133. The Heart Disease Your Cholesterol Test Cannot See with Dr. Abid Husain

WEBVTT
1
00:00:04.850 --> 00:00:10.535
Welcome to Rooted in Wellness with me, wellness advocate and holistic nutritionist, Mona Sharma.
2
00:00:11.055 --> 00:00:21.243
Together, we will take a journey to discover natural healing practices from imbalance to balance guided by ancient wisdom and modern scientific insights.
3
00:00:22.064 --> 00:00:31.687
I was raised living summers on an ashram, so I learned early on that food is medicine and your kitchen is your greatest source of healthcare and prevention.
4
00:00:32.187 --> 00:00:40.750
After facing two heart surgeries, anxiety, and weight challenges, I discovered that just because your symptoms are common doesn't mean that they are normal.
5
00:00:41.370 --> 00:00:51.273
Together with some incredible guests, we will explore the power of our mind, body, and soul connection, returning to our roots to rediscover our greatest well-being.
6
00:01:02.663 --> 00:01:12.873
If you've ever walked out of a doctor's appointment with a clean bill of health and still felt like something was quietly off, this episode is going to change the way that you think about your heart.
7
00:01:13.835 --> 00:01:20.162
Heart disease is the number one killer in the world, and there's a reason it's often the silent killer.
8
00:01:20.643 --> 00:01:26.109
For many people, the first warning does not come until the disease has already been developing for years.
9
00:01:26.649 --> 00:01:32.295
What makes that even more unsettling is how much trust we place in the same routine tests.
10
00:01:32.856 --> 00:01:38.297
We've been told that a normal cholesterol panel and EKG mean everything's fine.
11
00:01:38.717 --> 00:01:44.179
So we stop asking questions without realizing how much may not have been investigated.
12
00:01:44.779 --> 00:01:46.019
I know that feeling personally.
13
00:01:46.479 --> 00:01:51.220
During my own heart journey, my doctors were so focused on solving the problem in front of them.
14
00:01:51.660 --> 00:01:59.402
But looking back, I wish that they had asked so many more questions about everything else that was happening in my body and in my life.
15
00:02:00.062 --> 00:02:04.083
This is why I wanted to have this conversation with the incredible Dr. Abid Hussain.
16
00:02:04.423 --> 00:02:16.827
He's a triple board certified cardiologist and integrative medicine physician who spent years inside conventional cardiology, seeing how much could be missed before a patient even reached an emergency.
17
00:02:17.267 --> 00:02:20.227
Eventually, he stepped away and built something very different.
18
00:02:20.508 --> 00:02:28.890
Today, he combines advanced cardiac imaging with functional medicine, hormones, and cellular health to look far beyond a cholesterol number.
19
00:02:29.650 --> 00:02:43.541
In this episode, we get into the risks a standard cardiac workup may leave out, why some people can look healthy while heart disease is still developing, and what a more complete approach would investigate before symptoms begin.
20
00:02:44.002 --> 00:02:50.847
We also talk about the blind spots that women face in midlife and the questions worth bringing to your next appointment.
21
00:02:51.388 --> 00:02:56.752
This is a conversation I wish I had before my own heart procedures, and I cannot wait for you to hear it.
22
00:03:07.991 --> 00:03:10.172
Dr. Hussain, welcome to Rooted in Wellness.
23
00:03:10.712 --> 00:03:11.873
Thank you for having me, Mona.
24
00:03:11.893 --> 00:03:12.793
It's a pleasure to be here.
25
00:03:13.194 --> 00:03:18.376
I was just sharing with you that I don't think I've ever had so many notes for a doctor who's come on this episode before.
26
00:03:18.476 --> 00:03:20.917
I'm so excited about this conversation with you today.
27
00:03:20.937 --> 00:03:21.878
Fantastic.
28
00:03:22.442 --> 00:03:31.825
As I was sharing, you know, I told you about my story and ultimately me going back to the ashram was about becoming more rooted in who I was for me to heal my body first.
29
00:03:32.286 --> 00:03:38.968
So we kick things off by first asking, tell me two or three things that help you feel more rooted in your health, your happiness, and who you are.
30
00:03:39.443 --> 00:03:47.649
Yeah, I have a daily practice that involves fitness and doing something creative on a daily basis.
31
00:03:48.249 --> 00:03:53.473
So in the past, I've been a painter in the past, and that's sometimes a little hard to dial into.
32
00:03:53.953 --> 00:03:56.115
So these days, it's now music.
33
00:03:56.375 --> 00:04:01.979
So I play the piano or do something voice related, but it's a creative practice.
34
00:04:02.139 --> 00:04:06.062
And that gets me really dialed into, it grounds me and plays.
35
00:04:06.802 --> 00:04:11.370
lets me do something for myself before I get into more intellectual or medically related things.
36
00:04:12.059 --> 00:04:13.980
I think you're the first person to ever give that answer.
37
00:04:14.420 --> 00:04:15.101
That's incredible.
38
00:04:15.121 --> 00:04:17.822
And it's such a big part of who we are, right?
39
00:04:17.862 --> 00:04:24.306
So yeah, and I'm sure if you looked into the science around the nervous system regulating aspect of that and everything, it's beautiful.
40
00:04:24.346 --> 00:04:24.606
Yeah.
41
00:04:25.066 --> 00:04:33.951
Having gone through the journey that you've gone through, you know, a lot of people sitting in your chair have gone through some sort of a journey when, you know, my clients will say it's falling off the wagon.
42
00:04:34.531 --> 00:04:38.654
But do you notice, are there certain practices in your life that cause you to feel uprooted?
43
00:04:38.774 --> 00:04:40.555
And do you catch yourself in the moment?
44
00:04:41.408 --> 00:04:42.789
Definitely, definitely.
45
00:04:43.289 --> 00:04:45.791
I know when I'm feeling uprooted because I feel it in my body.
46
00:04:46.151 --> 00:04:53.716
I mean, I feel it's mostly work-related or just life-related stress that builds up.
47
00:04:53.796 --> 00:04:59.160
I mean, on a regular basis, as a physician, there's a fair amount of stress that we have to deal with.
48
00:04:59.340 --> 00:05:01.121
But then, and that's manageable.
49
00:05:01.141 --> 00:05:03.462
I've gotten used to that over the years.
50
00:05:03.542 --> 00:05:10.247
But it's when things get compounded, I can feel it in my body in particular, and it shows up in back spasms.
51
00:05:10.567 --> 00:05:12.267
And so, or leg tension.
52
00:05:12.367 --> 00:05:22.990
And so I, when that starts happening and even, and I, and I may fall off of my, my stretching routine, my, you know, my mobility routine.
53
00:05:23.290 --> 00:05:27.510
And I just focus on doing sort of the lifting or the exercise, the regular exercise.
54
00:05:28.211 --> 00:05:32.211
My body does not cooperate and it will create back spasms.
55
00:05:32.331 --> 00:05:34.752
My sleep will start to get impacted.
56
00:05:41.037 --> 00:05:41.318
Mm-hmm.
57
00:05:41.738 --> 00:05:43.621
And did that happen at an age for you?
58
00:05:43.661 --> 00:05:50.330
I'm curious, you know, there's a lot of wisdom that comes with being able to tune in and obviously stress as we age may tend to get a little bit higher.
59
00:05:50.631 --> 00:05:55.698
Was there like an age that you noticed that there was a correlation between the body aches and pains in your stress?
60
00:05:56.118 --> 00:05:58.539
It's been in the past three to five years.
61
00:05:59.220 --> 00:06:05.583
You know, prior to that, I still was blessed with the ability to push through a lot of stress and just manage it.
62
00:06:06.524 --> 00:06:17.830
But, you know, I'm 53 now, and as I'm getting to this age, as I've reached closer to my 50s, these problems started happening in my lower back.
63
00:06:17.990 --> 00:06:24.854
And I have a structurally normal back, but having back problems and chronic back pain was really surprising.
64
00:06:25.534 --> 00:06:29.478
to the point where it sidelined me from doing my exercise.
65
00:06:29.578 --> 00:06:36.844
So it's been relatively recent, but my awareness of my body has been there for a long time.
66
00:06:37.584 --> 00:06:38.425
And what a gift, right?
67
00:06:38.445 --> 00:06:44.690
The good old days of being able to muscle through your stress and show up for life with no sleep and inflammation.
68
00:06:45.151 --> 00:06:47.613
Now we have to tune in, we really have to tune in.
69
00:06:47.993 --> 00:06:49.654
And gosh, I would have guessed that you're in your 40s.
70
00:06:49.895 --> 00:06:50.375
You look great.
71
00:06:50.715 --> 00:06:51.056
Thank you.
72
00:06:52.897 --> 00:06:55.878
All right, to kick things off, we're going to go into some rapid-fire questions.
73
00:06:56.058 --> 00:06:59.660
We're obviously going to go deeper into all of these, so everyone loves these ones.
74
00:06:59.880 --> 00:07:00.360
Here we go.
75
00:07:00.460 --> 00:07:00.700
Yeah.
76
00:07:01.160 --> 00:07:07.503
What's one thing on a standard blood panel that people obsess over that you almost never look at?
77
00:07:08.103 --> 00:07:17.506
Oh, I love this question because everybody tells me what their cholesterol is, and that is probably the last thing that I want to look at when I'm assessing cardiovascular risk.
78
00:07:17.606 --> 00:07:18.087
Brilliant.
79
00:07:18.107 --> 00:07:18.547
Brilliant.
80
00:07:19.263 --> 00:07:19.563
All right.
81
00:07:19.663 --> 00:07:21.684
Statins or lifestyle changes?
82
00:07:22.205 --> 00:07:26.647
If you could only choose for a 45-year-old with early plaque, which one wins?
83
00:07:27.048 --> 00:07:28.428
Definitely lifestyle changes.
84
00:07:29.269 --> 00:07:30.570
Where have you been all my life?
85
00:07:32.231 --> 00:07:32.571
Wow.
86
00:07:32.951 --> 00:07:33.651
I'm so excited.
87
00:07:33.752 --> 00:07:33.952
Okay.
88
00:07:34.232 --> 00:07:39.355
What's the most dangerous thing that a person can do for their heart that gets sold to them as healthy?
89
00:07:40.440 --> 00:07:44.765
Ooh, right now, that's a tough one.
90
00:07:45.405 --> 00:07:51.191
I mean, clearly, smoking is one of the most dangerous things that we can do, but that's never been sold as healthy.
91
00:07:51.512 --> 00:08:01.422
I'd probably say vaping is a clandestine version of smoking that a lot of people do that's caught on that really is still bad for you.
92
00:08:03.897 --> 00:08:04.778
fruit-flavored vaping?
93
00:08:05.119 --> 00:08:06.762
Can we say that for today?
94
00:08:06.782 --> 00:08:08.164
All right.
95
00:08:08.425 --> 00:08:09.367
Finish this sentence.
96
00:08:09.747 --> 00:08:13.334
The real cause of most heart attacks isn't cholesterol, it's...
97
00:08:14.538 --> 00:08:16.840
The real cause of most heart attacks is inflammation.
98
00:08:17.661 --> 00:08:21.804
This or that advanced cardiac imaging or a full hormonal panel.
99
00:08:22.204 --> 00:08:24.426
Which tells you more about someone's true cardiac risk?
100
00:08:24.926 --> 00:08:29.229
Ooh, I would have to go with the imaging at this point.
101
00:08:30.010 --> 00:08:33.772
That gives me more to work with on a treatment level.
102
00:08:34.593 --> 00:08:41.098
Hormonal levels are vital, but they don't quite make it to tell me what their risk is.
103
00:08:42.028 --> 00:08:46.972
What's one daily habit that does more for your heart than any medication that you can prescribe?
104
00:08:47.633 --> 00:08:49.835
Daily exercise or movement routine.
105
00:08:50.936 --> 00:08:52.857
Isn't it wild we live in this world too?
106
00:08:52.877 --> 00:08:53.798
We're so aware of this.
107
00:08:53.818 --> 00:08:57.201
We're so aware of how important movement is.
108
00:08:57.221 --> 00:08:58.942
We feel it when we practice it.
109
00:08:59.143 --> 00:09:01.965
And yet, we continue to live these sedentary lifestyles.
110
00:09:02.225 --> 00:09:03.546
And life is demanding that from us.
111
00:09:03.666 --> 00:09:04.167
Absolutely.
112
00:09:04.928 --> 00:09:06.909
And heart disease, as you know, obviously, so...
113
00:09:07.970 --> 00:09:09.630
It's pretty frightening when you look at the numbers.
114
00:09:10.170 --> 00:09:12.091
It's the number one killer globally.
115
00:09:12.211 --> 00:09:16.171
Nearly half of people who suffer a heart attack had no previous symptoms.
116
00:09:17.012 --> 00:09:29.674
We've become so great at treating these cardiac emergencies, but not nearly good enough at detecting, I would say, these like decade-long processes that precurs the actual heart attack.
117
00:09:29.694 --> 00:09:31.214
So let's start with that.
118
00:09:31.694 --> 00:09:36.955
You know, most people assume that heart attack, heart disease, it announces itself.
119
00:09:37.675 --> 00:09:41.997
chest pain, the trips to the emergency room, a really scary health result.
120
00:09:42.377 --> 00:09:47.080
But you're saying that the real danger is actually building up silently years before.
121
00:09:47.860 --> 00:09:52.082
So let's start with, what does early cardiovascular disease actually look like?
122
00:09:52.562 --> 00:09:55.864
And why are we missing the mark, even with the numbers where they are at today?
123
00:09:56.619 --> 00:10:00.560
Yeah, it's an insidious process and we don't feel it.
124
00:10:01.081 --> 00:10:02.981
A lot of cardiac conditions are like that.
125
00:10:03.622 --> 00:10:10.344
And, you know, we think of cardiology or cardiac conditions as being emergency issues that we see in the hospital.
126
00:10:11.024 --> 00:10:17.787
And that's the dramatic end result, the end of the spectrum, sort of end of the line, end of the line.
127
00:10:18.287 --> 00:10:19.608
evolution of the disease.
