Bypass vs Stent Mortality: New England Jl of Medicine EXCEL Trial November 2019

By Adem Lewis / in , , , , , , , , , , , , , , , , , , , , , , , , , , /

Down there we go okay so let me know
when I’m live well you should already be alive there’s just a delay of roughly
around ten seconds very good good morning Bart good morning
Bob today we’re not going to have a PowerPoint presentation we’re going to
talk a little bit about a new article that just came out in the New England
Journal of Medicine it’s about comparing the outcomes for
CABG and CABG that means bypass graft for PCI and PCI means
percutaneous it means stent doing going in and putting a stent in before we do just a couple of comments
we’ve got the the Louisville event coming up day after tomorrow Friday and
Saturday we’re very excited about it it’s going to be two days of very deep
it’s almost like in some ways like two days of listening to binge listening to
videos and that’s a bit much for a lot of people but here’s the big draw to it
it’s also you attendees can get their labs and most of them have already done
that then bring their labs to the event and we would go out we talked about
specific lab interpretation so now you’re hearing about this stuff while
you’ve got your own information in front of you in addition we have the CIMT so
you will have the CIMT available as well so it’s a great way to get it all
done at once and get a much deeper dive now I was talking with Chuck Smith
earlier today Chuck Smith is going to be doing a well I’ll go back to this Chuck
Smith is going to be doing a presentation at it you may recognize the
name the told his story on the video Wild Ride Chuck realized he was having
some cardiovascular risks he’s a businessman in Florida runs a high-tech
business called Guardian Manufacturing they do I hear’s what I keep remembering
they fixed the fixed rides like the Harry Potter ride or other similar rides
that shake people up and you have to make sure that there’s a technical
connection between between what they see visually and what they’re feeling
but he does a lot of work within a lot of other areas and does a lot of
automotive work in terms of some of the high-tech equipment for automotive
industry he also does a lot of work with ozone ozone is a great way to to
sterilize and preserve fruits and vegetables without getting into the
problems with antibiotics and things like that anyhow Chuck began to see he
got the book by Caldwell Esselstyn started following that actually became a
patient of Dr. Esselstyn’s and continued to try to cut those oils out of his diet
he didn’t he he lost his 30 or 50 pounds um a lot of weight a few weeks later he
was at the gym he had to work out and on the way home and started to have
chest pain he knew what it was he drove a Tesla he let the Tesla drive
into the hospital while he was leaned into the backseat to get was looking for
his nitrates so again while drive to the hospital during an event but you got to
go back and ask the question why on earth would he have an event after
losing 30 pounds and here’s what happened he started looking a couple of
channels and I hear this over and over from from new patients my channel and
I’ve were coming The Fat Emperor and let’s talk a lot about insulin resistance
started looking then and found out his triglyceride over HDL was
5 and here’s the here’s the problem for those of us that have trouble
metabolizing carbs it’s very difficult to go on a a low-fat diet it’s difficult
or even impossible to go on a low-fat diet and get enough calories but still
manage your carbs because you’ve only got three macronutrients you’ve got
protein you’ve got fats and you’ve got carbs now so many folks that talk about
low fat diets yes I’m absolutely sure that the low fat diets have saved a lot
of lives because if you’re eating your typical American diet the standard
American diet you’re getting tons of fats tons of carbs and protein now
here’s one of the things that we know the most dangerous combination is a lot
of fat and a lot of carbs at the same time the carbs stimulate your insulin
insulin shuts down fat burning and so you know that’s why you just keep adding
the fat on but if you cannot metabolize carbs then
it’s very dangerous to rely on carbs as your major source of fuel and that was
exactly what Chuck was doing on his low-fat diet so he changed diets went
low-carb continued to lose weight looks great and has been doing very well
he’s gonna be speaking and sharing his experiences at the event he’s also going
to talk a little bit about challenges in terms of encouraging other people to get
involved with this it’s sort of like being on an airplane flying into DC
let’s say you look down you see the Potomac then all of a sudden the plane
lurches you look out the window you see one of the engines is smoking out you
know just like Sully in the end the crowd when they had that problem with with the birds hitting the the engine
and wiping it out you hear the you hear the emergency communications coming on
on the airplane then they’re saying go ahead get your oxygen mask on first and
then help somebody else and you you start to think about well you know I
don’t know why that engine went out I don’t know while we’re doing oxygen solo
