Knife Down

Dave Feldman came into my studio and we went through Simon Hill's critique of the KETO-CTA data one clip at a time — high LDL, "rapid plaque progression," the retracted paper, the new preprint. We disagree, and we do it honestly.

At the center is the new KETO-CTA preprint: 100 lean mass hyper-responders, two coronary scans a year apart, and a real fight over what the numbers mean. Why the first paper was retracted, the measurement "noise floor" that makes one-year plaque data so slippery, whether 21–29% "rapid progressors" is alarming or expected, and if NATURE-CT is a fair comparison or a borrowed control group. Long and in the weeds on purpose. Watch and decide for yourself.

⏱️ CHAPTERS
0:00 Why I brought Dave Feldman on
3:30 "We only care about LDL because of drugs"
5:28 Why the film resonates: mistrust of medicine
7:19 Biology vs. drugs, HDL, and admitting when medicine is wrong
11:21 What a lean mass hyper-responder actually is
16:00 "Cautiously optimistic": Dave answers for the phrase
19:54 KETO-CTA: 100 people, two scans, one year
21:35 The retraction and the Cleerly anomalies
26:45 The new preprint: same data, Q-angio and HeartFlow
28:02 Reading the abstract: "15% regressed" and the bias question
30:18 The noise floor: what one year of imaging can't tell us
32:56 Which endpoint matters: total vs. non-calcified plaque
40:39 Percent atheroma volume, and defining "rapid" progression
47:11 Where the 1% comes from: PARADIGM and MACE
52:59 NATURE-CT: 3% vs. 21–29%, and my rebuttals
1:01:04 "Integral over time": LDL of 400 and lifetime exposure
1:03:30 Population vs. individual prediction
1:09:25 Gambling on being an outlier, and the comment-section problem
1:12:45 The film clip: Eric's story, and who to treat
1:16:53 The hard question: treat high ApoB with no plaque?
1:20:26 The "business model" question — and Dave's answer
1:23:35 My takehome: debate is healthy, the science isn't settled

📚 STUDIES DISCUSSED
NATURE-CT (the comparison cohort): Aldana-Bitar J, et al. NATURE-CT. J Cardiovasc Comput Tomogr. 2026. https://www.sciencedirect.com/science/article/pii/S1934592526000973

PARADIGM registry (where the "1%/year = rapid progressor" definition comes from): Lee SE, Chang HJ, et al. Effects of Statins on Coronary Atherosclerotic Plaques: The PARADIGM Study. JACC Cardiovasc Imaging. 2018;11(10):1475-1484. doi:10.1016/j.jcmg.2018.04.015. PMID: 30093065. https://pubmed.ncbi.nlm.nih.gov/30093065/

▶️ WATCH NEXT: My reaction to the KETO-CTA retraction: https://youtu.be/w8XxoqUoVJc

⚕️ DISCLAIMER This channel is for education, not medical advice. I'm a board-certified vascular surgeon, but I'm not your surgeon, and nothing here replaces a conversation with your own physician. If you have high LDL or ApoB — on a ketogenic diet or otherwise — don't start, stop, or change a medication based on a debate you watched on YouTube. Bring it to your doctor and decide together, with your own numbers and your own history in front of you.

💬 If this kind of respectful, in-the-weeds debate is useful to you, subscribe — Dave and I floated doing a round two on the lipid hypothesis itself, and your comments help me decide what's worth the deep dive.

Pre-Order my book Disconnected here:
https://www.amazon.com/Disconnected-Surgeons-Search-Healing-Broken/dp/B0H86K1T7R

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

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___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

In this comment-response episode, I break down what I eat in a typical day as a vascular surgeon focused on cardiometabolic prevention. I also discuss the reliability of CIMT testing, why I plan to repeat my own scan, and what first drew me to preventive health.
More on CIMT—and a conversation with the CardioRisk CEO—coming soon.
For educational purposes only; this is not individualized medical advice.

Pre-Order my book Disconnected here:
https://www.amazon.com/Disconnected-Surgeons-Search-Healing-Broken/dp/B0H86K1T7R

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Order your own labs here:
https://www.ultalabtests.com/partners/lilyjohnstonmd
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www.ownyourlabs.com

Other tools for optimal health (note these are affiliate links):
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Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

My CIMT results came back—and one number moved in the wrong direction. In this video, I walk through my own carotid intima-media thickness (CIMT) scan, explain arterial age, plaque burden, IMT progression, and measurement variability, and talk about what a “worse” CIMT result actually means.

If you’ve had a CIMT test or are considering one for cardiovascular risk assessment, this is a practical look at how to interpret the report without letting one scary-looking number hijack the whole story.

