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 looks like.

📚 STUDY DISCUSSED
Soto-Mota A, Norwitz NG, Manubolu VS, Kinninger A, Wood TR, Earls J, Feldman D, Budoff M. Longitudinal Data From the KETO-CTA Study: Plaque Predicts Plaque, ApoB Does Not. JACC Adv. 2025;4(7):101686. PMID: 40192608. https://pubmed.ncbi.nlm.nih.gov/40192608/ (Retracted Publication)

Expression of Concern: "Plaque Begets Plaque. ApoB Does Not: Longitudinal Data from The KETO-CTA Trial" [JACC: Advances, Volume 4, Issue 7, July 2025, Article 101686]. JACC Adv. 2026;5(3):102607. PMID: 41906601. https://pubmed.ncbi.nlm.nih.gov/41906601/

▶️ WATCH NEXT
Is Ezetimibe the Secret to Preventing Dementia? Surgeon Reacts to @nicknorwitzMDPhD: https://youtu.be/Rzz2g9gRL_8
Is Lower LDL Actually Better? New Research Has an Answer: https://youtu.be/Q2lvd9ND7rA

⚕️ DISCLAIMER
This channel is for education, not medical advice. I'm a board-certified vascular surgeon, but I'm not your surgeon, and nothing here replaces a conversation with your own physician.Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
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Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

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 Health trials add to the picture: LDL-C did rise over two years, but it was driven by a shift toward larger, less atherogenic particles, and carotid imaging showed no progression of arterial disease.

Original video: https://youtu.be/CygSkDzDOHE

Studies referenced:
Bhanpuri et al., 2018, Cardiovascular Diabetology — PMID 29712560 — https://pubmed.ncbi.nlm.nih.gov/29712560/
Athinarayanan et al., 2020, Cardiovascular Diabetology — PMID 33292205 — https://pubmed.ncbi.nlm.nih.gov/33292205/

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
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Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
Intake Breathing Nasal Support: https://amzn.to/48dfQQ1
Personal Blender: https://amzn.to/4pyNGGl
True Nutrition Protein: https://oken.do/q2xzqeqw
Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

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 Viagra and Cialis Impact Mortality?
09:54 - Study Funding and Conflicts of Interest
10:51 - How PDE5 Inhibitors Actually Work
12:53 - Observational Studies vs. Clinical Trials
14:41 - Understanding the Dataset (TriNetX)
16:41 - How Patient Cohorts are Defined
19:54 - Comparing Cialis vs. Viagra for Heart Benefits
21:26 - Why Prostate Health Matters in This Research
24:21 - Breaking Down the Five Key Outcomes
26:30 - Statistical Matching: Making the Groups Fair
30:03 - The Results: Mortality, Stroke, and Dementia Risk
33:57 - Absolute vs. Relative Risk Reduction
37:29 - Tadalafil’s Half-Life Advantage
39:18 - Crossing the Blood-Brain Barrier
41:04 - Study Limitations: What We Might Have Missed
42:24 - The "Partnership" Factor in Longevity Data 43:32 - Final Thoughts: Is it Time for a Label Change?

In this session, I'm diving into your questions from our last AMA and taking a deep look at a fascinating new study on PDE5 inhibitors like Cialis (tadalafil) and Viagra (sildenafil). We explore whether these medications could have a role in longevity, heart health, and even dementia prevention. I also address questions on fibromyalgia, stopping statins, and the latest on testosterone and cardiovascular risk.

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
WaterPik: https://amzn.to/4894Xi8
Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d
Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
Intake Breathing Nasal Support: https://amzn.to/48dfQQ1
Personal Blender: https://amzn.to/4pyNGGl
True Nutrition Protein: https://oken.do/q2xzqeqw
Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

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 don't know yet." If you want the short version of how I think about metabolic and vascular risk, this is a good place to start. Grab a coffee, skip around with the chapters, and take what's useful for you.

