Exercise shrinks Plaque, but it does more than that…

[@MikeStabler]

Most people with peripheral artery disease, atherosclerosis in their leg arteries, like myself, know about the development of collateral arteries via exercise. We walk until the ischemic pain precludes more walking, rest until the pain subsides, and then start walking again, repeating the process again and again. It works! The distance without pain keeps increasing because of improved blood flow. Standard procedure for PAD patients. It works for stable angina too. Thanks for your videos, excellent work.

[@hikedayley9309]

I hike daily. Been doing it over 40 years. Climbing hills is easy for me. Zero calcium score. I try to eat mostly good natural food. But I do have some cake, pie, ice cream, candy and pizza . I have normal blood pressure. don't smoke or drink alcohol and I don't hang out with people who practice self destruction. Life is good.

[@Physionic]

Your username fits your character. :) I'm really glad - you're living well. :)

[@hikedayley9309]

@@Physionic I try to keep it simple. Nobody gets out of here alive. I'm just not in a hurry to go. I have 8 grand children with one (a boy) on the way

[@Physionic]

Congratulations!

[@mjt1517]

Don’t drink, don’t smoke…what do ya do?

[@jameswalter3136]

Be grateful you don't have arthritis.

[@brianrasmussen2956]

I had never heard of "collaterallizing" before. thank you for your continues efforts to bring this high end content.

[@Physionic]

Me neither... haha! Thanks, Brian!

[@seahog32]

I have. Makes me feel uselessly superior.

[@Joseph1NJ]

Probably the most concise video on the subject I've seen. You have a superior skill for articulating complex subjects.

[@Physionic]

Thanks Joseph - that's really kind of you. I work at packing the videos with new information without getting too repetitive. Thank you.

[@joecity9]

I would add he seems to have an outstanding skill for finding humour in medical science. And, before you ask, I don't mean blood, yellow bile, black bile or phlegm.

[@Physionic]

Good one :)

[@Jeffs60]

I like how he shows how to reverse plaque, age spots and wrinkles on an 80 year old and how the special diet and exercise reverses the drainage system for glaucoma patients who are slim and have all perfect lab tests.

[@drott150]

The interesting thing about the process for the body creating its own bypass via collateralization is the same process of how a river creates its own "bypass" when it's gradually dammed up by some obstruction. The turbulence you describe triggering the artery to create a branch artery is directly analogous to the river's water turbulence eroding the beginning pathway into the shoreline for what will eventually become a new parallel pathway around the obstruction.

[@Physionic]

I love the analogy

[@milanpintar]

@@drott150 this is what happened to me in 2023, i had a long term 100% blocked LAD which was found during an angiogram. After the stent all my symptoms disappeared, it all started after a high intensity personal training session 12 years ago. oh they found i had grown new arteries.

[@drott150]

@@milanpintar Congrats on the successful stent. But why didn't the parallel new arteries create relief on their own without the stent? Or was it that the new arteries may have been keeping you alive, but they didn't create enough flow to fully restore circulation so that you felt well?

[@petertownsend252]

​@@Physionic This is cool. I never thought this topic would ever wander into my academic field (Geology, more specifically and Fluvial Geomorphology). The "bypass" process described in the lead comment is called stream "avulsion". Avulsion occurs when the sediment load is too high (sediment load has increased and/or the stream energy (flow rate) has decreased. The stream bed fills with sediment until the active stream flow overflows the banks (typically during a large low frequency flow event) and down cuts a new straighter channel across the former floodplain. This has the effect of shortening and straightening the stream, thereby increasing the gradient (energy) of the stream to achieve a new homeostasis (equilibrium) between the sediment load and the flow rate of the stream. Avulsion tends to happen suddenly and episodically in response to am unusually large catastrophic flow event with a very stark near instantaneous before and after configuration of the stream path. The opposite process of stream avulsion is stream "meander". Stream meander occurs when there is a decease in sediment load and/or an increase in stream flow (energy) resulting in gradual bank erosion and cutting (during moderate intensity flow events that do not over top the bank) focused on the outer bank of the stream where the flow velocity (energy) is highest and deposition on the inner bank where the flow velocity is lowest. This has the effect of slowly and gradually increasing the overall stream length over time, thereby decreasing the stream bed gradient (energy) of the stream to achieve a new homeostasis (equilibrium) between the sediment load and the flow rate of the stream. So an overall sort of mixed bag of yes and no with the river analogy. The plaque "plugging" process (avulsion) in the stream analogy would tend to shorten and straighten the blood vessel length if the analogy where to strictly hold. An avusion event would be more like a sudden catastrophic event akin to a sudden heart attack where a large chunk of plaque breaks loose all at once. However, the increase in velocity caused by the plaque plugging process would also cause gradual slow erosion of the outer bank (blood vessel wall) leading to the cutting and formation of a new longer channel path "meander" around the plaque blockage. So if a I am voting, I would call it something of a hybrid mixed analogy with elements of stream avulsion and stream meander processes, but tending much more to a slow gradual stream meander analogy. The initial "plugging" has a strong overtone of the process which leads to stream avulsion, whereas the development of collateral blood flow passages around the blockage has an overtone of stream meander.

[@dscarson1]

I had a venal occlusion in the retina of my eye. The retinologist injected (!) a medication into the eye that had only been FDA approved for treating, of all things, colon cancer. But it produced collateral vessels in the retina and the edema was completely eliminated.

