Heart Disease Prevention: Beyond Cholesterol with Dr. Bruce Clarke

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Hello, and welcome back to the Elevated Health Podcast. I'm Amanda Jones.
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I'm your host and the founder of Elevated Health in Canyon, Texas.
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Today, I'm joined by Dr. Bruce Clark. He's my mentor and friend and physician. Welcome to the show.
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Well, how are you today, Amanda?
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I'm good. Well, you know, we had a windstorm, so we're all stuffy.
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And I feel like every other week I say that I'm stuffy because of wind,
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because we live in the Panhandle.
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That's the Panhandle for you.
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So how did you end up practicing family medicine?
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Oh, you know, that started in high school.
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My mom was a nurse, and I liked the science books she had, and I liked the thought
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of helping people that way.
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And so when I got to college, I started taking my classes seriously,
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and I did an EMT course, got to ride on ambulances and go to the hospital while I was doing my classes.
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And then I got a job in the burn unit down at Tech. Oh, that's cool.
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And that was a great experience for me, you know, to see patients like that.
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And I got to see a lot of doctors and medical students and, you know,
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the attendings and how that works. And I was just really blessed,
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you know, to, to be there at that time and,
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Got accepted to go to medical school at Tech, and the rest is history.
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The rest is history. Yeah. I was exposed, basically, in the town we grew up
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was rural, and the doctors that I knew were family doctors.
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They seemed to do everything at that time in life, and I felt that was my calling,
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you know, when I got into medical school.
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So I pretty much was going to be a family doctor.
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Just now? Well, yeah, because especially then, did you get to deliver babies right.
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Off the job? Oh, yeah. Yeah?
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How many babies have you delivered?
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A thousand, maybe, maybe a little more.
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That's a lot of babies. Yeah. For a family, I mean, that's not normal anymore.
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No, no, it's not.
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When did they stop doing that?
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Well, I think they still can do it, but, you know, it's just times have changed.
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Health care has changed. you know obviously there's more specialty care
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Now practice insurance yeah.
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Yeah about practice insurance for obstetrics is pretty outrageous
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That's crazy you.
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Know it's it was a fun time in my life but i switched gears
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Yeah well like the across the lifespan you know my when i was going to go into
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nurse practitioner school i initially declared women's health and then I was
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told you were going to be doing gin visits,
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and just doing women's health and not the OB part and I said no thank you,
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that's pretty so niche and I'm so glad there are people that want to do just that oh I know.
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Yeah people like that too when I was in medical school you had to take like
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aptitude tests to see what you might fit into and everything pointed to me being
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a pediatrician for some reason and I did a lot of
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Child care, you know,
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Initially when I started practicing. But I've aged with my practice,
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so I'm an old guy to treat old people.
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And you just stay with the same group the whole time.
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That's right.
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Kids too older.
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I know. I've had some patients that have been with me for 30 years,
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so it's remarkable. It's been that long.
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Well, I guess that would be me.
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Yeah.
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Too. I think I was eight, so, yeah. Well, you.
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Know, a long
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Time. I don't want to talk about my age either. No. No.
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So when did you start getting interested in the cardiovascular part?
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I mean, the whole time, of course.
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I've always liked it, but I think it's when I started doing more learning about
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functional medicine, integrated medicine, and looking at health care through a different lens.
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And, you know, the cardiovascular module was really outstanding with,
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you know, how to look at cardiovascular disease.
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And it's not just all about, you know, cholesterol and, you know,
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don't eat fat and all this stuff that, you know, we were taught.
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So that's kind of got me more interested in it and just the physiology of the
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vascular system is very awesome.
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Yeah, it is. It's so much more broad than we, I think, going through school,
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you learn how to not kill people, right?
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And not how the lifestyle part is supposed to go.
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Right.
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So I think that's really, really fascinating and we went to the A4N conference
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together and listened to Dr.
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Houston and that was my first exposure of making it so functional and real life
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examples and how to live better instead of not die faster.
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Healthcare is mostly chronic, but, you know, we treat it as an acute care issue
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and it's not really that simple.
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And so we have to broaden our mind about labs and treatments and everything
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that goes into preventing, you know, a heart attack or stroke.
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You know, that's really where the biggest bang for your buck is, is prevention.
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Right. Yeah, where you live in the best country if you have a heart attack, right?
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Oh, yeah. If you have a heart attack, you want to be here. Yeah. Good old UFSA.
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Yeah, but we're not good at the prevention. So I think it's sad that it's taken
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this long to get us to the prevention side, where other countries,
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I think, are probably miles ahead of us in preventing disease.
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True, true. I think so. Their lifestyles are better.
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Yeah, they like walk and know about fats and eat butter. And they did that long before we did.
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They look at their vegetables that they're going to buy and, you know, feel them and
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That kind of stuff. Yeah, I don't know. I still don't know how to pick a cantaloupe.
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I don't know. Yeah, I don't know. I don't know if it's the thump method or what it is that
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Works the best. My mom's good at it. She can thump it and she smells it and
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knows the veins and stuff. Yeah.
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That's her time in Europe, I guess. She learned how to do that stuff.
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Cantaloupe whisperers.
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But tell her that. So what kind of do we get right? Right.
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What did schooling teach you initially about heart health and what we do the right way?
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Well, just how we talked about it a second ago, the acute care things like EKGs
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and lab sets for a cardiovascular event, we do that exceptionally well.
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But there's so much more to prevention and that's, you know, different labs.
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You know, it's not just your general lipid panel. There's more to it than that.
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Dr. Houston talked a lot about, you know, how this all happens,
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you know, is you have inflammation responses.
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And that's the problem. The cardiovascular system gets irritated.
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You have 60,000 miles of arterial tubing in our body, you know.
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It's a lot of highway there.
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It's a lot of information moving back and forth through it.
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And anything that disrupts that flow, like a poor diet, toxins like smoking,
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infections, anything like that can start affecting that interior lining of the
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cardiovascular system called the endothelium.
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So that oxidative stress loads from the same things, poor diet,
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stress, all that sets into motion your immune system, which wants to respond
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to something, and it does.
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And that starts creating, you know, vascular change.
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And then you start having this events of inflammatory responses.
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And they don't go away. And that, you know, can lead to high blood pressure
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and plaque progression.
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You know, all these things are going to lead to a heart attack or stroke that
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we're trying to prevent.
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We think of, you know, in school for me, then I walked away thinking you have,
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you eat fat, you eat cholesterol. all and then it gets higher in your bloodstream
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and that's what clogs your veins and arteries and that's what leads to a heart attack.
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Right. But we didn't learn the inflammation part.
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Right.
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In near in the depth that we should have.
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We need cholesterol.
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But cholesterol is in a way just an innocent bystander of all this.
