126-How Inflammation Drives Heart Disease

Prepare to shatter myths surrounding heart disease with our guest, renowned cardiologist, Dr. Joel Kahn.  Together, we delve into the world of inflammation, its role in heart health and how to effectively combat it. What if I told you that your lifestyle choices can override your inherited predispositions to disease? Yes, you've heard it right! Witness this phenomenal revelation, as Dr. Kahn shares his insightful journey from traditional cardiology to a more holistic approach.

We're not stopping there! We dig deeper into heart disease, shedding light on the detrimental role of inflammation, the significance of routine blood tests, and the potential of natural ways to lower blood pressure. We don't ignore the power of the mind either. Imagine how probing into childhood trauma could help with heart disease and longevity? Fascinating, isn't it? This episode doesn't shy away from hard-hitting facts.

Finally, we get candid about the often overlooked importance of screening for heart disease and the potential of reversing its effects. Dr. Kahn shares his wisdom on omega-3 deficiency, the merits of a plant-based diet, and the magic of fasting programs. With our guide, get ready to adopt healthier lifestyle choices, transforming not just your heart health, but your life. Tune in to this episode of the HealthLongevity Secrets Show and arm yourself with the knowledge you need for a healthier, longer life. No spoilers, but we're also revealing some secret tips for longevity and healthy living. So buckle up for the ride of a lifetime!

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Transcript

Speaker 1: 0:02

Welcome back to the HealthFond Jeopardy Secret Show, and I'm your host, dr Robert Lufkin. Today we'll be speaking about the important topic of heart disease, which, of course, is the number one killer that we all face. And today we'll be discussing the effect of inflammation and how it drives heart disease, and this will be done with my co-host, dr Steve Sideroff. We're going to learn not only how inflammation drives heart disease, but also the secrets we can all do to reverse its effects. So be sure to stay to the end of the presentation. Our guest for this discussion is Dr Joel Kahn. Dr Kahn is a respected cardiologist and clinical professor of medicine at Wayne State University School of Medicine. If you're enjoying this program, please hit that subscribe button or, even better, leave a review. Your support makes it possible for us to create the quality programming that we're continually striving for. Also, let us know if there is a certain topic that you would like to see covered or a particular guest that you would like to hear from. And now, please enjoy this conversation with Dr Kahn.

Speaker 2: 1:21

I'm very pleased today to have as our guest Dr Joel Kahn, realizing that the single greatest determinant of longevity is heart disease. And our guest Joel is an expert in this field. Dr Kahn is a practicing clinical cardiologist and clinical professor of medicine at Wayne State University School of Medicine. He's the director of the Kahn Center for Cardiac Longevity and he's written many popular books, including your Whole Heart Solution and Dead Executives, don't Get Bonuses. Welcome, dr Kahn.

Speaker 3: 2:02

A great honor. Thank you, Dr Sideroff.

Speaker 2: 2:06

It's a pleasure to have you here, and I want to mention to the audience that I've been enjoying your newsletters for a long time now and I find them chock full of useful information, so I appreciate you sending them. Keep them coming.

Speaker 3: 2:22

Kind of you. That's the plan and thanks so much yeah.

Speaker 2: 2:26

So, to begin with, why don't you just kind of give us a sense of what got you into the area of longevity and your interest in that area?

Speaker 3: 2:35

Yeah, and it was not a straight path. I think there's a famous meme about reaching the endpoint and everybody thinks it's a straight path and it's a very circuitous. I am beaming to you from suburban Detroit, michigan. I grew up in suburban Detroit, michigan. I'm a real trendsetter here. Six decades later I haven't left, but I did train at University of Michigan and Conventional Medicine Medical School went down to Dallas. Conventional Cardiology became a interventional stent heart attack cardiologist and that concluded training about 33 years ago.

Speaker 3: 3:11

But the only thing other than a really solid academic and clinical training experience was I bumbled into nutrition. Actually, even before medical school I adopted what is now trendy to call a whole food plant-based diet, a vegan diet, something I did in undergrad and I just enjoyed, felt great, knew nothing about it, but it led me on a path of reading about nutrition. When my friends were going to the U of M football games, I was reading nutrition books and that just percolated along for about 20 years. Of course, in the field of cardiology, being able to assist your patients in nutrition education and nutrition advice when data was coming on about the critical role of various nutrition patterns for heart health and longevity was very helpful to them and it became an increasingly big part of my practice.

Speaker 3: 4:05

While I was rushing in and three in the morning and about a dozen years ago I said you know what?

Speaker 3: 4:09

There's a lot of things I don't know, I don't know my body well, I don't know the science of various fitness protocols and sleep issues, and I went back to an integrative training, year-long rigorous program and that was about 10 years ago and I brought that into my practice until about seven years ago. I said you know what I'm just going to focus? I mean rather risky left, a big practice, left the big hospital, left a big cath lab, and that's all I do now. I take the time to talk to people about their current status, very detailed testing to evaluate their inflammation and other markers of potential risk and then put together a program for them centered around healthy lifestyle. And we got to use pharmaceuticals. We use pharmaceuticals but we try and keep that pretty minimum. So I'm a real hybrid now and I've put in 15,000 stents, but I own the trademark prevent, not stents, because I strongly believe we're not reaching people young enough early enough with the idea they never need to develop most kinds of heart disease.

