Ep. 319 Cholesterol Revolution: Empowering Insights on Cholesterol and Fat with Jonny Bowden
- December 16, 2023
- No Responses
I am thrilled to finally have the privilege of connecting with Dr. Jonny Bowden today! He is a board-certified nutritionist and the author of many books, including The Great Cholesterol Myth, my favorite one, co-authored with cardiologist Dr. Stephen Sinatra.
In our conversation, Dr. Bowen and I dive into the anti-propaganda and flawed foundations that permeate the health and wellness space. We discuss the role of politics, economics, medicine, and commerce in shaping our health narratives and shed light on the misinformation, deception, and cognitive dissonance surrounding cholesterol. We explain how cholesterol works mechanistically in the body, explore why so much cognitive dissonance prevails within that space, and scrutinize the inadequacies of conventional lipid tests and the shift in focus to fat instead of sugar and insulin resistance, also looking into the metabolic plague of the 21st century, from insulin resistance to healthy and unhealthy metabolisms, to various types of fats. Additionally, we explain how statins work and share some side effects, and Dr. Bowden discloses the supplements he deems vital for a healthy life.
“The metabolic plague of the 21st century is something called insulin resistance, and it underlies every major chronic disease you can think of.”
– Jonny Bowden
IN THIS EPISODE YOU WILL LEARN:
- Debunking some of the myths surrounding cholesterol
- How statins get overprescribed
- The lesser-disclosed side effects of statins
- How our understanding of cholesterol has been corrupted
- The history behind low-fat diets
- The truth about cholesterol
- How the fear of fat has negatively impacted people’s health
- The cognitive dissonance caused by the belief that fat and cholesterol cause heart disease
- The importance of advanced lipid panels for heart health assessments
- How insulin resistance underlies every chronic disease, including high cholesterol
- Dr. Bowden discusses his recommended supplement
Bio:
Dr. Jonny Bowden is a board-certified nutritionist, and the best-selling author of 15 books including “The 150 Healthiest Foods On Earth”, “Living Low Carb”, “Smart Fat”, and the controversial best-seller (with cardiologist Dr. Steven Sinatra), “the Great Cholesterol Myth”. He is a frequent guest on podcasts, has contributed to articles in over 50 major publications, and has appeared on every major television network His favorite subject to talk about is healthy aging.
Connect with Cynthia Thurlow
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- Submit your questions to support@cynthiathurlow.com
Connect with Dr. Jonny Bowden
Book Mentioned
The Great Cholesterol Myth by Jonny Bowden and Stephen T. Sinatra
Transcript:
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I’m your host Nurse Practitioner, Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent, is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today, I had the honor of finally connecting with Dr. Jonny Bowden. He’s a board-certified nutritionist and best-selling author of numerous books including my favorite, The Great Cholesterol Myth, that he wrote in conjunction with cardiologist Dr. Stephen Sinatra. We spoke at great length about the antipropaganda and faulty premises that proliferate in the health and wellness space, the role of politics, economics, medicine and commerce, why we’ve been misled, misinformed, and in some cases lied to about cholesterol, the role of cholesterol in terms of how it works mechanistically in the body, why there’s so much cognitive dissonance in the space, why conventional lipid tests oftentimes are very unhelpful, the role of shifting the focus to fat as opposed to sugar and insulin resistance, the metabolic plague of the 21st century, insulin resistance defining healthy and unhealthy metabolisms, different types of fats and helpful information about how statins work and some of the common side effects, as well as supplements that he feels are vital in our lives. Don’t worry, I’ll have Dr. Bowden back soon to unpack a lot of other great information. I know you will enjoy this conversation as much as I did recording it.
[00:01:54] Welcome, Jonny. I am so glad we were able to make this happen. I know it has taken us about a year to coordinate our calendars. I’m so excited to connect with you and share all of your knowledge and information with my Everyday Wellness Community.
Dr. Jonny Bowden: [00:02:07] Thank you. I am absolutely beyond thrilled to be here, and it took over a year [Cynthia laughs] of back and forth with your amazing assistant, Jamie. But thank you for hanging in and making it happen and working with my schedule.
Cynthia Thurlow: [00:02:19] Absolutely, absolutely. So, I would love today if we do a cholesterol-centric podcast because I think it’s not only important to dispel myths around cholesterol, but also to talk about the conventional way that allopathic medicine is viewing cholesterol treatment. And let me be really clear for listeners, for 16 years I prescribed hundreds of thousands of statins because that was the traditional evidence-based medicine way of addressing cardiovascular disease. There’s a lot that I learned while prepping for this podcast, things I did not even know that I think are really going to be very helpful and very insightful for listeners to be able to advocate for themselves and help find the right practitioner for themselves.
Dr. Jonny Bowden: [00:03:05] And I thank you and when we wrote– Steve Sinatra the cardiologist, he died a couple of years ago, wonderful cardiologist. When we first wrote the book, and even when we wrote the revised edition of the book, we were frequently called anti-statin. And there was this group in Australia that tried to get a video taken down because people would die if they followed this crazy advice. We were never really anti-statin. We were antipropaganda. We were anti over prescription and brand extension of a drug that had a moderate success in a certain tiny niche population, which was middle-aged men with previous heart disease. The expansion of the brand, which is something every corporation does with every product you buy. But when they do it in medicine, it’s like, “Come on, guys, you’re giving it to 13-year-olds.” It was just based on such a misunderstanding of cholesterol and what it does and how it works and the harm it does and the good it does that we came across as being anti-statin.
[00:04:08] What we were was anti over prescription of statins. I can’t prescribe. Steve, of course, can. He did prescribe statins once in a great while. It’s not like they had no use whatsoever. It’s not like they were this evil drug. I get letters from people who are like, “Oh, those statins, and it’s a conspiracy and all that.” I’m not quite there. I think it’s terribly overprescribed medication with a long laundry list of side effects that nobody talks about and that they continue to try to just silence. And yet the studies are very strong on that, so we can talk about all of that as well. I just want to make clear that “I am not, statins are the devil.”
Cynthia Thurlow: [00:04:47] [laughs] Right, right. I think that that’s important. And we’re also not, in this conversation, suggesting that if you’re currently taking cholesterol-lowering medication that that’s inappropriate. This is really to fuel education, inspiration, and empowerment for those that are in that camp.
Dr. Jonny Bowden: [00:05:05] Always, always.
Cynthia Thurlow: [00:05:05] And let me be very clear, if you’re on a statin, you have cardiovascular disease, and you’re a male, in no way are we recommending anyone to stop anything that they’re doing but where we’re just providing information and really encouraging people to do their homework. So, let’s talk about cholesterol. Like, what exactly is it? Why is it so important, and how did it get so bastardized? How did we go from eating things like butter and saturated fat and meats to all of a sudden being fearful of fat and recognizing how much of a detrimental impact that has had on our health?
Dr. Jonny Bowden: [00:05:38] Right there is basically an hour and a half.
[laughter]
Cynthia Thurlow: [00:05:42] Hence, you understand why I’m like we could have many conversations.
Dr. Jonny Bowden: [00:05:45] Well, it’s a very interesting story because it really illustrates the intersection of politics, economics, commerce, medicine. It’s almost impossible to talk about it without mentioning all those. And there have been so many books. I thought ours was pretty good in going through that history, but Gary Taubes, Nina Teicholz, which I’m sure you’ve had her on there. I mean, you can’t do better than that. That book is the perfect history of what happened, and we all are basically telling the same story, but I would like to start, if I may, with my personal conversion from a low-fat vegetarian, raw, raw, don’t touch the fat to where I am now. Because I think if you can understand my skepticism growing, the audience will– that makes sense. Maybe I could take them on that journey. So, I started life as a personal trainer.
[00:06:34] It was a career change. I changed in 1990. I became a personal trainer. I started my career with Equinox. I spent seven years there. I was the dean of the Equinox Fitness Training Institute and I believed in low fat. I believed in low fat, I believed in calories, all that mattered. I believed that if you just worked on the StairMaster enough, you were going to get that fat off and nothing else mattered. That’s all we knew as trainers then. And everything we learned, we learned because the American Dietetic Association taught it to us as trainers which I’ve gone on record as saying is the most destructive organization for the health of America that has ever, ever been formed, possibly with the exception of the American Medical Association, but don’t get me started. So, we learned the orthodoxy.
