Why Normal Test Results Do Not Always Mean Your Heart Is Healthy with Dr. Abid Husain

What's one thing on a standard blood panel that people obsess over that you almost never look at?

Oh, I love this question because everybody tells me what their cholesterol is, and that is probably the last thing that I want to look at when I'm assessing cardiovascular risk.

Finish this sentence: the real cause of most heart attacks isn't cholesterol, it's—

The real cause of most heart attacks is inflammation.

Dr. Hussain, welcome to Rooted in Wellness.

Thank you for having me, Mona. It's a pleasure to be here.

I was just sharing with you that I don't think I've ever had so many notes for a doctor who's come on this episode before. I'm so excited about this conversation with you today.

Fantastic.

Well, as I was sharing, you know, I told you about my story. And ultimately, me going back to the ashram was about becoming more rooted in who I was for me to heal my body first. So we kick things off by first asking, tell me 2 or 3 things that help you feel more rooted in your health, your happiness, and who you are?

I have a daily practice that involves fitness and doing something creative on a daily basis. So in the past, I've been a painter in the past, and that's sometimes a little hard to dial into. So these days, it's now music. So I play the piano or do something voice-related, but it's a creative practice, and that gets me really dialed into— that grounds me. And lets me do something for myself before I get into more intellectual or medically related things.

I think you're the first person to ever give that answer. That's incredible. And it's such a big part of who we are, right? So, yeah. And I'm sure if you looked into the science around the nervous system regulating aspect of that and everything, it's beautiful.

Yeah.

Having gone through the journey that you've gone through, you know, a lot of people sitting in your chair have gone through some sort of a journey when, you know, my clients will say it's falling off the wagon. But do you notice, are there certain practices in your life that cause you to feel uprooted? And do you catch yourself in the moment?

Definitely. I know when I'm feeling uprooted because I feel it in my body. I mean, I feel the— it's mostly work-related or just life-related stress that builds up. I mean, on a regular basis as a physician, there's a fair amount of stress that we have to deal with. But then— and that's manageable. I've gotten used to that over the years. But it's when things get compounded. I can feel it in my body in particular, and it shows up in back spasms and so— or leg tension. And so, when that starts happening and I may fall off of my stretching routine, my mobility routine, and I just focus on doing sort of the lifting or the regular exercise, my body does not cooperate and it will create back spasms. My sleep will start to get impacted. So, I can tell. when I'm falling off the wagon because my body lets me know.

And did that happen at an age for you? I'm curious. You know, there's a lot of wisdom that comes with being able to tune in and obviously stress as we age may tend to get a little bit higher. Was there like an age that you noticed that there was a correlation between the body aches and pains and your stress?

It's been in the past 3 to 5 years. You know, prior to that, I still was, was blessed with the ability to push through a lot of stress and just manage it. But I'm 53 now, and as I've gotten to this age, as I've reached closer to my 50s, these problems started happening in my lower back. And I have a structurally normal back, but having back problems and chronic back pain was really surprising to the point where it sidelined me from doing my exercise. So, it's been relatively recent, but My awareness of my body has been there for a long time.

And what a gift, right? The good old days of being able to muscle through your stress and show up for life with no sleep and inflammation. Now we have to tune in. We really have to tune in. And gosh, I would've guessed that you're in your 40s. You look great.

Thank you.

All right. To kick things off, we're going to go into some rapid-fire questions. We're obviously going to go deeper into all of these. So everyone loves these ones. Here we go.

Yeah.

What's one thing on a standard blood panel that people obsess over that you almost never look at?

Oh, I love this question because everybody tells me what their cholesterol is, and that is probably the last thing that I want to look at when I'm assessing cardiovascular risk.

Brilliant. All right. Statins or lifestyle changes? If you could only choose for a 45-year-old with early plaque, which one wins?

Definitely lifestyle changes.

Where have you been all my life? Wow. I'm so excited. Okay. What's the most dangerous thing that a person can do for their heart that gets sold to them as healthy? Ooh.

Right now, that's a, that's a tough one. I mean, clearly smoking is one of the most dangerous things that we can do, but that's never been sold as healthy. I'd probably say, Uh, vaping is, is, uh, is a clandestine version of smoking that a lot of people do that's caught on that really is still bad for you.

Uh, fruit-flavored vaping. Should we say that for, for today? All right. Finish this sentence. The real cause of most heart attacks isn't cholesterol. It's—

The real cause of most heart attacks is inflammation.

This or that, advanced cardiac imaging or a full hormonal panel, which tells you more about someone's true cardiac risk?

Ooh, I would have to go with the imaging at this point. Yeah, that gives me more to work with on a treatment level. Hormonal levels are vital, but they don't quite make it to tell me what their risk is.

What's one daily habit that does more for your heart than any medication that you can prescribe?

Daily exercise or movement routine.

Isn't it wild? We live in this world too. We're so aware of this. We're so aware of how important movement is. We feel it when we practice it, and yet we continue to live these sedentary lifestyles, and life is demanding that from us.

Absolutely.

And heart disease, as you know, obviously, so it's pretty frightening when you look at the numbers. It's the number one killer globally. Nearly half of people who suffer a heart attack had no previous symptoms.

Right.

We've become so great at treating these cardiac emergencies, but not nearly good enough at detecting, I would say, these, like, decade-long processes that precurse the actual heart attack. So, let's start with that. You know, most people assume that heart attack, heart disease, it announces itself— chest pain, the trips to the emergency room, a really scary health result. But you're saying that the real danger is actually building up silently years before. So let's start with what does early cardiovascular disease actually look like, and why are we missing the mark even with the numbers where they are at today?

Yeah, it's a, it's an insidious process and we don't feel it. A lot of cardiac conditions are like that. And, you know, we think of cardiology or cardiac conditions as being emergency issues that we see in the hospital. And that's the dramatic, end result, the end of the spectrum, sort of end of the line evolution of the disease. That's how it shows up. When the heart stops, it's dramatic. But there is, in every single cardiac condition, there is a slow, steady progression that we can detect early on. And it doesn't necessarily have to be showing up in the heart because it's hard to, to visualize sometimes these changes in the heart. It happens metabolically and it happens in other organs. So, really true cardiovascular prevention is a systems approach. And so, we have to look at glucose regulation, we have to look at the liver health.

Mm-hmm.

Taking a step back discussing the liver, liver is central. It is an intersection of so many different systems where we're talking about energy regulation, where cholesterol is produced, where we detoxify. I mean, the liver is so vital, and it is intimately tied to cardiovascular health. And, this is becoming more and more obvious. When you look at fatty deposition of the liver, this was thought to be just a problem with the liver and something that alcoholics or diabetics suffer from.

Hmm.

We are now seeing many, many people that don't have those problems and they have fatty deposition, and it's part of the contribution to cardiovascular disease. That plus inflammation. So, so when you're looking at what, how heart disease shows up early on, it's may— it's not necessarily looking at the heart, it's looking at everything else around the heart.

Mm-hmm.

I mean, definitely gut health is, is intimately tied to it because 70% of our immune system resides in the gut. So anything that, that affects the, or activates the immune system there is definitely gonna impact It's interesting.

