Intro to Lipids & Lipoproteins: Why there is no ‘bad’ or ‘good’ cholesterol | Peter Attia, M.D.

[@pavelchorda8425]

Honestly, I like this format not because is 12 min long, it's because you explained in a way that most of the people can understand it. Congrats

[@CJP3626]

Appreciate you publishing this. It reflects the intelligent and fact based commentary your following has grown to respect, and expect from you.

[@AnnhilateTheNihilist]

As opposed to the 25hrs of podcasts? How shocking!!!!

[@SlavaEremenko]

Gonna burst your bubble and inform you that an average person can’t even come close to understanding this. Did you know that 54% of Americans can only understand what they read at a 5th grade reading level or less and have trouble inferring things from what they read?

[@buckmurdock2500]

doesn't take long to tell a lie.

[@bekeneel]

There is bad cholesterol tho, or however u call it. But it's not exactly the LDL, only a smaller part of it. So the total of your LDL doesn't say that much. Triglycerides is one of the other worst to avoid. Except for like those in coconut oil, imo. This is perfectly explained in this video "The BIGGEST Risk Factor For Heart Attack" by Dr. Mike Hanssen, must watch. So what you basically just have to avoid in food is processed foods (can be a lot of things, not all processed foods are necessarily bad), saturated fats from animal meat or eggs, milk etc. Then for a big part refined/added sugars, especially in higher doses like cola etc. And then just 1 more that is pretty known too, fried foods, not necessarily cuz the amount of fat it contains but often unsatured fats are used there & several times again which might create trans fats too, some of the worst. And then it's often combined with like some fat meat & sauce etc. So I don't think any of the natural/vegetal & pure oils are bad, it's more the processed shit or animal fat u gotta avoid. So those pure oils, fats probably indeed don't create any "bad cholesterol". But if U wanna know real risk or how high ur bad cholesterol is gotta look for the LDL type B i believe. And meds like statins are mostly just affecting the harmless part of LDL cholesterol, but it's all in that video I gave :)

[@deeprollingriver52]

All the related women in my family have very high cholesterol. Mine is 350 and my 94 year old aunt’s cholesterol is 480. We have no heart disease, no dementia, and live into our 90’s. For some reason, our cholesterol has a protective affect. My doctor, or my previous doctor wanted to put me on cholesterol lowering medication. I just laughed. Why? Why? He wanted to decrease the very thing that may be keeping me healthy.

[@Buorgenhaeren]

Aunty's heart probably look like an uncleaned sewage pipe 😂

[@impatientimp3292]

In familial hypercholesterolemy the chance for a heart attack or stroke is higher and life long statins are standard. Now we dont know if your aunt is really lucky OR your entire family hasn't had any cardiovascular events in which case maybe u really dont have a reason to take them

[@waltpayne9348]

Actually, very high total cholesterol is quite common in centarians. That is why total cholesterol is a meaningless marker.

[@gmk22799898]

​@@Buorgenhaeren what would make you think that?

[@vickiroberts3469]

Exactly!!!! Statins can cause dementia! Muscle weakness!

[@teresacesario6247]

I have spent many many hours walking and riding my 3 speed bike just listening to your podcasts, even when I can barely comprehend the science, but I have learned SO much!! Thank you!!

[@Pug71]

Spot on… Cholesterol is not a problem unless you have excessive inflammation in your arteries. The real problem is insulin resistance resulting in high sugar and high insulin in the blood which causes arterial inflammation. When you have inflamed arteries, then cholesterol can become an issue.

[@i.loveyou]

and what cause insullin resistance?hyperlipidemia so

[@wilsont1010]

@@i.loveyou Sugar.

[@JD-rc6lq]

​@Thebe Kgositsile high triglycerides are caused by liver conversion to fat from carbohydrate as well as inability to dispose of fatty acids due to high insulin (also a result of too much carbohydrate). The result is high LDL dwell time and athrogenic particles.

[@headholio]

I don't know of any data that says higher cholesterol does not increase risk if insulin resistance is not present. In fact I'm sure there is plenty of data to show the opposite, so your "only if" statement is wrong.

[@wilsont1010]

@@headholio Insulin resistance leads to more OxLDL, why are we still discussing this subject which has already been 50 years outdated?

[@D84-m2l]

Great work Peter! As someone who works in biomolecular science, I've been a long time listener to the podcast, however, I like to share easy to follow short videos such as these with friends who may not have the time or interest to listen to 2+hours of in depth biology discussion

[@nabilbensaad7636]

Ily

[@Healthify360]

Thank you for this. I am a lay person, I watched many hours of your podcast interviews on this subject and heart disease. Unfortunate the medical terminology is way past my comprehension. I turned it over to my sister who was a nurse to try and sort out what is what. So yes, I would so appreciate you doing more of these type of video's for those of us who are just trying to figure out what to do to stay healthy. I appreciate your content as you seem to take a well balanced view of all the information that is being presented, without having a huge bias. You are my Go To source to trying to find out what the truth is on many health related subjects. Thank you for your time investment to improve our health.

[@Richard-eg6fw]

Peter, this is the best video on cholesterol! You’re doing a great public service. God bless you!

[@yschuler1]

Good God! That means that most doctors I’ve spoken to don’t understand the basics of lipids and lipoproteins! I’ve heard it countless times described as good LDL versus bad LDL. All I have to say is, thank goodness for you, Peter, for sharing your knowledge. And by the way, I have your book, phenomenal!

[@Leitmotif4659]

I would say that Dr. explains in the most understandable way.

