Cindy Geyer
Cindy Geyer is a contributor to the field of lifestyle medicine. Her published research in the American Journal of Lifestyle Medicine examines the relationships between weight, chronic pain, and mood, integrative approaches to sleep, and the role of psychosocial support in breast cancer treatment. She also discusses the impact of inflammation, insulin resistance, and metabolic dysfunction on cardiovascular disease.
9 claims checked on air: 1 contradicted 8 supported
What they said on air
Cardiovascular disease is the leading cause of death worldwide and is the leading cause of death among women.
"Yeah, it's still the number one killer around the world, not just here. And it's still the number one killer in women who, you know, they think that it's breast cancer. No, no, this is it." (said at 0:00:03)
Global epidemiological surveillance consistently establishes that cardiovascular disease (CVD) is the leading cause of death globally and specifically the leading cause of mortality among women. According to data from the Global Burden of Disease (GBD) studies, CVD accounted for over 19 million deaths worldwide in 2023, with ischemic heart disease and stroke as the predominant causes. The Lancet Commission on Women and Cardiovascular Disease similarly confirms that CVD is the leading cause of death in women globally, causing far more female deaths than breast cancer or other malignancies.
Approximately 80% of heart disease and diabetes cases are preventable with diet and lifestyle modifications.
"But we know that 80% of cases of heart disease and diabetes may actually be preventable with diet and lifestyle." (said at 0:00:31)
Large prospective cohort analyses indicate that approximately 80% or more of coronary heart disease and type 2 diabetes cases are attributable to modifiable lifestyle factors, including diet quality, physical activity, body mass index, and non-smoking status. In landmark analyses from the Nurses' Health Study, 82% of coronary events and 91% of type 2 diabetes cases were attributable to non-adherence to a low-risk diet and lifestyle pattern.
Fewer than 3% of the United States population meets four core low-risk lifestyle characteristics: non-smoking, 150 minutes of weekly exercise, diet in the top two quintiles of whole foods, and a healthy body fat percentage.
"fewer than 3% of the US population is meeting the core four basic characteristics that predict low risk. And it's a pretty low bar, Mark... It's not smoking... Getting the minimum recommended 150 minutes of exercise a week, eating in the top two quintiles of what's considered a whole foods diet, and having a healthy body fat percentage. Fewer than 3%." (said at 0:02:45)
A nationally representative study of US adults using 2003–2006 National Health and Nutrition Examination Survey (NHANES) data evaluated four healthy lifestyle characteristics: being sufficiently physically active (measured via accelerometry), eating a healthy diet (top 40% of the Healthy Eating Index), being a non-smoker (serum cotinine), and having a recommended body fat percentage (measured via DXA). The authors found that only 2.7% (95% CI, 1.9%–3.4%) of US adults met all four criteria, directly supporting the claim.
Standard clinical lipid panels calculate LDL cholesterol via a mathematical formula rather than directly measuring it.
"and they would do a standard cholesterol profile, which interestingly enough calculates your LDL cholesterol, the one we usually think of as being the lousy cholesterol, from a formula, doesn't even really measure it" (said at 0:05:42)
Standard clinical lipid panels typically measure total cholesterol, HDL cholesterol, and triglycerides directly, while calculating LDL cholesterol using mathematical formulas (most commonly the Friedewald equation, or newer alternatives such as Martin-Hopkins or Sampson equations) rather than direct homogeneous assays or reference ultracentrifugation.
Large pattern A LDL particles are less prone to oxidative stress, inflammation, and plaque rupture compared to small, dense pattern B LDL particles.
"There's big, fluffy, puffy pattern A LDL cholesterol, which is less easily made into a plaque in the artery, less prone to inflammation and oxidative stress and rupture. So it's a less risky LDL, whereas somebody could have small, dense pattern B LDL, and that's the really risky LDL." (said at 0:09:21)
Published experimental and observational studies demonstrate that large, buoyant LDL particles (predominant in LDL phenotype pattern A) are more resistant to oxidative modification and less strongly associated with pro-inflammatory vascular activation and atherosclerotic progression than small, dense LDL particles (pattern B). Biochemical assays show that resistance to oxidation (measured by lag time before copper-induced oxidation) is significantly longer in larger LDL fractions and shorter in dense fractions, making small dense LDL more susceptible to oxidative modification. Additionally, pattern B profiles are associated with elevated expression of pro-inflammatory cytokines and chemokines and increased cardiovascular risk.
