Dr. Justin Marchegiani welcomes his special guest, Dr. Jack Wolfson, in this interview where 
they discuss topics related to cardiology practice in the Paleo World. Dr. Jack Wolfson shares his knowledge, views and expertise in successful testing and treatment of his patients following a Paleo approach.
Learn all about cholesterol, including its functions in our bodies as well as the important markers like triglyceride, HDL, APOa’s contributing to cardiovascular events. Gain a better understanding on the tests involved in assessing the above mentioned markers. Learn about statins and other alternative drugs involved in the treatment process as well as valuable information about diet, supplements and lifestyle to help improve heart-related issues.
In this episode, we cover:
5:40 Cholesterol & its function
10:12 HDL, LDL APOa: laboratory tests and ways to improve these levels
18:23 Statin drugs & how our body responds to it
24:30 Markers for inflammation
29:06 B vitamins & its relation to homocysteine & heart disease
30:57 Alternatives to statin drugs
Dr. Justin Marchegiani: Hey there! Here today, we have an awesome podcast with Dr. Jack Wolfson the Paleo cardiologist, Dr. Jack. Welcome to the show.
Dr. Jack Wolfson: It’s a pleasure to be out with you. We had much fun in Paleo effects in 2016 and we’d sure be sitting out there again. And once again it is wonderful to talk to you and I appreciate your message.
Dr. Justin Marchegiani: Awesome. Yes, well – well, also you were the Paleo cardiologist I know. You kind of got into cardiology to the back door. You came into to the conventional medical route. You’re doing a lot of the conventional cardiology procedures and then now you're kind of in the functional medicine-paleo world. Can you just walk our listeners through how you – how you got there?
Dr. Jack Wolfson: Yeah, sure. I mean – uh, my father was a doctor of Osteopathic medicine. I followed right in his footsteps. He was the head of cardiology in Chicago and I – you know, went through four years of Osteopathic medical school, three years internal medicine, three years cardiology. And I was out here in Arizona for job a couple of doing all the angiograms, pacemakers, all the fun stuff.
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: And uh – met my wife. My future wife and she is a doctor of Chiropractic and like she says, a doctor of causation and she taught me how to become a doctor of cause. And I started to change my practice, change my philosophy, get educated, open up my eyes to the reality and uh – it’s just been very successful ever since 2012 opened up my own practice at Paradise Valley. Our website is www.thedrswolfson.com and people schedule all over the world. Uh – with the us on that website and it's really just been miraculous and reception results, you know, uh – I just can’t say enough. I, I can’t wait and say that I wish I did it earlier. In 2012, so the, the medical sickness paradigm.
Dr. Justin Marchegiani: That’s great. And so when you first met our wife, how was that like? So did you think she was kind of a little quaky at first? Like how long did it you or how long did it take her to kinda get through to you and educate you? What was that like?
Dr. Jack Wolfson: You know, I opened up my eyes pretty quickly to say so. My father who was getting sick in his mid 50’s. I saw –he dies eventually at 63 of a strange neurologic disease. And I talked about this in my book, the Paleo Cardiologist or teaching what kind of happened to my father. And then meeting Dr. Heather, she started telling me it was your father, you know eat the bad food, exposed to environmental toxins, is not getting sleep and the sunshine. All these different things that really just seem so basic. And I just –a light bulb went off in my brain and I said, this is really some interesting stuff and I started to read and I looked at the scientific literature and a lot of these stuff that you and I talked about. Doctor Justin is in the scientific literature. So, you know, it’s looking at it a fresh perspective, changing my practice. And uh – you know, listen, unfortunately most medical doctors don't listen to this message because they are stuck in the fill on procedure model and they are holding on to the almighty dollar. So they’re not gonna make a change.
Dr. Justin Marchegiani: Totally get that. I'd patient who was seeing a cardiologist and we had the monk kinda like a paleo template type of approach. You know, high quality saturated fats, keeping the carbohydrates on the lower side because they were more insulin resistance so more vegetables may be a little bit lower sugar type of fruit here and there. But this patient went in to see their cardiologist and the cardiologist had recommended the standard American diet. You kinda know that is, lower fat and 10-12 servings of grains etc. etc. and the patient asked the doctor and said, “Hey, what do you think about this type of eating plan? I mean, you know, talk about kind of a lower carbohydrate, kinda paleo approach?” And the cardiologist looked at him and said, “Well you know, what that's exactly how I eat.” But you know, I'm kinda hamstrung by the American cardiology board and what I can recommend nutritionally going outside of the recommendation. And so I'm just curious on your take. It seems like a lot of conventional medical physicians are really ham struck – hamstrung what their board will allow them to talk about nutritionally.
Dr. Jack Wolfson: Well you know, in reality it is that medical doctors get about zero training nutrition. And this is well-documented even at Harvard Medical School. They get very little nutrition in training. So unfortunately your medical doctors are just like the last place you’re gonna go for nutritional advice. And frankly, look at most of the medical doctors. They are overweight, they are unhealthy, they take drugs themselves. So uh – they’re not the right person to go to. And as far as I’m concerned, uh – you know, listen I’m getting people better I'm telling people, you know uh – uh you know there were nutrition plan and paleo is the way to go. Our ancestors did it for millions of years. And you know, frankly if there’s any doctors that are listening and in medical doctors, you know guidelines or guidelines. But you know, it’s not uh, it’s not the law. You know, a letter in a line that you got to follow.
Dr. Justin Marchegiani: Got it.
Dr. Jack Wolfson: Well, “the guidelines” We can step outside the guidelines a little bit when we’re doing what’s best for our patients.
Dr. Justin Marchegiani: Yeah, even conventional dieticians that are in the hospital. It seems like they really are restricted to that food pyramid type approach. I mean think of the last really good meal if you had at a local hospital, right. I mean, I can’t think of any.
