The best process is no process 📜Roadmap - how to look young & feel strong: drstanfield.com/pages/roadmap 💊MicroVitamin (multivitamin & mineral that I take): drstanfield.com/products/microvitamin
TELL THEM DOCTOR !!!! I GET ALL THESE TESTS DONE, THANKS TO THE NATIONAL HEALTH SERVICE IN THE UNITED KINGDOM !!! PEOPLE FOR ALL THOSE WHO ARE WATCHING THIS IS A MOST EDUCATIONAL AND INFORMATIVE PIECE OF ADVICE COMING FROM A VERY GOOD MEDICAL PROFESSIONAL
@@orionxtc1119 What did the statins do to you?????? I am currently taking statins and my doctor says there are no problems and also I have no side effects
@@kofyadega5341 You are right as documented by high Lp(a) is good and low is bad the exact opposite of what this young kid says. "Remarkably, one-quarter of the centenarians had high Lp(a) serum levels even though they never suffered from atherosclerosis-related diseases." 1998 G. Baggio. 2012 article title: Low Lipoprotein(a) Concentration Is Associated with Cancer and All-Cause Deaths: A Population-Based Cohort Study (The JMS Cohort Study).
4 Additional Tests mentioned when there's a clinical purpose: #1 Liver function #2 Thyroid function #3 Micronutrients (e.g., Vitamin D levels) #4 Cancer Screening (e.g., for men the PSA test)
@@TheStudioManila Take enough per day, then the value will fit accordingly. It is sufficient to check once whether the target value can be reached or whether the body has problems absorbing vitamin D (but this is the exception)...
@@kasten8020 Vitamin D needs vitamin A (in addition to K2) in order to be as effective as possible. Taking vitamin A at the same time raises vitamin D levels much higher than taking vitamin D alone. I take 5000IE vitamin D with 200mcg K2 and 10,000IE vitamin A.
Great information - compelled me to add Lp(a) to my annual blood work this year - my doc was resistant since I am at a healthy weight, no family history, excellent a1c, great blood pressure, lipid panel all in "healthy range" - so to my surprise my Lp(a) came back elevated at 53! Knowledge is power. I'll continue my healthy lifestyle but now consider medication to get my LDL to the more aggressive healthy range you've spoken about in many videos.
I agree CGMs probably aren't useful for clinics to make decisions, but I still think they're worthwhile for individuals trying to improve their hbA1c... My hbA1c was 5.4 and started creeping up. Getting a CGM for a month or so and using an app that tracked activities and meals and the corresponding effect on blood glucose was extremely useful for me to see immediately how my diet and daily activities affected my blood glucose... how what I ate, how I slept, and how I spent my days caused it to elevate or to stay stable in a healthy range. Wearing a CGM for a month or so is useful to truly impart on an individual via instant feedback about how their daily routines affect their blood glucose for the better or worse, and so it's a useful accountability tool, much like weekly weigh-ins. It even gave me weekly averages, the causes of the biggest spikes, etc. For example, for me, when I eat my favorite processed food, even in moderation, I would see my blood glucose spike to 180, despite having an otherwise whole-food plant-based healthy diet. It was the final push I needed to remove the last bits of processed foods from my diet... replaces that with some fruit and now my blood glucose maxes out at 130. Pushed that hbA1c back down to a 5 where it always was. The feedback from a CGM gave me the real-time data needed to convince me to avoid processed food like my life depended on it. 🙂
Did anyone ever tell you Medicare doesn't cover A1c testing unless you test pre-diabetic or diabetic? I looked it up and true. Something everyone should be tested for yearly, especially seniors.
Am going through the statin and LDL conundrum. Not sure what to do as the scientific explanation of inflammation and laying down of LDL in an attempt to heal arterial walls makes a lot of sense. I personally don't think LDL below 70 sounds healthy, but I'm on the fence. Cardiologist I went to didn't order ApoB. I asked for it and it was 104, high (s/b below 90, some say 75). He did order LP(a) and that was only 29. I would also add vitamins D and B12 to standard testing every year, liver panel and inflammatory markers like hs-CRP.
Unfortunately in the USA it’s the insurance companies that decide what tests you can get not your doctor. For example the last time I went to get bloodwork the lab told me that my insurance wouldn’t cover one of the tests ordered and if I wanted that test I had to pay $178. The price without insurance is often outrageous. Another test I asked about had a price of $400 without insurance. If my insurance allows the test the negotiated price was $12.
I do a free annual checkup (basic blood test); for anything i curious about i use ULTALABS as often as i want ; prices are amazing and they often have 20% off (basic blood test $12.99, apoB around $30, etc) I purcase my tests there, than schedule convinieant for me appoitment at Quest Diagnostics - Done:)
OwnYourLabs allows one to order a set of tests online, print it out, and take it to a LabCorp location near you. I just got a battery of tests for $180. There are 4 or 5 states that don't allow this, the rest are good to go. Other companies out there too that do it as well. "walkinlabs" and "ultralabtests" are others.
There is a potential problem with the kidney function tests. The creatinine test is likely compromised in people who supplement creatine, which is the number one recommended supplement on this channel. It should have been at least mentioned. (One solution is to stop creatine supplementation for sufficient time before the test, not sure for how long, but I would guess at least 5 days. Another option is to use a different test: Cystatin C.)
So explain this to me then... I've had genetically high cholesterol all my life. So much so that every doctor basically begs me to go on statins, to which I always flatly refuse. I'm also classed as a lean mass hyper responder, so if I do keto my cholesterol goes absolutely through the roof. And yet essentially all of my other health markers are flawless, and I have low blood pressure and I've never smoked before. A recent coronary artery calcium scan and carotid ultrasounds shows ZERO occlusion, and I've never had even a hint of a heart attack or other cardiovascular insufficiency at age 50. And yet you would argue that I still need to lower my LDL. I respect most of what you say but I completely disagree with this utter demonization of LDL. It IS absolutely necessary to the body, and it IS the other things (such as inflammation levels of said cholesterol) that are the issue, NOT just the LDL cholesterol itself. You, and most western doctors, seem to have this programming that "all humans are born with a statin deficiency".
