Can You Unclog Arteries? A Vascular Surgeon Reacts to Dr Kevin Ham ​

Plaque reversal is one of the most debated topics in preventive cardiology, so in this video I react to Dr. Kevin Ham’s CAST protocol for plaque reversal: Causes, Adding Cures, Strengthening the Body, and Training the Mind and Body.

Overall, I think this is a thoughtful framework and I agree with much of it. But as a vascular surgeon who treats advanced atherosclerosis, I also add some nuance around what “plaque reversal” really means, what may be missing from this conversation, and where I’d want more granularity in a real-world cardiovascular prevention plan.

We talk about the causes of plaque buildup, metabolic health, lifestyle change, cardiovascular risk reduction, and the difference between improving risk factors versus actually changing plaque biology. I also share where I think protocols like this can be helpful—and where they risk oversimplifying atherosclerosis.

If you’re trying to understand plaque reversal, atherosclerosis, heart disease prevention, metabolic health, LDL, ApoB, inflammation, insulin resistance, and cardiovascular risk, this video will help you think more clearly about the problem.

Let me know in the comments: Do you think “plaque reversal” is a useful term, or does it create more confusion than clarity?

#PlaqueReversal #Atherosclerosis #HeartDisease #CardiovascularHealth #MetabolicHealth #Prevention

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🧬 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.

Transcript

SPEAKER_01 0:00

Recently in the comments, one of you mentioned a new channel to me, and that is Dr. Kevin Ham. He has a video about how he reversed 30 years of his arterial plaque and the protocol that he uses to do it. Today we are going to go through that video together and learn about Dr. Ham's protocol. I am really enjoying the content on his channel, so let's go through it together. If you guys don't know me, my name is Dr. Lily Johnston. I am a board-certified vascular surgeon treating arterial disease, but I also specialize in cardiometabolic prevention. So hopefully you never need me as a surgeon. Let's dive into Dr. Ham's cast protocol.

SPEAKER_00 0:41

Leg. What's the first thing that you do when you go to the hospital? They will cast it. They will protect it from the cobs. The first thing is to protect and cast the bone, and then the body naturally heals it. And after the first three months, that crack in the bone, the fracture, becomes even stronger if you re-strengthen it, train it, and rehabilitate it. That became the model for me to develop what I call a cast protocol. Hi, I'm Dr. Kevin Hamm from Vancouver, Canada. This past May, I discovered I had major calcium plaques in my heart. In July, I discovered I had a 77% blockage in one of the branches of my heart vessels, the coronary arteries. For the past eight months, I've been trying to figure out diet, exercise, lifestyle to reverse these plaques. Most doctors, friends of mine, say it's impossible. But I found studies that show that it is possible. In three months, I reversed the plaque in my neck. Plaque in the heart vessels are a lot harder to reverse. They take time. Some of them are calcified, meaning they are like stone or like teeth in the heart vessels. My first goal is to reduce the soft plaque. So I thought about what can possibly do this. And I named my protocol after the cast, but I also have acronyms for each letter. So C A S T.

SPEAKER_01 1:57

I think it's interesting that he mentions that reversing plaque in the neck is easier or faster than reversing plaque in the coronary arteries. I'm not sure of any data that support that. As far as I know, plaque is plaque. Now, there are places where we are able to image more sensitively than others. And the neck, certainly, when we use ultrasound, we have very sensitive detection down to hundredths of a millimeter. If you've heard me talk about the CIMT exam before, so it's a lot easier to detect very small, minute change to plaque in the neck or even uh the intimal medial thickness if it's not yet plaque, but it's just thickened and abnormally. So for your age, we can detect reversal of that long before we would really see a big change in plaque burden. But I would expect that to be true throughout the body. I always mention that atherosclerosis or the buildup of plaque in the arteries is a systemic disease. It is not happening independently in the neck versus the legs. Now it does happen more in some people, in some places versus others, and we really don't understand why some people seem to get it more in the neck versus in the heart, but certainly the processes like lifestyle, medication, supplementation, exercise, if that's impacting the blood vessels positively in the neck, I would also expect it to impact the vessels positively in the heart. Now he's mentioning different types of plaque. It is the soft atheromatous, meaning fat-containing plaque, that will reverse. But we can also stabilize plaque. And honestly, plaque is still a proxy measure. What does that mean? Plaque is related to the likelihood of having a heart attack or stroke. So the plaque rupture is what we're trying to prevent. We also don't want narrowed blood vessels, right? We don't want to impede the circulation. So that's a secondary issue. But at the end of the day, if we're not having heart attack and stroke, but we still have some calcified stabilized plaque, that's not necessarily a bad thing. And people really get fixated on the reversal or remission of plaque. And that's nice. Everybody likes that idea. And it does show in early studies that maybe that does help with reducing event rates versus just stabilizing. But honestly, stabilizing and preventing progression of disease and converting any fat-rich plaque into the more stable calcified plaque is truly what we're after. So let's see what that cast protocol is.

