Can Heart Disease Be Reversed? After His Own Heart Attack, This Surgeon Changed Everything | Dr. Jeremy London

Heart disease is still the leading cause of death worldwide. Yet many people assume it only happens to those who are older, out of shape, or obviously unhealthy. In this episode, I sit down with cardiovascular surgeon Dr. Jeremy London, whose own heart attack challenged many of the assumptions we make about heart health. We discuss why prevention isn't always as straightforward as it seems—and how understanding your personal risk can help you take a more proactive approach to your health. We cover: Why some healthy people still develop heart disease The difference between standard cholesterol tests and a more complete assessment How to better understand your personal cardiovascular risk The lifestyle changes that can help lower your long-term cardiovascular risk Interested in more comprehensive lab testing? Learn more at Function and use code MARK2026 to save $50 on your membership. Heart disease is often preventable—but only if you know what to look for. Listen to my conversation with Dr. Jeremy London to learn how a better understanding of your personal risk can help you protect your long-term heart health. View Show Notes From This Episode Sign up for Dr. Hyman’s Brainshaping Academy to learn how to nourish the biological systems that support your mental, emotional, and cognitive health https://drhyman.com/products/brainshaping?utm_source=dr_hyman_show&utm_medium=newsletter&utm_campaign=may_27&utm_content=link Get Free Weekly Health Tips from Dr. Hyman https://drhyman.com/pages/picks?utm_campaign=shownotes&utm_medium=banner&utm_source=podcast Sign Up for Dr. Hyman’s Weekly Longevity Journal https://drhyman.com/pages/longevity?utm_campaign=shownotes&utm_medium=banner&utm_source=podcast Join the 10-Day Detox to Reset Your Health https://drhyman.com/pages/10-day-detox Join the Hyman Hive for Expert Support and Real Results https://drhyman.com/pages/hyman-hive This episode is brought to you by Paleovalley, Pique, Perfect Amino, Seed, BON CHARGE, and Cozy Earth. Shop nutrient-rich foods and supplements at paleovalley.com/hyman and save 15% off your first order. Elevate your daily wellness ritual at piquelife.com/hyman and enjoy 20% off plus free gifts. Help fill protein gaps at bodyhealth.com and use code HYMAN20 for 20% off. Support your gut health daily at seed.com/hyman and use code 25HYMAN for 25% off your first month. Explore red light products at boncharge.com/hyman and enjoy 15% off with code HYMAN. Upgrade your sleep setup with cozyearth.com and enjoy 20% off with code HYMAN.

• 0:00Speaker 00

  You talk as a cardiovascular surgeon about how you want to make, you know, heart disease the number two killer in the world, not the number one killer. But the irony is you had a heart attack. What are the factors that people should be paying attention to? Because this is really a preventable condition.

• 0:11Speaker 01

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• 2:24Speaker 00

  Jeremy, it's great to have you on the podcast. Thanks for coming all the way from Georgia.

• 2:27Speaker 01

  Thank you.

• 2:27Speaker 00

  You know, your story is quite compelling. You know, we were just chatting a little bit before. You're a cardiovascular surgeon. You do bypasses and you, you know, fix arteries and do major big surgeries. It's like cardiovascular surgery and brain surgery are like the two top surgical specialties that are really tough and hard to learn and that take a lot of time to become expert at. And somehow in all that process, you discovered that you were kind of treating things at the wrong end of the stick. You were kept seeing over and over cases coming back over and over with bad habits that they never changed and needing another surgery, another surgery. And you did that for a while, but it sounds like you had your own epiphany

• 3:08Speaker 00

  in medicine where you realized you might be not thinking about things the way you should. And you had your own health crisis. You talk as a cardiovascular surgeon about how you want to make, you know, heart disease the number two killer in the world, not the number one killer, which is a great aspiration. But the irony is you had a heart attack. So tell us about that. And I mean, you look healthy. You seem healthy. I'm sure you don't smoke. I'm sure you eat pretty good and look fit, exercise like, and you're kind of the, you know, the kind of person you wouldn't think would get a heart attack. But here you were and you had a heart attack. And that's kind of what I want to get into a little bit on the show, which is why are so many people who seem and look healthy getting heart attacks?

• 3:45Speaker 01

  It's an ongoing question for sure. And to make it even more egregious from, from my standpoint, the timeframe between making that shift of treating the endpoint of disease and when I actually had my event was another 10 years later. So I was already very dialed into, you know, really, really working on solid lifestyle choices. And I thought that I was doing a really, really good job. I really did. And what I have come to learn is that none of us are immune to cognitive dissonance. We know better, but so often we just don't do better.

• 4:30Speaker 01

  It can be simple things, you know? The smoker knows they shouldn't smoke, but they continue. You know, you shouldn't reach for the chips, but it's what's convenient. You're tired, you deserve them. However, you defend that. And no one knew better than me.

• 4:46Speaker 00

  Yeah.

• 4:46Speaker 01

  The signs and the lead up. I mean, I lived it, I taught it, I dealt with it.

• 4:54Speaker 00

  Yeah.

• 4:55Speaker 01

  And like I said.

• 4:56Speaker 00

  What did you miss?

• 4:58Speaker 01

  Intellectual honesty. And I fell deeply into that gap of knowing better and not doing better.

• 5:04Speaker 00

  And what were the things you weren't doing that led you?

• 5:07Speaker 01

  Well.

• 5:07Speaker 00

  It was only a few years ago, right? It was like.

• 5:09Speaker 01

  It was three years ago. Yeah, well, it, it really, it didn't hit me until after the event because it was really in the midst of it that I fell kind of first tripped into the space because I woke up one morning with what I thought was just reflux.

• 5:26Speaker 00

  Harper.

• 5:27Speaker 01

  Harper. And I get up early. I was pacing around the room and my wife's like, are you okay? I'm like, yeah, yeah, I get a little reflux. She goes, you don't look like you have reflux. I'm like, seriously, you're going to tell me?

• 5:40Speaker 00

  I'm a doctor.

• 5:41Speaker 01

  That I don't have reflux? I mean, come on. So I sat down, I read for a little while, felt fine, took the dogs out for a walk. It was December. We get a quarter mile from the house. It's cold outside. I'm peeling my clothes at this point, sweating. And she looks at me, she goes, reflux? I was like, yeah, you know, it's just really, she's like, okay. So we go back to the house.

• 6:05Speaker 00

  Is she a doctor too?

• 6:06Speaker 01

  She is not. She's just an incredibly brilliant woman. We get back to the house and not to be overly graphic, I sit down on the toilet and within 30 seconds of sitting down, symptoms went away. And I immediately was like, no. Exertional symptoms, relieve with rest? No, not me. It's not possible. Couldn't be. Could not be. So at that point, I did what someone who is the poster child of cognitive dissonance would do, and that's explain it away. And through the course of that entire day, I would go upstairs, have it come back a little bit and let's sit down and it would go away. Oh yeah.

• 6:50Speaker 01

  That evening, my family went back into town and I was with my youngest son. And we were out in the woods that evening, dark. He's 14 years old, quarter mile from the truck, no cell service. And I go down on my knees with significant chest pain, like I knew what was going on. And my son's like, dad, are you all right? Like, what's going on? I said, oh, it's just reflux. He goes, you can't walk around when you have reflux? I was like, oh, you're another smart one in the family. So I pull myself together. I get, we get back to the truck and I drive home.

• 7:25Speaker 00

  Oh, man.

• 7:26Speaker 01

  Oh, yeah.

• 7:29Speaker 01

  I'm going to lay it all out for you. I didn't say I was going to be proud. So I get home, I take a beta blocker and an aspirin and I go to sleep.

• 7:36Speaker 00

  Oh, wow.

• 7:37Speaker 01

  Wake up the next morning.

• 7:38Speaker 00

  Not the right decision, but good thing you woke up.

