Weight Gain & Artery Age: My CIMT March 2019

I come from a family with some bad
stories around food. My dad spent most of his adult life between – from 250 pounds
up to 350. So these right 2 categories. A BMI of 35 to 40, and then higher. How
did we get – how did he get there? He loved sweets; but it wasn’t just sweets, it was
just piles and piles and piles of food. My mother actually got up over 160 at
one point. So, here’s one of the – and I got up over 190. I’m currently 155 and what
does all that got to do with heart attack and stroke health? Obviously, a lot
and that’s the battle that I routinely fight. I have – over the – as an adult – well,
as a young adult in college I got up to 190 then I decided I wanted – I needed to
lose weight and I went on more of a low low-fat, plant-based diet. Got down to
about – have actually, for the most part of my adult life, gone between 155 – 160. I
have been over 160 a few times. A few years ago got up to 170. Now, it’s an
interesting thing – what does that got to do with CIMT? With my CIMT. it has to do
with a lot and we’ll go through that over the next few minutes in this video.
My arterial age tends to be driven to a large extent by my BMI and I’m not alone.
That’s a – that’s a key item. I get a lot of grief for being so aggressive about
BMI and body fat, as you may know, and if you’re saying “Well, BMI is not exactly
body fat.” I know that but if I inserted RFM (relative fat) mass and every time I said BMI – nobody would – even fewer people would understand what I’m
trying to say. So I’m referring to body – body fat mass or relative fat mass. Fat
does cause some things that challenge your insulin – your body’s response to
insulin and, therefore, your – your routine sugar values – glucose values; therefore,
also, some plaque values and that is where the connections start to get made.
There’s a strong case that insulin itself, drives a lot of this plaque as
well and that’s not what this video is about. This video is just starting off
making that connection between body mass or relative fat mass and CIMT results.
Now, as you start looking at my CIMT, my – one of my early videos covered my early
experience with CIMT and made a case that despite having stayed around,
actually, for the most part in my life as I said, in the 150s – 160s, I had gained
weight as I got older. I started getting that middle-age spread.
I was playing two hours of basketball full court twice a week plus a half
marathon once a week; so I was running too much distance for a 50 year old and
I also decided to bulk up a little bit to be able to bump people around on the
basketball court. It was after one of those events, one of those two hour
activities that I remember thinking about it and praying and saying “You know what? If I get too fat and start having some heart attack stroke risk maybe I
can start sharing some of this with the other folks that are gray Panthers or
folks that are beginning to become gray Panthers.” I still expected though, during
– after getting my first CIMT, to do a victory lap because, again I was not eating unhealthy food, again, plant-based; although, significant
carbs. That was in February of 2015. I was 57 years old and I had an arterial age
of 73. At that point – and I also had some plaque
by the way. At that point I just – it motivated me. Here was the representation of that plaque – 1.49 millimeters heterogeneous plaque in the right common carotid. I bit the bullet despite being very anti medications, especially on the
statins topic. I decided to go ahead and start statins a couple of years earlier.
I had developed high blood pressure, went on – I’ve been on Losartan for a
couple of years that’s an ARB; switched from the ARB to an ACE inhibitor
Ramipril and started statins. I bumped around from simbastatin, pravastatin – and then as the price continued to drop on Crestor, I went to rosuvastatin or
crestor. Now, over the – I got very deep. I started a more of a concierge practice
and started doing more of these CIMTs. I was gettintg them – I was able to get them
done every month because they’d come in to be done for my patients and I’d say
“Hey, while I’m here, let me hop up on the table.” I saw a very interesting and very
nice pattern – linear pattern of a drop. You can see that pattern here in the
Nomagrams. In October of 2015, just what? eight months later, I had dropped, wh-? 14
years? From 73 year old arteries to 59 year old arteries. In another, October to
September of ’16, another 11 months, I dropped seven more years.
These are Noma grams down here. These are basically, how those numbers of years are
calculated – the arterial age is calculated. You see, there’s population
norms for intima-media thickness testing,
starting as early as age five. The pink line is women and the blue line is men.
Men tend to lay down a little bit more oxidized LDL inside the artery walls. if
you don’t understand IMT (intima-media thickness test) or LDL
or oxidized LDL, that’s probably – that’s – that would be too much of a digression
for this video. So when I did that video, it was – at one point, my “giving my devil
his due” meaning actually admitting that – Yes, lifestyle is very important but – especially when for the first few years
