I had a viewer make a comment a couple of days ago,
"it's the endothelium," Yes that viewer was right. In fact it comes
up at least once a day in the work that I do everybody's blaming LDL( the bad
cholesterol). According to most people & their
assumptions its LDL I'm gonna show you a few images
that I got from Brad; Brad Bale and Amy Doneen. I did a good bit of work with
them recently. I went through their courses. They've got a great program, teaching
docs, dentists other healthcare workers in the public regarding cardiovascular
inflammation & this whole point that it's not LDL so much as it's cardiovascular
inflammation now this image actually is a cartoon that Brad
had one of his family members do. it's a really good one. now this is really
just focused on lipoproteins. as you look through here we're talking about LP(a)
very low density lipoproteins LDL small dense LDL. Yes you've got some bad
actors in there, but are those really the major issues you can get LDL problems
it's inherited and it's not very common it's familial hypercholesterolemia FH
you can look that up on the internet now and if you have questions about it just
put them below and I'll help you in terms of finding information about
familial hypercholesterolemia I think I did a video on it a while back now
here's one of the reasons why it's so easy to assume that it's LDL if you go
back and you look again this image is also from Brad & Amy.
The major concerns that we have in terms of your typical artery are three layers
the intima or endothelial layer the media which is the muscle layer which
provides that structure so the intima doesn't blow apart with the blood
pressure and then the adventitia which keeps the artery in place in terms of
cardiovascular inflammation and LDL and plaque it's really those two internal
layers that that create the that's where the action is now again if you go back
and look at an artery these past two images were images of
arteries that in people that have had a heart attack
here's that media layer here's the intima or endothelial layer and all of
this is plaque most people have they think of an analogy of your shower drain
or a tub drain filling with hair clogging with hair that's not really the
way it happens hair is on the inside of the pipe as you see plaque is not really
on the inside of the pipe it's between the inner layer the lining and that
muscle layer and here's where the real issue comes in inflammation that's a
liquid pocket where the immune system has attacked that plaque and if that
liquid pocket gets out there go breaks through this intimal layer liquid plaque
or inflamed plaque can cause the clot and the patient to you know if it's a
big enough clot and it goes to a big enough place like the heart it's a heart
attack or if it goes if it's big enough and it goes to the brain it's a stroke
that's exactly what happened here this is the intima layer this is the media
layer all of this in between is plaque this section used to be one of these
which is a small area of plaque inflammation the immune system attacking
that and you see it's starting to turn brown there
this turned completely Brown and liquefied and this black stuff is not
really liquid plaque anymore this black stuff is a clot so you had breaks in the
intima you had inflammation some of that liquid liquid plaque went out into the
bloodstream and formed a clot now here's the problem the biggest part of this
clot as you see this clot actually went on up into the area where that that hot
plaque was in between the intima and media layers but here's the big issue
the vast majority of this clot is not seen it has floated downstream in terms
of the artery and that is what killed this patient caused a heart attack that
clot did now let's go back though so again the question is LDL why does it
get all the the blame a couple of reasons number one that's what Doc's
tend to keep looking for and again the standards of Medicine when you when they
treat with statins most guys are just looking at LDL now again if your LDL is
very high it can cause more rapid plaque buildup but again it's the endothelium
that that commenter that viewer was correct now what causes the end of
endothelium to to get inflamed well there's a lot of things as again this is
also from Brad and Amy's group as you see genetics obstructive sleep apnea
lifestyle genetics dysfunctional HDL etc now there's a key one that I don't see
on here oh yes here we go nicotine exposure smoking smoking is a huge cause
of endothelial inflammation and cardiovascular inflammation now as we
know and as you see with this channel I do this for a living
and I see it time and time and time again the major causes insulin
resistance and the major causes of insulin
resistance some people think our obesity yes that's clearly one of them getting
older is a bigger one as we get into our 50s and 60s beyond 60 we tend to get
insulin resistant over half of us by that point by age 60 have insulin
resistance now let's go back this image helps under helps us understand a little
bit more about about LDL and its role and the endothelium in its role this is
the endothelium this is plaque and this is the media of
the artery the intima are in the thelia in this case is developing holes
inflammation cracks and again that can come from all of these things that we
talked about up here but in terms of my patient population and the majority of
us it's insulin resistance that causes that
what within insulin resistance you could start talking about well insulin itself
causes that there's a good case to be made for that also just the
hyperglycemia associated with it but no matter how that debate ends up if you
get cracks in your endothelium you're gonna get this LDL flowing out of the
bloodstream and into underneath it endothelium and lodging there between
the endothelium and the media this is a great image from Berkley heart lab
showing an early process and the process continues to get worse and worse this is
the endothelium or intima and this is the media and this is increasing plaque
deposition as you get to these further areas on the right you see inflammation
it's starting to the plaque is starting to turn red and here liquid plaque is
even spewed out into the and again we know what happens there you
get a clot and you get - nothing Goods gonna come from forming clots (in arteries)! thank you
very much for your interest