[00:07:17] And I was truly one of those people who would go into a restaurant, order an egg white omelet, the stupidest idea in nutritional history, order the egg white omelet, and if it came with even this much yolk on it, I’d send it back because I absolutely knew that I would get a heart attack if that stuff entered my system. So, I was that. The way I came to question some of this stuff was we had clients who were not doing well on low-fat diets. There were many of them. As I told you, I started around 1990 with Equinox, 1991, when they first opened their doors. And the Atkins Diet, version number three, the third edition, first came out in 72. There was another one, then there is 92 was the big one, had just come out and was getting a lot of publicity, and everybody was talking about it, “Oh, we’re losing all this weight on this thing called ketosis.” And it was like just a new thing. And people were excited about it. And many of our clients who were frustrated with what was going on with them and their endless hours on the StairMaster and the same old low-fat foods that they had were coming to us and saying, “Think I’m going to try that Atkins Diet. My neighbor had great luck with it. The guy I played golf with had great luck with it.” And we, the training community, and all of us at Equinox, mea culpa, would say, “You cannot do that, dude.” I mean, it’s absolutely insane. You might lose a few pounds, but you’re going to have a heart attack. You’re going to die. You cannot do this.
[00:08:45] They didn’t listen and I’m thinking of one in particular who really turned the switch on for me. Guys would come back or these women would come back and not only did they lose weight, I’m thinking in one in particular, but their whole countenance changed. You can look at someone and know if they’re working out. You can look at someone and intuitively know what the health is. I’m not talking medical intuitives. I’m talking just good intuition developed by years and years of clinical practice. And you go, “Yeah, that person’s– something off with that one. Coming back and their eyes and their waistline has shrunk.” And the most impressive thing of all is they’re going to the doctor and their blood lipids have changed.
[00:09:29] I’m thinking there’s a concept in psychology called cognitive dissonance. It means you cannot hold two ideas that are contradictory in the same space. Something can’t be both a circle and a square. It’s one or the other. And the two ideas that weren’t going to exist in the same space for me is either fat and cholesterol cause heart disease and people die when they eat this stuff or it doesn’t. They can’t both be true. Either what were taught is BS or this guy’s faking his good health [laughs] and his loss of waist and all the rest of it, which caused me to do some thinking. And at the time I wasn’t trained in nutrition. I didn’t have a graduate degree or anything. I just had a lot of certifications as a personal trainer. I started reading research and I started, “Oh, wait, men on ketogenic diets have improved blood–”
[00:10:20] Wait, this doesn’t– any of this make sense? And I started to think it through and realized that if, in fact it didn’t make sense, if, in fact, all of our dietary recommendations were based on a false premise what happens to the dietary recommendations to stop eating butter and cheese and all the foods that you listed that we ate for all of the time that we’re on the planet up to 1950. What happens to the dietary recommendations? They crumble like a set of dominoes because they’re based on something that doesn’t look to me like it’s true. So, as you can imagine, taking this position in that zeitgeist was questioning vaccines three years ago or questioning vaccine policy. It was heresy. And everyone who loved when I spoke at conferences and when I taught low fat and I taught training, they loved me.
[00:11:12] All of a sudden, this guy’s not even a doctor. What is he doing questioning this stuff? He doesn’t even have a degree. You immediately get attacked. And that’s what got me to go back to school and get a doctorate in nutrition. At which point I said, “Guys, you are full of it. And now I have the letters behind my name to be able to say that. And I’ll show you why.” So that was the beginning of my journey, questioning medical authority if you will. And ever since, that has been my mission to look at how we eat and how that affects our long-range prospects for a healthy and long life. And as I was telling you before, I mean, I feel like I speak to this with two qualifications if you will. One is I’ve studied this stuff all my life. I have a master’s in psychology, a PhD in nutrition, I’m board certified, and I’ve written 15 books. That’s that part. But the more important to me is that I’m going to be 77 this month, November 29. And I feel great, and I live an amazing life, and I’m madly in love. I got married a month ago. I play tennis two hours a day. So, I talk to the audiences like a fellow traveler. And believe me, I don’t eat low fat. So that’s my history with the concept and my skepticism. How it became the party line on health is an interesting story and probably it’s been told five million times in this age when we have people very, very forceful men who have an opinion and get it across no matter what and they won’t take note.
[00:12:46] We all know examples of this. They’re very famous. Well, there was such a man in government at that time, in the 1950s. His name was Ancel Keys. He was a physiologist. His PhD had been in eels. Those are the eels you’re thinking you get in the sushi restaurant and it’s swimming. So that was his background. No nutrition, no medicine. And he had an idea. And his idea was, “You know what? People are getting heart disease because of what they’re eating.” And let me also set this up. It was in the 50s that we had a president named Dwight Eisenhower who got a heart attack in office, and it scared the pants off of everybody because we didn’t even know– heart disease wasn’t a thing. There wasn’t a profession called cardiology till the first 50 years of the 1900s.
[00:13:31] Doctors would have to come over on the Queen Mary to watch heart operations because they didn’t even know what cardiology was. So, all of a sudden, this terrific general, he was probably the last person that everybody liked, democrats, [Cynthia laughs] a nice guy and smart, he gets a heart attack. Now, of course, we didn’t know anything then. He was also a chain smoker and God knows what else. And all of a sudden, heart disease is on everyone’s mind. And here’s Ancel thesis goes, “I know what it is. They’re eating too much fat.” You know how I know? I went to the Mediterranean and they don’t eat any fat, and they don’t have heart disease. So, it’s got to be that.” So, I won’t bore you [laughs] with how he got this cockamamie theory approved. He did some research very well cited study called the Seven Countries Study.
[00:14:14] And lo and behold, he found seven countries where the more fat you ate, the more heart disease there was. But as most people know from this story, there was data from many more countries than seven. And when you plotted all the countries, it just looked like a shotgun had hit a target and it was all over the place. No line. But you could make a line if you picked just those seven countries. So that became the basis of our thinking and our government policy. In 1986, it was so contentious. They had what they called a consensus committee. And they locked themselves in a room. They came out and they said, “Yep, you shouldn’t eat fat. You shouldn’t eat cholesterol.”
[00:14:48] But that consensus committee, now that we’re looking at it, we’re looking at all the papers of what really happened to it looked like the US Congress today. They hated each other. Nobody agreed on anything. It was shouting. There were people calling each other’s names. They say, “How can you think this?” And somehow Ancel Keys got his position across, and all of a sudden the government started recommending no more than 30% of your calories. In fact, they made that number up. I don’t know where it came from, but they thought that was the number. No more than 10% of saturated fat. Remember the lobbying that’s going on here? The meat industry is going crazy. Meanwhile, the people who are making all the wheat-based products, they love this. Bring this on. They’re not supposed to eat meat anymore, oh we got-.
[00:15:29] And of course, there was a huge opportunity, and then the explosion of junk food and labeling of foods and grain products and huge amounts of sugar because we had to avoid the fat. Nobody knew then about the sugar and so we just put sugar in the food. People thought, it tastes fine, low fat. I’m healthy. This is great. And this is basically Cynthia, the zeitgeist in which we lived. And I’ve been fighting that ever since.
Cynthia Thurlow: [00:15:57] Yeah, it’s interesting because I’m old enough to have remembered when I got out of college, it was still in the fat phobic years and SnackWell’s were huge.
Dr. Jonny Bowden: [00:16:07] Oh, my God, that was-.
Cynthia Thurlow: [00:16:08] SnackWell’s are the most horrifically, not only is it unpalatable–
Dr. Jonny Bowden: [00:16:15] [crosstalk] but those are. Do people remember those?
Cynthia Thurlow: [00:16:17] I think people that are of a certain age, definitely myself. I graduated college in 1993, and I remember my roommate and I were like, “This is great. We’re going to buy all the cookies and all the crackers and they tasted like crap because there’s no fat in them, and they just loaded them up with sugar.” And so, the impetus of this fat phobia time period really deflected attention off of sugar being the– insulin resistance and diabetes being the main drivers of cardiovascular disease, the main drivers of these lipid issues, and made the emphasis on fat. And so even to this day, I was amazed. I indicated to you on Twitter and on Instagram and on Facebook, I was asking people, this is who I’m interviewing this week. What are your questions? Overwhelming amount of questions from people.
[00:17:04] So many, in fact, I could bring you back two or three more times just to answer. AMAs. [laughs]
Dr. Jonny Bowden: [00:17:08] I hope you will, I hope you will. Lets go– [crosstalk]
Cynthia Thurlow: [00:17:10] I definitely will, I definitely will. So, before we talk more about our methodology, how we’re addressing cholesterol issues, what is cholesterol? Because I think that’s an important distinction so that listeners understand we’ve put a lot of emphasis on cholesterol issues, when, in fact, it’s not the cholesterol that’s the problem.
Dr. Jonny Bowden: [00:17:32] It’s not the cholesterol as we know it that’s the problem, a 100% right. And anyone who’s getting a prescription or a diagnosis based on the old-fashioned HDL, LDL test is practicing 1963 medicine. It’s like using a flip phone in the days of the galaxy, [Cynthia laughs] whatever they’re up to now, or the iPhone 15, it’s just antiquated test. And it continues to persist for many economic reasons. If money were no issue and economics were not part of this, they would have retired that test a decade or two ago.