[@bob-ss4wx]

One of the best podcasts I've ever about cholesterol! Peter Attia did a superb job by speaking in "English" and keeping it short so we don't get lost in the weeds of medical terminology.

[@debra13]

I got lost in the weeds! ;-). I don't have any scientific background at all and find him very difficult to understand- I know he has a lot to offer me- someone with diabetes and metabolic issues- but I feel so lost when he speaks. I thought the "ratio" was what was important. On my labs (yes, I guess they don't matter?), my LDL is extremely high, my HDL was decent enough as I recall, my triglycerides were just fine. My ratio of "risk" was not high but cardiologist freaked , especially since I am trying and failing to do LCHF diet. I don't know where to go to find information like Peter's that I can actually understand.

[@dieselbourbon3728]

@@debra13 Short answer. Eat a low to no carb diet. Eat fatty clean meat in ratios your bowels need to operate properly. Stay away from all sugars and processed edibles. Don't worry about cholesterol. Personally I need allot of fat to keep my energy level high enough. Triglycerides have never been lower.

[@chi5168]

@@debra13 look into Dr. Berg's podcast info. It's fairly simple to grasp.

[@fabioq6916]

@@dieselbourbon3728 none of that is recommended by Attia though so why offer it as a translation of what this video says?

[@luk5827]

@@dieselbourbon3728When you talking about low carbs means low refined carbs ? Because Fruits and Vegetables are also carbs . Potatos and Rice are also carbs . Need to eat “good” fats ?

[@pfunk2637]

Peter - this was excellent! So in summary, measuring apoB (it only costs $20 out of pocket) is a more comprehensive way to look at risk, rather than the individual tests. Please do more of these TLDR topics!

[@w1975b]

Research CAC scan/score. edit - it measures CALCIUM buildup/plaque in arteries

[@ly5504]

@@w1975b I just did one of these electively at 40 yr old out of curiosity. Gives you piece of mind to know you're not clogged and your diet and lifestyle hasn't been too bad on your cardiovascular system

[@w1975b]

@@ly5504 if you're talking about CAC scan, yes, I agree. I had one done a year or two ago and my score was zero, which surprised me. But I'm not complaining! Of course, that's not the only way that people can have a heart attack, just one area to check.

[@dorianmichelarmenterossanc668]

Apo a1/B ratio give u a better u understanding cuz Apo A1 have the HDL fraction into account. Is also cheap

[@Gary-ib8dz]

What is TLDR?

[@jackcunningham3401]

The best summary of anything I have ever seen, ever.

[@jasonhobbs2405]

First, I love most of Peter Attia’s work. Second, he’s much smarter than I and has done more good for more people than I. Third, why did people like this video? It was just musings on inactionable semantics.

[@LedByGrace]

Is God amazing…as I was listening to all this, how amazing / miracle our bodies created by the Lord. Just mind boggling to me. I didn’t understand any of this but what I do get is how wonderfully we were made by the hand of God. Truly amazing.

[@leighnapier4505]

We are fearfully and wonderfully made !!

[@esgee3829]

i see no evidence of fear in the evolutionary process

[@surfreadjumpsleep]

We are so lucky that Peter is so smart!!

[@gabyzoebl2515]

This is explanation is great! Would you consider doing more of these short videos (complicated things explained in an understandable way)? Also, I have honestly never been to an MD who makes these distinctions. Thanks for all the great work you are doing.

[@danielmccarthyy]

Doctors: Your total cholesterol is too high! Doctors: Forget that, now your LDL-C is too high! Doctors: LDL-P is a better measure. Doctors: OK, we need NMR tests to detect small, dense LDL. Doctors: Yikes, your Lp(a) is elevated. Doctors: Actually, we should look at ApoB instead. PATIENT: WTF? Is there a different treatment for each? DOCTORS: No, we'll just give you a statin which doesn't work anyway. PATIENT: WTF???

[@Arunkumar-bg5xk]

I hear you! I share the same experience... I think the problem the doctor faces is whether or not it is necessary to put you on a statin coz once they do, you're on the pill for the rest of your life....well atleast a good doctor will actually do this.

[@danielmccarthyy]

@@Arunkumar-bg5xk And once you get on the Statin, type two diabetes is just around the corner, and diabetes brings heart disease with it. So obviously this is the wrong approach. Then there are some new medication‘s which have not proven a mortality benefit which will get the patient on the liver transplant list. So it seems the diet and exercise, whatever that might mean for the particular patient, is the only viable way forward

[@Arunkumar-bg5xk]

@@danielmccarthyy you may already know this Peter Attia's whole approach to longevity focuses on exercise as its centerpiece.

[@eswaribalan164]

Cholesterol 'medication' is like the corona virus 'vaccine'.. made by humans to sell for profit.

[@Arunkumar-bg5xk]

@@eswaribalan164 uh... no

[@CelticDruidess1]

That's really interesting - especially given the fact that the medication that physicians give like ALL seniors/pre-seniors is to get rid of cholesterol which they require to maintain basic life forces.

[@jjp007]

It doesn’t get rid of it all.

[@p-Claud73]

So fascinating! Our bodies and the universe is so complex.

[@bobjary9382]

Yeah ! A true truth seeker , a true scientist and a great teacher . So many whilst entering into the venture with a good heart cannot help evangelising and speaking in certainties leaving the viewer thinking ..yay! I need only do this and I'll be all fixed up ... Really we have suffered at the hands of the food industry , private shareholders, an ignorant and reactionary self serving government and the problems that beset our health must be completely understood to be tackled . Thank you so much for what you're doing.

