118. Dr. Suzanne Steinbaum: A New Roadmap to Female Heart Health

Most people think heart disease is obvious and predictable, yet women often present with completely different warning signs that traditional testing fails to catch. We now have the tools to identify risk decades earlier and reverse disease before it becomes dangerous. In this episode of Extend, we sit down with Dr. Suzanne Steinbaum, cardiologist and leading voice in women's cardiovascular prevention, to uncover why standard testing misses female heart disease, how microvascular dysfunction develops long before blockages appear, and why expanded markers like ApoB and HSCRP should replace outdated cholesterol panels. We break down the role of CLEERLY scans, the power of CPET for detecting endothelial dysfunction, and the exact metabolic shifts that happen during perimenopause and menopause. We also explore how zone two training restores endothelial health, why soft plaque is more dangerous than calcified plaque, and how personalized exercise prescriptions can reverse early disease at any age. Dr. Suzanne Steinbaum is a pioneering preventive cardiologist, founder of the ADESSO model for women's heart health, and a national leader in microvascular research whose work is redefining how we diagnose, prevent, and reverse cardiovascular disease in women. What's Discussed: (04:15) Why women experience heart disease through microvascular dysfunction rather than classic blockages (07:50) How outdated cholesterol panels miss early cardiovascular risk in women (12:40) Why ApoB, HSCRP, and metabolic markers reveal the real drivers of plaque (17:05) How CLEERLY scans detect dangerous soft plaque that calcium scores miss (22:30) Why standard angiograms often look normal in women despite real disease (27:55) How CPET testing uncovers endothelial dysfunction and identifies true zone two (33:20) How zone two exercise restores arterial flexibility and reverses early disease (39:45) Why perimenopause, stress, sleep, and pregnancy history raise cardiovascular risk and demand personalized prevention Thank You for Our Sponsors: Timeline: 20% off your order. Go to timeline.com/drshah. That's timeline.com/drshah http://timeline.com/drshah. Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram:@darshanshahmd https://www.instagram.com/darshanshahmd/ Learn more about Dr. Suzanne Steinbaum: Website : drsuzannesteinbaum.com https://www.drsuzannesteinbaum.com/ Instagram: @drsteinbaum https://www.instagram.com/drsteinbaum/ X: @Dr. Suzanne Steinbaum https://x.com/DrSteinbaum Linkedin: Dr. Suzanne Steinbaum https://www.linkedin.com/in/drsuzannesteinbaum/

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:49Dr. Darshan Shah?

  Dr. Steinbaum, thank you so much for joining us today.

• 0:52Speaker 01

  Thank you. Thanks for having me.

• 0:54Dr. Darshan Shah?

  And even in the past few minutes, talking about what we're going to talk about today, I can already tell that this is going to be a game-changing conversation for the podcast, so.

• 1:04Speaker 01

  I think so.

• 1:04Dr. Darshan Shah?

  I know.

• 1:05Speaker 01

  I think we gotta go deep.

• 1:06Dr. Darshan Shah?

  Yes, I'm so ready to launch into this. So you're a cardiologist, and you've been a cardiologist now for how many years?

• 1:12Speaker 01

  I keep, I said 20 for a really long time, so now I upped it to 25, and now I decided to stop counting. But I did one of the first preventive cardiology fellowships in this country when there was like no such thing.

• 1:25Dr. Darshan Shah?

  Right.

• 1:26Speaker 01

  And so it's been an interesting journey. What's now longevity medicine was really preventive, like when I started. And just how it's evolved and transformed, it's been really interesting.

• 1:39Dr. Darshan Shah?

  It's so interesting. And you know, I think that we're at this pivotal moment right now where we have better tools available to us. And also, what we're going to talk about today is how women should think about their heart health differently, and some of the additional tools that both men and women can use that you're developing. And I'm super excited because I think we're at a pivotal moment because you know, number one cause of death in the Western world is heart attacks and heart disease, right? And I really feel like we can flip the script on that.

• 2:08Speaker 01

  I mean, what's really amazing to think about, and I just wanna put this in context. When I started, there was literally no such thing as women and heart disease.

• 2:17Dr. Darshan Shah?

  No, I know.

• 2:18Speaker 01

  And the reason I did a preventive fellowship was because I wanted to prevent heart disease. And we know that 80% of the time, heart disease is preventable for both men and women.

• 2:28Dr. Darshan Shah?

  80% of the time.

• 2:29Speaker 01

  80% of the time. So if you look at this big picture, we've been doing this for, you know, it's like 30 years. It's time, because we have technology, we have tools, we have the capabilities, and now the most important thing, people want to be healthy.

• 2:45Dr. Darshan Shah?

  Yes.

• 2:46Speaker 01

  It is no longer a reactive medical community where you get sick, we're gonna treat. This is really about prevention and not getting sick, and that's what we're focused on now.

• 2:56Dr. Darshan Shah?

  Yeah, no, this is incredible. And the problem that I see from my vantage point, and you probably will agree with this, is that the way most physicians are practicing cardiology right now is still stuck back in like 1980, 85. And I see a lot of primary care doctors just really focused in on LDL, statins, and that's really it, you know? It's really very superficial, not using any of these new tools. And every year, year after year, you see the CDC publish causes of death. Heart disease is number one by a landslide, right?

• 3:30Speaker 01

  Yeah.

• 3:31Dr. Darshan Shah?

  And it's unfortunate because I feel that the tools are available and the thought process around heart disease is there, which we're gonna talk about today, but people just don't have the information. Even the physicians don't have the information.

• 3:44Speaker 01

  One of the biggest issues is, and this is across the board, it takes about 20 years for clinical research to hit practice.

• 3:55Dr. Darshan Shah?

  Right.

• 3:55Speaker 01

  And what that means is the research is done, but the doctors are not implementing it.

• 4:01Dr. Darshan Shah?

  Right.

• 4:01Speaker 01

  So someone like you and me and a lot of the people that we know are really curious and want to implement the research before it's standard of care. And it doesn't make it not valid, it just makes it cutting edge.

• 4:16Dr. Darshan Shah?

  Yes.

• 4:17Speaker 01

  And so what we have to understand, and a lot of times I'll talk to doctors and I'll say, "Let me explain what I'm talking about." And I'll give them like a 30-minute speech and they're like, you know, "Do I get CME credits for listening to you?" And it's like, "Well, maybe you should, because..." You're 100% right. They're stuck in the 80s and we are on a, we are in a new place in understanding the profound impact that our work can have on really changing the outcomes of people's lives.

• 4:47Dr. Darshan Shah?

  Yeah, it's such a pivotal moment. And you know, you said standard of care. And a lot of times I'll get on the phone with other physicians that are managing patients with me, co-managing patients with me, and I'll suggest something and the immediate retort when they don't know something is that's not standard of care.

