Prevent and Reduce Heart Disease, with Dr. Joel Kahn

The only diet plan that's ever been shown to halt and reverse plaque is a diet that's nearly or completely whole food plant based.

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I'm Dr. Ed Levitan. Welcome to the Five Journeys podcast where.

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Welcome to another episode of the Five Journeys podcast, Live like youe Matter. I'm Dr. Wendy Trubo and my host is Dr. Edward Levitian. And our guest today is Dr. Joel Kahn. And let me just say, he's wicked smart. If you're not from Boston, you got to master the wicked smart. Dr. Joel Kahn is a practicing cardiologist and a clinical professor of medicine at Wayne State University School of Medicine. Known as America's Healthy Heart Doc. He has triple board certification in that's why I say he's Wicked Slat. Internal medicine, cardiovascular medicine and interventional cardiology. He has five books in publication including your Whole Heart Solution, Dead Execs Don't Get Bonuses and the Plant Based Solution and Lipoprotein A, the Heart's Silent Killer, and has hosted his podcast Heart Doc VIP for over four years. Shout out to Marie, who recommended that we get in touch with you. Dr. Khan, welcome to show.

Thank you, Marie. Thank you, you power team.

So I'm personally excited because we we've been doing the extended Cardinal metabolic panel lipid panel for a while and I don't feel like we got to talk enough about it.

No, yeah, that'd be great to talk about.

I'm really excited.

It's heart disease. It's heart disease. It's everywhere and it needs to be talked about. So that's why I'm so excited to join you guys.

Very cool. So why do we care about cholesterol?

Right? Exactly. Number one cause of death in the Western world, men and women, equal opportunity. We've made a very small dent in that in terms of reducing cardiac death. 2021, number one on the list. For 113 years it has been. Cardiovascular disease is a cause of death. We haven't been able to replace it. Cancer is pretty close and Covid was number three the last two years. But heart disease is number one. Most people die suddenly. Most people have heart attacks suddenly. It's a wicked dangerous disease that affects ultimately about a third of us during our lives and may shorten our lives dramatically. And we don't talk about it much. We talk so much about detoxification as we should because we all feel tired and bloated and brain fog, then we have to talk about that. And you know, when we talk about GI issues and the rest and they're all important, but ultimately your listeners, I always say I'm very deep into longevity sciences. I'm sure you are. And always kind of assessing what's woo and what's good. If you have not characterized your heart with cardiometabolic panels like you mentioned, that with cardiovascular imaging, all of which is not an elite process, it's actually covered by insurance or cash based, very inexpensive. I don't need to order multi thousand dollar panels. I can evaluate somebody's heart for a few hundred dollars and make a difference so profoundly. And I like to teach it because I can't do all of it myself. So I mean that's the plea. And where does cholesterol come in? Because it can be, and I say my words very carefully, it can be the cause of clogged arteries that robs individuals of lifespan or quality of life, causes strokes, heart attacks, erectile dysfunction, let's get below the waistline and you know, less commonly clogged leg arteries that cause a person to get a condition. You're familiar with peripheral vascular disease.

So when you're evaluating someone, what's the, when someone walks in, what are you doing? What is it like your hello kind of thing? You're looking at this from hello. What's your pick list?

