High Blood Pressure Is Not the Starting Point – The Early Changes That Lead to Hypertension and Heart Rhythm Issues | Heart Disease | E135

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So I had moderate to severe sleep apnea. I did CPAP, hated it, lost all the weight, right? I was 230. I'm 167 now. I never snored, by the way. Thought I solved the problem, went back and got a sleep study and they said, no, it's still there. It's just mild. So I got an oral appliance and then I said, how do I know this is working? And I did a sleep study with it in and it completely resolved the issue. So I've had it and I use it and it's a game changer and that will shave points off your blood pressure, which will decrease your risk of all the things we were just talking about, including the electrical stuff. I do remember having PVCs. I don't anymore. I was on blood pressure medicine. My blood pressure is perfect now. Like, all these things that just got better before they became too much of a problem.

Welcome back once again, everybody. We are continuing to go on the pathway of Metabolic cardiology, you are as old as your arteries are. If you want to biohack, you want to be ultimate survivor kind of thing, live as long as possible, be as healthy as possible, you have to control the age of your arteries, which is ultimately what happens with heart disease and neurological disease, which is 2 of the 4 horsemen, right? It's neurovascular, cardiovascular, metabolic, and cancer. And so literally 2 of the 4 horsemen are directly just artery age in your brain and your heart. Today, we're going to talk about blood pressure, atrial fibrillation, and electrical issues in the heart. Because many times they go together. Someone will get high blood pressure and they get hip surgery, something like that. They come out in AFib. They will get older. They get a pacemaker put in. And so your heart is not just the age of the arteries, which is super important. It's also the microvasculature and the electrical stuff. And hypertension, having uncontrolled hypertension for many times is a prerequisite to the electrical issues and the atrial fibrillation.

Yeah. Plumbing begets an electrical problem.

Yeah. And toxins can be, you get electrical issues, but hormones, sleep apnea, thyroid, right? 100%. So hypertension originating as dysfunction in the cells in your arteries. But what happens before hypertension? Like what leads up to hypertension? Because we, it gets up, here's your medication and they're not controlled. They're not controlled. But yet there's a process that goes to that. So would you talk a little bit about that process of getting, I know high blood pressure is bad.

Yeah.

Or maybe start the conversation before you tell us what leads up to that. What are the numbers for that? Cuz isn't it 140 over 90? If it's 1, if it's 138 over 88, isn't that okay? Like what?

Yeah, those are all too high now. We talked about this last time a little bit, and really the goal is to get the numbers. I think the more that people are studying this, the more they're realizing that the numbers need to be lower and lower. And it's, you know, it's almost approximating what we used to call hypotension, you know? That being said, 120s. Over 70s, 110s, 110s over 70s is really the ideal optimal goal. So 130s over 80s is, is not okay anymore. Clearly 140s over 90s, that person needs to be treated or at least figure out quickly what's going on. The goal is to get the number tight and keep it that way, have some flexibility. And in that case, that means vascular compliance, the compliance of your blood vessel, the elasticity, the stretch, the ability to expand and contract, because it's all a muscle. And when you lose that compliance or you increase that systemic vascular resistance you start to develop things like hypertension. And the question is, how did that come to be? Is this secondary to endothelial dysfunction, meaning the lining of the blood vessels getting damaged, the arteries are getting plaque formation, therefore they're getting stiffer? Is there calcification involved? Is this an issue related to something like aldosterone, which is a hormone that's regulating your salt-water balance and affecting the intravascular volume? So is it more of a hormonal volume salt-water balance issue? Is it a renal issue? Where now that you're getting kidney disease, that's affecting your body's ability to regulate your blood pressure because there are signals sent from the kidneys to the rest of the vascularity, the heart itself, that kind of maintain and control this, the stretch receptors and how they're being affected, your heart rate. Do you have dysautonomia? I mean, there's just so many players involved with the goal being that you want to maintain that number. And if the number's high, determine if that person is, is a low or higher end in hypertension. Is there an aldosterone issue? Is this a coronary artery disease issue? Is this a renovascular disease issue? And then go after it in that way, shape, or form, like some form of attack. And so that's kind of how I work it up.

And even when you think about the blood pressure itself, when you look at the medications we use, beta blockers are drug blocking the effect of adrenaline, these beta receptors. So we block that. So we're blocking adrenaline. Clonidine, alpha agonist blockers, they're, they're medications that block part of your adrenergic nervous system affecting. So we nervous system involvement. With blood pressure is a thing.

Yeah.

ACE inhibitors and ARBs, like they're blocking this. You mentioned the kidney, the kidney, the renin-angiotensin-aldosterone system.

Angiotensin becoming angiotensin 1, becoming angiotensin 2.

