Undoctrinate Yourself - #21 - Dr. Michael Twyman

Episode Date: March 12, 2025

Dr. Michael Twyman is a preventative cardiologist practicing decentralized medicine out of his private practice, Apollo Cardiology, in St. Louis. He is also a member of the Quantum Biology Collective. Find Dr. Twyman on instagram ⁠@drtwyman⁠⁠Dr. Twyman's website⁠: www.drtwyman.comFollow the podcast on Instagram ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@undoctrinateyourselfpod⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow Dr. Alexis on Instagram ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@dralexisjazmyn⁠⁠

Hello, everyone and welcome back to Undoctrinate Yourself. Today I have an incredible guest for you. This is Dr. Michael Twyman. He's a cardiologist, specializing primarily, I think you'll get into it, but preventative cardiology, and also is a part of the quantum biology collective. And so he's really jiving with my current interests surrounding quantum biology and just all of the incredible detail and potential it has to help support human health. But first of all, welcome, Michael. It's so great to be. have you on. Thank you for the opportunity. Yeah, my pleasure. We were initially connected through Gabrielle, a lion, and actually for like a family member who needed some help navigating cardiology space. And then I reconnected with you because I didn't realize that the person I listened to on Dr. Max's podcast, which was you, was also the same person I was talking to for the consulting for my family friends. So it's great that we can connect in this capacity. And I'm really excited to learn from you today. Yeah, I mean, it's a small. world and it's you know it is fascinating you go from muscle-centric medicine to quantum biology so spans all the

things so do you want to tell us a little bit about how you got into cardiology what when did you decide you wanted to go into medicine and then why cardiology to to begin with maybe then we can take it from there so i pretty much always wanted to be a doctor i think i knew for sure when i was in fourth grade and i was just naturally pretty good at science you know through high school and then we were just talking offline you know i was math almost physics major in college got all the way through quantum physics before I dropped the physics part of it because I needed to focus a little bit more in the biology and the chemistry did for my med school studies. And then went through medical school, St. Louis University, hometown. I did, you know, do a couple years of internal medicine.

I had an obligation to the U.S. Navy. I was an internist for the Navy for a few years, taking care a lot of marine recruits out in Paris Island and South Carolina. But I always knew I wanted to do cardiology after I had gone through my internal medicine training. I just found the hard to be a fascinating organ. And, you know, the day for our average cardiologist is never the same. I mean, you take care of very sick people, you know, in the hospital, the ICU. There's procedures in the cath lab. There's imaging.

There's lipids. There's hypertension. You know, so it's a whole gamut of things. I mean, it's very hard to be, you know, bored in the cardiology world. And it was doing invasive cardiology for many years. I was taking care of very sick people in the hospitals. But I always felt that it was, you know, we were kind of waiting a little bit too long to treat these people. It was very rewarding to help them.

when they're on the cath lab table, but it was like, maybe if we had you about 10 years ago, maybe we wouldn't be here in the middle of the night, taking care of this problem. So initially found, you know, functional medicine, integrated medicine, and you kind of have an idea of like, oh, well, we'll help optimize their nutrition or there's some supplements we can use. And that does help some people, but there's still a lot of things we're missing. And then at some point, it was just kind of serendipitous that, you know, I was taking a long trip to Asia, and I knew the jet lag was going to be pretty bad.

So I just found some article that was talking about wearing blue biking glasses. So got the crazy biohacker glasses and warm on the plane. And I did not understand the science at this time. But, you know, got over to Asia and the jet lag was not that bad. I was like, that's crazy. I have no idea how that works. But that's awesome. I'll go read about it when I get home.

And then that's what kind of really sent me to hand the rabbit hole of, you know, quantum biology. And then finding Dr. Cruz. And then, you know, everybody who kind of goes around in his circles, I'm like, oh, it's a little bit more complicated than just optimize. things with supplements and diet. And now that's really kind of what I focus on is, you know, how do I use my traditional cardiovascular skills, functional medicine skills, and then the quantum biology skills to optimize people's cardiovascular health. I love that. So how long were you practicing before you found the Uncle Jack and the quantum biology side of things? So I finished my

cardiovascular fellowship in 2012. So went out in practice, you know, knew enough about what I I wanted to do initially, but it did ultimately more, I wanted to focus more on the outpatients. And then it was 2017, I think it's the first time I had heard about Dr. Cruz, but then really started going down there out about 2018 with his work. That's powerful. So the first thing that you really started implementing for yourself was the blue blocking glasses and how did that transition into your practice look like? How long were you studying, let's say, and learning about these topics before you started

trying to implement some of them with, like, patients, for example? I just literally led by example. I mean, like, once I realize it works so well, for jet lag, I start playing around with it, you know, for optimizing sleep. And fortunately, I've never had major troubles with sleep other than him I was on call every third night sleeping in hospitals. But I quickly realized that, oh, if I, you know, keep the place dim at night, you know, if it'd wear the glasses, my, you know, sleep metrics would improve.

And I was a relatively early adopter of the original ura ring, which was like a giant mood ring at that point. And eventually my sleep got dialed in. It was like, I don't really need to use this. ring to tell me how good my sleep is. So I kind of abandoned the ring for a while, but I never gave up wearing the glasses, especially even in the hospital. I mean, the hospitals are some of the worst lit places in the entire world. And so I'd be walking in the ICU with the blue blockers on and people like, you know, who do you think you are, Bono or something? Like, no, this helps my circadian rhythms.

