1 00:00:09,480 --> 00:00:12,680 Speaker 1: Hey, everybody, Welcome to another edition of the podcast. And 2 00:00:12,760 --> 00:00:15,360 Speaker 1: this is a podcast that is about to change its name. 3 00:00:16,079 --> 00:00:18,720 Speaker 1: So in the next couple of weeks, I am going 4 00:00:18,760 --> 00:00:20,919 Speaker 1: to change the name of the podcast from the Paul 5 00:00:20,960 --> 00:00:25,160 Speaker 1: Taylor Podcast to the Hardiness Lab Podcast. And that reflects 6 00:00:25,200 --> 00:00:29,760 Speaker 1: a couple of things. Firstly, I have started a lab 7 00:00:29,880 --> 00:00:32,199 Speaker 1: with my old mate, so you'll be pretty familiar with 8 00:00:32,560 --> 00:00:36,760 Speaker 1: Professor Grant Schofield, and in that lab we are going 9 00:00:36,840 --> 00:00:41,920 Speaker 1: to be conducting research looking at the beneficial effects of hardiness, 10 00:00:42,440 --> 00:00:47,080 Speaker 1: both physical and psychological hardiness. The second reason for the 11 00:00:47,159 --> 00:00:50,839 Speaker 1: change the podcast is my new book, The Hardiness Effect, 12 00:00:51,080 --> 00:00:55,280 Speaker 1: is now out for pre order on Amazon, and that 13 00:00:55,440 --> 00:00:58,560 Speaker 1: really is reflecting all the stuff that we're doing in 14 00:00:58,600 --> 00:01:01,760 Speaker 1: the lab. And in that book, I go into all 15 00:01:01,840 --> 00:01:05,680 Speaker 1: of the research on psychological hardiness and how this is 16 00:01:05,760 --> 00:01:09,280 Speaker 1: the one psychological trait that you need in your life, 17 00:01:09,760 --> 00:01:15,000 Speaker 1: way above resilience, and also physiological hardiness, which people don't 18 00:01:15,000 --> 00:01:17,240 Speaker 1: really talk about, but me and Grant are going to 19 00:01:17,280 --> 00:01:19,520 Speaker 1: be exploring. So there we have it. Then we're going 20 00:01:19,600 --> 00:01:22,400 Speaker 1: to have a name change, and then if you like 21 00:01:22,480 --> 00:01:25,759 Speaker 1: my first book, Death by Comfort, jump onto Amazon and 22 00:01:25,840 --> 00:01:30,319 Speaker 1: you can pre order ny the hardiness Effect by doctor 23 00:01:30,520 --> 00:01:34,960 Speaker 1: Paul Taylor. Now let's get on with the podcast, and 24 00:01:35,000 --> 00:01:38,280 Speaker 1: today's show is a little bit of a hybrid. It 25 00:01:38,400 --> 00:01:41,600 Speaker 1: is a Saturday show, which is normally an interview, but 26 00:01:41,760 --> 00:01:44,160 Speaker 1: it's going to take the form of a kind of 27 00:01:44,280 --> 00:01:50,200 Speaker 1: extended Wisdom Wednesday podcast. And this is because I had 28 00:01:50,400 --> 00:01:53,240 Speaker 1: a couple of listeners actually reach out to me, and 29 00:01:53,440 --> 00:01:57,360 Speaker 1: a couple of conversations with friends that kind of all 30 00:01:57,400 --> 00:02:04,320 Speaker 1: around the same topic around cardiovascular disease. And I think 31 00:02:04,400 --> 00:02:07,680 Speaker 1: maybe the driver of those conversations was obviously me having 32 00:02:07,760 --> 00:02:12,359 Speaker 1: my open heart surgery, but talking about assessing your risk 33 00:02:12,440 --> 00:02:18,240 Speaker 1: for cardiovascular disease and the whole talk about LDL cholesterol. 34 00:02:18,600 --> 00:02:22,520 Speaker 1: So I thought this is worth a deep dive, and 35 00:02:22,600 --> 00:02:25,000 Speaker 1: what I'm going to talk about is probably going to 36 00:02:25,040 --> 00:02:28,720 Speaker 1: blow your mind. And we're going to talk about the 37 00:02:28,880 --> 00:02:33,080 Speaker 1: limitations of LDL cholesterol, why it's there as a marker, 38 00:02:33,480 --> 00:02:37,240 Speaker 1: but also a simple blood marker that predicts your risk 39 00:02:37,320 --> 00:02:40,440 Speaker 1: of dying from a heart attack between three to five 40 00:02:40,600 --> 00:02:44,880 Speaker 1: times better than your LDL cholesterol, which is the number 41 00:02:44,960 --> 00:02:49,240 Speaker 1: that your doctor tends to obsess about. And here's the kicker. 42 00:02:49,360 --> 00:02:53,239 Speaker 1: It's been hiding in plane sight on your standard blood 43 00:02:53,280 --> 00:02:59,040 Speaker 1: work this entire time, and as well as being a 44 00:02:59,200 --> 00:03:02,160 Speaker 1: very strong per day of your risk of cardiovascular disease 45 00:03:02,200 --> 00:03:05,359 Speaker 1: and dying from a heart attack, it also is a 46 00:03:05,400 --> 00:03:09,720 Speaker 1: strong predictor of your risk of metabolic disease, particularly type 47 00:03:09,720 --> 00:03:14,360 Speaker 1: two diabetes. And if you take those two together, cardiovascular 48 00:03:14,400 --> 00:03:19,000 Speaker 1: diseases and type and metabolic diseases, and they account for 49 00:03:19,040 --> 00:03:24,480 Speaker 1: a wobbing proportion of ill health and early deaths. So 50 00:03:25,320 --> 00:03:27,440 Speaker 1: actually getting on top of the two of them with 51 00:03:27,600 --> 00:03:31,840 Speaker 1: one blood marker, I think is really key. So let's 52 00:03:31,919 --> 00:03:34,760 Speaker 1: start with a question. It's going to make it. Think 53 00:03:35,320 --> 00:03:37,040 Speaker 1: how many of you being to the doctor, got your 54 00:03:37,080 --> 00:03:40,120 Speaker 1: cholesterol checked and walked out thinking that you knew everything 55 00:03:40,120 --> 00:03:44,120 Speaker 1: about your heart health because your LDL you're bad cholesterol 56 00:03:44,160 --> 00:03:47,520 Speaker 1: and inverticomas was in the normal range. Well, I hate 57 00:03:47,520 --> 00:03:49,760 Speaker 1: to break it to you, but you've been focusing on 58 00:03:49,800 --> 00:03:52,160 Speaker 1: their own number, and we're going to dive into the 59 00:03:52,240 --> 00:03:56,320 Speaker 1: cold heart science about that. So let's first paint the picture. 60 00:03:56,720 --> 00:04:00,600 Speaker 1: For decades, and I mean decades, the medical ist bablishment 61 00:04:00,920 --> 00:04:04,560 Speaker 1: has been layers are focused on LDL cholesterol as if 62 00:04:04,640 --> 00:04:07,920 Speaker 1: it's the holy grail of heart health, and they've built 63 00:04:08,320 --> 00:04:13,760 Speaker 1: entire treatment protocols around it, billions of dollars in stating prescriptions, 64 00:04:13,840 --> 00:04:19,000 Speaker 1: countless dietary recommendations, all centered around this one number. But 65 00:04:19,120 --> 00:04:22,479 Speaker 1: here's what they don't tell you. Half of people with 66 00:04:22,600 --> 00:04:25,880 Speaker 1: high cholesterol never have a heart attack, and half of 67 00:04:25,920 --> 00:04:29,560 Speaker 1: people who die from heart attacks do not have high cholesterol, 68 00:04:29,600 --> 00:04:34,239 Speaker 1: particularly they have normal LDL cholesterol. And this is such 69 00:04:34,279 --> 00:04:38,640 Speaker 1: a big predictor. Why is it that half of people 70 00:04:38,640 --> 00:04:41,799 Speaker 1: who die from heart attacks don't have what they think 71 00:04:42,000 --> 00:04:45,800 Speaker 1: is the best predictor? Just think about that for a second. 