WEBVTT
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You guys had amazing questions about the IMT protocol that we went over in the last video.
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Let's get into it.
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If you're new here, I'm Dr.
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Lily Johnston.
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I'm a vascular surgeon, but I specialize in cardiometabolic prevention, so hopefully you will never need me as a surgeon.
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At Peters616, thank you.
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That was very informative.
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I can't help but be a little suspicious about the thickness measurement having a 12-year swing in two years.
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I wonder if the ultrasound device was placed in a slightly different section of your artery.
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I understand that can have a big impact on thickness.
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So, Peters, this is about the accuracy of the cardio risk CIMT protocol.
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And it's one of the really fascinating things about how Dr.
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Todd Eldridge has crafted this test for a cardio risk in particular, because we take multiple pictures of the artery and they make multiple measurements from those multiple pictures.
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But this was not the only question about the accuracy, repeatability, and validity of the test.
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At 345DF says, if you can get another CIMT test at low or no cost, please consider doing it.
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That will tell us something about how repeatable the test is.
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Maybe the difference in your previous results and your current results is just noise.
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That is a really great point.
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The advertised threshold for detectable meaningful change in a CIMT from cardio risk is 0.02 millimeters.
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That is based on the data that Todd Eldridge, Dr.
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Eldridge has collected.
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But here's two things that we will do.
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One, Dr.
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Eldridge has already agreed to come on the podcast here and give us a more in-depth perspective on the exam protocol, the statistics behind it.
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We do not usually present those in any kind of clinical reports, but I think it's really important to understand just why we think this so highly of this test.
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So I don't have it scheduled yet, and I have um spoken with his team, but previously he has agreed that that would be something he would do.
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So we will get that on the books.
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We will bring Dr.
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Eldridge here to discuss the repeatability, validity, and reliability of this test.
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Secondly, I can get another CIMT.
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Let's do it.
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Let's just have that experiment and we'll go from there.
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At Dr.
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Bolt, nice video.
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As the age is based on average, how do they account for variation in body time?
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For example, highly muscular versus thin and exercise levels, athlete versus sedentary.
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Are these likely both to impact blood flow demands?
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Isn't there a natural thickening for muscular athletes?
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The last part of your question, isn't there a natural thickening for muscular athletes?
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I actually don't know the answer to that.
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We should look it up, I should look it up and bring that back to you at some point here soon.
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In terms of accounting for variation, the only really good way to do this is to take a broad swath of the population and create this population-based average.
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To the best of my knowledge, that is how these standards, right?
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The blue and pink or blue and purple lines, depending on what you saw, are created.
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And they are in healthy controls.
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Does that mean they have no disease?
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Probably not, but it means that they are the best we have to understand what is normal for aging over time.
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That's Stephen Cole, 7331.
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So the question is: do you have disease?
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The next question is the rate of formation.
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What is the risk level projected into the future?
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As you suggested, you could outlive the progression, and this is just one location.
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If you have formation, what is the cause?
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I believe you said your inflammatory markers were good.
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Your only problem I think you suggested is LDL.
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So yes, parsing this out.
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The first question, is there plaque or not?
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The answer is I don't have plaque yet.
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I am concerned that the rate of progression in my IMT may lead to plaque formation if it continues at its present pace.
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Now, you guys, lots of questions about the rate of progression, the accuracy of the test.
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We'll get to that.
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But the biggest problem in my labs is my LiPoproteins, and that is part and parcel also with my omega index.
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So, yes, that is something I'm interested to see.
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If I correct it, will the rate of progression change?
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Does that absolutely mean if it does, that that's what fixed it?
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We don't know.
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We're doing the best we can with the amount of data we have, but correct.
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You know, there's two components.
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Do I have plaque?
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No.
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What is the risk of progression and what else is involved?
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So I hope that was helpful.
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We the people, Dr.
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Lilly, do you have any theory of what might have caused the change in your IMT numbers?
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Genetics, food, lifestyle changes.
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So I have some theories.
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I don't have any concrete evidence.