• 5:03Speaker 01

  Right.

• 5:04Dr. Darshan Shah?

  And that's a big problem because standard of care, as you and I both know, it needs to change much more rapidly than it is right now. Standard of care doesn't change for years. And, you know, there's a ton of research that needs to be done before whatever governing body says this is now the standard of care.

• 5:20Speaker 01

  Right.

• 5:20Dr. Darshan Shah?

  Right?

• 5:21Speaker 01

  Right. So that is what makes technology so interesting. That's what, you know, I hate to bring up the AI word because it's dicey, but when we use data and massive amounts of data and query it in the right way, we are cutting off decades that we need to have in the clinical research that the way it usually is.

• 5:45Dr. Darshan Shah?

  Right.

• 5:46Speaker 01

  So we can have standard of care happening sooner because of all the technology that's out there.

• 5:52Dr. Darshan Shah?

  Yeah.

• 5:52Speaker 01

  So it is really to the point that we're seeing not only how disease develops, but also what are the most important factors that we should change to prevent it?

• 6:06Dr. Darshan Shah?

  Right.

• 6:06Speaker 01

  And that's a fascinating concept because we were never able to do that before without this technology boom.

• 6:12Dr. Darshan Shah?

  Yeah, yeah. So the listeners of the podcast today are going to update their knowledge to an incredible degree. And then they're going to need to take maybe the notes or the show notes and present it to their physicians and say, look, this is what I heard is the current thinking. And What if the doctor doesn't know? Like, where can they get the information? Because a lot of the, a lot of the listeners of my podcast are actually practicing providers, whether it be physicians, nurses, you know, nutritionists. Where can they get this updated knowledge? Is, do you have some on your website?

• 6:45Speaker 01

  Yeah, it's on my website. And we'll talk a little bit more, but I have a program really designed for women's cardiovascular prevention, health and wellness called ADESSO. And we have a lot of this information on adeso.health, which is our platform to really help educate.

• 7:02Dr. Darshan Shah?

  Amazing, okay. Before we dive into women, which is like the number one reason I wanted to bring you on this podcast, I'd love to hear some of the new thinking around the science. Because for a long time, the science around cardiovascular disease was really focused on cholesterol causing blockages and then needing a catheterization and then needing a stent. And you have a different way of thinking about this now, right?

• 7:27Speaker 01

  Yeah, so this is, this is a big picture. You know, we're gonna look at this from how do we approach this problem? It is not just cholesterol. It's metabolism, it's genetics, it's inflammatory, it's physiology, it's functional data, it's hormonal, it's metabolic. And guess what? It's psychosocial also. And if we're not looking at these eight factors, we're missing the problem. If there is calcified plaque that's non-inflamed, for example, that doesn't have a soft plaque component to it, that's non-calcified, it's probably stable, right?

• 8:09Speaker 01

  And so when we look at plaque, we don't even look at plaque the same way. We don't look at LDL the same way. It's really about apolipoprotein B. It's really about HSCR-P. It's really about all these other variables that play a role in whether that plaque is what we call vulnerable or more likely to rupture.

• 8:30Dr. Darshan Shah?

  Yeah, and it's so important that if all you're getting is LDL, total cholesterol, HDL, you're totally missing the mark in 2025 on markers of cardiovascular disease, right?

• 8:42Speaker 01

  One of the things that I often hear from my women patients is that they were told, That their ratio is good. And women, um, HDL is, is the ratio that they're talking about. And HDL is one of the particles that we get in a cholesterol panel. And it's often high with estrogen. So women's ratios tend to be really high. Um, the cholesterol is HDL and what we know, sorry, HDL to cholesterol ratio is high. And what we know is that it's going to be high, which is part of why women have been missed. When it comes to treatment for cardiovascular disease.

• 9:24Speaker 01

  Every algorithm that has been designed, has been designed for men's hearts. So let's just focus on this women thing for a second.

• 9:33Dr. Darshan Shah?

  Yes, please.

• 9:34Speaker 01

  Because we've got to change the algorithm. It has not been working. One in three women die of heart disease, more than all cancers combined. The way that coronary artery disease manifests in women is completely different than how it manifests in men. So why, how is it possible that we are actually using the same algorithm that we've been using for men? It does not make sense.

• 9:56Dr. Darshan Shah?

  Yeah, and I think the whole, even from being at home and noticing whether or not you're having cardiovascular disease. Typically, what everyone is taught is if you have chest pain that's radiating down to your left arm, then that's a indicator of heart attack or angina. And for women, that's less likely to be the indicator than other symptoms. Is that right?

• 10:20Speaker 01

  That's right. And it's partially because how the heart disease and how atherosclerosis, which is really that plaque manifests inside the arteries. Men get it in one spot, one location. They can feel it. There's a lack of blood flow in that one area of the muscle and it hurts. And the way that it manifests is really that crushing elephant sitting on the chest, chest pain with radiation. Women's disease is often diffuse throughout the arteries. It's in the smaller arteries called the microvascular turf. And as I say, we are oftentimes more subtle than men and our heart disease is more subtle as well. Through how it manifests in those arteries, our symptoms are more often.

• 11:05Speaker 01

  Shortness of breath, chest pain, it could be jaw pain, back pain, nausea, flu-like symptoms, and even sleep disturbances. I used to speak a lot and I would tell this to a group of New York women and they'd get really uncomfortable in their chairs, like, hey, we feel like this every day. And it's like, wait, hang on. But these symptoms are so subtle. And if you're getting that shortness of breath and nausea, you know, think about your heart. This is the one time that I say exercise is your friend in more than one ways. It's, it really gives you a sense of how well you're doing. You know, it's your barometer. Like if every day you're walking 10 blocks, I'll do a New York thing,

• 11:49Speaker 01

  carrying packages and all of a sudden you can only walk two and you're short of breath, that's when you really have to start thinking about your heart.

• 11:57Dr. Darshan Shah?

  Uh, so interesting. Okay, so, and that brings up an important point is, okay, so exercise tolerance or being able to just do less, tiredness. You mentioned even just, you know, maybe having brain fog. Like, these are all symptoms that are really kind of hard to parse into like, there's a lot of different things that can cause those symptoms, right?

• 12:17Speaker 01

  Yeah.

• 12:17Dr. Darshan Shah?

  And so I think, I think what you're trying to say is that we need to really be checking women for heart disease much, much earlier because the symptoms are so nonspecific. Is that correct?

• 12:28Speaker 01

  That's 100% correct. So there are two parts to this. When we look at this big reason, like, why are women dying more of heart disease? We know that the research really didn't begin until 1993, when the Office of Women's Health opened up. So there was no research done before then. The doctors in medical school were not trained about women and heart disease.