@@ИванХаралампиев-э6иRe: 1 - So I have ZERO other signs of ill health, no symptoms whatsoever of heart disease, skin at 50 that looks like I'm 30, I'm ripped, etc ad nauseum... And you STILL wanna tell me I'm unhealthy SOLELY because of my LDL? Re: 2 - I also have high HDL and very low trigs on keto - maybe ask first before assuming I don't.
You're asking about a niche group of people, where the data is only just being established. It doesn't apply for the masses. And the long term data for LMHR isn't there yet. You're probably alright, but we don't have the long term data. It still means that apoB/lipids is very relevant for most of the population. LMHRs really think the whole world is on keto, it's an echo chamber
I would have added crp and esr... eGFR w/ creatinine (especially for CKD patients)....great list doc...i get the apo b, and the lipo (a) done every few years..mitigate Bsugar, and BP, stay away from the middle isles of the grocery store eat right and limit booze....seems to work for me.
I understand that the current research shows little effect of diet and exercise on lp(a), but I think that may be a function of the limitations of clinical research. As a personal anecdote I have blood tests showing a 63% reduction over the course of a year. Obviously I can’t say exactly what did it, but I did go from essentially no aerobic exercise to running 40 miles a week in that time. That’s a pretty extreme change in exercise that won’t show up in most interventions.
We are still using this in our practice. The USPSTF recommends that adults aged 40 to 75 with a 10-year cardiovascular risk of more than 10% be screened for and treated for lipid disorders. For those with a 10-year cardiovascular risk of 7.5% to 10%, the USPSTF recommends selectively offering treatment.
It sounds like the studies are saying that if you naturally have lower LDL, you have a lower chance of heart disease. What I don't see in the studies is whether lowering the cholesterol of someone with high LDL will lower THEIR chance of having heart disease. This is the reason that the studies on statins do not show any real benefits in terms of like expectancy. This indicates to me that you need to determine why someone has high LDL and aproach it from that standpoint instead of artificially lowering their LDL through drugs which show no mortality benefit and ignore the real reason for the high cholesterol.
Low TG , High HDL are of themselves indicators of a higher percentage of large bouyant LDL. Also if these levels are optimal AND give a low TG/HDL ratio they indicate that there is not a a high level of small dense LDL particles present which are a major player in atherosclerosis. A global level of LDL does not tell the whole story. A lipid fractionation test tells a better story but is expensive. TG, HDL and their ratio give a good proxy for whether the LDL fractionation is "healthy" or not. Literature also suggests that people with optimal TG, HDL and TG/HDL ratio will gain no benefit from statin therapy in lowering LDL and may indeed be worse off due to potential side effects.
Risk tracks with ApoB particle number. Once you control for that, particle size loses statistical power in almost all studies looking at this question. It has also been proven to be an independent risk factor for CVD risk even after controlling for HDL and TG level. So Brad is correct in tracking global LDL levels.
@@davidbarnes774 I haven't seen any studies specifically looking at such a population. However if there was residual risk associated with elevated sdLDL to lbLDL in the setting of low ApoB, then the studies I mentioned would have found that particle size still retained statistical power even after adjusting for ApoB particle number. Additionally, lbLDL still retains the ability to cross the arterial lumen via transcytosis and deposit cholesterol into the vessel wall. So even if the majority of one's subtraction of ApoB containing lipoproteins is large buoyant, there is still residual risk associated with such a phenotype if the ApoB particle number is high. In fact, individuals with Familial Hypercholesterolemia, which is a condition associated with early onset of heart attacks and strokes, have the vast majority of the LDL distribution consisting of the large buoyant variety.
@davidbarnes-BUT, what if, for example, one has a a hyper absorption of LDL. Even small amounts then could be cause for a potential problem. Factor in other potential risk factors, say, carbs, smoking, alcohol, HBP, etc and the LDL discussion is not about how low or how much, but what its effect in the context of these other issues. And what if one individual follows the guidelines for 2 drinks a day and is perfectly fine but another person slowly develops a damaged glycocalx? The second person will likely develop CVD even with normal LDL and even with an optimal HDL/ TRIG ratio. The major player then is context, not simply numbers and medical stats.
Speaking about the under 60 mg/dL LDL, you sometimes mention that you take low dose rosvustatin to reach that threshold. Is there any reason as to why low dose rosvustatin is preferable to ezetimibe monotherapy in cases where the patient already has great cholesterol levels but wants to push it below that 60 mg/dL level or either is fine? I know that the overwhelming majority of data shows that statins are safe, but there are those small effects on blood glucose and statins still scare me a little more than ezetimibe for being more systemic rather than just blocking absorption of cholesterol at the intestine level (although that intuition might be naive of me given the fact that ezetimibe does seem to have a few rare but dangerous side effects when looking at WebMD). Thanks for the great work!
ApoB is more important to know than LDL cholesterol, because it can diverge from LDL-C, so that you can have a relatively low LDL-C, but your ApoB number can be dangerously high. It's the ApoB particle that transports LDL-C in the blood, and when their number exceeds the body's physiological need, they can pass through the artery wall, and become trapped there and oxidized in that subspace of the artery wall, which is the origin of plaque formation. So, the emphasis should be on lowering the number of ApoB particles as much as possible. The longer ApoB is high, the greater the risk of heart disease. Diets high in saturated fat will increase LDL cholesterol in the blood causing the body to create more ApoB particles to transport it. Same with sugar. This is a subject with life and death importance. Above all, beware of doctors like Dr. Brewer and Dr. Berry who deny the role of LDL cholesterol and ApoB in causing heart disease. If you know that you have plaque, going on a high fat keto diet can kill you.