72 00:04:46,000 --> 00:04:48,400 Speaker 1: This is like flipping a coin. If half the people 73 00:04:48,400 --> 00:04:50,560 Speaker 1: with high cholesterol never have a heart attack and half 74 00:04:50,560 --> 00:04:52,479 Speaker 1: the people who die from heart attacks don't even have 75 00:04:52,560 --> 00:04:56,240 Speaker 1: high cholesterol, this is a coin flip. Now, don't get 76 00:04:56,279 --> 00:05:01,120 Speaker 1: me wrong. LDL cholesterol is not completely useless. The research 77 00:05:01,200 --> 00:05:05,480 Speaker 1: is clear that it is associated with cardiovascular events. Right, 78 00:05:05,520 --> 00:05:08,000 Speaker 1: So we're going to dig into the research here, so 79 00:05:08,040 --> 00:05:11,760 Speaker 1: strap yourself in. So there's a massive meta analysis of 80 00:05:11,920 --> 00:05:16,720 Speaker 1: sixty randomized control trials that showed for every one millimoll 81 00:05:17,000 --> 00:05:21,559 Speaker 1: per liter reduction in LDL cholesterol, and you get about 82 00:05:21,560 --> 00:05:26,200 Speaker 1: a twenty two percent reduction in major vascular events, right, 83 00:05:26,279 --> 00:05:28,560 Speaker 1: which seems to be pretty compelling. But here's where it 84 00:05:28,600 --> 00:05:31,080 Speaker 1: gets interesting, and this is from a study published in 85 00:05:31,080 --> 00:05:34,200 Speaker 1: the Journal of the American Heart Association that looked at 86 00:05:34,240 --> 00:05:37,880 Speaker 1: over fourteen thousand adults for more than twenty years. They 87 00:05:38,000 --> 00:05:42,559 Speaker 1: found something that isn't really talked about very much, very 88 00:05:42,680 --> 00:05:49,839 Speaker 1: low LDL levels below seventy mailograms per deci leader, which 89 00:05:49,960 --> 00:05:54,479 Speaker 1: translates to about one point eight one milli moles per lider. 90 00:05:55,040 --> 00:05:57,480 Speaker 1: Now it's a little bit confusing. I realized I just 91 00:05:57,520 --> 00:06:02,080 Speaker 1: need to explain this. This is like the US use 92 00:06:02,400 --> 00:06:05,440 Speaker 1: milligrams per deesto leader, some places like Australia in the 93 00:06:05,600 --> 00:06:10,240 Speaker 1: UK use millimoles per leader. In order to convert milligrams 94 00:06:10,279 --> 00:06:13,160 Speaker 1: per dest leader to millimals per leader, you divide by 95 00:06:13,320 --> 00:06:15,880 Speaker 1: thirty eight point sixty seven. You can just look for 96 00:06:16,000 --> 00:06:18,719 Speaker 1: a cholesterol ratio. Now I may use these two terms 97 00:06:18,760 --> 00:06:22,920 Speaker 1: interchangeably based on the different research where that research has 98 00:06:22,960 --> 00:06:26,560 Speaker 1: been conducted. But basically to say, to get back to 99 00:06:26,680 --> 00:06:30,600 Speaker 1: this very low levels of cholesterol the type that they 100 00:06:30,800 --> 00:06:34,840 Speaker 1: often want you to get down to, so below seventy 101 00:06:34,920 --> 00:06:38,120 Speaker 1: milligrams per deest leader are below one point eight one 102 00:06:38,720 --> 00:06:43,760 Speaker 1: milli moles per liter. And what they actually found was 103 00:06:43,839 --> 00:06:49,240 Speaker 1: it was associated with increased mortality, a forty five percent 104 00:06:49,480 --> 00:06:53,680 Speaker 1: higher risk of all cause mortality to be exact. Now, 105 00:06:53,920 --> 00:06:59,200 Speaker 1: that is absolutely massive, a forty five percent increased risk 106 00:06:59,279 --> 00:07:02,600 Speaker 1: of death from any cause. That is something that you 107 00:07:02,680 --> 00:07:06,080 Speaker 1: need to sit up and take notice about. So whilst 108 00:07:06,600 --> 00:07:09,440 Speaker 1: lower LDL cholesterol you seem to get a reduction in 109 00:07:09,840 --> 00:07:14,240 Speaker 1: major vascular events, you can't go too low and then 110 00:07:14,600 --> 00:07:19,560 Speaker 1: with very high levels, so above one hundred and ninety 111 00:07:20,560 --> 00:07:26,000 Speaker 1: milligrams per desi liter, which equates to an LDL level 112 00:07:26,160 --> 00:07:29,640 Speaker 1: of four point nine millimles per liter, So that that 113 00:07:29,960 --> 00:07:34,600 Speaker 1: is pretty bloody high, and that was bad too in 114 00:07:34,720 --> 00:07:37,760 Speaker 1: terms of risk for all cause mortality. But the point 115 00:07:37,880 --> 00:07:41,960 Speaker 1: is LDL cholesterol seems to have this weird u ship 116 00:07:42,120 --> 00:07:45,280 Speaker 1: relationship with death that nobody wants to talk about, in 117 00:07:45,400 --> 00:07:49,560 Speaker 1: that high levels are clearly not good, but low levels 118 00:07:49,760 --> 00:07:53,840 Speaker 1: are clearly not good as well. Let's now talk about 119 00:07:54,040 --> 00:07:56,760 Speaker 1: the game changer, and this has been as I said, 120 00:07:56,840 --> 00:07:59,200 Speaker 1: hiding and playin insight on your blood tests, and that 121 00:07:59,440 --> 00:08:04,360 Speaker 1: is your try glyceride to hit DL ratio. So triglycerides 122 00:08:04,920 --> 00:08:09,120 Speaker 1: are basically a measure of the excess fat that is 123 00:08:09,240 --> 00:08:12,160 Speaker 1: running around your bloodstream and it's often because we're just 124 00:08:12,280 --> 00:08:17,679 Speaker 1: eating excess energy, particularly excess carbohydrates. Hats DL, you may remember, 125 00:08:18,200 --> 00:08:22,760 Speaker 1: is the good cholesterol in inverted commas. So let's talk 126 00:08:22,800 --> 00:08:26,320 Speaker 1: about this number that is a game changer, and that's 127 00:08:26,360 --> 00:08:29,360 Speaker 1: the triglyceride to hits the L ratio. Now, that isn't 128 00:08:29,720 --> 00:08:33,599 Speaker 1: an obscure, expensive test, and this is something that is 129 00:08:33,840 --> 00:08:38,080 Speaker 1: standard on every single lipid panel that you've ever gotten. 130 00:08:38,600 --> 00:08:42,679 Speaker 1: And what you do is your triglycerides are divided by 131 00:08:42,760 --> 00:08:45,120 Speaker 1: your HITS d L cholesterol and you get a number 132 00:08:45,240 --> 00:08:49,680 Speaker 1: and that's it. And here's the bombshell, the Framingham Massive 133 00:08:49,800 --> 00:08:53,680 Speaker 1: Framingham research study, so that this ratio can be three 134 00:08:53,800 --> 00:08:57,480 Speaker 1: to five times more predictive than a heart attack risk 135 00:08:57,640 --> 00:09:02,400 Speaker 1: than LDL cholesterol. About that. Now, let me walk you 136 00:09:02,480 --> 00:09:06,240 Speaker 1: through some of the research that is really going to 137 00:09:06,280 --> 00:09:08,360 Speaker 1: get you to think about this stuff. Right. So, a 138 00:09:08,480 --> 00:09:12,760 Speaker 1: systematic review and meta analysis published just a few years 139 00:09:12,800 --> 00:09:17,040 Speaker 1: ago looked at thirteen cohort studies with over two hundred 140 00:09:17,080 --> 00:09:20,000 Speaker 1: and seven thousand participants in total, and what they found 141 00:09:20,120 --> 00:09:24,040 Speaker 1: was pretty stunning. People with the highest triglyceride to hit 142 00:09:24,120 --> 00:09:27,839 Speaker 1: stale ratios had a forty three percent higher risk of 143 00:09:27,920 --> 00:09:32,319 Speaker 1: cardiovascar events compared to those with the lowest ratios. But wait, 144 00:09:32,440 --> 00:09:37,240 Speaker 1: it gets more interesting in the Cooper Center Longitudinal study. 145 00:09:37,800 --> 00:09:41,120 Speaker 1: And in this they were following about forty thousand men 146 00:09:41,400 --> 00:09:45,080 Speaker 1: for over half a million person years. So what they 147 00:09:45,160 --> 00:09:47,800 Speaker 1: do is they obviously get the forty thousand and they 148 00:09:47,880 --> 00:09:52,320 Speaker 1: were following them for over ten years each, twelve twelve 149 00:09:52,360 --> 00:09:55,319 Speaker 1: and a bit years each, and they tried glysride to 150 00:09:55,440 --> 00:10:01,040 Speaker 1: heat Sdale ratio predicted Carnelie heart disease, cardiovasc disease, and 151 00:10:01,360 --> 00:10:07,000 Speaker 1: all cause mortality even after adjusting for all the traditional 152 00:10:07,160 --> 00:10:12,520 Speaker 1: risk factors, which included LDL cholesterol. And here's my favorite, 153 00:10:12,800 --> 00:10:15,800 Speaker 1: probably to pick up a bunch. And this study looked 154 00:10:15,840 --> 00:10:19,840 Speaker 1: at women with suspected heart problems and something that's called 155 00:10:19,920 --> 00:10:24,360 Speaker 1: the Women's Ischemia Syndrome evaluation. You can look that up. 156 00:10:24,800 --> 00:10:27,719 Speaker 1: And the triglys stride to hit the L ratio was 157 00:10:27,840 --> 00:10:31,760 Speaker 1: such a powerful predictor that women in the highest quartile, 158 00:10:31,880 --> 00:10:35,360 Speaker 1: so the highest twenty five percent, had a hazard radio 159 00:10:35,600 --> 00:10:39,280 Speaker 1: ratio of one point nine to five for death by 160 00:10:39,320 --> 00:10:43,560 Speaker 1: all causes. That means they were almost twice as likely 161 00:10:43,720 --> 00:10:47,800 Speaker 1: to die compared to the women in the lowest twenty 162 00:10:47,840 --> 00:10:50,800 Speaker 1: five percent for the draglystride to hit SDL ratio. So 163 00:10:50,960 --> 00:10:53,120 Speaker 1: to be clear on this, what you want to have 164 00:10:53,320 --> 00:10:57,760 Speaker 1: is low traglyst rides and high levels of hithdl. So 165 00:10:58,360 --> 00:11:02,920 Speaker 1: why is this ratio better than ldale cholesterol? I think 166 00:11:02,960 --> 00:11:06,920 Speaker 1: it's useful to really dig into it. So ldale cholesterol 167 00:11:07,600 --> 00:11:11,520 Speaker 1: is like looking at one picture of a very very 168 00:11:11,679 --> 00:11:16,760 Speaker 1: complicated puzzle. And LDAL cholesterol they don't actually measure directly. 