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You know, it's being transported by structures, you know, these lipoproteins, you know.
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And so that's the problem is the passenger just gets trapped and he gets trapped in this bus.
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Let's call LDL a bus because that's what it is. Comes in different sizes, big sizes, small sizes.
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And something happens to it. The bus gets a flat tire, you know,
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the antenna on it gets messed up.
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And it has to stop, and it stops in the arterial wall.
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And that's where the nidus of the plaque starts. And that's all this stuff.
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And that's when the immune system comes in and does its thing and creates foam cells.
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And then you get a plaque, and then it keeps growing. And then,
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Lord forbid, it might rupture and go downstream, and it's going to block.
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And that's when you have that ischemic event happen, you know,
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that causes a stroke or a heart attack.
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So that's what we have to prevent, but it's more than just cholesterol.
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So that's understanding lipidology, and that's kind of hard to do, but it's possible.
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Yeah, it's possible. It's intense. There's a lot to it.
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But I think the statin thing where there's some cardiologists and family doctors
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and such that we think that statins should just be in the water.
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Just give a baby aspirin and a statin and you'll be fine.
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Yeah, without mention of other things like diet and other change.
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So some studies said 50% of people who have heart attack have normal cholesterol values.
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So that gets you thinking, well, what is it?
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It's not just about that cholesterol, but it's more about what's going on in
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the vascular tube with the inflammation responses and what happens to LDL and
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what's leading it to be dysfunctional.
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That's more lifestyle. It's what we're putting in our body, which a lot of us
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are putting a lot of garbage in our body.
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Grains and fats are horrible. You know, they're going to modify LDL and it's
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going to get oxidized and change and it's not going to function as well.
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HDL levels as well, which they call the good cholesterol, which is not always necessarily true.
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It helps LDL work and function and take stuff back to the liver.
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But if you don't have enough or sometimes if you have too much,
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which means you're probably not working very well, then you're going to have
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still the same problems.
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We don't have any medications to really fix HDL. Maybe exercise and a plant-based diet.
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Yeah, we talked about, and Dr. Houston talked about that, that HDL is almost like a dump truck.
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If we've got a bus for LDL, then we've got a huge dump truck that's HDL,
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so it's just a quote-unquote better carrier in some ways.
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Still just as necessary, both types. So what does a statin do?
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What is its action on cholesterol?
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It disinhibits the formation of cholesterol, which, you know, you make cholesterol.
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You have to because it is the base molecular structure for your hormones.
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It helps cells repair themselves, cell walls. It's kind of involved in your
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immune system response, actually.
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So we need it. That's important.
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And statin drugs just inhibit the formation of it.
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And then it inhibits all kinds of cholesterol. So it's kind of that across the
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board with exception of triglycerides.
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Right, yeah.
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Or just lowering everything all at once. It's not only selecting LDL or the
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inflammatory part. It's just overall.
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Yeah, just that. So then you're, in theory, that would maybe decrease your LDL
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because you don't need as much to carry to deposit to tissues to do what it's supposed to be doing.
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Same way with triglycerides,
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You know, they're basically from carbohydrate metabolism. They're transported
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in the same structure in LDL and are picked up by HDL to be moved back to the liver, you know.
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So that's a carbohydrate response, you know.
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It's basically going to be formed into fat and it's going to be stored.
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And that's where, you know, insulin comes in. And that's the whole problem,
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how we start snowballing into metabolic syndrome because of that.
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And that's why this is a vascular disease.
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You know, it's a whole body disease. But, you know, one thing sets off another, sets off another.
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Right, right. I talked a little bit about cholesterol and fatty liver and how
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that's a heart risk in itself. And so millions of people probably have this
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fatty liver at some end of the spectrum or another in the middle.
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Almost 33% of the population has a fatty liver of some degree.
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You're talking about moving the cholesterol to the liver, and it's supposed
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to, if we have a functional liver,
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that's doing what it's supposed to be doing and not dealing with a ton of toxins
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or blood glucose, then we're supposed to be metabolizing that cholesterol,
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moving it, and then excreting it.
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But if we've got a fatty liver, but we're just holding all of that in.
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Right. Well, you know, when you make triglycerides, you're going to burn them as energy,
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like beta-oxidation, or you're going to go into that giant lipoprotein,
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got like very low-dense lipoproteins, or it's going to be stored in your liver as fat.
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That's kind of the three things it does, and, you know, which is all led by insulin resistance.
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Right. So getting the insulin down, again, I talk a lot about insulin resistance, of course.
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So making sure that that's, you said, all to start with diet and lifestyle,
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which we go to, hey, your cholesterol looks like it's getting high.
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Do you have family history of it? Oh, yeah, you do. Well, it starts you on a
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stat and I'm going to send you to cardiology.
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And then we started doing stress tests and all these things that are great and
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the screenings and the blood pressure screenings, all of that,
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that we kind of missed the prevention part of why does your family have a history
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of elevated cholesterol and why do you ask those questions regularly?
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How's your sleep? How's your stress? All of those things.
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All this stuff sets off in inflammatory response. I mean, I love Dr.
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Houston. He's just such a smart guy.
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I think he autographed one of his books. I've got one.
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Oh.
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Yeah. Exciting. And anyway, but he feels all disease is set off by those three
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things, inflammatory response, oxidative stress in the immune system,
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responding to this, everything.
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So he's probably right. It's imperative that we figure out how to decrease inflammation
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through lifestyle. It's the only way to do it.
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And, you know, we've gone through the functional models. You,
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of course, are certified with IFM.
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But spending time with patients and leading them to the right things is difficult in a short visit.
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So, you know, that's why we do a lot of referrals to each other.
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There, and okay, well, they're going to need to have the big stuff,
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the big labs and screenings and all that stuff that our model does a really
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great job with, and then going,
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I'm going to need you to spend an hour just talking about diet with this person.
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So it's a good thing to have a couple of providers in your corner so that you're getting all of it.
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Or you can go to Dr. Clark and do all of that together.
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So whenever somebody is going in and doing their quote-unquote normal labs,
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their normal physical labs, can you talk a little bit about why that's not comprehensive?
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Well, it's kind of like you're playing darts.
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You're throwing at the wrong bullseye. It seems like a general lipid panel,
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let's say, has total cholesterol, HDL, VDL, VL.
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VLDL? Yes. There we go. Got it.
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And, you know, an LDL, which is a calculated value.
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So that's what we're basing this off of.
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But there's other things out there that we know of, like APO-B,
00:17:40.783 --> 00:17:45.703
which is a good marker for, you know, it's a good surrogate marker for like
00:17:45.703 --> 00:17:51.703
LDL particle, which is part of a higher level lipid panel.
00:17:51.703 --> 00:17:57.683
So looking at those markers, there's more studies that show those actually are
00:17:57.683 --> 00:18:03.143
more indicative of cardiovascular disease that's being set in motion.
