The mistake behind CHOLESTEROL checks

The mistake behind CHOLESTEROL checks

Check out the video on The mistake behind CHOLESTEROL checks.
Hello everyone welcome to earlier Tuesday night 5 30 our Eastern Time thank you thank you for showing up early I get to be a mom at a track meet watching my son pole vault uh starting like now so we are doing the show a little bit early thanks for those that are tuning in great to see the folks from Minnesota and South Dakota.

And uh in New York thank you for checking in we do have a a great conversation we're going to have tonight uh thanks in part to all of your comments that you guys had about our recent video on YouTube about cholesterol and how uh how rewarding you guys found and how helpful you found it so thank you for putting those comments.

Out there they really do help me pick the content for the live shows so when I see you guys interested I try to turn into that spin and give you a little bit more uh and I thought I would tie that into a question that I get a lot which is Doc I'm on the ketogenic diet I'm worried about my cholesterol when should I check it uh or should I check it yes.

You should check it but there are some definite limitations on what you need to think about before you do that we are going to use a case study tonight that gives you some insight and for those of you that are gonna see me in Texas uh this upcoming uh season you're gonna see this case uh live out to do a lot of teachable moments so we're going to use.

The first part of it tonight before we get carried away uh we are going to uh do the the basics here which is check my numbers so I think I'm like I don't know 56 hours or something into a fast um and I am checking ketones and glucose here so we'll get ketones um counting down for a 10 second.

Countdown starting there you go nine eight seven and then the glucose only takes five seconds but if I do it right they both uh almost turn out at the same time Ketone 3.2 glucose 58. I am definitely I can't wait after my Tuesday night lives if I um if I feel hungry which I do when my blood sugar is 58. I I treat myself to.

Some carnivore crisps and I have my last little bag of of crumbs tonight that I'm actually they're sitting right here I'm like I can't wait to do this I put extra salt on them I have beef heart left uh and I'm gonna go chew on some beef heart while I watch my son pretend he knows how to fly which is another name for pole vault.

Um and I will if you don't follow me on Instagram You're Gonna Want to follow me on Instagram because you can usually see me chirping about what he's up to recently so uh all right I am thanks for doing that uh DVR uh Deb it is a DVR of 18.1 I am gonna have some pucker up uh again not because I need help making ketones but to show you this is a uh if.

You're gonna if you're gonna pinch and you are looking for how do you get ketones um out of the ditch or how do you help yourself I don't know recover from when your sister's in town and you have an extra glass of wine that you shouldn't have the next morning you should do this you should do this.

Um all right so we do have this big question we are going to get to it um I have a few different um announcements that I'm going to sprinkle throughout this lesson because it's going to get a little heady and of course your questions that you write in truly help me um we already have one of them a really.

Good question from private Susie so know that your questions first on the list thanks for typing it in uh and I am going to um to get right into the lesson uh and then when I need a break uh because it is a lot it is a lot to go through tonight and.

Um I do want I do want you to appreciate a couple of things that are not easy to explain so I'm going to start by um going here going here and you know how you build a plane while flying it sometimes I that's how I feel like my slides for these shows are that as I get ready for a stage presentation.

They're very well done but when I get ready for my lives sometimes I'm like yeah yeah we're close enough we're ready enough um all right so I am going to start by talking about um the difference between a lipid panel and something else because yes there are some absolute rules that I follow with.

My patients when it comes to um not only um advising them about cholesterol but um preparing that if if I'm not your doctor there are a few things that you should help your doctor with when it comes to a cholesterol panel um so let me get out of there and we're.

Going to start here I'm going to start by introducing you to um I'm going to start by introducing you just to some particles the particles are what uh if we could start the conversation over when it comes to cholesterol we would not use words like bad cholesterol or good cholesterol or.

Small cholesterol well we might use the word small but we wouldn't use low density very low density high density we would have some better descriptors but the history lesson that comes with talking about cholesterol really does make this a lot more confusing so when looking at someone's cholesterol.

Let me go over to this picture here this is a picture of a um what is actually called A lipoprotein the lipoprotein is the the carrying agent um let's see here if I can make this go why won't my pencil right let's try again push play One More Time there we go so this this is called a.

Carrying agent this is what carries cholesterol around it is one of many lipoproteins and when you look deep inside uh this carrying agent there is a cholesterol unit in it but most of what's inside this carrying agent uh called A lipoprotein are these little red things with uh um.

Come on oh I gotta start over here um oh it's being a little crabby hold on just let me let me get it straight well I might have to do this without a pencil um oh there we go so yeah that's your cholesterol agent these little uh these.

