Summabase
Heart

Heart disease biomarkers your checkup probably skips

  • What to do: ask for ApoB, a fasting insulin or insulin resistance score, and lipoprotein(a) at least once, instead of relying on a standard LDL-only cholesterol panel.
  • Why it matters: insulin resistance and elevated ApoB damage the artery wall years before cholesterol looks abnormal, and most heart attacks today trace back to metabolic dysfunction, not just high LDL.
  • How to apply it: track blood pressure using the seven-two-two rule (twice a day for seven days) and calculate your waist-to-height ratio at home; aim to keep it under 0.5.
  • Metrics: a fasting insulin under 5 is ideal, an ApoB test can reveal risk that a normal LDL panel misses entirely, and a ten-minute walk after meals measurably lowers post-meal blood sugar.
  • Tools: continuous glucose monitors, coronary artery calcium scoring starting around age 45, and AI-enhanced CT angiograms that separate soft plaque from calcified plaque.
  • Risks: treating a stent or bypass as a cure is a common misunderstanding: surgery relieves a blockage but does not stop the underlying disease process from continuing.

Why the scale lies: 5 better ways to measure your health

  • What to do: Stop relying on the bathroom scale alone. Track your waist, your strength, your blood pressure, and key blood markers instead of just body weight.
  • Why it matters: Two people with identical weight and BMI can have completely different health outcomes depending on muscle mass, visceral fat, and how well their cells respond to insulin.
  • How to apply it: Measure your waist first thing in the morning with a snug tape at the belly button, check your blood pressure at home once a week, and add fasting insulin and ApoB to your next blood panel.
  • Metrics: Keep your waist under half your height (roughly under 40in/102cm for men, 35in/80cm for women), aim for a triglyceride to HDL ratio under 1.5, and ask your doctor about fasting insulin and ApoB, not just standard cholesterol.
  • Tools: A simple tape measure, a home blood pressure cuff, and a lab panel like the one offered through this episode's sponsor, Function, at functionhealth.com/mark.
  • Risks: Crash dieting burns muscle along with fat, which slows your metabolism, so regained weight tends to come back as fat rather than muscle.
  • Exceptions: A woman's waist measurement can bloat by about an inch the week before her period; that fluctuation is hormonal, not a sign of new fat gain.

AI coronary plaque analysis and heart disease risk

  • What to do: If you worry about your heart, ask your doctor about a coronary CT angiogram with AI plaque analysis.
  • Why it matters: Fewer than half of heart attacks come with warning symptoms, and this tool measures plaque directly instead of guessing.
  • How to apply it: Consider the test if you have symptoms or a coronary calcium score between 1 and 300, and repeat scans on the same machine to compare.
  • Metrics: Your plaque volume is compared against nearly 300,000 people by age and sex; a calcium score of zero means low risk but not absence of plaque.
  • Tools: Calcium score, CT angiogram and AI plaque analysis such as HeartFlow, validated against intravascular ultrasound.
  • Risks: There is some radiation and iodine contrast, and insurance rarely covers the test without symptoms.

Cardiovascular disease: inflammation, not just cholesterol

  • What to do: Ask your doctor for a comprehensive panel that includes fasting insulin, ApoB, Lp(a), and an NMR lipoprotein profile, not just a standard cholesterol test.
  • Why it matters: Calculated LDL does not measure particles directly and is not the best predictor of cardiac risk; chronic inflammation and insulin resistance are the primary drivers.
  • How to apply it: Reduce sugar and refined carbohydrates to control insulin; exercise moderately for at least 150 minutes per week; sleep well and actively manage stress.
  • Metrics: Only 12.2% of Americans are metabolically healthy; fasting insulin should be below 5 mIU/L; postprandial insulin should stay below 25-30 mIU/L after a glucose load.
  • Tools: NMR lipid profile; hs-CRP; ApoB; Lp(a); polygenic risk score; AI retinal scan; Function Health offers many of these tests in a combined panel.
  • Risks: Potent statins increase type 2 diabetes risk by 1-2% per year; PCSK9 inhibitors are an alternative without that side effect for high-risk patients.

Do supplements really reverse plaque in your arteries?