and you but then you forget all that you get the oxygen on you look at the person
next to you and they’re stuck on looking out the window they’re not getting their
oxygen own you’re trying to help them and they don’t want to be helped
and sure enough Chuck has gotten CIMTs paid for CIMT’s for a lot of family
members a lot of co-workers and seeing a lot of significant challenges there but
like many of us you can find somebody that needs help they’ll typically the
dentists have this problem as well they’ll typically then go to their doc
and the doc will say I don’t know what CIMT it can’t be right this is your
labs or your cholesterol levels are fine so we’re going to have some discussion
at the the event this weekend about how to I hate to say it you’d be that
that use the term but how to be a ninja list for helping people learn to take
this help real health information seriously how to take prevention
seriously and prevent that heart attack rather than suffer a heart attack and
then hope the docs going to be able to treat you that is not the right solution
so again we’ve got a lot of interesting stuff coming up we’ve got a couple of
other events coming up David’s gonna David Meinz is gonna be having a CIMT
access event I think it’s in San Antonio that one maybe in February we’ll put a
schedule out applied if you would please remind me that we need to do that
David’s also going to be in Detroit and will again we’ll put that schedule out
we have the email addresses for all of you that have signed up at CardioRisk.US/Ford
and glad if you could we’ll send that information
out we also have a couple of other events coming up where it’s not only
just CIMT you can get a CIMT but you can also go ahead and get an
evaluation as well pardon the digression and pardon me for clearing my throat
there’s the of you who have seen a lot of my videos know that problem a lot of
it was biologic overlay I admit there may be some there but I got a sore
throat about two weeks ago my upper respiratory system is similar to my
mother’s we get one of those things and it’s like an asthmatic getting a cold in
their chest we have problems for weeks a lot of
inflammation in our upper respiratory areas anyway back to the point there are
going to be a couple of other events coming up one in Orlando looks like it’s
going to be February timeframe actually we may have to in Orlando during a
February February timeframe one of them may be
a joint event with Chuck Smith that I just told you the story about his Wild
Ride and it’s Tesla another one to be announced we also have another one
coming up with a fellow named Mark Bentley
he’s the dentist and we doing event for Western Ohio Dental Society the both of
those events are scheduled to be a one-day event one of the things we’re
realizing is it helps patients sometimes are people sometimes to think about I
don’t want to listen to this for two days that’s just way too much but maybe
one day is a little bit more practical and we’re gonna try that see how that
goes we’ve already got a lot of signups for um for the Ohio event in fact we
have opened it up to two YouTubers and others who want to come from the from
the public now let’s get back to PCI and CABG or stent and bypass so here’s
what this article from the New England Journal this week says they took a look
at five-year outcomes for stent or bypass for the left main coronary for
left main coronary disease now first of all let’s ask the question why are we
talking about left main disease because we’re talking about a the number one the
most common place that you get it number two we’re talking about a single vessel
disease here’s what’s important about that piece if you have a single lesion
it’s much more amenable to a stent you have to start thinking about more of a
bypass when you’ve got three vessel involvement and you’ve got multiple
places in the multiple plaque areas in in multiple vessels I mean you just
can’t do that with you can but you end up with you end up putting enough stents
in you end up with what some people sarcastically call a full metal jacket
now here’s the next thing let’s go basically go simply down to the
conclusions in patients with left main coronary artery disease of lower
intermediate and anatomical complexity in other words as a single vessel
disease not a whole lot of separate plaques there was no significant
difference between stent and bypass with respect to the rate of the composite outcome of death stroke or myocardial infarction at five years I
want to focus for a second on the last part of that that statement
with respect to the outcome that they’re talking about here is death stroke or
myocardial infarction I’m not in great shape to talk straight for two days now what I get and I’ve got a lot of
these comments and I actually have I saw a patient yesterday he’s a great patient
very disciplined doing all the right stuff and he said Doc you know I heard
you on another video say stents don’t work I have to tell you mine worked and
I came you know I gave the the standard statement that look I’m just talking
about the results of the of the studies and that was for example the courage
trial this was the effect of stents in patients with stable ischemic disease
what we’re talking about in both of these we’re not talking about
improvement of symptoms as you can see the outcome is death stroke or
myocardial infarction you’re bringing this up and I appreciate
your perspective on it and you know what maybe I can do some clarification on in
the future as I describe this when you look at the studies they’re mostly
talking about outcomes are you going to have another heart attack they’re
talking about is it going to prevent you having another heart attack and
again as we saw in the COURAGE trial and several others the answer is no this
this this thing this week makes a good point about comparison of bypass graft
with with stents but let’s go back to that outcomes again as you notice
there’s nothing in the statement about outcomes regarding symptoms and like my
patient said yesterday I had really bad symptoms I had pain I had any time I
started to get more than a walk I had I started sweating I just couldn’t get
beyond a walk now I can I’m doing high intensity intervals so it’s made a very
positive impact on my life so again and wanting to bring yeah and this
distinction between preventing another heart attack and or death or stroke
versus symptoms so this these are the studies they’re talking about preventing
another heart attack horse or stroke or death and instrumentation doesn’t do
that you know that sounds confusing and I tried to come up with an analogy I’ll
give you the analogy and hopefully this helps imagine you’ve got a break in your
plumbing from the the main line out at the street it’s coming under your your
yard and then it comes into the house but in that break under your yard you’re
getting a lot of dirt into your pipes you keep having problems with your
plumbing inside the house so if you if you fix the plumbing inside
the house it’s clearly gonna fix the current symptom that you’re having with
maybe the the commode not working the shower not working what a sink not
working whatever but it’s not going to change long term until you go out and
you fix the original or root cause problem and that’s getting dirt into the
system from the from the very beginning from from the first part so think of
these procedures like bypass and stents like fixing the plumbing inside the
house that’s already been damaged it can have a big basics can have a positive
impact but they’re not going to change the significant long-term outcome until
you stop getting dirt in your pipes so same thing with lifestyle vs. procedures
procedures may help their plumbing right now they’re not going to decrease your
they’re not going to there’s no evidence yet that they’re going to change your
long-term outcomes so I hope that’s been helpful we’ll go ahead and take some
comments now now I’ve got this thing technology is wonderful till it doesn’t
work and the problem is I usually don’t know how to make it here we go okay
Thomas Gronek good morning Dr. Brewer is it possible to mitigate arthritic
damage or even possibly reverse it on a carnivore diet with supplements and if
so which supplements I’m not going to be a great expert on changing arthritic
inflammation with the carnivore diet however I will say a few things the
inflammatory diseases we have inflammatory arthritides
mean that’s arthritides is the is the plural of arthritis rheumatoid
arthritis psoriatic arthritis and psoriatic basically is coming from the
from the word psoriasis inflammatory diseases of the gut like inflammatory
bowel disease one of the most common that people don’t understand that don’t
link with this is Hashimoto’s thyroiditis all of these tend to be
inflammatory diseases for the one other I’ll mention is yes gluten and leaky gut
is real and we’ve there’s a fellow named Alessio Fasano at Harvard who has done
an incredible amount of work on this and he’s shown that yes glutens bleedings
or gliadins as some people call them actually cause our tight junctions in
our gut to to dissociate and that allows jump to
come in from our from the food that we’re eating that’s in the gut and come
into the bloodstream and cause gut related problems that problem is found
mostly in people who have haptoglobin 2-2 I’m not going to go down that
digression there’s a I’ve got a whole series of haptoglobin videos go take
a look at those but we do find people that have haptoglobin 2-2 genetic
variation tend to have leaky gut they have thyroiditis they tend to have the
other inflammatory diseases so when you consider that so back to your original
question Thomas yeah when you consider that this is an inflammatory disease
that one of the more common in flammond something that that spurs inflammation
some one of the most common inflaming systems and gliadins once you cut
that out of the diet it does tend to have a very positive impact
I see that with my patients as well cutting and it’s and it goes right along
with cutting carbs you know the major source of carbs are grains and the major
source of pollutants and gliadins are grains you cut that out you get a
positive impact in both spots I’m not going to deal with this the supplement
I’m going to go to another question 147DegreesWest how are you doing I
hope things are well in Alaska I hope the weather’s good hey Doc try some
