Facilitated

27| Metabolic Health: It's Not About Vanity

• The Facility Denver • Episode 27

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Heart disease, cancer, and Alzheimer's disease may appear to be separate illnesses, but they all share a common root cause: metabolic dysfunction. Dr. Mitchell Rasmussen explores the connection between these top killers and reveal how addressing your metabolic health can protect you from multiple diseases simultaneously.

• The LDL versus inflammation debate isn't either/or – both factors work together in heart disease 
• Endothelial dysfunction turns blood vessels from "Teflon" to "Velcro," allowing plaque formation
• LDL particle count (ApoB) matters more than particle size for cardiovascular risk
• Metabolic syndrome creates fertile soil for heart disease, cancer, and neurodegeneration
• Exercise improves insulin sensitivity with muscles acting as glucose "sinks"
• Mediterranean diets lower both LDL and inflammation, while processed foods do the opposite
• Poor sleep, chronic stress, and environmental toxins accelerate metabolic dysfunction
• Claims about medications being the third leading cause of death oversimplify complex data
• Addressing root causes can reduce medication dependence and prevent major diseases



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Mitchell:

Heart disease, cancer, alzheimer's these are some of the top killers in the United States, and they do seem like separate diseases, but the truth is they all share a common kind of root, which is metabolic dysfunction. Today, I'm going to be sitting down by myself to talk about some topics that I'm passionate about, things that we have discussions with our patients and clients with quite often, and so often I find myself bridging the gap between the conventional and the holistic side. I don't like to be woo-woo too much and I don't like to be too Western. I really like to live in the middle, which is often where healing occurs, and unfortunately for social media, this doesn't make for a ton of clicks, because people tend to get a lot of traction in that way when they're very extreme, but oftentimes that's not where healing occurs, and I'm much more interested in helping people get better. So in this episode, I want to break down this whole LDL cholesterol versus inflammation debate. I want to talk a little bit about how endothelial dysfunction will set the stage for heart attacks, and I also want to show why metabolic syndrome doesn't just lead to diabetes. It also fuels cancer and neurodegeneration, which, as we've talked about before as being such top killers is a vital aspect of health. I'm even going to tackle that controversial claim that's been going around social media Are medications really the third leading cause of death? So if you want a little bit of a clearer picture of what's really driving modern disease and what you can do to protect yourself, this is the episode that you don't want to miss.

Mitchell:

Let's start with the numbers, and you know, if you've been listening for a while, you know that I sometimes like to just shoot from the hip and it annoys Kate. Well, today I've actually prepared some notes and some numbers and I'm hoping that we can follow a nice linear path talking you through this. So, according to the CDC, the leading cause of death in the United States all these causes. They're pretty clear. Number one is heart disease, killing about 680,000 people a year. Number two is cancer, with over 600,000 deaths. And number three is accidents and unintentional injuries, things like car accidents, drug overdoses, falls, stuff like that, stroke, chronic lung disease, alzheimer's and diabetes. They come after that. You may have heard people say that medications or medical errors are actually the third leading cause of death. We're going to dig into that too, because the truth is more nuanced than the headlines. But first, I'd like to help you see the big picture. These top killers are not random, right? They share this common thread, and that thread is metabolic dysfunction.

Mitchell:

You've probably seen the online fights some cardiologists yelling that heart disease, it's all about LDL cholesterol. And others shout back it's all about inflammation. Here's how I like to explain it. Ldl is like the raw material for a pothole in the road. Without LDL, there's no plaque. Inflammation is like that jackhammer that cracks that pothole wide open into a sinkhole. That's when people have heart attacks. So which is it? Both right. Ldl loads the gun and inflammation helps pull that trigger. That's why statins have a beneficial effect. Yes, they lower LDL, but they also calm inflammation, and this is why there's a bunch of newer anti-inflammatory drugs, things that have traditionally been used for gout, like colchicine, that actually show benefits in people even if they have low LDL.