Pre-Order my book Disconnected here:
https://www.amazon.com/Disconnected-Surgeons-Search-Healing-Broken/dp/B0H86K1T7R

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Order your own labs here:
https://www.ultalabtests.com/partners/lilyjohnstonmd
OR
www.ownyourlabs.com

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
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Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

In this video, Dr. Lily Johnston addresses viewer questions about lipid panels, heart disease risk, and diagnostic testing. Key topics include:

Coronary Calcium Scans vs. CCTA/CIMT: Why calcium scores may not be sufficient for younger patients and the benefits of soft plaque detection.
Exercise and Lipids: Clarifying that while exercise is vital for longevity, its impact on LDL-C numbers is often minimal.
MRI vs. CT for Plaque: Why MRI is generally not the preferred tool for assessing arterial plaque buildup.
Inflammation and Cardiovascular Risk: A discussion on the "Zeus" trial and the ongoing relevance of inflammation in heart disease.
LDL-C to ApoB Ratios: Explaining discordance and why both particle count and cargo matter for risk assessment.
ApoB Particle Size: Debunking myths about "large fluffy" particles and emphasizing the importance of total particle burden.
N=1 Experiment: Dr. Lily reveals she will be testing both Dihydroberberine and Ezetimibe to observe their effects on her own lipid levels, starting with Dihydroberberine.

Chpaters
00:00 - Introduction and reaction to lipid panel comments
00:33 - Coronary calcium scans: Scores, age, and soft plaque risk
01:58 - CIMT and CCTA: Better alternatives for soft plaque detection
02:28 - Does exercise move the needle on your lipid numbers?
03:51 - Is MRI better than CIMT for assessing plaque?
05:14 - Why a community poll for a personal medical experiment?
06:05 - The Zeus Trial: Inflammation vs. Lipids debate
08:46 - Understanding the LDL-C to ApoB ratio and discordance
12:24 - Small vs. Large LDL particles: Does size really matter?
15:05 - Dr. Aloe and the "sole predictor" stance on LDL-C
18:14 - The Verdict: Starting the Dihydroberberine experiment

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Order your own labs here:
https://www.ultalabtests.com/partners/lilyjohnstonmd
OR
www.ownyourlabs.com

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
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Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d
Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
Intake Breathing Nasal Support: https://amzn.to/48dfQQ1
Personal Blender: https://amzn.to/4pyNGGl
True Nutrition Protein: https://oken.do/q2xzqeqw
Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

Can a simple 5g scoop of creatine do more than just build muscle? In today’s video, I’m reacting to Thomas DeLauer’s insights on how creatine might “spare” your body’s methylation cycle—and then diving deep into the actual clinical data to see if it really lowers homocysteine.

As a vascular surgeon, I’m always looking for ways to reduce cardiovascular risk. We know that high homocysteine is a major red flag for heart attack and stroke, but the evidence for using creatine to fix it is surprisingly nuanced.

In this video, we cover:

The "Metabolic Cost" of making your own creatine.
How methylation impacts your DNA repair and neurotransmitters.
My breakdown of the 2015 Journal of Nutrition study on creatine and homocysteine.
Why the "MTHFR mutation" changes the whole conversation.
My current stance on methylated B vitamins vs. creatine.

Chapters:
0:00 - Reaction to Thomas DeLauer’s Creatine Theory
1:15 - How Creatine Synthesis Drains Your Body
3:02 - The Glycine Connection: Joints, Skin, and Detox
5:42 - Implications for MTHFR and High Homocysteine
8:18 - Does Creatine Lower Homocysteine? (Open Evidence Search)
12:28 - Deep Dive: Bangladesh Randomized Controlled Trial
18:10 - The Verdict: Folic Acid vs. Creatine
21:30 - My Recommendations for Patients

Let me know your thoughts on creatine in the comments! Are you taking it for more than just the gym?

Do these suggestions align with the direction you want to take for this video?

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Order your own labs here:
https://www.ultalabtests.com/partners/lilyjohnstonmd
OR
www.ownyourlabs.com

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
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Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

What do you do when your "bad cholesterol" (LDL) flags high, but your other metabolic markers look great? In this video, I’m sharing my personal lab results to explain why standard lipid panels only tell part of the story.

We’ll dive deep into the world of lipoproteins, exploring why ApoB is a more precise measure of cardiovascular risk than LDL-C alone. Using a highway analogy, I’ll show you why the number of "cars on the road" (particles) matters far more for plaque formation than the "cargo" (cholesterol) they carry.

In this video, we cover:

Standard vs. Advanced Testing: Why I look at the Triglyceride/HDL ratio and ApoB.
The Concept of Discordance: What it means when your LDL and ApoB numbers don't track together.
Metabolic Health: How inflammation and insulin resistance act like "potholes" on your arterial highway.
The 2026 Guidelines: How to put your numbers into the context of your overall risk.
Beyond the Lab: Why I’m prioritizing imaging (CIMT) over blood work to decide my next steps.
🔬 JOIN THE EXPERIMENT! I’m going to run a 90-day experiment to see how different interventions affect my numbers, and I want YOU to choose the path. Vote in the comments:

Dihydroberberine: A supplement known for lipid and glucose support.
Ezetimibe (Zetia) Monotherapy: A medication that targets cholesterol absorption.
Drop your questions about lipids below—I’ll be answering as many as I can in an upcoming Q&A!

