Good afternoon, I'm Dr. Todd Binkley, practitioner of functional medicine and non-force doctor of chiropractic.
I've been getting a lot of questions about the episodes I did a while back about heart disease,
about how cholesterol doesn't cause heart disease.
Well, if cholesterol doesn't cause heart disease, why do we hear about cholesterol-lowering drugs
and why is everybody obsessed with their cholesterol levels all the time?
Well, cholesterol is important, but it's associated with heart disease. It does not cause it.
Inflammation causes heart disease and there are better ways to test your level of inflammation
and better ways to test other factors in your bloodstream, in your blood vessels
that increase your risk of having a heart attack or a stroke.
So we're going to talk about that and a dramatic case of someone who I was able to help survive heart surgery
and who was basically left for dead.
I mean, I hate to say that, but it's the most accurate way I can describe it.
We'll come back to that before that.
In the news, I always like to present something from the most recent news and this is really interesting.
Three in five physician practices are now owned by non-physicians.
So people ask me all the time, functional medicine sounds great.
Why don't all doctors do this?
Well, several reasons. Number one, most people don't show up to see their doctor until they're in such a mess.
They need standard medical care.
So it's not necessarily your doctor's fault.
It depends on how well you've taken care of yourself.
But it is also sort of demoralizing to learn that three in five U.S. physicians are now owned by non-physicians.
So most doctors work for corporations like health insurers, private equity firms,
large pharmacy chains, and this reached 30 percent as of January for the first time,
surpassing ownership by hospitals and health systems.
So as a result, three in five physicians are now owned by non-physicians.
So what does that mean?
Your doctor, most likely the doctor that your insurance company is covering, UDC or doctors,
are their medical decisions are governed by boards of directors of corporations that are mostly concerned
about cutting costs and maintaining their bottom line and getting their profit margins up over your health.
And that's just sad.
In 2020, corporations owned about 17 percent of U.S. medical practices,
while hospitals and health systems owned about 25 percent, according to a report released by the Physician Advocacy Institute.
But corporate ownership of medical groups has surged.
Well, it surged during the pandemic.
And so these trends raise questions about how best to protect patients and physicians in a changing employment landscape,
says Kelly Kenney, the Physicians Advocacy Institute chief executive officer.
Quote, quote, corporate entities are assuming control of physician practices and changing the face of medicine in the United States
with little to no scrutiny from regulators.
And the CEO of the Physicians Advocacy Institute goes on to say, quote, physicians have an ethical responsibility to their patients' health.
Corporate entities have a fiduciary responsibility to their shareholders and are motivated to put profits first.
These interests can conflict with providing the best medical care to patients.
You think? Well, you're not alone.
Even the FTC now is saying, given recent trends,
we are concerned that some transactions may generate profits for those firms at the expense of patients' health,
workers' safety, quality of care, and affordable health care for patients and taxpayers,
said the Federal Trade Commission and the Justice, the Department of Justice, and the Health and Human Services Department
in a joint statement which appeared in those agencies' joint request for information, which was just announced in March.
So a request for information is a tool that federal agencies can use to gauge the level of both support and opposition
they would face if trying to change policies.
So anyway, the government's working in the background.
This is a big deal.
And this is responsible for the reason we spend more money in the United States of America on health care,
more than twice the amount of money of all the other industrialized nations.
We spend more than twice what all the nations in Europe and Japan and Korea and all developed societies on health care.
And we have crappier outcomes.
We have sicker people.
It's just not right.
And this corporate pursuit of profits over actual health care is a big part of the problem.
For this reason, I often recommend that everyone get a health savings account or a medical savings account
connected to a high deductible, less expensive health insurance policy and spend your money on things that actually improve your health
instead of just crossing your fingers and waiting till you need medical care to save your life.
You need that backstop.
Obviously, you want to have insurance to cover you in a crisis.
But don't just wait until you're in the crisis.
I mean, you know, I know listeners to this show are probably I'm preaching to the choir.
That's why you're listening to this show.
Functional medicine, restoring normal function before you become dependent on pharmaceuticals for the rest of your life
is obviously a better way to go.
And unfortunately, insurance doesn't cover that.
You do have to pay a little bit out of pocket, but it's much less expensive than you might imagine,
especially considering the consequences and expenses of waiting until you end up in the hospital and are out of work for several weeks or months
and have to pay the deductibles and co-payments of even good insurance.
So there are better options.
So I've been getting a lot of questions about heart disease.
I talk about how cholesterol doesn't cause heart disease.
