Cardiologist Explains LDL (Bad Cholesterol) Spike with Keto
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hey everyone welcome back and today we have a real special guest dr. nadir Ali is here and he is a keto friendly cardiologist from Houston Texas so welcome welcome to this channel can you hear me I I can hear you well okay great thank you I am honored to be here on this channel and I’m honored to be a part of your program and as I told you I have had a long-held admiration for you many of my patients are avid fans of yours and your Friday podcast so they look forward to it they come and give me all kinds of feedback I have learned how to communicate with my patients based on what you do to some degree Wow Wow thank you that’s awesome well I’m really a pleasure to meet you meet you in person or actually sort of through the line internet lines here you know just for everyone’s knowledge you’re gonna be one of the main speakers at our next Quito summit coming up in August at the end of August August 31st and September 1st it’s uh I think it’s Labor Day weekend and we’re gonna have a blast so I’m really excited to have you come out and speak you know you you bring to the table something very unique I mean you know one of the big things right now hot topics is this cholesterol thing and the LDL and people are concerned and you see these things in the in the news where oh don’t to key though it’s gonna raise your cholesterol and you’re gonna die have a heart attack yeah I yeah and so I’m coming just from your field I mean I guess that’s what what you’re taught right in school like I guess the whole cholesterol dogma has been pushed so much it’s so ingrained in us that it’s sometimes it’s hard to look at the actual data what’s your what’s your thought on that that’s like delving right into it and I’m glad you’re doing it that way because we don’t waste time in unnecessary stuff exactly but I’ve been practicing for almost 30 years and as a cardiologist and the dogma that has been taught to us is that low cholesterol low LDL is one of the best things for you to do and unfortunately if you compile all information about optimal human nutrition about human brain size about what we need to eat and how we need to behave to reduce our LDL cholesterol C Nevitt ibly it’s going to lead to very poor health it’s gonna lead to obesity insulin resistance diabetes hypertension all the chronic diseases that are going to reduce your quality of life that’s gonna make you die earlier and so I was kind of surprised that there’s such a huge paradox between LDL cholesterol and every other biomarker of health you can take anyone you know they go in opposite direction if you want to improve your insulin resistance your LDL is going to go up if you want to reduce your weight your LDL is going to go up interesting interesting so I started thinking about this as a paradox but then when you put everything together you understand that that’s how our body is probably designed to behave and so I go out there now for the last five years it took me time to understand why LDL goes up on a low-carb diet and it took me time to understand that that is not necessarily bad and in some ways having higher LDL cholesterol with very good other biomarkers might be something to celebrate not my own and I could elaborate on some of that but I wanted more interaction I wondered you to kind of chime in and say hey I want to lead this podcast in this direction yeah exactly because I wanted to there’s some there’s some things that I’m interested in personally that I would like to know your viewpoint on you know cholesterol LDL this is called bad cholesterol but really it’s a it’s a cargo ship it’s a transport ship and it delivers cholesterol we need cholesterol I’m hoping that most people know that our body makes cholesterol but what I’m interested to just start off with talking about is your take on LDL actually carries I think all of the fat soluble vitamins but I’m an a de K k1 and k2 have you seen any data on that especially even vitamin e to as an antioxidant I think it does the data on this is kind of not at least I’m not aware of some very good data on that okay that vitamin D does have its own carrier protein and that may be the LDL is a secondary mechanism for carrying vitamin D around but I guess one of the other major functions of LDL would be to carry Co Q 10 because I’m not sure all the muscle cells are capable of making the Co Q 10 that they need for mitochondrial function and but you’re right LDL is a carrier molecule not just for triglycerides and cholesterol per se but for many antioxidants fat soluble vitamins Co Q 10 yeah and I do know that you have all these phospholipids as well that our I think it’s a that make up the cell wall and so we have a transport system of cholesterol cholesterol doesn’t just float around by itself it needs to be transported and I think that if you could just touch a little bit on the the necessary function of LDL that’s one area I wanted to want to touch on and then also I want you to maybe mention a little bit about statins and what the problem with statins that you run into I’m sure that you know it’s a hot topic with in your field I mean I’m a lot of cardiologists prescribe them right so let’s first talk about cholesterol in general and then move on to allyl cholesterol in particular