It just helps me think clearer, helps you sleep better. I don't care what you think of them. I'm going to keep doing them. And then people eventually kind of were, come around. And then you see some more of the nurses at the stations wearing the glasses when they're you know, working on the epic EMR system. And then the patients, they just expected it. Like, I was just going to always be wearing the glasses in the office. And so that's just kind of how it evolved. Like, I just never went back. And so I'm still very much with the patients circadian biology first. Of course, we're going to talk about your lipids and your blood pressure. And maybe that's even why you're coming to see me. But if we don't get your circadian rhythms right, it's really

hard to get everything else right. Yeah, absolutely. And I've found that the blue blocking glasses are a great conversation starter. And I love when people ask me about them because I'm, just always ready to burst about this information, right? Because I'm so excited about it. It's been so impactful for my life and my client's lives and family and friends. So it's like I always invite the conversation to be had. And it's great when like there's actually hard science now that backs, you know, the use of these and also just the impact of circadian biology on basically every system in our bodies. So are there some like primary impacts that circadian health and hygiene has on the cardiovascular system in particular? Well, there are circadian.

to the heart rate. Your heart rate is supposed to be dropping while you sleep. You know, the whirring does track that. You know, you also have a kind of circadian mechanism to your blood pressure. You know, your blood pressure should dip about 15% while you sleep. So often I get a lot of patients come into the office with, you know, issues with their blood pressure. But, you know, an office blood pressure is just, hey, you know, check one time in the office is not as accurate as an average blood pressure at home.

And there are devices that you can send patients. out on these 24-hour ambulatory blood pressure monitors that give you an average blood pressure without the day. But the benefit, too, is it gives your blood pressure while they're sleeping. And your blood pressure because of, you know, dips in cortisol, it should be dropping about 10 to 15 percent while you sleep. And then when cortisol starts to kind of crank up about 3, 4 a.m., you'll start seeing the blood pressure surge. And so you just want to make sure that they're not having blood pressures that say constant overnight or worse, go up. If they're going up overnight, it may be something like sleep apnea that's driving it. So then you go diving deeper and figure,

okay, why is this person not getting fully restorative sleep? Do you notice that there's, like, maladaptive changes in these markers that occur if somebody's shifting their sleeping window? Let's say instead of sleeping from like 10 p.m. to 6 a.m., they're sleeping from like 1 a.m. to 8 a.m. Is there a big difference that you see in like the heart rate or heart rate variability or blood pressure or is it kind of independent of those? I don't know if I've actually actually looked hard at the data for each patient like that. I just always kind of like sitting with a patient from me and looking at the biophysical markers that we do and then the biochemical and just coming up with a plan with them. But, you know, I usually tell you're like most people are not truly night owls.

I mean, you have to kind of play around with your life environments and then see. I mean, in my own story, when I was in the Navy, I'd stay up to midnight every night and, you know, wake up, throw on my uniform and rush into base and start seeing patients right away. And then once I kind of figured out the circadian biology mechanism, you know, my sleep really switched. I mean, I'm up by five every single morning, seven days a week. I'm usually in bed by 9, 930 every night. And so my cycles are just much more regulated to the sun now. I don't like, I'm not special. I think this is how most people are wired.

And so, yeah, I don't really comment too much of people say, hey, my bedtime is midnight. I'm like, how about we try these things? And then when they come back six months later, they're like, hey, I'm sleeping a lot better. And like, yeah, I thought so. Yeah, exactly. I feel like there's just certain times of day where we're not supposed to be up and active. And I think the advent or like the research around chronotypes in general is very much a modern thing. Like in the past, when we didn't have a lot of artificial light and stimulation to keep us up at night, there's not really an incentive, let's say, to stay up at night. You're just going to naturally get tired. You're not going to have this other light that's disrupting your melatonin and and cortisol cycles.

And so you're just naturally going to get sleepy, you know, within like an hour or two after it gets dark. And so I feel like a lot of what we, let's say, get wrong or ways that we disrupt our sleep and our circadian rhythm is just a lot of what's been normalized societally that's actually completely abnormal from an evolutionary perspective. Absolutely. Yeah. So with regards to, we talked a little bit about quantum biology or at least mentioned it. How do you think about quantum biology, just maybe in general? And then in the context of cardiovascular or heart health, are there specific areas that you see quantum biology? emerge as like a very important feature of the system?

Well, I mean, barring from, you know, Dr. Cruz, you know, talking about light water magnetism being three big levers that optimize, you know, mitochondrial biology. And that's why behind me on the wall in my office, I have a huge mitochondria on the wall. Like, we're going to talk about your lipids, but we're going to fix your mitochondria as well. And I think one of the how moments I have was, yeah, I've read, I don't know how many thousands of EKGs in my career. I never really thought about like, why is this electricity coming off the heart?

