Episode 9: Interview with Dr. Joel Kahn, America's Healthy Heart Doc

What does it take to cure diseases, not just manage their symptoms? This is Inside the Cure from Allure Medical and its founder, Dr. Charles Moak. He explores world renowned healthcare that benefits patients and the economy. I'm Cam Carman and Dr. Moak and I are joined today by Dr. Joel Kahn, who is a best selling author and one of the world's top cardiologists. So welcome, Dr. Khan.

I'm very excited and honored and great to reconnect with you, Cam, and obviously always with Dr. Moak.

Wonderful. Great to see you. I see you're at your restaurant and I've been there several times and I know it's called is it Green Space?

Green Space. And I apologize to anybody listening. We're gonna have great content, but you might hear a few glasses or silverware clinking in the background. It's kind of busy. Time to prep for dinner.

Yeah, we forgive you. Well, we do have a lot to talk about. We're also very excited to have you as part of our podcast. So I know you and Dr. Mok are really big believers in the prevention of heart attacks and heart disease, and I want to get both of your thoughts. Still though first, Dr. Khan, tell us about your heart disease reversal programs, if you will.

Well, I will, but I'll just point out I had the honor to present them at Allure Medical just this week. In fact, with Dr. Mok's great team. I spoke to a great public crowd and always my favorite topic. But I am from Detroit and trained at University of Michigan and did hardcore macho tough cardiology for decades in the cath lab heart attacks. But about 10 years ago gained an interest in prevention as you mentioned, and actually found a way to go back to university, kind of after hours, weekends and really dive deep at University of South Florida in Tampa and got a degree in preventive cardiology. So about five years ago, I opened a clinic in Bingham Farms, Michigan, where we try, if possible to identify 10 years before the heart attack, 10 years before the stroke, 10 years before the bypass, or 10 years before dropping dead. What's the status, what's the risk? Genetics, lifestyle. And the other portion are people who've already had an event but are working hard to maximize the chance they're not going to end up back in the hospital. Live a worry free life. Those programs center around, always goes to basics, very careful history on everything, dental history, sleep history, food history, previous operations, stress, social connection, vitamins, prescription drugs. Of course I don't focus on sexual health in an odd way, but it's a Quality of life issues. So we get there a little more with men than women. And we then do very advanced testing, blood work and blood vessel testing and put together a plan that takes all that high tech stuff and tries to get it down to natural therapy. I'm not anti drug surgery or stent, but if it is a lifestyle, food, sleep, yoga, meditation, acupuncture, vitamin approach, and we can keep away from a medication List of 10 drugs that makes me happy and I find plenty of people, it makes them happy too.

Now I've read that your goal is to prevent 1 million heart attacks by using western medicine and alternative therapies.

Yeah, it sounds, you know, don Quixote, there's 2,300 people a day that die in the United States of cardiovascular disease and about a heart attack every 40 seconds. So while we're talking, you know, that might be 30, 40 more people in the United States had a heart attack.

I want to go back to this thing about seeing people 10 years before they had the cardiac event. I think that's really important that we talk to the audience about what that's about because right now, if you're a woman over 50, you're going to do a mammogram every two years. If you're a male over 50 or a woman over 50, you're going to check for colon cancer. We do dermatology screenings for cancer, we do aortic ultrasounds for men over 60, have had smoking history, look for aneurysms. But for heart disease we pretty much check cholesterol, which is almost a useless measure. And we know there's some more advanced ways we're looking at other than your epidemiologic risk, looking at your actual personal risk of cardiac event in the next 10 years. Right.

