Episode #70 Featuring Dr. Philip Ovadia! STAY OFF THE OPERATING TABLE! A masterclass on heart health! Overcoming Myths on Cholesterol and

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Hey, everyone. Dylan Gemelli here today with an extremely exciting announcement.
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I am now on the Manect app as an expert.
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That is Patrick Bet-David's app, so you can hire me today.
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You can ask me questions about hormones, peptides, neuroscience, cardiology,
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cellular health, finances, faith, religion, whatever it may be.
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I am there.
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You can book me for your podcast, and you can
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also apply to be on mine. But go over... Download
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the Manect app. Find at Dylan Gemelli. I will answer
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either by audio, by text. You can get video responses.
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You can even book a phone call with me. I'm
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extremely excited to be available to work with all of you.
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And I thank you all for your support. So check
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me out on Manect today. Today's episode is sponsored by
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at the cellular level. As we age, our mitochondrial health
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starts to decline and one of the keys to living
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assure you, your cells will thank you. All right, everybody,
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welcome back to the Dylan Gemelli podcast. We are on set,
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which is how I like to do it. So it's
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a nice personal conversation. And my guest, Flew in to
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see me today, which I am very honored because he
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is extremely popular, extremely knowledgeable. And not only that, but
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he is a good friend to me. I'm going to
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explain to you why in a second. But first, let
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me give him the intro that I feel he deserves.
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So he's a board-certified cardiac surgeon. He's the founder of
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Ovadia Heart Health, and you'll see I Fix Hearts as
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part of that. And his mission, which I am 100% behind,
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is to optimize the public's metabolic health and to help
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people stay off his operating table, which goes hand in
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hand with his book. It is called Stay Off My
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Operating Table, and it's a heart surgeon's metabolic health guide
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to lose weight, prevent disease, and feel your best every day.
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He also has a podcast, Stay Off My Operating Table.
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I'm sure you can see where we're going here. And
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I just, I love his message. I love how he
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delivers it. I love what he stands for. I just
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love the guy in general. So without further ado, Dr.
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Philip Ovadia, welcome to the show, man.
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Thank you, Dylan. It is great to be out here
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with you. I agree with you. Doing these podcasts in
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person always leads to a great conversation. And I know
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sometimes the logistics make it difficult, but I was happy
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to come out here and join you.
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I appreciate it. I know you're busy and I know
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that you're requested everywhere and with good reason, which is
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why I wanted to have you here and I think,
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you know, pretty much by now, unless there's new listeners
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that are following me, they know how personal like art
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discussions and issues are to me. And before we get started,
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I just want to make it known the kind of
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guy that you are to everybody, aside from the obvious
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with your wealth of knowledge and the great work that
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you do. You know, I've had issues like I've discussed before,
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and Dr. Ovedi and I are both in this large
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like group of different types of influencers, doctors, people in
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the the health space, and I had never even talked
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to you. And there was a message in there that
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I had an incident and I was in the hospital
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and a few people reached out to me. And as
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busy as you are, you not only reached out to me,
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but you kept checking on me. You gave me tons
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of free information and didn't know me from the next.
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And that told me all I needed to know about you.
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And so I just want everybody to know. that a
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lot of people, you see us do these things, you
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see us talk, but you don't know what kind of
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people they are until you hear these kinds of stories.
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I want everybody to know just, you know, what kind
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of person you are and how much I appreciate you.
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And like I told you before off camera, I will
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not ever forget it.
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Well, thank you. I, uh, I definitely appreciate it. Uh,
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you know, always kind of humbling. Uh, and you know,
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I've always tried to remember, right. That, We do these things, right?
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And we get on platforms and, you know, we can
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reach millions of people, which is amazing. But it's always
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about the person that's in front of you, right? This
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is all about one-on-one relationships. And I just, you know,
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I'm on a big mission, but that's always... composed of
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lots of little missions.
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Yeah. Right.
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And, uh, I also believe in the ripple effect, right?
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I help you. You can talk to your audience. It
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starts to spread. And that's how we're ultimately going to
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change the course of that we're on, you know, take
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back control of health that I always talk about. And, um,
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it all, it's going to be more and more individuals
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that are waking up to these realizations about how broken
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our healthcare system is. And I'm sure we're going to
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get deep into that conversation. But again, this starts with
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us as individuals.
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Absolutely. And that's why I wanted you to come here
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because I know you have dedicated your life to this.
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I have spent the last several years now digging into
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this and I almost feel, I don't feel regretful, but
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so many years of discussing steroids and training bodybuilders and
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knowing the effects on the heart. And it took something
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to happen to me to really dig in like I should, because,
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you know, my knowledge base was limited. And understanding now
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all of these different aspects and how they work and
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then how broken the recommendations are and the things that
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we go through and the misconceptions on cholesterol and all
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the things we're going to get into and diet related stuff.
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That's why this is important. And you are one of
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the key experts out there on this subject matter. So
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it is you and I's mission now to convey this together.
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And I am happy to just to be a part
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of that. And so let's dig right into it. First,
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just kind of you have a nice journey to talk
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about and why you do what you do and what
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you've gone through. And I'd like to just get a
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little bit of backstory before we start nailing these details home. Yeah,
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definitely so.
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And, you know, the challenges that we all go through, right,
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that I think is our best education. And my background,
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you know, fairly typical to start with, right? I go
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to medical school. I decide to become a heart surgeon.
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I go through the training process for that. And I
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go to work, right? And what I do as a
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heart surgeon, right, is people come come to me and
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they have advanced heart disease, they've had heart attacks, and
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they need help. And, you know, surgery is one way
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to do that. But along the way, I was becoming
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more and more unhealthy. And I reached a point where
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I was morbidly obese. I was pre-diabetic. And I realized
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that I was going to end up on my own
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operating table, so to speak. I was following a journey
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that so many of my patients had followed. And like them,
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I didn't know what to do about it. I realized
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that the advice that I had been taught to give,
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the advice that I would give to my patients, right?
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Eat less, move more, eat a low-fat diet, you know,
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lower your cholesterol, right? It wasn't working for me. It
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wasn't working for them. And that led me to start
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asking some different questions. Thankfully, I started to get exposed
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to some different information, you know, than other the sort
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of bubble that you get into in medicine and in cardiology.
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And ultimately, I was first able to overcome my health challenges.
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I was able to lose 100 pounds, reverse my prediabetes.
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And then as I started talking to friends, family, patient
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about it, saw their success, and then I started asking why, right?
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Why didn't I know this before? why didn't I learn
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this in school? Why didn't my, you know, why didn't
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I learn this from my colleagues? And that's when I really,
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you know, came to the realization, right, that this is
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the best way that I could be helping patients. And
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this is the mission I needed to go on. And
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so that's what I've been doing, you know, and we'll
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talk about all the Different.
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Ways maybe that I've been doing that.
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But ultimately, I realized that no matter how good a
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surgeon I might be, no matter how good all the
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heart surgeons out there are, you're never as good after
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you had the heart surgery as you would have been
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if you didn't need the surgery in the first place.
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Well said. You know what I find to be important
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is these conversations is not.
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Calling. When we're calling out bad information, it's not getting angry.
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It's not dwelling on it. It's not any of that.
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Far too many people waste too much time doing that
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as opposed to going, this is where we're wrong. This
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is how we fix it. Just get over it. Right.
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And that's one of the things about learning from mistakes.
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you don't dwell on it. You're thankful for it because
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then you learn from it and you can overcome it. So,
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and I've, I've never heard you go on this bash
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fest or anything. I can't do that with people. I
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just can't do it. I want the time that we
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have to focus on. This is what's wrong. This is
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how we fix it. Right. And so I appreciate that,
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that you go about it that way and appreciate your
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journey and sharing that, you know, I want to get
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into the low fat diet first. I've made it no
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secret that I did that for, 20 some odd years.
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And I feel like that's probably part of the reason
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why I have the heart problems that I do. Complete
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lack of understanding and not really eating any fat. And
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once I switched, my whole life has changed. It's been
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about a little over a year or something like that
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where I did that. And I went from like 20
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grams of fat a day to 130 some. I'm like,
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you know, 40, 40, 40, 20 protein, fats, carbs. And
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for me, it's working. But Let me ask you this.
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Why has fat been demonized for so long in your view?
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And just how important is it to us to have
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as a major part of our diet? Yeah.
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So fats are essential, right? And especially animal fats, which
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have been the most demonized, but are actually the most
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important component of our diet. It's literally the food that
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allowed us to evolve into human beings. Our ability to eat, absorb,
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and utilize fat is what made us different, what allowed
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us to evolve As humans and become what we are
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as a species. You know, why did it get demonized?
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You know, and that's a story that many people will
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have heard, right? You go back to the 1950s, heart
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disease is exploding in this country, right? And rightfully, people
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were panicked. And, you know, the scientists of the time,
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the physicians of the time were trying to figure out why,
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what's causing this. And there were two competing theories, right?
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school of thought was it was sugar primarily that was
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causing it. And the other school of thought was it
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was fat that was causing it.
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And, you know, the.
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Fat theory won out and, you know, maybe there are
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reasons that people can look back and say, you know,
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they were kind of nefarious, right. And it wasn't completely
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scientific based, but again, I don't worry too much about that.
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And I can understand, you know, there was a crisis.
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We had to kind of make a guess and act
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upon it.
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Right.
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And so, you know, the prevailing theory became that the
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dietary fat, especially saturated fat that we were eating, is
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what was driving heart disease. And therefore, to correct this, right,
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we first had to remove dietary fat and we had
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to lower our blood cholesterol levels.
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Right. Right.
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And this really came to a head then in the
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late 1970s, early 1980s. The U.S. dietary guidelines in their
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first version get released promoting, you know, less saturated fat, especially.
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In the diet.
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And then the pharmaceuticals come along to help lower blood
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cholesterol levels.
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Right. And again, OK, let's give it a try. Right.
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It seemed to make sense as a hypothesis.
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But.
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The evidence was always there. And then it continued to
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accumulate that this wasn't working. Heart disease remained the number
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one killer. We started to see a little bit of
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improvement in heart disease starting in the mid 1980s, continuing
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through the 1990s.
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Right.
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And the mistake that was made there is it was
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assumed that that was because of low fat diet and
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lowering cholesterol. In reality, it was because people stopped smoking.
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And that was a major contributor to heart disease as well.
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But then you look and, you know, after it kind
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of plateaus in the mid 1990s, heart disease starts going
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up again. And the reaction was, OK, now we have
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to double down on all of this stuff.
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Right.
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And we have to get cholesterol levels even lower and
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we have to get more fat out of the diet.
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Right.
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And you and I are about the same age. Right.
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We remember the you know, all the low fat, the
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snack wells, the, you know, everything that came in.
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I used to eat.
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Yeah, I know. And, you know, we all ditched our
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butter and had our margarine and, but our health has
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just continued to worsen. So what I can't excuse is
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here we are 70 years later, this low fat experiment
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has clearly failed and we can't change our ways. You know,
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the mainstream approach to this is just, Well, we're just
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not doing it hard enough. People aren't listening to the advice,
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but they are. Our consumption of animal products has dropped
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dramatically in this country. Our consumption of fat overall, and
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especially saturated fat, is down 40%, at least. Some stats
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show even more than that. And yet heart disease is
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getting worse and worse. So it's time for us to
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step back, re-examine the classic saying by Einstein, right, that
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the definition of insanity is doing the same thing over
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again and expecting a different result.
