83. Dr. Joel Kahn: Why Most Cardiologists Are Missing the Real Causes of Heart Disease

What if everything you've been told about preventing heart disease is only half the story? In this episode of Extend, I sit down with Dr. Joel Kahn, a pioneering preventive cardiologist who's spent decades challenging the traditional approach to cardiovascular medicine. We explore why the 1961 Framingham risk factors represent an incomplete picture of heart disease, and the hidden culprits damaging your blood vessels every day. We also dive into why a $100 calcium score should be as routine as a mammogram, how your cooking methods could be aging your arteries, and the surprising connection between erectile dysfunction and heart attacks. Dr. Joel Kahn is a preventive cardiologist, author, and founder of the Kahn Center for Cardiac Longevity. He is one of the few cardiologists advocating for plant-based nutrition and comprehensive lifestyle medicine. He's written multiple books including "The Whole Heart Solution" and hosts "Heart Doc VIP" podcast. We Also Discuss: Beyond Cholesterol: The 20+ Hidden Risk Factors Your Doctor Isn't Checking The $100 Test That Could Save Your Life (And Why Insurance Won't Cover It) Advanced Glycation End Products: How Your Barbecue Is Aging Your Arteries The Glycocalyx: Your Body's Secret Vascular Protection System Why Every Man with ED Needs a Calcium Score TMAO and the Dark Side of Choline Supplements Blood Pressure Devices That Work Without Pills The Trauma Surgeon with Perfect Arteries Despite Sky-High Cholesterol EECP Therapy: The NASA Technology Rebuilding Hearts Nitric Oxide: The Nobel Prize-Winning Molecule You're Probably Destroying ApoB vs. LDL: The One Number That Matters Most Why Listerine Might Be Sabotaging Your Blood Pressure Thank You for Our Sponsors: NextHealth: Your destination for cutting-edge health optimization—from IV therapy to hormone balancing. Explore at https://www.next-health.com/ Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram: https://www.instagram.com/darshanshahmd/ Learn more about Dr. Joel Kahn: Website: https://www.drjoelkahn.com/ Instagram: @drjkahn https://www.instagram.com/drjkahn/

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?

  Hello, Dr. Khan. How are you today?

• 0:51Speaker 01

  I am so excited and honored you to have me on. Thanks so much.

• 0:55Dr. Darshan Shah?

  This is a massive honor for me. Like I just shared with you a little bit ago, I read your book cover to cover twice when I was going through my own health journey. It was absolutely transformative. So I feel like I'm talking to a guru of mine. And I'm so excited to have this conversation with you.

• 1:12Speaker 01

  Thank you.

• 1:12Dr. Darshan Shah?

  You know, what really drew me to you, Dr. Khan, is number one, cardiac disease, as we all know, most of us will die of some sort of cardiac issue. And the way we treat this in Western medicine right now, we're just covering up the symptoms with medications. And your approach is completely different. And I would love to hear from you, Dr. Khan, a little bit about you and how you came up with this approach. And you're a trendsetter in this. A lot of cardiologists probably disagreed with you when you first wrote your book.

• 1:41Speaker 01

  It's kind of you. I mean, very quickly, there were two paths in my life that led to my current role as an aggressive preventive cardiologist. I'm not a passive one. One was I grew up in a home where we kept kosher. So I always had to think before I ate. I was, was it okay? Was it not okay? Was my mother watching? And I was gonna get my mouth washed out with soap because I had bacon or something. Now, she's a wonderful woman still alive. But when I got to university, University of Michigan, I wanted... To keep honoring that faith and there was a giant salad bar. So I've actually, I'm in my forty eighth year of being completely vegan. I mean, I have not had egg, cheese, poultry, meat.

• 2:22Speaker 01

  I don't judge anybody. You eat the diet that works for you. Unless you're a heart patient, I gotta get two minutes in and give you my piece. But that's my little bit. And then number two, I knew I wanted to be a cardiologist when I was ten years old. I had a murmur. I went to a pediatric cardiologist. I got into med school and I was eighteen and on my path and I graduated in nineteen ninety as a big shot interventional cardiologist, came back to Michigan. I did my training out of state and I was cracking plaque and busting up clots and treating heart attacks. But three weeks later, Dean Ornish's famous paper, The Lifestyle Heart Trial, was published July twenty one nineteen ninety in Lancet and it came to my mailbox and I read it and I said, I've never talked to a patient about

• 3:06Speaker 01

  nutrition because there really wasn't, I had not heard of Nathan Pritikin at that point. I didn't know about some other pioneers in the back because there's others. And I just started sharing that article and then he wrote a book and, you know, then we got some resources like John Robbins, A Diet for a New America and Caldwell Esselstyn at the Cleveland Clinic appeared on the location and I visited the Pritikin Center. So I was sort of combining nutrition and holistic and aggressive cath work. And about thirteen years ago, I said, enough of the cath work. I have stood next to an X-ray machine for hours and hours a week and it came out of it, as far as I can tell,

• 3:47Speaker 01

  still healthy. I got a few natural killer cells left in me, thank goodness. But not many, but a few. But I went back to AFRM, one of the big, you know, integrated medicine programs and did the whole functional medicine thing. And it's been ten years of really, I mean, I joke with people, my hobby is reading literature and I don't say this to be pompous. I'm so grooved on trying to figure out atherosclerosis and, you know, pharmaceutical pathways when needed, natural pathways when needed, you know, trying to explain.

• 4:20Speaker 01

  To my patients and the public. So I write books. I do a podcast, but mainly I see a lot of patients Detroit, Florida, and about 20 states, including your beautiful California. I got a bunch of patients in Malibu. We just telemedicine and all. But yeah, I think, you know, what you introduced that I just always got to shout this every 34 seconds, somebody dies in America of heart disease.

• 4:42Dr. Darshan Shah?

  Right.

