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Why your LDL cholesterol is not the best predictor of heart disease risk - and what is! · Hardiness with Dr Paul Taylor

• 0:09
  Speaker 1: Hey, everybody, Welcome to another edition of the podcast. And
• 0:12
  Speaker 1: this is a podcast that is about to change its name.
• 0:16
  Speaker 1: So in the next couple of weeks, I am going
• 0:18
  Speaker 1: to change the name of the podcast from the Paul
• 0:20
  Speaker 1: Taylor Podcast to the Hardiness Lab Podcast. And that reflects
• 0:25
  Speaker 1: a couple of things. Firstly, I have started a lab
• 0:29
  Speaker 1: with my old mate, so you'll be pretty familiar with
• 0:32
  Speaker 1: Professor Grant Schofield, and in that lab we are going
• 0:36
  Speaker 1: to be conducting research looking at the beneficial effects of hardiness,
• 0:42
  Speaker 1: both physical and psychological hardiness. The second reason for the
• 0:47
  Speaker 1: change the podcast is my new book, The Hardiness Effect,
• 0:51
  Speaker 1: is now out for pre order on Amazon, and that
• 0:55
  Speaker 1: really is reflecting all the stuff that we're doing in
• 0:58
  Speaker 1: the lab. And in that book, I go into all
• 1:01
  Speaker 1: of the research on psychological hardiness and how this is
• 1:05
  Speaker 1: the one psychological trait that you need in your life,
• 1:09
  Speaker 1: way above resilience, and also physiological hardiness, which people don't
• 1:15
  Speaker 1: really talk about, but me and Grant are going to
• 1:17
  Speaker 1: be exploring. So there we have it. Then we're going
• 1:19
  Speaker 1: to have a name change, and then if you like
• 1:22
  Speaker 1: my first book, Death by Comfort, jump onto Amazon and
• 1:25
  Speaker 1: you can pre order ny the hardiness Effect by doctor
• 1:30
  Speaker 1: Paul Taylor. Now let's get on with the podcast, and
• 1:35
  Speaker 1: today's show is a little bit of a hybrid. It
• 1:38
  Speaker 1: is a Saturday show, which is normally an interview, but
• 1:41
  Speaker 1: it's going to take the form of a kind of
• 1:44
  Speaker 1: extended Wisdom Wednesday podcast. And this is because I had
• 1:50
  Speaker 1: a couple of listeners actually reach out to me, and
• 1:53
  Speaker 1: a couple of conversations with friends that kind of all
• 1:57
  Speaker 1: around the same topic around cardiovascular disease. And I think
• 2:04
  Speaker 1: maybe the driver of those conversations was obviously me having
• 2:07
  Speaker 1: my open heart surgery, but talking about assessing your risk
• 2:12
  Speaker 1: for cardiovascular disease and the whole talk about LDL cholesterol.
• 2:18
  Speaker 1: So I thought this is worth a deep dive, and
• 2:22
  Speaker 1: what I'm going to talk about is probably going to
• 2:25
  Speaker 1: blow your mind. And we're going to talk about the
• 2:28
  Speaker 1: limitations of LDL cholesterol, why it's there as a marker,
• 2:33
  Speaker 1: but also a simple blood marker that predicts your risk
• 2:37
  Speaker 1: of dying from a heart attack between three to five
• 2:40
  Speaker 1: times better than your LDL cholesterol, which is the number
• 2:44
  Speaker 1: that your doctor tends to obsess about. And here's the kicker.
• 2:49
  Speaker 1: It's been hiding in plane sight on your standard blood
• 2:53
  Speaker 1: work this entire time, and as well as being a
• 2:59
  Speaker 1: very strong per day of your risk of cardiovascular disease
• 3:02
  Speaker 1: and dying from a heart attack, it also is a
• 3:05
  Speaker 1: strong predictor of your risk of metabolic disease, particularly type
• 3:09
  Speaker 1: two diabetes. And if you take those two together, cardiovascular
• 3:14
  Speaker 1: diseases and type and metabolic diseases, and they account for
• 3:19
  Speaker 1: a wobbing proportion of ill health and early deaths. So
• 3:25
  Speaker 1: actually getting on top of the two of them with
• 3:27
  Speaker 1: one blood marker, I think is really key. So let's
• 3:31
  Speaker 1: start with a question. It's going to make it. Think
• 3:35
  Speaker 1: how many of you being to the doctor, got your
• 3:37
  Speaker 1: cholesterol checked and walked out thinking that you knew everything
• 3:40
  Speaker 1: about your heart health because your LDL you're bad cholesterol
• 3:44
  Speaker 1: and inverticomas was in the normal range. Well, I hate
• 3:47
  Speaker 1: to break it to you, but you've been focusing on
• 3:49
  Speaker 1: their own number, and we're going to dive into the
• 3:52
  Speaker 1: cold heart science about that. So let's first paint the picture.
• 3:56
  Speaker 1: For decades, and I mean decades, the medical ist bablishment
• 4:00
  Speaker 1: has been layers are focused on LDL cholesterol as if
• 4:04
  Speaker 1: it's the holy grail of heart health, and they've built
• 4:08
  Speaker 1: entire treatment protocols around it, billions of dollars in stating prescriptions,
• 4:13
  Speaker 1: countless dietary recommendations, all centered around this one number. But
• 4:19
  Speaker 1: here's what they don't tell you. Half of people with
• 4:22
  Speaker 1: high cholesterol never have a heart attack, and half of
• 4:25
  Speaker 1: people who die from heart attacks do not have high cholesterol,
• 4:29
  Speaker 1: particularly they have normal LDL cholesterol. And this is such
• 4:34
  Speaker 1: a big predictor. Why is it that half of people
• 4:38
  Speaker 1: who die from heart attacks don't have what they think
• 4:42
  Speaker 1: is the best predictor? Just think about that for a second.
