Jay Feldman 0:12
Welcome to Episode 29 of the energy balance podcast, where we teach you how to live without constant hunger and fatigue, brain fog, poor sleep and all sorts of other low energy symptoms by maximizing your cellular energy. I'm Jay Feldman. I'm a health coach and independent health researcher, and joining me again today is my good friend Mike. Fave Mike and I have been studying health and nutrition together for a long time now, and Mike also draws on his experiences from working within the healthcare industry. Today's episode will be part one of a two part series talking all about cholesterol. So today, in part one, we'll be focusing on the mainstream view that high cholesterol causes heart disease, and where this view has gone wrong and why it's not quite that simple. We'll also be talking about why we may want to reconsider the use of statins, the cholesterol lowering drugs in the vast majority of cases. We'll be talking about why we don't need to be avoiding high cholesterol foods, even if we have high blood levels of cholesterol. And we'll discuss what actually leads to increases in blood cholesterol levels because it's not eating high cholesterol foods. And then we'll also discuss why the cholesterol lowering drugs are often more harmful than helpful. And there's a ton of research to dig into when it comes to the cholesterol hypothesis and heart disease and statins and and throughout this series, we will not be able to dig into every single one of these studies, but I will be sure to link to a bunch of the ones that we didn't get to in the show notes. You can find those show notes at Jay Feldman wellness.com where I'll also link to other studies or articles or anything else that we discussed throughout today's episode. And throughout today's episode, we will be talking a little bit about how to lower cholesterol levels, and the relationship between cholesterol and our metabolism and stress and gut function. So if you are interested in resolving any of those issues or lowering your cholesterol levels or reducing any other low energy symptoms, whether that is weight gain or constant hunger and fatigue, hormonal imbalances, poor sleep and other gut symptoms or issues. Then head over to Jay Feldman wellness.com/energy, where you can sign up for a free energy balance mini course, where I'll walk you through the main things that you want to focus on to optimize your metabolism. I'll go through some of the main principles as far as nutrition and lifestyle are concerned. To do that, which will then allow you to resolve all of these low energy symptoms. So to sign up for that free energy balance mini course, head over to Jay Feldman wellness.com/energy, and with that, let's get started. So cholesterol is basically one of the most misunderstood nutrients, and throughout the mainstream conventional medical view, is the primary culprit behind heart disease. And because of that, because heart disease is such a widespread problem, it affects 12% of the American population, which is over 30 million people, it's the leading cause of death in the United States, which leads to over 650,000 Americans dying every year from heart disease. So it's no surprise that the statin drugs, which lower cholesterol are the most prescribed drugs in the United States. And this, you know, we've talked in the past about some of the flaws of the medical system, and this is, I mean, a pretty good example of it. But basically this, this cholesterol hypothesis, this idea that the more cholesterol we have in the blood, and we'll discuss this in more detail, but the more cholesterol we have in the blood, the more plaque builds up, and the more heart disease we get. That cholesterol hypothesis is treated as fact, and because of that, anything that raises cholesterol, or anything that has cholesterol in it, for example, foods that we eat, or foods that we eat that have saturated fats in it that raise cholesterol, those are basically synonymous with being unhealthy, and cholesterol itself is considered to be the bad guy, and this is so this is so so much treated as fact that doctors have even suggested putting statins in the water supply, because they're just so universally beneficial and cholesterol so universally harmful that everybody would be better off on these sorts of drugs. So and this is pervaded as well into the dietary guidelines, as I mentioned, where we've been told for decades now. I mean, closer to a century, I guess at this point that cholesterol and saturated fat that we're eating contribute to heart disease through this cholesterol hypothesis. So, yeah, and so obviously this is something that is a pretty major influence in our lives and throughout the medical system, and has has quite a few flaws. That will, that will dig into.Mike 5:01 Yeah, it's an interesting topic, because even with, like, numerous studies basically calling into question over the years, within the medical model, it's still I recognized, or still believed to be the cause of heart disease, and that's cholesterol, and essentially the the all the recommendations are around lowering fat in the diet, lowering cholesterol in the diet, and then taking statin drugs to lower cholesterol. And then they keep adjusting ranges for cholesterol in the blood down despite what the research says, and things like that. And and then what previous diets were, prior to all the the rapid rises in heart disease and things like that, and then, and then, essentially increasing components in the diet now, like polyunsaturated fats to lower cholesterol, and still having heart disease like prevalence or an incidence increase, even though, at least in this current century, supposedly the heart disease deaths have, or mortality has been going down a bit. Um, and there's could be other reasons for that. Um, so essentially, the basic view to dig into it in more detail, instead of just having Go ahead..Jay Feldman 6:12 Yeah, I mean, I was just