Cardiac surgeon says: Cholesterol doesn't matter!!?!
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- Опубліковано 4 січ 2022
- tweet: “I no longer accept paradigm that high LDL cholesterol causes heart disease” - cardiothoracic surgeon
he doesn’t believe high LDL cholesterol causes heart disease
patients have normal or low cholesterol. cholesterol doesn’t matter?
the paradigm that high LDL cholesterol causes heart disease. Is that the paradigm? No
it’s not high cholesterol that causes heart disease. it’s the lipoproteins that carry cholesterol
vehicles determines plaque/artery blockage, whether lipoproteins have more or less cholesterol
usually if cholesterol is high there are more lipoproteins. if they mismatch, risk follows lipoproteins, not cholesterol level
we can count lipoproteins that cause heart disease with apoB
high apoB + low LDL-c = high risk. apoB causes heart disease. High LDL-cholesterol is an indicator, not the cause
"apoB is a better marker of cardiovascular risk than LDL-cholesterol"
"reframe lipid hypothesis as lipoprotein particle hypothesis"
"lipid hypothesis could be re-examined as lipoprotein hypothesis; risk most proportional to particles, not LDL cholesterol"
evidence for vehicles, against cholesterol as cause; experts don’t think there’s a debate
high LDL-c used as indicator of risk
patients have normal or low LDL-cholesterol so high LDL-cholesterol cant be the cause? are patients on cholesterol-lowering drugs?
Statins lower cardiovascular risk, dont eliminate it, still residual risk. Lowering cholesterol slows buildup of plaque, statins stabilize plaque, there is still plaque burden, statins doesn’t eliminate all plaque
common for someone on statins to have low cholesterol but still have risk of heart attack. risk is lower than with higher cholesterol but still residual risk
cholesterol drops after heart attack (Acute phase response)
"Acute coronary syndrome (heart attack) affects lipids/lipoproteins, low density lipoprotein (LDL) and total cholesterol decrease"
heart attack patients' cholesterol is lower. If i'm not aware of APR i might think "they have low cholesterol, cholesterol level has no relation with heart attacks!"
heart disease: Lipid levels during acute phase after heart attack may not reflect lipid levels leading up to heart attack
cholesterol-lowering drugs and change in lipids in acute phase of disease
threshold for high cholesterol is not where risk starts. the higher your cholesterol the more plaque
normal LDL-c = under100mg/dL, but can have plaque. Less than at 150 but not zero
people with ‘normal’ cholesterol can have plaque, yet high cholesterol is a risk factor
intermediate cholesterol more common
hospitalizations for heart disease + LDL-c levels. cholesterol of 200 is protective? no!!!
more people with cholesterol ~100.
authors: guideline revisions with even lower LDL goals
study: lower LDL cholesterol further
Risk is higher at higher ldl-cholesterol
measure cholesterol before disease. or split randomly, lower cholesterol in half, see who gets heart disease. group that gets drug has lower cholesterol and lower risk. people born with low cholesterol have lower risk of cardiovascular disease and death
LDL-cholesterol = indicator. drugs also lower apoB. if LDL-c and apoB don’t match, risk follows apoB
Bottomline, we don’t ignore high LDL-cholesterol, most of the time it indicates high apoB; if in doubt measure apoB
video: diet to lower apoB
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Animations: Even Topland @toplandmedia
References:
jamanetwork.com/journals/jama...
www.pnas.org/content/pnas/77/...
jamanetwork.com/journals/jama...
www.ahajournals.org/doi/full/...
www.ncbi.nlm.nih.gov/labs/pmc...
www.sciencedirect.com/science...
www.sciencedirect.com/science...
pubmed.ncbi.nlm.nih.gov/19081...
www.sciencedirect.com/science...
academic.oup.com/eurheartj/ar...
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
I swear you are the best health scientist/doctor on the Internet. I listen to many great podcasts, watch several great UA-cam scientists, and read many books - but yours are the most compelling. I wish your videos got millions of views instead of many pop ones that do. 👏
thank you!!!
amen
Chris, you are way up there too. You and Gil are both my favourites, for different reasons. Thank you both for the work you do.
@@tiagovsantunes I agree.
@@tiagovsantunes Thanks! Before I publish an episode, I check to see if Gil has something to say about the subject because he is so thorough. I'm doing that right now about a study on vegan kids and his insight has been gold.