SPEAKER_00 4:32

So the first one, the C is to cut the causes of any disease, right? Which is then prevention. If you if you remove the things that cause a disease, you won't get the disease. If you already have the disease and you remove the cause of you getting that disease, it will stop the progression of that disease. So whether you have disease or not, prevention is the key here because why? Heart disease is the number one killer everywhere in the world. So you want to defend against these attacks. I started to notice friends and family around me, once they got the screening exams, the carotid ultrasound, the heart calcium scam, they had verifiable plaque in their neck arteries and their heart arteries, whether they were 40, 50, 60, or 70. And the stats say that as you age every decade of life, for example, 40 to 50% of uh males will have already plaque in their arteries. And this evidence has shown that as you age, the average age of a heart attack is 61 in men and 71 in women. So women a decade later, it's very important to prevent it as you get older. And the average lifespan is 78. What are the causes of heart disease? It's the main factor. Smoking is a big one. Diabetes is another one, high blood pressure, high cholesterol, specifically high oxidized cholesterol. What is oxidized cholesterol? It's like nails rusting. So when the cholesterol rusts or oxidize, it starts damaging the blood vessels. And then the body starts to try to repair itself and creates these plaques or clots that then build up over time. Before we continue, please make sure you subscribe, like, and comment so that more people can see this video. And then I'm gonna add the cures. A stands for add the cures.

SPEAKER_01 6:27

What would you so I like the list of causes? We didn't talk a lot about inflammation, and I think that that's a really important one that went overlooked, except insofar as we talk about oxidized uh lipoproteins or lipids that do contribute to plaque formation. What causes that oxidation? Well, typically it's inflammation or glycation, like from sugar, high insulin, and uh diabetes or insulin resistance and excess glucose floating around in the bloodstream. So I think of the list as you know, good toxic exposures, nicotine is far and away the biggest one, but we also are gaining evidence that um marijuana, particularly when smoked, can result in formation of plaque. There's some evidence that heavy metals can do it. Um, we also see that like periodontal disease is a very important cause of inflammation. And so, again, is it its own root cause or is it just the inflammation? We can debate that. Uh, autoimmune diseases tend to be pretty profound in terms of increasing risk for cardiovascular issues and events. And then there are a number of female-specific things that we don't talk enough about, like uh adverse events in pregnancy, like pre-eclampsia, gestational diabetes, um, premature early onset menopause before the age of 40 or even 45 are both associated with an increased risk in cardiovascular events. And so, for all of these other root causes, I do think we want to be as inclusive as possible in terms of thinking about how are we going to manage risk factors and control the causes. We didn't even talk about things like uric acid or homocysteine. Those are additional risk factors. LP little A, we didn't talk about that, although that is also really problematic when it's oxidized. We do have an oxidized LPA uh issue that we've reviewed in one of the earlier videos. We'll link you to that in the show notes. And let's talk about the A.

SPEAKER_00 8:26

We'll help repair, help the body repair the blood vessels and take away the cholesterol and the deposits of plaque in the small heart vessels. Heart vessels are only six millimeters, three to six millimeters. So they're very small, smaller than a small straw. So just a little bit of plaque is significant. One millimeter of plaque, three millimeters of plaques, quite significant. So we have to get rid of this. But over time, over decades, this soft plaque hardens into very hard plaque, causes obstruction. The cap can break off and cause blood clots, which will cause heart attacks. So most of the heart attacks are actually from early unstable plaques. So we want to add the foods that are really good. What are they? Anything that helps repair the blood vessels. That's any foods that help increase nitric oxide, which we talked about in a different video. You should watch this video here. And this nitric oxide allows the blood vessels to expand. So if you have obstruction, but the blood vessels can expand, then you can have proper blood flow. So we want blood flow. Blood flow in the heart is life. And when blood flow is constricted, you start to get symptoms. And when it's totally obstructed, then that part of the heart that can't get blood dies in minutes. And in total, yes and no.

