Cholesterol & Metabolic Health | ft. Dr. Philip Ovadia
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- Опубликовано: 19 июн 2024
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Dr. Ovadia´s social media:
/ ifixhearts
ovadiahearthealth.com
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Facebook: / drgilcarvalho
Twitter: / nutritionmades3
Animations: Even Topland @toplandmedia
References:
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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 Introduction
2:24 Introductory remarks
3:31 What is metabolic health?
7:40 Cholesterol & ApoB
23:43 Low fat diets & obesity
28:32 Statins
35:37 ApoB lowering
40:57 Saturated fat
54:27 ApoB and mortality
58:00 ApoB & Metabolic health
Wow. Despite the differences, no crosstalk, ad-hominem, or screaming. This is how the exchange of ideas ought to be performed. Thank you.
Very true and refreshing to see such a sane and respectful exchange of perspectives, not sensationalized statements of opinion, or uniformed hard stances on personal positions.
@@PaulB_864What is your estimation of the truth?
This type of conversation is the type of conversation we need to hear in political issues as well.
We need more of these conversations in the medical industry. Big ups to both of you
There are large numbers of these discussions daily at hospital rounds, grand rounds, committee meetings and privately among doctors, but not shared with public. It is very confusing to public. Drs also aren't allowed the time to explain all this to every patient. It would be impossible to make every patient an expert about this, along with every other medical topic. There are always many disagreements about diagnosis, diagnostics & treatment among doctors, but discussion leads to consensus by doctors as to diagnosis , diagnostics & treatment. After consensus is reached the recommendations are shared with public.
Very impressed with the civility between these two doctors who clearly disagree with each other but can still express their positions without any vitriol. Well done! 👏 👏 👏
Fantastic discussion between two very intelligent doctors who remain professional and courteous during a very heated debate on heart disease. Thank you both.
I check fasting lipid panels on almost all my patients in the hospital. It’s amazing how many people with ACS or unstable angina have low to normal LDL. Let’s not forget that historically the goal LDL was 100 but people still were having heart attacks despite achieving this so the recommendations were changed to 70🙄, a goal that’s almost impossible for most people without the use of medication. On the other hand what I have never seen in the hospital is someone having a heart attack with a triglyceride/HDL ratio less than 2 yet this one of the best markers of metabolic health in my outpatient practice. ApoB may be atherogenic, but the primary end point is cardiovascular events. The best way to improve that is by achieving metabolic health. We tried by targeting LDL and it’s made little impact as heart disease is still #1 cause of death. It’s clear our approach has to change and it’s nice to see that even in the field of cardiology some practitioners are taking notice.
average LDLc in the US is ~120 (that's average so millions are well above) and ~50% of pts with *established* CHD are not on any LLT. we're not even close to managing lipids
of course, lowering cholesterol and not addressing the shocking rates of obesity, diabetes etc is not a winning strategy. we need to move on from the simplistic mindset of this risk factor OR that one. a healthy lifestyle addresses all aspects of health simultaneously. there´s no metabolic health with hypercholesterolemia, anymore than with diabetes or hypertension
many westerners dont even remember what real food looks like anymore. we have a crisis of scientific literacy even among health pros and a confused population jumping from 1 food fad to the next without ever truly addressing overall health. the answers are simple and we've always known them but they don't sound sexy or "novel". not viral material.
Fantastic commentary
Hi, you say you have never seen someone with heart attack (or maybe just serious CVD?) with a triglyceride/HDL ratio of less than 2? Well, I have been practicing intermittent fasting and low carb diet for years and my ratio is as low as 0,35 (HDL=92, triglyceride=33). Still, I was recently diagnosed with servere (99%) stenosis on LAD and had a stent inserted. I am a 58 year old male and very lean and fit. Still, I ended up on the operating table.
@@olekirkelund7755 and what was your ldl?
@@rosssundberg5510 3,3 mmol (or ca. 130 mg)
I really get what Dr. Ovadia is saying here. I know a patient with high cholesterol, in her eighties, who thinks Lucky Charms is heart-healthy food. (It is a highly processed breakfast cereal that is mostly sugar.) This is a change she made because of her doctor’s advice. She avoids egg yolks because of the cholesterol and eats fruit cocktail instead. She is morbidly obese. Her statins make her legs ache, so she stopped walking. She is now extremely sedentary. Dr. Ovadia is aware this is the reality of our current medical protocols.
