Pod Insights Extend Podcast with Darshan Shah, MD 95. Dr. Jeremy London: The Blood Tests Your Cardiologist Isn't Ordering That Could Save Your Life About this episode What if the blood tests you're not getting are more important than the ones you are? In this episode of Extend, Dr. Jeremy London joins me to explore the three lifestyle modifications that prevent most cardiac disease.
We dive into how a continuous glucose monitor revealed his own pre-diabetes despite feeling perfectly healthy. We also share the blood tests your doctor isn't ordering, why vaping may be more dangerous than cigarettes, and how functional medicine filled the gap that traditional surgery couldn't address.
Dr. Jeremy London is a board-certified cardiovascular surgeon with over 25 years of clinical experience. He received his medical degree from the Medical College of Georgia and completed his general surgery residency at St. Joseph's Hospital in Denver, Colorado, followed by a vascular and thoracic surgical fellowship at Carolinas Medical Center. Dr. London's mission is to provide accessible health information through his newsletter, podcast, and social platforms.
We Also Discuss:
Why Vaping Is More Dangerous Than Cigarettes According to This Heart Surgeon
The Three Blood Tests Your Doctor Isn't Ordering
How a Continuous Glucose Monitor Revealed Pre-Diabetes in a "Healthy" Surgeon
Why 50% of Americans Have High Blood Pressure and Most Don't Know It
The Calcium Score CT Scan That Reveals Hidden Heart Disease Risk
Why VO2 Max Is the Most Powerful Predictor of Longevity
How Functional Medicine Saved This Surgeon from Career Burnout
The Walking Desk Hack That Gets 10,000 Steps During Work Hours
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Learn more about Dr. Shah:
Website: https://www.drshah.com/
Clinic: https://www.next-health.com/
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Learn more about Dr. Jeremy London:
Instagram: https://www.instagram.com/drjeremylondon /
Website: https://www.drjeremylondon.com/
Transcript 15,509 words · 2 speakers
Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.
0:03 Dr. 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.
0:51 Dr. Darshan Shah? Today on Extend, I'm diving deep into the heart, both literally and metaphorically, with one of the most dynamic voices in cardiovascular medicine, Dr. Jeremy London. Dr. London is a board-certified cardiothoracic surgeon with over two decades of experience performing some of the most complex heart and vascular surgeries. He's done aortic aneurysm surgeries, valve replacements, and he's always been on the forefront of cardiac surgery innovation. But what really sets him apart here is his rare blend of surgical mastery, but he also has a deeply preventative, functional approach to our health. After years in the operating room, Dr. London recognized that too many of the conditions he was treating could have been prevented. So he goes way beyond the conventional medicine.
1:34 Dr. Darshan Shah? He has completed a training in the Institute of Functional Medicine, and then he became a nationally-recognized educator on the lifestyle drivers of heart disease and resilience. Through his podcast, his newsletter, and his massive online following, Dr. London translates cardiovascular science into actionable strategies. His mission is to keep people out of this operating room by empowering them to take control of their health before a crisis occurs. Join me in welcoming Dr. Jeremy London.
2:09 Dr. Darshan Shah? Dr. London, it's such an honor to have you here on my podcast and I've been looking forward to this day for a very long time. So, thank you for coming out here to do this.
2:18 Speaker 01 Well, it is an honor to be here and we have both been looking forward to this. So, very excited.
2:23 Dr. Darshan Shah? Exactly. So, I mean, since Vonda Wright on this podcast, I have not had another surgeon here in this chair. And it's incredible that here we are, two surgeons having a conversation.
2:36 Speaker 01 We are a rarity and I think that it's nice to find the common ground, even though we come from a little different perspective. I think we've got a lot of common mission and look forward to finding that space with you.
2:51 Dr. Darshan Shah? Yeah, absolutely. So, you are a cardiothoracic surgeon and you've been doing this professionally for many years and you spend your days looking at the beating heart and helping people survive longer with their heart disease. And that is a very special place to be because you're literally looking at life in front of you every single day. How do you feel now that you're at this part of your career after, how many years have you been doing this?
3:19 Speaker 01 Going into 26.
3:21 Dr. Darshan Shah? 26 years. That's as long as I've been doing surgery for myself before I, a couple of years ago is when I put my last stitch in. And how do you feel of this moment where, you know, you've had that incredible career and you're making this shift to talking about health, wellness, and really spreading the word of longevity and helping people avoid the table, right? I mean, that's what it's all about. How is that making you feel?
3:45 Speaker 01 Yeah, you know, the last 25 years, now headed into 26, it's really, it's been an honor and a privilege, quite frankly, to have the opportunity to develop relationships with my patients and their families and to develop a level of trust that they allow me to work on their beating heart every single day. And I'm so grateful for that. And what I found is that I can only take care of one patient at a time. Whether it was in the office or in the operating room and there's tremendous value there and there has been and I feel like I've been value added in my community and would
4:27 Speaker 01 not give any of that up, but it's not a scalable model at all. And as I reach, you know, mid to end of my career, I had to look towards what was the next phase, you know, now that I have all of this experience and crystallized knowledge, what do I do with it? Because we all age out of our professions, no matter what it is, at some point, it's just where you decide to make that change. And I've been fortunate enough with the help of my oldest son to start developing social platforms that then allow me to continue this mission in a very scalable way as opposed to helping one individual at a time.
5:10 Speaker 01 I can reach so many people and impact so many lives and it's really, it's been amazing.
5:16 Dr. Darshan Shah? Yeah, it really is. And so, you know, my thought always is whenever I'm operating on somebody, like, why is this person here in the first place? I wish I had the opportunity to tell this person a few things 20, 30 years ago before they led this lifestyle that got them to the operating room table, right? And now you have, you know what you wanted to tell them, but you can do it at a mass scale.
5:39 Speaker 01 No question. And I, and we've discussed this before, after about 10 years in practice, I got to a point where I was, I was absolutely frustrated dealing with the end game of disease.
5:52 Dr. Darshan Shah? Right, exactly.
5:54 Speaker 01 You know, whether at the time I was doing thoracic oncology, vascular surgery and cardiac surgery and, you know, doing north of 650 cases a year and it was a lot. And it was the same repetition of the result of smoking, the result of poor diet, the result of sedentary lifestyle. And I would operate on these patients and nothing would change. It was fix me doc and nothing would change. And I'm not blaming patients for that necessarily, but I'm blaming part of the health system for that and the attitude that has been engendered, both from physician perspective as well as patient perspective. I felt like it was an exercise in futility.
6:32 Dr. Darshan Shah? Right. It really felt that way to me, too.
6:34 Speaker 01 And that is one of the worst feelings in life, but particularly in medicine and especially in surgery.
6:42 Dr. Darshan Shah? Yes, exactly. Right. You're absolutely right. It's almost like, you know, you see the Hoover Dam cracking apart in front of you and you're just trying to run around and duct tape it together.
6:51 Speaker 01 Exactly.
6:52 Dr. Darshan Shah? And you know, you know, this is never going to be a sustainable fix to the problem, right? And so now it's an honor to have you on the podcast and we can maybe make some headway through spreading the information.
7:03 Speaker 01 Yeah. Well, it's an honor to be here with that goal in mind, that's for sure. And you have certainly been tip of the spear with leading this charge for all of us and setting an example of, of exactly how to, how to manifest this in your life and then share it with other people. So it's, we appreciate that.
7:25 Dr. Darshan Shah? Thank you so much. So just, you know, a couple of quick questions just to set the stage here. If you were to go back to the beginning of your career and you met a bunch of people, maybe at a, you know, at a seminar you were doing, for example, and these were the same people that were going to end up in your operating room table 25 years later. You had a crystal ball, you could see this happening, but you had the opportunity to give them one or two pieces of advice to change the direction of where they were headed, so they would not end up there. Okay? And now we're kind of focusing in on cardiac disease because a lot of what you were doing were, was probably bypass surgery. And so let's talk about that. What are like three pieces of advice that are just simple that people can incorporate today
8:09 Dr. Darshan Shah? that changes direction of their destiny with cardiac disease?
8:13 Speaker 01 Well, I think let's deal with the obvious one first and we'll, we'll, we'll put this as a bonus and that's smoking. If I have to pick one lifestyle modification, choice, et cetera, is if you are smoking, you have to stop smoking because it is, it is a damage multiplier when we're looking in the cardiovascular space. And most people know that. So we won't count that as the three, but I feel.
8:37 Dr. Darshan Shah? Well, can I ask you, I'm so sorry to interrupt you on that before we move on from smoking, because I feel like the word smoking now has multiple definitions. It is not just smoking cigarettes, right?
8:47 Speaker 01 Yes.
8:47 Dr. Darshan Shah? Is it, is vaping, is smoking marijuana, are all those equally problematic?
8:55 Speaker 01 So it's a little bit of a slippery slope and, and that's okay for several reasons. One, we know that smoking cigarettes, it's been around a long time. We have a lot of data. We know what the implications are. With vaping, we don't really know what the long-term impact is. But I could tell you that the trajectory of vaping is very worrisome. Why is that? Well, number one, because it is odorless and socially acceptable now, you know, there's no more room at the, at the airport, the shun from society room that you have to go to, to vape.
9:37 Speaker 01 The amount of exposure through the course of the day is dramatically higher because you don't have to go outside, you don't have to, you know, leave the room, you don't have to hide. So the amount of the, of actual exposure is dramatically higher. There's very little regulation with the amount of nicotine. So the, the level of addictive potential is much higher. And there are products and byproducts in the vaping, whether it's in the oils or whether it's in a preservative or in the flavorings. And there's a lot of controversy with all of this these days that are of significant concern.
10:18 Speaker 01 What have I seen personally with acute dangers of vaping? EVALE, which is e-cigarette vaping associated lung injury? It is devastating in young patients to have them come in from vaping even one time and have such bad lung injury that even being ventilated on the breathing machine, that was inadequate to deliver oxygen and remove carbon dioxide from their bodies, that we have to put them on an ECMO circuit, which It's tragic. It's tragic to remove blood from the body, put oxygen in, remove the CO2 and put the oxygenated blood back in the body. And unfortunately, some of these young patients don't survive as a result of it.
