---
title: 'The Real Cause of Heart Disease and How to Reverse It'
source: 'https://youtube.com/watch?v=34UaP9xd-nk'
video_id: '34UaP9xd-nk'
date: 2026-07-28
duration_sec: 672
channel: 'Nutrition Made Simple!'
---

# The Real Cause of Heart Disease and How to Reverse It

> Source: [The Real Cause of Heart Disease and How to Reverse It](https://youtube.com/watch?v=34UaP9xd-nk)

## Summary

This video challenges the common belief that high cholesterol is the primary cause of heart disease, explaining that the real issue lies in the number and type of lipoprotein particles that carry cholesterol. It provides evidence-based dietary strategies to reduce heart disease risk and even reverse plaque buildup.

### Key Points

- **Cholesterol Myth Introduction** [00:00] — High cholesterol is often blamed for heart disease, but many with high cholesterol never develop it, and many with normal cholesterol do. The real cause is the number of lipoproteins (vehicles) that carry cholesterol into artery walls.
- **Role of Lipoproteins** [01:03] — Cholesterol is carried by microscopic vehicles (lipoproteins). When too many of these vehicles circulate, they cross into artery walls and form plaque, even if cholesterol levels are normal.
- **Insulin Resistance and Remnants** [01:40] — Diet high in refined grains, sugars, and alcohol causes insulin resistance, increasing the largest lipoproteins called remnants. This elevates heart disease risk even with normal cholesterol.
- **Dietary Reversal Evidence** [02:21] — A randomized trial showed that limiting processed foods and favoring whole grains, fruits, and vegetables reduced artery wall thickness and plaque, demonstrating reversibility.
- **Triglycerides and HDL** [03:14] — In insulin resistance, triglycerides rise and HDL falls. High triglycerides are a red flag for excess remnant lipoproteins, even if cholesterol is normal.
- **Other Lipoprotein Sizes** [04:11] — Even lean individuals with normal triglycerides can have heart disease due to excess small lipoproteins, which are influenced by dietary fat types.
- **Healthy Fats Reduce Risk** [05:10] — A French trial replaced unhealthy fats with olive oil, fish, and canola, cutting heart disease death by over 70%.
- **ApoB Test** [05:37] — ApoB blood test measures the number of atherogenic lipoproteins. A free formula can estimate it without spending money.
- **Lp(a) Genetic Risk** [06:10] — Lp(a) is a genetically determined small lipoprotein that causes heart attacks in young people. One in five have high levels, with no current therapy to normalize it.
- **Inflammation Accelerates Disease** [07:12] — Generalized inflammation speeds up lipoprotein transport across artery walls. Foods rich in tocopherols, potassium, and catechins can reduce inflammation.
- **Blood Pressure Control** [09:12] — High blood pressure damages artery walls. The DASH diet, potassium salt, and foods like leafy greens and nuts help lower pressure and reduce soft plaque.
- **Genetics and Imaging** [10:21] — Individual genetics affect risk. Imaging (calcium score, CT angiogram) can assess actual plaque burden.

### Conclusion

Heart disease is driven by lipoprotein particle number, not just cholesterol. Dietary changes can reverse plaque and reduce risk, especially when combined with managing inflammation, blood pressure, and genetic factors like Lp(a).