So and cholesterol, measuring your cholesterol isn't the best way to predict your risk of heart disease.
There are so many other tests that do a better job of that.
And I include several of them on the regular blood panel that I do on almost all of my patients.
So tests like C, reactive protein, a measure of inflammation throughout your body.
Tests like erythrocyte sedimentation rate.
This just means as a measure of blood viscosity, how thick is your blood?
They literally just set a timer and see how long it takes your red blood cells,
erythrocytes, red blood cells to sink to the bottom of a test tube and measure that.
That is a measure of how thick your blood is.
And what causes your blood to become thicker is mostly inflammatory cytokines,
inflammatory debris.
Inflammation makes your blood thicker.
So C, reactive protein and sed rate are both good markers for inflammation.
I also test ferritin levels, iron storage throughout your body,
which in addition to measuring iron overload and iron deficiency is also a marker of systemic inflammation.
Uric acid is a marker of inflammation that mostly affects your joints when it's super elevated.
That is the marker for diagnosis of gout.
But it is also a marker of inflammation throughout your body, especially your joints.
And as we talked about earlier,
inflammation in your joints can affect your entire body, including your brain,
and risk of cognitive decline.
So here's another. So these things are included on my panel.
I test them on everyone. They're better. I also check the cholesterol, of course.
But these things are better markers, but even better than that.
So the top of the line, if you want a full, really comprehensive measure of your cardiovascular health,
do you have risk factors?
Did your father or your uncle have a heart attack in their 30s or 40s or 50s?
Do you have a loved one who is already on several medications for high blood pressure,
for cholesterol, any heart medications?
You're at high risk for cardiovascular disease. Otherwise, you wouldn't need those medications.
So anyone who's at risk for cardiovascular disease should consider, number one,
doing that basic panel that I talk about all the time.
But if you want to be even more comprehensive, then the test I use for people at higher risk is by doctors' data.
Doctors' data is not the only one that does a profile like this.
The Cleveland Clinic first developed a similar list of criteria
for a closer and more intensive look at your risks for cardiovascular disease several years ago.
So LabCorp, lots of other labs offer a similar test.
But I like the doctors' data test because it's very comprehensive.
It's about a little less than $200, $195, I think, $199.
It's right around $200. Maybe it went up a little bit.
But anyway, it includes your standard lipid test, total cholesterol, triglycerides, good and bad cholesterol,
but also things like oxidized LDL.
So oxidized LDL is a much stronger risk factor than just LDL.
So LDL is low-density lipoprotein.
That's the quote-unquote bad cholesterol.
But a high level of oxidized LDL is a much stronger predictor of risk for coronary artery disease, heart attacks, strokes, etc.
And high levels of this also markedly increase your risk for developing metabolic syndrome within a decade.
Next on the list is small-dense LDL.
So these are what are called fractionations.
These are subsets of the total bad cholesterol that you have.
The small-dense LDL, low-density lipoprotein bad cholesterol, is extremely atherogenic subtype.
So that means it's very much involved in the creation of plaque and damage on the linings of the blood vessels
that end up causing arteries to become clogged and bits to break off and cause strokes.
Three times greater risk for cardiovascular disease than normal-sized LDL bad cholesterol particles.
These small-dense LDL bad cholesterol particles are also associated with elevated triglycerides,
low-good cholesterol, obesity, metabolic syndrome, pre-diabetes, insulin resistance, renal or kidney dysfunction,
hepatic steatosis, meaning fatty liver disease, and dietary trans fatty acids.
These small-dense LDL particles more readily penetrate the arterial endothelial wall
and are more prone to oxidation, which is the result of this inflammatory process.
So the endothelial wall, just to review your blood vessel, is the pipes that carry nutrients and oxygen to every part of your body,
starting with the big ones that exit the heart, and they're sort of a three-layered tube.
So the outside of your blood vessels is made of connective tissue like many other parts of your body.
It creates the strength and the integrity of the pipe itself, kind of like a garden hose, the outer part.
And inside that is a muscular layer that allows the blood vessels to expand and contract on demand
to control and regulate blood pressure throughout your body.
Then inside this innermost layer in every blood vessel is called the endothelium.
The endothelium is kind of like silky pantyhose liner that lines the blood vessels to keep the walls nice and smooth.
So all of these red blood cells and white blood cells and nutrients that are hurtling through your blood vessels
can get where they're going without becoming stuck to the walls.
And so you can have high cholesterol and nice, slick, smooth endothelium and not get any plaques.
