The Insulin & Heart Doctor: The Fastest Way To Burn Dangerous Visceral Fat. This is How Insulin Is Quietly Clotting Your Blood! - Dr Pradip Jamnadas

I'm 32, juggling family, working full time and earning a bachelor's degree at University of Phoenix. I earn career relevant skills with every five week course. Skills I can use now, not just after graduation. Earn skills in weeks, not years. Visit phoenix.edu if you have a belly sticking out, you have a problem because the fat that's in the stomach, that's called visceral fat, this is very detrimental fat and that's the epidemic that we have today. But the only thing that will make you lose that fat very quickly is Dr. Pradeep Jamnatas is a world leading cart cardiologist who has treated more than a quarter of a million patients with chronic heart disease. Now he's using his voice to help.

Millions more prevent ending up on the operating table.

Through simple lifestyle techniques. This is crucial. Glucose actually is toxic inside the bloodstream and the body pours insulin into the bloodstream to push glucose out. But frequent consumption of carbs, sugar, processed foods is causing insulin to stay up, which can lead to insulin resistance. And you're going to be more prone to heart disease, which is the number one cause of death all over the world right now. But this is where fasting comes in because after 12 hours you start pulling the fat out and the first place the fat comes out of is gonna be visceral fat. But with modern living, we have lost this physiology of fasting. So we'll go into that and there.

Must be certain things which people aren't aware aren't healthy. As it relates to my cardiovascular health.

Yes. So I see that people who overly do aerobic activity, they end up with more coronary artery disease than patients who do short sprints and resistance exercises. Then there's mold. And almost 70% of homes these days have some form of mold toxicity in them. But also one night of bad sleep, you become insulin resistant the next day. And there's calcium supplements, excessive fruit, white rice.

White rice.

You'd be surprised how much arsenic there's in rice these days.

I watch a lot of true crime. People kill each other with arsenic.

Yes. And it'll slowly kill you. And lastly. Is this going to surprise you?

Just give me 30 seconds of your time. Two things I wanted to say. The first thing is a huge thank you for listening and tuning into the show week after week means the world to all of us. And this really is a dream that we absolutely never had and couldn't have imagined getting to this place. But secondly, it's a dream where we feel like we're only just getting started. And if you enjoy what we do here. Please join the 24 of people that listen to this podcast regularly and follow us on this app. Here's a promise I'm going to make to you. I'm going to do everything in my power to make this show as good as I can now and into the future. We're going to deliver the guests that you want me to speak to, and we're going to continue to keep doing all of the things you love about this show. Thank you, Dr. Pradeep Gymnadas. What is it? You spent the entirety of your career, especially the last few decades of your career, focusing on prevention of heart disease.

Which is the number one cause of death all over the world right now. You see, the heart is made up of many parts, so this is important. It's a pump, so it's a muscle. So you have diseases of the muscle, and it's rampant these days. Cardiomyopathy, weakness of the muscle. Then you have the arteries on top of the heart, and that's called coronary artery disease. Diseases of the arteries, they block up. Then you have the valves. The valves tend to get damaged as well. For example, aortic stenosis. And then you have the peripheral circulation, all the blood vessels that go to your carotids, your brain, your legs, and to all the organs of your body. And then you have microvascular disease, which is the tiny capillaries that they become dysfunctional as well.

What's a capillary?

Capillary is the branch of the branch of the branch.

Okay, so like the tiny little veins, spinal ones.

Yeah. So when they become dysfunctional, that organ becomes dysfunctional as well. So cardiology affects all these aspects.

And how long have you been operating on people's hearts?

About 35 years now.

And how many hearts do you think you've treated?

In excess of 30,000.

And what's the age range of those patients?

They used to be mostly older people over 65. Now, I would say 50% of them are under 65 and 50% are over 65. So the demographics is changing. The younger people are developing heart disease.

So the youngest patient you've ever treated, 28. And what was the predicament in that case?

He was having a full blown heart attack. So that means that one of his arteries was completely clogged up. It had a blood clot in it. There was no circulation past that artery. And the therefore he was having acute chest pain, sweating, blood pressure was low. He comes straight to the hospital. I rushed to the hospital, take him straight into the Cath lab and tried to open up that blockage. And we did open up that blockage and put a stent in it and got rid of that blockage immediately to restore that blood flow to the heart muscle.

And at 28, how does one get a heart attack? You said it was blocked up.

There's a lot of nuance in that. Most people don't understand what a heart attack is. So in a nutshell, I'm going to tell you what it is. When you have a plaque, a plaque is a buildup of a little fibrous material inside the artery, and that doesn't cause a heart attack. A heart attack is caused when one of those plaques cracks. Now, in this diagram, for example, it's showing that the plaque is closing up the artery, and this will cause angina. That means a lack of blood supply over here. So this patient may complain of chest discomfort, or he may not complain of chest discomfort. Because remember, when you have a blockage like this, only 20% of the patients actually get chest pain. That means that you could have a blockage like this in a patient, and he may not have any chest discomfort. And the only way you're going to pick that up is by doing a stress test or a coronary calcium score or some other modality to see whether he has blockage or not. A heart attack is when a minor blockage, which is not causing much flow disturbance, suddenly cracks.

And what happens to the plaque that cracks off?

And when it cracks open, the blood that's going past it sees the crack and wants to repair it and forms a blood clot on it. So the final thing that shuts down that artery is the blood clot. It's not the plaque that shuts it off. It's a blood clot. So a heart attack is caused by a blood clot at rupture. And what causes rupture is inflammation.

Okay, so when people say that heart disease is the number one killer of people generally that are diseased, is it that process that's causing it alone, or is there a multitude of processes that lead to heart disease?

There's a multitude of things that lead to heart disease.

Look, that was a heart attack.

That's right. Okay, so one, you're making plaque. You shouldn't be making plaque. A plaque is an inflammatory area inside your arteries. It's reacting to something. And I can go into the nuance of what's actually. What's the body reacting to? What's inflammation? Inflammation is reacting to something. What is that something? And I think it's Important for your audience and everybody to know what that something is. Now you've got this pimple. Think of it as a pimple on the inside of the artery. Now, one day, when there's enough inflammation in your body systemically, that pimple is going to crack open just like a pimple on the skin breaks open. Now that artery has this little pimple on the inside, and it cracks open and a blood clot forms on it, and that's a heart attack. So you don't want plaque formation, you don't want plaque instability, which is rupture of that plaque, and you don't want a blood clot to form on it. There are factors that affect each of these processes, and all three processes are going wrong today. And that's why we have so much plaque formation and instability of the plaque, which then leads, of course, to heart attacks. And our blood in general, we have more coagulation issues today than we ever did before, which means our blood, because of inflammation, is more ready to clot more easily. So we're having the perfect triad. It's the perfect storm. That's why we're seeing an epidemic of this, and that's why we're not making a dent in it. Yes, you can have a plaque rupture and have a heart attack and we'll put a stent in you. Okay, that's fine. But what did we do to look at the underlying reason as to why you formed that plaque and why did you rupture it? And why was your blood so clotty in the first place that made you actually seal off the artery?

Is this an increasing problem?

Yes, it's a huge problem because those factors have been identified now. And that's what we go for in my practice. We look for the factors. Why did you make this plaque? Why is there so much inflammation in your body? Inflammation is a reaction to something foreign. What is that foreign stuff? What is that abnormal physiology in you that your body's reacting against? Because that's what inflammation is. And inflammation. Of course, whenever there's going to be inflammation, there's going to be increased tendency to make blood clots. So we go in, we chase all these things in patients to find out that's the real prevention.

That 28 year old that came in and you treated him, was that a surgery you did?

We call it a surgery, but it's not. It's an angioplasty. So we go in from the wrist.

Yeah.

Or we go in from the groin with a catheter and we go into the coronary artery.

A catheter being like a tube, it's.

A hollow tube, and we put it into the coronary artery, we shoot the dye inside. We can see where the blockage is. And then we thread a tiny wire into that artery through the blockage and then bring in a balloon and squash the blood clot out of the way, restore the circulation, and then bring in a stent. A stent is like a spring that opens the artery up. We leave the stent inside there, we remove everything else. And now you have an open artery and you have blood flow going down that artery.

And what had that 28 year old done to end up in your surgery? What were the decisions that they had made that brought them there?

So he was number one. He was overweight, but he wasn't just overweight. The overweight was all in his belly. And he had a fatty liver and he had what is known as visceral fat. He was not a diabetic, but he was a pre diabetic. That means he had a lot of insulin in his body and his glucose levels were good. So if you went to his family doctor, they'd say, oh, you're not a diabetic. Your hemoglobin A1C, which is a blood test that you do for diabetes, is actually okay. But actually that patient had a very high insulin blood level. Now, insulin is a very atherogenic molecule. It causes smooth muscle proliferation. Smooth muscle is in the walls of the arteries, it causes vasoconstriction, it makes your blood more clotty, and it causes inflammation. So this patient was a pre diabetic. And this is very important. This is what caught my attention, because when I looked at my patients that were coming in when with heart attacks and hardening of the arteries, and when I tried to identify why they're doing this, none of them were diabetics. But then I did a glucose tolerance test on them. And what happened? It was just by chance that I happened to have these tests in my office where you can measure the blood glucose. So I had about 120 of them. So I said, look, let's just do some random testing on these patients. And I found that at least half of them had no diabetes, but their glucose intolerance, that means that the sugars went up, but not enough to make them a diabetic. But it did go above the normal range. We did not have insulin testing at that time. About 10 years later, we started testing insulin in the office, and I bought a machine for this purpose in my office to measure insulin levels. And life was never the same again.

Why?

Because it's all about insulin when it comes to the metabolic derangement. So I found that these patients, their sugars were going up to 150, 160 after giving them a glucose drink. So you say, okay, he's not a diabetic. Look, the sugar didn't really go high. But when you measured the insulin level, the insulin was off the roof.

So when you say this is an insulin problem, can you explain this to me? Like, I have no idea what glucose and insulin are?

You.

For any of my listeners out there that have an inexperienced understanding of these terms and what they do and mean, it's crucial.