gonna say also just how ubiquitous this is. I mean, the the heart healthy sticker is still all over every whole grain product that's out there, and the bottles of canola oil and vegetable oil, they all get that health, heart healthy sign. And this, I mean, yeah, it's, it's pervaded into this idea that the polyunsaturated fats are beneficial and the saturated fats are harmful. And we have talked in detail about why that's not the case, and we'll talk about it more today, but I'll also link to that episode on the polyunsaturated fats in the show notes for anyone who wants to dive into that a little. Dive into that a little deeper. Mike 6:44 Okay, so the basic, conventional view of cholesterol is that high cholesterol in the blood, or even before we get there, what is cholesterol? So cholesterol is it's a lipid, or it's a fatty substance. It has a specific structure. It's actually the formation, or the backbone of all steroid hormones in the body, and it has numerous functions in the body as the structural component, as a precursor to many different things, many different components, whether it's steroid hormones, whether it's certain component of certain enzymes or functions in the formation of certain proteins within the cell. It's, it's not just some random fat that sticks to your arteries and causes heart disease. It actually has numerous functions throughout the body. And there's a reason it's found in in most animal products, and that's because within animal cellular structure, it is, it is legitimately a structural component that and also an extremely important component of many different functions. So it's not just it's not because cow just have cholesterol in their in their meat, or chickens are depositing cholesterol in their eggs to give you heart disease. It's there for a very specific reason. And our bodies are filled with cholesterol, and they're it's having serving multiple functions that we'll get into more specifically. But the general idea, or the general hypothesis, is that high cholesterol in the blood, particularly LDL, and we'll break get into the differences between LDL and HDL, but particularly LDL, causes the deposition, or the or the accumulation of what's called plaques, which are basically just fatty accumulations along the vessel walls. And these plaques generally tend to to accumulate mostly around the coronary arteries and the and like the high pressure areas of the heart, like the aorta and places like that, and they are, there is cholesterol in there, and there's a bunch of immune components as well. And there's immune cells filled with with phagocytized or basically the immune cells have eaten the cholesterol. So then the other component with that is, so now we have this idea that high cholesterol in the blood is causing heart disease. So from there, the question is, well, how do you get high cholesterol in the blood? And so the idea from mainstream medicine is that if you eat too much cholesterol in the diet, or too much saturated fat in the diet, it gives you high cholesterol. They also talk about sugar and things like that causing high cholesterol. That's not so much in the research. The sugar aspect, that's sort of just like a general societal myth, that it's sugar causing high cholesterol and this, and that.Jay Feldman 9:30 Was one of the original arguments against eating sugar, was that it increases cholesterol, and of course, cholesterol causes heart disease. So.Mike 9:37 Yeah but currently, that's not supported at all. And I don't, I don't see doctors, at least the ones that I've worked with, recommending sugar as being cause of cholesterol. Now, sugar causes diabetes, which is a completely different topic, but, and then the other thing is that the general idea is that LDL is bad, HDL is good.Jay Feldman 9:56 And the reason for that being that. I mean, we'll dig into the detail. Of it, but that the LDL is carrying cholesterol from the liver to the peripheral tissues. So when you're seeing this LDL and or cholesterol deposition and the plaques, it's typically going to be with that LDL protein carrier. So LDL and HDL are carriers of cholesterol.Mike 10:19 But HDL and LDL are proteins because the because the cholesterol is lipid, it's not very soluble in in water, and blood, or plasma, is essentially mostly water. There's some proteins and whatnot in there, such as lipoproteins. And the lipoproteins basically surround the cholesterol. This is your HDL and your LDL, and there's a bunch of other little proteins in there, and they basically allow it to be transported. This is the theory, transported from throughout the bloodstream, essentially to all different areas. And LDL transports from the liver to the tissues, and HDL transports from the tissues back to the liver. That's the the offhand, easy way to remember it, um, and so with all these, with all these general points that we have, high cholesterol causes heart disease, and then high cholesterol is caused by eating too much cholesterol, eating too much saturated fat, or eating too much sugar, and then the idea that LDL is bad, we get these basic generic prescriptions that almost every doctor is going to give you is that you need to eat a low fat, low sugar, low sodium, diet that's high in fiber, because that binds cholesterol. And then if you have high cholesterol, you need to take a statin so that your body stops producing cholesterol. And then the other thing is you need to eat a lot of polyunsaturated fats rather than the saturated fats, because polyunsaturated fats lower cholesterol production. So that's the general that's the general conventional model, which apparently or obviously isn't really working so hot. A lot of studies will tend to look at a Western diet, and a lot of people will post quote these studies that look at a Western diet versus the Mediterranean diet. And then, when you look at the Western diet, it's essentially a bunch of refined grains and refined vegetable oils, or