And I was like, oh, it's the mitochondrial. doing this and then researching it that there's, you know, thousands upon thousands of mitochondria per myocide. It must be pretty important to work on mitochondrial health. And, you know, if you look at, like, heart disease is still the number one thing that kills people. So in the United States, at least, every 40 second somebody has a heart attack, maybe there's something to do with mitochondrial health, why so many people still have cardiovascular disease

or neurodegeneration. So, until it's just like, you might be coming to see me for your heart issues, but if we kind of fix these, but also really decrease your risk of Alzheimer's and Parkinson's, and all the things you don't want to slow you down with your health span. So I really do focus on the light water magnetism for every patient that walks in. And is your practice primarily preventative cardiology at this point? At this point, yes. I mean, that was kind of the goal, is that I was transitioning out of my previous career as an invasive cardiologist,

was that I wanted to focus more on doing the advanced non-invasive testing to tell people how healthy is their endothelium, which I'm sure we're going to be talking about. and then using some of the comprehensive blood work panels to say like, okay, this is what's driving the oxidative stress and inflammation, and these are things you can do about it. But previous to knowing about quantum biology, my only levers were pharmaceuticals and nutraceuticals. I didn't really understand the benefits of sunlight and grounding to be able to improve a lot of these things. Now I just combined the best of all of it. And usually patients, you know, starts seeing rapid improvements if they actually follow the plans. Yeah, I love that. And it's, I mean, the more I learn about these

topics too, the more frustrating and concerning it is that these topics aren't taught in medical school when they're very foundational to just, you know, building a foundation of health. And I feel like there's such a focus on just like treating symptoms and treating like the emergent properties of the system versus like actually understanding the system and how to support it at a fundamental level. And that's why I also like totally find a lot of value in considering like light water and magnetism as these fundamental forces that are shaping the way that mitochondria are functioning. and as a result are shaping the way that the body is manifesting at the level of its health. But you mentioned like some biophysical metrics and maybe metrics.

Maybe we can walk through if you have a new client coming in. What are your first steps that you're going to take to assess this person and maybe also some approaches that you might use to leverage to help improve them, whether it's, you know, their lipids or just from a preventative state, maybe they're just looking to stay healthy if they're already healthy, what that might look like. So I tell patients, you know, you have 60,000 miles of blood vessels, which is an amazing, you know, fact. The health of the blood vessels comes down to the health of the glycopalics and the endothelium. And so lining your 60,000 miles of blood vessels is a one cell layer of thick surface called the endothelium.

It's like the air traffic controller, which determines what stays in lumen with the blood flowing and what has access to the underlying arterial wall. But a few years ago, it was demonstrated that the endothelial glycochalix is what actually protects the endothelium. And the glycochalix is a protective gel coating. You know, think if you took a fish out of water and it's slimy, that's what the coating of the glyco calyx is laying on the endothelium. You know, I tell patients, there's many things that can damage the glycochalics, but a lot of it's going to be oxidative stress and inflammation. If that glyco calyx gets shipped away, then the things that are floating through the blood, such as the lipoproteins, the white bloods, the white blood cells, they're much more likely to stick to the artery and kick off these cascades that lead to plaque building up in the arteries. So we used various tests to look at the patient's

ability to produce nitric oxide and then look at arterial elasticity. So there's a device called the max pulse that looks at when the blood's ejected, how fast does the artery expand and snap back? So elastic arteries are healthier arteries. The new Gen 3-4 ring has a feature like this. It's called the cardio age, I think is what they're calling the feature. It's just looking at elasticity of the arteries. Then we have a device called the endopat. The endopat is basically like a stress test for the arteries. So when you exercise, blood's forced over your glycochalix and then the underlying endothelium will release nitric oxide, which is the signaling molecule that dilate the arteries and push the blood flow downstream. So with endopat, we have a blood pressure cup pumped up over your

systolic pressure to temporarily cut off the flow to one arm. And then when we open up the stopcock, the blood rushes back in and you get reactive hyperemia. Essentially, the glycopalyx, gets tickled, tells the underlying endothelium, hey, here comes a big slug of blood, nitric oxide gets pumped out, and then the blood rushes back down to the person's hand. And we can measure how much is the artery dilate when this reactive hyperremia is occurring. And it should really triple or quadruple in size when that happens. Endothel dysfunction is the first sign that there's a problem with your arteries. And if you don't fix that problem, you're headed down the path where you will get vascular inflammation and potentially plaque 10, 20 years down the road. So you can

start testing people in their teens, 20s to see, do they have healthy endothelium? It's not always genetically driven that you're going to have healthier, unhealthy endothelium. It's a lot of it's your lifestyle. And now that I'm starting to understand the quantum biology world a little bit better, the glyco calyx is heavily sulfated. It's full of structured water or easy water. And easy water is heavily negatively charged. The lipoproteins are negatively charged.

Negative repels negative. So I tell patients like the glycocalyx and the lipoproteins are supposed to be like a maglev train. The lipoproteins are supposed to slide on by. But if you have high oxidative stress, if you have inflammation, if you're a smoker, which hopefully most of them aren't still smoking, there's so many things that insult the glycochalics, you're damaging that structured water. And then the white blood cells and the lipoproteins stick there like Velcro and kick off a cascade of inflammation in the arterial lining.

So it's a fascinating process. But if you kind of figure out where the person is on that pathway, you can interrupt. it and often just halt the atherosclerosis buildup process right there. And then you generally can actually see the inflammation in the plaque shrinking back. And so that is what lights me up. This is why I get up every day to do this because if we find people early enough, they don't go down the path where they're meeting the cardiologist in the middle of the night. So that's really interesting. Do we know if the glyca calyx is strictly like this easy water or are there any like musin proteins or any sort of protein composition of that like slimy coating or is it strictly water?

