WEBVTT 1 00:00:16.960 --> 00:00:21.239 Welcome to The Wellness Transcription Podcast, the podcast that combines the power of Christian 2 00:00:21.320 --> 00:00:26.039 values with evidence based nutrition, fitness, and lifestyle content. I'm your host, 3 00:00:26.039 --> 00:00:30.280 doctor Patrick Early. Join me each week as we explore the intersections of 4 00:00:30.359 --> 00:00:34.479 Christianity and wellness, offering you insights to help nourish your body, mind, 5 00:00:34.560 --> 00:00:38.719 and soul. Whether you're looking to improve your physical health or simply strengthen your 6 00:00:38.759 --> 00:00:44.119 personal relationship with Jesus, We've got you covered. Stay tuned for inspiring discussions, 7 00:00:44.359 --> 00:00:47.799 expert guests, interviews, and practical tips to help you live the life 8 00:00:47.799 --> 00:01:00.799 God calls us to live. All right, guys, thank you for coming 9 00:01:00.799 --> 00:01:03.680 back to another episode of the Wall This Transcription Podcast. It's been a while. 10 00:01:03.760 --> 00:01:07.040 I've had to revamp some things and restart something, but I have a 11 00:01:07.079 --> 00:01:11.040 returning guest where I You're the first returning guest on the show, So thanks 12 00:01:11.040 --> 00:01:15.439 for being Thank you guys. I think it was episode two that we put 13 00:01:15.439 --> 00:01:19.239 out, or two or three actually, where I think me and Ryan were 14 00:01:19.280 --> 00:01:22.560 doing a real deep dive on cholesterol and what all that looks like. And 15 00:01:22.599 --> 00:01:26.159 today I think we're going to talk about an area that your healthcare provider most 16 00:01:26.280 --> 00:01:30.719 likely hasn't talked to you about yet, and that's not only just your typical 17 00:01:30.799 --> 00:01:33.959 cholesterol out to what we're going to be talking about the risks and all that 18 00:01:34.000 --> 00:01:37.640 associated with something that's called remnant cholesterol. So if that's a new term for 19 00:01:37.680 --> 00:01:41.719 you guys, this is something that I think you'll find pretty beneficial. Me 20 00:01:41.760 --> 00:01:45.079 and Ryan work pretty well together in the s field that we're trying to really 21 00:01:45.120 --> 00:01:48.159 figure out a better way to educate people about all the pieces of all this 22 00:01:48.239 --> 00:01:51.920 works together. So with that being said, Ryan, I appreciate you being 23 00:01:51.920 --> 00:01:55.040 here. Thank you for taking time out of your data to chat with me, 24 00:01:55.519 --> 00:01:57.719 and you know I can talk to you for hours, So I just 25 00:01:57.760 --> 00:02:00.640 appreciate you being here and being so willing to help educate people about stuff that's 26 00:02:00.680 --> 00:02:05.359 so important. Yeah, well thanks for having me. Pat. You know 27 00:02:05.400 --> 00:02:07.879 how much Patrick, you know how much I love to educate, So just 28 00:02:07.960 --> 00:02:12.560 whenever you're right into it. So right, this was something that I wasn't 29 00:02:12.639 --> 00:02:15.919 very familiar with as a healthcare wrider. Now I have a little bit more 30 00:02:15.960 --> 00:02:19.639 extensive training and nutrition and other things. I've heard of these words before, 31 00:02:20.400 --> 00:02:23.000 but in practice, I just don't really see it very often. So that's 32 00:02:23.120 --> 00:02:30.120 this concept of really focusing on remnant cholesterol, and even if your cholesterol labs 33 00:02:30.159 --> 00:02:34.199 are good, so to speak, that you may not necessarily be out of 34 00:02:34.240 --> 00:02:38.560 the woods as far as risk goes. For the audience listening, If you 35 00:02:38.599 --> 00:02:42.159 go to your doctor's office and you get your typical cholesterol panal checked, you're 36 00:02:42.199 --> 00:02:47.120 looking at your total cholesterol HDL, LDL and maybe treeglycerides. That's about it. 37 00:02:47.159 --> 00:02:51.560 And your doctor will either say it's good or bad, and if it's 38 00:02:51.680 --> 00:02:55.599 bad, typically what they'll do is they'll start what's called a statin medication that 39 00:02:55.680 --> 00:02:59.159 he would pick up from someone like me at a pharmacy, and then we 40 00:02:59.240 --> 00:03:02.639 go from there. Usually it you're usually ormostatic for a long period of time 41 00:03:04.639 --> 00:03:07.599 and then depending on how lads go depends on if you go up or down 42 00:03:07.639 --> 00:03:12.280 in dose. But remnant cholesterol is not something that's rarely ever checked, but 43 00:03:12.319 --> 00:03:14.800 it can be easily calculated, as me and right are going to go into 44 00:03:15.159 --> 00:03:16.639 details about it. So, Ryan, what can you tell us just in 45 00:03:16.680 --> 00:03:22.360 generally what remnant cholesterol ends and why we should be concerned about it. What's 46 00:03:22.400 --> 00:03:28.680 the literature say, because it's something that's kind of hitting this hitten capturing researchers 47 00:03:28.719 --> 00:03:34.199 and clinicians attention as far as stuff to put to pay attention for. Yeah, 48 00:03:34.280 --> 00:03:39.000 Patrick, For me, as a practitioners well licensed pharmacists, we know 49 00:03:39.120 --> 00:03:46.520 that we focus on LDL and specifically statins, and study after study has shown 50 00:03:46.919 --> 00:03:52.400 the benefit of statins in certain individuals. And what I mean by certain individuals 51 00:03:52.639 --> 00:03:58.599 is that there was a landmark study published in two thousand and none where the 52 00:03:58.759 --> 00:04:06.680 investigators looked at several hundred thousand events cardiovascular events across the nation, and what 53 00:04:06.719 --> 00:04:13.400 they were looking at was how many of those folks had lipid panels, and 54 00:04:13.439 --> 00:04:15.560 they found that there were a little over one hundred thousand of those folks had 55 00:04:15.639 --> 00:04:21.439 lipid panels. And what stood out to them is that literally seventy five percent 56 00:04:21.879 --> 00:04:29.040 of those with cardiovascular events had quote normal or target this is a better way 57 00:04:29.040 --> 00:04:33.560 to put it, target at LDL levels. So it really started this conversation 58 00:04:33.879 --> 00:04:41.120 or really I guess it added momentum to this conversation around Okay, if LDL 59 00:04:41.319 --> 00:04:46.800 lowering represents twenty to thirty percent and pick your number, but it's still a 60 00:04:46.959 --> 00:04:51.000 minority of the overall risks. What are the other factors that come into play 61 00:04:51.319 --> 00:04:57.279 when you're trying to assess your risk factors. We're going to stay in the 62 00:04:57.360 --> 00:05:02.319 lipid space. We're not going to talk today about about really interesting information markers. 63 00:05:02.360 --> 00:05:05.399 Right, we were familiar with reactive protein. We'll maybe leave that for 64 00:05:05.439 --> 00:05:11.160 another day. We'll stay in the lipid space, and specifically, what other 65 00:05:11.439 --> 00:05:18.680 information can we glean from a typical lipid panel and move off of an LDL 66 00:05:18.800 --> 00:05:24.759 sort of centric interpretation of the panels. And so if we take a step 67 00:05:24.839 --> 00:05:30.360 back and we say total cholesterol, what does total cholesterol represent? We know 68 00:05:30.399 --> 00:05:35.560 that total cholesterol obviously a component of that is ld and most of your listeners 69 00:05:35.639 --> 00:05:40.720 are familiar with what we'll call the LDL, right, the bad cholesterol, 70 00:05:41.079 --> 00:05:44.839 the villain, if you will. And then we know that HDL is the 71 00:05:44.920 --> 00:05:49.160 so called good cholesterol. So now you've got total cholesterol, which is comprised 72 00:05:49.199 --> 00:05:57.160 of LDL plus HDL. But there's a third component of that total cholesterol that 73 00:05:57.319 --> 00:06:02.839 receives stray little airtime, if you will, outside the research the clinical research 74 00:06:02.920 --> 00:06:11.959 community, and that are the triglyceride rich remnant proteins okay, blip it proteins. 75 00:06:12.000 --> 00:06:19.000 So basically, the measure the difference between total cholesterol LDL and HDL are 76 00:06:19.160 --> 00:06:26.680 the so called VLDLs. These VLDLs, again, as I said, carry 77 00:06:26.720 --> 00:06:32.120 a lot of our triglycerides, such that if we compare VLDL levels to triglyceride 78 00:06:32.240 --> 00:06:36.120 direct cognasurement, they're pretty close. There's an association, not a strict association. 79 00:06:36.519 --> 00:06:41.839 There are differences, but there's a really good correlation. And so what 80 00:06:42.079 --> 00:06:49.160 this VLDL is triglyceride carrying cholesterol component has become known as one name is remnant 81 00:06:49.240 --> 00:06:56.319 cholesterol. Those have been a lot of research around what contribution is remnant cholesterol 82 00:06:56.399 --> 00:07:01.160 to that residual risk, and so the research is showing that it actually contributes 83 00:07:01.600 --> 00:07:10.920 highly to the residual risk related to cardiovascular events. And so this is important 84 00:07:11.000 --> 00:07:15.279 because now it starts to raise sort of this idea about Okay, since they 85 00:07:15.319 --> 00:07:19.920 are triglyceride carrying, it brings triglycerides back into the mix in terms of discussion 86 00:07:19.959 --> 00:07:25.160 about residual risks. We'll come back that. But first to your listeners, 87 00:07:25.360 --> 00:07:29.920 say, okay, it's a real simple number to calculate. So I have 88 00:07:30.000 --> 00:07:38.120 my total cholesterol that's equal to my LDO plus my HDL plus my remnant cholesterol 89 00:07:38.240 --> 00:07:42.519 or VLDL these triglyceride carrying rocks. So it's really that simple. If I 90 00:07:42.639 --> 00:07:46.199 know my total cholesterol, I can subtract my OLDO, I can track my 91 00:07:46.360 --> 00:07:53.560 HDL, and the leftover. The remaining the residual is that remnant cholesterol VLDL 92 00:07:53.759 --> 00:07:59.920 triglyceride carry So that's where a lot of research is focusing now on remnant cl 93 00:08:00.079 --> 00:08:03.959 lestrol. That's how to calculate. That's why it's important in terms of the 94 00:08:03.959 --> 00:08:07.399 residual. I think, yeah. A couple important points that I like to 95 00:08:07.399 --> 00:08:11.680 make is there's it's a big part of the equation which going back to that 96 00:08:11.720 --> 00:08:15.720 study you first alluded to where they looked at over one hundred thousand patients and 97 00:08:15.839 --> 00:08:20.399 the rates of risk and events that were going on. It says before admission. 98 00:08:20.399 --> 00:08:22.800 I'm looking at the paper now, it says that only twenty one percent 99 00:08:22.839 --> 00:08:28.480 of patients had received some form of lipid lowering medication before they were admitted for 100 00:08:28.600 --> 00:08:31.960 the event. That's important too, is those labs may look fine, and 101 00:08:33.000 --> 00:08:35.159 a doctor may go, you don't need a statin, or you don't need 102 00:08:35.200 --> 00:08:37.919 something right now. Just lifestyle changes things like that, you'll be fine. 103 00:08:39.080 --> 00:08:43.320 Well from a patient perspective, you hear okay, I mean doctor said, 104 00:08:43.360 --> 00:08:46.159 I'm good, I'm not at risk for an event, when in reality you 105 00:08:46.279 --> 00:08:50.919 still could be. You just don't really know. Another thing is that was 106 00:08:50.960 --> 00:08:52.720 done in two thousand and nine, so I'd be hard pressed to think if 107 00:08:52.720 --> 00:08:58.080 you repeated that study now that those numbers would probably be higher. I think 108 00:08:58.159 --> 00:09:01.759 the statin rate is pretty standard now. However, there are a lot of 109 00:09:01.799 --> 00:09:07.039 side effects that statins do bring about that. It's definitely an impact compliance as 110 00:09:07.080 --> 00:09:13.000 far as that goes. And again that statin may get that LDL quote bad 111 00:09:13.080 --> 00:09:16.039 cholesterol in range, but that doesn't if you're not looking at the other pieces 112 00:09:16.039 --> 00:09:18.679 of the puzzle like you're talking about, we're not looking at remnant chosterol. 