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Mark Kaplan

@markkaplan20

May 28 • 14 tweets • 7 min read • Read on X

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I have posted six threads in the last month. Over 400,000 views. Thousands of replies.

The same question keeps appearing. Over and over. In every thread.

"What tests should I actually get?"

Here are the five tests. Under $150. No prescription needed at most direct-access labs. Backed by studies published in the New England Journal of Medicine and JAMA Cardiology.

These five tests would have caught my heart disease years before it almost killed me at 52.

Your annual physical does not include a single one of them.

🧵

Your standard annual physical tests three things related to heart disease.

Total cholesterol. LDL cholesterol. Fasting glucose.

That is it. Those are the numbers your doctor uses to decide whether you are healthy or sick. Whether you need medication. Whether you are at risk.

The Women's Health Study ranked LDL cholesterol last at 1.4x. Total cholesterol at 1.0x. Fasting glucose does not move until 10 to 20 years after the disease starts.

Your doctor is testing the weakest predictors. The ones that catch it last. The ones at the bottom of the list.

Fasting insulin. The earliest marker of insulin resistance. Detectable 10 to 20 years before blood sugar moves.

hs-CRP. Chronic inflammation. The mechanism that actually drives plaque formation. 2.98x risk. More than double LDL.

HOMA-IR. Your insulin resistance score. A free calculation your doctor already has the numbers for but never puts together.

HbA1c. Your 90-day blood sugar average. Shows what fasting glucose hides.

Lp(a). A genetic risk factor that 20% of the population has elevated. Most have never been tested. Cannot be changed with lifestyle. Must be managed.

Five tests. Five markers that actually predict disease. None of them on your standard blood panel.

This is the most important blood test your doctor has never ordered.

In 1975, Joseph Kraft tested 14,384 patients and proved that insulin pathology is detectable 10 to 20 years before blood sugar moves.

Look at the chart. The red line is insulin. Rising for 20 years. The teal line is glucose. Flat. Normal. The entire time.

Your doctor tests the teal line. Glucose. The last domino.

The red line is where Type 2 diabetes, heart disease, Alzheimer's, and metabolic syndrome all begin. In the same place. With the same marker.

A fasting insulin test costs under $30. Target: below 5 µIU/mL.

Your doctor says anything under 25 is normal. Functional medicine says over 5 is a warning. That gap is where disease hides for two decades.

Take your fasting insulin and your fasting glucose. Multiply them. Divide by 405.

That is your HOMA-IR score. Your insulin resistance number.

Under 1.0: optimal. Your cells are responding to insulin efficiently.

1.0 to 2.0: early resistance. This is where you catch it. This is where you fix it.

Over 2.0: insulin resistant. Your risk for diabetes, heart disease, and metabolic syndrome is elevated.

Over 3.0: significant resistance. Your metabolic system is under serious stress.

This calculation is free. Your doctor already has both numbers from your standard blood work. They just never put them together. Because it is not in the guidelines. Because there is no drug to sell for it.

High sensitivity C-reactive protein. A marker of systemic inflammation.

The JUPITER trial. 17,802 patients. Harvard. Published in the New England Journal of Medicine. People with normal LDL but elevated CRP had significantly higher cardiovascular risk.

The CANTOS trial proved that reducing inflammation alone, without touching cholesterol, reduced heart attacks by 15%.

The Women's Health Study ranked hs-CRP at 2.98x. More than double the risk of LDL cholesterol.

An hs-CRP test costs under $25. Target: below 1.0 mg/L.

Your doctor tests LDL. Your body is dying from inflammation. This test measures the fire. LDL measures the fire alarm.

Your doctor tests fasting glucose. That is a snapshot. One moment in time. First thing in the morning before you eat.

HbA1c is the movie. It shows your average blood sugar over the last 90 days. Every meal. Every snack. Every spike.

You can wake up with a perfect fasting glucose of 90. Your doctor says fine. But your HbA1c reveals that your blood sugar has been spiking all day. Every meal. Every glass of juice.

A fasting glucose of 90 with an HbA1c of 5.7 means your body is struggling. Your doctor might not flag it until 6.5. By then you are diabetic.

The window between 5.0 and 5.4 is optimal. Between 5.4 and 5.7 is where you catch it. Above 5.7 is where you fix it. Above 6.5 is where your doctor finally notices.

An HbA1c test costs under $30.

Lipoprotein(a). The genetic one. Pronounced "lipoprotein little a."

