OneMedicine Podcast

Rob Lutz 00:02
Hello and welcome to the OneMedicine Podcast with Today's Practitioner. In each episode, we share the expertise of a respected thought leader, some you will know and others you'll probably meet for the first time. We cover topics important to you, always with a focus on improving the health outcomes of the patients you treat, while expanding your understanding of the many healing modalities being used today.

Rob Lutz 00:24
Welcome to the OneMedicine Podcast. I'm your host Rob Lutz. And with me today is Dr. Mark Houston. We'll be discussing dyslipidemia and how Dr. Houston recommends approaching this common health challenge. Dr. Houston is the Director of the Hypertension Institute, Medical Director of the Division of Human Nutrition and Medical Director of Clinical Research at the Hypertension Institute. He is a clinical instructor in the Department of Physical Therapy and Healthcare Sciences at George Washington University School of Medicine Health Science. He has four board certifications by the American Board of Internal Medicine, the American Society of Hypertension, the American Board of Anti-Aging and Regenerative Medicine, and the American Board of Cardiology Certification in Hypertensive Cardiovascular Disease, Dr. Houston has presented over 10,000 lectures nationally and internationally and published over 250 medical articles, scientific abstracts of peer-reviewed medical journals, books and book chapters. He's a true thought leader and author, clinician, researcher, and a gifted teacher. Dr. Houston, welcome to the One Medicine Podcast. Thank you; it's truly an honor to have you with us today.

Mark Houston 01:30
Thank you, Rob, it's a pleasure to be with you. Thank you very much.

Rob Lutz 01:34
Thank you. Before we jump into the topic, I always like to hear from our guests, especially you with your conventional background, one of the top medical schools in the country in a time when integrative alternative medicine really wasn't as popular as it is today, how did you make that transition? What was your path that brought you to more of a functional and integrative approach to medicine?

Mark Houston 01:55
It was actually a very personal issue with my father. He had developed prostate cancer and was told by most of the traditional treatment neurologists and oncologists that his disease was not going to be treatable and he probably would die within a year. I knew nothing about integrative care at all. I knew nothing about oncology, because I never studied that being a cardiovascular person. But I looked into it and found a whole host of scientific information that I thought might help him. And most of this was nutrition and nutritional supplements, none of which the traditional doctors had even mentioned to him. So, I put him on this program, and he did extremely well for four years. I said: "Well, if this works for something I know nothing about, perhaps there are some things that I need to learn about cardiovascular medicine that are more integrative." And that's when I started delving into this. And that was in 1997 that I started doing this when it wasn't really very popular. People really weren't doing it. And I did that for about five years, just on my own. And then I finally decided I needed further education. That's when I went back and got a Master's Degree in Nutrition at University of Bridgeport. So, I've been practicing integrative cardiovascular medicine now since about 1997, '98.

Rob Lutz 03:25
Wow, that's great. I guess I'm curious, you describe yourself as an integrative cardiologist.

Mark Houston 03:32
Right.

Rob Lutz 03:33
Another question I typically ask my guests: Is there one common thread that pulls all these different types of medicine together, whether it's integrative, functional, alternative, ayurvedic? Do you think there's a common thread, a unifying principle, let's say?

Mark Houston 03:51
I say this over and over again--it's kind of my mantra--and that is: "A wise healer uses that which works." If you follow that principle, then you don't negate anything that's even remotely scientific; you're going to try to use it to heal your patient. So it's a combination of drugs and nutrition, supplements, lifestyle changes, exercise, weight management--it's everything you can pull together to make your patient do better with whatever disease they happen to have.

Rob Lutz 04:24
That makes sense, and I agree with that. I often think about traditional Chinese medicine or ayurvedic medicine, 5000 years old. And it was basically the medicine that worked; they figured out what worked to help someone who might be ill in a certain way. There was no billion dollar marketing campaign that convinced you to go talk to your doctor and get recommended with something. It was really things that worked. And I think now scientists really verified some of those things, and we've discovered so many new things. So I like that idea of the medicine that works. And I think it's going to continue to evolve as we learn new things and find new approaches to address challenges that we have now, and maybe challenges that will come up later, too.