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Right. And that's essentially what we're doing. So frustrating. You know,
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it's wild, too, because like you said, we keep seeing evidence,
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we keep seeing evidence, but they keep pounding it into
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our heads that it's something different than it actually is.
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I mean, I've been doing a lot of studies on
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like cells and cellular biology and seeing the importance of
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fats for the cell membrane. And that, I mean, that's
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how we live. I don't, and that's part of the
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problem is people don't understand or study cells and how
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they actually function and work and what they need, you know,
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nutrient wise to, to, to be efficient. And I think
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if they did that, they'd understand the importance and that's
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not just that. I mean, as you know, but my
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whole world's opened up since I made those changes. I mean,
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that low fat And like the yogurt, for example, when
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I stopped eating low fat yogurt, when I realized they
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strip everything out of it. So not only does it
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taste like shit and you have to be miserable that way,
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but you're losing every nutrient too. And the same thing
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with all the egg whites over and over again. And
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I was doing a not eating yolks.
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Yeah.
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You know how angry I was telling my wife, you
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know how just flat out angry I am that I
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haven't been cooking in grass fed butter for so long.
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I mean, aside from not sticking to pans, the flavor.
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It's amazing.
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You can look at it at so many levels, right?
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You can get down to that biochemical cellular level and
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you can see the importance of these things and just
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at the, you know, macro level.
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Right.
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And, and, you know, I see it every day now,
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how much better patients feel when they eat this way.
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Yeah.
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Right. And, and the concept that, you know, patients can
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feel better and most, right. the way the standard medical
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00:17:41.559 --> 00:17:44.140
system looks at it, right, is most of their numbers
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get better, right? But because one number might get what
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perceived as worse, this medical system has decided, right, that
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this is a dangerous approach. And it's really just nonsensical, right?
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Like you said, I don't like to spend my time
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arguing with people about, you know, these bad ideas that
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they have. Uh, but you just, you know, it never
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ceases to amaze me because it literally is almost a
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daily occurrence when I'm dealing with patients and they'll go
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to their regular doctor.
327
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Right.
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And they'll lost weight and their blood pressure is better
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and they're off medications. And, you know, their triglycerides are
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lower and their HDL is higher. And the doctor then
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looks at their cholesterol level or doesn't even look at
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the cholesterol level, just says, wait, you mean you're eating
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all this red meat, all the saturated fat?
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Right. That's going to kill you. You have to stop. Right. Right.
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It's just crazy. Well, they're brainwashed with that in school now.
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I mean, that's what they're told. Yeah. So you can't
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even really fault them. I mean, to an extent. Right.
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Because that's just. I learned that from talking to so
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many people that I'm thankful that I'm able to know, like,
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you know, and they tell me that's just kind of
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what we're taught. And that's the way it is. When
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I was in the hospital and I, I don't think
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I sent this to you. They gave me this Bart
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healthy menu. Yeah. It had, it literally said dinner rolls, margarine.
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Me and my wife were dying. She said, does that
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say chicken Parmesan and tortellini? I said, what? This is
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heart healthy?
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Yeah.
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I mean, you should have seen what was on there.
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All these cereals, like sugary cereal. Oh, yeah. So you
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tell me this then, if we're looking at macros and
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foods and stuff, what are the real dangers to causing
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heart disease in our diets? What are the things that
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we really need to be watching out for? And I'm
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assuming there are bad saturated fats and bad fats, like
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there's bad proteins and bad carbs. Just what is the
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main problem areas that people should avoid? Yeah.
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00:19:50.180 --> 00:19:52.519
You know, before we really talk about the foods, I
359
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think it's important to get down.
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To that sort of cellular level. Right.
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And when we look at what are the true drivers
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of heart disease. Consistently what you see when you really
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look at the studies is it is insulin resistance and
364
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it is inflammation, right? So that leads us to say, okay, well,
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what do we eat that causes insulin resistance and inflammation? And,
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you know, you look at carbohydrates, especially the highly processed,
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highly refined carbohydrates. You look at things like vegetable and
368
00:20:26.279 --> 00:20:31.460
seed oils, right? That drive the inflammation. And that really
369
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shows you what you should and shouldn't eat. You know,
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the bottom line for me, the way that I came
371
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about this, right, and the way that I talk about
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it in the book is any diet that's going to
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lower insulin resistance and lower inflammation and make you more
374
00:20:47.769 --> 00:20:53.839
metabolically healthy, right? That's the diet that you should be eating. Now,
375
00:20:54.640 --> 00:20:57.519
that can have some different varieties, right? But I think
376
00:20:57.579 --> 00:21:01.940
some important concepts to understand are animal proteins and animal
377
00:21:01.980 --> 00:21:05.160
fat are essential to our health. You know, again, the
378
00:21:05.220 --> 00:21:08.279
concept that these might be harmful to our health is
379
00:21:08.339 --> 00:21:15.039
just crazy, right? Bad science combined with maybe some politics,
380
00:21:15.140 --> 00:21:19.869
maybe some religion that gets in there, but Again, animal proteins,
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00:21:19.950 --> 00:21:22.210
animal fats, they are essential to health. They are the
382
00:21:22.269 --> 00:21:25.369
foods that we evolved on as human beings. You want
383
00:21:25.410 --> 00:21:28.890
to throw in some, you know, non-processed carbohydrates. You want
384
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to throw in some vegetables.
385
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Fine.
386
00:21:31.970 --> 00:21:34.990
It's not essential. You can live on just the animal
387
00:21:35.029 --> 00:21:38.029
fats and the animal proteins alone, right? And many people
388
00:21:38.089 --> 00:21:40.970
do carnivore diets and they do great with it. It's
389
00:21:41.049 --> 00:21:44.650
actually what I personally enjoy. do because it works well
390
00:21:44.710 --> 00:21:48.089
for me. Uh, but I don't think it's the only.
391
00:21:47.869 --> 00:21:49.289
Approach that can work.
392
00:21:49.829 --> 00:21:51.990
Uh, but you know, the, the real kind of first
393
00:21:52.049 --> 00:21:55.269
principles that I stick to are avoid the foods that
394
00:21:55.289 --> 00:21:58.529
are causing insulin resistance and inflammation. And those are going
395
00:21:58.549 --> 00:22:02.490
to be the processed foods to refine carbohydrates, get your
396
00:22:02.529 --> 00:22:07.569
essential animal proteins and animal fats, and then fill in
397
00:22:07.609 --> 00:22:10.730
the rest with some non-harmful stuff if you want it.
398
00:22:11.079 --> 00:22:13.920
So if you could make a list of your top
399
00:22:14.000 --> 00:22:16.420
five essential foods or the few that you think that
400
00:22:16.480 --> 00:22:19.740
everybody should be incorporating, I'll give you mine. I'm curious
401
00:22:19.759 --> 00:22:21.619
how they stack up with yours. Cause I think it'll
402
00:22:21.640 --> 00:22:24.180
be cool to see because you know, what's crazy is
403
00:22:24.359 --> 00:22:26.940
like some of these are stuff that I haven't touched
404
00:22:26.980 --> 00:22:30.990
my whole life until just recently. Avocados would be one eggs,
405
00:22:31.210 --> 00:22:35.250
whole eggs, especially would be probably number two. I would
406
00:22:35.349 --> 00:22:42.990
say probably either grass fed beef or. like grass fed pork,
407
00:22:43.069 --> 00:22:46.910
something like that. And I would probably say salmon. And then,
408
00:22:46.930 --> 00:22:50.329
I mean, honestly, I would say like the grass fed
409
00:22:50.430 --> 00:22:53.250
butter or something along that line, or maybe like an
410
00:22:53.349 --> 00:22:55.670
olive oil, an extra virgin olive oil or something like that.
411
00:22:55.690 --> 00:22:58.470
Cause I would just categorize that into my, my food.
412
00:22:58.549 --> 00:23:01.269
So that's kind of where I feel like those are
413
00:23:01.309 --> 00:23:03.299
stuff that I don't ever want to be without and
414
00:23:03.319 --> 00:23:06.460
that are essential to my fat burning, my health and
415
00:23:06.599 --> 00:23:08.920
everything that I've changed. And the funny thing is, Never
416
00:23:08.960 --> 00:23:11.640
would I touch salmon. Never would I go near avocados.
417
00:23:11.660 --> 00:23:14.380
I mean, I always loved eggs, but a lot of
418
00:23:14.420 --> 00:23:17.650
this stuff I just started doing and I'm seeing drastic differences.
419
00:23:17.710 --> 00:23:20.170
And I think what's the correlation? Well, most of them
420
00:23:20.230 --> 00:23:23.329
are like healthy fat. Yeah, that's exactly it. Right.
421
00:23:23.430 --> 00:23:26.950
And, you know, the only, you know, I would probably
422
00:23:27.009 --> 00:23:30.980
include those same five foods. I might put them in
423
00:23:31.019 --> 00:23:33.259
a little different order for me. You know, again, I
424
00:23:33.299 --> 00:23:35.980
do a primarily carnivore diet, so it's going to be,
425
00:23:36.380 --> 00:23:40.539
you know, meat of all kinds, but primarily beef, uh,
426
00:23:40.599 --> 00:23:45.049
certainly seafood and salmon and tuna are my go-tos as well.
427
00:23:45.490 --> 00:23:48.970
I love eggs. I eat plenty of eggs. I include dairy,
428
00:23:49.289 --> 00:23:53.089
you know, butter and cheeses and maybe, you know, yogurt.
429
00:23:53.269 --> 00:23:53.490
Yeah.
430
00:23:53.670 --> 00:23:56.990
And, um, yeah, of the non-animal stuff that I eat,
431
00:23:57.210 --> 00:24:00.279
avocados are probably at the top of the list for
432
00:24:00.319 --> 00:24:03.779
me as well. Uh, you know, but, uh, you look
433
00:24:03.880 --> 00:24:08.130
at it again and it's, Literally the exact opposite of
434
00:24:08.190 --> 00:24:11.920
what I was taught in school, what, you know, I
435
00:24:12.480 --> 00:24:16.359
believed and what everyone around me believed, you know, for
436
00:24:16.380 --> 00:24:19.380
the majority of my career until I made this change.
437
00:24:19.660 --> 00:24:23.869
But it's just undeniable. Again, you know, I've now seen
438
00:24:23.890 --> 00:24:28.089
the results in so many people, right, in my patients,
439
00:24:28.250 --> 00:24:31.509
in the, you know, community that you can't, you know,
440
00:24:31.829 --> 00:24:34.700
you can't deny that. the evidence that's right in front
441
00:24:34.759 --> 00:24:38.099
of you, right? And they can talk about their studies and,
442
00:24:38.259 --> 00:24:42.440
you know, and we can discuss why those studies might,
443
00:24:42.920 --> 00:24:46.170
you know, have led us astray, why they're lousy science.
444
00:24:46.509 --> 00:24:50.769
But ultimately, again, coming back to how we started this discussion,
445
00:24:50.910 --> 00:24:54.809
you know, dealing with individuals and seeing the results that
446
00:24:54.849 --> 00:24:59.450
individuals are getting, that's the evidence that really becomes overwhelming.
447
00:25:00.220 --> 00:25:05.180
Right. So everybody... Remember, inflammation, and I knew you were
448
00:25:05.200 --> 00:25:07.180
going to go there because it is like just the
449
00:25:07.279 --> 00:25:09.160
end all be all of all the problems we have.
