Insulin Resistance Syndrome: A Neglected Risk Factor for Chronic Disease

[@inasbriek]

I have a question. My HoMA IR is 4,4. Really high, but all my other blood dates still in green. How could that be? or what does it mean?

[@nourishedbyscience]

Excellent question, and one I considered addressing in the video. In general, in the insulin resistance syndrome, insulin resistance is caused primarily by excess ectopic fat, visceral fat, and low-grade chronic inflammation. This is the case in the vast majority of people with overweight and obesity, but also some who have a high body fat percentage in spite of a low body mass index. In that syndrome, we expect several of these 8 biomarkers to be at least somewhat elevated. If someone has just one marker elevated way above the others, then it's a good idea to consider other causes. For example, some people have genetic reasons for extremely high LDL-cholesterol or triglycerides, others eat a diet that may give them extremely high LDL-cholesterol even though all of their other markers are in the green. And of course, there are numerous reasons someone could have low-grade chronic inflammation, such as an autoimmune disease. So, in your case, I certainly cannot say what the issue specifically may be, but if HOMA-IR is way further right on the graph than anything else, the insulin resistance is less likely caused by ectopic/visceral fat and low-grade inflammation and more likely by one or several of the other potential causes we discussed in the last video: kzbin.info/www/bejne/forXn5-IeNZradU Probably a good idea to discuss those that you consider possible with a physician. Does this make sense? Best, Mario

[@ryans1623]

@@nourishedbyscience My hoMA IR is 9 but hba1c is 5.2 and fasting glucose 5.4 and the rest of my labs are normal to optimal.

It can be very simple answer. HOMA IR is Glucose x Insulin /22,5(or 405). Also if you do something what increases glucose before you do homa-ir test, result will be off. As example I was driving before test trough heavy traffic and cursing whole time and my test was 250 percent off :). Stress increases glucose and glucose increases insulin and... If your test is multiple time so high, reason will be not so simple of course.

[@wocket42]

​@MarianJavorcik if you drive this way every day, your test was still accurate

@@wocket42 also you are saying I can measure my HOMA-IR direct after a meal. because I am eating each day ?

[@zdravljed5888]

Hi, I am Health Coach from Australia and I spent at least 13 000 hours reading books, listening youtube video's, taking courses etc. I have to say that this is one of the top 30 health videos I watched.

[@nourishedbyscience]

Thank you. Best, Mario

[@okay1904]

While this channel requires paying attention to details, and the average individual may find the approach a bit hard to understand initially, this is a really good channel, that is about the most accurate and comprehensive. No hype, just well researched information, with no bias. Well done and thank you.

[@TomiRantanen]

I'm consistently impressed by every video on this channel! It's so hard to find experts who understand this stuff in the first place, but you also have the skill of explaining things so clearly. And the visuals and animations are incredibly helpful. Thank you again, you're such a great resource for metabolic science.

[@nourishedbyscience]

Thank you!

[@metalrunner4398]

Amazing video Mario. As someone who was told that I am destined to get t2d in my 30s since all my family members had it, my trigs were 160, LDL 150 and fibroscan showed 67% of liver fat I can especially appreciate it. In 4 months I went to zero (0%) liver fat, trigs 42 and LDL and apoB both in low 60s. A1c 4.6% Nobody is destined to get t2d. My recipe was calorie deficit (in my case plant based high protein diet combined with cardio and weightlifting).

[@nourishedbyscience]

Wow! Congratulations! Thank you for sharing! Did you go vegan/vegetarian, or just heavy in whole plant foods with some protein source, including animal protein? Wishing you all the best to keep it up, and doing so happily! Cheers Mario

[@metalrunner4398]

@@nourishedbyscience I am vegan for the ethical reasons. I think that from a health perspective fish and some dairy are health foods so my decision is purely ethical. I get protein from lean plant protein sources like tofu, tempeh, seitan, tvp, legume based pastas complemented by what I call a “secondary proteins” beans, lentils, nuts, seeds. Full disclaimer: I think I would have achieved this with any kind of whole food calorie restriction. This simply aligns with my values and is sustainable for me.

[@wocket42]

​@@metalrunner4398do you eat to satiety now or do you still need to limit yourself?

[@metalrunner4398]

@@wocket42 I eat to satiety. Protein and fiber make you full. I have been doing this for 5 years. Eat 3 meals a day. Third one I have to force myself to eat to get enough calories since I workout in the evening 😄

[@212aeh]

Congratulations! And always great to see someone who chose to be vegan but is not being dogmatic about it 🎉❤️

[@danieldana6884]

Thank you! Simply the best video I have seen about the whole insulin resistant ordeal a lot of us go through in life.

[@beverleybrangman2191]

Great video. I was told my sugars were high in my 40’s, and no advice was given. Now age 71, I see a nutritionist, who has been a gem. My numbers are better, but I lost 15 pounds, and she helped me gain 5 pounds. I now weigh 95 pounds, but I am strict with diet and exercise. If I relax, my numbers go up. I also see an endocrinologist, because I have antibodies to type 1 Diabetes.Thank you

[@alexm7310]

Yes, exactly... all this time nothing is ever done to address the root cause. Yes, exactly... we all should accept more responsibility for our own health! Thank you Mario 😊❤

[@aliciab4236]

You are a fantastic teacher. My only complaint is you weren't my teacher in college. What a clear picture of the lifecycle of most people in the west. I will be sharing this with my MD friends. Maybe they will begin sharing your channel with patients. 🤞🙏

[@nourishedbyscience]

Appreciate your kind feedback. And your help getting the word out! Cheers Mario

[@jackolantern7342]

Mario, this is an incredible piece of work tying together all these key biomarkers, internal conditions, and external inputs and painting a picture of what is, at its core, a system problem. I can't help but feel that these disease conditions are like cascading failures within that system.

[@nourishedbyscience]

Yes! Good analogy. The problem is that the system initially (often for years, depending on the person) can largely compensate such that the underlying issues are barely becoming visible in those lab measures that are commonly measured, and because - IMO - the thresholds at which we start to pay attention, are quite high. Cheers Mario

[@Daniele__D9]

One of the Best Health Videos in the Whole World Right Now !

[@nourishedbyscience]

That's high praise. I am glad you found it helpful. Thank you for taking the time to provide feedback. Cheers Mario

[@sac1964]

Yet another outstanding video. I can only imagine the amount of work that must go into this. Well done and thank you for taking the time to produce such helpful content.

[@ebluz]

Excellent presentation. I don't know what it's gonna take, but ignored health markers like insulin levels, Homa-IR, and C-RP need to be added as standard items for routine blood tests.