Mark Houston 05:04
Absolutely.

Rob Lutz 05:04
So we're going to talk about dyslipidemia, and and how you approach that. And recently, one of my writers wrote a piece about crafting a protocol for cardiovascular health. There was a quote that you gave Lisa--we talked about cardiovascular health as being very complex, nuanced, lots of different factors that influence that--and you gave us a quote, and I'll read it: "Precision and personalized cardiovascular medicine must be the new medicine of today and the future. This means that every patient must have a complete genetic profile, a detailed medical history, and a comprehensive physical examination along with advanced cardiovascular labs and testing." Can you expand a little bit about that? I know it's never one size fits all for every patient, right? I think that's somewhat of what you're saying there. But can you just unpack and expand on that a little bit for me?

Mark Houston 05:54
Yes, certainly. First of all, "personalized" really means that each patient that comes into you is a number of one. And they're not a statistic, which means whatever you do for them is going to be unique. And to personalize it, you have to have their genetics. You really can't apply anything well, or optimal at least, without genetic testing. And then you couple that with everything else you typically would do with their history and physical testing, and design a program that fits them perfectly. And that's the precision piece, which is everything you do is precisely designed to give them the optimal ability to heal or cure or make better everything they have wrong with them. So that could be a lot of different things, particularly in cardiovascular medicine where you have so many risk factors for coronary heart disease. But once you narrow it down with that sort of precision and personalized approach, it becomes much better at reducing that person's risk, and not assuming that what you're doing for them might work for another patient, or it works epidemiologically so to speak, for the population.

Rob Lutz 07:18
Yeah, it does seem like a lot of medicine these days, conventional medicine, is a one size fits all. You've got, in this case, probably a statin, right? "Hey, my cholesterol is high." "Here's a statin. We give them to everybody; you should put in the water." But they don't really talk about maybe some other risk factors or what else that might be doing to them. And I would like to come back to that. You mentioned genetic testing; can you tell me a little bit about that? As we focus this conversation maybe around--and I'd heard a term: Primary Prevention--so some of them maybe haven't had a heart attack or something like that, but your more general public that has high cholesterol, is that the primary prevention category? Am I getting that right?

Mark Houston 07:53
Well, if you're talking about primary prevention, cardiovascular disease, it's very broad. It certainly is dyslipidemia, but it includes an enormous number of other things, and we'll get into some of these today. Blood pressure, diabetes, homocysteinemia are just a few of the things...inflammation, oxidative stress, immune dysfunction, and looking at the 400 different risk factors that cause heart disease and heart attacks.

Rob Lutz 08:22
Okay, so we'd better narrow that down a little bit for our 45-minute talk.

Mark Houston 08:25
Today, we're going to concentrate on just a very small part of it, which is the dyslipidemia story, which I would say, Rob, if you had to pick one topic that is most misunderstood not only by doctors but also by the lay public, it's dyslipidemia. There are so many misconceptions about how you become dyslipidemic, what it does, how do you treat it, how do you prevent it, that people take opposing views, which is sad. And when you do that, you don't allow yourself to be treated appropriately.

Rob Lutz 08:58
So what are some of the misconceptions?

Mark Houston 09:01
Probably the biggest misconception is that--people have written books about this actually--which basically says cholesterol doesn't cause heart disease. That's really not true. Cholesterol does cause heart disease; there's no question about it. But the word "cholesterol" is misleading, because we don't even use total cholesterol now to define dyslipidemia; it's obsolete. So when you do what's called advanced lipid testing, you would say that there's the surreal story, which is LDL cholesterol--which is the bad cholesterol--LDL particle number, HDL function, are the real drivers of coronary heart disease and MI. Well, you're not going to have somebody write a book that says: "LDL particle number doesn't cause coronary heart disease," because if you said that, you would be slammed into total disreputation because you have not followed science. Or if you were to say, if your HDL is not functional: "Don't worry about it; it's not going to cause heart disease." So these books about the cholesterol myth--cholesterol doesn't cause heart disease--are just skimming the surface with misleading information. And they say: "Well, if you don't believe in cholesterol, then you should never take a statin because statins are terrible. Statins are terrible drugs because they cause side effects. They cause dementia; they cause this, that, and the other." Well, I write statins all the time; I've been doing it for my entire career. In fact, if you know how to prescribe a statin, and watch for side effects, they're wonderful drugs for reducing lipids, but also reducing heart attack risk. They ignore the idea of primary vs. secondary prevention. You can take any topic you want, you know this, and you can find something to support your view.

