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The Dr. Gabrielle Lyon Show

Your Doctor Is Watching the Wrong Number. LDL, ApoB & Heart Risk Explained. - Dr. Kevin Maki

5/26/20261 hr 25 min

Most people think the cholesterol number on their lab report tells them whether their heart is at risk. But former National Lipid Association President Dr. Kevin Maki explains that LDL is just one piece of a much bigger picture and focusing on it alone can mean missing the markers that matter most.

In this episode, Dr. Gabrielle Lyon sits down with Dr. Kevin Maki, former President of the National Lipid Association and co-editor-in-chief of the Journal of Clinical Lipidology, to discuss:

  • Why ApoB and Lp(a) are better predictors of heart risk than LDL and why only about 2% of people ever get Lp(a) tested
  • What a beef-vs-chicken feeding study revealed about red meat and cholesterol (the LDL results came back identical at 112 mg/dL)
  • The evidence behind the seed oil debate, including why higher linoleic acid levels tracked with lower inflammation markers across a 2,000-person dataset
  • Why the balance of cholesterol-raising and cholesterol-lowering foods matters more than saturated fat alone
  • The simple "ABCs" framework: A1c, blood pressure, cholesterol - for actually lowering long-term cardiovascular risk

By the end, you'll know which numbers actually predict heart risk, which tests to ask your doctor for, and how to cut through the conflicting noise around fat so you can make evidence-based decisions for the long haul.

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Chapters

00:00 - Introduction

00:31 - Dr. Kevin Maki and the National Lipid Association

01:04 - New dietary guidelines and the LDL confusion

02:04 - What raises and lowers LDL cholesterol

03:51 - Cholesterol levels from birth through puberty

05:11 - The lipid panel kids should get before age 11

06:42 - Lp(a): the test only 2% of people get

08:18 - ApoB and the three risky particle types

11:35 - Do we have evidence for "lower is better"?

14:09 - The FLASH-GLICK risk factor framework

17:10 - The 10% saturated fat guideline explained

19:36 - Many dietary patterns can be healthy

24:50 - Beef vs. chicken: identical LDL results

27:10 - The balance of fatty acids that matters

29:24 - Olive oil vs. corn oil feeding study

31:00 - Lower for longer: 40-year risk reduction

34:15 - Genetic cholesterol disorders and risk

40:33 - The omega-3 index and why it matters

49:10 - Are seed oils really driving inflammation?

53:11 - How seed oils are processed and refined

1:07:48 - Inherited beliefs and outdated nutrition science

1:08:54 - Butter vs. cheese and high-fat dairy surprises

1:14:48 - Exercise effects on HDL and triglycerides

1:21:20 - The ABCs of reducing cardiovascular risk

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Disclaimers: This episode includes paid sponsorships.

The Dr. Gabrielle Lyon Podcast and YouTube are for general information purposes only and do not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast, YouTube, or materials linked from this podcast or YouTube is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professional for any such conditions.

Clips

Healthy-user bias bombshell
Butter vs. Cheese Surprise
Only 2% Get Lp(a) Test
Exercise: 30-Minute Magic Pill
AI, Imaging & Job Growth

Transcript preview

First 90 seconds

  1. Kevin Maki· Guest0:00

    We call them the four white poisons: saturated fat, salt, added sugars, and refined starches. So these are the things that the American diet tends to be higher than might be optimal in.

  2. Gabrielle Lyon· Host0:11

    In light of the new dietary guidelines, I think that the 10% saturated fat becomes a challenge because 10% saturated fat, the reason typically people are saying to reduce that is because of its impact on LDL cholesterol.

  3. Kevin Maki· Guest0:25

    Saturated fat is one thing in the diet that influences LDL cholesterol. An elevated level of LDL cholesterol is one of the major risk factors for heart disease and cardiovascular disease in general, which includes strokes as well.

  4. Gabrielle Lyon· Host0:40

    Notably, if someone has LDL cholesterol above one thirty, we have to make the decision, is it genetic? Is it diet? We decide that we are going to really double down on this balance of fatty acid profiles.

  5. Kevin Maki· Guest0:56

    What is more important than saturated fat is the balance of cholesterol-raising and cholesterol-lowering factors in the diet.

  6. Gabrielle Lyon· Host1:05

    How do we-- and we say it's gonna lower it. Is it going to lower it in a clinically significant way?

  7. Kevin Maki· Guest1:15

    I think that you have a lot of difficulty because you can't statistically unravel all of these things. So I think the answer is

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