The plaques start when you have micro tears in this endothelium that then must be bridged with a little scab,
just like when you cut your skin. You heal the cut with a scab that forms, which is made up of scar tissue and some other things.
And in the lining of your blood vessels, these little breaches in this inner lining of the blood vessels,
little scabs form, which are made of fibrin, the scar tissue that heals every damaged part of your body.
But then that scar tissue is a matrix that then becomes impregnated with calcium and cholesterol.
So that is the connection between cholesterol and heart disease.
If you get the tears, then you're going to have buildup of fibrin, buildup of calcium and cholesterol in those scabs.
But if you keep inflammation under control and don't get all those micro tears in the first place,
then it doesn't matter so much how high your cholesterol is because cholesterol will just keep moving through your body
and eventually get filtered out or used to make cell membranes, steroid hormones, cholesterol, as an essential nutrient.
It is the foundation block, building block nutrient for all of the sex hormones, estrogen, progesterone, testosterone, etc.
And it's a key component of making cell membranes throughout your body.
So if some doctor told you, you need to get your total cholesterol down to 100,
I've heard this in the last week or two, three or two or three times from patients.
All my doctor told me I need to get my total cholesterol down to 100. That's ridiculous.
The total current total level of total cholesterol recommended is 200 and it used to be 240.
This is only when they invented statin drugs that they lowered the quote-unquote normal total cholesterol to 200
so they could put everybody on statin cholesterol lowering drugs.
It used to be fine. Everyone was fine at 240 for decades.
There's research that shows that the ideal range for total cholesterol is more around 225 for most people.
But these are all averages. Everybody's situation is different.
Which is why it's always so important to get tested.
I am Dr. Todd Binkley. You're listening to Safe, Effective, Natural Solutions to Almost Any Health Challenge.
Today, we're talking about more advanced tests to measure your true risk,
to better measure your risk of cardiovascular disease, your risk of heart attack or stroke.
If you or someone you love is on several medications for blood pressure, cholesterol, heart disease,
who has had a previous cardiovascular event of any kind, then they are at high risk of cardiovascular disease.
If someone in your family, your brother, your father, or mother, women, are at cardiovascular disease risk as well,
if anybody close to you, a close family member, has had a cardiovascular event, way too young,
in their 30s, 40s, 50s, then you're probably at risk of heart disease
and might want to consider doing a little bit more advanced testing.
And so the best advanced test, it's not the only one,
but it's the one I like the best because for about $200 you get a tremendous amount of information
that would otherwise cost several hundred dollars to do as individual tests.
So we've talked about a few of those so far.
The next on the list is the PLAC test.
So high levels of lipoprotein phospholipase activity, the acronym is the PLAC test,
PLAC, is strongly associated with increased risk of coronary artery disease, disease progression,
PLAC instability, and cardiovascular events.
So it's a very highly indicative test of significant hardening of the arteries,
especially the coronary arteries, and risk for rupture of advanced plaque.
So it's when you have a rupture of an advanced plaque that that little chunk travels further downstream
and blocks an artery to your heart and causes a heart attack,
or travels up to your brain and causes a stroke.
So high levels of plaque, PLAC, are associated with double the risk of cardiovascular disease
regardless of the level of your cholesterol levels.
Next on the list of the doctor's data, cardio metabolic profile is homocysteine levels.
Homocysteine levels have been tested for a long time and used to be considered a strong indicator,
risk factor for cardiovascular disease, which has sort of since been disproven,
but it is still a good measure of whether or not you're getting adequate B vitamins in your system.
Which can be a factor. So that's included on the test.
Elevated high sensitivity CRP. So I test CRP on everyone.
High sensitivity, HSCRP is just a more sensitive as the name suggests,
measure of a very narrow range of CRP that's strongly associated with heart disease.
So that's included on the panel.
And apolipoprotein B. This is a test that is not commonly done, not commonly ordered separately,
not even commonly ordered by cardiologists, but a high level of apolipoprotein B,
or just apob for short, is a strong risk factor for cardiovascular disease.
And elevated levels of it increase risk of fatal heart attack,
even when LDL bad cholesterol levels are normal.
So elevated apob is a better indicator of risk of cardiovascular disease
in either total cholesterol or the LDL bad cholesterol level.
And there's abundant research to document this.
And the nice thing about this doctor's data cardiometabolic profile is it explains all of this,
right in the report, explains your levels and it explains what I'm reading to you now.
All of the indicators, what these tests mean and the research to back it up.
Next on the list, in addition to apob, is apoa.
So apoa is another lipoprotein that is an excellent metric for your risk of cardiovascular disease.