Yeah. Which is vasoconstriction. Correct. And diuretics, you know, which we could maybe get in, you know, good diuretics and bad diuretics, but ultimately a volume issue. And let's just deplete it a little bit. You know, the SGLT2, there's a whole class of diabetes medications They're now morphed into heart failure cardiovascular drugs because part of what they did with diabetics was like Jardiance, for example, is they volume depleted people. So all of a sudden excessive volume becomes an issue. So all of a sudden, just looking at the medications we use to treat blood pressure tells us there's more going on.

Yeah.

Than just your calcium channel blockers. You know, there's more going on than simply, you know, a tight blood vessel, right? Yeah.

There's plumbing issues. Yeah. And it's, it's neurovascular issues.

It's hormonal issues. Yeah. It's hormonal. It's fluid electrolyte status issues.

Correct.

Oh yeah. And so one of the things I like to talk to people about as well is when we talk about blood pressure, it's like taking a tree and pulling it up by the, by the trunk. You have all those little rootlets. That's where blood pressure starts. That's where you get the microvascular. Yeah. Yeah. Microvascular. It kind of works its way up. And this big trunk is ultimately your aorta and it goes to your heart, right? By the time you get dilation there, you get, your heart gets a little bigger. It's like you got a lot of stuff here going on out. And so And that's where looking for things like, does your blood pressure drop when you sleep? Are you a dipper? Which is where this kind of starts. Yeah. Is your, the perfect blood pressure, if you pick a number, it's like 117 over 72 and like, well, you know, when you're 125, 130, are we catching this stuff earlier? Do you have, you know, it's really interesting, erratic blood pressure changes, like me getting stressed out, you know, you know, white coat hypertension.

Yeah.

Someone comes to my office, blood pressure's fine at home. You check it at home. Okay, great. They come here. You should get stressed out. You should do things. Your blood pressure should go up 5 points, 10 points. It shouldn't go like 120 to 150. Yeah. That's telling this— there's this nervous dysregulation. Dysregulation. Yeah. And getting at that stage is better than waiting until you've had an event.

Yeah. And that's the white coat hypertension is the one that gets dismissed. Oh, it's just white coat hypertension. Kind of like, oh, it's just fatty liver disease. Right. It's a hallmark.

Yeah.

There's something else going on and badness to come. Same way that if you're a non-dipper or a paradoxical dipper, you know, all these things are early indicators if you're paying attention to them of a future problem, if it doesn't already exist. So you have to pay attention to that stuff. You can't dismiss it. The microvascular disease are the things that we try to pick up early, but if you're already behind the eight ball, you gotta be more aggressive with these patients.

And one of the things I think most of my patients are getting this now, you can actually get a retinal exam. Insurance doesn't pay for it. They dilate your eyeball and they actually will use a special camera, look at the arteries in the back of your brain, your back of your eyeball. And they can actually pick up early. They're literally looking at your brain and the arteries that are going, your optic nerve. They can actually pick up vascular disease years in advance just by that really good retinal exam. Yeah. Awesome. Which is $75. So pay the extra money and get it.

Yeah.

Because insurance doesn't pay for it. But so all of a sudden, like this idea of hypertension, I'm waiting till my blood pressure's 140 over 90 or for stage 1 or stage 2, you know, 160 over, um, 100. Like that's waiting way too long. So someone comes in, they have high blood pressure. We know it's directly related to cardiovascular, you know, heart disease, brain disease, renal disease, peripheral artery disease. What could be some causes for that? What are some underlying things that people often overlook? A better question. What are some common things that are often overlooked that are simple fixes, maybe some more complicated that can be beneficial in these people who, you know, 138/90, 142, who might not meet criteria for— or close or needing to like start, you know, the number for starting on medication if you fail diet and lifestyle is 140/90. So people that say 138 over, you know, 88 number where you don't meet American Heart, AHA criteria for blood pressure medication, but it's not healthy. What are some things you see that—

low-hanging fruit?

Yes.