Millard and lard, at this point is very high in polyunsaturated fatty acid because of what they feed the animals. And so the Western diet obviously does terrible. And then the Mediterranean diet, which is yet it is better than the so called Western diet, actually does, performs better. And obviously so, why would it not? I mean, you're eating a bunch of granulated sugar and heavily processed grain products, like muffins with all different types of components in there, and then vegetable oils, refined vegetable oils, you're obviously going to do better eating a diet that at least has some nutrients in it and a lack of toxic compounds. So that's the general idea. That's the general convention, conventional model that we can work that's been going on forever and hasn't really made much of a difference in anything. Yeah, um, you still people who are taking their blood pressure medications and their statins, still get heart disease, still get heart attacks, still get strokes. The mortality on some on between these and people who aren't isn't much better. And then there's a lot of side effects, and we'll get into those from lowering cholesterol, and a lot of negative effects from having the cholesterol, even without a statin, being very low. So it's important to the real question we'll get into is, why is the cholesterol elevated in the first place, especially considering it has all these other beneficial functions, Jay Feldman 13:36 And why is it in the plaque? So? Mike 13:37 And why is the cholesterol in the plaque? Yes, yeah. Jay Feldman 13:40 And so basically, every point that you brought up from that conventional view, the idea that the cholesterol causes the plaque, the idea that, you know, dietary cholesterol raises cholesterol, the idea that LDL is just bad and HDL is good, essentially, there are problems. And just the idea that cholesterol causes heart disease as a whole, there are problems along each of these points and, well, I guess we, you know, let's dig into those a little bit. What those problems are, pull up some of the research, and then also kind of explain this opposite view, which is that rather than cholesterol being the problem, it's a very it's a protective, necessary nutrient that is vital to optimal function and health, and it's much more similar to blaming the symptom for the problem. So a lot of times, with cholesterol and the plaque, the very generalized analogy is, is they'll say it's like blaming firemen for a fire, where, yes, the plaque is the fire, and that's that's a problem, but the cholesterol is more there as a an immune component that's cleaning things up and and it is not the problem itself, and we'll dig into that too. But so let's, I mean, let's start by just digging into this idea that cholesterol causes heart disease. So one of the largest studies that's ever been done on this is the Framingham Heart. Study. And so I'm going to pull up a graph here that is showing it's showing the it's showing people with and without heart disease versus their cholesterol levels. And so if you can see this graph, it's quite clear. It's quite clear that the for the like, for the vast majority of people, there's there's a huge overlap between the cholesterol levels of people who have heart disease and people who don't, and more or less, their cholesterol levels are virtually identical. So this whole idea that cholesterol causes heart disease, obviously, what you would expect to see on this graph is that, you know, on one hand, you have the vast majority of people without heart disease and their cholesterol is all pretty low. It's, you know, between 140 and 200 and on the right side, you would see this, you know, the dotted line here, of people with CO heart disease and their cholesterol would all be, you know, 200 of 400 but in reality, it's not at all. What you're seeing, wait, instead, you're seeing is basically that these graphs are almost identical. The heart disease one is shifted over maybe 10 points. And what it also shows is that what the study has shown, when they've analyzed some of the data, is that at least half of, or around half of the people who have heart attacks don't have high cholesterol at all. And I mean this on its own, directly, flies in the face of this idea that the cholesterol is directly causing heart disease. And as we'll talk about, this doesn't mean that having high cholesterol is necessarily a good thing. It depends a lot on the context, and we'll discuss some of that context, but that's just a really important piece of evidence to consider as far as this idea that cholesterol just directly causes heart disease?Mike 16:43 Yeah. I mean, I think it's a great graph to look at, because one of the things they see is people who are having heart attacks, and there's studies of this, a lot of them don't actually, don't even have high cholesterol, even when they're having the heart attack, right? And then there's people who are having heart attacks. There's a decent amount of people who have heart attacks who don't actually show any sort of signs of plaque accumulation in the heart. Anyway, they don't. So it's the hypothesis. Has a lot of areas in it where it's not, where, like, there's it doesn't, like work out where it doesn't it's not black and white. Factual, like taking as much of the fact is people display the other thing to talk about is that for cholesterol to be a factor causing heart disease, why would it have so many other beneficial functions, like being the precursor to all steroid hormones, this includes testosterone, which is vital for Male function, and dihydrotestosterone, vital for male function. Progesterone, vital for female function and pregnancy. Cortisol and adaptive hormone aldosterone, adaptive hormone estrogen, the major hormones dehydro, epi and ROS drone, which is DHEA and then pregnant alone. So it's a precursor to all those it functions in the in the production of different components of the electron