Mark Bell's Power Project - My Heart Scan Shows VERY HIGH RISK Plaque | Dr. Michael Twyman

Episode Date: October 7, 2026

Mark Bell talks with cardiologist Dr. Michael Twyman to break down Mark’s actual heart scans and what they reveal about his cardiovascular health. Dr. Twyman walks through Mark’s plaque burden, the difference between soft and calcified plaque, why someone can feel perfectly healthy while cardiovascular disease develops in the background, and what can actually be done once plaque is found.They cover CAC scores vs. CT coronary angiograms, LDL, ApoB, Lp(a), blood pressure, inflammation, saturated fat and ketogenic diets, anabolic steroids, exercise, sleep, stress, genetics, nattokinase, supplements, lipid-lowering medications, and the markers Dr. Twyman believes people should routinely monitor.Mark also reflects on years of extreme powerlifting, performance-enhancing drug use, high blood pressure, and dietary experimentation—and why being strong, lean, active, or metabolically healthy doesn’t necessarily mean your arteries are free of plaque.Follow Dr. Michael Twyman: DrTwyman.com0:00 Understanding High Risk Plaque Findings4:20 Dr. Twyman's Transition to Preventative Care8:15 The Truth About Exercise and Heart Stress12:40 Can Plaque Actually Be Reversed17:10 Why ApoB Matters More Than LDL22:30 Supplements for Arterial Health28:15 Nattokinase Research and Bleeding Risks34:50 Reviewing Mark Bell's CTTA Results41:10 Soft Plaque vs. Hard Plaque Explained47:35 Choosing the Right Heart Scan53:20 Saturated Fat and Genetic Sensitivity1:00:15 Lean Mass Hyper Responders1:06:40 Impact of Stress and Sleep on Arteries1:12:55 The Mediterranean Diet for Heart Health1:18:10 Essential Blood Markers to Monitor1:23:45 Final Recommendations for LongevityIf you found this information helpful, please hit the like button and subscribe for more deep dives into health and performance. Always make sure to consult with a medical professional before starting any new supplement or medication protocol based on your personal blood work and scans.#hearthealth #cardiology #fitness #cholesterol #longevitySpecial perks for our listeners below!🥩 HIGH QUALITY PROTEIN! 🍖 ➢ https://goodlifeproteins.com/ Code POWER to save 20% off site wide, or code POWERPROJECT to save an additional 5% off your Build a Box Subscription!🩸 Get your BLOODWORK/TRT/PEPTIDES! 🩸 ➢ https://marekhealth.com and use code "POWERPROJECT" for 10% off Self-Service Labs and Guided Optimization®.🧠 Methylene Blue: Better Focus, Sleep and Mood 🧠 Use Code POWER10 for 10% off!➢https://troscriptions.com?utm_source=affiliate&ut-m_medium=podcast&ut-m_campaign=MarkBel-I_podcast

plaque on your scan showed you had 1,265.6 millimeters a total plaque. This is a high risk finding. This test tells you you're very high risk of having a cardiac event unless you do something different. I was on performance enhancing drugs and I was on a lot of them and my blood pressure was also really high. I mean, I've definitely seen morbidly obese people who have completely clean cornered arteries. They have no observable plaque.

And I've seen triathletes who had heart attacks while they were on the biot. Just because you're thin doesn't guarantee you're knocking out black. And just because you're heavy, it doesn't mean that you have tons of plaque either. But I tell patients is exercise is one of the best anti-aging drugs. And then unfortunately, once you start getting into kind of more of the endurance athlete type of things, there's often a time of diminishing returns. And just for the record, I take full responsibility for anything that I've done, whether it be steroids or whether it be the fact that I followed a ketogenic diet for a long time.

All right, well, I'm here with Dr. Twyman's doctor. Can you explain, you know, your back. around and stuff for people before we dive into all this heart disease stuff? Sure. So I'm Dr. Twyman. I'm a board certified cardiologist. My practice is Apollo cardiology and I'm located in San Luis, Missouri. I've been a physician since 2002 and my passion is trying to help people not have heart attacks and strokes. Do you actually do surgeries and stuff? Previously he was doing invasive procedures, but when I eventually decided I wanted to focus on preventing heart attacks instead of treating them, I stepped out of the hospital about seven years ago.

So you have been inside the body, though, and you've seen all this stuff up close and personal. Correct. I've seen how bad it gets. Yeah. Yeah. So what I would like to go over today is, you know, I've been announcing to people. I've been putting out some information more recently about my calcification, about my plaque, and there's a lot of just misunderstanding, I think, of all this.

And I think, I think rightfully so, like the information is coming out is pretty quick. it seems like things are changing, you know, in your time in cardiology, I'm sure some recommendations and some things have changed. I know even the lipid lowering drugs and stuff like that have advanced quite a bit to where they have less negative side effects and stuff like that. And we can review all that, but I think the place I'd like to start first is because I think there's these things that are kind of like caught in people's minds about like what fixes heart disease. So what are some things that I guess could maybe prevent, what are some preventative

measures? You know, if you had a list out of top five, what do you think are five, top five practices that you think could potentially help somebody stay away from cardiovascular disease? Sure. So, yeah, and when we're speaking to cardiovascular disease, I think today we're mostly going to be speaking about coronary artery disease or plaque in the arteries. because there's also valvular heart disease, there's congenital heart disease. We're mostly talking about the thing that is most common, the number one thing that kills Americans.

So plaque is extremely common, particularly if you do these very advanced tests such as yourself, like the clearly analysis, you can find plaque at a very early stage. Generally, when the person is asymptomatic, so they're not having any exercise-induced symptoms. So approximately 20 million Americans have plaque in their arteries,

and 800,000 a year have heart attacks. One second. 20 million Americans have plaque, is that just of people that gotten tested? Or is that an estimation? That's what's known. But yes, probably if more people were screened, we'd have a higher incident. So it's 20 million that have been tested in one way or another for plaque. Okay, I understand.

But once you have plaque, then that's what we'll jump into is like, what can you actually do about it? But first you've got to find it. But yes, lipids are going to be important, but you also have to be metabolically healthy. You have to have low oxy of stress inflammation. And then one of my kind of interest is really looking at the lining of the arteries, the endothelial glycolax and the endothelium. That's the protective coating of the arteries. So your glycolax is the consistency of the wide of your eyes, or if you took a fish out of water, and it's slimy. It's just glycoprote, these proteoglycans, and these glycosamino glycans

or gags. But just think of it as like a carbohydrate-rich gel coat that lined your arteries. And if that coating is healthy, your arteries stay healthy. But if you have high blood pressure, high blood sugar, high insulin, heavy metals, infections, many, many things will damage that protective coating. And then it's off to the races that you potentially will start developing endothel dysfunction and then ultimately plaque in the arteries. So there's many things that can be done other than just lowering lipids. You know, and where does exercise like lifting weights, cardiovascular training, you know, because we hear cardio, right? Cardiovascular training. Well, it sounds like that, would prevent heart disease if I just train my heart, if I exercise my heart. However,

being on extreme ends of, being on the extreme ends of the couch or being on extreme ends of running also doesn't necessarily seem to be the answer. That actually seems like a recipe for disaster. In some cases, I think maybe you can speak from experience, but I know other cardiologists who have said they've had a lot of runners, you know, ultra runners and marathon runners with just hearts that aren't as healthy as you might think because they're maybe causing extra stress. So power lifting, running. Some of these things could have potentially be more harmful than we thought. Correct.

And I tell patients is exercise is one of the best anti-aging drugs. You do have to do it. So no exercise or being sedentary definitely increases your cardiovascular risk of having a heart attack stroke, need for stints or bypass. There's a very large sweet spot of a healthy amount of. exercise. And then unfortunately, once you start getting into kind of more of the endurance athlete type of things, there's often a time of diminishing returns where you're starting to overtrain, the nervous system, it doesn't recover. You have chronic inflammation, particularly if you're

short sleeping yourself. And with that chronic inflammation, the arteries, glycochalics, is going to get damaged, and you're potentially going to start developing more plaque. It tends to be that the kind of endurance runners tend to have more calcified plaque or more stable plaque. They don't always go on to having heart attacks or needing stents, but they do have a lot of plaque in their arteries, more than you expect. What did you say? Did you say short sleep? Correct. Sleep is when your body recovers. If you don't sleep well, you're not going to age well. Yeah, sleep is a really crazy thing, just to think that, you know, just by not having decent sleep throughout your life, which is like people tend to kind of complain about it, like, oh man, I just always have a rough time with sleep.

I'm one of those people. I've always had a rough time with sleep. And who knows, maybe my cardiovascular issues maybe are all linked to just that. You know, it's hard to really figure out exactly what they're linked to. I would like to maybe discuss for a moment here about supplementation. So, and also what we can do about plaque, not in terms of like what you can actually do, but what's feasible. You know, currently right now, it doesn't seem like we can necessarily reverse it. Is there any evidence of anything that you've seen, of anything that's showing, is there anything in the literature right now that has been tested with CTTAs or CACs,

which will get into what those are, before and afters of like this person had this amount of plaque and now they have this massive reduction in plaques? Is there anything, any medications that do that currently? Yes, there are medications that do have data on plaque regression. But I kind of phrase it first about first you have to note how much plaque you have. We'll talk about the test to do that. Once you have plaque, then you come up with a plan how to treat the plaque. Because the goal is to stabilize the plaque.

