24. Can You Reverse Heart Disease? | Ajay Joseph, MD

Fascinating conversation with Dr. Ajay Joseph, an interventional cardiologist from Tulsa who's doing something remarkable.

He spends 4 days a week putting stents in patients' hearts, and 1 day a week teaching them how to cook healthy meals so they never need stents in the first place.

Here's what stopped me in my tracks:

→ 90% of heart attacks are preventable

→ Researchers have actually proven you can REVERSE plaque buildup through lifestyle changes

→ It's the soft plaque (not the hard calcified stuff) that causes most heart attacks and strokes

His perspective really hit home: "Putting in stents is like mopping the floor while the faucet is still running. Someone's gotta mop, but we should also turn off that faucet."

The story that got me was about his patient who needed stent procedures every 6 months for years. After changing his diet and starting to exercise, he hasn't needed a single procedure in 4 years!

Now this patient drives an hour to Dr. Joseph's cooking classes just to share his story with other patients!

Dr. Joseph runs programs where patients learn to cook, manage stress, and understand how their daily choices connect to their health outcomes. It's not about perfection - it's about sustainable progress over time.

What struck me most: every medical specialty has patients they can't fully help with traditional treatments. Fatty liver, early-stage Alzheimer's, diabetes complications - these are the conditions where lifestyle medicine can make the biggest difference.

Worth listening to the full conversation on the Move Eat Give podcast if you're interested in how we might prevent rather than just treat chronic disease.

LinkedIn: Ajay Joseph, MD

Click Here to:

Donate Your Weight  & celebrate your weight loss victories!

(Donate $1.00 for every pound you lose to help fight hunger. Proceeds benefit a food pantry near you!)

Follow along on all your favorite platforms as we try to make Boerne, the #HealthiestSmallTown in Texas!

https://interrupthunger.org/
"Lose Weight while Feeding the Hungry"

Contact us:
jollie@interrupthunger.org

@InterruptHunger  Facebook
@InterruptHunger Instagram
@InterruptHunger LinkedIn

Transcript

Ajay Joseph (00:00)
When you're born, you have clean blood vessels, beautiful blood vessels. When as about teenagers, when small bits of plaque start depositing in your blood vessels based on the way we eat, the McDonald's, the Denny's, all the fast food, that plaque just gets deposited within your blood vessels.

And over time that plaque starts getting hardened up and becomes calcified, becomes really hard. And the calcified plaque is very difficult to reverse. It's almost impossible to reverse it because it's just really hard. But that's not really the cause for concern. It's the soft plaque that causes all the problems. The heart attacks, the strokes, it's the soft plaque that causes most of the problems. That soft plaque, you can reverse it. And that's what Dr. Dean Ornish and Esselstyn have already shown. That soft plaque, you can reverse it.

With good food, all the greens, the whole greens and all that, you can actually reverse that with food, exercise, with lifestyle changes.

Jollie (03:07)
Hi everyone, Jollie here with Interrupt Hunger's Move Eat Give podcast. Thanks for joining us. Today we've got Dr. Ajay Joseph all the way from Tulsa, Oklahoma with us. Dr. Joseph, thank you so much for joining us.

Ajay Joseph (03:19)
Thank you, Bill. It's my pleasure.

Jollie (03:21)
So why don't you tell us about yourself and your practice to get started?

Ajay Joseph (03:26)
Yeah, I am an Intermanagement Cardiologist and to make that simple, I'm the guy who you come to when you have a heart attack or when you have some chest pain. That's what I've been trying to do, put stents in for blockages in your heart, your legs and all of that. But I'm more passionate about this whole field of lifestyle medicine, which is about 20, 25 years old, but really touches on the root cause of what we're dealing as a country, as a health system, be it strokes, diabetes.

heart disease, dementia, you name it. 85 % of what I see in the hospital is from my lifestyle choices. And that's what I do part-time. Four days a week I put stents in and fix blockages, but one day a week I teach patients how to cook healthy meals and exercise and sleep better and handle stress better. So that's me.