Dr. Jack Wolfson: Well, hospital food is totally embarrassing and I talked about a certain way all the time is that can you imagine, Doctor Justin into a patient’s room. And the patient has diabetes. There are diabetic diets. And what do they have on their plate – they have the stack of pancakes and sugar-free syrup. You know, why made it – It just can’t get any worse with that microwaved artificial food, you know – that they’re serving. The hospital’s the sickest place in the world. I’d tell anyone who I know who’s going in the hospital. And fortunately, we uh – you know, keep a lot of people from going to the hospital. They do windup there, they do need some form of surgery. Uh – you know, bring your own food, have a local one bring in your food, get a nice, uh – you know, you know high quality protein powder. Bring your green strings and do everything you can not to eat the hospital food.
Dr. Justin Marchegiani: Absolutely. I 100% agree. So kinda switching gears a little bit to cholesterol coz you know, you’re a cardiologist. That’s the buzzword. Everyone’s gonna be looking for that type of a topic discussed here. How important is cholesterol to you when looking at someone's health. Like – like, where’s the cut off where it matters and where doesn't it matter?
Dr. Jack Wolfson: Well, you know at first I’d educate people and tell them the importance of cholesterol – that every cell in the body is cholesterol. The cell membrane which is that protective fence around the cell that lets things in the cell that belongs.
Dr. Justin Marchegiani: Yes.
Dr. Jack Wolfson: And keep things out that don’t belong. It’s a large part of the cell membrane and how hormones and other vitamins and minerals interact with the inside cell. We teach people that Vitamin D comes from cholesterol. And digestion as far as bile acids and bile salts come from cholesterol. Cholesterol makes up all of our sex hormones and cortisol and aldosterone.
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: We teach them the importance of cholesterol. But then we – uh, you know, you know, we start diving in deeper into the numbers. And I talk about this extensively of course in the book. And you know, total cholesterol things like that. I mean listen – you know, when your total cholesterol is super high, let’s say numbers of like – you know, 300, 400.
Dr. Justin Marchegiani: Yes.
Dr. Jack Wolfson: That’s definitely their problem. There’s no there's no doubt about it. But anything below 300, we certainly want to look at the breakdowns for the particle, particle numbers, particle sizes. Same thing with the HDL, that APL will APL ratio is uh – the number one risk that factor we know when it comes to lipids. So let's go beyond the 1970s testing and get the uh – you know, state-of-the-art 2017 and beyond test. That's what matters.
Dr. Justin Marchegiani: Okay, got it. So let’s kinda run through some hypothetical markers here. So my clinic – one of the big things we’ll look at is a big fan of the triglyceride to HDL ratio. If we see the trig’s go too high that could, could be a big sign of excess carbohydrate insulin resistance. Any feedback on HDL to trig’s ratio?
Dr. Jack Wolfson: You know – I uh, think you know if you are gonna use a 1970s panel in yeah –
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: I think the panel that you’re talking about is very important as well. I think that gives us a good surrogate as far as there’s cardiac risk. If you know, you’re producing too many triggers, like you said from – uh, too much carbs, too much sugar, insulin resistance. I mean that’s clearly in every study linked to cardiovascular events, cancer, on and on. Uh – and that low HDL, you know it’s important. When you look at HDL, it’s nice to break it down into APOa1. APOa1 is a protein that is on the surface of the LPL. And that really has to do with the HDL functionality because – uh, clearly we know from studies, where you raise HDL certainly with pharmaceuticals, estrogen for example, didn’t change outcomes. In fact it made outcomes worse. So raising HDL as far as a number is not necessarily a good thing. We wanna raise the APOa1s which is a sign that we are improving HDL functionality because HDL functionality is really the key because HDL is responsible for reverse cholesterol transport.
Dr. Justin Marchegiani: Yes.
Dr. Jack Wolfson: Where you're pulling – pulling basically going cholesterol from plaque and recycling of that to the liver. That’s what it's really about.
Dr. Justin Marchegiani: Great. So when you're talking about increasing the APOa1s that’s what you said. That's primarily gonna be done with what healthy saturated fats like grass-fed meat, coconut oil and even fish oil. Is that the best way to improve those levels?
Dr. Jack Wolfson: Well, uh – yeah, I think that sunshine, physical activity –
Dr. Justin Marchegiani: I got it.
Dr. Jack Wolfson: Yeah I mean the whole white cell that we talk about.
Dr. Justin Marchegiani: Got it.
Dr. Jack Wolfson: Then, you know one thing that’s super big right now is getting a lot of people to use a lot of spices.
Dr. Justin Marchegiani: Uh-huh.
Dr. Jack Wolfson: Because even the best paleo eaters – you know, maybe they’re, they’re eating their grass-fed brown beef. And they’re eating their – you know, wild sea food. I mean they’re doing a lot of good things there that we – uh, you know as thousand paleo. But two things I think they’re missing – They’re missing number one, the organs. Uh –
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: Liver, kidney, thyroid, thymus, adrenal that our ancestors ate as their first choice. They weren’t reaching for filet. Uh – and number is two is spices. And if you look at spices medical literature map, I’m uh – putting together a blog post on this. Spices are little natural pharmaceuticals and in fact in a pharmaceutical industry no doubt came from the spice in the plant industry.
Dr. Justin Marchegiani: Totally.
Dr. Jack Wolfson: And a lot of these – a lot of these, uh – you know spices are proven to increase APOa1. They’re proven to, to increase reverse cholesterol transport. And uh – yeah, it’s really exciting and they of course do wonders some other cardiovascular factors including LDL's and operating LDL receptors, on the liver. So, uh – yeah, add those early and often.
Dr. Justin Marchegiani: So we have the APOa1, you said. And the APOa2 is the, the kind of the negative marker. Is that correct?
