America's #1 Heart Risk & How You Can Prevent It

My life-changing annual event, The Summit of Greatness, is happening September 12 & 13, 2025. Get your ticket today! Heart disease kills 20 million people worldwide each year, yet most people fear cancer more than the real threat silently building in their arteries. Dr. Jeremy London, a heart surgeon with 25 years of experience and over 6,500 heart surgeries under his belt, shares the raw truth about what lands people on his operating table. His personal wake-up call came at age 55 when he needed his own heart procedure, leading him to quit alcohol and transform his entire approach to health. The most vulnerable moment comes when he describes losing patients - something that still keeps him awake at night after decades of surgery. We discuss life-saving insights for anyone who wants to protect their heart before it's too late, with specific action steps that could prevent you from becoming another statistic. Sign up for Dr. London’s FREE newsletterThe Dr. Jeremy London PodcastIn this episode you will learn:Why obesity and poor diet create the perfect storm for heart disease and how to break the cycleThe shocking truth about vaping that's sending healthy young adults to the ICU on life supportHow "broken heart syndrome" can literally cause your heart to fail after emotional traumaThe three pillars that reduce cardiovascular events by over 50% (and why most people ignore them)Why alcohol might be the next cigarettes and how quitting transformed a heart surgeon's lifeFor more information go to https://lewishowes.com/1803For more Greatness text PODCAST to +1 (614) 350-3960More SOG episodes we think you’ll love:Dr. Rhonda Patrick – greatness.lnk.to/1707SCDr. William Li – greatness.lnk.to/1410SCGlucose Goddess – greatness.lnk.to/1575SC Get more from Lewis! Get my New York Times Bestselling book, Make Money Easy! Get The Greatness Mindset audiobook on SpotifyText Lewis AIYouTubeInstagramWebsiteTiktokFacebookX

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

• 0:00Lewis Howes?

  Do you think someone can die from a broken heart?

• 0:02Speaker 01

  The short answer is yes.

• 0:04Lewis Howes?

  Really?

• 0:04Speaker 01

  And there is an actual syndrome, Broken Heart Syndrome.

• 0:08Lewis Howes?

  Really?

• 0:08Speaker 01

  It is a thing. 50% of Americans have high blood pressure.

• 0:13Lewis Howes?

  Really?

• 0:13Speaker 01

  And the majority don't even know they have it. Most people, if you ask them, you know, what are you afraid of dying of? They all say cancer, but it's really not the case. It's heart disease.

• 0:23Speaker 02

  He is a board-certified cardiovascular surgeon.

• 0:25Speaker 03

  His tips for living well and protecting your one and only heart have racked up nearly 50 million views on YouTube.

• 0:32Speaker 04

  I am super excited to introduce you to Dr. Jeremy London.

• 0:36Lewis Howes?

  What is the main cause of us having heart disease, heart attacks, heart conditions?

• 0:42Speaker 01

  Nothing happens in a vacuum in our bodies.

• 0:44Lewis Howes?

  It's all connected?

• 0:45Speaker 01

  Everything is connected.

• 0:46Lewis Howes?

  How much does vaping affect the heart health for Gen Z?

• 0:50Speaker 01

  Have I seen really life-threatening situations from vaping? 100%.

• 0:56Lewis Howes?

  What have you seen?

• 0:57Speaker 01

  The short story with vaping is

• 1:03Speaker 01

  I read a stat that said 805,000 people have heart attacks each year in the U.S. One heart attack every 40 seconds, which seems crazy to me that this is such a big issue for us as Americans. And it sounds like around the world as well. So I'm curious then, what is the main cause of us having heart disease, heart attacks, heart conditions that affect us living a healthy life or dying? To zoom out just a little bit further to put the perspective on this worldwide?

• 1:37Lewis Howes?

  Yeah.

• 1:37Speaker 01

  It's 20 million deaths a year. So it's the leading cause of death of men and women worldwide. And most people, if you ask them, you know, what are you afraid of dying of? Or what do you think the biggest? They all say cancer. But it's really not the case. It's it's heart disease worldwide. Now, of that group, the most common reason is blockages in the heart arteries. And that's what causes heart attacks. We have arteries that are on the surface of our heart that bring nourishment to the heart muscle, which is just a pump.

• 2:15Lewis Howes?

  Uh huh.

• 2:16Speaker 01

  It's just, you know, that pump requires energy. And in our bodies, that's nutrition and oxygen. Well, if you get a blockage in there over time, usually from cholesterol buildup, that then creates a, basically a roadblock to the heart muscle below. And if that gets tight enough or completely blocks, that's when you have heart attacks. And that's, that's the single biggest bucket in that 20 million. But there are a lot of different reasons why people get heart disease. You can have valve problems within the heart. You can have electrical problems. Those are the three most common buckets. And then there's, of course, congenital heart disease. People are born with abnormalities, and they all go in those numbers too.

• 3:00Speaker 01

  But the majority of it is because people are getting blockages.

• 3:04Lewis Howes?

  How much does stress affect heart health?

• 3:10Lewis Howes?

  If someone's just feeling like overwhelmed, burnt out, mentally in their head constantly?

• 3:15Speaker 01

  Sure.

• 3:15Lewis Howes?

  Can that affect heart health or hurt you?

• 3:19Speaker 01

  So the way I would look at this is nothing happens in a vacuum in our bodies.

• 3:24Lewis Howes?

  It's all connected.

• 3:25Speaker 01

  Everything is connected. Our mind, our nervous system, all connected to our blood vessels, our heart, et cetera. Is that a major risk factor? No, it's not necessarily a major risk factor, but it definitely plays a role in heart disease.

• 3:45Lewis Howes?

  It influences it.

• 3:46Speaker 01

  A hundred percent.

• 3:46Lewis Howes?

  It influences your body feeling sick. And if your body feels sick, it puts

• 3:50Speaker 01

  Absolutely.

• 3:51Lewis Howes?

  stress on the heart and that could, yeah. So what would you say then are the three biggest factors of heart disease?

• 3:56Speaker 01

  Sure.

• 3:58Speaker 01

  The first would be obesity.

• 4:01Lewis Howes?

  Really?

• 4:01Speaker 01

  Yep. Mm hmm. And along with that, you know, comes poor diet and insulin resistance, high blood pressure,

• 4:12Speaker 01

  diabetes.

• 4:16Speaker 01

  High cholesterol,

• 4:20Speaker 01

  sedentary lifestyle, and we cannot leave out smoking.

• 4:25Lewis Howes?

  Really?

• 4:27Speaker 01

  Because that is the single worst thing you can do for your body. Again, thinking about it like a vacuum. Smoking affects the lungs, it affects all the arteries, and it's the leading risk factor really for heart disease.

• 4:43Lewis Howes?

  Really?

• 4:44Speaker 01

  Oh, yes.

• 4:44Lewis Howes?

  So here's a question that most people are not gonna like the answer to probably. How much does vaping affect the heart health for Gen Z?

• 4:53Speaker 01

  Yeah, so the short story with vaping is unlike tobacco use, we don't have the years of data. So it's hard to really say, you know, there's all the data of, oh, it's better than.

• 5:08Lewis Howes?

  Right, right, right.

• 5:09Speaker 01

  We don't know what the long-term implications are. What we do know is there's a lot of people doing it. They're doing it all the time because unlike cigarettes, you don't have to go outside.

• 5:20Lewis Howes?

  You're smoking every five seconds.

• 5:21Speaker 01

  Right.

• 5:22Lewis Howes?

  Yeah, yeah.

• 5:22Speaker 01

  You constantly see the blue lights all the time. You don't have to go to the room at the airport anymore that now they've actually taken those out altogether. So the issue is we just don't know the long term. But the nicotine content in those vaping formulations is essentially unregulated. So they can have just multitudes higher levels of nicotine than cigarettes. And again, because you can do it all the time, the exposure is all day long. So nicotine in and of itself is a vasoconstrictor.

• 6:03Lewis Howes?

  So it constricts the valves?

• 6:06Speaker 01

  Not the valves, the actual blood vessels themselves to constrict.

• 6:11Lewis Howes?

  And what does that do when it's pumping through the heart?

• 6:13Speaker 01

  Right, so if you think about it again as the heart as a pump.

• 6:17Lewis Howes?

  You got a, you got a little example here.

• 6:18Speaker 01

  Absolutely, so the big chambers down here, you have the right and the left chamber. The left chamber here is. The main pumping chamber and it's pushing blood out through the aorta. That's why it's red because it's got lots of oxygen in it to the rest of the body. So if all of these blood vessels are clamping down and this pump is trying to work against that system. What do you think that causes? High blood pressure. Interesting, and that's one of the main causes of. Exactly, because high blood pressure over time does two major things. One, you get decreased, what we call elasticity of the blood vessels. They become stiff, so they don't flex with each heartbeat.

• 7:03Speaker 01

  And as they become stiff, they can then become damaged. And the repair process from that damage is what causes atherosclerosis or hardening of the arteries. So you've got direct damage from the higher pressure. And then over time, because the left ventricle or that pumping chamber is just a muscle. What happens if you put any muscle time under tension? It's going to grow, it's going to get thick. Well, when the muscle gets thick, it decreases the size of the cavity where the blood comes from. So less blood is getting ejected from the heart. And then the end result of that, as it works against resistance, is eventual heart failure. Interesting.