• 4:42Speaker 01

  Forty seconds, somebody has a heart attack in America. You know, 1,000 people a day. This is the worst statistic dropped dead suddenly. That's called SCD, sudden cardiac death. Almost all of them have bad blockage. Many of them had no clue they had bad blockage. They didn't hug anybody goodbye. They die in the toilet. They die in bed. They walk out of the gym. They die in their car. They die at the football stadium. Yeah, we resuscitate less than 10% of people, even in the hospital. You've got a defibrillator right there, but it just doesn't work well. So the only answer is start at age 15, 18, 20, 25. I identified people in institute, hopefully with

• 5:23Speaker 01

  the new, you know, administration and Bobby Kennedy, we may actually, you know, bring health up to where it belongs. And I hope cardiac health, because I don't hear much out of Washington about cardiac health, but it's a move forward. And, you know, so I am more fired up to talk about what we're talking about right now and what you read about in that first book of mine. So thank you.

• 5:43Dr. Darshan Shah?

  Yeah, no, this is such an incredible time we live in. But I just want to highlight 10 years ago, when I read your book, you kind of opened my eyes to the multifactorial nature in of cardiac disease. And what I mean by that is, I was taught in medical school, you know, I graduated medical school back in 95, and I was taught in medical school that really cardiac disease was due to cholesterol. And high levels of cholesterol cause atherosclerosis, and that's it. And that's why we go after cholesterol. And your book really opened my eyes to no, cholesterol is one piece of a big problem. And I'd love for you to unpack that a little bit, because I don't think a lot of people know this. Definitely, I, you know, I have a lot of

• 6:28Dr. Darshan Shah?

  family members that are cardiologists, invasive cardiologists, doing stent still. And when I talk to them about your book, this is in 2025, people still practice, people, doctors still practice medicine, including my family members, not recognizing that it's more than just cholesterol. I'd love for you to unpack that for the audience.

• 6:47Speaker 01

  And I love your last term because I'm not a cholesterol denier. I think in some people cholesterol, lifestyle induced, environment induced, or genetically induced, kills them. I've got so many examples of them, my practice, not necessarily dead, but you know, documented severe disease. But there's so many exceptions to the rule. I just got to share with you, just a moment ago, a trauma surgeon left my office patient. I'm going to fold this over so there's no chance to see her name. Her cholesterol is 275, her LDL is 200, and her lipoprotein little a genetic cholesterol is 337. These are very high numbers. So her apolipoprotein B is 150.

• 7:29Speaker 01

  And she had a calcium score of zero, but she wasn't satisfied. She had a carotid. She wasn't satisfied as clean. So she got the famous clearly CT AI study. She's one of the four people in my practice out of a thousand who've had Cleelys. She doesn't have one drop of plaque. So I, this doesn't deny that cholesterol doesn't matter because I can show you, you know, 90 other people. But how does this happen? She eats healthy and she's thin and she exercises and then she's had a negative sleep study at all. But how does this happen? And you know, that's what keeps me reading medical journals. I think there's something to the argument that if you're vitamin C deficient, you have more fragile arteries.

• 8:12Speaker 01

  This was a Linus Pauling PhD theory. And if your diet or your supplements are vitamin C replete, and I take personally about 10 grams a day of vitamin C. I'm like an old Linus Pauling guy. Um, I take it as powders or tablets and I eat a lot of vitamin Cers food. You may actually have bulletproof arteries, but never trust your labs. You've got to do cardiac imaging, which we'll talk about. But so really quickly, because we, you know, limited time, 1961, I love reading the original article. The Framingham Study, everybody's scratching their head. Are heart attacks just age or can we identify risk factors? 1961, they identified hypertension, high cholesterol, and LVH on the EKG, left ventricular hypertrophy.

• 8:57Speaker 01

  Is why people should ask their primary care doc for an EKG, even though Medicare won't cover it. Just ask for one. So an abnormal EKG, hypertension, high cholesterol. Then they added on diabetes a few years later. Then they added on smoking. Then they added on family history. Mom, dad, brother, sister had an early heart attack. And still to this day, that's the only framework that most internal medicine, primary care and cardiologists operate on. A 1961 framework. I think it's still accurate, but let's talk about 20 more. I just mentioned one lipoprotein little A, or the six tests you can get about inflammation of your vascular supply. Or your homo cystine methylation pathway, or your omega three and your vitamin D genetics.

• 9:41Speaker 01

  We can check APOE and a obscure gene called 9P21. We can do more. You know, air pollution, environmental toxins, you know, it's really a complex formula and we don't have that calculator. We have American Heart Association calculators. They don't even include lipoprotein little A, even though 25% of people inherit a genetic cholesterol that can be very dangerous for them or not, as this doctor just showed you. So I think it's so interesting to, you know, open your mind to all the possibilities. But when I see one patient, I have to look at their arteries. I've got to either look at their carotids with an ultrasound or do a simple hundred dollar calcium CT scan. This surgeon came back zero, unbelievably.

• 10:24Speaker 01

  Or really, if you want to up the game, as you know, you can bring state of the art AI technology and do a CT angiogram with some iodine dye and there's no better test in the world than what I just showed you. I mean, this woman is just bulletproof, but I never would have sent her out of my office. I didn't put her on prescription drugs. She has no atherosclerosis. I, you know, healthy lifestyle and some supplements. So it's so fascinating that atherosclerosis, we've got a new one called TMAO. If you're taking choline or carnitine or eating a lot of egg yolk or red meat, check your blood, Quest Lab Corp for TMAO. I had a lady today, TMAO levels should be less than six. It was 95, one of the highest. Wow.

• 11:06Speaker 01

  And I asked her, she goes, oh, I'm taking four grams a day of carnitine for energy, which is a reasonable choice. But TMAO may damage your endothelium and your kidney. So we're going to have to come up with some compromise. So. We're learning, you know, all the time, new pathways. Um, I just learned today that Fosamax is a mitochondrial toxin. There was a new paper. It inhibits your body's ability to make CoQ10. And, uh, you know, put Fosamax on the list, uh, you know, an osteoporosis drug that many people know about. It's a potential new factor, along with other drugs, proton pump inhibitors.