Little uh uh red in my in mine uh diagrams I have the top part as red because it's a glucose and then there's three strings of fat that comes from it that's a triglyceride and that's what's in most of these carrying agencies these lipoproteins when you look at um the first thing the biggest of them which is only present for a few minutes.

After you eat in your circulation this is called a chylomicron now we don't have anything on our blood tests that measure chylomicron in fact sometimes when I send blood to the uh to the lab if they have a bunch of chylomicrons in their lab the lab tech will write back saying a whole bunch of fat was found on top meaning they just.

Probably ate a fatty meal or they have a genetic disorder that makes the chylomicrons not clear out of the blood they should only be in your blood for a few minutes so we if you came in fasting for your cholesterol test you shouldn't ever see these the next thing we look at is after it gets rid of a bunch of triglycerides we.

Call this a vldl and if you look at a lipid panel you'll be able to see that you can check out what's your vldl that's on every lipid panel it's not something we usually talk about when it gives away a few more of these triglycerides so a bunch of triglycerides left for the chylomicron and that turned into a vldl then a few.

More kylo triglycerides leave and that turns into an ideal and the next one is your LDL or that bad cholesterol and we'll point out especially if you watch my video over the week that weekend that these two are different sizes they're both Liberty bad cholesterols but they are they shouldn't be called that because neither of them are bad they are.

Just a smaller size they are the lowest density and this little turkey over here he is a high density um we're not going to talk about him today all right so I'm going to show you a a process us that is a better way to look at cholesterol called a NMR a nuclear magnetic resonance so when I look at a um this chart I'm.

Going to use a patient's report to show you um these the the ability to look at your cholesterol should never have been measured by good cholesterol bad cholesterol instead it should have been measured by how big are those particles and what's inside them are they mostly.

Cholesterol are they still left over with those triglycerides and that ratio of what's inside those particles would be a much better guidance for how well our body is metabolically healthy how well is it using the fat which is what you should want to know if you're on a ketogenic diet and you say well is my is my cholesterol bad I'm like well let's.

Talk about that all right okay so first of all when we're looking at an NMR so this test is an n m r and I'll I'll write that on the screen here in just a minute but when you're looking at um the NMR the first thing you're going to look at is how many of those.

LDL lipoproteins those low density lipoproteins those blue circles filled with red and yellow things how many of them are the smallest of size and then what is the size of your LDL so this is measured in nanometers oh that's an n and this is an M nanometers and if we keep it under a hundred that's a good.

Uh that's that's about where um that's about where oh no that's not I'm sorry sorry sizes down here see there's the size that's the nanometers this one oops is particle count for LDC so again how many of oh that's calculated sorry sorry sorry don't don't look at that just yet the next one is triglycerides.

And all of your um lipid panels the regular ones that come from the doctor that you've had for the last 50 years all of those have a triglyceride count the total cholesterol again I don't like this much total cholesterol doesn't do me any good in most of the.

Lipid panels uh here's where it starts to get a little bit better how many of them are the bad guys are the true bad guys which are small low density lipoproteins so we want them um we want the number of these little small LDL particles to be under 500 and we want the size of them to be 20.5 I'm.

Going to go through this in just a minute so don't get overwhelmed with these numbers just yet let me take all this writing off of here all you should remember is this is called an NMR uh all right so we have several nmrs uh taken by a patient over time that I want to show you um in comparison to what was going on in.

Her body what happened to her uh her cholesterol those carrying agents that were circulating around her blood now this gal was trying to be keto she started on keto and then she kind of fell off and then she did Dirty keto and then she did a little bit better and I think after the last 21 day chorus she absolutely is at least headed in the.

Right direction but it does give testimony to how hard this can be when you're even when they're well educated but they're doing it on their own so um so this this panel a couple things I want you to look at is the number of LDL particles uh should be less than a thousand now you'll notice none of hers.

Came close to that this number I'm not going to talk about right now because it does get a little complicated uh we're gonna try to keep this simple because this might be a three-part lesson so next week will be a different set of animations to try and deliver this message because understanding cholesterol is also.

Understanding your fat metabolism how well your body is able to use the the fat that you are consuming and the fat that your body makes which brings me to triglycerides now triglycerides are one of the markers that I use have used my whole I've never screwed this one up triglycerides should always be less than 100. always be less.

Than a hundred okay so she only has one of them that made it less than 100 over these several checks um and it was the time when she was well she was doing a good job on the ketogenic diet um unfortunately triglycerides over 150 are one marker that you're headed for insulin resistance if you get it under.