Speaker 2: 5:19

Yeah, right, so there are a lot of variables that go into aging process and longevity. Can you give us your perspective on the primary factors in both aging and longevity?

Speaker 3: 5:33

Yeah, if you read the science and I have to say I read the science a lot, including today, of what's up to date in aging and longevity and is it clear cut? We know all the explanations and we know the proper approach? Of course not. It's very much an evolving field. Some people indicate there's a famous statement the genes load the gun, but the lifestyle pulls the trigger that you may inherit certain predisposition to disease and short life span. But with excellent attention to healthy lifestyle you can overcome that and I do believe that. How much is genetic? Some people put it as low as 8% of longevity. Some of the more recent data can be as high as 40%. There's dispute in science. How surprising. There's always dispute in science. So if your parents made it to a reasonably healthy 90 or 100, you're in a little bit better shape than somebody who lost their parents in their 50s. You're not damned because there's so many exceptions to the rule. But there are longevity genes. A lot of them do affect inflammation and our response and that's always a good factor. You know you're more of a brain guy and I'm more of a heart network guy, but there's a gene called EPO E4, epo, lipoprotein E4. And if your parents should share with you. One or two of the alleles are called, but if you're EPO, e4, e4, your heart disease risk early in life goes up and your brain disease risk in life early goes up. So there's a lot of connectivity between the organs. But that leaves between 60 and 92% lifestyle choices for longevity and maybe the.

Speaker 3: 7:15

You know you can't do a randomized study. You guys have a bad lifestyle, you guys have a great lifestyle. We'll follow you for 50 years. Nobody's going to fund it, nobody's going to stick with it. What you do is you do observational studies and the best are from the Harvard School of Public Health. And if you're around age 50 and you can say I don't smoke, I get 30 minutes of exercise a day, I sleep seven hours a day, my body weight is sort of in that optimal level, I eat a lot of fruit and vegetables, just a better than average diet you may get 12 or 14 extra years of longevity compared to a 50 year old.

Speaker 3: 7:51

That doesn't pay attention to those. That's studies about three years ago, harvard School of Public Health, very similar to maybe the observations by Dan Butener and the Blue Zone's pocket of longevity. That it's about family and it's about faith and it's about community. And it's about food choices, of which legumes are the most common longevity food amongst all the planet. It's about ideal body weight. What destroys it? The oldest woman in the world that's believed to actually have an actual date of survival is Jean Clement. She lived 122. And the last picture I ever saw of her at 121, she had a cigarette in her hand. So it's people like that. They're the exception to the Harvard School of Public Health observations and findings. So we can't change our genes, but we always have the ability to study and upgrade our lifestyle and it's critical for the brain, for the heart, for the cancer risk, for the diabetes risk, for generally just enjoying life.

Speaker 2: 8:58

You mentioned that you are a vegan. Can people have good heart health on other?

Speaker 3: 9:04

diets. Yes, probably you know, and you can have good heart health on a terrible diet, because there are always exceptions to the observations made in nutrition studies, epidemiology studies. You can smoke and live a long life Again, these are always the headlines Died at 103 and ate eggs and bacon every morning. But all we can do as individuals is take the mass of the data and the major trends and decide if we want to apply it or not. So the Mediterranean diet, of course, brought to the United States in books written by a famous University of Minnesota scientist, ansel Keys books very popular in the 60s and the 70s I have copies of them in my library here in my office, just a couple of feet away Popularized the Mediterranean diet Less red meat, less dairy, no processed food, fresh whole foods, often vegetable based, olive oil not butter, red wine, not Coca Cola, and exercise and community. And that remains the most studied pattern. There's a version for the brain Some people may know, called the MIND mind diet that adds a few more brain friendly foods like walnuts and blueberries. There's a version for high blood pressure called the dash diet. That's lower in salt than the average Mediterranean diet, but they're pretty much all the same pattern when you get to junk food we know that's not a good choice to process food.

Speaker 3: 10:35

The common American Western diet the controversy is the popular ones now the carnivore, all meat, nearly all meat. The paleo we mimic our ancestors and the ketogenic diet and frankly, in my opinion strongly. They have short term benefits for some people. But to claim their longevity diets is completely and inappropriately not grounded in science. They're not traditional. I mean, of course, paleolithic diet is a traditional diet of 50 or 100,000 years ago, but we're not quite sure what that diet was. It varied all over the world, just like there's different versions of the Mediterranean diet between Greece and Italy and Lebanon and Israel, and there are variations. But I think it's not scientifically grounded to say I'm going to put butter in my coffee and eat lots of red meat regularly and plan on longevity Really is going to make it, but it's not one you'd put your dollars on at Vegas on the roulette wheel of nutrition choice.