• 11:42Dr. Darshan Shah?

  Right, right. Yeah. So, you know, you, you bring up a really important point, I think, is like, we've practiced medicine for so long, having to use risk factors to determine what is our risk of disease. So then we determine our therapy based on that because it's impractical, really, to do an angiogram on everybody, an invasive angiogram to discover disease proactively. We have the calcium score, but for whatever reason, it's kind of buried in medicine because insurance doesn't cover it for some reason. I get all my patients to do the hundred dollar calcium score. It's just, uh, there's no reason not to do this test. But now we're at this new age where we have this clearly test and we can, for a very quick CAT scan of your heart,

• 12:24Dr. Darshan Shah?

  even though insurance won't cover it for everybody, we can get with high resolution, a really good idea of what's actually going on with the coronary blood vessels, right? And so what's mind blowing to me, and you've, that patient of yours is just blows my mind. A trauma surgeon with an LPA of 300 and no cardiac disease. It just shows you that, you know, unless you really take a look, it's hard to know what's truly happening just based on risk factors. So do you think that we're going to get to a world where the coronary calcium score AI scan is part of just a normal workup of everybody?

• 12:57Speaker 01

  We should have been there 20 years ago. I mean, you know, this hundred dollar calcium score, it used to be a thousand dollars, but because of simplicity of imaging, it's now a hundred dollars or less. It's free in Cleveland. Just go to University Hospital. You know, that's been around since 1990 and widely available since the year 2000. And yet my own estimate, less than 5% of primary care docs added to the list. If the US Services Preventive Task Force says, do it, people will do it. Now, uh, you know, they aren't that innovative. Creative and creative and then secondarily it comes back abnormal and where's the protocol? Where's the double blind randomized studies which sorely are sad? We don't have that many. Um, I certainly have my own protocol, what to do with a high calcium score.

• 13:41Speaker 01

  I've written articles about it. Um, I'm writing a new book that will go over that, but it's not a set protocol. Aspirin and statin would be the standard knee jerk from a cardiologist, maybe a stress test. In my mind, you go ahead and you get the clearly CT angiogram if you have disease and you define it all. So we should have had mammogram or thermogram, colonoscopy or Cologuard in calcium score 20 years ago. And I don't know anybody in Washington pushing that agenda. If anybody's going to watch this, hi Bobby Kennedy, I'll talk to you anytime. I have, I have given him my books when he was campaigning in Michigan a couple of months ago before the election. But whether he read them or not, I don't know. Uh, so it is time for that now.

• 14:22Speaker 01

  There are those that argue skip the calcium score, hundred dollars, no IV, no allergy potential for my iodine. Go right to a $1,600, you know, Ferrari test called a clearly AI CT angiogram. And of course clinics like yours and some of the others make that widely available and I do too. But, um, I don't think, you know, we're ever going to win the battle of that becoming routine yet. It's just too big a test and too expensive and you got to prepare a patient with beta blockers. You know, the routine. So my own protocol is if your calcium score is zero, very rarely do I think you need to step ahead. This surgeon really said, I, I don't believe it. I want to know my soft black.

• 15:04Speaker 01

  And there's a lot of soft black out there, but, um, the prognosis for 10 years with a calcium score zero risk. Our tech is very close to zero. So, you know, if you'll take care of your lifestyle. Some people get that calcium score zero, the good result and say, great cheeseburgers, french fries and Coca-Cola. No, if you'll take that and say, by the grace of God, I'm not aging aggressively and throw in lifestyle. You'll probably end up in good shape. So it's, you know, people are doing true age and all these other aging tests. There's some pretty good literature. If you get that heart CT scan and it's, you know, zero. You've got healthier brain, healthier kidneys, low cancer risk. It's a very good metabolic marker for, you know, the whole body network.

• 15:48Dr. Darshan Shah?

  Yeah, absolutely. I mean, obviously, if you have cardiac vessel disease, you might have vessel disease elsewhere as well. And so it's an indicator of just overall the status of your circulatory system. So

• 15:59Speaker 01

  And just on that note, not to interrupt you, but if a guy is listening to this, or a partner of a guy is listening to this, if a guy has erectile dysfunction, they have to get a calcium score at least. And, you know, I just read, literally, a 240-page guideline by the European Urology Society on andrology, on sexuality. And on page 240, last line, "Consider a cardiology evaluation for a man with erectile dysfunction." I knew it had to be in there. It couldn't have been buried deeper in the article. I really thought by now, this is also a 25-year-old concept. A man with erectile dysfunction has vascular disease to prove it otherwise, and below the waist and above the waist are

• 16:41Speaker 01

  related. So, don't let them die of a heart attack just because you gave them, you know, tadalophyll or sildenafil, you know, check the heart. It's so important, and it's so available.

• 16:51Dr. Darshan Shah?

  Absolutely. And you bring up a really important point there, which is something that I'm talking a lot about now with my patients. It's not just about the status of the blood vessels in your heart. It's really the status of the blood vessels of your entire body. What is the status of your vascular system, and also your microvasculature? Because the more I think about it, the more I feel that it's really the damage that we're doing to our vascular system that way precedes any type of heart attack, stroke, kidney disease, you know, to your point, erectile dysfunction. It's the vascular system damage that we're doing from a very young age that creates these problems later on in life, even Alzheimer's disease, I feel. And so, maybe, it sounds like your

• 17:34Dr. Darshan Shah?

  next book is going to talk a lot about the vascular system. And I'd love to hear some previews out there. How do we think about this?

