How Can We Protect Our Heart? | Dr. Steven Masley

Today, I'm excited to introduce you to somebody I've actually known for a long time, Dr. Steven Massley. Brilliant, brilliant man who's got lots of things that I want you to learn about. He's a physician, nutritionist, and also chef, which I didn't know, and creator of one of the top health Programs at on PBS called 30 Days to a Younger Heart and we're going to talk more about that today. He's a fellow of the American Heart association and the American College of Nutrition and a clinical associate professor at the University of South Florida. His latest best selling book is a new and revised 30 day heart tune up, which we'll talk more about today with a plan to help prevent and reverse heart disease. His work has been seen by millions on pbs, this Discovery Channel, the Today show and dozens of other health outlets. Welcome Dr. Massley, so great to see you again.

Delighted to be with you and very nice to see you again.

So let's dig deep into the questions. So we know that heart disease is a huge problem in the country. We talk about it all the time. And we also know that 90% of the time it's preventable. So why is it not better controlled? What's the problem here?

That's a really important question because you're absolutely right. With the right lifestyle choices, we can prevent 90% of heart disease. Yet for men and for women, it's the number one killer. For both, it's probably the thing that disables more people for both. I think there's two main issues here. One is our healthcare system. We still spend 90% of our healthcare resources on training, end stage disease risk procedures and hospital care. We're not doing nearly enough. We don't even attempt to prevent heart disease. And even close to the level that we spend treating people in the hospital. The second part is for us as educators and healthcare providers, I think we've made it really confusing. There's so many myths and misinformation out.

And a lot of the things people aren't able to follow. So I think we have to be much better about giving a clear message on what's been proven to work that's easy to follow.

So let's backtrack a little bit. Okay. So we know that heart disease is a big problem, especially for women. When they hit menopause, they're 21 times more likely to have heart problems. And we talk about nutrition all the time. Why are people not making the connections? Why are they not able to understand that? Truly, if you change your diet and if you change your exercise and you change your mindset and prevent so much of the problem, what's the disconnect? Why are people not getting more on board to say, hey, sign me up?

I think part of it is because there's so many conflicting messages that people to some degree feel paralyzed. But I think for heart disease, oftentimes it's like we procrastinate. I think Americans are major procrastinator when it comes to a diet. So they're waiting for a problem like weight's the most obvious. If you're overweight, most people know it, but most people don't really know they have heart disease. The first sign of heart disease, as you probably know, is either death.

Heart attack, or stroke. And by then it's kind of late. So we're not, we shouldn't be waiting for a sign. To prevent the number one killer for people, we need to take steps. And I think what I'd like to convey are what are clear cut steps that will work, that are effective, that are proven and that are easy to follow? Because I think too often we've given people conflicting information and a plan that's too complicated for an average person to follow and they're paralyzed and they get nowhere.

So let's dig into this concern, which is that everybody thinks that heart disease and high cholesterol go hand in hand. If you've got high cholesterol, it's a matter of, you know, kind of, oh my God, you've got a few years to live. And we know that that's not true. Can you kind of take us down that path a little bit?

Heart disease, I mean, there is a cholesterol link, but cholesterol is not the important risk factor. Blood sugar is far more important. Blood sugar is the number one cause for heart disease. And even mildly elevated blood sugar puts you at major risk. Elevated blood sugar is the number one cause for memory loss and dementia. We need to do more about that. A bigger risk factor for heart disease than cholesterol is probably now the gut microbiome. I mean, I had to actually rewrite a new addition because in the last six years the evidence has become really powerful that the gut microbiome impacts our risk for heart disease in a major way. By controlling blood sugar and dealing with a healthier gut, that's going to be more important than just focusing on cholesterol. It's not that I would tell people just to ignore your cholesterol, but relatively those other two are much bigger factors.

And why is the gut microbiome so intimately connected to heart disease. Can you describe that for us so people understand?