It made gags glycosamineoglycans. So heparin sulfate, chide droitin sulfate, dermatin sulfate. There's a lot of different other compounds in it that are part of the clotting cascades. There's antitharbin 3. There's superoxide dysmutase, which prevents the oxidative stress to the glyclicyx. So you almost think of the glycopacicase is kind of like a kind of like a, sea bed and there's different little proteins and carbohydrates there in the sea bed. And then when the glycolycic gets damage, things get released. And so this was kind of the idea behind what happened

with COVID is that the spike proteins would damage the glycochalics and then there's all these clotting factors in there. And then the microcirculation would just continually clot. And then this was particularly happening in the lung macrobascular system. And this is why these patients were significantly hypoxic. All the blood vessels were essentially occluded, a clot. Wow. And then, I mean, you think at the same time that there was so much advocacy to stay like inside when you're not, you know, able to leverage the sun to get the UVA light to support nitric oxide production. And actually, I wanted to ask you. So what in the beginnings of endothelial dysfunction, is it primarily a nitric oxide issue? It's like not being, that system's not being engaged properly or is that at the level of the mitochondria in the endothelium? Do you have any sense of like what's like the first spark that sets off this cascade? So the endothelium releases nitric oxide in the presence of oxygen and all arginine, and then the enzyme endothel nitric oxide synthase converts it to citroline and nitric oxide. But approximate at age of 40, that enzyme speed starts to slow down.

So endothelial dysfunction becomes more common as people age. But Mother Nature built in a backup pathway, this oral salivary pathway, So if dietary nitrates are coming into the system, which are mostly in dark green, leafy vegetables and beads that people are eating the beads, the nitrate reducing bacteria in your saliva breaks those things down into nitrides. You swallow them and in your stomach, as long as their stomach acid, it will convert it to nitric oxide gas, which diffuses through the gastricinicose and then goes systemic. So you have a backup pathway.

So as long as you don't break both pathways, you generally don't develop hypertension. You don't develop stiff arteries. But a lot of things people do that disrupt the oral microbiome is things that would include mouthwash, using things that have fluoride in it, using things that will disrupt the gastric acid levels, using H2 blockers, proton pump inhibitors. They break these coupled systems. And then now you have this deficiency of nitric oxide. So I would get asked by like, well, how can I improve nitric oxide?

Well, exercise is one of the best ways to do it, is you're forcing blood across the glycochiax and then the endothelium has released nitric oxide in that presence. You can try to eat more nitrates in your diet, but sometimes it's challenging to get a full bolus of nitrates because it depends on the soil conditions that the foods grew in. There's nasal breathing as the air is forced over the epithelial cells. You can get nitric oxide released. But in the quantum biology world, which I learned was that, you know,

when UVA strikes your skin, the dermal pools will release nitric oxide in response to that. So people who tend to be indoor workers and not to get a lot of UVA light throughout the day, they tend to have higher blood pressures. So those are kind of the lifestyle interventions people can do to boost nitric oxide. Yeah, that's great. And it's amazing all the redundancy, right? And yet somehow in our modern lives, we've somehow like broken all of them at once just by our ignorance in a lot of ways.

And I mean, it sounds like the perfect solution would be to do like some intense cardiovascular exercise, outdoors, nasal breathing, like in the sun, bare feet on the ground. And like, this is just like the perfect, maybe having some beats beforehand or some arginine or some precursors of nitric oxide too. It would be like the perfect stimulus to optimize that system. Correct. Yeah. I mean, it's you stack the hacks. Yeah. Yeah. And I remember actually the first time I heard, I was listening to a podcast back in probably like 2017. And there were, there was a paper that came out about use of mouthwash before like consuming. dietary nitrites and how you lost the benefit to nitric oxide production. I remember thinking,

wow, that's so striking and something that a lot of people also do unconsciously, especially back, you know, even just a few years ago when I would say more of the alcohol-based mouth washes and the fluoride toothpaste were like the only options essentially out there. Luckily, we've been moving into alternatives now, like the hydroxy appetite toothpaste toothpaste, which work amazing. Like I've seen such an incredible difference in my teeth using those as somebody who literally never had a checkup without a cavity my entire life. I always had issues with my teeth. As soon as I started like taping my mouth at night and using hydroxyapotite toothpaste, I had my first cavity free checkup in literally my entire life. So it's been life changing.

Yeah. And I know you asked a question, you know, before and online about the oral systemic link. Yeah, there definitely is a link between the health of your oral cavity and the health of your arteries. I mean, if you have periodontal disease or you have abscesses, that drives vascular inflammation. that can damage the endothel lining. And I don't remember the names of the microbes per se, but there have been previous studies where, you know, when patients were having myocardian farkins, one of the procedures is you can go in there and do a catheter aspiration

that basically use a straw to suck out the clot in the artery right before they deploy a stint of the artery, and they would send those, you know, plaques, ruptures all for analysis, and they would often find oral microbes inside of the plaques. The question still really is, is it the bacteria itself that drew the plaque to grow? Or was it the oral bacteria that actually caused the plaques to rupture? I tend to fall in the camp of the latter is that it's driving the inflammatory response that causes the plaques to rupture.