[@johntim3491]

🥴

[@credterfe]

多謝！

[@Physionic]

Thank you!

[@letsthink2819]

I am Engineer by profession surrounded by Doctors in the family. But you did the best job my friend.. truly appreciate your efforts.. beautiful presentation and engineering representations. 😀

[@Physionic]

Thanks!

[@EstamosDe]

Watching this while making my morning exercise 💪 Greetings, from Chile

[@ivyr336]

Hows the weather over in Chile?

[@Christopher-b1p]

Watching cherries from Chile go on sale. Wow!

[@Physionic]

You rock - keep it up!

[@EstamosDe]

@@ivyr336 hoot, its hard to do exercise during the day, even being in front of the fan, that is why Im trying to do the most demanding exercises in the morning (now its 82°f/28°c at 13:39 in Santiago, in the side of the building that is permanently on shadows, outside is even worst)

[@EstamosDe]

@@Christopher-b1p there are cherries and sour cherries, sour cherries are amazing because of their melatonin content (pistachios have even more, but also more calories), good for sleeping, have you tried them? Picture a pistachio veggie milk with sour cherrie juice: perfect sleep? The only problem with sour cherries here is that we have something like 2 weeks of them a year, Im not sure btw

[@Tenzordk]

Thanks for the take away!

[@philpecoraro5458]

Do-overs are a good thing! Obviously it is so much better to prevent than reverse, but the information is so much better today, and so much more available. Great video, thanks!

[@Physionic]

Definitely, Philipe!

[@JohnnyBoy-c4b]

I enjoyed this. And it speaks to my thinking that the cliche "You can't outrun your diet" lacks nuance. Thank you!

[@ConniePretula]

Mind blown so early in the morning 🤯 🤓 The body will never cease to amaze me. It is so fascinating how hard it works at keeping us alive regardless of what we do to it with less healthy lifestyle and eating habits. You continue to increase my knowledge, thank you 😊

[@Dard_heck]

You’re such a 🔥nerd!

[@invertage]

I'm turning 60 in 7 weeks, I'm taking a calcification test around then. It cost $150 with having insurance. My cholesterol is high, but my LDL to HDL ratio is good. Low carb clean Mediterranean-ish diet, 2MAD, no processed, no added sugar. Fasting 16/8 daily, 24 hrs weekly, 72 hrs monthly, workout 5 or 6 days a week. I'm hoping for a clean score on test.

[@gefumiracle5032]

Good day physionic I am faithful follower of your channel and also like the diagrammatic explanation you give.Thank you for the knowledge u brings to us all.

[@Physionic]

Thanks for watching :)

[@fyrerayne8882]

Great, thank you

[@peterbedford2610]

Im 66 and have done resistance training and hiit for many years. BMI is 21. My recent CIMT puts my material age at 46.But, it showed soft plaque. My CAC was 150 three years ago. Ive been eating WFPB for many years. So, I guess exercise has served me well.

[@MrTea7]

Anybody decode WFPB? Don't recognize that one.

[@k.h.6991]

@@MrTea7 whole foods plant based. It's a way of eating that is, like exercise, good for arterial health. It's about eating a plant exclusive or plant predominant diet, usually consisting of fruit, vegetables, legumes (beans, peas, lentils, tofu and tempeh), nuts, seeds and whole grains.

[@m4inline]

Whole grains are without doubt bad for you full stop.

[@Gluttonyed]

Great motivation for me to start exercising.

[@AlanWil2]

High blood pressure is a genuine problem and will likely lead to a stroke and/or heart attack. A person definitely needs to fix this problem right away.

[@Physionic]

No doubt

[@stevemc2626]

Everyone excepts that high blood pressure is bad news. But at the same time when resistance training acutely the blood pressure can go very high. So why do we not get worried about these spikes? Has there ever been a study where they look at ‘average daily blood pressure’ rather than resting blood pressure and the link to poor outcomes?

[@mjt1517]

@@stevemc2626 it’s expected when you exercise. It’s therapeutic rather than harmful.

[@stevemc2626]

@@mjt1517You’ve missed my point. I know the data shows that resistance training improves many outcomes and when you train your blood pressure spikes but that doesn’t mean the spiking blood pressure is therapeutic.

[@ForwardFeedback]

@@stevemc2626 I don't understand your point. If someone has resting high blood pressure then they're constantly in a worse state than someone with normal blood pressure who lifts weights for

[@DIABETESHEALTHS]

I learnt about collaterals 30 years ago when I had my first heart attack. call it anjaina attack. Cardiologist told me that I saved my life because of my collaterals.

[@theonetrueshibe9567]

I love this deep dive to Atherosclerosis. Everyone so far was just talking about how to manage but hearing these reversal effects are great.

[@Physionic]

It's a growing field, but so far, it's mind blowingly cool!

[@NoLimitsNatty]

Thank you for all the information

[@Physionic]

Thank you!

[@paulshearer9140]

Thanks

[@BillyBoy66]

I will say, that stuff about angiogenesis is very cool! Any more insights as to how this happens? Very cool topic, Nic!

[@dennisward43]

The magic of evolution?

[@BillyBoy66]

@@dennisward43 That's doesn't answer anything.

