DR. NADIR ALI | Why LDL Goes Up on Low Carb + Is LDL Cholesterol Bad + Risks of Statins

Name: DR. NADIR ALI | Why LDL Goes Up on Low Carb + Is LDL Cholesterol Bad + Risks of Statins
Uploaded: 2021-02-11T06:00:05.000Z
Duration: 1 h 58 min 43 s

The Role of LDL Cholesterol in Heart Disease

In this section, Dr. Nadir Ali discusses the role of LDL cholesterol in heart disease and how it is often misunderstood.

Understanding the Benefits of a Low Carb Lifestyle

Patients on a low carb lifestyle experience lower insulin levels, blood sugar levels, inflammation, and triglycerides.

Weight loss, lower insulin and sugar levels, and lower triglycerides are all beneficial for overall health.

Despite these benefits, people often become fixated on their LDL cholesterol levels when they go up.

Is High LDL Cholesterol Bad?

There is a fear around high LDL cholesterol because it is often implicated in heart disease.

However, Dr. Ali believes that LDL cholesterol is like a firefighter that goes to help heal damaged blood vessels caused by inflammation or metabolic dysfunction.

He does not believe that LDL cholesterol is the culprit behind plaque buildup.

Introduction to Dr. Nadir Ali

In this section, Morgan introduces Dr. Nadir Ali and his background as an interventional cardiologist.

Becoming a Cardiologist

Dr. Ali became interested in cardiology because his mother was also a physician.

He started out as an interventional cardiologist who opened up blocked blood vessels using catheters under x-ray guidance.

He found himself disappointed with working in an office setting where he was unable to improve patients' lives through medication alone.

Skepticism Towards Cholesterol Medication

Despite being able to reduce cholesterol with medication, Dr. Ali was always skeptical of its effectiveness in treating heart disease.

Evolution of a Cardiologist

In this section, Dr. Bret Scher talks about his evolution as a cardiologist and how he became an advocate for a high-fat diet.

Personal Transformation

Prescribing statins for heart disease and cholesterol can lead to worsening heart disease.

Dr. Scher gained weight in 2011-12 despite being thin and active.

He discovered low-carb lifestyle through Chris Froome's magazine article.

Low-Carb Lifestyle

Dr. Scher found little information on low-carb medicine when he started researching it.

He lost weight easily on a low-carb diet and felt satiated without going hungry.

Patients who followed the same diet lost weight, reduced diabetic medications, dropped their walkers, and had a reduction in blood pressure medicines.

LDL Cholesterol on Low-Carb Diet

In this section, Dr. Bret Scher discusses why LDL cholesterol sometimes increases on a lower carb lifestyle diet.

Understanding LDL Cholesterol

LDL is not inherently bad but becomes problematic when it oxidizes or gets damaged.

The size of the LDL particle matters more than the number of particles.

Why Does LDL Increase?

When people switch to a low-carb diet, they often eat more fat which can increase their LDL levels temporarily.

However, studies show that over time, there is no significant increase in cardiovascular risk with higher levels of LDL cholesterol on a low-carb diet.

Is High LDL Bad?

In this section, the speaker explains why high LDL is not necessarily bad and how a low-carb lifestyle can increase LDL levels.

LDL is a Good Molecule

The speaker argues that LDL is actually a good molecule because it has several functions, including fighting infections, dampening inflammation, and supplying cholesterol to our ovaries and testes to make estrogens and testosterone.

The speaker also notes that CoQ10, which is needed by our muscles for them to function well, is carried in the LDL.

Why Does LDL Go Up?

The speaker explains that when we eat animal food (which contains cholesterol), the liver stops making cholesterol since it doesn't need to pick up the cholesterol from the bloodstream. As a result, the LDL levels go up.

The speaker gives an example of a vegan who doesn't eat any cholesterol. In this case, the liver is forced to make about 3000 milligrams of cholesterol every day, which is a very energy-expensive task for the liver.

Is High LDL Bad?

The speaker acknowledges that high LDL can be bad but notes that it's important to consider other factors such as HDL, glucose, insulin, and triglycerides before determining whether elevated LDL levels are problematic or not.

The Relationship Between LDL and Diabetes

In this section, the speaker discusses how a person with low insulin, low triglycerides, high HDL, and low inflammation markers can have a higher LDL level. They compare this to a person who has high sugars, insulin resistance, high triglycerides, and low HDL. They also discuss how an uncontrolled type one diabetic is at very high risk of heart disease.

Type One Diabetic

A type one diabetic is somebody who's not making any insulin.

If they're not given exogenous insulin their sugar levels go up, their triglyceride levels go up, their HDL levels go down.

LDL levels are actually on the low side for type one diabetics.

Low-Carb Lifestyle

Patients in the speaker's practice who came and said they don't want to have abnormal blood sugar went on a low-carb lifestyle.