Dr needs to break that down than to them.
Seems like a far stretch to use this anecdote to justify having a doctor saying misleading and factually incorrect things, like Ovadia does. And furthermore his response when challanged on theese things and literally getting them explained directly to him is to essentially just ignore the argument and repeat his strawman based arguments.
Sure he is arguing with a nice and "respectful" tone as so many people seem to be so amazed by for some reason, but that doesn't change the fact that he is wrong and that he spreads misleading and dangerous strawmans and faulty reasoning.
Great conversation, respectful and incredibly well referenced.
Nurse here. All the surgeon is trying to say is more needs to be done on metabolic syndrome when it comes to not just ldl when it comes to MI and the need for heart surgery. Diabetes is one of the leading causes populational heart disease.
Absolutely!
except he sounds like he is pushing saturated fats wow.
@@lorimckay2704 You clearly weren't listening.
@@lorimckay2704that’s the whole idea, fats are essential!
except thats not all he's saying. Look at other interviews where he knows he wont get any pushback. he believes eggs red meat and butter help your heart and encourages their unlimited consumption, he thinks the hearts function better in ketosis, he thinks whole fruits damage the heart.
When he's around a knowledgable person like Gill who will push back with real data and reasoning, he'll dance around topics and be careful what he says, but when he's on another interview with someone who just lets him say whatever with no pushback, he says bold things with certainty and authority, and people listen...
I follow you both, despite your different viewpoints, and this session was very rewarding. Thanks to you both for doing it.
Back in the 70’s people were told to reduce fat without telling them what to replace it with. I remember those days. Around the time the government was setting the guidelines to reduce fat, food manufacturers cashed in on that by making processed foods that clearly stated lower in fat or not fat. These foods had mainly refined carbohydrates and sugar to make them taste palatable. I would look at the products, be it cookies or crackers or whatever and think, oh good, low fat. It’s okay to eat. Many people just didn’t know what to replace the fat with and relayed on the unhealthy processed food. It was not the complex carbs that got the population fat. People were not told that refined and processed foods are also bad and nto to turn to those foods. I was a teen during the 70’s and luckily at home my mom made home cooked meals that were Mediterranean style as that is where she was from and we ate healthy. These are my thoughts on the subject.
Also, the amount of marketing of fat free foods has been immense, most of it a refined carb sh$%%^to show. I worked at a health food store when the fat free wave started and it was amazing.
Thank you for this Doctor. I can hear so much passion in your voice when you talk about communicating medical information clearly and accurately to lay people, it's clearly something you care a lot about. Thank you for being an advocate for a lay person like myself.
Great clarifying discussion Gil, thank you for hosting it. You were able to ask concrete questions and explain your arguments in a clear and concise way. Oftentimes the message some people take away is cholesterol is irrelevant, two of my family members who are quite obese believe this. You have a talent for scientific communication and I hope you keep having time to do more of it.
They believe in this because they don't want to change their habits and they just look for anything on the internet that affirms their beliefs. I know many people like that.
I have always had high LDL, high HDL and low triglycerides. My calcium score was zero. But I struggle with blood sugar. My A1c hit 6.5. My cardiologist didnt care about blood sugar and he didnt mention that crestor raises blood sugar. He put me on 40mg - the max dose. THAT is what Dr Ovadia is talking about. A single minded, myopic focus on LDL with no consideration of other and in my case more important issues.
Did you tell your doc that it raises blood sugar?
I’m in somewhat similar situation, but my LDL is “only” in the 130’s so not high enough to warrant statin, especially my TG/HDL ratio indicates (a proxy) a low risk. My A1c just reached 5.7 a year ago. My doc agreed to let me try life style intervention first and continue to observe. By the way, A1c being higher than 5.7 is already a risk factor indicating insulin resistance (likely going on for a long while already, which in itself could have negative systemic impact including CVD risk.
A cac only shows hard stable plaques. Soft volatile plaque is much more likely to cause a thrombus and occlude an artery. I'm betting your doctor didn't ignore your high blood glucose he probably told you to lose weight and bring your belt size down.
@@trotskyite1 i’m 5’10” and 170 at 14% body fat roughly, with a belt size of 33, at 54 years old. Not really much room to lose more weight. Maybe 5 lbs if I want to be really lean.
My lipids improved dramatically and A1c is fine, but my free testosterone took a dive. This all happened when I reduced my eggs; stopped fasting; and added 70g dry oats daily.
