's a spectrum of risk. And the farther along you marked that spectrum, the higher the risk of heart disease and diabetes.

22:01So if somebody's glucose used to be 85 and then it was 91 and now it's 98, we're going to talk to that person right off the bat about all the things they need to put into place to prevent it from progressing because they're already on that spectrum. We also want to know insulin levels, not just a fasting insulin, but sometimes the insulin response to food because the other thing that's emerged is insulin is a player. And way before somebody's blood glucose goes up, they might be pumping out tons of insulin to try to keep it in a good place. And insulin by itself contributes to inflammation and more weight gain around the middle, that visceral adipose tissue.

22:40So we want to know their insulin, both fasting and in response to a challenge.

22:44Dr. Mark Hyman:So wait, wait, wait. Are you saying there's sugar, not fat, that's causing heart disease? And sugar, the thing that's driving the insulin? Because fat doesn't cause insulin spikes. well there is some i mean fat is a player fat by itself fat by itself if you eat fat with other food it will but yeah yeah yeah and i would say i would say that quality of fat does matter and we can talk some more about that but i think fat plays a role with artery elasticity which is another component of vascular risk yeah so fried foods trans fats right fine oils those are nasty absolutely absolutely but but fat itself if it's made from whole food sources and nuts and seeds and avocados and olive oil.

23:23Dr. Mark Hyman:Might actually be beneficial. Actually beneficial, yeah. So what you're talking about is a set of diagnostic tests that are so important but mostly ignored. So the particle size and number, which nobody's doing. And the second is not just measuring your blood sugar, A1C, which may be perfect, and you may be in really bad trouble, but measuring also insulin in response to drinking like a couple of Cokes, right? I have a patient, Cindy, that I remember who was at super high risk for heart disease. And she had, uh, I mean, she looked like the Tasmanian devil. I mean, she was just like a round apple ball like this.

24:01Dr. Mark Hyman:And her belly was just like this big thing. And I'm like, this woman is in big trouble and she's inflamed. She's a high risk of heart disease, high blood pressure, diabetes. And I'm like, let's check her glucose tolerance test with insulin. And this was, you know, this was like 20 plus years ago. And no one was like looking at this. Even today, no one's looking at this. It's like, so hard. I mean, it took 50 years from the time the guy said, hey, we should wash our hands before surgery for us to wash our hands. You know, McKinley died, President McKinley, because he got shot in the belly. And the doctor, McBurney, stuck his finger in the wound to check it out without washing his hands.

24:34Dr. Mark Hyman:You know, that's like crazy. It took 50 years from the time the guy said, let's do a stethoscope so we don't get lice jumping into the doctor's hair to start using the stethoscope because the doctor used to put their head on the patient. So it takes forever. And we've been doing this. So anyway, this woman, I did this test, I gave her this drink and it was the most shocking thing I'd ever seen. And it taught me so much about what we miss in medicine. Her blood sugar was perfect, like 80, like, and, and she took the sugar drink and it was like perfect. Like it never went over 110 after taking like the equivalent of two Coca-Colas.

25:09Dr. Mark Hyman:Oh, she's fine. Her A1C was perfect. her insulin normally should be under five fasting and under like 25 or 30 after a drink her insulin was like 50 fasting wow and like 250 after a drink so her body was just pumping out insulin which was making her hungry slowing her tablets putting fat in her belly cells which were basically inflammation factories and leading to this perpetual cycle and she was able with 50 pounds like that when we cut out starch and sugar. And I just feel like, you know, that showed me so much because you can even do a normal glucose tolerance test. And that looks perfect. And if you were super hyperinsulinemic, you're going to miss that patient's real problem.

25:56And, you know, it's interesting, Mark, because that scenario is also associated with that cholesterol profile we talked about with a small, dense LDL and low HDL and the sequelae that we usually linked to diabetes. Fatty liver, peripheral neuropathy, all these other organs that are affected, and it can happen with the high insulins alone before the sugars go up.

26:18Dr. Mark Hyman:Yeah. It's a metabolic imbalance. Yeah. So that's really the take-home here, is that heart disease is really a hormonal issue around insulin and insulin resistance and an inflammation issue. So let's talk about the heart disease prevention, because people say, well, that story's been told. We've got statins, we've got this piece of SK9 inhibitors, we're all good. What's the big deal? What should we worry about. It's just all about LDL cholesterol. What's new? What should we be looking at? What should we be thinking about? And why are we still seeing so many people with heart disease? Yeah, it's still the number one killer around the world, not just here.

