614: Whole Heart Solution with Dr. Joel Kahn, Holistic Cardiologist

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It is my pleasure to welcome Dr. Joel Kahn. He is one of the world's top cardiologists. He's got some unique ideas for aggressive prevention of heart disease. And since everybody in our audience has a heart, or at least I hope so, I think this interview will be very valuable to all of you. Joel, welcome. How are you?

Thank you so much. I'm great. And if anybody wonders what the heck I'm doing, I'm on a treadmill desk that I use in my cardiology practice most of the day, every day. So I apologize for getting a few calories burned while we're having this important conversation, but I was just going to mention example, and, you know, I had a standing desk and I found Amazon sold this really short treadmill that wasn't very expensive.

And it's just completely enhanced my clinic day. And my patients love the idea, and many of them have bought one, too.

Yeah, that's fantastic. I'm curious.

No discount code for anybody, right?

I'm curious, how many steps do you get in a day?

I try to get, you know, 13 before patients come. I'm here for an hour, prepping at two miles an hour. So I get two miles. And during the day, I have to slow it down a bit to be a little bit more presentable and.

Attentive to the details of the visitors. I'm hopping on and off, but I get about another five to six miles. So, you know, six, seven miles a day. You know, that's 12 to 14,000 steps roughly. So I work out in the morning at home before I come here, but I actually, on the days I'm in the office, I work out a little more gently because I know I'm getting this.

Well, you've got several books, and I got to tell you, I love the title of one of your books. It is kind of morbidly funny, but debt execs don't get bonuses. I think that's a good lesson for all of us. You know, know we've got to manage our health and our stress and so forth to get to that next level that everybody's trying to get to. But tell us about some of your, you know, general philosophies and techniques for preventing heart disease.

Sure. And there's just basically an odd observation. If anybody just pauses for a minute, you know, you're 50 years old and you go to your internist, and if you're a woman, you're being told, go get a mammogram even though you have no breast complaints. And if you're a man or a woman, you're told you're going to get a colonoscopy even though you have no colon complaints. And you sit back and you ask the question, what did they do for my heart? Well, hopefully your blood pressure was taken, your cholesterol was checked, maybe an EKG was done, maybe not, because insurance companies don't really pay for that routinely anymore. But we are much more aggressive at screening for asymptomatic diseases that are 10 times less likely than number one on the list, good old clogged arteries. Risk of dying, drop dead. Just had a very famous Canadian movie director drop dead in the last week reported to be a heart attack. And there's this assumption that we don't check for early heart disease in the manner we do for those other potential conditions. And I'm not the one that blew that up. But technology became available over 30 years ago in a protocol to screen people about age 45 to 50 for Silent Heart disease. And I just have bought into that for years and years. I was trained as a stent heart doctor. So I usually saw people at the end of the road having a heart attack. And now I'm really what I call upstream. I want to catch you 15 years, 5 years, 10 years and make sure you never have a heart attack.

That's not an expensive or even that difficult of a protocol. It just, it's a different paradigm that sadly, like many paradigms, takes 15 years to change doctors practice habits. Well, some of us don't have 15 years to wait. We're going to have a heart attack or bypass. So I just constantly trying to teach people by social media or in my clinic in suburban Detroit, test, not guess. It's a hashtag I use. TestNotGuess. Don't get about your heart.

What is that protocol you mentioned that people should have over 45.

Yeah. The minimum, actually, the single most important minimum is there is a heart CT scan that was developed in 1990 at University of California, San Francisco, a new exotic CT scanner. When it was introduced into practice, for example, in Michigan, 1995, you'd have to pay about $1,500 cash to lie in a stretcher, go in a tube, go home, get a report. Report comes back, zero. You have clean heart arteries. Report comes back, 200, 400, 800, 1200. A digital analysis. How much plaque was present? You've got a problem. And this is all in people that are asymptomatic. No clue. Maybe they're smokers. Maybe their blood pressure, maybe cholesterol, maybe diabetes, Maybe none of the above. Maybe a family history of heart disease, and it's reality serum. You probably want to know at age 45 or 50, if you're aging internally, you know, prematurely and aggressively. What has happened in the last.

