47. Your Doctor Isn’t Telling You the Full Story About Heart Disease with Dr. Michael Twyman

So just pounding blue light all day long can raise your blood sugar. You can beat Atkins, get no carbohydrates and still be diabetic because you're using technology at the wrong times of day. And that light comes in the eyes and it raises ACTH.

That's gonna raise cortisol. Cortisol is gonna tell your liver pump out more glucose. When we think about cardiometabolic factors, no one's really finding the interconnectivity. Like we're not connecting the dots on how our body is systemic. It works as a system and how something like your metabolic health could influence or maybe be a predictor of whether or not you're at risk for cardiovascular vascular disease. Do you have your patients wear a glucose monitor? Welcome, Dr. Michael Twyman to Rooted in Wellness. I'm so excited to meet you today.

Thank you for the opportunity. It's gonna be fun.

Yeah. So a dear friend, a shout out to Drew Prohitt for making the introduction with myself and so many others. But he's been singing your praises for so long, just in the way that you to speak. I know a big part of your passion is just like, disease prevention when it comes to cardiovascular disorders. So we're going to dive into all of that because I really want to crack the code for so many people who are confused around the numbers that they're seeking, the tests that they're doing. We'll go into all of that today.

Sounds fun.

So to get going, to tell you a bit about the podcast. So this podcast is all about ancient wisdom in our modern world and how we can become more rooted. And that's a feeling of feeling rooted in ourselves, but also in our health and even in knowingness to, to heal. So I would love to know from you as a cardiologist, what are some things that help you feel extremely rooted in your health and, and who you are?

So I'm very big into circadian biology, obviously by, you know, wearing the biohacking glasses. And so we are beings of light. So I try to optimize my environment always to be, you know, ideally outside, but if I'm inside, I always have the proper kind of light signal. So in my office where I'm at right now, I have windows on both sides, getting natural light in. I have some UVA lights. I got some red lights coming into my room. So I'm always trying to get the right light signals into my eyes on skin. But my grounding practice would be literally be outside grounding facing the sun early in the morning at sunrise.

You are so great. You're such a great advocate for reminding people about these simple practices. And I think every picture that I've seen of you, you're with some sort of light glasses. We'll talk about that and its impact on the body. Um, so let's consider just the opposite side for a second. So you mentioned something something that's grounding to you, but on the opposite side, what's something that causes you to feel uprooted? You know, I know you see probably many patients a day who you'd think on the outside, they're meditating or journaling, but still they come to see you and they're not feeling their best. So what are some things that cause you to feel uprooted?

I think it's the double-edged sword of, you know, devices, our screens. You know, this is how we're connected, this I'm chatting with you over the, you know, the interwebs, as they say, but. People kind of get sucked into these devices and the technology, while great to be able to communicate, there's also somewhat of a health issue with it because the artificial light that comes off these devices confuse our body's timing mechanisms. So I know myself, I know how addicted these devices can potentially be, and I always have to kind of catch myself, okay, that's enough technology for the day. It's time to wind down for the rest of the night.

Yeah, yeah, it's so important. And I still, I don't understand why with what we're learning around the impact of light on our circadian rhythm, we're still not normalizing changing our light bulbs or wearing these glasses, which are so inexpensive. So let's pause on that because I know that you're going to deep dive on how that impacts our health. So as a nutritionist, I think that one of the biggest assumptions are that people don't have to worry about their heart health until they're older. It's a mindset that I think that we have to shift, especially we know now living in this era of hyper wellness, we know more about health than ever before, and yet the issues and rates of cardiovascular disease are on the rise. So why is this something that we need to start considering? And, you know, do you tell your clients at a certain age to come in to see you?

So it's a great question. And one of my mentors actually educate me that, you know, atherosclerosis or plaque in your arteries, Heart disease, it starts in utero. It starts before we're even born. We have up to 60,000 miles of blood vessels. And there's a lining in the artery called the glycocalyx. It's a protective gel coating lining the arteries. So you're born and there's many things in your environment that ultimately can damage that protective coating. So most people don't notice this is happening until they're 40, 50 years old, but it really starts early in life.

In utero, and I'm curious, do you do things like genetic testing with everyone that comes through your office?

Not necessarily everyone. And your question is who should be screened? Well, pretty much anybody over the age of 40 should consider getting the heart screen because atherosclerosis is more common as you age. But if you have a very strong family history where somebody's having a heart attack in their 40s, 50s, 60s, you may want to start getting really screened earlier in life. Then those people, it's more likely you're gonna start with genetics. There's a few genes that tend to run in families if they have early cardiovascular disease.

Right. Yeah, I'm curious. I'm so hyper aware. We'll talk about my heart surgery in a little bit, but the understanding around my genetics being at more risk for a predisposition for cardiovascular disorders, but also being South Asian. So we know that there are certain ethnicities that might be more prone to the risk of heart disease. what precautions would you recommend? And are you seeing a prevalence of this anymore? Like, is this something that you still would say is true, or has it become more widespread?

I mean, it's, you know, there are certain genetic populations that are at higher risk, but I always tell patients, you know, your genes are what you inherit from your patients. Your epigenetics, your environment determines how much those genes are actually activated. And because your genetics, you know, are not mutable, but you're, mitochondria, your epigenetics is. So just because you have a bad genetic predisposition, if you do things differently than your parents, you'll probably have a different outcome. But that being said, certain genetics give people the false sense that they're going to be okay. Just because they're not overweight does not mean that you don't have significant atherosclerosis on the inside. You can be insulin resistant and not be heavy.

Okay. That's such a great point about epigenetics, whether or not we're pulling the trigger on specific diseases. With that said, I'm still concerned. So let's talk about going into our doctors. So over the past 15 years, when I'm looking at cardiovascular blood panels that have been done, one, the panels are all different. I have very few doctors who are looking at, you know, all things from particle sizes or checking on APOA or APOB. What's kind of the gold standard? If people listening are going to go into their doctor and they want to do a full cardiovascular panel, What do you say they need to be checking on?

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What is in your blood is important, but you also have to actually look at the health of the artery. So there's the biochemical and then there's the biophysical. And so on the biochemical, you know, I usually break it down to three big buckets. Now, bucket one is what is affecting the nitric oxide pathways. Nitric oxide is a critical molecule for cardiovascular health. Nitric oxide is what dilates your arteries, that helps keep your blood pressure normal. And nitric oxide prevents things basically from sticking to the arteries in the first place. The second bucket is looking at markers of oxidative stress and inflammation. How much fire is in your arteries at this time? The more inflammation your body carries, the more likely that protective gel coat, that glycocalyx in your arteries will be damaged and you're more prone to developing plaque. And then the third bucket is going to be the lipoproteins. So cholesterol is not the boogeyman. We don't have cholesterol just because it's going to give us a heart attack or stroke. We have cholesterol because we need it for our hormones, our bile acids, our cell membranes. So without cholesterol, we're not alive. But because cholesterol is a waxy compound, it's not going to float in our liquid blood. So our body makes things, as you noted, called lipoproteins. They're lipid protein carriers. and so if anybody's watching the video, I always show a little tennis ball example. The tennis ball is the lipoprotein. The cholesterol goes inside as the passenger, and then this is floating through your blood to be delivered to one of your other organs who needs something inside the lipoprotein. So that can be assessed. It's the LDL particles that you're really wanting to look at. And then there's something called Apo lipoprotein B or Apo B for short. The example that I just showed the tennis ball. That's basically the LDL particles. ApoB would be this white stripe on this tennis ball that holds this thing together in a sphere. And the ApoB is what allows it to bind to different receptors. So ApoB is on the outside of all the lipoproteins that could particularly injure your arteries. Most times it's going to be just your LDL particles, but 20% of the population has something called lipoprotein A or Lp(a), and that is genetically predetermined what levels you'll have. so families with strong family histories of vascular disease often carry Lp(a). And if you have a high ApoB, you gotta make sure they don't have Lp(a).

Fascinating. I was shocked on my last round of blood labs, my LPA just shot up. And I'm, you know, from the practitioners that I've been meeting with, it's, there's not a whole lot that we can do except for follow and adhere to kind of like a cardiovascular healthy lifestyle, which I'm already doing.