26:53And it's still the number one killer in women who, you know, they think that it's breast cancer. No, no, this is it. This is exciting because we do know the things that we've been reviewing for risk factors, but we have a way to now establish the risk. Are they really high risk without, before they ever have heart disease, 20 years plus. And the way we do that is we can get a simple lipid panel, add the LP little a, APOB, so a little more than what is the standard lipid panel. The LP little a will be part of a lipid panel in the next year or two. But anyway, when we get that lipid panel, which is again, very inexpensive.

27:35And we can also get a polygenic risk score, very inexpensive. We can also get a heart clock, right? And we can get inflammation markers. Anyway, now you have the full stack with your records and you have somebody who is well before they've ever manifest heart disease. And you say, oh, wow, this person is really high risk for heart disease. What do we do? Well, you get their LDL down, not just to low 70. We go down to 20 or less than 30, right? We have so many ways to do that now. We have these injectables that are against this PCSK9. We've got new drugs, five new LP little a drugs that are going to be out within the next

28:16Dr. Mark Hyman:year or so that are really popular. And we've had none of them, none until now. Yeah. We never had one. We always tell, well, too bad your LP little a is over a hundred, you know, nothing we can do. We're going to be able to change that. And that's going to have a big impact. We can get all the inflammation, get all over it, right? In terms of bringing the inflammation down, we've already seen how GLP-1 drugs do that before any weight loss. So that should work well in people who aren't even obese. And we've seen how that can prevent heart, preserve ejection fraction heart failure, which is half of all heart failure, right?

28:50GLP-1s prevent that. So for heart disease, we're seeing some really breakthroughs for the treatment, particularly the new target of LDL that we have five different drug classes, statins you've mentioned. But the PCSK9, we have three different ways to do that now. We got other new drugs that are coming. Just recently, the CETP inhibitor worked really well on top of... So we can stamp out inflammation. The other thing is we have a metric we never had before, which is AI. And by the way, that also goes with Alzheimer's. You can do a retina AI exam. So I have a picture of the retina and you do AI on it and it tells you when you're going to have Alzheimer's, if you're going to have Alzheimer's, five to seven years in advance.

29:37The retina also tells if you're going to have heart disease or a stroke in advance. It will even tell if you're going to, you know, your calcium score of your heart arteries through your retina. It's remarkable. And that should be widely available. It isn't yet, but it will be. We'll be doing smartphone retina checks someday, right? But here's where we get a real kick on, a jump on this, because if you are concerned about high risk, and somebody, you know, say 40, 50, they have significant risk factors, you can do a CT angio, which is now becoming very inexpensive, and you can look at inflammation in the artery.

30:22I go through this in the book. Inflammations in the artery without a narrowing, okay? So the, It basically does AI of the fat around the artery. And this is something that was developed in the UK. And it's now getting ready for FDA approval. This is a big jump because we always were -

30:40Dr. Mark Hyman:So this isn't the clearly scan? This is something else? No, no. Clearly and the other ones in the US don't do this. But this is a Oxford, University of Oxford spin out. I think it's called Carista. They're going to have that available soon. and I went through the data in the book. I mean, they've had multiple papers, but it's striking. If you have inflammation without a narrowing, it's, you know, you could have 15-fold risk of a heart attack. So that's when you use that as a metric, just like we were talking about the P-Tau 217 for Alzheimer's. We've got all these new things for cardiovascular.

31:18We are going to get a grip on this and we got to, you know, ideally start early, but, you know, the lifestyle factors work really well. This is the most preventable known of the three big age-related diseases through lifestyle.

31:31Dr. Mark Hyman:Because even without a lot of the drugs, lifestyle plays a big role. I've seen data up to 90 % by healthy diet, exercise, stress mitigation, sleep, right? Yeah. In the book, I found all these studies that I was really struck by that are recent that showed that if we practice the lifestyle factors that we've been reviewing with the details that we discussed, that gets us seven to 10 years of healthy aging without one of these age-related diseases. I mean, who wouldn't want seven to 10 years of healthy aging just from the stuff we've been discussing without any magic potion or pill? So that's, I think, people don't know about that.