20% of the population has elevated Lp(a). Most have never been tested. Most doctors have never ordered it.

If your Lp(a) is high, it does not mean you are doomed. It means you need to be more aggressive about managing every other risk factor. Insulin. Inflammation. Metabolic health. The things you CAN control.

You cannot manage what you do not know about.

An Lp(a) test costs under $40. It only needs to be tested once in your lifetime.

Screenshot this. Print this. Take it to your next appointment.

Fasting Insulin. Under $30. Target: below 5.
HOMA-IR. Free to calculate. Target: below 1.0.
hs-CRP. Under $25. Target: below 1.0.
HbA1c. Under $30. Target: below 5.4.
Lp(a). Under $40. Test once for life.

Total cost: under $150. No prescription needed at most direct-access labs.

Your annual physical costs more and tells you less.

If your doctor says no, say this.

"I am requesting these tests based on published research in the New England Journal of Medicine and JAMA Cardiology. I would like them ordered or I would like a note in my chart explaining why they were declined."

That sentence changes the conversation. A doctor who declines a test and documents why is taking legal responsibility for the decision. Most will order the tests.

If they still say no, go to a direct-access lab. Walk in. Order them yourself. No doctor needed. Results in 48 hours.

Look at this chart one more time. The Women's Health Study. 27,939 women. 21 years.

Diabetes: 10x risk.
Metabolic syndrome: 6x.
Inflammation: 2.98x.
LDL cholesterol: 1.4x. Dead last.

The five tests in this thread measure the risk factors at the TOP of that list. Insulin resistance. Inflammation. Metabolic dysfunction.

Your standard physical measures the ones at the BOTTOM.

These five tests would have caught my heart disease years before it almost killed me. They cost less than a dinner out. And your doctor has probably never ordered them.

In 12 years of annual physicals, not one of my seven doctors tested fasting insulin. Not one tested hs-CRP. Not one calculated HOMA-IR. Not one ordered Lp(a).

They tested cholesterol seven times. Flagged it seven times. Recommended statins seven times.

I said no for 12 years. Then I had a heart attack at 52. Then they put me on a statin anyway.

It took almost dying to learn that the thing they kept measuring was the weakest predictor on the list. And the things that could have saved me were never measured at all.

You asked what tests to get. Now you know.

Five tests. Under $150. No prescription. Available at any direct-access lab. Backed by the largest studies published in the most respected journals in the world.

Your doctor will not order them. Not because they are wrong. Because the system was not designed to find the root cause early. It was designed to wait until you are sick enough to need a drug.

Do not wait. Test now. Know your numbers. The earlier you catch it, the easier it is to reverse.

The truth heals

If this reached you, send it to everyone. Not just someone on a statin. Everyone. Every person over 30 should know these five numbers.

Screenshot the cheat sheet. Take it to your doctor. Take it to your parents. Take it to your spouse. Take it to your friends.

The five tests that actually predict disease cost less than your annual physical. And nobody orders them.

Co-founders of HealthTruth:
Dr. Philip Ovadia, Cardiac Surgeon · @ifixhearts
Dr. Aseem Malhotra, Cardiologist · @DrAseemMalhotra
Dr. Robert Cywes, Metabolic Surgeon · @carbaddictiondr
Prof. Tim Noakes @ProfTimNoakes

With thanks to @bigfatsurprise @BillAckman @garytaubes @drjasonfung @DoctorTro @nicknorwitz @LDLSkeptic

Mark Kaplan
Founder, HealthTruth

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More from @markkaplan20

Mark Kaplan

@markkaplan20

May 25

I want you to look at this chart and tell me what you see.

20 years. Seven diseases. Every single line is going up.

Alzheimer's up 260%. Parkinson's up 150%. Fatty liver up 125%. Diabetes doubled. Obesity up 42%. Cancer up 16%. Heart disease went down then came right back up.

Trillions of dollars. The most expensive healthcare system in human history. And not a single metabolic disease is improving.

Something is causing all of them. The same something. And nobody is stopping it.

🧵

700,000 Americans die from heart disease every year. Number one killer for over 100 years.

Alzheimer's deaths up 134x since 1960. 38 million Americans have Type 2 diabetes. 96 million more are pre-diabetic. That is 134 million people. Almost half the adult population.

These numbers are not stabilizing. They are accelerating. In the richest country on earth.

The system is not failing by accident. It is failing because it is treating the wrong thing.

Life expectancy by region. 1984 to 2019. Pre-COVID.