#Cholesterol #ApoB #HeartHealth #MetabolicHealth #LDL #VascularHealth #PreventativeMedicine

Chapters:
00:00 – Introduction: My cholesterol results are in
00:24 – The standard lipid panel: Total cholesterol vs. Triglycerides
01:22 – Why the Triglyceride to HDL ratio matters for metabolic health
02:11 – The myth of raising HDL: Trials and outcomes
03:08 – Understanding LDL calculations and limitations
04:18 – The deep dive into ApoB: Why lipoproteins matter more than cholesterol
06:02 – The highway analogy: Particles vs. cargo
07:49 – Two types of ApoB (100 vs. 48) and their roles
10:20 – Road conditions: The role of the endothelium and inflammation
11:32 – 2026 ACC/AHA lipid guidelines and risk assessment
13:41 – Understanding discordance: Why my LDL is high but ApoB is normal
16:56 – Advanced testing: NMR particle count breakdown
21:09 – LPIR: Assessing insulin resistance through lipids
22:38 – Why numbers aren't enough: The importance of imaging (CIMT)
24:38 – The Experiment: Help me choose between Berberine and Ezetimibe

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Order your own labs here:
https://www.ultalabtests.com/partners/lilyjohnstonmd
OR
www.ownyourlabs.com

Other tools for optimal health (note these are affiliate links):
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Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She practices at Scripps Clinic and is also the founder of CorSight Health, where she is a passionate advocate for reimagining how medicine approaches chronic disease.

After I walked through my own labs last week, you had sharp follow-ups — Vascepa versus a mixed omega-3, why my lab screenshots had no reference ranges, which lab company I actually use — so the first half is me answering them. Then I count down my real top 10 tests for catching cardiovascular disease early, from hemoglobin A1c at number 10 up to my number one, which isn't a blood test at all. Watch the countdown and let me know in the comments how many you've already had!

⏱️ CHAPTERS
0:00 The top 10 tests, and why I'm ranking them
0:19 Vascepa (icosapent ethyl): EPA vs. DHA, and why I skip it
1:59 "Where are the units?" Normal vs. optimal ranges
3:14 Methylated B complex for high homocysteine
4:14 Which lab company I actually use 5:07 hs-CRP's day-to-day swing, and the GlycA question
7:20 Top 10!

Order your own labs here:
https://www.ultalabtests.com/partners/lilyjohnstonmd
OR
www.ownyourlabs.com

⚕️ DISCLAIMER This channel is for education, not medical advice. I'm a board-certified vascular surgeon, but I'm not your surgeon, and nothing here replaces a conversation with your own physician. The "optimal" ranges I use are tighter than what a lab flags as normal, and they're the targets I set for myself and my patients — yours may be different. Don't start, stop, or change anything based on a single number without talking to the doctor who knows your whole picture.

💬 Found this useful? Subscribe, and leave your LpPLA2 and inflammation questions in the comments — those are getting their own deep dive soon. Until next time, take really good care.

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
WaterPik: https://amzn.to/4894Xi8
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Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
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Personal Blender: https://amzn.to/4pyNGGl
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Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

How to read your blood test results — from a vascular surgeon using her own bloodwork. I go line by line through the complete blood count (CBC), fasting glucose and insulin, kidney and liver panels, thyroid, inflammation (hs-CRP), ferritin, and a lipid panel that's getting its own video. This is exactly how I read labs for my metabolic patients, with all my own numbers on screen: the good, the bad, and a couple that genuinely disappointed me.

Along the way: why my hs-CRP finally dropped under 1 after years of nagging me, the omega-3 result I'm not proud of, what fasting insulin and A1c say about insulin resistance, and how a "high" calculated LDL can sit right next to a normal ApoB. Pull up your own blood test results and read along.

⏱️ CHAPTERS
0:00 The good, the bad, and a little ugly
0:26 CBC: blood counts and what red-cell size hints at
3:28 Platelets, and my inflammation hunch
5:44 The differential, quickly
6:53 The fasting glucose that annoyed me (and the post-call excuse)
10:06 Kidney function, and the tests I skipped
13:41 Calcium, and the vitamin D catch
14:53 Uric acid: gout, fructose, and purines
16:07 Liver "dysfunction" tests: AST, ALT, bilirubin
17:43 My vitamin D, homocysteine, and MTHFR
21:22 Ferritin and my iron stores
21:56 My worst result: the omega-3 balance
24:58 Metabolic markers: A1c and fasting insulin
25:34 Thyroid, read on replacement
26:37 The hs-CRP win: from 3 down to 0.6
27:44 Lipid teaser: 209 total, ApoB 86, and the next video

▶️ WATCH NEXT
7 Life-Saving Tests Your Doctor Might Skip!: https://youtu.be/vPw38B9QzjM
5 MORE Tests That Reveal What's Really Happening Inside Your Body: https://youtu.be/vwORTxzeEMg

Order your own labs here:
https://www.ultalabtests.com/partners/lilyjohnstonmd
OR
www.ownyourlabs.com

⚕️ DISCLAIMER
This channel is for education, not medical advice. I'm a board-certified vascular surgeon, but I'm not your surgeon, and nothing here replaces a conversation with your own physician. One lab value is a single snapshot in time; reference ranges, timing, and your own history all change what a number means. Don't start, stop, or change anything based on one result. Bring your labs to your own doctor.

💬 Found this useful? Subscribe, and tell me in the comments which panel you want me to break down next. We'll get to as many questions as we can. Until then, take really good care.

