So I'm supposed to be finishing a blog a blog on
what you can and cannot find out from a stress test
and I woke up at 6 getting ready to go and I started noticing myself scratching
here again and I thought um I still have to do that video on
inflammation what does inflammation look like
on the outside
if I've said it once I've said it a thousand times heart attack and stroke
are due to inflammation but when I say that it just
sounds very theoretical right theoretical when you begin to see inflammation on
the outside you begin to understand what
inflammation is when this is going on in your artery
walls you're at risk for heart attack and stroke this is a
big deal you look at some people would say maybe I'm starting
to look like Tommy Lee Jones at least the
Two Face side out of the movie Batman Forever we'll go a little deeper into
that nobody would say I look like Kim
Kardashian-West she has psoriasis which is a very
similar skin condition with inflammation of the skin
now we're going to go into a whole lot more detail on that this is going to
take a few minutes if you don't have the time to take
that's the quick version inflammation is where immune
cells come to an area with me they're coming
to my skin right now because I've applied imiquimod
because of my basal cell carcinomas which I'll
explain with Kim Kardashian it's because of her psoriasis those of us at
risk for heart attack and stroke it's in our artery walls and it's
because we've got plaque there and our arteries are attacking our
immune system is trying to attack and get rid of that plaque
as you see in the middle it's when the you create that liquid plaque if that
liquid plaque goes out and touches the blood
it can cause a clot and if the clot's big enough and goes to the heart
boom that's a heart attack if it's big enough and it goes to the brain
it's a stroke again we'll go into some depth in this
video and maybe try to connect all the dots
from TIME magazine when they were talking about inflammation being the big
killer and cause of heart attack over 20 years ago
and the cardiologists still not quite getting it to how to test for it
yourself if you want to take a look speaking of testing for yourself
and taking a look this is a copy of one of my inflammation tests as you can see
I've got zero inflammation these first two tests are myeloperoxidase
and PLAC2 those are two actors they are
enzymes released by certain types of immune cells which go
into your artery wall if you've got plaque that's
being attacked and softened by this inflammation
process there's a couple of other things here too high sensitive HS-CRP
it's a protein made by the liver in response to
inflammation microbumin over creatinine ratio
that's when you're spilling a little bit of protein because the lining of your
artery walls which is also the filter membrane of the
kidneys is inflamed and is letting protein
through into your urine at that point we also
know it's letting cholesterol out from the
blood to get lodged in your artery wall which
causes plaque so again TIME magazine knew about
this way back in 2004 cover issue
the surprising link between inflammation and heart attacks cancer
Alzheimer's and other diseases what you can do to fight it
and this was Cardiology Interventions Inflammation for the Cardiologists just
two years ago and the cardiologists still haven't wrapped their heads around
this stuff yet so where's the initial area of injury it's
the glycocalyx that fuzzy mucus-like lining of the artery
walls and here's what happens well that's not
in this slide we'll talk about what happens
and how the injury occurs a little bit later it's
usually high blood sugar hour after hour day after day month after month
or high insulin but it can also be a couple of other things too like
rheumatoid arthritis now here's a couple of pictures of guys
who are doing what I'm doing they're applying imiquimod now why am I
applying imiquimod to my face and what is
imiquimod well imiquimod is what's called a
cytokine don't panic over the word cyto meaning
cell kind meaning attractant it's a chemical that attracts immune
cells to an area now why am I doing that do I want to
look like Two Face in Batman no I don't but I do have it I've got it
here I've got it here I don't know if you can
see that or not I've got it on my leg I've got it on my scalp
here's the story with me so my mom is in her mid 80s she's had over 200
basal cell carcinoma that's a very benign type of cancer
and that sounds like oxymoron benign cancer it is it's not totally harmless I
mean it's eaten up some it can eat up you're like your nose your ear and stuff
like that but it's not as aggressive as lung cancers
pancreatic cancers things like that it's a nuisance and again my mom's 85 86
she's had over 200 of these I'm 63 I inherited something
genetics something in her genetics her skin my skin doesn't recognize these
basal cells either my dad never had one my mom had a bunch
I'm 63 I've had almost 100 now in my gosh what was it
late 40s imiquimod came out they called it Aldara at that time
imiquimod is the generic term it's this cytokine you apply it to your
skin it attracts these cytokines these immune cells begin to recognize
bits of growing new birth basal cells other
humans and most people you have these all the
time and when I was younger I'd have these all the time
but my skin would recognize these basal cells and wipe them out
kill them before it ever got to this extent
not so good at that anymore so I need a little help and that's what happens so
I'll go for two to four months looking like Two
Face and again hopefully this helps you get a
picture of what's going on in your artery walls
if you have risks for heart attack and stroke
and what's going on in my skin right now you see this is
a skin with some of these issues but then
this skin has some blueness here but then it's got all these red dots
everywhere that's what's going on those red dots
are immune cells so immune cells with these
red dots on the left immune cells with these black dots in
arteries on the right and as I said yep there's a
model for this with humans where you see this inflammation
on the skin a lot more than just you know when you're taking imiquimod
it's called psoriasis and yes that's
Kim Kardashian-West and yes she did a little thousand blog
a thousand word blog anyway here's more pictures
of psoriasis inflammation of the skin here's the article it's in the Journal
of Immunology and it's imiquimod-induced psoriasis-like skin inflammation and
they tell how it's mediated this the axis of immune cells that actually
cause the problem now let's go back now having seen that having looked at that
let's go back to what we've presented in our
inflammation course and a gazillion other videos for this channel
here's what's going on here's what the artery looks like as you know
from very very early videos that's fairly simplified there are
multiple layers of arteries and veins but let's just keep it simple right now