Did the PESA study just look at total LDL or did they look at fractionation analysis of LDL? I'll have a look at the study but I suspect that due to cost the breakdown of LDL particles was not done. In that case it would be surprising if very low levels of LDL did not reduce mortality. It may be that optimising the particle analysis in LDL is a better way to reduce risk than driving down LDL to very low levels especially if heavy medication use is required to do so.
So what do you do when you tried statins and reacted VERY badly to them? I was in constant pain inside and out, my blood sugars were completely uncontrollable, and my liver panel got (I quote precisely) "wonky." My cholesterol didn't budge. So I got ZERO benefit and every nasty side-effect possible (just like my Dad, BTW). Now what? Please will someone, anyone, discuss ANY alternative to statin therapy?
sorry to hear about your reaction. The most 'gentle' statin is probably pravastatin 10mg taken at night. Other options (that aren't statins) are Ezetimibe and PCSK9i. Bempedoic acid is also another option. Strongly suggest you discuss the above with your doctor
Hi Dr Stanfield, my GF bought your micro vitamin and has an issue swallowing 5 pills, is it ok to empty them into a glass and mix the powder with water to drink it?
What are your thoughts re Dr Matthew J Budoff, Dave Feldman, Nick Norwitz (..et al) “Lean Mass Hyper-Responder” preliminary research study findings, published very recently in the J.A.C.C ?
For people on the keto diet and are LMHR... They maybe ok. We don't have long term data yet. But my view is that they are probably ok. But 99% of the population is not on the keto diet. Nick and co are very specific about who their research applies to - they are careful to say it's LMHR on keto and not the general population
I checked my HbA1c (hemoglobin - blood sugar) and it was at 7.6 which is too high and couldn't explain why. so I monitored with a sensor on my arm the levels. and I was always in the normal range. so why could be the HbA1c high but when I monitor 24/7 I'm fine?
Wait wait wait… A test has a false result once in 10,000 tests, therefore of every 10 positive results 9 are incorrect???? Err, run that past me again. (Confused face emoji)
I already asked but never got a reply, why do you favor your medication (07:00) over red rice yeast ? It seems to have some really good effect and few/little negative effects
1) I have had many PSA tests, all of which had been covered by insurance. So, I would check into that. 2) I do not know when PSA screening should start, but I do know it does have some value in the 40's, 50s, and 60's. The trouble is false positives, common to this test. It is after 70 that many experts recommend not doing this test. Not below 60 as your doctor said. So, I would get a second opinion. 3) Do research on this subject; many doctors are behind the curve on the prostate. Good Luck.
If you live in the states you can either order your own individual tests through Ulta Labs OR you can pay for a package through Function Health, you get 112 biomarkers tested for $499. That’s what I do and can’t recommend enough.
There’s a recent study from AHA that hsCRP is a great bio marker for CVD risk especially for women. According to the study this is better than Apo(b) or Cholesterol.
My last Lp(a) result was 330 nmol/L 😅 it was 380 nmol/L before that and two years ago it was 246 nmol/L. It definitely changes but it’s always high. Since I can’t do anything about my Lp(a) number, I just avoid all things that raise my LDL/ApoB and try to keep those numbers as low as possible as well as my A1C and insulin.
"Remarkably, one-quarter of the centenarians had high Lp(a) serum levels even though they never suffered from atherosclerosis-related diseases." 1998 G. Baggio. You should be happy it is high as you will live a long time.
@@beepbeepnj2658 would you be happier with a quarter or 75 cents? That means that 75% of centenarians did NOT have high Lp(a). I will say despite my mom smoking and having high Lp(a) she has never ever had any problems with her heart or cholesterol, but she also stays away from butter and red meat and sticks to a Mediterranean diet. Her cholesterol is always under 90 and thankfully so because it’s done her good. She is 70 now.
There’s zero, I mean zero evidence that “seed oils” cause inflammation. Someone made that up with no evidence to back it up and ran with it and now people with little education regurgitate it like it’s proven science. It’s not. However, there is copious research on saturated fats and those do cause a plethora of problems but people want to believe what they want to believe. This coming from a farmer who raises grass fed cows.
I checked my LDL and it is 138. how to lower the LDL? even when I have a good healthy diet already and regular excersice? even my body fat is very low with 8.5% I was surprised by this test result.
I have a diabetic HbA1C (6.4%), normal fasting glucose (94mg/dL), very low fasting insulin (4.4uUi/ml), normal HOMA-IR (1.0), normal weight (BMI 25) and I am lean (12% bodyfat). Then Why the heck does my HbA1C says I am almost diabetic when I am obviously not?
@@jackics6540 unfortunately I live in Canada and getting the appropriate tests and/or CGM is almost impossible. I will have to keep thinking that it is due to my erythrocytes living longer than average, thus getting more glycated over time.
Doc what about elevated creatinine levels because of regular creatine supplementation? Shoud we stop taking creatine some time before doing a kidney test?
My creatinine levels would always come back as elevated, so now I just go off creatine for two weeks before the test. I also don't lift any weights for a couple of days prior, as my doctor said that could cause an elevated reading.
So with LP(a), you start off by saying that exercise and diet don't have much effect but then, if you have a high level, you need to control diet and exercise. I guess this is saying "a little is better than nothing"? But at the same time, it doesn't make me feel like it's an important test since any effect I can have on it will be minimal. If anything, it might just cause extra stress, knowing that there is a danger that I can have little impact on.
Depends on the person - it may make you take your exercise and diet more seriously. But it might make you anxious - depends on the person. Pre testing consent is important
If your Lp(a) is low then you need to raise it to protect the body from disease. 2012 article title: Low Lipoprotein(a) Concentration Is Associated with Cancer and All-Cause Deaths: A Population-Based Cohort Study (The JMS Cohort Study)
@@whatthefunction9140 I don't know of any test that can even check for soft plaques so I don't know. that's why I would be wary of any claims that fasting would help.