11:02 Speaker 01 I've never seen that from smoking cigarettes. So I think that I think that in the end, we are going to have a predictable end point with vaping. But from a data perspective, I can't, I can't lay that out for you other than my own experience. And the CDC has a actual registry for eVali where they keep track of this across the country. Interestingly, when you brought up marijuana, then the smoking marijuana now has been listed as a nearly equivalent risk factor for cardiovascular disease.
11:37 Dr. Darshan Shah? Okay, all right. So we know that now.
11:39 Speaker 01 And that's just in the last six months. So I think that that danger, that data of the dangers associated with smoking marijuana is now coming to light. I don't know quite what the burden of evidence is there, but it certainly is suggestive.
11:54 Dr. Darshan Shah? Yeah, but it's one of those things, you don't need to wait for the data to just intuitively know from your vantage point as a cardiac surgeon that this is all bad stuff.
12:02 Speaker 01 Exactly. And I mean, our lungs are meant for bringing oxygen in and CO2 out. Really, nothing else is safe. And as you point out, in medicine, protocols are derived from the data. There's no question about that. But the practice of medicine is knowing the protocols. The art of medicine is knowing when to apply those protocols, or more importantly, when not to. And you don't always need level one data to make a decision. There's no level one data to show that tying off blood vessels in surgery reduces blood loss, but you do it anyway.
12:40 Dr. Darshan Shah? Exactly.
12:41 Speaker 01 And I think that there are just certain boxes, certain categories, certain buckets in medicine where connecting the dots is not that hard.
12:50 Dr. Darshan Shah? Yeah, absolutely. Well said. So advice number one, don't smoke anything. Piece of advice number two for people that are headed towards cardiac disease 30 years before they get there.
13:01 Speaker 01 Be mindful of what you put in your mouth.
13:04 Dr. Darshan Shah? That go deeper.
13:05 Speaker 01 Focus on a whole foods diet, avoid processed and ultra-processed foods. And look, life's not perfect. We're not perfect. What do I shoot for personally? If I'm able to eat a whole foods diet 80% of the time, and 20% of the time I'm out on those edges, I consider that a win. For myself personally. And I understand when we start to talk about nutrition and dietary plans, the emotion surrounding that is like bringing up religion and I can appreciate that. And it is a very individual decision and choice and figuring out what works for you personally. If vegan works for you and you feel good and your bio, all your lab tests and biomarkers are good, then absolutely that works for you. If it's carnivore, whatever it may be.
13:50 Speaker 01 But in general, our bodies run on proteins, fats and carbohydrates. And our grocery cart should reflect that.
13:57 Dr. Darshan Shah? Right, exactly. And none of these dietary programs advocate the use of ultra-processed foods being the majority of your diet.
14:05 Speaker 01 Absolutely not, right.
14:06 Dr. Darshan Shah? Exactly.
14:07 Speaker 01 And that's why I think if those tend to follow, if you tend to follow those, even though they may seem extreme, if they work for you, they work for you. Because again, I think it removes the processed and ultra-processed foods.
14:21 Dr. Darshan Shah? Absolutely.
14:22 Speaker 01 I think the, the next one is move every day. Avoid a sedentary lifestyle. And that can look very differently for many people. What's ideal is a combination of aerobic training and resistance training. The aerobic training to try to maximize your VO2 max, which is just a fancy way of saying how efficient is the heart working? How do you get there? Well, you do baseline aerobic training where you're getting your heart rate up at a conversational pace several days a week. And then you want to push yourself a couple of days a week to try and shift that curve. VO2 max is a very powerful predictor of longevity, probably the most powerful actually.
15:03 Speaker 01 But that is not the only form of exercise that we really need. And the, the other piece of this is resistance training. Because muscle mass is so important. Important as we age for a variety of reasons. The obvious ones, meaning being structural integrity, being able to control our bodies and balance and avoid falls. And the other is muscle mass is a sink for glucose. And that is really important for our overall metabolic health to be able to manage our glucose. And as we age, we lose muscle mass. So unless you're actively training it and supplementing the dietary piece with adequate protein and appropriate calories
15:46 Speaker 01 and not overfeeding your body and increasing your muscle mass, you can get that, you can certainly get that benefit.
15:53 Dr. Darshan Shah? Yeah, absolutely. And just to kind of put a bow on the whole story of movement, resistance training and VO2 max training or cardio training is great and we all need to be doing that, but it does not replace avoiding sedentary behavior.
16:10 Speaker 01 Absolutely not. Yeah. And you're referring to, you know, the, the sitting disease.
16:16 Dr. Darshan Shah? Exactly.
16:16 Speaker 01 And the mindset is, well, if I get up early and I go for my run and then I go to my cubicle and I sit for four or five hours, I'm good because I got my run in. The reality is you're not. And it's been shown that that, that degree of, of sedentary behavior is very unhealthy with respects to, again, glucose management throughout the course of the day. So if you've been sitting for a period of time, getting up, walking around for a few minutes, 10 air squats has been shown to be a great way to handle that to integrate movement throughout the course of your day. In addition to the, the more formal type of training.
16:58 Dr. Darshan Shah? Exactly. Yeah. And I think all three aspects of physical activity are extremely important and equally important. And I think people tend to focus on one, maximal two, but rarely do I see people honed in on all three. And I think the sedentary behavior piece is, is a problem because, you know, sometimes I've done it myself. You sit in front of a computer and you get into a flow state or you just got a lot of emails to answer. And before you know it, two and a half hours have gone by and you haven't moved. And so it's really important to have some sort of alert or alarm. I use an egg timer now. I just put an egg timer on my desk and I turn it and I have a walking desk too. So.
17:34 Speaker 01 That's the best.
17:36 Dr. Darshan Shah? The walking desk is the biggest hack.
17:37 Speaker 01 Yeah, I I'm not there yet, just because I'm not sure I can write and walk at the same time. I don't know if I'm that coordinated, but I mean, that's the answer.
17:46 Dr. Darshan Shah? Yeah, yeah, I I find that I can't write and walk, but I can certainly type and walk. Yeah, so I'll do a lot of zooms up from my walking desk and I will do some email answering from the walking desk as well. And now I can get 10,000 steps in easily during the course of a workday. So that's a hack for people.
18:02 Speaker 01 Yeah, that's awesome.
18:03 Dr. Darshan Shah? Yeah. All right, so that's great, great setup. So I want to take it kind of.
18:07 Speaker 01 I've got a third.
18:08 Dr. Darshan Shah? Oh, you have another one.
18:08 Speaker 01 You asked for three.
18:09 Dr. Darshan Shah? I'm so sorry. Yes, I do not want to eliminate the third one. Let's do it. Let's do it.
18:14 Speaker 01 The three, which I think is equally as important, but often forgotten, is sleep hygiene and a solid sleep program, because that's where our bodies recover. And recovery is where the most growth occurs, be it from your physical muscles or your mental muscles, because that is where all of our our brain capacity is rejuvenated and the waste products are removed. And the same thing for for our bodies physically. And I I know that that working on sleep is not sexy like many of the other in vogue topics these days, but it's equally as important.
18:54 Dr. Darshan Shah? Right, that's so true. And I think it's become more at the forefront of people's minds lately.
18:59 Speaker 01 Absolutely.
18:59 Dr. Darshan Shah? Um, and, um, you know, I don't know about you, but I grew up in a time where, and I know we grew up in the same time, so I'm I'm being facetious here, but sleep was considered a weakness, especially in surgical residency, where the more you slept, the more weak of a resident you were found to be. And now we know the exact opposite is true. Like you're without sleep, you lose a lot of your lifespan and health span.
19:22 Speaker 01 And I continue to to struggle with exactly that. That's my Achilles heel. And that's why I wasn't willing to leave it off the list, because it's something that I personally struggle with. And it's really hard to, because unlike being able to control what you put in your mouth, or being able to control your motivation to get yourself off the couch and go and move, the more I try to control my sleep, the worse it gets. And so I've really had to work to change my relationship with sleep. And that's come in lots of different forms, but I think that it's it's not in the forefront of people's minds, and it's not something that people want to deal with many times, because it's hard to deal with.
20:04 Dr. Darshan Shah? Well, Dr. Michael Bruce, who you got reintroduced to last night,
20:07 Speaker 01 I did.
20:08 Dr. Darshan Shah? can definitely help you with that.
20:09 Speaker 01 We have already, we have already made arrangements for such. And he immediately said, I know I can help you. And that was great to hear. And I am open. I really am because I, like you, always had this mindset. I'll sleep when I'm dead.
20:24 Dr. Darshan Shah? Yeah.
20:25 Speaker 01 Because to, you know, pull out early from work and or go to the call room and take a nap. God forbid, was it was an absolute sign of weakness. But now we know that allowing residents and physicians to rest reduces errors. It makes them, you know, sharper with decision making, sharper in the operating room. It just, it makes good sense.
20:47 Dr. Darshan Shah? And also just for learning, I think, you know, the, the attitude when we were going through residency was the more hours we spent in the operating room, learning the, the more we would learn. And the reality is none of that sticks with you when you're past your,
21:00 Speaker 01 Right.
21:00 Dr. Darshan Shah? you know, when you're past your hours of sleep that you, that you've missed. And you end up learning nothing from that. In fact, you end up forgetting the things that you've already learned.
21:08 Speaker 01 Right. Those deep memory, the deep memory work, all of those things occur while you're asleep.
21:15 Dr. Darshan Shah? Right.
21:15 Speaker 01 And so without that, it really, it becomes for naught.
21:18 Dr. Darshan Shah? Now, there was a recent study, actually, for, that they did on students on memory, where the students that learned for 30 minutes and actually took a nap afterwards, retained 100 times more, 100% more information than the, than the people that just kept studying all the way through.
21:34 Speaker 01 Yeah. It's great to hear that those are starting to happen.
