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In this episode of The Brain Warrior’s Way Podcast, Dr. Daniel and Tana Amen are once again joined by the “Nutrition Myth Buster” Dr. Jonny Bowden. In this episode, the discussion is on insulin resistance, and why this marker is a major predictor for major potential health problems. Dr. Bowden and the Amens also reveal which tests should be considered in place of the traditional cholesterol test to give you more important information.
For more info on Dr. Jonny Bowden, visit https://jonnybowden.com/
Daniel Amen, MD:
Welcome to the Brain Warrior’s Way podcast. I’m Dr. Daniel Amen.
Tana Amen, BSN RN:
And I’m Tana Amen. In our podcast, we provide you with the tools you need to become a warrior for the health of your brain and body.
The Brain Warrior’s Way podcast is brought to you by Amen Clinics, where we have been transforming lives for 30 years using tools like brain SPECT imaging to personalize treatment to your brain. For more information, visit amenclinics.com.
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Welcome back everyone. We are here with Dr. Jonny Bowden, our friend, and author of the Great Cholesterol Myth, Revised and Expanded. We hope this is really helping you. Johnny, what are the cholesterol numbers people should know?
Jonny Bowden, PhD CNS:
The tests that I think people should get are not the LDL HDL test. If you want to look at blood lipids, which is what that basically is, you need to ask for some version of the particle test, and if your doctor, like Tana did, balks at that, then ask for APO B. APO B, is a magnificent surrogate for the particle test. As we talked about in a previous episode, particles are the boats. Cholesterol is the cargo. We don’t care that much about the cargo. We want to know about the boats. Those are the ones that get damaged. Those are the ones that get stuck in the endothelial wall and cause all the mischief and the inflammation and the oxidation and eventually the beginning of plaque.
But, it’s the boats that get caught in those parking spaces, not the … Cholesterol doesn’t get dumped until the boat gets injured, so we need to be counting those particles. We need to be looking at the size and condition of those [inaudible [00:02:02] , those particles, and those tests are available now. But the thing that we found in redoing this book and really doing a deep dive into research, going back to 1970, is that there is a predictor, not only for heart disease, but for the entire portfolio of cardio-metabolic problems, starting with pre-diabetes and metabolic syndrome, progressing to diabetes, progressing to what we call pre- heart disease, and then onto heart disease and obesity. All of them have one underlying similarity.
That particular thing that we can test for, shows up a decade before your doctor says, “Oh, Mrs. Jones, you got some high cholesterol there. Maybe we should put-” Before they even see your A1C for diabetes, for any of that, this shows up. I don’t know if your audience will know the term. It’s not a sexy term, but I’d be happy to explain it in really simple terms. It’s called insulin resistance. When you see insulin, I’ll give you a perfect example of one of the seminal studies in this. 1970, this guy invents the insulin assay, which is a test for insulin resistance. It’s a very, very rigorous test. The patient has to be in the doctor’s office for a number of hours.
They have two different tubes. One’s measuring blood. One’s keeping blood sugar constant. The other’s measuring insulin. It’s not a test that everybody would have, but he developed this perfect, wonderful test. He put 4.000 or 5,000 patients he had gone through that, and he put them into groups in terms of insulin resistance. Insulin resistance is just a short, technical term for you. You don’t metabolize carbohydrates in an ideal way, so your blood sugar goes up too high, and then insulin comes along and tries to bring it down. After a while, if you keep overdoing it with carbohydrates, the system stops working. The cells stop listening to insulin, and you’re on your way to pre-diabetes.
That’s basically what it is. You can measure this. He would put these people in categories of how well their insulin system work. They eat carbohydrates, in comes insulin. We move the sugar from the bloodstream. Those are incident- sensitive people. He put them in five groups. The people who were really insulin sensitive, their carbohydrate metabolism right on, they eat, it goes down, perfect. Second, the third, the fourth and the fifth worst, with the fifth, worst being the most insulin resistant, the system didn’t work. Then he watched them for 10 years to see who died.
When he combined things like heart disease, heart attacks, death, strokes, all that, all that stuff, it turns out that they were all in the high groups, four and five. You know how many people in the insulin-sensitive group died over the next 10 years? Zero. This was the first clue. The wait a minute, we’re able to see this stuff. These deaths from heart disease is showing up 10 years earlier. It starts with insulin resistance, even before the other step starts moving. In the ’80s, probably your audience may even be familiar with Gerald Reaven from Stanford University, invented, “Syndrome X,” which then became metabolic syndrome. Did the same thing. He measured insulin resistance. He put it on the map. He came up with this syndrome of five things, where you have abdominal obesity and you have high triglycerides and bad HDL.
It’s called metabolic, say high blood pressure, it’s metabolic syndrome. He kept finding that this insulin- resistance, tracked with all these cardio-metabolic diseases. At the end of his career, he said, “I wonder if they track with anything else? It’s not the best predictor we have for diabetes and 80% of diabetics die of heart disease. So, I mean, there’s definitely,” but he wondered, could it be related? [inaudible [00:05:51] He does the same study that Kelly did in 1970, and he literally tracks it. Guess what? It predicts cancer. It predicts fatty liver disease. It predicts some lung … It is a magnificent predictor of bad things to come. As you know, and as your audience probably knows, they’re even calling Alzheimer’s type-three diabetes because it all has this same root. We think, that if you catch insulin resistance early and you can treat it, reverse it, or prevent it with diet, you can wipe out about 40% of the heart attacks.
