What Is The Healthiest Cholesterol Level To Prevent Disease?



earlier this week um Gabriel Cousins was here and he follows a whole food plant-based diet mostly a raw whole food plant-based diet and he agrees with the things that you say in general um one thing he did say that is an outlier from what I normally hear is he was saying that he thinks the average caleche the best cholesterol would be like 159 and that low cholesterol sometimes are associated with depression and he says that is not really he's completely against eating animal products but he says among people who are eating plant-based diets that it's better if your cholesterol is a little bit higher um do you want to comment on cholesterol levels and what they should be and assuming we're eating a plant-based diet if it matters any thoughts on that I'll start well the first thing is that associations not cause-and-effect relationship so I use your lines all the time dr. Campbell about phone polls and heart disease and driver's licenses of breast cancer you know in countries where they're above more phone polls you have more heart attacks well that doesn't mean phone polls cause heart attacks right so so the people cite these associations all the time and infer a cause-and-effect relationship and that's how bad ideas catch on and become pretty entrenched depression by the way is not caused by low cholesterol it's a thinking disorder and your cholesterol level doesn't affect how you think that's that's to be worked out with a psychologist furthermore I think where a lot of this low cholesterol is bad for you came from his studies showing that people with low cholesterol people diagnosed with cancer had low cholesterol but we now have a pretty good amount of evidence I wrote a paper on this that I was able to find seven or eight studies supporting it that when cancer when cells become cancerous they start eating cholesterol plasma cholesterol becomes an alternative fuel and so by the time the cancer is diagnoseable cholesterol levels are very low so what you haven't is an association but it's the opposite it's not that the low cholesterol causes cancer it's the cancer causes the very low cholesterol at the time of diagnosis so I think that there's a problem in jumping to the cause-and-effect relationship from from an association so I think having said that I think ideal cholesterol levels lower the better I said this afternoon my father's IQ is higher than his cholesterol that's the way we like to keep it so 150 total cholesterol 80 lower 84 LDL i subscribe to dr. esselstyn's recommendations on that and that's what we try it strive to do in our office great a great answer so from the cardiology point of view we've had a little bit of whiplash here we were doing that 30 billion dollar statin because they you know people talk about their side effects and I usually tease that the biggest side effect of statins is breaking the Medicare trust fund because people are dead they actually do work they should be unnecessary but they do work now the the issue that we were concerned about is that if you've got that and this was just I'd say three or four years ago if you got the LDL cholesterol we'll talk about LDL because when you talk about the total that would include the good cholesterol and some people are genetically pre-programmed to have a high cholesterol because they're good cholesterol is really high and then you're the only way to really talk about their risk is to talk about the bad stuff the LDL the stuff that plugs up arteries so we thought that if your LDL cholesterol got below 25 your brain would fall apart or something like that and this was just it was just accepted jargon then there was the Dallas Heart Study and they saw some people some very few people who had extremely low LDL cholesterol 714 well we've got to find out what are they doing are they in mental institutions you know once an aerobics instructor ones a business person they're the normal normal human beings and they have no heart disease in their families so they run the genome and they find out that they're missing and this is probably one of just a few such things but the one that became famous about this story was called pcsk9 how many of you have heard of that just a handful okay so pcsk9 is a molecule that's responsible for telling your LDL receptors in your liver it's time for you to quit you been out here too long it's time we're gonna involute you you're gonna go inside delivery you're not gonna work anymore if you're pcsk9 is not working your LDL receptors just keep going and keep going under energizer bunny type stuff and they pull the cholesterol out of the bloodstream and your LDL gets extremely low and it protects your heart and your blood vessels so it turns out that big industry got wind of this and they came up with in injectable antibodies for $14,000 a year you two can just inject it twice a month and your cholesterol will fall incredibly well and so you know vegan diet is a wonderful way high-dose statin is a great way getting your cholesterol down but pcsk9 inhibitors are just absolutely fantastic I do have one patient who's doing all three as LDL is three and a half okay and so it's Annie's doing fine and so the question is why would you want it to ever be that low okay so just last two things on it one is that in development the the babies who are trying to do brain growth and body growth they're LDLs are single digits and then they get double digits and then they grow as you start feeding them more animal stuff so you were not genetically pre-programmed to have these high cholesterol number two is that if you look at the pcsk9 research which is getting more and more extensive one of them called the glad off trial who was named after Seymour glad off my mentor at university Chicago who spent all of his career looking at plak plak morphology plaque in arteries showing that oh you know I'm not gonna ask how many people have had an angiogram and been told oh you've got a 10% narrowing you've got your fine well no the glaad off hypothesis is that you actually get remodeling outward when you put plaque in your arteries it grows and grows and grows and it's only when