As the head of the Global PAD Association, I’ve met countless doctors who treat peripheral artery disease. But when I interviewed Dr. Lily Johnston of Scripps in San Diego for our 2025 Global Excellence Award, I knew her approach was something special that every PAD patient needs to hear about.
[Watch the full video interview below]
“The operations that I perform are an anatomic solution to a system-wide body problem,” she told me. “One of the reasons that our patients have this revolving door of ongoing procedures is because we haven’t done anything with procedures alone to address the illness that caused this plaque to form.”
Understanding the Root Causes of Peripheral Artery Disease
Dr. Johnston uses a powerful image that helps patients understand what’s happening in their bodies. She describes PAD as a “fire in the arteries” that keeps burning unless you address the source. “Whatever started this fire in the arteries that is causing plaque to form will keep happening if we don’t do something to understand why it’s happening in the first place,” she explains.
Instead of just focusing on the blockage itself, Dr. Johnston looks at what’s causing inflammation in your blood vessels. She starts by checking for signs of what doctors call “metabolic syndrome” – a combination of high blood pressure, high triglycerides (a type of fat in your blood), low HDL (the “good” cholesterol), high blood sugar, and increased belly fat. Having three or more of these conditions can predict problems with your arteries long before you feel any symptoms.
How Inflammation Affects Your Arteries and Blood Flow
“Inflammation and oxidative stress is really what sets things off in the artery wall,” Dr. Johnston explains. “Plaque is just the body’s attempt to repair an injury in the blood vessel wall. Your body’s trying to help.” Understanding this helps patients see that plaque isn’t just something bad happening to them – it’s actually their body trying to heal damage.
PAD Symptoms: Why Waiting Until You Feel Pain Is Too Late
One of the most shocking things Dr. Johnston pointed out is how differently we approach heart disease compared to other conditions. “Why on earth do we not have mandated screening for the number one leading cause of death in the country and in the world?” she asked. “We screen for breast cancer and prostate cancer and colorectal cancer, but not cardiovascular disease.”
This means most people don’t discover they have PAD until they already have significant blockages. “By the time you come to me with pain in your legs when you walk, we think that represents an 80% narrowing in your artery somewhere,” she explained. “What if we could figure out that you were prone to developing this when it was a 10 to 20% piece of plaque that did not limit blood flow? Now we don’t have to pick out the big guns necessarily.”
GLP-1 Medications and PAD: What Patients Should Know
I asked Dr. Johnston about the popular weight loss medications like Wegovy and Ozempic (known medically as GLP-1 receptor agonists) and whether they help with PAD. Her answer shows how connected our metabolism is to our blood vessel health.
“These medications help reduce the fat that builds up around the organs—that fat is inflammatory,” she explained. The research shows these medications can help people with PAD walk farther and have fewer heart problems. But Dr. Johnston emphasizes you don’t necessarily need expensive medications: “Do we have other strategies that may contribute to improved metabolic health before we get to those medications? Absolutely.”
Simple Lifestyle Changes That Improve PAD Symptoms
What I love about Dr. Johnston’s approach is how practical she makes it for patients who might feel overwhelmed. Instead of giving people a long list of lifestyle changes, she offers what she calls a “menu of things.”
“Look at all the different things we could do. Which of those feels easy right now? Pick one, just pick one,” she advises patients. This might mean cutting out sugary drinks, improving sleep habits, or taking a 15-minute daily walk. “Get a win and then build that confidence in yourself that you have capacity to change. And then as you build that confidence, then we move on to harder things.”
I’ve seen this work in my own family. My father, who’s 83, called me excitedly after a dinner out where he’d ordered both a beet salad and lamb chops. Instead of just picking at the salad to save room for meat (as he would have done before), he ate the entire salad first, prioritizing the healthier food. These small choices add up to big changes over time.
Dr. Johnston believes many people don’t even remember what it feels like to be truly healthy. “I think part of the problem in our current society is we have so many things that make us unwell that we forget what it feels like to feel good,” she notes. As patients make positive changes, they often rediscover energy and wellbeing they thought was gone forever.
Supplements for PAD: What Works and What Doesn’t
Another area where Dr. Johnston stands out is her approach to supplements. When I talk to PAD patients, questions about supplements are among the top three things they ask about. Many doctors dismiss supplements entirely or avoid the conversation, leaving patients to figure it out alone.
Dr. Johnston takes a more balanced approach: “I treat supplements like medications. They are an exogenous substance that we are giving or taking to achieve a very specific effect.” She doesn’t recommend the same supplements for everyone, but instead looks at each person’s specific needs based on testing.
