As a Clinical Pharmacist, I really value his superb evidence based content AND I know that in time he WILL get the millions if subscribers. Also he is so good yet SO humble!
Gil, you are a wonderful human. Your compassion and skills are so deeply appreciated! I'm glad you exist and have found your purpose. We are lucky to have you spreading ways to health.
I always knew I had a high susceptibility to heart disease, family history, high blood lipids, borderline high blood pressure and an A1C that was high normal. I tried several statins with terrible side effects, so I have been on a WFPB SOS free diet for many years. It helped my lipids, but they were always still above normal. I kept my bmi at 20, and exercise daily. But at 69 it caught up with me! 3 weeks ago I had a big heart attack, fortunately, I got to the hospital quickly and with a wonderful cardiologist I had 4 stents placed and removal of a large blood clot. I’m starting to feel better now, I can take slow walks, and do housework and cooking. I’m doing well on a new statin that doesn’t cause me pain, and Zetia, blood thinners and beta blockers. And I’m feeling pretty grateful to still be here. I’m embracing modern medicine and hope to get some more years ahead of me. I just want to say lifestyle for some of us won’t get us into old age. But it’s probably going to help me get back to a normal life again quickly. ❤️
@@carlbernngl I was vegan for 10 years, but WFPB, SOS free for 7. I haven’t eaten red meat for 35 years, and was mostly on a low fat diet for 30 years ever since I read Dean Ornish’s work. I was also a nurse so I understood what my lipids and family history meant. I’m feeling pretty lucky to be here now. I’ve been able to find some statins that I can tolerate and now I’m on blood thinners and beta blockers. But I learned the hard way, that for some of us, diet alone isn’t a sure thing. But I still follow the WFPB SOS free diet too.
Yeah, how can people expect to undo a lifetime of damage within a few years? Plus, some of us are cursed with terrible genetics. CVD runs in my family. I'm vegan for ethical reasons, and I am not SOS-free; I don't eat processed stuff, and that's about it. I like vegetable oils (such as olive oil); they make me glow (weird, right?). I almost wrecked my liver with a terrible sedentary lifestyle. I went SOS-free for 4 weeks and walked for 1 hour a day, and things are back to normal. My SGPT went from 70 to 16 (I was shocked). But since I'm really young (18), I think I can change and be in better health than most who choose to change at a later stage in life..
Why doesn't this channel have at least a million subscribers? We need to spread the word people and end all the B.S. we're being put through from most nutrition influencers.
Hey Gil! Thank you for your content. I just wanted to give you a little tip coming from someone who’s a sound engineer and who consumes your content mostly on earphones or in the car. You might want to compress your voice a bit to reduce the dynamic range. Currently, there are some quiet parts and some dramatic spikes in volume when you speak louder. This makes it a bit challenging to listen to comfortably, as I have to keep the volume low to avoid the louder parts hurting my ears. A little compression can help balance out the volume levels, making your videos more enjoyable for listeners in varying environments. Thanks again for all the valuable information you provide!
Love the suggestion. Nothing ruins wonderful info more than improperly functioning/flowing sound. In case Gil does not know how to easily and quickly fix this (as i wouldn't), are you able to instruct at all? I'm not making any assumptions on behalf of Gil, at all, but just in case Gil doesn't have the time or the immediate fix, is it something you can easily relay in a general way that could be applied to any setup? Thanks for sharing your audio skills.
@@NutritionMadeSimple Hey Gil. You can use the free program "Audacity" to do so (there may also be other quicker options depending on the editing software you're using). There are plenty of tutorials on TH-cam, but it can be difficult to apply if you're new to audio processing. I would be happy to assist if you are interested and need help. It's also possible the sound engineer has better suggestions :)
@@NutritionMadeSimple my suggestion would be to install Logic Pro if you’re on mac or cubase if you’re on PC. Then get an audio guy to create you a template session with a good voice mix. All done with native compression and EQ plugins. Then, when you shoot a video, when you’re done recording your voice, just drop the audio file in the session and export in wav 24 bit 48.000 hz. You might want to ask the audio guy how to do this. Then, import the track in your video editing software. With a bit of practice, it could take you 1 minute to do it.
This video really cleared it all up for me. I never fully understood how all the things fit together to better control my outcome because I have a ton of genetic risk and family history risk. Thank you Dr. Carvalho
I have a high calcium score, I found out from a X-ray of my hip that showed calcium in my arteries. Besides that’s in good health for a 67 year old man. I love your videos cause it grounds me and gives me HOPE
I love this video! It is such a clear explanation of the basics of atherosclerosis, it is like the clouds have finally parted! I now "get" the importance of ApoB, yay! Thanks so much, Gil. As a layman who is interested in nutrition and disease prevention, I find your videos incredibly helpful. Thank you, thank you!!
This is the best explanation of this topic that I have come across. The emphasis on the many factors that contribute to heart disease is refreshing and enlightening. It's clear to me now that treatment is a very personal issue. There is probably not a one size fits all treatment for all people. Thanks for making this video.