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
WaterPik: https://amzn.to/4894Xi8
Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d
Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
Intake Breathing Nasal Support: https://amzn.to/48dfQQ1
Personal Blender: https://amzn.to/4pyNGGl
True Nutrition Protein: https://oken.do/q2xzqeqw
Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

Dr. Abs pulled bloodwork from 50 of his carnivore patients — cholesterol up, triglycerides down, A1C and CRP better across the board. It's a genuinely good data set. It's also the best-case scenario, not the average one.

I'm reacting to walk through what those numbers actually mean, why cherry-picked wins don't tell you what happens to everyone on this diet, and what two Virta Health trials add to the picture: LDL-C did rise over two years, but it was driven by a shift toward larger, less atherogenic particles, and carotid imaging showed no progression of arterial disease.

Original video: https://youtu.be/CygSkDzDOHE

Studies referenced:
Bhanpuri et al., 2018, Cardiovascular Diabetology — PMID 29712560 — https://pubmed.ncbi.nlm.nih.gov/29712560/
Athinarayanan et al., 2020, Cardiovascular Diabetology — PMID 33292205 — https://pubmed.ncbi.nlm.nih.gov/33292205/

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
WaterPik: https://amzn.to/4894Xi8
Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d
Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
Intake Breathing Nasal Support: https://amzn.to/48dfQQ1
Personal Blender: https://amzn.to/4pyNGGl
True Nutrition Protein: https://oken.do/q2xzqeqw
Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

Chapters:
00:00 The Replication Crisis & Messy Science
02:11 Why the KETO-CTA Study Was Retracted
03:25 Mediterranean Keto vs. Standard Keto
06:14 Cholesterol Balance: Absorption vs. Production
10:50 The Million-Dollar Question: What Causes Plaque?
13:07 Small Studies & Statistical Manipulation
15:03 Addressing Bias, Personalities, and Grifters
16:56 My Position on ApoB and Personalized Care

In this video, I dive into the "spicy" comments from my recent keto reaction video to address the complexities of heart health, the reality of the scientific replication crisis, and the nuances of personalized medicine. We discuss why a major keto study was retracted, how to think about cholesterol absorption vs. production, and why "testing, not guessing" is the only way to truly understand your own cardiovascular risk.

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
WaterPik: https://amzn.to/4894Xi8
Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d
Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
Intake Breathing Nasal Support: https://amzn.to/48dfQQ1
Personal Blender: https://amzn.to/4pyNGGl
True Nutrition Protein: https://oken.do/q2xzqeqw
Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

The KETO-CTA trial got retracted this year, and most of the internet treated it like a takedown. The authors pulled their own paper because they found real errors in the analysis. That took integrity. I react to how other creators have covered this retraction, walk through what the errors actually were, and make the case that watching scientists correct themselves in public is what good science looks like.

📚 STUDY DISCUSSED
Soto-Mota A, Norwitz NG, Manubolu VS, Kinninger A, Wood TR, Earls J, Feldman D, Budoff M. Longitudinal Data From the KETO-CTA Study: Plaque Predicts Plaque, ApoB Does Not. JACC Adv. 2025;4(7):101686. PMID: 40192608. https://pubmed.ncbi.nlm.nih.gov/40192608/ (Retracted Publication)

Expression of Concern: "Plaque Begets Plaque. ApoB Does Not: Longitudinal Data from The KETO-CTA Trial" [JACC: Advances, Volume 4, Issue 7, July 2025, Article 101686]. JACC Adv. 2026;5(3):102607. PMID: 41906601. https://pubmed.ncbi.nlm.nih.gov/41906601/

▶️ WATCH NEXT
Is Ezetimibe the Secret to Preventing Dementia? Surgeon Reacts to @nicknorwitzMDPhD: https://youtu.be/Rzz2g9gRL_8
Is Lower LDL Actually Better? New Research Has an Answer: https://youtu.be/Q2lvd9ND7rA

⚕️ DISCLAIMER
This channel is for education, not medical advice. I'm a board-certified vascular surgeon, but I'm not your surgeon, and nothing here replaces a conversation with your own physician.Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
WaterPik: https://amzn.to/4894Xi8
Intake Breathing Nasal Support: https://amzn.to/48dfQQ1
Personal Blender: https://amzn.to/4pyNGGl
True Nutrition Protein: https://oken.do/q2xzqeqw
Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

Dr. Abs pulled bloodwork from 50 of his carnivore patients — cholesterol up, triglycerides down, A1C and CRP better across the board. It's a genuinely good data set. It's also the best-case scenario, not the average one.

I'm reacting to walk through what those numbers actually mean, why cherry-picked wins don't tell you what happens to everyone on this diet, and what two Virta Health trials add to the picture: LDL-C did rise over two years, but it was driven by a shift toward larger, less atherogenic particles, and carotid imaging showed no progression of arterial disease.