21:37 Dr. Darshan Shah? Yeah, yeah, exactly. All right. So great. That was a great list of tips to help that particular audience avoid the operating room table. But, you know, you're an expert in heart disease. Obviously, you're a cardiothoracic surgeon. Let's take it back to a 30,000 foot view. Let's define what heart disease is because we talk about heart disease all the time. And I think a lot of people reference it to mainly referring to plaque. And heart attacks, right? And that's the number one cause of death in the CDC's top 10 causes of death is heart disease, not necessarily plaque disease, right? So can you talk a little bit about that?
22:12 Speaker 01 Absolutely. And, and you're right. I mean, it is the number one killer of both men and women. It's 20 million lives a year worldwide. And the bucket is, is diverse, but let's talk about the three most common things that we see, that I see as a cardiac surgeon and that occur worldwide. And those are, as you first mentioned, blockages in the heart arteries or coronary artery disease. That's the number one killer. That's what causes heart attacks. The second is valvular heart disease. In other words, what separates the heart chambers and keeps the blood flowing in a forward direction. That can either be blockage or stenosis of those valves or leakage of those valves, both.
22:54 Speaker 01 And the final one is electrical abnormalities of the heart. Those are the three most common. Then off beyond that are congenital heart disease. In other words, conditions that people are born with, whether it's babies or you've grown to adulthood with a congenital abnormality, infections of the heart, things and malignancies of the heart, which are very, very rare, that kind of bring up the rear on all of that. But primarily, when you, when we talk about heart disease as a killer, it's the coronary artery disease in the vast majority with the valvular disease as a distant second, actually. And then the electrical abnormalities is a third.
23:37 Dr. Darshan Shah? Right. And, you know, we're at the dinner table yesterday with the three people that had electrical abnormalities of the heart and were
23:43 Speaker 01 Yeah.
23:44 Dr. Darshan Shah? then had to go through some ablation procedures. And so these are not uncommon, atrial fibrillation.
23:50 Speaker 01 Absolutely.
23:50 Dr. Darshan Shah? These are things that people need to be aware of. And I think it's important to have that view of heart disease that there are, besides your coronary vessels, you have valves, you have an electrical system, and these can also cause problems for different reasons.
24:03 Speaker 01 Absolutely. And as you point out, you know, atrial fibrillation is the most, one of the most common diagnoses in Medicare.
24:09 Dr. Darshan Shah? Right.
24:09 Speaker 01 So you, you may Or you may have atrial fibrillation or know someone that has atrial fibrillation because it's so incredibly common, but people don't necessarily associate that with, you know, the bigger, the bigger picture of heart disease.
24:23 Dr. Darshan Shah? Exactly. And then I think also in part of your purview as a cardiac surgeon is cardiovascular disease in general. And so, you know, zooming out beyond the heart to the other blood vessels that connect to the heart, there's also diseases that we need to be aware of there. Could you maybe just give us a quick list of some of the ones that are common there?
24:42 Speaker 01 Sure. So the most common that we would deal with would be aneurysms of the aorta. An aneurysm is just a thinning or ballooning of the blood vessel. Why is that dangerous? Well, once it gets to a certain size, the risk of that rupturing goes up. If you think about it like a clown balloon, like the clown balloons where they make the little animals, they're really hard to blow up at first, but once you get them to a certain size, they blow up really quickly. It's the same thing that happens in the main blood vessel, the aorta. Once it reaches around five, five and a half centimeters, then the expansion can be very rapid. Things like high blood pressure and other, other conditions can aggravate that,
25:27 Speaker 01 but the size of the aorta is predominantly what pushes us to surgical indication and to potentially fix that.
25:33 Dr. Darshan Shah? Right.
25:33 Speaker 01 Then the other types are typically blockages in arteries outside the heart. The most common would be in the carotid arteries, which are the arteries leading to the brain. And the risk there, of course, is stroke. And it's not necessarily that the artery gets blocked, but that pieces of that plaque or clot that has been formed around that plaque break off and then go to the brain and cause a portion of the brain to actually die and cause a stroke.
26:03 Dr. Darshan Shah? Or a stroke, right, exactly. And I think it's important for people to understand the full spectrum of
26:08 Speaker 01 Sure.
26:08 Dr. Darshan Shah? of these issues because a lot of them are related. And I think all of them are avoidable with appropriate diagnostics and also appropriate, and the same lifestyle interventions kind of can prevent all of these different problems from happening with, um, and so you're kind of mitigating the risk of all of these at the same time, but putting some lifestyle interventions in place.
26:30 Speaker 01 Yeah, I mean, I think the bottom line is nothing happens in our body. It's not a vacuum.
26:34 Dr. Darshan Shah? Yeah.
26:35 Speaker 01 You know, nothing happens in the vacuum and the blood vessels in the neck, although they act differently than the blood vessels in the heart, functionally, they're exactly the same.
26:44 Dr. Darshan Shah? Uh huh.
26:45 Speaker 01 And they are exposed to the exact same stressors and pathophysiology. And so when you're fixing the problem, as it were, you are addressing the problem in all of these areas. That's right.
26:56 Dr. Darshan Shah? Yeah. So the last 25 years, you know, when you started doing cardiac surgery up to now, you have seen probably the greatest amount of change in the way we diagnose and manage this disease process. And I would say some things have gone completely 180 on this, right? And I'd love to hear kind of like your purview of where things started, where things are now. And what does really good proactive heart care look like now in 2025?
27:24 Speaker 01 Yeah. Well, I will qualify by saying I'm not a cardiologist.
27:28 Dr. Darshan Shah? Yes.
27:28 Speaker 01 And so I will give it to you from a surgeon's perspective. This is typically done, you know, through a cardiologist, not me. But I agree with your assessment that the changes and the advancements have been absolutely dramatic. And I think a lot of the answers to your questions too, we have to maybe break down based on how old you are first.
27:52 Dr. Darshan Shah? Okay.
27:53 Speaker 01 Because I think that then changes what your risk factors are. Now that heart disease has become kind of center stage for many people, people say, okay, well, it's the number one killer. It's not cancer. I've been worried about cancer for a long time. And so there's younger patients now in their 30s that are saying, well, do I have heart disease? How do I know if I have heart disease? Well, under the age of 40, it's pretty rare to present with heart disease unless you have a very strong family history or genetic abnormality with the way that you metabolize cholesterol or something of that nature. Nonetheless, there are options even at that age as far as investigation,
28:32 Speaker 01 because I think that there is value in just allowing people to know whether they have heart disease or not. And this then carries through as we age. These tests are still available. They are relatively non-invasive and they give you a fair amount of information. Specifically, what I'm referring to is the calcium scoring CT scan. And what this does is you go through a standard CT scanner. This test is without any IV dye at all. You get a moderate dose of radiation with that, but the risk is very small as associated with it. And what the information that you get is the calcium burden in the arteries themselves,
29:13 Speaker 01 in the arteries that feed the heart muscle itself, which is where the blockages occur. Now, remember, this is a screening test. It is not an absolute test. So how are screening tests useful? Most of the time, if they're totally normal, in other words, you have a calcium score of zero, or if they're really abnormal, or if you have a very high calcium score of 400, 500 or greater. The gray zone can be very, very confusing. And so you have to be willing to respond to the gray zone. Yeah. So the next test would be, if you fall into that gray zone, would either be a stress test, which would involve either placing you on a treadmill
29:54 Speaker 01 with EKG pads and then exercising at various levels of exertion, and then identifying any changes in the EKG, or a stress echocardiogram, which is really a nice test because it's functional as well. What do I mean by that? We're able to see how the heart is reacting and responding to stress directly. And we look for segments of the heart that may not be working well as other segments. So from a non-invasive standpoint, that's kind of the stopping point. Now, if the question is not answered at that crossroads, then the gold standard is a cardiac catheterization,
30:36 Speaker 01 which involves putting a small catheter in an artery and driving it up to the heart, either through the wrists, which is how it's done actually most commonly now. It used to be done most commonly through the groin. The problem with that is patients had to lay flat for an extended period of time. There was bleeding complications from the groin, et cetera. This makes it really much less invasive, in my opinion. Even though you're still going in the artery, the complications from this are really minimal. Then contrast or dye is injected into those arteries under X-ray and it gives you a roadmap.
31:09 Dr. Darshan Shah? Right.
31:09 Speaker 01 And it gives you a roadmap of where the potential blockages are.
31:12 Dr. Darshan Shah? Right.
31:13 Speaker 01 And when and how all of these tests are utilized are again based on your age, your risk factors that you may or may not have for cardiac disease and what the results are of each test along the way, going from less invasive to more invasive to get the answer.
31:30 Dr. Darshan Shah? Right, right. And so, and then that's where you come in, when the angiogram is showing major blockages that are potentially causing not enough blood to get to segments of the heart, which is also shown in the stress echo, and now we have to do something about it.
31:46 Speaker 01 Correct. And if, if they're not able to place stents, and that's also done through those small catheters, usually that involves one, maybe two blockages. They have to have certain characteristics that a stent is going to be successful. Multi-vessel coronary disease, which is usually two or more, typically requires an evaluation from a surgeon to make sure that that's not a better way to go. When I say better, more sustainable, more durable, long-term, it's all a risk-benefit type of decision.
32:17 Dr. Darshan Shah? Right, right. Are you seeing like CT angiograms and clearly exams where you use AI for the CT angiograms, replacing some of the angiography that's being done now?
32:27 Speaker 01 So I think right now, and what you're referring to is the CT scan, but with the addition of the dye.
32:35 Dr. Darshan Shah? The dye, right.
32:35 Speaker 01 The advantage to that is twofold. One, it can pick up soft plaque.
32:39 Dr. Darshan Shah? Yes.
32:40 Speaker 01 Which is a real thing in addition to the calcified plaque. And it can estimate a degree of blockage in those arteries. I don't think the technology is at a point where, where we can rely on it to make a decision like going to surgery at this point.
33:00 Dr. Darshan Shah? Sure.
33:00 Speaker 01 Because I think it still falls in the screening test category and it tends to be more sensitive and essentially over-read blockages in comparison to the gold standard.