Dr. Jack Wolfson: Yeah. I mean it’s uh – you know the APOa’s in certain most literatures right now is on the APOa1 and that’s clearly gonna – you know, demonstrate the best part functionality of that HDL particle.
Dr. Justin Marchegiani: Great. And the things that are gonna make the APOa2 or the negative APO’s uhmm go down the wrong direction are gonna be what – what trans fat, extra refined carbohydrates, insulin resistance, inflammatory foods, gluten. Those kind of things?
Dr. Jack Wolfson: Uh – you know, I think you're right. All the bad stuff that we all talk about. Uh – clearly is associated with – you talked about it before, the – you know, omega-3. Uh – you know it kills me that so many people are following this vegan plan of – of you know, the China study.
Dr. Justin Marchegiani: Yes.
Dr. Jack Wolfson: And the fire – firemen who wrote a book on- on nutrition and all.
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: With all due respect, to firemen.
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: In any case, uh – you know, I mean uh every study shows that fish eaters eat the longest the longest. And you’re – you’re, it’s so clear on the benefits of omega-3 when it comes to lipids, when it comes to inflammation, when comes to insulin resistance. You can't get omega-3 from sucking down on walnut oil. You have to eat fish – plain and simple. You eat shellfish. Avoid the large fish coz unfortunately they are high in heavy metals. So, when we talk about fish, we talking about salmon, sardines.
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: anchiove and those smaller fish. And I’ve got no problem with seafood. I test people’s heavy metals. Uh, when you’re getting high quality of shellfish, I think you’re in good shape. Maybe I wouldn’t overdo it. Uh, but I’ve got no problem with shellfish – one or two times a month. I mean oysters, how more –––– is an oyster? Why can’t a vegan eat an oyster? Why does an oyster have many more feelings than that a cabbage does?
Dr. Justin Marchegiani: Exactly. Yeah, totally. And I’ve seen a lot of patients who are vegan. This is really hard for a lot of people to get their head wrapped around. I’ve seen a lot of patients who are vegan and they actually have elevated cholesterol. And when I educate my patients I tell them, “diet has very little effect on your cholesterol”. If you look at the enzyme that the statin blocks that hemo method glutaric CoA reductase enzyme, the HMG enzyme – one of the biggest things that stimulates that enzyme is insulin. So you have many vegetarians and vegans that are on a carbohydrate diet. And the extra carbohydrates feed that insulin and that causes more internal production of cholesterol. So I see dietary cholesterol actually is very little impact. I eat about 60 to 70% fat. My cholesterol’s still under 200 and my trig’s are at a one-to-one ratio with HDL probably at 1660. Any comment on that?
Dr. Jack Wolfson: Well, you know, listen – LDL, HDL these are part of the immune system. And when you eat uh – bad foods, or you eat gluten containing foods that are damaging intestinal lining and leading to the leaky gut – well, leaky gut leads to inflammation.
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: And it needs system activation. When you activate the immune system, you’re stimulating the production of the repair crew, LDL and HDL. It’s not a surprise that they are elevated. But a lot of times vegan diet can dramatically lower lipids.
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: And in most cases, it’s – it’s too low because you know, two things – number one, you’re not giving the body the tools it needs to make cholesterol. Uh, that’s number one. Number two when you're avoiding fat and you do not need to make the uh – cholesterol to put into the bile, bile acid, bile salts to digest fat. So – you know, once again it’s kinda two-fold. You don't need to make the cholesterol because you're not using it in the gut. And you don't get the tools your body needs and you suffer the long-term effects.
Dr. Justin Marchegiani: I agree and I think it's the vegans that are more insulin sensitive. Meaning they don't over produce insulin. Their cells are numbed insulin. Those are the ones whose cholesterol really drops and I – I agree and I see that frequently. Now in my practice, you know – we find that upping the cholesterol, increase in the saturated fats as many studies meta -, analysis many studies their conglomerate together to look for correlation they find that there's no correlation between saturated fat cholesterol and heart disease. I think the Framingham heart study echo that. What do you think?
Dr. Jack Wolfson: Well you know, yeah – it was definitely thought on Framingham and uh, in 2010 American Journal of Clinical Nutrition –
Dr. Justin Marchegiani: Yes.
Dr. Jack Wolfson: – the biggest nutrition journal. They looked at 350,000 patients and concluded that sat fat has nothing to do with cardiovascular disease. Uh – uh, I believe it was four years later in 2014 there was another analysis over 5000 patients. So, yeah -the data is very clear set that is not linked cardiovascular disease. Sat fat is great for cooking. Uh, and most importantly, our ancestors have been eating sat fat for, you know, a million of years. And animals eat sat fat. Uh, breast milk – the healthiest food in the planet for a newborn baby up until the age of 3-4 years of age. Uh, this – this breast milk is loaded of sat fat. So I think that pretty much ends that debate.
Dr. Justin Marchegiani: Yeah, I totally agree. You kinda talked about the HDL and LDL. You mentioned it earlier. I just emphasize it for the listeners. People are out there always talking about good cholesterol, bad cholesterol. One of the things I echoed my patients is cholesterol, like LDL or HDL or good or bad, those are just the bosses. The LDL is basically the boss the takes cholesterol from the liver out to the – the peripheral tissues to help repair and fix whatever's going on. Cholesterol is a powerful antioxidant and the HDL is the bus back home it's the bus back home from the peripheral tissue back to the liver to recycle that cholesterol. Can you echo or comment a little bit more on that topic?