Speaker 2: 11:37

So here we have some pretty common guidelines and ranges, but some of the things that we want to stay away from are in agreement on most of these diets.

Speaker 3: 11:50

Sure Added sugar. I didn't mention, of course, sugar sweetened beverages, high fructose corn syrup. They're quite toxic. A teaspoon is different than eight teaspoons, so some people just need to completely avoid all sugar because they have more of a sugar addiction, but clearly limiting it. I mean, I essentially don't think I ever add sugar to any food I eat, but it's hidden.

Speaker 2: 12:14

Right.

Speaker 3: 12:15

But you do your research, you get your sugar-free barbecue sauce and your sugar-free ketchup and your sugar-free salad dressing and you can dramatically diminish the amount of sugar in your diet.

Speaker 2: 12:25

Can you educate our audience on the different types of heart disease?

Speaker 3: 12:30

Yeah, you know, the big elephant in the room, as the expression goes, is what is called coronary artery disease, more commonly known as hardening of the arteries, atherosclerosis. The fact that about 700,000 Americans a year die related to that illness, usually as a heart attack or what's called a sudden death just found in bed, found on the floor in the bathroom, and usually on autopsy. There's very severe blockages. We're always born with clean arteries. Some animals just will not develop hardening of the arteries, atherosclerosis. They have different physiology than we do. I think dogs are an example of that. But we are a setup. We have a gut and a digestive system and a diet that I think again, predominantly a high saturated fat, high sugar diet will injure our arteries. Other things will, of course drugs, alcohol, predominantly smoking, high blood pressure. But that is the big one. If we could make a dent, decrease the number of heart attacks, strokes, stents, bypass clogged arteries, also throw in erectile dysfunction as a common manifestation of that problem, we would drop mortality and extend lifespan in the United States and other Western nations a lot. It's been the number one cause of death clogged arteries since 1918. So it's a sad tradition that for 104, 105 years we've not been able to knock that number down and get it off the list.

Speaker 3: 14:05

There are other kinds of heart disease. You can have high blood pressure without clogged arteries, and that can be a killer. You have to have a home blood pressure cuff and you have to monitor your blood pressure. There is no watch that's really reliable at this point for blood pressure. There are wearables for other purposes, and I like wearables. You can have leaky valves that are weak hearts. You can have heart rhythm problems, irregularities, the most serious of which, at least in frequency, is atrial fibrillation. That can be a setup for stroke, and then you have heart and brain disease back as a pairing. Again. There's more and more data over the last decade that what ages the brain ages the heart, what ages the heart ages the brain, between diet and exercise and poor sleep, and poor sleep has erupted as perhaps one of the biggest drivers of inflamaging and aging about the brain and the cardiovascular system.

Speaker 2: 15:02

Yeah, so, and that leads into my next question, which is the role of inflammation in heart disease.

Speaker 3: 15:10

Yeah, there have been observations really by pathologists I think Virchow, if I'm pronouncing his name right over 150 years ago, that when you look under the microscope from an autopsy or even visually in a disease segment of an artery there's a lot of components but there's a lot of white blood cells, there's a lot of signs of inflammation and in the more modern era, at least for 100 years, we know that the immune system plays a very important role in protecting our body. Of course, in certain situations like infection, but it responds to stimulation, whether it be poor diet, poor sleep, smoking, high blood sugar, perhaps genetics and overactivity of our immune system. So there's a panel of blood work that is different than the blood test you might get if you suspect you have a pneumonia. There might be inflammation going on and your doctor might check your white blood count or something called your sedrate SED for pneumonia. But we have a panel of blood work for inflammation of blood vessels. The most famous is a blood test available every lab in the world called high sensitivity C reactive protein or HSCRP, and primary care docs have been slow to adopt adding it to the routine panel. But it's a role as a sign that you have excessive inflammation involving your vascular system, your blood vessel system. You have, you know, there's dormant volcanoes and there's active volcanoes, and when your HSCRP blood test is elevated, you have an active volcano in your vascular system and it might be the clue to a future heart attack, a future stroke, a future emergency room visit or, you know, even worse, a sudden death. So that should be a routine test people ask for.

Speaker 3: 16:59

The hardest thing, though, is it's elevated in many people and trying to track down why and what to do about it. What's your weight, how's your diet, how's your sleep? Dental health is worth giving a shout out. People, particularly during the pandemic, have skipped two or three years without a dental exam, without a dental cleaning, and gum inflammation is a huge driver of body wide inflammation and a huge driver of heart events, as well as other diseases, erectile dysfunction, diabetes and dementia. So don't leave the mouth out. The beginning of the gut. It matters a lot.

