Dhru Purohit Show - The Latest Science on Preventing Heart Disease and Atherosclerosis: Best Heart Tests, Supplements, and Lifestyle Changes with Joel Kahn, MD

Episode Date: September 14, 2023

This episode is brought to you by BiOptimizers, Joovv, and Rupa Health. Today on The Dhru Purohit Podcast, Dhru sits down with Dr. Joel Kahn to discuss the different screening tests and biomarkers that can paint a clearer picture of heart health. Dr. Joel Kahn is a practicing cardiologist and a clinical professor of medicine at Wayne State University School of Medicine. He’s triple-board-certified in internal medicine, cardiovascular medicine, and interventional cardiology. In this episode, Dhru and Dr. Kahn dive into (audio version / Apple Subscriber version): -How to truly know if your heart is healthy (2:16 / 2:16) -The various blood and metabolic biomarkers for testing cardiac function (4:00 / 4:00) -The Cleerly scan for measuring soft plaque (17:47 / 15:16) -Dr. Kahn’s recommendations for HIIT and resistance training (25:15 / 22:33) -Lifestyle tips for reducing soft plaque build-up (34:20 / 30:24) -Endothelial health, nitric oxide production, and the risk for heart disease (40:50 / 36:51) -What specific biomarkers can tell us about heart disease risk and the role of personalized medicine for effective treatment interventions (45:36 / 41:39) -Supplements to aid in lowering soft plaque levels (53:57 / 50:00) -Genetic testing for assessing heart disease risk (1:02:46 / 58:48) -Dr. Kahn’s thoughts on dietary protein and resistance training for longevity (1:15:31 / 1:11:58) -What Dr. Kahn does daily to support his longevity (1:31:30 / 1:28:00) Also mentioned in this episode: -Kahn Center for Cardiac Longevity -Heart Doc VIP Dr. Joel Kahn’s podcast -What Do I Do With My High Coronary Calcium CT Results: A Guide -HIIT Training Improves Soft Plaque (study) -Try This: VO2 Max as the Best Predictor of Longevity -GB Insight Genetic Testing and Analysis -Maxi Health Kyolic 400 Aged Garlic Extract  -Gotu Kola and Pycnogenol French Maritime Pine Bark Extracts BiOptimizers is offering 10% off plus a special gift with purchase. Just head over to magbreakthrough.com/dhru with code DHRU10. Right now, Joovv is giving my listeners an exclusive offer on your first order. Head over to Joovv.com/dhru and apply my code DHRU. Access more than 3,000 specialty lab tests with Rupa Health. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com today. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

Trans fats will raise your LDL cholesterol more than almost any other fat that you can ingest. They do sometimes have an adverse impact on your blood sugar, so it can raise your hemoglobin A1C. And those are two of the standard risk factors for developing atherosclerosis. Now there's 25 plus risk factors for atherosclerosis. The other standard ones are smoking high blood pressure and mom, dad, brother, and sister having an early heart event. How do you actually know if your heart is? truly healthy? If you're curious about this question, today's episode is absolutely for you. Welcome to the Drew Proet podcast. Each week, we explore the inner workings of the brain and the body with

one of the brightest minds in wellness, medicine, and mindset. This week's guest is cardiologist, Dr. Joel Kahn, and he's here today to talk about the top test that everyone needs to run to see whether or not their heart is truly healthy or not. He's also going to be sharing his top lifestyle tips, dietary tips, and supplement recommendations for anyone that cares about preventing cardiovascular disease. Now, a little bit more about Dr. Joel Khan. Joel is a practicing cardiologist and a clinical professor of medicine at Wayne State University of Medicine.

He's triple board certified in internal medicine, cardiovascular medicine, and interventional cardiology. He was the first physician in the world to certify in metabolic cardiology with A4M and the University of South Florida. He founded the Khan Center for Cardiac Longevity in Bingham Farms, Michigan, just outside of Detroit, and he and his team also treat patients via telemedicine all across the United States. Dr. Khan has authored scores of publications in his field, including articles, book chapters, and monographs. He has six books in publication today, including your whole heart solution, dead executives don't get bonuses, and lipoprotein A, the heart's silent,

killer. Stay tuned for a fantastic episode with Dr. Joel Kahn on all things that you can do today, including top test and diet and supplement recommendations for anyone looking to improve their heart health today. Dr. Joel Kahn, welcome to the podcast. Let's jump right in. People want to know is their heart truly healthy. As a cardiologist, tell us what test do you look at and do on your patients to know whether or not their heart is or isn't healthy? Sure, and heart disease, way too common to base it on, I feel good, I went to the gym, I have healthy heart. That's great. That's not enough. You can drop dead. You can have heart attack. You have to have a CT scan of your heart. The minimum one is called a coronary artery calcium CT scan. Every medium and large hospital will do this for you for 50 to $99 range, all through L.A., all through Michigan where I am, coast to coast, north and south. and sometimes even in other countries. Not a brand new test, heart calcium CT scan.

You want to be a zero. And if you're a zero, it's kind of like colonoscopy. Go do it again in about five years and prove that you're a zero. It's a painless test, no injection, no needles, no claustrophobia. Radiation dose is like a mammogram that a woman gets, which is considered very low. And you want to be proactive. and if you're not a zero, you've got work to do on your lifestyle and your genetics, and we'll talk about all that.

So that's the bare minimum. If you want to up the game, and I don't really call it a screening test, you can do the same CT scan with injected iodine dye in an IV, and you can get the whole picture. That's called a CT angiogram. But I don't consider that yet the one you rush to as your first test, although it is on the menu if you want to do that. What about blood test and metabolic health?

What are your thoughts on that? Are those important to help people understand how well their heart is or isn't functioning? Yeah. And I, you know, I honor all other health care workers, but I look at lab values from other clinics all over the country, sometimes all over the world. It's like your grandfather's Oldsmobile. There used to be an ad about that. We get the same lab panel we got in the 1970s. It does not cut the mustard for disease.

prevention. You've got to know that hemoglobin A1C. You just mentioned metabolic health. That's your three-month blood sugar. You might want to get your fasting insulin. These are all widely available. You absolutely want to know your HSCRP, high sensitivity, C-reactive protein. Is your diet, is your skin health, your dental health, your sleep health? Is it working for you? Or is your immune system all jacked up because something's off? And the last one, just to add to your routine list, is a of cholesterol called lipoprotein little A or LPTLLA, a very awkward name for a common genetic cholesterol. Won't show up on your routine cholesterol panel. So you may hear from your doctor, cholesterol is good.

It's 190. You're doing okay, Drew, but you don't know that you're one of the 25% of people that inherited a second cholesterol that can be very damaging the arteries. We call it the silent heart killer because all these things generally are asymptomatic till the worst and most advanced disease. So you want to do that extra hard work and protect your health a little bit more than average. So I want to pull on some threads that you mentioned there. The first one being you mentioned lipoprotein little A, which is, again, genetic.

You inherited from your parents, right? And then you didn't mention lipoprotein B. Is there a reason why that's been getting a lot of attention these days? Right. So it's actually, and just to clarify, it's called apole. Lipoprotein B or APOB, it's a very easy test to get at LabCorpQuest, your local hospital, it's one number should be generally less than 90, maybe less than 70, that tells you all the bad cholesterol particles in one number. Maybe your LDL cholesterol is high from your diet

or your genetics. Maybe your lipoprotein A is high purely from genetics. That one test called apo-lipoprotein B captures all those particles in one number. And it's something I do routinely and have done for a long time. I like it particularly in the 25% of people that inherited that lipoprotein little A, because if I track, and I don't want to confuse people with these terms, if I track their APOB, I want to drive it down, down, down. It could be diet, fitness, supplements, or prescription drugs. So it's a very useful drug, but I would get your standard cholesterol panel.

I would get your lipoprotein, little-age, genetic cholesterol at least once. And I would follow over time your APOB, which has been endorsed by cluster experts, you know, for literally decades. It's not a new test. It's just gaining in popularity right. This episode is brought to you by bioptimizers. You know, I've had a bunch of experts on my podcast talk about the insane benefits of magnesium. The super mineral powers 600 plus enzymatic reactions in the body. That means if you're not getting enough of it, and most people aren't, 600 plus enzymatic reactions cannot function properly.

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hemoglobin a1c what should the good range be because many people people go to their doctor. Even the folks that listen to these podcasts, they've heard you on podcast, and they ask their doctor for these tests. And sometimes the reference ranges that the doctor or the laboratory company would be telling them that, hey, look, you're normal. They'll give them a pat on the back and they'll send them on their way. And even in some instances, even well-meaning cardiologist, they actually could order the test, but they may not have a lot of reference of where the ideal values should be. So let's start off with hemoglobin A1C. where do you like to see that in terms of its range?

And that is one that most labs use the same range. And it's pretty simple. It's a measurement of your red blood cells and how sugar-coded they are. What percentage of your red blood cell membranes are sugar-coded? That's what it's called hemoglobin, A-1C. And it should be under 5.6%. But you would really optimally like to be closer to five. and ideally actually under 5%.

