#351: The "Evil Cousin" to LDL - Why Everyone Should Know Their Lp(a) Number with Dr. Akil Taher
Dr. Taher summits Mt. Kilimanjaro in Tanzania.
What if one simple blood test could reveal a genetic risk factor for heart disease that affects 1 in 5 people worldwide?
Rip sits down with physician, endurance athlete, and author Dr. Akil Taher to talk about a critical—but often overlooked—marker for cardiovascular risk: Lipoprotein(a), or Lp(a).
Despite decades of research linking elevated Lp(a) to heart attacks, strokes, and aortic valve disease, fewer than 2% of Americans have ever been tested.
Dr. Taher shares his remarkable personal story—from heart disease and bypass surgery to becoming a marathoner and mountain climber in his 70s—and explains why understanding your Lp(a) level could be lifesaving.
They dive into:
• What Lp(a) actually is and why it's called the “evil cousin of LDL”
• Why genetics—not lifestyle—largely determine your Lp(a)
• Why many healthy people still suffer heart attacks
• The surprising link between Lp(a), inflammation, and blood clotting
• Who should absolutely get tested
• Why the nanomoles-per-liter test matters
• How lifestyle medicine and a whole-food plant-based diet still play a critical protective role
Dr. Taher’s message is simple but powerful:
Get tested. Know your number. Protect your heart.
Because what you don’t know can hurt you—but what you discover could save your life.
Key Takeaways:
• Lp(a) is genetic and affects about 20% of people worldwide.
• Elevated levels dramatically increase risk of heart attack, stroke, and aortic valve disease.
• Most doctors don’t routinely test for it.
• A whole-food plant-based diet may help reduce Lp(a) and dramatically improve overall cardiovascular health.
• New therapies targeting Lp(a) are currently in Phase 3 clinical trials.
About Akil Taher, MD
Dr. Akil Taher is a practicing medical doctor, an author, eternal optimist, explorer, adventurer, and a strong advocate for a whole food, plant-based vegan lifestyle. He is a Septuagenarian athlete who after surviving heart bypass surgery has educated thousands to understand a way out of the pain of chronic illness and disease and he believes that what you eat is the most important pillar of the 6 Pillars of Lifestyle Medicine. Dr. Taher knows and shares through his incredible story, the lifechanging benefits of living a WFPB vegan lifestyle and it’s more than what you may think. Dr. Taher’s book “OPEN HEART: The Transformational Journey of a Doctor Who, After Bypass Surgery at 61, Ran Marathons and Climbed Mountains” is available on Amazon, Kindle and now on Audible (read in the author’s own voice). All proceeds from book sales go to charity. Get a copy at: https://amzn.to/3sy299g
Order Dr. Taher’s book, Open Heart
Episode Resources
Watch the Episode on YouTube: https://youtu.be/fNvO4eYhnlU
Information on a FREE lp(a) test - https://www.akiltaher.com/lpa
We hope to see you at one of our Plant Strong Events: https://plantstrongevents.com/
Give us a like on the PLANTSTRONG Facebook Page and check out what being PLANSTRONG is all about. We always keep it stocked full of new content and updates, tips for healthy living, delicious recipes, and you can even catch me LIVE on there!
We’ve also got an Instagram! Check us out and share your favorite PLANTSTRONG products and why you love it! Don’t forget to tag us using #goplantstrong 🌱💪
To stock up on the best-tasting, most convenient, 100% PLANTSTRONG foods, including our cornbread, teas, stews, pancakes cereals, granolas, pizza kits, broths and soups, check out all of our PLANTSTRONG products HERE. Use code: STRONG15 for 15% off your first order.
Full Transcript via AI Transcription Service
I'm Rip Esselstyn, and you're listening to the Plant Strong Podcast.
[0:05] What if I told you that there is a major risk factor for heart disease, one that affects one in five people worldwide, and most people have never heard of it. And here's the kicker. It's genetic. It's not usually included in your standard cholesterol panel, and for many people, it may be the missing link behind out-of-the-blue heart attacks and strokes, even in people who look perfectly healthy. Today, we're talking about lp(a), that's lipoprotein(a), and this is one of those episodes that could quite literally save your life or the life of somebody that you love.
[0:50] My guest is Dr. Akil Taher. He's a physician, heart disease survivor, and one of the most passionate advocates that I know when it comes to raising awareness around this critical marker. You may remember Akil from a previous episode where he shared his amazing journey from bypass surgery in his 60s to running marathons, climbing mountains, and completely transforming his health through a whole food, plant-strong lifestyle. But today, we're going deeper. We're talking about what LpA actually is, why it's often called the evil cousin of LDL, who is at risk the most, why most doctors aren't testing for it, and most importantly, why you should really know this number. What you don't know might hurt you, but what you learned today could be life-saving. Let's learn all about this marker right after these words from PlantStrong.