• 7:41Speaker 01

  I share it. I share it hoping that others will do. Sometimes you need an example of what not to do.

• 7:47Speaker 00

  They call, they call, you know, they usually say the first symptom of heart disease is sudden death for 50% of people. And, and I've had people I know who've had that experience. And you're lucky you had some morning signs. They call the silent killer, but it's, in your case, it wasn't so silent.

• 8:01Speaker 01

  And about five or six years prior, we had a good friend who was a radiologist at 48, that that's exactly what happened to him. So it's not like I'm not aware. I woke up the next morning. We live in a home with staircases. Went down to make my coffee, came up, same symptoms. So then I had to come clean. And my wife says, this has been going on since last night? Why didn't you, why didn't you say something? She said, well, you would have made me go to the emergency room. And she's like, well, that's what you do when you're having chest pain. I said, well, I didn't like the cardiologist that was on call that night. Are you kidding me? She's like, you're friends with all of them.

• 8:36Speaker 00

  Yeah.

• 8:37Speaker 01

  And then she stopped for a minute and I always kind of get goosebumps. She looked at me and she said, that is the most selfish thing you've ever done to me and the boys. And that really, that hit hard, as you might imagine. And I said, I hear you. I am terribly sorry, but can we go, can we go to the hospital? So I called one of my buddies. He's like, there's no way, man. I said, I'm telling you. I said, I've tested it pretty good here. So he's like, come to the office. I'm like, oh, I don't think that's a good idea. He goes, no, no, no, no. Just walking around the office. He took one look at me and I was in the cath lab and, you know, one stent in the right coronary, you know, and I was fine.

• 9:19Speaker 01

  So I wouldn't let him sedate me, you know, for the procedure because I want to know what's going on. So he passes the wire across it, which occludes the coronary.

• 9:29Speaker 00

  And you had severe chest pain.

• 9:30Speaker 01

  EKG changes, severe chest pain. And I'm like going, hey, man, hey, man. He pulls the drain, he goes, I need you to shut up. So I can get this done. Sedated me, got it done, went out and told Tracy, I dream of stenting cardiac surgeons, but doing anything to your husband was an absolute nightmare. She goes, oh, I'm sure. I'm absolutely sure.

• 9:52Speaker 00

  So what were the things that you did that led up to that? Because you obviously have been in this field. You're aware of heart disease. You're not doing the normal bad thing.

• 10:00Speaker 01

  It's really only in retrospect now that, that I was able to really unpack all of that for myself because the immediate response was, I do, I have a stressful job. And certainly a component, but not enough to really lay your hat on. The second was after 25 years.

• 10:21Speaker 00

  And you're still doing cardiac surgery?

• 10:22Speaker 01

  Yo, yeah, yeah. I went back to work that, that Tuesday after, as soon as they would let me. So, you know, my sleep was totally out of whack. I was on DEFCON one all the time. So I was like, okay, that's certainly a risk factor. If your sleep's off, everything's off. Certainly a risk factor. Well, it really wasn't until we started with the platforms and my son Max was instrumental in all this. You know, he said, dad, wouldn't it be interesting if like you put on a CGM?

• 10:57Speaker 00

  Wouldn't that be interesting? I was like, Max, if I need to show you what a great job I'm doing with my diet, with my exercise, that's fine. He's like, Dad, I don't care what it shows. I just think it'd be cool, like, show people, you know, the process and look at your numbers. Yeah, within 48 hours, it became very clear that my baseline glucose was unacceptably high. Checked A1C, I was 5.7. Flipped into a, you know, fasting insulin level, which I'm gonna, I'm embarrassed to give you the number. I'll say it was, I'll Come on, give it to me. Forty. No. Forty? Forty.

• 11:38Speaker 00

  Seriously? I mean, just for those listening, it should be less than five. The lab reference range is 18, which is, I think, terrible. Forty is, is high. You, you were, what, you had a little belly or what? You know, not really, no. Bread, pasta, rice? Not really, and So how come it was so high? I don't really have that answer, but I definitely retooled my diet as a result of it. You know, using the CGM, I was able to kind of see like, and I added 10 minute walks after meals. I tried to add more cardio, back off on some of the strength training. I used to do a lot of endurance work. And that made a difference, for sure. My A1C came down to

• 12:20Speaker 00

  5.5. We got the, you know, the insulin level down to acceptable ranges. So more risk factors then were obvious. Again, look healthy, but you don't know until you know. And we'll add the coup d'etat on top of it, which would be an APOB of 180. Wow. And you had checked it or hadn't? LDL's, LDLC only, which was mildly elevated around my event. You know, mildly elevated, my triglycerides were a little high, which is in line, of course, with the Insulin resistance. Insulin resistance and all those things, but not shockingly so. You know, it wasn't 500. It wasn't in line with that. What was your triglycerides?

• 13:01Speaker 00

  I don't remember. I want to say they were probably upper 100, 200. So Yeah, yeah. High, but not That's high. It should be under 70. Right. But I think the lab reference ranges, you know, would say 150 is You're not gonna cut me any slack today. Here I am pouring myself out to you to give you an example for other people. It's amazing. You're, this is important information because you're highlighting the fact that you're, here you are, a cardiac surgeon, you're into functional medicine, you're trying to do the right thing. You know, you maybe had a few things off of your diet, but there was something going on. It could be other factors like your microbiome or toxins that can cause insulin resistance. But like, your, your numbers were numbers that most people don't look at, right? And you hadn't even looked at. I didn't. Which is amazing. And, you know, APOB is now, which is basically a culmination

• 13:45Speaker 00

  of all the, we call it atherogenic lipid particles, so triglycerides and LDL particles and, you know, intermediate density particles and so forth. LP little a, these are all together in APOB. So it's now recognized by cardiologists as being the most important biomarker for predicting heart disease risk. But it's almost never tested by traditional doctors. It's just they check your regular cholesterol panel and that's it. And yours was a little bit off, but not terrible. And here you are sitting on a time bomb and you're lucky you didn't actually have a clot and die. I mean, you could have. Absolutely. And, you know, it goes back to that, you can't fix what you don't measure. And it really took me understanding that my priorities needed to change, that I truly

• 14:29Speaker 00

  needed to engage in secondary prevention. And to do that, I needed to know what my numbers really were. And the grace at this point is I have now normalized all those things. My particle counts are really pretty phenomenal on Repatha and a little low dose Crestor and It's really important what you're saying is because, you know, looking at you, no one would say, oh, here's a high risk heart attack patient. You know, smoke, you know, high blood pressure, you're, you know, you're, you're looking, you seem to, you know, into health. But like, these things are under the surface on a lot of people. And we're seeing this a lot with function health. We're seeing a lot of people who are now measuring this on. I mean, I've been doing this in my practice for 30 years. I've been measuring lipoprotein

• 15:10Speaker 00

  little a, measuring particle number, particle size, even when before that was a, when it was a company called Liposience, which did this particle numbers and size before LabCorp bought them, before Quest developed their tests. I've been doing this for decades and measuring APOB and all these numbers. And it's amazing to me that they've been available. But, I mean, I sat with the head of, the executive physical at Cleveland Clinic, who was an older gentleman, who remain nameless. And I was like, listen, I think your executive physical labs are a little dated. Maybe you should do, you know, particle number, particle size, you know, APOB and all this. He's like, well, you know, we don't like to do things before this adequate research. And I'm like, well, this has been around for 40 years. Ron

• 15:54Speaker 00

  Kraus has discovered this 40 years ago, that particle size and number matter, and they track with your carbohydrate intake, not fat. So like, if you're eating more starch and sugar, you're gonna have more of these atherogenic particles, you're gonna have high APOB, you're gonna have more particle number and smaller particle size. These are all the things that no one's looking at. So I think, you know, getting these things tested is so important. And at function health, that's what we do with everybody. And we're seeing it's huge, huge number of people who have particle numbers that are highs, over 90% have really some degree of abnormality. And when you map it to like, imaging, then you can actually see what's going on. And then, you know, you can treat it. Like, you might have some genetic factors. There's lipid genetics that play a role, I'm sure,

• 16:35Speaker 00

  for you. I certainly have like a, an inherited familial lipid disorder. It's not like class, the classic one, but it's, now we have more genetics we can do. I've done my full genetics for lipids. And, and, you know, we're gonna be offering, you know, genome, whole genome sequencing soon and so forth. Like, I think we're seeing a lot of, of potential to really understand your unique biology and then how to customize treatments. If you're a woman in your 40s or 50s or beyond, I want to talk to you directly for a second. Around perimenopause and menopause, your body becomes much less efficient at building and maintaining muscle. And most women are never told this. They're told to eat less and move more. When in reality, protein needs actually go up as estrogen declines. And that's one reason I use Perfect Amino myself every morning in my smoothie.

