In this episode of The Feldman Protocol, a provocative question anchors the conversation: how much of cardiovascular risk is about cholesterol itself versus the context it operates in? Guest **Josh Wageman, DPT, PA-C, PhD**—a clinical lipid specialist and researcher—makes the case for using metaphor, metabolic health, and imaging to think differently about risk. The discussion spans coronary calcium scoring, lipid particles, insulin and inflammation, endurance training extremes, neurodegeneration, and why communicating science clearly actually matters. 🔥 This episode is sponsored by us -- Own Your Labs `http://ownyourlabs.com` -- private blood testing services.🩸Over 300 blood tests💰Extremely affordable❤️ We love our customers(Yes, we are literally funding the entire podcast from our own company -- so if you want to show your support, keep getting your private blood testing through our service. Thank you! 🙏)🔗 CONNECT WITH DAVE FELDMAN:Main Channel: `https://youtube.com/@realDaveFeldman`X/Twitter: `https://x.com/realDaveFeldman`Instagram: `https://instagram.com/realDaveFeldman`Website: `https://thefeldmanprotocol.com`⏱ Chapters3:00 – Why metaphors matter in medicine9:32 – Josh’s unconventional training path15:48 – Overtraining, illness, and collapse21:56 – Thyroid failure and recovery28:10 – Learning endocrinology the hard way34:42 – From PT to lipid specialist41:05 – Why lipids became the focus47:22 – Humor as a teaching tool53:40 – Writing the “lipid neighborhood”1:00:02 – Four pillars of metabolic health1:06:18 – Insulin and context over numbers1:12:35 – Inflammation isn’t one thing1:18:52 – Drugs as a risk factor1:25:14 – Cholesterol doesn’t live on paper1:31:28 – CAC as a reality check1:37:44 – Zero CAC and residual risk1:43:59 – Genetics vs lifestyle1:50:12 – ApoB’s necessary role1:56:27 – Why plaque still forms2:02:41 – Extreme endurance and CAC2:08:55 – When fitness backfires2:15:10 – Imaging vs biomarkers2:21:26 – Dementia and lipid biology2:27:40 – Neurodegeneration as frontier2:33:55 – Teaching clinicians differently2:40:08 – Credentials vs trust2:46:22 – Patient-first frameworks2:52:36 – Science communication failures2:58:49 – Measuring what matters3:04:55 – Meaning beyond metrics3:11:10 – Legacy and patient impact3:15:42 – Where Josh wants research to go3:18:43 – Closing thoughts and gratitude#FeldmanProtocol #DaveFeldman #JoshWageman #Lipids #Cholesterol #MetabolicHealth #ApoB #CACScore #Endocrinology #PreventiveCardiology #HealthCommunication