Preventative Cardiology with Dr. Matthew Budoff: Rational Wellness Podcast 434

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Dr. Matthew Budoff discusses Preventative Cardiology with moderator Dr. Ben Weitz at the Functional Medicine Discussion Group meeting on September 25, 2025.  This was the second annual Dr. Howard Elkin memorial Preventative Cardiology lecture.

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Podcast Highlights

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Dr. Matthew Budoff is a professor of medicine at the David Geffen School of Medicine at UCLA, Program Director and Director of Cardiac-CT, Division of Cardiology, Harbor-UCLA Medical Center and he is an investigator with The Lundquist Institute https://lundquist.org/matthew-budoff-md.  Dr. Budoff’s research is devoted to advancing procedures that can help doctors identify patients early that are at high-risk for cardiac events and progression of atherosclerosis. This early detection can lead to patients being placed on the correct therapeutic path to prevent a heart attack. Additionally, Dr. Budoff’s research focuses on determining the effect of different therapies on atherosclerosis and determine if heart disease can be reversed. His office is in Torrance, California and his office number is 310-222-2773.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

 

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Podcast Transcript

Dr. Weitz:  Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, dr whites.com.

Thanks for joining me, and let’s jump into the podcast. Welcome everybody to the Functional Medicine Discussion Group of Santa Monica. I’ve been running this event for the last nine years. I’m not sure what we’re gonna do going forwards. We’ve had a tough time since the pandemic getting everybody to show up.  So we may have to rethink how we do things. But as of right now, this is the last event for 2025 for sure. And so, if you’re not, if you’re a practitioner and you’re listening to this and you’re not on our closed Facebook page, jump [00:01:00] onto the Santa Monica Functional Medicine Discussion Group of Santa Monica, closed Facebook page.  I post scientific articles on a regular basis, and we have discussions about cases, et cetera, so we can continue the functional medicine discussions here. Also, I’m recording this and this’ll be part of my weekly Rational Wellness podcast. So if you don’t subscribe to that, listen to that. You can watch it on YouTube, you can listen to it on all the podcast apps and if you go to my website, you can get the complete show notes.

So today is the second annual Dr. Howard Elkin memorial preventative cardiology lecture. As most of you know how Dr. Howard Elkin was a beloved member of our functional medicine community, and he spoke regularly at our meetings. He attended most of our meetings. He was a good friend of mine. He worked out of my office last year.  He was [00:02:00] due to speak in August, and he passed. And so I gave the lecture using his notes as the first annual Howard Elkin memorial lecture. And so today we have Dr. Matthew Budoff, who’s a preventative cardiologist. He’s published hundreds of scientific studies and he’s also an expert on cardiology scans, like the coronary calcium scan and the CT angiogram with artificial intelligence.  If you’re not aware of what those scans are. They’re very important ways to not just get a sense of whether or not you might have plaque, but actually seeing the plaque and seeing what state it’s in. So, Dr. Budoff, thank you. Thank you so much for joining us.

Dr. Budoff: You knew Howard. I certainly an honor this speaker speaking, conferencing this name.  I’m not a really a formal functional practitioners. I do a lot of, I do a lot of therapies that are well [00:03:00] considered functional in some ways. And I certainly incorporate a lot of that into my practice. I called it LED practice, but I didn’t wanna out focus on lipids. I think there’s a lot of great data out there on alternative ways of lowering LDL, like treat and with hyperlipidemia.  I do think that lipids are generally a bad thing, although I just finished a keto study, which I’m not gonna study the heels like that. Oh. But the keto diet, which did show very high LDLs, they, the hyper responders or LDLs were in the two face, steep 300 gram hologram deciliter, FDL, and they didn’t have much changes in their plaque in a perspective one year study.  But we’ll leave that one off. But I do think lipids are important, and I do think generally that people are very high or elevating LDL cholesterol or offers us an opportunity to reduce cardiovascular risk. This study is called the UR study. It’s probably [00:04:00] one of the most important studies in cardiology and preventive cardiology because it shows us what the contributions are of different modifiable risks towards heart disease.  And you can see that they calculate was based on 30,000 patients. That the attributable risk adjusted for the risk factors that if you address all these things that you can reduce risk by about 90%. There’s still a little bit that we can do. We can. Maybe change your sex? Does change your risk?  I don’t think so. Certainly changing your age. Not possible to say why about it. And your genetics, we had changed, whatever. Anything else in effect? 

Dr. Weitz:  So when you talk about lipids, is this based on a basic lipid profile or is it an advanced lipid profile? This is not. Right. So what perc, what percentage better attribution would you get if you did a more extensive advanced lipid profile?  You looked at [00:05:00] homocysteine, you looked at omega threes, et cetera. 

Dr. Budoff:  I think you’re probably looking at maybe 70% of the answer. Okay. Yeah. This is just basic LDL, HDL, triglycerides, just the very basic paddles that we historically look at. You see informally, psychosocial issues are a big deal, stress, depression, anxiety.  It’s usual, but you know, things that wouldn’t normally be targeted very aggressively. Things like smoking. It’s important to get people to quit smoking, but less even than just allow EIC lipid at and hypertension, much less. So, not to say that we shouldn’t be getting people to quit smoking and controlling their blood pressure, but I think lipids represent the biggest opportunity for us to change people’s outcomes.  So understanding that we have alternatives to statins and this is one of them that’s relatively new. It’s called Bempadoic acid. It’s sold as Nexlitol and I’ll show you this combination pill with azetamide as well that’s [00:06:00] available. So STAs work here in the liver. This is the liver and this is where it makes cholesterol.  So normally in the liver, all almost 85% of your cholesterol in your body is manufactured in your liver. So your liver takes citrate, goes through a bunch of steps about seven enzymatic steps to create cholesterol. If we block cholesterol here in HMG coa, reductase the statins, we slow down this pathway and we decrease cholesterol.  But there’s another enzyme now that we can target called a two P citrate lily, an ACL or A two P citrate. Lyase is a enzyme that has different properties and different side effect profiles than targeting H and GCO reductase it. It also slows down the process. It also lowers cholesterol and it can actually be used together with a statin kind of two heads on the system and slow down the [00:07:00] process even more.  The reason that I think statins cause a lot of issues is because they’re active compounds. They’re not a prodrug, they’re active compounds. They can cause most of them can cause blood brain barrier and. All the other barriers that you can think of and really penetrate muscle and tissue.