113 00:09:18.679 --> 00:09:24.399 We're not really factoring in the impact trogly rides have in that whole process, 114 00:09:24.440 --> 00:09:28.799 where just we might be missing a big piece of the puzzle as far as 115 00:09:30.000 --> 00:09:33.879 getting all that in check goes. So, I mean, here's another part. 116 00:09:33.919 --> 00:09:37.600 It says almost half the LDL levels we're less than one hundred milligrams per 117 00:09:37.600 --> 00:09:41.519 desolator. More than half the patients have in minsioned HDL levels less than forty 118 00:09:41.639 --> 00:09:46.799 whereas less than ten percent have HDL levels greater than sixty. What that means 119 00:09:46.480 --> 00:09:52.000 LDL looks okay. HDL is in the majority of patients more than half, 120 00:09:52.080 --> 00:09:56.399 where subpar forty is for female. I minimum would like it to be forty 121 00:09:56.440 --> 00:10:01.000 five to fifty, probably higher if you can or females. Males can get 122 00:10:01.000 --> 00:10:05.320 away with a little bit less, so forty five or higher for them is 123 00:10:05.399 --> 00:10:11.080 usually okay. But that's one part of the pharmacological piece of at all is 124 00:10:11.080 --> 00:10:16.840 there's really not anything available behind the counter, like prescription wise or even over 125 00:10:16.879 --> 00:10:22.279 the counter that really affects HGL to any degree. The only thing that was 126 00:10:22.399 --> 00:10:28.000 used clinically for a long time was diacin that did actually impact HBL levels a 127 00:10:28.000 --> 00:10:30.279 good bit, but you had to take very high doses of it. And 128 00:10:30.320 --> 00:10:33.960 I can tell you as someone who's taking too many B vitamins that once before 129 00:10:33.519 --> 00:10:37.159 that it is not fun. I was driving home from or I was driving 130 00:10:37.200 --> 00:10:39.879 to work at the pharmacy when I was in pharmacy school, and I had 131 00:10:39.879 --> 00:10:43.519 taken my settlements that morning, and I'd forgotten I was doing something else, 132 00:10:43.519 --> 00:10:48.120 so I took my settlements again. And normally that's not a problem, doeshn't 133 00:10:48.120 --> 00:10:50.200 to worry about. But I'm driving to work and it's like a cold December 134 00:10:50.279 --> 00:10:52.879 day and I'm like, yeah, I'm warm. What is happening? Like, 135 00:10:52.919 --> 00:10:56.879 I don't this doesn't feel right this. I'm like, I'm this is 136 00:10:56.919 --> 00:10:58.799 not good. I look in my rear view. I look in my mirror, 137 00:10:58.799 --> 00:11:03.720 and I am I look like a lobster, like I am here reared 138 00:11:03.879 --> 00:11:07.879 everywhere, and I'm like, that's not good. Maybe I'm like, you 139 00:11:07.919 --> 00:11:09.519 know, something's wrong. Oh no, I took too much of my niosin, 140 00:11:09.639 --> 00:11:13.519 like too much of my bee vitamins that I sense was causing this flushing. 141 00:11:13.559 --> 00:11:16.240 I got to work and to my boss goes, do you go to 142 00:11:16.279 --> 00:11:22.720 the beach this weekend? And to just stay there. So it's it's interesting 143 00:11:22.720 --> 00:11:24.080 because you can still use high to his knives and there's a prescription, but 144 00:11:24.200 --> 00:11:30.279 again, it's so rough on the system that a lot of times doctors are 145 00:11:30.279 --> 00:11:33.000 like, patients aren't gonna stick with this. So there's really as far as 146 00:11:33.039 --> 00:11:35.559 getting HDL up, they just say eat more fatty fish and kind of keep 147 00:11:35.600 --> 00:11:39.720 your you know, exercise and all that and check and it might go up. 148 00:11:39.399 --> 00:11:41.480 But that's a whole other piece of the puzzle too. I just thought 149 00:11:41.519 --> 00:11:46.600 that was interesting about that study because it's it's really startling when you think about 150 00:11:46.600 --> 00:11:48.840 it, because I mean, if your level can be that good and you 151 00:11:48.919 --> 00:11:52.320 still have events, I mean you're talking about just about everybody at that point, 152 00:11:52.000 --> 00:11:54.320 is it risk for those things? Yeah, So I think it's really 153 00:11:54.360 --> 00:12:00.519 important to understand the man and how to calculate the vel. Also, to 154 00:12:00.600 --> 00:12:07.200 your listeners, I'll use VLDL and rhymnet cholesterol interchangeably. I point that out 155 00:12:07.279 --> 00:12:15.759 because technically remnant cholesterol is your VLDL the intermediate ditity so ideal, but I 156 00:12:15.799 --> 00:12:18.080 think your listeners need to know that as well. So I am fluedging a 157 00:12:18.080 --> 00:12:22.399 little bit lumping in IDL and VLDL, but so your readers know that. 158 00:12:22.480 --> 00:12:30.279 But that's important because for two reasons. One is VLDL when it interacts with 159 00:12:30.440 --> 00:12:33.200 HDL. We'll talk about that in a minute. To offload a lot of 160 00:12:33.240 --> 00:12:37.879 the bad lippets. As it decreases in size, the VLDL, then that's 161 00:12:37.919 --> 00:12:45.200 what becomes the LDL. So said differently, VLDL through interaction with HDL is 162 00:12:45.240 --> 00:12:50.320 turned into LDL. And so that's important for two reasons. Is if you 163 00:12:50.519 --> 00:12:56.639 talk about LDL, we know that they're really two proponents to that LDL. 164 00:12:56.639 --> 00:13:01.399 There's one that's non genetically determined and one that's genetic determined. So you'll hear 165 00:13:01.480 --> 00:13:07.720 patients when practitioners talk about at L little age. But basically, that's your 166 00:13:07.759 --> 00:13:13.000 portion of LDL that is bound to another lip of protein app of protein eight 167 00:13:13.519 --> 00:13:18.200 and it's genetically to move for the most part, and so it doesn't appear 168 00:13:18.320 --> 00:13:24.600 that SI statins impact that portion of LDL to any great extent. So I 169 00:13:24.600 --> 00:13:28.799 always like to give patients rationale its like you may be on a high those 170 00:13:28.799 --> 00:13:33.080 statin and you still have this stubbornly high LDL. It could be that you 171 00:13:33.240 --> 00:13:37.000 have that genetic component of LDL that just remains stubbornly high. So keep that 172 00:13:37.080 --> 00:13:43.360 in mind as you're talking about LDL. And where LDL comes from ultimately comes 173 00:13:43.360 --> 00:13:48.200 from VLDL remnant cholesterol. Okay, So the other part of that in terms 174 00:13:48.240 --> 00:13:58.240 of relationships is we know that remnant cholesterol is in balance with your HDL. 175 00:13:58.440 --> 00:14:01.679 Do they interact? So another words of the LDL, it's carrying those triglycerides, 176 00:14:01.879 --> 00:14:09.200 it's carrying that free cholesterol, and so through interacting with HDL VLDL all 177 00:14:09.200 --> 00:14:13.360 floats, does triglycerides st HDL, it all floads that free cholesterol to HDL, 178 00:14:13.879 --> 00:14:18.159 and so that's the other reason why you want to have higher HDL levels. 179 00:14:18.159 --> 00:14:22.279 You've got to have us think, right, those clesterol and triblysterride molecules 180 00:14:22.279 --> 00:14:28.679 from vldal ideally go to HDL. So if you look at numbers, typically 181 00:14:28.759 --> 00:14:31.480 what you'll see as an inverse relationship. If you have high rimnict cholesterol, 182 00:14:31.759 --> 00:14:37.159 you'll have low HDL, and vice versa. These are generalizations, but if 183 00:14:37.200 --> 00:14:41.240 you're just looking at your numbers, and that makes sense because HDL is that 184 00:14:41.480 --> 00:14:46.279 sync for those triblycerides and free cholesterol that are coming from the remnant cholesterol. 185 00:14:46.399 --> 00:14:52.559 So that's the other really important reason to understand what that remnant cholesterol number is. 186 00:14:54.080 --> 00:14:58.919 And then in relation to your HDL, it gives you some idea of 187 00:14:58.960 --> 00:15:03.519 how well you're clearing not only clearing your clysterides, we're not, but what's 188 00:15:03.559 --> 00:15:07.080 the source to those triglyrods. Then you get into the next step, which 189 00:15:07.120 --> 00:15:13.159 is really Okay, if I have hot rimnedy cholesterol and I have low HDL, 190 00:15:13.559 --> 00:15:18.159 what options do I have? And I think that's where I think your 191 00:15:18.159 --> 00:15:20.559 listeners might be interested to say, Okay, First, where do those vo 192 00:15:20.600 --> 00:15:26.080 deals come from? And why might I have an overload of those veils. 193 00:15:26.159 --> 00:15:30.240 I'll make two important points because I would say, I want to say it's 194 00:15:30.279 --> 00:15:35.000 around twenty percent of the cholesterol and is impacted by diets. So that's what's 195 00:15:35.000 --> 00:15:39.320 called exogenous cholesterol. So you've got you eat something with that at it it 196 00:15:39.360 --> 00:15:43.200 gets broken down, it's terified and then bile, and then it gets absorbed 197 00:15:43.200 --> 00:15:48.879 by things called kylum microns. Colum Microns transport those across the intestinal barrier into 198 00:15:48.919 --> 00:15:52.879 the liver, where they're then packaged and done. So that that is so 199 00:15:52.960 --> 00:15:54.559 if people say, oh, you know, my doctor said that in order 200 00:15:54.559 --> 00:15:58.039 to get my cholesterol down, I have to eat you know, less eggs 201 00:15:58.080 --> 00:16:03.559 or less cholesterol rich foods and vice versa, you're all that stuff might be 202 00:16:03.600 --> 00:16:07.480 okay to do. I don't cast you. Reducing it doesn't make much of 203 00:16:07.480 --> 00:16:11.960 a difference in my opinion, if you eat foods that are hiring cholesterol. 204 00:16:11.960 --> 00:16:15.200 There's a lot of healthier foods that are, it really doesn't move the needle 205 00:16:15.240 --> 00:16:18.519 there as much. So that's an important piece to keep in mind is what 206 00:16:18.559 --> 00:16:22.279 we're really talking about with these risk factors is more of a dodgenous production of 207 00:16:22.600 --> 00:16:26.519 cholesterol, which is your liver. One of your liver's primary jobs is the 208 00:16:26.519 --> 00:16:32.360 production and packaging of these things. An important thing. You mentioned ideal earlier 209 00:16:32.399 --> 00:16:36.919 too, and it's important for people to go, Okay, well, let's 210 00:16:36.960 --> 00:16:38.799 say I coloculated my remnant, but I don't know what my ideal is. 211 00:16:38.879 --> 00:16:42.600 Ideals intermediate for a reason, it's halfleck. This is very short. It 212 00:16:42.600 --> 00:16:48.879 gets quickly converted to BLDL pretty fast. Yeah, or yeah ldld quickly, 213 00:16:48.919 --> 00:16:51.480 like both. It's a fast process. So it's really even if you were 214 00:16:51.519 --> 00:16:53.919 to able to measure it, it's like it's not necessarily very useful because it's 215 00:16:53.960 --> 00:16:57.919 so hard to kind of catch. You'd have to get the live measure stuff 216 00:16:59.080 --> 00:17:03.000 really quickly. But yeah, I think for most people on statins, again, 217 00:17:03.039 --> 00:17:06.079 if we're only looking at one piece of the puzzle, we're just for 218 00:17:06.200 --> 00:17:10.079 missing things. And then again it's what else can you do to kind of 219 00:17:11.599 --> 00:17:15.640 affect the other things? Because the reason HDL is oftentimes referred to as good 220 00:17:15.680 --> 00:17:19.799 cholesterol or it's very it helps a lot with reverse cholesterol transport, which is 221 00:17:19.799 --> 00:17:25.720 what you mentioned, but without saying reverse cholesterol transport. It helps take that 222 00:17:25.839 --> 00:17:29.359 cholestero back up, send it back to the liver where it's recycled and reused. 223 00:17:29.799 --> 00:17:33.519 But again, if your HDL is low, we're dumping off more l 224 00:17:33.559 --> 00:17:37.759 el in cholesterol rich things than we are actually recycling it back, and then 225 00:17:37.799 --> 00:17:41.720 your triglysrids go up. And it's always kind of this vicious cycle. So 226 00:17:41.759 --> 00:17:45.960 thank you for eloquently explaining that one. But those are those are some things 227 00:17:45.039 --> 00:17:51.359 that are important to keep in mind to that. Yeah, so what do 228 00:17:51.400 --> 00:17:55.440 you want to do as a patient. As a healthcare practitioners, you know 229 00:17:55.559 --> 00:18:00.319 that statins are in your armamentarium for lowering YELD. Great, it's if they 230 00:18:00.319 --> 00:18:03.880 work in your patients used, right, it's you know best in your patient. 231 00:18:03.160 --> 00:18:07.400 I think the other piece where we're bringing up here these residual risk factors 232 00:18:07.799 --> 00:18:15.599 is okay, how do we reduce remnant cholesterol and how do we increase our 233 00:18:15.839 --> 00:18:22.079 HDL? And so we said they're related, so you can impact both in 234 00:18:22.799 --> 00:18:29.920 a decrease VLDAL increase HDL and have an added potential synergistic effect. And so 235 00:18:29.960 --> 00:18:34.519 the other part of that is when those VLDLs via IDL are converted to LDL, 236 00:18:36.000 --> 00:18:41.079 recognize that removes the triglycerides. In other words, ldl's not carry triglycerides 237 00:18:41.640 --> 00:18:45.200 l els, right, And that's the process of going from vld old id 238 00:18:45.319 --> 00:18:49.119 old lios. So that's the other remnant cholesterol is that triglyceride carrying component lip 239 00:18:49.200 --> 00:18:53.559 protein LDL is not. So that's the other reason to focus on those triglycerides. 240 00:18:53.920 --> 00:19:02.000 And you appropriately pointed out those triglycerides are full initially in the liver. 241 00:19:02.279 --> 00:19:07.279 And we can talk for three podcasts about how triglycerides excess triglytrides get into the 242 00:19:07.319 --> 00:19:11.599 liver, but whether say that for another day. But the bottom line is 243 00:19:11.920 --> 00:19:15.960 to be able to impact rhymnic cholesterol, you've got to be able to impact 244 00:19:17.160 --> 00:19:22.240 synthesis of these remnant cholesterol, these VLDL molecules in the liver. And this 245 00:19:22.279 --> 00:19:26.880 is where it gets really fascinating, Patrick, because we really don't talk about 246 00:19:26.880 --> 00:19:32.599 this in pharmacy school, medical school, pharmacolleague, pharmacology in general. Excuse 247 00:19:32.640 --> 00:19:37.440 me it. For me, it's most exciting because the first is the debt. 248 00:19:37.680 --> 00:19:42.559 Okay, if you're going to reduce VLDL, what's the literal first step 249 00:19:42.640 --> 00:19:51.079 in the liver. The first step begins with april lipoprotein B one hundred synthesis. 