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First piece of evidence is there is some genetic component to this.
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My mom has plaque in her arteries as well.
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And to that extent, we both have somewhat elevated lipoproteins or APOB levels.
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Hers are worse than mine, but that's partially part of this, I think.
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Food, I have to acknowledge food is a possibility.
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I do not eat a strict diet anymore.
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I eat what I think is a pretty healthful diet.
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We'll come back to that in just a minute if you stick around.
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But I don't think it's changed a lot in the last two years.
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If it has changed, in my opinion, it's changed for the better.
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And again, I'll talk to you about what I think that means here shortly.
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Lifestyle changes is also very possible.
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Somebody during the premiere mentioned the role of stress and the role of sleep and kind of the more nebulous pieces of lifestyle that are absolutely relevant, right?
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We know if we look at the population level, again, sleep is a big deal.
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Disordered sleep is certainly associated with worse cardiovascular outcomes and events.
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To what extent adequate versus like normal, non-disordered, but lower levels is a problem.
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At the level of plaque, I don't know.
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We know at a broad level that people who sleep in that seven to nine hour range every night do better than people who don't.
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Whether that impacts plaque specifically, I don't have a paper for you on that.
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Stress is a very similar situation.
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We know that big traumatic events, severe mental illness, chronic stressors, shift work, all of these things contribute to poor metabolic health, and they also contribute to higher rates of cardiovascular disease at a population level.
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Is there an effect size that I can point to that says, oh, I have a chronically stressed life, that means my risk is X fold higher?
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I don't have that for you because again, how do we measure the chronic stress?
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How do we measure my on call and that I was woken up at midnight to deal with an emergency last night while I was on call?
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We don't have a way to quantify that yet that's helpful.
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However, I will acknowledge that despite having changed a lot about my work life, my home life, there's still a fair amount of chronic stress in my life.
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And there's a lot of busyness in my life that I probably need to do better about.
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So is that the cause?
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I don't know.
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But I'm open to the possibility that it is possible, that it is related, right?
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That's I have to acknowledge that.
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So um the things that are actionable for me now, the lipids and to some extent the food, although not as much, but we'll talk about that in a second.
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Lifestyle is is absolutely something that needs to be considered.
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At Johnny Rockton, you are not trained in prevention, so why are you acting like it?
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Two things to say about this.
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If you were in a profession where you worked really, really hard and bent over backwards to try to help people and ultimately realized it wasn't helping, that's a problem.
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So I, as a vascular surgeon, do lots of operations to try and help people deal with the consequences of blocked arteries, whether it's in their arms, their legs, their neck.
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It's a big deal.
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And as the consequence of the end stage of that disease process, I ended up doing a lot of amputations.
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And it's a traumatic thing for the patients, but it's also a traumatic thing for doctors.
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There's not a doctor on earth who wants to be doing that, even when it's necessary, even when it's life-saving.
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It is tragic to amputate a part of another human's body.
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So it became my mission to do what I could to avoid having to do that over and over again.
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I was not originally classically trained in prevention.
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There is no cardiometabolic prevention board certification or formal training pathway.
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There is something called preventive cardiology that does exist in a few niche areas, but it's not widespread.
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It's not common.
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Modern medicine in general does a poor job of preventing chronic disease.
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But there are pockets, and I have gone out to find places who will teach me how to do this better, how to learn about what metabolic health is, how to understand how the components of nutrition and exercise and sleep and kidney function and diabetes and hormones and all of this come together to create a whole human.
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And that whole human is at risk for cardiovascular disease and a whole host of other things.
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So, long story short, I've made it my mission to become an expert in prevention.
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I'm not gonna get it all right.
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I don't have it all figured out, but I am going out of my way to do better and learn more and share what I can here so that the surgery piece doesn't need to be the end result for all of my patients going forward.
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At Bill DoubleWhopper says, if you eat the SAD, you have coronary artery disease, standard American diet.
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If you eat a high-fat animal, high animal product diet, you have coronary artery disease.
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Um username checks out.