The Northeast climbed to 80 years. The West to 79.5. The Midwest stalled and started declining. The South is going backwards. Mississippi is at 72.8 years.

7.2 year gap. Same country. Same healthcare system. Same FDA. Same guidelines.

The regions with the highest obesity and highest diabetes rates die the youngest. The gap is not closing. It is widening.

We are not getting healthier. We are dying earlier. Despite spending $4.5 trillion a year on healthcare.

Read 15 tweets

Mark Kaplan

@markkaplan20

May 23

My statin thread reached over 460,000 people. Thousands of you asked the same question.

"If cholesterol does not cause heart disease, then what does?"

The answer has been published for years. In the largest risk factor study ever conducted. 27,939 women. 21 years. Published in JAMA Cardiology.

Here is what they found. And here is why nobody told you.

🧵

The pharmaceutical industry spent billions of dollars trying to prove that lowering cholesterol saves lives.

60 clinical trials. 323,950 patients. Statins. PCSK9 inhibitors. Ezetimibe. Every drug class. Every dose.

Look at the chart. The x-axis is how much they lowered LDL. Some trials dropped it by 20%. Some by 60%. Some by 80%.

The y-axis is mortality benefit. How many lives were saved.

Every single dot is clustered around zero. Some are below zero. Below zero means more people died.

They reduced LDL by up to 80%. Nobody was saved.

So how do you take those results and turn them into the best-selling drug class in the history of medicine?

You change the language.

Instead of saying "1 in 200 people benefit," you say "36% risk reduction." Same data. Different framing. One sounds useless. The other sounds like a miracle.

The absolute risk reduction is 1.1%. For every 200 people who take a statin, 1 avoids a heart attack. 199 get no benefit.

Abramson and Wright. BMJ. 2007. 83,000 patients.

With those results you would think this drug would disappear. Instead it became a $200 billion industry. 250 million prescriptions worldwide.

That is not science. That is the greatest marketing campaign in pharmaceutical history. And 250 million people fell for it.

Read 16 tweets

Mark Kaplan

@markkaplan20

May 21

I took a statin for two years after my heart attack. It destroyed my memory.

I never once asked what it was made from. Neither did my doctor.

When I found out, I could not believe it. The most prescribed drug in the history of medicine came from mold growing on rice in a grain shop in Japan.

This is the origin story they never tell you.

🧵

In 1971, a Japanese biochemist named Akira Endo started a project at Sankyo Pharmaceuticals in Tokyo.

His goal was simple. Find a chemical that blocks the enzyme that produces cholesterol in your liver. The enzyme is called HMG-CoA reductase.

He did not look in a chemistry lab. He did not design a molecule. He went looking in nature. Specifically in fungi. Molds. The organisms that grow on rotting food.

His logic was that fungi produce toxins to kill competing organisms. If he could find a fungal toxin that happened to block cholesterol production, he would have his drug.

He was not looking for medicine. He was looking for a useful poison.

Endo screened 6,000 fungal compounds over two years. In 1971, he found his first hit.

It was called citrinin. A mycotoxin produced by Penicillium mold. It blocked cholesterol synthesis exactly as he hoped.

There was a problem. Citrinin was a known nephrotoxin. It destroyed kidneys in every animal it was tested on. Rats. Dogs. Rabbits. Complete kidney failure.

Citrinin is still classified today as a dangerous food contaminant. The European Food Safety Authority monitors it. It causes kidney damage, liver damage, and cellular toxicity.

This was the first compound that showed statins could work. A fungal poison so toxic it could not be given to a living animal without destroying its organs.

Endo threw it out. But he did not change his approach. He kept looking for more fungal toxins.

Read 13 tweets

Mark Kaplan

@markkaplan20

May 21

My statin thread hit over 400k + views yesterday. Thousands of you asked the same question. “What about Repatha?” Here is the answer. It is a bomb shell. You better sit down.

I remember sitting on my bathroom floor with a needle in my hand.

My cardiologist told me Lipitor was the answer. 80mg. Within months I started losing my memory. Words disappeared mid-sentence. I could not remember my daughter's phone number.

He switched me to Crestor. Same thing.

Then he told me the future had arrived. A new drug called Repatha. A PCSK9 inhibitor. $14,000 a year. An injection I had to give myself every two weeks.

I sat on the cold tile of my bathroom floor, pushed a needle into my own stomach, and injected a foreign substance into my body because a doctor told me a number on a lab report was going to kill me.