you have so much plaque in there that it can't grow any more then it starts to narrow so by the time you have a 10% narrowing you have a massive plaque burden okay so that's what he's famous for and so it's nice to name a trial after him that looked at how what happens to plaque over time now it wasn't as impressive as what you see with dr. Esselstyn but it was they had good large population they could actually make a line and it turns out for a hundred percent of people to have plaque going away you need an LDL less than 58 which is close to what we were thinking Oh a 70 or at 60 something like that but the interesting part defending the idea that as low as possible is that that line keeps going down the lower it is the more plaque regression you get and so you know for you treating a coronary disease carotid disease peripheral artery disease population getting the cholesterol down and keeping it low is a really good idea not being a clinician like my colleagues here my introduction to the cholesterol world to a great extent was in our China study which was analyzed chemically at least in a laboratory about 1990 so what is that a quarter of a century ago already at that time we wanted to analyze cholesterol of course there was a general idea that any cholesterol level below 150 was bad you know it was said that suicides are higher colon cancer was a couple of studies indicated that was possibly higher and some of that was what dr. popper just referred to you know the result of the cholesterol going down once diagnosed but in any case that was that was the same rate at the time the discussion and so we got cholesterol levels in China average 127 127 Bill Castelli was a friend of mine he's a what it directed the premium heart study for at that time and even Bill found that really rather remarkable we should have such levels but he allowed for it because he thought that might be real but in any case the feedback I got at the time from some of my colleagues your crazy the Chinese just that can't be true and so my being skeptical myself to some extent we looked back and analyzed it by two more methods than two more different laboratories and essentially got the same results so all of a sudden here we had an average 127 in a range of means for the counties ranging from 90 from 80 eight total cholesterol to a high of 170 so we were in a new territory and when we started looking at you know what kind of disease rates changed throughout that region it's very clear Western type of diseases I mentioned today one of the one of the slides Western diseases just gradually as their group came down the lower and lower the cholesterol and I know of course we get into LDL HDL discussion is big particles little particles all that sort of stuff but and I know you also have to say I don't see cholesterol as being from like this set definition as a cause quite frankly disease it's a really good on a population-based studies is a very good indicator of concedes risk including not just heart disease but also cancer and some other things and so I I don't know I think the Celestra we're getting too much into the weeds you're talking about cholesterol in too much detail because there's one more factor to consider and that is that we know of people with high cholesterol levels who don't have heart disease and some people with flush whole levels at low levels they do have heart disease you had that with Joe Joe crow your friend and so we get ranges and and sometimes we worry I suppose on an individual level of what it's good or bad if we have a to 10 to 20 or maybe that's too high even when 80 is too high for a lot of people and I see it too in that sense cholesterol is just one indicator it's a good indicator it's a good indicator for overall diet and disease risk but III think you know I mean that's all I can say I said it's really it's a general trend that's so clear if you look at Western populations at the time we did starting up from around 300 down to 200 that was the range considered normal in those days we saw a decrease in heart disease risk mr. Fick trial and others but we continued that same range previously not having an opportunity to see it go from 170 all the way down to 88 and we saw this remarkable a correlation really highly significant with Western diseases in China which were all that common but we saw the same relation and so I became really impressed with the idea that cholesterol we don't we don't necessarily get danger zones when we're down below 150 at the time maybe I guess we can make some cases but cholesterol levels too we know lots of things but one thing it does have to do with I'm very convinced is whether or not we were nursed when we were young and whether that in turn left an imprint would publish that work in science and I'm so should we talk about that but I'm incidentally dr. waves I have a question is if I'm not mistaken did you say that you said something like statins work and and so I'm just talking today I have to make a comment on this because I offered the possibility that from my analysis of the literature as I say not being a cardiologist dad yes you know coronary deaths are not really lower to any significant extent by status the best I could find was about a 9% reduction and yes and short is true statins you know a lot lower cholesterol I agree with you but whether that translates into lower mortality rates if you will okay what to talk about that stuff because I need to get a caught up to date on that I think yeah the other this is a interesting story I've it's hard for me to really figure out how when I when patients call me and they said they can't get their cholesterol down there they can't take any statin drugs because they're so allergic to them they can't get their cholesterol under 180 190 or 200 but no number has ever caused heart disease what causes heart disease is what is passing through your lips every day that is going to absolutely destroy the capacity of your endothelial cells to make an adequate quantity of the life jacket of your blood vessel which is there nitric oxide level and as you begin decade after decade eating the horrible Western diet and as your level of nitric oxide