Speaker 3: 17:34

So inflammation is a big deal and of course, we believe in many brain diseases we share. Of course, there's blood vessels in the brain, so if blood vessels are inflamed, they're going to be involved in you know. Some people will call it a leaky brain syndrome. The blood vessels are inflamed and allow toxins into the brain. Well, when we talk about heart arteries or leg arteries or sexual organ arteries, the blood vessels get inflamed and may allow oxidized cholesterol and white blood cells to accumulate in the arteries and then you're starting to build blockage, starting to build narrowings, starting to build really some people use the analogy it's not a pretty one of pimples in the artery. You know irritated, inflamed, white blood cell rich areas and they may heal and resolve, probably do a lot. But then maybe you know to trigger to why at three in the morning you can't breathe and your chest is heavy and you're calling 911, you've got a very inflamed segment of one of your heart arteries.

Speaker 2: 18:36

So you mentioned the brain and it's a good opportunity for us to bring in the mind into our conversation. And let me ask you for your perspective on the role of mind in heart disease and as well as in longevity.

Speaker 3: 18:55

I'll quote one of my mentors. Many people know the name, dr Dean Ornish, a lifestyle doctor in Sausalita, california for many decades, who was asking questions as a medical student decades ago about the connection between the mind and the body. In his academic training that was downgraded as not a very much importance and he's famous for having asked his professor well, have you never had an erection? Isn't that proof that there's a mind-body connection? It's a funny comment and I hope I didn't offend anybody, but if you think about it you realize there obviously is a mind-body connection. I'll let women decide if they find any analogy they can create. There's a huge connection.

Speaker 3: 19:43

It's often quoted that the root cause of office visits to primary care doctors unscheduled ones, can be linked back to stress some work stress, child stress, elderly parents stress, spousal stress, finance stress, creating maybe lifestyle patterns binge eating, missing the gym, poor sleep, grabbing cigarettes leading to disease, or just that awful feeling. We know when we're stressed, things ache, the back hurts, the energy's down and they may all drive doctor visits when maybe it'll come up. I'm not a specialist on childhood trauma but I do take time with my patients and even just yesterday it just came out at the last minute. A very nice 55-year-old man no, I used to have three children. I only have two children now and one of my children died suddenly and sleep and it led to a wonderful, warm but meaningful 10 minutes of conversation. It's hugely meaningful to probe and discuss that. Of course, it's a very approachable area. I mean whether it be through learning and meditation practice, yoga practice, a simple breathing practice. There's devices. I just finished, right before we logged on 30 minutes of something called a vagal nerve stimulator. I plug in my air and it buzzes away and it's a mind body scientific-based, little wearable device. A lot of people find nature a mind body booster, find exercise a mind body booster.

Speaker 3: 21:24

Humor I think you and I both share the fact that a good belly laugh, laughter, is the best medicine isn't just a meme. It's true, there's a huge connection and a lot of it's through, just without being too obscure. But it's that portion of our nervous system, the autonomic nervous system, split maybe not so simply into this sympathetic fight or flight nervous system. I've got a deadline. My spouse gave me grief today. I'm hungry. But your sympathetic, your adrenaline system is up, your heart rate goes up. Your blood pressure goes up, your blood vessels constrict, your blood sugar goes up. These things in a chronic mode are all adverse to good brain health and good heart health. And there is the other side and that's why I was wearing this. Vagal nerve stimulator is the parasympathetic rest and digest portion of our nervous system, longest nerve in the body, from the brain down to the pelvis, and we can train these things. It may be an app on the phone, it may be a meditative practice, it may be a breathing practice Probably the most impactful study I've ever seen.

Speaker 3: 22:33

I'll give a shout out again.

Speaker 3: 22:35

When Dr Dean Ornish did a series of studies called the Lifestyle Heart Trial, everybody in the active treatment group was trained breathing and yoga and meditation and he documented without question reversal plaque and heart arteries.

Speaker 3: 22:50

But there's a professor, richard Schneider MD, in Iowa, affiliated with something called the Maharishi Institute but also the university, and he did a randomized study of a couple hundred survivors of a heart attack. And survivors of a heart attack go through a process called cardiac rehab or exercise. But half of them were taught a meditation, actually specifically trans and dental meditation, like Jerry Seinfeld and Howard Stern, and half of them were taught just a breathing practice but not formal meditation. Five years later, the heart attack surviving group that taught trans and dental meditation were 50% less likely to have a follow-up heart attack, stent bypass or death. Medications rarely offer a 50% reduction and this was published in 2012 in one of the most premier cardiac journals. But if you think most heart patients are told about it, of course not. It's something they stumble across or will listen to this conversation and something I bring up with my patients.

Speaker 2: 23:52

So this is very helpful, very useful information and, reflecting on my last physical that I took a year ago, I was very surprised that my systolic blood pressure was elevated into the high 130s, and I was further shocked that, in my conversation with my primary physician, the only thing that she suggested was let's wait and see what happens. Essentially, let's see if you'll need medication at some point in the future, and didn't give me all of these alternatives that you and I both know are some things that we could do to make a difference. I am a biofeedback practitioner and I wound up doing biofeedback and some other things and brought my blood pressure down, but I imagine, and based on our conversation, that if someone like me comes into your office, you have many of these different suggestions and tools that you would give them.

