The Dr. Hyman Show - Can Heart Disease Be Reversed? After His Own Heart Attack, This Surgeon Changed Everything | Dr. Jeremy London

Episode Date: August 5, 2026

Heart disease is still the leading cause of death worldwide. Yet many people assume it only happens to those who are older, out of shape, or obviously unhealthy. In this episode, I sit down with cardiovascular surgeon Dr. Jeremy London, whose own heart attack challenged many of the assumptions we make about heart health. We discuss why prevention isn't always as straightforward as it seems—and how understanding your personal risk can help you take a more proactive approach to your health. We cover: Why some healthy people still develop heart disease The difference between standard cholesterol tests and a more complete assessment How to better understand your personal cardiovascular risk The lifestyle changes that can help lower your long-term cardiovascular risk Interested in more comprehensive lab testing? Learn more at Function and use code MARK2026 to save $50 on your membership. Heart disease is often preventable—but only if you know what to look for. Listen to my conversation with Dr. Jeremy London to learn how a better understanding of your personal risk can help you protect your long-term heart health. View Show Notes From This Episode Sign up for Dr. Hyman’s Brainshaping Academy to learn how to nourish the biological systems that support your mental, emotional, and cognitive health https://drhyman.com/products/brainshaping?utm_source=dr_hyman_show&utm_medium=newsletter&utm_campaign=may_27&utm_content=link Get Free Weekly Health Tips from Dr. Hyman https://drhyman.com/pages/picks?utm_campaign=shownotes&utm_medium=banner&utm_source=podcast Sign Up for Dr. Hyman’s Weekly Longevity Journal https://drhyman.com/pages/longevity?utm_campaign=shownotes&utm_medium=banner&utm_source=podcast Join the 10-Day Detox to Reset Your Health https://drhyman.com/pages/10-day-detox Join the Hyman Hive for Expert Support and Real Results https://drhyman.com/pages/hyman-hive This episode is brought to you by Paleovalley, Pique, Perfect Amino, Seed, BON CHARGE, and Cozy Earth. Shop nutrient-rich foods and supplements at paleovalley.com/hyman and save 15% off your first order. Elevate your daily wellness ritual at piquelife.com/hyman and enjoy 20% off plus free gifts. Help fill protein gaps at bodyhealth.com and use code HYMAN20 for 20% off. Support your gut health daily at seed.com/hyman and use code 25HYMAN for 25% off your first month. Explore red light products at boncharge.com/hyman  and enjoy 15% off with code HYMAN. Upgrade your sleep setup with cozyearth.com and enjoy 20% off  with code HYMAN.

You talk as a cardiovascular surgeon about how you want to make heart disease the number two killer in the world, not the number one killer. But the iron is you had a heart attack. What are the factors that people should be paying attention to? Because this is really a preventable condition. If a farmer looks out on his fields and all of your crops are sick, where's the first place they look? It's in the soil. Being mindful of what you're putting in your mouth, focusing on a whole foods diet, limiting ultra-processed foods, limiting saturated fats in your diet. You've got to be so careful these days with the more extreme choices.

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You know, we're just chatting a little bit before. You're a cardiovascular surgeon. You do bypasses and, you know, fix arteries and do major big surgeries. That's like cardiovascular surgery and brain surgery are like the two top surgical specialties that, you know, are really tough and hard to learn and take a lot of time to become expert at. And somehow, in all that process, you discover that you were kind of treating things at the wrong end of the stick. You kept seeing over and over cases coming back over and over with bad habits that they never changed and needing another surgery and another surgery.

And you did that for a while, but it sounds like you had your own epiphany in medicine where you realized you might be not thinking about things the way you should. And you had your own health crisis. You talk as a cardiovascular surgeon about how you want to make, you know, heart disease the number two killer in the world, not the number one killer, which is a great aspiration. but the iron is you had a heart attack. So tell us about that. And I mean, you look healthy, you seem healthy.

I'm sure you don't smoke. I'm sure you eat pretty good. It's like fit, exercise. And you're kind of the kind of person you wouldn't think would get a heart attack. But here you were and you had a heart attack. And that's kind of what I want to get into a little bit in the show, which is why are so many people who seem and look healthy getting heart attack? It's an ongoing question for sure. And to make it even more egregious from my standpoint, the time, the time.

timeframe between making that shift of treating the end point of disease and when I actually had my event was another 10 years later. So I was already very dialed into, you know, really, really working on solid lifestyle choices. And I thought that I was doing a really, really good job. I really did. And what I have come to learn is that none of us are. immune to cognitive dissonance. We know better, but so often we just don't do better. It can be simple things. You know, the smoker knows they shouldn't smoke, but they continue. You know, you shouldn't reach for the chips, but it's what's convenient. You're tired. You deserve them. However, you defend that. And no one knew better than me. Yeah. The signs and the lead up. I mean,

I lived it, I taught it, I dealt with it. Yeah. And like I said, what did you miss? Intellectual honesty. And I fell deeply into that gap of knowing better and not doing better. And what were the things you weren't doing that led you? Well, there was only a few years ago, right? It was like, it was three years ago.

Yeah. Well, it really, it didn't hit me until after the event because it was really in the midst of it that I fell kind of first tripped into the space. because I woke up one morning with what I thought was just reflux. Harper. Harper. And I get up early. I was pacing around the room.

And my wife's like, are you okay? I'm like, yeah, yeah, I get a little reflux. She goes, you don't look like you have reflux. I'm like, seriously, you're going to tell me. I'm a doctor. That I don't have reflux. Come on. So I sat down.

I read for a little while, felt fine, took the dogs out for a while. It was December. We got a quarter mile from that. house, it's cold outside. I'm peeling my clothes at this point, sweating. And she looks at me, she goes, reflux. I was like, yeah, you know, it's just really, she's like, okay. So we go back to the house. Is she a doctor, too? She is not. She's just an incredibly brilliant woman. We get back to the house and not to be overly graphic, I sit down on the toilet. And within 30 seconds of sitting down, symptoms went away. And I immediately was like, no. Exertional symptoms, relieved with rest. No, not me. It's not possible. Couldn't be. Could not be. So at that point, I did what someone who is the poster child of cognitive dissonance would do, and that's explained it away. And through the course of that entire day, I would go upstairs, have it come,

back a little bit and I'd sit down and it would go away. Oh yeah. That evening, my family went back into town and I was with my youngest son and we were out in the woods that evening, dark. He's 14 years old, quarter mile from the truck, no cell service, and I go down on my knees with significant chest pain. Like I knew what was going on. And my son's like, dad, are you all right? Like, what's going on? I said, It's just reflux. He goes, you can't walk around when you have reflux? I was like, oh, you're another smart one in the family. So I pull myself together.