Mitchell:

So I don't want you to get trapped in this one versus the other argument. It's not just LDL or inflammation, right, it's LDL and inflammation. Like does your car need an engine or gas? Well, obviously you need both right. Taking that one layer deeper, the real action in heart disease happens at the level of the endothelium, this lining of your blood vessels. A new concept in alternative medicine right now is the endothelial glycocalyx, the support structure for our blood vessels. I like to say that an endothelium is kind of like Teflon. If blood's flowing smoothly, nothing will stick. But with chronic stressors I mean, you know, high blood sugar, smoking, poor sleep, chronic infections, oxidative stress beyond the capacity for our innate antioxidant defense systems to protect us this Teflon will turn into Velcro. Ldl starts sticking to the walls, white blood cells move in and plaques form. At the same time, insulin resistance reduces nitric oxide. Nitric oxide is a beneficial compound to help with dilation and opening of blood vessels. So if you've got insulin resistance driving poor nitric oxide production, these arteries are going to become stiff and unable to relax. That is endothelial dysfunction, and I like to think about it as kind of being one of these launch pads for vascular disease Another myth that gets thrown out about a bunch when it comes to heart diseases.

Mitchell:

Does LDL particle size matter? Some people laugh at the idea. Right, all LDL is the same. All LDL is a problem because there's not much difference between the small, dense LDL and the big, fluffy. Well, here's the deal. Each LDL particle is like a car on the freeway. Right, the real danger. I don't really care what you're driving Are you in an SUV, are you in a sedan? It's really about how many cars are there total, and that's what we call your ApoB particle count, and this is something that we now measure in every single person we work with.

Mitchell:

Back to this analogy if you mostly see little cars, it usually means you're in a bad neighborhood, you've got high triglycerides, you've got insulin resistance, aka metabolic syndrome. Particle size is a marker, but the real problem is traffic congestion, which is too many particles, and this ties directly back to metabolism. When you've got insulin resistance on board, particle counts go up, particles get smaller and this connective protective system within our arteries, the endothelium, that really starts to suffer. And this is where it gets really interesting. When we say metabolic syndrome, we think about things like a high waist size, a high fasting blood sugar, high triglycerides, low HDL, high blood pressure. This is not just a diabetes problem. This is the soil in which the big killers grow. Let's think about the heart More small, dense LDL, more inflammation, more endothelial dysfunction if you have metabolic syndrome, if you've got metabolic syndrome and we think about cancer, high insulin, high insulin-like growth factor these are like fertilizers for tumor growth and inflammation helps it spread.

Mitchell:

What about the brain? Glad you asked. Insulin resistance in the brain reduces energy delivery, damages blood vessels and it fuels inflammation. This is why now some people are calling Alzheimer's disease type 3 diabetes, right? We always say one of the first pieces of the body impacted by insulin resistance is the frontal cortex. Stress is a massive part of this because within the frontal cortex, so much of its job is to signal the brainstem and the brainstem is where the autonomics, the parasympathetic nervous system, begins. So if we have chronic hyperinsulinemia, we start to have frontal lobe involvement because neurons, again, they need oxygen, they need stimulation and they need fuel. Well, you're not getting fuel, very well if you're insulin resistant. Now that frontal lobe can't signal to the brainstem adequately and we're going to be stuck without that calming effect of that parasympathetic nervous system, simply because it's not getting the signal.

Mitchell:

So if we talk about metabolic health, listen, it's not all about vanity, right? It's not just about your weight or your blood sugar. It's about whether we're creating fertile soil for these diseases that kill most Americans. Here's some good news this isn't your destiny, right? Metabolic dysfunction is reversible.

Mitchell:

We know that exercise improves insulin sensitivity, right? This is sometimes why we have people with high fasting insulin do squats after they eat. I like to say you know these big, strong muscles, these quads and these hammies and these glutes. They function as a sink for glucose. If your muscles are in need of glycogen, that doesn't require an insulin transporter in order for those quads, those muscles, to take up glucose. So if you've got high insulin after a meal, by simply moving your body a little bit, you will create this, essentially this hypoglycemic effect, simply because these muscles need glucose and it's a free sink to absorb glucose. We also know that exercise will lower your ApoB. Particle number goes down and it will boost your nitric oxide, which is key for that endothelium. Even a simple walk after a meal makes a difference.