But irrespect of that, every patient I see, I always ask them, like, when's the last time you've seen the dentist? Are they concerned about anything in your mouth? If you have significant parodontal disease, there's certain markers on the blood test. One of them, L-P-PLA-2, that's often elevated. And when people say, I can't find why this is high, I'm like, go back to your dentist and have and look at something. Like, you know, there's potentially, you know, a hidden issue with like an old root canal or a bridge. Something's in your mouth that you got to go looking for.

Yeah, I was actually just going to ask about root canals because I've definitely heard of latent infections being in the mouth, especially from like root canal teeth, that is there like a direct pathway in which like the mouth drains to the heart or do you know if there's like a direct link that could cause the migration of the microbes or bacterial products? I don't think there's a direct connection. I just think it's through the macabascular circulation, just transporting those compounds through it is probably the link for it. Yeah, got it. That makes sense. That's wild, too, because a lot of people have root canals and, you know, maybe don't know if they have issues with those. And I think there's some, like, cone beam scans that can be done to look for

latent infections in the root. Also, like, wisdom teeth, too, I think, the, like, the cavitations that can form. and some, you know, it's just a, there's lots of little crevices in the mouth where problems can arise. And for the parodontal disease, so that would be like, you know, basically like gum inflammation and plaque buildup. And that's largely driven by smoking. Is there anything else that people would look out for for that? Probably just like, you know, highly processed sugar diet type of thing. You know, so does juices. It's probably one of the worst things for kind of the oral microbiome itself directly. Yeah, that makes sense. And also regarding smoking, because you mentioned it earlier, I wanted to ask, is that the nicotone specifically that's irritating to the mucosa and to like the arteries or are there other aspects

of smoking as well that are problematic? So the nicotine can vaso-constrict the arteries, but it's not the nicotine that's causing the damage. So the lining, it's the other combustants that are in the delivery system. So nicotine from a patch or gum is going to work completely differently than if it's coming through a cigarette or vaping. Okay, got it. That makes sense. So you were talking about the glyco calyx before and how the role of structured water is really important in that context. What are some practical ways that people can help to structure the water in their body? Like, is that coming from the environment through light, or is it coming from some endogenous process that's structuring that water or both? I think it's a combination of things. I mean, it's, you know,

being outside, getting full spectrum light on the skin. Yeah, the red is going to expand, the red wavelengths of light are going to expand the structured water. The UV is going to also help and then grounding, you know, Dr. Steven Sinatra, who was, you know, the basically founding integrative cardiologist. He actually heard a book many years ago about grounding for cardiovascular benefits. And most general cardiologists still have no concept about what grounding actually is and that there's actually science behind it at helping lower blood pressure, at helping balance autonomic nervous system, at improving blood flow because it helps with the heat, you know, the red blood cells not sticking together. So the Zeta potential is, you know, effective with grounding. So grounding and getting

full spectrum light on your skin is probably the best things to do at helping structure the water in your body. And then if you're inside, then this is where sauna use can be beneficial. This is where photo biodulation panels may be helpful. Yeah, that makes a lot of sense. And the best thing about that is it's also free for the most part if you're going to leverage, you know, just being outside, even on like sidewalk or pavement, you can ground through that, especially if it's wet. And obviously grass and sand. The beach is probably one of the best places we can go to get it like supercharged grounding. And then obviously the sun and we're going to get red light year round from the sky, even if it's on a cloudy day. So that's something that everybody can access. And I think that's

really important because I often feel in the biohacking space and just maybe in health optimization space, there's so much like there's so many gadgets and supplements and things that can really rack up a hefty bill. And the beauty of like the more quantum biological approach to health is that a lot of it is just really getting back to basics that most people will have access to without having to pay a penny. Absolutely. It's just literally reconnecting with nature. I mean, we just lost our way.

Yeah, the technology is amazing that, you know, we can be communicating across the world with this technology, but too much stuck inside, your mitochondria are basically disconnected from what they need to thrive. And so it's not saying people should not use technology. It just use technology wisely. And then, you know, if you're, I always tell you, I always get the question like, well, well, how much time do I spend outside? I'm like, how sick are you? If you're extremely sick, you need to charge up a lot more than somebody who's pretty healthy who can kind of disconnect

from the earth, go run for a bit, and then go re-plug back in. I often joke with people like, you know, you're not necessarily starting your day when you wake up. You're starting to do your day when you go to sleep. You go to sleep, you basically repair your mitochondria damage that you had from the day before, so you're charging up your system, and then you go dissipate it throughout the day. If you're sicker, you're going to need longer time to sleep to charge up, and you're need more light into the environment to get the mitochondria respiratory proteins to start trying to shrink back down. Yeah, that's really powerful. I would love to talk a little bit about some like testing and what like lab tests and other potential biometrics that you pull from in your

practice to help really get the full spectrum picture of a person's state of health. Do you want to dive into some of you mentioned biophysical and like blood labs as well that could be useful to look at? So for the labs, I usually kind of break it down into three buckets. You know, there's a bucket that affects nitric oxide pathways. There's a bucket that affects oxidative stress and inflammation pathways. And then there's the lipoproteins. So the nitric oxide pathways, some of the quick tests is just a urine, microabdom, and cradone ratio.

You know, almost every doctor has done this test in patients, you know, when they have high blood pressure or diabetes. You know, it just doesn't market like, well, how much damages the kidneys sensing from these disorders? but it's actually somewhat of a novel way to think about the glycochalics to the kidneys is impacted if you're leaking protein into your urine. So the higher your microabineria, the worse your glycochalics function is. So figure out what's driving that and tried to reverse it.