32:14I didn't know about that.

32:15Dr. Mark Hyman:It's really impressive. That's powerful. So, So what you're saying is some of the advances in cardiology are more pharmacological that you're thinking are coming, like the drugs that lower this genetically determined lipoprotein called LP little A, which I've been checking for 30 years. ApoB, which I've been checking for 30 years. I read some article the other day that was like, there's this great new test that can be more predictive of your risk of heart attack than any other test has just discovered. I'm like, what is that? I'm like, look, click through the article. It's like ApoB. I'm like, oh God.

32:45I mean, you only need to get it once, and then you can tell if you need to check it further. But you're getting at a key point here. It isn't just that we have better, more armamentarium of drugs, but we didn't know how to get the risk down. We didn't know how to say, this person's really high risk for atherosclerosis because we didn't use the polygenic risk score. We didn't have, as we do now, we're going to have a heart clot. we so there's a big debate out there as you probably know how low should we go on ldl should we pull out all the stops well if you look at all the data the lower you go the more protection but you don't want to necessarily give people you know ezetimibe and statin and a injectable and all these things unless they really are at high risk then you go for broke and you also get the lpa and you get the inflammation down we have ways that we can do that and we're going to keep having better ways.

33:45So this is a striking, it's a combination of who's at risk, the partitioning risk, and having a better ways to work on that risk.

33:54Dr. Mark Hyman:Just to play devil's advocate, because this conversation comes up all the time, you're a cardiologist, so your favorite organ is the heart. And so your idea is get the LDL as low as you can. But your brain is made up of a lot of... Only in people who are at high risk. And people are at high risk. Okay, so if you're really high risk. But like, what about the effects, for example, on the brain and cognitive function, because the cholesterol is a big part of your brain and sex hormones, which is what your testosterone is made from is cholesterol. So how do you kind of navigate that? And what's the truth then?

34:23Dr. Mark Hyman:What do we know? Yeah. I mean, the statins are probably the most studied drug class in history, really. Some of the data that comes out of these big meta-analyses would say, oh, people don't get any leg cramps. That's not true. You and I know that's not true. People do get severe leg cramps where they can't even sleep at night, you know, and all sorts of other, you know, leg and muscle related symptoms. Now, with respect to cognitive and sexual dysfunction, the data really don't show a hit there at all. And in fact, you know, I think that we have some data to suggest the chances of having dementia in people, and Alzheimer's, as you know, accounts for 70 % of dementia, that if you don't have the LDL lowered to, let's say, less than 100, less than 70, you're going to be at higher risk for dementia.

35:23So if anything, the data support statins, and you know the data for sexual dysfunction it's again some of that's vascular and it if it's vascular we're talking about atherosclerotic uh and that again is going to be uh ameliorated with and of course we don't have to just rely on statins a lot of people do have side effects from status no matter what the group at Oxford keeps saying that everyone can take a statin and And it's just, you know, it's mental if they can't. When I wrote an op-ed in the New York Times like a decade ago, and I called out the diabetes from statins, okay? Because if you take a very potent statin, you have a higher risk of developing type 2 diabetes, right?

36:10Oh, did I get slammed by my cardiology colleagues for that? I think, well, wait a minute. That's the data, folks. I'm sorry. And over the years, we've seen many more reports about, you know, the potent statins, high doses where you get a higher risk. And you know what? Most physicians are not keeping up with this. They're not watching their patients to see if their glucose, glycohemoglobin, you know, A1C or fasting glucose. And this is bothersome to me because that is a side effect of statins, particularly potent statins. So again, this is important because if we're going to lower LDL and pull out all the stops and, you know, high doses of resuvastatin Crestor or atorvastatin Lipitor, that could also raise the risk of that person developing type 2 diabetes.

36:55We don't want to do that. And we have cardiologists, my colleagues, they are really sold on statins and they basically ignore this diabetes issue. And did I ever take grief? No.

37:10Dr. Mark Hyman:I agree with you. And I think there's a concern I have around its effect on mitochondrial function. And some of the data I've seen that even in people without muscle pain, even without elevated muscle enzymes, that there's mitochondrial damage on muscle biopsies. And for me, mitochondria are so key to healthy aging in the brain, in everything from Parkinson's to heart disease, diabetes. Diabetics have poorly functioning mitochondria. That may be part of why it causes it. And so I'm wondering, you know, some of these other drugs that are coming down the pike, even though some of them are expensive, maybe a better solution.

