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Pedram: Hi everybody. I'm back with Dr. Jonny Bowden. Hello, Doc. How are you?
Jonny: Yes. How are you, Pedram? Pedram: Fantastic. Fantastic.
Jonny: Good. Pedram: I am excited to keep going. The dialogue
that we've had has been fun to say the least. Today, I want to follow up on heart disease,
and basically what people can do about it, because that's the thing that everyone is
so scared about. Everything is fine, then you get heart disease, and then you freak
out. I know you and I were talking about a study that you could do like a low tech study
that you were mentioning that might be helpful for people to do at home. How about it? What's
... Jonny: Before we even do that, I just want
to grab something that you just mentioned about everything is going along fine, and
all of a sudden you get heart disease. It really just didn't happen like that. The step
is very accumulative. These kinds of injuries that take place in the vascular system, they
don't happen overnight. Sure, there are occasional times when stress will trigger a heart attack
or some event and you think it just came out of nowhere, but generally there's something
going on before that. That leads us to this test that I wanted to
talk about today. Because as you and I have mentioned many times in conversations both
in this broadcast and off the air, there's a lot of resistance in the conventional medical
community to test like the particle size test or the particle density test. These newer
tests that in my opinion are far more accurate in terms of figuring out what kind of cholesterol
are you having, whether it's a problem or not.
The old fashion good cholesterol, bad cholesterol test it's way past its expiration date. It
really doesn't give us a lot of valuable information, because as we talked about before, but we
now that LDL, the so called "bad cholesterol" comes in several different flavors, two primary
flavors, LDL A, and LDL B. They're very, very different, and it lets you know what you've
got. It's not really prudent to treat the number then you're treating a number, not
a patient. We need to know this, and a lot o doctors
are going to resist doing it. A lot of doctors are just very conventional. They see as number.
They write a prescription for the state and drug. That's the end of that.
I want to tell about a test you can do without your doctor's permission, and it's right on
your blood test. If you've ever had a blood test at all, and it's got to be recent because
you don't want to find out what was going on like two or three years ago, you want to
do it with a relatively short time ago. You want to look at two numbers. You want
to look at your triglycerides, and you want to look at your HDL. If you've ever had a
blood test, those two numbers are on it. They don't do blood test that don't include triglycerides,
and HDL cholesterol, so you've already got it there.
I am going to tell you how to do this ratio, and I know we're in America, I know everybody's
eyes glazed over when we mention even fourth grade method. This is really easy, and it's
very simple. You're going to take your triglycerides, and you're going to divide it by your HDL.
That gives you what's called the "ratio." For example, if you want to know what the
ratio is of 115, 100 divided by 50, you got a ratio of two. You have 300 and 30 on the
other you divide 300 by 30, get the ratio of 10. Ratio is very easy to do. It's just
the bigger number, the triglyceride number divided by the HDL number.
Let's give a couple of examples. Let's say if somebody's triglycerides are 150, and their
HCL is 50. They have a ratio of three. A 100 triglycerides, 50 HDL, ratio is two. Once
I did a blog on this, and I said almost always 99.999999% of the time triglyceride is going
to be higher, and you're going to get a positive number; one, two, five, ten.
Occasionally it's a really healthy person has incredibly low triglycerides and incredibly
high HDL may actually have a negative rate ... the ratio is actually under one. Like
I had a couple of people write to me, and he said, "My triglycerides are like 49, ad
my HDL is just 61," and they actually have a fractional number. That's very, very good.
It doesn't happen often, but for the most part, most people [inaudible 04:24] triglycerides
are going to be higher than your HDL. Now, let's talk about what this ratio predicts.
In one study done in circulation which is the General American Heart Association, it
was found that people who had a high triglyceride to HDL ratio, and by high I would say, anything
over five is pretty high. People who had that high ration have a 16 time greater risk of
heart disease than those who had the lower. That's a way better predictor than anything
I know. It doesn't just predict heart disease. It's a fantastic stand-in for insulin resistance.
Another test you may have a conventional doctor [inaudible 05:13] and say, "We don't need
… we just look at fasting blood sugar." You don't really just want to look at fasting
blood sugar. You want to know what your insulin is doing, and you want your insulin to be
low when you haven't eaten. When you do a fasting test in the morning
after having fasted all night long, and presumably you didn't do any night eating, you don't
want your insulin high. There's no need for it to be high. There's not a lots of sugar
in the blood stream that insulin has to take out, so there's no need for it to be high.