Is that true? So at this time, there are not great pharmaceutical options to lower Lp(a). The injectable PCSK9 inhibitors, that's mainly Repatha and Praluent, they may lower Lp(a) up to 30% or so, but we don't know yet if that's really clinically relevant. There are at least five drugs in up to phase three trials that are trying to show that if you lower Lp(a) by 90% or greater, are you lowering the risk of heart attacks, strokes, need for procedures or dying, the things that patients actually care about. So it's likely that those drugs, at least one of them will be released in 2025. But in the interim, even if we can't necessarily lower it directly, and the sidebar is that actually there is a procedure called apheresis where you get hooked up to a machine, it pulls your blood out, they can pull the LPA out, and then you can go about living your life for a while. But usually within two to three weeks, the LPA builds back up. So you gotta go back in for the procedure. It's a procedure more common in Germany, not so common in the US, but I did misspeak. There is one FDA approved technology for lowering LPA, just most people aren't gonna choose to do it. But in the interim, you can do things that lower your vascular risk by keeping oxidative stress and inflammation low. It's because LPLA is somewhat of a scavenger. It's only gonna really, quote, injure your arteries if you have a lot of oxidized phospholipids or high enzymes called LpPLA2 activity. Those things are high. Your RDs are on fire and Lp is more likely involved with that. So I always check that on the blood work because not everybody with Lp goes on to have plaque or events. Right. And then the people who have high Lp and inflammation, those are the people.

You'Re really concerned about. Got it. Okay. So I love the analogy of the tennis ball. That was really helpful. I love that you have it there. Okay. So nitric oxide, oxidative stress and inflammatory plaque and lipoproteins. so I feel like nitric oxide in the nutritional world kind of was on a rise for a little bit. I'm, I think it was around bodybuilding specifically and vascular support. This isn't to say that people just should go out and start supplementing with nitric oxide or eating a ton of beets or beets powder or I think Arginine also is an amino acid that boosts nitric oxide.

Yeah.

Which I take because of a deficiency that I had, but tell us about who, when, why. to take this.

So nitric oxide, it's so critically important that the discovery of it in 1998 in its role in the cardiovascular health won the three scientists, the Nobel Prize in medicine. They're redundant pathways in the body because if you lower nitric oxide, almost everything's gonna go downhill, particularly, you know, atherosclerosis risk, diabetes risk, brain fog. lots of things go wrong if you don't make sufficient nitric oxide. So the major way people make nitric oxide before the age of 40 is when blood flows across the lining of the arteries. This is one of the reasons why exercise is so protective for longevity. It's because that increased blood flow during exercise causes the stimulation to release nitric oxide from the shear stress is going across that gel coat, that glycosaminoglycans. But after the age of 40, there's an enzyme called endothelial nitric oxide synthase or eNOS for short. You'd mentioned arginine. It's an amino acid. Most people are not deficient in arginine, but what happens is that enzyme that converts arginine to citrulline, it slows down. In the presence of oxygen and arginine, nitric oxide and L-citrulline is gonna be produced. So you can shove all the arginine into the system, but if the person has a weak ENOS enzyme, they're not gonna make more nitric oxide. So the body has a backup pathway where if you eat foods high in nitrates, For the most part are the dark green leafy vegetables or beats. Then if you have healthy bacteria in your mouth, so meaning you're not using, you know, antiseptic mouthwash where you kill all the good bacteria. There's this nitrate reducing bacteria that break down those nitrates in those foodstuffs. You swallow it and eventually through a process it becomes nitric oxide. So people who damage the oral microbiome and are aging, they kind of got a double hit. They start having lower and lower nitric oxide. so how can you optimize nitric oxide? Exercise is going to help it as blood's flowing across the lining of the arteries, eating your green leafy vegetables, ideally, and then sunlight, UVA spectrum of sunlight, when it hits your skin, is going to liberate nitric oxide. So often talk about like, it's kind of like filling a funnel. You're just trying to put a ton of nitric oxide into the top of the funnel so it drifts on down. Yeah, I'm a cardiologist, but There's guys that come in and they start talking about ED type issues. ED equals ED. If you have erectile dysfunction, you most likely have nitric oxide issues. And then people prescribe Viagra, the Cialis type medications. And it's fine if that works for them, but the issue is that they don't have enough nitric oxide often. And you give those medicines, all it does is keep nitric oxide around longer. It doesn't give the person nitric oxide. So the medicine works for you, Then it just means there's something wrong with your nitric oxide pathways.

Go looking for what's causing that. Wow. Okay. We have to unpack that. Let's hover on this cuz I know it caught many people's attention. Erectile dysfunction is a sign and symptom of nitric oxide deficiency and something that you can look into. That is so important for the men and the woman, obviously. Great to know. Um, when we work our way upstream, you mentioned the oral microbiome and you're the first cardiologist to mention oral microbiome to me, even though we know that Dr. Melissa J. Smith: there is a relationship to heart health and our oral health. So we're doing so much though to deplete our oral microbiome these days, right? So I think the understanding is, you know, some people maybe just in LA, we're catching on to the Colgate's and the Crest and the Listerine and the bright blue and orange mouthwashes are actually terrible for us. They're killing bacteria that are really the instigator of digestion, right? So is there a way outside of just simple practices, I'm guessing you recommend.

Oral hygiene practices now in your appointments? Correct. I always ask, when's the last time you've seen your dentist? Do you have any issues with periodontal disease? Because if you have gum disease, you very likely have vascular disease because the inflammation in your gums is transmitted through your cardiovascular system. But in our office, we have various vendors that we've acquired the nitrate reducing test strips. So, you know, it's like litmus paper. You put it in your mouth and the saliva you know, soaks into a pad, you press the developer on it, and if it's white, your body's not making nitric oxide through your salivary pathway. If it's bright red, you are. So first, you always want to try to withdraw the offending agent. So if they're using antiseptic mouthwash, stop that. You know, if they're using a lot of products that have a lot of fluoride in it, stop that. If they're not eating anything with nitrates in it, you know, it's, you know, they're carnivore, for example. Yeah. Then you're gonna have to give them nitrates through that pathway. And there's various vendors that make different lozenges and such that can give them nitric oxide through that pathway. The second part of it was that I didn't mention it was that you also need stomach acid for this to work. So if you're on a proton pump inhibitor, you're pounding, you know, antacids all the time. If you don't have stomach acid, you're not gonna be able to make these chemical reactions happen. So, you know, look for somebody who knows how to kind of help with, you know, acid reflux, you know, not.

Just taking pills to block the stomach acid. About a year and a half ago.

I love that you brought that up, that test strip.

Do you know Dr. Sebastian Patel?

I know of him, yes.

Yeah, so he gave me one to put on and sure enough, I was deficient in nitric oxide, which led me down that path. This is great insight. Can people do a test, the ENOS enzyme? Is that a test that people can do?

Not directly, but there's a lab called ADMA, asymmetric dimethylarginine. If that blood test is high, you'll often have low endothelial nitric oxide synthase.

Such good insight. And I'm owning in on these things because it's really pulling back the scope of what we think optimal heart, sorry, is really pulling back the scope of what we think optimal cardiovascular health should be. All right, so increasing exercise, optimizing our greens intake, and let's dive into sunlight. The magic of circadian rhythm for our body. My introduction to this especially for heart health was through an ashram. I spent a lot of time growing up at an ashram and through yoga and understanding that different organs within the body have their own circadian rhythm. But now you're telling us so much more and you're doing it through a Western lens, which I appreciate so much. Talk to us about the power of sunlight for cardiovascular health.

I mean, we've evolved under full spectrum sunlight, and it's only been in the past 100 years or so that we've decided to live the majority of our lives inside under artificial lights. There's not a coincidence why all these chronic diseases have popped up in the 20th century. Diabetes, cancer, heart disease all got worse. Our food, yes, there's more industrial food, but our genetics have not changed as much as people suspect. It's our light environments that have significantly changed. And our body is always trying to seek what time it is. There's two primary zeitgebers. The German term for time giver. It's the light that enters your eyes and is the timing that the nutrients are coming into your system. The nutrition one, when patients come to see me, I usually only start with three questions. What time of day do you start eating and stop? How much protein are you eating? How much seafood are you eating? Then we'll dive into what their goals are and what the biomarkers show. But the food one, I always leave with that is the time. Because food is not only energy, it's information. It's information of what season is it? You should be eating food that's locally appropriate to your environment. And you should ideally be eating during daylight hours because when food is in the digestive system, the liver and gut are like daytime, let's do what we need to do. If you're eating one hour before bed and it's 11:00 p.m., your body's like, well, they're probably going to still eat, so the liver and gut clocks are going to stay on for about four more hours. So now it's 2:00-3:00 a.m. in the morning before your liver and gut shut off. you don't metabolize food as well, your temperature's hotter, you don't get to those deeper levels of sleep. So eat during daylight hours, I optimally, or at least stop eating whatever you're eating three hours before you go to bed. So I always start with that. And then the light, it is a little bit more challenging, but you know, light has different frequencies, different colors. There's a receptor in the eye called melanopsin. It is not a vision receptor. It's not a photoreceptor where you can see, but it is sensing different photonic energy that is in the blue spectrum of light. So when we go outside in the morning time, those blue photons of light hit the melanopsin receptor. Those get transmitted to the brain, tells the brain's master clock, the suprachiasmatic nucleus, it's daytime. Start making more cortisol, start making your sex hormones, get ready for the day. The sun looks different at noon time. It's 5500 Kelvin at noon time. Our devices are set at that exact same color temperature. So when we stare at these devices, our brain is always getting signaled that it's noon time. Well, right now we're having this conversation. It's close to noon, not a big circadian disruption. But if the sun has set and you're staring at this, your brain just got to hit that it's noon time. Here's more cortisol. You need to be alert. You need to be hunting for food at this time. But in the evening when the sun would set, normal blue photons of light would hit the, the receptor. The body gets a signal, oh, it must be going into evening time. And cortisol would start to drop. Melatonin, which is being produced during the day, finally is allowed to be released. And melatonin helps you stay asleep. The melatonin is one of the master antioxidants that basically helps the mitochondria, the engines in your body, repair from any of the damage that happened during the day. And that's all yoked by the light signals. So I often tell patients, if you.