Rob Lutz 10:48
Absolutely.

Mark Houston 10:50
When I talk about lipids, I have a very strong position about what dyslipidemia is, but it's based on pure science, and you can't argue with the science. When I tell you what this is going to do to you, I can guarantee you, this is what will happen. It's not mythical.

Rob Lutz 11:07
So how do you define it? What's what's your definition?

Mark Houston 11:11
Well, let's go back for a second. The first misconception is what causes dyslipidemia. People know about familial, genetic...everybody gets that one. Everybody knows about nutrition. Everybody knows that if you're overweight, that's an issue. But didn't you say: "Well, what else is out there?" And they'd say: "Well, I don't know. I think that's pretty much it, isn't it?" I say: "No, the most common reasons that you're not talking about that cause dyslipidemia are infections and toxins." And I say: "Well, how many people who have dyslipidemia have had either of those even checked by their physician?" I would guarantee it's probably less than 1%.

Rob Lutz 11:51
So what would you be checking for?

Mark Houston 11:53
We check all their toxicology--pesticides, organicides, heavy metals. We check their acute and chronic infection using different laboratory tests, and if they have any of those, we try to remove those issues. Lo and behold, a lot of times getting rid of the cause of the dyslipidemia will correct the dyslipidemia. Obviously, everybody can say: "Well, go on a diet and lose weight; that's going to work." Well, yes it does for most people, but not to the point you might get to your goal levels, which you're going to define as dyslipidemia, which we'll get to next. So, first is a misconception of what causes dyslipidemia. And the second is, what does the dyslipidemia actually do? Why is it bad? What does it do to set off plaque formation and heart attacks? Well, dyslipidemia itself in your bloodstream is not a bad thing. Because if it were, you would be dead because LDL cholesterol by itself in its native form is not atherogenic. And that's totally missed out there, too. What I mean is: The LDL that circulates in your blood doesn't kill you. Otherwise, you make antibodies to it. If you had a horrible antigen antibody reaction, you'd be dead. So what does the LDL do? Well, it goes into the wall of the blood vessel--it's called the endothelium, so that's the endothelial lining--and it sticks. Small particles get in more than big particles. Well, once it gets in there, it's stuck. It can't get out. Now, it becomes an antigen because it's not where it's supposed to be. So your body mounts a response to that. Antibodies, oxidative stress, inflammation. What happens--and this is the missing piece people don't talk about--what LDL cholesterol does when it gets into the subendothelial layer sets off three finite responses that cause vascular disease: Inflammation, oxidative stress, and vascular immune dysfunction. And there's 45 steps from the time that happens until you form a plaque that ruptures and causes your first heart attack. You think about that: 45 steps. How many of those 45 steps when you go into your doctor's office, does he say: "Well, we've got 45 things here that we've got to address with a drug or a nutrient or lifestyle"?No, no, no, it's not that at all. It's: "Here, take this statin to lower your LDL. End of story. You're fine." When that obviously doesn't work.

Rob Lutz 14:29
Yeah, that's really interesting. And obviously it's not something you're hearing out there.

Mark Houston 14:33
No, unless you read some of the books that I've written and talk to some other integrative cardiologists or lipidologists, you're not going to hear this in traditional lipid medicine. They just don't talk about it.

Rob Lutz 14:47
That's a shame. Do you think that'll change? Is it just a matter of getting this story out there in a bigger way?

Mark Houston 14:53
The story has been out there for a long time, and it's not changing much, at least in the practice of medicine all across the United States. Because I talk to physicians all the time, I talk to patients, teach physicians, and they're not hearing it. And because they're not hearing it, they're not being treated appropriately.