• 7:49Speaker 01

  And so it's really a continuum timeline. And that's why high blood pressure is such an important risk factor. And, you know, 50% of Americans have high blood pressure. Really? And the majority don't even know they have it. And it's one of the single most modifiable risk factors that we can have. How can we lower our blood, high blood pressure if we have it? Well, the pillars that we talk about all the time, you know, a solid. Nutrition, low stress. That's right, regular exercise, both, you know, with aerobic training as well as resistance training. All of those things are really, really important.

• 8:30Speaker 01

  And you can modify your blood pressure significantly with just lifestyle changes. Now, many people do need medications, and that's not a failure, you know. But getting your blood pressure under control is really important from a heart disease standpoint. How many heart surgeries do you feel like you've done in the last 25 years as a heart surgeon? You know, we've estimated this on multiple different times because the beginning of my career, I was doing, you know, crazy, crazy numbers, probably somewhere around 6,500 to 7,000.

• 9:04Lewis Howes?

  Wow. Six to 7,000 heart surgeries in 25 years or heart operations in 25 years. What are the three things that all those people had in common that got them on your operating table with some type of heart failure?

• 9:19Speaker 01

  So they don't all have heart failure. So I think that's, yeah.

• 9:25Lewis Howes?

  Some heart condition.

• 9:26Speaker 01

  Exactly.

• 9:27Lewis Howes?

  Gotcha.

• 9:28Speaker 01

  And depending on why they're there, again, the three buckets, either blockages in the arteries, problems with the valves, or problems with the electrical system. That's why they get there. So let's go with the most common, which is blockages in the heart artery.

• 9:42Lewis Howes?

  That's where the most common, when you see it?

• 9:44Speaker 01

  That's the most common operation that we do.

• 9:46Lewis Howes?

  Like 60, 70%?

• 9:47Speaker 01

  Probably, yeah, probably 60% would be a.

• 9:52Lewis Howes?

  Is a blockage?

• 9:53Speaker 01

  Yes. It would be a blockage in the artery that would be picked up either because patients were having symptoms, or because they were in a high-risk category and their internist or cardiologist recognized that and intervened before there was a problem.

• 10:09Lewis Howes?

  What are the main symptoms someone might have if they're in, if they have, you know, that restriction?

• 10:14Speaker 01

  Sure. So, heart symptoms from blockages is frequently referred to as the great masquerader. Because not everybody presents with what I call the TV heart attack, where it's clutching the chest, pain into the jaw, pain down the, now, many people do. But the symptoms can be very subtle, even in that pre-heart attack phase, there are warning signs. Well, if you have a blockage in one of the main arteries that's supplying, again, the pump, and that blockage gets significant enough, as you exert yourself, you outstrip

• 10:55Speaker 01

  the amount of nutrients and oxygen that can get to that portion of the heart. What happens in your calf when that? Happens when that occurs, you get a charlie horse.

• 11:04Lewis Howes?

  Mm hmm.

• 11:05Speaker 01

  What happens in your, in your heart muscle is you have tightness in your chest. Or it can be shortness of breath, or it can be abdominal pain even. And the symptoms can be very subtle. The key is that the symptoms come on with activity. And then when you sit down, it's relieved with rest. That's referred to as stable angina or stable chest pain. In other words, warning signs of something potentially bigger to come.

• 11:35Lewis Howes?

  If someone's having that type of a warning sign, what should they do?

• 11:39Speaker 01

  That is, that is a red flag and you should be evaluated by a qualified healthcare.

• 11:44Lewis Howes?

  Call 911 right away or is it?

• 11:46Speaker 01

  Not necessarily 911, as long as the pain goes away.

• 11:50Lewis Howes?

  Got it.

• 11:51Speaker 01

  If the pain continues, absolutely 911 is the answer. But if it's the kind of thing where you notice, for example, every time I take the garbage out. I get this little tightness in my chest and I have to stop for a minute. The pain goes away and I go walk back in the house and it, eh, it kind of comes back. But every time I rest, it's relieved. That's stable angina. It is definitely something that needs to be evaluated, but not, not necessarily an emergency. However, if you're ever concerned, that's the safest route to take.

• 12:23Lewis Howes?

  Wow. Okay. So again, I heard you in the beginning say obesity with poor diet is one of the main causes or the, or the main reasons why people have heart conditions, heart diseases. High blood pressure and diabetes also influences heart conditions or failures in a big way. Sedentary lifestyle. And you also mentioned smoking. We were talking about vaping a little bit, which we don't have the data it sounds like yet of how it actually influences the heart. But are you seeing or noticing? Signs or patterns of people coming in who also vape? That are just happen to also be vaping that have heart conditions?

• 13:04Speaker 01

  So, think about the demographic of people that are vaping primarily. It's usually younger.

• 13:08Lewis Howes?

  Yeah, yeah, yeah.

• 13:09Speaker 01

  So, folks under the age of 40 that don't have a family history, they're not diabetic. You know, the risk of heart disease there is certainly lower. Now, have I seen really life-threatening situations from vaping? Absolutely, which is why.

• 13:25Lewis Howes?

  You have.

• 13:26Speaker 01

  100%, which is why.

• 13:28Lewis Howes?

  What have you seen?

• 13:30Speaker 01

  Well, there is a syndrome called E-VOLI, which is e-cigarette vaping-associated acute lung injury. And this is an injury that can occur from vaping one time, from an inflammatory process that happens in the lungs in these really young folks. They come in the hospital, they're so sick that even the ventilator, the breathing tube, is not adequate to nourish their body with oxygen. And we have to put them on something called ECMO, which is an external lung circuit where we take blood out of the body.

• 14:10Lewis Howes?

  Yeah.

• 14:11Speaker 01

  Put blood back, oxygen back into the blood and return it to the body. And these can be 18, 21-year-old, 23-year-old individuals. And unfortunately, we've had several that haven't survived.

• 14:24Lewis Howes?

  Really?

• 14:25Speaker 01

  Absolutely.

• 14:25Lewis Howes?

  So, these are all patients who have vaped? It was caused from the vaping?

• 14:29Speaker 01

  Absolutely.

• 14:30Lewis Howes?

  What's the youngest patient you've had to operate on?

• 14:34Speaker 01

  To place them on ECMO for the.

• 14:37Lewis Howes?

  Just as like a heart, a heart failure, a heart disease?

• 14:39Speaker 01

  So, for heart disease, 23-years-old is the youngest patient I've ever operated on for bypass surgery, for blockages in the arteries. 23-years-old, had a very strong family history of heart disease. And they had a genetic propensity for very high cholesterol, which is not common, but it does occur. And their cholesterol. was in the thousands whereas normally you know you want it around ninety to a hundred theirs was in the thousands

• 15:11Lewis Howes?

  was this person healthy in general or were they not they were more obese or more

• 15:16Speaker 01

  no

• 15:17Lewis Howes?

  poor diet as well

• 15:18Speaker 01

  absolutely

• 15:18Lewis Howes?

  they weren't influencing the reversal of that

• 15:21Speaker 01

  they were not and they would have needed medication to help do that because they had all of the genetic force behind them then to get to that spot and then they didn't take care of themselves on top of it

• 15:34Lewis Howes?

  so we don't have a lot of the data yet I'm hearing or the research around how vaping causes heart disease yet is what I'm hearing but you've had to operate on many people who have come in because of vaping is that correct

• 15:46Speaker 01

  yeah it's not many I would say yeah I don't think that

• 15:50Lewis Howes?

  handful

• 15:51Speaker 01

  yeah for sure but I mean you see three four five young adults not survive from an addiction and something that has become normative in our society today you know and I have three boys

• 16:06Lewis Howes?

  wow

• 16:07Speaker 01

  and so it hits really close to home for me I'm I am really on a personal quest to get the information out about about vaping and look in the end your body your rules like I get it but at least know the facts at least understand that we really don't know the implications of this the all of the all of the chatter about this is a safe alternative we don't know that

• 16:36Lewis Howes?

  do you think those people that came in if they weren't vaping or weren't smoking do you think they would have also been there because of other lifestyle choices or do you think the vaping or smoking heavily influenced the heart failure

• 16:47Speaker 01

  so for sure the cardiac patients a hundred percent it's it's like a you know ten twelve fifteen X factor when people are smoking cigarettes in particular

• 16:59Lewis Howes?

  wow

• 17:00Speaker 01

  yeah for sure for sure I mean if you're gonna examine like if we're gonna take a step back for a second and say am I healthy right now you know how would how would you do that Number one would be, do you smoke? Let's start there. The next on the list would be.

• 17:19Lewis Howes?

  Alcohol or?

• 17:20Speaker 01

  Well, yeah, we can, we can leave that one off for, for just a minute. It can even be broader than that. There's a real powerful tool just to put yourself in a category like, how healthy am I? Excellent, good, you know?

• 17:33Lewis Howes?

  Average.

• 17:34Speaker 01

  Fair, poor. Believe it or not, they use that in research and it just kind of puts you in the mindset of where do I fall?

• 17:41Lewis Howes?

  Interesting.

• 17:42Speaker 01

  Then what are you going to do next? You're going to weigh yourself, right?

• 17:45Lewis Howes?

  Body mass index.

• 17:46Speaker 01

  Which is not a great indicator of longevity. And we can talk about the better ways to do it, but it's a good place to start. Right? Then just measuring your abdominal girth to your height. That ratio is very meaningful. Again, we talked about obesity, this over consumption problem. Well, we know that visceral fat or the fat that's in your belly around your organs is the engine for inflammatory diseases, particularly heart disease.