128
00:10:19.648 --> 00:10:20.629
That's how it shows up.
129
00:10:20.769 --> 00:10:22.731
When the heart stops, it's dramatic.
130
00:10:22.991 --> 00:10:30.777
But there is, in every single cardiac condition, there is a slow, steady progression that we can detect early on.
131
00:10:31.137 --> 00:10:38.943
And it doesn't necessarily have to be showing up in the heart because it's hard to visualize sometimes these changes in the heart.
132
00:10:39.284 --> 00:10:41.766
It happens metabolically and it happens in other organs.
133
00:10:42.346 --> 00:10:47.609
So really true cardiovascular prevention is a systems approach.
134
00:10:48.049 --> 00:10:50.771
And so we have to look at glucose regulation.
135
00:10:50.971 --> 00:10:54.353
We have to look at the liver health.
136
00:10:54.393 --> 00:10:57.975
Taking a step back, discussing the liver, liver is central.
137
00:10:58.055 --> 00:11:07.400
It is an intersection of so many different systems where we're talking about energy regulation, where cholesterol is produced, right?
138
00:11:07.880 --> 00:11:09.161
where we detoxify.
139
00:11:09.181 --> 00:11:13.503
I mean, the liver is so vital and it is intimately tied to cardiovascular health.
140
00:11:13.883 --> 00:11:15.964
And this is becoming more and more obvious.
141
00:11:16.505 --> 00:11:26.730
When you look at a fatty deposition of the liver, this was thought to be just a problem with the liver and something that alcoholics or diabetics suffer from.
142
00:11:27.230 --> 00:11:32.492
We are now seeing many, many people that don't have those problems and they have fatty deposition.
143
00:11:32.892 --> 00:11:38.735
And it's part of the contribution to cardiovascular disease, that plus inflammation.
144
00:11:39.555 --> 00:11:48.299
So when you're looking at how heart disease shows up early on, it's not necessarily looking at the heart.
145
00:11:48.359 --> 00:11:50.080
It's looking at everything else around the heart.
146
00:11:50.821 --> 00:11:58.988
I mean, definitely gut health is intimately tied to it because 70% of our immune system resides in the gut.
147
00:11:59.309 --> 00:12:11.180
So anything that affects or activates the immune system there is definitely going to impact cardiovascular system because inflammation is one of the key drivers of cardiovascular disease.
148
00:12:12.618 --> 00:12:13.238
It's interesting.
149
00:12:13.258 --> 00:12:15.299
This is where I always go back to Eastern wisdom.
150
00:12:15.859 --> 00:12:19.521
Eastern traditions typically looked at the entire body as a system.
151
00:12:19.541 --> 00:12:19.641
Yeah.
152
00:12:19.941 --> 00:12:25.163
They would never just isolate on the heart or the liver or the stomach or the brain.
153
00:12:25.183 --> 00:12:27.264
They would look at the body as an entire program.
154
00:12:27.684 --> 00:12:33.687
As a nutritionist, I spend so much time obviously talking about digestion and gut health, but we always have to work upstream.
155
00:12:34.087 --> 00:12:36.228
And working upstream means we go to the liver.
156
00:12:36.248 --> 00:12:36.348
Yeah.
157
00:12:36.808 --> 00:12:46.198
And to your point, I can imagine that a lot of doctors who are trained in conventional cardiology, you know, somebody on the exterior looks healthy.
158
00:12:46.679 --> 00:12:47.600
They're not drinkers.
159
00:12:47.620 --> 00:12:48.641
They're not overweight.
160
00:12:48.721 --> 00:12:50.183
They could actually be quite lean.
161
00:12:50.243 --> 00:12:53.927
And, you know, they're relying on that while they're looking at these exercises.
162
00:12:54.427 --> 00:12:57.110
at these cholesterol panels without looking at the full picture.
163
00:12:57.250 --> 00:13:07.221
So for you, what was the point in your career where you had to branch out of, I guess, what your education probably taught you into the knowing of treating the body as a whole?
164
00:13:08.165 --> 00:13:09.426
That happened a long time ago.
165
00:13:09.446 --> 00:13:12.990
It happened probably 2010 around that area.
166
00:13:13.970 --> 00:13:19.796
I was working full-time as a cardiologist and doing inpatient, outpatient care.
167
00:13:20.556 --> 00:13:27.202
And it was a revolving door of heart failure and atherosclerosis and younger and younger people coming in.
168
00:13:27.523 --> 00:13:29.825
And it just didn't seem like the
169
00:13:30.725 --> 00:13:34.966
It didn't seem like we were making a dent in these new people arriving into disease.
170
00:13:35.106 --> 00:13:43.589
And people that were already existing with disease, they just, you know, we weren't really making a, we were stopping them in the emergency situation, controlling those.
171
00:13:43.649 --> 00:13:47.010
But then they would have a, they would relapse very quickly.
172
00:13:50.312 --> 00:13:53.015
It felt like I wasn't really making a dent.
173
00:13:53.275 --> 00:13:57.139
And my curiosity was, how do we prevent this?
174
00:13:57.179 --> 00:14:02.705
And there was nothing that I was taught in medical school and up to fellowship about prevention.
175
00:14:02.745 --> 00:14:05.208
It was all about treating the end-stage disease.
176
00:14:06.328 --> 00:14:17.191
And then I had a personal revelation, not necessarily a crisis, but I burned out and decided that it was long hours, on call all the time.
177
00:14:17.691 --> 00:14:19.811
And I just didn't really see a point in it all.
178
00:14:20.391 --> 00:14:30.154
And I decided I'm going to take a step back and take a sabbatical, retrain myself, understand what was happening in a different way.
179
00:14:30.494 --> 00:14:31.934
And that's how I found functional medicine.
180
00:14:32.174 --> 00:14:36.957
Functional medicine is the study of chronic disease, looking for root causes.
181
00:14:37.438 --> 00:14:42.041
I've always been an athlete interested in diet and exercise and optimization of health.
182
00:14:42.381 --> 00:14:44.543
And so that was the first foray into it.
183
00:14:44.783 --> 00:14:48.886
And that's when I started changing and thinking about things from a system standpoint.
184
00:14:50.082 --> 00:14:50.742
Fascinating.
185
00:14:51.442 --> 00:14:56.844
And I can imagine it feels a lot more rewarding as a practitioner because now you're part of prevention and preventative health care.
186
00:14:57.084 --> 00:14:57.304
Yeah.
187
00:14:57.904 --> 00:14:59.825
You know, it's surprising.
188
00:15:00.005 --> 00:15:04.646
It's a step back to more generalized care because I'm looking at all the systems.
189
00:15:05.206 --> 00:15:09.968
And, you know, you find a cardiologist that asks you to do a stool test or wants to take a picture of your liver.
190
00:15:10.308 --> 00:15:13.609
You know, it's surprising, but that's what I end up doing.
191
00:15:13.869 --> 00:15:15.709
And it reveals a lot.
192
00:15:16.149 --> 00:15:18.570
It helps better outcomes for sure.
193
00:15:19.097 --> 00:15:19.297
Yeah.
194
00:15:19.878 --> 00:15:23.120
So you'd mentioned the words root cause, which is really powerful.
195
00:15:23.500 --> 00:15:32.407
Living in today's modern world, especially with the access of these functional biomarker testing companies that we can all go and get, most people don't know what to do with these labs.
196
00:15:32.987 --> 00:15:37.651
A lot of people come back with inflammatory markers in different systems of their body.
197
00:15:38.051 --> 00:15:42.735
And for me, looking back, it's funny, you know, you mentioned gut, you mentioned metabolic health.
198
00:15:43.315 --> 00:15:51.560
If I were to go back in time, I wish that the cardiologist at the time of my surgery were asking or investigating into my metabolic health.
199
00:15:52.180 --> 00:15:54.681
You know, my circadian rhythm was completely off.
200
00:15:55.181 --> 00:16:03.706
I was on, I remember at the time thinking that I felt better if I removed starches, like it would minimize my tachycardia episodes.
201
00:16:04.066 --> 00:16:05.127
But they didn't ask about that.
202
00:16:05.587 --> 00:16:12.429
And I wish the doctors had asked about the fact that I was on antibiotics for about 15 years straight, sometimes twice a year growing up.
203
00:16:12.869 --> 00:16:22.452
And so when we think about that working upstream right now, I'm sure that most cardiologists are still looking at that cornerstone, basic lipid profile.
204
00:16:23.052 --> 00:16:24.132
Where does that leave people?
205
00:16:24.452 --> 00:16:31.915
You know, the state of awareness that we are in today, how are cardiologists still left in the dark around looking at a bigger picture to get to that root cause?
206
00:16:32.355 --> 00:16:32.695
Yeah, absolutely.
207
00:16:33.935 --> 00:16:43.457
I think that part of it is there is a deficiency of cardiologists and the ones that are available are usually swamped with a lot of work.
208
00:16:43.817 --> 00:16:54.320
And the other thing to remember is cardiology has historically been a procedure-driven specialty, working with our hands, doing stent implantation, doing ablations.
209
00:16:54.960 --> 00:16:58.781
There is a lot of visual interpretation too, but that's an aside.
210
00:16:58.801 --> 00:17:07.643
It is procedure-oriented, so there's not a lot of thinking as to what is going on metabolically and on a cellular level.
211
00:17:07.923 --> 00:17:19.185
So there's an issue of time because there's a lot of people that need help when they get to that end stage, and there's only a certain number of cardiologists that are able to do this type of thing for these people that are in emergency needs.
212
00:17:19.705 --> 00:17:24.969
So that being said, there's also just, you know, there's a lack of education.
213
00:17:24.989 --> 00:17:38.879
I mean, it takes a real curiosity and, you know, and time to be able to investigate these root causes, these other cellular pathways and processes that cause cardiovascular disease.
214
00:17:39.459 --> 00:17:49.603
It's time intensive and, you know, it's taken me 10 years to get to this point, 10 years of additional training after working and being in practice and then retraining myself.
215
00:17:49.703 --> 00:17:59.246
So it's labor intensive and there's got to be a true love to it and a curiosity and openness to understanding that, okay, I don't know everything.
216
00:17:59.686 --> 00:18:01.247
I'm still learning and I'm always going to learn.
217
00:18:02.045 --> 00:18:02.846
I think it's powerful.
218
00:18:02.866 --> 00:18:04.789
I think we're heading into that direction.
219
00:18:04.809 --> 00:18:07.652
I hope we are with the numbers that are on the rise.
220
00:18:08.033 --> 00:18:13.139
However, I can imagine that you're probably meeting with a lot of people who are exercising.
221
00:18:13.680 --> 00:18:14.962
They're eating well.
222
00:18:15.522 --> 00:18:19.367
They might think that they're managing their stress or they've become accustomed to living well.
223
00:18:19.888 --> 00:18:21.790
with a certain level of stress every single day.
224
00:18:21.870 --> 00:18:24.673
But a lot of people feel like they're doing a lot of things really, really right.
225
00:18:25.234 --> 00:18:29.098
And yet we see their numbers, they're coming back, and they do have these inflammatory markers.
226
00:18:29.158 --> 00:18:31.501
And we do see that things are going wrong.
227
00:18:31.961 --> 00:18:36.627
So what are you finding in these people that conventional medicine is missing?
228
00:18:37.187 --> 00:18:40.149
It goes back to looking at the gut.
229
00:18:40.210 --> 00:18:46.214
I find that we live in an increasingly higher stress burden environment and a toxic environment.
230
00:18:46.615 --> 00:18:53.400
And that can be mental stress, that can be food desert stress, it can be oxidative stress.
231
00:18:53.680 --> 00:18:55.421
You know, these things add up.
232
00:18:56.081 --> 00:19:05.486
And especially in somebody that thinks they're doing everything right, there are really insidious places where this starts to creep in.
233
00:19:05.846 --> 00:19:08.627
I mean, everybody's exposed to environmental toxins.
234
00:19:08.947 --> 00:19:17.811
And that shows up in maybe food sources that have higher content of, say, arsenic or mercury or lead.
235
00:19:18.132 --> 00:19:20.813
Those in particular have high cardiovascular effects.
236
00:19:21.273 --> 00:19:25.456
You know, then you've got food that has glyphosate in it.
237
00:19:25.516 --> 00:19:39.584
And if you're not particular about, you know, about being aware of your gluten status or even just having antibiotics like you had and still eating well, you know, the many courses of antibiotics changes your microbiome.
238
00:19:39.664 --> 00:19:44.987
So all of this contributes to overall cardiovascular disease.
239
00:19:45.307 --> 00:19:49.670
And so it really takes looking at it from that, you know, sort of ground up standpoint.
240
00:19:50.923 --> 00:19:53.004
What would you say is a basic cardiovascular panel?
241
00:19:53.044 --> 00:19:57.026
I'm guessing LDL, total cholesterol, HDL, triglycerides maybe?
242
00:19:57.046 --> 00:19:59.988
Yeah, that's a basic lipid panel.
243
00:20:00.028 --> 00:20:03.230
But for me, I would like to see an ApoB.
244
00:20:03.590 --> 00:20:11.274
I'd like to see a C-reactor protein, hemoglobin A1C, fasted glucose, insulin levels.
245
00:20:11.894 --> 00:20:14.015
Those are just some basic numbers.
246
00:20:14.155 --> 00:20:18.538
And I mean, if you take a look at what you can actually do from a basic standpoint,
247
00:20:19.058 --> 00:20:33.628
there are some really wonderful ratios that you can get from very cheap, basic labs that can give us a lot of information about underlying inflammation, liver health, and overall metabolic health.
248
00:20:34.088 --> 00:20:37.430
So it doesn't take a lot of high-level testing.
249
00:20:37.530 --> 00:20:45.756
You can do it with a CBC with differential, a comprehensive metabolic panel, lipid panel, ApoB, and an A1C.
250
00:20:45.896 --> 00:20:47.497
Those are all very basic.
251
00:20:48.554 --> 00:20:49.795
Yeah, they definitely are.
252
00:20:50.356 --> 00:20:53.298
And most practitioners should be running those anyways.