37:47Well, people that have clear-cut adverse effects, you know, the PCSK9 injectable drugs are a winner because they're potent. And they have not been associated with diabetes, which is really interesting. They have not been associated with cognitive or other side effects. So most insurers cover that now. We went through years where it was because they were so expensive, the cost has come down. So as long as people have the right indication where they have significant side effects or they need to have their LDL substantially lowered, it's usually not a financial stress for most people.

38:27Dr. Mark Hyman:So heart Z is still its lifestyle, but then there's a cocktail of other drugs in very high-risk patients that you can detect early to figure out. And what about lipoprotein fractionation, which is a lab test that we include as part of Function Health, as well as APO-B and LPA, something I've been testing for 30 years. But do you think that's as important? Because to me, the particle number and particle size story is important. And it's sort of a clue that there's insulin resistance, which is one of the biggest drivers of heart disease and all the other age-related diseases. Yeah, I mean, I think it's mild, potentially mild incremental information.

39:01I just don't see that it has nearly the impact of just zeroing in on LDL and LP little a. And I do recommend everybody get an ApoB at least once. And then you can figure out whether that needs to be further assessed. These other things, you know, it's an additional expense. I just haven't seen the value. But, you know, I have colleagues that are lipidologists that test every known particle in the mankind, right? I just haven't. I haven't really seen the benefit because it doesn't change usually. To me, I got to know the person's risk. And then I'm going to go after inflammation. I'm going to work on their lifestyle.

39:40And if necessary, get their LDL down as low as possible. So the other things just don't have, for me, added value. But I do know there are people that are wild and crazy on every particle, small, large, dense, you name it, out there. Yeah.

39:59Dr. Mark Hyman:Yeah. So I hear you on that. I think it's, you know, sometimes more information isn't always better, but you know, then what is the most important information? I think you cover that in your book. And I think, you know, we're going down the kind of the horseman of the apocalypse, you know, the, uh, the, the, the heart disease, the cancer, the dementia, I think diabetes is sort of all in there related, but you're talking about how there's kind of a newer, with the advances in our diagnostics, whether it's imaging or retinal scans or new, new ways we can measure dementia biomarkers we never had before cancer we'll get into in a sec that these diseases can become more optional like they're not inevitable they have more agency than we ever had before given what we know now and when you layer what we're learning with a ai and using multimodal treatments we're really able to actually make a big dent if people really understood how to navigate this and the sad part is that you know you spend your time thinking about what's coming, most physicians are just trying to deal with the onslaught of what is and don't have the bandwidth to actually apply this stuff until it kind of is way often decades later.

41:07Dr. Mark Hyman:And so I really appreciate your sort of paying attention to, you know, what's happening and keeping your nose to the scent of where things are emerging because otherwise people just don't know. And doctors, like you said, don't know. And the average person doesn't know, but this is such a hopeful message and and i'd love you to sort of unpack how you came to go from being a trained cardiologist who basically swallowed the gospel yeah to one who understands and has looked at the literature and has come to a different conclusion because it's not just that you're anti-drug or you're anti-medical care anti the system you're for the truth and for science and for an objective look at the facts.

41:50Dr. Mark Hyman:So the question I have is, how did you go from being a trained cardiologist who believed in statins to one who started to question statins to one who's come to understand that our approach to cardiovascular disease might be a little bit misguided? And we'll talk about what the right approach should be later. But I kind of want to start with, unpack the science for us. Because everybody listening has no one's heard if their cholesterol is high to take a statin. So statins cause side effects, which they do for a lot of people, probably 20 % get some muscle damage or some symptoms or increase the risk of diabetes.

42:22Dr. Mark Hyman:You know, we'll talk about that data. There's still a huge drive in our society for prescribing these and globally. Yeah, absolutely. So my interest in this came from really looking at the initially the obesity epidemic. So 2004, WHO announced it as an epidemic. You know, by 2010, I was in nine years qualified as a doctor. I was specialist registrar in my cardiology training. um i was seeing more people this viscerally i'm very sensitive to how to put it suffering around me if you like but also seeing my colleagues under more stress in the system i was like hold on a minute this if we carry on down this trajectory the whole healthcare system is going to collapse we want to even manage people acutely if they are ill right i never thought that would happen and and ultimately that one of my two of my own pay two of my parents both basically died because of failures in the system because the system's under so much stress, right?