Dr. Jack Wolfson: Yeah. You know, I agree with everything you said a 100%. The LDL vilified by the pharmaceutical industry and therefore, in they push on the medical doctors and medical doctors told that same jargon. Why would the body make LDL if it didn’t have some role and some benefit? Uh – you know LDL’s the bad cholesterol in our body makes it. Does our body’s like uh, you know program to kill us and cause heart attacks? Why the animals make LDL particles? Why the animals make HDL particles? There’s a reason for all of it. Just as you said, we measure the good and the bad amongst the uh, the LDLs – there is good and bad LDL. There’s good and bad HDLs. And we measure those levels and uh, make recommendations based on that.
Dr. Justin Marchegiani: That’s great. And what kind of particle size test are you doing? I was doing the VAP by Azoteq but they close down recently. So I’ve been looking at the NMR as well as the cardio IQ. And for the listeners, the particle size has to do with basically how big or small the LDL or the HDL are. And I tell my patients big and fluffy particle size A – you want the A on the test. You want the larger, fluffy particle size A. And you wanna avoid the B for bad – the small atherosclerotic dense LDL particles. Can you comment on that a little bit more? And what lab tests are you using for your particle size testing?
Dr. Jack Wolfson: Well I think – Yeah, as you said it, there’s a lot of different companies that are out there. I personally use vibrant by America.
Dr. Justin Marchegiani: Okay.
Dr. Jack Wolfson: For my uh – for my lab testing and they’re doing amazing leaky gut panel. So really excited about that company. And uh – they uh, you know, started up a few years ago getting really, really high quality results from them. I’ve been using true health diagnostics like what you say, Cleveland, Heartland, Boston. There’s a lot of different companies uh, that are doing advanced lipid analysis. I think the important thing is to get the – the testing done and get that information.
Dr. Justin Marchegiani: Got it. So you're looking for more of the – more of the A’s less of the B’s, generally speaking?
Dr. Jack Wolfson: Well, I mean like I said the, uh – the, in norm risk factor that we know is that APLB to APLA ratio. And you get the ration down below 0.6, uh – your urine are pretty darn good place regarding your lipids.
Dr. Justin Marchegiani: Can you go more into that ratio one more time? I just wanna make sure I get that.
Dr. Jack Wolfson: Yeah. Sure, thanks. So, APLB would obviously be a measure of LDL, VLDL, IDLs. All of the, lipid, you know – factors. Uh, so it gives you much more information than just LDL particles. And in ourselves, it’s kinda all those non-HDL's. And then APLA would be a measure of HDL and really the HDL functionality, so uh – that’s what we’re using and uh – yeah, then I think obviously everything that where we work so many case studies where we’re making big differences.
Dr. Justin Marchegiani: Got it. APLA’s, the HDL’s, the APLB’s everything else essentially.
Dr. Jack Wolfson: Yes
Dr. Justin Marchegiani: Okay. Great. So, looking at you being a cardiologist, maybe you get people with hypercholesterolemia coming in. When do you prescribe a statin? Is there a time where you – are you able to avoid prescribing it most of the time? How does that look?
Dr. Jack Wolfson: Uh, yeah. You know, the uhm – uh, you know to be candid about my practice, I mean unlike people that are on statins in my practice to the people that, that insist on it. So uh, you know, and some and those typically gonna be the people that have had a cardiovascular event already, that had a heart attack, that had bypass surgery, or somebody familial hyperlipidemia. And so many people of course come in and say, “Oh, I’ve got a family history.” Well, uh – you know, 50% of the population in the United States has cardiovascular disease. We all have bad family histories. Uh, so we can't blame it in the family but there is a small, small subset of people that you have total cholesterols above 300 and LDL particles that are sky high that no matter what you do – once their APLB’s are high, their LDL particles are high, their LDL’s are high. Everything’s high in them. And those people requires significant intervention. I try everything – nutrition, I try supplements. Uh, I wouldn’t go through a whole litany of supplements that I think are beneficial. Sometimes at the end of the day, we reach for a low-dose statin. Uh, uhm – but once again I – uh, it’s not very frequent even in my practice.
Dr. Justin Marchegiani: Got it. And with statins is there one that you're finding has less side effects? Are you doing like a Zocor or Zetia-Lipitor. What works the best? What's like the typical low-dose you like?
Dr. Jack Wolfson: Yeah, typically I will reach for something like Rosuvastatin, which is a – the brand name is Crestor. I can get away with pretty low-dose on that. I think we can dose it to three times a week and getting success. But even amongst those genetic hyperlipidemia patients, the statins don’t have that much effect against them, either. So the new kid on the block is the PCS canine inhibitors that uh, uh – you know Repatha injectable. Uh, uh – things that help to increase the LDL receptors on the liver to clear LDL particles out of circulation. So I have not prescribed that yet. I have a few patients that are on that from another cardiologist. But I've not written that script yet. Uh, this is where I think – you know more on the spices actually help –
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: – increase LDL receptors on the liver and then my favorite supplement when it comes to – uh, lipids and blood sugar and so many other things is Faverin, PER, PCR, IME. The literature on that is – it’s extensive and prolific. And so many different things that's really exciting product. That one on the way is it works. Uh increases MPK enzyme, therefore progrades degradation of the LDL receptors. In the liver, work similar to the PCS Canines, not as – as dramatic effect. But without the side effects with other benefits and uh, it’s natural.
Dr. Justin Marchegiani: Got it. So I think I’ve seen one of your cardiovascular supports, right. You put uh, the berberines in there as well?
Dr. Jack Wolfson: Yeah. Uh, right now we use a straight protocol BERBE – uh, B-E-R-B-E and you know – uh, anticancer. It lowers blood sugar, excellent for lipids, improves BPH symptoms. Uh, uh the polycystic ovarian –
Justin tin Marchagiani: Yeah.
Dr. Jack Wolfson: You know – syndrome. It’s like there’s a role in that for everything. So it’s a pretty exciting product.
Dr. Justin Marchegiani: It also helps with SIBO, too – small intestinal bacterial overgrowth.