cholesterol in general is an extremely important molecule for life there is no life on earth without cholesterol every living cell has cholesterol if you go back to some of the earliest parts of evolution when we started out as single-celled beings in this world those single cells also had cholesterol really if you look at cholesterol it is an integral part of every cell membrane the cell membrane gets its structural integrity the fluidity so that it acts as a barrier because cholesterol is connecting the phospholipids in such a way that it is providing those functions the second major way to think about cholesterol is to look at brain function because in our brain there are these cholesterol rafts and these rafts are locations where neurotransmitters set so the structural integrity of the neurotransmitter receptors is because of these cholesterol rafts and if you deprive the brain of cholesterol the integrity of these neurotransmitter receptors is affected so there is a lot of data that comes out and says that there are certain statins that cross the blood-brain barrier can have significant cognitive dysfunction – and in fact cholesterol is so important for the brain that it does not delegate the responsibility to any other organ to make cholesterol it makes its own Wow and I often joke that I would not be able to deal with the stress of being a cardiologist or giving this podcast if it were not for cholesterol because the LDL molecule is supplying cholesterol as raw material to my adrenal gland so that it can make the stress hormone which is called cortisone and and that’s an absolutely amazing fact that many of the hormones the backbone of that is a cholesterol molecule and the carrier molecule that is supplying that cholesterol to make that is the LDL and I often joke to audiences saying that hey men look handsome because of LDL cholesterol I like that and the reason is is because the LDL is the one that is supplying testes with cholesterol the raw material to make testosterone and similarly women look beautiful because their ovaries also need cholesterol to convert cholesterol to estrogens so these are functions that are sometimes completely skimmed over when we tried to knock the LDL down like crazy and say hey we the lowest is better and it made no sense to me as a cardiologist because I’ve been practicing for 3
0 years and I have seen people come in having extensive three vessels heart disease with blockages everywhere with cholesterol levels as low as 50 Wow Wow and I have seen 90 year old women or older with LDL cholesterol in the mid to hundreds who I take them to the cardiac cath lab and I find that they have the most beautiful blood vessels that you and I although maybe several decades younger would be happy to trade those blood vessels for them Wow Wow that’s that’s fascinating so I’ve been a bit of a skeptic all my life about this cholesterol being a causal factor in coronary artery disease because it made no sense and if you really take the trouble to talk to patients you would find that they complain of all kinds of side effects on cholesterol reducing medicines it’s just that the medical profession has moved in such a direction that we rely so much on information coming in from societies that we have given up our clinical acumen we have given up our critical thinking ability we want to just follow guidelines we don’t want to do our own work we don’t listen to patients we don’t want to be skeptics as a physician I think it’s highly necessary for us to be quite skeptical about every information and use our clinical intuition when we are taking care of patients exactly I also was fascinated that the LDL cholesterol is so involved in host defense and this is not something many people talk about because host defense that means how we protect against bacteria and viruses is in some ways mediated by the LDL cholesterol put out some elegant information from different studies that I have looked at in which like for example there is this fascinating paper which looked at a mouse lung and they infected the mouse lung with bacteria and these bacteria they elaborate a little protein that goes in as a pilot to investigate and see if the milieu is suitable to establish an infection so the bacteria themselves is smart they won’t go in and start an infection without checking the area out first and that marker protein comes back and gives an information to the bacteria it’s called quorum sensing protein and it comes back and says hey let’s establish infection and I was surprised to find that in this paper this elegant work that shows that it is the LDL cholesterol that is going in there and neutralizing this protein so that bacterial infection cannot gain a foothold Wow fascinating fascinating I definitely want to get a copy of that so um it yes it actually has ability to attack pathogens it also has the ability to bring antioxidants into a certain area and dump vitamin E into an epithelial wall to help protect against lesions I mean now most the time from my viewpoint it seems like people go on a keto program and it lowers the LDL but then you have people that have a higher LDL lets us talk about what would be some of the reasons why someone would actually cut the carbs down and their LDL would go up any reason for that yeah that’s one of my strengths I think that I’d like to take a little