He also has other videos you may be interested about. cholesterol, ApoB, LDL size: th-cam.com/video/3sSEKceB0bw/w-d-xo.htmlsi=iaFQLuEgullnN5fa th-cam.com/video/18FF4pYLxek/w-d-xo.htmlsi=4URZ0McDptZwIwps th-cam.com/video/NUTvzuDphmg/w-d-xo.htmlsi=dagj2HH_Jnh2FaGd High LDL with high HDL th-cam.com/video/Xt1fEB4cQpc/w-d-xo.htmlsi=NFmgpK20PuyCcsp2 Ratios th-cam.com/video/0dLzKwOrr8Q/w-d-xo.htmlsi=UfGXJ3Cz7op_gZ0B Saturated fats, seed oils and cardiovascular threats th-cam.com/video/mBFe1QattAU/w-d-xo.htmlsi=oPsEUlBWulHHZ6kS Low carb diet in heart health th-cam.com/video/UFamJhtV4a0/w-d-xo.htmlsi=Yg4pvO5yRIsKumtp Coronary Calcium Score (CAC) th-cam.com/video/gxIeRUbHauw/w-d-xo.htmlsi=gjtil7OUVlQ1DLS3 Seed oils again th-cam.com/video/_VwDZVbfrKo/w-d-xo.htmlsi=vIrLbWwTVWFlEvhp Triglyceride levels th-cam.com/video/-B8ybQ-L264/w-d-xo.htmlsi=F8-RhSKZjkHtj4NK Nexlatol effect on CVD risk th-cam.com/video/597VGPQS-ko/w-d-xo.htmlsi=FlpIEUhysNSdq4sS Plaque forming in arteries vs veins th-cam.com/video/0u0K97ty8xs/w-d-xo.htmlsi=ejBPk0gJnHoeQ-Qo Canola oil specifically th-cam.com/video/M8tzaXQH1G4/w-d-xo.htmlsi=UnGm1PrynJ8OtUKo Cholesterol th-cam.com/video/exIP2NdGLsw/w-d-xo.htmlsi=FDb3bVtXtDhWq1HT Relation of IR with heart disease th-cam.com/video/pcp_uKo-wwM/w-d-xo.htmlsi=TNvOLX0EnS485rf_ Causes of heart disease th-cam.com/video/IwzNnUhqUzc/w-d-xo.htmlsi=czcnMIxE6VGd-4N1 Exercise to reduce plaques th-cam.com/video/ucCIS0DxXOg/w-d-xo.htmlsi=i7m-kkGg_U4cxi22 LDL size & heart disease th-cam.com/video/kplh30RmYo8/w-d-xo.htmlsi=MRfnrHhnyVhxxZHq The French Paradox th-cam.com/video/tXJ8eo3P0V8/w-d-xo.htmlsi=5XiOdKN9hh2rq99Q Since how long heart disease plagues humanity th-cam.com/video/EiqYmbZIBEY/w-d-xo.htmlsi=0pgLVD39_P2u3-6E High Protein diet effects on heart disease th-cam.com/video/1OnXZFlPm0g/w-d-xo.htmlsi=eXy82ORNpkmzxpu7 Oils vs. nuts th-cam.com/video/rvawEvNLbUM/w-d-xo.htmlsi=eIJKwCkv_Ggl--wZ TMAO th-cam.com/video/kkE31Gc06W4/w-d-xo.htmlsi=yNz2wod3t4m3jafS Fish oil th-cam.com/video/PzunyCl4moA/w-d-xo.htmlsi=Ifqac_CszRqlRrPT And this one. Since of these are in depth interviews with some of the best experts on their respective fields!
Love this - clear with great analogies...with one tiny exception - bullets of course don't contain gunpowder... they are lumps of metal launched using gunpowder. The cholesterol is the metal inside the bullet. Some bullets are big and heavy, some smaller and lighter (some may contain more complex structures inside the jacket etc) - but I'll be sharing the video as overall it is excellent and everyone could learn a lot from it.
Another great video Gil. You are really a shining light in the dark tunnel of so many of other health videos, especially on this topic. Hope all is well...
This is the perfect illustration for cholesterol deniers... They see valid evidence that factors impacting metabolic health have an impact on heart disease (e.g. trig/HDL ratio as a loose proxy for insulin sensitivity) and they insist that is the ONLY factor, thereby failing to see that two things can be true at the same time. Metabolic factors MODIFY risk, and sometimes with great effect, but there is still an underlying etiology that involves ApoB in a causal chain based on exposure over time.
I’ve been watching your videos over the last few years and just want to let you know how useful I find your content. It’s very difficult to find diet information (besides reading articles from the top university journals). Whenever I get confused or feel like I’ve forgotten key aspects that make up a healthy lifestyle, I always come back to your channel to re-educate myself.
I loved this simplification of a very complex problem. Normally I am drawn to your videos because of your focus on scientific studies and analysis of same. This was a departure, but so good at synthesizing complex ideas.
This is the best health related vid I have ever seen 🔥🔥🔥🔥 Doc Gil is just a pro explanator of difficult things in simple words. Moreover, that is scientific based ❤❤
Excellent review and useful summary of what to expect as well as anything one can do to lower the risks of CVD's. Your contents are always very fact-based as well as insight drawn from well researched sources
An exceptional video that has made a lot things clearer for me. As usual great content that's enlightening and easy to understand. Love the unifying concepts of bullets vs barrier and the interplay between the two. Given that I'm someone who didn't win the genetic lottery this has put me at ease in managing my risk. At age 74 arterialscherosis is now real in my life. One can only work on the best strategies to mitigate it and do the best you can.
Hi Doctor Carvalho! I want you to know how much I appreciate the evidence-based approach you take to your videos. In a world where others shout their pet theories and diets from the rooftops, a voice like yours is sorely needed. Your channel is the home of sober second thought, the Senate of TH-cam. It's not that there's nothing to what these others say. Much or most of it is supported by evidence, but they will casually mention that high cholesterol is good without attribution, for example. They say the best lie is hidden between two truths. I'm not necessarily suggesting that these others are malicious, but we need to be cautious about applying things we hear from the internet to our own lives. In this you are very helpful. Your channel is severely underrated by my way of thinking, but thanks for doing all this. Cheers from Canuckistan!
We can’t control our genetics, but we should still be conscious of if we are at higher risk of certain diseases because of our genetics so that we can ensure we are doing everything possible to reduce our risk.
Would love a discussion re gender differences. Isn’t the efficacy of statins quite a bit lower for women, and, if yes, then why? The menopause transition dramatically raises LDL, thereby creating dyslipidemia. Does the increased need for cholesterol in estrodial production play a factor? Should it be treated differently given the difference in causation? Really appreciate your ability to tactfully clarify and then create synopses of complex issues!! Thank you!!!
I agree about estrogen which is why I don't understand why so many Dr's think hrt is more of a risk for women over 65. I'm no Dr but I just think common sense says hrt would outweigh the risk for many woman when it comes to the brain, heart and bones.
the reason cholesterol goes up after menopause is because it's used to make sex hormone and it is no longer doing that. I don't worry about it but my friends my age are all being told to eat low fat by their doctors. it's ridiculous. the main thing after menopause is don't overeat - stick to energy requirements, and exercise a lot. fat itself isn't going to 'cause' a heart attack when eating within a calorie controlled energy intake. it's so important to ditch the extra junk and know your calories after menopause. no one talks about energy intake - they just say 'switch to low fat milk and limit animal fats' but the low fat stuff (carbs) cause terrible health issues when consumed to excess - the limit should be on refined carbs!!!