00:18:03.523 --> 00:18:10.363
So looking at maybe a different type of LDL called LP little a,
00:18:10.463 --> 00:18:16.183
which is very genetic and it can lead to stroke and heart attack at an early age.
00:18:16.363 --> 00:18:21.583
So those are things that you could throw that into the mix. You can look at
00:18:21.583 --> 00:18:25.363
ratios like triglycerides to HDL ratios.
00:18:25.803 --> 00:18:31.203
All those might be a little more higher indicators of cardiovascular progression.
00:18:32.223 --> 00:18:39.643
So that, insulin levels and A1C, all these can show you, like if you have someone
00:18:39.643 --> 00:18:44.723
who has a pre-diabetic level, well, that's not, oh, it's pre-diabetes. I'm okay.
00:18:44.943 --> 00:18:49.843
Well, no, it's not. That's probably inflammation setting up in your body,
00:18:49.843 --> 00:18:52.623
and that's going to lead to further progression.
00:18:53.379 --> 00:18:53.699
Right.
00:18:54.039 --> 00:18:57.879
Well, we were just talking about a shared patient as we came in and talking
00:18:57.879 --> 00:19:03.179
about they have a family history of cardiovascular events, of heart attacks.
00:19:03.399 --> 00:19:08.659
They're afraid to take some of these medications because of their father's history.
00:19:08.939 --> 00:19:14.419
So setting them up with some labs and you're talking about another test, a CT.
00:19:14.419 --> 00:19:20.939
Right, yeah. So we can even look at calcium deposition in your coronary arteries.
00:19:21.259 --> 00:19:24.379
It's a CT coronary calcium score test.
00:19:24.579 --> 00:19:29.239
I mean, you do get a little radiation exposure from it, but you don't have to do it all the time.
00:19:29.399 --> 00:19:36.039
But that's a good test, I think. It's a good screening test as well that can
00:19:36.039 --> 00:19:40.519
kind of give you options about treatment maybe for your patient.
00:19:41.279 --> 00:19:45.819
So I like that. You know, that could proceed into a CT coronary angiogram,
00:19:46.039 --> 00:19:48.679
which is more of an invasive study as well.
00:19:49.039 --> 00:19:56.859
Do carotid interval thickening with a Doppler. These are all things that show signs of plaque per se.
00:19:57.079 --> 00:19:59.659
And that's what we're trying to decrease.
00:20:00.599 --> 00:20:05.819
Some studies have showed plaque developing in early people in their 20s.
00:20:05.919 --> 00:20:06.559
Oh my gosh.
00:20:06.679 --> 00:20:08.059
So that's kind of scary.
00:20:08.059 --> 00:20:12.239
So we think, again, we talked about how we think in our 20s that we can just
00:20:12.239 --> 00:20:16.759
handle anything and, you know, the drinking all night and eating Wagga Burger
00:20:16.759 --> 00:20:18.739
for every meal and all that.
00:20:18.899 --> 00:20:20.319
But it's guilty as charged.
00:20:20.519 --> 00:20:25.359
Guilty as charged myself as well. So but then maybe 30, 40 years later,
00:20:25.579 --> 00:20:29.279
then that stuff comes out that you can't hide from that forever.
00:20:29.539 --> 00:20:33.959
No. It's been there the whole time. So plaque, when you talk about plaque,
00:20:34.159 --> 00:20:39.099
that's cholesterol that's been deposited in the artery and the endothelium.
00:20:39.239 --> 00:20:41.439
Can you describe plaque a little bit more?
00:20:42.054 --> 00:20:48.454
Well, there's LDL that gets trapped in the intimal wall of the artery.
00:20:48.614 --> 00:20:52.554
They usually, most plaque is around bifurcated areas where, you know,
00:20:52.654 --> 00:20:57.894
where an artery splits and then below it, that Y, that's where there's a lot
00:20:57.894 --> 00:20:59.314
of pressure gradients that develop.
00:20:59.614 --> 00:21:03.594
And that's where you can see, you know, LDL getting stuck in those areas,
00:21:03.994 --> 00:21:08.454
You know, goes right past the endothelial lining into the next layer of the
00:21:08.454 --> 00:21:13.234
intima. And when that happens, then your immune system is going to respond to that.
00:21:13.454 --> 00:21:19.094
And you've got this LDL, it's full of cholesterol and triglycerides,
00:21:19.134 --> 00:21:23.454
and you're going to have these immune system cells going to go in there and
00:21:23.454 --> 00:21:27.734
microphages, and they're going to gobble it up because they're going, this shouldn't be here.
00:21:27.854 --> 00:21:31.614
I'm going to take care of it. And they gobble it up and they form these foam
00:21:31.614 --> 00:21:33.534
cells, which they keep growing.
00:21:33.774 --> 00:21:39.814
And it's like the blob starts growing. And then it doesn't have anywhere to go.
00:21:40.014 --> 00:21:45.574
It can either pooch out into the lumen of the artery or it can kind of bulge
00:21:45.574 --> 00:21:49.634
back into the enema and into the smooth muscle of the artery.
00:21:49.874 --> 00:21:57.814
And if it bulges out, well, that decreases flow possibly and it has to form a cap.
00:21:58.054 --> 00:22:03.554
And that cap can be soft or it can develop a firmness over it,
00:22:03.554 --> 00:22:07.734
a hard plaque. And then you can get some calcium deposition in that hard plaque.
00:22:07.814 --> 00:22:11.734
And that's what we're seeing on, you know, CT coronary calcium test.
00:22:11.954 --> 00:22:15.634
But, you know, so it doesn't tell us the whole story because what's more dangerous,
00:22:15.634 --> 00:22:17.154
hard plaque or soft plaque?
00:22:17.394 --> 00:22:22.874
Well, it has to be soft plaque. It's more after rupture and it spills its content
00:22:22.874 --> 00:22:25.274
into your cardiovascular system.
00:22:25.434 --> 00:22:28.094
It keeps going and going and going until it finds, you know,
00:22:28.214 --> 00:22:29.574
smaller artery where it can't go.
00:22:29.774 --> 00:22:32.134
And that's where we see damage.
00:22:32.827 --> 00:22:36.627
So, that's kind of how plaque is developed.
00:22:37.447 --> 00:22:42.047
That was a good picture of that. Yeah, when your immune system is trying so
00:22:42.047 --> 00:22:46.787
hard to help you out, but especially if you have a very reactive immune system,
00:22:46.947 --> 00:22:51.907
like an autoimmune condition or, yeah, in diabetes, you've got a bunch of blood
00:22:51.907 --> 00:22:56.967
sugar coursing through your vessels, and then you've got glucose added to the
00:22:56.967 --> 00:22:59.987
party of immune cells to add to that plaque.