169 00:11:17,920 --> 00:11:21,440 Speaker 1: It's done through a formula, which and I don't want 170 00:11:21,480 --> 00:11:23,120 Speaker 1: to dig into it because it just gets a bit 171 00:11:23,200 --> 00:11:28,080 Speaker 1: mind blowing. But the formula actually predicts your LDL cholesterol 172 00:11:28,640 --> 00:11:34,480 Speaker 1: and sometimes it's not tremendously accurate. Right, But let's talk 173 00:11:34,520 --> 00:11:39,120 Speaker 1: about trigger started to hit stale ratio firstly, and this 174 00:11:39,320 --> 00:11:43,880 Speaker 1: is really really important. It is a marker of insulin resistance. Right. 175 00:11:44,360 --> 00:11:47,760 Speaker 1: And you may have heard people like Peter Atia, doctor 176 00:11:47,800 --> 00:11:53,320 Speaker 1: Peter Atia talk about the four horsemen of chronic disease. 177 00:11:53,600 --> 00:11:57,920 Speaker 1: These are the four big buckets of chronic disease, and 178 00:11:58,040 --> 00:12:06,760 Speaker 1: they are cardiovascular disease also also metabolic diseases such as diabetes, 179 00:12:06,840 --> 00:12:08,959 Speaker 1: chronic kidney disease. These sorts of things that tend to 180 00:12:09,000 --> 00:12:13,040 Speaker 1: be lumped in together. We also have neurodegenerative diseases, and 181 00:12:13,120 --> 00:12:15,160 Speaker 1: then we have all the cancers. So if you put 182 00:12:15,240 --> 00:12:18,679 Speaker 1: them together, they're called the four horsemen of the apocalypse. Right, 183 00:12:19,160 --> 00:12:22,120 Speaker 1: and what your hites DL, tri grad trig sorry truglist 184 00:12:22,200 --> 00:12:25,280 Speaker 1: right hates DL ratio does. We've already established that it's 185 00:12:25,360 --> 00:12:31,520 Speaker 1: a very important predictor more important than ALDL of cardiovascular diseases, 186 00:12:31,840 --> 00:12:35,800 Speaker 1: but it is also the best predictor of metabolic diseases. 187 00:12:36,200 --> 00:12:39,719 Speaker 1: And that's because it's a marker of insulin resistance. When 188 00:12:39,800 --> 00:12:43,440 Speaker 1: your drag list rides are high, remember that's the fat 189 00:12:43,520 --> 00:12:47,160 Speaker 1: that's running through your bloodstream, and your HDL is low, 190 00:12:47,800 --> 00:12:49,800 Speaker 1: it is a sign that your body is struggling to 191 00:12:49,880 --> 00:12:55,839 Speaker 1: process glucose and fat properly. This creates a metabolic environment that, 192 00:12:56,120 --> 00:13:00,480 Speaker 1: as well as destroying your metabolism, is rocket fu for 193 00:13:00,720 --> 00:13:07,160 Speaker 1: heart disease. Secondly, this predicts the type of LDL particles 194 00:13:07,240 --> 00:13:11,079 Speaker 1: that you actually have, right, and we need to have 195 00:13:11,160 --> 00:13:15,000 Speaker 1: a little diversion on this. So your LDL that gets measured, 196 00:13:15,080 --> 00:13:17,839 Speaker 1: the number that you get from your doctor is the 197 00:13:18,000 --> 00:13:22,240 Speaker 1: total of all of your LDL particles. But those LDL 198 00:13:22,400 --> 00:13:27,120 Speaker 1: particles come in different sizes. Some are what we generally 199 00:13:27,240 --> 00:13:29,240 Speaker 1: refer to we put them in a bucket as big 200 00:13:29,400 --> 00:13:35,600 Speaker 1: fluffy LDL, and the other ones are small dense LDL. Now, 201 00:13:35,920 --> 00:13:39,680 Speaker 1: what we know from the research is that the small 202 00:13:39,920 --> 00:13:44,720 Speaker 1: dense LDL are the ones that are dangerous. They are 203 00:13:44,760 --> 00:13:48,800 Speaker 1: the ones that are athrogenic. It's those small dense LDL 204 00:13:49,559 --> 00:13:52,679 Speaker 1: that are the ones that get involved with the plaque 205 00:13:52,760 --> 00:13:57,920 Speaker 1: in your arteries. The big fluffy LDL are not pathogenic 206 00:13:58,360 --> 00:14:02,720 Speaker 1: at all. And what we know is your LDL test 207 00:14:03,160 --> 00:14:05,800 Speaker 1: that you get from your doctor tails you nothing about it. 208 00:14:06,160 --> 00:14:08,839 Speaker 1: So I'll give you a personal example. I've known for 209 00:14:09,000 --> 00:14:13,959 Speaker 1: years that my LDL cholesterol is reasonably high, but my 210 00:14:14,120 --> 00:14:19,280 Speaker 1: HATHDL cholesterol is also super high right now. I when 211 00:14:19,280 --> 00:14:22,040 Speaker 1: I saw my doctor years ago, it was talking about 212 00:14:22,040 --> 00:14:23,760 Speaker 1: the risk, but I kind of knew the research, and 213 00:14:23,880 --> 00:14:26,840 Speaker 1: I went and I actually had to pay to go 214 00:14:26,920 --> 00:14:30,240 Speaker 1: to a different lab and paid to get a whole 215 00:14:30,480 --> 00:14:36,000 Speaker 1: cholesterol panel which looks at the size of the LDL particles. 216 00:14:36,040 --> 00:14:38,920 Speaker 1: And you can get these from many different labs if 217 00:14:39,000 --> 00:14:42,120 Speaker 1: you work with a functional medicine doctor and they can 218 00:14:42,280 --> 00:14:46,440 Speaker 1: order you for them for them. Naturopaths can also order 219 00:14:46,480 --> 00:14:49,640 Speaker 1: them registered nutritious like me, you can also order them. 220 00:14:50,640 --> 00:14:53,960 Speaker 1: And what I found was that all of my LDL 221 00:14:54,280 --> 00:14:59,560 Speaker 1: is big fluffy LDL and very little of it was 222 00:14:59,640 --> 00:15:03,480 Speaker 1: small dense LDL. And then I know that my my 223 00:15:03,600 --> 00:15:06,000 Speaker 1: trag glytrides are very low and my hits d L 224 00:15:06,200 --> 00:15:10,040 Speaker 1: is very high, So that actually gives me a really 225 00:15:10,280 --> 00:15:13,440 Speaker 1: good profile in terms of cholesterol. And I've also looked 226 00:15:13,440 --> 00:15:16,520 Speaker 1: at something called apo B which is really interesting as 227 00:15:16,560 --> 00:15:19,680 Speaker 1: well as a little A but we're not we're not 228 00:15:19,840 --> 00:15:21,280 Speaker 1: going to dive into that because it gets a bit 229 00:15:21,320 --> 00:15:25,040 Speaker 1: more complicated. Let's just come back to this. So the 230 00:15:25,480 --> 00:15:28,280 Speaker 1: track glytride hits the L ratio as well as being 231 00:15:28,280 --> 00:15:31,000 Speaker 1: a marker of insulin resistance and your risk of developing 232 00:15:31,520 --> 00:15:35,000 Speaker 1: type two diabetes, chronic kidney disease, all those sorts of things, obesity, 233 00:15:35,560 --> 00:15:41,680 Speaker 1: and it also and it predicts that you will have 234 00:15:41,960 --> 00:15:45,360 Speaker 1: more small dense LDL. So the higher that ratio is, 235 00:15:45,960 --> 00:15:49,840 Speaker 1: the more likely you are to have small dense LDL particles, 236 00:15:50,240 --> 00:15:53,400 Speaker 1: the really nasty ones that burrow into your audio walls 237 00:15:53,480 --> 00:15:57,680 Speaker 1: like tiny bullets. Now, when this ratio is low, you 238 00:15:58,120 --> 00:16:02,480 Speaker 1: will have large, fluffy l L particles that are relatively harmless, 239 00:16:02,520 --> 00:16:05,560 Speaker 1: and that's exactly what mine showed when I tested both 240 00:16:05,600 --> 00:16:09,800 Speaker 1: of them. Now, thirdly, and this is crucial, the triglyceride 241 00:16:09,840 --> 00:16:15,640 Speaker 1: to Hitsdale ratio capture something called residual risk. This is 242 00:16:15,760 --> 00:16:21,800 Speaker 1: the cardiovascular risk that persists even when your LDL cholesterol 243 00:16:22,400 --> 00:16:26,520 Speaker 1: is perfectly controlled with statins. So we know from the 244 00:16:26,640 --> 00:16:31,040 Speaker 1: research on statins statins can be useful in preventing death, 245 00:16:31,520 --> 00:16:35,240 Speaker 1: but only the research shows only in people who have 246 00:16:35,400 --> 00:16:40,840 Speaker 1: had a carnary event or have existing carnary artery disease. 