Don'T get your light right, you're not gonna get get your health right. Wow. We haven't even talked about food or exercise, really. So when we think about light, okay, so photonic energy that we're receiving and really the communication that's happening with our entire endocrine system. And even you touch, like hearing you tell that story of the light and our cortisol spiking for too long, the exhaustion that happens in the body, like just hearing you talk about it, we can immediately understand why we're stressed and tired. It's no wonder why we're stressed and tired. We're constantly looking at these lights. We have so many things. that are keeping us alert. God, I wish I had my blue light glasses right now. But there's a deep understanding because if the messengers in our body aren't communicating effectively, then obviously our body can't send out the attention or the energy that it needs to take to make key organs function, right?

Correct.

So you mentioned time and light. The other two things that you asked your clients about, or your patients about protein and seafood, Correct.

So the seafood one is, it's about how much DHA that they're getting in through their diet. The reason being is that up to 60% of your retina and 30% of your brain is made up of DHA. And the quantum reason why you need DHA is that if your cell membranes are full of DHA, then when those lights, the sun hits your surfaces that have DHA, it acts like a kind of an insulated wire. It basically captures that light energy and then transmits it to the neighboring cells. If you don't have enough DHA, it's kind of like having a half charged iPhone or, you know, Android phone if you use it. You know, it's going to work just not at peak capacity all day long. And then, yeah, I'll stop there for a second.

Now I can tell you about the protein part. Yeah. No, it's just fascinating. One, that you put a quantum reason around DHA and ultimately, like you're, you're talking about things that come from nature that We essentially need to function at our prime, at our best. And I think that we've lost that wisdom. And I'm going to say it again, just hearing a cardiologist, hearing a Western trained medical doctor shed this light over our health is just making me really, really happy right now. So yeah, we'll keep diving into that because obviously we have to go from here to mitochondria, but talk about protein first.

Sure. And so, you know, protein is the building blocks for your muscles, your muscles or your metabolic engines. and so, yes, you may be physically active, but if you're not giving your body enough leucine, the amino acid that triggers muscle growth, you're gonna potentially stall out over time. We're all gonna be losing muscle mass as we age. We all develop some degree of sarcopenia. We're gonna fight against it as much as possible. So you need to do your strength training, you know, three times a week or so, and then you gotta give your body enough protein to maintain that metabolism of the muscles. And you need at least 90 grams of protein a day to be able to make that happen. if you're trying to add on muscle mass, it's going to be more in the neighborhood of a gram of protein for each pound of ideal body weight that you want to be at. So if you're trying to gain mass.

You'Re going to have to really increase your protein intake. Something I've really been trying to crack the code on as you're speaking, I'm with you. Like I've looked at all of the studies around protein intake and prevention around sarcopenia and all of those things, but I can't help but think back to our ancestors. So if I'm thinking about the, I'm half Indian, half Danish, the South Asian side of things, now have a strong susceptibility to getting cardiovascular disease. It's known. But when I ask, you know, if it was an issue in the past for our ancestors in India, it wasn't an issue, which begs the lens then. Well, one, they weren't counting their protein grams every single day to the environment and the foods that they're eating right now. But also, maybe we weren't living longer. Right, so this is kind of like the, maybe the adjustment that we need to take, our ancestors might not have been doing it, but we're also taking on so much more of an assault from our environment that we're looking at things like protein intake, like light that we just need out of, essential to living in today's modern world.

Well, the, to make it even a little bit easier is that we've kind of touched edges on nutrition.

Yeah.

You know, I will talk nutrition with patients, but I'm going to start with like, I need to know what kind of mitochondria you got, what kind of engines you got, because that's going to determine what fuel we're going to talk about. But breaking it down, if you're eating real food, photosynthesis has to touch that food. Yes. The sunlight grows the food. Your mitochondria's job is to reverse the sunlight back into a different form of energy. And 2-300 years ago, we did not live indoors. We would have eaten foods that were appropriate to the environment you're in. You trapped your food. where the food was growing and you ate it. I'm in St. Louis, Missouri right now. The ground is frozen. There are not fruits growing in St. Louis this time of year. So my ancestors would not have been optimized to eat bananas in St. Louis in January in St. Louis. They would have eaten more animal based products this time of year. If you're in India and there's tons of vegetables and fruits because you're at a lower latitude, your body's optimized to eat it. So if you take your people and put them at a northern latitude where the foods aren't growing, there's a mismatch in their circadian biology and their kind of mitochondrial sense of like, I'm supposed to be more close to the equator. My people have now been more north. My engines aren't going to work as well up north. So that's what the challenge is, is that we have a kind of a food war sometimes for people, and it's really simply stick. It's like food is stored up sunlight. You just gotta figure out like how to decode that information. And in the old days, we would've been living outside getting the sun directly on our surfaces. We would've been connected to the earth. those are the two main ways that you get electrons other than you're eating those electrons and food stuff.

We would have been eating seasonally just out of necessity. I'm a big believer and even from the Ayurvedic lens, like foods that are grown at different times of year also contain an intelligence, whether it's the type of fiber, the fat, or even the bacteria that grow on them to support our immune system. Right. So it's I think that's something that we really need to own in on and maybe for listeners, because I, oh, the diet wars. they get me. And like, look, you being vegetarian could work for you for part of the year. You going paleo for the second part of the year could be magic, but we certainly have to end the war around which one is better, considering we are also bio, we're also bio individual. So thank you for that reflection. I also agree. Mitochondria obviously is becoming a buzzword. I really think that this is a science that is gonna kind of explode. as we gain all this information, it's really the mitochondria are the source of light within our body. And from what I'm reading and studying about the more optimized our mitochondria, the more optimal our health, the more optimized our mitochondria, the more our organs can function better because especially around, I'm sure you'll share more, the concentration around mitochondria around the heart, the brain, our ovaries, I guess also. Yeah. Tell us a little bit more. You know, when we're thinking about optimizing our mitochondria, we've talked about sunlight, we've talked about the right foods, we've talked about the, the energy information that we get from the foods, but optimizing our mitochondria for the lens of our heart.

No, it's such a critically important topic that behind me is a giant mitochondria on the wall. So when the patient sits there, I'm looking right at the mitochondria.

Yeah.

The mitochondria, you know, are so important that without good mitochondria, you're not gonna live a long healthy life. So going back in time, you only inherit your mitochondria from your mother. So your mother is the one that passes them down to you. So that's what I start with when I take a family history with somebody. Like, how healthy is your mom? How healthy is your grandma from that side? If they're very healthy living in their 80s to 90s without a lot of chronic diseases, that's your potential in life. They gave you your engines. If your mom had breast cancer at 40 years old, when you're born, you may be 20 years old on the inside as a baby. And so by the time you're 40, you're actually 60 years old and you're getting diseases of aging. So it always starts with how healthy was your mother because that's your potential life. Again, epigenetically, you might live completely different than your mom, but if she gave you bad engines, you're gonna have to do more. then you have to think about the engines as you talk about, like we are literally beings of light. The mitochondria make biophotons. They also make infrared light heat. So the inputs of mitochondria are not carbs and fats. It's those compounds ultimately become protons and electrons. The mitochondria through evolution made it where out the other end of the mitochondria becomes ATP, which is something that helps with energy by helping with water to get into different proteins. The mitochondria also produce carbon dioxide. You breathe that out. The plants grab the carbon dioxide, make us food. It's a nice cycle. And then mitochondria make water. The water is extremely important. It's more important than the water you drink. That water is another form of energy. When the light sources hit our surfaces, that water traps that energy and we literally make a battery out of it. this is, you know, coherent domains or structured water, easy water, those are all kind of synonyms. Those are extremely important energy sources. And then our mitochondria also make infrared heat. That infrared heat, you know, basically helps charge up that water a little bit more, but it also makes the mitochondria, you know, who, I should back it up a little bit. When I was talking earlier about people at the equator, people at the equator have Generally what's known as coupled mitochondria. Their mitochondria are very efficient at making energy. This is why the Kenyans went every long distance race because the foods that they put into their engines becomes almost 100% efficient at energy. When people moved out of the equator, moved further north, their skin became lighter, their eyes became lighter because the sun was becoming weaker, the ground would start to freeze. If you don't have heat, you freeze. So the mitochondria became less efficient at making energy and they uncoupled. So think of like the little proteins inside of them. They stretch apart a little bit and it's like a radiator. Some heat escapes that kept the person from freezing to death. So food is, you know, not going to be perfectly metabolized energy. So somebody of Northern European latitude heritage is probably not going to be the best world long distance runner. They're not as efficient as somebody who has highly coupled mitochondria.