⏱️ CHAPTERS
0:00 Welcome, and how these AMAs work
0:33 Shockwave therapy for ED, and how it grows new blood vessels
3:05 Can an ultrasound tech get CIMT-qualified? Why CardioRisk controls quality
6:52 Aspirin after a stent: how long, and who actually needs it
11:04 Small vessel disease and brain bleeds: the stroke signs to watch
13:01 Nattokinase, lumbrokinase, serrapeptase: do the enzymes work?
16:20 The genetic lottery: 45 years of partying and still standing
18:15 How long does a statin take to work? (and the clotting angle)
21:02 How often should you really see your preventive cardiologist?
25:23 Soft plaque, leg cramps, and the statin-intolerance playbook
29:52 Age 73: when can I stop my statin, aspirin, and lisinopril?
33:47 Supplements worth the money: magnesium, creatine, D3/K2, fish oil
40:05 Why all the statin hate? Relative vs. absolute risk, and trust
45:15 Lp(a): who should test, and why it matters for your family
49:48 Will Lp(a)-lowering drugs be covered for prevention?
53:36 Thyroid and heart health: why I check free T3 and free T4
55:26 Sleep, sleep apnea, and metabolic health
57:32 Walking after meals: GLUT4, meal timing, and insulin resistance
1:06:50 Testosterone and heart disease, for men and for women
1:10:51 What sleep apnea physically does to your arteries
1:13:31 The real problem with long-term PPIs
1:16:52 Is a carotid ultrasound worth it? It depends who reads it
1:19:35 Is plaque stabilization real science, or a gamble?
1:23:12 Nitric oxide lozenges, ADMA, and the oral microbiome
1:30:44 Building a lab panel: the tests I want, and how I read them
1:35:31 Microalbumin (UACR): the underused early-warning test
1:41:50 Why there's no one perfect diet (and why nutrition science is so hard)
1:53:25 Retatrutide, peptides, and the "just buy it online" problem
1:59:35 CAC vs. CIMT vs. CCTA: which imaging should you get?
2:14:18 CAC of 8 at 47, LDL 110: do you need a statin?
2:15:32 Wrap-up, and where to find me

📚 STUDIES & TERMS REFERENCED
JUPITER (rosuvastatin lowers events via hsCRP): Ridker PM, Danielson E, Fonseca FAH, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359(21):2195-2207. PMID: 18997196. https://pubmed.ncbi.nlm.nih.gov/18997196/

Multivitamin and cognition (COSMOS-Mind): Baker LD, Manson JE, Rapp SR, et al. Effects of cocoa extract and a multivitamin on cognitive function: a randomized clinical trial. Alzheimers Dement. 2023;19(4):1308-1319. PMID: 36102337. https://pubmed.ncbi.nlm.nih.gov/36102337/

▶️ WATCH NEXT
AMA #2 — Why a "Perfect" LDL Won't Save You: https://youtu.be/v2Pa7UUTLO8
AMA #1 — Lp(a), Microplastics, Testosterone & CAC: https://youtu.be/r1p-LpCruHc
Try THIS Instead of Nattokinase (the enzyme deep dive): https://youtu.be/yA26H0_7-_U
My video on statins and the brain: https://youtu.be/pgfNT7o08_g

⚕️ DISCLAIMER
This channel is for education, not medical advice. I'm a board-certified vascular surgeon, but I'm not your surgeon, and nothing here replaces a conversation with your own physician. Supplements and medications carry real risks, including bleeding. Talk to your doctor before starting, stopping, or changing anything — especially statins, aspirin, or any supplement if you take blood thinners or antiplatelet medication.

💬 If you got something out of this, subscribe and share it with a friend. Every new viewer helps our small channel grow one curious mind at a time.

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

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 Care

In this video, I dive into the "spicy" comments from my recent keto reaction video to address the complexities of heart health, the reality of the scientific replication crisis, and the nuances of personalized medicine. We discuss why a major keto study was retracted, how to think about cholesterol absorption vs. production, and why "testing, not guessing" is the only way to truly understand your own cardiovascular risk.

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
WaterPik: https://amzn.to/4894Xi8
Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d
Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
Intake Breathing Nasal Support: https://amzn.to/48dfQQ1
Personal Blender: https://amzn.to/4pyNGGl
True Nutrition Protein: https://oken.do/q2xzqeqw
Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

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 randomized trial testing lumbrokinase for secondary stroke prevention. I go through the design, the parts that gave me pause, and the plaque and IMT findings that genuinely caught my attention. My take, for what it's worth with the evidence we have: if you're going to hang your hat on an enzyme, lumbrokinase looks like the safer bet. Watch and decide for yourself.