[@givemethejob3293]

Fascinating talk Nicholas. From an engineering stand point and shown in the athletes chart. Exercise will increase blood flow considerably and blood pressure if its heavy resistance training so if turbulence in the arteries together with high blood pressure is responsible for atheromas there must be a level or another factor at play. It all starts with damage to the glycocalyx (not shown) then the endothelial layer. Or does it?

[@drott150]

I've heard it is possible under certain relatively rare circumstances for calcified plaque to be removed. Documented with people on aggressive lipid lowering strategies, some of them have regressed their CAC scores. You've explained how soft plaque can be migrated out of atheromas under the right conditions...but how does the same happen for calcified plaque?

[@partridc00]

@@drott150 I don't know for certain, but off the top of my head, there are 2 things which might help. Vitamin K2: as MK7 or MK4. This can help reverse calcification of soft tissues, and steer calcium into bones where it belongs. Magnesium: this helps keep calcium in solution in the blood and thereby reduces crystallisation and calcification of plaque. Possible third option: thrombolytic enzymes such as serrapeptase and nattokinase. Plaque is not 100% calcium, and the enzymes can help break down the protein matrix which forms the body of the plaque. These are just off the top of my head, but I believe the information is correct.

[@Corkfish1]

If it was easy as taking a few vitamins everyone would do it. Statins are the only way to achieve any regression and even then it's minimal

[@brennus01]

Very cool! The body can make it's own bypass. That blood vessel bypass info is some of the coolest info ever...not as cool as cells stealing mitochondria...but, still, very interesting.

[@Physionic]

Did you watch my video on stealing mitochondria?

[@brennus01]

@@Physionic Yeah. I had that photo as my background for a long time. I'm probably half the views on that one.

[@Physionic]

You're my kind of person - I still think that's the coolest discovery of 2024 for me.

[@JamiGoss-f3h]

Thank you for great information. I wonder what the affect is on LPa?🤔

[@randombartz8163]

Video topic suggestion: Could you talk about this same topic but in the context of the brain/strokes/alzheimer instead of the cardiovascular system given that the brain has a separate cholesterol pool due to the blood brain barrier and the fact that most LDL lowering interventions target the liver (which won't directly help with lowering LDL in the "brain pool", although it could possibly indirectly help by indirectly changing gene expression in the brain due to systemic changes or something).

[@Physionic]

Interesting - I like the idea...

[@petertownsend252]

My dad ended up in the ER with a sudden heart attack at age 76. He had one artery that was 100% blocked, another that was 90% blocked, and three that were 70% blocked. The cardiologist explained that he was alive because the plaque accumulation occurred slowly over time which allowed for the development of many small collateral flow bypass vessels around the primary arterial blockages. The cardiologist analogized the situation to a large traffic accident that that closes down the main freeway, causing traffic to exit the freeway upstream of the accident scene, reroute through various minor surface streets around the accident scene, before rejoining the main freeway downstream of the accident scene.

[@rainserene]

Interesting, another knowledge related to artery are now written in my book. Please do more videos related to this matter sir, here some coffee for caffeine boost ☕️

[@Physionic]

Thank you, I will

[@DrProfX]

In fact, cardiologist from Switzerland published an article on his own growth of collateral blood flow as he was increasing his weekly running volume!

[@SD_TSD]

@@DrProfX can you post (reply to this message)the title of that article? I’d love to read it. I can also share it with my aging family members and friends. Thanks!

[@paulonunes2591]

Our body is really cool!!!

[@coolsatpalsingh2]

Best test to know the plaque or heart condition

[@archstanton3763]

Is nitric oxide playing a role in plaque reduction ? Interesting video, thank you.

[@Physionic]

Probably not - it helps in preventing heart attack and PAD, but it doesn't necessarily have a role in reversing atherosclerosis

[@glenneric1]

When I was wearing my continuous glucose monitor I noticed that walking dramatically and quickly lowered any blood glucose spike I may have been experiencing after food. And what I've read is that these blood glucose spikes can lead to arterial plaque. It would be interesting to know how the timing of exercise with respect to eating affects plaque.

[@StevenBrener]

Would this include resistance training?

[@Physionic]

No evidence of that up to now

[@notaras1985]

Dr. Physionic? What are your 2 Favourite mitochondrial support supplements? Thank you in advance ❤

[@jameswarhol442]

Not clear if the collateralized new artery is equivalent to the old one? Is it exactly the same as the old one in terms of how it functions? Is it more like a smaller vein which is not susceptible to high blood pressure? However everything seems to revert back to the two usual suspects: LDL (Apob) and HTN.

[@fredrikhviding3334]

Praise God for His wonderful creation! We just have to follow and do what He made us to do

[@DARRONLing]

thank you. it seems like you need to be your own doctor these days. for everyone reading this i recommend the book the hidden herbs by anette ray

[@maskofthefather3138]

5:06 OMG😧

[@davidking3699]

The conflict with the calcified caps and Vit K2 that supposedly removes calcium from the arteries is something I would like to see clarification. K@ is good for bones in combo with D3 and Vit C, but can it be making arterial issues potentially worse...?

[@triviamolemais7253]

@@davidking3699 Good question! I m interesting to know the answer or the explanation 👍

[@jimdandy8996]

It will erode the calcium lattice and then possibly fragment and occlude.