Some of my patients are 4.6, 4.7, 4.8. Super glucose metabolic control for the past three months. Red blood cells have about a 90-day lifespan so that hemoglobin A1C represents an average blood sugar over the last three months. 5.7 to 6.4% is the range we call pre-diabetes. But don't be comfortable being. a pre-diabetic. Pre-diabetic is advancing heart disease, advancing vascular disease, advancing erectile

dysfunction, advancing kidney disease. 6.4% and higher is the range where a type 2 diabetic or the less common type 1 diabetic will be when they're diagnosed. And then over treatment, we're trying to drop that number at least into the pre-diabetic range and maybe back all the way into the normal range. Type 2 diabetes is very often a reversible condition if you work very hard at it and we want to regulate it. So it's one of the most scientifically proven biomarkers. I want to live a long healthy life with minimal health issues. You want a hemoglobin A1C around 5%. And you want to work hard at achieving that and go for it. The next one you mentioned is fasting insulin. Talk about that. And that's a test that's actually quite cheap for a lot of doctors to order,

but it's often not ordered. So where would you like to see it? And what would you be your call to action to practitioners that are out there that are not routinely ordering this? Yeah. And I'll make a point. It's actually endorsed now by most medical societies that the routine blood work you get at your primary care doc does not have to be done fasting. That it's better to just get the labs, certainly things like C-reactive protein, hemoglobin A1C, general blood panels can be done any time of the day, and that's the rule I use in my clinic. But there are certain ones that you have to demand a patient show up fasting if you want to get, and fasting insulin, obviously by the title is one of them. When you eat, your insulin will go up. And there may be value in

knowing that too, but it's not as well codified, what's a normal range. So you can have two people with a hemoglobin A1C, let's say 5.2%. That's in the normal range. I'll take a little side tour. Maybe they're both wearing continuous glucose monitor patches out of biohacking interest. And they both have a hemoglobin A1C that's in the 5.2% range pretty darn good.

But one on their CGM is just bouncing up and down like crazy, and one is seeing smoother peaks in valleys. It may be that the second example is healthier than the first. example, even though on the hemoglobin A1C, they look good. Insulin gives a bit of that perspective, too. If your hemoglobin A1C is 5.2%, pretty optimal, and your fasting insulin is two or three, which you want to be under 10 and you want to be lower, if possible, you're probably in pretty good metabolic shape overall.

Now, a lot of it, the hemoglobin A1C, I said, is about a 90-day average perspective. The fasting insulin is going to really represent maybe the last 24 hours. So it's not as long live the view. And, you know, if you really did it up the night before with cheeseburgers in paradise, to give a little shout out to our friend in heaven, you know, your insulin level may be higher than all. So you have to keep a perspective on that. And if you have that hemoglobin A1C of 5.2%, but your fasting insulin is 12 or 14, you may be, be masking some insulin resistance, the inability of your muscle cells, particularly in your

liver cells, to rapidly take glucose out of the blood because insulin's working very efficiently on those muscle and liver cells. So it's refining, it's further kind of triaging, as the term we use in medicine, super duper metabolically healthy, low risk. You know, metabolically healthy, but at a little risk, and then the full-blown disease states of pre-diabetes and diabetes. Let's pivot for a second. We'll jump around a little bit. But let's pivot again for a second to cholesterol, LDL, APOB, which you kind of covered a little bit earlier. Could you be somebody that has higher cholesterol, high levels of AB, but that you have lower fasting insulin in the optimal range, or that you have your fasting glucose in an optimal range,

Is that something that you see in your practice? Yeah, absolutely. You know, all of these things are a combination of lifestyle factors, environmental factors, more and more we're looking at endocrine disrupting chemicals like PFS and BPA. Those all affect both your cholesterol and your metabolic control. Air pollution has amazingly you're living in L.A. And we just had the Canadian smoky fires all summer here in Michigan. We had really poor air quality.

the science between poor air quality and metabolic health and cholesterol health has really come on as a solid, well-published science. And then we got genetic input. And, you know, you can have an optimal lifestyle in suboptimal genetics and have a very high lipoprotein A or run a very high LDL cholesterol, despite an optimal lifestyle. So they are separate paths. So you can absolutely have what you describe. Great metabolic health, but suboptimal, you know, cholesterol analysis. and you need to have, as we open the show, vascular testing, you need to know your calcium score. You know, an LDL of 120 in a person with a calcium score is zero is a very acceptable level to keep it.

An LDL of 120 and somebody with a calcium score of 300 or a previous heart attack bypass or stent is, by current criteria, a very suboptimal level of LDL. We personalize. We customize evaluation and care. And this is not exotic and not expensive. It's just the right thing to do. Now also endorsed even by the American Heart Association. It took a long time to get them on board with this idea. Let's talk about that for a second because I've been pretty transparent with my audience that I'm one of those individuals that falls in that category. I've had some genetic testing done as well when it comes to my genetic markers around sort of hyper cholesterol production. and inheriting that for my family. And my metabolic labs are in the optimal range. And I sent to you my Clearly scan that a colleague of yours, a friend in the space, Michael Twynam, ordered for me. And so that's what you would do for patients that are in this category.

You would make sure that they had a Clearly scan, which is an injectable die CT contrast scan. I think it costs, it's not covered by insurance, at least it wasn't covered for me. but it's like about $2,000. You need somebody to order it for you, like a cardiologist. But more importantly, you need a cardiologist who's trained in how to read it, because then it's going to be what do you do with this information? You order this test pretty frequently in your practice. Is that correct?

I do. I do hundreds of examples, right? So I sent you my test. So just talk about it. I talked about it a little bit before, but in the context of these labs and multiple cardiologists telling us, me that because my cholesterol is high, because my LDL is high, because my APOB is high, I need to make sure that even though I work out, even though I eat well, I don't really drink alcohol, but ever,

that I needed to do this. So what showed up for me? Yeah. So if you had rung my bell, I probably would have talked to you about a heart calcium CT scan that $99, no injection screening test. Like an endopat? Is that what it's called? No, that's a heart calcium CT scan or a calcium score. Okay, got it. I probably started with you at age 40, 41 with that.

I did do that. So that's the standard CT scan, right? And I think you would have come out of zero. I did, yes. I did it, and I did it when I was 39, and I came out of zero. Yes. Right. And there are two drawbacks.

Let's talk about the benefits of the calcium score you had at age 39. Inexensive, no injection, no iodine allergy potential, widely available. And you don't have to have an optimal heart rate when the actual scan is done. You literally just lie down, hold your breath, and go home. The downsides of the heart calcium CT scan approach is you don't see a kind of plaque that's called soft plaque, also called non-calcified plaque, because the very nature of this widely available screening heart scan, the calcium score, is it identifies calcified plaque in the heart arteries. So if you have no calcified plaque, bone-like plaque, but you have soft plaque, you won't see it and you'll miss it. And we know that happens in under

10% of people that come out with a zero, and very few of them will go on to an emergency room visit, heart attack or stent, less than 1%. But for that less than 1%, it's very meaningful and frustrating. Doc, I did your test. I got a zero. Why am I in the emergency room? with problems and they're talking about putting a stent because there are some people that start out building up a lot of soft non-calcified plaque hidden on the simple basic CT scan and rarely but meaningfully for a few people clinically active you went on to do the Cadillac test here and interestingly it does measure using artificial intelligence a clearly health CT endocrine how much calcified plaque is in your three heart arteries, how much non-calcified plaque is in your three heart arteries?

And is there actually any narrowing in the arteries? So the measurement on you was, and you know, if you were talking about it, so it's, people can probably see it on the screen. It's about a five-page report, but there's a one-page summary that I printed off here, and that's yours. But it says you have essentially no calcified plaque. So if you would have waited two years and this year done a calcium score, I think it would have come out zero again. But you have 11 cubic millimeters of soft plaque, which is a drop in the bucket. It's very low amount. In fact, it's the second lowest I've ever seen on a scan like this after about 250 and a variety of patients. It's very, very small amount. It's a second lowest, but yours was lower than mine. I'm 23 years older than you and mine is lower

than yours. Seven cubic millimeters of soft black and no calcified black. I knew I had a calcium score zero, but I didn't know about my soft black because you can't tell it. And it also says very fortunately that none of your arteries are actually narrowed. They can't measure any narrowing. I always love with my patients, I use a little artery model and we're all born with perfectly clean arteries.

So, you know, I doubt your audience can even see that there's... Well, the folks on YouTube will be watching, but for the folks that are listening on audio, can you describe a little bit of what you have? Yeah, it's just a little model that looks like a tube or a straw that's an artery that's clean on one end and very clogged on the other. And your arteries are gorgeous, although just imagine a freshly paved highway and just one little spot that's maybe a little irregular. I mean, there is plaque in your arteries.

Now, the kicker, and it's not like we're pitting my health is. your health in any way. We all want to stay healthy and live long. You're 41 years old, and you do have some plaque. And there's a recent large series out of Denmark. I don't have it with me in front of me, but it was 25,000 citizens in Denmark. And they very regularly get these advanced CT scans as part of their health screening. They're way ahead. Wow, I didn't know that. To what we do. And they published about six months ago that just on average, these are just healthy 45 to 50-year-olds, no heart disease. About 40 to 45 percent have detectable soft and hard plaque. The disease is beginning, and it may not be to your 60, 65 years old, that you start

to develop angina or you're in an emergency room or you're having a heart attack, but the disease starts in the 40s. So I would be not nervous, not concerned. I wouldn't have a patient leave my office with this result feeling down in the dumps. But I would take it to heart to say gym time, food quality, sleep expertise, and maybe some supplements. There really isn't any good data in the medical literature for starting Lipitor or Crestor statins when your calcium score is zero. That has been studied and there is no strong data. Some cholesterol experts in L.A. Cleveland Clinic would still tell you, Drew, start a stat and you're 41, you got a little bit of plaque, you've got an opportunity to stay healthy to your 120 or beyond with all the changes going

on a message. But I would probably start you on supplements that have science behind them for actually reducing and maybe eliminating this drop in the bucket of soft plaque that you have. Well, what would be some of examples just so that people are aware of what's possible? What supplements would be there? And by the way, supplements are always supplemental. They're secondary. The first thing that you mentioned is working out, right?