Rob Lutz 15:11
But it also sounds like your approach to the patient care, it's a lot of time right? You're doing a lot of work.

Mark Houston 15:18
You have to take personal time, you've got to explain everything, but you also have to give them educational material. It's too much for anyone to absorb in one visit. I mean, this is like months of training and understanding. So we have books that I've written, and we can talk about those and where they can get them. Probably the best one for your audience, both for laypeople but also physicians that want to learn this, is a book that is called "The Truth about Heart Disease." You can get it on Amazon. But in that book, "The Truth about Heart Disease," there's a whole section on how the lipids cause the things we just talked about, explains it in great detail. And then we have other handouts in the office, and we have videos, we have audio, but we give those to the patient. So they become a partner in learning, and once they learn they're open to do whatever you think is appropriate to treat them.

Rob Lutz 16:14
I'll have a question for you a little bit later that relates to that point. So, the advanced lipid test that you mentioned, can you just tell me a little bit more about what you're looking for and how does that guide your approach?

Mark Houston 16:24
Advanced lipid testing goes way beyond the traditional lipid profile you get in your office. In the old days, you got a total cholesterol and the LDL cholesterol, triglycerides, and an HDL, and that was it. Well, with the advanced lipid profile, you get all that plus about 10 other things like lipid particle size, lipid particle number--both for LDL, HDL, and triglycerides, or VLDL. You get LPa, which is a very hidden risk for heart attack. And once you have all that, you know their true risk and you also know what to treat them with.

Rob Lutz 17:03
That gives you a guide to the roadmap that you're going to share with them as to how to go from where they are today?

Mark Houston 17:10
And the LDL particle number--LDLP as it's referred to--is the driving force for lipids for heart attack. Not LDL. LDL particle number. And most of the time, if the particle number is high, it's very small, dense LDL. And that's the ones that travel into the endothelium and stick. That's why they're so bad. And the other big risk is HDL dysfunction. And that's another whole complicated story we can talk about. But HDL levels in and of themselves are not particularly indicative now of coronary heart disease; it's their functionality that drives the risk.

Rob Lutz 17:51
So these advanced lipid tests, I don't think my practitioner did that for me. I think I had the standard tests and so forth. Where do you go to get those tests? Where can a practitioner...

Mark Houston 18:01
They're available from the top labs in the country--Quest, Labcorp, everybody uses one of those--has advanced lipid testing. And it doesn't really cost any more than a regular lipid profile now; they're so common. There's no reason not to get them.

Rob Lutz 18:18
I go to a clinic--there are MDs and naturopaths, it's a holistic health center-- but that's not the lipid test they did for me. That wasn't the one they recommended. Maybe they didn't feel like I needed it, but I would think in my standard checkup and bloodwork...

Mark Houston 18:32
I think you have to take the approach that everybody needs it, because otherwise you miss it.

Rob Lutz 18:37
Right. We discussed a little bit about particle size. Is there anything else that you want to say about that?

Mark Houston 18:42
Yeah, just briefly. Basically, a high LDL particle number, the higher the number, the greater the risk. Using the advanced lipid testing we talked about, you want to get your LDL particle number usually below 1000. That's for primary prevention, okay? That means you haven't had a heart attack, or you don't have non-coronary heart disease by various definitions. However, if you've had a heart attack, or you have non-coronary heart disease, or you have a lot of risk factors, then you go into really a secondary prevention. Now that number drops from 1000 to 500. And then the LDL for primary prevention is about 100. And the LDL for secondary prevention is 30 to 60. So it's very aggressive.

Rob Lutz 19:31
I know we're going to talk a little bit about your approach to bringing these numbers down. That's primarily through supplementation, a formula that you've created. So we'll talk about that.

Mark Houston 19:41
And/or drugs, all together.

Rob Lutz 19:44
Does cholesterol have any positive attributes?