And when they get into the skeletal muscle, which they can do quite readily, they also block H and B co and cause problems. We also have to get stat deplete coins on Q 10 and thus CO Q 10, which I’m not gonna talk about tonight. But we have, we actually did a very nice study showing that it improves endothelial function, but but statins cause muscle toxicity, ’cause it’s inactive compound beic acid, is that an inactive compound?  So it needs to be activated and the only place we know that it has any significant co conversion is in the liver itself. It gets converted by this enzyme, it gets activated and then it blocks cholesterol synthesis. It’s inactive. [00:08:00] Muscle, so it cannot cause muscle toxicity. So for those patients who have muscle toxicity from statins or don’t wanna take a statin, beic acid decreases cholesterol synthesis.  Now while without affecting the muscle, the other major factor, beca dark acid that people don’t recognize is that it not only has all the antiinflammatory properties of a statin, it actually might be more potent as a side effect of your lower inflammation, but it actually reduces diabetes. It’s the only lipid drug we know of that actually improves diabetes.  Whereas statins increased diabetes, right, worse than diabetes and the CT and the PCSK nine injectables also causing more diabetes. So we have a decrease in diabetes, a decrease in inflammation, and no muscle tone system. So I think for [00:09:00] those patients who need pharmacological therapy, OSIS a nice benefit.

I’ll show you the outcome gave in a

Dr. Weitz: moment. Another complaint that some patients have is brain fog. And there seems to be some data that at least in some patients that statins might be negative for the brain. What about Bempadoic acid on the brain?

Dr. Budoff: So statins definitely have a small but measurable effect on, on, on in some patients.  I don’t think it’s most, and I know most cardiologists are taking a statin and most of them every seem pretty clear to me. So I don’t think it’s everybody, but who knows Basically, like there were sharp before they start find be acid has not been shown to have that any activity in the brain.  It just doesn’t, it does, it can’t be activated the brain. So it should have no off target effects as we would think about it. So the problem with teric acid is that while it lowers LDL, it’s, and it lowers it by about 25%. It’s not as only as statin. Statins can lower LDL by 40, even 50% Persu statin, for [00:10:00] example.  But it does have a very nice effect on H-S-C-O-P. So is it anti-inflammatory? It has a robust benefit, and this is on top of a statin. So despite or improved on top of a statin, it lowers inflammation, which I think is a good thing for the body. And it can be combined with ezetimibe. Ezetimibe works completely differently.  It blocks absorption of cholesterol into the body, so you block reduction with pmp, doric acid, or a statin. You block absorption. With Ezetimibe and you end up with a nice adjunctive benefit. Now, when we add the two together, we get about a next lat instead of setting it inside the pill. So it’s a single pill.  It’s the same price as Nexlitol. It comes with a copay card. So it’s, I think it’s for most patients who have insurances five to $10 a month, but it does lower LDL by about 38%. And this on top of a statin. If statins are not in the mix, it’s actually a little more [00:11:00] focused than that. It’s probably about 45% LDL.  So this becomes statins as far as its LDL lowering without the brain fog, diabetes, or muscle toxicity. So just from a pharmacological perspective, this is a once a day pill. This is a dilation. We did an outcome study. I was parting this. I was one of these part principal investigators of this clear outcomes trial.  We randomized patients just to beic acid or placebo. We didn’t use Zetia part ’cause we didn’t wanna, we wanna see what just this drug did suffering. But I don’t use this drug without ezetimibe in most patients unless it had tolerated predictive or events. Three point mace, which is a primary endpoint, mi, stroke and death reduced by about 15% was significant was statistically significant.  Heart attacks reduced about 23% and revascularization about 90%. Do you choose. So a good benefit, a decent benefit, and certainly full [00:12:00] outcomes. Now with daic acid, if you add acetamide, which also has outcome benefit, you’re obviously gonna do better than this. So. What about other therapies? 12, you know, fish oils and in cardiology we don’t think that the mixed E-P-A-D-H-A has as much benefit as jerk EPA, at least for cardiovascular benefits.

So DHA for brain development as a young person or for eye development very important. But DHA disrupts the membranes and can decrease the efficacy of therapy. And that’s been shown now in a few different ways. But pure EPA has always consistently shown benefit. I’ll just show you two of the trials, but there’s now nine that show benefit if he has purified EPA, which is one of the two Omega where it’s only one of them.

So this is I’m sorry. This is EPA 1.8 grams. They did have statins on board as background therapy. The FDA requires [00:13:00] background therapy of statins for the clinical trials. So we don’t have any monotherapy with ETA outcome studies. But in this trial, I is from Japan, the jealous trial. EPA lowered cardiovascular events by 19 statin, which is pretty robust on top of a statin.

This was actually the first study ever in all of cardiology to have people on a statin. It improve outcomes further. ’cause we had great data in the early days with niacin cova. We added niacin to a statin. We didn’t see as much in net reduction. We had great data in the early days with fibrates like gem fibril.  When we added it to a statin, we didn’t see that same benefit. So we think that some of statins might have. Taking away some of the risk and then the residual risk was lower, or these agents overlapped too much with statins and didn’t really show the same benefit. But despite being on a statin, when you add EPA, you get additional cardiovascular benefit.  Sorry, did you say that [00:14:00] DHA interferes with the action? Yeah, so DHA, if I don’t have the mechanistic slides here, but DHA, we know from cardio, at least from a cardiologist point, it interferes in the lipid bilayer. And it makes that the lipid bilayer more permeable to things like oxidation. So, ’cause we’ve done, now, I don’t have the slide, but there are nine, nine outcome studies with EPH plus DHA.  Right. And all nine are negative. This shows no over benefit. We have nine studies with. Our EPA some anatomical studies and three big outcome studies, and all of them are positive. So we kind of should infer that DHA must take some of the

Dr. Weitz: benefit out. I’m gonna suggest that you consider at some point doing a study with EPA and DHA and also include tocotrienols, which are a vitamin E compound that reduces the oxidation.