Jollie (04:11)
Yeah, that sounds fun. So on one hand, you're catching people at their absolute worst after they've made really a lifetime of unfortunate choices versus the alternative. so which one is getting more folks healthy?

Ajay Joseph (04:27)
I think the way I put it is that when I put a stent in, what I show them is a picture of a guy mopping the floor while the faucet was open. So somebody has to mop the floor. I mean, you've got to mop the floor, but you also got to close the faucet. So both have a place, right? There is a place for medicines, there's a place for tests, procedures, and all kinds of things. But I think what we tend to focus on is more just that. We just try to focus on medicines and procedures, whereas

the, well, that faucet of disease, that's the food that we eat, the way we handle stress, the exercise that we don't do, and the poor sleep, that's kind of the main faucet that's overflowing. that's, so there's a big part of that as well that needs to be addressed. And that's what we, so there's a, the point is that there's a place for both of those roles. And I try to meld both of them together in my practice.

Jollie (05:13)
So how'd you get started with lifestyle medicine? We're meeting more and more folks that are getting certified. How'd you get started so early?

Ajay Joseph (05:18)
Yeah.

It's interesting, it started with my own personal health journey. I was training in Chicago back in 2015 to become a cardiologist and I noticed eating the cafeteria garbage that I was eating in my hospital, my own cholesterol and my sugars were creeping up and then I was almost about to start myself on some pills and for my cholesterol and for my sugars and that's when I met my mentor who is I think one of few people who you can...

you might relate to they change the trajectory of your career, your life, everything, right? So his name is Dr. Kim Williams and he's one of the founding fathers of this whole field of lifestyle medicine. He's a preventive cardiologist at Rush University and I trained under him and I was working with him for about three years and I mentioned all these things to him and he said, why don't we just think about your lifestyle? Why don't we just talk about what you're eating? And then we kind of did a deep dive into what I was eating and then of course it was quite eye-opening and then...

That led to me to the path of lifestyle medicine. And then it's been, I've never looked back since then. My sugars have course dropped, my cholesterol has dropped, and then of course I had to bring that up into my practice as well.

Jollie (06:22)
That's wonderful. So let me ask you, so this is a loaded question for you. Well, roughly what percentage of the patients you see on the interventional cardiology side of your practice could avoid ever having to come to see you if they led a healthy lifestyle.

Ajay Joseph (06:39)
So it's a very nuanced question, right? In the sense, if you're coming in with a heart attack, right? If you're coming with an acute event, a heart attack where your blood vessel is completely blocked up, you have to, of course, go and open it up. But if you ask the question as how much of it could be preventable, up to 90 % of heart attacks can be prevented, nine zero, 90%. 90 % of heart attacks, 90%.

Jollie (07:01)
90%.

Ajay Joseph (07:04)
In fact, coincidentally, just last week, a study was released, I believe, in Land, was a journal of American College of Cardiology, they, well, what they did was interesting. What they calculated was the American Heart Association has what it's called a checklist of all the risk factors. Are you eating healthy? Are exercising? Are you sleeping well? And if you check all the aid boxes, your risk of a heart attack drops down by 88%.

So close to 90%. So to answer your question, up to 90 % of our disease is preventable.

Jollie (07:36)
Yeah, that's something. So I've heard you compare your clinic. I think you use the word roadblock or obstacles that other specialties are seeing and don't know what else to do. And you kind of went through a list of some of the common problems from other specialists. Would you share that story with us?

Ajay Joseph (07:46)
Game play.

Yeah,

it's interesting because every specialty has a pain point that I say that is not being addressed or cannot be addressed or they just don't have enough tools in their toolbox. For example, you have, if you're diagnosed with fatty liver, right, that's one of the most common liver problems that we have. About 33 % of Americans have some stage of fatty liver.

