Encore: Why Normal Cholesterol Doesn’t Always Mean Low Heart Disease Risk

High cholesterol has been treated as the main cause of heart disease for decades. But over the years, I've changed my mind. Today, I believe cholesterol is only part of the story, and that inflammation, insulin resistance, and metabolic health are often the real drivers of cardiovascular disease. In this encore episode, I'm revisiting one of my most talked-about Office Hours conversations to share how my thinking has evolved and why understanding the root cause of heart disease can completely change the way you approach prevention.

In today's episode, I discuss:

• Why cholesterol alone is a poor predictor of heart disease—and the biomarkers I believe matter even more, including ApoB, lipoprotein(a), inflammation, and insulin resistance
• The surprising role sugar, refined carbohydrates, and metabolic dysfunction play in driving cardiovascular disease
• Why two people with the same cholesterol can have dramatically different heart disease risk—and how a personalized approach changes the conversation
• The nutrition, lifestyle, and testing strategies I use to help reduce inflammation, improve metabolic health, and lower cardiovascular risk at its source

Heart disease isn't simply a cholesterol problem—it's often a metabolic and inflammatory problem. When you understand what's really driving your risk, you can stop chasing a single number and start addressing the underlying biology that supports lifelong cardiovascular health.

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Have a question you'd love answered on Office Hours? Submit it here'

(0:00) The cholesterol and heart disease paradox; introduction and overview of cholesterol, inflammation, and metabolic health

(1:11) Sponsor: Function Health

(1:41) Traditional views vs. new science on cholesterol, inflammation, and heart disease

(4:52) Inflammation and sugar as key factors in heart disease

(8:41) Advanced markers: ApoB, lipoprotein fractionation, and comprehensive testing

(13:57) Causes of inflammation and holistic heart disease prevention

(19:35) Metabolic health risks, new technologies, and personalized interventions

(22:35) Diet, exercise, lifestyle, and supplements for heart and metabolic health

(25:03) Understanding heart disease beyond cholesterol

(25:37) Sponsor: Brain Shaping Academy

(26:33) Community engagement, sharing, and final thoughts

(28:07) Sponsor acknowledgments and closing remarks