Thanks Gil for doing this. I hope to see a similar discussion with Peter Attia
This may be the best nutrition debate I've seen to date. You are fantastic in this context and I hope you'll do more of this. Thank you!
nutrition? I heard a lot about the particulars of metabolic health markers, in the context of CVD not really anything specific to nutrition (beyond LDL/apoB interactions with specific types of fats, and what one might replace those with to achieve a particular outcome with *isn't* individually predictive of metabolic health necessarily but ARE at population statistics levels).
My stage 3 CKD completely resolved after very low carb diet for one year in which I lost 50 lbs. Now I'm curious as to whether this was due to diet or weight loss.
What a fabulous discussion. I've had really great success with very low carb diets, but I think maybe we are all a little different. Glad to hear a professional discussion.
If apob is so important and I’m sure that is is, why aren’t we tested for it with our regular lab work?
These are exactly the type of conversations I like to hear. One-on-one where both people can present their views and respond to the other. Thank you for doing this.
Thank you Gil for this video. You are lucid, respectful and everything a scientist in this field should be. Your rebuttals prove why a partial understanding and faulty logic can be so dangerous for thinkers in this area. Kudos to you!
This channel is gonna blow up
Such an underrated channel. I think his channel is a shining example of what science/nutrition examples should strive to be.
What a wonderful and instructive discussion. I don't think I've ever heard this explained so clearly ... and I do NOT have any medical background except what I've learned through my partner's 22 years of heart disease, diabetes, and other medical issues. Thank you for making this.
This is great! we need more long form public discussions between practicing clinicians and scientists like that!
Absolutely fantastic discussion. Thank you so much!
Fantastic conversation between two smart and educated people. Both of you did a great job of explaining your views (and in a very civilized manner) and it all made a great deal of sense to me. Thank you for educating the public. We are very grateful to you!
Gil… this is gold…. Thank you very much!
some of the most solid info i've found on managing high cholesterol/preventing heart disease. My lipid profile was enough to go on statins, but along with my doctor's advice, I spent time in the trenches of the nutrition youtube rabbit hole and found some gold like this channel -- keep up the good work making sense out of and mediating all the different perspectives on nutrition
Wow, never seen such a rich & RESPECTFUL conversation. Thank you Great physicians
I can’t have these healthy conversations with my parents. They’ve bought into the idea that there is a conspiracy to keep people medicated so Big Pharma makes money. Everything revolves around an unhealthy conspiracy theory and toxic relationship with food (this food is good vs that food is “bad”).
Seeing this conversation go so well, even as you both disagree on certain specifics, honestly makes me a little sad that I couldn’t have this kind of healthy, spirited, calm conversation with my parents.
So anyway, thank you for setting a great example of how conversations could go, and aspire to be better. You both are awesome for the respectful dialogue and fact-based debate. Thank you!
Thank you so much to both of you for this. Please join forces and make things happen. Humanity depends heavily on people like you to discuss, clarify confusion and evolve beyond our current situation.
Amazing. More than 40 references. And, as always, the tone. For both
Great, respectful video. Thanks to both of you!
Ovadia's repeated subtle reminders of his "clinical" experience, implicitly opposed to your more supposedly distanced "benched" or "lab" approach, is where I think the rub lies. His personal experience, however impressive, is necessarily anecdotal. The stats of good studies, or meta-studies, overwhelm such experience when the two kinds of data collide. Not always in the individual case, of course, but in the broader case across populations.
Finally a comment I agree with.
The plural of anecdotal is what?........ evidence
@@zacharybean1687 "Relying on anecdotes, no matter how numerous, fails to specify any value of the independent variable ...... The plural of “anecdote” is not “data.”"
I’d add that Ovadia’s clinical points are important because that variance between research and application is critical. I think being a practitioner has great input that researchers should hear, consider and follow up on.
Agree 100% - no comparison
Thank you both.
Wonderful news and updates.
Thank you for this productive conversation, the explanations and analogies were really helpful! 🙂
Very informative discussion. Thanks to both. It is amazing that all references are shown. I will read the meta analysis about the saturated fat now as the discrepancy of opinions surprised me a little. And I am very impressed how profound Gils knowledge and accuracy is.
Fantastic discussion. Thank you!
Wow Dr. Gil is a master. Beautifully done sir.
Fascinating, thank you very much.
