Knife Down
Knife Down is a health podcast hosted by vascular surgeon Lily Johnston. The show focuses on preventing cardiovascular disease and improving longevity through evidence-based strategies. It translates scientific research on metabolic health and prevention into practical advice. The tone is informative and nuanced, avoiding wellness hype while acknowledging the realities of modern medicine.
Episodes
High LDL, Rapid Plaque Progression?! Dave @FeldmanProtocol & I Debate the Data
Dave Feldman came into my studio and we went through Simon Hill's critique of the KETO-CTA data one clip at a time — high LDL, "rapid plaque progression," the retracted paper, the new preprint. We disagree, and we do it honestly.At the center is the new KETO-CTA preprint: 100 lean mass hyper-responders, two coronary scans a year apart, and a real fight over what the numbers mean. Wh
What a Vascular Surgeon Eats—and the Artery Test I’m Repeating
In this comment-response episode, I break down what I eat in a typical day as a vascular surgeon focused on cardiometabolic prevention. I also discuss the reliability of CIMT testing, why I plan to repeat my own scan, and what first drew me to preventive health.More on CIMT—and a conversation with the CardioRisk CEO—coming soon.For educational purposes only; this is not individualized medical advi
My Arteries Got Older?! A Vascular Surgeon Explains CIMT Results
My CIMT results came back—and one number moved in the wrong direction. In this video, I walk through my own carotid intima-media thickness (CIMT) scan, explain arterial age, plaque burden, IMT progression, and measurement variability, and talk about what a “worse” CIMT result actually means.If you’ve had a CIMT test or are considering one for cardiovascular risk assessment, this is a practical loo
What Really Causes Heart Disease: LDL or Inflammation?
In this video, Dr. Lily Johnston addresses viewer questions about lipid panels, heart disease risk, and diagnostic testing. Key topics include:Coronary Calcium Scans vs. CCTA/CIMT: Why calcium scores may not be sufficient for younger patients and the benefits of soft plaque detection.Exercise and Lipids: Clarifying that while exercise is vital for longevity, its impact on LDL-C numbers is often mi
This Changes How I Think About Creatine
Can a simple 5g scoop of creatine do more than just build muscle? In today’s video, I’m reacting to Thomas DeLauer’s insights on how creatine might “spare” your body’s methylation cycle—and then diving deep into the actual clinical data to see if it really lowers homocysteine.As a vascular surgeon, I’m always looking for ways to reduce cardiovascular risk. We know that high homocysteine is a major
High LDL. Normal ApoB. Now What??
What do you do when your "bad cholesterol" (LDL) flags high, but your other metabolic markers look great? In this video, I’m sharing my personal lab results to explain why standard lipid panels only tell part of the story.We’ll dive deep into the world of lipoproteins, exploring why ApoB is a more precise measure of cardiovascular risk than LDL-C alone. Using a highway analogy, I’ll show
The 10 Blood Tests I Run to Catch Heart Disease DECADES Early
After I walked through my own labs last week, you had sharp follow-ups — Vascepa versus a mixed omega-3, why my lab screenshots had no reference ranges, which lab company I actually use — so the first half is me answering them. Then I count down my real top 10 tests for catching cardiovascular disease early, from hemoglobin A1c at number 10 up to my number one, which isn't a blood test at all
I Checked My Own Labs: Here’s Exactly How I Read Them
How to read your blood test results — from a vascular surgeon using her own bloodwork. I go line by line through the complete blood count (CBC), fasting glucose and insulin, kidney and liver panels, thyroid, inflammation (hs-CRP), ferritin, and a lipid panel that's getting its own video. This is exactly how I read labs for my metabolic patients, with all my own numbers on screen: the good, th
Carnivore Bloodwork: Best Case, Not the Whole Case
Dr. Abs pulled bloodwork from 50 of his carnivore patients — cholesterol up, triglycerides down, A1C and CRP better across the board. It's a genuinely good data set. It's also the best-case scenario, not the average one.I'm reacting to walk through what those numbers actually mean, why cherry-picked wins don't tell you what happens to everyone on this diet, and what two Virta H
Cholesterol Balance & Keto Bias
Chapters: 00:00 The Replication Crisis & Messy Science 02:11 Why the KETO-CTA Study Was Retracted 03:25 Mediterranean Keto vs. Standard Keto 06:14 Cholesterol Balance: Absorption vs. Production 10:50 The Million-Dollar Question: What Causes Plaque? 13:07 Small Studies & Statistical Manipulation 15:03 Addressing Bias, Personalities, and Grifters 16:56 My Position on ApoB and Personalized Ca
Surgeon Reacts to the KETO-CTA 'Scandal'