I get, we get back to the truck and I drive home. Oh, man. Oh, yeah. I'm going to lay it all out for you. I didn't say I was going to be proud. So I get home, I take a beta blocker and an aspirin, and I go to sleep. Oh, wow. Wake up the next morning.

Not the right decision, but good thing you woke up. I share it. I share it, hoping that others will do other. Sometimes you need an example of what not to do. They call, you know, they usually have the first symptom of heart disease is sudden death for 50% of people. And I've had people I know who have that experience. And you're lucky you had some morning signs. They called the silent killer, but in your case, it wasn't so silent.

And about five or six years prior, we had a good friend who was a radiologist at 48 that that's exactly what happened to them. So it's not like I'm not aware. I woke up the next morning. We live in a home with staircases, went down to make my coffee, came up. same symptom. So then I had to come clean. And my wife says, this has been going on since last night. Why didn't you, why didn't you say something? She said, well, you would have made me go to the emergency room. And she's like, well, that's what you do when you're having chest pain. I said, well, I didn't like the cardiologist that was on call that night. She goes, are you kidding me? She's like, you're friends with all of them.

Yeah. And then she stopped for a minute. And I always kind of get goosebumps. She looked at me and she said, that is the most selfish thing you've ever done to me and the boys. And that really, that hit hard, as you might imagine. And I said, I hear you, I am terribly sorry, but can we go, can we go to the hospital? So I call one of my buddies, he's like, there's no way, man. I said, I'm telling you. I said, I've tested it pretty good here. So he's like, come to the office.

I'm like, oh, I don't think that's a good idea. He goes, no, no, no, no. Just walking around the office, he took one look at me. and I was in the cath lab and, you know, one stint in the right coronary, you know, and I was fine. So I wouldn't let him sedate me, you know, for the procedure because I want to know what's going on. So he passes the wire across it, which occludes the coronary. And you had severe chest pain. EKG changes, severe chest pain.

And I'm like going, hey man, hey man, he pulls the drais pain. He goes, I need you to shut up. So I can get this done, sedated me, got it done, went out and told, Tracy, I dream of stenting cardiac surgeons, but doing anything to your husband was an absolute nightmare. She goes, oh, I'm sure. I'm absolutely sure. So what were the things that you did that led up to that? Because you obviously have been in this field.

You're aware of heart disease. You're not doing the normal bad thing. It's really only in retrospect now that I was able to really unpack all of that for myself because the immediate response was, I have a stressful job. and certainly a component, but not enough to really lay your hat on. The second was after 25 years... And you're still doing cardiacs.

Oh, yeah, yeah. I went back to work that Tuesday after. As soon as they would let me. So, you know, my sleep was totally out of whack. I was on DefCon 1 all the time, so I was like, okay, that's certainly a risk factor. If your sleep's off, everything's off. certainly a risk factor. Well, it really wasn't until we started with the platforms and my son Max was

instrumental in all this. You know, he said, Dad, wouldn't it be interesting if like you put on a CGM? Wouldn't that be interesting? I was like, Max. If I need to show you what a great job I'm doing with my diet, with my exercise, that's fine. He's like, Dad, I don't care what it shows. I just think it'd be cool. like show people, you know, the process and look at your numbers. Yeah, within 48 hours, it became very clear that my baseline glucose was unacceptably high. Checked the A1C. I was 5.7. Flipped into a, you know, a fasting insulin level, which I'm embarrassed to give you the number. Come on. I'll say it was, I'll, come on, give it to me. Forty. No. 40? Really. Forty.

40. Seriously. I mean, just. for those listening, it should be less than five. The lab service range is 18, which is, I think, terrible. 40 is high. You were what, you had a little belly or what? You know, not really, really, no. Bread, pasta, rice. Not really.

So how come it was so high? I don't really have that answer. But I definitely retooled my diet as a result of it. You know, using the CGM, I was able to kind of see, like, and I added 10-minute walks after meals. I tried to add more cardio back off on some of the strength training. I used to do a lot of endurance work. And that made a difference for sure.

My A1C came down to 5.5. We got the insulin level down to acceptable ranges. So more risk factors than were obvious. Again, look healthy, but you don't know until you know. And we'll add the coup d'etat on top of it, which would be an APOB of 180. Wow, and you had checked it or hadn't? LDLs, LDLC only, which was mildly elevated around my event, you know, mildly elevated. My triglycerides were a little high, which is in line, of course, with the insulin resistance and all those things.

But not shockingly so. You know, it wasn't 500. It wasn't in line with that. What was your triglystriids? I don't remember. I want to say they were probably upper 100, 200. So high, yeah, high, but not. That's high.

It should be under 70. Right. But I think the lab reference ranges, you know, would say 150 is okay. You're not going to cut me any slack today. Here I am pouring myself out to you. I'll give me an example for other people. It's amazing. This is important information because you're highlighting the fact that you're here,

you're a cardiac surgeon, you're into functional medicine, you're trying to do the right thing. You know, you maybe had a few things off of your diet, but there was something going on. It could be other factors like your microbiome or toxins that can cause insulin resistance. But like your numbers were numbers that most people don't look at, right? And you hadn't even looked at. I didn't. Which is amazing. And, you know, APOB is now, which is this, basically a combination of all the, we call

atherogenic lipid particles. So triglystorides and LDL particles and, you know, intermediate density particles and so forth, LP, little A, these are all together in APOB. So it's now recognized by cardiologists as being the most important biomarker for predicting heart disease risk. But it's almost never tested by traditional doctors. It's just they check your regular cholesterol panel, and that's the end. and yours was a little bit off, but not terrible.

And here you were sitting on a time bomb, and you're lucky you didn't actually have a clot and die. I mean, you could have. Absolutely. And, you know, it goes back to that, you can't fix what you don't measure. And it really took me understanding that my priorities needed to change, that truly needed to engage in secondary prevention.

And to do that, I needed to know what my numbers really were. And the grace at this point is I have now normalized all those things. My particle counts are really pretty phenomenal on rapatha and a little low-dose crestore. And it's really important what you're saying is because, you know, looking at you, no one would say, oh, here's a high-risk heart attack patient. You don't smoke. You don't have high blood pressure. You're, you know, you look fit.