Yeah, I typically I just go over to a little $5 model. That's what your arteries are like throughout your body. That's your carotid artery, that's your coronary heart arteries, that's your penile artery. And of course there is an equivalent for women. It's just we're not as adept and comfortable talking about it. I'm sure that could be arteries to the other organs of the body and we don't know, just Wheel of Fortune. Are you like this all clogged up? Are you like this 50% clogged? Stress test won't tell you. My EKG won't tell you. We're going to do a very deep history in physical like all good functional medicine doctors do. I mean I know when my patients have been to the dentist and their root canal history and their silver filling history and I know their breakfast, lunch, dinner, snacks and cheat foods and I ask all those questions but, but ultimately I'm going to do that very deep Cardiometabolic blood panel that Ed mentioned because science and numbers are power and I find nutritional deficiencies almost everybody, but I find genetic, the genetics. And just quickly, because we don't have four hours, of course you're going to get a lipid cholesterol panel and I don't care if you're fasting or not. If you ate breakfast, I want to know if your triglycerides are 700 because you have a metabolic disorder. We'll take your blood when we can get your blood. I'm going to do the cholesterol numbers. I want to know if you have genetic heart disease. Lipoprotein protein A, a $25 blood test that about 25% of people inherit from mom, dad or both and could be quite dangerous, but it's still a risk factor. I have crazy patients with crazy high lipoprotein A's and their arteries are fine and we just ignore it. You know, I want to know your inflammation panel. There's a little gene called 9P21. You can get it on the Quest lab panel and maybe others. Not that expensive. And it's actually the most predictive gene for developing premature coronary artery disease. Except there's nothing you can do about it. You can just tell a person you're at risk and you need to do more with your lifestyle.

Is that on 23andMe? If you had that done or Ancestry.

It's on 23andMe and it's available from Quest and LabCorp. It's available then in addition to labs, in addition to history, in addition to physical, we're going to do some vascular imaging, the most accessible way. And maybe your audience isn't to wear because this is 2022 and we still have maybe 5% of primary care docs ordering. But in 1990, a test was developed, a CT scan, coronary artery calcium scan. Sometimes we call it a CACS. There's about 2,500 research studies in humans on this test. You're on a stretcher, you go in a circular CT scanner. No iv, no injection, no pain, no iodine dye. They tell you to hold your breath for five seconds and you go home. Very often you're wearing your shirt. You might have a couple EKG leads for the 5 second breath hold. The report comes back, same day, next day. Your coronary artery calcium score is zero. Meaning by that age in your life, 45, 50, 55, you've not developed bone like deposits in your heart arteries and most plaque, most disease in heart arteries is calcified. So it's not a perfect test because we can't see the other cheese like plaque called soft, non calcified plaque. But they usually birds of a feather run together. And if there's calcified plaque, there's also non calcified cheese like soft plaque. I keep saying cheese like because it's probably the major cause of cheese like soft plaque. If you have a calcium score of 0, I might do one other test. It's very simple to do a carotid ultrasound with digital imaging. Everything now is precision, precision, precision. And I'm going to find out if your carotid arteries to your right brain and your left brain are completely clean.

How often do you repeat the calcium score?

There's a change going on. I'll bring you really up to date precision cardiology. What a calcium score shows and doesn't show is crucial. If you're a zero. I do my calcium score about every five, seven years. More like seven, eight years. And that's what the science says. If you're a zero, wait seven, eight years. The amount of radiation from a coronary calcium CT is like a mammogram. Women get mammogram every year or two. We're talking about maybe once every seven years. And really, if you've had two of them and they're both zero, you probably can stop. You're probably not going to develop atherosclerosis. You're lucky you've got good genetics or good lifestyle or excellent doctors at five journeys or something. If it's high, I don't repeat it because it never goes down. We don't really think calcified plaque disappears. The number of actually verified cases where somebody had a calcium score and the second one seemed to be low are very small, questionable scientific studies online. I will probably move that patient in the next couple of years to a coronary CT angiogram. This is a huge revolution in cardiology. It's a bigger test. You have to get an iv. You get injected with iodine dye. You really feel hot, like niacin for 20 seconds. It's about triple the radiation. It's still not crazy radiation, but it's about triple the radiation. But now using both the fact that the dye enters the coronary arteries and the reports come out telling two things you don't get on the calcium score. How much soft plaque, how much non calcified risky plaque do you have? You can't see it on a calcium score. And how much narrowing is in your arteries. You can have a high calcium score. And arteries that are only 10 or 20% narrowed. You can have a high calcium score and have 80% narrowed arteries. You just don't know the CT angiogram. With the dye, you know everything. So I wasn't a big order of them except in an emergency room setting or somebody with previous bypass where I want to know how many were open. But now there's an artificial intelligence company called Cleerly. I'm not an investor. C L E E R L Y. They're in New York City. They'll take your CT angiogram, run it through this crazy analysis. I'm sitting down and telling my patients now it's like cancer grading. You have stage four coronary disease because you have 822 cubic millimeters of plaque, 600 cubic millimeters of soft plaque, 222 cubic millimeters is hard calcified plaque. You've got a 47% narrowing in your proximal LAD and a 18% narrowing in your mid right coronary artery. It's really like on drugs. So if I have those at risk patients and particularly if they need motivation, what's your level?