Gil, I don't know what I would do without you. Thank you for your excellent explanations.
Incredibly good decision to blur out names. It's the argument that matters, not the individual.
If I could only like your comment more times.
@@StillTrustNo1 Thanks so much for your kind words!
thanks!! we talked it over and decided to try this out. unfortunately doesn't work in the few occasions where we feature video... :(
@@NutritionMadeSimple Still, it will encourage more productive and civil dialog among people compared to just ad-hominems.
You lost credibility right out of the gate by censoring your sources of opinions you disagree with. Yes, we can google the phrase and probably in short time find out who it is, but you went out of your way to make it extra work for the viewer. You will be more credible if you exercise transparency.
I'm so glad to see you're uploading again!!! You're one of my all time faves for sure!! :D I learn heaps from you, thanks!
Man, I just love your personality, you're so likeable. You understand people's mistakes, you dont call them idiots(which I dont mind that much from regular people, but doctors should really not have that word in their vocabulary when talking science, but many call uninformed people idiots on all platforms), you clear musunderstandings perfectly with very good logic and I dont know, its just a joy to hear you talk
Also, if you are interested, I'd love to hear your opinion on dangers of too low cholesterol, of course, not cardiovascular dangers, but those associated with mood and depression and sex hormones. What is the ideal range? Cause just crashing cholesterol seems also dangerous to me
Also, a video about how inflamation interacts with heart disease would also be pretty interesting.
I dont want to force ideas onto you. You should do videos only about what you find interesting and like. I was just rambling.
thank you sir!! we covered the inflammation link in a previous video (the 2 part video with the carnivore doc on joe rogan) but will touch on it again in the future no doubt :)
Yeah, there are some other doctors who I respect for their intelligence, but if they disagree with someone, they will call them all manner of horrible things. It's like how is that productive in any way? They get sensative about being called out and call it "tone policing" but I just think it's common courtesy to show people respect regardless of how much you disagree with them. Doing otherwise only leads to the eventual collapse of society.
Actually, Nutrition Made Simple did a video in low cholesterol. I actually had asked about it too awhile back because I kept hearing about it being a indicator of disease and early death.
There is no such thing as too low cholesterol and there is no correlation between mood disorders like depression and lower sex hormones with low cholesterol, if that were true then we would see higher rates of these things in people with a PCSK9 gene mutation which causes them to have abnormally low cholesterol levels yet we don't and these people also have the lowest rates of heart disease and atherosclerosis due to this. The claims made about the supposed "dangers" of having cholesterol levels that are "too low" are not based on any actual evidence and are just blatantly made up claims, blood cholesterol can never be too low.
There is no evidence that low cholesterol has any detrimental effects. People can have an LDL of 4mg and still function as they did with high cholesterol
A controversial topic! See below & challenge:
“LDL levels can increase for two reasons. First, if you’re eating a ketogenic or low-carb diet and burning fat as fuel, your liver may send out more LDL “boats” to supply fat fuel to your muscles. The empty LDL boats return to the liver to dock, restock, and go back to work. The second reason is more sinister: When you overeat carbs, it’s as if you’re filling your bloodstream with sugar glaciers. The LDL boats bump into these sugar glaciers and get damaged in a process called “glycation.” Glycation, in turn, makes those LDL boats further vulnerable to oxidative stress. Once they’ve been damaged by the sugar glaciers, the LDL boats can’t return to the liver and end up accumulating in your bloodstream. Eventually, they sink down to your artery walls and develop into atherosclerotic plaques, a titanic health catastrophe.”
- The New Mediterranean Diet Cookbook: The Optimal Keto-Friendly Diet that Burns Fat, Promotes Longevity, and Prevents Chronic Disease (Keto for Your Life) by Martina Slajerova, Thomas DeLauer, et al.
Let's be clear that dietary cholesterol, then total serum cholesterol, then HDL cholesterol were either not associated with heart disease or were never at the level of causality, yet they led to the disastrous low fat diets that fostered frankenfoods. You and leading lipidologists might know it's about apob, but that isn't the case on the ground. If low carb diets work to lower obesity and insulin resistance (and, of course, blood sugar), then the blood lipids are largely insignificant.
Thank you for this series on cholesterol, heart disease, etc. It's been excellent analysis and full of action-oriented behaviors to follow. Well done, Sir....