You came into health. But like, these things are under the surface on a lot of people. And we're seeing this a lot with function health. We're seeing a lot of people who are now measuring this on. I mean, I've been doing this in my practice for 30 years. I've been measuring lipoprotein little A, measuring particle number, particle size. Even when before that was a, when it was a company called liposcience, which did this particle numbers in size before a lab corp bought,

before Quest developed their tests, I've been doing this for decades and measuring APOB and all these numbers. And it's amazing to me that they've been available, but, I mean, I sat with the head of the executive, physical at Cleveland Clinic, who was an older gentleman who made name last. And I was like, listen, I think your executive physical labs are a little dated. Maybe you should do, you know, particle number, particle size, you know, APOB and all this. He's like, well, you know, we don't like to do things before there's adequate research. And I'm like, well, this has been around for 40 years. Ron Krause has

discovered this 40 years ago. That particle size and number matter and they track with your carbohydrate intake, not fat. So like if you're eating more starch and sugar, you're going to have more of these atherogenic particles, you're going to have high OPAB, you're going to have more particle number, smaller particle size. These are all the things that no one's looking at. So I think, you know, getting these things tested is so important. And it's function help, that's what we do with everybody. And we're seeing, it's huge, huge number of people who have particle numbers that are high. Over 90% have really some degree of abnormality. And when you map it to like imaging, then you can actually see what's going on. Sure. And

then, you know, you can treat it. Like, you might have some genetic factors. There's lipid genetics that play a role, I'm sure for you. I certainly have, like, an inherited familial lipid disorder. It's not like a classic one, but it's, now we have more genetics we can do. I've done my full genetics for lipids. And, you know, we're going to be offering, you know, genome, whole genome sequencing soon and so forth.

Like, I think we're seeing a lot of, of potential to really understand your unique biology and then how to customize treatments. If you're a woman in your 40s or 50s or beyond, I want to talk to you directly for second. Around perimenopause and menopause, your body becomes much less efficient at building and maintaining muscle. And most women are never told this. They're told to eat less and move more. When in reality, protein needs actually go up as estrogen declines. That's one reason I use perfect amino myself every morning in my smoothie. It delivers all nine essential amino acids in a predigested form your body can use immediately to support muscle and bone health without adding

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and why I continue to recommend it. Go to c.com slash Heimann and use the code 25 Hyman to get 25% off your. first month. That's sED.com slash hymen and use the code 25 hymen. I mean, I think you make some really interesting points. Like take L.P. Little A, for instance. I mean, it has really been around for, for decades. A long time. And- At least as long as I've been doing medicine. And if you look at the history of that of why it didn't come to center stage, and I'd be interested to know what your thoughts are on this, but it was that attitude of,

well, we can't do anything about it. So why should we actually be testing for it? And, you know, And I mean, that's that's such a misguided mindset because, you know, knowing something is as, is important, even if you can't do anything directly about the thing you know. Right. Like having that information so that you can change everything else. Right. You can reduce all the other risk factors. Exactly. And even with the inherited factors, the other inherited factors, that's such important information to be able to stratify people that otherwise.

look healthy, that you know you need to get those numbers lower, that you need to be more thorough, that you need to be more engaged so that you don't end up in the situation. Yeah, because I'm sure those numbers that you had, if you've been tracking them for decades, you would, you would start to see the trend line going like this. For sure. That's what's available to know for people. For very low cost, I get function health, but basically do a dollar a day. You can get all this stuff done and, you know, twice your testing and get a really deep view, not just of your, you know, your lip is, but also like metabolic health, which is, you know, you kind of, you're a case in point that most heart attacks today are really, aside from the small subset that's just inherited

lipid disorders, it's coming from metabolic syndrome, from prediabetes, from poor metabolic health, where we're eating so much sugar and starch that's causing high insulin and hydrolycerides and high abo B and all these things that are really from what we're eating. Things get misconstrued many times because they come in, you know, patients, two patients, right? You have the healthy 50-year-old that has normal standard panel, physician shakes their hand and says, you're good to go. And 18 months later, that patient's in the back of the ambulance with a heart attack. And the response is, see, LDL doesn't matter. Cholesterol doesn't matter.

None of those things matter. Then you have the other patient that had high cholesterol, was well treated, has LDL levels of a 15-year-old also in the back of the ambulance. 18 months later, and that patient's response is, I was safe. I did all the things. And they're both wrong. Why? Well, because the truth is somewhere in the middle, right? Because LDL just doesn't tell the whole story. Now, before we break, you know, before we attack LDL, clearly LDL is causal. We have lots of data that supports that. But it's not the whole story. ApoB, LP-L-P-L-A, the metabolic components, you know, that that's a. a very, very important component. The second arm of that is the things we can control.

We've over-insects on LDL because we have a drug that tree set. The truth is that that may not be the right target for treatment. And when you look at the data, like even things like triglyceride to H.L. Is far more predictive than LDL. And that's a reflection of metabolic health. So high-traclycerize and low-achel means you probably are heading towards pre-diabetes. And that's really the driver. You sort of mentioned people who have normal cholesterol and have a heart attack or have, you know, treat a cholesterol and have heart attack.

There was a big study that was like looking at, I think maybe you know this study. I think I'm like 130,000 people who were admitted to the emergency room with heart attacks. And I think 75% had, quote, normal LDL, but only like, I don't know, 10% had normal triglyzeries. It was like, it was so. It's just not the only villain in the room. Yeah. And for most of us, myself included, that certainly was the case. You know, and I think that that's, that's the reality. And that's, you know, understanding that you, we can all fall into this gap, recognizing it before we do, understanding what we, what tools we have available, whether you can move the needle with lifestyle changes, or you do all the foundational pieces, you eat well, you move, you sleep, you have your relationships and check, all those things. And you're still not right, you know, it may be time to consider a different lever, you know, people to

think that taking medication is a failure. No, it's not. It's not. And it's both the fault of patients and physicians. Yeah. You know, I think about it like a scale. You know, at the one end of the patient scale, you've got the individual who's like, just treat me, Doc.

I'll do whatever, I'll do whatever you say. And at the other end is, I don't want anything to do with medication. I can do all this myself. Somewhere in the middle is where we need to be. Well, the physician scale is not very different. You know, you've got on one end, the physician that's giving out medication like it's a Pez dispenser. Yeah. And I think, honestly, more dangerous.

What's wrong with Pez? I ate that when I was a kid all the time. It depends on what's inside when you, when you said. I haven't heard that phrase. You're about my age. I haven't heard that. I don't know, do they still make those? I'm like.