450
00:25:09.259 --> 00:25:13.279
I mean, it really is inflammation and insulin resistance. So
451
00:25:13.519 --> 00:25:16.180
I want to talk to you about blood panels. And
452
00:25:17.009 --> 00:25:19.589
one of the issues that I have that I actually
453
00:25:19.630 --> 00:25:22.450
had to figure out on my own was... you know,
454
00:25:22.509 --> 00:25:24.809
learning the actual panels that we need to be looking
455
00:25:24.869 --> 00:25:26.349
at that are really going to tell us what we
456
00:25:26.390 --> 00:25:28.230
need to know that we need to have the focus on.
457
00:25:28.289 --> 00:25:31.470
I mean, I'm not saying LDL, HDL triglycerides are not
458
00:25:31.509 --> 00:25:33.910
important because we need to know that. But for me,
459
00:25:34.190 --> 00:25:36.230
and then you tell me as the professional, this is
460
00:25:36.279 --> 00:25:39.400
what I've gathered and learned over the time is one,
461
00:25:39.460 --> 00:25:42.759
you need to get that intricate, you know, panel, that
462
00:25:42.960 --> 00:25:47.039
full cholesterol panel where you're looking at APOB, LP little
463
00:25:47.099 --> 00:25:50.160
a particle sizes, things like that. I find to get
464
00:25:50.180 --> 00:25:52.910
the personally consistent That's where I've learned the most data.
465
00:25:54.250 --> 00:25:57.250
For you, what are the things of importance that you
466
00:25:57.289 --> 00:25:59.430
look at and what are we missing when we just
467
00:25:59.470 --> 00:26:02.930
go to general doctors and GPs and things like that
468
00:26:02.950 --> 00:26:05.319
that they're not looking at that they should be? Yeah.
469
00:26:05.400 --> 00:26:09.480
So, you know, the advanced lipid panel is, I say,
470
00:26:09.599 --> 00:26:14.279
essential because it's showing you the quality of your cholesterol.
471
00:26:15.019 --> 00:26:18.309
And that's what is important when it comes to, you know,
472
00:26:18.589 --> 00:26:22.109
LDL cholesterol. It's not about how much LDL you have.
473
00:26:22.130 --> 00:26:25.630
It's what is the quality of that LDL. Because if
474
00:26:25.710 --> 00:26:29.529
it's good quality LDL, which it should be if you're healthy,
475
00:26:29.829 --> 00:26:33.859
and again, this means having the larger particles, right? And
476
00:26:33.980 --> 00:26:38.000
these particles are not harmful. And again, this is something
477
00:26:38.039 --> 00:26:42.630
that unfortunately the vast majority of doctors don't know. They
478
00:26:42.670 --> 00:26:45.710
don't get discussed, right? They've been told just look at
479
00:26:45.759 --> 00:26:48.119
the LDL and if it's high, you have a problem.
480
00:26:48.599 --> 00:26:51.440
But the reality is, is that if you have a
481
00:26:51.579 --> 00:26:57.619
lot of large LDL particles, those are not atherogenic. They
482
00:26:57.660 --> 00:27:00.700
are not plaque forming. And in fact, they play so
483
00:27:00.759 --> 00:27:03.319
many vital roles in our bodies, right? They're part of
484
00:27:03.420 --> 00:27:08.640
our immune system. They get converted into hormones like testosterone
485
00:27:08.700 --> 00:27:12.759
and estrogen and progesterone. They get converted into vitamin D,
486
00:27:12.849 --> 00:27:18.529
which is essential to us, right? So we need good cholesterol.
487
00:27:19.130 --> 00:27:22.779
The problem is most doctors don't understand what good cholesterol
488
00:27:22.859 --> 00:27:26.599
actually is. Now, you know, I then kind of step
489
00:27:26.660 --> 00:27:30.259
back a level and say, well, what causes larger particles
490
00:27:30.640 --> 00:27:34.500
and what causes the smaller particles that we are trying
491
00:27:34.539 --> 00:27:37.839
to avoid? And it goes back to what we mentioned earlier,
492
00:27:38.000 --> 00:27:42.069
insulin resistance and inflammation. So if I'm assessing a patient,
493
00:27:42.109 --> 00:27:43.930
if I'm getting a blood panel, I want to know
494
00:27:43.990 --> 00:27:48.799
about insulin resistance and inflammation. Measure your insulin level, measure
495
00:27:49.319 --> 00:27:53.759
your glucose. And, you know, hemoglobin A1C is a better
496
00:27:54.299 --> 00:27:56.920
number of that, you know, better measure of that because
497
00:27:56.960 --> 00:28:00.779
it gives you a average, right, over about a three-month
498
00:28:00.839 --> 00:28:03.680
period as opposed to just a spot glucose, which can
499
00:28:03.720 --> 00:28:08.480
be affected by lots of different things. And then inflammation, right?
500
00:28:08.519 --> 00:28:13.910
And my High level measure here is what's called C-reactive protein, CRP.
501
00:28:14.910 --> 00:28:18.369
And that's a good general measure to look at. And,
502
00:28:18.609 --> 00:28:21.769
you know, if you just stop there, you're going to
503
00:28:21.789 --> 00:28:25.180
get a pretty good picture of where you stand on
504
00:28:25.220 --> 00:28:29.400
your metabolic health and specifically for your heart health. There
505
00:28:29.460 --> 00:28:32.059
are some other things that, you know, I do go
506
00:28:32.160 --> 00:28:35.579
deeper with my patients on. But when I'm talking to
507
00:28:35.619 --> 00:28:39.250
people about how to just start You can do that
508
00:28:39.329 --> 00:28:43.089
panel many ways to get that done inexpensively.
509
00:28:43.109 --> 00:28:46.069
Uh, you know, you can go on many websites.
510
00:28:46.230 --> 00:28:48.309
One that I like in particular that I don't have
511
00:28:48.390 --> 00:28:52.630
any affiliation with is called own your labs.com. And you
512
00:28:52.670 --> 00:28:55.019
put that all those things together, it's going to cost
513
00:28:55.059 --> 00:28:58.440
you a hundred dollars. Somewhere in that range. You know,
514
00:28:58.660 --> 00:29:00.779
it's a good investment in your health. If you can
515
00:29:00.819 --> 00:29:03.000
get your doctor to do it and get your insurance
516
00:29:03.039 --> 00:29:05.779
to cover it, I guess that's even better. Uh, but
517
00:29:06.019 --> 00:29:09.029
sometimes you're fighting an uphill battle there. That's just not
518
00:29:09.069 --> 00:29:09.500
worth it.
519
00:29:09.650 --> 00:29:12.869
Right. I have mine on auto every three months. Yeah.
520
00:29:13.049 --> 00:29:15.630
I mean, I have to, but I just do it anyway.
521
00:29:15.670 --> 00:29:18.890
And it's, it gives me a nice idea of where
522
00:29:18.910 --> 00:29:21.309
I'm at. And like you said, since I made that
523
00:29:21.369 --> 00:29:24.349
change to the higher fat diet, I, I, I just
524
00:29:24.430 --> 00:29:26.710
had a panel done and I haven't had this good
525
00:29:26.730 --> 00:29:28.710
of a liver and kidney value. And I have a
526
00:29:28.750 --> 00:29:30.339
higher kidney because of the way I work out and
527
00:29:30.390 --> 00:29:33.250
train your, you know, you know that, but. All of
528
00:29:33.309 --> 00:29:36.960
those other levels, including like triglycerides and all that, the
529
00:29:37.140 --> 00:29:40.740
only thing that went up was LDL and ApoB. and
530
00:29:40.819 --> 00:29:43.759
total my total is like 205 or something like that
531
00:29:43.859 --> 00:29:47.700
and that's scary to the doctor you know and it's
532
00:29:47.759 --> 00:29:50.480
crazy to me and I want to get into that
533
00:29:50.519 --> 00:29:52.640
in a second but I just want to touch real
534
00:29:52.700 --> 00:29:56.309
quickly back on the particle sizes if you would so
535
00:29:57.660 --> 00:30:00.630
What kind of foods would you is it the same
536
00:30:00.670 --> 00:30:02.369
kind of foods you're talking about that will increase the
537
00:30:02.410 --> 00:30:04.630
size of the particles and then that will make the
538
00:30:04.690 --> 00:30:09.059
smaller ones is the processed foods and the ones that
539
00:30:09.119 --> 00:30:15.339
are causing inflammation and everything. So why are the small
540
00:30:15.400 --> 00:30:16.960
particles so dangerous?
541
00:30:17.660 --> 00:30:21.940
Yeah, so the small particles are really a damaged form
542
00:30:22.000 --> 00:30:24.640
of LDL. Those are the ones that tend to be
543
00:30:24.859 --> 00:30:29.009
oxidized or most easily oxidized, and those are ones that
544
00:30:29.730 --> 00:30:32.890
they get stuck in the blood vessel wall, and they
545
00:30:32.990 --> 00:30:37.029
set off an inflammatory reaction within the blood vessel wall,
546
00:30:37.470 --> 00:30:40.730
and that's what leads to the plaque formation. The large
547
00:30:40.890 --> 00:30:44.420
LDL particles, the large fluffy particles you'll hear them call,
548
00:30:44.440 --> 00:30:49.390
they don't cause that problem. Yeah. So, you know, again,
549
00:30:49.450 --> 00:30:52.009
this is to take a step back, right? How was
550
00:30:52.069 --> 00:30:56.910
the system designed, right? The system was designed that, you know,
551
00:30:57.130 --> 00:31:00.250
blood vessel walls are going to get damaged, right? There
552
00:31:00.289 --> 00:31:03.079
are lots of things that cause damage to them. And,
553
00:31:03.200 --> 00:31:05.339
you know, some of them we can avoid and some
554
00:31:05.400 --> 00:31:09.119
of them, you know, are unavoidable, right? LDL cholesterol is
555
00:31:09.180 --> 00:31:14.000
a repair mechanism, right? It comes, it gets attracted to
556
00:31:14.039 --> 00:31:16.900
the blood vessel wall and when the blood vessel wall
557
00:31:16.960 --> 00:31:23.720
is damaged. If you have good functioning, normal functioning LDL cholesterol,
558
00:31:24.259 --> 00:31:26.500
it's going to go and it's going to repair that
559
00:31:26.559 --> 00:31:29.640
blood vessel wall. And then it's basically going to kind
560
00:31:29.680 --> 00:31:32.480
of melt away, right? It's going to get reabsorbed is
561
00:31:32.680 --> 00:31:35.759
kind of the technical term for it. And, you know,
562
00:31:35.819 --> 00:31:38.539
you're going to be left, there's going to be nothing
563
00:31:38.599 --> 00:31:42.359
damaging left behind. But the problem is if your LDL
564
00:31:42.420 --> 00:31:46.339
is these small particles, these oxidized particles, It goes there
565
00:31:46.400 --> 00:31:50.039
to repair the damage. It goes into the blood vessel wall.
566
00:31:50.460 --> 00:31:55.269
And because it's oxidized, because it's damaged, the body then
567
00:31:55.329 --> 00:31:59.450
reacts to it as a problem. And it sets off
568
00:31:59.490 --> 00:32:03.329
this inflammatory reaction within the blood vessel wall. And that
569
00:32:03.490 --> 00:32:06.750
is then what causes plaque to start forming. And you
570
00:32:06.769 --> 00:32:09.529
do this over and over again, right? Because let's say
571
00:32:09.589 --> 00:32:13.579
your blood sugar level is always high. Let's say you're diabetic.