Plaque is very common. Not everybody goes on to having a heart attack. It tends to be the people who have soft plaque and particularly the kind of more inflamed plaque. Those are the people that are going on to having a heart attack stroke, need for procedures. So those are people that need very aggressive treatment. You're throwing the kitchen sink at those individuals, including lipid lowering therapies, anti-inflammatories, you know, metabolic marker things if they're elevated, they're insulin resistant, maybe using a GOP, maybe using an S2 inhibitor. But back to your question about plaque regression, most of these

studies that show plaque regression, they're going to be utilizing invasive procedures, intervascular ultrasound. So this is what was kind of the standard before these new AI-enabled tests, because most people who weren't asymptomatic had no idea how much plaque was in their arteries. And once you have plaque in your arteries and you start treatment, you weren't necessarily going back to the cath lab to go look to see did the plaque get better. You would just be like, the person is not having symptoms, let them live their lives. Now we have better test to be able to find plaque in kind of earlier cases. And we're starting to see, you know, particularly, with my practice.

Anecdotally, I've definitely seen plaque stabilize where the plaque doesn't continue to grow at a high rate, and that's still winning. The person's not going into the cath lab and having procedures. But I've definitely seen plaque regress. Now, plaque doesn't always shrink all the way back to zero, and that's not necessarily the goal. It's trying to take the salt plaque that's prone to rupturing and causing a heart attack and firming it up with smooth muscle and calcium.

Some of it is, you know, we're just trying to, I guess, like, mitigate any form. further damage, right? So the body, the body's really smart, and I don't think the body really makes mistakes. I don't know exactly what its reason for, you know, clogging up our system is, but it must have, it must have its fair amount of reasons. And in this case, we're not like always just trying to like zap all the plaque out of there. And with if, and with what we have, the best that we can kind of hope for is no further progression of plaque. And as you're mentioning, in some individuals, there's a regression in plaque. What are some of those medications or what are some of those strategies where people can

maybe feel a little bit more comfortable that their plaque isn't going to progress and maybe even they'll be able to knock their plaque backwards a little bit? So we'll start with kind of the tried and true. It's going to be intensive lipid lowering therapy. And I will tell you, like, it's more than just cholesterol. So I start with patients that cholesterol is not the boogie. man. You know, you weren't giving cholesterol to give you a heart attack. Cholesterol is the building block for your hormones, your bile acids, your cell membranes.

But because cholesterol is waxy, it can't float in your liquid blood. So your liver makes something called a lipoprotein. Think of it like a cargo ship for the cholesterol to be transported through your blood. If the lining of the artery, the glycopalics, gets damaged for any reason, that lipoprotein is more likely to be attracted to the lining of the artery. Once the kind of the artery, kind of pulls that lipoprotein into the artery wall, it starts a process where the immune system gets activated. The macrophages come in, they start kind of gobbling up the cholesterol particles, and that then causes this crystallization of the cholesterol in the lining of the arteries.

And eventually, more and more of these things are happening, you start developing a fatty streak and eventually plaque, and the body treats this as sort of like an infection or an abscess, and the body will try to put smooth muscle over it to kind of seal it, and eventually it will start to ossify it and calcify it. The calcification is kind of a late stage finding, but calcium is trying to deal with the damage. It's not the primary problem. You know, cholesterol will trigger this cascade, and if you generally lower the lipoprotein burden, you can stop the forward progression, and then the body can get to work at trying to repair the damage that's occurred. So there's various lipid lowering therapies that can get you down to these ranges. It tends to be the higher dose

of statins like resuvostan or torvastan or the medications known as the PCAsk9 inhibitors, the most commonly used ones are rapatha and preliant, but there are some oral ones that coming online. They just lack some of that outcome data right now. So you pick whatever lipid lowering therapy you're comfortable with, but you're generally trying to target, you know, if you just have a basic lipid panel, you're trying to target an LDL cholesterol of around 55 or less if you're really trying to look for plaque regression. LDL cholesterol, for people that, you know, maybe get a little confused on some of these subjects. I was one of those people.

I got confused every time it was brought up. I'm like, which one is the HGL, which one's the LDL? The LDL is the bad cholesterol and the HDL is the good cholesterol. And then we, even within the cholesterol, there's a bunch of other things to examine. Can you share with us the blood profile that you recommend to people? I believe it's like the Cleveland Clinic. health or blood panel because that might really help people to kind of have a better understanding

of like what type of blood work they should get. Sure. So the two vendors that I mostly use and there's others is I use, you know, Cleveland Heart and they use Boston Heart Diagnostics. They do very similar panels. So most people are going to be used to having a traditional cholesterol where you get your total cholesterol, your HDL cholesterol, your triglycerides, and your LDL cholesterol, which is generally an estimated value of your LDL cholesterol. That's why I don't personally use the word good cholesterol or bad cholesterol. There's just cholesterol and there's different transporters for the cholesterol. So if people are watching the video, I always use a tennis ball analogy. The tennis ball represents the lipoproteins. These are the cargo ships for the cholesterol,

the triglycerides, the fat soluble vitamins, different building blocks for the cell. So the liver is producing these lipoproteins. And if you do an advanced livid panel, you can actually measure how many of these lipoproteins are basically floating around in your blood at any one time. So think of these as cargo ships. You can check some called LDL particle number. That counts how many of these particles are there. And then there's something else that often you will look at some called apo lipoprotein B or APOB for short. ApobB is a protein.

And the tennis ball analogy, APOB is like those white stripe on this tennis ball. The APOB holds these things together like in a sphere. and APOB acts like a little key to bind into the LDR receptors. So if you count up all the APOB proteins, then you know how many LDL particles you have, how many VLBLs, ILBLs, and then LPLA, if you have high levels of LPA, will also have APOB on the outside of it. How many tennis balls do I need to eat a day to have clean pipes? Yeah, and that made me kind of a joke is that like,

but dietary cholesterol has very little to do with what the cholesterol is in your bloodstream. You know, cholesterol in your bloodstream is mostly produced by your liver. Don't eat too much shrimp and egg yolks. Right. It's extremely rare that people have issues with dietary cholesterol raising their serum cholesterol. I've seen it, but it is far and few between. It's much more likely the person is having an issue with either potentially too many carbohydrates for the amount of activity that they're doing, or they are one of those people who are more sensitive to dietary fats, such as saturated fats. Not everybody is that sense of saturated fats. Not everybody is that sense of saturated fats causing their lipids to become more abnormal.

We will circle back to the saturated fat issue and the LDL stuff. You've recommended to me some various supplements before. And, you know, I think for the consumer and for the person that goes and gets their blood work done and spends the time and everything else to get a CAC or a C. TTA, the results that they'll get from like just some supplementation, they're not going to really notice a lot. You know, it's not going to be like some huge differences. However, there could just be these small ticks and maybe they're bigger things for someone

like you who has been studying this for a long time. When you keep seeing the blood work come back and the blood works a little bit better and the blood works a little bit better and the person's blood pressure comes down, maybe there's some inflammatory markers that come down, but just like they didn't feel the heart disease creep up on them, just like somebody didn't feel or notice that they couldn't see as well as they thought until they just woke up one day and like, crap, man, I think I need readers. You kind of don't, you don't really feel that. You're not telling your wife or significant other, you're not like, man, my eyes are really hurting. And normally, I mean, there are cases where people do have chest pains

and stuff, but normally you're not like, man, I think something's going wrong with my ticker, you know, I think something's going on with my heart. You don't feel some of these things coming on. So some of the usage of K2 and natokinase and whatever these other supplements are that someone's going to utilize, it's going to be very gradual. It's going to be a long road. This is something that you're going to have to do for a little while. But it's nice to have someone like Dr. Twyman's to work with,

or if you're communicating with somebody, someone like the people at Merrick Health, and you're going back and forth, and you're just noticing little by little, you're getting these small wins. It might not be the wind that you want. It might not be the bench press PR or that you dunk to basketball or something like that. It's not going to feel the same. But, you know, over time, you could be kind of assured that you're heading in the right direction. What kind of supplements do you see having at least a slight impact of some sort?

Sure. And I think just to frame it is that, like, coronary disease. is a chronic disease. It's not like an infection where you're going to treat it with, you know, 10 days antibiotics and it's gone. Once you find it, this is a lifelong process. And you always got to start with the lifestyle interventions because they're going to be the bedrock. So it's going to be, what are you fueling the body with? How are you moving the body? I'd really some combination of cardio and strength. How well are you sleeping? If you have sleep apnea, go get your sleep at me to treat it, or if you're only sleeping four hours a night, why is that? Figure out how you can

sleep better. If you use a tracker, cool, figure out what's breaking your sleep. And then the third part, or I should say kind of the fourth kind of lever that I always look at from a lifestyle is like, how well is that person actually managing the stress in their life? You know, if you're a high-level athlete, you're putting a ton of physical stress on your body. You have to recover from that stress. But then if you're also trying to run a business and you have a lot of, you know, psychosocial stress, your nervous system is going to be kind of shot. That high sympathetic drive tends to raise your blood pressure, makes your blood stickier, you're going to have higher cortisol. Everything starts aging faster as you have these stress hormones high at all times. So these are people that maybe

need to learn how to meditate or do yoga or do biofeedback or do vagal nerve stimulator, something to kind of cool their nervous system down. Once you've kind of fixed kind of the lifestyle stuff, you're going to use whatever combination of supplements and medications that has some data that may help with plaque stabilization. So you usually use pharmaceuticals first if the person's very high risk. You're trying to put out the five alarm fire. So pick whatever lipid lowering therapy you're comfortable with and drive the apobie particles down. I usually shoot for people who are very high risk, shoot for an apobie into the like 55 or lower range, because that's where you may see the plaque shrink.

