This video, titled "Rethinking Heart Risk," explains that heart disease is more than just a cholesterol problem; it's a metabolic problem driven by insulin resistance and inflammation. Dr. Deb Ford discusses how the traditional view of LDL cholesterol as "bad" is outdated, and instead, people should focus on expanded lipid testing that looks at factors like LDL particle number and size. She also offers actionable advice on diet, exercise, and supplements to improve heart health and reduce inflammation.
Key Takeaways
1
Heart disease is primarily a metabolic problem, not just a cholesterol problem, driven by insulin resistance and inflammation.
2
Almost half of people hospitalized with heart attacks have normal LDL cholesterol levels, indicating that LDL alone is not the sole cause.
3
Cholesterol is vital for many bodily functions, including hormone production, brain function, cell membranes, and vitamin D production.
4
Damage to artery linings, caused by high insulin, blood sugar spikes, oxidative stress, and inflammation, allows LDL particles to slip in and cause plaque formation.
5
Small, dense LDL particles, which are associated with insulin resistance, are more damaging and likely to penetrate arterial walls than large, buoyant LDL particles.
6
The triglyceride to HDL ratio is a powerful marker of metabolic risk; a ratio above two suggests insulin resistance, while below one is optimal.
7
Expanded lipid testing, including LDL particle number (LDL-P) and ApoB, provides a more accurate assessment of cardiovascular risk than standard cholesterol tests.
8
High sensitivity C-reactive protein (HSCP) and homocysteine are important markers for systemic inflammation and increased clotting risk, respectively.
9
Optimal fasting insulin levels should be under five, as anything higher can indicate insulin resistance that silently contributes to heart disease.
10
Key lifestyle changes for heart health include prioritizing protein, eliminating sugar and ultra-processed carbs, consuming healthy fats and vegetables, strength training, improving sleep, and managing stress.
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0:00
Good morning everyone and welcome back
0:02
to today's nutrition. I'm Dr. Deb Ford
0:05
and for the last 10 years or so on this
0:08
show, we've been bringing you the latest
0:10
research in a way that is practical,
0:13
doable, and empowering. So today, we're
0:15
going to talk about something that
0:17
affects almost every family listening,
0:21
heart disease. It is February and
0:24
yesterday was Valentine's Day. So, we're
0:26
thinking a lot about hearts right now,
0:29
but not in the old way. Not in the your
0:34
cholesterol is high, here's your
0:35
prescription way. That's just not me.
0:37
Today, we're going to go deeper. We're
0:39
going to go into what actually drives
0:42
cardiovascular risk and what you can do
0:46
to change that and how to more
0:49
accurately
0:50
test it. Because friends, heart disease
0:53
is not just a cholesterol problem. It's
0:56
a metabolic problem. And when we
0:59
understand that, everything changes. You
1:02
might want to get a pencil and paper
1:04
because I'm going to cover a lot of
1:07
really important information in detail,
1:11
actionable detail. The old cholesterol
1:14
conversation you have heard for decades.
1:17
It's kind of like the 1970s version is
1:21
that cholesterol is dangerous. LDL is
1:25
bad. You even remember it being called
1:27
lousy. So you'd remember L. HDL is good.
1:31
And we've been told H was standing for
1:34
healthy and happy. Lower is better. You
1:37
could almost not go too low. But here is
1:42
the uncomfortable truth. Almost half the
1:45
people hospitalized with heart attacks
1:48
have absolutely normal LDL cholesterol.
1:52
And many, many people with really
1:55
elevated cholesterol never have heart
1:58
disease. The oldest people on the planet
2:01
have high cholesterol. Your brain is 80%
2:05
dry weight cholesterol. So clearly we're
2:08
missing something. And it's said to be
2:10
the culprit. Maybe because the
2:13
pharmaceutical industry has a good
2:15
sledgehammer for cholesterol. So that
2:18
must be the problem. Total cholesterol
2:20
is really a very blunt instrument. It's
2:24
like trying to judge traffic safety by
2:27
just counting how many cars are on the
2:29
road instead of looking at if they're
2:32
speeding or if they're crashing into
2:33
each other or if they're licensed
2:36
drivers that are driving safely.
