What causes heart disease? | Dr. William Cromwell

Is cholesterol cause or consequence? How does it get into the artery wall? How can we avoid plaque and heart attacks altogether?
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Animations: Even Topland @toplandmedia
References:
1-www.ncbi.nlm.nih.gov/pmc/arti...
2-www.sciencedirect.com/science...
3-pubmed.ncbi.nlm.nih.gov/33870...
4-pubmed.ncbi.nlm.nih.gov/25340...
5-www.sciencedirect.com/science...
link.springer.com/article/10....
6-www.ncbi.nlm.nih.gov/pmc/arti...
7-pubmed.ncbi.nlm.nih.gov/22621...
8-pubmed.ncbi.nlm.nih.gov/12745...
9-www.ncbi.nlm.nih.gov/pmc/arti...
10-www.ahajournals.org/doi/full/...
11-www.sciencedirect.com/science...
www.ncbi.nlm.nih.gov/pubmed/2...
12-www.sciencedirect.com/science...
13-link.springer.com/article/10....
www.sciencedirect.com/science...
14-www.sciencedirect.com/science...
15-www.sciencedirect.com/science...
16-academic.oup.com/eurheartj/ad...
17-pubmed.ncbi.nlm.nih.gov/26103...
18-www.ahajournals.org/doi/full/...
19-academic.oup.com/eurheartj/ad...
20-www.sciencedirect.com/science...
Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author's knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!.
#NutritionMadeSimple #GilCarvalho
0:00 Intro
1:49 Cholesterol, LDL & HDL
5:17 Why cholesterol is unreliable
10:05 Discordance and cardiovascular risk
14:10 Why are doctors focused on cholesterol?
21:52 Inflammation & heart disease
23:37 How does it get into the artery wall?
25:21 Retention & oxidation
30:54 Transcytosis and its function
35:14 Reducing our risk
40:02 Summary & takeaways

[@astonuk9403]

🎯 Key Takeaways for quick navigation: 00:00 🛡️ Cholesterol alone is not a strong predictor of heart disease events; it's the particle number that matters. 02:17 🎾 Cholesterol is transported in the blood via lipoprotein particles, like LDL and HDL. 06:17 🔄 LDL cholesterol and LDL particle count can disagree; risk is linked to particle count, not cholesterol levels. 10:11 💼 Discordance between cholesterol and particle number is common, especially in conditions like diabetes. 13:23 📊 LDL particle number, not cholesterol, significantly predicts heart disease events, especially with therapy. 16:32 🚀 Guidelines often aim for general population health; individual cases may require more nuanced assessments. 19:45 📋 Understanding individual risk factors, including LDL particle count, is crucial for personalized heart health. 22:41 🔍 Inflammation becomes more significant in advanced atherosclerosis, but it's not the primary initiator of plaque formation. 23:29 🩺 Chronic inflammatory conditions, like psoriatic arthritis, are associated with plaque formation due to arterial damage. 24:21 🩸 ApoB-containing lipoproteins, which contribute to plaque formation, move into the artery wall through a process called transcytosis. 25:31 🔧 The "response to retention" model suggests that once lipoproteins enter the artery wall, they need additional modifications to initiate plaque formation. 26:52 🚫 Triglyceride Rich Remnant particles are more atherogenic and contribute more quickly to plaque formation compared to LDL particles. 27:46 🧬 Type 3 Dyslipoproteinemia leads to the accumulation of atherogenic particles, causing rapid plaque formation. 29:03 🌊 Lowering LDL levels doesn't necessarily reduce all ApoB particles, and elevated triglyceride Rich remnants can still lead to heart events. 30:20 🩸 Modulating transcytosis or post-retention oxidation specifically is not currently possible. The primary focus should be on overall physiological health. 33:10 🛡️ Foam cell formation is the critical step in atherosclerosis. Reducing atherogenic particles helps prevent plaque formation. 35:03 📊 The risk of plaque formation depends on the concentration of lipoproteins that enter the artery wall, influenced by various factors like endothelial damage and lipoprotein levels. 38:04 🌱 Lifestyle changes, like managing blood pressure, glucose levels, cholesterol, and insulin resistance, are crucial for reducing plaque formation. More specific interventions are still under research.

[@alexm7310]

Thank you!

[@drott150]

Incredible! Thank you for summarizing so extremely well. This channel combined with good people like you literally make this a college level course on survival. Seriously, putting these pieces together over time is a roadmap for long life and healthy living. 👍👍👍

[@chrisdom7731]

Thank you for this. Cheers!