Dr. Jack Wolfson: Uh, I mean – and that’s where all the literature kinda started off as far as what it did for us in antibacterial, uh and to improve bowel health. In fact I found a study recently that came out about how Berberine improves leaky gut. Uh how it’s uh – intestinal permeability is decreased when you put people in Berberine. So it’s uh – it’s really a, uh kinda a Swiss Army knife of supplements.
Dr. Justin Marchegiani: Totally agree. Now, I wanna pivot one second. I heard you mentioned leaky gut and know you mentioned a test that you run earlier – test for leaky gut. How are they assessing leaky gut? Is it based off of zonulin or occludin? What’s the, what are the markers?
Dr. Jack Wolfson: Yes. So in particular the uh, Vibrant America does the test called Wheat Zoomer. And the Wheat Zoomer looks for leaky gut. It looks at zonulin. It looks at antizonulin or antibodies again zonulin, antibodies against actin. Uh, and antibodies against lipopolysaccharides as active components of bacteria that you know, some of them get into the body but it shouldn’t be a lot. So they’re not looking at occludin. Uhm – uh I think Cyrex lab looks at occludin.
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: Uh – and uh, it’s, it’s kinda like you know, Mercedes-Benz or you know, BMW. They’re both high end products. I happen to like the panel from Vibrant. The quality of the company that I know Vibrant is – I have nothing against Cyrex. I mean they’re both – both good options but you, you know, Dr. Justin, this is really kind what you consider kinda be the holy Grail of how things happen, right. And now – you know, we can really put it all together where you have the intestinal damage known as leaky gut. Bad things get in the immune system.
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: Inflammation, oxidative stress and you know the immune system comes in and just consent with the machine-gun. And that machine-gun damage kills off bad bacteria and other particles but it also damages the rest the body. So, you know, the conventional cardiologist – this doesn't get it. The conventional cardiologist thinks that coronary disease is, is a lack of statin drugs. Coronary disease is a cholesterol issue. Uh and they’re just totally missing the boat.
Dr. Justin Marchegiani: And we know so much of the cholesterol can be responding to inflammation. The cholesterol is kinda this natural band-aid. So if we have a lot of inflammation in the gut that could affect cholesterol level systemically.
Dr. Jack Wolfson: Oh, most uh – most certainly. Cholesterol’s part of speckle on the wall. You know, there’s damage on the wall and uh – you know, you thought a speckle. Cholesterol is part of that speckle. Speckle did not cause the damage.
Dr. Justin Marchegiani: Yes.
Dr. Jack Wolfson: It’s coming, you know, the process.
Dr. Justin Marchegiani: Yes, love that. Typically in my clinic, one of the tests, a couple the test we’ll look at – we’ll do all the panels that you just mentioned on the cholesterol. One of the things I have to start working on, uh the APO, uh the APO1-2. I gotta start looking at that more. But we’ll also look at the inflammatory markers. We’ll look at uhm highly sensitive CRP, we’ll look at homocysteine, we’ll look at fibrinogen. What you think about those markers for inflammation or there any other markers that you also like to look at, too?
Dr. Jack Wolfson: Well I think you mentioned a – uh, yeah certainly HSCRP. The most data is on HSCRP.
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: And there – there’s phospholipase 2.
Dr. Justin Marchegiani: Uh-huh.
Dr. Jack Wolfson: Which is PLA2. Uhm, real quick – If there’s, that’s thinking to get a CT, coronary in CT or coronary in calcification scan, I’m totally against it. I don’t know what your opinion is, Doctor Justin. But uh, I’m anti-radiation. You know causes heart disease, radiation causes cancer. Let’s just assume most people have coronary calcification because they do. So therefore let’s just use these lab tests. Let’s use maybe CIMT, endopath markers of vascular reactivity to – to define health. Uhm – but uh, and the other inflammatory marker is – is the oxidized LDL.
Dr. Justin Marchegiani: Yup.
Dr. Jack Wolfson: That’s the – the pinnacle of the testosteroid. There are, you know you’re measuring damage to LDL particles that are eventually targeted for uh – uptake by the immune system. And those oxidized LDL will go right into the vessel wall. They’re taken up by the system. The monocytes would become macrophages. And then –
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: Foam cells –
Dr. Justin Marchegiani: Foam cells, yeah.
Dr. Jack Wolfson: The foam cells rupture and people die. So that’s where that goes.
Dr. Justin Marchegiani: And what’s that test, the oxidized, you just call it oxides LDL test?
Dr. Jack Wolfson: That’s an OX LDL.
Dr. Justin Marchegiani: That’s it. Wonderful. Very good. I don’t really have an opinion on the, uhm calcification test. Glad that you brought that up. I know Dr. Davis – I think he’s a cardiologist. Well I think he’s – he has spoken highly of it in the past but you're not liking it more just from the radiation exposure side of it?
Dr. Jack Wolfson: Right Yeah. Yeah, I feel Davis – uhm, uh you know up, up in Minnesota.
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: He became the uh, famous cardiologist because of a test he did called, track your plaque.
Dr. Justin Marchegiani: Yes.
Dr. Jack Wolfson: And that was his – he keep on doing CT scans. The more you keep doing CT scans, the more you’re gonna create coronary artery disease.
Dr. Justin Marchegiani: Totally.
Dr. Jack Wolfson: Radi – radiation causes cancer. Radiation cause heart disease. We know from young guys who had non-Hodgkin – uh, I’m sorry, the Hodgkin lymphoma. They had uh – uh, radiation to their chest. They all had severe coronary disease. They all have rate valvular damage from it. Uh – So it’s just a test we don't, we don't need it. Uh- frankly I think that’s a big reason why insurance doesn't cover it either. Uh- because it's just not useful beneficial test. If you know, you’re a 50 year old male, let’s just assume you’ve got coronary disease, now let’s do something about it. So, uh –you know once again, I'm totally anti-CT scan. Uh, you know radiation is factor that killed my father. Working as a cardiologist for all those years.