This is where I always go back to Eastern wisdom. Eastern traditions typically looked at the entire body as a system. They would never just isolate on the heart or the liver or the stomach or the brain. They would look at the body as an entire program. As a nutritionist, I spend so much time obviously talking about digestion and gut health, but we always have to work upstream. And working upstream means we go to the liver. And to your point, I can imagine that there's a lot of confusion about the liver. I can imagine that a lot of doctors who are trained in conventional cardiology, you know, somebody on the exterior looks healthy, they're not drinkers, they're not overweight, they could actually be quite lean. And, you know, they're relying on that while they're looking at these cholesterol panels without looking at the full picture.

Yeah.

So for you, what was the point in your career where you had to branch out of, I guess, what your education probably taught you into the knowing of treating the body as a whole?

That happened a long time ago. It happened probably 20— 2010, around that area. I was working full-time as a cardiologist and doing inpatient outpatient care. And it was a revolving door of heart failure and atherosclerosis and younger and younger people coming in. And it just didn't seem Like the— we were— it didn't seem like we were making a dent in these new people arriving into disease. And people that were already existing with disease, they just, you know, we weren't really making a— we were stopping them in the emergency situation, controlling those, but then they would have a— they would relapse very quickly. And so it just— it felt like I wasn't really making a dent. And my curiosity was How do we prevent this? And there was nothing that I was taught in medical school and up to fellowship about prevention. It was all about treating the end-stage disease. So, and then, you know, I had a personal revelation, not necessarily a crisis, but I burned out and decided that it was long hours, no, you know, on call all the time. And I just didn't really see a point in it all. And I decided I'm going to take a step back And take a sabbatical, retrain myself, understand what was happening in a different way. And that's how I found functional medicine. Functional medicine is the study of chronic disease, looking for root causes. I've always been an athlete interested in diet and exercise and optimization of health. And so, that was the first foray into it. And that's when I started changing and thinking about things from a system standpoint.

Fascinating. And I can imagine it feels a lot more rewarding as a practitioner because now you're part of prevention and preventative healthcare.

Yeah.

Yeah.

You know, it's surprising. It's, it's a step back to more generalized care, but I, because I'm looking at all the systems and, you know, you find a cardiologist that asks you to do a stool test or wants to take a picture of your liver, you know, it's, it's surprising, but that's what I end up doing. And, and it, It reveals a lot. It helps, helps better outcomes for sure.

Yeah. So you'd mentioned the words root cause, which is really powerful. Living in today's modern world, especially with the access of these functional biomarker testing companies that we can all go and get, most people don't know what to do with these labs. A lot of people come back with inflammatory markers in different systems of their body. And for me, looking back, it's funny, you know, you mentioned gut. You mentioned metabolic health. If I were to go back in time, I wish that the cardiologist at the time of my surgery were asking or investigating into my metabolic health. You know, my circadian rhythm was completely off. I was on— I remember at the time thinking that I felt better if I removed starches, like it would minimize my tachycardia episodes, but they didn't ask about that. And I wish the doctors had asked about the fact that I was on antibiotics for about 15 years straight.

Hmm.

sometimes twice a year growing up. And so, when we think about that working upstream, right now, I'm sure that most cardiologists are still looking at that cornerstone basic lipid profile. Where does that leave people? You know, how come being at the state of awareness that we are in today, how are cardiologists still left in the dark around looking at a bigger picture to get to that root cause?

I think that part of it is there is a deficiency of cardiologists, and the ones that are available are usually swamped Yeah. And, the other thing to remember is cardiology has historically been a procedure-driven specialty working with our hands, doing stent implantation, doing ablations. There is a lot of visual interpretation too, but that's an aside. It is procedure-oriented. So, there's not a lot of thinking as to what is going on metabolically and on a cellular level. So, there's an issue of time because there's a lot of people that need help when they get to that end stage and there's only a certain number of cardiologists that are able to do this type of thing for these people that are in emergency needs. So, that being said, there's also just— there's a lack of education. I mean, it takes a real curiosity and time to be able to investigate these root causes, these other— cellular pathways and processes that cause cardiovascular disease. It's time-intensive and it's taken me 10 years to get to this point, 10 years of additional training after working and being in practice and then retraining myself. So, it's labor-intensive and there's got to be a true love to it and a curiosity and openness to understanding that, okay, I don't know everything. I'm still learning and I'm always going to learn.

Yeah, I think it's powerful. I think we're heading into that direction. I hope we are with the numbers around the— that are on the rise. However, I can imagine that you're probably meeting with a lot of people who are exercising, they're eating well, they might think that they're managing their stress or they've become accustomed to living with a certain level of stress every single day. But a lot of people feel like they're doing a lot of things really, really right. And yet we see their numbers, they're coming back and they do have these inflammatory markers and we do think They see that things are, are going wrong. So what are you finding in these people that conventional medicine is missing?

It goes back to looking at the gut. You know, I, I find that we live in an increasingly higher stress burden environment and a toxic environment. And that can be mental stress, that can be food, you know, food desert stress. It can be oxidative stress. You know, there, these things add up. And especially in somebody that thinks they're doing everything right, there are really insidious places where this starts to creep in. I mean, everybody's exposed to environmental toxins and that shows up in maybe food sources that have higher content of, say, arsenic or mercury or lead. Those in particular have high cardiovascular effects.

Yeah.

You know, then you've got food that has, uh, that has glyphosate in it. And if you're not particular about being aware of your gluten status, or even just having antibiotics like you had and, and still eating well, you know, the many courses of antibiotics changes your microbiome. So all of this contributes to overall cardiovascular disease. And so it, it really takes looking at it from, from that, you know, sort of ground-up standpoint.

What would you say is a basic cardiovascular panel? I'm guessing LDL, total cholesterol, HDL, Triglycerides maybe?

Yeah, that's a basic lipid panel. But for me, I would like to see an ApoB. I'd like to see a C-reactive protein, hemoglobin A1c, fasted glucose, insulin levels. Those are just some basic numbers. And I mean, if you take a look at what you can actually do from a basic standpoint, there are some really wonderful ratios that you can get from very cheap basic labs that can give us a lot of information about underlying inflammation, liver health, and overall sort of metabolic health. So, it doesn't take a lot of high-level testing. You can do it with a CBC with differential, a comprehensive metabolic panel, lipid panel, ApoB, and an A1C. Those are all very basic.

Yeah, they definitely are. And most practitioners should be running those anyways. But at what age would you say, you know, if we say we're noticing that prevention is key here, at what age would you start looking for panels like that? I'm imagining it's before any concerns come up.

Yeah, I think that looking at ApoB and cholesterol, that's going to, you know, in younger years, it's probably, it's important to get an assessment for that initially. Early on in life, certainly, that's going to be checked, I would say, within late 20s, 20s, then during your 30s if there's no issues. The other thing to check early on is lipoprotein, which has emerged as a genetic risk factor. And then, have the family checked. Usually, if there's family members that have it, that'll provoke somebody in the family getting tested young. And, we can get into lipoprotein in a minute.

Yeah.

Yeah, I would say that lipids will change and they will track upwards. They will drift upwards as we, as we get older and so will inflammatory markers, but it's good. It's important to get them early on so we don't miss the people that may have some of that risk early on.

A lot of this has to do with inflammation. I think we've said that word a few times. So not only from the demands of life, this could be from poor sleep. This could be from, you know, Poor gut health, overwhelm, toxins in our environment, our food, our water. If inflammation is the root cause, then how do we understand where this becomes, you know, something that is preventable? How do we know what to deal with first? So you mentioned looking at your biomarker testing first and foremost, but are we seeing the rise in these cardiovascular numbers as a result of just living in our modern-day world? Mm-hmm.