Then, if people have a lot of inflammation, medication-wise, colchocene, old drug used for gout, it has data from the low doco trial at lowering cardiac events. So you have elevated HSCRP, colchocene will help lower the inflammation, potentially stabilizing the plaque. And then if you're somebody who has high triglycerides, particularly, you know, it's due to, like, metabolic reasons, and you've tried, died, and exercised, and you can't get your triglycerides down, then high dose omega-3 with the EPA variant. So this is the VASEPA is the brand name of the drug. I can say that name again.

I didn't quite hear what you said. VAS-C-E-P-A. It's just EPA, omega-3. So fish oil, that's just EPA. That can help stabilize it. Now that's when you get into, okay, you've done all the bedrock therapies that have been shown to stabilize or treat plaque.

Then that's when you start looking at the supplements. So I usually break it down into three buckets. It's going to be the first bucket is, what can you do to support endothel, glycolax, and the endothelium? So again, the glycochalics is this protective gel coat that lined your arteries. It's full of structured water. So things that can improve the structured water are things that put infrared light into your systems. So sunlight, sauna, grounding can all help this kind of layer.

But supplements that can help potentially regenerate the glycochalics, there are a couple brands, one that I tend to use a lot, is called arteriacell from a company called Calroyd. It has some data, more for cradid stabilization of plaques where they saw on MRIs, that the lipid-rich cores are kind of the softer plaques, would tend to stabilize and shrink. Now, they just haven't done all those type of studies in the coronaries yet, but anecdotally, I've seen plaque stabilized with this thing being added to the regimen. Then nitric oxide. Nitric oxide is critically important to your vessels. You have nearly 60,000 miles of blood vessels, and they need nitric oxide to dilate.

Nitric oxide gets produced when blood flows across your arteries, and the glycochalix tells them to thalam release nitric oxide. So this is why exercise is beneficial to the heart. Nitric oxide is getting released. When you're outside in the sun, and UVA light hits your skin, so basically when your skin starts feeling warm, the nitrates in your skin are going to get it liberated, and nitric oxide gets released. And then green leafy vegetables, things with nitrower.

If you have a healthy oral microbiome, the nitrates will help phasodilate your arteries. So start with kind of the, what is doing the damage to the glycochalix and underlying ethylion and support that. Then, if people will have, you know, significant plaque, then this is where probably chylokage garlic has the most data from a supplement standpoint to stabilizing the lipid-rich core, kind of the more kind of inflamed plaque. And you're just trying to put a thicker cap over the plaque. I started eating garlic cloves for a little while there, but I couldn't get a kiss from my wife anymore.

Yeah, probably not. Or, you know, it's like that. I put a stop for that. Yeah. So the garlic just is, it's anti-inflammatory. It prevents the lipids from oxidizing. So if I ever say the word oxidation, just think of rusting. So prevent your lipids from rusting.

And it does have some effect on lowering blood pressure. But it's not going to make the plaque go away. It's just trying to stabilize the plaque. And then vitamin K2 has some data. not as strong as some other supplements, but vitamin K2 is something that helps with calcium metabolism. So calcium is supposed to be in your bones in T. If vitamin K2 is low, you have more risk that there's going to be some vascular calcifications. So K2 may help more stabilize the plaque.

It doesn't prevent the plaque from building up in the first place. So those are kind of the bread and butter supplements. And then, yes, there are some other ones that have a little more niche use, but it's individualized to kind of what you're seeing with the person's blood work and what their kind of goals are. I really appreciate all that you've been doing over the last several years because you're not someone who's, you know, putting out like clickbait stuff. And it's just great, you know, to have somebody with as much experience as you, someone that's actually performed surgery, somebody who's helped people with managing their plaque and regressing their plaque. Because you just keep seeing on the Internet, whether it's a YouTube video or whether it's a Instagram clip,

just keep seeing these reels over and over again of like hey i knocked back my plaque or i got rid of my plaque and it's most of the time i've actually tried to contact these people i've actually tried to like communicate with them and then there's always some story of like well i don't really have a before or well you know the after was a different study or a different scan and you're like they don't really have any you know now it is nice to have anecdotal evidence like that's great I love bro science, you know, count me in for some pro science. I'm all in on that. But it's like, man, we really need some good, we need some good strong data on this.

People have continuously told me over and over again that there's some good data with natokinase. And I think they, some people were referencing that there was a study with like 11,000 people. I don't really know if that's true or not. What have you seen with natokinase and has it been something that is something that you've utilized in practice? So natokinase is a fibonylic, so it helps break up fibrin, which is a clotting factor. Natokinase comes from fermented soy.

So I was in Japan last year. I did try some nato. It's the sticky, very sour type of bean. So the Japanese probably lead the world in the dose of natokinase they're getting through their diet. But it's something where it has some. some effect at basically thinning the blood out. So it is not for everybody, particularly if there's a reason for you're already to be on aspirin or blood thinners, because you really potentially increase your risk of bleeding in that case with not a clear benefit that you're truly

stabilizing or reversing plaque. The way that sometimes I frame it is that, like, I have no pharmaceutical, you know, ties. I don't take money from drug companies. You can look on the Sunshine website. We know. We know doctors. I don't have any money. funny under the table, you're rich as hell from all this big pharma. Yeah, I don't get paid per prescription. I don't care. I use whatever works. And that's one of the reasons why, you know, I was able to step away from the hospital

because I wanted to work just for the patient, not for the hospitals, not for the insurance, not for the drug companies. I work for the patient and I use whatever works. You know, Wise Healer does that. But, you know, pharmaceutical companies have millions and actually billions of dollars to do the studies to figure out which drug candidates actually. actually work. And quick sidebar, there was a recent drug trial that was looking at a drug that lowers liboprotein A. It didn't work. They probably spent over a billion dollars trying to prove

did it work or not. So these studies which kind of look at these supplements, they're not going to have these huge outcomes, you know, they're not going to have huge randomized controls trials. Those cost hundreds of millions of dollars to do. So a lot of times, it's not necessarily bro-science, but a lot of times it's just observational data or it's just kind of looking back at charts. like these people took natokinase, did they have more events or not? But the one study that tends to pop up a lot on social media is this study where they're using higher doses of natokinase. You know, usually people are taking like 2,000, 4,000 forming units of natokinase. This study was done with 10,800 forming units. But it was not a blinded study. There was also

no control group. So you don't know that the person also clean up their diet, start exercising more, taking other medications. They were just taking natokinase. they were getting crowded scans to look for plaque in their crotids, and then a year later they were looking at their crotid and seeing what happened. And it was reported that the plaque shrank something like 30% in one year, which would be a miracle. It would be the greatest plaque reduction thing there has ever been, for the most part. But the challenge is that study has not been replicated.

Nobody else has been able to do it. And then, while I don't know the people who did the study, but there is probably some inherent bias because five of the people who are running the study owned the supplement company that was providing it to the study participants. So somebody else has to replicate this study who doesn't have financial ties to natokines. And that's the biggest challenge. If natokines works, great. I will use whatever tool that works, but I have not seen significant plaque regression in my

patients who utilize it. And then the risk of bleeding is not zero. It's not excessively high. It's not like you're going to bleed out dry balls the second you take it. But it's something that you really need to know what you're doing with it. And if you have an indication to be on aspirin, there's no strong reason to be on natokinase. I would like to plug legendary foods, Ron Pena, and what they're doing at bio-shift right now. So if you're somebody that, you know, you like some sweet treats here and there,

what they're doing at legendary foods, Ron Pena has taken $30 million of his own money. Talk about like not having, you know, money to be gained in this whole thing. but he's actually just blowing a lot of his own money on cancer research and heart disease, trying to find some cures for it. So the money, you know, some of the money that he makes from legendary foods goes directly back into studying heart disease and cancer. And these are things he's been studying for years. He studied, he did the keto pet sanctuary years and years ago,

studying the metabolism of dogs and the ketogenic diet and stuff like that. I just bring that up because a lot of times we're like, man, it would be great if someone was doing some of the studies. Well, this guy is taking it upon himself to go and do the studies, which is really cool. So that's part of the study that I'm involved in. It's called the Luna study. It's from a company from Bioshift. And out of respect for all that they're doing with me, I'm not going to share too much until I get further information. Because we can't go celebrating and running around and telling people stuff until we have.