[@sigmamalegrindset132]

its just association. Arterial calcification from blood turbulence / high bp and cholesterol plaque from endothelial dysfunction, not calcium in blood or cholesterol in blood.

[@charlestoddsullivanforpres6628]

In the 90s, JAMA had an article showing rearrangement of connective tissue in the endothelium in response to laminar, pulsatile flow conditions - like you get with exercise. Turbulent flow made the fibers look like spaghetti. Pulsatile flow made them align like re-bar. This makes it less likely for damaged endothelium and thus no infiltration of lipids and the cascade that follows.

[@chrisk8978]

Great info as always. I have been wondering of late if there is another overlooked benefit of exercise: enhanced endogenous infrared light generation. While most is in the 3k-50k nm wavelength (mid infrared), there seems to be some evidence of metabolic benefit in that spectrum as well. Just a thought…

[@petertownsend252]

I am curious how my exercise regime (long duration, low to moderate intensity) might fit into this discussion? Maybe somebody could provide some insight? I have a dog in the fight as I had a CAC test done in 2023 that showed a total plaque score of 180. I believe the plaque is likely an enduring relic of my first 55 years on the standard american diet (SAD) when I suffered from a variety of metabolic problems. I plan to repeat the CAC test sometime this year to see if the plaque score is stable, decreasing, or increasing. I am a 61 year old long distance thru-hiker. I hike carnivore and OMAD. I hike in a fasted state and eat one meal after I am done hiking for the day. I am now 5 years keto and OMAD and 2.5 years carnivore and OMAD. Keto and OMAD quickly reversed all of my medical problems. I currently have no medical problems and take no medications, vitamins or supplements. Vitals and lab blood work all very good. Resting heart rate is in the high 40s. I had comprehensive blood work done after about 90 days on-trail last year. Not surprisingly, fasting insulin and C-Peptide were at the bottom of the reference range. NMR lipoprofile shows low risk of cardiovascular disease and high insulin sensitivity. 5 of the 6 NMR parameters were pegged to the green with a couple off scale below the reported lab detection limit. Insulin Resistance Score (LP-IR) was reported as off-scale low

[@therealscot2491]

So what cardio would you recommend doing zone 2, or zone 3 ? Thank you!

[@partridc00]

Without trying to sound facetious. The best cardio is the one you do regularly. The one you can make a habit. This is personal preference. I like HIT. Although it does seem that for this specific issue (vessel plaque), medium intensity seems best. Super high intensity can dislodge plaque in severe cases.

[@mikaelajasonnn3]

Thanks. Has anyone heard of the book 'Health and Beauty Mastery' by Julian Bannett, can’t believe how underrated it is. This book has some serious knowledge you won't find anywhere, definitely recommend.

[@MikeW-t6l]

yes thanks

[@energysourcelove]

The website that offers this book says Big Pharma banned it. There are lots of books that trash Big Pharma that are not banned. Something is fishy here!

[@sigmamalegrindset132]

11:35 Arterial calcification sure may make it more stable, but also way harder to get rid of no?

[@stevenfenster1798]

Have you done a video on serrapeptidase?

[@ChuddmasterZero]

How does the ApoB containing Lipoprotein bypass the Endothelium layer in order to penetrate the intima? I'm fascinated because this is the first time I've seen a mechanistic explanation of atherosclerosis. I thought that a healthy layer of endothelial cells effectively forms a barrier to prevent the passage of most material into the arterial wall such that this simple transit as you describe here shouldn't be possible without pre-existing damage / insult to the endothelium. Eager to learn more please.

[@Christopher-b1p]

How do immune cells pass from the blood vessels to tissue?

[@bill2292]

Great video. I'd like to hear your explanation regarding the cause of the formation of plaques. It seems the plant based theory is that occlusions are oxidised LDL that sticks to the endothelium, whereas the paleo tribe believes it's sugar that corrupts innocent particles of fat. Will sugar give me a heart attack or is it eating saturated fat, cholesterol, and triglycerides??? I realize this will draw you into conflict and rage, but I think you're the man for the job!

[@dennisward43]

It could be neither. It could be multifactorial, such as being diabetic, long term high blood pressure, genetics (family history), inflammatory disease, lack of exercise, stress, lack of good sleep, old age and being overweight.

[@bill2292]

@@dennisward43 You said nothing to answer my question. Seems like your goal is to confuse people who want legitimate answers.

[@dennisward43]

@@bill2292 No. I said what I believe is the truth. Sorry if you can't handle it.

[@bill2292]

@@dennisward43 It was a pathetic non answer designed to confuse people. I think you're a shill for some meat company

[@dennisward43]

@@bill2292 How is saying there are many factors in atherosclerosis (which is fact) designed to confuse people? I think you are a shill for some big food processing company that deliberately tries to get young children addicted to sugar via breakfast cereals.

[@livephysiology]

Would endothelial nitric oxide synthase play a role in the exercise-induced angiogenesis at the site of the atherosclerotic lesion? It's interesting that VEGF didn't play a role.

[@mco51193]

We need to talk about your skin, dude. Maybe I am imagining it, but it looks fantastic the last few months. What are you doing for it? Any changes? Ha, might be time for a video on that.

[@Physionic]

Just doing what I always do, although I've gotten a few comments on it lately, so maybe I'll make a video on it - thanks, mc.

