Transcription
I reversed 20 years of arterial plaque. For years, I was eating the wrong diet. When I actually got tested, I was emotionally annihilated. Despite my efforts, I still developed cardiovascular plaque. I truly believe that what I did can be done by many people. Not everyone can reverse plaque, but almost everybody can stabilize it and decrease your risk of a heart attack. Take the vast majority of that risk right off the table.
This is what I did. This is my story of how I reversed my arterial plaque. This video is about how I found plaque in my own arteries and what I did to reverse it. I hope my story can help you identify whether you have plaque... and what you can do to minimize it. I'll cover the dietary, lifestyle supplements, and medication changes I did after I found out that I had plaque. You'll see both my actual CiMT studies showing the presence and then the reversal of plaque in my arteries. Stay until the end, and I'll show you how my latest numbers turned out. We'll also show medical lab tests demonstrating the exact cause of the problem, and then blood tests that show what reversed that plaque. Spoiler alert. I'm like most of us. Aging took a toll on my insulin receptors. Remember, growing old is just not for sissies. At the end of the video, I'll share a confession with you. It's about an unpopular choice I've made to manage my plaque, and I've already caught a lot of grief.
Here's what happened. At age 57, I thought I was healthy... I've been a prevention doc for over 40 years. About four decades. I ran the preventive medicine program at Johns Hopkins. So I taught the doctors at Johns Hopkins, and that's arguably the number one preventive medicine program in the world as far as prevention was concerned. I also practiced what I preached, and that was all about lifestyle and no medications. Low fat dietary guidelines were the standard at that point in time... Nobody questioned it at that time, we were just discovering that cholesterol in the diet might not be the cause of cholesterol in the artery walls. So as that concept turned around, it was turning towards calories. Since fat was the most calorie dense, fat must be the biggest problem. That was the logic, anyway. I believed it at that time and for decades. Not anymore. But that's a different story for later.
Back to those previous decades of my lifestyle. I overachieved in the cardio exercise space. I ran half marathons, sometimes more than every week. I ran a dozen full marathons. By age 55, I was not only against medication, but also against supplements. To me, supplements at that point where just expensive urine. But something happened. At age 54, I should have paid a lot more attention. During a routine screening, I noticed my blood pressure was 130 over 90 and it didn't come back down. I didn't like it, but I finally agreed to take medication to lower my blood pressure. I retired... yet again. Ive retired a few times and started looking for something to do. A mutual friend introduced me to Brad Bale and Amy Dunene. Brad and Amy teach their own form of preventive medicine... I read their book beat the Heart Attack Gene, which opened the door to two other perspectives for me.
First, it made me question the standard model of heart disease focused on... ldl cholesterol or bad cholesterol. Like most of us, of course, I knew that diabetes caused heart disease. But I had no clue just how common prediabetes is. And also, like most docs, I didn't know how to diagnose it. And like most docs, I really had no clue that metabolic disease... causes most chronic diseases... and even most of what many of us call normal aging. The second perspective I got from reading Brad and Amy's book was test don't guess. Coming from Hopkins, I'd always been focused more on William Osler's advice on history... Listening to the patient, getting focused on Brad and Amy, and thinking about tests don't guess gave me a whole different perspective. I began to realize that patients listen to lab tests when they won't... often listen to their doctor. So Brad and Amy invited me to their next event... They were training doctors in Las Vegas. I joined them there. Some vendors were providing a free screening test called CIMT... It was a quick test, literally less than five minutes. Safe, there is no radiation, and inexpensive. The routine price was between two and $300. That test, again, is called the CImt. It stands for carotid intima media thickness test. It's an ultrasound of your neck with a special measurement technology component. It's used to measure plaque instead of what most tests, like the stress tests do, measuring blood flow. So why looking at the neck, the carotid instead of the heart? Plaque formation is due to metabolic issues. Metabolism. Metabolism is the same all over your body. So if you have plaque in one artery bin, you have it in all the others. But here's the key... CIMT doesn't focus on blood flow. It focuses on plaque and more importantly, the type of plaque. Again, that's why cardiac stress tests, which measure blood flow, do not predict heart attacks.
Back to the story. So I took the CiMT test expecting to see no plaque I was wrong. Look at this chart. This was 2015, and you can see my name and two pictures, my right and left carotid arteries. What really impacted me here was the number next to it, 1.209 mm on the right side and 1.215 mm on the left side. Now, what does that mean? This is an artery, and it has many layers. Let's focus on two of these layers. The one in the middle is called the media. It's made mostly of muscle. It allows the artery to expand like one of those expanding garden hoses. Then you have the inner layer of the artery wall, the intima... It deals with the essential metabolic functions of the vessel, like dropping off oxygen and picking up cellular waste materials. Guess where plaque builds up? No, not on the inside, but between... those two layers, the intima and the mediaev. Thats why they call this test the carotid intima media thickness test. The ideal thickness is 1 mm or less. Any time you go over that, its considered a significant... plaque. Some more conservative researchers dont count plaque until it reaches 1.3 millimeter thickness.