How high of a calcium score do you want to get up to before you start hitting the panic button?

Calcification of coronary arteries is age related phenomenon. So we usually say your calcium score is 122 and you're in the 92nd percentile for age or way above average. I'll treat them for a year or two. Then I will order anything over 100 and that's a pretty arbitrary cutoff, but anything over 100.

Do you measure intimal thickness?

Yeah, that is carotid IMT which stands for CIMT. T is for thickness. A thicker artery is a sicker artery. And you need digital imaging. Just you take a little picture of your carotid. You measure how thick it is. It should be about 0.6 millimeters for pretty much I'm older than you. But for an average age person, if it's 1.1 millimeters, twice as it should be, you're old. In fact, the chart actually there's big databases. You're 48 years old in my clinic and it says you're 78 years old on the basis of your artery age. Very reversible, Very reversible number. I love the test. In very few states. Is it covered by insurance? A standard gradual ultrasound is covered by insurance. The calcium score is between 50 and $150. And you usually pay cash.

In Boston it's 300.

Probably they're ripping people off at University Hospital in Cleveland. They do it for free. If you walk in the University Hospital in Cleveland, they are so committed to the idea that public screening is a value, they do it for free. In the state of Texas, it's covered at age 50 in your insurance program for every citizen in Texas. But in most states, you pay the carotid IMT Ultrasound is not covered by the standard carotid ultrasound billing code. It's $150 to $250. It's so valuable because in my clinic, you come back a year later and you've done six different things with your lifestyle, your supplements, maybe your medication. And we joyfully celebrate. Boy, you just dropped seven years of artery age in one year. And I put those pictures on Instagram and Facebook all the time. And I don't see too many other cardiologists. I fully believe Ornish was right. Esselstyn was right. Pritikin was right. Barnard is right. Disease is reversible. It's better to prevent it. I mean, I'd rather catch somebody young. And they always have clean carotid. I'll just say I'm 63 with a little change. I have not a plaque in my carotids. I have thin carotids. I have a calcium score of 0. I have a coronary CT angiogram that has no plaque. I've been vegan for 45 years. I do work out every day. I have a lot of habits. One are imperfect and there's always five pounds. And I'm praying Prolon fasting mimicking diet is going to make go poof and makes go poof for a little bit and then it comes back. And you guys should definitely have Valter Longo on your program to talk about, you know, prolon and the fasting mimicking diet.

But I have a quick question about genes And I know Ed has 18 million questions always, but tell me about the. In addition to the one gene you mentioned, are you looking at anything else? Like, are you looking at mthfr? Do you have a gene panel?

I don't probably. About six months ago, there was an excellent paper and I think it was published out of the Mayo Clinic where they took 800 heart patients and they ran a panel of 162 cardiovascular genes. Was in 23andMe. They actually found, surprisingly, that they estimated that of their patients with atherosclerosis, prior heart attack, bypass stents, erectile dysfunction, again, that 60% was lifestyle and 40% was genetics. That's the highest number ever reported because unless you Do a big panel, you're obviously never going to know. Other than taking a family history and supposing that it's genetic, you're not going to know it. The number one gene on that panel was proved to be this NP21 gene. We still don't know why it raises the risk for atherosclerosis and for abdominal aortic aneurysm, but it's available. And when I get a 41 year old that's had a heart attack and a stent and we're scratching our head, I mean, it will be a routine Partridge panel. Apoe, did you inherit APOE four or double fours, which is not a fun thing to inherit, Although there's a new phase one research study for people that inherited APOE4.4 that I've got enough patients trying to refer them to. But phase one studies are dicey. Everybody gets an mthfr, but I'm not running a full panel beyond that, mainly due to expense. I mean, I got enough to focus on identifying. The only one that's actionable is when I check lipoprotein A blood levels, which I urge everybody listening to ask their primary care or their functional medicine doc. I heard about this cholesterol called lipoprotein A. Can I get a blood test or send your blood to lifeextension.com or send your blood to some of the other companies that will let you order your own lab test for a few bucks.