If insulin is high in the morning, that's a sign that you're insulin-resistant. There's
too much insulin around. It's not getting into the cells, that's why there's excess
there when there really shouldn't be. Now, we have test for this, like fasting insulin
test, but again, you may encounter some problems with conventional doctors who do this by the
books. Here's where the triglyceride to HDL ratio comes in. High triglyceride to HDL ratio
almost always predicts insulin resistance, something you don't want to have. Of course,
we've talked and we'll talk again in short about what to do about these things, what
you do you do if you're insulin resistant, but first know if you are, and that's a great
way to find out whether you are, without even having to ask your doctor for a special test.
By the way, while we're on the subject of low tech test, here's another one you could
do. Pre-insulin resistance, and it's almost infallible. Stand in front of a wall. Walk
towards it. If your belly hits the wall before you notice this, you got insulin resistance.
That one stands out, it stands out the test of time, I'm telling you.
Yet even another one is just measure your waist size, and generally speaking, good rule
of thumb, of course, it's not infallible, although [inaudible 06:53] normal caveats
there's going to be an exception, 95% of the time men who have a waist line of 40 or over
are probably insulin resistant. Women who have a waistline of 35 or over are probably
insulin resistant. So that sort of a variation and walks towards the wall, if your belly
hits it first. That's the apple shape, and that's a tell-tale sign of insulin resistance.
We've got these two fantastic things that triglycerides to HDL ratio will tell you.
One is relative risk for heart disease, another is insulin resistance. A third is a test that
you will get some resistance from your doctors, and that's the one you and I talked about
before, but the LDL particle size. Remember we said, LDL comes in lots of different flavors,
and the one that you're really concerned about is that nasty little atherogenic LDL B particle.
How do you even know which ones you have? You do a particle test. Your doctor may say
as many of the doctors, friends of mine, and family of mine have sent them to their doctors
and said, "Throw out that cholesterol test, ask them for a particle test," and they either
don't know about it, or if they know about it, they just don't know anything about it,
and they think, you're not getting one of those.
You got a doctor like that? Here's what you do. You do your triglyceride to HDL ratio,
because it's a wonderful predictor of the type of LDL you have. High ratio, bad, nasty
atherogenic, small BB gun particle type LDL B, low ratio, almost always big fluffy LDL,
nothing to worry about. You got three major gains from doing this very simple ration test,
and it's a really telling and important test that you can do at home that really gives
you a lot of information about your health. Pedram: That is fantastic. What I'm going
to do is I'm going to link to the blog that you wrote and [inaudible 08:39] spell it out
make it easy for people to go in there, and do the math. You're right. People are afraid
of math. Jonny: I am telling you, this is so simple.
This is just divide the smaller number into the bigger number. It's all that is. Nine
divided by three, you got a ratio of three. That's it.
Pedram: Right. What kind of scale ... you said, basically, over five is a problem.
Jonny: Yeah. The general thinking here is that if you got two or less, you're in pretty
darn good shape. It's probably a sign that your LDL, even if it's high, is of the harmless
LDL A variety. It's probably a sign you're not insulin resistant, and it probably a sign
that you're at very low risk for heart disease. A ratio of two or under, and as I said, I've
had some people write to me, and whose ratio is less than one, because their triglycerides
are so low and their HDL is so high, that's fantastic. Very rare, but it happens. If you
got two or under, man, you are in good shape. When it starts ranging around five or higher,
this is the time to take action. I would take action at four and by action that we can talk
about what that means. Because insulin resistance small particle size, risk for heart diseases,
the diabetes, this thing is tend to cluster together.
Generally, in my opinion, the best thing to do for all of them is a lower carb diet, which
will handle the insulin resistance. More saturated fat counter intuitively for most people, because
you may have [inaudible 10:05] that can possibly be good, but it is. Saturated fat actually
changes the distribution of LDL particles, makes the population more like the big fluffy
non-atherogenic particles, and less of the nasty little gang numbers. It really shifts
the thing. A lower carb diet, a little more saturated fat, cut back on the carbs, and
you handle really all three of the things that you are at risk for with a high ratio.