[@kacykacem]

This is honestly the best video/explanation I have ever encountered. Thank you, Doc.

[@tomk2708]

Interestingly, when my GP (whom I respect) recommended statins, I decided to look into the topic before adding a long-term pharmaceutical to my life. When I learned about ApoB and asked her if she had included it on my blood requisition she said, "No, but I can" and checked it off. I was a bit astonished that a medication could be recommended without such a basic check. The moral of the story is that the "G" in GP stands for "General" and these people often do not have time to keep up. One addition to Peter's excellent summary: high HDL has not been shown in studies to confer any benefit regarding atheroschlerosis, however, high LDL corresponds to an increased risk of CD approximately 80% of the time (meaning that 20% it does not). He is right therefore not to equate high LDL automatically with increased risk, but there is a significant correlation.

[@stellasternchen]

And that 80% is the problem. Through misinformation most people don‘t believe they are at risk. That it is old science or that they are certainly the exception or that it is all a lie of big Pharma is worrisome.

[@fhowland]

It’s criminal that they don’t teach this in health or biology class !

[@hbjeff36]

Because this wouldnt sell drugs to lower cholesterol, AND cause muscle issues, memory issues, and diabetes/cancer. Its a limitless market

[@thebob01]

@@hbjeff36 Follow the money

[@zsuzsuspetals]

This is a great video. I honestly think when you are reading or hearing "good cholesterol/bad" it's about making it easier to understand for average people. I can tell you that anyone watching this video who has a desire to even try to learn is maybe 1 in 10 average Americans (I can't speak for other countries) So if the masses are going to be reached, they need to have it broken down easily. Because this is where the carnivore eaters get their foothold in saying "There is no bad chloesterol. The body needs cholesterol" and then they never go on to explain what LDL is. So we got some people thinking all cholesterol is bad and others who say none of it is bad. For me, it's always been easy to remember HDL= high number good. LDL= number should be low= high number is bad. It's kindergarten level for sure but it gave me a good starting place. 😂

[@suemiller294]

Amazingly easy to follow and make sense. Got popped on a stain at 60 with one set of “ bad labs” after 6 months of junk food ( another story) . No chance to change diet … just Framingham 🤦🏻‍♀️. Lost 40 lbs on keto ( why not on crestor?) now perfect looking labs, trying to convince my doc to update testing after 3 months of Mediterranean & exercise. You’ve given me ammo my fellow Canadian !!!! Love the podcast, you as a guest on others- thanks for all you do !!

[@Dina379]

Dear Dr. Attia 😍🥰. I loved your book “Outlive”. Brilliantly written, educational and easy to understand👍 Highly recommend for anyone looking for preventative measures!!! Absolutely love this channel! I didn’t know that you have one… came across it after I read your book. Thank you from the bottom of my heart for all you do ❤❤❤. With love from Vancouver, Canada 🇨🇦

[@george5120]

Great video. First time that I heard this doctor. No splash screens, multimedia, music in the background. Just a quick delivery of what we need to know. My guess is that few physicians have his understanding of lipidology. Most physicians probably just read markers in a Lipid Panel and then prescribe statins based upon ranges printed on the Lipid Panel itself for what is healthy versus unhealthy.

[@iamjon1986]

Thank you for this. Being my moms POA, its difficult to convince her DR i want to get her off the medication. I have her on a healthy diet reversed her diabetes and hashimotos.

[@robkoering2702]

What does her diet consist of?

[@cps_Zen_Run]

More specifically, it’s the damaged LDL that causes problems. Damaged LDL cannot be recycled because they no longer fit into the receptacles. Inflammation causes the damage. Refined sugars and excess vegetable oils are inflammatory.

[@madhatter9001]

How about ALL sugars? Added sugars are killers.

[@stellasternchen]

We have literally antibodies against those removing them from the blood under normal circumstances. Just during arteriosclerosis the antibodies somehow are making it worse. The damaged LDL also are produced by artheriosclerosis, not cause it.

[@johnburn872]

You need to do more videos like this. Breaking down basics for people, basic biology. You are so articulate and great at breaking things down. Thank you for this, I am I big fan.

[@jeremiash5180]

Thank you for being warrior in this seemingly endless fight! ps. Love that Richard P. Feynman photo in the background. It would be104th birthday for him today, may he rest in peace.

[@chentheartist]

i am so interested in the topic now. Peter Attia did a great job explaining it. He would be a great instructor.

[@mattbhagify]

You are helping my family and I so much with this content. Paid subscriber here. Thank you for putting in the hard work. I love the detailed long form discussions as well as these short summaries.

[@andrelemoine1815]

I cannot thank you enough! For a neophyte, your explanation is worth its weight in gold. Education at it's best.😊

[@Maria_Serbina]

Peter, thank u so much for awesome and easy to understand explanations. Unfortunately lots of doctors wrapped up in the cholesterol BS and as result prescribing lipitor or similar destructive to the body meds where they are not needed.

[@HUGEbanks]

This subject is so confusing to me. My doctor just put me on atorvastatin for my cholesterol. My LDL is double what it “should” be. I hate taking meds and would love to drop this statin. When is a statin needed and why?

[@Maria_Serbina]

@Matthew Eubanks , you need to look at the hld number and the difference between ldl and hdl. The healthy doffere difference is 10-15. If it s close to 40, then you are pushing it. This number shows your insulin resistance. Avoid statins at any cost. They destroy your body. My mom bis taking them. They create more harm. Find a holistic doctor who understands the power of fasting .