The very best thing to do is not taking any unnecessary medication. Always eat foods that contain at least 28 vitamins and minerals. And you will not have health problems, are at least, your organs, won’t suffer. But you might break your back. From an accident. And then only take meds that come from the pharmacy. Not illegal, that will kill you for sure! P S no sugar!
Dr. Stanfield: Are there evident that high TSH is associated with high LDL (or total cholesterol) . If this is the case, should I take care of hypothyroidism first before taking statin for high LDL? Thanks.
You most likely will not read this message, but I will write as if you would. While I agree with you in some of the topics you have mentioned and disagree in others, the case of vitamin D deserves a separate comment. Vitamine D testing is really vital and more cases than celiac, Chron or other issues. The latest guidelines are a joke. They intend to solve the problem of low vitamins D by no measure it. I am not a doctor, but I do have a brain and I know enough statistics and how the world works in terms of economic incentives to understand this is a very bad choice. If vitamin D is low in more than 70% of the population, the general recomendación cannot be do not supplement it. If anything, should be the other way around. I have not seen any other doctor that follows all the guidelines but you. It seems that you are doing it without enough critical thought. It does not matter whether you do a video or not about it if the video does not have your own reflection on the topic but it limits to repeat the results from studies or Cochran reviews. You are an intelligent person. You can do better. Some points to discuss: How was the healthy range defined? What happens if you are over 100? Is hypercalcinemia a problem that derives from those values always? What can you do to prevent that from happening? Are all forms of vitamins K2 the same? Are all forms of MK7 the same? Is 500 units per day enough for everyone? 1000? 10000? What is the effect of the pharmaceutical presentation? You tend to oversimplify the problem if you do not ask yourself these questions and look for answers to all of them methodically and scientifically. I know a person who takes 10^5 units daily, without hypercalcinemia and more than doubles the upper limit. How is that possible? Do not throw this away saying that is an exception. Go deep to the biochemistry of the matter.
Careful with HgA1C interpretation, Hemoglobin A1c (HbA1c) targets can vary by age and other factors, and there isn't a one-size-fits-all target. HbA1c levels naturally increase with age, even for people without diabetes. For example, a 20-39 year old might have an HbA1c of 6%, while a 40-59 year old might have an HbA1c of 6.1%, and someone over 60 might have an HbA1c of 6.5%
Unfortunately HbA1c is in fact a one size fits all marker. The reason why it increases as we age is due to the fact that pancreatic beta cell function on average diminishes with age. Once A1c levels go above 5.7 into the prediabetic range, pancreatic beta cell mass has reduced on average by 50-70%, and once an individual reaches diabetic levels (6.5%) that number goes up to 90% beta cell loss.
That's a late stage finding. It's like waiting to see if lung cancer has developed before stopping smoking. Much better to address the heart disease risk factors now, than wait until calcium has built up in blood vessels
@@DrAJ_LatinAmerica Totally agree. CT calcium is a screening test and not a great one imo. Coronary CT angiogram is vastly superior, albeit it is a late stage test, but nevertheless useful if there is any suspicion of coronary artery disease or high risk there off. Modern 640 Slice CT scanners are extremely fast at acquiring very high quality images whilst minimising radiation exposure to that of a chest x-ray or an 8 - 12 hour airline flight which exposes you to some radiation from space.
you know, you cite all these trials but give no specifics. I dont think any of you guys have a clue. And if you want to convince us, then give some details about these studies.
The best process is no process
📜Roadmap - how to look young & feel strong: drstanfield.com/pages/roadmap
💊MicroVitamin (multivitamin & mineral that I take): drstanfield.com/products/microvitamin
TELL THEM DOCTOR !!!! I GET ALL THESE TESTS DONE, THANKS TO THE NATIONAL HEALTH SERVICE IN THE UNITED KINGDOM !!! PEOPLE FOR ALL THOSE WHO ARE WATCHING THIS IS A MOST EDUCATIONAL AND INFORMATIVE PIECE OF ADVICE COMING FROM A VERY GOOD MEDICAL PROFESSIONAL
The guide lines are manipulated by big pharma. Nonsense video
I will NEVER take statins again.....
@@orionxtc1119 What did the statins do to you?????? I am currently taking statins and my doctor says there are no problems and also I have no side effects
@@kofyadega5341 You are right as documented by high Lp(a) is good and low is bad the exact opposite of what this young kid says. "Remarkably, one-quarter of the centenarians had high Lp(a) serum levels even though they never suffered from atherosclerosis-related diseases." 1998 G. Baggio.
2012 article title: Low Lipoprotein(a) Concentration Is Associated with Cancer and All-Cause Deaths: A Population-Based Cohort Study (The JMS Cohort Study).
5 Main Blood Tests Recommended: #1 Lipoprotein Lp(a) #2 Cholesterol Panel (+ Apo B) #3 HbA1c #4 Kidney function (Sodium, Potassium, Creatinine) #5 Full Blood Count (CBC)
4 Additional Tests mentioned when there's a clinical purpose: #1 Liver function #2 Thyroid function #3 Micronutrients (e.g., Vitamin D levels) #4 Cancer Screening (e.g., for men the PSA test)
Vit D levels: essential
@@TheStudioManila Take enough per day, then the value will fit accordingly. It is sufficient to check once whether the target value can be reached or whether the body has problems absorbing vitamin D (but this is the exception)...
@@Balteumhow much do you take?
@@kasten8020 Vitamin D needs vitamin A (in addition to K2) in order to be as effective as possible. Taking vitamin A at the same time raises vitamin D levels much higher than taking vitamin D alone. I take 5000IE vitamin D with 200mcg K2 and 10,000IE vitamin A.
The tests:
1. Lp(a)
2. Cholesterol Panel
3. HbA1c
4. Kidney function
5. Full blood count
👍
plus 4 more tests that certain individuals should consider :-)
2. Cholesterol Panel includes apoB
Thank you!
This is very useful! Please do more videos like this!
I almost always feel better after watching these videos. The explanations are sobering and enlightening. Thank you, Dr. Brad.