[@sethanderson5679]

Just use the chapters selection in the video description of each video. 🙄

[@yengsabio5315]

After having read this summary & relating this current information to decades past information, a lot needs to be changed because they are already proven wrong.

[@DrTomMD]

The number #1 lipidologist on earth! Bill is a great friend who I first listened lecture over 15 years ago. Excellent episode!

[@SandyCheeks63564]

You can tell when someone REALLY knows their stuff - they are able to explain it so even nonprofessionals can understand the main points. They tread the fine line between glossing over and going too deep. Dr. Campbell really explained this all so well. Not saying I'll retain it all - but I have a much better understanding than I did before.

[@trubrit5036]

When I was going through chemo, and having regular CT Scans, they found two blockages. I talked to my Radiation Oncologist about it, and he said 'Not to worry'. I wish he had said 'Game on'. Maybe I would not have had the massive heart attack - maybe I would have changed my diet. I will admit to getting quite lost, watching this, but I will watch it a few more times, and pick up a bit more each time.

[@dovlieb]

Would love to hear about how diet affects particle number

[@ahmadmulhim8872]

Great interview, but i wish that you asked dr. William what’s his thought of the right diet to prevent heart disease. Thanks

[@henrypham-gq8xi]

Everyone should listen to this presentation. At least if not everyone, all cardiologists and primary care physicians should watch this. Incredibly informative and easy to understand. I sincerely hope that Dr. Cromwell will get invited back for a few more episodes.

[@mattbmartin]

Great video, Gil and Bill! My opinion may be a bit biased, but I'm a firm believer that EVERYONE needs to hear this conversation.

[@Guishan_Lingyou]

This is immensely valuable information conveyed in a very comprehensible manner. This channel is solid gold.

[@mariomenezes1153]

Fantastic interview. Thank you! You are doing a phenomenal job educating the public. Had a couple of questions. 1. Is it only LDL particles stuck in the intima that can be damaged or can freely flowing LDL particles be damaged if exposed to glucose/insulin in the bloodstream. 2. Are all damaged LDL particles stuck in the arterial wall or can they come loose and get back into the bloodstream. 3. If damaged particles can get back in the bloodstream, can the LDL receptors on the liver still pick them up. 4. How do you balance the risks of lowering LDL particles with a statin versus the side effect of the statin (which may include causing diabetes), especially in the population that is low risk of getting plaque buildup even with a high apo-b count. 5. Does the triglyceride count and /or the insulin resistance increase risk of starting plaque formation (not increasing existing plaque formation which he said was almost certain).

[@jaychon8418]

why don't we make things easy for everyone- just measure APOB as it tracks cause/risk better? not sure why we are still having this discussion. apoB test is like 30 bucks. why not run both?

[@randallcotner2155]

Trying not to wear my tin foil, it's likely that there is just too much money to be made doing it the way they've been doing it all these years. I wholeheartedly agree with you though. Thanks to Dr. G, I learned that ApoB is a thing and had mine tested. It's extremely high, and diet and exercise has changed!!!!

[@billusingh3439]

what diet and statin and dose to reduce Apo(b)

[@niranjanpaul2176]

@@randallcotner2155 Dr Sniderman

[@askingwhy123]

​@@billusingh3439Every person responds differently. I only need 30mg Rosuvastatin to lower APOB from 129 to 59. Someone else may need multiple drugs, including expensive PCSK9 inhibitors, to achieve that. Talk to your doctor and experiment together.

[@DaviDeMarco]

What a masterclass! Thanks for another great video Gil

[@paulgaras2606]

Have you ever considered turning some of your content into a podcast? This is great info and I’d really appreciate it if it were in podcast format.

[@darkpatches]

I've seen this type of request before and it confuses me. If you stop watching the video and only listen to it, don't you have a podcast?

[@paulgaras2606]

@@darkpatches yes that’s what I usually do. But you have to pay KZbin to listen with video off.

[@darkpatches]

@@paulgaras2606 Wow. YT just deleted my response comment and gave me a big personal warning about it. I explained how to get around the problems you have with the YT app. They're just plain mean and sore losers. I guess I can only tell you there are ways around it....

[@darkpatches]

@@paulgaras2606 In regard to watching YT videos in a browser on your phone, I can only tell you to be brave. Be b r a v e.

[@drott150]

@@paulgaras2606 No you don't. You simply play the video on your phone and listen to it on earphones or via the phone's speaker. I just did that very thing and it works fine (other than having to skip through the ads).