The science has advanced, but the practice of medicine hasn't in general. And the insurance coverage hasn't always advanced. But fortunately the testing necessary is very low cost. That's the beauty of what I do. And you're right. We learned 50 years ago your blood sugar, your blood pressure, your blood cholesterol, your smoking and mom, dad, brother, sister's history are fundamental in our value. But we miss people every day with that system. They die or they're over treated and they don't need it. Because we don't look at the organ colonoscopy. You're looking at the organ prostate exam, you're looking at the organ mammography, you're looking at the organization, let's look at arteries. You have the facilities that allure to do that with cimt, a form of ultrasound of the carotid arteries. I have that ability in my clinic. Plus there is a CT approach and they're all reasonably priced. But for reasons that can make you infuriated, I think they infuriate you a little bit. You go to everybody who's 50 and thought about if you had a physical at your primary care doc, and I'm not anti doctor, I'm pro doctor. You said you got stethoscope, blood pressure, some simple blood work. You're not allowed to do an EKG and get paid for it in that scenario, electrocardiogram, let alone definitive testing. So we're talking about the next 10% to really nail down your risk. And it's very science based.

I'd like you to kind of like, because you're kind of going through this really fast on CIMT and CAT scan. So tell the audience a little bit about not just the pros and cons. I don't think that's so important. But what is this? How long does it take? What does it cost? About.

Yeah. So actually, amazingly, an English physician 400 years ago named Thomas Sydenham, he was as famous as Sanjay Gupta is today. And his time said, if you know the age of your arteries, you know the age of your body. A man is as old as his arteries is a direct one. Well, that means if you went to a doctor and they tested and told you how old your arteries are, you'd be fulfilling the amazing vision that has proven to be true of 400 years ago. But a stethoscope and electrocardiogram and blood work does not tell you the age of your arteries. So there are two ways anybody listening can find out critical information that science says is valuable. You can have an ultrasound. Easiest test in the world. We have, you know, a gift to us is we have two big arteries right under the skin in our neck, directly up to the brain. They're large, they don't move. And with an ultrasound in 20 minutes, you can go to lifeline screening, you can go to a hospital. But what you do, Dr. Mok and I do is a bit more advanced digital software analysis. And the report, at least the ones I use, will say you're 48 years old, but your arteries are like a 44 year old. Yes, in the amount of plaque and thickness, or you're 48 years old and your arteries are like a 72 year old, which is a very common event in my clinic. But it's very hopeful because early detection leads to early prevention. And reversal. There's also at your local hospital of medium or large size, a 10 second CAT scan developed 25 years ago in San Francisco. You want to learn more, you watch a Netflix documentary called the Widowmaker Movie. It's fascinating, but anybody for about $75 to $100 could go 10 seconds in a CAT scanner. No injection, no IV, no contrast. The official name is coronary artery calcium scan. It is the exposure radiation that a mammogram is. So that's considered quite low dose and you have it maybe once in your life. So unlike a mammogram, it's a very infrequent exposure and you get a number based on how your arteries appear on CAT scan. Amazingly accurate evaluation. If you're a zero, you have no plaque detected. Incredibly good news based on hundreds if not thousands of scientific studies. The next 10 years are very optimistic. And the amount of prescription drugs and treatment you need may be very low. Those are all again, kind of American Heart association recommendations. They just haven't made it into practice. If on the other hand, you feel great, you play tennis, you go scuba diving and you fly around the world. But we uncover silent disease that's 10 years before the bypass. Let's get the program in line. Food, fitness, sleep, smoking, vitamins, nutraceuticals, prescription drugs, stress management, whatever it takes. You know, it's the aesthetics of heart arteries, you know, which you're an expert at aesthetics inside and out. But we don't really talk about that in heart arteries. It's actually amazingly similar. We don't do Botox or heart arteries. We do broccoli.

Yeah, we have a family friend and one of our employees, father, he's in his 50s and he had been doing everything right. He had lost 40 pounds. He had gotten a little overweight over time. So he lost £40 the last couple years. Not a smoker. He thought he was eating healthy. He started kind of routinely exercising. He went in for a stress test about six months ago as negative cardiac stress test by a cardiologist. And in November he was up north snowmobile and he had a heart attack. And if we had done a CIMT or score, we would told him, no, you actually have disease. But he was actually under the impression he was perfectly clear. And it's sort of so important that we can identify this way cheaper and easier than a stress test. We had a definitive answer.