SPEAKER_01 9:47

So obstruction can be sudden or it can be chronic. And this is he he mentioned this briefly when we talk about plaque rupture events, right? That's that soft, unstable plaque. And the more of that there is, the higher the risk of the plaque rupture event. So in patients who have higher degrees of narrowing, we do tend to see higher risks of heart attack. But there are plenty of people who rupture plaque when the plaque was not significantly narrowing the artery, meaning less than 50% narrowed. Six millimeters is a pretty big coronary artery. I would say generally speaking, they're they're probably on the order of two to four in most of, especially the older folks. And indeed, you know, it doesn't take very much obstruction to cause a big issue, but there are plenty of people who live with a chronically occluded vessel, either in the neck, in the heart, even in the legs, who don't know it for a very long time. And that's because when it happens slowly, chronically, just little bits at a time, progress progressively, the body can work around it. And especially for people who are very active and are building what we call collateral circulation networks, meaning small little county roads that are going around those major freeways that are blocked, we can we can accommodate a fair amount of obstruction. And you know, you might have symptoms with a lot of activity, but otherwise at rest, you're feeling okay. So there's a big distinction to make between blockage that happens very suddenly when the body does not have an opportunity to go around those areas that are narrowed in a sudden fashion, versus slow progression of disease over time that doesn't rupture but does cause blockage. Now that can be serious, and certainly in many people, uh, it still will require intervention, but it's a very different pathophysiology and a good distinction to make.

SPEAKER_00 11:44

12 minutes, we call that a heart attack. So we know four minutes without oxygen, if we can't breathe, brain dies. That also happens in the heart. You want to add the things that are really good, which are all the leafy green vegetables. They all increase the nitric oxide, they help repair the blood vessels. And we talked about the top three foods, which you can watch over here. Then you want to strengthen your body, your system. And what will help repair is sleep and less stress and more movement, more exercise. These three things will help. Now you have these cures going through you, and they will flow to all parts of your body, not just your heart, but every place where there's blood vessels, which is all your body, because every single cell needs blood vessels. And the last one is to train your mind and train your body to be very consistent day in, day out. You don't have to be perfect. As long as you do these cast protocol day in, day out, eventually your body will heal. So, what happens if you walk on a cassid leg every day? It doesn't heal. It doesn't heal as fast. And if you walked on it every second day, it will heal a little faster. If you didn't walk on it for a week, it'll even heal any faster. So this is a base protocol. And it just imagine a fractured bone able to heal in three months. Your body is remarkable, has remarkable healing powers. Your mind is remarkable. And if you think you can't do it, you won't be able to do it. You have to have a positive mindset. That is actually the first thing, even before the cast protocol. Ask yourself and look at the data and say, what caused my blocked arteries here? The first science, actually, what I realized now is ringing in my ears preceded even blocking of my arteries in my heart. It was already blocking the arteries in my ears, in my eyes. And so I have uh heart appearing, I have ringing in my ears, my eyesight got worse as my blockages in my arteries got worse. So it affects every single part of your body, but the most fatal would be your heart because it causes death. With the eye, you go blind, you get vision loss, blindness, with the ear, you get ringing in the ear, you get deafness. Those won't kill you. They just incapacitate you. But the heart and the brain, if you get blood clots in the brain, which we call a stroke, those will kill you. So the cast protocol is an easy way to remember. First, cut out the causes, add the cures, strengthen your body, and then train your body and mind to repeat and be very repetitive and consistent. So I would email it.

