Dhru Purohit Show - The Daily Habits That Quietly Lead to Heart Disease (And How to Stop Them) with Dr. Jeremy London

Episode Date: July 23, 2025

This episode is brought to you by Cozy Earth, Fatty15, and Ollie. Heart disease is the leading cause of death for both men and women worldwide. But it's not just about genes or bad luck. Our daily habits, developed over decades, play a major role in determining our risk. Today’s guest, a cardiovascular surgeon, shares his personal experience with heart disease and offers insights into what we can do to lower our risk. Today on The Dhru Purohit Show, Dhru sits down with Dr. Jeremy London to explore the common lifestyle habits that can fast-track your path to heart disease or a heart attack. Dr. London highlights the critical roles that sleep, restorative practices, exercise, and diet play in prevention. Drawing from his own heart attack experience, he shares how it transformed his approach to patient care and prevention. He also breaks down how to identify the key factors that influence your cardiovascular risk and how to pinpoint the area that needs the most focus. If you're looking for a deep dive into heart disease prevention, this episode is for you. Dr. Jeremy London is a board-certified cardiovascular surgeon with over 25 years of clinical experience. He earned his medical degree from the Medical College of Georgia and trained in surgery in Denver and Charlotte. To expand his approach, he completed the Institute of Functional Medicine’s core program, integrating a root-cause, whole-body perspective with traditional medicine. Dr. London’s mission is to share practical, easy-to-understand health information through his newsletter, podcast, and social media. In this episode, Dhru and Dr. London dive into:  The lifestyle habits that fast-track heart disease (00:30) How high blood sugar, fasting insulin, and A1C damage the heart (5:05) Why stress management is critical for cardiovascular health (11:50) The importance of prioritizing sleep (16:39) How high blood pressure works and why it matters (18:15) The blood work and tests that are key for prevention (26:47) Dr. London’s transformative story of surviving a heart attack (32:42) The impact of chronic sleep deprivation on overall health (56:40) How diet affects our physiology and ways to improve it (1:08:00) Why metabolic health and tracking key markers are essential (1:23:08) The specific tests Dr. London recommends (1:30:47) Why alcohol-based mouthwash harms oral health (1:36:27) Dr. London’s personal experience with alcohol and its effects on the body (1:39:14) What you need to know about coffee and paper filters (1:47:32) How to respond if you think you’re having a heart attack (1:51:00) Final thoughts and key takeaways (1:57:03) Also mentioned in this episode: https://www.eightsleep.com For more on Dr. London, follow him on X/Twitter, Instagram, YouTube, TikTok, LinkedIn or visit his Website. This episode is brought to you by Cozy Earth, Fatty15, and Ollie. Right now, get 40% off your Cozy Earth sheets and sleepwear. Just head over to cozyearth.com/dhru and use code DHRUP. Fatty15 is offering an additional 15% off its 90-day subscription Starter Kit. Go to fatty15.com/dhru and use code DHRU to replenish your C15 levels for long-term health. Want to give your dog the best in clean eating? Take the online quiz and introduce Ollie to your pet. Right now, Ollie is offering 60% off your first box of meals when you subscribe today! Just head to Ollie.com, use the code DHRU and you’ll get 60% off your first box of meals in your subscription. Sign up for Dhru’s Try This Newsletter Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Jeremy London, welcome to the podcast. As you know, and some of our audience doesn't, heart disease is the number one killer in the world, not just for men, but for women as well, claiming over 20 million lives a year. But here's what most people don't realize. In the vast majority of cases, it's not just bad luck or genes, we'll talk about that more, it's a result of daily choices and actions. Genes play a role, but our actions play a bigger role. But our actions play a bigger role. So let me ask you this. As a board certified cardiovascular surgeon, if you wanted to fast track someone's path to heart disease, which again might sound a little diabolical, but it's designed this question to prove a point. If you wanted to fast track someone's path to heart disease,

how would you design their day from morning to night? Let's start with the obvious things that may not be so obvious. Don't brush your teeth and don't floss in the morning. The first thing most people do. If you want a hard disease, if you want to fast track somebody's path to getting heart disease, don't brush your teeth, don't floss. And don't floss. What's, you know, one of the first things you do when you wake up, you get up and you brush your teeth or flush your teeth or or both, hopefully, the connection between oral health and cardiovascular health is dramatic. There's a direct connection between the back. bacteria that live in the mouth and bacteria that are found in atherosclerotic plaques.

In addition, there are routines that people have in the morning with alcohol-based mouthwashes that affect blood pressure. So there's a lot of oral health protocols, if you will, that directly impact cardiovascular health. And it goes even deeper because when we think about our microbiome, am, where does it start? Our mouths are directly connected to our esophagus, the swallowing tube, stomach, further down. It all starts in our mouth.

So we know that a healthy gut is important for overall health and in particular cardiovascular. So don't brush your teeth. And you'll get there. That'll help you. And we'll talk about this later. But people who have gum disease are more likely to get. cardiovascular disease, and it seems to be that bacterial connection. Absolutely. And it even expands beyond that, and we can touch on that later. And this is a little bit of a preview. We'll come back

to this as well. But would you go so far as to say that if you really want to destroy this beneficial bacteria in your mouth, have mouthwash, you know, morning, afternoon, and evening, regularly use alcohol-based mouthwash and destroy. And a lot of people do. Absolutely. They think they're being socially I'm responsible by keeping a fresh mouth, but what they're actually doing is destroying the healthy bacteria in the mouth, which can set up for trouble later. Okay, I got a few more questions about that, but walk us through the day. Walk us to the day. You've woken up and don't brush your teeth. Go to the kitchen and eat a ultra-processed high-fat, high-sugar meal, and then sit down and work for six hours straight and don't move.

Sedentary lifestyle. Avoid exercise. Avoid movement. That's next. So four dietary choices, not being thoughtful about what you're putting in your mouth, and then sit down and don't move. Now, what does that do specifically?

Well, we know that ultra-processed foods generate higher volumes of inflammation in the body directly and indirectly. But I think one of the things that people don't realize is changes in glucose levels are paramount when it comes to risk factor for cardiovascular disease. In other words, we have normal spikes in our blood sugar levels when we eat. We all do. That's expected, but you don't want your blood sugar levels to come up and stay up. What will ensure that they do that? Don't move because movement burns the available glucose is energy that you need throughout the course of the day. So create a sedentary lifestyle for yourself.

Eat a high fat, high sugar meal. Don't brush your teeth and you're well on your way. Okay, one follow up question about that. And there might be some more. I think you probably have something to say, especially about the category of sleep and stress and what that would look like in the day. You're taking my thunder.

But, but, right, it's a little preview. It's a little teaser to keep the YouTube audience listening. But you're going to give the answer. But one quick follow-up question, and we'll do a deeper dive on it. Why is high blood sugar, high fasting insulin, high A1C? Why is that so damaging to the heart? Give us the short version.

And then later on in the podcast, we'll tease it out a little bit more. In its most simple form, having high, chronically high blood sugars, in other words, circulating glucose in the bloodstream, changes the chemical structure of the cells of the lining of blood vessels, which sets it up for injury. The endothelium? Exactly. Exactly.

That inside layer, which is normally very slick, allows blood to pass very easily. And once you begin that injury process, the body responds to that to repair it. And it's that repair process that then many times can result in the laying down of additional cholesterol and inflammatory cells that result in plaque or calcium plaque formations. So it's a direct damage. In addition, high blood glucose levels throughout the body, you know, it's going to be stored if it's not used as fat, particularly visceral fat.

which is the fat that surrounds the organs in the, it's the beer belly, effectively. We know that that volume of visceral fat is an engine for inflammation in the body. And it is a direct risk factor for not only cardiovascular disease, but chronic disease in general, to include type 2 diabetes, metabolic syndrome, a lot of the autoimmune diseases. It really, none of these things happen in a vacuum. And I think that's one very important point as we talk about cardiovascular disease in particular, that it's not just here. It's we have blood vessels from the top of our head to the tip of our toes and they're all affected. And when those blood vessels are affected, so are the organs as well, our kidneys, our brains, et cetera.

So the tendrils, if you will, of the implications of the high glucose don't just affect the heart. It affects the kidneys. It affects brain function. It affects blood pressure directly as well. So it's really, it's a compounding scenario. But when we talk about specifically for cardiovascular disease, it's the vessel wall injury. that is most impactful. Great.

And we're going to chat more about that. Sure. You're continuing to walks through the day. So far, if you could just recap, right? If you want heart disease, and especially if you want to fast track it, which nobody does, but we're trying to prove a point here. Give us a recap. Don't brush and floss as soon as you wake up.

Eat a high fat, high sugar, highly processed meal, and sit down and work for an extended period of time without any activity. Yeah. Or even with light activity. Right? Like if people are just walking around, but they actually are not tracking their steps or their movement, they're thinking, oh, I've been walking around. I walk to the kitchen. I went to my car. I went there. But then when you actually look at the data, the average American in many instances is getting less than like 4,500 steps. That's the number. Which the CDC says is living a sedentary lifestyle. So even many people who think they're walking around a bunch or are kind of active. Sure, they wish they were more. they actually according to what you're talking about are basically just sitting down all day and increasing the risk of heart disease.

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Are you comfortable being uncomfortable during the day and managing that? Do you have healthy responses to stressful? We all have stressful situations. Life is life. That's our choice to make as to how we respond to those things. stress level certainly impacts cardiovascular disease, increased blood pressure, increased stress throughout the autonomic nervous system, in other words, the fight or flight, rest, digest portion of the nervous system that directly controls blood pressure.

So I think stress management throughout the day is very important and your overall mental health, if you will. So if you want to get a fast track to heart disease, stay. angry, stay combative, and utilize unhealthy coping mechanisms to deal with stressful situations, stress eating, drinking, whatever it may be. Everybody knows the list, you know, add tobacco onto that and what have you. The obvious things, but poor stress management through the course of the day, I think, is very, very impactful.

That's huge because what I'm hearing you say is that it's not just the stressful events, which we all have a certain amount of stress that's there, but it's not having active recovery from those stressful events that could be downtime. For some people, that's yoga. For some people, that's a walk and talk with some friends. Absolutely. Even every few days seeing somebody, having an outlet where you can get stuff off of your chest and talk to somebody and feel understood, get some insight could be a Bible study group. Right? Could be a church community that somebody's part of. Whatever it is, these are all things that help us recover and repair.