Yeah, you bring up a really good point because you can. I mean, I have patients that have had bypass surgery for four bad blockages and their electrocardiogram is normal. So that simple paper test isn't worthless, but it's not an effective screening test. It's not even paid for on your routine physical. And for a asymptomatic 50 year old man or woman, insurance companies don't pay for a stress test cause they're not effective. There are false readings that lead to lots of nervousness and concern. And just like your friend, they will miss a substantial amount. So there's actually in the headlines this week, a lot of talk, the executive physical. Maybe your company will pay for it or you choose even in Mayo Clinic, Cleveland Clinic, and you're paying a lot of money. The treadmill test for the asymptomatic 40, 56 year old has been evaluated by the American Heart association as worthless. And they don't encourage insurance companies to pay for it. Whereas you will dip in your pocket and bring out 75 or $100 to pay for this CAT scan or a little bit more for the ultrasound. They're both wonderful strategies, but you will fulfill that information. You may not like the data. Oh my God. I didn't know I was walking around with some plaque in my arteries. But that's when we go upstream, as I call it, to really wrap you with love and support and information. And I saw a patient yesterday, the last patient that six weeks ago, he came to me with three trips to the cath lab, three stents, nobody had sat down and said, you know, this disease can be controlled. And I loved him because without hardly anything, diet change, fitness change, his lab values are better. And you just got to give people the information. And a lot of them will grab on and make the changes because most of those changes are not prescriptions and not hospitalizations. They're lifestyle.

And I think that's a very good point. And what I'm seeing is I'm really focused on our company trying to save healthcare. And we look at healthcare as more of a disease management. And you and I have been talking about prevention or cures. And I'm perplexed on one hand that doctors don't recommend their patients routinely to get a coronary calcium screening or carotid imaging when they turn 50 or why they're not routinely talking to them about their diet. It's almost like I see this hemoglobin A1C as a test for blood for diabetes. And doctors will do it until you get diabetes. And once that happens, they know exactly what to do. But the three or five years leading up to it, there's very little discussion about intervention unless it revolved around doing additional insurance tests or drugs.

You got a lot to break down on what you just said. So, you know, why are these CTs and carotids not routine? Again, Anybody wants to dive into a fascinating the Widowmaker movie on Netflix, you'll see some authentic background interviews and all. There is no representative coming to a family doctor internal medicine gynecology office saying, hey, our local hospital is offering this amazing $75 program. It's not a profit center and it's not a priority of most cardiology or radiology departments. Rarely I've seen, even in the Detroit area, a hospital put up a billboard. We're offering in February a heart CT scan. It's very rare. They'd be very wise if they did it because the downstream is enormous. Even though it's a low expense cost. You bring up diabetes and you're absolutely right, but we know the data. Our government 15 years ago announced the results of something called the DPP Diabetes Prevention Program. You're moving towards diabetes. You're randomized to just some routine information. A prescription drug many people know of called metformin, or some classes to teach you how to eat, exercise and manage your weight. Which was the winner in preventing the movement of diabetes. It actually was the lifestyle training. Everybody's still surprised it wasn't the drug. Everybody will take a drug. So that program has been absorbed into ymcas, diabetes prevention programs and ymcas. Proven and effective and often covered by insurance. But I agree with you. It's pretty rare to tell a patient your type 2 diabetes, not the insulin requiring type 1, but type 2 could be prevented. And actually if you have, it may be reversed. I understand diabetes is about a $15,000 a year expense to insurance companies. You'd think they'd be wrapping patients around halt and reverse your type 2 diabetes at every stage of the disease, rather than will refill your drugs and your insulin and your glucometer and your continuous glucose monitor. Undoubtedly it would decrease cost. Without a doubt.