Everybody needs to understand the relationship between sugar, which is glucose, and insulin. When you consume sugar or glucose, the body has to get rid of that glucose very quickly from the bloodstream, because glucose actually is toxic inside the bloodstream, even though it is what the body uses for energy in the bloodstream. It glycates all the blood vessels and the walls and the components in blood. And the hemoglobin as well glycates it. That means the glucose attaches itself to that molecule. So now that molecule can't work properly. That is why the higher your blood glucose, all your chemicals don't work well, your enzymes don't work well, your hormones don't work well. Nothing works well. And you age prematurely because you, you're getting glycation. A glycated molecule can't work normally. It doesn't function normally. So when you consume the glucose, the glucose has to come out of the bloodstream. And how does the body do it? It sends a message to the pancreas. The pancreas says, aha, I'll make some insulin. It pours insulin into the bloodstream. Insulin comes into the bloodstream, pushes the glucose into the cells, and where does it push in it? Into the liver, into the muscles, into every cell in the body. Insulin will push glucose out. Now, how much insulin is the question. If I'm eating every three hours and I'm consuming glucose, or I'm consuming starchy foods, or I'm consuming carbohydrates. Now watch where I'm going with this, because you're already beginning to know where I'm going with this. I'm consuming glucose and carbs every two, three hours. I'm stimulating my pancreas, I'm stimulating my insul, my insulin goes up, it comes down. But before it even gets a chance to come down, it goes up again. So the repeated Consumption of and frequent consumption of glucose is causing my insulin to stay up, because insulin stays a little bit longer in the bloodstream than the glucose. The glucose will come down in about two to three hours, but the insulin stays higher for about four hours. Now, what happens is that you continue this lifestyle for a few years. Now the body, because these are all hormones, will say, well, you know, I'm going to need to make more insulin. Now you become insulin resistant. Any hormone that stays in your body for a long time, the body becomes immune to it. So the next time I eat the sugar, I'm going to have to make more insulin to produce the same effect. That is called insulin resistance. So now you've got this patient who's been eating carbs, sugar, processed foods. What does that mean, processed foods? That means foods that are quickly absorbed into the bloodstream. Processed foods. These are products without fiber. So the absorption is very quick. So the poor pancreas has to react just like that, produces a whole bunch of insulin. And then the frequent eating and the frequent consumption makes you insulin resistant. So now you produce a whole bunch of insulin in order to bring that sugar level down. So then you say, okay, well, it doesn't matter because the insulin is bringing the sugar level down. So what's the harm done? Because your A1C is still good. You're not diabetic. No, but it's that background high insulin that is destroying your metabolism. It's that high insulin level in the background. So insulin pushes glucose into the liver and you develop a fatty liver. It pushes the calories into production of new fats around your viscera. The viscera means in your belly, around your pancreas, you get visceral fat. Now, this fat is produced from glucose. It's a different kind of fat. Look, if I gave you a high calorie diet right now of all sorts of foods, you put on weight everywhere, okay? But if I give you glucose, you put it on mostly in your stomach, and your stomach will protrude, and that's called visceral fat. It's on the inside. You can't pinch it.

It's on the inside around your organs.

Around the organs. This is very detrimental fat. And that's the epidemic that we have today.

And that's a direct result of eating starchy glucose carbohydrates, which creates insulin, which creates this downstream effect on wrong foods and eating too frequently, too frequently, okay?

Because remember, it's also the frequency of eating. Because before that insulin gets a chance to come down, you're ready popping Yourself with more food. And hence you develop insulin resistance. You get a very high insulin. It takes this much insulin now just to bring that sugar level down. And then the one day when you cannot control that sugar, now that sugar will go out. And now your doctor will say you're a diabetic, but by that time you've already had 10 years of hyperinsulinemia. So what happens by the time you make a diagnosis of diabetes? To say, well, now your sugar is really high. And it is high because your body has not had the ability to keep it down. Why? Because even that high insulin could not keep your sugar level down. You became a diabetic. You lost that whole opportunity of prevention. It's those 10 years. Look, by the time you're a diabetic and you come and see Dr. J in his cardiac clinic, you already have coronary artery disease. Like that 28 year old. The 28 year old didn't have diabetes. He already has coronary artery disease. By the time you are diagnosed as having diabetes, you already have coronary artery disease. We have a great opportunity here to actually start screening these patients with insulin levels very early on. But most doctors don't have the ability or knowledge to do the insulin level testing.

But it should be done in someone like me. I'm 33 years old now. When does the damage begin?

It starts right now. It starts right now. As soon as you around 30, you're already starting to have trouble. You have to. But you know, this is what I do. I look at that patient walking into my room and if I see that he's got a belly sticking out, I already know he's probably got insulin resistance because all the fat is in here, because the fat that's in the stomach, sideways. He looks terrible from the back. He looks great. His waist is increased. He doesn't have all the fat everywhere else in his body. That's the phenotype of somebody who has hyperinsulinemia. That same person goes on a cruise, he'll come back five to ten pounds more because he's got so much insulin in his body. Insulin is a storage molecule, puts everything away. And it's very hard for him to lose weight.

Why is it harder?

The only thing that will make you lose that fat very quickly is to change your diet, of course. But you have to do fasting because fasting brings your insulin level. See, this is where fasting comes in. So what does fasting do?

Do you mean fasting or a calorie deficit? Or is it the same thing in your view?

No, they're not the same thing. They are not the same thing. You see, when you don't eat, your insulin levels come down because you're not stimulating your pancreas anymore. So you want to bring your insulin levels down. The best thing you can do in the world is to do fasting, because there's no. Look, if I just simply cut down on my calories, then there's a different physiology that's going to take place in the body. And when you fast, there's a totally different physiology. When you cut down on calories, the body senses that this caloric deficit, your metabolic rate changes, actually slows down and the body will start breaking down everything, muscles included. So you lose fat and you also lose muscles. On the other hand, when you're fasting, it's a different physiology. Fasting is, I've put on fat now I'm going to take it out of the bank. Now. The bank is going to be available for me to pull out my calories and use it now. And you start burning the fat. So in the first 12 hours of a fast, you take out all the glucose in the form of glycogen from your muscles and your liver. After 12 hours, you start pulling the fat out. And the first place the fat comes out of is going to be visceral fat. That is why fasting benefits you so much, because it gets rid of that worst fat, the fat that is very inflammatory. You see, if I did a biopsy of your visceral fat versus a biopsy of, let's say, a fat formula on your buttock, two different types of fat. One is full of inflammatory molecules, the other one is not full of inflammatory molecules. One is producing interleukin 6 and tumor necrosis factor. And this other fat is not. These are two different fat storages. Visceral fat is very toxic, it's very inflammatory. And that is why patients who have visceral fat make all these molecules. So when I do the blood test, I see that, oh, you've got so much inflammation, you've got interleukin 6 is high, tumor necrosis factor is high, your CRP is running high. And one of the reasons for this is not just leaky gut and other things that I look at, but in your case, it is also because you have a lot of ectopic fat. Ectopic fat. Ectopic fat is, now we're realizing, is not just only around the liver and around your pancreas, it's also on your heart. So when we look at the coronary arteries. And we see all those fat around the coronary arteries. You had a very nice diagram right there. And you can see that around each artery there's that yellowness. That yellow is all plaque fat. There's fat around that and it's plaque forming. It's plaque forming. It stimulates plaque. It's inflammatory. And now we can do CT scans that will actually detect how much inflammation is in the fat around the arteries as well. Ectopic fat is around the coronary arteries. It's in your liver and in your pancreas, and it is very inflammatory on.

This point of fasting. So if you have someone come to you and they have that physique where there's a bit more of that protruding belly fat. You said that fasting is a much better approach than just sort of a calorie restriction. I was looking at some studies that said research shows that calorie deficits of any kind can reduce fish or fat. But fasting will give it an edge because of the insulin sensitivity stuff that you talked about as well. What kind of fast should one be doing? Because there's so many different names for these fasts. People do these 40 day water fasts and they do intermittent fasting.

That's a great question. So there are many, many different types of fasting depending on your goal on what do you want for that particular patient. So if a patient is just simply looking to reduce his visceral fat, then I start with 1212, which means 12 hours, you don't eat anything. You just drink liquids with no calories in it. And then 12 hours is your feeding period. We start with that and we do that for about two to three weeks. Then we quickly move to 18, six. 18 six means six hours. You get to eat 18 hours. It's only water, black tea, black coffee, green tea, no calories. 18, 6. 18, 6. And then that's one type of fasting. Now, if a patient is very overweight, a patient has diabetes, and your goal is to reverse the diabetes, the patient needs to lose 60 pounds, then those patients have a special type of need for them. I will take them to a 48 hour fast once a week. Sometimes I'll go to a three day water fast every nine days. Every nine days, you will do omad. Omad means one meal a day only, every day for nine days. And then you're gonna give me a three day water fast.

Is the same advice applicable to women because obviously they're contending with a variety of hormone fluctuations and estrogen. And I know that the female body responds differently to these kinds of stresses like fasts.

I've been asked that question so many times from patients as well. Most of the women can actually handle it. The only women that cannot are those who are trying to become pregnant or they have, or they're already pregnant. I think that women are not that different when it comes to the fasting programs. So in my experience, I've been able to get women to fast. I just finished a fast on one lady just now for 72 days. 72 days. She was terribly overweight, she had diabetes, she had hypertension, she had hyperlipidemia, she was having hip replacements, knee replacements, joint problems, she had skin problems. And we fasted her for 72 days.

What did she have in those 72 days in terms of drinks, electrolytes, coffee, what was she?

Great question. So she would have black tea, black coffee, water. And in the water, once a day, I tell her to put some electrolytes in there. So there's an electrolyte called elementi. Or sometimes I just tell them to go buy some Celtic salt and put half a teaspoon in there. And once a day you take that. If you get cravings and you feel really, really hungry, take some MCT oil, a teaspoon and put it in your water and you can drink that as well.

I think it's worth saying that probably you shouldn't try this at home, ladies and gentlemen, because obviously medical supervision is critical here. But in the case of that lady, what was the before and after of that 72 day fast?