more we need more evidence of what's going on but we are seeing some promising results with natokinase but that's not that doesn't mean that everyone should run out and and take a bunch of natokinase it could have potential negative side effects for some people I mean what if you already have a condition where you have a little bit of issue with clotting or something like that you know you could you could run into some serious issues so I kind of hate to be the guy to be like oh we see a physician but you should should go to somebody that knows more than you at least

and have someone review your blood work and see if you're a potential candidate to do something like this. I'll also just finish by saying like there are things that are coming down the pipeline. It seems like there'll be multiple. I think within the next year or so, there'll be multiple things that are going to help

advance plaque reversal. You know, maybe it won't be like crazy miraculous, but I think there'll be a lot of, I think there'll be new things that are that are exciting that makes it that will make getting the test done in the first place even even more encouraging because you know for a few years there it seemed like it wasn't that encouraging to go get a test it's like hey go get a test and then get bummed out you know that's where I was years ago when I got my first CAC which let's let's kind of bring some of this stuff up so I had a CAC and I've had two subsequent

CTTAs. And during that process of having the CAC and all these different things, I think I started the process weighing about 240 or 250. I wasn't fat. I was just like big and strong. And, you know, I lost weight. I shifted into running. I've been doing a lot of different things to try to get things heading in the right direction. I don't always make the right choices. People know of my performance enhancing drug usage. There was times, even during that. even after having that knowledge, where I took more stuff than I should have. There are times when I sort of ignored my LDL and things like that. And so as a consequence of that, what you'll see and what Dr. Twyman is going to share today

is you'll see that my calcification, I don't know if I'm saying that right, but my calcification continues to go up. And we'll be able to show you whether I have soft plaque or whether I have a hard plaque. Remember the soft plaque is quote unquote the more the bad plaid. that's the stuff that can break off and cause stroke or heart attack. And the calcified plaque is a little bit more stable to work with. So if we could start to kind of show some of the test results that I've shared with you, and if you can kind of help us review it and make sense of it, that would be amazing.

Sure. All right. So, all right. So I'm going to share, this was the second CT coronary. I'm sorry, it's the CT coronary angiogram that you had. So the kind of- Tell us what that is real quick. Correct.

So the difference between the two tests you're saying, we'll talk about that first. So a CT-cornerary calcium score test is a dry CT, meaning it doesn't require contrast. It doesn't require an IV. It doesn't require, you know, increased radiation. It's something where you go in the scanner, you hold your breath for 10 seconds, they take a picture, and they tell you how much hard plaque is in your arteries. Your calcium score test should be zero. for as long as possible. But if you live long enough, almost everybody will have a positive calcium

score test. I've seen people in their 70s and 80s with scores that are zero or low single digits, but I've also seen people under the age of 40 with scores of 1,300. You don't know just by looking at somebody in the outside what's exactly going on in the inside. So it's a good test, but a more sensitive test is where a test will use IV contrast to be able to tell you how much stenosis or block you have in your arteries, but also will tell you how much salt plaque is in your arteries. So this as your follow-up CT angiogram. So plaque on your scan showed you had 1,265.6 millimeters a total plaque. This is a high-risk finding. 250 is a cut point for kind of low-ish risk, 750's high risk, over 1,000 is very high risk. Therefore, you're on an aggressive protocol

to try to stabilize this plaque. It then quantifies it by what type of plaque. The low-density plaque that's not calcified or think of it as salt plaque. This is the more inflamed plaque possibly. And this is the plaque that's more prone to rupturing and causing a heart attack. Then there's the 935.1 millimeters of non-calcalfide salt plaque. So this is the lipid-rich plaque. So first, stop doing the damage. If you get your lipoproteins into that kind of fifth percentile where you got an LDL cholesterol, 55 or lower, or you have an APOB from an advanced test that's 55 or lower, you then will generally start seeing less buildup of this non-calcalsified plaque, and then you can start delipidating it or shrink.

I do want to comment for a second here. I want to say that. So I utilize rapatha, and I kind of forget some of the other stuff I'm on, but I was on Ruvostatin, but I switched over to like exetamide. And what do people sometimes recommend with exetamide, do you know? So there's four classes of medications that have MACE data, meaning major adverse cardiovascular end point data. So blast, heart attacks, strokes, stents, dying,

the things the patients care about. So statins, PCSK9 inhibitors, azatomide, and then there's something called Bempidoic acid. That's what I'm on a combination of that, exetamide and that. And that's usually called Nxtlatal when it's in the combination. So Nexitol is kind of for people who can't

tolerate higher dose statins. It is kind of for people who've had a lot of muscle symptoms on statins because it doesn't have receptors in the muscles, so you can't really get muscle pains with that medication. The challenge with the Bempidoic acid is that it's just not very potent, so meaning it doesn't lower the aldeol cholesterol that significantly by itself. So usually you're adding azatomib or PCA-Skinion inhibitor to it, depending on how high your lipoproteins were starting, and then what is your ultimate goal.

I also would like to say that I did my own experiment, which I don't recommend that you do this experiment, but I wanted to kind of say. for myself because I've had a lot of blood work done over the years and sometimes it's not always easy to make sure that you're getting like similar blood work done. And so I wanted to see, because I didn't have previous results of my LP little A and I wanted to see where my LP little A would go without the drug Repatha, which is a PCSK9 inhibitor. Did I get that right? That's correct. You got it. Awesome. There we go. So I used I did a test and I didn't have the rapatha and then my, I'm sorry, my, um, uh,

lipoprotein A did go up significantly. It wasn't like in some alarming number, uh, but it was, it was pretty high and my, um, and my APO B. And I know, I know the LP little A is like a little bit more associated with like genetics, uh, but that even moved for me. I, you know, whether it was direct, uh, result of the rapath, I'm not sure, but that. Apo B definitely made a huge difference there. And then also I have messed around too with like, because when I utilized statins, I don't know if it's more on the mental side or what it is, but I did notice like being a little weaker and some different things like that.

So I was like, all let me just kind of see how it is without them, you know. And so I either took way less or I removed them completely. And I just, for me, I just can't remove them completely. I cannot be on a diet, whether it's like do or die or not, that doesn't have any saturated fat in it. Now, I can cut my fats way down. I can cut my fats way back, but like trying to have me on a diet that there's no saturated fat in. I don't even know if that's a healthy thing to do in the first place, but it's just not for me.

I like to have at least some saturated fat. So saturated fat stays in and some of the pharmaceuticals. That's where some of the pharmaceuticals come into play for me. And I know some people, they get real emotional about, you know, particular diets. They get real emotion about particular drug protocols or even somebody using pharmaceuticals. But you have to keep in mind that we have some data here that shows that I'm at risk. And so to me, it only makes sense to like try to follow the protocols. Now, I know that I'm sharing with you that I've gone rogue a couple times, but it's like, you know,

sometimes you've got to learn for yourself a little bit. So I've been trying to experiment a little bit, trying to, within the confines of this, of this box that I got to kind of live in until I can figure out ways of getting rid of some of the plaque. Sure. And, you know, you're just doing a good risk analysis. This test tells you're very high risk of having a cardiac event unless you do something different than what you used to be doing. And you've obviously lost weight.

You're probably more metabolically healthy at this point. You're headed in the right direction. You're trying to mop up any of the mess in the past and stabilize this and keep living your life the way you want to live your life. So, you know, the plaque tells us you have a large burden of the plaque, but you did not have severe stenosis or blockages. So you're not going to feel these even with peak exercise. So the way that I look at this test is that you think that is?

Why do you think like I'm just lucky? Like, because somebody could. have similar, right, someone could have similar situation, it could have a similar scan or score, but they could have like a lot of blockage. And for some reason with me, I'm fortunate to not have a lot of blockage. Correct. And you're also doing this of the test where this is a, you know, relatively new test. You know, you got this initially in like June of 2021. So it's only been on the market five, six years. And previously, people who weren't having symptoms rarely went to look to see did they have plaque in their arteries. So most people who would see a cardiologist had chest

pain, short pain, short pain, short form of heart disease and their dad or their uncle, for example, like, and they just want to get checked out. So you're just being proactive to see, like, what happened from all your years of previous training did it cause a problem? And yes, there is some evidence that it did. But plaque tends to grow outward first, it's called the Glasgow principle. The artery actually gets bigger first is the plaque grows outward, and then later the plaque starts growing inward and starting to restrict the flow of the arteries. But most people will not have symptoms until the stenosis of the blockage is somewhere near like 70%. Once you're around 70%, you're just not getting as much oxygen nutrients through the restricted lumen. And so at kind of increased heart rates

with cardio, the tissues downstream aren't getting its oxym nutrients. The heart doesn't contract well and the person starts feeling pain, pressure in their chest, shortens of breath, or they're just like, I can't do this anymore. They stop the activity and the heart rate goes down. The symptoms go away. So that's stable angina. That's advanced coronary disease. Those people end up turning a lot of medications, and often they're getting revasperized with

stents or bypass surgery. So you don't have any of them to that where you're going to require a stent or bypass. It's just very aggressive lifestyle interventions, pharmaceuticals is tolerated and some fine-tuned supplementation and test. don't guess, come back and look and see what's going on with it. But I did want to show people like, what does plaque actually look like? So we'll just pick one of your arteries as an example. So this is the right corner artery.

So in this picture, this is where the blood is flowing in the lumen. This gray black tissue, this is the heart tissue itself. So the plaque is color-coded in this example. So the yellow plaque is the non-calcified plaque, the quote, salt plaque. The blue is the calcified plaque. This is the plaque that would show up on a CT-corner calcium scan or a KEC scan. But this number, it's apples and oranges comparing it to a calcium score test because this is measuring the millimeters tube to the plaque. But if you have a positive calcium score test, you're going to pick up the calcium score test.