00:22:59.987 --> 00:23:04.327
So, again, anything that you can do, right? We talk a lot about baby steps of
00:23:04.327 --> 00:23:06.087
what are some of the things you can do?
00:23:06.227 --> 00:23:11.967
You can't take away the Whataburger of your 20s, but what's something that you can do now?
00:23:12.507 --> 00:23:19.387
But, you know, they showed some study where they had patients eat some fast
00:23:19.387 --> 00:23:23.687
food and they checked an inflammation marker, C-rect protein,
00:23:23.847 --> 00:23:27.147
high sensitivity, which is also a test that should be done.
00:23:27.287 --> 00:23:27.547
Yes.
00:23:28.267 --> 00:23:33.727
And they did that, and these people spiked within so many hours, their CRPs.
00:23:33.887 --> 00:23:37.867
Well, they gave them that and broccoli. And they still got spikes,
00:23:37.907 --> 00:23:39.387
but it wasn't near as much.
00:23:39.827 --> 00:23:46.527
So, you know, offsetting a bad food with a good food might decrease some inflammatory
00:23:46.527 --> 00:23:50.787
responses, you know, altogether not eating that bad food. That'd be great.
00:23:50.827 --> 00:23:52.207
You know, we're going to do it.
00:23:52.387 --> 00:23:59.347
Yeah. I mean, it happens. And it's fasting might help that helps create autophagy,
00:23:59.467 --> 00:24:02.427
which that's your immune system doing good things.
00:24:02.607 --> 00:24:06.547
It's clearing up stuff that doesn't need to be there in your body.
00:24:07.067 --> 00:24:09.467
It's like a little bit of that autophagy.
00:24:10.088 --> 00:24:14.608
In other countries, I know they say autophagy, and they have all different pronunciations.
00:24:14.928 --> 00:24:17.188
I know, but up in Texas, that's how I say it.
00:24:17.188 --> 00:24:18.028
That's how I say it, too.
00:24:19.008 --> 00:24:22.988
It's a way of your body cleaning house.
00:24:23.288 --> 00:24:27.828
I think of it as a warehouse where it was full of workers, and they leave,
00:24:27.848 --> 00:24:31.248
and then the cleaning crew comes in to make it all nice for the next day.
00:24:31.928 --> 00:24:36.948
And our bodies form cells that, over time, don't work very well.
00:24:37.068 --> 00:24:39.828
They call them senescent cells or zombie cells.
00:24:40.088 --> 00:24:45.288
And you make proteins during the day that some just don't work very well.
00:24:45.388 --> 00:24:48.448
They're not molded properly. They're just not helpful.
00:24:49.168 --> 00:24:55.528
And they decrease our function of our metabolism at the microscopic level.
00:24:55.888 --> 00:25:00.828
So these immune system, I guess, knows this and that's why it's innate.
00:25:01.626 --> 00:25:06.086
And it goes in there and just, you're not good. I know you.
00:25:06.266 --> 00:25:11.706
You're bad. It takes it out of the system. It gets all this stuff out and it
00:25:11.706 --> 00:25:14.546
prepares us for the next day for health.
00:25:14.726 --> 00:25:19.046
And so that's what bad foods and toxins in our environment and all these things
00:25:19.046 --> 00:25:23.746
set up an immune response that it has to respond to it.
00:25:23.926 --> 00:25:28.706
And that's kind of how that works, autophagy. And the same way for your mitochondria.
00:25:28.866 --> 00:25:35.166
It's called mitology. And because that's really key, it's protecting your mitochondria
00:25:35.166 --> 00:25:38.466
because that's making the energy for your whole system to run itself.
00:25:38.726 --> 00:25:41.826
But that's a part of this. So that's how that kind of works.
00:25:42.486 --> 00:25:47.266
Makes sense. Yeah, because it literally means eating self autophagy. Right.
00:25:47.486 --> 00:25:52.766
So the cleanup part is that your immune system and the innate immune system
00:25:52.766 --> 00:25:56.806
is taking care of it by degrading and all these things.
00:25:56.806 --> 00:26:03.266
It's it's very cool and because a lot of us will eat at 10 o'clock at night
00:26:03.266 --> 00:26:06.766
and then we're eating again at seven o'clock in the morning you're not really
00:26:06.766 --> 00:26:08.766
getting your body a chance.
00:26:08.766 --> 00:26:13.406
Yeah you're just not giving it yeah by itself just eating anything even good
00:26:13.406 --> 00:26:17.966
foods can create oxidative stress loads to your body and you know a little bit
00:26:17.966 --> 00:26:21.446
of stress is good for the body but you know that's why you have to give time
00:26:21.446 --> 00:26:25.186
space it's why you know exercise is good it stresses your body out to a degree
00:26:25.186 --> 00:26:28.746
but then you have to have a recovery for a little bit. Then you get stronger.
00:26:28.966 --> 00:26:31.006
That's kind of what this is helping you with.
00:26:31.626 --> 00:26:37.266
Yeah, I think fasting and people experimenting with different levels and there
00:26:37.266 --> 00:26:41.486
are differences in men and women probably in childbearing years and things like
00:26:41.486 --> 00:26:43.426
that, but you've got to be careful.
00:26:43.686 --> 00:26:51.386
It's not probably a 12 to 16-hour fast. People are pretty generally okay with, would you say?
00:26:51.626 --> 00:26:59.486
Yeah, I like that. I do like a 12-hour fast most days. A 12-hour fast
00:27:00.186 --> 00:27:01.246
It's good for me.
00:27:01.326 --> 00:27:05.446
I have some patients that do a 72-hour fast once a month.
00:27:05.586 --> 00:27:09.446
They feel good when they do that. I don't think I could do that unless I'd have
00:27:09.446 --> 00:27:12.286
to be strapped down or put in a, I don't know.
00:27:12.966 --> 00:27:15.686
Lock the fridge in the pantry. Yeah.
00:27:16.466 --> 00:27:17.706
I would be very...
00:27:17.706 --> 00:27:19.966
I'd be cranky. I'd be too hangry. I couldn't get it.
00:27:19.966 --> 00:27:22.766
Angry, oh yeah, I'd be a I don't
00:27:22.766 --> 00:27:27.206
Think I'd be a nice person I have some patients that are very religious and
00:27:27.206 --> 00:27:33.746
they use fasting as part of their religious practice and I guess God helps them get through this Well.
00:27:34.046 --> 00:27:41.046
You know, fasting it's a survival technique that we have so we should utilize
00:27:41.046 --> 00:27:46.246
it makes us healthier we don't need to eat all the time No,
00:27:46.366 --> 00:27:50.926
I think we can go about 30 days without food, technically kind of survival,
00:27:51.266 --> 00:27:56.306
but, you know, going more than 12 hours, man, asking some patients to do that
00:27:56.306 --> 00:27:59.906
is a tall order, but it's really not that bad.