So for me, it's nutrients. There's 4 of them. CoQ10, what's your level? OmegaCheck, vitamin D, red blood cell magnesium. If your red blood cell magnesium is not greater than 5.8, for me, close to 6. If your CoQ10 is not close to 3, if your OmegaCheck is not close to 8, if your vitamin D is not above 60, I'm working on all those first. And you will literally shave points off of their blood pressure just by correcting those nutrients and get all the benefit that those things do other than manage your blood pressure, which is a lot, believe me. For every one of those individually, they're doing hundreds of things in the body. Two, salt and potassium intake. If your potassium intake is low, you can have hypertension just from that alone. If you can get your potassium intake over 4.5 grams a day, you can shave blood pressure. If your sodium intake is greater than a gram and a half, you can increase your blood pressure. So what's the salt ratio? What's the potassium ratio in their diet? If that's something you can quantify or you can encourage them. Eat less salt, eat less processed food, eat less, put less salt on your food, increase potassium. And here are the foods that I want you to eat more of. That's the starting point. The next step is what's going on with their stress? What's going on with their sleep? Do they have sleep apnea? Are they exercising or are they sedentary? Are they drinking a ton of caffeine or taking other stimulants? Like just run the list of things that lifestyle-wise, diet-wise, nutrient-wise, that can intervene and create a problem that all of a sudden you took a number that was prehypertension or stage 1 and you just made it normal and no medication was ever involved at any point in time. You could take someone that's even higher and correct it that way. I have a lot of patients that come in already on drugs. We do these things, their medication gets decreased and then eventually stopped. And I haven't done anything magical other than what I just listed. And that's before we even get into like the more in-depth stuff, right? Like, what are you looking for?

As far as labs, those 4 are brilliant cuz they're like super heavy hitters.

Yeah.

Big, you know, the next level is all your other nutrients. Your B stats. What's your homocysteine level?

Yeah.

If your homocysteine is elevated, you have endothelial dysfunction, you have detoxification issues, and that's fixable with methylated B vitamins.

Yeah.

Yeah.

And magnesium.

Magnesium.

Right. You're not methylating well, so you're not making nitric oxide well. Right. What's your protein intake? What's going on with your oral microbiome? What's their dentition like? If your dentition is a mess, if your oral microbiome is a mess, you're not making nitric oxide from dark leafy greens that you eat because you're not converting nitrates into nitric oxide into nitric. You know what I mean?

Yeah.

Either way, you're not making nitric oxide, which is important. So there's a lot of things that you can look at that again, aren't super complicated.

Oral health is interesting because if there's interesting data on if you use antimicrobial mouthwash, to keep your— Yeah.

Yeah.

You actually, your blood pressure goes up and your A1C will go up.

Yeah.

Why? Because you swallow anywhere from 3 to 5 trillion bacteria a day, which seeds your gut microbiome if they're the healthy kind. And then the whole process of liberating nitrates starts with your oral microbiome, your oral saliva, appropriate chewing that then goes to your gut. That's in your gut, then can do its thing. There's an association with hypertension. And metabolic disease with people on PPIs, which are drugs that block stomach acid. And so all of a sudden someone comes in with some of these issues. It's, it's like, what's your oral health like? See a good functional biological dentist to get your teeth cleared up.

Yeah.

What's your gut status? Are you on a PPI or an acid blocker?

Let's— or just have hypochlorhydria because previous use or SIBO, right?

Yeah.

It's nitrates into nitrites into nitric oxide. Got it. Nailed it. And that's because of your bugs and your stomach acid. Yeah, I don't like when my brain farts. Keep going.

Have you been told there's nothing wrong with you, or worse, there's nothing we can do for you? We were told our daughter Anna would never walk, talk, crawl, or even see. We were also told to start surgeries when she was just 18 months old, and we said no to all of it. Today at 19, she's thriving. And here's what really shakes me to the core: her story isn't rare. I've seen this happen in hundreds to thousands of patients in my clinic. In Curable, I show you exactly how you can do the same type of thing because you deserve the same fighting chance as my daughter had. The link is below. Get your copy today. So, so hypertension, a lot of cool things that can be done. You know, as a medical doctor who follows, you know, the standard of care is the entry level. It's, we have to at least do by that. And so if someone has a 140 over 90 to 160 over 100, no history of vascular events, recommendation, national level recommendations are diet and lifestyle modifications first. So even if someone has an elevated blood pressure, you still have time, 3 months. Yeah. 2, 3 months before the next visit to get it down without having to go to medications. And it's really interesting when, you know, when someone gets a gastric bypass surgery, they come out of the operation, what's the first thing this gastric surgeon does? Stop the diabetes medications flat out, stop the blood pressure medications flat out. Why? Because as they lose weight, if they don't do that, numbers will crash and they can cause issues. And so point being, I know I'm not recommending gastric bypass surgery, but significant lifestyle interventions can be ridiculously powerful.

Yeah. And the concomitant weight loss and metabolic shifts and body composition changes and all of the physiologic changes that happen because of that.

And if you're losing a lot of weight and you need healthy fats because you're detoxifying, liberating fats from your toxins, from your fat tissue, and if you don't have these the soap and the molecules to catch it up and poop it out. You can just change around your body and cause some—

you just redistribute it.

Exactly. Yeah. So blood pressure, you know, talk about the 4 things you like to do for that, but then there's a whole thing with blood pressure causing your heart to dilate. You get LV atrial, your left ventricle gets a little bigger. You get your dilation of your atria, which are the upper chambers of your heart. And now you get these, you get bigeminy, you get extra beats. The electrical patterns of your heart are getting off a little bit.