Thank you. It is not an exagerration to say you may have saved my life with your videos. 63 year old female, did whole food plant based badly (with 3-4 Lara bars each day), got an A1C of 6.0 two years ago for the first time ever. Switched to Keto/Atkins, watched many a video (some from actual MD's) saying high cholesterol was fine, its all about the sugar and eat as much fat and saturated fat as you want. Started getting mild angina even when I was sitting down and then my heart started racing at night. I knew something was wrong, but these guys were MD's making these high fat/carnivore videos. Wouldn't the AMA or someone take the MD away from their name if they are just making videos that are completely wrong?! (I am still not sure about this, do not know if the AMA or some other governing body cld take away their MD for making their videos, and, also, not sure if a governing body should. Everyone thought Semelweiss (sp?) was wrong at first, too, but he's why surgeons scrub their hands and wear masks/gowns today, is my understanding. Semelweiss was right, as the increasing numbers of moms who did not get childbirth fever showed. I am a sample of only 1, but the many others who start getting angina or worse will slowly tell the tale. Still, it is better to allow exploration of controversial ideas. However, in the case of the keto MD's, they are making errors in their understanding of the established science. It is not that they have made a new discovery, like Semelweiss did. The keto docs are misunderstanding findings and implications. They are not making new discoveries, though their misunderstanding causes them to believe they are. We need folks, like you, who understand the errors in statistical and other types of reasoning these MD's are making.). Anyway, then I found your channel. And you so clearly explain the misunderstanding that these MD's, even though they are MD's, are making. Your use of analogy is especially spot-on and targeted, you are answering exactly the questions the carnivore/keto MD's are making me confused about. I think most of the carnivore type MD's are good people, they follow the high saturated fat diets they talk about. But I can now see the errors they probably do not realize they are making. Many of them are young to middle aged and can get away with it bec, for many of us, our bodies give us 50-60 years of basically anything we do before they (our bodies) start complaining. I am now back on primarily whole food plant based, but with no Lara bars, still with a couple eggs per week, and chicken or tuna a couple of meals per week. One cheat meal per week where I eat whatever that week's craving is, last week was pepperoni pizza and the theater sized box of Junior Mints. Then, boom, right back to mostly whole food plant based with the next meal or in the morning. About 80% of my meals each week are vegan. My last A1C was 5.3. It had been 4.9 on keto, but 4.9 with resting angina and racing heart at night. Now its 5.3 with no angina in weeks and my last racing heart was in April. At 63, I cannot fool around, and I am not trying to fit into a bikini. I am trying to have as long a healthspan as possible, and I have 58 years (I first started whole food plant based at 58 when I ended up in the ER with ventricular something, PVC's, and they said cut the caffeine and stress) of messing up my arteries already. So my arteries likely already have the effect of 58 years of eating SAD. I cannot fool around, and I thank you again. You are truly a physician, truly healing people through your videos, and I am so grateful. I want to see my grandkids grow up. Thank you, Dr.
loved your comment. I've been trying to eat more plant based lately as well. I'm still learning more about nutrition and trying to implement things as I go along :)
I can so relate. I too fell for all of these carnivore and keto doctors and influencers and their spiel on how to heal on crazy high SFA and protein rich diets. I was going into a food coma after every meal of red meat, needing to take an hour's nap each time. I also felt constant fatigue, some gerd, and a hard time falling asleep at night. And I noticed that my eyesight worsened which scared me into rethinking this way of eating. Not to mention that I'd much rather not have to eat any animals or fish if i didn't have to. Trying to switch to a WFPB way of eating now. At 74 years of age, I don't have any time to fool around and experiment with my health.
JAMA Internal Medicine | Special Communication
Sugar Industry and Coronary Heart Disease Research
A Historical Analysis of Internal Industry Documents
Cristin E. Kearns, DDS, MBA; Laura A. Schmidt, PhD, MSW, MPH; Stanton A. Glantz, PhD
Early warning signals of the coronary heart disease (CHD) risk of sugar (sucrose) emerged in the 1950s. We examined Sugar Research Foundation (SRF) internal documents, historical reports, and statements relevant to early debates about the dietary causes of CHD and assembled findings chronologically into a narrative case study. The SR sponsored its first CHD research project in 1965, a literature review published in the New England Journal of Medicine, which singled out fat and cholesterol as the dietary causes of CHD and downplayed evidence that sucrose consumption was also a risk factor. The SRF set the review's obiective, contributed articles for inclusion, and received drafts. The SRF's funding and role was not disclosed. Together with other recent analyses of sugar industry documents, our findings suggest the industry sponsored a research program in the 1960s and 1970s that successfully cast doubt about the hazards of sucrose while promoting fat as the dietary culprit in CHD.