matcha for that upper respiratory thing I have I didn’t get a lot but a good mic
but maybe I didn’t try it enough even cheap rate of culinary much it might
help over the long run well that’s a good point I didn’t do a high-grade
high-grade matcha but thank you very much for the suggestion part of it
I will say this and you always start sounding worse when you start feeling
better and I’m really clear this stuff is loosening up at this point
Paul Gagnier Paul you never did confirm if I’m pronouncing your last name correctly
if you did I don’t remember it I hope I am looks something French to me good
morning Dr. Ford I’m healing up low-carb 5’5″ and 150 pounds
down from max 205 pounds well you’ve obviously just okay they can all go back
you know dig dirt in your pipes you’ve taken out a whole bunch of the original
metabolic challenges that you were causing your pipes your arteries when
you’re at 201 pounds congratulations on getting that done great advice sir but I
found bone broth homemade boosts healing especially immune diseases you know it’s
so frustrating I keep wanting to do a video or two or a series on bone broth I
use it all the time it’s wonderful I think it’s a bone broth is really good
my problem with not getting that series out is that we’ve got so much focus so
much need in growing response and need to focus on some of the more actual
medical related stuff I just keep focusing on stents and bypasses and
where they work where they don’t and medications and some of the other things
we talked about genetics and things like that
oh gosh this thing just moved again 1234Contractor I’m on mostly carnivore
keto after 20 years as a vegetarian well I have issues with the saturated fats I
will tell you this actually I just read a book by Nina Teicholz I already knew
some things about The Big Fat Lie and actually have a series called The Big
Fat Lie it’s talking about Ancel Keys 1234Contractor if you’re
doing this I’m assuming you know who Ancel Keys is and that whole that whole
progression from low carb – I mean look low fat low carb anyhow the book by Nina
Teicholz is called The Big Fat Surprise it’s a big big long book but if you’re
into big long books about fat I would recommend it it’s she’s a reporter and
she’s done a really good job with it bottom line I would say that I I’m not
seeing a whole lot of people having a whole lot of problems when they switch
from other diets to a keto or even carnivore diet I’ve got several patients
now on carnivore Mike Upshaw good morning Dr. Brewer oh and I’ll mention
one other person I don’t know if you’ve noticed this
he’s another YouTuber Doc oh dang I shouldn’t have started that because I’m
having a senior moment trying to remember his name he’s the one that just
went keto I saw a picture of him on a thumbnail and he’s continuing to lose
weight actually he didn’t go keto he went keto a few years ago lost like what
at least 50 pounds and has now gone carnivore and he’s continued to lose
more you could tell by looking at him that he he did had to have the room and
he’s looking better and better and better so the Bjorn2fly oh Chowceo I have Hashimoto’s thyroiditis does it contribute to inflammation and
what can I do about it doesn’t it’s not so much that it contributes the
inflammation it’s an outcome of inflammation so what I would do about it
if I had high pressure motors I’d probably go ahead and go ahead and get
the haptoglobin 2-2 gene study you can get that I’ve seen I’ve had patients
get that on 23andme and using 23andme and snippy dia SNP EDI a it’s a it’s a
public it’s like Wikipedia and it helps you
understand what you actually found when you got your 23andme if you have
inflammation then you’ve got increased risk for a heart attack and stroke
significant increase and you’ve got an increase for other things as well and
most people with Hashimoto’s have these kind of problems so I would go ahead
that’s why I would go ahead and get that test we can help if you have if you’re
if you have a struggle trying to get that on that dime Thomas Gronek thank
you Bjorn2fly did you see the TRIM study where for the
first time epigenetic aging was reversed do you think the results are real and
then will it also help for cardiac diseases you know what I think I did see
the headlines on it and I I don’t I don’t think I’ve got a chance to go back
and review it there’s a lot of work going on in in epigenetics I will tell
you I’m going to be talking about epigenetics just a little bit in the
upcoming event and redid some of my deck on it we first began to discover next
hole back in the 90s and one of the things you have to remember about
genetics is this the genetics the old saying genetics
loads the gun but but lifestyle pulls the trigger the connection between
lifestyle and pulling that trigger genetically he is epigenetics I’ve got
several videos on this you look up my name YouTube and epigenetics or look up
my name YouTube and methylome methylome METHYLOME and here’s what the
methylome is if you look at genetics it’s not just an issue we’ve got what
six billion base pairs in there every cell so I measured the library for
all of that genetic information how do you go in and find it and that’s exactly
what happens you know I didn’t develop insulin resistance
until my late 50s I didn’t change my genetics but my epigenetics changed I’ve
got a couple of significant risks I was born at ten and a half pound baby when I
was born that was a bad happy baby now we know babies born at eight and a half
pounds and more have significant risk for developing insulin resistance and
type 2 diabetes when they’re getting older I also have 4Q25 and a
couple of other things but let’s go back to that so what we’re finding also my
dad was 350 pounds when I was conceived what would that have to do it doesn’t
have anything to do with my genetics exactly but again both of those events
being born at ten and a half pounds and having a dad that was very heavy there’s
evidence piling up that both of those change my epigenetics now back to the
methylome the way this librarian for the genetics system works is by methylating
certain base pairs once he or she method once the librarian
methylates some of these base pairs they know they make it easier or harder to go
back and find that specific base pair and that base pair is located and
related to jeans so for me for example jeans that help my muscle cells and
liver cells be responsive to insulin they’re just not as responsive as they
used to be um actually I will say this Hardin today
all of these are digressions pardon this digression but I wish I had my results
out here I had an OGTT a couple of weeks ago and it wasn’t normal but it
was almost normal for the first time in years now how did I do that three
changes and I just want to make people aware of these I have had these
discussions with many of my patients who fit in this category where you’re older
you’ve gotten insulin resistant but like me you know you’re at a BMI of twenty to
twenty-two and yet you could still lose a little bit more weight but that’s
probably not gonna move the needle that much and you got everything else going
on there is a medication it’s called pioglitazone I did start taking that
used to be called Actos like any prescription medication it’s got its
downsides but I do think that Actos has made a
very positive impact on my insulin sensitivity that’s what it was always
known for now I’ve made a couple of other changes as well I greatly
increased my resistance training so and I am increasing my muscle mass I’m no
Arnold Schwarzenegger but I’ve got a lot of room to grow in that area but I have
significantly increased my muscle mass that can help because muscle mass
improves OGTT my sleep is improved a couple of things like that so you don’t
know I’m just like most of us I’m an N of 1 in terms of the experiment but I
suspect given all of the things that I know that it was probably the
pioglitazone or Actos okay Thomas Gronek Thanks Mike Upshaw what’s the maximum daily
amount of carbs that a person should shoot for well it depends on your goals
you know if you’re young and healthy and don’t have any of these problems and you
really don’t care about carbs you can eat a whole lot of them I personally
tend to to shoot for around a hundred grams per day or less I know some people
that are in the that are 50 and less and I know some people that are
significantly less than that at 30 or less Paul Gagnier I did huh okay thank
you Paul thank you very much I did pronounce Gagnier correctly and then I
move this thing so I can read it and oh okay Cliede if you I don’t know if
you can see the other comments Cliede put down a couple of comments regarding this
specific day David Meinz is gonna be in San Antonio February 15 and in Detroit
on April 4th so a couple of upcoming dates that’s for the CIMT tour
Dr. Kimberly Lane wow the large baby data had never heard of 9.5 I’ve been
here well thank you Dr. Lane and up at 1.5 you’ve got some increased risk
you obviously don’t have as much increased risk as I did but you have
some speaking I don’t want to make all this all about me but speaking of those
risks I was talking with my sister a few years ago when I had first shared with
her that I had atrial fib and I have both atrial fib genes 4Q25 and I’m
homozygous for p25 me I got an atrial fib risk gene from my mom an atrial fib
risk gene from my dad which we didn’t you know we didn’t know about until fairly
recently the other thing that we didn’t know until fairly recently was that long
distance high intensity workouts can increase your risk for atrial fib and I
did a lot of that I’ve run several and supply hours of full court first a base
football baseball basketball twice a week so I’ve gotten my weekend warrior
stuff in and yep I have atrial fib my sister was saying Ford why are you so
sick you know you’ve got this diabetes you’ve got atrial fib the rest of the
family’s fine well my answer for her was because I
looked and that’s one of the things I think most of you may understand on the
channel majority of people that have the atrial
fib at the level that I have or the insulin resistance at the level I have I
have that I have has in 90 95 percent or more have it and have no
clue so that’s part of the the goal of this
channel is to make people aware of risks and what you need to be looking for and
how you can manage those risks OldAlabamaGardener
good to see you OAG and for those of you who haven’t seen it tuned into