Great video! You should have more of these kinds of conversations! Looking forward to listening to you on The Proof podcast tomorrow! ✌️
Thank you both for great points
Awesome discussion and hats off to you both for being up for it. We need more like this!
Two of my favorite doctors together.. What a treat 😍🍰
Love the willingness to debate!
These are the discussion needed.
Really informative, this is the best way to clarify topics, this is the way to understand that discussions are not a problem, they are very useful when there is knowledge behind.
Cheers
Really good practice to have such a complete reference list where each link takes us to a full-text version of a study. Thanks. More podcasters should do this.
Wow, this was incredibly well done, which means thorough and nuanced and well referenced!! Respect!👏🏻👏🏻
Coming from a lay person, I found this to be very helpful in many ways. My take away is that you can blow an engine at x miles but the actual cause is likely several conditions (hi mileage, aggressive driving, oil change frequency, type of oils being used, loss of coolant resulting in hot engine etc, etc,etc) - all of which could have, over time, prevented or caused the eventual breakdown. But we know good driving behaviour, good oil “hygiene” etc, will more times than not extend engine life.
What we (the general population) should agree with is that there is no silver bullet, and no shield for said bullet. Therefore, the approach to take is only a more holistic approach to general lifestyle that mitigates risk on all fronts (diet, exercise, mental health). Regarding specific factors, whether it be aboB, saturated fats, cardio, stress, are all important to recognize individually as potential influencers. If we see strong correlations between factors and conditions, we should take note, but not target it necessarily. Rather, use it as a message to get all of you sh*t together to the greatest extent possible to promote more positive outcomes. In short, if your Apob is high, you waist is to big, or BP is out of whack you likely have to do more than just fix that one problem. Also consider that an unhealthy heart also leads to unhealthy liver, kidneys, brain, etc.
In summary, you bet, it is complex, so we should not gravitate to focusing on one condition thinking it is going resolve everything. Doctors and the medical profession in general, need to continually emphasize a more holistic approach to remedy. We can all agree consistent diet, exercise, mindfulness is far more beneficial overall than a statin or olive oil. It’s a tougher message, and what no unhealthy American wants to hear, but suck it up buttercup, apoB is not your problem, your long term lifestyle is. ApoB is just the messenger. You shouldn’t need a doctor to tell you that, and you already know how to fix it.
Thanks to both doctors for a sharing their insight, and in this manner.
Did you watch the whole video? High ApoB is an independent and a causal risk factor, even if your other parameters are good
@@FractoideRight.
Thanks to both you and Dr Ovadia. Both respectful, didnt interrupt each other, wasnt personal but an absolutely orderly discussion with different points of view. Rarely if ever seem that before in discussions about anything. Probably yelling and fighting will get more clicks tho ;)
I have been with my doc for 16 years - he is in his late 40s. He asked me if I wanted meds for my cholesterol - I said no. It was minimally high (1 point) He has never mentioned ApoB and he is well aware that I am on Ketovore - diabetic 2 and hypothyroid - aged 75. I now understand the situation much better and will be able to ask questions. Thank you
I would highly enjoy watching a discussion with Dr. Robert Lustig and yourself. Please.
Pic a topic. Metabolic health, the calorie, Cholesterol, sugar, mental health.
Great conversation, thanks!
I don't like conflict, and I always feel a bit squeamish even when listening to other people between whom there is conflict. But you handled this very well. Both of you had good and valid points. I have to agree with your guest that there are individuals who have high LDL or apoB and yet never develop cardiovascular disease and that these people need to be studied closely to find out why. But until we can find out the answers, I have to agree with you that the general advice needs to be that which will benefit the vast majority of people. Thanks for the great work you do!
Which is why they're called "risk factors"... And you're not "guaranteed" to not get heart disease but it increases/decrease your chances of getting one..
Well I would be curious how you came up with the conclusion "there are individuals who have high LDL or apoB and yet never develop cardiovascular disease"? Have they been studied until they die (of other causes)?
Stress would be an obvious suggestion
@@Somun-aThey actually have been.