100 then I think you're doing a much better job I actually like mine to stay under 75. I mean I should never be higher than that I can't remember what my last number was but it wasn't wasn't too terrible it was pretty close to my goal but I want you to notice what happens when her triglycerides get better.

Skip skip total cholesterol it doesn't teach me anything don't look at that um these small LDL particles if I could go back a slide actually I'll point that out in a minute again the small LDL particles are the ones that got too small for for uh the but they hung out in the circulation too long and those lipoproteins became the angry small tiny.

Cholesterol particles that are responsible for heart attacks so we want these small little turkeys to always be under 500. I think when I did my NMR test right before Christmas my small LDL particle was 90 or less than 90. like so low you couldn't measure it meaning I I'll show you why that number was so low in me and what we're going to tell this.

Patient here that she needs to work on all right so again the LDL particle size we want it to be fluffy we're going to go through that in just a second um and we also want um uh we'll show you why that size matters so much in just another slide here so hang tight a c reactive protein specifically we want the highly.

Sensitive C reactor protein also known as your cardiac C-reactive protein we want that to be like one anything under three we don't chirp about but uh she only hit that goal again one time in all these tests the time when she was doing a good job on her ketogenic diet now how do I know she was doing a good job on the ketogenic diet if you look at any of.

My uh my speaking tour when I was doing live um a lot not live on YouTube live actually on a stage in front of people the theme that I had last year was that there was one lab that matters way more when you're trying to to navigate the ketogenic diet and that was the average blood sugar and her average blood sugar.

Right here was five which means that uh her hemoglobin A1c was five which means her average blood sugar was around a hundred uh after that 5.2 and another 5.2 rather stable but having a tough time getting it back down to five after her first initiation but what I could tell you is that when her blood sugar was in that five in that lower area her.

Triglycerides were also a little lower we're going to explain that in just a second um but her particle count up here was well definitely too high all right so let's see if we can break this down into a little bit more uh sense the first thing I'm going to point out is when we are looking at the size uh of.

Particles or excuse me the amount of particles found in your blood you cannot get that with a a lipid panel that you get regularly from your doctor they have to order this nuclear magnetic resonance which counts the particles uh that are the size of ldls that are the size of ideals and that are the size of vldls those particle numbers are in your blood.

Are found in a Range that is very predictive of what your insulin is doing what is your blood sugar doing so when I look at somebody who's insulin sensitive so what that means is they're normal their body listens to insulin the insulin goes up it takes care of the the sugar it puts it where it's supposed to.

And um we look at well in in their blood what percentage how many particles are are responsible for carrying around the fat so now if you remember back on that first slide where I said yep it starts out at that really big that really big chylomicron he gives away some triglycerides he becomes an IDL he goes.

To light waste and triglycerides and he becomes the LDL so here was vldl here was your IDL and here was your LDL and the difference is the triglycerides that are present so when you look at well how many of them are the ldls most of uh what is in a normal person is your LDL cholesterol that what low density.

Lipoprotein the very smallest of those particles so most people with that are are healthy not diabetic not insulin resistant not pre-diabetic they have about 1200 of them are LDL particles when you look at the particle number that I mean that complete particle number so this is your LDL plus there's your IDL plus your.

Vldl okay total particle number uh 1200 if they are insulin resistant which means they're headed for diabetes which is what I would say this patient is headed for that very high particle count that very high amount of um uh of LDL cholesterol particles found in her blood.

Um she's definitely uh on on the Spectrum for getting uh too much insulin in her system even though she was able to keep her hemoglobin A1c at 5.2 and average blood sugar around you know 115. uh I can see that she's using a lot of insulin to do that and I can tell that because of her C-reactive protein that had steadily gone up and her.

Triglycerides that had gone up all right so let's go to the final one if you're diabetic you have the most particles in your blood you cannot seem to get the triglycerides to dish out of your little carrying agents swimming around your system and instead you you circulate those little those little uh carrying agents for fat they're in your blood.

They stay there longer than they're supposed to they circulate far too long we call it residency time The Residency time that they live in your blood way too long when you are a type 2 diabetic really long when you're insulin resistant which is what this patient had problems with so when I look at what her numbers were.

For October of 2019. her and this is just her LDL particle count I mean again this was total particle count this was her LDL only the LDL particle she was over 2400. again a sign of very high insulin in fact she has a higher particle count than most diabetics do so then she got um she got her game on she did pretty.