SPEAKER_01 14:24

I like the the S, which I think was, you know, sleep and stress. Um, I would have loved a little more granularity about how to help people really do that. Because every time I mention sleep, I get about 10 people in the comments that are like, well, it's easy for you to say you've never had insomnia for 40 years. Like, what do you mean? Just make a, you know, bedtime routine. Like that's not helping me. Uh, to which I say I think insomnia is a huge problem, and I am not an expert in this. There are some uh therapies that are very effective for people who are potentially not quite at that level of disease, but I think calling out testing for sleep apnea, this is huge. Uh I've done a short about this in the past, but I think it's a it's an enormously underdiagnosed and under-treated cause for cardiovascular disease. There was one observational study that demonstrated that the number of people that we would have to treat for sleep apnea to prevent heart attack or stroke was only three. Um, for every three people that you treat, you get one person who does not have a heart attack or stroke. Now it's not randomized controlled data, but uh it's very compelling, right? If people, especially with moderate or severe sleep apnea, it worsens blood pressure, it worsens our blood sugar control, it puts a lot of stress on the heart and the blood vessels around the heart. And so, you know, being really explicit that like if you have any sleep issues at all, you should get tested for sleep apnea. And if you have it, we have to come up with some kind of way to help me help you manage that that is tolerable. If it's not CPAP or Bipap, then let's talk about an oral appliance. If it's not that, maybe it's a stimulator now that that's available. But this is a big deal. Um, I do think bedtime routines are actually a big deal for a lot of people, and there's a lot of behavioral stuff around sleep that can be really helpful. Um, controlling the temperature of your bed or your room can be great. Noise, light, all of these things. Stress management, separate issue. But again, what are the more actionable things that really help people do this? Because we all live in a very stressful, busy environment. Uh, I was just talking to my friend earlier about how I am feeling a little tired and cranky because I've been under a lot of stress this month. And what am I gonna do about this? And like this is impacting my health. And, you know, um, do as I say, not as I do. We are working on it. These are hard, hard things and so important. So I still have a meditation practice. Um, exercise is a huge thing that not only helps my blood vessels, but also helps my mental health and my stress, and I lean on that a lot. Um, so you know, I think we should probably do a deeper dive into what specifically uh Dr. Ham has used in his own life to like work on his sleep. Was that an issue? I don't know. What about his stress? How has that changed for him? What's going on with that? How what are the tools he's using to help him do that? And then um again, like training your mind and body, to me, that's like similar. Like training your mind is meditation, that's working, or maybe that, maybe he meant that to be like cognitive training and games, sudoku exercises, I don't know, crosswords, maybe um training the body as exercise specifically. That's great. Although we also had that in add the cures uh as something that improves nitric oxide, blood vessel health, and collateral vessel formation. But overall, I do think that this is a neat framework to kind of help conceptualize the different areas where we can where we can make change. Let's see if there's anything else we have to add uh as we're starting to wrap this video up here.

SPEAKER_00 17:56

Encourage each of you to do one thing in this cast, right? Cut out one food, add one thing, add leapy green vegetables to every meal. Focus on getting eight hours, seven to eight hours of sleep, reducing your stress, doing some some sort of cardio exercise for 10, 20, 30 minutes every day, if you can. I will leave you with that and wish you good luck in this new year. If uh you found this useful, please forward it to three other friends or families or colleagues that you know, because this is the number one problem, health problem in the world globally. Someone's gonna benefit. You can help save a life. And if you want to learn more, I have more you more videos that you can watch, but also I have a newsletter at ham.com that is more detailed that you could read.

SPEAKER_01 18:47

So, final thoughts. Um, Dr. Ham also mentioned the mindset piece, and I think this is really helpful because one of the biggest barriers to change is people not believing that it is possible for them to change or for the changes that they're making in their life to actually impact the health issue that they're experiencing. And what I love about channels like Dr. Hams is that we have story after story of people making these changes and getting well. And every time we show that to the world, we are adding to this bank that says, yes, change is possible. We can stabilize, we can reverse this disease process, we can reduce the chances of having heart attack and stroke. Now, of course, none of us are gonna live forever. We are all gonna die, but the goal is to not die with significant disability. It is to stay out of the hospital, to avoid procedures if we can, and enjoy what life we have. And nobody knows what we'll have. But having this understanding that yes, these lifestyle interventions, when done thoughtfully and carefully, can absolutely reduce your risk. They do make a difference. And every one of you who is watching, who has been on the health journey, I am so proud of you for all that you've done, for all that you're continuing to learn and grow and do. It is really helping. So uh thank you, Dr. Ham, for your work in this area. I am so glad to have another voice in this space that is helping get the word out. And I'm gonna give that video a like. We will subscribe to his channel and uh hopefully see a lot more from Dr. Ham in good time. Until next time, guys, take really good care.