Cynthia Thurlow: [00:18:05] There’s a quote in the book when I started reading it that I just want to share with listeners. You have been misled, misinformed, and in some cases lied to about cholesterol. And so, this lipid panel, as most people know it it’s total cholesterol, it’s HDL, it’s LDL, it’s triglycerides. Now, I would argue that for individuals that are insulin resistant or individuals that are consuming way too much carbohydrates, you will see changes in triglycerides and HDL. And those are things that can be valuable information, it’s like throwing paint on a wall. It’s like, okay, I’d look at that. But there’s more to it than that. So, structurally, what does cholesterol do for our bodies? Why do we not want to have too low cholesterol levels? And I’ll give some clinical perspectives as a nurse practitioner, but for the benefit of those that are listening, that are like, “Okay, bad cholesterol is high. Low cholesterol is low. What’s going on?”
Dr. Jonny Bowden: [00:19:00] Let’s start there.
Cynthia Thurlow: [00:19:01] Yeah.
Dr. Jonny Bowden: [00:19:01] There is no such thing as bad and good cholesterol. If you look at cholesterol under a microscope, it is exactly the same, whether it’s in an HDL or an LDL. So, the example I use for audiences is, I’m about to get on a train. If I get on a train to Philadelphia or if I change my mind and I go on a train to California, guess what? I’m the same passenger. The train is different. Now, in this case, the train is called the lipoprotein. So high density lipoproteins are high density, that means they sink to the bottom of water. Low density, they’re light. They go to the top. But they are lipoproteins, both of them. That’s what the L you don’t see a C in there for cholesterol. You see high density lipoprotein.
[00:19:46] Look, the lipoproteins are the carriers, they are the trains. I always say they are the boats, cholesterol is the cargo. So, if for example, you are trying to prevent boating accidents, say you’re running a marina, what’s the first thing, what’s the most important thing you, as the director of the marina, trying to prevent boating accidents, what do you want to know? Well, I know what I’d want to know. How many boats are in the water at any given time? What’s the traffic of the boats? Because the more boats you got, more likelihood somebody’s going to bang up against somebody else. Do you want to know how many Coca Colas are in the fridge of the boat? Do you want to know what’s in the glove compartment of the boat? Cholesterol is the cargo. [Cynthia laughs]
[00:20:31] Now, when the boat crashes, it spills all over the place and everybody sees the cholesterol and they go home. That’s what caused it. But that’s like blaming the firemen for the fire. They show up at the fire, but they don’t like the match. So, cholesterol does cause harm in the body under certain conditions, most of which involve a crash. Otherwise, it’s just peacefully sitting in the boat, going from one place to the next, it’s not doing anything. But when it gets inflamed, when it gets oxidized, when it becomes a problematic molecule, it has a tendency to get stuck in what’s called the endothelial wall, that is, the lining of the arteries, gets stuck in a parking place it doesn’t belong in and starts a series of reactions that wind up being plaque.
[00:21:21] But if you didn’t have injured cholesterol in the first place, in the first edition of the book, we talked inflammation and oxidation. If you didn’t have those two things, if you could lower that, you’re not going to damage the cholesterol and you’re never going to see it. I’m exaggerating a little. It’s not scientifically, exactly accurate, but you get the idea. So, my belief is strongly that we should be looking at lipoproteins, not at the cargo in the lipoproteins. How do we do this? With a wonderful, absolutely available test, the advanced cholesterol test, which tells you how many lipoproteins, what size they are. Why do we care what size they are? Let me give you a very, very short excursion into why size matters when it comes to lipoproteins. [Cynthia laughs]
[00:22:07] So, you have a tennis net and everybody knows what a tennis net looks, it’s a woven fabric with little holes. And if you throw a tennis ball at it, a tennis ball is a big, fat fluffy thing with not a lot of volume or think volleyball. You’re not going to damage the ball. It’s just not going to go through anything. It’s a big, fluffy cotton bally thing. Now, if you take a golf ball and you put it on fire and you throw that, it’s a problem. So, I always use tennis balls and golf balls as examples. You want your LDL to be big, fat, and fluffy. It’s not that they’re good for you, they’re neutral. Cardiovascularly neutral. That’s Robert Lustig’s term for it. The large particles are neutral. The small ones are not. The small ones are a problem. But an HDL, LDL test doesn’t tell you anything about that. It just tells you how much cholesterol.
Cynthia Thurlow: [00:22:59] So, I think that in many ways, for many individuals that have been looking at traditional lipid panels, looking at total cholesterol, LDL, HDL, triglycerides, they may never have heard of an NMR. They may never have heard of this advanced lipid analysis in terms of the context of helping people understand that most people are– the traditional lipid panel that’s what most people think of. I still have I will not name names, but there are physicians, nurse practitioners, PAs that will reach out to me, and they’ll say, “This is all that we’re running.” And I’m like, “These advanced lipid panels are very helpful for determining whether or not someone is at greater risk, or if you need to do more diagnostic testing, or if you need to consider medication. But to go off of a plain lipid panel– [crosstalk]
Dr. Jonny Bowden: [00:23:50] Ridiculous. And by the way, I’m going to give you a personal story, and maybe at a later time we can go into it more in depth.
Cynthia Thurlow: [00:23:55] But I am a perfect example of this. For years, for decades, I had an absolutely sterling cholesterol panel. Any doctor that looked at it would, “God, you must be doing things wonderfully. LDL is under 100, not LDL. Total cholesterol is like 160, 150. I mean, they think that’s great. When I discovered that there were other ways and better ways to test that actually gave you much more valuable information, of course, I began getting those tests. And by the way, you mentioned NMR. There are many of them now. You just tell anybody, an advanced cardiac profile or cardiac IQ. They have different names. I think has the LabCorp has LP-IR, they throw insulin resistance.
[00:24:39] So, there’s a million different– you can ask for the particle test, the NMR test. I began getting those tests and it showed Cynthia a very different risk picture. I was like, “This ain’t good.” My particle numbers are very high. They’re in the red zone. None of this is seen if you look at HDL and LDL, none of it. It is really important to get better information. To this day, I answer questions on a wonderful platform called AnyQuestion, where people can submit questions and do a video answer. I get a million of them from people who, “My total cholesterol was 206 and my doctor wants to put me on a statin.” So, I want to quote Peter Attia for your audience if they don’t know who Peter Attia is.
Cynthia Thurlow: [00:25:22] They love Peter Attia.
Dr. Jonny Bowden: [00:25:23] Okay, so Peter Attia is like, I promote his books. I don’t even promote mine [Cynthia laughs] when I go and buy. The best book ever written on antiaging or on aging and age management medicine, best one ever. I’ve read them all, I wrote one, I know about this. There’s no better book. It’s called Outlive. This is what Peter Attia says about total cholesterol. I’m going to quote it. “Your total cholesterol has about as much to do with your risk for heart attack as your hair color.”
Cynthia Thurlow: [00:25:53] Yeah, yeah.
Dr. Jonny Bowden: [00:25:53] And there are doctors, 206. he’s going on a statin. They’re not looking at LDL, they’re looking at total.
Cynthia Thurlow: [00:25:59] Yeah.
Dr. Jonny Bowden: [00:25:58] Folks, I cannot tell you how crazy that is.
Cynthia Thurlow: [00:26:02] Well, and it’s interesting because there were many women in my Facebook group that that was what they said. My total cholesterol is 225, it’s 198. And I tried to explain them. I said, if your cholesterol isn’t high enough, you can’t make sex hormones. You can’t make–
Dr. Jonny Bowden: [00:26:18] Oh, yeah. You would ask, what does it do? [crosstalk] to get some attention.
Cynthia Thurlow: [00:26:19] Yeah. So those things I think are very important. And my story that I was going to share was, obviously, I worked in cardiology for 16 years. I wrote a lot of prescriptions for statins, appropriately, given my patient population. However, occasionally I would have patients, I would look at their lipids, and I would say your total cholesterol is around 110. This isn’t good. I would back off on their statin and then I would get reprimanded. And I would say, if you look at the research on low total cholesterol, it increases your morbidity and mortality. And it’s because cholesterol plays a lot of very important roles in the body. And maybe that’s the next thing to address in our conversation. What does cholesterol do? I mentioned sex hormones, vitamin D, bile acids, things that are very important.