[@dan-qe1tb]

The whole video was just explaining biology in a way that was neither overly dumbed down nor overly technical. He hadn't even gotten into statins or the real or imagined negative effects on your health if it's high. Just explaining what cholesterol is. I was prescribed Crestor and it's not due to, "cholesterol BS". It's not "destructive to the body". Those are both conspiracy theories of your own devising. Neither idea will improve your health and you might have a stroke someday if you ignore your lipid panel thinking any criticism of the results, are s a big pharma fear based scam to get people to buy more pharmaceuticals. I'm refusing to take the Crestor because I don't think they had conclusively proven that my LDL was at an objectionable level due to my perception of the tests having been bungled: they hadn't told me to fast or how close to meals I was supposed to have blood drawn. It changes a lot throughout the day. In fact, I have given a bit, to both sides. It's neither a huge health issue for me, nor should it be ignored.

[@christinasportiello9542]

Smartest man on the planet. Can’t stop learning from you.

[@marybradleyblack]

My cholesterol is 390. I maintain a good weight, exercise, my triglycerides are good and my glucose is good yet he wants to put me on statins! No effing way am I going to be put on a prescription drug with a ton of side effects that could be detrimental to my health. I mean really?

[@debraade706]

Good for you my Dr. also wanted me on statins, NO WAY

[@nutritionbyelsa]

I literally always watch a Peter Attia once I finish studying my biochem or physiology even if the video and what I studied aren’t directly connected it keeps me so excited and interested and feeling super smart and badas* that I just study better and learn 10x more and I love it

[@dorianmichelarmenterossanc668]

I like ur explanation of Lipoproteins i only disagree in the almost certain assertion abt LDL as “bad actors”. I don’t think the LDL are bad actors per ser (they’re needed for normal healthy processes) they have the potential to be oxidized and then become a troublemaker as u explained before but that doesn’t mean that they will do that or that’s their intended purpose. I just want to point this out cuz people are already under the impression they’re the villains of the movie and that’s not entirely true. Moreover than the amount of LDL-Cholesterol the size / amount of LDL particles are of more importance cuz the small and denser they’re then me more prone the become to oxidation and endothelial infiltration progressing to atheroma and atherosclerosis.

[@kygo]

This is the best explanation of cholesterol I've ever heard, I finally understand what it is now!

[@recuerdos2457]

Could you give a summary of what he s trying to say??!!… I m actually still confused 🤔

[@JustBrowsing777]

Great info nugget on cholesterol. Perfect format, length and the relevant level most people can benefit from understanding enough to make informed decisions when doctors start talking about "bad" or high cholesterol and statins.

[@Hertz2laugh]

Seems like the main argument starts at 11:13. The big points seem to be: • Cholesterol is a system-critical substance in humans - of itself, cholesterol is good and necessary for humans • But certain of the different ways cholesterol can be "packaged for shipping" by the body can have negative health effects • Therefore, claiming there is "bad cholesterol" is inaccurate, unhelpful language I feel like his presentation would have benefitted by dropping most of the section about testing and inserting a section about the stigma and common misunderstandings related to high cholesterol food consumption.

[@erastvandoren]

There is no stigma.

[@Hertz2laugh]

@@erastvandoren . *Stigma:* _An association of disgrace or public disapproval with something, such as an action or condition_ There is a stigma - "public disapproval" - of eating meat. In the U.S., the disapproval is regional although there is a generally widespread belief that eating red meat is bad for your heart.

[@zbLoodlust087]

Confused because on the huberman podcast you said these very things and clarified that dietary cholesterol isn’t correlated to blood cholesterol but saturated fats are in fact correlated to athlersclrosis

[@SJQuirke]

Thank you so much for this clarity Peter Attia MD - I have been reading your work for about a decade and I picked up this message - I did not have the context to ingest the finer detail - but I appreciate your persistence in all of this - Ha! "lower your APOB with these steps" - next watch

[@sandeeplalka]

Great information. However, if you would have touched upon the optimum number for each of these - LP(a), APO etc it would have been easier for viewers to correlate things from the traditional method - not saying that individuals assess themselves, but it gives a good understanding to the next level. Over all these years, we have numerically understood what and how much should HDL, LDL, LDLC etc should be. It would help to know the number or ranges for LP(a) and APO etc

[@Taureanfitness]

Thank you so much for putting this out. It makes perfect sense to me. I worked for a cardiovascular genetic company that did advanced lipid testing, and I'm aware of most of this. But you're even taking it a step further which is fascinating to me. You're also right. Most people do not know what they're talking about when it comes to cholesterol or even Blood Pressure for that matter And the general information. Their reading is totally incorrect and it just confuses them even more

[@diegocardona9281]

Peter.....this explanation is amazing.I have tried in many ways to explain this to my patients, but this video is what I've found more exactly what it means this topic.!!!!!!

[@unalusta3170]

I adore the way you explain things. Thank you, thank you, thank you.

[@kinwintube]

This is an excellent explanation. However, I just checked the website of the American Heart Association and they are still talking about good HDL and bad LDL and also that high cholesterol in the diet (red meat) will cause high cholesterol in body??? I suggest you, instead of attacking random people on Internet, you should publicly take on organizations such as the American Heart Association who continues to promote nonsense to the public.

[@Seanonyoutube]

When I cut out red meat my cholesterol came way down 🤷‍♂️

[@kinwin2003]

@@Seanonyoutube Exactly, that's the whole point of the video. You have been duped into worrying about your cholesterol, while you should really check your apoB, as Peter so elegantly explained.