Mark Houston 19:46
Absolutely. If we didn't have cholesterol, we wouldn't be able to have all our tissues hold together. We couldn't make a lot of hormones, steroid hormones, we couldn't make sex hormones, we couldn't make Vitamin D. It serves as a very important part of the cell membrane. So you have to have cholesterol, and it's just a matter of what level you can drop your LDL cholesterol to without getting into side effects that reduce some of these important pathways. The numbers I just gave you represent numbers that are safe to go to without causing downstream adverse effects.

Rob Lutz 20:24
Okay. You hear about the common side effect of a statin is CoQ10 depletion, but it sounds like if they're not really monitoring correctly, or the dose is too high, it could have much worse impact than just that, right?

Mark Houston 20:37
And, Rob, just to go beyond your very important point about CoQ10, statins deplete 10 micronutrients. Well, if you ask most physicians to name 10, they get maybe name CoQ10, and then go: "I don't know about the other nine." But you have to get a baseline on all 10 of those, micronutrient testing, and you have to follow them. And if they start to decrease, you've got to replace them. I mean, just to give you an example: Vitamin E is depleted, Omega-3 fatty acids are depleted, Vitamin A is depleted, Creatine. I mean, the list is very large.

Rob Lutz 21:17
No free lunch with that one, right? Yeah, if you're not what I would say is a responsible practitioner, and you're just prescribing statins: "Here you go, one size fits all," you could really be causing some serious issues down the road for those patients.

Mark Houston 21:31
Exactly.

Rob Lutz 21:31
I think about both of my parents. My dad's 91; he had open heart surgery and new valves and quadruple everything, 15 years ago, and I wonder if him being put on a statin--of course, he's 91--but is that part of his decline was having to do with that?

Mark Houston 21:49
Well, he would have been 75 or so when he developed his bypass, right?

Rob Lutz 21:54
Yeah. Right.

Mark Houston 21:55
So he's past that age range where you would think it would be a problem for you, because it's not really familial at 75. If he'd had it before he was 60, then yeah.

Rob Lutz 22:06
It was interesting. He's very active, walked a lot, and was just sure he was super healthy in that regard. They did a stress test, and the doctor was like: "We've got a problem." He was pretty well clogged up, I think, at that point. So anyway, testing would have helped that, right? A more thorough test, we would have known more at that point.

Mark Houston 22:26
Yeah, because obviously, this didn't happen overnight. This is something that happened for decades.

Rob Lutz 22:32
He's a lover of butter, and he always has been.

Mark Houston 22:36
There you go.

Rob Lutz 22:37
It's pretty funny. Okay, statins...that's the typical approach. For a lot of practitioners, it's a one size fits all. We've talked about why that's really not appropriate--the more personalized approach. We talked a little bit about the downsides of statin, the different depletions, which, again, CoQ10 seems to be the household understanding. That's the depletion. I can remember, I think it was back probably in the mid '90s, when Jim LaValle, who you probably know, he was one of the earlier guys to get some attention around the drug depletion, drug nutrient depletion. And I think he had developed a formula for different drugs. I don't recall what else was in the statin formula for that, but I imagine some of those were in there. Can LDL be too low? Can HDL be too low? What happens? We talked a little bit about that, but maybe talk a little more, if you don't mind?

Mark Houston 23:28
To answer the question "Can your LDL be too low?" you really have to go to the literature and look at double-blind placebo-controlled trials that have used one or more drugs--rosuvastatin, atorvastatin, whatever--and look at the levels in those studies, and then look at the side effects at the different levels. So there are studies out there that have done this. And if you take all the studies together, it is pretty clear, if you get your LDL below 30, you'll have side effects. Now that didn't say that there might not be people who have side effects at 60. That's not the point. But if you look at a population, 30 seems to be a number that you could probably shoot for in the high-risk patient. You could take it up to 60 if you had to. And that's with any of the statins. And the same is true with the LDL particle number. It seems that when you get down to about 500, that's about as low as you should go. And then the other thing that other doctors will measure, which is also in the advanced lipid test, is apolipoprotein B. And 70 has been the traditional cutoff for the mainstay primary prevention, but if you got into secondary prevention, you've got to start dropping it down to probably 50.