And when people don't have that, which usually means they don't have community, now you are fast tracking your path to cardiovascular disease. And I think to piggyback on that, I think you said the word, it's community. And how you are interacting with other people and your relationships that you're developing during the day and how you nurture those relationships is very impactful for your overall health. So, you know, be reclusive and non-communicative. Isolate yourself? Angry.

And don't give yourself the opportunity to have those recovery time periods. Creating that space for yourself is a fast track to heart disease. And I think that, you know, again, just to round out the topic, when we're talking about recovery, whether it's our mental muscle or our physical muscle. or our physical muscle, growth, true growth, occurs during recovery. That's where it occurs. And we can talk more about this with respect to sleep and exercise and all those things.

But it's so impactful. And I think people forget about it. I'm guilty of it myself. You know, I think that type A, you know, on-off personalities like myself have a difficult time functioning in the gray. which is where recovery occurs. It's huge. And we're going to talk about your story. You have a crazy story.

We're going to get to that in a second. And some people might have seen it because you've literally blown up incredibly, you know, for all the hard work that you, your family, you work with your son. He's here in the studio have done. And we're going to get to your story in a second. People hear stress management. And it feels so light. It feels so basic.

But they forget, and we've talked about this on the podcast, the number one longest running study for human sort of just general health and wellness and happiness showed that the people who had long, healthy, productive lives were also those individuals. This was a study done out of Harvard. You know, continuous study. It was all over the headlines last year.

It showed that those that had deep bonds in relationship had better quality health, had better quality levels of happiness, especially into their later years. So this isn't just fluffy stuff. This is real and it's impacting our lives on a daily base. Okay, so you talked about stress management, which is really about recovery, community, not isolating yourself.

What else would you do if you wanted to diabolically design somebody's life to get heart disease? I think the final one is at the close of the day is being mindful of your sleep hygiene program. I know it's not sexy. I know it's not cold plunging and doing saunas and all the things. that are in vogue right now. Also very important. I do all of those things, but we all have to sleep. And many of us, including myself,

it's what I struggle with personally. Don't prioritize sleep in our lives. And I think that if you want a fast track to a cardiovascular event, case and point, don't prioritize your sleep. Don't go to bed at the same time every night. get less than five hours of sleep, wake up multiple times during the night and do it night after night after night and it becomes a real problem.

A lot of follow-up questions on sleep. We're going to get to that in a minute. Absolutely. Right. But first, we're going to chat about your story. But before we chat about your story, I mentioned to you that a lot of my audience that's listening today, they consider themselves like the healthy person in their friend group. And what that often means is that they're looking for the cutting edge, best.

information and they're often sharing that with their friends and their family on how to stay healthy. So they like to get into the weeds of things. When it comes to hard health, let's talk about two more aspects that are there for somebody's daily routine, starting with one that people often overlook. And you made a really great video on YouTube about this recently. And that's blood pressure, right? So now let's go into some analytical things, some objective aspects. You know, you've given us the routine. But if somebody wanted to fast track their path, to getting a cardiovascular event, God forbid, we don't want that for anybody, but we also know it's the number one killer out there for men and women,

women pay attention. What would they be doing with their blood pressure, right? And obviously some of the things you already talked about are not great for blood pressure. But give us the numbers and give us the approach to you being mindful, checking, not checking with blood pressure. What would their blood pressure look like if you wanted to fast track? Let's talk about what blood pressure is first. I think that that's important.

In spite of the fact that your audience is so high functioning, I think it's always good to review. We need to zoom in and the zoom out. We've got to talk about things big picture and then we get into the details. So please, blood pressure. Simply put, the heart and the cardiovascular system is a closed pump, closed loop system with a pump mechanism at its central portion. Left and right ventricle, which are muscles that pump the blood through the blood. body. And normally speaking, our blood vessels are very responsive every time the heart beats. In other words, they are flexible. So when our heart beats, blood pressure is that pressure

that's then transmitted through this closed loop system to do what? That's to deliver oxygen and nutrients to all of our organs. That's the simple, zoomed out. definition, if you will, of what blood pressure is. So a normal blood pressure, less than 120 systolic top number, that's when the heart squeezes, less than 80 as the heart relaxes, the diastolic or bottom number, is considered a normal blood pressure. Believe it or not, over that is considered early high blood pressure or hypertension. So the blood pressure doesn't have to be 160 to have high.

blood pressure and there's different levels of hypertension. But the amazing thing is 50% of individuals in the US have high blood pressure. So either you or someone you know has high blood pressure, but many people don't know why because you don't check. So why is it even important? Well, what happens with high blood pressure is those normally very flexible blood vessels become less elastic or stiff so that when the pump is working instead of accommodating with each beat, it's seeing increased resistance over time.

That does two things. As the blood pressure goes up, 120, 130, 140, that inner lining, the endothelium that you mentioned, that lining that normally is the protective lining, if you will, then can become damaged as a result of a high-pressure system. Again, once it becomes damaged, it sets up that cascade for repair that can ultimately lead in atherosclerosis and significant blockages throughout the body. In addition, the heart is a muscle. It's a muscular pump.

And just like any other muscle in the body, time under tension does what? that muscle then grows. So as the heart is beating against this increased resistance, it gets thicker and thicker and thicker. And the cavity, which is where the blood is pumped from, gets smaller. So the efficiency of your cardiovascular system then goes down. And at a point, the marginal returns of that thickening fall off and the heart actually can become weaker. And you can end up. And you can end up with heart failure. So the two endroads, if you will, of high blood pressure, this is exclusively in the heart and it happens differently in other organs, is number one, direct damage to the blood vessels through the body, brain, kidneys, and the heart arteries themselves, the arteries that are supplying blood to the heart pump, blockage is there, cause heart attacks because those are the nutrient vessels to the heart pump itself.

And then chronic high blood pressure long term eventually leads to a road of heart failure. That's a great breakdown. It's almost like you have a garden hose and you're turning on the faucet and you want good pressure. So you can water the plants and do what you need to do or fill up the bucket, whatever. But imagine if all of a sudden that garden hose, which is nice and stiff, which allows for good pressure, all of a sudden gets so much wider in certain parts, less elastic, the pressure is going to go down. Yes.

It's not going to work as well. You're not going to be able to get the job done. Your heart is working so hard in this closed loop that you talked about. That's right. And now it doesn't have the healthy level of stiffness that we want inside of the arteries. And so it has to work overtime. And then you throw in plaque. blockages, damage that gets there.

And there's impediments that are there. So now all of a sudden we understand why blood pressure is something so important that cardiologist, cardiac surgeons like yourself, look at. And is it fair to say that it can be one of the earliest signs that somebody's heading in the wrong direction when the blood pressure is not looking good? I don't know that it's a predictable early sign. I would turn it maybe the other way that if you do have undiagnosed high blood pressure, it absolutely can set off this cascade to this perfect storm that you've just described

of a heart muscle that has to work harder but is potentially getting blockages in its nutrient blood vessels and then doesn't have the energy that it needs to work harder and over time then fails. Yes, I think that blood pressure certainly can set off that cascade, but I wouldn't say that it is a predictable early sign, but if it is in fact there, it is a red flag. It's a red flag. 100%. I know there was a recent study that came out. I think it was out of China where they followed almost like 10,000 people over a period of time. We'll look at it afterwards or maybe we might clip this out. But there's been an argument about what is the optimal blood pressure, right? So now we're getting out of giving it to somebody, but just since we're on this topic, and we might come back to

blood pressure later on, what is a good blood pressure that we want people to be shooting for? I think there was some debate about should it be 130 top line number, should it be 120. What are your thoughts on that? So the short answer is, for full transparency, I'm a cardiac surgeon, not a cardiologist. So you're getting a little outside of my wheelhouse of what I treat on a day-to-day basis. That being said, I'm familiar with the study that you're right. referring to and some of the discussion that has been around that study. And it's interesting because the response has been air on the side of caution. And when you're talking about the

implications of hypertension being so significant that choosing the number of 120, even though that has been historically the number, that's what's being challenged in that study, that the safety net, there is much more comfortable for practitioners because it's hard to control blood pressure in those really, really tight windows. Because blood pressure does this through the course of the day. That's why it's always best to not base your blood pressure on one reading. Yeah. You know, you take it multiple times during the day, at home, at rest, middle of the day,

before you go to sleep a night, and then you look at the average of those blood pressures. And they did that in this study. It wasn't based on one blood pressure. Right. But the response for folks that do this every day that I've read accordingly is to err on the side of caution. And it'll be interesting to see what the final word is there. Okay. One more thing when it comes to giving people heart disease, what would they be paying attention to or not paying attention to rather?

Or how would you design their life when it came to just top line blood work, everything from how often they got it and looked at their life? and looked at their levels and their lipids, and maybe just a little bit of a preview. We're going to come back to this of what those numbers might look like over a period of time. So if you wanted to give somebody heart disease, you already talked about blood pressure, why it's important, what would you do when it came to blood work, specifically these aspects of metabolic health and the lipids

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guess what, they deserve the best. And that starts with real food. You want your LDLs to be excessively high. You want heart disease. I know there's been a lot of discussion about LDLs and is cholesterol truly important in heart disease. I want to say unequivocally that I believe and the science supports that LDLC and the more granular forms of this and we'll mention some of that now are. directly related to increase cardiovascular risk. So you want high LDLC first to increase your risk of cardiovascular disease.

Second, in that common lipid panel, which you might get in your primary care office, would be triglycerides. High triglycerides. That'll take you down the evil pathway. Directly connected, but not intuitively connected to triglycerides, is glucose control. or hemoglobin A1C, which is a marker of how well your glucose is controlled over a 90-day window,

which is a much better way to evaluate how well your body regulates glucose than a fasting glucose. You need both, but the A1C is directly related. You'll find that folks with elevated triglycerides also have very poorly regulated blood sugars. So those two interconnected. To get more granular in the lipid space, and I'll remind you, I'm not a lipidologist. Totally. Just high level. Yeah, would be APOB or APO-Lipoprotein B.

What does this kind of give you? Think about this as the 25,000-foot view of your lipids. Because what this is an indicator of is the pathogenic or atherogenic portion of your overall lipid panes. And it includes all of these things. So if it's got a, if you have a high ApoB, then you know you have a high level atherogenic load and a higher risk then of developing cardiovascular disease. And then finally on the list would be LP. Little A or lipoprotein L.A.

Now, this is a genetically determined factor. It is a once in a lifetime test. You just have to check it once. You either have an elevated level or you don't. Unfortunately, right now, we don't have a way to modify that. But it's not something that you can necessarily do to allow yourself to have a higher LP little A. But if you do check it and you have it, don't do anything about lifestyle modification as a result of it. And a heart attack is probably two to three X higher knowing that you have the LP little A.