Best debate ever. Both sides great logic. In my own case, at 80th year of living, my Triglycerides were 52, HDL 53, A1C 4.8 total cholesterol 147, LDL 81. Non- HDL cholesterol 94. Have diverticulosis and IBS and eat what I can, including lots of cheese, etc. Walk 5 miles a day, lift weights odds days and have never had good health and deal with several historic injuries. Doc still thinks my cholesterol is too high? As for digestive issues. Anti acids, Omeprazole. Can't fix those? Just eliminate foods. Too bad. So the Cardio guy make a good point. Can't see the tree for the forest. One side empathizes the forest, the other the trees. The rubber meets the road where the trees are. But the forest is the overall health of the system as a whole. We need a system to look at trees as well as the forest. Our healthcare system with the doc looking at the computer more than the patient during the 10 minute session following protocols is not great for the individuals but great for general statics.
Wow! This is an amazing conversation. I think I will listen to this a dozen times!
Great discussion
the best video of the subject
So happy I discovered your channel!!!! Love that you go through evidence in such detail.....
Thanks for the great info
Liked the format
These guys are brilliant!!! Love to hear both are such gentlemen.
Thank You, it's very useful to hear the counter viewpoints
Great discussion. The main point of differences are there lens. Gil is using the population risk factor approach, which makes sense. The guest MD is approaching from the reality of how MDs and patients behave on the ground. May MDs only hone in on LDL without looking at other factors or discount or fail to talk to the patient to get that individual profile. That is for sure going on.
I'm both thankful for and somewhat frustrated by this discussion. I do appreciate you for having Dr. Ovadia on your channel and the dichotomy between each of your opinions and perspectives (clinical vs scientific). As a "lay viewer", it's frustrating that there are such opposite narratives on cholesterol, diet and metabolic health across the internet. I can't speak to the research, and I know you tend to be "evidence based" rather than "story based" (anecdotal), but I do believe there is often overlooked evidence in the anecdotes.
One thing that I believe Dr. Ovadia is correct on, and which you seemed to be shocked by, is that a large number (I'd submit MOST) of doctors (or PAs, NPs, etc.) ONLY focus on HDL-c/LDL-c or, worse, total cholesterol numbers on lipid panels when prescribing statins. (You accused him of a singular focus, when I contend that the opposite is true in the US) I'm currently 53 years old and have moved around my state a fair amount over the last 35 years and have seen multiple different practitioners (probably double digit) during that span. I have a family history of high cholesterol, and have had "elevated" cholesterol (230-329) most of my life. NOT ONCE in my lifetime has any doctor, nurse practitioner, physician assistant, LVN or RN ever suggested that I have anything other than a standard lipid panel beyond the HDL-c, LDL-c, triglyceride and glucose measurements. None have ever suggested that I modify my diet or increase exercise, but almost all of them have recommended or prescribed supplements or medication (statins) to reduce my "high" cholesterol.
In 2018, I decided I wanted to do the Keto diet (original with 70% fat (mostly saturated)) and went to see my doctor before I started (primarily to get her thoughts as well as to establish a baseline with my bloodwork. ) Three months later, I returned for a follow up and reminded her of my diet, even explaining that I was unsure how my numbers would compare to the baseline. She requested the bloodwork. In addition to losing 18 lbs, my numbers across the board were better - including lower blood pressure (112/77), lower glucose, lower triglycerides (82) - except for my total cholesterol (from 279 to 329) and LDL-c (from 179 - 220). So did the doctor recommend that I take an NMR, get a CAC, exercise more or even simply stop doing KETO ? Nope, I got a call that same day (from the nurse, not even the doctor) telling me that all my numbers looked great - other than my "cholesterol", which was severely high at 329 ("should be below 200") and TELLING me the doctor was going to start me on statins! Of course, I told her that I wasn't going to go on statins, but I effectively stopped keto...and proceeded to gain about 25 lbs, essentially returning to a standard American diet.
Five years later, I recently decided to try to shed the weight again, using a combination of alternate day fasting (24+hour), Mediterranean diet and exercise. I lost 17 pounds in the first 60 days. I returned to my doctor's office (saw a different practitioner) and had blood work done. Again, all of my numbers were solid (to good). Even my cholesterol was "better" than previous ((273 total, 179 LDL), although still "elevated." Armed with information that I learned from listening to folks like Peter Attia, Dr. Gundry, Dr. Ekberg, Dr. Berg, Thomas DeLauer and, yes, even Dr. Ovadia, I asked my practitioner if I could get a further breakdown of the other lipid numbers, including ApoB, LP(a), vLDL, etc., but was informed the lab at the regional medical center could not even test for that! I requested a CAC, and they said they'd call a different lab (about an hour away) to authorize and schedule the CAC and call me back to confirm. Two weeks later, I haven't heard a word.