[@mco51193]

@ And what do you always do? If you don't mind me asking. Obviously you're not obligated to share. Keep doing what you're doing though, Dr. Clearly it's working.

[@AngelofD69]

Is there anymore data or evidence on Nattokinase effects on plaque or atherosclerosis?

[@David_Avidmind]

Confusing: Are fibrinolytic such as Nattokinase now bad for us because we want thick fibrin? Is taking D3 + K2 (MK4) also now bad for us as we want to keep calcium in our blood and not drive it to our bones?

[@joelritenour6751]

I’m confused. Should I stop taking K2 so that I don’t reduce calcium in my coronary arteries?

[@jonarnold7689]

I have significant collateral artery growth above a 100% blocked LAD of my heart, calcium score 925. ❤This happened naturally over time due to significant amounts of endurance training. Both of my cardiologists were surprised, and lucky for me no heart attacks and no intervention needed because of my horrendous genetics.

[@DrewVandoozer]

Interesting, I've seen studies on endurance athletes having higher CAc scores.. were you a life long endurance athlete? I'm pretty big into running just started about 4 years ago ran about 8000 miles or so now. My biggest concern is these findings, although the body may compensate like you think yours has. This just makes me wonder. We're you a life long endurance athlete that maybe caused the problem and the solution? Or did you have a high plaque score relatively before the endurance training? Any insight?

[@jonarnold7689]

@ The hypothesis is that due to poor genetics I’ve been depositing plaque for decades, but that this has calcified slowly due to years of distance riding and running. I’m sure if my body dealt with LDL better I wouldn’t have such bad blockages, but luckily my heart just grew more arteries or the smaller ones got bigger to compensate as the main artery slowly became blocked. Yes endurance athletes generally deposit more calcium in their arteries but nothing close to mine. If you’re worried get you LDL and APOB checked. That will tell you. If low you’re likely fine, if in doubt get the calcium CAT scan done. I had to fight hard to get mine done as cardiologist didn’t think there was any point as I was 55 and very fit. Boy did we get a surprise :(. Sad but alive. :)

[@ChaiJung]

Hey, collateralization is a common process among patients developing CTOs. It also is often a reason not to revascularize a vessel as the adaptation is considering better than attempting to open the closed artery except in instances of VT/VF. It's interesting because they also usually have less fibrosis from my understanding

[@jimglass1290]

As to collateralized blood vessels: A good friend of mine after feeling chest pain went to have a heart scan. As the technician was looking at the screen, my friend heard him say these memorable words, "Hey, everyone come look at this!" His heart had grown a whole new chamber.

[@EdwardsNH]

New chamber? No, under no circumstances can a heart grow a new chamber. You are showing us why the game of telephone proves unreliable information. Honestly, you might as well have said he grew a second head.

[@jimglass1290]

@@EdwardsNH There was a bit of humorous exaggeration in the telling. Both on his part and mine. Perhaps I should apologize for that? But the boring actual details of substantial collateralization would be hard to get into a comment here. And the, "Hey, everyone look at this!" was entirely real. When you have that experience you can choose to tell your story humorously or pedantically as you prefer.

[@cromyjr1592]

@@jimglass1290 then a little alien bursted out of his chest

[@noer0205]

Really appreciate the illustrations! This is way out of my field of expertise, and often I can't follow along, so don't watch till the end. But this time I feel like it understood what was talked about all the way through this video! Great work 😊

[@Physionic]

Awesome - I'm really glad; I try to make sure they're in line with what I'm talking about and develop as I'm talking. I'm glad they're worthwhile.

[@Christopher-b1p]

I defintely have seen foamy cells before. Remember that there are M1 and M2 macrophages. M1 macrophages contribute to inflammation, and fight stuff. M2 macrophages go around cleaning up stuff. Macrophages can switch from M1 to M2 based on conditons in the body. Also, foamy macrophages tend to become foamy due to certain lipids, and perhaps even some viruses, such as Sars COV2.

[@Physionic]

Good call on the M1 and M2 - they've actually switched to more of a spectrum, although M1 and M2 as still rudimentarily used.

[@Christopher-b1p]

@Physionic I have a paper for you to read, when I'm finished reading it. A good introduction to the type of research that I have done.

[@fizywig]

KZbinr Slimland quoted studies the show theatre walking 10-15k steps a day reduces mortality by 60%. Any thoughts? And is walking " ideal" zone 2 for health or is it some other stress reducing effect?

[@Physionic]

Have videos, I agree

[@yellads]

Would a "reverse cholesterol transport" show up as an increase in blood cholesterol in blood tests?

[@Physionic]

Well, possibly elevated HDL, but other than that, no

[@yellads]

@@Physionic Thanks, that could explain my recent increase in Cholesterol despite going to gym. Will ask my Doc.

[@cajampa]

The workout i have seen come up often to improve such conditions is interval walking.

[@Apologia315]

I would love to see some discussion of the now-decades-old research by Lester Morrison, who very successfully used very high doses of chondroitin sulfate to treat cardiovascular disease. It seems to sort of be the embryonic version of today's endothelial glycocalyx therapies.

[@harold18659]

Are you considering the future of this channel based on the effects AI might have on it, like deepseek? I got answers to questions, in just a few seconds that took me years to research.

