Building Lifelong Athletes

We’re diving into the weeds of the Lipid Energy Model and the viral 'Oreo Experiment.'  How do we make sense of Lean Mass Hyper Responders whose LDL skyrockets on keto? I’ll break down the physiology, the mainstream counterarguments, and what this actually means. Stop stressing over every health detail & start living! My FREE 'Necessary Nine' PDF cuts through the noise, giving you the essential things you need for a healthy life. ➡️ Download Here: https://www.jrennickemd.com/necessaryninepdf CHAPTERS:00:00 - Intro01:08 - The Lean Mass Hyper Responder Phenotype02:51 - The Lipid Energy Model Explained06:06 - The Oreo Cookie Experiment08:00 - Mainstream Lipidology Counterclaims10:27 - VLDL Production vs. Receptor Clearance12:22 - Confounders: Insulin, Ketones, and T316:24 - How to Resolve the Debate17:12 - Key Takeaways & Clinical Dilemmas18:16 - Final Thoughts for the Trenches SELECTED REFERENCES:10.1093/cdn/nzab14410.3390/metabo1205046010.3390/metabo1401007310.1016/j.jacadv.2026.10282410.1016/j.jacadv.2024.10110910.1097/MED.0000000000000762 *Disclaimer* This podcast is for entertainment, education, and informational purposes only. The topics discussed should not solely be used to diagnose, treat , or prevent any condition. The information presented here was created with an evidence based approach, but you please keep in mind that science is always changing and at the time of listening to this there may some new data that makes this information incomplete or inaccurate. Always seek the advice of your personal physician or qualified health care provider for questions regarding any medical condition.

Is heart disease driven by circulating ApoB particles, or is it inflammation or insulin reisstance? In this video, I break down the vascular biology of atherosclerosis from endothelial transcytosis and matrix retention to insulin resistance and inflammation. Let's move past the online tribalism and look at what the science actually shows about how plaque begins. Stop stressing over every health detail & start living! My FREE 'Necessary Nine' PDF cuts through the noise, giving you the essential things you need for a healthy life. ➡️ Download Here: https://www.jrennickemd.com/necessaryninepdf CHAPTERS:00:00 - Intro01:08 - Artery Anatomy: The Intima & Subendothelium02:05 - The Endothelial Glycocalyx03:13 - Passive Leak vs. Active Transcytosis04:28 - Particle Entry vs. Particle Retention05:16 - What Plaque Pathology Actually Shows06:11 - Steel-Manning Camp A: The ApoB Hypothesis07:50 - The Mutated ApoB Mouse Experiment08:44 - The Lipoprotein Lipase Plot Twist10:06 - LDL Particle Count vs. Particle Size11:22 - Why Are Veins and Internal Mammary Arteries Protected?13:17 - Steel-Manning Camp B: The Inflammatory Model14:31 - Insulin Resistance & Artery Wall Changes15:32 - Endothelial Insulin Signaling & The IRIS Trial17:40 - The Artery Wall Matrix: How Retention Happens19:12 - Can Native LDL Form Foam Cells?21:12 - The Seed and Soil Model of Atherosclerosis22:48 - Clinical Reality vs. Internet Dogma24:41 - The Collision of Particle, Wall, and Time SELECTED REFERENCES:10.1093/eurheartj/ehz962 (Borén 2020, EAS consensus statement)10.1161/CIRCULATIONAHA.106.676890 (Tabas 2007, response-to-retention update)10.1161/ATVBAHA.106.134080 (Nakashima 2007, early human lesions)10.2337/diabetes.55.02.06.db05-1103 (Nieuwdorp 2006, hyperglycemia and glycocalyx)10.1093/cvr/cvv218 (Armstrong 2015, LDL transcytosis)10.1056/NEJMoa054013 (Cohen 2006, PCSK9 variants)10.1093/eurheartj/ehx144 (Ference 2017, EAS genetic and trial evidence)10.1038/nature00804 (Skålén 2002, mutated ApoB mice)10.1161/CIRCRESAHA.107.149666 (Gustafsson 2007, lipoprotein lipase follow-up)https://pubmed.ncbi.nlm.nih.gov/40289348/ (Morze 2025, UK Biobank particle count vs. size)10.1161/ATVBAHA.121.316256 (Kraler 2021, internal mammary artery resistance)10.1056/NEJMoa1707914 (Ridker 2017, CANTOS)10.1056/NEJMoa2021372 (Nidorf 2020, LoDoCo2)10.1016/j.cmet.2010.03.013 (Rask-Madsen 2010, endothelial insulin receptor knockout)10.2337/diabetes.52.2.453 (Garvey 2003, insulin resistance and LDL particle number)10.1056/NEJMoa1506930 (Kernan 2016, IRIS)https://pubmed.ncbi.nlm.nih.gov/28550710/ (Hagensen 2017, diabetes and LDL retention in mice)https://pubmed.ncbi.nlm.nih.gov/15533943/ (Kruth 2005, macropinocytosis of native LDL)https://pubmed.ncbi.nlm.nih.gov/16606620/ (Zhao 2006, receptor-independent LDL uptake by human macrophages)https://pubmed.ncbi.nlm.nih.gov/36130017/ (Lin 2022, fluid-phase macropinocytosis and atherosclerosis)https://pubmed.ncbi.nlm.nih.gov/24481950/ (Allahverdian 2014, smooth muscle–derived foam cells in human plaque) *Disclaimer* This podcast is for entertainment, education, and informational purposes only. The topics discussed should not solely be used to diagnose, treat , or prevent any condition. The information presented here was created with an evidence based approach, but you please keep in mind that science is always changing and at the time of listening to this there may some new data that makes this information incomplete or inaccurate. Always seek the advice of your personal physician or qualified health care provider for questions regarding any medical condition.