transport chain, like CO, Q, 10. It has some components in the production of heme molecules, or some function in the production of heme molecules. It's elevated in times of infection. As a protection molecule, it binds endotoxin and different bacterial toxins and different viral proteins directly and allows them to be carried out of the body and detoxify. And then so it has a strong immune system component, and then it has a structural component within cells. So to look at and say, oh, so we just have this one random component, cholesterol that's causing heart disease, yet it has all these other protective functions doesn't really make a lot of sense, especially when they there's studies basically showing that lower cholesterol and older age, it predicts higher levels of cancer and higher levels of death from infection and things like that. And then when you look at people using drugs like statins, they actually get tons of dysfunction, particularly in the musculature, which includes the heart, because of the damage the mitochondria. So it's important to look at the whole picture of what cholesterol is for instead of and the thing is, the initial study that everybody is beat into death at this point is the Seven Countries Study from Ansel keys, which shows the countries that ate the most amount of saturated fat and cholesterol had the most amount of heart disease. There's tons and tons of work basically looking at it. I mean, like the coral. First of all, let's put it out there. It's a correlation study. Second of all, the study came out after World War Two, when a lot of Europe's, Europe's and Japan's, and some of the countries they looked at were completely decimated from the war, so what they were traditionally eating couldn't be really accounted for. And so there's tons and tons of where we won't go over all that here, but there's tons and tons of information on that. Um.Jay Feldman 19:49 There's also the 22 countries. Originally they did it for 22 you only included seven, and is the seven that proved the point, right? So it showed a nice correlation between saturated fat and taken. Uh, heart disease.Mike 20:01 yep. And then so the next piece I guess we'll get to. We will get to the HDL, LDL, more specifically, and then the build up of cholesterol and plaque. But if you wanted to cover cholesterol in the diet and saturated fat in the diet, and then the effects on cholesterol in the blood and things like that.Jay Feldman 20:18 Well, there's a couple other things I just want to mention. As far as the cholesterol and heart disease situation goes, because there's still, you know, we've mentioned a few things here, but there's a few other things I think are important to consider or to look at as far as evidence goes. So first is that prior to the statins, there were other cholesterol lowering drugs called the fibrates, and so those were used up until around the 1990s and assuming again that cholesterol that lowering cholesterol would reduce heart disease, you would expect these cholesterol lowering fibrate drugs to reduce heart disease risk. But here's a quick quote from a review that basically said that a review of trials of cholesterol lowering by diet and drugs published between 1966 and 1996 which included info information for more than 21,000 patients. And I'm paraphrasing by the way, it said Overall, these trials indicated no benefit in terms of reduction in risk of coronary deaths. So there are people who are talking about how statins do reduce, you know, reduce coronary deaths in certain instances, and we'll discuss that. But for one, the fibrate drugs did not and those also lower cholesterol, which suggests that there may be mechanisms other than cholesterol lowering, as far as the statins go, that are responsible for their small benefits in heart disease in certain at risk populations who already have heart disease or future heart attacks, in people who already have heart disease. Mike 21:46 if I'm not mistaken, too when they change the rules for releasing of raw data for clinical trials, I'm pretty sure this was for statins, but they basically weren't able to find any real relationship with protection against heart disease. Once they pharmaceutical companies were forced to release the raw data, and then other people ran the raw data to find significance.Jay Feldman 22:09 Yeah, yeah. There was definitely. There was a period of time where, when they were looking at just the studies published by the pharmaceutical companies, they were showing very different results from the independent studies. And there still seems to be some very small evidence that, or there still seems to be some evidence that in people who already have heart disease, statin drugs may lower the risk of future heart attacks. Which you can, you could, I think it's fair to argue that, and this is also in in men who are under the age of 70 or 80, depending on the research. So in this very particular population, statins may be helpful in preventing heart attacks at a major cost as well. Which, which we've discussed a little bit, these side effects of muscle damage and increased diabetes risk, which are at much higher rates than the rates that they're protecting people. You know there's as far as muscle damage risk goes, the rates are as much as one in 10 have some measurable amount of muscle damage, and one in 50 have an increased risk of developing diabetes, which is again, both of those are higher than preventing fatal heart attacks. So.Mike 23:18 Percent damaged or whoever would suffer those constant, constant consequences or side effects will be larger than the amount of people who would be protected against the heart attack. But the question is, is, even if they're protected against the future heart attack, are they protected overall for mortality going forward, right?Jay Feldman 23:37 And that's a right, and that's a separate question as well, where, even if they do potentially protect against heart