I think that's part of it, yeah. And, it is a— when we look at the population in general, so the wider population, it's metabolic dysfunction, it's glucose dysregulation, insulin, you know, because the obesity— because obesity is a growing problem despite having all the tools that we have. Diabetes continues to be a growing problem. And, that's where most of the population falls. The other population that we've kind of been talking about and alluding to is the healthier population that is watching what they're doing but still ends up getting cardiovascular disease despite their best efforts. That's an interesting population because that's where we have to start looking at some of those hidden risks and hidden sources of inflammation. So, it could be the combination of sleep dysregulation, work stress, sympathetic load. I think there's a— when I say sympathetic load, I mean mental stress.

Yeah.

And activation of your autonomic nervous system into constant fight or flight. I mean, we're in a society where we have news happening immediately all the time, and everybody's attached to their phones. And this leads to an anxiety-prone, overstimulated lifestyle and culture. And we're not meant to live that way. We are meant to live with stress and then disconnect and relax. That's That's a cyclical pattern. And when we have mental stress and we trigger adrenaline, that is an inflammatory activator for our vascular system. It increases blood pressure. So, there are real physiologic changes. And imagine if we're stimulating those changes constantly. So, there are a lot of these hidden triggers of inflammation. And so, in that population where They think they're doing everything really well. Really have to look at where the other sources are. I mean, overtraining is actually quite a common problem too. We think that, you know, more is better. Let's be more fit. It's not, you know, more is not better. We, we function best. Humans function best in a window, in a sweet spot. And if we don't give ourselves the right recovery, it will cause problems.

Oh gosh. The amount of unlearning, coaching around unlearning that I need to do with the people that I work with because they want to get back to their physical shape at 20 or 30, or even to optimize their metabolic numbers. I'm going to go hardcore. I'm going to start on Monday. I'm going to restrict absolutely everything.

Yeah.

And it puts their system under so much more stress. And I want to hover on this just for a second, because whenever I give talks— I was just at a retreat this weekend where I was speaking, and every single person that was there, when I asked, you know, on a scale of 1 to 10, let me know Who here suffers from a level 8, 9, or 10? Every single hand in that audience went up, and it was followed by laughter. And the followed by laughter is a really key component to this because it means that we've normalized this way of being in society.

Mm-hmm.

And from an Eastern perspective, when I saw, um, an Ayurvedic practitioner, you know, the reminder of stress is the instigation of all disease within the body. And so if we're having this conversation around preventing heart disease, and yet here we are in our younger, healthier ages, and we're experiencing these high levels of stress, then we can only imagine that this could be the instigation of heart disease in the future.

Yeah, I agree. It's— we— this is, I think, the first time in history where we've got such a high stress and sympathetic load that happens starting in childhood and then leading into adulthood. You know, and in the past, it's never been that way. It's never been constant stress burden. So, you know, when we look— when I look Look at why sometimes people are coming to me with heart disease more than expected at a younger age. There's, you know, these are, these are definite sources that we look into.

So we have to address our stress. I want that to be the number one takeaway. The second aspect, which I'm fascinated about because it really helps me personalize protocols with my clients, is looking at their genetics and understanding their susceptibility to developing cardiovascular disease. For me, on my genetics on both sides of my family, I'm, I'm a carrier for, you know, having issues with, with, with heart disease. So you mentioned ApoE.

Yes.

What else should we be looking at? And are you looking at genetic tests with patients that you work with, or when you're speaking to audiences, does this come up? I do.

I look at— yeah, there's, there's a few genetic tests that I'll look at. So Lp is one that's shown up as a, as a common one that's being in I mean, one of the reasons is because the pharmaceutical companies are looking at creating something to lower Lp. So, it gets a lot of marketing in that regard. But, Lp, just to discuss what it is specifically, it's a protein that's on the LDL particle that makes it more prone to being oxidized or inflammatory, makes it stickier, so to speak, and can predispose sort of calcium deposition, things like that.

Yeah.

So, there's very little you can do from a lifestyle standpoint, diet or exercise to lower it. There's a few medications that may be able to reduce it, but it makes LDLs more prone to causing problems. And the thinking behind it is if you lower the Lp, then you lower a risk factor. My thinking is back to a systems-based approach, it's that Lp is not necessarily a problem unless you have other risk factors. It's a risk amplifier. So, if you've managed your risk profile, managed your inflammation, managed your glucose, managed your stress, your tendency for your hormones, things like that, then you can mitigate the Lp and, and have, and make it have the least amount of impact. And the reason I say that is because there's a whole host of people that have Lp elevations that don't have heart disease.

Yeah.

So, so I'm one of them. Yeah. So there you go. You've, you've done a great job to mitigate the risk and it's because you've, you've addressed the rest of the system. So just a brief, you know, discussion about Lp.

Yeah.

The, the other, Genetic tests I'll look at will be ApoE genotype that looks at your risk, increased risk of atherosclerosis and Alzheimer's. So, you can get, you know, the ApoE4 genotype is the one that's of higher risk. And then, there's MTHFR. MTHFR has a specific SNP that has a, has Propensity for increased atherosclerosis, increased homocysteine, things like that. I will do a genetic assessment on patients when they come to me at a young age and there is no clear-cut reason for why they have atherosclerosis higher than expected. And because not everybody needs to get a genetic assessment.

Mm-hmm.

If they want it, I'm happy to do it. And, If you show up to me in your older years with an expected amount of heart disease, then it's also probably not necessary at that point because remember, genetics are only as important as the lifestyle you've used to activate those genetics. Meaning, like an analogy, the genetics are your library. What you've done to take— you can choose what books to take out of that library by life choices, by lifestyle, diet, all that stuff.

Yeah.

The books we take out are what show up in our body. So, if you've already spent 60 years of taking out the wrong books, I don't really need to know what's in the library to know how to fix that, how to change the metabolism. But, if you show up at a young age and you have atherosclerosis, then those genes are going to be more important to see.

Yeah. I think that the information— this is a blessing around Western medicine, right?— is that the science that is emerging, the things that we can now understand about our physiology for prevention is so key. But I'll always preface it with, as long as it doesn't induce fear or fear-like behaviors and how it's going to drive you.

Yeah.

And, you know, I'm seeing a lot of these come back. The MTHFR gene, homocysteine ability to— what am I saying— elevated homocysteine, or people's bodies' abilities to detoxify them. Is that the right word? To detoxify homocysteine properly?

Right.

Yeah. And so we come back with these precursors that we know are linked to heart disease, and yet a lot of doctors again aren't practicing this. So for listeners, I just think it's worthy of— if you know that you come from a family who has a history of genetic heart disease, then these are numbers that are definitely worth When you talk about the cardiovascular system, let's just go back to Lp for a second. Is Lp— is there a connection with what you're seeing over time to plaque buildup within the heart?

The connection— when we look at studies, they do see an association with Lp and increased risk of plaque and calcium on some of the valves. And then with, there are a few other associations, some vascular increase in thromboembolic events, but it's, the association doesn't cross over to the whole population, which is what, you know, there's a, you know, there, it's there and it's difficult to determine who it is that benefits, well, who it is that seems to show up with the disease. And I think it's because a lot of the studies haven't— they've looked at that as in isolation, but to look at it with the other disease modifiers and to see how that amplifies risk, I think hasn't been done yet.