• 4:46
  Speaker 1: This is like flipping a coin. If half the people
• 4:48
  Speaker 1: with high cholesterol never have a heart attack and half
• 4:50
  Speaker 1: the people who die from heart attacks don't even have
• 4:52
  Speaker 1: high cholesterol, this is a coin flip. Now, don't get
• 4:56
  Speaker 1: me wrong. LDL cholesterol is not completely useless. The research
• 5:01
  Speaker 1: is clear that it is associated with cardiovascular events. Right,
• 5:05
  Speaker 1: So we're going to dig into the research here, so
• 5:08
  Speaker 1: strap yourself in. So there's a massive meta analysis of
• 5:11
  Speaker 1: sixty randomized control trials that showed for every one millimoll
• 5:17
  Speaker 1: per liter reduction in LDL cholesterol, and you get about
• 5:21
  Speaker 1: a twenty two percent reduction in major vascular events, right,
• 5:26
  Speaker 1: which seems to be pretty compelling. But here's where it
• 5:28
  Speaker 1: gets interesting, and this is from a study published in
• 5:31
  Speaker 1: the Journal of the American Heart Association that looked at
• 5:34
  Speaker 1: over fourteen thousand adults for more than twenty years. They
• 5:38
  Speaker 1: found something that isn't really talked about very much, very
• 5:42
  Speaker 1: low LDL levels below seventy mailograms per deci leader, which
• 5:49
  Speaker 1: translates to about one point eight one milli moles per lider.
• 5:55
  Speaker 1: Now it's a little bit confusing. I realized I just
• 5:57
  Speaker 1: need to explain this. This is like the US use
• 6:02
  Speaker 1: milligrams per deesto leader, some places like Australia in the
• 6:05
  Speaker 1: UK use millimoles per leader. In order to convert milligrams
• 6:10
  Speaker 1: per dest leader to millimals per leader, you divide by
• 6:13
  Speaker 1: thirty eight point sixty seven. You can just look for
• 6:16
  Speaker 1: a cholesterol ratio. Now I may use these two terms
• 6:18
  Speaker 1: interchangeably based on the different research where that research has
• 6:22
  Speaker 1: been conducted. But basically to say, to get back to
• 6:26
  Speaker 1: this very low levels of cholesterol the type that they
• 6:30
  Speaker 1: often want you to get down to, so below seventy
• 6:34
  Speaker 1: milligrams per deest leader are below one point eight one
• 6:38
  Speaker 1: milli moles per liter. And what they actually found was
• 6:43
  Speaker 1: it was associated with increased mortality, a forty five percent
• 6:49
  Speaker 1: higher risk of all cause mortality to be exact. Now,
• 6:53
  Speaker 1: that is absolutely massive, a forty five percent increased risk
• 6:59
  Speaker 1: of death from any cause. That is something that you
• 7:02
  Speaker 1: need to sit up and take notice about. So whilst
• 7:06
  Speaker 1: lower LDL cholesterol you seem to get a reduction in
• 7:09
  Speaker 1: major vascular events, you can't go too low and then
• 7:14
  Speaker 1: with very high levels, so above one hundred and ninety
• 7:20
  Speaker 1: milligrams per desi liter, which equates to an LDL level
• 7:26
  Speaker 1: of four point nine millimles per liter, So that that
• 7:29
  Speaker 1: is pretty bloody high, and that was bad too in
• 7:34
  Speaker 1: terms of risk for all cause mortality. But the point
• 7:37
  Speaker 1: is LDL cholesterol seems to have this weird u ship
• 7:42
  Speaker 1: relationship with death that nobody wants to talk about, in
• 7:45
  Speaker 1: that high levels are clearly not good, but low levels
• 7:49
  Speaker 1: are clearly not good as well. Let's now talk about
• 7:54
  Speaker 1: the game changer, and this has been as I said,
• 7:56
  Speaker 1: hiding and playin insight on your blood tests, and that
• 7:59
  Speaker 1: is your try glyceride to hit DL ratio. So triglycerides
• 8:04
  Speaker 1: are basically a measure of the excess fat that is
• 8:09
  Speaker 1: running around your bloodstream and it's often because we're just
• 8:12
  Speaker 1: eating excess energy, particularly excess carbohydrates. Hats DL, you may remember,
• 8:18
  Speaker 1: is the good cholesterol in inverted commas. So let's talk
• 8:22
  Speaker 1: about this number that is a game changer, and that's
• 8:26
  Speaker 1: the triglyceride to hits the L ratio. Now, that isn't
• 8:29
  Speaker 1: an obscure, expensive test, and this is something that is
• 8:33
  Speaker 1: standard on every single lipid panel that you've ever gotten.
• 8:38
  Speaker 1: And what you do is your triglycerides are divided by
• 8:42
  Speaker 1: your HITS d L cholesterol and you get a number
• 8:45
  Speaker 1: and that's it. And here's the bombshell, the Framingham Massive
• 8:49
  Speaker 1: Framingham research study, so that this ratio can be three
• 8:53
  Speaker 1: to five times more predictive than a heart attack risk
• 8:57
  Speaker 1: than LDL cholesterol. About that. Now, let me walk you
• 9:02
  Speaker 1: through some of the research that is really going to
• 9:06
  Speaker 1: get you to think about this stuff. Right. So, a
• 9:08
  Speaker 1: systematic review and meta analysis published just a few years
• 9:12
  Speaker 1: ago looked at thirteen cohort studies with over two hundred
• 9:17
  Speaker 1: and seven thousand participants in total, and what they found
• 9:20
  Speaker 1: was pretty stunning. People with the highest triglyceride to hit
• 9:24
  Speaker 1: stale ratios had a forty three percent higher risk of
• 9:27
  Speaker 1: cardiovascar events compared to those with the lowest ratios. But wait,
• 9:32
  Speaker 1: it gets more interesting in the Cooper Center Longitudinal study.
• 9:37
  Speaker 1: And in this they were following about forty thousand men
• 9:41
  Speaker 1: for over half a million person years. So what they
• 9:45
  Speaker 1: do is they obviously get the forty thousand and they
• 9:47
  Speaker 1: were following them for over ten years each, twelve twelve
• 9:52
  Speaker 1: and a bit years each, and they tried glysride to
• 9:55
  Speaker 1: heat Sdale ratio predicted Carnelie heart disease, cardiovasc disease, and
• 10:01
  Speaker 1: all cause mortality even after adjusting for all the traditional
• 10:07
  Speaker 1: risk factors, which included LDL cholesterol. And here's my favorite,
• 10:12
  Speaker 1: probably to pick up a bunch. And this study looked
• 10:15
  Speaker 1: at women with suspected heart problems and something that's called
• 10:19
  Speaker 1: the Women's Ischemia Syndrome evaluation. You can look that up.
