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Colin Renaud, PA-C walks through how statins are prescribed, what a cholesterol panel does and does not tell you about your heart, and why two people with the same number can carry very different risk. Statins are one of the most prescribed medications in the world and for some people they are exactly the right call. The question this episode asks is narrower: how do you know whether you are one of those people, and what else belongs in the picture alongside the number on your panel. This episode is a discussion about how decisions get made. It is not a recommendation to start, stop or change any medication. Functional medicine for adults in Maine and New Hampshire.
Colin Renaud, PA-C walks through how statins are prescribed, what a cholesterol panel does and does not tell you about your heart, and why two people with the same number can carry very different risk.
Statins are one of the most prescribed medications in the world, and for some people they are exactly the right call. The question this episode asks is narrower: how do you know whether you are one of those people, and what else belongs in the picture alongside the number on your panel.
In this episode:
This episode is a discussion about how decisions get made. It is not a recommendation to start, stop or change any medication.
Med Matrix is a functional medicine practice serving Maine and New Hampshire. Learn more at medmatrixusa.com
This episode is for educational purposes only and is not medical advice. It does not create a patient provider relationship. Always talk with your own qualified healthcare provider before making any change to your treatment.
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We're going to get into it. We're going to be talking about statin medications today, heart health, preventive health, functional medicine, how the conventional medical system looks at statins. So it's going to be really exciting what statins are. One of the most prescribed medications, right, Colin? In the world, yeah. Give me fun facts about statins while we're waiting for people to roll in. I think the last time I checked, statin medications alone, excluding all their medications, it's like a $200 or $300 billion industry, just statins. Something like that. I looked up the statistics a couple of months ago, but it's crazy. Yeah, so it's not just a drug. It's also a huge moneymaker for- It's a huge, huge market in the pharmaceutical industry, yeah. I'm not saying that's good or bad. It's just a number. Yeah, we'll dive into that today. I think a lot of people are interested in kind of how big pharma and medicine is all connected. We're going to talk about that because it's certainly interesting. Awesome. All right, we got Michelle. Thank you, Michelle. Can you comment on statins? Michelle already knows what we're doing. Yeah, we're going to do some FAQs. If you guys have questions as the episode goes on, make sure to drop them in the comments. We can't guarantee that we're going to get to all the questions because sometimes we get a lot, but the earlier you comment, the more likely we are to answer them. So yeah, comment as we go on. So let's get right into it. So what if the medication you were told you need for the rest of your life is only part of the story? So statins are one of the most commonly prescribed medications in the world. Like Colin said, it's a $300 billion medication, but most people still do not fully understand who they actually benefit, what they are doing in the body, or whether the real drivers of cardiovascular risk, which is what statins are meant to prevent, are being addressed underneath, talking about root cause and functional medicine. So in this episode of the MedMatrix Method podcast, we're breaking down the truth about statins, who may benefit from them, where the conversation gets kind of oversimplified, and why cholesterol, which statins are meant to lower, should never be looked at as one isolated number. So we're also going to talk about cardiovascular risk, inflammation, insulin resistance, thyroid function, deeper heart labs that we can look at, lifestyle, and how a functional medicine approach helps patients understand the full picture before making long-term decisions about their health, right? So yeah, we're going to talk everything about functional medicine. Today's episode is called The Truth About Statins, Who's Actually Benefiting From Them? And we've been looking forward to talking about this because it's something that we see all the time. A lot of patients come into the practice already on statin medications are being told they need to take one. So patients who are prescribed a statin without fully understanding why are patients who are worried about cholesterol, but have never had the deeper conversation about what is actually driving their cardiovascular risk. So I'm excited to be joined today by one of our main functional medicine providers at the practice, Connor Nard, who's going to break down what patients should actually understand about statins, cholesterol, cardiovascular risk, and how functional medicine looks deeper and at the bigger picture beyond one number. So here's how today's episode is going to go. If you're just joining us in your live, we're going to start with our discussion. We're going to talk about what statins are, what they're good for, kind of what numbers we're looking at when we're assessing cardiovascular risk, all that. If you have any questions, like I said earlier, make sure to drop them below in the comments. After the discussion, we'll walk through a case study of actual patients, and then we'll do a live Q&A with you guys here today. Just a reminder, before we get started, this episode is for educational purposes only. This is not meant to be personal medical advice and should not replace care from your own medical provider. If you are interested in receiving personalized functional medicine guidance from us, one of our providers at MedMatrix, we'd be happy to help. You can go to our website, medmatrixusa.com, book a discovery call, and start the process of becoming a patient. All right, let's get started. So Colin, why don't you introduce yourself? Sure, Cole, thanks. I'm Colin Renard. As you said, I'm one of the lead practitioners or providers at MedMatrix. I have a pretty unique background in chiropractic medicine and natural medicine. I practice medicine as a PA at MedMatrix, and I am multiple board certified in various disciplines, including anti-aging, natural medicine. I'm fellowship trained in functional medicine, and I've been at this for a little over 10 years now. So I treat a lot of things, from cholesterol and heart disease to things like hormone replacement, nutrition, all kinds of things I do. So we do a wide range of things at MedMatrix, and cholesterol and heart health is just one of the many. So I'm excited about this topic. It's a great, great thing we need to talk about. Yeah, same here. So let's start at kind of like a high level. What exactly are statins, and what is the purpose of a statin? Yeah, so a statin, and we use the term statin because the medication that you're taking term statin because the medication names end in the word statin. Resuvastatin or whatever, all these different types of statins. So the statin is basically a medication used to lower LDL cholesterol, which is a type of cholesterol that has been shown to cause heart disease. But the word on that now is a little bit mixed. The studies are kind of just proving that essentially it's not that simple. So the cholesterol, cholesterol is produced by the liver. So the statin medication is commonly described to lower the LDL cholesterol, which ultimately can lower cardiovascular risk, especially in patients who have already had some sort of heart issue, heart disease, a stroke, they've had a heart attack, they have diabetes, or they have other risk factors like family history, they're a smoker, they're overweight. So basically the medication is to make your cholesterol be within certain numerical parameters on a blood test. So when we do cholesterol checks for patients, which we do at MedMatrix as part of their initial follow, as their initial visit, we're checking cholesterol, and