Because a lot of times in medicine, it's about finding what's causing the damage and getting the patient out of their own way. You can look at uric acid levels. Euric acid obviously goes up when, you know, people are abusing alcohol or they're, you know, having, you know, a high purine diet in some individuals. or they're drinking fructose at high levels. But uric acid oxidizes the glycopalix, and it impacts nitric oxide pathways.

Elevated homocysteine can cause issues with nitric oxide because it affects a compound called asymmetric dimethylrogenine or ADMA. High levels of ADMA competitively inhibit enos, driving down nitric oxide. And then you can look at other tests are just like a salivary test. We're talking about mouthwash. you know, there's salivary nitric oxide test strips that can kind of tell you, like, are you getting

enough nitrates into your diets, or are you eating enough green leafy vegetables and beads, or are you taking nitric oxide promoting supplement that gives you the nitrates? And then do you have actually the healthy oral microbiome that can actually convert the nitrates over to nitrites? There's a company working on actually being able to test what is your oral microbiome. Do you have those nitrate reducing bacteria? And then eventually there's going to be probably probotic type gums, which you can potentially chew and then try to repopulate it. So that's what you start to kind just look at from a lab test to say, okay, are you having things that are probably breaking your nitroxide pathways? The second in bucket is oxyaf stress and inflammation. So one of the easiest

marker for oxidative stress is GGT, which is on the kind of the liver function panel. But if GGGT is very high, then the person has a lot of issues with blowing through their glubothion stores. So if you don't have glutathione, a lot of other things are going to oxidize. And the patients I talk about oxidation is like rusting. You're just aging faster from the inside out. There's a test that you can look at on the bosa heart lab panels and the Cleveland heart lab panels that look at oxidized LDL, oxidized phospholipidapobee. So the lipoproteins are essentially rusting.

Those things get tagged by the immune system is foreign. And then they go to work at gobbling the stuff up and that eventually becomes foam cells. inflammatory markers are, I'll say, high sense of ECRP. It doesn't tell you where the inflammation is, but it just tells you how turned on is your immune system. And then some more specific vascular inflammatory markers, I mentioned a bit earlier, but there's one called L-PLA-2 activity. It's more of a marker of vascular inflammation, as is myeloproxidase, which if you have high myeloproxidase, you have a lot of white blood cells going around, gobbling a plaque in your arteries, most likely. Or you have a vascular immune issue.

So those are we're usually to kind of start with. And then the third bucket, which often sometimes that's the reason people are coming to see me is, you know, I have, quote, high cholesterol. And I don't be like, there's no such thing as high cholesterol. There's high lipoproteins. It's like, do you have too many lipopr proteins for what your body is doing with that information right now? So I will look at the NMR profile. So look at the LDL particle number. I will look at the LDL size, but the particle number trumps the size of them.

we'll look at the APOB concentration because APOB is on the outside of all the lipoproteins that potentially get into the arteries and contribute to plaque formation. And then there's some other novel testing you look at it. Maybe this is why this person's lipoproteins are abnormal. Is it genetic, is it dietary? And you can kind of find what lever to pull on it. But those three buckets usually give you a pretty good idea what's going on in that person's arteries at that time. That makes a lot of sense.

So with regards to homocysteine, just to go through a couple of these, what could be some drivers of hyperhomocystinemia that somebody might experience. Is it mostly genetic? Is it environmental? The two biggest ones I see are, you know, when people have renal dysfunction, if you have chronic kidney disease, you'll tend to have much higher levels of homocysteine. Another one is when people have different methylation issues. So they have a 677 or 1298 in HFR mutation.

You'll often see it in patients where they'll have, you know, relatively low B12 and folate. those are the individuals that usually benefit from supplementing with, you know, methylated B complexes. And sometimes they need, you know, trinthylethylene glycine. They may need a couple of other kind of things that help support the methyl tetarydefolate reductase enzyme, converting the homocysteine back into methionine. That makes sense.

What about creatine? Does it have a role in there? I don't know if it does or not. But, you know, that is an excellent supplement for most people. Obviously, great for muscle health. and also, you know, it's a kind of a cognitive booster for many people. It just helps mitochondria make energy more efficiently. Yeah, so I remember reading a paper back in grad school that was pretty striking and you

might find it interesting. And it was on creatine, the burden of creatine synthesis on metabolism. And it showed that let's say no creatine is coming in through the diet because you're not eating animal-based foods. Let's say you're on like a plant-based diet and you're not getting any creatine in that way. Up to 45% of the labial methyl groups in the form of like esedonyl-methyle methyan could be used to make creatine alone, which I thought was striking. And so I was like trying to connect some dots because if we're, let's say, maybe not getting

in enough through the diet, if we're going to add it in as a supplement, that might free up some of those methyl groups for use elsewhere. And actually, maybe do you have some thoughts on like, if homocysteine's going up, it could be either a high demand for methyl groups or low flux through the pathway that's causing it to accumulate? On the demand side of things, what are some exposures that people might have or environments that people might encounter that could drive up the demand for these methyl groups? I honestly haven't thought too much about it.