[2:00] I've got an important update on our Vital Signs event. This is our educational conference for health care providers. We are moving the event to October 18th to the 20th, and honestly, I am more excited than ever about what we're building here. As we've talked with more health system leaders and providers, it's become clear that there is a real hunger for this kind of a gathering, specifically practical tools, real community, and a chance for providers to learn how to apply this work, both personally and professionally. So mark your calendars for October 18th through the 20th in beautiful Cleveland, Ohio.
[2:43] Vital Signs is coming and it is shaping up to be something truly special. Also, we just wrapped up the Black Mountain retreat, and wow, what an experience. These events are powerful, personal, and deeply transformational. In fact, 98% of attendees have called the retreat life-changing. And now, all eyes are looking forward to Sedona. It's coming up September 28th through the October 3rd. it's already 50% full. So if you want to join us for an unforgettable week, head to plantstrongevents.com and grab your spot. And lastly, if you're not able to join us at a retreat, you can still create a little of that Plant Strong magic at home. Our food line is designed to make eating meals made from real whole plants, super easy, practical, and delicious. So if you've been looking for a simple way to stay consistent, head to planstrong.com and use the code PODCAST10 for 10% off your order.
[4:03] Dr. Akil Taher, it is a pleasure to have you back on the Plant Strong Podcast. It's lovely to be back, Rip, anytime, anytime. And it is lovely to see your exuberant, shining face. For those that don't know, you were on the podcast back in the middle of 2024. You were episode number 262. We had a really wonderful conversation. The name that we gave our podcast conversation was Living Life with an Open Heart, which is so appropriate because you wrote this book right here, Open Heart.
[4:48] It's the transformational journey of a doctor who, after bypass surgery at 61,
Understanding LP(a)
[4:55] ran marathons and climbed mountains. And I'm having you back on the show today because we really want to focus in on something called lp(a) and why you have become so passionate about lp(a) and why you think people should understand what it is, how it works, and get it tested. But before we jump into lp(a), which is really, in my opinion, it seems like it's just come into the cultural zeitgeist in the last three or four years. I want to talk about, just do a little recap of your remarkable story. And if you don't mind, I'll kind of set it up and then you can fill in the gaps. But.
[5:48] You were a former couch potato at about the age of 56 or so. You were over in the UK, and you started getting some chest pains and decided you'd fly back to the United States and get checked out. And what did that show?
[6:07] Well, before I get into that, let me tell you one small thing. Please. Had I known then what I know and understand today, I would possibly not have had the bypass surgery or the stents and have gone full force into whole food plant-based SOS diet. Yes. And that's my opening statement, because that is people should realize that that is the treatment of choice and not only treating and preventing, but reversing heart disease. Yes. But like so many people, you didn't know any better, right? And so if you could do things differently, if you could rewind the clock, yes, you may not have had the stents and you may not have had the bypass, but you are where you are. and now you're doing the absolute best that you can. Correct. Correct. Absolutely. It has really helped me, even though even people who had bypass or stents, they can be tremendously in reversing too. I am there. My collaterals have come up a lot. So now it is 16, 17 years since my bypass and I've had no reason to get a stress test because I do three and a half, four miles a day.
[7:28] Right. So what started off was I did have an erratic, bad lifestyle. Till the age of 61, I created my unhealthy lifestyle. I ate indiscriminately.
[7:44] I did not realize what foods could do to my body, like a heart attack or heart disease. I never thought it would happen to me. I always thought it was somebody else. And then in the back of my mind, I said, I'm a doctor. If something does happen, I know how to deal with it. There are people around me. And so besides the first generation Indians, that is the first generation, my group, age group, when they came to America, they did not even know how to spell exercise. Right, right. So the idea is that we were totally, not only no exercise, but we were couch potatoes. All we did was work, work, work. And paying very little attention to our health, our family, our friends. And if we were not eating or working, we would be lying on the couch. And so this created a lot of stress. And trust me, I was a type A personality. So I had to have done, get things done my way. It was my way or the highway.
[9:01] That created even more problems so over all this and plus i had a wolf parkinson white syndrome as i tell you in the last episode sounds like a horror movie but it is not it is a conduction defect yeah and uh it is an accessory pathway that can go into rapid heartbeats.
[9:25] Apart from that, I realized that my family history was extremely bad. My brother died at 52 of a stroke. My mother and sister died in their 60s with heart disease and kidney disease. I have a brother who is alive, who is two years older, but he has got pulmonary fibrosis now. So I have bad death genetics part of it. So all this culminated into a stress I could not handle. So I was not surprised when heart disease came knocking. Yeah. And doctors told me, get stents done. I got my stents. Did you feel better after you had the stents? You know, mine were non-medicated stents. I did feel better, but I did not change my lifestyle.