250 00:19:52.319 --> 00:19:56.200 So for the nerd listeners like myself that you have today, right, 251 00:19:56.440 --> 00:20:03.000 it's called apo B one hundred simply because because it uses one hundred percent of 252 00:20:03.039 --> 00:20:07.799 the amino acids in the gene for an apole B. That's what it's called 253 00:20:07.799 --> 00:20:11.440 OB one hundred. It's one of the largest proteins in the bodies, like 254 00:20:11.920 --> 00:20:17.240 over forty five hundred amino acids. One hundred just means that when you synthesize 255 00:20:17.319 --> 00:20:22.400 VLDL and you create that first step april B one hundred, it's using every 256 00:20:22.400 --> 00:20:27.559 one of those amino acids. But that's important to distinguish because if you the 257 00:20:27.599 --> 00:20:34.440 first part of the translating that april B one hundred in the hepatocyte, it 258 00:20:34.559 --> 00:20:41.039 only uses the first one hundred or so amino acids to begin the process. 259 00:20:41.279 --> 00:20:47.519 While that's important is if you look at the lipid composition of that april B 260 00:20:47.640 --> 00:20:55.440 one hundred beginning there in that patasite, it is seventy percent phosphatidocholiines. It 261 00:20:55.480 --> 00:21:00.279 only has twelve molecules a triblys ride, It only has six molecule us A 262 00:21:00.359 --> 00:21:07.480 cholesterol. It has fifty molecules of phosphatidal colines. And so step one in 263 00:21:07.640 --> 00:21:17.640 synthesizing triglyceride rich VLDL that are ultimately secreted into the bloodstream is comprised of phosphatidal 264 00:21:17.720 --> 00:21:23.119 colines. And so you've got to really understand how phosphacidal colines play into that 265 00:21:23.400 --> 00:21:29.680 synthesis. Okay, so that's where my interest is. As you know, 266 00:21:29.880 --> 00:21:33.960 Patrick, it says, all right, it's not just phosphatidal colines, because 267 00:21:33.960 --> 00:21:38.720 they're literally thousands of different species of phosphidal colides that are produced by the liver. 268 00:21:40.079 --> 00:21:45.559 What's fascinating to me is this the right ratio of polyensaturated fatty acid as 269 00:21:45.640 --> 00:21:49.960 well as saturated fatty acid containing phosphidal colies. If you get a disruption in 270 00:21:51.000 --> 00:21:56.240 that balance, what happens is that April B one hundred is degraded. It 271 00:21:56.319 --> 00:21:59.920 never gets converted, goes to the next step where now you start piling on 272 00:22:00.039 --> 00:22:03.920 the triglycerides, and you start piling on the cholesterols, and the cholesterol esters 273 00:22:03.960 --> 00:22:07.200 and it matures and then it is secreted. And so if you mess up 274 00:22:07.240 --> 00:22:12.240 that first step with those spospitive coalings, then it degrades. Guess what happens. 275 00:22:12.440 --> 00:22:17.759 That means those triglycerides stay in the liver, that cholesterol stays in the 276 00:22:17.759 --> 00:22:21.680 liver. But I know what that means. That's the big BA de liver 277 00:22:21.759 --> 00:22:26.200 disease, right, those lipid droplets, and so you don't get those phosphatidal 278 00:22:26.240 --> 00:22:30.680 colings right on the front end, you don't get efficient synthesis of VLDLs, 279 00:22:30.880 --> 00:22:37.440 you don't get efficient secretion of triglycerides lipids from the liver, and you don't 280 00:22:37.440 --> 00:22:42.440 get them out there in the plasma where they can interact with HDL molecules and 281 00:22:42.519 --> 00:22:48.119 thereby strip them of their triglycerides of pre cholesterol. That's what HDO does. 282 00:22:48.400 --> 00:22:55.079 So that's component one why those spostatidal coling molecules and metabolism in particular are so 283 00:22:55.480 --> 00:23:00.079 critical. But there's a second piece. So that's how I just now, 284 00:23:00.160 --> 00:23:04.200 it impacts the VLDL side of the VLDL rhymnic chlesterol HDLs, But how does 285 00:23:04.240 --> 00:23:11.799 it affect HDL it self? And we know that there's certain polysaturated fatty acid 286 00:23:11.920 --> 00:23:18.920 containing phosphat of colines that promote HDL synthesis. Said differently, if you have 287 00:23:18.079 --> 00:23:25.680 the right mixture including polynsaturated fatty acids EPA and DHA in particular. Then you 288 00:23:25.920 --> 00:23:32.400 promote synthesis of HDL in the plasma through interaction with the enzyme l cat or 289 00:23:32.480 --> 00:23:37.960 lesser than cholesterol acetyl transformational can. So now you start to see if rhemnic, 290 00:23:38.039 --> 00:23:41.759 cholesterol and HDL are critical and they relate with each other. Right, 291 00:23:41.839 --> 00:23:45.880 one offlow strip glyceritis three cholesterol, the others in exchange for cholesterol esters. 292 00:23:45.960 --> 00:23:49.839 Right, that's what's answered back to VLDL. If you look at phosphide of 293 00:23:49.920 --> 00:23:56.000 colines, it impacts that GLDL synthesis and secretions. It impacts the HDL, 294 00:23:56.480 --> 00:24:03.279 So it tends to decrease VLDL rhymnic chlesterol and the increase HDL. That's where 295 00:24:03.359 --> 00:24:08.319 we are now in terms of the conversation as as far as a new mechanism, 296 00:24:08.799 --> 00:24:14.799 No one to my knowledge besides us, are talking about that as the 297 00:24:14.880 --> 00:24:19.279 mechanism. Now what are we talking about. We're talking about high dose synthetic 298 00:24:19.680 --> 00:24:27.079 EPA for triglycerides in patients that are have high triglycerides that aren't impacted by statins. 299 00:24:27.680 --> 00:24:33.200 I don't know if you saw a couple of weeks ago the EMA Medical 300 00:24:33.240 --> 00:24:41.279 Association, thank you, they came out and stated strongly that looking at the 301 00:24:41.799 --> 00:24:47.160 evidence in Toto that you should really watch your patients that are taking high dose 302 00:24:47.279 --> 00:24:53.680 EPA for triglycerides for increased instance of a fit. Right, they said it 303 00:24:55.000 --> 00:24:56.519 is causing. So in other words, if you look back at all the 304 00:24:56.599 --> 00:25:03.359 meta analyses, if you're above one grand per day of EPA, your risk 305 00:25:03.799 --> 00:25:07.839 of aphibs starts to increase. For every grand per day. Above wearing one 306 00:25:07.920 --> 00:25:11.960 grand per day, you get about a ten percent increase in risk. So 307 00:25:11.119 --> 00:25:15.759 that when you get up to four grams per day, which was the reduce 308 00:25:15.839 --> 00:25:19.640 it tron, you see an increase in aphib risk of almost fifty percent. 309 00:25:21.359 --> 00:25:23.759 And so now you start to say, well, okay, we really don't 310 00:25:23.839 --> 00:25:26.640 have a lot of great options. You talked about NIS and when I say 311 00:25:26.680 --> 00:25:32.279 options, options are treating high triblycerides. And now you know why that's important 312 00:25:32.519 --> 00:25:36.720 rin the cholesterols in the contact, particularly of low HDL. And so if 313 00:25:36.799 --> 00:25:40.359 we don't have a lot of options, we do a vibration. Again, 314 00:25:40.440 --> 00:25:44.039 I don't, I don't. I'm sorry to interrupt, but I don't see 315 00:25:44.079 --> 00:25:47.599 a lot as a pharmacist, and I view a lot of pharmacy stuff. 316 00:25:47.680 --> 00:25:49.359 Let's be honest, I feel a lot of restrictions and a lot of different 317 00:25:49.480 --> 00:25:53.400 age grips and patient demographics, so I see kind of what's archaeting, what's 318 00:25:53.480 --> 00:25:59.559 up? I rarely see fit of five rates used anymore. Now is does 319 00:25:59.640 --> 00:26:03.960 that mean it's not used more frequently? No, But however it I just 320 00:26:03.039 --> 00:26:07.799 don't see it. They also come with side effects too that are pretty rough. 321 00:26:07.240 --> 00:26:10.559 They are kind of hard on the liver a little bit, and they 322 00:26:10.640 --> 00:26:15.240 do they have their own citizen. Again, no drug is without side effects. 323 00:26:15.279 --> 00:26:19.680 So if you're stacking a stat and have been a fibrite together, you 324 00:26:19.759 --> 00:26:26.119 know you can. Depending on which ones they are, you may be helping 325 00:26:26.279 --> 00:26:29.519 yourself from a blood worker perspective, but if you're causing, if you're increasing 326 00:26:29.559 --> 00:26:30.839 the likelihood for them to see adverse effects, I'm just not going to be 327 00:26:30.880 --> 00:26:34.359 compliant with it. And then we're back to squore one. It's a whole 328 00:26:34.400 --> 00:26:37.359 other important thing that I want to interject one one more time, and I'll 329 00:26:37.400 --> 00:26:40.720 let you get back to go because it's fascinating to me because, like you 330 00:26:40.759 --> 00:26:42.640 said, no one's talking about this, because no one really understands what's going 331 00:26:42.680 --> 00:26:48.119 on. I read a book a long time ago and I'm pretty sure. 332 00:26:48.799 --> 00:26:51.039 Yeah, it was one of the fasting books I remember. I think it 333 00:26:51.119 --> 00:26:55.160 was doctor Fun's fasting book I read two years ago, and he made an 334 00:26:55.200 --> 00:26:57.519 offhand comment in the book that just didn't It stuck with me, but I 335 00:26:57.559 --> 00:27:00.880 don't know why I remember it. And he was talking about how you know, 336 00:27:00.960 --> 00:27:03.440 when you eat too much you have insular resistance, Like all these bats 337 00:27:03.480 --> 00:27:07.960 get have to get deposited in different tissues, so that's when then they go 338 00:27:07.079 --> 00:27:10.920 deliver first. And it's like, that's what causes fat de liberties. In 339 00:27:11.000 --> 00:27:14.839 my head of it's that's not that simple, Like it's not just that part. 340 00:27:14.960 --> 00:27:17.799 Now that may play in for sure, because a lot of times in 341 00:27:17.880 --> 00:27:22.079 diabetics we see insular resistance and all these other issues, we're also going to 342 00:27:22.119 --> 00:27:27.640 see cholesterol issues and those go hand and hand. However, your mechanism and 343 00:27:27.720 --> 00:27:33.240 what I'm hearing, what we've talked about for hours off my off recording, 344 00:27:33.839 --> 00:27:37.680 is this seems to make more sense from a mechanistic standpoint of why we're seeing 345 00:27:37.680 --> 00:27:41.720 the fatt delivered disease rates. We're seeing why these things are going up because 346 00:27:41.720 --> 00:27:45.680 they're all everything. It's important to remember everything in the body is tied together, 347 00:27:47.200 --> 00:27:52.400 so as clinicians that they could for in pharmacy school, we oftentimes tend 348 00:27:52.440 --> 00:27:56.759 to compartmentalize certain areas, so it'll be like we're talking about cholesterol. We 349 00:27:56.839 --> 00:28:00.759 know that affects diabetes and stuff, but then we're talking about other things. 350 00:28:00.839 --> 00:28:06.680 So AFM is never brought up as far as I'm concerned with, like cholesterol 351 00:28:06.759 --> 00:28:10.119 and synthes works in the system and if you get one of these off or 352 00:28:10.480 --> 00:28:15.240 others are just kind of compounds. But that's really important that you mentioned that, 353 00:28:15.319 --> 00:28:21.519 because I think, go ahead, yeah, well I'll pick up there 354 00:28:21.559 --> 00:28:25.599 right where you tee it up. So right, doctor Phong nephrologists, Canadian 355 00:28:25.640 --> 00:28:29.279 nefrogs right, big believer Internet facing us. But I remember quickly the books 356 00:28:29.279 --> 00:28:34.559 called a Unity Code, that really fascinating ideas about how you change fatty acid 357 00:28:34.960 --> 00:28:38.960 metabolism in the liver. And I think that's a really important point here because 358 00:28:40.000 --> 00:28:45.000 it ties into what we're talking about. So again, regardless of how you 359 00:28:45.200 --> 00:28:49.799 get fatty acids formed, whether it's coming from the adipocide right breakdown and fatty 360 00:28:49.799 --> 00:28:53.680 acids are transporting pre fatty acid training by transported back delivered, or we're talking 361 00:28:53.720 --> 00:29:00.799 about fruptosu blue coals that through donovol lypogenesis are forming these fatty acid and then 362 00:29:00.880 --> 00:29:06.000 combining them with glycerl molecules. Right, we know that those fatty acids combined 363 00:29:06.079 --> 00:29:11.759 with glycols to form monoase oft prize for glycrool. But why I painstakingly go 364 00:29:11.920 --> 00:29:19.240 through that step by step is at the stage of diaso glycol the disoglyceol has 365 00:29:19.480 --> 00:29:25.119 at least two pathways, two primary pathways it can take. It can have 366 00:29:25.240 --> 00:29:30.799 an additional fatty acid attached and turn into a triasy glycol right triblyceride. But 367 00:29:32.000 --> 00:29:38.400 what most people don't talk about is that diaso glyceraol is also a precursor for 368 00:29:38.839 --> 00:29:47.880 phosphatidyl coline synthesis. And so if you have properly operating phosphatidical coline synthesis, 369 00:29:48.319 --> 00:29:55.400 it's consuming a number of those diaso glyceride molecules that are produced in the liver. 