• 18:14Lewis Howes?

  Yeah, and if you have a lot of excess belly fat, then you probably have fat around your heart too, I'm assuming.

• 18:19Speaker 01

  You do, but it's this fat in particular.

• 18:23Lewis Howes?

  The external fat, the visceral.

• 18:24Speaker 01

  The visceral around your organs, not the fat that's in, you know, under your skin in between here.

• 18:30Lewis Howes?

  Inside.

• 18:31Speaker 01

  Inside that you really can't.

• 18:33Lewis Howes?

  Not the belly fat.

• 18:33Speaker 01

  It's the beer belly.

• 18:35Lewis Howes?

  Gotcha.

• 18:35Speaker 01

  Is really how I would describe it. That really influences the overall inflammatory process in your body. And it's a known risk factor for metabolic syndrome and type 2 diabetes. What would be next on the list? Resting heart rate. You know, kind of where am I on, on that scale? And start with, with those things. Then you start to look specifically at lifestyle. You look at diet, you look at alcohol, you know, where am I on the scale? You look at your sleep. Simple things with sleep. What, am I going to bed at the same time every night? Am I getting, you know, six to eight hours? Am I waking up at the same time? And then, as you mentioned earlier, like, what is my mental health status? Where am I with that?

• 19:20Speaker 01

  And that can be tough, but there's some great online questionnaires that you can do. And that's a great place to start, like, how healthy am I? Not just from a, from a cardiac standpoint, but in general. And sometimes just kind of knowing where you are currently. As an opportunity opens that door.

• 19:41Lewis Howes?

  I mean, we're in a society right now that people praise those who are, you know, plus sizes or don't shame someone for how big they are, things like that. And I'm all for not shaming or judging people. But when it comes to people's heart health or just overall quality of life.

• 20:01Speaker 01

  Yeah.

• 20:01Lewis Howes?

  If they're extremely obese and they're not taking accountability for their lifestyle decisions, they might be causing a lot of physical harm to themselves, more medical bills, medications in the future, and also putting strain and stress on the people around them. By not taking care of their health. I'm not saying you have to have a six pack and be perfect. That's not what this is about. But what do you say as a doctor to society that says, you know, celebrate anyone for how big they want to be. It's a good thing, you know, let's not shame anyone. How do you navigate that to support people's emotions and feelings and how they feel or their their own personal experience in life versus

• 20:46Lewis Howes?

  leading them to take accountability in their life and take responsibility for their health? Not being perfect, not being a cover model or something like that, but like making sure you're responsible for your health, for your future, the family you have in the future, the people around you. How do you navigate that? People's emotions versus practicality?

• 21:06Speaker 01

  You've touched on so many things there, but let's, let's, let's try to slide down the first slippery slope.

• 21:12Lewis Howes?

  Yeah, yeah.

• 21:13Speaker 01

  Which is, you know, how do you enter that conversation and potentially change that narrative? Because I, I agree with you that I think that, that it's dangerous to validate a lifestyle that we know from the data is not healthy on so many, on so many fronts. So how do I do it personally? When, you know, when a patient comes in and you start that conversation, right? Like, they tell you, I don't have any risk factors and they're 70 pounds overweight. You're like, okay, let's, let's take a step back. I think many times.

• 21:55Speaker 01

  Allowing people to understand that the life they've lived to getting to that point doesn't necessarily define what their path is forward. And when you, when you kind of give them a new set point of, okay, you've, you've gone down a road and it's gotten you to a place where now you're potentially in trouble, or if you're seeing me, you probably are. How do you picture yourself five years, 10 years? Who's the person you want to be?

• 22:36Speaker 01

  And almost invariably, it's not who they are at that point. And each individual person is so different on how you have that conversation. But I do think that that overall narrative is dangerous because it creates an insulation in a way that, that you're really abdicating a potentially very unhealthy scenario. And so I think that backing into it from that perspective, from a non-emotional way, not totally non-judgmental, and then break down each of those things that you just talked

• 23:20Speaker 01

  about into really small steps for people. Because most of the time, folks are really overwhelmed. They don't really know where to start. They're scared. They're scared. They're already at a deficit. They're worried they're gonna fail.

• 23:36Lewis Howes?

  They're already in shame.

• 23:37Speaker 01

  Hundred percent.

• 23:38Lewis Howes?

  And the food relieves some of the shame feeling.

• 23:40Speaker 01

  Many times. Many times. And I don't know who said it, but I love that quote, you know, that fear is ocean wide, but only an inch deep. And I think that if you can help folks take that first step. And it can be simple stuff, just walking.

• 23:57Lewis Howes?

  Yeah.

• 23:57Speaker 01

  Like, many of those folks are just really uncomfortable walking into a gym, and you can appreciate that.

• 24:04Lewis Howes?

  Yeah.

• 24:04Speaker 01

  And all of the, "You need to be comfortable with the body that you are," that doesn't help. Now, do I think it's about finding, as you point out, the healthy weight for you? That doesn't mean that you're a swimsuit model necessarily. And so you have to set appropriate goals. So I think allowing people to identify where they are and the person they want to be, and then helping them break that down into really small steps, has worked really well for me in the practice.

• 24:34Lewis Howes?

  Yeah.

• 24:35Speaker 01

  It really has.

• 24:36Lewis Howes?

  I guess it's challenging because if someone is seventy, a hundred, a hundred fifty pounds overweight, it's not just a, you know, physical, practical thing for them that got them there. There's some type of emotional or mental trauma or blockage also.

• 24:53Speaker 01

  Sure.

• 24:53Lewis Howes?

  Not just a hard blockage, but an emotional or mental blockage that has allowed them to get to that place of not taking care of themselves in a certain way around health. Maybe they're like amazing people, and they're good for other people, and they're smart, and they're talented, but something has been blocking them emotionally or mentally to want to create that for themselves. And I can imagine how hard it is to reverse it, especially if it's been years of living in a familiar pattern. So it must be extremely hard. But how do we, how does someone watching this get through to someone in their life who is extremely obese and is just allowed, year after year, ten, twenty pounds a year to pack on every year,

• 25:37Lewis Howes?

  and they're not making any changes? It's almost like you need to be completely obsessed for a whole new identity and lifestyle. If you're gonna reverse a hundred pounds, seventy pounds, it's almost like you have to think a different way, and you have to start healing and mending certain things that caused those actions to get there, I'm assuming.

• 25:56Speaker 01

  Mm-hmm.

• 25:57Lewis Howes?

  But how does someone who's watching this, who has someone in their life they care about, who's struggling with this, that's afraid for their heart health?

• 26:05Speaker 01

  Sure.

• 26:06Lewis Howes?

  How can they communicate to the person they love in a way that doesn't judge them, but holds them accountable to start taking action?

• 26:16Speaker 01

  Yeah, and I think that that certainly is.

• 26:18Lewis Howes?

  That may not be your expertise.

• 26:20Speaker 01

  Yeah, you're stretching out outside of my wheelhouse, but not entirely. I mean, from my perspective, I have the benefit that if they're in my office, they're having a touch point in their life, that we are at a new crossroads. And so it enables me to utilize that as life is a series of choices, right? There's many times where we know better, but we don't do better. You now have a real reason to do better. And here's why, and here are the things that I recommend. And sometimes when folks fall into a level of complacency, as you've described, to break that pattern can be really tough.

• 27:02Speaker 01

  And so I think that obviously, from a supportive place, always makes the most sense. But when in doubt, fall back into the data.

• 27:11Lewis Howes?

  Share the data.

• 27:12Speaker 01

  How you started, how we started this conversation. It's not cancer that's going to take you most likely if you continue down this road. We know what the number one killer is of men and women. What do we need to do so that you don't get there?

• 27:26Lewis Howes?

  Yeah.

• 27:28Lewis Howes?

  And how much does alcohol affect heart disease?

• 27:34Speaker 01

  So, obviously, this has been a hotly debated topic that, you know, when we start talking about nutrition or alcohol, it rivals religious conversations with many people, with the emotional embodiment of how people step into this.

• 27:56Lewis Howes?

  But just on the data alone, not culturally or society.

• 28:00Speaker 01

  Let's talk about what happens when you drink. Okay, alcohol is broken down into two things. Acetaldehyde and acetate. Not to give you a bunch of chemical names, but acetaldehyde is what makes you feel good when you're drinking, if you find that to be good. It's also what's toxic to every single cell in your body.

• 28:22Lewis Howes?

  So poison?

• 28:24Speaker 01

  Hundred percent.

• 28:26Speaker 01

  And that is an undeniable fact. And acetate is basically empty calories. If you don't burn the acetate, you're going to turn that into fat, essentially. So those are the two major components. So when we look at this from a stepwise fashion, number one, it's directly toxic to cells. Number two, additional acetate goes to fat. Where does that fat go? It's visceral fat, abdominal fat, driving this engine. Not to mention the fallout is typically speaking, when you're taking in extra calories, when you're drinking, you're not mindful of what you're putting in your mouth. We've all been guilty of such. You know, so your overconsumption then becomes more of an issue.

• 29:11Speaker 01

  So there's a lot of ramifications to alcohol. But in the end, you know, alcohol is a personal choice. Of recent, even moderate alcohol use has really been questioned. And I think that data is going to come out very strong in the next two to three years. Personally, I think alcohol is going to be the new cigarettes in the next five to 10 years. I think there's going to be warning labels on alcohol, very similar to cigarettes.

• 29:42Lewis Howes?