572
00:32:13.990 --> 00:32:14.269
Right.
573
00:32:14.450 --> 00:32:17.470
And you just keep repeating this process over and over again.
574
00:32:17.529 --> 00:32:20.079
And now you have all this plaque buildup in your arteries.
575
00:32:20.619 --> 00:32:23.920
And that's what ultimately is going to lead to atherosclerotic
576
00:32:23.960 --> 00:32:25.660
heart disease and having a heart attack.
577
00:32:25.900 --> 00:32:29.380
Right. So then let's get into that a little bit. Now,
578
00:32:29.920 --> 00:32:34.450
I have learned through getting a calcium score first and
579
00:32:34.470 --> 00:32:36.829
then going through the process of the CT NGOs and
580
00:32:36.890 --> 00:32:40.190
every test known to man, because when I went for
581
00:32:40.210 --> 00:32:44.230
the calcium score I got 120 score back and I
582
00:32:44.269 --> 00:32:47.970
was like what what I mean I was shocked to
583
00:32:48.069 --> 00:32:51.750
shit on all end and you know then going a
584
00:32:51.789 --> 00:32:55.269
little bit deeper I find that I have a really
585
00:32:55.309 --> 00:32:59.069
high LP little a like 330 yeah so I then
586
00:32:59.150 --> 00:33:01.220
I begin to dig in to understand what that is
587
00:33:01.500 --> 00:33:04.299
and what that means and I'll let you talk about
588
00:33:04.359 --> 00:33:07.819
that from my studies from obviously I've spent a lot
589
00:33:07.859 --> 00:33:09.319
of time and talk to a lot of people it's
590
00:33:10.009 --> 00:33:12.789
one of those things that's inherited, like an inherited gene
591
00:33:13.170 --> 00:33:16.490
and it's not really controllable through diet and working out.
592
00:33:16.849 --> 00:33:19.730
I still would never advise to, I would still say,
593
00:33:20.130 --> 00:33:21.869
you know, keep those things in check for the other
594
00:33:21.910 --> 00:33:25.599
aspects of heart. But so I got that going for me,
595
00:33:25.720 --> 00:33:29.220
which is obviously sweet, you know, and then I'm, I'm
596
00:33:29.259 --> 00:33:32.190
looking at the CT angio comes back and it's, like
597
00:33:32.230 --> 00:33:35.869
a 38% blockage in the worst spot where everybody always
598
00:33:35.910 --> 00:33:39.069
has it, it seems, but thankfully caught early enough to where,
599
00:33:39.289 --> 00:33:41.170
you know, I mean, it's not end of the world.
600
00:33:41.210 --> 00:33:45.279
It's not, obviously it's not ideal, but I got that
601
00:33:46.099 --> 00:33:48.700
and looking at that and then I start to understand
602
00:33:48.720 --> 00:33:52.700
and learn, okay, hard plaque versus soft plaque, statins make
603
00:33:52.720 --> 00:33:55.839
your LP little A go up. They're, you know, I mean,
604
00:33:56.000 --> 00:33:58.460
all of this backwards things that I was being told
605
00:33:58.579 --> 00:34:01.400
and mind you, we went to Mayo Clinic which is
606
00:34:01.420 --> 00:34:04.150
supposed to be end all be all. And I'm on
607
00:34:04.190 --> 00:34:06.470
the way home and I never argue with my mom
608
00:34:06.490 --> 00:34:08.030
and my wife ever. This was one of the few
609
00:34:08.070 --> 00:34:10.309
times that we got into the argument. Well, you need
610
00:34:10.329 --> 00:34:12.230
to listen to them about, you know, cause I went
611
00:34:12.269 --> 00:34:14.489
in there and I said, you know, statins are not
612
00:34:14.510 --> 00:34:17.590
going to help me. And they, first they told me
613
00:34:17.610 --> 00:34:20.150
there was not enough information about LP little a, they
614
00:34:20.190 --> 00:34:22.349
even get into it. It would be bad practice to
615
00:34:22.389 --> 00:34:24.769
put me on a PCSK nine inhibitor or anything else.
616
00:34:24.849 --> 00:34:27.329
It's statin only. And so I got into a big
617
00:34:27.389 --> 00:34:30.110
argument with them. I said, I'm not taking the. Yeah. And,
618
00:34:30.250 --> 00:34:33.179
and I know, And anyway, now they'll tell you they
619
00:34:33.199 --> 00:34:35.449
were wrong. But I guess I want to go into
620
00:34:35.610 --> 00:34:38.610
all of this with you. What's the difference between soft
621
00:34:38.650 --> 00:34:40.429
and hard plaque? What do we need to be looking for?
622
00:34:40.849 --> 00:34:43.750
Why is a statin going to make the LP little
623
00:34:43.809 --> 00:34:46.510
a worse? And what even is LP little a? Yeah.
624
00:34:46.550 --> 00:34:49.760
So let's start with what is LP little a. So
625
00:34:49.920 --> 00:34:55.179
LP little a is LDL. These are LDL particles, but
626
00:34:55.219 --> 00:34:58.260
they have this extra protein on them. That's what the
627
00:34:58.949 --> 00:35:02.820
LP little a, lipoprotein A is. It's this extra protein
628
00:35:02.840 --> 00:35:07.139
that's attached to the LDL. And the reason that LP
629
00:35:07.199 --> 00:35:10.820
little a is problematic and the reason that LPA increases
630
00:35:10.860 --> 00:35:14.139
your risk of heart disease really has nothing to do
631
00:35:14.199 --> 00:35:18.159
with the cholesterol that's in that LDL particle. It's that
632
00:35:18.429 --> 00:35:22.889
LP little a protein causes that particle to interact with
633
00:35:22.909 --> 00:35:27.329
the blood clotting system. And so the risk from LP
634
00:35:27.369 --> 00:35:30.769
little a, again, has nothing to do with cholesterol. It
635
00:35:30.809 --> 00:35:34.320
has to do with blood clotting. And this, again, is
636
00:35:34.360 --> 00:35:39.019
something that just doctors don't understand. And so, you know,
637
00:35:39.460 --> 00:35:41.519
you look at that and you say, OK, well, then
638
00:35:41.840 --> 00:35:43.980
if I have high LP little a, it makes sense
639
00:35:44.019 --> 00:35:47.440
to do something to prevent blood clotting. And that's what
640
00:35:47.500 --> 00:35:50.039
I recommend to my patients. If you have elevated LP
641
00:35:50.059 --> 00:35:54.260
little a, Take a baby aspirin, take a supplement, natokinase.
642
00:35:54.280 --> 00:35:57.000
I was just going to say that. Take some natokinase,
643
00:35:57.460 --> 00:36:00.800
and that's going to help protect against the effects of
644
00:36:00.860 --> 00:36:01.869
the LP little a.
645
00:36:02.159 --> 00:36:02.619
Okay.
646
00:36:02.739 --> 00:36:06.010
Does it lower the LP little a? No, but it's
647
00:36:06.030 --> 00:36:08.860
going to help protect against the damaging effects from it.
648
00:36:09.710 --> 00:36:12.829
The other important thing that people need to know about
649
00:36:12.929 --> 00:36:17.570
LP little a is it is particularly problematic in the
650
00:36:17.630 --> 00:36:21.159
setting of inflammation. So the studies have shown that patients
651
00:36:21.179 --> 00:36:24.460
that have elevated LP little a combined with an elevated
652
00:36:24.519 --> 00:36:27.750
CRP level, those are the ones that have a lot,
653
00:36:28.110 --> 00:36:31.929
you know, high risk of heart disease. And so do
654
00:36:32.030 --> 00:36:35.210
everything you can to avoid the inflammation, right? And that
655
00:36:35.250 --> 00:36:37.050
leads back to all the diet and stuff that we
656
00:36:37.070 --> 00:36:37.780
were discussing.
657
00:36:37.969 --> 00:36:38.239
Right.
658
00:36:38.469 --> 00:36:42.659
Now, again, statins don't lower LP little a. No. And
659
00:36:42.679 --> 00:36:47.219
what's really interesting about statins is when you're looking at
660
00:36:47.300 --> 00:36:53.849
particle sizes, They preferentially lower the large particle and they
661
00:36:53.949 --> 00:36:58.449
leave the small particles behind. So again, I see this
662
00:36:58.530 --> 00:37:01.130
all the time because I check these things on my patients,
663
00:37:01.170 --> 00:37:04.110
but most doctors don't, right? You go to your doctor,
664
00:37:04.750 --> 00:37:07.550
they put you on the statin, your LDL level goes
665
00:37:07.610 --> 00:37:12.380
down and they're happy, right? But when you check particle sizes,
666
00:37:12.440 --> 00:37:16.159
what you see is, yes, your LDL cholesterol level might
667
00:37:16.199 --> 00:37:22.539
be 70, but 70, 80, 90% of those LDL particles
668
00:37:22.699 --> 00:37:26.260
are small particles. And that's why people are still at risk.
669
00:37:26.820 --> 00:37:30.010
That's why I see it routinely as a heart surgeon
670
00:37:30.449 --> 00:37:32.750
that the patients that are on my table have been
671
00:37:32.829 --> 00:37:36.070
on statins for decades and they still got the heart
672
00:37:36.110 --> 00:37:38.869
disease and still ended up on my operating table. Wow.
673
00:37:38.949 --> 00:37:42.260
So that's one thing. issue I have with statins. There
674
00:37:42.300 --> 00:37:44.960
are some other ones, but that's one of the big
675
00:37:45.019 --> 00:37:48.880
issues that I have with it. You mentioned about the foods, right?
676
00:37:49.000 --> 00:37:53.920
And it turns out that saturated fats in animal, you know,
677
00:37:54.340 --> 00:38:01.130
fats in animal proteins, they promote larger particles. The polyunsaturated fats,
678
00:38:01.190 --> 00:38:04.070
the vegetable and seed oils that have the sticker on
679
00:38:04.090 --> 00:38:09.619
them that say they're heart healthy are They promote smaller particles. Yes,
680
00:38:09.699 --> 00:38:12.389
they might lower your LDL, right? And that's the reason
681
00:38:12.409 --> 00:38:14.130
that everyone believes they're heart healthy.
682
00:38:14.150 --> 00:38:14.530
Yeah.
683
00:38:14.590 --> 00:38:18.150
But again, similar to the statins, they're lowering the wrong
684
00:38:18.230 --> 00:38:22.730
type of LDL and they're causing more of these damaged, oxidized,
685
00:38:22.829 --> 00:38:28.840
small particles that are leading to more problems. So, you know,
686
00:38:28.980 --> 00:38:32.599
this is how when you're looking at the wrong measure, right?
687
00:38:32.639 --> 00:38:35.880
When you're just looking at this LDL measure, you get
688
00:38:36.670 --> 00:38:38.840
led down the wrong path.
689
00:38:39.760 --> 00:38:40.469
But when you.
690
00:38:40.320 --> 00:38:42.559
Start looking at the particles, you start looking at the
691
00:38:42.639 --> 00:38:47.480
quality of the cholesterol, that's how we really start to
692
00:38:47.539 --> 00:38:49.000
lower the risk of heart disease.