Dr. Jonny Bowden: [00:27:06] If it did just that, we could stop, “Sex hormones, close the book.” [Cynthia laughs] Vitamin D, I don’t know what the percentage is. That is less than optimal. We have this cut off point the government gives us. They’re so good at nutrition and health of 30 mm/L. I can’t tell you how ridiculous that is. So having these cut off points that are arbitrary and wrong don’t help us in any way in terms of determining whether we’re healthy or not. So, vitamin D got on that because cholesterol is the parent molecule for vitamin D. Is it a surprise that and what percent. Again, you can’t say they’re deficient because the government says, “Oh, if you’ve got 30,” that’s like government saying if you make 20,000 a year, you’re not at the poverty level. Are you kidding me? That’s poverty level nutrition.
[00:27:59] So you want your vitamin D to between 50 and 80, is a really comfortable place. Mine’s 74. I’m thrilled with that. You don’t want a 30. And anyway, the point is most people aren’t even close to that 50 to 80. And I would argue that a part of that is that we are obsessively trying to lower the very parent molecule that makes vitamin D. Maybe that’s a factor.
Cynthia Thurlow: [00:28:22] Yeah. It’s interesting that in my patient population, for all those years, many patients on statins, how many of my male patients were also on Viagra because they had erectile dysfunction and not understanding that the very medication we were using to drive their cholesterol down was contributing along with insulin resistance, was contributing to this problem. And maybe that’s a good segue into talking about insulin resistance, which is–
Dr. Jonny Bowden: [00:28:48] I am so glad you brought that up.
Cynthia Thurlow: [00:28:49] Yes, there was a recent Twitter—It came out on Twitter. I was looking at it, but our diabetes care is over several billion dollars a year or day. I mean, it is unbelievable. So clearly our traditional way of addressing metabolic health is heading us in the wrong direction. So, let’s talk about how insulin resistance and poor metabolic health actually contributes to exactly the thing that we’ve been fearful of with high cholesterol. That’s not the issue. It’s this insulin resistance piece that is really driving poor metabolic health.
Dr. Jonny Bowden: [00:29:22] I’m so happy to hear you say that. So, if I have any mission at this stage in my life, it is to bring that knowledge to as many people as possible. I feel like Paul Revere just screaming the British are coming. And I’m not sure if anybody’s listening, but let’s be clear and we can go back and discuss the granular what insulin resistance is, how it develops and all that. But let me give you the summary first if I may. So, when Steve and I redid the book in 2020, we had already known that the HDL and LDL test was silly and that we were looking in the wrong place. And cholesterol, as we understood it, didn’t cause heart disease by itself. And there were all these other things, but we weren’t really sure what people should be looking for.
[00:30:04] So, now we had some time to really go back and we go back to the 70s and we look at the research and I can tell you that both of us concluded and it is my conclusion to this day, that the metabolic plague of the 21st century is something called insulin resistance. And it underlies every major chronic disease you can think of. Now where this really became clear to me, it was already clear to me when we wrote the book, but when the pandemic started, we would hear about comorbidities a lot. So, what were the comorbidities? Well, let’s see. And what is a comorbidity? It meant that these were the people who were most likely to have really bad outcomes if they caught COVID. I mean, I’ve had COVID so many times I can’t even count. But, I mean, there were people who had it. I’m not diminishing. I don’t think it was a conspiracy, but people died from it. And people were like, didn’t even notice I had it. In fact, most people didn’t know they had it. What was the difference? And there’s clearly a lot of factors and they’ll be sorting them out for the next 20. And anyone who pretends to know all of it now is either lying or self-diluting.
[00:31:05] But what was very clear is that certain conditions wildly increased the risk of a bad outcome. Bad outcome meaning you had to go to the hospital, you were on a ventilator, and you were more likely to die, that good definition. And those comorbidities, hypertension, prediabetes, diabetes, heart disease, obesity, Alzheimer’s, what they all have in common, every one of them had insulin resistance as a foundational causal factor.
[00:31:37] Now, I was confused because there were taking apart mental health issues like schizophrenia and socioeconomic issues, which were also factors when they do the statistics. Those were not good things to have if you were trying to, but taking those apart and just looking at physical, there was still lung disease, kidney disease, and liver disease. And I didn’t think they had anything to do with insulin. So, I thought, look, 5/8 in bed, if it’s a causal factor for most of them, we should probably be looking at it. But I spent a morning at the National Institute of Health Medical Library– The National Institute of Medicine Library online. Anybody in the world can look at it, pubmed.gov, look up any study you want. So, I go and start looking up insulin resistance and liver disease. Oh, I didn’t know that.
[00:32:24] Huge statistical correlation. I mean, fatty liver disease is a metabolic issue that one third of us have that we don’t know that we have, and that is completely in line with the same thing we’re talking about, kidney disease, lung disease, just go look for yourself. Insulin resistance, insulin resistance, insulin resistance. So, we are talking about a metabolic plague that affects 88% of Americans. Please look it up. Never take anything I say as guru talk. Just go investigate and you will see that figure, 88%. It’s in the literature. You can read the Science Daily report on it. I even talked to someone recently who’s even more up on this and she told me it’s up to 93%, but let’s go with 88%. That’s scary enough. Okay, even if it’s not 93%, have some degree of insulin resistance. And if you’re still not– insulin resistance is prediabetes.
[00:33:17] They are identical. Okay, so if we’re talking prediabetes and you’re not sure an insulin, same thing. In fact, there’s now a name. The World Health Organization now recognizes cardiometabolic syndrome as a thing and that is insulin resistance, prediabetes, the same thing we’re talking about. And what we found in our reading of the research was that insulin resistance shows up 10 years before your doctor says, “Your cholesterol is elevated, Mrs. Jones. We should put you on a statin.” Or 10 years before they say, “No you can’t and A1c is climbing up a little. I think we need some metformin. Ten years earlier, you could see insulin resistance.
Cynthia Thurlow: [00:33:52] Yeah, it’s interesting. When I was a student, so I trained in Baltimore and there were always postdocs from other countries that would come to where we were because Baltimore had two major research hospitals. And this lovely Australian doctor said, “I don’t know what it is about you Americans, but you do a really lousy job managing diabetes.”
Dr. Jonny Bowden: [00:34:15] Oh.
Cynthia Thurlow: [00:34:16] And I looked at him and I said– and this is like the early 2000s. And I said, “Why would you say that?” Because I was still very indoctrinated into, we’re doing everything right. And he said,-
Dr. Jonny Bowden: [00:34:24] Oh my God.
Cynthia Thurlow: [00:34:24] -you all wait for your patients to get diabetes. Why aren’t you intervening earlier? And I remember at the time,–
Dr. Jonny Bowden: [00:34:29] Ask your average doctor if he or she tests for fasting insulin.
Cynthia Thurlow: [00:34:34] I talk about that all the time how important it is– [crosstalk]
Dr. Jonny Bowden: [00:34:35] They’ll either say what’s that or why should we do-
Cynthia Thurlow: [00:34:38] I don’t know how to interpret it. That’s what I sometimes will hear because I will tell clients, here’s a list of labs I recommend you ask your GYN, your PCP, your internist to do. And more often than not people will say, “Why do I have to do a fasting insulin?” And I’ll explain that is like years before your fasting glucose dysregulates. And no, a fasting glucose of 103 is not healthy or normal. Helping them understand this is the canary in the coal mine.
Dr. Jonny Bowden: [00:35:04] Oh my God, you’re so right Cynthia. Yes, yes. And what she’s said folks, I mean, you’re right.
Cynthia Thurlow: [00:35:10] Yeah. And what’s interesting is for anyone that’s listening I have no skin in the game when I say this. Dave Feldman, who’s been a guest on the podcast, who’s really changing the narrative for how clinicians look at lipids and look at lean mass hyper-responders. He’s a brilliant engineer.
Dr. Jonny Bowden: [00:35:28] Brilliant.
Cynthia Thurlow: [00:35:28] He has a–
Dr. Jonny Bowden: [00:35:29] [crosstalk] funny by the way how many of the best thinkers about this have come from outside medicine? Ivor Cummins, Dave Feldman I mean, they’re not doctors, they’re not nutritionists. They just understand how things work-
Cynthia Thurlow: [00:35:42] Yeah, their systems.
Dr. Jonny Bowden: [00:35:42] -and they go wait a minute, this doesn’t make sense. If this goes to this, then they do it like an engineering problem.
Cynthia Thurlow: [00:35:47] Yeah, yeah. No. I’m married to an engineer.
Dr. Jonny Bowden: [00:35:50] What?
Cynthia Thurlow: [00:35:51] [laughs] I’m married to an engineer. So, I know exactly how they think.
Dr. Jonny Bowden: [00:35:52] So you know, I play tennis with engineers. They think they are a different breed in the way they think.
Cynthia Thurlow: [00:35:58] Yes. They definitely.
