Exercise shrinks Plaque, but it does more than that…

[@MikeStabler]

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

[@Joseph1NJ]

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

[@Physionic]

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

[@joecity9]

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

[@Physionic]

Good one :)

[@Jeffs60]

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

[@brianrasmussen2956]

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

[@Physionic]

Me neither... haha! Thanks, Brian!

[@seahog32]

I have. Makes me feel uselessly superior.

[@hikedayley9309]

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

[@Physionic]

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

[@hikedayley9309]

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

[@Physionic]

Congratulations!

[@mjt1517]

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

[@jameswalter3136]

Be grateful you don't have arthritis.

[@drott150]

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

[@Physionic]

I love the analogy

[@milanpintar]

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

[@drott150]

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

[@jimglass1290]

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

[@AlanWil2]

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

[@Physionic]

No doubt

[@stevemc2626]

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

[@mjt1517]

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

[@stevemc2626]

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

[@ForwardFeedback]

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

[@dscarson1]

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

[@johntim3491]

🥴

[@peterbedford2610]

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

[@MrTea7]

Anybody decode WFPB? Don't recognize that one.

[@DIABETESHEALTHS]

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

[@philpecoraro5458]

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

[@Physionic]

Definitely, Philipe!

[@EstamosDe]

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

[@ivyr336]

Hows the weather over in Chile?

[@Christopher-b1p]

Watching cherries from Chile go on sale. Wow!

[@Physionic]

You rock - keep it up!

[@EstamosDe]

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

[@EstamosDe]

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

[@gefumiracle5032]

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

[@Physionic]

Thanks for watching :)

[@theonetrueshibe9567]

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

[@Physionic]

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

[@mco51193]

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

[@Physionic]

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

[@mco51193]

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

[@ConniePretula]

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

[@DrProfX]

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

[@drott150]

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

[@partridc00]

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

[@Corkfish1]

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

[@letsthink2819]

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

[@Physionic]

Thanks!

[@rainserene]

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

[@Physionic]

Thank you, I will

[@BillyBoy66]

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

[@dennisward43]

The magic of evolution?

[@BillyBoy66]

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

[@Christopher-b1p]

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

[@Physionic]

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

[@Christopher-b1p]

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

[@charlestoddsullivanforpres6628]

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

[@Gluttonyed]

Great motivation for me to start exercising.

[@davidking3699]

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

[@triviamolemais7253]

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

[@jimdandy8996]

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

[@bill2292]

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

[@dennisward43]

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

[@bill2292]

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

[@brennus01]

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

[@Physionic]

Did you watch my video on stealing mitochondria?

[@brennus01]

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

[@Physionic]

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

[@randombartz8163]

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

[@Physionic]

Interesting - I like the idea...

[@Mario-forall]

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

[@EhurtAfy]

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

[@arihaviv8510]

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

[@partridc00]

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

[@glenneric1]

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

[@oolala53]

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

[@andrewcarlson2178]

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

[@gazorpazorp9798]

<a href="#" class="seekto" data-time="291">4:51</a> this guy is the best. He gets it.

[@Physionic]

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

[@roberto4188]

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

[@Physionic]

Glad it was fixed, but that is incredible

[@mj625]

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

[@LizA-xe4nz]

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

[@LagMasterSam]

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

[@harold18659]

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

[@Physionic]

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

[@DIABETESHEALTHS]

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

[@NoLimitsNatty]

Thank you for all the information

[@Physionic]

Thank you!

[@livephysiology]

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

[@salleone6387]

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

[@Physionic]

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

[@weston.weston]

@salleone6387 Hopefully, he'll respond.

[@bobkoure]

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

[@frelsmeg]

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

[@weston.weston]

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

[@donalkinsella4380]

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

[@ToyMachine9001]

This was very interesting especially when you mentioned that there is some evidence that exercise can increase calcification. I'm in my late 40's and play tennis 2-3x a week & stationary bike 7x a week. My heart rate can go in the high 170's bpm when playing a singles match without feeling fatigued and been doing it for multiple years. I do have a CAC score of 8 interesting enough and my LDL was 97 at the time. Unsure what caused the calcification.