• 12:53Speaker 01

  The women don't think it's their number one health threat. You know, when you ask women, they're like, it's breast cancer. I get a mammogram every year and it's like, you gotta get your mammogram, but you also need to pay attention to your heart.

• 13:04Dr. Darshan Shah?

  Right.

• 13:05Speaker 01

  So I'm gonna say, yes, women need to be checked more often, but I'm gonna put the onus a little bit on the women to really pay attention to themselves and advocate for themselves. Because nobody knows you better than you.

• 13:20Dr. Darshan Shah?

  Right.

• 13:20Speaker 01

  And if you go to your doctor and you're like, all of a sudden, I am not feeling great. And I used to do X on the treadmill and now I can't anymore. I'm concerned it's my heart. Here's the frustrating thing. Your EKG might be okay, your echocardiogram might be okay, and all of your tests might look normal and your doctor might tell you you're fine.

• 13:43Dr. Darshan Shah?

  Yeah.

• 13:44Speaker 01

  And you know, deep in your heart, that is not the case. And I don't want you to walk away and believe your doctor. I want you to walk away and believe yourself.

• 13:52Dr. Darshan Shah?

  Hmm, okay, so traditionally, that woman, maybe, can we paint a picture of a woman who's maybe forty-two years old? How does that sound?

• 14:00Speaker 01

  Let's go to forty-eight.

• 14:03Dr. Darshan Shah?

  Forty-eight, okay, you're forty-eight years old. You have less exercise tolerance, you're not able to do as much in the gym. You go to your doctor, they're like, okay, we're gonna do all the tests on you. We're gonna get a cholesterol panel, we're gonna get a EKG and an echo, just like you mentioned, and everything comes back normal. What are the tests that need to be done in addition to that to really have a full understanding of what's happening? Can we kinda run through a list there?

• 14:28Speaker 01

  Yeah.

• 14:28Dr. Darshan Shah?

  And why each test is important?

• 14:30Speaker 01

  So let's talk about that forty-eight-year-old woman. Because she's the woman who has been exercising, been taking care of herself, working, has two kids, kind of been really busy, hasn't been able to exercise as much, maybe gained a little weight and perimenopause. So now she's in this hormonal insanity and she's feeling...

• 14:55Speaker 01

  Weight gain and a little short of breath and can't exercise as much. And she goes to her doctor and gets normal test results.

• 15:03Dr. Darshan Shah?

  Right.

• 15:03Speaker 01

  She's still getting this weird sort of shortness of breath, maybe a little chest pain, maybe palpitations. She's not sure. Goes to her gynecologist. The gynecologist says it's probably from perimenopause. She's still not feeling great. And at this point, she's like, oh, my gosh, I'm gonna go to the ER. She goes to the ER with this shortness of breath, nonspecific chest pain. They do an EKG. She has another test. She has a stress test. And now that's normal.

• 15:31Dr. Darshan Shah?

  Uh huh.

• 15:31Speaker 01

  And now she said, you're fine, go home. It's probably your stomach. Maybe it's reflux. She goes to the gastroenterologist. Nope, no reflux. The rheumatologist, maybe it is something autoimmune. Goes to a rheumatologist. Nope. Endocrinologist, well, maybe it's that she's has the metabolic syndrome, prediabetes. Is that it? Well, her sugars are borderline. Turns out her blood pressure is borderline also. And now her triglycerides might be a little high, but her LDL isn't really that bad. And she's sent home. And now she thinks she's crazy and she ends up in a psychologist's office.

• 16:06Dr. Darshan Shah?

  Right.

• 16:06Speaker 01

  You know, like, that's the story.

• 16:08Dr. Darshan Shah?

  You've probably seen this story a thousand times.

• 16:10Speaker 01

  I can't tell you how many thousands of women's second opinion.

• 16:14Dr. Darshan Shah?

  Right.

• 16:14Speaker 01

  Because nobody can help them.

• 16:16Dr. Darshan Shah?

  Right.

• 16:17Speaker 01

  And here's the problem. We are just not looking at the big picture. So let's go back to what I said originally. How are we gonna look at this woman? Well, hormonally, we know that things are in flux. This is the the torrid event of perimenopause, which nobody prepared us about, and certainly not as doctors. And then there is like a little bit of this metabolic stuff going on, this high blood pressure, this triglycerides. And when we look at the cholesterol, now we have to understand what's the deal?

• 16:50Dr. Darshan Shah?

  Yeah.

• 16:50Speaker 01

  So an LDL. Which is really in that metabolic situation.

• 16:56Dr. Darshan Shah?

  Right.

• 16:56Speaker 01

  Can be low.

• 16:57Dr. Darshan Shah?

  Uh huh.

• 16:58Speaker 01

  But actually be really toxic if it's small particles.

• 17:01Dr. Darshan Shah?

  Yes.

• 17:01Speaker 01

  And how we learn about this is through apolipoprotein B. Apolipoprotein B tells us about all the different kind of LDL types that lead to plaque.

• 17:11Dr. Darshan Shah?

  Uh huh.

• 17:12Speaker 01

  So an LDL in this situation tells us nothing. The apolipoprotein B is incredibly important and we have to look at inflammation. A high sensitivity CRP.

• 17:22Dr. Darshan Shah?

  Sure.

• 17:23Speaker 01

  Will tell us if there's inflammation.

• 17:25Dr. Darshan Shah?

  Uh huh.

• 17:25Speaker 01

  We are looking at the triglycerides. We also want to look at the hemoglobin A1C.

• 17:30Dr. Darshan Shah?

  Sure.

• 17:30Speaker 01

  Greater than 5.7 really tells us if we're in that metabolic syndrome place. And then when we've reached 6.5, we're already at diabetes. There is that window in there where the sugar's elevated, inflammation is happening. This is a moment that a lot of people miss.

• 17:47Dr. Darshan Shah?

  Right.

• 17:48Speaker 01

  That becomes really important to whether or not there is a disease there. Then we have to go through the rest. Are you sleeping?

• 17:54Dr. Darshan Shah?

  Hmm.

• 17:54Speaker 01

  Are you stressed? Is sleep apnea possible in this scenario? You know, there are other issues that need to be brought up. And then we look at the woman's own personal risk. It's not just the basic. We have Life's Essential Eight by the American Heart Association talks about, you know, blood pressure, cholesterol, sugars, diet, exercise. Now we know sleep is essential and of course, smoking. But without really understanding, did she have adverse outcomes of pregnancy? Preeclampsia, for example, gestational diabetes.

• 18:28Dr. Darshan Shah?

  Hmm.