2:38
Cholesterol itself is not the evil
2:41
enemy. Your body makes cholesterol for
2:45
your hormones, testosterone, estrogen,
2:48
even cortisol. You need cholesterol.
2:52
Brain function. Your cell membranes have
2:55
to have cholesterol. And vitamin D
2:58
production requires cholesterol. If
3:02
cholesterol were truly toxic, would we
3:05
be designed to make it every single day?
3:10
So, the real issue is not simply how
3:12
much cholesterol you have. It's more
3:15
like what's happening metabolically in
3:18
your body. And that brings us to a real
3:21
important shift in understanding.
3:24
Cardiovascular risk is largely driven by
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number one insulin resistance and number
3:32
two inflammation.
3:35
Cholesterol is more like a marker and a
3:37
responder rather than the root cause. So
3:40
instead of just stopping at the basic
3:43
1970s lipid panel, we now have access to
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some really important information and
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it's called the expanded lipid profile.
3:54
So to really understand what's happening
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in the cells, I'm going to simplify it
3:59
for what's actually going on with
4:01
atherosclerosis or hardening of the
4:03
arteries or cholesterol buildup in the
4:06
blood vessels. It begins with damage to
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the inner lining of the artery. It's
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called the endothelium inner lining. So
4:16
what damages it? And this is the magic
4:19
to know because it can be controlled
4:22
simply. So what damages it? High
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insulin, high blood sugar spikes,
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oxidative stress like rusting. That's
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why we need antioxidantrich diet. Then
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chronic inflammation and smoking and
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poor sleep and visceral fat around the
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tummy. That is when the inner lining,
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the endothelial lining becomes irritated
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or injured and then those LDL particles
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can slip into that wall and then those
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particles become oxidized or glycated
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meaning damaged by free radicals or
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sugar. The immune system reacts. It gets
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really mad and that inflammation builds
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and then the plaque forms and the
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arteries stiffen.
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But now pay attention here, the LDL
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particle is not the original villain. It
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is the damaged metabolic environment
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caused by chronically elevated insulin
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that plays a big role here. When insulin
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goes high, the liver produces more of
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the really bad LDL particles.
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Triglycerides go up, LDL particles
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become smaller and denser. I call them
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like golf balls. And HDL, the good one,
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the one that takes it back to the liver,
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it drops.
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Those small, dense LDL particles, I
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liken to golf balls. You know, when you
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get hit with a golf ball, it hurts. It
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causes damage. And in the blood vessels,
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that's more likely to be able to
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penetrate the arterial wall and then you
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get things building up. So, the small
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dense ones are the ones that are
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associated to insulin resistance. In
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fact, there is a lab reading trick.
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Research consistently shows that
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triglyceride to HDL ratio is a powerful
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marker of metabolic risk and
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cardiovascular disease. So if you take
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your triglycerides to HDL,
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get that ratio there. If it's above two,
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that suggests insulin resistance. But if
6:36
it is under one, you're much better off.
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That's why I love looking at that ratio.
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It tells us what insulin is doing. And
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when insulin's chronically elevated, it
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is like fertilizer for plaque formation.
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So instead of asking, is my cholesterol
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high? You should be asking is my insulin
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elevated? Are my triglycerides high? Is
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inflammation present? Are LDL particles
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small, dense, and numerous?
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That's where the expanded lipid testing
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really comes in. The standard one's just
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going to tell you cholesterol and LDL
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and HDL and triglycerides. We're so used
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to that. But expanded tests go farther.
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So now you really might want to write
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this down. We want to know the LDL
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particle number. A lot of times that's
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just LDL-P.
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It's not going to just do total
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cholesterol. It's going to do the
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particle number. How many particles are
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circulating? And this matters because
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you can have a normal LDL but have a
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real high particle number. More
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particles mean more opportunities for
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those to enter the arterial wall.
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Lots of studies have shown that that LDL
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particle number correlates strongly with
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cardiovascular
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risk much more than LDL alone. You can
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think of it this way. You can have a
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thousand delivery trucks carrying cargo
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or you can have 500 delivery trucks
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carrying the same cargo. The number of
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trucks on the road matters when we're
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talking congestion and risk. So, we want
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a lower LDLP.