But the good news is, and this is some of the stuff. we're going to get into after we talk about your story, a lot of the opposite of what you just shared are things that even if you have the LP. Little A, which I do, right? So I have a higher genetic risk that's there. A lot of these other lifestyle factors can combat that when we do the opposite of what you're saying. Absolutely. Thank you for bringing me back into my comfort zone. We've teased about your story. And I want our audience understand that you've spent 25 years plus performing open heart surgeries, literally holding people's lives in your hands.

But it wasn't until you found yourself on the verge of your own heart attack that you understood and all these items we're talking about here at a different level and then also when your life completely ended up changing. So let's talk about that story. And in particular, after you share or sort of talk about the events,

that led up to your cardiac event, help us take the first part of what we talked about. And which one of those things were you, I don't want to say guilty of, but which one of those things were dramatically showing up in your life that somebody like you who's super fit ended up having a cardiac event? So let's talk about your story.

I will tell you that each time I relive this and discuss this, it's my level of, of disappointment in myself and some embarrassment certainly continues to rise because the basic premise of, you know, you're supposed to know, many times we know better, but we don't do better. I am like the poster child. And people appreciate hearing it from you because don't we all have that in some area of our lives? It is a universal human quality. It's a universal human quality. Absolutely.

And just to magnify the degree of this, to take a step back, really the transformative place in my medical practice and my approach to patient care, health and lifestyle happened years before I actually had this event. It was after 10 years in practice that I was really burned out and very frustrated with. treating in-game disease of whether it was cardiovascular disease at the time I was doing a lot of thoracic oncology and general vascular surgery. I was basically treating the end game of lifestyle management in patients and fix me doc and they go directly back to doing the things that they were doing was an exercise in futility, which there is nothing worse in medicine in life in general, but particularly in medicine. And that's when I really made a transformation.

I was fortunate enough to be exposed to functional. medicine at that 10-year mark. And that was a real pivot for me from a mindset standpoint, just to aggravate the situation when I go through the actual story, I truly do know better and I didn't do better. And when I made that pivot to functional medicine and truly understanding how food and movement and environmental stressors and our genetics and all those things impacted us at the, literally at the biochemical level, and at the cellular level, it reinvigorated my interest in medicine. And it really saved my medical career. I mean, entirely. And so it became foundational for me over the last 15 years. So one morning I woke up,

as I always do very early, typically right around 4 a.m. I usually get up and read and my time, quiet time, totally protected. I count on it every day. And I got up, I got out of bed, and I was kind of pacing around the room. And my wife said, are you okay? And I said, yeah, I've just got some reflux. She's like, you don't look like you have reflux. You don't look like you feel well.

I was like, seriously, you're going to tell me that I have, I don't have reflux. Like, I've got reflux. I get this every now and again. She's like, fine, whatever you want to do. I took some pepsid and I sat down and read and I was really okay. We got up. We have many dogs. We're dog people and we were out in the country about an hour from our home downtown.

We went out for a walk. It was December 4th at this time. These dates tend to become emblazoned. What year? How many years ago was this? This was three years ago. Three years ago. Yep, three years ago.

We go out for a walk, which we always do on these cold winter mornings and we get literally about a quarter mile from the house. And the reflux comes back. And I'm like, hmm. And I'm like, healing off my clothes. I'm sweating. And Tracy again is like, you sure you're, you sure you're doing okay? Like, I, you know, I just don't feel great.

She's like, yeah, I see that. So we make our way back. And I'm struggling, really, to get back to the house. Like, I don't feel good. And not to get overly graphic, but I went to the restroom and I sat down on the toilet. And within 15 to 20 seconds, my symptoms entirely went away. And I knew immediately what was going on. Because cardiac angina, significant cardiac angina, the red flag is symptoms that are provoked with activity and relieved with rest.

Why? Well, if you have a heart muscle that has a blockage in a nutrient vessel, that area below that blockage, as you stress it, is not getting adequate oxygen and nutrients. And so just like when you get a Charlie horse in your calf, your body is signaling to you that that portion of the heart muscle is in trouble. And that's what was happening. And I knew it, but I didn't believe it. I said, there's no way. And through the course of the day, I decided to test what was going on. I would go up the stairs and I'd get a little reflux and I'd sit down and it would go away.

And I kind of scaled my day to where, okay, well, I'm not going to have any more of this because this certainly can't be happening to me. I take such good care of myself. How is this possible? And the end of the day, my wife and other sons laughed and went home and I stayed to spend some time in the woods with my youngest son. We were deer hunting that afternoon. He harvested two animals. I came down out of the deer stand with him, pitch black. He couldn't drive, 15 years old, a quarter mile from the truck, and no cell service.

And I had crushing chest pain in the middle of the field. Wow. Down on my knees. Like, do not take another step, like that kind of pain. And I realized at that moment, I said, okay, this is, this is a real problem. Like, we're not going to find these two deer that we've harvested. My son's going to find me dead in the field. And I cannot do that to him. There's just no way. And, you know, he's like yelling at me going, Dad, what are you doing? I'm like, well, I'm looking over here. He's like, what, you're like 100 yards away from where you need to be. He knew there was something up.

But I pulled myself together. We made it back to the truck. Once I sat down in the truck and kind of relaxed, I got myself under control. Drove back into town. Came home, took an aspirin of beta blocker, and I went to bedrocker. Did not say a word to anyone. Just question on that. Yeah.

Why? What were you feeling? What were the complex set of emotions, both being an expert in this field, being a heart surgeon, and then also being a husband, a father. What were some of the emotions that you were feeling? Are you asking me how I could be so stupid?

No, I'm asking you the internal conflict that gets us. Absolutely. Let me let my wife answer that question for you. Well, Patron on Zoom. We have your wife here. I'm just kidding. I'm going to give it to you. I woke up the next morning.

We live in a 200-year-old house. It's got long staircases. I came back up the staircase after going down to get my coffee. Crushing chest pain came back. And I looked at Tracy and I said, I've really got something wrong and told her the whole deal. She said, first of all, you mean to tell me that this happened last night and you drove my child an hour back into town, went to sleep. did not say a word to me about this. And you're telling me now, she said,

this is without a doubt the most selfish thing you have ever done to me and the boys. I mean, like, I can't even say it. That's emotional. Yeah. And she was right. Yeah. All I can say was, I'm sorry. Yeah.

And then she asked me the exact same question that you just did. Why didn't you tell me last night? I said, because you would have made me go to the ER. She said, yeah, you bleep, bleep, bleep, that's what you do when you have chest pain like this. And I said, well, I didn't like the cardiologist that was on call. And she said, why didn't you call your friend? He would have come in and taken care of you. And I said, oh, I was going to be okay.

And I know, I know better. And I didn't do better. and I cannot think of a more poignant, painful example of that than my behavior at that time. Fortunately, my buddy, I went and saw him the next day and he looked at me, goes, there's no way you have anything going on. You eat right. You exercise, you don't smoke, you know, you're in a high stress job. And that's your only risk factor.

He's like, I'm not going to find anything. I said, yeah, you are. I said, and honestly, I hope you do because I'm in trouble. And literally walking out of his office, the pain came back. And he's like, let's go to the cath lab, which is where they put the catheters in, put the dye in the arteries. And to actually get a real look at like, how much blockage do you have? It's exactly what you were describing with the garden hose. You put the dye in there and take an x-ray and you can see where those roadblocks are.

And I had a 99% blockage on the back of my heart. Yeah, 99, just so people hear that. 99%. 99. Yep. So tight that when he placed the wire across that blockage, because that's the support you need to put the stint in, put a wire there first to create a rail that then the balloon and stint follow over that wire.

Well, the wire, which is, you know, 0.035 millimeters. Super tiny. Super tiny. Accluded it entirely where I said, hey, man, I'm having crushing chest pain again. And I wouldn't let him sedate me during the procedure. Classic doctor. A little bit of a control freak.

Well, I wanted to see what was going on. And I was like, hey, buddy, like, I'm really hurting. And he pulled the drapes and he goes, I need you to shut up so I can get this done. Stinted me, had a beautiful result, went out to talk to Tracy and said, I dream of stenting cardiac surgeons, but doing a procedure on your husband is an absolute nightmare. And she goes, oh, I am sure of that. But it was, you know, the coin was flipped on me.

I was the one laying on the table. And, you know, when you have these incredibly significant touch points in your life and the cherry tree just get, absolutely rocked. I woke up the next morning and things that were really important to me, 24 hours prior, were not even on the priority list at all. My family, my friends, people I love, and the people who love me, that was it. That was a list. And that was a transformative,

moment for me. It really was. It really was. Wow. Wow. I can't even imagine being in that situation and you literally, your entire life is flashing in front of you, not knowing are you going to be okay? Are you not going to be okay? Being in that in between, that stressful period where again, maybe somebody listening, they haven't had it with heart health, but you've been in this period where you know you need to do something. Could be in your, your relationships or being around toxic people could be in your finances and you're not giving them the attention and you're in that in between period where you feel also a little bit embarrassed that you should know better about it. But at the end of the day, you still need help

and you're trying to make that decision and the stress that comes with that. I can even imagine in that situation of heart health what that would be like. But I've definitely dealt with that in other areas of my life. Absolutely. And again, that's why I think that people appreciate it hearing from a heart doctor themselves that this is. is something that they went through and are using to literally not only transform their lives in terms of priority, but taking that experience and going and telling that story to as many people as they can so that we all can get a handle of this number one killer of men and women and actually maybe potentially take some steps right now so we don't end up in the same

situation. Absolutely. Is that your mission? A hundred percent. And to do it, hopefully, in a relatable, authentic and science-based manner that people can understand and can then apply to themselves, you know, to make it, anyone with an internet access should have the opportunity to have this information and have access to it in a digestible, tactical format. And I'm willing to share my story because I think it helps me mitigate. some of the embarrassment and personal disappointment that I have that I can turn this into something positive and really worthwhile, both for myself and hopefully for many other people. You know, one of the reasons that the platforms have been so transformative for me personally

is that for so many years, I've only been able to take care of one patient at a time. One patient in the office, one patient in the operating room. that is not a scalable model. This is an unlimited scalable model on so many different avenues. And if you're willing to put yourself out there, which I am, the number of people that I feel like we can impact with this information is really powerful. And it's, you know, kind of the next iteration for me personally. One of the top questions that human beings ask themselves, after any, life-altering event and in this situation, knock on wood, something that you were able to

not only survive from, but turn into a thriving experience in your life that's impacting other people. One of the top questions that people ask is, why did this happen to me? And there's two ways to look at that question. One is, woe is me, why did that happen to me? Absolutely. The victim place, which we've all thought that thought about different things, a bad breakup, a bad situation, whatever it might be, a health event that's there. You know, you feel like life is

happening to you, not always for you. So that's a human thing. We don't want to get stuck there, but it's natural to feel that first layer of it. But there's another side of that question, which is, hey, why did this happen to me? Which is said with a different attitude. And it's said with the attitude of if I can understand how I played a role in this or the circumstances that led to the situation, then I can do something about it. I call it the law of responsibility. If you had some role, it doesn't mean that you caused it. If you had some role in this situation happening, that's beautiful news because that means that you can do something about it. If you had no role in it, you unfortunately can't do anything and it's all 100% up to

genetics or whatever else is out there. So we know genetics load the gun, lifestyle pulls the trigger. And we also know from a lot of the research that's out there is that something like heart disease, it can start way earlier in our life well before we get symptoms. And then one more layer that's there. We also know that there's natural variation in life. Not everybody who smokes ends up with cancer. Not I mean, the majority of people will, but not everybody. That's right. Not everybody who's super fit will always have a heart that looks super healthy. So when you are asking yourself this question, why does this happen to me? What were some of the things that you found that were potential contributors in your situation?