attacks, they do increase the risk for or research has suggested that they increase risk for things like cancer and as I mentioned, diabetes as well, and neurodegenerative issues, infection, dementia is another, another major one, which is part of the issue as well, where, when they look at older populations, oftentimes lower cholesterol is much more dangerous and increases the risk of mortality overall, increases the risk of death from from heart disease and heart attacks. So yeah, and, you know, increase the risk of dementia, all of those things. So and as you were talking about, it's because of how important cholesterol is as as one of the main nutrients. And another thing to consider as well is that the statin drugs don't just reduce cholesterol production. They reduce there's kind of this whole process of cholesterol production, and they reduce, or block that process pretty high up in the chain. So it also ends up blocking co Q 10 production and Vitamin K, yeah, exactly. And vitamin k2 the MK four form, which those are? This is part of the reason for the muscle damage, is that these are so important for mitochondrial function. And, I mean, it could, could also argue that this is part of the reason for the neurodegenerative issues, although that that's cholesterol too. So I'll explain that in a second. But, yeah, I mean. You we can call them side effects, but they're not side effects. They're direct effects of these drugs that are contributing to these problems. And another thing that we didn't touch on as much is that is, as far as the reason for why this affects brain health so much is that 25% of of our total cholesterol in our bodies is in our brains, and that's because of how important cholesterol is for as a structural component there, and for brain steroid production, which are which is just such a huge part of brain health. So without this.Speaker 1 25:32 You need cholesterol to form the myelin sheath of nerves.Jay Feldman 25:36 Exactly.Mike 25:37 Which is a huge component of your brain, because your brain is all more mostly neurons. So without cholesterol, you you literally are losing structural components of your nervous system. So to then go and lower it, especially in populations that are already in higher risks for a lot of these things, the elderly population, particularly for dementia and diabetes and and muscular disorders and things like that, and infection.Jay Feldman 26:03 And, yeah, and these are things that aren't considered. I mean, these statin drugs are handed out like candy to anybody who has even a moderately increased cholesterol level. And also, which we will get to as well, yeah, which, yeah. I mean, there's way better ways to lower cholesterol if it's even a concern. But as we're talking about, and as I mentioned, too low cholesterol, especially in the elderly population, or as age increases, is a huge risk factor for all sorts of problems.Speaker 1 26:28 Yeah, the other what, what would be, what you should probably pull up at this point is for the idea of what low cholesterol is. So if you want to pull up that graph that shows the range of lowest mortality per amount of cholesterol, or milligrams of total cholesterol in the blood.Jay Feldman 26:46 Yeah. So this study is looking at total cholesterol levels versus mortality from and it's data from 164 countries. And so it's a little bit messy, but I'll link to it in the show notes, so you can take a look for yourself. But this blue line is the line for all cause mortality, and this dotted red line down here is for cardiovascular disease mortality. So you can see that the lowest the levels, the lowest all cause mortality, is for people with cholesterol levels between 202 and 240.Mike 27:17 And the statin cut offs, if I'm not mistaken, are to be below 200.Jay Feldman 27:21 For most,most of the time. Yeah, that's that's when they're starting to prescribe statins. Is once you hit that 200 level, and it depends on the doctor, but, I mean, that's considered borderline high cholesterol. But even at that point, they start often prescribing statins which is, which is just at the low end of the lowest all cause mortality. So what this graph is basically showing is that to have the best chance of living the longest and not dying. You want your cholesterol between 202 40. And there are some other factors here, and age is one of them as well. Where, as you age, having that higher cholesterol has been trying to be protective, and when you're younger, it depends on a lot of factors. Speaker 1 27:56 So the whole question becomes, why is the cholesterol elevated? That's the that's the most important question to ask here, because the cholesterol being elevated is indicating a problem going on. And it's not necessarily that the cholesterol is high. The cholesterol being high is a symptom or a marker of that problem, so just treating the marker makes absolutely zero sense. It's like every and you can use the fireman analogy. Every time there's a fire, there's a lot of firemen around, and it's annoying because the fire trucks and all the firemen clog up the road. So next time there's a fire, we need, or we should just get rid of the firemen, like we need to lower the amount of firemen so that the road isn't clogged. And that's sort of the it's looking purely at a marker. It's looking purely at an indicator. So if you're using firemen as the indicator for a fire, and then you're saying, oh, there's too much fireman is clogging up the road, then okay, we need to lower the firemen. Jay Feldman 28:52 It's even worse than that. It's saying that firemen are always there when there's fire, so they must be causing the fire. So we just need to take out the firemen so there's less fire, there's fewer fires. That's that's really what the comparison is.Speaker 1 29:02 So it's just, it's not like, it's a very simple like you can there's all these pathways and whatnot that they like to get into and try to try and justify the