a statin is designed to lower the cholesterol into the reference range. So the goal is really to make it as quote-unquote normal as possible. But the question is, is that really what is most appropriate for patients? And that's really where some of the research is going now is, how does this all work? Why is this appropriate? Is this actually what we're trying to do? So like you said, one of the most common prescribed medications, and I looked it up, statins generate $20 billion a year in revenue worldwide. So just those, yeah. Okay, I think I misspoke earlier. I think I heard an extra zero, but that's still a lot. No, yeah. Well, I think over the lifetime of the statins, it's produced hundreds of millions, but they make about $20 billion a year, and they've been out for X number of years. So the profit total is in the hundreds for sure. That's a lot. Wow. Okay. So you said something that challenged a lot of conventional medical thinking that probably most patients have heard from their doctors that they've talked about a statin, which is like LDL, cholesterol equals bad, right? You have too much LDL, that's bad. Why don't we dive in a little bit about the difference between LDL and HDL right now, just for context. Sure. Sure. So LDL cholesterol is basically been thought to and previously shown to cause heart disease. So basically LDL is a type of cholesterol that takes fat and moves it to the heart. HDL cholesterol does the opposite. It pulls away the bad stuff from the heart. So the LDL cholesterol has been, quote unquote, labeled as the bad cholesterol and HDL or high density lipoprotein has been deemed the good cholesterol and heart protective. So when we look at really what the difference is from a risk perspective, LDL cholesterol has been shown, as I said, to be strongly connected to atherosclerosis or plaque or hardening of the arteries and cardiovascular risk. So statins for decades have shown that the primary prevention of heart disease is trying to reduce that LDL. And that's what the statin is essentially doing. But new research in the last one to two years is basically saying, well, is that really what is best? And is really, is that really how we lower heart disease risk by lowering this parameter? And the evidence is showing that maybe what we've been doing for the last 20 years and lowering people's cholesterol is not as good as we thought in preventing heart disease. So that's really where the questions are starting to come up of appropriateness of statins for people. Should we be lowering cholesterol as low as we are trying to? Yeah, the data is proving that maybe it's not as easy as we thought. Cool. Yeah. A little cliffhanger for you there. We're going to definitely get more into that as far as what cholesterol does in the body and what's good, what's not. So yeah, we'll definitely talk about that later. So, okay. Why are statins so commonly prescribed in conventional medicine? They're so commonly prescribed because almost everybody is going to have a cholesterol that might be above that reference range of what is considered normal. For example, cholesterol is total cholesterol on a lab is anything below 200. So if you hit a certain age, 35, 40, if you're maybe even a little bit overweight, if you don't eat that great, your cholesterol is probably going to be over 200. And the target number for LDL that we've been talking about is 100 on a lab to be normal. It might be a little bit different depending on the lab, but that's kind of the average. So again, if your diet is not super perfect, you might be a little bit overweight. Maybe you don't work out very much. And that is probably what a lot of people nowadays in at least America, that's kind of American culture, a standard American diet. We're not as active as we used to be. We sit all the time. Most people's cholesterol are probably going to be beyond that number. And in the sort of healthcare industry, as we talk about on this podcast all the time, there's an industry behind medicine and there's algorithms and there's protocols. So if you don't want to potentially run into an issue later on for a patient with them developing heart disease, potentially, and their cholesterol is above those markers, you might be put on a statin. And it's kind of become commonplace. And for a lot of providers that work in big box healthcare, so what I mean by that is like big medical systems, hospital systems, university hospital systems, they have protocols. If you have a patient with a cholesterol above a certain number, they must be on a statin, or you could be fired, or you might have your pay docked because they track all those. It's all algorithmic in those big centers. So it's extremely common for people to be on statins. And heart disease is one of the most common issues we deal with now, just because as a culture, we've become so much more unhealthy. A lot of people are overweight. So it's a really, really commonly used medication. Very common. Yeah, gotcha. So you said some really interesting things there. One was the reference range. So there's like this reference range and it's pretty black and white. If you're over it, okay, here's a statin. And that's kind of like the conventional protocol that they have. Can you dive deeper into that? Because the initial question was like, why are so many people put on a statin? And it seems like part of the reason is because they kind of have this black and white number. Can you talk more about that? So it is a black and white number. And like I said, the reference range is probably lower than it should be, and it used to be. So for example, total cholesterol years ago, before statins were introduced, was thought to be normal up to 300. Then when statins were introduced, they changed it to 200 to sell more statins. And this is very widely understood. I mean, I'm not making this up. This has been documented in studies. So the thought was, well, if we need to sell this drug, we need to make sure that enough people will fit into the parameter of the labs because otherwise no one's going to be on this drug. So the question is, well, is the reference range too low? If you have a cholesterol of 250, do you need to be on a medication for that? Well, maybe you don't. What are the risk factors? What's your family history? What's your diet? What's your lifestyle? But again, in a conventional medical setting where there is this very distinct line in the sand, if you're over a certain number, it's kind of like an automatic. You kind of just get it. You know, not every prescriber is like that. Not every medical conventional medical provider is going to be like that. But I'd probably say a decent three quarters of the health care system is going to look at these labs as very black and white. So as soon as you go over that number, here you go. Here's your medication. And that's kind of the end of the story. And then once you're on the medication, if your labs are normal, that's it. You stay on it. And that's kind of there's really no question about it. And it kind of ends there. And people are starting to get frustrated with that because it's like, well, do I do this forever? Like, if I'm only 40, I'm on this medication for the rest of my life. Is that reasonable? I don't know. So then patients come to us and start asking us questions about it. Yeah. What do you think is the most frustrating part about all that for patients? I think the most frustrating part is, and this kind of goes into other facets of health care, is a lot of this is just unexplained to patients. Patients get frustrated because the reason why something is done for them is not necessarily explained very well. So you go to your doctor, maybe it's an annual physical or you're having some other complaint, and it's like, oh, your cholesterol is high. So here's a satin. See you in a year. You know, five minute appointment. Is that good? Is it bad? I'm not necessarily saying it's either. But patients kind of walk out of the appointment and it's like, I don't really know why I'm doing this. It wasn't explained to me. It wasn't really there was not a lot of context necessarily. And I'm speaking very broadly. I'm not saying every health care provider does this or this is every patient's experience. But it happens a