Original video: https://youtu.be/CygSkDzDOHE

Studies referenced:
Bhanpuri et al., 2018, Cardiovascular Diabetology — PMID 29712560 — https://pubmed.ncbi.nlm.nih.gov/29712560/
Athinarayanan et al., 2020, Cardiovascular Diabetology — PMID 33292205 — https://pubmed.ncbi.nlm.nih.gov/33292205/

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
WaterPik: https://amzn.to/4894Xi8
Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d
Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
Intake Breathing Nasal Support: https://amzn.to/48dfQQ1
Personal Blender: https://amzn.to/4pyNGGl
True Nutrition Protein: https://oken.do/q2xzqeqw
Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

Chapters:
00:00 - Introduction & AMA Catch-up
00:28 - Does Fibromyalgia Affect Heart Health?
01:43 - Advanced Markers for Inflammation (hsCRP, oxLDL)
03:04 - Upcoming LIVE AMA Details
03:48 - Is it Safe to Stop Lipitor for High Cholesterol?
05:23 - The "700 Point Drop" in CAC Score: What is Plaque-X?
07:51 - Testosterone & The FDA Black Box Warning Update
08:33 - Deep Dive: Do Viagra and Cialis Impact Mortality?
09:54 - Study Funding and Conflicts of Interest
10:51 - How PDE5 Inhibitors Actually Work
12:53 - Observational Studies vs. Clinical Trials
14:41 - Understanding the Dataset (TriNetX)
16:41 - How Patient Cohorts are Defined
19:54 - Comparing Cialis vs. Viagra for Heart Benefits
21:26 - Why Prostate Health Matters in This Research
24:21 - Breaking Down the Five Key Outcomes
26:30 - Statistical Matching: Making the Groups Fair
30:03 - The Results: Mortality, Stroke, and Dementia Risk
33:57 - Absolute vs. Relative Risk Reduction
37:29 - Tadalafil’s Half-Life Advantage
39:18 - Crossing the Blood-Brain Barrier
41:04 - Study Limitations: What We Might Have Missed
42:24 - The "Partnership" Factor in Longevity Data 43:32 - Final Thoughts: Is it Time for a Label Change?

In this session, I'm diving into your questions from our last AMA and taking a deep look at a fascinating new study on PDE5 inhibitors like Cialis (tadalafil) and Viagra (sildenafil). We explore whether these medications could have a role in longevity, heart health, and even dementia prevention. I also address questions on fibromyalgia, stopping statins, and the latest on testosterone and cardiovascular risk.

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
WaterPik: https://amzn.to/4894Xi8
Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d
Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
Intake Breathing Nasal Support: https://amzn.to/48dfQQ1
Personal Blender: https://amzn.to/4pyNGGl
True Nutrition Protein: https://oken.do/q2xzqeqw
Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

Two hours, your questions, and no script. You brought the good stuff: when it's actually safe to come off a statin, whether the enzyme supplements are worth it, what sleep apnea does to your arteries, how I build and read a full lab panel, and which heart-imaging test to get if you can only get one.

I answer fast, and I answer honestly — including the parts where the real answer is "we don't know yet." If you want the short version of how I think about metabolic and vascular risk, this is a good place to start. Grab a coffee, skip around with the chapters, and take what's useful for you.

⏱️ CHAPTERS
0:00 Welcome, and how these AMAs work
0:33 Shockwave therapy for ED, and how it grows new blood vessels
3:05 Can an ultrasound tech get CIMT-qualified? Why CardioRisk controls quality
6:52 Aspirin after a stent: how long, and who actually needs it
11:04 Small vessel disease and brain bleeds: the stroke signs to watch
13:01 Nattokinase, lumbrokinase, serrapeptase: do the enzymes work?
16:20 The genetic lottery: 45 years of partying and still standing
18:15 How long does a statin take to work? (and the clotting angle)
21:02 How often should you really see your preventive cardiologist?
25:23 Soft plaque, leg cramps, and the statin-intolerance playbook
29:52 Age 73: when can I stop my statin, aspirin, and lisinopril?
33:47 Supplements worth the money: magnesium, creatine, D3/K2, fish oil
40:05 Why all the statin hate? Relative vs. absolute risk, and trust
45:15 Lp(a): who should test, and why it matters for your family
49:48 Will Lp(a)-lowering drugs be covered for prevention?
53:36 Thyroid and heart health: why I check free T3 and free T4
55:26 Sleep, sleep apnea, and metabolic health
57:32 Walking after meals: GLUT4, meal timing, and insulin resistance
1:06:50 Testosterone and heart disease, for men and for women
1:10:51 What sleep apnea physically does to your arteries
1:13:31 The real problem with long-term PPIs
1:16:52 Is a carotid ultrasound worth it? It depends who reads it
1:19:35 Is plaque stabilization real science, or a gamble?
1:23:12 Nitric oxide lozenges, ADMA, and the oral microbiome
1:30:44 Building a lab panel: the tests I want, and how I read them
1:35:31 Microalbumin (UACR): the underused early-warning test
1:41:50 Why there's no one perfect diet (and why nutrition science is so hard)
1:53:25 Retatrutide, peptides, and the "just buy it online" problem
1:59:35 CAC vs. CIMT vs. CCTA: which imaging should you get?
2:14:18 CAC of 8 at 47, LDL 110: do you need a statin?
2:15:32 Wrap-up, and where to find me

