Cardiac surgeon says: Cholesterol doesn't matter!!?!

tweet: “I no longer accept paradigm that high LDL cholesterol causes heart disease” - cardiothoracic surgeon

he doesn’t believe high LDL cholesterol causes heart disease

patients have normal or low cholesterol. cholesterol doesn’t matter?

the paradigm that high LDL cholesterol causes heart disease. Is that the paradigm? No

it’s not high cholesterol that causes heart disease. it’s the lipoproteins that carry cholesterol

vehicles determines plaque/artery blockage, whether lipoproteins have more or less cholesterol

usually if cholesterol is high there are more lipoproteins. if they mismatch, risk follows lipoproteins, not cholesterol level

we can count lipoproteins that cause heart disease with apoB

high apoB + low LDL-c = high risk. apoB causes heart disease. High LDL-cholesterol is an indicator, not the cause

"apoB is a better marker of cardiovascular risk than LDL-cholesterol"

"reframe lipid hypothesis as lipoprotein particle hypothesis"

"lipid hypothesis could be re-examined as lipoprotein hypothesis; risk most proportional to particles, not LDL cholesterol"

evidence for vehicles, against cholesterol as cause; experts don’t think there’s a debate

high LDL-c used as indicator of risk

patients have normal or low LDL-cholesterol so high LDL-cholesterol cant be the cause? are patients on cholesterol-lowering drugs?

Statins lower cardiovascular risk, dont eliminate it, still residual risk. Lowering cholesterol slows buildup of plaque, statins stabilize plaque, there is still plaque burden, statins doesn’t eliminate all plaque

common for someone on statins to have low cholesterol but still have risk of heart attack. risk is lower than with higher cholesterol but still residual risk

cholesterol drops after heart attack (Acute phase response)

"Acute coronary syndrome (heart attack) affects lipids/lipoproteins, low density lipoprotein (LDL) and total cholesterol decrease"

heart attack patients' cholesterol is lower. If i'm not aware of APR i might think "they have low cholesterol, cholesterol level has no relation with heart attacks!"

heart disease: Lipid levels during acute phase after heart attack may not reflect lipid levels leading up to heart attack

cholesterol-lowering drugs and change in lipids in acute phase of disease

threshold for high cholesterol is not where risk starts. the higher your cholesterol the more plaque

normal LDL-c = under100mg/dL, but can have plaque. Less than at 150 but not zero

people with ‘normal’ cholesterol can have plaque, yet high cholesterol is a risk factor

intermediate cholesterol more common

hospitalizations for heart disease + LDL-c levels. cholesterol of 200 is protective? no!!!

more people with cholesterol ~100.

authors: guideline revisions with even lower LDL goals
study: lower LDL cholesterol further

Risk is higher at higher ldl-cholesterol

measure cholesterol before disease. or split randomly, lower cholesterol in half, see who gets heart disease. group that gets drug has lower cholesterol and lower risk. people born with low cholesterol have lower risk of cardiovascular disease and death

LDL-cholesterol = indicator. drugs also lower apoB. if LDL-c and apoB don’t match, risk follows apoB

Bottomline, we don’t ignore high LDL-cholesterol, most of the time it indicates high apoB; if in doubt measure apoB

video: diet to lower apoB

Connect with me:
Animations: Even Topland @toplandmedia

References:

Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author's knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!.

#NutritionMadeSimple #GilCarvalho

[PlantChompers]

I swear you are the best health scientist/doctor on the Internet. I listen to many great podcasts, watch several great YouTube scientists, and read many books — but yours are the most compelling. I wish your videos got millions of views instead of many pop ones that do. 👏

[Amy-tlxe]

Gil, I don't know what I would do without you. Thank you for your excellent explanations.

[corvoattano]

Incredibly good decision to blur out names. It's the argument that matters, not the individual.

[intimpulliber]

Man, I just love your personality, you're so likeable. You understand people's mistakes, you dont call them idiots(which I dont mind that much from regular people, but doctors should really not have that word in their vocabulary when talking science, but many call uninformed people idiots on all platforms), you clear musunderstandings perfectly with very good logic and I dont know, its just a joy to hear you talk

Also, if you are interested, I'd love to hear your opinion on dangers of too low cholesterol, of course, not cardiovascular dangers, but those associated with mood and depression and sex hormones. What is the ideal range? Cause just crashing cholesterol seems also dangerous to me

Also, a video about how inflamation interacts with heart disease would also be pretty interesting.

I dont want to force ideas onto you. You should do videos only about what you find interesting and like. I was just rambling.

[LionofJudah]

Really Dr Gil, you clear up confusion so well!! Love your videos.

[jacquesduranceau]

Also, the graph of cholesterol range does imply that LDL cholesterol is not the important causitive factor. The graph can be fixed, not by doing a different study about risk at higher levels, but by dividing the results by the fractions of the population with that reading. If you got a flat line, it would show that there isn't a dose response. Higher cholesterol is correlated to less all-cause mortality in at least two recent studies. The simplistic idea that lowering ldl cholesterol lowers heart disease by the introduction of a statin is like turning off a check engine light in order to fix the engine (at best). Most of the low carb doctors focus on triglycerides and Hdl ratio, not ldl.

