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Knife Down

Lily Johnston, MD MPH

 "Knife Down" is what a surgeon says in the OR when she puts her scalpel down so no one gets hurt — and it’s the mission here: put the knife down, long before anyone needs to use it.


Knife Down is a podcast about how to actually invest in your health so you can live longer, stronger, and with less time in doctors’ offices. The core focus is the world’s leading cause of death—cardiovascular disease—and what to do about it before it shows up as a catastrophe.


Hosted by a vascular surgeon on a mission to put herself out of business, the show translates cutting-edge science on prevention, metabolic health, and longevity into real-world strategies you can use in clinic or at your kitchen table. Expect evidence, nuance, and zero wellness hype—plus the occasional dark joke about the state of modern medicine.

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  • 21 episodes
  • Avg 39 min
  • English

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  • S2026 · E55
    Monday · 22 min

    My Arteries Got Older?! A Vascular Surgeon Explains CIMT Results

    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 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.

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  • S2026 · E54
    August 29 · 19 min

    What Really Causes Heart Disease: LDL or Inflammation?

    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 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

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  • S2026 · E53
    August 26 · 34 min

    This Changes How I Think About Creatine

    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 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

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  • S2026 · E52
    August 24 · 27 min

    High LDL. Normal ApoB. Now What??

    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 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 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.

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  • S2026 · E51
    August 22 · 13 min

    The 10 Blood Tests I Run to Catch Heart Disease DECADES Early

    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

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  • S2026 · E50
    August 19 · 29 min

    I Checked My Own Labs: Here’s Exactly How I Read Them

    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

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  • S2026 · E49
    August 17 · 39 min

    Carnivore Bloodwork: Best Case, Not the Whole Case

    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

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  • S2026 · E48
    August 15 · 22 min

    Cholesterol Balance & Keto Bias

    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

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  • S2026 · E49
    July 23 · 32 min

    Surgeon Reacts to the KETO-CTA 'Scandal'

    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.

    • Transcript
  • S2026 · E47
    July 22 · 39 min

    Carnivore Bloodwork: Best Case, Not the Whole Case

    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

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  • S2026 · E48
    July 21 · 44 min

    Do Viagra and Cialis Help You Live Longer? What This Study Actually Found

    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

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  • S2026 · E46
    July 20 · 2 hr 16 min

    AMA #3: When Can You Actually Stop a Statin? Plus Plaque, Lp(a), Sleep Apnea & Heart Scans

    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.

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  • S2026 · E45
    July 16 · 22 min

    Cholesterol Balance & Keto Bias

    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

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  • S2026 · E44
    June 30 · 31 min

    Try THIS instead of Nattokinase (Surgeon Explains)

    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

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  • S2026 · E43
    June 24 · 35 min

    I Stopped Using Nattokinase. Here’s Why.

    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

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  • S2026 · E42
    June 22 · 15 min

    Can You Take Too Much Vitamin K2? Vascular Surgeon Explains

    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 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

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  • S2026 · E41
    June 17 · 45 min

    Vitamin K Slows Coronary Calcium: NEW Netherlands Study

    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. 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 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.

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  • S2026 · E40
    June 15 · 31 min

    Surgery for Alzheimer's...Is It Real? (and other questions)

    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

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  • S2026 · E39
    June 10 · 47 min

    99% of heart attacks had a warning. Your doctor called it "normal."

    Can you have a heart attack with “normal” labs and no warning signs? Or are we missing the warning signs because our thresholds are too late and our prevention model is too reactive? Today I react to a fascinating video from Dr Brad Stanfield, BUT STICK AROUND because then we take a deep dive into the actual JACC paper behind the headline that “99% of people who had a heart attack had at least one warning sign beforehand.” We break down: * Why “normal” isn’t always optimal * The difference between diagnosed risk factors vs actual exposure * Why blood pressure of 128/82 may still matter * The hidden role of insulin resistance and metabolic syndrome * ApoB vs LDL-C vs non-HDL cholesterol * Why prevention needs to start decades earlier * The problem with reactive medicine * What Jim Fix’s story actually teaches us about cardiovascular disease This is not a message of fear. It’s a message of agency. Because clogged arteries rarely appear out of nowhere. Most of the time, the body whispers long before it screams. ⏰ Chapters ⏰ 0:00 The “99% of Heart Attacks” claim 0:57 Did people really have NO risk factors? 2:23 Why “SMURF-less” heart attacks confused cardiology 3:02 Are our thresholds too high? 4:21 Insulin resistance may be the missing link 5:14 The massive 9-million-person study 5:57 Over 99% had at least one non-optimal risk factor 6:50 Diagnosed risk factors vs actual exposure 7:18 The underdiagnosis problem in medicine 8:02 Why billing data can be misleading 10:13 Cardiovascular risk is continuous, not binary 11:42 Prediabetes still damages arteries 13:43 Why granular patient data matters 14:50 The tragic story of Jim Fix 16:47 “The second most common symptom is denial” 17:31 Exercise didn’t cause his heart disease 19:17 Why this data is actually hopeful 20:03 Reactive medicine vs prevention 20:32 “I lost weight… isn’t that enough?” 22:03 How aggressive should prevention targets be? 23:50 ApoB explained simply 25:29 My take on ApoB vs LDL-C 28:05 Deep dive into the JACC paper 35:28 Which risk factor was most common? 37:21 Most patients had MULTIPLE risk factors 39:26 Does this only apply to older people? 41:34 What happens when we use standard clinical cutoffs? 43:43 Why non-HDL cholesterol matters 45:47 The boring prevention advice still wins 46:38 Residual risk after lifestyle transformation 47:00 Why the fundamentals still matter most 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 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. This video is for educational purposes only and does not constitute personalized medical advice. Please discuss your individual health risks, labs, medications, and treatment decisions with your own physician.

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  • S2026 · E38
    June 8 · 11 min

    Can THIS Supplement Prevent Heart Disease? Surgeon Reacts to Dr Boz

    Are omega-3s really the #1 supplement for heart disease prevention? In this reaction to Dr. Boz, I break down the nuance: atrial fibrillation risk, rancid oils, DHA vs EPA, heavy metal testing, delivery forms, omega level testing, and why small fatty fish may beat supplements for most people. 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 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

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