[@nourishedbyscience]

Totally agree. I suspect, and this is my main critique of the healthcare system in this regard, that we are not measuring fasting insulin and HOMA because we don't have an approved drug to treat it in non-diabetics anyways. Cheers Mario

[@mhossain400]

Mario, i'm a systems engineer, and medicine is of course system engineering of the body. You've understood and captured the start to finish of the overall root cause/s of the key syndrome/s that lead to severe threats such as T2D, CVD cancer, etc.. Well done. I hope the medical community and GPs soon adopt your charts to be more practical and explicit in tackling this fundamental medical pandemic. Regards, Manzoor

[@shekatagani]

Thanks this is great information and you explain everything in simple very understandable ways. I started to change my ways at 67 years old, I was on a bad path, I am now near 70 years and In a few years I changed my diet and started to exercise more. I have lost extra weight and lowered my blood pressure and brought my lab work numbers closer to good values, I will continue to try to be more healthy in My life, and only wish more of my friends and family would follow the same paths.

[@nourishedbyscience]

I love this comment. It's one I hear so often because making healthy choices is difficult if everyone around you just eats fast foods, processed junk, cakes and cookies all day, and thinks that exercise is a waste of time. That's why I am actually considering creating an online community of like-minded people to learn and implement what we discuss in the KZbin videos together, with additional support, an ability to jump on Q&A calls with me, ask questions, exchange recipes etc. etc. If you'd be interested in something like that, send me a note using the contact form on my website (nourishedbyscience.com/contact/) or sign up for my email newsletter (sign-up form is also on the website) so I can keep you in the loop. Warm wishes, Mario

[@andreac5152]

Sweet, pun intended. I would add that a CRP above 0.2 mg/dl or 2 mg/L is already considered highish lately. Thanks a lot as always, not sure people realize how good this content is. It's like asking about metabolic health to chatgpt 10 for free.

[@nourishedbyscience]

Thank you. Even though I am not excited that you suggest I will be out of work in the very near future ...;-p Cheers Mario

[@vcbrittney4072]

The problem is, it isn’t a problem of ‘insulin resistance’, it is a problem of glucose saturation. Because of the high carbohydrate/sugar diets we are consuming, we are taking in more glucose than our bodies can utilize. All of the cells in the body then become saturated and insulin cannot transport anymore into the cells, therefore the excess is left to circulate. When a diabetic exercises, their circulating blood glucose readings will drop. Why? Because they have burned off the glucose that was (stored) saturated in the muscles for energy and thereby making room for insulin to then transport circulating glucose into the cells, resulting in decreased blood glucose readings. This is why you have to wait a few hours after you eat before you can accurately test your blood sugar. You have to give your body time to breakdown the meal and for the insulin to have time to transport the glucose from the food you ate into the cells that have room or need it. Your post prandial reading shows how much is still circulating after all the cells are saturated.

[@lotembenatar7163]

Thanks again, Mario, for the amazing video, I appreciate how you took such a complex topic and simplified it so well

[@jillbetts1241]

This is such an excellent and informative presentation. The best that I have seen on You tube. So helpful

[@nanka2002]

I will walk now for half an hour and will listen to this video

[@earthmamma85]

Thank. You. I’m going to show this to my husband who’s triglycerides have been high and HDL low for several years. He’s 40. I try and explain the urgency of the situation but he doesn’t seem to get it. He doesn’t exercise… I think the last time he actually put that effort in was in high school, he has a office job and eats very high carbohydrates, sugary foods. I worry so much about him.

[@briancarey3143]

Yes, refer to Dr Sean Omara.

[@briankellner970]

This is the clearest and most concise explanation of this topic that I've ever seen - fantastic job! My friends would often ask for advice on how to interpret lab results and how these various factors affected health, and I always felt like my answers were inadequate. I'm just going to send them this video and the link to download the poster now. Thx again!

[@nourishedbyscience]

Hi Brian, Nice to 'see' you again here in the comment section! Hope you are well! I appreciate your kind feedback. Cheers Mario

[@briankellner970]

Been a busy year, but I really enjoy all your great videos, Mario! @@nourishedbyscience

[@arunaratnasuriya5778]

Excellent and very logical presentation. The sad thing is most of the physicians don't think this way. Thank you for summarization of the whole perspective.

[@nourishedbyscience]

Actually, several physicians are among my closest friends and colleagues, and they are also among the smartest, most compassionate people I know. My personal perspective is that physicians are victims of medical training and a healthcare system that doesn't prioritize prevention, and those that try fight an uphill battle their entire career. Just like the food environment doesn't make healthy eating easy for us, the healthcare environement doesn't make it easy or even possible for a physician to take the time necessary to address root causes of chronic disease preventatively. I think many physicians are similarly frustrated with that. Cheers Mario

[@arnkbb4656]

You are a life saver Doctor! Always enjoy watching your super informative videos

[@whlewis9164]

Great video. Every clinician should be recommending this video for their patients.

[@andrewgrey5621]

This is the most helpful health related video I've watched, period! So very helpful to understand the interconnections between these markers and their flow on effects. A great synthesis of complex ideas into understandable and useful concepts. Thank you so much!

[@nourishedbyscience]

Appreciate that you took the time to provide feedback. Cheers Mario

[@andrewgrey5621]

Many thanks Mario - I really value the time you've taken to educate people about their health. I've been wearing a CGM, and found your channel by far the most helpful I've come across in making sense of my results.

[@blumingwellness]

Another slam dunk! Such valuable information! I like to say that investing in your health is like putting money in your health 'bank'. Early investment yields better results. Even just a little investment early is better than nothing. Thanks for pointing out the continuum of these blood markers--our metabolism changes gradually--so many opportunities to intervene! And, yes, it's lamentable that doctors will say nothing to the person with HbA1c of 5.6, if the test is even run! Our medical system has grave shortcomings, not to mention our entire culture with abundant, cheap hyperpalatable food... as a health coach I work to inspire and guide people to reclaim their health. Your videos are amazing educational tools! Hope to see you on some major podcasts soon to get the word out more widely. Really appreciate the posters, and that you created several by sex and skin color. Sorry for the long post. One question. What do you make of isolated hypertension where none of other levels are markedly elevated? Other causes of hypertension? Thank you, Marian Blum

[@nourishedbyscience]

Thank you for your kind words, Marian. Yes, I do think it's important to be clear that each of these eight factors could be elevated by itself for reasons. For example, there are genetic or dietary causes of elevated LDL-cholesterol or triglycerides in otherwise healthy, lean, insulin sensitive people, and similarly there are other cause of hypertension as well. Cheers Mario

[@desaibha]

Wonderful, prescient, unbiased, comprehensive and beautifully explained presentation. Thanks a lot.. I will use these points to educate my fellow physicians and educate public, especially younger generation so that they can improve their lifestyle.