Dr. Jonny Bowden: [00:35:57] You get a smart one who looks at this stuff. This is what Ivor Cummins said. You’ll love this. He said, “I as an engineer, if I had to go to market with a product that had the research behind it that the cholesterol hypothesis and statins, drugs do. And that was the quality of the research I had on this product. They wouldn’t let me take the product to market,”
Cynthia Thurlow: [00:36:17] No, yeah. Well, so what I was trying to say about– so Dave Feldman has a company called Own Your Labs. They undercut the cost of LabCorp and Quest. I have no skin in the game. I don’t get any affiliates, any of those.
Dr. Jonny Bowden: [00:36:30] That is great to know about.
Cynthia Thurlow: [00:36:31] But I refer people to Own Your Labs all the time because I’m like, “Listen, if your doctor or NP or PA will not draw this for you, it costs like $10. Go get your fasting insulin drawn. It will be so invaluable. It is so worth.” I trend mine throughout the year. I probably test mine four times a year, but it also lets me know, is my thyroid being properly managed? I mean, there’s a lot of good information there and I think that should be the gold standard for every single person to help them determine where they are on this continuum of insulin resistance. Because a lot of people maybe not until middle age, all of a sudden you have men and women that suddenly have changes in sex hormones. We know estrogen is an insulin-sensitizing hormone in women.
[00:37:13] All of a sudden, they’re like, “What’s going wrong? I’m gaining weight. I’m inflamed, my sleep’s gone south,” and they become insulin resistant. And many times, they’ll say me, “Well, my fasting glucose is fine.” Well, what’s your fasting glucose? It’s 97. And I always quote Robert Lustig and I always say, “Robert Lustig taught me that if your fasting glucose is between 90 and 99, it’s not benign. You are at a 30% greater risk.”
Dr. Jonny Bowden: [00:37:35] I think it’s really strong. But okay, he’s another one like Attia. You don’t argue with–
Cynthia Thurlow: No, no, no. but he would say–
Dr. Jonny Bowden: [00:37:42] I think that’s a little severe in terms of, I mean, mine’s in the 90s and I’m usually happy with that, but in an ideal world, guess he’s right.
Cynthia Thurlow: [00:37:49] Yeah, he had said you’re at 30% greater risk, so it doesn’t mean you’re going to but you’re at more risk. And certainly, looking at all the other variables are certainly important, but I think it’s helpful for people to stop focusing on A1cs and to start looking at some of these other metrics. And I know we’ll probably unpack some of these as well.
Dr. Jonny Bowden: [00:38:06] I would like, if I may so we’ve been talking about insulin resistance, and you have correctly and I think I have correctly said how important the fasting insulin test is. And someone listening might say, “Well, what is that going to tell me?” It just tells them that fasting insulin, here’s a little hack for you. So, you know how the body mass index calculator’s work. You put in your height and your weight in a very complicated algorithm that nobody’s going to know how to figure out. It does it for you and it tells you 22, 24, 29 tells you what your body mass index is. We got the same thing for insulin resistance. You need two numbers. You need your fasting glucose, which everybody in the world has if they’ve ever had a blood test, even the most basic blood test.
[00:38:45] It always gives you fasting glucose. Now you got fasting insulin. You go to the calculator online. I think it’s called the body code. There’s a number. Just put insulin resistance calculator into Google. There’ll be a couple of them. I’ve tried them all. I’ve tried them at different websites that do it, and it comes out the same number for me. So, I think they’re all accurate or at least consistent. And with those two numbers, they will give you a number. They will show you the normal range of insulin resistance and you will see exactly where you are on that. You don’t need to even spend the money on a lab test that actually looks for insulin resistance. That alone. And I’ll tell you a second way you can figure it out or at least get a good idea.
[00:39:20] Two numbers on that crappy test we talked about [Cynthia laughs] the triglycerides, the HDL, the LDL. You look at your triglycerides, you look at your HDL, people glaze over because there’s math involved here. But it’s so simple folks. You take the triglycerides, you divide it by the HDL. So, triglycerides are 100, HDL is 50. You got a ratio of 250 x 100. If it’s a little more complicated, maybe it’s 150 and 30, then the ratio is 5. Once in a great while, the ratio is under 1. It’s like, HDL is 90 and your triglycerides are only 80, and you have minus something that’s rare, but it happens. That number is more predictable of heart disease than cholesterol.
[00:40:05] The triglyceride to HDL ratio, you could do it at home with the numbers you already have there, knowing that they do change. If you have the numbers from last year, they may not still be accurate, but that is such an important and it’s also a surrogate for particles. Remember, we talked earlier in the discussion about the big fat particles that are neutral and the little mean particles that are not neutral at all? Well, the triglyceride to HDL ratio gives you a good idea if you’ve got small or big. If it’s a big ratio, you’ve probably got the nasty little small particles. And if it’s a very small ratio or under 1.5 or under 1, even the big fluffy ones, you ain’t getting a heart attack.
Cynthia Thurlow: [00:40:41] I love that you brought that up. And I think that the big message should be you start with the basics when we’re looking at labs. And I love that you’re empowering people to say, “Hey, go pull out your labs, take a look at them. It’ll give you a definitive sense of whether or not this is something you need to be working on.” I definitely want to talk a little bit about what makes insulin a unique hormone before we move on to statins, because I know that’s a hot topic, but insulin in and of itself is not a bad hormone, but it gets a really bad rap.
Dr. Jonny Bowden: [00:41:09] You die if you don’t have insulin. Type 1 diabetics were people who did not make insulin and before they invented or discovered insulin in the 1920s and we were able to make a molecule that mimicked it, every type 1 diabetic diet before the age of 20. You cannot live without insulin. So no, it’s not a bad hormone. Showing up in the wrong place, being elevated too high, doing all of that, very big difference. So, I wonder if it might be helpful for those who don’t know to just explain what insulin resistance is, spend a few minutes on that.
Cynthia Thurlow: [00:41:42] Absolutely.
Dr. Jonny Bowden: [00:41:44] Okay, so this is how I explain it. I hope it’s an explanation that you can endorse. I always say– insulin resistance is a metabolic problem. It’s something isn’t working properly.
[00:41:57] So, if you’re trying to figure out what’s not working properly in a car, the best thing to do is probably look at one that comes right off the assembly line, see how that works, and then see, what is this broken car not doing that a regular car– So, what’s a healthy metabolism look like? Let’s take a five-year-old kid and let’s put him back in the 50s before fast food and before all that stuff. He comes home, whatever, he comes home from first grade, he eats an apple. Blood sugar goes up a little. Because anytime you eat food, folks, and it depends on the food, yes, it depends on the macronutrient, but for most intents and purposes, eating food, blood sugar rises to some extent. So, he eats the apple, blood sugar goes up a little.
[00:42:36] Body says that’s great because this kid’s going to go out now and ride a bicycle and play on the jungle gym and do all the things kids did in the 50s before we micromanaged every play date. [Cynthia laughs] And the body needs that energy, so it’s totally happy that the sugar went up. When the sugar goes up, the pancreas has got a great monitoring system. It’s like the air traffic controller for blood sugar. It goes up, up went the blood sugar. Hey, insulin, get out there and round it up, put it into the muscle cells where it’s needed for energy, and the pancreas shoots a little bit of insulin into the system. Insulin is the Sherpa for sugar. It doesn’t want you to have high blood sugar because that’s very dangerous.
[00:43:14] So it now gathers up that sugar, comes knocking on the cell doors and say, “I got some energy for you.” The cells open it up, say, “Great, because kid’s about to do a bike ride.” That’s how a normal metabolism works. Then eventually the sugar drops a little bit, kid’s hungry, goes home for supper. All is well with the world, normal metabolism. Go forward 35 years. You wake up in the morning on your way to work. You are already stressed, your cortisol is on the ceiling, your hormones are dysregulated. You stop at the coffee emporium for a 9000 calorie, no fat brand muffin and a latte whatever the– and now your blood sugar is on the ceiling. The pancreas is going Code Blue, Code Blue, this guy just eats the equivalent of 12 Ding Dongs. It shoots all this insulin into the system.
[00:43:56] The insulin goes, “Okay, we’re going to gather it up, go to the muscle cells. The muscle cells, “Sorry, dude. We have no need for this. This guy’s going to go to the office. He’s going to sit in front of a computer all day. He’s going to get home. He’s going to play with the clicker. What do we need?” They said, “Take it elsewhere.” And they become resistant to the ability of insulin to bring sugar into the muscle cells. Now, you’re not yet in crisis time because the fat cells, they say, “Don’t worry about them, bring it on in. We’ll still take it. We love it.” Now you start getting a little belly fat. Now you start putting on a little weight because the fat cells are not insulin resistant. Yet eventually, even the fat cell says, “Okay, that’s enough. No mas.”