Policymaking committees should consider giving less weight to food industry-funded studies and include mechanistic and animal studies as well as studies appraising the effect of added sugars on multiple HD biomarkers and disease development.
JAMA Intern Med. do 10.1001/jamaintermed 2016 5394
Published online September 12, 2016.
I like what you said here.
Just a question here, do all of your vitamin stores check out? Any deficiencies? I recently found out I am vit d and iron deficient, which can give a host of problems, racing heart etc. I think it was all the green tea I was drinking, which brought my cholesterol down but I think may have depleted the iron not sure. Lots of strange things can change with the foods we eat. Something to consider. Be well.
Then why aren't doctors ordering apoB tests ? They are still using lipid profile tests
Progress is always slow when massive profits are at stake.
What a breath of fresh air. Research is not for everybody, that's why I appreciate trusting a professional. Keep the vids coming!
Thanks for this video. I have two future video suggestions....things that seem to keep popping up in discussions of nutrition; the danger of oxalates and the dangers of seed oils. I hope you'll address these in the near future. We appreciate you!
Great video! It's very informative. It goes very well with your previous videos on cholesterol.
I am so glad you’re back and thank you so much happy new year to you and hope the family is doing very well
To the point about base rates, another good analogy is drink driving. Most car accidents involve sober people, but we would never say that drinking alcohol decreases one’s risk of being in a accident. These numbers are simply because there are much more sober people driving overall, even if the percentage of accidents among people who are drunk is much higher. Great video as always!
Love your videos so much. Thank you for your work!
I am seeing you on the Internet after a long time! I have always enjoyed your videos. Welcome back!
Also, the graph of cholesterol range does imply that LDL cholesterol is not the important causitive factor. The graph can be fixed, not by doing a different study about risk at higher levels, but by dividing the results by the fractions of the population with that reading. If you got a flat line, it would show that there isn't a dose response. Higher cholesterol is correlated to less all-cause mortality in at least two recent studies. The simplistic idea that lowering ldl cholesterol lowers heart disease by the introduction of a statin is like turning off a check engine light in order to fix the engine (at best). Most of the low carb doctors focus on triglycerides and Hdl ratio, not ldl.
Thank you so much. The content you offer is amazing.
I'm so glad I watched this video. I was starting to get confused with all the misinformation. Thanks for clarifying.
Found your channel yesterday over the Plant Chompers channel and already hooked on your nuanced content. Keep it up man!
oh thanks! I recorded a convo with Chris, is it out yet?
@@NutritionMadeSimple hmm, I don't think so... will keep an eye out
love your content, so much to learn from you even as an MD
Amazing explanation as always Gil with some great examples to make it easier for us to understand thank you.
I love the analogies. It really improves my understanding. I have many questions now for my Dr. TY!
Your videos are excellent and really focus of the science behind nutrion and health. Great i stumbled on your content. Keep up the great work.
THANK YOU! Your explanation and analogies made it very easy to understand not only this topic in particular but also how one can be fooled by charts and narratives in general. Hope your mom is doing well.
Confucius said, ... discipline not well, fault of fathers; learning not good, laziness of teachers ...
He works hard to get your attention, his wonderful analogies hook you in.
Really Dr Gil, you clear up confusion so well!! Love your videos.
Brilliant! It's a bless that I came across of your video.
Thank you for being a "real" internet Doctor to help clear out all the false correlations, snake oils and sensationalization in the WWW.
Another great video which explains things in a way anyone can comprehend. Thanks Gil! It is great to have you back making videos. Best wishes to your mother.
Thanks for the very clear explanation! Keep the videos coming!
Just found your channel, great work on this! Subscribed!
Very interesting and well done vid! Follow up Q on cholesterol / LDL levels, what's your take on the Minnesota Coronary Study? My understanding is that the people with significantly lower cholesterol and overall LDL levels were the ones passing away sooner, based on the foods (animal fats vs. processed oils) being supplied in the study. Would love to hear your thoughts
Thanks so much for important topics you cover, so understandable to public, glad I found your channel.