that you start statins, they can be very impactful as well. Initially, if you go in
and you look at the – the statistics, statins can’t do – have a pattern of
decreasing plaque during those – especially those first couple of years
when plaque has just been laid down. Recently, now – let’s fast-forward to
another couple of years – April 2018 so actually that was what? I know there are six months after Sept – No, actually, what? 16 months after September 2016, I was continuing to do these CIMTs because of the practice at that
point but I just did not save any of my values. I did an event at the Kois Center
in April of 2018, with my friend Doug Thompson. By that point, I had started
– actually, at that point, I was starting to work full-time in the Medicare Advantage
space. It’s the – it’s very exciting for me because it’s – it’s an area where Medicare
is actually beginning to adopt preventive techniques so I became chief
science officer for a group of Docs, about 700 – 800 Docs who
are focused on prevention in the Medicare world. If you think Medicare
Advantage is for poor populations, it’s cheap – it doesn’t
give you a selection. You need to be thinking – again, all of the other
insurance types – private insurance, Medicaid, all – all of them – of the major
insurance groups are headed much more in that Medicare Advantage route and you
shouldn’t – you shouldn’t see that as a bad thing. Anyway, that’s a digression,
I’ll stop that. Let’s go back to my own scan results and what happened with me
and my scan and my plaque. Now, this one is 28. I still had maintained my weight. I
had not started into that full time travel and weight gain, so I was still
like 155; still about the same. A right common carotid plaque in the – or a plaque in the right common carotid artery. Plaque, for these terms – Discrete plaque
is labeled as anything over 1.3 millimeters. So you see I have several
other numbers in here: Right common carotid artery – 0.8, left common
carotid artery – 1.0, but they don’t have a letter next to them. The reason they
don’t have the letter is that, again, it’s not 1.3 millimeters or higher. Where did
we get that number? Again, from the research. If you go through the research,
the – it’s those discreet plaques that are 1.3 millimeters or Peaks that are 1.3
millimeters or higher, that contribute to your overall cardiac event risk –
Cardiac and stroke event risk. Now, so heterogeneous, the – that’s the next
question. There’s no question, as you watch the progression of these things.
Soft – you can see them and that’s the soft inflamed hot plaque; echogenic is
the calcified plaque and, despite what you may hear about calcification
in arteries, calcification, overall, is a marker that this plaque process has
been going on and you’ve been going through the cycles of laying – of getting
inflamed, laying down soft plaque, and then
stabilizing it and maybe going – getting inflamed again; softening that plaque
again; but there’s no question, echogenic plaque is stable and that’s what you
want to have. Now, what is heterogeneous or H – it’s in between the two. So, if you
look at my discrete plaque peak values, that’s what they – where they are in at
the Kois Center in April of 2018. Now, in comes working for full-time in
that Medicare Advantage environment, traveling every week, and I gained 10
pounds. I went from 155 up to 165 and I – I had an increase in my arterial age. It
went from – this is March 2019 at the healthy life summit in Orlando, and I
went from an arterial age of 52 – 53 up to 58, so that’s an increase of five years. I
didn’t go back to the 73 year-old number that I had back five years ago, but I
have to watch my weight. If you look at the actual peak values – those discrete
plaque numbers, they really did not change that much. This was really a risk
that was driven more by common ar- common carotid artery mean or arterial
age. If you go back and you look at these discrete plaques, the right common
carotid artery still had a 0.8. The bulb still had a 1.6, it
was still heterogeneous. The internal carotid was still 1.1;
On the left common carotid was 0.9. It was .1 before – I mean 1.0 before; 1.0 –
1.1, again, not significant changes. If you look at total plaque burden or average
CCA max region, or mean max, those really did not change significantly. what
changed? My arterial age. Why did it change? You know, some of this – there’s, I have no question, some of this could have been variation from the – the technique of
the – the ultrasound tech – what we call the interrogation. Because I’ve done other
videos to show you how just a tiny a few degrees difference in the orientation of
the – of the ultrasound wand can result in significant changes, but that’s for
another video. These cardio risks were done by Todd Eldridge’s group, and Todd
does about the best job I’ve seen in the country on being able to filter out all
of that noise and give us reliable numbers. So I got focused on full-time
work, travel every week, eating too much, I gained 10 pounds and my arterial age
went up. I’ve lost most of that, I’m back to – have it back to about 155 again. We’ll
see over the next few months what the impact is on my CIMT and my arterial
age. If you’ve made it through this far, thank you again for your interests.