253
00:20:53.378 --> 00:21:01.266
But at what age would you say, you know, if we say we're noticing that prevention is key here, at what age would you start looking for panels like that?
254
00:21:01.466 --> 00:21:03.668
I'm imagining it's before any concerns come up.
255
00:21:03.948 --> 00:21:04.188
Yeah.
256
00:21:05.072 --> 00:21:17.456
Yeah, I think that looking at ApoB and cholesterol, that's going to, you know, in the younger years, it's probably, it's important to get an assessment for that initially, early on in life.
257
00:21:18.016 --> 00:21:21.978
Certainly, that's going to be checked, I would say, within late 20s, 20s.
258
00:21:22.978 --> 00:21:24.960
Then do it in your 30s if there's no issues.
259
00:21:25.600 --> 00:21:32.506
The other thing to check early on is lipoprotein little a, which has emerged as a genetic risk factor.
260
00:21:33.066 --> 00:21:34.348
And then have the family checked.
261
00:21:34.588 --> 00:21:39.051
Usually if there's family members that have it, that'll provoke somebody in the family getting tested young.
262
00:21:39.572 --> 00:21:42.434
And we can get into lipoprotein little a in a minute.
263
00:21:42.775 --> 00:21:42.975
But...
264
00:21:43.535 --> 00:21:48.319
Yeah, I would say that lipids will change and they will track upwards.
265
00:21:48.619 --> 00:21:53.442
They will drift upwards as we get older and so will inflammatory markers.
266
00:21:53.482 --> 00:21:59.507
But it's important to get them early on so we don't miss the people that may have some of that risk early on.
267
00:22:00.064 --> 00:22:01.706
A lot of this has to do with inflammation.
268
00:22:01.746 --> 00:22:03.147
I think we've said that word a few times.
269
00:22:03.167 --> 00:22:13.397
So not only from the demands of life, this could be from poor sleep, this could be from poor gut health, overwhelm, toxins in our environment, our food, our water.
270
00:22:13.417 --> 00:22:14.718
If you're not, you're
271
00:22:15.419 --> 00:22:24.083
If inflammation is the root cause, then how do we understand where this becomes something that is preventable?
272
00:22:24.103 --> 00:22:26.543
How do we know what to deal with first?
273
00:22:26.563 --> 00:22:34.887
So you mentioned looking at your biomarker testing first and foremost, but are we seeing the rise in these cardiovascular numbers as a result of just living in our modern day world?
274
00:22:35.467 --> 00:22:37.589
I think that's part of it, yeah.
275
00:22:37.989 --> 00:22:39.730
And it is a...
276
00:22:40.711 --> 00:22:46.375
When we look at the population in general, so the wider population, it's metabolic dysfunction.
277
00:22:46.595 --> 00:22:55.042
It's glucose dysregulation, insulin, you know, because the obesity, because obesity is a growing problem despite having all the tools that we have.
278
00:22:55.522 --> 00:22:57.744
Diabetes continues to be a growing problem.
279
00:22:57.764 --> 00:23:00.846
And that's where most of the population falls today.
280
00:23:01.066 --> 00:23:12.654
The other population that we've kind of been talking about and alluding to is the healthier population that is watching what they're doing, but still ends up getting cardiovascular disease despite their best efforts.
281
00:23:12.874 --> 00:23:20.519
That's an interesting population because that's where we have to start looking at some of those hidden risks and hidden sources of inflammation.
282
00:23:20.619 --> 00:23:26.464
So it could be the combination of sleep dysregulation, work stress, sympathetic load.
283
00:23:26.784 --> 00:23:29.686
I think there's a, you know, when I say sympathetic load, I mean...
284
00:23:30.647 --> 00:23:36.833
mental stress and activation of your autonomic nervous system into constant fight or flight.
285
00:23:37.153 --> 00:23:44.321
I mean, we're in a society where we have news happening immediately all the time and everybody's attached to their phones.
286
00:23:44.521 --> 00:23:51.288
And this leads to an anxiety prone, overstimulated lifestyle and culture.
287
00:23:51.388 --> 00:23:53.010
And we're not meant to live that way.
288
00:23:53.450 --> 00:23:56.912
We are meant to live with stress and then disconnect and relax.
289
00:23:57.332 --> 00:23:59.494
That's a cyclical pattern.
290
00:24:00.314 --> 00:24:08.899
And when we have mental stress and we trigger adrenaline, that is an inflammatory activator for our vascular system.
291
00:24:09.279 --> 00:24:10.500
It increases blood pressure.
292
00:24:10.600 --> 00:24:13.022
So there are real physiologic changes
293
00:24:13.902 --> 00:24:17.146
And imagine if we're stimulating those changes constantly.
294
00:24:17.226 --> 00:24:23.273
So, you know, there are a lot of these hidden triggers of inflammation.
295
00:24:23.313 --> 00:24:30.561
And so in that population where they think they're doing everything really well, really have to look at where the other sources are.
296
00:24:30.962 --> 00:24:34.285
I mean, overtraining is actually quite a common problem, too.
297
00:24:35.115 --> 00:24:36.877
We think that more is better.
298
00:24:36.978 --> 00:24:38.259
Let's be more fit.
299
00:24:39.060 --> 00:24:40.663
It's not, you know, more is not better.
300
00:24:40.763 --> 00:24:45.890
We function best, humans function best in a window, in a sweet spot.
301
00:24:45.910 --> 00:24:49.936
And if we don't give ourselves the right recovery, it will cause problems.
302
00:24:50.902 --> 00:24:51.382
Oh, gosh.
303
00:24:51.983 --> 00:25:02.508
The amount of unlearning, coaching around unlearning that I need to do with the people that I work with because they want to get back to their physical shape at 20 or 30 or even to optimize their metabolic numbers.
304
00:25:02.828 --> 00:25:03.788
I'm going to go hardcore.
305
00:25:04.068 --> 00:25:05.109
I'm going to start on Monday.
306
00:25:05.129 --> 00:25:07.230
I'm going to restrict absolutely everything.
307
00:25:07.250 --> 00:25:11.072
And it puts their system under so much more stress and anxiety.
308
00:25:11.492 --> 00:25:28.491
I want to hover on this just for a second because whenever I give talks, I was just at a retreat this weekend where I was speaking, and every single person that was there, when I asked, you know, on a scale of one to ten, let me know who here suffers from a level eight, nine, or ten, every single hand in that audience went up.
309
00:25:28.951 --> 00:25:30.373
And it was followed by laughter.
310
00:25:30.913 --> 00:25:37.077
And the followed by laughter is a really key component to this because it means that we've normalized this way of being in society.
311
00:25:37.637 --> 00:25:45.922
And from an Eastern perspective, when I saw an Ayurvedic practitioner, you know, the reminder of stress is the instigation of all dis-ease within the body.
312
00:25:46.382 --> 00:25:56.428
And so if we're having this conversation around preventing heart disease, and yet here we are in our younger, healthier ages and we're experiencing these high levels of stress, then...
313
00:25:56.928 --> 00:26:00.811
We can only imagine that this could be the instigation of heart disease in the future.
314
00:26:00.831 --> 00:26:03.333
Yeah, I agree.
315
00:26:03.654 --> 00:26:14.723
This is, I think, the first time in history we've got such a high stress and sympathetic load that happens starting in childhood and then leading into adulthood.
316
00:26:15.444 --> 00:26:17.065
And in the past, it's never been that way.
317
00:26:17.105 --> 00:26:17.746
It's never been...
318
00:26:18.206 --> 00:26:19.488
constant stress burden.
319
00:26:19.548 --> 00:26:30.944
So, you know, when I look at why sometimes people are coming to me with heart disease more than expected at a younger age, there's, you know, these are definite sources that we look into.
320
00:26:31.522 --> 00:26:32.623
So we have to address our stress.
321
00:26:33.303 --> 00:26:34.704
I want that to be the number one takeaway.
322
00:26:35.144 --> 00:26:47.011
The second aspect, which I'm fascinated about because it really helps me personalize protocols with my clients, is looking at their genetics and understanding their susceptibility to developing cardiovascular disease.
323
00:26:47.632 --> 00:26:55.857
For me, my genetics on both sides of my family, I'm a carrier for having issues with heart disease.
324
00:26:56.177 --> 00:26:57.138
So you mentioned APOE.
325
00:26:57.158 --> 00:26:57.358
Yes.
326
00:26:58.038 --> 00:26:59.599
What else should we be looking at?
327
00:26:59.619 --> 00:27:03.580
And are you looking at genetic tests with patients that you work with?
328
00:27:03.600 --> 00:27:05.580
Or when you're speaking to audiences, does this come up?
329
00:27:05.860 --> 00:27:06.821
I do.
330
00:27:06.841 --> 00:27:09.902
Yeah, there's a few genetic tests that I'll look at.
331
00:27:09.922 --> 00:27:16.084
So LP little a is one that's shown up as a common one that's being discussed.
332
00:27:16.144 --> 00:27:20.205
I mean, one of the reasons is because the pharmaceutical companies are looking at...
333
00:27:20.765 --> 00:27:22.927
creating something to lower LP little a.
334
00:27:23.007 --> 00:27:27.171
So it gets a lot of marketing in that regard.
335
00:27:27.271 --> 00:27:31.455
But LP little a is just to discuss what it is specifically.
336
00:27:31.475 --> 00:27:45.708
It's a protein that's on the LDL particle that makes it more prone to being oxidized or inflammatory, makes it stickier, so to speak, and can predispose sort of calcium deposition, things like that.
337
00:27:46.088 --> 00:27:54.353
So, there's very little you can do from a lifestyle standpoint, diet or exercise, to lower it.
338
00:27:54.994 --> 00:28:01.458
There's a few medications that may be able to reduce it, but it makes LDLs more prone to causing problems.
339
00:28:01.858 --> 00:28:08.462
And the thinking behind it is if you lower the LP little a, then you lower a risk factor.
340
00:28:08.802 --> 00:28:11.824
My thinking is back to a systems-based approach.
341
00:28:11.864 --> 00:28:17.667
It's that LP little a is not necessarily a problem unless you have other risk factors.
342
00:28:18.028 --> 00:28:19.428
It's a risk amplifier.
343
00:28:19.949 --> 00:28:21.570
So if you have...
344
00:28:22.190 --> 00:28:39.300
if you've managed your risk profile, managed your inflammation, managed your glucose, managed your stress, uh, you know, your, your tendency for your hormones, things like that, then you can mitigate the LP little a and, uh, and have, and make it have the least amount of impact.
345
00:28:39.741 --> 00:28:46.865
And the reason I say that is because there's a whole host of people that have LP little a elevations that don't have heart disease.
346
00:28:46.925 --> 00:28:47.045
Yeah.
347
00:28:48.243 --> 00:28:48.523
Yeah.
348
00:28:48.603 --> 00:28:50.364
So, so I'm one of them.
349
00:28:50.384 --> 00:28:50.624
Yeah.
350
00:28:50.684 --> 00:28:51.385
So there you go.
351
00:28:51.445 --> 00:28:56.668
You've, you've done a great job to mitigate the risk and it's because you've, you've addressed the rest of the system.
352
00:28:57.068 --> 00:29:12.357
So just a brief, you know, discussion about LP little a, the, the other genetic tests I'll look at will be APOE genotype that looks at your risk, increased risk of atherosclerosis and Alzheimer's.
353
00:29:12.537 --> 00:29:12.997
So you
354
00:29:13.157 --> 00:29:18.760
You can get, you know, the APOE4 genotype is the one that's of higher risk.
355
00:29:19.161 --> 00:29:21.442
And then there's MTHFR.
356
00:29:21.642 --> 00:29:31.408
MTHFR has a specific SNP that has a propensity for increased atherosclerosis, increased homocysteine, things like that.
357
00:29:31.928 --> 00:29:44.657
I will do a genetic assessment on patients when they come to me at a young age and there is no clear-cut reason for why they have atherosclerosis higher than expected.
358
00:29:44.878 --> 00:29:47.259
Because not everybody needs to get a genetic assessment.
359
00:29:47.620 --> 00:29:49.101
If they want it, I'm happy to do it.
360
00:29:49.201 --> 00:29:58.568
And if you show up to me in your older years with an expected amount of heart disease, then it's also probably not necessary at that point because...
361
00:29:59.228 --> 00:30:05.911
Remember, genetics are only as important as the lifestyle you've used to activate those genetics.
362
00:30:06.651 --> 00:30:10.152
Meaning, you know, like an analogy, the genetics are your library.
363
00:30:10.693 --> 00:30:19.416
What you've done to take, you can choose what books to take out of that library by life choices, by lifestyle, diet, all that stuff.
364
00:30:19.796 --> 00:30:22.557
The books we take out are what show up in our body.
365
00:30:22.897 --> 00:30:34.440
So if you've already spent 60 years of taking out the wrong books, I don't really need to know what's in the library to know, fix that, how to change the metabolism.
366
00:30:35.620 --> 00:30:43.902
But if you show up at a young age and you have atherosclerosis, then those genes are going to be more important to see.
367
00:30:44.806 --> 00:30:45.126
Hmm.
368
00:30:46.007 --> 00:31:03.619
I think that the information, this is a blessing around Western medicine, right, is that the science that is emerging, the things that we can now understand about our physiology for prevention is so key, but I'll always preface it with as long as it doesn't induce fear or fear-like behaviors and how it's going to drive you.
369
00:31:04.099 --> 00:31:11.545
And, you know, I'm seeing a lot of these come back, the MTHFR gene, homocysteine ability to
370
00:31:12.225 --> 00:31:12.665
what am I saying?
371
00:31:12.725 --> 00:31:17.447
Elevated homocysteine or people's body's abilities to detoxify them.
372
00:31:17.467 --> 00:31:18.307
Is that the right word?
373
00:31:18.327 --> 00:31:19.948
To detoxify homocysteines properly?
374
00:31:19.968 --> 00:31:20.828
Yeah.
375
00:31:20.948 --> 00:31:25.189
And so we come back with these precursors that we know are linked to heart disease.
