Ep. #405: Dr. Spencer Nadolsky on How Not to Die of Heart Disease

Mike: Welcome, welcome to another episode of the most for life podcast. I am Mike Matthews, of course. And this time around, I’m talking with Dr. Spencer Nadolsky about heart disease. Why heart disease? It is the number one killer in the world. And if you are over the age of 65, you are more likely to die from heart disease than anything else.

And unfortunately, this trend is not getting better. It is only getting worse. Why though? Is it due to stress? Is it due to over or under exercising? Is it due to eating too much dietary fat, too much cholesterol, too much sugar, junk food, or maybe a bit of each of those things or something else altogether?

It is a tricky subject. Scientists have been searching for answers to those questions for a long time now. But if there is one thing, one culprit that has been fingered more than any other, it is definitely diet. For at least a couple decades now, we have been told by experts everywhere that saturated fat, cholesterol, and often just dietary fat in general, increases our risk of heart disease.

Now, this idea has been further bolstered by the food pyramid, which tells us to get most of our calories from whole grains like pasta, cereal and bread, and as few calories as possible from added fats like oils, butter, lard and others. Is it really that simple? that simple. Is reducing our dietary fat intake really the best way to avoid heart disease?

Of course these days with high fat dieting being the thing, being so trendy, many people would say absolutely not and that it’s all fake news and you should in fact eat as much dietary fat as you can and as little carbohydrate as you can. But is that really the answer? Frankly, while I have read enough to know that there are some major holes in the less fat equals less heart disease hypothesis and that eating more dietary fat can absolutely increase the risk of heart disease in some people, I don’t consider myself an expert on the topic.

And that’s why I invited my buddy, Dr. Spencer Nadolsky. on the show to break it down. And I caught him at a good time as well because he is currently studying for certification on this very topic. And in the interview, he shares some great insights on the most current scientific understanding of how our diets actually affect our kickers.

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All righty, that is enough shameless plugging. For now at least let’s get to the show. Dr. Spencer, a real doctor, I might add. That matters these days, man. You got to say that. Yeah, I know. 

Spencer: As opposed to some other, I don’t know. Everybody has a doctor in front of their name. I swear on Instagram anyway. How’s it going?

Not bad. How are you doing, buddy? I’m still here. I’m still going. Good. I’m getting a lot of patients from you still. So keep up the good work there. Really? That’s cool. Is that from? I think an old podcast, maybe. I don’t know. That’s why we got to update it. 

Mike: That’s the only reason for doing this.

Build people. Of money, that’s right. No, that’s great. I’m actually going to be, I’m working through a series of updates to muscle for life. There’s gonna be some aesthetic updates and some content stuff. I’m going to be adding a resources. I’m probably going to pull books off the menu. It doesn’t have to be on the menu and replace that with resources where I’m going to link to a bunch of people and things who, and that I like basically.

So you’re going to be on there, my friend. Perfect. All right. So what are we talking about today? We’re talking about Cholesterol. 

Spencer: Cholesterol, cardiovascular 

Mike: disease prevention. Let’s dig into it. I’ve written a bit about this. I’ve spoken a bit about this, mostly in the context of just dietary fat intake and I guess specifically just cautioning people against having saturated fat orgies, which is the thing these days, but otherwise I’m just going to listen to you and learn.

Spencer: Yeah, so if you go back in the history of diets, I don’t know when you were in elementary school, but I remember, I think it was third grade, third or fourth grade, when they had the big food pyramid out and they said eat a ton of basically bread and pasta and all the way, and that was the base of the pyramid, and all the way at the top was the tiny tip that basically said just get very minimal amounts of this, the fat, oils, anything like that, nuts, butter, lard, whatever.

Do you know how 

Mike: that, I don’t know the story didn’t, I think what’s her name? Denise menger is her name. Death by food pyramid. She has a book. I think that’s all about that. But yeah, there’s a lot of cool stories. How did that come about? How was it at one point where I was like, yeah, just eat a bunch of pasta and bread.

That’ll be good for you. 

Spencer: I think, with the obesity epidemic, it’s, it all aligned with that. Yeah. Unintentionally maybe, but there’s a lot of conspiracy theorists out there talking about the cereal companies and things like that. I haven’t gone into all the different books and different theories in there, but basically one of the ideas was that, Hey, we should probably have less fat since it has more calories.

Per gram really. And that’s not as satiating as, say carbohydrates and protein. 

Mike: It’s still, that’s an odd, like you go, okay, sure. But vegetables, so it’s, yeah, 

Spencer: we should probably have the vegetables at the base. Yeah, 

Mike: I agree. Why don’t we do fruits and vegetables at the bottom, which are going to be even better than wheat products, especially.

More highly processed wheat products can be lower in calories, higher in nutrients. You’re going to get some insoluble fiber, blah, blah, blah. 

Spencer: It’s interesting before we get into the fat stuff. I remember seeing that and going I better eat just bowls of pasta and rice. And I did. I ate a ton of.

It didn’t matter because I’m genetically, I was, I’m not predisposed to gaining much weight and pretty athletic when I was younger, but you can imagine maybe the effect on other people just eating huge bowls of pasta, especially with no understanding of 

Mike: energy balance. It’s just, this is what I’m supposed to be eating.

This is what the doctors say. Just eat all this 

Spencer: shit. Bowls of cereal, bowls of pasta. Yeah. So you go back to then saying low fat, and then all of a sudden we have the trend back to a lower carb diet. Carb higher fat approach. And it keeps going back and forth. Looking at heart disease, there’s something called the lipid hypothesis.

And now some people say that just eating fat in general is bad for your heart and eating saturated fat. You can imagine eating things like butter, anything that’s solid at room temperature, you eat it and it goes into your blood and you can see it just hardening again, and it’s hardening your blood vessels, right?

That’s what, at least what I imagined. And that’s what I think what my patients. Now that I know it’s a lot more complicated and a lot more detailed than how the digestion and how it truly affects you works. I don’t know. Have you ever thought about that? Have you ever discussed that on your podcast?