25 years that it's been available is in most cities now. It's about a $75 to $90 test of all the insanities. In the city of Cleveland, the University Hospital gives them away for free. You call, you schedule an appointment, you answer two or three questions. Have you had bypass stents or heart attack? Because if you've had those, you don't need this test. You know you have heart disease. You know you got an issue going on that you need to work closely with somebody on all the factors that lead to heart disease. So it's called a heart calcium Connecticut scan. Lie down, hold your breath, go home. No IV, no injection. In my city, it's 99 bucks. Other cities, 75. Some cities, zero.

That's fantastic. So in the book, I think you're referring to it, and I want to make sure it's the same thing as a coronary CT scan. Right?

Coronary CT scan, Coronary calcium. Yeah, yeah. It's the beauty of the beast. Heart disease is a beast. Number one killer of men and women. Every year since 1918, the number one killer of men and women in the United States and in the western world countries is heart disease. Sudden heart attack, complications of bypass surgery, complications of stents, congestive heart failure. It only makes sense in every other disease. We try and pick it up years before it's fully manifest. The mammogram, the colonoscopy. So heart calcium, CT scan, around age 45, 50. Could be a little younger if you really have got some.

How often after that, Is it annual or what?

It's never annual. In my practice, if you're a zero, and I will tell you, at 63 years old, as a pretty healthy cardiologist, I have the zero score, which is really, really low risk, I'll do it about every eight to 10 years. If you're very high, I don't ever do it again. I know we got to wrap around. The only other part besides the CT scan is a few extra labs. I do go through these in many articles I write on LinkedIn and other places and in this book. But you obviously want to know your blood sugar, your kidney function, your cholesterol, your blood pressure. But for example, the most recent book I've written, because this is not the most recent, it's about a cholesterol called lipoprotein A. And I don't want to make this too complex, but can you imagine there's actually a cholesterol that 25% of people inherit from mom, dad, or both that clogs our arteries up. And it's not on the routine blood panel. It's not like some one in a thousand. It's one in four people. And if you inherit lipoprotein A, So it's a $30 blood test at Quest, at LabCorp at your local hospital. So I've been very aggressive measuring that in people for years, and I manage people with high levels, but I like when people add on a few extra labs. Now, if you've got a zero, you probably don't need the extra labs. You're in good shape.

Okay, so lipoprotein A for 30 bucks. What else? What other labs should you add on calcium?

CT scan would be a good one.

Which is the one. That's the one we just talked about, right?

Exactly. If you have a little more interest, there's been a word in medicine and cardiology for more than 100 years. Everybody knows the word inflammation. The middle word is flame like a fire.

You don't want to walk around with elevated blood proteins that indicate your immune system is ticked off at something. Could be ticked off at your obesity, ticked off at the quality of your diet, your omega 3 vitamin D deficiency, your bad gums, your bad teeth, your psoriasis, your smoking. So there's a very simple blood test patented by Harvard Med School called high sensitivity C reactive protein, or CRP. Another $30 blood test. You want to be very low. You want some confirmation that your body is responding to your lifestyle with low inflammation. You don't want to walk around every day of your life. I mean, there are certain diseases like rheumatoid arthritis, lupus, bad psoriasis where you have inflammation going on every day. The best situation is to have a low cholesterol and low inflammation labs like high sensitivity C reactive protein. Okay, so let me argue. If you're the lucky zero on your heart scan, you might just stop there. I will say everybody should know their vitamin D level D like David, a little less directly connected to heart disease. There are connections, but with the pandemic we have clear cut data that if you get into an infection right now, and we're talking about the infection that's dominating the world, of course, walking into it with a inflamed body from all those factors or with a low vitamin D is a really bad risk factor. So you know, you can buy a three month bottle of vitamin D3 at your vitamin shop for $26 for six months or three months. You know, either ask your doctor to draw your vitamin D blood level D like David, or just take more vitamin D than maybe you're used to taking, but not so much that you're crazy. It might take three to 5,000 units of vitamin D every day.

Okay, so let me ask you about cholesterol because there's been some more recent debate about this. I guess that cholesterol is. And you know, yeah, there you go. Cholesterol really isn't a big deal, some say. Now I think you're going to disagree with this, but I just want to.