693
00:38:49.500 --> 00:38:52.260
Man, see, I didn't know that about the statins with
694
00:38:52.280 --> 00:38:54.960
the particle sizes at all. That really makes a lot
695
00:38:55.000 --> 00:38:58.159
of sense. And I understand it's just this illusion they
696
00:38:58.179 --> 00:39:01.719
like to create on one number without explaining all of
697
00:39:01.780 --> 00:39:04.219
the other negatives and the problems that it causes just
698
00:39:04.239 --> 00:39:07.650
to simply... cell. And I'll leave that alone, but it just,
699
00:39:07.690 --> 00:39:10.010
it makes, it frustrates me. So let's talk about the
700
00:39:10.050 --> 00:39:13.239
soft versus hard plaque. So when you get a calcium score,
701
00:39:13.260 --> 00:39:15.860
that's only testing for hardened plaque. Right.
702
00:39:15.880 --> 00:39:17.559
We're only seeing the calcified plaque.
703
00:39:17.639 --> 00:39:20.840
Right. So somebody that has a zero calcium score does
704
00:39:20.900 --> 00:39:23.719
not necessarily mean that they're free of any problems, right?
705
00:39:24.570 --> 00:39:29.139
You know, the incidence of having a significant amount of
706
00:39:29.280 --> 00:39:31.840
soft plaque, such that you're at risk of a heart
707
00:39:31.880 --> 00:39:35.480
attack with a zero calcium score, is actually pretty low.
708
00:39:36.679 --> 00:39:39.320
So I don't worry too much about that, right? I
709
00:39:39.699 --> 00:39:43.309
view the calcium score, the CAC test, as a great
710
00:39:43.409 --> 00:39:47.110
screening test. gives you a great kind of indication of
711
00:39:47.210 --> 00:39:50.389
where you stand relatively in terms of your risk. And
712
00:39:50.469 --> 00:39:54.619
then if you follow the CAC score over time, the
713
00:39:54.659 --> 00:39:58.300
progression of the CAC score is very predictive as well.
714
00:39:59.019 --> 00:40:02.300
The CAC score in and of itself, it does give
715
00:40:02.340 --> 00:40:06.989
you some indication of relative risk, but I've seen patients
716
00:40:07.130 --> 00:40:10.690
with scores, a CAC score as low as two or
717
00:40:10.690 --> 00:40:13.349
300 that end up having significant disease.
718
00:40:13.369 --> 00:40:13.690
Mm-hmm.
719
00:40:14.219 --> 00:40:17.139
I've also had patients that have scores in the multiple
720
00:40:17.219 --> 00:40:22.230
thousands that don't have any blockages that we've had to
721
00:40:22.289 --> 00:40:25.289
intervene on. They haven't needed a stent. They haven't needed
722
00:40:25.349 --> 00:40:29.590
bypass surgery. So, you know, the absolute score by itself,
723
00:40:30.150 --> 00:40:34.070
you can't completely rely on. And the reason is, you know,
724
00:40:34.159 --> 00:40:36.860
kind of what you alluded to. You're not seeing the
725
00:40:36.940 --> 00:40:42.489
soft plaque, the non-calcified plaque. And you also, the score
726
00:40:42.530 --> 00:40:45.590
doesn't tell you anything about the distribution of that calcium.
727
00:40:45.750 --> 00:40:46.030
Yeah.
728
00:40:46.070 --> 00:40:49.289
Right. You can imagine that you can have 200 worth
729
00:40:49.329 --> 00:40:52.760
of calcium all in one spot in one blood vessel,
730
00:40:52.960 --> 00:40:55.199
and that might be a problem. But you can have
731
00:40:55.219 --> 00:40:58.920
a couple of thousand of calcium spread throughout the blood
732
00:40:58.960 --> 00:41:01.409
vessels and no one spot might be.
733
00:41:01.909 --> 00:41:03.809
You know, problematic. Right.
734
00:41:03.909 --> 00:41:06.630
So that's why, you know, I love the calcium test.
735
00:41:06.829 --> 00:41:09.530
It's a great screening test. I recommend it. You know,
736
00:41:09.730 --> 00:41:13.349
men at 40 years old should get one. Women at
737
00:41:13.349 --> 00:41:17.480
50 should get one. If you have family history, if
738
00:41:17.519 --> 00:41:20.719
you know you're insulin resistant, if you have, you know,
739
00:41:20.880 --> 00:41:23.840
any reason to be concerned, get it earlier than that.
740
00:41:23.920 --> 00:41:24.159
Yeah.
741
00:41:24.280 --> 00:41:26.519
Because, you know, again, what I can tell you as
742
00:41:26.559 --> 00:41:29.300
a heart surgeon is I'm now seeing 30 year olds
743
00:41:29.380 --> 00:41:32.519
end up on my operating table. though it can certainly
744
00:41:32.639 --> 00:41:36.539
start earlier in life. And I really, at this point,
745
00:41:36.599 --> 00:41:39.639
don't think it's ever too early to get one. You
746
00:41:39.679 --> 00:41:41.969
just have to understand if you're 20 years old and
747
00:41:42.010 --> 00:41:44.309
you have a zero score, it doesn't really mean all
748
00:41:44.349 --> 00:41:46.809
that much. You have to kind of follow that and
749
00:41:46.849 --> 00:41:50.429
make sure it stays zero. But if you're 20 year old,
750
00:41:50.469 --> 00:41:53.300
you get a CAC score and your score isn't zero,
751
00:41:53.960 --> 00:41:57.119
that's a major red flag. And that should alert you
752
00:41:57.159 --> 00:41:59.800
that you got to start making some changes and So
753
00:41:59.840 --> 00:42:01.610
that it doesn't progress over time.
754
00:42:01.889 --> 00:42:04.150
Yeah. I think that that's like gold standard. Number one,
755
00:42:04.170 --> 00:42:06.949
you better do that first. That's like your entry point
756
00:42:06.989 --> 00:42:09.949
to you. You're okay. Now I need to really take
757
00:42:10.010 --> 00:42:12.769
it serious. Obviously blood panels, but I think testing wise,
758
00:42:13.309 --> 00:42:16.320
that's like, okay, start there and go from there. Yeah.
759
00:42:16.530 --> 00:42:19.750
If we're worried about heart disease, let's measure heart disease.
760
00:42:20.130 --> 00:42:23.869
We can argue all day long about what blood metrics
761
00:42:23.969 --> 00:42:27.710
are meaningful and not meaningful, but ultimately, let's look at
762
00:42:27.789 --> 00:42:29.230
whether or not you have heart disease.
763
00:42:29.250 --> 00:42:32.010
Right. Of course. No, I'm with you a hundred percent.
764
00:42:32.199 --> 00:42:36.059
So I've got several million questions. When we're looking at
765
00:42:36.460 --> 00:42:39.940
why is soft black the dangerous, I mean, they're obviously,
766
00:42:40.260 --> 00:42:42.559
you can say they're both dangerous, but why is soft
767
00:42:42.619 --> 00:42:45.460
plaque the higher risk? Explain that if you would. Yeah.
768
00:42:45.539 --> 00:42:48.469
So they're dangerous in different ways is how I explained
769
00:42:48.489 --> 00:42:51.690
to people, right? The concern with the soft plaque is
770
00:42:51.750 --> 00:42:56.949
that it's less stable. It could break off, right? And
771
00:42:57.070 --> 00:43:01.429
what we call a plaque rupture. And that causes usually
772
00:43:01.449 --> 00:43:04.320
a blood clot to then form in that area and
773
00:43:04.360 --> 00:43:05.099
block off.
774
00:43:04.960 --> 00:43:06.699
The blood vessel quickly. Okay.
775
00:43:06.889 --> 00:43:10.349
So there's risk from that. Whereas with calcified plaque, the
776
00:43:10.389 --> 00:43:14.170
risk is over time as that calcified plaque builds up
777
00:43:14.230 --> 00:43:17.789
more and more, you basically narrow that blood vessel to
778
00:43:17.829 --> 00:43:20.610
the point that you can't get enough blood through and
779
00:43:20.650 --> 00:43:23.809
that can lead to a heart attack. So they're both concerning.
780
00:43:24.690 --> 00:43:30.110
And the CT angiograms and especially the advanced CT angiograms
781
00:43:30.130 --> 00:43:33.599
that we now have that can show us exactly how
782
00:43:33.679 --> 00:43:36.380
much of each type of plaque they are, there are,
783
00:43:36.400 --> 00:43:39.179
are great. You know, they have some drawbacks in the
784
00:43:39.239 --> 00:43:42.539
amount of radiation that's involved, the cost involved that you
785
00:43:42.579 --> 00:43:47.010
have to, you know, give intravenous dye to do those studies. But,
786
00:43:47.329 --> 00:43:49.929
you know, that is allowing us to learn a lot
787
00:43:49.969 --> 00:43:56.119
more about this process, right? You commonly hear, the explanation that,
788
00:43:56.199 --> 00:44:00.179
you know, the plaque process starts with soft plaque and
789
00:44:00.280 --> 00:44:03.960
over time that soft plaque can become calcified plaque. And
790
00:44:03.980 --> 00:44:07.000
the reality is, is that we don't know that that's
791
00:44:07.340 --> 00:44:10.719
actually how things occur, right? And the more that we're
792
00:44:10.760 --> 00:44:14.440
now able to do these advanced CT angiograms and, you know,
793
00:44:14.480 --> 00:44:17.179
when we can start to do them more frequently, right,
794
00:44:17.199 --> 00:44:20.579
we'll learn more about, is it really a progression like that?
795
00:44:21.050 --> 00:44:24.449
Or are there different factors that predict Some people get
796
00:44:24.530 --> 00:44:28.170
more calcified plaque. Some people get more soft plaque. And,
797
00:44:28.210 --> 00:44:34.929
you know, what really is the most dangerous? It's really
798
00:44:35.030 --> 00:44:40.119
still an open question. The explanation, right, that it is
799
00:44:40.179 --> 00:44:44.840
this progression can sometimes, again, lead us to make conclusions
800
00:44:44.900 --> 00:44:48.469
that may not be correct. Because, again, one of the
801
00:44:48.670 --> 00:44:54.670
other sort of inconvenient facts around statins is that patients
802
00:44:54.769 --> 00:44:59.530
on statins see their calcification progress quicker.
803
00:44:59.590 --> 00:45:05.590
Yeah. Right. And so the, the explanation.
804
00:45:04.780 --> 00:45:08.360
Was put, you know, is put out there that the
805
00:45:08.420 --> 00:45:13.699
reason that is happening is because soft black was being
806
00:45:13.760 --> 00:45:18.219
converted to calcified plaque and therefore it was being stabilized.
807
00:45:18.280 --> 00:45:18.570
Right.
808
00:45:18.889 --> 00:45:22.190
And it leads you to a, and you'll hear cardiologists
809
00:45:22.230 --> 00:45:25.030
say this, right? Except they don't really think about it
810
00:45:25.070 --> 00:45:27.909
when they say it, that what they're saying is if
811
00:45:27.969 --> 00:45:32.190
you have a higher calcium score and you're not on statins,
812
00:45:32.610 --> 00:45:35.030
that means that you're at high risk of a heart attack.
813
00:45:35.289 --> 00:45:37.190
But if you have a high calcium score and you're
814
00:45:37.329 --> 00:45:38.190
on statins.
815
00:45:38.250 --> 00:45:39.869
And you're not. It's okay. And you're not.
816
00:45:40.190 --> 00:45:42.989
And it just, it doesn't make sense. The science doesn't
817
00:45:43.030 --> 00:45:48.260
support it. But I hear that repeated over and over again. No,
818
00:45:48.420 --> 00:45:50.440
that's the story. I was just going to say, isn't
819
00:45:50.480 --> 00:45:53.159
that the story? And of course you know that. So
820
00:45:54.300 --> 00:45:55.179
here's one for you.