Thank God you said that because I thought, “Okay, you just freaked out most of our audience,” including me. I have a tendency to be naturally, genetically, insulin-resistant. My grandmother had diabetes. She died of heart disease. She went legally blind. I mean, all of that stuff. I, by nature, am insulin-resistant and which is why I went on my odyssey to [crosstalk [00:06:44]
Many people are. Some people are just really good at metabolizing carbs, and some people, you give them a brussel sprouts and the blood sugar-
Exactly. I can do greens, but I can’t do a lot of fruit. But, and so that’s what I wanted to point out to people. When I was at my leanest, I was actually doing a vegan diet, and so I don’t think one diet works for everybody.
Okay. I agree.
I was doing a vegan diet, which is a lot of carbohydrates, but for the most part. It’s, plant-based, mostly carbohydrate, and I would fill it in, because I’m an athlete, with rice and stuff like that. Never had worse numbers. Now, when I go to a keto-type diets or modified, but more keto-
My could not be better. This is why I think it’s not perfect for everyone, and if you keep those numbers in the right zone, you’re not, just because you have it genetically, doesn’t mean you have to you’re loading that gun. Doesn’t mean you need to pull that trigger. [crosstalk [00:07:36]
I have a question because I’m still … My brain gets stuck on things. If you’re going to have one test, you said the APO B test. [crosstalk [00:07:46] Assuming APO B cholesterol is, with LDL, you have A particles and B particles. A, the big fluffy particles, not toxic B, the demon one.
The demon one. That’s right.
That’s trouble. If you have high APO B, so the test is APO B cholesterol, correct?
If the test is APO B, which is a protein that attaches itself to lipoproteins. APO A, attaches itself to HDLs and APP B attaches itself to all LDLs, including the fluffy ones and the others. But there’s one APO B protein per particle. If your doctor won’t do the particle tests and does the APO B test, it’s basically the same thing. There’s maybe, 1% difference between the APO B number and the total particle number. There is a slight little difference, but it’s so close to being 100% accurate that, that’s a test your doctor should never say no to. It costs four bucks, and it’s in the recommendations. It’s no longer this esoteric thing that they never heard of. They’re just being lazy. [crosstalk [00:08:53]
It’s high it’s trouble.
It’s more likely to be trouble. Is that it’ll also associated with insulin resistance?
Well, I think that there are … I think one is the number that has to do with your particles. The other is a number that gives you a sense of the direction your metabolism is headed. I think there are overlap, like inflammation. I mean, these are all signs that things aren’t going well. None of them by themselves is necessarily definitive. I imagined, I mean, I have a very high particle number. I am one of those people for whom the classic cholesterol test misses a treatment opportunity. I think many times the classic cholesterol test people get put on statins and they don’t need to be. There are people who might benefit from them, and it’s also obscured by LDL and LDL because HDL doesn’t tell you particles. I have a high number of particles, and I’m working very hard to bring it down, but I would never have known that.
I would’ve thought, “Oh, everything’s fine,” if had I just stuck with the old-fashioned test.
How do you bring it down?
Good question. I’m working with a couple of cardiologists and some functional medicine doctors, and we’re trying things. One of which, is to up my fat and lower my carbs, even more. The first thing, Dr. Douglas Triffon, who’s the Head Lipidologist at the Scripps Clinic, and who gave a presentation that was so packed, the last time I went down there with all these cardiologists sitting there, taking notes. I said, “This guy,” and he’s a nutritionist to boot. I want to go to him. I went to him. First thing he said, “I hope you’re eating a high-fat diet.” I said, yeah, but I still have high particles.” He says, “Maybe we need to go higher in fat and lower in carbs.” That’s one possibility, People we know from the weight-loss field, that there are some people who can’t eat any carbs, and some can manage pretty well with like 100 grams a day.
I actually keep my cards under, well, I had them under 25, but then I was having certain symptoms. Now, I’m more like 50. I had to modify it, between 50, yeah. 50 to 60. But, I don’t count fiber in that. I don’t know. Anyways-
No. Fiber doesn’t count. [crosstalk [00:11:02]
Fiber doesn’t count. One thing that I want for our listeners is, I want to, because I know I’m going to get questions. People write into me all the time. What about things like the red yeast rice, and Niacin? [crosstalk [00:11:20]
Well, I am actually trying rice yeast. You asked how to bring it down. That was one of the … I’d always been, “That’s just a natural version of a statin. Why do I want to take that?” But, Dr. Triffon, for example said, “That’s a thing.” There were a couple of other things as well, that he wanted to try it in a cocktail of nutritional supplements. I haven’t been retested since I started that, but that is certainly something that could help. I think there’s a lot less side- effects than there are with statin drugs.
I hate the flush and I’m not so sure-
The non-flush, I heard, actually could be not as good for your liver though. Is that true?
Yes. It’s not as good, and it’s also not as effective at lowering cholesterol.
All right. When we come back, we’re, we need to talk more about cholesterol and how to optimize it, so it serves your health rather than steals your health. Stay with us. What did you learn? Write it down. Post it on any of your social media sites, hashtag, brainwarriorswaypodcast. Also, go to brainwarriorswaypodcast.com and leave us a comment, question or review and we’ll enter you into a [inaudible [00:12:32] to get one of our books. Stay with us.
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Dr. Daniel Amen:
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