43:16Never predicted that would happen. But that's where I started from. And when I looked into the issue of obesity, you know, I concluded that one of the root causes, Mark, if not the main root cause, was this flawed hypothesis that we should have low-fat diets to prevent heart disease. Food industry exploited that. Increasing sugar intake, increasing refined carbohydrate intake, it became quite clear. There was a clear correlation between that change in guidance in the late 70s in the US and early 80s in the UK when the obesity epidemic started to then take its trajectory down the wrong way.

43:50Dr. Mark Hyman:In 2011, I visited a farm in southern Spain and a grilled seabream harvested that morning from an 8 ,000-acre restored wetland estuary. Flamingos flew 150 miles just to eat the fish. I wrote about it that week and called it a model for the future of food. I've been waiting for someone to make that model accessible ever since that farm is still operating today same family same management team dan barber featured in his ted talk and still serves it at his restaurant blue help and it's one of the farm seatopia sources from every seatopia product meets the seatopia standard third-party lab tested certificate of analysis published for every batch i eat their king standard at least twice a week one serving delivers 3 414 milligrams of verified epa and dha more than most people get in a week of supplements in a single meal in the forms your brain and body actually use when i eat ctopia i can relax that's food is medicine free shipping on your first order at ctopia.fish slash hyman that's h-y-m-a-n if you're like me and tend to sleep hot you know the summer months can make staying comfortable at night a lot harder as a result i found myself paying a lot more attention to the fabrics i use every day especially the ones i'm sleeping in those of This bamboo sheet set has been a game changer for me.

45:04Dr. Mark Hyman:The fabric is soft and noticeably cooler, so I'm not waking up overheated in the middle of the night. I've also been reaching for their all-day tea a lot lately. It's soft, it's lightweight, and it still feels comfortable even on long, hot days. Sometimes the small things in your life can have a bigger impact on how you feel than most people realize, especially when it comes to comfort and sleep quality. If you're looking to upgrade your daily essentials, head to cozyerick.com and receive 20 % off. Yeah, and I covered a lot of this in my book, Eat Fat, Get Thin, which I sort of unpacked the whole history of how we got this low-fat craze, led to this high-sugar starch craze that then led to this dramatic rise in obesity, which now, of course, we're treating with another drug, the GLP-1 agonist, and, you know, just hepatite and some glutide or zempic and majoro.

45:46Dr. Mark Hyman:It's kind of crazy, right? You just kind of flipped it upside down. Oh, absolutely. So when I looked at that and started looking at the data and spending years and months and years looking at it and looking at different bits of data, I was able to put it all together. And I wrote a piece in the BMJ in 2013 called saturated fat is not the major issue, right? I read it. That's how I first came across it. Yeah. And that got a lot of attention, right? It was international news and British news and CNN international and whatever, you know, cause obviously suddenly you've got a cardiologist busting this myth that we think butter has been bad for our cholesterol.

46:15But when I did that, okay. So what I looked at the data and it was very clear, there was no clear association with saturated fat consumption and heart disease. So if that's true, then, and we know saturated fat raises LDL cholesterol, that means LDL cholesterol can't be that important. So, and if LDL cholesterol, the total cholesterol isn't that important as a risk factor, how do statins work? But I knew statins had a separate effect to low cholesterol, which is their anti-inflammatory and their anti-clotting. And I knew this even, it's well known within cardiology circles. You know, I trained as an interventional cardiologist, and that means keyhole heart surgery, stents, for example.