The other aspect of that also, I'm curious, for men and women who notice at whatever point in their life their LP literally comes back and all of a sudden they're in the red, is there an association to hormonal changes also that are happening as we age?

Yes. Yeah. When women go into menopause, we tend to see higher Lp elevations start to happen a little bit more. And curiously, they may not have been detected in the past partially because we haven't really tested it on the wider population until recently. So, we don't know in postmenopausal women, but the estradiol is one of the things that can mitigate Lp and lower it. So, when women lose estradiol, In menopause, there is a possibility that it may cause some of that Lp elevation.

And eventually, does— you said there's very little to move the markers on that, but are there minimal shifts that happen with hormone replacement therapy with estradiol?

Yes, yes. Estradiol is one of the few things that can show some reduction in Lp. And one of the things, it's not pharmaceutical, it's— and it's got a global multi-system benefit.

It's fascinating because we would never associate the two together. Right. And I've noticed a trend even with perimenopause, that drop in estradiol and all of a sudden the Lp marker comes back. All right. So now we're connecting hormones to this as well.

Yeah.

So when we think about these shifts then that are happening, let's say as early as your 30s, but moving into your 40s, we talked about stress being a trigger. We talked about genetics also being a component here, but What other big components are you seeing? If you were to name 2 or 3 things that you would look out for in someone's lifestyle, what would they be?

Let's see. So in their lifestyle, well, you mentioned hormones. I am a big proponent of examining hormones and they are, in my mind, they are our nature's regenerative tools. And so the original regenerative tools that we have So replacing those are vital. That's mandatory as far as establishing baseline health and resilience in our practice. Other lifestyle questions I have, definitely I go into sleep. I ask everybody about sleep, whether it's restful, how that number of hours, if it's regulated, if they're waking up at night. We talked about bowel habits. I don't need to go into that anymore. Stimulant exposure, caffeine or any other power drinks or energy drinks, those have, if there's excessive amounts, that has an additive risk. And then, we talked about stress. That's also something really important. Not necessarily lifestyle, but I will also ask about COVID exposure.

Interesting.

COVID is an important vascular insult. It attacks the whole system, but it gains access to the system through the lungs, blood vessels, and then the rest of the body. So, your blood vessels, areas of high blood vessel concentration are the ones that are most susceptible. And so, it can affect all the blood vessels in the body. And, And, and create accelerated atherosclerosis.

Is that why we saw a rise in cardiovascular cases around the time of COVID Yeah.

One of the reasons. Yeah. It's a, it creates not, it would create inflammation directly in the myocardium because it's a highly vascular organ and other organs. But we see, we saw a lot of cardiovascular deaths and the rise in cardiovascular deaths because of COVID sudden heart attacks in People that might've not had it in the young people that were marginally at risk, all of a sudden tipping over. So definitely.

I've been noticing a trend in my practice where whether people, you know, had COVID and really suffered or had COVID and, you know, they thought it passed or people with long-haulers COVID, a lot of people since then, you know, it's not uncommon for these people to then have become more susceptible to getting mold. Or they felt more susceptible to nervous system dysregulation, not being able to hold or carry at a capacity that they used to. And a lot of these people, I guess I'll say myself included, I don't think I fully bounced back since those years. I had the onset of hormonal changes and perimenopause and things like that. But could this be a source of, you know, when the body is under a state of inflammation for a long period of time, and that inflammation goes systemic?

Hmm.

I can imagine that it's normal for, for it to take years for it to go back unless we're taking a proactive whole system approach.

Yeah, I would agree. Then that's, that's partially, that's what happens with, with long haulers. You know, they, they've gotten such a metabolic insult and it goes to the, down to the cellular level that any sort of challenge to the system is poorly tolerated. And, you know, if we wanted to talk about specifics, it's potentially a problem with mitochondrial function. It goes down to the subcellular range where the things that create energy are broken. The cellular structure is degraded and basic energy-producing mechanisms are gone. So, that means you can't produce energy for the initial activity. And, if you do, then they're set back because they don't have the ability to recover from that, to make the energy to recover.

Yeah.

And then, they don't have the energy for immune activation. And, part of the problem that people have in this situation that makes them susceptible to other conditions, other problems is that they've fatigued their immune system. So, the immune system can't react and so they become more susceptible to so many other things or the immune system overreacts. And then, you get sort of this overreacting histamine triggering, you react to everything sort of physiology. It's really difficult to, to regulate that when your basic structures are just degraded.

I can just hear listeners saying, all right, Doc, tell us what to do then. Low mitochondrial. And then I think you said it already. It all goes back to the foundations. You know, we really just— we can't, we can't talk about the foundations of health enough. Proper sleep, proper rest, proper stress management, proper food, proper movement every single day, proper sunlight for your circadian rhythm. It really is the secret to overall health. Now, I'm smiling because, you know, I look back at the time of my heart surgeries and I say, what a gift. I was able to look at my heart on this massive screen for hours and the wires going into my system, but also really developing a deep connection to my heart because I'd never been that up close and personal with it.

Yeah.

And I often, when we think about having this deeper connection, especially to our heart, this thing that has beat for us since before we even arrived on this planet, I think that our choices would probably be a little bit more aligned. So can you give us maybe a little bit more of a detailed scope to what this plumbing system within us is? And before the macro damages that we mentioned that we are aware of because of physical pain or lab markers, what's actually happening in these micro damage moments to our cell walls?

When you have the lining of the arteries is fascinating. You've got a cell, one cell layer thick called the endothelium. And that is, it's one of the largest organs in our body. It creates, it secretes hormones, it secretes anti-inflammatory compounds, and it actually creates something called the glycocalyx, which is a layer, like a slick layer.

Mm-hmm.

on top of this one cell layer thick. It's like a gel layer. And the combination of these 2 protect our vascular system and regulate our vascular system's ability to loosen, open up, to dilate, or to constrict, to tighten up. And so, there's a myriad of things that this endothelial layer and this glycocalyx layer in combination respond to. So, when you start having problems with hypertension or high blood pressure that wears away at maybe this gel layer, or you have inflammation that wears away at this gel layer, it starts to expose portions of the endothelium. And then, that means you have places where LDLs or immune markers, immune compounds can grab onto the lining of the artery. And then, Once it grabs on, it can move its way in between the cell and get underneath it into the vessel wall and create plaque. So that's what's happening on a, on sort of a cellular level. And that plaque can develop and create atherosclerosis, and that eventually can burst and create the macroscopic sort of heart attack. What's really interesting is you can have problems with the microscopic portion of these arteries too and not have atherosclerosis. You can have a problem with the ability for these arteries to dilate, to constrict, and that sort of problem doesn't show up in these large-scale images that we do, but it causes legitimate chest discomfort. Hormonal problems can make that happen, problems with precursors that make nitric oxide, which is the main gas, the main compound that allows the artery to dilate and constrict. And in particular, we see this happening with women. Historically, when women would show up with chest discomfort and they would get scans that looked negative, the default was, okay, maybe this is anxiety, maybe this is something That we can't see what's going on. There's chest discomfort, but we can't explain it. We have very limited things to do to treat it. Well, we know now that this is not the case. We've been doing women a disservice in cardiology for decades, and this is one of many disservices. And, you know, it's a legitimate, real problem where they're not getting enough blood flow microscopically, and it's because of microscopic dysfunction without plaque. And now that we know this, there's— we can do things to try and target that better.

So what's the best way then, with everything that you know, the knowledge of the tools that are out there, what's the best way to assess your microvascular system then? And how can we really detect the health of our glycocalyx?

That's a difficult question. You know, there's— the glycocalyx is a very dynamic structure. It's, you know, bulletproofing, it's a gel layer, it will grow and constrict. On a day-to-day, on an hour-to-hour basis in response to our environmental exposures, to our diet, things like that, stress, blood pressure. There are ways to take pictures of it. And, it's not fully widely established, but you can measure it. And, there's a couple of small-scale tests that can do that. And then, there's supplements that may be able to improve it. But really, what it comes down to is Again, going back to the basics, the same things that degrade the glycocalyx are the same things that are involved with poor health, with poor foundational health. There are some supplements that focus on the glycocalyx, but it's difficult to know. The studies aren't definitive on those.

Hmm.

Endothelial health, there are some tests that look at that. And, you can get what's called— there's an EndoPAT test. There's also something called flow-mediated dilatation. And, these are all office-based tests that can look at how the arteries respond to stressors or being, you know, having a blood pressure cuff put on, how they respond to lack of oxygen, things like that. So, you can assess endothelial function too. That can be helpful because if you see that the endothelial function is deficient, there are pharmaceutical therapies that can help Basic stuff that's, uh, that is, has been repurposed. For perfect example is, uh, Cialis. Cialis that was used for, and for erectile dysfunction, or, um, that taken at low doses can improve the lining of the arteries because that is the way this functions is by improving nitric oxide, but it's specifically in—

Dilating.

Yeah, right. But if you take it at low doses, it helps the whole system. And so, so this is just one of many tools that can be repurposed to help endothelial function. And so you can get maybe an EndoPAT test or something of that effect, testing for endothelial function and then starting that afterwards.

So there is a brand, I have zero affiliation with this brand. Let's see, Calroy.

Yeah.

Calroy. I was at a health conference and they were doing nitric oxide testing.

Yes.

Through these little strips on my tongue. And I had a conversation with a formulator there, and we're talking about heart health and taking— oh, look at that. It says endothelial glycocalyx support on the front of the bottle called Arterosil. So when we think about taking things like this, obviously as a nutritionist and you're saying nitric oxide, something that my husband and I do every day is we take 2 teaspoons of beetroot powder. Yeah, that mixes really, really easily into water. I have beta thalassemia, so this is something that I feel Really supports me as well with oxygenation of my cells. But where do testing— I guess we could actually test these things. We can test for citrulline, we can test for arginine, like all these amino acids that could be beneficial as well. So let's talk about supplementation then for a second. So a lot of people will go to their doctor, they'll be given a statin immediately.

Mm-hmm.

I think that there's a time and a place for statins. I think that, you know, you can tell me if there's like dosing for statins that may be good for somebody who's on the higher marker of genetic susceptibility. But where do supplements come into play with this, especially with optimizing our endothelial cells?

The supplements do play a really important role. And you bring up a really good point. Statins. Statins. One of the, one of the key benefits of statins is it really amplifies nitric oxide, and that's what really provides a lot of the anti-inflammatory benefits. So, when you look at the risk versus benefit with statins, it's not just about cholesterol lowering, it's about increasing nitric oxide. And so, that's where it tips over into being more of a wider-ranging multi-system effect, but it comes at a cost.

Mm-hmm.

So, we know that statins block the ability for, say, CoQ10 and block a process called protein prenylation, and we can account for those. You can test for levels of lower CoQ10. You can also test for the precursors that are needed to make nitric oxide. So, there are plenty of tests out right now. In particular, and similarly, I have no affiliation with this test with Vibrant, but—

Mm-hmm.

I love this new test that's out. It's called the CardioZoomer from Vibrant. It looks at arginine, it looks at citrulline, it looks at the ratios. It's one of the most, the most thorough tests that I've seen out there. It's a serum test, blood test that looks at the precursors to make nitric oxide, membrane health, all of the lipid markers, inflammation markers. It's really in-depth. And so, you can see if you're lacking in arginine or citrulline, and then replace it. And each one has a different effect, arginine versus citrulline, replacing which ones, seeing if they're at levels that you need for your cells, the endothelial cells to actually create nitric oxide. So, the only way to get that is going to be from a food source or to supplement it. So, and supplementing oral nitrates using beet juice, that's a great way to do it. And, it's a different pathway than say using Cialis or using pharmacologic agents that may help nitric oxide. And, the good news is that it does it sort of slowly so it doesn't interact with these other agents to drop your blood pressure. The one thing about oral supplementation with, say, beet juice and things like that, it's short-acting and you got to look at the dose because sometimes you got to take like about 400 milligrams of the nitric oxide and/or the arginine or beet juice extract, and you probably have to do it twice a day or something like that to get a more sustained effect. But these are really useful tools and you can test for, for how much you need or if you need it.

And why not? Is that a blood serum test?

Yeah, it's a serum test. Okay.

Fascinating.

Easy to do. Yeah. Very thorough.

Yeah. I keep just saying in my mind, why not do it? Why not do it? Especially with going back to what you said, the divergence between, you know, supporting women when they come in and they're complaining around anxiety and yet their numbers might look normal versus men. And I'll say flat out, my husband and I are in this situation. You know, he is in his 50s now, and his doctor, just as preventative, just said, oh, you know, you're in your 50s, we should go in and do these tests. We check in on, you know, on all of your numbers. We should do a CT scan as well.

Yeah.

And then for me, even with my history of heart disease, when I went to my cardiologist, I said, hey, shouldn't we just start checking into this? Should I do that CT scan now? Wait, you're healthy. You're young. You're a nutritionist. We don't need to do that yet.

Mm-hmm.

Like, that case in point, the two of us together, and we had a conversation around this. I'm the one with a history of heart disease and heart disease in my family. And look at the numbers around women's health and cardiovascular disease today. And still, I had to push versus him. So supplementation is one thing, but this— if you're a woman listening, take these testings that are available to us, access them, be proactive.

Definitely.

If we can prevent It's what, 100% of cardiovascular disease can be prevented unless it's something deeper.

I agree. Yeah, totally. I mean, heart disease is preventable if we know how to look at it, if we look at it early enough and we look at it from a system standpoint.

Yeah. All right. What else are we looking for then? So with people who are coming in, let's just say I work with a lot of high-performing men, their 40s and 50s. And I would say more often than not, when their primary care doctor sees any type of number that's elevated, if it's total cholesterol or LDL, they're immediately prescribed a statin. Yeah, just take it for prevention. Is there a time and a place to supplement at a small dose versus a standard dose? And what is a standard dose?

Yeah. Yeah, I believe— I think that starting a lower dose statin therapy is probably— there's a, there's a place for it. And it goes back to that nitric oxide effect. It's not necessarily that we are wanting to optimize the lipid lowering. I think there is a— there is an overfocus on lowering cholesterol, lowering LDLs, and there's an underappreciation of how statins can improve nitric oxide. And so when you use a smaller, lower dose— now, I preferentially use rosuvastatin in patients that need it because that has less penetrance to the brain and less incidence of muscle aches or pain. So, I use it probably about 5 milligrams every other day. If I can get them to split it, 2.5 milligrams daily, maybe 5 milligrams daily, that's the starting dose. And, that will optimize nitric oxide benefit without trying to drop the LDLs too much. Now, entry doses are where you get the most reduction of lipids. And then, after you scale up the doses, You get diminishing returns, reducing returns. So, I will not usually scale it up unless they have history of significant heart disease, atherosclerosis, or an event. So, I don't use atorvastatin that much, and the other statins have higher incidence of side effects. So, my preferred agent is rosuvastatin.