Diet plays a high role in protecting the endothelial layer. After moving to a whole plant-based diet and having had 3 CT angiograms, the evidence is clear to me that a healthy play is going on, resulting in vessel dilation and a widening of the artery wall.
I have compiled a family tree and my mother’s parents and most of her six siblings died from heart disease at early age 60s. I have very high lp (a), genetically determined. Now I know why they all died so young.
It is why statistics should be taught in HS & must pass to graduate. The scientific methods should also be mandatory, as much as history or humanities.
While I'm a person that can't get enough statistics, there are some people who not only don't get it, but don't have the ability to. They're the ones who I'm more likely to bring the beautiful music and art into our lives. Fortunately the analogy that Gil has provided is helpful for those people.
I like that you point to the scientific methods plural, because there are multiple methods. For example, a paleontologist typically can’t run an experiment in the same way a physiologist would on a living species…
Once again an awesome video, Dr Gil, thank you so much! ( 3:56 Not important for the message… but for the bullet/ApoB analogy, bullets that have been fired don’t actually have any gunpowder in them!)
Nice simple model that would be useful for those less inclined to dwell into the biochemistry mechanics of it all. My one criticism is with respect to diet. Diet IMO is the easiest and most impactful factor people can manipulate before a cardiac event happens. In this factor for those on a Western diet, the most critical item is Sugar (fructose) which is the worst component of a high carbohydrates diet. Fructose consumption directly impacts food cravings, fat storage, hunger (hunger and cravings have two different mechanisms), higher blood pressures (Increase Uric Acid which directly correlates to BP), glucose/insulin rollercoaster... Increase Sugar/Fructose consumption (Which also impacts other Carb consumption) directly tracts with increased rates and severity of most chronic diseases impacting folks in the West since the 1890s when consumption amount began increasing and spreading. Then in the 1970 with the creation of High Fructose Corn Syrup, and even cheaper form of Sugar, we are where we are at today. Cheers
Thankyou. That was a really usefull mental model that allows understanding of complex, interacting factors. [Note: I made an edit from useless to the correct word, "useful". I am unclear how auto-incorrect can change "useful" to "useless", but it did.] Maybe it would be additionally useful to explicitly discuss oxidative stress as a major domain weakening the bullet barrier? This would allow consideration of contributors such as obstructive sleep apnea, antioxidant poor diets, low vitamin D, dysbiosis, pollution (PM2.5), etc. Chronically elevated ROS levels (and factors that prevent this) can be discussed in terms of platelet activation (etc) contributing to contractile smooth muscle cell (SMC) activation -> migratory/ secretory SMCs that migrate to the intima and synthesise proteoglycans. Which, then allow 'capture' of postprandial remnant cholesterol. As the presenter mentioned, generalised inflammation, contributing to arterial plaque formation, is a major domain negatively affecting the bullet wall. One of my lifestyle pathways is determining whether I should use statins. I am aware of studies showing U-shaped all cause mortality curves with a minimum around ~ 3.6 mmol/L (140 mg/dL). My current research is to determine if ... with a CAC score of 1, normal BP, a diet mostly rich in antioxidants, vitD3/K2 (mk5&7) supps, exercise (resistance & walking), gly/NAC to boost glutathione, and good cholesterol (except LDL-C = 135 mg/dL) and apoB levels, intermittent fasting to reduce postprandial remnant cholesterol 'exposure, and now, also reducing exposure to PM2.5 and toxic people ... should I avoid statins. My understanding is that statins certainly have multifactorial benefits for at risk people. But, if the underlying factors leading to arterial inflammation and plaque formation are well managed, does taking statins then result in greater risks e.g. cancer) associated with low LDL-C? Fat and cholesterol are essential for good health. My current view is to avoid statins? Either way, I guess I am betting with my statistical life :)
Wow, I (or you) must be psychic because I was just about to suggest to you that you do a comprehensive overview of how the different risk factors for heart disease fit together, because I was confused as to how diabetes or blood glucose levels was a risk factor when Apo B was the thing that actually caused atherosclerosis. This video answered that. 👍
Ok I am going to put a rave comment on this one because literally if it's not one of the first nutrition videos to really discuss a prior, I can't remember what one was. The thickness of the barrier. So let's redo the model: we have tests, find out what each person can 'get away with' and focus on the ones with the weak barriers, and stop screaming at everyone as if they have weak barriers, even though you don't know.
this is all you need to be in good health : eat a balanced healthy diet exercise sleep regularly take care of your mental health - stress lower substance abuse be surrounded with loved one do you consider something more ?
@@AliceFarmer-bg4dw balanced diet means not eating too much food or too little and a variety of food so you can get all the vitamin and minerals balanced also mean not highly processed
Great video! You said losing bodyfat effects both the components... Do you know if the effects are linier, ie going from 20% bodyfat down to 15% will be the same as 15% down to 10%? Or do the effects (improvements) start to taper off the lower your bf % goes?
Thanks to your videos, I was tested and found I have very high ApoB and am now taking a statin and diet measures. You may have saved my life! Thank you! Would you mind explaining cholesterol in fish? Is it good cholesterol or are the omega 3s so helpful it makes eating fish worthwhile?
The importance of cardiovascular health cannot be overstated, and three critical exams play a pivotal role in assessing and managing heart disease risk: the CT Angiogram, CIMT, and Calcium Score. CT Angiogram (Coronary Computed Tomography Angiography - CCTA): This non-invasive imaging test provides detailed pictures of the coronary arteries. It helps in detecting blockages or narrowing in the arteries, which can lead to serious conditions such as heart attacks. By visualizing the coronary arteries, doctors can make informed decisions about the need for further intervention or treatment. CIMT (Carotid Intima-Media Thickness): CIMT measures the thickness of the inner two layers of the carotid artery. Increased thickness can indicate a higher risk of cardiovascular events like stroke and heart attack. This test is crucial for early detection of atherosclerosis, allowing for timely preventive measures. Calcium Score (Coronary Artery Calcium Scoring): This test quantifies the amount of calcium in the walls of the coronary arteries. A higher calcium score is indicative of a higher risk of coronary artery disease. By identifying the presence and extent of calcified plaque, healthcare providers can better stratify patients' risk and guide treatment to prevent cardiac events. Together, these exams offer a comprehensive assessment of cardiovascular health, enabling early intervention and tailored treatment strategies to improve patient outcomes.