[mrsonicsound]

What a breath of fresh air. Research is not for everybody, that's why I appreciate trusting a professional. Keep the vids coming!

[jreverie]

I'm so glad to see you're uploading again!!! You're one of my all time faves for sure!! :D I learn heaps from you, thanks!

[kat]

Thank you. It is not an exagerration to say you may have saved my life with your videos. 63 year old female, did whole food plant based badly (with 3-4 Lara bars each day), got an A1C of 6.0 two years ago for the first time ever. Switched to Keto/Atkins, watched many a video (some from actual MD's) saying high cholesterol was fine, its all about the sugar and eat as much fat and saturated fat as you want. Started getting mild angina even when I was sitting down and then my heart started racing at night. I knew something was wrong, but these guys were MD's making these high fat/carnivore videos. Wouldn't the AMA or someone take the MD away from their name if they are just making videos that are completely wrong?! (I am still not sure about this, do not know if the AMA or some other governing body cld take away their MD for making their videos, and, also, not sure if a governing body should. Everyone thought Semelweiss (sp?) was wrong at first, too, but he's why surgeons scrub their hands and wear masks/gowns today, is my understanding. Semelweiss was right, as the increasing numbers of moms who did not get childbirth fever showed. I am a sample of only 1, but the many others who start getting angina or worse will slowly tell the tale. Still, it is better to allow exploration of controversial ideas. However, in the case of the keto MD's, they are making errors in their understanding of the established science. It is not that they have made a new discovery, like Semelweiss did. The keto docs are misunderstanding findings and implications. They are not making new discoveries, though their misunderstanding causes them to believe they are. We need folks, like you, who understand the errors in statistical and other types of reasoning these MD's are making.). Anyway, then I found your channel. And you so clearly explain the misunderstanding that these MD's, even though they are MD's, are making. Your use of analogy is especially spot-on and targeted, you are answering exactly the questions the carnivore/keto MD's are making me confused about. I think most of the carnivore type MD's are good people, they follow the high saturated fat diets they talk about. But I can now see the errors they probably do not realize they are making. Many of them are young to middle aged and can get away with it bec, for many of us, our bodies give us 50-60 years of basically anything we do before they (our bodies) start complaining. I am now back on primarily whole food plant based, but with no Lara bars, still with a couple eggs per week, and chicken or tuna a couple of meals per week. One cheat meal per week where I eat whatever that week's craving is, last week was pepperoni pizza and the theater sized box of Junior Mints. Then, boom, right back to mostly whole food plant based with the next meal or in the morning. About 80% of my meals each week are vegan. My last A1C was 5.3. It had been 4.9 on keto, but 4.9 with resting angina and racing heart at night. Now its 5.3 with no angina in weeks and my last racing heart was in April. At 63, I cannot fool around, and I am not trying to fit into a bikini. I am trying to have as long a healthspan as possible, and I have 58 years (I first started whole food plant based at 58 when I ended up in the ER with ventricular something, PVC's, and they said cut the caffeine and stress) of messing up my arteries already. So my arteries likely already have the effect of 58 years of eating SAD. I cannot fool around, and I thank you again. You are truly a physician, truly healing people through your videos, and I am so grateful. I want to see my grandkids grow up. Thank you, Dr.

[anthonyrondolino]

As usual, you are a great teacher using good analysis and an understanding of evaluating claims & studies. Thank you!

[pedroaccorsi]

To the point about base rates, another good analogy is drink driving. Most car accidents involve sober people, but we would never say that drinking alcohol decreases one’s risk of being in a accident. These numbers are simply because there are much more sober people driving overall, even if the percentage of accidents among people who are drunk is much higher. Great video as always!

[pjayadeep]

Then why aren't doctors ordering apoB tests ? They are still using lipid profile tests

[g.w.stanley]

Great explanation! Thank you for sharing your knowledge!

[chill_nrg]

I'm so glad I watched this video. I was starting to get confused with all the misinformation. Thanks for clarifying.

[RaffiTheQuokka]

Found your channel yesterday over the Plant Chompers channel and already hooked on your nuanced content. Keep it up man!

[DP-drgi]

Thank you so much. The content you offer is amazing.

[mesamaromba]

Brilliant video explaining the bias behind the misunderstood of this topic. Is there a reason why docs don't measure directly apoB in blood? Why they only measure ldl?

[krc]

I love the analogies. It really improves my understanding. I have many questions now for my Dr. TY!

[dragonX]

Very interesting and well done vid! Follow up Q on cholesterol / LDL levels, what's your take on the Minnesota Coronary Study? My understanding is that the people with significantly lower cholesterol and overall LDL levels were the ones passing away sooner, based on the foods (animal fats vs. processed oils) being supplied in the study. Would love to hear your thoughts

[mathieuchoufani]

love your content, so much to learn from you even as an MD