It's interesting you bring up the continuous glucose monitor. So I do not have diabetes. I've been very fit. But everybody in my family has type 2 diabetes. Mom, dad, brother, sister, they all had heart disease, all had disease at a young age. Obesity is in my family. It's in my genetics. And I have done my hemoglobin A1C and it's about 4.9, pretty good level. I want to know how far I could go. So I bought the freestyle Libra, which is a blood sugar monitor. And I've been doing this for six weeks now, and I'm paying out of pocket because insurance only covers it if it's. If you have brittle diabetes, you have to monitor yourself frequently. What's interesting though is with a $40 device, I found out the things I was doing I thought were healthy for me were hurting me. For example, every morning I would have beet juice for the nitric, and it turns out my blood sugar goes up to 200 and guess what? I don't have beet juice anymore. And then I also found out if I have bread before.

A whole food tends to be less money.

You're spot on because now if I have beets with my salad, nothing happens. And then if I have bread before dinner, my blood sugar skyrockets, but I have carbs after dinner. After a very hearty green salad with olive oil, my blood sugar doesn't move. So I took my average blood sugar from 95 pre. My first run was pre. Now I'm about 74. And the impact on methylation in my body and aging and of course I'll never get that, but it's the knowledge of knowing live feedback, which foods I should avoid. And I really cut stuff out. I just changed things around and changed the way I was eating them.

I think most of my friends that do that for the fitness world, not the diabetic world, will tell you that I love grapes, but grapes will drive your blood sugar sky high. That's not to say I'd rather eat grapes than Fritos. So it's always an upgrade. But a few grapes might be. I used to keep frozen grapes as my sweet treat at night rather than a chocolate bar. But I kind of abandoned grapes because I haven't worn the monitor you're talking about. But it's instructive and soon it'll be. Actually, I'll tell you, I'm working with an Israeli company that via your camera phone, they have technology actually measure your blood sugar through your skin from your phone camera. That'd be about a year away. I've seen that demo.

So I think wearables, you know, when.

You'Re talking about talking wearables and even more advanced, it's called photoplethysmography. But when you get right down to it, like you said, I think the key message you just said, oranges are better than orange juice, beets are better than beet juice, apples are better than apple juice. Nature knows how to package sugar in a delivery system that actually provides health, not necessarily the risk of damaging your eyes, your arteries, your kidneys, and the rest.

I like the idea of us talking about consumers taking accountability for their own health. So you go to your doctor's office and basically you should see your doctor maybe for your annual physical exam, but basically when you're sick, because we know doctors don't take care of sickness. But you and I are talking about how do you prevent it? And from the wearables. I have an aura ring on, I have a blood pressure monitor, watch and Omron. I've got the sugar monitor. Yeah, I just love this stuff. The thing is that allows. I plan to live to 153, so I'm trying to reverse engineer that. The thing is that if we can start equipping people with the knowledge, like the person that does the CIMT crowded study or the calcium score, and it's a zero now, we should look at the risk for cancer and then we can do the risk for neurocognitive decline. If we start finding out what you're at risk for, is it cancer, neurocognitive decline, cardiovascular disease, then we can kind of hyper focus on that based on things that you'll do. And I hear people complaining that their insurance should cover for everything. Let's face it, they're not going to pay for you to shop at Whole Foods versus Aldi and they're not going to pay for your membership at Lifetime Fitness versus doing nothing. So we realize that if we want to live longer, healthier, more productive lives, we spend it on what we're eating and what we're doing for exercise. And it's okay to pay out of your pocket for health care. And I think that's something that actually for health prevention or cure, because insurance in the healthcare industry is designed to catch people with disease and manage the disease. But right now and in the foreseeable future, with the exception of a few cancer screening tests, it is not designed to prevent anything.