• 17:19Speaker 00

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• 17:59Speaker 00

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• 18:43Speaker 00

  At least as long as I've been doing medicine. And if you look at the history of that, of, of why it didn't come to center stage, and I'd be interested to know what your thoughts are on this, but it was that attitude of, well, we can't do anything about it. So why should we actually be testing for it? And I mean, that's, that's such a misguided mindset because, you know, knowing something is, is as, is important, even if you can't do anything directly about the thing you know. Right. Like, having that information so that you can change everything else. Right. You can reduce all the other risk factors. Exactly. And even with the inherited factors, the other inherited factors, that's

• 19:26Speaker 00

  such important information to be able to stratify people that otherwise look healthy, that you know you need to get those numbers lower, that you need to be more thorough, that you need to be more engaged so that you don't end up in, in the situation. Yeah. Cause I'm sure those numbers that you had, if you've been tracking them for decades, they would, you would start to see the trend line going like this. For sure. That's what's available to, for people, for very low cost. I get function health, but basically do a dollar a day, you can get all this stuff done. And, you know, twice your testing and get a really deep view, not just of your, you know, your lipids, but also like metabolic health, which is, you know, you, you kind of, you're a case in point that most heart attacks today are really, aside from the small subset that's just inherited

• 20:10Speaker 00

  lipid disorders, it's coming from metabolic syndrome, from prediabetes, from poor metabolic health, where we're eating so much sugar and starch that's causing high insulin and high triglycerides and high APOB and all these things that, that are really from what we're eating. Things get misconstrued many times because they come in, you know, patient, to patients, right? You have the healthy 50 year old that has normal standard panel, physician shakes their hand and says, you're good to go. And 18 months later, that patient's in the back of the ambulance with a heart attack and the response is

• 20:43Speaker 01

  See LDL doesn't matter. Cholesterol doesn't matter. None of those things matter. Then you have the other patient that had high cholesterol, was well-treated, has LDL levels of a 15-year-old also in the back of the ambulance 18 months later. And that patient's response is, I was safe. I did all the things. And they're both wrong.

• 21:07Speaker 00

  Why?

• 21:08Speaker 01

  Well, because the truth is somewhere in the middle, right? Because LDL just doesn't tell the whole story. Now, before, you know, we break, you know, before we attack LDL, clearly LDL is causal. We have lots of data that supports that, but it's not the whole story. ApoB, LP little a, the metabolic components, you know, that that's a very, very important component. The second arm of that is the things we can control.

• 21:36Speaker 00

  We've over-insects on LDL because we have a drug that treats it. The truth is that that may not be the right target for treatment. And when you look at the data, like even things like triglyceride to H L ratio is far more predictive than LDL. And, and, and that's a reflection of metabolic health. So high triglycerides and low H L means you probably are heading towards prediabetes. And that's really the driver. You're, you sort of mentioned people can have normal cholesterol and have a heart attack or have, you know, treated cholesterol and have a heart attack. There, there was a big study, it was like looking at, I think, um, maybe you know this study, I think, like a hundred and 30,000 people who were admitted to the emergency room with heart attacks. And I think 75% had, quote, "normal LDL." But only like, I don't know, 10% had normal triglycerides, something like that. It was like, it was so.

• 22:21Speaker 01

  It's just not the only villain in the room.

• 22:22Speaker 00

  Yeah.

• 22:23Speaker 01

  And, and for most of us, myself included, that certainly was the case. You know, and I think that that's, that's the reality. And that's, you know, understanding that you, we can all fall into this gap, recognizing it before we do, understanding what we, what tools we have available, whether you can move the needle with lifestyle changes, or you do all the foundational pieces. You eat well, you move, you sleep, you have your relationships in check, all those things. And you're still not right, you know? It may be time to consider a different lever. You know, people today think that taking medication is a failure.

• 23:01Speaker 00

  No, it's not.

• 23:02Speaker 01

  It's not, and it's both the fault of patients and physicians.

• 23:05Speaker 00

  Yeah.

• 23:06Speaker 01

  You know, I think about it like a, like a scale, you know? At the one end of the patient's scale, you've got the individual who's like, "Just treat me, doc. I'll do whatever. I'll do whatever you say." And at the other end is, "I don't want anything to do with medication. I can do all this myself." Somewhere in the middle is where we need to be. Well, the physician's scale is not very different. You know, you've got on one end, the physician that's giving out medication like it's a Pez dispenser.

• 23:35Speaker 00

  Yeah.

• 23:35Speaker 01

  And I think honestly more.

• 23:37Speaker 00

  What's wrong with Pez? I ate that when I was a kid all the time.

• 23:39Speaker 01

  It depends on what's inside when you.

• 23:41Speaker 00

  I haven't heard that phrase, you're, you're about my age. I haven't heard that. I don't know, do they still make those? I'm like.

• 23:47Speaker 01

  I have not seen them, nor have I looked for them.

• 23:49Speaker 00

  Don't know what that is. A little thing you had when you were a kid, where it was like a, it was like a little device that popped out a little candy and you could just pop it in, it would pop out a candy.

• 23:56Speaker 01

  And that's exactly how they hand them out. And at the, you know, at the other end of the spectrum, and I think this is actually a much more dangerous mindset for physicians, is, "We'll just watch this and wait." You know, "You're doing great. Continue doing what you're doing with abnormal labs." And the problem is, that's, that's like patient-centric care masquerading in this other form. And in the end, these are risk-benefit decisions, right? Like, yes, do the foundational things, do all the things that you need to do. But if that's not working, you don't leave your patient at risk. So both of those things are really at centerline is where they belong, somewhere in the middle.

• 24:36Speaker 00

  It's true. There's a real need to know what your numbers are and use those to guide you as opposed to, you know, just, "You look fine," or "Your basic cholesterol panel's fine." Because that, like you said, for you, yours was a little off, but it wasn't terrible.

• 24:49Speaker 01

  That's right.

• 24:49Speaker 00

  And I think that's the greatest for most people. And so, so I think the key here is, is tracking your trends over time. Because if you were 30 and you track your numbers, you'd probably start seeing them go a little off.

• 24:59Speaker 01

  Yeah.

• 24:59Speaker 00

  And then by the time you're 40 and then 50 and then, you know, you're getting into your upper 50s, then you really already have the disease. Like you already had a problem. So really, you wanted to start checking this earlier, right?

• 25:10Speaker 01

  For sure. And I think that my personal mindset is that atherosclerosis is something we have. It's not something we get. You know, if you look at autopsy studies from three-year-olds, there's a fatty streak in the aorta. If you look at the P-day study, you know, autopsies from trauma in the field, 18 to 35-year-olds have early changes in their coronary arteries. Now, none of those things are causing any problems at that age, but the propensity for that is already there. Our goal is to get the runway out as far as we can to not have problems. How do we make choices that, that push our body in the right direction? Not the right, how do we stay in that?