Pedram: Can you give me some examples of saturated fats? Because this is something that people
always get confused about. What are some good saturated fats?
Jonny: It's a great question. I actually reject the notion of good ... To me, the good fat,
bad fat dichotomy which has been drilled into our heads is bad fats or saturated fats, good
fats or vegetable fats, I think that's nonsense. Bad fats are damaged fats, wherever they come
from. One of the worst culprits is vegetable fat,
because now that we're on this anti-saturated fat four decade experiment, every restaurant
in America now uses canola oil, corn oil, all these crappy vegetable oil, which they
then re-fry and re-heat probably a dozen times a week, because from what I've read they change
the oil about once a week. That's a lot of heating and reheating, and reheating, and
reheating, this causes all kinds of compounds from trans fat to carcinogenic compounds,
that generally just damages the fat terribly, and because vegetable fats are higher in Omega-6,
they are much more subject to heat damage. Saturated fat stands up the heat. Saturated
fat is what is your warrior when it comes to heat, and that's why lard, again counter-intuitively,
except for people when that don't know, lard was demonized, but it's coming back now because
we finding out that's it's an actually safe. If you're going to fry real animal lard, and
I'm talking Crisco, I'm talking actual [inaudible 12:03] pork fat, is actually much safer to
deep fry it. Pedram: It stays stable.
Jonny: Not recommend ... Pedram: It stays stable, and ...
Jonny: That's the point. It's stable. It stands up. It's got armor on it. It doesn't mutate
the way vegetable fat does. We also know that vegetable fat is highly inflammatory. It's
a precursor, where Omega-6 is a precursor to the inflammatory compounds in your body,
and if you know, in my opinion information is one of the full primary promoters of heart
disease. We do not want information. We've all got
it, but we want to minimize it. We want to fund our anti-inflammatory army, and that's
so much of our inflammatory army, and the more vegetable oil we consume, the more we're
funding our internal inflammatory army, because that's what we make inflammatory cytokines
from. That's what we make inflammatory … excuse me … our carcinoids from, is Omega-6es.
Where are they found? In every vegetable around the supermarket corner or safflower oil, cottonseed
oil, canola oils, soybean oil, all of these are just highly processed Omega-6 or fats.
We need some Omega-6s, but when you talk about good fats, bad fats, to me the way to get
a better fat intake is to reduce your Omega-6s, up your Omega-3s, eat a lot of Omega-9s, reduce
amount of unsaturated fats and stop eating saturated fat.
You asked me, what are good saturated fats? Any that haven't been damaged, which means
if they are a natural [inaudible 13:28] they are natural to say coconut, these fats that
are in eggs, these saturated fats that are found in these whole foods are nothing to
be afraid of on any level. If anything, they are healthful, they are certainly not damaged.
One of the greatest myths of the irony balls is, is that half of these foods that are known
as saturated fat foods like beef, and actually mostly monounsaturated fat. I think, Garry
Tabs did an analysis of this once, and most of the beef, 51%, 52% is monounsaturated.
It's not even the primary fat in beef is saturated fat. I think that when it comes from a whole
food source, you have nothing to fear from it no matter what kind of fat it is.
In terms of additional fats that we put into our food that we cook with such as corn oil,
canola oil, soybean oil, all of these, I think we need to pull back on the Omega-6, and up
the Omega-3s. Eat plenty of olive oil, and stop fearing good, healthy saturated fat from
whole food sources. Pedram: One of the questions I get all the
time, we get it on well.org, we get it across all of the kind of content that we do is,
"What do I cook with?" Jonny: That's easy, really easy. If I was
on the Skype call I'd go into my cabinet and bring them all out for you. Here are some
of the best fats to use for cooking, coconut oil. I'm a big fan of Barlean's extra ***
coconut oil, very easy to make it in small batches. It's really pure. It makes it a terrific
stir fry. If you feel the cold slightly, coconut oil is a little too [inaudible 15:08] and
mix it with something like butter or palm oil, or one of the other ones, so coconut
oil is one of my stable cooking oils. Creamy organic butter hopefully thing from
grass-fed cows, nothing to fear from that, or you can even use ghee which is just clarified
butter. I am a huge fan of palm oil, and Malaysian palm oil particularly because it's really
… It also happens to be sustainable, and there's some environmental issues with palm
oil, and Malaysia Palm oil is much more sustainable, but any palm oil. You will notice it's red.