Let me first respond to how I navigated that why me kind of negative pathway, which I think, please, which I think is important for people to understand because it was a conscious conversation that I had with myself because it goes like so, I take really good care of myself. I exercise regularly. I'm really conscious about what I eat. I try to maintain all of the, I try to pull all the levers that we're all very familiar with. And you end up with the, so why would this possibly happen?

But then I took a moment and flipped that and said, think where I'd be if I hadn't done those things and I'd had had this event. That's powerful. And that just totally mitigated all of that negative connotation for me personally. Because I tell patients that too. You know, when they come in and they're fit and I'm going to operate on them, they're like, how did I end up with this operation? I said, well, you know, here are the reasons that I believe that this is. occurred for you and here's the things we're going to do about them afterwards. But think about where you would be if you hadn't taken care of yourself. Your recovery is going to be so much

different now and so much better and such a positive experience because you've done resistance training. You've been walking every day and all of the things that you needed to do. So you have to flip that narrative for yourself. And I did that. And I had to consciously do it. I really did. even, again, utilizing that tool for others, you know, do as I say, not as I do, is always something that you have to be mindful of. So, and you go through almost a depressive period with, I think, particularly for men as the, you know, head of the household potentially, depending on the setup and, you know, the protector and the provider and what have you. It's a very, it's a very difficult mindset shift to intellectualize that.

And it takes time. And we all have a different path with how we do that. So then the second piece is, okay, if we're going to have some real intellectual honesty about where we are, it's about now we got to identify what we need to do differently from this point forward. And that took some time and a process for me to get there because, as I mentioned, what did my cardiologist tell me? This couldn't possibly be you, right? You're doing all of those things. And when I get asked the question, you know, what's the one thing that people should do to avoid cardiovascular disease?

That's a really hard question to answer, right? There's no paper clip that fits every stack of people like every stack of papers, particularly when we're talking about medicine. So I tend to flip that on its head and I say, well, look at the levers, movement, diet, mindfulness, sleep. And which one are you bad at? Don't identify, because if I said to you, the one lever that everybody should work on is exercise. and maximizing V-O-2 max because we know that's the most powerful indicator for cardiovascular efficiency and longevity. And you say, well, my V-O-2 max is really good, so I don't have any risk factors.

Well, that's what I would have said about myself. My Achilles heel, at least from the first pass, was sleep. And that's as a result of 25 years of being on DefCon 1. and my life just being wound like the Eastering on a banjo at all times because I am always on go. Always. So I never really fall totally to sleep because I'm, you know, I take a week of call at a time. And even when I'm off, it's very difficult for me to gin down. The lack of sleep compounding over that period of time was absolutely a risk factor for me.

So I knew that that was what I was bad at and what I was. and what I was going to work at the most. Just to connect the dots to something you said earlier. Sure. I think what's so crucial for us all to understand. And you mentioned this earlier, is that sleep is where repair happens. In every organ system in the body,

our brain has its own detoxification system, the glymphatic system, which is activated in this deep sleep period, in particular, deep sleep, is super important for, cleaning the brain out, you know, taking short-term memory, putting in long-term memory, getting rid of all the garbage that also builds up. Absolutely.

And we know that when people have things like sleep apnea, which disturbs, high-quality, deep sleep in particular, they have a higher risk of Alzheimer's disease, right? Going back to what you were talking about with the endothelium, we've done a number of podcasts on this topic. We've had my own personal cardiologist on here. I don't know if you've ever connected with him, Dr. Michael Twyman. I'm not really great guys. You guys are like super complimentary with each other.

It's based in St. Louis, really good dude. Former Marine, sorry, former Navy doctor. And that went into, you know, private practice and everything. And one of the things that he talked about with sleep is that just like you were talking about, the analogy of our arteries and our endothelium and it getting damage during the day. Well, we all have damage. And it's not just from diet. we know that air pollution, especially in a city like Los Angeles, probably compared to where you live,

air pollution comes in our body. And it can cause these little damages, these PM2.5, parts per million 2.5. And that can damage our endothelium. Yes. And then that damage over time that doesn't get repaired because we don't have great sleep or great recovery, those become these sort of divvets that plot can build up in. again, you were mentioning that earlier. So sleep may feel like such, again, a light level intervention, although I do feel like sleep has finally been getting the attention that it deserves.

A lot more people are talking about it. No question. But that's how I understand it to be so important to what you're talking about here, that chronic sleep. Again, we all have a situation. You have kids. I don't have kids yet, but that's the next stage for my wife and I. Sure, my sleep is not going to be great for a period of time, right? and we need to double down and do whatever we can to bring it back in order without freaking out, right, so that we don't have this long-term exposure.

So if you had elements of your life, I'm guessing, and I'll turn it into a question for you before you go on a diet, if you had higher levels of LDL or APOB for years that maybe you were genetically prone to or just came from dietary aspects of more saturated fat in your life, if you had higher levels of stress, which also damaged the endothelium, if you, We're more of a regular drinker and alcohol being another thing that can also damage. If you were using mouthwash, which you talked about earlier, these are all these little damages that are there. Some we can control for, some we can't. But then sleep is off. We don't get the full repair process to happen. And now, just like things can compound in a good direction, things can spiral down in a downward

direction. So that's what you're talking about when you're talking about sleep. Yeah. And I think if we take this back to a physiology level, just from how our bodies work, our bodies are wonderful. Just like cells, they want to be in balance, homeostasis, right? Down to the cellular level. That's how our bodies function.

And it's about figuring out what we're doing to our bodies that are pushing us away from center line or what we need to, what we're missing that we need to add back in to nudge us back to center point. And that's what you're talking about. If everything you're doing or not doing is pushing your body away from center line, then it's a predetermined fate almost. If you're not allowing those, that equation, if you will, to balance your body to be in homeostasis. And I think that's really foundational for functional medicine. I mean, that's really what the mindset is trying to achieve with functional medicine.

Like, let's figure out what's happened over time that either you've been doing to yourself, whether it's environmental exposure or whatever it may be, that we need to remove. Or do you have deficiencies that we need to add back in to help, again, rebound? your system. And I think that's, that's effectively what you're talking about from a lifestyle decision standpoint. One of the other things about sleep when, you know, because a lot of people struggle with sleep. And there's a lot of people that are great sleepers. My wife is a phenomenal sleeper. I mean, all she has to do is sit down when she's tired and game over and gets a great night's sleep. And I just watch her. And by the way, it always sounds like it's always one person is good.

And the worst person is not that great. It's a healthy marriage. I rarely meet couples where it's like, no, we're both amazing sleepers. Absolutely. We're on the track. I guess polarity or opposites attract, huh? But maybe so. But my point is that what gets overlooked with sleep, unlike exercise, movement, and food,

like I can control what I put in my mouth. I can control my ability to get off the couch and go for a run or go and lift or get on the bike, whatever it is. But I found that the more I tried to control my sleep, the worse it got. And I really needed a lot, and still do, need a lot of help to change my relationship with sleep and not control sleep. And so I just, I think it's important, particularly for folks that are struggling right now that are trying different things or have tried lots of different things and feel, you know, like the deck is stacked against them, that that's not an unusual emotion with sleep in particular,

because even though it's something we all have to do, we don't really have control over it. What have been the best tools, and I understand it's a work in progress, what have been the best tools to help you let go of control? What does that look like on a practical level? And then what have been for your N of one experiences, what have been one, two, three things that have made the biggest

difference for you as somebody who has had years of not sleeping well. I'm not sure I've accomplished the lack of the control issue. So that's a work very much in progress. I think I'm better as far as not changing my relationship with sleep. The most transformative addition that I made was the eight sleep. Huge fan. I mean, you can't sleep without it, Right? Difficult. Eight sleep is a tech device. It's a pod. It looks like a little box.

You put it to the side of your bed. And then it pumps cool or warm water through a pump into a mattress topper. And with the idea being that temperature for men and women, but especially as I've seen, anecdotally for all the males in my life, men do not sleep well when they're. get hot. And it's both. I think the data shows that it's both. But the key is the temperature change to fall asleep. Yeah. Which is from a higher temperature to a lower temperature, that's what triggers the sleep hormones and neurotransmitters. That's why a hot shower works. Take a hot shower. You raise your body temperature. You get out, allow your body to cool and you feel relaxed. Well, by cooling

the actual mattress, you then can cool your body temperature and maintain that body temperature throughout the course of the evening. The opposite is true for when it's time to wake up. Your body naturally increases in temperature so you can allow that topper and everyone's different and there's an AI component that will adjust accordingly, which I think is absolutely amazing, that will adjust accordingly to allow your body to slowly warm. And I don't even, you know, I don't really use an alarm period, but the way that the wake-up method works for the topper is you get this very general, gradual vibration, and it's not a jolting, you need to get out of bed kind of alarm.

It's stressful. It's very stressful. I mean, I'm sure you've had found it, you know, a nice way to wake up as well. And so I think that that in and of itself has created some real structure to my physiology, number one, but more importantly, you get a lot of data direct from that topper that's on your phone. Why is that data important? Well, going to sleep at the same time, evaluating how long you're asleep total, and then, of course, the different phases of your sleep cycle, and then waking up at the same time.