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Thanks, Bill DoubleWhopper.
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And at PonycarFan says, I would love to see what a keto or carnivore diet would do in this situation.
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Nobody really knows, but there's lots of opinions.
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But I don't think it's been studied.
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A lot of things are caused by metabolic disease, which is almost always based on diet.
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Okay.
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So many of you may know this already, some of you don't.
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I, in general, personally, have adopted a lower carbohydrate way of eating.
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I was ketogenic for a number of years and I have liberalized that.
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My version of that today looks very Mediterranean inspired.
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And what I want to emphasize is this is what is working for me today, in 2026.
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I may change again.
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My review of the literature and the evidence suggests that there are several ways of eating that can work and are all an improvement over the standard American disaster diet, right?
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I think a whole food plant-based approach is a very reasonable one for many people at many times.
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For me, I am choosing to incorporate some animal products, but I have gone a little away from red meat and a little more into fish and poultry.
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I don't eliminate red meat yet.
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Maybe someday I will choose to do that.
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And I am leaning more into fruits and vegetables right now.
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I don't do grains.
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Again, I've discussed this on this channel before.
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It personally doesn't agree with me.
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And I am prone to overeating things that are baked, like breads, pastas, pastries, all of that stuff.
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So I choose not to do that in an effort to limit my total energy consumption.
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That doesn't mean it's not possible to achieve excellent metabolic health doing those things, but for me, it's not my optimal strategy right now.
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So let's talk about what I've had to eat in the last 24 hours and just give you a sense for how that looks in my life.
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Yesterday I worked out in the morning and then I made a protein shake.
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And that for me was about a cup of frozen berries.
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I put in about 40 grams worth of whey protein.
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I put two eggs in there and some chia seeds and some flax and some water.
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That's what was in there.
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Oh, sorry, I put my creatine in there too.
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So I had about 10 or 15 grams of creatine in that shake.
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And that held me over until early afternoon.
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I had some chicken breasts and avocado in the afternoon.
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And then I went to dinner with my parents and we had a really nice mixed salad.
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We had some fresh tomatoes and mozzarella from my dad who was growing tomatoes in the garden.
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So we had some fresh tomatoes and mozzarella and basil as a caprizi salad.
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And then we made hamburgers on the grill.
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So I had a hamburger with a slice of cheese on it, and that's probably the extent of red meat that I'll have for the week, but it was delicious and I really enjoyed it.
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And I had a square of dark chocolate to finish off the evening.
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And so far today, I have had my two cups of black coffee, but um I'm still fasted.
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And it's I'm recording this in late afternoon.
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So um not because I had a plan to do that.
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It's just kind of how my day has worked out, and that's fine.
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I feel great.
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That is what's working for me.
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It may or may not be what works for you.
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It's all a big mystery about how this is gonna go on any individual person at the population level.
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I feel like I've said that over and over this video.
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We know there are many, many patterns that are useful.
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The Mediterranean pattern can be really useful, the Dash diet pattern, the like Dean Ornish style pattern, like all of those are sort of leaning more towards whole food plant-based, but I also have people who are doing really, really well on a ketogenic diet, even some people who are thriving for several reasons on a carnivore diet.
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Is it optimal in every respect?
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There is no diet that is optimal in every respect.
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We have to go back to what is the problem, the biggest problem that we are solving for.
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If the biggest problem that you are solving for is cardiovascular disease, yes, perhaps there are some of those that weigh more heavily than others, but it's not the only reason we eat.
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We eat for anti-inflammatory properties, we eat for food addiction, we eat in a style that is compatible with our heritage and ethnicity and family structure and rules.
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There are a lot of reasons that people choose a certain pattern, and it's important to consider all of that when we're recommending that for people.
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So I recommend whole food plant-based approaches for some patients, and I recommend very low carbohydrate approaches for other patients.
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When possible, I do like to incorporate the more Mediterranean style low-carb approach, but it's not gonna work for everybody.
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That's okay.