00:28:00.146 --> 00:28:04.346
If you're going, you know, you finish eating at eight o'clock and you have something
00:28:04.346 --> 00:28:06.926
at eight in the morning, that's really doable.
00:28:07.246 --> 00:28:10.766
It is doable. It just takes practice like anything we do, you know,
00:28:10.826 --> 00:28:14.766
you just have to work at it, you know, have it, make it intentional.
00:28:14.766 --> 00:28:19.606
Mm-hmm. When there's things that people can do, like I like that if you're in
00:28:19.606 --> 00:28:25.106
kind of a modified fast, even things like bone broth or unsweetened tea or coffee,
00:28:25.266 --> 00:28:29.026
green tea, those kinds of things that still can kind of count as a fast.
00:28:29.186 --> 00:28:33.606
You're giving your body something and definitely liquids. Don't fast for liquids.
00:28:34.126 --> 00:28:39.146
Do that. But there are ways to do it without feeling like you're starving and
00:28:39.146 --> 00:28:41.466
definitely doing it in small steps.
00:28:41.706 --> 00:28:45.346
If you're going from eating every four hours, you wouldn't want to do a 20-hour fast.
00:28:45.566 --> 00:28:46.506
Please don't do that.
00:28:47.169 --> 00:28:50.709
Let's talk a little bit about sleep in the cardiovascular system.
00:28:50.869 --> 00:28:56.209
We talked about breaks, and I think that in itself is going to help autophagy and mitophagy.
00:28:56.329 --> 00:28:59.469
But what are some other recovery things for the cardiovascular system?
00:29:00.089 --> 00:29:07.369
Sleep is awesome. There's a lot of problems with sleep, but a good six or eight
00:29:07.369 --> 00:29:13.489
hours of sleep, well-intended sleep, is what helps us autophagy and helps our vascular system.
00:29:14.518 --> 00:29:18.498
Maybe decreases the inflammation response so it's a reset
00:29:18.498 --> 00:29:23.138
Well like you said that you need even exercise is stressful in that recovery
00:29:23.138 --> 00:29:27.638
period it's the same you've been going all day just shutting everything off
00:29:27.638 --> 00:29:30.618
is anti-inflammatory yeah itself that's.
00:29:30.618 --> 00:29:31.598
Fine it's good
00:29:31.598 --> 00:29:36.578
And definitely insulin resistance and blood glucose if you're not sleeping that's
00:29:36.578 --> 00:29:39.138
you've got higher cortisol levels.
00:29:39.758 --> 00:29:40.898
Yeah, good old cortisol.
00:29:41.158 --> 00:29:45.998
Yeah, no cortisol. Is there any cortisol-specific things in the cardiovascular system?
00:29:46.618 --> 00:29:52.358
It's precipitated by stress, and it's a regulating hormone, and it's going to
00:29:52.358 --> 00:29:57.218
cause you to discharge epinephrine, norepinephrine, and what is that going to do?
00:29:57.318 --> 00:30:00.758
Well, it's going to increase your heart rate, it's going to cause vasoconstriction,
00:30:00.838 --> 00:30:06.378
it's going to precipitate other hormone events, which continue to put pressure
00:30:06.378 --> 00:30:09.198
on that 60,000 miles of tubing.
00:30:09.538 --> 00:30:12.798
You know, we didn't mention that, you know, the inside of the lining,
00:30:12.958 --> 00:30:16.878
the endothelium, also has something attached called the glycocalyx,
00:30:17.058 --> 00:30:20.818
which is this amazing structure.
00:30:20.878 --> 00:30:25.418
It's kind of like, I envision it like seagrass, you know?
00:30:25.658 --> 00:30:30.438
And so, you know, you look at seagrass in the ocean just moving back and forth
00:30:30.438 --> 00:30:34.698
from, you know, these currents that you can't see. well, that's the same kind
00:30:34.698 --> 00:30:37.618
of thing that's going in our lumen.
00:30:37.958 --> 00:30:42.718
We have fluid through there, you know, and so we want to keep it flowing nice
00:30:42.718 --> 00:30:46.038
and smoothly, and the glycocalyx helps do that.
00:30:46.258 --> 00:30:51.598
It also has receptors on it and things like that. Well, things like poor sleep
00:30:51.598 --> 00:30:54.998
and poor diet and toxins can diminish the glycocalyx.
00:30:55.678 --> 00:31:00.538
So what happens is things don't flow as well. Things get sticky, you know.
00:31:00.538 --> 00:31:07.298
That affects the sensitivity of the endothelial lining because the endothelial
00:31:07.298 --> 00:31:11.178
lining is also making something called NO, nitric oxide.
00:31:11.952 --> 00:31:16.332
Nitric oxide is an amazing gas that was discovered in the 80s, I think.
00:31:16.532 --> 00:31:20.432
It does so many things. It stimulates your immune system response.
00:31:20.572 --> 00:31:23.072
It helps cause vasodilation.
00:31:23.692 --> 00:31:26.972
It does, God, there's so many other things. I can't even list them,
00:31:27.052 --> 00:31:29.172
but it's an amazing structure.
00:31:29.512 --> 00:31:36.052
So things like poor sleep or cortisol level elevations or putting pressure on
00:31:36.052 --> 00:31:42.092
that vascular system affect, you know, the functionality of the cardiovascular system.
00:31:42.192 --> 00:31:46.372
And that's really another, that's a big tick to develop with plaque.
00:31:46.692 --> 00:31:52.052
It is crazy. I was trying to put that together for a patient and made me think
00:31:52.052 --> 00:31:55.172
of a patient that has elevated,
00:31:55.492 --> 00:32:01.312
she's got some autoimmune disorders and she just did some labs with her specialists
00:32:01.312 --> 00:32:03.812
there and they did a cortisol level.
00:32:03.972 --> 00:32:06.472
I think it was in the 20s. Very high.
00:32:06.992 --> 00:32:13.732
She's had high inflammatory markers, and then her A1C jumps like two points into the sevens.
00:32:14.572 --> 00:32:18.952
And so we just got this over and over. And she asked me, well,
00:32:19.032 --> 00:32:20.772
they want to send me to endocrinology now.
00:32:20.932 --> 00:32:24.432
And she said, do we need to do that? Do we need to go to endocrinology yet?
00:32:24.572 --> 00:32:27.832
Or is there something else we can do? And I just started seeing her.
00:32:28.032 --> 00:32:32.292
So I told her we'd watch it and start doing some more because I'm worried about
00:32:32.292 --> 00:32:33.612
her cardiovascular vascular system.
