What if the sequence we've always assumed—plaque causes arterial stiffness—is actually backwards? Dr. Lily Johnston proposes that impaired nitric oxide signaling may stiffen arteries first, creating the endothelial injury that then promotes plaque formation.

Dr. Lily Johnston is a board-certified vascular surgeon and newly certified obesity medicine physician who bridges the operating room and metabolic medicine. After years of scraping plaque from arterial walls, she began questioning why surgical outcomes remain so modest—and discovered that what she was treating might represent the end stage of multiple distinct disease phenotypes, not a single condition.

In this episode, Dr. Johnston shares her forest fire analogy for understanding LDL risk, explains why tissue surrounding diseased arteries shows profound inflammation even in first-time surgeries, and reveals why 80–90% of the operations she performs could potentially be prevented with upstream metabolic intervention.

Questions Answered in This Episode:

• Do metabolically healthy people with elevated LDL need the same treatment as those with active disease?
• Why might someone with "great" biomarkers still have significant plaque burden?
• What will individualized cardiovascular treatment look like in 20 years?
• To what extent is vascular disease a metabolic disease—and is this accepted in vascular surgery?
• Where do you stand on the LDL particle number vs. metabolic context debate?
• What percentage of vascular surgeries could have been avoided with earlier metabolic intervention?

A surgeon's-eye view of what happens when metabolic dysfunction goes unaddressed for decades—and a practical framework for intervening before the fire starts.

Find more of Dr. Johnston online:

• Live Q&A
• Youtube channel
• LinkedIn
• Coresight Health

Special thanks to the sponsors of this episode:

✅ Genova Connect – Get 15% off any test kit with code METABOLICLINK here.

✅ Toups and Co – Get 15% off your first order with code METABOLIC here.

✅ Troscriptions – Get 10% off your first order with code METABOLICLINK here.

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In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!

You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel!

Find us on social:

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• YouTube
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Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

The term “ultra-processed food” appeared nearly 100 times in the White House’s Make America Healthy Again report. But questions remain about whether the concept is precise enough to guide effective policy.

Dr. David Ludwig—Harvard endocrinologist, obesity researcher, and author of Always Hungry—joins Dr. Dominic D'Agostino to dismantle the ultra-processed food framework from the inside out. Ludwig reveals why the NOVA classification system lumps protein bars with soda, why the FDA admitted they can't define what they're trying to regulate, and why the famous studies showing ultra-processed foods cause overeating may be fundamentally flawed.

This conversation cuts through the noise to identify what actually matters: the mechanistic difference between processing carbohydrates, fats, and proteins—and why that distinction should reshape nutrition policy.

Questions answered in this episode:

• Can ultra-processed foods be "fixed" through reformulation?
• What's the most overrated "healthy" food in supermarkets?
• Should omega-3 levels be part of standard blood work?
• Are GLP-1 drugs a metabolic reset or a lifelong crutch?
• If you could pass one food policy law, what would it be?
• Why did the low-fat diet era make obesity worse?

Dr. Ludwig argues that "ultra-processed food" is a compelling marketing term without mechanistic grounding—and that precise, actionable targets like highly processed carbohydrates and demonstrably harmful additives would do far more to improve public health.

Where to find more of Dr. Ludwig's work online:

• Blog on UPF
• NEJM paper on UPF
• Problems with short diet trials
• Carbohydrate-insulin model
• Website

Special thanks to the sponsors of this episode:

✅ Fatty15 – Get 15% off a 90-day Starter Kit with code METABOLICLINK here.
✅ Troscriptions – Get 10% off your first order with code METABOLICLINK here.
✅ iRestore - Get a huge discount on the iRestore Illumina Face Mask when you use the code METABOLICLINK here.
✅Genova Connect – Get 15% off any test kit with code METABOLICLINK here.

In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!

You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel!

Find us on social:

• Instagram
• Facebook
• YouTube
• LinkedIn

Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Glioblastoma has a long-term survival rate under 1% at ten years. After decades of research focusing primarily on mutation-targeted therapies, median survival has improved by only a few months. Dr. Tomás Duraj believes there's a better path forward.

Dr. Duraj is a physician-scientist at Boston College working on the metabolic vulnerabilities of cancer. In this Metabolic Health Summit presentation, he outlines a clinical framework for studying ketogenic metabolic therapy — one built on biomarker-driven protocols, not dietary guesswork.

The core argument: cancer cells depend on specific metabolic pathways for survival. Block those pathways while providing alternative fuels to healthy cells, and you create a therapeutic window that most tumors can't escape.

• Why cancer cells metabolically resemble organisms from 2 billion years ago
• The limits of the somatic mutation theory and why most targeted gene therapies have underdelivered
• Substrate level phosphorylation vs. oxidative phosphorylation — and why the distinction matters
• The Glucose-Ketone Index as a measurable, actionable biomarker
• The press-pulse strategy: sustained metabolic pressure paired with targeted interventions
• How to protect healthy tissue before targeting tumor metabolism
• Repurposed pharmacological approaches and the need for publicly funded clinical trials
• The case for small, non-randomized pilot studies with highly motivated patients

Metabolic therapy represents the future of medicine: a coherent clinical strategy grounded in decades of research and increasingly recognized by physicians and scientists across disciplines. For practitioners seeking complementary approaches that extend the reach of oncological therapeutics, this presentation lays out a practical roadmap for integrating emerging insights with standard care.

✅Genova Connect – Get 15% off any test kit with code METABOLICLINK here.

✅ iRestore - Get a huge discount on the iRestore Illumina Face Mask when you use the code METABOLICLINK here.

✅Piquelife.com - Get the Pu'er Bundle for 20% off here.

In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!

You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel!

Find us on social:

• Instagram
• Facebook
• YouTube
• LinkedIn

Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.