But what this test picks up that a calcium score test doesn't pick up are these two types of plaque. The good news is, at least in this artery, you didn't have any of this low-density non-calcified plaque. So if it's red, think of it's like plaque that's on fire and more prone to red. rupturing causing a heart attack, but you have a large burden of this soft plaque, and it's mostly in this proximal portion of the vessel. So the computer does its analysis and says that this is a 36% blockage. If you were in the cath lab, you probably would call this something called luminal regularities. Like it's mild, doesn't need a stent, you know, treat with medications. So the plaque is growing outward first. There's not a lot of it, you know, blocking the arteries. So sometimes

it's how patients, think of this like an iceberg. You want to keep it in this stage. You don't want the iceberg to start restricting the blood flow or a volcano that starts rupturing and the blood's clotting. You know, I think the difference between the tests are interesting. A CAC is quite a bit less expensive, right? And sometimes, you know, if you're a younger person and you're just kind of like just checking and kicking the tires, I don't know if your insurance will pay for that. And I'm pretty sure your insurance, won't pay for a CTTA, and I think that those can be pretty expensive, maybe unless you have symptoms. Correct. If you have symptoms, then a CT Cornyandrogram or CCTA is indicated. It's in the guidelines. You can do a stress test or you can do a CT cord angiogram. And if you're having symptoms,

generally insurance is going to cover those type of things. But if you're just a curious person, like do I have plaque and you're doing this as being proactive, you're going to be paying out of pocket for these type of test. And it depends on what Mark you're doing and determines like kind of what the price is. But on average, you know, a CT coronary calcium score test, you know, it's somewhere generally between $100 and $300 out of pocket. But a CT angiogram can be anywhere from $600 to $3,000. And then you're adding in kind of the AI analysis. And that's usually another $750 to $1,000 to have this kind of quantification of the plaque. So sometimes all in it's, you know, a $2,000, $3,000 test. Yeah, my buddy, Joel Jameson, he found a place that he can go to and just pay cash, which I think is really nice.

But he said it's still pricey, but I'm going to try to track down some CTTA scans or companies that will work with you guys a little bit easier. So that it's like just not such a pain in the butt. It doesn't cost so much money. I'll see what I can do because maybe if we just get more people to get scanned and tested, maybe they'll bring prices down. or maybe for the podcast or something, they can give people 20% off or something. I don't know. It is pricey, right?

And, you know, if you're out the door for 3K or 5K, man, that is a, it's a lot of money. But this is important. Like, this is a really important thing. Do you think maybe for people who are trying to decide and they're kind of like, oh, man, I don't know if I have the dough to do that, just get the CAC.

Do you think that's an effective first step? Start there. And oftentimes that's where I will. recommend people consider it. Now, I used to say, like, probably would have to be over 40 before considering it, but I've been seeing more and more early plaque in people that's pretty high risk. So I think if you're over 35 and do you have a family history of heart disease where, you know, dad had a heart attack in his 50s, probably 35 is the time to start thinking about that. But again, the challenge of the calcium score test is it only finds hard calcified plaque.

Autopsy studies from the Vietnam days show that, you know, soldiers who are 18 killed in combat had soft plaque in their arteries. So you're probably laying it down much earlier, and it's only calcifying later in life. So you don't want to miss the people are at high risk. You're still going to kind of blend some biochemical, like does this person have an l-dial cholesterol of 200? That probably has a genetic abnormality. Do they have uncontrolled diabetes? Okay, treat it however you're going to treat their metabolic disease. But calcium score test for many people is a good starting point. It's just not sufficient if you're really concerned of the person's higher risk. Because people who have a calcium score of zero, they can still be putting

soft plaque in their arteries. And oftentimes if you do the more kind of definitive CT angiograms, you're going to see plaque in people who had a calcium score of zero. But if you're like, hey, a couple of thousand dollars is just not going to work right now. Start with the, you know, the low dose calcium score does. Say, okay, score zero, you're relatively low risk over the next, you know, five years. But it's not a permanent low risk. You have to kind of to continue to do whatever you need to do to optimize your lifestyle, look at labs if you're looking at the labs, and then retest at some point. So if your calcium score is zero, good for you, but likely you'd want to repeat it somewhere three to five years down the road to make sure

it's still low risk. I would say that if you're kind of scratching your head right now and you're like, you know, I kind of, you know, I do have my LDL is like, you know, a little high here and there. I don't know about APOB. I haven't gotten that tested, but my blood pressure is high here and there. you know if you're if you're just kind of thinking in those terms and I think you should definitely look in to get in the CAC it's it's worth like it's worth looking at it's worth take you know because again heart disease is something that happens over a long period of time and you know there's some people on my Instagram and there's going to be more and more people coming at me but I I don't mind it because what I'm what I'm hoping is with sharing this that it's going to

really help a lot of people so the heck with the people that kind of have the negative comments but And I understand it too because I'm somebody that gets passionate about powerlifting or passionate about a low carbohydrate diet or something. So I understand people saying, hey, you did it to yourself. And maybe I did. But we have to also keep in mind that I'm the same person, even though I'm regimented these days and I do certain things these days and you guys have seen some of that, you got to keep in mind that even though I've been on, you know, social media and YouTube

and stuff like that for a long time, you haven't seen my life, you know, way before that. And so as a kid, I would eat Oreo cookies and Doritos. Like, it wasn't horrible. I wasn't like a tremendously obese kid or real fat kid. I was very active and I always loved lifting. But we can't forget that whole other part of my life before the internet came along and before people ever really saw me. That was a contributing factor to the way that things are now. And just for the record, I take full responsibility for anything that I've done, whether it be alcohol or which I have never really gotten into drinking a lot of alcohol. But whether it be steroids or whether it be the fact that I followed a ketogenic diet for a long time because maybe, and we could circle back to this now, the saturated fat and kind of LDL conundrum, you know, I did consume a lot of saturated fat for many years because I was just like, hey, this works great for me. I can lose weight this way. I'll just consume, you know, I'll consume as much

saturated fat as my, as my body can, as my body can kind of take in per day. And I know that I'm having Dominic DiAgostino on the podcast, he said he's having, you know, 400, 300 to 400 grams of fat a day. But I don't, he's never had a scan. You know, he said he's never had a CAC and a C-T-T-A. And I was like, maybe you should. But again, there's a lot of, there's, there's so many other risk factors that, that pop in there. It's not just the fact that you're eating saturated fat. You know, I don't think Dominic is a very smart guy. And Dominic's LDL and all these other things aren't off the charts.

He doesn't have high blood pressure. His hematocrats not high, you know, stuff like that. So it's like if you start to see two or three things where you're like, ah, that doesn't look great, then you're definitely someone that needs. needs to, in my opinion, it would be really wise to get scanned. But what is some of the relationship between saturated fat consumption, maybe even some people that do a keto diet, and our cholesterol? So saturated fat in some individuals significantly raises their LDL cholesterol fraction. Not everybody. Tends to be more in the people who have an APOE for allele. E is an echo. So APOE, you get one copy

from mom, you have one copy from dad. The patients with APE4 alleles are at higher risk of coronary artery disease, diabetes, dementia, and they don't tend to tolerate high fat diets as much as people have an APOE 3 or an APE2 allele. Not everybody, but the people who have this response will have an issue. Generally, it has the saturated fat basically tells the liver don't make as many LDR receptors. So the liver makes these LDLR receptors, which are kind of like the cargo docking stations for those tennis balls. If you don't make as many docking stations, these things are just continually floating through the blood, waiting to find their off ramp. But if you have a baseline panel, even if it's just your traditional cholesterol panel, you change up

your diet, you start eating keto, you start eating carnivore, which a higher saturated fat version of carnivore, and you see your LBO cholesterol, for example, go from 70 to 200, you're probably one of those sensitive people. You can do the confirmatory genetic testing if you desire. You know, there's a company that will look at well over 100 genes that affect your lipid metabolism, and oftentimes you find the exact gene that causes the problem with the fat that you're having a problem with, and then you get to make the decision. If that diet is the thing that makes your brain work as great as possible, you sleep awesome, you have energy in the gym all day long, and it, quote, messes up your cholesterol, are you willing to take therapy to, quote, treat the cholesterol? But the people

who need to be more aggressive are the people who go looking and see, wow, I have a lot of plaque in my arteries. There's no guarantee that just because you're metabolically healthy, that you're not laying down plaque with these high LDL fractions. You're kind of an end of one. You're doing your own experiment. So it's one of those things where it's like, I see it all the time. This is kind of the lean mass hyperresponder phenotype. You know, they don't have high triglycerides. They don't have high insulin or high blood sugars or high chemical when anyone sees. They're thin. but they still may have significant oxyof stress and inflammation. They can still have endothel dysfunction because they have issues with endothel nitric oxide

synthase. They may have a 9p21 gene. The heart attack gene, which affects the smooth muscle arteries, has nothing to do with cholesterol. So you don't know unless you go looking. As you said, there's many things that can damage the arteries. It numbers three to 400 things. You can't fix them all, but you have to go looking for it's like, okay, do I have a lot of plaque? then I need to be more aggressive doing whatever I need to do to try to stabilize this plaque.