[00:44:33] Now, what do you got in your bloodstream? High blood sugar because there’s nowhere for it to go, and high insulin because it’s frantically trying to get rid of that blood sugar. That, ladies and gentlemen, is the definition of diabetes.
Cynthia Thurlow: [00:44:44] Yeah, that’s really helpful. And I think for a lot of people, understanding that it can be a slow build but-[crosstalk]
[00:44:50] It is a slow build, that’s the thing, it takes years and it doesn’t get better, folks, if you don’t do something. And this is the thing. This is the punchline. This is the ironic part of this. Insulin resistance is, let’s say 99%, because I don’t like to talk in absolutes, is always an example of something that isn’t. So, for 99% of the time, insulin resistance is treatable, reversible, and preventable with diet, fasting, and lifestyle done. And that is demonstrable. There are studies where they reverse it in three days with lifestyle with the right diet and [crosstalk]
Cynthia Thurlow: [00:45:21] Lifestyle is medicine. This is something that for me, part of my frustration for why I left clinical medicine in 2016. It’s almost seven years ago now, April 1, 2016. And the cardiology group that I worked for I had the most outrageous schedule. I worked 6 hours two days a week. I mean, it got to the point where it was like they just kept giving me whatever I wanted. And I finally said, “I’m no longer challenged. I love my patients, and I love working for you all, but I need to do something different because I could not,” I didn’t have the amount of time I needed to spend with patients to teach them how to eat, to teach them how to sleep, to teach them how to go grocery shopping, all the things that would have likely have gotten them off of medications.
[00:45:59] And now I have the ability to bring experts like you on to actually help educate even more people. And so, I 100% agree with you these metabolic diseases are largely reversible, but it requires changes to our lifestyle. And that’s a key message that we’re both trying to make.
Dr. Jonny Bowden: [00:46:16] And obviously the question, if anybody thinks about it for a while is, well, what raises blood sugar and insulin? What starts us on this path where insulin is constantly going up and it’s elevated more than it should be? And why do we do fasting insulin? Because fasting insulin should be technically zero. Now, that’s not really true. There’s always a residual. But what’s insulin doing in the bloodstream if there’s no food there? Now, when it’s elevated, when you’re fasting, it means it’s ready to fight, it’s expecting it’s already like, got the arms and the troops already to fight the invading sugar molecules. So, what foods we would maybe think or what lifestyle choices raise this stuff in a way that we don’t want it to be raised. So, let’s look at the three food groups. Well, there are four that provide calories.
[00:47:02] Alcohol is one of them. But most people aren’t getting most of their calories from alcohol. So, you got protein, fat, and carbohydrates. So, carbohydrates absolutely the clear winner in the blood sugar and insulin sweepstakes, that is the food group that in general raises both blood sugar and insulin the highest. There are exceptions. Broccoli doesn’t necessarily do it, but in the huge tent that is carbohydrates, that’s where most the action is in terms of raising blood sugar and their afterwards insulin. Protein is in the middle. Protein will raise insulin and blood sugar, but not that much. It does raise it a little bit, but it doesn’t send it over the top. Guess what fat does to it? Nothing. Doesn’t even move the needle. Now think for a minute about the idiocy of recommending low-fat diets.
[00:47:51] The one thing that doesn’t raise the things that are making us diabetic recommending low-fat diets to diabetics and to people who are prediabetic and to people who are trying to lose weight. Because the one thing we didn’t mention about insulin is its nickname is the fat storage hormone. And it wasn’t nicknamed that for nothing because what it does, that sugar is if the muscle cells don’t take it, it goes to the fat cells, it stores it as fat. It’s a fat store. It is incredibly difficult to lose weight if your insulin is high.
Cynthia Thurlow: [00:48:24] That’s very true.
Dr. Jonny Bowden: [00:48:25] It’s just very, very hard to do.
Cynthia Thurlow: [00:48:26] And I think it’s interesting because helping people understand that we want to utilize stored fats as a fuel source as opposed to consuming copious amounts of fats. And this is one of the common mistakes, misunderstandings that I see is that people are like, “Great, I’m going to go low carb and ketogenic” and they’re eating like five sticks of butter a day and five avocados. And I’m like, “All right, time out.” Those healthy fats are healthy. However, we want to utilize the stored fat in our bodies as a fuel source, especially if fasting insulin is low. Let’s touch on one very special type of fat. So medium chain triglycerides, why are these so beneficial? And talk about how they’re metabolized differently than other types of fats.
Dr. Jonny Bowden: [00:49:14] What’s interesting about MCTs, medium chain triglycerides is that I would say from my personal experience, the vast majority of people don’t even know what they are. They don’t even know which ones of the fats qualify. I mean, how much– biochemistry can be very boring. I can try to give you a very, very simplified version of this. So medium chain, the word chain is all fats are chains of molecules, chains together of atoms. Long chain fatty acids, for example, the omega 3s, those are short chain fatty acids that tend to be saturated, not always. And there’s this group called medium. So, the short ones have like six in the chain, and the long ones might have 22. But then there’s this little category of 6, 8, 10 and 12 that are called medium chains.
[00:50:01] There’s 6, 8, 10, 12 in a row, and those are called the medium chains. And that’s why coconut oil is always thought of as a good source of medium chain fatty acids. It’s really not. And here’s why. So, in any continuum, whether it’s blood sugar or prices of items in the grocery store, it’s a continuum. Blood pressure doesn’t suddenly become high at 140/90. It’s getting high as it’s going up 135. So, in the same way, the shortest of the medium chain 6 is almost like a short one. And 12 is hinting into the long ones. They behave differently. Coconut oil is a wonderful source of C12, which is also known as lauric acid, which has amazing health benefits, but doesn’t really behave like an MCT.
[00:50:54] The ones that behave like MCTs that are metabolized for energy are 6, 8, and 10. And according to Dave Asprey it’s all C10. So, it’s not C12, which is what 60% of coconut oil is. Technically, it’s a medium chain, but it’s flirt with the long chains. And therefore, it is a wonderful thing for like, microbes. It’s antimicrobial and people use it for Candida, all kinds of things like that but it’s not really– The weight loss benefit is that these are fats that are metabolized, like carbohydrates. The body prefers to use them for energy rather than storage.
[00:51:29] And interestingly enough, MCTs became big, I don’t know what, 10 years ago, when I started as a trainer, 1990, there was a famous trainer in the Baltimore area, in fact, named John Perillo, and he trained professional bodybuilders and he had this thing called MCT oil, and nobody even knew what it was. And he would give it to the bodybuilders in the contest week because they had to shred up, but they didn’t want to lose weight because they had worked all this time for the muscle. So, what could they do to get the energy to work out and continue to maintain their muscle without getting fat, MCT oils because the body—[crosstalk] Perillo knew at that time that the body tended to metabolize them for energy. So, they would fuel the bodybuilders workouts without putting on fat. So that’s how MCTs work.
Cynthia Thurlow: [00:52:15] I think it’s really interesting, give the nod to Dave Asprey because he always finds curious ways–
Dr. Jonny Bowden: [00:52:21] He finds interesting things. doesn’t he?
Cynthia Thurlow: [00:52:23] Yes, he does. [laughs] But he talks about disaster pants. So, for anyone that’s new to the MCT oil conversation, I always say go low and slow because some people are more susceptible to the effects, the GI effects of MCT oil. Like start at a teaspoon and if you do fine, you can work up to a tablespoon, but don’t go to like three tablespoons and wonder why you’re running for the bathroom. Okay. We have touch on the statin thing because it’s a $30 million-a-year industry, 30 million.
Dr. Jonny Bowden: [00:52:53] I think it’s more than that.
Cynthia Thurlow: [00:52:54] I was about to say and that’s probably conservative.
Dr. Jonny Bowden: [00:52:56] I think so, yeah.
Cynthia Thurlow: [00:52:58] So, when you were doing your research and the updated version, you and Dr. Sinatra, I guess let’s start with some of the pros because there are some anti-inflammatory benefits. We know it can decrease blood viscosity and obviously if you’ve got cardiovascular disease, that can be very important. But let’s talk about the dark side because there are things, characteristics to the way mechanistically statins work that I think even many clinicians may not be fully aware of. And let me be clear, we all knew about the muscle achiness and sometimes people felt like they had some changes in cognition, which that’s quite significant. [Jonny Laughs] Yeah. I had an NIH researcher who I will never mention her name, wonderful, wonderful, woman who taught me a lot about statins.