Okay.

And, whenever I use a statin, I make sure to have them take CoQ10 with geranylgeraniol.

CoQ10.

So, that second addition, geranylgeraniol, we are starting to see is associated— is that protein prenylation that we're lacking that statins block. When we add GG for short, it restores that protein prenylation. And that's important because we see that that may be really what's associated with the muscle aches and pains. And there's data to support that it may be what predisposes some people to having glucose problems with statins.

Hmm.

So, it's a vital process that the statins will block. And remember, you know, you're taking— the reason to start with lower doses is not because it's a binary effect. You know, just because you're on a statin doesn't mean you've completely eliminated CoQ10 or this prenylation process. As you increase the dose, you get increasing effects, and that's why we get more side effects at higher doses. So if you use a lower dose and replace that, those compounds, we really minimize some of the potential side effects and then optimize the benefits.

When you're supplementing with CoQ10, is 100 milligrams enough? Are you looking for higher, upwards of 200?

I'll usually use 100 to 200 milligrams. But 100, if it's got GG in it, the other benefit about GG is that we think it helps get that CoQ10 intracellular more effectively. So, 100 milligrams will probably go a lot farther. If I'm going up on the— to higher doses, then I'll probably— I'll have them take more. I'll take 200 and then more GG.

What does it look like for listeners who maybe haven't put on a low dose? But they're really well-versed in the list of side effects that come with them. And they're also into this world of prevention and wanting to feel their best and make it to 100 years old, let's say.

Mm-hmm.

I've worked with so many people where I've worked with or partnered with an incredible functional medicine doctor, and through an intervention on lifestyle and stress and nutrition and supplementation and movement, we're able to get that person off a statin. It's not for everyone, but it's possible, which goes to show that the potential is there. What would you say then, what does an intervention look like for someone who's interested in having that conversation with their cardiologist to get off of it, especially if their cardiovascular doctor isn't a believer or a fan?

Yeah. Well, it's going to be difficult if they don't believe that these interventions can work, but it's a discussion about what it is aside from the LDLs themselves that they're targeting because LDLs are part of it. Inflammatory markers are another part of it. And what other agents are they using? The simple way would be as a person is doing their lifestyle changes, as they're making those changes, they can track the reduction of the LDLs. It should happen. As they're getting healthier, we should see a change. And then they don't need to, to continue to see those LDL numbers drop or the triglycerides that we start to ask to ease up on the therapy, you know? And it's an inch— it's an inching approach. You know, you reduce the therapy by half, maybe take it every other day, you know?

Right.

See how these numbers go because you're going to get follow-up lab work. And if they maintain themselves, And inflammatory markers are still where we want them to be, then that's a great time to have a discussion to say, hey doc, this is what I've been doing. I think I can get off of this. Are there any other alternatives? Maybe you can get switched to ezetimibe, which is not as strong but still has lipid-lowering effects. Can I reduce the use of the statin and maybe replace it with something else? And if they're not familiar with that, then at least then maybe get them something that says, okay, this is supposed to work like a statin. And can I alternate? Can I use this instead? Can we do a trial to see what this looks like for 3 months? Because if you're well, if you're, if your metabolism is well controlled, a 3-month trial is not gonna cause a problem.

So important. Like just echoes the fact that your, your doctor should be your partner in healing. Right. And if you're going there with these questions, and if you're not getting that partnership type of an answer, then maybe it's time to find a new doctor. Why not?

Yeah.

Get second opinions. And ezetimibe, is that something with fewer side effects long-term?

It has fewer side effects. It, it, it blocks the absorption of cholesterol from your, from your gut. Uh, the, the most common side effect is upset stomach and diarrhea, but that usually gets, uh, resolved after being on it a short period of time.

All right. Let's talk about one of the scary findings when you get a blood lab done and your cardiologist says you've got the widowmaker. Can you tell us what a widowmaker is? Why are we seeing it so prevalent today? And what can we do about it?

So the widowmaker is the— it's a blockage in the left anterior descending. Left anterior descending is the artery that goes down the front of the heart. And, it usually supplies the most amount of muscle but always supplies the most important muscle in the front of the heart, that left ventricle. And so, when you have a blockage in that artery, and it's a blockage that is most often associated with sudden cardiac death. So, people have a blockage there, it ruptures quickly, and then we lose blood flow to the major amount of muscle. And that causes a sudden event where people die. It's oftentimes the first place where plaque will show up. One of the reasons is because it's the major artery and because it's right in front of the heart, it sometimes gets the brunt of the high blood flow. So, higher blood pressure, maybe inflammatory markers, more wear and tear of that artery can make it more prone to having plaque buildup. So, if you think of it like a stream, when you have a stream that's going straight and it's the main river, the main part of that stream, the water will flow in that area preferentially instead of the side tributaries. So, that's what the LAD is, the left anterior descending.

Mm-hmm.

Now, imagine there's a turn in that stream or there's a rock pushing out and most of the water is still flowing straight in that stream, You will have a lot of turbulence there and you'll hear a lot of noise, and especially the turn. Well, the arteries are the same way. In that turn, there'll be a lot of wear and tear, a lot of rubbing on the turn. So, that's an area where you may get degradation of the glycocalyx, damage to the endothelium, and then plaque building up there. And then, once you get that happening there, It creates another change in flow that may go to another part of the LAD to create more plaque. So a lot of it's flow dynamics, pressure, and then access to, you know, to inflammatory compounds that damage that lining, that border.

And would you say, like, what would be the greatest precursor to this? I'm imagining it's probably multifactorial, but stress? versus diet? Is there one that pushes the lever most with a diagnosis like that?

I'd probably say diet and blood glucose. I mean, when we look at what hap— what's happening to the larger population, it's mostly dietary issues, inactivity, glucose dysregulation, obesity. You know, that's the driving factor for the population at large because that's what we still— that's still the major metabolic problem we have.

It's funny when we trace back, you know, we talked about looking back in time at what our lifestyle practices were that could have caused that accumulation to all of a sudden this diagnosis. And for a lot of these people, I'm noticing that, you know, this was the generation that was going to McDonald's. You know, we didn't know about the side effects of eating out, eating fried processed food. They were drinking Coca-Cola even casually in the summertime. Having these really high glucose beverages that were normal, and here they are today. So, can you talk to us about, maybe paint a clear picture for the impact? Because a lot of people, if they look healthy on the outside, they'll say, well, I'm healthy, my health is fine. My cardiologist said, yeah, McDonald's once in a while is okay. Having Coca-Cola once in a while is okay. Can you give us kind of a bigger picture on the impact of what this is doing?

Having fast food, processed food, when we were growing up and in past generations wasn't as ubiquitous and as easily obtainable as it is now. In decades past, we weren't surrounded by as many fast food places. And I can tell you the story is, as a kid, it was like a treat to go once a week to go to get something from fast food.

It was.