📚 STUDIES & TERMS REFERENCED
JUPITER (rosuvastatin lowers events via hsCRP): Ridker PM, Danielson E, Fonseca FAH, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359(21):2195-2207. PMID: 18997196. https://pubmed.ncbi.nlm.nih.gov/18997196/

Multivitamin and cognition (COSMOS-Mind): Baker LD, Manson JE, Rapp SR, et al. Effects of cocoa extract and a multivitamin on cognitive function: a randomized clinical trial. Alzheimers Dement. 2023;19(4):1308-1319. PMID: 36102337. https://pubmed.ncbi.nlm.nih.gov/36102337/

▶️ WATCH NEXT
AMA #2 — Why a "Perfect" LDL Won't Save You: https://youtu.be/v2Pa7UUTLO8
AMA #1 — Lp(a), Microplastics, Testosterone & CAC: https://youtu.be/r1p-LpCruHc
Try THIS Instead of Nattokinase (the enzyme deep dive): https://youtu.be/yA26H0_7-_U
My video on statins and the brain: https://youtu.be/pgfNT7o08_g

⚕️ DISCLAIMER
This channel is for education, not medical advice. I'm a board-certified vascular surgeon, but I'm not your surgeon, and nothing here replaces a conversation with your own physician. Supplements and medications carry real risks, including bleeding. Talk to your doctor before starting, stopping, or changing anything — especially statins, aspirin, or any supplement if you take blood thinners or antiplatelet medication.

💬 If you got something out of this, subscribe and share it with a friend. Every new viewer helps our small channel grow one curious mind at a time.

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

Chapters:
00:00 The Replication Crisis & Messy Science
02:11 Why the KETO-CTA Study Was Retracted
03:25 Mediterranean Keto vs. Standard Keto
06:14 Cholesterol Balance: Absorption vs. Production
10:50 The Million-Dollar Question: What Causes Plaque?
13:07 Small Studies & Statistical Manipulation
15:03 Addressing Bias, Personalities, and Grifters
16:56 My Position on ApoB and Personalized Care

In this video, I dive into the "spicy" comments from my recent keto reaction video to address the complexities of heart health, the reality of the scientific replication crisis, and the nuances of personalized medicine. We discuss why a major keto study was retracted, how to think about cholesterol absorption vs. production, and why "testing, not guessing" is the only way to truly understand your own cardiovascular risk.

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
WaterPik: https://amzn.to/4894Xi8
Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d
Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
Intake Breathing Nasal Support: https://amzn.to/48dfQQ1
Personal Blender: https://amzn.to/4pyNGGl
True Nutrition Protein: https://oken.do/q2xzqeqw
Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

The nattokinase video clearly hit a nerve. Your comments were sharp, occasionally feisty, and worth a real answer. So this is the follow-up Q&A: natto the food versus nattokinase the isolated capsule, whether CIMT is a test I actually trust, the dosing argument a lot of you raised, and the supplement many of you asked about instead — lumbrokinase.

The back half is a proper walk through the one randomized trial testing lumbrokinase for secondary stroke prevention. I go through the design, the parts that gave me pause, and the plaque and IMT findings that genuinely caught my attention. My take, for what it's worth with the evidence we have: if you're going to hang your hat on an enzyme, lumbrokinase looks like the safer bet. Watch and decide for yourself.

⏱️ CHAPTERS
0:00 Why I'm answering your nattokinase comments
0:25 Natto the food vs. nattokinase the supplement
1:54 Is nattokinase the same as vitamin K2?
2:46 Do I trust CIMT? Plaque vs. IMT, explained
3:59 The "n=1" critique, Susan, and Dr. Brewer
6:01 The dosing fight: 2,000 vs. 10,800 FU
7:58 Lumbrokinase and serrapeptase: what they actually are
10:22 The 2013 lumbrokinase stroke trial: setup
13:09 Where the trial design gives me pause
15:46 Results: the patients and the open-label problem
17:26 Baseline data and the missing standard meds
20:20 Lab results: fibrinogen, CRP, D-dimer, tPA
22:29 The interesting part: plaque and IMT changes
24:57 Stroke scores, outcomes, and the low event count
27:52 How lumbrokinase differs from nattokinase (and why it's likely safer)
30:15 Bottom line: should you take it?

📚 STUDY DISCUSSED
Cao YJ, Zhang X, Wang WH, et al. Oral fibrinogen-depleting agent lumbrokinase for secondary ischemic stroke prevention: results from a multicenter, randomized, parallel-group and controlled clinical trial. Chin Med J (Engl). 2013;126(21):4060-4065. PMID: 24229674. https://pubmed.ncbi.nlm.nih.gov/24229674/

▶️ WATCH NEXT
"I Stopped Using Nattokinase. Here's Why.": https://youtu.be/vpenJQ3UJh0
The VitaK-CAC study: https://youtu.be/ArxAXtzsue4
Vit K Comments & Questions: https://youtu.be/uORGxMsedic

⚕️ DISCLAIMER
This channel is for education, not medical advice. I'm a board-certified vascular surgeon, but I'm not your surgeon, and nothing here replaces a conversation with your own physician. Supplements carry real risks, including bleeding. Talk to your doctor before starting, stopping, or changing anything — especially if you take blood thinners or antiplatelet medication.