Rob Lutz 24:44
Okay, so protocol for your patient: You've done the testing, you've looked at their numbers, and of course you're going to talk, as we said, nutrition, stress reduction exercise, supplementation. Supplementation is pretty easy for most people. They can take a pill or drug. You mentioned, of course, statin isn't off the table if you're managing that the way that you've mentioned. How do you help your patients make...these are some pretty big changes. These are lifelong habits of eating poorly, no stress reduction, no exercise, or very little. How do you guide them and essentially influence them to improve their lifestyle?

Mark Houston 25:18
Well, there are certain patients where you can give them choices. There are other patients where you can't. You just say: "Look, I'm sorry, this is the way you've got to do it." But let's assume that the patient has a choice about how you could approach it. So you say: "Well, look, I can give you a drug, and here are the drugs I can give you. Here's the advantages and disadvantages of doing that." So for a drug, it's going to be only one pill, it's going to be covered by your insurance, and it's going to be probably less expensive, but there are some side effects, and here's what they are. Now, if you want to do natural therapy, we call this "nutritional supplementation," then you're going to have to take more pills, it's going to be out of your pocket, because insurance companies will not pay, but you won't have any side effects. I'd say: "I can get your LDL and your LDL particle number to the goal that I need for you. Either way, you tell me what you prefer." But with other people that are, for example, there might be secondary prevention-- if they've had a heart attack--and you say: "Look, your LDL is 200. I've got to get it to 60 or 30. I can't do that without using everything I can throw at you. A statin, maybe a PCSK9 inhibitor, natural therapy, whatever. So here are the things we have to do, here are the doses. We're going to try an integrative approach, but this is what you have to do to reduce your risk of another heart attack."

Rob Lutz 26:48
I know someone that had a heart attack, very high numbers, got on a statin, and decided he was just going to continue to eat the way he's always eaten. Because: "Hey, I'm taking this pill now, and I don't have to worry about it." So, I think the side effects of taking that approach, we've talked about that. But I think whatever side benefits, let's say, of the better nutrition, the stress reduction, the exercise...yes, you're going to help those numbers that are important to that aspect of their health challenge, but I do think that a patient that takes this more holistic approach, and improves on all these other aspects of their life, they're going to feel better, right?

Mark Houston 27:27
Absolutely.

Rob Lutz 27:27
The quality of their life is going to be much better. It's harder to get there probably, for a lot of patients to do that.

Mark Houston 27:33
That's correct.

Rob Lutz 27:35
I always wonder, what are some of the ways that a practitioner helps guide their patients to be doing what's really best for them, rather than just take the drug? Because it's easy, but there are all sorts of issues around that. I'm curious: I think you've got a book and a couple of chapters about nutrition that you recommend for patients that are suffering from dyslipidemia.

Mark Houston 27:56
The two books that I would recommend, the first one I mentioned earlier, is "The Truth about Heart Disease." It's very recent; it's probably a year, year-and-a-half old.

Rob Lutz 28:06
I'll include a link to these.

Mark Houston 28:07
It's very up to date, and you can just order that directly off Amazon. That's got the entire heart disease, lipid story, everything in there. And there's two chapters in there on nutrition where we have exactly what you need to eat. We've got recipes there, very easy to follow. And if you do that, you not only lose weight, but your cholesterol, LDL particle number, total LDL get better. Your blood sugar gets better, everything gets better.

Rob Lutz 28:39
I'm curious, what kind of food do you eat? What's your diet like?

Mark Houston 28:42
I follow pretty much what's in the books. It's sort of a combination of the tried and true Mediterranean diet, or the PREDIMED diet with a modified DASH 2 diet. So it's geared towards diabetes, hypertension, dyslipidemia, weight manifestation.

Rob Lutz 28:59
Stress reduction. What do you recommend for your patients as far as...