Man, three to 400 different things. A lot of stuff coming out of us, you know. And I think, you know, figuring out ways to like manage stress, whether the stress is self-induced from, you know, lifting or or some type of training protocol. It's like a lot of times, you know, I'm thinking of myself, you know, going from powerlifting to bodybuilding to marathon to like it's like I keep I keep gravitating towards things that are they're pretty intense you know they have they have a certain intensity to them and unfortunately it seems like the healthiest thing would be to be a little bit more in

the middle you know go to the gym maybe get after it here and there but you know do some leg extensions do some curls do a little bit of cardio and call it day, you know, type of thing. It'd probably be a much, uh, much safer thing. But at the same time, you're trying to figure out like, what's fun, you know, what do you, what do you want to do that's like entertaining to you or what, you know, following some of your interests. And again, I'm not saying to like, you know, fill your cabinet with pharmaceuticals and supplements, uh, so that you can just behave whatever way you would like. Um, but there, there is, there is a little bit, Like there's people that take diabetic medication and they'll have a little cake on their birthday

or something like that. Right. Like so there's there's these things that when I think about it as just being a logical or rational person, it's like I think that makes some sense, you know, to where you can still enjoy some of the things that you've always enjoyed or maybe you're just enjoying them slightly differently. Yeah. I mean, what is the kind of game playing for your life, you know?

Yeah. We're all going to have a certain amount of days on this planet. what do those days look like? Ideally, you have many decades in front of you. What do you want to be doing when you're 80 years old, if you want to make it to 80? What activities light you up? What do you got to be doing now

to kind of roll into that as a healthy 80-year-old? So, yes, sometimes you have to be a little bit restrictive with certain things, but you're not going to want to live a monk life to say that there's nothing that you can do that's fun. There's nothing you can do that's enjoyable. Because how much stress you're going to have in that case if you don't have socialization,

if you don't do something that lets the seam off. You're probably going to have a miserable life. You're going to have a shorter life. So it's not saying let the good times roll always, but you do have to enjoy your life along the way. Yeah, and I think there is some data, like, you know, there's a lot of evidence about how bad alcohol is. But there's also some information that some people that just let loose and have a little alcohol here and there live longer. It's probably the socialization part of it that does that. Yeah, just kind of just having, you know, having a good time type thing.

Let's talk a little bit more about the scans. You mentioned stress test. I know there's like some EKG tests. I had an issue years ago where I was waking up early training and I was doing some like boxing type training. And I don't know. It was just intense. It was hard. But I was waking up super early going to do it.

And then I kept having this like kind of pain in my chest. And it was off to the left side. And I was like, I don't know what that is. I don't know if that's my muscle or called one of my friends. It's a doctor at the time. And I was telling him, I was like, I have like a spasm. It's like, well, a spasm in your, it's like, that's like your peck. You know, that's not your heart, you know, but he said if you have any doubt,

then you should definitely get it checked out. And so I went and they put me on a treadmill and they gave me this like stress test. And it was actually kind of hard. I can't remember. I think they had me like running on a treadmill. I'm like, how am I running on a treadmill if I have a heart problem? This doesn't make any sense to me. But they did a test that way, and they did a test where I was also lying down.

Luckily, nothing came of the test. I was fine. I think I may have, like, slightly just hurt myself or tweaked something that just happened to be in that location. But, yeah, what are some of these other different types of tests we can get done? So the kind of bucket you can put in is like, is it something electrical, like a wiring problem, or is it a plumbing problem, like a artery problem? So if it's more that the person's having skipped heartbeats, fast heartbeats, slow heartbeats, feel like you're going to pass out.

You're going to do some type of electrical workout or workup. You'll have an electric cardiogram or EKG. They put the stickers on your chest. They're measuring the electrical activities that comes out of the heart. The cardiologist looks at the EKG and sees, is there any problem with your sinus node or pacemaker or is there any evidence that you're throwing early beads? They may put a heart monitor on you so that you wear basically the EKG. with a little box and you go home for two days or two weeks or a month to see, you know,

do you have atrial fibrillation or, you know, some other heart rhythm that is causing you those symptoms. Oftentimes then they're going to recommend doing like an ultrasound to your heart, an echocardiogram. So that's generally the test where you're lying down. They put gel on your chest. They use an ultrasound probe. They take pictures of your heart so then they can measure how thick the heart is, how enlarge the heart may be. You know, what is going on with the valves, you know, that's something where that's very common that you're looking at if people have rhythm disturbances. But if you're more concerned that this is a kind of a plumbing problem, you're having a lot of shortness of breath with exercise, you're having tightness in your chest,

then you're going to do generally a stress test. And, you know, you will put people on a treadmill, even if they're having symptoms, depending on what symptoms, to see can you recreate their symptoms under a stress that is being supervised? Can you see EKG changes while they're exercising. Can you see wall motion abnormalities if you're adding ultrasound imaging? You know, so they run on the treadmill and when they're, hey, that's it, I can't do anymore. You take them off the treadmill. You look at the heart when it's under peak activity and the heart should be pounding and you should be able to see all the walls squeezing together. If one of the walls isn't squeezing very well, that's often a sign that there's a blockage in the heart arteries causing that because

that tissue doesn't get oxygen and it won't contract. Then the test that we've been talking about is like when you're looking for plaque, then maybe somebody's not so symptomatic. You may be doing an ultrasound of the carotid arteries to look for plaque in their crotid arteries. You may be doing a CT coronary calcium score test or CT corny angiogram to look at their heart arteries. And then oftentimes, you know, I recommend people get a test that looks at the flow to their legs.

You can start off with some called an ankle brachial index. It's basically taking blood pressures in your arms, comparing to the blood pressure in your legs. your score should be greater than one if you do that ratio correctly. That is a quick test to tell you that is it likely to have what's known is something as peripheral arterial disease? Basically, do you have blockages in your leg arteries? Blockages in your leg arteries presents a little bit differently. You don't have chest pain, but you may have leg pain, calf pain with exercise that stops when you stop exercising.

It's because you have a blockage of the arteries going to the muscle, essentially. or if you're somebody who had a lot of leg hair at one point in your life, and I usually tell guys that, like, if you've never had leg hair, don't worry about this. But if you had leg hair, and you kind of rub it off with your socks, that's not the problem. But if you had a lot of leg hair hair hair and also, you see it receding, that's often a sign that you're losing blood supply to the hair follicles in your leg and the hair follicles fall out. You probably have blockages in your leg arteries. So that's a sign you have Athloscrosis. So you have nearly 60,000 miles of blood vessels, you don't develop it in the same territory all at the same

time. But younger people tend to develop more on their legs first and carotids and later in their heart. So if you only look at their heart, you're going to miss the other two areas. The other thing about heart disease, too, that's tough to, you know, at least in the study that I'm in and the people I've observed that are in the study, there's only like, there's only a couple people that are like heavy, you know, there's a couple people that are like a little bigger because like they lift and stuff. What's the correlation between that? Like, is there some general recommendations about like waste size and things like that that you've

seen like that, that, you know, you're like, oh man, they said that, you know, 30 years ago, but it's still the case today. Like if you have a, you know, 34 inch waste that you're most likely not going to run into these problems, but maybe maybe you still do. Yeah, generally, I think it's like 40 inches for a man around their midsection, 35 inches for a woman. You know, you can just use a tape measure. You can use your eyeballs. If you have more abdomen over your belt, that's probably an issue.

And it's not the kind of subcutaneous fat that is cosmetic. It's just that the more subcutaneous fat that you have, the more risk you have is more visceral fat, the fat that kind of lined your organs. And that visceral fat that surrounds your liver can contribute to something called fatty liver disease. If it's in your pancreas, the pancreas will start failing over time and you become diabetic. You can have fat around your heart tissues. There's a very interesting, you know, imaging technology coming out right now called christo. And it looks at coronary inflammation.

It looks at the inflammation in the heart arteries, mainly from the fats that surround the heart arteries. And the people who have inflamed fat around the heart arteries are the people who are at much higher risk of having a heart attack. So it's the fat around your tissues that is the concern when you see a lot of external fat. It doesn't always mean that they have high visceral fat, but you can do imaging. You can do CTs or MRIs to look for the fat. You can do a dex scan to quantify how much fat you think the person has viscerally. And then you make a plan on like, how do you treat this person? Yes, there's probably going to be some type of dietary intervention, but you're also going to probably have some type of strength training component so that your muscles are more activated.

you're trying to reduce your insulin resistance. You've got to manage your stress to decrease your cortisol. You've got to sleep well to have good functioning mitochondria. It's a whole kind of process to try to reverse a lot of that inflammatory fat that's basically coating the arteries. What about some of the work from Dr. Omera? Are you familiar with some of his work where he talks about like sprinting and how sprinting can get rid of visceral fat?

and he talks about, you know, people getting, I think, MRI scans. Do you think it like, I mean, I'm just thinking of overall health and heart disease in general, how important is it to potentially get an MRI to kind of keep tabs on how much visceral fat you have? I mean, it would be very educational for people to have that, but then again, you're looking at, you know, price versus what are you going to do about it? So a Dexascan is much more affordable, more accessible to most people. To do kind of a full body head-toe MRI. You're looking at $2,000, $3,000 again to get those type of scans.