It's like the gut and my heart. What do you mean?

Well, it's really a new concept and 10 years ago, if you had asked me, I couldn't have given you a link very effectively. But we've learned over the last five to 10 years that it impacts your weight, that the wrong microbes cause you have cravings, they cause inflammation, they lower your metabolism, so your weight goes up. But more recently, we've also realized that they impact your blood pressure, and blood pressure reflects the function of your arteries. It's a really important marker that your.

Gut impacts your blood sugar levels. The number one cause for heart disease that it impacts, it can. The right microbes in your gut can lower your cholesterol and the wrong ones will raise it. So it impacts weight, blood pressure, blood sugar, cholesterol, and importantly, it's the number one contributor to inflammation in the body. When you're.

You know, when your gut is out of balance and you have the wrong microbes, you're, you get leaky gut, you're inflamed. That's the number one cause for inflammation. All of those are risk factors, but there's one more big one, and that's, that's it. If you eat the wrong food and not the right foods, you produce bacteria that produce a new compound that's called tmao, trimethylamine oxide. That is a bigger risk factor for heart disease than your cholesterol. If your TMAO levels are high, increase your risk for heart disease by 62%. Pretty whopping.

So how do you know if your TMAO is elevated?

You could measure it. But more importantly, I actually think people, if they just eat the right food, vegetable, fruit, beans, nuts, I mean, more fiber, not fiber from necessarily grains that can raise your blood sugar level, but fibers from especially vegetable food. Beans and nuts are my favorite sources. And I say beans, assuming you don't have a lectin sensitivity. Some people do and they should avoid them. But I would say most people tolerate them. But those are the, that build the good guys. And adding probiotics will build more of those. So if you eat those, if that's most of what we eat, that's really important. If you're eating a lot of red meat, especially if it's not grass fed and especially if it's processed and sugar and flour, you're much more likely to produce bacteria that raise them. So you know, a Mediterranean diet, you could be vegan or much easier to follow a Mediterranean diet. If you tend to follow more a Mediterranean diet, you're not going to make tmao. You don't have to worry about measuring it. So who should measure it? Probably people who eat a lot of red meat and people who don't eat the vegetable, fruit, beans and nuts that you'd usually get from a Mediterranean diet. I think that's the best answer I could give you.

I want to add here, I see a lot of women coming into my practice that have huge digestive issues. Sometimes just changing the diet isn't enough. Sometimes we have to treat the overgrowth of bacteria or the yeast they may have in their gut. And I'm seeing a lot of parasites these days that sometimes needs to be addressed too, to get the microbiome back to normal. And also see a lot of sibo, overgrowth of bacteria in the small intestines. And again, all of these things can be treated. That's the exciting part. And now we know that there's an association between the gut and the heart, which is just astounding.

Yeah, it's a game changer because I think in the past, if you were just focused on taking your cholesterol meds for men, it may have had some modest benefit. For women, it probably had a minimal to trivial benefit because women are not, they're not little men. They're totally different. You know, we shouldn't treat them the same because they respond differently. So for women, the diet's even more important because the drugs that we have for heart disease are not as effective and it makes lifestyle a more critical issue.

No question. So, you know, one of the things that I mentioned before is that I do mostly women's health and I see women in my practice all the time. And one of the links that a lot of women don't understand is that as soon as they hit menopause, you know, estrogen is an anti inflammatory, their risk factor goes up pretty significantly. Can you talk a little bit more about that and why?

Well, yeah, so it is anti inflammatory, so their inflammatory markers go up. But when they go. When a woman goes through menopause and their estrogen and progesterone levels drop, they're tended, they make a different type of cholesterol. It's not that their cholesterol numbers go up, but the particles tend to get smaller. And more important than your total cholesterol is the type of cholesterol. And so there's maybe a gene that makes women more thrifty for energy when they go through menopause. I would say the average woman either needs, when she goes through menopause, eat a little bit better or be a little more active to offset the insulin resistance that occurs with menopause.