[@fyrerayne8882]

Great, thank you

[@gregkaufmann4502]

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

[@Youtubedisco]

The only 2 people I know who died of massive heart attacks were extreme athletes; one a tennis player and the other a runner. They each died before being able to get to the hopt, aged 47 and 57.

[@alanG3806]

@@KZbindisco I knew plenty when my parents reached their 50s. None of them exercised much at all. These days rapid care keeps them alive.

[@StevenBrener]

Would this include resistance training?

[@Physionic]

No evidence of that up to now

[@1122redbird]

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

[@AlexStephenson-b2x]

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

[@douglasmillar7560]

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

[@chrisk8978]

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

[@cajampa]

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

[@randombartz8163]

What I don't get about all those "plaque shrinking studies" is that if even people with a LDL cholesterol around 70 still have a very slow, but non-zero build up of plaque (according to that study Brad Stanfield often shows in his videos), that gives me the impression that plaque buildup can only be slown down, but not "go in reverse". If that is the case, how it is even possible in principle that plaque shrinks unless we're talking about some extreme situation where LDL cholesterol is droped down to 40 or something? Also, I've also heard that there were some HDL raising drugs tested in the early days of trying to prevent heart attacks with drugs, but they were very unsucessful, doesn't that go against the hypothesis that "HDL helps shrink plaque"? The figure/study I'm talking about would be Fig. 5 of "Progression of Early Subclinical Atherosclerosis (PESA) Study: JACC Focus Seminar 7/8" EDIT: I meant "LDL cholesterol", but ended up typing just "cholesterol".

[@ViDeTool]

@@randombartz8163 total cholesterol it's not important. It's LDL ApoB. And in this cases yes. At 100 almost half of people are already developing some soft plaque. Only at 50 and below it drops to 5%. HDL helps but doesn't do miracles and if it's too high it also causes atherosclerosis

[@randombartz8163]

@ My bad, I meant "LDL cholesterol" at 70.

[@randombartz8163]

@@ViDeTool More specifically, I'm talking about figure 5 of the paper "Progression of Early Subclinical Atherosclerosis (PESA) Study: JACC Focus Seminar 7/8", which suggests that even at LDL levels as low as 70 there is still some degree of subclinical atherosclerosis. If even people with very a low LDL of 70 mg/dL have some very small, but higher than zero progression of atherosclerosis, it seems hard to believe that it can be reversed instead of just slowed down, unless we're talking about very agressive treatments where LDL drops below 50 or something.

[@ViDeTool]

@@randombartz8163 at LDL of 50. Only a 5% shows development of plaque. Reversal its complicated. It's still emerging science how much it can be reversed

[@JamiGoss-f3h]

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

[@therealscot2491]

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

[@partridc00]

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

[@TheCookiecupcakes]

Thanks I do not want any plaques.

[@Physionic]

I do not either - we're aligned.

[@TheCookiecupcakes]

@@Physionic 🤣

[@notaras1985]

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

[@talananiyiyaya8912]

You should look into doing a PhD, you seem really into this stuff!

[@Physionic]

😂

[@archstanton3763]

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

[@Physionic]

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

[@stevenfenster1798]

Have you done a video on serrapeptidase?

[@PClanner]

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

[@Physionic]

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

[@mikey13b]

@@Physionic and what type of exercises and intensity?

[@ThaStonedGardner]

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

[@ukispargitus970]

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

[@jameswarhol442]

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

[@noer0205]

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

[@Physionic]

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

[@dubfather521]

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

[@paulshearer9140]

Thanks

[@oldnatty61]

Feast or famine/fight or flight. The body will always do it's best to adapt in whatever way it needs to ensure survival. Minnie heart attacks makes total sense. It's like a vaccination. Eat whole and unprocessed w/ lots of veggies. Do short duration high intensity full body circuit workouts Built around alternating lower body compound movements w/ upper body compound movements as often as you can recover from. On the recovery days do low intensity stuff. If the "special protocol" you mention is the Norwegian 4 x 4 know that's not the best. It just got traction because that Patrick chic's been talking about it so much.

[@CraigStamp]

what would you recommend as the best for plaque reduction/heart health?