247 00:16:41,440 --> 00:16:45,680 Speaker 1: The other research shows that statins in other populations actually 248 00:16:45,800 --> 00:16:50,640 Speaker 1: does not reduce deaths from cardiovascular diseases. Now, let's get 249 00:16:50,760 --> 00:16:54,360 Speaker 1: back to this triglystid hits The ratio I study published 250 00:16:54,360 --> 00:16:58,280 Speaker 1: in the Frontiers in Cardiovascular Medicine looked at diabetic patients 251 00:16:58,360 --> 00:17:02,600 Speaker 1: with carnery ardy disease who were already on statins, and 252 00:17:02,720 --> 00:17:06,720 Speaker 1: guess what, The triglyceride to hats Dale ratio was still 253 00:17:06,800 --> 00:17:11,920 Speaker 1: a powerful predictor of death and cardiovascular events even in 254 00:17:12,040 --> 00:17:16,960 Speaker 1: those people with LDL cholesterol that was well controlled by statins. 255 00:17:17,160 --> 00:17:21,440 Speaker 1: So this is what we call residual risks. So let's 256 00:17:21,480 --> 00:17:29,000 Speaker 1: get practical. What should your triglyceride to hates DL ratio B. Well, 257 00:17:29,040 --> 00:17:33,159 Speaker 1: of course this answer is not straightforward because it depends 258 00:17:33,320 --> 00:17:36,520 Speaker 1: where you're actually from or what units that you use 259 00:17:36,800 --> 00:17:41,880 Speaker 1: to be more accurate, right, because the conversions are different 260 00:17:42,160 --> 00:17:47,240 Speaker 1: for triglycerides and for hits DL. So basically, if you 261 00:17:47,480 --> 00:17:50,200 Speaker 1: use US standard units, so if you live in the 262 00:17:50,280 --> 00:17:54,040 Speaker 1: United States or you're using those units, if your number 263 00:17:54,160 --> 00:17:59,160 Speaker 1: is in milligrams per desi liter, then the recommended ratios 264 00:17:59,400 --> 00:18:02,520 Speaker 1: are less than three. Well, what we know is that 265 00:18:02,760 --> 00:18:07,240 Speaker 1: above three that is where you really get into trouble. 266 00:18:07,359 --> 00:18:10,960 Speaker 1: Anything above three in men and above two in women 267 00:18:11,480 --> 00:18:14,800 Speaker 1: put you in the danger zone. Right, that's if you 268 00:18:15,000 --> 00:18:19,520 Speaker 1: use milligrams per deesta leader, if you use millimos per leter, 269 00:18:20,640 --> 00:18:23,399 Speaker 1: anything above one point three per man So if you 270 00:18:23,440 --> 00:18:26,280 Speaker 1: live in Australia, UK, those sorts of places, anything above 271 00:18:26,400 --> 00:18:29,080 Speaker 1: one point three of that ratio. So if your triglystrides 272 00:18:29,119 --> 00:18:31,600 Speaker 1: are one in a third times you hate the ler more, 273 00:18:32,160 --> 00:18:36,439 Speaker 1: then you're in trouble. And women anything above zero point nine, right, 274 00:18:36,680 --> 00:18:42,320 Speaker 1: then you're in trouble. Now, what is optimal in the US, right, 275 00:18:42,480 --> 00:18:47,000 Speaker 1: the milligram per destileter ideally for optimal for both men 276 00:18:47,040 --> 00:18:49,240 Speaker 1: and women. Here it should be less than one, so 277 00:18:49,400 --> 00:18:53,440 Speaker 1: your HDL should be higher than your triglystrides. Right. For 278 00:18:53,600 --> 00:18:56,560 Speaker 1: the international standard the people who use millimals per leader, 279 00:18:57,240 --> 00:19:01,760 Speaker 1: like in Australia, it should be less than zero point four, right, 280 00:19:01,920 --> 00:19:06,960 Speaker 1: so your Hatesdale should be more than double your triglycerides. So, 281 00:19:07,320 --> 00:19:10,520 Speaker 1: just to clear up any confusion, the reason why those 282 00:19:10,600 --> 00:19:16,479 Speaker 1: ratios are different is that the conversion formula for triglycerides 283 00:19:16,960 --> 00:19:20,159 Speaker 1: between American and miligrams for deest leader and minimals per 284 00:19:20,240 --> 00:19:24,200 Speaker 1: leader is different to the conversion formula for Hatessdale cholesterol. 285 00:19:24,240 --> 00:19:26,720 Speaker 1: So that's why there's a discrepancy in the ratio for 286 00:19:26,840 --> 00:19:28,960 Speaker 1: any of those. They have a bit of maths and things, 287 00:19:28,960 --> 00:19:31,800 Speaker 1: and this is a bit weird. Anyway, back to the 288 00:19:31,920 --> 00:19:36,120 Speaker 1: story here, and some other interesting research has come out 289 00:19:36,400 --> 00:19:41,919 Speaker 1: that this ratio, that the trigrisside Hatesdale ratio, is even 290 00:19:42,080 --> 00:19:46,160 Speaker 1: more powerful as a predictor for women. A study published 291 00:19:46,200 --> 00:19:49,159 Speaker 1: in the Journaly of the American Heart Association looked at 292 00:19:49,240 --> 00:19:53,119 Speaker 1: women with non obstructive carn reority disease. These are the 293 00:19:53,119 --> 00:19:55,680 Speaker 1: women who have chest pain and heart problems but don't 294 00:19:55,760 --> 00:19:59,000 Speaker 1: have the classic blocked arteries you see in men. The 295 00:19:59,119 --> 00:20:05,320 Speaker 1: triglyceride dale ratio was a powerful independent predictor of major 296 00:20:05,480 --> 00:20:09,399 Speaker 1: adverse cardio vascular events in these women. And here's the kicker. 297 00:20:09,800 --> 00:20:14,800 Speaker 1: In some populations, this ratio predicts cardiovascular risk in women, 298 00:20:15,240 --> 00:20:19,840 Speaker 1: while the traditional LDLD hates dale ratio doesn't predict anything 299 00:20:20,040 --> 00:20:23,119 Speaker 1: at all. This makes sense when you think about it. 300 00:20:23,280 --> 00:20:27,440 Speaker 1: Women's heart disease often looks different from men's. They're more 301 00:20:27,600 --> 00:20:33,159 Speaker 1: likely to have microvascular dysfunction and metabolic abnormalities, and the 302 00:20:33,320 --> 00:20:38,439 Speaker 1: triglyceride hates stale ratio captures that beautifully. Now you might 303 00:20:38,520 --> 00:20:42,680 Speaker 1: be wondering, if this research is so compelling, why is 304 00:20:42,840 --> 00:20:46,159 Speaker 1: my doctor talking about this? Why isn't this the major 305 00:20:46,320 --> 00:20:49,440 Speaker 1: focus when I go to get my blood tests? And 306 00:20:49,720 --> 00:20:51,720 Speaker 1: it's a great question. The answer is probably a little 307 00:20:51,760 --> 00:20:57,280 Speaker 1: bit frustrating. And firstly, medical education moves at the speed 308 00:20:57,359 --> 00:21:01,920 Speaker 1: of molasses. It's well known that it takes seven to 309 00:21:02,160 --> 00:21:07,119 Speaker 1: ten years to get from research into medical education, and 310 00:21:07,200 --> 00:21:11,760 Speaker 1: the research I'm sharing with you is relatively recent now. Second, 311 00:21:11,920 --> 00:21:16,639 Speaker 1: the medical system has been built for decades around treating 312 00:21:16,760 --> 00:21:20,399 Speaker 1: LDL cholesterol. We have drugs at lower LDL, we have 313 00:21:20,600 --> 00:21:25,920 Speaker 1: guidelines based on LDL and try treatment algorithms are LDL centric. 