Dr. Justin Marchegiani: Right.
Dr. Jack Wolfson: So, uh- yeah. Let’s – let’s avoid it.
Dr. Justin Marchegiani: Totally. So I’m gonna go through a quick rapid fire questions. HSCRP – you like that below 1, below .5? What’s your range in that?
Dr. Jack Wolfson: I, uhm- I think the lower the better on an HSCRP, no doubt about it. I mean, HSCRP not only is it a marker, but it is a stimulator for- for dysfunction in the body. When you infuse lab rat –
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: – with uh, high sensitivity CRP, they all came down with hypertension and this filial dysfunction. And eventually coronary disease, so it’s not just a marker. It’s actually uh- a, a negative once it’s floating around. So you gotta get that lowered.
Dr. Justin Marchegiani: Absolutely. And how about homocysteine, do you like that below 8?
Dr. Jack Wolfson: Certainly. Uh, homocysteine – uh, I think 8 is uh, a nice position. Uh- you know, somewhere between uh, between 6 and 8.
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: I think is good. We certainly don’t want it too low because homocysteine has a purpose. Uh, we gotta lower that number down and you know, –––– above the B vitamins.
Dr. Justin Marchegiani: Yes.
Dr. Jack Wolfson: But another, uh- secret trick to lower that down for another part of the methylation pathways betaine. Uh and betaine, you get your digestive enzyme.
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: If you take Betaine HCL product that tremendously works as well. Sometimes the B vitamins just, uh- you know just don't get it done. Uh and of course you know, people have genetic snips and whatnot. But, you know, the betaine really helps to uh, lower that down. But you know, more importantly of course is uh- it’s for digestion. And everybody has not enough stomach gas as it is opposed to too much.
Dr. Justin Marchegiani: Totally. And the betaine is the trimethlyglycine, right? Same thing?
Dr. Jack Wolfson: Uh, well –what, uh when uh – trimethlyglycine, uh- is a fantastic methylator. Uh for this – from the betaine, you know-uh in a molecule, uh- in of itself but there in the betaine does contain, you know three methyl groups on there. So there is in similarity uh, but uh- it works, it works really well.
Dr. Justin Marchegiani: Loving the brain candy. Awesome. And I know the whole story behind – maybe our listeners don’t- but the whole, Kilmer McCully story of homocysteine. Basically he was laughed at Harvard. He’s trying to talk about the connection with homocysteine and heart disease. Basically figured out certain B vitamins, in particularly B6, P5P or folate or B12. Ideally, a methylated B-12 help lower that homocysteine. Do you find that taking those types of nutrients – those methylated B vitamins that I just mentioned, is that actually lower homocysteine? And does actually correlate or should I say, is that a direct causation because of that lower homocysteine to less heart disease?
Dr. Jack Wolfson: Why – the thing, uh- you know, the literature unfortunately has not been kind to the B vitamins to lower uh, uh- you know to make to a difference in cardiac endpoints.
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: So heart attack, stroke, ––––– So it clearly lowers the number down on- on homocysteine. And uh- I can like postulate that- number one, they’re using inferior supplements. Number two, it’s not the whole program. You have to put it in context of- you know, eating the right foods, living the right lifestyle. Taking McDonald's eater and trying to lower the homocysteine vitamins, you’re probably not gonna make a big difference. I think it’s all part of the big picture uh, in our holistic practices.
Dr. Justin Marchegiani: And they’re probably working from the inequated theory like, “let’s fortify some milk, orange juice, maybe some toast with some synthetic crappy B vitamins.” Obviously, that’s not gonna fix the underlying issue.
Dr. Jack Wolfson: Uh- I would agree.
Dr. Justin Marchegiani: Okay. So you think, looking at – if we just give the healthy B vitamins that we just talked about, at a higher level but we make the diet changes – you’re saying in your clinical practice, a reduced risk and a reduced outcome of heart disease?
Dr. Jack Wolfson: Uh- I mean, I think so. You know, I don’t have a big- uh, study to point to we’re doing. But I certainly think that you know, once again the edge here: improving the lipids, you’re improving the homocyesteine, you’re improving your omega 3’s, you’re improving the thyroid and blood sugar and all the things that we’re dealing. Uh- yeah, I think uh- it's making a huge difference.
Dr. Justin Marchegiani: That’s great. And you mention the only people you're really prescribing statins for. I wanna just make sure I heard you right. People that are already on a pre-existing statin that are coming to see you to manage that. Or you said number two, is people that were hypercholesterolemia. Is that correct?
Dr. Jack Wolfson: Uh, yes. Yeah. Uh, uh – that’s uh, uh correct. I’m not using it too often. Frankly, I use the Berberine, I use the Bergamot, I use Re–––
Dr. Justin Marchegiani: Yes.
Dr. Jack Wolfson: I use binders in the gut. So –
Dr. Justin Marchegiani: Yes.
Dr. Jack Wolfson: You know, uh – organic India. And you know, just really trying’ to- you know increase that fibrin in the diet. And uhm, uh- those are my therapies. But once again, once you address the basics. I mean, just get sunshine. Sunshine converts excess cholesterol back in the vitamin D.
Dr. Justin Marchegiani: Totally.
Dr. Jack Wolfson: And that’s- that’s free, you know. You know the big guys like you and I- a lot of money to do that. I mean, let’s just repair itself.
Dr. Justin Marchegiani: I know, that’s great. Coz I have a couple patients that have the hypercholesterolemia and are you typically diag-diagnosing that off of like PCS canine, the LDR receptor, the FH markers. Is that what you’re looking for that diagnosis?
