Nutrition Made Simple! - 2023-10-30
Is cholesterol cause or consequence? How does it get into the artery wall? How can we avoid plaque and heart attacks altogether? Connect with me: Facebook: https://www.facebook.com/DrGilCarvalho/ Twitter: https://twitter.com/NutritionMadeS3 Animations: Even Topland @toplandmedia References: 1-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764970/ 2-https://www.sciencedirect.com/science/article/abs/pii/0002934351901714 3-https://pubmed.ncbi.nlm.nih.gov/33870931/ 4-https://pubmed.ncbi.nlm.nih.gov/25340478/ 5-https://www.sciencedirect.com/science/article/abs/pii/S0002914903002625 https://link.springer.com/article/10.1186/s12944-021-01509-6 6-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070150/ 7-https://pubmed.ncbi.nlm.nih.gov/22621796/ 8-https://pubmed.ncbi.nlm.nih.gov/12745098/ 9-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437972/ 10-https://www.ahajournals.org/doi/full/10.1161/JAHA.113.000759#d3e917 11-https://www.sciencedirect.com/science/article/pii/S0140673610621745 https://www.ncbi.nlm.nih.gov/pubmed/29146277 12-https://www.sciencedirect.com/science/article/abs/pii/S0002870313004481 13-https://link.springer.com/article/10.1007/s11883-023-01118-x https://www.sciencedirect.com/science/article/abs/pii/S0021915020305396 14-https://www.sciencedirect.com/science/article/abs/pii/S0939475311002274 15-https://www.sciencedirect.com/science/article/abs/pii/S0939475311002274 16-https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehad337/7207673 17-https://pubmed.ncbi.nlm.nih.gov/26103610/ 18-https://www.ahajournals.org/doi/full/10.1161/JAHA.117.005549 19-https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehad446/7224046 20-https://www.sciencedirect.com/science/article/pii/S2666667722000551?via%3Dihub Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author's knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!. #NutritionMadeSimple #GilCarvalho 0:00 Intro 1:49 Cholesterol, LDL & HDL 5:17 Why cholesterol is unreliable 10:05 Discordance and cardiovascular risk 14:10 Why are doctors focused on cholesterol? 21:52 Inflammation & heart disease 23:37 How does it get into the artery wall? 25:21 Retention & oxidation 30:54 Transcytosis and its function 35:14 Reducing our risk 40:02 Summary & takeaways
When I was going through chemo, and having regular CT Scans, they found two blockages. I talked to my Radiation Oncologist about it, and he said 'Not to worry'. I wish he had said 'Game on'. Maybe I would not have had the massive heart attack - maybe I would have changed my diet. I will admit to getting quite lost, watching this, but I will watch it a few more times, and pick up a bit more each time.
Not to worry? 😮
I agree I’m totally lost.
🎯 Key Takeaways for quick navigation:
00:00 🛡️ Cholesterol alone is not a strong predictor of heart disease events; it's the particle number that matters.
02:17 🎾 Cholesterol is transported in the blood via lipoprotein particles, like LDL and HDL.
06:17 🔄 LDL cholesterol and LDL particle count can disagree; risk is linked to particle count, not cholesterol levels.
10:11 💼 Discordance between cholesterol and particle number is common, especially in conditions like diabetes.
13:23 📊 LDL particle number, not cholesterol, significantly predicts heart disease events, especially with therapy.
16:32 🚀 Guidelines often aim for general population health; individual cases may require more nuanced assessments.
19:45 📋 Understanding individual risk factors, including LDL particle count, is crucial for personalized heart health.
22:41 🔍 Inflammation becomes more significant in advanced atherosclerosis, but it's not the primary initiator of plaque formation.
23:29 🩺 Chronic inflammatory conditions, like psoriatic arthritis, are associated with plaque formation due to arterial damage.
24:21 🩸 ApoB-containing lipoproteins, which contribute to plaque formation, move into the artery wall through a process called transcytosis.
25:31 🔧 The "response to retention" model suggests that once lipoproteins enter the artery wall, they need additional modifications to initiate plaque formation.
26:52 🚫 Triglyceride Rich Remnant particles are more atherogenic and contribute more quickly to plaque formation compared to LDL particles.
27:46 🧬 Type 3 Dyslipoproteinemia leads to the accumulation of atherogenic particles, causing rapid plaque formation.
29:03 🌊 Lowering LDL levels doesn't necessarily reduce all ApoB particles, and elevated triglyceride Rich remnants can still lead to heart events.