Dr. Budoff: No, that’s a great idea. I think we need to be smart about our antioxidants. We didn’t do very good studies. I [00:15:00] wasn’t involved, but we didn’t do very good studies in cardiology of the antioxidants. We did a couple studies just kind of generic antioxidants and didn’t see a big benefit and kind of abandon that thought process.  But I think oxidized LDL. It’s bad. And I think if we can reduce oxidation, we’re gonna be in a better place Chief, and they plays not THA of the brain. Yeah. Yeah. So I think for the brain and for the eyes, THA is very good. I think once you’re fully developed, though, I don’t know if you need more, I don’t know if it, I don’t know how it works in adults, but I think for growing simple, DHA is very important also in children and infants and we, I mean, remember there’s very few pills that you can give pregnant women indiscriminately.  And one of them is fish oils because it’s so important to them and for the development of their child, right? So there are some prescriptions that are legitimate to give to pregnant women that we think are actually beneficial and have no risk upon. So. We had that trial from J [00:16:00] from the Jist trial, but that was a Japanese trial.  Like for some reason the FDA just will not accept trials that don’t have some US populations. Even though when we do US studies only and we export the data, we expect everybody to accept our findings. So it’s a little two-sided, but, so they made us do this trial and that was one of the principal in investigators for the REDUCE IT trial.  So the REDUCE IT trial took over 8,000 patients. They were on a statin ’cause the FDA acquired Statin background therapy and then Bobbi Triglycerides, and we randomized them to four grams of PPA. I, cosent. Ethyl is a precursor of EPA it or placebo and followed them for the next five years.  And in five years, this is the stat plus placebo arm, and the LDL was well controlled. It was well below 100 milligrams per deciliter, and they still had 20% event rate over five years. When you look at [00:17:00] the when you add fat cpa, you reduce their risk by 26%. So ENT ol, this is two of the trials jealous and reduce it.

There’s a third outcome study called Respect EPA, which ’cause nobody does and obviously seen in Japan. That also said about the 22% benefit. So 19 22, 20 6% benefit. I did a mechanistic study and these are just individual outcomes where you’ll see it’s very consistent. It lowers death by 20% and lowers stroke by 28% and lowered mi by 31% across the board benefits and so couldn’t be looked at.  There was benefit with being on EP. So I did a similar study of mechanistic study using CT angiography. So non-invasive angiography. We start an iv we would give a little bit of diet and he takes his pictures, we make three the images. Dr. Elkin was a big fan and ordered a lot of them for his patients.  And that’s how I [00:18:00] got to know Howard. But but the Evaporate study what we did, and I was the instance, I was the primary investigator for this trial was same triglycerides, a little bit up, LDL control Nystatin, and we looked at four grams of ient, ethyl, again, EPA, and this time this is statin monotherapy.

This is progression of apella above the line in red and in blue is the combination of EPA plus. Statin. And you can see across the board regressing of every block type that we measured calcified plaque doesn’t really change when it didn’t change over one period of time over 18 weeks, one and a half years wait I is DP administered in those studies?  Is this a pill something you take with It is a gel cap. Gel. Capsules, yeah. Two, two BID. They’re one gram each. So take two in the morning on empty stomach or, oh, it doesn’t matter. Doesn’t matter. Yeah. Alright. Okay. Yeah, and [00:19:00] they’re gel. It’s refined, so it’s not straight, short.  It’s refined. There’s nine. There’s knowing processes going from fish to purified. EPI, it has on average 98% pure EPI in the capsule. If you were to get, let’s say Mega Re or one of the other dietary supplements, they’re not those open seeing the production. But mega Re of 1000 milligram capsules has 300 milligrams of EPA and DHA and 700 milligrams of other, I don’t even know what it is.  This has 980 milligrams of EPA out of a thousand, so you might have 20 milligrams of other, so it’s much more purified. It’s also done in a highly controlled environment with no oxygen so that they don’t get that antioxidant and it doesn’t smell, which I think demonstrates the lack of some of the oxidation of and oxidative properties that we get.

Why fish becomes odor and more malodorous as it ages. [00:20:00] So it’s a odorless capsule if you were to break the little gel cap and take out the liquid. It’s not only CLIA but it’s also odorless. And we’ll talk more about odorless in a moment when you talk about garlic, ’cause it’s another process cap at Spring Strong to be able to purify garlic supplementation as well.

Cute. Yeah. This the one that is great. Oh, this is called vascepa. Oh, VAPA Prescription Claim. Prescription. Yeah. They have copay cards. It’s literally cheaper than in most, for most patients. It’s cheaper than buying a big bottle of fish oil tablets. ’cause it’s, I think it’s $8 with the, with a copay card.

Even though it’s a prescription. If they have. PPO or A CMO, they have coverage and there is a generic formulation as well. It wins. There is a generic formulation of out cepa, so it’s not, you don’t have to get the name brand and so it’s definitely something that I use in my practice. We only started even the [00:21:00] setting of high triglycerides, elevated triglycerides.

Chris, we always used to use fish oils as one of the ways that water triggers right. But we don’t really know if you’re total one, if you would benefit or not from this treatment. ’cause I just wanna show you testosterone just as a a little bit of a warning. I’m a fan of testosterone with plate treatments, but I literally saw patient this morning and it came in at his calcium score, went from a hundred at one 20 to over 400 in three years.

So he tripled, literally, it went up a hundred percent for a year, for three years in a row. And he’s healthy and he’s fit, and he works out and he’s thin and he says he eats well and he exercises a lot. And he couldn’t understand why. And I’m, and he shows me all his labs and his inflammation is normal and he doesn’t have diabetes.

His A1C is perfect and ZDL, his lipid profile is excellent, but his testosterone has been running about 1500 oh for three years in a [00:22:00] row. And I’m like, what? What? What’s going on? Like a lot of testosterone did this study, the testosterone trial, and we showed that if you overweight testosterone, this is progressing of testosterone of block.

All six types of plaque got worse. This is placebo, so it got worse for the placebo except for the calcification. It promoted more noncalcified plaque, more total plaque, more low attenuation plaque, fibro fatty plaque than wipe plaque. It actually increased the calcium score as well. Dense calcium is just a CT angio sub particle of calcification, but.

Well, it said clearly like you just, like, why would you take this much testosterone? I mean, I realize some people wanna, you know, pretty muscular, whatever. And he says it wasn’t a libido, it was that he was trying to get his free testosterone higher and he didn’t get it up until he was with pleading himself with that huge amount.

So I recommended that he goes down to 700 or lower [00:23:00] just because I think he’s driving. ’cause the only risk factory he had was this crazy testosterone level. But I do think he was over repleting. This testosterone and I do this it can cause

Dr. Weitz: significant issues. Do we know what the mechanism is? Is it because of a decrease in HDL?  Does it increase iron? Do we know what the particular…?