I have not seen them nor have I looked for them. No, no, no what that is. There's a little thing you had when a kid was like a little device that popped out a little candy. And you could just pop it in and would pop out of candy. It was like, oh. And that's exactly how that is. they hand them out. And at the, you know, at the other end of the spectrum, and I think this is actually a much more dangerous mindset for physicians, is, well, just watch this and wait. You know, you're doing great. Continue doing

what you're doing with abnormal labs. And the problem is that's, that's like patient-centric care masquerading in this other form. And in the end, these are risk-benefit decisions, right? Like, yes, do the foundational things, do all the things that you need to do. But if that's not working, you don't leave your patient at risk. So both of those things are really at center line is where they belong, somewhere in the middle. It's true. There's a real need to know what your numbers are and use those to guide you as opposed to, you know, just you look fine or your basic cholesterol panel is fine. Because that, like you said, for you, yours was a little off, but it wasn't terrible. That's right. And I think that's the way that's for most people. And so I think the key here is tracking your transover time, because if you were 30 and you track your numbers, you'd probably

start seeing them go a little off. Yeah. And then by the time you're 40 and then 50 and then, you know, you're getting into your upper 50s, then you really already have the disease. Like you already had a problem. So really you wanted to start checking this earlier, right? For sure. And I think that my personal mindset is that atherosclerosis is something we have. It's not something we get. You know, if you look at autopsy studies from three-year-olds, there's a fatty streak in the aorta. If you look at the P-Day study, you know, autopsies from trauma in the field, 18 to 35-year-olds have early changes in their coronary arteries. Now, none of those things are causing any problems at that age, but the propensity for that

is already there. Our goal is to get the runway out as far as we can to not have problems. How do we make choices that push our body in the right direction, not the right? How do we stay in that? That's the thing. So right now, we know enough. Like, we know. enough what to track, what to measure, how to test people. For sure. We can talk about imaging a little bit, but we also know that cardiovascular is mostly preventable.

I mean, I remember learning about William Osler when I was in medical school, and he was when, you know, the first textbook of internal medicine. He was at Johns Hopkins, this kind of very iconic physician we all learned about. And I remember reading about how when they would have a heart attack patient, it was a huge deal, and they would have a whole staff run, the medical students, the residents, the doctors, the attendees would all come around and see this patient because it was such a rare condition. It was rare to have a heart attack back in 1910. Sure. You know, maybe if you were eating really crappy diet, which was unusual. Because you could, yeah, if you were rich and had a lot of,

you know, money, you could buy a lot of expensive, you know, starchy foods, whatever, I don't know. But the point is now it's so prevalent and we have to sort of be more diligent about actually helping people map out what their history is over time and tracking that. But what are the factors that people should be paying attention to because this is really a preventable condition. I mean, you saying you want to take heart to from number one and number two, what would be required to do that? Yeah, I think you started the foundation, and this comes back from, you know, my time with you at the Functional Medicine Conference back in, you know, 20 years ago.

Yeah, yeah, it was in Baltimore. We were young bucks. Yes, yes, I was going for early morning runs around Baltimore. It tells you I wasn't so smart then either. But really start with the foundation. pieces. And, you know, I remember a friend of mine said, he was a wise, is a wise gentleman. He said, you know, if a farmer looks out on his fields and all of the, if all of the plants are sick, if all of your crops are sick, where's the first place they look? It's in the soil.

What are we feeding the plants? Sit in the airport and watch, watch our fields go by. So I think that, I think, being mindful of what you're putting in your mouth, focusing on a Whole Foods diet, limiting ultra-processed foods, you know, limiting, limiting saturated fats in your diet. You've got to be so careful these days with the, you know, the really kind of more fringe type choices, the more extreme choices, because you always have to be careful what you're substituting things for, right?

And so I think that that's a great place to start because it's something that we have such control over. right? And I think our gut is such a primary source, not that we understand the microbiome fully by any stretch of the imagination, but I think the principle really holds, you know, what we feed ourselves is our cells is the information that we're going to give our body to live on. You can connect those dots. I think most of us can connect those dots. And when you're thoughtful about it, you just feel better. I mean, I've had personal experience with that. clearly movement every day is critical both aerobic training and strength training.

They're great independently, but compound dramatically when they're put together. My personal Achilles heel, sleep, you know, I can tell you when your sleep is off, everything is off. And for me personally, it's the hardest because, you know, I can control what I put in my mouth. I can push myself to go to the gym. the harder I try and control my sleep, the worse it gets. So I've had to change my relationship. What have you done that's helped it? The biggest things I've done is changing my sleeping environment, dark, cold, taking a hot shower before bed so that I know that my body temperature is going to drop to help going to bed at the same time every night, setting alarm to make sure I'm going to bed at the same time, as well as waking up at the same time, trying to get outside as much as I can just to get sunlight in my eyes.

And can I tell you that it's perfect? no, is it a lot better? Yes. And again, know your numbers. You know, I've followed, I've been following my HRV, my heart rate variability, which is a wonderful indicator of your autonomic nervous system. Since you are pushing me for my numbers, I will tell you what they were and what they are now. My HRV was running between 15 and 17. Yeah, yeah, yeah. That's love. Yeah. And, and now I'm running in the mid to upper 30s. And occasionally I'll hit a 50 if I really am well hydrated. So I'm on the right track.

But is it, is it, no, it's not. It's always a work in progress. I am definitely that. So really this whole epidemic of heart disease is largely preventable. If you address diet, if you exercise, if you sleep, if you manage stress, if you avoid smoking, if you manage your blood pressure, which also is a big factor. And it's very much related to insulin resistance and pre-diabetes. this whole same phenomena is what causes high blood pressure.

So these aren't all separate problems. Blood pressure and heart disease and high cholesterol. They're all like, they're all kind of one thing. Nothing happens in a vacuum in the body. You know, it's one big ecosystem. And so when you start to knock off all these factors, you can start to really change things. And then also, you know, connection, community stress is a big factor.

I think a lot of people are lonely in that it's like smoking 15 cigarettes a day in terms of its effect on your health. And there's some very interesting studies looking at the gene expression patterns under stress. When you're lonely or isolated, you produce more inflammatory genes expression. So you have more inflammatory proteins out there in your body and causing more damage. And we know heart disease is an inflammatory disease, right? For sure. Maybe we talk a little bit about that because I think, you know, we used to think that it was just plumbing problem.