## Transcript

If you ask 100 people what causes heart disease,  the number one answer will be high cholesterol.   The problem with that idea is that although it  contains a nugget of truth, for many people,  
it's deeply misleading. Because when we obsess  over cholesterol level, we risk missing the real   cause of heart disease and the consequence can be  lethal. So today we're talking about the real root  
cause of heart disease and how once you understand  it, you can not only prevent the condition but   even to some extent reverse it if you already have  it. First, where does this idea of the cholesterol  
come from? Well, the main type of heart disease  involves plaque in the artery walls and the   primary component of plaque is cholesterol. There  is no plaque without cholesterol in the artery  
wall. So that part is true. Also, in populations  with higher cholesterol level, we see more heart   disease. So that's also true. But many people have  high cholesterol and don't have heart disease and  
many have heart disease with normal cholesterol.  So how's that possible? Well, what almost never   gets explained is how the cholesterol ends up  inside the artery wall. Cholesterol is carried  
by microscopic vehicles that float around in  our bloodstream. And it's those vehicles that   carry it across the artery wall. When we have too  many of these vehicles in circulation, they cross  
into the artery wall more often. They get stuck in  there and plaque grows even if cholesterol level   is completely normal. So you see how the tunnel  vision on the level of cholesterol can be fatal  
because it misses this key distinction and this  mismatch with the actual number of vehicles. And   this mismatch where the cholesterol level is  normal but the number of vehicles is high is  
incredibly common. We're not splitting hairs  here. In some populations we see it in 70 to   75% of people. What causes this problem is our  diet. Refined grains, purified added sugars,  
soda, alcohol, junk food. These products cause  insulin resistance and type 2 diabetes. And they   cause the number of some of these vehicles, the  largest kind, we call them remnants, to go up,  
even if cholesterol level stays completely normal.  One randomized control trial had people limit   commercial bakery products and sweets and pastries  to once a week maximum and also favor whole grains  
like steel cut oats or wild rice over refined  grains. and also have fresh unprocessed fruits   and vegetables daily. Over time, they saw a  reduction in the thickness of the artery wall  
and the thickness of the plaque itself. This is a  very striking result because we normally don't see   this in Westerners unless they're on very powerful  medication. But it turns out we can actually turn  
back the clock. We can reverse the problem to  some extent by changing our diet. This is such   a powerful concept and yet a lot of doctors still  don't realize this is possible. I wasn't taught  
this in medical school. These large vehicles, the  remnants, carry some cholesterol, but what they   carry a lot of is triglycerides. So that's the  typical presentation in type 2 diabetes, obesity,  
insulin resistance. Cholesterol isn't that high.  It can even be perfectly in the normal range,   but triglycerides are high and HDL is usually low  because these vehicles will swap different types  
of fats between them. So high triglycerides  usually go hand in hand with low HDL. And   those individuals are at high risk of heart  disease even though triglycerides don't form  
plaque because our body is very good at  breaking them down and removing them from   the artery wall. The high triglycerides are  a red flag. They're an indicator. They point   the finger that there are too many of these  large vehicles that cause heart disease. Now,  
some people have no diabetes. They're lean.  They have normal triglycerides, normal HDL,   but they still have heart disease because you can  have a normal number of these large vehicles, but  
there are many other sizes in circulation as well.  And any of those are problematic if there's too   many of them. You can think of the large vehicles  as buses on the road and the smaller vehicles as   maybe Ubers on the road. And too many of either  kind will cause a traffic jam. These other sizes  
of vehicles are also determined by our diet,  mainly by the types of fats that we eat. Healthy   fats like extra virgin olive oil and other liquid  vegetable oils, avocados, walnuts and almonds,  
different seeds like chia seeds or sesame seeds  and some fermented dairy like unsweetened Greek   yogurt and fatty fish. The types of fats in these  foods help maintain these vehicles in the normal  
range. In a randomized control trial conducted  in France, people who had suffered a heart attack   previously were given a diet where the main types  of fat in the western diet were replaced with  
healthy fats like fish and olive oil or canola  and their risk of dying of heart disease was cut   by more than 70%. Okay, how can we tell how many  of these vehicles we have in circulation? There  
is a blood test that can give you that reading.  It's called ApoB. It's a measure of the number   of these vehicles that can cause heart disease,  but you can also estimate that with a formula   without spending any money. It's free and it works  pretty well. I'll put it down here. You can pause  
the video and write that down. We also have an  entire video going over that in detail and I'll   link that in the description. Now, some people  have normal cholesterol, normal triglycerides,   and even normal ApoB, and they still have  heart disease. So, what's going on there? Well,  
we need to talk about the nastiest type of these  vehicles, a small subcategory called Lp(a). And   this is another big piece of the puzzle because  one in five people have a high concentration of  
these vehicles. And it's genetically determined.  It runs in families. It runs in my family. And   often what we'll see is in a family where people  have heart attacks at a young age in their 30s,  
cholesterol isn't that high. And yet they have  these massive heart attacks at a young age and   they just drop dead. Often that comes down to  high Lp(a). Now, there's nothing currently that  
brings a high Lp(a) down to the normal range.  There are therapies being studied. Right now,   what we do is we try to control everything  else. All the other types of vehicles we   talked about and also some important factors  we'll talk about next. Generalized low-grade  
inflammation is like throwing fuel on a fire.  It speeds up heart disease. It's not necessary.   You can have heart disease without generalized  inflammation, with normal inflammatory markers,  
many people do, but it makes things a lot  worse. Inflammation promotes the transport   of the vehicles across the artery wall. People  often think that the wall creates cracks and  
that's how the vehicles get in. And that can  happen and that makes things worse, but it's   not necessary. Vehicles are transported across an  intact, normally functioning artery wall. It's a  
normal biological phenomenon. Normally that's not  a big problem if everything is working well. But   if that transport is sped up either because we  have an abnormal number of vehicles or because   we have this generalized inflammation then  it can become an issue, and we can control,  
we can shut down inflammation very powerfully  using our food as well. Foods rich in tocopherols,   which neutralize free radicals and help shut  down inflammation: chia seeds and almonds and  
cashews. Potassium is another important player.  It helps lower inflammatory markers in the blood.   So foods like sweet potatoes and lentils and  avocado and spinach and kefir which is a fermented  
milk with probiotic effects that supports our  microbiome and helps shut down inflammation.   And catechins which have an anti-inflammatory  action as well and are concentrated in matcha  
tea and cherries and dark chocolate and many kinds  of berries. And there's a natural supplement that   helps turn down inflammation called propolis. We  have a whole video going over that and I'll link  
that below as well. It's also extremely important  to treat underlying inflammatory conditions like   inflammatory bowel and some autoimmune conditions.  Those diseases put your body in an inflammatory  
state and they help accelerate heart disease.  Okay. Another crucial player is blood pressure   because high blood pressure damages the wall of  the arteries and accelerates heart disease. Foods  
that help control blood pressure include leafy  greens like Swiss chard and kale. They're very   high in magnesium and nitrates which help relax  your blood vessel wall. And almonds and Brazil  
nuts can help bring down blood pressure  as well. And legumes like beans, edamame,   and beets. A randomized controlled trial used  a DASH diet which is aimed at controlling blood  
pressure. And over time, they saw a reduction  in soft plaque, which is the vulnerable type of   plaque that bursts and can cause heart attacks and  strokes. And in another large randomized trial,  
switching just 25% of regular salt with potassium  salt, which is still salty, but helps bring down   blood pressure, effectively reduced strokes and  total deaths. Okay, what if you don't have high  
Lp(a) or generalized inflammation or blood  pressure or diabetes? Well, then your risk   is much lower. But you can still have heart  disease if there are too many of these vehicles   in circulation and if your individual genetics  allows them to get through the artery wall. This  
is why we can have two people with the exact same  blood work and one is clean as a whistle and the   other has massive disease. Genetics is always  a factor, just like some smokers never get lung   cancer. How can you know if you individually  are at risk or not? Well, one tool are imaging  
techniques like a calcium score or a CT angiogram  or a carotid ultrasound. There's one workout that   has been shown in scientific studies to  help shrink the plaque in the artery wall  
and we covered that in this previous video right  here. So check it out and I'll meet you in there