376
00:31:25.350 --> 00:31:27.530
And yet a lot of doctors again are practicing this.
377
00:31:27.570 --> 00:31:38.074
So for listeners, I just think it's worthy of, if you know that you come from a family who has a history of genetic heart disease, then these are numbers that are definitely worth looking into.
378
00:31:38.754 --> 00:31:45.282
When you talk about the cardiovascular system, let's just go back to LP little a for a second.
379
00:31:45.343 --> 00:31:50.489
Is LP little a, is there a connection with what you're seeing over time to plaque buildup within the heart?
380
00:31:50.950 --> 00:31:56.377
The connection, when we look at studies, they do see an association with LP little a.
381
00:31:56.837 --> 00:32:02.380
and increased risk of plaque and calcium on some of the valves.
382
00:32:03.241 --> 00:32:09.945
And then there are a few other associations, some vascular increase in thromboembolic events.
383
00:32:10.445 --> 00:32:23.933
But the association doesn't cross over the whole population, which is what, you know, there's a, you know, it's there and it's difficult to determine who it is
384
00:32:24.473 --> 00:32:29.115
that benefits, well, who it is that seems to show up with the disease.
385
00:32:29.595 --> 00:32:34.357
And I think it's because a lot of the studies haven't, they've looked at that in isolation.
386
00:32:34.697 --> 00:32:42.160
But to look at it with the other disease modifiers and to see how that amplifies risk, I think hasn't been done yet.
387
00:32:42.569 --> 00:32:52.058
The other aspect of that also, I'm curious for men and women who notice at whatever point in their life, their LP, little a, comes back and all of a sudden they're in the red.
388
00:32:52.698 --> 00:32:56.502
Is there an association to hormonal changes also that are happening as we age?
389
00:32:56.950 --> 00:32:57.290
Yes.
390
00:32:57.330 --> 00:32:57.511
Yeah.
391
00:32:57.531 --> 00:33:04.238
When women go into menopause, we tend to see higher, the LP little a elevation start to happen a little bit more.
392
00:33:05.479 --> 00:33:13.548
And curiously, they may not have been detected in the past, partially because we haven't really tested it on the wider population until recently.
393
00:33:13.588 --> 00:33:14.149
So we don't know.
394
00:33:14.709 --> 00:33:22.798
in postmenopausal women, but the estradiol is one of the things that can mitigate LP little a and lower it.
395
00:33:22.939 --> 00:33:29.967
So when women lose estradiol in menopause, there is a possibility that it may cause some of that LP little a elevation.
396
00:33:30.567 --> 00:33:39.317
And eventually, you said there's very little to move the markers on that, but are there minimal shifts that happen with hormone replacement therapy with estradiol?
397
00:33:39.438 --> 00:33:40.118
Yes, yes.
398
00:33:40.218 --> 00:33:44.804
Estradiol is one of the few things that can show some reduction in LP little a.
399
00:33:45.244 --> 00:33:49.970
And one of the things, it's not pharmaceutical and it's got a global multi-system benefit.
400
00:33:50.991 --> 00:33:54.054
Fascinating, because we would never associate the two together, right?
401
00:33:54.414 --> 00:34:01.121
And I've noticed a trend, even with perimenopause, that drop in estradiol, and all of a sudden the LPLLA marker comes back.
402
00:34:01.761 --> 00:34:05.144
All right, so now we're connecting hormones to this as well.
403
00:34:05.164 --> 00:34:05.845
Yeah.
404
00:34:06.906 --> 00:34:14.374
When we think about these shifts then that are happening, let's say as early as your 30s, but moving into your 40s, we talked about stress being a trigger.
405
00:34:14.394 --> 00:34:20.220
We talked about genetics also being a component here, but what other big components are you seeing?
406
00:34:20.260 --> 00:34:25.245
If you were to name two or three things that you would look out for in someone's lifestyle, what would they be?
407
00:34:25.959 --> 00:34:26.720
Let's see.
408
00:34:26.880 --> 00:34:30.083
So in their lifestyle, well, you mentioned hormones.
409
00:34:30.343 --> 00:34:40.752
I am a big proponent of examining hormones and they are, in my mind, they are our nature's regenerative tools.
410
00:34:41.012 --> 00:34:45.956
And so the original net regenerative tools that we have, so replacing those are vital.
411
00:34:46.276 --> 00:34:51.421
That is mandatory as far as start establishing baseline.
412
00:34:51.441 --> 00:34:51.501
So,
413
00:34:51.801 --> 00:34:55.603
health and resilience in our practice.
414
00:34:56.223 --> 00:35:01.205
Other lifestyle questions I have, definitely I go into sleep.
415
00:35:01.305 --> 00:35:04.687
I ask everybody about sleep, whether it's restful,
416
00:35:06.988 --> 00:35:10.449
number of hours, if it's regulated, what if they're waking up at night.
417
00:35:10.829 --> 00:35:14.770
We talked about bowel habits, I don't need to go into that anymore.
418
00:35:15.350 --> 00:35:26.133
Stimulant exposure, caffeine, or any other power drinks or energy drinks, those have, if there's excessive amounts, that has an additive risk.
419
00:35:26.673 --> 00:35:30.814
And then we talked about stress, that's also something really important.
420
00:35:31.275 --> 00:35:36.356
Not necessarily lifestyle, but I also ask about COVID exposure.
421
00:35:37.077 --> 00:35:41.883
COVID is an important vascular insult.
422
00:35:43.945 --> 00:35:51.174
It attacks the whole system, but it gains access to the system through the lungs, blood vessels, and then the rest of the body.
423
00:35:51.295 --> 00:35:52.796
So your blood vessels...
424
00:35:55.598 --> 00:35:59.699
areas of high blood vessel concentration are the ones that are most susceptible.
425
00:35:59.779 --> 00:36:06.661
And so it can affect all the blood vessels in the body and create accelerated atherosclerosis.
426
00:36:07.321 --> 00:36:11.322
Is that why we saw a rise in cardiovascular cases around the time of COVID?
427
00:36:11.682 --> 00:36:22.169
Yeah, one of the reasons, yeah, it would create inflammation directly in the myocardium because it's a highly vascular organ and other organs.
428
00:36:22.229 --> 00:36:28.554
But we saw a lot of cardiovascular deaths and the rise in cardiovascular deaths because of COVID.
429
00:36:28.774 --> 00:36:36.799
Sudden heart attacks in people that might have not had it or in the young people that were marginally at risk all of a sudden tipping over.
430
00:36:37.219 --> 00:36:37.820
So definitely.
431
00:36:37.840 --> 00:36:37.980
Yeah.
432
00:36:38.624 --> 00:37:02.646
I've been noticing a trend in my practice where whether people, you know, had COVID and really suffered or had COVID and, you know, they thought it passed or people who had long haulers COVID, a lot of people since then, you know, it's not uncommon for these people to then have become more susceptible to getting mold or they felt more susceptible to nervous system dysregulation, not being able to hold or carry at a capacity that they used to.
433
00:37:02.666 --> 00:37:04.027
And a lot of these people, I've
434
00:37:04.748 --> 00:37:05.808
I'll say myself included.
435
00:37:06.228 --> 00:37:09.069
I think I fully bounced back since those years.
436
00:37:09.089 --> 00:37:12.910
I had the onset of hormonal changes and perimenopause and things like that.
437
00:37:13.010 --> 00:37:30.293
But could this be a source of, you know, when the body is under a state of inflammation for a long period of time and that inflammation goes systemic, I can imagine that it's normal for it to take years for it to go back unless we're taking a proactive whole system approach.
438
00:37:31.073 --> 00:37:31.814
Yeah, I would agree.
439
00:37:31.974 --> 00:37:36.678
And that's what happens with long haulers.
440
00:37:36.698 --> 00:37:46.907
They've gotten such a metabolic insult and it goes down to the cellular level that any sort of challenge to the system is poorly tolerated.
441
00:37:47.427 --> 00:37:53.311
And, you know, if we wanted to talk about specifics, it's potentially a problem with mitochondrial function.
442
00:37:53.531 --> 00:38:01.697
You know, it goes down to the subcellular range where the things that create energy are broken.
443
00:38:01.857 --> 00:38:09.162
They're not, the cellular structure is degraded and, you know, basic energy producing mechanisms are gone.
444
00:38:09.222 --> 00:38:11.904
So that means you can't produce energy for...
445
00:38:12.644 --> 00:38:13.945
for the initial activity.
446
00:38:14.285 --> 00:38:21.627
And if you do, then they're set back because they don't have the ability to recover from that, to make the energy to recover.
447
00:38:22.068 --> 00:38:24.929
And then they don't have the energy for immune activation.
448
00:38:25.589 --> 00:38:28.550
And part of the problem that people have
449
00:38:29.130 --> 00:38:36.212
In this situation that makes them susceptible to other conditions, other problems, is that they've fatigued their immune system.
450
00:38:36.492 --> 00:38:38.112
So the immune system can't react.
451
00:38:38.172 --> 00:38:40.733
And so they become more susceptible to so many other things.
452
00:38:41.293 --> 00:38:43.234
Or the immune system overreacts.
453
00:38:43.634 --> 00:38:50.495
And then you get sort of this overreacting, histamine triggering, you react to everything sort of physiology.
454
00:38:50.575 --> 00:38:57.457
So it's really difficult to regulate that when your basic structures are just degraded.
455
00:38:57.742 --> 00:39:00.523
I can just hear listeners saying, all right, doc, tell us what to do then.
456
00:39:02.164 --> 00:39:03.004
Low mitochondrial.
457
00:39:03.425 --> 00:39:04.725
And then I think you said it already.
458
00:39:05.205 --> 00:39:06.826
It all goes back to the foundations.
459
00:39:07.226 --> 00:39:11.708
You know, we really just, we can't talk about the foundations of health enough.
460
00:39:11.768 --> 00:39:19.112
Proper sleep, proper rest, proper stress management, proper food, proper movement every single day, proper sunlight for your circadian rhythm.
461
00:39:19.172 --> 00:39:21.153
It really is the secret to overall health.
462
00:39:21.773 --> 00:39:27.136
Now, I'm smiling because, you know, I look back at the time of my heart surgeries and I say, what a gift.
463
00:39:27.636 --> 00:39:40.283
I was able to look at my heart on this massive screen for hours and the wires going into my system, but also really developing a deep connection to my heart because I'd never been that up close and personal with it.
464
00:39:41.043 --> 00:39:49.408
And I often, when we think about having this deeper connection, especially to our heart, this thing that has beat for us since before we even arrived on this planet,
465
00:39:49.988 --> 00:39:53.431
I think that our choices would probably be a little bit more aligned.
466
00:39:53.991 --> 00:40:01.578
So can you give us maybe a little bit more of a detailed scope to what this plumbing system within us is?
467
00:40:01.898 --> 00:40:13.988
And before the macro damages that we mentioned that we're aware of because of physical pain or lab markers, what's actually happening in these micro damage moments to our cell walls?
468
00:40:14.627 --> 00:40:15.488
To the cell wall.
469
00:40:16.008 --> 00:40:19.910
Well, when you have what's...
470
00:40:19.970 --> 00:40:23.533
The lining of the arteries is fascinating.
471
00:40:23.553 --> 00:40:27.675
You've got a cell, one cell layer thick called the endothelium.
472
00:40:28.236 --> 00:40:29.076
And that is...
473
00:40:30.618 --> 00:40:32.640
It's one of the largest organs in our body.
474
00:40:33.081 --> 00:40:46.397
It creates, it secretes hormones, it secretes anti-inflammatory compounds, and it actually creates something called the glycocalyx, which is a layer, like a slick layer of,
475
00:40:46.857 --> 00:40:48.919
on top of this one cell layer thick.
476
00:40:48.939 --> 00:40:50.100
It's like a gel layer.
477
00:40:50.480 --> 00:41:03.970
And the combination of these two protect our vascular system and regulate our vascular system's ability to loosen it, open up, to dilate, or to constrict, to tighten up.
478
00:41:04.350 --> 00:41:13.037
And so there's a myriad of things that this endothelial layer and this glycocalyx layer in combination respond to.
479
00:41:13.517 --> 00:41:28.669
So when you start having problems with hypertension or high blood pressure that wears away at maybe this gel layer, or you have inflammation that wears away at this gel layer, it starts to expose portions of the endothelium.
480
00:41:29.009 --> 00:41:38.977
And then that means you have places where LDLs or immune markers, immune compounds can grab onto the lining of the artery.
481
00:41:39.377 --> 00:41:39.958
And then that
482
00:41:40.438 --> 00:41:48.341
Once it grabs on, it can move its way in between the cell and get underneath it into the vessel wall and create plaque.
483
00:41:48.702 --> 00:41:52.063
So that's what's happening on sort of a cellular level.
484
00:41:52.643 --> 00:41:56.485
And that plaque can develop and create...
485
00:41:57.145 --> 00:42:02.268
atherosclerosis and that eventually can burst and create the macroscopic sort of heart attack.
486
00:42:02.669 --> 00:42:13.196
What's really interesting is you can have problems with the microscopic portion of these arteries too and not have atherosclerosis.
487
00:42:13.656 --> 00:42:25.284
You can have a problem with the ability for these arteries to dilate, to constrict, and that sort of problem doesn't show up in these large-scale images that we do.
488
00:42:25.904 --> 00:42:28.226
but it causes legitimate chest discomfort.
489
00:42:28.606 --> 00:42:32.949
Things, hormonal problems can make that happen.
490
00:42:33.389 --> 00:42:43.315
Problems with precursors that make nitric oxide, which is the main gas, the main compound that allows the artery to dilate and constrict.
491
00:42:43.716 --> 00:42:46.117
And in particular, we see this happening with women.
492
00:42:46.477 --> 00:42:53.302
You know, historically, when women would show up with chest discomfort and they would get scans that looked negative,
493
00:42:53.862 --> 00:42:56.364
The default was, okay, maybe this is anxiety.
494
00:42:56.404 --> 00:42:59.607
Maybe this is something that we can't see what's going on.