Those are the basic components to a healthy sleep hygiene program. So I think that the ability to give up some control has been having that data so that I have some accountability about the time I'm going to sleep, the time I'm waking up, and then what is my sleep quality in between? And that's really what I'm working on now. So you can get too deep in the data and get too fixated and actually create anxiety if you're not careful. when I was doing long-distance endurance sports, all my training partners used to call me Jeremy Neutron because I was so dialed in to, you know, heart rate monitors and lactate level training.

And it's like, I'm 147, we got to walk, you know. I can get there with the data. I've learned over the years that that's not really helpful. But this has been really helpful for me, both from a practical standpoint and allowing me to sleep better and an accountability standpoint, again, I think from that control standpoint. That's great. So eight sleep, awesome product. I'm not affiliated with them.

I just love talking about them. They do good job. Made a difference in my sleep. So how much of a percentage of an increase in better quality sleep do you think it brought to you? Again, I know this is a work in progress. And then was there anything else that you've seen that's significantly moved the needle forward for you with sleep? I would say that my sleep is still variable. and now that I'm able to track it and put a number on it,

I really have a better idea of how to objectify it. But what that's enabled me to do is when I do have really good nights, whether it's one or a string of nights, I can then go back and say, okay, what did I do differently on those days that I need to continue? And then the opposite being true when it's really bad. Usually for me, when it's really bad, it's pretty obvious. I've been up all night operating.

I've been in stressful. situations. There's usually not a lot of mystery there. Sure. And so now I think that that a lot of what I'm trying to utilize is more mindfulness techniques and relaxation techniques like sauna, regular sauna through the week in the evenings, again, to create even more of a delta with that temperature change. You know, I'm a huge fan of the finished saunas. That's really where all of the data, the burden of data comes from as far as cardiovascular risk management, neurodegenerative, and overall, you know, total mortality risk, quite frankly. And so I think that those tools have been really important to help me dial in what's going

to ultimately work best. And I'm still really working on that. I wish I could tell you that, you know, I was Rip Van Riegel now and all was good, but it's just I'm not there. So this thread and why we talked about sleep is we were talking back to this retrospective that you were doing of why. Yeah. What were the things that I had some relationship with? And there's reasons why it had to happen. You created a beautiful life for you and your family. You've saved the lives of so many people being, you know, a cardiac surgeon.

and that lifestyle came with a trade-off. You know, you're working at all hours of the night, not sleeping well, et cetera, but it's good to understand, okay, great, sleep, and let me do the best that I can and continue improvement. You're about to get into diet. What do you want to say about diet? I think the preface is anytime I step into diet,

it's as emotional as a religious conversation for many people. And so I really try to maintain a fairly general conversation, and with the latitude that whatever works for you works for you, like whether you're a carnivore or whether you're vegan or whatever, if that works for you and you can check all the boxes, that's great. How do I feel about it? Generally, most of us can always do better with our diet when you really drill down on it. Now, we all go through periods when we're really tight and then we let things loose and come back.

But most of the time we can always do better because life gets in the, way it's inconvenient you know personally i feel like if i'm 80% whole foods and 20% i'm edging into the processed food that's a w that's a win for me what i didn't realize is that there were certain foods that i was eating that were dramatically affecting my physiology and honestly i have to thank my oldest son who's not but a arms throw away for helping me with this process because He came to me one day and said, Dad, why don't you put on a CGM, a continuous glucose monitor? He goes, it would just be interesting, you know, to see where you are. And I looked at him and I said, Max, if you need me to put this on so I can show you what a phenomenal job I do with my exercise, movement, dietary choices, everything, fine.

I will, if that's what I need to do to prove to you, I will put on a CGM. You know where this story is going. Put on a CGM, within 48 hours, my average glucose was in the upper 140s, low 150s. And I was like, yeah, it's just 48 hours. That's average. Not just like you're eating a meal, your blood sugar goes up. A normal physiological response, right? Like we all have that.

You eat, your blood sugars go up, but you secrete insulin. and they come down naturally or you exercise or whatever it is. But my blood glucose over that period of time was staying up. And then over several consequent days, it was staying up. And one of my close friends is my internist and we work out together. And I was like, hey, man, put this CGM on. And, you know, look at these numbers. And he's like, wow.

He's like, are you kidding me? He goes, you need to go get a hemoglobin A1C checked, which is one of the things we checked. We touched on earlier because that gives. gives you that 90-day picture of how well your blood glucose is regulated as opposed to kind of one point in time. Well, lo and behold, my A1C was 5.9, which is pre-diabetic. I fell in the 80% of individuals that are pre-diabetic that don't know.

And that was a real eye-opening experience for me. And so what it did was I had to take a step back and say, okay, well, now let's really look at this. And one of the biggest advantages is the CGM is it is real-time data. So in other words, you eat something and you can see what your blood glucose does. And so I started to really monitor because there were things that I was eating that I thought were really good for me and they weren't at all, particularly certain meal replacement bars that I was eating during the day when I didn't have time to eat a full lunch. or whatever.

I was eating a fair amount of rice, which I would love that was just skyrocketing my blood glucose. So I was able to identify those things that were spiking my blood sugar, remove them. Couldn't remove rice entirely, but cut it way, way, way down to the point where my blood glucose is, is, it was in the 140s, 150s. Now it runs in the 105 range. I want to get it down to less than 100. I've moved my hemoglobin A1C from 5.9 down to 5.7.

And I'm hopeful that I'm sorry, down to 5.5. And I'm hopeful to get it even lower than that on the next checks. But it's like, you know, that which is not measured cannot be improved upon. So the question that I had for you is that you said it was an eye opener, you know, being a medical doctor. And not every panel, you know, that people order that your doctor, you know, even though you're a doctor, you have a doctor who looks at you and you have a cardiologist that you'd go to. Was that something that never came up before in your blood work? You know, you said that the A1C was eye-opening for you?

I never had an A-1C. Oh, wow. No, I had never had an A-1C. And that's- And never had a fasting insulin done as well? I had have a-I-had had fasting glucoses and insulin's done. They were all normal. Because you've got to realize that's one moment in time, and I was fasted. Sure.

I was fully fasted. So I wasn't seeing, you know, these trends. sure over time and and that's why i think that that these extended blood tests that are available now are so important yeah you know one interesting note that i want to add in about the a1c that was useful in my instance is that there are some people whose red blood cells are more sticky which means that their red blood cells hang around a lot longer than maybe other individuals that is very true and I don't know what percentage of the population is,

but it's a smaller percentage of the population, maybe under 20. I always had a really good CGM report. I'm an early investor in levels, I'm a huge fan of the company. And I always had, once I got well aware of this world of blood sugar and started looking at things like fasting insulin,

also fact check, and also looking at A1C, I would always see like, okay, great, as I'm making these changes and not being on the roller coaster of blood sugar, sugar, but having more of a natural response, which partly was diet for me, but also as somebody who was a skinny fat vegan for many years, right? And undermuscled, adding about eight pounds of muscle was a huge difference for me. All of a sudden, I could actually even eat a little more

carbohydrates. Yeah. And I saw my fasting insulin improve. That was there. Anyways, but I always saw that my A1C is a little high. So I digged into a little bit. And then I found out for my cardiologist and a few of the people that some people, they have a little bit more sticky red blood cells. It sticks around. So if you're somebody that feels like, hey, I've been doing a lot of these things right, which was a few of our podcast listeners

that emailed me after hearing my story, my A1C is still a little high. Make sure you dig into it a little bit deeper. Always sort of fact check with like a fasting insulin as well too. And then look into this aspect or ask your cardiologist about this whole stickiness. We'll put some resources in the show notes so people can ask about that. Yeah, and I think the bottom line is no,

Every test has a certain amount of variance and error built into it, be it direct to the measurement or to physiologic changes like you're referring to. There's so many components that go into this. And so you really can't focus too heavily on one single number and make major shifts in decision making until you've been thorough with that process. So I think that's the point. Totally. But in this instance, that A1C was a wake-up call for you. Yes. Where again, you thought things were heading in the right direction. Absolutely.

You thought your diet might have been dialed in. Absolutely. But there was opportunity to improve things. One thing about diet, again, it gets controversial, but that's the point of podcast as we get a chance to talk about it. I was somebody who always felt that, okay, I was vegetarian growing up. That was kind of the religion and everything that I was brought up into. even though my parents always told me you can eat whatever you want to eat.

And then later on, for more ethical reasons, I thought, okay, I buy into this whole animal rights thing. It was in college. You're young. You're impressionable. You want different aspects that are there. But I also ended up having a dairy sensitivity that would break me out. Whenever I would have dairy, I'd break out. I have pimples. As soon as I stopped dairy, my face cleared up. So I literally thought I found the holy grail and that everybody needs to be eating this way. Right. You're young. You're on a soapbox. You're trying to tell everybody how to live. their life and that was me and I did that. So then I was vegan for a few years. And then naturally as I got into the world of learning about precision medicine, functional medicine, I started running lab test

to myself and I started seeing for me in particular who was feeling like, I don't feel like my brain is as sharp as it once was. It was actually looking at my omega fatty acid profile. Yeah. And seeing that I was so deficient in omega threase and looking at all the research around especially depression, brain health, mood. And I started to eat fish and I felt like my brain turned on. Yeah, it's amazing. And that's what I think is so worthwhile with the extended, extended blood test and beyond kind of the primary care panel is you were fortunate enough to be in tune with your body to trigger that, that action. But many times we feel fine overall. Yeah. And don't even know that these things are abnormal. Right. Or,

where we don't feel 100%, but we actually just think everybody's going through this. Right. Or it's the frog in boiling water, right? It's happened so slowly that you're like, I mean, sure, I'm a little bloated, but I can deal with that. Right. So where I was going with this story to tee up my next question is that then after eating, you know, fish and feeling good,

I started incorporating other animal foods and I started to feel like I feel a lot better. And then over course a period of time, I got more serious about resistance training and doubling down on the, like my exercise in a way that I was always active, but I was completely undermuscled. And I learned that from, you know, all of Dr. Gary Alliance work and her podcast that we had on here was super pivotal for me and pivotal for a lot of our audience. And then as I continue down the path of heart disease, a lot of people don't know this, but the highest at-risk population that's a minority in the United States is South Asians and

Indians, right? They have the highest cardiovascular risk, cardiac events for any sort of minority group that's there. And there's a lot of things that play in. You tend to be a lot of doctors, computer programmers, engineers, a lot of people who are sitting, they're not very active. You know, my dad was pretty active, but I didn't grow up seeing a lot of, I didn't grow up seeing nobody in my community really regularly working out.