• 17:41Speaker 01

  You know, you probably know Daniel Amen, the famous psychiatrist who said psychiatrists are the only specialty that treat an organ they never see. So he developed brain imaging. And really, we can do some good imaging nowadays, but you know, it all starts in aligning the endothelium. We can't see the endothelium. I mean, so we really are limited. And then we now know there's a mucousy layer on the endothelium in every artery in the body, 50,000 miles called the glyco calyx. And there is one very bizarre instrument you could put under the tongue and try and image little capillaries and measure the glyco calyx in research studies. But basically, we got so much left to learn. And you're right, if we're gonna pick up disease super early, we either need a blood test or an

• 18:25Speaker 01

  imaging study that's even earlier than a calcium score of zero. But for the meantime, that's clearly the best substitute, or a good quality carotid ultrasound, which is widely available. I'm not a big fan of lifeline screening. You know, I don't think they're the perfect answer, but you know, they do pick up some disease in asymptomatic people. You, you know, what you're doing picks up more at Next Health, of course.

• 18:50Dr. Darshan Shah?

  Yeah, you know, I, I think about the vascular system and very rarely is this talked about in primary care medicine. And so because there isn't a great way to evaluate it, to your point, right? And but, you know, I think people should know that they are creating damage to their vascular system through their diet, through the inflammation, through high blood pressure, in fact, just stress as well. All of these factors damage your endothelium, which is a very thin layer, so set one cell layer thick, right, of your, of the inside of your blood vessels. Once that gets damaged, the cholesterol comes in trying to heal it, and that's what creates plaque. But also, it just reduces blood flow in general to, to your entire body. How are people damaging their endothelium, besides some of the things I mentioned?

• 19:33Speaker 01

  Yeah, well, obviously, about 10% of America still smokes. I had a young man today who vapes five times a day, you know, nicotine. I mean, that's no better than smoking based on all the data. And lately, we've gotten some data that smoking cannabis is, you know, damaging arteries. So that's no longer put in a benign column. Um, you know, sedentary lifestyle versus active lifestyle, probably a high saturated fat diet. There's pretty clear data about damages your gut and gives you the opportunity to develop some leaky gut and. Endotoxin into your blood, but it probably damages your endothelium, at least transaminally. There's some, you know, one big milkshake and you can check uh blood flow in the forearm and research studies, one big cheeseburger, famous study by cardiologists in Colorado,

• 20:18Speaker 01

  one cheeseburger literally uh damages both your sexual response and your endothelial function. So, you know, diet's a factor and again, uh animal based saturated fat is probably the most suspicious of all. Um, you know, all the toxins in the world, all the endocrine disruptors, uh, there's a paper two weeks ago that 350,000 people a year in the world die of phthalate exposure, which is in plastics and PVCs, but it's also in ladies' perfumes and glade air fresheners and they are endocrine disruptors. And it was calculated 350,000 people a year in the world die due to phthalates. And then put in PFAS and PFAS. So, air pollution

• 21:00Speaker 01

  triggers endothelial dysfunction. If you're living in Mumbai or you're living in southern Detroit where the factories are, you better get a home air filter. There's no easy solution to it. You know, if you work around trucks and exhaust, it's not a benign thing. And it's amazing how much data there is for air pollution now. Um, pesticide, you're besides, you know, the whole environmental picture plays, obviously elevated blood sugar. You know, what's rarely talked about is advanced glycation end products. I'm like a geek on this topic.

• 21:32Dr. Darshan Shah?

  Let's talk about that.

• 21:33Speaker 01

  Thirty or forty years of science that there's two ways that you can alter proteins and fats predominantly in the body and make your nerves work poorly, make your blood vessels work poorly, raise your risk of cancer, heart disease, dementia, kidney disease. And they're called advanced glycation end products, which is abbreviated AGES, kind of cool because they do age you rapidly. And there's two ways your body accumulates lots of AGES. One is running a high blood sugar. So, the type three diabetes of Alzheimer's is just another way of saying increased exposure to this chemical reaction, this non enzymatic chemical reaction called advanced glycation end products.

• 22:14Speaker 01

  You know, wear your CGM or get your hemoglobin A1C in your fasting insulin. But, you know, check very carefully that you're not insulin resistant and hyperglycemic. But the other way that's so cool is you take a breast of chicken, which I don't eat, but I'm not going to make a judgment, and you put it in a tagine or a Instant Pot, a pressure cooker, and you cook it moist. You make almost none of these advanced glycation end products. You take the chicken and throw it on the barbecue. You take the chicken and you put it on a George Foreman grill or you roast it, and you create an enormous, it's a chemical reaction called the Mallard reaction. So you take meat and you grill it. You take chicken and you grill it. Even if you take tofu, it has to be high fat, high protein foods that you dry cook.

• 22:57Speaker 01

  How popular right now are dry steaks? These are actually the worst food in the world. No judgment is when you fry bacon, you create more advanced glycation end products. And you can actually calculate this. A researcher in New York, who's the queen of this, Helen Vlacerow, recently retired, made 200 publications on this. She has lists of food by food by food, how much advanced glycation and how you cook it. So moist cooking, if you're going to cook chicken on the barbecue, marinate your chicken, actually in lemon, vinegar, and brown beer. Those three things prevent this chemical reaction to a large degree. If you just put the dry steak on the barbecue, God bless you. Don't do it too often. Or take a vitamin called benfotiamin, which is a version of thiamine.

• 23:42Speaker 01

  It helps prevent that reaction. So cool stuff. But we don't talk about such a simple kitchen, you know, approach to better health. Anybody just go read on the topic because there's extensive literature. It actually causes aging and wrinkles. So I read more about advanced glycation end products in women magazine articles that just show up on my Google, you know, feed than I read in, you know, cardiology texts. But it's very much a cardiology topic.

• 24:09Dr. Darshan Shah?

  That's so interesting because my perception of advanced glycation end products is something that we create with high sugar levels inside of our bloodstream. But you're saying you actually create these and ingest them in the foods that we're eating as well. And it's the cooking of the food.

• 24:23Speaker 01

  It's a method of cooking particularly.

• 24:26Dr. Darshan Shah?

  Oh, that's, that's a great tip for people. I don't think anyone would have even thought of that unless they've read some of your work. So thank you for that.