  • What to do: Do not expect supplements alone to reverse arterial plaque; focus on the few with real human evidence and treat them as additions to diet and prescribed care.
  • Why it matters: Reversing atherosclerosis lowers your risk of heart attack and stroke, but most supplements only slow progression at best and several show no benefit at all.
  • How to apply it: Prioritize high dose purified EPA with your doctor, consider aged garlic extract and vitamin K2 for calcification, and use CoQ10 mainly if statins cause muscle pain.
  • Metrics: EVAPORATE used 4 grams per day of icosapent ethyl, aged garlic cut systolic blood pressure by about 8 mmHg, and a nattokinase study reported up to 36 percent less carotid plaque.
  • Risks: Do not combine vitamin K2 with vitamin K antagonist blood thinners without medical advice, and treat striking results from small single studies with caution.
  • Tools: Use the linked trial references in the show notes to check the strength of evidence behind each supplement before you buy anything.

How to lower cholesterol by fixing what drives it

  • What to do: Remove sugar, refined carbohydrates, and ultraprocessed foods for 10 days. Replace industrial fats with olive oil, avocado, and fatty fish. Add protein to every meal and increase fiber from vegetables, legumes, and nuts.
  • Why it matters: High cholesterol is, for most people, a signal of insulin resistance and chronic inflammation rather than an isolated problem. Treating the number without correcting the root causes does not improve real cardiovascular risk.
  • How to apply it: Cut for 10 days: sugar, refined flours, ultraprocessed foods, and industrial oils. Eat: eggs with sauteed greens and avocado at breakfast; salmon with mixed vegetables and olive oil at lunch; chicken or fish with roasted vegetables at dinner. Walk after meals. Do strength training two to three times per week.
  • Metrics: Monitor triglycerides and HDL (not just total LDL), fasting glucose, fasting insulin, and high-sensitivity CRP. These are the most relevant markers of real metabolic risk.
  • Tools: Omega-3 fish oil, psyllium husk as soluble fiber, plant sterols, magnesium for metabolic support. Red yeast rice has statin-like effects and requires medical supervision.
  • Risks: Not all dietary fat is harmful—eliminating it indiscriminately without distinguishing quality is a mistake. Calorie restriction without attention to nutritional quality may temporarily improve cholesterol without correcting the underlying insulin resistance.

GLP-1 and obesity: a bariatric surgeon's perspective

  • What to do: Consult a physician about GLP-1 medication if you have obesity, and pair it with a high-adherence Mediterranean-style diet.
  • Why it matters: Obesity is a chronic disease with a biological basis. Food noise cannot be resolved through willpower, and GLP-1s act directly on the brain mechanisms that generate it. The US obesity curve is declining for the first time thanks to these medications.
  • How to apply it: Always use FDA-approved versions (not compounded). Increase fiber and water intake to minimize constipation. Prioritize a Mediterranean diet with an adherence score of 5/9 or higher to maintain long-term weight loss.
  • Metrics: A Mediterranean adherence score of 5/9 or higher maintains weight loss at 5 years in bariatric patients. On Zepbound, Simpson reduced his daily high-stress zone from 3.5 hours to under 10 minutes.
  • Risks: 80% of GLP-1 emergency room visits come from compounded versions. Stopping the medication leads to weight regain, just as stopping any chronic disease treatment does. Early retatrutide data shows increased heart rate and potential arrhythmias, pending confirmation in phase 3 trials.

LDL and statins: the real evidence behind the numbers

  • What to do: Request fasting insulin, fibrinogen, and triglyceride/HDL ratio alongside your standard lipid panel; reduce carbohydrate intake if triglycerides are elevated.
  • Why it matters: The real benefit of statins is far smaller than reported. The absolute difference between groups in clinical trials is often below 2%, yet relative risk framing makes it appear as 30%.
  • How to apply it: Bring published studies to your doctor and ask them to justify treatment using absolute risk data, not relative risk numbers.
  • Metrics: Triglycerides below 150 mg/dL, TG/HDL ratio below 2, fasting insulin below 10 µU/mL, baseline fibrinogen.
  • Risks: In people with familial hypercholesterolemia, the real danger comes from excess clotting, not LDL itself. Test coagulation factors as well.