Beyond LDL: New Insights into Metabolic Health and Heart Disease

[@DK-pr9ny]

Sadly, most cardiologists only focus on LDL and prescribing statins..

[@michaelhegarty788]

Excellent explanation, thank Dr 😊

[@misterbaleize]

Fantastic presentation; thank you.

[@KevinG-159]

Thanks Doc! You have a great way of explaining a topic most people don't understand, (me.) All your videos seem to be like this! Again, thank you!

[@CashMoneyMoore]

The data is clear, get your metabolic house in order before worrying about LDL. Reducing your blood glucose, and triglycerides are dramatically more influential on health. The question will be whether ldl in those individuals is nearly as concerning as it is in metabolically unhealthy individuals. At that point it's just about whether you're willing to take lipid lowering ldl drugs or not. Feldman's work will provide much more insight

[@TheCompleteGuitarist]

I would say stress and sleep health are high on the list yet completely ignored as well as sun exposure.

[@metabolicmind]

Agree!

[@donaldmcpherson3226]

A super interesting video!

[@lauriaarnipuro5312]

Really usefull information-thanks!

[@justin333eb]

Interesting points! It’s amazing how much misinformation is out there. 'Health and Beauty Mastery' by Julian Bannett totally changed my perspective on what we’re told about health and wellness. Highly recommend for anyone who wants the full story!

[@AnnaLorris]

totally agree

[@bettesmith1117]

looked for the book on Amazon... not there. Odd.

[@alpoztan]

😮it s by design. Confusion causes mistrust ,so you can not see the truth.

[@dacisky]

My cardiologist is obsessed with the ldl and does not even care about what I'd like health with.I'm also a lmhr.

[@firstchoicefarm7767]

Same here. The doctor had no idea what LMHR was and when he looked it up, he just found the one case of a guy having issues who went on keto diet and he died. They just called him a LMHR, but there's no evidence of it. I fired him.

[@uphillbill]

You can take all these recommendations by this guy and the millions of youtube doctors out there and you may possibly live forever........that is until things change in 2 years, then it might be different.

[@biowm]

I think the comparisons of LDL/lipids to diabetes needs more context. The former are individual biomarkers with HRs expressed per standard deviation (SD) increase, while the latter is a diagnosis made via biomarker threshold (e.g. HbA1c) and so represents an advanced pathological state associated with many elevated biomarkers - BP/PWV, TGs/VLDL, glucose/insulin, CRP/LPS, ceramides, oxidation, etc. The fairer comparisons would be between biomarkers or diagnoses (note the HRs for SDs of HbA1c are similar to LDL). But as you suggest the constellation of risk factors associated with diabetes may account for its high HR and make it a priority. On the other hand, we have lots of studies on low risk (healthy) people showing LDL still correlates plaque and CVD (e.g. PESA, CARDIA, Cooper, etc.). As Libby points out, recently there has been a major shift in the typical CVD risk factor profile paralleling the global obesity/diabetes epidemic, but this doesn't make the traditional risk factors irrelevant. It does however create opportunities for misrepresentation.

[@markotrieste]

Why didn't you mention TG/HDL ratio?

[@metabolicmind]

That is a very good marker of metabolic health. It wasn't completely relevant to the study in question, but we are big supporters of people following the ratio as an important component of metabolic health.

[@rdc3397]

​@@metabolicmind and what is the ratio?

[@lloydhlavac6807]

@@rdc3397 It's best if your triglycerides are lower than your HDL.

[@jamiehayes6714]

Your statement "Metabolic dysfunction results in first chronically elevated insulin levels and eventually elevated glucose levels." perplexed me. I thought it was the other way around "elevated glucose leading to elevated insulin leading to insulin resistance". Brett, can you explain the nuance? Keep up the great work!

[@metabolicmind]

Thanks for the comment. You are correct that glucose levels start to rise, but we often don't detect that because the body compensates by raising insulin levels to keep the glucose levels in check. So, when we test for glucose, it may look "normal." However, this ignores the fact that the insulin level is elevated in an effort to maintain the glucose level. Then, eventually, insulin resistance increases to the point where the body can no longer keep the glucose level in check, so the glucose starts to rise. We hope that explanation clarifies it!

[@jamiehayes6714]

@ perfectly clear thanks Brett

[@345kobi]

The value here would have been 10 fold if it had included specifics on improving ones metabolic health.

[@georgewright1093]

This is totally wrong. It has been proven over and over again that Oreo Cookies are the key to good health. Eat as many of these as you can, for breakfast, lunch, and dinner. Wash them down with Mountain Dew or Coke. If you need a break and some variety, have some glazed donuts and Doritos, or some Twinkies. You will feel fantastic after eating these super foods.

[@timledbetter1781]

Corporate America's guidebook for a healthy diet 😅😂

[@maddy-L98-c]

Would following the medical keto diet help fix the structure of your heart or just the strength of the heart valves to where surgery is needed less and less

[@metabolicmind]

We are not aware of any data or experience that ketosis benefits heart valves.

[@biodivers5294]

Book: "Why we get Sick", Ben Bikman

[@Lssj100]

Book: "Good Energy", Casey and Calley Means

[@ssa8479]

Book "Doctoring Data,' Dr. Malcolm Kendrick

[@whlewis9164]

@@biodivers5294 love me some Bikman

[@GlennMarshallnz]

Book: Lord Of The Rings, J R R Tolkien

[@LetitiaDobosy]

Very useful but please slow down. For many, this is new info and, absent a transcript, we need to be able to understand every word you state. Also, it would have been helpful if you defined “non-HDL.” LMD

[@RainerMaelger]

Danke !!!!!

[@alexanderheyworth3242]

The other factor you didn't mention is the impact of metabolic disease on your mitochondria.