495
00:42:59.847 --> 00:43:02.209
There's chest discomfort, but we can't explain it.
496
00:43:02.609 --> 00:43:04.351
We have very limited things to do to treat it.
497
00:43:04.591 --> 00:43:06.973
Well, we know now that this is not the case.
498
00:43:07.013 --> 00:43:13.579
We've been doing women a disservice in cardiology for decades, and this is one of many disservices.
499
00:43:14.179 --> 00:43:24.746
And, you know, it's a legitimate, real problem where they're not getting enough blood flow microscopically, and it's because of microscopic dysfunction without plaque.
500
00:43:25.427 --> 00:43:29.990
And now that we notice, we can do things to try and target that better.
501
00:43:30.603 --> 00:43:39.225
So what's the best way then, with everything that you know, the knowledge of the tools that are out there, what's the best way to assess your microvascular system then?
502
00:43:39.586 --> 00:43:42.726
And how can we really detect the health of our glycocalyx?
503
00:43:43.227 --> 00:43:44.387
That's a difficult question.
504
00:43:44.407 --> 00:43:48.188
You know, the glycocalyx is a very dynamic structure.
505
00:43:48.248 --> 00:43:49.568
It's, you know, bulletproofing.
506
00:43:49.608 --> 00:43:50.489
It's a gel layer.
507
00:43:50.849 --> 00:43:51.289
It will...
508
00:43:51.949 --> 00:44:02.612
grow and constrict on a day-to-day, on an hour-to-hour basis in response to our environmental exposures, to our diet, things like that, stress, blood pressure.
509
00:44:03.232 --> 00:44:04.952
There are ways to take pictures of it.
510
00:44:05.432 --> 00:44:10.253
And it's not fully widely established, but you can measure it.
511
00:44:10.433 --> 00:44:13.594
And there's a couple of small-scale tests that can do that.
512
00:44:14.074 --> 00:44:17.035
And then there's supplements that may be able to improve
513
00:44:21.696 --> 00:44:28.546
The same things that degrade the glycocalyx are the same things that are involved with poor health, with poor foundational health.
514
00:44:29.026 --> 00:44:33.893
There are some supplements that focus on the glycocalyx, but it's difficult to know.
515
00:44:34.534 --> 00:44:36.757
The studies aren't definitive on those.
516
00:44:37.457 --> 00:44:40.300
Endothelial health, there are some tests that look at that.
517
00:44:40.680 --> 00:44:44.143
And you can get what's called, there's an endopat test.
518
00:44:44.383 --> 00:44:46.946
There's also something called flow-mediated dilatation.
519
00:44:47.246 --> 00:45:01.218
And these are office-based tests that can look at how the arteries respond to stressors or having a blood pressure cuff put on, how they respond to lack of oxygen, things like that.
520
00:45:01.418 --> 00:45:03.620
So you can assess endothelial function too.
521
00:45:03.980 --> 00:45:17.792
That can be helpful because if you see that the endothelial function is deficient, there are pharmaceutical therapies that can help basic stuff that has been repurposed.
522
00:45:18.152 --> 00:45:20.675
A perfect example is Cialis.
523
00:45:21.235 --> 00:45:25.298
Cialis is used for erectile dysfunction.
524
00:45:25.598 --> 00:45:37.687
That taken at low doses can improve the lining of the arteries because that is the way this functions is by improving nitric oxide, but it's specifically in sex organs.
525
00:45:37.727 --> 00:45:38.248
Dilating.
526
00:45:38.308 --> 00:45:38.528
Yeah.
527
00:45:38.848 --> 00:45:41.370
But if you take it at low doses, it helps the whole system.
528
00:45:41.730 --> 00:45:42.311
And so...
529
00:45:42.851 --> 00:45:46.977
So this is just one of many tools that can be repurposed to help endothelial function.
530
00:45:46.997 --> 00:45:55.288
And so you can get maybe an endopat test or something of that effect, testing for endothelial function and then starting that afterwards.
531
00:45:56.035 --> 00:45:57.837
So there's a brand.
532
00:45:57.937 --> 00:46:00.159
I have zero affiliation with this brand.
533
00:46:01.440 --> 00:46:02.000
Let's see.
534
00:46:02.081 --> 00:46:02.581
Calroy.
535
00:46:02.821 --> 00:46:03.001
Yeah.
536
00:46:03.522 --> 00:46:04.102
Calroy.
537
00:46:04.122 --> 00:46:11.409
I was at a health conference and they were doing nitric oxide testing through these little strips on my tongue.
538
00:46:11.429 --> 00:46:16.574
And I had a conversation with a formulator there and we're talking about heart health and taking, oh, look at that.
539
00:46:16.594 --> 00:46:20.417
It says endothelial glycocalyx support on the front of the bottle.
540
00:46:20.437 --> 00:46:21.999
It's called arterosil.
541
00:46:22.019 --> 00:46:22.119
Yeah.
542
00:46:22.639 --> 00:46:34.757
So when we think about taking things like this, obviously as a nutritionist, and you're saying nitric oxide, something that my husband and I do every day is we take two teaspoons of beetroot powder that mixes really, really easily into water.
543
00:46:34.857 --> 00:46:37.241
I have beta thalassemia, so this is something that I feel...
544
00:46:37.601 --> 00:46:40.103
Really supports me as well with oxygenation of my cells.
545
00:46:40.503 --> 00:46:44.667
But where do testing, I guess we could actually test these things.
546
00:46:44.707 --> 00:46:46.388
We can test for citrulline.
547
00:46:46.428 --> 00:46:51.192
We can test for argilline, like all these amino acids that could be beneficial as well.
548
00:46:51.292 --> 00:46:54.274
So let's talk about supplementation then for a second.
549
00:46:54.354 --> 00:46:56.296
So a lot of people will go to their doctor.
550
00:46:56.316 --> 00:46:58.357
They'll be given a statin immediately.
551
00:46:59.278 --> 00:47:01.581
I think that there's a time and a place for statins.
552
00:47:01.641 --> 00:47:09.370
I think that, you know, you can tell me if there's like dosing for statins that may be good for somebody who's on the higher marker of genetic susceptibility.
553
00:47:09.931 --> 00:47:15.298
But where do supplements come into play with this, especially with optimizing our endothelial cells?
554
00:47:16.118 --> 00:47:17.979
The supplements do play a really important role.
555
00:47:18.039 --> 00:47:21.641
And you bring up a really good point, statins.
556
00:47:22.021 --> 00:47:28.004
Statins, one of the key benefits of statins is it really amplifies nitric oxide.
557
00:47:28.324 --> 00:47:33.566
And that's what really provides a lot of the anti-inflammatory benefits.
558
00:47:33.586 --> 00:47:34.507
So when you look at statins,
559
00:47:34.927 --> 00:47:37.569
the risk versus benefit with statins.
560
00:47:37.629 --> 00:47:39.670
It's not just about cholesterol lowering.
561
00:47:39.690 --> 00:47:41.732
It's about increasing nitric oxide.
562
00:47:42.412 --> 00:47:48.617
And so that's where it tips over into being more of a wider ranging multi-system effect.
563
00:47:49.137 --> 00:47:50.738
But it comes at a cost.
564
00:47:51.278 --> 00:48:00.785
So we know that their statins block the ability for say CoQ10 and block a proximate
565
00:48:01.065 --> 00:48:05.928
a process called protein prenatalation, and we can account for those.
566
00:48:06.308 --> 00:48:09.390
You can test for levels of lower CoQ10.
567
00:48:09.650 --> 00:48:16.334
You can also test for the precursors that are needed to make nitric oxide.
568
00:48:16.734 --> 00:48:19.256
So there are plenty of tests out right now.
569
00:48:20.036 --> 00:48:20.917
In particular, and I
570
00:48:21.597 --> 00:48:28.142
And similarly, I have no affiliation with this test with Vibrant, but I love this new test that's out.
571
00:48:28.182 --> 00:48:30.624
It's called the CardioZumer from Vibrant.
572
00:48:31.045 --> 00:48:33.106
It looks at arginine.
573
00:48:33.126 --> 00:48:34.247
It looks at citrulline.
574
00:48:34.267 --> 00:48:35.548
It looks at the ratios.
575
00:48:35.929 --> 00:48:40.032
It's one of the most thorough tests that I've seen out there.
576
00:48:40.172 --> 00:48:47.238
It's a serum test, blood test that looks at the precursors to make nitric oxide, membrane health.
577
00:48:47.718 --> 00:48:52.022
all of the lipid markers, inflammation markers, is really in depth.
578
00:48:52.422 --> 00:48:59.228
And so you can see if you're lacking in arginine or citrulline and then replace it.
579
00:48:59.689 --> 00:49:13.401
And each one has a different effect, arginine versus citrulline, replacing which ones, seeing if they're at levels that you need for your cells, the endothelial cells to actually create nitric oxide.
580
00:49:13.861 --> 00:49:13.962
So
581
00:49:14.542 --> 00:49:18.143
The only way to get that is going to be from a food source or to supplement it.
582
00:49:18.443 --> 00:49:25.805
So, and supplementing oral nitrates using B-truth, that's a great way to do it.
583
00:49:26.145 --> 00:49:35.207
And it's a different pathway than, say, using Cialis or using other, you know, using pharmacologic agents that may help nitric oxide.
584
00:49:37.087 --> 00:49:43.171
And the good news is that it does it sort of slowly, so it doesn't interact with these other agents to drop your blood pressure.
585
00:49:43.471 --> 00:49:50.056
The one thing about oral supplementation, let's say beet juice and things like that, it's short acting and you gotta look at the dose.
586
00:49:50.076 --> 00:49:58.582
Because sometimes you gotta take like about 400 milligrams of the nitric oxide or the arginine or beet juice extract
587
00:49:58.822 --> 00:50:03.627
And you probably have to do it twice a day or something like that to get a more sustained effect.
588
00:50:03.707 --> 00:50:10.474
But these are really useful tools and you can test for how much you need or if you need it.
589
00:50:11.415 --> 00:50:11.836
And why not?
590
00:50:11.896 --> 00:50:13.037
Is that a blood serum test?
591
00:50:13.337 --> 00:50:14.358
Yeah, it's a serum test.
592
00:50:15.499 --> 00:50:15.760
Okay.
593
00:50:15.980 --> 00:50:16.660
Easy to do.
594
00:50:16.781 --> 00:50:18.002
Yeah, very thorough.
595
00:50:18.242 --> 00:50:18.703
Yeah, excellent.
596
00:50:19.223 --> 00:50:21.424
I keep just saying in my mind, why not do it?
597
00:50:21.524 --> 00:50:22.365
Why not do it?
598
00:50:22.725 --> 00:50:32.110
Especially with going back to what you said, the divergence between, you know, supporting women when they come in and they're complaining around anxiety and yet their numbers might look normal versus men.
599
00:50:32.290 --> 00:50:36.272
And I'll say flat out, my husband and I are in this situation.
600
00:50:36.533 --> 00:50:42.316
You know, he is in his 50s now and his doctor just as preventative just said, oh, you know, you're in your 50s.
601
00:50:42.336 --> 00:50:43.596
We should go in and do these tests.
602
00:50:43.636 --> 00:50:43.696
We
603
00:50:46.638 --> 00:50:48.941
On all of your numbers, we should do a CT scan as well.
604
00:50:49.381 --> 00:50:56.028
And then for me, even with my history of heart disease, when I went to my cardiologist, I said, hey, shouldn't we just start checking into this?
605
00:50:56.048 --> 00:50:57.429
Should I do that CT scan now?
606
00:50:57.770 --> 00:50:58.511
Wait, you're healthy.
607
00:50:58.971 --> 00:50:59.432
You're young.
608
00:50:59.452 --> 00:51:00.292
You're a nutritionist.
609
00:51:00.332 --> 00:51:01.313
We don't need to do that yet.
610
00:51:01.333 --> 00:51:01.434
Yeah.
611
00:51:01.914 --> 00:51:06.095
And it's like that case in point, the two of us together, and we had a conversation around this.
612
00:51:06.555 --> 00:51:10.176
I'm the one with a history of heart disease and heart disease in my family.
613
00:51:10.716 --> 00:51:14.117
And look at the numbers around women's health and cardiovascular disease today.
614
00:51:14.137 --> 00:51:17.418
And still, I had to push versus him.
615
00:51:17.478 --> 00:51:19.478
So supplementation is one thing.
616
00:51:19.558 --> 00:51:23.359
But this, if you're a woman listening, take these testings that are available to us.
617
00:51:23.839 --> 00:51:24.619
Access them.
618
00:51:24.639 --> 00:51:25.640
Be proactive.
619
00:51:25.920 --> 00:51:31.521
If we can prevent, what, 100% of cardiovascular disease can be prevented unless it's something deeper?
620
00:51:32.221 --> 00:51:32.602
I agree.
621
00:51:32.742 --> 00:51:34.423
Yeah, totally.
622
00:51:34.723 --> 00:51:39.046
I mean, heart disease is preventable if we know how to look at it.
623
00:51:39.406 --> 00:51:42.348
If we look at it early enough and we look at it from a system standpoint.
624
00:51:42.708 --> 00:51:43.068
Yeah.
625
00:51:43.609 --> 00:51:44.089
All right.
626
00:51:44.829 --> 00:51:46.050
What else are we looking for then?
627
00:51:46.150 --> 00:51:52.795
So with people who are coming in, let's just say I work with a lot of high performing men, their 40s and 50s.
628
00:51:53.675 --> 00:52:04.557
And I would say more often than not, when their primary care doctor sees any type of number that's elevated, if it's total cholesterol or LDL, they're immediately prescribed a statin.
629
00:52:05.337 --> 00:52:06.597
Just take it for prevention.
630
00:52:07.097 --> 00:52:11.658
Is there a time and a place to supplement at a small dose versus a standard dose?
631
00:52:11.698 --> 00:52:12.738
And what is a standard dose?
632
00:52:12.778 --> 00:52:13.058
Yeah.
633
00:52:13.538 --> 00:52:13.818
Yeah.