When they achieve normal blood sugar levels their sugars come down, their triglycerides come down, their HDL goes up and their LDL rises dramatically.

Cognitive Dissonance

People experience cognitive dissonance when they see other numbers improving but are told that they need to go on medication because of high LDL cholesterol.

The speaker tries to relieve some of this cognitive dissonance by providing clarity around the fear of high LDL cholesterol.

Demographic Data

When you take 50,000 patients in Europe followed in the Hunt Trial for 10 years there is actually a trend towards lower mortality with higher cholesterol levels.

Roughly three fourths, two thirds to three fourths of your cholesterol is going to be LDL cholesterol.

Cholesterol and Mortality

In this section, the speaker discusses two researchers who looked at 16,000 patients and divided them into thirds based on their cholesterol levels. They found that lower cholesterol was associated with higher mortality rates.

Researchers and Patient Study

Two researchers, one from Europe and one from Scotland, looked at 16,000 patients.

The patients were divided into thirds based on their cholesterol levels.

Lower cholesterol was associated with higher mortality rates.

Leiden Study

A study in the town of Leiden in the Netherlands followed people between 85 and 95 years old for 10 years.

People with high cholesterol had the lowest mortality rates and lowest cancer risk.

People with low cholesterol had higher mortality rates, higher cancer risks, and higher infection risks.

Japan vs United States

During World War II, Japan had a much higher incidence of strokes compared to the United States despite having lower cholesterol levels.

As Japan became more affluent and started eating more animal products, their cholesterol levels rose but their stroke rate decreased.

LDL Cholesterol: Firefighter or Arsonist?

In this section, the speaker discusses whether LDL cholesterol is a firefighter or an arsonist when it comes to plaque buildup in blood vessels. He argues that there is not enough conclusive evidence to prove that LDL is a culprit in heart disease.

Plaque Buildup

When looking at plaque buildup in blood vessels, one needs to ask whether LDL cholesterol is a fireman or an arsonist.

The speaker believes that LDL cholesterol is a firefighter that goes to help heal the blood vessel that is damaged from inflammation, high blood pressure, insulin resistance, and metabolic dysfunction.

Biochemical and scientific data are not conclusive in proving cholesterol as a culprit in heart disease.

Lowering Cholesterol

The next step would be to look at clinical studies that attempted to lower cholesterol and see how much benefit there was in terms of protecting people from heart disease and strokes.

The Role of LDL in Medicine

In this section, the speaker discusses why physicians prescribe statins to lower LDL and how there is a significant body of research that says we don't need to be fearful of LDL.

Physicians Prescribing Statins

Most physicians are ingrained in group think and have their ideas set in stone.

Building more evidence on top of a weak foundation can lead to going down the wrong path.

There is a lot of research that talks about how LDL is bad, but very few studies question this dogma.

Impact of Lifestyle Changes on Cholesterol Levels

People are improving their health by taking critical thinking into their own hands and changing their lifestyle.

A vegan diet can significantly reduce LDL cholesterol levels in just three weeks.

However, people may experience weight gain and increased triglycerides while on such diets.

Studies on Cholesterol Reduction

In this section, the speaker discusses studies related to cholesterol reduction and highlights that most studies are done by the pharmaceutical industry.

Pharmaceutical Industry's Role in Studies

Almost 99% of studies related to cholesterol reduction are done by the pharmaceutical industry.

The pharmaceutical industry hires physicians, universities, case managers, bio-statisticians, and ghostwriters to collect data and write manuscripts for publication.

There may be incentives for the pharmaceutical industry to exclude certain data or lie about results.

Overall, the speaker emphasizes that while there is a significant body of research suggesting that we don't need to be fearful of LDL cholesterol levels, it's important not to jump to conclusions. Additionally, he highlights potential biases within the medical community related to prescribing statins and conducting studies.

Conflict of Interest in Clinical Trials

The US Congress required companies to register and publish clinical trials online. However, companies may still choose to publish only the trial that shows their drug in the best light and ignore others.

Conflict of Interest

Companies may publish only the trial that shows their drug in the best light and ignore others.

The US Congress required companies to register and publish clinical trials online.

Best Clinical Trial for Statins

Mortality is a robust endpoint.

The Forest Trial is the best clinical trial for statins.

It was done in 1994 with 4000 patients who had established heart disease.

Half were given a statin, half were not given a statin, and they were followed for five years.

Reduction in mortality at one year would be a little over half a percent (0.6%).

Side Effects of Statins

Statins have side effects such as myopathy, memory and cognitive side effects, erectile dysfunction, fatigue, weakness, tiredness.

Common Side Effects

50% of patients have some type of myopathy.

Patients feel fatigued, weak or tired.

Memory and cognitive side effects are common.

Erectile dysfunction is also common because it reduces testosterone levels.

More Recent Clinical Trials on Statins

Many more recent clinical trials have been done with greater reduction in cholesterol than the Forest Trial.