Dr William Cromwell (on the podcast with TheProof) said that in fact apo-b lipoproteins enter AND exit the artery wall by transcytosis (probably the incorrect spelling). Thus, the body wants them to pass through. The issue seems to be that some of them somehow get oxidized and as a result are unable to be transported out again. This is very different from Dr Dayspring’s description of apo-b ‘crashing into the artery wall’. If Dr Cromwell is right, then working out how they get oxidized might be a better way of preventing CVD
Thx Gil for the info. If someone asked you if a 7 month old baby was just beginning to eat things like eggs, what would you recommended the egg should be fried in? They currently fry in ghee (Saturated Fat) I’m sure that’s not the right thing for a baby based on clinical evidence, but just wanted ur thoughts on this.
Althought the video was published today, they must have been working on it for days. And he was thinking of that analogy for weeks or months. Still... what a coincidence.
The most unfortunate thing we dont have reliable diagnostic for plaque that is not invasive! We need better more clear reliable methods to diagnose measure observe this
Ive just discovered at the age of 35 that i have Multivessel Coronary Artery Disease. To say I am terrified would be an understatement. I have already switched to WFPB, stopped the smoking etc. The occlusion is 25-40% in 3 arteries. 30-40% in 2 and less than 25 in another. I am hoping that while I cannot turn back time I can do what I can to fight this. But I am not feeling very confident. I will get Apob tested, I am in Portugal if anyone can recommend any good lipidologists or any advice in general. Thanks Dr Gil
I recently had my bloodwork done, and I was shocked and disappointed at my cholesterol and ApoB levels. They were "good." They were all at what would be considered baseline. However, considering everything I do to keep those levels low, I was disappointed that my numbers were just at baseline good. I've been on a high fiber plant-based vegan diet for 5 years (no vegan junk food), I take Omega-3, psyllium husk, beta glucan supplement, soy protein isolate, I weight train 5 days a week and do a two mile walk on the other two, but my levels were just at baseline. My doctor said, "Well, imagine how bad it could be if you didn't do all that." He's right, and I know he was trying to make me feel better 😂. As of now, he says there's no need to take a statin, but we'd keep monitoring. I'm kind of bummed out how much genetics play into it. All my other risk factors were good, except my red blood cell count was high, but I've always known that about my family history and donate blood every 3 months.
You made a fantastic video about alcohol and mandelian randomization, explaining imo very clearly where our level of knowledge is right now. I would personaly love to see a video around the topic of training and heart disease. It sounds like a straight forward thing, but training is actually associated with both sudden cardiac arrest and heart fibrillation. So what do we actually know on the impact of training on different metrics of heart health, perhaps beyond associative studies?
Hi Gil, I have a question. I have a family member who claims their diet and lifestyle gives them a very low risk of heart disease and MACE. However, when I shot them with several bullets as per your model, they still experienced severe negative health outcomes. Is this to be expected, or do you think they are some kind of outlier? Unfortunately, I'm having trouble finding additional volunteers to repeat this experiment with.
Fully active matrix gla protein protects the arteries from plaque build-up. To understand how it works, is to know that mgp is found in mice too. Researchers knocked out mgp from mice. They all died within 6 to 8 weeks of age. They all had arteries constricted by plaque and many had burst arteries.
TIny nitpicker comment: there are some risks that are 100%, my example would be mesothelioma. 4 grains on an X-ray gets you a stage 4 diagnosis. Some people last 20 years (Stephen Jay Gould) some go down in a few years (Warren Zevon), but nobody escapes it.
Is the penetrability of the arterial wall from lipoproteins associated with the stability of the glycocalyx and/or junctions for the endothelial membrane or is it something else? Because i want the understand the arterial wall resistance on a molecular level.
it affects metrics like LDLc and HDLc but actual risk has not consistently been seen to improve. Idk if that FDA status will change or not. there may be controversy
I do not understand why you do not have millions of subscribers. Such high quality, valuable, health-promoting content! Sending love from Texas ❤
Because sensationalism sells, especially on the internet. Theres a natural and sad tradeoff between quality and popularity.
@@mikechang6737 sadly, so true
He does not have the number of subscribers because he's not trying to tell people to only eat saturated fats like the influencers do.
As a Clinical Pharmacist, I really value his superb evidence based content AND
I know that in time he WILL get the millions if subscribers.
Also he is so good yet SO humble!
@@19111959 right, the terrible signal to noise ratio on YT means it will take time, because those who want his type of content are picky.
Gil, you are a wonderful human. Your compassion and skills are so deeply appreciated! I'm glad you exist and have found your purpose. We are lucky to have you spreading ways to health.
Agree with every word you stated. Dr. Gil Carvalho is saving lives by explaining TRUTH about health and nutrition.
I always knew I had a high susceptibility to heart disease, family history, high blood lipids, borderline high blood pressure and an A1C that was high normal. I tried several statins with terrible side effects, so I have been on a WFPB SOS free diet for many years. It helped my lipids, but they were always still above normal. I kept my bmi at 20, and exercise daily. But at 69 it caught up with me! 3 weeks ago I had a big heart attack, fortunately, I got to the hospital quickly and with a wonderful cardiologist I had 4 stents placed and removal of a large blood clot. I’m starting to feel better now, I can take slow walks, and do housework and cooking. I’m doing well on a new statin that doesn’t cause me pain, and Zetia, blood thinners and beta blockers. And I’m feeling pretty grateful to still be here. I’m embracing modern medicine and hope to get some more years ahead of me. I just want to say lifestyle for some of us won’t get us into old age. But it’s probably going to help me get back to a normal life again quickly. ❤️
How long did you stay on the WFP diet?
@@carlbernngl I was vegan for 10 years, but WFPB, SOS free for 7. I haven’t eaten red meat for 35 years, and was mostly on a low fat diet for 30 years ever since I read Dean Ornish’s work. I was also a nurse so I understood what my lipids and family history meant. I’m feeling pretty lucky to be here now. I’ve been able to find some statins that I can tolerate and now I’m on blood thinners and beta blockers. But I learned the hard way, that for some of us, diet alone isn’t a sure thing. But I still follow the WFPB SOS free diet too.