Dr. Budoff:  That’s a great question and I’m not sure we know all of the effects of testosterone. It, it was thought when we did the testosterone trials, which was seven randomized trials sponsored by the NIH. Taking men with low testosterone and giving them AndroGel.  So hypothesis was, it was gonna do a lot of good. It was gonna help with bone density, it was gonna help with muscle mass, it gonna help with libido, it’s gonna help with depression. And it was gonna help with plaque and coronaries. The endocrinologist fully believed that they, but their, these patients would be better at and they got worse.  And I think it’s, I think we just think a 75-year-old man at turning them into a 30 5-year-old man may be a little bit too much. But I don’t [00:24:00] know if we know the exact mechanism, lower level. I think a lower level is safe. At least be able to traverse trial. It shows that it’s safe and I think to address symptoms, just like I use hormonal placement therapy in my postmenopausal women.  I use it to replace plete their to help them with their symptoms. I keep the doses lower than we’ve historically used and we don’t see all of those negative effects. I think the same is true of test testosterone. We don’t need to turn up 70-year-old woman into a 30-year-old woman with high hormone levels screen, need to get her back to where she’s feeling better and not losing bone and other benefits of hormone replacement therapy.   I think the same is true in me but I think a lot of people just abuse it. ’cause once they’re on it and they’re getting more muscular, it’s. Might as well inject a little bit more. And we just know that we know it has a lot of adverse effects. ’cause we see all the bodybuilders who suffer long-term consequences.

Dr. Weitz: He’s saying you don’t see 1500 testosterone in men who use gel. It’s [00:25:00] pretty much from injectable. He was injecting.

Dr. Budoff: Yeah. He said he was injecting 0.2 twice a day, but I don’t know. Wow. But he, is it only 0.2? I try not twice, say twice a week. Oh. I think he was using more than that because Right.

We’re across the board. Right. And his, I don’t know, I don’t know his primary, I didn’t know recognize the doctor’s name, but I just told him I think that you have overt proof that your credit, we did CTAs as well. And the CT joke got words too. Wasn’t to the point where he needs bypass surgery, but.

In three years certainly looks worse from his coronaries on the outside. He looks great and all his labs are. So it was like scratching my head. I’m like, I have no idea until I saw his vesto levels. I’m like, I have right head out of what’s going

Dr. Weitz: on. Not everybody here probably knows the difference between a coronary calcium scan and CT angiogram.

Dr. Budoff: I’m gonna show that in minute. Okay. Yeah. I have some studies on garlic where we did CT angio and I’ll show you some pictures here, but thank you. So let me now go into garlic. I’ve been [00:26:00] studying garlic now for 20 some years and I actually came into this not as a believer in garlic supplements for heart disease, but this company WGA from Japan, in Japan, they study this as a pharmaceutical, so it’s a pharmaceutical.

Study called a pharmaceutical product in Japan. So we have this age called extracted it ages for nine to 18 months until there’s a certain amount of what they call s alleles cysteine in the SAC in the product. And then they stop aging and then they bottle it, or it have up, it comes in a liquid form or they make it into a gi.

So they came to me and said, look, we have a lot of trials to show lower blood pressure. They the lower cholesterol we want see if the lower plaque and coronary arteries. So I’m like, that’s fine. So they paid for a study and we did a randomized trial. She’s actually our second trial. We did a small study.

24 patients [00:27:00] all just randomized 24 patients. And it slowed coronary calcium compression significantly. And I was totally surprised ’cause I was just didn’t expect it to work. But I wanted to give them the benefit of the doubt. And they have a lot of trials in Japan that shows different types of benefit, but they never looked at the CT scan.

So we did this study, which was another coronary calcium scan and we gave them placebo or caric ion they matching. I don’t know why they’re not matching here. But anyway, this had a combination. This was a it was called a folic cyte reducing formula as well. And it tried maybe 12 fold gib being six L arginine along with aged garlic.

What was the point of the L arginine? The, this was their homocysteine, lord. Oh, okay. So they wanted they, this was at what the time that was when everybody was going after homocysteine very aggressively. And this was their formulation. It was a prepackaged formulation. Okay. And we did if you look at a flip bases, LDL went down nicely at [00:28:00] almost 20%.

HGL went up quite a bit. And total cholesterol came down, triglycerides came down as well. We didn’t placebo, we didn’t see much in action as we would expect. And then it had a significant effect on the lipids at one year. Then looked at endothelial function. So we had this cuff that we inflated, the deflating that looked at how quickly the capillaries we filled to show how robust the blood flow was.

That, and if it comes back nicely, it’s healthy. And if we show then yeah, lower is better for vascular function, decrease the. Less impairment of vascular function as compared to placebo. So having a overall vascular chain, but, and it slowed coronary calcium. So we did another study this time, firefighters again, looking at this time we use Coens and Q 10.

This was another one of their prepackaged formulations of [00:29:00] garlic h garlic plus Cote Q 10. And we looked at our firefighters and this time we looked at just corona calcium as the primary endpoint. And we followed these firefighters for a year, randomized either placebo or age garlic plus CO G 10 calcium progression slowed by 53% in the patients on age garlic.

We did see a, about a 30% slowing in the previous study. But this was a little narrow loss. We takes the endothelial. Function again in sleep to vascular health, improve by about 90% as compared to placebo and Creactive protein letdown significantly with this combination of H Quality in CO had.

But the, now we know, I don’t have more slides on it than this, but I think it does play a nice supplemental role with lipid lowering, especially if people are gonna use statins. I always add, I always put them on coq [00:30:00] 10 as a supplemental health balance outcome of, I think it does have a number of physiological properties that are helpful.

And we did see this in the trial. We did see inflammation benefits. We did see benefits on vascular health. And we did a separate study with a company that just makes CO G 10. And we actually showed improvement in endothelial function and vascular health. We again saw this nice reduction in C-reactive protein and another lppl A two, which is another, what we see as a more coronary specific antiinflammatory marker.

Both went down in this combination of co high H Dora Wasco Etan. So this combination, nice job on inflammation and a nice job on, on coronary calcium. But then we moved on to more advanced studies. Now we, there’s a couple years later we now have CT angiography and I’ll show you the pictures, but we can see really [00:31:00] elegant plaque types in the study I showed you with the fish oil, with the cepr and the testosterone.

We’re done with serial CT angiography where we inject dye into the corona areas. We can see noncalcified plaque, soft plaque. We can see vulnerable plaque. We can see the artery stenosis. So we get a lot of information. It’s just the clearly scan. It clearly is AI of that study. Okay. Yeah. So it’s a clearly the scan that we use and then send it to clearly ai.

Got it. Yeah. So this is 72 patients randomized, either coic with placebo. This time we just used coic by itself to try to see what the pure effects were of the h garlic. ’cause if we keep mixing with other things, we never really know what’s causing the benefit. These are some of the sample pictures.