If you have fatty liver and if you go see a gastroenterologist, there very limited options that they have. There are some pills that have just come up recently, but nothing well proven, long lasting without any side effects and all that. So what they do is that they tell you to go home, eat healthy, lose weight, live a healthy lifestyle and all of that. But then how do you do that? That's a pain point from a GI perspective. There's not much they can do about that. Similarly, if you're diagnosed with mild cognitive impairment, which is the first stage of Alzheimer's.

That is again a stage where if you make some dramatic lifestyle changes, you can actually reverse the process. Same thing for that. That's a pain point. There's not much of treatment for that. There are some again treatments, it's exorbitantly expensive, $35,000 a year and all those things. But again, that's another pain point from a cancer survivorship standpoint. If you've survived cancer, you've gone through cancer, there's a lot of data showing that if you live a healthy lifestyle, your chances of recurrence

go down significantly, your chances of a secondary cancer go down significantly, you survive longer. So every specialty similarly has what I call a pain point which lifestyle medicine can fulfill.

Jollie (09:21)
So you're in Tulsa, which is on a lot of lists as being one of the worst, yeah, in the entire country, not just to stay, but in the entire country. I know that there's some folks that are really trying to make a difference. You're making an impact, and Erin Martin and her outfit making a real impact.

Ajay Joseph (09:26)
Round zero.

I was a call with her this morning right before this.

Jollie (09:43)
really? no kidding. Yeah, it's incredible. Sorry, just like random. Are y'all able to work together yet or y'all have some plans?

Ajay Joseph (09:50)
Yeah,

that's exactly what working through. We're working through some logistics of how do we get both these things together. It just makes sense, intuitively makes sense.

Jollie (09:58)
Yeah, yeah,

that's fantastic. tell us, so can you think of a like a success story of one of your patients that, you know, came into you just just a train wreck and and and scared and their family scared and all of a sudden you got you got a hold of them and made help to make some changes.

Ajay Joseph (10:15)
Yeah, yeah.

think one of the patients that I remember was from about four years back and this is a gentleman who had diabetes. He was diagnosed with heart disease of course in his 50s. Had a bypass, three bypasses, multiple stents, think 10 or 15 stents and his sugars were way out of control. A1C was 9.8 or something. And what happens is that when your diabetes is out of control, your stents just keep getting clogged up. Your bypasses just keep...

getting clogged up. That's what happens when your sugar is out of control. So he would come in every six months for a chest pain and we would go back in, find a stent that's clogged up and just balloon it again and he would come back in again in six months. Again, his stents would be clogged up. And then one of his, when I first met him was when I told him, I'm like, know, I'm going to do your ballooning again, but you really need to change your lifestyle. And I had him watch a few documentaries and give him a small little booklet that I have about food.

And after this procedure, his wife and him, he decided, you know what, this is it. We're not going to be doing this every six months coming back with these procedures because each of these procedures have risks. Why would you want to do that? He went gung-ho, changed the way he ate, started exercising. And that was the last time I needed to balloon a stent for him. was four years back. Right. And that was, this is a guy who would be getting a ballooning or a stent every six months for the past 10 years he was being doing that. So the point and

His story was so compelling that I asked him, can you come and share your story with my patients? He would drive an hour away from here, Skokie, which is about an hour away. He would come every few weeks to kind of share his story with my patients when I do my cooking classes. So just to give him, make it more realistic, more human. So that's one story. And there are just numerous stories that I've had of patients who've lost sugar with diabetes, better control, lost weight, fatty liver, reverse.

It just shows the power of lifestyle medicine.

Jollie (12:07)
So how does, first I'll ask you like how it actually helps to reverse or treat. And then we'll talk about like what are the meat and potatoes of your clinic. So somebody with needing a stent, they need an interventional cardiologist. How does lifestyle medicine in your clinic actually reverse their disease?

Ajay Joseph (12:27)
So first off I think we need to understand that when I put in a stent for somebody in their 30s or 40s or 50s That blockage didn't start five months back or a year back that started way back in the teenage, right? It didn't start in In the immediate past or anything it started way back. So that's it's a very slow building process plank buildup is a very slow building process, right?

There are times when these plaque rupture and that's what causes a heart attack and that's when we go in, we just got the whole vessel shuts down, we got to go in and open it up with a stent. But the process of plaque buildup, it's a very slow process. Now if you think about it, let's say you come in with chest pain and I put in a stent and I balloon the plaque up, the plaque all gets smushed to the side, I put a stent in to keep it open. If you don't change the basic process about how this plaque came on, that plaque just keeps building up within the stent.

However, if we change the process, if we first order a business to be the stop what's already building it up, stop what you're doing, right? And then we push back on the plaque, right? We push back on that plaque with food, with exercise, with sleep, with stress and all that. In fact, there is good data. There are actually just two people in the world who've actually shown plaque reversal, right? One is Dr. Dean Ornish at UCLA. He showed that 40 years back, 40 years back.

he showed that you can actually reverse plaque with angiogram. He actually went in, did angiogram, then he saw plaque reversal. And Dr. Colwell Esselstyn at the Cleveland Clinic, again, same thing. He's shown plaque reversal with intensive lifestyle changes. So it's definitely doable, it has been shown, and it's been demonstrated that we just don't give enough importance to that.

Jollie (14:04)
if you stop the injury, so you change, you you're eating good, you're exercising, all this stuff, if you stop the continual injury, does your body just gradually remove the plaque? ⁓

Ajay Joseph (14:18)
The soft

plaque. The soft plaque. So I need to clarify that. If you've got calcified plaque, the plaque starts off as soft. So the way I tell patients is that

when you're born, you have clean blood vessels, beautiful blood vessels. When as about teenagers, when small bits of plaque start depositing in your blood vessels based on the way we eat, the McDonald's, the Denny's, all the fast food, that plaque just gets deposited within your blood vessels.

And over time that plaque starts getting hardened up and becomes calcified, becomes really hard. And the calcified plaque is very difficult to reverse. It's almost impossible to reverse it because it's just really hard. But that's not really the cause for concern. It's the soft plaque that causes all the problems. The heart attacks, the strokes, it's the soft plaque that causes most of the problems. That soft plaque, you can reverse it. And that's what Dr. Dean Ornish and Esselstyn have already shown. That soft plaque, you can reverse it.

with good food, all the greens, the whole greens and all that, you can actually reverse that with food, exercise, with lifestyle changes.

Jollie (15:20)
That's beautiful. Okay, so tell us about your clinic. Yeah, tell us about the lifestyle medicine and how you help folks get healthy.

Ajay Joseph (15:26)
So we see patients in the clinic and we see them for different reasons, right? GI refers their patients for fatty liver, neurology for cognitive impairment, diabetes, endocrinology, heart disease. My own colleagues refer their patients. We see them, we do an intake survey where we kind of do a deep dive into the lifestyle. What's your dietary habit like? What do you have for breakfast, lunch, you all kinds of things.

How much you sleep? How much you exercise? What's your level of stress? What's your level of social isolation? All kinds of things. It's deep dive questionnaire. And based on that, we kind of formulate an individualized plan for each patient. What's your priority? What is it that you want to fix over the next few months? We make a plan for these patients that each of those visits are about 40 minutes. But I can tell you, 40 minutes barely suffices and flies by.

But 40 minutes, that's one office visit that we do. And then if I see, if we feel that the patient is really motivated to make some dramatic changes, we offer them a cooking program that we have, which is more intensive, it's more hands-on, more labor intensive. It's an eight week program where I have patients come in as a group, 12 to 15 people in a group. It's conducted at our health facility, our gym facility where

I divide them into four parts. have a chef who teaches them how to cook healthy simple meals. Nothing fancy, nothing really basic, just building up culinary skills. I have a dietitian who teaches them the basics of how do you read a food label, how do you do grocery shopping, batch cooking, all different aspects of culinary medicine that we teach in the one and a half hours. And there's a stress management session, there's exercise planning, there's a didactic lecture about how first aid is heart disease, how does...

How does the food that you just cooked, how does that relate to heart disease? How does that relate to strokes? How does that relate to cancers? Eats and so on and so forth, kind of covering the entire gamut of lifestyle diseases. So that's an eight week, much more hands on, much more intensive program. And then of course they see us as a follow up after that as well, about three months after they complete the program. They see us as a follow up after three months just to make sure.

The way I tell patients is that you want to look at this as a journey, not a destination. You're just starting this now, but you want to look at this as in a year from now when you come and see us, you should look back and say, boy, this is completely different from how I used to eat a year back, how I used to move, how I used to sleep, how I handle stress. Because we are living in this world where we want those instant results. Everybody wants instant results. They just don't last. Instant results don't last.

Slow, sustained progress. And that's what we try to emphasize in our approach.

Jollie (18:02)
So who's, who's, leading the, the, the sleep and the, and the stress portion of that, is that a dietician also or exercise physiologist?

Ajay Joseph (18:10)
Yeah,

we have a chef who does the cooking portion and then after that there's a didactic that's run by a nurse, health coach, and then there's a 30-minute stress management session run by a therapist. And then we have an exercise for judges, of course.

Jollie (18:22)
Okay, very good.

All right, so if.

What about in the near term, in the next couple years? How are you going to scale your program? Because this is fantastic right now and getting it paid for is the tough part. But how do you scale?

Ajay Joseph (18:37)
Yeah,

we actually in the right now that's why we just had this meeting this morning with our consultant, we're working with a consultant to kind of build a business plan. And I think the premise of lifestyle medicine is cost savings, right? It's not revenue generation, it's cost savings, right? And there are significant profound cost savings from these measures, from these things that we're talking about. And being able to quantify those cost savings is has

is and has been the biggest challenge, right? But there are ways of how you can quantify those cost savings. What's the cost saving of decreasing your A1C from 10 to 5.5, especially in a value-based care setting that we're in right now. So there are ways of doing that. That's exactly what we are trying to build in a business plan and kind of expand this program.

Jollie (19:21)
You have any advice for a motivated provider that is starting to hear more and more about these types of programs gradually pop up around the country?

Ajay Joseph (19:34)
I think the advice that I would have is to start small first. Start very small. I mean, this has been a five year process for me. Especially in large health systems, if you're working within a large health system, you need to think that you are going against the grain. So there will be a lot of pushback, will be lot of skeptics, there will be a lot of people who think that you're doing voodoo medicine.

but you just gotta keep going with it and just start small, keep building on small success stories and then keep building on that and building that momentum. So starting small is one and secondly is the thing is that you have to build a team of support systems within your administration. And you've got those success stories is what build that momentum within the health system. And last but not the least is whatever I encountered in my case is

If you're doing something that is so consequential, that is so consequential to patients lives and their families trajectory and all that, the universe will conspire to help you. I have no doubt. I've experienced that time and time and time and time again. It's not even a joke. So if you go on this path, you will find things just lining up for you.

Jollie (20:41)
sounds like a pretty fantastic place to end there, sir. That's wonderful. Well, thanks so much for taking a few minutes with us today. how do you, you're doing some really neat stuff. So how do folks follow what you're doing or get in touch with you?

Ajay Joseph (20:44)
Yeah.

Of course.

Well, I think the easiest way would be, I'm on LinkedIn, that's my only social media, that's my way of, and the only reason why I'm on social media is to promote lifestyle medicine. That's one, and of course our website is the same, just Google St. Francis Lifestyle Medicine, you'll find all resources that are.

Jollie (21:08)
All right, very good. Well, Dr. Joseph, thank you so much. I appreciate it. Keep spreading joy. You're wonderful work.

Ajay Joseph (21:14)
Same to you as well, Thank you.

Jollie (21:16)
Thanks a lot.