You know, you're a plumber essentially. You're like, oh, I am. Do cardiac bypasses and open up arteries and. fix aorta's and fix, you know, memorable arteries and all these things that they get clogged up. And so it's kind of like a plumber going in and rerouting the pipes or opening up the pipes and cleaning them out. And the truth is it's not necessarily just a plowing problem. It becomes a plumbing problem, but it starts off as an inflammatory problem. And there's ways to check that. So tell us about the role of inflammation and heart disease and also about how do we measure that.

So I want to separate the roles of inflammation and heart disease because I think that there is a bit of a misconception in the lay public when it comes to how we think about systemic inflammation versus specifically what's happening at the arterial wall. So when we talk about the inflammatory process specifically when a plaque or a blockage is forming, the wall of the artery is penetrated by an apobie-driven molecule, lipoprotein, if you will, that then sets off a cascade of event. one of which is an intense inflammatory reaction in the arterial wall, which draws those inflammatory cells into that area, which then starts this cascade of collection of more cholesterol, a healing process that then starts, and it's that healing process many times where we start to

see the actual stenosis forming. So we have a local form of inflammation that's result of an injury repair pattern, if you will. But the question is, what made the arterial wall vulnerable at the first place? And that, I think, is a distinction that people don't truly understand. Right. So if we break down what's actually happening, there's two components. The artery wall is being attacked. And then it's the integrity of your endothelium or the intima, the inside lining.

that is either capable of fending that off or it's vulnerable. So it's the balance of those two things. I think that you have to kind of separate what's happening from an inflammatory standpoint. Because if you talk to a pure lipologist, they're going to tell you, CRP doesn't have anything to do with, you know, creating a stenosis. Well, specifically, they're not wrong. You know, you can't, having that inflammatory process in the wall of the artie isn't going to show up on a CRP.

Yeah, but the CRP tells you what the general environment is. What the general environment is. However, my perception of how to utilize this is it's an indicator of your endothelial resiliency. What are the things that are keeping the endothelium intact that are guarding against those outside forces? And when you have insulin resistance, metabolic syndrome, and inflammatory factors, those are, look, we know that just elevated chronic glucose alone is impacting the vessel wall. Again, making it weak, making it more susceptible.

And that's why it's an equation, really. It's more of a heuristic than it is an equation because it's more of a guide, you know, just to understand that these are balances. So when we start to talk about those things like what can we do differently, exactly what you said, how do we put the fire out that is creating this vulnerability that then creates a ripe environment for injury to the wall itself? Yeah, I mean, I think that's an important distinction between, you know, the inflammation happen at the local level and systemic inflammation that sets the stage for things to go wrong. Yes. And you talked about insulin resistance, pre-diabetes, insulin resistance, belly fat, those, that belly fat is, producing a whole cascade of inflammatory molecules is spewing out through the whole body

and is causing havoc everywhere, including on your arteries. And that's, you know, that's really people understand that sugar is inflammatory. That sugar and starch are inflammatory. And that's a lot of what's driving. And obviously it's pollution, it's stress. It's, you know, microbiome. There's a lot of other factors. But that's predominantly what it is.

And I think, you know, most heart attacks probably before the last, you know, 60 years were probably not metabolic syndrome. They were probably different. Yeah. You know, they were smoking. they were, you know, people were thinner, they didn't have all the sugar and starch. I think it's changed.

I think you should be looking at it. It's changed. And what's interesting is that doctors aren't measuring insulin and they're not measuring insulin resistance. Mine had never, mine had never been measured. Yeah. Until.

And here you are, a cardiac surgeon, and probably the most important predictor of whether you're going to get a heart attack is your degree of insulin resistance. And yet it was never measured, which is just sort of staggering. There's actually a new test that we offer through function health,

which is called the insulin resistance score, which is a, it's, it's the most accurate measure of insulin resistance that we have now, other than more of an interventional lab test, which is called like a euclycemic clamp test, which you wouldn't do is in a research study. But it's, it's better than the calculated version we used to call Homa IR, much, much better than that. And you can now measure using a C-peptide level and an insulin level using mass spectrometry. And we offer it through function health. And it's, it's amazing to see how, you know, where people are on the spectrum. And then you can actually monitor it, like an A1-6.

and see how it changed. And I think that that's been one of the biggest limitations with the insulin level is the lack of standardization across labs. You know, what do the numbers actually mean? What's the standardization? So I think to have something that's got some real data behind it's going to be really powerful and something that we can actually count on. Yeah.

It's pretty exciting. So now with the deeper diagnostics, with becoming more affordable, with accessible, diagnostics, people can actually know what's happening. And I think people should start early, like get a baseline in your 20s, see what's going on. You know, and I think, you know, the heart imaging era is also changing. So before you'd have to do an angiogram,

you have to stick a big catheterine, and guys growing, you'd have to shoot dye up there, you put a lot of x-rays on, it was a whole thing. And it wouldn't that accurate tests often you'd miss stuff that was, you know, concentric plaque or you'd miss some stuff, you know, then then developed like more interesting tests, like a CT angiogram, and they now have AI enhanced CT antigrams, which are really interesting.

So you can look at soft plaque and hard plaque. And now we can do also a chest and heart CT scan, looking at calcium in the heart. How do you use the imaging, like this coronary calcium score or the AI enhanced coronary angiograms on CT scan? How do you use those? So I think that this is, this is very much an evolving, an evolving space very, very quickly. And as you pointed out, it kind of started with the early, the early CT calcium scoring only than to CT angiogram, et cetera.

Now, I will say that coronary angiography is still the gold standard with FFR measuring, measuring actual drop in pressure across stenoses or questionable areas, using intravascular ultrasound. I think that there are ways that, again, like the imaging has progressed for the less invasive or non-invasive. It's also progressed. It's also progressed on the other side to address the things. So I think these things are complementary. I think that for sure, until we added CT angiography, really knowing, soft plaque is so important. Now, knowing calcific plaque burden is helpful as a screening test if you're

out totally normal or on the other end of the spectrum. It can get really gray and can really confuse things sometimes in asymptomatic patients without any symptoms that are in that middle ground. It can, you know, it can, it can require further investigation. But as the- Like a CT-engineer. Exactly. Yes. It's a good screening test. That's exactly right. If it's that normal, you want to follow up. Exactly right. And now with this AI component, I think it's going to, when you can digitize the information

and you can actually not miss the calculation, it's not, it becomes less of a subjective reading and more of an objective reading when it comes to actual measurements, the accuracy, I think, of those tests is going to change dramatically. Now, how is that going to look clinically? What is that going to look like for outcomes? all of those things, or that's why I say, I think it's just an evolving space right now.