credit that I’m the first one to point out in a national audience now as to the molecular mechanisms why LDL is going up and and I’m so glad that you brought that up because this is something that has bothered me a lot you know as a cardiologist for the last five years I have been practicing a low carb diet myself and recommending it to a lot of patients and I have been seeing that as many you know in large majority of these patients as they lose weight as their diabetes improves as they come off diabetic medications as their triglyceride levels go down as their HDL level goes up the one troubling finding that was happening is that the LDL goes up and it goes up unlike what people think it goes up almost in everyone it may go up to a variable degree but it goes up in everyone so I wanted to explain why that is happening and in the final analysis I think this is and although this is my model and it’s not being proven in studies yet but I think that’s what we should do is that when you are going on a low-carb diet by design you’re burning fat we have very limited carbohydrate reserves we run out of them in a situation in which we stop eating like intermittent fasting or going on a fast for several days you’re gonna run out of carbohydrate reserves in about six to eight hours and then your body predominantly becomes fat burning so it’s burning triglycerides and it’s there are certain tissues that cannot directly burn triglycerides so what it does is that the liver takes the triglycerides and converts them to ketones so the liver is the only organ that has the enzymatic machinery to make ketones so it’s taking the triglycerides it converts the triglycerides to acetyl co a which then enters the mitochondria and then the acetyl co it through a series of enzymatic reaction gets converted to HMG Kawai now hmg-coa fascinatingly is a branch point it’s the same raw material that cholesterol uses to make cholesterol in the body that means hmg-coa can go on and make cholesterol and hmg-coa can also get converted to ketones that’s right interesting so if by design you are doing better oxidation of fat it just means that you’re burning fat if you’re burning fat you are making a lot of ketones and if you’re making a lot of ketones by design you’re going to make a lot of cholesterol in the liver and I’m not just basing this on hypotheses there are a lot of animal studies that are human studies that give you indirect evidence that this is what is happening and if you think it’s right I want to take you through a few of these yeah yeah I think you know it’s it’s it makes total sense because ya could go split off this way and make ketones or cholesterol so I do remember that chemistry so like wow I never actually considered that viewpoint but that that makes a lot of sense and I think the this in this day and age the reason it’s important to collaborate is because a biochemist is not gonna completely look at that point and say hey I want to think about it that way right neither is a nutritionist and not as a cardiologist along because they don’t understand the details of the biochemical steps in the liver but when you put all of these people together in a podcast like yours or at a local conference it starts gelling this information and that’s how we would make advanced by collaborating right so I to go back into this information so there is there are these drugs which are being used for diabetes which are called sglt2 inhibitors in Kanna is one of them Giardia –nz is one of them and basically what these drugs do is that our body filters sugar in the kidneys but it reabsorbs most of the sugar but these drugs poison the kidney tubules in such a way that you don’t reabsorb the sugar that you’re filtering so basically you’re dumping sugar so when you’re dumping sugar and if you’re not eating carbs or if you are let’s say fasting the body switches to fat metabolism because you don’t have sugar available you’re going to do now fat burning so when they started using this in humans they started noticing that ketone levels go up they also started noticing that LDL cholesterol levels go up and fascinatingly in some of these studies now that since there is no conflict here in the sense that the pharmaceutical companies and I’m sorry for being a skeptic but the pharmaceutical companies want to show that hey dumping sugar and reducing your blood sugar is beneficial for you and by the way it’ll be helpful for you to prevent heart disease and that’s what they found but they could not explain hey you’re improving heart disease but your LDL levels are going up and so there’s an accompanying paper that’s done in a in a hamster which goes into the biochemical mechanisms with this so what’s happening is that as you are dumping sugar you are not making more ketones and as you’re making more ketones the liver is synthesizing more cholesterol and since the liver has a higher amount of cholesterol it doesn’t need cholesterol for itself otherwise what the liver does is that hey cholesterol is so important for me let me soak up some cholesterol from circulation and it has these LDL receptors these receptors