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Let's figure out what's going on, solve for the biggest problem we can, and manage the rest in with whatever other tools we have.
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I hope that was helpful.
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Thank you guys for the great questions.
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Until next time, take really good care.
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You guys had amazing questions about the IMT protocol that we went over in the last video.
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Let's get into it.
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If you're new here, I'm Dr.
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Lily Johnston.
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I'm a vascular surgeon, but I specialize in cardiometabolic prevention, so hopefully you will never need me as a surgeon.
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At Peters616, thank you.
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That was very informative.
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I can't help but be a little suspicious about the thickness measurement having a 12-year swing in two years.
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I wonder if the ultrasound device was placed in a slightly different section of your artery.
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I understand that can have a big impact on thickness.
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So, Peters, this is about the accuracy of the cardio risk CIMT protocol.
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And it's one of the really fascinating things about how Dr.
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Todd Eldridge has crafted this test for a cardio risk in particular, because we take multiple pictures of the artery and they make multiple measurements from those multiple pictures.
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But this was not the only question about the accuracy, repeatability, and validity of the test.
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At 345DF says, if you can get another CIMT test at low or no cost, please consider doing it.
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That will tell us something about how repeatable the test is.
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Maybe the difference in your previous results and your current results is just noise.
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That is a really great point.
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The advertised threshold for detectable meaningful change in a CIMT from cardio risk is 0.02 millimeters.
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That is based on the data that Todd Eldridge, Dr.
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Eldridge has collected.
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But here's two things that we will do.
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One, Dr.
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Eldridge has already agreed to come on the podcast here and give us a more in-depth perspective on the exam protocol, the statistics behind it.
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We do not usually present those in any kind of clinical reports, but I think it's really important to understand just why we think this so highly of this test.
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So I don't have it scheduled yet, and I have um spoken with his team, but previously he has agreed that that would be something he would do.
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So we will get that on the books.
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We will bring Dr.
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Eldridge here to discuss the repeatability, validity, and reliability of this test.
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Secondly, I can get another CIMT.
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Let's do it.
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Let's just have that experiment and we'll go from there.
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At Dr.
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Bolt, nice video.
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As the age is based on average, how do they account for variation in body time?
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For example, highly muscular versus thin and exercise levels, athlete versus sedentary.
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Are these likely both to impact blood flow demands?
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Isn't there a natural thickening for muscular athletes?
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The last part of your question, isn't there a natural thickening for muscular athletes?
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I actually don't know the answer to that.
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We should look it up, I should look it up and bring that back to you at some point here soon.
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In terms of accounting for variation, the only really good way to do this is to take a broad swath of the population and create this population-based average.
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To the best of my knowledge, that is how these standards, right?
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The blue and pink or blue and purple lines, depending on what you saw, are created.
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And they are in healthy controls.
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Does that mean they have no disease?
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Probably not, but it means that they are the best we have to understand what is normal for aging over time.
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That's Stephen Cole, 7331.
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So the question is: do you have disease?
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The next question is the rate of formation.
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What is the risk level projected into the future?
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As you suggested, you could outlive the progression, and this is just one location.
00:03:30.479 --> 00:03:32.479
If you have formation, what is the cause?
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I believe you said your inflammatory markers were good.
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Your only problem I think you suggested is LDL.
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So yes, parsing this out.
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The first question, is there plaque or not?
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The answer is I don't have plaque yet.
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I am concerned that the rate of progression in my IMT may lead to plaque formation if it continues at its present pace.
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Now, you guys, lots of questions about the rate of progression, the accuracy of the test.
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We'll get to that.
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But the biggest problem in my labs is my LiPoproteins, and that is part and parcel also with my omega index.
00:04:07.199 --> 00:04:09.919
So, yes, that is something I'm interested to see.
00:04:10.159 --> 00:04:13.199
If I correct it, will the rate of progression change?
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Does that absolutely mean if it does, that that's what fixed it?
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We don't know.
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We're doing the best we can with the amount of data we have, but correct.
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You know, there's two components.
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Do I have plaque?
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No.