314 00:21:26,520 --> 00:21:30,119 Speaker 1: Changing that system is like trying to turn a friggin 315 00:21:30,240 --> 00:21:34,199 Speaker 1: oil tanker. Now. Third, and this is where you can 316 00:21:34,240 --> 00:21:36,720 Speaker 1: be a bit more cynical. There's a shitload of money 317 00:21:37,160 --> 00:21:41,000 Speaker 1: in the current system. Starting prescriptions are multi billion dollar 318 00:21:41,200 --> 00:21:45,080 Speaker 1: industries and studies are often funded by this. And I'm 319 00:21:45,119 --> 00:21:49,240 Speaker 1: not a conspiracy theorist, but when there are finance strong 320 00:21:49,359 --> 00:21:53,359 Speaker 1: financial interests, you do have to question stuff. And this 321 00:21:53,680 --> 00:21:59,399 Speaker 1: entire cholesterol industrial complex is built around LDL cholesterol. But 322 00:21:59,480 --> 00:22:04,600 Speaker 1: here's what's encouraging some forward thinking doctors really focus on this, 323 00:22:04,800 --> 00:22:08,960 Speaker 1: particularly if you have a functional medicine doctor, because the 324 00:22:09,080 --> 00:22:12,040 Speaker 1: research really is too compelling to ignore, or if you've 325 00:22:12,040 --> 00:22:15,480 Speaker 1: got a doctor who has the time to actually dig 326 00:22:15,520 --> 00:22:19,440 Speaker 1: into the research. So let's talk about the metabolic connection, 327 00:22:19,640 --> 00:22:22,840 Speaker 1: because this is huguely important. It's not like cardiovascular disease 328 00:22:22,920 --> 00:22:27,000 Speaker 1: is completely independent from metabolic disease. There is a very 329 00:22:27,160 --> 00:22:31,280 Speaker 1: strong overlap. You know, we are a complex ecosystem, So 330 00:22:31,680 --> 00:22:35,280 Speaker 1: when your triglycerides are high, it usually means one of 331 00:22:35,359 --> 00:22:39,520 Speaker 1: two things. Either you're eating too many refined carbohydrates and sugars, 332 00:22:40,320 --> 00:22:45,240 Speaker 1: or your body has become insulin resistant and can't properly 333 00:22:45,400 --> 00:22:49,840 Speaker 1: clear fat from your bloodstream. So, just to add a 334 00:22:49,880 --> 00:22:53,200 Speaker 1: little bit of color on that Althow, triglycerides are a 335 00:22:53,400 --> 00:22:58,840 Speaker 1: fat in the bloodstream. It's basically driven by refined carbohydrates 336 00:22:58,880 --> 00:23:03,520 Speaker 1: and sugars that I actually create those triglycerites, right, So triglycerites, 337 00:23:03,520 --> 00:23:05,239 Speaker 1: even though it's a fat, doesn't mean you're eating too 338 00:23:05,320 --> 00:23:09,160 Speaker 1: much fat. It's generally too much refined carbohydrates and sugars, 339 00:23:09,720 --> 00:23:12,960 Speaker 1: or just too much carbohydrates for your tolerance level, because 340 00:23:13,000 --> 00:23:17,080 Speaker 1: we can all tolerate different levels. Now, switching over to HATESDL. 341 00:23:17,640 --> 00:23:21,760 Speaker 1: When your hatesdale is low, that means that your body's 342 00:23:21,920 --> 00:23:26,840 Speaker 1: natural clean up crew, the particles that pull cholesterol out 343 00:23:26,880 --> 00:23:29,800 Speaker 1: of your artery walls and transport it back to your 344 00:23:29,840 --> 00:23:34,640 Speaker 1: liver for disposal, it's understaffed essentially. Now, when you put 345 00:23:34,720 --> 00:23:39,720 Speaker 1: these two together, you got the perfect storm. More athrogenic 346 00:23:39,800 --> 00:23:43,479 Speaker 1: particles in your blood, less clean up activity, and an 347 00:23:43,720 --> 00:23:50,480 Speaker 1: underlying metabolic dysfunction that creates inflammation and oxidative stress. And 348 00:23:50,600 --> 00:23:54,639 Speaker 1: a study published in Scientific Reports followed three hundred and 349 00:23:54,640 --> 00:23:58,680 Speaker 1: fifty five patients with stable angina for over four years, 350 00:23:59,119 --> 00:24:02,399 Speaker 1: and they find that patients in the highest quartile, the 351 00:24:02,480 --> 00:24:06,240 Speaker 1: highst twenty five percent of the tiger side hat stale 352 00:24:06,320 --> 00:24:10,000 Speaker 1: ratio had nearly three times the risk of death or 353 00:24:10,119 --> 00:24:14,560 Speaker 1: heart attack compared to those in the lowest quartile. And 354 00:24:14,760 --> 00:24:19,320 Speaker 1: this was independent of their LDL cholesterol levels, right, And 355 00:24:19,480 --> 00:24:22,600 Speaker 1: you don't get anything like that when it comes to 356 00:24:22,880 --> 00:24:26,920 Speaker 1: LDL cholesterol. You don't get three times the risk of 357 00:24:27,040 --> 00:24:29,919 Speaker 1: death or heart attack with people with high LDL compared 358 00:24:29,960 --> 00:24:32,880 Speaker 1: to those with low LDL. And that's how I talk 359 00:24:32,960 --> 00:24:37,800 Speaker 1: about the Cooper Institute, which is a really, really good 360 00:24:37,880 --> 00:24:43,119 Speaker 1: research institute. Now they've been studying health and fitness for decades, 361 00:24:43,440 --> 00:24:47,600 Speaker 1: and they looked at the relationship between cardio respiratory fitness, 362 00:24:47,920 --> 00:24:49,760 Speaker 1: which you've heard me talk about this BO two max 363 00:24:49,840 --> 00:24:51,840 Speaker 1: the single biggest predictive of how long you're going to live. 364 00:24:52,119 --> 00:24:55,160 Speaker 1: They looked at a relationship between that your trigglysarid hayte 365 00:24:55,160 --> 00:24:58,960 Speaker 1: stale ratio and death from cornery heart disease in men, 366 00:24:59,200 --> 00:25:02,320 Speaker 1: and what they found was pretty remarkable. Even among the 367 00:25:02,400 --> 00:25:06,560 Speaker 1: men with the lowest healthiest triglist ride to hate stale ratios, 368 00:25:07,040 --> 00:25:10,880 Speaker 1: those who were physically unfit were more than twice as 369 00:25:11,040 --> 00:25:14,160 Speaker 1: likely to die from heart disease compared to those who 370 00:25:14,240 --> 00:25:17,960 Speaker 1: were highly fit. But here's the really interesting part. Across 371 00:25:18,200 --> 00:25:22,160 Speaker 1: all fitness levels, men with higher triglyst ride to hate 372 00:25:22,160 --> 00:25:27,200 Speaker 1: stale ratios had significantly higher death risks our death rates. 373 00:25:27,600 --> 00:25:32,200 Speaker 1: This ratio was independent predictor regardless of how fit you 374 00:25:32,280 --> 00:25:36,080 Speaker 1: you were, and this is key when it comes to research. 375 00:25:36,160 --> 00:25:41,840 Speaker 1: When you see it across different groups or subgroups of people, 376 00:25:42,480 --> 00:25:45,240 Speaker 1: then you start to go, hey, this evidence is becoming 377 00:25:45,440 --> 00:25:50,480 Speaker 1: pretty compelling and it tells us something crucial. Fitness matters enormously, 378 00:25:50,640 --> 00:25:54,159 Speaker 1: as I've said, but metabolic health as reflected by the 379 00:25:54,240 --> 00:25:58,240 Speaker 1: triglist right hates stale ratio is very very important as well, 380 00:25:58,320 --> 00:26:01,879 Speaker 1: and it interacts with your fitness. So let's talk about 381 00:26:02,960 --> 00:26:06,359 Speaker 1: how we can use this information practically. So first of all, 382 00:26:06,400 --> 00:26:08,480 Speaker 1: you need to calculate your ratio, all right. You take 383 00:26:08,520 --> 00:26:12,560 Speaker 1: your trig list ride number on your results blood results, 384 00:26:12,600 --> 00:26:15,800 Speaker 1: you divided by your head stale number, and both should 385 00:26:15,800 --> 00:26:19,480 Speaker 1: be from the same blood test and ideally at fasted 386 00:26:19,520 --> 00:26:23,200 Speaker 1: blood tests because they can be affected, particularly your trig 387 00:26:23,280 --> 00:26:26,439 Speaker 1: list rights. So let's remember back to the formulas. If 388 00:26:26,520 --> 00:26:30,159 Speaker 1: you use the US centric milligrams per desant leader. If 389 00:26:30,200 --> 00:26:33,439 Speaker 1: that's what it says on your test. If your ratio 390 00:26:33,640 --> 00:26:37,159 Speaker 1: is above three for men or two for women, you 391 00:26:37,600 --> 00:26:41,480 Speaker 1: have to take action. And that more above that it 