46:46Patient comes in, we didn't even check their cholesterol. Maybe some of the thinking was the lower the better, which we'll come on to as well. So it doesn't matter what their cholesterol starting from, the lower your cholesterol, the better. In fact, 2011, our cardiologist, one of the editors, I think, of the American Journal of Cardiology wrote an article, which I mentioned in my book, A Statin-Free Life, which was entitled, It's the Cholesterol Stupid. And what did he say in that? He said, you can be an obese diabetic smoker that doesn't exercise. That sounds crazy. But as long as your cholesterol is low enough, you're not going to get heart disease that's like like really so okay i had to unpick that and and and what i what i also then did moving forward from 2003 so that's how i got down this track realizing that our obsession with

47:34Dr. Mark Hyman:ldl lowering has been you looked at the saturated fat literature and you weren't impressed and data showed that it didn't both observational data and randomized control trials no benefit like in lowering it no association nothing right right and when you look at all the data so that was the first sort of bit that I was like, okay. And some might even have been protective, like some of the dairy fat. Well, we know now, yes, there is some suggestion that dairy fat could be protective, absolutely. So there's all that. And then coming back to the LDL hypersers. By the way, you're not alone on this.

48:01Dr. Mark Hyman:I mean, there was a major paper published by Dariush Muzaffarian from Tufts and others looking at butter and actually showing that there really wasn't evidence that it wasn't. So Mark, this is what's interesting. That article I wrote, because it creates such a lot of headlines and backlash or whatever else, that's when people like Darius started looking at this again. So it was all really from the back of that BMJ piece. It all came together. So then everybody's like, you know, I know. And at the time I was, I was writing this to a commentary, which was peer reviewed, but I could have got it wrong.

48:29I could have, but I was like, you know what? There's enough here for me to provoke the thoughts. And then it all got proven that, you know, what I'd written had validity, right? Which is good. But the other aspect of this, if we go back and you mentioned cholesterol, so the, So is high cholesterol a risk factor for heart disease? And is LDL a cholesterol risk factor? Yeah. So you have to go back to square one, right? So these are the Framingham studies that started in Massachusetts in 1948 and went over decades looking at thousands of people where a lot of risk factors emerged for heart disease, whether it's diabetes, high blood pressure, smoking, for example.

49:04High cholesterol. And high cholesterol, right? So you go and look back at the Framingham studies. and what and the just to summarize it without complicating the situation too much william castelli is a cardiologist and he published uh he was a co-director of framingham and in 1996 he published in one of the cardiology major cardiology journeys a summary of framingham specifically looking at ldl cholesterol let's just let's just look at ldl because that is the so-called bad cholesterol and he said from framingham unless your ldl was above 7.8 millimoles which by the way, I think in your units is probably 250 or 300, 250 probably, I think.

49:42Maybe we can look it up and calculate. But let's just say for argument's sake, around 250, which is very, very high, by the way. It absolutely had no, it was useless as a predictor for coronary heart disease. LDL. Now, why is that? When you correct for triglycerides and HDL, okay, which by the way is a more important predictor of heart disease, LDL loses its significance completely. completely so then if that's true and i'm saying that means ldl isn't really a risk factor for heart disease and i believe with everything i know now that to be the case okay let's let's unpick every part of it does lowering ldl cholesterol from diet or drugs but more specifically drugs because they're the most potent ways of lowering ldl cholesterol whether it's pck9 inhibitors whether it's statins whatever is the is there a clear correlation is this dogma true that the lower the better.

50:32So myself and two cardiologists did a systematic review of the totality of drug industry-sponsored trials, by the way, and some diet trials, but many drug industry-sponsored trials. All of the randomized control trials on cholesterol-lowering drugs, statins, PCK9, blah, blah, blah. Was there a clear relationship as you lowered LDL in low-risk and high-risk patients, Mark? Okay. Over 30 studies. Yeah. Was there a relationship with lowering LDL and preventing cardiovascular events? No. Even in high-risk patients? Even in high-risk. It's nonsense it's nonsense so the question then is why do we all so firmly believe so does that mean but then i said well of course statins have a role they do have a benefit from the from the rct data which is small because i knew already they're anti-inflammatory and anti-clotting so it's nothing in my view listen i could be proven wrong here but the evidence at the moment looks very clear that there is no consistent relationship right it's definitely not a clear relationship so if even if it's a weak relationship mark let's just argument say let's say there is a weak benefit learning ldl what else is going on and what else are you ignoring right yeah what else do statins do they cause insulin resistance say one in a hundred people get type 2 diabetes because of statins one in two one in a hundred one in a hundred yeah one in a hundred so about one to two percent but one in a hundred some some studies say one in 50 right we'll get type 2 diabetes because of the statin probably reversible still but not ideal right if you understand drug the The second thing is, look at the whole patient coming in.

51:56We have the illusion of protection. We have patients I used to see coming in and they thought, my cholesterol is low, I can go and eat at McDonald's, it's fine. And they're getting more and more overweight, more insulin resistant. They're increasing their cardiovascular risk. They're not told the statin is going to give them a 1 % benefit, i.e. more likely than not, they're not going to benefit. So you could imagine that concept that the overall net effect of the way that statins are prescribed and the dogma around them, in my view, has been negative and has actually been one of the main reasons why we have got this pandemic of chronic disease.

52:31Dr. Mark Hyman:Because we've overemphasized an index on LDL cholesterol and forgotten everything else. Absolutely. Right. Because there's a drug for it. It was interesting to me, if there was a drug for insulin resistance that worked really well, and we have metformin, but it's eh, and it fixed insulin resistance, you know, everybody be prescribing it, but we don't even diagnose it in most people because we don't have a drug for it. And it's stunning to me that, you know, I was talking to the lab director at Quest Laboratories. I said, what percent of your tests you get to come in are measuring insulin, which is, I think, one of the most important things you need to know about your biomarkers.

53:08Dr. Mark Hyman:And he was like less than 1%. And it's part of why I co-founded this company Function Health to really look at a deep biomarker set around cardiometabolic risk factors, including insulin, including LpA, including something called ApoB, which I want to talk to you about, not just your total LDL, HDL, triglyceride levels, but also particle number, particle size, inflammation markers, all the things that are often missed, but that are much better at giving you a holistic picture of your cardiovascular risk. And then you know where to intervene. And one of the studies that was so interesting to me was actually from, I think, Scotland, or Ireland was where they looked basically at a series of patients who came into an emergency room with a heart attack.

53:50Dr. Mark Hyman:And they did glucose tolerance tests on everybody who came in with a heart attack. And they found that two-thirds either had diabetes or prediabetes who had a heart attack. That that was really the big driver. Now, there's a subset of people who have familial lipid disorders, inherited genetic lipid disorders. And those people probably need to be treated more directly. But for the majority of people out there who are obese or have prediabetes or metabolic dysfunction, which is basically in America, 93 % of Americans, that's what's driving probably most of the heart disease, not butter or saturated fat or LDL elevations.

54:25Well, something else to throw into the picture, right? So you can make the argument, okay, Dr. Mahatra, you're saying there's no consistent relationship. There may be a benefit. Why not just lower your LDL? Okay. So 2016, and the reason we did this, me and a number of international scientists looked at, we decided to do a systematic review of observational data looking at people over 60. Was there a relationship with LDL cholesterol and heart disease? And the reason we did this, by the way, is another thing that was interesting from Framingham, which wasn't well publicized, is that when, after people hit 50 years old, as their cholesterol dropped, their mortality increased.

54:58So we thought, okay, is there something, you know, because for it to be a risk factor for heart disease, it should be consistent really across all age groups and both sexes, right? For mortality. For mortality, yeah. But even for heart disease as well right that's a good point so we looked at was there first of all any association if you're over 60 with ldl cholesterol and heart disease right we found none okay interesting but what was surprising was there was an inverse association with ldl cholesterol and all-cause mortality in other ways statistically if you're over 60 the higher ldl the less likely you are to die so what's the reasoning for that well something that's been forgotten or missed or not discussed cholesterol is has a very vital role in many functions in the body including you know brain the brain hormone production but also the immune system and it's likely that that's where the protective benefit comes because older people are more vulnerable to dying from infections and we also know there is an association i'll use this word an association right can't say it's definitely causal between low cholesterol and cancer again it's probably related to the immune

56:02Dr. Mark Hyman:system yeah i mean i think i think which is very interesting the problem of this data though is and I'll just push back a little bit, is it's observational data. And the data from the Hawaii study showed that you're older and you had higher cholesterol, you're more likely to live longer than if your cholesterol is lower. But it may be because the people who have low cholesterol are malnourished, have cancer, and other reasons. So let me push back on that. So we counted for that. And we found actually, no, when you count time lag, you would go back five or 10 years. No, it's not. That does happen.

56:28But no, it's independently, it does seem to be an issue.

56:31Dr. Mark Hyman:Okay, so you sort of looked at all the data, and you came up with this very kind of contrary opinion, which is that LDL isn't all that's cracked up to me, that statins work a little, but not for the reasons we think, meaning they lower inflammation, and they may have other properties that may be beneficial. So we don't even know what called this, pleiotropic effects. So they, for example, they induce nitric oxide synthase, which dilates your blood vessels and reduces inflammation and helps your lining of your blood vessels. All that's protective. And so it may be a stabilizer plaque. It may help in those ways, but it may not be the LDL-lowering effect.

57:06Dr. Mark Hyman:In fact, Paul Richter from Harvard, I remember he published a trial. I think it was the Jupiter trial where they showed that if you had a high LDL but didn't have any inflammation, you didn't have that significant risk of having heart disease. But if you had a high level of inflammation, high LDL, you had a much higher risk. So it was the inflammation that was really driving the heart disease. And that was really the seminal paper. It was in the New England Journal of Medicine over 20 years ago. I remember reading it by Paul Ritker and his crew that really laid out how heart disease is not a plumbing problem.

57:34Dr. Mark Hyman:It's an immune problem. 100%. It's a chronic inflammatory process exacerbated by metabolic risk factors or inter-resistance. And I wrote a editorial - Metabolic risk factors. By that you mean problems with your blood sugar and insulin. Inter-resistance. And prediabetes. 100%. And actually we published an editorial with two cardiologists I did in British sports medicine in 2017, which was a very long title, but it got a lot of publicity and more than a million downloads, which was saturated fat does not clog the arteries. Coronary artery disease is a chronic inflammatory condition, which can be effectively managed with lifestyle changes.

58:07That was the title of this thing, but it's all there. It's free access. People look it up and read it. But we talked that we've overdone the thing. And it wasn't just Dr. Mahatra, his opinion being controversial. My two co-authors were both editors of medical journals and cardiologists. Lief Redberg, editor of John Metatural Medicine, and Pascal Meyer, editor of BMJ Open Art.

58:23Dr. Mark Hyman:So why is this not getting more play? Why is still the dogma and the orthodoxy that if you have a high LDL, you take a statin? Do you want my honest answer, Mark? Yeah. I mean, I know doctors are usually very good-hearted, very smart, well-intentioned, don't want to hurt their patients. try to do what's in the best interest of their patients and follow the science. So why are they not hearing about this? Okay, so let's go to the root cause of the problem. Even in society today, what's the big issue in health? We have commercial distortions of the scientific evidence. Who is behind that and who has more power and control over medical education, medical training, the media than ever before?

59:08Big corporations, in this case, big pharma. And the level of this control and power mark has got to a level where it can be very easily and rationally not in an inflammatory way or overplaying it as as being tyrannical what all what what also happens with these big corporations in the way they exert their power is that they want to avoid conflict right they want to avoid the truth coming out so there's a debate and discussion because ultimately people like myself like you who are obsessed with the truth who want to get it out to help patients when we speak and act from a place of of integrity and truth it has a very powerful resonance with people and it can very quickly destroy all these other dogmas that people have created because of that power that the truth has they want that conflict to remain latent to remain hidden so that you know noam chomsky says the general public doesn't know what's happening and they don't even know that they don't know that's right right so a lot of these doctors and i agree are well-intentioned, but they don't, they're living, you know, in many ways, they're living,

1:00:10Dr. Mark Hyman:they're climbing up the wrong wall to success when it comes to helping patients, because it's a drug companies that are really calling the shots. So we are under a situation of tyranny. And the reason I call it tyrannical is because there are doctors that know this, Mark, there are a few doctors that kind of know this, but then they're less, they're afraid to speak out. And only a minority of the doctors that know what's going on will then speak out. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at dr. Mark Hyman.

1:00:39Dr. Mark Hyman:Please reach out I'd love to hear your comments and questions Don't forget to rate review and subscribe to the dr. Hyman show wherever you get your podcasts and don't forget to check out my youtube channel At dr. Mark Hyman for video versions of this podcast and more Thank you so much again for tuning in. We'll see you next time on the dr. Hyman show This podcast is separate from my clinical practice at the ultra wellness center My work at Cleveland Clinic and function health where I am chief medical officer This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests.

1:01:09Dr. Mark Hyman:This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness Center at ultrawellnesscenter.com and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health.

1:01:43Dr. Mark Hyman:This podcast is free as part of my mission to bring practical ways of improving health to the public. So I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.