Prior to listening to health podcasts and videos, I had no clue there was anything other than "good" or "bad" cholesterol (thank you for elaborating on the differences on your channel). I don't think my situation is unique. I'd bet the vast majority of people in the US, and even MOST OF THE PEOPLE THAT ARE CURRENTLY ON STATINS to reduce cholesterol - have no clue what their other "risk factors" of cardiovascular disease are other than high blood pressure and total cholesterol and MAYBE LDL-c .
Again, I appreciate your take on many of these opposing viewpoints. I originally watched a few of your videos to get a different perspective from some of the folks I mentioned above (regarding cholesterol, fasting, low carb vs low fat, etc.) and I've modified some of my thoughts and things I've incorporated into my health journey. However, I think the medicate first approach that our US healthcare system propogates is MUCH MORE dangerous than the advice and guidance being provided by Dr. Ovadia and the others I've mentioned (and you appear to be somewhat naive about that (probably because of your "science based" approach.)) I can assure you that I am MUCH more aware and in control of my personal health today than I was a few short months ago.
Apologies for my long-windedness!
I love this. Very interesting
So my takeaway from that discussion is all metabolic factors are important. Lipid panel, APOB, glucose, weight and BP must be delt with.
Didn’t we already know this? I believe Gil proved that apob and ldl are independent risk factors, no matter the context. It’s in the references he posted here.
Fasting insulin and HbA1c are better indicators than fasting glucose.
@@ApoBeef No way Triglycerides are most important
Gil, I'm very impressed with how you handled this. I'm too used to these online discussions, even if they're civil, ending up in a "yeah but I've read that..." "no but I've read this other thing and.." and we all end up none the wiser. But you were able to respond to and even quantify every issue Dr. Ovadia raises. I tried to keep an open mind going into this, but there's really only one side of this discussion that was convincing here.
This is a great discussion, conducted civilly and based on what is known from different perspectives-thanks to both docs👍🏼.
No ad hominem is a much more effective and respectful way to discuss topics. I remember several work groups where even with Robert’s Rules we were not able to stay on track civilly. Great job to both of the doctors for maintaining a sincere mutual respect during the entire podcast. Now can we get our elected leaders to do the same thing…..please!!!
THANK YOU FOR THIS VIDEO!!!!!!!!!!!!!!!!!!
Thank you amazing .
For this dude to say we as American tried a low fat diet and it didn’t work is ridiculous.
Good doctors are not easy to find, at least in my experience. Both these guys are good and a debate between them is awesome knowledge.
Excellent discussion, doctors!
Dr Gil im in love with your brain
Thank you Gil for the video. I finished my masters last year and did a little bit of research in university. I haven't considered continuing on with research but your knowledge, logical and positive approach to explaining topics has given me motivation to spark my interest in pursuing research. Thank you for your content.
This is an outstanding video, very informative on many levels. It shows just how nuanced the issue of heart health is. Thank you very much for posting it.
Wow that was amazing! Well done Gil 👏 you crushed it!
I always wanted to see what you'd be like in this setting and as expected you handled things cordially and accurately. I mean the way you were able to recall all the studies and then relay the science so clearly just like in all your videos. Bravo Gil bravo 👏 🙌
@@waynegolding14 I was amazed by his composure and his ability to emphasize the good instead of the misunderstanding. It's one thing to do that in a video but another in a "live discussion".
@@tofu-munchingCoalition.ofChaos Exactly! Easier to do when you can press pause, edit and delete but to be doing this so well in real time. That's true knowledge and skill
Thanks to Dr. Carvalho I limited the consumption of animal foods even though I'm not planning on going fully vegan. I'm medically trained, too, but I've never seen anyone as non-dogmatic, humble and with such extensive knowledge on what they preach as Dr. Gil. I'd love to see more medics willing to discuss things rather than giving "trust me, I'm a doctor" vibes.
This made me deeper understand the issue at hand.
It's baffling that Dr. Ovadia casts doubt regarding LDL & ApoB but seemed quite receptive to espouse that insulin resistance could be the cause for heart disease.
Both pathways need to be closely monitored (LDL’s as well as insulin) as they both metabolically lead to the same negative outcome.
Another great video Dr. C!
Great discussion, nice job guys.
