02:40 A Functional Medicine approach looks at why the body would lay down plaque as a rational response to coat the artery wall against inflammation or oxidation or glycation
06:08 I asked Dr. Elkin what is view is on cholesterol and he mentioned that half of patients who have heart attacks have normal cholesterol
08:09 Dr. Elkin discusses the benefits of the Berkley Heart Lab and other advanced lipid profiles for better assessing true CVD risk
09:36 Howard explains how small, dense particles are more likely to be oxidized and incorporated into arterial plaques
10:50 I explained how larger HDL particles perform reverse cholesterol transport to remove potentially harmful LDL particles from the blood stream
11:02 I asked how Dr. Elkins treats patients who have small, dense LDL particles and he explained that he gets his patients to change their lifestyle and he uses certain nutritional supplements such as niacin before he puts them on medications
13:10 I asked Howard what are some of the most important dietary factors to change to lower cardiovascular risk in such a patient? He said it’s not about cutting our eggs and saturated fat, like we used to think. Howard’s way of thinking is that sugar not fat is the main villian, since it is pro-inflammatory.
16:57 I asked Dr. Elkin about one of his recent blog articles where he wrote about the new PCSK-9 inhibitor medications for cholesterol. Dr. Elkin explained these may be effective, but they showed that they could bring LDL cholesterol levels down to 36 and this is actually not a good thing, since you need cholesterol for hormones, vitamin D production, and brain function. Also, these drugs cost $14,000 per year.
20:30 Howard explained that when he does places patients on statins, he always puts them on CoQ10 to prevent muscle problems. He usually uses 100-200 mg to start with. With patients who have heart failure he will use very high dosages, along with magnesium, L-Carnitine, and D-Ribose.
24:22 Dr. Elkin discusses what nutritional supplements he will use to raise HDL levels: 2 tablespoons daily of Extra Virgin Olive oil, coconut oil, low carb diet, exercise, weight reduction, and niacin.
27:52 I asked Howard how to lower Lp(a). He said that this fragment of LDL is extremely atherogenic and is highly likely to get oxidized. Niacin, estrogen, and fish oil can help. I mentioned that I also found that berberine and tocotrienols were also helpful.
30:30 We discussed what to do about patients with elevated CRP (indicative of inflammation). Dr. Elkin mentioned that this test should be done routinely on all patients, but it is often not measured. There is a link between obesity and CRP and also between oral cavity problems and sinusitis and even poor sleep. He likes fish oil, turmeric, ginger, and boswellia to reduce inflammation.