It was not a thing. Instead, it was, you know, how well can you do on your SATs and what's the best job and university you can get into? And then I also understood that a lot of, you know, Indians also, too, there's a higher risk of certain genetic aspects that are related to cardiovascular disease. There's many people that are hyperproducers of cholesterol that might have familial hypercholesterolemia. And then I found this to this other bucket, which I was a hyper absorber of cholesterol. These are people that tend to recirculate high level from what I understood from my cardiologist,

cholesterol in their gut, and they have a harder time getting rid of it inside of the system. And very simple tools can actually help with that. And sometimes medication could be useful. and I did end up deciding a few years ago to start on Zetia, azetamide, which made a huge difference in my APOB. I think I was hovering around like 160, you know, 170. My highest, I think, was even like 180 and being on just increasing my fiber content and going on Zetia and using a paper coffee filter.

This is a recent experiment that I've been using. I don't know if you've heard about this. We're going to talk about this in a second. I'm learning right here. I can't wait for that. tell you about this. You have a lot of hacks here with the alcohol and don't drink mouthwash. I'm going to give you one hack of your own. You can steal. We'll talk about that in a second. I got my APOB down to 80 and I'm on a new experiment with the coffee filter and I have blood work coming

up and I know that just on the trending of where things have been, it looks like I might for the first time be able to get a little bit lower than 80 as well too. So what I'm basically saying is that on the diet side, I used to think if you're metabolically healthy, which when you're, when I cleaned up my act, I was. It doesn't matter how high your LDL is. And as people know, there was a lot of controversy around this with this keto heart study. I had the authors on this podcast in the early days before the controversy. And the idea was if your metabolic health is good, if your A1C is good, if your fasting insulin is good,

if your average glucose, fasted glucose is good, then it's okay. it actually might even be protective and you can have sky high LDL 250, 300, 350, some people that were part of the study 400 plus LDL, 200 plus APOB and it's okay, you're protected. And that study came out, there was a lot of controversy. It turned out that those 100 people that they measured

had massive increase in plaque, soft plaque in particular, higher than even at-risk groups like diabetics that were in other studies that were. there. And I've addressed that with a few other people and I've written some newsletters about my thoughts about it. So from chatting with my own cardiologist, I was always borderline about whether or not I believe that I could, okay, maybe there's some truth to it. And the reason that I thought there was truth is I went and got an advanced CCTA done through a company called Clearly,

no affiliation. And I had one of the cleanest hearts that my cardiologist had seen for a male. I think it was the second cleanest. And I had basically no soft plaque, the tiniest little soft plaque that was there and no calcified heart plaque that was there. So I kind of was like drinking the Kool-Aid. Okay, LDL doesn't matter that much. I guess that's why I have such a clean heart is that it's protective because it's metabolic health. I was drinking the Kool-Aid, but I was still on the fence a little bit about it. And now, since the controversy has come out about the study and chatting a little bit more,

and even being with my cardiologist and being on a Zetamide for the last, you know, two years, I really feel that high LDL and APOB over the course of the long haul in somebody's life is shots on goal. And just like not everybody who smokes gets heart disease or cancer, but on average they will, there will be people that have maybe a genetic anomaly. Or maybe it was because I had so much fiber in my diet and I was younger and my LDL was probably lower because I was vegan, but I was eating a lot of vegetables. And I didn't do a lot of damage then. There's so many factors that play into it. But overall, I tell people now, having your LDL and APOB is shots on goal, do you really want to risk that lifetime risk that's there? Or do you get treatment or make

massive changes now so you don't end up in that situation? Do you think, what are your thoughts on that and how do you think that played into your story? I categorically agree with you. I mean, 100%. And I think that it just, it just goes to show how, and because I've bought into lots of various extreme type diets over the years as well, that you have to take a step back and temper this with some good common sense many times, right? Like, you would convince yourself, well, I'm metabolically healthy in all of these other areas, but we've got years and years and years of data to show us that LDL and APOB is a red flag and we should be concerned. And I think we just have to be very cautious about how we make those decisions and

prioritize all of these things. And in the end, we all have our own instruction manual. Like yours is going to be different than mine. I could eat, you know, more of a keto-style diet and not have my LDLs go up, you know, and you could have the opposite happen. And it is, the end game is metabolic health. But you have to include all of those points, and you have to include them in a prioritized fashion. They're not all weighted equally, the overall formula, if you will, you know,

particularly when we're looking at cardiovascular disease in particular. Yeah. It was too much of taking the train tracks, you know, down a left turn down a dirt road, if you will, when that study came out about the really high LDLs for me. Yeah. You know, that it just didn't, it just didn't feel right. And so I wasn't surprised when the second, the second arm came out at all. And to be fair to Dave Feldman and Nick Norwitz, who again, I think are doing great work in areas. Absolutely.

The science done. You know, their response largely has been. that, hey, there's some problems with solutions like clearly, again, which is a CCTA. It's an advanced, AI-enhanced sort of way of imaging of looking at not just hard plaque, like if people get a calcium score. Sure. It's also looking at soft plaque. And I think there's some truth to it.

What they're saying is that that test compared to maybe other tests at looking at soft black tends to slightly overestimate. I went through this with my dad. My dad got a clearly test on because we have cardiovascular. disease that runs in the family, Indian, everything else like that. And I got my dad to start working with this cardiologist, Michael Twyman. And we went in and did the full workup. And part of that included blood work, Boston heart, et cetera, all this stuff, measuring blood pressure multiple times a day, you know, grip strength, you know, he really takes it to the next level. I really

appreciate his practice. And he got my dad a clearly scan. And he, in that clearly scan, it showed that there was a 60% blockage in a couple of the major arteries in the heart, and I don't have that report in front of me to be able to tell you which areas. So immediately, my brother-in-law, who's a cardiologist, Dr. Neil Patel, he's down in San Diego, works at Kaiser, incredible doctor, very on board with all this way of looking at stuff. He said, you know, we should go in and actually look. Do a cath. Do the same thing that you did. Absolutely. Do a cath. When they did a cath on my dad, and they actually looked in at some of those same areas that showed a 60% blockage. There was a significant blockage, but it was 40%.

Right. Right. So there was some discrepancy that was there. Now, the people that are criticizing the study are saying, dude, you guys picked your poison. You picked clearly. You can't now say that that wasn't the best way to do it, right? And again, there may be nuances that are there that I'm not, you know, understanding of. And hopefully they do more studies that are there.

I think the bottom line, though, is everybody. learned a lot. I'll agree with that. If you, regardless of whatever diet, because I also know people that are vegan for many years have been really paying attention to their LDL. There's a very famous podcaster. His name is Simon Hill. He just came out having one of the world's top lipidiologist on the podcast, and they went

over his clearly scam. And he, surprisingly, I don't know if you saw this episode, had a lot more blockage and soft plaque than he thought he should have had. Yeah. Right. And it was super important for him because his dad had a cardiac event. And that was what got him into this world in the first place. So I think test, don't guess.

Pay attention to your LDL, APOB, your A1C and these other markers. Yes. A CGM, if you can do that as well. Track it over time because there's so many nuances that go into. I mean, you probably saw it. Last year there was that Italian study that came out that when they went into people's hearts, they saw that the individuals that had the highest levels of microplastics, enough of me with that study.

In the heart had the highest levels of plaque buildup as well, too. Interesting. I'll send you the study. It was a small study, but they were actually going into the heart and looking and looking at the plaque. And I'll let you chime in over here. But there's so many nuances that play a role. Absolutely. But pay attention to your numbers because that is.

is a huge part of prevention. 100%. I mean, you know, it's kind of if we, if we've, the discussion has kind of gone from the, from the broader of high blood pressure, obesity, you know, now we're talking about testing and getting getting much more finely granular about defining our metabolic health and whether or not are you healthy or not. One of the comments I'll make about CT scans and relation to the studies and what have you, you have to realize that whether it's a calcium scoring or a calcium CTA, would either,

either or both preferably, it is a screening test. Yeah. It is not a definitive test. And when you look at trying to enroll people in a study, you know, to get people to sign up to have a catheterization where there's a 1% risk of stroke associated with it versus a non-invasive test that's going to have some predictive variability associated with it, you're not going to, you're not going to get your in if you're trying to get people sign up for catheterization to define this.

Why would they? I mean, there's, and really, it's not an ethical study at on the forefront with looking at large populations like this. So I think that that criticism is something that is built in to the study on the front end. So it's very difficult. You're talking about the keto heart study. Yes. Yes. And to, and to criticize utilizing now a more, a test that may pick up soft plaque at a different level. It is a screening test. And it's really helpful when it's totally normal or really, really abnormal. It's the middle ground like these 60%, you know, are they actually physiologically

important lesions that then become gray and require the gold standard, a cardiac catheterization, to then determine whether or not those lesions are actually important. That is standard of care when we're using those tools clinically. So to turn that into somebody who's listening and they're like, hey, I'm 40 plus, which is most of my audience, men or women, heart disease, the number one killer, do you recommend as a heart surgeon that they get a CT scan? Do you recommend that they look at an advanced CCTV screening, which is a little bit more expensive and obviously a lot more expensive if you use these companies like clearly, I think I paid like $2,500.

You got to have a doctor order it. So it's not always affordable for everybody. But do you recommend these things? Do you not recommend these things? Like all things, is it maybe? It's somewhere in between. And I'll answer that question in two ways. And the calcium scoring is now being evaluated to being included on the American Heart Association list of risk factor assessment for coronary disease.

It's not included yet, but it is being examined along those lines. And again, it's getting a little out of my wheelhouse to get into the cardiology space like that. But now because it is so cheap in comparison to other types of CT scans, meaning it's accessible for so much. many people, it's becoming commonplace where people are saying, well, why wouldn't I get that so that I know? And personally, I think that that's enough reason or motivation to get one. Like, I'm getting to be 40, 45. I'm just curious. Am I zero or am I 400 on my numbers? Right. You're looking for the extremes. For the extremes, because those are the ones that are really helpful. I typically don't recommend it de novo has been my, has been my modus. But when

individuals are worried, like a lot of my friends after I had my event are like, wait a minute. What about me? What about me? What do I do? I mean, they all went and got a CT scan and a cardiology appointment like within two months afterwards. So I think it's, it depends not necessarily a maybe, but it depends on the individual situation. Do I think it's going to become a very common screening test? Yes. And not just for cardiovascular disease, but we pick up lung cancers and a lot of other chest-related pathology

from doing this on average $99 to $100 scan. It's got moderate doses of radiation. It's not low dose. It's not high dose. It's moderate dose of radiation, I think, is a one-time test, it's certainly very low risk with that moderate dose of radiation. Yeah. If anything, when I got mine done, first I got a CT scan done, and then I learned about clearly, and I got that done, it made me realize that, again, there's so many nuances that may

play into my heart health. My sister got one done, my brother-in-law's wife, my sister. She got one done, and she scored zero across the board, like not just with, like, cal, but like soft, like there was nothing on the report. Has she been better than you her whole life? Or is this? And, and I, you know, started eating kind of what I would call more saturated type fats that are there that would, that I saw a bump in my LDL. She has largely just sort of stuck to like fish.