So diabetes gone, Blood pressure normalized, Weight loss, tremendous weight loss. I mean, I think she lost about 55 or 60 pounds. Okay. And not only did she lose all that weight, yes, all that weight from her belly was gone, but even her face under the arms. So when you lose weight in a fasting program, it's very different from losing weight. When you are restricting calories, you actually retract your skin so you get real changes in your entire body. I had one patient that fasted for 183 days under supervision. Okay. So he went from £400 to £210. And when he walked into the office, you would not recognize that he's just lost all this weight because he did not look like skin on top of bones. And then having to have surgery to remove all that excess skin. Fasting is a totally different physiology. In fasting, the body is doing a whole lot of things that are very different. And we can go into the physiology of fasting. That's fascinating. It's a physiology that has not been used by us. We've lost it. So one of the things about modern living, modern living, we have lost this physiology of fasting. First of all, why do we still have that physiology in us? It's because it's supposed to serve a purpose. Because we're supposed to be fasting and feasting, but now we're only feasting all the time and we're not fasting in order to go back to normal, you should be fasting. Fasting is supposed to be a normal part of your existence. That's the way you were designed, not this modern industrialized living that we've been doing in the last fraction of a millisecond in the total existence of the human race. We've changed our lifestyle so much, modern man has, but our genetics and our physiology has lagged behind. We are supposed to use fasting and feasting as part of our normal program, as our normal physiology. That's why we still have it. That is why after 12 hours, you start making some more ketones in your body. And the ketones come from fat. You're moving that fat out of storage.

What is a ketone?

Ah, ketones. So ketones are an energy molecule produced by the liver. How does it make it? It makes it from fat. So the fat gets liberalized. And by the way, the fats only start moving when your insulin levels are down. So because of fasting, your insulin levels are really low now. Okay, because you've been fasting, right? So now the fats start dissolving. So you get free fatty acids. The free fatty acids float into the bloodstream. Free fatty acids are fat products. They float into the bloodstream, they go to your liver. Your liver converts those into ketones. Now, ketones are an energy source of the body, an alternative source to glucose. So in general terms, you are either going to be running on glucose and glucose metabolism or you're running on ketones. Okay.

And so ketones basically show up in the. When glucose isn't around.

That's absolutely right. So ketones and ketones are actually a cleaner fuel for the body. And in terms of producing reactive oxygen species in the metabolism, the way your mitochondria works, you actually produce less reactive oxygen species, which is damaging to your physiology when you're in ketones and ketones are signaling molecules that also change your physiology in a number of ways. Number one, it causes the production of brain derived neurotropic factor that occurs under ketogenesis. Brain derived neurotropic factor. Which means that you become smarter, you're growing new cells, your reflexes are better, your visual acuity is better. Why? Because nature wants you to become a better specimen so you can go out and get your next kill.

So why don't we all just stay in a state of ketosis then if it's so miraculous?

Well, that's a great question. You don't want to be in ketosis all the time because that's not what ketosis, what, what our physiology was made for. Because then you'll just be burning fats. Burning fats, burning fats all the time. And that's not a good state to be in constantly either. So you want to be able to do both. You're supposed to get your current account and your deposit account. You're supposed to work with both of them. That's the normal physiology. So not only brain derived neurotropic factor increases, but also stem cells. Stem cells are amazing. And in my patients, of course, I see that.

What is a stem cell?

Stem cells. So stem cells, we all have stem cells and we all still make stem cells. And they're produced by the bone marrow. These are pluripotent cells, cells made that will then go out and become whatever they need to become. So they can go out into your circulation, become a muscle cell, they can become a retinal cell, a skin cell. They can transform into anything. So what happens is when you break your fast, you get a surge of stem cells coming out of your bone marrow. Some of them become immunocytes. That is why we know that fasting also boosts your immunity. People who fast get less infections, get less sore throats and coughs and colds and the viruses that are going around, the immunity is better. The stem cells are not. I'm particularly interested in the stem cells because of a thing called the progenitor cells. Endothelial progenitor cells. Progenitor cells are. You see, you're always hurting your blood vessels. The lining of the blood vessels and, and the lining of your blood vessels have to be constantly repaired. And they are repaired by the progenitor cells. When you do intermittent fasting and time restricted feeding, you will produce more, and this has been shown in numerous studies, more progenitor cells. And these progenitor cells go and repair your blood vessels. So I do what? Why am I interested in this? Because I'm a vascular doctor. I want my blood vessels to constantly be repairing themselves for, from the damage that we do in day to day life. So stem cell mobilization, brain derived neurotropic factor Growth hormone, you make more growth hormone in fasting. So when should you exercise? When you're fasting at the peak of your fast. So if I'm going to break my fast at 6pm, I tell patients to go to the gym at 4 o' clock in the afternoon. But they said, but doc, how can I do that? You will find that you will put on more muscle and you will retain more muscle as well because you have higher growth hormone. The fastest way and the best way to actually increase your growth hormone production is to do intermittent fasting.

When I sat with Dr. Stacey Sims, who does a lot of work on women's physiology and women's performance, one of the things she said to me is that if a woman in particular tries to do a workout fasted, the body will break down the muscle in a woman. Because she said a woman's body's much more the hypothalamus, it's much more sensitive to changes in a woman's glucose levels because it's trying to defend against pregnancy and all these kinds of things. So it shuts down the menstrual cycle if there's not enough glucose in the blood. And so she said for women in particular, you do want to have eat something before you work out or your body will take from the muscle. And it would definitely won't. The body's very sensitive. It won't want to help you build muscle if there's not enough glucose energy in the body. She said for men it's slightly different because we're a little bit more robust and we were meant to hunt. So if we were fasted, our body is, you know, designed to kind of keep up its normal processes to help us complete a hunt per se. So I guess I threw this question out to you about, about women exercise and fasting.

Yeah, I think that's a great observation. So again, it's what kind of exercise is the woman doing? You see now there's two kinds of basic exercises. One is aerobic activity and one is resistance exercises. And you can also throw into that high intensity interval training. So when it comes to the training that I'm talking about in a fasting state, I like resistance training. So in resistance training, that glucose issue is not going to become a problem. Now if you're going to put that female patient on a treadmill and make her run for a long period of time, let's say you're going to make a run for 40 minutes on the treadmill, I think that yes, you're absolutely right. You are going to deplete a glucose and you may cause some problems and then the muscle will start breaking down. But I do believe from all the experience that I've had with my patients that when I tell them to do hiit, which is high intensity interval training, all the women do just as well as the men, because all you're doing is you're intensely working the muscles and you're doing some resistance exercise and then you're totally resting as well. And, and I see fantastic results with that.

In terms of ketosis. Do you cycle in and out of a ketogenic diet? And just for anyone that doesn't know, a ketogenic diet is a diet that's very, very low in carbohydrates. So less than 50 grams of carbohydrates a day typically. Do you cycle in and out of that diet?

Yes, yes, you have to. Because I don't want them to stay in a ketogenic state all the time. So I do, I do, I do, I tell them, look, look, you know, what is your goal here? What is your goal? If your goal is that, okay, I need to lose £70, then you're going to do this till you get to your goal. Once you get to your goal, then you're going to go back to time restricted feeding, which means 18:6, so you'll still make some ketones. And then intermittently, you can still do a 36 hour fast. That means normal, healthy people, you and me, we should still be doing one 36 hour fast at least once a month. So we'll go to that, we'll go to that. Fasting must still become part of your program, but you don't need to stay in ketogenesis all the time. Remember also that when you are in ketogenesis, you are also in autophagy. How much autophagy can you do? That means you're recycling all your organelles inside your cells.

What does that mean in simple terms for someone that doesn't know the term autophagy?

So bottom line is the cell senses that there is no new parts coming in here. So it takes the redundant organelles inside the cells and breaks them down, packages them up into these little packets and exports them out of the cells. So these cells, all your cells in the body now, are full functioning at a much more efficient level. So mitochondria also have autophagy. So you're getting new mitochondria, you're repairing your mitochondria and you know it's all about mitochondria, right? Your energy mitochondria are those organs, organelles inside each cell. And we just think of them as only an energy source that. Oh yeah, my mitochondria, they make ATP. That's not the whole story. Yes, they produce ATP, but they also produce this thing called reactive oxygen species and thereby they influence the metabolism of your cell as well. They send signals, they send signals to your chromosomes so that you start producing new proteins, you start producing new molecules. So your mitochondria are very important. If you have old mitochondria, you're going to have fatigue, tiredness. But when you get mitophagy, one reason why you feel so good after a fast, because you have new mitochondria, they are much more efficient in producing ATP and less reactive oxygen species. So you have mitophagy recycling of your parts. Cellular function improves. Toxins get out of your cells as well. Toxins.

Do you think there's a preferable or a best exercise for heart health? Like if you were going to say Steven to make, you know, I think my family has a history of heart related issues. One of my uncle died from a heart attack, so I'm very aware of my own susceptibility to heart related illnesses. I think there's other people in my family that have heart related issues as well. Is there a particular exercise that is best for the heart? Because I'm guessing resistance training, I.e. strength training, might not be there. The number one recommendation for good heart health. You mentioned HIIT. I'm wondering if that's yes.

So I'm just gonna tell you broadly speaking what I see in my practice. I see that people who do overly do aerobic activity, that means they cycle 100 miles a day or they're running on the treadmill for two hours at a time every day. They're doing a lot, a lot of marathon training all the time. They actually end up with more inflammation in the body and they end up with more coronary artery disease than patients who do short sprints and patients who do resistance exercises and patients who do hiits. So in terms of cardiology, look, you need some aerobic training. Why? Because you want to develop some endurance, right? You don't want to be running behind the bus and get short of breath just in a few hundred feet. So for some endurance, you do aerobic activity. How much aerobic activity? Which is running on the treadmill, for example, or just sprinting? Only about 15 to 20 minutes. That's it. So I tell patients, you want to run on that treadmill, you want a bicycle 15 to 20 minutes. And then you got to go into resistance exercises. The resistance exercises that I have seen work best in my patients is simple things. You don't have to go crazy. You do floor exercises, you use your own body weight as resistance. So you can do the planks and leg lifts and all these other exercises and you can do hiit, but they have to be very specific. So you exercise really hard for about 30 seconds to 45 seconds, and then you completely rest for another 30 to 45 seconds.