Well, let's talk about why lipoprotein A in particular. Why that one? Right? There's this whole panel we get. Why are you picking on lipoprotein A?

So lipoprotein A was discovered in 1963 by a Scandinavian scientist as a cholesterol circulating in the blood made in the liver, like the more commonly discussed LDL cholesterol molecule, but made in a separate pathway. It's like one automotive line making Chrysler one on line making Ford. 25% of us inherit the ability to make lipoprotein A, which means there's about 1.6, 1.7 billion people in the world are in the United States. 90 to 100 million people in the United States, they have no clue that from conception. And by about age 2, if you inherited lipoprotein A, it's fully being made and circulating your blood. H2, H3, H4, H5, that can cause inflammation, atherosclerosis, thrombosis, can cause your valve, called the aortic valve, to calcify and get premature aortic stenosis, but mainly to Cause atherosclerosis. It can be taken up in the wall of arteries just like standard ldl. It looks like LDL cholesterol with like a funny head mask on it. It's got this piece called APOA that is attached. And so why lipoprotein A? Because it's extremely common. You know, if one out of every four or one of every five patients in your clinic in one week, you're going to identify, you know, 10, 12, 20, whatever, you're going to be telling people. I always chuckle when they're 82 years old and I'm telling them, boy, your whole life you've had this thing. But it's a risk factor. People will live a long and healthy life sometimes with it. But I check their arteries to triage them. Lipoprotein A with premature disease, lipoprotein A with healthier arteries. And then the pharmaceutical industry is three companies right now, Novartis, Amgen and a company called Silence Therapeutics have actual pharmaceutical drugs because statins don't lower Lipitor, Crestor, Zocor, Zetia, which is not a statin, of course they don't lower lipoprotein A and they sometimes actually cause a reflux increase in it. So all those people out there that are taking Crestor and they've never had their lipoprotein A check, their LDL goes down and they don't have a clue if they're the one in four people that might actually be having a bit of an adverse lipid reaction with their lipoprotein A going up. We'll see that change. Niacin lowers lipoprotein A and I happen to use a lot of over the counter niacin in my clinic, which is unusual, but it lowers cholesterol and it lowers lipoprotein A. Hormone replacement therapy in a perimenopausal woman lowers lipoprotein A. So I refer that out. But I'm a big fan in women with lipoprotein A to follow that. What tie do you so just to confuse. The test has been available for 20 years. It used to be reported out in milligrams per deciliter. Like a creatinine, I think, or glucose is milligrams per deciliter. And it used to be over 30 is abnormal, over 50 is at risk. And some people were 23400. There's been a change. It's more accurate to report it out in animals per liter. Quest reports in animals per liter. LabCorp does too. And over 75 is elevated over 125 is at risk and many people are 3, 4, 5. I've seen a couple around 600. It's a challenge. You can take it out of the blood with a technique called apheresis, which is similar to dialysis. There's a hospital in Germany, they have 1500 patients with lipoprotein A that come in every two weeks, get their blood cleaned, their cholesterol goes down, their lipoprotein A goes down, and then it just goes back up. Because that's an aggressive approach, this new pharmaceutical, three companies and ultimately some gene editing capability in the next decade will make it a non entity. But it has actually been calculated. I had a heart attack, I'm on all the American College of Cardiology guideline drugs and I have a second heart attack. Lipoprotein A is the biggest piece of that pie. That's called residual risk. There's a need to identify it and a need to treat it.

So what do you do to treat it non pharmaceutically?