Sure.

That's a little bit of a tangent, but the cases that, you know, the mitochondria are the stories. Like you take your mitochondria engines, you put 'em into the world where you're at, and you try to figure out how do you optimize, how they can.

Make ATP, water, carbon dioxide, and infrared light. Fascinating. Thank you for making that so tangible. And for the aha, our mitochondria come from our mothers, which for me, my mom with autoimmune disease, like it's just, it's so much a part of my journey. So this is such great insight. and also explains why, I'm not a speedrunner, potentially, with my Eastern European side. So you brought up something around, you know, with mitochondria. I love that you have now 30 minutes into this podcast, you've related our cardiovascular health, the health of our mitochondria, to the water, the sun, our light, and the soil. So everything that comes from nature, which I think holds a lot of wisdom in a world where, we become so reactive, you know, We go to a cardiovascular doctor and it's all about prevention or going on medication without getting to the foundation of the body first, which is what you're talking about. And when I think back, I mentioned to you when I reached out, I've had two heart surgeries for atrial tachycardia, probably around six ablations during those two surgeries. But I wish doctors back then asked questions around my energy, my consumption, my circadian rhythm, and everything that was happening then in my 20s, right? As well as my emotional health. But instead they popped me on to do a stress test, which I think a big part of the population can pass easily. And they just wanted to know how much I was eating out at McDonald's or smoking cigarettes. And that's about it. And then sure enough, inevitably, I ended up saying no to doing an ablation because there was a risk of me wearing a pacemaker. But looking back at that time, there was other symptoms that were happening in my body. One, there was weight gain. I had PCOS. I became completely lethargic. I was on a prescription medication, which I know also can impact our mitochondria as well as my digestive health and so much more. But thinking back to a surgery like that, the discussion that was had back then, let's say 20 years ago, versus what you know now. Like, I know ablations are a pretty common surgery, and I get reached out to once a week, at least with somebody who suffers from palpitations. And nobody ever back then attributed that to, you know, my anxiety or my environment or my mitochondria. So can you talk a bit about it?

So arrhythmias are just when your heart is beating out of balance. So the body has a natural pacemaker called the sinus node. It's in the top chamber called the atria on the right side. So the sinus node fires and it's kind of like dropping a pebble in the water. The electricity ripples out, it goes downstream, and it hits what's known as a relay switch called the atrioventricular node or AV node for short. And that sends the message down to the bottom chambers called the ventricles, and then your bottom chambers fire. When patients have palpitations, it can be due to either abnormal beats come from the top atria, or it can be coming from the ventricles. The atria tend to be more common. In your case, if you're having atrial tachycardias, which is a form of super ventricular tachycardia, so the ventricle is the bottom chamber, super just means above the ventricle. The top chamber just starts firing off very rapidly on its own. The natural pacemaker is not firing. And so in some people, there is a congenital abnormality. They basically have an extra wire in their system. thAt just keeps firing off sometimes, you know, you can try to look for y'all, can make sure they're not, you know, thyroid's not overactive that, you know, they don't, you know, they're not abusing nicotine or cocaine or something that's gonna stimulate the system. But if they're not doing those things, then often they would recommend either a beta blocker or a calcium channel blocker, which slows down the atrioventricular conduction. So the message from the top chamber slows down getting to the bottom chamber. In some people, that's enough to cause them not to have their symptoms anymore. But anything they put in your system, risk benefit or potential side effects. Sometimes these medications make people more fatigued and they really don't like being on the medications. In that case, if they can't tolerate the meds or they're just very symptomatic from the kind of the rapid heartbeats, then ablations can be considered. When it's a supraventricular tachycardia, generally the ablations are generally successful. one and done. It is a procedure, there's always a risk, it depends where the arrhythmia is coming from. And in some cases, if the arrhythmia is coming very close to that atrial particular node, during an ablation, they're using either cooling or heating instruments basically to snip the wires. That's kind of the non-medical way to say that. But if the wire is too close to your kind of atrioventricular node and it gets damaged, then your body's, or they damage your sinus node in the process, then they're going to have to consider putting a permanent pacemaker in to take over the work for your body because the wiring system has now really been damaged in your system. There's also ablations for atrial fibrillation. Atrial fibrillation tends to be an older population that has it, and those ablations are a little bit more complicated. They come with a lot more risk based off of where they're trying to fix those from. But for younger people, it's generally going to be super ventricular tachycardia when people.

Are talking about ablations. Such a great way to describe it. Yeah, I always described it as burning off this extra electrical node around my heart as they did. And it's funny, I feel like I've kind of cured myself in a way, but I also had the ablation. So, you know, I'll never know how much of each world I needed. So I'm very mindful for people who reach out, whether they're on a beta blocker or considering a beta blocker. For me, it just wasn't right for me. It was a bad situation that caused me to gain 45 pounds and I became completely lethargic. And in my twenties, I stopped living my life. So I think further investigation, especially taking into consideration the tips that you've mentioned today, are so key and so essential. So thank you for that. Let's talk about blood pressure. So a lot of people, this is the first sign that they, this first thing that we check when we go to our doctors. But when we think about any signs that people should be keeping an eye out for as we age?

So high blood pressure or hypertension, it's the number one risk factor for cardiovascular disease. In the greatest majority of times, it's asymptomatic. You know, it's very rare that people have blood pressure so high that they're having vision changes or headaches. So it's the silent killer. So a normal blood pressure is 120 over 80 millimeters of mercury forever. The only reason you would not want to push people that low is that if they're older and you're lowering that blood pressure enough that they're not profusing the brain as much and they start getting a lot of lightheadedness or dizziness or the person's very at risk of falling, then maybe you back off on those targets. But if you're a relatively young person, the risk of disease in your cardiovascular system really starts to increase when your blood pressure is greater than 115 over 75. So for every one point on the systolic, the top number that your blood pressure is, so example, normal optimal is 115 and your blood pressure is 135, which people say, oh, just a little bit.

Yeah.

It's actually a 20% relative increased risk of a stroke. That's not insignificant. So optimal 115 75. If people are on medications, the goal is 120 over 80. But to back up, blood pressure is often not taken correctly. You know, people are taking it, you know, right when they come in from the parking lot. They sit down, they're talking, they're still holding their coffees.

Yeah.

Yeah. They need to sit down ideally for five minutes. Your back has to be supported, your feet has to be on the ground, your arm has to be at heart level, and they have to use a blood pressure cuff that appropriately fits on the bicep. If the blood pressure cuff's too big or too small, you're gonna get falsely abnormal recordings. And I wouldn't , not be remiss to say that, like, you need to have it on bare skin. So every time I go to somewhere else and they're checking my blood pressure, they're like, oh, just put over here. I'm like, you don't understand. I'm a cardiologist who's very specific.

Like I'm taking this shirt off, put it on the bicep, get a real blood pressure shirt. So such good insight.

And do you recommend that people keep blood pressure cuffs at home? Is it something that's a, you know, we're into wearables or is this one of them? Sure, sure. And it's, it is one of the cases where, I don't want people to hyper Focus on it if you don't have an issue with blood pressure. I think it's worthwhile to, you know, if you are going to your doctor or other healthcare providers and they keep telling you like your blood pressure is a little bit high, then it's always a good idea to start checking at home because your home blood pressures on average is a much better tell of what's going on in your cardiovascular system than a one off in the doctor's office. But if you're at home, you do want to have a cuff that, you know, is kind of, I don't wanna say FDA approved, but it should be a quality cuff. there's a lot of stuff on Amazon you can buy that is honestly really junk and you may not be getting the right results. You really, for the most part, want to avoid anything that's like wrist mounted for blood pressure. Yeah, I bought a few of the toys. I call them toys on Amazon. Some of them are slightly accurate for your blood pressure, but most of the wrist-based ones are not yet. There is one going to come out in 2025. It's already available in Europe. It's called the Actia band. It'll be a wearable by the size of like a root band, and it will do 24-hour blood pressure monitoring. So it's really gonna be a game changer for people who have blood pressure issues because you're going to be able to know is your blood pressure just high in the morning or it's before bed. And ideally, you want to see your blood pressure dropping while you sleep. If your blood pressure is not dropping while you sleep, that's a really big.