[@Seanonyoutube]

@@kinwin2003 but whenever my LDL goes down, so does my Apo-B 🤷‍♂️

[@w1975b]

Bart Kay is a nutritionist and does response videos. But he portrays a character who cusses as entertainment, and that channel has the most subscribers. His other strictly professional channel doesn't have as many videos or subscribers. If cussing doesn't bother you, I'd suggest checking out the videos to see if any are what you're looking for.

[@Thalbouny]

Did you just cut red meat or other stuff from ur diet? If you cut out sugar or lower carbs it will also make ur LDL go down. Lowering the inflammation in ur body helps.

[@katherinegill6015]

That you for your time and how you tried to explain the “basic” to us all. ❤ really appreciate your video!

[@user-cc5od3zk4p]

Thank you Dr. My doctor didn’t like it when I mentioned she do some research as there is no good or bad cholesterol. I also told her that I will never take statins. She referred to them as life saving drugs.

[@thefreshprinceofnohair9703]

That’s because most doctors know nothing about nutrition and want solve all your problems with drugs , because its less work for them.

[@danr3131]

Dr. Attia would agree that statins are life saving drugs. He advocates for them.

[@pitabread71]

@@thefreshprinceofnohair9703 You have a very uncharitable view of providers. It is not "less work" for them to prescribe. They are recommending drugs based on evidence based practices. It is up for debate on whether or not the evidence that is gathered is done in the appropriate way, or if we should make generalizations when we know there's variation amongst people. However, most providers are really just trying to help their patients in the only ways they know how. And all of them also recommend diet and lifestyle changes, but it is up to the patient to actually make those changes.

[@marysavage6707]

I just wanted to say thank you for simplifying this so we all can understand it!

[@Z06GT1]

Thank you Dr. Attia!

[@chriso17]

If LDLc is being used as a proxy to help determine LDL risk, who cares if we call it bad LDL or bad LDL cholesterol. As science learns more, we sometimes get stuck with outdated language. Just because someone writes in terms of what the public understands (from decades of outdated wording) doesn't mean they don't know what they are talking about. I completely understand there are now better ways to measure/access lipoprotein risk. This video really should've been split in 2 parts. Part 1 = nuance of lipoprotein vernacular; Part 2 = better ways to measure lipoprotein risk. Mixing the 2 just confuses both subjects.

[@lexitejeda6209]

I appreciate this video, even though I have listened to or read close to all of your TLDR stuff. Excellent summary. Thank you.

[@greensmoothieparty]

A formula for calculated ApoB = -33.12 + 0.675 x LDL + 11.95 x ln(TG). TG is triglycerides and ln is the natural logarithm function. Since this formula uses the LDL and triglycerides numbers to estimate ApoB, it appears to be logical to focus on reducing LDL and triglycerides to reduce ApoB. Total cholesterol = LDL + HDL + 0.2 x TG. Note that the ApoB formula above more heavily weights the TG number and that HDL does not even figure into ApoB. This is apparently because ApoB is not found in HDL, just ApoA.

[@dylanb_2011]

Just tried your Apob formula and does not even come close.

[@greensmoothieparty]

@@dylanb_2011 the research paper claimed that it was accurate to about 95% (CCC & CI) from what I recall - just search for apoB formula and it is likely the first result that pops up

[@michaelschachter4050]

Great Video! I am an internist and often site you a good resource to learn more. I do have to respond to your criticism of the medical communities approach to ASCVD risk assessment. 1. An average office visit is 15-20 minutes. This is just one topic that needs to be covered. While, in the perfect world, we would sit down with each patient and have a conversation like this one, it is not realistic. There is too much variability in patient medical literacy and engagement, the reimbursement from insurance would make the longer office visits necessary to cover this would make any medical practice unsustainable, and if we increased office visit time, the amount of doctors needed to accommodate this increased demand would bring an already strained system to a standstill. 2. I think this approach overemphasizes disease oriented data and downplays patient oriented evidence. High risk individuals will, on a whole, benefit from statin interventions for example. Knowing the exact pathophysiology, while important, will not prevent an ASCVD event. That being said, I truly did love the video!

[@C02045]

How high a risk? On what evidence?

[@denofpigs2575]

Statins are poison. Nobody benefits from statin. Period. Scientists in a lab are not smarter than nature. THe human body is able to accurately manage over 2000 different compounds in the blood. Why would anyone even consider that some guy in a lab coat is able to interfere with that in any capacity and think they'd do a better job than the body.

[@mtbse789]

Fantastic. Will be looking for the podcast. Thanks.

[@ericgould1349]

As always, super well done. I know when I listen to you that I always learn something new. Breaking complex topics into consumable knowledge is an art. Thank you.

[@700317]

This is pure gold..

[@GenesisReveal]

When someone asks what's your hdl or ldl level, I think it's generally understood that they're talking about hdl or ldl cholesterol. It's just how people talk, trying to avoid big words whenever possible.

[@amybee234]

such a clear and interesting explanation, thank you! amazing that these resources are free

[@crystalnichols7224]

This is literally 101. I learned about this in my intro college biology class as a non science student. I still have the printed copy of the article we read about this topic since I so often heard the terms "good" and "bad" cholesterol.

[@geoffharrower2845]

What about the important ratio of small dense LDLs to buoyant LDLs. See Prof. Robert Lustig, endocrinologist at USF, and his episode explanation of cholesterol.