Okay?

And that's allowing your body to clean up the reactive oxygen species you just created through that exercise. Because your rate limiting step in cleaning up the metabolic mess that you get when you get too much exercise. It's a rate limiting step. Your glutathione production, your superoxide dismutase production. These are chemicals that clean up the metabolic mess that you get when you eat too much activity. That's a rate limiting step. So when you rest, you exercise and you rest, you exercise, you rest, you are going to get a cleaner physiology with your patients.

How many patients do you think you've treated or worked with in your career? Ooh, if you had to guess to.

The nearest thousand, it would have to be at least nothing less than quarter million.

How do you deal with the heartbreak? That's no pun intended, but I'm saying how do you deal with the heartbreak of watching people's lives? Either them losing their life or their lives being changed permanently, forever, or dealing with the families of people who lose their husband or wife or son or daughter?

It's very difficult, especially when we've been trying everything and still things can go wrong. Based on that, I've realized that sometimes you can do everything to try to extend life, but you cannot. Life is still finite. We will pass, yes, but we want better health span and we want a longer lifespan. I want to give the patients a better quality of life. Also. I can't make you live forever. I will see people die. Sometimes they die in front of me while I'm even holding their hands. They'll pass away in the hospital right there. But what I do want to do is to give them a quality of life. Until then, that's going to change. And in all this education, it's all so that you can live an optimal life and then pass away just like that.

Have you seen many people that made all the right decisions? They were healthy, they had a good diet, they were doing exercise, and they still end up passing away on your hospital table because of heart related illnesses?

Yes, yes. Give me One such example, typical example of FELLOW in the 60s, his coronary calcium score was over 1,000. So, you know, that's a CT scan that we do, and it looks at calcium on the arteries of the, of the wall. So all this plaque that you, you, you, you showed this yellow stuff here, all that has calcium in it. So the more calcium you have, the more plaque you have. So he had a calcium score of over 1000. So sit down and talk with him and say, okay, so tell me, why do you have all this calcium? No diabetes, no high blood pressure, Doc, I don't even drink. I don't do anything. I don't smoke. I exercise regularly, I go to the gym. And then the question is, why do you have all this coronary calcium in your coronary arteries now? And it turned out that ever since he was a kid, he had a bad microbiome. And in him I found that that was the reason why he got it. So he was shocked when he left the office. He was totally shocked because he thought that being constipated and having a bowel movement every three or four days is just normal. Because it was always like that for him until I dug into it and found out that he's actually got a lot of GI problems. And that's what probably caused him to have inflammation, and that's what's probably caused him to have coronary artery disease. That's why he's got all this coronary calcification. Yeah.

So let's talk about the gut microbiome then. You mentioned earlier that that's really pertinent in cardiovascular issues. Can you explain to me exactly why and how that happens?

The biggest difference between you and your outer environment is actually your gut. Not outside your skin. It's actually the gut. There's 100 trillion bacteria sitting in there, and there's probably 400 trillion viruses sitting in your gut. And they're not just hitching a ride for you. They are there doing something. There's a symbiotic relationship between the gut and you. They produce micronutrients which get absorbed into your bloodstream. If the right microbiome is not present, you are being deprived of those micronutrients. For example, short chain fatty acids, which are special kind of thing, but also they maintain the integrity of the lining of the intestines. If the lining of the intestines is breached, then bacterial wall products get into the bloodstream and the first place they'll get to is the liver. Hence you get a fatty liver. There are basically three reasons for Fatty liver. Either you're drinking too much alcohol or you get a leaky gut or you have too much insulin, because insulin causes the conversion of glucose into fat. Right. So you get a fatty liver when.

You say leaky gut.

So that's a leaky gut.

Oh, okay. So a leaky gut is when the microbiome is dysfunctional.

The microbiome that is dysfunctional causes the integrity of your intestinal lining to be compromised.

Ah, okay.

Yeah. So now, molecules that are supposed to stay in the gut, dead bacterial wall products, they call lipopolysaccharides, they're supposed to stay in the gut, but now they get into the bloodstream, they go up the portal vein and up the portal vein, they'll end up going straight to the liver. And when they end up in the liver, they cause that fatty liver. Now you get this big fatty liver, which causes a lot of inflammation. A fatty liver. There's an epidemic of this going on today. At least 25% of the population now have a fatty liver.

And what is upstream from that? Is it alcohol and all these processed foods and things like that?

It's basically processed foods, sugar and leaky gut and, of course, toxins, alcohol being the biggest toxin.

Okay.

This is the seat of metabolism. So, as a cardiologist, I became interested in this because I found that if you have a fatty liver, you are going to be more prone to inflammation and you're going to be more prone to coronary artery disease. When we fix the fatty liver, we change the diet by changing your diet. And now you start eating real food and not processed foods and products. When we increase the fiber intake so that the good bacteria start coming back into your gut, and when I give you certain supplements to restore all your nutrition in your body, then all of a sudden, the progression of coronary calcium flattens out. You see, let's say you came to me for a test and I did a coronary calcium score, and it's 500, and two years from now, it's 800. That means. Wait a second, something's not right here. Right. Your coronary calcium should not be going up. Now, I can't get rid of the coronary calcium because that's plaque in the walls of your arteries. But it shouldn't keep going up because one day it's going to be 2000. So how do I follow how? Well, my treatment for you is, is I follow the coronary calcium score.

And again, the coronary calcium score is a marker of the amount of plaques.

Correct.

Around the heart and in the vessels of the blood?

Yeah, in the walls.

In the blood vessels. Okay, so you want low coronary calcium.

Like my calcium score is zero. You shouldn't have any coronary calcium in the walls of the arteries. So we have the yardsticks now.

We should probably differentiate between calcium supplements and the calcium that you're talking about.

So pertinent calcium supplements actually increase the risk of cardiovascular events. Calcium supplements should not be taken. The problem is not calcium supplements. The problem is lack of D3 and lack of K2.

So we shouldn't be taking calcium supplements?

Absolutely not. Absolutely. I stop all calcium supplements on all my cardiac patients and I tell them you should take vitamin D3 so you'll absorb calcium better into your gut. And you take vitamin K2 because vitamin K2 is going to make sure that you don't get the calcium buildup in the wrong places in your vasculature, for example.

Just to give some context on the research, some large observational studies suggest that high dose calcium supplements, which is especially above 1000mg a day from pills, may increase the risk of heart attack and stroke, while others find no clear link.

Yeah, okay. Yeah, no, I. Look, also, they advise high calcium supplements in women to prevent osteoporosis, for example. Right. And osteopenia. I live in Florida and all these young women, they come to me in their 30s, they all have osteopenia. And the question is that they got calcium supplements put inside. The milk in the orange juice has calcium in it and they're taking calcium supplements. And why would they. And they have sunshine and why would they have osteopenia? And the reason is D3. You need D3 and K2. That's what you need. It's a hormonal thing. It's not the elemental thing.

So when people are on blood thinners, do they typically have low vitamin K1?

If you're taking Coumadin. Coumadin is a type of blood thinner that lowers your vitamin K1 levels and it'll also lower K2. So Coumadin will lower K2 as well. So you will get increased coronary calcification. And that's been documented. So patients who have, who are taking warfarin, for example, or coumadin, have been shown to have increased coronary calcification because of the fact that the K2 levels come down as well as the K1 levels, both come down. So you need vitamin K2.

And do you supplement that or do you get it from dietary.

I supplement it on all my patients because diet comes from fermented foods. And we don't eat enough fermented foods to contain enough vitamin K2. So one of the reasons why I do like my supplements is because today's food is not as rich as it was in the past. So we're not eating the variety of foods, but also we're not getting enough vitamin K2 in our regular diet.

So if you want to give me advice then on having a great gut so that I don't end up with leaky gut, which will cause all of these downstream effects, what is the advice you'd give me to have a perfect gut?

Number one, lots of fiber. Because the fiber is going to be eaten by your bacteria. And you're going to get a wide variety of good bacteria eating fiber. If you eat a lot of sugar, you will get bacteria too. But there are the bad ones, the ones that you don't want. So you're going to get a condition called sibo, for example, but you want to eat lots of fiber. So because our diets today don't give us enough fiber, I do advise all my patients to take Inulin with FOS. It's called Inulin with FOS. It'S a powder, it's a soluble fiber. And I just tell them to take one scoop in your water every day or put it in your whatever you're going to have whatever liquid you're going to have. Number two, fermented foods. The fermented foods will give you not only the bacteria themselves, but because, for example, kefir has so many different strains of good bacteria, but they also have the postbiotics. What is a postbiotic? A postbiotic, for example, vitamin K2. It's a product that the bacteria make. Short chain fatty acids. That's a product that the bacteria make. So you want bacteria, you want good bacteria in your gut, and they will stabilize the ratio of all the other bacteria in your gut. So the keystone species have to come back into your gut.

I was reading some research around fiber and it says that in the United states, women are 40% fiber deficient and men are roughly 50% fiber deficient. And in the UK we're about 40% fiber deficient. I don't think people know that. Where do I find fiber? What do I need to be eating to increase my fiber?

Fiber is found in anything that's non processed, because the very act of a processed food is to take out the fiber so that you can increase the shelf life of it. So any processed food, anything that's manufactured in a factory for Example, anything that already comes ready made, they've taken the fiber right out of it. So you got to eat real food, so you're going to eat real vegetables and that to a variety of vegetables. You see, you're supposed to eat 30 to 40 different types of vegetables a week. And we don't tend to do that. So you want fiber from a variety of sources. So we got to eat a little bit of all these different, different types of vegetables, including spices. They all count as one vegetable. So that's something I stress to everybody, that you got to have variety, you got to have all these different fibers because they will foster the growth of different types of bacterial species in your gut.

What about lifestyle recommendations for improving my gut? Things like, I don't know, stress, sleep, exercise.