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That's telling us how many trucks are on
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the road. Second thing, that particle
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size is super important.
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Not all LDL particles are the same. You
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can have big buoyant LDLs. Those are
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like beach balls. You know, if you get
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hit by a beach ball, it bounces off, no
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problem. Those are much less likely to
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penetrate the arterial lining. Or you
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can have the small dense ones like golf
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balls. You get hit with a golf ball and
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you got a lump on your noggin. So, what
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causes the small dense LDL? Not eggs,
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not butter, insulin resistance.
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High triglycerides are going to push
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that LDL particle into smaller, denser
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ones. When we improve metabolic health
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through protein prioritization,
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strength training, better sleep, better
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blood sugar control, nutrientdense diet,
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we often see LDL particle size shift to
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the big bouncy beach ball variety.
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That's metabolic healing. That is health
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in so many words.
9:50
Then I'm just going to touch on APO
9:53
B. It is a protein found in every
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aoggenic particle.
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APO gives us a count of all the
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potentially plaque forming particles.
10:08
Many experts really consider the APOB
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as one of the most reliable indicators
10:15
for cardiovascular risk. Again, it's
10:19
about particle number, not cholesterol
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content.
10:24
Then I touched on this, but I want to go
10:26
back to it. The triglyceride to HDL
10:29
ratio. One of my favorite ones. And you
10:32
can get this off of just your basic
10:34
yearly profile. Simple, powerful. You
10:37
take your triglycerides, you divide them
10:39
by your HDL.
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We want that number to be under two for
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sure. The closer to one you get, the
10:48
better metabolic health that's going to
10:50
reflect. Higher ratios are going to
10:53
correspond with insulin resistance,
10:56
small dense LDLs, and of course,
10:59
increased cardiovascular risk. ratio is
11:03
really more reflective of metabolic
11:05
health rather than just LDL alone. Then
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we're going to talk LP little A. This
11:12
one is largely genetic. It is where we
11:15
are going to tend to make more sticky
11:18
LDL particles that would tend to have
11:21
more of a clotting tendency. So, if
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you've got a strong family history of
11:26
early heart disease, this one is really
11:29
worth checking once.
11:31
Your heart is determined not by one
11:34
number. It is determined by the whole
11:36
environment you create inside your body
11:39
and that you can influence.
11:42
And we're going to build on that when we
11:44
talk about the things that influence
11:45
those numbers. We're going to talk about
11:48
inflammation and oxidation, insulin
11:50
resistance in real life and what we can
11:53
do about it. Because whereas knowledge
11:57
is powerful,
11:59
action is what's transformative.
12:01
And we really want to be clear about
12:04
this. LDL particle alone doesn't cause
12:06
heart disease. LDL becomes dangerous
12:09
when it gets damaged. When it rusts, it
12:12
oxidizes. When it enters the arterial
12:14
wall, that's when it causes problems.
12:16
Inflammation,
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that's the trigger. It is dry tinder
12:22
sitting there waiting for a spark.
12:27
So, what is going to drive that fire?
12:31
Blood sugar spikes. You know, I say
12:34
again and again, the devil made sugar.
12:36
Also, chronically elevated insulin is
12:40
going to drive inflammation.
12:42
ultrarocessed foods, seed oils, visceral
12:46
belly fat, poor sleep, chronic stress,
12:50
and we know that heartbreak or loss can
12:56
absolutely trigger problems. So, chronic
12:58
stress cannot be ignored.
13:03
Gum disease strongly correlated there
13:06
and gut permeability.
13:09
inflammation.
13:11
It really is systemic. It doesn't just
13:13
politely stay in one location. Oh, that
13:16
it would mind its manners. But no. So,
13:19
we want to look at the lab marker that
13:21
can show us if you've got this systemic
13:25
inflammation. And that is the HSCP,
13:29
highly sensitive C reactive protein. We
13:33
want it to be under one.
13:36
If you got it between one and three,
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you've got moderate risk. If you're over
13:40
three, you've got significant
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inflammation that we must address.
13:46
Another important marker is homocyine.
13:49
That also is a nutritional thing.
13:52
Elevated homocyine damages the
13:54
endothelium and increases clotting risk.