• 25:54Speaker 00

  That's the thing. So right now, we, we know enough. Like, we know enough what to track, what to measure, how to test people.

• 26:00Speaker 01

  For sure.

• 26:00Speaker 00

  We can talk about imaging a little bit, but we, we also know that cardiovascular disease is mostly preventable. I mean, I remember, I remember learning about William Ossler when I was in medical school, and he was one, you know, the first textbook of internal medicine. He was at Johns Hopkins, this kind of very iconic physician we all learned about. And, and I remember reading about how when they would have a heart attack patient, it was a huge deal and they would have the whole staff run, the medical students, the residents, the doctors, the attendings would all come around and see this patient because it was such a rare condition. It was rare to have a heart attack back in 1910.

• 26:31Speaker 01

  Sure.

• 26:31Speaker 00

  You know, maybe if you were eating really crappy diet.

• 26:34Speaker 01

  Which was unusual.

• 26:34Speaker 00

  Because you're, you could, yeah, if you were rich and had a lot of, you know, money, you could buy a lot of expensive, you know, starchy foods, whatever, I don't know. But the point is now it's so prevalent and, and we, we have to sort of be more, more diligent about actually helping people map out what their history is over time and tracking that. But what, what, what are the factors that people should be paying attention, attention to? Because this is really a preventable condition. I mean, you, you saying you want to take heart disease from number one to number two. What would be required to do that?

• 27:01Speaker 01

  Yeah, I think you started the foundation. And this comes back from, you know, my time with you at, at the functional medicine conference back in, you know, 20 years ago. Yeah, yeah, it was in Baltimore.

• 27:15Speaker 00

  We were young bucks.

• 27:16Speaker 01

  Yes, yes. I was, I was going for early morning runs around Baltimore. It tells you I wasn't so smart then either. But really, start with the, the foundational pieces. And, you know, I remember a friend of mine said, he, he was a wise, is a wise gentleman. He said, "You know, if a farmer looks out on his fields and all of the, if all of the plants are sick, if all of your crops are sick, where's the first place they look? It's in the soil.

• 27:48Speaker 01

  What are we feeding the plants?

• 27:49Speaker 00

  Mm-hmm.

• 27:50Speaker 01

  Sit in the airport, watch, watch our fields go by." So I think that, I think being mindful of what you're putting in your mouth, focusing on a whole foods diet, limiting ultra-processed foods, you know, limiting, limiting saturated fats in your diet. You gotta be so careful these days with the, you know, the really kind of more fringe type choices, the more extreme choices. Because you always have to be careful what you're substituting things for, right? And so I think that that's a great place to start because it's something that we have such control of.

• 28:26Speaker 00

  Yeah.

• 28:27Speaker 01

  Right? And I think our gut is such a primary source. Not that we understand the microbiome fully by any stretch of the imagination, but I think the principle really holds. You know, our, what we feed ourselves is, our cells is the information that we're going to give our body to live on. It, you can connect those dots. I think most of, most of us can connect those dots. And when you're thoughtful about it, you just feel better. I mean, I've had personal experience with that. Clearly, movement every day is critical, both aerobic training and strength training. They're great independently, but compound dramatically when they're put together.

• 29:09Speaker 01

  My personal Achilles heel, sleep, you know, I can tell you when your sleep is off, everything is off. And for me personally, it's the hardest. Because, you know, I can control what I put in my mouth. I can push myself to go to the gym. The harder I try and control my sleep, the worse it gets. So I've had to change my relationship.

• 29:29Speaker 00

  What have you done that's helped it?

• 29:30Speaker 01

  The biggest things I've done is changing my sleeping environment.

• 29:35Speaker 01

  Dark, cold, taking a hot shower before bed so that I know that I'm my body temperature's going to drop to help going to bed at the same time every night, setting alarm to make sure I'm going to bed at the same time, as well as waking up at the same time, trying to get outside as much as I can just to get sunlight in my eyes. And can I tell you that it's perfect? No. Is it a lot better? Yes. And again, know your numbers. You know, I followed, I've been following my HRV, my heart rate variability, which is a wonderful indicator of your autonomic nervous system. Since you are pushing me for my numbers, I will tell you what they were and what they are now. My HRV was running between 15 and 17.

• 30:20Speaker 00

  Yeah, yeah, yeah.

• 30:21Speaker 01

  Yeah. And

• 30:22Speaker 00

  Higher the better.

• 30:23Speaker 01

  And now I'm running in the mid to mid to upper 30s. And occasionally I'll hit a 50 if I really am well hydrated. So I'm on the right track, but is it, is it? No, it's not.

• 30:35Speaker 00

  It's always a work in progress.

• 30:36Speaker 01

  I am definitely that.

• 30:38Speaker 00

  So, so really this whole epidemic of heart disease is largely preventable. If you address diet, if you exercise, if you sleep, if you manage stress, if you avoid smoking, if you manage your blood pressure, which also is a big factor. And it's very much related to insulin resistance and prediabetes. This whole same phenomena is what causes high blood pressure. So these aren't all separate problems. Blood pressure and heart disease and high cholesterol, they're all like, they're all kind of one thing.

• 31:04Speaker 01

  Nothing happens in a vacuum of the body. You know, it's one big ecosystem.

• 31:08Speaker 00

  And so, so when you start to knock off all these factors, you can start to really change things. And then also, you know, connection, community, stress is a big factor. I think a lot of people are lonely and that it's like smoking 15 cigarettes a day, in terms of its effect on your health. And there's some interesting studies looking at the gene expression patterns under stress. When you're lonely or isolated, you produce more inflammatory genes expression. So you have more inflammatory proteins out there in your body and causing more damage. And I mean, we know heart disease is an inflammatory disease, right?

• 31:42Speaker 01

  For sure.

• 31:42Speaker 00

  Maybe we can talk a little bit about that. Cause I think, you know, we used to think that was just plumbing problem. You know, you were, you're a plumber essentially. You're like, oh, I am. Do cardiac bypasses and open up arteries and fix aortas and fix, you know, femoral arteries and all these things that they get clogged up. And so it's kind of like a plumber going in and rerouting the pipes or opening up the pipes to clean them out. And, and the truth is, it's not necessarily just a plumbing problem. It becomes a plumbing problem, but it starts off as an inflammatory problem. And there's ways to check that. So tell us about the role of inflammation and heart disease, and also about how do we measure that?

• 32:16Speaker 01

  So I want to separate the, the roles of inflammation and heart disease, because I think that there is a bit of a misconception in, in the lay public when it comes to how we think about systemic inflammation versus specifically what's happening at the arterial wall. So when, when we talk about the inflammatory process, specifically when a plaque or a blockage is forming, the wall of the artery is penetrated by an APB driven molecule, lipoprotein, if you will, that then sets off a cascade of events, one of which is an intensive inflammatory

• 32:57Speaker 01

  reaction in the arterial wall, which draws those inflammatory cells into that area, which then starts this cascade of collection of more cholesterol, a healing process that then starts. And it's that healing process, many times where we start to see the, the actual stenosis forming. So we have a local form of inflammation that's a result of an injury repair pattern, if you will. But the question is, what made the arterial wall vulnerable at the first place? And that I think is a distinction that people don't truly understand.

• 33:38Speaker 00

  More systemic inflammation.

• 33:39Speaker 01

  Right. So if, if we break down what's actually happening, there's two components. The artery wall is being attacked. And then it's the integrity of your endothelium or that in the entima, the inside lining that is either capable of fending that off, or it's vulnerable. So it's the balance of those two things. I think that, that you have to kind of separate what's happening from an inflammatory standpoint. Cause if you talk to a pure lipologist, they're going to tell you CRP doesn't have anything to do with, with, you know, creating a stenosis. Well, specifically, they're not wrong. You know, you're, you can't, having that inflammatory process in the wall of the artery isn't going

• 34:23Speaker 01

  to show up on a CRP.