Tell that, you know, maybe you have sleep apnea or that there's some stress hormones going on that is keeping your blood pressure high when your body's supposed to be recovering at night. Yeah, you're not restoring. Okay, so blood pressure cuff over your bicep, bare skin, instead of those cheap flimsy ones that go over your wrist, always folding up towards your heart. So feel free to correct the nurse who checks you next time, you're now getting empowered.

Right.

Now, the other aspect, you know, we're going to talk about wearables. I know you talk about cardiovascular risk and metabolic function. And the two really go hand in hand. And again, I'm going to keep looking back at all these instances around my heart health when things were at their worst. I was on the Atkins diet and not because I was into dieting at all, but I just, I noticed the correlation with my heart palpitations and my glucose spikes from having things like white bread or sandwiches or potatoes and stuff like that. So can you talk about that correlation?

Between glucose and palpitations?

Or even metabolic health and the risk of cardiovascular disorders on the rise?

Oh, for sure. Cardio metabolic health, it's very much a buzzword these days, but it really comes down to that health of that glycocalyx, that protective gel coat in your lining of your arteries. So earlier you mentioned PCOS. PCOS is insulin resistance, high insulin, high glucose. Those are two of the biggest things that damage the glycocalyx. If you damage the gel coat, you're opening up the doors to developing high blood pressure, atherosclerosis. So metabolic health is intimately tied to cardiovascular health. Now, you know, one thing I didn't mention was that we were talking about blue light and affecting, you know, kind of stress hormones, but just getting the wrong timing of blue light into your eyes, is going to raise your blood sugar. You can beat Atkins, get no carbohydrates and still be diabetic because you're using technology at the wrong times of day. When that light comes in the eyes and it raises ACTH, that's going to raise cortisol. Cortisol is going to tell your liver pump out more glucose. So just pounding blue light all day.

Long can raise your blood sugar. I think about that every morning when I check my stats for my aura ring. It's an addiction. but such great insight because when we think about cardiometabolic factors, you know, no one's really finding the interconnectivity. Like we're not connecting the dots on how our body is systemic. It works as a system and how something like your metabolic health could influence or maybe be a predictor of whether or not you are at risk for cardiovascular disease. Do you have your patients wear a glucose monitor?

At times I will, you know, particularly for the ones that are kind of more the biohackers or just like really want to know like, okay, what are my trigger foods? Oftentimes people eventually figure out what their trigger foods are, but they're usually more surprised by like when they short sleep themselves or they're under a lot more mental stress or they're getting more blue light, you know, than they expect. Their blood sugars are higher than they want to be, you know, or they're just not matching enough protein at their last meals and they're having these kind of real fluctuations glucose. So I think it is illuminating for many people, but then I also have other people that it's paralyzing to them to see their blood sugar not be perfect. And so I was like, the stress is probably raising your blood sugar more.

So take the thing off. Yeah, I'm so curious. I mean, it's definitely a marker that I'm interested in looking at for my clients. I would say especially in the past year, a lot of the clients that I worked with who have issues with lots of spikes and dips. when I'm looking at something like a levels glucose monitor, that's, these are people who are fit. They look fairly slim on the outside and they're athletic, but they're also very A-type and they're on their screens for multiple hours a day. So I think that that correlation is actually really strong. It's not just about the physical body.

Correct. And they can also be skinny fat. I mean, they can have visceral fat that's driving inflammation on from the inside, and they still look very fit on the outside.

Mm-. Okay, so you mentioned glycocalyx, then how do we optimize our glycocalyx?

Defense. We start with stop doing things that damage it. So if you're insulin resistant, you need to fix the insulin resistance. You know, if you are not making sufficient nitric oxide, promote things that boost nitric oxide. Blood pressure honestly is a good tell for it. If your blood pressure is not optimal, you probably have some degree of glycocalyx dysfunction. so they just do the blood work that we talked about earlier. There are some specialized testing that can get done. You know, I do it in my office, which looks at arterial elasticity, how stiff the arteries are, how much nitric oxide the arteries can release. And then we do the comprehensive blood work. We say, oh, you have very high uric acid levels. Let's work on getting your uric acid low, or you have very high ADMA.

Levels or high homocysteine, figure out what the root cause is, and then dialing that back. So all the same functions, like looking at the basic foundation of your body first, to help optimize everything else. What would you say then today are, you know, the key risk factors for the people that you're seeing in your office? The things that you can kind of connect the dots that are happening in our modern world that are the biggest culprits. What are they?

So I often talk about four pillars of health. You know, there's gonna be nutrition, exercise, which most people have some idea of what they should be doing. They may not budget the time for it or have access to doing it all the time, but they generally know what they should be doing, but not everybody's very good at managing their stress. And stress isn't the problem. It's kind of the issue when you're kind of stuck more in these high sympathetic tones for long periods of time. Your arteries are gonna be clamped down, which is gonna raise your blood pressure. Cortisol levels will be high, raising your blood sugar. So, you know, the, the wearables, you know, track heart rate variability. So that's how much stress your body's sensing right at that moment. Um, often like, you know, you talk about meditation's outstanding to kind of balance out that nervous system, autonomic nervous system. You know, there's things such as heart math, which is biofeedback. There's now the other wearables that, you know, vibrate at different frequencies to kind of calm down the, the vagal tone. So dealing with stress is extremely important. You know, the type A personalities, it's great. It allows them to accomplish much, but they often age faster because of that. They're burning the candles at both ends. Yeah. And then the fourth pillar, and it's the most important, it's sleep. It's not the most sexy topic, but it is so critical for optimizing your health and longevity. If you do not sleep well, you will not age well. And so I always start back with the circadian biology.

If you don't get circadian biology right, it's really hard to sleep well. It's rest and recovery, right? You know, I always talk about this wisdom of our body. Our heart has been beating for us before we even arrived in this planet. Right. And the amount of energy we don't give any thought to it. It pumps for us every single day. And yet most of us aren't giving our bodies the rest that it needs to restore. And HRV is something that I think is very important to watch. And I know that it's supposed to be different for, for everyone. Um, when we think about optimal HRV and our body's ability to restore, would you say that somebody tracking this, if they're seeing their heart rate variability consistently go down, is this a sign like go see your cardiologist?

Possibly. It just also means that your body's, you know, facing something. You may be getting a virus or, you know, you are starting to over train, or you ate a really late meal and you're just gonna have lower heart rate variability. It's more the kind of the overnight heart rate ability and the first thing in the morning is the most important. Um, a quick caveat is that the majority of the wearables that are either ring or kind of wrist based they're not actually measuring heart rate variability. They're looking at pulse wave velocity and kind of estimating what your HRV would be. So if you don't get numbers on your trackers and it doesn't make sense to you, then you really got to use kind of the gold standard and actually use a chest strap. There's various vendors that make the chest strap. I have no affiliations with any of them, but, you know, the Polar, the frontier, and the Morpheus, those are the three big ones that I, I personally have, and also most my patients use. and most of them have their own software that tracks it. You know, you want to compare your heart rate variability to yourself, not necessarily your peers because the technologies, if they're using a different, you know, they're using ring and using a chest strap, they're going to be completely different numbers. You want to, you know, get your baseline. So you want to record data for at least seven days before you even start really looking at it and then start trying to spot trends because you'll generally start seeing that, you know, if you're starting to get sick, your heart.

Rate variability will change 24, 48 hours before you start noticing your first symptoms. Right. such a great call out and great to note also because I think we give so much control to these wearables. It's funny for me on my aura ring, I have zero affiliation with this brand at all, but it will often show that I had a stressful day, two hours in stress or three hours in stress when I have the most relaxing day. I teach yoga and meditation. I talk about food every day, but you mentioned pulse rate velocity. Could this be why? Like, I know I still on occasion do get palpitations. They're very mild and very subtle. Could this be why?

