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Knife Down

Lily Johnston, MD MPH

 "Knife Down" is what a surgeon says in the OR when she puts her scalpel down so no one gets hurt — and it’s the mission here: put the knife down, long before anyone needs to use it.


Knife Down is a podcast about how to actually invest in your health so you can live longer, stronger, and with less time in doctors’ offices. The core focus is the world’s leading cause of death—cardiovascular disease—and what to do about it before it shows up as a catastrophe.


Hosted by a vascular surgeon on a mission to put herself out of business, the show translates cutting-edge science on prevention, metabolic health, and longevity into real-world strategies you can use in clinic or at your kitchen table. Expect evidence, nuance, and zero wellness hype—plus the occasional dark joke about the state of modern medicine.

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  • 23 episodes
  • Avg 40 min
  • English

Episodes 23

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  • S2026 · E39
    June 10 · 47 min

    99% of heart attacks had a warning. Your doctor called it "normal."

    Can you have a heart attack with “normal” labs and no warning signs? Or are we missing the warning signs because our thresholds are too late and our prevention model is too reactive? Today I react to a fascinating video from Dr Brad Stanfield, BUT STICK AROUND because then we take a deep dive into the actual JACC paper behind the headline that “99% of people who had a heart attack had at least one warning sign beforehand.” We break down: * Why “normal” isn’t always optimal * The difference between diagnosed risk factors vs actual exposure * Why blood pressure of 128/82 may still matter * The hidden role of insulin resistance and metabolic syndrome * ApoB vs LDL-C vs non-HDL cholesterol * Why prevention needs to start decades earlier * The problem with reactive medicine * What Jim Fix’s story actually teaches us about cardiovascular disease This is not a message of fear. It’s a message of agency. Because clogged arteries rarely appear out of nowhere. Most of the time, the body whispers long before it screams. ⏰ Chapters ⏰ 0:00 The “99% of Heart Attacks” claim 0:57 Did people really have NO risk factors? 2:23 Why “SMURF-less” heart attacks confused cardiology 3:02 Are our thresholds too high? 4:21 Insulin resistance may be the missing link 5:14 The massive 9-million-person study 5:57 Over 99% had at least one non-optimal risk factor 6:50 Diagnosed risk factors vs actual exposure 7:18 The underdiagnosis problem in medicine 8:02 Why billing data can be misleading 10:13 Cardiovascular risk is continuous, not binary 11:42 Prediabetes still damages arteries 13:43 Why granular patient data matters 14:50 The tragic story of Jim Fix 16:47 “The second most common symptom is denial” 17:31 Exercise didn’t cause his heart disease 19:17 Why this data is actually hopeful 20:03 Reactive medicine vs prevention 20:32 “I lost weight… isn’t that enough?” 22:03 How aggressive should prevention targets be? 23:50 ApoB explained simply 25:29 My take on ApoB vs LDL-C 28:05 Deep dive into the JACC paper 35:28 Which risk factor was most common? 37:21 Most patients had MULTIPLE risk factors 39:26 Does this only apply to older people? 41:34 What happens when we use standard clinical cutoffs? 43:43 Why non-HDL cholesterol matters 45:47 The boring prevention advice still wins 46:38 Residual risk after lifestyle transformation 47:00 Why the fundamentals still matter most 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. This video is for educational purposes only and does not constitute personalized medical advice. Please discuss your individual health risks, labs, medications, and treatment decisions with your own physician.

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  • S2026 · E38
    June 8 · 11 min

    Can THIS Supplement Prevent Heart Disease? Surgeon Reacts to Dr Boz

    Are omega-3s really the #1 supplement for heart disease prevention? In this reaction to Dr. Boz, I break down the nuance: atrial fibrillation risk, rancid oils, DHA vs EPA, heavy metal testing, delivery forms, omega level testing, and why small fatty fish may beat supplements for most people. 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

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  • S2026 · E37
    June 2 · 2 hr 14 min