And it's important because, you know, I'm sure you've seen patients like this, but you know, I have patients who have perfectly normal labs but have plaque and clogged arteries and people who have, even the labs you'd expect would be abnormal, or people who have terrible labs

and whose arteries are normal. Yes. And I'm like, wow, you have a high particle number, you have high APOB, you have high LPA. I'm like, you should be having a heart attack right now, but you're 65 and your arteries are clean. Yeah. So I think, for me,

What it's taught me is that I can't really put people on a lifetime prescription or a medication unless I know the anatomy because cholesterol is a risk factor. It's not the problem. It's a risk factor. And sometimes it's high. Sometimes it's not. Sometimes treating it isn't the real solution is figuring out what the other causes are and treating those, like, insulin resistance.

I think you make a great point. I mean, it's like every decision we make in medicine is a risk. benefit decision. And you have to make certain that you're maximizing benefit and minimizing risk and you're mitigating in favor of that patient. And you can't rely on just one number or even two numbers. You know, each patient is so dramatically unique and different. Just because there was a pulmonologist who said to me years ago, he said, Jeremy, the protocols are the practice of medicine, knowing when to and when not to apply those protocols is the art of medicine. And that's what you're talking about. Yeah. It's like if you followed the protocols, and there's nothing wrong

with that, we all follow the standard of care protocols. Those are our guidelines. But if you plugged that patient into the protocols, you would have put that patient on medication right away without any additional information. If you would, because, but you were thoughtful about that particular patient. Yeah. And I think. that that's so incredibly important, you know, and one of the things that is of concern for me as I look at medical education moving forward, because there's such a high reliance on protocol-driven medicine, which is wonderful. Well, it's the baseline.

It doesn't, but it doesn't go deep enough. It's a place to start. It's a standard protocol. You're not getting lipid fractionation. You're not checking people, but you're not checking up you let alone. you're not checking in some levels, you're not checking in some resistance scores, you're not checking all these other things

that are so important that have to be part of a full clinical picture to make a decision. Right. That's what worries me. It's not that it's not the good starting place. It's just inadequate. Yeah. Yeah, I think that's, yeah, I think you're right.

It's not that it's wrong. Like, my medics right now is LDL's high statin. Like, that, to me, is completely screwed up. It's not wrong. It's incomplete. Yeah. You know, I think is the way to look at it. And, you know, at some point, you know,

maybe listen to the paper. patient. Yeah. Examine the patient, you know, do the things that you be a doctor first and then understand how to put all these things together to make the best decision. Discuss it with the patient, God forbid, you know, and let them be a part of that decision-making. And I, you know, I think that's one of the great things about function health, right? It allows patients to regain a fair amount of agency in their own health care.

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It addresses some of the gaps, you know, some of the gaps that are out there in terms of how we're trained as doctors, how we approach prevention. We're kind of in a reactive system, not a proactive system. And I think about heart disease, I mean, by the time you have plaque, it's late in the game, when you have a, like what you had with the symptoms of chest pain, needing a stent.

I mean, that's kind of down the road. Yeah. And who knows what would happen if you would have found this when you were 35? And you'd done a heart CT where you did a calcium score and you had your APOB checked

and your insulin checked. You're like, oh. And I think that's where we are now in medicine, which is that we have to have more agency as individuals and not just rely on the healthcare system because the training's going to take a few decades or generations to change. It takes a long time for medicine to change.

It's turning a battle ship. You know that better than I do. Yeah, I tried. I was Cleveland Clinic for 10 years. It was a very big battle chef. Yeah. And they were very open. It was great.

We did a lot of great work there. But it was also, it was very hard to get people to change how they think, you know, to really do more of a proactive approach. I want to sort of talk a little bit about this set of idea about this person who looks healthy, having a heart attack, and what you would advise people to sort of check. Because, like, you know, for me, like, I exercise them, you know, my body bad is 10%. I eat healthy, like, I shouldn't really have a problem. So why would I bother checking?

But actually, I did check. And because of my family history, like everybody in my grandfather's side, dropped dead in their 50s. I'm like, I got a problem. So I had to manage it. And I think, you know, I wouldn't have thought I would be a person who would have high risk, right? Because I've been running since I'm 14 years old.

I've been eating healthy my whole life. I've been, you know, just, I mean, yes, I'm stressed, like, and sleep issues because I'm being a doctor and life in general. Like, it was interesting. So what would you advise people who are listening who think they're healthy? What should they be doing? What should they be checking? What should they know?

And when should they start doing it? Let's start with the simple things first. Get a blood pressure cuff at home and check your blood pressure. You know, if you can't do that, find a friend that has a blood pressure cuff and take it on a regular basis. You know, it's really the silent killer for a reason because it's not a problem until it's a problem. most 50% of Americans have it and many Americans don't even realize that they have it. And it's the most modifiable, the most easily modifiable cardiovascular risk factor that we have. And it's just back to that same tenant. If you don't measure it, you don't know. And it's so easy. And doing it once at your

primary care visit is not enough. You know, you need the 722 rule, you know, for seven days, twice a day, two measurements, record them, take an average. That's what your physician really wants to know and what they need to know to be able to come up with an accurate number. So I think that's a great place to start and to really potentially move the needle because it's such a significant component of cardiovascular. Yeah, and blood pressure is not just random. It's caused by certain things. Absolutely. You can actually figure out too.

Well, that'll come to the next suggestion. And this goes along with the how well, we look issue. It's not always your weight. It's the distribution of your body fat. And that's why I really recommend that people are checking their waist to height ratio. Very simple to do at home. And that tape measure is a very cheap medical device. It really is. Be honest about where it is and where you're measuring. Be at the belly button. And you don't want your number to be greater than 0.5. And that's just an indicator, again, of, you know, the amount of intra-abdominal fat, that visceral fat that functions really as an endocrine organ if we look at it for what it's actually doing.

And again, what you're saying, it's, it's a, there's drivers of all of these things and they're also interconnected. So I think those are two very simple places to, blood pressure and waste. Blood pressure and waste. And then you get down to, and waist to height would be waist in inches and height in inches. That's right. Or centimeters in both. Yeah. You know, just keep the units the same so that you make sure it's an actual ratio. It should be less than 0.5. Exactly. And that gives you something to really follow and track progress, both blood pressure

and something that you can do at home. You don't have to go to a physician's office. You don't have to do any of that. You know, from there, I think we look at some of the specific labs that I think people should be checking. I think an APOB is crucial. LP. Little A, for sure, at least once.

in your lifetime because it is a genetic factor. I think that menopause may change those numbers slightly. So I think for women, directed by your physician, it may be best to do it pre or peri or perimenopausal and after menopause as well. There may be some ways to modify that. There's also new drugs that are coming around that might be helpful for that.