[@Physionic]

That's a great question, Harold. There's multiple things AI doesn't do, although I use it a lot in my own work. To name a few, AI gets a lot of things wrong in relation to sourcing material. I've checked its sources on things it states and often it either references incomplete data or it completely misses the information. I think that will be fixed with time, though. The other, more important, limitation of AI is that it doesn't analyze the data in the studies and cross reference it with other studies - I don't mean regurgitating what the researchers state, but actually analyzing the statistics on each data set, making sure the effect sizes are worthwhile, making sure the researchers are citing impactful literature when making their arguments, and much more that actually takes *reading* the study and understanding the physiological nuances to be able to make connections. I think that once AGI (or whatever the next one is that can actually reason), that'll be a different story - until then, the current AI models are extremely useful and offer good information, but that information isn't based on deep analysis - just compiling work of varying quality and assuming it's all the same (which it often isn't). Still, it's an awesome tool and I plan on continuing to use it, because it removes so much of the mundane from my work so I can focus on the actual study analysis and those nuances that are necessary.

[@DIABETESHEALTHS]

​@@Physionicyes most of the time AI is wrong when it comes to health issues.

[@salleone6387]

General question: If these studies are peer reviewed, why does a study that has problematic (at best) statistical analysis pass muster? Shouldn't part of the peer review process be that the analysis of the data is a correct interpretation?

[@Physionic]

Great question - because many researchers A) have a basic understanding of statistics (they know infinitely more about their field than statistics), and B) it's definitely not what most researchers pay attention to - it's unfortunate, but often the case. It would be preferable to include a 4th review (the horror!) that's a statistician.

[@weston.weston]

@salleone6387 Hopefully, he'll respond.

[@bobkoure]

@@salleone6387 Peer review isn't magic. Things like statistical errors slip through all the time. Think about it. Reviewers aren't paid for their time. They're probably busy people. They're also usually anonymous - so no real consequences from missing something. There are even instances where the abstract claims aren't backed up in the numbers.

[@frelsmeg]

Good point, but a peer review only determines if the paper is good enough to publish. It’s up to the research community and meta studies to grade the paper’s value

[@weston.weston]

@bobkoure I work in academic medicine, and reviews may not be fine tooth combed, but they are fairly thorough.

[@AlexStephenson-b2x]

Wouldn't, then, this process of reverse cholesterol transport indicate that the ratio of HDLs to LDLs does, in fact, have a somewhat causal relationship in reducing or mitigating the effects of "bad" cholesterol in the blood, and is therefore not just an epidemiological proof?

[@douglasmillar7560]

@@AlexStephenson-b2x this was tested in a large ph3. dalcetrapib raised HDL and Roche spent a fortune on the trial program, and building up the pre launch teams, enthused by this hypothesis. It sounded highly compelling at the time. Unfortunately the 16k person RCT failed to show a reduction in cardiovascular events and was halted.

[@AlexStephenson-b2x]

@@douglasmillar7560 Thanks for that info! Interesting. It seems there was no reduction in cardiovascular events, as you say. However, according to what I've been reading on the subject, these trials use patients with various preexisting vascular diseases with high-risk features (e.g., acute coronary syndrome, cerebrovascular atherosclerotic disease, peripheral arterial disease, etc.), but which all seem to relate to restricted blood flow caused by plaquing (i.e., atherosclerosis). However, these high-risk patients may introduce other unforeseen variables that could be unaccounted for and therefore might affect outcomes. I would like to see a study on people who don't have any preexisting vascular diseases to see if there is any reduction in cardiovascular events. It just seems to me that if reverse cholesterol transport is true, and that it's also true that atherosclerosis is the main cause of cardiovascular events (i.e., cardiovascular death, resuscitated cardiac arrest, non- fatal myocardial infarction (MI) or non-fatal stroke), then there must be some causal relationship between HDL and LDL ratios, we just haven't found it yet (Perhaps the actual ratio number might be important, too). Anyway, just some thoughts....

[@AlexStephenson-b2x]

@@douglasmillar7560 Thanks for that info! Interesting. It seems there was no reduction in cardiovascular events, as you say. However, according to what I've been reading on the subject, these trials use patients with various preexisting vascular diseases with high-risk features (e.g., acute coronary syndrome, cerebrovascular atherosclerotic disease, peripheral arterial disease, etc.), but which all seem to relate to restricted blood flow caused by plaquing (i.e., atherosclerosis). However, these high-risk patients may introduce other unforeseen variables that could be unaccounted for and therefore might affect outcomes. I would like to see a study on people who don't have any preexisting vascular diseases to see if there is any reduction in cardiovascular events. It just seems to me that if reverse cholesterol transport is true, and that it's also true that atherosclerosis is the main cause of cardiovascular events (i.e., cardiovascular death, resuscitated cardiac arrest, non- fatal myocardial infarction (MI) or non-fatal stroke), then there must be some causal relationship between HDL and LDL ratios, we just haven't found it yet (Perhaps the actual ratio number might be important, too). Anyway, just some thoughts....

[@BillyBoy66]

Hey Nic, can you please look into CLEERLY heart disease technology? With a CAC score of 600 (at age 58) I may be interested in trying it. Would love to get your take on this technology.