Now, it took me time to realize that despite all of my healthy habits, I had still developed cardiovascular plaque. That was a gut punch. At first, I felt like all that work, that discipline to stay healthy, was wasted... I felt like maybe I should have just let myself go, eat all I wanted, lie on the couch, watch tv, be lazy, eat nachos, etcetera, etcetera, etcetera. It took me weeks to emotionally wrap my head around the other side. If I still had plaque with my focus on prevention, what shape would I have been in if I had not taken care of my body? It slowly dawned on me that I could already have had a heart attack. I could even already be dead. It doesn't take much plaque to cause a heart attack. Now, here's another thing that changed my life... Right here, you can see even though my average IMT was below 1 still had more plaque than the average 57 year old, I actually had the arteries of a 73 year old... And that's when I started to think, I've got to change something, or I could die. I lived in Lexington, Kentucky at the time... Each Saturday morning, I ran my half marathon through some of the most beautiful horse country in the world. I remember starting the Saturday morning after discovering my plaque. It occurred to me that if I had a heart attack out there in those horse farms, it would be hours before my body was found, cold and lifeless. Pardon the drama, but those fears are normal for someone that's first recognized their mortality and often from finding the first time your own cardiovascular... risk.
Then I finally composed myself and realized I'm a professional in this space. I know more about it than most... And I needed to listen to my own medicine. For example, exercise, like jogging, doesn't cause heart attacks... And I needed to move on. So that's what I did. When I returned home from that run, I decided to make a few changes... I did a few more tests. I did multiple tests. But the most important was an oral glucose tolerance test. These next three sentences are the three most important sentences in this video. If you hear nothing else, at least hear this. My blood sugar peaked over 160. That meant I had enough prediabetes to cause cardiovascular plaque. Let me repeat. My blood sugars peaked... at greater than 160, indicating enough prediabetes to cause plaque and heart disease risk.
So you remember those changes I committed to make? One of them was, and the biggest one was I switched from a low fat diet... to a low carb diet. My biggest change out of all of them was switching from a low fat diet to a low carb diet. And today I've tested multiple diets ranging from carnivore to vegan to paleo ketavore and everything in between. But all were on the low carb side. Now I'm doing even keto. I'm ketotic about five days a week. I've been fat adapted for about ten years. These days, I blow acetone in the range of between five and 20 parts per million. Again, five days a week. So if you didn't get that, let me say it differently. I'm ketotic. Most days I'm burning fat. No matter which diet I'm on, I just don't eat enough carbs to change that part of my diet. No matter which diet I try vegan or carnivore. I especially avoid processed carbs and grain products.
Let me show you the progress. This is the biggest progress I've ever made. In about one year, I was able to reduce my average CIMT from 0.88 to 0.67 mm. That was one year reduced my average CIMT intima media thickness from 0.88 to 0.67... mm. Now, let me explain what that means. If you look at the image right here, it means that I was able to reverse my arterial age from 73 to 52 years. In one year, I was able to reverse about 20 years of worth of arterial plaque deposition. Now, how did this happen? Let's go back and talk about what does, quote plaque reversal actually mean when you reverse plaque you're not necessarily taking calcium out of the artery... It doesn't even mean taking cholesterol out of the artery, necessarily. Here's what you're doing. What you are doing is taking the inflammatory liquid, the swelling and pus out of the plaque. So it's like you're deflating a balloon or a tire... It will decrease the size of the plaque and the size of the intima media thickness. Loss of inflammation makes plaque shrink. Calcium deposits are just biomarkers. They're biomarkers of decreasing inflammation.
But not everything is sunshine and rainbows. I still had plaque. Take a look at another CIMT from 2019. You can read the description of the CIMT in different areas of the carotid artery here in the comments. My right carotid bulb says 1.3 again in millimeters, and the letter H. H stands for heterogeneous. Heterogeneous... This sounds geeky, but hang in there for a minute. It's essential. You'll see why... you've seen the word heterogeneous. Heterogeneous means mixed, just like homogeneous means consistent... Heterogeneous plaque is a mixture of soft and calcified plaque. How calcified?.. Well, it's actually mostly calcified, as you can see in the white in the image right here. Soft, hardened and mixed plaque is classified by the amount of calcium embedded in that plaque. Nuplaque is homogeneous, soft, and deadly. It can squeeze into the bloodstream where the inflammatory goo causes clots. The clots cause the problem, not the plaque itself. The inflammatory liquid is basically pus. Soft plaques have a very thin cap near the entom. It doesn't even have to be big, just soft. As the body heals the plaque, it calcifies. This is an example of heterogeneous, partially calcified plaque... You can see it has some calcium, which is good. Calcium, in this case, helps with the healing and scarring process. It's a biomarker of plaque stability. Now, here, this is not the healthiest calcification... Calcium is all over the place. It's not organized and it's surrounded by a lot of hot liquid, like islands of hot liquid and calcium. This plaque can still rupture if the cap is thin. This is calcified plaque. The calcium is well organized and it has a thick captain. It won't break. It's stable. It won't cause a heart attack or a stroke. Removing inflammation or reversing plaque causes more stable plaque and less or no soft plaque. The best goal is to have no plaque at all... But most of us develop plaque as we age into insulin resistance. When we do, heres what to do... Stabilize that plaque and keep it stable...