[@nourishedbyscience]

Thank you for your kind words. Cheers Mario

[@krollpeter]

This is the best information about insulin resistance, and the relationships to it and as well in between the different data from a blood test. If my English makes sense. This is a complex subject that was presented so well, that it became an easy to understand subject. Also the Insulin Resistance Poster provides a clear visual representation where I am. Now I see the urgency "to do" something, instead of just a few numbers on a lab report. I am doing a few prints and distribute them among friends as well. Yours are most recommended contributions, Mario!

[@AccordionLadyDi]

Fantastic way to present this problem. Thank you

[@pqvid]

Good to see you have recovered so quickly! Thank you for the video!

[@mbusch2669]

👍🏻Yes, good to see! 👍🏻

[@Calgary-70-Yahoo]

Love this channel. Thanks Mario! To me, the simple Trig/HDL ratio is a useful indicator of one's insulin resistance status. If I had known about this calculation 20 years ago, when I weighed 192 pounds, it would have helped me realize I had a problem. Fortunately I still have my lab blood tests going back to 1997, and was able to calculate this Trig/HDL ratio (using mg/dL values) as consistently ranging from 3.5x to 5.5x back then. From this video by Mario we learn that an 'optimal' result for this Trig/HDL ratio is 1.25 (75 mg/dL of Trig divided by 60 mg/dL of HDL). And according to Coach Kait, a ratio result under 1.9 means one is insulin sensitive, a value between 2.0 and 3.0 means one has some insulin resistance and a value over 3.0 (like me 20 years ago) means one has significant insulin resistance.

[@tiangsae8482]

my trig/HDL is 72/48 = 1.5 which means insulin sensitive, but my Homa IR (fasting glucose x fasting insulin) is (126x20.61)/405 = 6.41 very insulin resistant

[@HDCybersun]

The big takeaway I'm seeing from all of these is, eat healthy whole foods within your calorie count requirement and exercise daily. And never stop doing so until you die, hopefully at age 95+.

[@nicolatesla5786]

I study metabolic aging and life span. Yes a plant based diet is like medicine it prevents metabolic diseses. Exercise is also a requiment.its VERY common for humans to live in high 90s to 116byears old " raw vegan"

[@tragicevans4157]

We won't be here if our ancestors are Purely Vegans. Healthy Balanced Diet is the best

[@whlewis9164]

@@nicolatesla5786kinda depends on what the plant based foods are. Personally, I’ve corrected my accumulated metabolic issues on a zero plant diet.

[@jaysphere7519]

​@@nicolatesla5786nonsense. Vegan and vegetarian works well for female anatomy the most.

[@shamakasuraweera]

Thank you very much for your video.This is great explanation

[@chremis]

Very Good Content, keep going, much appreciated. I went keto/low carb this year. Weight, now ideal, lost 16kgs, Blood Pressure, trigs, hdl, hba1c, kidney, liver, thyroid markers...all good. Moved from insulin resistant to sensitive based on trig/hdl ratio, No smoking, very little alcohol, Smart scales say age 20 years younger than I am...only trend which went wrong...total cholesterol/ldl...now elevated to high...lots of community help saying dont worry, lots in this position, but, I am taking action on reducing sat fats, ...visceral fat at warning level...stubborn reducing this one also...medical folks were good...any history of CVD in the family,...no, so overall risk factors low anticipating low ldl small dense particle count, but cannot get the test for that, still at 22% risk of developing CVD in 10 years, but thats using old assumptions calculator, ie out of date ldl weighting

[@nourishedbyscience]

Thank you for sharing. In this comment section, I have commented repeatedly that I think it's great if people can reverse the insulin resistance syndrome with most of its components by going low-carb, keto, or carnivore. And obviously these changes will substantially reduce risks of many chronic diseases, so I celebrate that. And also let me say that I am generally in favor of low-carb diets to reverse metabolic disease. However, I still think it is prudent to assume that LDL-cholesterol is a major risk factor for CVD in this scenario until we have better data. As of today, it's a hypothesis at best that LDL-cholesterol is less atherogenic in people on low-carb diets, and I personally would not bet my life on that. At this point, I know of no circumstance in which elevated LDL-cholesterol was not independently associated with atherosclerotic progression and CVD. Is it possible that high LDL on keto is THE exception? Yes, I think we should always be open to the idea, and I like Dave Feldman's work on this a lot. But I do think it is premature to declare that elevated LDL-cholesterol in this setting is harmless. My 2 cents Cheers Mario

[@chremis]

@@nourishedbyscience thank you for your reply, very wise, I agree with your thoughts on this, best wishes

[@anhhongnguyen3307]

Cảm ơn bạn!

[@nourishedbyscience]

Thank you!

[@alchemy1]

Date August 3rd, 2023. This was after having been on keto for 4 months I noticed this ratio of 57/60 = 0.95 TG/HDL-C Gave me the least remnant cholesterol, value of 8. TC 293 LDL-C 225 . Then on: Oct 27,2023 The lowest ratio of TG/HDL-C gave me the highest remnant cholesterol. In fact this was historical high. TG/ HDL-C 49/75 = 0.65 Highest remnant cholesterol 60. Total C of 491 LDL-C of 350 Then a month later Nov 23, TC 442 LDL-C 356 TG/HDL-C 93/72 = 1.29 Remnant cholesterol 14 ========================= Consider A1C in the above readings at 5.3 LPA 28.7 ================================= Here is my lipid reading at my worse year of obesity. August 2022 Weight 210 TC 183 LDL-C 104 HDL-C 42 TG 221 A1C 5.8 TG/HDL-C 5.3 And remnant cholesterol 38 By the way this is the first time in a long time I have seen my total cholesterol and LDL-C to be within so called acceptable range. By the way at this time I was indeed in pain. I mean real pain. I was hurting. ==================================== At home in the morning after a relatively good night sleep my blood pressure reads 95/65 and if the night was not as restful consider it 115/75 and less. Durig afternoon on typical day, it is around 120/75, maybe 125/80. At doctor's office it is 140/90 on a good day. But as a role higher than that. Visiting doctors is dangerous to your health and then they put you on medication. Go figure. I AM 65 YEARS OLD. 5'7". went from 210 to 170 lbs. within months on keto diet.

[@nourishedbyscience]

Thank you for sharing. I can see how your personal experience would make you question that LDL-chol/apo B are negatives for long-term health. However, I just don't see your experience and the apo B-ASCVD link as mutually exclusive. I am worried about the very high LDL-chol in some people on keto, and talk about it more here: kzbin.info/www/bejne/rpuzdXRmeMifa5Isi=z_JlijtWDqCPGgZL Cheers Mario

[@alchemy1]

@@nourishedbyscience I have decided to comfortably add more carbs in my diet, not through refined carbs but through vegetables and dairy. The only other option is to also take Statin. I go for walks my with my dog but I don't think that is such an effective activity for lowering cholesterol. I do it because I just like going for walks. The only other thing is to exercise like a fool just for the purpose of lowering cholesterol. Losing more weight? I don't know about that. An added information: I got a call for LabCorp that my LP/IR was less than 25. I don't know what that means. And I supposedly don't have metabolic syndrome or something to that effect. When I went online and searched what metabolic syndrome is, it seems that there is no mention of cholesterol .