Great information - compelled me to add Lp(a) to my annual blood work this year - my doc was resistant since I am at a healthy weight, no family history, excellent a1c, great blood pressure, lipid panel all in "healthy range" - so to my surprise my Lp(a) came back elevated at 53! Knowledge is power. I'll continue my healthy lifestyle but now consider medication to get my LDL to the more aggressive healthy range you've spoken about in many videos.
I agree CGMs probably aren't useful for clinics to make decisions, but I still think they're worthwhile for individuals trying to improve their hbA1c... My hbA1c was 5.4 and started creeping up. Getting a CGM for a month or so and using an app that tracked activities and meals and the corresponding effect on blood glucose was extremely useful for me to see immediately how my diet and daily activities affected my blood glucose... how what I ate, how I slept, and how I spent my days caused it to elevate or to stay stable in a healthy range.
Wearing a CGM for a month or so is useful to truly impart on an individual via instant feedback about how their daily routines affect their blood glucose for the better or worse, and so it's a useful accountability tool, much like weekly weigh-ins. It even gave me weekly averages, the causes of the biggest spikes, etc.
For example, for me, when I eat my favorite processed food, even in moderation, I would see my blood glucose spike to 180, despite having an otherwise whole-food plant-based healthy diet. It was the final push I needed to remove the last bits of processed foods from my diet... replaces that with some fruit and now my blood glucose maxes out at 130. Pushed that hbA1c back down to a 5 where it always was. The feedback from a CGM gave me the real-time data needed to convince me to avoid processed food like my life depended on it. 🙂
Presente desde Auckland, New Zealand. Gracias por compartir sus conocimientos!!!🎉
Did anyone ever tell you Medicare doesn't cover A1c testing unless you test pre-diabetic or diabetic? I looked it up and true. Something everyone should be tested for yearly, especially seniors.
Am going through the statin and LDL conundrum. Not sure what to do as the scientific explanation of inflammation and laying down of LDL in an attempt to heal arterial walls makes a lot of sense. I personally don't think LDL below 70 sounds healthy, but I'm on the fence. Cardiologist I went to didn't order ApoB. I asked for it and it was 104, high (s/b below 90, some say 75). He did order LP(a) and that was only 29. I would also add vitamins D and B12 to standard testing every year, liver panel and inflammatory markers like hs-CRP.
Unfortunately in the USA it’s the insurance companies that decide what tests you can get not your doctor. For example the last time I went to get bloodwork the lab told me that my insurance wouldn’t cover one of the tests ordered and if I wanted that test I had to pay $178. The price without insurance is often outrageous. Another test I asked about had a price of $400 without insurance. If my insurance allows the test the negotiated price was $12.
In other countries it is govt (ie NHS in UK) that decides what you can have. At least in the states you can elect to pay for it out of pocket
Simple solution = go private
Actually it's you that decides to get the blood test or not. Ask King Tut you can't take the gold with you to the Grave
I do a free annual checkup (basic blood test); for anything i curious about i use ULTALABS as often as i want ; prices are amazing and they often have 20% off (basic blood test $12.99, apoB around $30, etc) I purcase my tests there, than schedule convinieant for me appoitment at Quest Diagnostics - Done:)
OwnYourLabs allows one to order a set of tests online, print it out, and take it to a LabCorp location near you. I just got a battery of tests for $180. There are 4 or 5 states that don't allow this, the rest are good to go. Other companies out there too that do it as well. "walkinlabs" and "ultralabtests" are others.
There is a potential problem with the kidney function tests. The creatinine test is likely compromised in people who supplement creatine, which is the number one recommended supplement on this channel. It should have been at least mentioned.
(One solution is to stop creatine supplementation for sufficient time before the test, not sure for how long, but I would guess at least 5 days. Another option is to use a different test: Cystatin C.)
I really like listening to your accent 😃 as someone interested in linguistics.
So explain this to me then... I've had genetically high cholesterol all my life. So much so that every doctor basically begs me to go on statins, to which I always flatly refuse.
I'm also classed as a lean mass hyper responder, so if I do keto my cholesterol goes absolutely through the roof.
And yet essentially all of my other health markers are flawless, and I have low blood pressure and I've never smoked before.
A recent coronary artery calcium scan and carotid ultrasounds shows ZERO occlusion, and I've never had even a hint of a heart attack or other cardiovascular insufficiency at age 50.
And yet you would argue that I still need to lower my LDL.
I respect most of what you say but I completely disagree with this utter demonization of LDL.
It IS absolutely necessary to the body, and it IS the other things (such as inflammation levels of said cholesterol) that are the issue, NOT just the LDL cholesterol itself.
You, and most western doctors, seem to have this programming that "all humans are born with a statin deficiency".
@@ИванХаралампиев-э6иRe: 1 - So I have ZERO other signs of ill health, no symptoms whatsoever of heart disease, skin at 50 that looks like I'm 30, I'm ripped, etc ad nauseum... And you STILL wanna tell me I'm unhealthy SOLELY because of my LDL?
Re: 2 - I also have high HDL and very low trigs on keto - maybe ask first before assuming I don't.
You're asking about a niche group of people, where the data is only just being established. It doesn't apply for the masses. And the long term data for LMHR isn't there yet. You're probably alright, but we don't have the long term data. It still means that apoB/lipids is very relevant for most of the population. LMHRs really think the whole world is on keto, it's an echo chamber
Excellent, important and very informative Brad...thank you!
I would have added crp and esr... eGFR w/ creatinine (especially for CKD patients)....great list doc...i get the apo b, and the lipo (a) done every few years..mitigate Bsugar, and BP, stay away from the middle isles of the grocery store eat right and limit booze....seems to work for me.
No blood test will prevent anything. Yet, blood tests can show what one needs to address.
Great video as always!