Sleep is absolutely important. So the next thing is actually sleep and stress because lack of sleep causes a change in your gut microbiome. You got to sleep seven hours a night and cutting down on sleep is going to affect your entire physiology in your body and your repair processes and your vagus nerve and your delta sleep, but also your gut microbiome. One night you'll get insulin resistance. One night of bad sleep, you become insulin resistant the next day. If you're changing time zones very frequently, the liver dysfunctions and the gut microbiome also dysfunctions. So we got to be more cognizant of that. That lifestyle is very important and we have to have plenty of omega 3 in the diet.

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Yeah.

What do you mean by toxins? And what role is toxins playing in my physiology and my heart health and my gut health?

Yeah.

And what is a toxin?

Toxin is a molecule that should not be in your body. You should not have been exposed to it. So let's take a pesticide or a herbicide. These are chemicals which man has made and not perhaps adequately tested it in rigorous studies. And yet these chemicals get into the body. And we know that many of them are estrogen receptor disruptors and that causes inflammation as well. So if you look at pesticides and herbicides, we look at plastics forever chemicals, for example, PFAS and other chemicals, bpa, these chemicals all disrupt our metabolism in our body. And then of course, mold is a toxin. And lastly, heavy metals are toxins. When the gut is not working properly, you're going to be more prone to toxicity because the gut bacteria normally grab a lot of those things and take them out in your stools. So when we look at toxicity, we look at gut health and the liver health. The liver is supposed to get rid of a lot of toxins, but in today's day and age, because of the foods that we're eating, the environment that we breathe, the environment that we walk out into, we're getting too many toxins and this poor organ here is getting overwhelmed and cannot detoxify adequately. So when I do a blood test, urine sample and a stool sample, I get a very good bird's eye view of what's going on with their ability to detoxify and which levels are high. And I'm finding that many of my patients who have gut issues and liver issues are very, very high with not only heavy metals, but they also have a lot of pesticides, herbicides and mold in the body. And mold, I'm finding a lot of mold and mold. And all these extraneous toxicities cause inflammation. Inflammation is a reaction to something that your body shouldn't have.

Where is the mold coming from?

Mold is very interesting. I've only started researching it in the last one year. Basically, almost 70% of homes these days have some form of mold toxicity in them, either from previous water damage or exposure. And mold is ubiquitous, it's just about everywhere. And it can reinoculate you every time you're in that environment. And it causes your innate immune system to start reacting to it and causes low grade inflammation in your body. And when I get rid of the mold, all of a sudden I'm noticing that the patients are not only feeling better, but the rate of progression of coronary artery disease flattens off.

I have this steam room in one of my houses, and I went in there the other day and I smelled. I could smell it smelled a bit funny. And I recognized that smell from when I was younger as being mold. So I, like, I googled it. What is that, like, earthy, strong, pungent smell in my steam room? I think what's happened is part of the seat has come away from the wall, so it's not sealed anymore. And I think the moisture has got in there with the water, and I think it's moldy. And Chatgpt said to me, when I was asking, Chatgpt said, smell near the. Like, cracks?

Yes.

And if you smell. If it smells really strong near the cracks, then that's mold. And I smelled near the crack, and it was really, really strong. I remember thinking, oh, like, so I had I not known that, would have been sitting in there 30 minutes a day inhaling all of that strong mold smell. And from doing this show, I've learned that the downstream impacts that can have on your body and your cardiovascular health and everything in between is really, really bad. So I had a team come over and just fix everything, repair it, and do a deep clean. But I don't think people are very aware of how mold, which we kind of think of as like, oh, the bread has gone green, whatever, can have a chronic downstream impact.

And also this mold can come in and then become part of your microbiome, so you can actually come into here. So let's say you get out of this place, but if the mold is still in your gut or it's in your sinuses, for example, and you get chronic sinusitis, you're reinoculating yourself over and over again with this mold. And this is an area of great interest and a lot of research needs to be done. It is real, and we've known about it for a long time. But the medical profession as a general, has not really taken this and run with it. But it is very important. And we certainly looking at mold toxicity in our practice because we find that it is actually more prevalent than we ever, ever imagined before. And we know the chemistry. We know that it causes a systemic inflammatory reaction in the body, and it's reflected in the blood work. We see that the CRP is up. We see that the complement levels are high. We see that the certain ratios of certain inflammatory molecules are off. So we do want to treat mold. We want to treat sources of mold toxicity, both in the gut as well as in the sinuses. And yes, people are surprised when I tell them that that affects their cardiovascular health.

When we talk about the clogging of arteries, why is it that healthy people still end up sometimes with these clogged arteries?

I think it's because they have sources of inflammation that we have not identified. For example, we say, oh, you have no cholesterol, you have no smoking, you're exercising, you're not overweight, you don't have diabetes. Well, then I don't know why you got all these art. No, there's always. If you dig deeper inside, there's always something, and we'll find the source of the inflammation. There's always a reason why you get hardening of the arteries.

What's in that list?

In that list is mold.

Mold? Yeah.

Leaky gut, huge food sensitivities. Oh, let me tell you about food sensitivities. So another reason for the leaky gut is that certain foods punch holes into your intestines, in a sense, and causes a leaky gut. And I've had at least one patient in the last six weeks that I can remember who actually has celiac disease. And he didn't even realize he had celiac disease because he had no constipation, diarrhea, and he had premature coronary artery disease. And we identified that he had celiac disease. We cut out all wheat from his diet. And that's going to stop this inflammatory process from occurring. See, it's all about inflammation. We need to get rid of inflammation in order to get rid of coronary artery disease. Any source of inflammation, get rid of the source. So if the pesticide levels are high, herbicide levels are really high. Get off that source. Maybe you're living on a golf course and you smell those chemicals every day. Maybe you're using it yourself in your yard. Maybe you have toxicity coming from mold, as you mentioned, but we got to find the source of it. So a thorough evaluation of the gut microbiome, a thorough evaluation of toxins in your body and a nutritional status, your body is able to work and get rid of this type of pathology if you have good nutrition. We don't have good nutrition today.

Let's talk about nutrition then. So if I wanted to end up on your surgical table, if that was my goal, what would you recommend that I ate? And, yeah, consumed.

You should eat nutrient deficient processed foods every day.

Give me some examples of things. Pringles and correct.

So it'll be things made out of wheat, refined wheat, biscuits, cookies, cakes, lots of bread. Basically fast foods, foods that come in a box, ready made food with labels. Anything that comes in a packet that you open up, including some of these that are high protein bars or some of these because they have all sorts of other chemicals in them. And I would have lots and lots of artificial colorings in my food, in all those processed foods, artificial sweeteners, lots and lots of diet drinks and sugary drinks.

Orange juice.

Orange juice is, is certainly on my list because that produces such a profound increase in my glucose level. And then my insulin spike that I'm going to get afterwards will cause me to become very hungry three to four hours later. So yeah, I would not eat real food. And you'll end up on my table, obviously.

Alcohol, smoking alcohol, no fiber.

Because none of those foods will have fiber in them. None of those processed foods have fiber in them.

Your patients must come to you at times and tell you what they're doing in terms of what they're eating and lifestyle choices. And there must be certain things which very people aren't aware of aren't healthy. You actually mentioned bread.

Yeah.

Is all bread bad?

No, not all bread is bad. Most bread is bad. I don't mind some sourdough because it's fermented. So it's going to get rid of some of those lectins that are already in the flour. So those lectins are gone out because they've been fermented. So it's probably a little bit. Okay. But again, not large amounts of it. You know, a slice once or twice a week is fine. But really it's a survival food. Bread is a survival food. Just empty calories. That's all it's going to do.

Is there like a worse bread? Is there like one bread which is.

Yeah, pure white bread. Simple white bread. The simple light white bread. It's pure calories, 70 calories right there. You're talking about just 10 teaspoons of sugar instead in one slice. I mean, it just doesn't make any sense whatsoever.

White rice.

White rice. I. White rice is a staple food of many people and they cannot live without it. So I run into this problem all the time. So I tell them that this is what you're going to do. You're going to first and foremost soak your rice in water and then discard the water after an overnight soak because it contains arsenic in it and other heavy metals. You'll be surprised how much arsenic there's in rice these days. You see, see the problem we have our sourcing of our foods. I mean, here as a cardiologist has to talk to his patients about how to cook rice.

What is arsenic for people that don't.

Know, It's a heavy metal that is found in the soil and the water. It's in contaminated soil and water and in these paddy fields are now full of arsenic.

It's a poison, isn't it? People I watch a lot of true crime people kill each other with arsenic.

It's a very, very strong poison and it'll slowly kill you.

Is there anything else on that list of misconceptions?

So the rice has to be soaked, then you'd get rid of the water. Then you cook it with lots of water, throw away the rice again. I mean, throw away the water, not the rice. And then you cool the rice in the refrigerator and then you eat the rice the next day by reheating it. Now what you've done is you've created resistant starch. Now what's gonna happen is that that rice is not going to have the same insulin effect in your body and weight gain effect and changes in your metabolism because it's now got resistant starch. Resistant starch means that those molecules have all bound to each other. They don't. They resist absorption and digestion until they get to your colon. And then who's going to eat it? Your bacteria. So you're basically feeding the bacteria with your rice. So if you're going to have rice, this is the way you're going to do it.

So is there anything else on that list that people should be thinking about that they probably consider to be healthy right now?

Yeah, yeah, yeah, yeah, yeah, yeah. So it's also what you do to your food. Look, you take a nice piece of fish, for example, and if you burn it and you blacken it really bad, you're creating what is known as advanced glycation end products. You fry something, you're creating advanced glycation end products. So let me define that for you. If nature does not have the ability on its own to take glucose, protein and fat and combine them at very high temperature, but you can do it in your air fryer and you can do it outside when you're blackening your food and over blackening your food, it's called advanced glycation end products. So when you over burn your food, when you overcook your food, you're creating these molecules. Now you're consuming these molecules and they've been shown to cause a radical increase in the inflammation in your body because your body reacts to those products. There's receptors to get rid of Those they call rages and they get rid of these products, but you overwhelm them and now you get inflammation.

And is there any other. Watch out. Foods that, you know, people think are healthy, but maybe if, if I was trying to have an optimally healthy heart, I should avoid.

This is going to surprise you. Excessive fruit, because I'm not a very big follower of fruit. Fruit should be eaten only in season because it has too much fructose in it.