[@esotericsolitaire]

38:22 Layman's explanation: Eat whole, non-processed foods instead of ultra-processed foods however and whenever possible. Don't overeat. Be active. Pass around five forks for one dessert. Don't smoke. Don't drink alcohol unless you can stop at one drink. Recent data is suggesting to just quit. That should be it.

[@jrennickemd]

What a great video. Often times we lose the nuance in medicine but Dr. Cromwell does a great job of explaining it. This needs to be required viewing for anyone who wants to take control of their own health.

[@bryanleaman5942]

The information you provide on your channel helped me understand that I needed to reduce saturated fats, which brought my LDLc down by 25%. Thank you! Can't wait to see my Dr. in a couple days! Now as long as I'm not one of the ones where that's an inaccurate measure ....

[@peterfaber7124]

Gill, did your views on atherosclerosis change as a result of this interview?

[@HakuCell]

- Dr William Cromwell is a clinical lipidologist, professor at Wake Forest University School of Medicine, and he has published many studies on lipid physiology and metabolic disease. 10:05 chapter on the discordance between LDL-C and ApoB: he said that 30-50% of healthy people have such discordance, while metabolically unhealthy people are more likely to have discordance (up to 70% of them have it). he also says there is no discordance when LDL-C is very high or very low.

[@erastvandoren]

Discordance is not essential. Have low LDL-C, low blood pressure, low inflammation, low blood glucose and you are safe.

[@hmbdata]

Great talk. Thanks for putting in that list of references!

[@Jc-ww5kg]

Thank you Gil! So glad i subscribed. You are a solid channel!

[@schumiiit04]

Awesome video and great interview!

[@kouritasvonkafthor468]

Thank you Mr. Cromwell. The approach you take to the subject of Cardiovascular problems is scientifically honest without fanaticism, comprehensive and without placing yourself on any side of the conflicting parties

[@alfonso365]

This channel is a gem!

[@embarq12]

Great information. Thanks

[@del7506]

fantastic information!

[@nickyoung798]

This video, and this channel altogether, are so profoundly informative. Truly grateful Gil

[@willbrink]

Excellent show full of useful info.

[@bc2647]

See...this is one of the more interesting topics I wish you could dive into....really need a 10 part series on this to break it all down

[@DrTomMD]

What else more do you want to know?

[@DrDGr2]

So good! Thank you very much

[@Lisa_BisaRN]

Fantastic information, thank you both.

[@nathalierey7663]

This was amazing! One of the most informative explanations

[@jayalexandertilley]

Such a beautiful and wise conversation

[@EmyrEvans1]

Brilliant interview, thanks Gil. Would love to know Dr. Cromwell's proferssional thoughts on HDL.

[@ToddHoff]

That was very nicely explained. Thanks. It reminds me of how BMI is an easy measure but not always the best measure.

[@racking4507]

Just brought my wife home from the hospital after having a 95% blockage in one and 80-90% in another. Amazingly good cholesterol levels. Unfortunately, it is probably genetic and does tend to run in her family. But I agree, just the cholesterol numbers are not a very good predictor of heart disease. Total cholesterol was 147 and LDL was 72. Believe it or not they were going to put her on a statin. So far they haven't.

[@NutritionMadeSimple]

does she have high lp(a)? just a thought

[@Megaterranova]

Thanks that cleared up a lot of misunderstanding about heart disease.

[@dwights1464]

You really need to be your own health advocate and this channel is a wonderful tool for that purpose. Thank you so much Dr. Carvalho!

[@pavelchorda8425]

Great episode Gil! My insight about this metabolic problem with the foam cells etc is that some prolonged fasting could be an amazing method to prevent issues.

[@faizankazi99]

Fascinating stuff

[@mindofown]

Highest level info from the key experts, thankyou so much from Perth Australia

[@bgrune1]

Despite eating a plant based diet and exercising frequently I discovered through advanced screening that my risk for diabetes and heart disease is higher than I expected and much higher than I want. I am currently using fiber supplementation and sodium reduction to reduce my risk and then I am going to re-test. I already noticed that my blood pressure has come down since I started the interventions. I'm very excited to see how well these interventions have worked to reduce my risk but I'm trying to wait because the testing is fairly expensive and I want to give it time to work.

[@Teneab]

Try switching to a WFPB (if you don't practice it already) and try using very little salt, or using combinations of sodium-free salt and sodium-containing salt. You can find more information about this on Gil's video on the best salt for health, where he discusses a sodium-free version of salt. Read the comment section on the video too, people there had good suggestions.