[00:53:43] And the more she taught me, the more I understood why she was being labeled noncompliant because she didn’t want to take the statins. But I thought to myself, here’s a medical researcher who is hesitant to take statins. She had no documented cardiovascular disease. Let me also tuck that in there. But I learned a lot from her and I think that this is a very important conversation, especially for listeners. Let’s talk about some of the side effects that come along with statin use.
Dr. Jonny Bowden: [00:54:08] The big ones are muscle pain, memory loss, loss of libido, and loss of energy. Those are the biggies. Now, here’s an interesting thing. We talked about how politics, economics, and medicine all intersect and stuff like that. So, there is a seminal study by Beatrice Golomb at Stanford on statin side effects and what she found. I’m doing this from memory, so I might have a number wrong here and there, but 65% of doctors don’t report the statin side effects to the adverse effects reporting system that they use. Why don’t they? Because the manufacturers have convinced them that the client complaints are either because the Internet tells them this stuff and they’re being influenced or because it’s something other than the statins. So, for example, I play tennis with a lot of older guys. They’re not exclusive.
[00:55:00] I also play tennis with 15-year-olds, but I play with a lot of 70-year-olds. And they’re all on statin drugs, and they go back often to the doctor, and they go, you know, “Doc, ever since you gave me this Crestor, I’m forgetting my wife’s name, it’s not that bad, [Cynthia laughs] but they’ll say I’m forgetting things all the time. And they said, Mr. Jones, it’s not the statin. It’s mild cognitive impairment. It’s age appropriate. It’s not a big deal. It’s just–“But, Doc, ever since you gave me this statin drug, I’m getting these muscle pains, It’s arthritis, its muscle, it’s this.” It’s always something else and they have been so programmed that these drugs don’t have these side effects and that the patient must be making it up or misattributing it.
[00:55:42] They’re getting a little arthritis, they’re getting a little memory loss and stuff like that. No dude, it’s the drug. And these side effects are numerous. And you and I, Cynthia, would willingly take a drug with side effects if it was going to save our life. If we had a terrible disease and we knew, okay, you got a shot with this cancer drug, probably going to have these side effects. We’ll go, sign me up. I don’t want to die. These statins aren’t saving lives. And every time I see the studies reanalyzed by people who are not in the drug industry, like David Diamond is a great source. Go to YouTube. Look up David Diamond. He’s smarter than me. He’s got the charts.
[00:56:18] He reanalyzed all the data, and you find that, yeah, in the statin group, you might have one less heart attack, but in the placebo group that didn’t get the statin, but you also had one extra death from diabetes, and so they cancel each other out. And when you look at the whole thing, no lives are saved. And that’s come up, John Ableson from Harvard has confirmed that you’re not saving lives. As John Ableson says, if you die from a heart attack instead of diabetes, that’s not a success. So, I don’t as we started off with that these are the devils brew and that they’re horrible drugs. You mentioned that they do some good things. Interestingly enough, the guy who started the whole statin skepticism, this brilliant European Dr. [unintelligible [00:57:00], I can never pronounce his last name, but you know who I mean.
[00:57:03] [crosstalk] often said that statins would be a better drug if they didn’t reduce cholesterol, because here’s what they do. That’s good. Let’s tell the truth about it. They decrease viscosity– thickness of the blood, as Sinatra used to say, turning it from ketchup into red wine. Okay, that’s good. They are antiplatelet aggregation and they’re slightly anti-inflammatory. I would argue that you could drown the anti-inflammatory effects with one drop of fish oil, but with none of these side effects. But that’s a separate issue, but they are mildly anti-inflammatory. In the general population, we can use all the help we can with anything that’s anti-inflammatory and apparently most people are not taking fish oil and quercetin and all the other things that work as natural anti-inflammatory.
[00:57:44] So, there is a little anti-inflammatory benefit, a little blood thinning benefit. All true. But the lowering of the cholesterol is probably the least important thing that they do, and that’s the one that produces all the side effects. You didn’t mention this, but cutting off the production of cholesterol also cuts off in the way that statins do, also cuts off the production of one of the most important nutrients for the heart, which is Coenzyme Q10. Apparently, they have known this all along. Merck apparently had a patent for statin plus CoQ10 knowing this. Back in the day they never developed a drug because they said nobody knows what the Coenzyme Q10, it won’t even be a selling point. So, it cuts off. And that is so ironic because Coenzyme Q10 is an energy molecule for every cell in the body. But the heart never takes a vacation. It needs a lot of energy, like the brain. So, you don’t want to cut off CoQ10. And how many doctors actually tell their patients, “I’m putting you on a statin. I need you to be taking 200 mg of Coenzyme Q10 starting right this minute.”
Cynthia Thurlow: [00:58:45] Or you wait until they develop myalgias, which are muscle aches, which are incredibly common. I think that the things that were surprising to me when I was looking through your book and then went down a couple of rabbit holes looking at the studies is that it impacts the size and composition of our bile acids, which has a direct implication on the gut microbiome, reducing gut microbiome diversity, reducing levels of butyrate, and actually changes the gut microbiome to resemble patterns seen in diet-induced obesity. That blew my mind.
Dr. Jonny Bowden: [00:59:17] Wow, I didn’t know that.
Cynthia Thurlow: [00:59:18] Yeah. The other thing that I think is so significant and I remember when these studies started coming out, the higher risk of diabetes.
Dr. Jonny Bowden: [00:59:27] Yes. That I did know.
Cynthia Thurlow: [00:59:28] But I remember when these studies started coming out talking about statin use and a significant higher risk of diabetes in patients who were already vulnerable to developing insulin resistance and diabetes. And so, I’m curious through the research that you did for the book, you and Dr. Sinatra, I think this is really compelling. I don’t think a lot of patients are getting a full sense of the potential side effects. You can see how upset my dogs are about this. But full potential set of side effects or conditions that can come from the utilization of statins.
Dr. Jonny Bowden: [01:00:03] Yeah. Just look at Beatrice Golomb study. She’s got a list of them. It’s a long list, then the politics come in. The statin companies say, “Yes, there are risks to every drug, and there are side effects, but they’re very, very rare.” I don’t think they’re that rare. We don’t really know because, as I said, doctors have been so well marketed to that they don’t report them as side effects of the statin drugs. So, we really don’t know the extent of them. But anecdotally I know you must have seen a lot of it. I have seen tons of it.
Cynthia Thurlow: [01:00:31] Yeah. Well, and it’s interesting because the muscle aches or the technical word is myalgias, I saw quite a bit of that. I definitely had a lot of patients who had concurrent heart failure and would ask me about CoQ10 and I would always say, “I think it’s absolutely fine.” I didn’t realize how extensive CoQ10 is in the heart. So, it makes complete sense.
Dr. Jonny Bowden: [01:00:51] Of course.
Cynthia Thurlow: [01:00:51] I think one of the other things that I found interesting was a reduction in oxytocin. And so, this is this very special hormone that’s not derived from cholesterol. But anyone that listens to this podcast knows how important oxytocin is because it helps lower cortisol. Let’s talk about that because I think that mechanistically. It works a little bit differently. It’s not derived from cholesterol, but the receptors that oxytocin docks into are highly dependent on cell membranes, which, if you’re on a stat, that’s really driving those down.
Dr. Jonny Bowden: [01:01:23] Yeah, but that’s a really interesting thing, Cynthia. I had not thought of that. And it shows you how connected all this stuff is in ways that I mean, I’ve been reading this stuff for 30 years. I did not even know the oxytocin connection, but I completely accept it because I know in other examples where something that you’re taking or doing or not doing is affecting a receptor, which in turn is affecting a release of a hormone, which in turn is and that’s what functional medicine is, isn’t it?
Cynthia Thurlow: [01:01:50] Yeah, and looking at those–
Dr. Jonny Bowden: [01:01:52] How all the stuff’s connected, not going into little silos for this condition or that condition, but like, how does the thyroid talk to the adrenals? How does the adrenals talk to the–? That’s what functional medicine is.
Cynthia Thurlow: [01:02:03] Yeah, absolutely.
Dr. Jonny Bowden: [01:02:04] That’s what Peter Attia calls medicine 3.0. He doesn’t call it functional medicine, but he’s talking about the same thing when we’re talking about a patient, not a lab test.
Cynthia Thurlow: [01:02:12] Yeah. I would love to at least touch on some supplements because you do talk about this extensively in the book, and then without question, we’re bringing you back because I have so many other things, I would love to ask you-
Dr. Jonny Bowden: [01:02:23] I would love to talk to you.
Cynthia Thurlow: [01:02:25] [laughs] -but we’re not making this a three-hour podcast, so we’ll have to bring you back. Let’s talk about some supplements that have benefits for our health that you are a proponent of, you like the research that’s been done on them.