Well, the dyes in the center here on its colorized green just to show the lumen. This is what it really looks like is white and we can see the artery and if there’s a blockage, we see a pinch, and then we can see the plaque type. And we can see all of this [00:32:00] redy blue stuff is noncalcified plaque and fibrous plaque in the artery.

And we cut the arteries into tiny thin slices, less than a millimeter. So we kind of cut the art like a little spread, very thin cuts. And we measure the plaque in every single spikes. So we get plaque at baseline, we get plaque of follow up, and we can see are people getting better? We’re getting worse under the influence of drug X or drug Y.

This is very ocular Now we’re doing trials with LP A, we’re doing trials with Lyran, we’re doing trials with Pcsq nine inhibitors. We’re doing trials with tirzepatide, the GLP one, GIP combo bill or her injection with lil. We’re doing all kinds of studies with these ages and basically if you use chi, like total plaque went up a tiny bit of this course said year one of the placebo, but went up significantly on more.

Same thing with soft plaque with noncalcified plaque. The dangerous plaque, which is a [00:33:00] primary influence such as low attenuation plaque, actually wipe down significantly. That’s a big change of low attenuation plaque and calcified plaque, again, stay stable. So we publish that work and said it slows down soft plaque and non ified plaque that lower attenuations what we call vulnerable plaque that got better with garlic.

We then did a meta-analysis. This was one of my former fellows. First home we did this meta-analysis of all of our studies and 210 patients total. Ron Garlic. We can see in the garlic group that the progression, the change over the course of a year was 10 points on the calcium score and the placebo group was 18, so it was about a 40% reduction in the rate of progression of coronary calcium.

Didn’t reverse calcification but exploded significant. This was four trials out of four, so every time we did another study in a [00:34:00] double blinded placebo controlled environment, Gox slows calciums regression. So I use a lot of this H golic extract. Because of this significant And how recurrent benefit, a very consistent benefit that we see on two pills twice a day.

It’s that’s the maximum dose. Yeah. They usually go one pill twice a day. But we did one of the studies we did at 1200 milligrams, which is two pills twice a day. That would be the most I would give somebody. But you can go up that hot. You I was just

audience: at the dose. It’s usually one twice a day.

Dr. Budoff: It’s usually 300 plus BID say just 600 milligrams a day. But you can go up to, I’m sorry, 600 BID, sorry, 600 milligram tablets twice a day, 1200 milligrams. But we did one of the studies we did at 2,400 Millers action. We did two pamphlets twice a day. It’s odorless. It’s again, it’s age and so there’s no odor.

So it’s nice ’cause they’re getting garlic without smelling like a clove. But it’s very few side effects. Most people tolerate it. There [00:35:00] is a small percentage of patients who will get upset stomach from the garlic, but it’s very well tolerated compared to trying to eat a lot of going on. It doesn’t act that same of issues.

These are the four studies. I say 1, 2, 3, and four for the four trials that happening. But anyway, for it slowed in garlic slowed calcium progression in first trial. In the second trial, in the third trial, adding the fourth trial to in benefits across all four studies. So, well, and then I was like, this is just, and then this is another benefit of garlic.

This was done by a Gar, a hypertension expert in Australia named Karen Reeb. She does blood pressure trials. She looked at all of the different published trials that have ever been done with NIK on blood pressure, and she saw consistent benefit of H Gold extract. All of these were h extract trials.

You can see they do a lot of studies like Karen [00:36:00] Reed herself in Australia did four different trials. And in our studies as well, we saw a consistent effect on blood pressure plus. So it does lu blood pressure, it does lower LDL. And it does lower cre, react protein salt, and then it lowers plaque in the cornine.

So I think it’s one of the nicer supplements, if you will. I think it’s cheaper. I eat a ton of garlic that they don’t need it. For sure. And part of the Mediterranean diet, if your fans, garlic is a big component of that. I think that might be one of the major benefits. It’s interesting ’cause garlic goes back thousands of years as a historical supplement on the Olympic athletes in Olympic greats.

The Olympic athletes used to use go as a performing Hansen before they compete. Huh? They read Go grave if they use. So yeah. So it goes back quite ways. It’s also about to have an anti-inflammatory, I mean an antiviral effect. So, so, yeah. All knock out Cool. Real. Yeah. Yeah. And I think if people are using it in COVID as well to try to help.

[00:37:00] Offsets some of the viral activity I saw. Okay. I’m not sure I caught accept things.

audience 2: Why each garlic would be superior to crush garlic.

Dr. Budoff: Well, so, I think the problem is when we crush garlic or dice it or cook it or saute that it might have release different properties. So it’s just an inconsistent effect.  There was a pro, a study done at Sanford where they gave garlic supplements. They gave it in, they, you sliced garlic and they put it in sandwiches just to look at the LDL effects and it didn’t have much effect, but. It might be the amount, the consistency, how you cook it, how you dice it. This is just a very consistent formulation.  But I agree with you, if they’re eating a ton of garlic already, I don’t supplement that is more garlic. But a lot of patients either can’t tolerate garlic or don’t like it or just don’t eat enough of it. And I think, you know, a capsule that gives you the same efficacy as a clove is probably beneficial for them in multiple [00:38:00] ways.  So, anyway, so lemme just move on to writing rice of a fan, actually.

audience 2: The cream. Yep. There’s a lot of variation in the quality of marshal garlic. Are there any Dan brands that or available that we can have?

Dr. Budoff: I think this is, this one I like the most. It’s called H Golf or Colac. This is the one that I Kyolic.  Yeah, it’s a Japanese, it’s made in Riverside, though. It’s actually not an, it’s actually a domestic product if you wanna support in us. But it is the, this fair company is a SSIS company called they’re in Hiroshima, Japan. I like this one. We studied it a lot. They have literally hundreds of publications of clinical trials that they’ve sponsored where it is lik, or a lot of these other companies have not, they’ve never done a trial.  They just strain package it. And as the state used to have Larry King. As this Spokeperson. But you know, they’re still on the radio. I saw them [00:39:00] recently. There were, there’s television they not too long ago. So they’re still advertising, but there’s just no science behind it. And maybe their formulation is just not as pure.

Just like the fish oil arguments, if you don’t have a purifying version, you might be getting a lot of junk. Remember the Food and Drug Administration by law is not allowed to oversee dietary supplements. That was a law passed. I don’t know why, but they will not ask by dear Nebraska or North Dakota.  One of the one of the senators there, practice law passed that says they’re not allowed to oversee production of dietary supplements. So all they can do is stop people from baking. Over claims of health, but if they want to put just talc, you know, in a capsule, then sell it as coq 10. They can do that.

