Ask Me Anything (AMA) – February 17, 2025

Summary of YouTube Video: Ask Me Anything with Dr Twyman

Introduction
• Dr Twyman hosts his weekly Q&A, covering vascular health, cardiovascular prevention, biohacking, and functional medicine.
• Discusses his practice at Apollo Cardiology in St. Louis, specializing in early detection of atherosclerosis.

Key Discussion Topics & Answers

Carotid Ultrasound & Cardiovascular Risk
• How often should you repeat a carotid ultrasound?
• Two types:
1. Carotid duplex ultrasound (measures blood flow & blockage) → Repeat yearly if abnormal.
2. CIMT (Carotid Intimal-Medial Thickness) scan (measures vascular aging) →
• If normal, repeat every 12-24 months.
• If abnormal, repeat yearly.

Genetic Testing for Heart Disease
• Four key genes to check:
• Lipoprotein(a)
• 9p21 (heart attack gene)
• KIF6
• ApoE (lipid metabolism gene)
• Testing like GB Insight requires a medical provider.

Nitric Oxide & Vascular Health
• Nitric oxide (NO) is essential for artery function.
• Ways to increase NO:
• Exercise (stimulates NO production)
• Sunlight (UVA exposure releases NO from skin)
• Nitrate-rich foods: Spinach, arugula, kale, beets (organic preferred)
• Supplementation: Dr. Nathan Bryan’s NO lozenges or Vasovox

Calcium Score Screening
• 42-year-old with a zero calcium score:
• If no strong family history → Retest every 3 years.
• If strong family history → Retest every 2 years.
• In the meantime, track arterial health with CIMT scans, EndoPAT, and pulse wave velocity tests.

Blood Pressure & White Coat Hypertension
• Always measure blood pressure in both arms.
• If a 20+ point difference between arms → Possible subclavian artery stenosis.
• Best practice: Measure at home with a validated monitor.

How to Repair Narrow Arteries Naturally
1. Protect the endothelial lining (glycocalyx).
2. Boost nitric oxide production.
3. Reduce oxidative stress & inflammation.
4. Optimize lipoprotein levels (ApoB, LDL, Lp(a)).
5. Key interventions:
• Exercise
• Sleep optimization
• Stress management
• Targeted supplements (e.g., Arterosil)

Artificial Sweeteners & Heart Health
• Diet soda is not ideal—potential negative effects on gut microbiome & insulin response.
• Better options:
• Tea, coffee, mineral water without artificial sweeteners.

Raynaud’s Disease & Endothelial Health
• Raynaud’s (cold sensitivity in hands & feet) can indicate microvascular dysfunction.
• Solutions:
• Boost nitric oxide production.
• Use red light therapy & cold adaptation.
• Supplementation: Calcium channel blockers or long-acting nitrates in severe cases.

Can Low Sodium Affect the Heart?
• Low sodium (hyponatremia) is more of a brain issue but can indicate heart failure.
• Causes of hyponatremia:
• Overhydration
• Heart, kidney, or liver failure
• Certain medications (antidepressants, antipsychotics)

Vitamin D in Winter – Do You Need Supplements?
• Dr Twyman does NOT recommend synthetic vitamin D pills.
• Best way to optimize vitamin D:
• Get natural sunlight during spring, summer, and early fall.
• Eat vitamin D-rich foods
• Store vitamin D in fat tissue for winter use.

Wim Hof Breathing & High Blood Pressure
• Dr Twyman does NOT recommend Wim Hof breathing for people with high blood pressure.
• Cold exposure is beneficial, but the breathing technique lacks strong scientific backing.

Can the Flu Cause Heart Racing?
• Yes, viral infections like influenza can trigger atrial fibrillation (AFib) due to oxidative stress and inflammation.

Relationship Between Muscle Strength & Blood Pressure
• More muscle mass is generally linked to better blood pressure, but:
• Bodybuilders & strength athletes may have high blood pressure if they have sleep apnea or excessive inflammation.
• Exercise & nitric oxide production help maintain healthy blood pressure.

Final Takeaways
• Early detection of cardiovascular risk is crucial—calcium scores, CIMT scans, and genetic testing help.
• Nitric oxide production (via exercise, sunlight, and diet) is key for heart health.
• Repairing arteries naturally involves lifestyle changes, stress management, and supplementation.
• Avoid artificial sweeteners, increase whole foods, and get natural sunlight instead of relying on supplements.
• Wim Hof breathing isn’t ideal for high blood pressure, but cold exposure is beneficial.
• If you have the flu and your heart races, monitor closely—it can trigger heart rhythm issues.

Dr Twyman will be back next Monday at 6 PM Central for another Q&A. More insights are available on his YouTube channel and newsletter.