370 00:29:56.000 --> 00:30:00.759 Said differently, those diasoglyceride molecules that are going into five through the coalings 371 00:30:00.039 --> 00:30:07.200 are not going into triblycerize and vice versa. And so that's yet another reason 372 00:30:07.160 --> 00:30:15.759 in link between proper phosphattic coaling metabolism and fat production and deposition in the liver. 373 00:30:17.359 --> 00:30:23.200 So the idea is this, if you can figure out how to positively 374 00:30:23.359 --> 00:30:32.759 impact phosphitic coaling metabolism, you can potentially impact remnant cholesterol and HDL and all 375 00:30:32.920 --> 00:30:37.640 the downstream things that are related. Things pathophysiologies that are related that we know 376 00:30:37.759 --> 00:30:42.480 about and that we don't know about that are we're just starting to appreciate and 377 00:30:42.559 --> 00:30:47.599 some of the things we're seeing anecdotally in the patients that are taking this supplement 378 00:30:48.039 --> 00:30:52.759 that's been developed by my group over the last few years. And so it's 379 00:30:52.799 --> 00:31:00.119 a unique mechanism. It focuses solely, not primarily, It focuses solely on 380 00:31:00.200 --> 00:31:06.720 the nutritional deficiencies that we see in patients that impact plastord to colding metabolism completely 381 00:31:07.359 --> 00:31:11.400 natural it will. Therefore, I think that's why we're seeing some of the 382 00:31:11.559 --> 00:31:17.960 really cool results that we're seeing in patience when it comes to alterations in lipid 383 00:31:18.039 --> 00:31:21.599 pms. Yeah, it's very important. Yeah, there's a piece that no 384 00:31:21.680 --> 00:31:25.279 one's talking about, and the fact that we that you've developed a potential answer 385 00:31:25.359 --> 00:31:29.319 to that. I mean, it's I've seen it work. It's very important. 386 00:31:30.039 --> 00:31:34.279 I just it's my mind can go on all sorts of different things. 387 00:31:34.319 --> 00:31:41.480 I'm looking at this. Yeah, I mean there's really never been an answer 388 00:31:41.559 --> 00:31:45.160 to how do we get those ratios correct? You know, normally, And 389 00:31:45.200 --> 00:31:48.359 when I mentioned this before on the last podcast I had you one, normally 390 00:31:48.440 --> 00:31:52.480 they'll go, okay, well, EPA and DHA, we know we're good 391 00:31:52.559 --> 00:31:55.559 and the racious for what high quality officials instead of so let's do that, 392 00:31:55.759 --> 00:31:57.680 let's exercise, let's do some other things, and you're kind of hoping at 393 00:31:57.720 --> 00:32:02.039 that point. You don't really know how all that gets utilized. And I 394 00:32:02.119 --> 00:32:07.519 think that's so important. Where the Sessamon component comes in is because I was 395 00:32:07.559 --> 00:32:09.599 looking I was just curious. I was looking into a lot of the studies 396 00:32:09.720 --> 00:32:15.000 just thought of sesame oil in general and their effects on cardio metabolic risk factors 397 00:32:15.039 --> 00:32:16.759 and things like that. In time. Again, in all the papers, 398 00:32:16.799 --> 00:32:21.640 you see LDO goes down, HDO goes up, Tragosa reds drop like it's 399 00:32:21.720 --> 00:32:25.640 over it up. You see in multiple systematic reviews it's like people who utilize 400 00:32:25.680 --> 00:32:29.799 this and have this as a mainstay of their diet, that there is marketing 401 00:32:29.920 --> 00:32:32.480 provements. And then every study that I saw says they need to figure out 402 00:32:32.519 --> 00:32:37.240 mechanistically how this is going on and why this is happening, because it just 403 00:32:37.400 --> 00:32:38.759 it looks good, but we just don't know why. And I think that's 404 00:32:39.079 --> 00:32:43.880 you've kind of really teased that out, I think, and it's been it's 405 00:32:43.960 --> 00:32:46.880 that missing piece because a lot of times when people see these changes happening in 406 00:32:46.920 --> 00:32:52.240 the liver and metabolism, they tend to oversimplify what's actually going on. And 407 00:32:52.720 --> 00:32:57.640 to my knowledge, I never heard of it before getting involved with you and 408 00:32:57.720 --> 00:33:00.519 talking about this and kind of getting into the weeds. I have never heard 409 00:33:00.759 --> 00:33:05.640 of fosphitooch coolon being a part of that to any great degree. Only on 410 00:33:05.720 --> 00:33:09.759 the handful of podcast as that mentioned, but it's never the mainstay of the 411 00:33:09.799 --> 00:33:15.400 conversation. So I think that's really it's well, it's interesting, Patrick, 412 00:33:15.440 --> 00:33:20.359 because it's like anything else. The literature is out there. There are some 413 00:33:20.680 --> 00:33:25.680 brilliant biochemists who have worked out VLDL synthesis and the role of phosphit of coolies, 414 00:33:25.759 --> 00:33:29.519 the role of the ratio poster doth that all means a hospital coli, 415 00:33:29.880 --> 00:33:34.599 the role of triglycerides, etc. The are brilliant biochemists have worked out how 416 00:33:34.680 --> 00:33:40.920 sostitial colines impact the HDLs. But that's been sort of in your silos where 417 00:33:42.039 --> 00:33:45.319 that's what you're funded to do as a researcher, and you does some really 418 00:33:45.440 --> 00:33:50.599 interesting works, but no one to my knowledge, at least outwardly and in 419 00:33:50.759 --> 00:33:53.480 podcasts like this, is talking about how you call all that information together to 420 00:33:53.680 --> 00:34:01.839 provide a potential I keep emphasizing potential solution for patients. And I was in 421 00:34:01.920 --> 00:34:06.359 the military for a number of years and one of my favorite things that had 422 00:34:06.400 --> 00:34:08.639 a boss that always told me said, pedosciates, don't come to me with 423 00:34:08.760 --> 00:34:12.880 a problem, and you have a solution. And so a lot of people 424 00:34:13.000 --> 00:34:17.079 have problems. But it's frustrating as a practitioner if you know there's seventy five 425 00:34:17.199 --> 00:34:22.480 percent residual cardiovascular risk, but you don't have anything to tell patients. And 426 00:34:22.559 --> 00:34:27.960 I'm not suggesting for one second that this supplement of the UREAU or treatment mitigation 427 00:34:28.159 --> 00:34:31.480 whatever. Would never say that, But what I would say is it begins 428 00:34:31.639 --> 00:34:37.480 to address the nutritional deficiencies. And by definition, right in the course with 429 00:34:37.599 --> 00:34:45.440 the SHA dietary c health education now is a supplement to diet which can positively 430 00:34:45.840 --> 00:34:52.559 impact fostered or coding metabolism and thus through mechanisms that are completely I don't say 431 00:34:52.559 --> 00:34:57.679 complete, you're never perpleleg but are really well characterized, will have an impact 432 00:34:57.800 --> 00:35:02.480 on these different lipid parameters. These are known pathways. You just have to 433 00:35:02.559 --> 00:35:08.960 be able to impact them in a positive way without causing horn. And when 434 00:35:09.039 --> 00:35:16.000 we take the reductionist approach of everything is sort of a pharma. It's a 435 00:35:16.119 --> 00:35:21.440 one size fits all. Its EPA is really good, and now we're going 436 00:35:21.519 --> 00:35:28.199 to give you four grams per day of synthetic EPA, right extroversion, then 437 00:35:28.440 --> 00:35:30.920 that's going to be even better. Well, the data are clear and the 438 00:35:31.039 --> 00:35:36.320 EMA is spoken, and cardiologists in the world is spokens. That's not okay. 439 00:35:36.760 --> 00:35:38.559 There are side of that. So when you take the reductionist approach, 440 00:35:38.920 --> 00:35:45.000 so why don't we do what nature does, take a step back and say, 441 00:35:45.119 --> 00:35:50.000 this is a systems pharmacology. This is a multifactorial process. I don't 442 00:35:50.239 --> 00:35:55.159 need to shove four grams of EPA into somebody to ECHI is that I need 443 00:35:55.239 --> 00:36:00.880 to have some a way to impact piland saturated fat as metabolism step once, 444 00:36:00.159 --> 00:36:07.159 and then those downstream events that augment that proper diet. And believe me, 445 00:36:07.599 --> 00:36:12.400 I'm not here even advocating taking official suppment. I'm here advocating eat your fatty's 446 00:36:12.559 --> 00:36:19.119 ish once a week twice. What are I think the average recommendation from the 447 00:36:19.239 --> 00:36:22.559 USDA, the food organizations here as well as an em A and all that 448 00:36:22.599 --> 00:36:27.719 stuff. I want to say it's minimum two a week, if you can 449 00:36:27.960 --> 00:36:30.800 ideally three two to three. It seems to be the sweet spot. Now 450 00:36:30.880 --> 00:36:35.280 again, if you eat every if you're piscatarian and that's the only meat, 451 00:36:35.280 --> 00:36:39.360 so yeah, that's fine. Yeah, I guess my point is that it's 452 00:36:39.800 --> 00:36:45.079 yes, it always starts with eat right and exercise, but in this case 453 00:36:45.159 --> 00:36:49.719 it stop there because that's what's the frustrating things for patients sometimes is that's difficult 454 00:36:49.760 --> 00:36:52.480 to understand what it means right, eat right, and exercise. Does it? 455 00:36:53.559 --> 00:36:59.239 It's gonna gives you nothing to go off of. So yeah, if 456 00:36:59.320 --> 00:37:07.559 you can give your liver the dietary ingredients it needs to process those proper dietary 457 00:37:07.760 --> 00:37:13.519 inputs, those essential fatty acids, to me, that's a much better approach 458 00:37:14.000 --> 00:37:17.559 than inhibiting. I mean, I've been in drug discovery for over twenty something 459 00:37:17.760 --> 00:37:23.239 years and the most common approach is something is going to right. Let inhibit 460 00:37:23.679 --> 00:37:29.800 a basic process, whether it's beta block. I mean again, I'm not 461 00:37:30.039 --> 00:37:34.679 cast throwing shade though those are important, but it's always block a process as 462 00:37:34.719 --> 00:37:38.639 opposed to how do we augmit what we know to be a beneficial process to 463 00:37:39.159 --> 00:37:45.840 attack not the symptom, but rather the ultimate cause for on pats of physiology, 464 00:37:45.880 --> 00:37:50.000 And that's what my you know, I'm actually as a big proponent here. 465 00:37:50.760 --> 00:37:55.000 How do we augment what people are doing from a prescription and dietary standpoint 466 00:37:55.119 --> 00:38:00.639 to achieve an even better There was a point you made earlier about study with 467 00:38:00.760 --> 00:38:02.960 a FIB and EPA risk and stuff, and it's like, okay, let's 468 00:38:02.960 --> 00:38:06.719 say, I mean, if that's well established in a load tried I think 469 00:38:06.760 --> 00:38:09.480 I went through that paper you sent me on that one. That's very a 470 00:38:09.599 --> 00:38:13.920 very interesting link. I would have you know, a normal practitioner would have 471 00:38:13.920 --> 00:38:16.039 never thought about that as being an issue. But obviously there's pattern there, 472 00:38:16.079 --> 00:38:21.440 and if there's enough people saying this is causative, then there's good data to 473 00:38:21.480 --> 00:38:24.920 back it up. However, if you were doing that, let's say you 474 00:38:25.039 --> 00:38:30.719 had an imbalance there of fallen centric botty acids and metabolism and stuff, and 475 00:38:30.840 --> 00:38:36.239 we've now progressed into an aphib situation. From a pharmacological standpoint, as a 476 00:38:36.280 --> 00:38:39.840 pharmacist, there's only really conductive medications or beta blockers that can help with that. 477 00:38:40.440 --> 00:38:45.239 You're looking at your medications like amiodorones, paphnoones like other things for different 478 00:38:45.280 --> 00:38:51.519 aphibs and beta blockers, and that's about it. Like they only touched the 479 00:38:51.599 --> 00:38:55.920 circuitry part of the cardiovascular issue that they have because they need to get that 480 00:38:57.039 --> 00:39:01.760 under control immediately. But as far as looking at the liver side of things, 481 00:39:01.800 --> 00:39:06.039 that's just not done, at least in a hospital setting, and I 482 00:39:06.079 --> 00:39:07.840 don't think that's something that they need to look at. I think that's something 483 00:39:08.000 --> 00:39:13.280 from a primary care of pharmacists standpoint, like, Hey, this is what 484 00:39:13.360 --> 00:39:17.239 my labs look like. What could I do to impact these to minimize even 485 00:39:17.320 --> 00:39:22.360 having to go down that route in the future. And all this ties back 486 00:39:22.440 --> 00:39:25.159 into remnant cholesterol risk because it's like if you only go to your doctor, 487 00:39:25.679 --> 00:39:29.599 you know, maybe a year or every six months or something, and you 488 00:39:29.719 --> 00:39:31.599 check everything and he just says, all good, You're gonna keep going about 489 00:39:31.599 --> 00:39:35.480 your business. But if he says, hey, your labs look good, 490 00:39:35.639 --> 00:39:39.760 but your remnant cholesterol is looking a little bit off the ratios off, then 491 00:39:39.880 --> 00:39:45.320 you can then have some additional guidance as to how to control that to further 492 00:39:45.480 --> 00:39:51.320 minimize your risk. Because it's very interesting the papers that you've sent me and 493 00:39:51.400 --> 00:39:54.599 that I've looked at myself, and how all this would impact ASCBD scores because 494 00:39:54.679 --> 00:40:00.119 in the pharmacy world that is the gold standard. What's their ASCBD risk and 495 00:40:00.199 --> 00:40:04.119 then what can we do to minimize it? In pharmacy school, I heard 496 00:40:04.159 --> 00:40:07.480 this one hundred times. Calculate their ASCVD risk score and then what would you 497 00:40:07.559 --> 00:40:12.760 do to you know, decrease the risk. The answer was always this exercise 498 00:40:12.800 --> 00:40:15.760 and lifestyle change and if they're smoking, stop poking. That was the extent. 