But for the most part, everything was home cooked and we didn't eat out very much. That's changed. The environment has gone away from cooking whole foods, eating whole food at home, and going and eating out more. What's driving that? Higher stress, less time, less ability to focus on the foundations and to do something basic like make a good meal.

Wow.

So, the present, it's not just having processed food and bringing processed food in from the grocery store too. The size of the processed food aisles has taken over the grocery food section, the grocery stores, as opposed to getting more natural foods. I think that's starting to change a little bit, but The, the ease of getting these foods and the convenience of having these available in a high, in a high-demand world has made it so that we, we get these wrapped, these easily obtainable foods that are highly processed. And it's accelerated over the years. We have done more of that. We eat out more. You know, it's almost like you got to make a conscious decision to stay at home and eat sometimes.

Yeah. Absolutely.

And so, there's a lot of different hidden dangers in that too because it's not only that the food is processed and it has high carbohydrate load or high refined sugars, it's that you're getting seed oils in there. You're getting oils that maintain shelf life but are highly inflammatory. So, there are all these stacking factors that make these food choices become more important. And then more GMOs, more pesticides and herbicides in the food to grow them at higher volume. So you can see that in the past, you could have gotten away with an occasional meal out or a fast food meal. I mean, and that's probably what we grew up with, but it's accelerated and it's become like sort of a mushrooming of these availabilities and they're more toxic.

Yeah, it was a treat for us growing up as well. I had immigrant parents, obviously it was, you know, it was a thing, but we have seen so many side-by-sides, the foods that we consumed then and what went into them versus the foods today. And everything is processed. And even the healthy foods in the health food section are ultra processed. We don't know the ingredients that come in with them. And I can imagine you're like me when you travel in the summer, no matter where you go in the world, why is it when you get to an airport, get off the plane, or go into any city center, the first things that you see standing outside any convenience store or newsstand— Coca-Cola and Sprite and Doritos and chips and Pringles and everything. This is a global phenomenon that's fueling the rise of disease.

Mm-hmm.

And the reason why I want to get passionate about this for a second is that we see those foods in our school system today. And if we're forecasting the future of health for our children, You know, I hear a lot of parents saying, well, I don't want to deprive my kids. You know, they need to live their life. They should be able to experience these foods. No, it's actually making them sick. And the more that we fuel the pockets of the people producing these foods, the more sick we're going to get. And I understand with compassion, you know, we see these foods so often that we've normalized them. And it's funny, Dr. Usain, I thought about you last night. We had to drive like about 2 hours to enter LA.

Yeah.

to an area that I'd never been before. And we went into a supermarket and it was a big chain, but not one that I was familiar with. And they had a small organic section. There was maybe one tiny aisle, but all of the other produce was wrapped in plastic. And then this superstore had 2 aisles of chips and gummies and candies, and one specifically on both sides of soda. Front to back, all the way down. And I just couldn't believe it. And if we look up and we look around at the people who are walking around and we see obesity in adults and in children, gosh, I just wish that, you know, the people who are in charge of our healthcare took a greater stand in what was available and really connecting the dots to the science that you're talking about today. The world would be such a different place. We wouldn't be sick and suffering.

Would be, definitely. I agree with you. It's shocking to see how far it's weaved its way into our lifestyle and nobody is immune to it.

The other thing that we're not immune to is, you know, I want to hover on what you were speaking to with women, women going in and talking about anxiety and often getting dismissed. This was the case for me when I was younger, kind of dismissed the anxiety that I was talking to them about and really just wanted to know how much alcohol are you consuming? How many drugs are you doing? doing, you know, and kind of ended there. But in your work today, as you've branched out, are you making the social— that kind of psycho-emotional connection to heart health today? This is something that Eastern wisdom has done for centuries, but now there's institutes like HeartMath who are understanding heart frequency and things like that. Is it— is this a discussion you hope that cardiologists are having with their patients in the future?

I hope it is. You know, there's There's definite studies that look at the impact of stress on the cardiovascular system. And these studies will say that this is an underappreciated source of atherosclerosis and hypertension, arrhythmias. So, I have that discussion. I always ask about what the stress load is, what are their coping mechanisms, do they feel that this is something that can be manageable? I mean, and it's got to the point where at the office we also have a mindfulness program that if patients are very— if they're unable to manage it or they feel like they are overwhelmed, or if they just feel like they want help or other tools, we'll give them access to a coach and have them work through how they're managing stress and what their personal story is.

Beautiful. I often say you have to cultivate the inner environment for your body to heal in order for the protocol to work. So I love that you have that. You're actually practicing integrative healthcare. We've talked about it for so long, but few doctors are actually doing it. So everyone probably wants to know what you're eating. Can you maybe just make a declaration? We've talked about the good, the bad, and the ugly, but let's really focus on the foods that move the needle when we try to optimize our heart health and our LDL scores.

What I am eating It varies on the day depending on my work schedule. But I will, when I can, I oftentimes will do some intermittent fasting. So, it's convenient for my schedule, but I will have a couple of— I have my coffee in the morning. It's black coffee without any addition. It's my ritual. I have my 2 cups of coffee a day and that's it. And then, once I have lunch, it's— or if I'm lucky enough to have breakfast, It's a day working from home or a weekend. It's usually some eggs, some greens, some salad, and a complex carb. So, because I work out regularly, I want to make sure I'm getting all my macros, trying to focus on protein. You know, if you wanted to summarize my diet, it's basically a Mediterranean diet with an emphasis on protein intake.

Right.

So, I can maintain my muscle mass, maintain, you know, good protein muscle synthesis, and at the same time have anti-inflammatory effect of the right fats, enough omega-3s, the complex carbs.

You know, I—

we put in legumes and fruits and vegetables whenever we can as snacks. But every meal, Tries to have something green or something colored in it.

Beautiful. And do you wanna talk to us about, I really wanna hover on the greens. I don't think enough people are getting their greens every single day. And I think fiber as well, right?

Yeah, definitely.

The connection between fiber and heart health and gut health.

Absolutely. Yeah. The fiber is vital. And, and I, I get a lot of patients that tell me they have a salad all the time with every meal. And I think that's really good. But it's not a— salads aren't hard vegetables. They're not a full vegetable that has higher fiber content too. So I really emphasize getting some broccoli, some asparagus, some of these larger, more hearty vegetables into their diet as well. And the reason why fiber is so important is because, well, there's so many reasons. One is helps with the satiety, makes you feel fuller faster so you don't overeat, number one. It's got polyphenols. It's got all of those important compounds that nature produces that give it color, that are antioxidants, anti-inflammatories, and that feeds the microbiome. So, the polyphenols feed the microbiome and so do the non-digestible fibers. So, why do we want to feed the microbiome? Why is that so important? Because when we feed the microbiome the right way, it produces the right metabolic compounds that then feed our gut lining to maintain health and maintain the environment and protect the— protect us from getting an inflammatory leakage into our bloodstream. Looking at it from a cardiovascular standpoint as well, a little bit more specifically, that extra fiber reduces the amount of cholesterol we might absorb. And then, it may also regulate how quickly we're absorbing the sugars in the food.

Mm-hmm.

So, reducing the rapidity of how— of sugar absorption reduces glucose spikes, keeps us more even in our energy levels. So, fiber is so important. Having regular bowel movements then allows us to detoxify normally. We don't recycle the toxins and/or hormonal metabolites. So, it's a vital aspect of normal health.