OldAlabamaGardener he’s like the the original farm-to-table but for his farm
to his table my cup shawl what whatever it takes to maintain your weight at the
level you want exactly right Cliede Castaneda ow another one CIMT and on May
2nd in Memphis I think from the way this system is looking like we’re getting to
the end of the questions if we don’t get any other questions
soon I’ll go ahead and wrap it up and we’ll have a short one today
Angelus ad tenebras some wonder what that means
and Angelus ad tenebras I think upcoming drugs like Ligandrol will
help you with your muscle and bone density well thank you for for that
comment let me just make sure that we Terry Wyatt good morning my glucose
during three to four day fast doesn’t start coming down until about
day three less than a hundred where is it coming from on days one and two and
there’s this some proof of IR it makes me suspect IR but I need to know some
other things Terry like what your overall BMI is in other words what is
your fat mass the higher that is the more you can have of this but usually
the more you have of that again is being driven by instant resistance and
starting off with higher numbers if it’s taking you three and four days to get
down below a hundred you need to take a deeper look at this one of the questions
the another question I have is what is your full cycle during the day are you
using continuous glucose monitoring or are you just doing occasional finger
sticks because it’s very important to find out if you’re over a hundred
between the hours of 3:00 a midnight excuse me an 8:00 a.m. then that’s also
a problem you should be dipping most of us tend to dip in then our cortisol
kicks off sometime in the dawn and we get an increase as our body’s preparing
to to head into the day Richard Lund good to hear from you Richard I will let
you know I had a couple of significant problems with my camera my friend
Michael at new friend Michael at Laura’s Lane pointed out a couple of very
interesting things like I had it stuck on auto zoom thought you might be
interested Richard’s done a lot of work he’s got a production background and did
a lot of work helping me get set up and moving me from the old shaky paper days
to to the production that we have now so Richard says I plan a video on making
bone broth with four Chinese herbs and chicken in the instant pot sounds really
good I got an instant pot based on what I found what I saw in old Alabama
Gardner’s channel and have AM gearing up to using that I got a
pork shoulder the other day and it was really fast really easy
so James Kantor good to hear from you James
my blood sugar can’t can me losing after a meal not sure what that sentence means
then be higher fasting blood sugar in the morning
can be lower after evening meal and then be higher after passing blood and then
higher fasting blood sugar so I I think what you’re describing
James well I thought you might have shared
that you have a significant problem with your blood sugar before on one of the
comments so I think what you’re talking about and what you the question that may
be implied in those statements is this why would your blood sugar why would you
eat an evening meal your blood sugar does it’s it’s a little peak and then it
dips down but then it comes back higher the next morning how does it get higher
and if that’s what you’re asking then that’s again due to cortisol cortisol is
like a longneck it’s an hormone made by the adrenal
glands the adrenal glands also make epinephrine or adrenaline
that’s why adrenal adrenaline and if you may remember adrenal adrenaline or
epinephrine or the fight-or-flight drug you know it’s where you get really
excited your body your blood sugar goes up your body goes ready to go do
cortisol is a more of a long-acting version or it’s a hormone that has a
long-acting adrenaline type of effect it gets you ready for stress and we
typically have what we call the diurnal or a circadian change in our cortisol
with it’s beginning to peak early in the morning that leads to what diabetics
called the dawn effect D A W N at the dawn of the day some people have a
significant increase in blood sugar now how does that happen
cortisol is peaking one of the impacts that cortisol has is that it tells the
liver okay go in and find those glycogen take the glycogen molecules that you
have and you remember what glycogen is glycogen is just long strings of sugar
glucose attached one after another after another and all it takes is a couple of
seconds for the liver to shave off a bunch of those glycogen glucose term as
moieties glucose molecules and it can you can flood your blood with sugar it
was stored in your liver as glycogen so yes James you did share I thought I was
I started to say that because I thought that you had but thank you for sharing
yes James has diabetes and has shared that a couple of times and I think I
think that answered your question if it didn’t let me know
Dj Kessler you mentioned being a large baby and for us and its influences
what about preemie babies I was two months premature and weighed 2 pounds 11
ounces well you know as you probably know DJ premature as a whole yes has a lot
of health risks it’s a whole different kettle of fish though the biggest