lot. Happens a lot to my patients and patients, my colleagues, patients. So it's definitely something that we see significantly. So it becomes more of an issue when patients just don't feel like they know what they're doing when they leave their doctor's appointments or why something was given to them. Yeah. And why? Like, in your opinion, why is that a problem? It's a problem because we're taking away autonomy from patients. We're taking away patients kind of ability to understand their health. And it becomes more of a system like on a patient rather than the patient understanding why they're doing something. Their health care just becomes, like I said, algorithmic and pre prescribed by certain standards. There's not really a lot of understanding. People are losing that autonomy. They don't know how their body works. They don't know what to expect from certain things. They don't know what to expect from side effects or potential issues. And it just becomes a collection of prescriptions as they get older. Every couple, five, ten years, they've accumulated a few more, a few more, a few more. And if you ask patients, I do it all the time. It's like they don't even know why they're on some of the stuff. Yeah, my doctor gives it to me. I don't even know why I'm taking it. Yeah. You know, it's tough. Yeah. And I'm not saying that's a good or bad thing, but I really value in the way I practice health care and teaching patients. I'm an educator, really, as a health care provider. I'm supposed to educate patients so they understand what they're doing and can make health a very active thing for themselves. Yeah, totally. Well, I think there's a problem when patients don't understand why they're doing certain things, right? Totally. So, okay, let's transition into, I think insurance and the whole conventional medical system is going to keep popping into the conversation because this is just like one of the, you know, one of the things that I've I think best examples of kind of how conventional and functional medicine are different is like heart health and statin medication. So we'll kind of keep coming back to that, but I'm going to try to keep us on the agenda here. So let's talk about like, why is it? So we talked about LDL at the beginning, like here's this number. It's kind of like black and white, right? Patients, there are over 200. They're kind of most of the time in the conventional medical system, they're handed a statin medication. Why is LDL not enough? Like just looking at that one isolated number, black and white, why is that not enough? Yeah. So LDL is not really enough because there's some recent studies that have come out that basically say if LDL is high, is that a good predictor of heart disease? And some of the recent studies that have been published with hundreds of thousands of people are basically saying, well, we don't know if LDL being elevated is a good predictor of heart disease. There's a lot more to it than that. So we can look at LDL and being high in the presence of say someone who has diabetes or is pre-diabetic, is obese, has a very strong family history, has high blood pressure, has other types of cardiac markers that are elevated. Their diet's really poor. They're a smoker or were a smoker. So if we take LDL by itself, that's not really a great predictor. And this is how I try to educate my patients to say, well, you might need a medication. You might need a statin if some of these other things are going on, right? Have you smoked? Are you overweight? Do you have diabetes? Do you have high blood pressure? What's your diet like? Do you drink a lot of alcohol? Those are the things that really start to influence LDL being bad. And really what happens is the LDL becomes really misfunctioning. It doesn't function well. You get a lot of inflammation from being overweight, from smoking, from poor diet. And that's really when it starts to become a problem. So you have to take into consideration all those things, but the conventional healthcare setting might not. They're just looking at the number and say, okay, well, your LDL is high. You're going on a statin. It's like, well, I've had patients that are triathletes with high cholesterol. Do they need a statin? You have to consider all these other things. So that's really where the personalized approach from a functional medicine perspective, I think, is most important. Because I want to make it very clear, I'm not poo-pooing statins. We're not having this podcast episode to poo-poo statins or the healthcare system. We're just trying to understand all the different parameters of how this all works together for patients and come up with the best possible outcome for a patient and not just one size fits all healthcare. Yeah. And let's talk about it. Let's talk about how you actually do take a deeper, more personalized approach to evaluating the patient as N of 1, not averages or different black and white ranges. So when you see a patient, what's the type of patient that you're like, a statin is actually going to benefit them? This is a good idea. Right. So we assess patients from a cardiovascular risk all the time. So some people could benefit from it. Statins may be highly beneficial for some patients and less clearly beneficial for others. And if a patient has had previous heart disease, they've had a stroke, they've had a heart attack, they're pre-diabetic or diabetic, that a statin is probably highly appropriate for them because the goal is to not have them have another heart attack or another stroke. But in the conventional medical setting, that's kind of where it stops. Right. And I'm not saying that's bad. It's a good thing because we don't want the patient to have another heart attack. But really, from our perspective in functional medicine, it's like, well, we're trying to reverse the course here. If the patient is overweight, if the patient is diabetic, if the patient does have high blood pressure, if their diet is poor, I'd love to get my hands on this person and say, OK, do you want to reverse your course of your health issues so you don't have another heart attack? If you do, great. If you don't, well, I hope the statin protects you from a heart attack. Great if it does. But the goal for us is to really take that patient and change their health altogether and not just keep the statin for as an insurance policy, but change the health care outcome altogether. So it is they are beneficial, but I'd love to maybe make it so that the patient didn't need it essentially, maybe in the future, or they needed it at less of a dose or something. You know, there's always a way to improve things. That's kind of what we're trying to do. Gotcha. And then what's the explain to me the type of patient who like some of the patients you see, like the example you gave was the triathlete. Right. When when do prescribing statins become more nuanced and you're starting to look at other cardiovascular risk markers? Yeah. Yeah. So so like we said, if you're drawing this hard line in the sand, who's really benefiting from the statins and who might not benefit? So if you're if you have a patient that has very low risk, you know, maybe they're not obese, they don't have diabetes, they're not prediabetic or have insulin resistance, they don't have high blood pressure, they don't have a strong family history, they take really good care of themselves, they eat really well, they exercise, their cholesterol might be a little bit high for maybe another reason. Maybe their hormones are low, which can cause high cholesterol to be higher. So should they be on a statin to prevent heart disease that is probably likely not even there, given their parameters of health? I'd probably argue no. But if you try to convince a family doctor or an internist or a cardiologist of that, it's going to be a hard it's going to be a hard bargain because they are taught, well, if the cholesterol is over a certain number, they have to be on a statin. And we've talked about on this podcast all the time. There are medical legal implications to this, too. If you don't prescribe certain medication the way it's supposed to be prescribed based on certain outcomes, you could be liable if something happens to that patient. So rather than open yourself up for liability, you prescribe the drug and you just, you know, leave it alone. So we're not trying to over under prescribe in a functional medicine perspective. We're trying to do what's most appropriate. And sometimes from a cardiovascular risk, we can do other tests, imaging studies, other types of screening tools to assess patients' cardiac risk rather than just rely on cholesterol. And that's really what I try to do and educate patients on is what else can we do to understand if you do really need this? Because if you do, great. If you don't, then let's try to figure that out. Yeah, it's really interesting because, I mean, again, something I want to like, Kim, what you said is like your hormones, like your high cholesterol can be a result of lifestyle. So that is your diet, stress, sleep, your hormones, right? So you go in and then the surface level thing that's presenting is a high LDL, so you get put on a statin, but none of these other things get addressed. And this is, again, this isn't to say that like, you know, this is every single other conventional medical office, but it's the general case out there. Yeah, what happens when I imagine you see patients in every stage of the journey before they get put on the statin and decades after they get put on the statin, what happens to patients when they get put on a statin that's addressing the high LDL, but the lifestyle isn't addressed, their hormones aren't addressed, and all the other root cause factors that are leading to this go unaddressed? Yeah, so what happens to patients when they're put on the medication and things are not addressed is that they just kind of go about a status quo, right, until they get kind of sick and tired of not having these other things addressed. So in an ideal world, I have, and this is not necessarily appropriate for everybody, but I have had cases where the patients will have high cholesterol, maybe it's not too high, they're on a statin, and we start to do a lot of work. Their diet, their lifestyle, hormones, all kinds of things, and it comes to a point where their cholesterol becomes too low, and that's not good, and that's something we're going to talk about soon is sort of what role cholesterol plays because cholesterol is not bad. We're supposed to have it. We're not just supposed to take medication and get rid of it as much as we can and not have any. That's not how this works. So I have had patients completely change their life and when I repeat their cholesterol levels, it's like, oh, your cholesterol is now getting too low, so let's have a conversation with your doctor about maybe coming off of the statin and seeing what happens, and that happens a handful of times in a month, in every few weeks, where it's like we really need to take a look at what we're doing with your medications because the statin is now causing things to be too low based on the work we've done, and it's really not appropriate for you to be on it anymore, and that's where we work with patients' doctors or primary care providers and really come to a consensus amongst all of us of if this is appropriate. So that's really the goal. It doesn't happen with everybody, and it's not appropriate for everybody, but it is cool to see when we can reverse some of this stuff. Yeah. Yeah, let's talk about some of the root causes that as like a functional medicine provider and the other clinicians at MedMatrix are looking at. So let's go into each one. So first one's hormones. How do your sex hormones contribute, and if you could also just kind of go through what your sex hormones are real quick, contribute to your cholesterol and cardiovascular health? So with sex hormones, so sex hormones are estrogen, progesterone, and testosterone. So sex hormones significantly impact cholesterol because sex hormones such as testosterone are made by cholesterol. So a lot of times I see patients where they will have elevated cholesterol in the presence of low hormones. Basically what the body is trying to do is produce more hormones by spitting out more cholesterol. So when hormones can get regulated like a testosterone in a male, optimizing that testosterone will almost always, not always, but a lot of times reduce the cholesterol without any other intervention. And it's pretty remarkable to see, and it's quite a lot. It can be 100 points. It could be 50 points. I mean, that's a huge amount. So if a patient is on a statin and then we optimize their testosterone and their cholesterol comes down 50 points, it's like it might be too low now. So that's where we have to do all this work to understand what's best. So sex hormones are a huge, huge influence on cholesterol. I see it all the time. And patients get upset when they're, not at me, but they get upset when they say, why didn't my doctor tell me this? And it's like, well, it's not that they don't know it. They learned it in school, but it's not relevant to what they're trying to do. They're trying to sell you the medication. That is their answer. Um, it's not good or bad or wrong or right. It's just what they are told to do. That's how the education is in that conventional medical setting. Right. So the patients get annoyed. They're very upset. They don't understand why some of these other parameters are not discussed. Totally. Yeah. Um, I have a question that kind of veers into the hormone replacement world. Um, which I know you're an expert in. So, okay. Patient comes in, let's say it's a male. Right. He's low testosterone. So he's in his fifties and he's on a statin medication. Um, or, or, or a woman, right. Dealing with like estrogen. Right. Um, yeah. And after menopause, you put this patient on a hormone medication, right. And we can talk about bioidentical hormones, which we use at the clinic. And then they're able to get off the statin. But why, like the end goal is like to get like patients off medications. Like why is being on testosterone a better option as a medication, uh, than being on a statin? Right. Cause it's like, okay, we've placed one medication with another one. Why is like, why is this a more like preferable medication? Does that make sense? Yeah, it makes sense. But I want to make sure I'm, I'm, I'm clarifying for our audience that I, I don't want people to think that our goal is to at med matrix or from a functional medicine perspective, we are not here to remove people's medications. You don't come to us and we take all your medications away. That's not what we do. That's not appropriate healthcare. We augment medications with the patient's doctor that prescribed that medication. Um, cause that's a professional courtesy. It's not my job to take medications away that I didn't prescribe, but what we're trying to do and to answer your question is we're trying to make the treatment plan the best for the patient with whatever that looks like. So some patients do need a statin even if they've had, even if they're on hormone replacement because they had a heart attack or there's some genetic issue or they're a smoker or there's pre-diabetes or whatever. So it's not like hormones are going to replace a statin, but what you're asking is wouldn't it be better to optimize a patient's hormones and try to optimize cholesterol and cardiac parameters than just feed cholesterol medication? Yes, that would be preferable. Does that happen all the time? Not necessarily, but if I can take a male from your example, optimize his testosterone, get him feeling a lot better and his cholesterol gets down low enough where he doesn't have to be on a statin, that would be very ideal. It'd be great. It'd be totally, totally great. Is that always the case? No, but it does happen. It does happen all the time for sure. Yeah. So what are, because again, we're going back to root cause idea because the hormones are going to affect the, kind of lead to the higher cholesterol, which then leads to statin, right? So what are some of the, you mentioned how hormones need cholesterol to essentially be built in the body, right? For our body to make hormones. So what are the like long-term side effects of being on a statin medication? Because there's probably, there's a lot of good things and there's a lot of bad things that go with it, right? Reduce cardiovascular risk, but then there's also people say