This week on the podcast, we have a special episode with Dr. Noel Williams, a conventionally trained MD who specializes in using supplements like bergamot, berberine and fish oil to manage his patients’ heart health. He realized along his journey that if conventional medicine wasn’t helping, he needed to learn more about nutrition to see what can help his patients. This is a great episode that helps us bridge a significant gap in the reinvention of medicine.

Highlights include:

  • Discussing what a statin is and why introducing some supplements and reducing statin use can help certain patients
  • The use of bergamot and how Dr. Williams came to learn more about this supplement for cardiovascular health
  • How Dr. Williams became the COVID taskforce director for Oklahoma and what he learned from working with immunologists during this time
  • And so much more!

Resources mentioned in this episode:

Noel Williams, Best Clinical Practices for Applying Bergamot


James Maskell: Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs in health technology, as well as practical tools to help you transform your practice and the health of your community. This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective, functional, and integrative medicine. To find out more and to get started, go to goevomed.com/lmrc. That’s goevomed.com/lmrc.

Hello, and welcome to the podcast. This week, we feature Dr. Noel Williams from Oklahoma City. We are going to be talking about a number of things, but specifically about bergamot because we had a podcast earlier this year on bergamot. We got a ton of good feedback, so I was like, “I want to talk to a doctor who’s doing this every day.” How are they using it? What’s the protocol? How do you get people off statins? How do you use the gammas and statins? What are synergistic protocols? Turns out, Dr. Williams is a wealth of information, has a ton of great clinical pearls. We also talk about the reinvention of medicine. He actually served as the COVID taskforce director for the state and so had a lot of interesting thoughts on the re-invention of medicine. Really powerful clinical half an hour. Enjoy.

All right, so a warm welcome to the podcast, Dr. Noel Williams. How you doing, Doc?

Noel Williams: I’m doing great. How are you doing?

James Maskell: Hey. Thanks for making time. I know you have a really busy practice. I guess I just wanted to start by sharing a little bit about who you are because I asked you at the beginning, tell me about your functional medicine practice, but it sounds like you don’t really have a functional medicine practice. I think the audience would like to know what you do.

Noel Williams: Okay. Well, James, as I told you we’re, I’m a gynecologist by training. I’ve been a board certified gynecologist for 25 years. I’ve been in practice 27. We do a tremendous amount of gynecology, internal medicine, endocrinology, all combined in an integrated fashion. Before functional medicine ever was a concept, I realized very quickly in practice that there was a lot of things I didn’t know and hadn’t been taught in medical school and residency. I started to try to figure out how do I get people better when my medicines don’t work and I can’t seem to make any progress?

I started using nutritional products and started researching nutrition. That was way back in 2000. Because your first few years in practice, you’re just trying to figure out how to do your job. How do you take care of patients? How do you do surgeries? How do you do it? Then after you’ve been doing it a few years, you start to realize you don’t know what you didn’t know, and you have to start reading and reading and reading. I realized I didn’t know much about nutrition. As silly as it sounds, I figured it had to be important, but where I went to medical school at Ohio State, I always remember we had one, one-hour lecture on nutrition in four years at Ohio State back in the late 80s. I started researching nutrition and first figured out fish oil was extraordinarily important for everyone, not just for cardiovascular health. Then I figured out, well, vitamin D was really important and then methylated folic acid, but really by 2004 or 5, I’d figured that out, which is a lot of themes that functional medicine providers incorporate now.

I look at that as just actually doing internal medicine and understanding the physiology of how cells work, how then that builds how organs work, and that then shows how the body works, and getting that down. I think it’s an essential step for every provider, whether they’re someone like me who does a lot of integrative medicine, and internal medicine and gynecology, or someone who is just a primary care doctor. I don’t mean that as a just, but everyone has to understand how the body functions, how the organs function and how the cells function. I don’t think of it as functional medicine, I think of it as doing real medicine. I always think it’s just doing real medicine. How can you practice medicine without knowing how the body functions?