[10:18] Because I was, I guess I was severely depressed. Yeah. So I thought that I was a doctor and I was supposed to treat patients, not become one. And then I thought medical science would get me out of it. So I had a very, five years were terrible, terrible. But here is a thing that I want people to understand, that I did not know that I had lp(a) high elevated. I did not know at that time. But just to tell you, Rip, a brilliant cardiologist, because when they put stents, I had a cardiac arrest.
[11:02] So he saved me that day. Brilliant guy. So he saved me. But guess what? Two years after that, he was on his treadmill. Now, obviously, the cardiologist, he was lean. He must have got his cholesterol and everything checked. But two years after that, he had a massive heart attack while he was on his treadmill. And he was 43 years old. So let me just make sure I understand this. So the cardiologist, is this the cardiologist that did your stents? Or the cardiologist that did your bypass? My stents. Okay. So the cardiologist that did your stents, and you said that when you were getting the stents, you went into cardiac arrest? I went into cardiac arrest. Yes. So he was able to bring you back to life. Did they have to shock you? Shock me. Wow. Wow. Do you remember anything about that experience or nothing? I do remember getting up. It burns on my chest, And I didn't know why all this redness and burns were there. But then they told me that you went into an arrest and we had to shock you and let your wife know. So it was horrendous. So they had to stop doing the stance for that first one and then get me next day to do it again.
[12:19] Do you know what exactly happened during that procedure that caused your heart to go into cardiac arrest? I have no idea. I think probably related to the WPW. I'm not sure. What's a WPW? Wolf, Parkinson, White. Oh, gotcha, gotcha, gotcha, gotcha. So the point I'm making is... Now I'm reasonably sure that that doctor would be having a high lp(a). Yeah. 43 years old. He was 43? Yes. And that's when he had a heart attack and died on his treadmill. On his treadmill. That's super sad. Yeah. Very sad. Very sad for a young person to go. And he was brilliant. Yeah. And where did you have that procedure done? What hospital? Birmingham in Alabama.
[13:16] And why did you seek out this particular hospital and physician? Because I heard a lot. I did my homework, and I found this guy had done tons and tons of stents. So I said, okay, let me go over there. My cardiologist was also doing in Gadsden, Alabama. But he said, no, you better go here and get done by this is the top guy. And he died so that was a sad part of it so what i'm saying is rip that till five years i did not change my lifestyle yeah and i got worse because when you get depressed then you get all these physical problems coming yeah so you get your sinuses and your pneumonias and your bronchitis visit you every year you get hemorrhoids and you get uh inguinal hernia and anal fissures and the infamous diverticulitis perforated twice and the second time the surgeon a friend of mine he says akil if i don't take you down and operate on you right now you may not survive, and so i called up all the gi's and then i said let me hold on and then it sort of subsided and And I was out of the hospital. But five years later, I had the blockages again. So, so...
[14:42] Just because I want to understand, and I think it's important for the audience to understand, you had three or two stents put in? I had one in my LAD and one in the circumflex. Okay. I caught on it, three. Okay, so you had three stents put in. And were those the exact same arteries that five years later were clogged up? Yes. Okay. So what would be your advice to somebody that's getting a stent? If you don't change your lifestyle, those stents will start to clog up within a matter of years? Well, not as fast as it happened to me because now they're medicated stents. Yes, yes, yes. Mine was last year that I had non-medicated in 2006. Then came the medicated stents. And just so we understand, bring us laypeople up to speed, what does a medicated stent do that back in the day, a non-medicated stent didn't do? Yeah, because see what happens in an angioplasty, when you put that stents after doing the angioplasty, these things get blocked again. You get atherosclerosis, blood buildup again, and blockages. Or when medicated stands, it does not happen.
[16:12] Why? Why? Because of the medication that prevents. It may be a thinner that does not allow clots to form. Whatever the reason may be, that is why they put you on a thinner for one year after stents, to even help you more. So the point was that I failed. Whatever the reason may be, I've got back my chest pains. And now they said, come into surgery. And when I got into surgery, that's the time when my, I always say this, Rip, adversity can either be your best friend or your worst enemy. Yeah. It was my worst enemy the first time I got my heart news, the coronary artery news. But my bypass surgery was the best thing that happened.