💬 Found this useful? Subscribe, and drop your lumbrokinase questions in the comments. We'll get to as many as we can next time.

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
WaterPik: https://amzn.to/4894Xi8
Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d
Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
Intake Breathing Nasal Support: https://amzn.to/48dfQQ1
Personal Blender: https://amzn.to/4pyNGGl
True Nutrition Protein: https://oken.do/q2xzqeqw
Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

Nattokinase is one of the most hyped supplements in cardiovascular health — claimed to lower blood pressure, shrink arterial plaque by 36%, and drop LDL cholesterol without a statin. I put a patient on it. Then I looked closer at the data. Now I've stopped.

In this video, I break down what the evidence actually shows:

✅ Blood pressure: Real, but modest. A 2023 meta-analysis of 6 RCTs found just 3.45 mmHg systolic reduction — roughly half the effect of a low-dose ACE inhibitor.

❌ Plaque reduction: The headline 36% plaque reduction comes from a single retrospective chart review (Chen 2022) with no control group, no randomization, co-administered confounders, and 5 of 10 authors employed by the supplement manufacturer. Meanwhile, the rigorous double-blind NAPS trial (Hodis 2021, n=265) found zero effect on carotid plaque.

❌ Lipid lowering: In randomized trials (Yang 2009, Hsia 2009), nattokinase alone doesn't move lipids. The signal only appears in non-randomized studies — often confounded by red yeast rice, which contains monacolin K (chemically identical to lovastatin).

📉 The case study: I put "Susan" on high-dose nattokinase for a year. Her arterial age went from 64 to 73. We stopped.

The lesson: Test. Don't guess. Never start a supplement without a plan to stop it if the numbers don't move.

⏱️ Chapters
0:00 Why I stopped using nattokinase
0:21 Meet Susan
1:46 What nattokinase actually is
2:14 How nattokinase works
5:00 Does it survive digestion?
6:14 The real signal: blood pressure
8:34 The plaque-regression claim
9:59 Problems with the 2022 study
13:09 The 2017 plaque study
14:50 The 36% plaque reduction problem
16:30 Does it lower ApoB or LDL?
19:31 Why plaque ultrasound is tricky
22:56 Safety and bleeding concerns
25:57 What’s actually in the bottle?
27:24 The NAPS trial
28:48 Was the dose too low?
30:29 Susan’s one-year follow-up
32:51 What if you take it anyway?
33:42 Final take: test, don’t guess

⚠️ This video is for education only and is not personal medical advice. Please talk with your own physician before starting or stopping any supplement or medication — especially if you take aspirin, clopidogrel, warfarin, Eliquis, Xarelto, Pradaxa, or any other blood thinner.

— PRODUCT POTENCY TESTING —
Natural Informant (Danny Curtin). "Nattokinase: We Tested Them All… Which Products Can You Trust?" https://youtu.be/K1l_g6-vdC4?si=h4oOnGEw_Vvh51cx

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
WaterPik: https://amzn.to/4894Xi8
Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d
Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
Intake Breathing Nasal Support: https://amzn.to/48dfQQ1
Personal Blender: https://amzn.to/4pyNGGl
True Nutrition Protein: https://oken.do/q2xzqeqw
Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

Can you take too much vitamin K2? In this video, I answer the most common follow-up questions about vitamin K2, including dose, safety, testing, interactions, and whether more is actually better.

Here's the original video on the K2 clinical trial: https://youtu.be/ArxAXtzsue4

We’ll cover:
* Whether vitamin K2 toxicity is possible
* Whether using MK7 to slow coronary artery calcification is desirable
* What we know — and do not know — about upper dosing limits
* Who should be especially cautious with vitamin K supplements
* Why warfarin/Coumadin changes the conversation
* Whether vitamin K2 levels can be tested
* The difference between MK-4 and MK-7
* Whether vitamin K2 can “remove” calcium from arteries
* How I think about vitamin K2 in real-world cardiovascular prevention

The bottom line: vitamin K2 looks promising, but “promising” is not the same thing as “take as much as possible and hope your arteries applaud.”

This video is for education only and is not personal medical advice. Do not start, stop, or change supplements or medications based on YouTube — especially if you take warfarin or another medication affected by vitamin K. Talk with your own clinician.

⏰ Chapters
0:00 - More of your vitamin K2 questions
0:22 - Is softer plaque more dangerous than calcified plaque?
2:35 - Should people with high CAC avoid vitamin D3?
4:13 - Didn’t the AVADEC trial already show K2 works?
6:25 - Would a higher dose of K2 work better?
7:33 - Does K2 actively stop calcium from entering plaque?
8:28 - Can too much vitamin K2 cause blood clots?
8:55 - Vitamin K2 and warfarin/Coumadin
9:48 - Is K2 safe with Eliquis or Xarelto?
10:23 - Is 100 mcg enough—or should you take more?
11:16 - Can vitamin K2 remove calcium from arteries?
11:53 - Can you test for vitamin K deficiency?
12:37 - MK-4 vs MK-7: which form is better?
13:25 - Food sources vs K2 supplements
14:33 - Should K2 be taken with vitamin D3?
14:58 - Final takeaways

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Sign up for more information on my own practice here: https://corsighthealth.com/

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
WaterPik: https://amzn.to/4894Xi8
Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d
Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
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___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

Can vitamin K2 slow coronary artery calcium? A new JAMA Cardiology randomized trial found that MK-7 may reduce CAC progression over 2 years — but the real story is more complicated.