And absolutely. And now they're coming out of phase three clinical trials. It'll be interesting to see where those end up because the question, of course, will be just because you can lower LP. Little A, what are the outcome studies that are going to be as a result of that? But story still to be told and very promising, which is great. I think that that's very useful. I think knowing your hemoglobin A1C and some form of fasting insulin is just really, really important. And I think if those are really the core that are not on a stanchis, panel at all. CRP is kind of plus minus. I think there are a lot of primary care who are starting

to do it. Those are really not. Unless there's some trigger for hemoglobin A1C, they're just not. They're just not checking it. They're just not checking it. Mine wasn't check. No knock on my primary care physician. Because I'm sure we're just not trained that way. And these are, these are really affordable tests. I mean, they're all included with all the things you mentioned are included with a lot of other tests like 160 tests for literally just a dollar in day, 365. $25 a year for twice year testing. It's not free, but it's not that much, considering when people spend money on coffee and whatever they spend loosely money on,

it's investing in your health. And, you know, sometimes the doctors won't do it. I met with the dean of the medical school in Bentonville, the Dallas Walton School of Medicine. And she's, she was, I think a, gynaecologic oncologist, and she said she's, she's an Indian descent from India. She went to the doctor, to her cardiologist.

She said, I want you to measure my insulin. He's like, no. And he wouldn't do it. And he's like, yeah, well, we know it lower body weights. We get more insulin resistance, so like, I want to check it. And he's like, you don't need it. And it was just that level of this, she said, she went to her doctor and said, I want to get my vitamin D checked because I don't feel so great,

I'm not tired. So you don't need it. She said, I don't care. I want it. She said, my insurance won't pay for it. She said, I don't care, I want it. She got the vitamin D, and it was zero. Oh, wow.

Because she was, you know, dark skin, lived and worked inside. Right. Didn't go out much, you know. So I think we're missing so much. And that's, you know, really why a company like Function Health that I co-found has really started to give people agency to go and no, what's going on to, they'll not have to be someone like you who's, you know, at 57 has blocked arteries and wish they could have figured that out sooner, right? Absolutely.

Hopefully your son's getting all those tests. Oh, and then some. I think he is going to be a lypologist before the end of all of this, I can tell you, because he probably knows more about lipid metabolism of genetics than I do at this point. Is he in medical school? He is not. No, he is not. You know, you spend a lot of time fixing damaged hearts, like, literally.

And you now want to help people never have surgery. So how do you think about really putting that mission and moving that into the world? Like, coming out of my podcast is great. You're writing a book. You have a website, you have a podcast. But how do you see kind of doing this for yourself? Well, I hope that sharing my story and being willing to allow people to peek behind the curtain, if you will, and admit that none of us are immune, it may not prevent people

falling into that cognitive dissonance gap, but you will think about it, you know. So my hope is that I can. raise awareness. And then by really trying to communicate relatable, high-quality, health, and wellness information that's really tactical in people's lives, you know. And the world that we live in right now is so maximized, maximize, maximize, maximize, maximize, that everybody feels like they're taking a test. And if they miss one thing on the protocol that they failed at that, And just give everybody an opportunity to let their shoulders down a little bit. Take breath and know that if you miss one workout, you haven't failed.

You're just going to come back the next day and start over. And to help people really integrate that into their lives, the really foundational pieces. And then helping them understand, well, what's the next layer of that? Okay. You've done the work. Check your blood pressure. Check your body fat distribution. check your labs.

You can't fix what you don't measure. Be proactive about, you know, atherosclerosis, which is something that we know we're born with, something we have. It's not something we get. We get the problems. Can we keep inflammatory factors at the lowest? Can we keep our insulin levels where they need to be

so that we don't have problems at 57 years old? Yeah, true, very true. All right. Let's do some rapid-powered questions. You ready? I'm ready. Okay. So what's the single biggest mistake people make when it comes to heart health? They think it's not going to be them. Yeah. They convince themselves that I'm fine. I'm fine. Yeah. It's just not going to happen to me. That's an important one because a lot of people stick their head in the sand. They wait until it's too late. And medicine just doesn't seem to focus on prevention. So what's one heart health myth you wish would just go away?

The one that I deal with on a regular basis is that patients that come in with heart disease and get a stint or bypass surgery, think they're cured. And I always tell people, we're not treating the underlying problem. All we're doing is getting you out of trouble. You now have to do the work because the process is still going on. I think when you crack somebody's chest, they change your lifestyle, but often not. Most of the time not. Because I think there's a misunderstanding that they think we've cured the problem. That's right. And really all we've done is gotten them out of trouble. We can save you. We can't heal you. But when you tell them that, do they get it? It depends. I mean, I lay it out. I say if you're going to continue to smoke, all bets are off. We've taken all this upfront risk. I'm not going to soapbox you about smoking. This is your decision. These graphs could be down in six months if you continue to smoke. We've taken all this upfront risk for an operation. You don't want to be back to do it again. But I think that's one of the things. It's more of a misunderstanding than it is a myth, but it's become kind of the perception.

What's the most underrated habit for preventing heart disease? 10 minute walk after meals. 10 minute walk after meals, why? Because it keeps blood sugars under control. There you go. It keeps your blood sugar and insulin. Yeah, because your muscles can take up glucose without actually needing insulin, which is amazing. But insulin obviously helps, but it's true.

I think it's a very simple habit. What's one food you wish people would eat more of? Fiber. Fiber. Why? Well, because it helps control blood sugars. it helps with cholesterol metabolism. It satiate you.

And so you eat less. It's, look, it's not sexy, but... And it's good for your microbiome. And it's critical. I agree with you. It's critical for your microbiome. I agree. And the side effects of eating fibers are eating a lot of other plant foods. Exactly.

So it's like, how about what do you wish people eat less of? Saturated fats. Saturated fats. Okay. We didn't really go into that too much. But, you know, there's been a lot of controversy about saturated fats. Yeah. I'm a believer.

I think it's, you know, I love to hear your perspective because I think my understanding in literature and also treating, you know, thousands of patients is that it's so individual. Yes. Yes. Like I had a patient who, a patient who was a overweight woman. She had high-trickless rides like 300 or H-DL was like 30. Her, you know, particle number was high. She was insulin resistant.