[@tkc5793]

Coronary angiograms are not a new technology. The only thing CLEERLY seems to offer is “AI” which means it’s just a model that’s studied lots of pictures. Find a good cardiologist who’s not using AI and you’ll probably get a better analysis. If you want an angiogram tell your doctor. It’s not usually something people get for preventative medicine because it’s not usually something insurance will cover unless it’s absolutely necessary. Your insurance will want prior unresponsive “treatments”with negative symptoms before they approve something like that for someone who’s not in the ED - even then, it can be a lot of work to argue against an insurance company to cover a CTA w/out undergoing some invasive cardiac surgery first.

[@mikedunn7795]

Sadly,all of this would likely not have done much for Jim Fixx, a distance runner and the author of several books on running,and what got me into running several years ago. They found him deceased at the side of the road from a heart attack which he suffered on a training run.

[@HereAfterNow]

What kind of exercise are we talking about though? Would burning calories through just weightlifting count

[@chuckMvideos]

Can fasting reverse these blockages? 100% blocked seems too late, but 99% could turn into 89, then 79, then ect....

[@gregkaufmann4502]

Love the turn of phrase, I will avoid the “Corroded lips of death”! Hah!

[@donalkinsella4380]

You know when you have created many new blood flow pathways in your legs and feet when you can cross your legs or sit awkwardly for extended periods without developing crippling pins and needles when you eventually move. The blood is taking different routes to those during teenage and early adulthood. I haven't had numbness or pins and needles in years. I've had circulation issues for years which have resolved without treatment.

[@DrewVandoozer]

Haven't fully watched yet, but there are mant studies on longterm endurance athletes(runners I believe) having higher CAC scores than "sedentary healthy individuals" as a long distance runner this has somewhat troubled me, thoughts?

[@Physionic]

Watch the full video :)

[@BarakaAndrew]

When I was 95kg used to have chest pains every morning thought I was having heart attacks for about a year, went to multiple doctors did tests they told me I have no problem, decided to work out, after a month that pain just disappeared, its 4 years now workout every week I have never had that kinda pain again, maybe it was this. I don’t see myself ever stopping the gym.

[@billballinger5622]

At what height and age do you mind saying?

[@SomeKidFromBritain]

How early in their life can people start producing artery plaques?

[@PClanner]

So... more confusion here What you are saying is that clots are NOT 100% responsible for strokes? Occulsions are also responsible? And, thanks for the info but again, it is as generalistic as it could possibly be, but what TYPE of exercise and what INTENSITY of program will rid the arteries of plaque - and what study is there to back that up.

[@Physionic]

There are different types of strokes - hemorrhagic is not considered clot related, generally. However, an occlusion can occur from a clot, as well - leading to a second type of stroke, ischemic stroke.

[@mikey13b]

@@Physionic and what type of exercises and intensity?

[@ThaStonedGardner]

​@@mikey13byour best bet to live a long healthy life and to reverse such medical issues is to do resistance training regularly, 3-5x a week, and to do zone 2 and 3 cardio and HIIT cardio. Do a zone 2 run once a week, a zone 3 run once a week, and a HIIT session once a week. This all needs to be paired with a healthy diet of whole foods.

[@ukispargitus970]

@@ThaStonedGardner Thanks for these details and schedule. Do you have any sources confirming the benefits of these exercises series?

[@roberto4188]

My heart grew collaterals. I was able to go an entire week with a blocked artery. Before a stent was put in. I had no additional damage to the heart. I was doing hour of exercise 7 days a week for 9 years.

[@Physionic]

Glad it was fixed, but that is incredible

[@mj625]

@@roberto4188 you exercised an hour per day for 9 years and still had heart problems. To me, this speaks volumes for diet being the most important factor in prevention heart disease. How were you eating during this period?

[@LizA-xe4nz]

@@mj625 I had a friend who has a genetic disposition where her body produces high amounts of cholesterol dispite a good diet. Runs in her family. Yes, diet plays a hugh role and works well for most of us, but not all.

[@LagMasterSam]

@@LizA-xe4nz Genetics plays a huge role. I eat a bit healthier now, but I used to eat about as unhealthy as it was possible to eat, and my yearly blood and urine results were always absolutely perfect, even into my late 30s

[@dubfather521]

I noticed in the "after" image rhe vein was more round so it got reshaped for better blood flow

[@shiselsela2583]

Interesting

[@oolala53]

I was glad to finally hear how much exercise they’re talking about but I also am not clear on how much improvement there is. As you said, it wasn’t necessarily enough of an improvement. It’s interesting about the amount of exercise being enough to burn 2000 cal. I have been reading about the exercise paradox in that the researcher Herman Pontzer found that people of similar stature in both sedentary and active cultures burn the same number of calories per day. So exercise doesn’t necessarily mean that you burn more calories than when you’re not moving around. The body simply shifts its use of calories. I wish I could find the link, but I read another article that said that you actually had to burn 3000 cal a week to initiate weight loss without any kind of dietary change.

[@andrewcarlson2178]

The rule of thimb, or median across most demographics, states that all of our body processes (breathing, heart circulation, nueral and brain function, digestion, motor function) is 1600 cal/day. That's likely where you are getting the similar active/sedentary numbers. It's impossible to be more active and not burm more energy (calories). Exercise goes on top of these basic functions. An example would be extended fasting. Taking in no calories puts you in an automatic deficit regardless of level of exercise

[@1122redbird]

Interesting science with a little humor woven in. And turns out, exercise is good for you. Who knew.