Why is it red? Because it's got all the carotenes in it. It's not only with antioxidants and
it can because it is a saturated fat. It holds up to heat, fantastic [inaudible 15:50] of
the palm oil. Macadamia nut oil which is just like olive
oil, high end monounsaturated fats but a little bit more resistant to heat. The thing about
olive oil for cooking, a big fan of olive oil, olive oil, provided by extra *** olive
oil This is something people don't think about oil. What do you mean extra *** olive oil?
What does the extra *** olive oil mean? It means that it's basically as close to being
processed to ... if you had the old wine barrels or olive barrels you had old Greek men stumping
around at them and they would just churn it into an oil, a liquid just by the pressure
of their feet. It's as close to that as you can get, they don't have old Greek men walking
around in the barrels but they do it without heat or without substantial heat. They do
it in a very gentle way so that all the [inaudible 16:37] aren't interfered with or broken in
any way, and they do it with low heat so that there isn't any damage to those compounds
in the olive oil. You're spending all this money to get extra
*** olive oil and then you're going to cook it at 300 degrees. That makes no sense.
You are now defeating the purpose of getting the extra *** olive oil. In my opinion
when you use extra *** olive oil for cooking it should be at a very low temperatures, [inaudible
17:02] that's the most, a little bit maybe some extra cook up the pan, you really don't
want to heat that to 3- or 400 degrees. Macadamia nut oil, which is basically the
same kind of fat, monounsaturated fat stands up to heat a little bit better. I would use
extra *** olive oil at lower heat. I would use macadamia nut oil, I'd use palm oil, coconut
oil, butter. That's a nice little ... once in a while some sesame oil, high Lebanon sesame
oil. It's got a lot of Omega-6s in them. I'm not saying never use them but I would rotate
that in maybe not make that my number one but sesame oil is a really good one as well.
Pedram: Leave the extra *** stuff that you just paid extra for, for the salads.
Jonny: I think that's a better way to go and at maybe low heat.
Pedram: Okay. Excellent. Those are the questions that we get all the time. One other questions
that we get that I'd love for you to just clarify real quick because some guy listening
to this just walked into a wall to test whether or not he's insulin resistant. What is insulin
resistance specifically? Jonny: A great question. Here is how it works.
When your metabolism is working properly ... Let's take a five year old kid as an example. Let's
assume they haven't screwed things up yet. Let's even put them back in the 1950s when
they actually went around and moved and played and rode their bikes and did stuff like that.
You're average five-year-old kid with a nice, normal healthy metabolism comes up from school,
he eats an apple. Blood sugar goes up slightly. Pancreas says, "Blood sugar went up, little
bit [inaudible 18:35]" and it squirts in a little bit of this hormone called insulin
whose major job in this scenario is to lower that blood sugar, to work as a shipper. It
goes in, gets the sugar out of the blood stream, takes it into the cells, the cells are very
happy to have it because the kid's going to run about now on a bicycle and the monkey
boys, and he's going to play and run and jump. The muscle cells are going to use up all that
sugar and insulin has done its job which is a little bit and then blood sugar goes down.
The kid comes home, he's hungry again. That's the way metabolism cells work.
Now, as for who's 30-40 years. You wake up in the morning, your cholesterol levels, your
stress hormones are high, you skip breakfast, you run to Starbucks, you get this 900 calorie
low fat Bran Muffin. Now your blood sugar is on the roof. Insulin, the pancreas goes,
"Oh my God, this guy just ate the equivalent of 10 Ding Dongs, let's call blue, call blue"
and it starts squirting insulin out in large amounts.