• 34:26Speaker 00

  Yeah. But CRP tells you what the general environment is.

• 34:29Speaker 01

  What the general environment is. However, my, my perception of how to utilize this is it's, it's an indicator of your endothelial resiliency. What are the things that are keeping the endothelium intact that are guarding against those outside forces? And when you have insulin resistance, metabolic syndrome and inflammatory factors, those are, look, we know that just elevated chronic glucose alone is impacting the vessel wall.

• 35:05Speaker 00

  Yeah.

• 35:06Speaker 01

  Again, making it weak, making it more susceptible. And that's why it's, it's, it's an equation, really. It's very, it's more of a heuristic than it is an equation. Because it's more of a guide, you know, just to understand that these are balances. So when we start to talk about those things, like what can we do differently, exactly what you said, how do we, how do we put the fire out that is creating this vulnerability that then creates a ripe environment for injury to the wall itself?

• 35:38Speaker 00

  Yeah. I mean, that's, I think that's an important distinction between, you know, the inflammation happened at a local level and systemic inflammation that sets the stage for things to go wrong.

• 35:44Speaker 01

  Yes.

• 35:45Speaker 00

  And then that you talked about insulin resistance, prediabetes, insulin resistance, belly fat, those, that belly fat's producing a whole cascade of inflammatory molecules that's spewing out through the whole body. And it's causing havoc everywhere, including on your arteries. And that's, you know, that, that's really, people don't understand that sugar is inflammatory, that sugar and starch are inflammatory. And that's a lot of what's driving it. Obviously it's pollution, it's stress, it's, you know, microbiome, there's a lot of other factors, but, but that's predominantly what it is. And I think, you know, most heart attacks probably before the last, you know, 60 years were probably not metabolic syndrome. They were probably different.

• 36:19Speaker 01

  Yeah.

• 36:19Speaker 00

  You know, they were smoking, they were, you know, people were thinner, they didn't have all this sugar and starches. I think it's changed. I, I think if you look at it, it's changed. And what's interesting is that doctors aren't measuring insulin. And they're not measuring insulin resistance.

• 36:32Speaker 01

  Mine had never, mine had never been measured.

• 36:34Speaker 00

  Yeah.

• 36:35Speaker 01

  Until, until.

• 36:36Speaker 00

  And here you are, a cardiac surgeon, and probably the most important predictor of whether you're going to get a heart attack is your degree of insulin resistance. And yet it was never measured, which is just sort of staggering. There's actually a new test that we offer through Function Health, which is called the Insulin Resistance Score, which is a, it's, it's the most accurate measure of insulin resistance that we have now, other than more of an interventional lab test, which is called like a euglycemic clamp test, which you wouldn't do as have been a research study. But it's, it's better than the calculated version we used to call HOMA IR, much, much better than that. And you can now measure using a C peptide level and an insulin level using mass spectrometry. And we offer it through Function Health. And it's, it's amazing to see how, you know, where people are on the spectrum. And then you can actually monitor it, like an A1C

• 37:21Speaker 00

  and see how it changes.

• 37:22Speaker 01

  And I think, and I think that that's been one of the biggest limitations with the insulin level is the lack of standardization across, across labs. You know, what do the numbers actually mean? What's the standardization? So I think to, to have something that's got some real data behind it's going to be really powerful and, and something that we can actually, actually count on.

• 37:43Speaker 00

  Yeah. It is pretty exciting. So now with the deeper diagnostics, with becoming more affordable, with accessible diagnostics, people can actually know what's happening. And I think people should start early, like get a baseline in your twenties, see what's going on. You know, and I think, you know, the heart imaging era is also changing. So before you'd have to do an angiogram, you have to stick a big catheter in a guy's groin, you'd have to shoot dye up there, you put a lot of x-rays on, it was a whole thing. And then you, it wouldn't that accurate a test of how often you'd miss stuff that was, you know, concentric plaque, or you'd miss some stuff, you know, then, then they developed like more interesting tests, like a CT angiogram. And they now have AI enhanced CT angiograms, which are really interesting. So you can look at soft plaque and hard plaque. And now

• 38:28Speaker 00

  we can do also a chest and heart CT scan, looking at calcium in the heart. How do you use the, the imaging, like this coronary calcium score, or the AI enhanced coronary angiograms on CT scan? How do you, how do you use those?

• 38:44Speaker 01

  So I think that this is, this is very much an evolving, an evolving space, very, very quickly. And as you pointed out, it kind of started with the early, the early CT calcium scoring only then to CT angiogram, et cetera. Now, I will say that coronary angiography is still the gold standard with.

• 39:10Speaker 01

  F F R measuring, measuring actual drop in pressure across denoses or questionable areas using intravascular ultrasound. I think that there are ways, there are ways that again, like the imaging has progressed for the less invasive or non-invasive.

• 39:27Speaker 00

  It's also progressed.

• 39:28Speaker 01

  It's also progressed on the other side to address the thing. So I think these things are complimentary. I think that for sure, until we added C T angiography, really knowing soft plaque is so important. Now, knowing calcipic plaque burden is helpful as a screening test if you're out totally normal or on the other end of the spectrum. It can get really gray and can really confuse things sometimes in asymptomatic patients without any symptoms that are in that middle ground. It can, you know, it can, it can require further investigation. But as

• 40:06Speaker 00

  Like a C T angiogram.

• 40:07Speaker 01

  Exactly. Yes.

• 40:08Speaker 00

  So it's a good screening test.

• 40:10Speaker 01

  That's

• 40:10Speaker 00

  If it's abnormal, you want to follow up.

• 40:12Speaker 01

  Exactly right. And now with this A I component, I think it's going to, when you can digitize the information and you can actually not miss the calculation, it's not, it becomes less of a subjective reading and more of an objective reading when it comes to actual measurements. The accuracy, I think of those tests is going to change dramatically. Now, how is that going to look clinically? What is that going to look like for outcomes? All of those things are, that's why I say, I think it's just an evolving space right now.

• 40:43Speaker 00

  And it's important because, you know, I'm sure you've seen patients like this, but you know, I have patients who have perfectly normal labs, but have plaque and clogged arteries and people who have even the labs you would expect would be abnormal, or people who have terrible labs and whose arteries are normal.

• 40:57Speaker 01

  Yes.

• 40:57Speaker 00

  And, and I'm like, wow, you have high particle number, you have high A P O B, you have high L P A. I'm like, you should be having a heart attack right now, but you're 65 and your arteries are clean.

• 41:06Speaker 01

  Yeah.

• 41:07Speaker 00

  So I think for me, what it's taught me is that I can't really put people on a lifetime prescription or a medication unless I know the anatomy, because cholesterol is a risk factor. It's not the problem.

• 41:22Speaker 01

  Yeah.

• 41:22Speaker 00

  It's a risk factor.

• 41:23Speaker 01

  Sure.

• 41:24Speaker 00

  And sometimes it's high, sometimes it's not. Sometimes, you know, treating it isn't the real solution is figuring out what the other causes are and treating those like in some resistance.

• 41:34Speaker 01

  I think you make a great point. I mean, it's like every decision we make in medicine is a risk benefit decision. And you, you know, you have to make certain that you're maximizing benefit and minimizing risk and you're, you're, you're mitigating in favor of, of that patient. And you can't rely on just one number or even two numbers. You know, each patient is so dramatically unique and different. Just because, there was a pulmonologist who said to me years ago, he said, Jeremy, the protocols are the practice of medicine. Knowing when to and when not to apply those protocols is the art of medicine. And that's what you're talking about.

• 42:17Speaker 00

  Yeah.

• 42:17Speaker 01

  It's like, if you followed the protocols, and there's nothing wrong with that. We all follow the standard of care protocols. Those are our guidelines. But if you plugged that patient into the protocols, you would have put that patient on medication right away without any additional information. If you would, because, but you were thoughtful about that particular patient.