499 00:40:16.000 --> 00:40:21.079 That was the extent of it. Very rarely until now, I would 500 00:40:21.119 --> 00:40:22.239 have never made the link to oh, well, we've got to make sure 501 00:40:22.280 --> 00:40:29.400 delivers metabolizing polyunsaturated batty acids correctly. You know, those ratios are correct and 502 00:40:29.559 --> 00:40:31.960 we have to have a way to get those in check and provide a solution. 503 00:40:32.159 --> 00:40:36.239 Otherwise you're just diagnosing another problem and saying, well, we'll figure it 504 00:40:36.280 --> 00:40:39.400 out in ten years when the science is there. So I think it's I've 505 00:40:40.320 --> 00:40:44.559 the product that you've developed and stuff with the sessiment and all that and other 506 00:40:44.719 --> 00:40:49.280 in the extra mile, you guys went to make sure we have enough methal 507 00:40:49.360 --> 00:40:52.360 donors in there and make sure we're further facilitating that process and not just throwingame 508 00:40:52.679 --> 00:40:58.079 sessiment at it and seeing in real time how all that plays into effect. 509 00:40:58.239 --> 00:41:04.480 It only solidifies mechanistically that what you're saying makes the most sense. I mean, 510 00:41:04.599 --> 00:41:08.000 it's pretty obvious if when you lay it out the way that it's laid 511 00:41:08.000 --> 00:41:12.760 out, that it works. And again, I'm not saying like you were, 512 00:41:12.800 --> 00:41:15.280 I'm not saying that assessment is going to be the end all be all, 513 00:41:15.679 --> 00:41:19.000 like cured anything. I don't like using the word here because it's not 514 00:41:20.119 --> 00:41:23.199 that term gets thrown around all the time and it's bothersome. But again, 515 00:41:24.480 --> 00:41:30.559 it's having a dietary supplement and nutrition component that you can easily change with minimal 516 00:41:30.599 --> 00:41:37.519 side effects without having to go up on that set and you're already on you 517 00:41:37.599 --> 00:41:39.800 know, it's say, there's just so many implications there. I think it's 518 00:41:39.840 --> 00:41:45.559 just going to make it easier on patience for clients purposes. It's I'm sorry, 519 00:41:45.599 --> 00:41:50.559 I'm rambling, but I think it's very intriguing that we're finally get in 520 00:41:50.719 --> 00:41:54.000 some real answers to these problems that people have been able to diagnose but not 521 00:41:54.119 --> 00:41:58.440 solved for a long time. Or mitigate, I guess is a better word 522 00:41:58.480 --> 00:42:02.119 to say it. And the bottom line is it's not a problem that has 523 00:42:02.199 --> 00:42:08.320 been solved. And so what I'm suggesting through my approach is that we rethink 524 00:42:09.079 --> 00:42:15.480 how we approach these different parameters, again without using these terms, et cetera, 525 00:42:15.800 --> 00:42:21.719 but how do we approach it from a nutritional standpoint? And I think 526 00:42:21.880 --> 00:42:25.719 the other part we want to point out is that there is a rare allergy 527 00:42:27.079 --> 00:42:35.199 to sessan And by allergy, it's written. It's well known enough that the 528 00:42:35.239 --> 00:42:38.119 Food and Drug Administration points that out to people. It just says, hey, 529 00:42:38.159 --> 00:42:43.840 if you have an allergy to sesame, then you shouldn't be using sentime 530 00:42:43.920 --> 00:42:47.039 seed all or you shouldn't be consuming sesame seeds, right, which the old 531 00:42:47.079 --> 00:42:51.800 McDonald's right to all be patty special software n sesame seed buns, right, 532 00:42:51.920 --> 00:42:58.280 So anything specimen. So nothing even in nature, comes without risk. But 533 00:42:58.400 --> 00:43:00.199 as long as you're ware of what that risk is, then you can make 534 00:43:00.320 --> 00:43:05.639 better decisions. And that's what I'm saying with this lipid panel. There's so 535 00:43:05.960 --> 00:43:13.039 much more information baked into that lipid panel that we have to grease out. 536 00:43:13.599 --> 00:43:19.840 I told you offline that I had an individual who is highly trained and has 537 00:43:19.960 --> 00:43:24.639 a medical background who basically said that the lipid panels really wasn't useful in his 538 00:43:24.840 --> 00:43:30.480 practice. And so we've just talked about the sort of counterway to think about 539 00:43:30.559 --> 00:43:34.480 that, and we hope we've given you guys something to think about and go 540 00:43:34.599 --> 00:43:37.480 out and read more. But a lot of what we're talking about has occurred 541 00:43:37.480 --> 00:43:44.960 in the last ten to fifteen years, and that's sort of science and clinical 542 00:43:45.039 --> 00:43:46.880 science. That's the good, the bad, and the ugly. So in 543 00:43:46.960 --> 00:43:51.320 other words, the good news is is we're always living for we're always trying 544 00:43:51.360 --> 00:43:54.719 to improve opponents. The bad is that well that the other good of that 545 00:43:55.039 --> 00:43:59.400 is, well, we'll talk about bad. The bad is things changed very 546 00:43:59.559 --> 00:44:05.320 slow in terms of practice and research. And that's even though it's a bad 547 00:44:05.360 --> 00:44:07.119 thing, it changes slowly. It's actually good because we don't want to be 548 00:44:07.239 --> 00:44:12.360 changing with the win. You don't want to be changing practice guidelines hid in 549 00:44:12.400 --> 00:44:15.639 fifteen, probably even twenty years. But you have to be aware of what 550 00:44:15.880 --> 00:44:21.599 cutting edge somebody it's the same and say, how can I translate that to 551 00:44:21.880 --> 00:44:27.679 my patient? As the fiance catches up with sort of the recommendations and it 552 00:44:27.760 --> 00:44:30.679 becomes and reaffirmed. So let's go back to the a FIB with the EPA. 553 00:44:31.159 --> 00:44:37.519 This was a meta analysis published in the journal Circulation of really High Profiles, 554 00:44:37.679 --> 00:44:43.880 highly respected journal that said that's their conclusion after looking at the reduced trial, 555 00:44:44.360 --> 00:44:49.199 all the other trials and says there's something to this. And for the 556 00:44:49.360 --> 00:44:52.559 EMA to come out and say something, right, that's what I mean by 557 00:44:52.920 --> 00:44:58.119 it takes years to really get something to change practice guidelines. But that doesn't 558 00:44:58.199 --> 00:45:01.559 mean you have to wait or your patience to try things that make kids. 559 00:45:04.679 --> 00:45:08.119 There's an important thing that I think that I want to tease out as and 560 00:45:08.239 --> 00:45:12.360 I think as a patient. Again, it's really hard for me to take 561 00:45:12.519 --> 00:45:17.119 my scientist's credential hat off if I'm thinking like a patient, and this can 562 00:45:17.199 --> 00:45:21.320 be applied just about anything medically. It's like, well, I don't trust 563 00:45:21.480 --> 00:45:25.400 what these experts are telling me because it seems like every ten to twenty years, 564 00:45:25.480 --> 00:45:30.679 like what they said was for sure the way to go is not necessarily 565 00:45:30.719 --> 00:45:32.480 what they end up changing. And I think science is meant to change. 566 00:45:32.519 --> 00:45:37.119 Otherwise it doesn't progress anywhere. So as scientists and you have an expert telling 567 00:45:37.199 --> 00:45:39.559 you, well, I do not know. The evidence isn't there yet, 568 00:45:39.599 --> 00:45:43.679 I'm not sure. That's not then just saying I don't know what you're talking 569 00:45:43.719 --> 00:45:46.679 about. It's that this I can't speak for the solidification of the science because 570 00:45:46.679 --> 00:45:50.760 you never know where it's going to go, and you have to constantly adapt 571 00:45:50.840 --> 00:45:53.960 and change things. Now, as far as treatment guidelines go for as CBD 572 00:45:54.119 --> 00:45:58.760 and things like that in cholesterol, I don't see them changing very frequently. 573 00:45:59.000 --> 00:46:04.599 However, if you can come up with an option nutritionally or from a supplement 574 00:46:04.719 --> 00:46:09.800 area that helps facilitate making those guidelines work better. Because again I'm not saying 575 00:46:09.880 --> 00:46:15.519 that like this product that you've come up with is going to magically get everyone 576 00:46:15.599 --> 00:46:19.960 off their status. That's not how That's not how I see it going. 577 00:46:20.039 --> 00:46:25.159 There's too much of a benefit for statin therapy in patients support disease that you 578 00:46:25.280 --> 00:46:30.119 can help augment to where we're not dealing with just pushing this, just turning 579 00:46:30.199 --> 00:46:35.760 the stat and level from zero to ten and hoping for the best. You're 580 00:46:35.800 --> 00:46:42.559 really helping all the other aspects of this mechanism that aren't being impacted to be 581 00:46:42.679 --> 00:46:47.800 impacted, then you have to use less medication potentially. Again, that's one 582 00:46:47.800 --> 00:46:51.920 of the hard things because people in chylog don't trust. I don't trust the 583 00:46:51.920 --> 00:46:55.079 signist because it feels like there it's always shady. It's what has to That's 584 00:46:55.119 --> 00:46:59.280 why I'm very careful to never speak at absolutes, and you're not like that 585 00:46:59.400 --> 00:47:02.119 either. Very We'll see where this goes. We'll tease this out, but 586 00:47:02.280 --> 00:47:07.639 it's never I hate setting the sites to settle on the topic because as we 587 00:47:07.719 --> 00:47:10.679 continue to grow and learn more, it's never going to be there. Well. 588 00:47:10.760 --> 00:47:15.159 But that's why we put back to statins as a great examples is we 589 00:47:15.360 --> 00:47:21.920 knew for years that they benefit in curtain patients. The studies showed that time 590 00:47:22.000 --> 00:47:27.159 and time again that there is benefit, but it took years to come back 591 00:47:27.239 --> 00:47:30.280 and say there is residual risk. And that's what I keep coming back to. 592 00:47:30.760 --> 00:47:36.440 And it will take us years to really hone in on what's the next 593 00:47:37.199 --> 00:47:40.079 uh SATIN if you will, in terms of reducing that risk. But we 594 00:47:40.280 --> 00:47:45.000 have to be thinking about other markers outside of the LDL sure to cover where 595 00:47:45.400 --> 00:47:50.920 those statins don't provide benefit to patients. And as you pointed out earlier, 596 00:47:51.039 --> 00:47:54.320 there are reasons that I mean, we have to accept as health care practice, 597 00:47:54.360 --> 00:47:59.639 theirs that our patients aren't going to take standard of care for some reasons, 598 00:47:59.800 --> 00:48:01.880 but for reasons that are their own. People. Some people don't want 599 00:48:01.880 --> 00:48:06.000 to take stabs. There may be side effects, it maybe farm the natural 600 00:48:06.039 --> 00:48:10.400 approaches. So I think we have to give patients the options that they want 601 00:48:10.599 --> 00:48:15.880 and provide them at the same time with as much information and education as possible 602 00:48:15.000 --> 00:48:20.280 along with those options, and not just throw things to get to the walls 603 00:48:20.880 --> 00:48:22.880 what sticks. Because at the end of the day, that's why we have 604 00:48:23.159 --> 00:48:29.719 a license to practice, is you have that is a responsibility to those patients 605 00:48:30.000 --> 00:48:32.880 as well, And so I approach it in the pharmacy too. It's like 606 00:48:34.280 --> 00:48:37.199 I'm never gonna I tell this to people all the time. I'm never going 607 00:48:37.280 --> 00:48:42.760 to recommend something to you from a supplement or a nutrition stance. There isn't 608 00:48:42.880 --> 00:48:45.320 backed up by enough science for me to go this might have benefit or it 609 00:48:45.440 --> 00:48:50.679 might not. You know, as a if I got if I knew nothing 610 00:48:50.719 --> 00:48:53.760 about pharmacy and I was