• 10:24
  Speaker 1: And the triglys stride to hit the L ratio was
• 10:27
  Speaker 1: such a powerful predictor that women in the highest quartile,
• 10:31
  Speaker 1: so the highest twenty five percent, had a hazard radio
• 10:35
  Speaker 1: ratio of one point nine to five for death by
• 10:39
  Speaker 1: all causes. That means they were almost twice as likely
• 10:43
  Speaker 1: to die compared to the women in the lowest twenty
• 10:47
  Speaker 1: five percent for the draglystride to hit SDL ratio. So
• 10:50
  Speaker 1: to be clear on this, what you want to have
• 10:53
  Speaker 1: is low traglyst rides and high levels of hithdl. So
• 10:58
  Speaker 1: why is this ratio better than ldale cholesterol? I think
• 11:02
  Speaker 1: it's useful to really dig into it. So ldale cholesterol
• 11:07
  Speaker 1: is like looking at one picture of a very very
• 11:11
  Speaker 1: complicated puzzle. And LDAL cholesterol they don't actually measure directly.
• 11:17
  Speaker 1: It's done through a formula, which and I don't want
• 11:21
  Speaker 1: to dig into it because it just gets a bit
• 11:23
  Speaker 1: mind blowing. But the formula actually predicts your LDL cholesterol
• 11:28
  Speaker 1: and sometimes it's not tremendously accurate. Right, But let's talk
• 11:34
  Speaker 1: about trigger started to hit stale ratio firstly, and this
• 11:39
  Speaker 1: is really really important. It is a marker of insulin resistance. Right.
• 11:44
  Speaker 1: And you may have heard people like Peter Atia, doctor
• 11:47
  Speaker 1: Peter Atia talk about the four horsemen of chronic disease.
• 11:53
  Speaker 1: These are the four big buckets of chronic disease, and
• 11:58
  Speaker 1: they are cardiovascular disease also also metabolic diseases such as diabetes,
• 12:06
  Speaker 1: chronic kidney disease. These sorts of things that tend to
• 12:09
  Speaker 1: be lumped in together. We also have neurodegenerative diseases, and
• 12:13
  Speaker 1: then we have all the cancers. So if you put
• 12:15
  Speaker 1: them together, they're called the four horsemen of the apocalypse. Right,
• 12:19
  Speaker 1: and what your hites DL, tri grad trig sorry truglist
• 12:22
  Speaker 1: right hates DL ratio does. We've already established that it's
• 12:25
  Speaker 1: a very important predictor more important than ALDL of cardiovascular diseases,
• 12:31
  Speaker 1: but it is also the best predictor of metabolic diseases.
• 12:36
  Speaker 1: And that's because it's a marker of insulin resistance. When
• 12:39
  Speaker 1: your drag list rides are high, remember that's the fat
• 12:43
  Speaker 1: that's running through your bloodstream, and your HDL is low,
• 12:47
  Speaker 1: it is a sign that your body is struggling to
• 12:49
  Speaker 1: process glucose and fat properly. This creates a metabolic environment that,
• 12:56
  Speaker 1: as well as destroying your metabolism, is rocket fu for
• 13:00
  Speaker 1: heart disease. Secondly, this predicts the type of LDL particles
• 13:07
  Speaker 1: that you actually have, right, and we need to have
• 13:11
  Speaker 1: a little diversion on this. So your LDL that gets measured,
• 13:15
  Speaker 1: the number that you get from your doctor is the
• 13:18
  Speaker 1: total of all of your LDL particles. But those LDL
• 13:22
  Speaker 1: particles come in different sizes. Some are what we generally
• 13:27
  Speaker 1: refer to we put them in a bucket as big
• 13:29
  Speaker 1: fluffy LDL, and the other ones are small dense LDL. Now,
• 13:35
  Speaker 1: what we know from the research is that the small
• 13:39
  Speaker 1: dense LDL are the ones that are dangerous. They are
• 13:44
  Speaker 1: the ones that are athrogenic. It's those small dense LDL
• 13:49
  Speaker 1: that are the ones that get involved with the plaque
• 13:52
  Speaker 1: in your arteries. The big fluffy LDL are not pathogenic
• 13:58
  Speaker 1: at all. And what we know is your LDL test
• 14:03
  Speaker 1: that you get from your doctor tails you nothing about it.
• 14:06
  Speaker 1: So I'll give you a personal example. I've known for
• 14:09
  Speaker 1: years that my LDL cholesterol is reasonably high, but my
• 14:14
  Speaker 1: HATHDL cholesterol is also super high right now. I when
• 14:19
  Speaker 1: I saw my doctor years ago, it was talking about
• 14:22
  Speaker 1: the risk, but I kind of knew the research, and
• 14:23
  Speaker 1: I went and I actually had to pay to go
• 14:26
  Speaker 1: to a different lab and paid to get a whole
• 14:30
  Speaker 1: cholesterol panel which looks at the size of the LDL particles.
• 14:36
  Speaker 1: And you can get these from many different labs if
• 14:39
  Speaker 1: you work with a functional medicine doctor and they can
• 14:42
  Speaker 1: order you for them for them. Naturopaths can also order
• 14:46
  Speaker 1: them registered nutritious like me, you can also order them.
• 14:50
  Speaker 1: And what I found was that all of my LDL
• 14:54
  Speaker 1: is big fluffy LDL and very little of it was
• 14:59
  Speaker 1: small dense LDL. And then I know that my my
• 15:03
  Speaker 1: trag glytrides are very low and my hits d L
• 15:06
  Speaker 1: is very high, So that actually gives me a really
• 15:10
  Speaker 1: good profile in terms of cholesterol. And I've also looked
• 15:13
  Speaker 1: at something called apo B which is really interesting as
• 15:16
  Speaker 1: well as a little A but we're not we're not
• 15:19
  Speaker 1: going to dive into that because it gets a bit
• 15:21
  Speaker 1: more complicated. Let's just come back to this. So the
• 15:25
  Speaker 1: track glytride hits the L ratio as well as being
• 15:28
  Speaker 1: a marker of insulin resistance and your risk of developing
• 15:31
  Speaker 1: type two diabetes, chronic kidney disease, all those sorts of things, obesity,
• 15:35
  Speaker 1: and it also and it predicts that you will have
• 15:41
  Speaker 1: more small dense LDL. So the higher that ratio is,
• 15:45
  Speaker 1: the more likely you are to have small dense LDL particles,
• 15:50
  Speaker 1: the really nasty ones that burrow into your audio walls
• 15:53
  Speaker 1: like tiny bullets. Now, when this ratio is low, you
• 15:58
  Speaker 1: will have large, fluffy l L particles that are relatively harmless,
• 16:02
  Speaker 1: and that's exactly what mine showed when I tested both
• 16:05
  Speaker 1: of them. Now, thirdly, and this is crucial, the triglyceride
• 16:09
  Speaker 1: to Hitsdale ratio capture something called residual risk. This is
• 16:15
  Speaker 1: the cardiovascular risk that persists even when your LDL cholesterol
• 16:22
  Speaker 1: is perfectly controlled with statins. So we know from the
• 16:26
  Speaker 1: research on statins statins can be useful in preventing death,
• 16:31
  Speaker 1: but only the research shows only in people who have
• 16:35
  Speaker 1: had a carnary event or have existing carnary artery disease.