In this episode, we explore the cholesterol counterculture and the evidence behind non-traditional lipidology. From the collapse of trust in dietary guidelines to the Lipid Energy Model, Lean Mass Hyper-Responders, and the Keto-CTA study, we examine whether sky-high LDL carries the same vascular risk in a metabolically healthy body.Stop stressing over every health detail & start living! My FREE 'Necessary Nine' PDF cuts through the noise, giving you the essential things you need for a healthy life.  ➡️ Download Here: https://www.jrennickemd.com/necessaryninepdfCHAPTERS:00:00 - Intro00:42 - The Collapse of Trust in Dietary Guidelines01:33 - Rediscovered Data: Sydney & Minnesota Diet Heart Studies02:41 - LDL Cholesterol and Mortality in Older Adults03:47 - The Thrombogenic Model of Atherosclerosis04:42 - Metabolic Context & The CAC Score Zero Paradox05:56 - The Low-Carb Keto Surge & Skyrocketing LDL07:26 - The Lean Mass Hyper-Responder (LMHR) Phenotype08:46 - The Lipid Energy Model & The Oreo Cookie Experiment10:56 - The Keto-CTA Study: High LDL vs Plaque Burden12:52 - Individualizing Risk & The N=1 ApproachSELECTED REFERENCES:Ramsden et al. (2016): https://doi.org/10.1136/bmj.i1246Ravnskov et al. (2016): https://doi.org/10.1136/bmjopen-2015-010401Mortensen et al. (2022): https://doi.org/10.1001/jamanetworkopen.2021.48139Feldman, Norowitz, Soto-Mota et al. (2022): https://doi.org/10.3390/metabo12050460Norowitz et al. (2024): https://doi.org/10.3390/metabo14010073Budoff, Norowitz et al. (2024): https://doi.org/10.1016/j.jacadv.2024.101109*Disclaimer* This podcast is for entertainment, education, and informational purposes only. The topics discussed should not solely be used to diagnose, treat , or prevent any condition. The information presented here was created with an evidence based approach, but you please keep in mind that science is always changing and at the time of listening to this there may some new data that makes this information incomplete or inaccurate. Always seek the advice of your personal physician or qualified health care provider for questions regarding any medical condition.