Good she was following the ketogenic diet really lowering the amount of um the amount of blood sugar and you can tell that because her hemoglobin A1c went down to five uh she got her total particle count down to eight just under 1900. so the best one she had for all of those numbers as she fell off the wagon a little bit.

Her particle count went up to over 2200 and then by the last part of last year she um well she was still over 2200 for her particle count so let me just review what I tried to explain in this um in this uh slide deck so that vldl these particles right here as they're.

Circulating around This Woman's uh bloodstream you'll notice that in a healthy person the triglycerides meaning the the number of red dots I'll change my pen to Red here the number of red dots are the triglycerides and it is it is dishing out triglycerides as as she lowers the size of her vldls she goes around to her liver cells to.

Her tongue cells to her you know bicep styles to her bone cells and they need they need fat they need triglycerides and so she dishes out these triglycerides in an ideal world that vldl will empty out all of uh those triglycerides within two hours meaning it goes from this size of a vldl all the way down to here within two hours.

It hangs out in this ideal equation I mean with that many triglycerides you can kind of see it's a much smaller number you know maybe for another four hours that's healthy and then it gets down to the LDL which is where I'm checking your blood at the 12 hour mark so now it's been 12 hours since you've.

Eaten the fat that's come in needs to be delivered to the cells that need it and we are going to measure what is the size that's left um when we check that blood and in a healthy person you get rid of those triglycerides in the vldl really quickly so the size of your vldl gets really close to an IDL.

Before that four hours is up and and then it continues to say anybody else last little triglyceride it hands it out to the last few cells that need it and it gets small enough that we call it a LDL particle um but as soon as it is an LDL particle we are recycling that back to the liver we actually recycle some of the idls.

Back to the liver and we even recycle some of the vldls back to the liver so we're getting particles out of the blood The Residency time spent in circulation of delivering fat is is short and when you are insulin sensitive when your body is listening to insulin you can see it get rid of that.

Cholesterol in a quick hurry when you look at the opposite of that again this one was the healthy patient um this one is the insulin resistant patient they can't get rid of their triglycerides as much notice the size difference between here and here again both of the particles came out and they're trying to dish out those.

Triglycerides please take some triglycerides take some triglycerides and as he stops over at the at the pancreas cells and then he stops over at the intestinal cells and then they stop over at the kidney cells and then the muscle cells they're like hey I'm full you gave me a lot yesterday oh you know what I'm full I don't need any.

Triglycerides I I don't have any place in the end I don't have any space for your resource and because of that these idls stay in circulation up to 10 to 12 hours so now when I draw your blood and I say by golly come in fasting to let me draw your blood the vldls these little turkeys here they're bigger they couldn't get rid of their.

Triglycerides so they're much bigger in size and there's a whole bunch more of them and they're filled with triglycerides when I uh when I look at triglycerides and I see a whole bunch of them instantly my mind says uh oh they couldn't get rid of their triglycerides they knocked on all the doors of the.

Cells in their body to say do you need some triglycerides do you need some triglycerides do you need some trigger threads and all of them said um I'm still full from yesterday I'm still full from yesterday and unfortunately by the time you get uh the idls made and now you get ldls made unfortunately they're circulating around.

In their body for five to six days that's a nightmare my swatch says it doesn't understand that's a nightmare uh that's a cholesterol that is far too high that is an LDL particle that says I give up I can't get rid of my triglycerides I can't get back into the liver to get recycled I'm just going.

To go hide out inside the blood vessel which is the beginning of an atherosclerotic uh or uh that's the beginning of a heart attack so when people say Doc I I've been on the ketogenic diet for a while I want to know um is my cholesterol okay.

Uh I'm gonna teach you how are you going to find out if you have a healthy VL deal one that got rid of plenty of trigly triglycerides and got down to that smaller size within about two hours or if you're insulin resistant and your vldl is still floating around it uh six to 12 hours and it did not get rid of the.

Triglycerides it was supposed to the other part that I want you to think about is um this is supposed to be LDL that a healthy LDL is actually bigger and all of these little yellow circles in there that is cholesterol that's where the LDL or bad cholesterol got its.

Name it is filled with cholesterol why because it got rid of all the triglycerides it did its job and now it needs to recycle back into the liver now before I do that I want to go to um hold on one second here I I have uh before I give away the little punch line here that I'm about to tell you I want you to see this.

So there are a couple things that I did last year and I I am just super thankful that I did them that I want to announce that I'm doing it again this year and it is uh it's a fundraiser for my kids school it's something that I only do one time a year and uh it's for a really good cause uh the gal that won this last year.