And if they wanna put vitamin C and sell it as whatever, they can do that. Like there’s nobody, no, there’s no regulations on what they’re putting in their capsules and no, no oversight. So it’s always a little bit, you have to get the right product. Obviously while we’re talking about sub

audience 2: and just only, there are third [00:40:00] parties.

Dr. Budoff: There were some, but the problem is you ate a plague. So the third parties, you pay them to say that your product is pure. So I’m just. Not a hundred percent sure that’s an independent third party. It is a third party. But because you pay them to validate the product, I don’t know. There might just be a little potential for bias there.  It’s not like the an independent agency that’s doing this naturally. There’s a company in Australia that looked at 22 fish oil products and found like be 20 of them, had like high levels of oxidants in the capsules and a lot of saturated fat in the capsules. Just a totally independent study of these dietary supplements.  But you’re right, there are some consumer, what’s it called? Not consumer reports, but there is a consumer labs. Yeah, they do. I think. I think that’s it. And they do supervise things, but again, the only ones they supervise when the company themselves pay for the, [00:41:00] for them to endorse, to validate the product.  So it just might be a little funny compared to how we think about. Third party checking on the safety and efficacy of these, pure purity of these of these capsis. Red rice has really will bus data. Most of it’s outta Japan or chain of rather. So it is a little bit limited in our global understanding of how well it works.

But these studies that came out with pretty good high doses of Reggie’s rice did show very consistent benefit on LDL cholesterol. A little bit of an inconsistent benefit, but largely a slight raise in HDL and certainly a very dramatic drop in C-reactive protein. And I think we all recognize that RIN Twice is very largely a naturally occurring statin.

Say this is the statin event. But if you get to high enough doses, you get a very much a statin like effect in patients like it just because it’s not. [00:42:00] I don’t know, manufactured by the, for the big companies, but some of them there were, there are statin induced myopathies that have occurred with red reduced rice as well.

But it is a way that I get some of my patients who are one on a statin to be on a statin without calling it a statin. So it does work to get them on treatment, so our outcome studies as well, and the effects are quite good. Now, again, a lot of these are now this is the only one. The these three are heritage.

They, you can see the effect. It’s quite good. It was again, a Chinese study and there’s always a little bit of question about the accuracy of the data coming out of China. They tend to do things a little bit differently than we do, but almost 5,000 patients, four and a half years. And it did have a nice reduction in non-fatal MI and culinary gap which was up there with let’s say the four s trial, this indecent Bible study.

Also 4,000 patients, also five years. And another similar primary effect. So it does have [00:43:00] at least one good outcome study this Chinese coronary secondary prevention study. But I don’t think we have a lot of great. Data from this, like 20 years old, this study. So I think it’s a little jaded.

I,

Dr. Weitz: I think a lot of the studies at 12, 400 milligrams are really under dosing, and from what I’ve seen, I think 24 to 48 is really the sweet spot. I

Dr. Budoff: think I, I use mostly 2,400. I haven’t gone higher but I agree with you. I think you can get up to that really full effect of the drug, at least with 2,400.

You mentioned this vitamin E formulation. It is actually incorporating some of the red, these rice products. And it does have an antioxidative properties for sure, and it does have some di inhibition of Cory reductase like a statin. So it does have kind of cost is over towards ESE rice and they’re often combined with ESE rice as well.

So it does lower LDL, it does lower C-reactive protein. So [00:44:00] another option is this vitamin E product, which I think is the. Also the vitamin eight sub antioxidants. I think it’s probably the most ash above them.

Dr. Weitz: Yeah. Designs For Health has a product with Red G Rice and Tocotrienols also, yeah.

Combination. Yes. Which is the company designs for Health for Yeah, it’s, it got Barry Tan working with them, who’s the guy who really pioneered the Toco tree and s I’ll remember that design.

Dr. Budoff: And then something that I always thought was gonna make a huge splash. It was actually a company that was starting to market this probably a few years before COVID, a few years, about seven years back, and then they just disappeared.  I don’t think it was due to COVID, but I think they just never really got a foothold here with like Citrus Ide. This is afraid of mine. Peter Tele. It was a very full very well-respected lipidologist. Did this study. He took any subjects, he took patients with hypercholesterolemia and he gave them this oid d extract blood be [00:45:00] art.  He was 160 milligrams of flavanols, which is just a formulation of the Fibrate for six months. But he saw very nice drops in. Now, I’ll show you the benefit in LDL in just a minute. But he not only had a drop in LDL, had a nice increase in HDL and it caused a decrease in small dense LDL particles, which we think are the bad players.

And most impressively, the carotid INT, the carotid ultrasound decrease significantly from 1.2 millimeters to 0.1 millimeter, which is 25% in just six months, huh? So he said that this is abstract supplement, significantly reduced plasma lipids and improved the lip glypho poin profile and two is also reduced significantly over a relatively short timeframe.

When you look at the effect, even going from. The first quartile of fat all the way down to the board. There’s a pretty consistent effect of LDL [00:46:00] reduction, far from about 18% down to about 2020 2% LDL reduction. So as a nice, and this is just a six month trial nice reduction in again, small dense LDL particles went down, all the different particles went down.

It. A sma, I think it’s out there. Oh yeah. We use it all the time. Formulations. I don’t know if this one, okay. What? I don’t know if photographed is a Oh, sutras berg. Yeah. Yeah. SU’s matter, the formulation. So this is no, I don’t think so. This is the name of the supplements. Yeah. Yeah.

There’s different about it. No I think it’s a very effective one and the works completely differently than some of the other mechanisms. So it should be very complimentary to other ways of lower cholesterol. So we have beda acid, we can add it ezetimibe. We have ethyl Vascepa bapa. We have h garlic, you have Reggie’s rice with Choco triol.

We have the citrus bergamot. There’s others that I didn’t go into today just for the sake of time, but there’s [00:47:00] very nice data on stanols and sterols lowering LDL. There’s very nice data on ine, although that’s another one that kind of what. Lad out with, when we tried adding it to statins, it didn’t seem to have that same benefit, but I still use it for patients with very low HDL.

It’s a very nice supplement. It’s just gotta go slow. ’cause of the flushing,

Dr. Weitz: significant lowering of LP little a Yeah. Yeah. And it’s one of the few compounds that can increase LDL particle size and no, I think

Dr. Budoff: it has great lipid benefits. Unfortunately the big outcome studies that were done, I think just recruited the wrong patients.