This was a great discussion. My problem with Dr. Ovadia's overall reasoning is this: he says that the risk/benefit analysis should be done at an _individual_ level, as the population-level studies will not translate to every individual. On the other hand, his messaging on social media is at a _population_ level, promoting blanket disregard for LDL and other markers.
Interesting to see more important role of insulin resistance in heart disease, and role of ApoB over LDL. Will try to convince doc to get ApoB test next time round.
IR is what caused heart disease, elevated insulin and inflammation
Finally a very knowledgeable team, not an interviewer who is bowled over but offers very good arguments. What about homocysteine as riksk factor?
Thanks for this video. Learned a lot from you on how we should based our views/beliefs on careful analysis of the scientific evidences and how easy it is for people to ignore or misinterpret evidences that their views/beliefs are wrong. It is not easy for people on low carb (high saturated fat) to accept that high LDL/ApoB is an independent risk factor as they have invested a lot of time and efforts into the low carb diet. Hope your video could change some minds.
Huh??
I really enjoyed this discussion and it is totally relevant to my personal case.
Congratulations to both contributers. The discussions covered most of the issues i was trying to get a better understanding of. A lot to unpack and consider but it was presented in a really constructive format. Well done!
You're the boss and your videos are incredible
Every cardiologist I've been to only tests blood lipids and bp. I have to go to an endocrinologist to find out about metabolic issues dealing with sugar... and then I can't find out my insulin level if my a1c is not high enough.. It is very frustrating to find out information about oneself here in the US and I have to be the one to put the disparate pieces of information together....no doctor will. Everything is driven by what insurance will pay for and insurance companies base their policies on decades old parameters. I adopted an extremely low fat and no salt diet and dropped total cholesterol to 127 but ldl only went from 70 to 68. I'm still in the danger zone and have a parental history of heart disease on both sides. My thoracic aorta is already calcified. I think your points on this video were articulate with clarification perfect for helping us lay people follow this conversation. I'm glad you stuck to your guns about our never going on a lowfat diet here in the US. Low fat here is still defined at around a rather high 30%. We never even got to that. True lowfat diets with carbs coming from complex carbohydrates do not lead to obesity...it is impossible to gain weight. You both made such pertinent comments.
in no world is 68 or 70 a high LDL number. and the notion that you "can't gain weight" with minimal fat and maximal complex carbohydrates is ridiculous. of course you can. if you eat more of them than you burn. how is this mysterious in any way?
“Saturated fat has only been shown to be beneficial…” Whaaaaat???
Fabulous conversation! You're a model for intelligent discussion!
Love this discussion so much! I am taking 5mg of a statin and 5mg of Zetia... I have family history, high CAC score, and high cholesterol.... I see both sides - I believe I'll continue what I'm doing ....
What a healthy discussion. 👍👍👍
So Gil is saying that car crashes have many causes including speed but not ignoring the brakes or tires. Philip is saying that we are concentrating on speed too much and should not have speed limits.
I believe that survival is a long and winding road not an autobahn, speed will eventually get you even with new tires.
One of the things that bugs me the most about arguments like, “well people with low LDL end up on my table, so obviously lowering LDL isn’t as important as ,” is that this is a terrible argument on its face.
That argument doesn’t even understand the premise of reducing plaque accumulation by lowering LDL; if it did, the CT surgeon should be asking how long the patient stayed away from the table by lowering LDL, not if they still got there. Then you could actually compare that scenario to lowering risk via another route, e.g. targeting metabolic health via the five factors he outlined in the beginning.
Of course as someone on the preventative side of this and not the life-saving intervention side, I can tell you that his assumption that his proposed strategy would be more effective doesn’t line up with my reality. It’s really, really hard to get people to make the lifestyle changes necessary to reduce heart disease risk via those mechanisms. Useful? Absolutely, and I make a career by helping them through that process. But that’s not the argument he’s made here.
This is obviously a both/and situation versus an either/or, but a physician should *of course* be concerned with lowering a risk factor in way that’s both proven to be effective and also easy to follow through on.
TL;DR
Lower your APoB (and LDL) via medication and lifestyle changes if your heart disease risk indicates it, but don’t throw the baby out with the bath water.
His premise ignores base rates as well. He doesn’t know how many people with low LDL-C DONT end up on his table.
What he said is a huge over simplification of a real case anyway.