just an average normal person walking around and I went 611 00:48:53.800 --> 00:48:55.920 to the doctor sett I need to be on this stat And then I went 612 00:48:55.960 --> 00:48:59.679 to the store and picked it up and they'll say I read the package insert, 613 00:48:59.760 --> 00:49:02.719 which a lot of people read now when I was, you know, 614 00:49:02.840 --> 00:49:06.280 even in a couple of years, I've seen more people reading the package in 615 00:49:06.760 --> 00:49:07.800 and they're like, oh my god, I read the side effect profile, 616 00:49:07.840 --> 00:49:09.559 and that's terrifying. I don't want to be on that. It's like, 617 00:49:09.719 --> 00:49:14.079 okay, well they have to. Legally, they have to put every possible 618 00:49:14.159 --> 00:49:16.840 thing on that package insert that could happen so they don't get sued. That's 619 00:49:17.000 --> 00:49:21.280 basically how it works. They have to tease it out. There's years of 620 00:49:21.320 --> 00:49:23.760 clinical trials, so they have to be as upfront and honest with you with 621 00:49:23.920 --> 00:49:28.119 the information. Does that mean all those bad things are going to happen to 622 00:49:28.159 --> 00:49:32.559 you? Probably not, but side effects do happen, and they're not rare 623 00:49:32.639 --> 00:49:36.480 if they happen to you. I had a professor at pharmacist school always tell 624 00:49:36.559 --> 00:49:38.159 us that he goes, it's not rare if it happens to you, and 625 00:49:38.239 --> 00:49:43.880 I'm like, that's very good way of looking at things. So I think 626 00:49:44.000 --> 00:49:46.599 if there's other answers to have to where patients are like, look, I've 627 00:49:46.639 --> 00:49:52.559 tried satins felt terrible on them. Probably some pharmacogenetic aspect to that, and 628 00:49:52.639 --> 00:49:58.199 that's been well established now too that not many clinicians are aware of or that 629 00:49:58.280 --> 00:50:06.960 pharmacists advocate for, but they if they've tried it, and then there's no 630 00:50:07.119 --> 00:50:12.000 other alternative option B that can help facilitate that. They're just patients are just 631 00:50:12.039 --> 00:50:14.480 gonna get frustrated, like, well, I mean, okay, I want 632 00:50:14.519 --> 00:50:16.599 my cholesterol down so I don't have a stroke or a heart attack, But 633 00:50:16.880 --> 00:50:21.559 I don't like the fact that my legs feel like they're getting hit with baseball. 634 00:50:21.719 --> 00:50:24.079 That's because of this satin and I don't know what to do. It's 635 00:50:24.079 --> 00:50:27.719 like I can't and if I get off them, then my levels shoot way 636 00:50:27.760 --> 00:50:30.639 up. And it's just like they get it's frustrating and it causes a lot 637 00:50:30.719 --> 00:50:35.119 of anxiety and other things along with that, and it allows that sentiment to 638 00:50:35.199 --> 00:50:38.000 be created to where I don't know who has my best interests at heart, 639 00:50:38.239 --> 00:50:43.400 Like I don't know why I'm not getting any benefit there. And to be 640 00:50:43.559 --> 00:50:46.480 far and to be fair and balanced, Patricks, there are those patients that 641 00:50:46.679 --> 00:50:52.039 are perfectly happy with their statings. It's doing exactly what it was supposed to 642 00:50:52.119 --> 00:50:55.760 do. It's lowering their LDL and they're thrilled by their LDL levels, but 643 00:50:55.920 --> 00:51:00.719 they start to recognize again there's some there could be and their specificus is something 644 00:51:00.800 --> 00:51:06.440 that is beyond meaning additive to statins. So you're right, we need to 645 00:51:06.480 --> 00:51:10.239 talk about candidly about those folks that aren't satisfied with statins. But we also 646 00:51:10.360 --> 00:51:15.679 need to talk about candidly those folks that really are pleased with what their statin 647 00:51:15.800 --> 00:51:19.559 is doing, but they're looking for other things to address that residual risk. 648 00:51:19.679 --> 00:51:23.280 And I think we have to have that curturation with patients for sure. Respect 649 00:51:23.320 --> 00:51:27.199 to that too. That is kind of catching fire, especially like social media 650 00:51:27.280 --> 00:51:30.000 and stuff is they'll see there's proponents that kind of go, oh, we 651 00:51:30.400 --> 00:51:34.400 LDL cholesterol is a terrible diagnostic marker for heart disease, like don't pay attention. 652 00:51:35.039 --> 00:51:37.559 It's like, well, you can't say that either, because patients that 653 00:51:37.679 --> 00:51:40.199 are responding really well on statins and their levels are looking really good. Now 654 00:51:40.280 --> 00:51:44.119 you're telling me that the doctors don't know what they're talking about, and then 655 00:51:44.119 --> 00:51:47.199 they shouldn't be looking at that. So there's so many different goals for thought 656 00:51:49.000 --> 00:51:52.480 and again, it always goes back to this who do I trust? Like? 657 00:51:52.800 --> 00:51:55.639 Who? Okay, one guy's telling me that I need to take a 658 00:51:55.679 --> 00:51:59.440 stat and to help my LDL MYL the olds improving. Then I hear another 659 00:51:59.480 --> 00:52:02.480 reputable source, supposedly over here saying that Eliel's dumb, we don't need to 660 00:52:02.519 --> 00:52:06.559 look at it. And then we have someone who you alluded to that goes 661 00:52:06.599 --> 00:52:09.000 to cholesterol labs are not beneficial in my practice. So it's like you get 662 00:52:09.239 --> 00:52:14.519 three different schools of thought there, and the patient's just caught. They're just 663 00:52:14.559 --> 00:52:17.199 spinning out of control and they can't make sense in it. But again, 664 00:52:19.280 --> 00:52:22.760 it's never as easy and as simple as it seems like if you get into 665 00:52:22.880 --> 00:52:27.639 the mechanisms, even further down the rabbit hole where this goes, it's a 666 00:52:27.719 --> 00:52:31.079 bit overwhelming. But the body is complex and overwhelming. So to say that 667 00:52:31.199 --> 00:52:36.000 it's black and white or cut and dry a plus bak, we'll see mechanism. 668 00:52:36.079 --> 00:52:38.800 It's just usually not I try to stay away from that kind of language 669 00:52:38.800 --> 00:52:43.920 because it's just not usedul Now I do I have a couple other questions going 670 00:52:43.960 --> 00:52:45.840 back to Sessimon for you, and then we'll kind of wrap it up a 671 00:52:45.880 --> 00:52:52.039 little bit. How we've talked about how it helps with polyuncentury if iding have 672 00:52:52.199 --> 00:52:58.880 some metalloism, how we get that EPA to DHA ratio of in fostituol colid 673 00:52:59.000 --> 00:53:02.079 rich dha go down the LCAT pathway to help with HDL. We've also talked 674 00:53:02.079 --> 00:53:07.400 about the triglyz red lowing and then the cholesterol remnant lowering piece of that. 675 00:53:07.159 --> 00:53:13.679 However, how exact I know you alluded to this earlier about talking about inflammation 676 00:53:13.800 --> 00:53:16.239 and stuff too, which is another big buzzword thing that I think we'd like 677 00:53:16.320 --> 00:53:21.840 to talk to touch on. Correct me if I'm wrong, But like Sessamon 678 00:53:21.960 --> 00:53:25.599 and the papers I've looked at, it helps with really decreasing or not really 679 00:53:25.639 --> 00:53:30.079 decreasing, but decreasing and balancing our achdonic acid production. And it does that 680 00:53:30.280 --> 00:53:34.519 by is it? I think? Is it the enzyme is a delta five 681 00:53:34.599 --> 00:53:37.199 desaturase that it helps. Yeah, that's what I'm saying. It's an inhibitor 682 00:53:37.199 --> 00:53:44.599 of delta five dsaturase, which basically lowers the amount of omega six conversions. 683 00:53:44.840 --> 00:53:47.639 Correct, Well, let's I think this is I think this is fascinating for 684 00:53:49.400 --> 00:53:53.679 pharmacologists, pharmacists, which as most of your listeners are many of your listeners 685 00:53:53.760 --> 00:54:00.639 are. Is the if you look at pollen saturaated fatty as metabolism, we 686 00:54:00.840 --> 00:54:07.199 know that there are two groups Omega six and omega three, so there is 687 00:54:07.599 --> 00:54:12.480 a single enzyme right in that past. So in other words, is a 688 00:54:12.639 --> 00:54:16.840 multi step process, multi inzomatic process. We metabolize essentral fatty ads as omega 689 00:54:16.880 --> 00:54:22.679 six and omega three. What's really unique about that pathway is these enzymes. 690 00:54:22.719 --> 00:54:29.360 And you pointed out the rate limiting step Delta five to saturates. It has 691 00:54:29.599 --> 00:54:36.440 an omega six input and it also can process an omega three input, so 692 00:54:36.719 --> 00:54:42.760 it's the same enzyme, but it can metabolize either omega six substrate or in 693 00:54:42.800 --> 00:54:47.880 a maja Maga three precursor. That's important, really important when it comes to 694 00:54:49.119 --> 00:54:53.239 sessiment because as you know and as your listeners know, on the omega six 695 00:54:53.360 --> 00:54:59.400 side, the output of that enzyme is the rhachodonic acid. So now we're 696 00:54:59.440 --> 00:55:02.239 in a look at t we're into a cyclop you know, it's all sorts 697 00:55:02.280 --> 00:55:08.199 of pro and anti inflammatory markers. On the omega three side, the output, 698 00:55:08.599 --> 00:55:13.199 the metabolite, if you will, is EPI. Okay, So when 699 00:55:13.239 --> 00:55:16.840 you think about delta five disat raates the rate limiting steck. It kicks out 700 00:55:17.000 --> 00:55:21.760 a rackodonic acid on the omega six side, and it kicks out EPA which 701 00:55:21.800 --> 00:55:25.320 is subsequently converted to DHA and further downstream events. Right, So then it 702 00:55:25.400 --> 00:55:30.400 begs the question, well, how can I inhibit or I mean, it 703 00:55:30.559 --> 00:55:34.559 would not be inhibiting. If I'm inhibiting their enzyme would not be inhibiting racodonic 704 00:55:34.639 --> 00:55:39.199 acid formation in EPA formation simultaneously, So it's a canceling out and the answer 705 00:55:39.280 --> 00:55:47.039 is no. This is what's fascinating about Sessimon. Sessimon appears through mechanistic studies 706 00:55:47.119 --> 00:55:54.760 pharm acology studies in vitro and and vivos to preferentially inhibit the omega six mechanism 707 00:55:54.960 --> 00:56:00.320 of delta five satur rates, meaning it shuts down, not complete, but 708 00:56:01.000 --> 00:56:06.199 minimizes or mitigates a rackotonic acid formation, and we know that's good in the 709 00:56:06.239 --> 00:56:09.840 setting of high racotonic acid, so that can be anti inflammatory, while at 710 00:56:09.880 --> 00:56:16.400 the same time it maintains or potentially enhances the EPA formation subsequent downstream DHA. 711 00:56:16.880 --> 00:56:24.719 So that's how a single molecule in sesame sidol extraction can impact inflammation significantly just 712 00:56:24.920 --> 00:56:31.000 through that single mechanism of action, and then the other those folks interested in 713 00:56:31.079 --> 00:56:37.159 nutrogenomics, we know that there are two types of individuals and it's race based, 714 00:56:37.239 --> 00:56:40.559 and we can go into this in another call or a podcast. You're 715 00:56:40.599 --> 00:56:45.320 either a very rapid metabolizer, right, so let's go back to our P. 716 00:56:45.400 --> 00:56:47.880 Four fifty right, our drug metabolism. Language are a poor metabolizer extensive 717 00:56:47.880 --> 00:56:52.719 metabolism. You're either an extensive metabolizer, meaning you form a lot of a 718 00:56:52.800 --> 00:56:55.159 rackotonic acid in epa And that's the term what your diet is, right, 719 00:56:55.760 --> 00:57:00.280 Mega six versus high and magas three or vice versa. Okay, and there's 720 00:57:00.320 --> 00:57:07.400 another cobortive individuals for genetic reasons, they're slow metabolizers, and so the impact 721 00:57:07.519 --> 00:57:12.639 of a bad diet is less than those individuals. And how that sorts out 722 00:57:12.960 --> 00:57:22.639 from a racial standpoint is that the more from a genealogical standpoint genetic standpoint, 723 00:57:22.239 --> 00:57:30.800 that African origin people have a much higher chance of inheriting a rapid metabolism. 724 00:57:31.239 --> 00:57:37.360 So there have been numerous studies that have said if you heat Omega six and 725 00:57:37.519 --> 00:57:42.159 you have an African descent, then you're forming lots of araconomic aget that's related 726 00:57:42.159 --> 00:57:49.559 to obesity and inflammation in general the non African origin. So now you're talking 727 00:57:49.599 --> 00:57:57.679 about your European Caucasians, they through evolution have acquired a slower form of the 728 00:57:57.840 --> 00:58:05.800 gene, so now they metabolize those EPA and arachdomic acid pre precurasors more slowly, 729 00:58:06.480 --> 00:58:10.920 and the bad the result of a bad diet is manifest less in those 730 00:58:10.960 --> 00:58:16.480 who have slow metabolism. So that starts to raise this interesting conversation around racial 731 00:58:16.599 --> 00:58:24.840 differences. So there is every potential that this approach using cess received extract may 732 00:58:24.960 --> 00:58:30.599 have an impact that is differential or differential impact based upon race. Those are 733 00:58:30.639 --> 00:58:34.800 all sorts of things that can be looked at in the future. Right, 734 00:58:34.920 --> 00:58:37.760 But that's just one step on the inflammation side, and I probably want a 735 00:58:37.760 --> 00:58:42.840 little deeper. That's you know, that's a great way to think about the 736 00:58:43.199 --> 00:58:46.000 nation piece. Uh. Yeah. Inflammation is a big buzzword, very important. 