30:20 🩸 Modulating transcytosis or post-retention oxidation specifically is not currently possible. The primary focus should be on overall physiological health.
33:10 🛡️ Foam cell formation is the critical step in atherosclerosis. Reducing atherogenic particles helps prevent plaque formation.
35:03 📊 The risk of plaque formation depends on the concentration of lipoproteins that enter the artery wall, influenced by various factors like endothelial damage and lipoprotein levels.
38:04 🌱 Lifestyle changes, like managing blood pressure, glucose levels, cholesterol, and insulin resistance, are crucial for reducing plaque formation. More specific interventions are still under research.
Thank you!
Incredible! Thank you for summarizing so extremely well. This channel combined with good people like you literally make this a college level course on survival. Seriously, putting these pieces together over time is a roadmap for long life and healthy living. 👍👍👍
Thank you for this. Cheers!
Just use the chapters selection in the video description of each video. 🙄
After having read this summary & relating this current information to decades past information, a lot needs to be changed because they are already proven wrong.
Everyone should listen to this presentation. At least if not everyone, all cardiologists and primary care physicians should watch this. Incredibly informative and easy to understand. I sincerely hope that Dr. Cromwell will get invited back for a few more episodes.
Great interview, but i wish that you asked dr. William what’s his thought of the right diet to prevent heart disease. Thanks
This is immensely valuable information conveyed in a very comprehensible manner. This channel is solid gold.
Great video, Gil and Bill! My opinion may be a bit biased, but I'm a firm believer that EVERYONE needs to hear this conversation.
Would love to hear about how diet affects particle number
38:22 Layman's explanation: Eat whole, non-processed foods instead of ultra-processed foods however and whenever possible. Don't overeat. Be active. Pass around five forks for one dessert. Don't smoke. Don't drink alcohol unless you can stop at one drink. Recent data is suggesting to just quit. That should be it.
Fantastic interview. Thank you! You are doing a phenomenal job educating the public. Had a couple of questions. 1. Is it only LDL particles stuck in the intima that can be damaged or can freely flowing LDL particles be damaged if exposed to glucose/insulin in the bloodstream. 2. Are all damaged LDL particles stuck in the arterial wall or can they come loose and get back into the bloodstream. 3. If damaged particles can get back in the bloodstream, can the LDL receptors on the liver still pick them up. 4. How do you balance the risks of lowering LDL particles with a statin versus the side effect of the statin (which may include causing diabetes), especially in the population that is low risk of getting plaque buildup even with a high apo-b count. 5. Does the triglyceride count and /or the insulin resistance increase risk of starting plaque formation (not increasing existing plaque formation which he said was almost certain).
What a masterclass! Thanks for another great video Gil
What a great video. Often times we lose the nuance in medicine but Dr. Cromwell does a great job of explaining it. This needs to be required viewing for anyone who wants to take control of their own health.
The information you provide on your channel helped me understand that I needed to reduce saturated fats, which brought my LDLc down by 25%. Thank you! Can't wait to see my Dr. in a couple days! Now as long as I'm not one of the ones where that's an inaccurate measure ....
Have you ever considered turning some of your content into a podcast? This is great info and I’d really appreciate it if it were in podcast format.
I've seen this type of request before and it confuses me. If you stop watching the video and only listen to it, don't you have a podcast?
@@darkpatches yes that’s what I usually do. But you have to pay YouTube to listen with video off.
@@paulgaras2606 Wow. YT just deleted my response comment and gave me a big personal warning about it. I explained how to get around the problems you have with the YT app. They're just plain mean and sore losers. I guess I can only tell you there are ways around it....
@@paulgaras2606 In regard to watching YT videos in a browser on your phone, I can only tell you to be brave. Be b r a v e.
@@paulgaras2606 No you don't. You simply play the video on your phone and listen to it on earphones or via the phone's speaker. I just did that very thing and it works fine (other than having to skip through the ads).
You really need to be your own health advocate and this channel is a wonderful tool for that purpose. Thank you so much Dr. Carvalho!
See...this is one of the more interesting topics I wish you could dive into....really need a 10 part series on this to break it all down
What else more do you want to know?
Highest level info from the key experts, thankyou so much from Perth Australia
Wow! The best video on the subject I've seen/heard. Please put the auto-translate in all languages captioning on for my non-english speakers like my wife who thinks all is fine. Thanks, dr. Carvalho & Cromwell.
This video, and this channel altogether, are so profoundly informative. Truly grateful Gil
What a refreshing change to have actual science on YouTube!