Hear, you know, I spent an hour last night listening to a podcast on that topic. These are people that I'm friendly with and associate with. I think they're completely wrong. So cholesterol is a fatty molecule that comes from eating animal foods, meat, chicken, turkey, beef, fish, pork. Because you make cholesterol in the liver. And probably most of your listeners will realize a cow has a liver and a broccoli doesn't. So there's no cholesterol in your salad, in your broccoli, or in your baked potato, unless you put butter or cheese on top. And there is cholesterol in all animal foods. And there clearly is a connection between your diet choices and your blood cholesterol. In the 1960s and 1970s, we spent a lot of money in this country, nothing like we're spending now trying to figure out heart attacks and strokes. Because President Eisenhower had a major heart attack, President FDR had a major stroke from high blood pressure. We identified that a high blood cholesterol simple lab test was a risk factor. Your risk during your life of having a heart attack was higher. If your cholesterol is 300 than if it's 170. That's not disputed, but it was only one of many risk factors, which is why you read about somebody who's 103 years old and they smoked and they eat bacon and they eat butter and eggs. There are exceptions because these are risk factors.

You can go without a seatbelt every day and not have a fatal car accident, but wearing no seatbelt is a risk factor for a fatal car accident. So it doesn't mean destiny. You know, it's really like, why buy life insurance? Why might you want to know your cholesterol, Work on your diet and get the numbers under 200 as a relatively mild goalpost? Because in general, you're optimizing your chances and not developing strokes and heart attacks, need for bypass, need for stents. Don't imagine it's the only thing or even that strong of a thing. You know, you can't smoke. You need to measure your blood pressure, you need to know your blood sugar. You need to get some fitness in. From dancing to gardening to walking to standing to hardcore HIIT, boot camp, CrossFit, whatever you want. Don't do too much. Don't hurt yourself during exercise. But the debate to me is.

A loud, noisy distraction. Cholesterol doesn't matter what is fairly and without trying to confuse your listeners, it is debatable. You eat three eggs a day and I eat three eggs a day. One person raises their cholesterol significantly and one person doesn't. There's so much variability in our gut health and our gut metabolism and our genetics. It's not a standard formula. Three eggs equal a rise in cholesterol, equal a heart attack risk. If you're eating keto, if you're eating Paleo, if you're eating dirty keto with eggs and bacon and kind of a poor quality choice, at least get your labs drawn. You might be the person that your cholesterol shot up to 400. And I see those people and I think they're harming themselves just to be fair. The other side of the equation is it's mainly about blood sugar, processed food, insulin levels. I mean, there's nobody telling you to eat cookies, there's nobody saying drink more coke, there's nobody saying have more processed foods. Couldn't agree more. Everybody is either totally plant based, mixed Mediterranean, maybe more meat based, but there's no junk in those diets if they're authentic health experts.

Yeah, I'm waiting for the lockdown of all the fast food restaurants and the outlawing of French fries, I mean, that kills the lockdown.

They should just take Visqueen and go around every fast food restaurant and put closed till further notice. And that really would have been an upgrade to our health. I mean, we kept the liquor stores and the fast food restaurants open and we closed churches. And, you know, you can't possibly defend that in retrospect. It's crazy. And just get everybody to take some vitamin D. We would have done some good for people, too.

Yeah, right, right. Okay, so more plant based food or all plant based food? The egg thing is debatable. I know that's been around for decades. We've been going back and forth on that. You know, part of it is that men need cholesterol because it helps us generate testosterone. You know, what about that part of it? If you really cut that out, what do you think?

Number one, and this is a really esoteric fact, the brain has its own cholesterol production system. So we have no way actually to measure brain cholesterol routinely. Your blood cholesterol might be 150 and your brain cholesterol is high. Your blood cholesterol might be 300. Your blood cholesterol and your brain cholesterol is low. There's all kinds of. It's a fact, but we don't have the technology to measure it.

Number two, coming back, I happen to be studying cardiology in Dallas, Texas, in the mid and late 1980s as a trainee. And the Nobel Prize in Medicine was awarded at that time to two researchers named Dr. Brown and Dr. Goldstein for cholesterol research. And at their acceptance speech, they both said, cholesterol is necessary in the body, but the optimal level of cholesterol can be an LDL cholesterol as low as 25. To support all your vitamin D, your testosterone, your estrogen, your cortisol production.

You don't need a lot of cholesterol to support your hormone system. We have powerful medicines now, plus diet, plus exercise. It's not uncommon now to have a patient with a total cholesterol of 85 and an LDL cholesterol of 30. And all the research is for that severe heart patient. That's not a routine public recommendation, but for that severe heart patient, that's not only safe, but it's probably optimal to stop plaque in their arteries. Now, for most of us, those numbers are not necessary as goals, but until you get that heart CT scan, you really don't know for sure.