33:13 Dr. Darshan Shah? Mm-hmm.
33:13 Speaker 01 So you, you know, you have to kind of weigh the components, pluses and minuses of each modality to be able to make the next step decision.
33:22 Dr. Darshan Shah? Right, right. Yeah, I think, I think you probably wouldn't go to surgery solely based on a CT angio.
33:28 Speaker 01 No.
33:28 Dr. Darshan Shah? You'd probably definitely need to see a standard angiogram.
33:32 Speaker 01 Yes.
33:32 Dr. Darshan Shah? And understand where the, where the blockages are in the standard angiogram.
33:35 Speaker 01 Absolutely.
33:36 Dr. Darshan Shah? Makes total sense. Okay. So you see a lot of, I mean, you're opening up these arteries. You, you look at the plaque, you're sewing new arteries to them. And, I mean, you know, you can see plaque on CT angiograms and angiograms. And you can see plaque like a cardiac surgeon does. And I'm just wondering, you know, from your vantage point, do you feel like if someone gets diagnosed a plaque, whether, doesn't matter what modality, is it reversible?
34:03 Speaker 01 So plaque, calcified plaque in and of itself is really not reversible. You know, there have been some studies with some specific medications that have maybe shown some promise that there was some what we call plaque regression or less plaque. But I think the party line where we are in 2025 is that we really don't have anything that causes plaque regression. I think now what we want to avoid is progression.
34:33 Dr. Darshan Shah? Right, right.
34:35 Speaker 01 Because whether or not you get stented or I do bypass surgery, neither of those things stop the underlying problem of the hardening of the arteries.
34:44 Dr. Darshan Shah? Yeah.
34:45 Speaker 01 And you have to make those lifestyle modifications, plus minus medications that you may or may not need, to then prevent this from happening again.
34:54 Dr. Darshan Shah? Yeah. What about, you know, there's been some studies that are probably like 20, 30 years old now about the Mediterranean diet and reversing plaque. I think Dean Ornish did those studies. And then I've seen, you know, some studies on supplements like nattokinase. I've also seen some talk about PCSK9 inhibitors potentially helping, not with calcified plaque, which absolutely like.
35:18 Speaker 01 Sure.
35:18 Dr. Darshan Shah? I mean, the idea there is once it's calcified, it's basically hard and it's solid. And that's our body's attempt at stabilizing the plaque.
35:24 Speaker 01 That's correct.
35:25 Dr. Darshan Shah? But what about, you know, using Mediterranean diets, lifestyle changes, maybe some targeted supplementation, maybe even PCSK9 inhibitors? If you're someone that gets diagnosed with just a ton of soft plaque, do you think that could be helpful?
35:39 Speaker 01 I mean, I would like to believe so, but I am not familiar with any hard data that really has proven that there has been regression in a significant patient population to where it's statistically significant that we're able to actually counsel patients that that is going to happen. I think that there have been patients that have been on those medications where there has been regression and we're awfully glad when that occurs, but it's so multifactorial that it's hard to know what did or did not cause that. There may be more patient genetics than anything.
36:14 Dr. Darshan Shah? Yeah, yeah, that's true. Okay, so say you're 40 years old and you're worried now about cardiac disease and do you have it or not? And you know, you're seeing your doctor, but you really don't think your primary care doctor is listening to you. Surprise, surprise, like maybe, maybe they're not. What are some of the tests that people should be asking for that, you know, it's 2025. What are some of the maybe even newer tests that people should ask for to understand kind of their risk of cardiac disease?
36:44 Speaker 01 Well, I think, again, the calcium scoring CT scan is a great place to start. I think the American Heart Association is actually looking at adding that to one of the heart disease risk factor variables in the next few years. They're still not there, but they are currently evaluating that. And because it's accessible to patients without a physician's prescription, it's something that many patients are doing on their own. It's very consumer-driven and they just want to know. And I think that's perfectly reasonable. Outside of that, all the rest of it is obviously going to require, you know, the buy-in from your healthcare professional, which is fine. And it includes echocardiogram and a stress test. And then
37:29 Speaker 01 we start looking at blood tests.
37:32 Dr. Darshan Shah? Yes, let's talk about the blood test.
37:33 Speaker 01 Yes.
37:34 Dr. Darshan Shah? Because I feel like those are much more accessible now. People can go and get them at a lab themselves.
37:39 Speaker 01 Absolutely.
37:39 Dr. Darshan Shah? You know, a lot of clinics will make that part of their, like our clinic, we make it part of their evaluation. So yeah, let's talk about the blood test and what are some of the important ones there.
37:48 Speaker 01 So let's look at the standard primary care panel, which is usually fairly limited. Fifteen to twenty-five blood biomarkers, I would say. You would probably know better than me. The ones that are important from a cardiovascular disease, obviously your lipid profiles, which is your cholesterol, triglycerides, and your fasting glucose, which is kind of standard. Once we start to step outside of that, I think we need to look at a little more granular breakdown of the cholesterol. What would be the key points there? I think the big ones would be Apo B, apolipoprotein B, which is, if you think about it as a thirty thousand foot view of
38:30 Speaker 01 how much dangerous cholesterol do you have? When I say dangerous, I mean atherogenic or cholesterol that is, has a proclivity for causing damage to the blood vessels. So it encompasses lots of different components of that lipid profile and is a nice marker. I think in addition to that is the LP little A, which is a genetic marker, really. You only need one in a lifetime to know if it's low, medium, or high, and where you are on the spectrum. It is genetically determined. It's lipoprotein little A. Why is this important? Well, it's a extra proteinaceous tail
39:11 Speaker 01 that's attached to cholesterol that increases the risk of clotting and thrombosis, as well as damage to the arterial wall. The difficulty with the LP little A is that because it's genetically determined, obviously lifestyle modifications, and currently, although hopefully soon, there are no medications right now to mitigate that increased level. So what do you try to do? You try to work on everything else in hopes of tipping the scales in your favor, but you need that. Test one time to know whether you're in that category or not. And then I think the final one from a basic approach is a hemoglobin A1C.
39:51 Speaker 01 Because I think that that glucose management is really crucial when we're looking at overall metabolic health. It directly impacts our triglyceride levels. And I think knowing those particular markers can really help determine where you fall as far as your overall metabolic health and your cardiac risk.
40:12 Dr. Darshan Shah? Yeah, I'm so glad you mentioned those because I can't tell you the number of people that send us their blood test from their regular doctor. None of them have, I mean, not none of them, many of them do not have a hemoglobin A1C, an APOB or an LP little A ever checked. And I've seen, you know, an incredible amount of abnormal LP little A.
40:34 Speaker 01 My wife found out she had it.
40:35 Dr. Darshan Shah? Wow, really?
40:36 Speaker 01 I never knew.
40:38 Dr. Darshan Shah? Oh, my gosh.
40:38 Speaker 01 Yes, just recently, never knew.
40:41 Dr. Darshan Shah? And you know, I feel that if you have a family history of someone that died early from a heart attack, maybe your grandfather died when he was 52 years old of heart, I hear this all the time. And then I'm like, oh, we gotta check your LP little A because I bet you there's some genetic factor going on here and it's probably LP little A.
41:00 Speaker 01 And I think that is the red flag for people. If you have early onset heart disease in your family and a first degree relative in particular, so mother, father, brother, sister. When I say early onset heart disease, in other words, they had a heart attack or they passed away very young. LP little A is crucial, for sure.
41:22 Dr. Darshan Shah? Another thing that I see, and I'm talking to my patients a lot about this when they have LP little A, is they tend to also have an increased risk of valve disease as well.
41:31 Speaker 01 Yes.
41:32 Dr. Darshan Shah? Like aortic calcifications.
41:33 Speaker 01 Denosus in particular, yes, there is a, there is a correlation with LP little A and an increased risk. And the calcification on the aortic valve, although very similar to the calcification in the arteries, it is a little different in the way that it occurs because most of our valves will calcify if we get old enough. That's not necessarily true with our coronary arteries.
41:57 Dr. Darshan Shah? Right, right, right. So when your wife found out she had LP little A, did you recommend the additional testing? Did you send her for a calcium score or other things?
42:07 Speaker 01 That is exactly what I did.
42:08 Dr. Darshan Shah? Oh, okay.
42:09 Speaker 01 And I, you know, that is not necessarily a standard protocol.
42:13 Dr. Darshan Shah? Right.
42:14 Speaker 01 But I think knowing that information is very comforting. Her calcium score was zero.
42:20 Dr. Darshan Shah? Great, okay.
42:21 Speaker 01 And so, does that mean that, that her risk has been? No, we have not altered her risk at all. But I think that what people need to realize too is just because your LP little a is high, it's not a death sentence. Doesn't mean that you're definitely going to have a heart attack. It means that you need close surveillance and you need some really aggressive lifestyle modification and potentially medication to drive the other factors, the other blood levels of cholesterol, triglyceride, et cetera, LDLs, et cetera, as low as you possibly can to hopefully counterbalance the scales.
42:58 Dr. Darshan Shah? Yeah, yeah, for sure. And like you said, with LP little a too, I think, um, I don't know what you recommended for your wife, but you probably want to increase the surveillance until there's some treatment available.
43:09 Speaker 01 And that's exactly what we did.
43:10 Dr. Darshan Shah? Right, right.
43:10 Speaker 01 Yeah, we, we closed that gap a bit, just to, just to keep a, keep a close eye.
43:15 Dr. Darshan Shah? Exactly. And, um, did you also get her to do a, a carotid scan or?
43:20 Speaker 01 So, we just talked about that recently, only because one of her friends also had LP little a and she said, well, so and so had a carotid, you didn't tell me to get a carotid ultrasound. I said, well, I'm not, not worried about that, but because her calcium score was zero, the likelihood of having associated carotid disease is, is pretty low.
43:43 Dr. Darshan Shah? That usually happens after the coronary disease, right?
43:45 Speaker 01 Exactly, typically speaking. And so because her calcium score was zero, you can't be faulted for doing it, but I don't think it was necessary. And that's what I explained to her.