392 00:26:41,760 --> 00:26:45,159 Speaker 1: is the quicker and the stronger the action that you 393 00:26:45,320 --> 00:26:49,320 Speaker 1: need to take. And then if you use minimals per Leter, 394 00:26:50,280 --> 00:26:52,639 Speaker 1: if it's above one point four for women or not 395 00:26:52,880 --> 00:26:55,840 Speaker 1: point nine, sorry one point four for men and not 396 00:26:55,920 --> 00:26:59,119 Speaker 1: point nine for women, then you gotta take action. But 397 00:26:59,240 --> 00:27:03,879 Speaker 1: the good new is that this ratio responds beautifully to 398 00:27:04,080 --> 00:27:10,879 Speaker 1: lifestyle interventions. Low carbohydrate diets have consistently been shown to 399 00:27:11,160 --> 00:27:15,680 Speaker 1: dramatically improve the triglyceride to hit stale ratio. A meta 400 00:27:15,720 --> 00:27:19,680 Speaker 1: analysis published in plus one plus one showed that low 401 00:27:19,800 --> 00:27:25,160 Speaker 1: carb diets consistently lower trigly rides and reis hate stale cholesterol, 402 00:27:25,960 --> 00:27:31,080 Speaker 1: and exercise is equally powerful. A regular aerobic exercise and 403 00:27:31,600 --> 00:27:35,800 Speaker 1: regular strength training increases hate stale cholesterol. Particularly strength training 404 00:27:36,560 --> 00:27:39,919 Speaker 1: and both types of exercise help your body become more 405 00:27:39,960 --> 00:27:45,320 Speaker 1: efficient at clearing triglycerides from your bloodstream. Intermittent fasting can 406 00:27:45,440 --> 00:27:49,000 Speaker 1: also be incredibly effective because it gives your body regular 407 00:27:49,119 --> 00:27:54,119 Speaker 1: breaks from insulentce spikes, allowing your trigly rides. To normalize. Right. 408 00:27:54,480 --> 00:27:59,240 Speaker 1: So how you use this practically is doing those sorts 409 00:27:59,240 --> 00:28:04,080 Speaker 1: of informat intermittent fasting, so you know, stop eating three 410 00:28:04,119 --> 00:28:07,399 Speaker 1: hours before you go to bed and in fast for 411 00:28:07,640 --> 00:28:11,359 Speaker 1: twelve to sixteen hours, right, and that is going to 412 00:28:11,520 --> 00:28:15,200 Speaker 1: really get your insulin under control. And then eating low 413 00:28:15,280 --> 00:28:19,199 Speaker 1: carbohydrate diets with good amounts of protein and good amounts 414 00:28:19,240 --> 00:28:22,680 Speaker 1: of fat will keep your inchinin levels under control. And 415 00:28:22,920 --> 00:28:27,480 Speaker 1: just managing your carbohydrates is really really key for this thing. Now, 416 00:28:28,080 --> 00:28:30,359 Speaker 1: one other thing that I have actually been playing with 417 00:28:31,280 --> 00:28:36,240 Speaker 1: to keep that level lower, to keep insulin, which is 418 00:28:36,400 --> 00:28:38,880 Speaker 1: as we said, is reflected with your tagles start hit 419 00:28:38,960 --> 00:28:43,080 Speaker 1: stale ratio is for your breakfast is to just change 420 00:28:43,160 --> 00:28:45,960 Speaker 1: what your breakfast looks like, to make sure that your 421 00:28:46,080 --> 00:28:51,800 Speaker 1: breakfast is a high protein, high fat, low car breakfast. 422 00:28:52,280 --> 00:28:56,360 Speaker 1: And that is really key because it's the carbohydrate that 423 00:28:56,600 --> 00:29:01,680 Speaker 1: gives us the big insulin spike. So certainly not the 424 00:29:01,760 --> 00:29:04,080 Speaker 1: breakfast that a lot of people eat of breakfast cereal 425 00:29:04,240 --> 00:29:06,560 Speaker 1: or toast and orange juice, those sorts of things they'll 426 00:29:06,560 --> 00:29:10,600 Speaker 1: play havoc with that. You want to be eating stuff 427 00:29:10,800 --> 00:29:13,840 Speaker 1: like an omelet without the toast, and those sorts of 428 00:29:13,920 --> 00:29:19,240 Speaker 1: things are any of those ketigenic are low car breakfasts 429 00:29:19,440 --> 00:29:22,280 Speaker 1: are absolutely the way to go, and that will keep 430 00:29:22,320 --> 00:29:26,280 Speaker 1: your insulin under control for more than half the day, 431 00:29:26,560 --> 00:29:30,440 Speaker 1: which is really really important. Now here's something else that's 432 00:29:30,800 --> 00:29:33,560 Speaker 1: interesting to come out of the research. Certain medications can 433 00:29:33,680 --> 00:29:37,200 Speaker 1: improve your triglists right to hit stale ratio, but not 434 00:29:37,280 --> 00:29:40,800 Speaker 1: always in a way that you'd expect. So statins, which 435 00:29:40,880 --> 00:29:44,680 Speaker 1: millions of people take, they're cholesterol lowering drugs. They can 436 00:29:44,920 --> 00:29:47,880 Speaker 1: improve that the triglists are to hit stale ratio by 437 00:29:47,920 --> 00:29:52,160 Speaker 1: about ten to twenty percent. They typically lower tracklist rides 438 00:29:52,520 --> 00:29:57,600 Speaker 1: by up to fifty percent in some people. However, some 439 00:29:57,880 --> 00:30:01,480 Speaker 1: people when they take statins, their risk of diabetes and 440 00:30:01,520 --> 00:30:06,280 Speaker 1: metabolic function dysfunction actually goes up. So you have to really, 441 00:30:06,680 --> 00:30:09,000 Speaker 1: if you're honest, that you've gotta look at this stuff. 442 00:30:09,160 --> 00:30:12,760 Speaker 1: But there is other things, or there are other things. 443 00:30:12,960 --> 00:30:17,400 Speaker 1: Fibrates niacin, which is a vinamin one of the B vinamins, 444 00:30:17,440 --> 00:30:20,440 Speaker 1: and a mega three fatty acids are often more effective 445 00:30:20,600 --> 00:30:23,040 Speaker 1: at improving this ratio than statins, and they don't have 446 00:30:23,120 --> 00:30:27,560 Speaker 1: the side effects. They specifically target triglys rides and they 447 00:30:27,600 --> 00:30:29,840 Speaker 1: can rease hate DL cholesterol as well. So they're working 448 00:30:29,880 --> 00:30:33,040 Speaker 1: on both sides of the equation, and that's why quite 449 00:30:33,040 --> 00:30:36,640 Speaker 1: a few progressive cardiologists are starting to look beyond just 450 00:30:36,720 --> 00:30:42,240 Speaker 1: prescribing statins and are also considering combination therapies that target 451 00:30:42,320 --> 00:30:47,200 Speaker 1: the entire lipid profile, not just LDL cholesterol. So let's 452 00:30:47,600 --> 00:30:51,960 Speaker 1: go back and and really reconnect the dots around diabetes, 453 00:30:53,720 --> 00:30:58,600 Speaker 1: because this triglys ride hates the L ratio also predicts diabetes. 454 00:30:58,880 --> 00:31:02,880 Speaker 1: The Cooper Center for Longitudinal study found that trieglist rate 455 00:31:02,960 --> 00:31:06,880 Speaker 1: hits stale ratio was a strong predictor of developing type 456 00:31:06,880 --> 00:31:11,640 Speaker 1: two diabetes in man, so it's an early warning that 457 00:31:11,720 --> 00:31:14,480 Speaker 1: you're on your way to diabetes. That makes perfect sense 458 00:31:14,480 --> 00:31:17,440 Speaker 1: because this ratio reflects in shilin resistance, which is the 459 00:31:17,560 --> 00:31:20,680 Speaker 1: underlying driver of type two diabetes. And anybody tells you otherwise, 460 00:31:20,720 --> 00:31:25,360 Speaker 1: it's completely and utterly bonkers. So if your triglistrid hit 461 00:31:25,400 --> 00:31:28,800 Speaker 1: stale ratio is elevated, you're not just at high risk 462 00:31:28,880 --> 00:31:31,760 Speaker 1: for heart disease, you're also at high risk for diabetes 463 00:31:31,840 --> 00:31:35,560 Speaker 1: and all of the other metabolic consequences of that. And 464 00:31:35,720 --> 00:31:40,200 Speaker 1: if you develop diabetes, your cardiovascular risk goes through the roof. 465 00:31:41,000 --> 00:31:44,720 Speaker 1: This is why this ratio is so powerful it's capturing 466 00:31:44,840 --> 00:31:51,040 Speaker 1: an underlying metabolic dysfunction that drives two of the four 467 00:31:51,360 --> 00:31:58,040 Speaker 1: horsemen of chronic disease. Now age also plays a role here. 468 00:32:00,240 --> 00:32:03,840 Speaker 1: A meta