Yeah, right, Right. So that, that sounds like a great scan. And the additional labs, I think are a great idea. So any other tips you want to share as we wrap it up on lowering cholesterol? If someone's into the higher numbers, anything they should do outside of what you've mentioned, which is exercise, plant based food, Anything else? Any more specific?

Some people will do research or watch a documentary you can get online called Forks over Knives. Or a couple of years ago there was a really good document called Game Changers movie. They'll do their research. I've been totally plant based by choice for 45 years. No chicken, no turkey, no eggs, no dairy, no cheese. Feel great. Fish my weight. No fish. Keeps my weight stable, keeps my numbers good. And I like it. I've done it so long, I like it. Unfortunately, the world has exploded where eating plant based or vegan, whatever you want to call it, you know, is pretty damn simple in most places around the world for many people, they don't want to go there. Okay, so let's talk about the Mediterranean diet where we replace most red meat with salmon or mackerel and we eat lots of beans and peas and whole grains and we use olive oil instead of butter lard and we drink a little red wine instead of, you know, Mountain Dew and monster drinks, which is, if you're able to do it, a little bit fun and pretty healthy. And then finally I'll just give a shout out, somebody look up the portfolio Diet doc. I don't want to make a lot of changes, but I want my cholesterol down with diet. Portfolio Diet is a research based program at the University of Toronto. There's nice little handouts online. You just make subtle changes. More oats, more sunflower seeds, sesame seeds, a few more nuts, not honey roasted nuts, but nuts like walnuts and pecans, almonds. And then finally lots of what's called soluble fiber you might find in beans and all. And you can Lower your cholesterol 25, 30% with some subtle adjustment to what you're doing. And look at that.

I pulled it right up here. Yeah.

What's interesting, this was a research project about 20 years ago, university of Toronto. Relatively modest numbers, but impressive results. And then just as you can see, Dr. Jenkins is the. It flew by there, the reference. But just in the last couple months, I believe it was Harvard School of Public Health had a database. If you eat like the Portfolio diet or don't, there was a tremendous difference in your risk of stroke and heart attack and follow up. So it's proven a little beyond the original study, I think around 2008, that it not only might make your numbers better it might keep you out of a cardiologist cath lab, getting stents and the rest.

I've got to ask you about one more thing before you go, Joel, and that is something that I've been pretty impressed with the research on this recently and have started to practice it just a little bit myself. Intermittent fasting, right?

Very familiar. The leading expert on fasting in the academic world, not necessarily selling books on Amazon world is a professor at University of Southern California. Dr. Valter Longo. L O N G O I'd be happily endorse his book called the Longevity Diet a couple years ago is one of the best books on nutrition balanced science based, unemotional for sure. He developed something called the fasting mimicking diet. Can you enhance your health by eating less? And he's very reasonable too. He's Italian background and it's all about la dolce vita. You don't want to starve yourself every day. You're never going to have any fun. So it's a program where for five days in a row you eat less. Fasting, mimicking diet. You eat quality food and then you go back to a healthy diet the rest of the month. His research is amazing. This is a variation of what other people do every day. Doc, I eat between noon and 7. Every day I eat between 10 and 7.

That's an option that's easy. Just shrink that eating window.

For some people it works real well. The science is on both sides of the map in terms of is it really science based? I mean it makes common sense that if you skip breakfast you're going to save 3, 4, 500 calories, maybe more depending on what you're eating. But you usually compensate by eating a little more at lunch and dinner if you have tremendous willpower and good whole food plant based diets. Dr. Longo doesn't favor skipping meals. He likes portion control.

But it's not. The worst thing you can do is stop at the gas station, get the egg bacon cheese wrap because you're just running around in a harried way. Try and figure out how to take the time to make a bowl of oatmeal with walnuts and cherries or how to make a smoothie or maybe whole grain bread with some almond butter or something. That's what Dr. Longo likes in the morning. I think he talks about it. Book.

Excellent, Excellent. Good to know. Well, Dr. Joel Kahn, thank you so much for all of the wisdom. Do you have a website or any resources you'd like to share? The books are available on all the all the usual places, of course.

Yes, I have a very active practice in suburban Detroit, but we both do telehealth and people come in from all over the place. But it's all located at DrJoel Khan.com Dr. J-O-E-L-K-A H N.com links to my clinic, links to my podcast I do every week, links to six books and we have a fun time. A little bit more aggressive than the family doctor protocol.

Good stuff. Dr. Joel Kahn thank you.

Thank you sir.

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