Yeah, unfortunately, it's a pretty common phrase to say it doesn't respond to diet, to exercise, to weight loss. Like LDL cholesterol will sometimes phenomenally drop with a change from a processed food diet to some kind of whole food diet with fitness, with weight loss. So it's not very lifestyle responsive. And again, most experts would say you don't treat it. I disagree. Coenzyme Q10L, carnitine, niacin, amla, the Amla berry. It could be in a powder. You just throw it in your smoothie, lowers it and I get it down. And a lot of people, I get it down. Niacin, as I mentioned, hormone replacement therapy. What I'll often do is I'll take their 40 milligrams of Lipitor, make it 10 milligrams of Lipitor, put it with Ezetimibe, Zetia, and I get the same cholesterol. It's two prescription drugs used for lipid therapy that are very synergistic. But I'm taking their 40 milligram down to 10 milligram of the statin. With the 10 milligram azatimab, I get the same total cholesterol, 135, the same LDL cholesterol, 54. The numbers we shoot for now. But all of a sudden the lipoprotein A drops because I dropped the statin dose. That's a Con center clinic experiment because we know it's bad. But there's very few therapeutic trials for lipoprotein A.

Essentially none okay, so niacin, it's so funny. I started niacin about a year and change ago and I'm due for my labs. I'm super curious whether it's made a difference. I'm the chosen person, right? I got all the terrible genes, so I got the lipoprotein A, the celiac, the homocysteine, got it all. So I'm just really curious. I'm so curious what effect? Because I've been in the sauna for a year and a half with the nice and I'm curious what effect that's had. So I'll keep you all posted.

Good.

So we talked about the supplements, we talked about seeing someone, we talked about getting the data. Are you advocating for a vegan only diet for people? Where do you fall on that?

Yeah, this is a bad disease that can be tamed, can be prevented. The only diet plan that's ever been shown to halt and reverse plaque, and I think it's the soft non calcified plaque, is a diet that's nearly completely whole food plant based. We want to talk a thin body. There's a lot of ways to try using diet to get a thin body. When we're talking I had bypass surgery 12 years ago and my doctor tells me to add steak and cheese and your carbs are too high because you enjoy a bean salad. I've got to spend the time to bring people back to reality. 95% of the scientific data, it's never going to be 100% IS. You want to talk prostate cancer, breast cancer. You want to talk about recently melanoma, eating tuna fish and raising your risk of melanoma has been in the news. You want to talk about Alzheimer's dementia, a largely or completely bright, colorful, organic, whole food plant based diet with most of it home cooking is going to win every time. But I don't tell those that adopt it, you're going to be perfect. Or you won't need to have vitamins because yes, you may be missing iodine or selenium or just simple things to check and correct. I do think it's the best choice. I think if you're struggling with weight, I mean, there are different pathways for that. But if you're struggling with heart disease, you got to read Ornish's Undo it and Esselstyn's Reverse heart disease and Mr. Pritikin's books. And you got to know who these people are because, I mean, we're talking hundreds and hundreds of scientific studies versus essentially zero for alternative diets. I'LL just bring up olive oil has been a bit of a hot point in the vegan doctor movement. The best diet in the world is a whole food plant based, no sos, no salt oil, sugar diet. Well, that was based on what in my analysis is there some small healthy volunteer studies where they drank olive oil and measured their artery function a few hours later in Spain right now, thank God, they're doing a study of 1,002 people with heart disease. So these are not healthy volunteers. These are heart patients. They went on a high olive oil diet in Spain or a low olive oil diet. All the diets were low in saturated fat. All the diets were high in complex carb healthy foods. But high olive oil, low everything they're measuring with seven year follow up, they actually stopped the study early because there was fewer events in the high olive oil arm, fewer heart attacks, fewer bypass. They had to stop the study early. But when they look at the carotid imt, it's actually better in the high olive oil group. When they look at endothelial function a year, it's better in the high olive oil group. But when they actually look at heart attacks and survival, it's better in the high olive oil group. So I don't sell olive oil. I've been called an olive oil snake oil guy. My wife doesn't like olive oil. I'm quite a collector aficionado. But I think when you get a study that defines and has challenged and has refocused us, that you do a 20 patient one hour study in a healthy volunteer compared to these, we need to rethink it. So it's a small little point, but it brings up a lot of you talk to Dr. Fasano, who I know you know, or Dr. Longo about Olive oil. They're going to. What do you mean it's not healthy? It's what, you know, they put it in my baby bottle when I grew up in Italy.