• 18:28Speaker 01

  You know, even depression increases the risk of heart disease. Autoimmune issues is really part of the story. So in looking at this woman, we have so many other things to go through.

• 18:39Dr. Darshan Shah?

  Yeah, you have a full battery of workup you have to do along multiple different systems.

• 18:45Speaker 01

  Exactly. So now here's the clincher. Women do not oftentimes get disease in the major arteries. In fact, when they enter the emergency room with chest pain, 66% of the time, her diagnosis is missed. Because even if an angiogram is done, it's looking for disease in the epicardial arteries, the big ones in the heart, when actually, the disease oftentimes is in the microvascular disease, the small arteries that we can't actually see. There's another step. There's a CAT scan angiogram. And now we have Clearly, which uses AI to look for noncalcified plaque and can really tip you off

• 19:28Speaker 01

  if there's some noncalcified plaque there. Right now, again, that standard of care tells us to get a calcium score, which oftentimes is zero in a woman. Because it does, we don't have calcified plaque. But we really need to look for that noncalcified. And most importantly, we need to assess that microvascular disease. I started working 15 years ago with Mettest. It's a CPET company that really, over the years, has been focusing on microvascular disease. And I've had the pleasure and honor to work with them for so long. The algorithm can really pick up microvascular disease in both men and women. And not only tell us if it's there at early stage,

• 20:13Speaker 01

  it's very sensitive. So we know if there's coronary artery disease. We know if there's valvular disease or even heart failure with preserved ejection fraction. We can pick these things up, which happen most commonly in women. But when we look at this test, we can say, guess what? Your shortness of breath? It's microvascular disease. And most importantly, we can fix this.

• 20:37Dr. Darshan Shah?

  That's amazing. Okay, so this is the part of the conversation that I really wanted to get into with you, is the CPET testing and the microvascular testing, which is for most, you know, even myself as a physician, I just started hearing about this maybe five, six years ago. And you've been in this field for 15 years. And just to highlight what you said, because I want to make sure the listeners got this, is you get the cholesterol markers, you're still having pain, you're still, even though your standard cholesterol markers are normal, we need to do an expanded blood panel, including ApoB, LP little a. Hemoglobin A1C to measure for metabolic disease, inflammatory markers, all of that stuff. But those are all risk factors. And then we can take a look at your heart by doing this coronary calcium test,

• 21:22Dr. Darshan Shah?

  a CT scan, looking for calcium. But that's not going to be positive in many women. Women do not calcify their plaque like men do. Instead, they develop what's called soft plaque, which we can now look at using the Clearly scan, which is using AI to look at a CT angiogram. That's fantastic that we have that. And now that's looking at some of the larger vessels and finding soft plaque in women. So we can see soft plaque in the larger vessels, which is good for us to know if there's any of the soft plaque, which is actually more dangerous, right?

• 21:52Speaker 01

  Yes, it's more likely to rupture.

• 21:54Dr. Darshan Shah?

  More likely to rupture. So that's a critical test for women to get, which, I mean, I would love to hear your feeling about this. The standard angiogram, where we inject an artery with dye and we look at the blood vessels, we're going to get less information from that than a CT angiogram with AI. What do you think?

• 22:12Speaker 01

  Yeah. So the way that an angiogram is really assessed, the way that a stress test is assessed is comparing normal to abnormal.

• 22:24Dr. Darshan Shah?

  Right.

• 22:25Speaker 01

  In men, they get disease in one area. So you could see very easily it's abnormal. The rest of the artery is normal. That's where the stent goes, which, by the way, it's a Band-Aid. It's not a fix. It's a Band-Aid. And so a lot of times, women will go for an angiogram. The whole thing is abnormal. And if you could picture that, a tube, the entire outside of the tube getting smaller.

• 22:49Dr. Darshan Shah?

  Yeah.

• 22:50Speaker 01

  The whole thing looks normal.

• 22:52Dr. Darshan Shah?

  Right.

• 22:52Speaker 01

  Unless there's some advanced testing, unless there's really looking at it, IVUS, there's an ultrasound or FFR, which tells us about flow. You really need to assess or even inject the arteries with the medication to see if they relax or constrict can give us a clue as to the health of the lining of the artery, which is called the endothelium.

• 23:17Dr. Darshan Shah?

  Right.

• 23:17Speaker 01

  Without that, that angiogram just told you nothing.

• 23:21Dr. Darshan Shah?

  Exactly.

• 23:22Speaker 01

  Zero.

• 23:22Dr. Darshan Shah?

  And I want to highlight that because a lot of women come to me with the chest pain and they got an angiogram and it was normal.

• 23:29Speaker 01

  Yeah.

• 23:29Dr. Darshan Shah?

  And I almost wanted to say to myself, like, I'm not even going to believe that normal angiogram at all. And when you go and look at the actual study, you see all the major blood vessels look tiny.

• 23:40Speaker 01

  Yeah.

• 23:41Dr. Darshan Shah?

  And that's because they probably have diffuse soft plaque that we're not noticing.

• 23:45Speaker 01

  Yeah, that's exactly right.

• 23:46Dr. Darshan Shah?

  Yeah.

• 23:47Speaker 01

  I don't think, in my opinion, an angiogram for a woman is the first step unless she's actively having a heart attack.

• 23:57Dr. Darshan Shah?

  Right, right.

• 23:58Speaker 01

  And I think that it really comes down to, and one of the things that I talk to my patients about is we're going to get a CAT scan angiogram and a CLEARLY so we can create a roadmap.

• 24:09Dr. Darshan Shah?

  Right.

• 24:09Speaker 01

  So we know where you are, we're going to aggressively treat you with diet and exercise. And you know what, sometimes medication and sometimes supplements and we are going to tailor all of this. There is such a thing as personalized precision medicine. We have that now.

• 24:26Dr. Darshan Shah?

  Yes.

• 24:26Speaker 01

  And we can actually reverse disease. I was told that was not possible. I will tell you it is 100% possible.

• 24:33Dr. Darshan Shah?

  100% possible.

• 24:34Speaker 01

  And see it every single day and to understand what that disease looks like and to track it and see improvement. Now that is powerful stuff and catheterization doesn't tell me that.

• 24:46Dr. Darshan Shah?

  Yeah, it's so true. And it's incredible world we live in now where I can check the CT angiogram with CLEARLY and then we put in place a program, like you say, and we check again in a couple of years and we see a lot of plaque reversal if you have your medication dosage right, your lifestyle right, et cetera, right?

• 25:05Speaker 01

  Isn't that amazing?

• 25:06Dr. Darshan Shah?

  It's amazing.

• 25:07Speaker 01

  It's amazing.

• 25:08Dr. Darshan Shah?

  It's completely counterintuitive to what we were taught.