[@ColinMcRaeVIT]

I really enjoy Peter's efforts, but often after listening to a 2 hour podcast I find myself asking "so what are the actionable items here??". I appreciate the science but as I often can't piece it together sufficiently to actually DO something with it, I., and I think much of the audience, needs more focus on final take-away's. Such as in this case, it would have been good to say "your best bet is to go and test apoB". However this format of a video is great, just that last 1% needed to be "so, go do ____" to get ____ result". Even if non-absolute, with caveats and disclaimers etc., it's still something to "DO" vs. just something to "somewhat understand". :)

[@xmazurx]

He doesn't want to give medical advice because there is a nuance to everything. Just measuring apob is not always enough to determine your risk for cardiovascular disease.

[@ColinMcRaeVIT]

@@xmazurx Yeah I can respect that. It’s kind of a shame that there exists in this culture where everybody hast to make a disclaimer that they’re not giving medical advice. I realize the stems back to the whole litigious nature of American society with all the lawsuits and nonsense but in my perspective if somebody follows advice given by anybody, whether it’s from a KZbin channel or some blog post, and something bad happens that’s on them as their responsibility to make the choice. Anyway, different subject different discussion I suppose :-)

[@erastvandoren]

Plant-based diet, exercise, amla, nattokinase.

[@erastvandoren]

@@ColinMcRaeVIT Actually, you will get your monetization cancelled if you give out medical advice. Thank google for that.

[@lola.t.6399]

@@xmazurx😊

[@derekconn9950]

I hope Peter sees this, how exactly does the ldl stick to the epilthial cell? What is the mechanism as to why this is happening. I’ve seen a hypothesis that believes the epithial cells and it’s glycocalyx is damaged and a clot forms and progenitor cells overlap the clot creating the plaques after repeated repair and damage, if so non of these would be considered “bad” it’s just the high pressure environment with various particles causing damage to the wall that is the issue

[@DanteLikesRock]

that's exactly right.

[@blueberry11051]

Although I thought I knew almost everything about cholesterol in great detail, this is an excellent explanation of cholesterol and its circulatory system. Thank you very much, Dr. Attia.

[@richardharrison8249]

Thank you both, my GP (from UK) Wants me on statins following a TIA last year, now going to ask for insulin, liver and fill lipid profile test. Thanks

[@aclassmedicine3306]

Great to hear such clarity. Like “essential hypertension” this good/bad cholesterol misnomer will take a while to eradicate.

[@zazzleman]

Thank you for dumbing this down. If only people explained the stuff like this we would understand.

[@debra13]

Oh dear, if this is "dumbing it" I am an idiot, and I have 2 Master's ;-). But in English and Social Work. lol

[@joetart9905]

Curious to your thoughts on Lean Mass Hyper Responders... those with really high LDL's and HDL's, but low triglycerides who practice low carb diets?

[@johnny7808]

yeah I want to know too

[@caryncook25]

Me too. I don’t do low carb, but am a faster. Always does a number on my cholesterol.

[@phwshopping1426]

This is me!

[@mariehelenegrenier8146]

Finally a clear info for beginner...you are great. More

[@chuckbecker8735]

Watching hundreds of outubes on optimum health for years has cause me to be selective and picky. This channel is creative & unique.

[@Wass_85]

Serum triglycerides: 1.69 mmol/L Serum cholesterol: 5.0 mmol/L Serum HDL cholesterol level: 1.25 mmol/L Se non HDL cholesterol 3.7 mmol/L Serum cholesterol/HDL ratio 4.0

[@Wass_85]

My last blood count, I'm a 38 year old male, good or bad? My trig levels were 0.53 mmol/L two years prior. I don't think my diet is significantly different, the only difference is I have been suffering from severe anxiety/stress.

[@jemag]

Very interesting. I think some added visual support (drawings/diagrams) could help, just a suggestion

[@charlotteechols3035]

I always find your talks interesting and accessible. Thanks for producing such great content.

[@rosies3622]

This article might be of interest to those of you scrolling through the comments: ApoB Gains Ground as Best Lipid Predictor of MI Risk. “The risk of myocardial infarction in patients with and without atherosclerosis is best predicted by the number of apolipoprotein B (apoB)-containing lipoproteins, and this risk is independent from the lipid content and type of lipoproteins typically measured and targeted for therapy, according to a new analysis. The results, which showed that only apoB was associated with the risk of MI in a model that fully adjusted for other lipids and clinical factors, suggest that apoB “may be the primary driver of atherosclerosis” and that drug therapy should target all apoB-containing lipoproteins to reduce the risk of adverse cardiovascular events, say researchers. “We looked at apolipoprotein B, non-HDL cholesterol, and triglycerides, and all three are predictive of risk when you look at them independently and without adjustment,” lead investigator Nicholas Marston, MD (Brigham and Women’s Hospital, Boston, MA), told TCTMD. “Even when you adjust for clinical factors, each were predictive of MI, which is the endpoint of interest in this study. However, when you also adjusted for the other lipid parameters, apolipoprotein B was the only one that remained significant.” continued here: www.tctmd.com/news/apob-gains-ground-best-lipid-predictor-mi-risk

[@lloydhlavac6807]

This has me confused, and I did read the full article in the link. I just had extensive blood tests done a few weeks ago, after 3 months on the carnivore diet, and my Apo B tested very high. My LDL-C is also very high, as was LDL-P, but it's mostly large pattern A with hardly any small pattern B, and very low VLDL number, plus my HDL-C was good, with triglycerides lower than HDL-C. My oxidized LDL was also well within normal ranges, and my Myeloperoxidase (a marker of inflammation) was in the low CVD risk range. Lp(a) was also in the low range. I do not have any underlying health issues, and I might be a lean mass hyper responder (LMHR). So some of my test results seem to be counter to what is mentioned in that article, even though my Apo B is very high.