Now in that study, are they making sure that it's real olive oil?

Because they're not rancid. Not rancid either.

Yeah.

Rancid or combined or.

Yeah, yeah. Every family got a liter of extra virgin olive oil once a week, so it couldn't be, you know, fresher. It's certainly. They weren't going to the, to the Wegmans and buying it in a plastic bottle sitting on the shelf for two years. Nothing against the Wegmans. I hope they have high quality olive oil.

Did I track this? So the olive oil was bad? The olive oil was.

No, that was Good, good, good, great.

But Alessia would say it was good too. So that's where I got confused. I was like, wait a second, there.

Is this small slice of the plant based medical world.

How can we get high quality olive oil?

Unfortunately, I think you're going to, you know, don't buy it in a plastic bottle. It should be in a dark glass bottle. A lot of them will have organic labeling. And how do you know your generic Cialis has even any Tadalafil in it? I mean, that's a pharmaceutical representative. Yeah, we're all at some risk, but I probably wouldn't buy my olive oil at cvs.

So the only thing for listeners, I just want to make sure, I just had another person yesterday was very surprised. We do not cook with olive oil.

We don't behave that way.

We do not heat olive oil. That's really, really important.

I mean, the best olive oil you treat gently, like fine wine, which it really is about the same price as fine wine.

So to recap, let's go big picture recap. So basically, whenever you get the message, get your lipoprotein A evaluated, do your coronary calcium score, have an ultrasound of your arteries, and if anything's not right, get working.

It's absolutely true. Strong family history. If your family history is brothers, sisters, mom, dad, grandparents, aunts, uncles, had early events, do it earlier, do it more aggressively. I'm not the only preventive cardiologist. I'm a reformed. I wasn't interventional and now I call it interpreventional because I intervene all the time. But it's a beautiful salad or sleep therapy or something. We're working hard, but yeah, I mean, don't assume that is the. Don't assume you'll get burned over and over, that just because you look good and feel good, you're good inside. I mean, I hate to say it, you may be, but you're about $500 away, maybe from knowing for sure. And if you do the calcium score, do the calcium score, you might just be $99 away from knowing for sure. I volunteer in a little clinic in inner city. Det. I can't order a stress test. They don't have insurance. That's $800. I can't do an MRI. That's $1,200. They can afford a $75 CT scan. They're getting better care than some of the executives that are running companies that are doing hundreds of millions of dollars a year. It's a crazy irony that the best test for accurate heart early detection is actually one of the least expensive tests on the panel. Except in Boston. You guys are just. You got to work.

Of course.

All right, Joel, this has been amazing. So where do you want to direct people to find you? What's the action you want people to do from here?

Yeah, we'll do all these steps. I mean, I would like to tell you it's easy to find doctors that share my philosophy. It's not. I do have licenses in about 30 states, so I do quite a bit of telemedicine, but I have a clinic in suburban Detroit. Conlongevitycenter.com Kahashnlongevitycenter.com and we see people. It's fun. From the Philippines and from Israel, but mainly from the Midwest, but coast to coast. I have a podcast every week, heart doc, VIP and also I'm very reachable by email. Drconcenter.com, d r k a h n@khan center.com People ask me, do you think there's somebody in my town that can arrange it? Or what are the questions I need to ask? I'm not flooded with those questions. I really do answer myself. So.

All right. So we will put everything in the show Notes. Thanks for listening to another episode of the Five Journeys podcast live. Like youe Matter. If today made a difference for you, please give us a five star rating and tell all your friends so they can have transformation too. Our guest today was Dr. Joel Kahn and we were just delighted to talk about heart health, lipoprotein A and how to live and live well. So thanks for being here. Have a great day.

Thank you. It's been a pleasure.

Thank you.

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