Full Transcript The limitations of labs 0:01 I've worked with hundreds of patients 0:02 I've worked with hundreds of patients whose cholesterol looked normal, yet 0:04 whose cholesterol looked normal, yet 0:04 whose cholesterol looked normal, yet they were still quietly heading toward 0:06 they were still quietly heading toward 0:06 they were still quietly heading toward heart disease. And very often, this one 0:09 heart disease. And very often, this one 0:09 heart disease. And very often, this one test is where the real story finally 0:11 test is where the real story finally 0:12 test is where the real story finally shows up. If you're new here, I'm Dr. 0:14 shows up. If you're new here, I'm Dr. 0:14 shows up. If you're new here, I'm Dr. Fred Bloom, an integrated physician. A 0:16 Fred Bloom, an integrated physician. A 0:16 Fred Bloom, an integrated physician. A big part of my work is helping people 0:18 big part of my work is helping people 0:18 big part of my work is helping people who've been told, "Your labs look fine," 0:21 who've been told, "Your labs look fine," 0:21 who've been told, "Your labs look fine," but they don't feel fine. And deep down, 0:23 but they don't feel fine. And deep down, 0:24 but they don't feel fine. And deep down, they know something is being missed.
The NMR lipo profile 0:48 >> Today I want to talk about cholesterol 0:48 >> Today I want to talk about cholesterol but not in the usual way. I want to 0:50 but not in the usual way. I want to 0:50 but not in the usual way. I want to explain the NMR lipo profile by LabCore 0:55 explain the NMR lipo profile by LabCore 0:55 explain the NMR lipo profile by LabCore and why it often changes how we assess 0:57 and why it often changes how we assess 0:57 and why it often changes how we assess real cardiovascular risk even when 1:00 real cardiovascular risk even when 1:00 real cardiovascular risk even when standard labs look reassuring. This 1:03 standard labs look reassuring. This 1:03 standard labs look reassuring. This isn't about fear. It's about clarity and 1:06 isn't about fear. It's about clarity and 1:06 isn't about fear. It's about clarity and prevention. Most routine cholesterol 1:08 prevention. Most routine cholesterol 1:08 prevention. Most routine cholesterol tests measure total cholesterol, LDL, 1:12 tests measure total cholesterol, LDL, 1:12 tests measure total cholesterol, LDL, HDL, and triglycerides. Those numbers 1:15 HDL, and triglycerides. Those numbers 1:15 HDL, and triglycerides. Those numbers tell you how much cholesterol is being 1:18 tell you how much cholesterol is being 1:18 tell you how much cholesterol is being carried in the blood. What they don't 1:20 carried in the blood. What they don't 1:20 carried in the blood. What they don't tell you is how many particles are 1:22 tell you is how many particles are 1:22 tell you is how many particles are carrying it, how aggressive those 1:24 carrying it, how aggressive those 1:24 carrying it, how aggressive those particles are, or how likely they are to 1:27 particles are, or how likely they are to 1:27 particles are, or how likely they are to cause plaque and inflammation. I've seen 1:30 cause plaque and inflammation. I've seen 1:30 cause plaque and inflammation. I've seen many patients with perfect LDL and no 1:32 many patients with perfect LDL and no 1:32 many patients with perfect LDL and no warning flags who still had significant 1:35 warning flags who still had significant 1:35 warning flags who still had significant cardiovascular risk once we look deeper. 1:38 cardiovascular risk once we look deeper. 1:38 cardiovascular risk once we look deeper. That disconnect is far more common than 1:41 That disconnect is far more common than 1:41 That disconnect is far more common than people realize. The NMR lipo profile
Analyzing lipid particles 1:44 people realize. The NMR lipo profile 1:44 people realize. The NMR lipo profile looks at lipoprotein particles, not just 1:47 looks at lipoprotein particles, not just 1:47 looks at lipoprotein particles, not just cholesterol content. That distinction 1:50 cholesterol content. That distinction 1:50 cholesterol content. That distinction matters. Think of it this way. One truck 1:53 matters. Think of it this way. One truck 1:53 matters. Think of it this way. One truck carrying 10 boxes versus 10 trucks, each 1:56 carrying 10 boxes versus 10 trucks, each 1:56 carrying 10 boxes versus 10 trucks, each carrying one box. Same amount of cargo, 2:01 carrying one box. Same amount of cargo, 2:01 carrying one box. Same amount of cargo, very different traffic risk. One of the 2:03 very different traffic risk. One of the 2:03 very different traffic risk. One of the most important markers on this test is 2:06 most important markers on this test is 2:06 most important markers on this test is the LDL particle number, LDLP. You can 2:10 the LDL particle number, LDLP. You can 2:10 the LDL particle number, LDLP. You can have normal LDL cholesterol, but a high 2:13 have normal LDL cholesterol, but a high 2:13 have normal LDL cholesterol, but a high LDL particle count. More particles mean 2:17 LDL particle count. More particles mean 2:17 LDL particle