22 comments

  1. I just had a CIMT by Cardiorisk based on your suggestion. Results have not been interpreted yet by Cardiorisk. When questioned by the person doing the scan I was told that most likely my results will be consided fairly good because my arteries were thin and there was very minimal plaque. I was asked if I took statins. I don't. Nevertheless, this surprised me because I fall into the borderline between morbidly obese and super obese for about 10 years and am pushing 60 and have a HA1c about 5.5 and insulin done during glucose challenge after 2 hours of 30. My stress levels are extremely high too. I am being treated for mild sleep apnea, blood pressure has risen to 80/120, moderately elevated lipids.. I have been on a course of improved diet and exercise for a few months. Could that have helped in so little time? Also, what other heart problems can be associated with such high levels of obesity? Heart failure? Valve problems? Quick onset of diabetes? I am a caretaker and don't want to have to pass on the baton too early to other family members.

  2. I appreciate your proactive attitude toward heart disease! I am spreading the word about your youtubes and also the CIMT scan.

  3. Thanks for sharing this information and being so transparent. Your work will help to end the heart disease epidemic.

  4. The BMI always confuses me… how can the formula not contain specific body measurements ie waist/chest size? For example if 2 people have the exact height and weight but one has a 32” waist while another has a 52” waist and they have the same BMI and health determinations are made? Something is seriously wrong with that formula and I think it’s junk science.

  5. Thank you for sharing your personal CIMT results. I am scheduled for my first CIMT this Tuesday. You said you thought BMI (or relative fat index) and CIMT were apparently related (in your case) and noted how your CIMT varied most recently with a 10 pound weight gain. However, I am wondering, did your inflammation markers change during this time? If the inflammation worsened, it would make sense but if it didn't, then doesn't that imply a different mechanism for plaque deposition? Thank you very much.

  6. I just wonder if an eating protocol that focused on blood sugar rather than weight might be more helpful. So if you do put on weight, but BS/Insulin inflammation events are kept to a minimum there is less opportunity for plaque to be laid down? So if weight is put on it is less of an issue than if it were caused by carb consumption. Of course there is the issue of inflammation via lectin and gluten from plant foods that increases gut permeability and triggers immune response to the lectins/gluten, that also can mistake normal cells as well (I have extenseive idiopathic calcification to the pancreas and this may have been the cause). Many good reasons to go Keto or low carb with leafy greens – to keep plaque and inflammation under control… just my thinking on the matter. It is what I do. I think my last slice of bread was March 2018. I think in the last 6 months my highest blood sugar reading after a meal was around 6.4

  7. Thank you, Dr.Brewer for another excellent video. My goal this summer is to drop 10-15 lbs but when I do I may need to jump around the shower to get wet. What range of fasting blood sugar do you have your patients shoot for?

  8. I fixed my blood sugar by fasting for 16 hours and eating 8….the best way because its the easiest…you just dont eat..dont eat till i get home so got rid of eating on the go…also lost 20 lb in 1 month…i recommend it

  9. Dr. Brewer, would you consider a video on CT Angiography?

    I had a carotid CIMT scan done and a calcium score of 50, and thought I was in excellent shape.

    But I went ahead and spent $400.00 on a CT Angiography scan and it found 50% blockage of my LAD, and a new calcium score of 598 which came as a real shock since my Carorid/Brachial artery CIMT came back so good.

    I consider it the best $400.00 I have spent to really know how the heart is doing from a stenosis, flow (LVEF), and heart chamber perspective.

    I have the images and radiologist report if you want a copy for a future video.

  10. I wish we could standardize CIMT measurements. My reports look nothing like yours. My reports are far less comprehensive than yours. I get an "age" and a really basic description, but overall it's not terribly useful.

  11. Plaque is LDL that became oxidized because it was present in the arteries for too long, because HDL could not remove it since there was too much other LDL to be removed???

  12. Fascinating. So I wonder, as a lean man of 155-160 pounds, a gain of simply ten pounds had a substantial impact on your Arterial health, one shudders to wonder about the typical American man at 198 pounds and 5 ft 9, based on the CDC's latest stats for mean age adjusted data (BMI of almost 29.1 now avg) – if he is carrying 40 pounds above the healthy middle of BMI spectrum (say, BMI 22-ish), perhaps his arteries are a couple or more decades older than his chronological age? Taking the average heights and weights of insured businessmen from the 1896-1914 Medico-Actuarial mortality investigations, guys back then were averaging a mean height of about 5 ft 8, and 157 pounds fully clothed in their mid life (around age 35-40s), approx. a BMI of 23.5 to 24. Imagine, men have gained 5 BMI points, or approx. 35 pounds, if we adjust for stature increase, in a century of America.

  13. around 4:40 you said signficant carbs. what, please, were the foods and how many / what percent of carbs?

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