Yeah, how can people expect to undo a lifetime of damage within a few years? Plus, some of us are cursed with terrible genetics. CVD runs in my family. I'm vegan for ethical reasons, and I am not SOS-free; I don't eat processed stuff, and that's about it. I like vegetable oils (such as olive oil); they make me glow (weird, right?). I almost wrecked my liver with a terrible sedentary lifestyle. I went SOS-free for 4 weeks and walked for 1 hour a day, and things are back to normal. My SGPT went from 70 to 16 (I was shocked). But since I'm really young (18), I think I can change and be in better health than most who choose to change at a later stage in life..
Why doesn't this channel have at least a million subscribers? We need to spread the word people and end all the B.S. we're being put through from most nutrition influencers.
I know. it's insane. I learned so much.
Hey Gil! Thank you for your content.
I just wanted to give you a little tip coming from someone who’s a sound engineer and who consumes your content mostly on earphones or in the car.
You might want to compress your voice a bit to reduce the dynamic range. Currently, there are some quiet parts and some dramatic spikes in volume when you speak louder. This makes it a bit challenging to listen to comfortably, as I have to keep the volume low to avoid the louder parts hurting my ears.
A little compression can help balance out the volume levels, making your videos more enjoyable for listeners in varying environments.
Thanks again for all the valuable information you provide!
Love the suggestion. Nothing ruins wonderful info more than improperly functioning/flowing sound. In case Gil does not know how to easily and quickly fix this (as i wouldn't), are you able to instruct at all? I'm not making any assumptions on behalf of Gil, at all, but just in case Gil doesn't have the time or the immediate fix, is it something you can easily relay in a general way that could be applied to any setup? Thanks for sharing your audio skills.
@@jayalexandertilley Gil doesn't know how!! :)
@@NutritionMadeSimple Hey Gil. You can use the free program "Audacity" to do so (there may also be other quicker options depending on the editing software you're using). There are plenty of tutorials on TH-cam, but it can be difficult to apply if you're new to audio processing. I would be happy to assist if you are interested and need help. It's also possible the sound engineer has better suggestions :)
@@NutritionMadeSimple my suggestion would be to install Logic Pro if you’re on mac or cubase if you’re on PC. Then get an audio guy to create you a template session with a good voice mix. All done with native compression and EQ plugins.
Then, when you shoot a video, when you’re done recording your voice, just drop the audio file in the session and export in wav 24 bit 48.000 hz. You might want to ask the audio guy how to do this.
Then, import the track in your video editing software.
With a bit of practice, it could take you 1 minute to do it.
@@NutritionMadeSimple Audacity is amazing and free
This video really cleared it all up for me. I never fully understood how all the things fit together to better control my outcome because I have a ton of genetic risk and family history risk. Thank you Dr. Carvalho
We're so lucky to get these valuable information from an actual doctor for free. Thank you so much Doctor.
I have a high calcium score, I found out from a X-ray of my hip that showed calcium in my arteries. Besides that’s in good health for a 67 year old man. I love your videos cause it grounds me and gives me HOPE
I love this video! It is such a clear explanation of the basics of atherosclerosis, it is like the clouds have finally parted! I now "get" the importance of ApoB, yay! Thanks so much, Gil. As a layman who is interested in nutrition and disease prevention, I find your videos incredibly helpful. Thank you, thank you!!
Love the analogy. This one of your best videos.
This is the best explanation of this topic that I have come across. The emphasis on the many factors that contribute to heart disease is refreshing and enlightening. It's clear to me now that treatment is a very personal issue. There is probably not a one size fits all treatment for all people. Thanks for making this video.
He is always like this. No BS, to the point, started clearly and add simple as possible.
He also has other videos you may be interested about.
cholesterol, ApoB, LDL size:
th-cam.com/video/3sSEKceB0bw/w-d-xo.htmlsi=iaFQLuEgullnN5fa
th-cam.com/video/18FF4pYLxek/w-d-xo.htmlsi=4URZ0McDptZwIwps
th-cam.com/video/NUTvzuDphmg/w-d-xo.htmlsi=dagj2HH_Jnh2FaGd
High LDL with high HDL
th-cam.com/video/Xt1fEB4cQpc/w-d-xo.htmlsi=NFmgpK20PuyCcsp2
Ratios
th-cam.com/video/0dLzKwOrr8Q/w-d-xo.htmlsi=UfGXJ3Cz7op_gZ0B
Saturated fats, seed oils and cardiovascular threats
th-cam.com/video/mBFe1QattAU/w-d-xo.htmlsi=oPsEUlBWulHHZ6kS
Low carb diet in heart health
th-cam.com/video/UFamJhtV4a0/w-d-xo.htmlsi=Yg4pvO5yRIsKumtp
Coronary Calcium Score (CAC)
th-cam.com/video/gxIeRUbHauw/w-d-xo.htmlsi=gjtil7OUVlQ1DLS3
Seed oils again
th-cam.com/video/_VwDZVbfrKo/w-d-xo.htmlsi=vIrLbWwTVWFlEvhp
Triglyceride levels
th-cam.com/video/-B8ybQ-L264/w-d-xo.htmlsi=F8-RhSKZjkHtj4NK
Nexlatol effect on CVD risk
th-cam.com/video/597VGPQS-ko/w-d-xo.htmlsi=FlpIEUhysNSdq4sS
Plaque forming in arteries vs veins
th-cam.com/video/0u0K97ty8xs/w-d-xo.htmlsi=ejBPk0gJnHoeQ-Qo
Canola oil specifically
th-cam.com/video/M8tzaXQH1G4/w-d-xo.htmlsi=UnGm1PrynJ8OtUKo
Cholesterol
th-cam.com/video/exIP2NdGLsw/w-d-xo.htmlsi=FDb3bVtXtDhWq1HT
Relation of IR with heart disease
th-cam.com/video/pcp_uKo-wwM/w-d-xo.htmlsi=TNvOLX0EnS485rf_
Causes of heart disease
th-cam.com/video/IwzNnUhqUzc/w-d-xo.htmlsi=czcnMIxE6VGd-4N1
Exercise to reduce plaques
th-cam.com/video/ucCIS0DxXOg/w-d-xo.htmlsi=i7m-kkGg_U4cxi22
LDL size & heart disease
th-cam.com/video/kplh30RmYo8/w-d-xo.htmlsi=MRfnrHhnyVhxxZHq
The French Paradox
th-cam.com/video/tXJ8eo3P0V8/w-d-xo.htmlsi=5XiOdKN9hh2rq99Q
Since how long heart disease plagues humanity
th-cam.com/video/EiqYmbZIBEY/w-d-xo.htmlsi=0pgLVD39_P2u3-6E
High Protein diet effects on heart disease
th-cam.com/video/1OnXZFlPm0g/w-d-xo.htmlsi=eXy82ORNpkmzxpu7
Oils vs. nuts
th-cam.com/video/rvawEvNLbUM/w-d-xo.htmlsi=eIJKwCkv_Ggl--wZ
TMAO
th-cam.com/video/kkE31Gc06W4/w-d-xo.htmlsi=yNz2wod3t4m3jafS
Fish oil
th-cam.com/video/PzunyCl4moA/w-d-xo.htmlsi=Ifqac_CszRqlRrPT
And this one.