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What is the risk of progression and what else is involved?
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So I hope that was helpful.
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We the people, Dr.
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Lilly, do you have any theory of what might have caused the change in your IMT numbers?
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Genetics, food, lifestyle changes.
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So I have some theories.
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I don't have any concrete evidence.
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First piece of evidence is there is some genetic component to this.
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My mom has plaque in her arteries as well.
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And to that extent, we both have somewhat elevated lipoproteins or APOB levels.
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Hers are worse than mine, but that's partially part of this, I think.
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Food, I have to acknowledge food is a possibility.
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I do not eat a strict diet anymore.
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I eat what I think is a pretty healthful diet.
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We'll come back to that in just a minute if you stick around.
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But I don't think it's changed a lot in the last two years.
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If it has changed, in my opinion, it's changed for the better.
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And again, I'll talk to you about what I think that means here shortly.
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Lifestyle changes is also very possible.
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Somebody during the premiere mentioned the role of stress and the role of sleep and kind of the more nebulous pieces of lifestyle that are absolutely relevant, right?
00:05:41.759 --> 00:05:45.680
We know if we look at the population level, again, sleep is a big deal.
00:05:45.839 --> 00:05:50.639
Disordered sleep is certainly associated with worse cardiovascular outcomes and events.
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To what extent adequate versus like normal, non-disordered, but lower levels is a problem.
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At the level of plaque, I don't know.
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We know at a broad level that people who sleep in that seven to nine hour range every night do better than people who don't.
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Whether that impacts plaque specifically, I don't have a paper for you on that.
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Stress is a very similar situation.
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We know that big traumatic events, severe mental illness, chronic stressors, shift work, all of these things contribute to poor metabolic health, and they also contribute to higher rates of cardiovascular disease at a population level.
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Is there an effect size that I can point to that says, oh, I have a chronically stressed life, that means my risk is X fold higher?
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I don't have that for you because again, how do we measure the chronic stress?
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How do we measure my on call and that I was woken up at midnight to deal with an emergency last night while I was on call?
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We don't have a way to quantify that yet that's helpful.
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However, I will acknowledge that despite having changed a lot about my work life, my home life, there's still a fair amount of chronic stress in my life.
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And there's a lot of busyness in my life that I probably need to do better about.
00:07:09.519 --> 00:07:11.920
So is that the cause?
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I don't know.
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But I'm open to the possibility that it is possible, that it is related, right?
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That's I have to acknowledge that.
00:07:19.759 --> 00:07:30.720
So um the things that are actionable for me now, the lipids and to some extent the food, although not as much, but we'll talk about that in a second.
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Lifestyle is is absolutely something that needs to be considered.
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At Johnny Rockton, you are not trained in prevention, so why are you acting like it?
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Two things to say about this.
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If you were in a profession where you worked really, really hard and bent over backwards to try to help people and ultimately realized it wasn't helping, that's a problem.
00:07:58.560 --> 00:08:11.199
So I, as a vascular surgeon, do lots of operations to try and help people deal with the consequences of blocked arteries, whether it's in their arms, their legs, their neck.
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It's a big deal.
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And as the consequence of the end stage of that disease process, I ended up doing a lot of amputations.
00:08:21.279 --> 00:08:25.839
And it's a traumatic thing for the patients, but it's also a traumatic thing for doctors.
00:08:26.000 --> 00:08:32.799
There's not a doctor on earth who wants to be doing that, even when it's necessary, even when it's life-saving.
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It is tragic to amputate a part of another human's body.
00:08:37.120 --> 00:08:46.720
So it became my mission to do what I could to avoid having to do that over and over again.
00:08:47.200 --> 00:08:50.799
I was not originally classically trained in prevention.
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There is no cardiometabolic prevention board certification or formal training pathway.
00:08:57.679 --> 00:09:02.720
There is something called preventive cardiology that does exist in a few niche areas, but it's not widespread.
00:09:02.879 --> 00:09:03.840
It's not common.