The Journey to a Plant-Based Life
[17:07] Because I immediately thought, I have no choice. Only two ways to go now. Either to make a real concentrated effort to get myself out of it and change my whole lifestyle. That's when I read your dad's book and I read Dean Ornish and I read all these things. And I started working. Because even though I was now eating better and exercising and meditating, but I was not a plant-based. Yeah. A better eat. So it sort of helped me, but my diverticulitis would still flare up. My sinuses would flare up. And I was wondering why. So I did a deep dive. I went into research. I read all the books that are there, journals, medical journals. And the more I read, the more I realized there is something here. That is when I came across the whole food plant-based diet being the cornerstone with the other five, exercise, proper sleep, and handling of stress, and avoiding substance abuse, and having a robust social relationship support. And that's when I found that out. So that is when I became a firm believer of this nutrition aspect to it.
[18:31] From then on there was no stopping because now I could do my 100 mile bike ride and climb Mount Kilimanjaro Mount Kailash I did I did triathlons, I did marathons and it was absolutely a remarkable thing so when people ask me hey buddy how old are you I would say 15 years old because the rest of the time I didn't live.
[18:57] I love all that Akeel, tell me this. You had the bypass and.
[19:06] When they did the bypass, because the bypass I would imagine is they took other arteries from you and went around the existing blockages that you now had in where you had the stents. Did they remove those old? No. So those stents are still there. Still there. Okay. What they did was I had it done on a beating heart. Yeah. That is a much better way to go instead of using the heart-lung machines. Because what I noticed in my colleagues and my patients, that there was a big problem of memory.
[19:47] So when you do it on a beating heart, mine was done in nine minutes. They were grafted. So they're taken out. And another important thing is, by that time, I was trying to figure out that I have to run. I have to keep up the promise that I made to the nurses. I would do my first half marathon. So I didn't want them to take my leg veins. What I wanted was my memory arteries. They last longer than the veins. And you can still exercise and do things. So they got that out and grafted that. And from then on, I have absolutely no problems touch wood regarding the heart issues. And the diverticulitis is back in the back burner.
[20:36] So, yeah. So they took the... Instead of taking the vessels from your leg, you said they took them from your... From my memory arteries okay okay so why is that not the common practice i have no i have no idea i i i have asked so many people i guess let me put it this way in india it is normally done on a beating heart the reason being in my days at least or 10 days 10 years ago because it is cheaper, you don't use the heart lung machines you didn't know you don't need those companies to give you that right but then there were a lot of cases which did not you have to be really quick but we really great at doing that yeah yeah at the time when i was having it done there were only 15 centers in the u.s that were doing it in doctors i believe were doing it so i found this one doctor in New Jersey, and he did it.
[21:45] And that was great. I was so happy that I got it done on a beating heart. And you said he was able to do this procedure in, did you say, nine minutes? Yeah, nine minutes with two other people helping him because they have to graft very fast because they don't have time. Golly, that almost sounds impossible. Yeah, that's what they did. That's what they did. That's incredible. You know, one of the reasons I also love seeing you and talking to you is because it is so apparent. You carry so much joy and I think gratitude in your heart. You seem, from what I, you know, in reading your book and everything, to be very much a changed man. Yes. Grateful is the right word. Gratefuk is the right word. And I'm just like... Looking back, looking back at the Akil Taher before the bypass, you know, before you told the nurses, I'm going to run, you know, half a marathon. What do you think was that kept you such a type A personality, so tightly wound, so stressed, all those things? Not willing to accept reality.
[23:11] Anger disbelief wanting the medical science to get me out of it, sometimes I felt okay my family history is bad so who cares, it's going to happen to me but not realizing that these are genetics Wolf-Parkinson-White syndrome you cannot control you are born with it lp(a) you cannot control you are born with it but high cholesterol otherwise, blood sugar, diabetes, blood pressure, all these can be controlled. Even if it's genetic, even if your parents have it, your brothers and sisters have it. So what happened to me was that just like that doctor, I was figuring out why my cholesterol is not getting back to normal the way I want my LDL to be in 50s. But it wasn't happening. So I had to ask my cardiologist, can you please do my lp(a) And this is how long ago? Last year. Just last year? Last year. 77 years I was. Gosh. Okay. And he said, and I don't blame him because most of the doctors and people don't know about this. But lp(a), he says, okay, we'll do it. Sky high.
[24:35] So, when you have that lp(a) sky high, and just remember one thing, Rip, 20% of the worldwide people have an elevated lp(a). Now, having said that, we South Asians, that means overall it is 1 in 5. We South Asians are 1 in 4. South Asian, meaning that India and countries around it, like Nepal, Sri Lanka, Pakistan, all those places where there are South Asians, it is one in four, 25%. Wow. And in Africa, it is very high, one third. So there's 33%. So blacks in America of African descent, they have 33%. Yeah. Now, there's a lot of different directions that I could go in right now with the question I'm going to ask you. um in your opinion.
[25:44] If you have this elevated lp(a)that it's a genetic component how protected can you keep yourself by eating a whole food plant-based diet even with the llp(a) before i go into that Yes. Let your viewers understand what lp(a) is. Definitely. Much good. Good. Please. See, lp(a), you see, we've got this alphabetical soup, so to speak. Total cholesterol, LDL, HDL, triglycerides. Now comes a new kid on the block. lp(a). Now, what is lp(a) lp(a) is exactly like your low-density lipoprotein LDL. They both have the ApoB, which is the protein, which is very heterogenic. But unlike your LDL, lp(a) has an extra protein, ApoA, which is like the tail covering off that LDL.
[26:49] That is in a shape like a kringle, which is a Swedish pastry. Okay. A kringle shape, which is a tail. This is the rogue that causes, whereby you call lp(a) the evil cousin of LDL. Because it can cause, making this extra protein be there, it can now become very sticky. It can become very much more what you call inflammatory, clotting, so that it can cause your chances of getting a heart attack or strokes are two or three times much more likely. Plus, it affects your aortic valve. So your aortic valve is what? For the listeners, not for you, but for the listeners, Aortic valve is a gate where the oxygenated blood from your heart flows into the different parts of your body. Now, this aortic valve, what lp(a) does is calcifies it.
[28:02] So once it is calcified, it narrows and becomes stiff. So you get aortic stenosis. So now the heart has to work harder. And then the heart fails. And once the heart fails, you need a replacement of the aortic valve. So all these things are there. Plus you've got peripheral. So it can cause increased peripheral arterial disease, heart attacks, strokes, and aortic valve problems.
[28:30] Now, you asked me a question as to what whole food plant-based is. Now, let me tell you this, that generally speaking, a good diet, say for example, Mediterranean diet, I'm just saying generally, and exercise and sleeping well and reducing stress does not affect the lp(a).
[28:56] What studies have been done are lp(a) when you have a whole food plant based diet can bring it down by 16%, Now, that's the only diet that can bring. Along with observational studies have been done on Indian gooseberry. That is called the amla. Amla, yeah. That can bring it down. Observational studies, we're not talking about control studies, can bring it down by 30 to 35%. So does almonds can bring it down. Now, having said that, there is one thing that can bring it down 30% to 35%. But before I delve into that, let me explain.
[29:47] lp(a) can be with a high cholesterol like I had. lp(a) can be without high cholesterol, normal cholesterol, normal LPL. So let me give you an example of Sandra Tremolous. Sandra Tremelis is a big speaker on people getting tested. She has also talked in the house. And she is the person who, because of her history, bad history, heart disease history in the family, she was sort of leading a healthy lifestyle, exercising, cholesterol was normal. But despite her cholesterol being normal, plaques started building up in her coronary arteries. And at the age of 39, she got a massive heart attack. 90 to 95% blockages, which almost killed her. Further testing found out that she had a very high elevated lp(a). Now you see why people, athletes, young athletes died on the field.
[31:00] Do you know what her lp(a) number was, how high it was? I don't. I don't. But she talks about it. It doesn't come to mind, but it was high. So let me explain to you what are, what are the tests that you can do? Because I want everyone, like in Europe, everyone gets tested. Most of the european countries not england but most of the european countries you can get it tested once why would we not now the fda approves to get it tested get it tested yeah if it is negative is genetically inherited so you must remember that if your parents have it there is a 90 chance that you are going to have it so if it is genetically inherited from your this thing you have to do this test negative you're home free yeah except in certain cases but when you say you know positive or negative what's your definition of negative if it's testing it comes back normal which is what level like yes yes very good very good question i i'll try to explain this in my time when i did it last year i did it milligrams per deciliter okay that That suggests the mass of lp(a).
[32:20] So below 30 is normal. Above 50 is high. Between 30 and 50 is intermediate gray zone.
[32:33] Now, this test should be obsolete because it only measures the mass. The test that everyone should ask is nanomole per liter. Nanomole per liter. Why? Because it measures the size of the particles of lp(a) and the number of the particles. So, if you have got 75 and less, normal, 125 and above, high, between 75 and 125 is that intermediate range. And then 160 or 170, 150 is extremely high.
[33:21] Now, having said that, I told you that there is one instance or two instances where you have to check it again. Otherwise, if it is negative, you are home free. Two instances you have to check it again or three even. What happens if you are in menopause and levels go high up in women as opposed to men of the same age?
[33:45] So, if you were having a normal lp(a) as a woman, when you reach menopause, it will increase. So, if you're tested when you were young, you've got to test it again when you're menopause. Okay. Number two, if you're a child and your parents have got a high lp(a), you should check your lp(a) at the age of five. Generally the pediatricians check it at the age of 9 to 11 the lipid panel but in this case you should check it at 5 because that is when the lp(a) is high but there are some studies which show that if you turn into an adulthood that child the increase may be there but at 5 you should get it checked okay if it is negative now if it is positive you must remember one thing, that Repatha, shorts that they give you for lowering your LDL cholesterol, also brings down lp(a) by 30 to 35%. So, the whole idea is that FDA does not approve to be used for lp(a).
[35:03] It only allows you to be used for high LDL, you cannot control the cholesterol. So in a way, it's an odd thing for me to say this to your viewers. It is better to have a high cholesterol and lp(a)because you can get Repatha shots and lower your lp(a)too. Right. But if you got only high lp(a), FDA does not approve. So is Repatha, is it like a statin? No. No. In fact, ripped statins increase lp(a) . Oh, wow. Really? Yes. Wow. Wow. So I've never heard that before. Yes. Yes. Do you know by what percentage?
[35:46] It is 15% to 20% sometimes. Oh, that's substantial. Yes. Yes. And remember one thing. There's another thing which I disagree because it's just coming to my mind before
Treatment Options and Recommendations
[35:57] I forget. In menopause women, estrogen has been shown to decrease lp(a). Obviously, the estrogen they had in the body was protecting them. But outside estrogen can decrease the lp(a) but I do not advocate it. Yeah. Because of the breast cancer, because of the strokes, because of the uterine cancer and 101 things. So I do not advocate, but there are studies showing that. Are there any, what are some of the side effects from the Repatha shots that you know of? You sometimes get a little bit of flu-like symptoms initially because you have to take it every 15 days.
[36:42] But it brings down your total cholesterol under 100. Wow. Total cholesterol under 100. Yeah. So I want to review something that you said. So there's two different ways of getting your lp(a) tested. One is milligrams per deciliter. Is that correct? And the other is, what do you call it? Nano? Nanomoles per liter.
[37:10] Nanomoles per liter. and so you recommend the nanomoles per liter 100 right 100 and i'll tell you another thing is that when you uh talk about nanomoles uh every every lab is doing it now so don't even try to do the milligrams the doctor says milligrams per deciliter you know i want nanomoles to be done now there are everybody should get the test done once but there are certain people that should ask their doctors who are these people i want people to know your viewers to know if you have got a premature heart disease stroke peripheral arterial disease before the age of 50 or 55 you must ask your doctor to get an llp(a) done number two anybody has got cholesterol which does not come down like the familial hypercholesterolemia the familial hypercholesterolemia one third of the patients have high lp(a)now third is african americans and south asians with as i explained to you earlier yeah number four is menopause number five is children of people number six is it's called cascade testing that means anybody a close relative of a person who has got high lp(a), their parents, their children and their siblings.
[38:37] Because this is called casket testing.
[38:42] So all these people should get it done. Now, why you ask me, why is it not being tested so often in America? Why? Why?
[38:54] Because there is no awareness from the people. Doctors are not aware of it. Only 1% of the people in America have got tested. And only 1.2% of the doctors asked for this test. Why? Because in the medical schools, it was not taught. So the doctors over here have not been really, it was not really heavily taught about lp(a) Number two, there is no drug right now to lower it. So they don't want to do it. What is there in them for them? Number three, lipid panels don't have this lp(a). Because they write, doctors are, we are funny creatures. We write lipid panels. Yeah. lp(a) is not there. So my advice to everybody is that if they should have a lipid panel for the first time when they come, they should have an lp(a) on it. Yeah. And otherwise, get it done. It costs half a gas of tank, $40, $45. And if your people are interested, I know places where you can get it free. And some people won't pay you a stipend of $75.
[40:08] Wow. Well, maybe we can get that information from you and we can put it in the show notes. Tell me this. Based upon what you know, Akil, and you've obviously done your research and you know a lot about this subject.
[40:25] Let's say that I had...
[40:29] A cholesterol, I'm just going to give you a hypothetical, and you do your best. I have a total cholesterol of 250. I've got an LDL of 140. And I've got a lp(a) of 300. Would you recommend that I go on a statin or not go on a statin because it'll actually raise my lp(a)? And will that put me at more of a risk for heart disease? Yeah. the first thing that you should do is try to get your llp(a) down so in your case there is a good chance of getting the repathor so it gets 30 to 40 percent down number two unlike unlike this other uh you see when you have atherogenic ldl is atherogenic it forms plaques lp(a) is atherogenic, but also forms clots. So it is a good idea for an anti-platelet medication. And that is your baby aspirin. So I would advise to go on a baby aspirin, but be careful in talking to your doctor about bleeding problems. If you've got peptic ulcer, then absolutely no. So are you personally a fan of statin medications? No. No. So baby aspirin is there.
[41:57] Repatha is there. No statin. But what you do when people turn around and say, if there are no treatments, very few treatments, what am I going to do if I have Ilp(a)?
[42:08] Be more aggressive and proactive in your other risk factors. Yeah. But I'm going to go back to my question because I don't – so let's say my lp(a) is fine, right? It's negative. But I've got an elevated cholesterol. Do you recommend statins or not? No. Okay. So you're not a fan of statins, period. Okay. Good. I am a whole food plant-based diet man. Okay. So that's what I am. But when people are doing it under the supervision of their doctors, my advice is no, but you go ahead with your doctors and talk about it. That's not my place, but I can advise you as a personally because I've had, I've got high cholesterol, I've got high lp(a), and what am I doing right now? I'm following a whole food plant-based diet. I'm taking a baby aspirin, and I am taking a shot of Repatha because it has brought down my lp(a)quite a bit. And from that very high, it has got me into intermediate. Can you tell us your numbers? My numbers, the first time that I did was milligrams per cent, milligrams per deciliter, sorry. It was 300 plus. So then I did my nanomoles. It was 175.
[43:33] So that was pretty high. So having the repath, following the whole food plant-based diet, doing the six pillars of lifestyle medicine, not as much as other people do, but I'm trying my best. It has come down between 75 and 125. Wow. 118.
[43:58] That's substantial. Substantial. So people turn around and say, what can we do? We've got high lp(a). You can do things. Yeah. And I have the Indian gooseberries, all that in my morning thing that I have. Yeah. So how much do you feel a whole food plant-based diet can protect you, if you do have the lp(a), you test positive and you're elevated? Yeah, it protects you because in 16% it lowers. So my whole food plant based, I had to 16%. My reprata is 30% to 40%. My gooseberry is 35% to 40%. So overall, it has helped. Yeah, yeah, yeah. I love it. Now, there are a few drugs in the pipeline. And they are in the phase three trials. But they're waiting to see if these can actually lower the risk of getting a heart attack. Just not lowering the lp(a). Right. So once they get that, they should be in the market in 2026 or 2027. There is a lot of research to be done. So tell me this. Why do you think...
[45:18] One out of five Americans, one out of four Asians, one out of three Africans have this elevated lp(a). It seems like there should, like in nature, there's a reason why stuff happens. Like, do you have any idea? See, lp(a), basically, as I think I said this, that it was discovered by a Norwegian doctor. A Norwegian doctor in the 1960s. Really? I know. No, you didn't say this. 1960s. So 50 years after, 50, 60 years, we are coming to know how important it is in forming clots and forming heart attack, I mean, getting heart attacks and strokes and aortic stenosis. After so many years, we have come to know. But I read somewhere, I'm not too sure about this, but I read somewhere that you have this lp(a) initially in days, hundreds of years back when we didn't have things to stop bleeding. So during heavy, during delivery, during an accident, this lp(a)clotted the blood.
[46:32] But why it went on to certain areas, we don't know. But also remember, as I said, in Africa, India there, but just close by India is what? Another giant, China. Oh, yeah. No lp(a) high, very high. And all the surrounding countries over there, Taiwan and all, they don't have high.
[47:01] And there was one other study which was done, which is, again, I'm not too sure about it, but atoms have a high ILP, literally. So overall, we look at it. There are so many things that needs to be done. But my main goal is that, hey, get it tested, period. Yeah, yeah. You know, you've made that very clear. Now, what can you say about lipoprotein B? see.
[47:33] Lipoprotein EpoB we are talking about. See, every particle has got an EpoB. Be it LDL particle, be it very low density VLDL particle, intermediate particle, all these have EpoB plus lp(a) has EpoB. So when you test only LDL you're testing the LDL FOB, you're not testing the FOB other places that is why now they said test your FOB and not just your LDL because imagine so many boats in a river each boat LDL boat, your very LDL boat or your intermediate they're all carrying this boats are carrying this, but if If you see about the FOB in all these boats, it gives you a true picture. If you see FOB only in your LDL, it does not give you a true picture. So that is why FOB is very atherogenic.
[48:43] But more atherogenic and more clotting-bissing is your FOA. Yeah. So you emphatically said to everybody, get your lp(a) tested. What about the ApoB? Yes. Yes. You have the disease and the doctor is doing your lipid panel. You can just gently ask, is it possible for me to get an ApoB done? My cholesterol is so high. Yeah. All right. So...
[49:17] Let's say that I'm your patient, Akeel, and you want me to go get some blood testing done. Tell me, what exactly would you recommend? What should I go get tested besides the lp(a) and the ApoB? Anything else? Looking at your rep, I would say, just do nothing. Just be yourself. Okay. No, no, no. Having said that, yes, I would say go for getting a lipid panel, but get your FOB as well as your lp(a). Okay, okay. That is a must. I love it. It's great. Yeah, go ahead. Go ahead.