I understand that the current research shows little effect of diet and exercise on lp(a), but I think that may be a function of the limitations of clinical research. As a personal anecdote I have blood tests showing a 63% reduction over the course of a year. Obviously I can’t say exactly what did it, but I did go from essentially no aerobic exercise to running 40 miles a week in that time. That’s a pretty extreme change in exercise that won’t show up in most interventions.
Very clear. Thank you.
Good that you explained the topic on false positives. Doctors not understanding this partially caused all of our covid struggles
We are still using this in our practice. The USPSTF recommends that adults aged 40 to 75 with a 10-year cardiovascular risk of more than 10% be screened for and treated for lipid disorders. For those with a 10-year cardiovascular risk of 7.5% to 10%, the USPSTF recommends selectively offering treatment.
It sounds like the studies are saying that if you naturally have lower LDL, you have a lower chance of heart disease. What I don't see in the studies is whether lowering the cholesterol of someone with high LDL will lower THEIR chance of having heart disease. This is the reason that the studies on statins do not show any real benefits in terms of like expectancy. This indicates to me that you need to determine why someone has high LDL and aproach it from that standpoint instead of artificially lowering their LDL through drugs which show no mortality benefit and ignore the real reason for the high cholesterol.
Low TG , High HDL are of themselves indicators of a higher percentage of large bouyant LDL. Also if these levels are optimal AND give a low TG/HDL ratio they indicate that there is not a a high level of small dense LDL particles present which are a major player in atherosclerosis. A global level of LDL does not tell the whole story. A lipid fractionation test tells a better story but is expensive. TG, HDL and their ratio give a good proxy for whether the LDL fractionation is "healthy" or not. Literature also suggests that people with optimal TG, HDL and TG/HDL ratio will gain no benefit from statin therapy in lowering LDL and may indeed be worse off due to potential side effects.
Risk tracks with ApoB particle number. Once you control for that, particle size loses statistical power in almost all studies looking at this question. It has also been proven to be an independent risk factor for CVD risk even after controlling for HDL and TG level. So Brad is correct in tracking global LDL levels.
@@karoshitv7506 Is there any information out there regarding the distribution of sdLDL and lbLDL when ApoB is reduced to low levels?
@@davidbarnes774 I haven't seen any studies specifically looking at such a population. However if there was residual risk associated with elevated sdLDL to lbLDL in the setting of low ApoB, then the studies I mentioned would have found that particle size still retained statistical power even after adjusting for ApoB particle number. Additionally, lbLDL still retains the ability to cross the arterial lumen via transcytosis and deposit cholesterol into the vessel wall. So even if the majority of one's subtraction of ApoB containing lipoproteins is large buoyant, there is still residual risk associated with such a phenotype if the ApoB particle number is high. In fact, individuals with Familial Hypercholesterolemia, which is a condition associated with early onset of heart attacks and strokes, have the vast majority of the LDL distribution consisting of the large buoyant variety.
@davidbarnes-BUT, what if, for example, one has a a hyper absorption of LDL. Even small amounts then could be cause for a potential problem. Factor in other potential risk factors, say, carbs, smoking, alcohol, HBP, etc and the LDL discussion is not about how low or how much, but what its effect in the context of these other issues. And what if one individual follows the guidelines for 2 drinks a day and is perfectly fine but another person slowly develops a damaged glycocalx? The second person will likely develop CVD even with normal LDL and even with an optimal HDL/ TRIG ratio. The major player then is context, not simply numbers and medical stats.
@@karoshitv7506 If possible can you post links to the studies that you have mentioned?
Great video thank you!
Thank you, Dr., such a great channel.
Does anyone in the U.S. know if Medicare will pay for these 5 tests?
What about toxin tests, nutrition- nutrient tests, food intolerance tests, and others that could determine what the 5 tests results are?
Speaking about the under 60 mg/dL LDL, you sometimes mention that you take low dose rosvustatin to reach that threshold. Is there any reason as to why low dose rosvustatin is preferable to ezetimibe monotherapy in cases where the patient already has great cholesterol levels but wants to push it below that 60 mg/dL level or either is fine? I know that the overwhelming majority of data shows that statins are safe, but there are those small effects on blood glucose and statins still scare me a little more than ezetimibe for being more systemic rather than just blocking absorption of cholesterol at the intestine level (although that intuition might be naive of me given the fact that ezetimibe does seem to have a few rare but dangerous side effects when looking at WebMD). Thanks for the great work!
ApoB is more important to know than LDL cholesterol, because it can diverge from LDL-C, so that you can have a relatively low LDL-C, but your ApoB number can be dangerously high. It's the ApoB particle that transports LDL-C in the blood, and when their number exceeds the body's physiological need, they can pass through the artery wall, and become trapped there and oxidized in that subspace of the artery wall, which is the origin of plaque formation. So, the emphasis should be on lowering the number of ApoB particles as much as possible. The longer ApoB is high, the greater the risk of heart disease. Diets high in saturated fat will increase LDL cholesterol in the blood causing the body to create more ApoB particles to transport it. Same with sugar. This is a subject with life and death importance. Above all, beware of doctors like Dr. Brewer and Dr. Berry who deny the role of LDL cholesterol and ApoB in causing heart disease. If you know that you have plaque, going on a high fat keto diet can kill you.
Did the PESA study just look at total LDL or did they look at fractionation analysis of LDL? I'll have a look at the study but I suspect that due to cost the breakdown of LDL particles was not done. In that case it would be surprising if very low levels of LDL did not reduce mortality. It may be that optimising the particle analysis in LDL is a better way to reduce risk than driving down LDL to very low levels especially if heavy medication use is required to do so.
Thanks for posting. Now I’m comparing what you recommend to what is commercially available.
So what do you do when you tried statins and reacted VERY badly to them? I was in constant pain inside and out, my blood sugars were completely uncontrollable, and my liver panel got (I quote precisely) "wonky." My cholesterol didn't budge. So I got ZERO benefit and every nasty side-effect possible (just like my Dad, BTW). Now what? Please will someone, anyone, discuss ANY alternative to statin therapy?