are there that soak up the cholesterol from the circulation and remove it for liver to be able to use it but since LDL since liver is synthesizing so much cholesterol it doesn’t need that cholesterol from circulation so it down regulates the LDL receptors and also since it’s making so much cholesterol and since cholesterol is not a metabolic fuel in other words we can’t burn cholesterol like we can burn sugar and triglycerides the only way for us to eliminate it is in bile well the paper shows that your cholesterol elimination and bile goes up so you can see that the feces are now filled with cholesterol Wow Wow and another fascinating mechanism that they talked about is that the LDL cholesterol is in some way an antioxidant it it is fighting antioxidant injury and it gets oxidized in the process when it gets oxidized in the process it gets picked up by the macrophages through a certain receptor so the macrophages go around and say hey this LDL has done its job let me just pick it out from circulation and this paper shows that these macrophages that are laden with oxidized LDL cholesterol their elimination through the gut through feces is promoted in the setting of fat oxidation so here is a complete picture you’re burning fat you’re making more ketones you’re making more cholesterol in the liver and hence you gonna make more LDL because the liver has to mobilize that cholesterol it’s going to down regulate the LDL receptors because it doesn’t need cholesterol anymore it’s gonna up regulate cholesterol elimination so your bile acid production goes up the elimination of body goes and it also improves the elimination of oxidized cholesterol fascinating so so um a couple things if you’re getting an increase by all production you could also have could be create a laxative effect you could have a little diarrhea maybe some of the side effects but the question I have is that time so people are probably understanding this now but they’re thinking is this extra cholesterol going to stick and my arteries and clogged up an artery that’s I think that’s the big question that they are concerned about so I think that one thing I would like to humbly submit is that we don’t understand the molecular mechanisms why we get plaque in our blood vessels and I almost hesitate to call it an adverse periodic plaque because that gives it a connotation that somehow cholesterol is the culprit so I want to stay and say hey it is plaque formation and to say that the LDL is the primary culprit that gets on to the vascular wall onto the sub endothelium and I know I want to be cognizant on by not using too many medical terms that is the layer just beneath the lining of a blood vessel and then initiate a response in which you are making plaque is by no means scientifically agreed that that are the mechanisms it is quite equally possible that the LDL cholesterol is there to help repair an injury that happened as a result of oxidative stress which means that whenever you burn something you create an injury an oxygen when it is used in a certain way creates an injury at the level of the vessel and that could be from high blood pressure that would be from result of an infection that could be because you have insulin resistant and as a result of that you have systemic inflammation that is leading to vascular injury and is this vascular injury being promoted by the LDL or is the LDL just there to help prevent oxidative damage and in the process you see it around and that does not mean that it is the culprit and one of the many people from whom I have borrowed this line is that if you order a scene of a fire you’re gonna see firefighters but you’re never gonna blame the firefighters for causing the fire right right and so is the case with the LDL I’m not sure it is there too cause I don’t know if it’s the culprit I don’t know if it is there to help right the paradox is that you see vascular damage in people with very low LDLs and you see no vascular damage in people with LDLs in the mid to hundreds and it simply does not jive that it is a graded culprit if it is a graded culprit you should see consistency of effect right and if it’s a graded culprit you should see that hey if I reduce my cholesterol LDL cholesterol down to 30 milligrams per deciliter since this is my primary hypothesis that this is what is causing vascular injury I should see no vascular injury and I can take you through many papers in which they have dropped the LDL down to 30 milligrams and have changed the event rate either by less than half a percent or have done it in the opposite direction so to me that makes no sense and this is the kind of critical thinking that I want physicians who are taking care of patients to do is that you cannot rely on relative risk reduction that many of the papers talk about but you want to look at absolute risk reduction you want to look at the integrity of data you need to be a skeptic and see who is doing the studies and what is their bias behind that right right yeah they just I think they in 2005 they came out with a rule I’m not sure how well drug companies follow it that they have to be more transparent upload all the research on a given drug I don’t know if they’re following that but before 2005 they you could selectively publish what you wanted to publish unfortunately so if you’re if you as a doctor researching and you’re only getting half the picture you’re just you’re gonna see something that’s not not the true data one thing I was gonna ask you being a cardiologist what when you’re looking into an artery looking at plaque do you find a certain