821
00:45:55.199 --> 00:45:58.929
So I was told you can't ever reverse plaque. And
822
00:45:59.010 --> 00:46:01.050
I was also told my LP little a score was
823
00:46:01.070 --> 00:46:02.650
kind of like, well, you're, you know, you're kind of,
824
00:46:03.010 --> 00:46:05.010
you maybe get it down a little bit or whatever. Well,
825
00:46:05.090 --> 00:46:08.050
miraculously I've gotten mine. I haven't tested it in a while,
826
00:46:08.090 --> 00:46:11.070
but I went from three 30 down to 94. Now
827
00:46:11.829 --> 00:46:14.469
tell me about the reversal of plaque. Is that possible?
828
00:46:14.820 --> 00:46:17.800
Yeah, it's definitely possible. And I see it in my patients.
829
00:46:17.960 --> 00:46:19.679
I always tell them, right. You're not going to go
830
00:46:19.719 --> 00:46:22.280
from a thousand to zero or, you know, we see
831
00:46:22.340 --> 00:46:26.960
people go down 10, 15, maybe 20%. My primary goal
832
00:46:27.000 --> 00:46:29.539
with my patients is we want to stop plaque from
833
00:46:29.599 --> 00:46:32.969
getting worse, right. Before it can get better. You have
834
00:46:33.010 --> 00:46:35.480
to stop it from getting worse. So that's what I
835
00:46:35.539 --> 00:46:39.719
really focus on with people, you know, and whatever level
836
00:46:39.760 --> 00:46:43.079
of plaque that you have, certainly if you haven't gotten
837
00:46:43.139 --> 00:46:45.860
to a point where, you know, you've needed a stent
838
00:46:45.920 --> 00:46:49.159
or you've needed bypass surgery and you're not having symptoms
839
00:46:49.239 --> 00:46:51.739
related to it, if we just stop it from getting worse,
840
00:46:51.760 --> 00:46:52.679
you're going to be fine.
841
00:46:53.480 --> 00:46:54.139
Even if you.
842
00:46:54.039 --> 00:46:57.179
Have had a stent or you have had bypass surgery, right?
843
00:46:57.610 --> 00:47:00.010
It's still the same goal. We just want to stop
844
00:47:00.050 --> 00:47:00.849
it from getting worse.
845
00:47:00.929 --> 00:47:01.170
Right.
846
00:47:01.289 --> 00:47:05.309
Listen, we can't undo, you know, what was done. Can't
847
00:47:05.369 --> 00:47:08.130
change the past. But if you just stop it from
848
00:47:08.170 --> 00:47:11.849
getting worse, you're going to be better off in the
849
00:47:11.909 --> 00:47:15.230
long run. And then, you know, I believe, as I
850
00:47:15.269 --> 00:47:18.829
know you do, right, the body has an amazing capacity
851
00:47:18.869 --> 00:47:19.289
to heal.
852
00:47:19.309 --> 00:47:19.670
Yep.
853
00:47:19.909 --> 00:47:22.769
And if you just stop doing the damage and then
854
00:47:22.809 --> 00:47:26.039
you let the body do its thing, you'll see some
855
00:47:26.099 --> 00:47:29.920
healing and that can manifest as decreased levels of plaque.
856
00:47:30.280 --> 00:47:32.840
And again, I'm seeing it routinely in my patients.
857
00:47:33.619 --> 00:47:37.050
God created a magnificent body. Just like at the beginning
858
00:47:37.090 --> 00:47:39.030
of time, we were given animals to eat just to
859
00:47:39.070 --> 00:47:40.809
go back on the animal. I mean, that's what we
860
00:47:40.829 --> 00:47:44.510
were given to eat. Right. So it just, anyway, let's
861
00:47:44.550 --> 00:47:47.489
talk about a couple other tests and what they mean. Um, so,
862
00:47:47.630 --> 00:47:49.210
I mean, I've had everything out of the sun now
863
00:47:49.230 --> 00:47:51.469
at this point. Um, I, and I think the clearly
864
00:47:51.489 --> 00:47:53.699
is the only thing I haven't had done yet, but, uh,
865
00:47:54.369 --> 00:47:56.800
When I was in the hospital, they did the catheter
866
00:47:56.880 --> 00:47:59.840
up my arm and all of that. And I'm telling you,
867
00:48:00.320 --> 00:48:02.920
and I'm curious how evasive this is in terms of
868
00:48:03.000 --> 00:48:05.840
seeing plaque build up. Because when the doctor looked at me,
869
00:48:05.840 --> 00:48:07.510
because I had told him, you know, I've had plaque
870
00:48:07.550 --> 00:48:10.489
in the past. And I told him everything because I
871
00:48:10.530 --> 00:48:14.650
was awake the whole time. And I explained it to him.
872
00:48:14.670 --> 00:48:16.489
He looked right at me. He's like, I don't see
873
00:48:16.550 --> 00:48:19.480
anything in there at all. And I'm like, well. How
874
00:48:19.559 --> 00:48:21.920
much are they actually seeing on that kind of test?
875
00:48:22.320 --> 00:48:24.940
That's like a catheter angio. Is that what that is? Yeah.
876
00:48:25.380 --> 00:48:27.199
So how much are they actually able to see on that?
877
00:48:27.260 --> 00:48:28.630
Or is it just they can only see if there's
878
00:48:28.670 --> 00:48:31.090
like a major blockage and they can't see anything else?
879
00:48:31.130 --> 00:48:33.210
Or do they get a clear picture? Yeah, you get
880
00:48:33.250 --> 00:48:34.429
a pretty clear picture.
881
00:48:34.550 --> 00:48:37.730
But what you're really looking at there, right, is the
882
00:48:37.849 --> 00:48:42.420
narrowing of the blood vessel. Some of this plaque does
883
00:48:42.480 --> 00:48:44.739
not cause narrowing.
884
00:48:45.320 --> 00:48:45.559
Right.
885
00:48:45.900 --> 00:48:48.409
Um, when you, you know, now that we have these
886
00:48:48.489 --> 00:48:52.590
advanced CT angiograms, right. We can really see the detail, right.
887
00:48:52.650 --> 00:48:52.769
That.
888
00:48:53.170 --> 00:48:56.389
Some of this plaque ends up sort of outside the
889
00:48:56.429 --> 00:48:59.079
blood vessel, right? Or it's in the blood vessel wall.
890
00:48:59.460 --> 00:49:02.639
So it's not narrowing that flow channel, what we call
891
00:49:02.679 --> 00:49:06.539
the lumen. And when you do a catheterization in that situation,
892
00:49:06.599 --> 00:49:09.139
you may not see much. Doesn't mean that there's no
893
00:49:09.239 --> 00:49:11.860
plaque there, but it means that you don't have any
894
00:49:11.929 --> 00:49:14.969
significant blockage. So, you know, you don't need to be
895
00:49:15.030 --> 00:49:16.090
concerned about that.
896
00:49:16.280 --> 00:49:16.940
Okay.
897
00:49:17.260 --> 00:49:21.860
Because the catheterization is an invasive test, right? And it
898
00:49:22.199 --> 00:49:26.760
does involve actually even more radiation than the CT angiogram does.
899
00:49:27.059 --> 00:49:30.079
I typically prefer the CT angiogram first.
900
00:49:30.159 --> 00:49:30.380
Yeah.
901
00:49:30.630 --> 00:49:33.610
Now, the only situation, right, where that might change is
902
00:49:33.690 --> 00:49:34.670
if someone's coming in.
903
00:49:34.650 --> 00:49:35.949
With a heart attack. Right.
904
00:49:35.989 --> 00:49:38.860
Right. The advantage of the catheterization is if you see
905
00:49:38.900 --> 00:49:41.719
a blockage that needs to be treated, you can treat it.
906
00:49:41.739 --> 00:49:42.019
Right.
907
00:49:42.059 --> 00:49:44.000
You can put the stent in. You can, you know,
908
00:49:44.099 --> 00:49:47.980
do the angioplasty, what we call the balloon, the, you know,
909
00:49:48.239 --> 00:49:52.989
open that blood vessel up. And so that is the advantage.
910
00:49:53.070 --> 00:49:55.110
And if you have someone in front of you that
911
00:49:55.170 --> 00:49:59.010
you think needs that, go to the cath lab, get
912
00:49:59.030 --> 00:50:03.019
the catheterization done. But for most other patients, I much
913
00:50:03.099 --> 00:50:05.000
prefer a CT angiogram first.
914
00:50:05.360 --> 00:50:11.179
My order has been calcium score, CT angiogram, and then
915
00:50:11.360 --> 00:50:19.150
the echocardiogram, and then that catheter, and then the cardiac MRI.
916
00:50:21.809 --> 00:50:25.199
You run the gamut. We haven't gotten you a stress
917
00:50:25.219 --> 00:50:26.059
test yet, but.
918
00:50:27.239 --> 00:50:29.030
Nor do you need one, but I was going to say,
919
00:50:29.050 --> 00:50:31.909
I'm learning to handle stress a lot better through prayer,
920
00:50:31.949 --> 00:50:35.710
and I don't need any other stress tests of any kind. Exactly.
921
00:50:36.389 --> 00:50:39.250
Well, let's shift here towards the end then.
922
00:50:39.090 --> 00:50:41.699
To more like the heart failure side, the ejection fraction,
923
00:50:41.719 --> 00:50:44.559
the echocardiogram, the functions of the heart. I think we
924
00:50:44.599 --> 00:50:47.920
covered the basis pretty well on blockages and things of
925
00:50:47.960 --> 00:50:51.719
that nature. So what's the importance of the echocardiogram? What
926
00:50:51.760 --> 00:50:52.590
does that show you?
927
00:50:52.969 --> 00:50:56.480
Yeah, so the echocardiogram is showing a different aspect of
928
00:50:56.559 --> 00:50:59.260
the heart, right? We've been talking about the blood vessels
929
00:50:59.320 --> 00:51:04.039
that provide the nutrients, the oxygen, right, that the muscle
930
00:51:04.159 --> 00:51:07.840
of the heart needs to function, right? The echocardiogram is
931
00:51:07.889 --> 00:51:10.449
really showing you the function of the heart itself. How
932
00:51:10.530 --> 00:51:13.769
well is that muscle working? It shows you the heart
933
00:51:13.869 --> 00:51:17.909
valves within the heart, right, that are controlling sort of
934
00:51:17.969 --> 00:51:20.760
the direction that the blood is flowing in. And you
935
00:51:20.800 --> 00:51:22.920
can look at those valves and you can make sure
936
00:51:22.960 --> 00:51:27.980
that they're not leaking or they're not stiffened and too tight,
937
00:51:28.079 --> 00:51:34.170
what we call stenosis. So the echocardiogram gives you different information. And,
938
00:51:34.190 --> 00:51:38.329
you know, it can be related. So heart failure is
939
00:51:38.389 --> 00:51:42.269
when the heart is no longer pumping as strongly as
940
00:51:42.349 --> 00:51:46.869
it should. That can be due to blockages in the artery.
941
00:51:46.949 --> 00:51:47.190
Right.
942
00:51:47.269 --> 00:51:50.230
But it can also occur for different reasons. So these
943
00:51:50.369 --> 00:51:55.090
tests end up being complimentary. We don't have one test
944
00:51:55.150 --> 00:51:58.099
that shows us everything we need to know about the heart.