00:32:33.932 --> 00:32:39.312
Yeah, because what does cortisol do is stimulating insulin response or,
00:32:39.332 --> 00:32:42.392
you know, it's creating sugar elevation.
00:32:43.472 --> 00:32:49.772
And that's what a lot of people don't need, you know, because that's going to affect, well, insulin.
00:32:50.518 --> 00:32:52.338
It's going to cause the inflammation.
00:32:53.338 --> 00:32:56.298
So you can do a big panel of testing.
00:32:56.518 --> 00:33:03.058
NMR, the lipid panel, is there a searchable way for people to find these panels
00:33:03.058 --> 00:33:05.178
or ask their physicians?
00:33:05.438 --> 00:33:14.338
NMR lipid panel and an insulin C-peptide level and an A1C and a high sensitivity
00:33:14.338 --> 00:33:16.938
CRP, C-reactive protein.
00:33:18.398 --> 00:33:22.178
And an ApoB and a LP-Lalay.
00:33:22.278 --> 00:33:27.718
Those would be add-on tests that you should ask your health care provider to do.
00:33:28.218 --> 00:33:31.918
A lot of times if I have somebody that comes in and their lipids are pretty
00:33:31.918 --> 00:33:36.098
altered and they've got some of these inflammatory markers, then I can all go,
00:33:36.218 --> 00:33:39.178
yeah, you got to go back to the lab. I got to try some other stuff.
00:33:39.949 --> 00:33:45.829
You know and it is it's we don't think about it because we've got this small little lipid panel,
00:33:46.509 --> 00:33:51.369
and over and over i had these people that go yeah it's okay that my triglycerides
00:33:51.369 --> 00:33:56.549
are okay they said that they're within normal limits so we're not doing anything
00:33:56.549 --> 00:34:02.409
about that or my insulin's normal now i don't get very many people that tested
00:34:02.409 --> 00:34:06.089
insulin but it's like normal is around 2 to 20.
00:34:06.729 --> 00:34:11.869
It's this huge range. Right. It's huge range in what is normal.
00:34:12.249 --> 00:34:12.749
Right.
00:34:12.949 --> 00:34:17.709
You know, and so I can catch people in their 20s than I have going,
00:34:17.889 --> 00:34:19.849
we got to start now. Yeah.
00:34:20.389 --> 00:34:24.229
I'd say less than five, probably for insulin levels, normal.
00:34:24.789 --> 00:34:29.749
I think we've got a lot more things that we could test that would help a lot.
00:34:29.929 --> 00:34:34.689
And then family history considerations when we're talking about that.
00:34:34.689 --> 00:34:38.529
A lot of times we'll ask about, do you have any family history?
00:34:38.689 --> 00:34:43.489
And people leave out a lot, too. They leave out a lot of cardiovascular and
00:34:43.489 --> 00:34:46.629
metabolic things that they go, oh, well, they had diabetes.
00:34:46.929 --> 00:34:47.109
Yeah.
00:34:47.829 --> 00:34:48.849
Do you get a lot of that?
00:34:49.249 --> 00:34:53.529
Yeah, you got to really ask the right questions with these patients and hone
00:34:53.529 --> 00:34:56.529
everyone, you know, that family history.
00:34:56.989 --> 00:35:01.309
And, yeah, of course, obviously their dietary history as well. But, yeah. Yeah.
00:35:02.113 --> 00:35:06.533
Dietary histories, are there things, what do you kind of recommend if you are
00:35:06.533 --> 00:35:09.933
short on time, you've got a 15-minute visit,
00:35:10.113 --> 00:35:13.333
and you've got somebody that really needs to work on things,
00:35:13.473 --> 00:35:17.593
do you have them go research something, or what do you like to talk about?
00:35:17.593 --> 00:35:25.533
Well, I guess it depends on their goals, but with IFM, they have so many great
00:35:25.533 --> 00:35:28.693
nutritional plans that work for different things.
00:35:29.913 --> 00:35:32.393
There's no right way to eat,
00:35:32.473 --> 00:35:39.633
I guess, but none of these health plans are like, oh, please include processed food in your diet.
00:35:40.409 --> 00:35:44.809
You know, they're not saying that. So that's, you know, that's an easy thing. Yeah.
00:35:45.309 --> 00:35:47.929
What's a processed food? That's where you have to explain it.
00:35:48.089 --> 00:35:52.949
You know, well, it's, you know, unfortunately, it's a piece of bread, a cracker, a chip,
00:35:53.189 --> 00:35:58.049
you know, your, your white rice, you know, I mean, that those are things you
00:35:58.049 --> 00:36:00.929
have to start talking about. you know, well, what do I do?
00:36:01.109 --> 00:36:06.569
Maybe substitute quinoa for your rice or spaghetti squash for spaghetti noodles.
00:36:06.889 --> 00:36:11.029
You know, just you got to kind of feel, you know, feel them out a little bit,
00:36:11.169 --> 00:36:12.209
what they're willing to try.
00:36:12.629 --> 00:36:16.769
You know, but if they're willing just to decrease cheeseburger and fries,
00:36:17.129 --> 00:36:19.909
you know, that they have maybe three or four times a week, you know,
00:36:19.989 --> 00:36:22.329
maybe cut back. Just start somewhere.
00:36:22.649 --> 00:36:27.649
You know, get more vegetables in your diet. I just talk about the rainbow of
00:36:27.649 --> 00:36:31.769
color that you can get in your diet that's through vegetables and some fruits, you know.
00:36:31.929 --> 00:36:35.169
So, you know, that's kind of keeping it simple.
00:36:35.789 --> 00:36:38.349
That's what you need to do when you don't have a lot of time.
00:36:38.869 --> 00:36:40.529
Talk about water consumption.
00:36:40.849 --> 00:36:45.229
You know, of course, ask them about other consumption of fluids like alcohol
00:36:45.229 --> 00:36:51.889
or beer or whatever, you know, or Cokes or Diet Cokes or sodas.
00:36:52.109 --> 00:36:52.869
That's just the next one.
00:36:53.029 --> 00:36:55.749
Sodas and Cokes. In Texas, we say Cokes. Yeah.
00:36:56.069 --> 00:37:00.669
So that's some of the simple things that I can do, you know,
00:37:00.749 --> 00:37:03.549
when I have time crunch with patient care.
00:37:03.809 --> 00:37:07.489
And then we can come talk to you more about stuff.
00:37:07.909 --> 00:37:11.209
But that is a good way to do it. What are you willing to do?
00:37:11.971 --> 00:37:17.011
And, you know, even when I have an hour with somebody, that's a lot of what
00:37:17.011 --> 00:37:19.731
we do is, this is how I'd like you to eat.
00:37:19.831 --> 00:37:22.351
This is how we can go somewhere in the middle.