737 00:58:46.320 --> 00:58:49.960 It's one of those things that's like you need, let's be honest, 738 00:58:50.000 --> 00:58:52.000 you need inflammation for things to work, do some other process you want to 739 00:58:52.119 --> 00:58:59.719 completely mitigate or whatever it is. However, but here's the other important thing 740 00:58:59.760 --> 00:59:07.079 for a nutrition standpoint, is destiny seed oil for thousands of years was the 741 00:59:07.599 --> 00:59:10.480 oil of choice. One of reasons, one of the reasons, my main 742 00:59:10.559 --> 00:59:15.679 reason is for stability. It's such a high antioxidant oil that it was much 743 00:59:15.760 --> 00:59:22.159 more stable than less well more stable than those oils that weren't as rich in 744 00:59:22.320 --> 00:59:25.679 antioxidants. And so now you've got this. You know, we talked about 745 00:59:25.719 --> 00:59:30.280 cesciling, you talked about delta fied to saturation and how that can impact inflammation, 746 00:59:30.599 --> 00:59:36.480 but we also know that those antioxidants in this oil and the extract can 747 00:59:36.559 --> 00:59:42.760 also positively impact inflammation. Yeah, and then man, there's so much cool 748 00:59:42.760 --> 00:59:45.960 stuff. And we didn't even get to touch on the postitium component of like 749 00:59:45.079 --> 00:59:50.039 cognition improvement as well as skin improvements too. That's another podcast rabbit Hole, 750 00:59:50.119 --> 00:59:53.039 want to go down on every want to go down in, because that's a 751 00:59:53.119 --> 00:59:57.760 whole other interesting interlude. Like, all these systems are interlinked, so it's 752 00:59:57.880 --> 01:00:00.880 very interesting when you start to tease out why it's doing what it's doing, 753 01:00:00.440 --> 01:00:05.960 different aspects of it all. But yeah, inflammation is a big one that 754 01:00:06.159 --> 01:00:10.360 I think a lot of people and I've talked about information to a little bit 755 01:00:10.400 --> 01:00:14.159 of a degree on some other podcasts. I need to kind of recover it 756 01:00:14.239 --> 01:00:19.400 because I'm generalizing here, but I think it's not a stretch for me to 757 01:00:19.480 --> 01:00:23.159 do this. What people here, especially on social media or other platforms sell 758 01:00:23.199 --> 01:00:27.119 here inflammation they just think it's all inflammation is the same, and it's not. 759 01:00:27.239 --> 01:00:30.320 In case, there's differences between acute and systemic. And what I want 760 01:00:30.360 --> 01:00:35.119 to point out is when you're talking about crp air lucan six, like other 761 01:00:35.239 --> 01:00:38.840 cytokines inflammatory cytokinds that are out there, that is systemic inflammation. And that's 762 01:00:38.960 --> 01:00:45.280 not usually something you see acutely raised unless we're dealing with some other situation sepsis, 763 01:00:45.360 --> 01:00:47.920 other things like that. But when you're talking about chronic inflammation, that's 764 01:00:47.960 --> 01:00:52.440 what most people are referring to. As these systemic blood markers of inflammation that 765 01:00:52.519 --> 01:00:57.920 we see time and time again correlate perfectly with these chronic diseases that we've seen 766 01:00:58.039 --> 01:01:01.840 on the rise. Well, now let's bring these full circle, Patrick, 767 01:01:02.280 --> 01:01:07.800 And there's a fascinating paper that just published I shared with you via text over 768 01:01:07.880 --> 01:01:16.800 the weekend that looks at independent risk markers for ASCVD remnic cholesterol. Near the 769 01:01:16.840 --> 01:01:21.440 top of the list if not the top of the list. An independent but 770 01:01:21.719 --> 01:01:30.760 equally important risk modifier for ASCVD is see reactive protein. So this chronic inflammatory 771 01:01:30.920 --> 01:01:35.199 process, and you distinguish that that's eloquently from acute right where you've got these 772 01:01:35.239 --> 01:01:38.239 pro inflammatory side of kinds in the systemic inflammatory response centers. We're not talking 773 01:01:38.280 --> 01:01:43.639 about that. We're talking about chronic inflammation. We're talking about he reactive protein 774 01:01:43.719 --> 01:01:51.079 CRP, and that is a very important marker of risk that it gains independent 775 01:01:51.199 --> 01:01:54.800 of remnant cholesterols. But what this paper shows is in this very large I 776 01:01:54.840 --> 01:02:00.679 think it was forty thousand plus patient study, is when you can consider those 777 01:02:00.800 --> 01:02:06.800 as independent markers CRP and remnant cholesterol, that really starts to hone in on 778 01:02:06.960 --> 01:02:12.679 what your risk is from an ASCVD standpoint. And that's the fascinating. Yes, 779 01:02:13.039 --> 01:02:17.239 that paper, three thousand patients, I think they like that in that 780 01:02:17.440 --> 01:02:21.320 sea reacting for a team paper. I've got it pulled up, I think 781 01:02:21.360 --> 01:02:25.440 yours, Yeah, thank you. That was similar to the two thousand and 782 01:02:25.519 --> 01:02:30.920 nine paper where they looked at statins and risk and a residual risk. But 783 01:02:30.119 --> 01:02:36.639 yes, the large study is the bottom line, like thousands of people that 784 01:02:37.000 --> 01:02:45.599 looked at CRP and rhymney cholesterol independent highly insignificant terms of predicting ASCVD risk. 785 01:02:47.599 --> 01:02:50.800 Yeah, I think I think we've hit the nail on the head with it. 786 01:02:50.920 --> 01:02:52.719 It's just really cool how it all kind of ties in and works together, 787 01:02:52.880 --> 01:02:55.519 and how you see that really Oh, here we go, I found 788 01:02:55.559 --> 01:03:00.760 it. Here we go. I found out paper. Yeah, you're right, 789 01:03:00.039 --> 01:03:04.320 it's like forty thousand patients. And then I was referring back to the 790 01:03:04.840 --> 01:03:07.400 other one we talked about where it was over one hundred thousand, So started 791 01:03:07.400 --> 01:03:12.519 to get that mixed out there, but still a lot of people right that 792 01:03:13.199 --> 01:03:17.880 it's not just one hundred person trials and CRP. If you go to lab 793 01:03:17.960 --> 01:03:22.800 core for examples, and you look at labport, what panel do they offer 794 01:03:22.920 --> 01:03:27.159 for inflammation? I mean, your father and I run a phase one clinical 795 01:03:27.239 --> 01:03:30.480 center and one of the things we look at is inflammation, and C reactive 796 01:03:30.519 --> 01:03:37.239 protein is what lab poor offers as their general inflammatory marker. So that's a 797 01:03:37.360 --> 01:03:42.320 really solid marker, and it's neat to see that it connects back to ASCVD 798 01:03:42.599 --> 01:03:49.199 risk and connects back to independently connects back to the remnant cholesterol. So I 799 01:03:49.239 --> 01:03:52.719 think that's a great way to sort of think about this one last aside I 800 01:03:52.800 --> 01:03:58.000 want to make because it's another popular thing that's kind of catching win now because 801 01:03:58.519 --> 01:04:02.000 again this is a peo. I feel like for the nutrition world, all 802 01:04:02.079 --> 01:04:06.199 of the world's problems have been thrown in some sort of nutrition camp. Like 803 01:04:06.320 --> 01:04:11.320 for in the nineties, it was like sugar most of the problem, and 804 01:04:11.400 --> 01:04:14.199 then before I would say the two thousands, it was okay, sugar is 805 01:04:14.239 --> 01:04:17.639 the real cause of issues, and then before that with it was hello, 806 01:04:17.800 --> 01:04:20.880 fat diets are the way to go. And now it's kind of the next 807 01:04:20.920 --> 01:04:24.840 one that's kind of catching win is, Oh, it's the seed oils that 808 01:04:24.920 --> 01:04:27.039 are causing all these issues that we cook at it. It's like, I 809 01:04:27.119 --> 01:04:30.199 think if anyone gets anything out of this podcast that we talked about sessamon as 810 01:04:30.239 --> 01:04:33.039 much as we've talked about that, I think maybe the case can be made 811 01:04:33.320 --> 01:04:38.519 that seed oil it's fine and really beneficial. So it's like, again, 812 01:04:38.559 --> 01:04:41.760 I think it's funny, how though, what all the seed oils together. 813 01:04:41.840 --> 01:04:45.760 It's like, you know, it's funny you should say that, Patrick, 814 01:04:45.840 --> 01:04:48.920 because I literally had that question last week. It says, oh, but 815 01:04:49.039 --> 01:04:54.400 I thought this, well, the question was I thought sesame seed oil was 816 01:04:54.519 --> 01:04:56.800 banned, so I dug in a little bit, well, well, because 817 01:04:56.840 --> 01:04:59.519 of reading about seed oils and things like that, and to your point, 818 01:05:00.000 --> 01:05:02.679 we lumping things together. I mean, there's a reason why, to sess 819 01:05:02.760 --> 01:05:08.119 me, seed oil was the primary cooking oil for thousands of years, and 820 01:05:08.679 --> 01:05:14.119 I'm not saying that it's not detrimental in certain sceniar, but it's not something 821 01:05:14.280 --> 01:05:20.559 that science is pointing to as causative for cardiovascular events, and at least from 822 01:05:20.599 --> 01:05:25.000 my reading, I shouldn't state that's so sens aticate. I mean, another 823 01:05:25.039 --> 01:05:28.039 reason that they use sesame oil for the longest time to cook with is because 824 01:05:28.079 --> 01:05:30.079 it's one of the oils to cook with that has the highest smoke point, 825 01:05:30.159 --> 01:05:34.320 so you're less likely to have bubbling. And like if you cook with olive 826 01:05:34.360 --> 01:05:39.320 oil at really high temperatures, its flashes everywhere. It's not fun to deal 827 01:05:39.400 --> 01:05:43.679 with. But I mean, as far as a seed oil or an oil 828 01:05:43.840 --> 01:05:46.400 used for cooking that has a high smoke point but yet actually it has flavor 829 01:05:46.480 --> 01:05:49.440 enhancing properties, selling me oil is like I guess, like four hundred and 830 01:05:49.599 --> 01:05:54.760 ten or something like that. I'm stretching because I had to dive into all 831 01:05:54.800 --> 01:05:57.800 of that when I was doing my master's program. We were talking about oils 832 01:05:57.840 --> 01:06:02.320 and all sorts of stuff. But again it yeah, and I'm a fonatology 833 01:06:02.559 --> 01:06:08.239 not a nutrition right, They've got to be very I'm not a seed oil 834 01:06:08.280 --> 01:06:12.519 expert either, but I think and then it goes back to the education piece 835 01:06:12.559 --> 01:06:15.199 of things, because people will go, oh, they're highly processed. It's 836 01:06:15.239 --> 01:06:19.239 like, okay, a lot of foods that have any sort of packaging or 837 01:06:19.280 --> 01:06:24.960 shelf li for process to a degree. But they'll talk about using from a 838 01:06:25.039 --> 01:06:27.360 seed oil perspective, They'll say, oh, well, you have to use 839 01:06:27.360 --> 01:06:30.320 all these different solvents to extract the seed oils out, and you have to 840 01:06:30.599 --> 01:06:34.559 put them into this these big machines to do all of that expel the oil 841 01:06:34.599 --> 01:06:40.920 out. Okay, Like I think the big the big one now is oh 842 01:06:40.960 --> 01:06:44.360 they use he saye to like get the oil separated. It's like, okay, 843 01:06:44.400 --> 01:06:46.039 well, if the final improduct has zero hexane in it, they have 844 01:06:46.119 --> 01:06:51.719 to get all of it out, so whoop to do? Yeah, you 845 01:06:51.760 --> 01:06:55.960 know, you raise an interesting point. I need to better educate myself on 846 01:06:56.519 --> 01:07:00.159 the pressing versus the use of organics. And I'm not certain, so I'm 847 01:07:00.199 --> 01:07:04.559 not saying one way or the other how sesame seed oil is typically processed, 848 01:07:04.920 --> 01:07:12.079 but my reading is mainly through pretty processing and not use of texting. But 849 01:07:12.440 --> 01:07:17.519 I need that however, I will. I'm pretty sure of the seed oils, 850 01:07:17.559 --> 01:07:23.760 like you have to do less less expeller processing, and you don't have 851 01:07:23.880 --> 01:07:26.719 to do it at higher temperatures. For sesame oil, it's very easy to 852 01:07:26.800 --> 01:07:30.400 coal press sesame oil out. As far as sesame seeds in general, they 853 01:07:30.440 --> 01:07:35.400 have a higher concentration will in them as opposed to say corn or canola oil 854 01:07:36.559 --> 01:07:41.960 or soybean oil that you have to use higher temperature heating to kind of get 855 01:07:42.159 --> 01:07:45.639 in more of the product to get that oil extracted out, whereas olive oil, 856 01:07:46.360 --> 01:07:51.320 peanut I think, and then sesame oil that just there's more oil