So let's address that because we tend to want to go for supplements. And I will say that I've always been active. My adult life, I played soccer and tennis when I was younger. I still regularly kind of hit the tennis ball here and there. I hike every week. But strength training is something new for me. And I've been sharing that with my audience that I only serious, I only got serious about strength training and working on my VO2 max about when I was 39. And so I strength train

about three times a week. I've seen massive improvements. I saw a jump in my testosterone go up. I did my VO2 max. I wrote a whole newsler about it. We could put in the show notes. I think I scored like 46 or 47. I had to end the test a little early because I did it running. I want to go back can do it rowing or biking because I'm not a big runner. And I think I have some asymmetry issues in my knee, but still tested pretty well. So that's typically one of the first things that you recommend for people is the lifestyle components before they go to supplement and food. Is that right? Yeah, absolutely. The basis is in every patient, good sleep, good fitness. We can talk about diet. There's a whole range of good diets.

Your audience, if they know me, will know I favor a whole food plant-based diet. I'm celebrating my 46th year as a vegan. But I accept patients and teach all kinds of clean diets. But in terms of this topic of reversal of atherosclerosis, and I do want to answer your fitness question, but there's limited nutritional data for reversing atheroscosis and soft black. And it favors the research of Dr. Dean Ornish, something called the Lifestyle Heart Trial, 1990 through 1998 publications where there was absolutely documented you can shrink your atherosclerosis. And in his research study, it was hopefully plant-based diets plus yoga, plus meditation,

plus walking, plus socialization, and community support. We can come back to that. Just in the last couple of months, there's been, I think the first study showing that you can reverse atheroscler, or sclerosis using this technology, get a baseline CT angiogram with quantitation. Which is the brand name of that test is called clearly. You run in your clinic. I have no affiliation with it. It's not anything that we are financially tied to.

It's just where it's the latest test that's there that actually gives you better measurements. Exactly. And I'm also not invested. It's a great company. They're available all over the United States. It's a software company. But it actually hit exercise. high-intensity interval training, maybe three times a week, was just shown baseline CT,

hit exercise, follow-up CT. There was a reduction in the plaque with hit exercise. In the soft plaque specifically. In the soft plaque specifically. That's pretty huge. Yeah, it's pretty huge. We're not sure you can actually reduce the calcified plaque. Right.

The CEO physician of Clearly Health will actually teach you can't reverse calcified plaque. And if you repeat this study in a couple of years and your soft plaque went down and your calcified plaque snuck up a little bit, that's actually a good result. Calcified plaque may be more stable and enduring and lower risk. We want to measure and shrink the soft non-calsified plaque. Now, I give you a flip side. I think your listeners will find this interesting. But there's been, you know, for more than a decade, a concern that repeat, repeat, repeat, long-term, endurance athletes, talking 50-mile runners, 100-mile bikers, you know, multiple full triathlon

competitors, not one dime, but, you know, lifelong, may actually develop arthrosis a bit faster than typical exercises like you and me, very concerning data, that the calcium score may be higher than expected. And just again, in the last couple months, using this technology CT angiograms, lifelong endurance athletes. these happened to be all men. It was 550 patients in the study in about a third of them. Lifelong, you know, these guys had done a lot of marathons and triathlons and particularly long bike rides over and over and over, had not only more calcified plaque, they actually had more soft, non-calcified plaque in their heart arteries, blowing away the idea that it's guaranteed

if you're a long-term athlete, you're favoring heart health. Don't stop exercising. Just get a calcium score or get the more advanced CT andrograph. if you fit in that category of lifelong endurance athletes. We're still struggling to figure out why is that the case, but it's been observed over and over. It may be that there's a sweet spot for exercise. Clearly, too little is not ever recommended. But it may be that there is too much, too much inflammation,

too much injury and recovery, and that includes the heart arteries. So don't stop exercising. Just get these tests done. If I can mention one point, because I know you're about to go into something else, you know, you are aware of and I would say probably a fan of the work of Brian Johnson, the elite longevity explorer. We had him on the podcast. And it's very interesting.

In that instance, you have somebody, and we'll link to his episode that we did in the show notes, you have somebody that is working out every single day, but also takes his recovery very seriously, goes to bed every night, not that I'm recommending this for everybody, but he goes to to bed every night at 8.30. He has a 100% sleep score. He doesn't drink alcohol. So it does seem to be that even an intense workout every single day has to be matched with intense recovery, where people get into problems and his lab markers across the board. I haven't seen his clearly. I don't know if he's done it before. I will see this. I'm an unpaid advisor to Brian. Okay. I connected him with the cardiologist at UCLA, because Brian Lee,

is in Venice. And I cannot yet convince him to get, he hasn't even had a calcium score, let alone, clearly, but I'm trying to get him to go over to UCLA where they have phenomenal CT scanners with very low radiation. Yes. And get the study done. So it'll be a work in progress. I think he's missing the boat, not knowing his baseline, you know, coronary anatomy and

then track it with time. And he works out about an hour a day. So I don't think that would fit into this really, you know, multiple endurance. Got it. So you're talking about extreme situation where somebody's running like... Century bike rides. Century bike rides. That's what's kind of the distinguishing feature of this recent research study. This episode is brought to you by Rupa Health. When it comes to achieving optimal health, my philosophy is test don't guess. And I'm sure that's the case for many of the practitioners that are out there listening to. The problem is ordering comprehensive lab tests can be super complicated, tedious, and time consuming for both. patients and practitioners. That's why I'm so glad that there's Rupa Health.

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ordering lab test as a practitioner for your patients has never been easier or painless. Best of all, Rupa Health is free for practitioners. You can find out more information by going to RupaHealth.com. That's RUPAHealth.com to sign up for free today. Okay, got it. So I'm with you. So you kind of were interjecting before you're going on to your next thought that was related to basically addressing soft plaque.

And I was saying that one of the first things you tell people is the importance of resistance training. And then you mentioned that this new study came out that we would love to link up in the show notes about how hit workouts does seem to be improving soft plaque. So that's good news for anybody. I do at least. Was there a recommended dose? I do about one hit workout a week. Should I be doing more? Yeah, I'll pull out the paper and send it to you.

I think it was three times a week a hit exercise. It's pretty typical. Do hit three times, do resistance training three times a week and maybe take a day off a week kind of overall. Okay, great. So I need to up mine. I've gone through different cycles, but right now I'm in a cycle of one hit workout a week. So I need to up it and take a look at that paper and we'll share. So the next thing we were kind of going into is there before we get into supplements, again,

is there any other lifestyle components that you recommend to people when you see that they have some buildup of soft plaque, which, by the way, if mine and your scores, I got the second best. you get the best. Other people, if they get this scan done, are probably going to have some soft plaque. So give them the good news. What are other lifestyle things they can do before we get to food, before we get to supplements that might have an impact on soft plaque? Yeah, given that this is a relatively new technology, I mean, we've had clearly scans that I've been ordering for about two and a half years only. Maybe the company is as long as three years total. There's much more data relating lifestyle to calcium scoring, the simpler, more available test without injection.

So we know for sure that disrupted poor sleep is associated with high calcium scores. Now, those are associations. Maybe people that sleep poorly, eat poorly, don't exercise, have extra weight and extra inflammation. All that's probably likely. But, you know, optimizing your sleep, being a Brian Johnson and tracking and improving your sleep is a huge factor for many people. We know that oral health, never ignore your gums, never ignore your root canals, get to the dentist. I think COVID really interrupted a lot of people's dental visit frequency, just talking to patients.

It's time to get back on track. And there's clear research about periodontal disease, bleeding gums, and high calcium scores. Now, that probably will prove to be the same, but I don't think I've seen a study. nutrition. I mean, you know, let's just all agree, processed food, fast food, chemical content food, frozen food, none of that's going to do you a favor. I don't think I've seen a study relating that to clearly CT soft black, but we know it has to be the case from decades of prior research. And can I ask a question about that? You know, we just wrote this really fantastic newsletter on the history of trans fats. If somebody is having a lot of trans fats, if somebody is having a lot of

trans fats in their diet, which still can kind of sneak in to our foods these days, even though they're technically banned. And there's a whole bunch of reasons why processed food companies can get away with, if it's less than a certain amount, right, they can still kind of sneak in some trans fats there. Would trans fats be an example of some of the things that could potentially, if somebody had a lot of them in their diet, add up to the soft plaque that we see in the heart? Is there any relationship? Yes, because trans fats will raise your LDL class.

more than almost any other fat, you know, that you can ingest. They do sometimes have an adverse impact on your blood sugar. So, you know, it can raise your hemoglobin A1C. And those are two of the, you know, standard risk factors for developing atherosclerosis. Now there's 25 plus risk factors for atherosclerosis. The other standard ones are smoking high blood pressure and mom, dad, brother, and sister having an early heart event. But that's a very limited list because we've already talked about hemoglobin A1C. We talked about lipoprotein little A. There's other biomarkers that are widely available that you might want to check and know about. But yes, clearly trans fats should be minimized and, you know, the food industry, anything that says hydrogenated, just put it down.

And of course, that's the whole focus on staying away from process, pre-made, storebought, frozen, cardboard box foods. You know, get them out of your life because they will develop soft black and that's gross. So it's just by eating at home already before we get into all the dissections of, you know, the diet that you follow, the diet that you recommend to patients, the diet that I eat, just people eating at home more frequently, which obviously gets into a whole bunch of components about time, how many jobs people are working, etc. But just eating at home, eating out less, even eating out less at restaurants and eating

less packaged food in general, that's going to be something that people will immediately start to see improvements in their blood lipids. Yeah, and, you know, just staying on food for a minute without preaching a particular diet. I mean, there aren't a lot of single foods that have a study that they reverse atherosclerosis. And a lot of the studies, not to confuse your audience, use a surrogate for heart disease. This is heart disease. But you can do an ultrasound of your carotid arteries. And an ultrasound is painless, no radiation, simple test. And there are similar software analysis packages like clearly, and that quantitate how much plaque. And you can see soft and hard plaque in the carotid is very simple. It's called a CIMT, carotid intimal medial thickness test.