Mark Houston 29:03
Well, I ask them, what do they do? And then what would they be willing to do if I could give them a program? How many minutes a day would they follow something and they'll say: "Oh, I can give you 10 or 15 minutes, but that's about all I have." Okay, then I'll design something around their time commitment. I'll say: "Well, if you promise you'll do 10 or 15 minutes, here's what you need to do." And so the first thing is deep-breathing exercises. That's really easy, and it's quick, and it's free.

Mark Houston 29:33
So, while you do that, you go to a nice quiet room where it's dark, and you breathe in through your nose for five seconds. And then you purse your lips and you slowly expel seven seconds. You do that five times. And you repeat it five times. It takes you all of probably less than five minutes. Then, do some sort of meditation; figure out what works for you. If you're religious, then read the Bible, say prayers, do some sort of other types of meditation. If you want to do yoga, or you're a Buddhist or Hindu, whatever works for you, do that meditation. That's where you start your day, if you can, with that 15 minutes. But also during the day, if you get stressed out, you can go in a quiet room for two minutes and do your deep breathing again, and you'll feel better. Just do it all day. It resets the sympathetic and parasympathetic nervous system.

Rob Lutz 29:33
It works.

Rob Lutz 30:36
I find that stuff very interesting. I meditate in the morning, and you're probably familiar with, I think it's an app or a device: HeartMath.

Mark Houston 30:43
Yes, of course.

Rob Lutz 30:44
I use that. I'll start my meditation usually just using that, where it gives you this guide for your breath. What I've found, because I'm also tracking my heart rate variability, that when I do this, it spikes. I mean, it might be 170 during that session, but I feel so much more relaxed, and it lasts throughout a pretty long period of the day. The other thing that I've been looking into that I find interesting is vagus nerve stimulation, but same thing. I notice if I'm using this consistently, my heart rate variability, which is that alignment, cohesiveness. So that's interesting. But, yeah, I do think if a patient can-- say: "Look...15 minutes, can you give me 15 minutes?" It can definitely change your world, I think.

Mark Houston 31:27
I agree.

Rob Lutz 31:28
And then exercise, what do you do for exercise? What do you recommend for your patients?

Mark Houston 31:33
In the book I just mentioned, there's two chapters on the best exercise program. It is called the Hypertension Institute Pogram. HIP: H-I-P. It's one hour a day for six days a week. You start out with 40 minutes of resistance training, and 20 minutes of aerobic training, and you do it in that order. There's various stages that we implement: 1 through 5. So, you can be a couch potato, start at Phase 1, and work your way up to be an Olympic athlete if you want to do so. It's very scientific; I worked with a gentleman named Charles Poliquin, who is one of the top strength trainers in the world. He and I put together this protocol along with a few other folks. But it's probably the best exercise program out there to really condition yourself for both muscle strength as well as aerobic training.

Rob Lutz 32:28
Again, all these things that you're recommending for dyslipidemia, all the side benefits are going to improve their life in so many different ways. More energy, they're just going to be more relaxed, they're going to feel better. All right, so let's spend some time talking about supplementation. Again, I know that you've developed a formula for Biotics. Full disclosure, you clearly did that for them, and Biotics is a partner with us. They sponsor our Cardiovascular Health Resource Center and a few other things. But if you could talk to me a little bit about the ingredients that you added to that formula and why, and maybe some of the the impact that they have. I will mention that in the show notes, we'll have a link to the different books and some of the different resources that you mentioned, but we'll also link to this webinar that you gave probably about a month ago with Biotics where you go into much, much more detail. There's some great Q&A with some practitioners about that formula. But if you could touch on the different ingredients and the mindset as to why you included those.

