In today’s episode, we address a question many people face: “I’m in my 30s or 40s, I feel healthy, but my scan shows coronary calcium or early atherosclerosis, what does this mean, and what should I do next?” We’ll walk through what a comprehensive medical evaluation looks like, which hidden risk factors may be at play, how to uncover them, and most importantly, how to slow or stabilize disease progression and, in some cases, even reverse it. My goal is for you to leave feeling informed and empowered. And while this conversation is primarily directed toward younger individuals, the content discussed today is relevant to individuals of all ages.
Blog Post and References:
https://kevinforeymd.com/ascvd/
In today’s episode we will be challenging the long-standing “eat less, exercise more” narrative by introducing The Toxic Food Hypothesis, a framework that shifts the focus from calorie counting and body weight to food quality and metabolic health. Inspired by Derek Thompson’s Plain English episode, “A Grand Unified Theory of Why Americans Are So Unhealthy,” we’ll explore how a food system dominated by highly processed products may be the true driver of chronic disease, affecting not only those with excess weight but also millions of lean individuals. We’ll examine why calorie-centric approaches fall short, the evidence behind improving diet quality without cutting calories, and why rethinking public health messaging may be the key to reversing America’s health crisis.
Blog Post and References:
In today’s episode, we’ll be discussing one of the most frequently discussed, and often debated, topics in preventive medicine, do statins influence the risk of dementia? You’ve probably heard some express concern that statins can cause memory loss or increase the risk of dementia, whereas others may emphasize the ability of statins to protect brain health. So what does the science really say? In this episode, we’ll explore the role of cholesterol in normal brain health, theoretical mechanisms explaining how statin therapy may cause harm as well as potential neurologic protection
transition to review high quality evidence from randomized clinical trial, mendelian randomization, and even studies investigating those with genetic abnormalities resulting is exceedingly low levels of LDL throughout their lifetime genetic studies. And then most importantly, how this translates into practical decisions for those seeking to promote longevity and reduce their likelihood of dementia.
Blog Post and References:
In today’s episode, we will be diving into the topic of remnant cholesterol, a largely unknown and underappreciated risk factor of cardiovascular disease. Not only does remnant cholesterol contribute to heart attack, stroke, and peripheral artery disease, it is now recognized as an independent risk factor of atherosclerosis, even when LDL-C and ApoB levels are considered optimal. In other words, having "good" ApoB and LDL cholesterol numbers doesn't eliminate the possibility of atherosclerosis, where remnant cholesterol is now recognized to account for a meaningful amount of this "residual risk." Even more intriguing is the mounting body of research that suggests that remnant cholesterol may actually be a stronger predictor of cardiovascular disease than LDL-C itself, yet very few people are even aware it exists. Not only am I excited to share this topic with you today, but I’m also excited to share what you can do about it.
Blog Post and References:
In today’s episode, I will be discussing a comprehensive overview of advanced testing and early identification of insulin resistance, but more importantly, evidence-based strategies to prevent and reverse insulin resistance. We will have an in-depth analysis of the comparative effectiveness of food and nutrition, aerobic exercise at moderate and high intensity heart rate zones, and strength training. We will also look into the effect of sleep duration, sleep quality, sleep fragmentation, and psychological health and their relationship to insulin resistance. Additionally, we will touch upon commonly utilized supplements and medications for overcoming insulin resistance and type 2 diabetes.
Blog Post and References:
http://kevinforeymd.com/insulinresistance
In today’s episode, we will be discussing the shortcomings and alternatives to some of the most commonly utilized tests for longevity and preventive medicine, including LDL cholesterol (LDL-C), Hemoglobin A1c (HbA1c), and Continuous Glucose Monitors (CGMs). With advancements in technology, there are now multiple laboratory tests that provide more accurate and useful information than LDL-C, HbA1c, or CGMs. Despite these improvements in testing, widespread awareness and adoption of these superior tests remain limited. The purpose of this podcast is to demonstrate the shortcomings of LDL-C, HbA1c, and CGMs. By examining alternative testing strategies, this podcast seeks to empower health conscious individuals and healthcare professionals in their ability to adopt more effective testing strategies for the prevention of disease and promotion of longevity. In summary,a normal LDL-C does not rule out the risk of cardiovascular disease, and thatnormal results from HbA1c and CGM data do not rule out the possibility of insulin resistance. Meanwhile, there are more effective testing strategies available to those who are seeking to optimize their health, likelihood of longevity, and ability to identify disease risk as early as possible.