Dr. Jonny Bowden: [01:02:37] If I may, I want to start– I have a supplement conversation a lot with my sister-in-law, who’s a tenured professor in environmental medicine at Rutgers. And I won’t say she’s not closed minded, but she’s very rigorous about the science she wants to see before she will take something. I’m not that rigorous, and I’ll tell you why. I believe, in general, that most of us have to operate in life with less than complete information. We do it in 100 different ways in 100 different venues. So, I take probably, I’ve reduced it now to about 38. It used to be like, 52 supplements a day. And I’m not even including the collagen I put in the coffee and just 50 supplements a day.
[01:03:22] Can I tell you that every one of those is making a difference in how I feel or in clinical endpoints? Of course not. I mean, some of them have massive research like vitamin D, some maybe not so, it’s suggestive. But I look at it like, on balance, the downside of taking all these supplements is that it costs a little bit of money, and it’s a pain in the ass to get them together for me and Michelle for weeks, it takes an hour for the week to get them, and I had to swallow a lot of pills. That’s not much of a downside. The potential upside is enormous. And I’ve been taking supplements more or less this number and with this obsessiveness since I was 38.
[01:04:01] I’m not interested in a science experiment to try to well, do I know whether it’s this one or that one, or is it the synergy? So, I’m flying a little bit on faith with this. I do look at the research. I do see what makes the most sense, but it’s not perfect research. And for those who want to shoot bullets at, it’s an easy target. There isn’t perfect research on any of these things. I would argue that there’s not perfect research on most of the drugs we take either. So that said, are you asking me what I think are the core ones that any audience could benefit from, or what I take, or what’s in between?
Cynthia Thurlow: [01:04:38] I would love to start with core. And then for you, I know that you take quite a few, as do I. What are your favorites for you?
Dr. Jonny Bowden: [01:04:47] For the people who ask my opinion, my tennis partners, my family, I recommend three things. That is what I consider to be the greatest return of investment on the least effort. I would like to add a couple to those, but most people are willing to take three if they’re even asking. And that might be the top. Those three, without question, fish oil, magnesium, vitamin D. That’s my core. And I would add to that if they’re willing to take one more, a multiple that has at least 25 mg of zinc and hopefully 200 mcg of selenium. But I’ll go with 100 if you eat some meat or some Brazil nuts. But I need the 25 mg of zinc and there are multiples like that have it.
[01:05:27] I don’t sell them or any life extension is one that I use and I like that because there’s only two a day. A lot of the better multiples, in order to get decent amounts of different nutrients, you need six to eight a day. And that’s a lot. And some turn it. So, I’d add the multiple to that and I’d probably add probiotics, but I just wish that we knew more about which ones and stuff like that. But those are the five, I think, we get the most return on investment. Now, beyond that, we could go all day. [Cynthia laughs] Coenzyme Q10, definitely if heart is an issue on any level. I mean, even if it isn’t, Steve used to say, “For normal people, 100 mg a day, people on statins, 200.” So, nobody gets a free lunch without– you need Coenzyme Q10.
[01:06:07] I was amazed. I take 200 a day. And I just got back a very thorough blood test, and my Coenzyme Q10 levels were low. And I have to figure that out with my cardiologist, why that is. So, sometimes taking it doesn’t guarantee, your receptors might not be working properly. You might not be absorbing it properly, it might be some other condition. But I think Coenzyme Q10 is high on that list.
Cynthia Thurlow: [01:06:29] Yeah, that’s really helpful. And what are your thoughts on things like red yeast rice? That was a question that came up frequently as an alternative to statin-esque properties in a supplement.
Dr. Jonny Bowden: [01:06:41] I think red rice yeast, if it’s well made and it’s from a really good source that you can trust a company that designs for health. Again, I have no thing with this. These are the brands that people like Cynthia and I use. I think it’s a very good supplement for that. It’s a little out of my lane to know exactly the biochemistry, but what I understand of it is if you picture like radiation therapy, where they take this wave and they go all at that one thing versus if they take much lighter waves coming from 50 different directions, so there’s much less damage. But at the point where you’re trying to affect something, it all adds up. I feel like that’s how red rice yeast works. It works in a different mechanism to lower cholesterol.
[01:07:25] And you have to remember how much Merck fought the introduction of red rice yeast in the supplement market. Like you can’t believe, because they knew it worked just as well as statins at least in lowering cholesterol. So, I think that’s a very good– again don’t take the medical advice as you got it. The trick is to find the right doctor, provider–
Cynthia Thurlow: [01:07:44] Provider, yes.
Dr. Jonny Bowden: [01:07:46] That’s a big trick. But I do think red rice yeast is very good.
Cynthia Thurlow: [01:07:49] Yeah, because it’s interesting. As I was prepping for today, I was looking through and I knew this would be a common question. So, things like niacin, resveratrol, berberine, cacao. Yeah.
Dr. Jonny Bowden: [01:08:02] Yeah, I would love to comment on all of those. I’m a big fan of berberine. I’m not really sure what it does to cholesterol. It really supports a lot of metabolic pathways that you want supported. So, all the things you want done, burning fat, more energy, detoxification, all that stuff, berberine supports the metabolic pathways that do that. So, it’s really good for blood sugar and things. They call it a natural metformin. I actually take metformin and berberine and I begged my doctor for metformin. I didn’t get it prescribed as a diabetic drug. It happens to be antiaging drug. It’s one of the really good guys of drug use and they are researching it at the NIH for its longevity effects. And there was even a piece on 60 minutes about it. So big fan of metformin. But berberine is great. What else did you just mention?
Cynthia Thurlow: [01:08:49] I had mentioned resveratrol.
Dr. Jonny Bowden: [01:08:51] Yeah, I was a big fan of resveratrol for a while. I still think it’s a very important flavonoid and it has a lot of benefits. I don’t know about cholesterol. There was a conference on resveratrol about 10 years ago, I think, in the Scandinavian countries, and the list of conditions that they found it to be helpful for was pretty impressive. So, I think that’s a good one. And I know there was one other that I wanted to come at, a berberine, resveratrol.
Cynthia Thurlow: [01:09:15] I think I had said cacao only because my one vice in life is dark chocolate. So, any additional, whether it’s a superfood but the benefits of cacao.
Dr. Jonny Bowden: [01:09:26] I think with dark chocolate and cacao, the big one is blood pressure because there are these studies and the flavanols in there and I forgot what– Oh, God. [unintelligible 01:09:36]. There’s a society where they chew on cocoa leaves all day.
Cynthia Thurlow: [01:09:41] Yes, yes.
Dr. Jonny Bowden: [01:09:42] And they don’t get blood pressure elevations as they get older, which is a weird phenomenon because everybody does and they don’t. So, I think that’s where the cocoa flavanols came in as a potential for lowering blood pressure. I’m going to reinvestigate that because I think it’s an important thing to know so, yes cocoa.
Cynthia Thurlow: [01:09:59] About well, this has been an unbelievable-
Dr. Jonny Bowden: [01:10:01] We have done already, no.
[laughter]
Cynthia Thurlow: [01:10:04] I was going to say this has been an unbelievable but I know I’ve had you for 90 minutes, so I want to be respectful of your time. Obviously, I would love for you to come back and talk about healthy aging because looking at you, it is hard to believe you’re getting ready to celebrate your 77th birthday. You’re very vital and active and sharp. And so, I want to learn all the things. How can my community connect with you, purchase your books, obviously, The Great Cholesterol Myth is the one that we really focused in on today. But you have a plethora of books. I have many in my bookshelf. So how can they connect with you on social media? How can they connect with you if they want to work with you or want to learn more about you.
Dr. Jonny Bowden: [01:10:38] All of that is on my website, which is jonnybowden. And there’s articles on there about my blog on where and how to buy vitamins and on disinformation and different things like that. There’s a Work with Me section for people who want to do private consultations. And I don’t do much social media folks, but it’s @Jonnybowden and Facebook is Dr. Jonny Bowden.
Cynthia Thurlow: [01:11:03] Awesome. Well, this has been such a pleasure. I’m so glad we made this happen.
Dr. Jonny Bowden: [01:11:06] I hope we get to do it again. This flew by. I can’t believe it’s done [Cynthia laughs]
Cynthia Thurlow: [01:11:11] That’s a good sign. Sometimes you may be doing interviews and you are watching the clock, but this was an effortless and easy conversation.
Dr. Jonny Bowden: [01:11:17] No I was watching [crosstalk] How much more time do we have left? Not like, how much more time do we have left? I don’t want this to end. Thank you so much.
Cynthia Thurlow: [01:11:25] Thank you.
Dr. Jonny Bowden: [01:11:26] I hope we can do it again. I would really appreciate that opportunity.
Cynthia Thurlow: [01:11:30] Absolutely.
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