Dr. Jack Wolfson: Well, I think there’s a lot of different uh- you know, genetics. You know, and I think you label the big ones there as far as why people have hyperlipidemia. Uh- but you know, once again if the uh- total cholesterol uh- that's in the 35400 range, the LDL particles above 3500. I think that’s a pretty good sign the they’ve got- you know familial hyperlipidemia. You know, but sometimes you see people that are just- just this metabolic syndrome. They’re overweight, hypertensive, they have LDL particle number 2800. Those are not the familial people. Those are the people that- you know just have all the, you know-
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: -all the bad habits that lead to the lipids.
Dr. Justin Marchegiani: Yeah. And I gotta- these patients are actually expecting this interview so I told them I might ask some of these questions for them. But uhm, we talked about some of the natural things we could do. Would you be comfortable- would you want someone to be on the statin even if they're trying not to be honest at with those conditions, if they're doing the Berberine, if they're doing the CoQ10, if they're doing some, some of the red rice yeast and all the things you mentioned? Or would you still want them to be on a low-dose statin, as well as everything else?
Dr. Jack Wolfson: No. For the most part, I don’t want them on statins.
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: I think about myself personally and I wouldn’t want to take a statin in any under circumstance. So I don’t push them on that at all. It’s really kinda patient-driven. Uh- you know, if they, if they say they wanna be on the biggest what they read or whatever then they can-they can stay on it. I’m not gonna totally dissuade them from it. And listen- you know, Dr. Justin, all we can do is give people the facts and say, “hey, listen-when you take a statin drug, your risk of having a cardiovascular event. is reduced from 7% ,for example, you know, down to 5.5%. And if you want that 1.5% benefit, go ahead. But I think in my plan and your plan, we’re gonna get down to close to 0%.” And when you explain that to people, they get it. It’s not just about moving numbers, it’s not about moving numbers at all. It’s about lowering risk of heart attack, stroke and dying. And in any statin study, under any circumstances, the benefit is small.
Dr. Justin Marchegiani: And what is the research say coz you talked about the 1.5% benefit.
What does the research say, though on increasing chance of Alzheimer's, diabetes and uh, cancer- being on a statin?
Dr. Jack Wolfson: Uh- well, listen now they see increase in diabetes risk. There’s no doubt about that . Uh- you know, cancer risk is kind of equivocal. Uh- and listen, there’s lot of studies telling the benefits of statins and I think you have to look at a lot of those uh- you know with an inquisitive eye and saying who’s paying for the studies, who is doing the studies, what’s the motivation behind it? But you know, all these diseases, whether its heart disease, cancer, dementia, this is not from a-a you know, deficiency of statin drugs. There’s a reason for it. And the natural doctor finds that reason.
Dr. Justin Marchegiani: And I’ve also heard, too that the uh, the NT or the number needed to treat for a statin is what, 99. So that means 99 people have to take that drug for one person to be helped by it. Are you familiar with that?
Dr. Jack Wolfson: Well, you know- you know, most certainly so. And I love number needed to treat.
Dr. Justin Marchegiani: Yes.
Dr. Jack Wolfson: And that’s what anybody should ask their doctor regarding heart disease or stroke prevention and certainly cancer prevention, chemotherapy. You know, if I get this chemotherapy, uh- what’s number needed to treat-You know, how many people need to take chemo for one person to benefit? And what is that, is that a three-month benefit? Is it a five-year benefit?
Dr. Justin Marchegiani: Yes.
Dr. Jack Wolfson: Give me-give me numbers. Give me numbers that’s what we encourage- you know, for that. But listen, your statins come in different category. For primary prevention, for example on women, the statin data- uh, you know, number needed to treat, uh as far as uh heart attack reductions- yeah, it’s around a 100-15. Uh- uh, you know for women primary prevention statins do not increase mortality at all. for man, it gets a little bit better. Studies are mixed. Uh- secondary prevention is where statins “shine”. And in that scenario you can uh- uh, make number needed to treat regarding heart attacks. Uh you know, is about 1 in 30 to 40 mortality data maybe 1 to 70 to 80. But then again- hey listen, the pharmaceutical companies are doing the studies. Uh, there is a better way. Uh- you know, in any of these scenarios, you know in 39 out of 40 people don't get benefit after taking the drug every single day for five years.
Dr. Justin Marchegiani: That’s crazy.
Dr. Jack Wolfson: I think, uh- they can come up with uh- a, with a better plan. Uhm, uh- you know, by the way, real quick- you know, we’ve talked about like B10 to lower uh- uh, homocysteine. I just wanna correct myself uh- you know really quickly. I think about it uh- you know, TMG. TMG, you very astute and correct. It’s another way to do it. I just happen to like using betaine HCl because it's kind of a 2-in1 thing.
Dr. Justin Marchegiani: Totally.
Dr. Jack Wolfson: So with the homocysteine, while we’re really cranking up digestion.
Dr. Justin Marchegiani: Yup. I totally agree. Most patients I find as you know, when they’re stressed, they uhm. have lower levels of stomach acid. And if we have stomach acid, it’s a two for one, you get better digestion and you get the reduction in some of the homocysteine. I agree.
Dr. Jack Wolfson: Love it.
Dr. Justin Marchegiani: And when you said secondary just a second ago, you meant secondary benefits like the persons already had a heart attack. Now they're coming in to get treated by- with a statin that that has a little bit more benefit than preventative.
Dr. Jack Wolfson: Correct, correct. Some of the- uh, really- it’s gonna shine on people that had a heart attack. Uh- there will be some better data on- on you know, people that had bypass surgery or angioplasty. For it’s really in those post-heart attack people where there is the evidence of successful. Once again, it’s not about lowering the risk from 7 to 5 1/2 . It’s about lowering the from 7 to 0.