634
00:52:13.898 --> 00:52:20.380
I believe, I think that starting a lower dose statin therapy is probably, there's a place for it.
635
00:52:20.840 --> 00:52:23.280
And it goes back to that nitric oxide effect.
636
00:52:23.360 --> 00:52:29.145
It's not necessarily that we are wanting to optimize the lipid lowering.
637
00:52:29.505 --> 00:52:35.810
I think there's an over-focus on lowering cholesterol, lowering LDLs.
638
00:52:36.411 --> 00:52:41.015
And there's an under-appreciation of how statins can improve nitric oxide.
639
00:52:41.375 --> 00:52:54.775
And so when you use a smaller, a lower dose, now I preferentially use rosuvastatin in patients that need it because that has less penetrance to the brain and less incidence of muscle aches or pains.
640
00:52:55.376 --> 00:52:57.278
So I use it probably about
641
00:52:57.859 --> 00:52:59.520
five milligrams every other day.
642
00:52:59.640 --> 00:53:05.785
If I can get them to split it two and a half milligrams daily, maybe five milligrams daily, that's the starting dose.
643
00:53:06.185 --> 00:53:12.910
And that will optimize nitric oxide benefit without trying to drop the LDLs too much.
644
00:53:13.131 --> 00:53:17.934
Now, entry doses are where you get the most reduction of lipids.
645
00:53:18.315 --> 00:53:23.979
And then after you scale up the doses, you get diminishing returns, reducing returns.
646
00:53:24.379 --> 00:53:32.608
So I will not usually scale it up unless they have history of significant heart disease, atherosclerosis, or an event.
647
00:53:33.349 --> 00:53:42.579
So I don't use atorvastatin that much, and the other statins have higher incidence of side effects.
648
00:53:42.599 --> 00:53:46.343
So my preferred agent is rosuvastatin.
649
00:53:46.643 --> 00:53:54.811
And whenever I use a statin, I make sure to have them take CoQ10 with geronyl geronil.
650
00:53:55.151 --> 00:54:06.883
So that second edition, geronyl geronil, we are starting to see is that protein prenatalation that we're lacking, that statins block.
651
00:54:07.363 --> 00:54:13.165
When we add GG for short, it restores that protein prenatalation.
652
00:54:13.485 --> 00:54:19.807
And that's important because we see that that may be really what's associated with the muscle aches and pains.
653
00:54:20.187 --> 00:54:27.330
And there's data to support that it may be what predisposes some people to having glucose problems with statins.
654
00:54:28.311 --> 00:54:31.735
So it's a vital process that the statins will block.
655
00:54:32.256 --> 00:54:39.345
And remember, the reason to start with lower doses is not because it's a binary effect.
656
00:54:39.405 --> 00:54:45.592
Just because you're on a statin doesn't mean you've completely eliminated CoQ10 or this prenatalation process.
657
00:54:46.273 --> 00:54:49.156
As you increase the dose, you get increasing effects.
658
00:54:49.256 --> 00:54:51.738
And that's why we get more side effects at higher doses.
659
00:54:52.239 --> 00:55:01.668
So if you use a lower dose and replace those compounds, we really minimize some of the potential side effects and then optimize the benefits.
660
00:55:02.662 --> 00:55:06.465
And when you're supplementing with CoQ10, is 100 milligrams enough?
661
00:55:06.525 --> 00:55:08.447
Are you looking for higher upwards of 200?
662
00:55:08.707 --> 00:55:10.969
I'll usually use 100 to 200 milligrams.
663
00:55:11.089 --> 00:55:19.497
But 100, if it's got GG in it, the other benefit about GG is that we think it helps get that CoQ10 intracellular more effectively.
664
00:55:19.937 --> 00:55:23.000
So 100 milligrams will probably go a lot farther.
665
00:55:23.400 --> 00:55:27.143
If I'm going up to higher doses, then I'll have them take more.
666
00:55:27.203 --> 00:55:29.065
I'll just take 200 and then more GG's.
667
00:55:29.705 --> 00:55:38.451
What does it look like for listeners who maybe haven't put on a low-dose Stutton, but they're really well-versed in the list of side effects that come with them?
668
00:55:38.892 --> 00:55:46.057
And they're also into this world of prevention and wanting to feel their best and make it to 100 years old, let's say.
669
00:55:46.497 --> 00:55:51.398
I've worked with so many people where I've worked with or partnered with an incredible functional medicine doctor.
670
00:55:51.938 --> 00:55:59.740
And through an intervention on lifestyle and stress and nutrition and supplementation and movement, we're able to get that person off a statin.
671
00:56:00.180 --> 00:56:04.461
It's not for everyone, but it's possible, which goes to show that the potential is there.
672
00:56:05.042 --> 00:56:05.982
What would you say then?
673
00:56:06.102 --> 00:56:14.604
What does an intervention look like for someone who's interested in having that conversation with their cardiologist to get off of it, especially if their cardiovascular doctor isn't...
674
00:56:15.364 --> 00:56:16.905
A believer or a fan.
675
00:56:17.125 --> 00:56:17.385
Yeah.
676
00:56:18.046 --> 00:56:24.170
Well, it's going to be difficult if they don't believe that these interventions can work.
677
00:56:24.650 --> 00:56:34.156
But it's a discussion about what it is aside from the LDLs themselves that they're targeting.
678
00:56:34.276 --> 00:56:36.197
Because LDLs are part of it.
679
00:56:36.658 --> 00:56:38.499
Inflammatory markers are another part of it.
680
00:56:38.759 --> 00:56:40.260
And what other agents are they using?
681
00:56:40.420 --> 00:56:51.990
The simple way would be as a person is doing their lifestyle changes, as they're making those changes, they can track the reduction of the LDLs.
682
00:56:52.130 --> 00:56:52.891
It should happen.
683
00:56:53.271 --> 00:56:55.453
As they're getting healthier, we should see a change.
684
00:56:55.813 --> 00:57:06.180
And then they don't need to continue to see those LDL numbers drop or the triglycerides that we start to ask to ease up on the therapy.
685
00:57:06.220 --> 00:57:09.042
And it's an inching approach.
686
00:57:09.082 --> 00:57:11.203
You reduce the therapy by half.
687
00:57:12.144 --> 00:57:13.325
Maybe take it every other day.
688
00:57:13.345 --> 00:57:13.445
Okay.
689
00:57:13.705 --> 00:57:17.290
you know, see how these numbers go because you're going to get follow-up lab work.
690
00:57:17.430 --> 00:57:27.102
And if they maintain themselves and inflammatory markers are still where we want them to be, then that's a great time to have a discussion to say, hey, doc, this is what I've been doing.
691
00:57:27.203 --> 00:57:28.504
I think I can get off of this.
692
00:57:30.005 --> 00:57:31.326
Are there any other alternatives?
693
00:57:31.386 --> 00:57:39.048
Maybe you can get switched to ezetimibe, which is not as strong, but still has lipid lowering effects.
694
00:57:39.428 --> 00:57:44.430
Can I reduce the use of the statin and maybe replace it with something else?
695
00:57:45.070 --> 00:57:51.872
And if they're not familiar with that, then maybe get them something that says, okay, this is supposed to work like a statin.
696
00:57:52.692 --> 00:57:53.833
And can I alternate?
697
00:57:54.013 --> 00:57:55.213
Can I use this instead?
698
00:57:55.473 --> 00:57:57.634
Can we do a trial to see what this looks like?
699
00:57:58.234 --> 00:57:59.275
for three months.
700
00:57:59.795 --> 00:58:05.020
Because if your metabolism is well controlled, a three-month trial is not going to cause a problem.
701
00:58:05.520 --> 00:58:06.481
It's so important.
702
00:58:07.062 --> 00:58:11.606
It just echoes the fact that your doctor should be your partner in healing, right?
703
00:58:11.626 --> 00:58:17.891
And if you're going there with these questions, and if you're not getting that partnership type of an answer, then maybe it's time to find a new doctor.
704
00:58:18.271 --> 00:58:18.972
Why not?
705
00:58:19.212 --> 00:58:20.133
Get second opinions.
706
00:58:20.614 --> 00:58:24.437
And azetamine, is that something with your side effects long-term?
707
00:58:24.757 --> 00:58:26.018
It has fewer side effects.
708
00:58:26.578 --> 00:58:29.519
It blocks the absorption of cholesterol from your gut.
709
00:58:30.459 --> 00:58:37.362
The most common side effect is upset stomach and diarrhea, but that usually gets resolved after being on it a short period of time.
710
00:58:37.822 --> 00:58:38.102
All right.
711
00:58:38.582 --> 00:58:46.285
Let's talk about one of the scary findings when you get a blood lab done and your cardiologist says you've got the widowmaker.
712
00:58:46.946 --> 00:58:48.526
Can you tell us what a widowmaker is?
713
00:58:48.946 --> 00:58:52.868
Why are we seeing it so prevalent today and what can we do about it?
714
00:58:53.168 --> 00:58:58.772
So the widowmaker is a blockage in the left anterior descending.
715
00:58:58.972 --> 00:59:13.062
Left anterior descending is the artery that goes down the front of the heart, and it usually supplies the most amount of muscle, but always supplies the most important muscle in the front of the heart, that left ventricle.
716
00:59:13.563 --> 00:59:20.648
And so when you have a blockage in that artery, and it's a blockage that is most often associated with sudden cardiac death.
717
00:59:20.968 --> 00:59:31.454
So people have a blockage there, it ruptures quickly, and then we lose blood flow to the major amount of muscle, and that causes a sudden event where people die.
718
00:59:32.014 --> 00:59:36.097
It's oftentimes the first place where plaque will show up.
719
00:59:36.657 --> 00:59:37.978
One of the reasons is because it
720
00:59:38.558 --> 00:59:46.581
Because it's the major artery and because it's right in front of the heart, it sometimes gets the brunt of the high blood flow.
721
00:59:46.921 --> 00:59:56.585
So higher blood pressure, maybe inflammatory markers, more wear and tear of that artery can make it more prone to having plaque buildup.
722
00:59:57.085 --> 00:59:59.266
So if you think of it, think of it like a stream.
723
00:59:59.826 --> 01:00:11.458
When you have a stream that's going straight and it's the main river, the main part of that stream, the water will flow in that area preferentially instead of the side tributaries.
724
01:00:11.839 --> 01:00:14.602
So that's what the LAD is, the left anterior descending.
725
01:00:14.982 --> 01:00:23.124
Now, imagine there's a turn in that stream or there's a rock pushing out and most of the water is still flowing straight in that stream.
726
01:00:23.665 --> 01:00:28.726
You have a lot of turbulence there and you'll hear a lot of noise and especially the turn.
727
01:00:28.826 --> 01:00:30.787
Well, the arteries are the same way.
728
01:00:31.287 --> 01:00:36.708
In that turn, there'll be a lot of wear and tear, a lot of rubbing on the turn.
729
01:00:36.888 --> 01:00:38.689
So that's an area where you may get...
730
01:00:39.249 --> 01:00:46.354
You may get degradation of the glycocalyx, damage to the endothelium, and then plaque building up there.
731
01:00:46.774 --> 01:00:55.960
And then once you get that happening there, it creates another change in flow that may go to another part of the LAD to create more plaque.
732
01:00:56.441 --> 01:01:07.308
So a lot of it's flow dynamics, pressure, and then access to inflammatory compounds that damage that lining, that border.
733
01:01:09.071 --> 01:01:13.217
And what would be the greatest precursor to this?
734
01:01:13.257 --> 01:01:22.270
I'm imagining it's probably multifactorial, but stress versus diet, is there one that pushes the lever most with a diagnosis like that?
735
01:01:22.931 --> 01:01:25.993
I'd probably say diet and blood glucose.
736
01:01:26.073 --> 01:01:36.758
I mean, when we look at what's happening to the larger population, it's mostly dietary issues, inactivity, glucose dysregulation, obesity.
737
01:01:36.838 --> 01:01:46.463
You know, that's the driving factor for the population at large, because that's still the major metabolic problem we have.
738
01:01:47.063 --> 01:01:57.130
It's funny when we trace back, you know, we talked about looking back in time at what our lifestyle practices were that could have caused that accumulation to all of a sudden this diagnosis.
739
01:01:57.411 --> 01:02:03.295
And for a lot of these people, I'm noticing that, you know, this was the generation that was going to McDonald's.
740
01:02:03.815 --> 01:02:07.717
We didn't know about the side effects of eating out, eating fried processed food.
741
01:02:08.097 --> 01:02:15.379
They were drinking Coca-Cola, even casually in the summer times, having these really high glucose beverages that were normal.
742
01:02:15.759 --> 01:02:16.940
And here they are today.
743
01:02:17.080 --> 01:02:22.362
So can you talk to us about, maybe paint a clear picture for the impact?
744
01:02:22.682 --> 01:02:26.623
Because a lot of people, if they look healthy on the outside, they'll say, well, I'm healthy.
745
01:02:26.663 --> 01:02:27.384
My health is fine.
746
01:02:27.404 --> 01:02:28.404
My cardiologist said fine.
747
01:02:28.584 --> 01:02:30.365
Yeah, McDonald's once in a while is okay.
748
01:02:30.385 --> 01:02:32.266
Having Coca-Cola once in a while is okay.
749
01:02:32.286 --> 01:02:36.408
Can you give us kind of a bigger picture on the impact of what this is doing?
750
01:02:36.828 --> 01:02:49.055
Yeah, so having fast food, processed food, when we were growing up and in past generations, wasn't as ubiquitous and as easily obtainable as it is now.
751
01:02:51.396 --> 01:02:56.219
In decades past, we weren't surrounded by as many fast food places.
752
01:02:56.679 --> 01:03:04.383
And I can tell you the story as a kid, it was like a treat to go once a week to go to get something for fast food.
753
01:03:04.463 --> 01:03:09.986
But for the most part, everything was home cooked and we didn't eat out very much.
754
01:03:10.526 --> 01:03:11.467
That's changed.
755
01:03:11.927 --> 01:03:13.688
The environment has gone far.