statins cause Alzheimer's. Well, we know they can lead to hormone imbalance. So can you talk about like the long-term side effects of statin medications? So the statins, one of the, I'll start with what some of the good things are cause I don't want to poo poo too much. But some of the good things about statins from what the literature shows is that if a patient has plaque or some sort of atherosclerosis in their arteries where there's a hardening, basically people know that, you know, hardening of the arteries, a statin has been shown very, very successfully to stabilize a plaque. So if a patient has known plaque in their arteries, basically it can stabilize it so it doesn't break off and cause an embolism or a floating body in the bloodstream that could cause a stroke or a heart attack. So statins do a very good job at stabilizing already existing heart disease, okay, which is great. But on the flip side, statins do have a lot of side effects. Fatigue is a huge one, like fatigue to the point where people are unfunctional, pain, muscle pain, significant muscle pain. One of the biggest side effects of statins is it reduces some of your energy molecules like CoQ10 or Coenzyme Q10, which is a molecule that basically is needed by your cells to produce energy and give you energy. Also, Vitamin B12 can be affected, another energy molecule. So a very common issue with statins is this really, really bad fatigue, low energy, muscle pain to the point of like really extreme debilitation. And that's where we have to understand, okay, what's going on here? Why is this happening? And is this still appropriate for a patient? And I have patients that have barely any risk factors, their cholesterol was 20 points above the limit, and they're put on like the max dose of a statin, and they have tons of side effects. It's like, oh boy, okay, not saying that this is wrong, not saying you shouldn't be on a statin, but why is it so high? You're having tons of side effects. So there's a lot of risks and benefits that really have to be discussed with patients. And that's another thing, what we were talking about earlier, a lot of this is not discussed with patients either. So it's just like, here you go, you have to be on this, no discussion of risks, alternatives, benefits, and patients get frustrated when they don't tolerate the medication, and then it just becomes a, well, you have to be on it, too bad. So there is good and bad, but side effects are common. I will say that, do see side effects a lot. Gotcha. Why do you... Hold on, can you hear my AC unit? It just went on. I don't want to be an annoying sound. I don't hear anything. Okay, great. I just want to make sure audio is good for you guys. Thanks for asking, but no, I don't hear anything. We got like 40 people here live. I don't know how many are on Instagram. I don't know how many are on the website, but if you guys are enjoying this, drop a comment, let us know if you're learning something. And if you have questions, odds are that someone else has the exact same question. So by commenting, you're going to help everyone learn more. It's going to be more fun. So if you have a comment or a question, just definitely drop it below. We're going to get into Q&A in like probably 15, 20 minutes here. Okay, so let's transition into the functional medicine approach and how we kind of actually do this day to day. So how does functional medicine, we've kind of touched on this, but we're going to go deeper. How does functional medicine look at cholesterol and statins differently? That's a great question because that's what we do. So functional medicine, the functional medicine approach really looks at cholesterol from a broad spectrum of view. It's not in isolation. So our philosophy on healthcare from a functional medicine perspective is to ask why the cholesterol pattern exists and what's really happening in the body. Is there inflammation? Is there insulin resistance? Is the patient overweight? Is there a thyroid problem? Is there a hormone imbalance or hormone deficiency? Is there a liver issue? Cholesterol is made in the liver. So is that a problem? You mentioned this, Cole, your sleep, your stress, your nutrition, what's your body composition? How much body fat do you have? And also genetics plays a huge role. So we talk about patients' family history. I've had patients where, yeah, my dad, my uncle, my brother all died of a heart attack at like age 45. Oh, okay. That's really significant. So certainly metabolic disease, obesity, diabetes, and heart disease are knife and fork disorders really at their core, but there are also genetic components. So we cannot ignore that too. So there's a lot of things to discuss from a functional perspective and understanding all these parameters is really how we make the best treatment plan for a patient around their heart health or just health in general. That's exciting. I mean, yeah, I mean, why wouldn't you want that type of approach when it comes to your health? It almost seems common sense, right? When you say it's like, yeah, why wouldn't you do that? But it's not the case. It's common sense to us because it's what we do. We live this every day, right? You and me. This is our very existence. And when I see patients every day and when they tell me the stories of what they deal with with their doctors, it's sometimes hard for me to believe because I don't live in that world as a healthcare provider, but it is the norm. And I forget that because we're like in this little bubble in our beautiful clinic treating patients and they're doing great. And it's like, doesn't everybody do this? No. Oh, I forgot. So yeah. Yeah. So we're excited for all of you to join us live. Whether you're new to functional medicine, you're actually an active patient. I know we have a lot of patients that tune in. And if you know someone who's struggling or wants more for their health, definitely share this episode with them. So, okay. Next question, which I think a lot of people are going to love, which is when evaluating a patient, what are some expanded testing that you typically wouldn't see in conventional medicine that allow you to evaluate heart health and just do a better job? Yeah, it's a great question. Expanded testing, cardiovascular testing is really where you get a lot of data about patient's health beyond a standard lipid panel. And a lot of these markers we're doing from the very beginning with a patient as part of their new patient blood panel. There are things like apolipoprotein B, lipoprotein A, LDL particle number and particle size, non-HDL cholesterol. I know these are big medical terms and I'm not necessarily going to define all of them, but there are other types of cholesterol markers beyond a standard lipid panel that people really should be getting as part of a standard approach to their heart health because it gives a lot more data. And there's a lot of literature and medical studies to prove that. Basically saying the standard lipid panel, the total cholesterol, the HDL, the LDL is not quite enough to understand a patient's heart risk. But you also need other things that might not necessarily be related directly to cholesterol, but have an effect. Things like your insulin, which is what controls your blood sugar, a hemoglobin A1C, which is a marker of diabetes, something called a C-reactive protein or CRP, which is an inflammatory marker, an amino acid called homocysteine, which has been linked to heart disease. And then also things like your thyroid hormones, your liver markers. We can measure omega-3 fatty acids, which are types of fats in the body that are very beneficial. Things like vitamin D can also have a significant impact. And then from day one, as part of patients' initial onboarding with MedMatrix, we do a full body composition analysis. So like, how much visceral fat do you have? How much muscle do you have? Real quick, what is visceral fat? Visceral fat is fat around your midsection and around your organs. So visceral fat is the worst kind of fat. It is fat that is basically kind of enveloping around your organs internally, your kidneys, your liver. It's the worst kind. It's the most been shown highest mortality rates when people have high visceral fat. When you go to your normal