immediate concern is whether or not you’ve developed your the surfactant in
your lungs well enough I’m so sorry guys well enough to
to be able to breathe effectively once you get beyond that you can have some
some scarring and some like you’ve mentioned director you can have
retrolental fibroplasia as well 1957kato how long should anybody do
high-intensity training that is a great question and for you know that’s one it
here them is the most common error that I see with high intensity training
number one that you don’t do it at all that’s the most common the second most
common is number two that you do too much the third most common is that when
you do it you do in adequate intensity and too long of an interval people say
I’ll go in and I’ll do five minutes five minutes is too long if you’re able to
maintain that level of intensity for five minutes it’s not intense enough you
need to go back and limit the intense part of your cycle or your interval to anywhere from 90 seconds on down to
like maybe two minutes that preferably 90 seconds on down to about 30 seconds
there are professional cyclists who’ve done most of their training on 30-second
intensity intervals now they’ll get up to 10 15 20 I don’t recommend getting
beyond 10 and I don’t recommend doing them more often than three days a week I
actually recommend them two days a week so I hope that helps with I guess part
of the other question is how much of a recovery interval in between and that
can be anywhere from 30 seconds to 90 seconds as well Cliede Castaneda Oh Cliede
is saying OAG you can reach out to Cliede at 859 721 1414
Cliede one thing you may not know you can go in and look at some of our videos
OAG has been a patient of ours he put he put together a couple of videos on
his channel and we did a few videos on our channel with interviews for OAG he
is way out in the boonies in Alabama got a wonderful farm there which that’s what
his channel is all about OAG used to be a rocket maintenance
person by the way so he gets some very very interesting gardening videos anyway
we’ve done several videos together he’s a friend basis point James Kantor
yes it did so this is normal Bill Boswell is it the don’t effect that
causes me to wake up at 3:00 a.m. can this cause early awakening I would tell
you Bill I would say this I’ve had a lot of patients and it’s happening to me too
where they noticed they were fasting they wake up at 3 or 4 in the morning
and they had very low blood sugars like in the 50s and even I did a couple of
times in the um if you’re waking up at 3:00 a.m. one
thing I would recommend is that you get CGM continuous glue to glucose
monitoring there are a couple of them that we’ve that we’ve done a couple of
them that are out there the Libre is made by Abbott it’s Freestyle Libre and
actually have right now to share we got a long-sleeve shirt on I’m not gonna
take that off but it’s a little button right here be all I don’t you can’t see that very
well can you mmm sorry about that oh but I’ll check my glucose maybe it’ll show
up here so here’s the thing if you’re waking up at 3 a.m. yeah I
just had a meal about an hour ago and I’m at 101 I don’t know if you can see
that and that’s what you do now this Libre button has a an
eight-hour storage in it so what can happen is you begin to find out exactly
what your blood sugar was doing between 12 and 8 a.m. while you were asleep and
you’re just not gonna get that with finger sticks I mentioned that there are
two of them the other one is Dexcom Dexcom has just gone from Dexcom 5 to
Dexcom 6 my friend and an a great dentist in terms of oral systemic health
Doug Thompson encouraged me recently to go ahead and do some more research using
the Dexcom 6 he’s got one he loves it I have one I’ve done a couple of videos
on it I’m not even sure that they come out yet I didn’t like it
it’s supposed to be far more accurate than the Libre and I don’t have a real
problem with Libre accuracy and frankly when I did the comparison I in a dig I’m on my belly
they were both remained accurate during the full 14 days I did here’s here’s the
thing that really ticked me off more than anything else the Dexcom is more
complicated it’s got a transmitter which you attach to your belly
and I don’t like the belly because I kept I kept feeling it I never feel my
Libre button and in fact quite often I forget that I’ve got it on like I
haven’t done that since last night I forgot I had it on with the Dexcom 5 I
felt that in my belly all the time I just didn’t like it there the other
thing is because you’ve got the two components to the Dexcom you’ve got the
transmitter and then you’ve got the sensor which pops into the transmitter I I don’t remember at this point what I
did but I think I took both of them off and threw him in the trash just like I would
Libre well that was three or four hundred dollars worth of sensor that I
threw away and it’s because you know I don’t like it
I spent a decade working at Toyota and I’ve had that same focus then in in
automobile world I always had it in the medical world either I do not lie
I don’t like passive engineering is a critical thing in other words engineer
a product such that people cannot make mistakes with the Dexcom you have to
