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 Why the first paper was retracted, the measurement "noise floor" that makes one-year plaque data so slippery, whether 21–29% "rapid progressors" is alarming or expected, and if NATURE-CT is a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

Order your own labs here:
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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
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.

#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):
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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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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

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):
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 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
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

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