The KETO-CTA trial got retracted this year, and most of the internet treated it like a takedown. The authors pulled their own paper because they found real errors in the analysis. That took integrity. I react to how other creators have covered this retraction, walk through what the errors actually were, and make the case that watching scientists correct themselves in public is what good science lo
Carnivore Bloodwork: Best Case, Not the Whole Case
Dr. Abs pulled bloodwork from 50 of his carnivore patients — cholesterol up, triglycerides down, A1C and CRP better across the board. It's a genuinely good data set. It's also the best-case scenario, not the average one.I'm reacting to walk through what those numbers actually mean, why cherry-picked wins don't tell you what happens to everyone on this diet, and what two Virta H
Do Viagra and Cialis Help You Live Longer? What This Study Actually Found
Chapters:00:00 - Introduction & AMA Catch-up 00:28 - Does Fibromyalgia Affect Heart Health? 01:43 - Advanced Markers for Inflammation (hsCRP, oxLDL) 03:04 - Upcoming LIVE AMA Details 03:48 - Is it Safe to Stop Lipitor for High Cholesterol? 05:23 - The "700 Point Drop" in CAC Score: What is Plaque-X? 07:51 - Testosterone & The FDA Black Box Warning Update 08:33 - Deep Dive: Do Via
AMA #3: When Can You Actually Stop a Statin? Plus Plaque, Lp(a), Sleep Apnea & Heart Scans
Two hours, your questions, and no script. You brought the good stuff: when it's actually safe to come off a statin, whether the enzyme supplements are worth it, what sleep apnea does to your arteries, how I build and read a full lab panel, and which heart-imaging test to get if you can only get one.I answer fast, and I answer honestly — including the parts where the real answer is "we do
Cholesterol Balance & Keto Bias
Chapters: 00:00 The Replication Crisis & Messy Science 02:11 Why the KETO-CTA Study Was Retracted 03:25 Mediterranean Keto vs. Standard Keto 06:14 Cholesterol Balance: Absorption vs. Production 10:50 The Million-Dollar Question: What Causes Plaque? 13:07 Small Studies & Statistical Manipulation 15:03 Addressing Bias, Personalities, and Grifters 16:56 My Position on ApoB and Personalized Ca
Try THIS instead of Nattokinase (Surgeon Explains)
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
I Stopped Using Nattokinase. Here’s Why.
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 just
Can You Take Too Much Vitamin K2? Vascular Surgeon Explains
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/ArxAXtzsue4We’ll cover:* Whether vitamin K2 toxicity is possible* Whether using MK7 to slow coronary artery calcification is desira
Vitamin K Slows Coronary Calcium: NEW Netherlands Study
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 p
Surgery for Alzheimer's...Is It Real? (and other questions)
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 microsurg
99% of heart attacks had a warning. Your doctor called it "normal."
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 one
Can THIS Supplement Prevent Heart Disease? Surgeon Reacts to Dr Boz
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/l
AMA #2: Why a 'Perfect' LDL Won't Save You--Plaque, Statins & Metabolic Health
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 every
The Biggest Walking Mistake I See: PAD Q&A
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 certified
Got APOE4? A Vascular Surgeon’s EXACT Plan to Protect Your Brain
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” starts
Brain Health Q&A: ApoB, APOE2, pTau217 & More
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/y8vkJE
Half of Alzheimer's Patients Carry APOE4 - You Don't Have to Be One of Them
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 raises
Can Low LDL Cause Dementia? Your Questions Answered
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. Vascul
LDL Study Q&A: kidney damage, NNT, and funding sources
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 ca
Is Ezetimibe the Secret to Preventing Dementia? Surgeon Reacts to Nick Norwitz MDPhD
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 d
Is Lower LDL Actually Better? New Research Has an Answer
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 final
The Truth About Aspirin and Heart Attack Prevention
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 pre
Ask Me (Almost) Anything With Dr Johnston | Live Q&A
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
Can You Unclog Arteries? A Vascular Surgeon Reacts to Dr Kevin Ham
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 aroun
I'm a Vascular Surgeon — Stop Getting Repeat CAC Scans. Here's Why
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 tip
Is Your Candle Slowly Poisoning You? Vascular Surgeon Reacts to Joe Rogan
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 thro
GLP-1 Drugs Cut Heart Attack Risk — And It Has Nothing to Do With Weight
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
What We Get Wrong About Poor Circulation (with Vascular Surgeon Dr. Jackie Majors)
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, smok
They Don’t Want You Well. They Want You Worried.