No, I agree. You know, it's early detection and I'm intrigued. Now we're going to high level stuff. I just want to say the basics are the basics. Don't smoke, have some fitness in your life, manage your weight without extreme measures. Eat a lot of fruit and vegetables, whole grains and legumes, if not exclusively, at least a lot. Get sleep and manage stress in the community. I mean, Harvard School of Public Health says the list I just read rather quickly can add 14 years of life to a woman at age 50 and 12 years of life to a man at age 50. And we always end up on the short end of the stick as we jump out of airplanes and ride motorcycles a bit more than women, but nonetheless, lifestyle is the ruler. But I'm intrigued. Now I've had just to go one up on you for technology. I've had my entire genome sequenced in San Diego. Something that used to cost a million dollars. I spent a couple grand I now offer in my office for about $250 if somebody's interested. Cancer screening genome, heart disease screening genome, that was $1,000 six months ago. And the ability not to diagnose it, but to say you do have a pancreatic cancer risk and there is some data that coffee reduces your pancreatic cancer risk. And we actually emphasize drinking coffee in that particular person. That tailored personalized precision medicine as you know the term and I know the term. I think it's exciting as hell. But we do have to figure some of that out a little bit more.

Yeah, I've been to Health Nucleus in San Diego.

That's where I had mine. So I can't one up you.

I've tested my stuff all over the place and it comes up with the same answer. And my answer is always the same thing. I have very little cancer risk, very little risk of neurocognitive decline. But I do have a high risk of cardiovascular disease and diabetes. So now I know the enemy. And you and I are both on a plant based diet. I'm about 99%. I'll have some fish maybe once a week or every three weeks.

That's a very smart move. I don't choose to do it, but it's a very smart move.

But I think the thing is that in some people doesn't really matter, so they should know. And so I think some people, even genetically we might look at does a keto diet work for you or does the Mediterranean diet work better? How much olive oil can you have? We can actually check our blood to see how much olic acid is in it. What's interesting and you'll love this story is that I've always had an issue with consuming oleic acid. And I have olive oil and last time I checked my spectracell, my level is very low. So I did that refrigerator test with my olive oil and my wife was buying. Olive oil is actually the fake stuff. You know, there's a big issue with olive oil. There's been a big sk scam with them putting soybean oil and corn oil in it. But it turns out Kroger's stuff and Kirkland are both solid good olive oils. And some of the other stuff you Buy with big names. They're actually fake. They've been doctored.

Wow, you have a lot of interesting tidbits there. And a couple of things you said. Oh, so it's not only identifying which diseases you might get and not get, being more precise. The most practical example is a 44 year old woman. Cam. Carmen, a 44 year old woman goes to the gynecologist, says Your cholesterol is 230. Here's your prescription for the rest of your life. For Lipitor, the data is very strong. If you have a CIMT carotid ultrasound or if you have, I wouldn't necessarily rush to do it on a 44 year old woman. A calcium cat scan, that's zero. I mean there's no data to be on a statin unless your cholesterol is 500. Something obscene. And so there are widespread over treatment. And this isn't a radical cardiologist. This has become the language of the American Cardiology and the American Heart association in a little tiny box on the algorithm. It just hasn't entered mainstream practice.

Cam, do you have other questions for us to discuss? I'm not sure what our timeframe was.

Well, I think we're about ready to wrap up. I know the importance of food. I mean we both talked about that and you both are experts on that. Anything else that you'd like to offer our listeners that you put into your diets other than you being almost plant free? Dr.

Mobile.

How about you, Dr. Khan?

Yeah, you know, there's a couple cute little reminders, but they work. There's a very famous food, Dr. Dr. Joel Fuhrman, multiple New York Times books and PBS specialists. He talks about G bombs every day. Try and get G greens, arugula, kale, spinach. I take romaine, if nothing else. B are berries, O are onions, onions and garlic. They're a very wonderfully healthy group. And part of the mid grain diet. M are actually mushrooms and S is seeds. And I left out B. There's two Bs, G bombs. B is beans. I forgot that. So, you know, that's a cute little quick one that provide fiber and sulfur, antioxidants, polyphenols, all the fancy words, but G bombs, greens, beans, onions, mushrooms, berries and seeds. Fun little stuff. And I actually purposely strive to get those in many days of the week.