[@Seanonyoutube]

Diet and exercise aren’t everything. Emotional wellbeing is HUGE and very overlooked.

[@Caladcholg]

Yeah, lifestyle is very important. And remember; it's not about the stressor, it's about the stress: two people can experience the exact same situation and solve the exact same problem, but the person who does it in a more calm and calculated manor rather than allowing the stress to really get to them will have better health biomarkers because their endocrine system isn't being overtaxed. I know it sounds a little of there but it's true.

[@spiph23]

Good work on adapting! I had to do the same thing, even though I was eating a whole food plant based diet like you, I ended up having to exercise more, get rid of ground grains from my diet (bread, pasta, etc), potatoes, and salt. I also added some potassium chloride. With these changes, over the course of a few months my numbers moved into optimal range.

[@bgrune1]

@@Teneab thanks I already try to eat WFPB for the most part but the junk creeps in. Part of the intervention is trying to avoid the plant based junk as well. I’ve been using a 50/50 blend of potassium chloride and salt and using less of that overall. I have lost weight and I feel like I’m really on the right track. Wishing you good health!

[@Mike-du1dc]

Very informative & most importantly very understandable! Much Appreciated! Thank You!

[@azdhan]

Very interesting, educational, and informative. Many thanks for sharing Dr Carvalho

[@kestag2110]

Very interesting and informative discussion. Thanks 😊

[@AndrewPawley11]

Excellent

[@michaelmackey754]

Great video…thanks

[@alblee]

Dr. Gil, exposição muito clara. Obrigado!

[@jaythardin]

Thank You for these videos!!!!!!!!!!!!!!!!!!!!!!!!!!

[@pjcdm]

Wow! The best video on the subject I've seen/heard. Please put the auto-translate in all languages captioning on for my non-english speakers like my wife who thinks all is fine. Thanks, dr. Carvalho & Cromwell.

[@myentertainment55]

Great video. After I finish it I will check your other videos about it and saturated fat that I watched but didn't grasped fully. Good explanations. I think now I got it more fully.

[@rw9347]

Look for the book Nourishing traditions. It's an older book but really explanatory and good information

[@stephx9759]

Sad to hear this info cant go mainstream because the old view of cholesterol is too deeply lodged into our healthsystem. Thanks for these type of videos, greatly appreciated to get information from suxh a knowledgable person

[@rejoyce318]

I'm working my way through this very helpful video. I recently had blood work done in preparation for my annual physical, and asked if the could add an APoB test, thanks to Dr. Gil's videos. What I didn't know until after I'd had the blood drawn is that it takes a good week to get the APoB results back from the lab, instead of the normal 24-48-hour turnaround.

[@MikeMcMulholland]

From what I understand from the web is that there are many factors in a heart attack or stroke, one is calcified veins, arterial plaque caused by cholesterol and cholesterol, how much your body is making and how much you're consuming; what causes an event is blockage, cells blocking the bloodstream due to these factors, what really helps make this event occur is a high does of saturated fat in the bloodstream caused by diet, if you're overweight you will already have a lot of fat in your bloodstream, all theses elements make the risk higher for an event to occur.

[@aroundandround]

So ApoB is a good predictor irrespective of LDL is what is being implied, yes?

[@WilliamRoscoe]

Absolutely yes.

[@toddtheisen8386]

I've decided that every expert has valid points. Every meta study has valid assertions. Every individual has to realize that neither of those two facts mean much to their particular health condition. It is a roll of the dice because of too many unknown factors in our bodies.

[@AndyThomasStaff]

Fantastic video! Dr. Cromwell says at 25:30 that "once you're in" it's not guaranteed that you'll "stir the pot and cause problems." Does this mean that oxidization has some specific cause? Or is it entirely that certain types of particles get oxidized and others don't? Asked another way - is it the particle type that determines retention + oxidization, or are there other mechanisms that cause more retention and oxidization?

[@Vezmus1337]

While this is an interesting conversation, I'm not sure how useful it will be to the average viewer. I appreciate the technical explanation of why measuring cholesterol isn't perfectly accurate to every individual, but I don't know how to apply this information to a real-life scenario. Basic information on how to manage the potential risk factors (like exercise, smoking cessation, drinking cessation, lowering cholesterol, etc.) would be more practical for me. In what way does the information presented here change the advice given to the general public? If someone were to ask me what causes heart disease, I wouldn't know how to translate this information in a way for them to practically understand.