Because we can go into 

Mike: a little bit, but I think it’s worth going into. I remember I have an article on like, how many grams of fat should you eat per day? And I recorded a podcast based on the information in the article. So I probably have touched on this, but It’s been a while, so 

Spencer: let’s do it.

Yeah, cool. So I’m actually studying for my lipidology boards basically to take the exam that says I’m an expert in lipidology, the study of lipids, cholesterol, and triglycerides and everything like that. So it’s really interesting because I don’t think as a kid, you really taught about how that works.

You may have a physiology class and then maybe you go through college, maybe have some biology, physiology, pathophysiology, but in medical school, we learn it and, but you forget it quickly when you go through all the other subjects. When everybody says saturated fat, they just think this one term of type of fat.

But actually there’s different types of saturated fatty acids. There’s different types of polyunsaturated fatty acids, and there are different types of monounsaturated fatty acids. I’m sure you’ve talked about that. The reason that they’re either monounsaturated or polyunsaturated or saturated, it’s the biochemical structure of it.

There’s double bonds in the structure. And if there’s multiple double bonds, it’s polyunsaturated. If there’s just one double bond, it’s monounsaturated. And if there are no double bonds, it’s completely saturated. Now we all just think, yeah, saturated fat’s bad for you, but there’s actually multiple different types of these saturated fatty acids and they each have likely different effects on your health.

And what we mostly think about is our cholesterol. Most people think that eating saturated fat is going to elevate your cholesterol, but it does so in a very interesting way. And I don’t think anybody’s ever talked about that with you. Have you discussed that at all? 

Mike: No, just hearing from people, a question, a more even basic question that I often get that you might want to quickly touch on is eating cholesterol going to raise my cholesterol.

And is that bad? If I want to eat some eggs, is that a problem? 

Spencer: Yeah, no, not necessarily. So it’s an interesting thing. Okay. So we’ll go through, we call it the exogenous. Pathway of how you absorb cholesterol before we get into the saturated fat stuff. So when we eat things that contain cholesterol and things can contain both cholesterol and saturated fat, they’re two different things.

Cholesterol is not a fatty acid and it’s like a waxy substance, right? Yep. So a lot of people confuse saturated fat and cholesterol. They’re two completely different types of molecules. There’s triglycerides and fatty acids that are used for energy. And then cholesterol is a different type of molecule.

That’s used for our membranes, used for our bioproduction, used for hormones. Each cell actually produces the cholesterol molecule, every cell in our body. However, we can also eat foods that contain cholesterol. So what it does is it gets into your intestines and then it actually gets absorbed. And then gets put into these little particles called chylomicrons.

They circulate our system, your tissues take some of the fatty acids that are also in these chylomicrons, and then they get reabsorbed into your liver. Now it’s interesting because when you. Eat things that contain cholesterol, not all of it necessarily gets absorbed. And then it’s actually not the biggest component of the cholesterol that’s in your intestines, the bile that goes into actually break down the fats that we eat.

I don’t know if, do you know anything about biles? Biles is the thing that’s made by a liver goes out the gallbladder and helps us digest fat. It emulsifies the fat so we can absorb it. So that’s actually the biggest component of cholesterol in our intestines. So when people don’t think of that, so you eat a ton of cholesterol in your diet and it may not make as much of a difference because we also have this, a ton of our cholesterol from bile acids.

So it’s just a little aside thing there. Now, once you eat cholesterol, If you’re absorbing more of that cholesterol, your liver can actually shut down production of more cholesterol that’s pushed out into the system. So that’s why you don’t necessarily see this huge change in cholesterol.

Some people do, when they eat more cholesterol, they see a big change. Especially if you’re vegan, if you’re not used to eating cholesterol at all. And if you eat a lot of cholesterol, there may not be as much of a change when you start eating more of it. In the new dietary guidelines that people don’t focus on it as much.

It does make a difference. Some people will have big time changes in their serum, their blood cholesterol from eating more higher cholesterol containing foods. But a lot of people that are just eating a standard kind of diet that are eating. foods that contain cholesterol. As long as you’re not a vegan, you won’t see as big of a change.

Mike: And that’s why research has shown, right? That like eating eggs doesn’t increase the risk of heart disease or eating other forms of cholesterol. Cause it sounds like the body’s feedback loops work pretty well here. 

Spencer: Yeah. And eggs are a whole different story. There may be something in the eggs that also change the absorption of the cholesterol too.

So that’s another thing we’ll talk about when we get into the saturated fatty acids because, Oh, okay. Not only are these little components of the foods we eat matter, it’s also the food constituents, the food matrices, they call it. What else is in the food, right? Yeah, it can change how we absorb it and change how we metabolize in the rates of gastric emptying, all these different things.

An obvious 

Mike: example of that, right? Could be the difference of high fructose corn syrup in some pop tarts or fructose in an apple. 

Spencer: Yep, exactly. Similar kind of analogy there. That’s the dietary cholesterol. So just to sum it up, the amount of cholesterol that you eat pales in comparison to the cholesterol that’s actually contained in your bile that goes to digest the fat.

There are people that absorb more or less dietary cholesterol. If you eat no cholesterol and you start eating cholesterol, you’ll have a much bigger jump in general. Again, this is variable. You’ll likely have a much bigger jump in your serum cholesterol, blood cholesterol than if you were already eating a lot of cholesterol and started eating like double that.

I guess in time it would probably normalize though, right? Yeah, the curve kind of slows down. It’s really interesting stuff. Some new studies just came out. There’s a guy, Kevin Mackey, he’s one of the lead researchers on this, just came out with a new article, the meta regression of the LDL changes from eating dietary cholesterol.

One of the things I also want to talk about is that When we talk about blood cholesterol, when we measure it, we’re talking about the cholesterol measured on these things called lipoproteins. The cholesterol can’t circulate your blood without being contained on one of these proteins since it’s not water soluble.

You don’t just eat cholesterol, it doesn’t just go into your blood and clog your arteries. It has to actually go on these proteins. It’s like a transporter, right? And those proteins are actually, once they get down to the low density lipoproteins. Those are the things that actually get stuck in your artery walls and start the atherosclerosis 

Mike: cascade.