I'm fortunate that like in St. Louis, and there's a lot of other functional medicine doctors, and so if my kind of low-level knowledge is a cardiologist and how the methylation path the way it works doesn't get them to optimal, I'm usually referring them on at that point. Are there people that you see that if they're using, let's say, methylfolate and a B-12 and their homocysteine doesn't move? Is that something that you see? And like, is there anything that you've connected the dots with to suggest why that might be the case. I haven't yet, but I'll definitely have to be looking at them. I mean, I've not actually thought about a quantumology connection to it, but I'm sure

there's got to be something that is driving it. Yeah, I think it's interesting. And somebody that I know personally is kind of dealing with it right now, so I have a vested interest in getting to the answer to that question. So let me know if you find anything. On the lipid side of the equation, do you want to unpack a little bit about how the perspective or your perspective on lipids and cardiology is evolving. Do you see LDL cholesterol or LDL particles as a sign of a deeper issue,

or is it pathological in and of itself or a combination of both? I think it's a complex topic that sometimes there's not enough nuance because people want to bucket it down to that cholesterol should be eliminated from the system and cholesterol doesn't matter. And it's more like it's always in the middle. And so I always tell patients it matters what are your arteries doing with what's floating through your blood. And so I really believe it comes down to the health of glycolics and then the endothelium.

If that layer is healthy, that layer is going to be repelling the lipoproteins from sticking to the artery in the first place. Now, they're people who have genetically high lipoproteins. They have familial hyperlipidemia. If they have homozygous ph, you know, they develop adioscrosis in their teens in 20s. And they're not smokers. They're not somebody who has things that. otherwise would significantly damage a glyco-calyx.

It's just overwhelming burden of these APB particles crash in the glyco-calyx. So I'd just talk about it as like potential. You know, it's shots on goal. It's, you know, basically like, it's probability. It's not guaranteed, but the more particles that you have, the more possibility that they are getting attached

to the glyco calyx endothelium, intemal lining, and kick off this cascade where vascular inflammation and plaque builds up. So I usually will have patients come in, we'll do a biomarker test, and we'll look at these lipoproteins. But there's other testing you can look at. You can look at this cholesterol balance test, which shows lanthosterone and desmastral levels. If those are elevated, then that person's a hyperproducer sterols. They use more in their liver, so they're cranking out more sterols, so they have to make more lipoproteins

that ferry the cholesterol through the system. Then there are people who have issues with their LD receptor. The Ldereceptor sits on that side of the liver. It's like a docking station and then grabs these lipoproteins as they go by and pulls them in, breaks them down into their constituent products, puts them into the gut, and the body's supposed to eliminate it. But some people hyperabsorbed those sterols from the gut. And about 20% population this happens. So you can look at the beta-sidic sterile levels on the Boston Heartlight panel and say,

oh, this person's a hyper-absorberer of steroids. This person would likely respond better to a medication like a Zetamide. Close the Neman-C1-like gates so that that cholesterol doesn't go back through the portal circulation. So I usually talk about with patients like think of cholesterol as water going into a batham. You need a certain amount of water. You just don't want the water to overflow. So how do you prevent the water from overflowing?

You can reach in there and dial back on the faucet, the production markers. That's using statins. there's a new medicine called bentipidoc acid or nexitol. The supplement way to do that is reddish rice or bergamot, but you don't want the sterols to be totally off. If you shut desmosterol too much, you're much more likely to cause brain fog and other issues. So you just want to dial back a little bit, if need be.

There are certain people that just really can't get the water out of the bathtub. Their LD receptors don't work well. You know, patients with an APOE4 allele don't make as many LDL receptors. So even if their liver doesn't produce a lot of, sterile particles, they can't get them out of circulation. So they're just whipping around their arteries just trying to find an offram. But eventually, they get out of the drain. And then some people, the water is in the drain and supposed to go out to the sewer.

That sewer is plugged. This is where a Zetamite comes in, opens up that sewer and gets the water to flow out. So you usually can figure out which supplement, which medication, which lifestyle intervention may have the most effect for that person. And then there's a whole host of genetics. I mean, there's probably 3,000 genes affect lipid metabolism. And I can't say that I'm smart enough to understand all the 3,000 genes, but I usually buckets down into one of those three kind of mechanisms in action.

They produce too much. Their other receptor doesn't work very well, or they keep hyper absorbing the sterols. And then you come up with a plan for them. So for the people who don't have FH, does it seem to be the case that we see that like decreased scavenging from the gut or from the liver is influenced by like liver or gut changes in metabolism. So let's say like insulin resistance at the level of the liver, does that change the receptors ability to translocate into the membrane to pull LDL particles out? Is there like an inability to sense adequate sterile levels coming in? And then we're producing more as well on that side

of things. Is that something that you see? It's often a marker that's like, you know, when patients come in for, you know, myocardine infarctions, half the time, their lipids are normal. They don't always have lipids. But once they're in the ICU for a couple of days, if they have a really bad heart attack or they're in the hospital with substance, their lipids are going to be sky high because the lipids are part of the immune system. They're going out there to scavenge and try and figure out what's going on. So you do have to kind of look at the context of like, what is the person's kind of homeostatic load at that point? If they're significantly insulin resistant, well, insulin resistance is doing many things throughout the system. Insulin is like one of the

biggest things that's going to knock down the glycochalx. You start becoming insulin resistant, You start making more, more triglycerides because you can't get more fats into the fat cells. And you've got to wrap them up in more VLDL particles and those VLDL particles and eventually shrink down to more LDL particles. So, of course, if I see insulin resistance, you start attacking there. And then you generally are going to see the lipoproteins starting to shift back into a more favorable pattern. But, you know, there's no such thing as, you know, a perfect level of lipids. It's, you know, what does your body need at that time? And if you're significantly inflamed, your lipoproteins are going to be much higher.