and look at the intima which is the lining
the media which is the muscle part and the adventitia
which we don't have to worry about what happens is if the intima gets
inflamed if we get this process of inflammation which can happen with
rheumatoid arthritis but most often happens with
too much high blood sugar or high insulin
attacking this thing called the glycocalyx which is made mostly of
sugars a sugar and protein mix and you can see if you get real high
sugars maybe that's sort of wiping out that glycocalyx
here's a picture of a healthy glycocalyx right there see that looks like a forest
there's a cross section there's a diagram
and here's what happens when you have too much glucose
for too long it's like a lawnmower came through and just cut that glycocalyx
right out that then allows cholesterol in your blood even if you
have low LDL or if you have high LDL that LDL starts passing through that
layer and guess what that layer is the filter layer of your kidneys
and if cholesterol is passing through there
then in your kidneys protein is going to be spilling into
your urine so you do that long enough and you get this build up of plaque
well here's what happens you can have plaque that's nice and stable and waxy
or you can have the immune cells come in and start attacking plaque
and yes they'll often do that through vaso vasorum
meaning the tiny arteries that go to the artery wall
itself there was a lot of information and buzz about vaso vasorum
associated with a theory that was presented on Ivor
Cummins' channel recently talking about how it
maybe was changing the whole format no it's not the same thing
we've always felt that inflammatory cells were coming in
in this case through the vaso vasorum as they do what happens is you get this
release of liquid you get release of myeloperoxidase PLAC2 other
chemicals enzymes and cytokines which bring in more cells
which bring in more liquid which create this
soupy soft plaque and if that soft plaque breaks through
the intima and goes out here it forms a clot if the clot's big enough
and goes to the heart causes a heart attack if it's big enough
and goes to the brain causes a stroke this is the intima this is not plaque
this is the clot and the biggest part of the clot broke
off went to the heart killed this patient so again another
diagram vaso vasorum the vessels going into the
artery wall itself and inflammation the inflammatory
cells monocytes foam cells macrocytes neutrophils
this is a picture of neutrophils and this is a diagram of
inflammatory cells getting into the artery wall
I mentioned that it's stable usually when
cholesterol leaks through that intima unless the immune system starts
attacking it when it does attack it all these enzymes
get released and this liquid starts coming in and that's
exactly why this little patch right here looks like liquid and it's retracted
away from the slide itself so again not going to repeat this
I talked about it a few minutes ago we've known about inflammation for a
long time it's just that the medical community has not known
that much about what to do for it here's another diagram and this
starts with a "normal" "healthy" artery wall here
here you're starting to get some F2 isoprostanes in other words
not the greatest lifestyle some oxidation products
oxidized LDL getting into the wall then you start getting some inflammation
microalbuminuria high sensitivity C-reactive protein
you get release of this green stuff the green stuff is actually green
it's green because of a color in myeloperoxidase
myeloperoxidase you might remember this sort of a gross
image but you know when kids get a viral illness
they can get a greenish tint to the snot coming out of their nose that's because
myeloperoxidase which is in that mucus is green
it's related to the fact that hemoglobin is also red
not going to go down that bunny trail but just a fun fact
if you get enough of this going on you get release of this stuff
if you get release of that stuff you get a clot
so that's helping you understand a little bit more about this process
you've heard the terms oxidized LDL this gets into a little bit about why
oxidized LDL is so important it drives a lot of
this spiral of inflammation again
the inflammation panel as I mentioned before
like any of the other lab stuff these labs are often difficult
to find showing people where to find it showing a little bit about the filter
in the kidney another diagram of the filter in the kidney and
how kidney has the urine leaks or filters through the intima space
this is a little bit more explanation about exactly what
microalbumin looks like urine strips testing methods things like that in the
inflammation course itself we go into a little bit deeper into diagrams in the
actual cells themselves what they look like
where you see them how they grow what they're doing how we can find them
under the microscope C-reactive protein we talk about
C-reactive protein and what that looks like
we also talk about some interesting new developments in terms of
anti-inflammatories there are a lot of different types of anti-inflammatories
for example the most commonly known are the
non-steroidal anti-inflammatories NSAIDs those actually for the most part tend to
increase cardiovascular risk so don't take those there's been some
interesting research in terms of different colchicine which is an
anti-inflammatory for gout several other medic canakinumab
which you see on this New England Journal article
stuff that's used for it's a high level micro
biomedical chemical that's been used it actually showed some decrease in heart
attack and stroke it also decreased their immune function
and so probably not going to see a lot more in
that space so again appreciate your interest and
that's the story on what inflammation looks like
on the outside just in case you were wondering what it looks like
on the inside
so I'd like to talk with you a minute about the webinar people don't
understand what the webinar is it's actually a great way to get some
access to health care that you're just not going to get any other way
you actually get the lab tests yourself for at a local lab a Quest lab near you
for the inflammation panel and the OGTT and the insulin survey these are things
inflammation and prediabetes that your doctor just
does not know about and here's the thing Harvard Health and
many others have said look sudden death is not always so sudden the
Hollywood picture that it's evolved out of the blue is not realistic it's
more like real lightning preceded by clouds wind and rain
stop that metabolic storm before the lightning strikes
and here's where that metabolic storm comes from
it's inflammation and it has to do usually with prediabetes so again we
actually get labs we go over them in the webinar
and then you can start finding out how you can prevent that heart attack
others said that you couldn't even predict
we can show you how thanks