945
00:51:58.380 --> 00:51:58.539
Right.
946
00:51:58.559 --> 00:52:03.179
There's no like perfect test. So, you know, depending on
947
00:52:03.219 --> 00:52:06.360
the situation, you're going to draw upon these different testing
948
00:52:06.480 --> 00:52:10.010
options to kind of put the story together about what's
949
00:52:10.050 --> 00:52:12.050
going on with that patient's heart. Then.
950
00:52:12.559 --> 00:52:16.949
In terms of heart failure, once again, obviously there's different stages. Yep. Now,
951
00:52:17.389 --> 00:52:19.889
is it correct in me saying ejection fraction should be
952
00:52:19.949 --> 00:52:23.170
about 55 to 70? Is that pretty standard? Yes. Where
953
00:52:23.210 --> 00:52:24.929
do you prefer to see it?
954
00:52:25.130 --> 00:52:28.050
So first of all, let's just explain a little more.
955
00:52:28.269 --> 00:52:32.789
So we're talking about the left ventricular ejection fraction, right?
956
00:52:32.809 --> 00:52:32.889
Okay.
957
00:52:33.219 --> 00:52:36.210
So the left ventricle is the main chamber in the
958
00:52:36.269 --> 00:52:39.929
heart that then ejects the blood out into the system.
959
00:52:40.090 --> 00:52:40.429
Okay.
960
00:52:40.670 --> 00:52:44.000
And so we're looking at each time the left ventricle
961
00:52:44.139 --> 00:52:47.199
is contracting, is squeezing, how much of the blood is
962
00:52:47.239 --> 00:52:50.610
getting pushed out. And a normal value there is going
963
00:52:50.630 --> 00:52:54.409
to be, like you said, 55 upwards to about 70, 75%.
964
00:52:54.409 --> 00:52:55.019
Okay.
965
00:52:55.099 --> 00:53:00.880
Heart failure generally is going to be when that ejection
966
00:53:00.920 --> 00:53:04.239
fraction is reduced. And most people would say less than 40%,
967
00:53:04.239 --> 00:53:09.269
some less than 45%. Although you can actually have heart
968
00:53:09.409 --> 00:53:14.110
failure without a reduced ejection fraction. Okay. The ejection fraction
969
00:53:14.170 --> 00:53:17.110
is measuring how well the heart squeezes, but we also
970
00:53:17.150 --> 00:53:19.050
have to, the heart has to relax.
971
00:53:19.260 --> 00:53:21.239
Right. You know, between the squeezes. Right.
972
00:53:21.389 --> 00:53:25.219
And if it's not relaxing well, that's a different type
973
00:53:25.260 --> 00:53:28.940
of heart failure. The ejection fraction may look okay, but
974
00:53:28.980 --> 00:53:30.320
you still can have heart failure.
975
00:53:30.400 --> 00:53:36.000
Got it. Okay. So- What would cause, aside from blockages,
976
00:53:36.179 --> 00:53:40.940
what else could cause prior drug use, steroid use? What
977
00:53:41.000 --> 00:53:42.840
else could cause bad ejection practice?
978
00:53:42.880 --> 00:53:47.460
Yeah, so there are many medications, many drugs, illicit drugs,
979
00:53:48.039 --> 00:53:53.489
and prescription medications. Things like chemotherapy, for instance, can damage
980
00:53:53.530 --> 00:53:55.909
the heart muscle and lead to heart failure.
981
00:53:56.429 --> 00:53:58.909
Viruses, right? COVID.
982
00:53:58.929 --> 00:54:06.690
Mm-hmm. flu, other viruses can lead to heart failure. Those
983
00:54:06.769 --> 00:54:10.929
are probably, I would put blockages, what we call ischemic
984
00:54:11.250 --> 00:54:16.789
heart failure, viral heart failures, and either drug or medication-induced
985
00:54:16.809 --> 00:54:20.329
heart failures are probably the majority of them. There are
986
00:54:20.349 --> 00:54:23.719
some less common things that cause heart failure as well.
987
00:54:25.000 --> 00:54:28.780
So how would you know if say like COVID caused
988
00:54:28.860 --> 00:54:30.949
it or like there was, if that would that, what
989
00:54:30.969 --> 00:54:32.449
would that show on or how would you know?
990
00:54:32.610 --> 00:54:36.650
Yeah, it, it actually, there's no definitive test that would
991
00:54:36.730 --> 00:54:38.789
show that, right? You just got to put the clinical
992
00:54:38.849 --> 00:54:42.210
picture together, right? If you have someone who showed up
993
00:54:42.230 --> 00:54:45.309
with heart failure, you know, shortly after they had a
994
00:54:45.349 --> 00:54:48.710
bout of COVID and they don't have anything of any
995
00:54:48.750 --> 00:54:51.429
of the other explanation, right? They don't have blockages in
996
00:54:51.449 --> 00:54:54.440
their arteries. They haven't, you know, taken drugs or, or
997
00:54:54.500 --> 00:54:58.280
been on any of those medications or then we'll usually,
998
00:54:58.300 --> 00:55:02.219
you know, say it's a viral or, you know, COVID specifically,
999
00:55:02.389 --> 00:55:05.469
or more broadly, there can be other viral causes. You know,
1000
00:55:05.650 --> 00:55:09.489
sometimes it's difficult to figure out exactly what caused it.
1001
00:55:09.690 --> 00:55:13.630
But most of the time, we are able to identify
1002
00:55:13.650 --> 00:55:17.570
a cause for the heart failure. And then what caused
1003
00:55:17.659 --> 00:55:21.119
it may change how you treat it for us.
1004
00:55:21.710 --> 00:55:23.590
One of the words that I don't like to use
1005
00:55:23.610 --> 00:55:25.989
the word hate, but I hate this word is idiopathic.
1006
00:55:26.030 --> 00:55:27.860
I hate hearing that word. I don't want to hear that.
1007
00:55:27.949 --> 00:55:30.239
You know what I mean? Because what does that mean?
1008
00:55:30.260 --> 00:55:31.139
So everybody else knows.
1009
00:55:31.579 --> 00:55:36.039
So the technical definition is, you know, that there's no explanation.
1010
00:55:36.480 --> 00:55:38.559
We don't know what caused it. It's a tricky way
1011
00:55:38.599 --> 00:55:40.460
of saying, I don't know. Yeah. Yeah.
1012
00:55:40.760 --> 00:55:44.440
And, you know, I'll sometimes joke that idiopathic means that
1013
00:55:44.480 --> 00:55:47.449
the doctor's an idiot and hasn't been able to figure
1014
00:55:47.489 --> 00:55:47.780
it out.
1015
00:55:47.840 --> 00:55:48.090
Right.
1016
00:55:48.570 --> 00:55:51.289
And that's the reality. Oftentimes, it just means that we
1017
00:55:51.960 --> 00:55:56.769
haven't looked hard enough, right? Because again, there should, there
1018
00:55:57.230 --> 00:56:01.170
is always a reason. It's just a matter of, are
1019
00:56:01.230 --> 00:56:04.090
we looking at things right? And you start to get
1020
00:56:04.130 --> 00:56:07.809
into some more unusual things that maybe the medical system
1021
00:56:07.869 --> 00:56:13.360
doesn't necessarily even recognize as causes, right? But other toxicities,
1022
00:56:13.500 --> 00:56:18.519
you know, heavy metal, mold, chronic Lyme disease, right? These
1023
00:56:18.559 --> 00:56:21.230
are all things that I hate uncovered in some of
1024
00:56:21.289 --> 00:56:25.530
my patients that the medical system just, it's not in
1025
00:56:25.590 --> 00:56:28.630
their standard algorithm. You know, they check sort of the
1026
00:56:28.690 --> 00:56:31.440
common things and then they stop. And that's when we
1027
00:56:31.460 --> 00:56:35.480
call it idiopathic. But in reality, it just means we
1028
00:56:35.500 --> 00:56:36.619
haven't looked hard enough.
1029
00:56:36.880 --> 00:56:41.449
So it's perfectly plausible that somebody that has like, I'm
1030
00:56:41.469 --> 00:56:43.909
just going to make something up here, but like either
1031
00:56:44.750 --> 00:56:47.650
High exposure to certain toxins or heavy metals that's built
1032
00:56:47.710 --> 00:56:51.809
up over time, some sort of nasty parasites or these
1033
00:56:51.869 --> 00:56:54.719
things that never get tested for. It's plausible that if
1034
00:56:54.739 --> 00:56:58.360
they're having some sort of issues with their heart, that
1035
00:56:58.400 --> 00:57:00.940
could be a contributing factor. Yeah. Okay.
1036
00:57:00.960 --> 00:57:01.159
Yeah.
1037
00:57:01.420 --> 00:57:03.699
All right. So that's what I thought. So I know
1038
00:57:03.719 --> 00:57:05.639
we're getting close to the end. I do have another question,
1039
00:57:05.659 --> 00:57:08.610
another term that I want you to discuss really quickly.
1040
00:57:08.650 --> 00:57:09.969
What is cardiomyopathy?
1041
00:57:10.550 --> 00:57:15.309
Yeah, so cardiomyopathy just means that the heart muscle isn't
1042
00:57:15.750 --> 00:57:18.530
working well, isn't, you know, squeezing well enough. It's kind
1043
00:57:18.570 --> 00:57:23.090
of just another way of describing, you know, heart failure
1044
00:57:23.150 --> 00:57:28.150
is sort of really the end clinical manifestation, right? The
1045
00:57:28.230 --> 00:57:30.989
symptoms that occur. You get short of breath. You have
1046
00:57:31.090 --> 00:57:35.289
fluid retention. You know, that's what heart failure is. Cardiomyopathy
1047
00:57:35.369 --> 00:57:40.300
is describing why you have heart failure because the heart muscle,
1048
00:57:40.900 --> 00:57:42.059
isn't working well.
1049
00:57:42.360 --> 00:57:46.110
You can improve ejection fraction and come out of like
1050
00:57:47.280 --> 00:57:50.750
a heart failure. Is that possible? Yeah, definitely. So, right.
1051
00:57:50.949 --> 00:57:53.710
And, you know, some of that may be because you
1052
00:57:53.769 --> 00:57:56.809
identified a cause and you treated it, right. If you
1053
00:57:56.849 --> 00:57:59.869
had a blockage in your artery and it was causing,
1054
00:58:00.429 --> 00:58:02.869
you know, the heart function to decrease and you treat
1055
00:58:02.909 --> 00:58:06.320
that blockage with a stent or with bypass surgery, we'll
1056
00:58:06.360 --> 00:58:09.059
see the heart function improve. If you have a virus
1057
00:58:09.400 --> 00:58:12.809
that resolves and you treat it, the heart function can improve.
1058
00:58:12.989 --> 00:58:20.519
It's certainly possible. Unfortunately, right? The medical system, oftentimes, again,
1059
00:58:20.760 --> 00:58:24.760
you know, we stop looking for the cause. We don't
1060
00:58:24.840 --> 00:58:28.599
find the cause. We focus now on treating the heart
1061
00:58:28.699 --> 00:58:33.460
failure itself, right? Trying to relieve the symptoms using medications primarily.
1062
00:58:34.280 --> 00:58:39.070
And we see the heart function get worse. And many doctors, again,
1063
00:58:39.119 --> 00:58:42.409
just think this is sort of a natural history that's unavoidable.