13:58
We ideally want that homocyine to be
14:01
somewhere around 6 to 8. And then
14:03
there's the oxidized LDL whether it is
14:07
directly being measured by the particles
14:09
that have been damaged. And here is what
14:12
is encouraging. Inflammation is highly
14:16
modifiable.
14:18
All the things I always talk about
14:20
lowering your insulin, improving sleep,
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reducing that belly fat, and increasing
14:26
omega3.
14:28
And that C reactive protein drops
14:31
beautifully. I've seen it over and over
14:34
and over again in my clinical practice.
14:36
The body wants to heal. You just got to
14:39
remove what's irritating it and give it
14:41
what it needs to repair. So, now we're
14:44
going to talk insulin resistance. You
14:47
don't just wake up one day and be
14:49
diabetic. Insulin resistance develops
14:52
gradually. You're going to see your
14:54
blood sugar going up a little bit and
14:56
triglycerides creeping up and HDL going
15:00
down. And this is also when the LDL
15:03
becomes smaller and denser. You may feel
15:07
fine until one day you don't. High
15:11
insulin promotes all the bad things. Fat
15:14
storage, especially around the
15:15
waistline, arterial stiffness,
15:19
sympathetic nervous system activation.
15:22
You know, it's kind of like you feel a
15:24
lot more stressed in the old fight
15:26
orflight mode, ready for emergencies.
15:29
And that's just because of high insulin.
15:32
Also, high insulin can increase sodium
15:34
retention and increase blood pressure.
15:38
Insulin resistance. It is important to
15:41
pay attention to. But another key
15:43
number, fasting insulin. And I love this
15:47
one. Most labs are going to say a
15:50
fasting insulin. Now, I'm not talking
15:52
blood sugar. I'm talking insulin.
15:54
They're going to say anything under 25
15:56
is normal. Yikes. I can tell you I don't
16:00
want to be normal. I want to be optimal.
16:02
And fasting insulin
16:04
optimal under five. That's a far cry
16:07
from 25. When you think about it, you
16:10
haven't eaten for 8 to 12 hours and
16:11
there's no carbohydrates for it to work
16:13
on. So, there shouldn't be a whole lot
16:15
of insulin unless there's insulin
16:17
resistance. And that can often proceed
16:22
blood sugar issues for years. But
16:26
silently it is causing problems. Plaing,
16:30
heart disease. But the beautiful part,
16:34
metabolism responds quickly when you
16:36
give it the right signals. Okay, now I'm
16:38
going to talk supplements. But let me be
16:40
really clear. Supplements support a
16:43
healthy lifestyle. They don't override
16:45
it. You cannot outsupplement a bad diet
16:48
and lifestyle,
16:50
but they can be powerful allies to a
16:53
really good diet and lifestyle. First of
16:56
all, omega-3 foundational. 93% of all
17:00
Americans are deficient. We're farmers,
17:02
not fishermen. You want the deep sea
17:05
cold water fatty fish. Great sources.
17:08
They're going to lower triglycerides,
17:09
lower inflammation, improve that
17:12
endothelial function, make it nice and
17:15
pliable, and improve plaque stability. I
17:19
only like highquality molecularly
17:21
distilled fish oil like Barlines or
17:23
Nordic Naturals. There are a heck of a
17:26
lot of companies out there that are
17:27
using rancid or poorly processed
17:30
omega-3s. I would never recommend them.
17:33
Then there's aged garlic. We love aged
17:36
garlic. I love bourberine. Terry
17:38
Naturally's bourberine met X. Fantastic.
17:43
That's going to help improve insulin and
17:45
triglycerides and blood sugar and LDL
17:49
particle size. It can be a gamecher.
17:52
Then you've got magnesium toate,
17:54
magnesium glycinate. Many adults are
17:57
deficient. Going to be really good.
18:00
CoQ10 essential especially if on
18:02
statins. The heart is a mitochondrial
18:05
dense organ. It needs energy and statins
18:10
lower your body's CoQ10 production.
18:13
So supplements can be very powerful.
18:17
Polyphenols, green tea, my all-time
18:20
favorite, Terry Naturally's curcumin and
18:23
resveratrol that is fantastic for
18:27
oxidative stress, inflammation.