[@NutritionMadeSimple]

good question. the general knowledge to heed high glucose, blood pressure or cholesterol levels is directionally correct but can miss risk factors in many people, hence knowing insulin resistance metrics, ApoB or nonHDL-cholesterol can provide more information. also see some of our previous content on heart disease where we touch on a lot of the basics like diet tips, lipid panel etc. In response to that, many viewers asked for more detailed videos on the mechanistic & molecular aspects and that's what this series partly aims to cover

[@Vezmus1337]

Thanks, that helped to clarify a lot of the misunderstandings I was having. So this is just more accurate information that we can use to in order to assess hidden risk factors.

[@manubhatt3]

Hey, can you please consider making a video on Chonline, the possible deficiency of it in lacto-vegetarians and vegans and how those two groups can have sufficient levels? PS: Again, posted this on twitter too but again I have doubts twitter is working properly or may be censoring tweets for some reason.

[@walterski8377]

Where has he been? Love the info, but what about specific numbers of what is too high, target numbers? what about any of the usual ratios? & What about HDL, Triglycerides, & ApoA?

[@RogerHyam]

The lifestyle measures of heart disease risk: 1) Are you overweight? (BMI above 25): No. 2) Do you get angry when I ask what your waist measurement is? No. 3) Do you smoke at all? No. 4) Do you drink more than very occasionally? No. 5) Do you eat a plant *biased* diet with the majority of your calories coming from whole (high fibre) foods? Very low in saturated fats. Yes 6) Do you exercise; about 5 hours a week *brisk* walking with hills and stairs or equivalent plus some weight/isometrics? Yes. That covers all the practical things you mention in your other videos. My theory is most people who are obsessed with biomarkers are trying to find a reason those questions don't apply to them!

[@dwights1464]

I don't know about most people but I don't fit the normal model of a high risk person (no family history of early events, never smoked, BMI of 22 and regular exercise for many decades, no symptoms, etc.) so when I got a "severe" coronary artery calcium scan, biomarkers became the way to measure my progress in reducing risk. Hopefully that's what other people who're smart enough to watch this video are doing with them also.

[@RogerHyam]

@@dwights1464 What are you doing to reduce your risk that isn't on my list?

[@dwights1464]

@@RogerHyam I have been taking rosuvastatin for about 3 1/2 years and Zetia for about 3 years to lower my risk.

[@RogerHyam]

@@dwights1464 and have you been on a wholefood, plant based diet for most of your life?

[@RogerHyam]

In my original point I say *most* people are trying to get out of one of the items on the list and you haven't said you have done all the things in the list - plus you might not be *most* people.

[@jimking6484]

Fantastic explanation of lipoproteins

[@davidmoser8901]

Hey Gil @nutritionmadesimple I couldnt find the video you mentioned at 37:12 "large fluffy ldls are harmless truth or myth". Can you post a link? Thanks. Dave

[@pattylow1]

Thanks so much for the video. I've been plant-based for 11 years now and have listened to Drs Esselstyn and Greger to get my LDL below 75 and total cholesterol to below 150. So now I need to make sure my apoB is below 100 mg/dL? Thanks Gil!!!

[@WeatherMoon]

I'm from a family w catastrophic heart attacks, high blood pressure, and very high cholesterol which IS added to by diet. I however have very high cholesterol (yhe highest was almost 400 LDL). On pravastatin as it doesn't cause brain issues or joint and muscle pain. Down to almost satisfactory levels by medical standards, but too low (ideal level) is brain foggy and memory issues. No calcium in heart also. I'm about finished with worrying about my cholesterol and trying to get it lower. No heart issues at this time, and those who had catastrophic heart attacks or issues were already showing problems before they died

[@zhilahaghbin4766]

Thanks much, my questions are how often we see low or normal LDL cholesterol, while the Particle numbers are too high? and is it always in the context of presence of other illness like DM or other inflammatory disease? do we see this situation in healthy people having low LDL cholesterol and very high Apo B particle counts? thanks

[@jp7357]

Love the bottle of scotch on the desk - must be fortification for the incomming denier/inflammation deluge - always excellent …

[@alexrheamusic]

lol I think it’s a green screen backdrop. But that is funny.

[@tozhr5995]

Dr. Cromwell is a great doctor. However, it would be great if Dr. Cromwell would continue to treat his patients that are dependent upon him to answer questions and fill prescriptions.

[@kato8504]

Hey hello I have heard a lot of people talking about BERGAMOT for lowering cholesterol ....Do you know anything about that?

[@sammychem5920]

Hello Doc: can you share your diet and lifestyle (sleep, exercise, anything else important) for good health? Since you have researched a variety of topics over the years, I imagine you follow some best practices. Thank you so much

[@niranjanpaul2176]

Secret

[@kate60]

Whole food plant based. No coffee. Decaf only. No fat.