• 16:41
  Speaker 1: The other research shows that statins in other populations actually
• 16:45
  Speaker 1: does not reduce deaths from cardiovascular diseases. Now, let's get
• 16:50
  Speaker 1: back to this triglystid hits The ratio I study published
• 16:54
  Speaker 1: in the Frontiers in Cardiovascular Medicine looked at diabetic patients
• 16:58
  Speaker 1: with carnery ardy disease who were already on statins, and
• 17:02
  Speaker 1: guess what, The triglyceride to hats Dale ratio was still
• 17:06
  Speaker 1: a powerful predictor of death and cardiovascular events even in
• 17:12
  Speaker 1: those people with LDL cholesterol that was well controlled by statins.
• 17:17
  Speaker 1: So this is what we call residual risks. So let's
• 17:21
  Speaker 1: get practical. What should your triglyceride to hates DL ratio B. Well,
• 17:29
  Speaker 1: of course this answer is not straightforward because it depends
• 17:33
  Speaker 1: where you're actually from or what units that you use
• 17:36
  Speaker 1: to be more accurate, right, because the conversions are different
• 17:42
  Speaker 1: for triglycerides and for hits DL. So basically, if you
• 17:47
  Speaker 1: use US standard units, so if you live in the
• 17:50
  Speaker 1: United States or you're using those units, if your number
• 17:54
  Speaker 1: is in milligrams per desi liter, then the recommended ratios
• 17:59
  Speaker 1: are less than three. Well, what we know is that
• 18:02
  Speaker 1: above three that is where you really get into trouble.
• 18:07
  Speaker 1: Anything above three in men and above two in women
• 18:11
  Speaker 1: put you in the danger zone. Right, that's if you
• 18:15
  Speaker 1: use milligrams per deesta leader, if you use millimos per leter,
• 18:20
  Speaker 1: anything above one point three per man So if you
• 18:23
  Speaker 1: live in Australia, UK, those sorts of places, anything above
• 18:26
  Speaker 1: one point three of that ratio. So if your triglystrides
• 18:29
  Speaker 1: are one in a third times you hate the ler more,
• 18:32
  Speaker 1: then you're in trouble. And women anything above zero point nine, right,
• 18:36
  Speaker 1: then you're in trouble. Now, what is optimal in the US, right,
• 18:42
  Speaker 1: the milligram per destileter ideally for optimal for both men
• 18:47
  Speaker 1: and women. Here it should be less than one, so
• 18:49
  Speaker 1: your HDL should be higher than your triglystrides. Right. For
• 18:53
  Speaker 1: the international standard the people who use millimals per leader,
• 18:57
  Speaker 1: like in Australia, it should be less than zero point four, right,
• 19:01
  Speaker 1: so your Hatesdale should be more than double your triglycerides. So,
• 19:07
  Speaker 1: just to clear up any confusion, the reason why those
• 19:10
  Speaker 1: ratios are different is that the conversion formula for triglycerides
• 19:16
  Speaker 1: between American and miligrams for deest leader and minimals per
• 19:20
  Speaker 1: leader is different to the conversion formula for Hatessdale cholesterol.
• 19:24
  Speaker 1: So that's why there's a discrepancy in the ratio for
• 19:26
  Speaker 1: any of those. They have a bit of maths and things,
• 19:28
  Speaker 1: and this is a bit weird. Anyway, back to the
• 19:31
  Speaker 1: story here, and some other interesting research has come out
• 19:36
  Speaker 1: that this ratio, that the trigrisside Hatesdale ratio, is even
• 19:42
  Speaker 1: more powerful as a predictor for women. A study published
• 19:46
  Speaker 1: in the Journaly of the American Heart Association looked at
• 19:49
  Speaker 1: women with non obstructive carn reority disease. These are the
• 19:53
  Speaker 1: women who have chest pain and heart problems but don't
• 19:55
  Speaker 1: have the classic blocked arteries you see in men. The
• 19:59
  Speaker 1: triglyceride dale ratio was a powerful independent predictor of major
• 20:05
  Speaker 1: adverse cardio vascular events in these women. And here's the kicker.
• 20:09
  Speaker 1: In some populations, this ratio predicts cardiovascular risk in women,
• 20:15
  Speaker 1: while the traditional LDLD hates dale ratio doesn't predict anything
• 20:20
  Speaker 1: at all. This makes sense when you think about it.
• 20:23
  Speaker 1: Women's heart disease often looks different from men's. They're more
• 20:27
  Speaker 1: likely to have microvascular dysfunction and metabolic abnormalities, and the
• 20:33
  Speaker 1: triglyceride hates stale ratio captures that beautifully. Now you might
• 20:38
  Speaker 1: be wondering, if this research is so compelling, why is
• 20:42
  Speaker 1: my doctor talking about this? Why isn't this the major
• 20:46
  Speaker 1: focus when I go to get my blood tests? And
• 20:49
  Speaker 1: it's a great question. The answer is probably a little
• 20:51
  Speaker 1: bit frustrating. And firstly, medical education moves at the speed
• 20:57
  Speaker 1: of molasses. It's well known that it takes seven to
• 21:02
  Speaker 1: ten years to get from research into medical education, and
• 21:07
  Speaker 1: the research I'm sharing with you is relatively recent now. Second,
• 21:11
  Speaker 1: the medical system has been built for decades around treating
• 21:16
  Speaker 1: LDL cholesterol. We have drugs at lower LDL, we have
• 21:20
  Speaker 1: guidelines based on LDL and try treatment algorithms are LDL centric.