In this episode, I try to cut through the noise of the cholesterol debate and walk through 150 years of vascular science. From ancient mummies to modern genetics, we examine how lipidology reached its consensus, the response-to-retention hypothesis, why ApoB particle count matters more than LDL cholesterol mass, and what landmark clinical trials reveal about cardiovascular risk.Stop stressing over every health detail & start living! My FREE 'Necessary Nine' PDF cuts through the noise, giving you the essential things you need for a healthy life. ➡️ Download Here: https://www.jrennickemd.com/necessaryninepdfCHAPTERS:00:31 - The Ideological War in Lipidology01:30 - Is Heart Disease a Modern Industrial Illness?03:39 - The History of Atherosclerosis04:31 - Early Rabbit Experiments & The Discovery of Foam Cells06:13 - Post-War Heart Epidemic & The Framingham Study07:53 - Disproving the Threshold Theory: MRFIT & Observational Data09:18 - The Response-to-Retention Hypothesis Explained12:30 - Mendelian Randomization: Nature's Lifelong Clinical Trial16:04 - ApoB vs. LDL-C: Counting Particles vs. Cargo17:18 - Statin & Non-Statin Randomized Controlled Trials20:30 - The Scientific Consensus on ApoB and Cardiovascular RiskSELECTED REFERENCES:Thompson et al. (2013): https://doi.org/10.1016/S0140-6736(13)60598-XKannel et al. (1961): https://doi.org/10.7326/0003-4819-55-1-33Stamler et al. (1986): https://doi.org/10.1001/jama.1986.03380200061022Williams & Tabas (1995): https://doi.org/10.1161/01.ATV.15.5.551Cohen et al. (2006): https://doi.org/10.1056/NEJMoa054013Voight et al. (2012): https://doi.org/10.1016/S0140-6736(12)60312-2Richardson et al. (2020): https://doi.org/10.1371/journal.pmed.1003062Scandinavian Simvastatin Survival Study Group (1994): https://doi.org/10.1016/S0140-6736(94)90566-5Cannon et al. (2015): https://doi.org/10.1056/NEJMoa1410489Sabatine et al. (2017): https://doi.org/10.1056/NEJMoa1615664 Schwartz et al. (2018): https://www.nejm.org/doi/full/10.1056/NEJMoa1801174Nissen et al. (2023): https://doi.org/10.1056/NEJMoa2215024*Disclaimer* This podcast is for entertainment, education, and informational purposes only. The topics discussed should not solely be used to diagnose, treat , or prevent any condition. The information presented here was created with an evidence based approach, but you please keep in mind that science is always changing and at the time of listening to this there may some new data that makes this information incomplete or inaccurate. Always seek the advice of your personal physician or qualified health care provider for questions regarding any medical condition.

Was Ancel Keys a visionary pioneer of preventive cardiology or the villain who triggered our metabolic health crisis? In this episode, I pull back the curtain on the real science, the controversial 1953 graph, hidden trial data, and sugar industry influence. We explore where Keys was decades ahead of his time, where his model failed, and what his legacy teaches us about navigating scientific dogma in clinical practice today.Stop stressing over every health detail & start living! My FREE 'Necessary Nine' PDF cuts through the noise, giving you the essential things you need for a healthy life.  ➡ Download Here: https://www.jrennickemd.com/necessaryninepdfCHAPTERS:00:00 - Intro00:35 - The Ancel Keys Debate01:14 - Wartime Physiology, K-Rations & Starvation02:34 - The Lipid Hypothesis & The Keys Equation04:04 - The 1953 6-Country Graph Controversy07:24 - The Seven Countries Study & Mediterranean Diet08:54 - Minnesota Coronary Experiment & Publication Bias10:10 - Sugar vs. Fat & Sugar Industry Influence11:37 - Trans Fats & The Flaw in the Fat Swap13:18 - Beyond Total Cholesterol: ApoB & Lipoproteins14:26 - Ancel Keys' Legacy & Lessons for Modern ScienceSELECTED REFERENCES:Seven Countries Study: Cardiovascular Disease in Seven Countries (Keys A, 1984): https://pubmed.ncbi.nlm.nih.gov/6739443/ Re-evaluation of the Traditional Diet-Heart Hypothesis: Minnesota Coronary Experiment (Ramsden et al., BMJ 2016): https://pubmed.ncbi.nlm.nih.gov/27071971/ Sugar Industry and Coronary Heart Disease Research: Historical Analysis (Kearns et al., JAMA Intern Med 2016): https://pubmed.ncbi.nlm.nih.gov/27617709/Disclaimer:This podcast is for entertainment, education, and informational purposes only. The topics discussed should not solely be used to diagnose, treat, or prevent any condition. The information presented here was created with an evidence based approach, but you please keep in mind that science is always changing and at the time of listening to this there may some new data that makes this information incomplete or inaccurate. Always seek the advice of your personal physician or qualified health care provider for questions regarding any medical condition.