count. More particles mean more contact with the arterial wall, 2:20 more contact with the arterial wall, 2:20 more contact with the arterial wall, more oxidative stress, and higher plaque 2:23 more oxidative stress, and higher plaque 2:23 more oxidative stress, and higher plaque risk. When LDLP is elevated, I pay 2:27 risk. When LDLP is elevated, I pay 2:27 risk. When LDLP is elevated, I pay attention. Even if LDL cholesterol 2:29 attention. Even if LDL cholesterol 2:30 attention. Even if LDL cholesterol itself looks fine. Another key finding 2:33 itself looks fine. Another key finding 2:33 itself looks fine. Another key finding is small, dense LDL. These particles 2:37 is small, dense LDL. These particles 2:37 is small, dense LDL. These particles penetrate the arterial wall more easily. 2:40 penetrate the arterial wall more easily. 2:40 penetrate the arterial wall more easily. They oxidize more readily and they're 2:43 They oxidize more readily and they're 2:43 They oxidize more readily and they're strongly linked to insulin resistance 2:45 strongly linked to insulin resistance 2:45 strongly linked to insulin resistance and inflammation. When I see this 2:47 and inflammation. When I see this 2:47 and inflammation. When I see this pattern, I'm not just thinking about 2:50 pattern, I'm not just thinking about 2:50 pattern, I'm not just thinking about cholesterol. I'm thinking about 2:52 cholesterol. I'm thinking about 2:52 cholesterol. I'm thinking about metabolic health, blood sugar 2:54 metabolic health, blood sugar 2:54 metabolic health, blood sugar regulation, chronic inflammation, and 2:57 regulation, chronic inflammation, and 2:57 regulation, chronic inflammation, and hormonal balance. This is where 2:59 hormonal balance. This is where 2:59 hormonal balance. This is where cardiology and metabolism overlap. HDL
Metabolic health markers 3:04 cardiology and metabolism overlap. HDL 3:04 cardiology and metabolism overlap. HDL is another area where people get 3:05 is another area where people get 3:06 is another area where people get confused. HDL cholesterol alone can be 3:09 confused. HDL cholesterol alone can be 3:09 confused. HDL cholesterol alone can be misleading. HDL particle number gives 3:12 misleading. HDL particle number gives 3:12 misleading. HDL particle number gives insight into how well cholesterol is 3:14 insight into how well cholesterol is 3:14 insight into how well cholesterol is actually being cleared. I've seen 3:17 actually being cleared. I've seen 3:17 actually being cleared. I've seen patients with great HDL numbers whose 3:20 patients with great HDL numbers whose 3:20 patients with great HDL numbers whose HDL particles weren't doing their job 3:22 HDL particles weren't doing their job 3:22 HDL particles weren't doing their job effectively. Function matters more than 3:25 effectively. Function matters more than 3:25 effectively. Function matters more than appearance. One of the most clinically 3:28 appearance. One of the most clinically 3:28 appearance. One of the most clinically useful parts of this test is the LPIR 3:31 useful parts of this test is the LPIR 3:31 useful parts of this test is the LPIR score, a marker of insulin resistance. 3:34 score, a marker of insulin resistance. 3:34 score, a marker of insulin resistance. This score often becomes abnormal years 3:37 This score often becomes abnormal years 3:37 This score often becomes abnormal years before diabetes shows up, before fasting 3:40 before diabetes shows up, before fasting 3:40 before diabetes shows up, before fasting glucose rises, and before A1C looks 3:43 glucose rises, and before A1C looks 3:43 glucose rises, and before A1C looks concerning. In real life, this helps 3:46 concerning. In real life, this helps 3:46 concerning. In real life, this helps explain why weight loss feels 3:47 explain why weight loss feels 3:47 explain why weight loss feels impossible, why inflammation won't 3:50 impossible, why inflammation won't 3:50 impossible, why inflammation won't settle, and why cardiovascular risk 3:53 settle, and why cardiovascular risk 3:53 settle, and why cardiovascular risk stays elevated. It gives us a head 3:56 stays elevated. It gives us a head 3:56 stays elevated. It gives us a head start, not a late diagnosis. Traditional
Targeted treatment strategies 3:59 start, not a late diagnosis. Traditional 3:59 start, not a late diagnosis. Traditional cholesterol management often turns into 4:02 cholesterol management often turns into 4:02 cholesterol management often turns into one number, one medication, and one 4:05 one number, one medication, and one 4:05 one number, one medication, and one standard approach that misses nuance. 4:08 standard approach that misses nuance. 