[@TheCookiecupcakes]

Thanks I do not want any plaques.

[@Physionic]

I do not either - we're aligned.

[@TheCookiecupcakes]

@@Physionic 🤣

[@thedolphin5428]

Without all the science and chemistry, the message of this video is: *Exercise is good for you* !

[@defudge]

You didn't explain why plaque is formed in the first place?

[@kev4241]

cholesterol is taken up in order to repair damage to the endothelial cell lining. the damage may be due to reactive oxide species, air pollution, too much sugar, not enough antioxidants, ...

[@gazorpazorp9798]

4:51 this guy is the best. He gets it.

[@Physionic]

I knew it all along... trust me bro...

[@ETBrooD]

We can see very clearly that exercise helps, even though we don't understand the underlying mechanism. It can prevent strokes etc. Patients should exercise more rather than less. >7000 steps is better than 60 minutes > 30 minutes > 0 minutes. The effect is very clear. However, the effect of exercise on plaque regression remains uncertain. Prior research shows no effect and recent research only shows a very moderate effect. I wouldn't consider that conclusive. But this changes nothing about the fact that frequent exercise is key to good health. Even if it's just walking at a steady pace.

[@mistahtom]

4:32 Akshually it’s collateralize like the word “collateral.” Not co-lateral-ize

[@Wall_Street]

Hi Nicholas can you help me? I am fit and keep running long distances, never smoked, don't drink alcohol, eat few carbs and no more than 2500 mg of sodium per day, yet my systolic BP doesn't go any lower than 134.

[@Physionic]

Have you looked at my content on BP? I have several on potassium and the exercises to reduce BP (it's not long distance running).

[@Wall_Street]

@Physionic yes I never miss any of your videos since I discovered your great work months ago. I eat 3 or 4 bananas each day for potassium, and my recent blood work was great, except for low platelet and mildly elevated TSH, but electrolytes were good. I need to try that exercise though. Thank you for your reply.

[@wolfrahmphosphoros5808]

thank You very much. how come Athletes have plaque at all? Those are healthy-living, active, well-eating Non-Smokers. I don't get it. regards.

[@kev4241]

anything close to standard american diet probably makes plaque. most people get it

[@MJ-hl1kk]

Idk about my ApoB but my total cholesterol is almost 300mg/dL and my LDL is 211. i have been resisting statins, though they say that diet and exercise alone are not enough for those with familial cholesteromia and that statins are a must.

[@catlyn777]

You need to listen. Take the statins until you can get it under control. It’s really all up to you. I improved all my metrics by eating a vegan wfpb diet and taking daily 4 mile walks. I’ve been doing it for almost 3 years and loving it because I feel so much better!

[@adrianmccall6402]

I have familial hypercholesterolemia and hypertriglyceridemia. I resisted statins for decades, the dumbest thing I ever did. Please start the statins and probably add Ezetimibe, Fenofibrate and a PCSK9 inhibitor if you can. I can also attest that a WFPB diet will likely not be enough to get your levels down to a safe area. I had been vegan for 40 years before I finally kicked my stupidity and started pharmacological solutions. I suspect being vegan might have helped me avoid a stroke or MI but you still need the drugs.

[@adrianmccall6402]

I also want to make it clear I didn't kick the vegan diet! 😂

[@brucejensen3081]

I would think exercise would be causing you to be using more lipoprotein for energy. Then you probably produce a bit more hdl to mop up the cholesterol that then becomes waste. Combined with other things that are making circulation better, shit gets better, not worse. Calcium is more likely to go into bone, instead of come out.

[@gyffjogofl7676]

4:30 priceless 👌

[@Physionic]

Just being honest... :)

[@bmp713]

There are thousands of videos talking about how exercise effects the heart but hardly any about how to improve circulation and the vascular system with exercise. Why does nobody every talk about what kind of exercises improve vascular health and how?

[@bobkoure]

If you want a good '101' on how the two lipid 'circuits' work, check Peter Attia's interviews with Tom Dayspring (AKA 'Dr Lipid). Lots more on LDL/apoB than on HDL/apoE as there's a lot less understood about how HDL works.

[@Physionic]

You'd consider that 101? When Dayspring speaks, it's a graduate lecture :) But yes, great resource

[@bobkoure]

@@Physionic It starts out as a 101. :-)

[@Mario-forall]

Don't overdo it though. Marathon runners have higher plaque than would be expected for their BMI and activity level, but they tend not to get heart attack from it.

[@EhurtAfy]

I wonder if it could be something like this. Marathoners need a ton of calories so maybe they are accumulating plaque faster because they consume more food than the average person, including saturated fats. Over 2000 calories are burned during a Marathon so TDEE would be 4000+ calories on race day

[@arihaviv8510]

Many of them do think they can out train a poor diet. Some will be able to be lean despite their diet but quality still matters

[@partridc00]

​@@EhurtAfyI think the research suggests that it is the physical stress on the blood vessels and elevated blood pressure that is responsible for vessel issues in endurance athletes. The human body is not an industrial machine, and simple wear and tear can accumulate rapidly.

[@lukastemberger]

With exercise, vegan diet and no smoking or drinking, you don't need to worry about almost any lifestyle caused health issues.