Do you recommend taking a fiber supplement? I talk about bowel movements every day with my clients, and we talk about optimizing your elimination process, having at least 1 or 2 bowel movements a day. And yeah, when I ask my clients to do a food journal, I think they're— they believe because they're eating a salad a day, they're intaking enough fiber, when there's actually not enough fiber. There could be fiber at one meal. So, when does fiber supplementing— would you say that this would be a good preventative measure for optimal heart health?

If, if they're not getting enough fiber through their diet, then yeah, preferentially, I will have them take a supplement. It could be psyllium husks. I try not to use any of the commercially made ones because they can have sugar in them. But I mean, ideally, I want to stress getting it from natural sources.

Yeah, I typically say psyllium, but not too often, especially if your colon's dehydrated. Flax meal, chia seeds. There's a lot of prebiotic fibers out there that are really great too. And as a nutritionist who never takes away coffee from people, I love that you enjoy your coffee. Where does dairy fit into this picture? A lot of us come from cultures where dairy was common and acceptable, and obviously before a time where we saw these rates of disease rise. Do you remove it explicitly?

I don't remove it explicitly. If they can, if they want dairy, then really it's a matter of personal tolerance and what the underlying health is. If they've got other inflammatory conditions, then dairy may trigger it. Yogurt and cheese, less likely to do that. They're fermented, a little bit less provoking. But, it is one of the primary irritants to our gut. So, if there is a gut centralized problem, I will have them eliminate it. And then, as things start to heal, we can try and reintroduce it. But, it's up there with gluten. It's the second thing.

Yeah. Dairy, soy, sugar, The quality is not what it used to be.

Yeah.

So when we think about these things moving the most, moving the needle the most long-term when it comes to arterial health, let's talk about movement for a second. You know, we get to our 40s and 50s, maybe our capacity to move the way that we did in our 20s and 30s is a little bit different. VO2 max is something that's trending these days, could be beneficial for some people, maybe not if you're in perimenopause or going through some major hormonal or stress events within your life. But where are you seeing the science kind of shine a light and what type of movement should we really start to optimize if we want to move that needle even more?

So VO2 max is, is a useful, is a useful marker, but it shouldn't be everything. You know, VO2 max is like our top speed. But so, so you can have a really good top speed, but if it's at the expense of efficiency and you're doing it with with making a lot of toxins, then we don't need to push our VO2 max. And really, there's other markers that look at lactate threshold and which look at more of the zone 2 tolerance and efficiency. And, that's really where we see capacity for fat burning and metabolic efficiency.

Yeah.

So, I will look at VO2 max and it can be a good assessment of overall fitness, But it's not necessarily a good assessment of metabolic health. And so, yeah, so I try and focus on more, more of zone 2 training in combination with resistance training, and that really optimizes that zone 2 and metabolic health.

What's your gold standard for an HbA1c score?

Oh, HbA1c, I'd like to see it, you know, Below 5.5, certainly I'd probably want to get it to like the 5s. That's what— that's Michael, like 5.0.

I'm with you. I, for me, I always say 5 is my, my gold standard if I'm working on a protocol with somebody. But a lot of doctors out there are saying the 5.7 is normal, or they're not gonna move the needle forward until they get over that 5.7 mark. And yeah, there's room for optimization. So really understanding that I'm taking that away as a cofactor. for heart health today. And I'm so grateful that you've really— we've talked about every aspect of healing, from hormones to metabolic function to gut health and stress, and really looking at heart health through an integrative approach. And it's not something that I hear often from a practitioner like yourself. So I'm so grateful for that. The last piece that I want to tie into this, when we think about this world that is so focused on longevity, I'm so sick and tired of the narrative around making it to a certain age.

Mm-hmm.

If the years until that age aren't marked with joy and happiness and, you know, waking up and living with more of an abundance mindset. But where do you see, like, feeling a sense of purpose and happiness every day as a cardiologist? How does that fit into this longevity heart health conversation?

Oh, that's, that's vital because the years, it's not about accruing the years, but more about accruing the positive years, the years that are rewarding and have purpose. And so that's one of the things that we we look at, at, uh, at the practice. You know, we, we want to see— I want to ask what their goals are. I want to ask what, uh, what is it that's giving them joy? What is it that's the reason that they're coming to the office to want to live, uh, as to their, to their peak? Just living at your optimum is, is not going to sustain you through decades of going through these practices and, and making them become a sustained practice. You got to really have And, humans are purpose-driven creatures. If we don't have a purpose for doing something, we will fall off the wagon. And, part of that has got to be joy, it's got to be gratitude, it's got to be consciousness, it's got to be creativity. And so, I ask all of my patients, what's the goal? What's the purpose here? And, how can I help you achieve that goal? Because it's empty without that. And the longevity discussion seems to, we allude to that once in a while, and I think it's a deficiency in the industry where we don't really acknowledge that we're going to die. I don't care what people think is going to happen in 5 years or what we, we have to assume that that's going to happen. And we have to We have to be able to live with gratitude, satisfaction, and joy in the moment, as well as try and plan for helping us do that in the future. And we have to accept these processes, you know, that we're not going to stay like we were 25 all the way till we're 90 and then drop dead. It's not realistic. And there's no wisdom that happens if we don't have hardship along the way to change. So I try and encourage sort of this acceptance and this discussion.

Incredible. You're such a phenomenal educator. Are you active with your community on social media? Is that your thing? Yes.

Yeah, that's wonderful. Yeah, I am. Thank you for that. I have a YouTube channel. It's Dr. A. Hussain. I post on Instagram and then I'm a keynote speaker for conferences and for festivals whenever I can.

And did you just launch a course?

I did. Thank you. Yeah.

Can you share about that?

Yeah, it's Next Generation Medicine. It is a cardiology course specifically focused on atherosclerosis. It's open to everybody and targeted for practitioners to give a systems-based approach to atherosclerosis. But, It's available to anybody that's curious and it, it's approachable.

Fantastic. I'm a student for life, and I know a lot of our listeners are as well, so I wanted to make sure you shared about that. Thank you for today. To wrap things off, I wanna know what's something that excites you most about the world of integrative cardiology in the future?

What's exciting me is the, the application of imaging to what we're doing with cellular medicine. You know, that, that's never happened before. We've never been able to really look at the atherosclerosis in this detail. And I'm really excited about how cellular medicine is being applied to things like hypertension and AFib and other heart, heart conditions. It's, uh, what I mean by cellular medicine is it's this, this approach that we've been talking about.

You know, you just reminded me of one last question I want to squeeze in is, um, soft tissue plaque detection.

Mm-hmm.

Do you see a world where these tests are gonna become a lot more affordable and available to the masses?

Yeah, I do. I do. It's— we're still not in full— I think they're early phases of these, of these tests, and there's still room for refinement. And I think that as computing power increases, these tests will get cheaper and we'll get better, more refined data out of it.

And would you say that there's an age to go and get that test done for a soft plaque test?

I, I would recommend people do it at, you know, before 40, do it at 40, get it done early because then we can see if you're getting disease at an earlier basis, an earlier rate. And if you're one of those people that, that is at high risk, it'll detect it at that time.

Prevention is key. All right, Dr. Hussain, thank you so much. It's such an honor to connect with you. Thank you for your time and your energy, and I can't wait to meet you in person.

Likewise, Mona. Thank you.