756
01:03:14.188 --> 01:03:19.469
away from cooking whole foods, eating whole food at home and going and eating out more.
757
01:03:19.969 --> 01:03:20.829
What's driving that?
758
01:03:21.189 --> 01:03:29.031
Higher stress, less time, less ability to focus on the foundations and to do something basic, like make a good meal.
759
01:03:29.411 --> 01:03:37.193
So it's not just having processed food and bringing processed food in from the grocery store too.
760
01:03:37.573 --> 01:03:42.454
The size of the processed food aisles has taken over the grocery food
761
01:03:44.195 --> 01:03:47.856
grocery stores as opposed to getting more natural foods.
762
01:03:48.136 --> 01:04:06.865
I think that's starting to change a little bit, but the ease of getting these foods and the convenience of having these available in a high demand world has made it so that we get these easily obtainable foods that are highly processed
763
01:04:07.525 --> 01:04:08.986
And it's accelerated.
764
01:04:09.166 --> 01:04:11.308
Over the years, we have done more of that.
765
01:04:11.348 --> 01:04:12.369
We eat out more.
766
01:04:12.769 --> 01:04:16.752
You know, it's almost like you got to make a conscious decision to stay at home and eat sometimes.
767
01:04:17.012 --> 01:04:18.493
Yeah, absolutely.
768
01:04:18.573 --> 01:04:24.357
And so there's a lot of different hidden dangers in that, too, because it's not only that the food is processed.
769
01:04:24.697 --> 01:04:31.121
and it has high carbohydrate, high carbohydrate load or high refined sugars.
770
01:04:31.542 --> 01:04:33.083
It's that you're getting seed oils in there.
771
01:04:33.103 --> 01:04:38.546
You're getting oils that maintain shelf life, but are highly, highly inflammatory.
772
01:04:38.886 --> 01:04:45.851
So, you know, there are all these stacking factors that make these food choices become more important.
773
01:04:46.431 --> 01:04:46.732
And then,
774
01:04:47.372 --> 01:04:54.134
more GMOs, more pesticides and herbicides in the food to grow them at higher volume.
775
01:04:54.474 --> 01:05:02.375
So you can see that in the past, you could have gotten away with an occasional meal out or a fast food meal.
776
01:05:02.415 --> 01:05:13.118
I mean, and that's probably what we grew up with, but it's accelerated and it's become like sort of a mushrooming of these availabilities and they're more toxic.
777
01:05:13.818 --> 01:05:15.881
Yeah, it was a treat for us growing up as well.
778
01:05:16.101 --> 01:05:18.784
Immigrant parents, obviously, it was a thing.
779
01:05:18.864 --> 01:05:25.332
But we have seen so many side-by-sides, the foods that we consume then and what went into them versus the foods today.
780
01:05:25.673 --> 01:05:26.894
And everything is processed.
781
01:05:27.154 --> 01:05:28.997
And even the healthy foods...
782
01:05:29.457 --> 01:05:31.958
in the health food section are ultra processed.
783
01:05:32.018 --> 01:05:34.019
We don't know the ingredients that come in with them.
784
01:05:34.399 --> 01:05:36.539
I can imagine you're like me when you travel in the summer.
785
01:05:36.579 --> 01:05:52.765
No matter where you go in the world, why is it when you get to an airport, get off the plane, or go into any city center, the first things that you see standing outside any convenience store or newsstand, Coca-Cola and Sprite and Doritos and chips and Pringles and everything...
786
01:05:53.245 --> 01:05:57.508
This is a global phenomenon that's fueling the rise of disease.
787
01:05:57.928 --> 01:06:02.931
And the reason why I want to get passionate about this for a second is that we see those foods in our school system today.
788
01:06:03.451 --> 01:06:10.235
And if we're forecasting the future of health for our children, you know, I hear a lot of parents saying, well, I don't want to deprive my kids.
789
01:06:10.255 --> 01:06:11.816
You know, they need to live their life.
790
01:06:11.856 --> 01:06:13.577
They should be able to experience these foods.
791
01:06:14.097 --> 01:06:15.018
No, it's absolutely not.
792
01:06:15.078 --> 01:06:16.458
actually making them sick.
793
01:06:16.978 --> 01:06:23.300
And the more that we fuel the pockets of the people producing these foods, the more sick we're going to get.
794
01:06:23.560 --> 01:06:28.541
And I understand with compassion, you know, we see these foods so often that we've normalized them.
795
01:06:28.881 --> 01:06:31.182
And it's funny, Dr. Hussain, I thought about you last night.
796
01:06:31.422 --> 01:06:36.523
We had to drive like about two hours to inner LA to an area that I'd never been before.
797
01:06:36.543 --> 01:06:41.064
And we went into a supermarket and it was a big chain, but not one that I was familiar with.
798
01:06:45.445 --> 01:06:50.307
aisle, but all of the other produce was wrapped in plastic.
799
01:06:50.908 --> 01:07:02.173
And then this superstore had two aisles of chips and gummies and candies and one specifically on both sides of soda, front to back, all the way down.
800
01:07:02.293 --> 01:07:03.613
And I just couldn't believe it.
801
01:07:03.973 --> 01:07:11.977
And if we look up and we look around at the people who are walking around and we see obesity in adults and in children, right?
802
01:07:12.517 --> 01:07:22.282
Gosh, I just wish that, you know, the people who are in charge of our health care took a greater stand in what was available and really connecting the dots to the science that you're talking about today.
803
01:07:22.342 --> 01:07:24.142
The world would be such a different place.
804
01:07:24.563 --> 01:07:25.843
We wouldn't be sick and suffering.
805
01:07:25.883 --> 01:07:26.684
Would be, definitely.
806
01:07:26.724 --> 01:07:27.324
I agree with you.
807
01:07:27.384 --> 01:07:35.367
It's shocking to see how far it's weaved its way into our lifestyle and nobody is immune to it.
808
01:07:37.131 --> 01:07:41.956
The other thing that we're not immune to is, you know, I want to hover on what you were speaking to with women.
809
01:07:42.497 --> 01:07:46.361
Women going in and talking about anxiety and often getting dismissed.
810
01:07:46.681 --> 01:07:48.323
This was the case for me when I was younger.
811
01:07:48.343 --> 01:07:54.189
Kind of dismissed the anxiety that I was talking to them about and really just wanted to know how much alcohol are you consuming?
812
01:07:54.509 --> 01:07:55.690
How many drugs are you doing?
813
01:07:56.131 --> 01:07:57.993
You know, and kind of ended there.
814
01:07:58.513 --> 01:08:06.043
But in your work today, as you've branched out, are you making the kind of psycho-emotional connection to heart health today?
815
01:08:06.083 --> 01:08:13.832
This is something that Eastern Wisdom has done for centuries, but now there's institutes like HeartMath who are understanding heart frequency and things like that.
816
01:08:14.233 --> 01:08:18.138
Is this a discussion you hope that cardiologists are having with their patients in the future?
817
01:08:18.538 --> 01:08:19.099
I hope it is.
818
01:08:19.720 --> 01:08:25.829
You know, there's definite studies that look at the impact of stress on the cardiovascular system.
819
01:08:25.889 --> 01:08:33.060
And these studies will say that this is an underappreciated source of atherosclerosis and disease.
820
01:08:33.480 --> 01:08:35.341
hypertension, arrhythmias.
821
01:08:35.582 --> 01:08:37.343
So I have that discussion.
822
01:08:37.383 --> 01:08:42.647
I always ask about what the stress load is, what are their coping mechanisms?
823
01:08:43.287 --> 01:08:46.089
Do they feel that this is something that can be manageable?
824
01:08:46.730 --> 01:09:01.080
And it's gotten to the point where at the office, we also have a mindfulness program that if patients are unable to manage it or they feel like they are overwhelmed or if they just feel like they want help or other tools,
825
01:09:01.821 --> 01:09:09.582
We'll give them access to a coach and have them work through how they're managing stress and what their personal story is.
826
01:09:10.372 --> 01:09:11.052
Beautiful.
827
01:09:11.432 --> 01:09:16.334
I often say you have to cultivate the inner environment for your body to heal in order for the protocol to work.
828
01:09:16.575 --> 01:09:17.495
So I love that you have that.
829
01:09:17.815 --> 01:09:19.616
You're actually practicing integrative healthcare.
830
01:09:21.737 --> 01:09:24.758
We've talked about it for so long, but few doctors are actually doing it.
831
01:09:25.198 --> 01:09:27.799
So everyone probably wants to know what you're eating.
832
01:09:27.959 --> 01:09:29.680
Can you maybe just make a declaration?
833
01:09:30.420 --> 01:09:39.544
We've talked about the good, the bad, and the ugly, but let's really focus on the foods that move the needle when we try to optimize our heart health and our LDL scores.
834
01:09:39.964 --> 01:09:45.968
But what I'm eating sort of varies on the day, depending on my work schedule.
835
01:09:46.429 --> 01:09:50.392
When I can, I oftentimes will do some intermittent fasting.
836
01:09:50.832 --> 01:09:52.553
So it's convenient for my schedule.
837
01:09:52.593 --> 01:09:56.096
But I will have a couple of, I have my coffee in the morning.
838
01:09:56.516 --> 01:09:58.898
It's black coffee without any addition.
839
01:09:58.918 --> 01:10:00.379
It's my ritual.
840
01:10:00.599 --> 01:10:03.041
I have my two cups of coffee a day and that's it.
841
01:10:03.061 --> 01:10:03.661
It's my coffee.
842
01:10:03.781 --> 01:10:18.417
And then once I have lunch, it's, uh, or if I have, if I'm lucky enough to have breakfast, uh, it's a day working from home or a weekend, it's usually some eggs, some greens, some, uh, some salad and a complex carb.
843
01:10:18.797 --> 01:10:25.865
So, uh, because I work out regularly, I want to make sure I'm getting all my macros, try to focus on protein, uh.
844
01:10:27.046 --> 01:10:34.529
If you wanted to summarize my diet, it's basically a Mediterranean diet with an emphasis on protein intake.
845
01:10:34.869 --> 01:10:41.792
So I can maintain my muscle mass, maintain good protein muscle synthesis, and at the same time have...
846
01:10:42.192 --> 01:10:49.399
anti-inflammatory effect of the right fats, enough omega-3s, the complex carbs.
847
01:10:49.799 --> 01:10:57.546
You know, we put in legumes and fruits and vegetables whenever we can as snacks.
848
01:10:58.327 --> 01:11:02.631
But every meal tries to have something green or something colored in it.
849
01:11:03.110 --> 01:11:03.611
Beautiful.
850
01:11:03.631 --> 01:11:06.653
And do you want to talk to us about, I really want to hover on the greens.
851
01:11:06.693 --> 01:11:09.355
I don't think enough people are getting their greens every single day.
852
01:11:09.375 --> 01:11:11.357
I think fiber as well, right?
853
01:11:11.437 --> 01:11:11.898
Yeah, definitely.
854
01:11:12.298 --> 01:11:14.840
The connection between fiber and heart health and gut health.
855
01:11:15.000 --> 01:11:15.441
Absolutely.
856
01:11:15.461 --> 01:11:17.302
Yeah, the fiber is vital.
857
01:11:17.362 --> 01:11:22.647
And I get a lot of patients that tell me they have a salad all the time with every meal.
858
01:11:23.047 --> 01:11:28.834
And I think that's really good, but it's not a, salads aren't hard vegetables.
859
01:11:28.854 --> 01:11:33.640
They're not the full vegetable that has higher fiber content too.
860
01:11:33.680 --> 01:11:41.429
So I really emphasize getting some broccoli, some asparagus, some of these larger, more hardy vegetables into their diet as well.
861
01:11:41.990 --> 01:11:46.774
And the reason why fiber is so important is because there's so many reasons.
862
01:11:46.914 --> 01:11:52.399
One is helps with the satiety, makes you feel fuller faster so you don't overeat, number one.
863
01:11:52.639 --> 01:11:56.463
It's got polyphenols, it's got all of those important
864
01:11:57.023 --> 01:12:04.507
compounds that nature produces that give it color, that are antioxidants, anti-inflammatories, and that feeds the microbiome.
865
01:12:04.947 --> 01:12:09.370
So the polyphenols feed the microbiome and so do the non-digestible fibers.
866
01:12:09.870 --> 01:12:12.411
So why do we want to feed the microbiome?
867
01:12:12.431 --> 01:12:13.512
Why is that so important?
868
01:12:13.932 --> 01:12:33.123
Because when we feed the microbiome the right way, it produces the right metabolic compounds that then feed our gut lining to maintain health and maintain the environment and protect us from getting an inflammatory leakage into our bloodstream.
869
01:12:33.643 --> 01:12:51.795
So, looking at it from a cardiovascular standpoint as well, a little bit more specifically, that extra fiber reduces the amount of cholesterol we might absorb, and then it may also regulate how quickly we're absorbing the sugars in the food.
870
01:12:52.315 --> 01:13:01.681
So reducing the rapidity of sugar absorption reduces glucose spikes, keeps us more even in our energy levels.
871
01:13:02.102 --> 01:13:04.843
So fiber is so important.
872
01:13:05.424 --> 01:13:10.267
Having regular bowel movements then allows us to detoxify normally.
873
01:13:10.547 --> 01:13:14.510
We don't recycle the toxins and or hormonal metabolites.
874
01:13:15.030 --> 01:13:17.452
So it's a vital aspect of normal health.
875
01:13:17.472 --> 01:13:17.792
Yeah.
876
01:13:17.932 --> 01:13:19.673
Do you recommend taking a fiber supplement?
877
01:13:20.253 --> 01:13:27.758
I talk about bowel movements every day with my clients and we talk about optimizing your elimination process, having at least one or two bowel movements a day.
878
01:13:28.278 --> 01:13:37.124
And yeah, when I ask my clients to do a food journal, I think they believe because they're eating a salad a day, they're intaking enough fiber when there's actually not enough fiber.
879
01:13:37.144 --> 01:13:38.444
There could be fiber at one meal.
880
01:13:38.845 --> 01:13:44.408
So when does fiber supplementing, would you say that this would be a good preventative measure for optimal heart health?