• 25:10Speaker 01

  Absolutely.

• 25:11Dr. Darshan Shah?

  Yeah.

• 25:12Speaker 01

  And the other piece about this that I really want people to understand, calcium is not bad. So when people get their calcium score and they have a number, they freak out.

• 25:23Dr. Darshan Shah?

  Right.

• 25:23Speaker 01

  What is bad is the non-calcified plaque. It's the soft plaque. So if you think of calcium as being mature plaque and soft plaque being kind of new plaque, if you have a lot of soft plaque, your body is making it. It's happening.

• 25:39Dr. Darshan Shah?

  Right.

• 25:40Speaker 01

  If that soft plaque calcifies, you did it.

• 25:43Dr. Darshan Shah?

  Yeah.

• 25:43Speaker 01

  You know, you stabilized it. It's not going to block the arteries. It's not going to rupture. It's under control and that's really what your goal is.

• 25:51Dr. Darshan Shah?

  Exactly. Okay.

• 25:56Dr. Darshan Shah?

  So I'm 52 right now, but I'm still pushing all of my limits. I'm running long distances. I travel across many time zones to support my work. And I just want to live my life to the fullest. Staying active as I age isn't just about willpower. It's about supporting my mitochondria, the powerhouses of my cells, with the energy that they need to recharge my muscles and recharge my brain. Mitopure is a supplement that I take. It's backed by solid research showing that it can boost cellular energy, increase muscle strength and support overall healthy aging. Personally, I take Mitopure every single day. It's helped me continue my active lifestyle, whether it's a high intensity workout or keeping up with my kids.

• 26:38Dr. Darshan Shah?

  So if you are looking to support your body and want to feel younger from the inside out, my friends at Timeline are offering you a 10% discount on your first order. Go to timeline.com/drsah to get started. That's timeline.com/drsah. Your future self will thank you.

• 27:01Dr. Darshan Shah?

  So we've gotten past the CTE angios phase, but now we're adding a new piece to the algorithm, which is the microvasculature. So explain to us how the CTEP technology works. What is it looking for? How does it, how does a patient get this test? How does all that happen?

• 27:17Speaker 01

  So let's talk about what it looks for.

• 27:19Dr. Darshan Shah?

  Yes.

• 27:20Speaker 01

  Because the body is relatively simple if you understand the mechanism. Like, we just explained how plaque hardens. You know, we know this.

• 27:29Dr. Darshan Shah?

  Right.

• 27:30Speaker 01

  We also really understand exercise physiology. And we understand the difference between aerobic and anaerobic and what happens. So this is a cardio pulmonary exercise test. Everyone is familiar with the VO2 Max. It's the new kid on the block. But that just doesn't tell us enough. Because VO2 Max tells us our capability of exercising. But how we got there is really interesting. Are we getting there through aerobic exercise? Or are we getting there through anaerobic? Here's a perfect way to describe it. You see two people finishing a marathon. We just had the New York City Marathon.

• 28:09Speaker 01

  One person is running across the finish line, smiling, waving, doesn't even seem to be short of breath. That person's really still probably in aerobic. That person that is huffing and puffing. You can see is limping a little bit, lactic acid buildup. That really does not have any more energy. That is really pushing, that's mental. And that is really getting to the finish line through anaerobic. And anaerobic is when the heart no longer can deliver oxygen. And when that happens, assuming the heart function is normal, is when the arteries can't dilate anymore. So think about this.

• 28:53Speaker 01

  We're beating away and our heart is pumping blood and oxygen. The only time that our arteries can fill with blood is when they dilate. And that only happens when the heart relaxes. So if it's beating really, really fast. There's no relaxation times, there's no filling of the arteries. So here's the story. You're running along and your heart is pumping and you are now getting to the point where the arteries cannot fill anymore. So the heart rate increases very, very quickly to compensate. The heart function plateaus and we go from aerobic to anaerobic.

• 29:37Speaker 01

  And you can see that in the accumulation of lactic acid, you could see that in a huge spike in heart rate. You can actually see that in a decrease in what we call Pico two pulse, which is cardiac output, actually. It's the amount of blood ejected from the heart. And that point is really microvascular disease because it begins with endothelial dysfunction, meaning the arteries can't dilate. And when it happens diffusely, it happens in the microvasculature and that is an essential diagnosis.

• 30:08Dr. Darshan Shah?

  And when you say diffusely, do you mean diffusely in the heart or diffusely throughout the entire body system?

• 30:14Speaker 01

  The arteries don't know where they live. They all are the same organ. So now here, here's a, here's a take home. You want, a lot of people are worried about their brains. There are arteries from head to toe. They do not know where they live. If you take care of your heart, you're going to prevent dementia. You're actually going to prevent Alzheimer's. You're going to prevent kidney disease, eye disease, peripheral vascular disease. I always say, if you live from the heart, you've got it covered. Because the arteries, they function the same way, no matter where they live.

• 30:50Dr. Darshan Shah?

  Got it. So if I were to come to your office and do this test, is the test named ADESSO?

• 30:55Speaker 01

  The test is part of the ADESSO clinical model.

• 30:58Dr. Darshan Shah?

  Got it.

• 30:59Speaker 01

  Um, we work with MetTest and this is a, this is a real partnership.

• 31:03Dr. Darshan Shah?

  Got it.

• 31:04Speaker 01

  Of how the data is queried and brought into the ADESSO platform to really create not only diagnosis, but exercise prescriptions. So think about this. You're told to go exercise. Most people have absolutely no idea what that means. In fact, one of my patients came in to do a stress test and she was wearing heels. And I was like, wait, wait. No one told you how to scuff. When you exercise, usually it's sneakers. She's like, okay. It's like the basics. But not only that, I mean, when we think back, and I think back to like the eighties, nineties, if you were not exercising to like vomit, you were not doing a good job.

• 31:47Speaker 01

  And that's not where we're at right now. So when we say exercise, it's based on exactly where the arteries don't dilate anymore. It's exactly at that anaerobic threshold. Got it. And that, believe it or not, is your zone two. And that's the other new kid on the block. Everyone's trying to get to zone two. Certainly you could do it through a calculation, but we can specifically tell you where your zone two is. Here's the most amazing thing. It's slow. It's not painful. I say to my patients, bear with me. Just do it. Just do it for four months. Let's repeat this test. And I, I can't tell you how many times, and I think of this one patient in particular,

• 32:31Speaker 01

  and she's like, oh my God, it worked. That's awesome. And it's really, it's amazing to see. Now, let's also think about this. Why can we prevent heart disease? Let's go back to the endothelium, the lining of the artery. The lining of the artery's function is to allow the arteries to dilate and constrict. If that lining stays healthy, then no longer could it develop heart disease because heart disease develops when the artery gets stiff. Why? Think of a pipe cleaner that bends versus a popsicle stick that breaks. When it's stiff, it breaks.