• 42:38Speaker 00

  Yeah.

• 42:38Speaker 01

  And I think that that's so incredibly important, you know, and one of the things that is of concern for me as I look at medical education moving forward, because there's such a high reliance on protocol-driven medicine, which is wonderful. And

• 42:58Speaker 00

  Well, it's the baseline. It's not, it doesn't, but it doesn't go deep enough. Like it

• 43:02Speaker 01

  It's a place to start.

• 43:02Speaker 00

  Follow the standard protocol, you're not getting lipid fractionation, you're not so you're checking, you're not checking L P L A, you're not checking in some levels, you're not checking in some resistance scores, you're not checking the, all these other things that are so important that have to be part of a full clinical picture to make a decision.

• 43:17Speaker 01

  Right.

• 43:18Speaker 00

  That's what worries me. It's not, it's not that it's not the good starting place. It's just inadequate.

• 43:22Speaker 01

  Yeah. Yeah. It's, I think that's, yeah. I think you're right. It's not that it's wrong.

• 43:26Speaker 00

  My medicine right now is LDL's high statin. Like that, to me, is completely screwed up.

• 43:30Speaker 01

  It, it's not wrong, it's incomplete.

• 43:32Speaker 00

  Yeah.

• 43:32Speaker 01

  You know, I think is, is the way to look at it. And, you know, at some point, you know, maybe listen to the patient.

• 43:38Speaker 00

  Yeah.

• 43:39Speaker 01

  Examine the patient, you know? Do the things that you, be a doctor first, and then understand how to put all these things together to make, to make the best decision. Discuss it with the patient, God forbid, you know, and let them be a part of that decision making. And I, you know, I think that's one of the great things about, about function health, right? It, it allows patients to regain a fair amount of agency in their own healthcare. And I think a lot of patients want to do that in this day and age. You know, I think that, that people are frustrated because access is such a problem. You know, pick up the phone and try and get an appointment with your primary care physician. It's hard. And I'm not suggesting that it's intentional. They're busy and they're seeing a lot of

• 44:23Speaker 01

  patients and it's tough. And I think that, that to really regain that agency and to take full responsibility for your healthcare, you have to have options to be able to actually follow through with that. And I think that's one of the great opportunities that, that function health offers.

• 44:42Speaker 00

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• 45:26Speaker 00

  aside for your health. So head to boncharge.com/hyman and use that code HYMAN for 15% off. That's B O N C H A R G dot com slash Hyman. If you're like me and tend to sleep hot, you know, the summer months can make staying comfortable at night a lot harder. As a result, I found myself paying a lot more attention to the fabrics I use every day, especially the ones I'm sleeping in. Cozy Earth's bamboo sheet set has been a game changer for me. The fabric is soft and noticeably cooler, so I'm not waking up overheated in the middle of the night. I've also been reaching for their all-day tea a lot lately. It's soft, it's lightweight and it still feels comfortable even on long, hot days. Sometimes the small things in your life can have a bigger impact on how you feel than most people realize, especially when it comes to comfort, facility

• 46:09Speaker 00

  quality. If you're looking to upgrade your daily essentials, head to cozier.com/hyman and receive 20% off. It, it addresses some of the gaps, you know, some of the gaps that are out there in terms of how we're trained as doctors, how we approach prevention. We're kind of in a reactive system, not a proactive system. And I think about heart disease. I mean, by the time you have plaque, it's late in the game when you have a, like what you had with the symptoms of chest pain, meaning a stent. I mean, that's kind of down the road.

• 46:36Speaker 01

  Yeah.

• 46:36Speaker 00

  And who knows what would happen if you would have found this when you were 35 and you'd done a heart, a C, a heart C T where you did a calcium score and you had your A P O B checked and your insulin checked. You're like, oh. And I think that's, that's where we are now in medicine, which is that we have to have more agency as, as individuals and not just rely on the healthcare system because the training is going to take a few decades or generations to change. It takes a long time for medicine to change.

• 46:59Speaker 01

  It's turning a battleship. You know that better than I do.

• 47:02Speaker 00

  Yeah, I tried. I was Cleveland, Cleveland Clinic for 10 years. It was a very big battleship.

• 47:05Speaker 01

  Yeah.

• 47:06Speaker 00

  And they were very open. It was, it was great. We did a lot of great work there, but it was also, it was very hard to, to get people to change how they think, you know, and to, to really do more of a proactive approach. I want to sort of talk a little bit about this set of idea about this person who looks healthy, having, having a heart attack and what you would advise people to sort of check because like, you know, for me, like I exercise, I'm, you know, my body bad is 10%. I eat healthy. Like, I shouldn't really have a problem. So why would I bother checking? But actually, I did check and because of my family history, like everybody, my grandfather's side dropped dead in their 50s. I'm like, I got a problem. So I've had to manage it. And I think, you know, I wouldn't

• 47:48Speaker 00

  have thought I would be a person who would have high risk, right? Because I've been running since I'm 14 years old. I've been eating healthy my whole life. I've been, you know, just, I mean, yes, I'm stressed, like, and sleep issues because I'm, I'm a doctor, but and life in general, but like, I, it was, it was interesting. So what would you advise people who are listening who think they're healthy? What should they be doing? What should they be checking? What should they know? And when should they start doing it?

• 48:11Speaker 01

  Let's start with the simple things first. Get a blood pressure cuff at home and check your blood pressure. You know, if you can't do that, find a friend that has a blood pressure cuff and take it on a regular basis. You know, it, it's, it's really the silent killer for a reason because it's not a problem until it's a problem. 50% of Americans have it and many Americans don't even realize that they have it. And it's the most modifiable, the most easily modifiable cardiovascular risk factor that we have. And it's just back to that same tenet. If you don't measure it, you don't know. And it's so easy. And doing

• 48:51Speaker 01

  it once at your primary care visit is not, is not enough. You know, you need the seven two two rule, you know, for seven days, twice a day, two measurements, record them, take an average. That's what your physician really wants to know and what they need to know to be able to, to come up with an accurate number. So I think that's a great place to start and to really potentially move the needle because it's, it's such a significant component of cardiovascular.

• 49:17Speaker 00

  Yeah. And then blood pressure is not just random. It's caused by certain things.

• 49:21Speaker 01

  Absolutely.

• 49:22Speaker 00

  You can actually figure out too.

• 49:23Speaker 01

  Well, that'll come to the next suggestion. And this goes along with the, the how we look issue. It's not always your weight, it's the distribution of your body fat. And that's why I really recommend that people are checking their waist to height ratio. Very simple to do at home. And that

• 49:43Speaker 00

  Take measure is a very cheap medical device.

• 49:45Speaker 01

  It really is. Be honest about where it is and where you're measuring.

• 49:48Speaker 00

  Belly button.

• 49:49Speaker 01

  That's me at the belly button and And you don't want your number to be greater than point five. And that's just an indicator again of, you know, the amount of intra-abdominal fat, that visceral fat that functions really as an endocrine organ, if we look at it for what it's actually doing. And again, what you're saying, it's, it's a, there's drivers of all of these things and they're also interconnected. So I think those are two very simple places to Blood pressure and waist to Blood pressure and waist. And then you get down to And waist to height would be waist in inches and height in inches. That's right. Or centimeters in both. Yeah. You know, just keep the units the same. Yeah. So that you make sure it's a, it's an actual ratio. It should be less than point five.