Speaker 3: 25:01

Yeah, there's a huge number of natural approaches to blood pressure and you come in at 200, over 130, you're going to leave with a prescription while we work on some of the natural.

Speaker 3: 25:12

Of course we want to do advanced blood work and maybe a simple test like an EKG or an echocardiogram. You might be very deficient in vitamins and nutrients, you might have a kidney problem, you might have a low potassium. You got to do basic, good medical practice that your primary care doctor can do. But if you get beyond that and say, are there natural ways? One observation is and it's just since you brought up your example the American Heart Association teaching on home blood pressure measurements, which I would advise everybody to get a home blood pressure cuff on the upper arm. Just hit a button, the cuff goes up and down. It's a $70 investment that can change your life as much or more than having a home scale or a thermometer or an oxygen meter that many people buy.

Speaker 3: 26:02

Get a home blood pressure cuff, but the official recommendation is always check your blood pressure three times in a row, a minute apart, and I have all my patients do that. Now, if the first time you check it it's 108 over 68, kind of perfect, you can probably stop. But if you're 150 over 96, wait one minute. Repeat it, wait one minute. It's very often 120 over 70. And it's just like a little biology lab of how wired we are to have reactions, our sympathetic nervous system. It's like when I smell alcohol and see cotton swabs I think of being a kid in the pediatrician office. That bitch my blood pressure goes up. It's just like almost automatic. I think when people hear the velcro and feel the pressure the first time around, it's a little stressful. So our nervous system is very quickly responding and can very quickly relax.

Speaker 3: 26:51

But infrared sauna, weight loss exercise. Maybe you need a home sleep study and maybe you need some attention to sleep apnea. Improve your dental health. Stop using mouthwash. People that stop using mouthwash, their blood pressure drops, or at least the mouthwash with antibiotics in it, like listerine and scope. These are published data.

Speaker 3: 27:12

Upgrade your diet. Have a green smoothie. Grab an apple. Have some pomegranates. Eat some beets. Have some ground flaxseed Ground flaxseed is, in my world, a super superstar and lowers blood pressure. Eat more garlic lowers blood pressure. Use biofeedback. Use heart math. Use a vagal nerve stimulator. There's a breathing device it's a little expensive called Respirate, but it's a slow, measured breathing that balances your nervous system.

Speaker 3: 27:42

Many people can avoid prescription drugs or limit their prescription drugs or get off, but you have to do it very carefully. Work with your natural or standard practitioner, I use a lot of ouriometric herbal preps for blood pressure. They might include ashwagandha and bakopa. They have science behind them. I mean I literally could keep on going with. You know, boost your nitric oxide. Some of that can be done through food like beets and greens and pine nuts and watermelon, but there's literally dozens of nitric oxide powders and lozenges. We interviewed one of the world's nitric oxide experts recently for a project I'm doing so. A lot of my patients, including my 90 year old mother, use a little nitric oxide last and shit, oh, really smooths out their blood pressure.

Speaker 2: 28:32

I appreciate all of these different types of approaches. They're really excellent in giving our audience some good suggestions. You did mention some specific lab tests, but I'm wondering what about CT scans of measuring calcium, things of this nature?

Speaker 3: 28:52

Right. So just as a intro, if you think about it, you're 45 or 50 and you and I are a little past that, dr Siddhartha. But we can think back. Your doctor might recommend a mammogram. If you're a woman, maybe a thermogram, maybe an MRI for breast issues, a colonoscopy or the stool test called a colicard. But wait, wait, wait, wait.

Speaker 3: 29:12

Number one cause of death is heart disease. You walked out of there and other than routine, simple blood work, where was the discussion about screening for heart disease? In reality, we have really missed the ball in the Western world the entire world because for over 30 years there's a technology called a coronary calcium CT scan or calcium CT scan. It's about a 10 second test where you're at a hospital or imaging center on a stretcher. You're in a CT scan no IV, no injection, no iodine, no pain, no scare factor, and you hold your breath and then you go home and it's a very odd that in most states it's not covered by insurance. It is covered in Texas. It's also free in the city of Cleveland, which is crazy. In my community of Detroit it's about $75. In some communities in California it can be 150 to 200. They're still taking in a little more profit, but you want to.

Speaker 3: 30:11

That's a screening test. That's the colonoscopy of the heart, that's the mammogram of the heart. You don't do it if you had a bypass, a stent or a heart attack. You don't need a screening test. But certainly if you had a mother, father, aunts, uncles, grandparents, brothers, sisters who've had a stent, a bypass, a stroke, a heart attack. Or if you just want to know, you want to be a zero. I mean I'm 63, 64, and I've been a zero About every 10 years. I do that test. It's pretty good information, Gets me a discount on my life insurance because the actual aerials know that I'm not going to be in a coronary care unit and an expensive admission for a heart attack because I take the time to check my arteries. Coronary artery calcium scan Very rare reason not to do one unless you already have heart disease and maybe never again. Maybe do it once at 50, maybe 10 years later. So a little abnormal. You got a little problem. If it's a lot abnormal, it can be life changing and potentially life saving.