And that’s the LDL cholesterol that many people listening have probably heard. You’ve probably heard LDL is just the bad quote unquote in HDL. The high density is the quote unquote good. Exactly. 

Spencer: And yeah, and that’s the other thing. People think. Oh, bad cholesterol, good cholesterol. The cholesterol is the cholesterol.

Like I said before, it’s the molecule on it. It’s really the lipoprotein that’s probably harmful. So HDL, high density lipoproteins that carry that same cholesterol that can also be in an LDL particle or low density lipoprotein particle, it’s the same cholesterol, so it’s really the lipoprotein that carries it.

might be a stupid question, but 

Mike: what’s the purpose of having these two different types of lipoproteins? Something I guess I haven’t answered for myself along the way. Again, this isn’t an area that I’ve read that much about. I’ve given myself a basic education on it to share the basic practical advice.

Spencer: They have different mechanisms. So like I said, when you, we call it from the exogenous pathway, when we eat foods and cholesterol and fats, they get carried on these chylomicron particles. They’re similar to those. LDL particles, but they’re huge. They pass around in our blood and get Muscles and fats take up the triglycerides and things like that and then they go back and get reabsorbed in the liver then can also Push out these things called very low density lipoproteins And those that go around in our blood they get triglycerides taken off of them And they get smaller and then they turn into an LDL basically.

Oh, okay low density lipoprotein There is actually no purpose that we know of You LDL, other than it’s just the garbage left over that just needs to go back to the liver to get recycled. With HDL, these things are transferring cholesterol and triglycerides all the time, but HDLs don’t have that same purpose of delivering triglycerides to the, tissues.

They can deliver cholesterol to like things like your adrenal glands, if they need it for extra cholesterol to make hormones and things like that. But the HDL aren’t like the other lipoproteins. We call it reverse cholesterol transport where they go in the macrophages that have. plaque atherosclerosis and start sucking up cholesterol from there, but they’re not harmful as, as far as we can tell, they don’t actually get into the artery walls and start the atherosclerosis.

So that’s the difference there. 

Mike: I see. Okay. Now, obviously the problem would be is, okay, so if you are eating too much of atherosclerosis, In this case, it’s like saturated fat, which then just necessitates more and more LDL molecules to process all of it. If you do that long enough, that’s where you can have buildup that accumulates over time and so forth.

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Spencer: So I was talking about eating cholesterol in the endogenous pathway. And that just means in the body, so endo inside. Yeah, so exogenous meaning taking in food and then endogenous meaning it’s already producing like the liver. The endogenous pathway, this is where the saturated fat makes the bigger difference.

So it’s not that we just eat saturated fat and for some reason our cholesterol goes up and then it clogs our artery like butter, it’s saturated. That’s why oils like olive oil, monounsaturated, polyunsaturated, they’re liquid at room temperature. Usually the saturated fat like coconut oil and butter and lard, those are solid at room temperature.

So it’s not that you just eat these and then they harden up in our vessels and clog our arteries. The way they actually would. increased risk of cardiovascular disease, or at least it’s thought, is that they change the LDL receptor activity. So what that means is, I talked about those LDLs kind of being like garbage, basically left over after your liver made some very low density lipoproteins and they get It’s smaller and smaller as our body uses the triglyceride that’s on them for fuel.

Those LDLs build up in our system when our LDL receptors aren’t working so well. There can be people that have genetic causes for that. The familial hypercholesterolemia. Have you heard of that? I’ve heard of the term. So it’s a condition where people can have, severely higher risk of cardiovascular disease earlier in life because they have some sort of genetic issue with usually their LDL receptor.

There’s a couple different types, but in general, their LDL receptors aren’t working so well, so they have even at birth. And throughout life, they have higher than average low density lipoprotein particle numbers or cholesterol. If those people are at risk, they have longer lifelong levels of that high LDL.

If something were to decrease the LDL receptor activity, then that probably increases your LDL cholesterol that builds up in your body, because you’re not recycling it as well. And that means you’re probably at higher risk for heart disease. In fact, saturated fat, like I said, there’s multiple different types of saturated fatty acids.

Specifically, the one that’s in butter, the most common one, palmitic acid, seems to downregulate the LDL receptor activity, so then you get increased levels of LDL cholesterol. in the blood because it just keeps building up because you’re not recycling it as well. Polyunsaturated fats seem to increase the LDL receptor activity.

So that’s why you see people’s LDL cholesterol levels decrease when they eat more polyunsaturated fats and monounsaturated fats. Polyunsaturated is the bigger one that seems to have a more positive effect. Problem is that people look at some of these studies and the way that these studies are done and they don’t see much of a difference.

In risk, that’s why you see these studies saturated fat wasn’t bad. Here it was bad, and it’s a lot of back and forth. When they start teasing out the trials that have actually been done, it seems there is the most recent Cochrane meta analysis that pooled all these studies together.

The most recent Cochrane one showed that there is a decreased risk of cardiovascular events with reduced saturated fat and increased polyunsaturated fat. 

Mike: I guess that kind of back up some of the research out there on the Mediterranean diet, right? 

Spencer: Yeah, that’s one of them. Now, some of these high fat proponents will be like the one of the studies called the PREDIMED study that actually recently got retracted and republished, but they didn’t have differences in their LDL cholesterol levels between the two groups.

This is like comparing a Mediterranean diet. Really, it’s just olive oil and nuts versus a controlled diet, differences in cholesterol, but they had a decreased risk of basically strokes. So that’s one of these proponents of saying the cholesterol doesn’t matter. Yeah. But high fish, high nuts, seeds, that’s why the dietary guidelines are there to focus on those types of fats versus things like butter and coconut oil.

The thing is, it’s controversial because not everybody has these massive increases in LDL cholesterol. And if they’re trying to focus on any type of diet, they’re probably have other healthy behaviors too. So even people that are. Chugging down bulletproof coffee and, drinking butter in their coffee and doing all these other things, they probably have very low risk factors otherwise, because they’re probably exercising and doing these other things.