• 50:32Speaker 01

  Exactly. And that gives you something to really follow and track progress, both blood pressure and something that you can do at home. You don't have to go to a physician's office. You don't have to do any of that. You know, from there, I think we, we look at some of the specific labs that I think people should be checking. I think an APOB is crucial. LP little A for sure, at least once in your lifetime, because it is a genetic factor. I think that menopause may change those numbers slightly. So I think for women, it

• 51:08Speaker 01

  directed by your physician, it may be best to do it pre or perimenopausal and after, after menopause as well. There may be some ways to modify that. There's also new drugs that are coming around that might be helpful for that. And, and absolutely. And now they're, they're coming out of phase three clinical trials. It'll be interesting to see where those end up because the question of course will be just because you can lower LP little A, what are the outcome studies that are going to be as a result of that. But story's still to be told and, and very promising, which is great. I think that that's, that's very useful. I think knowing your, your hemoglobin A1C and some form of fasting insulin is, is just really, really important. And I think if, if those are

• 51:51Speaker 01

  really the core that are not on a standard panel at all, CRP is kind of plus minus. I think there are a lot of primary care who are starting to do it. Those are, are really not, unless there's some trigger for hemoglobin A1C, they're just not. Not checking it. They're just not checking. They're not checking APOB. Mine wasn't checked. No knock on my primary care physician. Cause I'm sure we're just not trained that way. And these are, these are really affordable tests. I mean, they're all included with, with all the things you mentioned are included with a lot of other tests, like 160 yes for literally just a dollar a day, $365 a year for twice a year testing. It's, it's, uh, it's, it's not free, but it's not that much considering when people spend money on coffee and whatever they, they spend loosely money on, it's, it's

• 52:35Speaker 01

  investing in your health and that. And, and you know, sometimes the doctors won't do it. I, I met with the dean of the medical school at, um, at Bentonville, who the Dallas Walton School of Medicine. And, uh, she's, she was, she's a, I think, um, gynecologic oncologist. And she said she's, she's a Indian descent from India. She went to the doctor, to her cardiologist, said, I want you to measure my insulin. He's like, no. And he wouldn't do it. And he's like, yeah, well, we know at lower body weights, we've got more insulin resistance. So like, I want to check it. And he's like, you don't need it. And we're just that level of just, she said she went to her doctor and said, I, I want to get my vitamin D checked because I don't feel so great. I'm tired. So you don't need it. She's like, I

• 53:18Speaker 01

  don't care. I want it. She said, but insurance won't pay for it. Well, she's, I don't care. I want it. She got the vitamin D and it was zero. Oh, wow. Cause she was, you know, dark skin, lived and worked inside, you know, didn't go out much, you know? So I think we're missing so much. And that's, that's, you know, really why a company like Function Health that I co-found has really started to give people agency to know what's going on, to, to not have to be someone like you who's, you know, at 57 has blocked arteries and wished they could have figured that out sooner, right? Absolutely. Hopefully your son's getting all those tests. Oh, and then some. He's, I think he is going to be a lapologist before the end of all of this, I can tell you. Um, because he probably knows more about lipid metabolism and genetics than I do at this point. Is he a medical?

• 54:02Speaker 01

  He is not. No, he is not. You know, you spend a lot of time like fixing damaged hearts, like literally, uh, and, and you now want to help people never have surgery. So how, how do you think about really move, bring that mission and moving that into the world? Like coming out of my podcast is great. You're writing a book, you have a website, um, you have a podcast, but like, how, how do you see kind of doing this for yourself? Well, I hope that sharing my story and being willing to allow people to peek behind the curtain, if you will, that, and admit that none of us are immune. It may not prevent people falling into that cognitive dissonance gap, but you will think about it, you know?

• 54:47Speaker 01

  So my hope is that I can raise awareness. And then by, by really trying to communicate relatable, high quality health and wellness information that's really tactical in people's lives, you know? And the world that we live in right now is so maximize, maximize, maximize, maximize, that everybody feels like they're, they're taking a test. And if they miss one thing on the protocol that they failed at that, and just give everybody an opportunity to let their shoulders down a little bit, take breath and know that if you miss, you know, if you miss one workout, you haven't failed, you're just going to come back the

• 55:28Speaker 01

  next day and start over. And to help people really integrate that into their lives, the really foundational pieces. And then helping them understand, well, what's the next layer of that? Okay. You've, you've done the work. Check your blood pressure. Check your body fat distribution. Check your labs. You can't fix what you don't measure. Right. Be proactive about, you know, atherosclerosis, which is something that we know we're born with, something we have. It's not something we get. We get the problems. Yeah. Can we keep inflammatory factors at, at the lowest? Can we keep our insulin levels where they need to be so that we don't have problems at 57 years old?

• 56:11Speaker 01

  Yeah. And true. Very true. All right. Let's do some rapid fire questions. You ready? I'm ready. Okay. So what's the single biggest mistake people make when it comes to heart health? They think it's not going to be them. Yeah. They convince themselves that I'm fine. I'm fine. Yeah. It's just not going to happen to me. That's, that's an important one. Cause a lot of people stick their head in the sand. They wait till it's too late and medicine's just, doesn't seem to focus on prevention. So what's one heart health myth you wish would just go away? The one that I deal with on a regular basis is that patients that come in with heart disease and get a stent or bypass surgery, think they're cured. And I always tell people, we're not treating the underlying problem. All we're doing is getting you out of trouble.

• 56:54Speaker 01

  You now have to do the work because the process is still going on. You think when you crack somebody's chest, they'd change their lifestyle, but it often, often not. Most of the time not, because I think there's a misunderstanding that they think we've cured the problem. That's right. And really all we've done is gotten them out of trouble. We can save, we can save you, we can't heal you. And when you tell them that, do they get it? It's depends, you know, it, it depends. I mean, I lay it out. I say, if you, you're going to continue to smoke, all bets are off. We've taken all this upfront risk. I'm not going to soapbox you about smoking. This is your decision. These grafts could be done in six months if you continue to smoke. We've taken all this upfront risk for an operation. You don't want to be back to do it again. But I think that's one of the things, it's,

• 57:36Speaker 01

  it's more of a misunderstanding than it is a myth, but it's become kind of the perception. What's the most underrated habit for preventing heart disease? Uh, 10 minute walk after meals. 10 minute walk after meals. Why? Cause it keeps blood sugars under control. There you go. Keeps your blood sugar and insulin. Yeah. Cause your, your muscles can take up glucose without actually needing insulin, which is amazing. Uh, but insulin obviously helps, but it's, it's, it's true. I think it's a very simple habit. What's one food you wish people would eat more of? Fiber. Fiber? Why? Well, because it helps control blood sugars. It helps, it helps with cholesterol metabolism, metabolism. It satiates you. And so you eat less. It's, it, look, it's not sexy, but And it's good for your microbiome.

• 58:21Speaker 01

  And it's, it's critical. I agree with you. It's critical for your microbiome. I agree. And the side of, the side effects of eating fibers are eating a lot of other plant foods that are good for. So it's like, what, how about what do you wish people eat less of? Saturated fats. Saturated fats. Okay. We didn't really go into that too much, but you know, there's been a lot of controversy about saturated fats. Yeah. And I'm a believer. I think it's, you know, I'd love to hear your perspective because I, I think my, my understanding in literature and also treating, you know, thousands of patients is that it's so individual. Yes. Yes. Like I had a patient who, a patient who was an overweight woman. Um, she had high triglycerides, like 300, her HDL was like 30.

• 59:02Speaker 00

  Her, you know, particle number was high. She was insulin resistant. She was pre-diabetic. She had A1C that was up. And I said, you're like, she was struggling with weight loss and just couldn't knock it down. And I said, well, why don't you try a ketogenic diet? I put her on coconut oil and butter, saturated fat. Her LDL came down 100 points. Her triglycerides came down 200 points. Her H1 went up 30 points. I was like, and she lost 20 pounds and her insulin resistance went away. And she went on basically a ketogenic diet with saturated fat. Another guy was a thin biker. He's like, I heard this keto diet's great. I don't know. I want to try it. I'm like, I don't think you need it, but like, okay, but let's monitor what you're doing. And he was riding this bike 50 miles a day. It was like, super healthy and ended up causing his cholesterol to go exactly the opposite direction. High particle number, you

• 59:46Speaker 00

  know, lots of small particles, high LDL. I was like, wow. Okay. So there's a lot of genetics involved here and, and different people respond differently.