[@sub_tropic]

Can you recommend any similar resources with this level of detail for children’s nutrition? Your videos are great, thank you.

[@nourishedbyscience]

No, I am sorry. I do plan to publish some videos that will be similarly relevant for children. Any specific areas of interest? Cheers Mario

[@sub_tropic]

@@nourishedbyscience thank you. Any key differences between nutritional approaches for children vs adults would be interesting to me.

[@karolina8367]

Thank you for your hard work 🙏 It is greatly appreciated!

[@Jack_Schularick]

Excellent presentation! A physician myself, I happen to agree with everythin you say about IRS, Mario. But I do not agree it's the food industry that is to blame but the general welfare. The economic incentives in modern societies force food producers to develop hyper-palatable, ultra-processed food in order to be competitive and survive. You'd have to forbid certain combinations of fat/sugar/salt and/or processing above some defined level. And reduce or remove subsidia for agriculture.

[@nourishedbyscience]

Yes, totally see your point. A cereal or potato chip maker who made their products bland and plain would be out of business soon. Thanks for your feedback. Hope you're well! Cheers Mario

[@phil6082]

Quite simply an excellent video Mario - very many thanks indeed.

[@janborkowski9494]

Its great stuff. Well done and kudos for the hard work you put into those vids. Keep going as I do belive you already saved or prolonged live of many❤

[@danieleperucchinhi6007]

Danke!

[@nourishedbyscience]

Vielen Dank zurück! Cheers Mario

[@robevans2114]

Well done. I am Joe. I wish I had your video when I was young but better I know and can work on these now. Thank you

[@nourishedbyscience]

Sorry, Rob, to be the bearer of bad news. However, I hope it's going to help you in the long run. Best wishes, Mario

[@christytaddei7972]

Excellent presentation.

[@mplt6151]

Great value video, nicely illustrating and therefore easy to understand. Thank you.

[@jveals]

Dear Mario, I immensely appreciate your videos for their scientific rigour and unbiasedness. I have a question though regarding weight loss, which seems a huge factor in reducing metabolic risks. I gather from most of your videos that you advocate a balanced diet, and watchfulness regarding caloric density (for ex. your video on Anne’s 3 lunch variants vs. satiety). Do I take it that you do not share the view that reducing carbs in an otherwise healthy diet would provide quicker results with regard to weight loss, and also less problems with hunger? Cheers!

[@nourishedbyscience]

Thank you for your kind feedback. I actually do not advocate any specific way of eating, other than eating foods that are unprocessed or minimally processed and micronutrient dense, that minimize the risks of negative components of our diet, that maximize satiety and minimize overeating, and that we happily enjoy. That can be done in many different ways. Low-carb is one option, and it's a particularly good one for people with glucose intolerance, insulin resistance, or strong sugar cravings. For others, low-fat or a balanced macronutrient diet may be equally good options. To answer your question directly, I don't think the data support the idea that going low-carb is in any way superior to other ways of eating when the goal is weight loss. It is superior in quickly lowering blood sugar and insulin levels, and in people with chronically high blood glucose and insulin, that is a major benefit. I'll make several videos about the different dietary approaches to reverse insulin resistance and glucose intolerance, and to lose weight. So that's where I'll go into more detail on these questions, and provide references as well. Cheers Mario

[@jveals]

Thank you so much for your useful reply, Mario. Unfortunately I probably fall in the category of insulin resistance and glucose intolerance with an a1c of 5,7 and probably a bit worsening development according to a recent trial of GCM (average glucose 116 mg/dl and Glucose Management Indicator of 6.1). I have in this light taken steps and reduced carbs (although in an overall healthy diet) and increased exercise and resistance training. I am 69. Lipids/triglycerides/colesterol apparently unproblematic. I hope to see an improvement in light of these steps. I look very much forward to a video on the subjects you mention! Cheers

[@yongchingkhumlachang1270]

Video of great value.thanks

[@jackharper6746]

it would be amazing if you gave simple and specific advice to adhere to to reverse insulin resistance

[@maplenook]

Avoid carbs and stress. Exercise.

[@MMartin-pt9yv]

It is important to remember that raised Insulin can precede obesity /Insulin Resistance. It can be the main driver of raised carbohydrate+fat intake. The mistake that has been so destructive was the unscientific assumption that Obesity caused the original problem of Insensitivity. (I was actually taught this, as were many doctors) Prof Jim Johnson, UBC is a leading researcher in this field.

[@KenH-63]

Thanks Mario, I've enjoyed all the videos and found them very instructive. In the UK there is limited content in our routine blood tests. No fasting ones either. I've done the Zoe programme which showed blood fat response to be good, microbiome to be healthy but (as expected) glucose response bad. At the time I was pre-diabetic on the basis of Hba1c...though a month after the Zoe test I was back in "normal". My Zoe results (effectively a glucose intolerance test) are of no interest to my surgery (once I was normal on their single criterion)...nor were they interested in my cgm results showing a "high" overnight fasting level. So all I can do is to reduce my carbs and try and avoid too many spikes by using my learning from the cgm and adopting general good practice. My triglycerides are good as is my cholesterol ratio....but I still wonder if I'm insulin resistant or whether my glucose sensitivity is due to something else. I did the Mayo clinic test...was surprised at how against all saturated fat they were. I feel the science is now differentiating red meat fat and certain dairy. That view being that full fat yogurt, Kefir and cheese are beneficial.... do you have a view on this Mario? K

[@nourishedbyscience]

Yes, I do have a much more nuanced view on this, and there will at some point be videos about the impact of dietary fats and the fatty acid composition on the serum lipid profile. To answer your question now, the short story is that dairy fat in whole foods, such as cheese, milk, and yogurt, does seem to have no or pretty modest effects on the serum lipid profile compared to the same amount of isolated dairy fat (butter) does. Cheers Mario

[@OnyxOnyx-r7w]

@KenH-63 Could you please clarify which Mayo clinic test you are referring to?

[@gtcih]

Very well done Mario. After being diagnosed with CVD, I started a very low carb diet 8 months ago. I have lost 20+ lbs (BMI is now at 26) and have lowered my A1c from 5.7 to 5.3. Recent blood work shows HS CRP at 2.2, particle numbers are not great and my LDL pattern is B. Doctor says I’m not diabetic, don’t have metabolic syndrome, hypertension, not obese or overweight. I’m not a smoker. If I understand you correctly from an answer you gave, could my visceral fat still be causing my elevated triglycerides. It is my understanding, as well, that many low carb/ no carb dieters see their LDL increase. Should I lower consumption of saturated/animal fat from my diet? My diet seems to be working for everything else.