And they suck. It sucks to sit in those late laying those things. Yeah, I mean, I saw a patient today. Like, he's super fit, but highly claustrophobic. Like, there's no way he's going to lie down for an hour and get this type of scan. Yeah, it's kind of the same with me. I do think Dr. O'Hara, I do think he's got some good ideas about, you know, cardio activity, maybe being a little faster, doing some sprint work and stuff like that, obviously,

and people that are already healthy. And this is, you know, again, to, you know, maybe target that kind of visceral fat that people may accumulate. What's athletes' heart? Have you heard that reference before? Yes, I mean, it's generally, you know, picked up on either an EKG or, you know, the echocardiogram, the heart ultrasound. There's some adaptive responses to exercise as you have to start increasing your stroke volume, so how much blood gets pumped out of your heart with each heartbeat. Oftentimes, the atria will start to enlarge so that you have more blood volume to be ejected

with each heartbeat. And then oftentimes the left ventricle will either start getting more thick or more dilated in certain cases. Tends to be more, and the strength training people, they tend to have the thicker hearts and the people who tend to be more, you know, cardio-driven, they tend to have more of the kind of the dilated hearts, you know, and then one of the things you kind of mentioned earlier is that, you know, when people are utilizing anabolic steroids, one of the things it does is that your myocardium, your heart is a muscle. Those compounds will also tend to make the heart muscle grow and get thick. And then that puts more stress on the heart. Often your blood pressure increases. And so it's something where, you know, if you're not, you know,

adding, you know, antibiotics to the situation, you know, athletes' heart is generally something that is not going to cause long-term issues from a kind of performance standpoint. But there is still the issue that, you know, you may be overtraining at some point, having a little bit of low-level inflammation all the time, and you may end up developing coronary disease, but that's different than an athlete's heart. It's kind of more the adapter response to kind of chronic, kind of high-volume activity where you need more stroke volume. part of the reason why some of these, I think, TRT clinics have popped up and HRT and so on and why they become so popular is because that to just go out and take some testosterone,

you know, there are some differences between steroid cycles and just taking some TRT. Legitimate replacement dosages, I think people could argue back and forth, whether it's healthy or not healthy, but you probably wouldn't really get anywhere. There's some good arguments on both sides, I think. I think that once you start to get over that amount, that's when you start to get into, a lot of things can happen from taking, you know, large doses of testosterone. One, your blood pressure could increase. Your hermatic rate could increase.

So think about the pressure of your blood is higher and then your blood is thicker, you know, and men sometimes already have, you know, high iron and huboglobin and some of these different things. Hopefully I'm saying some of this stuff, right? But the blood can get like sludgy, you know. And then on top of that, sometimes people take like fat burners or pre-workout. And so now they're taking things that are maybe, you know, getting the heart rate up a bunch. And then they're going to the gym and they're training. And it's like, well, I don't know, like maybe doing that a little bit.

Like maybe isn't like the end of the world. But you start doing that often. And like, again, with me, it's like, I don't know exactly what the cause is, but I'm not dumb or numb to the fact of what I've done with my training over the years. You know, the powerlifting stuff that I was doing, holding your breath, getting your blood pressure to these like, you know, catastrophic numbers while, you know, being under 1,000 pounds. And then on top of that, yeah, I am on performance enhancing drugs and I was on a lot of them.

And my blood pressure was also really high. So it's kind of amazing that I didn't like drop dead from doing that. It's amazing that's that your body could go that far because, and I'm not even saying like, you know, that that should necessarily kill someone in like two seconds flat, but it's, you know, to think about it now, I'm like, holy shit, like, man, that was a lot, but that was everything to me. That was what I was into. Just like somebody might be into race and motorcycles or somebody might be into skateboarding doing some extreme games or extreme sports.

That's what I was locked in on. That was my life. That's what I enjoyed. Yeah, and those guys, they're probably going to meet some orthopedic surgeons at some point in their life. It's like you choose what risk you're willing to tolerate. It's just going eyes wide open. What do you think about the Donald Trump method? I don't know if you've ever heard Trump talk about exercise,

but he says he kind of believes you only have a certain amount of heartbeats. and he doesn't want to use up all his energy. I think it's an excuse for him to not work out. But, I mean, just thinking about that as a thought experiment, has that ever been a finding of anyone? Has anyone ever said, okay, well, we got two million beats or something in our lifetime? Is there anybody ever studied anything like that before that you're aware of?

I mean, that's outside my air of expertise to know that for a fact. But, I mean, I've definitely heard those type of thoughts. that there is a, you know, kind of a limit. And, you know, but it's sort of like, you know, you have to kind of figure it out. Like if you're exercising, you have a higher heart rate during the exercise. But then you've trained your nervous system to have a lower resting heart rate. You know, the highest performance athletes generally have heart rates in like the 40s, you know, maybe even lower. Yeah.

So they have low heart rates for the rest of the hopefully 23 hours a day. And so it's the people, I think, who are high endurance all the time doing eight hours a day of training, they're maybe burning up that kind of whatever limit they have. Right. What diet do you usually recommend to people? We only touched a little bit on the like leafy greens and fiber. And that's definitely an area that I still need to do better with. I do eat some fiber, but I'm definitely not upwards of like 30 grams or anything like

that or even maybe it might be rare for me to get to 20. But yeah, what kind of diet do you usually recommend to people that, Maybe you already have a little bit of plaque or trying to reduce it. So, I mean, from a plaque stabilization standpoint, you know, the one that's going to have the most data behind it is a Mediterranean type of template. You know, you're eating a lot of, you know, dark green leafy vegetables for the polyphenols, the nitrates. You know, you're probably eating some amount of seafood. You know, I tell you're like, seafood is brain food. The DHA that comes from the seafood is very important for the neurons in the brain.

The EPA that comes from the seafood is very important to help you keep arterial inflammation low. It also somewhat thins the blood out. It can stabilize the plaques. Maybe you're eating some olive oil, so getting some other polyphenols and olive oil. Then it's really about, you know, what are that person's goals? So there's a lot of diets that can work for people. You can do genetics if you like to kind of figure out like, do you really want to optimize, you know, to be more kind of fat burning or carb burning?

But I think that's sometimes a lot of social media noise when you just high, hyperfixate on that, this is the only diet that can work for the person. I tend to think about things as like, how does your body make energy? And it's going to be the kind of the light that comes into your system and how your body's absorbing that light. And then it's how does the mitochondria actually take the foodstuffs, strip out the electrons from the carbs and the fats, and run it through the electron transport chain and make ATP on the other side. So you can do that with carbs. You can do with fats, but ideally, you're going to do it with whatever is the seasonally appropriate diet for you. So I saw a patient is like, imagine it's 1850. Wherever you're living at that moment,

whatever seasoned it is, you walk outside your door. What are you going to be eating? It's probably growing in your neighborhood, or it's an animal that lives in your neighborhood. And if it's Scandinavia and the ground is frozen, you know, whatever, nine months of the year, you're probably eating a lot of animal products because food isn't growing in the ground at that time. So it's really going to be specific to the environment that you choose to live in. I love those thought processes. I think that that's, I mean, it sounds logical, you know, not to just be drinking like endless amounts of orange juice in February.

Right. When you live in a climate that's really cold where you just wouldn't have that much access to that. Not that you have to live that way all the time, but it's a decent experiment to kind of walk yourself through. And I always tend to like a lower carb diet kind of in general, but especially at the it gets colder out. And then I notice any time the season starts to change, as soon as it starts to get warmer, I start to really crave fruits and things like that at that time. But I definitely

need to do a better job of getting in some of those leafy greens. I did want to mention the sugar diet. Now, you know, some people are like, hey, I think you did it to yourself with the sugar diet. The sugar diet is something I did just for a couple months, you know? So can you do damage in a couple months? Sure. I think you probably, I think we could. Could I all agree? Yeah, you probably could, but I don't think that was doing anything too crazy. And my lipid profile and stuff was awesome when I was doing that diet because I wasn't eating hardly any fat. And I was taking rapatha and the lipid lowering drug.

So I was kind of okay in that time. Yeah. Were you wearing like a continuous glucose monitor during that experiment? No, but that would have been amazing to watch that thing freak out. that thing probably would have been going crazy. Yeah, and that's why I tell people was like, you know, carbohydrates is a fuel, you know, how much muscle masks you have, how much activity are you doing, determines how much fuel you can tolerate per feeding, essentially.

You know, if you're Michael Phelps and you're swimming eight hours a day, you're eating 10,000 calories. You're having a whole lot of oxidative stress to kind of metabolize that amount of food, but he didn't get morbidly obese. He was utilizing that fuel source right then. And so if you were at the continuous glucose monitor, sometimes you figure out like you're more sensitive to rice or potatoes or that you just can't eat 50 grams of carbs anytime you want unless you're active. You know, if you put your carbs in

and you go for your walk afterward or you go knock out some wall squats, your muscles are going to use that glucose preferentially right away and they're not using insulin to kind of pull that glucose in. So people have kind of these fluctuating blood sugars. That's the kind of the first sign that there's probably going to be a problem with your metabolism and those kind of fluctuation blood sugars are going to require you to secrete more, more insulin to try to bring those blood sugars in check, and high insulin and high blood sugar both damage the glyco calyx. They damage the lining of the artery that kind of opens up the doors for you to start laying down more plaque. So if you wear the monitors, you generally want to keep your blood sugars, you know, sub 140.