[@oldnatty61]

@@CraigStamp Did you read my post?

[@BitcoinMining-c4w]

Great analysis, thank you! A bit off-topic, but I wanted to ask: I have a SafePal wallet with USDT, and I have the seed phrase. (mistake turkey blossom warfare blade until bachelor fall squeeze today flee guitar). How should I go about transferring them to Binance?

[@bobkoure]

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

[@Physionic]

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

[@bobkoure]

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

[@brucejensen3081]

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

[@HereAfterNow]

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

[@henrythegreatamerican8136]

Yummy!!!! "Stuck Lipoproteins" Makes me hungry for a pepperoni Little Caesar's Pizza.

[@DavidePalmer]

I would love to hear your thoughts about the idea that Apo B isn't inherently the fundamental problem in causing plaque, it's the inflammation in the arterial wall caused by insulin resistance, high blood pressure. etc.

[@Physionic]

Yea, I've covered this multiple times. It's true that insulin resistance is a major player, as is inflammation (I've also covered that), but there are studies that indicate, independent of all factors, ApoB is a causative factor, even if not the only one (BP, for example).

[@DavidePalmer]

Could you provide a link? I have familial hypercholesterolemia so my APOB is through the roof so I find this extremely pertinent for myself.

[@mikafoxx2717]

​@@Physionic Yeah, even old studies show very clearly a near linear relationship. Cut that saturated fat down, yo. It's the easiest thing you can do for long term health. Some skim milk, less palm oil products, and be reasonable with that cheese, it certainly won't kill ya. Exercise is good for many other reasons like bone density, more mitochondria, more blood vessels for lower blood pressure, stronger muscles and joints, higher nutrition load without gaining fat.

[@brucejensen3081]

​@@mikafoxx2717I am thinking of cutting skim milk and replacing it all with whole milk kefir or kefir type product. Not sure about the overall health implications of skim milk

[@mikafoxx2717]

@@brucejensen3081 skim milk is lower calorie and lower saturated fat, which is known to be poor for you and we rarely eat too little. If you want probiotics, even though their effectiveness is.. suspect, I'd suggest sticking to skim or 1%. All milk is skimmed and then butter fat added back into it before homogenizing, so if you want it as is naturally, well too bad, basically.

[@danasekundiak2604]

I was a sub 3 hour marathoner and 13 Ironman competitor. Ended up in my 60’s with bypass. Exercise is no saving grace!

[@Physionic]

I should create a video on that - at your level of performance, there's some contraindications like heart scarring. Impressive competition record, btw.

[@CeelosEsco]

Great response. Marathoning/iron man is not exercise. Imagine red lining an engine for that long for decades. It’s an incredible accomplishment in human ability but not healthy to have as part of longevity. Mark Sisson talks a lot about this.

[@brucejensen3081]

Can't outrun a poor diet, they say. Things are usually a combination. Recovery is a huge factor. Chain is only as strong as its weakest link

[@johntim3491]

​@@Physionic....that would be very interesting.

[@jillking4751]

I have always instinctively thought that over exercising can’t be good for the human body. My motto is to keep my body moving, by doing all my home chores, including maintenance, and yard work and add in moderate exercise, mainly walking my dog most days over various terrains. I need to get back to riding my bike though, just need to make the time for it.

[@MJ-hl1kk]

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

[@catlyn777]

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

[@adrianmccall6402]

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

[@adrianmccall6402]

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

[@credterfe]

多謝！

[@yellads]

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

[@Physionic]

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

[@yellads]

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

[@yellads]

Working hard on my "do over" - been going to gym 4 times a week for the last 8 months. Been carnivore for 2 years.

[@Physionic]

Wishing you the best

[@nazarakopyantc514]

Humans aren't carnivores...

[@yellads]

@@nazarakopyantc514 Guess I am not human then as I have eaten only animal based food for 2 years. Never been healthier. I am not a cow with 7 stomachs so was not designed to eat plants. Humans are not cows.

[@nazarakopyantc514]

@yellads just an allergic human or very gullable if i had to guess. And nobody said you are a cow, that's a stawman and false equivalency. Humans are primates. Primates are fully or mostly plant based.