Falls and Falls you start making these plaques when you're in 12 years old you make more when you're in teenage not enough for your events and now you're into your forties you're still eating the same way you've got enough plaque that you have this disease but we found that that when we got patients to totally stop any food morsels to their lips that we're going to injure their endothelium not only does it stop injuring I mean it's the end of the– Liam but the endothelium begins to recover and it makes enough nitric oxide that your disease is holding and often you can get evidence of disease reversal and I just would sort of feel I would much so much rather have everybody begin to eat correctly rather than to have everybody be on a drug because these drugs do have side effects and then we have anything we have any number we have any number of patients who simply cannot take any of these statin drugs they are in no way precluded from enjoying the benefits of whole food plant-based nutrition when they do it record there's a fascinating study that just came out in the American Journal of Cardiology which we get automatically you want me to come a member and it had to do with these 1200 people in Spain they had absolutely normal risk factors across the board 1200 then they carefully studied them they did carotid ultrasound calcium score of the heart ultrasound in the Infernal a order ultrasound in the iliofemoral region 49 percent of those people have cardiovascular disease so you know here they are doing getting all the right numbers that we would want them to have and they have half of them have already started forming this disease there's another study that has been so fascinating to me which is called cantos and Ken I mentioned it to you today when I spoke earlier this morning and cancels was using a very very powerful anti immune drug kind of kid about and the fascinating thing was in the group that responded and had fewer cardiac events they did not even budge their LDL cholesterol so comes back that inflammation is probably much more powerful than we ever thought before and guess what is a lot safer and less expensive than Kanaka nabob plant-based nutrition and it's very powerful for long crust roll and it's very powerful for getting rid of inflammation and i think that's the way we got to go if someone's a 54 year old male they are thin they feel great and they eat animal products every meal would you recommend that they be on a statin drug what are the pros and cons of statin drugs and do they help prevent deadly heart attacks and strokes showing dr. Campbell just you just google the words mortality statin use and you'll see that the placebo group lost every trial except one that was all hot all had and that's because it was open labeled and the people saw the doctor saw the cholesterol is high and they put him on statin so at a high frequency so every true placebo controlled trial you couldn't get up one passed an investigational review review board the data is so strong so and you know so so where can we really believe them because you know a lot of us many of us up here and probably some in the audience have a little skepticism when it comes to pharmaceutical sponsored trials where they have a vested interest in the outcome so there's one trial that didn't have that it was the TNT trial called treats and new targets it was low dose lipitor versus high dose lipitor they weren't gonna make him a penny more because they were charging the same for the 10 milligram in the 80 milligram I was about a 18% decrease in heart attack stroke and death in the high dose okay now the reason to mention it because I really want to double down on what dr. Esselstyn is saying is that you know we're giving these drugs expecting that everybody's going to take them and it's just not true so in that particular trial they said oh the symptoms and it's usually muscle soreness are just not that frequent as oh and it's not that dose related it's more like 8 percent versus 8.5% in the high dose so it's so you'll be fine well the way you get a low number like that is you do a run in period okay so you ask people will they participate you give them a drug for three weeks and if they tolerate it you enrolled in the trial if you don't tolerate it you're out well that is actually is done with every trial for for toxicity for safety you do a running period so it's standard methodology but you can't use that in your office and say oh it's 8% so being a person who's treating a lot of disease and a lot of people who are refractory to changing their diet no matter what I do and say which is a handful but there's they're still there and then people who genetically have so much LDL cholesterol they've got the xanthomas and the knuckles with the with the big cholesterol deposits you need all hands on deck work for everyone like that so we do end up using a lot of statins and we the higher the dose the lower the event rate and so there aren't gonna be people who really need them but it shouldn't be thirty billion dollars it shouldn't be the majority of Americans because most of the people can do it with lifestyle and so we had you know somewhat controversial guidelines come out in 2013 where we said we're not just treating the LDL cholesterol anymore we're gonna treat the risk and so maybe many of you may have the app for your phone for the ACAC sees risk calculator and I made it said oh well what's just gonna increase the number of statins use no I was actually taking people off because if they had an LDL greater than 130 I was taught that I was supposed to put them on the drug but if they have no hypertension they are not a smoker you put a put every all of the risk factors in and they come out 5% you don't I took them off the statin okay and and see if they can maintain that and so it we have learned a lot over the years statins I believe have their rightful place but if everyone was a thin walking everyday vegetarian we would not be needing this this big pharmacopoeia of drugs including statins so I would say there they're not as dangerous as people say they are they're not as safety there is the other side would tell you they are not necess Cerie