I Did Everything Right - And Still Had Plaque in My Arteries | Simon Hill | The Proof EP#439

Key wellness strategies, self-care, and productivity takeaways

1) Use a “cumulative exposure” mindset

• Atherosclerosis risk reflects lifetime exposure to LDL/ApoB—think “area under the curve.”
• Eating well now doesn’t guarantee you won’t have plaque, especially if ApoB/LDL exposure was higher earlier in life.

2) Track the right metabolic biomarkers

• ApoB is emphasized as the best lipid marker because it reflects the number of atherogenic particles.
• Other factors that independently influence risk include:
  • Blood pressure
  • Insulin resistance
  • Inflammation
  • Lp(a)
  • Genetics

3) Diet strategy: high-fiber, protein-forward plant-based pattern

An evidence-based “whole foods” approach:

• Shifted around age 30 to a fiber-rich plant-based diet with higher protein:
  • 1.2–1.6 g protein/kg/day
• Protein sources:
  • Tofu, tempeh, seitan, plant protein powder
• Fiber-rich foods:
  • Beans, chickpeas, lentils, edamame, nuts, seeds
• Carbohydrates (mostly whole foods):
  • Legumes, oats, potatoes, rice, sourdough
• Fats:
  • Mostly unsaturated (e.g., olive oil, avocado, nuts, seeds, soy products)
• He reports that a higher-fat / moderate-carb plant pattern improved how he felt and lowered ApoB.

4) Exercise strategy

• Strength training: 3–4x/week, about 1 hour/session
• Cardio: padel 4–5x/week
  • Notes an injury recovery period; during downtime he did more bike
• Reports lab-measured VO2 max ~51 (suggesting mid-to-high 50s now)
  • Uses steady, enjoyable cardio he can sustain.

5) Sleep strategy: make sleep a controllable routine

• Prioritizes consistent ~8 hours nightly.
• Uses a “bedtime lever” since he naturally wakes around 6am:
  • In bed by about 10pm to make 8 hours possible
• Sleep quality tactics:
  • Avoid bright light and stimulating activities (e.g., email) for a few hours before bed
  • Keep the room/bed cool, dark, and comfortable
• Mentions using 8 Sleep temperature-regulating technology for recovery.

6) Supplements: intentional minimalism during the “experiment” phase

Between scans:

• Took no artery-targeting supplements to avoid confounding results.

• Only:

  • Multivitamin
  • Creatine
  • ~1.5g omega-3 (EPA/DHA)
  • Prebiotic powder Afterward:

• Added aged garlic extract (2400 mg/day) as an additional plaque/calcification lever (separate from lipid lowering).

7) Medication strategy: treat based on targets + risk context

After the second scan:

• Started a PCSK9 inhibitor (Repatha/evolocumab; previously started with another and switched).
• Goals:
  • Target ApoB ~40 mg/dL or lower
• Rationale includes:
  • Current ApoB wasn’t at guideline/desired intensity for his profile
  • Imaging evidence (e.g., GLAGOV) suggests more plaque stabilization/regression with lower ApoB/LDL
  • Preference for monotherapy because lifestyle already moves his numbers substantially
  • Adherence advantage vs daily statin pill burden
• Important note:
  • He is not anti-statin; statins remain first-line for many people.

8) Measurement/productivity-adjacent “quality control”

A key caution:

Don’t over-trust short-interval plaque scan changes—especially when measured by different AI platforms.

Practical guidance:

• If tracking plaque over time, pick one provider/platform and stick with it
• Ensure scans are comparable (same center/settings; ideally longer intervals)
• References guidance that serial scans are generally years apart, not ~1–2 years.

9) Stress/wellbeing: mindset rather than avoidance

• Uses a perspective-based approach:
  • Acknowledge irritation quickly
  • Address what can be changed; release what can’t
  • Return to small pleasures and gratitude
• Framed as avoiding stress loops (not avoidance).

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Presenters / sources mentioned

Presenter

• Simon Hill (aka “Simon Gill” in subtitles; host of The Proof)

People / institutions / studies

• Dr. Matthew Budoff (Lundquist Institute; CTA imaging expert)
• Dr. Robert Green (medical geneticist; genomic profiling)
• Dr. Michael Eisenberg (Stanford urologist; Swimclub 90-Day Protocol reference)
• Dr. Campbell Rogers (HeartFlow Chief Medical Officer; referenced for an additional episode)
• Lundquist Institute (Los Angeles, CA)
• Deakin University (Melbourne)

Studies / guideline sources

• NEJM study (Denmark/Spain scans; asymptomatic adults and plaque prevalence)
• GLAGOV (PCSK9 inhibitor + statin; plaque regression vs LDL lowering)
• REACT (NEJM; atherosclerosis in asymptomatic patients; uses QAngio)
• Miami Heart Study (JACC: Cardiovascular Imaging; discusses AI quantitative CT overestimation)
• 2026 ACC/AHA dyslipidemia guidelines (released March; treatment targets)
• American College of Cardiology (ACC) statement on quantitative plaque analysis / serial scan intervals

Sponsors / commercial sources

• 8 Sleep
• I AM 8
• Swimclub (and Swimclub 90-Day Protocol)
• Upwork
• Aged garlic extract (supplement brand/product context; no brand specified)