881
01:13:44.688 --> 01:13:45.669
Yeah.
882
01:13:45.869 --> 01:13:51.676
If they're not getting enough fiber through their diet, then yeah, preferentially, I will have them take a supplement.
883
01:13:52.036 --> 01:13:53.898
It could be psyllium husks.
884
01:13:54.158 --> 01:13:58.063
I try not to use any of the commercially made ones because they can have sugar in them.
885
01:13:58.403 --> 01:14:01.767
But I mean, ideally, I want to stress getting it from natural sources.
886
01:14:02.401 --> 01:14:02.641
Yeah.
887
01:14:02.841 --> 01:14:08.684
I typically say psyllium, but not too often, especially if your colon's dehydrated, flax meal, chia seeds.
888
01:14:09.624 --> 01:14:12.145
There's a lot of prebiotic fibers out there that are really great too.
889
01:14:12.666 --> 01:14:17.988
And as a nutritionist who never takes away coffee from people, I love that you enjoy your coffee.
890
01:14:18.008 --> 01:14:19.889
Where does dairy fit into this picture?
891
01:14:19.909 --> 01:14:23.691
A lot of us come from cultures where dairy was common and acceptable.
892
01:14:23.811 --> 01:14:28.813
And obviously before a time where we saw these rates of disease rise, do you remove it explicitly?
893
01:14:28.973 --> 01:14:30.274
I don't remove it explicitly.
894
01:14:30.294 --> 01:14:39.760
If they want dairy, then really it's a matter of personal tolerance and what the underlying health is.
895
01:14:39.780 --> 01:14:43.462
If they've got other inflammatory conditions, then dairy may trigger it.
896
01:14:44.763 --> 01:14:47.165
Yogurt and cheese, less likely to do that.
897
01:14:47.245 --> 01:14:50.487
They're fermented, a little bit less provoking.
898
01:14:50.967 --> 01:14:55.030
But it is one of the primary irritants to our gut.
899
01:14:55.130 --> 01:15:01.914
So if there is a gut-centralized problem, I will have them eliminated.
900
01:15:02.234 --> 01:15:05.857
And then as things start to heal, we can try and reintroduce it.
901
01:15:05.957 --> 01:15:08.738
But it's up there with gluten.
902
01:15:09.019 --> 01:15:10.840
It's the second thing, dairy, soy, sugar.
903
01:15:10.860 --> 01:15:11.040
Yeah.
904
01:15:12.443 --> 01:15:13.664
The quality is not what it used to be.
905
01:15:13.704 --> 01:15:13.944
Yeah.
906
01:15:14.124 --> 01:15:14.444
Right?
907
01:15:14.544 --> 01:15:14.985
That's right.
908
01:15:15.205 --> 01:15:23.290
So when we think about these things moving the needle the most long-term when it comes to arterial health, let's talk about movement for a second.
909
01:15:23.631 --> 01:15:29.595
You know, we get to our 40s and 50s, maybe our capacity to move the way that we did in our 20s and 30s is a little bit different.
910
01:15:30.075 --> 01:15:32.678
A VO2 max is something that's trending these days.
911
01:15:33.139 --> 01:15:46.394
Could be beneficial for some people, maybe not if you're in perimenopause or going through some major hormonal or stress events within your life, but where are you seeing the science kind of shine a light and what type of movement should we really start to optimize if we want to move that needle even more?
912
01:15:46.414 --> 01:15:46.514
Yeah.
913
01:15:46.954 --> 01:15:53.540
So VO2 max is a useful marker, but it shouldn't be everything.
914
01:15:54.140 --> 01:15:57.823
You know, VO2 max is like our top speed.
915
01:15:58.043 --> 01:16:08.672
So you can have a really good top speed, but if it's at the expense of efficiency and you're doing it with making a lot of toxins, then we don't need to push our VO2 max.
916
01:16:08.872 --> 01:16:15.418
And really, there's other markers that look at lactate threshold and which look at,
917
01:16:15.838 --> 01:16:20.280
more of the zone two tolerance and efficiency.
918
01:16:20.580 --> 01:16:26.382
And that's really where we see capacity for fat burning and metabolic efficiency.
919
01:16:26.902 --> 01:16:35.445
So I will look at VO2 max and it can be a good assessment of overall fitness, but it's not necessarily a good assessment of metabolic health.
920
01:16:36.145 --> 01:16:37.066
Exactly.
921
01:16:37.106 --> 01:16:37.346
Yeah.
922
01:16:37.406 --> 01:16:46.511
So I try and focus on more of zone two training in combination with resistance training.
923
01:16:46.631 --> 01:16:49.993
And that really optimizes that zone two and metabolic health.
924
01:16:51.901 --> 01:16:54.725
What's your gold standard for an HBA1C score?
925
01:16:55.566 --> 01:17:01.293
Oh, HBA1C, I'd like to see it, you know, below 5.5.
926
01:17:01.433 --> 01:17:04.497
Certainly, I'd probably want to get it to like the fives.
927
01:17:05.178 --> 01:17:05.819
That's my goal.
928
01:17:05.859 --> 01:17:06.359
Like 5.0.
929
01:17:08.542 --> 01:17:09.062
I'm with you.
930
01:17:09.683 --> 01:17:13.904
For me, I always say five is my gold standard if I'm working on a protocol with somebody.
931
01:17:13.945 --> 01:17:21.508
But a lot of doctors out there are saying the 5.7 is normal or they're not going to move the needle forward until they get over that 5.7 mark.
932
01:17:21.808 --> 01:17:23.129
There's room for optimization.
933
01:17:23.209 --> 01:17:24.329
So really understanding that.
934
01:17:24.349 --> 01:17:25.810
I'm taking that away as a co-factor.
935
01:17:26.290 --> 01:17:27.271
for heart health today.
936
01:17:27.551 --> 01:17:39.058
And I'm so grateful that you've really, we've talked about every aspect of healing from hormones to metabolic function to gut health and stress and really looking at heart health through an integrative approach.
937
01:17:39.458 --> 01:17:42.900
And it's not something that I hear often from a practitioner like yourself.
938
01:17:42.960 --> 01:17:44.181
So I'm so grateful for that.
939
01:17:44.201 --> 01:17:49.624
The last piece that I want to tie into this, when we think about this world that is so focused on longevity,
940
01:17:50.324 --> 01:18:02.211
I'm so sick and tired of the narrative around making it to a certain age if the years until that age aren't marked with joy and happiness and, you know, waking up and living with more of an abundance mindset.
941
01:18:02.291 --> 01:18:07.234
But where do you see like feeling a sense of purpose and happiness every day as a cardiologist?
942
01:18:07.574 --> 01:18:10.296
How does that fit into this longevity heart health conversation?
943
01:18:11.000 --> 01:18:25.704
No, that's, that's, I think it's vital because the years, it's not about accruing the years, but more about accruing the, the positive years that the years that, that are rewarding and have purpose.
944
01:18:25.784 --> 01:18:33.707
And so that's one of the things that we, we look at, at, at the practice, you know, we, we want to see, I want to ask what their goals are.
945
01:18:33.987 --> 01:18:35.827
I want to ask what, what is it that's giving them joy?
946
01:18:35.907 --> 01:18:38.568
What is it that's, that's, that's, that's, that's, that's, that's, that's, that's, that's,
947
01:18:38.628 --> 01:18:56.925
the reason that they're coming to the office to want to live as to their, to their peak, just living at your optimum is, is not going to sustain you through decades of going through these practices and, and making them become a sustained practice.
948
01:18:56.985 --> 01:19:01.289
You got to really have a purpose and humans are purpose driven people.
949
01:19:02.090 --> 01:19:02.610
creatures.
950
01:19:02.990 --> 01:19:07.353
We don't have, you know, we, if we don't have a purpose for doing something, we will fall off the wagon.
951
01:19:07.813 --> 01:19:10.074
And part of that has got to be joy.
952
01:19:10.134 --> 01:19:11.655
It's got to be gratitude.
953
01:19:11.715 --> 01:19:13.536
It's got to be consciousness.
954
01:19:13.656 --> 01:19:15.096
It's got to be creativity.
955
01:19:15.136 --> 01:19:22.520
And so, you know, I, I, I ask all of my patients, what's the goal, what's the purpose here and how can I help you achieve that goal?
956
01:19:22.600 --> 01:19:26.802
Because if it's, uh, if, if it's, it's empty without that,
957
01:19:27.382 --> 01:19:33.825
And, you know, the longevity discussion seems to, you know, we allude to that once in a while.
958
01:19:33.985 --> 01:19:39.467
And I think it's a deficiency in the industry where we don't really acknowledge that we're going to die.
959
01:19:39.487 --> 01:19:47.430
You know, I don't care what people think is going to happen in five years or what we, you know, we have to assume that that's going to happen.
960
01:19:47.651 --> 01:19:49.531
And we have to be able to live together.
961
01:19:51.532 --> 01:19:58.057
with gratitude, satisfaction, and joy in the moment, as well as try and plan for helping us do that in the future.
962
01:19:58.358 --> 01:20:00.079
And we have to accept these processes.
963
01:20:00.179 --> 01:20:07.645
You know, we're not going to stay like we were 25 all the way till we, you know, all the way till we're 90 and then drop dead.
964
01:20:07.965 --> 01:20:08.846
It's not realistic.
965
01:20:09.346 --> 01:20:14.390
And there's no wisdom that happens if we don't have hardship along the way to change.
966
01:20:14.751 --> 01:20:19.995
You know, so I try and encourage sort of this acceptance in this discussion.
967
01:20:21.087 --> 01:20:21.627
Incredible.
968
01:20:22.207 --> 01:20:23.988
You're such a phenomenal educator.
969
01:20:24.508 --> 01:20:26.708
Are you active with your community on social media?
970
01:20:26.828 --> 01:20:26.968
Yes.
971
01:20:26.988 --> 01:20:27.628
Is that your thing?
972
01:20:28.049 --> 01:20:28.649
Yeah.
973
01:20:28.849 --> 01:20:29.329
Wonderful.
974
01:20:29.369 --> 01:20:30.089
Thank you for that.
975
01:20:30.149 --> 01:20:33.030
I have a YouTube channel.
976
01:20:33.870 --> 01:20:35.670
It's Dr. A. Hussain.
977
01:20:36.170 --> 01:20:37.611
I post on Instagram.
978
01:20:37.771 --> 01:20:45.573
And then I'm a keynote speaker for conferences and for festivals whenever I can.
979
01:20:45.653 --> 01:20:46.433
And did you just launch a course?
980
01:20:46.453 --> 01:20:46.553
Yeah.
981
01:20:47.653 --> 01:20:47.893
Yeah.
982
01:20:48.053 --> 01:20:48.754
Can you share about that?
983
01:20:48.914 --> 01:20:49.094
I did.
984
01:20:49.234 --> 01:20:49.615
Thank you.
985
01:20:49.635 --> 01:20:50.015
Yeah.
986
01:20:51.416 --> 01:20:53.718
It's Next Generation Medicine.
987
01:20:53.738 --> 01:20:57.781
It's a cardiology course specifically focused on atherosclerosis.
988
01:20:58.721 --> 01:21:07.288
It's open to everybody and targeted for practitioners to give a systems-based approach to atherosclerosis.
989
01:21:07.388 --> 01:21:07.568
But
990
01:21:08.088 --> 01:21:11.031
It's available to anybody that's curious and it's approachable.
991
01:21:11.171 --> 01:21:14.013
I am a student for life and I know a lot of our listeners are as well.
992
01:21:14.073 --> 01:21:16.636
So I wanted to make sure you shared about that.
993
01:21:16.696 --> 01:21:17.576
Thank you for today.
994
01:21:17.597 --> 01:21:23.382
To wrap things off, I want to know what's something that excites you most about the world of integrative cardiology in the future?
995
01:21:23.962 --> 01:21:31.786
What's exciting me is the application of imaging to what we're doing with cellular medicine.
996
01:21:31.966 --> 01:21:33.827
You know, that's never happened before.
997
01:21:33.887 --> 01:21:38.790
We've never been able to really look at atherosclerosis in this detail.
998
01:21:39.210 --> 01:21:46.414
And I'm really excited about how cellular medicine is being applied to things like hypertension and AFib and
999
01:21:47.855 --> 01:21:50.558
other heart conditions.
1000
01:21:50.998 --> 01:21:55.142
And what I mean by cellular medicine is it's this approach that we've been talking about.
1001
01:21:55.363 --> 01:22:02.009
You know, you just remind me of one last question I want to squeeze in is soft tissue plaque detection.
1002
01:22:02.610 --> 01:22:04.972
Do you see a world where these tests are going to become a
1003
01:22:08.472 --> 01:22:08.972
Yeah, I do.
1004
01:22:09.073 --> 01:22:09.853
I do.
1005
01:22:10.053 --> 01:22:16.879
We're still not in full, I think they're early phases of these tests, and there's still room for refinement.
1006
01:22:17.520 --> 01:22:25.887
And I think that as computing power increases, these tests will get cheaper and will get better, more refined data.
1007
01:22:25.907 --> 01:22:28.970
Would you say that there's an age to go and get that test done for a soft plaque test?
1008
01:22:30.258 --> 01:22:33.161
I would recommend people do it before 40.
1009
01:22:33.421 --> 01:22:40.166
Do it at 40, get it done early because then we can see if you're getting disease at an earlier basis, an earlier rate.
1010
01:22:40.467 --> 01:22:44.510
And if you're one of those people that is at high risk, it'll detect it at that time.
1011
01:22:44.950 --> 01:22:46.071
Prevention is key.
1012
01:22:46.372 --> 01:22:48.113
All right, Dr. Hussain, thank you so much.
1013
01:22:48.133 --> 01:22:49.474
It's such an honor to connect with you.
1014
01:22:49.494 --> 01:22:52.437
Thank you for your time and your energy and I can't wait to meet you in person.
1015
01:22:52.897 --> 01:22:53.637
Likewise, Mana.
1016
01:22:53.718 --> 01:22:54.038
Thank you.