190. What a cardiologist thinks of my cholesterol, with Michael Twyman, MD
Nov 21, 2022
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Board certified cardiologist, Michael Twyman, comments on Paul's blood lipids and discusses apoB, cardiovascular risks, oxidized LDL, and seed oils. They explore true indicators of cardiovascular risk, insulin resistance, the importance of nitric oxide, glyphosate problems, the Lp-PLA2 test, and mitochondrial health.
Insulin resistance is closely linked to cardiovascular disease, indicating the importance of considering metabolic health when assessing risk.
Traditional lipid panels are limited in predicting cardiovascular risk, while markers like HDL cholesterol and triglycerides provide better insights into insulin resistance.
Maintaining a healthy endothelium is crucial for cardiovascular health, with nitric oxide playing a key role in preventing plaque buildup and optimizing function.
Dietary factors, including the consumption of seed oils high in omega-6 fatty acids, can impact cardiovascular health, while choosing organic and grass-fed options and consuming nitrate-rich foods promote better outcomes.
Deep dives
Insulin resistance and cardiovascular disease
The podcast episode highlights the correlation between insulin resistance and cardiovascular disease. The speaker argues that there is a significant amount of cardiovascular disease that is clinically meaningful and it is usually linked to insulin resistance. Although insulin resistance may go undiagnosed, it is closely tied to the development of cardiovascular risk. The conversation emphasizes the importance of considering insulin sensitivity and metabolic health when assessing cardiovascular risk, suggesting that these factors could be more impactful than LDL cholesterol levels.
Understanding Lipid Panels
The podcast discusses the limitations of traditional lipid panels in predicting cardiovascular risk. The speaker explains that key markers to assess include HDL cholesterol and triglycerides, as these provide insights into insulin resistance. They mention that total cholesterol and LDL cholesterol are interesting but do not accurately predict risk. The importance of considering additional factors such as apolipoprotein B (apo B) and LDL particle count is highlighted, as these factors provide a better understanding of risk. The speaker mentions the value of knowing more about a person's lipid profile beyond traditional markers to determine a more accurate assessment of cardiovascular health.
The Role of Endothelial Health
The episode underscores the significance of endothelial function in cardiovascular health. The speaker reveals that endothelial dysfunction is often the first sign of atherosclerosis and stresses the importance of maintaining a healthy endothelium. They explain the role of nitric oxide in endothelial health and how it helps relax blood vessels and prevent plaque buildup. The discussion highlights the impact of various factors, such as insulin resistance, inflammation, air pollution, and even viruses on endothelial health. The speaker emphasizes the need to optimize endothelial function to reduce the risk of cardiovascular disease.
Considering Dietary Factors
The episode explores the connection between dietary factors and cardiovascular health. The speaker mentions the impact of consuming seed oils, which are high in omega-6 fatty acids, and their potential to increase inflammation and oxidize LDL cholesterol. The importance of maintaining a balanced omega-6 to omega-3 fatty acid ratio is emphasized. Additionally, the role of nitrate-rich foods like leafy green vegetables and raw honey in promoting nitric oxide production and improving endothelial function is discussed. The conversation suggests that protecting oneself from pesticides and choosing organic and grass-fed options may contribute to better cardiovascular health.
The Importance of Avoiding Seed Oils
Seed oils, such as canola oil, contain high levels of trans fat, which is concerning for health. It is recommended to avoid seed oils and opt for healthier alternatives.
Understanding Atherosclerosis and Plaque Formation
Atherosclerosis, the buildup of plaque in arteries, is influenced by factors like LDL particles, endothelial dysfunction, and oxidation. High levels of linoleic acid, commonly found in seed oils, can contribute to plaque development. Tests like CT coronary angiogram and calcium score can help evaluate plaque and cardiovascular risk.
Focus on Mitochondrial Health
Mitochondria are the powerhouses of cells and play a crucial role in energy production. Optimizing mitochondrial health can be achieved through strategies like prioritizing sleep, managing circadian rhythm, and reducing inflammation. Checking biomarkers like CoQ10 levels can provide insights into mitochondrial health.
This week, Paul interviews board certified cardiologist, Michael Twyman. Michael comments on Paul’s blood lipids and they both chat about apoB, cardiovascular risks, oxidized LDL, and, of course, seed oils. They both share what they believe the true indicators of cardiovascular risk really are, aside from LDL.
A note from Paul: Throughout my training and practice as a physician I have come to one very disappointing conclusion: Western medicine isn’t helping people lead better lives. Now that I’ve realized this, I’ve become obsessed with understanding what makes us healthy or ill. I want to live the best life I can and I want to be able to share this knowledge with others so that they can do the same. This podcast is the result of my relentless search to understand the roots of chronic disease. If you want to know how to live the most radical life possible I hope you’ll join me on this journey.