So if your cholesterol worsens and your blood sugar goes up and you're more inflamed, clearly that's going to have a big impact on the risk for heart disease. And we see that, that as soon as women go through menopause, they're at much higher risk of a heart attack, stroke, or death.

I think women forget about that part. My experience has been that they worry about breast cancer a lot during that time, and heart disease is a much bigger issue. And I think women just didn't know that or they are not paying attention to it. I think your point is so well taken that we really do have to pay attention and change our diet. I talk about that all day long. It's like food is the most powerful drug we have. It can change your diet, it can change your life.

But you made a really good point there. If you ask the average woman on the street, what's the number one around, especially if you ask around the age of menopause, what's the number one killer in women? They're going to overwhelmingly say breast cancer. But for every one woman who dies of breast cancer, six women die from heart disease. Yes, breast cancer is very important, but heart disease is a much bigger factor.

Absolutely. So what about the foods that we need to stay away from? What are those foods that we really should not really have in our diet?

Well, top two, I would put our sugar and flour, they cause insulin resistance, they cause hormonal imbalance. You know, something you and I have talked about for probably a decade, at least.

At least or more.

I mean. Yeah, really, that's. I think if you're going to make one change, cutting out the sugar and the flour, I don't think a lot of people realize eating table sugar and eating flour, even whole grain flour, is almost the same thing. A bowl of sugar, a bowl of white flour, a bowl of whole grain flour, have the same impact on your bloodstream. So that would be huge. I mean, there are some bad fats out there, hydrogenated fats, trans fats. Fortunately, there's less of them now, but we still find them in processed food and in especially fried food. Like if you go to a. A drive through and they're frying the food, all those fats become hydrogenated in those fryers over time.

I mean, those are, to me, the biggest foods we want to put A red flag around and try to avoid.

So people listening and they're saying, oh my God, seriously, how do I even know how healthy my heart is? Where do they start? What are the tests that you recommend that they kind of look at? Besides a hemoglobin A1C and A blood sugar, your blood pressure, what are some other things that would be really helpful to understand your biochemistry?

Well, for traditional medical risk factors, you hit the top two. I think right there. Fasting, blood sugar and blood pressure really are the most important things that a typical doctor might measure. Of all the things probably more important than cholesterol. So thank you for at least right off the bat, hit those top two. But I other things that we don't often think about are like inflammation, especially for women. There's really good data that women are much more risk for heart disease from inflammation than probably are men. So like a high sensitivity C reactive protein, HS CRP is a very good marker more so for women to assess the risk for heart disease. Because if you're inflamed, that means your arteries are probably inflamed, not alone that your joints hurt and you gain weight and you have brain fog. So there's lots of reasons, as I'm sure you've talked about many times, to lower inflammation.

But other factors are nutrient intake. The data from our clinic would actually show that meeting your nutrient needs for several key nutrients is more important than those lab measures, your cholesterol or our blood pressure.

Well, I think we can hopefully come back to that. You know, so Mark and fitness, people don't think about fitness as something they can measure, but they can't. I mean people could meet with a trainer once a year and get a fitness eval because we've noticed that fitness is one of the most powerful predictors. You mentioned that in the very beginning. You know, food, exercise, I forget which word you might have said fitness. And you know something about stress management and mental well being. I usually use four. I use food, activity, nutrient intake and managing our stress. Those are my four pillars for preventing heart disease. I'm sure a lot of people would put food and nutrients together, but I like to keep them distinct because oftentimes you could even eat health. A lot of people eat healthy food are still nutrient deficient.

The other things that I oftentimes test for my patients because so many of them are trying so hard and they're not losing weight is I do a fasting insulin and then a two hour insulin. If I can get my lab to do it. They always do Glucose instead, even though I underline it, but that gives me information as to kind of where they are. And oftentimes I see it with enormous amounts of stress that they become insulin resistant because their cortisol level has been up for so long, or they for so long as well, which many women do. So let's talk about nutrients. I mean, let's talk about, you know what, before we do.

I mean, one more marker I'd like to throw. So, yes, Abs, I completely agree with you about. I like to look at fasting insulin, because if it's elevated, not only are you hurting your heart, but you're decreasing your cognitive performance and you're accelerating brain loss and memory loss. So I'm really glad that you like to look at insulin, because I think that's. Especially if your blood sugar is even mildly elevated. It's a very important thing to look at. The last factor I really like to look at is are you growing plaque? We can now do that with ultrasound. The carotid artery right here has a 97% correlation with your heart arteries. If you're growing it in one, you're growing in the other, and it's very easy to. Or you don't need a CT scan. With radiation, a little ultrasound, we can actually measure the age of your arteries. I've been doing arterial age measurements, carotid IMT for over.

15 years, and that's probably. If I only did one measure once, that would really be it. All the others are things I do yearly, but I just wanted to throw that out there before we hit nutrients. Hope you don't mind crowded imt Because I think it's really important.

No, I think that's really important because, you know, the goal for me with these podcasts is to educate people so that they know what to do. You know, my theory has always been I want to teach people how to be their own, you know, I call it midwives, so that they can really learn how to take responsibility for themselves and say, can we do do this test? Can we do this test so we can really find out where I am? Because, as you know, disease is the model we have. Prevention is not. And this is all about prevention, which is a wonderful thing. So what about the nutrients? Tell me about what the most important nutrients are that you find are really important for people in your practice.

Well, from our clinic, having done carotid IMTs and looking at plaque age and thousands of patients and followed them yearly over time to see, is your plaque shrinking, shrinking, grow. Hopefully shrinking. Is it growing? I hope not or staying the same.

We published our data on this and we looked at lab markers and fitness and nutrients and food and all these factors and probably the most powerful ones turned out to be some specific nutrients. Clear at the top were like magnesium and zinc. Maybe this probably doesn't surprise you, but magnesium is so important for heart health and 70% of Americans are deficient. Even in my clinic, when I point out the foods a lot of people, when we go, is it realistic for you to eat enough every day to get 4 to 600 milligrams of magnesium? Most of my highly educated patients would say, no, I'm not going to. I could do it one day, but you're asking me to do it seven days a week. They need, most people need a supplement. So magnesium impacts your blood sugar, your blood pressure, the function of your arteries. It helps prevent cardiac arrhythmias that can even be fatal. You know, it helps with migraines and constipation, helps with sleep. I mean, it's essential. So magnesium turned out to be our number one nutrient. Zinc, which helps with blood sugar and immune function, was also really powerfully associated. So. And that's pretty easy to get in a multi.

Yeah, absolutely. And what magnesium are you talking about, Steve?

Well, I like protein bound form. So either magnesium.

Glycellate, malate, a chelate, anything but magnesium oxide, which to me is more of a GI irritant.

And what other nutrients? So we've got magnesium and zinc. I also am a big person of vitamin D, primarily because I live in Maine and most of the time people are vitamin D deficient.

Okay, well, I live in Florida now and 90 plus percent of my patients are vitamin D deficient if they're not on a supplement. So in Florida, my average patient needs a minimum of 2000 international units a day and some people need three or five long term to maintain. So I do it until your levels look good, like over 50. So the minimum to me is 2,000 a day for vitamin D in Florida, the Sunshine State. I can't imagine in Maine where you don't make any vitamin D through your skin and sunlight six months of the.

Year, eight months of the year, eight.

Months of the year.

I get it. Fiber, as in I said before, fiber feeds your gut, but fiber lowers your blood pressure, especially if it doesn't have sugar in it. So if your fiber is from vegetable, fruit, beans and nuts, it really helps with blood sugar and cholesterol, improves the size of your cholesterol particles. So really good for you. It lowers inflammation when you Eat more vegetable, fruit and nuts. So I mean that's really so.

Fish oil. And I don't mean like flaxseed oil, which is a medium chain. I'm looking at the long chain fatty acids that come from seaweed. Or you don't have to eat fish, you could eat seaweed or take a seaweed capsule or shellfish like cold water shellfish, like oysters and mussels and clams or wild salmon. But I do prefer wild than farm raised. So that's for omega 3 sources. Vitamin K turned out to actually be a really important factor in our research. We get most of that just from eating a cup of green leafy vegetables every day, along with many other nutrients from green leafies. But, you know, so those are really the top nutrients that we saw. Thank you for mentioning vitamin D, because that was definitely one of those top nutrients that we noticed was associated with increased risk for how old are your arteries when we first meet you? And are you able to shrink your arterial plaque over time? We had hundreds of patients who shrunk their artery plaque by more than 10% making their arteries 10 years younger by following our protocol.

So kind of recapping the protocol, which we'll talk a little bit more about when we Talk about the 30 Day Heart tune up is lifestyle, dietary changes. And I talk a lot about trauma and emotions because that plays into the heart and heart health and nutrients. So what I love about what you're saying though is that we can change.

A heart condition such as large amounts of plaque and it doesn't have to be our forever.

You can shrink it? Yeah, if you're on a cholesterol med, a blood pressure med, a diabetic med. I'm not anti medication. My goal is to make it so you're so healthy you don't need them, that you're shrinking plaque. And when we take the meds away, you keep shrinking it. So that's really my emphasis is that if you do the right lifestyle things, most people, there's still going to probably be 5% of people. I'm glad we have these medications for they have something genetic. But for 95%, 90 to 95%, I really believe we can do this with lifestyle.

Fabulous. So for those of you that are hearing this for the first time, how can they get a carotid evaluation? Where do they go? How do they get that?

I mean the easiest to probably google it for your area, you know, so we're not looking at the traditional carotid Doppler ultrasound. They do at the Hospital and clinics that's looking screening for a surgical procedure to operate on your carotid arteries. Something I clearly want to help people prevent and avoid if at all possible. So we're looking at carotid intimal medial thickness carotid imt Google for your area who's doing carotid IMT testing. You might have to go to the local university hospital to get something like that down. And don't be surprised, it may not be covered by insurance. This is a measure of aging, as you said before. Very well. This isn't disease screening. When we screen and treat a disease, it's typically covered by insurance. Sadly, as soon as we're looking at how do we make you healthier, more vibrant, turn back the clock on aging, maybe reverse some of the aging you've experienced. I'm not against aging, but if I could make you five to 10 years younger, I'm in for that.

Oh yeah. And you know that I think the myth that they have out there also is that as we get older, it's just going to happen. You know, you just gain five pounds a year. You just don't have your energy. You don't. And I'm like, it is so not true. But people don't know that. So I love your message, which is we can change these things, we can reverse these things. We can get healthier as we get older.

But your point is so well said in the sense that I don't think most people realize they've forgotten how great they could feel. They've forgotten what it's like to want to bounce out of bed in the morning and get stuff done, to be happy, to be joyous, to be productive, have fun.

They have a little bit of that, but they've forgotten how fantastic a day can be if they really haven't taken care of themselves.

Absolutely. And they can reverse it. And I just love that message. I mean, Steven, it's amazing what you're saying. So it's great. So tell me a little bit more about your 30 day heart tune up. Tell us a little bit more about that.

Well, we looked from our clinic as to what was able to, what predicted people's plaque when we met them, how old were their arteries, how big was their risk? And we realized over time that people were shrinking plaque, losing weight, their cholesterol got better, their blood pressure got better, they felt better, their sex lives got better. I mean, especially if you improve circulation for men and for women, you really, by improving circulation, you improve sexuality and sexual function.

And I've Learned some of that from you over time on how important that can be. But you know, so here we are in a point where I realized, wow, my patients are literally getting younger. And I felt, you know, I've had some personal tragedy in my family. My stepmother, excuse me, my stepfather and my mother in law, both of them basically died of heart disease from procedures. And I made a commitment a couple decades ago to spend help people prevent that, to turn to change our current system. And you know, writing this new book, this revised edition that includes all the information on the gut microbiome and how important that is as a risk factor, I mean it's just, it's been transformational not just for my practice, but for the online world for, you know, thousands of people. I've been able to help and help transform their lives. So yeah, for me this is about stopping the number one killer to men and women in America today and helping people feel fantastic at the same time.

Awesome. So what I hear from women a lot in my practice, because I only see women, is it sounds like too much to take on. So what are the baby steps that you would say they need to start with? You know, how do they kind of begin this process without kind of taking it all on at once if they can't do that?

Well, you said the right food, you know, so really. And I think when we look at what's the easiest diet to follow, you know, the US News and World Report ranked the Mediterranean diet the easiest diet to follow, the best diet for heart disease, the best overall diet. So I'm a big, we want to prevent and reverse heart disease, prevent dementia, help prevent diabetes and elevated blood sugar levels. To me, I'm a big fan of following the Mediterranean diet because, and I have adopted a low glycemic version which you would probably like.

Yes.

Less rice, less pasta, more seafood and poultry and vegetable, fruit, beans, nuts, olive oil, herbs and spices. Food that tastes fantastic, it's easy to prepare. So that's really my message, is let's pick something that's easy for people to follow. Their family and friends are happy eating the same food and it really makes a huge difference. So I would start with food. When you add food, you feel better, so suddenly it's easier to go out and add more activity. But here's a really important point I want to make that I've seen over and over in studies like the finished trial they did for dementia. They were afraid it would be too complicated if they asked people to eat healthy food, be active and manage their stress.

But what they had more better compliance. When they asked people to address all three, they felt better and their compliance was far greater than if they only asked them to do one of those things. So sometimes for the right motivated person, and my guess is you work a lot with motivated people by asking them to do something that's going to give them the best results, they have a really easy time.

Succulent.

So kind of summing it all up then, what I love about your message is that 90% of heart disease is preventable, which is an enormous take home. That changing your diet, changing your exercise lifestyle, getting the right nutrients and right mindset because mindset plays into cortisol, as I talk about all the time. You can actually get younger in terms of your arteries as you get older?

Yes, absolutely.

What did I forget? What's the take home that I forgot to mention? I forgot to ask you about? That's very, very important. Besides, that was great.

I think that.

An important take home message is most people are waiting for a symptom to get started, but the first symptom most of the time is a heart attack, stroke or death. So don't wait. If you take better care of your heart, you improve your circulation and you have more energy, you have more drive, you have better sexual function, you sleep better and you are preventing heart disease. So my main take home message is don't wait, get started, do this. Today.

I talk a lot about with women when they're really addicted to that sugar or the carbohydrates or even dairy, that you just take baby steps to get rid of it, but start to understand why that food is there. Sometimes it's because you don't have enough sweetness in your life and sometimes because the microbiome is overgrown with yeast and you're going to crave sugar then. So there are reasons for some of these things and what I love about what you're saying is we don't have to have a heart attack or have a heart condition, but we need to see what to do before that. And I appreciate that take home so very much.

So thank you so much. And we're going to put a link to the book below so that you can get more information and if they want to find out more about you and you know, what kind of programs you have, how do they begin to do that?

Easiest just go to the website. I've got a regular blog where I put out recipes and great content. So@drmasley.d r m a s l e y.com that's the website and they can sign up for that blog. It's free and they can unsubscribe at any time.

Awesome. Well, thank you so much. I look forward to reading your book. And we will have people probably change your lives because of this. So thank you so much.

Well, and wonderful to see you again. Thank you so much for having me on your podcast.

Sam.