Link toOriginal Blog Post andReferences.
Link toLPIR Score.
Link toTriglyceride-Glucose Index (TyG Index).
Link toHOMA-IR Calculator.
In this podcast episode we will review the evidence demonstrating the variety of strategies capable of achieving partial reversal and regression of atherosclerosis in the human body, including aerobic exercise, the targeted lowering of atherogenic lipoproteins including LDL-C and Apolipoprotein-B (ApoB), the use of Icosapent Ethyl (Vascepa) in those with and without elevated triglycerides, blood pressure lowering agents including Angiotensin Receptor Blockers (ARBs), glucose-lowering agents such as Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors, and medications with anti-inflammatory properties, including Colchicine. Additionally, we will review the preliminary data regarding atherosclerotic plaque regression and Glucagon-like Peptide 1 (GLP-1) Receptor Agonists.
References:
https://kevinforeymd.com/reverseASCVD/
In today’s episode, we will be discussing a very specific risk factor of cardiovascular disease known as Lipoprotein(a), abbreviated as Lp(a). Lp(a) is a distinct lipoprotein particle that is not routinely measured on the lipid panel, and is instead ordered as an additional test. For those seeking to promote longevity and optimize cardiovascular risk factors, it is reasonable to obtain a Lipoprotein(a) measurement at least once. Because if you have an elevated level, you want to know about this.
References:
Character limit reached. Full references available at https://kevinforeymd.com/lpa
In today’s episode, we will be discussing what I describe as the Fundamentals of the Simple Path to Health. In other words, this is my core message and the framework that I use with my patients as well as the promotion of my own health, wellbeing, and pursuit of longevity. (1)
Juul F, Parekh N, Martinez-Steele E, Monteiro CA, Chang VW. Ultra-processed food consumption among US adults from 2001 to 2018. Am J Clin Nutr. 2022;115(1):211-221.
Neri D, Martinez-Steele E, Monteiro CA, Levy RB. Consumption of ultra-processed foods and its association with added sugar content in the diets of US children, NHANES 2009-2014. Pediatr Obes. 2019;14(12):e12563.
Martínez Steele E, Baraldi LG, Louzada ML, Moubarac JC, Mozaffarian D, Monteiro CA. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open. 2016;6(3):e009892. Published 2016 Mar 9.
Wang L, Martínez Steele E, Du M, et al. Trends in Consumption of Ultraprocessed Foods Among US Youths Aged 2-19 Years, 1999-2018. JAMA. 2021;326(6):519-530.
Martínez Steele E, Popkin BM, Swinburn B, Monteiro CA. The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study. Popul Health Metr. 2017;15(1):6. Published 2017 Feb 14.
Hall KD, Ayuketah A, Brychta R, et al. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Cell Metab. 2019 Jul 2;30(1):226.
Lustig RH, Mulligan K, Noworolski SM, et al. Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome. Obesity (Silver Spring). 2016;24(2):453-460.
Schwarz JM, Noworolski SM, Erkin-Cakmak A, et al. Effects of Dietary Fructose Restriction on Liver Fat, De Novo Lipogenesis, and Insulin Kinetics in Children With Obesity. Gastroenterology. 2017;153(3):743-752.
Geidl-Flueck B, Hochuli M, Németh Á, et al. Fructose- and sucrose- but not glucose-sweetened beverages promote hepatic de novo lipogenesis: A randomized controlled trial. J Hepatol. 2021;75(1):46-54.