[@tallgrass9366]

Why do cardio doctors push statins when statins in nnt data have a higher association of causing diabetes than preventing cardio events?

[@salleone6387]

Can someone have good triglycerides (below 60) and still be insulin resistant? I've reduced my carb intake to 100 grams a day and my triglycerides have been in the 50's for years but my a1c continues to creep up?

[@metabolicmind]

It is possible, although less common. Triglycerides are a very good marker of metabolic health, but no one marker is perfect. It's best to use a combination of findings such as fasting insulin, CGM readings, TG:HDL ratio, etc.

[@salleone6387]

@@metabolicmind Just curious but have you had any experience with numbers being off after COVID? As I said my Triglycerides, as well as other Cholesterol numbers, have been fairly stable for years. I had COVID in August and took a cholesterol panel in September. All my numbers, while still fairly normal were off, HDL down by over 10 points, Triglycerides up into the 70's, LDL down a few points. Very odd.

[@jons2447]

*FINALLY!*

[@nickf2170]

Could someone have ideal levels of HDL, triclycerides, LP (a), no inflamation.....but still have an APO B that is above the recommended top limit? And if yes, does that higher level still carry the weight of being a "high" risk factor?

[@metabolicmind]

The answer to the first question is yes, and the second question is unknown, but there is reason to suspect the answer may surprise many in the medical field. Here's a video we did about this question. kzbin.info/www/bejne/qHbFqX-bZph1gdk.

[@Shakerhood69]

I am a LMHR with high LDL and Apo-B, add some carbs in to bump those numbers down a little.

[@-What-are-your-thoughts]

My understanding is if your LDL is elevated your apob will be elevated. What is your LDL Pattern A or B ? Also what is your high sensitivity c reactive protein ?

[@nickf2170]

@@-What-are-your-thoughts Lab report states my LDL is pattern A and CRP was green (.9). APO B is 144 and doc is pressuring me to go on statins. I see that as last ditch for me.

[@nickf2170]

@@Shakerhood69 I suspected that as well, thanks. My carb level was quite low, but felt great. Recently I added in small amounts of quinoa and buck wheat for some additional carbs. Also just added Niacin. I'll get another lab test in several months and see what nets out. Thanks again. You a mustang guy?

[@ang1783]

use statics only can lead to wrong prediction. should use cause and effect

[@maidomaidonaidekka]

Insulin rips off the glycocalyx in arterial walls, thus leading to damage and hypertension...

[@ShoppingEmail-dr1fs]

one never hears about the glycocalyx. so important.

[@btudrus]

not insulin, but blood glucose and blood fructose!

[@stevelanghorn1407]

And yet many prominent health & nutrition KZbinrs who don't advocate / promote Low Carb / Keto / Carnivore diets still quote "mainstream advice" regarding the CVD implications of high LDL. It causes a lot of confusion for Joe Public...particularly those with heart issues. And there's always a little nagging concern that it may be in the best interests of "our gang" to convince ourselves that high LDL is "no problem whatsoever"! I try to keep an open mind regarding this on-going, "click-baitey", hot topic.

[@marklondon3823]

The Hazard Ratio data that you showed is different for men and women. Can you elaborate on the gender issue in a future video?

[@randyjnaron]

Talk to your healthcare provider before changing lifestyle, because they know so much 😂

[@whlewis9164]

Have an irritating, expensive and ultimately fruitless discussion with your healthcare provider before changing your lifestyle to carnivore which will put them out of business. 😂

[@metabolicmind]

Or better yet, find a healthcare practitioner who works with you! Here are a few directories that may help find someone. www.diagnosisdiet.com/directory thesmhp.org/directory/ www.dietdoctor.com/low-carb/doctors nutrition-network.org/find-a-practitioner/

[@ssa8479]

Doc: "You don't do that keto thing, do you?" Me: "Actually, I do! Never felt better, my weight and fitness are in a good place, I sleep well, full of energy all day."

[@dannyc9784]

I couldn't care less what my LDL is, in fact the higher the better. The higher it is the longer humans live. Carnivore FTW!!

[@dennisward43]

LDL is probably one of the worst markers of metabolic disorders. New York University nutrition professor Marion Nestle began informally tracking studies funded by food and beverage companies, as well as trade groups, in 2015. Her research uncovered 168 such studies in that year alone, and of those, 156 showed biased results that favored the sponsor’s interests, she told the Guardian. Ergo nutritional studies are tainted and irrelevant. What matters is actual science (anatomy, physiology, biology, carbon and nitrogen isotope findings, etc) not associative assumptions alluded to in manipulated studies

[@johngriswold2213]

This attempt to untangle the causes of coronary artery disease does not exist in a vacuum...people anxious to support a dietary lifestyle choice may well tend to grasp at your hypothesis to judge that choice as harm free, which may not be the case. Coronary artery disease is our prime killer, but not the only one. Your videos are fairly obviously in support of a "ketogenic" diet, which for most people is one high in animal proteins and fats. There is significant evidence of a raise in all cause mortality risk as consumption of animal based foods raises, and a corresponding lowering of that risk a consumption goes down. I hope you understand and are addressing these data and are aware of the power you have to influence people's health choices.

[@metabolicmind]

Thank you for your comment. As we state in the video, a big problem with the data and assumptions that exist is the presence of underlying metabolic dysfunction and usually a poor background diet quality. So when someone is metabolically healthy and eating an overall high quality diet, things tend to be much different. So, if we have "power" as you say, we hope our influence leads people toward prioritizing metabolic health and a high quality, whole-foods diet.

[@peterbedford2610]

Huge amount of data correlation should not be ignored

[@ChuckMcC]

Borderline Niacin Deficiency....