It was not even a question for me while listening, who is more factual with real evidence. Dr Ovadia's perspective was very anecdotal...as another comment emphasized it very well. Thank you Gil for this great discussion!
Just a heart surgeon treating thousands of patients with heart disease. What would he know?
Thank you Gentlemen for taking the time to share your knowledge :)
I’m really shocked by how many people in this combox are enthralled by Gil’s criticisms and questioning. The majority of it amounts to reading too much into what the cardiologist is saying. The cardiologist isn’t making blanket universal affirmatives, by which a counter particular would invalid it. He’s merely pointing to an undue emphasis placed on such-and-such an item in the literature and/or clinical practice; ultimately, such-and-such an item, like LDL, is accused of a type of causality it apparently doesn’t have.
He did however make blank statements on causal effect of LDL on mortality, and did not know the literature on that topic. In addition to saying that olive oil is a polyinsaturate fat (it does have some, but it is mostly omega-9 monoinsaturated oleic acid), which I did not expect to hear in this conversation.
@@Sobchak2 I’d review that again. I said universal affirmatives.
I had a cat scan of my heart and pet scan of my brain about ten years ago because I refused to go on statins for my high cholesterol. There was no appreciable plaque build up. Also, many members of my family have/had high cholesterol but no one has heart disease. Now, all these years later I still am bullied by my healthcare professionals to take medication but they will not give me any scans to see if I need them. I have to not eat eggs as they spike my cholesterol. If I avoid them my cholesterol levels are lower. Part of my diet are nuts and olive oil without raising my ldl. Wish the medical community could establish better guidelines for people like me.
It is difficult to reliably measure the amount of plaque in your blood vessels. Just because it is absent in a particular artery doesn't necessarily mean you don't have a problem. It can be anywheres and kill or maim you. There is no rational reason to avoid statins. The only "serious" side effects are liver damage but that is extremely rare. Stories about muscle soreness are mostly not real. The risks of having a stroke or heart attack by not taking a statin when you have high cholesterol are way higher than the risk of any serious side effect. That is why doctors prescribe it.
@@donwinston I agree and I do. I tried diet alone and while my LDL plummeted , it needed to plummet more.. I am now on a statin, but knowing it can increase the risk of diabetes makes me even MORE scrupulous about what I consume. Since I've been on a statin, my diet is the best it's ever been, 95% whole food plant based.
Firstly, when I did a Coronary Calcium scan at the age of 50, my score was zero. About twelve years later it was 42. They say under 100 is not too bad, but there's still hard plaque. That's what is measured. What cannot be measured is the soft plaque and where there's hardened plaque, there's soft plaque, and that's the insidious, dangerous stuff. High LDL is a sure sign that there's circulating soft plaque in the arteries. I tell you this only because I was like you. I resisted a statin for many years, but after much research, I realized it was definitely the better option than possibly having a stroke like my mother did.
Not to say I didn't clean up my diet. I can't believe how much my diet has improved over the years. But I did it gradually. I find all these videos and podcasts have changed my life. But it's up to me to synthesize the info and still confer with a trusted doctor. By the way, a wonderful resource about heart disease, is Doctor Kim Williams. He's the former president of the American College of Cardiology and he's the best of the best. I'm fortunate enough to have a cardiologist who's in conversation with him. It makes me trust her more. I recommend Googling Dr. Kim Williams and listening to him. He's also nice and funny, not boring at all. By the way, I would definitely go to a cardiologist who is willing to prescribe a coronary calcium scan, if not a carotid artery ultrasound. I know how tricky this whole health journey is. We're all in the same boat. Good luck to you.
Katherine since how many years, you have high cholesterol?
@@rizwanbajwa3414 since my blood was fist tested late 1980’s. I have to add the maternal side of my family generally have high cholesterol but none have had heart disease/issues plus they lived into their late 80’s and early 90’s.
I am 30 minutes in, and it's becoming frustrating to listen to Philip. He's not responding properly to Gil's points. Gil says "We can't ignore apob because of *insert good reasons."* Then Dr. Philip responds by saying "The problem is that we have focused too much on LDL." That's not an answer dude. It's like if Person 1 says "We can't ignore the risk factors that come from smoking cigarettes when it comes to cancer", and then Person 2 says "The problem is that there has been too much focus on smoking cigarettes." Sure, and Person 1 can even agree with that, but saying there has been too much focus on X is *not* a justifiable reason to ignore X! Come on man.
But let's see if it changes.