4:08 standard approach that misses nuance. When I use advanced lipid testing, I ask 4:11 When I use advanced lipid testing, I ask 4:11 When I use advanced lipid testing, I ask different questions. What's driving the 4:14 different questions. What's driving the 4:14 different questions. What's driving the particle dysfunction? Is this metabolic, 4:16 particle dysfunction? Is this metabolic, 4:16 particle dysfunction? Is this metabolic, inflammatory, hormonal, or lifestyle 4:19 inflammatory, hormonal, or lifestyle 4:19 inflammatory, hormonal, or lifestyle related? Treatment may involve nutrition 4:22 related? Treatment may involve nutrition 4:22 related? Treatment may involve nutrition timing, improving insulin sensitivity, 4:25 timing, improving insulin sensitivity, 4:25 timing, improving insulin sensitivity, sleep and circadian rhythm support, 4:28 sleep and circadian rhythm support, 4:28 sleep and circadian rhythm support, hormone optimization, 4:30 hormone optimization, 4:30 hormone optimization, targeted supplements, and sometimes 4:32 targeted supplements, and sometimes 4:32 targeted supplements, and sometimes medication, but deliberately, not 4:36 medication, but deliberately, not 4:36 medication, but deliberately, not automatically. The goal is correction, 4:39 automatically. The goal is correction, 4:39 automatically. The goal is correction, not suppression. In my experience, this 4:42 not suppression. In my experience, this 4:42 not suppression. In my experience, this test is especially useful if you have a 4:44 test is especially useful if you have a 4:44 test is especially useful if you have a family history of heart disease, carry 4:46 family history of heart disease, carry 4:46 family history of heart disease, carry weight around the abdomen, are 4:48 weight around the abdomen, are 4:48 weight around the abdomen, are parmenopausal or post-menopausal, have 4:51 parmenopausal or post-menopausal, have 4:51 parmenopausal or post-menopausal, have metabolic syndrome, or want prevention 4:54 metabolic syndrome, or want prevention 4:54 metabolic syndrome, or want prevention rather than surprises. This isn't about 4:57 rather than surprises. This isn't about 4:57 rather than surprises. This isn't about being extreme, it's about being precise. 5:01 being extreme, it's about being precise. 5:01 being extreme, it's about being precise. I never interpret this test in 5:03 I never interpret this test in 5:03 I never interpret this test in isolation. I integrated with 5:05 isolation. I integrated with 5:05 isolation. I integrated with inflammation markers, hormones, thyroid 5:08 inflammation markers, hormones, thyroid 5:08 inflammation markers, hormones, thyroid function, glucose and insulin patterns, 5:11 function, glucose and insulin patterns, 5:11 function, glucose and insulin patterns, symptoms, and sometimes imaging. That's 5:14 symptoms, and sometimes imaging. That's 5:14 symptoms, and sometimes imaging. That's how lab data becomes inside, not 5:17 how lab data becomes inside, not 5:17 how lab data becomes inside, not anxiety. Cholesterol itself isn't the
Conclusion and engagement 5:20 anxiety. Cholesterol itself isn't the 5:20 anxiety. Cholesterol itself isn't the villain. The real issues are particle 5:23 villain. The real issues are particle 5:23 villain. The real issues are particle burden, inflammation, and metabolic 5:26 burden, inflammation, and metabolic 5:26 burden, inflammation, and metabolic dysfunction. The NMR lipo profile 5:29 dysfunction. The NMR lipo profile 5:29 dysfunction. The NMR lipo profile doesn't replace clinical judgment. It 5:31 doesn't replace clinical judgment. It 5:31 doesn't replace clinical judgment. It sharpens it. And for the right patient, 5:34 sharpens it. And for the right patient, 5:34 sharpens it. And for the right patient, it can change the entire trajectory. 5:36 it can change the entire trajectory. 5:36 it can change the entire trajectory. Now, I'd love to hear from you. Have you 5:38 Now, I'd love to hear from you. Have you 5:38 Now, I'd love to hear from you. Have you ever been told your cholesterol was 5:41 ever been told your cholesterol was 5:41 ever been told your cholesterol was normal, but something didn't sit right? 5:43 normal, but something didn't sit right? 5:43 normal, but something didn't sit right? Has anyone ever explained particle 5:45 Has anyone ever explained particle 5:45 Has anyone ever explained particle number or insulin resistance to you? Do 5:48 number or insulin resistance to you? Do 5:48 number or insulin resistance to you? Do you think prevention should start 5:50 you think prevention should start 5:50 you think prevention should start earlier than it currently does? And 5:52 earlier than it currently does? And 5:52 earlier than it currently does? And would you want deeper testing, or does 5:54 would you want deeper testing, or does 5:54 would you want deeper testing, or does it feel overwhelming? Drop your thoughts 5:56 it feel overwhelming? Drop your thoughts 5:56 it feel overwhelming? Drop your thoughts in the comments. I read everyone. And if 5:59 in the comments. I read everyone. And if 5:59 in the comments. I read everyone. And if this was helpful, like, subscribe, and 6:02 this was helpful, like, subscribe, and 6:02 this was helpful, like, subscribe, and share it with someone who keeps hearing 6:04 share it with someone who keeps hearing 6:04 share it with someone who keeps hearing your labs look fine, but knows there's 6:07 your labs look fine, but knows there's 6:07 your labs look fine, but knows there's more going on.
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