It’s going to be really hard to tell in the long run, whether they truly have an increased risk. But based on the data we have right now, if they probably are, if all things else are being equal, take two people, one person has the higher LDL from drinking butter. The other person doesn’t. Okay. That person drinking butter with the higher LDL likely has a higher risk given everything else being equal.

So the story gets a little bit more complicated again, because it’s not just that palmitic acid saturated fatty acid. There’s also the types of foods, just like we talked about eggs and other cholesterol containing foods may not increase cholesterol the same way based on the food it’s packaged in. And the same goes for saturated fat. Yes, exactly. So there’s different saturated fatty acids as we Palmitic acid in butter was one example. What’s another example? Yeah. So like stearic acid, that’s the one that people talk about. It’s in chocolate and it actually has a neutral effect, not LDL. So do they know why is it understood yet?

Or is working theories or yeah. So that’s actually something that I want to study more. Because I think it’s interesting I’m pretty sure it all had to do with LDL receptor activity. So something about that palmitic acid, I have no idea why. Why does that decrease LDL receptor activity? I don’t know.

And so people are talking about from an evolutionary standpoint, why would it do that? I’m not exactly sure, but And you 

Mike: think is it the stearic acid per se, or is it something else in chocolate that when combined with stearic acid? I think it’s the stearic acid because it’s seen in other foods that contain 

Spencer: stearic acid.

Oh, okay. Yeah, because you can get it in meat as well. That’s why people say meat’s not bad because it has actually meat has like monounsaturated fats in it as well. Of 

Mike: course, even good sources of monounsaturated fat have some take an avocado. It has a bit of saturated fat, doesn’t it? 

Spencer: Yeah.

There’s a little bit of saturated fat and even olive oil has a little bit of saturated fat. saturated fat. So that’s why some people even say, Oh, olive oil is bad for you. It’s no, just shut up. 

Mike: Makes me think of I published an article recently on most for life on Tom Brady’s diet. Oh, nice. Yeah.

And then we have an article going up. But any day now in the plant paradox, which is worse because you got to blame the scammy right hand man, his life guru guy. That guy is an actual con man. Brady doesn’t claim to even be an expert. He just says, Hey, look, this is what I do. And he’s following the advice of this quack and wouldn’t believe that of course, but he’s following the advice of this guy.

And he just says, this is what I do. It works for me. I don’t know. I’m not an expert. Leave me alone. Whereas the plant paradox is they. Calculated scam. 

Spencer: I can’t say I want to take them all down. I can’t stand these quacks So there have been some studies looking at say like yogurt cheese and then versus butter each of these have different effects on LDL cholesterol levels simply because The food that they come in with changes the way either the absorption or there’s something called a milk fat globule membrane.

I don’t know if you’ve guys talked about that on your podcast at all. Some of these things that obviously change the way either the absorption of the way the palmitic acid affects it. So butter specifically doesn’t have some of these. Calcium protein or the milk fat globule membrane and so it’s hypothesized that hey, these other foods.

Yeah, they seem to not have that effect. So they’re probably beneficial. Whereas butter tend to have people minimize butter as much as possible. There can be healthier things in it, but it’s one of those things where you’d have to eat a lot of it to get any of those other healthier. What are some other foods that 

Mike: you.

Tend to recommend people eat maybe not as little of as possible, but to limit their intake of 

Spencer: generally coconut oil. 

Mike: That’s still super trendy. Cause that was a big thing for a while. I’m going to check Google trends while you’re answering. 

Spencer: I still have tons of people saying, but coconut oil is a healthy oil.

And I’m like I don’t think it’s unhealthy. I don’t think any of these things, I don’t like to call anything unhealthy per se. I would just say we should focus on. These types of foods, we know these eating patterns are associated with longevity. We can see it from a experimental basis. We can see it from observational.

Studies as well. So probably eating these types of food panders, probably the best. I don’t know of any long living tribes or areas out there that drink butter. I’ve never heard of it. It doesn’t necessarily mean that it’s wrong, but based on the evidence we have right now, it’s probably not right. And a lot of that came from Dave Asprey, right?

Mike: Yeah, I know. Do is an actual joke. The guy’s actually a joke. So you can’t listen to anything that guy says. You read his articles. I don’t know if you’ve read some of his stuff and you’ve checked citations. Sometimes the citations literally have nothing to do with even the claims. Like they’re just citing random shit and assuming that no one’s going to check it.

Anyway. 

Spencer: Mercola does that. I’ve looked at some of his, god, that guy’s one of the biggest quacks on this planet. But have you talked about Mercola on this spot? No, 

Mike: I don’t know that much. I’ve seen some of his articles and I’m like, that’s bizarre. And so I’ve 

Spencer: only heard between him and Dave Asprey.

I don’t know who’s a bigger quack, but Mercola is actually a doctor. So like I would call him worse. Dave Asprey is just trying to make some money. Obviously Mercola is too, but. I don’t know. We take a Hippocratic oath and just, it’s not cool to lose your integrity, lose your scruples, but. Random aside, have, 

Mike: have you seen that from the inside?

I’ve always been curious how that works exactly. Have you seen someone go to the dark side? Not 

Spencer: like good friends. Cause I would be like, I would be very upset, but, and I’d call him out, too. It’s interesting, so nobody from my med school necessarily, but to see someone like that, and you know that they went through med school, they had to take their exams at one point, they were taught a certain way, at one point someone jumped ship.

They just decide that money is more important than integrity, Ben Greenfield. He’s not a doctor, but I’ve been tweeting at him. He said, vaccines cause autism. They do indeed cause autism. And I was like that’s not true. Like you, you got to actually back your claim up. And he actually, what he did is he cited a Mercola article, ironically.

Really? Yeah. At some point, cause other people were saying, What? Ben Greenfield used to be so good. He did this and that. I’m like I don’t know. At some point he jumped ship, people turned crazy. I think it’s mostly monetarily driven. Although there may be a fame portion in there too. They like to have a bunch of followers and they like to polarize and polarize for the wrong integrity is more important to me than, of course, we all want to make a lot of money, but you basically.