• 33:13Speaker 01

  So now your blood pressure might go up as the blood flows across the artery. You can get micro tears. Those micro tears is how the cholesterol gets inside. Inflammatory markers go inside. Now you have the development of a plaque. So if you never, ever, ever have problems with the endothelium. You never get heart disease.

• 33:34Dr. Darshan Shah?

  Hmm.

• 33:35Speaker 01

  And so when we really make that endothelium healthy again by simply exercise, notice I didn't mention any medication, supplements, or anything else. Just with exercise, you're gonna start the beginning of reversing disease.

• 33:51Dr. Darshan Shah?

  Yeah, that's amazing. So zone two exercise is really the key to healing the endothelium.

• 33:57Speaker 01

  Healing.

• 33:58Dr. Darshan Shah?

  Which then, once the endothelium heals, you can prevent heart disease because that's the inciting factor for all heart disease.

• 34:05Speaker 01

  That's right.

• 34:05Dr. Darshan Shah?

  Yep. And also the microvascular disease that you were talking about.

• 34:08Speaker 01

  That's right. Exactly. Exactly.

• 34:10Dr. Darshan Shah?

  And how does, how does zone two exercise heal the endothelium? What is actually happening there physiologically at a microscopic level?

• 34:19Speaker 01

  So when you're in zone two, and again, it's at the point when there is, you're going from aerobic to anaerobic.

• 34:28Dr. Darshan Shah?

  Right, that lactate threshold level.

• 34:29Speaker 01

  Yeah. So the heart is so simple. It's all about volume and pressure. And if you put pressure inside of the arteries, because you're increasing filling time.

• 34:41Dr. Darshan Shah?

  Uh huh.

• 34:41Speaker 01

  Okay, so let's picture this. You're increasing the amount of time that your arteries can fill. And if you do that, they're gonna fill more, which means they're gonna put more pressure inside of the arteries, which means they dilate. Think about squeezing the bottom of a balloon.

• 34:59Dr. Darshan Shah?

  Right.

• 34:59Speaker 01

  And the top expands.

• 35:01Dr. Darshan Shah?

  Yeah.

• 35:02Speaker 01

  That's the heart.

• 35:03Dr. Darshan Shah?

  Yeah.

• 35:03Speaker 01

  It's very simple.

• 35:04Dr. Darshan Shah?

  Makes, makes total sense. And when you're giving these exercise prescriptions, how much zone two exercise should someone do daily or weekly? What is, what is the number?

• 35:16Speaker 01

  It's very, I say this, it's very calm. It's 30 minutes, five days a week.

• 35:21Dr. Darshan Shah?

  That's totally doable, right?

• 35:23Speaker 01

  It's so nothing.

• 35:24Dr. Darshan Shah?

  And if you have someone tell you what your zone two is and you, you realize it's a lot easier than you think it is, it's, it's really, it's really where you're at that resting perceived exertion of you can still have a conversation, but you don't want to kind of a thing?

• 35:38Speaker 01

  It's almost like you can finish your sentence. Like you and I could talk and I might be like.

• 35:43Dr. Darshan Shah?

  Yeah.

• 35:44Speaker 01

  Like a little, you know, it's, it's not bad. And in fact, for some people, and this is the truth for most people, it feels very, very easy because they're used to pushing themselves. They think the more I do, the better. So when they were exercising in the past, and this is the other thing, they got tired. They had such an increase in lactic acid that the next day they feel awful. There's more fatigue when you're exercising wrong. When you start exercising right, you're energized. Everything changes.

• 36:16Dr. Darshan Shah?

  Right.

• 36:16Speaker 01

  So this is the kind of thing, I think it's almost meditative. Put on a podcast, go for 30 minutes, listen to music. Make it your time and not the time that you're going to make yourself be exhausted. Make this the time that you really put in that says, this is literally for me in a way that is going to nourish me. And this is not, you know, we're so used to doing things hard and fast, the most, the maximum. This is the reverse. And guess what? Your doctor's telling you to do it so you don't have to feel guilty.

• 36:52Dr. Darshan Shah?

  I love it. Yeah. And I think, you know, like you said, I was brought up in the eighties where, you know, you were taught like calories in, calories out, go to the gym, you know, run as hard as you can on the treadmill for as long and as far as you can. And just look at the calories on the treadmill machine or the bike. And, and that's how much fat you're burning. But the reality is that's more zone three, zone four. And it's kind of like that dead man's zone where there's not a lot of actual physiological benefit to that beyond just burning calories. And so really focusing in on this zone two is what's going to heal your endothelium, reverse our disease and also really good for your mitochondrial health as well. Right?

• 37:32Speaker 01

  Oh, we didn't get to talk about mitochondria, which is like my favorite. Mitochondria are so interesting because I have to tell you, when I started my preventive fellowship, I was with the cardiology fellows and, and I did a cardiology fellowship afterwards, which I'll never forget. My first rotation was in the cath lab and I was putting stents in. And I was like, this goes against my belief system. You know, it was really interesting, but I was lecturing to them about mitochondria and everyone's rolling their eyes. All they wanted to do was put in stents and now I could talk about it and everyone is interested. The coolest thing, and again, this goes back to the body's physiology, which is extraordinary.

• 38:16Speaker 01

  And this is something that happens during menopause also. We store our mitochondria in our slow twitch muscle fibers. That's where they get stored. Those muscle fibers are the ones that are happening to get bigger with strength training. So as we muscle waste during menopause, we're losing mitochondria. Like, we are tired, you know? And so if you don't focus on strengthening your muscles, you actually don't have the mitochondrial support for the cardiovascular. So one of the things that I really think becomes important for everyone to understand is,

• 38:58Speaker 01

  yes, cardio matters, yes, but you have to do the strength training, especially as you get older, for that mitochondrial support. And this is when supplements becomes really interesting. I don't believe in supplements for everybody and all. Like, nobody in my mind should be swallowing 10 fistfuls of supplements a day. It's really about who you are and what you need. And if you're that person that is really struggling, like, getting back into exercise and has some muscle wasting, this is that 48-year-old woman who's like, I get you. You've been working, raising the kids, but you've got to get that muscle mass back.

• 39:41Speaker 01

  And that might be where supplements for mitochondrial support does become helpful.

• 39:46Dr. Darshan Shah?

  Can you give us the name of a couple that you really like?

• 39:49Speaker 01

  NAD. You know, there's always the argument, is it NAC or is it NAD? We can discuss that, but that's really interesting. Everyone's talking about creatine these days. I have mixed feelings about it, quite honestly. Believe it or not, we used to... I was studying it back in the day. Mark McGuire and Sammy Sosa, do you remember them?