piece, but the underlying logical progression or ideology behind it is very simplistic and not really reality. The question again is, why is the cholesterol elevated? And there's a few things that can cause the elevation of cholesterol, and one of the most important ones, or I guess two of the most important ones, would be infection, and then the second one would be lower thyroid function. And lower thyroid function can be from numerous different things. And so basically what happens is, as we were talking about before, you have LDL and HDL. LDL is from the liver to the tissues, and HDL is from the tissues back to the liver. And thyroid function basically increases the amount of cholesterol that the tissues are able to take up, and then, in turn, turn that cholesterol into steroid hormones or or whatever components that it needs to cholesterol. Four, and that's via process of thyroid hormone inducing respiratory metabolism, which is required for the conversion of cholesterol into steroid hormones. You need to have the you need to have that respiratory metabolism going the enzymes, I think it's p4 50 enzymes which convert cholesterol into the steroid hormones, are present within the mitochondria and dependent upon NAD plus and NADH ratio and energy production and things like that, and prevalence of ATP and things like that. So it's really important..Jay Feldman 30:33 Just to translate that real quick, what you're basically saying is that with high thyroid function, our cells end up using more cholesterol and converting them to other components that are helpful and protective, namely the steroid hormones. And with low thyroid function, that process is happening less so you have a buildup of cholesterol, and that leads to elevated total cholesterol, elevated LDL as well. Speaker 1 30:57 Yep, and the way they talk about in the studies is I'm pretty sure there's the LDL receptor, and thyroid up regulates LDL receptor and and basically allows the cholesterol to be moved from the liver in or from the LDL carrier protein into the tissues. The next piece we have is infection. And in with infection, certain components will specifically through our mediated through cytokines, which are cellular signaling molecules, but specific components like bacterial proteins or bacterial lipopolysaturides, which is a combination of a lipid and carbohydrate, stimulates cells, specifically immune cells, to produce certain cytokines or signaling molecules, such as tumor necrosis factor alpha and interleukin six that caused the production of cholesterol in the liver. I think it's from hmga, HMG, CoA. Is that the enzyme, yeah, but just Yeah, that's the enzyme that's blocked by that's blocked by stats, exactly. So the endotoxin basically induces this enzyme to produce more cholesterol, and the cholesterol binds, and this is also either viral proteins and other bacterial components that stimulate the immune system. There's like a sort of a general response with some of these inflammatory situations and immune responses. So it stimulates you, the liver, to produce a bunch of cholesterol. The cholesterol binds these different bacterial components and basically inactivates them. It binds them and then inactivates and bring to the liver, and they get detoxified out and it lowers it's actually extremely protective. It lowers the immune response, the inflammatory cascade that occurs because it prevents certain cells, like macrophages, from getting an excess of endotoxin and stimulating a further negative response. And so in situations like sepsis, where you have a bacterial infection in the bloodstream, the elevated cholesterol and and it also elevates triglycerides and bile acids and things like that. It's actually extremely protected, and it's shown that in different rat studies, removing bile acids from the intestine, which allows for absorptions of fats and triglycerides and things like that, or blocking cholesterol production, actually increases mortality. So the cholesterol is extremely, extremely protected from the immune standpoint. So just getting rid of it, and this, I think this is partly the mechanism for why you see increased diabetes with a blocking of cholesterol production. Because within diabetes, you generally, you generally tend to see an elevated endotoxin level in the bloodstream. And so the cholesterol and the diabetes, you also see the hyperlipidemia. So it's like a chronic low grade influx of endotoxin from the gut. So when you block this, this endotoxin from coming into the when you block the endotoxin for being bound, bound to cholesterol, by lowering cholesterol, you allow more endotoxin to reach the cells, and the endotoxins effect on the cells is to basically directly lower energy metabolism by stimulating nitric oxide production. If I have that, if that's, yeah, yeah, too, not too in depth or...Jay Feldman 34:10 Well, so the, I mean, I want to tag on a little bit as far as the diabetes risk, which I think also the CO Q 10 and Vitamin k2 Yeah. Inhibition is a big part of that, as well as the production of the steroid hormones that are major, major thing that drives energy production and allows us to adapt to stresses, things like that. So to Yeah, I mean what you're basically saying as far as the relationship with cholesterol and infections and lipopolysaccharide or endotoxin is that cholesterol is this major part of our immune system. And when we have infection, or we have some sort of problem with our gut, like an infection in our gut, a dysbiosis, or we have pathogenic bacteria in there, they produce metabolic toxins that. We absorb and that then are what causes all the symptoms that we experience, and is also associated with all sorts of diseases like heart disease and diabetes and on and on. And these toxins directly block our ability to produce energy. They they lead to basically huge amounts of destruction, and so cholesterol is one of the main things that helps to protect us