The Hidden Risk of Heart Disease
[50:00] No, no, you ask me questions, whatever it is. Because, you see, what I believe is that every – I've said it repeatedly, but what you don't know see it is a hidden risk is people don't know that the first time they find out if they get a heart attack or a stroke so it's a hidden risk what we need to do is talk to our doctors ask our doctors talk to the family talk to your colleagues talk to your friends because what you don't know can hurt you but what you discover can save not only your life but somebody else's life.
[50:42] I really appreciate all this information that you have shared with us around this very important topic. Who cooks the food in your house? Let me put it this way. I cook, but I'm a bad cook, and she's a good cook. So basically, we have got lots of leftover the day I cook. Yeah. And is everybody? I've got a show. I do shop and cook. Oh, good. I like that. I've already done about 8 to 10 recipes. Then I do monthly talks on all this, lp(a) and chronic diseases. And then I've started Walk with a Dog every second Saturday. So I'm pretty busy at 78. Good. Well, we'll be sure to put in the show notes how people can tune in to all the great things you're doing. And people can also go up to American Heart Association where they have the advocacy group for lp(a). They can go to the American College of Cardiology to find out, to get more, and I will let them know if there is time to – I don't have a – but I do have where they can go and get lp(a)done free. Do you have any grandchildren? One, 13-year-old. And is it a he or she? He. And is he whole food plant-based? No.
[52:09] Are his parents? Yes. Okay. But we are trying very hard. Good, good, good, good, good. What about, do you ever eat out? Yes, I do. Yes, I do. But I have difficulty, and that is one thing, Rip, I would like to bring it to you. This is a down it's only downside to eating healthy and a lot of people have never told you this but the one downside to eating healthy is what that the moment you travel, you cannot get. Then you have to live on bananas and apples. Because till you reach your destination, till you are there, it's going to be a problem. And so what happens is that people who are not used to this terrible diet, I mean, who are not eating this terrible diet and eating a whole food plant-based, suddenly when there's no choice, your stomach hacks up.
[53:09] And says, what the... What have you been doing? I'm feeling terrible right now. So that is what my only downside to it. I hope more choices were there, more airports were having this. Yeah, yeah. No, it can be very challenging. What did you have for breakfast today? I had, yesterday was my shop and cook day. So I'd made a cold salad of brown rice pasta along with asparagus, the green beans, and artichokes with chives and all that that I made. Not a drop of oil. And that's for breakfast? That I had for breakfast, which I made yesterday. So I have a huge breakfast because I do three and a half, four miles. I get very hungry. Yeah, yeah. How tall are you? 5'4". 5'4". And so how much do you weigh? 115. Wow. But I did have a visceral obesity when I had the – my BMI was normal. Really? Yeah, because all Indians have a normal BMI, but they have a visceral obesity. It's like a pouch with a kangaroo, what the kangaroo has.
[54:28] How much did you weigh when you were 56? Never, never overweight. Wow. Never. That's what I'm saying. No cholesterol, no blood pressure, no blood, no cholesterol, yes. No blood pressure, no sugar, not really obese to that level. Yeah. Not a smoker, did drink. Okay, that's really fascinating stuff. All right, Akil, this is my last question for you.
Defining Happiness and Living in the Now
[54:57] What is your definition of happiness?
[55:03] My definition of happiness is to learn how to live in the now. We are always living in the future or the past. Yeah. Oh, what can happen to me? Or, oh, what happened to me? If you can live in the now, that's happiness. And any recommendations on how best to live in the now? I guess what we can do is if people forget about this, the Asian things which are now picked up more in the U.S., like meditation, yoga, a little bit of breathing exercises. Yeah. Open up your lungs and just be, I tell this in my talk sometimes, love lots, laugh loud, and live large.
[55:58] I think we need to call that the name of today's episode. So, Akil, I love what you just said about happiness. I want to appreciate you for coming on the show for the second time. And can I get you to give me a plant strong fist bump on the way out? Yes, yes, of course. All right. Plant strong, Akil. Go get them, baby. Yep, yep. Absolutely. Absolutely. If there's one thing that I want you to take away from today, it's this. Get your lp(a) tested. It's a simple once-in-a-lifetime test that can reveal a hidden genetic risk for heart disease and stroke. And remember, whether your number is high or low, knowledge is power. You can't change your genetics, but you can absolutely change how you respond to them. That's where a whole food, plant-based lifestyle, movement, sleep, and stress management all come into play. Be sure to share this episode with someone that you love because what you discover could save a life. And as always, always keep your plant strong.