Sell your soul. So I don’t know. I’ve never seen like personal friends do it, but you see some of these people that are a little bit older than you, that I’ve met some guys 

Mike: that were like that they are once I can think of, we’re pretty brazen. I remember one guy. Yeah, he openly would say I sell pills in a bottle.

I don’t know what’s in there. He wasn’t trying to pretend not that’s admirable, but I find that at least a little bit like hypocrisy is the most, Disgusting of traits in people. And you have liars and hypocrites are just universally despised by everybody, but you can have someone that you’re not going to be friends with them, but you can at least respect their honesty.

So that, that guy, I remember he was like, I have no idea what’s in it. I don’t care. I’m just making money. I’m like, okay, at least there, there’s some. Some honesty there, at least he’s not pretending like he’s trying to help anybody and could probably, if I really dug into it, he could probably say something like, and it’s always easy.

If you get into that rationalizing mindset, it’d be like, yeah my pills do nothing. Yes, that’s true. I think they were like weight loss pills. Okay. So my pills do nothing, but. If it encourages people to to start dieting because they think the pill is going to help them as well, then I’ve helped some people.

Of course, you could say, yeah, that’s true, but people like that, where they don’t want that conversation to go is weighing. Sure. So there’s been some construction, there’s been some help. That’s true. But now you got to weigh it against. All of the people that you’ve let down and all the money you’ve taken from them and how many people have been disappointed and then they’ve given up on their weight loss journeys, and maybe even rebounded and blah, blah, blah, right?

So when you weigh it, you go, eh, nah, dude, your entire business is a net negative on society. Like you are. Taking from society, you are imposing costs on society. So anyways, I’ve met some people that were a bit more like that about it. Just yeah, whatever. Fuck it, dude. I have multimillion dollar homes and cars and shit, and I have a private jet and you don’t.

So what else is there to say? But yeah, 

Spencer: it’s like, Good for you, man. I hope you can live with that. 

Mike: Ironically, that guy apparently now is having all kinds of health problems himself. It’s poetic justice. His body’s all broken. Now he’s all fucked up. So it goes around, comes around sometimes. 

Spencer: It’s probably all the weird stuff he put in his pills.

Mike: Whatever else he was putting in his 

Spencer: body. Yeah. The cocaine or whatever. 

Mike: Yeah. Yeah, exactly. 

Spencer: Oh, man. Yeah. 

Mike: I don’t know what we were talking about. We got into that via coconut oil. So I was asking like, what’s another, and I guess that also, that was big on the MCT oil thing too, is a coconut. It was a great source of that.

I looked on Google trends, coconut oil Pete, let’s see, it was March of 2014 was peak. And then it was pretty good there for a few years. And now it’s on a downswing, but it’s still far more popular now than it was back in 2010. So yeah, it’s still a thing for sure. Yeah. I 

Spencer: get patients asking about it or Diet templates that we don’t mention coconut oil as a healthy fat to eat.

And they’re like, what about coconut oil? I’m like, you can have it. It’s just don’t focus on it. Focus on the things that we know are good for you. Or just have something else. Unless you love it, 

Mike: I guess. But people ask me sometimes what to cook with. I’m going to cook with olive oil. It’s a solid, you can’t go wrong cooking with olive oil.

Spencer: No, you can’t. People worry about the smoke point of. There’s actually a recent study looking at the differences between coconut oil and olive oil or extra virgin olive oil and avocado oil and extra virgin olive oil did a bang up job on not being oxidized. 

Mike: I probably know the paper you’re talking about because in the Tom Brady diet, that was one of the things that I was talking about there is as oils to cook with.

Cause I think. If I remember correctly, part of it was you can only cook with olive oil. And even then you have to watch out and make sure you don’t overheat it. And there were a couple of studies I found where it was being used to fry food. So it was getting abused and yeah, they compared different oils and it barely had oxidized after getting pummeled over and over, I don’t know, 20 fryings or something.

And it was still perfectly. fit for consumption, frankly, 

Spencer: The reason people use the coconut oil is because it said with the bio Chemical structure with no double bonds. It doesn’t get oxidized as readily as say Polyunsaturated fats with multiple double bonds. Those are more readily oxidized. But the monounsaturated was the one that You know, like you said, olive oil, extra virgin specifically does very well.

Especially considering 

Mike: we’re not deep frying a hundred batches of food in a row and then drinking the oil or just like stir frying some vegetables. 

Spencer: Exactly. So if somebody comes to you, their cholesterol is high, their blood LDL cholesterol, And you want to get it down and it’s not familial.

It’s not genetic. So what do you do? You look at their diet. A lot of them are doing paleo bulletproof type of coffee. They’re cooking everything in coconut oil. They’re putting butter on their ribeyes. Here’s an easy way to change it. You tell them switch all the butter, every coconut oil and butter that they have to basically only nuts, olive oil, and avocados.

And maybe avocado oil, have them switch their meats to a little bit of a leaner cut if possible. And then one other thing is soluble fiber. So things like oats, lentils, legumes, apples, those types of things, those actually bind up not only some of that dietary cholesterol that you’ll eat, but also some of that bile acid cholesterol that’s also in your intestine.

And that’s why I wanted to mention it. is because, yeah, you could cut out the dietary cholesterol, but you’re still going to have a ton of that cholesterol in your bile that just keeps getting reabsorbed and recirculated. And that’s not necessarily a problem, but if you want to lower your cholesterol levels, your blood cholesterol levels, it’d be nice to lower that somehow.

Soluble fiber sources may actually do that. Oats in general are the, probably the biggest one. Beta glucan. And you can also get soluble fiber from fruits 

Mike: and vegetables, of course, another good source. 

Spencer: Yep. Apples. And then, there are, you can do psyllium husk if you really wanted to supplement with it.