from those metabolic toxins that are produced from infections, and I think those like that.Speaker 1 35:29 Yeah, and then so blocking that cholesterol production basically destroys your ability to protect yourself against these toxins. And in diabetes, you see an influx of these toxins in the bloodstream, chronically, yeah, that you see it in diabetes, you see it in obesity, you see it in heart disease, you see it in kidney disease, yeah. And so it's just which system, and each each system seems to be some sort of process in trying to mitigate the damage from the endotoxin and either into obesity, it's depositing. There's other factors involved, but endotoxin seems to be a prime promoter in a lot of these you see, you see endotoxin basically in obesity being deposited with fatty acids and causing immune inflammation and in the fat tissue and being deposited there and causing damage in the liver and causing like insulin resistance and things like that. And then diabetes, you see direct insulin resistance from the cells and from the liver. And then kidney disease, you see it starting to break down the kidneys. And then heart disease, you start to see break down the vasculature and things like that. And they all tend to converge on each other eventually. It's just why you tend to see people who are very obese have higher rates of diabetes, and then heart disease, and then kidney disease and things like that. So it's general pathways that go together, and endotoxins very important than those. And so is cholesterol, and so are other factors like polyunsaturated fats, which is very interesting, considering we're told to increase polyunsaturated fats at the expense of saturated fats in these in these circumstances, and I guess that will lead into talking about the deposition, or the specific effects of plaque buildup on the on the blood, in the bloodstream with heart disease, and the importance of cholesterol in that. If you want to go into all that.Jay Feldman 37:14 I first just want to summarize where we're at so far. So basically, rather than the cholesterol that's inside our bodies, rather than that causing heart disease, directly causing plaque buildup, being this, this generally harmful and damaging thing that we want as little of as possible. Cholesterol is instead a vital nutrient that's necessary for all sorts all various aspects of our health, including brain health and our immune function, which is why it's so important for preventing things like dementia, and why it prevents it protects us from all sorts of, you know, infections and other healing and in general, and reducing inflammation. And the secondary component that we're kind of getting at here is that cholesterol is used as a response to damage and inflammation and stress to as a protective mechanism. And so in general, the the rise in cholesterol that we're seeing is like that we might see would result from these, from these other problems, and in a defensive way, it's not in a way like it. So instead of just reducing that cholesterol by using a drug that reduces our ability to produce cholesterol, we would want to sort out what's causing the increase in cholesterol in the first place and focus negate that, yeah, which is kind of what we're about to get to.Speaker 1 38:40 So the cholesterol is just an indicator of these underlying problems. And so the goal isn't to treat the cholesterol directly, it's to treat the underlying problem and then watch the cholesterol lower itself once the underlying problem is addressed. And in a lot of these cases, the underlying problem could be elevated endotoxin production from the gut, some low grade type of infection, things like that.Jay Feldman 39:05 Low, metabolism, low thyroid function, yeah, exactly. Or excess, And this goes hand in hand with lower metabolism and things like that. But excess cortisol production, because cortisol or glucocorticoids or stress hormones, essentially the signal, signalers of stress, basically cause elevated cholesterol in the blood as well. They increase blood cholesterol, they increase blood lipids, like triglycerides, and they also increase blood sugar, and they also increase blood pressure. So there's, and these are very, very general main pathways, you see, and so, so far we have lower thyroid function or lower metabolism, elevated stress, and then infection as some of the three largest causes of the elevated cholesterol, heart disease and things like that. And then specifically towards heart disease. And you can if you want to cut me off here, and yeah.I just wanted to edit. Another thing too. Just to summarize this so far, as far as the drugs go for lowering cholesterol, is that we have these older drugs, the fibrate drugs, that we know they lower cholesterol and they did not improve heart disease risk or anything. Then we have these statin drugs that have been shown to reduce heart disease risk in a very particular high risk population that already has heart disease where they reduce the risk of further like compound, yeah, but they come at a huge cost elsewhere and the other and there's also this suggest, the suggestion that, or evidence that they have other anti inflammatory effects. So a lot of people are saying, as far as those set drugs, is that those anti inflammatory effects are more likely to be responsible for some of their benefits, and then the actual inhibition of cholesterol production is likely more of legendary, yeah, yeah, more secondary, and is where a lot of those side effects are coming from. Mike 40:53 The other thing with statins, if I'm not mistaken, is they have a degree of antibiotic effect. And this is the same thing that happens with some of the blood sugar medications, like Metformin, they have an antibiotic effect in the gut, and so those can be also directly lowering endotoxins. So rather than their proposed primary drug mechanism, they can have other primary mechanisms that are having the effect, not through