  I hope so. I mean, I'm sure there's a lot of people in business who run alcohol businesses or restaurants that probably don't like me saying that. But I just don't know the benefit. There's got to be another way to sell product that people can enjoy that doesn't hurt them.

• 29:55Speaker 01

  Yeah.

• 29:55Lewis Howes?

  You know what I mean? There's got to be something else like that society can come up with. But I've never been drunk in my life. So I've never known what that feeling is. I've had sips of alcohol, but I've never been had a full beer. I've never had like

• 30:08Speaker 01

  Wow.

• 30:09Lewis Howes?

  A glass of wine. I have only had one sip of wine one time. It was with Gary Vaynerchuk because I told him I'd do it like 10 years ago. And I was like, this is the one and only time of doing this. And I've never been drunk. And I don't feel like I'm missing out because I just, I know what it does to the body. I know how it impacts the mind and how being around people who are extremely drunk is different than being around people that just drink a little bit. But when you're around really drunk people and you're not drunk, it's not enjoyable. It's different if it's like I'm having a glass or two. It's like, cool, I can be around that. It's fine. But it's like, if you're just unable to think clearly, we're not having fun.

• 30:46Speaker 01

  Yeah.

• 30:47Lewis Howes?

  And it, you don't look like your body is having fun the next couple of days either. So how is there a benefit to this? You know, I get it culturally, religiously, for some religions, societally. There's benefit for bringing people together, but you can come together and play board games. You can come together and have fun and talk and open up vulnerability versus needing the courage of alcohol to start sharing the truth.

• 31:11Speaker 01

  Yeah.

• 31:12Lewis Howes?

  Knowing that the damages are way stronger. Now, I might die of some random thing and be like, oh, you died of this. You could have been drinking your whole life and whatever, but I just don't think there's benefit to it personally.

• 31:24Speaker 01

  There's, there's not benefit.

• 31:27Lewis Howes?

  And it hurts your, your heart. It sounds like.

• 31:29Speaker 01

  Every cell of your body. So I had a little different path than you.

• 31:33Lewis Howes?

  Didn't you used to drink?

• 31:34Speaker 01

  I did, but I want to validate.

• 31:36Lewis Howes?

  You were, you were like a good southern boy who was like, let's drink every few nights and you know.

• 31:40Speaker 01

  Well.

• 31:41Lewis Howes?

  Tell me your drinking experience.

• 31:42Speaker 01

  I'm not going to admit to too much.

• 31:44Lewis Howes?

  No, no judgment. I don't judge. I'm just.

• 31:46Speaker 01

  I enjoyed, I enjoyed alcohol. I enjoyed wines. I enjoyed pairing wines with food. I enjoyed the whole experience like you discussed.

• 31:54Lewis Howes?

  Yes.

• 31:54Speaker 01

  I did. It was, it was very much part of my lifestyle. It, no question about it. And when um I started to not feel well prior to my own cardiac situation, I said to myself, well, I mean, the one thing you can do at least is quit drinking. At least remove that from your life and make sure, because I didn't really know what was going on.

• 32:22Lewis Howes?

  See what happens.

• 32:23Speaker 01

  See what happens.

• 32:24Lewis Howes?

  How old were you?

• 32:25Speaker 01

  I was fifty-five at the time.

• 32:30Lewis Howes?

  It's like a year ago or what was this?

• 32:31Speaker 01

  No, thank you. That was three years ago.

• 32:37Speaker 01

  And it didn't really make a lot of difference because I had something else going on. Yes. It made some difference for sure. But once I knew what was happening and I got a stint and I felt much better. The first thing my wife said to me, she's like, and she doesn't drink, by the way. She said to me, are you gonna start drinking again? I said, this has been a year at this point. I said, no way. I don't even want to. Because of all the things that you just mentioned. I like to live my life untampered. You know, the good times are the good times. I deal with the bad times accordingly. And with alcohol, people drink it both times. Yeah. To celebrate. And when they're sad. And when you're sad.

• 33:20Speaker 01

  And it's the one drug that your friends will encourage you to continue to do. Let's have a beer. Yeah, yeah. And one of the other things that really got my attention that you said is that it's really not fun to be around a bunch of drunk people. If you're sober. And I didn't realize that for a long time. Interesting. And it, I can tell you that removing alcohol from my life was probably the single most transformative decision I've made as an adult. That's great. No, there's no question about it. And, you know, I heard Lance Armstrong say on a podcast not long ago. When he was talking about, I guess he's removed alcohol recently or in the last year or two. He said, I've never heard anyone say

• 34:01Speaker 01

  I regret moving alcohol from my life. I wish I hadn't quit. And I was like, that's so true. And for me, it is like the, this, this magic sauce of every day is the same. Every day is predictable. I'm clear. Yes. And, you know, people feel like I'm very judgmental when I talk about it this way. I'm not at all. Like, when I say your body, your rules, like, go for it. Live your life. I don't have any room to be judgmental, nor, nor do, nor do I want to be, but it's kind of like when you read a good book or go see a good movie, you want to like share that experience. And that's kind of the sense I got from you

• 34:44Speaker 01

  when you were sharing, you know, your experience without alcohol. I have seen the contrast of that. And just how powerful that change has been for me. And so.

• 34:58Lewis Howes?

  Life has gotten better for you.

• 35:00Speaker 01

  No question.

• 35:01Lewis Howes?

  Yeah.

• 35:02Speaker 01

  On all fronts.

• 35:03Lewis Howes?

  Yeah. Health wise, relationship wise, you've saved me money, like all these things.

• 35:07Speaker 01

  Absolutely.

• 35:08Lewis Howes?

  Yeah, yeah.

• 35:11Lewis Howes?

  Now, do you wish you could go back and quit sooner? Or do you feel like, okay, it's served a purpose for 50 years of my life and now?

• 35:19Speaker 01

  Well, yeah, I mean, I do because it's been so powerful.

• 35:23Lewis Howes?

  Interesting.

• 35:24Speaker 01

  That I, I do wish I had realized it sooner, but it just wasn't my path.

• 35:30Lewis Howes?

  Yeah, exactly.

• 35:30Speaker 01

  Wasn't my path and I'm okay with that.

• 35:32Lewis Howes?

  Yeah, of course.

• 35:32Speaker 01

  You know, I'm enjoying it now.

• 35:35Lewis Howes?

  Yeah, yeah. I'm curious about this. You've done over 6,500 plus heart operations, heart surgeries. How many hearts have you held in your hand?

• 35:46Speaker 01

  Well, all of those.

• 35:47Lewis Howes?

  You put them, you like take it out of the body or some of them you leave?

• 35:50Speaker 01

  No, no, it's every, everything remains in the body, but you have to manipulate the heart. So the arteries that I was talking about on the front of the heart are these red, red lines. So if we're operating on the front of the heart, the heart can kind of sit here.

• 36:05Lewis Howes?

  But if it's on the back?

• 36:06Speaker 01

  But if I'm not, you're right. So we stop the heart for the majority of these operations.

• 36:10Lewis Howes?

  Stop it.

• 36:11Speaker 01

  Mm-hmm, utilizing a heart lung machine.

• 36:13Lewis Howes?

  Holy cow. So how do you?

• 36:14Speaker 01

  So the blood, the blood continues to go around the body.

• 36:17Lewis Howes?

  But not through the heart.

• 36:18Speaker 01

  We put a, we put a clamp here.

• 36:20Lewis Howes?

  Otherwise there's blood coming out everywhere.

• 36:22Speaker 01

  Exactly. And then we infuse the heart with a high potassium containing cold solution that puts the heart muscle in a hibernating state. And then we can actually maneuver the heart, open the heart. That's how we fix the valves. That's how we do all of that. And then we maneuver the heart. So you're actually handling the heart when you're doing all those things. But no, we don't remove it like.

• 36:43Lewis Howes?

  Yeah, yeah. But you're kind of adjusting.

• 36:45Speaker 01

  Absolutely.

• 36:45Lewis Howes?

  In the chest cavity.

• 36:46Speaker 01

  Sure.

• 36:48Lewis Howes?

  Yeah. What is that like holding the heart of a human being?

• 36:54Speaker 01

  You know, I look at what I do as an honor and a privilege, honestly. And it starts well before I ever get into the operating room. And that's the relationships that I develop with my patients. And that is just one component of it for me. For the patients, it's like you've had my heart in your hand. I get that comment a lot, you know, I think it's, and I don't, I don't wanna, I don't wanna deprioritize or belittle the comment that they're making. But when you're doing something every day, it becomes, it becomes part of the routine.

• 37:36Speaker 01

  But again, to develop a relationship that there's enough trust, that I'm given that opportunity to do that, that's what's meaningful for me.

• 37:49Lewis Howes?

  Yeah, yeah. Now, this may be a very sensitive topic. We don't have to talk about it if you don't want to. But I'm assuming you've been a surgeon for 25 years. There's been people that haven't made it from surgery, right?

• 38:00Speaker 01

  Sure.

• 38:01Lewis Howes?

  Have you ever talked about that stuff of what that is like when you're invested in a person? And you know how high risk it is, like they may not make it either way. And you've got to go in and operate and then they don't come out of that alive? How has that impacted you either emotionally, mentally, confidence wise? Just kind of how do you deal with that in general? I know a lot of doctors have to face this, unfortunately.

• 38:27Speaker 01

  Yeah.

• 38:28Lewis Howes?

  You know, brain surgeons, heart surgeons, this is, this happens unfortunately.

• 38:32Speaker 01

  Sure.

• 38:32Lewis Howes?

  Obviously, you hope it doesn't happen that often. But what has that been like for you?

• 38:37Speaker 01

  So for elective operations, lowest risk operations, the risk of patients dying is, is 2%, 1 to 2%. Which sounds like a small number until you put it in the perspective of 6,000 patients, right?

• 38:50Lewis Howes?

  Right.

• 38:51Speaker 01

  And so if you ask me what the single most difficult Part of what I do is it's patients dying.

• 38:59Lewis Howes?

  Wow.

• 39:00Speaker 01

  And that's no easier today than it was when I started 25 years ago. It is absolutely no easier. And you know, you mentioned the patients that are really high risk and aren't going to make it. You know, honestly, from a mindset standpoint, if it's a real hail Mary operation, the expectations with that patient and the family are very low.

• 39:28Lewis Howes?

  Oh, man.

• 39:29Speaker 01

  But for elective operations, when someone walks into the hospital and they're a mother, a husband, you know, what, and they fall in that 1 to 2%.

• 39:40Lewis Howes?

  Oh, my gosh.

• 39:41Speaker 01

  It is, it is really, really, really difficult and remains so to this day. And I still wake up in the middle of the night thinking about some of those losses over the years. But you know, in the end,

• 40:01Speaker 01

  with, when and if that were to ever go away, I would quit what I do.

• 40:09Lewis Howes?

  What do you mean?

• 40:09Speaker 01

  Because if, if that sense of attachment and the importance of that event occurring and the way it impacts me personally was never,

• 40:23Lewis Howes?

  Yeah.

• 40:24Speaker 01

  then I don't think I should be doing what I'm doing.

• 40:27Lewis Howes?

  If it didn't bother you or affect you.

• 40:28Speaker 01

  Exactly, exactly. And you know, you do, as you mentioned, have to compartmentalize because you can't take that home and you got to get up the next day and you got to come back.

• 40:39Lewis Howes?

  You can't do it at heart surgery the next day and thinking about that.

• 40:43Speaker 01

  Right.

• 40:43Lewis Howes?

  I mean, obviously you're thinking about it, wanting to do the best job you can and making sure you're taking the right actions, but you can't. I hope this doesn't happen again.

• 40:50Speaker 01

  You cannot go into the operating room with that mindset and you have to compartmentalize.

• 40:54Lewis Howes?

  How did, did anyone teach you? I don't know if they teach you this in med school, but did anyone teach you how to navigate when you lose a patient, like how to process that emotionally? Or is it more, you have to just? Compartmentalize, do the job and almost like not stuff it, but stuff the emotion so you can show up your best self the next day.

• 41:16Speaker 01

  So the first part of your question, can you teach that? No. And it doesn't really happen until you're technically out of training entirely.

• 41:27Lewis Howes?

  Yeah.

• 41:28Speaker 01

  And the responsibility is 110% on your shoulders.

• 41:32Lewis Howes?

  You're like 10 years in as a doctor, training, student, you're like, you've done so many reps.

• 41:36Speaker 01

  But you're not truly the response, but the buck doesn't stop with you.

• 41:42Lewis Howes?

  Yes.

• 41:43Speaker 01

  And until you get into that situation, it's very difficult. It's like trying to instill ownership into someone as an employee, right? Like you can't really do that until they're there and they're part of your business and what have you. And they either have that or they don't. Same thing as, as a physician, as a surgeon, you know, until you show up and all of that responsibility is on you, you don't have that emotional attachment, even though you see it and are part of it in training.

• 42:10Lewis Howes?

  Cause you've seen other doctors lose patients that you were helping or guiding.

• 42:14Speaker 01

  Absolutely. And you're still, of course, I mean, you feel badly in those situations. It's not that you're non-emotional.

• 42:20Lewis Howes?

  But you're not the one in there doing the job.

• 42:23Speaker 01

  You don't have to go out and look the family in the eye and have that conversation.

• 42:28Lewis Howes?

  I don't know how you do that.

• 42:29Speaker 01

  Yeah. It's, um, it's not easy and it's never gotten any easier.

• 42:33Lewis Howes?

  Oh my goodness.

• 42:35Speaker 01

  Yeah. It's never gotten any easier. It is not. It is not the, the fun part of my job. It is not.

• 42:41Lewis Howes?

  Has there ever been a patient that has come in on the operating table? That you were said, this is the biggest long shot of success. Like there's a 1% chance this will work and, or something like that. And they have somehow recovered and lived a longer life because of that operation?

• 43:04Speaker 01

  Absolutely. I mean, yeah, absolutely. I think most cardiac surgeons would identify with that too.

• 43:10Lewis Howes?

  Just like miracles.

• 43:11Speaker 01

  Yeah. I mean, look, we never walk in the operating room alone. That's, that's the bottom line. We're just people operating on people. And there's certainly, you know, we, we always do the best we can, but the end is not up to, is not up to us. That's that ultimate. The ultimate outcome is not up to us, but we certainly have taken patients, particularly younger patients that come in with really grave problems. We're going to give them an opportunity, even if it's a very low percentage, because why wouldn't we?

• 43:44Lewis Howes?

  Of course.

• 43:45Speaker 01

  You know, if somebody's lived a long life and they're in their 90s and they have multiple medical problems, they come in with that same problem. It's a different conversation with the family.

• 43:53Lewis Howes?

  Yeah, yeah, wow.

• 43:54Speaker 01

  But absolutely, that does occur.

• 43:57Lewis Howes?

  Do you have a ritual before you go into surgery? And do you have a relationship with God, where you bring God to the room with you?

• 44:07Speaker 01

  So I go through very much a process. It doesn't necessarily happen right before the operation, but days leading up potentially. And much like military or sports, where I visualize the operation that I'm going to do. Then I identify the three or four worst possible scenarios that I can get into and how I'm going to get out of it.

• 44:37Lewis Howes?

  That's smart.

• 44:39Speaker 01

  Because, you know, we never rise to the occasion. We always fall to our level of training. I mean, that's just human nature.

• 44:45Lewis Howes?

  Military 101.

• 44:46Speaker 01

  Exactly. I mean, I like to occasionally believe that we do rise to it occasionally. But that's under duress, you can't count on that.

• 44:53Lewis Howes?

  No.

• 44:54Speaker 01

  And so.

• 44:55Lewis Howes?

  Unless you've trained for it, you're going to fall to the level of your training.

• 44:58Speaker 01

  Every time. And so that's absolutely what I do. And then I always bring it back the morning of, when I see patients before surgery, to the patients that we're actually going to be operating on that day. Because I tell patients in the pre-op conversation that I can't guarantee them that we're not going to have bumps in the road. But what I can guarantee them is they're going to have 110% of my attention at all times. And I'm going to care for them like they're my own family.

• 45:29Lewis Howes?

  Wow.

• 45:29Speaker 01

  And that I truly mean.

• 45:31Lewis Howes?

  That's great.

• 45:32Speaker 01

  And I think that that's how I express to them that. I'm truly gonna be a part of this.

• 45:40Lewis Howes?

  Yeah.

• 45:40Speaker 01

  I'm fully engaged.

• 45:41Lewis Howes?

  Do you bring God into the, your ritual at all? Or is that not part of your life?

• 45:45Speaker 01

  I, I don't specifically.

• 45:48Lewis Howes?

  Some doctors are full faith based and other doctors are like, I just gotta.

• 45:51Speaker 01

  I am a very, I'm a very spiritual person. I'm not a very religious person. And I also find that with the breadth of religions that, you know, there's times when it's appropriate and there's other times when it's uncomfortable for patients.

• 46:08Lewis Howes?

  Of course, yeah.

• 46:08Speaker 01

  And so my job is to try to make them as comfortable as possible. And so I want them to know that, that I'm coming to them fully engaged.

• 46:20Lewis Howes?

  Yeah.

• 46:20Speaker 01

  And.

• 46:21Lewis Howes?

  That's great.

• 46:22Speaker 01

  And open and fully responsible.

• 46:24Lewis Howes?

  You know, a lot of the topics that we talk about on the School of Verinus is around relationships. I think relationships is one of the keys to either living a fulfilling life or, or suffering in life based on the quality of your relationships. I'm curious from a heart surgeon standpoint, do you think someone can die from a broken heart? Based on relationships, not like, again, the mind and the emotions impact the heart so much if they feel devastated from a loss, grief, a breakup, a divorce, where the heart just cannot go on.

• 47:04Speaker 01

  The short answer is yes.

• 47:06Lewis Howes?

  Really?

• 47:06Speaker 01

  And there is an actual syndrome.

• 47:09Lewis Howes?

  What is that?

• 47:10Speaker 01

  Tokisabu's cardiomyopathy or broken heart syndrome.

• 47:15Lewis Howes?

  Really?

• 47:16Speaker 01

  It is a thing.

• 47:17Lewis Howes?

  Come on, so you can be a healthy human being, have none of these, you know, workouts, healthy, no belly fat.

• 47:24Speaker 01

  Now, it is most commonly occurs in women over the age of 55 or 60. Most commonly, it happens in men too.

• 47:34Lewis Howes?

  You've seen this?

• 47:35Speaker 01

  Oh, absolutely. We see it multiple times during the year. Typically, as you pointed out, it's after the death of a loved one, financial loss, major emotional stress. So we think, and we don't truly know the cause. That it is an overstimulation of the autonomic nervous system, which is that fight or flight, or the rest or digest. It's like an imbalance of that. That then causes like acute heart failure. And patients present just like they've had a heart attack. And many times they end up being evaluated by a cardiologist, actually having the dye put in the arteries, the catheterization, and they have no blockages.

• 48:19Speaker 01

  But the heart function that was before normal is now down to like 20%. Now, here's the, here's the good news and bad news. The majority of these patients get better just with support. Some medications, support and time, and it gets better.

• 48:39Speaker 01

  Women, it's much more common, but the death rate is very low, somewhere around 1 to 2%. Men, it happens much less commonly, but the death rate is much higher. Really? 5 to 8%. There was some research early on that this maybe has something to do with the decrease in estrogen, which is why we're seeing it in perimenopausal and menopausal women more commonly. But men get it too. So it's, there's those, those theories aren't holding water across the board. So we don't really understand it. But yes, you can die from a broken heart and we see it. And we see this syndrome.

• 49:22Speaker 01

  I have had patients that I have operated on that have been really sick. And then their family member comes in two weeks later with broken heart syndrome. And they're both in the hospital. Come on. Oh yeah, it's crazy. But you can't operate on broken heart syndrome. No, you don't have to. There's no, there's no blockages. There's no blockages and the valves are working fine. It's just that the heart function, that heart pump that normally is strong, is now weak. And with time and support, thank goodness, the majority of them come, yeah. Wow, so don't start drinking when you have a broken heart.

• 49:58Lewis Howes?

  Don't start overeating and drinking.

• 50:00Speaker 01

  That's, that's, that's good advice. That's good advice.

• 50:03Lewis Howes?

  What is the difference? You know, I hope I never witnessed this and I hope no one has to witness this, but what is the difference between someone having a stroke? Or stroke-like symptoms?

• 50:13Speaker 01

  Sure.

• 50:13Lewis Howes?

  Versus a heart attack or heart attack like symptoms? What do they do? How do they respond? What are they saying?

• 50:19Speaker 01

  Yeah.

• 50:19Lewis Howes?

  Between the two?

• 50:21Speaker 01

  That's a good question, and I think that it's, it's not an uncommon confusion. Because people think that, that there, there's a lot of overlap and sometimes there can be. But let's start with stroke first, okay? So that you understand what's happening. Basically with a stroke, it's lack of blood flow to a portion of the brain.

• 50:43Lewis Howes?

  And does the heart influence the blood flow to the brain?

• 50:45Speaker 01

  Not typically in standard stroke symptoms. And I don't want to get too far in the weeds. There are cardiac sources that can cause strokes. It's not a blood flow issue though, from a heart problem.

• 50:57Lewis Howes?

  Got it.

• 50:57Speaker 01

  Most of the time. What, where's the most common places that strokes come from? It's blockages in the carotid arteries that break off, pieces break off and go north and cause blockages in the small arteries in the head. And then cause a lack of oxygen and nutrients to the brain, just like a heart attack in the heart. So the, the essential problem is the same. The symptoms are very different.

• 51:25Lewis Howes?

  So when someone's having a stroke, what are the symptoms that you'll see or notice?

• 51:28Speaker 01

  The things that you want to look for are changes in speech, drooping of the mouth, weakness typically on one side of the body and not on the other. But it can be, you know, there can be some crossover. But it's usually facial changes, slurred speech, visual changes and one side of the body, meaning upper extremity, hand and/or leg not moving properly, weakness.

• 51:58Lewis Howes?

  Okay.

• 51:59Speaker 01

  So that's a stroke and that is a medical emergency.

• 52:03Lewis Howes?

  911 now.

• 52:04Speaker 01

  Absolutely.

• 52:05Lewis Howes?

  Stop what you're doing.

• 52:06Speaker 01

  Hundred percent.

• 52:07Lewis Howes?

  Call a paramedic. Get them to the hospital.

• 52:09Speaker 01

  Absolutely. That is, that's a medical emergency, as is a heart attack.

• 52:14Lewis Howes?

  And what are the main symptoms of a heart attack?

• 52:16Speaker 01

  So the main symptoms are going to be crushing chest pain, typically described as like an elephant sitting on your chest, shortness of breath, radiation of pain into the arms or up into the jaw. That being said, as I mentioned earlier, can be the great masquerader. Patients can have intense abdominal pain that doesn't go away. It can be difficult to discern, but those symptoms of crushing chest pain that does not go away, pain that radiates or into the jaw, shortness of breath, 911.

• 52:50Lewis Howes?

  911?

• 52:51Speaker 01

  911, absolutely.

• 52:53Lewis Howes?

  I hope I never have to witness that, but that's good information to know. So you're taking action as opposed to, ah, you'll be fine or you know.

• 52:59Speaker 01

  And always win in doubt. You're never, you're never going to be, you know, you're never going to be criticized for calling 911 and going to the hospital when there's a concern. The commodity is too great to not do that.

• 53:16Lewis Howes?

  Yes. Yeah. You gotta take care of your life. And what would you say are the

• 53:23Lewis Howes?

  three biggest things then? Everyone should be adding to their life to help their heart. And the three biggest things people should be removing from their life to support their heart health.

• 53:35Speaker 01

  Okay.

• 53:36Lewis Howes?

  We talked about some of them already, but if you're like, here's the three things you need to add to your life and three things to remove and you'll improve the quality of your heart health, much better, what would you say those things are?

• 53:47Speaker 01

  So let's talk about the things that you should add, because I think people are much more willing to add things to their life than to remove things that they've gotten accustomed to or they've enjoyed. So I think the first is to move every day.

• 54:05Speaker 01

  And not live a sedentary lifestyle. And that comes in a lot of forms. Ideally, like if we're following the data, what do we want that to include? We want that to include aerobic training, where you are getting your heart rate up at least two to three times a week significantly, so that you can move what's called your VO2 max. Again, a fancy term. What does it mean? It just simply means how efficient your cardiovascular system is working. So the better your VO2 max, the more efficient your heart is working, that increases your health span and lifespan. Probably the single most important predictor, honestly, is VO2 max. Okay.

• 54:49Speaker 01

  Then along with that is resistance training. Yep. So important. As Gabrielle Lyon says, muscle is the organ of longevity. Why does she say that? Well, obviously, having a solid muscular mass as we age, because we know we're going to be losing muscle mass after the age of 30, it's dramatic. Having that in place, you're more stable, you're less likely to fall, you're able to pick up your grandchildren and pick up suitcases and function, have a functional life. In addition, muscle is a glucose sink or a sugar sink in our bodies.

• 55:32Speaker 01

  And maintaining stable blood glucose levels is critical, not just for cardiovascular health, but for chronic disease in general. So I think exercise is so important to add. Okay. I think the next one would be a solid sleep hygiene program. Yep. Because you, as an athlete, understand that the biggest gains happen during recovery. Yes. And it's hard for guys like you and me that just want to go harder to get those results, right? Just push harder, harder, sometimes to take the step back and actually allow your body to recover. And it's not just your heart and your muscles. It's our brain, too.

• 56:16Speaker 01

  Our brain rejuvenates when we sleep. That's when all of the waste products that have occurred in the brain during the day get washed out. So sleep is important across the board.

• 56:31Speaker 01

  Both from a cardiovascular standpoint and whole body. And then I think the third is what you mentioned earlier. I think relationships are really, really important to longevity. You know, my dad's about to be 89 years old this month, actually. And he called me one time and said, you know, I'm going to give you one piece of advice as you age. He said, keep your friends really close to you. He goes, because you're not sure which ones you're going to lose, which ones are going to be able to communicate. Because having someone pick up the phone and just say, hey, what you doing?

• 57:16Lewis Howes?

  Yeah.

• 57:17Speaker 01

  Or how are you doing? He goes, not that you have to make any great plans, but just that connection, I think, is a really, really important factor.

• 57:26Lewis Howes?

  That's cool.

• 57:27Speaker 01

  In the reasons we get up every morning.

• 57:30Lewis Howes?

  Mm hmm.

• 57:31Speaker 01

  And that really stuck with me when he made that comment.

• 57:35Lewis Howes?

  Good wisdom.

• 57:36Speaker 01

  Particularly on the eve of his 89th birthday. And he said this actually years ago. It wasn't recently.

• 57:41Lewis Howes?

  Wow. So three things to add to increase your heart health is to move every day aerobic and resistance training, have a healthier, better sleep hygiene program, you know, get quality sleep every night, and improve the quality of your relationships. And what would be three things to remove to improve your heart health?

• 58:01Speaker 01

  Okay. So the first would be be conscious of what you're putting in your mouth. Remove the processed and ultra-processed foods and added sugars. Because glucose management, sugar management is such an important risk factor when we look at things like type 2 diabetes, metabolic syndrome, all of these things that drive coronary disease, as we discussed earlier. Obviously, ultra-processed foods, again, driving this inflammatory engine. So removing those, focusing on a whole foods diet, and really just being thoughtful about what you're putting in your mouth.

• 58:46Lewis Howes?

  Okay.

• 58:47Speaker 01

  The next one is obviously smoking. We got to, we got to remove that from the list.

• 58:52Lewis Howes?

  And vaping, right?

• 58:53Speaker 01

  I would love to include both. If I could support it with the data, I would definitely put it on there. But I think that ultimately, yes.

• 59:01Lewis Howes?

  Well, the data of you've seen young people come in your operating room.

• 59:04Speaker 01

  Absolutely.

• 59:05Lewis Howes?

  From vaping.

• 59:06Speaker 01

  Absolutely.

• 59:06Lewis Howes?

  That has impacted their heart. I mean, that's your personal data. You haven't seen the data in the literature, I guess, right?

• 59:11Speaker 01

  Exactly.

• 59:12Lewis Howes?

  And the third thing to remove?

• 59:14Speaker 01

  Yeah, I would have to put alcohol on that list, both from my personal experience and from my clinical experience. That the patients that I, you know, the patients that I care for that don't drink are a different group of patients.

• 59:29Lewis Howes?

  Interesting.

• 59:30Speaker 01

  Than the, than the ones that do.

• 59:32Lewis Howes?

  Interesting.

• 59:32Speaker 01

  Just because typically, the rest of the pieces of that lifestyle also go in line with that mindset.

• 59:40Lewis Howes?

  Yeah, it's hard for someone to be healthy with their sleep and prioritize sleep.

• 59:45Speaker 01

  Yeah.

• 59:46Lewis Howes?

  Move their body, eat really clean.

• 59:49Speaker 01

  Right.

• 59:50Lewis Howes?

  Have good relationships, and then also be an alcoholic.

• 59:54Speaker 01

  Right.

• 59:54Lewis Howes?

  Like, it's hard to have, you know, it's like, if you're doing all these things well, you see the effects of alcohol. It's hurting my sleep. It's hurting my relationships. It's hurting my, my fitness levels. I can't train as hard. So you're probably more mindful. Maybe you drink every now and then, but you're not drinking every night, you know? You're more mindful. If you're conscious of all these other things, but not here, something's off.

• 1:00:14Speaker 01

  You know, and I think that brings up a point. You know, we all have our own instruction manuals.

• 1:00:18Lewis Howes?

  Yeah.

• 1:00:18Speaker 01

  Right? Like, yours is different than mine. Your diet is gonna be a little bit different than mine. It's about what, what works for you. And I think a big part of this whole journey is, is figuring out what that instruction manual is. These are kind of the, the major levers, and then you need to figure out how and where and when you're gonna.

• 1:00:43Lewis Howes?

  Yeah, exactly.

• 1:00:44Speaker 01

  Work after those.

• 1:00:45Lewis Howes?

  I mean, and I, and I speak with a lot of conviction, but I hope that people watching or listening to both of us, you know, if people wanna drink, drink. You know, my,

• 1:00:54Speaker 01

  Yeah.

• 1:00:54Lewis Howes?

  I know I don't live a perfect, healthy lifestyle. I have too much sugar. I probably have too many processed foods, and I know that, but I'm conscious of it, and I have more whole foods than I do processed, most of the time.

• 1:01:08Speaker 01

  Yeah.

• 1:01:09Lewis Howes?

  But I also know when I'm doing it, I'm like, And I need to be doing better.

• 1:01:12Speaker 01

  That's right.

• 1:01:12Lewis Howes?

  Let me pause this.

• 1:01:13Speaker 01

  What I say earlier, we know better, but we don't do better.

• 1:01:16Lewis Howes?

  So it's about being, you know, being cautious of it if you are drinking. It's about like, okay, I'm only going to do this once a week, maybe, or once every now and then, or something like that, and really try to limit it if you can. No one needs to be perfect and you don't have to worry about that. And I'm, I'm not here to judge people, but I am here to elevate myself and others to living a better life. And if that means calling people up, then that's what I want us to do.

• 1:01:42Speaker 01

  Absolutely. And it's about, it's about progression, not perfection.

• 1:01:44Lewis Howes?

  Exactly.

• 1:01:45Speaker 01

  And you're right, like even for me personally, if I'm eating Whole Foods 80% of the time.

• 1:01:50Lewis Howes?

  It's amazing.

• 1:01:51Speaker 01

  And 20% of the time I fall off, that's a W for me. That's a win.

• 1:01:55Lewis Howes?

  It's a big win.

• 1:01:55Speaker 01

  And I'm, and I'm comfortable with that for me.

• 1:01:58Lewis Howes?

  Yes.

• 1:01:59Speaker 01

  And when you talk about, you know, like, how do you evaluate where I start with my health? Or, you know, what's the one thing I would say do? It's very difficult when we talk about all of us as individuals to give that one thing. Cause if I came to you and said, well, you need to move every day, you'd be like, well, I do that. It's like, I don't need to do, I don't need to do that. What we need to do is we need to identify what we're bad at.

• 1:02:26Lewis Howes?

  Yes.

• 1:02:28Speaker 01

  You know, I'm a terrible sleeper.

• 1:02:29Lewis Howes?

  Right, yeah.

• 1:02:30Speaker 01

  So I need to work on my sleep. That's my Achilles heel, you know? And so first, having intellectual honesty to identify those things that you don't do well is the greatest opportunity to move the needle with your health span.

• 1:02:45Lewis Howes?

  That's amazing. And I wanted to ask you, I know a lot of people are confused about this. What is the difference between a heart attack and a panic attack? Because some people have a panic attack and they think I'm having a heart attack. What is the difference?

• 1:02:57Speaker 01

  It's tough to tell the difference many times because the symptoms can be so similar. And panic attacks can be very physical as well.

• 1:03:09Lewis Howes?

  Of course.

• 1:03:09Speaker 01

  And, you know, so what are those symptoms? Well, that's some of the things we've already talked about. Shortness of breath, sweating.

• 1:03:18Speaker 01

  Chest discomfort, you know, nausea.

• 1:03:22Speaker 01

  Changes in vision, you know, all these things, they can be panic attack, they can be heart attack. How do you tell the difference? Well, panic attacks typically are brought on by emotional scenarios, not always, but typically speaking. They'll typically last 10 to 30 minutes, self limited, and then they'll, then they'll ease off. Heart attacks, on the other hand, are typically, you typically have some warning signs of the progression of the discomfort before it comes on and doesn't go away. It's crushing chest pain, not a sharp chest pain, and it doesn't get better with time.

• 1:04:04Lewis Howes?

  Hmm.

• 1:04:05Speaker 01

  And that's a key, and that is a true medical emergency. Now, if you're in one of those scenarios and you're not sure, then you need to go to the hospital. Because that's always the safest thing to do. Because with a NKG and a simple blood test, you know, that can be, that can be delineated pretty easily. So, it's a difficult, it's a difficult scenario. It really is. And people frequently during panic attacks will say, "I'm having a heart attack." Now, the other important thing is, panic attacks do not cause heart attacks.

• 1:04:41Lewis Howes?

  Hmm.

• 1:04:42Speaker 01

  And I think that's a spin that a lot of folks will get into. "Yes, I'm having a panic attack, but now I'm having a heart attack." That would be very, very unusual.

• 1:04:53Lewis Howes?

  Very rare.

• 1:04:54Speaker 01

  Very, very rare.

• 1:04:55Lewis Howes?

  Panic attacks, you know, don't make you feel good, but it's not killing you.

• 1:05:00Speaker 01

  Correct.

• 1:05:01Lewis Howes?

  Right.

• 1:05:02Speaker 01

  Exactly.

• 1:05:03Lewis Howes?

  It might be influencing your overall health, but it's not creating a heart attack.

• 1:05:05Speaker 01

  Right. Right. And you may fear for your life during a panic attack. I've seen that many, many times, but you're not in danger.

• 1:05:13Lewis Howes?

  What's the best thing someone can do to recover from a panic attack?

• 1:05:17Speaker 01

  Yeah, so...

• 1:05:19Lewis Howes?

  So it doesn't happen again, you know?

• 1:05:21Speaker 01

  Yeah, well, so it doesn't happen again requires coping skills. But to break a panic attack, what you really want to do is divert your... nervous system in some way. The fastest way that I have found to do that is take a bag of ice. Fill it up and put it on the back of the neck. And it just kind of changes your whole focus. If you don't have a bag of ice, you can, you know, just put your face under cold water. Whatever, whatever opportunity you have, if you're driving, please pull over. You know, get a, get a cup of ice from the convenience store and put your hands in it. Or just hold on to some ice is usually enough. And it'll frequently break a panic attack. Now,

• 1:06:05Speaker 01

  treatment of panic attacks is way outside of my wheelhouse as far as long-term coping skills and things of that nature. But I think the good news is in most cases with appropriate support and guidance. People can get over panic attacks.

• 1:06:24Lewis Howes?

  Okay.

• 1:06:25Speaker 01

  I mean, I really think in anxiety in general, I think that it's not, it's not something that people have to live with forever.

• 1:06:32Lewis Howes?

  Okay, so I want to ask you, one through 10. Uh, 10 being the best. One being the least best. Uh, one through 10, how valuable is saunas for helping heart health?

• 1:06:47Speaker 01

  So I am a huge believer in sauna therapy. Now, all of the data has been done in traditional Finnish saunas. Um, I, I don't have a problem with the, the other alternatives.

• 1:07:02Lewis Howes?

  Red or whatever.

• 1:07:03Speaker 01

  With the infrared type saunas and there's, there's some other ones out there. But if we're going to talk about the data and what I personally use, that's, that's where I think the, the money lies, if you will. So the numbers are dramatic. That if you are utilizing sauna four to five times a week. Sessions of 11 to 12 minutes each, that 11 minute mark seems to be important. Somewhere over 175 to 180 degrees Fahrenheit. Your decrease in cardiovascular events is greater than 50%.

• 1:07:38Lewis Howes?

  Wow.

• 1:07:39Speaker 01

  And all-cause mortality is in that same. Level as well. In addition, now the neurocognitive benefits of sauna are starting to come out. As far as being protective from Alzheimer's dimension, what have you. Why does all of this happen? And I don't, I don't really have the capability to dive deeply into the science, but the basics. Is that we release something called a heat shock protein. When you're in the sauna, particularly when you get to that uncomfortable place in the sauna. Seems to be where you really have this release. You stay just a couple of minutes. A little bit, a little bit longer is where you really get the benefit. And that that is where the cardiovascular, all cause mortality and neuroprotective.

• 1:08:25Speaker 01

  Benefits come from. So one through 10, what do you think? Is that a 10 for you? Is that an eight, nine? It's a, it's a 10 for me. I sauna at least three to four times every single week. Okay, one through 10, ice therapy, cold therapy. So personally speaking, I am a huge believer in cold plunges. It's my morning routine, every single morning for a, you know. I like to start the day with something hard. It puts, puts my whole mindset in perspective. It wakes me up because you get this cortisol release and it really sets the tone plus. As I'm peaking at 60 here and like to stay really active. You know, when I get out of bed in the morning, my wife will say to me, what hurts? And I'll say, look.

• 1:09:10Speaker 01

  It'll be quicker for me to tell you the things that don't hurt right now. She's like, well, that's not good. But cold plunging really helps. On a day to day basis to keep all of that. That's good. Under control. The data from a cardiovascular standpoint and really overall longevity standpoint is not as powerful as it is with sauna. Gotcha. I can't tell you specifically what it is off the top of my head, but from a cardiovascular standpoint. I would say that I would have to put that on the lower end of the spectrum, one to 10. But for personal impact and the way that I've utilized it, it's an 11. What about over seven hours of sleep? Yeah.

• 1:09:55Speaker 01

  On one to 10 scale for heart health. It is, it's a 10 plus. Really? It really is because again. If we look at the recovery piece, what does that really impact? Well. The risk of type 2 diabetes and metabolic syndrome and how your body metabolizes glucose, all changes when you're recovered and well rested. Sleep apnea, where your oxygen level is changing during the evening, again affecting the hours of sleep that you have, is a direct risk factor for high blood pressure, which we know is a risk factor consequently to heart disease.

• 1:10:32Lewis Howes?

  Yeah, I guess the only thing I could, you know, I've never been drunk, so I don't know what that feels like. But I have been on a lack of sleep at different times in my life.

• 1:10:42Speaker 01

  Yeah.

• 1:10:42Lewis Howes?

  And I can almost sense that it feels like you're drunk. So if you're not sleeping well,

• 1:10:46Speaker 01

  Yeah.

• 1:10:47Lewis Howes?

  You're not performing well the next day, and it's starting to stack if you don't sleep well every night.

• 1:10:52Speaker 01

  Yeah.

• 1:10:52Lewis Howes?

  And so I can only imagine how much it could be hurting your physical health and creating excess fat and therefore impacting your heart.

• 1:11:01Speaker 01

  Absolutely. I think it's, I think it's one of the pillars that people miss many times. You know, it's not a new gym membership. It's not whatever, PR lifting or cold plunging or whatever. It's like, you know, you need to prioritize your sleep. We all have to sleep.

• 1:11:22Lewis Howes?

  That's great. Dr. London, this has been powerful. I've got a few final questions for you, but I want people to follow you. You've got amazing content on Instagram, DrJeremyLondon on Instagram, also DrJeremyLondon.com, your website. You've got a podcast as well, right?

• 1:11:38Speaker 01

  We do. We do.

• 1:11:39Lewis Howes?

  So you have a lot of the insights, the information. If people want to learn more, where can they go to get the podcast?

• 1:11:45Speaker 01

  YouTube, Spotify, Apple Podcasts. We've got a newsletter that usually tries to parallel many times.

• 1:11:53Lewis Howes?

  Okay.

• 1:11:53Speaker 01

  So whatever format you enjoy getting this information, we like to get it out to you so that, you know, we're spreading the word.

• 1:12:01Lewis Howes?

  That's great.

• 1:12:02Speaker 01

  Hopefully, hopefully giving folks insight into

• 1:12:04Lewis Howes?

  That's great.

• 1:12:05Speaker 01

  into things that is going to allow them to live longer and live better.

• 1:12:08Lewis Howes?

  DrJeremyLondon.com for the newsletter as well, right?

• 1:12:11Speaker 01

  That's correct.

• 1:12:12Lewis Howes?

  And you're working on a book right now, so in the future, we'll get a book from you. Hopefully, we'll have more of this stuff for people, more research and data as well. This is a question I ask you. If you could go back right before you started medical school. I don't know, where were you? Where'd you go to medical school like? I went to medical school in Augusta, Georgia. Okay, cool. So how old were you when you went to medical school? Do you remember? I was 21. 21? Yeah. So you make the decision, I'm going to medical school. You're getting your plans together. You go for the first day. Whatever, you're in class, or you're in the clinic, wherever you are. I don't know if you can remember that first day of medical school. Nearly 40- I'm not that old. Nearly 40 years ago, right? I can remember that. I know, yeah. I mean, 40 years ago, almost. 38, 39 years ago, right?

• 1:12:56Lewis Howes?

  If you could remember the excitement and the joy and the unknown of what was about to happen. And now almost 7,000 surgeries. Thousands of lives impacted in a positive way. The influence you've had on people's life personally, their families. The miracles that have happened. If you could go and give three pieces of advice to the younger you going into med school for the first day. What would you share? Wow. First one would be, don't take yourself so seriously.

• 1:13:29Lewis Howes?

  For sure. Be willing to live in the gray. Yeah, that's hard. And always trust your gut. Hmm, that's, that's good advice. Would your 21-year-old self having an advice for you currently? For this next season of life? As you're rounding into 60? Would he give you any advice? On what to expect for the next decade or two?

• 1:13:55Lewis Howes?

  Get outside. Relax. Enjoy the day. Mm-hmm. Let go. Yeah. That 21-year-old was pretty good at all that. Yeah, yeah. Yeah. You gotta remember some of that, huh? Yeah. Yep. Hopefully your son will remind you of that every day too, as he's working with you. Got lots of people to remind me.

• 1:14:19Lewis Howes?

  But listen to that inner voice inside of you.

• 1:14:21Speaker 01

  Absolutely.

• 1:14:22Lewis Howes?

  He's your gut.

• 1:14:23Speaker 01

  Yeah.

• 1:14:23Lewis Howes?

  That 21 year old's still in there.

• 1:14:25Speaker 01

  Yeah, there's no, there's no doubt.

• 1:14:27Lewis Howes?

  He's still in there, man.

• 1:14:28Speaker 01

  There's no doubt.

• 1:14:29Lewis Howes?

  Um, I want to acknowledge you, Dr. London, for the work you've done to inspire millions of people around the world. Helping people, even if just one video you shared has helped someone change their life and live better, healthier, happier life. You're saving lives with the content you're sharing. So I want to acknowledge you for your 40 years of experience, uh, hands-on, literally, helping people's hearts heal, but also now using your wisdom to share with others. So hopefully they can make better decisions in their life and impact the families and friends around them to live better as well. I want to acknowledge you for

• 1:15:06Speaker 01

  Well, thank you.

• 1:15:06Lewis Howes?

  The gift that you are.

• 1:15:07Speaker 01

  Well, thank you.

• 1:15:08Lewis Howes?

  And, uh, you may not be holding people's hearts literally in the future, but you're doing it, you know, spiritually, emotionally, mentally, through the content you're sharing through this conversation. So I acknowledge you for all the work you're doing.

• 1:15:22Speaker 01

  Thank you. That means, that means a lot coming from you. It really, it really does. And, and I think you really touched on what's important with the platforms and the effort that we're making. If we can, if we can just touch one life, it's all worthwhile.

• 1:15:40Lewis Howes?

  That's it.

• 1:15:41Speaker 01

  And we get so much feedback that it's been so much more than that, that it is really, that's the motivation for us to continue in doing this. So thank you for acknowledging it.

• 1:15:52Lewis Howes?

  Of course.

• 1:15:52Speaker 01

  I appreciate that.

• 1:15:53Lewis Howes?

  Final question, Jeremy, what's your definition of greatness?

• 1:15:57Speaker 01

  Always being willing to change.

• 1:16:01Speaker 01

  That I don't ever feel like I've arrived.

• 1:16:06Speaker 01

  And I feel like I'm always open to change.

• 1:16:11Lewis Howes?

  Yeah.

• 1:16:12Speaker 01

  And that is one of the things that I think has enabled me to To accomplish many of the things that I have in my life and I hope to accomplish many, many more as a result of maintaining a very open attitude towards opportunity. A lot. Thanks so much for coming on. Appreciate you.

• 1:16:33Lewis Howes?

  I hope you enjoyed today's episode and it inspired you on your journey towards greatness. Make sure to check out the show notes in the description for a full rundown of today's episode with all the important links. And if you want weekly exclusive bonus episodes with me personally, as well as ad-free listening, then make sure to subscribe to our Greatness Plus channel exclusively on Apple Podcasts. Share this with a friend on social media and leave us a review on Apple Podcasts as well. Let me know what you enjoyed about this episode in that review. I really love hearing feedback from you and it helps us figure out how we can support and serve you moving forward. And I want to remind you, if no one has told you lately, that you are loved, you are worthy, and you matter. And

• 1:17:17Lewis Howes?

  now it's time to go out there and do something great.