and we had another guy um wasn't jillette Adam hotkis who he he works with American he was mentioning that even when some people make nutritional changes sometimes their apob level still doesn't go down and they still need to they need to go the medication route so how would how would you assume somebody like what what do they need to do if they need to take that medication route as far as lowering their apob and how do you know if like you're actually at risk if like for example you feel as if you're in good health you've changed your nutrition your apob isn't going down do you then even if you everything feels okay would you still say that they should take some type of medication low their apob okay firstly I'm not a physician so I'm speaking here uh as someone who has I've done eight eight hours with Thomas dpring and interviewed a lot of Physicians and my expertise I have a masters in nutrition science so let me just put that out there for what it's worth but uh you're you're targeting the the goal a pob level depending on your risk profile risk right so if you're low risk we want you at 80 Mig per deciliter or lower even if you feel good because you can feel good and have cardiovascular disease Brewing underneath the surface of the skin and decades down the track have a cardiovascular event that you could have otherwise avoided I saw that firsthand my dad had a heart attack at 41 and and I was with him I was the only person with him I I saw that in person and my dad is a professor of physiology researching cardiovascular disease risk factors so um ironic he didn't die so it ended well was he unhealthy before that or just uh no he was he was representative of a young sort of Australian father eating the typical Australian diet he was moderately active pretty pretty stressed I guess with with work he did have high blood pressure and high cholesterol so he had a few risk factors in place um but to your back to your point we have to think about this as it's it's not either or combination between your nutrition and pharmacology is really important what we're trying to get you to is to go so how an interesting thing to think about here is how how much can dietary changes actually lower your cholesterol by for the average person and it it depends on the extent of the changes that you make if you if you look at uh someone like Dr David Jenkins in Canada he's known for for the dietary portfolio I did a whole episode with him on this and this this was a diet that has gone through quite rigorous randomized controled trials but it's very significant changes to the diet people are essentially eating very low or no animal protein they're eating lots of plant protein they're taking phytosterol supplements um nuts and seeds and soy food emphasis because they they will lower LDL cholesterol um more so than than other foods and in that context of that dietary pattern on average people were getting about a 30% drop in their LDL cholesterol what's that equivalent to sort of a a low uh dose Statin right so so they were getting results equivalent to a low dose Statin now there's going to be people out there where lowering their their cholesterol by 30% is not enough to get them say below 50 Mig per deciliter so they're going to have to work with their physician and decide if they if they want to make some changes to their diet and retest where did they land do they need to add in some help with some some different drugs whether that's a pcsk9 inhibitor or Zam or some type of Statin or a new drug out now that acts very similar to statins called bidic acid so there's now there there is a number of different options for people to explore from a a pharmaceutical point of you here to help lower IPO and get them to Target what you got Andrew well I was the one that was eating 10 eggs a day sarag goza diet yeah yeah um it I mean I've I've been feeling fantastic um body comps changing and this is in conjunction with starting Jiu-Jitsu recently So cardio's Gone up lifting has stayed about the same dropped off a little bit if I'm being honest um but I did get my labs drawn at the beginning of the year and that's where like the big red you know thing comes out saying that my cholesterol I I can check but it was somewhere around 200 for the uh LDL I'll check how about that and that's pretty high for LDL yeah yeah and so I guess my my my question is first off with that receptor that you were explaining about earlier how um it could be that I am a hyper responder or whatever the case may be can you improve that receptor to kind of handle the dietary cholesterol better instead of it being one of those things that's like okay you cholesterol now you're going to have higher cholesterol the way to to kind of approach that if you have being Delta a gene that sees you hyper absorbing cholesterol so that nean Pi C1 like one is is allowing too much dietary cholesterol to be absorbed really is through either limiting dietary cholesterol in the diet or taking a drug like a zamip which acts directly on that receptor and will essentially close that gate so that you won't absorb as much cholesterol and it's it's not just absorption of dietary cholesterol through that receptor we have cholesterol in our small intestine that our liver has produced and pumped into the small intestine as bile it's it's a key component of bile to help us absorb our fats and so if you're a hyper absorber you're absorbing a lot of the cholesterol in the food that you're eating but you're also reabsorbing a lot of the cholesterol in the small intestine that the liver had pumped out and so what's the the reason why how this all connects back to elevated a PO B is if you're pulling in all of this cholesterol into circulation now the liver can sense that and it doesn't need to produce as much cholesterol to produce cholesterol the liver sends a signal out to increase the LDL receptors to draw more back in from circulation so the the the kind of pathway by which this works on is if you're a hyper absorber what it does is it ends up downregulating the LDL receptor and again we get that backlog of those those ships in circulation