You might want to do go down to UCLA or Cedar Sinai and get a super high quality carotid ultrasound. a script and it's not covered by insurance. It's about $250. Not bad, price-wise. It's an easy thing to track. Once a year, I'll track my plaque and my carotid. I don't need to rush and do a CT scan every year. The radiation dose needs to be considered. So, for example, a food that's been shown to reverse atherosclerosis, of all things, unsweetened pomegranate juice. There's a series of studies in Israel measuring baseline carotid plaque, drinking eight ounces a day of unsweetened pomegranate juice. Now, you can probably do it by eating the pomegranate kernels. I don't know if you can do it with the pomegranate supplements and some of the powders that are out there because they are.

But it has been peer-reviewed published that you can reduce your carotid plaque with pomegranate juice. I actually don't know too many other foods that have been studied in that way. That's fascinating. They're indirect. Lower your hemoglobin A1C with a whole food diet. Lower your LDL cholesterol with a whole food diet. You know, it's a more complex situation. But I give a shout out to pomegranate juice, you know, things that boost nitric oxide production, green leafies like arugula, pine nuts, watermelon, particularly the white rind. You boost your nitric oxide.

You might also be reversing plaque. I don't think we actually have a study that documents it. It's, you know, likely it's helpful, but we don't know that superfood that does it for sure. One of the things we've talked about on this podcast previously, before we drill down more into some supplements, foods, et cetera, is that is the high APOB, is the high LDL the big issue? Or is it the combination of those markers being high and your endothelial high? health and your endothelial, and having endothelial dysfunction, this single cell layer that sort of protects your arteries. And one of the thoughts that individuals like Michael have brought up in the past is that we have to talk about endothelial health just as much as we talk about food and these

other components that are there and high lipids because they work hand in hand. What are your thoughts on that? Yeah. Well, there are a couple huge deficiencies. even in advanced cardiology practices like Dr. Twyman and mine. So we can talk about nitric oxide for hours. One, the Nobel Prize in medicine in 1998, three scientists. In fact, one of those Nobel Prize winners just died this week, sadly. So we'll give an honor to him at age 86, Dr. Marad. But if nitric oxide is so important, and that overlaps with endothelial function,

because you produce nitric oxide in your endothelial cells, Why don't doctors talk about it? Because very honestly, it's very hard to test. There is, you already mentioned, you're very up to date. There's a machine called the endopat machine. I have it in my clinic. It's very rare to find it in a clinic. It's a blood pressure cuff on the arm and some sensors. It's about a 20-minute non-invasive safe test. And it can give you a pretty direct measurement. My endothelium is healthy and my nitric oxide production must be high. Or the opposite. I have a deficit in endothelial function and nitricoxic. It's a very difficult test.

There's science behind it for sure, hundreds of publications, but not so easy to do in a clinic setting and never going to be found in your standard family practice internal medicine office. It's going to be a research clinic or an advanced clinic. We don't use it much. There is a blood test. Let's go back to biomarkers just for a minute. Four letters, ADMA, A.D.M.A.

asymmetric dye methyl arginine available at Quest may be available at other labs that indirectly but very scientifically a high level of ADMA means your nitric oxide production is low meaning your endothelium is sick a low level of ADMA means you got high nitric oxide production and your endothelium is healthy that's an easy test to do that's one I do on everybody and then you work to improve it if it's abnormal with that nitric oxide rich diet with exercise with supplements. And it's a little frustrating. I do it particularly in my patients with hypertension because they're all wanting to avoid medication and maybe we can boost their nitric oxide production, heal their endothelium, get their ADMA level down into the normal

range. But it doesn't always happen that simply. So talking about endothelial health is really important. Measuring it is really difficult and that's why we're kind of at a loss. Now for guys listening, I have to always bring up sexual health and erections is an endothelial miracle. And if you're doing that well, you've probably got some pretty decent endothelial cells. If you're struggling at age 40 to 50 to 55 with needing to take, you know, Cialis or Viagra, one, you need a heart check for sure. Get those tests, the heart calcium score, the more advanced CT endogram. But worry about, you know, your endothelial lining, your nitric oxide production.

And you might change your lifestyle and get your sexual health back, get back your mojo. So if you're having evening erections and you're above the age of 40, you're doing okay. Well, you know, just to bring up Brian Johnson again, he just got a lot of press. He always gets a lot of press. But Brian Johnson has been working on his Johnson, as he said, you know, to take it from a good level to a great level. Although apparently he's not really dating because when you go to bed at 8.30 at night, pretty hard to have a social life unless you got an afternoon dating schedule. But, you know, there are ways to monitor if people saw the movie the game changers a few years back. There's

some classic scenes about equipment that some urologists have to measure your nighttime erections and work to improve them. But that's all nitric oxide. That's all endothelial health. Never ignore the problem. Don't just take a Viagra. Get your heart check. It's critical. You know, going back to endothelial health, we know that it's important. And can you explain a little bit more in the context here that it's not just that you have high LDL or high total cholesterol or a high apobie. And that automatically means that you're going to get soft plaque, right? Can you just explain how do we get from here to here when it comes to those surrogacy markers for looking at sort of soft plaque inside of the body? Right. And I think what every,

understands we've got to bring up, you know, smoking is an enormous risk for heart disease, but not all smokers get a heart attack, a stent, a bypass, or drop dead suddenly. It's a risk factor. It's not the only risk factor for heart disease. And that's true of everything we can talk about. High cholesterol is a risk factor for clogging up your arteries and getting soft plaque. There are people, and many, that are exceptions to that relationship. True of diabetes, true of high blood pressure. You know, if you're a betting person and you have smoking high blood pressure and diabetes, you're not going to actually expect to be healthy, live a long life, and avoid soft and hard plaque and cardiac events. But there are those that sneak through,

because we haven't even mentioned the other 20. Maybe your LDL is okay, but your homocysteine is 30, because you have an MTHR genetic defect and homocysteine in the blood, a very simple blood test everybody should have, damages your endothelium. So you've damaged your endothelium, and even an average cholesterol and LDL cholesterol and APOB level allows entry of cholesterol under the lining of the endothelium to begin the process of atherosclerosis. You know, maybe you inherited lipoprotein little A

and you've never had it measured and you walk out of the office, my, LDL is not bad, but, you know, you're in the emergency room three months later. That's a real setup to check your lipoprotein, protein, little it like that can damage endothelium. And othelial cells are injured, a little bit like gut lining cells. They're not a solid barrier anymore. They're allowing entry underneath the endothelial cells for the inflammatory and

arthroscopic process to start up. And even an average LDL cholesterol and APOB level allows plaque to develop. So it's pretty comprehensive to really measure 20 different factors that can lead to heart disease. And, you know, I'm always amazed people in my office with high cholesterol, high lipoprotein A and other factors. And they really do have calcium scores of zero and, you know, relatively innocent advanced testing. But just don't bank on it. Don't be cocky about it. Do the hard work, get the testing done after the lab values. Yeah, I think what's beautiful about this time and day and age that we live in is that even if people have unique approaches to their life, we have so much advanced testing

and there are more and more physicians like yourself where people can go and visit. You're based in Detroit. Are you taking new patients just in case if the audience is interested in? Yeah, I'm licensed in about 30 states. Oh, amazing. So you even do a lot of telemedicine as well? I'm licensed in California. We do a lot of telemedicine. But a lot of people travel here and a lot of Detroiters, of course. And can you just mention the clinic just in case people want to look it up? Yeah, it's on my jacket. Khan, K-A-H-N Center for Cardiac Longevity in suburban Detroit. I always want to give a plug and a shout out to people that are out there,

and this was the point of my whole monologue, that are practicing personalized medicine because so much of the data, and it's a lot of great data that's out there in the world of health, but a lot of it has been observational data, correlative data, and we haven't had the ability to look deep into somebody's heart and say, do you actually have soft plaque buildup like we were referencing earlier as just one example? Or we haven't had the ability to do for most people. They didn't know about an endopath test and using that as sort of a little bit of a surrogate marker for nitric oxide.

So now we have, especially inside of my audience, we have people that are just beginning their journey that are looking for the basics they can do at home. and they may not have a lot of disposable income to go and do these tests or work with the doctor or find it. And they're trying to figure out how to improve their health by working with the means that they have and the health insurance that they have access to. Great. So we always want to provide takeaways to those individuals. We've already provided some working out, you know, pomegranate juice that you gave a shout out to, hit workouts,

generally moving away from ultra-processed foods, staying away from things like emulsifiers, improving your dental health and many other recommendations that are there. And then there's this other group of individuals, and I would fall into them, that health is so important to you. You're willing to sacrifice other things that you would spend money on to say that, hey, if this test costs a couple thousand dollars, but gives me super clarity on where my heart health actually is. And by the way, there's a bunch of other tests that we mentioned that are a lot cheaper. You just got to convince your doctor to order it for you and they have to know how to interpret it. I'm willing to dedicate resources to that to know now how is my n of one. What is my personal situation?

Can I still eat a particular way and have good heart health? Or do I need to change things up a little bit and modify my lifestyle? So I just want to give a big shout out to you and other physicians like yourself who are practicing that personalized aspect of health and willing to meet the patient and look at the exact level of these 20 different markers and give them a real idea. of how their heart is doing. One, I appreciate, and I agree. Everybody doing this extra work gets a shout out for sure, and you for helping be a big spokesman for it and introducing people to it.

