Do All Cardiologists Focus on Cholesterol?

I recently came across a conversation between Dr. Pradip Jamnadas and Dr. Rangan Chatterjee. Dr. Chatterjee is a celebrity doctor in the UK with whom you may already be familiar. But it’s the cardiologist Dr. Jamnadas who really intrigued me.

In the first few minutes of this interview Dr. Jamnadas admitted something that I had almost never heard a cardiologist say before. “When I looked at my patients who were still sick, who went on to have another heart attack or a stroke or had hardening of the arteries, most of them had normal cholesterol.”

Now I’m paraphrasing what he said, but this is something that all cardiologists must surely know. Roughly 75% of people who have a heart attack do so with “corrected” cholesterol, meaning that their cholesterol is either naturally low or being kept low with a statin. So focussing on lowering cholesterol - as Dr. Jamnadas did for years if not decades - isn’t a successful strategy.

What turned out to be a successful strategy for Dr. Jamnadas? Focus on the insulin.

The intervention that he talks about in the podcast is fasting, but exercise, low-carb diets, and other things have a role to play. (I go over the full list of causes and treatments for hyper-insulinemia in detail in The Health Dialectic.)

Why is this such a big deal? Cardiologists are perhaps the last holdout in a medical profession that has largely accepted the role that reducing insulin can play in preventing and reversing Type 2 Diabetes and other metabolic disease. The interventions that cardiologists tend to prefer - eat less, move more - simply don’t work. Although statin drugs do work for some people, their side effects have been understated.

As a naïve observer, I’ve been surprised that cardiologists don’t talk about insulin. The data shows clearly that high insulin is a far bigger risk factor for a heart attack than anything to do with cholesterol. Some will accuse cardiologists of being salespeople for drug industries, but I don’t believe that. Most cardiologists want what’s best for their patients.

Which is why I’m so glad to see Dr. Jamnadas and a few other cardiologists - led by Dr. Bret Scher at Diet Doctor - finally speaking up. The thing about Dr. Jamnadas in particular is that he’s put this into practise with a fairly large patient population. His decades worth of frustration at not being able to do anything for his patients has finally turned into joy at actually making a difference in his patients’ lives. And the interventions he’s using are not even the traditional domain of doctors - they’re the domain of health coaches like myself.

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