for most people but you know we've got to get our population a long way educationally in terms of lifestyle for us to be able to decrease their use I make it has a Becca comment here this is kind of fun I like the debate was dr. Williams just showed me some evidence supporting what he said before that I didn't not agree with that the more child is reduced I see this day to hear you're quite impressive what study was that and where so I literally just did put in statin reduction mortality I just put those into Google and went to images so you can see kaplan-meier plots those are the little survival plots and you see a massive number of them there's just trial after trial after trial of a reduction including the one that I talked about low dose versus high dose you have I mean a lot of people are still using hate to do trade names but zocor I mean when that lost every single trial and so you have two of them that are really powerful and five that are not and using the ones that are weaker have a weaker outcome and so they're all you know 20% and every population probably one of the most insightful ones was another one that looked at just taking your diabetic you know it's interesting that if you look at the Nurses Health Study and I'll talk about this one tomorrow and and talk about what causes nurses to die and they've got all of the risk factors and they're collect all this data we would have thought that smoking would be the number one thing smoking came in third number one was getting older okay okay number two was diabetes and so this this epidemic of obesity which creates diabetes particularly central obesity is really running havoc or not we have drugs that can take a diabetic who's otherwise asymptomatic and no other risk factors and lower the more tech the cardiac event rate by 22% and that's just a low dose lipitor now again I would say they're they're great drugs I'm not a fan of them because it's unnecessary the diabetes is accumulating because of the central obesity and if you get that bat to go away you don't need the drugs you don't need you insulin and all those things are there actually increasing plaque by the moment and the folks are really at high risk and you know we have to actually do this as a population not just with drugs so I'm agreeing with you for the wrong reason there is data but we still shouldn't be using them we shouldn't have to okay just one more follow up on that I do recall two things one I thought that I've read that statins are connected with increase in diabetes and I also remember a Business Week article like 12 years ago saying with all this statins they are lowering cholesterol but they're almost almost not even lowering deaths at all which is the real gold so and I was relying and so that's the part the second part is what we were just talking about just just just Google those three words and you'll see all these you know just massive numbers of studies where people have spent a lot of time and effort a lot of it is pharmaceutical industry but they still have shown yeah that heart attack stroke and death probably the one where we were more shocked recently if I had to pick out a highlight was the hope 3 trial where you might have heard of the poly pill where they put a statin in with a antihypertensive and they gave it to people with one risk factor and then they jumbled all the data up you know it so you had you know sort of four quadrant you had the fake pill completely fake you had the fake statin the fake antihypertensive and the people who are on both and then you could divide it into two halves and in two ways and and see what the results were what there's a lot of good data and it did what you thought it would do it would decrease events but the shocker was the effect of statins on stroke in the people who were ran – to not get the anti hypertensive and their blood pressure was averaging 140 150 if they were on a statin they could tolerate that blood pressure with almost a 50% reduction in strokes so they really have a role I'm just saying again saying I'm not against them I'm against the fact that we have to use them because it really shouldn't exist plant-based nutrition No so yeah that way an entire industry that's totally unnecessary that you've been saying this for four years I mean and so we have unnecessary diseases being treated with unnecessary medicines but they do work you know I mean seat belts work I mean if you have all automated cars and there are no mistakes you don't need seatbelts but right now we do need them can I have any comment here about your reference to the poly pill yes I find that one of the most troublesome works I've seen in recent years you know we're talking about poly toes my god you know if one doesn't work one drug doesn't work let's try two three whatever right is what I mean you know a general sense for published it's even discuss the possibility we might be working for toward toward developing power pills right troubles me because that really sort of conveys the message you know okay we can live by drugs we're gonna have one sooner or later right and talk about the real thing that matters connect double down on that so the whole idea of the poly pill is that's something you would not do in the United States that is people expect individualized care you don't say oh you've got a risk factor we're gonna give you the we're gonna throw this pill at you but in third world countries that shouldn't even have high blood pressure and high cholesterol and diabetes they're getting it because they're westernizing they're having our franchises on their corners and it's if they're incentivized to do it because it's cheap food they are ruining their lifestyle losing their agrarian society and doing less exercise sitting in a chair and so now they and and they can't afford the drug cost that we have here and so you just take this large population of people who are all of a sudden cardiovascular disease is number one and you throw poly pills at them and actually work but I mean but again sure I can say it I Pro is done I'm probably gonna say it 50 times these are totally unnecessary you shouldn't need a poly pill but does it work yet does you