[@rosies3622]

@@lloydhlavac6807 I’m sorry, I have such little knowledge upon this subject, and you have just confused me, too :)

[@crispyjeffers]

Keep these videos coming! I just finished your book, Outlive, and I loved it. I've been incorporating different aspects of the book into my life, slowly but surely. I have a blood test scheduled with my doctor and am going to request an ApoB level test as part of it.

[@timmiet47321]

Great explanation. What is it about the LDL cholesterol molecules that makes them implant themselves into vessel walls? Aren't they made up of the same outer shell which should allow them to flow freely through our vessels?

[@director2345]

Damaged artery needs repair....LDL wants to repair and digs in to patch....then cascade of immune cells pile in to form plaque....If there is no damage to artery, then LDL has no reason to dig in to repair...statins block VLDL in the liver before it even turns to LDL...also blocks COQ10 which is also needed in every cell..

[@archstanton9547]

Good question which is not addressed here as far as I can tell. From what I've read the cholesterol oxidizes and calcifies which is what adheres to the artery walls. I still don't know what causes the oxidation but it could be excess glucose in the blood and so the theory is that high carb diets and not fats cause plaque build up.

[@erastvandoren]

Simply too much of it. We can't metabolize cholesterol, we only can get rid of it through cell loss or via making bile acids. Macrophages in the arteries gobble up lipoproteins, but can't process cholesterol, and end up accumulating it. HDL can return some of it to the liver, but if LDL is high, then the accumulation occurs.

[@erastvandoren]

@@director2345 This is nonsense.

[@timmiet47321]

@@erastvandoren Not sure I'm buying that. If the vessel walls are not inflamed, any lipids flowing by should not imbed themselves into a vessel.

[@VelocityRE]

Thank you. I'd listened to the multi-part podcast with you and Dr Lipid, this summary helps

[@d2row96]

That was an awesome explanation! Thank you!

[@hkazmi86]

I enjoy all your podcasts and videos. I'd like to humbly share one piece of constructive criticism, if you would. As a medical professional who works in cardiovascular diseases, it's not uncommon to use terms like "good cholesterol" and "bad cholesterol" as parlance simply for the sake of patient understanding given time constraints and not being able to explain in such detail to each patient. In fact, many patients may not necessarily care about the biochemistry of lipids. That being said, by saying anyone who uses these terms does not understand lipids and their effects is undermining the efforts of many healthcare providers who are doing wonderful work in trying to reduce ASCVD. I work alongside many cardiologists and lipidologists who are brilliant in their fields but still use these terms. Many of the comments in this thread share the same theme of, "Wow my doctor uses these terms and has no idea what they are talking about," and it seems as if this video is potentially undermining the efforts of physicians. I very much enjoy all of your content but want to respectfully remind you that you are a respected public figure and while you've done immense good for the educating the public, your eloquence may make people trust you more than their doctor so please be mindful of words like these as they may do more harm than good. Looking forward to future content!

[@jicalzad]

Agreed.

[@mikevaldez7684]

@@jicalzad Who tf are you dweeb? 🤣🙋

[@mikevaldez7684]

hkazmi86, what do you do? Change bed pans? I'm Mike's brother in law--- you're nobody to talk to him like that! Come on down and we'll give you free lessons.

[@AngieMeadKing]

Because of your videos Im now trying to figure out how to lower my APOb and LPa markers

[@Joy80JJ]

This the best explanation on cholesterol. Thank you Peter

[@marydo3175]

Thanks! I can't wait for the next videos of thos series.

[@asarcadyn2414]

Why would an undamaged LDL particle randomly insert itself into the epithelium? And why would it only do it in some arteries and not in veins all over the body? I’m baffled.

[@claudiucosar]

touche it seems that only the high blood pressure arteries are prone to CVD not the ones with low pressure -returning blood with co2. and even mr thomas dayspring stated that if your endothelium is hard like a castle fence there’s no penetration…

[@Seanonyoutube]

I still would like to understand why Apo-B has a tendency to stick to artery walls? Like, I thought you said it’s s special package that is protein on the outside which allows it to pass through more easily? So why is it sticking to the arteries?

[@samfisher8885]

It has to do with oxidation, normally ldl particles are able to enter and leave arterial walls without issue. However if they get oxidized (damaged via glycation, if you have high ldl type B, consume refined seed oils, smoke, etc) then that oxidized particle can get stuck in the arterial wall and contribute to atherosclerosis.

[@w1975b]

@@samfisher8885 another big cause of glycation is too much sugar consumption (all carbs = sugar and starch).

[@Seanonyoutube]

@@w1975b i’ve heard many times that outcome studies show a big difference between refined carbs like sugar and carbs in their whole form like legumes fruit etc.

[@w1975b]

@@Seanonyoutube there's zero harm cutting out plants/all carbs because humans require zero carbs. And all plants contain toxins as defenses against being eaten. Oxalate, lectin, phytate are just a few, there are hundreds. Can people see improvements in their health by reducing processed carbs? Sure. But their health would improve even more if they cut all carbs. It's as if someone is starting from the standard American diet, which is the worst. They're reducing only one aspect of many that make it terrible. But people can eat whatever they want, and do. It's up to each person to decide what level of health they want. Some people want the best health they can get, and that means cutting out all or almost all carbs. If anyone doesn't know, humans can create all required glucose through gluconeogenesis, that's why we don't need to consume it from external sources.