doctor, they're really just looking at the weight and BMI, right? Right. You mostly weight. Yeah, weight. How much do you weigh compared to your height? And give you a BMI. And BMI is basically a really poor marker of any type of risk because I have a high BMI, but I'm a bodybuilder. So based on my height and weight ratio, I have a very high BMI. I'm technically obese, but I'm not. I'm like single digit body fat. So it's a very, very poor indicator of things. So understanding some of these body composition metrics is much more useful. A hundred percent. Yeah. Yeah. That's the essence of the functional medicine approach. So, okay. I know one of the tests that I know a lot of patients come to us to get specifically, and that's pretty important, is the APOB test. Can you talk in inflammatory markers? Can you talk more about those? Yeah. So APOB. Yeah. Apolipoprotein B is part of our new patient standard panel for all new patients. And APOB can help show the number of atherogenic particles that may contribute to plaque. So basically it's a protein that tells us how much potential plaque is in the body. And then lipoprotein A is a genetically influenced risk marker that may not show up on a standard lipid panel. And these markers really help explain why a person with normal cholesterol may still have a risk. And then why someone else may have a different level of risk. So we do these cardiac markers, like I said, on all new patients because it gives us a baseline of their risk and we can sort of understand what we need to do, if anything, to understand for potential more testing. And then we talked about the CRP, the C-reactive protein. It's a mark of inflammation. Again, if you take high cholesterol and start introducing inflammation, that's when it becomes a problem. So high cholesterol by itself is not necessarily a problem. It's when you introduce inflammation, that's when it starts to plaque and stick together. So when you look at all these parameters together, you get a much better sense of a person's heart disease risk versus just a lipid panel by itself. Great. That's exciting. Okay. I'm just looking at timing here. It seems like we have an awesome, engaged audience with us today, so we're probably going to have more Q&A. So let's go into a case study and then Q&A, and then that'll probably put us at about an hour. Yeah. So I kind of alluded to this before. It's a case of a male who had low testosterone, and the goal was not necessarily to do anything about heart disease. He came to me with symptoms, very common symptoms of low testosterone, low motivation, fatigue, feeling run down, low libido. His testosterone levels were low. He was concerned about body composition. He wanted to see more results in the gym, more muscle mass, less fat. So he had also pretty high cholesterol to the point where it was still pretty high, even with statins. He was on a statin, but his cholesterol was still beyond the limit of the normal reference range. So I treated him for about six months with optimizing his testosterone, hormone replacement therapy, and we got to a point where his cholesterol started to dip too low. So to give people perspective, I'm talking about the total cholesterol, which, like I said, the reference range goes up to 200, and then beyond 200 is technically abnormal, quote-unquote. After about six months, his cholesterol went from 250-something on the statin, and then it was down to 140-something, if I remember, and I was like, it's getting a little bit low, anything below 150. So I put a message through to his primary care doctor, and I was like, listen, you know, he's been improving, his health is changing, we're on hormone replacement, and I'm concerned about the cholesterol getting too low, especially for a male on testosterone. It's like you need that cholesterol, you need that cholesterol to feed the brain, you need that cholesterol to feed the soft tissues of the body. So his doctor was totally, he's like, yeah, let's come off of it, see what happens, keep monitoring the cholesterol. If it goes back up again, we can see. He didn't have a very strong family history of heart disease, he didn't have a prior heart attack or anything. So yeah, with his doctors, okay, we got him off the cholesterol med, and I'll check it again, I think I'm due to see him in a couple months. But it was kind of a really exciting thing, because this sort of stubborn, as they called it, cholesterol, where it's like, yeah, you're on a statin, but it's still really high, so we're going to keep you on the statin. Well, his hormones were influencing the cholesterol, and that's really where we started to see the win of the cholesterol being the culprit, or part of the culprit. So it's fun, it was fun. When I can get people off of meds that they don't necessarily want or need to be on, it's fun, it's cool. It's not appropriate for everybody, I want to make that very clear. But per your question earlier, Cole, it's like, well, what's better, getting a guy optimized on his hormones or relying on a statin forever? Well, obviously, the hormones will be better. So when we see cases like that, it's really exciting. And especially exciting when their doctors are like, awesome, this is great. Thanks for doing this work. You've extended this guy's life by probably 10 years. Thanks, I know. But it's really nice to have people's conventional doctors be supportive of what we do, because it's not like that all the time, unfortunately. Yeah, yeah. I know, it's interesting. You'd think most doctors would want all their patients to be going above and beyond for their health, but not always the case. And what about other benefits for this patient or other patients? Because now that his testosterone is optimized, he's off of medication that's maybe lowered his cholesterol that his body needs. What are the improvements that other patients or these patients have seen when things like that happen? Well, a lot of times we are experiencing, especially with something like statin, we're dealing with patients that are having side effects. And that's really the biggest issue. And more often than not, patients come to me and it's like, yeah, I started that statin. And I just like, I'm tired all the time. I get these muscle cramps. My doctor won't take me off of it because they don't want to and they're worried about me having a heart attack. And it's like, okay, not saying that the statin is bad. Not what I'm trying to say. But could we do some work to potentially lower the dose, right? Do you have to be on the 40 milligrams? Could you be on 10 or 5 in a perfect world and have a much better potential outcome and side effects? So it's trying to do the best you can for the best outcome. And it's not always getting off medication. Like I said, it might be lowering the dose if we can do that. And the side effects get better. These are the goals we're trying to get. So it's exciting when we can do it. That is very exciting. Okay. Sorry. I got one more question left here in my notes that I skipped over and then we're going to go right into Q&A. So question is, can you just explain the process from A to Z when someone comes to MedMatrix and their goals are around high cholesterol, statin medication, heart risk, all that? Yeah. When someone comes to us at MedMatrix with high cholesterol or questions about statins, the process really begins with a full health history. We do that for every patient no matter what the chief concern is. We do a full medication review. We talk about family history. We talk about their symptoms and their chief concerns. We do a full lifestyle assessment, which you don't get at most other healthcare offices. We talk about your nutrition, your stress levels, your sleep. How much water do you drink? Do you drink wine? Do you drink alcohol? Do you smoke? We do a full assessment of body composition. Like I said, every patient that walks in the door as a new patient gets a full body composition analysis. And then we do a really deep dive in labs. We check over 80 biomarkers for every new patient. So when we put all this information together, the goal really is to understand the patient's complete cardiovascular metabolic health and how we can utilize that as part of the healthy aging process of their