TL;DR: In this randomized trial, people with symptomatic coronary artery disease and CAC scores between 50–400 took either MK-7, a form of vitamin K2, at 360 mcg daily or placebo for 2 years. The MK-7 group had slower progression of coronary artery calcium and calcium mass, with no major safety signal. But this study did not prove fewer heart attacks, fewer stents, or lower mortality — so this is interesting, not a miracle. Especially important: do not start vitamin K supplements without medical guidance if you take warfarin/Coumadin.

Article link: https://jamanetwork.com/journals/jamacardiology/fullarticle/2850256

In this video, I break down the VitaK-CAC trial: who was studied, what dose was used, what happened to CAC scores, why plaque calcification is biologically complicated, and what I would — and would not — take away from this as a vascular surgeon.

⏰ Chapters
0:00 - New vitamin K study: why this matters
0:39 - The paper: MK-7 and coronary artery calcium
1:42 - Vitamin K1 vs K2, why MK-7
2:13 - What the VitaK-CAC trial tested
3:08 - Calcified plaque vs total plaque burden
3:28 - Study design: randomized, placebo-controlled, double-blind
4:41 - Who was included and excluded in the trial, plus why it matters
6:32 - What “symptomatic CAD” actually meant here
8:47 - The intervention: 360 mcg MK-7 daily
9:13 - CT scans, CAC scoring, and calcium mass
10:59 - How vitamin K status was measured
12:29 - Primary outcome: CAC progression, not heart attacks
13:03 - Statistical methods and “fast progression”
16:44 - LDL levels, statins, and a possible data discrepancy
18:25 - Baseline characteristics of the study population
22:12 - Adherence, adverse events, and vitamin K blood levels
23:31 - Matrix Gla protein: did MK-7 do what it was supposed to?
24:58 - Primary results: CAC progression slowed with MK-7
26:21 - Why the effect is exciting but modest
29:17 - Fast progressors: no significant difference
30:07 - Calcium mass and intention-to-treat analysis
32:02 - Secondary outcomes: plaque type and stenosis
33:32 - The big question: is less calcification always better?
35:40 - Discussion: promising, but clinical significance unknown
37:13 - Why MK-7 does not “remove” existing calcium
38:23 - Vitamin K biomarkers and possible under-dosing
42:25 - Study limitations
43:41 - Funding, conflicts of interest, and final takeaways
44:48 - My clinical take on vitamin K2/MK-7

This video is for education only and is not personal medical advice. Do not start, stop, or change supplements or medications based on YouTube — especially if you take warfarin or any medication affected by vitamin K. Talk with your own clinician.

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Sign up for more information on my own practice here: https://corsighthealth.com/
___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

In this Q&A session, Dr. Lily Johnston dives into complex viewer questions regarding cardiovascular health and emerging medical research. She covers the impact of hormone therapies on LP(a), the nuances of managing cholesterol after a heart attack, and how to interpret advanced imaging like CIMT and Calcium Scores.

The episode concludes with a fascinating look at a novel, experimental microsurgical approach for Alzheimer’s disease being studied in China, which aims to improve the brain's waste clearance through lymphatic connections. Dr. Lily breaks down the mechanistic rationale, the early clinical data, and the significant physiological and ethical concerns surrounding this "brain plumbing" surgery.

Timestamps
00:00 – Intro: Meet Dr. Lily Johnston, Vascular Surgeon & Cardiometabolic Specialist.
00:16 – Q&A 1: Can hormone replacement therapy (HRT) or testosterone reduce LP(a)?
02:53 – Q&A 2: Recovery after a STEMI—Statins vs. PCSK9 inhibitors and the role of Colchicine.
06:49 – Q&A 3: How to distinguish between stable and inflamed plaque using CIMT tests.
09:34 – Q&A 4: High Calcium Score (CAC) vs. CIMT results—Is a heart cath or CT angiogram next?
12:39 – Q&A 5: Does starting Menopausal Hormone Therapy (MHT) late increase cardiac risk?
16:48 – Addressing the "Omega minus-3" nomenclature (A quick biochemistry deep dive).
17:53 – Q&A 6: Does taking Phosphatidylcholine improve fish oil absorption?
19:02 – Q&A 7: Krill oil vs. traditional fish oil.
20:47 – Deep Dive: Deep Cervical Lymphovenous Anastomosis—A surgical treatment for Alzheimer's?
25:40 – Reviewing clinical evidence and controversies of Alzheimer's surgery.

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
WaterPik: https://amzn.to/4894Xi8
Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d
Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
Intake Breathing Nasal Support: https://amzn.to/48dfQQ1
Personal Blender: https://amzn.to/4pyNGGl
True Nutrition Protein: https://oken.do/q2xzqeqw
Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota