America's #1 Heart Risk & How You Can Prevent It

Do you think someone can die from a broken heart?

The short answer is yes.

Really?

And there is an actual syndrome. Broken heart syndrome.

Really?

It is a thing. 50% of Americans have high blood pressure.

Really?

And the majority don't even know they have it. Most people if you ask them, you know what are you afraid of dying of? They all say cancer but it's really not the case. It's heart disease. He is a board certified cardiovascular surgeon. His tips for living well and protecting your one and only heart have racked.

Up nearly 50 million views on YouTube.

I am super excited to introduce you.

To Dr. Jeremy London. What is the main cause of us having heart disease, Heart attacks, heart conditions?

Nothing happens in a vacuum in our bodies.

It's all connected.

Everything is connected.

How much does vaping affect the heart health for Gen Z?

Have I seen really life threatening situations from vaping? 100%.

What have you seen?

The short story with vaping is.

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I read a stat that said 805,000 people have heart attacks each year in the U.S. one heart attack every 40 seconds, which seems crazy to me that this is such a big issue for us as Americans, and. And it sounds like around the world as well. So I'm curious then, what is the main cause of us having heart disease, heart attacks, heart conditions that affect us living a healthy life or dying?

To zoom out just a little bit further to put the perspective on this, worldwide, it's 20 million deaths a year. So it's the leading cause of death of men and women worldwide. And most people, if you ask them, you know, what are you afraid of dying of? Or what do you think? The biggest, they all say cancer, but it's really not the case. It's heart disease worldwide. Now, of that group, the most common reason is blockages in the heart arteries, and that's what causes heart attacks. We have arteries that are on the surface of our heart that bring nourishment to the heart muscle, which is just a pump. It's just, you know, that pump requires energy, and in our bodies, that's nutrition and oxygen. Well, if you get a blockage in there over time, usually from cholesterol buildup, that then creates a. Basically a roadblock to the heart muscle below. And if that gets tight enough or completely blocks, that's when you have heart attacks. And that's. That's the single biggest bucket in that 20 million. But there are a lot of different reasons why people get heart disease. You can have valve problems within the heart. You can have electrical problems. Those are the three most common buckets. And then there's, of course, congenital heart disease. People are born with abnormalities, and they all go in those numbers, too. But the majority of it is because people are getting blockages.

How much does stress affect heart health? If someone's just feeling, like, overwhelmed, burnt out, mentally in their head constantly, can that affect heart health or hurt you?

So the way I would look at this is nothing happens in a vacuum in our bodies.

It's all connected.

Everything is connected. Our mind, our nervous system, all connected to our blood vessels, our heart, et cetera. Is that a major risk factor? No, it's not necessarily a major risk factor, but it definitely plays a role in heart disease. It influences it 100%.

It influences your body feeling sick, and if your body feels sick, it puts stress on the heart. And that could. Yeah. So what would you say then are the three biggest factors of heart disease?

Sure. The first would be obesity.

Really?

Yeah. And along with that, you know, comes poor diet and insulin Resistance, high blood pressure, diabetes, high cholesterol, sedentary lifestyle. And we cannot leave out smoking, really, because that is the single worst thing you can do for your body. Again, thinking about it like a vacuum, smoking affects the lungs, it affects all the arteries, and it's the leading risk factor really, for heart disease.

Really?

Oh, yes.

So here's a question that most people are not going to like the answer to. Probably how much does vaping affect the heart health for Gen Z?

Yeah. So the short story with vaping is unlike tobacco use, we don't have the years of data, so it's hard to really say. You know, there's all the data of, oh, it's better than. We don't know what the long term implications are. What we do know is there's a lot of people doing it, they're doing it all the time. Because unlike cigarettes, you don't have to go outside.

You're smoking every second, right? Yeah, yeah.

You constantly see the blue lights all the time. You don't have to go to the room at the airport anymore. That now they've actually taken those out altogether. So the issue is we just don't know the long term. But the nicotine content in those vaping formulations is essentially unregulated. So they can have just multitudes higher levels of nicotine than cigarettes. And again, because you can do it all the time, the exposure is all day long. So nicotine in and of itself is a vasoconstrict, vasoconstrictor.

So it constricts.

So it causes, not the valves, the actual blood vessels themselves to constrict.

And what does that do when it's pumping through the heart?

Right. So if you think about it again as the heart, as a pump, you.

Gotta, you got the little example here.

Absolutely. So the big chambers down here, you have the right and the left chamber. The left chamber here is the main pumping chamber and it's pushing blood out through the aorta. That's why it's red, because it's got lots of oxygen in it to the, to the body. So if all of these blood vessels are clamping down and this pump is trying to work against that system, what do you think that causes high blood pressure?

Interesting. And that's one of the main causes of.

Exactly. Because high blood pressure over time does two major things. One, you get decreased what we call elasticity of the blood vessels. They become stiff, so they don't flex with each heartbeat. And as they become stiff, they can then become damaged and the Repair process from that damage is what causes atherosclerosis or hardening of the arteries. So you've got direct damage from the higher pressure. And then over time, because the left ventricle or that pumping chamber is just a muscle, what happens if you put any muscle time under tension? It's going to grow, it's going to get thick. Well, when the muscle gets thick, it decreases the size of the cavity where the blood comes from. So less blood is getting ejected from the heart, and then the end result of that, as it works against resistance is eventual heart failure.

Interesting.

And so it's really a continuum timeline, and that's why high blood pressure is such an important risk factor. And, you know, 50% of Americans have high blood pressure.

Really?

And the majority don't even know they have it. And it's one of the single most modifiable risk factors that we can have.

How can we lower our high blood pressure if we have it?

Well, the pillars that we talk about all the time, you know, a solid nutrition. Yeah.

Low stress. That's right.

Regular exercise, both, you know, with a aerobic training as well as resistance training, all of those things are really, really important. And you can modify your blood pressure significantly with just lifestyle changes. Now, many people do need medications, and that's not a failure, you know, but getting your blood pressure under control is really important. From a heart disease standpoint, how many.

Heart surgeries do you feel like you've done in the last 25 years as a heart surgeon?

You know, we've estimated this on multiple different times, because the beginning of my career, I was doing, you know, crazy, crazy numbers. Probably somewhere around 6,500 to 7,000.

Wow. Somewhere 6 to 7,000 heart surgeries in 25 years or heart operations in 25 years. What are the three things that all those people had in common that got them on your operating table with some type of heart failure?

Mm. So they don't have. All have heart failure. So I think that's. Yeah.

Some heart condition.

Exactly.

Gotcha.

And depending on why they're there, again, the three buckets, either blockages in the arteries, problems with the valves, or problems with the electrical system. That's why they get there.

So let's.

Let's go with the most common, which is blockages in the heart.

That's one of the most common when you see it.

The most common operation that we do.

60, 70%.

Probably. Yeah, probably 60% would be a reasonable.

As a blockage.

Yes. It would be a blockage in the artery that would be picked up either because patients were having symptoms or because they were in a high risk category and their internist or cardiologist recognized that and intervened before there was a problem.

What are the main symptoms someone might have if they're in. If they have, you know, that restriction.

Sure. So heart symptoms from blockages are. Is frequently referred to as the great masquerader because not everybody presents with what I call the TV heart attack, where it's clutching the chest, pain into the jaw, pain down the. Now many people do, but the symptoms can be very subtle. Even in that pre heart attack phase, there are warning signs. Well, if you have a blockage in one of the main arteries that's supplying again the pump, and that blockage gets significant enough as you exert yourself, you outstrip the amount of nutrients and oxygen that can get to that portion of the heart. What happens in your calf when that occurs? You get a charley horse. What happens interesting in your heart muscle is you have tightness in your chest, or it can be shortness of breath, or it can be abdominal pain even. And the symptoms can be very subtle. The key is that the symptoms come on with activity and then when you sit down, it's relieved with rest. That's referred to as stable angina or stable chest pain. In other words, warning signs of something potentially bigger to come.

If someone's having that type of a warning sign, what should they do? Should they.

That is, that is a red flag and you should be evaluated by qualified healthcare provider.

Do you call 911 right away or.

Is it not necessarily 911 as long as the pain goes away.

Got it.

If the pain continues, Absolutely. 911 is the answer. But if it's the kind of thing where you notice, for example, every time I take the garbage out, I get this little tightness in my chest and I have to stop for a minute. The pain goes away and I go walk back in the house and it kind of comes back. But every time I rest, just relieved. That stable angina, it is definitely something that needs to be evaluated, but not, not necessarily an emergency. However, if you're ever concerned, that's the safest route to take.

Wow. Okay, so again, I heard you in the beginning say obesity with poor diet is one of the main causes or one of the main reasons why people have heart conditions. Heart diseases, high blood pressure and diabetes also influences heart conditions or failures in a big way. Sedentary lifestyle. And you also mentioned smoking. We were talking about vaping a little bit, which we don't have the data it sounds like yet of how it actually influences the heart. But are you seeing or noticing signs or patterns of people coming in who also vape that are just happen to also be vaping that have heart conditions?

So think about the demographic of people that are vaping. Primarily it's usually younger.

Yeah, yeah, yeah.

So folks under the age of 40 that don't have a family history, they're not diabetic, you know, the risk of heart disease there is certainly lower. Now have I seen really life threatening situations from vaping? Absolutely, which is why 100% which is why.

What have you seen?

Well, there is a syndrome called evali, which is e cigarette vaping associated acute lung injury. And this is an injury that can occur from vaping one time from an inflammatory process that happens in the lungs. In these really young folks, they come in the hospital, they're so sick that even the ventilator, the breathing tube is not adequate to nourish their body with oxygen. And we have to put them on something called ecmo, which is an external lung circuit where we take blood out of the body, put blood back oxygen back into the blood and return it to the body. And these can be 18, 21 year old, 23 year old individuals and unfortunately we've had several that haven't survived.

Really?

Absolutely.

So these are all patients who have vaped, it was caused from the vaping?

Absolutely.

What's the youngest patient you've had to.

Operate on.

To place them on ECMO.

For the just as like a heart, heart failure heart.

So for heart disease, 23 years old is the youngest patient I've ever operated on for bypass surgery for blockages in the arteries. 23 years old, had a very, a strong family history of heart disease and they had a genetic propensity for very high cholesterol, which is not common, but it does occur. And their cholesterol was in the thousands, whereas Normally, you know, one at around 90 to 100, theirs was in the thousands.

Was this person healthy in general or were they not? They were more obese or more poor diet as well?

Absolutely.

So they weren't influencing the reversal of that?

They were not. And they would have needed medication to help do that because they had all of the genetic force behind them then to get to that spot and then they didn't take care of themselves on top of it.

So we don't have a lot of the data yet I'm hearing or the research around how vaping causes heart disease yet is what I'm hearing. But you've had to operate on many people who have come in because of vaping. Is that correct?

Yeah, it's not many, I would say. Yeah, I don't think that handful. Yeah, for sure. But I mean, you see three, four, five young adults not survive from an addiction and something that has become normative in our society today, you know, and I have three boys. Wow. And so it hits really close to home for me. I'm. I am really on a personal quest to get the information out about, about vaping. And look, in the end you're by your rules like I get it, but at least know the facts, at least understand that we really don't know the implications of this, that all of the, all of the chatter about this is a safe alternative. We don't know that.

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You think those people that came in, if they weren't vaping or weren't smoking, do you think they would have also been there because of other lifestyle choice? You think the vaping or smoking heavily influenced the heart failure?

So for sure, the, the cardiac patients, 100%. It's, it's like a, you know, 10, 12, 15 X factor when people are smoking cigarettes in particular. Wow. Yeah, for sure, for sure. I mean if you're going to examine like if we're going to take a step back for a second and say, am I healthy right now? You know, how would, how would you do that? Number one would be do you smoke? Let's start there. The next on the list would be alcohol or. Well, yeah, we can leave that one off for just a minute. It can even be broader than that. There's a real powerful tool just to put yourself in a category like how healthy am I? Excellent, good, you know, average, fair, poor. Believe it or not, they use that in research. And it just kind of put you in the mindset of where do I fall? Interesting. Then what are you going to do next? You're going to weigh yourself. Right.

Body mass index, which is not a.

Great indicator of longevity. And we can talk about the better ways to do it, but it's a good place to start. Right. Then just measuring your abdominal girth to your height. That ratio is very meaningful. Again, we talked about obesity, this over consumption problem. Well, we know that visceral fat, or the fat that's in your belly, around your organs, is the engine for inflammatory diseases, particularly heart disease.

Yeah. And if you have a lot of excess belly fat, then you probably have fat around your heart too.

I'm assuming you do. But it's this fat in particular, the.

External fat, the visceral, the visceral around.

Your organs, not the fat that's in, you know, under your skin, in between.

Here, inside, inside, that you really belly fat.

It's the beer belly.

Gotcha.

Is really how I would describe it that really influences the overall inflammatory process in your body. And it's a known risk factor for metabolic syndrome and type 2 diabetes. What would be next on the list? Resting heart rate. You know, kind of where am I on that scale? And start with those things. Then you start to look specifically at lifestyle. You look at diet, you look at alcohol. You know, where I'm on the scale, you look at your sleep. Simple things with sleep. Am I going to bed at the same time every night? Am I getting six to eight hours? Am I waking up at the same time? And then as you mentioned earlier, like, what is my mental health status? Where am I with that? And that can be tough. But there's some great online questionnaires that you can do and that's a great place to start. Like, how healthy am I? Not just from a cardiac standpoint, but in general. And sometimes just kind of knowing where you are currently as an opportunity opens that door.

I mean, we're in a society right now that people praise those who are, you know, plus sizes or don't shame someone for how big they are or things like that. And I'm all for not shaming or judging people, but when it comes to people's heart health or just overall quality of life.

Yeah.

If they're extremely obese and they're not taking accountability for their lifestyle decisions, they might be causing a lot of physical harm to themselves. More medical bills, medications in the future, and also putting strain and stress on the people around them by not taking care of their Health. I'm not saying you have to have a six pack and be perfect. That's not what this is about. But what do you say as a doctor to society that says, you know, celebrate anyone for how big they want to be, it's a good thing, you know, let's not shame anyone. How do you navigate that to, to support people's emotions and feelings and how they feel or their, their own personal experience in life versus leading them to take accountability in their life and take responsibility for their health? Not being perfect, not being a cover model or something like that, but like making sure you're responsible for your health, for your future, the family you have in the future, the people around you. How do you navigate that? People's emotions versus practicality.

You've touched on so many things there. But let's try to slide down the first slippery slope, which is how do you enter that conversation and potentially change that narrative? Because I agree with you that I think that it's dangerous to validate a lifestyle that we know from the data is not healthy on so many fronts. So how do I do it personally? When a patient comes in and you start that conversation right, like they tell you, I don't have any risk factors and they're 70 pounds overweight, you're like, okay, let's take a step back. I think many times allowing people to understand that, that the life they've lived to getting to that point doesn't necessarily define what their path is forward. And when you, when you kind of give them a new set point of okay, you've, you've gone down a road and it's gotten you to a place where now you're potentially in trouble, or if you're seeing me, you probably are. How do you picture yourself? 5 years, 10 years, who's the person you want to be? And almost invariably it's not who they are at that point. And each individual person is so different on how you have that conversation. But I do think that that overall narrative is, is dangerous because it creates an insulation in a way that, that you're really abdicating a potentially very unhealthy scenario. And so I think that backing into it from that perspective, from a non emotional way, not totally nonjudgmental, and then break down each of those things that you just talked about into really small steps for people because most of the time folks are really overwhelmed. They don't really know where to start. They're scared. They're scared that they're already at a deficit. They're worried they're going to fail.

They're already in shame 100%. Food relieves some of the shame feeling many times.

Many times. And I don't know who said it, but I love that quote. You know, that fear is ocean wide, but only an inch deep. And I think that if you can help folks take that first step and it can be simple stuff, just walking. Yeah, like many of those folks are just really uncomfortable walking into a gym. And you can appreciate that and all of the. You need to be comfortable with the body that you are. That doesn't help. Now do I think it's about finding, as you point out, the healthy weight for you. That doesn't mean that you're a swimsuit model necessarily. And so you have to set appropriate goals. So I think allowing people to identify where they are and the person they want to be and then helping them break that down into really small steps has worked really well for me in the practice. Yeah, it really has.

I guess it's challenging because if someone is 70, 100, 150 pounds overweight, it's not just a, you know, physical, practical thing for them that got them there. There's some type of emotional or mental trauma or blockage also. Not just a heart blockage, but an emotional or mental blockage that has allowed them to get to that place of not taking care of themselves in a certain way around health. Maybe they're like amazing people and they're good for other people and they're smart and they're talented, but something has been blocking them emotionally or mentally to want to create that for themselves. And I can imagine how hard it is to reverse it, especially if it's been years of living in a familiar pattern. So it must be extremely hard. But how do we, how does someone watching this get through to someone in their life who is extremely overbeast and is just allowed year after year, 10, 20 pounds a year to pack on every year and they're not making any changes. It's almost like you need to be completely obsessed for a whole new identity and lifestyle if you're going to reverse £100, £70. It's almost like you have to think a different way and you have to start healing and mending certain things that caused those actions to get there, I'm assuming. But how does someone who's watching this, who has someone in their life they care about, who's struggling with this, that's afraid for their heart health?

Sure.

How can they communicate to the person they love in a way that doesn't judge them but holds them accountable to start taking action.

Yeah. And I think that that certainly is.

That may not be your expertise.

Yeah, you're stretching out outside of my wheelhouse, but not entirely. I mean, from my perspective, I have the benefit that if they're in my office, they're having a touch point in their life, that we are at a new crossroads. And so it enables to utilize that as life is a series of choices. Right. There's many times where we know better, but we don't do better. You now have a real reason to do better. Yes. And here's why. And here are the things that I recommend. And sometimes when folks fall into a level of complacency, as you've described, to break that pattern can be really tough. And so I think that obviously from a supportive place always makes the most sense. But when in doubt, fall back into the data.

Share the data.

How you started, how we started this conversation. It's not cancer that's going to take you most likely if you continue down this road. Yeah, we know what the number one killer is of men and women. What do we need to do so that you don't get there?

Yeah. And how much does alcohol affect heart disease?

So obviously this has been a hotly debated topic that, you know, when we start talking about nutrition or alcohol, it rivals religious conversations with many people, with the emotional embodiment of how people step into this.

But just on the data alone, culturally, society.

Let's talk about what happens when you drink. Okay. Alcohol is broken down into two things, acetaldehyde and acetate. Not to give you a bunch of chemical names, but acetyl aldehyde is what makes you feel good when you're drinking. If you find that to be good, it's also what's toxic to every single cell in your body.

So poison.

100%. And that is an undeniable fact. And acetate is basically empty calories. If you don't burn the acetate, you're going to turn that into fat, essentially. So those are the two major components. So when we look at this from a stepwise fashion, number one, it's directly toxic to cells. Number two, additional acetate goes to fat. Where does that fat go? It's visceral fat, abdominal fat driving this, this engine, not to mention the fallout is typically speaking when you're taking in extra calories. When you're drinking, you're not mindful of what you're putting in your mouth. We've all been guilty of such, you know, so your, your over consumption then becomes More of an issue. So there's a lot of ramifications to alcohol, but in the end, you know, alcohol is a personal choice of recent. Even moderate alcohol use has really been questioned, and I think that data is going to come out very strong in the next two to three years. Personally, I think alcohol is going to be the new cigarettes in the next five to 10 years. I think there's going to be warning labels on alcohol very similar to cigarettes.

I hope so. I mean, I. I'm sure there's a lot of people in business who run alcohol businesses or restaurants that probably don't like me saying that, but I just don't know the benefit. There's got to be another way to sell product that people can enjoy that doesn't hurt them.

Yeah.

You know what I mean? There's got to be something else like that society can come up with. But I've never been drunk in my life, so I've never known what that feeling is. I've had sips of alcohol, but I've never been. Had a full beer. I've never had like, wow, a glass of wine. I have only had one sip of wine. One time was with Gary Vaynerchuk because I told him I'd do it like 10 years ago. And I was like, this is the one and only time I'm doing this and I've never been drunk. And I don't feel like I'm missing out because I just. I know what it does to the body. I know how it impacts the mind and how being around people who are extremely drunk is different than being around people that just drink a little bit. But when you're around really drunk people and you're not drunk, it's not enjoyable. It's different. If it's like, I'm having a glass or two, it's like, cool. I can be around that. It's fine. But it's like, if you're just unable to think clearly, we're not having fun.

Yeah.

And you don't look like your body is having fun the next couple days either. So how is there a benefit to this? You know, I get it culturally, religiously, for some religions, societally, there's benefit for bringing people together. But you can come together and play it. You can come together and have fun and talk and open up vulnerability versus needing the courage of alcohol to start sharing the truth.

Yeah.

Knowing that the damages are way stronger now. I might die of some random thing and be like, oh, if you died of this, you could have been drinking your whole Life and whatever, but I just don't think there's benefit to it personally.

There's. There's not benefit.

And it hurts your. Your heart. It sounds.

It hurts every cell of your body. So I had a little different path than you.

Didn't you used to drink?

I did, but I want to validate.

You were like a good Southern boy who's like, let's drink every few nights and, you know. Well, tell me your drinking experience.

I'm not going to admit to too much. No judgment.

I don't judge. I'm just.

I enjoyed. I enjoyed alcohol. I enjoyed wines. I enjoyed pairing wines with food. I enjoyed the whole experience, like you discussed. Yes, I did. It was. It was very much part of my lifestyle. No question about it. And when I started to not feel well prior to my own cardiac situation, I said to myself, well, I mean, the one thing you can do at least is quit drinking. At least remove that from your life and make sure. Because I didn't really know what was going on.

See what happens.

See what happens.

How old were you?

I was 55 at the time.

It's like a year ago, or.

What was this? No, thank you. That was three years ago. And it didn't really make a lot of difference because I had something else going on. Yes, it made some difference for sure. But once I knew what was happening and I got a stent and I felt much better. The first thing my wife said to me, she's like. And she doesn't drink, by the way. She said to me, are you gonna start drinking again? I said, this has been a year at this point. I said, no way. I don't even want to because of all the things that you just mentioned. I like to live my life untampered. You know, the good times are the good times. I deal with the bad times accordingly. And with alcohol, people drink it both times.

Yeah. To celebrate, and they're sad.

And when you're sad and it's the one drug that your friends will encourage you to continue to do.

Let's have a beer.

Yeah. Yeah.

And one of the other things that really got my attention that you said, is that it's really not fun to be around a bunch of drunk people if you're sober. And I didn't realize that for a long time.

Interesting.

And it. I can tell you that removing alcohol for my life was probably the single most transformative decision I've made as an adult.

That's great.

There's no question about it. And, you know, I heard Lance Armstrong say On a podcast not long ago, when he was talking about, I guess he's removed alcohol recently or in the last year or two, he said, I've never heard anyone say, I regret moving alcohol from my life. I wish I hadn't quit. And I was like, that's so true. And for me, it is like this magic sauce of every day is the same, every day is predictable, I'm clear. And people feel like I'm very judgmental when I talk about it this way. I'm not at all, like, when I say your body, your rules, like, go.

For it, live your life.

I don't have any room to be judgmental, nor do I want to be. But it's kind of like when you read a good book or go see a good movie. You want to share that experience. And that's kind of the sense I got from you when you were sharing your experience without alcohol. I have seen the contrast of that and just how powerful that change has been for me.

And so life has gotten better for you, no question. Yeah.

On all fronts.

Yeah. Health wise, relationship wise. You've saved me money, like, all these things.

Absolutely.

Yeah.

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Quince.com Lewis now do you wish you could go back and quit sooner or do you feel like, okay, it served a purpose for 50 years of my life and now.

Well, yeah, I mean, I do because it's been so powerful that I do wish I had realized it sooner, but it just wasn't my path.

Yeah, exactly.

Wasn't my path. And I'm okay with that.

Yeah, of course.

You know, I'm enjoying it now.

Yeah. Yeah. I'm curious about this.

This.

You've done over 6,500 plus heart operations, heart surgeries. How many hearts have you held in your hand?

Well, all of those.

You put them.

You like take it out of the body or some of them, you know, like.

No, it's every, everything remains in the body. But you have to manipulate the heart. So the arteries that I was talking about on the front of the heart are these red, red lines. So if we're operating on the front of the heart, the heart can kind of sit here, but if it's on the back. But if on the. You're right. So we stop the heart for the majority of these operations.

Stop it.

Utilizing a heart lung machine.

Holy cow.

So the blood, the blood continues to go around the body, but not through the heart. We put a, we put a clamp.

Here, otherwise there's blood coming out.

Exactly. And then we infuse the heart with a high potassium containing cold solution that puts the heart muscle in a hibernating state. And then we can actually maneuver the heart open the heart, that's how we fix the valves. That's how we do all of that. And then we maneuver the heart so you're actually handling the heart, when you're doing all those things. But no, we don't remove it. Like.

Yeah, yeah, but you're kind of adjusting.

Absolutely.

The chest cavity.

Sure, yeah.

What is that like holding the heart of a human being?

You know, I look at what I do as an honor and a privilege, honestly, and it starts well before I ever get into the operating room. And that's the relationships that I develop with my patients. And that is just one component of it for me. For the patients, it's like you've had my heart in your hand. I get that comment a lot. You know, I think it's a. And I don't want to deprioritize or belittle the comment that they're making, but when you're doing something every day, it becomes part of the routine. But again, to develop a relationship that there's enough trust that I'm given that opportunity to do that. That's what's meaningful for me.

Now, this may be very sensitive topic. We don't have to talk about if you don't want to, but I'm assuming you've been a surgeon for 25 years. There's been people that haven't made it from surgery, Right, Sure. Have you ever talked about that stuff of what that is like when you're invested in a person and you know how high risk it is, like they may not make it either way and you've got to go in and operate and then they don't come out of that alive. How is that impact you either emotionally, mentally, confidence wise? Just kind of. How do you deal with that in general? I know a lot of doctors have to face this, unfortunately.

Yeah.

You know, brain surgeons, heart surgeons, this is. This happens, unfortunately.

Sure.

Obviously you hope it doesn't happen that often, but what has that been like for you?

So for elective operations, lowest risk operations, the risk of patients dying is. Is 2%. 1 to 2%, which sounds like a small number until you put it in the perspective of 6,000 patients. Right, right. And so if you ask me what the single most difficult part of what I do is, it's patients dying.

Wow.

And that's no easier today than it was when I started 25 years ago. It is absolutely no easier. And you know, you mentioned the patients that are really high risk and aren't going to make it. You know, honestly, from a mindset standpoint, if it's a real Hail Mary operation, the expectations with that patient and the family are very lower.

Oh, man.

But for elective operations, when someone walks into the hospital and they're a mother, a husband, you know what? And they fall in that 1 to 2%.

Oh my gosh.

It is, it is really, really, really difficult and remains so to this day. And I still wake up in the middle of the night thinking about some of those losses over the years. But you know, in the end with when and if that were to ever go away, I would quit what I do. What do you mean? Because if, if that sense of attachment and the importance of that event occurring and the way it impacts me personally was never.

Yeah.

Then I don't think I should be doing what I'm doing.

If it didn't bother you or affect you.

Exactly, exactly. And you know, you do, as you mentioned, have to compartmentalize because you can't take that home and you got to get up the next day and you got to come back.

You can't do it at heart surgery the next day. And thinking about that.

Right.

I mean, obviously you're thinking about it, wanting to do the best job you can. Absolutely. Sure you're taking the right actions, but you can't. I hope this doesn't happen again.

You can't not go into the operating room with that mindset. And you have to compartmentalize.

How did anyone teach you? I don't know if they teach you this in med school, but did anyone teach you how to navigate when you lose a patient? Like how to process that emotionally? Or is it more you have to just compartmentalize, do the job and almost like not stuff it, but stuff the emotions so you can show up your best self the next day?

So the first part of your question, can you teach that? No. And it doesn't really happen until you're technically out of training entirely.

Yeah.

And the responsibility is 110% on your shoulders.

You're like 10 years in as a doctor training student. You're like, you've done so many reps.

But you're not truly the responsible. The buck doesn't stop with you.

Yes.

And until you get into that situation, it's very difficult. It's like trying to instill ownership into someone as an employee. Right. Like, you can't really do that until they're there and they're part of your business and what have you. And they either have that or they don't. Same thing as a physician, as a surgeon. You know, until you show up and all of that responsibility is on you. You don't have that emotional attachment, even though you see it and are part of it in training because you've seen.

Other doctors that you were helping or guiding.

Absolutely. And you're still, of course, I mean, you feel badly in those situations. Not that you're non emotional, but you're.

Not the one in there doing the job.

You don't have to go out and look family in the eye and have that conversation.

I don't know how you do that.

Yeah, it's, it's not easy and it's never gotten any easier. Oh my goodness. Yeah, it's never gotten any easier. It is not, it is not the, the fun part of my job. It is not.

Has there ever been a patient that has come in on the operating table that you said this is the biggest long shot of success, like there's a 1% chance this will work and, or something like that and they have somehow recovered and lived a longer life because of that operation?

Absolutely. I mean, yeah, absolutely. I think most cardiac surgeons would identify with that too.

Just like miracles.

Yeah. I mean, look, we never walk in the operating room alone. No, that's, that's the bottom line, that we're just people operating on people. And there's certainly, you know, we always do the best we can, but the end is not up to, is not up to us. That's that ultimate, the ultimate outcome is not up to us. But we certainly have taken patients, particularly younger patients that come in with really grave problems. We're going to give them an opportunity, even if it's a very low percentage, because why wouldn't we? Of course, you know, if somebody's lived a long life and they're in their 90s and they have multiple medical problems, they come in with that same problem. It's a different conversation with the family.

Yeah, yeah. Wow.

But absolutely, that, that does occur.

Do you have a ritual before you go into surgery and do you have a relationship with God where you bring God to the, the room with you?

So I go through very much a, a process. It doesn't necessarily happen right before the operation, but days leading up potentially. And much like military or sports, where I visualize the operation that I'm going to do, I then identify the three or four worst possible scenarios that I can get into. Wow. And how I'm going to get out of it.

That's smart.

Because, you know, we never rise to the occasion. We always fall to our level of training. I mean, that's just human nature.

Military 101. Exactly.

I mean, I like to occasionally believe that we do rise to it. Occasionally, but that's under duress. You can't count on that, no. And so unless you train for it.

You'Re gonna fall to the level of.

Your training every time. And so that's, that's absolutely what I do. And then I always bring it back the morning of when I see patients before surgery to the patients that we're actually going to be operating on that day. Because I tell patients in the pre op conversation that I can't guarantee them that we're not going to have bumps in the road. But what I can guarantee them is they're going to have 110% of my attention at all times and I'm going to care for them like they're my own family.

Wow.

And that I truly mean.

That's great.

And I think that that's how I express to them that I'm truly going to be a part of this and fully engaged.

Do you bring God into the, your, your ritual at all or is that not your life?

I, I don't specifically.

Some doctors are full faith based and other doctors, absolutely.

I just gotta, I am a very, I'm a very spiritual person. I'm not a very religious person. And I also find that with the breadth of religions that, you know, there's times when it's appropriate and there's other times when it's uncomfortable for patients. And so my job is to try to make them as comfortable as possible. And so I want them to know that I'm coming to them fully engaged.

That's great.

And open and fully responsible.

You know, a lot of the topics that we talk about on the School of Greatness is around relationships. I think relationships is one of the keys to either living a fulfilling life or suffering in life based on the quality of your relationships. I'm curious, from a heart surgeon standpoint, do you think someone can die from a broken heart based on relationships? Not life? Again, the mind and the emotions impact the heart so much if they feel devastated from a loss, grief, a breakup, a divorce where the heart just cannot go on.

The short answer is yes. Really? And there is an actual syndrome.

What is that?

Tokasoba's cardiomyopathy or broken heart syndrome.

Really?

It is a thing.

Come on. So you could be a healthy human being, have none of these, you know, workouts, absolutely nobody fat.

Now, it is most commonly occurs in women over the age of 55 or 60. Most commonly it happens in men too.

You've seen this?

Oh, absolutely. We see it multiple times during the year. Typically, as you pointed out, it's after the death of a loved one, a financial loss, major emotional stress. So we think, and we don't truly know the cause, that it is an overstimulation of the autonomic nervous system, which is that fight or flight or the rest or digest. It's like an imbalance of that that then causes like acute heart failure. And patients present just like they've had a heart attack. And many times they end up being evaluated by a cardiologist, actually having the dye put in the arteries, the catheterization, and they have no blockages. But the heart function that was before normal is now down to like 20%. Now here's the, here's the good news and bad news. The majority of these patients get better just with support, some medications, support and time. And it gets better.

You know that old saying, it's not what you say, it's how you say it. I think that goes for how we live too. It's not just what we do. It's the energy, the intention, the presence we bring. And that's exactly what the Range Rover.

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But the death rate is very low, somewhere around 1 to 2%. Men, it happens much less commonly, but the death rate is much higher, 5 to 8%. There was some research early on that this maybe has something to do with the decrease in estrogen, which is why we're seeing it in perimenopausal and menopausal women more commonly. But men get it, too, so those theories aren't holding water across the board. So we don't really understand it, but yes, you can die from a broken heart. And we, we see it, and we see this syndrome. I have had patients that I have operated on that have been really sick, and then their family member comes in two weeks later with broken heart syndrome, and they're both in the hospital. Oh, yeah, it's crazy.

But you can't operate on broken heart syndrome.

No, you don't have to operate.

There's no blockages.

There's no blockages and the valves are working fine. It's just that the heart function, that heart pump that normally is strong is now weak. And with time and support, thank goodness, the majority of them come. Yeah.

Wow. Don't start drinking when you have a broken heart. Don't start overeating and drinking.

That's, that's, that's good advice. Yeah, that's good advice.

What is the difference? You know, I hope I never witnessed this, and I hope no one has to witness this, but what is the difference between someone having a stroke or stroke, like symptoms.

Sure.

Versus a heart attack or heart attack, like symptoms? What do they do? How do they respond? What are they saying between the two?

That's a good question. And I think that it's, it's not an uncommon confusion because people think that, that there, there's a lot of overlap and sometimes there can be. But let's start with stroke first. Okay. So that you understand what's happening. Basically, with a stroke, it's lack of blood flow to a portion of the brain.

And does the heart influence the blood flow to the brain?

Not typically in standard stroke symptoms. And I don't want to get too far in the weeds. There are cardiac sources that can cause Strokes. It's not a blood flow issue though, from a heart problem most of the time. Where's the most common places that strokes come from? It's blockages in the carotid arteries that break off. Pieces break off and go north and cause blockages in the small arteries in the head and then cause a lack of oxygen and nutrients to the brain, just like a heart attack in the heart. So the, the essential problem is the same. The symptoms are very different.

So when someone's having a stroke, what are the symptoms that you'll see or notice?

The things that you want to look for are changes in speech, drooping of the mouth, weakness, typically on one side of the body and not on the other. But it can be, you know, there can be some crossover, but it's usually facial changes, slurred speech, visual changes, and one side of the body, meaning upper extremity, hand and or leg not moving properly, weakness. Okay, so that's a stroke and that is a medical emergency for 911 now. Absolutely.

Stop what you're doing 100%. Call A paramedics, get them to the hospital.

Absolutely. That is, that's a medical emergency, as is a heart attack.

And what are the main symptoms of a heart attack?

So the main symptoms are going to be crushing chest pain, typically described as like an elephant sitting on your chest, Shortness of breath, radiation of pain into the arm or up into the jaw. That being said, as I mentioned earlier, can be the great masquerader. Patients can have intense abdominal pain that doesn't go away. It can be difficult to discern. But those symptoms of crushing chest pain, that does not go away, pain that radiates or into the jar, shortness of breath. 91 1. 91 1, 91 1. Absolutely.

I hope I never have to witness that. But that's good information to know. So you're taking action as opposed to, ah, you'll be fine or, you know.

And always when in doubt, you're never, you're never going to be, you know, you're never going to be criticized for calling 911 and going to the hospital when there's a concern the commodity is too great to not do that.

Yes. Yeah, you got to take care of your life. And what would you say are the three biggest things then everyone should be adding to their life to help their heart and the three biggest things people should be removing from their life to support their heart health. Okay, we talked about some of them already. Sure. If you're like, here's the three things you need to add to your life and three things to remove and you'll improve the quality of your heart health much better. What would you say those things are?

So let's talk about the things that you should add, because I think people are much more willing to add things to their life than to remove things that they've gotten accustomed to or they've enjoyed. So I think the first is to move every day and not live a sedentary lifestyle. And that comes in a lot of forms. Ideally, like if we're following the data, what do we want that to include? We want that to include aerobic training where you are getting your heart rate up at least two to three times a week significantly so that you can move what's called your VO2 Max. Again, a fancy term. What does it mean? It just simply means how efficient your cardiovascular system is working. So the better your VO2 max, the more efficient your heart is working. That increases your health span and lifespan. Probably the single most important Predictor, honestly, is VO2 max. Then along with that, is resistance training so important? As Gabrielle Lyons says, muscle is the organ of longevity. Why does she say that? Well, obviously, having a solid muscular mass as we age, because we know we're going to be losing muscle mass after the age of 30. It's dramatic having that in place. You're more stable, you're less likely to fall. You're. You're able to pick up your grandchildren and pick up suitcases and function, have a functional life. In addition, muscle is a glucose sink or a sugar sink in our bodies. And maintaining stable blood glucose levels is critical not just for cardiovascular health, but for chronic disease in general. So I think exercise is so important to add. I think the next one would be a solid sleep hygiene program because you as an athlete understand that the biggest gains happen during recovery. And it's hard for guys like you and me that just want to go harder to get those results. Just push harder, harder sometimes to take the step back and actually allow your body to recover. And it's not just your heart and your muscles, it's our brain, too. Our brain rejuvenates when we sleep. That's when all of the waste products that have occurred in the brain during the day get washed out. So sleep is important across the board, both from a cardiovascular standpoint and whole body. And then I think the third is what you mentioned earlier. I think relationships are really, really important to longevity. You know, my dad's about to be 89 years old this month actually, and he called me one time and said, you know, I'm going to give you one piece of advice. As you age, he said, keep your friends really close to you. He goes, because you're not sure which ones you're going to lose, which ones are going to be able to communicate. Because having someone pick up the phone and just say, hey, what you doing? Yeah, or how are you doing? He goes, not that you have to make any great plans, but just that connection, I think is a really, really important factor.

That's cool.

In the reasons we get up every morning. And that really stuck with me when he made that comment. Good wisdom, particularly on the eve of his 89th birthday. And he said this actually years ago. It wasn't recently.

Wow. So three things to add to increase your heart health is to move every day. Aerobic and resistance training, have a healthier, better sleep hygiene program, get quality sleep every night and improve the quality of your relationships. And what would be three things to remove to improve your heart health?

Okay, so the first would be be conscious of what you're putting in your mouth. Remove the processed and ultra processed foods and added sugars because glucose management, sugar management is such an important risk factor. When we look at things like type 2 diabete metabolic syndrome, all of these things that drive coronary disease. As we discussed earlier, obviously ultra processed foods, again, driving this inflammatory engine. So removing those, focusing on a whole foods diet and really just being thoughtful about what you're putting in your mouth. The next one is obviously smoking. We got to remove that from the list.

And vaping.

Right. I would love to include both. If I could support it with the data, I would definitely put it on there. But I think that ultimately. Yes.

Well, the data of. You've seen young people come in your operating room.

Absolutely.

From vaping.

Absolutely.

That has impacted their heart. I mean, that's your personal data. You haven't seen the data in the literature, I guess. Right, but exactly. And the third thing to remove.

Yeah. I would have to put alcohol on that list. Both from my personal experience and from my clinical experience that the patients that I, you know, the patients that I care for, that don't drink are a different group of patients.

Interesting.

Than the ones that do.

Interesting.

Just because typically the rest of the pieces of that lifestyle also go in line with that mindset.

Yeah. It's hard for someone to be healthy with their sleep and prioritize sleep, move their body, eat really clean.

Right.

Have good relationships and then also be an alcoholic.

Right.

Like it's hard to have, you know, it's like if you're doing all these things. Well, you see the effects of alcohol, it's hurting my sleep, it's hurting my relationships, it's hurting my. My fitness levels. I can't train as hard. So you're probably more mindful. Maybe you drink every now and then, but you're not drinking every night. You know, you're more mindful if you're conscious of all these other things, but not here. Something's off.

You know, I think that brings up a point. You know, we all have our own instruction manuals. Yeah, right. Like, yours is different than mine. Your diet is going to be a little bit different than mine. It's about what. What works for you. And I think a big part of this whole journey is. Is figuring out what that instruction manual is. And these are kind of the. The major levers. And then you need to figure out how and where and when you're gonna.

Yeah, exactly.

Work after those.

I mean, and I. And I speak with a lot of conviction, but I hope that people watching or listening to both of us, you know, if people want to drink, drink. You know, my. Yeah, I know I don't live a perfect, healthy lifestyle. I have too much sugar. I probably have too many processed foods, and I know that, but I'm conscious of it. And I have more whole foods than I do processed most of the time. Yeah. But I also know when I'm doing it, I'm like, you know, I need to be doing better.

That's right.

Let me pause this.

What did I say earlier? We know we know better, but we don't do better.

So it's about being, you know, being conscious of it. If you are drinking, it's about like, okay, I'm only gonna do this once a week maybe, or once every now and then or something like that, and really try to limit it if you can. No one needs to be perfect, and you don't have to worry about that. And I'm. I'm not here to judge people, but I am here to elevate myself and others to living a better life. And if that means calling people up, then that's what I want us to do.

Absolutely. And it's about. It's about progression, not perfection.

Exactly.

And you're right. Like, even for me personally, if I'm eating whole foods, 80% of the time, it's amazing. And 20% of the time, I fall off. That's a W for me. That's a win.

It's a big win.

And I'm comfortable. And I'm comfortable with that. For me, yes, and when you talk about, you know, like, how do you evaluate where I start with my health or, you know, what's the one thing I would say do? It's very difficult when we talk about all of us as individuals to give that one thing. Because if I came to you and said, well, you need to move every day, you'd be like, well, I do that. Like, I don't need to do, I don't need to do that. What we need to do is we need to identify what we're bad at.

Yes.

You know I'm a terrible sleeper, right?

Yeah.

So I need to work on my sleep. That's my Achilles heel, you know. And so first, having the intellectual honesty to identify those things that you don't do well is the greatest opportunity to move the needle with your health span.

That's amazing. And I want to ask you, I know a lot of people are confused about this. What is the difference between a heart attack and a panic attack? Because some people have a panic attack and they think I'm having a heart attack. What is the difference? Difference.

It's tough to, to tell the difference many times because the symptoms can be so similar. And panic attacks can be very physical as well, of course. And you know, so what are those symptoms? Well, some of the things we've already talked about, shortness of breath, sweating, chest discomfort, you know, nausea, changes in vision, you know, all these things, they could be panic attack, they could be heart attack. How do you tell the difference? Well, panic attacks typically are brought on by emotional scenarios. Not always, but typically speaking, they'll typically last 10 to 30 minutes, self limited, and then they'll, then they'll ease off. Heart attacks, on the other hand, are typically, you typically have some warning signs of the progression of the discomfort before it comes on and doesn't go away. It's crushing chest pain, not a sharp chest pain. And it doesn't get better with time. And that's a key. And that is a true medical emergency. Now if you're in one of those scenarios and you're not sure, then you need to go to the hospital because that's always the safest thing to do. Because with an EKG and a simple blood test, you know, that can be, that can be delineated pretty easily. So it's a difficult, it's a difficult scenario. It really is. And people frequently during panic attacks will say, I'm having a heart attack. Now the other important thing is panic attacks do not cause heart attacks. And I think that's a spin that a Lot of folks will get into, yes, I'm having a panic attack, but now I'm having a heart attack. That would be very, very unusual, very rare, very, very rare.

For the panic attacks, you know, don't make you feel good, but it's not killing you.

Correct, right, exactly.

It might be influencing your overall health, but it's not creating a heart attack.

Right, right. And you may fear for your life during a panic attack, I've seen that many, many times. But you're not in danger.

What's the best thing someone can do to recover from a panic attack? Yeah, so, so it doesn't happen again, you know.

Yeah, well, so it doesn't happen again requires coping skills. But to break a panic attack, what you really want to do is divert your nervous system in some way. The fastest way that I have found to do that is take a bag of ice, fill it up and put it on the back of the neck and it just kind of changes your whole focus. If you don't have a bag of ice, you can, and you know, just put your face under cold water. Whatever, whatever opportunity you have, if you're driving, please pull over. You know, get a, get a cup of ice from the convenience store and put your hands in it or just hold on to some ice is usually enough and it'll frequently break a panic attack. Now treatment of panic attacks is way outside of my wheelhouse as far as long term coping skills and things of that nature. But, but I think the good news is in most cases, with appropriate support and guidance, people can get over panic attacks. I mean, I really think, and anxiety in general. I think that it's not something that people have to live with forever.

Okay, so I'm going to ask you, 1 through 10, 10 being the best one being the least best, 1 through 10, how valuable is saunas for helping heart health?

So I am a huge believer in sauna therapy. Now all of the data has been done in traditional finished saunas. I don't have a problem with the other alternatives. Infrared or whatever you have with the infrared type saunas, and there's some other ones out there. But if we're going to talk about the data and what I personally use that, so that's where I think the money lies, if you will. So the numbers are dramatic that if you are utilizing sauna four to five times a week, sessions of 11 to 12 minutes each, that 11 minute mark seems to be important. Somewhere over 175 to 180 degrees Fahrenheit, your decrease in cardiovascular events is greater than 50% and all cause mortality is in that same level as well. In addition, now the neurocognitive benefits of sauna are starting to come out. As far as being protective from Alzheimer's, dementia and what have you. Why does all of this happen? And I don't, I, I don't really have the capability to dive deeply into the science, but the basics is that we release something called a heat shock protein when you're in the sauna, particularly when you get to that uncomfortable place in the sauna seems to be where you really have this release.

You stay just a couple of minutes.

A little bit longer is where you really get the benefit. And that, that is where the cardiovascular all cause mortality and neuroprotective benefits come from.

So 1 through 10, what do you think? Is that a 10 for you? Is that an 8?

9? It's a 10 for me. I sauna at least three to four times every single week.

Week.

Okay, 1 through 10. Ice therapy, cold therapy.

So personally speaking, I am a huge believer in cold plunges. It's my morning routine every single morning, 4:00am you know, I like to start the day with something hard. It puts, puts my whole mindset in perspective. It wakes me up because you get this cortisol release and it really sets the tone. Plus as I'm peaking at 60 here and like to stay really active, you know, when I get out of bed in the morning, my wife will say to me, what hurts? And I'll say, look, it'll be quicker for me to tell you the things that don't hurt. Right now she's like, well that's not good. But cold plunging really helps on a day to day basis to keep all of that under control. The data from a cardiovascular standpoint and really overall longevity standpoint is not as powerful as it is with sauna. I can't tell you specifically what it is off the top of my head, but from a cardiovascular standpoint I would say that I would have to put that on the lower end of the spectrum. 1 to 10. But for personal impact and the way that I've utilized it, it's an 11.

What about over seven hours of sleep? Yeah, a 1 to 10 scale for.

Heart health it is, it's a 10 plus.

Really?

It really is. Because again, if we look at the recovery piece, what does that really impact? Well, the risk of type 2 diabetes and metabolic syndrome and how your body metabolizes glucose all changes when you're recovered and well rested. Sleep apnea, where your oxygen level is changing during the evening, again, affecting the hours of sleep that you have is a direct risk factor for high blood pressure, which we know is a risk factor, consequently to heart disease. Yeah.

I guess the only thing I could, you know, I've never been drunk, so I don't know what that feels like. But I have been on a lack of sleep at different times in my life.

Yeah.

And I can almost sense that it feels like you're drunk. So if you're not sleeping well, you're not performing well the next day and it's starting to stack if you don't sleep well every night.

Yeah.

And so I can only imagine how much it could be hurting your physical health and creating excess fat and therefore impacting your heart.

Absolutely. Yeah. I think it's. I think it's one of the. Of the pillars that people miss many times. You know, it's not a new gym membership. It's not whatever PR lifting or cold plunging or whatever. It's like, you know, you need to prioritize your sleep. We all have to sleep.

That's great. Dr. London, this has been powerful. I've got a few final questions for you, but I want people to follow you. You've got amazing content on Instagram. Dr. Jeremy London on Instagram. Also, drjeremylondon.com, your website, you've got a podcast as well, right?

We do, we do.

So you have a lot of the insights, the information. If people want to learn more, where can they go to get the podcast?

YouTube, Spotify, Apple Podcasts. We've got a newsletter that usually tries to parallel many times. So whatever format you enjoy getting this information, we like to get it out to you so that, you know, we're spreading the word and hopefully giving folks insight into.

That's great.

Into things that is going to allow them to live longer and live better.

Drjaminglondon.com for the newsletter as well, right? That's correct. And you're working on a book right now. So in the future we'll get a book from you. Hopefully we'll have more of this stuff for people, more research and data as well. This is a question I ask you if you could go back right before you started medical school. I don't know.

Where were you?

Where'd you go to medical school?

Like, I went to medical school in Augusta, Georgia.

Okay, cool. So how old were you when you went to medical school? Do you remember?

I was 21. 21, yeah.

So you make the decision, I'm going to medical school. You're getting your plans together. You go for the first day, whatever. You're in class, you're in the clinic, wherever you are. I don't know if you can remember that first day of medical school.

Nearly 40, not that old.

Nearly 40 years ago.

I can remember that.

I know, Yeah.

I mean, 40 years ago, almost 38, 39 years ago.

Right.

If you could remember the excitement and the joy and the unknown of what was about to happen. And now almost 7,000 surgeries, thousands of lives impacted in a positive way. The influence you've had on people's life, personally, their families, the miracles that have happened. If you could go and give three pieces of advice to the younger you going into med school for the first day, what would you share?

Wow. First one would be don't take yourself so seriously. For sure. Be willing to live in the gray, man. That's hard. And always trust your gut.

That's good advice. Would your 21 year old self have any advice for you currently for this next season of life as you're rounding into 60, would he give you any advice on what to expect for the next decade or two?

Get outside, relax, enjoy the day, let go.

Yeah.

That 21 year old was pretty good at all that.

Yeah, yeah, yeah. You got to remember some of that, huh? Yeah.

Yep.

Well, hopefully your son will remind you that every day too, because he's working with you.

Got lots of people to remember me.

But listen to that inner voice inside of you.

Absolutely.

Like he's your gut. Yeah. That 21 year old's still in there.

Yeah. There's no, there's no doubt.

He's still in there, man.

There's no doubt.

I want to acknowledge you, Dr. London, for the work you've done to inspire millions of people around the world. Helping people, even if just one video you shared has helped someone change their life and live better, healthier, happier life, you're saving lives with the content you're sharing. So I want to acknowledge you for your 40 years of experience, hands on, literally helping people's hearts heal, but also now using your wisdom to share with others so hopefully they can make better decisions in their life and impact the families and friends around them to live better as well. I want to acknowledge you for the gift that you are.

Well, thank you.

And you may not be holding people's hearts literally in the future, but you're doing it spiritually, emotionally, mentally through the content you're sharing through this conversation. So I acknowledge you for all the work you're doing.

Thank you. That means a lot coming from you. It really does. And I think you really touched on what's important with the platforms and the effort that we're making. If we can just touch one life, life, it's all worthwhile.

That's it.

And we get so much feedback that it's been so much more than that, that it is really that's the motivation for us to continue in doing this. So thank you for acknowledging it. Of course, I appreciate that.

Final question, Jeremy, what's your definition of greatness?

Always being willing to change that. I don't ever feel like I've arrived and I feel like I'm always open to change. And that is one of the things that I think has enabled me to accomplish many of the things that I have in my life and I hope to accomplish many, many more as a result of maintaining a very open attitude towards opportunity.

Allow thanks so much for coming on. Appreciate you.

I hope you enjoyed today's episode and it inspired you on your journey towards greatness.

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