Yeah.

Could you talk about that progression? You know, in my primary care practice, routinely see people come in with extra beats, PVCs, PACs. You look at them and you're like, oh, okay, when was your last EKG? It's been 3 years ago. They're there. That's normal for you, right? Yeah. But they have— they're getting short circuits, right? Your good old days, you'd see people coming when those things keep on progressing or spike to arrhythmias. Yeah. And then all of a sudden now they're not getting enough blood to the brain. Talk about the whole idea of the electrical impulses I mean, we do— every cardiologist does EKG. It's looking at the electrical map of your heart.

Yeah.

Talk about that a little bit in, in relationship to heart disease.

Yeah. It's the architecture of the heart will change. So if you have a plumbing issue, the issue then not just— we're not talking about coronary artery disease to the extent of inevitable myocardial infarction, which is our way of saying heart attack, or decreased blood flow, which we would call myocardial ischemia. And then the, the resultant effects of that, we're talking about just chronic hypertension, chronic plaque, chronic disease that leads to the remodeling of the heart and the changes in these baroreceptors, the stretch receptors in the vascularity, in the kidneys, in the heart itself that cause shape change. And the heart goes from what it's supposed to be to what it's not supposed to be. And that, that's different depending on what we're talking about, but The word for that change in shape of the heart is cardiomyopathy. And you can get left ventricular hypertrophy, which is basically like working the same muscle over and over again. You go to the gym and you just lift with your right arm. Your right arm's going to get like Popeye's. Your left arm's going to be small and frail. So that left ventricle that's constantly pumping out against this increased pressure gradient, increased systemic vascular resistance leads to hypertrophy, makes that muscle thicker, less compliant. The backflow of that is to the left atrium. The backflow of that is to the pulmonary tissue. So your lungs, now maybe you're developing pulmonary artery hypertension. Backflow of that affects the right heart. Backflow of that affects the liver. And it can go the other way as well. If you have chronic liver disease, you can develop hepatic congestion or portal vein hypertension that affects the preload or the volume going back to the heart. So now the right heart is the incendiary event. Related to the liver that then leads to left heart failure. So it can go either way. It's all connected. But what happens with that remodeling, left or right atrial enlargement, left or right ventricular hypertrophy, or the heart changes its shape and becomes dilated or globular in its shape. These things affect the electrical current that's supposed to emanate from that right atria and the SA node or the sinoatrial node. That beat-to-beat comes from your SA node. That will literally go across from right atria to left atria, down the middle of that main septum or the muscle wall that, that separates the compartments of the heart. It's called the bundle of His and the Purkinje fibers goes, poof, poof, left ventricle, right ventricle will lub dub, pump blood out of the aorta, and then deliver oxygenated blood to the rest of the tissue. Rinse and repeat over and over again, however many beats per minute. If you have an ectopic beat, you're now getting an electrical impulse coming from somewhere else in the heart that isn't where it's supposed to come from. and now it's interfering with that normal conduction. And it might be what we call a benign premature ventricular contraction or PVC or a PAC, premature atrial contraction, or you start to stack these up and now you're developing things like multifocal atrial tachycardia or, you know, bigeminy and trigeminy or V-fib or ventricular tachycardia or atrial fib or atrial flutter, any of these arrhythmias that are either atrial, meaning the top of the heart, or ventricular, the bottom of the heart, or both. That are leading to irregular beats, fast beats, bradydysrhythmias, which are slow beats, pauses, you know, just something that's going to cause the heart to eventually create other problems. Is that that you now throw off a little clot, you take a thrombus and cause it to become an embolus because the heart rate goes up and it's irregular, and now you just got a stroke, or does the heart pump so fast for so long that you have backflow of blood and you wind up with congestive heart failure and now you're, you're drowning on dry land. Or do you go into a fatal dysrhythmia that you're just not perfusing at all and you need CPR because you're about to go into cardiac arrest? I mean, there's all these things that can happen from a dysrhythmia that originates from heart disease that originated from hypertension that wasn't managed long-term. That's how these problems start and eventually lead to catastrophic stuff that I would see over and over again in the emergency department.

Yeah. And think about it. Is, you know, just like we talked about all this fancy testing for the inflammatory markers, you know, doing an EKG, basic, you know, EKG, getting what's your electrical pattern of your heart? What's it look like today? Here and now? What are the intervals between when you're— the lub-dub, I love that. Yeah. That's good. Like what's interval? What's your PR interval? What's your Q— you look at these things.

Axis intervals, rate, right?

Measuring all this stuff.