• 21:26
  Speaker 1: Changing that system is like trying to turn a friggin
• 21:30
  Speaker 1: oil tanker. Now. Third, and this is where you can
• 21:34
  Speaker 1: be a bit more cynical. There's a shitload of money
• 21:37
  Speaker 1: in the current system. Starting prescriptions are multi billion dollar
• 21:41
  Speaker 1: industries and studies are often funded by this. And I'm
• 21:45
  Speaker 1: not a conspiracy theorist, but when there are finance strong
• 21:49
  Speaker 1: financial interests, you do have to question stuff. And this
• 21:53
  Speaker 1: entire cholesterol industrial complex is built around LDL cholesterol. But
• 21:59
  Speaker 1: here's what's encouraging some forward thinking doctors really focus on this,
• 22:04
  Speaker 1: particularly if you have a functional medicine doctor, because the
• 22:09
  Speaker 1: research really is too compelling to ignore, or if you've
• 22:12
  Speaker 1: got a doctor who has the time to actually dig
• 22:15
  Speaker 1: into the research. So let's talk about the metabolic connection,
• 22:19
  Speaker 1: because this is huguely important. It's not like cardiovascular disease
• 22:22
  Speaker 1: is completely independent from metabolic disease. There is a very
• 22:27
  Speaker 1: strong overlap. You know, we are a complex ecosystem, So
• 22:31
  Speaker 1: when your triglycerides are high, it usually means one of
• 22:35
  Speaker 1: two things. Either you're eating too many refined carbohydrates and sugars,
• 22:40
  Speaker 1: or your body has become insulin resistant and can't properly
• 22:45
  Speaker 1: clear fat from your bloodstream. So, just to add a
• 22:49
  Speaker 1: little bit of color on that Althow, triglycerides are a
• 22:53
  Speaker 1: fat in the bloodstream. It's basically driven by refined carbohydrates
• 22:58
  Speaker 1: and sugars that I actually create those triglycerites, right, So triglycerites,
• 23:03
  Speaker 1: even though it's a fat, doesn't mean you're eating too
• 23:05
  Speaker 1: much fat. It's generally too much refined carbohydrates and sugars,
• 23:09
  Speaker 1: or just too much carbohydrates for your tolerance level, because
• 23:13
  Speaker 1: we can all tolerate different levels. Now, switching over to HATESDL.
• 23:17
  Speaker 1: When your hatesdale is low, that means that your body's
• 23:21
  Speaker 1: natural clean up crew, the particles that pull cholesterol out
• 23:26
  Speaker 1: of your artery walls and transport it back to your
• 23:29
  Speaker 1: liver for disposal, it's understaffed essentially. Now, when you put
• 23:34
  Speaker 1: these two together, you got the perfect storm. More athrogenic
• 23:39
  Speaker 1: particles in your blood, less clean up activity, and an
• 23:43
  Speaker 1: underlying metabolic dysfunction that creates inflammation and oxidative stress. And
• 23:50
  Speaker 1: a study published in Scientific Reports followed three hundred and
• 23:54
  Speaker 1: fifty five patients with stable angina for over four years,
• 23:59
  Speaker 1: and they find that patients in the highest quartile, the
• 24:02
  Speaker 1: highst twenty five percent of the tiger side hat stale
• 24:06
  Speaker 1: ratio had nearly three times the risk of death or
• 24:10
  Speaker 1: heart attack compared to those in the lowest quartile. And
• 24:14
  Speaker 1: this was independent of their LDL cholesterol levels, right, And
• 24:19
  Speaker 1: you don't get anything like that when it comes to
• 24:22
  Speaker 1: LDL cholesterol. You don't get three times the risk of
• 24:27
  Speaker 1: death or heart attack with people with high LDL compared
• 24:29
  Speaker 1: to those with low LDL. And that's how I talk
• 24:32
  Speaker 1: about the Cooper Institute, which is a really, really good
• 24:37
  Speaker 1: research institute. Now they've been studying health and fitness for decades,
• 24:43
  Speaker 1: and they looked at the relationship between cardio respiratory fitness,
• 24:47
  Speaker 1: which you've heard me talk about this BO two max
• 24:49
  Speaker 1: the single biggest predictive of how long you're going to live.
• 24:52
  Speaker 1: They looked at a relationship between that your trigglysarid hayte
• 24:55
  Speaker 1: stale ratio and death from cornery heart disease in men,
• 24:59
  Speaker 1: and what they found was pretty remarkable. Even among the
• 25:02
  Speaker 1: men with the lowest healthiest triglist ride to hate stale ratios,
• 25:07
  Speaker 1: those who were physically unfit were more than twice as
• 25:11
  Speaker 1: likely to die from heart disease compared to those who
• 25:14
  Speaker 1: were highly fit. But here's the really interesting part. Across
• 25:18
  Speaker 1: all fitness levels, men with higher triglyst ride to hate
• 25:22
  Speaker 1: stale ratios had significantly higher death risks our death rates.
• 25:27
  Speaker 1: This ratio was independent predictor regardless of how fit you
• 25:32
  Speaker 1: you were, and this is key when it comes to research.