[@ralphbuschmann740]

Setting the Standard again and again …

[@stevenmchenga1176]

Thanks. Great video.

[@lwintint4662]

Thank you very much, Dr. it is fully explained!❤❤❤

[@mirzamanmirzaman1482]

My favorite video. I can learn a lot from this.

[@anahitawilson9682]

I think the metabolic syndrome scale you put forward makes a lot of sense.

[@ef9033]

Super gut erklärt Danke 😁

[@wellnesssecrets2014]

Brilliant, amazing content and presentation. Seven essentials for good health balances five elements

I was Joe at 50 years, no doctor told me something about insulin resistance, I had to come to it myself and I do now low carb. But I do not fit now to your table. My waist circumference is 84cm, triglycerides are 0,95(84,17), HDL 1,76(68), average blood pressure 107/67(without pills), fasting glucose 4,8 (HbA1C 4,9), HOMA-IR 1,28, CRP 0,43 (I have psoriasis), but my LDL is 4,89(189). Is high LDL ALLWAYS a risk ? I can lower my LDL if I eat more carbs, but other parameter will go up. My doctor has seen my progress and said I can ignore my LDL, is she wrong ?

[@acke26]

within the psoriasis science it's well-known that ldl is elevated. the reson for this is debated and some experts mean it's a reaction from the body to heal inflammation caused by the autoimmunity of psoriasis

[@wocket42]

Try keto carnivore / paleo keto diet to heal auto immune issues. I have Crohns Got my hsCRP ultra low this way. No biologicals needed anymore.

[@nourishedbyscience]

Hi Marian, Congrats on your progress. Your question is a common one, and I invite you to look for similar questions in this comment thread, including my answers. In general, and in spite of what you may be hearing, LDL-cholesterol at concentrations exceeding about 80 mg/dL is clearly a major risk factor for atherosclerosis and CVD. This is based on multiple lines of evidence, and summarized in this consensus statement here: Low-density lipoproteins cause atherosclerotic cardiovascular disease. pubmed.ncbi.nlm.nih.gov/28444290/ Note that this group of scientists even used causal language in the title, which is almost unheard of in biomedical science. Now, that said, if your former self had slightly lower LDL-cholesterol levels, but at the same time also suffered from hypertension, insulin resistance, fatty liver disease, and pre-diabetes, it is well possible that your overall CVD risk is reduced on a keto diet in spite of the elevated LDL-cholesterol. However, I personally would not be content with 'lower' risk than before, because at your current LDL-cholesterol level, most preventive cardiologists would still say that it is likely that atherosclerosis (the process that leads to CVD) will progress over time. You may have heard the claim in the low-carb community that elevated LDL-cholesterol is not a concern in people on low-carb diets because they are metabolically healthy or because the LDL-particles in people on high-fat diets are mostly the large, fluffy ones and not the small, dense LDL particles that are more atherogenic. It is true that the size of LDL particles tends to be higher on high-fat diets (I have published a paper on this myself), and this means that the variable that really counts, the number of LDL particles (often measured as apo B concentration) is going to be somewhat lower for you compared to someone who has the same LDL-cholesterol concentration but mostly small dense LDL particles. It still means that you have too many LDL particles. You may have also heard that there is a hypothesis, formulated by Dave Feldman (google him if you haven't heard of him) that in lean, metabolically healthy people, the increase in LDL-cholesterol on ketogenic diets is not atherogenic. He is currently doing a clinical study to test his hypothesis, which I think is commendable and interesting. However, at this point, this remains a hypothesis, and personally, I think the prudent thing to do is to assume that LDL-cholesterol is atherogenic in all circumstances until we have good data to suggest otherwise. To be clear, I know of no instance in all of biomedical science in which elevated LDL-cholesterol is NOT associated with an increased risk of CVD. So, I cannot give medical advice, but I personally would address my LDL-cholesterol if it was this high, no matter how good my health was otherwise. Hope this is helpful. Best, Mario

@@nourishedbyscience my primary problem is , for each study saying LDL is associated or causal to CVD exists study which say opposite (multiple studies implying lower all cause mortality with higher LDL and half of CVD deaths have LDL in norm). For each expert/doctor saying LDL level is importing exists expert/doctor saying opposite. And I do not mean youtube influencer, but people as Tim Noakes, Jeff Volek, Stephen Phinney, Ben Bikman, Robert Lustig. I am following Dave Feldmans work with hope that after years someone addressing root of the problem. All other studies do not distinguish between LDL on low carb and other people. And preliminary data from Daves study are very promising . When I was insulin resistant my LDL was in range. But all other parameters were bad, my ALT was some times 2.4 (144) and 10 years has no doctor said to me, you are insulin resistant, you must do low carb and intermittent fasting. That is precisely that what you are saying, if doctor had done fasting insulin test, all were clear years ago . I know I am not alone with my LDL problem, I struggle to believe that my body want to kill me because I eat healthy now. But this is multi variable problem , because I have psoriasis and psoriatic arthritis, I have prescription for HUMIRA (but now only half of dose) and I make tests after 18 hour fasting, and as I understand this, all factors can have influence on LDL.

[@nourishedbyscience]

I understand it can be confusing out there with all the different opinions. The big question I suggest you ask yourself is: do both sides provide equally compelling evidence, and more specifically, has anyone provided me with evidence (data, not an opinion) that elevated LDL-cholesterol is harmless in the context of a ketogenic diet? Dave's data are promising, but they are VERY preliminary. Also, ask yourself whether the data are truly 50:50 as you suggest. If the data were as inconclusive as you suggest, would an international panel of experts conclude that LDL-cholesterol is causal in atherosclerotic CVD? As is probably clear from my videos, I do absolutely agree that many other risk factors are as important for chronic disease risks as blood lipids, even if we just consider CVD. But I do maintain that until we have better data, it is prudent to not discard the one inconvenient risk factor. I see this all of the time: people in the low-carb community talk about the dangers of blood glucose and insulin all day while denying the risks associated with LDL-cholesterol; and people in the low-fat vegan camp talk about LDL-cholesterol all day while rarely ever mentioning blood glucose. It's curious, isn't it? If both sides strictly valued the scientific evidence, they would talk about both equally. Cheers Mario

[@omg_wtf]

Excellent content, thank very much.

[@jacobgnanapragasam929]

Thank you. Very good information.

[@Overlord1241]

Thanks for all this information.

[@MerlHall]

thank you ❤

[@obfuscatid]

Perhaps a video devoted to GLP-1/GIP agonists is due considering recent popularity, primarily touching on how they work, pros/cons, and potential negative side effects.

[@ryans1623]

Ive been trying to find a lab that will do the Kraft insulin test but no luck in Canada.