Number two is, you know, having now, you know, I've been in practice for over 30 years. I used to be largely a stent cardiologist, a heart attack cardiologist, but it's been about a decade, completely preventive cardiology. You absolutely have no idea if you have disease or not, just on your outward appearance or even necessarily your athletic performance in the way you feel.

This is a scary, silent disease for years and years. We screen for cancer. This is the biggest deficit in modern medicine, in my opinion. We offer people colonoscopy and mammography and, you know, gynecologic exams for cervical cancer and prostate cancer. And if you've been a smoker, low-dose lung X-ray CT imaging for lung cancer, we don't screen for heart disease. And if you pause for a moment and say, I had my annual physical and I got my script for my colonoscopy and for my mammogram, but nobody mentioned my heart. Do you want to lead life with the risk that you're walking around with a serious burden, a heart disease and have no opportunity to intervene? And we've already talked about sleep and dental and diet and supplements, which we'll talk about a little more probably, and exercise programs.

There's so much to do, but you've got to get a heads up on it and you've got to get an early diagnosis. So we can make the biggest impact on American health and international health by just starting to focus on early heart disease detection. And you don't have to be a multimillionaire. I mean, for $99, if you do nothing to get the heart calcium CT scan, and it comes back zero, go to bed at night with a big smile on your face. And it comes back 487. You find somebody that knows what they're doing that helps you down the road. Let's go back to a few other takeaways around soft plaque. them you mentioned was supplements. This is building on top of a whole bunch of other lifestyle

recommendations. And we didn't even mention stress, right? Because we know that stress eats away at almost every single disease out there is connected. And we know that there's a connection between stress and endothelial health. So of course, we've done a bunch of podcasts on that. Everybody knows it. But if you're really worried about your heart health, you've got to figure out how to manage that stress and have active relaxation methods, whatever it might be. Yoga Nidra, yoga, meditation, whatever it is for you to be able to manage the amount of stress that's in your life. Now, let's go back into supplements.

You had hinted that there might be some things that are out there that people could take that could be impacting soft black. Right. And this is, number one, no financial conflict. I don't have my own vitamin line and the ones I'm going to talk about are unrelated to anything I'm invested in or something. So people can take this as a clean recommendation. But in your city at UCLA, a very well-published cardiologist, Dr. Matthew Boodoff, more than a thousand

peer-reviewed publications on, he's certainly one of the readers for clearly and, you know, for calcium scoring, came back, and I think I got the story right, but from Japan a little over a decade ago, that cardiologists in Japan were treating a lot of heart patients with aged garlic extracts. And there particularly was a company with a brand name Keolol. Some people know that, K-Y-O-L-I-C, a lot of vitamin shops carry, and now there's like 20 different versions. But Dr. Budoff, to his credit, asked the question, we sure don't do that in Western medicine. Is there actually value to it or not? And there are now about eight published peer-reviewed studies.

The most compelling one was a CT angiogram of the heart arteries. It didn't have the trade name clearly, but it was the same analysis. One year of therapy. and a repeat study at 12 months focused on how much soft plaque was in heart arteries, baseline, and year follow-up. The randomization was placebo or 2.4 grams, 2400 milligrams, of aged garlic tablets a day, which is basically two big tablets a day that will cost you, I don't think it'll cost you a dollar a day. And amazingly, there was a major statistically significant reduction in soft black by taking age,

garlic extract. And in my case, you just do it for the rest of your life. Age garlic extract is different than eating garlic. You can eat all the garlic you want, and you probably should. There's something about the process of drying that garlic for more than a year before they pulverize it into tablets, lowers cholesterol, lowers homocysteine, lowers blood pressure, so it has a lot of uses in that regard. And it's just a standard part of my practice, you know, evidence-based. And there's more than one publication, but the one with CT imaging is the most fascinating. The other one I'll give a shout out to is there's a big vitamin company in southern Florida called Life Extension. A lot of people have seen their magazine and their supplements. And out of their 500 supplements,

I use one in thousands of people. It's called arterial protect. Very interestingly, it's two herbs. One is an Indian herb called Gotu Cola, G-O-T-U-K-O-L-A, nothing to do with Coca-Cola. GoToCola also has a branded version called Centellicum. I don't want to confuse people, but on the bottle of ArturoProtect, it says Centellicum with a little registered bark. And the other component is another registered herb called Picnaginol, also known as French Maritime Pine Barc extract. Actually comes from the bark of trees in a region of France that also grows some of the healthiest grapes or wine, the Tenotian. grape. But anyways, pygnodginal and go-to-cola have been studied in a university in Italy, about eight peer-reviewed publications. Some have as many as a thousand subjects, which for a

vitamin trial is a pretty big trial, double-blind, randomized one year looking at carotid plaque before and a year later. Some of them now are looking at cardiac plaque. And one study actually looked at outcome, like heart attack, stroke, and hospitalization. In every instance, one One, arterial protect tablet a day for long term compared to placebo, reduced plaque, soft, and even in some studies suggest maybe a bit of an influence on hard plaque, definitely soft plaque, and seems to improve outcome. Now, you know, cardiologists don't know that this is in the peer-reviewed literature. You know, it's not a pharmacologic drug.

No drug rep is coming by educating people. But those two are just almost always in my regimen. There are others that are worth consideration, but I really put them way down the list. Vitamin K2, a lot of conversation that vitamin K2 very often combined with vitamin D3 may promote your calcium in your calcium, or maybe you're taking supplemental calcium, going in your bones in your teeth instead of in your arteries. But in a publication in the last 12 months, about 350 people randomized to very high-dose vitamin K2 as a vitamin or placebo. There was no difference on calcium scores at the end of a year.

It was rather a bust of a study. So to actually say that we've got a great piece of data that spending and taking vitamin K2 at a high dose every day will shrink your soft plaque or prevent your heart plaque is still something we can't say, I think, with confidence. It may be a reasonable supplement to take for bone health. And it's not going to hurt your heart, but I have de-emphasized it as a supplement in my practice. And then there's a whole lot of interesting contenders. A lot of people have heard of a green seaweed supplement called arterosil, A-R-T-R-O-S-I-L. Interesting, some data on reducing plaque, mainly carotid studies. I don't think I've ever seen a cardiac plaque study with our TIRSIL, not so easy to do. I'll tell you one more that's crazy, but there's a

supplement from Australia called REMC-H-O-L, not invested. It's actually a rectal application, not exactly a suppository. It's a little squeeze rectally because if you take it orally, it doesn't work. It's chemically, it's a ring of glucose molecules. So it's called cyclodextrin, a cycle of dextrose molecules. It won't make you diabetic and you're not taking it orally. But it was actually approved about 20 years ago in an unusual genetic disease in children called Neiman Pick disease. This circular molecule likes to grab onto cholesterol and trap it in the center of the circle and actually remove it from the body, removing cholesterol from the body, which accumulates aggressively in this Neimanpicked genetic disease. In the last three or four years, a company in

Australia by the name of Kavodex has been making cyclodextrin under the brand name Remcall, a lot of words there, available. And for a couple hundred bucks a month, you can buy a box with 30 applicators and put it up the back door once a day. I learned about it a couple years ago. I did it myself for a couple months. My blood cholesterol level went down like crazy. I couldn't believe it. I'm not on a statin. And so there was no other change in my life other than taking that supplement for two months. I don't have enough plaque to personally identify any improvement because I just don't have much plaque. But one of my colleagues, an integrative cardiologist in Toledo, Ohio, has now published a series of case studies. And when I say published, it's on his website. It's not

in the peer review literature of improvements in plaque, people having angina pain improving, people having leg circulation symptoms improving. He's a credible cardiologist I've known for years. And it's kind of an off-the-wall approach. The company's talking about maybe using it two months a year every year, kind of like a two-month cleanse and all. A lot of science needs to be done. But I think we can be confident it's safe.

And it could be an add-on to the Keolic garlic and to the arterial protect double herbal. approach. But I can take pot shots for talking about it because it doesn't have as much science as the Keola Garlick, published science. I appreciate that. Some very fascinating things that are there. We'll have the links to all those that you mentioned to in the show notes. Again, neither you or I have any financial ties to any of these companies. And I appreciate you just laying out some of the most exciting things that all go back to this idea of what are the big pillars that we know that everybody can benefit from. And then, of course, getting your own

testing done, working with a cardiologist like yourself, getting testing done so that you can personalize that approach because many aspects of life then have to be personalized. I know in my instance, I mentioned to you that I did some genetic testing and I knew that my entire life I've had, you know, even being when I was vegan previously, I'm not vegan now, when I was vegan previously, I always had very high cholesterol. I always had very high LDL. So I knew that there was some sort of familial, you know, cholesterolemia, things like that. But then when I got my genetic test done, I saw that it was actually the case. An interesting thing about the genetic test that I got done is that where in the past, doctors have recommended to me, not sort of the personalized

doctors like yourself, oh, you should be on a statin. One of the genetic tests that I did, which I'll have to link to in the show notes because I'm blanking on the name right now and I can't pull up the labs. It was actually showing me that I would not actually be a great candidate for a statin because it wouldn't work on me because of my genetics. Do you, are you familiar with these tests that are out there? I'd have had a panel that's pretty available called Boston Heart. I had a Boston Heart and then I had another genetic test that was done. But yes. Boston Heart analyzes a chemical in the blood called sterols and can give you guidance. I'm a hyperproducer of cholesterol where a statin might be a good idea. Or I'm a hyper absorber of cholesterol

where you might lower your dietary cholesterol and saturated fat, or you might take drugs, or there really aren't well-known supplements, but there's a drug called eczetimib or Zetia. It's not a statin, but it's a cholesterol absorption inhibitors. Right, which is what I'm on right now. If you're a hyper-absorber, etymeibesedia, a very safe drug been around for about 20 years is a reasonable choice. We don't have a great study that says if we use this distinction, hyper-absorber, hyperproducer, and some people are both, some people are neither. We can better treat patients. It makes sense logically, but it isn't yet absolutely a proven approach. There is a company called GB Insight that does genetic cholesterol. Yes, I believe that was the test. And I use one now

Genencode, but I had mine done recently. I hadn't done that before. And I genetically tend to make more LDL cholesterol than the average American. I didn't know that before. And I'll I'll tell you, a lot of my fellow vegans are very frustrated. I watch forks over knives. I follow that diet. And my LDL clusters 120. How come I'm not like one of those, you know, rock stars in that famous documentary with a cholesterol of 150?