If you're saying these blood sugars go to 200, then whatever you're doing is not being metabolized while for you at that time. I think energy toxicity is a really interesting conversation and topic because you would just think, like just, you know, my observation and all the, all the stuff that I've looked at and researched over the years, I'm like, well, I think, you know, so much disease lies in energy toxicity, people just consuming too much. And so, therefore, you know, just don't get fat. But again, it doesn't seem like that's the only thing at play. And I just, I find that to be really fascinating.

Like, why, let's say you barely exercise, you know, you exercise a little bit, you know, you're in the middle of the road for, everything and you weigh your six foot you weigh 175 or 180 you're not fat you know you maybe have done construction on and off most of your life you get outside you do all these things and there you are still your body's full of tons of plaque that's like to me that that kind of boggles my mind because i'm like it doesn't it doesn't seem like that guy did a bunch of stuff to basically you know earn or get that plaque you know he didn't take any drugs or smoke or or drink or you're just like, you're like, damn, like, what, you know, what made that person's body respond that way? And sometimes, you know, it could be some, maybe some things the

person did when they were younger, maybe there's some bad habits or something like that, but it's not always attached. You know, I think we have to be quick with our, we have to be, uh, considerate with our judgment, uh, to place judgment on people right away. If people want to judge me, it's fine, because I put a lot of stuff out there and it's, I'm fair game, you know, But I think to judge other people and the judge family members, I think you've got to be kind of cautious with that. Because we still don't, there's definitely things we know and you're talking about the breakdowns of the endothelial cells and the glycochalids and all this different stuff that we can't really see or we can't really tell or feel. All this stuff's kind of playing in the background. It could mainly just be genetics.

There's going to be a large genetic predisposition for many people. but I mean I've definitely seen morbidly obese people who have completely clean cornered arteries. They have no observable plaque. And I've seen triathletes who had heart attacks while they were on the bike. So just because you're thin doesn't guarantee you're knocking out plaque. And just because you're heavy doesn't mean that you have tons of plaque either. So tests don't guess. Do these type of tests we've been talking about.

Get yourself a calcium score test or upgrade to a CT angiogram and look for the salt plaque. Then you really know what you're dealing with. You know, diet and exercise, yes. It is a bedrock. You should be focusing on it. But there's so many other things. If you're not managing your stress or sleep, look there as well because those are so critically important.

There's going to be the diet wars online probably forever. You can argue like, you know, do you need to do more strength or cardio? It's like do a combination of both. But if you don't manage the stress and sleep, which most people kind of ignore, you're still probably going to hit up with vessel disease sooner than you expect. Doctor, if you could give us maybe five or six or so things that we should study and continually monitor, that would be fantastic. You know, what comes in mind for me is the LDL, APOB, LP, LP, A, blood pressure,

but maybe you have a couple other to add to the mix. That would be, and also maybe what particular ranges to try to make sure that those numbers stay within. So I usually like to break it up into the biophysical and the biochemical. You need both because your labs don't tell the whole story. So first, go look at the rdase themselves with a CT coronary calcium score, a CT corn angiogram, a carotid scan, a peripheral disease scan, figure out how much plaque you have. Then start looking at the blood work. But before the blood work, what's actually going on with things that you can measure at home? You can monitor your blood pressure at home. Ideally, the blood pressure in your arms should be 120 or 80 or less. If it's higher in that, once or twice, not an issue. But if it's consistently one-frews 40 over 90 and you've done whatever lifestyle intervention you're doing, you need to be talking to your health care provider to talk about what therapies you can do to get the blood pressure back down.

Because high blood pressure is the silent killer. You don't usually feel it. Some people have vision changes or headaches, but most people don't know they have high blood pressure until somebody goes monitors it. And a blood pressure at the doctor's office is something maybe you're only doing once or twice a year. So what is your blood pressure doing the rest of the 364 days that you're out there? then the blood work. So usually break it down to three categories. So from an etothelial lining kind of testing, I would be looking at the urine microbiome and cratinin ratio. The test is used for people who are diabetic, but if you're spilling protein into your urine, you're damaging the lining to your kidneys, you're often going to be damaging the lining to your heart arteries or your brain arteries.

You can look at uric acid. Uric acid, high can increase the risk of gout. crystals in the joints, not fun, but high uric acid damages the glycopalix. And high uric acid is kind of a byproduct of how well your body breaks down protein, fructose, or alcohol. So if you're a high consumer of one of those things, you might have to adjust it. High homocysteine is associated with elevated asymmetric dye methyl arginine or ADMA. Those compounds lower nitric oxide that can make the artery stiff. After that bucket, I would be looking at the oxy of stress and inflammatory markers.

You can look at HSCRP. Generally, that value should be less than one. You can look at oxidized LDL. When the LDL gets oxidized, it's been modified or damaged. That oxidized LDO is kind of the building blocks for more plaque in the arteries. Different labs have different cutoffs for the oxidized LDL, but you want to be in the green zone on those labs. There's a couple markers that are more specific to the arteries sometimes called LP, PLA2. or the plaque test, and then myeloproxidase.

If those are elevated, oftentimes there's some, you know, inflammation in the artery lining, there's plaque being kind of actively laid down. And then the third bucket would be the lipoproteins themselves. So, yes, go ahead and look at your total cholesterol. You know, I don't look at that as a predictor of risk personally, but if it's over 300, you probably have a genetic abnormality. I will look at your H.O. cholesterol and triglycerides. You know, the lean mass hypersponder responders are hyperphorferocer,

focused on that, you know, the ratio is one and they're probably not, you know, metabolically unwell, but there's a lot of people that have abnormal ratios and they're still metabolically well. So I don't care too much about, you know, what your H.L. Tricloseride ratio is. I just kind of look at like, if your HL is really low, maybe it's genetic, but you're not trying to optimize HDL with medicines or drugs, trying to see, like, is it inflammation suppressing it? I'll look at the LDLDL cholesterol. If you do not have plaque in your arteries, maybe an LDLDLL cholesterol 100 is okay for you. You have a high risk. calcium score test are clearly, you're probably looking at LBO cholesterol under 55 in those

individuals. And then if you're doing the advanced lipid testing, you're going to be looking at apo-lipropotene B, APOB, you know, 50% of the population will have a value about 100, so 50% have values higher, 50% have values lower. The more plaque you have in the arteries, the lower the the abo-b should generally be. So if you're just kind of intermediate risk, you're probably shooting for an APOB of around 70. If you're higher risk, generally in the heart. may it will be under 55, however you can get there. If you can do it with diet, awesome. Do it with diet. But many people need some support with medications. Sometimes supplements may work, but if you're going to go down the supplement route, only give yourself about three months to see if it

works. If it doesn't work, use something that actually will get you to your goals. And then you'd mention it a couple of times, lipoprotein A. Lipoprotein A, been in the news recently. It's a lipoprotein that increases the risk of atherosclerosis. It increases. It increases. increases the risk of erotic stenosis. It can damage the valve that lets the blood flow out of the heart. Everybody produces LPLLA or lipoprotein A, but approximately 1 in 5 or 20% population produces high levels. And the lipoprotein A particles are more athergenic and thrombogenic, meaning they're more

likely to damage the arteries contributing to plaque. They're more likely to cause the blood to clot. At this time, there are not great treatments at lower lipoprotein A directly. The PCA scantinibers do have some effect at lowering it, but there was a recent trial that was halted because the drug did not lower cardiac events. LPA went down over 70 percent. People had the same amount of heart attacks, strokes need for stents. We're recording this in September, 2026.

We're not going to know until November 2026 what actually happened in that trial. So to date, the first drug that was developed at lower LPA did not help people have less events. Made the labs look pretty, but we just care about like are people showing up to the hospital with cardiac events. So everybody should have their lipoprotein aid checked at least once in their life. If their level is low, generally less than 75 on most tests, you'll never have sky high levels of LPA. But if you have high levels when you're 30 years old, if you're fortunate enough to check at early in life, you're somebody who is at higher risk, not guaranteed have a heart attack, but you should be aggressive with your risk factors that you can manage, your blood pressure,

your stress, your other lipids, your blood sugar, manage those things to the best that you can. Again, it comes down from kind of top tier of like if you had a CAC or a CTTA, and it turns out that you have quite a bit of plaque and or it turns out you have quite a bit of soft plaque, then your path forward is going to be different than somebody who's got a zero. If somebody has a zero on their, they have hardly any calcification at all, they might not have to really pay attention to their LDL cholesterol being a little higher. They might not have to pay attention to their APOB being higher. Again, it's like once you have like two or three things and you've got to really start to pay attention,

and that's why if you're just routinely getting some blood work done maybe once a year and you get some of these scan done, maybe what, every four years, On a calcium score test, if it's zero, maybe every three to five years. Yeah, somewhere in that range. But if you do have symptoms and you do have a higher score, then you're just going to have to start to change your plans. Otherwise, you're just going to keep heading in that same direction. Thanks again, doctor.

Really appreciate it. You're very welcome.