TLDR;
In this video, Dr. Ford Brewer discusses how he reversed 20 years of arterial plaque and provides evidence from a CT angiogram with AI analysis. He explains the importance of understanding plaque character rather than just the amount of plaque, focusing on soft plaque as the primary risk factor for heart attacks. He also shares his lifestyle changes, including diet and exercise, and touches on the role of sleep, stress management, and medications in maintaining cardiovascular health.
- Plaque character (soft vs. stable) is more critical than plaque quantity.
- Lifestyle changes, especially diet and exercise, are key to managing arterial plaque.
- Even with a diagnosis of diabetes, it's possible to maintain very little unstable plaque and reduce heart attack risk.
Introduction: Reversing Arterial Plaque [0:00]
Dr. Brewer shares his personal experience of reversing arterial plaque accumulation over 20 years, supported by a CT angiogram report. He highlights that stabilising arterial plaque is achievable, regardless of one's current health status. About 10 years prior, at age 57, a CIMT test indicated that his arteries resembled those of a 73-year-old. Through targeted lifestyle adjustments, he observed a consistent improvement in his arterial age, as confirmed by subsequent CIMT tests.
Understanding CIMT and Plaque [0:53]
Dr. Brewer explains the science behind CIMT (carotid intima-media thickness) and emphasises that plaque is a systemic metabolic issue rather than a localised anatomical one. To further investigate, he underwent a CT angiogram with AI analysis (Clearly Analysis) to assess the characteristics of his plaque. This advanced test provides detailed information about the consistency and nature of plaque, which is crucial for determining cardiovascular risk.
Analysing the Clearly Report: Atherosclerosis, Stenosis, and Dominance [1:55]
The Clearly report assesses three key aspects: atherosclerosis (plaque quantity), stenosis (arterial narrowing), and dominance (which artery supplies blood to the lower heart). Dr. Brewer acknowledges the presence of plaque in his arteries, which is common for his age (67). He has 75.6 cubic millimetres of plaque, but the most critical factor is the character of the plaque, categorised as low density non-calcified (soft), non-calcified, and calcified.
The Significance of Plaque Character: Soft, Calcified, and Non-Calcified [2:58]
Soft plaque, or low density non-calcified plaque, is the most dangerous type because it is inflamed and prone to causing clots that can lead to heart attacks or strokes. Calcified plaque, on the other hand, is stable and does not pose a significant risk. Non-calcified plaque is intermediate and can either stabilise or become unstable depending on lifestyle factors. Dr. Brewer's results show only 0.1 cubic millimetres of soft plaque, indicating a minimal risk of heart attack. He has 31 cubic millimetres of stable, calcified plaque and 44 cubic millimetres of non-calcified plaque, which is considered stable due to his lifestyle.
Stenosis: Understanding Arterial Narrowing [7:01]
Stenosis refers to the narrowing of arteries. Dr. Brewer clarifies that the degree of narrowing is less important than the character of the plaque. Most heart attacks occur in people with less than 50% blockage, highlighting the significance of soft plaque. His report indicates minimal soft plaque in areas of stenosis in his right coronary artery, left anterior descending (LAD), and circumflex arteries. The LAD, often called the "widowmaker," has a 17% narrowing, but overall, he is relieved and not worried due to the minimal presence of soft plaque.
Dominance and Overall Assessment [11:03]
Dominance refers to which artery supplies blood to the lower part of the heart; in Dr. Brewer's case, it's the right coronary artery. He emphasises that a CT angiogram is the definitive study for assessing plaque and cardiovascular risk because it reveals the character of the plaque. His percent atheroma volume is 2.5%, indicating a very low amount of plaque.
Diet: The Number One Change for Protecting Arteries [13:16]
Diet is the most critical factor in protecting arteries. It's essential to recognise and address metabolic disease by reducing carbohydrate intake if the body cannot process carbs effectively. This means avoiding processed foods, breakfast cereals, and grain products like bread, pasta, and rice. Dr. Brewer aims to keep his blood sugar below 140 and engages in gentle exercise to manage blood sugar spikes. He has shifted his calorie intake from carbs to healthy fats, consuming foods like eggs fried in butter, avocado, olive tapenade, fish (mackerel, anchovies, salmon, herring), poultry, and fermented foods like sauerkraut. He also uses non-sugar sweeteners in his ice cream.
Intermittent Fasting and Body Composition [18:57]
Intermittent fasting is another key lifestyle factor for decreasing insulin levels. Reducing the eating window to 12 hours or even 4 hours can significantly impact insulin response. Maintaining a healthy body composition, with body fat under 20% and visceral fat under two pounds, is also crucial. A DEXA body composition scan can help assess visceral fat levels.
Exercise: Resistance Training and HIIT [20:16]
Resistance training and high-intensity interval training (HIIT) are more effective than long slow distance exercise for improving mitochondrial function and muscle capillary penetration. Dr. Brewer focuses on leg exercises and incorporates short bursts of intense activity, such as hill sprints and rebounder workouts, along with resistance training using dumbbells and barbells. He also includes rehit (reduced exertion high-intensity interval work) sessions.
Sleep and Stress Management [28:03]
Improving sleep quality and managing stress are essential for cardiovascular health. Dr. Brewer addressed his sleep apnea by using Invisalign to improve his dental arch and by sleeping on his side. He also practices slow breathing techniques to increase carbon dioxide levels, stimulate the vagus nerve, and reduce stress.
Medications: Statins, Blood Pressure, Aspirin, and Metformin [31:10]
Dr. Brewer discusses his experience with medications, including low-dose statins (Crestor or Livalo), blood pressure medication (Losartan), baby aspirin, and metformin. He emphasises that aspirin is not recommended for primary prevention based on age alone but is appropriate for those with existing plaque. He takes metformin at a low dose (1 gram per day, three to four days a week) to manage his metabolic health.
Conclusion: It's Not Too Late [35:53]
Dr. Brewer summarises that his lifestyle changes have resulted in very little unstable plaque, despite being 67 years old and having a diagnosis of diabetes. He encourages viewers to take charge of their health by making lifestyle changes, reducing carbohydrate intake, and addressing metabolic health issues. He emphasises that it's never too late to make progress and improve cardiovascular health. He also clarifies that his level of obstruction (17% in the LAD) is typical for someone under 40, highlighting the significant difference between his results and what is normally expected for a 67-year-old male with diabetes.