Glucamonin is another one, but I like to do it from oats and lentils, legumes and fruit. But so yeah, you do those two things. I’ve seen people go from an LDL cholesterol in the two hundreds down to the low one hundreds. It can have a major effect. How does 

Mike: that map in terms of risk for heart disease? Just as a doctor, you say you see that you see two 20 or something.

Spencer: Yeah. So if your total cholesterol is two 20, you want to look at the HDL cholesterol and stuff like that. So the LDL cholesterol, the level we want it, obviously for me, People might disagree. I want my LDL cholesterol as low as possible, but most people are going to run around the 100 to 120, 130 level for LDL cholesterol.

I’d want mine closer below 100 for years, if possible. Ideally for me, I’d like to be at under 80. For me, it’s not going to happen. My genetics seem to have a slightly higher level. Once you get over that 190 milligrams per deciliter, that’s where the doctors really want to throw you on a statin. ’cause that’s the level shown to increase without any other risk factors.

Actually at lower, even 1 30, 1 40, 1 50, 1 60, the higher you get the higher risk. But at that one 90, they’re a little bit. More scared because possibly have the risk of familial hypercholesterolemia and that puts you at a higher risk. But even if you don’t, you’re still at a higher risk above that one 90.

So I think something 

Mike: just worth commenting on that what sucks is that’s probably what happens in a lot of cases, right? Is there’s no talk about diet or making any of the changes you’re talking about. It’s just you’re on drugs now and these drugs, like all drugs have side effects and we’ll see where this goes.

Spencer: Yeah, exactly. And that’s where a lot of these diet or Bloggers get really upset because the doctors don’t have much time. I think it’s a system issue. The doctors don’t have much time. They’re they come in, they see your level there and they go, all right, here’s a script. First of all, I could change my cholesterol very quickly.

There’s a guy, Dave Feldman, he’s a buddy of mine. He’s a cholesterol denialist, but that’s okay. Cause the cool thing he’s done, and I’ve seen this with my patients is that you can actually change your LDL cholesterol within just a day or two, just with massive. changes to your diet. And I’m actually going to do some more self experimentation to me.

I want to see how high I can get my cholesterol and then see how low I can get it. Cause I think I can manipulate it based on that LDL receptor activity. So you’re about to get fat is what’s going to happen. You’re going to be eating like 

Mike: five sticks of butter a day. I’m 

Spencer: going to drink butter basically.

And then I’m going to cut out all cholesterol, all saturated fat. So it’ll be interesting, but I think I can manipulate it within days. Okay. So if it’s going to be within 

Mike: days, then whatever you have, 9, 000 calories of fat for over a few days. 

Spencer: Yeah. So the doctor comes in, sees your cholesterol super high, and you’re doing a bulletproof coffee or doing a paleo.

And they’re just like, here’s a stent. You’re probably not going to go back to the doctor. You’re going to think that doctor is an idiot. The doctor is not an idiot necessarily. They just may not know enough about. Dietary differences and they just figure everybody’s either has a poor lifestyle, not going to change or that they have a genetic cause for their high cholesterol.

And so that’s why they just give you the script. That’s not how they’re supposed to do it. They’re supposed to talk to you about things like hypothyroidism, birth control, all sorts of things can increase your cholesterol to not just diet. So they should have a conversation with you. You should give it a good lifestyle try.

I would not drink butter and coconut oil in your coffee. We see major changes with that. But yeah, like you said, they just throw you on a medicine and not have that discussion. That’ll piss a lot of people off. 

Mike: With foods that contain saturated fats. So you mentioned a couple here, butter, coconut oil, generally stay away from it.

Just minimize your intake of Meat, however you mentioned earlier may not be as bad, but then you said that you would recommend people if they need to bring their cholesterol down to eat leaner cuts of meat. What about for the average person who’s listening? He doesn’t have necessarily any issues, but this is advice I personally Already follow.

Like I eat, I’d say on a day to day basis, actually no butter and no coconut oil. I cook with olive oil. I get my fats from I have some olive oil on a salad that I eat for lunch. I have some avocado and I mostly just chicken for meat. And I’ll have some red meat, usually 90, 10, once or twice a week.

I’ll make a hamburger or something like that. Where are you at on, let’s say red meat intake. That’s really like the question these days, right? Yeah. 

Spencer: Yeah, so if your cholesterol is fine, and you’re eating a stable amount of red meat, say you’re eating beef once a day even, and your cholesterol is fine, some would say I guess it’s not having an effect.

Others would say, the vegans specifically, would probably say, hey look, there’s some epidemiological evidence, meaning they didn’t do a long term trial randomizing one person to meat, and Another person to know red meat, they’ve looked at the people that just have dietary patterns where they eat lots of red meat versus not, and that’s the kind of the evidence they have.

There may be some suggestion of increased risk of eating more red meat. Now they have to. Then tease it out into process like hot dogs and bratwurst and things like that versus whole unprocessed, say like beef jerky and shit. 

Mike: Yeah, 

Spencer: exactly. Versus a nice pasture raised cow. And it seems that there is a less risk with those things that are eating unprocessed or less process.

Cause obviously the process to 

Mike: some 

Spencer: degree, 

Mike: just to put it in the store. 

Spencer: Exactly. There are other things about. The red meat that there may be, maybe there’s an issue that heme iron. It’s a form of iron that may cause metabolic disturbances and may increase your risk of atherosclerosis.

I’m not completely convinced. And that may be me saying that because I like red meat. There’s also, if you heard a T MAL, there’s this molecule that may. I feel like this isn’t in 

Mike: connection to cancer. Or am I thinking of something else? Maybe I’m thinking of the wrong, 

Spencer: you’re probably think of the heterocyclic amines that are Yeah, for from cooking, right?

Yeah. I guess it’s burning. Yeah, exactly. It’s like searing, really getting charred T miles. This trimethyl amine oxide molecule that is thought to increase when eating a lot of meat, and it may be. Associated with atherosclerosis. So eating more of it may somehow increase the rate of atherosclerosis. It’s controversial though.