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.
When "Healthy" Is a Lie: @DrFordBrewer on Insulin Resistance, Hidden Plaque & His Prevention Pivot
• 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 preventio
The Blood Pressure Myth That Won't Die: A Vascular Surgeon Reacts to @DrAlexWibberley
Hypertension isn’t a mystery. It’s physics. And it’s quietly remodeling your arteries while you’re out here arguing with your salt shaker.In this reaction to @DrAlexWibberly, I’m mostly nodding along—because he nails the big idea: blood pressure is a mechanical force + a hormonal system problem, not just “too much sodium.” We talk through the three levers that create blood pressure (cardiac output
HIIT vs Heart Plaque: Randomized Trial Deep Dive
In this research report deep dive, I walk through a randomized trial that asked a very specific, very modern question: can high-intensity interval training (HIIT) measurably change coronary atherosclerotic plaque—not just your VO₂ max?We go line-by-line through the paper: who they enrolled, what the HIIT protocol actually was, how they measured plaque (and plaque type), what outcomes moved, what d
My CIMT Walkthrough: How I Spot Plaque in 30 Minutes or Less
Sign up for more information on my own practice here: https://corsighthealth.com/Wondering what a CIMT (carotid intima-media thickness) exam is actually like? In this quick “what to expect” walkthrough, I show you how the test works, what it feels like, how long it takes, and what the images can tell us about early plaque and cardiovascular risk.Other tools for optimal health (note these are affil
ChatGPT’s Medical Reply - Vascular Surgeon Fact Check!
A subscriber asked about statins—so I made ChatGPT answer first… and then I fact-checked it as a vascular surgeon. We’re talking cholesterol, LDL, ApoB, plaque growth and plaque rupture, and what “prevention” actually means when the goal is avoiding the first heart attack (or the next one). We’ll cover when statins make sense, when they’re oversold, and why “my numbers are fine” doesn’t always mea
New Drugs Cut Lp(a) Over 90%...Will They Prevent Heart Attacks?
In this video, we explore the exciting pipeline of drugs targeting lipoprotein a and its implications for cardiovascular disease prevention. We'll examine how these cholesterol drugs are designed to work, including those utilizing sirna technology, and discuss the reasons for both enthusiasm and caution regarding this medical breakthrough. This discussion aims to clarify the current landscape
The Cholesterol Myth That Won’t Die – A Vascular Surgeon Reacts to @Physionic
Original video:https://www.youtube.com/watch?v=mJLKTyKy-14&list=WL&index=31We’ve been obsessed with this cholesterol number for decades — but what if we’ve been chasing the wrong thing this whole time?In this video, I’m reacting to Physionic’s powerful “We Were Wrong” episode on cholesterol, where he argues that one widely celebrated marker has never actually been shown to be a therapeutic
High Lp(a)? Here's What Works (And What Doesn't)
High Lp(a) cholesterol is common—and frustrating—because there’s no single drug that fixes it (yet).In this video, I walk through how I manage elevated lipoprotein(a) today, using the tools we actually have: metabolic health optimization, LDL/ApoB lowering, statins, PCSK9 inhibitors, aspirin (in select patients), and menopausal hormone therapy where appropriate.If you’ve been told your Lp(a) is hi
A Meal to Unclog Arteries? Watch This First (Dr. J Reacts to @LeonidKimMD )
In this video, I react to a recent post from Dr @LeonidKimMD a physician who shares evidence-based nutrition and lifestyle medicine content here on YouTube. His channel focuses on strategies for health, and this video discusses a meal pattern proposed to support cardiovascular health.In this reaction, I walk through: • What claims like “unclogging arteries” usually mean in physiologic terms • W
1 in 5 People Have This — And Most Never Get Tested
Lp(a) Explained: The Genetic Cholesterol Most Doctors Don’t Check (And Why It Matters)You can be fit, lift heavy, eat “clean,” and still have a hidden cardiovascular risk most standard cholesterol tests miss.In this video, I break down lipoprotein(a), or Lp(a) — a genetically determined cholesterol particle that quietly raises the risk of heart attack, stroke, peripheral artery disease, and calcif
My First No Incision Bypass | Advanced Treatment for Arterial Blockages