• 59:55Speaker 01

  Exact, exactly. And I think that that's why following the biomarkers are so important.

• 1:00:01Speaker 00

  Yeah.

• 1:00:02Speaker 01

  You know, but I, my impression is that if we look at the bell curve and we look at the majority of people and how they're going to respond with saturated fats, they're going to fall into a place of, of concern. I don't know that they're going to fall into those, those outliers. I think it's more of a, more of a risk factor than not, but you don't know until you know.

• 1:00:23Speaker 00

  Okay. What about saturated fat versus sugar and starch? Who's worse? What's the worst?

• 1:00:28Speaker 01

  I mean, I think it would depend on how much of each. I think if you're going to eat only saturated fats, you better follow your biomarkers very closely. If you're going to try to cut out all of those things and you're going to shift to, you know, eating a lot of higher carbohydrate foods, you need to follow there too. You need to be following your blood. I think, I think there's a balance between those two.

• 1:00:50Speaker 00

  Yeah. Check your numbers too.

• 1:00:51Speaker 01

  Yeah. Check your numbers because we all metabolize differently.

• 1:00:54Speaker 00

  What about non-negotiables in nutrition? It's just like something you never do?

• 1:00:58Speaker 01

  Mine's pretty general. I adhere to an 80 20 plan. I do the best I can 80% of the time and I know it's not going to be perfect. So I grace myself for 20%. That's my non-negotiable.

• 1:01:10Speaker 00

  And the 20% is what? Is, you're not having Twinkies?

• 1:01:12Speaker 01

  No, I'm not having Twinkies. It's bread or pasta or a piece of cake at a birthday party.

• 1:01:18Speaker 00

  Real food, but not ultra processed.

• 1:01:20Speaker 01

  Exactly. Essentially removed ultra processed.

• 1:01:22Speaker 00

  I think, I think that should, just for you listening, that 20% should not be soda or, or industrial processed food.

• 1:01:28Speaker 01

  Yes.

• 1:01:29Speaker 00

  Those are deadly and they're not actually food by definition.

• 1:01:32Speaker 01

  They're edible food products.

• 1:01:33Speaker 00

  I mean, it's true. If food, if you look up the Webster's dictionary definition or Funk and Wagon with a food, it's definitely not what, what ultra processed food is. That's defined as something that supports the, the growth and health of an organism, which none of those things tip. What about in terms of exercise, cardio or strength training?

• 1:01:50Speaker 01

  Individually, they're strong. Together, they're exponential. You know, I really, if you look at the data, the VO2 max and aerobic data is certainly very potent and, and significant when it comes to decrease of cardiovascular events. There's no doubt about it. We look at cardiovascular health and when it's measuring how efficient our cardiovascular system is, what does that equate to? That equates to ejection fraction or how much heart is being pumped out of the heart with each beat? We know that ejection fraction is directly related to longevity and survival. So the data

• 1:02:29Speaker 01

  is powerful there and, you know, connect the dots very literally. It really is. But when you look at strength training and we talk about muscle and it being the sink for glucose in our body, it's like, they're so hard to separate. I get asked that question all the time. And, and I just, look, we're, we're all drawn to one or the other. You know, I'm working with this woman now. She is an endurance runner and she hates to do resistance training. I'm like, you have to do.

• 1:02:56Speaker 00

  That was me. That was me. That was me. I was 40s, skinny, could run a lot, but bike 100 miles, but like, I couldn't do 10 pushups.

• 1:03:03Speaker 01

  And, and I did the same thing. I was an endurance athlete and I think that physiologically, we're very fit, but mechanically, we're not. And that comes to being able to do things as we get older, but more importantly, we know we lose muscle as we age. We know how important it is for our overall metabolism.

• 1:03:19Speaker 00

  Definitely. I've indexed way more on the cardio for most of my life. In the last five, six years, I've been more on the strength training. Okay. What about a piece of advice that every 30 year old should know?

• 1:03:28Speaker 01

  That it's, it's never too early to start because the deadlifts you're doing at 30 ensure that you're able to pick up your suitcase at 80. The, the, the aerobic training you're doing at 30 is what's going to enable you to, you know, travel and have the endurance to be able to do the things. The decisions you're making now are not going to just in, in impact your overall cardiovascular health, but they're, they're going to change your, your functional capacity later in life. It's, it's just.

• 1:03:59Speaker 00

  If you want to enjoy the fruits of your labor when you're older, you have to take care of yourself when you're young.

• 1:04:02Speaker 01

  That's right.

• 1:04:02Speaker 00

  I see that often. People like run themselves on the ground. They retire and then they just can't do anything.

• 1:04:07Speaker 01

  That's right.

• 1:04:08Speaker 00

  What's one thing you wish every six year old would, would know?

• 1:04:10Speaker 01

  I would flip that corner around. It's never too late to start exercising either. And we, we know the data with that, right? We know that you take 55 and 60 year olds that have never exercised in their life and you watch how their heart function changes in a very consistent regimented program, it gets stronger. So it's never too late, but start small.

• 1:04:32Speaker 00

  Yeah.

• 1:04:33Speaker 01

  Make it, make it fun. Pick things that you want to do. Pick things that are, that are enjoyable for you.

• 1:04:39Speaker 00

  I love, I love, um, that's sort of like the guy's 65, never exercised, starts growing and now he's like fitter than most 30 year olds, you know, like he's 95 years old.

• 1:04:46Speaker 01

  Yeah. Well, and remember too, like particularly in the beginning, that's when they see the biggest benefit. When you've gone from never exercising to a consistent program, they get a huge, but so it's never too late to start.

• 1:04:57Speaker 00

  All right. Now, as a heart surgeon, what's, what's one thing you avoid?

• 1:05:00Speaker 01

  There's so many things. I gotta pick one, huh?

• 1:05:03Speaker 00

  Or maybe how about this? What's one thing you avoid that you actually like that you don't want to avoid?

• 1:05:07Speaker 01

  Well, I'm going to, I'm going to, I'm going to zoom out way, way far on you. The one thing I I avoid is complacency.

• 1:05:16Speaker 01

  Because I think that that's a very, very dangerous place to be. And I think that's very much where I ended up. Because I felt like I was checking all the boxes. You know, I was doing triathlons. I was, I was competing at the iron distance. I was doing all this, doing all the stuff, right?

• 1:05:35Speaker 01

  But I became complacent in, in how I evaluated things. And to me, the willingness to change is what allows you to grow and to change and to change paths as the road changes underneath you. So I avoid complacency.

• 1:05:52Speaker 00

  That's good. I like that. I like that advice. And lastly, uh, if there's one biomarker you get to pick as a heart doctor that everybody should check, what is it?

• 1:05:59Speaker 01

  ApoB.

• 1:05:59Speaker 00

  ApoB. Okay. Everybody get their ApoB done. Okay. Great. Amazing. Well, thanks, Jeremy, for sharing your story. Uh, thanks for your vulnerability and, uh, getting other people to think differently about this. Cause you know, you've been at the, at the shit end of the stick of the plumbing problem and heart disease for a long time. And I think, you know, waking up to the fact that this is actually a preventable disease, that we actually can move the needle on this, that if people actually knew what to look for, what to do, what to measure and how to change their habits, that we could actually beat this thing.

• 1:06:27Speaker 01

  Well, thank you so much for having me. I really enjoyed it.

• 1:06:29Speaker 00

  Thanks, Jeremy.

• 1:06:30Speaker 01

  Yeah, man.

• 1:06:31Speaker 00

  If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to the Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health, where I am Chief Medical Officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional

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