• 40:09Dr. Darshan Shah?

  Of course, yeah.

• 40:10Speaker 01

  Okay. This is my limit on what I know about baseball. But it was fascinating because they got in trouble for actually taking it.

• 40:20Dr. Darshan Shah?

  Yeah, they did. I remember that.

• 40:21Speaker 01

  Do you remember? It was prohibited.

• 40:23Dr. Darshan Shah?

  Right.

• 40:23Speaker 01

  And so when you, I mean, I found this riveting because it was a supplement. And to make a supplement, something that a player couldn't take. I did a deep dive. So what, that was in the 90s, right?

• 40:35Dr. Darshan Shah?

  Yeah, I think it was the 90s.

• 40:36Speaker 01

  And the fact that it's now like everyone's taking it, mentally, I'm like, whoa, like what happens? And so I think it becomes important to understand, again, the same idea that more is better. Just think about what it is you're taking, how much you're taking. We all respond differently. You know, this is something, get your liver checked, get your kidney function checked. You know, who are you?

• 41:00Dr. Darshan Shah?

  Right.

• 41:00Speaker 01

  Um, we all have different fat content. So that means our metabolism of different things differs. We're all exercising differently. So if you take something like creatine and you're not doing strength training, don't take it. It's not helping you. It's not going to make your muscles bigger. You're just drinking it. Do you know what I mean?

• 41:20Dr. Darshan Shah?

  Yeah, exactly.

• 41:21Speaker 01

  And so I think that it's very, very helpful in the setting of, of strength training and something, you know, certainly to consider.

• 41:28Dr. Darshan Shah?

  Got it. And then, you know, one of the things I want to make sure we touch on too is you mentioned a while ago, a woman's genetics, or even just a person's genetics can have a lot to do with their risk of heart disease. And you had a little bit of a reframing around APOE that I wanted to talk about. Can you talk about APOE a little bit?

• 41:45Speaker 01

  Yeah. You know, it's so funny, like going back into history, I'm sort of reframing everything in a way.

• 41:50Dr. Darshan Shah?

  Right, you are.

• 41:50Speaker 01

  Um, which I don't know if is good or bad, but I always think understanding the history of things becomes really important for you to understand where you are today.

• 41:59Dr. Darshan Shah?

  Yes.

• 42:00Speaker 01

  And APOE is one of them. So again, that 25, whatever, years ago, when we were looking at APOE, it was really focused on metabolism. How do we metabolize? And APOE is a genetic marker that tells us that. This is something we get from our parents, one from our mom, one from our dad, and it's two, three, and four. So when we look at APOE 3.4 or 4.4, our body is not metabolizing fats well. Think of like a shuttle system. I actually sometimes did, I don't know if this is a great analogy, but Pac-Man like eats little dots.

• 42:38Dr. Darshan Shah?

  We're really getting into the eighties today.

• 42:41Speaker 01

  Okay, that just says, I was not in medicine in the eighties, just for the record.

• 42:46Dr. Darshan Shah?

  Well, I mean, we had a really awesome conversation getting to know each other that we were raised like literally five, 10 miles apart from each other in New Jersey.

• 42:52Speaker 01

  We hung out at the same mall, at the same time. I mean, what are the chances?

• 42:57Dr. Darshan Shah?

  Oh, my gosh.

• 42:58Speaker 01

  There is something about being a Jersey kid that you know that life.

• 43:01Dr. Darshan Shah?

  Yeah, I think the minute you met me, you're like, that, he's a Jersey boy.

• 43:05Speaker 01

  Yeah, for sure. So let's go back to being at that mall playing Pac-Man. But no, really, it's about a shuttling system and how the fats get really shuttled out of the body. And when you have an APOE 3.4 or 4.4, the fats don't get shuttled out as well. Meaning you're really bad at Pac-Man.

• 43:22Dr. Darshan Shah?

  Right.

• 43:23Speaker 01

  You know?

• 43:23Dr. Darshan Shah?

  Right.

• 43:24Speaker 01

  And so the fats sit in the lining of the arteries. If those arteries are in the heart, you get coronary artery disease. If in there the brain, you get dementia or even Alzheimer's.

• 43:35Dr. Darshan Shah?

  Yeah.

• 43:36Speaker 01

  So here's the interesting thing about it. The treatment for an APOE 3.4 or 4.4 is not a statin necessarily. Cause a statin works on shutting off the production of cholesterol in the liver. This is a shuttle problem. The treatment for this is really a mostly vegetarian diet. And so when we talk about diets and we talk about protein, again, I want to give you context. Protein is important, but if you have an APOE 3.4 or 4.4, your protein source should not be from saturated fats.

• 44:11Dr. Darshan Shah?

  Right.

• 44:12Speaker 01

  Absolutely should not be because your body cannot metabolize it. And so when we look at the data about genetic predisposition of things. I want everyone to look at APOE and not get scared because that data was done on a generation before where meat and potatoes was standard of life. How we live now, your exercising, your diet, if you're really doing the right thing, you can change your outcome of disease. And a little bit more about that APOE. A 2.3 is associated with a little problem metabolizing carbohydrates. And so you should be on a low carb diet. I'm not going to tell you to binge out on saturated fats because that's not exactly my belief system,

• 44:57Speaker 01

  but I'm going to tell you you're less likely to have trouble compared to if you ate carbs.

• 45:03Dr. Darshan Shah?

  That's incredible bit of knowledge because every time we've talked about the APOE gene on this podcast, it's been in the context of Alzheimer's disease and the risk of Alzheimer's. But the actual mechanism of that is how you metabolize your fats. And so totally agreed, you know, going more towards a vegetarian diet and more lean sources of protein is not just helpful for your brain, but also helpful for your heart.

• 45:28Speaker 01

  Absolutely. You know, when you look at the diet data, the Mediterranean diet has really shown to be like the way to go. I mean, what's terrible on the beaches of Greece, Italy, just eat that food.

• 45:41Speaker 01

  And so when you think about it, it's lower in saturated fats and higher in good fats, like omega-3 fatty acids, olive oil, fish. That's really, should be your focus. And with that APOE 3.4 and 4.4, it's really cutting back on the saturated and focusing on really those good fats, which I think are essential, essential, essential.

• 46:05Dr. Darshan Shah?

  Absolutely. Yeah, and Dean Ornish did a lot of research on this years ago with his Ornish diet, which he showed the Mediterranean diet actually reversing cardiovascular.

• 46:15Dr. Darshan Shah?

  Black, which is one of the first ways we were able to reverse black.