There’s a lot of it in fish and eating a lot of fish is good for you. Blah, blah, blah, blah, blah. I’m not completely convinced that’s an issue, but so the question is there something about red meat other than cholesterol and changes in LDL cholesterol? That could increase your risk of atherosclerosis.

These are just a couple of things that people think, but again, a lot of people that are pushing this are also plant based eaters. Again, I like red meat, so it may be my bias that says, I don’t know, I’m questioning it, but I think there probably is something to it if it were me. I don’t eat as much red meat anymore.

I still eat it cause I like it. It tastes good. And I think the risk is relatively low and I have other low risk factors, but there may be something to those other things. 

Mike: Yeah. General advice would be don’t follow the carnivore diet, but if you’re going to have some red meat here and there, and you’re doing other things, it’s probably not a big deal. And if you really wanted to know, you can get some blood work done and then you would know. I haven’t done it 

Spencer: myself. I want to do this, but you can actually check your TMAO levels. Just interesting thing. But yeah, the carnivore diet, the thing is if say if you’re 400 pounds and for some reason the carnivore diet.

You, you’re sitting there eating Pop-Tart, just eating crap all the time. You just can’t stop eating this yummy food. Buy into the carnivore diet. You lose 200 pounds or a hundred pounds or whatever, and you feel amazing and all of your other risk factors decrease. Then, hey, who am I to?

To say you’re an idiot? That’s probably a net positive. But for somebody that’s someone like you or me. That just decided that we’re going to do carnivore, probably not the best option, but 

Mike: yeah. Anything else with saturated fat that you had floating around that you want to touch on? You mentioned a couple of different types of saturated fats and they do different things in the body and different foods.

Spencer: I’d say if you get more fermented forms of dairy that contain saturated fat, yogurt and cheeses, it’s probably more beneficial than the butter. If you’re gonna eat it, I would get it from yogurt and cheese as opposed to butter. A little bit of butter’s not gonna kill you. I’m not one of these butter Nazis or whatever you wanna call these low fat folks.

But, a little bit of butter on a little piece of bread once in a while, probably not the biggest deal. Yeah, what amount of intake? For you would make you say, Oh no, we need to slow down. So some people could have a few, maybe three or four servings a day and probably not have a huge effect, but I have a feeling sticking to around a serving or zero to one serving is probably fine.

Okay. And a serving is what, like an ounce or something? One tablespoon. Yeah. What do you need that much butter anyway, unless you’re just pulling, how much are you supposed to put in one of the bulletproof coffees? Yeah, I believe it was one to two tablespoons of grass fed butter. And you and I both know that do a tablespoon.

They’re probably grabbing that fricking big spoon in your roar. That’s not a tablespoon. That’s just, yeah, it’s probably a tablespoon and a half. Yeah. So it ends up being three tablespoons. And then Dave Asprey, the bulletproof people, they say to use Their MCT oil, their brain octane oil. So most people use coconut oil though, because coconut oil does have some of these medium chain triglycerides, but I believe I’d have to look up the medium chain triglycerides in the brain octane oil, most people use coconut oil, which will probably raise your LDL cholesterol more than specific MCT oil.

I’d have to see if there’d been studies comparing the two, but so you can imagine three tablespoons of butter. And then another two or three tablespoons of coconut oil. That’s 80 grams. Yeah, let’s see, three. Yeah, that’s like about 80 grams of fat in one little thing. And then take that, then you go and eat a ribeye later.

You melt some butter on it because you think it’s good. Those are massive increases in your LDL cholesterol. Not something I would recommend. Pat a butter here and there, put it on your toast, or even if you wanted to put it on some steak or something like that. Probably not the biggest deal. It’s when you’re drinking it and just over consuming it.

That’s where you see these huge effects that I see in the clinic. Anyway, 

Mike: these Bulletproof coffees, I actually don’t run into this very much, but it sounds like you run into a bit more. Are people drinking just one of these a day or some people 

Spencer: drinking too? It’s usually one, I got caught a flag on Twitter because I said this guy basically cut his.

Cholesterol in half and lost 20 pounds or eight pounds or whatever it was from cutting out his bulletproof coffee. And people are like, that’s the only change he made in his diet. Yeah. And they’re like, how is that even possible? I’m like it had 400 calories in it. And they’re like, that doesn’t make sense.

I’m like They weren’t taking a tablespoon and taking a knife and flattening it out and then putting it in and now they’re probably dunking it in And it’s just a massive fat bomb and they’re basically but that’s supposed to replace breakfast though They shouldn’t be eating on top of that.

I’m like, I don’t know he didn’t satiate him So he had to eat sooner than later after drinking it And so I just told him to cut that out eat a normal breakfast like usual instead of Drinking the stupid coffee and he lost eight pounds over three months or whatever it was. 

Mike: There’s a weight loss hack.

Just stop doing anything that is trendy or fad related period. That’s the new fad diet is if it’s recommended in a fad diet, don’t do it. You’ll lose weight. Yeah. 

Spencer: Just 

Mike: stop 

Spencer: listening to these idiots. 

Mike: The problem is it’s hard to sell The truth. It’s much easier to sell bullshit. It’s much easier to say lectins kill you.

So you have to pressure cook your beans before you eat them. Then it is say you have to learn how to control your desires and you can’t overindulge and you have to develop a healthy relationship with food, which. Means probably, I don’t know if you’d agree with this, but means that you have to not care that much about food.

I don’t know about you, but I’m that way myself. And in having worked with a lot of people who are super fit and stay super fit, it’s pretty common that they like food. They can eat, a lot of food or not eat a lot of food doesn’t really matter that much to them. They’re not quote unquote addicted to anything.

They don’t really deal with cravings. They’re just very well balanced, and I understand it. It can be hard to get there for some people, especially starting at a young age, we’re introduced to these hyper palatable, hyper engineered foods. And then who knows, do you think eating that way, starting at a young age can mess your body up in ways that are irreparable or that are very hard to change?

Kind of like how if a teenager smokes weed it’s, Worse, like it messes with their brains in a way that you don’t see in adults. 