analysis of LDL cholesterol reduction studies, so these 469 00:32:03,880 --> 00:32:08,160 Speaker 1: were intervention studies, found that the relative benefit of lowering 470 00:32:08,560 --> 00:32:13,920 Speaker 1: LDL cholesterol appears to decrease with age, particularly in primary 471 00:32:14,000 --> 00:32:17,000 Speaker 1: prevention and starting and trying to prevent disease before it 472 00:32:17,040 --> 00:32:20,800 Speaker 1: actually happens. But you know what doesn't lose its predictive 473 00:32:20,840 --> 00:32:23,320 Speaker 1: part with age, the triglyst right to hit the L 474 00:32:23,440 --> 00:32:26,720 Speaker 1: ratio right. So some of the research that's coming out, 475 00:32:26,800 --> 00:32:28,920 Speaker 1: just to give a bit more on that, shows that 476 00:32:29,360 --> 00:32:36,240 Speaker 1: LDL cholesterol reduction can be protective in people in their thirties, forties, fifties, 477 00:32:36,680 --> 00:32:39,480 Speaker 1: but once they get into their sixties, it's a lot 478 00:32:39,640 --> 00:32:42,880 Speaker 1: less protective. But managing the triglyst right hates d L 479 00:32:43,000 --> 00:32:46,960 Speaker 1: ratio works across all of the age spans. And it 480 00:32:47,040 --> 00:32:49,959 Speaker 1: makes sense when you think about it, because as we age, 481 00:32:50,480 --> 00:32:56,080 Speaker 1: metabolic dysfunction becomes increasingly important as a driver for cardiovascular disease, 482 00:32:56,360 --> 00:32:59,800 Speaker 1: and the triglystrid hates the L ratio captures this metabolic 483 00:33:00,040 --> 00:33:05,200 Speaker 1: opponent that LDL cholesterol actually misses. Now, I want to 484 00:33:05,840 --> 00:33:09,440 Speaker 1: circle back to something that I mentioned earlier, and that's 485 00:33:09,480 --> 00:33:12,480 Speaker 1: about women's heart health and saying that this ratio is 486 00:33:12,520 --> 00:33:16,640 Speaker 1: particularly crucial, and that's because women's heart disease doesn't follow 487 00:33:16,680 --> 00:33:20,040 Speaker 1: the same pattern as men's heart disease. They're more likely 488 00:33:20,840 --> 00:33:24,480 Speaker 1: to have that microvascular dysfunction as I mentioned earlier, and 489 00:33:24,640 --> 00:33:27,520 Speaker 1: this is problems with tiny blood vessels in the heart 490 00:33:28,280 --> 00:33:31,800 Speaker 1: rather than blockages in the major arteries. Now, this type 491 00:33:31,800 --> 00:33:36,720 Speaker 1: of heart disease is closely linked to metabolic dysfunction, insulin resistance, 492 00:33:36,760 --> 00:33:40,560 Speaker 1: and inflammation, all the things that traglystrid hates stale ratio 493 00:33:40,640 --> 00:33:47,360 Speaker 1: captures beautifully. And the Women's Ischemia Syndrome Evaluation Study followed 494 00:33:47,400 --> 00:33:50,440 Speaker 1: over five hundred women for six years, and what they 495 00:33:50,480 --> 00:33:53,480 Speaker 1: found was that the traglystride hates stale ratio was a 496 00:33:53,880 --> 00:33:59,520 Speaker 1: powerful predictor, such a powerful predictor that it remains significant 497 00:33:59,640 --> 00:34:04,840 Speaker 1: even and after they adjusted for age, race, smoking, high 498 00:34:04,880 --> 00:34:09,520 Speaker 1: blood pressure, diabetes, and the results of their coronary and geograms. 499 00:34:09,680 --> 00:34:14,000 Speaker 1: So this is really really powerful and if you're a woman, 500 00:34:14,320 --> 00:34:17,480 Speaker 1: you really need to think about this. And if you 501 00:34:17,520 --> 00:34:20,040 Speaker 1: have chest pain, fatigue, or other symptoms, but your doctor 502 00:34:20,080 --> 00:34:23,280 Speaker 1: says your orderies look fine, ask them about your trackler 503 00:34:23,320 --> 00:34:26,360 Speaker 1: storry to hit stale ratio because that might be the secret, 504 00:34:26,640 --> 00:34:31,279 Speaker 1: little key to what is actually going on. Now, let's 505 00:34:31,280 --> 00:34:34,000 Speaker 1: talk about some other research. We are getting towards the 506 00:34:34,120 --> 00:34:37,400 Speaker 1: end of this. But scientists have started using advanced imaging 507 00:34:37,480 --> 00:34:40,400 Speaker 1: techniques to look not just at whether you have plaque 508 00:34:40,400 --> 00:34:43,800 Speaker 1: in your arteries, but what type of plaque that you have. 509 00:34:44,120 --> 00:34:47,000 Speaker 1: And actually I had this done on me because obviously 510 00:34:47,239 --> 00:34:51,800 Speaker 1: for my open heart surgery. Now, as my carreologist explained 511 00:34:51,800 --> 00:34:56,000 Speaker 1: to me, some plaques are stable, They're like concrete. Now 512 00:34:56,080 --> 00:35:00,560 Speaker 1: they might narrow your arteries, but they are not likely 513 00:35:00,680 --> 00:35:04,440 Speaker 1: to rupture and cause a heart attack. And these are 514 00:35:04,520 --> 00:35:11,360 Speaker 1: plaques that have calcium basically stabilizing them. Other plaques are vulnerable. 515 00:35:11,880 --> 00:35:14,960 Speaker 1: They're like volcanoes are wailing to erupt. And a study 516 00:35:15,000 --> 00:35:19,480 Speaker 1: published in the European Heart Journal use cornery ct angiograph 517 00:35:19,840 --> 00:35:23,440 Speaker 1: to identify high risk vulnerable plaques, so we can actually 518 00:35:23,480 --> 00:35:26,640 Speaker 1: look at this now. What they found was remarkable. Patients 519 00:35:26,680 --> 00:35:30,560 Speaker 1: with higher triglist right hate stale ratios were significantly more 520 00:35:30,760 --> 00:35:34,480 Speaker 1: likely to develop these dangerous, vulnerable plaques. And here's the 521 00:35:34,520 --> 00:35:38,360 Speaker 1: kicker that that ratio triglist right hate stale ratio was 522 00:35:38,440 --> 00:35:41,960 Speaker 1: an independent predictor of future cardiovascular events. With the hazard 523 00:35:42,040 --> 00:35:45,239 Speaker 1: ratio of one point ninety four. That means that people 524 00:35:45,280 --> 00:35:47,719 Speaker 1: with higher ratios were nearly twice as likely to have 525 00:35:47,800 --> 00:35:51,080 Speaker 1: a heart attack or a stroke, right, And this suggests 526 00:35:51,160 --> 00:35:55,840 Speaker 1: that this ratio doesn't just predict cardiovascular events, it actually 527 00:35:55,960 --> 00:35:59,879 Speaker 1: helps identify the people who have the most dangerous type 528 00:36:00,160 --> 00:36:05,040 Speaker 1: of plaque in their arteries, right, the unstable plaque, which 529 00:36:05,080 --> 00:36:07,319 Speaker 1: is key. And if you think about it, this makes 530 00:36:07,360 --> 00:36:13,520 Speaker 1: sense because hits dl can actually have a beneficial effect 531 00:36:13,680 --> 00:36:16,239 Speaker 1: on the plaque that you actually have. And then there's 532 00:36:16,280 --> 00:36:21,279 Speaker 1: the whole triglyceride thing. But another thing I wanted to 533 00:36:21,320 --> 00:36:25,360 Speaker 1: talk about is just to revisit again that residual risk idea. 534 00:36:26,880 --> 00:36:29,799 Speaker 1: So for decades it was thought that if you can 535 00:36:30,080 --> 00:36:33,759 Speaker 1: just get LDL cholesterol low enough, you're gonna limit most 536 00:36:33,840 --> 00:36:37,320 Speaker 1: cardiovascular risk. And a lot of people still think of it, 537 00:36:37,360 --> 00:36:39,480 Speaker 1: and it turns out that the evidence does not support it. 538 00:36:40,200 --> 00:36:44,640 Speaker 1: Even when LDL cholesterol is optimally controlled with statins, many 539 00:36:44,760 --> 00:36:47,239 Speaker 1: people still have heart attacks and structure. So they call 540 00:36:47,360 --> 00:36:50,799 Speaker 1: this residual risk, and it's a huge problem in cardiology. 541 00:36:51,960 --> 00:36:56,080 Speaker 1: Multiple studies have shown that the triglystraide hates the L 542 00:36:56,200 --> 00:37:01,560 Speaker 1: ratio captures this residual risk beautifully. That identifies people who 543 00:37:01,640 --> 00:37:05,400 Speaker 1: are still at high risk even when their LDS cholesterol 544 00:37:05,520 --> 00:37:09,360 Speaker 1: profile looks perfect on paper. And these people might be 545 00:37:09,440 --> 00:37:12,439 Speaker 1: thinking they're fine, but they can still be at risk. 546 00:37:12,840 --> 00:37:16,319 Speaker 1: And they're studying diabetic patients with carniordy disease who were 547 00:37:16,400 --> 00:37:20,680 Speaker 1: already on STATNS founded triglstraide hit stale ratio was still 548 00:37:20,719 --> 00:37:25,000 Speaker 1: a powerful predictor of death and cardiovascular events. And the 549 00:37:25,120 --> 00:37:28,839 Speaker 1: hazard ratio for the highest churchil the highest and thirty 550 00:37:28,880 --> 00:37:32,080 Speaker 1: three percent was one point seven to seven for all 551 00:37:32,200 --> 00:37:35,919 Speaker 1: cause mortality and one point five to two for cardiovascular death. 552 00:37:36,040 --> 00:37:39,440 Speaker 1: And that is massive, And this is why this ratio 553 00:37:40,080 --> 00:37:43,880 Speaker 1: is so clinically important. It helps identify the people who 554 00:37:44,040 --> 00:37:49,959 Speaker 1: need more aggressive intervention beyond just LDL lowering. So let's 555 00:37:50,000 --> 00:37:53,360 Speaker 1: not get practical after all of that. If your head 556 00:37:53,560 --> 00:37:57,759 Speaker 1: has stopped spinning, So first of all, it's get your 557 00:37:57,840 --> 00:38:02,080 Speaker 1: numbers right, and remember those numbers what they need to be. 558 00:38:02,719 --> 00:38:06,360 Speaker 1: If you're us centric, you need to have that number. 559 00:38:07,560 --> 00:38:11,560 Speaker 1: Ideally it's below one, right, so your heat stale is 560 00:38:11,600 --> 00:38:15,560 Speaker 1: higher than your triglys rides if you are and also 561 00:38:15,760 --> 00:38:18,560 Speaker 1: uk those sorts of things you use minimals per leader. 562 00:38:19,160 --> 00:38:23,279 Speaker 1: Ideally that's below zero point four that ratio, right, so 563 00:38:23,360 --> 00:38:27,080 Speaker 1: your heat stale should be more than double your triglyss rides. Right. 564 00:38:27,600 --> 00:38:31,320 Speaker 1: If it's not like that, here's your action plan. Firstly, 565 00:38:31,920 --> 00:38:37,200 Speaker 1: it's fix the diet. This this ratio responds incredibly well 566 00:38:37,560 --> 00:38:41,960 Speaker 1: to reducing refined carbohydrates and sugar, and even for some 567 00:38:42,160 --> 00:38:47,160 Speaker 1: people reducing complex carbohydrates because we all tolerate carbohydrates differently. 568 00:38:47,960 --> 00:38:50,960 Speaker 1: Every grammar sugar you potentially reaches your truglyst rights and 569 00:38:51,040 --> 00:38:54,280 Speaker 1: lowers your heat stale. And it's particularly ultra processed foods 570 00:38:54,920 --> 00:38:58,520 Speaker 1: are a real issue here. So I would highly recommend 571 00:38:59,000 --> 00:39:01,840 Speaker 1: going on a low diet if there's an issue with 572 00:39:01,920 --> 00:39:06,359 Speaker 1: that ratio. And then movement right. Regular exercise is one 573 00:39:06,360 --> 00:39:09,200 Speaker 1: of the most powerful ways to improve this ratio, and 574 00:39:09,320 --> 00:39:14,680 Speaker 1: a combination of cardiovascular stuff and strength training seems to 575 00:39:14,760 --> 00:39:19,400 Speaker 1: be the optimal. And then potentially consider intermittent fasting. Giving 576 00:39:19,440 --> 00:39:23,160 Speaker 1: your body regular breaks from food allows that trag list 577 00:39:23,280 --> 00:39:28,280 Speaker 1: ride and level to normalize and can improve your insulin sensitivity. 578 00:39:28,880 --> 00:39:31,520 Speaker 1: And if you don't want to do that fast, make 579 00:39:31,600 --> 00:39:34,840 Speaker 1: sure that your breakfast is a very low car breakfast 580 00:39:34,880 --> 00:39:37,359 Speaker 1: that has plenty of protein and fat that will give 581 00:39:37,400 --> 00:39:40,040 Speaker 1: you good satiety. You'll find you don't need the morning 582 00:39:40,120 --> 00:39:44,200 Speaker 1: snack anymore and that will control your inchin level and 583 00:39:44,280 --> 00:39:46,960 Speaker 1: your trig list ride to HAITSTL. And the other thing 584 00:39:47,040 --> 00:39:50,840 Speaker 1: is sleep. Sleep breaks havoc on your metabolic health and 585 00:39:50,920 --> 00:39:54,759 Speaker 1: can worsen that ratio. So having all the good sleep 586 00:39:54,760 --> 00:39:58,080 Speaker 1: pagen that I've talked before, and then managing stress. Stress 587 00:39:58,360 --> 00:40:03,120 Speaker 1: elevates cortisol and it cordisol has been known to drive 588 00:40:03,200 --> 00:40:08,040 Speaker 1: insulin resistance and negatively impact that profile. The last thing 589 00:40:08,280 --> 00:40:12,080 Speaker 1: that I would say is triglyrites and HDL. They are 590 00:40:12,239 --> 00:40:16,040 Speaker 1: two components of the metabolic syndrome. And we know that 591 00:40:16,120 --> 00:40:20,920 Speaker 1: if you have metabolic syndrome, your risk for lots of 592 00:40:21,040 --> 00:40:25,720 Speaker 1: different chronic diseases actually goes through the roof. So metabolic 593 00:40:25,760 --> 00:40:29,440 Speaker 1: syndrome is defined. It's a cluster of conditions to do 594 00:40:29,560 --> 00:40:35,880 Speaker 1: with metabolism, and different organizations will identify it differently. Most 595 00:40:35,960 --> 00:40:39,799 Speaker 1: of them say three from five of these things. High 596 00:40:39,840 --> 00:40:45,799 Speaker 1: blood pressure, high triglycerides low HDL right, so that traglystrid 597 00:40:45,840 --> 00:40:49,759 Speaker 1: hates stale ratios in there, central obesity, which is a 598 00:40:49,880 --> 00:40:54,000 Speaker 1: lot of fat around the middle right. And the last 599 00:40:54,080 --> 00:40:58,720 Speaker 1: thing is high fasting blood glucose, and that is often 600 00:40:58,920 --> 00:41:02,160 Speaker 1: the last thing to go is your blood glucose. So 601 00:41:02,200 --> 00:41:04,160 Speaker 1: a lot of people just look at the blood and 602 00:41:04,280 --> 00:41:07,560 Speaker 1: go I'm fine, when actually you're not. You could have 603 00:41:07,760 --> 00:41:12,040 Speaker 1: the metabolic syndrome even if you have normal blood glucose. 604 00:41:12,120 --> 00:41:15,280 Speaker 1: So I would just throw that one out there because 605 00:41:15,480 --> 00:41:20,279 Speaker 1: I think the metabolic syndrome has been massively or has 606 00:41:20,400 --> 00:41:23,959 Speaker 1: not been focused on anywhere near enough when it comes 607 00:41:24,000 --> 00:41:26,800 Speaker 1: to our long term health. So the take home for 608 00:41:26,960 --> 00:41:31,480 Speaker 1: me is to not make decisions on drug therapy based 609 00:41:31,520 --> 00:41:36,399 Speaker 1: on LDL alone. Use that ratio. That ratio is really 610 00:41:36,480 --> 00:41:38,480 Speaker 1: powerful at trigg list right that hits the L ratio. 611 00:41:39,000 --> 00:41:42,040 Speaker 1: If you want to be more comprehensive, you can order 612 00:41:42,120 --> 00:41:44,759 Speaker 1: through a number of different health professionals. You can go 613 00:41:45,200 --> 00:41:50,320 Speaker 1: and get an entire LDL panel looking at your particle size. 614 00:41:50,880 --> 00:41:54,920 Speaker 1: You can also measure your APO B, which is much 615 00:41:55,000 --> 00:41:57,520 Speaker 1: more important than L d L and your APO B 616 00:41:57,640 --> 00:42:01,480 Speaker 1: to APO a ratio. But if you don't want to 617 00:42:01,520 --> 00:42:04,400 Speaker 1: go and spend all that money just making sure that 618 00:42:04,520 --> 00:42:07,120 Speaker 1: you control your tragglyst ride to hates the l ratios, 619 00:42:07,200 --> 00:42:09,480 Speaker 1: drive down those tragg list rides, drive up those hat 620 00:42:09,640 --> 00:42:13,160 Speaker 1: d ls. That really is one of the keys to 621 00:42:13,280 --> 00:42:16,920 Speaker 1: metabolic health. That's it for this week, folks, Catch you 622 00:42:17,040 --> 00:42:17,399 Speaker 1: next time.