• 46:19Speaker 01

  I'm gonna give a little shout out to Dean Ornish. So I did his original research in New York. We were the East Coast site. And so when I started my preventive fellowship, it was because of him. He was the first person that was on the block, who was doing the work. We had our stress, our support group, that was stress management. We had our diet, our exercise, and we had yoga. In Beth Israel Medical Center in New York City, we had a yoga studio. And we were actually looking at PET scanning, which is really a more, actually PET scan picks up microvascular disease, but it is obviously not accessible everywhere.

• 47:04Speaker 01

  And we could see regression through this PET scan. It was unbelievable, unbelievable.

• 47:11Dr. Darshan Shah?

  Yeah, yeah, incredible research. And I had the pleasure of meeting Dr. Ornish at a TED conference about a decade ago. And I just, in all, because he changed medicine in many ways that I think really pushed us towards this preventative mindset in a big way.

• 47:30Speaker 01

  A hundred percent. And but what he showed in his trial, which I think is so important to understand, it wasn't just the diet, it was the exercise.

• 47:41Dr. Darshan Shah?

  Yes.

• 47:42Speaker 01

  It was also stress management in the form of yoga. Could you imagine talking about yoga back then?

• 47:48Dr. Darshan Shah?

  No.

• 47:49Speaker 01

  And it was group support. And I really want to put a little pin in that concept. Group support, we were isolated from each other for so many years from COVID. And that concept of community is something that I think everyone should understand is part of the blue zones. It was the original part of Ornish's study. And it is so relevant. And if we don't actually think about the importance of the connection between our mind and our hearts, we're missing a big piece of this. Data is critical. And I love talking about all of the blood tests and how to do this from that data analytics. But I'm going to tell you something. Every single person is different.

• 48:34Speaker 01

  And their differences occur in their thoughts, in their feelings, in how they approach the world, in their stress. And that piece of this story is also incredibly relevant.

• 48:46Dr. Darshan Shah?

  It's so true. The Harvard study that was done showing the most important variable in following people for 75 years in how long they lived and how healthy they were was community, more than anything else.

• 48:58Speaker 01

  Isn't that amazing?

• 48:59Dr. Darshan Shah?

  It's amazing.

• 49:00Speaker 01

  And we don't, we don't put that on the checklist.

• 49:02Dr. Darshan Shah?

  Right.

• 49:03Speaker 01

  And we should, we have to. I mean, it is clear, the connection between the mind and the heart. Actually, can I tell you this coolest study ever?

• 49:10Dr. Darshan Shah?

  Please, I want to hear it.

• 49:11Speaker 01

  Okay.

• 49:12Dr. Darshan Shah?

  And we'll link to it in the show notes.

• 49:13Speaker 01

  Thank you for indulging me. In 1994, there was a study done on the heart. This was autopsy. And in autopsy, the cells of the heart were looked at. And there were actually the same cells in the brain are on the heart.

• 49:32Dr. Darshan Shah?

  Oh.

• 49:33Speaker 01

  And they started calling it the little heart, the little brain, sorry. It, the heart has been known as the little brain. So what happens? Like when we think of a stress response, right?

• 49:44Dr. Darshan Shah?

  Yes.

• 49:44Speaker 01

  So, oh, we didn't get to talk about the autonomic nervous system, but here we are. Because the stress response is really epinephrine, norepinephrine, and cortisol, which increases inflammation. When you have those hormones going through your body, they're not going through your body and reaching your heart. There is a direct impact on the heart. And this is causing inflammation. This is causing an increase in heart rate and shortness of breath. This is those little microvascular arteries spasming, causing chest pain. And we all know what that feels like. Like that stress, that heartache, like we all get it.

• 50:25Dr. Darshan Shah?

  Right.

• 50:25Speaker 01

  And that's really from stress hormones.

• 50:27Dr. Darshan Shah?

  Wow.

• 50:28Speaker 01

  And so it's important to understand, the more we manage stress, and this is where meditation comes into play. This is really, you know, the David Lynch Foundation has been working on transcendental meditation, really understanding, this is where yoga mattered, that we have to have tools to shut off that stress response also.

• 50:48Dr. Darshan Shah?

  It's so true. Wow. I think we've laid out an incredible plan for women and for the men who are listening for how to really reverse cardiovascular disease in 2025. There's so many more pieces to the puzzle and a lot of them that we've talked about in this podcast already, but I think today what we added to this knowledge was a knowledge around APOE. I haven't talked about that. And also the microvasculature, which is such a critical piece of this puzzle. So I'm really excited that we've talked about this, really excited to give people a new roadmap on how to prevent and reverse heart disease. And I really appreciate you bringing this incredible knowledge to the table.

• 51:31Speaker 01

  Thank you so much. It's been really fun. Thanks for the conversation.

• 51:34Dr. Darshan Shah?

  So can I end it with, if there were three critical thing that if you were to talk to that 47 year old woman, you want to give her top three critical things that she should be doing to think about why she's not feeling herself, what are they in respects of the heart?

• 51:49Speaker 01

  I think you really have to do a deep dive on understanding yourself. And one thing that we really have done in a deso is know your own risks. When you go through the standard risk analysis, it's not asking you the question. And the questions include, are you sleeping enough? Are you drinking too much? Like, what's your deal? You've got to be honest with yourself. And what can I do? And the next thing is movement is life. And you've got to figure out how to get up and start doing something, some exercise component. And that might be as simple as walking. You don't have to really make yourself sick by exercising, but just get up and do something.

• 52:29Speaker 01

  And I think the last thing is really take that one piece of your life that you absolutely know is hurting you, whether it's that muffin in the morning or that second or third glass of wine at night. Pick the, pick that thing and just don't do it anymore. And that one change is going to have a massive impact.

• 52:54Dr. Darshan Shah?

  Yeah, such incredible advice. Thank you so much for joining me. And I look forward to visiting your clinic and doing this testing.

• 53:02Speaker 01

  Oh, I can't wait.

• 53:04Dr. Darshan Shah?

  How can people find you and learn more from you? And if they want to get the ADESSO testing done, how could they do that?

• 53:09Speaker 01

  ADESSO, A D E S S O dot health. Send us an email. We'll tell you where to go. And you can find me, Dr. Steinbaum, Dr. Suzanne Steinbaum on social, my website. Please reach out. Love to hear from you. And would love to really make ADESSO a movement. Because we are at the point right now, as we know, we've got to change things.

• 53:32Dr. Darshan Shah?

  Right.

• 53:33Speaker 01

  And the more that women say, I am not happy with the standard of care, the quicker that we can make this happen.

• 53:41Dr. Darshan Shah?

  I love it. Thank you, Dr. Steinbaum.

• 53:42Speaker 01

  Thank you.

• 53:47Dr. Darshan Shah?

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