Since of these are in depth interviews with some of the best experts on their respective fields!
Love this - clear with great analogies...with one tiny exception - bullets of course don't contain gunpowder... they are lumps of metal launched using gunpowder. The cholesterol is the metal inside the bullet. Some bullets are big and heavy, some smaller and lighter (some may contain more complex structures inside the jacket etc) - but I'll be sharing the video as overall it is excellent and everyone could learn a lot from it.
Thanks Gil, for your simple interpretation, listening to you was time well invested!
Another banger. What a treasure! Thanks Dr 🙏
Another great, informative and educational video. This good doctor rocks!!
Another great video Gil. You are really a shining light in the dark tunnel of so many of other health videos, especially on this topic. Hope all is well...
Thanks Gil. I'll be using this analogy with my diabetes groups. Love a good analogy!
You explain everything so well. Thank you!
Great video! Very helpful, especially for those who are just entering the field of health self-improvement.
This is the perfect illustration for cholesterol deniers... They see valid evidence that factors impacting metabolic health have an impact on heart disease (e.g. trig/HDL ratio as a loose proxy for insulin sensitivity) and they insist that is the ONLY factor, thereby failing to see that two things can be true at the same time. Metabolic factors MODIFY risk, and sometimes with great effect, but there is still an underlying etiology that involves ApoB in a causal chain based on exposure over time.
Probably the best analogies I've ever heard on the subject - great stuff
I’ve been watching your videos over the last few years and just want to let you know how useful I find your content. It’s very difficult to find diet information (besides reading articles from the top university journals). Whenever I get confused or feel like I’ve forgotten key aspects that make up a healthy lifestyle, I always come back to your channel to re-educate myself.
Great analogy
presentation. Thank you Dr Gil glad you’re out there clarifying all the noise!!!
I loved this simplification of a very complex problem. Normally I am drawn to your videos because of your focus on scientific studies and analysis of same. This was a departure, but so good at synthesizing complex ideas.
Great info, love the channel!
Amazing video. Among your very best.
This is the best health related vid I have ever seen 🔥🔥🔥🔥
Doc Gil is just a pro explanator of difficult things in simple words.
Moreover, that is scientific based ❤❤
I can only add my thumbs up 👍 to the others. Excellent video
You explain this concept so well. Thank you bro
That was very well laid out and easy to understand. Packed full of great information. I like the bullets and barrier analogy.
Excellent review and useful summary of what to expect as well as anything one can do to lower the risks of CVD's. Your contents are always very fact-based as well as insight drawn from well researched sources
Very nice video that everybody can understand. We don't need any other video after this one.
Excellent visual! ❤
"A simple visual that ties everything together" - you are talking about the Dude's rug?
Gil Carvalho Abides
that visual really tied the room together
Good video Gil.
Love your great explanations!!!
Amazing analogy and explanation!
An exceptional video that has made a lot things clearer for me. As usual great content that's enlightening and easy to understand. Love the unifying concepts of bullets vs barrier and the interplay between the two. Given that I'm someone who didn't win the genetic lottery this has put me at ease in managing my risk. At age 74 arterialscherosis is now real in my life. One can only work on the best strategies to mitigate it and do the best you can.
Great presentation
Hi Doctor Carvalho! I want you to know how much I appreciate the evidence-based approach you take to your videos. In a world where others shout their pet theories and diets from the rooftops, a voice like yours is sorely needed. Your channel is the home of sober second thought, the Senate of TH-cam.
It's not that there's nothing to what these others say. Much or most of it is supported by evidence, but they will casually mention that high cholesterol is good without attribution, for example.
They say the best lie is hidden between two truths. I'm not necessarily suggesting that these others are malicious, but we need to be cautious about applying things we hear from the internet to our own lives. In this you are very helpful.
Your channel is severely underrated by my way of thinking, but thanks for doing all this. Cheers from Canuckistan!
Great, I'm always after all kind of unifying theories!
We can’t control our genetics, but we should still be conscious of if we are at higher risk of certain diseases because of our genetics so that we can ensure we are doing everything possible to reduce our risk.
Really high quality lesson.
Very nice presentation and explanation. 👍💙
Hi Gil
Thanks for another intelligent overview of this fraught area. 🙏
Thanks for the quick resource to show people I care about
Very clearly explained - not easy to do! 😊
you are a gift to us i really appreciate your efforts
Excellent analogy!! Thank you!
Outstanding video, well done sir.
Outstanding, as always!
A good summary!!!
Brilliant! Thank you!
I will keep taking the stations then. Thanks
Would love a discussion re gender differences.
Isn’t the efficacy of statins quite a bit lower for women, and, if yes, then why?
The menopause transition dramatically raises LDL, thereby creating dyslipidemia. Does the increased need for cholesterol in estrodial production play a factor? Should it be treated differently given the difference in causation?
Really appreciate your ability to tactfully clarify and then create synopses of complex issues!! Thank you!!!
I agree about estrogen which is why I don't understand why so many Dr's think hrt is more of a risk for women over 65. I'm no Dr but I just think common sense says hrt would outweigh the risk for many woman when it comes to the brain, heart and bones.
the reason cholesterol goes up after menopause is because it's used to make sex hormone and it is no longer doing that. I don't worry about it but my friends my age are all being told to eat low fat by their doctors. it's ridiculous. the main thing after menopause is don't overeat - stick to energy requirements, and exercise a lot. fat itself isn't going to 'cause' a heart attack when eating within a calorie controlled energy intake. it's so important to ditch the extra junk and know your calories after menopause. no one talks about energy intake - they just say 'switch to low fat milk and limit animal fats' but the low fat stuff (carbs) cause terrible health issues when consumed to excess - the limit should be on refined carbs!!!