Mitchell:

What about nutrition? This has now been shown that a Mediterranean style diet lowers LDL and inflammation. Okay, it's both of these factors, it's not one or the other, it's all related. As it comes to these top killers, we know that processed foods and sugar they literally do the opposite. They increase LDL, they increase triglycerides and they drive chronic smoldering, low-level systemic inflammation. Poor sleep you know, when you sleep poorly, you will have worsening insulin resistance and your endothelial matrix will become dysfunctional.

Mitchell:

Stress, as we talked about earlier. Chronic high cortisol literally fuels inflammation and blood pressure. You can become resistant to any hormone and if you have chronic stress, you will have chronic high cortisol. And what do we know about cortisol? It's anti-inflammatory, right? Sorry, I didn't give you enough time to answer. Well, eventually a few things can start happening and I've recorded an entire podcast about this but you will get receptor down regulation to cortisol. So, even if you have high cortisol, after a while the body quits listening to it. So you've got the inflammatory driver, whatever that is, and then now you've lost the dampening effect of the cortisol that's meant to be there to suppress the immune response and bring you back to homeostasis. That's what we might call all gas, no brakes, right? We also know that chronic stress is going to drive hypertension, which is really not good for heart disease risk stratification.

Mitchell:

We also have toxins, right? Toxins? What toxins? Right? People are saying that right now. What toxins? Well, here's the deal. It's a little bit of mold, it's a little bit of PFAS, it's a little bit of microplastics, it's a little bit of pesticides in the grass you walk your dog in. It's a little bit of heavy metals, it's a little bit of poor sleep, it's a little bit of shitty food. You know, it's all these little things that add up and our detox system is not programmed to be able to handle the onslaught that we provide it in this modern world. And if you're asking what toxins I mean, we can measure these things. We can measure your bisphenols in your urine. We can measure your phthalates and your parabens in your body. We can look at heavy metals. We can look at mold toxins. These are all things that we can quantify for each person to be able to really assess exposure and detoxification capacity. So, yeah, maybe you don't need an air quote cleanse, but if you're not supporting phase one, phase two, phase three detoxification in the body, I'm telling you your systems will be impacted and it can possibly lead to systemic, widespread chronic disease. And I also know that the more toxins on board that the body can't deal with, your endothelium is going to age fast and you're also going to be more likely to develop hormone problems and gut problems and energy problems and then everything falls. So that is absolutely a vital thing and every one of these levers improves not just heart risk but cancer risk and brain health too.

Mitchell:

I want to circle back here to that claim that you might have heard that medications are the third leading cause of death. But here's the reality the CDC lists accidents as the true number three cause. But and I found this some analyses estimate around a quarter million deaths per year from adverse drug events. These include overdoses, prescribing errors as well as side effects. So if you count it that way, like that, they would rival accidents. And actually I found a 2016 British medical journal study called medical errors as the third leading cause of death. But the methods were shaky. They extrapolated from limited hospital data and a lot of experts have criticized it as inflated. But here's the truth Adverse drug events are real. They probably kill over 200,000 Americans a year. I just think that calling them the third leading cause of death oversimplifies and sometimes even sensationalizes the data. Again, it grabs headlines and it gets clicks. Here's my takeaway we do need safer prescribing, we do need better monitoring and, in my opinion, we need more focus on what's actually driving these conditions, so that we can eventually reduce dependency on medications wherever possible.

Mitchell:

Here's how it all comes together disease, cancer, alzheimer's the big killers. These all share a common soil metabolic dysfunction in the arteries. That dysfunction shows up as endothelial damage, too many ldl particles in chronic low-level inflammation in the brain and in cancer. Biology it shows up as energy dysregulation, growth signaling and immune dysfunction. Medications help, but they're not the full answer usually, especially if we ignore lifestyle. So if you want a simple sound bite, ldl loads the gun. Inflammation pulls the trigger and metabolic dysfunction is the finger on the trigger.

Kate:

Our job as clinicians, as patients, as a society, put the safety on by restoring metabolic health. For more about what we do at the facility, check out our website, wwwthefacilitydenvercom. You can also follow us on instagram at the facility denver for extra tips behind the scenes, fun and updates on new episodes. Thanks for listening. Now go facilitate your own health and we'll see you next time.