    AMA #2: Why a 'Perfect' LDL Won't Save You--Plaque, Statins & Metabolic Health

    A live, unfiltered Ask Me Anything on preventive cardiology and metabolic health — recorded on about three hours of sleep after a night in the OR, which tends to make me a little more candid than usual. We cover the questions you actually ask: how plaque forms and how to stabilize it, what the "best" diet for cardiovascular health really is (spoiler: it depends on you), statins from every angle, Lp(a) and ApoB, the lean mass hyper-responder phenotype, GLP-1s and dementia risk, coronary CT angiograms and the AI tools reading them, carotid disease and how I think about stenting vs. surgery, and a few honest detours into supplements, what I eat, and why medicine is so much better at rescue than prevention. No oracles here — just an informed guide working the front lines, thinking out loud with a curious, generous audience. Use the chapters below to jump to whatever you came for. ⚠️ Educational content only. This is general information, not personal medical advice. Talk to your own clinician before changing any medication, supplement, or treatment plan. Chapters 0:00 — Welcome + how this AMA works 0:58 — High CAC score but a clean carotid duplex: how can both be true? 3:45 — Cleerly vs. HeartFlow: which AI coronary CT analysis is better? 6:26 — The "best" diet for cardiovascular health (there isn't just one) 10:59 — How to actually find a preventive / metabolic cardiologist 13:08 — Amlodipine, dizziness, and tachycardia after weight loss 14:41 — Do you need an ApoB test if LDL is already low on a PCSK9 inhibitor? 16:26 — The fibrous cap: can you thicken it and stabilize plaque? 18:59 — How does arterial plaque actually form? (Atherosclerosis 101) 23:47 — Beta blockers, AFib, and valve repair: a medication for life? 28:09 — When statins raise Lp(a) but lower ApoB 30:10 — How is familial hypercholesterolemia (FH) diagnosed? 32:20 — Erectile dysfunction and vascular health 33:46 — Statins, the full picture: benefits, side effects, and monitoring 45:23 — Lean Mass Hyper-Responders (LMHR), high LDL, and a clean CT 51:59 — Gene therapy for high cholesterol: promise and unknowns 56:04 — Rosuvastatin every other day vs. daily 57:20 — Best statin for ApoE4 carriers + the obicetrapib (CETP) story 1:00:57 — Easing statin muscle pain: CoQ10, vitamin D, gentler statins 1:02:15 — Is high cholesterol a sign of a liver problem? 1:04:24 — GLP-1s and dementia risk: what the data show 1:09:20 — Can your LDL be too low? 1:12:02 — Longevity influencers and GLP-1s 1:13:23 — Saturated fat and LDL cholesterol 1:15:22 — How often to order coronary CT angiograms — and why AI overlays worry me 1:23:19 — What tests prove your heart is healthy? (Why stress tests miss plaque) 1:28:24 — Citrus bergamot with statins or PCSK9 inhibitors 1:29:55 — Bypass conduits: mammary artery, leg vein, and radial artery 1:30:47 — What supplements I personally take 1:34:13 — What I personally eat 1:37:17 — Weak, rolling veins and difficult blood draws 1:38:12 — Why there's still no screening program for the #1 killer 1:44:42 — Is there a CIMT-style test for the heart? 1:45:43 — Post-COVID and post-vaccine vascular problems 1:48:13 — Can surgeons operate from a CTA, or is an angiogram needed? 1:51:25 — Do we use robots in vascular surgery? 1:54:29 — Carotid stenting vs. endarterectomy (and the CREST-2 results) 2:02:19 — Lp(a) of 295, Repatha, and when new Lp(a) drugs may arrive 2:04:17 — At what degree of carotid narrowing do you intervene? 2:07:01 — Book recommendations (and a preview of "Disconnected") 2:13:46 — Bonus: how much do I trust the gut microbiome science? Resources mentioned Bale-Doneen Method provider directory: https://baledoneen.com/find-a-provider/ "Healthy Heart, Healthy Brain" by Dr. Brad Bale & Amy Doneen: https://amzn.to/4o3GvGv My Lp(a) video series — start with the first explainer on how Lp(a) is measured (mg/dL vs. nmol/L) and the "Lp(a) — what now?" follow-up: https://youtu.be/i761M_-zjJQ?si=7yjVJ46GC60Mk85a https://youtu.be/ZdUxECOqd1o?si=i8DhYKF55lKLSafy My two videos on the lab tests I recommend beyond a standard annual physical (Lp(a), hs-CRP, fasting insulin, HOMA-IR, and more): https://youtu.be/vPw38B9QzjM?si=E1HJqn-bKwOW10Xb https://youtu.be/vwORTxzeEMg?si=CpFnD3-MRJjbw39p Let's keep going If you'd like this to become a monthly feature, say so in the comments — and tell me which questions you want answered next time. Got a bike-tour recommendation? Drop it in the comments! High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start ___________________________ 🧬 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.

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Showing 21–23 of 23 episodes