treatment plan and how we can maximize that for the patient. A lot of it is health assessment risk. It's trying to prevent a heart attack in five years. It's trying to get patients on a new journey. So that's really what we're doing is preventive care, a lot of preventive care. Yeah. And then what does the initial visit look like with a provider like yourself? It's exactly what I just said. The initial visit is doing all those things, asking all those questions, full health history, family history, lab review, body composition review, coming up with a treatment plan, discussing further treatment or sorry, further testing that might be needed. You know, do you need further imaging to assess your cardiac health? Do you need a specialist? What types of medications are you on? What are your goals? So this is all done in the first visit. It's a lot of information in the first visit. So I always tell patients, you know, when you come to the first visit, bring like a notepad, bring your questions. There's a lot to talk about because there's a lot of stuff to absorb. And it's really the beginning of a health journey for our patients. Yeah. Exciting. Love it. All right. Let's get ready to Q&A. Thank you guys for sticking around. Let's start with this one. What about a woman's case study for a giant cholesterol cardiovascular disease? Well, that puts me on the spot. I'd have to think. Guys, when I prepare for these podcasts, I have to kind of go through my Rolodex of patients to think about something to do. A woman's case study in relation to cholesterol. Heart disease is still a very common cause of death in women. And I feel like women and heart disease are still underappreciated. Like women don't have heart attacks and women don't have it. They do 100 percent. So one case that sticks out is I had a patient, a female patient who on her initial labs, her cholesterol was very high and she was like the picture of health. I think she was in her early 40s, worked out all the time, ate perfectly, but her cholesterol was really high. So it's like, OK, well, how do we understand this better? Right. Do you need a statin? Do you need a cardiologist? Do you need what do you need? So I ended up doing a what's called and we should do a whole other podcast on this. It's called a calcium score. It is a CT scan of the heart with a calcium score. And basically it assesses plaque in the arteries of the heart. And this otherwise perfectly healthy 40 something year old woman, thin, no heart disease that we knew of, no diabetes, no blood pressure, no strong family history, or actually, yes, she did have a strong family history. She had a moderate amount of plaque in her heart arteries from this calcium score that we did based on the extensive cardiac panel that we did. So I did send her to a cardiologist and the cardiologist did a full workup on her stress testing and all kinds of stuff. And between the two of us, we came up with a really reasonable treatment plan to keep her safe and to prevent further heart disease. But it was not somebody that was a very typical picture, but there was a really strong family history. So that might have been the culprit. But again, it was, you know, if we hadn't done the work we did and the further testing, she might have had a heart attack at like 45, 50, being a thin athletic woman, which who would think, right? So it's really, like I said, the goal here is not to necessarily poo-poo on medicine. The goal is to come up with really, really good preventive treatment plans, preventive outcomes. That's the goal. So that was, yeah. Yeah, that's a great story. And that's also like a really good example of like how functional medicine and conventional medicine can like work together. I think sometimes people pin functional and conventional medicine as like enemies and like these are things that work against each other. I think what we're against is just like, you know, half-assed healthcare, right? But like they can actually work together like really well. So that was a great story. Let's see. I think this one's really interesting. Julie, I feel like I've seen you on these lives before, so. We have to do some of the earlier questions too, Cole, because you tell people the earlier, if you, well, we'll answer this one, but tell people, get in early. I got to teach you my work. We'll get back. Sorry, that's my bad. Cholesterol nourishes your soft tissues, i.e. your brain, heart, even low, too low equals brain issues, dementia leading to Alzheimer's, question mark. So I don't, I'm not going to say that too low cholesterol leads to Alzheimer's or dementia. That's a very, very bold statement that I'm not going to make. But do we know that cholesterol is really important for your brain health and nourishing the brain? Yes, we do. Neurocognitive decline like dementia, Alzheimer's is a very, very complex multifactorial. These are multifactorial issues. So it's not appropriate to say, well, if your cholesterol is too low, you're going to get Alzheimer's or dementia. Or if you're on a stat and you're going to get Alzheimer's or dementia, that is not appropriate to say. I'm not going to say that. What I will say, like I said, is we do know that the importance of cholesterol in the brain is high. It's an important molecule for your brain. And I think that's the best way I can answer that. Okay, great. Yeah. Let's see, go to the top. Michelle, we kind of answered that. We'll get to your other question. Can you comment on statins and stroke risk? So as I commented earlier, that if you've had a stroke or if you have known heart disease, the good thing about statins is they can stabilize plaque. So if there's known heart disease, if there's known atherosclerosis, or if you've had a previous heart issue, the statin can stabilize the plaque inside the artery so that it won't break off and cause another stroke. So for people that have had prior strokes or really significant heart attacks, statin therapy is like a no negotiable from cardiology or like a family doctor. And from a functional medicine perspective, I'm not going to argue with that either because the data does show that if you are on, if you have had a prior heart issue, a heart event, a stroke or whatever, there is some data to support that. So it's not my job to kind of override that and say, no, no, conventional medicine is wrong. That's not, like you said earlier, Cole, we're trying to work together. So if we can help prevent future stroke with a statin, great. We'll leave that alone. Our goal and our job at MedMatrix as functional clinicians is to say, how else can we improve this patient's health and longevity? What else can we work on? Can we work on diet? Can we work on hormones? Can we work on longevity and all these other things? So that's really what we're trying to do. Awesome. Yeah. Should we eat a big breakfast? Should we eat a heavy breakfast? Oh, gosh, this is like a, this is a whole nother podcast. I don't know how to answer that. Should we eat a heavy breakfast? I don't know. I don't know what this person is referring it to. I guess in general, just in general nutrition, some people say do fast, don't eat breakfast. Some people say eat a lot of protein at breakfast. What's your favorite breakfast protocol? Depends. Depends on the patient. Some people do really well fasting to like lunchtime. Um, some of the best clinical evidence for longevity says you should have at least 30 to 40 grams of protein when you wake up in the morning to get your energy and your blood sugar. Yep. To get your energy and your blood sugar balance for the whole day. Um, that's probably my best advice, but it's very different depending on the person. Okay. Yeah. Um, your ApoB and inflammation markers are much better for heart disease risk risk. Yeah, we talked about that. Um, they are really valuable tools to understand heart disease risk. So thank you for the comment, Julie. Can you talk about oxidized LDL? Um, so oxidized LDL is, um, so we talked about LDL or low density lipoprotein. So oxidized LDL is, um, it's, it's LDL that's been damaged by free radicals, which are chemicals in the body that have specific effects on soft tissues. Um, oxidized LDL is the primary driver of atherosclerosis or hardening of the arteries because, um, not