Here's the problem. Insulin starts taking that sugar, shuffling that sugar, taking it
over to the muscle cells, but the muscle cells are going, "Dude, why do we need this? This
isn't [inaudible audio skips] jumping plane here. This guy's going to sit at the computer
all day. When he gets home he's going to sit in front of the TV. We really don't need any
more. We're full. Take it somewhere else." Insulin's got its job cut out for it. Now,
it's got to your blood sugar down because high blood sugar is a danger. What's it going
to do? First thing it does is it takes it takes it to the fat cells and the fat cells,
at least in the beginning for a couple of years are going to be very welcoming. They'll
say. "Hey, we've got plenty of room here. Bring that sugar in. [inaudible 20:04] happening,
is that now your blood sugar goes way down, now you have more cravings, and mind swings,
and you're going to kill somebody if you don't get some sweets, and then the whole terrible
cycle starts. When this continues like this for a while,
different period of time, I can't tell you how long, how many weeks, how many months,
how many years but when this is your lifestyle eventually none of the cells will take that
sugar in, even the fat cells become resistant. What they do is they become resistant to the
effect of insulin. In other words in the five year old example insulin not coming to door
of the muscle cells and muscle cell, "Hey, come on in."
Now everybody's turning their back. It's like New York City. You hear a lot of noise, you
just close the door and turn the music up. The cells are basically resistant to the effect
of insulin, incorporating sugar into them. Now you have high insulin and high blood sugar
because you've got nowhere to go. That is a absolute perfect scenario for diabetes,
first for metabolic syndrome which is by definition high insulin, high blood sugar, nowhere to
go, you're just escaping diabetes but then if this continues a little bit more you're
into full blown diabetes and ultimately and then mutually increased risk for heart disease.
That's what insulin resistance is. It's the resistance of the cells to the action of insulin,
to the ability of insulin to get the sugar into the cells because they just didn't have
in it anymore. You ate too much of it and they're tired.
Pedram: Thank you for that. Just a recap then. You had mentioned turning your diet into a
lower carb diet so that you aren't loading up the pancreas staff to secrete that much
insulin in. Jonny: You cannot loading up your blood sugar.
Remember insulin just reacts to high blood sugar. If there's no high blood sugar, accepting
the case when you have high fasting insulin that's the result of years of the thing I
just described you but in normal circumstances if there's no high blood sugar there's no
need for the pancreas to shoot insulin because there's nothing for it to do. It doesn't have
to remove the excess blood sugar. If you continue to eat that Starbucks 900 calorie low fat
Bran Muffin way your blood sugar is always going to be high and insulin's always going
to be trying to keep up with the job, trying to keep up with that load of reducing that
sugar. How do you make insulin behave it? Very simple.
Don't give it so much work to do. Stop eating stuff that converts to sugar and your heart
beats ... and that your blood sugar is always on the roof and insulin's frantically wandering
around like, on that man trying to catch it. You can insulin resistance in round about
three days. Just give it a rest and the way you give it a rest is with a lower carb diet
because protein will raise blood sugar a little bit, nothing like carbohydrates.
Guess what doesn't raise insulin at all, fat. If you eat more fat and you don't try to do
a low fat version of a low carb diet which is a big mistake a lot of people do, and you
eat more fats and you eat more protein and you cut that on carbs your blood sugar is
going to normalize. Guess what, insulin is not going to have that big job to do and it's
going to start to get back down into the normal levels and you will then be what's called
insulin sensitive which is exactly what you want.
Pedram: Fantastic. Your take on the other side of that. A lot of people say, "Get your
muscles working and get moving so that the muscles can actually require some of the blood
sugar as well." What's your take on that? Jonny: That's a 100% true. One of the things
I learned in personal training school back in 1990 and I didn't know what it meant then
because I wasn't a nutritionist and I was just learning, I was kind of mimicking what
I was told. One of the things I remembered hearing time and time again is exercise has
an insulin like effect. "Well, dah" because if the muscles now need that blood sugar you're
going to be way more welcoming to insulin so you will not need as much insulin to bring
blood sugar down because there's not going to be tons of tubes banging on the door. The
muscle cells are going to be saying, "Guys, let them wait, bring some of that stuff in
here." Yes, exercise has an insulin-like effect in
that it helps lower insulin because it gives the insulin and sugar somewhere to go. The
muscle cells, there are now going to be doing something.
Pedram: Fantastic. Whirled in for business type of thing.
Jonny: Okay. Good. Pedram: Fantastic. Doc, always a pleasure.
Looking forward to our next talk. You're a superstar. Anyting you want to add?
Jonny: No, thank you man. It's been great. Lots of fun.
Pedram: Excellent. We'll see next time. Jonny: You bet. Bye-bye.