Fructose being the sugars.

Fructose is the sugar. And fructose causes fatty liver. So our over consumption of fruit is another factor that is contributing to coronary artery disease and diabetes and fatty liver. And we think of fruit as being a healthy thing, you see, but fruit should only be consumed really in the fall and in season and in small amounts because that high fructose level really causes major changes in your metabolism. So I'm not too fond of fruit. You can eat fruit in season, small amounts of it. But, you know, people go crazy about fruit. I mean, I had a patient who was having mental problems as well as cardiovascular disease, and that's all he lived on, is fruit, morning lunch and dinner. And the moment we stopped that, his health changed completely, got so much better. So excess of fruit is also no good. Excessively cooked foods, processed foods, refined products, and another one, vegetable seed oils. So any food that you prepare or you buy that contains vegetable seed oils is a no, no. Because vegetable seed oils are a product, and if you look at all of them, they're exceedingly high in Omega 6. And the ratio of Omega 6 to Omega 3 is what the problem we have today, we have far too much Omega 6, very little Omega 3. So anything that contains vegetable seed oils. So I always tell my patients, get rid of that vegetable seed oil bottle from your home.

So what oil should I use instead?

The oil at home, if you're going to use any oil, is going to be olive oil, extra virgin olive oil for your, for your salad. And if you're going to do high temperature, put a little pat of butter or use a little bit of ghee, or you can use a little bit of coconut oil.

This is a bit more of a different question, but you said earlier on that when a patient walks into your office, you can kind of look at them and generally see if their cardiovascular health is intact. And we're generalizing here, but if I'm sat at home right now and I'm trying to figure out if I'm healthy as it relates to my cardiovascular health, what are the symptoms of cardiovascular poor health throughout the whole body. What should I can. I sort of obviously don't want anyone to self diagnose at home, but what kind of symptoms should I be looking at when I just. Even when you look at me. Let's do this on me to make it easier.

Yeah. So number one, look at your weight. Okay, if you're overweight, that's one strike against you already. Number two, if you're overweight, where is it? It's mostly on the belly.

I'm overweight according to the bmi.

But again, you've got to look at bmi, you know, is a little crude. It's not a very accurate way of actually looking at it because some people are very muscular and the BMI of 28 is actually perfectly okay for them. It's the constitution I look at and it's visceral fat. Now I can't measure your visce by looking at you, but I can tell if your belly is protruded. Now in my office I do visceral fat analysis.

So what else? I don't have a protruding belly per se. What else should I be looking for to understand if my cardiovascular health is intact?

Is there any just by looking at you physically? Yeah, no, that's it. Basically it's your BMI and your overall weight and must not have a belly. Just don't have a belly. If you have a belly, you have a problem.

And what about my joints and stuff like that? Is that an indicator of.

Yes, if you have joint now symptoms. If you're having joint pains. Look, if you're having joint pains, people think, oh, it's just degenerative joint disease. In my experience, what I have seen, it's all inflammation. Because when I change the diet, when I fix the gut issues, when I fix the inflammation in the body, they all come back and say the joints got better. All of them, uniformly. Especially patients who have autoimmune disease. For example, many patients have rheumatoid. And the moment we change their diet, their lifestyle, the frequencies of eating introduce a little bit of fasting. So we do everything right, right. We've changed the gut microbiome, we've made the liver better by giving them some supplements. We do intermittent fasting, we do some exercises, we give them some stress management, we improve their sleep. All of a sudden the joint pains get better, rheumatoid gets better, skin diseases get better, psoriasis gets better. Because it's the fundamental underlying part is all inflammation.

This is a random one. But I'm just Connecting dots from different podcast guests I've had on the show. What about bad breath?

Bad breath? Bad breath is real.

But what is it? Is my oral microbiome linked to my heart health? Yes.

There's a microbiome that goes all the way from your nose, mouth all the way down to the anus. And each one is specific and can predict whether you're going to get cardiovascular disease or not. There's unequivocal data to show that if you have bad teeth, bad dental hygiene, bad bacteria in your mouth, you're going to get valvular disease, such as aortic stenosis, premature calcification of your aortic valve, and you're going to get coronary calcification. That's been proven unequivocally. Patients who have chronic sinusitis in your. So you think that that's benign if you have chronic sinusitis?

What's chronic sinusitis?

Chronic sinusitis infections inside your maxillary sinuses, frontal sinuses, constantly. And you get these headaches and you get the cold and your blocked nose and you're constantly cogged up inside here. That's inflammation. And oftentimes that's also linked to premature coronary arteries and inflammation in your body, especially when it's fungal. There's a condition called fungal sinusitis. Again, it comes down to mold. And this mold, it causes that low grade inflammation in your body. And this has been linked to coronary artery disease. See, what's happening is we're transforming the whole definition of the causes of coronary artery disease. We have been so myopic in our definition of what causes coronary artery disease. Whereas everything, your entire lifestyle, mental, physical, eating, everything will affect your coronary arteries. Everything. Everything.

Do you think much about overstimulation? So I mean, really mean, like too much caffeine? Does too much caffeine play a role? And I say this in part because I think there's been a few times where I've had like a pre workout or too many glasses of coffee and I've got like heart palpitations. And you almost like feel like you're dying.

Yes, yes, yes. Caffeine. Caffeine is very similar to the adrenaline molecule. Now why would you want to have too much adrenaline in your body? Because then you're living in a state of existential threat constantly. And then what happens? You don't get the offset either. So you don't get the parasympathetic. So you're only in sympathetic all the time. Fight or flight all the Time. So caffeine generates that and the physiology. It'll do. Look, caffeine is not as benign as we think it is. Now, there's nothing wrong with having one or two coffees a day. That's fine, okay? But I know people who drink about six glasses or six cups of coffee a day. And I think that that's just. That's toxicity, you see. That's toxicity. Too much caffeine, and it's a diuretic. And a diuretic will cause intravascular volume depletion. And that also turns on your neurohormonal activation, so you become more sympathetic, you see? So it's a vicious cycle. Makes you dehydrated.

I was reading about this earlier because I did have heart palpitations one day because I think I drank too much coffee. And what I see here in the research says that moderate caffeine is safe and even heart protective for most people. But excessive caffeine, when you get, you know, above 600 milligrams a day, can raise blood pressure, trigger erythms, arrhythmias. Arrhythmias. And stress the heart.

Yes. Now, I want to tell you why coffee is good. It's not good because of the caffeine. And so it's not good that. Oh, yeah, I'm getting that caffeine. So it's good for me. No, because, believe it or not, coffee has a lot of soluble fiber in it. So there is some soluble fiber in it and it has polyphenols. So coffee has polyphenols just like how cocoa has, you know, cocoa, cacao, 85% cacao, chocolate. That's fantastic. It's got soluble fiber because who's going to consume the soluble fiber? It's actually the bacteria. So a coffee a day is actually good for you for a different reason. It's good because it's good for your bacteria, because it's getting soluble fiber and it's getting polyphenols. And all those polyphenols are consumed by your bacteria.

They call cacao, don't they, the something of the heart? My girlfriend's quite spiritual, and in her practice they call it like the heart medicine, cacao.

Cacao it is because it has a lot of antioxidants and it has a lot of soluble fiber. So wait a second, it's a soluble fiber? Yes, because that's fostering the growth of the good microbiome. The good microbiome is then going to produce postbiotics, and the postbiotics are gonna give you all the benefit that you're gonna need. So it's gonna cause less leaky gut, less inflammation, and your enteric nervous system. Your vagus nerve. Your vagus nerve is gonna be protected. Cause we're destroying our vagus nerve right now with the leaky gut.

When people get heart palpitations, I imagine a lot of them message you. Because it's quite scary, isn't it, when you feel your heart beating, what is typically going on and when is it cause for concern? If you've got heart palpitations.

Yeah. If you have underlying structural heart disease, let's say you have blocked arteries, let's say you have a cardiomyopathy, a valvular disease, and you're having an arrhythmia, which is palpitations. That is definitely life threatening. They need to come straight to the office and we need to monitor you and find out what's going on. But let's say you're otherwise perfectly healthy, young person, perfectly healthy, no heart disease whatsoever, and you're having palpitations. Then it's usually an imbalance of your sympathetic and parasympathetic nervous system.

You're too stressed.

It's basically either too much sympathetic or not too much sympathetic, but you have too little parasympathetic. And that is one thing that I want people to realize, that if you've knocked your vagus nerve off because you have a leaky gut or because of your lifestyle and your vagus nerve is not working very well, you will have this imbalance. Because the imbalance is not with absolute levels. It's the relative levels of sympathetic versus parasympathetic. So, for example, I see a lot of young women in their 30s and 20s who come to me with tachycardia. They have a rapid heartbeat all the time. And especially when they stand up, they get a rapid heartbeat. This is called postural orthostatic tachycardia. And when they come to me, I find out that it's actually the gut. I fix their gut, and the tachycardia gets better. Because by fixing the gut, I'm fixing the vagus nerve. By fixing the vagus nerve, the heart rates come down.

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Yes, yes, yes, yes. Over exercise. This has been shown. When you do what you just did, you're diverting blood from your gut to your muscles because your muscles at that point really need all that blood supply. And this has been well documented. So what happens when you overly exercise like that? You're causing relative ischemia to your gut. Ischemia. Ischemia. What does ischemia mean? Lack of circulation to your gut. So your poor gut at that point had lack of circulation. Not to a point where it's going to go gangrenous. No, don't get me wrong. But it affects your gut, and in the gut is the enteric nervous system. The vagus nerve ends in your gut lining and the vagus nerve got affected. So your vagus nerve didn't work very well. When you get vagus nerve not working well, you get too much sympathetic, you don't get tachycardia, you're going to get arrhythmias, palpitations.

So tell me what the vagus nerve is and what I can do to get my vagus nerve in check. By the way, Jemima, it was totally worth it. But just tell me what I can do to get my vagus nerve in check and like, what role my vagus nerve plays. I've got this photo here of the vagus nerve.