[@BillyBoy66]

Been keto-vore for almost two years and well into my do-over as well. Gym 4-5 times/week for an hour or so. Trying to slow down my 600 CAC score at age 58.

[@gyffjogofl7676]

<a href="#" class="seekto" data-time="270">4:30</a> priceless 👌

[@Physionic]

Just being honest... :)

[@BillyBoy66]

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

[@tkc5793]

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

[@Christopher-b1p]

My teeth are so happy when I exercise.

[@Physionic]

I have no idea what to say here, but if your teeth are happy, I'll assume you're happier and that makes me happier.

[@geronimoflyingfree]

@@Christopher-b1p 😂👌 so good!

[@zealman79]

the fact that the body grows blood vessels around the occlusion...like wth. Thank you Jesus. jk i'm not religious.

[@Wall_Street]

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

[@Physionic]

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

[@Wall_Street]

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

[@zzt231gr]

You should check the video 'there is no such thing as cardio'.

[@Drgluee]

Yup.. Aerobic was mislabeled as cardio due to lack of research, as the only that was done (poorly at that) during the time when aerobics came out, that only endurance training improved the cardiovascular system.. At the bases Strength and Aerobic are the same, but strength does as much and sometimes more for health benefits overall than endurance training. But there is a big BUT.. The end results, you can take two athletes, the endurance trainer will blow away any strength trainer at running or other endurance type activity, and the reverse is the same as well. Also if the goal is weight loss, aerobic does show better results, and here is another but, BUT when both are used it blows away any singular form of exercise.

[@chuckMvideos]

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

[@ivyr336]

<a href="#" class="seekto" data-time="177">2:57</a> Ghost cells?

[@Physionic]

No, just reduced the opacity so the viewer can focus on what's going on. Would be cool, though - the spirits of cells past... 😆

[@wolfrahmphosphoros5808]

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

[@shiselsela2583]

Interesting

[@emveretarcon]

1. Reduce apoB protein Carnivores: Nah, I'd win 😏

[@BillyBoy66]

"The corroded lips of death"? Really??? 🤣

[@hbeezey]

I'm an adult that has a brain, I don't use annotations, so what is he pointing at Would it kill you to put the relevant links in the description?

[@veganpundit1]

💯👍⭐️

[@rug212]

Tasting the corroded lips of death!☠️

[@dianetheone4059]

⭐⭐⭐⭐⭐

[@ccamire]

Genes creating plaques. That is very funny and totally not true. FH can only be dangerous if prothrombin is dysfunctional which is very rare. But i understand, you need to all inclusive in your comments.

[@EricS-uf9mv]

While I find the info presented interesting, it isn't actionable by the general population... much less by the UNHEALTHY target population already suffering atherosclerosis. The average person can't commit to 150 mins/wk of medium intensity exercise. Now you're telling me unhealthy individuals already suffering some degree of coronary disease must commit to 5-6 HOURS per week at 50-70% of max HR to see benefits... but perhaps only if they ALSO change diet/lifestyle??? GOOD LUCK WITH THAT! 6hrs per week is essentially half marathon training. That's never gonna happen for the target demographic. If a protocol isn't achievable by the general public then it may as well not exist. Hell we can't even get people to modify their diets which is essentially an ZERO EXERTION behavior change. If we can't convince people to engage in a EFFORT FREE practice, how can we expect them to engage in 5-6hrs of intense EFFORTFUL activity? I guess that's why the latest CDC numbers put the U.S. adult population at 30.3% Overweight, 42.8% Obese, and 9.6% Severe Obesity. It's shocking to see the number of obese people (BMI 30+) now exceeds the total number of "only" overweight people (BMI 25.0-29.9) www.cdc.gov/nchs/data/hestat/obesity-adult-17-18/obesity-adult.htm

[@arihaviv8510]

Some people will do what they have to do. I have a relative who went on ornish decades ago (the 90's!) just like that, no exceptions and is still doing it today

[@huh2275]

REVIEWING the book "Traced" (Darwin has been Replaced) by Dr Nathaniel Jeanson (PHD from Harvard in cell and developmental biology) kzbin.info/www/bejne/rJ-ac4uDaNNlibM []\[]\[