[@anggadi1564]

Look 37:46

[@ninja8flash742]

​@@kate60 no fat ?!? Maybe you mean no animal fat but you need some fat in ur diet xd

[@eringo-bragh4243]

But will your insurance pay for the scan? I received a scan from my cardiologist who found nothing after an odd EKG and strong echo; 6 weeks later I had my heart attack and got 4 stents. The term 'worthless" comes to mind.

[@alphaomega1351]

Who needs a heart ❤️ when a heart ❤️ can be broken 💔? 😶

[@Battery-kf4vu]

What about the importance of keeping the functionality of HDL to improve cholesterol efflux? How can the fonctionality of HDL be increased? Also I would have liked to know if lowering LDL a lot doesn't lead to problems in other tissues? Some say that going as low as possible is ok, is it true? It seems for instance than in old age people need more LDL.

[@aginsfbayarea7350]

He says at the end if there's plaque, it's time to "shut it down." Well, how does one do that?!

[@megavegan5791]

Doing all of the things that prevent plaque formation will also help stabilize existing plaques.

[@southerngirl1408]

@@megavegan5791 What are all the things that prevent plaque formation? Is it just not eating saturated fat?

[@megavegan5791]

@@southerngirl1408First and foremost, get ApoB down to a healthy level, either through diet & lifestyle, prescription medication, or both.

[@jcmacmusic]

Does diet play a part in heart disease and if so what foods cause it?

[@bradleyshank6243]

Question: If transcytosis is predominantly how LDL particles get into the artery wall and retained, why does disruption in laminar blood flow contribute to atherosclerosis? Does more turbulent blood flow increase transcytosis?

[@JoeS97756]

Interesting info that explains in part how it is that people with normal LDL get heart attacks--Their particle number was high and never checked. So my layperson take away is...if your LDL is high it probably needs to be addressed. If your LDL is normal, get an ApoB particle test to make sure you're ok. Did I get that right? Neither my primary care doc nor my cardiologist do ApoB.

[@katprowler6805]

So how does one go about lowering or decrease # of particles? I feel this most important ? was missed.

[@m_m991]

Eat more fiber and more plant Protein and less saturated Fat

[@julioandresgomez3201]

It´s rarely discussed one of the most important metrics of health, possibly the most. The omega 3 to omega 6 ratio in your tissues, ideally 1:1 and even 1:3 is within healthy range. Balance is key. If your omega 3 is low you´ll have to tightly handle your omega 6 s. If your omega 6 s are through the roof you´ll have to push your omega 3 through the roof. Some believe that omega 3 s are magic pills that will make all your body problems evaporate. They are not, but still very helpful.

[@karen96978]

I enjoy these interviews with lipidologists. Because of the last few I've seen, I have gone back on a statin. I have low bmi, zero calcium cacs.....etc etc. My remnant cholesterol is extremely low, but after learning that the number of particles is a driving factor, I decided to make this change. It would be good to see a video explaining apo b and ldl particles. Is apo b the size of the ldl particles? If that's the case, mine are the fluffy A ones based upon all other information.

[@dwights1464]

ApoB is the mass (remember mass is independent of the force of gravity so your mass is the same on Earth and the Moon) of the ApoB containing particles in a deciliter of blood. The units of measure are mg/dl. It is my understanding that LDL particle number is a numerical count of LDL particles. The units of measure are nanomoles per liter of blood. One mole is 6.022 times 10 to the 23rd power. A nanomole is one billionth of that.

[@Lennybird91]

Can someone explain to me something, please: I understand the notion of measuring cholesterol versus particle count, especially the ApoB marker for seeing how many lipoprotein transporters there are. I understand that these transports can be packed full of cholesterol/triglycerides, but what triggers the creation of lipoprotein carriers themselves? Does the body make more to respond to excess cholesterol/triglycerides in the blood?

[@drchem4127]

Yes; no excess cholesterol/triglycerides(i.e. fats), no need for the body to make ApoB. ApoB is there just to wrap around cholesterol/triglycerides and help them dissolve into the blood (which is mostly water), since they (fats) are unable to do so by themselves.

[@lisamilla5466]

So given the dr ‘s answer, why would there be discordance where there is low cholesterol but high ApoB?

[@ad3781]

Very informative but what are the next steps? This was good information, but what can a person do in regards to lifestyle to get their LDL particle down and their APO B? Any particular diet or lifestyle change?