[@veraarena1583]

Excellent!!Thank you!

[@MrJargo3]

great video

[@ivarrand]

Excellent information It would be nice if you could expand the tests to include the age for healthy ranges for people in the 80s

[@nourishedbyscience]

I understand where you are coming from, but I would argue that older age does not change how to interpret these values all that much. Age does have some negative health consequences, but many of these - I think - can be avoided or minimized if we manage to keep these markers in the green areas for as long as possible. I know, easier said than done, but I feel there is value in understanding where the goal is ... Warm wishes, Mario

[@marynguyen6417]

Thank you for your time put in preparation of this lecture! How do you explain the senario where LDL is very high ( over 300mg/dL), very high HDL ( over 100 mg/dL), yet very low triglyceride (30), and my CAC score is O. These are my results after 5 consecutive years of eating keto, ketovore/ carnivor diet.

[@ArdGeal]

Have you looked at the work of Dave Feldman on "Lean Mass Hyper Responders"? Your numbers put you in this group for sure.... I've got the same issues with LDL but TGL/HDL both hovering around the 60 mark (still a perfect TGL/HDL ratio though)....

[@Dilsli]

​@@ArdGealHe didn't say he's lean. And Feldman didn't "prove" it's healthy to have high cholesterol, as far as I could find material about it. Did I miss some paper? Could you please share if you have some? I'm trying to find more information. My cholesterol isn't very high, but it is above normal. Thank you in advance!

[@salleone6387]

As always extremely informative and well explained. Thank you. I've tried to find out via google why I have optimal trig @ 63 but sub optimal LDL @ 126. The information I come up with is that my diet is filled with healthy fats. So, if I take a whole body approach in a case like mine, my sub optimal LDL is less of a concern? Doctors see that number and want to prescribe a statin which I am not in favor.

[@nourishedbyscience]

I pinned a question that I gave a detailed answer to above that is relevant to your question as well. In short, it is important to realize (and I should have maybe made this more clear in the video) that any of these markers can be elevated for other reasons as well. So if only one marker is in the red and all others are in the green, then it would seem that this one factor is elevated due to some other issue. For LDL-cholesterol, in particular, the diet composition is important, but there is also a major genetic component. Some people on the healthiest diets and without any metabolic issues have LDL-cholesterol levels of 200-400 mg/dL if they are homozygous for a defect in the LDL receptor that removes LDL particles from blood, for example. Best, Mario

[@Mark0528]

Regarding optimal BMI, why do you view 20-25 as optimal? There is a paper titled "Sources and severity of bias in estimates of the BMI-mortality association" by Ryan K. Masters. It finds that optimal BMI is 18.5 to 20.0, anything higher than that is progressively worse for health.

[@lola0600]

Because for one thing, people are different, Asians can have a BMI of 20-25, and it can affect their health negatively, but people of black African can have a higher BMI, and they are okay. People are built differently

[@testuser3167]

I'm condemned by the chart, specifically because of the BMI component - as a dense tall black male, the BMI has never been my friend, according to published standards. If my waist circumference dropped below 82 cm, I would surely be in a hospital bed or a coffin, but I am also about 2 meters tall and the charts don't appear to allow for height adjustments... Most folks think I'm a normal sized person until they get close enough to compare or see me filling up a doorway, and most underestimate my weight by 50 lbs at a glance. That can't all be due to flattery. I'm not sure where most of my other markers are, but I should soon get my lab results back to find out. At least here (USA) the insulin test is rarely done & I had to insist on getting it at my expense.. (Not expensive, just unconventional)

[@MacksCurley]

Your safety is your responsibility and health so educate yourself.

[@MaryRaymond-cg3wn]

There is a group called defeat diabetes who say the LDL is not as significant as doctors suggest and should be

[@bettywhill]

Can you look into LMHR (lean mass hyper responder’s)? Instead of high LDL + high triglycerides + low HDL, LMHR have high LDL + low triglycerides + high HDL. They are usually metabolically healthy. Usually lean (low BMI). Thanks!

[@abdelilahbenahmed4350]

Thx for this fantastic and comprehensive presentation of the topic. We can see that the root trigger of the insulin resistance syndrome is maybe the caloric intake excess.Do you think it could be a daily caloric intake threshold that could minimize or totally protect us from the risk of insulin resistance ,maybe 1200 cal per day , in addition to the classical healthy life style changes?

[@nourishedbyscience]

Preventing chronic overeating and weight gain is undoubtedly one of the most important things we can do for our long-term health. However, 1,200 kcal per day is well below the total energy expenditure for most people. Plus, I personally I am not a fan of calorie counting (it's a pain long term, and takes the fun out of eating). I think that if we eat well and pay attention to some general rules, we can usually avoid overeating. I, for example, have no idea of how many calories I eat, and never never counted my daily calorie intake. Obviously, please do whatever you enjoy and whatever works for you. Best, Mario

[@abdelilahbenahmed4350]

Thx Mario for your answer.Admittedly like you I don't obsess with calorie counting and eat delicious dishes according to my cultural and societal background but I do my best to not overeat, to avoid eating at night and practice some mild form of portion control, to avoid processed foods and to enjoy the pleasure of healthy foods. I think we all have to educate our children about the health risks of eating too often and too much because a large part of them are very probably going to be diabetics if it's not already the case.For instance 1200 calories per day is too restrictive for most people but 4000 calories even of healthy foods is also excessive for most people.

[@peterbedford2610]

Is there any kind of home test for insulin reaction?

[@FelixNL05]

Danke sehr !

[@lpodverde]

Is there a way to know exactly your caloric needs so that you don't exeed calories? Cheking if you gain weight regularly or body mass composition?

[@CipovPeter]

Wow, what a great Video! I was happy to see histograms at the end of video. it is simple and yet approachable to anyone. What is source of your data for them ? is there some study containing these numbers ? Or it is some compilation ? would not population percentyles chart be better ?- Instead of 3-4 bucket having more? I would love to see this method to be peer reviewed and be used by GPs. It gives so much more insight then just plain lab results. It also shows how diet is crucial. It is big elephant in the room. people need to loose weight and just fraction need pills. yet we give pills to everybody and rarely speak about diet... keep your great work sir !

[@nourishedbyscience]

Thank you for your feedback. The chart is based on scientific evidence, to some degree, all of which I cite in the blog post associated with the video (links to blog posts with all references can always be found in the description box below each video). However, I will admit that the exact cut-offs are partly based on my experience and interpretation, based on 25 years of conducting clinical research in this area and reading 1,000s of papers over the years. I absolutely admit that the absolute values could easily be slightly different. I do think to make this really solid, this would be a dissertation project for sure, because it would require a lot more literature search, evaluation of clinical data, cross-testing against different cohorts with long-term health outcome data etc. I certainly can not afford to make every video into a dissertation first, and while I agree that this could easily be improved upon, I do also think this is already helpful in this form. And I will solicit feedback and refine it in the future, so this is not set in stone as it is now. Cheers Mario

[@CipovPeter]

@@nourishedbyscience fair, thank you for honest answer

[@momentsofo]

It was so interesting, and this video answered many of the questions I had. Thank you so much, Dr. Mario. There's just one thing I'd like to ask you: If you don't have excess ectopic fat or visceral fat, does that mean you won't develop insulin resistance or high LDL levels?

[@nourishedbyscience]

Great question. It's important to be clear that there are numerous potential causes for insulin resistance, and also for elevated LDL-cholesterol or elevated blood pressure. For example, I have summarized the main causes of insulin resistance in the video linked below. However, the syndrome I outline in this video is a very common constellation that most people with overweight or obesity suffer from to some degree at some point in their lives. The purpose of the video was to recognize this syndrome, to be able to understand the root causes and all of the associated chronic disease risk factors such as fatty liver disease or insulin resistance that are commonly not measured and therefore not treated. Hope this makes sense!? Best, Mario kzbin.info/www/bejne/forXn5-IeNZradUsi=zwqYCpRO68981HYt

[@marekadamek7697]

Thank you for yet another highly educative video! I have been on a low-carb diet (less than 50g/day) for three months after being diagnosed with borderline pre-diabetes (fasting glucose - 5.7, H1C 5.6. I have recently received results of my new blood tests and they were rather disappointing - fasting glucose 7, H1c 6.1, and most concerning, fasting insuline less than 2, down from 6.4 from 3 months ago. Is it possible that a low-carb diet compromises insuline secretion? That is what appears to have happened to me.

[@nourishedbyscience]

It is unlikely that what you are experience was brought on by your low-carb diet. Yes, a low-carb diet reduces glucose tolerance (temporarily) by reducing the first-phase insulin response, but that would matter in the postprandial state (i.e., after a meal). I am not aware of any research suggesting that the ability of the beta-cell to secrete insulin in the fasting state is impaired by a low-carb diet. I don't want to alarm you, and certainly also cannot say anything diagnostic, but I would visit a knowledgable doctor and have fasting insulin and C-peptide measured again, ideally with whatever follow-up test the doctor feels makes sense. Given a fasting glucose of 7, a fasting insulin of 2 should not be interpreted as evidence of good insulin sensitivity, but suggestive of impaired beta-cell function. Best wishes, Mario

[@Dilsli]

I've been trying to keep a good A1c (below 5.6) with a low carb diet. But it made my cholesterol go up. Then I've been trying to find a balance between low carb AND lowering my cholesterol. It's elusive. My doctor wants me to take statins and I think I should, but I've read statins increase the probability of one becoming diabetic. I'm prediabetic and afraid the statins could push me into full blown diabetes. Could you please share your knowledge about that, Mario (statins as causing diabetes side effect)? I want to find the best possible way to keep A1c in the normal range, fasting BG under 100 mg/dL AND cholesterol in the normal range. Looks like mission impossible just with diet and no medication. I did ask my doctor about it, told her about my fear, but she just smiled, as someone who isn't sure and doesn't want to risk saying something wrong.

[@anahitawilson9682]

Are LDL values per se useful without defining particle number and size? Do you think that Lp(a) is more relevant bio marker than heart disease ?

[@nourishedbyscience]

Yes, LDL-cholesterol itself is a ASCVD risk factor, and the size and density distribution is an additional factor on top of that, not instead of LDL-cholesterol. Lp(a) is very interesting, and yes, I do think the data support that it is particularly atherogenic. Cheers Mario

[@lumonar]

Amazing content! Thank you so much. Therefore, the main problem is the consistent energy excess intake. Someone eating a very unhealthy diet but, somehow not consistently eating in excess of energy needs, would not develop the IR syndrome. And another person eating a very healthy diet but with a consistent energy excess intake would still develop IR syndrome. Is this correct?

[@nourishedbyscience]

I'd say very clearly that keeping body fat mass below the personal fat threshold (see video linked below) is one of the most important things for long-term health. Diet quality clearly matters as well though. It's fair to say that each dietary factor usually has a small effect, but the cumulative effects of an overall poor diet can add up to a huge impact over all, and people can certainly become insulin resistant (and develop other ailments) just from eating a poor diet, independent of whether they gain weight. Does that make sense? Cheers Mario

[@OnyxOnyx-r7w]

Since the HOMA2 has been released nearly 20 years ago (2004), why we are still dealing with the original HOMA-IR dated back in 1985?

[@nourishedbyscience]

Good question. My decision came down to three things: one, HOMA-IR can more easily be calculated. Two, we have a lot more data on how to interpret HOMA-IR values across the range. And third, I don't think it makes much of a difference for our purposes here. Cheers Mario

[@OnyxOnyx-r7w]

@@nourishedbyscience Thank you for your reply. The base of my question, is I am getting *weird* values with HOMA-IR vs HOMA2: with 98 mg/dL fasting glucose and 8.2 µU/L fasting insuline, according to HOMA-IR the result is 1.98, while HOMA2 Calculator (by Radcliffe Department of Medecine) shows %B: 84.0; %S: 92.0 and especially IR: 1.09. -- That 1.09 would be totally normal (and fine

[@santarosa6676]

I have been in pediatrics for over 30 years. I see this arc compressed down to a decade. 8 yo= the 35 yo, 12 yo = 50 yo, and an 18 yo = 65 yo. Sadly our current patterns of school, access to poor quality foods, and often unavoidable sedentary lifestyle sets our children up for failure.

[@maplenook]

Injections too

[@GaryKatch]

Your poster has “optimal” values all lined up at the left side. I would rather see the optimal line in the middle, because surely values *under* the optimal must progressively tend to pathology as well. When does that green at the left tend back to red? You want my LDL, blood pressure and waist circumference all at zero (i.e. dead)?!

[@nourishedbyscience]

You make a good point. I may consider this for future iterations of this poster. The challenge is that we have much less data on where the suboptimal range begins on the other end of the scale, if there is even any. For example, at this point, no lower limit for hsCRP, LDL-cholesterol, and triglycerides are defined. For HDL-cholesterol, we are beginning to understand that very high HDL-cholesterol concentrations may be associated with a slightly increased risk of ASCVD, but where exactly that is remains somewhat unclear. It is fair to say, however, that I could have added these numbers for those biomarkers for which a clear lower limit has been defined (i.e., 70 mg/dL for fasting glucose). Best, Mario

[@Lycogol]

My doc uses C peptide as a substitute for insulin. Does anyone know the conversion factor to insulin?