00:09:04.080 --> 00:09:09.440
Modern medicine in general does a poor job of preventing chronic disease.
00:09:09.759 --> 00:09:33.600
But there are pockets, and I have gone out to find places who will teach me how to do this better, how to learn about what metabolic health is, how to understand how the components of nutrition and exercise and sleep and kidney function and diabetes and hormones and all of this come together to create a whole human.
00:09:33.759 --> 00:09:38.879
And that whole human is at risk for cardiovascular disease and a whole host of other things.
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So, long story short, I've made it my mission to become an expert in prevention.
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I'm not gonna get it all right.
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I don't have it all figured out, but I am going out of my way to do better and learn more and share what I can here so that the surgery piece doesn't need to be the end result for all of my patients going forward.
00:10:01.279 --> 00:10:08.080
At Bill DoubleWhopper says, if you eat the SAD, you have coronary artery disease, standard American diet.
00:10:08.320 --> 00:10:13.919
If you eat a high-fat animal, high animal product diet, you have coronary artery disease.
00:10:14.159 --> 00:10:16.240
Um username checks out.
00:10:16.399 --> 00:10:18.159
Thanks, Bill DoubleWhopper.
00:10:18.960 --> 00:10:24.480
And at PonycarFan says, I would love to see what a keto or carnivore diet would do in this situation.
00:10:24.639 --> 00:10:26.720
Nobody really knows, but there's lots of opinions.
00:10:26.879 --> 00:10:28.320
But I don't think it's been studied.
00:10:28.480 --> 00:10:32.159
A lot of things are caused by metabolic disease, which is almost always based on diet.
00:10:32.399 --> 00:10:32.720
Okay.
00:10:33.519 --> 00:10:37.120
So many of you may know this already, some of you don't.
00:10:37.360 --> 00:10:42.639
I, in general, personally, have adopted a lower carbohydrate way of eating.
00:10:42.799 --> 00:10:46.879
I was ketogenic for a number of years and I have liberalized that.
00:10:47.200 --> 00:10:51.279
My version of that today looks very Mediterranean inspired.
00:10:51.519 --> 00:10:57.600
And what I want to emphasize is this is what is working for me today, in 2026.
00:10:57.919 --> 00:10:59.600
I may change again.
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My review of the literature and the evidence suggests that there are several ways of eating that can work and are all an improvement over the standard American disaster diet, right?
00:11:11.840 --> 00:11:17.120
I think a whole food plant-based approach is a very reasonable one for many people at many times.
00:11:17.360 --> 00:11:25.840
For me, I am choosing to incorporate some animal products, but I have gone a little away from red meat and a little more into fish and poultry.
00:11:26.000 --> 00:11:28.080
I don't eliminate red meat yet.
00:11:28.240 --> 00:11:30.320
Maybe someday I will choose to do that.
00:11:30.639 --> 00:11:34.000
And I am leaning more into fruits and vegetables right now.
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I don't do grains.
00:11:35.279 --> 00:11:37.200
Again, I've discussed this on this channel before.
00:11:37.360 --> 00:11:38.960
It personally doesn't agree with me.
00:11:39.120 --> 00:11:46.000
And I am prone to overeating things that are baked, like breads, pastas, pastries, all of that stuff.
00:11:46.080 --> 00:11:50.639
So I choose not to do that in an effort to limit my total energy consumption.
00:11:50.879 --> 00:11:59.039
That doesn't mean it's not possible to achieve excellent metabolic health doing those things, but for me, it's not my optimal strategy right now.
00:11:59.200 --> 00:12:07.440
So let's talk about what I've had to eat in the last 24 hours and just give you a sense for how that looks in my life.
00:12:07.759 --> 00:12:12.559
Yesterday I worked out in the morning and then I made a protein shake.
00:12:12.639 --> 00:12:16.159
And that for me was about a cup of frozen berries.
00:12:16.399 --> 00:12:19.600
I put in about 40 grams worth of whey protein.
00:12:19.759 --> 00:12:25.759
I put two eggs in there and some chia seeds and some flax and some water.