18:30
Food first, supplement second. But they
18:33
surely do reinforce the foundation. Now
18:35
I'm going to simplify the heart
18:38
protective eating prioritizing protein
18:41
at every meal. The government is
18:43
recommending 1.2 to 1.6 g per kilogram.
18:47
You know my scale, I don't know about
18:49
yours, but mine weighs in pounds, so
18:51
it's kind of difficult. I can help you,
18:52
but rarely is that under 100 grams a
18:55
day. We're talking a lot of protein. And
18:59
that's why I love my perfect amino.
19:02
Provides the equivalent of 30 gram of
19:05
whey protein with no calories and it's
19:07
vegan. Wonderful. Protein absolutely
19:11
stabilizes blood sugar and improves
19:14
insulin.
19:16
Number two, eliminate sugar, especially
19:20
liquid sugar. I say the devil created
19:22
sugar. I do not like it. soda, sweet
19:25
tea, fancy coffee drinks. Oh my gosh.
19:29
Ban them. They spike insulin
19:32
dramatically. Number three,
19:34
ultrarocessed carbohydrates. They're
19:36
going to drive triglycerides and that
19:38
small LDL, but instead increase extra
19:42
virgin olive oil, avocados, wild caught
19:45
fish, pasture-raised eggs, leafy greens,
19:48
cruciferous vegetables, and all those
19:51
other colorful vegetables and low sugar
19:53
fruit. That fiber is going to feed the
19:57
gut. And a good healthy microbiome in
20:00
that gut reduces inflammation.
20:04
Strength training non-negotiable.
20:07
It is a glucose disposal organ and it is
20:11
the organ of longevity. Going for a walk
20:14
after a meal is powerful metabolic
20:17
strategy. Sleep underestimated. Stress
20:21
that stress response blood sugar goes
20:24
up, cortisol goes up. That's damaging to
20:26
the blood vessels. So you can see why my
20:28
heavenly framework works so beautifully
20:31
for heart health. It is sleep. It's
20:34
exercise. It's avoiding stress. It's
20:36
your mindset. It's eating properly and
20:38
getting rid of those toxins.
20:41
Heart health is lifestyle. So, here's
20:44
the big takeaway. Cardiovascular risk is
20:47
not determined by one cholesterol
20:50
number. It is determined by particle
20:52
number, insulin levels, inflammation,
20:56
oxidation, visceral fat, lifestyle
21:00
patterns. We can improve metabolic
21:03
health. We can change the trajectory of
21:06
heart disease because metabolic health
21:09
is responsive. The body is resilient.
21:13
You are not powerless by any means. So
21:17
get the expanded lipid testing. Know
21:20
these numbers and then build your
21:23
heavenly plan because your heart doesn't
21:26
need fear. It doesn't want fear. It
21:28
wants your action. It wants nourishment.
21:31
It wants strength, rest, and metabolic
21:33
balance. And that, my friends, is within
21:36
your reach. You can do it. So, happy
21:40
belated Valentine's Day and let's take
21:42
action.
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Rethinking Heart Risk
Deb Ford DCN RDN
7 views
Feb 16, 2026
21:43
Today we’re talking about something that affects almost every family listening… ❤️ Heart disease. But not in the old way. Not in the “your cholesterol is high, here’s your prescription” way. Today we’re going deeper — into what actually drives cardiovascular risk — and how we can measure it more accurately. Because friends, heart disease is not just a cholesterol problem. It is a metabolic problem. And when we understand that? Everything changes. You might want to get a pencil and paper because I am going to cover a lot of really important information in detail. The Old Cholesterol Conversation we have had for decades is: • Total cholesterol is dangerous. • LDL is “bad.” And even remembered it as lousy • HDL is “good.” And even were told h stood for healthy and happy • Lower is always better. You could almost not go too low. But here’s the uncomfortable truth… Almost half of people hospitalized with heart attacks have normal LDL cholesterol. And many, many people with elevated cholesterol never develop heart disease. So clearly — we are missing something. And is recommended to be THE culprit because the pharmaceutical industry has a good sledge hammer for cholesterol. So that MUST be the problem. RIght?