Do you have evidence of previous heart attack, right? Do you have Q waves? Do you have flipped T waves? Are you actively having a heart attack? Do you have an arrhythmia? Are P waves present or is this an atrial dysrhythmia? That's just an EKG that's capturing that moment in time. So to be clear, that's important. That's basic. That's what he's saying. But if you suspect you have one of these issues, you need like a Holter monitor or you need an event monitor. You need someone who's gonna track that beat-to-beat variation for days and capture the dysrhythmia. And cardiologists can establish this and set this up. And then they interrogate it and they say, yeah, you had a couple of runs of AFib, they were non-sustained, or you had a couple of runs of VTAC, but they were non-sustained. But that— they then dismiss that as it's okay because it was just a little bit here and a little bit there. But that's a harbinger of badness to come. You know, these are things that you want to know about.

In the preventive cardiology world, getting that baseline EKG is important and then checking it every 1 to 2 years depending on your age for changes.

Changes.

Yes. I've— there's been so many patients I've picked up. Why is your QRS lengthening? Oh, your, your progression on your lateral leads is changing.

Yeah.

You can actually see the shape of these things changing. You know, something's going on versus waiting for— I was actually talking with someone this morning, having breakfast with some guys, and one of the guys was like, da da da, had some issues and he's in his late 60s and his first EKG of his life was in the hospital for chest pain, his late 60s. And I'm like, physical every year, never had an EKG.

That's insane.

And that's standard of care.

Yeah. The other thing is you can pick up information about the electrolytes that are important for the heart to pump, essentially for your rhythm to be normal. It's calcium, it's sodium, it's potassium, and it's magnesium. These four are the most important, right? It's sodium potassium pump in the cell membrane causing calcium-induced calcium release. That gets into the muscle and causes actin and myosin to interact and contract that muscle. And potassium is the relaxation. Magnesium is a cofactor and is relaxation. Sodium and calcium are about contraction. If you're looking at an EKG and you see someone has T waves that are peaked, that person might have hyperkalemia, high potassium. If you're looking at an EKG and that person's QT interval is prolonging, they might have a need for magnesium. If you're looking at an EKG and someone's got U waves in their T waves, may, or U shape, that person might have hypokalemia or low potassium. So I could look at an EKG of which I've seen thousands in my career and not only tell you, is this normal? Do you have extra beats? Do you have an arrhythmia? Have you had a heart attack? Are you having a heart attack? But also I could probably guess what your sodium, potassium, calcium, and mag look like on labs. Like this is stuff that you should know and should be tested.

And you're also looking at, you can look to see if there's more pressure on the right side of your heart versus the left side of your heart.

100%. The axis will change.

You can see that if the top part of your heart is a little dilated.

Yeah.

You can see if the left ventricle's a little dilated.

Yeah.

Looking at how the electricity goes through your lateral leads, you can tell is there, is your heart kind of shifting in certain ways? Yeah. And how long has this technology been around? 100+ years, you know, but the point is that electrical issues can be caused by a lot of environmental toxins and chemicals.

Yeah.

Viral infections, you know, it's one of the interesting things, virally induced cardiomyopathy, heart issues. And all of a sudden what sets you up for that? And one of the answers is actually chromium and certain mineral deficiencies. I think we talked about this sometime in the past about the whole thing in China when they had cardiomyopathy, they're trying to develop a vaccine. I won't go through the story before, basically found out if they replaced, you know, chromium, all of a sudden people would get the, the viral infection, typically kids, and they wouldn't develop the cardiomyopathy. So they Gave everybody the supplement and voilà, this went away.

Yeah.

And this is one of those places, like a rural place in China where like only 50 million people live, kind of those things, you know, it's like, and all of a sudden it's like, wow, does that happen here? It's like, yes, we have the goiter belt Midwest with this low iodine in the soil. We have, depending on what you read, maybe 89% of Americans are potassium deficient. Maybe 68% of Americans are magnesium deficient. You know, all of a sudden these things are real. And, you know, nature's calcium channel blocker for heart issues is actually magnesium. Yeah. All of a sudden magnesium is actually something that can help. Back in your— actually, when you do training, at least when I was at MCV, someone comes in with hypertensive crisis, we would do IV magnesium. Someone's coming with seizures, you could do IV magnesium. Someone was coming with hypertensive crisis, you could do IV magnesium. And then now we've got—

migraines, IV magnesium. We would give— you give IV magnesium before you give somebody potassium because you can't replete someone's low potassium without adequate mag. Mag's cofactor in its transport. We give IV magnesium magnesium preload before we would electrically cardiovert someone at AFib with Corvert, which is obutilide. It's an old school drug. Before you give obutilide, you gotta give magnesium cuz you'll drop their mag and get 'em outta AFib and send 'em into torsades. Like you don't wanna do that, right?