In this episode, I break down the underlying science of cholesterol, lipoproteins, and heart disease. We'll cut through the online noise and examine how cholesterol actually moves through your bloodstream, why particle count (ApoB) matters more than total cholesterol weight, how statins and other medications work at the cellular level, and how plaque forms in atherosclerosis. Everything you need to understand lipidology 101. Stop stressing over every health detail & start living! My FREE 'Necessary Nine' PDF cuts through the noise, giving you the essential things you need for a healthy life. ➡️ Download Here: https://www.jrennickemd.com/necessaryninepdf CHAPTERS:00:00 - Intro00:42 - What Is Cholesterol & Where Does It Come From?01:25 - How Cholesterol Moves: The River Analogy02:10 - Lipoprotein Structure Explained02:55 - The Main Lipoproteins: Chylomicrons to HDL04:20 - Apolipoproteins: ApoA vs. ApoB05:35 - Why ApoB Is a Better Test Than LDL-C06:40 - APOC2, APOC3, and APOE Mechanics07:45 - Cellular Cholesterol Regulation & How Meds Work09:10 - The Real Science of Atherosclerosis & Plaque10:35 - LDL vs. ApoB Discordance11:50 - Lipoprotein(a): The Genetic Triple Threat13:00 - Conclusion Disclaimer:This podcast is for entertainment, education, and informational purposes only. The topics discussed should not solely be used to diagnose, treat , or prevent any condition. The information presented here was created with an evidence based approach, but you please keep in mind that science is always changing and at the time of listening to this there may some new data that makes this information incomplete or inaccurate. Always seek the advice of your personal physician or qualified health care provider for questions regarding any medical condition.

Welcome back to the trenches! In our final breakdown of the 2026 ACC/AHA lipid guidelines, we are unpacking the pharmacology toolbox. From statins and ezetimibe to PCSK9 inhibitors and the nuances of side effects like SAMS, I want to give you the practical, evidence-informed strategies we need for our patients. We are all just trying to navigate this together. Stop stressing over every health detail & start living! My FREE 'Necessary Nine' PDF cuts through the noise, giving you the essential things you need for a healthy life. ➡️ Download Here: https://www.jrennickemd.com/necessaryninepdf CHAPTERS:00:00 - Intro00:01:00 - Statin Mechanism of Action00:01:34 - Types of Statins and Intensities00:03:04 - Hydrophobic vs Hydrophilic Statins00:05:15 - Statins and Glycemic Control00:06:14 - Pleiotropic Effects of Statins00:07:12 - Statin Side Effects Overview00:08:36 - Ezetimibe as First-Line Add-On00:09:54 - Bempedoic Acid00:11:18 - PCSK9 Inhibitors00:13:16 - Inclisiran and siRNA Therapy00:14:26 - Bile Acid Sequestrants00:15:47 - The Rule of 6 and Combination Therapy00:17:16 - Statin-Associated Muscle Symptoms00:19:04 - CoQ10 Supplementation00:20:07 - Special Populations: Older Adults and Pregnancy00:21:20 - Liver Safety and Drug Interactions00:23:15 - Statins, Dementia, and Brain Fog00:24:23 - Statins and Diabetes Risk00:25:21 - Managing High Triglycerides00:27:06 - Conclusion and Summer Sabbatical SELECTED REFERENCES: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001423 *Disclaimer*This podcast is for entertainment, education, and informational purposes only.The topics discussed should not solely be used to diagnose, treat , or prevent any condition.The information presented here was created with an evidence based approach, but you please keep in mind that science is always changing and at the time of listening to this there may some new data that makes this information incomplete or inaccurate.Always seek the advice of your personal physician or qualified health care provider for questions regarding any medical condition.