• 25:36
  Speaker 1: When you see it across different groups or subgroups of people,
• 25:42
  Speaker 1: then you start to go, hey, this evidence is becoming
• 25:45
  Speaker 1: pretty compelling and it tells us something crucial. Fitness matters enormously,
• 25:50
  Speaker 1: as I've said, but metabolic health as reflected by the
• 25:54
  Speaker 1: triglist right hates stale ratio is very very important as well,
• 25:58
  Speaker 1: and it interacts with your fitness. So let's talk about
• 26:02
  Speaker 1: how we can use this information practically. So first of all,
• 26:06
  Speaker 1: you need to calculate your ratio, all right. You take
• 26:08
  Speaker 1: your trig list ride number on your results blood results,
• 26:12
  Speaker 1: you divided by your head stale number, and both should
• 26:15
  Speaker 1: be from the same blood test and ideally at fasted
• 26:19
  Speaker 1: blood tests because they can be affected, particularly your trig
• 26:23
  Speaker 1: list rights. So let's remember back to the formulas. If
• 26:26
  Speaker 1: you use the US centric milligrams per desant leader. If
• 26:30
  Speaker 1: that's what it says on your test. If your ratio
• 26:33
  Speaker 1: is above three for men or two for women, you
• 26:37
  Speaker 1: have to take action. And that more above that it
• 26:41
  Speaker 1: is the quicker and the stronger the action that you
• 26:45
  Speaker 1: need to take. And then if you use minimals per Leter,
• 26:50
  Speaker 1: if it's above one point four for women or not
• 26:52
  Speaker 1: point nine, sorry one point four for men and not
• 26:55
  Speaker 1: point nine for women, then you gotta take action. But
• 26:59
  Speaker 1: the good new is that this ratio responds beautifully to
• 27:04
  Speaker 1: lifestyle interventions. Low carbohydrate diets have consistently been shown to
• 27:11
  Speaker 1: dramatically improve the triglyceride to hit stale ratio. A meta
• 27:15
  Speaker 1: analysis published in plus one plus one showed that low
• 27:19
  Speaker 1: carb diets consistently lower trigly rides and reis hate stale cholesterol,
• 27:25
  Speaker 1: and exercise is equally powerful. A regular aerobic exercise and
• 27:31
  Speaker 1: regular strength training increases hate stale cholesterol. Particularly strength training
• 27:36
  Speaker 1: and both types of exercise help your body become more
• 27:39
  Speaker 1: efficient at clearing triglycerides from your bloodstream. Intermittent fasting can
• 27:45
  Speaker 1: also be incredibly effective because it gives your body regular
• 27:49
  Speaker 1: breaks from insulentce spikes, allowing your trigly rides. To normalize. Right.
• 27:54
  Speaker 1: So how you use this practically is doing those sorts
• 27:59
  Speaker 1: of informat intermittent fasting, so you know, stop eating three
• 28:04
  Speaker 1: hours before you go to bed and in fast for
• 28:07
  Speaker 1: twelve to sixteen hours, right, and that is going to
• 28:11
  Speaker 1: really get your insulin under control. And then eating low
• 28:15
  Speaker 1: carbohydrate diets with good amounts of protein and good amounts
• 28:19
  Speaker 1: of fat will keep your inchinin levels under control. And
• 28:22
  Speaker 1: just managing your carbohydrates is really really key for this thing. Now,
• 28:28
  Speaker 1: one other thing that I have actually been playing with
• 28:31
  Speaker 1: to keep that level lower, to keep insulin, which is
• 28:36
  Speaker 1: as we said, is reflected with your tagles start hit
• 28:38
  Speaker 1: stale ratio is for your breakfast is to just change
• 28:43
  Speaker 1: what your breakfast looks like, to make sure that your
• 28:46
  Speaker 1: breakfast is a high protein, high fat, low car breakfast.
• 28:52
  Speaker 1: And that is really key because it's the carbohydrate that
• 28:56
  Speaker 1: gives us the big insulin spike. So certainly not the
• 29:01
  Speaker 1: breakfast that a lot of people eat of breakfast cereal
• 29:04
  Speaker 1: or toast and orange juice, those sorts of things they'll
• 29:06
  Speaker 1: play havoc with that. You want to be eating stuff
• 29:10
  Speaker 1: like an omelet without the toast, and those sorts of
• 29:13
  Speaker 1: things are any of those ketigenic are low car breakfasts
• 29:19
  Speaker 1: are absolutely the way to go, and that will keep
• 29:22
  Speaker 1: your insulin under control for more than half the day,
• 29:26
  Speaker 1: which is really really important. Now here's something else that's
• 29:30
  Speaker 1: interesting to come out of the research. Certain medications can
• 29:33
  Speaker 1: improve your triglists right to hit stale ratio, but not
• 29:37
  Speaker 1: always in a way that you'd expect. So statins, which
• 29:40
  Speaker 1: millions of people take, they're cholesterol lowering drugs. They can
• 29:44
  Speaker 1: improve that the triglists are to hit stale ratio by
• 29:47
  Speaker 1: about ten to twenty percent. They typically lower tracklist rides
• 29:52
  Speaker 1: by up to fifty percent in some people. However, some
• 29:57
  Speaker 1: people when they take statins, their risk of diabetes and
• 30:01
  Speaker 1: metabolic function dysfunction actually goes up. So you have to really,
• 30:06
  Speaker 1: if you're honest, that you've gotta look at this stuff.
• 30:09
  Speaker 1: But there is other things, or there are other things.
• 30:12
  Speaker 1: Fibrates niacin, which is a vinamin one of the B vinamins,
• 30:17
  Speaker 1: and a mega three fatty acids are often more effective
• 30:20
  Speaker 1: at improving this ratio than statins, and they don't have
• 30:23
  Speaker 1: the side effects. They specifically target triglys rides and they
• 30:27
  Speaker 1: can rease hate DL cholesterol as well. So they're working
• 30:29
  Speaker 1: on both sides of the equation, and that's why quite
• 30:33
  Speaker 1: a few progressive cardiologists are starting to look beyond just
• 30:36
  Speaker 1: prescribing statins and are also considering combination therapies that target
• 30:42
  Speaker 1: the entire lipid profile, not just LDL cholesterol. So let's
• 30:47
  Speaker 1: go back and and really reconnect the dots around diabetes,
• 30:53
  Speaker 1: because this triglys ride hates the L ratio also predicts diabetes.
• 30:58
  Speaker 1: The Cooper Center for Longitudinal study found that trieglist rate
• 31:02
  Speaker 1: hits stale ratio was a strong predictor of developing type
• 31:06
  Speaker 1: two diabetes in man, so it's an early warning that
• 31:11
  Speaker 1: you're on your way to diabetes. That makes perfect sense
• 31:14
  Speaker 1: because this ratio reflects in shilin resistance, which is the
• 31:17
  Speaker 1: underlying driver of type two diabetes. And anybody tells you otherwise,
• 31:20
  Speaker 1: it's completely and utterly bonkers. So if your triglistrid hit
• 31:25
  Speaker 1: stale ratio is elevated, you're not just at high risk
• 31:28
  Speaker 1: for heart disease, you're also at high risk for diabetes
• 31:31
  Speaker 1: and all of the other metabolic consequences of that. And
• 31:35
  Speaker 1: if you develop diabetes, your cardiovascular risk goes through the roof.
• 31:41
  Speaker 1: This is why this ratio is so powerful it's capturing
• 31:44
  Speaker 1: an underlying metabolic dysfunction that drives two of the four
• 31:51
  Speaker 1: horsemen of chronic disease. Now age also plays a role here.
• 32:00
  Speaker 1: A meta analysis of LDL cholesterol reduction studies, so these
• 32:03
  Speaker 1: were intervention studies, found that the relative benefit of lowering
• 32:08
  Speaker 1: LDL cholesterol appears to decrease with age, particularly in primary
• 32:14
  Speaker 1: prevention and starting and trying to prevent disease before it
• 32:17
  Speaker 1: actually happens. But you know what doesn't lose its predictive
• 32:20
  Speaker 1: part with age, the triglyst right to hit the L
• 32:23
  Speaker 1: ratio right. So some of the research that's coming out,
• 32:26
  Speaker 1: just to give a bit more on that, shows that
• 32:29
  Speaker 1: LDL cholesterol reduction can be protective in people in their thirties, forties, fifties,
• 32:36
  Speaker 1: but once they get into their sixties, it's a lot
• 32:39
  Speaker 1: less protective. But managing the triglyst right hates d L
• 32:43
  Speaker 1: ratio works across all of the age spans. And it
• 32:47
  Speaker 1: makes sense when you think about it, because as we age,
• 32:50
  Speaker 1: metabolic dysfunction becomes increasingly important as a driver for cardiovascular disease,
• 32:56
  Speaker 1: and the triglystrid hates the L ratio captures this metabolic
• 33:00
  Speaker 1: opponent that LDL cholesterol actually misses. Now, I want to
• 33:05
  Speaker 1: circle back to something that I mentioned earlier, and that's
• 33:09
  Speaker 1: about women's heart health and saying that this ratio is
• 33:12
  Speaker 1: particularly crucial, and that's because women's heart disease doesn't follow
• 33:16
  Speaker 1: the same pattern as men's heart disease. They're more likely
• 33:20
  Speaker 1: to have that microvascular dysfunction as I mentioned earlier, and
• 33:24
  Speaker 1: this is problems with tiny blood vessels in the heart
• 33:28
  Speaker 1: rather than blockages in the major arteries. Now, this type
• 33:31
  Speaker 1: of heart disease is closely linked to metabolic dysfunction, insulin resistance,
• 33:36
  Speaker 1: and inflammation, all the things that traglystrid hates stale ratio
• 33:40
  Speaker 1: captures beautifully. And the Women's Ischemia Syndrome Evaluation Study followed
• 33:47
  Speaker 1: over five hundred women for six years, and what they
• 33:50
  Speaker 1: found was that the traglystride hates stale ratio was a
• 33:53
  Speaker 1: powerful predictor, such a powerful predictor that it remains significant
• 33:59
  Speaker 1: even and after they adjusted for age, race, smoking, high
• 34:04
  Speaker 1: blood pressure, diabetes, and the results of their coronary and geograms.
• 34:09
  Speaker 1: So this is really really powerful and if you're a woman,
• 34:14
  Speaker 1: you really need to think about this. And if you
• 34:17
  Speaker 1: have chest pain, fatigue, or other symptoms, but your doctor
• 34:20
  Speaker 1: says your orderies look fine, ask them about your trackler
• 34:23
  Speaker 1: storry to hit stale ratio because that might be the secret,
• 34:26
  Speaker 1: little key to what is actually going on. Now, let's
• 34:31
  Speaker 1: talk about some other research. We are getting towards the
• 34:34
  Speaker 1: end of this. But scientists have started using advanced imaging
• 34:37
  Speaker 1: techniques to look not just at whether you have plaque
• 34:40
  Speaker 1: in your arteries, but what type of plaque that you have.
• 34:44
  Speaker 1: And actually I had this done on me because obviously
• 34:47
  Speaker 1: for my open heart surgery. Now, as my carreologist explained
• 34:51
  Speaker 1: to me, some plaques are stable, They're like concrete. Now
• 34:56
  Speaker 1: they might narrow your arteries, but they are not likely
• 35:00
  Speaker 1: to rupture and cause a heart attack. And these are
• 35:04
  Speaker 1: plaques that have calcium basically stabilizing them. Other plaques are vulnerable.
• 35:11
  Speaker 1: They're like volcanoes are wailing to erupt. And a study
• 35:15
  Speaker 1: published in the European Heart Journal use cornery ct angiograph
• 35:19
  Speaker 1: to identify high risk vulnerable plaques, so we can actually
• 35:23
  Speaker 1: look at this now. What they found was remarkable. Patients
• 35:26
  Speaker 1: with higher triglist right hate stale ratios were significantly more
• 35:30
  Speaker 1: likely to develop these dangerous, vulnerable plaques. And here's the
• 35:34
  Speaker 1: kicker that that ratio triglist right hate stale ratio was
• 35:38
  Speaker 1: an independent predictor of future cardiovascular events. With the hazard
• 35:42
  Speaker 1: ratio of one point ninety four. That means that people
• 35:45
  Speaker 1: with higher ratios were nearly twice as likely to have
• 35:47
  Speaker 1: a heart attack or a stroke, right, And this suggests
• 35:51
  Speaker 1: that this ratio doesn't just predict cardiovascular events, it actually
• 35:55
  Speaker 1: helps identify the people who have the most dangerous type
• 36:00
  Speaker 1: of plaque in their arteries, right, the unstable plaque, which
• 36:05
  Speaker 1: is key. And if you think about it, this makes
• 36:07
  Speaker 1: sense because hits dl can actually have a beneficial effect
• 36:13
  Speaker 1: on the plaque that you actually have. And then there's
• 36:16
  Speaker 1: the whole triglyceride thing. But another thing I wanted to
• 36:21
  Speaker 1: talk about is just to revisit again that residual risk idea.
• 36:26
  Speaker 1: So for decades it was thought that if you can
• 36:30
  Speaker 1: just get LDL cholesterol low enough, you're gonna limit most
• 36:33
  Speaker 1: cardiovascular risk. And a lot of people still think of it,
• 36:37
  Speaker 1: and it turns out that the evidence does not support it.
• 36:40
  Speaker 1: Even when LDL cholesterol is optimally controlled with statins, many
• 36:44
  Speaker 1: people still have heart attacks and structure. So they call
• 36:47
  Speaker 1: this residual risk, and it's a huge problem in cardiology.
• 36:51
  Speaker 1: Multiple studies have shown that the triglystraide hates the L
• 36:56
  Speaker 1: ratio captures this residual risk beautifully. That identifies people who
• 37:01
  Speaker 1: are still at high risk even when their LDS cholesterol
• 37:05
  Speaker 1: profile looks perfect on paper. And these people might be
• 37:09
  Speaker 1: thinking they're fine, but they can still be at risk.