remember I take that transmitter off I put it somewhere I clean it up sterilize
it whatever I’m gonna do and then I use it again or I just leave it on and then
I have to use the other sensors all at the same time neither of which is a
great solution for me so I don’t like the Dexcom as much as the Libre the next
time is still far more expensive – so now Doug loves the Dexcom I know that
Chuck Smith loves it as well I like the good old fashioned cheap Libre
but if you’re not doing either one there’s no way you’re gonna know what’s
what your blood sugar’s doing while you’re asleep Bill Boswell oh I hope
that answered your question one more and then we’re going to wrap it up folks
thank you very much for your interest Eric Janse is being metabolic
flexible significant high calorie intake does not impact your weight over a
medium period of time a couple of months equal to being insulin yeah well yeah
that’s a good question I I’m not an expert in that area but my
first response when I’ve looked at that before is that yeah if you’re able to
burn any of the fuels which met it makes a metabolic flexibility implies then you
clearly can’t have significant I mean that’s definition of insulin resistance
is you cannot burn carbs very well so again I sorry about all the coughing I’m
as you can imagine I’m very concerned about standing up for six hours
excuse me six hours a day for the next couple of days this weekend so I
apologize to you and if you’re coming to the event I apologize even more so in
advance OAG Cliede Castaneda thank you I’ll call you okay talk to you guys
later thanks for your interest and now I need to figure out how to turn
this off

11 thoughts on “Bypass vs Stent Mortality: New England Jl of Medicine EXCEL Trial November 2019

  1. I am watching from England. I had cardiac arrest but survived due to defibrillation and ended up having a triple bypass. Stents wereÔÇÖt an option because two of my coronary arteries were full blocked. I was 61 when it happened and was a fit and slim vegetarian. I am committed to trying to optimise my heart health. I have gone onto intermittent fasting, low carbs and no sugar. I would be prepared to go vegan but am concerned about low b12 , k2 and omega 3. I am confused by the competing advice on You tube. I am on atorvastatin, adizem, ramprill and dabigantran. . All I can do now is improve my exercise. My main problem is the difficulty of measuring benefits. I measure blood pressure and it remains high at times. I do not really have a question I just wanted to thank you for putting this information out there.

  2. hello DR Brewer . i did low carb no oil but olive oil and no sugar. 6 feet 170 pound with A1c of 5.6 . my normal blood pressure is 11 over 7 .should i expect Chang in my pressure. thank you good doctor.

  3. Thanks Dr. Brewer, another very informative session. I am senior. I have T2B, but no diagnosed CVD. On treadmill, it shows the heart rates when it reaches 65% and 80% based on age. I do HIIT 3~4 times a week. Two minutes high intensity with one minute slow walk in between. Repeat five times. During the two minutes HI, I tried to control my heart beat between 130~150. I actually used about 80% of my effort to reach the heart beat target. I wonder if I should use 100% of my effort without worrying how high the heart rate reaches? In the mean time, I will reduce HIIT to 1.5 min and 45 sec as you suggested. Thanks.

  4. I am posting this article because I believe dr.brewer may find this interesting. I know he is not a fan of beta blockers. But I have seen some studies that show carvedilol can improve insulin resistance. Carvedilol can Replace Insulin in the Treatment of Type 2 Diabetes

    Mellitus Anis Ahmad*

  5. How many stents are too many? I just had 3 on LAD and doc wants to go back in and do two more in OM1 and OM2. My Facebook page of CABG participates have many that have had 20 or more stents!

  6. LoL I just restarted HIT. I always do 20 minutes. 12 second rest 8 second sprint etc – exercise bike. Twice a week is enough, until you get acclimatized. However they say there is no further benefit more than 3 times a week.

  7. I was just thinking, listening to the discussion. That people with existing CVD going on to a keto diet should be very careful with their electrolytes, especially potassium. I don't have CVD but was getting arrhythmias because of what turned out to be low K. I was adding Na salt to the diet, but apparently that can push out K if you are pushing through lots of fluid, i.e. in the tropics here working outside sweating a lot etc. So I would suggest using Lite salt (which is 50/50 sodium potassium salt). Just my experience, and I don't have CVD. But somebody with it really wouldn't want a K problem.

  8. Lost 30 lbs too. I had triple bypass surgery 3 years ago. Decided to try Keto. The results were fantastic. I have since recovered normal endothelial function, hdl up from 35 to 50, CRP 0.75. I have never felt better. Thankfully my Cardiologist is a keto enthusiast, so I don't have to fib when I have an appointment. I still take a low dose statin on my docs recommendation. Evidently they are beneficial for CABG recipients.

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