My total cholesterol has been high for 7 years now. Last month, it was 300. But my blood presure was 110/75, and my triglyceride was 61. Leading cardiologists here on youtube say that insuline resistence is the cause of heart disease. So you need to pay attention on triglyceride, not cholesterol.
sadly, that's in all likelihood incorrect. both TGs and LDL-c are markers of essentially the same thing, the lipoproteins that carry them. either metric being very high is a red flag. we have videos explaining this in detail and linking the evidence (which is really all that matters, ignore the claims...)
@@NutritionMadeSimple according to those cardiologists' experience for years with their patients, many with low LDL die from heart disease.
@@lowcarbsgood7847 that's precisely the topic of this video
@@NutritionMadeSimple l just don't understand why doctors everywhere always say high LDL cholesterol causes heart disease. So you should take statin and avoid saturated fat. Eat less eggs and less fat from any kinds of meat. But, statin can cause diabetes and heart disease can be triggered by diabetes. So, it's so suck to me. I drink virgin coconut oil that l make myself 2 tsb twice a day, and use it as cooking oil as well. l eat 2 or 3 eggs every single day. I haven't had any problem at all for years and l am 65 years old now. I just always avoid refined carbs like sugar and flour products like bread, pasta and others. My doctor say l am very healthy.
@@lowcarbsgood7847, ApoB is the key metric. There are various ways of lowering it. If you're taking statins, I'd look for one with a low association with diabetes.
Great explanation! Thank you for sharing your knowledge!
Thank you. You have explained this so well.
Gil - this is the best of your videos that I have seen (have not seen them all yet but I will). Congratulations! This topic to me had become more confusing as time passed.
As usual, you are a great teacher using good analysis and an understanding of evaluating claims & studies. Thank you!
This is the most underrated channel on UA-cam about nutrition. Well done sir, so clear, concise and objective!
I love your analogies .. people often have the perception that doctors know everything.. no..they don't.. they're humans too..they can be biased too . And i totally appreciate your accuracy and how updated you are..
We have to learn quite a lot of things in order to become a doc..a ton of mechanisms , processes , weird hard-to-pronounce names , countless number of books.. ... And it can be totally different from the real world ..atleast that's what what our brain makes it seem ... It's impossible to learn everything..so i learn from you ... Everyday.. I'll be preparing for med school this year... And everything seems so different... We don't get to analyse it ...as we remember and try to swallow it down our throats..
man i love your channel. so glad you're making content again. wish you and your family and specifically your mom the best.
Thanks Gil! So much conflicting information out there. Maybe you could take a look at the healthcare triage video saying how cholesterol isn't in an issue. It would be great if we could resolve some of the conflicting messages.
Good to have you back Doctor. You inspire me on WFPB eating.
Brilliant video explaining the bias behind the misunderstood of this topic. Is there a reason why docs don't measure directly apoB in blood? Why they only measure ldl?
I think that ApoB level determination is more expensive than LDL level. Maybe doctors think that the LDL level is good enough.
(... Or they maybe don't know about ApoB. The cardiologist featured at the beginning of this video is may be an example. ;) )
I don’t think most doctors are up to date on the latest studies and expert hypotheses. The 80’s-paper seemed only like a recent (back then) hypothesis, so that’s probably the reason it’s not part of most current doctor’s education, but now where “the debate is over”, I think it should be and hope so too.
Exactly what I was thinking!
Mostly cuz of cost and only subset of people require apo B measurement
@@osirzz I've been reading comments of videos about ApoB and was amazed that it seems like an exotic, expensive test. I just had my blood work in a walk in clinic in Indonesia and got ApoB test just like that. For about 200$ I had all the works included.
Thanks for your excellent explanation. This is my cholesterol experience. I used to eat the Standard American Diet. I don’t smoke, and don’t drink alcohol. My total cholesterol was often at 235. I had at times irregular heartbeat, intestinal disorders, faint spells, and loss of vision. I went through numerous test, including observation for heart attack risk. In 1987, I was diagnosed through a biopsy from ulcers in my throat with Leukocytoclastic vasculitis (LCV). My doctors advised drugs for treatment only. I could not tolerate these drugs, and against my doctors advice I changed to a selective starch and plant-based diet. This diet has maintained my health for over 35 years. I recently ate extra amounts of olive oil, and my total cholesterol increased to 275. A physical checkup indicated no health issues. Cholesterol from a strictly plant-based diet has apparently not the negative health effects caused by the Standard American Diet. I maintain now a total cholesterol of about 180.