Because genetics are a very strong input on your final blood cholesterol level. I'm asking you to sort of, you know, think about this for a second from everything that you've been through. is that wouldn't there be a reason why, I mean, the human body is not, you know, designed to mess up, really, and except for very rare instances where there are genetic mutations. But, you know, we've lived and evolved a really long time. Wouldn't there be a reason why that we would be certain individuals might be over producers or over absorbers of cholesterol if you had to think about it from an evolutionary standpoint? Do you ever, do you ever have any thoughts about that? You know, everything regresses ultimately to the idea we're really on this planet only to reproduce.

And everything we do after we reproduce is bonus. But nobody ever had a 40, 50 year, 60 year bonus period. So, you know, for example, the one that's discussed, why is there a molecule in the blood called lipoprotein little A? If this genetic cholesterol causes blood clotting, causes atherosclerosis, causes inflammation, can clog up your arteries, cause strokes, cause heart attacks, and actually cause one of your heart valves to get calcified in clog called aortic stenosis. Why do we have it? Why would 25% of people still carry a gene on chromosome 6 to make it?

And at least it's discussed because it does cause thrombosis clotting, that a woman delivering a child that starts to hemorrhage that inherited this gene from her parents might actually have a bit of a survival advantage in a situation like that. Or maybe we're gored by a saber-toothed tiger, you know, 100,000 years ago, we might have a survival advantage. There actually is one study I'm aware of. You have a brain bleed, a suborectnoid bleed, and you inherited lipoprotein A. You may actually have a slightly smaller brain bleed than the person that did inherit it. So that may get you through child birth and have a slight survival advantage. But then again, we're living towards 78 or 85 or 93.

It's the next 50, 60 years after childbirth and after reproduction that there may be a downside to what might have been a survival advantage. How cholesterol, just plain old LDL cholesterol fits into that, I think it's a little more difficult to talk about because we all make cholesterol. Why does some of us carry genes? We do know there's a kind of science you've probably seen called Mendelian Rural. randomization named after Gregor Mendel, the white pea, green pea genetic professor that many of us learned about in undergrad, that if you find a population of people, and there are these databases,

the UK Biobank database, has 500,000 people with complete genetic information is a very common one. You find people that genetically make less LDL than the average population. What you see when you track those people is they have fewer strokes, heart attacks, and they have better survival. They're, you know, and that's not proven. It's not a, it's not a randomized by science purposes. It's randomized by biology, people that have higher and lower. But there is a survival advantage to having a lower LDL cholesterol.

It's never zero. I mean, you know, we debate cholesterol good or bad. Everybody needs cholesterol to make your sex hormones and your cortisol and your vitamin D. The rest, but, you know, the guys that won the Nobel Prize in Medicine said, you need an LDL cholesterol about 25 milligrams per deciliter to run your body. And everything over 25 is actually excess in terms of optimal production. And I think we talked about this a while back, but a very famous cardiac pathologist just died in the last couple of months in his late 90s, Dr. William Roberts, MD from Dallas, Texas,

world famous, published over a thousand pathology papers. And he always made the point, he wasn't a vegan, but he favored that kind of diet, that the only necessary component in the blood to get plaque is LDL cholesterol, because that's actually what's in the plaque. You know, it isn't necessary to have high blood pressure, isn't necessary to have diabetes, isn't necessary to be a smoker. All those can injure your endothelium and maybe start the process. But the single molecule that's necessary for plaque is LDL Cluster,

which is why a lower concentration in the blood times many years does translate in these Mendelian randomization studies to lower risk. Yeah, it's fascinating. And I think that, again, it all just goes to this idea that I am so excited about the future and I really feel like this is just the beginning of personalized approaches. Because it's like we can get so many different inputs from different sides. You know, you've been very vocal over the years about. why you've chosen to be plant-based, how you live a vegan lifestyle, and how you generally feel that

following those tenants are going to be very helpful for people. I've been honest on my podcast. I'm not a physician. I'm not an expert. I'm just talking about my own, sort of my own journey, about what limitations that I went through when I was vegan. I grew up vegetarian. I was vegan for about seven years. And out of those seven years, four of those years, I don't know if you know this, I was a raw foodist, right? So I was not just a vegan, but I was a raw foodist for four years, which meant that I didn't even eat like cooked food. I was part of the whole raw food movement, which was a funny situation. There's actually a few people that have been in this field of functional medicine, wellness, integrative medicine that were in the raw food world at one point in time, like Sean

Stevenson from the Model Health Show. I don't know if you're familiar with him. He was part of that as well. And you know how I adopted my lifestyle. That doesn't mean that I ever reduce the amount of plants that I eat. I tell people all the time, I still eat the same amount of plants that I ate before. Like, I eat a lot of plant food to the degree that most people would have a hard time, even many other vegetarians that are friends and family of mine, when they come and they stay with me and they see how much plant food that I'm eating inside of the day to get my fiber quotas. They often struggle to eat that much amount of plant food that's there. But I do personally choose to eat some animal food. It started with fish, and now I include a few other things that

are there. But again, there's a lot of reasons why people have different dietary approaches and recommend those things. And then this personalized layer on top of that, I feel takes out a lot of the confusion where now we're trying to decide what's unique and right for us. And then you can see that maybe there's somebody that's been carnivore for a few years. And even though they scored zero on their hard plaque, you know, CT score, their soft plaque is through the roof and they need to make major lifestyle interventions. Or you have people that have been vegetarian their whole life, but drink alcohol, are in a high-stress job, eat a lot of fried food, are living a sedentary lifestyle, which pretty much explains a lot of the South Asian and Indian

population that's out there, especially here in the United States and increasingly in India. And they don't have great blood markers at all. And I don't know a lot of them that I've been able to convince to get it clearly. Hopefully I'll send a lot of them to you soon, but I can imagine they clearly would score high as well, too. So I think we're getting out of the, hey, you've got to be this or you got to be that. And now, show me the numbers. Show me the numbers of where you're at so that then you can get recommendations from a physician like yourself.

And then you can decide what recommendations are right for you, right? That's not to take away from the fact that I'm not trying to de minimise the fact that you still believe most people would benefit from being more plant-based or even being fully plant-based, right? But I'm just giving you my perspective on the whole situation. No, I think you're right. And I think, you know, the message that, again, maybe you've got a really good advanced biohacking, you know, group. But, you know, have you had a heart calcium CT scan for $99, bare minimum?

You know, whatever you're doing, get real. If you're age 40 and up, I used to say maybe 45 to 50, but I'm willing to order calcium scores routinely now and people 40 and up, particularly guys, women that are still premenopausal. I might push that back a few years. You know, do you want to go get a clearly CTN? there's going to be a little financial impediment. It can't be iodine allergic. But get the data, make sure what you're doing is working for you. I agree.

I use a hashtag on social media, test, not guess. And it's frustrating to me. 1990 we introduced heart CT scanning as an available way to cut through the chase and where do you stand. You know, there's this concept. A scientist, we haven't really mentioned this, an English physician in the 1600s. His name is Thomas Sidingham, very famous physician, world leader in his age, said you are as old as your arteries. Go look that up. You'll see a million memes that you can find on social media.

You are as old as your arteries. But that concept has not gotten into standard medicine. And it's just laziness and its lack of pushing the paradigm and pushing the envelope. And it's time to do it. And that's why I go on podcasts like this. You know, it's not that I don't have any skin in the game about what diet you choose and I have my opinions. What I really care about is don't walk around with your eyes shut. Don't walk around blind.

If you've got a problem, find it early. We do that for cancer screening and a few other conditions. We are miserable at doing that for heart disease. It's so available. I would love to have you comment on one thing. You know, we did this whole summer weight loss and body composition series with a bunch of different experts in this field. And pretty much across the board. even when we've had individuals like Simon Hill on the podcast previously, who is, uh, runs the

proof podcast and, uh, is a plant based, uh, individual former, I believe rugby, rugby player whose father just one day in Australia, uh, I think was driving to work and just, uh, you know, was always seeing himself as healthy. Everybody, you know, his blood reports and everything is lipids would always come back well and had a cardiovascular event. And that kind of sent him on this journey of, you know, going down the road that he's on. But one of the things that's come up pretty frequently as part of this whole conversation, which isn't just about weight loss, isn't just about body composition, although we do know that it's important to have less visceral fat in the body, and that is generally associated with better overall health and less chronic

disease. One of the consistent things that individuals in the series have talked about is the importance of strength training. And also, regardless of what your diet, approaches, making sure that you eat enough protein. And having enough protein to, of course, support the buildup of lean muscle mass and how lean muscle mass is related to longevity from really two standpoints. And I want to get your opinion on this. One standpoint is muscle is our protective tissue that protects our bones, makes us stronger, increases our grip strength.