00:37:22.511 --> 00:37:28.031
Because I remember shadowing you, I think it was like the first day I'd moved back to the panhandle.
00:37:28.111 --> 00:37:31.111
And you looked at somebody and said, well, you know, pizza's going to happen.
00:37:34.231 --> 00:37:38.431
That's good to think about, too, because those things are going to happen.
00:37:38.431 --> 00:37:42.271
And then you are going to need to go get a cheeseburger some night when it's,
00:37:42.291 --> 00:37:45.771
you know, eight o'clock and you've had three kids practices and whatever.
00:37:46.111 --> 00:37:50.511
But how to fit that into your life and then maybe don't have a cheeseburger
00:37:50.511 --> 00:37:52.211
the rest of the week. Yeah.
00:37:52.391 --> 00:37:58.371
Or you have two pieces of pizza with a side salad with oil and vinegar instead
00:37:58.371 --> 00:38:00.571
of blue cheeks or, you know, whatever.
00:38:00.571 --> 00:38:06.471
Where making those little switches throughout the day makes such a huge difference
00:38:06.471 --> 00:38:08.671
in keeping blood sugar steady.
00:38:09.031 --> 00:38:13.091
And then maybe you can add a 12-hour fast a few days a week at least.
00:38:13.711 --> 00:38:19.911
Things like that that are just not so intense. They're not going to just rock your world.
00:38:20.171 --> 00:38:27.571
We sure wish you would, but I'm not about to just eat vegetables and chicken every day.
00:38:27.811 --> 00:38:33.871
No, there's no reason to. but that's that's a good approach everyone's unique
00:38:33.871 --> 00:38:37.751
you know and you have to meet them where they're at some people are more motivated
00:38:37.751 --> 00:38:39.471
than others and just gotta
00:38:39.891 --> 00:38:44.491
let them through it and they're gonna work their plan it's not my plan it's
00:38:44.491 --> 00:38:49.411
their plan you know I can support it and give them ideas and they can give them a thanks and
00:38:50.078 --> 00:38:54.818
So we go back to, of course, the lifestyle and the diet. I do want to touch
00:38:54.818 --> 00:38:56.778
again on exercise, though.
00:38:57.238 --> 00:39:02.718
What kind of exercise do you talk to your patients about and what do you subscribe to yourself?
00:39:03.578 --> 00:39:10.018
Well, it kind of depends on the patient, the age, you know, their chronic problems,
00:39:10.238 --> 00:39:12.358
muscle skeletal, whatever.
00:39:12.358 --> 00:39:18.198
But, I mean, most people seem to be pointing towards like a high-intensity interval
00:39:18.198 --> 00:39:21.158
training kind of stuff, which is great.
00:39:21.478 --> 00:39:23.878
If you're, you know, if you can do burpees in your 20s,
00:39:23.918 --> 00:39:24.858
I think that's good.
00:39:25.018 --> 00:39:32.218
But I, in my 60s, I can't do a burpee. But I can do fast motion things with,
00:39:32.218 --> 00:39:35.038
you know, time intervals and stuff like that.
00:39:35.098 --> 00:39:39.738
And that's what I do, you know, on a stationary bike or a lift trainer or,
00:39:39.878 --> 00:39:41.738
you know, I have to work around my body.
00:39:41.738 --> 00:39:44.978
And what resistant training is great you
00:39:44.978 --> 00:39:47.878
know that's some type of form of you know weight training
00:39:47.878 --> 00:39:51.378
whether it's a band or actual you
00:39:51.378 --> 00:39:54.378
know weights themselves i have something i
00:39:54.378 --> 00:39:57.258
call my seven minute workout which is just kind of
00:39:57.258 --> 00:40:00.598
jumping jacks and planks and some lunges
00:40:00.598 --> 00:40:03.718
and all that and you just do it take seven minutes
00:40:03.718 --> 00:40:07.338
to do because it's a little station it's like 30 seconds with
00:40:07.338 --> 00:40:10.718
the rest interval that somewhere I
00:40:10.718 --> 00:40:13.738
get people to start somewhere if they can just walk us
00:40:13.738 --> 00:40:16.398
and walk it because we we need to
00:40:16.398 --> 00:40:21.378
be more active you know if you can stand more than sit if you can walk more
00:40:21.378 --> 00:40:26.038
than stand that's what we have to do every day you can do exercise snacks where
00:40:26.038 --> 00:40:30.138
you can just do butt touches on a chair up and down for 30 seconds to a minute
00:40:30.138 --> 00:40:35.478
I mean you can do that during the day a couple times a day you know with your work you know
00:40:36.439 --> 00:40:41.059
That is what you have to do. There's just so many things you can do to stay active.
00:40:41.519 --> 00:40:42.959
That's the first step.
00:40:43.319 --> 00:40:47.219
I think that's good because I think a lot of people, when they think high-intensity
00:40:47.219 --> 00:40:50.379
interval training, then immediately they go to CrossFit.
00:40:50.539 --> 00:40:52.919
Right. And I can't do that anymore.
00:40:53.339 --> 00:40:59.119
But, you know, modifying an exercise does not make you lazy or weak.
00:40:59.119 --> 00:41:01.179
You're doing it to your body.
00:41:01.339 --> 00:41:04.999
And then maybe you can level up or maybe you never do. Maybe you do,
00:41:05.019 --> 00:41:06.619
what do they call, knee push-ups.
00:41:06.759 --> 00:41:07.079
Yeah.
00:41:07.519 --> 00:41:11.639
Forever and ever. It's still a push-up. It's still working the muscles.
00:41:11.819 --> 00:41:12.579
You're supposed to work.
00:41:13.159 --> 00:41:18.079
I challenge all my patients to do push-ups now after reading the article about
00:41:18.079 --> 00:41:23.839
doing 40 push-ups can decrease your heart attack risk. So I don't know where the study came from.
00:41:24.039 --> 00:41:26.399
But it sounded good. It sounded like I didn't get to kill anybody.
00:41:26.779 --> 00:41:30.919
Yeah, I think that's great. But that's what I do. I do push-ups.
00:41:31.499 --> 00:41:34.219
Yeah? Yeah. And you're still standing, so that's good.
00:41:34.439 --> 00:41:39.959
I started, I can only do 20 now. I do like 55 this morning. Really? Yeah.
00:41:40.199 --> 00:41:45.059
Oh. And a two-minute plank and do my, call it my Bruce yoga.
00:41:45.739 --> 00:41:48.459
I don't know how to do yoga, so I do these word stretches.
00:41:49.279 --> 00:41:51.299
It sounds like my daughter. That's what she does.
00:41:51.539 --> 00:41:52.739
Yeah. Pulls out the yoga mat.
00:41:52.819 --> 00:41:56.479
I don't know what she's doing over there. Oh, yeah. She seems happy. That's good.