I like people to look at Furman's ANDI index too. You know, the ANDI index is basically how much nutrition there is per food. Interestingly, Whole Foods lists the ANDI index on certain foods and like there's certain foods that have packed with nutritional, usually phyto based, plant based things but packed with nutritional density versus foods that have almost none. And if you look at the average American diet, it's usually in the Andy score of very low yellow or red whereas the green which is the high end scores things that we just don't think of eating that much. A little bit more, you know, like obviously more plants but even like heavier, richer, stronger, colorful plants.

Right. Again giving a shout out to a good friend of mine, my other Joel, nutrition doctor Joel Furman. But his book Eat to Live which goes through that concept nutritional density, health equals nutrition over calories, nutrients over calories. Book Eat2Live has changed many lives and helped many people because a donut is the opposite. No nutrition, lots of calories. The health ratio is very low. A giant salad with many colors is many nutrients at a relatively reasonable calorie value. If you just keep that idea in mind and think about it on your birthday, have a little fun, right?

All right. Dr. Mok, do you have any parting thoughts?

We had a great discussion. I really appreciate it. I'm glad we got to hook up. Even though you're at your restaurant here at home. I'm going to do my own vegan meal tonight at check. My wife's out of town so I have to be creative.

I'm totally inspired to get a continuous glucose monitor and find out what's triggering my sugar rises. So one thing I'd add, I have added in some variation of fasting to my protocol. I don't find eating breakfast is necessary and other people have an individuality. There's actually a argument online going on right now between mark Wahlberg and Dr. Oz on this topic. Breakfast good, breakfast bad. Of course, Wahlberg's not a doctor, but he's pretty into fitness and nutrition. I eat within about a 10 hour window now, which is not restrictive. 9am to 7pm it does favor based on actually published human data, lower blood sugar, lower blood cholesterol, better weight, actually better sleep in a recent randomized trial. Every other kind of fasting is a bit more difficult. I'm not going to eat every other day on and off. That's really the true intermittent fasting. So for most people we got too many calories and having a limit. And I just like this recently published data on 10 hours that people can adapt today just like that.

I think we're going to find in the future. The most potent drug we have right now is fasting. We just don't know the dosing, the timing, the frequency. I've been doing two days a week fasting for about a year and a half. It is difficult and I can't get my patients to do it. It's sort of a habit now. I sort of look forward to it. And then on the other days they do time restricted feeding. So I only eat between like 1pm and 7pm and now it's become a habit. But we're seeing is I have patients that come in with neurologic disorders and autoimmune disorders, Ms. and sojourns and rheumatoid arthritis. And we've done a lot of things. We're trying to change your microbiome, but the time restricted feeding with a little bit of intermittent fasting absolutely improves your microbiome. It's almost like the germs in your gut that are eating the hamburgers and eating the sugars and eating the rapidly digestible foods. They seem to die out and it tends to lead to higher biodiversity when you go through periods of starvation. If we look at the history of mankind, there was never a genetic selection for longevity, but there was a definite genetic selection for being able to survive periods of famine. And periods of famine have occurred in our history over the past couple thousand years where a lot of the population was wiped out that could not survive a famine. We had that left over. That's actually probably a key to why we get diabetes when we overfeed ourselves. We are a really a famine adapted race of people. We just don't exercise that enough. And I think just periodically doing it, people see significant health benefits, particularly when they're having, I think, gastrointestinal issues such as leaky gut, which leads to inflammation and autoimmune disease.

There's actually some very interesting animal data that completely supports what you're saying and I'm sure soon we'll see human data. But as I say, what you're doing is kind of the Olympics of using fasting for the average person. I'd be delighted if they just said 7pm I'm done eating. Because the chips and guac and salsa at 11pm are probably the worst thing you can do, let alone cookies, cakes and ice cream. So good point. Thank you.

Thanks so much. Take care.

Absolutely. Thanks, gentlemen. Appreciate it.

Bye bye.

Thanks for listening to Inside the Cure with Dr. Charles Moak. See you next time.