to get too biochemical, but basically the, um, the immune system cells in the body consume oxidized LDL and they turn it into what's called a foam cell. This is like bringing me back way back to college days. Um, and then what happens is, is the foam cells stick to your artery walls and build plaque. So, um, unlike standard LDL, which safely transports cholesterol, like I mentioned at the beginning of the podcast, oxidized LDL triggers vascular inflammation and vascular inflammation is what causes the plaque to build up. So, um, yeah, this is where we run into problems. So yeah, not to biochemical on people, but, um, yeah, gosh, that's what's bad. And how do we, how do we, what drives oxidized LDL and what reduces oxidized LDL? So, um, the, like I said, when you, um, when you have like these free radicals in the body, um, which are particles that can disrupt certain membranes and soft tissues, um, oxidative stress, basically it's a balance between unstable molecules and antioxidants or, um, uh, important molecules or, or, um, um, things that, that reduce stress. So when free radicals, when these free radicals were these unstable things floating around, um, outnumber the good ones, the antioxidants, they, uh, attack the lipids and, um, they, they chemically modify them to make them more harmful. Essentially. It's a whole biochemical pathway that I had to learn 20 million times that is fried in my brain. Um, so, you know, things like cigarette smoking, diet, all that stuff is big. Yeah. Gotcha. All right. Does lowering the dosage of statins mitigate the side effects? It can. Yeah. And I'm not saying that to advise you, whoever this person is on things that you should do. If you have concerns about side effects of a statin, you need to talk to your doctor. But, um, yes, dosing I have seen can change the side effects. So from say like a five milligram of a something to a 20 milligram of a something can definitely change the side effect profile. So I said this before, if I have a patient that needs to be on a medication and we're doing a lot of work, diet, exercise hormones, and I can get them from a 20 milligram of a something to a five milligram of a something very safely with their doctor's help. Um, that's great. You know, if they had side effects and they're, they're feeling better now, that's a win. Yeah. Sweet. I love this question right here. Can beetroot help reduce cholesterol? Um, I love beetroot. Why do you love this question? I don't know. It's just fun. I think it's like, it's like a little health hacks are always fun. Um, so beetroot is, uh, beetroot helps with what we call vasodilation. It dilates the veins. Um, so in the arteries, so it's a very, very commonly used, um, supplement. I use it all the time. I use it every day, but beetroot can naturally support healthy cholesterol because it's a very, very high soluble fiber and it has very high antioxidants. So because it's highly pigmented, it's that really strong red color. Um, it has a lot of antioxidants and a lot of phytonutrients. So these ox, these antioxidants and phytonutrients basically bind, um, certain what we call bile acids, which are made of cholesterol and they remove them from the body, which can promote lowering, um, bad cholesterol and preserving good cholesterol. So, uh, not necessarily a primary treatment, but could be used as a, as a, um, an adjunct of a, like a cholesterol lowering treatment plan for sure. Yeah. Great. Um, great discussion. What about other problems like liver disease, chronic kidney disease? Have we done a podcast on kidneys? I don't think we have. I don't think so. On chronic kidney disease, we should. Yeah. This is a whole, this is like a whole episode. This is like an hour long. I don't really know what the question is. So like cholesterol and chronic liver disease or chronic kidney disease. Um, I mean the, the cholesterol, you know, high levels of cholesterol and triglycerides damage small blood vessels in the kidneys, which can reduce blood flow. Um, and also, uh, conversely chronic kidney disease impairs the body's ability to process fat. So this can cause an abnormal cholesterol profile. So it kind of works both ways. Um, but this is like a whole podcast episode. Yeah. We should make a note of that. That's a good one. All right. And then last one, are you saying with a history of stroke heart attacks, one should be on a stand to prevent a second event? I am not going to answer that. That is a personal health question for a patient's doctor. But according to the medical literature, if a patient has had a heart event like a heart attack or a stroke, um, the medical literature has shown that statins do prevent subsequent events, subsequent events, but every patient needs to be evaluated on a different level for their risk. Um, it's not a blanket thing for everybody. And this is really where personalized healthcare comes in. And this is where cardiology does excel. And when patients do have an issue, what's the best way to prevent another issue? Um, so I don't want to guide anybody in one way or another, but the literature does support that. Yeah. So the answer is depends. It depends. And, um, there's a lot of risk factors there. There's a lot of different variables to look at, but generally it is acceptable. It is accepted and well, and well understood in the medical literature that the, one of the best ways to prevent a second or subsequent, um, heart event is with statins as part of an entirely multifaceted other treatment plan as well. Great. All right. Yeah. Cool. That's it. We're a little over time here. Um, Colin, what should patients do if they want more personalized healthcare and they live in Maine and New Hampshire? Yeah. So if you're, you know, interested in a more personalized approach to your health, whether it's, um, you know, statins, cholesterol hormones, um, you know, they, we'd love to have you, we evaluate, um, whether you need any of these things, right. Um, but we're trying to understand from a patient's perspective, all the parameters that we talked about, right. Um, we're trying to understand all the labs. We're trying to understand your cardiac markers. We're trying to understand your risk factors. We really want to understand your nutrition, you know, what your blood sugar is doing. Um, how much visceral fat do you have? What's your strength training? Like what inflammation do you have? Do you smoke? What's your family history? So there's a lot of parameters that go into this. And really that's what we're excelling at admin matrix is understanding all of these different parameters together. Um, whether it's to evaluate for heart disease or for a hormone dysfunction or any other common problem that we treat every day. Um, so yeah, that's, that's really, uh, what we do best. Well said. Yeah. And if you learned anything from today, like we talked about earlier, it's like, this is not common knowledge for a lot of people. And you know, a lot of patients are out there guessing with their health and there's, you know, we can definitely provide a lot of answers. There's more answers out there. You should be in the know when it comes to your health. Um, so yeah, share this with a loved one, a friend who you think would benefit. And then if you are interested in working with us as a patient at med matrix, you can go to med matrix, usa.com and you can apply to be a patient there. Uh, with that said, thank you everyone for joining. Thanks for the comments. It was so fun to be with you guys and we'll see you in the next one. Hey Colin, what's the next, what's the next podcast people? Uh, what is it? Um, we got someone's coming up. We got, I got the calendar here. We got muscle menopause. Uh, we got, oh wait, no, no. We got how to stay strong, sharpen energy as you age. That's with you and Dr. Rose. Yeah. That's next Thursday. Yeah. Yeah. So next Thursday, how to stay strong, sharp and energized as you age to really longevity focus. That's going to be with Colin and Dr. Rose. If you guys want to tune in there, you can find that on our social media. Uh, you can follow us on Instagram at med matrix, main or Facebook med matrix USA. All right, that's it. Got everything. All right guys. Thank you for joining. Thank you Colin for the time. All right. Bye.