[@NutritionMadeSimple]

see kzbin.info/www/bejne/Z2mpd2emjrGrm80

[@JackFalltrades]

This is only one aspect or type of heart disease. What about arrhythmias? Afib is common in older people. Why? What causes it? Can it be prevented?

[@jurryx]

You can prevent it with a pacemaker.

[@betzib8021]

You cannot prevent arrhythmia with a pacemaker. A pacemaker just lowers hb per min. Some people have episodes of afib...but when not in afib their hb is very low already. That is why ablation is the no 1 procedure for afib...but it doesn't always work.

[@jurryx]

@@betzib8021 thank you for your explanation :)

[@elisabethg7713]

Very interesting video but then I might be a little lost: I am a 40yo female on low carb diet for years (my LDL was worst 10 y ago before I started my diet) . My LDL is @ 195 mg/dL but my Apo B is 105 mg/dl & Lp (a) 49 mg/dL ; does it mean or not, I'd better start a treatment? Is an Apo B at 105mg/ dL considered low? Is this a case where LDL contradicts Apo B?

[@talequibond]

This might be a stupid question. But can you please explain (in a scenario where APO-B is high and LDL is low) how that leads to cardiovascular disease? To explain my question, I will use this analogy. Let's say I have 10 people with bad intentions that want to get from point A to B to cause harm. And, there are 100 cars available to transport them with each car able to transfer one person. Once all ten have been transported, the remaining 90 cars on their own can't cause any harm as there are no more ill intentioned passengers to transport. They are empty. But not for the cars, there would be no harm done at point B. But, if there are more cars than bad intentioned people, how do the cars cause more harm? Thanks for the great video. It would just be great to have a better understanding of the actual numbers of APO-B vs LDL in a situation where LDL is low and APO-B is high. Thanks again!!!

[@artsmodelstation9396]

In a future video can you discuss ‘Enhanced external counterpulsation (EECP) therapy”

[@eldigitom9680]

As a layman, when hearing this type of discussion I'm constantly hearing references to inflammation but it's never explained or how it's detected. I assume it's not the same as what I may feel in my joints or muscles, etc. When I had a prostate biopsy my sheet showed (possible) inflammation in the numbers. I asked him what that meant, he said "I don't know". Any simple answer?

[@pjcdm]

What are the non-hdl cholesterol risk levels numbers? Apob is hard to get in my country.

[@CliveWebber]

I can’t give you anything beyond what the normal ranges are, but where I live Non HDL-C range is between 1.7 and 4.2 mmol/L (multiply by ~38.6 to get mg/dL I think)

[@pjcdm]

@@CliveWebber thanks a lot. That works!

[@stvemq]

Does apoB measure particle number?

[@megavegan5791]

Can there be discordance between ApoB and non-HDL?

[@CliveWebber]

As far as I know, yes, they can be discordant because Non HDL-C is a measure of cholesterol amount, not number of particles.

[@lseh4720]

What should patients do? I’m trying to get my brother to the doctor. He has a huge gut, fat face, and we have diabetes in both sides of our family. Do doctors get upset if you come in and ask for tests? My numbers are ok, says my doctor, but I know I have a problem too because my blood sugar goes up when I eat certain foods. Thanks Docs, both of you, for sharing your knowledge.

[@notrueflagshere198]

Are ApoB tests more expensive than HDL/LDL? Does triglycerides and HDL/LDL information predict ApoB?

[@veganfortheanimals6994]

Didn't get to finish the video yet. Is it apo B or lipoprotein a that we should get tested for in order to determine our heart disease risk ? (I wish insurance would pay for these tests, I'll have to do it on my own, somewhere)

[@ladagspa2008]

ApoB should be done with every lipid panel. Lp(a) is only a one time test to assess genetic risk. It doesn't vary much offer time.

[@justynasidorska4702]

When does cholesterol need to be transported around, in other words what causes the cholesterol demands of a cell exceed its own supply? Is it infection? Would it help prevent arteriosclerosis if one avoided situations in which cholesterol has to be transported via bloodstream?

[@lotembenatar7163]

The way I look at it is with this formula: (Non-HDL-C / Amount of atherogenic particles) = average particle size. Since ApoB measures the number of atherogenic particles, let's separate it in the formula, and we get: ApoB = (Non-HDL-C / average particle size). So, to optimize ApoB, we should try to optimize two things: 1. Reduce Non-HDL-C 2. Increase particle size Looking at Non-HDL-C is just half of the equation. So, my question is: As lab tests can already measure Non-HDL-C, and most people don't have access to ApoB measurements, how can we estimate the average particle size by other results and determine if Non-HDL-C is an accurate representation of our risk?