So... what did I do to reverse my plaque? Remember when I said I came back from that first long run after finding out my plaque and I decided to change a few things? I changed the way I as I said, I went from low fat to low carb. I changed the way I exercise. I changed my mind on supplements... I changed the way I slept. And yes, I even started medications. Some of these changes, like medications and supplements were helpful... but far less important than lifestyle. That's been proven time and time and time again. Lifestyle is king. The most important change... for most people is weight loss... At 510, I weighed about 157 pounds, so I didn't have much opportunity there... I did lose five to ten pounds and that did help... I also traded in marathon level distances for a lot more hit and resistance training, especially... in the legs... Metabolically active, strong legs are the most effective internal safety valve against rising blood sugar. I started taking supplements. I started with vitamin D three 5000 international units and niacin 2000 milligrams a day, mostly because I had some hdl issues... I've updated that list to my current needs and now I'm taking vitamin D three 5000 international units a day, k2... 400 micrograms a day with an additional tablespoon of natto, lcitrulline, magnesium, l threonate, magnesium chloride, kialic garlic and I'm also eating taking more natto.
Let me tell you where I am now. This is my latest CIMT from December 2023. This cIMT is from cardio risk. Cardiorisk has world class CIMT quality processes. As you can see in my left carotid artery, I still did not develop more significant plaque. It stayed mostly below 1.2 mm... on my right side. That plaque I had from the beginning is still 1.3. It's still stable or heterogeneous. Let's take a closer look at that obnoxious plaque. As you can see in the image, it's very white. That's calcium... It's mainly calcified. Again, it's stable. I was 66 years old when I did this test in December of 2023. My arterial age is now. Drum roll please. My arteries are still back at the healthy level of 58 years old and I'm still way below the average for my age...
Now, regarding labs, we talked about those early on. I've had low hdl for most of my life. I've actually increased my hdl when I went low carb. I did that even though I was aging. And most of the time, people age and decrease their hdl. Now, why is that important?.. Low hdl is a very strong warning sign of unhealthy carb metabolism, meaning that ive probably had subpar carb metabolism even when I was much, much younger. In other words, probably bad genetics. Getting those carbs out of my diet has helped my metabolism, as shown in lipid or cholesterol profiles and fractionation.
Now, what am I doing at this point? First and foremost, I keep my body fat down. I've had two Dexa scans. Here are the images. My body fat stays around 20%. That's equivalent to an 18 year old. The average 18 year old. My visceral fat stays around a half a pound to a pound. That's also very healthy for an older man like me. And it's not incredibly easy either. But after decades of watching my body fat, it's not that difficult either. By the way, I have ice cream twice weekly. As you can see, my diet is usually, but not always, lightly to moderately ketotic. Even with the ice cream, I never had positive urinary ketones until recently. Recently I went on a five pound water fast and really got very ketotic urine strips of but ive always known, or over the past couple of years ive known that im ketotic because of breath ketones. I exhale about ten parts per million acetone most days. Yes, acetone... finger polish removal, stuff that chemical. And yes, your body makes it when its burning fat. Urinary ketones are far more challenging to see. If one, you've been fat adapted for a long time and two, you remain mildly to moderately ketotic... Both of those descriptions fit me. I've been managing my carbs at this point for over a decade. I also work out regularly and hard. I do hit and re hit high intensity interval training. As you see on the screen, I'm not just jogging, I am sprinting uphill. I followed Sean Amara's uphill sprinting advice... long before I'd ever heard of Sean Amara... These uphill sprints are also aggressive for a 67 year old man. I do multiple types of muscle training, especially in my legs. Strong, metabolically active leg muscles are our best safety valve against rising blood sugar, and I do this work multiple times each week. It takes discipline, but whether it's diet or exercise, the hardest part is actually making that change and making the change stick.