Um I want um in fact Angela can you post that link in uh in in the I bet oh no I can't do it uh I was gonna have you post the link to the um to the auction.

Inside the the chat so this is uh a fundraiser for our the kids the boys school that my son goes to and all boys Jesuit school and I put in one item actually I have two but you should only bid on one you can bid on two I don't care but uh the item if you go to the the link uh under ibid and you look under the.

Gadiosa auction I'm going to show you what I have on on there last year the gal that won it her name is Lou and I I just loved the the story that I got to learn because of her so it starts at 125 dollars last year it sold for a pretty good price and although it comes with uh um the um the books two two bags of the keto combo it also comes with an hour.

Consultation from me all the money it goes towards helping kids pay for the tuition to go to this school which I think is Raising some of the best men that I've seen in the 21st century where they are um you know they have they have acts of service that they do they are in a culture of other uh strong.

Uh men of faith that they get to imprint from and I just I couldn't be more um proud to have my son go there but also to do whatever fundraising I can do to help as many kids uh that can that can't afford to go there to be able to go there so um the auction is actually open as of right now but it closes Saturday.

Night at I think 10 o'clock Eastern time so if you're looking if you want a free con or if you want a console it's not free to you but it's it's it's my free donation um you can bid on this it comes with a fora care and some test strips it comes with a box of pucker up and then the keto combo which is now off uh the sale.

It's the last two bags we have of it as well as some books but most importantly it's an hour consultation with me and I I would be happy to uh to to do that with you all right two other things that I was going to show you uh ketocon is still counting down for April 21st uh my friend uh Robin who lives right near me here she lives near Tampa in in Saint.

Pete we have tried for three weeks now to get our live uh a conversation to happen we're going to try again over the next couple weeks two busy women trying to get together but if you are coming to ketocon uh I'm gonna be there I I don't have a booth but I am planning on lots of hangout time so if you would like if you'd like to do that I'll be there and.

This conversation about cholesterol will be much more Polished by then all right the two other things I wanted to point out um I uh I'm gonna point out something in just a minute that if you go to the Dr baz favorites um I want you to see.

Um that this is where you find these okay uh when if you go on to the DR Boss page and then you push DR Boss favorites these are the places where some of the things that I really like um they end up here all right last but not least is my dashboard and that is um uh something that during our 21 day.

Course um the gal that we're talking about on this case tonight her blood sugars from the beginning of the course to the end of the course dramatically improved they dramatically improved not because there was some magic sauce that we spread you know throughout everybody's uh dietary.

Plan but because she was in community using positive peer pressure in her classroom to uh to improve her numbers that when you look at her case today she's been struggling since 2000 I think 19 was the first time I saw her numbers came in and the ability to get a reversal process of her.

Of her particle size the little particles that carry around cholesterol they stem from how well she can control her blood sugar now I put mine up here these are these are my numbers um and what what I uh I'm gonna show you the V uh oh it's down here.

No it's not down here put 50 of them in there I wanted to show the graph detail readings uh oh I think I gotta go back out I don't want to do that today all right so I'm not going to show you the graph tonight the point I was trying to show you is.

How well this dashboard worked for our classrooms and you do not need to be um you do not need to be um affiliated with us to use this dashboard this is dashboard by keto Mojo and they have been not only very supportive of everybody in the in the ketogenic Community but.

Um very powerful Improvement on creating a community that speaks in numbers which is what we teach in our 21 day course we put everybody in a group we put my numbers in every group that you can see it's not just something I pretend to do either if I want my cholesterol to be the numbers that I can show you um didn't used to be this good but are.

Are better now the first thing I improved was my blood sugar the first thing that I got stabilized was my hemoglobin A1c so let's go back to this case um we are going to go back to our keynote and I am going to talk about um again I want you to write down this.

Little thing nuclear magnetic resonance that is the name of the blood test that checks the cholesterol particles not just um the uh lipid panel that says what are your triglycerides what's your total cholesterol this actually measures how many particles are in the vldl uh status how many particles are in the LDL status.

And then it measures what is the size of that vldl because if it's been in circulation too long the vldl stays too big and that's a predictor of high insulin that says you've got too much insulin going around you cannot get rid of those triglycerides that's what predicts a heart attack It also says if you are able to get rid of your LDL or.

The quote bad cholesterol quickly then you're only going to have the fluffy cholesterol the ones that don't have an association with a heart attack but if they hang out in circulation for six seven days the size of that LDL particle gets too small and now it fits in between the epithelial cells in your blood vessels and this is what predicts.