Is it possible to fix a blocked artery without major open surgery? In this video, I explain the Detour procedure (Percutaneous Transmural Arterial Bypass)—a new, minimally invasive technique that routes blood flow around blockages to restore circulation. For patients with advanced peripheral artery disease (PAD), this innovation offers a powerful alternative to traditional leg bypass surgery.DETOU
5 Things I've Learned On Call as a Surgeon
What Is It Really Like Being On Call as a Surgeon? | Life, Death, Burnout & Decisions at 2AMWhat does being on call as a surgeon actually mean—beyond the pager, the scrubs, and the stereotypes?In this video, a board-certified vascular surgeon pulls back the curtain on life on call: the anxiety, the ethical decisions made at 2 a.m., the mistakes you never forget, and the rules that keep patient
Are We Treating Cholesterol Completely Wrong? | Vascular Surgeon Explains
Cholesterol isn’t the villain you were taught to fear — it’s the fuel. And in this video, I’m breaking down why fuel isn’t the same thing as fire, and why most people are fighting the wrong battle when it comes to heart disease.If you’ve ever stared at your LDL number and wondered, “Is this actually going to kill me?” — this one’s for you.Most people obsess over cutting down a few trees… while ign
Hormones, Hot Flashes, & Heart Disease: Your Doctor Didn't Tell You THIS
Dr. Lily Johnston is back to discuss why women are often underdiagnosed and undertreated for heart disease, highlighting often-overlooked risks in standard assessments. She addresses common menopause myths surrounding menopausal hormone therapy (HRT) and its impact on cardiovascular health. This discussion seeks to inform and reassure viewers about the latest research and recommendations for women
3 Myths About Menopause & Heart Health — A Surgeon Explains
Most women have been taught to fear menopausal hormone therapy.Blood clots. Heart attacks. Strokes.A generation of headlines convinced millions that estrogen was dangerous—even when the science didn’t actually say that.As a vascular surgeon and metabolic health specialist, I spend my days treating the consequences of cardiovascular disease. And I can tell you this: women deserve far better informa
The Scan That Reveals Heart Disease Years Before Symptoms
In this video, I break down CAC (coronary artery calcium score), CIMT (carotid intima–media thickness), and CCTA (coronary CT angiography) — the three imaging tests that reveal your real cardiovascular risk. If you’ve ever been told your cholesterol is “fine” or “high” and you still don’t know what that means for you, this is the missing link.Most people think cholesterol numbers (LDL, HDL, trigly
5 MORE Tests That Reveal What's Really Happening Inside Your Body
Most standard lab panels miss the early warning signs of heart disease, metabolic dysfunction, thyroid trouble, and chronic inflammation. In Part 2 of this series, I break down 5 more essential tests every patient should understand before symptoms show up.In this video, we cover:✅ Ferritin — why low or high iron can signal hidden disease✅ ApoB — the most important cholesterol number (and why your
What a Vascular Surgeon REALLY Does (And How to Never Need One) | Lily Johnston, MD
What does a vascular surgeon really do?Most people think it’s all about legs. It’s not. Your vascular system reaches every organ — your heart, brain, kidneys, gut...and even lower 🍆... — and when blood flow goes wrong, everything goes wrong with it.In this video, I break down:✅ What vascular surgeons actually treat (PAD, aneurysms, carotid disease, clots, strokes, ulcers, amputations)✅ Why these p
Amputations Broke My Heart. So I Changed Everything.
My first job felt like cleaning up 20 years of bad decisions that looked like normal life. Metabolic disease doesn't announce itself—it compounds quietly while you're "fine" until your heart gives out or your brain shorts or you lose a limb. I was the last stop, and by then, I was just damage control with a scalpel.It took me 2 years to realize I was fighting downstream from th
7 Life-Saving Tests Your Doctor Might Skip!
Which blood tests should you get? Most people get “standard labs” every year—but those basic tests often miss the early signs of heart disease, insulin resistance, kidney damage, and metabolic dysfunction.In this video, vascular surgeon and metabolic health specialist Dr. Lily Johnston breaks down the essential lab tests every patient should know—PLUS the advanced labs she orders in her prevention
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