Speaker 2: 31:13

That's. Those are good points to know. I'm curious when we think about we can think about prevention, but I'm wondering if people find that they, for example, have a high number on that or some other indication of some heart disease process that's ongoing or beginning. What's the data on reversing any of these kinds of conditions?

Speaker 3: 31:45

Yeah, it's a great question. I absolutely can say as a cardiologist who may have seen more examples of heart disease reversal than almost anybody, because that's exactly what I do in my clinic. Usually I use, as a substitute, an ultrasound of the carotid arteries, because then we don't have to do a CT scan ultrasound we identify how much plaque garbage. We do it with digital imaging, artificial intelligence interpretation, and a year later we ask the question you got older, are your arteries worse, better or the same? And we see example after example, lifestyle changes, nutraceutical vitamins, maybe prescription drugs, and we see plaque shrinking, plaque shrinking In reality. We have to give a shout out to Nathan Pritikin, the Pritikin Longevity Institute, for identifying clinically in the 1970s and 80s that you can extend life with lifestyle programs. Dr Dean Ornish, who used invasive cardiac catheterization to show you can actually shrink plaque over a five year period and improve blood flow dramatically. Dr Esselstyn at the Cleveland Clinic. We are at a time though it's very exciting and a revolution.

Speaker 3: 33:01

The coronary artery calcium CT scan I mentioned is a great screening test, but we have no scientific basis to believe we can make the calcium go away. In fact, the current feeling is the calcium is the stable part of an abnormal artery. The calcium is the mortar and the brick holding the pathology together. There's a kind of plaque called soft plaque, non-calcified plaque. Unfortunately, you can't see it on that simple CT scan. You have to do a more advanced CT scan In your town. You do it at UCLA, at Cedar Sinai, at Harbor, at the world class, but anywhere in the United States you can now characterize. You do have to inject dye when you get the CT scan. It's a little more radiation, but then the results show you exactly, using artificial intelligence, how much plaque is in your heart arteries, how much is the soft, mushy kind, how much is the hard, calcified kind. And we now have examples in 2021, 2022, 2023 of actually documenting to precision shrinking a plaque, shrinking a plaque, shrinking a plaque very exciting times. And these are all published in large databases.

Speaker 3: 34:13

So we've never been more confident in saying you can shrink plaque, diminish your heart disease, lower your risk. It takes very low cholesterol levels, which can be achieved through diet but often do require either intense supplements or pharmacology. But it's really transformed the way I approach disease. In fact, the current language this is very new is if you're diagnosed with cancer, unfortunately are you stage one, stage two, stage three, stage four. We're now able to address and use that language in coronary artery disease. Is your plaque at which stage? And these are still algorithms getting finalized, but the language has transitioned and obviously we'll approach a stage four heart blockage patient more intensely than we will a stage one. We'll treat them all but exciting times very hopeful. Of course, prevent, not stent. You're far better off not having the disease and not having to worry about reversal. So the earlier you get on the bandwagon of a healthy lifestyle, the better you are.

Speaker 2: 35:23

Would you, if someone has a zero on the, would you then recommend the CTA? Is that very?

Speaker 3: 35:32

Very, very rarely. There there is scientific examples of people who have no calcium, so there's zero. But for some reason we're still concerned. They have symptoms, maybe their stress test was abnormal, and very rarely you'll find somebody who has only soft black. They're usually younger, maybe a smoker, and the calcium score will mislead us. So you still have to talk to your patient, listen to your patient and I, as part of a research study I was a zero but I went on to have these artificial intelligence corner CT angiograms. I took one for the team because it was a little radiation I didn't really need and it just confirmed clean arteries. So I was pleased pretty much.

Speaker 3: 36:15

Absence of any plaque of any kind and I'm a good calling card for lifelong healthy lifestyle does actually matter because I've been doing this for a long time but it's pretty rare. When you're a zero, don't go out and celebrate with a cigar and a hot fudge Sunday. But you do need less intense lifestyle modification or you certainly rarely need drugs. If your calcium score is zero, you don't need statins. American Heart Association says if you get a calcium score and it's zero and let's say your cholesterol is 220, the cholesterol medicine your doctor gave you may well be unnecessary. So a radical different approach than is done in most clinics.

Speaker 2: 37:00

But it is already incorporated into the language of the Canadian Heart Association, the American Heart Association, Right right, We've covered a wide range of areas here, but is there anything that we missed in terms of lifestyle measures to lower inflammation?