00:41:56.999 --> 00:42:00.599
Starting with yoga. It's Vivian yoga. Vivian yoga, Bruce yoga,
00:42:00.739 --> 00:42:02.579
whatever kind of yoga you want to do. That's right.
00:42:02.879 --> 00:42:08.639
And then all those stretches being limber, again, that is very helpful as well.
00:42:09.299 --> 00:42:13.319
So I'm kind of wrapping up talking about, well, you got our lifestyle,
00:42:13.399 --> 00:42:17.979
you got your diet, you know what lab tests to ask for that's not,
00:42:18.219 --> 00:42:20.359
your basic thing is a good place to start.
00:42:20.519 --> 00:42:23.679
If you're going every year, every six months and getting the basics,
00:42:23.939 --> 00:42:28.319
that's fine, but knowing that that's not the whole story.
00:42:28.599 --> 00:42:28.819
Right.
00:42:29.607 --> 00:42:34.267
I think it's been important for my patients when they need a new primary care
00:42:34.267 --> 00:42:39.887
physician when I'm telling them to go see somebody what to be asking for and
00:42:39.887 --> 00:42:42.087
how to know it's a good fit.
00:42:42.287 --> 00:42:47.747
Being dismissed for wanting comprehensive testing is a big red flag to me.
00:42:48.427 --> 00:42:51.847
So, you know, going to somebody like Dr. Clark and saying, you know,
00:42:52.027 --> 00:42:56.347
I've heard some, there's some more tests that we can do and how do we really
00:42:56.347 --> 00:43:01.427
know about my risk as opposed to, here's your labs, they look pretty good, see you next year.
00:43:02.047 --> 00:43:06.467
Telling the company line, you know, well, data statin,
00:43:07.067 --> 00:43:11.987
you know, I mean statins have their place, but you know, lifestyle has its place,
00:43:12.587 --> 00:43:18.587
you know, a lot as well, so it's a blend of to me functional,
00:43:19.167 --> 00:43:23.567
which is more lifestyle driven with science behind it
00:43:24.322 --> 00:43:28.082
And the conventional wisdom, that has science behind it as well, too.
00:43:28.742 --> 00:43:32.502
But everything is changeable, debatable. Mm-hmm.
00:43:33.222 --> 00:43:38.222
Yeah, I do think that, you know, say don't throw the baby out with the bathwater.
00:43:38.342 --> 00:43:40.762
There are some good things that have been very well researched,
00:43:40.762 --> 00:43:43.382
and there is a place for all this stuff.
00:43:43.642 --> 00:43:47.622
And some people will come see me and they go, well, I just want just the natural stuff.
00:43:47.922 --> 00:43:48.122
Right.
00:43:48.222 --> 00:43:50.662
Well, I do both. I'm in the middle.
00:43:50.962 --> 00:43:51.162
Yeah.
00:43:51.422 --> 00:43:55.122
There's a place for medications if we need them, if I'm really going to help your risk.
00:43:55.362 --> 00:43:59.002
I did put somebody on a low-dose statin the other day. Yeah.
00:43:59.222 --> 00:44:04.142
Because they had the risk. They had, you know, overage of all of their cholesterol
00:44:04.142 --> 00:44:06.602
markers, and they had diabetes.
00:44:06.642 --> 00:44:10.942
And I said, well, you know, it's not going to fix the whole thing,
00:44:11.082 --> 00:44:15.702
but maybe we'll lower that part of your risk the best we can.
00:44:15.902 --> 00:44:17.642
I mean, it's little by little.
00:44:18.042 --> 00:44:23.222
Oh, and things like baby aspirin, you know, I think that that's not a bad thing
00:44:23.222 --> 00:44:25.982
to do. Yeah, that's a good one. You still do that.
00:44:26.622 --> 00:44:28.422
Yeah, I think turmeric's good too.
00:44:28.642 --> 00:44:33.382
Oh, yeah. I love it. I did put somebody, I have curcumin behind me.
00:44:33.682 --> 00:44:35.642
Curcumin's the active ingredient in turmeric.
00:44:35.882 --> 00:44:36.062
Yeah.
00:44:36.382 --> 00:44:39.902
Yeah, starting people on that is wonderful. And then you don't have to worry
00:44:39.902 --> 00:44:42.822
about the GI bleeds. Yeah. That's nice.
00:44:44.362 --> 00:44:47.642
But if they'll just work their plan,
00:44:47.662 --> 00:44:51.342
we just have to help them understand what the plan means and how we're gonna
00:44:51.342 --> 00:44:57.922
has to be implemented the hardest part is the beginning that's where the most
00:44:57.922 --> 00:45:04.142
amount of pain is is starting always you know whatever it is so whether it's
00:45:04.142 --> 00:45:07.642
an exercise program or eating differently or whatever I mean it just
00:45:08.695 --> 00:45:10.095
A little bit of self-sacrifice,
00:45:10.195 --> 00:45:12.655
So painful initially, but it gets better.
00:45:12.935 --> 00:45:18.295
It does get better. Well, this has been great. I think this was a great start.
00:45:18.295 --> 00:45:20.235
I'm sure I'll have you back to talk about more.
00:45:20.355 --> 00:45:23.855
Oh, yeah, we got more stuff to talk about. We got more stuff to talk about always.
00:45:25.175 --> 00:45:29.675
But Beginner's Guide to Cardiovascular Health, we'll call this one. Yeah.
00:45:30.375 --> 00:45:34.795
But it's been good, and thank you for coming on and talking about all this.
00:45:34.795 --> 00:45:39.995
And y'all let us know what else you want to hear from Dr. Clark or other guests.
00:45:40.135 --> 00:45:43.795
You know, all my socials are at Elevated Health Texas. I'm easy to find.
00:45:44.175 --> 00:45:49.495
Again, I love hearing the stories and people that are finding me through the
00:45:49.495 --> 00:45:51.195
podcast and coming to see me.
00:45:51.415 --> 00:45:54.435
And that's always fun to hear your stories.
00:45:54.695 --> 00:45:58.335
So thank you for joining us and thank you for being here.
00:45:58.715 --> 00:45:59.715
Thank you very much, Lynn.
00:46:00.135 --> 00:46:01.755
All right. We'll see you all next week.
00:46:05.995 --> 00:46:10.895
The Elevated Health Podcast is for educational and informational purposes only.
00:46:11.115 --> 00:46:15.115
The information discussed on this podcast does not constitute medical advice
00:46:15.115 --> 00:46:20.235
and is not intended to diagnose, treat, cure, or prevent any medical condition.
00:46:20.435 --> 00:46:23.435
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00:46:23.675 --> 00:46:27.135
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00:46:31.795 --> 00:46:34.695
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