Yeah. You know, the vagus nerve is fascinating. It is the largest nerve in the body and it basically is sending messages from the brain to the whole body and receiving messages back to say, what is the state of affairs? And the largest distribution, believe it or not, is all in your gut. Now that tells you something right there, that what is the brain most concerned about? It's most concerned about the most treacherous border in your body, which Is your gut, your gut health is so important that the body has dedicated a huge nerve called the vagus nerve just to take care of your gut. Because your gut is that important. That is why, by the way, it also has endings on the heart, in your lungs, in your face. So there's lots of endings of the vagus nerve.

And what is it doing? Is it telling? Is it basically the communication channel between your gut, your heart, your body state of affairs?

What is going on in the gut? What should I be doing back and forth, traffic information going back and forth. So when you, the body is supposed to be in a state of sympathetic followed by parasympathetic, what does that mean? You run away from the tiger, you hide behind the rock. The tiger is gone now. And now you're supposed to be parasympathetic.

So sympathetic is the fight. Parasympathetic is the relaxation, rest, relaxation, repair.

Guess what? We're not getting enough repair these days because we constantly in the fight, flight, fight, we never give our chance to go into repair. That's what the problem with the vagus nerve that we have today is. So we don't get a chance. So that is why, why don't we do it? Well, one is our lifestyle. Two, our gut is not right because it has made our vagus nerve dysfunctional. When I fix the gut, one of the things I notice is heart rate variability gets better. What does that mean, heart rate variability? That means your pulse. With each breath in and each breath out, there's a little variation in your heartbeat. That's called heart rate variability. Now, when you lost your heart rate variability, it means that your vagus nerve is not working very well. In all patients, when I fix their gut, their heart rate variability gets better as well. When you fix the gut, your vagus nerve will be able to work more efficiently and you'll be able to repair yourself after the sympathetic drive. So you get the yin and then you get the yang as well. And the nice thing about the vagus nerve that I find is that you can repair it through the gut, but you can also hack it and you can give it some nutritional supplements. The nutritional supplements are omega 3, which right now, 50% of the population is very low in omega 3. And you need DHA and omega 3 to make your vagus nerve work optimally. You need to fix the gut. And thirdly, you can hack the vagus nerve. So how do you do that? You do the breathing exercises. So when you do the deep expiration, you stimulate all those parasympathetic nerve endings. And your heart rate goes down, blood pressure goes down.

What kind of breathing exercises?

So breathe in to the count of four, breathe out to the count of eight. Very simple. I tell it to all my patients. Breathe into the count of four, breathe out to the count of eight. It's a deliberately long expiration. You do that for about 10 minutes a day. And when you do that, your vagus nerve is getting stimulated. And any nerve that is stimulated frequently enough will work more efficiently.

What about this eyeball thing that I've heard you talk about where you eyeball.

Does affect the vagus nerve function too. So when you look to the right, look to the left at the top, look down, look left. It stimulates the vagus nerve. There's a nerve on the ear. There's also the vagus nerve that can be stimulated. Here in the neck, that can be stimulated. The facial nerve also has branches that go to the vagus nerve. So there are a few hacks that people can use. I even have a small contraption that I give patients that wear around the neck. And it releases little signals onto the vagus nerve over here. And I've placed it on patients and they in front of me and they'll say, oh, my God, I already feel so relaxed and nice. And it's. I was shocked when they did that.

I heard you talk about massaging the eyeball.

Yes. And cold water on the eyeballs. So I don't advise massaging too often. But cold water and gentle massage on your eyeballs stimulates the vagus nerve. And you can do it yourself. You'll notice that if you're on a monitor and you do that, your pulse rate goes down. It's the deep dive reflex that we have in all of us. Dive into water.

What about putting an ice pack on the back of your neck?

I think that's fantastic. Back of the neck. But I prefer the front of the neck.

Oh, okay.

Because the front of the neck is closer. The vagus nerve is very close to the carotid sheath over here. And when you put ice packs on it, the vagus nerve is stimulated.

Humming for 10 minutes.

10 minutes, both sides.

What do you mean by humming? Give me an example.

Oh, humming. Oh, humming. Oh, yeah. That sound is transmitted to the vagus nerve. So it's like shaking that vagus nerve. And it creates electrical impulses in the vagus nerve that's been shown singing. Singing, singing, humming, laughing. You know that there are laughing clubs? Maybe you should start a laughing club. But laughing clubs. Yeah. Laugh for no reason. Just sit there and laugh. So that diaphragmatic movement, that constant diaphragm in laughing, stimulates the vagus nerve.

I've heard you talk about this valsalva manoeuvre. Yeah, what's that?

The valsalva is when you breathe in and then you breathe out, but don't let the air out. And you're straining. And that straining compresses the thoracic cavity, but also the abdominal cavity and stimulates the vagus nerve. And that is also found to be very, very helpful.

And remind me again, if I have a healthy vagus nerve, if I have a calm, healthy vagus nerve, what is the downstream impact going to be across my life?

Downstream impact is going to be faster healing, less coronary disease, less high blood pressure. Your blood will not be so sticky and make blood clots, less inflammatory markers. The blood tests that we do, the interleukin 6, the tumor necrosis factor, the CRP levels, small, dense LDL. We didn't even talk about LDL. But LDL, the bad cholesterol, all those get better.

And what is the role of LDL as it relates to heart disease? Because I've heard this word, cholesterol, I really don't really understand what it is. Or I know there's good cholesterol, there's bad cholesterol. I guess that bad cholesterol comes from fast food and processed foods and stuff. But simply what do I need to understand about the role cholesterol plays in heart disease and how to not have bad cholesterol?

The LDL carries most of the cholesterol in the body. It's not complicated.

LDL is what?

LDL is a lipoprotein.

Yeah, right.

And you have hdl, which is good cholesterol, ldl, bad cholesterol, total cholesterol and triglycerides. These are the four tests. So the LDL is a reflection of your cholesterol. Now, cholesterol is a normal molecule in your body, and you should have cholesterol, because if you don't have cholesterol, I don't think you live too long. And you need to move this cholesterol around your body. Every cell in the body makes cholesterol. Your liver makes most of the cholesterol, actually. Now, what happens is that when that LDL molecule becomes damaged, it becomes a small, dense LDL particle. A damaged LDL causes inflammation because now you have a molecule that's floating around your body. It's been damaged, it's small, it's dense. Now, your white cells, your macrophages see that and want to gobble it up. That's number one. Number two, these molecules get oxidized in the lungs and then the first place they come out from after the lungs is the coronary arteries. So it's the small, dense LDL particles which are now oxidized. They destroy the glycocalyx, which is the lining of the coronary arteries, and they activate the endothelium. When they activate the endothelium, which is the lining of your coronary arteries, that's when you're going to start getting atherosclerosis. So atherosclerosis and LDL are related, but it's not the total cholesterol. It's when you have small, dense, damaged ldl. So let me explain the impact. In my practice, patients come to me because they either cannot tolerate cholesterol medications or they don't want to take cholesterol medications. What I do then is I look and say, okay, your ldl, is it high or low? Is that what I'm really concerned about? Or is it that it's small, dense ldl? So I do a sub fractionation, and this is important for you to understand because they don't do it in every country in the world. It's very difficult to get some of these blood tests abroad. But in the United States, it's easy to do it. It's called sub fractionation of your ldl. So it tells you whether you have small, dense LDL or not. So let's say you came to me and Your LDL is 150. But if it's all made up of large, fluffy, good, normal ldl, it's not going to be implicated in your inflammation or in your coronary artery disease. I leave that alone. But if you have small dense ldl, that also is a problem because it's pointing me towards inflammation. Because what causes small, dense, damaged LDL are glucose, omega 6, advanced glycation, end products, toxins, and lipopolysaccharides that come from the gut, leaky gut. So now I just gave you the primer for treating coronary artery disease. These five things promote coronary artery disease. And it's small dense ldl, those macrophages, they engulf small dense LDL and those macrophages become foam cells. The endothelium has been already activated, so they bind to the endothelial lining.

What's the endothelium lining?

The endothelium is the lining of the artery in your coronary artery. So these white cells that are Full of fat. The bad fat attach themselves to it and then become endothelialized. That means they become part of the wall.

So they become a plaque.

That's. Now you got it. That's making the plaque. You just hit it right on the head.

So how would I naturally lower my LDL without taking statins or any of these other medications? Is there a way to do it naturally?

You stay away from meat? Yes. You've gone a vegetarian diet. Yes, it'll come down, but there's no meat.

Or meat.

Or meat. Because they all have cholesterol.

Even chicken?

Even chicken, yeah. If you want to bring it down. But the question is, do you really want to bring it down? Do you really want to bring it down later? The most recent data is very scary. It shows that patients who have the highest LDLs actually make it into the 90s and live a healthier life. It's not the LDL, it's the damaged LDL that's the problem. So this, the medical profession as a whole, and all of us are having a problem grappling with this. Is it the total LDL that we should be concerned about? Point to your question, what is a normal cholesterol and should we be lowering cholesterol? And the answer really is not that simple. What we should be doing is not to have small, dense ldl. So the question is, where does that come from? And small, dense LDL are five things. Sugar causes it, omega 6, advanced glycation, end products, toxins, and leaky gut. They make your cholesterol become small, dense particles.

A lot of people are concerned about eating eggs because they think it might raise their cholesterol levels.

Absolutely no concerns whatsoever.

And what about statins? So a lot of people are prescribed statins when they have heart related issues. Are they safe in the long run? Are they effective?

Okay, first part, are they safe? For the most part they are. But at least 20 to 30% of patients will suffer from sarcopenia, which is loss of muscles. So they'll get weakness, aches, pains, they'll get diabetes because it causes mitochondrial dysfunction. So they'll do sugar problems. And many of them also do develop mental diseases. So I've seen that they become forgetful and they just can't think right. And I stop the statins and all of a sudden they start feeling better. So, no, not all statins are safe. You need to monitor statins. Also, they can cause liver dysfunction. So you need to watch that. Number two is that the statins, are they effective? Effective in what? If the endpoint is to reduce your ldl? Yeah. Statins will bring your LDL down, but does that translate to a decrease in cardiovascular event rates? That's a totally different question. You see? So is your goal just to reduce the ldl, or is your goal to reduce the damaged, oxidized, small, dense LDL levels?