And then she's eating most of her food from healthy, you know, vegetarian sources, high fiber, not a processed food vegetarian. And so, you know, maybe there's something genetic that's going on. with our family. Maybe there's this, maybe there's that. But what it made me really feel is if I want to keep it this way, because I'm also choosing to have a particular lifestyle, I'm living in Los Angeles that might have more air pollution. I'm generally knowing that I have somewhat of a life that my sleep quality may be impacted a little bit here and there, you know, working late, whatever it might be, even though I try to do my best. It made me feel like if I want to keep it this way, I need to

continue to pay attention to those numbers. And I also, in my situation, that's when I went to go also say, okay, my LDL was lower before and it's increased from lifestyle and dietary factors, which I derive a lot of pleasure from. But I'm going to choose to go on something like a Zedia, which is not a traditional statin, but blocks sort of, for my audience that's listening, obviously you know, blocks some of that cholesterol re-uptake. And I was able to bring my APOB to a number that felt a lot more comfortable that, okay, if I'm going to live this way for the next 40, 50 plus years, I feel comfortable at this level, right? It's not an automatic thing that my heart is going to be okay because there's a lot of factors, as you've mentioned, but it gave me at least a sense if I want to

keep it this where I got to be proactive about this aspect for me, right? Not medical advice for anybody else. And I think that that is a component of the current environment of medical care that could not be over-emphasized. And that's taking personal responsibility and accountability for your own health care. Yeah. You know, we as physicians have a responsibility to educate and engage and communicate. And I wouldn't say that that's done really well. I think access and communication is a huge problem with our health care system. But again, I think that patients being willing to take responsibility and fully engage and be fully accountable for these decisions, even if that decision is, okay, it's not perfect, but I'm making a conscious decision that this is where I'm comfortable.

I mean, that's really powerful. Okay. Are you open for a few rapid fire questions to follow up on some things that I told the audience that we'd come back to? Let's do it. First one, you talked about a big picture. mouthwash destroys the beneficial bacteria. But now with everything else that you've shared, which has added more layers and nuance to the heart disease conversation and plaque buildup,

help us dig a little bit deeper. Why do you not recommend people using alcohol-based mouthwash on a daily basis? Why do they need to throw it in the trash? And what should they be doing instead? So it's really a physiology lesson of what happens with the bacteria in the mouth. a cellular level. There is a generation of a compound called nitric oxide, which is released in lots of areas in the body, many, most actually, but there's this specific reaction. And what nitric oxide does is it causes the smooth muscle of the blood vessels to relax. Well,

when those blood vessels relax, blood pressure comes down. When you use alcohol-based mouthwash, you kill the bacteria that help to promote that chemical reaction in your mouth, which decreases the level of nitric oxide. So the blood vessels are not relaxing to the same degree. And particularly for folks that have a propensity for high blood pressure, there is an aggravated response as a result of that. In fact, there's been many patients that there's been difficult situations where medications were not controlling their blood pressure well.

they've removed the alcohol-based mouthwash, and they were able to control the blood pressure on one medication. It's also been shown in normal individuals as well to have a statistically significant change in blood pressure. Along with that, because the end game is destruction of the normal flora, you then are starting that process from the top of the tube, if you will, that then can get continued through the rest of the gut, because that is all connected. And so it's not just the nitric oxide and the high blood pressure. That's not the only reason, but you are basically at the starting line of your microbiome and you're sterilizing it.

What are the options? There are plenty of non-alcohol-based mouthwashes available. I don't have the names of them off the top of my head, but they're easy to find, as well as some more mechanical type activities. that you can add to your oral hygiene, be it tongue scraping. I'm a huge fan of that. Waterpicking, either associated with a rotary toothbrush or separately, is a really good way to manage that,

as well as a regular flossing routine. And that should be a part of dental hygiene to begin with. Alcohol. Talk to us about alcohol. You've made a number of videos about it, but also talk to us about your journey with alcohol. and if you've changed your mind over the years. Well, let me tell you about the journey first. And then I think that'll get us to the place to today.

So when I began having, in retrospect, problems with my cardiac scenario, it was probably a year prior. And the symptoms were really soft. Just fatigue, like not really feeling right. I would come home at the end of the day and have to lay down for 30 minutes, just dog tired.

We'd go for a walk in the afternoons, and I wouldn't have symptoms, but I would be dragging. And, you know, that's coming from someone who did, you know, endurance level stuff for 15 years. So it wasn't normal for me. I knew something was wrong. Really went hard down the functional medicine pathway with evaluation, and we could not really put our hands on any one thing. And in the midst of that, I said to myself, the least I can do is remove alcohol for my life. I mean, I know it's not great. Like, why not?

Like, at least don't do that and make sure that it's not a factor. And I loved wine. I loved pairing wines with food. I love the social aspects of alcohol. You know, the Southern Coastal lifestyle is revolved. revolves around embitment of two carbon fragments that is the basis of many social interactions. And it was a lot of fun for a long time. And I just felt like at this point, I didn't feel good.

And I wanted to start really trying to move the needle. So I removed alcohol. Well, fast forward, I really didn't feel that much better overall. but I had an underlying problem. And of course, the day that I got stented, my wife looked at me and said, are you going to start drinking again? She doesn't drink at all. She said, you're going to start drinking again?

And I was like, you know what? No, I'm not. Because I realized that I was living life untampered. The good times were the good times, the bad times I had to deal with. But that was okay. That's what the way life is supposed to be, in my opinion. and every single day was the same. You know, it was never a little foggy from a couple glasses of wine or, you know, just feeling off because my sleep was off as a result of a couple glasses of wine or whatever it may be.

And I was very clear in my thought process and emotional liability. And I said, you know what? No. And I really have no desire even to go there. This was before I really had done a deep dive on the physiology of alcohol or the pathophysiology of alcohol is probably a more appropriate way to say it. But from my personal experience, I feel like it's been the single most transformative decision I have made as an adult. As far as the impact on every single aspect of my life, there's a great quote that says, and I can't remember if we read it in Arkansas, comments or on another podcast comments, but it said, alcohol promises everything that sobriety

delivers. Yeah, that's powerful. And that really sums it up for me. It really does. And look, it's a personal choice. And I am far from judgmental. Like, I enjoyed, I have no regrets, but it's almost like if you read a really good book or see a really good movie, you want to share, kind of like you wanted to with coming off the dairy. Like you wanted to share that experience with everybody. And alcohol is something socially that, you know, we drink to celebrate. We drink when we're upset. It's the one drug that your friends will actually prompt you and push you to come on.

You don't want to have that one drink. They don't do it with any of the other drugs. And in the end, you know, I think that I probably was trying to defend myself because I I certainly marginalized a lot of my friends as a result of this decision. And I don't know that that's necessarily a bad thing now that I really look at it. In some cases it is. In some cases, maybe it's not. But when we look at how alcohol affects our bodies, when we drink alcohol,

it's broken down into two things. It's broken down acetylaldehyde and acetate. Acetylaldehyde is what makes you feel good or feel like you've had a couple of drinks. but it's also what is directly toxic to every single cell in your body. There's no cell that is safe. And acetate is basically an empty calorie source. Now you can burn it if you're going out for a walk after drinking or what have you, but most of the time, that's unused calories that then is stored primarily as fat.

And as you mentioned earlier, alcohol is a driver of inflammatory response directly in the body. that acetate then gets stored as visceral abdominal fat, then adding to that inflammatory engine from yet another perspective. And it becomes this compounding physiologic response of overall increased inflammation with direct toxicity to every cell. And so, number one, I feel so much better. My life is better. If I'm taking all of this time and energy to exercise and dial in my nutrition and work

on my sleep, which I know it impacted my sleep for many years, why would I then put all of this effort out and then make a decision to poison my body? And it just didn't make any sense. And I don't miss it. Like it's no longer, you know, any kind of, it really never was a willpower thing. It was a decision. Like I literally woke up on a Sunday morning and I said, I'm not drinking anymore. And Tracy looked at me, she goes, there is no way. Jeremy London's not, I said, I'm done. I am done. And that was it. And I've never looked back. Never looked back. So, yeah, it's really been, it's, and look, it's a, it's an incredibly personal decision. And, you know, the red wine piece always comes into this conversation. And you know

the data. And I'm sure I don't need to repeat it for many of your listeners, but I think we should. because red wine, you know, the French paradox from the early 90s where there was that examination of the lifestyle in France where they ate all these very rich foods but had a lower level of cardiovascular disease. And the thought was that it's related to red wine. Well, we were all ecstatic that we now get to drink red wine for a health benefit for the resperatrol, which is found in the skin of the grape. And it does, in fact, have anti-inflammatory and direct endothelial effects in very, very high doses, primarily in rats. I believe there's been some early human studies that maybe there's been some physiologic benefit. But there's never been, there's never been outcome studies that have shown decreased cardiovascular events. And to get adequate levels of resveratrol through wine, you would have to drink hundreds of bottles of wine.

to get that benefit, it would clearly be outweighed by the toxicity of the alcohol. And I think that whatever your mindset is on alcohol, we would all agree that that wouldn't be appropriate. But in the end, if you like red wine, drink red wine because you enjoy red wine, not because you think that there's a health benefit associated with it. For sure. For sure. One thing I'll throw in as a follow up, which could actually be a cool experiment if you

want to also try it to. Okay. Is I went down this rabbit hole of looking into this whole class of, you know, this whole class of these molecules that come along with coffee, these oily part of the coffee bean, when you make coffee, they're called deterpins. And basically what the data was showing,

and there's multiple studies on this, is that when you make coffee in the morning, and let's say you make it espresso style, which is my favorite. I have like an all-metal espresso machine that somebody gifted me when I got married to my wife. And it's an Italian brand. And so I love it.