Thanks so much Gil
Very informative & most importantly very understandable! Much Appreciated! Thank You!
Thank you Mr. Cromwell. The approach you take to the subject of Cardiovascular problems is scientifically honest without fanaticism, comprehensive and without placing yourself on any side of the conflicting parties
Brilliant interview, thanks Gil. Would love to know Dr. Cromwell's proferssional thoughts on HDL.
That was very nicely explained. Thanks. It reminds me of how BMI is an easy measure but not always the best measure.
The lifestyle measures of heart disease risk:
1) Are you overweight? (BMI above 25): No.
2) Do you get angry when I ask what your waist measurement is? No.
3) Do you smoke at all? No.
4) Do you drink more than very occasionally? No.
5) Do you eat a plant biased diet with the majority of your calories coming from whole (high fibre) foods? Very low in saturated fats. Yes
6) Do you exercise; about 5 hours a week brisk walking with hills and stairs or equivalent plus some weight/isometrics? Yes.
That covers all the practical things you mention in your other videos.
My theory is most people who are obsessed with biomarkers are trying to find a reason those questions don't apply to them!
I don't know about most people but I don't fit the normal model of a high risk person (no family history of early events, never smoked, BMI of 22 and regular exercise for many decades, no symptoms, etc.) so when I got a "severe" coronary artery calcium scan, biomarkers became the way to measure my progress in reducing risk. Hopefully that's what other people who're smart enough to watch this video are doing with them also.
@@dwights1464 What are you doing to reduce your risk that isn't on my list?
@@RogerHyam I have been taking rosuvastatin for about 3 1/2 years and Zetia for about 3 years to lower my risk.
@@dwights1464 and have you been on a wholefood, plant based diet for most of your life?
In my original point I say most people are trying to get out of one of the items on the list and you haven't said you have done all the things in the list - plus you might not be most people.
I'm working my way through this very helpful video. I recently had blood work done in preparation for my annual physical, and asked if the could add an APoB test, thanks to Dr. Gil's videos. What I didn't know until after I'd had the blood drawn is that it takes a good week to get the APoB results back from the lab, instead of the normal 24-48-hour turnaround.
Very interesting, educational, and informative. Many thanks for sharing Dr Carvalho
Such a fantastic channel and interview. Second time I watched this. Dr. Cromwell is so lucid, you can't help but understand, and Dr. Carvalho's summary at the end helps to get you to the practical application of what you learned to protect your cardiovadcular health.
This channel is a gem!
- Dr William Cromwell is a clinical lipidologist, professor at Wake Forest University School of Medicine, and he has published many studies on lipid physiology and metabolic disease.
10:05 chapter on the discordance between LDL-C and ApoB: he said that 30-50% of healthy people have such discordance, while metabolically unhealthy people are more likely to have discordance (up to 70% of them have it). he also says there is no discordance when LDL-C is very high or very low.
Discordance is not essential. Have low LDL-C, low blood pressure, low inflammation, low blood glucose and you are safe.
I've decided that every expert has valid points. Every meta study has valid assertions. Every individual has to realize that neither of those two facts mean much to their particular health condition. It is a roll of the dice because of too many unknown factors in our bodies.
Great video.
After I finish it I will check your other videos about it and saturated fat that I watched but didn't grasped fully.
Good explanations.
I think now I got it more fully.
Look for the book Nourishing traditions. It's an older book but really explanatory and good information
Very interesting and informative discussion. Thanks 😊
Such a beautiful and wise conversation
Sad to hear this info cant go mainstream because the old view of cholesterol is too deeply lodged into our healthsystem.
Thanks for these type of videos, greatly appreciated to get information from suxh a knowledgable person
Thank you Gil! So glad i subscribed. You are a solid channel!
Thanks that cleared up a lot of misunderstanding about heart disease.
Great episode Gil!
My insight about this metabolic problem with the foam cells etc is that some prolonged fasting could be an amazing method to prevent issues.
Hello Doc: can you share your diet and lifestyle (sleep, exercise, anything else important) for good health? Since you have researched a variety of topics over the years, I imagine you follow some best practices. Thank you so much
Secret
Whole food plant based. No coffee. Decaf only. No fat.
Look 37:46
@@kate60 no fat ?!? Maybe you mean no animal fat but you need some fat in ur diet xd
Thanks so much for the video. I've been plant-based for 11 years now and have listened to Drs Esselstyn and Greger to get my LDL below 75 and total cholesterol to below 150. So now I need to make sure my apoB is below 100 mg/dL? Thanks Gil!!!
