Knife Down

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...

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 j...

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 de...

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...

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 microsur...

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 o...

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/...

A live, unfiltered Ask Me Anything on preventive cardiology and metabolic health — recorded on about three hours of sleep after a night in the OR, which tends to make me a little more candid than usual. We cover the questions you actually ask: how plaque forms and how to stabilize it, what the "best" diet for cardiovascular health really is (spoiler: it depends on you), statins from ever...

Peripheral artery disease Q&A — including one of the biggest mistakes people make when trying to “walk off” PAD symptoms. In this video, we break down: • Why erectile dysfunction is actually a sign of vascular disease • What an ankle-brachial index (ABI) actually measures • Normal ABI ranges and what abnormal results can mean • Whether you should have vascular testing done at home or in a cert...

Got APOE4? Here’s the exact prevention strategy I would use to protect my own brain if I carried this gene. In this video, I walk through the major modifiable dementia risk factors identified by the Lancet Commission — and how I would actually approach them in real life as a vascular surgeon specializing in cardiometabolic prevention. We cover: * ApoB, vascular disease, and why “brain health” star...

What's the optimal ApoB level to reduce Alzheimer’s risk? Is lifestyle or genetics more important? And what does a pTau217 result actually mean for your brain health? In this Brain Health Q&A, I answer your questions about ApoB, APOE2, dementia prevention, blood-based biomarkers, and what the science actually says right now. Missed the first video? Check it out here: https://youtu.be/y8vk...

If you've been told APOE4 means you're destined for Alzheimer's, the science says something very different. As a vascular surgeon who has spent years treating the end-stages of preventable disease, I want to give you a clearer picture of what APOE4 actually does, and what it doesn't. In this video, I break down: - What the APOE4 gene is and how it affects your brain - Why it ra...

You asked 349 questions about my LDL video. I'm answering the ones that matter most — including who paid for the study. Last week I broke down the LDL cholesterol trial. The comments flooded in — and several of you asked exactly the right questions. In this follow-up, I'm going through the most important ones as a vascular surgeon who's spent years treating the consequences of bad c...

Does lowering LDL cholesterol cause dementia? And how much dementia is actually “vascular” dementia versus Alzheimer’s disease? In this video, I’m answering two viewer questions about dementia, vascular risk, statins, LDL cholesterol, and brain health. First, we look at the relative prevalence of vascular dementia compared with Alzheimer’s dementia — and why that distinction gets messy fast. Vascu...

A common cholesterol drug might protect your brain from Alzheimer's — but I read the actual study, and there's a red flag nobody is talking about. Nick Norwitz covered this story. I went further — I pulled the original paper published in Aging Biology and read every line. Here's what I found. Researchers ran a hypothesis-free screen of FDA-approved drugs to find compounds that could...

Is lower LDL cholesterol actually better for your heart? In this video, I break down the brand-new results from the EZ-Pave study to answer the question that keeps my patients up at night: How low should your cholesterol really go?  As a vascular surgeon, I see the end-stage results of heart disease every day.  We’ve heard the "lower is better" mantra for decades, but new research is fin...

I've seen daily aspirin save lives from heart attack — and cause fatal bleeds. As a vascular surgeon, here's my honest take on heart health. The answer isn't yes or no — it depends entirely on who you are. In this video I break down the three groups you need to know: ✅ Who SHOULD take daily aspirin — if you've already had a heart attack, stroke, or stent, aspirin for secondary...

We hit all the high points today! Nutrition, exercise, lipids, dental health, hormones, and more. We had amazing participation and it was wonderful to have a chance to interact with everyone in real time. Thanks SO much for taking some of your precious weekend to talk cardiovascular health, heart scans, CAC scores, and all the other nerdy prevention things with me. Hope you enjoyed it! If you want...

Joe Rogan got half a million people talking about what's happening inside their blood vessels. As a vascular surgeon, I've spent my career trying to do exactly that. So when a celebrity does it for me, I pay attention (and thank my lucky stars ;). In the clip, Dr. Shauna Swan joins Joe Rogan to discuss the surprising hazards linked to everyday household products. In my reaction, I go thr...

If you’ve had a positive calcium score (CAC score), you’ve probably asked the obvious next question: when should I repeat it? In this video, I explain why I generally do not order another calcium score if the first one is positive—and what I prefer to use instead to follow atherosclerosis over time. We walk through what a coronary artery calcium score actually measures, why it’s really just the ti...

Plaque reversal is one of the most debated topics in preventive cardiology, so in this video I react to Dr. Kevin Ham’s CAST protocol for plaque reversal: Causes, Adding Cures, Strengthening the Body, and Training the Mind and Body. Overall, I think this is a thoughtful framework and I agree with much of it. But as a vascular surgeon who treats advanced atherosclerosis, I also add some nuance arou...

SELECT trial explained: does semaglutide reduce cardiovascular risk because of weight loss, or is something else going on? In this video, I break down the SELECT trial and the follow-up analysis examining whether the cardiovascular benefit of semaglutide was directly mediated by weight loss. The answer matters, because the data suggest the reduction in major adverse cardiovascular events was not s...

When people hear “poor circulation,” they often assume the answer is a procedure. Not so fast. In this episode of Knife Down, Dr. Jacqueline Majors and I talk about when opening a blocked artery helps, when it backfires, and why the real work of saving legs often starts long before the operating room. We get into what patients with poor circulation, blocked leg arteries, leg pain with walking, smo...

Are supplements safe? Not automatically. In this video, I explain why supplements are really drugs, why the industry has so little oversight, which products worry me most, and how I think about using supplements more safely in real life. I’m a board-certified vascular surgeon specializing in cardiometabolic prevention, and I do use supplements in practice — but in a targeted, evidence-informed way...

• Feeling “healthy” is not a screening test.   In this episode, Dr. Ford Brewer ( @DrFordBrewer ) tells the origin story: an ER doc who believed he was doing the right things—until he actually checked and found plaque. That discovery didn’t just change his health plan. It changed his entire job. He walked away from the adrenaline economy of emergency medicine and moved into cardiovascular preventi...