[@Seanonyoutube]

@@w1975bit will be interesting to see how long all you carnivores will live for.

[@musicforaarre]

Wow ! You have such an excellence of explaining these basics in simple enough terms that I understood them. You didn't skip steps of understanding that others often do. The datum that all cholesterols were the same except that the protein covering is different is new 'old' info to me. Thanks for speaking to me, instead of over me. Aarre Peltomaa

[@abdelilahbenahmed4350]

Thanks for the valuable information. It is interesting to also show how an individual can know if his very high HDL cholesterol level (more than 1,10 gr and up to 1.40 for instance), obtained without any medications, is actually" functional" or" dysfunctional". Waiting for your coming video on this topic, I speculate that this would refer to the "big picture" : if you are not diabetic or insulini-resistant, and all the other parameters of your lipid profile are good, and your inflammation level is very low, and you have no atherosclerosis, THEN your HDL cholesterol could be considered as FUNCTIONAL. Equally important to know what are the factors that contribute to this extremely high but still functional HDL cholesterol : genetics, diet, exercise, fasting ....

[@beardumaw24]

Great ! Short concise understandable and to the point ! More please.

[@KekeLight8]

OK, from a patient's point of view, what do patients do when the doctor is telling us our bad cholesterol is too high? And More importantly if statements don't really work what do we do?

[@jaynepower4330]

Very clear & essential information thank you 🙏 You have a knack for translating complex medical info into plain English.

[@marsevar]

Would love to hear a podcast with you and Paul Mason on this subject, especially to clarify if ApoB is a risk itself or only if glycated

[@claudiucosar]

what i learned is that this particle is bad only if oxidized or glycated which can be due to chronic inflammation, high blood pressure or too many carbs

[@richardelson2179]

yes please address this question. I currently understand that the ApoB is the point at which the problem occurs and not the cause of problem. So sure. . .more ApoB. . .more opportunity for problems. The cause of the problems is not ApoB but rather glucose spikes which cause glycation followed by oxidation of the ApoB which is guaranteed with high oxidation from diets high in seed oils. Depleted LDL's are normally recycled via the liver. The liver has ApoB receptors to facilitate this. Glycated/Oxidized ApoB's are unrecognizable to the liver, therefore the amount of oxLDL's become elevated. . .and cause problems.

[@claudiucosar]

@@richardelson2179 what i assembled is that indeed LDL-p tries to protect actually the damaged endothelial cells with the transporting cholesterol however as you point out i'm pretty sure that the fireman is NOT the cause of a fired-building just like the LDL-p in this case. So i would assume that for a healthy endothelium wall that particle was NOT designed and not evolved during 350.000 years such that it produces more harm than good. I struggled most of the time to lower that apoB particles however i don't think that's the approach since i was eating many carbs as well which on the long run can produce glycation which in the end i don't want to end up with since i assume even a "NORMAL" level of apoB with a damaged and inflammed endotelium walls can penetrate and produce deposits/foam...immune responses. from what i learned there are the 2 kinds of damage that a particle can be harmed: oxidation + glycation. so i would assume even in a moderate apoB levels if one has an inflammed wall from a protective perspective the particles would penetrate those cells. true for the last statement as from what i also understood from Peter's long educative lessons however for a non-affected non glycated apoB i don't see any problems. i m using my car on needs, i put gas on it(that could kill me when leaking...) but if everything is in order i can run fine with it....

[@kalex888]

Correct, glad you explained this. I hope that next time you are someone else's podcast and they start acting like they know a lot about a subject but they actually don't, you chastise them the exact same way.

[@jasonskeel6474]

Just my 2 cents here, I think if someone is watching this and able to follow what you are explaining they probably understand what density is.

[@pimacanyon6208]

right. I think you're saying if someone has high density mental capacity they are not going to watch a video like this.

[@Oberon44]

seriously, huberman does that too

[@DiegoPereyra]

Great educator...! Very cool Dr. Thank you.

[@VikingHunde]

I would pay monthly for just a weekly TLDR from Peter on subjects like this!

[@debra13]

what is a TLDR?

[@VikingHunde]

@@debra13 To Long Didn't Read

[@simev500]

Thanks for clarifying the concept of the cholesterol 'transporters' ( hdl-c, ldl-c) from that umbrella term of good or bad cholesterol that's been flooding our consciousness for the last 3+ decades by mass media, making us too inure, unsure, and stupefied to care anymore. So everyone's just following buzzwords created my marketeers to peddle products in the guise of health promotion.

[@joshmcgarry88]

Hey Peter, great snippet here im actually a type 1 diabetic however im in extremly good health and my diet is really good too, I exercise regulary through runnung and strength and conditioning and have a good control of my sugars, however i have been advised by my doctor after some bloodwork that i may have Familial hypercholesterolaemia. I will be going to see a cardiologist soon, however it would be great to have some questions i might be able to ask him based on the fact that my health in general is so good, any suggestions or insights would be great 👍

[@kathycollins484]

at the end of the video when Dr. Paul says that saturated fats are bad, I believe that's wrong. also wrong, is the reference to using canola oil to lower LDL. Many experts doctors etc. agree with what I'm saying. it's my understanding that canola oil along with all the other oils ( except for extra-virgin olive oil, butter, and ghee ) are contributors to oxidation which is bad.