She was pre-diabetic. She had A1C that was up. And I said, you're like, she was struggling with weight loss and just couldn't. knock it down. And I said, well, why don't you try a ketogenic diet? I put her on coconut oil and butter, saturated fat. Her LDL came down 100 points. Her triglystriac came down 200 points.

Her H2 went up 30 points. And she lost 20 pounds, and her insulin resistance went away. And she went on basically a ketogenic diet with saturated fat. Another guy was a thin biker. He was like, I heard this keto diet's great. I don't know. I want to try it. I'm like, I don't think you need it.

But like, okay, but let's monitor what you're doing. And he was riding this bike 50 miles a day. It was like super healthy. and ended up causing his cholesterol to go exactly the opposite direction, high particle number, you know, lots of small particles, high LDL. I was like, wow, okay, so there's a lot of genetics involved here, and different people respond differently. Exactly, exactly.

And I think that that's why following the biomarkers are so important, you know. But my impression is that if we look at the bell curve and we look at the majority of people on how they're going to respond with saturated fats, they're going to fall into a place of concern. I don't know that they're going to fall into those outliers. I think it's more of a more of a risk factor than not, but you don't know to you now. Okay, what about saturated fat versus sugar and starch? Who's worse? Which is worse? I mean, I think it would depend on how much of each. I think if you're going to eat only saturated fats, you better follow your barren markers very closely. If you're going to try to cut out all of those

things and you're going to shift to, you know, eating a lot of higher carbohydrate food. You need to follow there too. You need to be following your blood. I think there's a balance between those two. Yeah, check your numbers too. Yeah, check your numbers because we all metabolize differently. What about non-negotiables in nutrition? It's just like something you never do.

Mine's pretty general. I adhere to an 80-20 plan. I do the best I can 80% of the time, and I know it's not going to be perfect. So I grace myself for 20%. That's my non-in-goshable. And the 20% is what? You're not having twinkies. No, I'm not having tweakies.

It's bread or pasta or a piece of cake and a birthday party. Real food, but not ultra-processing. Exactly. Essentially removed ultra-processed. I think that should, just for you know, that 20% should not be soda or industrial processed food. Yes. Those are deadly. And they're not actually food by definition.

They're edible food product. I mean, it's true. If you look up the Webster's dictionary definition, or fungal organism of food, it's definitely not what ultra-prolose food is. That's defined as something that supports the growth in health of an organism, which none of those things too. What about in terms of exercise?

Cardio or strength training? Individually, they're strong, together. They're exponential. You know, I really, if you look at the data, the VO2 max and aerobic data is certainly very potent and significant when it comes to decrease of cardiovascular events, There's no doubt about it. We look at cardiovascular health, and when it's measuring how efficient our cardiovascular system is,

what does that equate to? That equates to ejection fraction or how much harder is being pumped out of the heart with each beat. We know that ejection fraction is directly related to longevity and survival. So the data is powerful there in, you know, connect the dots very glitter. It really is. But when you look at strength training and we talk about muscle and it being the sink for glucose in our body, it's like they're so hard to separate. I get asked that question all the time. And I just, look, we're all drawn to one of the other.

You know, I'm working with this woman now. She is an endurance runner and she hates to do resistance training. I'm like, you have to do resistance. That was me. That was me. I was 40s. Skinny could run a lot, but I could bike 100 miles. Well, because I couldn't do 10 pushups.

And I did the same thing. I was an endurance athlete, and I think that physiologically, we're very fit, but mechanically, we're not. And that comes to being able to do things as we get older, but more importantly, we know we lose muscle as we age. We know how important it is for our overall metabolism. It's true. I've indexed way more on the cardio for most of my life.

In the last five, six years, I've been more on the string training. Same. Okay. What about a piece of advice that every 30-year-old should know? That it's never too early to start because the dead lifts you're doing at 30, ensure that you're able to pick up your suitcase at 80. The aerobic training you're doing at 30 is what's going to enable you to travel and have the endurance to be able to do the things. The decisions you're making now are not going to just impact your overall cardiovascular health, but they're going

to change your functional capacity later in life. It's just... If you want to try the fruits for your labor when you're older, you have to take care of yourself when you're young. I see that often. and people like run themselves on the ground, they retire, and then they just can't do anything. That's right. What's one thing you wish every six-year-old would be able? I would flip that corner around. It's never too late to start exercising either.

And we know the data with that, right? We know that you take 55 and 60-year-olds that have never exercised in their life and you watch how their heart function changes in a very consistent, regimented program. It gets stronger. So it's never too late, but start small. Yeah.

make it make it fun pick things that you want to do pick things that are that are enjoyable for you i love i love um that's sort of like the guys of 65 never exercise starts growing and now he's like fitter than most 30-year-olds you know like he's 95 years old yeah well and remember too like particularly in the beginning that's when they see the biggest benefit yeah when you've gone from never exercising to a consistent program they get it huge but so it's never too late to start all right now as a heart surgeon what's what's one thing you avoid there's so many things i got a pick one Or maybe how about this? What's one thing you avoid that you actually like that you don't want to avoid?

Well, I'm going to, I'm going to, I'm going to zoom out way, way far on you. The one thing I enjoy, I avoid is complacency. Because I think that that's a very, very dangerous place to be. And I think that's very much where I ended up because I felt like I was checking all the boxes. You know, I was doing triathlons. I was, I was competing at the iron distance. I was doing all this, doing all the stuff. stuff, right? But I became complacent in how I evaluated things. And to me, the willingness to change

is what allows you to grow and to change and to change pass as the road changes underneath you. So I avoid complacency. That's good. I like that. I like that advice. And lastly, if there's one biomarker you get to pick as a heart doctor that everybody should check, what is it? Apobie. APO B. Okay, everybody gets their APO B done. Yeah. Okay. Great. Amazing. Well, thanks, Jeremy, for sharing your story. Thanks for your vulnerability and getting other people to think differently about this because, you know, you've been at the shit end of the stick of the plumbing problem and hard disease for a long time. And I think, you know,

waking up the fact that this is actually a preventable disease, that we actually could move the needle on this, that if people actually knew what to look for, what to do, what to measure, and how to change their habits, that we could actually beat this thing. Well, thank you so much for having me. I really enjoyed it. Thanks, Jeremy. Yeah, man. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out.

I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to the Dr. Hyman show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health where I am chief medical officer. This podcast represents my opinions and my guest's opinions.

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