And when people say they have high blood pressure, that's because there's potentially a narrowing of their blood vessels, so the blood has less space to go through. So it's kind of like squeezing a hose pipe that it shoots out faster. Is that typically what it means by high blood pressure?

Sort of. Let me explain. When your insulin levels are running high, all your blood vessels and your capillaries all don't vasodilate properly.

Oh, okay. And vasodilation is the expansion and shrinking.

Yeah. So they don't vasodilate properly. So you will get high blood pressure. So one of the biggest things I've noticed with diabetes patients is when I bring their insulin levels down through my fasting program and dietary changes, the blood pressures go away. See, that's another thing. There's no such thing as essential hypertension. Essential hypertension meaning that you just have high blood pressure. There's always a cause. Either you have sleep apnea or you have hyperinsulinemia, because sleep apnea also causes hypertension. So hypertension does not always necessarily mean that you're going to be committed to blood pressure medications for the rest of your life.

I've heard you talk quite a lot about breakfast. People ask you about what they should have for breakfast, because everybody wants to know how they should be starting their day. What is your advice on what we should be eating for breakfast? To have a healthy heart and cardiovascular system.

Breakfast is a tough one. I tell most of my patients that if you absolutely have to have a breakfast, have a couple of eggs, and if you are a vegetarian, it makes it a little bit more tough. But you can have some kefir with two to three blueberries, two to three blackberries, and about four blueberries in it. And then you put your inulin powder in it, and that's your breakfast. That's all you should have but a heavy breakfast and also breakfast. In my opinion, breakfast should be. We should pass breakfast for most adults and just go for lunch and dinner only, because then you can do your 18, 6. If you absolutely gonna have breakfast, then you have breakfast and lunch and then no dinner. But you got to plan 18 hours. 18 hours is optimal and we can do it. A lot of people say they can do it, but most of us can do it. You will notice how much more energy you have. You know, when I do my omad, which I do at least three to four times a week, which I only have one meal a day at 6 o' clock in the evening, I actually have more energy than I do in the morning.

What does your diet look like, doctor?

My diet, Yeah. I do eat meat and I do eat fish, chicken and turkey. But I'll have source it right. Always make sure that it's grass finished. Always make sure it's organic and I'll have small amounts of it.

Grass finished, Grass fed.

Grass finished.

What does that mean, grass fed?

Just means they took it out one day and put it out in the field and they fed it some grass. So this advertising that industry does is a little deceiving and I had to investigate this to find out it's a lie. It has to be grass finished from beginning to end. So then it's going to have more Omega 3 in it, it'll have more K2 in it, it'll have more nutrition and less toxins also in it. So less Omega 6. Because if your cows are eating corn, then you're going to get all that Omega 6. And the cow is not supposed to be eating corn, cow is supposed to be eating grass. So I do eat some meats and I eat some vegetables with it. Coming from a background, my great grandfather's from India. We do eat Indian food as well. So we have some lentils and some curries of course. So you can cook the meats in a curry form as well. I don't eat much chapatis because those are very full of carbs. I love the taste of it. I love none once in a while.

And what do you supplement with? What's your supplement stack look like?

I take D3K2 Omega 3 fish oil. So I take two capsules every day. Vitamin C, one gram inulin kefir. I drink that every day and I count it. Magnesium. And I take nattokinase. Nattokinase? Nattokinase. I take about 8,000 units a day. What it is is that it does thin the blood a little bit so that you're less likely to make blood clots. Part of metabolic syndrome is a tendency to make blood clots and have a high fibrinogen level. My fibriginol was at the upper limits of normal, so I just take nattokinase. It doesn't cause any bleeding or any problems like that. And then I also take a probiotic and it Basically is called mega spores probiotic. So it's spores. There's no real bacteria in there. It's all spores.

What's a spore?

A spore, a bacteria can survive by sporulating, so it becomes a spore. So it's no longer a bacteria, it's a spore. But it'll germinate under the right circumstances. So these little things, they are the spores of the bacteria that are in soil. So soil has certain species of bacteria, the bacillus species. The spores I consume, they go in my gut because remember, if I take a probiotic, the acidity in my stomach is going to kill most of the bacteria.

So what does the spore do? Sorry.

So the spore passes through the stomach, goes all the way down to your intestines, and then it germinates there, it grows there. So now the spore becomes a bacteria, so it gets past that acidity of your stomach. So I do take that as a supplement as well.

Dr. J. What is the most important thing we didn't talk about that we should have talked about for the people at home that have clicked on this episode? And, you know, I guess one way that you might tackle this question is just by thinking about the most popular questions you get asked from your audience on a daily basis that we might not have covered today.

How can I screen myself right now? What tests should I do right now to see at what stage of inflammation and coronary artery disease am I in? Because coronary artery is the number one cause of death and inflammation is the underlying cause. So what test should I be doing right now? That is an important question. If you're over the age of 30 and you have concerns, one, get a coronary calcium score. If your coronary calcium score is zero, you have no calcium, then you are in a good place. If you have coronary calcium, you need to go see a good cardiologist that's going to do a prevention program because it means you already have atherosclerosis.

Atherosclerosis meaning plaque hardening of the arteries.

Number two, you need a good blood test to look for inflammation. The blood test that I order is called a Cleveland heart Labs. In it, you get your HDL LDL cholesterol, but you look at particle sizes. Is my LDL small dense? If it is small dense particles, is it oxidized? Yes. I have a problem. My CRP level, other inflammatory interleukin 6, tumor necrosis factor, hemoglobin A1C sugar level, all these are part of that panel of tests. So you should get a good inflammatory panel, which is the Cleveland heart labs. So those are the two things that everyone must do. Get a chronic calcium score, all adults, and do an inflammatory panel. Inflammation. You got to know whether you look, you know, you may not feel inflammation. It's not like you get a big pimple and it's going to hurt you. But if you have inflammation in the body, yeah, you could know about it. How you have mental fog. I'm not optimal, Doc. My memory is going down. I'm depressed. Depression is inflammation. Depression is not something psychological. Okay, now this I have to stress to you. And I tell my patients, you come in, I'm depressed. You're depressed because that very symptom of depression is a symptom of your inflammation. You can be depressed about something that, oh, my car's not working very well. That's the difference from depression. Depression is inflammation in the brain. So you'd be surprised how many patients go on my anti inflammatory diet, which is I change the diet and fix them all up and the depression goes away. So ask yourself not just questions about physically how you're feeling, but mentally also. And if the answer is that, doc, I'm not optimal. I'm forgetful, I'm depressed, I'm having sleep disturbance. I'm really things I've changed. My body's also changed. You have inflammation.

We have a closing tradition on this podcast where the last guest leaves a question for the next guest, not knowing who they're leaving it for. And the question that's been left for you is what was the most difficult day of your life and how did you overcome it?

The most difficult day of my life was a very personal one for me. You know, when my dad passed away and, you know, and I'm Dr. J. And when he was sick and he didn't want to go to the hospital, and then he passed away in his sleep. And then you always ask yourself, could I have done something differently? You know, you second guess yourself. And that second guessing happened with him. Of course it was very, very painful. But it happens with patients as well. But how did I overcome? Taught me a lot about my own limitations as well as a physician, as a son, as a scientist, as a reader. And that's why I'm motivated to do what we are doing here also is to do the best you can to educate people.

What was he sick with? What was his predicament?

He was a cardiac patient already. And he's got a very interesting story, actually. He was told that he only had a few Years to live after he had bypass surgery. But then I put him through all the things we talked about today. He lost a lot of weight. He went from 185 pounds to 135 pounds. He changed his diet, and he lived another 30 years, and he did another six world tours and traveled, and he had a wonderful life. Okay. The impact of simple things that we can do to change his life. So he stopped drinking all alcohol as well. And he really had a very clean diet and everything else. But that night, he came down with some sort of infection. He had massive diarrhea and massive, massive explosion. And I think that what really happened is he got overwhelmed. It's just the gut. He got overwhelmed with a toxin from his gut. And then he passed away. But here's a man who lived to 89 was supposed to have passed away in his 60s. And the impact. But the thing is that we shouldn't second guess ourselves. We don't want to live in the past. I want to live in the present moment, not even in the future. So all these things have taught me to live in the moment. And one of the skills I've developed is just that, that when I'm with you, I'm only with you if I'm doing your surgery. I'm only doing your surgery if I'm having a conversation with you. You and I are the only people that matter right now. And this being in the moment, that ability to be that is something I learned over time. Because before, you know, something bad happens, your next case, you're still reminiscing about that and you're regretting that you can't do that. Life is only expressed in this moment right now. So learning how to live in the moment applies not only to me, but to everybody. We all living in the past otherwise, or we're worried about the future. So how do you learn present moment awareness and live in this moment so that we will be happier? We can do what we want to do, make the changes we need to make, get the courage and have the willpower to go out and make a difference to yourself and to everyone around you. Starts with you being here. Are you here? Or are you in your past? Or have you gone off into the future? That's a skill that medicine has taught me, and I've become humbled by it. And this is something that I have learned and I want to pass on to all my patients, too, as well. Okay. She's got all these things going on, but learn to live in the moment.

Dr. J, thank you so Much thank you so much for the wisdom that you've shared with so many people. If people aren't familiar with you, you're extremely prolific and well loved across the Internet for the public education work you've done and the heightening of awareness of people's heart and their cardiovascular health more broadly. Until really before you started making videos online, a lot of this stuff was opaque. It was a mystery to a lot of people. And your YouTube channel has almost a million subscribers now. And you, you go through some of these subjects that we've talked about today in even greater detail. So I'd highly recommend people go and check you out there. But also just thank you for saving so many people's lives because, you know, that's what you do day in, day out and that's an incredibly, I mean, there's probably not a higher calling one can answer. So thank you for doing what you do. And I can see now why you people love you so much online and on YouTube because you're so incredibly engaging, I guess is the word engaging wise. And you make the information accessible in a way that I don't think has been done before. So thank you so much. It's a pleasure to meet you and to have this conversation with you and thank you for enlightening my audience.

The pleasure was mine. Thank you.

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