A heart attack so if you look at what should be happening with every one of the this is an example of LDL cholesterols those tiny ones they should be able to go into the receptors in the liver this is your liver up here and there is a um a cholesterol receptor it should fit.

Into that receptor and be recycled through the liver your IDL should do that a few vldls should do that and all of your ldls should be recycling when they get stuck in that circulation and their residency time in your blood is too long they don't fit into the receptor because they get marked one of the predictors for how that happens is.

To look at what is your hemoglobin A1c if your hemoglobin A1c which is your average blood sugar is above six and I know that ours was the gal that we're talking about hers was only five and then went up to 5.2 but I contend that it was it was using a lot of insulin to get there so when people say what's the key to looking at my LDL cholesterol the.

First thing I talk about is well you see there are oxygen carrying spots in your blood hmm those oxygen carrying spots um get messed up when there is too much blood sugar around when you have a hemoglobin A1c of 100 of six your average blood sugar is 126.

When you have um let's see oh and this is the five for the gal who was there when when five slot when you have a hemoglobin A1c of five which means out of the hundred seats that are supposed to carry oxygen.

Five of them five percent out of the out of a hundred are filled with sugar they're glycated glycated hemoglobin A1c that's what this is and that A1C is an average of 97. I think there's a there is a way this is the part that I was trying to foreshadow on my website is uh hemoglobin A1c is something that you can check on your own that when this gal.

Came to me and said well what what should what should I be worried about um a hemoglobin A1c or excuse me should I be worried about my cholesterol the answer is yeah she has a lot to worry about but in order for us to make sense of what her um cholesterol uh is doing she needs to have a stable blood sugar as the blood.

Sugar Rises and the blood sugar runs into the storage problem much like the triglycerides were not able to be doled out from that cholesterol what happened before that is that the storage for sugar got too full so as her blood sugar went higher and came out of the 4.5 into that you know average of 80 then average of 85 then average of 90.

Now she's got a hemoglobin A1 cf5 and although every single textbook will say no problem it's a hemoglobin A1 cf5 you're fine but 5.2 isn't fine 5.4 isn't fine the trend upward says no it's taking so much insulin to keep that Sugar controlled that we have every storage unit filled to the point where we can't take.

Triglycerides a unit of fat another unit of energy because we have stuffed every corner filled with uh strings of blood of sugar that sugar that glycogen is stuffed in the liver it's stuffed in the muscle it's stuffed in every cell that needs energy so much that we can't feel any more fat either.

And when people say well I started on the ketogenic diet last month I wonder what my cholesterol is I'm like don't do that do not check your cholesterol on the ketogenic diet until you have three months in a row that show you a stable hemoglobin A1c that I have a pretty good sense of what this patient's blood cholesterol is doing that she has a.

Problem she has way too many particles of cholesterol that are not dishing out the triglycerides her blood sugar is too high do I think if she was well if she was in the 21 Day course every day for a year where she had had a tribe of people she was checking in that if she fell off the wagon she got right back on I do think we could lower her particle.

Number size do I think it's enough that it would prevent a heart attack I don't know until she lowers the blood sugar and keeps it stable in the meantime she's making far too many particles of LDL cholesterol I mean just take you back to that one slide um let me go here let's see here.

I'm going to go back to her numbers here quick um okay let me come over here and push this in so when you look at uh her numbers the the LDL particle size uh shoot it's not gonna let me write out I don't think um oh no no no no.

No no don't do that so let's just blow this up so I don't have to do that again so the LDL particle size uh uh should be less than 20. or should be greater than 20 it should be fluffy and she she hit that right there in October of 2019 actually the the since October of 2019 we've changed it that the LDL particle size.

Should be greater than 20.8 not 20.5 so you'll see that metric has changed uh see if I can make this turkey go um so the first the first time she checks it um it's 20.5 right on the mark right there at 20 in October of 2019. so a few particles are getting outside that circulation they're getting stuffed into.

The artery wall when she's doing a good job when the A1C is averaging that at 97 that blood sugar of 97 which is a hemoglobin A1c of five then her C-reactive protein her inflammatory marker lining the insides of her blood blood vessels went from six to 2.0 I wish I could draw that for you but my pen is not working.

Um but then she fell off again and her blood sugars went up again now they're at 5.2 so now we're at a average blood sugar of around 113 or something and her C-reactive protein went from two which is good not great great is less than one uh it's good but hers went up to 7.83 at the same time her triglycerides went up and the size of those LDL cholesterol is.