They recruited and used the

Dr. Weitz: wrong product. One of ’em, yeah, one of ’em had niacin compared with a product that reduced the flushing. Flushing, yeah. Yeah. That is known to, yeah. Yeah. Yeah.

Dr. Budoff: So, and they also didn’t take patients with low HDL, which is where I think the MET is the greatest. They took patients with normal HDL, with kinda sewage.

So I know they really proved that Greg. Oh, what’s [00:48:00] his name? I gonna say Greg Stone, but that’s not it. Greg. Anyway, the person who did the hats and the fats trials, a lot of the early studies, he studied patients with high LDL and no HDL. He showed remarkable benefit plaque regression by doing coronary angiograms really nice benefits of adding niacin to, to patients.

And unfortunately when they did the big outcome studies, they studied a different population. It just didn’t work so well. They that it was largely abandoned. But I agree with you. I think it saw has some really nice properties and I saw a good number of patients. We take cin and then resin binders are actually really interesting because not only do they bin LDL in the gut, but they actually lower glucose significantly.

They actually lower hemoglobin A1C by about 20%. They’re actually listed in the American diabetes as an anti oral hypoglycemic agent separately from their LDL effects. We don’t use them a lot. Cholestyramine whole Cho, yeah. [00:49:00] Colestipol. But they actually lower LDL and hemoglobin A1C white Cate.

So di of curation agents. Yeah, there’s some, yeah, there’s some curation. Yeah, I mean, the chelation data, the big studies that we did, tact and T two tact showed a very nice benefit. Tattoo didn’t show as much of a benefit. But again, I think they were somewhat limited by sample size and selection of agents.

But chelation is another oral chelation. Now. Agents are a little more robust than it used to be as well back then. Back then we were doing weekly infusions for chelation. So I think that’s mostly what I wanted to show you. I leave you with this 5,000 year old concept of probably the English instead of the Chinese, that training medical superior doctor, preventive disease, medioc, doctors, tricky disease.

P before comes evidence and inferior doctors treat the full blown disease. And I think at least in cardiology, we’ve often waited for patients to [00:50:00] present with heart attacks with severe blockages needing stents. That I think we do a lot better with prevention. I’m not sure we totally prevent sclerosis and wise to the level of being a superior doctor in the eyes of East Chinese, but I think we can definitely do better than we’re doing in most of our practices.

Dr. Weitz:  So there’s been a lot of discussion in recent years about the endothelium, which is the lining of the arteries and that being a big issue in terms of plaque formation. And so there are various natural compounds that are fairly popular that can modulate the endothelium. They don’t necessarily lower LDL, but they potentially lower the risk for cholesterol to form plaques.  And one of them is something called arterial cell. I don’t know if you’re familiar with that. And then the other product that’s, there’s a series of products that are used to reduce, to increase nitric oxide [00:51:00] production. So we have products with fermented beets and have ni nitrates in them that are converted into nitrites and and needs have shown a lot of benefit.

 

Dr. Budoff:  What do you think about, I did a study with one of them German, remember the name of the one we did with the meth, nitric oxide raising? It was kind of the formulation, Zyme or Neo 40 or, oh, I’ll look it up. Okay. You, which for was, but no I think the endothelium is really important.  We know that’s part of the benefit of let’s say the sildenafil or, you know, Viagra. We did it pulmonary hypertension ’cause it was effect by the endothelium and it raises nitric oxide. There’s a new drug bur has for heart failure called siggu which. Ends up raising nitric oxide levels, basically type GP and we, we use Rios of it for pulmonary hypertension, and now they’re trying to formulate this new medicine for work [00:52:00] failure.  So those are all endothelials, direct endothelial benefits. But I agree with you. I think end the dealing’s really important. We have some good data with the garlic. I showed a little bit of the endothelial protection, but not, doesn’t probably work directly through nitric oxide, but I think that’s a really important additional aspect here to think about.

audience 2: I’ve seen a product a conference and I don’t remember exactly, but they were addressing the glycocalyx in they singing Yeah, the arteriosil,

Dr. Weitz: the art arterial. Yeah. That’s their, yeah. It has this special kind of seaweed that helps to support the lyco kx, what the

audience 2: name of the pump. They will have example, what you must have seen them do.

It’s up to spa is on

Dr. Budoff: up to, yeah, I’ve heard of Arteris silk for the GCL kill, so I’m sure there’s other products out eat right now. There’s never just one but yeah, it’s, I think

Dr. Weitz: brown seaweed is the important ingredient that supports the glyco. So

Dr. Budoff: anyway, I was hoping at the cherry [00:53:00]

audience 2: regarding the CT angiogram number one, how does this stack up?  Who gets the physical? DLA And how does clearly compare with the Tesla and number two, how do you approach like when to get out, like to mention someone in the forties, fifties versus exposing know to, right.

Dr. Budoff: Yeah, so I mean, unfortunately here on the west side, most of the scanners are pretty old and the radiation doses end up being pretty high when clearly takes the existing non-invasive angiogram.  The CT angiogram that we do that with an iv, we take pictures. A lot of those scanners that they’re using. Are just old and they give up ger radiation and it clearly takes those pictures those three dimensional pictures. And then it does additional analysis, ai analysis to give you plaque types.  So it’ll tell you how much vulnerable plaque you have, log calcified plaque, kinda what I showed you, those six [00:54:00] components, it’s the same thing that clearly does except those took us three hours per person to make those measurements. It clearly it takes seven seconds. I love that. Yeah. So, yeah, and I use it to follow patients over time because if their noncalcified plaque is getting worse, then I know that they’re not quiescent in there, in their disease state, which can look for targets maybe with all these different therapies and we can potentially apply it for them to them.  And so I think it’s a nice way to track. Patients over time.

Dr. Weitz:  Can you explain the significance potentially of soft plaque versus calcified plaque?

Dr. Budoff: Yeah, so we think, you know, we think the calcified plaque is basically just a marker of how much plaque you have in your body. So it’s kind of like a, almost a bystander.  It’s the old plaque that’s gotten scar, it’s like scar tissue and you end up with a lot of calcified plaque. If you have a lot of calcified plaque, you almost always have a lot of noncalcified plaque as well. We think it’s like, we think of it as the iceberg [00:55:00] where the, you know, 20% of the iceberg floats above the surface of the water when it satanic was going downstream and it’s an iceberg.  Florida didn’t send divers down below the water to say, I wonder if there’s anything that could rip the hole. We know that it was there. Calcium score is the same, or calcium scan, no contrast, no iv. Just a simple stent. Always low dose can give you how much calcified plaque you have, and that’s not the dangerous stuff, but it’s a marker of how much dangerous stuff you have.  The clearly exam the CT angiogram can now tell you exactly how much noncalcified plaque you have, which is this dangerous stuff. That’s the stuff that can rupture and cause mis and blockages, and then you can watch it convert from noncalcified plaque to calcified plaque and become stable. So inly with serial scanning, you can see people’s plaque hopefully go from a lot of noncalcified plaque to a lot of calcified plaque, so the calcium score goes up.  The soft plaque goes down.