• 24:36Dr. Darshan Shah?

  This episode was brought to you by Next Health, a health optimization and longevity clinic located in Los Angeles, Manhattan, and soon to be opening in Montecito, Nashville, Miami, and many other cities in the United States and Canada. Next Health is the Apple Store of wellness, where you can optimize your health span and lifespan using cutting-edge technology. I actually founded Next Health eight years ago to give my patients a place to go get extensive biomarker testing done and provide them with all the tools that I use to get my health in order. The longevity circuit in Next Health using hyperbaric oxygen, sauna, cryotherapy, and LED light is a game changer. In addition, the doctors at Next Health measure thousands of biomarkers and put into place

• 25:21Dr. Darshan Shah?

  a longevity optimization plan using advanced tools like ozone, plasma exchange, and peptides. Go to www.nex.health to check it out.

• 25:34Dr. Darshan Shah?

  What are some of the other things that people can do to rehab their blood vessels? Say they have endothelial damage. Other than the things that you mentioned, avoiding all these potential toxins to our blood vessels, how can we treat them and rehab our glycolyx and our endothelium?

• 25:50Speaker 01

  Great question. So I mean, such an obvious thing, but I insist people own a home blood pressure cuff. You know, there's lots of wearables. There's basically no wearable blood pressure item right now. There is one in England. It's not FDA approved. You can't download the app. I own it. It's a bracelet, but I can't use it because the app is shut off in the United States. By next year.

• 26:13Dr. Darshan Shah?

  Yeah, I think they'll have, the founder came on my podcast as well.

• 26:16Speaker 01

  I think I heard him. Right, exactly. And that's going to be a breakthrough. Or maybe they'll sell to Apple or they'll sell to, you know, Whoop or Fitbit because, you know, if you can't do it in the meantime, spend 90 bucks and make it a ritual. Make it Blood Pressure Sunday. And just so you can rehab your endothelium by identifying you're running 150 over 90, not 110 over 70, and you know, working on it through multiple ways. Number two, you know, avoid some of the toxins, avoid the advanced glycation end products. Make sure I I'm not, you know, diet judgmental, but eat whole grain, eat fruits and vegetables. We know that the polyphenols in brightly colored foods and all are very endothelial friendly.

• 26:59Speaker 01

  I'm a supplement guy. Coenzyme Q10 is, I think is a universal supplement for everybody. And it is clearly an endothelial restorative supplement. That's so safe and very research based. I think vitamin C falls in the same, very inexpensive, endothelial friendly, antioxidant, anti-inflammatory. And of course, you could keep going with, you know, nitric oxide supportive supplements, whether they be beetroot or arginine or citrulline. Although I don't think we should depend, you know, solely on supplements, but there are. The Glyco Calyx right now, the only thing that's out there, there's a couple of supplements that are seaweed based, interesting.

• 27:42Speaker 01

  Green seaweed, Monastroma is the name of the seaweed. They're quite popular right now in the integrative world. I can shout out a brand name. I don't, you know, have a real tie, but Arturacil. Arturacil, yes. E R O X I L is a seaweed based supplement. And I give the company credit, Calroy, because they do research. And it's not, you know, routine to see a supplement company do research. And if you have a intact Glyco Calyx, it helps you have an intact endothelium. Maybe that's why the trauma surgeon's walking around. We talked about that with such beautiful arteries, despite a lot of potential toxins in her blood. You know, fitness, HIIT training have all been shown.

• 28:26Speaker 01

  There's been data that HIIT training particularly can help shrink soft plaque. Hopefully you don't develop plaque, but most of us get some. HIIT training, a couple of times a week can help shrink plaque. All exercise is good. But HIIT training as part of it may be a super good idea. Yes. Don't smoke. I mean, it's the, I didn't mention sleep. You know, sleep has come on in cardiology, you know, like a, like a storm and the data that sleeping less than five hours a night increases your coronary calcification, increases soft lack, raises your risk of all cardiac events, including for sure atrial fibrillation. Are you not sleeping because of obstructive sleep apnea? You know, do a home sleep study. That's like almost routine in my clinic. Do a home sleep

• 29:10Speaker 01

  study. They're so simple and inexpensive, you know that. Find out if you got sleep pathology or just get in bed for seven and a half, eight hours, you know, you're a hard worker. I'm a hard worker, but you can't, you can't cheat mother nature if you're sleeping four or five hours a night as you did during your residency, as I did three years. I don't do that anymore. So, you know, good sleep hygiene and good sleep is key. So.

• 29:35Dr. Darshan Shah?

  Yeah. Fantastic list. Um, there's a few devices that I recently came across. I don't know if you have as well. There's one called Zona. It's one where you apply isometric contraction from your hand. Supposedly that's, that's helpful for high blood pressure. How do you feel about that one?

• 29:49Speaker 01

  Yeah, it came from the astronauts in NASA and they found when they were in their seat and clenching on takeoff, that actually their blood pressure seemed to be better controlled. So they developed a device. I'm all for it. It's one of the cool, non pharmaceutical ways to manage blood pressure. There's one called Respirate, which is more based on breathing and probably autonomic balance. There's HeartMath, which is based on breathing and autonomic balance. These can all lower blood pressure and have actually pretty surprisingly strong cardiac data for health versus illness. And then there's even, um, you can train your diaphragm to be stronger. We think about training muscles. We never think about training our diaphragm.

• 30:31Speaker 01

  So there is a few devices for about $80, uh, that you can breathe and, um, you know, four or five minutes a day. Actually, you can get a lower blood pressure in published research data.

• 30:43Dr. Darshan Shah?

  Like an incentives spirometer type of device?

• 30:45Speaker 01

  Yeah. Power Breathe. Instead of spirometer is kind of the low end of it. Power Breathe, it's a UK device, but you can buy it all over the States. I have it across my room. So I had to take my.

• 30:57Speaker 01

  Yeah, but it's getting on as well. So these are weak devices. Why take a pill if you can work with some, you know, devices and lifestyle, sleep therapy and avoid pills. That's obviously a good goal.

• 31:09Dr. Darshan Shah?

  Yeah, you know, I usually give my patients when they, first of all, you're absolutely right about getting a home blood pressure cuff. I can't tell you how many patients I see that have ignored a high blood pressure reading at their primary care office for a decade because they attribute it to white coat syndrome. Someone didn't take it right and they told, come back in a year and see me while we measure it. And they go decades without looking at their blood pressure. And I think we all know from the research that even a 10 milligram of mercury rise of blood pressure over 120 over 70 over the long term is deleterious, right? And so it's so important to know your blood pressure at home and measure it correctly and understand what it is. And so what I do, and tell me if you do something different, is I'll give many people a three to six month chance to try to manage it on their own

• 31:54Dr. Darshan Shah?

  at home, but usually I try to get them on some sort of combination therapy or therapy for their blood pressure with pills with the agreement that our goal is to get off of these blood pressure medications over time. And we're going to do all of these things that you talk about, but I think it's important not to live years and years with a blood pressure over 130 over 80 and just keep banging your head up against a wall, trying to get it down without treatment. Do you agree with that? Or what are you, what is your protocol use of blood pressure?

• 32:22Speaker 01

  Again, I couldn't agree more, although people come to me, the holistic cardiologist, the functional cardiologist, you know, I care about their heart and I often make that negotiation. I always tell them these drugs are not for life guaranteed. They're for life if we don't make progress or you don't make changes or you don't, you know, if you don't work at it, we're going to have to rely on some of these pills, but I hope that we can do it without, you know, pills long term. I had that discussion with a gentleman today. I actually saw him six weeks ago and I put him on a very odd herbal blood pressure pill. I'll just give you a tip called Mukta Vati. You buy it on Amazon. Mukta, M U K T A Vati, V A T I.

• 33:04Speaker 01

  It's got ashwagandha and brahmi and some other herbal and it works in like 90% of my patients, very inexpensive. But I got his echo report back and his echo showed quite a lot of thickening left ventricular hypertrophy, which really identifies a higher risk. Blood pressure patient and I told him, I'm going six months with meds. You gotta lose 20 pounds. He's already lost 15 and we'll reevaluate the meds, but I can't afford to let you have ongoing cardiac damage. I agree. It's that I told him it's a carrot at the end of the stick. Let's get you off meds, but you do your job. I'll do my job. And in the meantime, you know, maximize the chances. Not going to be any cardiac damage.

• 33:46Dr. Darshan Shah?

  So I agree. Exactly. Yeah. And Dr. Khan, you know, you, you were talking a lot about cardiac damage, but what's great about what we're talking about is really attacking the root causes of all disease. So, you know, when we were looking at high blood pressure, we're not just protecting your heart, we're protecting your brain from Alzheimer's, we're protecting your kidneys, we're protecting every organ and every organ that gets blood flow in your body. Right? So we use a heart as an indicator of how our treatments are working because it's so important to, to protect our heart, of course, but you're just really promoting overall health.

• 34:17Speaker 01

  Yeah, I agree. And, you know, I'll throw out a controversial one. I don't like statin medication, but this surgeon we talked about is the exception. My practice is full of 48 and 52 year olds with very advanced silent heart disease on the calcium score, on the CT angiogram, on the Carata study. I mean, they've got 30 years to get through life, 35 years without a bypass, without a stem, without a heart attack. And, you know, one day we'll have gene therapy and CRISPR technology, but right now we got the tools we got. And, you know, if I got to get their LDL to 40 or 50, which is the international guideline for advanced heart disease, you know, I'll try like hell with supplements and diet and

• 35:01Speaker 01

  antioxidants, but you know, ultimately they need statins. And, you know, although it's the word on the street that statin medication causes dementia, all the studies in the last 24 months say the opposite, that you are protecting a person's small and large vessels through their brain and the database. And again, statins are basically free nowadays. So it's not a multi-billion dollar industry with generic statins. And I'm not pushing drug. I'd like it to be known. I'm the guy that tries to take you off drugs. But like you said, when you really care about the patient, you, you know, you gotta hit certain targets. And if I can do it with diet and fitness and supplements, fantastic. But the targets are tough nowadays. I mean, we really are pushing people's numbers down

• 35:46Speaker 01

  that have serious disease. Now, the good news is, like the surgeon, when you, I see 52 year old woman, they're on Lipitor. And I say, whoa, let's get a calcium score, let's get a carotid, they have no disease. You know, we're de-prescribing, I love that word. We're taking their drug away. So that's the flip side. Too many, you know, pre-menopausal or menopausal women are on drugs they don't need. Although they're at risk, women are at risk. And I'm a big HRT fan, you know, if you're going through menopause, go get somebody else, expert like you.

• 36:17Dr. Darshan Shah?

  I agree with that. And you know, like, I think a lot of women, when they go through menopause, their cholesterol goes up because of hormone deficiency. And then the knee jerk reaction of a primary care doctor is he got to put you on a statin. And really, they didn't need that in the first place. What they needed was hormone replacement therapy. So it's super important. One device before we move on from high blood pressure that I'm really excited about is E E C P. Have you seen this? And what do you think about E E C P?

• 36:41Speaker 01

  I bought the first machine in the state of Michigan in 1995. I had read some literature that they had. So there's a device that cardiologists use in the cath lab, super sick people called a balloon pump. Oh, I love putting in balloon pumps. Big sheath in the groin, ba boom, ba boom, you know, the whole room says, you know, that guy's in charge, you know, it's like a super macho testosterone thing. But some Chinese investigators said, if it works to rotate the blood internally with a balloon, can't we put trousers on the outside of a patient and go ba boom, ba boom, and circulate the blood? And they created this room sized device. And then a researcher in upstate New York named Peter Kahn, miniaturized it

• 37:24Speaker 01

  and published data, actually randomized studies, that angina goes away and nuclear stress tests got better. A 1,200 patient randomized study and the FDA approved it. So I bought a machine in suburban Detroit, and we were the first to treat patients. An hour a day, five days a week for seven weeks. That was the protocol from China and New York, 35 sessions. Quite expensive, five, six thousand dollars, but it was FDA approved, so you apply to insurance if you were having an angina. Stuff works, whether it builds collaterals, whether it improves endothelium, whether it lowers cardiac hormones. It has gone by the wayside due to stents, due to better pharmacotherapy, due to hopefully lifestyle therapy.

• 38:08Speaker 01

  But academic centers will still have it. I've always heard that Barry Gordy in LA, and actually John Sally in LA, the great seven foot MBA star, used to talk to me forever. Let's put in a center in LA of E E C P. And I I've heard that Barry Gordy had a center just for wellness, and there are people trying to offer it for wellness. I don't know what it'll do for blood pressure, but it does improve endothelium. There are men that report improved sexual function. Uh, you know, we hear about cold plunge, we hear about infrared sauna. You don't hear that much about E E C P. The machines used to be a quarter million dollars. They're now about, you know, fifty thousand dollars, so it's a little bit more accessible. But, and it's pretty safe, but you just don't hear that much about E E C P anymore.

• 38:53Dr. Darshan Shah?

  Yeah. So, you know, I've seen some studies on blood pressure as well, and um, I'm so excited about it. We're putting E E C P in all of our next health offices, actually, to use it for wellness.

• 39:03Speaker 01

  Brilliant wellness step. Yeah.

• 39:05Dr. Darshan Shah?

  Right. Yeah. So I'm I'm super excited and, you know, we're gonna have thirty locations all over the country, hopefully Detroit as well. So, you know, we'll we'll have, um, we'll have someplace to send people. Yeah. I'm I'm excited about it because it is something that you can, it's not a pharmaceutical that can be potentially very helpful. So, we're gonna obviously be studying it as we as we launch it.

• 39:24Speaker 01

  People with long COVID that have endothelial damage from the spike protein, go pump away. I mean,

• 39:30Dr. Darshan Shah?

  Exactly.

• 39:31Speaker 01

  We're seeing a lot, a lot of spike protein damage in my clinic, seriously.

• 39:36Dr. Darshan Shah?

  Same, same. We're seeing a ton of, it's just mind blowing and this, we're gonna be learning so much about spike protein. Can we touch base on nitric oxide real quick? This is another very important topic that doesn't get enough airtime. Love to hear your perspective on nitric oxide.

• 39:50Speaker 01

  Sure. So for those that may not know, there was this chase in the 1970s and 80s. What causes arteries to relax and dilate? And a chemical that had three different names around the world, ultimately was found to be the same chemical. And the name was agreed upon to be NO, nitric oxide, one nitrogen, one oxygen. Those three researchers won the Nobel Prize in Medicine in 1998. And there's a hundred thousand articles about nitric oxide in the medical literature. The more you make, the more normal your blood pressure, the more normal your endothelium, the better your sexual health, the better your pulmonary function, the better your brain function. It's a, you know, a signaling molecule made by the artery.

• 40:33Speaker 01

  It goes right back and causes the artery to stay healthy. It only lasts for a couple of seconds. So you can't get a nitric oxide blood level. It's too quick. Which is the problem because 1998 was at 37, 27, 37 years later. We don't have a good test for it. You can buy these little test strips.

• 40:52Dr. Darshan Shah?

  I always have.

• 40:53Speaker 01

  Little test strips right there and you put your saliva and if it turns bright pink, you've got a lot of nitric oxide in your saliva, which is a good thing. And if you're using Listerine and Scope or fluoride toothpaste, you kill that reaction. You can prove that. Your blood pressure may go down if you quit Listerine, Scope. I've got people that have Raynaud's, the cold, red, white and blue. They stop Listerine and Scope. They make more nitric oxide. They can prove it. And their Raynaud's goes away. It's the most fascinating thing. You know, brush your teeth, floss, water pick, but maybe not use antibacterial mouth treatments if you don't need them. There's a blood test called ADMA asymmetric dimethylarginine.

• 41:34Speaker 01

  It competes with nitric oxide and if it's high, your nitric oxide production is low. But all we can do is all the good things, all the good things should make more nitric oxide. The exercise, the monitoring of blood pressure, the eating leafy greens, eating beets, eating watermelon, eating pine nuts and others, um, they all contribute to nitric oxide production. That's why there's so many beetroot powder chewies and, you know, powders that are on the market. I'm not a big fan of any of them, but, uh, some athletes have found that certain beetroot powders, uh, red spinach is a major dietary nitrate contributor. And you can get capsules with red spinach or powders with red spinach. There's no oxalates in red spinach, so you don't have to worry about kidney stones. Kind of a cool little tip.

• 42:19Speaker 01

  Um, so, um, and of course indirectly Viagra and Cialis now generic. They work by maintaining your nitric oxide in your blood, uh, for longer duration. They, uh, block the enzyme that degrades it or degrade cyclic GMP. But if you're not making enough, those drugs aren't going to work. That's why some guys try those drugs and they don't have much of a response. Cause their vessels are so damaged or their lifestyle is so altered, they're just not making nitric oxide. So you don't have any around to prolong its activity level. So, yeah, it would be a huge breakthrough if we could test it better. There are some interesting lozenges and if you don't know Nathan Bryan, PhD, but you might know him. He's sort of the king of nitric oxide.

• 43:03Speaker 01

  He's got a new book out. He'd be a great person to interview. Um, very dear friend and he makes a nitric oxide lozenge called N101, uh, which is what I go to when I need a lozenge. It's, um, a very interesting breakthrough in nitric oxide support.

• 43:19Dr. Darshan Shah?

  Oh, I'd love to interview one of these days because I'm very interested in the topic. Fantastic. And then let's talk a little bit about, I'm a big believer in empowering our patients, right? And one of the ways I try to empower my patients is to educate them on the biomarkers that they should be following for themselves, because no one's going to care more about your health than you do, right? Even Dr. Khan or Dr. Shaw that really wants to see you be healthy, we just don't have the bandwidth to monitor every patient's biomarkers every single day. And so I would like to empower my patients by telling them, these are the two or three things that you need to follow. So you understand the status of your cardiac, your cardiac status. And so to me, I tell everyone they need to know what their LPA is, they need to check it one time, make sure it's not high. I'm a big believer in

• 44:04Dr. Darshan Shah?

  just giving them one number now, ApoB to follow. What are your thoughts around ApoB?

• 44:08Speaker 01

  Yeah, if you actually had to pick one, you know, people get the full page cholesterol panel.

• 44:14Dr. Darshan Shah?

  They're so confusing to people.

• 44:15Speaker 01

  And things are yellow, red, green. That one number, ApoB, does count all the bad particles in one number. Now, if you have inherited lipoprotein A, it'll be there. If you just have lifestyle or genetic cholesterol, it'll be there. So I agree. And, you know, the most recent data published three weeks ago from the UK Biobank said, you know, it's all about ApoB. But that's a 40-year-old marker. I mean, I went to, I, I co-lectured with Thomas Dayspring, one of the country's leading cholesterol experts, 40 years ago, and he was screaming, "Check ApoB." So again, us doctors are so slow to incorporate new ideas. And it's, you know, a $25 blood test. So if we just tracked ApoB, you're dropping

• 45:00Speaker 01

  it from 130 to 110 to 90. And a lot of people are well under 60 nowadays, which is kind of a nice sweet spot for arteries.

• 45:08Dr. Darshan Shah?

  Right. Fantastic.

• 45:10Speaker 01

  And you know, the thing is, everybody's screaming, "You need cholesterol for your brain." I don't hear anybody screaming, "You need ApoB for your brain." So we're going to get a couple of years of peace and quiet from the cholesterol deniers.

• 45:22Dr. Darshan Shah?

  Oh my gosh, the, the, the arguments are so ludicrous on social media about cholesterol. It just doesn't make any sense.

• 45:28Speaker 01

  Well, thank you for saying that because I'm so exhausted by fighting, uh, the deniers. And I've done it for so many decades.

• 45:36Dr. Darshan Shah?

  Right, right. And I'm sure you also face a lot of, uh, controversial, um, statements around your, your diet choice, being a vegan. And, um, you know, I, my talk track with my patients is, look, I don't, I don't, I really don't care if you eat meat or not, but if you are going to eat meat, the saturated fat for most people will cause long-term problems for you. And then we talked about a lot of different ways, not just increasing cholesterol, but also increasing inflammation. And I think that's a really important way to kind of frame this. And also I see vegans that are super unhealthy because their diet is mostly horrific processed carbohydrates. So, you know, I, I, I'd love to hear how you talk to your patients about their diet.

• 46:19Speaker 01

  Yeah. And, and I agree, you know, I've had the opportunity to be on Rogan and debate diet with a pro paleo. And I've been on the doctor's show and debated Paul Saladino, carnivore, paleo, keto. And, you know, I try and have reasonable conversations with people. Obviously, everybody agrees and, you know, get rid of highly processed, you know, fast food, frozen food, chemical rich, uh, the very conversation going on in Washington DC, thank goodness, you know, and we got to start with the kids and the school lunches because they're the most vulnerable, but it's important for us too. Then the question is if your plate is full of fruits and vegetables and a small portion of your protein of choice, I love the term, my protein of choice, maybe tofu and yours is chicken or grass-fed beef

• 47:04Speaker 01

  or salmon or something. I mean, it's a pretty small debate at that point. Um, you know, all carnivore, I recognize there's some amazing clinical responses, you know, reported, not in the medical literature, there's so little medical literature, but you know, uh, uh, and I believe, you know, Michaela Peterson probably did get better with a carnivore diet. God bless her. So I'm happy for her. But I agree, just get rid of crap. I mean, there are too much crap everywhere. And, you know, doctors eat crap non-stop, but I walk up and down the hall of my medical building at lunchtime to just move a little bit and I can look in the lunchroom of the endocrinology group and they're eating crap that the rep brought in.

• 47:43Dr. Darshan Shah?

  Krispy Kreme, right?

• 47:45Speaker 01

  You know, we're all so susceptible and weak and you just can't have it in my house. I just can't have it around. So get rid of crap would be a great start.

• 47:55Dr. Darshan Shah?

  I love it. I love it. Well, Dr. Khan, this has been such a fantastic conversation. I know you have patients. I am so coming up here right after this talk and I'm so appreciative that you took some time out of your busy schedule to talk to me and my audience. You're one of the most innovative and exceptional cardiologists that I've ever met. And you know, I read your book 10 years ago, The Whole Heart Solution. I suggest everyone read that book. It's an easy read and it's not just about your heart. It's about just overall health. And Dr. Khan, when's your next book coming out and what's it going to be called?

• 48:27Speaker 01

  Yeah, it's called The War on Heart Attacks. It's going to be thick. It's going to have all my secrets. I hope to be practicing for about another 10 years, but I it's time to just share everything. It's a pretty like if you know the term red ocean, blue ocean. Preventive cardiology is a pretty blue ocean. There's not a lot of people talking, writing, you know, social media. So I feel an obligation to, you know, kind of write a big book, hopefully grab a good publisher. So it'll be 2026. Thank you.

• 48:56Dr. Darshan Shah?

  Thank you. I can't wait to have you back on to talk about that book as well, if you don't mind.

• 49:01Speaker 01

  You betcha. Thank you so much.

• 49:02Dr. Darshan Shah?

  Thank you so much, Dr. Khan. Until next time, you take care.

• 49:06Speaker 01

  Bye bye.

• 49:07Dr. Darshan Shah?

  Thank you.

• 49:10Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.