Now sunk back down to 20.6 I know it's not yellow in this chart but it is high we want it to be 20.8 um so then she does get the she's on the mend here a little bit in August of 2022 because the particle size got fluffy again she's recycling a little better her triglycerides are down to 128 not as.

Good as they were in May of 2021 and the the number of um of of small LDL particles again you don't want to have those she went from 1300 down to a thousand now it's not the 425 that she was able to hit when she was doing a good job when her insulin was lowered and you say well doc how how should you how should you manage this.

And the answer isn't to just guess it is to check uh your hemoglobin A1c three consecutive months getting it as close I mean where do I like mine I like my hemoglobin i1 C between 4.5 and 5. and if you've been watching this show long enough you'll know that last fall after moving across the country and moving the businesses and having kids and a lot of.

Life in a year and a half I had checked my hemoglobin A1c like the year prior and it was you know lovely 4.7 or 4.8 and then it was 5.6 I'm like oh that's not good that's not good and I've been working really hard to say no I know my blood sugars get low in this fasting state but it's it's what it takes to really bring down that average.

Hemoglobin A1c my particle count uh of number of small dense LDL particles less than 90 solo they couldn't measure them because I recycle them so quickly that doesn't that didn't always happen uh when my A1C was higher my LDL particle size was higher as well so the punch line here is to know that you cannot guess what your particle size is.

Or what your particle count is you must measure it the NMR nuclear magnetic resonance your doctor can order it you'll need to ask them to do that I paid cash for mine and it was like eighty dollars for the whole panel so it's not cost prohibitive but many people will not have them they won't be offered it because it is not standard.

And some insurances aren't going to cover that but before you spend the money on that three months in a row get your hemoglobin A1c stable when it's stable then you can make sense out of what's happening with your particles of cholesterol before that you're measuring a bunch of noise that it will change so.

Dramatically when the blood sugars are going up and down and up and down that I continue you're wasting your money to check your NMR until your blood sugars are stable for three consecutive months all right let's get over to some questions and then I need to get to a I need to get to a pole vault um.

Pole vault uh uh track meet okay let's go over to questions um and we're going to start with the the uh I thought we had a uric acid one I must well anyway something's changed since I left here that's okay I began eating keto diet two weeks ago it says Chris G.

Uh have been in ketosis most of the time yesterday my triglycerides were in the 700s liver function was elevated is this normal again you're so close uh to a a flood of incoming fat that all you're telling me is yeah two weeks in you're gonna have some crazy numbers uh and you you have a lot of work to do uh but uh I highly recommend.

And I I mean this without being salesy that you read the book keto Continuum that um that book over my shoulder right there keto Continuum is what I use in my clinic it comes with a workbook it comes with a book if you don't like to read there's an online course that you can listen to little videos you can pick her on YouTube I know but it if you're.

Looking at at a at a triglyceride of 700 first of all I would have never looked all you're going to find is moving fat inside that person and yes we can measure it in the in the lab that's true that's what you did but to say are you going in the wrong direction you can't say that at two weeks you have to head in this.

Direction and stay stable enough keeping your blood sugars stable what I would do I would check your A1C because it will be so much better you know in a month and it'll be even better in two months if you stay the course that workbook and that book were not just accidentally popped out of my brain this is what patients did over.

And over and over again and if you could just stop them from making the same mistake that you see all of these patients making because there wasn't a good guidance uh for how to do a ketogenic diet to get you to health to get you off of blood pressure medicines to get the cholesterol where it really is healthy that you don't need to take.

Medications well it has it has some rules the human body has some rules and I know that it's really easy to hate on doctors and say they told me wrong I always took a Statin for 20 years or whatever uh they were doing the best that they could with the information but we have new information now and.

Um I would I would read the book I would read the book and follow the workbook because you're gonna if you've got weight to lose and you've got triglycerides of 700 you definitely need to be monitored all right let's go to the next question that's a great question actually next.

Question is uh okay if I get an NMR lipid panel done at the end of a 72 hour fast will this give me a good look or will testing after 12 hours fast be better a 72 hour fast is a does send people into a wave of different Mobility for fat so what you're trying to measure at the end or in an NMR in any cholesterol test.

Is how well did we take the fat in and distribute it to where it needs to be how much of it was stuck in residency time um is is what we're trying to measure and now we can get a pretty good look at that by how small or large the cholesterol is the the lipoproteins are at the time of the.

Blood test but you're going to have a lot better reproducibility of saying where where is my cholesterol cholesterol at now what is my cholesterol doing at this season of my life if you stick to a 12 hour fast I mean 12 to 12 to 18 hour fast is a fine fast for an NMR what I don't like people to do is come in 72 hours fasted.