That was the lowest point of my life.

What I did not know yet is what the data actually said about the drug I was injecting.

🧵

The FOURIER trial was the largest study ever conducted on Repatha. 27,564 patients. Published in the New England Journal of Medicine.

The drug crushed LDL cholesterol by 59%. The press release said it reduced cardiovascular events by 15%. Doctors celebrated. Amgen's stock price soared.

Then in 2022 independent researchers obtained the original clinical study report from European and US regulators. What they found should have made front page news. It did not.

There were significant inconsistencies between the raw trial data and what was published.

After readjudication:

113 cardiac deaths on Repatha.
88 cardiac deaths on placebo.

28% more people died of cardiac causes on the drug than on nothing.

The drug I was injecting into my body on my bathroom floor had more cardiac deaths than a sugar pill.

Nobody told me. Nobody told any of us.

This is not the first time a cholesterol drug killed more people than it saved.

In 2006 Pfizer ran the ILLUMINATE trial on torcetrapib. 15,067 patients. The drug raised HDL by 72% and lowered LDL by 25%. On paper it was perfect.

82 deaths in the drug group. 51 on placebo. A 58% increase in mortality.

Pfizer's CEO called it "one of the most important compounds of our generation." Two days later they pulled it and told every patient to stop immediately.

Read 11 tweets

Mark Kaplan

@markkaplan20

May 20

I had a heart attack at 52. My cardiologist put me on 80mg of Lipitor.

Within months I started losing my memory.

He switched me to Crestor. Then Repatha. Nobody asked why a cholesterol drug was affecting my brain.

I fired my cardiologist. I healed myself. This is the thread about what I found.

🧵

After my heart attack I was told to lower my cholesterol. That was the priority. That was the entire plan.

Nobody mentioned that I carry the APOE4 gene. Nobody tested my fasting insulin. Nobody explained that the drug they gave me crosses into the brain.

I asked my doctor one question. "What does lowering my cholesterol do to reduce my Alzheimer's risk?"

He could not answer it. Because the answer does not exist.

A few weeks ago I posted about Alzheimer's as a metabolic disease. 604,000 people read it. Doctors debated it. People sent it to their cardiologists.

The data is clear. Alzheimer's deaths up 134x since 1960. Type 2 diabetes up 8x. Obesity up 3.2x. Same timeline. Same inflection point. Same curve.

This is not genetics. Genetics do not change in 60 years. This is metabolic disease.

But I left something out of that thread. The statin part. The part nobody wants to talk about.

Read 14 tweets

Mark Kaplan

@markkaplan20

May 20

I've watched vegans and carnivores fight each other for years.

Keto vs paleo. Plant-based vs animal-based. High fat vs low fat.

Everyone thinks their tribe is right.

So I went looking for real tribes.

Not internet tribes. Actual civilizations. People who have eaten the same way for thousands of years.

Five populations. Five continents. Five completely different diets.

One thing in common.

Zero heart disease. Zero Type 2 diabetes. Zero Alzheimer's.

All of them.

Five populations on five continents. Five completely different diets.

The Tsimane in Bolivia eat wild game, fish, and plantains. The Maasai in Kenya eat meat, blood, and milk. The Kitavans in Papua New Guinea eat tubers, fish, and coconut. The Inuit in the Arctic eat seal, whale, and caribou. The San Bushmen in Southern Africa eat wild game, roots, and berries.

Some eat almost all meat. Some eat mostly plants. Some get 75% of their calories from fat. Some eat high carb.

Zero heart disease. Zero Type 2 diabetes. Zero Alzheimer's. All of them.

The experiment has already been run. Not in a lab. On entire civilizations.

The Tsimane of Bolivia have the healthiest arteries ever recorded in any population on earth. Published in The Lancet in 2017. 705 adults were CT-scanned. Coronary artery disease was five times less common than in the United States. An 80-year-old Tsimane had the vascular age of a 55-year-old American.

The Maasai of Kenya eat a diet that is at least 60% saturated fat. Meat. Blood. Milk. George Mann studied 388 men in 1964. Average total cholesterol was 130. They were virtually free of heart disease. On the highest saturated fat diet on earth.

The Kitavans of Papua New Guinea eat tubers, fish, coconut, and fruit. Staffan Lindeberg studied them for years. No heart disease. No stroke. No diabetes. No obesity. Despite eating a high-carb diet. The difference. Their carbs were unprocessed.

Read 7 tweets

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