Speaker 3: 37:19

There's a couple of simple tests people can do that are in the scientific literature. There was a study out of Harvard, published about two years ago, that if you can drop down and do 40 push-ups in a row versus not being able to do that 30, 20, or less than 10, it predicts your next 10 years of heart healthy lifestyle, as well as a stress test or other measures. So when we're done with this interview, everybody can maybe with knees on the floor or maybe you can't do it, but if you can run four flights of stairs in about a minute, it predicts exceptionally low risk, as if you had a formal stress test. There's actually one if you can do 30 squats in 45 seconds. All these have been studied and compared to other formal measures, so that is not directly inflammation, but they are useful and easy to do. There's actually interesting data about hand grip strength that you can actually buy online a little hand meter if you really want to see a number, or you can buy those muscle strengthening hand grip spring devices. But as you get older, hand grip strength is a very good predictor of frailty, muscle loss, increasing morbidity. So pay attention to these little things. And then, finally, I just say blood work, most of the time at the doctor's office do the exact same blood work we did 30, 40 years ago, so full advance available at Quest, at LabCorp, local hospitals.

Speaker 3: 38:48

We mentioned one, your high sensitivity C reactive protein. I'll just mention one other. There's a very inflammatory cholesterol particle called lipoprotein A, lipo protein and A is a lower case A. In fact it's sometimes read as lipoprotein little A and in the last 60 years since it was discovered, we've learned that about 25% of people on the planet get from their parents the ability in their liver to make two kinds of cholesterol the regular one, your doctor's checking, but this unique one called lipoprotein A, completely genetically determined. But I want to go back 25% of people, that's maybe 90 million Americans and one and a half billion or plus worldwide, and this particle, which you will start making from childhood, your entire life, is inflammatory as all get out, causes blood clotting and causes irritation of arteries leading to plaque. It's about a $30 blood test only in the last couple of years.

Speaker 3: 39:52

There are now societies recommending, like the European Society of Cardiology, everybody should have this check, maybe at age 20 once and modify the lifestyle If you find out you're in the 25%. Eat better, move more, stop smoking, get your body weight better. I've been ordering these this lab for about a dozen years, so literally thousands of patients. It's amazing how it has an impact potentially on your heart health, not having it as a good thing. We don't know any benefit to inheriting it. That's a interesting question of our makeup. But we do know that in some people it can determine your lifespan, your risk, heart attack and stroke. So get a lipoprotein, a inflammatory particle, blood level.

Speaker 2: 40:38

So one of the things that is being highlighted in our conversation is the importance of awarenesses, different awarenesses, like of this genetic awareness of your calcium awareness, of different blood levels. All of these things are important for people to be aware of so that they know how the kinds of changes they may need to make in their lifestyle, in their lives, absolutely.

Speaker 3: 41:09

Somewhere there's a quote about knowledge is power and I would say applied knowledge is power. If you find out but you don't do anything, then it didn't really alter. But that is really again you ask me, as heart disease reversible? It's preventable and reversible, the majority of people. It's much easier if you start early, if you knew at age 40, and that's late but that you had some calcium in your arteries or your lipoprotein A or your C reactive protein, or you spoke to your mind body balances off and you're living in a chronic chistrate situation. Make the changes, get on board and use mind body practices.

Speaker 3: 41:51

The number one symptom this is a very profound statement of atherosclerotic heart disease. The number one, most common symptom is sudden death. Yes, some people get shorter breath, some people get chest tightness called angina, some people feel weak, but being dead is the number one, most frequent first symptom. So waiting till you get a clue can be a very adverse, lethal and sad choice. We should be much more aggressive and the good news is the heart CT scan can be under $100 or go to Cleveland. It's free at the university. The blood work can be covered by insurance. Eating healthy isn't expensive. Sleeping is an expensive. Sleeping seven and a half hours isn't necessarily expensive. So this is not a lecture for the elites. This is a mass attack on lowering heart disease fatalities.

Speaker 2: 42:45

Yeah, yeah, these are very good points and unfortunately, from a psychological perspective, people wait until symptoms get to the point where they must do something, instead of earlier on, where they get some symptom, and now they begin to ask themselves what can I do differently? And that's the earlier you catch symptoms and I'm hearing you say something very similar the more benefit you're going to get by the changes you make.

Speaker 3: 43:18

Absolutely. I think people credit. Pythagoras was saying don't dig your grave with your fork in your spoon. I like that one so much. Of course he's also credited to have been one of the first plant eater vegetarian vegans, going back 2,500 years ago or so. And yeah, you just don't want to wait. You want to. You know. That's why I wrote a book called Dead Exx Don't Get Bonuses. My wife said you can't put that title on a book. I said I don't want a gentle title. I've seen people die in my 33, 34 year career of cardiology. I've seen tragic. We've all seen, and I think we're seeing more than ever sadly, younger people with tragic sudden deaths. So we can't stop them all. But this conversation can do a lot. Just people have to listen and act. Ask your doc for some of these testing. Read a book, go online and study this a little bit more.