James Maskell: I couldn’t agree more. That’s really this like two worlds that we’re trying to bring together here at the Evolution of Medicine Podcast, so well said and let’s bring it all together to practice great medicine. You mentioned nutrition. Obviously, you mentioned some supplements there. What is your overarching nutritional thesis? Are you more of like a Mediterranean, ketogenic? Do you do intermittent fasting with your patients or is it individualized?

Noel Williams: It’s individualized, but I think our number one thing is thinking about inflammation. Every step, I think for medicine and disease prevention and disease modification is pretty focused as people age on limiting inflammatory mediator production. We use all three of those things. I’ll use an example. I had a patient yesterday who was in with a new diagnosis of metastatic breast cancer. She’s going to be starting her chemo in the next two weeks. We did several for me…because we do a lot of collateral cancer care, like probably a lot of your listeners. Besides going over what her chemo is going to be, like she’s going to be on doxorubicin so we want her on CoQ-10 and doing that routine stuff, but then I brought up, “Hey, what about starting intermittent fasting and starting metformin? Or if you didn’t want to use metformin, you could use berberine because you want to get those insulin receptors sensitized and you want to get those cells stressed in the right way as they go into their chemotherapy, so we get autophagy and a much better result with the chemo.”

For her, we’re going to use intermittent fasting and we use people…just for helping with weight loss, we use it, but some people, as I think everyone listening knows, some people look at intermittent fasting as like, I can’t do that in any form or fashion, whether you’re doing it at 24 hours for one day a week, or one or two days a month, or if we’re doing the more cyclic one where you eat from 11 to 7 and then you’re off for 16 hours. We use a ketogenic diet for people.

There’s a great book I always refer to. I think it’s Bacon & Butter, which has a lot of good recipes and it’s pretty easy. Then we use a classic Mediterranean diet also. We pick based on the individual and what sounds reasonable to them. The thing with medicine as someone who’s very, very experienced, it really sitting and listening to them and figuring out what sounds good or doable to them because all of us as providers have great ideas, but our great ideas may actually be terrible for that particular patient. They’ll sit there and not want to disappoint you, especially because a lot of people who do this kind of stuff, I think, are a little more personable. Provider wants it, nice, and so they want to make you happy, but they don’t want to tell you sometimes when the plan is silly or bad to them just because it’s not applicable because they don’t want to do it for whatever reason. Trying to figure that out is very important.

James Maskell: Awesome. Yeah, well that makes a lot of sense. I know you work with a lot of people with high cardiovascular risks. Take us through your intaking process to determine which direction you’re going to take a patient. Are there any specific things that you do that help you understand how to individualize your care?

Noel Williams: Just a quick review for everyone on cholesterol, which I’m sure everyone knows, but if we look at what the average cholesterol is in a heart attack patient, it’s 200, which means that half the people are between 100 and 200 and half the people are between 200 and 400. Is it really the cholesterol number? No, it’s the inflammation. How inflamed is the plaque? How inflamed is the blood vessels? We are always thinking about yes, cholesterol numbers and their LDL particles and their HDL particles because we know that as their HDL particles go above 50, we lower heart attack. For example, if every point about 50 for a girl, you get a 2% reduction in cardiovascular events. For guys, it’s 3% reduction, but then we also look at LDLs and do they have small…we’ve done fractionated. Do they have more large bouncy particles that don’t stick to the blood vessels, or small sticky ones? That’s always in the back of my mind.

When we start with someone, it’s what’s their global health status? What medical problems do they have? Are they a smoker? Things like that. Then we look at their cholesterol levels and we do that as a test. Then we then sit down with them and look at what are their risk factors of cardiovascular event in the next few years? We do a little bit easy testing in the office. We do plethysmography, which is just vascular resistance training. We’ll also sometimes send people just initially for a calcium score, but from there, what we try to do is figure out is this a higher risk person, a medium risk or lower? When you have someone who’s higher risk, you take a different approach than someone who’s lower risk.

If you have, let’s say a guy who’s my age, 56. His cholesterol is 280, he’s 40 pounds overweight and he hasn’t done anything, you really want to go get a hold of his cholesterol and his inflammation really aggressively. For those people, we’re going to usually get them immediately on fish oil. We’re going to start a discussion about how do you lower cholesterol and add things that are additionally anti-inflammatory to the vascular system?

If it’s someone who’s younger or really low-risk we’re to be really focused, again on…we always think omega-3 is a key component along with vitamin D and all this other stuff, but keeping it simple. Then is this someone we need to start planting the seed and helping them understand how do we prevent oxidative damage in the vascular system? They probably haven’t had that much, but how do we prevent it and what small steps can we take? Because I always feel like we’re planting seeds to get someone from point A to point B over sometimes several visits or a few months when they’re like that. Then you have the medium person where you may be in between from being really aggressive.

Once you get someone who you’re a little more concerned with and they have elevated cholesterol and they have bad lifestyle, our number one thing is we don’t want them to have a heart attack anytime soon. That’s our primary mission. If they’re a very high-risk, we’re going to do a little more cardiac testing and we may get a cardiologist to clear them, but collaterally, we’re going to also start doing some things to help their cholesterol and their vascular inflammation.

I already said, we’re always going to get them on a pretty good dose of fish oil and some of that’s by weight and size, but generally somewhere between 1,520 and 200 milligrams of EPA to DHA with a three to one ratio, but then we’re going to start talking about how do you lower cholesterol and how do we get inflammation out? One of the things that I’ve realized over the years is that the last thing a lot of people want to hear about is a statin because they’ve all heard about statins. If they’re seeing someone like me or someone who’s listening to this, they’ve already been to a primary care provider or three. said, “I just want to put you on a statin.” They may have taken it. They took it for a month. They got all muscle achy. Now and then, they may have gotten a little sick from it for various reasons and that’s the opposite of what they want to do, and so we start talking about what are the different techniques for addressing cholesterol? That’s where, for me, bergamot has been a great add on.

James Maskell: Yeah, let’s talk about that because about three months ago, four months ago, we had the godfather of bergamot on the podcast, Dr. Vincenzo Mollace from Italy. He did an amazing job of talking about his journey. After that, we had so much good feedback on the podcast from doctors who they’re really interested in it. They were like, “Well, look, I want to speak to a doctor that’s using it every day.” That’s how we got introduced. I’d love to just get your thoughts on it, and how you came to using it and what you’ve seen as a starting point because we get a lot of questions. What initially attracted to you, I guess, in that way as an alternative to statins or what?

Noel Williams: I think it’s a combo. One, a really good alternative and two, from some of these studies, and there’s two studies I think we’re going to include at the end of the podcasts that are great reference points for everyone, you can use the bergamot onto itself, but if you’re not getting the cholesterol where you want it, what also happens with bergamot is little, teeny, tiny doses of statin are really synergized with the bergamot. It’s really important to remember something about statins which I think most people forget. If you look at atorvastatin, or Crestor or whatever one you’re talking about, the lowest dose, so whatever that lowest dose is, is going to give X effect on lowering your cholesterol. If you double it, it only goes up 6%. If you double it again, it only goes up 6%. If you double it again, you only go up 6%, but as you do that, your side effect profile skyrockets.

If you nerd out reading papers on outcome, as you start getting above that initial dose, there’s a fixed complication, right? The complications come rather impressive, and if you’re using the highest dose of any statin, you’re probably unfortunately killing, to an extent, more patients than you would ever save it’s because the intent to treat data with statins is terrible. The number of patients you have to treat to prevent one heart attack is usually somewhere between 300 up to 1,000, which means it doesn’t work in 99.7 to 99.9 patients.

James Maskell: I’m really interested in that, actually, because I’ve heard a lot of people talking more and more about the difference between absolute risk and relative risk. Now people think it makes a huge impact, but the number needed to treat is really high.

Noel Williams: You always have to look at the need to treat number because the relative risk, remember, was invented by big pharma to make things look better. Sometimes that number can be really impressive because let’s say you’ve got a 50% chance of disease X and the relative risk reduction is 50%. You go to 25, that’s a huge change, but most of the time, you’re shifting from 5 patients out of 5,000 of a heart attack to 4 patients out of 5,000. It’s really not that meaningful, but statins can have a role and I’ll get to where I think they are really. The way to look at it is when you have that patient, talking about the inflammation is the lead in for fixing them and helping them understand that we need to get the inflammation out of your vascular system and out of your plaque. That is your primary goal. That’s straight from the American College of Cardiology, it’s inflammation.

You think about the fish oil and you think about the bergamot because the bergamot’s going to do two main things. Thing one, and this is why I got interested in it, was it’s going to generally lower the LDL. It’s generally going to raise the HDL, which actually is even more important in my mind. Third, it’s going to lower the triglycerides. That was really attractive to me. If I have someone whose cholesterol is 250, their LDLs are 160 and their HDLs are 40 and I get about a 30% decrease roughly in the ballpark in a bunch of these patients of their LDL, and a 20 to 30% increase in their HDL and their triglycerides go down, all of a sudden, I may only go from 250 to 220, but now I have the HDLs up another 20% and the LDLs now, instead of being 140, 150s, may be 125. I’m materially affecting their vascular long-term.

Number two, the second thing that happens is I’m giving a super potent antioxidant and its antioxidants…remember, we’re oxygen breathers, and as we’re breathing it in and the oxygen is being processed, we make O3, or an oxygen with an extra electron, which then that electron has to be deposited somewhere. Unfortunately, when it hits a blood vessel wall, it causes injury and inflammation. When you have, in the vascular system, an antioxidant or something that absorbs that electron you, stop the oxidative damage. That’s what made bergamot so attractive to me as I was using it, seeing some people get really…to jump ahead, if you start using bergamot and it’s usually 500 milligrams BID, but you can go more to a higher dose too, you’re going to have patients who get remarkable results and you have people it doesn’t work so well on because it’s all about how your liver works and the enzyme pathways with the HMG coenzyme A. That’s very important to know, everyone has their own genetics, but the other part is it doesn’t affect the CoQ-10 production.

James Maskell: That’s big, yeah.

Noel Williams: You don’t have to worry about…you’re not going to give them muscle aches. You’re not going to damage anything with their muscles. You’re not going to give them any heart problems from the CoQ-10 depletion, so that made it really, really attractive. I thought, “I’m going to give this a shot,” because I’d read the papers that had been published on it. I thought, “Let’s use it.” We started to and we saw pretty much the exact same thing that the paper showed. Then in the people who were the more difficult patients, someone who, let’s say, his cholesterol was 300 or 350, and they had 200 LDLs and they were 100% little sticky ones. I think LDL through seven or whatever, fractionated. What we’d see is we’d see those people come down, but they’d still be elevated. Then what we would do is add just a smidgen of a statin, like a half of the lowest dose of Crestor. That’s what one of those papers showed that you probably talked about when you had the originator of all this on, you get this really good synergy.

I’ve had someone recently who we got his lipids back this week who had been at 300, he had 200 LDLs. His HDLs were at 50. We’re three months in and he was put on berberine/bergamot because berberine will synergize with bergamot and five of Lipitor, or atorvastatin. His cholesterol dropped to 208. His HDLs went to 62 from 50 and his LDLs now were 108. That is the best his cholesterol has been in seven years after being on every conceivable…20 milligrams of Lipitor, 40 milligrams of Lipitor, and then having problems the whole time. You build the synergistic pathways in the liver with antioxidants to help them. This is a guy, too, who did not have the APOE 34 mutation, which on many lab tests is marked as re, but I always think, no, it’s the single best mutation you can have because then omega-3 will lower your cholesterol. He didn’t have that, so cholesterol doesn’t have any effect on his cholesterol levels.

James Maskell: I’m glad you mentioned the berberine thing there for the synergy because that obviously means that it works better and it’s easier and more sustainable. Have you seen any other synergies with other supplements in your regime for helping in this way with bergamot?

Noel Williams: I think berberine’s our main one and we always want to include vitamin D because vitamin D is going to sensitize the insulin receptor. When you add the berberine, which has an insulin sensitization effect and antioxidant effect, a mild effect on the lipids too, with vitamin D and the bergamot and the fish oil, we’re really getting a pretty focused event on the cardiovascular system and for blood sugar. Then we’re then segueing into a lot of these people who have fatty liver. Again, the bergamot, since it’s changing how lipid is processed in the liver, the preliminary data is it’s going to help fatty liver, too. That’s something I think all of us know we have to eventually address. It’s just it’s not addressed a lot because it’s a difficult, and at times tedious subject, to get a liver to go from being fatty to non-fatty.

James Maskell: Absolutely. In your experience, are there any patients where you wouldn’t use bergamot and why?

Noel Williams: I would not use bergamot alone in someone with very high LDL three through seven particles, the really sticky ones by itself long-term if you were not getting a great result because since those are a little more sticky than the big bouncy, as I always call them, that’s how I remember it. All of us have to do that, but you figure if someone’s LDL particles are predominantly large and they’re running at 150, you get them to 120 and their HDLs have come up a little bit, you’re probably good. If you’re have a person with predominantly LDL small particles and they’re at 150, 160, and you’re only getting them down to 140 or 135 and their HDLs haven’t come up, you have to always remember those patients are higher risk. You have to be a little more aggressive with getting figuring out how to get HDL up and LDL down. I would always use it, but I wouldn’t depend on it alone.

James Maskell: Okay. In the previous protocol, you spoke about…have you seen success in eventually getting people off the statin altogether?

Noel Williams: Yes. Many times.

James Maskell: Is there anything that practitioners should know about the end part of that titration?

Noel Williams: I think you’ll find, generally, that’s going to be the patients who are often not as far down the road in terms of their metabolic syndrome development. What you basically do is when we start people on…if someone’s on just a very low dose of a statin anyway, or the silliest concept ever in the planet is, oh, there’s a family history of heart attack, and their doctor unfortunately has put them on a statin prophylactically, or they have rheumatoid arthritis and they’re on a statin prophylactically.

All that data, there’s no data supporting that. I want to be very, very clear about that. That’s marketing from drug companies. That group, we’re just going to immediately stop the statin and just put them on the bergamot and explain why we’re doing it. If someone actually does have elevated cholesterol, but it hasn’t been particularly elevated super high, we’ll generally just stop the low-dose statin, if they’re on 10 milligrams of whatever one and put them on the bergamot. If they don’t have any signs of insulin resistance, we’ll just do that with the fish oil and the vitamin D. We’re just going to wait six months. That’s one of the things you have to know about bergamot. You can look early, but if they’re on a statin and you stop it, their cholesterol is going to come up first before it comes down. You don’t want to check too early. You want to wait four to six months.

James Maskell: You’ve obviously got a lot of clinical pearls. You’ve been doing this a while.

Noel Williams: Yes. We see a lot of people. It’s been a blessing.

James Maskell: Anything else you want to want to share on the use of bergamot? Any other clinical pearls you want to drop before we get into the last question?

Noel Williams: The last few things is there’s some data that it’s neurochemically active and can be helpful for cognition and mood. It’s extremely well-tolerated. There will always be someone who has a complaint about a supplement, but so far in the last three years, we really have had scant…it’s a very, very minimalistic approach to this problem. I just think always remember about the berberine is a great add-on with it to your baseline fish oil and vitamin D.