Possibly. I love the devices for certain parts, but other parts, you know, particularly these ones that are using like the lights to pick up things. Sometimes at certain heart rates, it sort of gets blinded. It doesn't really pick it up that well. So if the data doesn't make sense to you, For the most part, throw it out and use some other different measuring technique. Yeah. Because I, you know, I consider myself a pretty decent biohacker. And I've had many different wearables. And sometimes, you know, you know, be the biohacker that has, you know, four things on at once. And the amount of discordant information was concerning because, you know, some of the watches would say like, oh, you're sleeping real well. The, the ring would be like, yeah, it wasn't so good. So pick whatever device that you're comfortable with. but a quick caveat is that otherwise, you know, this ring, this ring is always in airplane mode. I don't wear anything electronic on my body. My phone is not on my body. My watch is not, you know, pinging me with, you know, notifications all day long. When you're getting those kind of non-native EMFs, those are stressors to the mitochondria. They open up what's known as the voltage gated calcium channels. that causes all this oxidative stress in the system. So your mitochondria are trying to basically sense what's going on in the environment. If you have a bunch of wearables on and your body's getting pinged with all this EMF, the mitochondria are kind.

Of getting radar jammed at that point.

Where were you in my 20s? I didn't know this then, but I've.

Known for at least 10 years. Exactly. It's just so relevant. And so where the data also is what's making me stressed. So that's such great insight. And I really do think, you know, in the past few minutes you've talked about EMF, our level of exposure to EMF today is insane. I also have two Teslas, which I'm really concerned about. And at home, you know, I'm really focused on things that block EMF for myself and for our kids and on our devices and stuff like that. But I'm fascinated around the fact that our heart is an electrical organ. It's founded on electricity and you mentioned frequency and you mentioned vagal tone and you mentioned heart math. So here we are now. And I just, I love the understanding that I have around the wisdom of my heart now, looking back at my surgeries and the things that I felt then, but now understanding like, oh, you were really stressed. You were exposed to a lot. My body was going through a lot. You were depleted. You didn't have the light, the minerals, the nutrients that you needed to function or you had sadness also, which we know impacts our frequency. I can imagine you can't use words like vibration and frequency with all the patients that walk through your door, but you're aware of it. You know, is this something that we can consider for preventing cardiovascular disease maybe as a fifth bucket when we think about nutrition, exercise, stress, and sleep?

I think so. I mean, the interesting thing is that, you know, I've obviously looked at thousands of EKGs in my life. And I never once thought about like, what makes this electricity? Why is this here? It's the mitochondria doing that. And your heart cells have nearly 3,000 to 5,000 mitochondria per heart cell. They're very energy dense organs. The majority of chronic diseases either go in your heart or your brain. Those are where most your mitochondria are buried. But at the top of the podcast, You mentioned ovaries. That's the fun fact. The ovaries have the most mitochondria per cell at a hundred thousand because they're making a new human being.

That's awesome.

But the heart, it's making electricity and it's also making magnetic waves. You know, that magnetic wave comes out, I believe, up to 30 feet from your body. So you literally have a connection with people when you're live and front to front from them. You can feel their vibrations. this is probably why when you get a gut feeling like, I don't like this person or something's off, you're sensing their fields. That obviously sounds woo, but it's actually not. They've been able to use these mag meters to actually measure the magnetic frequencies coming off the body. And there's actually a company. I've been to their headquarters in Cincinnati, and they're developing a scanner that basically measures the magnetic fields coming off your heart to be able to tell you what's going on inside your heart.

Oh, I can't wait. Can that become mainstream?

Like, I hope so.

Understanding around our body. Yeah, I would say, you know, it's funny. We're talking about these foundations that we should all be practicing, you know, although we don't all the time, things like exercise and. And nutrition. More often than not, when I'm working with someone and they're constantly in a state of stress or they're in, you know, they're. just constant sympathetic dominance. I often say to them, the healthiest diet in the world is not going to do a whole lot for you. Like you're stuck in a state where your body can't be optimized. And so when you speak about frequency and our energy radiating 30 feet from our body, you're obviously very familiar with heart math, but the concept of coherence. And this is where I think ancient healing traditions really They had mastery around it. Regulate your nervous system, come into your body, and then focus on the other modalities after that. There was, there was never a, oh, it's a busy, stressful day. Yeah, just go, go work really hard and don't worry about what you're eating. It's like, no, no, no, stop. Breathe, rest, come into coherence. And this is where, you know, gratitude, like I wish going back, if I, if my cardiologist 20 years ago, said, you know what? Before we start, I just want you to start to come into your body. Are you okay? What are you grateful for today? Like, I think he would have just seen on my face. I would have had an immediate breakdown. Tears coming down my face. He probably would have come my. Might become my therapist in the moment. But I think that we cannot forget this aspect of our heart. Our frequency really matters.

Absolutely.

All right, so let's go. You know, you are an expert in this field. You put out so much education around it. what are some practices that you have around sleep optimization every night?

So I start with what kind of an optimal day would be, you know, personally, I'm up by five every single day and I don't hit snooze. There's no reason to hit snooze on your dreams is what one of my business coaches told me. So get up, go about doing what you need to do. So my practice, I'm up at five. The sun where I'm at right now Rises at about 7am. So I have two hours where it's still dark out. So I wear my blue blockers inside my place. I have some nice circadian rhythm friendly lighting my place, so it doesn't really bother me much there to have it be dimmer. I usually, I always meditate first thing in the morning, and then after that, go get the first cup of coffee and then either read or I'm listening to a podcast. The majority of days, I go outside for about a 45 minute walk right around sunrise. I want to see the sun break the horizon. I don't forget that question. Do you have to actually see the sun? You just have to be outside. Some places I know you have trees or valleys and you can't see it. Just be outside, getting the light in your eyes. It's a good way to start the day. If you're trying to change body composition and there's a concern that you're leptin resistant, then you really should consider eating your first meal within an hour of sunrise and then go about your day. You know, for the most part, either workout most mornings on like during a palatine type ride or, you know, some body weight exercises.

Yeah.

Then I come to the office by nine. I have a circadian rhythm friendly office. So my body knows what time it is. Go home, usually do the strength training in the evening time. And I'm always, for the most part, eating within an hour of the sunset. Sometimes I can't really get before the sun sets, but, but my home is very nicely lit with red lights. It looks like a submarine at night sometimes. wear the biohacker glasses, usually watch, you know, half hour of TV or something like that, wind down. But I've usually shut down all the kind of things that are really going to ping your attention. I'm not checking texts or social media, you know, an hour or two before bed. I just talk to my wife or, you know, listen to a podcast. And then usually in bed by 9, 9 30. And people are like, why do you go bed so early? It's like, well, I'm up at five, but it's actually the reverse. You almost should think about your day doesn't start when you wake up. your day starts when you go to sleep.

Yeah.

You know, set a reverse alarm if you need to, like set an alarm to go to bed. So you give the body the opportunity to sleep the eight hours or so that you need. You may not get the whole eight hours, but give it your best shot. And if you're going to bed at nine, you're gonna get up at five. I can't physically sleep more than that much time right now. Think about sleep is when your body is repairing those mitochondria engines. Some people, yes, can get by by six and a half, seven hours, but those are rare people. Some people need 9, 10 hours. When you've ever had a cold, you sleep more. It's because you need more time for recovery. If you're sleeping a lot, that's a sign to your body that you probably need to be doing that. So charge up your battery from the sleeping and then go about doing the good things you need to do for the day.

Love that. Your day starts when you go to bed at night. You're really dictating the type of day you're gonna have. You mentioned the exercise that you do. Everyone's gonna wanna know. We know strength is so important. You talked about protein and muscle mass. um, cardiovascular health and doing cardio exercises. There's been all, you know, a bunch of people who are out there saying, cardio, don't do cardio, focus on weights. And I just think that's such a disservice, you know, cardiovascular exercise for me on a treadmill. I get the greatest surge of happy endorphins that give me like just more light and energy for the day. But can you talk about the, the benefits of specific exercises for heart health?

It's always going to depend on what the person's goals are, but most people, you know, they need a combination. They're gonna need some type of cardiovascular training. They're gonna need some type of strength training. Ideally they're doing some type of flexibility training. You need all of 'em, but it's just mostly how do you budget it in the time. Ballpark, 80% of your cardio type exercises probably really should be in that kind of zone two type of range. zone two has been, you know, something talked about in the past few years, mostly from Peter Tia and Dr. Sam Milan, and they're a good podcast they did a couple years ago. But zone two is at a pace where you could hold a conversation with somebody if you needed to. You shouldn't be out of breath or out of breath. You're getting into these higher heart rate zones. 10 out of 10, you're sprinting. You can't do this for more than 30 seconds.

Right.

This should be at a five out of 10 intensity. And then if you're wearing a chest strap and you're getting your heart rate, It's gonna be about 60% to 70% of your maximal heart rate. Um, so that is 80% of the stuff I do is usually on a Peloton. And then if I really kind of get a lot more time in my schedules on the weekends, I'll try to throw in like a zone five HIIT type training on the weekends. Um, I, you know, unless you're a professional athlete or you're training for event, I'm just training for kind of like general cardiovascular health.

Yeah.

But the strength training is, I think a lot of people fall down on myself included. For many years it was just like, just do a bunch of cardio cuz that's what everybody told you to do. So you're, you know, doing the ellipticals or the bikes, but you're not doing a whole lot of weight training unless.

You were in a culture that, that was important to you. Yeah. But the strength training is extremely important as well. I love that. And you really mentioned a variety, right? And the name of the game now, as we, I think anyone over 40, it's around prevention. You know, we've had our parents get stints in their heart or go on medications or God forbid a heart attack or a stroke. It's really all about pretty prevention. So I think it's important for you to say that, especially if cardio does bring you joy and walking. You talk about walking. Walking is magic. I forced myself to walk every Monday last year, and it was a game changer. And I think it, yeah, it did so much for my, my health. Yeah, it just helps you clear your mind and you, you know, your best.

Ideas usually come when you're walking. Yeah. All right. So we've optimized our sleep.

We've put in these inexpensive red lights into our hell, our house, maybe some dinner, maybe we have lit some candlelight. We're going bed earlier. Now, when we wake up in the morning, what do you think is, has greater impact on cardiovascular health? Is it the stress that we feel or our diet that day?

I mean, I always think about like food is just a structure to the system that the body's got to, you know, help mitigate, you know, food has to be processed, you know, through the mitochondria. There's going to be reactive oxygen species. You know, again, use the engine analogy. You're burning fuel. There's going to be smoke.

Mm-.

Hopefully your body is building up enough antioxidant defenses that that smoke is not damaging the rest of the system. So this is why food is not a holy energy, it's information to the system. So stress comes through many sources. You know, it's the physical stress, you know, you're running, there's the mental stress, but eating is a stressor to the system. And so it's really about back to the mitochondria. It's like, what are you doing to support the mitochondria? If you have great mitochondria, You could probably put chicken nuggets in it all day long and go, go, go. There's a famous story that Usain Bolt in the '08 Olympics did not like the Olympic food in China. So he would go to McDonald's and get big things and chicken nuggets and then went out there and won a gold medal in the fastest time ever run by a man. So it shows you that food is not as important for everybody. If you have finely tuned engines, you can put anything into them. But if you're very sick, that's not gonna go as well for you. But that's the converse is when people are like, I put in all this great organic, clean food, and I still don't feel good. It's cuz you have mitochondrial engines, which you've never changed their spark plugs.

That engine's not gonna go 200 miles an hour the next day. You got it. Okay, that's great. And in terms of, of foods. So everyone wants to know from a.

Cardiologist, what's the best diet to prevent cardiovascular disease? I don't think there's one best diet. It's the best diet for that person's mitochondria, but I really think DHA, the seafood story is absolutely critical. Without DHA, you're not gonna optimize your cardiovascular health. so seafood is the key. If you're absolutely allergic to it, then that's the one case where I say, okay, supplementation might be reasonable, but I don't want people to think that taking official pills is the exact same as eating it.

Mother Nature gave it to us in a special package. Yeah, there's kind of a constant echoing of a message, like of going back to your mitochondrial health, how your body functions first, and then figuring out what your body needs depending on what your lifestyle is.

Right.

And, you know, I think we all know at this point that it It's those ultra processed foods that are really causing a dysfunction in our health. There was the onset and release of these types of foods that I'm sure you saw in your end is when all these numbers started to rise. But if we look back at what our ancestors ate, if our grandmothers would recognize the food, then chances are we're probably a little bit more safe. Right.

And it's, this would be kind of like a two hour conversation about talk about deuterium, but these highly processed foods are very rich in deuterium, which is heavy hydrogen. those heavy hydrogens basically break the engines inside your mitochondria. So that's why regular seasonal whole foods is what your mitochondria are optimized to utilize that time of year.

Welcome back to our mitochondria.

It always does.

Well, with that said, microplastics, what's the effect of microplastics and other environmental toxins on cardiovascular health?

Yeah, this is a big topic. And this is the one I, you know, spoke about on Drew's podcast. is that there was a study the other year that was looking at patients who had carotid endarterectomy. So they're having surgery to remove very severe plaques in the arteries going up to the brain. These are generally patients that had strokes and they're trying to reduce the risk of having another stroke. When they took these plaques out, they basically literally almost scooped the plaque out of the carotid artery and then sewed the artery back up. They looked at those plaques under microscopes and ballpark, I can't remember the exact numbers, but about half the patients had these plastics inside the lipid rich plaques that they're pulling out. The more interesting thing to me, honestly, is if 50% did, why don't 100%? What were those other people doing that prevented it is probably the interesting thing. The microplastics, they're everywhere. We're not going to get away from them completely, but we can mitigate the main sources. And the big sources are going to be using plastic water bottles, drinking water that comes out of your refrigerator that goes through a plastic filter and you're drinking it. So you want to try to do some type of processing to your drinking water so that you're not drinking this stuff. But the microplastics, they're going to be unfortunately in our food stuffs. Like it's going to take a long time to kind of clear this out, but I kind of have a little bit different perspective is that, you know, we have this glycocalyx, this gel coat that lines our arteries. The microplastics are just one more insult to potentially damage that glycocalyx. So can we remove the other things that we possibly can remove? Can we make sure that we're getting the right light signals? Are we eating a seasonally appropriate diet? Are we doing things we can do to support the glycocalyx? Because it's somewhat like a death by a thousand cuts.

Microplastics is just one of those things. Right. Yeah. Do an audit of your, your house. I think that's the best thing that you can do, control as much as you can, and then do your best when, when you're out. How would you say that your approach to assessing and preventing heart disease differs from traditional methods that people, you're like a lot of the people listening, a lot of the people that I work with, they have their primary care doctor who works with a cardiologist that their father or maybe their grandfather saw, that it's hard to kind of step out of the relationship that we have with that doctor. how is your approach different? Obviously you've mentioned so much insight to the foundation of the body. What else are you doing in your practice that's really empowering people to prevent this disease?

So my practice is more proactive and not as reactive. Unfortunately, the majority of people that meet a cardiologist, it's because they're already having palpitations or shortness of breath or chest tightness. You know, they go to a cardiologist, they do a stress test, they fail the stress test, they go get a heart catheterization. oh, you have a severe blockage. Let's put some stents in, and then you're on the medication train. That's what they're very good at doing. I did it for many years, and it is needed. It can save people's lives in the emergency. But that wasn't something I learned in the three years of cardiovascular training I did. You know, we're talking about preventing heart attacks as much as we're treating the cute ones right in front of our face. And you need somebody to do that acute work. But I just got more interested in, okay, what can we do to really slow the roll? preventing this. I don't want to wait till somebody shows up with symptoms. I want to meet somebody when they're 22 years old, put them through a battery of tests and say, you,'re going to be at higher risk in your 40s. These are the things now, if you really prioritize your sleep, your stress management.

You'Re not going to end up like your grandpa who had a heart attack at 55. Wow. Proactive and preventative. It's, I think it's the scariest part about heart disease, right? Like people that we hear who randomly just out of the blue had a heart attack or God forbid died. as a woman, a stat that I'm hearing all the time is that I'm predisposed to have a heart attack on top of my genetic predisposition. So this is the year in part of the inspiration also with reaching out to you and looking into different types of scans. So for listeners who might have the same concern as me, who maybe have a father or mother who went through some sort of cardiovascular heart disease, what scans are you doing? what are most effective? Which, which should, what should we be looking for? Yeah.

And that's a great question is that, you know, blood work is a great starting point for many people, but it doesn't tell you what's actually going on in the cardiovascular system. You have to actually go look at the arteries non-invasively. So before 40, usually recommend people consider a carotid intimal medial thickness scan or CIMT. It's an ultrasound of the arteries on the side of the neck. It will assess are you developing any plaque in the arteries, but it will also look at how much inflammation is in your arteries. It looks at the thickness of the intima. Intima, if it's thick, if it's thick, your vascular ages can be higher than your biological age. You're aging faster than you should. There's a very strong correlation between what goes on in your carotid arteries and your coronary arteries, your heart arteries. If you're over 40 and you've not had a heart attack, stroke, stent, or bypass, then I recommend people consider getting a CT coronary calcium score, or CAC score. It's a low dose CT scan, low dose radiation CT scan, usually can be between about 100 and 200 US dollars. Think of it almost like a mammogram for the heart. You're trying to find plaque well before you have your first symptom. It is not a perfect test, but is a better test than a stress test. So the reason the stress test is maybe not the best test is you're not gonna fail stress tests until you have severe disease. This is gonna try to find disease well before you have your first symptom. So if your calcium score is zero, then you're very low risk of having a heart attack. If your calcium scores over 400, if you're higher risk, if your score is over a thousand, you're very high risk. So it helps quantify people. And I've seen patients in their 80s with calcium scores of zero. I've seen, unfortunately, a gentleman who was 37 years old and this score was in the 1300s, which is the highest score I'd ever seen in somebody. under the age of 40. So I kind of changed my perspective because I used to not really start screening people at that scan until they were 40 or later. But now with this gentleman, I'm starting back down to maybe 35, 30 if there's the right family history. So it's a very good test to start with. But if people are like, you know, I have a very strong family history and I want to know exactly what's going on in my cardio arteries, the issue with the calcium score test is it cannot see the more immature soft plaque. and it's often the soft plaque that's causing the heart attacks. So there's a test called a CT coronary angiogram. More radiation, more financial cost, and it does require an IV to get IV contrast because they're gonna fill your arteries up with this contrast so they can take a picture inside the arteries to tell you how much quote blockages or stenosis you have. But more importantly is you can take those images, send them to a company called Clearly and their AI machine learning algorithms can tell you exactly what types of plaques you have in your artery walls. So think of plaque as like an iceberg. You're just trying to figure out like how much is an arterial wall and is it hard plaque, which is kind of a scar and just, that's just gonna be there, or is it soft plaque that if you don't do something about, more likely will cause you an event heart attack down the road.

That's the scarier plaque. And are there any risks to doing the CT coronary angiogram?

There's small risks from a contrast reaction. Most people, if they've had a CT in the past with contrast and they didn't have a reaction, they're gonna be okay. But if you've had a reaction in the past, then they have to pre-medicate you with steroids and stuff so that you don't have a allergic response to the contrast. There is a, you know, not small, but it's not a large amount of radiation. So radiation, you know, at a high enough dose, will induce DNA damage. So if you get the scan once, not a concern. This is not a scan that you're going to do every year for the rest of your life. The risk of potentially causing a cancer starts to increase when the medical radiation dose gets high enough. So I've had the scan done twice personally. You know, I probably would repeat it every two to three years for myself, but I always work with the patient and say, okay, does it make sense for them?

Fascinating. Yeah, this is the year I'm definitely curious for myself and for my husband. And I'm looking into Clearly. Are you connected with Clearly at all? I know Clearly because of you. So it's C-L-E-E-R-L-Y. And you have to find a practitioner who can go through your results. But why not? I feel like the more information that you have in terms of something that, like the earlier that you catch it, prevention is everything, right? So why not?

Yeah. Correct. you know, I was a math major in college. Yeah, I'm very data centric. It's like, and I'm also from Missouri. You have to show me, show me your RDs are healthy, and then you can keep doing whatever nutrition plan sounds good to you. But if we find things that are putting you into a high risk category, then we really gotta have a conversation. Is this, you know, dietary plan optimal for you? Are you truly managing your stress and sleep as well as you need to? You know, your health is in your own hands. You know, your doctors are supposed to be the sharpest. They're just supposed to help you figure out. what's going on and try to point you in the right direction.

You got it. We're going to start to wrap things up that went by so fast. I guess in closing, people are going to want to know. So I feel really happy for the amount of clients that I worked with who their doctor kind of had that knee-jerk reaction to write a prescription for Libitaur. And then all of a sudden they had a doctor who could be their partner to get off of Libitaur. Not all doctors are open to this. Let me know your thoughts on how you know, prevalent these prescriptions are happening. But also maybe your top three takeaways for listeners on things that they can practice if they were given that prescription.

So I always talk about like stands or tools, you know, use the right tool for the job. So if you've already had a heart attack, stroke, stent or bypass, it is a good tool because it's going to reduce your risk of having that again. Where it gets it more into the gray zone is when we're talking about primary prevention. You've never had a cardiovascular event and you have a quote high cholesterol. Do those people benefit as much? I'm gonna always say it really depends. It really depends on, you know, what are your other risk factors? If you have lipoprotein(a), you're probably gonna benefit more than somebody who doesn't have lipoprotein(a). But I'm always gonna wanna look at the arteries. If your calcium score is zero, your CIMT, your carotid scan is normal, and you're like, I really don't wanna be on medication right now, I'm going to say, well, your risk seems relatively low at this point. Do what lifestyle interventions you're going to do, and let's repeat things in a few months and see how well the lifestyle interventions have done. If lifestyle works, which you wanted to do, great. If it doesn't work, you still get benefit by making lifestyle changes. You potentially reduce your risk of insulin resistance or cancer or Alzheimer's. You still get the benefits. It just may not have fully optimized your lipoproteins for the risk reduction that you're looking for. Some people really just cannot tolerate the stanols for whatever reason. They may have muscle symptoms, they may have brain fog, some people times it affects their blood sugar enough. Okay, there's other tools to utilize. I often use a company called Boston Heart because you can kind of tell, is it more an issue that their liver is producing too much cholesterol and the stanol would be a really likely option to work well for them, or is there something where their gut is recycling too much cholesterol? and a medication called the Zetomibe would work better for those people. So I can sometimes fine tune and say, well, let's try this tool for you and then repeat in a few months to see how well that one.

Worked for that person. Such good insight. And I think it's so important to know, like, I think there is a time and a place for all of these medications when there's a need. Some of my clients are on a Statin out of necessity. I think it's a really, really good choice. And it's partnered with either a doctor or a practitioner. who is educating them on the pillars of the core foundations of healing. All right, how do you communicate with your audience? What's the best treat for people to find you? So I'm on Instagram a little bit.

I say every Monday, 6:00 PM Central time, I do an Ask Me Anything for about 30 minutes so people can submit their questions ahead of time. I'll take some live questions as well. I have a YouTube channel, just my name, Dr. Twyman.tv goes to the YouTube channel. and then if you just search for my name on that kind of the whatever podcast app you use, I, I don't know, 70, 80 different podcasts. The, the two I've done with Drew are kind of like master classes on lipoproteins and vascular health. That's a good one. I've recently one did one with Dave Asprey. He was kind of the, the biohacker that got me into understanding what these blue blockers did. So I talked a little bit more about light in those ones. So if there's a particular topic that resonated with you, we talked about today, just search my name. that topic, and I probably talked about it a little deeper on a different podcast.

Wonderful. Yeah, you're a great teacher. All right, some quick rapid fire questions to ask. Sure. What are some of the most common mistakes or misconceptions that you're seeing people make with their health?

That they think it's all about diet.

Thank you. Diet's not even the first place that I start. I actually start with my clients. I love that you said that. What's one way that women are making healing and health to.

Complicated. What's a good one? I don't know if it necessarily is just women in general, but it's probably that I would say that, that they don't understand that their cardiovascular risk is when they're premenopausal, it's less than a man. But once they're postmenopausal, it's equal to a man. And your risk of cardiovascular disease is significantly higher than your breast cancer risk. So you want to make sure that your heart is checking out just as your boyfriend or husband's heart is checking out good.

Absolutely. Yeah, that's why we're doing it together. Dr. Twyman, do you have a favorite ancient healing remedy?

It probably would be, I don't know, probably be meditation. I just found it by accident. I initially started with just one of the apps on the phone, the Headspace one, and I literally still can have that Andy guy's voice in my head sometimes when I'm doing it, but it was literally the health habit I picked up in the past five, six years. It's the one that short of, I don't mess with my circadian rhythms. It's the one habit I don't skip. I don't miss days. I think I got a 147 day streak right now on the meditation app I'm using. So I think your mind really controls the body. So sickness is something that, for most part, comes from the mind, but it's, a lot of it, it's mitochondrial dysfunction. So it's everything we just talked about for the past hour. pulse, focus on healing the mitochondria and start with your mindset first.

I love it. And lastly, if you could leave our listeners with a takeaway of something that you feel really passionate and excited about right now, what would it be?

Well, one, yeah, don't miss a sunrise for the rest of your days. If you optimize your circadian rhythms, things are going to go much better. But I think there's great technology coming out in the near future that's really going to help optimize people's , ability to screen for cardiovascular disease at an even earlier stage. And then people are going to be able to be very more proactive, you know, at times, yes, you may need a doctor if things are getting too bad, but I think a lot of things will be able to be screened at home and people can start staying kind of more proactive on their own, but not necessarily waiting until they're symptomatic.

I love it. And thank you. And thank you for really shedding light today on, you know, on the mitochondria, like really just optimizing the ability that our bodies have to heal itself and how that in and of itself is prevention for so many diseases. So thank you so much, Dr. TwymAn.

You're very welcome.