She’s honest about what the research does and doesn’t show. “Is there evidence that supplementing vitamin D above and beyond a critical level will absolutely reduce your risk of heart attack or stroke? Absolutely not,” she says clearly. “But I do think that there is some evidence that it may support good immune function.”
This approach resonates with me personally. When my mother and I sought advanced metabolic testing and asked her doctor about supplements, the doctor dismissively said, “Well, I hope you feel like you’re getting your money’s worth. I don’t believe in supplements. They don’t do anything.” This kind of response shuts down patients who are trying to take an active role in their health.
Finding the Right Specialists for Comprehensive PAD Care
Dr. Johnston acknowledges that our healthcare system makes it difficult to have the in-depth conversations needed for personalized care. “These discussions are not brief. They are not black and white or entirely straightforward,” she says. That’s why she’s created a separate clinic and appointment structure for these comprehensive evaluations.
She recognizes not every doctor can provide this level of care, but encourages patients to advocate for themselves by asking for referrals to dieticians, cardiologists, physical therapists, and other specialists who can help with different aspects of vascular health.
What makes Dr. Johnston truly special is her compassion. When I asked about a defining case in her career, she shared a moving story about a patient with severe Parkinson’s disease who had limb-threatening ischemia (severely restricted blood flow). After thoughtful discussions about options, he chose a palliative amputation but sadly passed away from complications days later.
“I was haunted by my choices,” she admitted. Later, she received a card from his family thanking her for the compassion she showed. “The lesson for me was it doesn’t really matter what you pick and it’s not your choice. It’s his. It’s your patient’s choice. And sometimes the best healing we do is with our hearts, not our scalpels.”
Different Types of Arterial Plaque Require Different Treatments
Looking toward the future, Dr. Johnston believes we’ll increasingly understand that different types of plaque have different causes – and need different approaches. “Patients with insulin resistance and diabetes have one type that leads to plaque. Smokers have a separate type. Patients with autoimmune disease have a different inflammatory problem that leads to plaque,” she explains.
This means that your treatment should be tailored to what’s causing your specific type of plaque. At the same time, she emphasizes that her approach doesn’t replace standard treatments: “Nothing I do replaces the guideline-directed therapy. We have to build upon the foundation if it’s not enough.”
Questions Every PAD Patient Should Ask Their Doctor
So what does this mean for you as a patient? Don’t be afraid to speak up and ask questions at your next appointment:
- What type of plaque do I have?
- What’s causing my blockages?
- Can you check my metabolic markers (blood pressure, triglycerides, HDL, blood sugar)?
- Would a referral to a dietician, physical therapist, or other specialist help me?
- Are there supplements that might benefit my specific condition?
How to Advocate for Better PAD Treatment
You deserve doctors who will help you understand the root causes of your PAD, not just treat the symptoms. Dr. Lily Johnston represents what we look for in our Global PAD Impact Awards: a provider who truly transforms how we understand and treat vascular disease. Her approach combines advanced diagnostics, nutrition strategies, and conventional treatments to create personalized plans that are changing lives—one patient at a time.
Get Help Finding the Right PAD Doctor for You
If you have questions about PAD or need help finding a doctor like Dr. Johnston who understands the importance of addressing root causes, please call our Leg Saver Hotline at 1-833-PAD-LEGS (1-833-723-5347). Our team can connect you with resources and help guide you to appropriate care.
I also encourage you to join our supportive community of PAD patients and caregivers in our Facebook support group at padsupportgroup.org. Connecting with others who understand what you’re going through can make a tremendous difference in your journey.
Kym McNicholas is the Chairman/CEO of the Global PAD Association and host of the Global PAD Impact Awards.
Global PAD Impact Awards - Important Disclaimer
A
ward Clarification and Patient Guidance
The Global PAD Impact Awards are not an endorsement of any award recipient’s medical practice, research, or clinical services. These awards are:
Based on specific, carefully evaluated criteria
- Nominated by patients who have experienced care
- Selected by a diverse panel including patients, physicians, and clinical experts
- Important Patient Guidance
Receiving this award does not guarantee that a particular healthcare provider is the right fit for every patient’s unique medical needs. Peripheral Artery Disease (PAD) is a complex condition that requires personalized medical attention.
Choosing the Right Healthcare Provider
If you need assistance in selecting a healthcare provider for PAD:
Contact the Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS
- Speak with experienced professionals who can guide you through the process of finding the most appropriate doctor for your specific presentation of the disease
- Remember: Every patient’s medical journey is unique. Professional consultation is crucial in making informed healthcare decisions.
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