Torsades is a, is a, a death signal basically.

It's another dysrhythmia. It's called torsades de pointes. It means twisting of the points. And if you see that, that's not good. It's, it's, it's a bad, yeah.

Yeah.

So it's absolutely all those things, but then like hyperthyroidism, right? Toxins, like you mentioned, holiday heart, which I would see a lot, you know, holiday heart, man. People going home for Thanksgiving or Christmas, eating a ton of bad food, drinking their faces off, wake up, pop into AFib, and they would come into the ER. We saw more AFib post-Thanksgiving, post-Christmas, and we would see it any time of year. And patients that didn't have it, new onset AFib with RVR, which means rapid ventricular response, and it was aptly named holiday heart because it was induced by Lifestyle by holiday choices, which is clearly alcohol mostly because turkey doesn't hurt you.

But we would see— when did you— your residency was 2003 to 6? Yeah, I was 2000, 2003. So same time, you know, north side of Richmond. And during my residency, I hated being on call during Thanksgiving and during race days at the raceway.

Yeah.

Because people come in and drink their beer, and a bunch of people go in AFib or heart failure.

Yeah.

Virginia ham during Thanksgiving. Oh, that's so—

and people go into heart failure.

And those, one of those things I was like, man, so I, I tried work not to be on. I'd be like, yeah, when's the rate? I wanna avoid that. 'Cause you knew it was gonna be bonkers in the ER. And the—

'cause those are my favorite days. 'Cause you're, 'cause you wanna be busy, right? Like if you're gonna practice emergency medicine, you wanna see sick stuff.

Yeah.

You wanna see the critical stuff. Like, well, I, it was all the primary care that came through that I didn't like. It was, it was the stuff that wasn't emergent that didn't belong in the ER utilizing resources that I didn't like. I mean, I, I liked practicing actual emergency medicine, but that was hardly the case.

And.

Not often.

Yeah. I was kind of the opposite where we have our hospitalized patients and your clinic patients, but having the ER patient always just threw your schedule off. Yeah. Because now you're like, oh, I gotta go there. Yeah. And we were doing call at night. You're like, gotta get up. And it was just like, can I sleep like more than 2 hours straight?

Yeah. But let's, let's go back to magnesium for a quick second. Okay. I have a patient who has coronary artery disease and we're managing it and we're working on stabilization and regression and he's got PVCs. And his P2C burden was 13% on a Holter monitor. And his doctor said, we gotta put you on a beta blocker. And he said, I don't want to do it. Can I come off of caffeine? And I put him on some chicory root, which he's using in place of caffeine. Can I come off of caffeine? Can I take some magnesium? And I said, well, magnesium taurate is great for stabilizing the heart. Let's do some mag taurate and yeah, quit the caffeine. And his cardiologist begrudgingly agreed. Went back, got the halter, dropped by 5%. He's down to 8% burden, and they said, you don't qualify for a beta blocker. So we saved this guy from being on a drug just by getting rid of a stimulant and giving him magnesium, and his RBC mag levels still aren't replete, and so we're still working on that. So there's many ways that you can go after these things, even in the setting of pathology already being there.

Did you by chance check his caffeine CYP gene for caffeine metabolism?

I have not.

See if he's a slow metabolizer. I don't know.

Because like 5% of people are slow metabolizers.

I'd be curious. If he's like one of those people who like the caffeine also.

It just kicks around.

Yeah. It just, it's just, it's like super stimulant.

Yeah.

It's crazy. Caffeine is healthy for you.

Is it 3A4?

Forget which one it is.

I think it might be.

Yeah.

I have the opposite. I can drink caffeine at bedtime and still go to sleep.

I used to be able to do that when I was younger.

I'm a rapid metabolizer.

I'm not, well, you're regular. I'm not a regular. I'm not a low metabolizer. I'm just regular. I'm not, I guess I'm just minus, I guess that's rapid metabolizer.

It might be 3A4. It's always, it's, it's always 1B1, 1A1, 3A4, 2D6. It's one of those. I know those, but no, I didn't test it on him yet.

Yeah. Yeah. That'd be a curiosity because it's like, yeah, if you did the cardiac gene lab that we talked about with him on.

Yeah, I think we're probably going that route for him because we've been working not very long. All his numbers are better, but we just updated his CAC CT and it's slightly worse. But again, I've only had him as my patient for about a year. And I mean, I'm talking about decade undoing decades of stuff takes time. His first CAC CT was the first one that we had, so I don't know that we haven't slowed the rate down.

Yeah.

It's not much worse. I feel like it's a win.

What was, what, what, how much worse was it?

