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Knife Down · 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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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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