the pathways that are supposedly elucidated. And this happens a lot with different drugs, they supposedly for this pathway, but it does. It's not only what the indicated pathway or mechanism of action. It can't be that has a lot of molecules in nature. Just in general, have broad effects across multiple systems and just affecting one pathway, like HMC, HMG, uh, CoA, which is the Amazon COA reductase, yeah, that produces cholesterol just by inhibiting that, you affect multiple other pathways downstream, because they're dependent upon product from that pathway. So to just say, oh, it just lowers cholesterol through this pathway, and that's it. No, that's impossible. You can't just do it that way. Just think about it that way is ridiculous. Honestly, which is absolutely ridiculous, yeah, like, if we dam up the river here, well, nothing's going to happen downstream or above stream. It's like, okay.Jay Feldman 42:11 Right, right. And, and along with that, too is we haven't talked as much about dietary cholesterol and what we should be doing dietary and we'll get there. But I think it's also important to mention that regardless of how much cholesterol you eat, our bodies produce its own cholesterol, between 1002 1000 milligrams on average, which a day, right per day, and which is just, you know, a suggestion of how vital this is, how important it is. I mean, that's much more than anybody's going to be getting from food on average. I mean, yeah.Mike 42:44 Just unless you're eating a keto diet or and you're eating a lot of butter and eggs and bacon and organ meats, then you can, you can elevate your you can elevate your intake of cholesterol from food. But the general person, the general individual who's following the american heart association diet guidelines and whatever their doctor tells them and they have elevated cholesterol, they're going to be hard pressed to be taking in an excessive amount of cholesterol from their diet. The most of that is production by liver. And then there's also studies showing the liver will adjust production based on what dietary intake is. So if you're eating a lot, the liver may down regulate production.Jay Feldman 43:20 And this, I mean, even for somebody eating a Western diet, you know, burgers and pizza and ice cream or whatever, they're still not getting anywhere near the amount of cholesterol that's normally produced. And as you said, however much they eat, that there's kind of a compensation mechanism that prevents that amount of production. But it's just, again, in an entirely healthy person, they're always producing this amount of cholesterol. The pure amount of cholesterol has very little to do with any disease risk or anything like that. What we're looking at when we're talking about because, and I think this is important, important to point out, because it just leads to all this confusion. But as far as the cholesterol that's being carried throughout the blood and where it's being carried, what types of proteins like the LDL versus HDL and the lipoprotein a and all of that, those can be, as we said, helpful markers of inflammation and heart disease and infection and things like that. But just to make it clear, it's not the cholesterol itself that is the problem here at most. It is just a again, the fire. I mean, I think a good correlation is the fireman, because it is actually very protective and helpful, but it just, yeah. I think it's an important clarification to make that, even if you want to make the argument that high LDL is a very minor risk factor, which I don't even think is even worth considering all that much, because.. Mike 44:38 Its a risk factor indicating that you have other problems going on? Exactly? Yeah, LTL is the problem, right?Jay Feldman 44:46 All right. I hope you enjoyed that episode. In part two, we'll be continuing the discussion on cholesterol, and we'll be focusing on what causes the buildup of plaque in our arteries and why cholesterol is not the culprit there. We'll be talking about. About various foods and dietary components and how they relate to cholesterol and our heart health, including why eating a lot of the Omega threes and other polyunsaturated fats found in vegetable oils, focusing on whole grains and low fat diets are not the way to go as far as improving our heart health. We'll also discuss the healthy ways to lower cholesterol levels and the importance of our gut health and our thyroid health when it comes to lowering cholesterol. If you did enjoy today's episode, please leave a review, a like, a comment, a five star rating on iTunes. It really does a lot to help support the podcast. To check out the show notes for today's episode, which will include links to various studies that we discussed throughout today's episode, as well as other articles and studies that we referenced. You can check those out at Jay Feldman wellness.com/podcast and throughout today's episode, we did talk about the relationship between our metabolism and stress and gut health and cholesterol levels. So if you are looking to improve any of those areas of your health or improve various other low energy symptoms, whether those are symptoms related to heart health or maybe other symptoms like weight gain or fatigue or hunger and cravings or hormonal imbalances. Or if you're just looking to have more energy, head over to Jay Feldman wellness.com/energy, where you can sign up for a free energy balance mini course, where I'll walk you through the main things that you'll want to focus on to optimize your cellular energy balance, and also explain why this is the key to resolving all of these low energy symptoms, including high cholesterol levels. And so I'll walk you through some of the main things you want to focus on as nutrition and lifestyle are concerned, to maximize your cellular energy. So to sign up for that free energy balance mini course, head over to Jay Feldman wellness.com/energy, and I will see you in the next episode.