Grip strength is really a proxy. of muscle mass inside of the body. We're more likely able to stop ourselves when we fall. We're less likely to have maybe a hip fracture, et cetera, et cetera. And then on the other side, generally, and I saw this with myself as well, once I got serious about strain training and I added about eight to nine pounds

of lean muscle mass over the last year, is that muscle mass, lean muscle mass is associated with better overall metabolic health because your muscle is using up that free flow glucose inside of the body and you can actually get away with eating a little bit more carbs. You can get away with these other things. And I saw almost all of my markers improve, especially my testosterone, which was a little bit lower. In fact, I'll just mention here because I have it in front of me.

I think my testosterone before I started working out was like 480. And then after I started working out and being consistent with it, I got it up to about 541, which is I think in the, you know, in a good range. It may not be as high as some people would want it to be, but I did see a major improvement that was there. So what are your thoughts about specifically the conversation about protein, regardless of where people get it from? You can get it from plant-based foods that are out there. It might take a little bit more work and figuring it out. Do you think it's an important part of the conversation? Yeah, it's a great question. I do think it's an important part of the conversation. I've had to personally educate myself,

jump in and follow. And there is a great question. I do think it's an important part of the conversation. I've had to personally educate myself, is a confusing aspect that I'll bring up. I agree that sarcopenia and frailty is a major risk as we get older, probably older than me in my early 60s, mid-60s, and certainly older than you. But if we want to have that health span and be active 70-year-olds and 80-year-olds into our 90s and into our 90s and we're doing a lot of biohacking to work on that, we better focus on our lean muscle mass. And of course, you can get a Dexas scan and pretty inexpensively and pretty safely, periodically measure that. And like you said, actually see that you're dropping your visceral fat and adding your lean muscle mass. There seems to be a very strong trend on social media amongst physicians and other counselors that it's probably going to be animal protein that promotes it.

Now, number one, you're not going to gain lean muscle mass if you're not in the gym lifting weight. So the conversation has to be just what you're doing, which is the same thing I'm doing, three days a week of strength training. If you're not lifting weights, it's not going to happen. But then the question is, is there an advantage to a plant protein focused diet with your strength training or an animal focused diet? And there actually have been five or six randomized studies, not perfect, but actual randomized studies. We took 30 healthy volunteers that were not doing strength training. We put them through an eight-week, a 12-week strength program monitored. We fed them a high animal protein diet or we fed them a high plant protein diet.

Sometimes it was fava bean based. Sometimes it was soy-based. There's been a variety. And all six studies that I've read, and they're all in the last two years, have shown that there's similar gains in lean muscle, mass, and strength. If you do the gym time and you have adequate protein in your diet, and the source of the protein doesn't matter. Yeah, Dr. Donald Lehman, who's been on this podcast previously, is a big protein researcher.

He always tells people 75% of the formula is being in the gym, right? Yeah. Having resistance training. That statistic. I'd agree with that statistic. And then 25% would be the dietary aspect of protein, which he does also agree that you can get it from a lot of different components, right? You can get it from it's we got to, he even says that we need to move away from, you know, protein and talk about essentially amino acid. right? And those amino acids can come from a lot of different sources of foods.

And then the flip side of the conversation, which I don't have a resolution for you and your audience, is longevity science. And I always default to Dr. Walter Longo, right in your beautiful city of L.A., you know, head of a department called Biogerentology at the University of Southern California School of Medicine. You know, top number one funded researcher in the United States may be on a path to winning the Nobel Prize of Medicine for multiple, multiple breakthroughs, including that fasting, mimicking diet that he's published over and over on. But, you know, he's been teaching for over a decade that a lower protein diet, and, you know, the USDA recommendation is 0.8 gram per kilogram body weight.

And I want to emphasize that, 0.8 grams of protein per kilogram body weight. Dr. Longo actually teaches half that as being the optimal longevity diet until you're 65 or 70. And 65 or 70, you might inch it up. Maybe not all the way to 0.8 grams per kilogram, but you might inch it up a bit based on some of his own published data about protein needs as we age. You know, lower, so 50, 60 grams of protein a day from a plant source, from an animal source is what he will teach and talk about. Because protein is one of the triggers of the mTOR pathway and IGF1 that if constantly at high levels and activate it may promote cancer growth and accelerated aging. And, you know, maybe you have a high IGF level for a while, then you lower it by doing the fasting mimicking diet or going plant-based. Some kind of cycle on and off may be optimal.

We don't know that for sure. What I've seen some of the influencers on social media, I'm not calling them out, is they've changed. the USDA formula very subtly to 0.8 grams per pound body weight. Well, that's 2.2 times difference. So the 50 to 60 grams a day instantly becomes 120 grams a day. Nobody's actually, you know, the government hasn't accepted we throw away kilograms and use pounds because if you just quickly think about it, it's a whole different level. You're getting up there in the 150 to 200 grams a day of protein. And whether that that actually will help you get that lean body mass quicker, according to these six randomized studies,

not necessarily. And whether there's any detriment to keeping that kind of level, particularly of animal protein diet long term, on your atherosclerosis, your cancer risk, your general aging, you know, be a biohacker. You know, do some of these tests on your epigenetic age or your glycan age. That's a company that does a very well-accepted aging test. Make sure these things are working for you. That's more personalized medicine there. Don't just accept it outright. I have to throw this in because I know a friend of yours and a friend of mine, a famous doctor has been quoted a million times that he's biologically 20 years younger

than his chronologic age is, you know, the glycan, it's a company, G-L-Y-C-A-N-H. Yeah, I actually just, I just ordered it, you know, and I'm going to do it. When I did it at age 63, I'm 64 now, I was 23 years old in my glycane. age. And I showed it to my wife and she cracked up. She goes, you have not been 23 years old in 40 years. That's a funny result. But there's some meaning. There's some meaning to it. And I don't really say that in any way to be obnoxious and brag. But do the biohacking if you're going to go off on a high animal protein diet with your weightlifting. Make sure your C-reactive protein stays optimal. Make sure your hemoglobin A1C stays optimal. Make sure your LDL cholesterol and your

ape-obis stays optimal. Just make sure these things. are working for you. They're simple. You know, we started with biomarkers and we're back to biomarkers. Yeah. It's an important conversation. And I want to acknowledge, you know, we've had Walter Longgo on the podcast so much respect for his work. Of course, his work and he even says it itself is the combination of really three things. It's these centenarian surveys that are being done in places like Italy, where he's from. It's these large observational, you know, data extraction that's there in the observational trials that they put together. And it's these mouse model testing, right? Those are the three things, the three intersections, which is a lot more

data than most people have when it comes to their components. And again, these are large averages amongst different things and extracted survey data's that are there, which is why I think there's a lot of fascinating components that are there. And I think that I've heard some great arguments of where that might be meaningful or not as meaningful. For example, one of the arguments that have heard when it relates to EMTOR and cancer in some of the research that's been done is that, well, there's a lot of things that actually spike up mTOR. One of those things is strain training.

When you're working out and you're doing hit workouts, you actually get a temporary spike in EMTOR. And guess what? It comes down after a while, which probably goes back into recovery. and other things. And you might have spikes in mTOR that come from higher protein diets, especially animal protein diets. And I by no means I'm an expert in this, but I love hearing the conversation. And I think that we have to talk about these things. You know, we have to have good, healthy debates, friendly debates about them,

friendly discussions. But you might get an animal protein spike from this mTOR that's there. But generally, if you're eating a lot of good quality fiber and other stuff, it's going to come down afterwards. So is a temporary spike a really big issue? And is it that individuals that eat meat who are more likely to get cancer, just eat less vegetables overall. But now if we get them to eat higher amounts of vegetables, they're not smoking, they're not drinking, which is a lot of people that are listening to this podcast here, then is it still a concern? And I don't know, I'm not even, I'm just the person that's asking the questions, but I do think that it's important that people are aware of the spectrum of ideas. And then most

importantly, again, go get your own testing done, right? I still have, you know, just to share, you know, since doing my clearly scan, getting my Boston Heart labs done with my cardiologist, which again is something that you run with a lot of your patients to, I was able to, I decided to start on azetamide, which was the prescription drug that you had mentioned previously, which helps me with my hyperabsorption of cholesterol, which it seems. And I was able to lower my APOB. I think the last time that I got my test results done, which I have in front of me over here, I was at, this is my second to last time that I'm reading off of, but my highest I was at 124 was my APOB. And actually, sorry, 144 was my APOB.

And by making a couple modifications, I have not started on some of the supplements that you've recommended. But I want to start on those two. Do they do those supplements? Could they potentially impact APOB, the garlic and things like that? The garlic. The garlic good. So I want to start on that. I want to try that too.

But being on a Zetamide, my APA B came down to 86. and I think the last one that I did it was around like 70, right? And I think that's like my goal to be around there. That's a meaningful drop, a 50% drop. That's excellent. Definitely. And so I had to take pharmaceutical interventions and I did a ton of research in the space. I talked to a lot of people.

And generally I saw, again, this is you having to work with a cardiologist like Dr. Khan to really decide for yourself. I wasn't too worried about taking acetamide, right? I wasn't too worried about taking about that comparatively to some of the concerns that maybe people have about. statins, which is a whole other conversation, you know, that, you know, we don't have to go into that over here. So again, it's that personalized approach that's there for you. I am personally on what would be considered in your world, a higher protein diet. I'm having about 120 to about

140 grams of protein a day, which would combine from a combination of different, you know, primarily animal sources, but also plant sources inside of that as well. I don't drink alcohol, except like genuinely when I say occasionally. I'm talking about, you know, maybe a half a glass of wine every like three months. And of course, there could be benefits to including those things. But knowing me who already has all these higher aspects that are there in my blood lipids, I'm trying to make sure I reduce all these other things that might have a connection to destroying my endothelial help.