⏱️ CHAPTERS
0:00 Why I'm answering your nattokinase comments
0:25 Natto the food vs. nattokinase the supplement
1:54 Is nattokinase the same as vitamin K2?
2:46 Do I trust CIMT? Plaque vs. IMT, explained
3:59 The "n=1" critique, Susan, and Dr. Brewer
6:01 The dosing fight: 2,000 vs. 10,800 FU
7:58 Lumbrokinase and serrapeptase: what they actually are
10:22 The 2013 lumbrokinase stroke trial: setup
13:09 Where the trial design gives me pause
15:46 Results: the patients and the open-label problem
17:26 Baseline data and the missing standard meds
20:20 Lab results: fibrinogen, CRP, D-dimer, tPA
22:29 The interesting part: plaque and IMT changes
24:57 Stroke scores, outcomes, and the low event count
27:52 How lumbrokinase differs from nattokinase (and why it's likely safer)
30:15 Bottom line: should you take it?

📚 STUDY DISCUSSED
Cao YJ, Zhang X, Wang WH, et al. Oral fibrinogen-depleting agent lumbrokinase for secondary ischemic stroke prevention: results from a multicenter, randomized, parallel-group and controlled clinical trial. Chin Med J (Engl). 2013;126(21):4060-4065. PMID: 24229674. https://pubmed.ncbi.nlm.nih.gov/24229674/

▶️ WATCH NEXT
"I Stopped Using Nattokinase. Here's Why.": https://youtu.be/vpenJQ3UJh0
The VitaK-CAC study: https://youtu.be/ArxAXtzsue4
Vit K Comments & Questions: https://youtu.be/uORGxMsedic

⚕️ DISCLAIMER
This channel is for education, not medical advice. I'm a board-certified vascular surgeon, but I'm not your surgeon, and nothing here replaces a conversation with your own physician. Supplements carry real risks, including bleeding. Talk to your doctor before starting, stopping, or changing anything — especially if you take blood thinners or antiplatelet medication.

💬 Found this useful? Subscribe, and drop your lumbrokinase questions in the comments. We'll get to as many as we can next time.

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
WaterPik: https://amzn.to/4894Xi8
Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d
Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
Intake Breathing Nasal Support: https://amzn.to/48dfQQ1
Personal Blender: https://amzn.to/4pyNGGl
True Nutrition Protein: https://oken.do/q2xzqeqw
Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

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/ArxAXtzsue4

We’ll cover:
* Whether vitamin K2 toxicity is possible
* Whether using MK7 to slow coronary artery calcification is desirable
* What we know — and do not know — about upper dosing limits
* Who should be especially cautious with vitamin K supplements
* Why warfarin/Coumadin changes the conversation
* Whether vitamin K2 levels can be tested
* The difference between MK-4 and MK-7
* Whether vitamin K2 can “remove” calcium from arteries
* How I think about vitamin K2 in real-world cardiovascular prevention

The bottom line: vitamin K2 looks promising, but “promising” is not the same thing as “take as much as possible and hope your arteries applaud.”

This video is for education only and is not personal medical advice. Do not start, stop, or change supplements or medications based on YouTube — especially if you take warfarin or another medication affected by vitamin K. Talk with your own clinician.

⏰ Chapters
0:00 - More of your vitamin K2 questions
0:22 - Is softer plaque more dangerous than calcified plaque?
2:35 - Should people with high CAC avoid vitamin D3?
4:13 - Didn’t the AVADEC trial already show K2 works?
6:25 - Would a higher dose of K2 work better?
7:33 - Does K2 actively stop calcium from entering plaque?
8:28 - Can too much vitamin K2 cause blood clots?
8:55 - Vitamin K2 and warfarin/Coumadin
9:48 - Is K2 safe with Eliquis or Xarelto?
10:23 - Is 100 mcg enough—or should you take more?
11:16 - Can vitamin K2 remove calcium from arteries?
11:53 - Can you test for vitamin K deficiency?
12:37 - MK-4 vs MK-7: which form is better?
13:25 - Food sources vs K2 supplements
14:33 - Should K2 be taken with vitamin D3?
14:58 - Final takeaways

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Sign up for more information on my own practice here: https://corsighthealth.com/

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
WaterPik: https://amzn.to/4894Xi8
Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d
Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
Intake Breathing Nasal Support: https://amzn.to/48dfQQ1
Personal Blender: https://amzn.to/4pyNGGl
True Nutrition Protein: https://oken.do/q2xzqeqw
Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota