Ep 64: Before the Stent: How to Prevent Heart Disease with Cardiologist Dr. Kim Williams

Heart disease is largely preventable — so why aren’t we preventing it?

Dr. Kim Williams, Chair of Medicine at UofL and former President of the American College of Cardiology, joins us to discuss why lifestyle must be the foundation of cardiovascular care. From nutrition and plant-based eating to exercise, sleep, and stress, he explains how daily habits shape long-term outcomes.

Dr. Williams explains why:

• Nutrition isn’t optional in heart prevention — it’s central
• A plant-forward diet can rival medications in effectiveness
• Medications and lifestyle together can be even more powerful
• His concerns about the newest dietary guidelines
• Why prevention deserves more attention in modern medicine

If you’ve ever wondered what a prevention-focused cardiologist really thinks, this conversation is both eye-opening and practical.

Find Dr. Kim Williams, MD

Cooking For Your Heart and Soul cookbook

Study by Dr.  Esselstyn on disease reversal with plant based diet

Life's Essential 8 from the American Heart Association

thestartinggatepodcast.com

Email us with questions and topics you want us to cover at
contact@thestartinggatepodcast.com

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The content in this podcast is for general reference and educational purposes only.  It is not meant to be complete or exhaustive, or to be applicable to any
specific individual’s medical condition.   No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis or treatment.  This podcast does not create a physician- patient relationship and is not a substitute for professional medical advice, diagnosis or treatment.  Please do not rely on this podcast for emergency medical treatment.  Remember that everyone is different so make sure you consult your own healthcare professional before seeking any new treatment and before you alter, suspend, or initiate a new change in your routine.

Transcript

Ep 64: Before the Stent: How to Prevent Heart Disease with Cardiologist Dr. Kim Williams

[00:00:00] Before we start today's episode, I would like to quickly read you our podcast disclaimer. The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive or to be applicable to any specific individual's medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis, or treatment.

This podcast does not create a physician patient relationship, and it's not a substitute for professional medical advice, diagnosis, or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different, so make sure you consult your own healthcare professional before seeking any new treatment, and before you alter, suspend, or initiate a new change in your routine.

Welcome to the starting day. We're your host, Dr. Kitty Dotson and Dr. Sarah Schuetz. Two internal medicine doctors who spent years practicing traditional primary care. Over time, we realized something was missing from modern healthcare, a [00:01:00] real understanding of how everyday lifestyle choices impact overall health.

We'll help you cut through the noise of the countless health influencers and their conflicting opinions because no matter who you follow, the basics of lifestyle medicine are at the heart of it all.

 Welcome back to the starting gate. We're your host, Dr. Kitty Dotson 

and Dr. Sarah Schuetz. 

So it's February, which means it's American Heart Month.

And really there is no more important topic. Heart disease is still the leading cause of death. Despite our advances in our medications, our testing, and our treatments available for heart disease, we spend billions of dollars on stents, medications, scans, procedures, and still so many people end up facing heart attacks and strokes.

And really, I felt like in my practice, a lot of patients, especially if they'd had someone in the family that had had a heart attack, felt like it was inevitable to them. It really was just a matter of. When is it gonna happen to me and can we put it off? And it's so sad that [00:02:00] we really felt that way because so much of this could be prevented if we could start changing our daily habits.

So today we have a guest who has spent his entire career asking this really important question of how do we move from reactionary medicine and really focus on prevention of many of these chronic diseases Americans are seeing today. Dr. Kim Williams is a world renowned cardiologist, former president of the American College of Cardiology.

He served for many years as chief of cardiology at Rush University and came to the Bluegrass State in 2022 and is the chair of medicine at the University of Louisville. We are so excited to have you as a guest today, and thank you for joining us. 

 Thank you for having me. And thank you so much for wearing Cardinal Red, even though you're in Lexus.

I had told kitty that I specifically was like, I don't wear red often, but I felt like I needed to do that today. 

I know it's heart month, but that should be Louisville Cardinal Month as well. Trying so hard to fix heart disease here. 

We wanna [00:03:00] review some of those lifestyle factors that do have a big impact on heart disease as well as help our patients understand why lifestyle changes matter and why they need to be a focus. And really addressing what can we be doing in our healthcare systems? What can we be doing as physicians to help actually move the needle more in this preventative practice?

And maybe touching on even some unique challenges that we see here in Kentucky with our patient population. And then we wanna round it out and would love to hear your perspective on the new food guidelines because we know you're a champion of food as medicine and that's definitely ruffles and feathers with some of that information that has come out.

And really your take on what this means for heart health as these new food guidelines have really been all over the news. So let's get started. 

Yeah. Can you tell us a little bit about, I think most people think of cardiologists as fixing heart attacks or fixing things once they've happened, but your [00:04:00] career really took a shift in thinking about prevention.

What happened to make you want to make that change? 

 I actually was a cardiologist trying to manage disease for so long. And about 23 years ago, I showed up to an American College of Cardiology meeting and found out that I had a problem. And that problem was that my LDL cholesterol had skyrocketed, had no idea why, other than the fact that I was eating an American Heart Association diet, no red meat, chicken and fish, no skin, not fried thinking that was healthy.

It wasn't there is no healthy diet that, that has any animal products in it. But we didn't have all that research back then. Harvard. Darn. Harvard had not published until 2016. The fact that all animal products increase mortality and the mortality goes down if you replace them with vegetables.

So anyway, based on my LDL cholesterol taking off I actually and did a big investigation. The good news was that the [00:05:00] portfolio diet, which is a plant-based diet, popularized by a Journal of American Medical Association, university of Toronto, David Jenkins talked about how to manage cholesterol.

And by the way, c-reactive protein inflammation with a plant-based diet. A lot of plant sterols, a lot of soluble fiber. I adopted it and within a few weeks, my LDL had gone down from one 70. Don't fall outta your chair all the way down to 90. 

And that was in just a few weeks.

Yep. Yep. That's right. Yeah. And in fact David Jenkins data showed it, it actually only took two weeks. I didn't measure it again until six weeks, but that really did change my career. Until then, I was, I had been, incoming president of the American Society of Nuclear Cardiology.

I was dedicated imager doing CT scanning and nuclear cardiovascular radiology. What a cardiovascular radiologist does is take a picture of how bad things are and tell somebody what to do about it.

Whether it's the patient, the surgeon the person with the stent in their hand, ready to deploy it. And at some point we [00:06:00] would all. Hopefully start going back in time and on the pathophysiologic curve and do some prevention so that all of my cts and nuclear scans would come out normal.

Wouldn't that be great? And I started on this path of trying to do much more in the way of prevention. I'd always been interested in hypertension just 'cause I'm African American from the inner city, of course, had to be interested in hypertension. You see it in every family and similarly chronic kidney disease.

But lipidology became part of what I do and been at it ever since, trying to do plant-based cardiology going against the grain that's. Whole grain, not refined grain. Okay. It is really something that every person in cardiology should be doing. And I had a couple of, famous quotes like the one that got me in a fair amount of trouble as incoming president of the American College of Cardiology a few years later.

And there's two kinds of cardiologists, vegans, and those who haven't read the data. [00:07:00] Controversial. But the fact is we now have even more data. Good news is that we have a recent publication that showed that card cardiologists are listening and adopting plant-based nutrition more, and they're recommending it way more than they were just a few years ago.

So we're on our way. We're not there yet. It's still a minority of people who are focused on this. And I try to tell every organizer of an academic meeting that we need more attention to prevention at this convention because that's really what we should be doing instead. We're seeing a lot of devices, new drugs, they're all great but they ultimately are mopping up the floor.

Okay. I'll admit it. Cardiology has the best mops in the history of mops. Okay? But we're still mopping up the floor instead of turning off the faucet. 

Why do you think more. Healthcare providers are not focusing on it. Do you think it's the physicians don't think it's effective as far as making lifestyle change and diet change for [00:08:00] prevention?

Or do you think they think patients won't do it? Or a combination? Why? Why are we lagging behind in that 

good combination? Um, uh, People will get frustrated with trying to do the right thing themselves and finding out that the patients have even more resistance than the physicians do. But a lot of it is just lack of knowledge.

We have a publication with our nutrition work group. If nobody remembers I was a c, c President they hopefully will remember that somebody. That was me, started the nutrition work group at the American College of Cardiology. We have, about 60 mostly plant-based and we tried not to beat up on the Mediterranean folks too much, but mostly plant-based folks who are very interested in the science of nutrition and the pathophysiology and relationship between heart disease and heart disease prevention.

And we have do a lot of studies a lot of publications. And one landmark in 2017, Steve DeVries spearheaded a survey of cardiologists That was so sad. It said that 1% of the [00:09:00] practicing cardiologists felt comfortable and knowledgeable in nutrition and nutrition counseling. And it was 0% of the trainees.

Now the good news is that we have kept at it, and so we do have more information out there. Hopefully every conference has something on prevention. It may not always be nutrition, but some aspect of prevention. And we are getting folks to recognize that the six pillars of lifestyle medicine, that is whole food, plant-based diet.

Exercise regularly avoid substances. That's everything from crack cocaine to cigarette smoke. They all hurt the heart, okay. Including alcohol. Having good social connections, having a method of mindfulness and calming yourself, and then not not the least sleep. If you do those six pillars that by the way, belongs to the American College of Lifestyle Medicine.

Those six pillars will extend [00:10:00] lives and decrease our cardio vascular disease budget and help our nation. And we all need to do it, and we all, but we all have to be knowledgeable about it. 

Yeah, and I know that's something that both Kitty and I have talked about on the show. Lots is how little we felt like we learned in our training.

And both of us were primary care doctors and a big chunk of primary care is prevention as well. And not until we really had more education through lifestyle medicine training, did we actually understand the significance of the impact lifestyle has? Of course, we talk about it and we knew that each of these things played into it, but not how large of an impact and how well these work as preventative measures.

Absolutely. 

 American Heart Association says about 80% of cardiac events could be prevented through life's essential eight, which is very similar to the six pillars of lifestyle medicine. If someone is just thinking about themselves, they've got a family history, they want to start making a [00:11:00] change they're maybe not ready to go full force.

But they wanna start making a change. Where would you recommend someone start? 

Honestly. And I really would start with artificial intelligence. Probably surprise you with that answer. 

You did. You did. 

It's it was the recognition really, just a few months ago in clinic that I was one of the co-authors, four of us put together the heart cooking For Your Heart and Soul.

It's a cookbook from the Association of Black Cardiologists. If anybody wants it, it's online, it's free. You can download the PDF and share it with your patients. Share it with your family. Great. Whole food, plant-based diet. 22 recipes. Do you know what's in a cookbook? What the authors want to eat.

Okay. What about the patients? Okay. And so once that hit me I started using my artificial intelligence spot. I don't usually brand names, but everybody knows chat. GPT probably could use any, anyone. I don't know. I just ha happened to use that one. And I [00:12:00] ask it for the specific patient that I'm seeing.

I'd say please print me out a two week menu. Breakfast, lunch, and dinner. Come up with meals with beans, grains, nuts, seeds, fruits, vegetables, and mushrooms. But avoid blank what? And blank And blank. Whatever the patient says they don't want. The most common is actually okra. Okay. People will say uh, the next one tends to be mushrooms, which is so strange, , but that seems to be number two.

And then whatever fruit they're allergic to, or nuts, they're allergic to whatever it is. I make sure that those things are not included. And then I put the, what the patient has, dyslipidemia, central obesity metabolic syndrome. Elevated hemoglobin A1C, systemic hypertension, coronary artery disease.

And we're trying to do regression. And, if no one has seen the coronary disease regression, please, go into your chat box and look up Essylsten regression, hit images, and you will [00:13:00] see this patient pop up. That you can't unsee, why wouldn't we have all the plaque go away on everyone that we could?

 And so given the disease states and what the patient doesn't like, and the whole food plant takes, put those three things together and in about 90 seconds is created this entire document. And it usually has a nice beginning. Section that says what each disease is going to be treated with which plant?

Like more nitrates and more potassium for your blood pressure, more fiber for your LDL and your triglycerides. And it gives you just a good hint as to why it puts together the meals the way it does. As a author of a cookbook, we never even thought about doing that, but artificial intelligence can actually do that.

it's not just diet though. You could use AI algorithms or chat boxes for mindfulness. I know that. There's been a fair amount of attention paid to the fact that when people are [00:14:00] depressed or having psychiatric difficulty, that the chat boxes actually do work. Humans are better, that is psychiatrists are better if it's severe, depression, suicidal but less, anything less than that chat box actually does better than the psychiatrist by reports.

And that's true of pretty much all of cardiology as well. If you compare the management of AI versus a physician using ai, AI wins because it can follow all the guidelines and help you implement all the guidelines without having to think about it because it's a large language model and it knows all this stuff.

So I would say that leveraging, everything that we can do with AI would change a lot of preventive medicine and get it more embedded and have popups that say, you're giving a beta blocker for hypertension. But those went out in 2006. Okay. Even though people are still doing it, there are things like that, that we could do a whole lot better.

And so we actually did [00:15:00] a recent study and it's soon to be published, where we estimated out of the 300,000 unnecessary deaths that we have that are attributed to medical error, what would happen if we used AI all the time and it probably would cut at least two thirds of those down.

But that's 

impressive. 

It is impressive. But what I'm, I, what I'm really hoping is that we start to use it for lifestyle medicine. 

Yeah, I know that's something that Kitty and I have looked into and have explored as well because , there are lots of options of using AI for even behavior change and health coaching.

And really trying to make it affordable to many an option that used to be very expensive and many people wouldn't be able to have access to. 

you've moved to Kentucky in the last couple years, what are some things that you have noticed specific that Kentuckians tend to struggle with these lifestyle pillars?

I will say we, 'cause I've been here almost five years now have a lot of of weight challenges the type of food that we're [00:16:00] eating. Alcohol is part of the culture with the bourbon. And people don't necessarily realize that there are a couple ways to immediately stop fat metabolism.

If anybody who does a, like a fluorine, 18 deoxy glucose scan for their heart or for the cancer, what do they tell you? You have to go in there fasting. And then you get glucose loaded and it'll turn it on, right? Sugar. Is one way to stop fat from being metabolized and alcohol is the other, it immediately stops it.

And so people are putting on weight and not doing enough exercise. And by the time they get to the age where they're coming into cardiology for blood pressure or even coronary artery disease, and having a cardiac event begin to the point where the ravages of obesity in terms of diabetes and joint problems, the once the joints are really bad, it's really hard to do the exercise.

So it's a great place to be an orthopedic surgeon , but the effect of the orthopedic surgery is gonna be less because of the [00:17:00] weight and the wear and tear. So what do we need is. Really primordial prevention. We need to get into the third grade get into the homes and get all the kids to understand lifestyle medicine.

Unfortunately it's not just heart disease here. Kentucky is once again for a, an about a year or so. It was number two, but it's once again, number one in cancer deaths per capita and cancer and heart disease pretty much have the same risk factors. It's diet. And I know a lot of people are trying to change the, their diet, get away from red meat that really will help.

It doesn't help heart disease to switch red meat to fish and chicken. You still get heart disease, but you could certainly reduce cancer. Particularly getting away from processed red meat. And the surgeon general's warning from January of 2025 saying zero alcohol. That's a tough message in Kentucky.

And I wasn't familiar at the time, just a lowly. [00:18:00] Knuckle dragging cardiologist. But when he said that, I just went on AI and said, what's he talking about? Eight different cancers that are increased by consumption of alcohol and the threshold is zero. If we change our lifestyle, do those six pillars we'd be one of the healthiest states.

 We have a lot of areas with clean air, we struggle with air in some places. We at University of Louisville with our environment. Institute doing everything we can to plant more trees and make everything healthier. But it's pretty much what you take in, whether it's breathing or eating that's making us suffer with a very high healthcare budget.

A lot of time off work, a lot of impoverishing our people and ending up where we have Medicaid roles of like 28% of the population and, 40% of our patients at U of L. So we can do it and it's gonna take programs like yours. Thank you so much for doing this getting the word out for people to change their lifestyles.

I come across this a lot with patients, so I'd love to hear what [00:19:00] message you tell your patients is, okay, I am hearing all this, I'm hearing I should be eating all these plants and, reducing alcohol, start exercising, but, there's so much going on with my life. There's so much that. If you're asking me to do, and I can't do it all at once, is it even worth trying?

I know what my response is, but what do you tell some of your patients when it comes to that? Because I think sometimes people just feel like there's no way I could do it perfectly, so I'm not gonna do it at all. 

you're really pointing out how difficult the change is. Behavioral change is difficult because people like what they're doing.

And let's be honest, when they're coming to my office, what they're really hoping for is Dr. Williams, please give me a pill so I can go back and do all the things that made me come to you in the first place. 

Yes. That's serious. That's hard truth. Yes. 

Okay. But I understand that it and the culture, the family dynamic, the social dynamic, the [00:20:00] vegans and the people who are exercising all the time are sticking out and not mixing necessarily very well.

And it's hard to be alone. , That Framingham study from, decades ago, there were, they stumbled on the fact that what predicted a person was going to gain a lot of weight during their lifetime, they were looking at their family and all that. And, mother, sister, brother parents turns out that wasn't it was the person who they had recorded, you might have heard about this.

They asked on their Framingham intake form, tell us the name of one of your friends who was likely to know who you would be in 10 years. It turns out it was the friend, their weight influenced the patient's weight. The social connections are important and you to have a successful breakaway in terms of lifestyle, you've gotta change not only your own habits, but the people around you to have a good success.

Do you ever try getting someone to stop smoking where everybody's smoking [00:21:00] around them is impossible? 

Yeah, 

exactly. Not easy. 

And what about for people that feel like a healthy lifestyle is too expensive? What, do you put that into AI as well or how do you help people navigate that? 

Good point.

That actually is an article that that we wrote chatting with chat, GPT The premise was if a whole food plant-based vegan, vegetarian diet. Would decrease our mortality, decrease our healthcare, our toxic levels of healthcare expenditures, save the planet and reduce animal cruelty. Why wouldn't we all do it?

And it gave me 10 really good answers, most of which I've been giving you this afternoon. one of them was the idea that plant-based diets are more expensive. It turns out it is never been true. That is, you could buy beans, grains, nuts, seeds in bulk, they don't rot very easily. And you could actually they, if you could compare the [00:22:00] pricing for that versus animal-based protein, plant-based protein is a lot cheaper.

And then there was a bird flu. And that was the beginning of last year where the prices of chicken went up and then there was a beef crisis as well. And it turns out that all the people who were making these vegan, plant-based chicken and fish and beef and pork substitutes, some of which are actually okay, they're maybe ultra processed, but if they don't have a high saturated fat, high sodium, high sugar to fiber ratio, they're actually fairly healthy.

And it turns out that they were all seemed to be dropping their prices. Some of it is competition because if you ever look up, go to go Google and put in vegan chicken, you're gonna find 500 products. And so they have to drop their prices to compete and it's a lot less expensive than real chicken.

So things have changed. It used to be that, buying the fancy substitute stuff was more expensive. Now it's actually [00:23:00] less. That's actually in the article, a little table showing that plant-based protein is actually less expensive. And and we're only talking about the upfront in-store cost.

How about the long-term cost? A person doing a whole food plant-based diet reportedly has about $250,000 less lifetime healthcare expenditure. And that is very serious when we recognize that the leading cause of personal bankruptcy in this country is medical debt. Just don't do it. Just eat a healthy diet and exercise every day.

Yeah. That's something we've been thinking a lot more about too, just as the cost of health insurance is skyrocketing. I don't think people realize , when you're in your forties, and let's say you're in decent health that you don't know about a lot of chronic disease yet, but that's where you can make such a change.

You're either gonna be spending hundreds of thousands of dollars on healthcare or you're not. If you start making some habit changes. During that, that [00:24:00] earlier time. And before we leave this can you maybe just tell people how much could you if you changed your lifestyle significantly, how much reduction in your risk of having a heart attack or stroke could you actually see?

It's 

really tremendous. And I would love to say that everybody who goes on a whole food, plant-based vegan vegetarian diet is cardiac immortal. That isn't true. But the reduction is at least as good as our best medications, which are statins. And of course I know there's a whole bunch of plant-based people who say, oh, he shouldn't take statins.

If you're at risk, you really do need the statins. And I've been doing this for quite a while, and I don't mind saying it out loud without knocking on wood or whatever. That, I haven't had one patient who's doing a whole food, plant-based vegan vegetarian diet and a statin with their heart disease for their heart disease.

Not one person has had a cardiac event, and it's easy to understand because the two biggest drivers are inflammation and LDL [00:25:00] cholesterol, and you could argue that it should be a OB, but either way your lipids and your inflammation determine your next cardiac event in most cases. And it turns out that both the statin and the whole food plant-based vegan, vegetarian diet.

Lower them equally. And so you put 'em together and people say . That new target of LDL getting it to less than 55, that's impossible. No, it isn't. I get it routinely because we're doing diet and medication together. , It is difficult for people to change. And just going back to that concept that people say all the time, you gotta meet people where they are.

And that is true. That's part of what we need to do as a clinician. Say, what's your motivation for change? How much are you willing to change? And sometimes it has to be incremental, and sometimes you get some people who you happen to be talking to, or African American male in over 60 and with a tendency genetically to have high cholesterol.

I would, if you tell me partly because of my risk and partly because of my [00:26:00] profession, the number of times I've done. CPR on somebody in the coronary care unit sent them off for a balloon pump or a mechanical support or off to bypass. I never wanna be the person on the table. So you tell me that. I hate to use brand names, but I say it all the time.

Pennzoil 10 W 40 is gonna clean out my arteries. I'm drinking it. Okay. But everyone else isn't like that. They haven't had that PTSD. Cardiovascular intensive care unit experience. And they, we all think we're gonna get away. There's every smoker that I've met would save a couple, think they're gonna get away with it, that the data doesn't apply to them.

And so we do the things that we enjoy, not worrying about the consequences. So if you have to actually, really assess if the person is someone who's thinking down the road. And unfortunately I have to say out loud, that tends to be people with higher levels of education. Not just because of health literacy, but because they've put some kind of huge investment.

[00:27:00] They gave up their youth to be educated and they're not giving it up easily. So they do everything they can to maximize their life expectancy. And so you really do have to assess people where they are. And try to help them move to the next level. I would remind everybody that there are multiple publications recently by the million Veterans Program talking about plant-based nutrition, and they all show the same thing.

. The more plant-based you are, the less heart attack, stroke, and death you have. And it's, and people will say like you were saying I can't do it. Or Can I just do it a little bit? And the answer is, yeah, and you're gonna benefit from a little bit.

You get to decide your disease level and everything in moderation. People say that's a moderate amount of disease, moderate amount of the leading killer of Americans since 1918. How about no.

I think that is a great way to assess that because , you never know how motivated they [00:28:00] may be.

And I think that's what we don't always do as clinicians is figure out what reduction they want in this condition. Because just like you had mentioned, you're like, there's no way I will do everything you tell me to do to a T because I don't want this to happen. But a lot of times we assume what our patients are willing to do instead of letting them be in part of that decision making process.

And I think we could do much better at that. 

 Well Said. 

I would like to talk a little bit more about exercise because I do feel like people that are concerned about having, either they've had a prior cardiac event, or they know that they have coronary artery disease, they almost become scared of exercise even though we know that is a powerful tool.

How do you help patients kind of work through that? 

Tell 'em right up front exercise is very dangerous. But not exercising is way more dangerous. And you go out, you get started, you do things gradually, not [00:29:00] just for cardiac risk, but to avoid injury. And you gradually increase, just, you're gonna go out for a walk, you haven't done it in a while.

You go to the end of the block and the next day you do two more houses. The next day you do a couple more and you keep going until you start to get your fitness back and listen to your body. If you're getting chest discomfort or shortness of breath, you gotta let me know. And we're gonna do this gradually and together.

And we used to use a lot of exercise testing to write exercise prescriptions. It does work. Cardiac rehab should be ordered way more than it is. Less than 50% of people in the United States who have a qualifying diagnosis actually get it ordered and actually get it done. And, but, and there's some economic limitations to that.

I know. But everyone can get out and do more. Probably the most important thing we could talk about with exercise is tennis. Not just 'cause I'm a tennis player, but because of an article published two years ago I think it was the Adventist Health.

It said 9.6 years of increased [00:30:00] life if you are a vegan. It's 9.7. Of extra life if you're a tennis player. Now, I'm assuming that those two are additive. Personally. 

What about 

pickleball? And that's the interesting thing, is that other racket sports didn't translate. And for, if anyone wants to have a laugh, you could actually look up Ted Talk Boston, TED Talk, Kim Williams where I go through the entire rationale of why you get 9.7 years of extra life basically preaching about the six pillars of lifestyle medicine.

But the, I the idea is that it is a sport that's very demanding. Pickleball is taken over. I know a lot of my I'm one of those U-S-P-T-A certified teaching pros from the 1970s and everyone who's in my genre, they're kinda like wrestling at all this pickleball saying that people are, they're taking over tennis courts and they, you get.

Two pickleball courts on a tennis court. I'm the opposite because I'm a cardiologist. I'm [00:31:00] seeing people who are not on the couch. Okay, now is it and let's just face it everyone should try to play tennis. Not everybody's going to, because you basically have to either be an athlete or become an athlete to play tennis effectively, where it's just about anybody can get out and get injured playing pickleball.

I know orthopedic surgeons just love in this sport. But it is taking over and I think it's going to be better. We do need the outcome studies because racquetball and badminton did not have the benefit that that tennis has. And and neither does marathon running there. A lot of other sports that just don't have it now have to admit.

The one thing I didn't talk about in the TED Talk, 'cause it would be a downer, is that I am a bio statistician at heart and sometimes you just have to admit that your studies have implicit bias and that implicit bias would be. In order to play tennis, you have to have a better economic strata than people who don't.

And those people live longer and you have to be a strategic [00:32:00] thinker. Strategic thinkers tend to be more educated. Those people have less cardiac events and you could just pile up a whole bunch of reasons. And it may be that as complete fakery, I'll just keep playing tennis just in case 

I don't think it'll hurt.

And so you mentioned earlier about having seen these severe outcomes that you've seen in your medical career. Seeing people having to, be resuscitated and go to surgery and that type of thing has given you the insight that, you don't wanna be that person. How do we reach people that haven't had that experience and how do we get them to understand that they don't wanna be that person either?

It is difficult. But we can have conversations. 'cause everyone knows, as I mentioned, heart disease being leading Killer of Americans since 1918. Everybody knows somebody who had a heart attack. They know when, if they're old enough, they remember when President Eisenhower had a heart attack, when President Johnson had a heart.

It's it's like it's ingrained in American society that people famous [00:33:00] people in the media having heart attacks. And so everyone knows about the disease. And if in our African American community, which then tends to be higher, about 30% higher risk, about the same as our Appalachian community, by the way.

So it's probably more behavioral kind of stuff and social stuff than it is race. Everyone knows someone who's on dialysis, everybody knows someone who had a stroke. And so we can try to refer and the closer the person is to them, the more made motivated the patient is to not. Have that outcome for themselves.

So then on top of that, I tend to use family guilt. Okay, that might be a little unfair, but I said, and how many children do you have? And how many grandchildren do you have? And how long do you wanna be with them? And, you are their best resource for institutional knowledge. And you're gonna make choices three times a day.

Some vegan people will say, digging your grave with your fork. So not sure I really like that [00:34:00] phrase. But that's honestly what we're doing as a society. And so I try to get them to understand that they are a powerful commodity and they're having heart attacks, stroke, or death, really profoundly affects their family.

And you can make a choice to live longer and healthier. And so why not do that for your family if you won't do it for your.

Another thing people can get confused about is on social media. Now you can really find someone that is saying whatever you it is you want them to say, if you wanna follow a carnivore diet or something, you can find someone on social media to say that is actually healthy and that will prevent a heart attack.

And then you kinda get this whole feed of things coming at you that probably are not sound healthy advice. Do you make any recommendations to your patients on how to get good advice through social media? 

So I avoid social media, I use artificial [00:35:00] intelligence. And I go back and forth and I usually publish this stuff.

But the one of more my more recent interactions was after that article with the 10 different things that chat, CPT said, why people will not change their diet or haven't changed their diet. I actually asked it if you had a human body, what would you eat? And it said, oh, whole food, plant-based, vegan, vegetarian diet.

And asked why. And it gave a marvelous analysis of exactly what you would expect from our artificial intelligence. It's looking at the entire world of information. And it will tell you that you've got the ethical considerations, you've got the planetary considerations and human health.

And so it's answered to me. I just read it to you. Lower risk of cardiovascular disease, type two diabetes, hypertension, certain cancers, lower LDL, inflammation, insulin resistance, improve gut [00:36:00] microbiome diversity and metabolic health for planet sustainability. That was, I just was never into this.

But you could actually get rid of almost one fifth of global greenhouse gas emissions if everybody had a plant-based diet. Deforestation, biodiversity loss and water usage. That just was never something that I thought of, but. I'm not chat. GPTI didn't have all this data in my head. The ethical considerations I'd heard that.

'cause I have so many people who are around me, who are animal rights folks and talking about animal suffering from factory farming that would be prevented. Transport slaughter and not, and treating sentient beings as if there were commodities. And you surprised that an AI bot would think if you could call it thinking and along those lines.

But it's good information. All the information is out there, and I think it's something that we all ought to pay attention to. 

That's an interesting way to, to twist that, being like, oh, we've got good [00:37:00] tools. Why are we not using ai? Stay off social media when you're trying to Yeah. To think of those.

That, that is a great new perspective on that

 based off that, because I feel like this did hit social media pretty hard and there was so much controversy over this. How are you addressing with patients the new dietary guidelines because they have really sent tons of mixed messages even so within the document itself?

Yeah it's hard for those of us who are in this space fighting really hard to decrease our healthcare budget and decrease the cardiovascular mortality to see what's happened. And, fo folks are more up in arms about this one than they were five years ago or 10 years ago, but it's happened three times in a row.

So what is actually happening? We have a dietary guideline advisory group that's put together with a large number of scientists. That are appointed this time they deliberated for [00:38:00] two years and came out with a, like a 200 page report, all with references, all the literature that would help us help the health of the nation.

Their recommendations came out January, 2025. And they were it turns out that they had some messages that were no longer allowed by the current administration. And so everything that had to do with. F health equity or which is a big deal. It's a big piece of the literature, the southern diet which is a nice way of saying soul food.

That kind of eating pattern has been shown to be so much worse than the rest of the American diet. That it was a relevant topic. And they had some messages about sustainability, planet sustainability that were not allowed to be. And somehow the final recommendations which were put together, not by the scientist, but the dietary guideline writing group, [00:39:00] the final one they're supposed to take the 200 page report, synthesize it down, make it digestible, no pun intended.

And approve it and promulgate it. They basically said that they went ahead and tossed it and started over. And if you look at what they've done, some of it. It had similar themes, but I can tell you that the original document this time was basically plant-based. The original five years ago was really anti-sugar.

And a lot of that got watered down. And the one 10 years ago said that Americans were eating too much protein, particularly red meat, and that one that essentially got removed from the final. And in fact, this fast forward 10 years later, they're saying that we should be eating more protein. If you look through the medical literature.

You won't find very many reports of of protein deficiency. I actually authored, the only one I know of is in the International Journal of [00:40:00] Disease Reversal and Prevention, and it was about a very restrictive vegan diet where they're only eating like four things over and over again, and they were missing a couple amino acids and getting protein deficient with horrible medical consequences.

It was so unique. It was worth writing up because it doesn't happen. That is beans, grains, nuts, seeds even fruits and vegetables and particularly mushrooms all have some protein. The beans, grains, nuts, seeds, and mushrooms have a massive amount of protein. And to say that Americans needed to eat more protein and to have more saturated fat, particularly beef tallow I have a bit of a beef with that because we have good literature showing that saturated fat increases LDL cholesterol and increases mortality.

And we would've liked to have seen much more of the whole grain and fruits and vegetables, like the original report had it was very plant-based and plant forward, if not [00:41:00] comp exclusively. And this one is not. So the shocking part, and you can anyone can look at journal of American Medical Association from last week where they published my viewpoint on this entitled, when Nutrition Science is Ignored, the Potential Public Health Costs of the 2025 Dietary Guidelines.

 The point that I make is that I know, we're in a red state and Louisville is blue, and Lexington is purple. But there's some things that we all of us re regardless of where we are in the political spectrum, would agree with, and one of them would be President Trump last May put out an executive order, 1 4 3 0 3.

Saying that every federal policy is supposed to use the gold standard science, the best science available. And that's the point I make in this article is that isn't what they did. They were [00:42:00] going with whatever commercial influences or , but it wasn't what we would expect to see from a scientific report.

And I know there have been plenty of other articles written like mine, and there's one group that's calling for a redo. And interestingly enough the document itself does say, Hey, contact us if you think we should be talking about something else. So we are taking advantage of that.

Neil Barnard of PCRM stands for physician committee for. Responsible medicine he getting a group together to do just that. And maybe there will be a reboot. And if we could just get them to pay attention to what president Trump asked use the gold standard science.

I would hope that our dietary guidelines would help us with our healthcare budget.

 Rather than promoting things that we have a massive amount of science saying that it would be harmful.

 I always want to be even handed., There was some [00:43:00] definite agreement with cutting back on refined grains. And cutting back on sugar and cutting back on ultra processed food that has damaging components. So you can't throw all ultra processed food under the bus, as I mentioned before.

If it has a healthfulness to it, it's probably fine. Even though it's a plant that went to a plant and came out, then you're worried that it's gonna plant you. No if it doesn't have a high sodium, high saturated fat or a high sugar to fiber ratio, it could be very healthy. there were some good things in the guidelines that came out three weeks ago.

But the big concern about adding more animal-based protein that's one that I think just sidelined everything else that was good about the guideline.

 Obviously, I think people are gonna have to do their own research when it comes to deciding what to do for themselves and may not rely on what is coming at them through necessarily the guidelines , and social [00:44:00] media. How do you use AI to help with stress and sleep in that component of lifestyle for your patients?

personally, I just play tennis, so that's the best stress believer ever. But I think you all referring to there are apps that do calming and helps sleep with like noise. And there's pretty much anything you want out there including a lawnmower you just go to your ai and say, can you help me with.

X with stress management and you'll see it. I the, this, I, I know the there are concerns. We all have concerns that they're not licensed. They're not FDA approved for healthcare and everybody's using it. I would think that at this point I would call for us to do some regulation and some certification to make sure that people are getting good advice.

It wouldn't it be nice if it was all regulated And and I understand that that would probably hamper [00:45:00] some of the development, but getting people, however we could do it, getting people to use the best data, and right now that is the large language models, whether it's open evidence and New England Journal of Medicine or Google Gem Gemini, or whichever one that's using the best evidence is something that would help human health.

Now when you talk about sleep with patients, how do you explain to them that their sleep impacts their heart? Because I know that's something that not everyone really can understand how that occurs. 

I'm, as a cardiologist, I'm on the end of the spectrum. That is, we have the obesity crisis that we've that we talked about, and even people who are overweight can have sleep disordered breathing, and that sleep disordered breathing, obstructive sleep apnea particularly, can drop your oxygen level.

When that happens, it leaves your heart subject to rhythm disturbances on the one hand, [00:46:00] atrial fibrillation. Worse rhythms, but more importantly more commonly just raises your blood pressure because your cortisol and your epinephrine and norepinephrine levels increase. And you want to get really good, better blood pressure control, whole food, plant-based diet, and making sure that a person gets a sleep study if their partner says that they're snoring that they're stopping breathing.

And let's be a little bit more liberal in our ordering of testing for sleep apnea. The more we discover it, the more we can cover it. 

 What gives you hope that we will make a difference and patients will start doing things and things will turn around and we will start preventing more disease.

That is so funny. You would ask that was the end of the chat GPT article. I thought it was hallucination. 'cause they say that AI has hallucinations. It said, oh, the science is so clear that plant-based nutrition is gonna take over and everyone's going to make a change. And I'm going, what?

I've been doing this for quite a while and I'm seeing [00:47:00] very small increments. But I'll tell you I have published in the last four years two different articles on physician surveys. One was Loyola and Rush academic Physicians, 274 physicians, one. Out of 274 was doing a whole food plant-based diet.

The one that was published a few weeks ago from the American College of Cardiology, albeit not academic physicians, but practicing cardiologists. It was 8% who were doing a whole food plant-based diet. More importantly, 41% were actually recommending it to their patients. So that eightfold increase, I'm looking at, like you were saying, maybe the, maybe this is going to happen.

But what does it take? It really takes media it takes recognition, more use of AI that I'm saying that and people relying on it for health because it wouldn't lead them astray in this case.

 . What's the biggest misconception you think physicians have about lifestyle and heart disease? And then what's the biggest misconception you [00:48:00] think? Patients have 

actually think it's the same.

The words I'm eating a healthy diet. I eat healthy. Those words come out so many times and it's not even close to being healthy. And that's on us as healthcare workers, as educators. If people think that what they're eating with fried food and processed meat. Processed meat.

That's bacon. Ham, hot dogs, sausage and lunch meat. Okay. Our group one carcinogens, people have actually taken bacon and modeled it every time you eat a bacon strip, it's 35 minutes off your life. Or it's similar with hot dogs. And that diabetes goes up 20% for every slice of beacon that you eat if you're doing it on a regular basis, all of this data.

Why? Why isn't that our, that people don't understand it. Part of it is marketing. And so it's another one of our articles that I did with my granddaughter. [00:49:00] So during COVID, she kinda had to come home from college and she stayed with her granddad and she was watching a lot of television. I said if you're gonna watch television, let's do something positive with it.

Every time you see a food commercial, write down what and then I gave her the American College of Cardiology article. It's actually from Harvard healthful versus unhealthful, plant-based diet. But it had animal stuff too that would, all, every animal was negative, but fried food was negative.

Refined grains, so was negative. And you can imagine a fast food restaurant commercial. It's got french fries and a large soft drink and a double cheeseburger or whatever with dairy and meat and refined grain in the bun. It was scoring terrible. And so we published it and the saddest recognition as , writing this data up that we are marketing mortality.

That was the name of the article. It was the recognition that university of Chicago had put out a study saying [00:50:00] that television is more pervasive and more effective in poor communities. That is the number of people who make a hundred thousand dollars or more who watch more than five hours of television, which they defined as excessive.

Per day was 1%, but it was like 37% of people who are in poverty. And it's a linear relationship going down. The more money you have, the less television you watch. And so we're taking it out on the poor, and if the marketing didn't work, they wouldn't do it. And I know people talking about healthcare differences between ethnicities and neighborhoods and saying this was published a while back that there are about 50 to 60% more fast food restaurants in black neighborhoods than white neighborhoods.

I'm not blaming the fast food places. that's their job is to go where the money is. And if people are gonna buy it, that's their job. They're in the business of selling the food. And if, but, so who am I blaming? Being the people who are buying the food and those who are not [00:51:00] telling them and getting, like you're saying, get that word out so that people understand what they're doing to themselves and to their families, to their communities and to the nation.

 I never want to say out loud that if a person isn't on a whole food, plant-based, vegan, vegetarian diet protecting their health paying into Medicare and never taking anything out of it, then they're not patriotic. But every time I say, I'm not saying that, I guess I actually am saying that.

So. 

I think we have had a wonderful conversation today and hopefully have given our listeners a lot of information on how they can improve their overall health, maybe clearing up some of the confusion that's out there. The whole twist on AI wasn't expecting that from you. So that was a really an awesome conversation to have and really thinking about using that because it is something that everyone has access to and leveraging that to help improve our health.

And so that, that's a really good thought and I know that I have patients using it more [00:52:00] myself. I use it more and is really just helps clear up some of the confusion that we get in our messaging. So that was a great idea. 

Yeah. Thank you so much. And thank you for all the work you've done and I know will continue to do, to try to bring light on how much we could be doing to prevent disease.

Thank you so much for having me. It's wonderful conversation and thanks for all you're doing. 'Cause we couldn't get anywhere without folks like yourself taking this on and trying to get people to live better lifestyles. 

Thank you. See you next week.