And they also include the ratio of apob to apoa.
And apoa is a direct indication of anti-atherogenic HDL particles.
So what does that mean?
It's a measure of the good cholesterol and a small fraction of the best among beneficial lipids
that are protective against cardiovascular disease.
Lastly, and this is really important, especially for people who are overweight or who have diabetes,
is the appetite suppressant hormones leptin and adenopectin are included.
So high leptin to adenopectin ratios have been associated with obesity, type 2 diabetes,
insulin resistance, inflammation, and of course cardiovascular disease.
And the recent evidence indicates that a high ratio is more clinically sensitive to risks
for metabolic syndrome, type 2 diabetes, and cardiovascular disease than other tests alone.
So this is another really important indicator of your risk factors and it is also included
on the doctor's data cardiometabolic profile.
I'm Dr. Todd Binkley.
You've been listening to Safe, Effective, Natural Solutions to almost any health challenge.
We've been talking today about cardiovascular, the best ways to measure your risk.
Someone you love's risk of cardiovascular disease before it's too late,
not just checking cholesterol but doing a more sophisticated panel.
It costs a couple hundred dollars and there are several out there,
but the one I like the best is doctor's data cardiometabolic profile.
You can Google that.
You can go to doctorsdata.com and pull up, just type in cardiometabolic profile and pull up a sample report
or you can email me and I will send you that report.
So I had a patient who came to me who had open heart surgery.
He had been coming to me for years because he had severe arthritis in his neck
and he would just come a couple of times a month for me to keep his neck loose enough
so that he could move and function properly and walk and he was pretty fit.
He was in his late 70s, pretty fit guy, always wore shorts, had muscular calves.
He looked really, really good for his age and he'd gone on vacation to visit his family in Minnesota
and three or four months had gone by.
I hadn't seen him and I knew he'd gone on vacation,
but it was very unusual for him to not come in and get his regular adjustment for his neck.
So I called him up and he said, oh, yeah, I've been meaning to get in.
I had open heart surgery and my cardiologist followed up and he just says that, you know,
it's just as good as it gets.
What do you mean?
Come get in here.
Yeah, Adam came in and he brought his test and he looked like a ghost.
He was hunched over.
He was pale.
He couldn't drive anymore.
His wife had to bring him in and I asked him if he did his BNP test.
I've talked about this before.
This is another really important test for current stress on the heart.
B type natrietic peptide.
B as in boy and as in Nancy, P as in Paul.
BNP.
Well, upper limit of normal for BNP is 100 medically.
The healthy range is below 40.
His BNP test after his heart surgery was 1200.
Well, a few days after heart surgery, that's pretty normal.
But four or five months later, his BNP was still 400, four times the upper limit of normal.
And his cardiologist told him, well, you're old.
Get used to it.
That's as good as it gets.
I said, no, that's not acceptable.
I put him on high doses of CoQ10 fish oil and some other nutrients.
And within, oh, by the way, his ankles were swollen up to the size of his calves because his heart,
he was having heart failure.
Heart failure doesn't mean your heart stops.
It just means it's failing to keep up with demand.
The pump is getting weak.
So his ankles are the size of his calves.
He slumped over.
He's struggling to breathe, shortness of breath, can't drive anymore.
After three weeks on a high dose of CoQ10, his ankle swelling had gone down by half.
He was standing up straight again and driving.
We cut the dose down from there.
Eventually got him after a little over a year to where his BNP level was back to near normal.
And he was like a new person, totally back to normal, driving, fit, walking, doing all the things
that he wanted to do.
He was on his deathbed and his cardiologist had told him, you know, get used to it.
This is as good as it gets after he had open heart surgery.
And instead, he went on to live several more years in excellent health, walking, fit, doing all the things
that he wanted to do.
And his wife was obviously and his family were obviously very happy about that.
So the point of all this is know your risk factors, get tested, do something to be healthier now
than you were last week.
And we're about out of time.
But I just before we run out, I just wanted to say about one more thing.
This is really exciting to me.
You can get a defibrillator.
You see these in the movies.
Somebody's having a heart attack and you pull out the paddles and the instructions are all there.
Anybody, almost anybody with just a little bit of reading the instructions can start somebody's heart.
Somebody's having a heart attack by getting an automated external defibrillator, an AED.
So you get these things used to cost thousands of dollars.
You can get one for less than a thousand, like $800.
So email me for more information about that.
We're out of time.
Have a fabulous weekend.
See you next Friday right here at 4 p.m. on KDAR 98.3 FM.
Have a fabulous weekend.