In this episode, I'm breaking down sections 4.2.3 through 4.2.10 of the dense ACC/AHA dyslipidemia guidelines so you don't have to. We'll cut through the noise on the new PREVENT equations, risk enhancers, imaging, and algorithms for primary and secondary prevention. Let's get you equipped to handle these complex lipid management decisions in the clinic.Stop stressing over every health detail & start living! My FREE 'Necessary Nine' PDF cuts through the noise, giving you the essential things you need for a healthy life.➡️ Download Here: https://www.jrennickemd.com/necessaryninepdfCHAPTERS:00:00 - Intro00:25 - Individualized Risk-Benefit Discussions02:24 - The New PREVENT ASCVD Equations Explained04:29 - Understanding New Risk Thresholds05:32 - The Math Behind the 3% Treatment Threshold09:28 - Risk Enhancers and Personalizing Risk11:21 - Reproductive Age Risk Markers12:15 - Polygenic Risk Scores13:12 - Selective Imaging: CAC and Coronary CT15:16 - Treating Incidental Plaque15:58 - The Core Primary Prevention Algorithm19:26 - Severe Hypercholesterolemia (LDL > 190)21:58 - Diabetes and Lipid Management23:15 - Residual Risk and Omega-3s23:37 - Secondary Prevention Targets26:46 - Special Populations: Children and Young Adults28:04 - Older Adults and Deprescribing28:54 - Pregnancy and Lactation29:55 - HIV, CKD, and Inflammatory Diseases31:14 - Heart Failure and Cancer Survivors32:05 - Managing Hypertriglyceridemia 34:18 - Lipoprotein(a) as a Risk EnhancerSELECTED REFERENCES:https://www.ahajournals.org/doi/10.1161/CIR.0000000000001423*Disclaimer*This podcast is for entertainment, education, and informational purposes only.The topics discussed should not solely be used to diagnose, treat , or prevent any condition.The information presented here was created with an evidence based approach, but you please keep in mind that science is always changing and at the time of listening to this there may some new data that makes this information incomplete or inaccurate.Always seek the advice of your personal physician or qualified health care provider for questions regarding any medical condition.

In this video, we break down the 2026 guidelines for lipid-lowering lifestyle treatments. From the minimalist vs. optimizer diet approach to exercise dosing and managing supplements, let's equip you with actionable tools for the primary care trenches. Stop stressing over every health detail & start living! My FREE 'Necessary Nine' PDF cuts through the noise, giving you the essential things you need for a healthy life. ➡️ Download Here: https://www.jrennickemd.com/necessaryninepdf CHAPTERS:00:00 - Intro01:36 - The Strategy of Primordial Prevention02:45 - The Dietary Shift: Minimalist vs. Optimizer04:56 - Titrating for Elevated Triglycerides06:23 - Weight Loss and Sick Fat07:31 - Physical Activity as the 5th Vital Sign08:27 - The Truth About Dietary Supplements10:15 - When to Consult a Registered Dietitian10:48 - The Comprehensive Impact & Takeaways SELECTED REFERENCES:https://www.ahajournals.org/doi/10.1161/CIR.0000000000001423 *Disclaimer*This podcast is for entertainment, education, and informational purposes only. The topics discussed should not solely be used to diagnose, treat , or prevent any condition. The information presented here was created with an evidence based approach, but you please keep in mind that science is always changing and at the time of listening to this there may some new data that makes this information incomplete or inaccurate.Always seek the advice of your personal physician or qualified health care provider for questions regarding any medical condition.