Great video. Clear demonstration of the issues with the logic of the original 'argument'. I usually don't like metaphors but yours were funny, and (more importantly) were only in support of the actual reasoning. Now I need to double check my latest test to see my actual number for my 'normal' LDL :)
I really like that you use analogies, it make this all a lot easier to understand
Excellent video, thank you so much for sharing!
great explanation! thanks for that
Amazing video, and the analogies are very helpful!
I have been looking at various sources on the internet, trying to make sense of conflicting ideas. It has been very stressful and anxiety ridden, because I only want to figure out what the actual truth is, so I can know the best way to manage my health, and I don't have any expertise in the fields of medicine or nutrition to be able to sort through the conflicting messages put forth by people who, on all sides, have expertise. It makes me, as I said, stressed and anxious.
But then I listen to you, and the stress and anxiety melt away as you explain why these conflicting interpretations of data exist, and how easy it is to come to the wrong conclusion. Fewer 7ft tall people bump their heads than do 6ft tall people, because 7ft people are rare in the population, not because their height protects them from bumping their heads. I will never forget that analogy, and it makes so much sense! That and so many other examples of the way of thinking I am learning from you are helping me to stop stressing out as I gain clarity of thought. Thank you!!
What about the claims that high HDL and low triglycerides and inflammation is more important than low LDL? The claim is that LDL doesn't matter as long as HDL is high and triglycerides and inflammation low.
Thanks,
Alex
Im guessing he would say blood pressure, waist to hieght ratio, and fasting glucose are huge to the equation as well. IF you got diabetes, high blood pressure, and a big belly, high HDL and low triglycerides probably aint gonna save you.
Then again, if you have high blood pressure, a big gut, and diabetes, ya probably gonna have high triglycerides, low HDLs, and tons of inflammation to go with it.
@@alg7096 well, you cant have low trig and high HDL if you have diabetes. Diabetes is the last stage of insulin resistance and high trig is one of the symptom of insulin resistance
It is not a claim. There are multiple studies that confirm this. A Longitudinal Study of 25 years out of China showed that a high Triglyceride to HDL ratio was a better predictor of CVD and CHD (and even Type 2 Diabetes) than high LDL cholesterol levels. It was just one of several.
@@johnow7 "There are multiple studies that confirm this. A Longitudinal Study of 25 years out of China showed that a high Triglyceride to HDL ratio was a better predictor of CVD and CHD (and even Type 2 Diabetes) than high LDL cholesterol levels"
There's lots of confusion about this issue because we are doing studies on unhealthy populations with unhealthy diets, and in which the vast majority of people have steadily worsening atherosclerosis. Basically, if everyone plays in traffic, then variables such as foot speed and reflexes become huge predictors of whether or not people get hit by a car. However, the decision to play in traffic or not play in traffic is still the more important causal variable. Similarly, in industrialized nations in which almost everyone has an unnaturally high levels of LDL (and thus apoB too), these other variables wind up being good predictors of risk of CVD events among people who almost all have elevated levels that cause plaque to form. But if you keep LDL levels in the normal range for a lifetime, apoB winds up being normalized too, and plaque doesn't form. No plaque= no CVD events
Watch this doc's videos on apoB, triglycerides, LDL-cholesterol, HDL. High HDL alone has no positive effect on cardiac health. apoB is the best measure of that health.
What about homocysteine levels? And how does it correlate. I'd love to see a video on this subject
Hey .. you got a heart.... Which means he will seen be soon be making a video on this topic
Yes! Our PCP/cardiologist acted like there is no correlation and my husbands homocysteine has been elevated for years. Currently 13.8! Would love a video on this topic.
@@killernug Have him take TMG.
@@killernug Should be under 10.
Happy to see you back on UA-cam, hope all's better at home for you. Happy New Year.
You are awesome. This is important information. I am so happy you are all about presenting good evidence and arguments with none of the personal attack and appeal to authority bullshit that is so prevalent elsewhere.