A meta analysis of your previous video content. Good idea👍
Diet plays a high role in protecting the endothelial layer. After moving to a whole plant-based diet and having had 3 CT angiograms, the evidence is clear to me that a healthy play is going on, resulting in vessel dilation and a widening of the artery wall.
Is plant based basically vegan?
@@HT-md7go could be Mediterranean, I think.
Hi Blood pressure, It weakens the barrier, I did not know. This Is such a good video. Thank you!!!
I have compiled a family tree and my mother’s parents and most of her six siblings died from heart disease at early age 60s. I have very high lp (a), genetically determined. Now I know why they all died so young.
Hey, do you know exactly how high your lp (a) is?
It is why statistics should be taught in HS & must pass to graduate. The scientific methods should also be mandatory, as much as history or humanities.
While I'm a person that can't get enough statistics, there are some people who not only don't get it, but don't have the ability to. They're the ones who I'm more likely to bring the beautiful music and art into our lives. Fortunately the analogy that Gil has provided is helpful for those people.
I like that you point to the scientific methods plural, because there are multiple methods. For example, a paleontologist typically can’t run an experiment in the same way a physiologist would on a living species…
Once again an awesome video, Dr Gil, thank you so much! ( 3:56 Not important for the message… but for the bullet/ApoB analogy, bullets that have been fired don’t actually have any gunpowder in them!)
I caught that too.
Dr Gil is not familiar with how pew-pews work.
Nice simple model that would be useful for those less inclined to dwell into the biochemistry mechanics of it all. My one criticism is with respect to diet. Diet IMO is the easiest and most impactful factor people can manipulate before a cardiac event happens. In this factor for those on a Western diet, the most critical item is Sugar (fructose) which is the worst component of a high carbohydrates diet. Fructose consumption directly impacts food cravings, fat storage, hunger (hunger and cravings have two different mechanisms), higher blood pressures (Increase Uric Acid which directly correlates to BP), glucose/insulin rollercoaster... Increase Sugar/Fructose consumption (Which also impacts other Carb consumption) directly tracts with increased rates and severity of most chronic diseases impacting folks in the West since the 1890s when consumption amount began increasing and spreading. Then in the 1970 with the creation of High Fructose Corn Syrup, and even cheaper form of Sugar, we are where we are at today. Cheers
Hi Gil, thank you for all the great health tips. Question: Can you have high LDL and low apoB?
thank you for the wonderful video
Many thanks for sharing Dr Carvalho
Thankyou. That was a really usefull mental model that allows understanding of complex, interacting factors.
[Note: I made an edit from useless to the correct word, "useful". I am unclear how auto-incorrect can change "useful" to "useless", but it did.]
Maybe it would be additionally useful to explicitly discuss oxidative stress as a major domain weakening the bullet barrier?
This would allow consideration of contributors such as obstructive sleep apnea, antioxidant poor diets, low vitamin D, dysbiosis, pollution (PM2.5), etc.
Chronically elevated ROS levels (and factors that prevent this) can be discussed in terms of platelet activation (etc) contributing to contractile smooth muscle cell (SMC) activation -> migratory/ secretory SMCs that migrate to the intima and synthesise proteoglycans. Which, then allow 'capture' of postprandial remnant cholesterol.
As the presenter mentioned, generalised inflammation, contributing to arterial plaque formation, is a major domain negatively affecting the bullet wall.
One of my lifestyle pathways is determining whether I should use statins. I am aware of studies showing U-shaped all cause mortality curves with a minimum around ~ 3.6 mmol/L (140 mg/dL).
My current research is to determine if ... with a CAC score of 1, normal BP, a diet mostly rich in antioxidants, vitD3/K2 (mk5&7) supps, exercise (resistance & walking), gly/NAC to boost glutathione, and good cholesterol (except LDL-C = 135 mg/dL) and apoB levels, intermittent fasting to reduce postprandial remnant cholesterol 'exposure, and now, also reducing exposure to PM2.5 and toxic people ... should I avoid statins.
My understanding is that statins certainly have multifactorial benefits for at risk people. But, if the underlying factors leading to arterial inflammation and plaque formation are well managed, does taking statins then result in greater risks e.g. cancer) associated with low LDL-C? Fat and cholesterol are essential for good health.
My current view is to avoid statins? Either way, I guess I am betting with my statistical life :)
Thanks doctor!
Wow, I (or you) must be psychic because I was just about to suggest to you that you do a comprehensive overview of how the different risk factors for heart disease fit together, because I was confused as to how diabetes or blood glucose levels was a risk factor when Apo B was the thing that actually caused atherosclerosis. This video answered that. 👍
that is so helpful, thank you very much 🙏
Ok I am going to put a rave comment on this one because literally if it's not one of the first nutrition videos to really discuss a prior, I can't remember what one was. The thickness of the barrier. So let's redo the model: we have tests, find out what each person can 'get away with' and focus on the ones with the weak barriers, and stop screaming at everyone as if they have weak barriers, even though you don't know.
Top notch.
this is all you need to be in good health :
eat a balanced healthy diet
exercise
sleep regularly
take care of your mental health - stress
lower substance abuse
be surrounded with loved one
do you consider something more ?
Balanced diet? 1/3 calories from Fat 1/3 from protein 1/3 from carbohydrates?
Luck …… genetics factors
@@AliceFarmer-bg4dw balanced diet means not eating too much food or too little and a variety of food so you can get all the vitamin and minerals
balanced also mean not highly processed
@@AliceFarmer-bg4dwyeah that can be good for shredding. On a maintenance diet, that is going to be high protein
@@AliceFarmer-bg4dw Balanced diet: Eat real food, not too much, mostly plants.
good stuff Doc, thanks...
Great video!
Great video! You said losing bodyfat effects both the components... Do you know if the effects are linier, ie going from 20% bodyfat down to 15% will be the same as 15% down to 10%? Or do the effects (improvements) start to taper off the lower your bf % goes?
Thanks for making this video! Very helpful
Thanks to your videos, I was tested and found I have very high ApoB and am now taking a statin and diet measures. You may have saved my life! Thank you! Would you mind explaining cholesterol in fish? Is it good cholesterol or are the omega 3s so helpful it makes eating fish worthwhile?