Spencer: Yeah, I’d say so. And there are some studies to suggest that what you’re saying is there may be a more propensity to keep doing it, whether it’s the psychological difference.

But there are studies looking at brain changes, and that’s what we talk about, like with obesity. Medicine is that, people with obesity tend to have neural connections that are changed and the reward pathway can be dysfunctional. Meaning they just have a higher propensity to keep going after those foods, similar to what we’d like an addiction state, but yeah, they truly, they have free will.

It may drive them to eat more of those types of foods. It’s interesting stuff. I, yeah. So ideally we’d get these things, minimize them as much as possible. They just taste so good. And it’s probably 

Mike: just an argument for general abstinence. I think of quoted this couple of times because it just sticks in my brain.

John Rockefeller senior didn’t drink alcohol. And I forget who, somebody asked him why. And he said that he can’t become an alcoholic if he doesn’t take the first drink. And he might’ve just been saying that for effect, but There’s truth in that. And the more you stay away from those foods, the easier it is to not eat those foods.

There’s something to be said for that. And even if you have good willpower or you have good self control, it requires even energy to resist temptations like that. And so even for I myself, again, somebody who doesn’t really care that much about food, if I eat, what’s the most recent, there were some little pop tart bites lying around.

I tried it one. It actually was gross. I don’t even, it tasted like nothing. Surprise. It tasted like nothing, like just sugar. Actually, so those weren’t good, but whatever. I don’t know, maybe chips or something. Again, there’s been who knows tens, maybe even hundreds of millions of dollars of research put into just perfecting this little treat and that every bite as delicious as possible.

I’m sure I’ll enjoy it as much as the next person, but by generally staying away from those foods, it never even pops into my head to eat. A bunch of chips or something. You know what I mean? How does that with you? 

Spencer: If I see that food, I get cravings for it. I’m like but sometimes if I’m dieting, if I’m getting like really lean, Oh man, I crave it a lot more, but 

Mike: yeah, I’ve run into that too.

I think that’s just inevitable. 

Spencer: Yeah, if I’m steady though. If I’m steady, regular weight, I can see it. I’m just like, nah, I don’t need it. But some people, they just, they can’t stop whether it was an ingrained habit versus reward pathway dysfunction or a combination of the two. There’s something going on there.

It’s weird for me is I can 

Mike: smell a food and. Actually get some sort of satisfaction from it and not have the desire to eat it. That’s amazing. I don’t think I could do that. It’s actually weird. Like I used to just to fuck with one of the guys that works with me. He did one of the guys who did the clean eating challenge where he did it, right?

He’s better now with food, but previously his diet was a joke. Basically he would eat bmr during the week. And those calories used to be like protein shakes and candy. I don’t think any vegetables whatsoever, just an actual, about as bad as it could be. So then he could binge on the weekends. So it’s be a martyr in the week to just explode himself on the weekends.

Just to fuck with him. I used to get donuts. I’d bring them in the office and put them in the. Toaster oven. So then the office was smaller. Even current office at work, within 10 minutes, the entire office just smells like delicious doughnuts. And I thought it was funny. That’s amazing.

And for me, I just enjoyed it. It just smelled good to me. I was like, Oh, this is good. I had no desire to eat the doughnuts. It just was a nice aroma. That’s awesome. Anyways anything else on the topic at hand? I think we’ve touched on all the things that I thought we were going to talk about. 

Spencer: Yeah, no, I think we’re good.

I just wanted to go into the mechanisms because people just think eating cholesterol, saturated fat, your arteries get clogged, but it’s really because of these lipoproteins that carry those things get into your arteries and each of the cholesterol and dietary cholesterol and saturated fat. They change your Cholesterol based on different mechanisms.

So saturated fat decreases the recycling, eating cholesterol may get more cholesterol into your serum by getting incorporated into the lipoproteins. But don’t drink butter. Don’t drink coconut oil. You can enjoy them if you want. Keep them minimal. Focus on nuts, olive oil, avocados, and fish. Eat your soluble fiber, lentils, legumes, oats, specifically fruits, 

Mike: And that’s probably not going to change that’s going to be the advice until we find some new, I don’t know, breakthrough type of food that just changes the game.

Yeah. That’s probably going to, it’s probably going to be it really. And eat a bit of protein if you especially if you’re physically active, which you should be and train your muscles, get enough sleep and. Don’t drink a bunch of alcohol. Don’t do a bunch of drugs. I don’t know the simple things.

Yeah. I think that’s great advice. All right. Let’s finish up with where people can find you and your work. And I know you’re just about to launch a new exciting company actually. So I want to let everybody know 

Spencer: that stuff. So Instagram is now my main place at Dr. Nadolski that’s D as in dog are. N as in Nancy, a D as in dog, O-L-S-K-Y, for the memes go to his Instagram for the memes.

For the memes. Yep. I love making some fun memes there. I’m on Facebook as well, Spencer, Dr. Spencer Nki. And then the new business is RP health.com. It’s a sister company to Renaissance periodization, combining dieticians and physicians for a more of a medical nutrition type of therapy to help people lose weight.

Mike: Awesome. And are you still working with patients? If anybody is I want this dude to be my doctor. Is that even an option? 

Spencer: Kind of, I’m pretty booked up right now. They’d probably have to email me and get on the wait list. Oh, the old takeaway, the scarcity, pretty much beg. You still are working with people.

I am. I have like about 300 patients that I Stick with, I don’t want to go too much over that. So that’s why I’m at least, do you maintain a waitlist? So if people are interested, they can reach out and then if they want to work with me, probably through RP health would be the way they would at this point.

Mike: All right, man. This was great. Thanks for taking the time and we’ll have to schedule another one. I enjoyed it. 

Spencer: Yeah. Cool, man. 

Mike: We’ll find a bunch of other things to talk about. Hey there. It is Mike again. I hope you enjoyed this episode and found it interesting and helpful. And if you did and don’t mind doing me a favor and want to help me make this the most popular health and fitness podcast on the internet, then please leave a quick review of it on iTunes or wherever you’re listening from.

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