[@victoriaboster1177]

Why do you think “most people” can’t get an ApoB?

[@mattbmartin]

As long as you can count the number of particles, the particle size is not predictive of ASCVD events. The misnomer of "small dense & "big fluffy" boils down to: "where there are a lot of them (particles) crammed into the same space (unit of blood), then they are more dense (smaller)." Getting insulin sensitive AND reducing particle number is the name of the game.

[@lotembenatar7163]

@victoriaboster1177 I don't. Maybe I should have written "some people", anyway I can't

[@lotembenatar7163]

@mattbmartin Seems like you did not understand clearly what I wrote. The average particle size does matter but not as a single measurement. It should be combined with Non-HDL cholesterol since together they can predict ApoB

[@megavegan5791]

​@@lotembenatar7163 Particle size is not relevant to risk because all atherogenic lipoprotein particles are small enough to get into the arterial wall.

[@timhanley4396]

I learn so much from this channel, but this video depresses me what can I do if I have this condition is there any hope

[@NutritionMadeSimple]

actually the knowledge and tools we have nowadays for cardiovascular disease have made it quite manageable!! see our extensive content on lifestyle and medical management. plenty we can do about it :)

[@timhanley4396]

Thank you I will watch it@@NutritionMadeSimple

[@michaelhimes8778]

I’m a bit perplexed because (due to a cardiac referral because of PVCs) I have had some of the advanced testing that shows my true risk picture and it is mixed. I learned that I have a clean calcium score, and low inflammatory factors, but high risk on particle count and have too many of the wrong sizes. I also have elevated LP(a) by about 3x the “safe” amount. But because I’m on the young side (48) and fit, they just wanted me to watch my diet and see them again in three years. I don’t really want to take a statin, but I remember Dr. Dayspring (another lipid expert) saying all those with high LP(a) should be on a statin. So, I think I need a second opinion? So, I’ve been put on notice, but doc was not alarmed… and it is a good practice (Dr. Pradip Jamnadas also on KZbin and actively practicing teaching) that focuses on metabolic health as well. They even gave me a script for a CGM… I was in range 98% of the time for the 15 day period.

[@prosewat99]

Cardiologist look at the 5 year risk of an event, to me that’s not good enough, I want to live to 90. By the time you’re showing signs you’re already ten years into pathology. I am in a similar situation and chose to go on a statin. I have zero side effects, it is super cheap, and it is prophylactic. I think my experience is very common. I wish I started a statin at 40 instead of 50. I want to live as long as possible, to see the world in 40 years rather than dying in 25 years from a heart attack or stroke. With robots, AI, gene manipulation and space travel the future looks amazing. We are on the cusp of dramatic changes, why not live to see them.

[@HakuCell]

is there a rate of clearance of atherosclerosis? in other words, is our body able to clear a little bit of atherosclerosis over time, if health parameters are optimal? in other words, is atherosclerosis in a constant dynamic equilibrium between clearance and accumulation?

[@prosewat99]

Google what happened in Norway in 1940, mortality from circulatory diseases. When Germans occupied Norway, they sent all meats and dairy products to the eastern front, in effect turning Norway vegan. It resulted in a nearly instantaneous 20% drop in cardiac/stroke mortality. The coroners saw these shadowed areas in the arteries of deceased Norwegians that were, they think, where plaques once were present. It would appear if you calorie restrict/fast and stop all saturated fats you can reabsorb plaque. This would obviously be a challenge, I suspect autophagy plays a role in plaque reversal.

[@Jammaster1972]

Your channel has excellent content. Thank you for this. I can forgive the fact that you look like Liza Minelli and Ralph Machio's love child.

[@jennan124]

Now I know the difference between LDL and APoB

[@MikeMcMulholland]

Mr. Carvalho I found something that just came out: Wang and his colleagues figured out that the element can bind to a complex needed by lipoproteins, chemical carriers that move lipids including cholesterol and triglycerides, into the bloodstream. This complex known as the coat protein complex II (COPII) needs to maintain a very precise chemical balance that the manganese disrupts. As a result of this disruption, the researchers found that in the mice they studied, even oral manganese dramatically reduced blood concentration of lipids and removed plaques that had been established in the rodents' blood vessels.

[@PaulHanna-yu9vq]

Dr . I take Burlinta and I have one stent in my arteries . But I work out daily and eat very healthy can I stop taking Burlinta . I feel strong and healthy now