So if you're sitting there and thinking, everybody knows that you should get a stress test and then a stent and then just be done with it instead of all of this hill sprints and diet management. If youre thinking that, be aware that I wrote a whole book on why stress tests dont predict heart attacks and stents dont prevent them. The calcium score is more well known and its harder to mess up than a CIMT. But calcium scores dont tell you everything. In fact, they dont tell you the most important thing. They dont tell you anything about soft plaque. Also, a high calcium score can mean either unhealthy calcification or healthy calcification. So it has its limits... I do recommend it to find out if you have plaque for the first time, but even a score of zero is no guarantee. There are plenty of people that have had heart attacks with a zero calcium scores. After watching this video, you may understand why. If not, we'll cover that in another video. Lastly, the new kid on the block CT angiogram with AI artificial intelligence. I'm a big fan. It can show both soft and calcified plaque with a lot of detail... However, it has some downsides. It's more expensive, it is invasive somewhat, and with the wrong interpretation. It can also put you through the process of getting an unnecessary stent or bypassed. I chose CIMT because despite its challenges, it's the only quick, non invasive, inexpensive way to identify soften plaque. Again, soft plaque is the key. You're right if you think the lack of radiation is an advantage too. It is. The other ones all have radiation, but I don't think the radiation from a CT angiogram or clearly a calcium score is significant if you're dealing with cardiovascular disease risk. I do plan to get a CT angiogram with AI analysis at some point. As we said, it's expensive, time consuming, requires radioactive diet. I just keep putting it off because... the only reason I really need to do it, a CT angiogram, is to provide it to my viewers on YouTube. And I obviously like you guys a lot, but CT angiogram is a headache.
We've yet to talk that much about what caused all this. In short, I belong to those 52% of us over age 18 with prediabetes. And guess what? Within a couple more years, my insulin receptors continued to age into a state of full type two diabetes. Now, I took all the risk off the table. I'm not worried about it. Again, I took the risk off the table. Many people like Jason Fong, Eric Westman would say, I think they would say I cured my diabetes. In other words, I don't eat carbs. I don't eat enough carbs to cause a problem.
Now, I also told you early on that I was going to give you a confession. The next thing is going to create controversy. It already has. I've gotten hater comments from some of the most prominent content creators and viewers... in this space. But be patient with me. Cutting carbs was not the very first thing I did. I didn't even know I had prediabetes for the first few weeks. The very first thing I did was to take a medication and guess what type it was? A statin by the name of simvastatin. It was low dose... and I wasn't trying to beat down my LDL cholesterol. In fact, LDL cholesterol was very low... And if you're about to click away, just hear me out for a second. Yes, I know statins are associated with significant problems. And yes, big pharma has made more than a ton of money from statins. But here's the problem. It's mainly used at higher doses and it's mostly used to beat down LDL cholesterol. Everybody beats up on statins and they beat up on me for saying that I use them. So what is the purpose of a statin? Is it, like most people think, to decrease cholesterol? No, I don't use statins to lower cholesterol. So why did I take it? The evidence is clear that low dose statins can decrease cardiovascular inflammation. I only use low dose statins myself or for my patients who choose statins... And I only recommend either rosuvastatin or pitavastatin, the generics... I actually switched from simvastatin to prevastatin. And even now I take a low dose rosuvastatin... five milligrams two or three times per week... Also, you don't have to take it every day, especially the ones like rosuvastatin with a longer half life. Now, this sometimes needs to be clarified and I get comments like here is a video from Doctor Breuer selling statins. I'm not selling statins. This video's not sponsored. The reality is, statins can't help. But they're not central to plaque management. They get way too much focus. They're simply an adjunct to lowering cardiovascular inflammation, not ldl. I also took baby aspirin. There is risk of bleeding, but it has been proven to decrease the risk of heart attacks by not developing clots... Baby aspirin is also not for everybody. I only recommend it when there is evidence of plaque. Anyhow, let's move on...
Multiple studies plus just plain old logic have shown multiple times. Prescription medications cannot come anywhere close to lifestyle. You cannot out prescribe or even out supplement a lifestyle. And the most important part of lifestyle is eating habits. Supplements are far more popular than prescription medications. There are times in my practice when over half of my patients have chosen zero medications. And not only am I okay with that, I'm very impressed with it. If you're wondering about ldl recently or my ldl, I've got another story there. Recently, when I transitioned from low carb to a keto diet, my ldl increased from 55 to 110. I'd always had low LDL... and then the next month up to 180. Additionally, even though I'm still technically diabetic, my triglycerides, a one c and insulin are as low as they can be. They're very, very low... And I have a healthy hdl cholesterol.
So if youve made it this far, thank you for your interest. Im retired, sort of. Yes, I love travel and golf, but I love having an impact far more. People tell us all the time that were saving lives every day with this information and we believe them. Theres no travel or leisure activity that can ever match saving a life. If youd like more information, let me suggest this video.