The importance of cardiovascular health cannot be overstated, and three critical exams play a pivotal role in assessing and managing heart disease risk: the CT Angiogram, CIMT, and Calcium Score.
CT Angiogram (Coronary Computed Tomography Angiography - CCTA): This non-invasive imaging test provides detailed pictures of the coronary arteries. It helps in detecting blockages or narrowing in the arteries, which can lead to serious conditions such as heart attacks. By visualizing the coronary arteries, doctors can make informed decisions about the need for further intervention or treatment.
CIMT (Carotid Intima-Media Thickness): CIMT measures the thickness of the inner two layers of the carotid artery. Increased thickness can indicate a higher risk of cardiovascular events like stroke and heart attack. This test is crucial for early detection of atherosclerosis, allowing for timely preventive measures.
Calcium Score (Coronary Artery Calcium Scoring): This test quantifies the amount of calcium in the walls of the coronary arteries. A higher calcium score is indicative of a higher risk of coronary artery disease. By identifying the presence and extent of calcified plaque, healthcare providers can better stratify patients' risk and guide treatment to prevent cardiac events.
Together, these exams offer a comprehensive assessment of cardiovascular health, enabling early intervention and tailored treatment strategies to improve patient outcomes.
Great comment. 👍
Thanks 🙏
Dr William Cromwell (on the podcast with TheProof) said that in fact apo-b lipoproteins enter AND exit the artery wall by transcytosis (probably the incorrect spelling). Thus, the body wants them to pass through. The issue seems to be that some of them somehow get oxidized and as a result are unable to be transported out again. This is very different from Dr Dayspring’s description of apo-b ‘crashing into the artery wall’.
If Dr Cromwell is right, then working out how they get oxidized might be a better way of preventing CVD
Thx Gil for the info. If someone asked you if a 7 month old baby was just beginning to eat things like eggs, what would you recommended the egg should be fried in? They currently fry in ghee (Saturated Fat) I’m sure that’s not the right thing for a baby based on clinical evidence, but just wanted ur thoughts on this.
“Bullets flying toward us…” this graphic was timely for you know who!
I was thinking the same thing, lol.
Althought the video was published today, they must have been working on it for days. And he was thinking of that analogy for weeks or months.
Still... what a coincidence.
yeah this video was in the queue for a couple months just coincidence :)
@@NutritionMadeSimple There are no coincidences
The most unfortunate thing we dont have reliable diagnostic for plaque that is not invasive! We need better more clear reliable methods to diagnose measure observe this
Ive just discovered at the age of 35 that i have Multivessel Coronary Artery Disease. To say I am terrified would be an understatement. I have already switched to WFPB, stopped the smoking etc. The occlusion is 25-40% in 3 arteries. 30-40% in 2 and less than 25 in another. I am hoping that while I cannot turn back time I can do what I can to fight this. But I am not feeling very confident. I will get Apob tested, I am in Portugal if anyone can recommend any good lipidologists or any advice in general. Thanks Dr Gil
I recently had my bloodwork done, and I was shocked and disappointed at my cholesterol and ApoB levels. They were "good." They were all at what would be considered baseline. However, considering everything I do to keep those levels low, I was disappointed that my numbers were just at baseline good. I've been on a high fiber plant-based vegan diet for 5 years (no vegan junk food), I take Omega-3, psyllium husk, beta glucan supplement, soy protein isolate, I weight train 5 days a week and do a two mile walk on the other two, but my levels were just at baseline. My doctor said, "Well, imagine how bad it could be if you didn't do all that." He's right, and I know he was trying to make me feel better 😂. As of now, he says there's no need to take a statin, but we'd keep monitoring. I'm kind of bummed out how much genetics play into it. All my other risk factors were good, except my red blood cell count was high, but I've always known that about my family history and donate blood every 3 months.
MVX is how to determine if you will live in the next five years. Metabolic Vulnerability Index Dr. Cromwell
Of course, I got a dominoes ad for this video.😂
You made a fantastic video about alcohol and mandelian randomization, explaining imo very clearly where our level of knowledge is right now. I would personaly love to see a video around the topic of training and heart disease. It sounds like a straight forward thing, but training is actually associated with both sudden cardiac arrest and heart fibrillation. So what do we actually know on the impact of training on different metrics of heart health, perhaps beyond associative studies?
KFC ad before the video 😭
Nothing wrong with KFC once a month or so.
Does weights and running strengthen the barrier to prevent cholesterol from entering ?
What’s your take on so called ‘plant sterols’ in margarine that have been clinically shown to reduce cholesterol?
If you can dodge a wrench, you can dodge heart disease!
Hi Gil, I have a question. I have a family member who claims their diet and lifestyle gives them a very low risk of heart disease and MACE. However, when I shot them with several bullets as per your model, they still experienced severe negative health outcomes. Is this to be expected, or do you think they are some kind of outlier? Unfortunately, I'm having trouble finding additional volunteers to repeat this experiment with.
Can a diet rich in foods that increase nitric oxide production help with the barrier side of risk?
Yes beet root juice did wonders for me
So strenghten ur barrier by lowering salt and inflammation and lessen fat?
So if I stop smoking does my barrier re-strengthen, or is the wall permanently torn down
Fully active matrix gla protein protects the arteries from plaque build-up.
To understand how it works, is to know that mgp is found in mice too.
Researchers knocked out mgp from mice. They all died within 6 to 8 weeks of age.
They all had arteries constricted by plaque and many had burst arteries.
Whew, I thought you were going to say exercise minimizes risk.
He does at 09:37
TIny nitpicker comment: there are some risks that are 100%, my example would be mesothelioma. 4 grains on an X-ray gets you a stage 4 diagnosis. Some people last 20 years (Stephen Jay Gould) some go down in a few years (Warren Zevon), but nobody escapes it.
Is the penetrability of the arterial wall from lipoproteins associated with the stability of the glycocalyx and/or junctions for the endothelial membrane or is it something else? Because i want the understand the arterial wall resistance on a molecular level.
Thanks for your reply. Nicotinamide is FDA approved for dyslipidemia, though, so surely there's some research to support the FDS's decision?
it affects metrics like LDLc and HDLc but actual risk has not consistently been seen to improve. Idk if that FDA status will change or not. there may be controversy