Udilova N, Jurek D, Marian B, Gille L, Schulte-Hermann R, Nohl H. Induction of lipid peroxidation in biomembranes by dietary oil components. Food Chem Toxicol. 2003;41(11):1481-1489.
Rohr-Udilova NV, Stolze K, Sagmeister S, Nohl H, Schulte-Hermann R, Grasl-Kraupp B. Lipid hydroperoxides from processed dietary oils enhance growth of hepatocarcinoma cells. Mol Nutr Food Res. 2008;52(3):352-359.
Yao Y, Wang T, Qiang Z, Du W, Li C. Mechanisms of the Formation of Nonvolatile and Volatile Oxidation Products from Methyl Linoleic Acid at High Temperatures. J Agric Food Chem. 2024;72(1):704-714.
Bassett CM, McCullough RS, Edel AL, et al. Trans-fatty acids in the diet stimulate atherosclerosis. Metabolism. 2009;58(12):1802-1808.
Turpeinen AM, Basu S, Mutanen M. A high linoleic acid diet increases oxidative stress in vivo and affects nitric oxide metabolism in humans. Prostaglandins Leukot Essent Fatty Acids. 1998;59(3):229-233.
de Kok TM, Zwingman I, Moonen EJ, et al. Analysis of oxidative DNA damage after human dietary supplementation with linoleic acid. Food Chem Toxicol. 2003;41(3):351-358.
Food and Agriculture Organization of the United Nations (FAO) (2017). "Food balances data 2017". FAO.org. Retrieved 01 September 2024.
Character limit reached. Full references available at https://kevinforeymd.com/episode-5/
In this episode, we will discuss a wide variety of landmark clinical trials regarding food and nutrition. Specifically, we will investigate how certain dietary patterns reduce the likelihood of health outcomes like cardiovascular disease, obesity, and diabetes, as well as a detailed discussion of the risk factors associated with these illnesses including the Lipoprotein insulin resistance score or LPIR, blood pressure, inflammation, cholesterol, lipoproteins, and more.
References:
In this episode, we will take a deep dive into the biomarkers, lab values, and other tools that we can use to measure, quantify, and predict the risk of death, disease, and many preventable medical illness. This includes cardiovascular disease, certain cancers, dementia, infertility, and more.
Centers for Disease Control and Prevention. National Center for Health Statistics. Leading Causes of Death.
https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
Cancer is a Preventable Disease that Requires Major Lifestyle Changes
Anand P, Kunnumakkara AB, Sundaram C, et al. Cancer is a preventable disease that requires major lifestyle changes [published correction appears in Pharm Res. 2008 Sep;25(9):2200. Kunnumakara, Ajaikumar B. Pharm Res. 2008;25(9):2097-2116. doi:10.1007/s11095-008-9661-9
World Health Organization: Between 30% and 50% of cancer deaths could be prevented by modifying or avoiding key risk factors
https://www.who.int/health-topics/cancer
The American Cancer Society states that 60% of uterine cancers are attributed to excess body weight
https://www.cancer.org/research/acs-research-news/more-than-4-in-10-cancers-and-cancer-deaths-linked-to-modifiable-risk-factors.html
Wu S, Zhu W, Thompson P, Hannun YA. Evaluating intrinsic and non-intrinsic cancer risk factors. Nat Commun. 2018;9(1):3490. Published 2018 Aug 28. doi:10.1038/s41467-018-05467-z
International Agency for Research on Cancer acknowledged that there was sufficient evidence to suggest that avoiding benign overweight obese was protective against at least 13 different cancers
Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body Fatness and Cancer--Viewpoint of the IARC Working Group. N Engl J Med. 2016;375(8):794-798. doi:10.1056/NEJMsr1606602
LPIR score is a useful predictor of future type 2 diabetes even in patients with a normal Hemoglobin A1c
Harada PHN, Demler OV, Dugani SB, et al. Lipoprotein insulin resistance score and risk of incident diabetes during extended follow-up of 20 years: The Women's Health Study. J Clin Lipidol. 2017;11(5):1257-1267.e2. doi:10.1016/j.jacl.2017.06.008