concentrated 857 01:07:51.400 --> 01:07:55.920 the seed itself, so it's easier to coal press it out. So I 858 01:07:55.960 --> 01:07:58.880 think for sesame oil, I think most of those are coal press, which 859 01:07:59.639 --> 01:08:01.559 most of your olive oil is cold press for that exact reason. So it's 860 01:08:01.599 --> 01:08:03.960 one of the ones that if I'm going to use, I like that one 861 01:08:04.039 --> 01:08:09.320 quite a bit. And again I don't fry foods very much, and I've 862 01:08:09.400 --> 01:08:11.920 never heard of I mean, you can saw tay things and sesame oil, 863 01:08:11.920 --> 01:08:17.439 but I don't think you rise like anything. Yeah, and if you've got 864 01:08:17.479 --> 01:08:20.800 any listeners who really want to read, let me go back to AY Evading 865 01:08:21.079 --> 01:08:26.960 Medicine texts and read about sesame seedel and AYE Evading medicine. There's a ton 866 01:08:27.119 --> 01:08:31.520 of information out there that's it's consistent with what we're seeing anecdotally. It's fast. 867 01:08:31.640 --> 01:08:38.680 Last thing I wanted to mention there's yeah, and we touched on I 868 01:08:38.720 --> 01:08:42.359 don't know if you're I want to pose one question to you because I had 869 01:08:42.399 --> 01:08:45.520 a patient asked me this the other day, literally, yes, Saturday, 870 01:08:45.239 --> 01:08:49.359 she came in and she was asking, she's wanting us to purchase the product 871 01:08:49.520 --> 01:08:54.439 that you've developed that we're that we have in this pharmacy. And she was 872 01:08:54.560 --> 01:09:00.880 asking if there's any risk for lead crimps or anything that you've seen with using 873 01:09:00.960 --> 01:09:06.000 something like sessimon in there. And I didn't nothing that I've come across that 874 01:09:06.119 --> 01:09:10.000 really would make me think about that to any certain degree. But have you 875 01:09:10.079 --> 01:09:13.880 seen that reported anywhere? Because I know in some cell studies that I've found 876 01:09:14.680 --> 01:09:19.600 sessamon does have some hmg CoA reduct tastes inhibiting a properties. So that's kind 877 01:09:19.640 --> 01:09:25.359 of working down that Staton pathway to a degree. Have you seen anything in 878 01:09:25.439 --> 01:09:29.279 there of the you've reported with like leg creeps or anything like that with Sessimon 879 01:09:29.359 --> 01:09:31.000 that because that was something that she asked me about, but I was just 880 01:09:31.119 --> 01:09:38.760 curious across anything like that. So I'd say two things. First, is 881 01:09:39.119 --> 01:09:42.199 ahe am not aware, which does not mean it's not out there, But 882 01:09:42.359 --> 01:09:48.800 I am not aware of any muscle related issues for Sessimon sesame seed oil extract 883 01:09:48.960 --> 01:09:54.960 or using it as a cooking oil. That's it. I will dig in 884 01:09:55.119 --> 01:09:58.039 and see if I can find anything to be more definitive, But I've read 885 01:09:58.119 --> 01:10:01.000 quite a bit about sesame seed a in Sesimon, and I am unaware of 886 01:10:01.159 --> 01:10:05.159 any side effect related to that. And we have had no reports any dotally 887 01:10:08.359 --> 01:10:13.000 but always were but as always right where pharmacants, we always have our ears 888 01:10:13.079 --> 01:10:15.720 open, right, what are some things that are just sort of unexplainable. 889 01:10:16.359 --> 01:10:23.000 But the other thing that I want to leave the listers with is that while 890 01:10:23.079 --> 01:10:29.680 this is natural, it is not a pharmaceutical approach. There's a blurred line 891 01:10:29.920 --> 01:10:35.159 between natural and pharmaceutical, and that blurred line is you're talking about small molecules, 892 01:10:35.239 --> 01:10:39.600 spider chemicals, in this case that interact with processes in the body, 893 01:10:40.319 --> 01:10:47.520 and so for sesame seed oil and specifically for sessimon, which is one of 894 01:10:47.600 --> 01:10:53.840 these actives in sesame cole extract. There is in vitro work, much like 895 01:10:53.960 --> 01:10:59.760 you do for a prescription medication, where you're looking at interactions between a molecule 896 01:11:00.119 --> 01:11:06.560 in cidercrop four fifties, there is evidence that sessimon is able to modulate SIP 897 01:11:06.680 --> 01:11:15.119 to C nine activity, and so the in vitro studies are more abundant than 898 01:11:15.199 --> 01:11:18.720 the in vivo studies. There was one in vivo study done in humans that 899 01:11:18.880 --> 01:11:25.920 did not see an interaction, but like got educated students for twenty something years, 900 01:11:26.720 --> 01:11:29.520 if it can interact, even at the end vitro level, that's why 901 01:11:29.560 --> 01:11:32.640 the FDA mex pharmaceutical companies put that information to packaging. Sir, Then you 902 01:11:32.880 --> 01:11:39.239 as a pharmacist need to be aware that if you see something untoward then that 903 01:11:39.359 --> 01:11:44.520 could potentially be the reason. So again that's the only not the only, 904 01:11:45.119 --> 01:11:50.399 well really the only thing that raises my pharmacists awareness when I'm talking about this 905 01:11:50.479 --> 01:11:58.199 suthing beyond the sympomy. Yeah, allergen for the but yeah, so stick 906 01:11:58.279 --> 01:12:01.039 two C nine so keep that in mind. If you're a practitioner, or 907 01:12:01.079 --> 01:12:05.520 if you're patient and you're taking other SIP two C nine, I check other 908 01:12:05.680 --> 01:12:12.239 if you're taking SIP two C nine mediated metabolism interactions or excuse me, medicines, 909 01:12:13.159 --> 01:12:15.479 Yeah, that's it. Two C nine is an interesting one. That's 910 01:12:15.520 --> 01:12:19.560 not one of the primary ones. But I remember often, well, we 911 01:12:19.720 --> 01:12:24.359 know that SIP three A and four, right, they comprise the vast majority 912 01:12:24.439 --> 01:12:29.640 of metabolisms. SIP two C nine is rare. But in terms of metalloism 913 01:12:29.720 --> 01:12:34.600 of prescription medical description, medications do absolutely and you need to be aware in 914 01:12:34.720 --> 01:12:40.279 that when you're on these together, right, and you know your dad could 915 01:12:40.359 --> 01:12:43.279 lectures for an hour on HERB drug interactions, right, is the world's leading 916 01:12:43.319 --> 01:12:45.239 expert. But that's just something I want to make sure he's pointed out to. 917 01:12:45.439 --> 01:12:48.520 Yeah, practitioners, I think patients. Common ones that come to my 918 01:12:48.640 --> 01:12:54.279 mind like colpidogrels one that is two C nine A leapers als two C nine. 919 01:12:56.159 --> 01:13:00.960 The only other one I really see this is flew with statin maybe a 920 01:13:01.039 --> 01:13:05.199 little bit, and then you know phenotone. But I mean some of those 921 01:13:05.359 --> 01:13:09.760 you come across very often. But again I guess I've said this on the 922 01:13:09.800 --> 01:13:13.319 podcast before. I always ask patients whenever I have something, say to you, 923 01:13:13.399 --> 01:13:15.479 take any prescription medications. And one patient when I asked her that, 924 01:13:15.560 --> 01:13:18.159 shecause You've asked me that every time I've come in here, and I'm like, 925 01:13:19.239 --> 01:13:25.880 there's there's a reason I'm making my job, so it's important, right. 926 01:13:26.319 --> 01:13:29.159 But that's what I wanted to point out here as well, is just 927 01:13:29.680 --> 01:13:32.039 always be aware of the potential. Now so I'm back in my pharmacy, 928 01:13:32.239 --> 01:13:38.159 you know, Professor days is always be aware of the potential right for what 929 01:13:38.319 --> 01:13:41.079 is it? Forewarned, is forearmed or whatever it is. But anyway, 930 01:13:41.199 --> 01:13:44.239 well keep that. Really appreciate you coming on again. I'll have you on 931 01:13:44.520 --> 01:13:46.319 multiple times because there's multiple every time I talk to you, there's like eight 932 01:13:46.359 --> 01:13:50.359 other areas I want to pick your brain on because you're sharing a lot of 933 01:13:50.560 --> 01:13:55.840 the same interests and stuff like that. So I think we've got an interesting, 934 01:13:57.760 --> 01:14:00.600 really good backed mechanism or what way for how we think's going on, 935 01:14:00.720 --> 01:14:05.359 and we'll continue to tease that out. But you've I really like the idea 936 01:14:05.560 --> 01:14:09.720 of really harping on the education piece of all of this, because that's the 937 01:14:09.800 --> 01:14:13.880 key is making how can we take these complex topics make them easier to understand, 938 01:14:14.039 --> 01:14:16.359 and how we can kind of take all the pieces together and not look 939 01:14:16.439 --> 01:14:21.359 at it so compartmentalized, you know, and just that piece and that holistic 940 01:14:21.399 --> 01:14:27.279 approach I think is just a great way of tackling complex issues, specifically around 941 01:14:27.319 --> 01:14:31.479 that cholesterol and risk and all that stuff for heart disease. Well, all 942 01:14:31.560 --> 01:14:36.960 Blatt, we talked about a continuing the education talk. It's right beyond LDL 943 01:14:38.199 --> 01:14:44.439 tackling residual risk and talking about these things in a structured environment and continuing education. 944 01:14:44.720 --> 01:14:46.159 That would be a fascinating I think people would get a lot of benefit 945 01:14:46.199 --> 01:14:48.439 out of that, and I definitely want to pick your money and help out 946 01:14:48.479 --> 01:14:53.279 there. I think we can wrap the episode up and then we'll go from 947 01:14:53.279 --> 01:14:56.279 there. I'll have you on again soon, And like I said, I 948 01:14:56.399 --> 01:14:59.560 really appreciate your time and always enjoy talking to you. You've been one of 949 01:14:59.600 --> 01:15:03.680 the best. You've been one of the mentors that like its always really pushed 950 01:15:03.800 --> 01:15:09.920 me to kind of expand my horizons as much as possible in ways of just 951 01:15:10.079 --> 01:15:12.800 continuing to stay on the forefront of where all this is going. So I 952 01:15:12.840 --> 01:15:16.479 appreciate you with that for sure more value to me than you want. Then 953 01:15:16.880 --> 01:15:21.199 it takes at effort. It takes a lot of effort in reading. And 954 01:15:21.319 --> 01:15:25.720 my wife who's also a pharmacist of twenty five plus years, that's what we 955 01:15:25.840 --> 01:15:31.000 talk about, is the difference maker is the reading and staying apreast of what's 956 01:15:31.119 --> 01:15:35.560 new. And that's why the education piece is so important. And why am 957 01:15:35.640 --> 01:15:41.000 I at this stage of my career learning about the importance of remnant cholesterols. 958 01:15:41.359 --> 01:15:44.600 It blows my mind and I should have known about it earlier. So yes, 959 01:15:44.680 --> 01:15:48.640 it's part of that passion just educating. Podcasts like yours and the motivations 960 01:15:48.680 --> 01:15:54.079 for doing that are really important. And maybe we'll get some listeners that'll have 961 01:15:54.239 --> 01:15:58.239 questions that you know or want to figure out how to help and educate as 962 01:15:58.319 --> 01:16:01.600 well and spread the words that's right, more people understand. I'd like to 963 01:16:01.640 --> 01:16:04.119 get that to it. I'd love to get to a point because some of 964 01:16:04.199 --> 01:16:08.560 the podcasts I really enjoyed do have like a live Q and a component, 965 01:16:08.680 --> 01:16:12.159 So it'd be interesting to see how that I could factor that in later, 966 01:16:12.319 --> 01:16:14.800 or you know, just have people send the questions to us and to see 967 01:16:14.800 --> 01:16:17.920 where and do like a ask me anything kind of episode where we just kind 968 01:16:17.960 --> 01:16:20.239 of answer people's questions. I think that would be a cool one to do, 969 01:16:20.600 --> 01:16:24.520 especially if you or my dad or your guys groups. You're right, 970 01:16:24.680 --> 01:16:27.439 that would all definitely work on some of that stuff. Ron, But I 971 01:16:27.760 --> 01:16:30.640 really appreciate you being here and thank you for your time, and thank you 972 01:16:30.720 --> 01:16:49.720 guys for listening. Thank you for joining us on today's episode of The Wellness 973 01:16:49.760 --> 01:16:55.640 Transcription Podcast. We hope you're inspired to live a healthier, more purpose filled 974 01:16:55.720 --> 01:16:59.920 by Christ. Remember your well being is a gift from God, and by 975 01:17:00.079 --> 01:17:02.680 taking care of your body, you give him the glory. If you enjoy 976 01:17:02.760 --> 01:17:06.119 today's episode, please subscribe, share, and leave us a review. We'd 977 01:17:06.199 --> 01:17:11.319 love to hear from you guys. Your continued support helps us spread this message 978 01:17:11.359 --> 01:17:15.520 of health and faith. Until next time, may God's grace and good choices 979 01:17:15.720 --> 01:17:18.560 guide your path to a life soil with joy, vitality, and a deeper 980 01:17:18.600 --> 01:17:21.840 connection with Jesus. God bless you all, and we'll see you in the 981 01:17:21.920 --> 01:17:23.640 next episode.