Because it is a completely different mobility of fat at the 72 hour mark than it is 12. and although we could make sense of it it's a it's a much more complex equation and as you can see by this last hour there's plenty of complexity here there's plenty of things that the doctor has to think of so we want to be able to measure this over.

Time were you able to get that particle size down were you able to get that C-reactive protein down are you able to get that the LDL cholesterols recycled back up in through the liver and the answer to that is well measure it at the same approximate time in a fast like 12 to 18 hours not 72. that is a really good.

Question I get that a lot I wish I could clip that and put it somewhere because I was like go watch this video all right let's go to private Susie oh there was Private Susie's the one who had this is the question I was thinking of um okay so private Susie I have chronic gout.

I am on keto I cannot tolerate allopurinol is fasting or eating sardines going to trigger gout or raise my uric acid which is eight I have trouble producing ketones I'm at 0.5 okay so that's the other reason why I was going to that um I was going to that uh favorites paid so go to see this thing out here at.

Bossmd.com click on favorites and you're going to want to order uric acid strips because you can check your own uric acid in your house and you will it is a difficult lab to change um much like hemoglobin A1c it's a slow steady grind of improvement that changes that and if you read either of the books keto.

Continuum or any way you can you'll you'll see a chapter in both of those about here's what happens with stones in our body whether it's a kidney stone or a uric acid Crystal those crystals didn't form overnight to undo them takes a shift in chemistry a ketogenic State a chronic ketogenic state is a very good way to reverse the.

Uric acid that's been stored in your body but if you've got a a ketone level that's at 0.5 and stays at 0.5 that's great that's a good beginning but to reverse gout you've got to be plunging and surging that that state of ketosis into a much higher level to be able to reverse gout where I see people end up in a.

Problem with their gout is they go in and out of ketosis they binge and then they then they they try to fast and they binge and then they try to fast and they binge and try to fast and what you're doing then is you're kind of growing the uric acid crystals you're changing the chemistry back to the the crystal building phase in a state of persistent.

Ketosis you will melt those uric acid you'll actually melt the kidney stones the problem is is if you if you've got a kidney stone hanging out in your in your kidney it's it's usually attached to the wall of the kidney yeah like inside the ureter and if you if you melt it from the bottom up no problem you won't even.

Notice it but if you happen to melt it from the top and it falls off of its anchor well then it rolls down your ureter and then you can end up in the air so don't blame the ketogenic diet this has been brewing in your system for a long time and to reverse it means a persistent state of ketosis um you know we do this course twice a.

Year which is an intense course that I take people through and say this is what I would do in my clinic you want to know how to do the ketogenic diet well enough to reverse uric acid get in a tribe follow these rules you will have the tools to reverse medical problems in your pocket in your brain you will have done that we make you we walk you.

Through it we do it as a group uh and we only do it twice a year because it's it's hard on us too it's very intense but I have no doubt that my my NMR cholesterol will be a good good again and again as we check it year after year one more question and then I'm gonna go.

Watch my little guy pole vault uh okay go back to questions here we go so last question um uh where does the lp little a fit in okay that that's actually I skipped kind of over that because I was like I wonder if anybody remembers that in in the.

Questions so if you look at this slide right here um right here see how this uh this has horns on it this is an LDL cholesterol that ended up with an extra attachment on there okay it only does that when it has been in residency in the circulation way too long that it you.

You get the size of here is what a nice fluffy LDL would look like it's been in residency time it gets to be about this size we turn it purple when it is oxidized which is another not good thing and then we add horns when it has an LP little a and so when you saw us try to say well can we recycle this um.

You know can we take this LDL cholesterol back up into the liver you'll notice that that LP delay doesn't fit into the receptor so it cannot be recycled so it is the most deadly version of that low density lipoprotein is when you put horns on it that's LP little a and you can do a test for that too.

All right once again I do appreciate all of your comments I read them even if I don't comment back to them and I use your questions and your comments on what I will do videos on what I think you're asking me so thank you thank you thank you for leaving comments we will have a um uh a video at the end of this screen which will not be on the live and it.

Only happens after we reprocess so give us a good 20 minutes uh that shows you what happens when we clog arteries and it's a really good one that fits into this discussion um again uh I really would love to see folks bidding on the the um the donated consultation that I'm using for the school we'll try to put.

That out on Instagram on Facebook and uh probably a message here on on YouTube as well the auctions open it ends at 10 o'clock on Saturday and all proceeds go to this school again something I'm very thankful that my son gets to be a part of

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