According to the Centers for Disease Control and Prevention (CDC), approximately 70% of the sodium Americans consume comes from packaged, processed foods
https://www.cdc.gov/chronicdisease/resources/publications/factsheets/nutrition.htm
Approximately 70-90% of total body cholesterol is found within the cell
Maxfield FR, Wüstner D. Intracellular cholesterol transport. J Clin Invest. 2002;110(7):891-898. doi:10.1172/JCI16500
Lipoprotein(a) Is Markedly More Atherogenic Than LDL: An Apolipoprotein B-Based Genetic Analysis
Björnson E, Adiels M, Taskinen MR, et al. Lipoprotein(a) Is Markedly More Atherogenic Than LDL: An Apolipoprotein B-Based Genetic Analysis. J Am Coll Cardiol. 2024;83(3):385-395. doi:10.1016/j.jacc.2023.10.039
Association of Triglyceride-Lowering LPL Variants and LDL-C–Lowering LDLR Variants With Risk of Coronary Heart Disease
Ference BA, Kastelein JJP, Ray KK, et al. Association of Triglyceride-Lowering LPL Variants and LDL-C–Lowering LDLR Variants With Risk of Coronary Heart Disease. JAMA. 2019;321(4):364–373. doi:10.1001/jama.2018.20045
Elevated remnant cholesterol causes both low-grade inflammation and ischemic heart disease
Varbo A, Benn M, Tybjærg-Hansen A, Nordestgaard BG. Elevated remnant cholesterol causes both low-grade inflammation and ischemic heart disease, whereas elevated low-density lipoprotein cholesterol causes ischemic heart disease without inflammation. Circulation. 2013;128(12):1298-1309. doi:10.1161/CIRCULATIONAHA.113.003008
In today’s episode, we will investigate and review the fundamentals of scientific nutrition so that you can more easily and confidently navigate and comprehend the myriad of dietary trends, media headlines, and conflicting nutritional recommendations that we are exposed to in our everyday lives. At the end of this episode, I hope for you to have a stronger understanding of how science can be used to study food, nutrition, and health, with particular attention to the various dietary study designs, and the relative strengths, weaknesses, and limitations of each.
2014 Cochrane Review: Dietary salt Reduction and cardiovascular outcomes
Adler AJ, Taylor F, Martin N, Gottlieb S, Taylor RS, Ebrahim S. Reduced dietary salt for the prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD009217. DOI: 10.1002/14651858.CD009217.pub3
2020 Cochrane Review: The effect of a low salt diet on blood pressure
Graudal NA, Hubeck-Graudal T, Jurgens G. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database of Systematic Reviews 2020, Issue 12. Art. No.: CD004022. DOI: 10.1002/14651858.CD004022.pub5.
Negligible effect of dietary cholesterol of serum cholesterol and lipoproteins.
Fernandez ML. Dietary cholesterol provided by eggs and plasma lipoproteins in healthy populations. Curr Opin Clin Nutr Metab Care. 2006;9(1):8-12. doi:10.1097/01.mco.0000171152.51034.bf.
The PREDIMED study, a landmark trial focusing on the effects of the Mediterranean diet on cardiovascular outcomes and risk factors.
Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet [retracted in: N Engl J Med. 2018 Jun 21;378(25):2441-2442]. N Engl J Med. 2013;368(14):1279-1290. doi:10.1056/NEJMoa1200303.
The PURE prospective cohort study demonstrating a higher risk of total mortality associated with high carbohydrate intake, and lower total mortality associated with low carbohydrate intake.
Dehghan M, Mente A, Zhang X, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet. 2017;390(10107):2050-2062. doi:10.1016/S0140-6736(17)32252-3.
A subsequent prospective cohort study published in the Lancet Public Health, demonstrating higher mortality in individuals consuming low carbohydrate dietary patterns.