pattern of where that plaque is located is it always in the carotid arteries is it in another artery does it happen in certain high pressure areas or does it just random well to a large degree it does happen with there are where there is shear stress so you know shear it could be a medical term so basically at a branch point the blood flow is not laminar the you know laminar is smooth blood flow turbulence is when the blood flow is not smooth and our areas of branch point there is possibility of turbulence and at this point there is a lot of stress on the vessel wall and that can happen as a result of high blood pressure that can happen as a result of the blood vessels getting constricted which means getting smaller so you predominantly see flag buildup those locations but it can also be found at other places that are more or less random that you would say hey this is a process that you can predict to some degree that it will happen at branch points and are places of high shear stress but it can also happen in other locations so like for example you mentioned the carotid arteries the carotid arteries bifurcate when I say bifurcate they divide into two blood vessels right here in the neck and at this point one blood vessels going and supplying the brain the other blood vessel is supplying the face and at that branch point there is more likelihood of you getting buildup of plaque and buildup of blockages and I’m trying to stay away from saying buildup of an asterisk erotic plaque right because that implies a certain causation and then you what about the coronary arteries that is that more common than the carotid so both occur concurrently like if you have coronary artery disease the likelihood that you can have carotid artery disease is about 50% and if you have carotid artery disease the likelihood of you having coronary artery disease goes up dramatically and what goes up even higher a more a further end-stage that means a more advanced stage of vascular disease would be blockages in the blood vessels of the leg so if you have lock edges in the blood vessels on the leg the possibility that you have heart disease which means blockages carotid disease the blood supply to the brain and kidney disease is very high so unfortunately people with blockages in their blood vessels that demonstrates that there is a more advanced vascular disease present in them and hence you would find it in other locations as well interesting the patients that come see you are they coming with blood pressure or are they coming because they already
been diagnosed and they need surgery what type of clients come to see you so in the first 24 years of my practice I predominantly tried to work in the cardiac cath lab so I would see patients referred to me with blockages in the blood vessels of the heart and I would take them to the cath lab and put stents in them and fix them and these people do have high blood pressure many of them are diabetic many of them have I would say I hate to use the term high cholesterol I would say poor quality cholesterol I’ve started using that term and poor quality cholesterol and my view is somebody who’s got high triglycerides and low HDL and if you divide or if you evaluate their LDL cholesterol properly it is the small dense molecule and launch not the large and fluffy molecule so they had a number of these factors and I would open them up in the in the cardiac cath lab but in the last five years have gone through a transformation and I said hey if this nutrition works and me I should try it in my patients and so now I spend more and more time at least 50% of my time or more in the office and I am surprised that I on a weekly basis get calls from people in New York California Arizona New Mexico and Louisiana saying that hey we want to come see you Wow for for nutritional advice for questions that they have about the LDL and you know and I tell them that look it’s I feel uncomfortable that you need to travel all the way to come see me I’m sure that you will find a local practitioner nearby who can give you all the information that you need because it’s too much for somebody to travel take an airplane just to come see a fish in our short office is it so now I’m beginning to see more and more people who are coming purely for nutritional advice and I say okay yeah I will do that but you will be surprised that when you’re giving nutritional advice you uncover that their poor nutrition has contributed to insulin resistance high blood pressure diabetes obesity in so many different ways and I am surprised that the impact of nutrition and lifestyle is so much greater than medications Wow it’s it’s it’s an order of magnitude greater than medications without the side effects and I’m not sure why people are not working at that and and and and that’s why my opening slide at low carb Denver said I’m concerned that the medical profession is gonna get buggy whipped that’s funny because they are not listening to the grass root movements that says hey I’m doing all these things and I am improving why as a medical professional are you not looking into this right right I know it’s it’s starting it’s like oh it’s like a wild flower flower just spreading all over the place so yes it may be if you if you don’t after all it comes down to the patient and the patient does want this shift is they want alternatives