Comparison with Other Clinical Trials

Many more recent clinical trials have been done with greater reduction in cholesterol than the Forest Trial.

The Jupiter trial reduced LDL cholesterol by almost over 50%, while the Forest Trial reduced it by 25%.

The Impact of Cholesterol-Lowering Medications

In this section, the speaker discusses the impact and mortality rates of cholesterol-lowering medications such as PCSK9 inhibitors.

Mortality Rates in the Jupiter Trial

The impact and mortality rate in the Jupiter trial was about 0.2 or 0.3% over two years.

The new drug on the market is the PCSK9 inhibitor.

Four Year Trial Results

The Four Year trial involved 28,000 patients, with 14,000 receiving PCSK9 inhibitors and 14,000 not receiving them.

LDL cholesterol was reduced by over 60% or by 30 milligrams per deciliter in those who received PCSK9 inhibitors.

Despite expectations of a dramatic reduction in deaths due to lowered LDL cholesterol levels, more people died in the group that received PCSK9 inhibitors compared to those who did not receive them.

Side Effects of Cholesterol-Lowering Medications

Statins can cause cognitive impairment and muscle fatigue.

There is clear evidence that cholesterol-reducing medicines cause diabetes and insulin resistance.

Lowering cholesterol too much can also cause side effects.

Understanding PCSK9 Inhibitors

In this section, the speaker explains what PCSK9 is and how it works in our bodies.

What is PCSK9?

PCSK9 is a molecule that our body elaborates as a defense mechanism against infections.

When we get an infection, our body produces more PCSK9 to prepare for invaders and fight inflammation.

How Does It Work?

One way PCSK9 works is by telling the liver not to pick up any cholesterol from the bloodstream.

This allows cholesterol to remain in the bloodstream to fight infections.

Risks of High LDL Cholesterol

In this section, the speaker discusses how high LDL cholesterol levels are traditionally viewed as a risk factor for cardiovascular disease and what other factors should be considered.

Determining Risk for Cardiovascular Disease

As a cardiologist, the speaker looks at multiple factors to determine someone's risk for cardiovascular disease, not just LDL levels.

The speaker emphasizes that people can confidently live with high LDL cholesterol if all other numbers are going in the right direction.

Addressing Heart Disease Risk Factors

In this section, Dr. Nadir Ali discusses the importance of addressing heart disease risk factors such as insulin resistance, diabetes, inflammation, and high blood pressure. He also talks about the significance of calcium scores in predicting heart disease outcomes.

Calcium Scores for Predicting Heart Disease Outcomes

A calcium score is a test that checks for calcium buildup in the blood vessels of the heart.

If a person has addressed all other beneficial markers such as insulin sensitivity and healthy liver, a zero calcium score predicts an extremely good 10-year heart disease outcome.

American Heart Association states that if you have a zero calcium score, you don't have any additional benefit from taking a statin.

Uncertainty Around High LDL Levels

When on a carnivore diet and fasting to become metabolically healthy, LDL levels can go up to 300-500 or even 700.

It is unclear whether high LDL levels are healthy or damaging to health.

Serial calcium scores can help determine whether higher LDL levels cause an increase in plaque buildup over time.

There is anecdotal evidence that higher LDL may not be the culprit and that there may be several other factors accompanying high LDL which may be causal. However, more research is needed to confirm this hypothesis.

Red Yeast Rice vs Statins

Red yeast rice is nothing but a statin because it's derived from fungi in yeast.

If someone wants to take red yeast rice for cholesterol-lowering benefits, they might as well take a statin because it will have the same side effects and benefits.

Dr. Nadir Ali's Proudest Accomplishment

Dr. Nadir Ali is unsure of his proudest accomplishment in the last 30 years as a cardiologist.

How to Find Dr. Nadir Ali Online

In this section, Morgan asks Dr. Nadir Ali how people can find him online and learn more about his work.

Finding Dr. Nadir Ali Online

Dr. Ali recommends going to his YouTube channels: Eat Mostly Fat and Dr. Nadir Ali, MD.

These channels have over 50 videos covering various aspects of low-carb diets, fasting, cholesterol, statins, sleep, heart rate variability, and resting heart rate.

Sleep and stress are important components that people need to address in addition to nutrition, fasting, and exercise.

You can also contact Dr. Ali via email which will be listed in the show notes on the blog post for this podcast episode or the YouTube video.

Conclusion

In this section, Morgan thanks Dr. Nadir Ali for sharing his expertise and empowering listeners with better information.

Empowering People with Better Information

The ultimate goal of Morgan's podcast and YouTube videos is to empower people with better information.

Listeners will come away feeling more empowered about elevated LDLs on a low lifestyle after listening to Dr. Ali's insights.

Morgan feels better informed about the topic and has more information to share with her members.

Morgan thanks Dr. Ali for joining her on the podcast and sharing his expertise with her audience.