It, it's, his first score was like 1,000 on the CAC CT, which is pretty high. It's 2-vascular disease. And the next one's like 1,140. And that's, I think you're, you're allowed 15% a year in the course of a year and a half.

Yeah. Okay. So that's typical. Yeah. Which.

Yeah, but all of his markers are better. He's on drug therapy and followed by cardiology as well as all the things that we're doing. But he was bummed and I don't blame him. But the goal is now get more aggressive, keep doing the work and, and watch it get better. 'Cause it will.

So one thing I wanna, you went down this pathway, you got kind of fancy. You mentioned heart failure and liver and kidney. I wanna mention hepato-renal syndrome. Yeah. Briefly. And yeah, it's the idea how if you get heart failure, it can affect your liver. If you get liver issues, it affects your kidneys. And vice versa, and how if you have heart issues and you have fatty liver or you have chronic renal insufficiency, all of a sudden you need to look at that triad and be treating those not just acutely, but also chronically. Interesting enough, I was reading this past weekend on the Medical Letter, and there's a new drug to treat metabolic-associated fatty liver disease, FDA-approved.

GLP-1s?

No, no, probably. No, but it's interesting because the drug actually is a selective thyroid receptor agonist specifically that activates thyroid receptors onto like alpha and beta, and I think beta-1 on the liver. So it only activates thyroid on your liver, on the cell membranes. So it's upregulating mitochondrial function to burn off stuff. But the point is like, it's a drug now, FDA approved to treat fatty liver disease. And it's literally given— you're making your liver slightly hyperthyroid.

That's awesome. Yeah.

So the question is, well, us optimizing thyroid function and all the stuff we do here, like, you know, if people, patients get better, the fact, you know, it's like, yeah, now there's a drug to do that, or we can do all this stuff too. So it's kind of, I was kind of excited about reading about that. I'm like, kind of cool.

Yeah. I mean, when I have panels that I do on patients, when I do thyroid panels, when I'm putting in codes to justify the labs, they have dyslipidemia. It's going on there. Cause they're absolutely intimately intertwined.

Thyroid liver disease.

Yeah. 100%. Yes. Yeah.

So I think we're good for today. Yeah. Talking about this topic, I feel like we could just ramble on.

I mean, the key is like everything is connected, right? And when you're talking about metabolic cardiology, it's complicated, which is why we're doing so many of these. And hopefully we're providing a good outline of what you should be looking for and what that means. And what are the low-hanging fruits that you can kind of figure out on your own or get your doctor, even your primary to look at, but like the cardiopulmonary tree, the vascularity, it's connected and everything leads to a target end organ. So like Dr. Hartman says, you're as old as your blood vessels are. If you have chronic kidney disease, if you have chronic liver disease, if you have chronic brain fog, like it's probably got a vascular component to it. So start there and a lot of things will get better as that gets better. It's about going for a root cause. And that's the whole goal of all this. It's finding the root cause. And I don't know of more of a root cause than healthy blood vessels, right? Get them healthy and see what happens. A lot of this is reversible. And if you're told it's irreversible, don't believe it until it's proven to be so. Even these arrhythmias can be corrected. Now, a lot of times they're just medically managed, right? A rate controlling drug. Sometimes you can be medically converted. Sometimes you're electrically converted, shocked out of it. Sometimes you need ablation therapy, but sometimes people spontaneously convert back into sinus rhythm. Why did that happen? What was behind that? Did someone intervene or did it just happen? Either way, it can. Don't give up, keep working towards it, find the low-hanging fruit, do something about it.

And something I think is commonly overlooked in the functional medicine as well as conventional world in these cardiac patients with rhythm abnormalities is sleep apnea.

Yeah.

If someone, you know, I, if you come in, come in 100%, I don't care if it was postoperative AFib, I don't care if it was from your hip replacement or whatever, you're getting a sleep apnea evaluation, a home sleep test. And 89% of those people come back positive. And it's like all of a sudden it's like, okay, let's treat this. But it's such a low-hanging fruit kind of simple, easy thing to address that is typically overlooked. Doesn't matter what world you're in, the conventional or functional, it's overlooked a lot.

All the time.

And so, part of my, you know, if you're personally, I think, you know, everybody needs a calcium score when they turn 50, right? You know, women can get a little older, men a little younger based on history, whatever. Everybody needs colonoscopies. Everybody, you know, sleep apnea. It's pretty exciting. Yeah. I mean, it's, it's really easy, really basic. You know, you might, you're—

I'm doing it on everybody now and I'm finding it all the time. And like, it's, it's rare that it's completely normal. It's often that it's at least mildly dysfunctional. And then you don't need CPAP, you just need an oral appliance or positional therapy or whatever.