I wish everyone took the same two valuable courses in college that I took. It was required for my psychology and social work degrees to take "research design & implementation," and " Introduction to statistics." Those clases taught me how to read and understand research studies, and how to determine if there are any obvious weakness or flaws in the study. Thanks for this video. I have been trying for a long time to find the full truth about cholesterol. I feel well informed now. I just resumed my cholesterol medication yesterday after watching another of your videos on the same topic.
we have a whole series on statins coming up discussing all the evidence and FAQs
I have subscribe to you due to the fact that your topics are always fair and unbiased and Truth seeking. You use peer reviewed studies, and studies that are randomized and double blinded. You do everything that the science-based community requires! There is no anecdotal evidence. Ihave lost 73 lb listening to Dr Fung, Gregor and Kim Williams. At 51 I'm in better shape than I have been in a decade, I have the scale and the labs to prove it but I'm always looking to better myself. Your information has been extremely valuable, thank you so much for everything you do, you have a loyal follower!
You're explanations are enlightening. Keep suppling those analogies.
Great info and love the analogies, makes it easy to make the point.
Awesome video, concise and thorough. Many thanks for uploading, very important topic that has many people confused. My brother who is obese has heard from his nutritionist that LDL is actually good for you and to demonize carbs.
I am in the medical field, and one thing that has never made any sense to me is the fact that, although lipoproteins, and their cholesterol cargo, are being carried systemically throughout the entire bloodstream, the vast majority of atherosclerotic plaque is deposited only in the arterial walls associated with the left side of the heart. In other words, unless a person has pulmonary hypertension, you will not find these plaques in pulmonary arteries, and never in veins. So this points to the fact that there must be an additional factor here connected to the higher pressures in the left side arterial system and the subsequent inflammation and damage being caused to the endothelium that begins the process of the body attempting to repair these damaged areas. This, I believe, is what causes the very complicated process that deposits many different components from the blood into the intracellular matrix. Additionally, the consistently high levels of glucose and insulin in the bloodstream of the typical American eating an abundance of carbohydrates adds to the inflammatory process and the cascades that facilitate this deposition in the arterial walls.
hi, yes BP in arterial territory is a factor & blood flow properties. inflammation, hyperglycemia etc can accelerate but aren't necessary, see this Monday´s video on this Q
I'm someone who changed my life around through the online advice around keto and fasting. I've lost 100 lbs, look and feel 8 years younger than I am. I was one of the people saying obviously saturated fat isn't the enemy, cholesterol is not the problem, while showing really promising results. HOWEVER, I found your channel about 6 months ago and now a big follower of your channel in addition to my other channels I follow, and you feel like a teacher to me who continues to also give me doses of reality, and to help PUSH me to continue being a lifelong *learner*, and to continue challenging everything I think I "know". Thank you so much for all your work and giving me new perspectives to consider!!
Love your analysis, just subscribed
I learned something new today. Good to know what to test if I want to know my risk.
Amazing information thanks very much for sharing
Great video doc! Thanks for clearing up confusions and fighting for the truth!!
thank you so much, especially to clarify all the misinformation online. do you know for a person with mild plaque buildup, would successful maintaining a good target TC (
Great explanations!! Great video.
Love the content and really appreciate the effort to clear up confusion. One question though is why ApoB is not used as the indicator for risk instead of looking at cholesterol numbers or is it? Could you also state the range of ApoB that is considered high risk? I don’t think I have seen this in any of my lipid profile results.
excellent Q and I think this will change in the future.
Widely publicized tests and mass marketable drugs are correlated.
There was a paper published that concluded there is a 93 to 96% accuracy using the formula:
ApoB = −33.12 + 0.675*LDL + 11.95*ln(triglycerides)
With my numbers:
ApoB = −33.12 + 0.675*156 + 11.95*ln(96)
my ApoB = 126.72
So if I cut my triglycerides in half:
118.44
cutting LDL in half:
74.08
Please do a video on creatine. I find such conflicting info on if it is good to take or not. I noticed my BP increased some while taking it so I stopped and now my BP is back where it was before, but according to a lot of info out there it shouldn't have this effect...and then some ppl say it's really bad for your kidneys. I would love some clean cut facts please :)
I’m not native English speaker so these simple explanations are great! Good video!!
Great show. Clear and simple Perfect way to teach and debunk based on data
Olá Dr. Carvalho. Good video. I appreciate your candor and openness. Please discuss Lipoprotein(a) and CVD and it's relationship w/ apoB when you havd a chance. Obrigado.
The multiple analogies in this video are brilliant!