Dr. Weitz:   Let’s say you are working with somebody who’s 30 years old and they have really high cholesterol and the coronary calcium scan, it’s relatively low. It may get like a two or a five or something, which is not zero. But should you do the CT angiogram? Because they might, because a calcified plaque is generally older plaque, and they might have younger plaque, so they might, for the

Dr. Budoff: younger patients, right.

Middle age patients, they could have a lot of noncalcified plaque. And the older patients, they might have less value. ’cause a lot of those patients have. Converted a lot of their calcium or to a lot of their calcified plaque already. And they tend to have a lot of plaque regardless. But I think in the younger patients, they can even have a score of zero and then we could start seeing noncalcified plaque in younger people.

So I, I do think that then now more value probably where we expect to see more noncalcified plaque that be younger people, women more so than let’s say a 75-year-old male. We [00:57:00] use the CT angiogram, but not clearly as much as just to say, do you have blockages? Do I need to think about stents bypass surgery?

Dr. Weitz: It’s one of the potential benefits of statins is that they tend to cause plaque to become calcified, making it stable. Do we know if any of these natural agents in current that that’s

Dr. Budoff: a great question. We have some data with ent, but we actually just studied semaglutide which is we wegovy or ozempic.

And it actually converted some of the Noncalcified plaque. Ified plaque. So we think that might be one of its mechanisms because it does lower cardiac events by about 20%, but we didn’t know how. So that might be part of its mechanism. I don’t think we have great serial CT angios in most of them being is studying except for Coex.

But we don’t have data on the other ones just ’cause we haven’t studied them as well yet. And again it’s the old, it’s a problem of these nutraceuticals just don’t have the research budgets that sure big pharma

Dr. Weitz: does. [00:58:00] And then do we know if the patients who are on a statin and they’re, and they get an increase in their coronary calcium scan potentially because the plaque is becoming calcified, do we know for sure that their noncalcified plaque is decreasing?

Dr. Budoff: Well, we know that with Dabent YL and with garlic. ’cause we’ve had some studies. Okay. But we don’t know with these other ones, arterio still. Okay. Or some of the other there, you know, the Reis rice. Right. Although we just presume since it has a statin mechanism that it would work at the C way.

Dr. Weitz: Is it important that a Reggie Rice supplement.  Not have will lovastatin in it. ’cause as some of the companies say, we make sure we test ours and make sure there’s no lovastatin in ours. To me,

Dr. Budoff: yeah. I mean I thought it was like kind of naturally occurring lovastatin, so I’d be worried if they say they have no lovastatin, that’ll have no effect.

I think that how would work if it now the stat, it’s like that’s kind of what it is, [00:59:00] right? Well, supposed 10. Well,

Dr. Weitz: but I lovastatin but I think my understanding is there this mixture of them sta like compounds and not having the lovastatin means you’re gonna get. Potentially the benefits without maybe some of the negative muscle effects.

Yeah. I would just hope

Dr. Budoff: you just have to make sure the LDL comes down, right? Yeah. We have niacin there. You know, niacin had the terrible flushing, so some companies started coming out with different formulations, right? Yeah. And no flushing, right. But also had no, no ine on the lipids, right? So there’s no flush niacin, but it had no niacin in it.

Right. So I’d be worried if you’re, I just felt, I don’t know. But if you’re taking out the active component, rid of the side effects, well then the product, the effect anymore. Well, so yes. I don’t know. I mean, it’s having a, that’s a placebo then I’ve seen a pretty soon lowering with that products talked about.

Yeah. They dry and other things that might be in there that might be [01:00:00] more similarly beneficial, but I’m just make sure it’s working right. There’s literally no flush. Niacin has no niacin and it all, it’ll have no effect on LDL or HDL, but they won’t flush. So it’s like that. What about the importance of iron levels?

Yeah. On iron is bad. I think high iron is bad. I’ve been trying to get a study through the NIH right to show that, to do CT angio and then give patients iron infusions or placebo. ’cause we use, some people use iron for heart failure. You and I think you have anemia and you give them iron, that’s fine. I think what exceeding back to normal is probably fine.

But I think my theory is that men have more heart disease than women, partly because they run higher iron levels. ’cause women lose iron every month for a long term iron and men don’t. And I think women tend to run low iron levels and that might be one of the reasons why men present with curlier.

Heart disease and why women when with the menopause and they stop having that iron loss and [01:01:00] that that they end up starting to catch up to men. So I think iron is part of that theory. It’s not all hormones. I think iron is, I think iron’s

Dr. Weitz: often overlooked and it often overlooked. It turns out that 30% of the population has at least one copy of a gene that makes them store iron.  The hemochromatosis, there’s three different hemochromatosis genes and so we started doing full iron panels on all our patients. And men usually don’t get iron measured. They’re all, and a lot of women just get a minimal and you’d be surprised how many people have high iron level. Sweet. I’ve seen vegetarians with Yeah.  Storing iron and. Everybody assumed they needed iron, so they just automatically gave ’em an iron supplement without even testing. Kind of seen it as a marker

audience: of inflammation. I have so ferritin. The ferritin, yes, definitely. And I think people who have high carbohydrate diet. Drink a lot of alcohol.  They tend01:02:00] to have high ferritin

Dr. Budoff: change the diet. It goes down. It’s also an acute phase reactive, so it goes up to make sure goes up within ferritin also is reacting. Interesting. Okay. It works both ways, goes your iron stores, but also can go up and down with in Summations. Rudo, I appreciate

Dr. Weitz: together.

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Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcast or Spotify and give us a five star ratings and review. As you may know, I continue to accept a limited number of new patients per month for functional medicine if you would like help.  Overcoming a gut or other chronic health condition and want to prevent chronic problems and [01:03:00] wanna promote longevity, please call my Santa Monica White Sports Chiropractic and Nutrition office at 3 1 0 3 9 5 3 1 1 1 and we can set you up for a consultation for functional medicine and I will talk to everybody next week.