Mark Houston 33:23
The name of the product is Cardio-Lipid, Cardio-Lipid. And we spent years developing this formulation. We went through various ingredients, various doses, combinations. We did clinical tests in the office on patients until we found the best combinations and best doses for the top four or five nutrients. And when we found it, we put it to the test with a clinical trial, and we found that taking anywhere from two to nine capsules a day we could decrease your LDL cholesterol and your LDL particle number by 50%. Which is about the same as you can get with the most potent statin, which is called Crestor. So what's in Cardio-Lipid is the best red yeast rice which is made Biotics; it's pristine, no toxins or whatever. A phytosterol, which helps to reduce cholesterol absorption in the GI tract. Berberine, which works on cholesterol; it also works on blood sugar. It's also a natural PCSK9 inhibitor; it does all kinds of great stuff. And kyolic garlic, which has all kinds of great effects not just on lipids but also on blood pressure, coronary heart disease, plaque formation. In fact, everything in Cardio-Lipid helps many other things other than just LDL cholesterol and LDL particle number. It's really a lipid/cardiovascular formulation. We found things that happen that we didn't even anticipate would happen, like reduction in blood pressure, reduction in inflammation, high-sensitive C-reactive protein. It has only been out a few months. In the webinar, we showed what response you get for the number of capsules you take. And so you figure out: "Okay, I want to drop your LDL so much," then you can figure out exactly how many capsules.

Rob Lutz 35:27
It makes it really easy, I think, for the practitioner.

Mark Houston 35:29
It's a really nice way to figure all this out. It works almost every time within maybe 5% of what you would project. And ever since this came out, I have a lot of patients taking it. Some are taking four a day, some are taking nine a day. The patients that I have looked at in my practice, every one of them are hitting within probably 2-3% of the projected reduction in those parameters.

Rob Lutz 35:57
That is amazing.

Mark Houston 35:58
It's working in reality.

Mark Houston 36:01
That's a really great story. I think hearing about a formula that isn't just so not this reductionist kind of concept where, but it's, it's doing so many other things for the patient, I think is, is pretty powerful. Okay, to just kind of wrap this up, and, what else? Are there any kind of pearls you want these practitioners who are listening today, as they think about dyslipidemia, what do you want them to walk away with?

Mark Houston 36:27
I think they just need to step back and just totally revise the approach that they take to dyslipidemia. When they come in the office, the first thing you do is have them get an advanced lipid profile, okay? Because at that time you don't know that what they have. So, they come back and see you in a week or two, and sure enough, they have dyslipidemia. So you say: "Okay, you have dyslipidemia, and here's all the causes"...and we've addressed those: You've got your nutrition, you've got your weight, you've got maybe some drugs you're taking that are messing it up, you've got your toxins and your infectious diseases. So, they check all of those things, and then they have a cause relationship. So they say: "Okay, we're going to find, if we can, a cause, but we're going to go ahead and start you on treatment for right now because I don't want you running around for months or years without having your cholesterol, the LDL part of it, untreated." So, you have this conversation: "Here's your LDL, primary prevention, this is what we're going to get to," or, "You've had a heart attack, secondary prevention, and this is what we're going to get to." So, here's our choices: "Tell me what you want to do," or "I'm sorry, this is what you have to do." And then, you get them controlled, and you've got all these tests that you've ordered, which are going to take weeks or months to get all this data back. And sure enough, it'll come back and say: "Gosh, did you know you had mercury and lead toxicity?" "No, I didn't." "Well, we're going to get chelation therapy going. And that's going to remove that stimulus, and that's going to help us get your LDL down even better." Or: "Did you know you had four occult infections, like CMV, or HBV or Hepatitis A, B, C. We've got to get those under control. So what you do is remove the causes, and pretty soon you'll find that the cholesterol LDL may be dropping, and you can begin to actually reduce whatever you're giving for treatment.

Rob Lutz 38:27
And they're probably feeling so much better...

Mark Houston 38:27
Yeah, because you not only address their LDL cholesterol, but you've addressed the reason that they had it in first place.

Rob Lutz 38:39
I love it. Thank you so much. This was great, really informative. Just a real pleasure to have you on the show.

Mark Houston 38:45
Thank you, Rob. I wish you the best.

Mark Houston 38:47
Thank you so much.

Rob Lutz 38:49
Thanks for listening to the OneMedicine Podcast. I hope you found today's episode interesting and came away with a few insights you can apply to your practice. If you're looking for the show notes, they can be found in the link below. If you want to go deeper on this topic or anything else, please visit todayspractitioner.com and consider registering for our weekly newsletter as well. Thanks again, and I hope you'll join us next time.