Bempedoic acid
Also ezetimibe and PCSK9 inhibitors (though those may be pricey)
sorry to hear about your reaction. The most 'gentle' statin is probably pravastatin 10mg taken at night.
Other options (that aren't statins) are Ezetimibe and PCSK9i. Bempedoic acid is also another option.
Strongly suggest you discuss the above with your doctor
@@larryc1616 Thanks, I will ask my doctor about that.
@@Greg_Chock Thanks! I will ask my doctor about that.
My ApoB is much closer to lower bound than LDL is. Can I ignore LDL and focus on ApoB?
Where do we get these tested
I was stunned to hear you say you are taking a statin. Have you looked at Red Yeast Rice as an alternative.
Omega3vsOmega6 saved my life. Willing to share the science and test anyone who is in the need.
Are you still on the finasteride as well? Do you take rapamycin? What other pharmaceuticals do you take?
would love to see a "what I eat in a day" video
Hi Dr Stanfield, my GF bought your micro vitamin and has an issue swallowing 5 pills, is it ok to empty them into a glass and mix the powder with water to drink it?
What about testing CRP? That is a good inflammation marker. Inflammation is a known indicator of health problems.
What are your thoughts re Dr Matthew J Budoff, Dave Feldman, Nick Norwitz (..et al) “Lean Mass Hyper-Responder” preliminary research study findings, published very recently in the J.A.C.C ?
Agree...there is new evidence that higher levels of LDL are not always harmful. Please address this.
For people on the keto diet and are LMHR... They maybe ok. We don't have long term data yet. But my view is that they are probably ok.
But 99% of the population is not on the keto diet. Nick and co are very specific about who their research applies to - they are careful to say it's LMHR on keto and not the general population
@@jj900 True. Thanks👍
So do we take statins
If so what milagram
I checked my HbA1c (hemoglobin - blood sugar) and it was at 7.6 which is too high and couldn't explain why. so I monitored with a sensor on my arm the levels. and I was always in the normal range. so why could be the HbA1c high but when I monitor 24/7 I'm fine?
Should lp(a) be rested regularly, or is one time enough?
If one takes creatine monohydrate, would this show up as elevated creatinine levels on the kidney function test?
My creatinine levels would always come back as elevated, so now I just go off creatine for two weeks before the test.
Yes mildly
Shouldn’t checking for uric acid ba part of regulat blood test?
What about the U-shape found by the 2020 cohort study in Denmark for LDL levels in all cause mortality?
Always check the papers exclusion criteria - did they exclude patients with established ASCVD or already on therapy due to their risk scores?
Wait wait wait… A test has a false result once in 10,000 tests, therefore of every 10 positive results 9 are incorrect???? Err, run that past me again. (Confused face emoji)
I already asked but never got a reply, why do you favor your medication (07:00) over red rice yeast ? It seems to have some really good effect and few/little negative effects
im 40 and my doctor said she would not recommend that PSA test for anyone under 60 and insurance would never pay for it
1) I have had many PSA tests, all of which had been covered by insurance. So, I would check into that.
2) I do not know when PSA screening should start, but I do know it does have some value in the 40's, 50s, and 60's.
The trouble is false positives, common to this test. It is after 70 that many experts recommend not doing this test.
Not below 60 as your doctor said. So, I would get a second opinion.
3) Do research on this subject; many doctors are behind the curve on the prostate. Good Luck.
If you live in the states you can either order your own individual tests through Ulta Labs OR you can pay for a package through Function Health, you get 112 biomarkers tested for $499. That’s what I do and can’t recommend enough.
Thank u for the valuable info!
What about HS-CRP? It is an inflammation marker and also related to heart problems. Thank u
There’s a recent study from AHA that hsCRP is a great bio marker for CVD risk especially for women. According to the study this is better than Apo(b) or Cholesterol.
@@nickalicious44 thx so much great!
My last Lp(a) result was 330 nmol/L 😅 it was 380 nmol/L before that and two years ago it was 246 nmol/L. It definitely changes but it’s always high. Since I can’t do anything about my Lp(a) number, I just avoid all things that raise my LDL/ApoB and try to keep those numbers as low as possible as well as my A1C and insulin.
"Remarkably, one-quarter of the centenarians had high Lp(a) serum levels even though they never suffered from atherosclerosis-related diseases." 1998 G. Baggio. You should be happy it is high as you will live a long time.
@@beepbeepnj2658 would you be happier with a quarter or 75 cents? That means that 75% of centenarians did NOT have high Lp(a). I will say despite my mom smoking and having high Lp(a) she has never ever had any problems with her heart or cholesterol, but she also stays away from butter and red meat and sticks to a Mediterranean diet. Her cholesterol is always under 90 and thankfully so because it’s done her good. She is 70 now.
What's worse Saturated fats or inflammation from seed oils/omega 6?
There’s zero, I mean zero evidence that “seed oils” cause inflammation. Someone made that up with no evidence to back it up and ran with it and now people with little education regurgitate it like it’s proven science. It’s not. However, there is copious research on saturated fats and those do cause a plethora of problems but people want to believe what they want to believe. This coming from a farmer who raises grass fed cows.
I checked my LDL and it is 138. how to lower the LDL? even when I have a good healthy diet already and regular excersice? even my body fat is very low with 8.5% I was surprised by this test result.
Read the conclusion of this study - pubmed.ncbi.nlm.nih.gov/33293274/
I have a diabetic HbA1C (6.4%), normal fasting glucose (94mg/dL), very low fasting insulin (4.4uUi/ml), normal HOMA-IR (1.0), normal weight (BMI 25) and I am lean (12% bodyfat). Then Why the heck does my HbA1C says I am almost diabetic when I am obviously not?
@@jackics6540 unfortunately I live in Canada and getting the appropriate tests and/or CGM is almost impossible.
I will have to keep thinking that it is due to my erythrocytes living longer than average, thus getting more glycated over time.