00:12:25.919 --> 00:12:27.039
That's what was in there.
00:12:27.200 --> 00:12:29.039
Oh, sorry, I put my creatine in there too.
00:12:29.120 --> 00:12:32.159
So I had about 10 or 15 grams of creatine in that shake.
00:12:32.480 --> 00:12:36.639
And that held me over until early afternoon.
00:12:36.879 --> 00:12:40.720
I had some chicken breasts and avocado in the afternoon.
00:12:40.799 --> 00:12:46.559
And then I went to dinner with my parents and we had a really nice mixed salad.
00:12:46.639 --> 00:12:51.279
We had some fresh tomatoes and mozzarella from my dad who was growing tomatoes in the garden.
00:12:51.360 --> 00:12:55.519
So we had some fresh tomatoes and mozzarella and basil as a caprizi salad.
00:12:55.600 --> 00:12:57.840
And then we made hamburgers on the grill.
00:12:57.919 --> 00:13:05.840
So I had a hamburger with a slice of cheese on it, and that's probably the extent of red meat that I'll have for the week, but it was delicious and I really enjoyed it.
00:13:06.000 --> 00:13:10.639
And I had a square of dark chocolate to finish off the evening.
00:13:10.879 --> 00:13:16.480
And so far today, I have had my two cups of black coffee, but um I'm still fasted.
00:13:16.639 --> 00:13:19.519
And it's I'm recording this in late afternoon.
00:13:19.759 --> 00:13:23.519
So um not because I had a plan to do that.
00:13:23.600 --> 00:13:25.840
It's just kind of how my day has worked out, and that's fine.
00:13:25.919 --> 00:13:27.200
I feel great.
00:13:27.919 --> 00:13:30.000
That is what's working for me.
00:13:30.240 --> 00:13:32.399
It may or may not be what works for you.
00:13:32.639 --> 00:13:38.080
It's all a big mystery about how this is gonna go on any individual person at the population level.
00:13:38.159 --> 00:13:40.159
I feel like I've said that over and over this video.
00:13:40.480 --> 00:13:43.519
We know there are many, many patterns that are useful.
00:13:43.679 --> 00:14:03.279
The Mediterranean pattern can be really useful, the Dash diet pattern, the like Dean Ornish style pattern, like all of those are sort of leaning more towards whole food plant-based, but I also have people who are doing really, really well on a ketogenic diet, even some people who are thriving for several reasons on a carnivore diet.
00:14:03.519 --> 00:14:05.919
Is it optimal in every respect?
00:14:06.159 --> 00:14:09.759
There is no diet that is optimal in every respect.
00:14:10.000 --> 00:14:14.559
We have to go back to what is the problem, the biggest problem that we are solving for.
00:14:14.720 --> 00:14:24.080
If the biggest problem that you are solving for is cardiovascular disease, yes, perhaps there are some of those that weigh more heavily than others, but it's not the only reason we eat.
00:14:24.399 --> 00:14:37.120
We eat for anti-inflammatory properties, we eat for food addiction, we eat in a style that is compatible with our heritage and ethnicity and family structure and rules.
00:14:37.360 --> 00:14:46.000
There are a lot of reasons that people choose a certain pattern, and it's important to consider all of that when we're recommending that for people.
00:14:46.159 --> 00:14:53.840
So I recommend whole food plant-based approaches for some patients, and I recommend very low carbohydrate approaches for other patients.
00:14:54.080 --> 00:15:00.559
When possible, I do like to incorporate the more Mediterranean style low-carb approach, but it's not gonna work for everybody.
00:15:00.799 --> 00:15:02.080
That's okay.
00:15:02.399 --> 00:15:09.519
Let's figure out what's going on, solve for the biggest problem we can, and manage the rest in with whatever other tools we have.
00:15:10.320 --> 00:15:11.519
I hope that was helpful.
00:15:11.679 --> 00:15:13.519
Thank you guys for the great questions.
00:15:13.840 --> 00:15:16.159
Until next time, take really good care.