Article I was reading about that a couple weeks ago, which it's one of those things I love, I love reading stuff that verifies what I clinically have thought for years.

Yeah.

And what it was is basically your patients with mild or moderate sleep apnea, like it's like, like there's like, let's say moderate, mild, severe. Let's say moderate, mild, like the first part of the moderate. If they're treated with a CPAP machine, have worse outcomes. I mean, how many of your patients with mild or mild, moderate sleep apnea, they don't like it. They can't tolerate it. They don't use it. It's the people, my patients who love their CPAP machine usually have bad sleep apnea. It's usually like, how are you still alive kind of thing? Yeah. And so clinically I thought, you know, you're mild and moderate. This is FDA approved. Let's go ahead and do the dental orthotic or whatever. And then after my patients are like, can I mouth tape instead? I'm like, sure, whatever. And then I retest them and I've had patients who literally mouth taping, not recommending this on, you know, this is medical information only. Right. But recheck their, yes.

Yeah. The similar, so it's, that's what I did. So I had moderate to severe sleep apnea. I did CPAP, hated it, fought it, but did it because I wanted to feel better. Lost all the weight, right? I was 230. I'm 167 now. I thought I solved the problem. I never snored, by the way. Thought I solved the problem, went back and got a sleep study and they said, no, it's still there. It's just mild. So I got an oral appliance and then I said, how do I know this is working? And I did a sleep study with it in and it completely resolved the issue. So I've had it and I use it and it's a game changer and That will shave points off your blood pressure, which will decrease your risk of all the things we were just talking about, including the electrical stuff. I do remember having PVCs. I don't anymore. I was on blood pressure medicine. My blood pressure's perfect now. Like all these things that just got better before they became too much of a problem.

You kind of were a mess at one point in time.

I was. My CACCT is a zero. I don't know how that's the case.

That's awesome.

I feel like I was a ticking time bomb. I just caught it early enough.

Yeah, that's the goal. That's the goal.

Me at 39, man. Like, I'm going to be 51 in April. And like, it's one of those things where I was messy. 12 years. Yeah. Yeah. 12 years.

Wow. Time flies when you're having fun, right? Yeah. All right, cool. Thank you all once again. Hopefully this information was helpful. Please like, share, subscribe. If this is helpful, please do share it though. That's how we get this information out here, how we get the word out. And one thing I will add on here for some of this cardiovascular stuff, we do have show notes. That where this goes. And so some of my patients I'm recommending now, if they're kind of confused by all this, just taking, cutting and pasting this and using an AI tool. You could literally take our 4 conversations, put in a tool, and then actually ask it questions and manipulate it. So that's how sometimes people can use our stuff and actually uplevel it for themselves if they're not seeing us as patients. So.

Yeah, sure.

Something to think about. So.

Cool, man.

I know you're still here. AI. I know.

I know. It's all right. That's all right.

It's. Hey man. It's the genius.

Whatever floats your boat.

Floats my boat. It's floating right now. So. I got my AI right here. You're pretty, you're a pretty smart guy. So you do it, you do have that.

I mean, it's inevitable. I feel that I'm just, I'm a little resistant right now. That's all. I'm stubborn. I change. I'm slow to change.

Sometimes you don't want to be the first one on. Yeah. And you don't want to be the last one off. You want, you want to be somewhere in the middle. Yeah.

I just got a new iPhone for the first time in 10 years. I brought it in and the lady was like, can I see your phone? And she's like, what model is this? I'm like, an iPhone 7. She's like, oh, I don't Oh my God, it still works. This is a 7. She wanted to put it in a glass case in like an Apple Museum somewhere. It was like, it's just an iPhone. How did you keep this thing alive for so long? I'm like, because I don't ever use it. Yes.

Wow.

My car just put 200,000 miles on it. 18 years old.

Battery didn't go dead?

No, man.

How'd you keep the battery from going dead?

I don't know. I don't know. I just take care of my stuff.

Battery life on those, these things is like, anyway, it was getting zapped.

More and more, but ultimately I upgraded. Now I have a 17, so I will hold on to this one for 10 years and then I'll get another one.

Well, who knows what'll happen.

Who knows, man? It'll be a chip and like built into your body or something.

I don't know. That's not ready for all this tech stuff. All right, dude. Anyway, everybody take care. We'll talk to you soon.

Yep. See ya.

My daughter was never supposed to walk, talk, or crawl. And today at 19, she's thriving. And guess what? We ignored every single thing the specialist told us to do. Hi, I'm Dr. Aaron Hartman, MD, and I wrote Incurable: From Hopeless Diagnosis to Defying All Odds so you don't have to navigate this alone. In it, we share the secrets that she and thousands of my patients have used. Grab the book or Audible wherever books are sold, or you can find it in the link below.