Small HDL particles are less capable of clearing LDL particles and facilitating reverse cholesterol transport than larger HDL particles.
"The same is true for HDL. We've historically thought of HDL as being the good, healthy cholesterol, but size matters there, too. Small HDL doesn't seem to be as able to cart out the bad LDL and get rid of it." (said at 0:10:12)
The speaker states the relationship between HDL particle size and cholesterol removal backwards. In reverse cholesterol transport, small, dense HDL particles (such as discoidal HDL and pre-beta HDL) are the primary and most potent mediators of cellular cholesterol efflux via the ABCA1 (ATP-binding cassette transporter A1) pathway. Experimental and clinical studies consistently demonstrate that cholesterol efflux capacity increases as HDL particle size decreases, with small HDL particles displaying 3- to 5-fold greater efflux capacity than larger HDL subfractions.
According to NHANES data from 2009 to 2016, only 12.2% of American adults were metabolically healthy across key markers including blood pressure, HDL, triglycerides, and fasting glucose.
"So, a recent study was looking at the NHANES data from 2009 to 2016, government surveys... And they found that 12.2% of Americans... 12.2% of Americans were metabolically healthy" (said at 0:16:29)
A widely cited analysis of NHANES data from 2009 to 2016 (n = 8,721 adults) by Araújo et al. (2019) evaluated metabolic health defined by optimal levels of five cardiometabolic risk factors (waist circumference, blood pressure, fasting glucose/HbA1c, triglycerides, and HDL cholesterol without medication). Using the most recent clinical guidelines, only 12.2% (95% CI: 10.9–13.6%) of American adults met the criteria for optimal metabolic health.
- supports: Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition E… (Metabolic syndrome and related disorders 2019) · cited 157x in the literature
"Data from the National Health and Nutrition Examination Survey 2009-2016 were analyzed (n = 8721). Using the most recent guidelines, metabolic health was defined as having optimal levels of waist circumference (WC <102/88 cm for men/women), glucose (fasting glucose <100 mg/dL and hemoglobin A1c <5.7%), blood pressure (systolic <120 and diastolic <80 mmHg), triglycerides (<150 mg/dL), and high-density lipoprotein cholesterol (≥40/50 mg/dL for men/women), and not taking any related medication. Changing from ATP III (Adult Treatment Panel III) guidelines to more recent cut points decreased the proportion of metabolically healthy Americans from 19.9% (95% confidence interval [CI]: 18.3-21.5) to 12.2% (95% CI: 10.9-13.6)." (abstract, results, passage verified)
pubmedfull study (doi)
Fewer than one-third of normal-weight individuals in the US are metabolically healthy.
"Fewer than one-third of so-called normal-weight people were metabolically healthy. So, that's another really important message." (said at 0:17:21)
A nationally representative study of US adults using National Health and Nutrition Examination Survey (NHANES) 2009–2016 data (n = 8,721) evaluated optimal cardiometabolic health based on guidelines for waist circumference, fasting glucose/HbA1c, blood pressure, triglycerides, and HDL cholesterol without medication. The study found that less than one-third of normal-weight adults met criteria for optimal metabolic health.
Ninety percent of Americans with prediabetes are undiagnosed by their physicians.
"when you look at that data and you also look at the parallel data that 90% of Americans with pre-diabetes are not diagnosed by their doctor, right?" (said at 0:19:00)
Surveillance data from the Centers for Disease Control and Prevention (CDC) using the National Health and Nutrition Examination Survey (NHANES) consistently demonstrate that approximately 85% to 90% of US adults meeting clinical criteria for prediabetes are unaware of their condition and have not been told by a health professional that they have it. In NHANES analyses, only 11% to 16% of adults with laboratory-defined prediabetes reported being aware of their diagnosis.
- supports: Awareness of prediabetes--United States, 2005-2010. (MMWR. Morbidity and mortality weekly report 2013) · cited 65x in the literature
"This report describes the results of that analysis, which indicated that, during 2009-2010, approximately 11% of those with prediabetes were aware of their condition. Furthermore, during 2005-2010, estimated awareness of prediabetes was <14% across all population subgroups, different levels of health-care access or use, and other factors." (abstract, results, passage verified)
pubmed - supports: Prediabetes awareness is not associated with lower consumption of self-reported added suga… (Annals of epidemiology 2022) · cited 2x in the literature
"Among 3314 adults with prediabetes, 528 reported being aware and 2786 reported being unaware of their condition." (abstract, results, passage verified)
pubmedfull study (doi)
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