Speaker 2: 44:14

Yeah, no-transcript.

Speaker 3: 44:22

A lot of people are low in omega-3. I didn't mention it another brain-hard overlap. The number one most common nutrition deficiency in my clinic is omega-3. There's a blood test there's two of them One's called the Omega Check and one's called the Omega Index. They both work so upping your omega-3, and no human makes omega-3. So we either have to eat salmon, sardine, mackerel, chia seeds, ground-flag seed, hemp parts, walnuts, or we take omega-3, or we do all of that.

Speaker 3: 44:55

Good at lowering cholesterol, good at lowering blood pressure, good at lowering inflammation. You know a whole brightly colored rainbow. Fresh fruits and vegetables rich in antioxidants and plant nutrients will lower inflammation. A classic study at New York University 100 patients after a heart attack put on a brightly colored plant vegan diet or put on the American Heart Association diet, the plant diet lowered inflammation more than the American Heart Association diet. Nobody was eating KFC buckets. These were already better than average diets.

Speaker 3: 45:28

Lowering inflammation. Vitamin D maybe to some degree. We always shout out turmeric, curcumin, maybe very helpful in certain people. Lower inflammation I mean addressing the root cause. Are you overweight? You need to do some kind of fasting. We maybe don't talk enough about something called the Prolon 5-Day Fasting, mimicking Diet, which is available as a food product that supports lowering inflammation levels and has some brand new data about its impact on preserving brain function and cognitive function. So you might have to use some fasting programs. You know, address the sleep, address the dental health, you'll see inflammation come down. Just one in the United States 75% of people are overweight or obese and a roll of fat around the waistline is a very inflammatory physical structure. That's medical science and healthy weight loss, not crash diets and probably not an all meat diet, but healthy diets. Mediterranean diet reverse a lot of that. The Mediterranean diet is a very anti-inflammatory diet.

Speaker 2: 46:38

Well, I'm appreciating this conversation very much. It feels like I have a direct link into the Journal of the American Medical Association with all of your great references that you're giving us, so I appreciate that. As a final question, I just wanted to check in if there's anything in the area of longevity other than what you're working on that's very exciting to you, that you want to share with our audience.

Speaker 3: 47:08

I think you know, from my perspective, the most important step in living a long, healthy life begins with cardiovascular health, and you know you can be taking. I can name you 50 supplements, from NMN to NAD to nicotinamide, riboside to C, buckthorn and on and on. That might resveratrol, of course, but if you don't know your calcium score and your C-reactive protein and your lipoprotein A and maybe the health of your carotid arteries, you know those supplements and even the prescription versions metformin, rapamycin, disetinib. These are drugs that are being used in certain clinics as anti-aging. Don't fool yourself. Check your heart first. That's the best longevity program, the proven longevity program, the Blue Zones, mediterranean Diet, harvard School, public Health Lifestyle lessons we've learned, and if you have optimal cardiovascular health, then maybe adding on some of these longevity programs may be beneficial.

Speaker 3: 48:08

I'm in a double blind randomized study of a drug called rapamycin. I'm a participant. I don't know if I'm getting a placebo for a year or I'm getting a active drug. This is a FDA approved drug for kidney transplant patients to suppress rejection, but in a very low dose. There's very hopeful data that may be an anti-aging drug. Most people feel it's probably the most hopeful drug, but I don't prescribe it to my patients. I invited them into this research study and a couple have entered, but it's a pain. I'm getting blood work all the time, I'm getting dexa scans and I'm doing stool tests. It's real research and I wanted to contribute and I may say I did a lot of stuff and all I got was a placebo for a year. But that's how science goes. So that's probably the one that I would give a shout out to as cutting edge, but we need research, so I'm doing it the way I think we ought to do it in randomized studies.

Speaker 2: 49:04

Yeah, yeah, I agree with you. This conversation has been really very informative. Dr Khan, I'm wondering. I enjoy your newsletter. If people want to reach out, get on your mailing list, get your newsletter, which has huge amounts of information, or reach you, how can they?

Speaker 3: 49:25

do that. Yeah, if you go to my main website, drjolkhancom, and that's d-r-j-o-e-l-k-a-h-ncom, at the bottom of the website there's a place to put in your email and get the newsletter not selling anything, and it comes out once a week. Like you said, at the top of the website is a link to a weekly podcast I do on iTunes and Spotify called HeartDoc VIP. It's under 25 minutes every week because my sanity only allows short podcasts and my listeners seem to appreciate short podcasts, and certain books that I've written are listed there too. So thank you for that, and I have an active practice. I mean, I beat myself up seeing people from all over the world. It's busy, but if you've got a clinical problem licensed in California, we discuss that in all over the place, even though I'm centered in Michigan.

Speaker 2: 50:18

Right, so thank you very much, and it's good to know that you're there and doing such good work, so we appreciate your time today, thank you.

Speaker 3: 50:27

Thank you.

Speaker 4: 50:29

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