It's my favorite ritual in the morning, going there, having a little bit of loan time, maybe listening to a podcast, listening to an upcoming guest, doing a little refresher on some material, I make some coffee. Typically, though, when you make espresso, you don't use any kind of filter that's there, typically. And there's other ways to make coffee, like if somebody makes a French press. That's also another way that people don't typically use a filter that's there.

Well, it turns out that some people, but overall, this looks like it applies to everybody, some people maybe a little bit more so. These deterpins on a regular basis, and most of us have a cup or two of coffee a day. over a period of time, they can increase your LDL by about 22%. Really? Yeah. And so an experiment, and Dr. Rhonda Patrick has done a deep dive on this. My friend Max Lugavir, who was one of the first people to tell me about this hack,

texted me his before and after on his LDL. And again, we're all doing a lot of different things, but he tried to control a lot of the variables and said, I started using a paper filter when I made my coffee in the morning and I switched, I believe he was using French press before. Okay. And that paper filter absorbs a lot of these oils and they don't end up in the final coffee. And as far as I can see, it hasn't really changed the taste of the coffee in any way that I can recognize.

Okay. And I'm in the middle of my experiment. So I want to give you hard, hard numbers once it's done and I have my follow up. I still have a few more weeks to go. But Max was able to lower his LDL by about 20% by just including this paper coffee filter. And there's plenty of, you know, there's, it used to be paper coffee filters. We're all bleached. Now they have like oxygen bleach.

And they have the brown ones, which are more the eco filters. Some people don't like that because it tastes. But that's what I use. I basically get these little paper coffee filters that are made for espresso. And I also have an aeropress. Yeah. If you're familiar with those, they just launched a glass version, which I was super excited about.

So I've switched with aeropress because that seems to be the area that I enjoy the coffee a little bit more. And I think the paper filters will have a little bit better of a job holding some of the oils and I make it that way. And I'm excited to see if I notice a difference with my own, but many people have reported this and there's multiple studies will include the receipts inside of the show notes and I'll send them to you as well. Thank you. That is, you have opened a whole new door for me. I look forward to digging deeper into that because I am, I drink an embarrassing amount of coffee. So it would be something that it could really move the needle. For me, I have

multiple different formats that I make coffee in. So I'm going to have to get creative. But, That is really interesting. I hadn't, that's something I had not heard about at all. Don't take my word, look into it, double click, not just you, but the audience as well. Absolutely. And it's so easy. It's just such an easy thing to do. Such an easy thing.

Awesome. Thank you. I heard you on a recent podcast share, talk about it as a hack, worst case scenario, sort of advice. As we started in the beginning of the podcast, heart disease is the number one killer of men and women. God forbid, but there's going to be somebody listens today that is going to find themselves in a situation where they are actively experiencing a cardiovascular event and they're at home. And you came in with some immediate and practical and actionable things that literally, if somebody listening finds himself in this situation or somebody that they love finds himself

in this situation, these action items could literally save somebody's life. Can you share some of those with our audience here right now? Absolutely. So the premise is that you're home alone and you have the heart attack symptoms, crushing chest pain, pain down the radiates down the arm or into the jaw. Classic symptoms, but they may not be that. You're worried you're having a heart attack. You've read about the symptoms.

You're concerned. What's the first thing you do? You call 911 and you activate the EMS system. Second thing, if it's at night, turn on your front lights so that EMS can identify your house. Open or unlock the door because if they can't get in, they can't help you. And what they will do is they will actually break down your front door. So open the door and make it easy for them. Sit down or lay down once you have done those things.

Why do you do that? Well, first of all, you want to make yourself accessible to EMS so they don't have to find you in the house. And if you were to become incapacitated and fall and hit your head, you've now added a head injury to an already very dangerous situation of potentially having a heart attack. So sit down or lay down whichever is comfortable. Typically where you breathe easiest, that's usually how you can evaluate that. Some people are most comfortable laying flat with their legs sloth. lightly elevated. That tends to be a pretty common position that people are comfortable in. And then finally, call a friend or a loved one so they know what's going on and that you're

going to be taken to the hospital so that you have communication with your support system. And whether or not to take a 325 milligram aspirin is always something that I'm hesitant to recommend to the masses, if you will, but it is the recommendation when you are having. having heart attack symptoms. And so I will include it here with the understanding that you're not allergic to aspirin. You don't have any bleeding complications, be it GI bleeding or a gastric ulcer, something of that nature. There's a lot of compounding factors here. And if you're going to take a 325 milligram aspirin, you chew it and not swallow it because you actually absorb the aspirin faster.

If you're going to get the full effect of that aspirin chewing it, which doesn't taste great, is the way to get the maximal effect the fastest. Those would be the suggestions home alone having a heart attack. Those are super powerful. And I think for not just the obvious reasons, we all think that this will never happen to us. Absolutely. You thought it would never happen to you. I think it's never going to happen to me. and yet we know if this is the number one killer,

it's going to happen. And it's going to happen to a lot of us that are there. God willing, it's way far in the distance. God willing, there's a lot more tools and techniques and other things that come out where we get a chance to catch heart disease early.

Many of the tips that you recommended here or processes to help us be able to do that. But also, too, if you don't practice a scenario before it happens and think, okay, all right, well, what did Dr. London say? Okay, make sure the door is open. First of all, call 911, right?

Make sure the door is open so they don't have to break down your door, which is stressful. I can imagine laying on the couch having a heart attack, and they're bringing down your door and you're getting stressed out even further about that situation. Make sure your lights are on so they can find you that are there. The aspirin and chewing it and sort of making that easier to be able to absorb inside of the body.

Some of the other tips that were there, that could literally save somebody's life. So I really appreciate that. worst case scenario, but that it's not as rare as people think. So we need to pay attention. And I want to say that I had a grand uncle many years ago in London who was experiencing a cardiovascular event and he was at home with his wife. And I don't know obviously all the details because she was in another room and none of us know. But what we do know is as he was feeling the chest pain, something must have happened and he fell, he hit his head and he bled out.

And it happens. And it happens all the time. It does. Which is why we need to actively make sure we get to a place where you're not going to end up falling, hitting your head. Exactly. And we were so saddened and heartbroken by that, you know, aspect. It's avoidable. And it's, and again, your point's well taken because in stressful situations, we rarely rise to the occasion.

We always fall to our level of training. It's the military mantra, if you will. And just having this in your repertoire, hopefully it'll give you that opportunity, you know, to review it. You know, and just go through the checklist in your mind and understand that, you know, this is what I'm going to do in this situation and check the list. You know, you made a viral video that got a lot of views. We're going to link to it in the show notes. But as we're winding down for today's conversation and we're zooming out and we're giving an opportunity to, also leave a message for the audience that's listening today who's been blown away by all your

tips, recommendations, advice, and also fundamentally your transparency. The video was, I think, 25 lessons, right? Yeah, it's depending on which one you watch. He was either 20 or 23, probably. 20, 23 lessons that are there. Somewhere in there. We're not going to go through them all. In conclusion of this conversation, is there one of those lessons. This is 20 lessons-ish that you learned being a cardiovascular surgeon and looking back on your life going through your own lesson that's there as we're winding down here take one of those lessons that is most relatable practical and topical for the audience at this point in time of the conversation and let's leave them with that our most precious commodity is our time and in the end no one's going to care that I did

another hundred operations or that you did another hundred exits or whatever it is you do, you did more than as opposed to being a good husband or a wife, being the best brother or sister, friend, and prioritizing the people that you care about and they care about you. Because in the end, that's what truly meant. An important reminder. And sometimes, unfortunately, life gives us an eviction notice, extreme situation. We don't want that to happen, but sometimes that happens.

And we have a wake-up call. You went through that yourself. But anytime you hear through these folks that have gone through this, they'll always tell you that you don't have to go through what I went through. Exactly. To learn this lesson. That's the deepest hope. and if you can step into this and close your eyes and just imagine

that if you went through that same situation, what would be the things that you would regret? What would be the things that you would reprioritize in life? What would be the changes? And that's one of the unique gifts that human beings have. We have the power of imagination. It's not exactly clear if other animals have that same ability. We have the power to imagine ourselves into a situation.

So use that power and look at your life right now and say, what stuff, what small thing, what little fight with my spouse, my child, my best friend, somebody that I care about that maybe I haven't talked to in a while, that I've left unsaid, what needs repair? Because the statistics show that for a lot of people, unfortunately, you could be surprised and you may not have that opportunity to ever repair again. So let's use the story of Dr. Jeremy London, who's been so gracious with this time here today, and transparently sharing what he went through, to actually embody that,

maybe I don't need to go through that, but I can imagine that so I can take action in my life right now. Forgive, forget, repair, say I'm sorry, double down on something that I've always wanted to do, take that adventure, volunteer, whatever matters to you, this is the opportunity to step into that. Dr. London, this has been a fantastic conversation. I'm so glad that our mutual friend, Mark Berhanna, introduced us. And it's been a pleasure to get a chance to know your work. I'm a huge fan of your newsletter. Thank you. People can sign up for it on your website if you want to just mention. It's Dr. Jeremy London.com. And then for those that are listening on YouTube, the first thing that you should do after this interview,

in addition to texting someone that you love them, go subscribe for your channel, also under Dr. Jeremy London as well. I feel like all this is leading to maybe a book one day. It's in the works. It's in the works. It's in the works. It's,

as you well know, the commitment to the book is, it's, I want it to be outstanding. And I'm not willing to do it halfway. And I want to make sure that I have the time and the full engagement. to offer that, but it's coming.

Yeah. It's coming. I can't tell you that there's, I'm definitely going to be one of the most excited people right up there with your family. Your wife and your kids who are awesome. As you've talked about them today, I'm excited to not only read it,

but share it back with our audience when that time is ready. That means more than you now. Dr. London, thank you again for being here on the podcast with us today. Thank you so much. Hi, everyone. Drew here. Two quick things.

Number one, thank you so much for listening. this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me. And it's the number one thing that you can do to support this podcast is share it with a friend, share with a friend who would benefit from listening. Number two, before I go, I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter. And it's called Try This. every Friday, yes, every Friday, 52 weeks a year, I send out an easy-to-digest protocol of simple steps that you or anyone you love

can follow to optimize your own health. We cover everything from nutrition to mindset to metabolic health, sleep, community, longevity, and so much more. If you want to get on this email list, which is, by the way, free and get my weekly step-by-step protocols for whole-body health and optimization, click the link in the show notes that's called Try This, or just go to drew perot.com. That's D-H-R-U-P-U-R-O-H-I-T dot com

and click on the tab that says, try this.