1064
00:58:43.150 --> 00:58:45.989
And the reality is, is if we can identify a
1065
00:58:46.050 --> 00:58:50.480
root cause, And we can correct that. We should expect
1066
00:58:50.519 --> 00:58:52.039
that the heart function will improve.
1067
00:58:52.539 --> 00:58:55.760
That's what I find. I hate when I hear this, oh,
1068
00:58:55.800 --> 00:58:58.750
you can't fix this or it's not fixable. And they
1069
00:58:58.809 --> 00:59:02.869
do that and they tell people that. And one, you
1070
00:59:02.909 --> 00:59:06.150
know this, then that loses an array of hope, which
1071
00:59:06.369 --> 00:59:08.869
also can be a contributing factor to making it worse,
1072
00:59:09.409 --> 00:59:12.099
adding stress. which will add inflammation, which will turn into
1073
00:59:12.599 --> 00:59:16.019
oxidative stress. And before you know it, you're just exacerbating
1074
00:59:16.059 --> 00:59:19.579
the problem. Yeah. With falsehoods. Yeah. Right. Yeah. I mean,
1075
00:59:19.659 --> 00:59:21.519
I think and I was talking about this before. I
1076
00:59:21.519 --> 00:59:24.059
don't think people understand the correlation of your mind and
1077
00:59:24.079 --> 00:59:27.079
your body together and how that affects everything. And when
1078
00:59:27.119 --> 00:59:29.920
you go through added stress and everything else, like they'll
1079
00:59:29.960 --> 00:59:32.440
tell me when I go in there, don't get stressed anymore.
1080
00:59:32.460 --> 00:59:34.670
And I'm like, man, I'm like a type one personality.
1081
00:59:34.710 --> 00:59:36.530
I'm always amped up. You know what I mean? Like
1082
00:59:36.570 --> 00:59:40.989
I'm trying. But how dangerous is that, that added stress
1083
00:59:41.010 --> 00:59:43.150
or having problems with your mind on the heart? How
1084
00:59:43.210 --> 00:59:45.670
serious is that? I think it's a huge problem.
1085
00:59:45.730 --> 00:59:49.880
And I think the disempowerment that we do, you know,
1086
00:59:50.030 --> 00:59:54.179
that we kind of enforce on patients, right? When you
1087
00:59:54.199 --> 00:59:56.719
tell someone the only thing you can do is take
1088
00:59:56.760 --> 01:00:00.719
a medication and, you know, and we know that over
1089
01:00:00.800 --> 01:00:03.119
time it's going to get worse and you're going to
1090
01:00:03.159 --> 01:00:04.639
need more medication. Right.
1091
01:00:04.719 --> 01:00:06.809
Right. The patient gives up. Right.
1092
01:00:07.309 --> 01:00:09.869
But instead, if you can say to them, listen, you know,
1093
01:00:10.269 --> 01:00:12.650
if you change the way you eat, right, you change
1094
01:00:12.670 --> 01:00:16.550
some things about your lifestyle, you can improve yourself.
1095
01:00:16.989 --> 01:00:17.210
Right.
1096
01:00:17.650 --> 01:00:21.739
You don't need the medications to do this. You have
1097
01:00:21.780 --> 01:00:26.300
the power. It's much more empowering. And patients react well
1098
01:00:26.340 --> 01:00:28.880
to that. And I've seen it over and over again.
1099
01:00:28.940 --> 01:00:32.619
I've seen the patients who, you know, they're hopeless. They
1100
01:00:32.679 --> 01:00:35.940
feel like they're in a hopeless situation. And when we
1101
01:00:36.000 --> 01:00:39.320
have a conversation and say, no, you can do these things,
1102
01:00:39.679 --> 01:00:44.349
they do it and they get better. And, you know, yeah,
1103
01:00:44.429 --> 01:00:48.190
some of it is the physical things that they've done.
1104
01:00:48.530 --> 01:00:51.429
But a lot of it, I agree, is the mental.
1105
01:00:51.190 --> 01:00:54.860
Aspect of that. So I've had COVID like seven times
1106
01:00:54.940 --> 01:00:57.420
probably that I know of. I don't know why I'm
1107
01:00:57.440 --> 01:01:01.610
so susceptible to it. Would you imagine that would have
1108
01:01:01.670 --> 01:01:04.710
some contributing factors to some of the problems I'm having
1109
01:01:04.849 --> 01:01:05.489
or have had?
1110
01:01:05.510 --> 01:01:08.449
Yeah, I think it certainly can, right? And again, this
1111
01:01:08.489 --> 01:01:12.050
gets controversial, right? And people start freaking out when you
1112
01:01:12.070 --> 01:01:15.880
start talking about this, but it's just scientific facts. The
1113
01:01:15.929 --> 01:01:20.599
COVID virus, the COVID vaccine, right? They both contain the
1114
01:01:20.699 --> 01:01:23.460
spike protein that is damaging to the heart.
1115
01:01:23.699 --> 01:01:25.260
And I never took it. Yeah.
1116
01:01:25.400 --> 01:01:29.199
And, you know, and again, it's not about, you know,
1117
01:01:29.320 --> 01:01:32.710
blaming people for their choices, you know, one way or
1118
01:01:32.750 --> 01:01:35.789
the other. And I know both sides, you know, will
1119
01:01:35.829 --> 01:01:40.210
blame the choices that people make. It's just scientific fact, right?
1120
01:01:40.349 --> 01:01:42.869
And if we can't talk about that scientific fact that
1121
01:01:43.010 --> 01:01:46.590
maybe COVID contributed to your heart disease, you know, again,
1122
01:01:46.670 --> 01:01:47.769
what hope do we have?
1123
01:01:48.250 --> 01:01:48.550
Right.
1124
01:01:48.769 --> 01:01:51.909
It, it, it just crazy to me that, you know, and, uh,
1125
01:01:53.010 --> 01:01:56.559
you know, what's really kind of, uh, galling to me is.
1126
01:01:57.800 --> 01:02:02.150
It's not like we didn't know that viruses cause heart problems, right?
1127
01:02:02.210 --> 01:02:04.369
We have so many examples of it. We see it
1128
01:02:04.449 --> 01:02:08.130
all the time before COVID. And then COVID came along
1129
01:02:08.210 --> 01:02:12.139
and it's another virus. And yes, it has probably a
1130
01:02:12.380 --> 01:02:15.840
greater affinity for the heart than maybe some other viruses.
1131
01:02:16.000 --> 01:02:18.199
But all of a sudden it became taboo to say,
1132
01:02:18.639 --> 01:02:21.559
Maybe this patient that's, you know, showing up with a
1133
01:02:21.619 --> 01:02:24.070
heart attack that had no evidence of heart disease in
1134
01:02:24.110 --> 01:02:27.690
the past, maybe COVID contributed to it. And all of
1135
01:02:27.750 --> 01:02:31.889
a sudden it's like, you know, some super controversial thing
1136
01:02:31.969 --> 01:02:34.869
and you're getting banned on, you know, social media for
1137
01:02:34.929 --> 01:02:36.210
just saying things like that.
1138
01:02:36.730 --> 01:02:39.150
Well, you know, once I really got a really good,
1139
01:02:39.230 --> 01:02:42.730
deep understanding of spike proteins and it was explained to
1140
01:02:42.769 --> 01:02:46.559
me properly that, And then I start piecing everything together
1141
01:02:46.599 --> 01:02:48.820
and putting it together. I have no horse in the race.
1142
01:02:48.860 --> 01:02:50.480
You have no horse in the race when we're talking
1143
01:02:50.500 --> 01:02:52.530
about this. The only thing that we're trying to do
1144
01:02:52.650 --> 01:02:55.829
is just say, Hey, you know, especially if you've got
1145
01:02:56.090 --> 01:02:58.829
previous heart problems or maybe family history, you might want
1146
01:02:58.849 --> 01:03:00.510
to be a little careful with this, what you're putting
1147
01:03:00.530 --> 01:03:02.989
into your body, right? That type of thing. And it's like, man,
1148
01:03:03.489 --> 01:03:05.340
you know, you came out here, you gave me your time.
1149
01:03:05.360 --> 01:03:08.880
I know how in demand you are. I know how
1150
01:03:09.940 --> 01:03:12.670
obviously you're, enlightened you are on all of this so
1151
01:03:12.730 --> 01:03:15.170
taking your time doing this with me means the world
1152
01:03:15.210 --> 01:03:17.809
to me giving it to the people means so much
1153
01:03:17.849 --> 01:03:21.289
to the audience so a big thank you and appreciation
1154
01:03:21.349 --> 01:03:24.190
for me on every level possible.
1155
01:03:24.070 --> 01:03:26.909
Definitely so and uh i do want to give something
1156
01:03:26.949 --> 01:03:29.389
to your audience we got a great gift for them
1157
01:03:29.780 --> 01:03:34.619
just go to ifixhearts.com slash dylan and a free copy
1158
01:03:34.659 --> 01:03:36.860
of the book Stay off my operating table. You'll be
1159
01:03:36.900 --> 01:03:39.480
able to download it right away. I want people to
1160
01:03:39.519 --> 01:03:42.940
have this information in their hands. I want them to
1161
01:03:42.980 --> 01:03:45.909
be empowered to take back control of their health.
1162
01:03:46.269 --> 01:03:49.389
That's generous, man. I'm going to go download that too.
1163
01:03:49.409 --> 01:03:51.130
I don't have a copy of that yet. We got
1164
01:03:51.150 --> 01:03:55.570
to get me one of those. I would strongly suggest
1165
01:03:55.610 --> 01:03:58.150
that you go read that book. And after you've listened
1166
01:03:58.170 --> 01:04:00.929
to this, just if anything, as a refresher to have
1167
01:04:00.969 --> 01:04:03.989
it always as a database to a point to go
1168
01:04:04.030 --> 01:04:06.150
back to, because you can't ever learn enough about this.
1169
01:04:06.210 --> 01:04:08.989
Like if there's anything that I can stress to you,
1170
01:04:09.369 --> 01:04:11.989
and this is from personal experience, you want to know
1171
01:04:12.050 --> 01:04:16.269
everything you can about your heart. Your heart is literally everything.
1172
01:04:16.409 --> 01:04:18.369
I would say heart and brain. You want to know
1173
01:04:18.409 --> 01:04:22.650
everything about it. Right. And so Dr. Ovadia, man, you're
1174
01:04:22.670 --> 01:04:25.840
the man. I can't thank you enough. I hope we
1175
01:04:25.889 --> 01:04:28.550
can actually do this again because I got like 700
1176
01:04:28.550 --> 01:04:31.530
million more questions for you. Sounds good. We're going to
1177
01:04:31.550 --> 01:04:34.530
have to do it again. I appreciate you. The audience
1178
01:04:34.570 --> 01:04:38.829
appreciates you. ifixhearts.com. Check them out on Instagram too. I'll
1179
01:04:38.869 --> 01:04:42.840
link everything in the description. ifixhearts.com backslash Dylan for the book.
1180
01:04:43.659 --> 01:04:46.920
So that being said, man, I appreciate it. Everybody, I
1181
01:04:46.980 --> 01:04:49.559
hope that you take as much as you can from this.
1182
01:04:49.579 --> 01:04:52.960
Take it serious. Start to learn about your heart. Educate others.
1183
01:04:53.780 --> 01:04:56.889
Stay tuned for plenty more to come. Dylan Gemelli and Dr.
1184
01:04:56.949 --> 01:04:58.309
Ovadia signing off.