• 37:12
  Speaker 1: And they're studying diabetic patients with carniordy disease who were
• 37:16
  Speaker 1: already on STATNS founded triglstraide hit stale ratio was still
• 37:20
  Speaker 1: a powerful predictor of death and cardiovascular events. And the
• 37:25
  Speaker 1: hazard ratio for the highest churchil the highest and thirty
• 37:28
  Speaker 1: three percent was one point seven to seven for all
• 37:32
  Speaker 1: cause mortality and one point five to two for cardiovascular death.
• 37:36
  Speaker 1: And that is massive, And this is why this ratio
• 37:40
  Speaker 1: is so clinically important. It helps identify the people who
• 37:44
  Speaker 1: need more aggressive intervention beyond just LDL lowering. So let's
• 37:50
  Speaker 1: not get practical after all of that. If your head
• 37:53
  Speaker 1: has stopped spinning, So first of all, it's get your
• 37:57
  Speaker 1: numbers right, and remember those numbers what they need to be.
• 38:02
  Speaker 1: If you're us centric, you need to have that number.
• 38:07
  Speaker 1: Ideally it's below one, right, so your heat stale is
• 38:11
  Speaker 1: higher than your triglys rides if you are and also
• 38:15
  Speaker 1: uk those sorts of things you use minimals per leader.
• 38:19
  Speaker 1: Ideally that's below zero point four that ratio, right, so
• 38:23
  Speaker 1: your heat stale should be more than double your triglyss rides. Right.
• 38:27
  Speaker 1: If it's not like that, here's your action plan. Firstly,
• 38:31
  Speaker 1: it's fix the diet. This this ratio responds incredibly well
• 38:37
  Speaker 1: to reducing refined carbohydrates and sugar, and even for some
• 38:42
  Speaker 1: people reducing complex carbohydrates because we all tolerate carbohydrates differently.
• 38:47
  Speaker 1: Every grammar sugar you potentially reaches your truglyst rights and
• 38:51
  Speaker 1: lowers your heat stale. And it's particularly ultra processed foods
• 38:54
  Speaker 1: are a real issue here. So I would highly recommend
• 38:59
  Speaker 1: going on a low diet if there's an issue with
• 39:01
  Speaker 1: that ratio. And then movement right. Regular exercise is one
• 39:06
  Speaker 1: of the most powerful ways to improve this ratio, and
• 39:09
  Speaker 1: a combination of cardiovascular stuff and strength training seems to
• 39:14
  Speaker 1: be the optimal. And then potentially consider intermittent fasting. Giving
• 39:19
  Speaker 1: your body regular breaks from food allows that trag list
• 39:23
  Speaker 1: ride and level to normalize and can improve your insulin sensitivity.
• 39:28
  Speaker 1: And if you don't want to do that fast, make
• 39:31
  Speaker 1: sure that your breakfast is a very low car breakfast
• 39:34
  Speaker 1: that has plenty of protein and fat that will give
• 39:37
  Speaker 1: you good satiety. You'll find you don't need the morning
• 39:40
  Speaker 1: snack anymore and that will control your inchin level and
• 39:44
  Speaker 1: your trig list ride to HAITSTL. And the other thing
• 39:47
  Speaker 1: is sleep. Sleep breaks havoc on your metabolic health and
• 39:50
  Speaker 1: can worsen that ratio. So having all the good sleep
• 39:54
  Speaker 1: pagen that I've talked before, and then managing stress. Stress
• 39:58
  Speaker 1: elevates cortisol and it cordisol has been known to drive
• 40:03
  Speaker 1: insulin resistance and negatively impact that profile. The last thing
• 40:08
  Speaker 1: that I would say is triglyrites and HDL. They are
• 40:12
  Speaker 1: two components of the metabolic syndrome. And we know that
• 40:16
  Speaker 1: if you have metabolic syndrome, your risk for lots of
• 40:21
  Speaker 1: different chronic diseases actually goes through the roof. So metabolic
• 40:25
  Speaker 1: syndrome is defined. It's a cluster of conditions to do
• 40:29
  Speaker 1: with metabolism, and different organizations will identify it differently. Most
• 40:35
  Speaker 1: of them say three from five of these things. High
• 40:39
  Speaker 1: blood pressure, high triglycerides low HDL right, so that traglystrid
• 40:45
  Speaker 1: hates stale ratios in there, central obesity, which is a
• 40:49
  Speaker 1: lot of fat around the middle right. And the last
• 40:54
  Speaker 1: thing is high fasting blood glucose, and that is often
• 40:58
  Speaker 1: the last thing to go is your blood glucose. So
• 41:02
  Speaker 1: a lot of people just look at the blood and
• 41:04
  Speaker 1: go I'm fine, when actually you're not. You could have
• 41:07
  Speaker 1: the metabolic syndrome even if you have normal blood glucose.
• 41:12
  Speaker 1: So I would just throw that one out there because
• 41:15
  Speaker 1: I think the metabolic syndrome has been massively or has
• 41:20
  Speaker 1: not been focused on anywhere near enough when it comes
• 41:24
  Speaker 1: to our long term health. So the take home for
• 41:26
  Speaker 1: me is to not make decisions on drug therapy based
• 41:31
  Speaker 1: on LDL alone. Use that ratio. That ratio is really
• 41:36
  Speaker 1: powerful at trigg list right that hits the L ratio.
• 41:39
  Speaker 1: If you want to be more comprehensive, you can order
• 41:42
  Speaker 1: through a number of different health professionals. You can go
• 41:45
  Speaker 1: and get an entire LDL panel looking at your particle size.
• 41:50
  Speaker 1: You can also measure your APO B, which is much
• 41:55
  Speaker 1: more important than L d L and your APO B
• 41:57
  Speaker 1: to APO a ratio. But if you don't want to
• 42:01
  Speaker 1: go and spend all that money just making sure that
• 42:04
  Speaker 1: you control your tragglyst ride to hates the l ratios,
• 42:07
  Speaker 1: drive down those tragg list rides, drive up those hat
• 42:09
  Speaker 1: d ls. That really is one of the keys to
• 42:13
  Speaker 1: metabolic health. That's it for this week, folks, Catch you
• 42:17
  Speaker 1: next time.