I live in Canada too and I bought a glucose metre for $35 to test my blood sugar at different times of day to observe if and when it spikes.
I wonder what happens to those high with LP(a) are to put on Rapamycin...
Doc what about elevated creatinine levels because of regular creatine supplementation? Shoud we stop taking creatine some time before doing a kidney test?
My creatinine levels would always come back as elevated, so now I just go off creatine for two weeks before the test. I also don't lift any weights for a couple of days prior, as my doctor said that could cause an elevated reading.
Test your cystatine C.
So with LP(a), you start off by saying that exercise and diet don't have much effect but then, if you have a high level, you need to control diet and exercise. I guess this is saying "a little is better than nothing"? But at the same time, it doesn't make me feel like it's an important test since any effect I can have on it will be minimal. If anything, it might just cause extra stress, knowing that there is a danger that I can have little impact on.
Depends on the person - it may make you take your exercise and diet more seriously. But it might make you anxious - depends on the person. Pre testing consent is important
If your Lp(a) is low then you need to raise it to protect the body from disease. 2012 article title: Low Lipoprotein(a) Concentration Is Associated with Cancer and All-Cause Deaths: A Population-Based Cohort Study (The JMS Cohort Study)
@@beepbeepnj2658 In the video, though, he starts off by saying that exercise and diet don't have much effect on it.
Does extended waterfasting (at a clinic) really clear soft plaque?
I've never heard of any evidence for that. Would be wary (I've done 5 day waterfasts in the past).
@@Greg_Chock how are your plaques lookn
@@whatthefunction9140 I don't know of any test that can even check for soft plaques so I don't know. that's why I would be wary of any claims that fasting would help.
Gene mutations teat ( mthfr…)?
The very best thing to do is not taking any unnecessary medication.
Always eat foods that contain at least 28 vitamins and minerals. And you will not have health problems, are at least, your organs, won’t suffer. But you might break your back. From an accident. And then only take meds that come from the pharmacy. Not illegal, that will kill you for sure!
P S no sugar!
Isn't there also a test for tumors?
9:00 , 12:02
Dr. Stanfield: Are there evident that high TSH is associated with high LDL (or total cholesterol) . If this is the case, should I take care of hypothyroidism first before taking statin for high LDL? Thanks.
You need to check for your T4 levels: high TSH and low T4 may indicate Hashimoto thyroiditis
tests like apoB is cheap. Why not get baseline levels if the cost is cheap. More data, the better.
Men: get a yearly psa test
Fasting insulin test is more important than a1c
No, the United States Preventive Services Task Force (USPSTF) does not recommend using lipoprotein (a) for cardiovascular risk screening.
the European atherosclerosis society does, which is what I quoted in the video :-)
Creatinine is not a good proxy for kidney function.
You most likely will not read this message, but I will write as if you would. While I agree with you in some of the topics you have mentioned and disagree in others, the case of vitamin D deserves a separate comment. Vitamine D testing is really vital and more cases than celiac, Chron or other issues. The latest guidelines are a joke. They intend to solve the problem of low vitamins D by no measure it. I am not a doctor, but I do have a brain and I know enough statistics and how the world works in terms of economic incentives to understand this is a very bad choice. If vitamin D is low in more than 70% of the population, the general recomendación cannot be do not supplement it. If anything, should be the other way around. I have not seen any other doctor that follows all the guidelines but you. It seems that you are doing it without enough critical thought. It does not matter whether you do a video or not about it if the video does not have your own reflection on the topic but it limits to repeat the results from studies or Cochran reviews. You are an intelligent person. You can do better. Some points to discuss: How was the healthy range defined? What happens if you are over 100? Is hypercalcinemia a problem that derives from those values always? What can you do to prevent that from happening? Are all forms of vitamins K2 the same? Are all forms of MK7 the same? Is 500 units per day enough for everyone? 1000? 10000? What is the effect of the pharmaceutical presentation?
You tend to oversimplify the problem if you do not ask yourself these questions and look for answers to all of them methodically and scientifically. I know a person who takes 10^5 units daily, without hypercalcinemia and more than doubles the upper limit. How is that possible? Do not throw this away saying that is an exception. Go deep to the biochemistry of the matter.
💖❤️🙏❤️💖
Wow!... :)
False, just need red meat, and eggs.
Careful with HgA1C interpretation, Hemoglobin A1c (HbA1c) targets can vary by age and other factors, and there isn't a one-size-fits-all target. HbA1c levels naturally increase with age, even for people without diabetes. For example, a 20-39 year old might have an HbA1c of 6%, while a 40-59 year old might have an HbA1c of 6.1%, and someone over 60 might have an HbA1c of 6.5%
Unfortunately HbA1c is in fact a one size fits all marker. The reason why it increases as we age is due to the fact that pancreatic beta cell function on average diminishes with age. Once A1c levels go above 5.7 into the prediabetic range, pancreatic beta cell mass has reduced on average by 50-70%, and once an individual reaches diabetic levels (6.5%) that number goes up to 90% beta cell loss.
Missing: Coronary artery calcification (CAC) test, the best predictor of a heart attack.
Is that the same as a CT calcium test?
That's a late stage finding. It's like waiting to see if lung cancer has developed before stopping smoking. Much better to address the heart disease risk factors now, than wait until calcium has built up in blood vessels
Late stage test.
Absolutely not. A Coronary CT angiogram is better. It shows calcified and non calcified plaque.
@@DrAJ_LatinAmerica Totally agree. CT calcium is a screening test and not a great one imo. Coronary CT angiogram is vastly superior, albeit it is a late stage test, but nevertheless useful if there is any suspicion of coronary artery disease or high risk there off. Modern 640 Slice CT scanners are extremely fast at acquiring very high quality images whilst minimising radiation exposure to that of a chest x-ray or an 8 - 12 hour airline flight which exposes you to some radiation from space.
you know, you cite all these trials but give no specifics. I dont think any of you guys have a clue. And if you want to convince us, then give some details about these studies.