After nearly 11 years of consulting in the functional medicine space, doctors still ask me (Mike) how to lower cholesterol. “What supplements lower cholesterol?” they often ask. As you’ll hear, insulin and glucose imbalances are primary drivers of heart disease. A leader in this space, Jeffry Gerber, MD, has tested post-meal glucose AND insulin levels in over 3000 patients. In this interview we discuss how the metabolic signature created from blood sugar and insulin imbalance promotes inflammation and oxidative stress. Dr. Gerber also discusses how advanced cholesterol tests, like lipoprotein particle analysis – often touted to be much better than standard tests – are just associations. If you’re concerned about heart disease, periodic cardiovascular imaging is another important tool. We discuss many other topics.
In our office, we perform standard and advanced lipid testing including total cholesterol, LDL-C, HDL-C, triglycerides, LDL-P, small-LDL-P, sdLDL, ApoB, particle size, and markers of cardiovascular inflammation and oxidative stress. There are several companies who perform these tests including Liposcience NMR, Berkeley Heart Lab, Atherotech VAP, Health Diagnostics Lab HDL, and Cleveland Heart Lab inflammatory testing. We also perform or order cardiovascular imaging studies including carotid intima media thickness (C-IMT), carotid doppler, and EBCT heart calcium scores. Questioning the predictive role of Carotid Intima-media Thickness. Carotid Intima-media Thickness testing.
02:07 Focus on Nutrition: Dr. Gerber has been focusing on nutrition and lifestyle for 17 years. He lost 40 pounds on the Atkins diet. His research found that metabolic disease is the root cause of many of the chronic diseases of today.
03:59 Calories/Fat-based Diets: Metabolic disease is related to insulin, hormonal dysregulation, inflammation, oxidative stress and advanced glycation. For over 50 years we have focused upon reducing calories and fat in the diet, which does not address hormonal dysregulation or insulin.
05:08 Insulin Metabolism: Dr. Gerber measures fasting insulin and 2 hour insulin, based upon the work of Dr. Joseph Kraft. There is a strong relationship between hyperinsulinemia and heart disease. The link between diabetes and heart disease may be closer than that of than lipids.
07:07 Preventive Imaging: Cardiologists see you after damage has begun. Prevention can begin with a CT of the heart, calcium score and ultrasounds to look for early plaque development. The calcium score is effective because the amount of calcium correlates with risk, by a magnitude of order more than other risk calculators. Cardiologists do not address atherosclerosis as a metabolic disease. You cannot make money in the healthcare industry if you tell people to how to eat and live better.
09:03 Glucose Challenge with Insulin Assay: A glucose challenge is an effective screening tool for diabetes, cardiovascular disease, chronic inflammation, weight issues and premature aging for the general public. Two thirds of us have a problem with hyperinsulinemia. You start in a fasted state. You drink 75 grams of a glucose solution. You are monitored for 2 hours, having taken a fasting insulin/glucose, a one hour glucose and a two hour insulin/glucose. Typical hemoglobin A1C and fasting glucose detects only about 30 percent of the patients who have problems.
14:04 Insulin: Insulin can compensate for blood sugar, so you can have hyperinsulinemia with normal blood sugar levels. It precedes insulin resistance.
15:05 Keto-Adapted/Low Carb: Taking a glucose challenge while keto-adapted, your insulin level would be flat during the insulin assay. Your blood sugar may be variable or even shoot sky high as a stress response. It does not represent a carbohydrate deficiency in the diet. Your body doesn’t need insulin on a low carb diet.
18:17 Cancer as a Metabolic Disease: Many forms of cancer are very sensitive to carbohydrates and glucose. You may be able to starve cancer through fasting or a ketogenic diet, as well as adding exogenous ketones. In rat studies, cancer is being cured using ketogenic diets with ketone supplementation and hyperbaric oxygen therapy. Human studies are being done using ketogenic diets. Case studies in human are promising. More rapidly growing tumors seem to be more responsive, particularly brain and breast cancer.
21:48 Insulin and Cholesterol: Cholesterol is a symptom of metabolic dysregulation. Cholesterol and lipoproteins are essential for the transport of nutrients around the body, among other important functions. Inflammation and oxidative stress causes damage to the blood vessel wall. Cholesterol and lipoprotein are there to repair the damage. Cholesterol can be stabilized by addressing inflammation/oxidative stress. The quality of cholesterol is more important than the quantity. The particle count is a better marker than LDL, but quality/size is more revealing. Cholesterol/lipoprotein counts are associative. If you believe the data, there is a small benefit to statins as an anti-inflammatory.
27:50 Weight Loss: Appetite control is paramount to weight loss. Forcing people to eat less does not work. A low carb or ketogenic diet, compressing meal time (aka intermittent fasting) are effective at keeping hunger at bay.
29:49 Body Composition and Cardiovascular Risk: Not everyone should be on a low carb/ketogenic diet. Genetics plays a role in whether being overweight is related to cardiovascular disease. Sometimes thin people have blocked arteries.
31:28 Diet: A whole foods diet is important, avoiding sugar, industrial vegetable oil, and processed foods. Some people can handle more carbohydrates and protein from whole food sources than others.
33:31 Advanced Cholesterol Testing: With standard lipid testing, looking at ratios and patient history, Dr. Gerber can tell what the particle size will be without testing. It can be used to confirm particle size, if necessary.
35:09 High/Low Cholesterol and Longevity: Often, people who have heart attacks are at goal cholesterol levels. A study of elderly people in Japan found that people with higher cholesterol live longer, challenging the cholesterol hypothesis.
37:04 Ketogenic Diet and Cholesterol: Cholesterol ratios improve with ketogenic diets, for the most part. HDL goes up. Triglycerides go down. Other metabolic markers like insulin and A1C improve. In as much as 1/3 of people LDL goes up, in 1/3 it stays the same and in 1/3 LDL will drop.
38:45 Dr. Gerber’s Morning Routine: He skips breakfast, but has bulletproof coffee. Occasionally, he will have eggs. He hits the gym for resistance training and cardio. We were designed to move. Time to unwind and be at peace is important.
40:45 Dr. Gerber’s Favorite Herb/Nutrient: He would bring Pemmican.
41:06 Dr. Gerber’s Elevator Pitch: It is true that sugar and starch helped to sustain civilization. But long term, it leads to chronic health issues. There is something wrong with our food supply.
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