It's fantastic that YOU focus on the substance so well and not rely on people's claims, but I think others (like me: not a doctor, but educated and interested) will still have to rely on people like you. It can become really hard and confusing to make sense of all the claims and research. You really have to dig into the research, and have an excellent understanding of the science, to make clear sense of it all. Of course, the benefit of the way you explain things, is that a person like me could perhaps (almost) understand the research by now, if I'd have the time for reading all those papers. Anyway, that's a big accomplishment, so a big thank you, again.
This channel is going to blow up. I am so glad to see someone who is capable of explaining the disconnect between science, medical proffesionals & nutrition influencers.
You're an incredible communicator 👌👍
Thanks for the video. APOB, best range or number is what? Appreciate your information.
Thank you for interpreting data and putting it in context. Hucksters often do the opposite & cause a lot of harm to the unwary.
Throughly eye opening. Thx.
Welcome back, Dr. Gil
thanks for the information!
Glad you’re back and doing the health and nutrition subjects again. What’s your thoughts on the book “Good Calories, Bad Calories” by Gary Taubes?
Hello, I understand that if we are following LDL-C the lower the better with the chart showing best around/under 60. What range are we seeing in ApoB that we are trying to keep numbers around for best functional term not necessarily accepted range? What other tests are we monitoring? Thank you for your channel. You do such an amazing job explaining everything.
hi, I´m interviewing a leading lipidologist next week and hopefully releasing a series of videos soon, we'll cover all the FAQs on ApoB and much more, stay tuned :)
I saw that Tweet and it's sad and depressing. A cardiac surgeon is also not a cardiologist but many will not understand the differences there. Total cholesterol is a crude measure of risk at best, but that does not = it should be ignored either, as it's rare to see high total yet otherwise excellent fraction profiles.
Thanks for another great video!
I’m new to your channel and so far I like your reviews of various nutrition topics. I enjoy ‘Mind Pump’ and Layne Norton’s channels. I’d love to hear your take on some of their views. Also, what does your exercise regimen look like? Do you strength train or do any cardio?
i'm not familiar with mind pump. i've seen a couple vids by Layne. i think we agree on the fundamentals. i normally do weights + some cardio - but with the family health crisis i barely have time to sleep, fitness went to hell... :(
will get back on the horse asap and maybe document it
Doc
Thank you for an intelligent response and educating the rest of us. Joe Weston B.S. (Mathematician)
It would be great for advancing the conversation if you had a dialogue with doctors who are experts in & recommend clean keto.
Thank You ..if i may ask..CAD reversible? curable? Lookin forward.
If 50% of his patients have normal cholesterol and 50% have abnormal cholesterol
That is irrelevant as the pool of normal cholesterol is much larger than the pool of abnormal cholesterol.
That is why we use x out of 100,000 to keep the relationship correct.
Analogies and cat videos are both awesome!
Good video, sir. Please tell me if ApoB is a better indicator or TG/HDL is a better indicator. What is your opinion on residual cholesterol (total cholesterol minus LDL-C minus HDL-C). Also, if LDL-C is low, can somebody have high ApoB?
My question is, how many confounders have we identified outside of ApoB? I read and interesting book called The Plot Thickens that discusses an alternative hypothesis. Would be great for you to discuss his arguments.
Great video! Keep up the good work :-).
Excellent video. Absolutely first class.
Literally one of the most important videos in the whole world right now. This video should be shown in every school.
Had heart attack June 5 2023..72, male 6 ft 2 166 lbs..3 stents… cholesterol 140, ldl 90..hdl 30, triglycerides 300
Thank you for this explanation! I had a full check up with my doctor who told me my cholesterol level was on the high side so to watch my diet etc. Confused as I eat mostly fresh produce and have VERY little processed food, exercise almost every day and my job keeps me on my feet, yet in comparison my flatmate who eats mostly fast food and sugar, has a sedentary job and only occasionally exercises, has a lower cholesterol level. Guess it's a little more like the BMI - a guideline vs a fast rule?
isn't bmi accurate if you dont exercise?
you eat too much milk, butter, animal foods... those are the cause of high cholesterol
@@ruterosdelmorro good try, that has been proven to not be the case. try to stay in 2022 instead of the 80s and 90s
Genetics plays a role, what were your actual numbers? how old are you compared to who you live with? How stressful is your job and life compared to who you live with? What exactly are you eating? May be something in your diet causing inflammation. Lots of possibilities
@@ruterosdelmorro 👍🏽