43:55 Dr. Darshan Shah? Got it.
43:56 Speaker 01 And then she was less mad.
43:58 Dr. Darshan Shah? Makes sense. So, you know, I think the moral of the story is, is I always tell my patients, you're an N of one, and what's going on in your body is going to happen differently, no matter what, no matter who you are. And like, your wife is a perfect example. She has an LP little a, she has a coronary calcium score of zero. Then you have people with LP little a that's positive, and their coronary calcium score is 500. And it's because everyone is different. And I think there's genetics at play, but there's also a lot of life factors at play here, right? And I try to counsel my patients, and tell me if you agree with this, is coronary vasco disease is multifactorial. It's not just high cholesterol. There's other factors involved.
44:40 Speaker 01 Absolutely. And it happens over time.
44:42 Dr. Darshan Shah? Right, right, exactly.
44:44 Speaker 01 It happens over time.
44:45 Dr. Darshan Shah? Yeah. And so, you know, some of those other factors, you mentioned one metabolic disease, right? I mean, if you have metabolic disease, then you add another reason that your coronary arteries could be damaged. Are there other factors that that could contribute to coronary artery disease? And you mentioned smoking as well, as well. What are some of the other ones?
45:03 Speaker 01 Yeah. Well, I think alcohol needs to be discussed.
45:05 Dr. Darshan Shah? Yes, let's talk about alcohol.
45:07 Speaker 01 Alcohol is a personal choice. I'll start there. And that is, that is everybody's individual agency, if you will, your body, your rules. But in the end, there really isn't much positive from alcohol. It's broken down into acetaldehyde and acetate. Acetaldehyde is toxic to every single cell in the body. Acetate is empty calories that if not utilized, typically is stored as fat. Unfortunately, it's most of the time visceral fat or the fat around your organs, which we know is also a risk factor for cardiovascular disease in addition. And so I think that alcohol directly has a toxicity to vessel walls.
45:50 Speaker 01 I think that it has a direct impact on high blood pressure and hypertension, or hypertension. And secondarily, by increasing abdominal fat, then driving and feeding this inflammatory engine that we has been proven over and over again to be a direct risk factor for coronary disease. I think also on that list is Blood sugars.
46:16 Dr. Darshan Shah? Hmm hmm.
46:17 Speaker 01 And I personally think that everybody should put a CGM or continuous glucose monitor on for at least a month.
46:25 Dr. Darshan Shah? Amen, I believe that too.
46:26 Speaker 01 I think it should be part of every internal medicine practice, primary care. Why not?
46:33 Dr. Darshan Shah? Why not, right?
46:34 Speaker 01 Why not? Because if you don't know, if you don't measure it, you don't know. And the impact is so great on not just the cardiovascular system, but your overall physiology, whether it's your cognitive function, or your kidney function, or again, nothing happens in a vacuum. So by, by checking your continuous glucose monitor for a month, you get a really good picture of what your baseline average glucose is.
47:03 Dr. Darshan Shah? Yeah.
47:03 Speaker 01 You can then correlate that with a hemoglobin A1C to give you a much broader view over a 90 to 120 day period to give you a good idea of how well your glucose is controlled. And then you can work backwards into your CGM and say, okay, well, which foods really affect my blood sugars? That's how I personally have found it most useful. Things that I thought were really healthy for me were not.
47:27 Dr. Darshan Shah? Right, right.
47:27 Speaker 01 And the power of just a 10 minute walk after dinner, I've watched my blood sugars just plummet. So I think that there's, there's definitely really simple and effective ways to manage a really big problem if it's missed.
47:45 Dr. Darshan Shah? Yeah, absolutely. And what I love about the continuous glucose monitor is, it's not like you're collecting a month's worth of data and then handing it to your doctor like a Holter monitor or something. You're learning the entire time.
47:56 Speaker 01 It's real time.
47:57 Dr. Darshan Shah? It's real time. It's going to your phone, you're seeing the glucose curves. Most of the apps now will give you real time feedback based on your dietary choices in that moment. You just learn what affects your individual biology and you can completely reverse metabolic disease, or at least stop it just by that educational process, right?
48:15 Speaker 01 I did it personally.
48:16 Dr. Darshan Shah? Yeah, yeah, me too. I did it too.
48:18 Speaker 01 I put a glucose monitor on after the urging of my oldest son Max.
48:24 Speaker 01 And within 48 hours realized that my baseline glucose was in the upper 140s, low 150s.
48:31 Dr. Darshan Shah? Oh, wow, okay.
48:31 Speaker 01 Which was significant. I checked my hemoglobin A1C, it was 5.9.
48:34 Dr. Darshan Shah? Ah, wow.
48:36 Speaker 01 And with just lifestyle modification and some really specific dietary changes, I've got it down, you know, to nearly 5.5 and hopefully the next one will be out of the prediabetic range altogether. So it's doable and I've lived it. And I fell into that 80% of individuals that had no idea that they're prediabetic. I was one of those.
48:57 Dr. Darshan Shah? Yeah.
48:57 Speaker 01 And I thought I was doing a really good job.
48:59 Dr. Darshan Shah? Right, right. And I think, you know, that's a really good point because if Max had not had you put that on, you think, you know, I'm exercising, I'm eating a whole foods diet. I walk, you know, and I'm doing all the right things. And you just didn't know. And there's subtle things that we do day to day that raise our blood sugar that add up over time. Things like eating a bowl of oatmeal in the morning. Maybe you eat, maybe you like to snack on bananas, you know? These are all things that can spike your glucose if unopposed and lead to long-term changes over time, right?
49:32 Speaker 01 And you can feel totally fine.
49:33 Dr. Darshan Shah? Yeah, you feel fine.
49:34 Speaker 01 And that's what, one of the things that people have to realize that I lived, like, I felt great.
49:39 Dr. Darshan Shah? Yeah.
49:40 Speaker 01 And I had no idea because I had never checked.
49:44 Dr. Darshan Shah? I think, you know, I say this all the time, this shout it from the rooftops, don't wait for symptoms to get yourself checked and evaluated. It's, it's, you know, we, I keep saying, we live in 2025. We have so much incredible data available to us, whether we have blood tests, continuous glucose monitors, you know, these tracking devices. We can, I have all my patients get a scale that tells you how much skeletal muscle mass you have. These are all pieces of data that can be woven into a story 30 years before you get diagnosed by, with a disease, right?
50:18 Speaker 01 Absolutely.
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52:19 Dr. Darshan Shah? I know, there's one major thing that we have not talked about yet is high blood pressure.
52:23 Speaker 01 Yes.
52:24 Dr. Darshan Shah? Let's, let's start talking about high blood pressure.
52:26 Speaker 01 So, high blood pressure is incredibly important because in this country, one out of two, 50%.
52:33 Dr. Darshan Shah? I have high blood pressure.
52:34 Speaker 01 There you go, I don't. There you go. Here's our, here's our, here's the statistics sitting here and thank goodness I don't because that's one that I don't have. Yeah, it's, it's important because it's common, many times people don't know they have it. And it's the most easily modifiable risk factor that we have on the list.
52:56 Dr. Darshan Shah? Right.
52:57 Speaker 01 And why is it important? Well, let's talk about what high blood pressure is or what blood pressure is to begin with, just so people understand. You know, the cardiovascular system is a closed loop system with a pump. That's what it is. And the blood goes around and comes back to the heart and is pumped out. And every time the heart beats, our blood vessels are normally very elastic or flexible. And so they accommodate. So when the heart beats, a certain amount of pressure is generated and then accommodated in those blood vessels. Adequate blood pressure to deliver oxygenated nutrients to our vital organs, our brain, kidneys, our extremities, whatever it may be. That's what the normal system, that's how the normal system functions.
53:42 Speaker 01 High blood pressure, what happens over time is there's primarily in the beginning, a loss of that flexibility of the blood vessels. Instead of being flexible, they become very stiff. So when the heart beats, it's seeing an increased resistance every time, requiring more pressure to actually eject the same amount of blood. Now, what does that mean long-term? Why is that even important? Well, the high blood pressure can directly damage the inner lining of the blood vessel. Once that injury pattern is set up, it's the repair process of that artery that ultimately can cause laying down of cholesterol and then plaque formation.
54:28 Speaker 01 That's how high blood pressure then affects the artery itself. This can happen in the carotid arteries that we've talked about, peripheral arteries, and in the arteries to the heart, which is why high blood pressure is a risk for heart attacks. In addition, the heart is a muscle.
54:43 Dr. Darshan Shah? Yeah.
54:43 Speaker 01 And if the heart is seeing increased resistance over time, well, that's time under tension. It's no different than curling weights in the weight room. It's gonna get thicker and thicker and thicker with time, which then makes the cavity smaller. So the effective blood volume that's being ejected from the heart is less. And the heart's having to work harder to get that equivalent amount of blood out. And over time, the heart function will start to slip off the curve. Instead of getting thicker and stronger, it'll actually become weaker and can ultimately result in heart failure. So what is high blood pressure?
55:27 Speaker 01 It's less flexible blood vessels that then cause damage and can potentially be a setup for a heart attack. And then, high blood pressure increases the workload of the heart. And over time, that can result in heart failure.
55:43 Dr. Darshan Shah? Yeah. So why do so many people have high blood pressure? One out of every two people? Like, what's going on?
55:48 Speaker 01 Yeah. So now you're easing out of my wheelhouse, with the exception of the fact that the majority of patients fall into a category of primary hypertension
55:58 Dr. Darshan Shah? Right.
55:58 Speaker 01 versus secondary hypertension. Primary hypertension is usually based on changes in volume status, kidney function, things of that nature. Whereas secondary is hormonal type changes or, you know,
56:17 Dr. Darshan Shah? Got it.
56:17 Speaker 01 neural neural changes.