they don’t necessarily like the drugs they want to get off the drugs so they’re looking for doctors like you and that can actually give them a good good information so yeah things are really really changing that’s so you you basically you you must have a lot of actually probably very enjoyable to take someone where you can see it’s pretty obvious and then completely shift them but by changing their diet it’s just it’s such a big of that you can create that probably before yeah I know in my practicing before I knew about some of this stuff you know I’d be treating these specific symptoms with all these different pills people would go home with a hundred pills and all these vitamins and stuff but I didn’t work on the basics I didn’t get the eating corrected until I started doing that like the need for all these other things go way down so it’s just remarkable so I’m so happy that I had a chance to talk to you I and get this great data and I’m excited to have you come out so those of you that are watching you should come out and definitely come to our event it’s going to be at the end I’ll put a link down below and I also want to put a link to your YouTube channel so people can start watching your videos I think you’re starting to release more videos yes that’s true they come either under my name which is Nadira lee md and they also come under eat mostly fats nutrition all right some of them are being released by keto fast and look up down under but if I mean I want to entice your audience and not that your your conference is not going to be completely sold out I heard that last year you did it on very short notice and even though you did it on short notice there were no seats that were unfilled and people were waiting in line but I wanted to still entice them to come because the talk that I am working on right now and which is very fascinating is to answer the question as to what is optimal human nutrition and the way I want to approach that area is by looking at these concepts and I’ll just leave you with the concepts I’ll not define them in any particular way one of them would be what is called the extensive tissue hypothesis what that simply means is that we have such an enormous energy expensive brain that is three times the size that you would predict based on our body size or any primate ancestor there’s 2% of our body mass and it consumes 20% energy so feeding that brain is very important the second aspect of that would be that how our digestive system has modulated and evolved over these periods what is the diet that is suitable for us the third thing would be what is our pancreas doing our pancreas kind of evolved without the stresses that the modern diet is putting on it and it’s not capable of handling glycemic load that we are giving to it in this day and age with the diet that PE and then finally I want to look at the microbiome you know we have a gut that has bacteria in it and how important is the microbiome how important is is fermentation and there are many other concepts that are going to come in play to evaluate the most optimal human nutrition Wow you guys you have to come to learn about this this is gonna be exciting I can’t wait to hear you it’s gonna be good thank you I hope I delivered on my promise I think you will you’re you’re a great presenter and you’ve filled with gold it’s great great and rate data so thank you so much and I’m looking forward to talking more with you in a couple of months I absolutely enjoyed being on your podcast Eric and I’m honored that I’ll be a part of your conference awesome thank you
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Dr. Berg interviews a special guest and one of the speakers in the upcoming keto summit, Dr. Nadir Ali. He is a cardiologist in Webster, Texas with over 25 years of experience and is affiliated with Clear Lake Regional Medical Center.
Dr. Eric Berg DC Bio:
Dr. Berg, 53 years of age is a chiropractor who specializes in Healthy Ketosis & Intermittent Fasting. He is the author of The New Body Type Guide and other books published by KB Publishing. He has taught students nutrition as an adjunct professor at Howard University. He no longer practices, but focuses on health education through social media.
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Dr. Eric Berg received his Doctor of Chiropractic degree from Palmer College of Chiropractic in 1988. His use of “doctor” or “Dr.” in relation to himself solely refers to that degree. Dr. Berg is a licensed chiropractor in Virginia, California, and Louisiana, but he no longer practices chiropractic in any state and does not see patients so he can focus on educating people as a full time activity, yet he maintains an active license. This video is for general informational purposes only. It should not be used to self-diagnose and it is not a substitute for a medical exam, cure, treatment, diagnosis, and prescription or recommendation. It does not create a doctor-patient relationship between Dr. Berg and you. You should not make any change in your health regimen or diet before first consulting a physician and obtaining a medical exam, diagnosis, and recommendation. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The Health & Wellness, Dr. Berg Nutritionals and Dr. Eric Berg, D.C. are not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this video or site.