[@nourishedbyscience]

You cannot just convert C-peptide to insulin. Google HOMA-IR based on c-peptide, and you'll find a formula for that. However, be careful, as the unit used for C-peptide is also not standardized, so pay attention to use the correct unit of measurement.

[@Ak-wg3xc]

Exactly my case

[@tuppybrill4915]

Hearing your explanation of what is going on in the blood I am wondering whether the use of statins is actually a bad thing in that it is removing a vehicle that the body is trying to use to get rid of excess sugar. The implication would be that if your cholesterol is high you should be aiming to maintain it or even increase it AND do everything you can to reduce sugars/carbs.

[@laurasc84366]

Exactly!

[@andrewcole4843]

Other bloggers have pointed to subdivision in LDL between large and smaller dense being critical. So which story is correct?

[@nourishedbyscience]

Both. The next video is about this exact topic, because many people are confused about it. Best, Mario

[@jovanajovanovic9]

What if someone is physical active (very) like marathon people. But dont have very much muscle mass. Are they prone to insulin resistance? Thanks in advance

[@nourishedbyscience]

If someone is very active and lean, they are probably fine. I see issues with low muscle mass causing insulin resistance mostly in older people who are inactive and who may also have other risk factors (some visceral and ectopic fat, for example, or chronic sleep deprivation). In general, however, it is fair to say that low muscle mass is a risk factor for insulin resistance.

[@jovanajovanovic9]

@@nourishedbysciencethank you very much for your answer. You are great!

[@jeffwatson151]

how can I get a HOMA-IR test? i'm about to change Doctors again my first Doc told me that I should stay off of google asking for random tests my current Doctor just told me that my triglycerides and cholesterol isn't bad enough to order that test my total cholesterol is 155, triglycerides 86, and my HDL took a recent dip from 47 to 37, however my LDL particle number is really high, how do I fix the high LDL particle number? I called my insurance company they said that Endocrinologists usually order that test so do I have to go see a specialist just for this test I know everything about myself chemistry wise my OXLDL 46, BNP9.8, CRP 0.45 are all very good. based on laboratory parameters I know all of my numbers except HOMA-IR I really want that one because I eat a lot of carbs beans, oats, fruit, rice, etc, and shame on me a fair amount of tortilla chips is my guilty pleasure from time to time.

[@nourishedbyscience]

It's frustrating that many doctors still think of insulin resistance as a 'random test'. Even so, I agree with him that your TGs do not suggest major insulin resistance, even though a high LDL particle number relative to LDL-cholesterol gives me some pause. In any case, I agree with you that it would be valuable to know, particularly if you eat a high-carb diet. You may be willing to pay for the test yourself. Have you offered that? Cheers Mario

[@sherimillman53]

It all makes sense

[@anahitawilson9682]

How can HDL exchange cholesterol in blood with VLDL when cholesterol is hydrophobic? Also, What is your opinion on the thrombogenesis theory (see Malcolm Kendrick’s book The clot thickens, based on Pfizer’s research pre statins) that challenges the atherogenic nature of LDL particles.

[@nourishedbyscience]

Goof question. The exchange is mediated by an enzyme that temporarily binds the lipids during the transfer. Don't know of Malcolm Kendrick or his book, but my very next video is about LDL-cholesterol and its relationship with CVD because so many people seem confused about it. Cheers Mario

[@benfromaustria]

CHAPEAU…great job ! 👏🏻👏🏻👏🏻

[@KJ-um1gq]

Does it all just come down to cutting weight and exercising?

[@nourishedbyscience]

I'd say having a body fat mass inside the personal fat threshold (see video below) is one of the most important things for long-term health. Exercise is similarly important, but I'd also say that beyond calories, there are a lot of dietary factors that each play a small role, but they add up to a big factor collectively. Also don't disregard chronic stress, sleep disruption, and disruption of a healthy circadian rhythm. kzbin.info/www/bejne/mYGYaKKDbdF1l7csi=GRhgNVmmyni9Z0dP Best, Mario

[@pauletteschiowitz8989]

I have stage 3 kidney disease with no symptoms. I don’t know which foods are good and feel I’m not being nourished.

[@michaelmorris9546]

By and large I would agree with most of what you've stated, however, ignoring the size of the LDL particles and simply demonizing all LDL particles is somewhat disingenuous. Larger LDL particles are healthy and do not contribute to CVD, while smaller particles are the real issue. You also mention several times that medication is beneficial, however, simply eating a proper human diet will do the same thing without side effects. That being said though, I thought this was a very informative presentation.

[@nourishedbyscience]

Thank you for the feedback. I understand where you are coming from. We used to think for many years that only small dense LDL particles are atherogenic (I myself published a few papers on this topic). However, that is no longer the current thinking in preventive cardiology. The one big factor we now consider the most is the number of apo B containing particles, of which LDL is one. Thus, the apo B concentration is far and away the biggest factor we should be worried about. What this means is that if you eat a high-fat high-saturated fat diet, your LDL particles will be larger and more buoyant (fluffy). So at the same LDL-cholesterol concentration, that person with more large, fluffy particles would have fewer LDL particles and a lower apo B concentration. So what you are saying is not incorrect, but it does not mean that LDL-cholesterol becomes invalid as a risk factor as long as LDL particles are mostly large and buoyant. I am saying all of this as someone who is very interested in the health benefits of low-carb diets. I am not at all against this as a dietary approach. But, in my fairly educated opinion (dissertation on this very topic, and 30+ years of following this literature), the idea that LDL--cholesterol is not atherogenic if mostly fluffy/person is on keto/person is metabolically healthy etc. is - at best - a hypothesis on which we have no good long-term data, and I would personally not bet my life on this hypothesis being correct. I suggest you follow low-carb cardiologists such as Dr. Ethan Weiss or Dr. Bret Scher, or someone like Dave Feldman, all of whom have reasonable evidence-based opinions about this. Best, Mario

[@nourishedbyscience]

I'll add something else, as I am not happy with the first part of my response above: the size distribution of LDL particles clearly matters, but there are a few important things to remember: - No one has just small dense LDL or just large, fluffy LDL. In everyone, it's a mix of both, with varying proportions. That is to say that the proportion of small, dense LDL is likely an important factor in addition to the absolute LDL-cholesterol concentration, but should not replace it. - The proportion of LDL particles that are small and dense tends to be elevated in people with the insulin resistance syndrome, so the type of elevated LDL-cholesterol that is also associated with insulin resistance, elevated TGs, and low HDL-chol is probably the most concerning type. - If you had a statistical model in which you used LDL-cholesterol (or, better, apo B) to predict risk of CVD, then most studies show that adding the proportion of LDL that is small and dense adds additional predictive value. However, if you now also add variables that are biologically linked to small dense LDL, such as HDL-chol and TGs, then the predictive value of small dense LDL tends to dissapear in most studies. More about all of this in the very next video. Cheers Mario