56:19 Dr. Darshan Shah? Right, right. Yeah, I feel that, you know, from my particular, I can, I can tell you my story about blood pressure was when I was around 40, you know, operating 12, 14 hours a day. I saw my doctor because I wasn't feeling good. I got dizzy in the operating room one day. He checked my blood pressure. He said, it's high, but you know, come back in six months and we'll check it again. Came back in six months. It was a little bit better. It was like 140 over 90. He said, yeah, you know, it's a little high. Go on a low salt diet. Come back in a year and we'll see where you're at. Another year goes by. It's still 145 over 95 or something. And he said, are you sticking to the low salt diet? I said, I don't know, man. It's so hard to stick to a low salt diet, right?
57:00 Speaker 01 Yeah, less than 1500.
57:02 Dr. Darshan Shah? It was literally was, the can was kicked down the road for four or five years before I finally got put on blood pressure medication. And then it took another two or three years to get my medication right. And to be honest, I never got it right. I was, I was struggling for this for a decade. And finally, a friend of mine introduced me to this device that I could wear on my wrist that gave me a continuous blood pressure reading.
57:27 Speaker 01 Really? I'm not familiar with that.
57:29 Dr. Darshan Shah? It's incredible. It's called Actiaban. I actually had their chief medical officer, whose last name is also Shah, but no relation, on this podcast, one of my first episodes. And we talked about blood pressure extensively. And the reality situation is, is these one-off readings at your doctor's office that ends up causing you to miss this diagnosis for sometimes like in my case, a decade. And I think this is more of a common story than an uncommon story, right? And so I advise a lot of patients to do, a lot of people to do, is to get their own blood pressure cuff. Measure, get one for your family. Everyone over the age of like 25, 30, let's like make it a family event that once a quarter, you
58:10 Dr. Darshan Shah? all sit, you do it together. You watch a good YouTube video on how to do this. Do it three times, average it. Let's just make sure everyone's okay.
58:18 Speaker 01 Yes.
58:19 Dr. Darshan Shah? Right?
58:19 Speaker 01 And if it's not, then check it over a two week period.
58:23 Dr. Darshan Shah? Right.
58:23 Speaker 01 And make sure that it wasn't just one reading when you're relaxed and what have you. I think that's great advice.
58:29 Dr. Darshan Shah? Yeah. And the whole concept of the low salt diet being a treatment for blood pressure, you're just masking the issue, right?
58:35 Speaker 01 Yeah, I mean, that is still the recommendation is the 1500 low salt diet as part of the lifestyle modification, but clearly aerobic exercise, resistance training, a really solid whole foods diet and allowing yourself to get to a healthy weight, making sure you're getting enough potassium as well as magnesium, those tend to be the key components. You could probably explain the potassium sink better than I could, but it has to do with the movement of sodium in the body. And the reason that's important, the reason that even a low salt diet is important is because water follows salt. And if you hold on to more salt, you're going to hold
59:20 Speaker 01 on to more water, which increases the volume in that pump system again, which increases blood pressure. So if you're not going to adhere to the low salt diet, or it's just hard, which it is, doing at least those other things, I think, really makes a difference.
59:34 Dr. Darshan Shah? Yeah, and I think those things make the biggest difference. All the things that you just mentioned, even at the beginning of this podcast, all the things you mentioned make a huge difference. And for me personally, I ended up never really following a low salt diet. Yeah, but I was able to get off of almost, I'm on just one low dose of a blood pressure medication now, but I was on three, I was able to get off of them.
59:53 Speaker 01 And I think that's pretty common for, for a significant number of people to require at least one medication in spite of life. And that's not a failure.
1:00:01 Dr. Darshan Shah? No.
1:00:02 Speaker 01 I think people need to understand that, you know, you, you adhere to the lifestyle modifications. If you need the medication, it doesn't mean that you failed the lifestyle modification. It's just what's necessary to help adjust your risk.
1:00:15 Dr. Darshan Shah? Right, exactly. And, you know, just to reference for the listeners, a huge trial on this, which was done, called the Sprint Trial, which you're probably familiar with. It showed that there is mortality risk for every 10 points you have above 130 or 80. And so it's really important to keep yourself at a level close to 120 over 70 as a goal. And if you're not, you need to start doing something about it, but get on medication until you can get, get it normalized.
1:00:41 Speaker 01 Absolutely.
1:00:42 Dr. Darshan Shah? There's nothing wrong with being, and these medications are so good, they have Pretty low risk of side effects. Obviously, no medication has no side effect, but I think it's important.
1:00:50 Speaker 01 The benefits far outweigh the risks.
1:00:51 Dr. Darshan Shah? Right, absolutely, absolutely. So, you know, we were talking last night about your story, and your story and my story is so similar. It's like, looking in the mirror, we went through the same kind of life path, being surgeons, and then discovering this new way of thinking about medicine from this root cause, functional medicine. And I'd love for you to kind of talk to us about how that came into your life and how it changed your life.
1:01:15 Speaker 01 Well, when I got into that rut of just exercises and futility, I was nearly ready to quit altogether. I was so frustrated and just beaten down by the process that functional medicine really kind of pulled me out of that space altogether and rejuvenated my interest in medicine. Why did it do that? Because it answered exactly the question and solved the problem that I was grappling with, and that is, why did these people get here in the first place? And that just made such good intuitive sense to me. In other words,
1:01:57 Speaker 01 you know, our bodies are so wonderful because they strive to be in balance, even down to the cellular level with that idea of homeostasis and what have you. And that concept of what have we done to our bodies, or exposed our bodies to, to push us out of center line? Or what have we been missing that we're depleted of that we need to add back to nudge us back to center? And that made so much sense to me. And learning to refocus medicine at the
1:02:33 Speaker 01 cellular level was really exciting for me. And understanding that our genes are our genes, and we can't run from our genes. But we can't impact how our genes are in fact expressed.
1:02:50 Dr. Darshan Shah? Right.
1:02:51 Speaker 01 Through primarily lifestyle modification with food being a very, very pivotal and foundational part of functional medicine, which makes so much sense, right? I mean, we internalize 90% of the outside world through our mouths.
1:03:07 Dr. Darshan Shah? Right.
1:03:08 Speaker 01 I mean, sure, we breathe and we take in some through our skin, but 90% is through our mouths.
1:03:14 Dr. Darshan Shah? That's a good point.
1:03:15 Speaker 01 And I heard a great quote years ago, it said, "If a farmer looks out onto his fields and sees that all of his crops are diseased, where's the first place that they look? It's in the soil."
1:03:30 Dr. Darshan Shah? Uh huh, right.
1:03:31 Speaker 01 This is our soil.
1:03:32 Dr. Darshan Shah? Hmm, yeah.
1:03:33 Speaker 01 You know, you sit at the airport and you watch all of the different shapes and sizes go by and you realize our crops are sick.
1:03:41 Dr. Darshan Shah? Yeah, absolutely.
1:03:43 Speaker 01 And it just made really good sense to me that you start with food and food really can in fact be medicine. And the other thing that I really liked about functional medicine was that it wasn't defined by its name, unlike, you know, a plastic surgeon or a cardiac surgeon. Functional medicine includes all of those things. And so it wasn't Eastern medicine versus Western medicine, allopathic medicine versus naturopathy, it was all encompassing.
1:04:15 Dr. Darshan Shah? Right.
1:04:16 Speaker 01 Depending on where patients were on the curve of their disease process.
1:04:21 Dr. Darshan Shah? Yes.
1:04:22 Speaker 01 And that too made really good intuitive sense.
1:04:25 Dr. Darshan Shah? Sure.
1:04:25 Speaker 01 To me. In other words, you know, I'm not, if a patient comes in with a heart attack, I'm not going to put them on an elimination diet. We're going to do what we need to do. By the same token, if they're here on the curve, then that's a different conversation. And certainly after bypass surgery, implicating, you know, implementing those, those changes is really important.
1:04:46 Dr. Darshan Shah? Yeah.
1:04:47 Speaker 01 So functional medicine was not just an eye-opening experience, it was really a life-saving experience for me. And it also impacted how I lived my life as well.
1:04:58 Dr. Darshan Shah? Yeah.
1:04:58 Speaker 01 It changed the way we were eating, the way we were moving. It was, it really was transformative for me.
1:05:06 Dr. Darshan Shah? Right, I think, you know, I think what happens to us being, you know, we're both Western medicine trained doctors and surgeons. And I think coming from the two of us, that functional medicine is real. It really does kind of fill that gap of what was missing from our medical careers. Right? And we incorporated functional medicine into our own lives because, I mean, how could you not believe in the power of food, sleep, movement? Right? It's that missing piece that's missing from Western medicine. And in India, my dad told me this because he's an Ayurvedic physician. He's a physician and he practiced Ayurveda. And what happens in India is when you go to the hospital, kind of the primary care of
1:05:51 Dr. Darshan Shah? India is the Ayurvedic doctor. So the Ayurvedic doctor is the one that sees you before you go there, tries to keep you healthy. And then if you get unhealthy, you go to the hospital. But the entire time, you're still working with the Ayurvedic doctor. And then when you come out, you go straight back to your Ayurvedic doctor to mitigate and reverse the damage that was being done, you know? And so it's like part of the process. And I think if we look at medicine in that way, the functional medicine works hand in hand with Western medicine.
1:06:20 Speaker 01 Right.
1:06:21 Dr. Darshan Shah? And they're both pieces of the journey, not fighting each other.
1:06:25 Speaker 01 Yes.
1:06:26 Dr. Darshan Shah? They're not separate from each other.
1:06:28 Speaker 01 It's not one versus, it's eastern and.
1:06:31 Dr. Darshan Shah? Right.
1:06:32 Speaker 01 You know? And I don't know if you had this experience, but I personally think that one of the foundational problems with medicine today is we've lost our focus on the patient.
1:06:43 Dr. Darshan Shah? Yeah, absolutely.
1:06:44 Speaker 01 And I think functional medicine really helped me refocus the patient's center stage. You know, as allopaths, we're trained to define the what. We're defined to make a diagnosis. In fact, we're applauded for making the diagnosis, for, you know, giving a medication or doing an operation and fixing that. But we rarely talk about the why. We got there. And, you know, I'm sure you remember Mark Hyman's slide of the Halsted quote.
1:07:15 Dr. Darshan Shah? Yes.
1:07:16 Speaker 01 The patient that has the disease is more important than the disease the patient has. And that was really powerful for me. I it just because everybody coming into my office up to that point was was a diagnosis.
1:07:31 Dr. Darshan Shah? Sure, right.
1:07:32 Speaker 01 I was guilty of it. I mean, I guess that is exactly how I was trained. And I firmly believe that if we refocus our attention on the patient, eighty percent of the problems in healthcare will go away.
1:07:47 Dr. Darshan Shah? Yeah, I I fully agree with you. I think, you know, in medical school, we were taught the art of the history and physical. Right. And functional medicine, I feel, is the only branch of medicine that really still uses that to to the degree that it's really meant to be used. Whereas now, we've replaced the history and physical in a lot of the things that we do in allopathic medicine with a scan or a blood test or.
1:08:10 Speaker 01 Absolutely.
1:08:11 Dr. Darshan Shah? Right, because you're trying to just arrive at a diagnosis. And those are much more efficient ways of getting of the diagnosis. But you meet all you miss all the soft stuff, right? You miss all the.
1:08:19 Speaker 01 No question.
1:08:20 Dr. Darshan Shah? Yeah.
1:08:21 Speaker 01 You know, I mean, if you're trained classically, the test that you order should only confirm.
1:08:27 Dr. Darshan Shah? Right.
1:08:28 Speaker 01 The diagnosis or list of differential diagnosis that you've made.
1:08:32 Dr. Darshan Shah? That's true.
1:08:33 Speaker 01 Not utilized to make the diagnosis. And I think that that is definitely a mindset shift that is going to be very difficult. It's going to be an uphill battle.
1:08:41 Dr. Darshan Shah? Yeah, I think also, you know, in allopathic medicine, when we look at a test number, we look at it as a zero or a one, you know? It's either a diagnosis or not a diagnosis. But in reality, there is the spectrum of optimal headed towards disease and disease state. And this spectrum occurs over time, twenty, thirty years sometimes. And we've lost sight of that in allopathic medicine, too, right?
1:09:08 Speaker 01 Yeah, I think that's perspective is huge or lack thereof. And I agree with you. It's a very binary type system. And that's how people are trained even now. And it's a very myopic way of taking care of people. You know, you lose so much of the opportunity when you don't look at where they came from and now, of course, where they're going to be headed as a result of this diagnosis. I agree with you. I think it's a big part of. Where we need shift in mindset.
1:09:38 Dr. Darshan Shah? Yeah, exactly. And I think it needs to start with each individual having the correct mindset. So, listening to this podcast today hopefully puts people in the right mindset to really take control of this journey.
1:09:48 Speaker 01 Well, it's a relationship.
1:09:49 Dr. Darshan Shah? Right.
1:09:49 Speaker 01 It's not just a change from the physicians. It's also engagement and accountability from the patient's side because none of this works. None of this works if you don't have that agreement, that relationship, that understanding. That's the beginning of a successful care pathway, whether it's in an acute situation or, you know, with primary care over time. It takes both of those. It's our job to educate and to communicate and to give access.
1:10:18 Dr. Darshan Shah? Right, right.
1:10:20 Speaker 01 And it's the patient's responsibility to fully engage and take accountability.
1:10:25 Dr. Darshan Shah? Yeah, absolutely. So, you know, you have three sons. I have two kids. My kids are a little bit younger than yours, but, you know, I always want to set them off in the right direction with their own personal health journey and they're gonna have, you know, they're gonna have problems with their health. I would say it's not realistic to think that even though your lifestyle is perfect, you're not going to have healthcare issues, right? Right? It's gonna happen. But I want to set them off in the right direction, how to think about their own health. And I'm just curious, how do you talk to your sons about their health journey and where, what should they start with? What should, where should they try to end? What should they be following?
1:11:04 Speaker 01 Well, I'll answer that question in two ways. First is that they're getting to the age where they do more telling to me.
1:11:10 Dr. Darshan Shah? Yeah, the continuous glucose monitoring, right?
1:11:12 Speaker 01 Than I do to them. Yes, it's a challenge for me personally, but clearly only have my best interest in mind. I'm just not the best patient. But to answer your question, I think we lead by example.
1:11:26 Dr. Darshan Shah? Right.
1:11:26 Speaker 01 I think that, that you set up a household that is active and wants to be outside and your kids see you exercising on a regular basis and the benefits of that and how important it is. And then the food choices that are in the house. How do we eat? Why do we eat that way? What's available when you open the cabinet? You know, how do you make choices when you're out to dinner? You know, how do you navigate this in different situations? What do you do when you're at a friend's house? You know, how do you, how do you deal with that? But I really think that, that you lead by example and that's the most powerful.
1:12:06 Dr. Darshan Shah? Absolutely.
1:12:07 Speaker 01 Because you're never going to coerce them. They're going to make their own decisions. But I think as long as we can give them the tools and, and show our, our kids the importance of all this and how to integrate it into their lives and still have fun and do all the things and go to our birthday parties and enjoy themselves and all those things, that it, it just becomes the norm. You know, it becomes the, it becomes a normative, you know, day to day.
1:12:36 Dr. Darshan Shah? Yeah, exactly. And I think, like you said, you set up the environment. The home is the environment for success, right?
1:12:42 Speaker 01 Yes.
1:12:42 Dr. Darshan Shah? They, it's so incredible to me how much my son does exactly what I do. Just by, never what I tell him, but always what he sees me doing.
1:12:52 Speaker 01 That'll change.
1:12:56 Dr. Darshan Shah? But, but it's also like a little bit scary because like I know, like, you know, if I'm going to reach for a bag of chips, he will find full permission to just eat the bag of chips.
1:13:03 Speaker 01 Sure.
1:13:04 Dr. Darshan Shah? And I think, um, I think you're right, it's all leading by example with, with the kids for sure. So Dr. London, what are you thinking around supplements? What are your supplement protocols and do you take supplements at all?
1:13:17 Speaker 01 Yes, I do. I have for, I have for a long time. You know, I think my overriding paradigm is that these are supplements, not substitutions for eating a whole foods, well-balanced diet with good hydration. That being said, if I try to hit 80% whole foods, I consider that a win. So there's, there's gaps automatically in my day-to-day routine, particularly with my schedule. And I know that and I've known that for a long time. And so I think that supplementation is individualized. I think that it's really, um, important to look at your diet, to look at your overall hydration,
1:14:02 Speaker 01 to look at your sleep and to know your data, you know, to know your lab work because. It's, everyone feels like they're drinking from a fire hose in the supplement space. It can be overwhelming and at least if you can personalize it and understand that we all have our own instruction manuals, I think it gives you some real direction to know that you're going to move the needle personally. What do I like to do on a regular basis? You know, I like to make sure that I'm covering multivitamins, prebiotics, probiotics, postbiotics. I personally like to use IM-8. I like to drink my supplements in the morning because I am horrible
1:14:41 Speaker 01 with my hydration during the day and that forces me then to start my day with at least 32 ounces of hydration. I get all of my basic supplementation first thing in the morning before I head out the door and it's done.
1:14:56 Dr. Darshan Shah? Yeah, I love it. I mean, I'm an IM-8 user as well. I love it that you could put a packet into 32 ounces of water and you get all the stuff you're like hearing about out there that could be beneficial, CoQ10 and you know, like you said, the multivitamins and methylated folate and all these things that you hear about, but it's like, how many different pills are you going to take, right? And so to have a powder that you can just drink every morning and get your hydration. I'm a bad hydrator too. Like unless, you know, my wife reminds me to drink some water and brings me a glass of water, I'm not drinking water all day.
1:15:26 Speaker 01 And when you're standing in the operating room, you know, for most of the day, like the last thing you want to do is just create overhydration and then have to, you know, deal with that. And the other thing I'll do with the IM-8 is, is keep my, keep the little packets in my office. So even if I end up operating all night, it's there the next day. It's super convenient. I personally like the CoQ10, being a cardiac patient as well. I think that that is something that I really like to see in supplements these days and it, it works for me, you know, it's, it's individualized, but that's what works really well for me.
1:16:03 Dr. Darshan Shah? Yeah, there's supplement overwhelm for sure. I think for a lot of people as well. And then, you know, I think because there are companies out there now that make really great targeted supplements that have patents around products too, I also add to my
1:16:18 Dr. Darshan Shah? My IM-8, which gets me all my basics. I add a few other things like Timeline and the Urolithin A. And I also add in the NAD supplement, True Niagen, which is NR, so it's absorbed better. And then it's much easier to take a couple of two or three good like pills that you know work that are science-backed. Oh, another, another one I take is Acromancia by Pendulum. And that's it. And I take this IM-8 packet that gets me all the basics, a few other things. And, you know, I always look at supplements as, when I talk to patients, you probably do this as well. I'm like, where do you fall on how many supplements you want to take? Because there are patients that are like, I don't want to take anything ever, don't even talk to me about supplements.
1:16:59 Dr. Darshan Shah? And then there are patients that are like, I want to take everything that Andrew Huberman, Mark Hyman, and Brian Johnson recommend. Whatever else you think I should do. And I make a meal out of it. But I think most people fall on the side of, I'll take two or three things and tell me what those are. And IM-8 gets to cover a lot of those.
1:17:16 Speaker 01 Yeah, and I'm with you on the, the timeline. I, I take that as well and have for about a year now, and I really like it. The other addition for me is omega threes.
1:17:27 Dr. Darshan Shah? Yeah.
1:17:28 Speaker 01 You know, I just find that that's something, again, being a cardiac patient, that I think is important for me. But I think it's important for everybody because it affects cell membrane function. And, and it's something that we don't all get in our diets regularly unless you really work at it. Plus, I've checked my levels and they were, they were low. And so that made it really easy to, to add that into my supplementation. I'm like you too, like four or five pills in the morning, fine. Fifteen, too many.
1:17:58 Dr. Darshan Shah? Too many.
1:17:59 Speaker 01 As a result, you know, creating all that. I feel like, I feel like my grandparents, if I have to do the Monday, Tuesday, Wednesday pill thing when I go out of town, you know, it just doesn't work for me. So.
1:18:10 Dr. Darshan Shah? Yeah, I'm the same way. You know, that, that speaks volumes too, that, you know, you checked your omegas. And I know how intentional you are with your diet. Like I, I watch your cooking videos and you're super intentional about it and you were still low. And so it just goes to show that we're just not getting even, you know, the, the levels that we need. No matter how hard you try, sometimes it's just hard to do it. And, you know, like you, I, I work a lot, I travel a lot. And so it's a really good idea to just have that little bit extra, just to kind of like a, like an extra belt and suspenders approach, I think.
1:18:41 Speaker 01 For sure. And you know, if you don't, if you don't check, you don't know.
1:18:45 Dr. Darshan Shah? Yeah.
1:18:46 Speaker 01 And, and that, that was a shift for me just, just recently, to be honest with you. You know, I felt I was kind of in that school. If some was good, more was better with the supplements. And now I am much more focused, like you said, I really, I think it just makes more sense.
1:19:02 Dr. Darshan Shah? Yeah, I agree.
1:19:03 Speaker 01 Correct it that way.
1:19:04 Dr. Darshan Shah? I agree. So, you know, I know that you are a chef and you have some incredible cooking videos that you've put on YouTube and also your Instagram. Where did that come from?
1:19:17 Speaker 01 So, as a, as a child, my mom taught me to cook very early on so that she didn't have to get out of bed Saturday mornings to cook me breakfast. Yes. So I learned to make eggs and basic things. And my parents traveled a lot when, when I was young. We, we had folks that stayed with us and I became very, very self-sufficient. But I've always enjoyed cooking. I always have. The cooking that we do on the various platforms is collaborative. My wife is a holistic nutritionist and so she helps devise the recipes.
1:19:58 Speaker 01 And then we do those things together, even though I'm front and center for, for the majority of it. But we really enjoy it and we, and it allows you to be really creative with very simple choices.
1:20:12 Dr. Darshan Shah? True.
1:20:12 Speaker 01 And that's kind of our mindset with food in the house is, you know, keep it really, really simple and they get creative with the things that, that you choose for that week. But I really, I, I find cooking very relaxing. I find it to be immediate gratification and watching everybody enjoy it is the best part.
1:20:31 Dr. Darshan Shah? Yeah, and especially when it's a family activity.
1:20:33 Speaker 01 Yeah.
1:20:33 Dr. Darshan Shah? I think it's a great way to bring family together.
1:20:35 Speaker 01 Mm hmm.
1:20:36 Dr. Darshan Shah? And when you're cooking, you can't really be on your phone. You can't be distracted. You're talking to each other. Every once in a while, there's a little fight that happens.
1:20:44 Speaker 01 Yes, there is. Yes, there is.
1:20:46 Dr. Darshan Shah? Right, but you know, it's all part of the, it's all part of the fun, I think.
1:20:49 Speaker 01 For sure.
1:20:50 Dr. Darshan Shah? The times that we cook together, I really, truly enjoy it. It's, um, and you just can't get enough of it.
1:20:55 Speaker 01 I agree. And, and it's interesting, if you had told me that, that the cooking videos were gonna be so incredibly popular, I would never have imagined that. But I think a lot of that has to do with the relatability and things that people can take immediately into their own lives and, and apply them.
1:21:12 Dr. Darshan Shah? Sure.
1:21:12 Speaker 01 They're like, oh, he's just in his kitchen. I could cook that.
1:21:15 Dr. Darshan Shah? Yeah.
1:21:16 Speaker 01 And we try to do things that are really very simple, not, you know, don't take a long time. How do you integrate it into a, you know, into a busy lifestyle or whatever, maybe?
1:21:25 Dr. Darshan Shah? Yeah, yeah, and I think, I think that's what's really powerful because obviously, you know, there's tons of books out there and chefs that are showing complicated recipes that take a thousand ingredients and hours.
1:21:34 Speaker 01 Right.
1:21:35 Dr. Darshan Shah? It has to be like something you can integrate into your life.
1:21:37 Speaker 01 Of course.
1:21:37 Dr. Darshan Shah? And you show that really well.
1:21:38 Speaker 01 Well, thank you. I appreciate it. I enjoy it. I do.
1:21:41 Dr. Darshan Shah? Yeah. So, you know, you've, you're having a moment right now in your life where you've kind of trend transitioning into more of a, um, of a teacher and educator of, to the public. And I'm just wondering, you know, and you've already told me this, but for our audience, kind of, where are you taking this? Where are you going? What, what's next for, for you?
1:22:04 Speaker 01 So I think that this has been, first of all, if you had told me two years ago that social media and being public facing was going to be the next curve of my life, I would have laughed at you. You could have listed a thousand things. It, it wouldn't have even been on there. So it's just interesting how opportunities present themselves. And I really enjoy being a beginner. And this has been a real journey for me because I've, I have no experience and I've been fortunate enough to work with my oldest son, who has lots of experience in this space and has given, you know, given me lots of guidance. In the early stages and we now are at a place where we've become really partners in this
1:22:46 Speaker 01 in this whole process and we feel like our mission is just to continue to offer easily digestible, relatable, health and wellness and medical information that people can can utilize and is very tactical in their day to day lives. And so as we continue this journey, you know, we layer things on top and we've started a podcast. We've got a newsletter that's been running for a while. We hope to start doing some public speaking in the near future and eventually there will be a book that will become foundational for for the whole platform. I think that that's a natural progression. It's also something I've wanted
1:23:26 Speaker 01 to do for a long time. I didn't know exactly what the topic was going to be, but I read voraciously as I know you do and I'm fascinated by how books are structured and I really, I want to do that, but that's going to have to be after I give up my clinical responsibilities because it's just the time issue is is too constraining right now.
1:23:49 Dr. Darshan Shah? Yeah, exactly. And, you know, we talked about this earlier. I still see patients, but I stopped doing surgery a couple of years ago and just having the time back to be able to communicate the knowledge that I've gained over the last 10 years in functional medicine has been transformative for me because I could just see so many more lives being affected, just like you're doing. And it's just so rewarding to see that.
1:24:13 Speaker 01 Yeah, it really is. And to see it scaled like it is too.
1:24:17 Dr. Darshan Shah? Right.
1:24:18 Speaker 01 That's what's the the power of that is overwhelming at times and really exciting.
1:24:24 Dr. Darshan Shah? Yeah. And I'm sure like through your messages, you've saved lives, you've changed lives and what a shame it would have been if you had just quit after you're done with your surgical career and all that's gone, right?
1:24:35 Speaker 01 I have thought about that. I really have like it's, you know, it was the CGM on one day and it was the all the platforms on the another that I have to give credit to my son Max for.
1:24:49 Speaker 01 Coercing me versus opening the doors towards stepping into an arena that was really foreign to me and has really become incredibly exciting and a whole new growth phase for me in life. And I think that when you stop changing and you stop growing, that's when trouble starts.
1:25:08 Dr. Darshan Shah? Yeah, exactly.
1:25:09 Speaker 01 And I never planned to do that.
1:25:10 Dr. Darshan Shah? Right. And that flip side of that coin is, you know, once you implement a change and it's positive and you get your excitement and your passion back for life, it's just a whole new lease on life. And I encourage anyone who's stuck in a rut of where they are or burnt out or whatever have you, there's something else out there, just find it for you.
1:25:28 Speaker 01 Sure. I mean, you know, we're all, we're all scared to change, but what we should really be scared of is staying the same.
1:25:34 Dr. Darshan Shah? Right.
1:25:34 Speaker 01 And, you know, I had to remind myself of that.
1:25:37 Dr. Darshan Shah? Yeah, exactly. Last thing I want to talk to you about is the concept of community and how important is that in your life? You seem like a very gregarious person. You, you seem like you love being around other people. Talk to me a little bit about community in your life.
1:25:53 Speaker 01 Yeah, I, I think that it is crucial to our overall health, to our wellbeing, to our, our, our health together as a community. And it's something that takes work. There's no, no question about that. But, you know, my, my dad, who's going to be 89, coming up here shortly, told me several years ago, he said, keep your friends close because you don't know which ones are not going to be around, which ones are not going to be able to communicate. He said, the power of someone just picking up the phone and saying, hey, what you doing? He goes, you don't have to make any big plans. Just someone to say,
1:26:35 Speaker 01 what are you doing? You know, that connection is really, really important. And whether it's distilling your friend group down over time, putting more effort into your family life, whatever it may be, and it's different for everybody. For me, my family is paramount and that's where, that's where it starts. And it's what makes it all worthwhile, you know?
1:27:03 Dr. Darshan Shah? Yep. Gives us all the reasons we need to get out of bed in the morning.
1:27:06 Speaker 01 Every day.
1:27:07 Dr. Darshan Shah? Yeah.
1:27:07 Speaker 01 Absolutely.
1:27:09 Dr. Darshan Shah? Dr. London, this has been incredibly educational and inspirational conversation for me. Thank you so much for joining me on this podcast.
1:27:17 Speaker 01 Well, thank you for having me. It is an honor to be here and I truly appreciate the invite.
1:27:21 Dr. Darshan Shah? Yeah, thank you. Where can people find out more about you?
1:27:24 Speaker 01 DrJeremyLondon.com is our website. We have a newsletter that comes out every week.
1:27:30 Dr. Darshan Shah? I love your newsletter.
1:27:31 Speaker 01 Thank you so much. We have a podcast that you can find on YouTube, Spotify, Apple Podcast, and come check us out. We'd really appreciate it.
1:27:40 Dr. Darshan Shah? And your social media handle is?
1:27:42 Speaker 01 DrJeremyLondon.
1:27:43 Dr. Darshan Shah? There you go. Thank you, sir.
1:27:44 Speaker 01 Absolutely. Thank you.
1:27:48 Dr. Darshan Shah? Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps us 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.
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