Seidelmann SB, Claggett B, Cheng S, et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health. 2018;3(9):e419-e428. doi:10.1016/S2468-2667(18)30135-X
Prospective cohort studying examining organic food consumption and the incidence of cancer in women in the United Kingdom
Bradbury KE, Balkwill A, Spencer EA, et al. Organic food consumption and the incidence of cancer in a large prospective study of women in the United Kingdom. Br J Cancer. 2014;110(9):2321-2326. doi:10.1038/bjc.2014.148
Negative trial of the MIND Diet for prevention of cognitive decline in patients with a family history of dementia
Barnes LL, Dhana K, Liu X, et al. Trial of the MIND Diet for Prevention of Cognitive Decline in Older Persons. N Engl J Med. 2023;389(7):602-611. doi:10.1056/NEJMoa2302368.
Comparison of a healthy “low-carbohydrate” and low-fat diet regarding weight loss
Gardner CD, Trepanowski JF, Del Gobbo LC, et al. Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial [published correction appears in JAMA. 2018 Apr 3;319(13):1386] [published correction appears in JAMA. 2018 Apr 24;319(16):1728]. JAMA. 2018;319(7):667-679. doi:10.1001/jama.2018.0245
The intention of this podcast is to promote greater awareness and understanding of food, nutrition, physical activity, and other day-to-day considerations regarding health and wellness. I've titled this podcast The Simple Path to Health because becoming a healthier you can in fact be really simple. Meanwhile, there is so much information out there that it also can be very overwhelming and confusing. Instead, my goal is to keep things practical, easy to understand, and applicable to you, the everyday individual.
Prevalence of insulin resistance among adolescents and young adults, including insulin resistance among those with a normal body weight.
Andes LJ, Cheng YJ, Rolka DB, Gregg EW, Imperatore G. Prevalence of Prediabetes Among Adolescents and Young Adults in the United States, 2005-2016. JAMA Pediatr. 2020;174(2):e194498. doi:10.1001/jamapediatrics.2019.4498
Prospective cohort study of premature cardiovascular disease, which demonstrated insulin resistance and metabolic syndrome as two of the strongest risk-factors.
Dugani SB, Moorthy MV, Li C, et al. Association of Lipid, Inflammatory, and Metabolic Biomarkers With Age at Onset for Incident Coronary Heart Disease in Women. JAMA Cardiol. 2021;6(4):437-447. doi:10.1001/jamacardio.2020.7073
Conflicts of interest among members of the 2020 US Dietary Guidelines for America.
Mialon M, Serodio P, Crosbie E, Teicholz N, Naik A, Carriedo A. Conflicts of interest for members of the U.S. 2020 Dietary Guidelines Advisory Committee. Public Health Nutr. Published online March 21, 2022. doi:10.1017/S1368980022000672
Historical example of financial conflicts of interest among the medical research community.
Kearns CE, Schmidt LA, Glantz SA. Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents. JAMA Intern Med. 2016;176(11):1680-1685. doi:10.1001/jamainternmed.2016.5394
Financial conflict of interest involving Coca Cola at the University of Colorado.Olinger, David. CU Nutrition Expert Accepts $550,000 from Coca-Cola for Obesity Campaign, The Denver Post, 6 June 2016.
Dietary Guidelines for Americans, 1985.
https://health.gov/sites/default/files/2019-10/1985thin.pdf
Randomized controlled trial of fruit-rich diet on liver health, insulin, resistance, and lipid panel in patients with fatty liver disease.
Alami F, Alizadeh M, Shateri K. The effect of a fruit-rich diet on liver biomarkers, insulin resistance, and lipid profile in patients with non-alcoholic fatty liver disease: a randomized clinical trial. Scand J Gastroenterol. 2022;57(10):1238-1249. doi:10.1080/00365521.2022.2071109
Isocaloric carbohydrate replacement trial in children with Metabolic Syndrome.
Lustig RH, Mulligan K, Noworolski SM, et al. Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome. Obesity (Silver Spring). 2016;24(2):453-460. doi:10.1002/oby.21371
Comments or Questions.