This was amazing! One of the most informative explanations
Great Education on Discerning Cholesterol Types !
Fantastic information, thank you both.
why don't we make things easy for everyone- just measure APOB as it tracks cause/risk better? not sure why we are still having this discussion. apoB test is like 30 bucks. why not run both?
Trying not to wear my tin foil, it's likely that there is just too much money to be made doing it the way they've been doing it all these years. I wholeheartedly agree with you though. Thanks to Dr. G, I learned that ApoB is a thing and had mine tested. It's extremely high, and diet and exercise has changed!!!!
what diet and statin and dose to reduce Apo(b)
@@randallcotner2155 Dr Sniderman
@@billusingh3439Every person responds differently. I only need 30mg Rosuvastatin to lower APOB from 129 to 59. Someone else may need multiple drugs, including expensive PCSK9 inhibitors, to achieve that. Talk to your doctor and experiment together.
Love the scientific way you go about proving what you say. Great channel. Does atorvastatin and rosuvastatin target cholesterol or Apo(b). My cholesterol LDL has been high since my 20's. been on low dose statin for 40 years. Still not low. Only time my LDL was below 100 was the 8 months on Atkins where i ate nothing but steak, cheese sauce and eggs. Lost 80 pounds. Cholesterol plummeted. HDL has always been low. My doctors could never answer why it dropped. At 60 my calcium score in chest was 0. Is there something else i should be checking.
Where has he been? Love the info, but what about specific numbers of what is too high, target numbers? what about any of the usual ratios? & What about HDL, Triglycerides, & ApoA?
Just brought my wife home from the hospital after having a 95% blockage in one and 80-90% in another. Amazingly good cholesterol levels. Unfortunately, it is probably genetic and does tend to run in her family. But I agree, just the cholesterol numbers are not a very good predictor of heart disease. Total cholesterol was 147 and LDL was 72. Believe it or not they were going to put her on a statin. So far they haven't.
does she have high lp(a)? just a thought
Whats her APO B???? How about LPa?? How about HS-CRP? Lastly and most important, whats her LDL particle number?? LDL and HDL are current day bullshit...But most docs have their heads up their asses regarding 99% of current findings and tests.
What was the ApoB? She should be on multiple cholesterol lowering drugs
Despite eating a plant based diet and exercising frequently I discovered through advanced screening that my risk for diabetes and heart disease is higher than I expected and much higher than I want. I am currently using fiber supplementation and sodium reduction to reduce my risk and then I am going to re-test. I already noticed that my blood pressure has come down since I started the interventions. I'm very excited to see how well these interventions have worked to reduce my risk but I'm trying to wait because the testing is fairly expensive and I want to give it time to work.
Try switching to a WFPB (if you don't practice it already) and try using very little salt, or using combinations of sodium-free salt and sodium-containing salt. You can find more information about this on Gil's video on the best salt for health, where he discusses a sodium-free version of salt. Read the comment section on the video too, people there had good suggestions.
Diet and exercise aren’t everything. Emotional wellbeing is HUGE and very overlooked.
Good work on adapting! I had to do the same thing, even though I was eating a whole food plant based diet like you, I ended up having to exercise more, get rid of ground grains from my diet (bread, pasta, etc), potatoes, and salt. I also added some potassium chloride. With these changes, over the course of a few months my numbers moved into optimal range.
@@Teneab thanks I already try to eat WFPB for the most part but the junk creeps in. Part of the intervention is trying to avoid the plant based junk as well. I’ve been using a 50/50 blend of potassium chloride and salt and using less of that overall. I have lost weight and I feel like I’m really on the right track. Wishing you good health!
@@bgrune1 Oh sounds like you are already doing everything correctly, lol! Keep up the great work. Have you checked your ApoB or cholesterol since you've started the intervention?
Who needs a heart ❤️ when a heart ❤️ can be broken 💔? 😶
What doesn’t kill you makes you stronger, right?❤
Excellent show full of useful info.
@DrTomMD - 2023-10-30
The number #1 lipidologist on earth! Bill is a great friend who I first listened lecture over 15 years ago. Excellent episode!
@SandyCheeks63564 - 2023-11-21
You can tell when someone REALLY knows their stuff - they are able to explain it so even nonprofessionals can understand the main points. They tread the fine line between glossing over and going too deep. Dr. Campbell really explained this all so well. Not saying I'll retain it all - but I have a much better understanding than I did before.