Dr. Justin Marchegiani: Exactly.
Dr. Jack Wolfson: And medical doctors cannot offer that. And Dr. Justin, you and I can.
Dr. Justin Marchegiani: Yes.
Dr. Jack Wolfson: -which is totally cool.
Dr. Justin Marchegiani: Yes. Exactly. And in your practice, are you putting those secondary people on statins or you still doing all the natural stuff that you already doing all the natural stuff that you reiterated earlier?
Dr. Jack Wolfson: Yeah. I mean, listen- if you wanna go on statins, go see somebody else.
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: You don’t have to pay me as a private- you know, private physician. Go see your bill pushy doctor and they’ll be happy to give it to you along with their three-minute office visit
Dr. Justin Marchegiani: Yeah, right. And I know the statins, too, they block the HMG CoA reductase pathway and if we look at the metabolites from that, you have the metabolic acid that comes after it which is the precursor to CoQ10. So does that mean when you’re- when you're managing patients that are already on statins, like you mentioned, are you making sure you give extra CoQ10 as well?
Dr. Jack Wolfson: Yes. For them and uh- you know, I measure CoQ10 levels and we see where people are at. And typically doesn’t take much to where we need to be. But you’re right. I mean, the downstream ramifications of, of uh the HMG CoA reductase inhibitors and blocking that enzyme are just catastrophic. What it does do a DNA and RNA replication. As you mentioned, CoQ10, uh- the squalene which has roles in our body.
Dr. Justin Marchegiani: Yup.
Dr. Jack Wolfson: And uh, uh dolichol.
Dr. Justin Marchegiani: Ughh.
Dr. Jack Wolfson: Dolichol is another cholesterol derivative. And dolichol, interestingly enough, is found in the substantia nigra in the uh
Dr. Justin Marchegiani: Midbrain.
Dr. Jack Wolfson: -midbrain and the neuromelanin cells.
Dr. Justin Marchegiani: Yup.
Dr. Jack Wolfson: And wouldn't you know that’s uhm- that Parkinson's, my father died of a Parkinson’s-like illness called progressive super nuclear policy. And my father is a cardiologist . He took Lipitor.
Dr. Justin Marchegiani: Ughh.
Dr. Jack Wolfson: So this is very, very important to me. And yeah, when you see that- you know, dolichol’s in that area, now you’re not gonna make dolichol because the drug- uh, we have a total linear connection on how it works. And it’s uh- it’s scary and sad and we need to stop it.
Dr. Justin Marchegiani: Dropping some truth bombs here. I love it. Very, very cool. Now, also one more question to you before we wrap up. Looking at CoQ10 we just talked about- Do you like the reduced or the oxidized form? The the ubiquinone or the ubiquinol? What does the research say?
Dr. Jack Wolfson: I personally use Ubiquinol. There’s good data, of course. I mean I use the Ubiquinol. But frankly, all the original data regarding CoQ10 was on ubiquinol.
Dr. Justin Marchegiani: Oh, yeah.
Dr. Jack Wolfson: So, so I think both serve a purpose. I think if you test levels, you can do that. But I think pretty much most people are going towards Ubiquinol version. Uhm, but you know, once- I think you do one that you’re taking. I think it’s fine,uh- and go from there.
Dr. Justin Marchegiani: And the Ubiquinol that's the reduced version, right. That has the extra electron to it?
Dr. Jack Wolfson: Correct.
Dr. Justin Marchegiani: Okay.
Dr. Jack Wolfson: Correct and you know, it’s more of the deactivated form, but the body shifts pretty easily. You know, to and from, both of those and uh- uh, you know I think when you're healthy, you’re gonna covert one to the other fairly easily.
Dr. Justin Marchegiani: Love it. Well, is there any other really important info that you wanted to talk about, but you haven’t get the chance to bring it to the surface?
Dr. Jack Wolfson: Uh, well I think you know- once again, our paleo ancestors ate- uh, you know ate- our pale ancestors ate paleo food, that’s number one. Number two, our paleo ancestors went to sleep with the sundown and woke with the sunrise.
Dr. Justin Marchegiani: Yeah.
Dr. Jack Wolfson: Let’s not forget about. Our pale ancestors were not in the artificial light, our paleo ancestors were in the sun all day long and they were naked. So, these things are free. Appropriate sleep is free, appropriate sunshine is free. Uhm-uh, you know the food is- is easily affordable. Get rid of the Starbucks and all the garbage. Uh, so – I think that’s about it, man.
Dr. Justin Marchegiani: I think that’s great. And last question for you. If you are on a desert island and you only could bring one supplement with you? One herb, one supplement, one nutrient, what would it be?
Dr. Jack Wolfson: Uhm- uh I would say, it’s gotta be probiotics.
Dr. Justin Marchegiani: Okay. Probiotics. I love it. Very good. And I just want to give you props, Dr. Wilson. You are a clinician as well as a researcher. You're in the trenches. There are a lot of people that are out there that are postulating in and you know, coming up with their theories on what's best based on the research but you're in the trenches doing it yourself. So I really appreciate that.
Dr. Jack Wolfson: Uh, you got it, Dr. Justin. It’s an absolute pleasure to talk to you. I’ll be happy to do it again anytime.
Dr. Justin Marchegiani: Absolutely. And again, that’s doctors- thedoctorswilson with a D-R We’ll put the link below in case you guys miss it. So you can click to get access and also check out Dr. Wilson's book the, The Paleo Cardiologist and he also has been getting a chance to do what you want for part two over at vaccinesreveal.com for Dr. Wolfson's uh- awesome info on vaccinations.
Dr. Jack Wolfson: Sounds, uh- sounds fantastic. I appreciate it and uh- yeah, here’s to health.
Dr. Justin Marchegiani: Thanks a lot, Doc. I appreciate it. Bye.
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