Paul Saladino MD podcast 75. What does a mainstream cardiologist think of my cholesterol? With Nadir Ali, MD
Oct 19, 2020
Nadir Ali, interventional cardiologist and cardiology chair with 25+ years of experience, favors lifestyle and animal-sourced nutrition for metabolic and heart health. He critiques mainstream low-fat guidance. They discuss LDL biology, oxidized LDL, dietary linoleic acid and polyunsaturated fats, PCSK9 inhibitors, and practical metabolic-health strategies like fasting, exercise timing, and animal-forward diets.
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Paul's High LDL But Zero Coronary Calcium
- Paul reported an LDL of 533 mg/dL with LDL particle size 24.7 nm and particle number >3,283 nmol/L while remaining metabolically healthy.
- Despite family history of early MI, his coronary artery calcium (CAC) score was zero after two years on an animal-based low-carb approach.
Metabolic Health Matters More Than LDL Alone
- Contextual markers (low insulin, low inflammation, high HDL, low triglycerides, large LDL particles) matter more than LDL number alone for atherosclerotic risk.
- Nadir emphasizes garden-variety cardiologists often focus only on LDL and miss metabolic health signals like HOMA-IR, HDL, TG and particle size.
PCSK9 Raises LDL As An Immune Response
- PCSK9 is an acute phase reactant: the liver raises PCSK9 during infection to keep LDL in circulation for immune defense; inhibiting PCSK9 may impair this natural response.
- Nadir warns PCSK9 inhibition alters LDL receptor dynamics and could increase organ lipid uptake and infection risk.