Of course, I don't smoke. I don't smoke weed. I don't smoke cigarettes, of course. And, you know, I actively work on stress management. working out, sleep, et cetera, et cetera, et cetera. So this is all about this personalized approach that's there for you. But I would never deter anybody away from any kind of lifestyle that they so have chosen. You know, Joel, as you know, you have a lot of patients that are Indian and South Asian.

Many of my family members, it's a religious thing for them, right? They genuinely believe morally it's not right to kill animals. And I have so much respect for that. That's the reason that I was vegetarian growing up. That was the reason that I became vegan is primarily because of an animal rights component that was there. So by no means would I ever tell anybody who has morally chosen, whether they grew up with it or not, to not follow this lifestyle that I was there, I would still tell them to get all these lipids and all the clearly scans done, because it's just so important to know are they actually genuinely healthy.

I'm sure you know in the United States, primarily because of lifestyle, working schedule, living a sedentary life. South Asians have the highest risk out of any ethnic minority for heart disease. And a good percentage of those individuals are vegetarian, but they still, even if they're vegetarian, they're still living a life that is not optimal to the way that we were meant to live, right? Sleep is off, sitting too much, not working out. So everybody really should be getting these tests done if they can afford to. Yeah, I think you packed a lot of good stuff there.

I'm not going to add too much more, but you know, you're spreading the word, and I'm well aware that that South Asian population, largely Indians, are the new name Barat. Congratulations to the country of Barat. I haven't heard if that's official or if that's just temporary. They're working on rebranding India since it sort of was a British name for the country, and they're going back to the ancient name of Barat. So I think that's a good move. I applaud that. But nonetheless, very high-risk population. anybody listening that's from the same segment of the world, get the biomarkers we talked about,

get the CT imaging we talked about, maybe get to carotid ultrasound we talked about, and absolutely don't live in a world of make-believe that you couldn't have silent heart disease. Silent heart disease is present for years before the day that something tragic happened. So don't be lethargic. Get off your chair now and stand up and say, I'm going to do it. I'm going to get these tests done. Joel, as we're winding down over here, give us a few of the things that you feel personally in your life you do in addition to, you know, the dietary component. You know, what keeps you healthy and has you feel, you know, not only the lowest amount of soft black that you've done for any kind of clearly scan that's there, but also great biomarkers pretty much across the board, including this glycation age test that you had mentioned.

Are there other lifestyle aspects that you do on a regular basis that you feel contribute to your version of creating your own blue zone there in Detroit for yourself? Yeah, I think part of it is creating a happy attitude. That's a blue zone. Some that comes from family and we have a house full of pets and I have a grandchild now and just generally. And I love music. I have music playing. Often it's yoga music. Could be right now I'm playing Jimmy Buffett nonstop.

just out of homage to one of my, you know, more favorite music. Rest and peace. I just, my patients know they're coming in. They might hear Mozart and they might hear yogi Bajan, Kundalini music. They never know what they're getting, but they're getting music. Really good sleep. I mean, we've mentioned sleep a couple times,

but I spent, you know, just in the medical training and being a heart attack cardiologist three in the morning, you know, I had 25 years where sleep was a very low priority. And we were schooled. I can remember in medical school. Real men get up at 4.30 and are reading the textbooks and making rounds on the words by 515. That was the culture. I ditched that and I really get a solid seven to eight hours and I welcome supplements. There's a lot of magnesium and a little bit of melatonin and a little bit of CBD and sometimes some glycine. I mean, I will sleep well, but I don't mind taking some safe natural supplements. track your sleep using any of the trackers that are out there?

I've had an aura ring since it was an ugly old version probably eight years ago from a mind-body green revitalized event. I think I got my first one. So I do track it. I'll go nights without wearing it because it's pretty consistently good now. I don't like to become completely dependent on all kind of wearables. I use them on and off just to check in. So really good sleep.

I'm a mouth taper. There's a really weird habit that a lot of people have heard of. But I wasn't a big snore, but I was a mouth open breather and really dry mouth. And I tell you, it's a strange habit every night to put a little X tape on your mouth. But I know that has been 20% of why my sleep has gotten better. And I can become kind of habitual about it. Regular fitness, we talked about it. I add in a strange yoga flow you might know of called the Five Tibetans.

Has a little cult following as a longevity yoga flow. So same exact flow, six, it's called the five Tibetans. There's actually six steps that you do just to confuse people. You can find it online. There's books written about it. I really enjoyed it. It's a lot of core and low back strength and flexibility, which as you get older, if you can keep your low back healthy, particularly as a cardiologist, you wear all this heavy equipment when you're doing procedures

and low back injury is very common, but I've been able to avoid that. A lot of supplements. I don't take as many as Brian Johnson. I think he's up to about 116 a day, but I'm in the 30 to 40 a day supplements a day. And they rotate. I mean, I will try new ones and all, but KU10. I mean, we haven't mentioned.

I think co-kutin is the most underrated vitamin on the planet. I think it actually has more data for cardiovascular benefits. Peer reviewed, randomized, you know, systematic reviews, meta-analysis. Co-Q10 saves lives. And that's in literature in December of 20, there was a massive vitamin study, 800,000 participants. CoQ10 came out with Sterling reviews,

like a 32% reduction in heart death by just taking co-enzyme Q10 every day. Probably more important as you get older, and more important if you're on a statin like Lipitor, but it's still important. Any other segments. What about community? What's your approach with the community? You know, my community, and I hate to say,

it's a lot of family and it's a lot of my patient, community. I'm a, I'm dedicated to what I do. Um, my patients know me. I know them. I send a weekly newsletter. They love hearing about my 91 year old mother and my granddaughter and my dogs. I always clue a few comments. They, you know, share that right back with me. Um, you know, we talk about grandkids and pets and vacations and all the rest. Um, I am involved in the community of Detroit. I've had various hats in the charitable community. I'm just joined the board of a very interesting emergency medicine charity to get to people quicker when they're having crisis using little scooters and e-bikes and motorcycles. It's a very cool concept that's, you know, way before

the ambulance is getting there is a trained medical technician on an e-bike. It's saving lives. It's all over the world, but interesting. So, you know, you have to be involved in community. We've learned that just from common sense, from the blue zones have emphasized that as an experiment. And just trying to not, there's a lot of negative in the world right now. And I have to say, I keep up on it. I read it. I know my politics and I know economics. I mean, but I really probably spend 20 minutes a day staying up to date because I can't live just in that world of strife and concern.

also not to be aware of what's going on. So I try and stay happy and try and focus on productivity. So good stuff. Yeah. And you're very active on Twitter. We'll link to your Twitter and Instagram, but I'm imagining that you're not getting your information of what's happening in the world by turning on the nightly news. Yeah, I'm not a big nightly news. I mean, there's a couple of websites where, you know, in five minutes I can review 25 new news articles, you know, that have been out there. So I have my favorites. And I don't want to offend anybody by shouting out what they are unless you really want to know. But anyways, good ones. That's fantastic. Dr. Joel Khan, this has been great. Again, we'd love to give another shout out to your clinic. And how can people keep in

touch with you? Yeah, I am all over social media. And if you want to put the links, it's very kind of you. I do it myself. I'm pretty dedicated about trying to find interesting posts and meaningful posts. And occasionally humor. I do like humor. But got to keep it. yesterday morning, my wife said, boy, that was a vulgar Instagram post. It was a humorous one about protein in the diet. So sometimes I probably would cross the line, but it's probably because of humor. You know, con longevity center.com. I do have a weekly short podcast. I just do 25 minutes a week called Heart Doc VIP. I'm in my seventh year, so about 320 episodes. I really enjoyed preparing for that and just, you know, really focus.

quick discussion of new cardiology literature that's meaningful. And there's so much out there that even in one week talk about three, four new breakthrough articles. It keeps me sharp and keeps, you know, my audience, my patient-based sharp too. Fantastic. And do you still have a restaurant? I believe you had one point of time at a restaurant? Thank God. I had three of them last decade and sort of got out of a mall right around before COVID because the restaurant world everywhere. but in Michigan it was really tough. We had super strong lockdown. So I am exited from, they were all plant-based restaurants.

The food truck I had still exists. It's in Austin, Texas. It's called ATX Food Co. But it's being run by two Detroiters. I'm divested. It's a great place. It's right by Barton Springs Road, if anybody knows where that is in Austin. But yeah, what a really great experience for five years.

but, you know, what a difficult business even in normal times. Not like now when, you know, the price you pay really wonderful employees is twice what we paid, you know, eight years ago, good or bad. It's just you can't charge $42 for a black bean burger. And sometimes to cover costs, that's what you almost need to do. Yeah, such a difficult industry. The fact that you were in it for as long as you were, hats off to you and your team. Well, we'll have the links to your center. and again, if you're looking for a good cardiologist to help you walk through this line of

personalized testing, Joel and his team are available. We have the link inside of the show notes that's there. And I super appreciate you coming on the podcast. It's been nice. I've known you now for many years. And I've always enjoyed my interactions with you. And I just want to thank you for helping to spread the word of what people can do to keep their heart healthy. Thanks, Drew.

It's been a pleasure. And, you know, I love listening to your podcast. Keep up the good work. Hi everyone, Drew here. Two quick things. Number one, thank you so much for listening to 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 dh-r-r-u-p-U-R-O-H-I-T dot com and click on the tab that says, try this.