22 comments

  1. Missed opportunity here. No discussion on triglycerides. Oh yea, it's OK to eat a little grass fed beef once and a while folks.

  2. Lance Baker: No, bc red yeast rice is where they discovered the first chemical that was made into a pharmaceutical, i.e. statin drugs. I smh when I see red yeast rice in health food stores. It’s no better than a statin drug, tho may be worse bc you can’t be sure in many cases of the dose you’re getting, regardless of labeling.

  3. Cholesterol = the lower the better? No! Not true. The 1st 2 doctors are misinformed., mostly by reading epidemiology research rather than prospective placebo-based studies. Sure, statins work to lower cholesterol, but have side effects that almost always cause more harm than any benefit from lowering cholesterol, unless you’re male and have had a heart attack, because statins are powerful anti-inflammatories. These 2 doctors have cherry-picked studies to support their beliefs about these topics. Pregnant women on statins give birth to babies with birth defects because of how critical cholesterol is to fetal development. Check out the book Lipitor: thief of memory, The Great Cholesterol Myth, and spacedoc.com.

  4. Popper lost me at "discuss with your psychologists." Sorry, no deal. Brain chemistry makes us function. If the chemistry isn't right, you aren't going to be well physically and especially mentally.

  5. Sally Fallon research= Lipitor came out of Japan as a poision & sold it to Merck. Lipitor was put in a pill & was a billion dollar gift. We did it for 20 years. Muscle loss & brain fog. We took the 550.00$ we spent on Lipitor & went organic. We are on no pills, just supplement. Good health at 87 & 83. No fast food. good oils & cook from scratch.

  6. Genetics genetics genetics. Some people like almost everyone in my family live well into there 90’s with elevated levels.

  7. I love Dr. Williams, he's presents the whole picture as well as all the options that are available to people.

  8. Saying cholesterol does not affect brain health is really a bold statement by a non brain scientist.

  9. Find a technician who knows how to send your host's mic directly to the camera / recorder. It sounds like he is in a barrel.

  10. We all love to listen to these guys, but guess what, we don't do damn thing about it. We just listen and waste time.

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