James Maskell: Beautiful. Well, Doc, I really appreciate you coming to share about bergamot here. I feel like hopefully everyone who’s listening to this has a lot better idea of how to use it. Obviously with COVID last year and then coming into 2021, our theme for this year is the reinvention of medicine because obviously we proved in 2020 that we didn’t really have medicine quite right as we dealt with COVID. You’ve been doing this for a long time. You’re right in Oklahoma City, so in the middle of the country, probably seeing the kind of patients that really need medicine to be reinvented for. I’d love to just get your take on the reinvention of medicine and what you think the reinvention should be.

Noel Williams: Well, that’s a great question, James. I happened to have been the COVID Task Force Director for Central Oklahoma for about 2 million people and coordinated the care for seven hospital systems, which was a very exciting thing to do in some respects. The reason that I ended up doing that was because I had been in the public health service back in medical school. The thing I realized very immediately with the whole approach to COVID, I realized this back in January of ’20, is we were missing the central theme of this is a disease of nutritional deficiency, which I’m sure every single person listening to this knows. To your point, it completely defined our failure…not mine and the people on this listening, I would bet, the complete failure of the overall health system to recognize that if we provide nutritional support to people and give them the right information about vitamins, and supplements, and nutrition, COVID would have never been a huge multinational event.

There’s a person named Dr. BD Straddler out of Austria, who’s considered the number top two immunologists in the world. He wrote an editorial about this, April, May-ish. He was terrified at first because he was an older guy, and then he started thinking, “Hey, I’m the number-one, or number-two immunologist in the world. What am I doing? I’m panicking. This is about nutrition and that’s what we needed to focus on. ” That’s the take-home point from COVID is the total failure of the medical establishment to ever go back to baseline nutritional therapy for the immune system, with iodine and zinc and a multivitamin and vitamin D, and then the add-on things you can do to treat early symptoms with whatever you choose to, whether it’s quercetin, and elderberry and all these things that were highly effective. I put out, I don’t know, about 150 posts about this. I’ve had a bunch of them taken down on Facebook for putting journal articles on data on how to make your immune system work with vitamins.

James Maskell: That’s not the reinvention that we’re looking for.

Noel Williams: That’s why all of us have to fight it. I would encourage all of you to go and blog about it. I would encourage all of you to go on Facebook, or if you choose Twitter or YouTube and speak with you, James, and do these podcasts. It is about nutrition. It’s about cellular nutrition. Let’s get medicine to focus on this and not treat us like outliers.

James Maskell: Absolutely. Doc, that’s so well said. It’s a sign of the times. I think everyone can resonate with what you said. I think everyone who’s listening to this either knows some of their favorite thought leaders being censored for sharing, like you said, studies directly from journals that don’t fit the official narrative. I think it’s all becoming open in the air as to what’s happening, which I think has been happening for a long time. I think it is really stealing our community for the journey ahead for this reinvention.

It’s really great to just have someone on the podcast who is at that cross-section of functional medicine and conventional medicine because ultimately, we need a bridge, right? We need a bridge to bring these two things together. I think what you’re sharing here…I could put this podcast in front of any cardiologist, you’d be like, “Oh, that’s really interesting. I’d like to hear more about that.” That’s really the energy that we need to be able to bring together. Thank you for all your hard work on the front lines. I’m sure it made a massive difference to the people in Oklahoma. I couldn’t agree more with your thesis for the reinvention. Thank you for being part of the podcast.

Noel Williams: No, James, thank you. It’s only through your work and educating everyone that we’re going to get the word out because we’re all just individuals, but we need people like you to spread the word. Just a note to everyone who’s doing this kind of medicine who’s listening, good luck and don’t let the people who criticize you and your community get you down because we’ve all been there and you’re doing the right thing.
James Maskell: Absolutely. Doc, thanks so much for being on the podcast. I’m your host, James Maskell. I’ve been with Dr. Williams all the way from Oklahoma City. We’ll share all the details about your practice on the show notes. Thanks so much for being on the podcast and we’ll see you next time.

Thanks for listening to the evolution of medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit goevomed.com/lmrc to find out more about their clinical tools like the group visit toolkit. That’s goevomed.com/lmrc. Thanks so much for listening and we’ll see you next time.

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