Well, go fix the underlying inflammation. That's the way I kind of think about things. That makes a lot of sense. And you said insulin, does insulin directly impact the glycochalics, or is it elevated glucose levels that tend to go along with elevated insulin levels that are impacting it, or is it both? I believe it's both, actually, damage the glycocalyx. Yeah, that makes sense.

And the endothelium that lines the arteries is also mitochondria-rich, right? I believe it does, yes. Yeah. The only thing it doesn't is the red blood cells. Yeah. Yeah, that makes sense. So you mentioned statins. There's different types of statins. Is there, is it the case that certain statins that are more lipophilic can impact the brain more negatively versus some of the more hydrophilic statins or is that something you've thought about? I've definitely thought about it. And that's kind of how I do practice. I don't know if the research fully backs it that way, but this is my clinical experience. I tend to see that the ones that are more going to be fat-sliable or the ones that are more likely to cause the brain fog type of side effects.

So my practice, I tend to use more resubistan, which used to be Crestor, or use Pravstan, Pravacol. Those are the two ones that I see less side effects from it. But that's a good question. I often get many patients coming in saying, like, either I can't tolerate stands or I just don't want to take one. Well, you can't tolerate one. That is often due to them being vitamin D deficient.

If you're vitamin D deficient, you will almost always have muscle symptoms on stance, no matter if it's fat soluble or water soluble stance. So optimize your vitamin D with doing things like you're doing right now. I usually shoot for a vitamin D of 60 without supplementating people. Then the APO-E-A-A-4 allel carrier, you're probably not going to tolerate high-dose stands, if stands are recommended to you. So use lower doses. And then a couple other things, if you're hypothyroid, if you have low co-inzyme Q10 levels,

you're going to have more issues. And then there's a gene called SLC-O-1B-1. if you have one or two copies of that gene, it increases your risk of muscle symptoms from statins three to four fold. So it's not saying you're allergic to stans, but you should be much more mindful. Maybe this person is only going to tolerate five milligrams of a suit stent. Maybe they don't tolerate five milligrams twice a week. Or if they just can't tolerate it, there's PCS can I inhibitors, the bipedoric acid,

there's azatomy, there's other tools to be utilized if you need to do this. The second part is when people say, do I need a stand? Nobody ever needs anything. You're just trying to lower risk when you see the risk that it's like there's still a five-horm fire. Sometimes you've got to put the fire out and then figure out, okay, this is what the fire is caused by. And then if you've cooled it down, maybe you don't need the stand long term per se. But there's definitely data that the stands can decrease the lipid-rich cores of these plaques, one to two percent a year if people will continue to take them.

But not everybody can tolerate them. And I understand that. And I'm not going to tell people like, suck it up. You got to take it anyway. We'll find another option for those people. Yeah, that makes a lot of sense. Is there a cutoff that you use or is it really just person by person where it's like if their cholesterol is over a certain amount, then we're going to use, we're going to try to use a satin versus if it's under a certain amount, then we're going to leverage lifestyle approaches first and see how it goes. I actually look more at, you know, how much plaque is in their arteries. I mean, you can use the CT Corny Calum Score is a good kind of starting point for people. The calcium score test is about a $100 test that tells you, do you have any calcifications in the walls of your three corner arteries?

the answer should be you should have none. But if you live long enough, your calcium score is generally going to be positive, which is what decade of life is it going to become positive? And it is relatively logarithmic. Yeah, if your score is zero, your risk of a heart attack over the next 10 years is about 1%. If your scores between 1 and 100, it's about 4%. But if your score is over 1,000, it's about 30, 35 percent you're going to have a heart attack unless you do something about it.

And it's not the calcium. That's the problem. The calcium is just a marker that you have plaque in the artery. reason the body formed a scar and part of the scarring process is that calcifies. What you're worried about is the soft plaque or kind of like the more lipid rich plaque. It's that soft plaque that's much more prone to rupturing. And when that plaque ruptures, it's kind of like a pimple popping. Then the blood clots and now you have 100% blockage. So you're just using the calcium score test to put people into those risk buckets. Okay, you're low risk. Work more in your lifestyle.

Do all the quantibology stuff that we're talking about. But I saw a patient today. You know, Kasm score is 1800. I was like, you really should be on a stand unless you can't tolerate it because you've got to put out all the fires. You know, you have such a high plaque burn right now that the risk of a heart attack is one in the next 10 years. We're just trying to lower the risk as much as possible, and that's the right tool for that person. But if you're a, you know, 25-year-old woman of quote, high cholesterol, stands are probably not the right starting point. You know, figure out if there's a genetic reason the person's that high or I've definitely seen the people who consider themselves, quote, lean mass hyper responders.

I don't really know the full mechanism of action how switching up to that diet fully affects the lipoproteins, but I've seen enough that know that it does happen where people had relatively normal lipid panels. They change up to a kind of a higher fat, you know, sometimes it's a carnivore-esque type diet as well. And then they see their LDLC shoot up to 300, 400 milligrams of desolator. And it looks like from the little hypolipidemia, but it's not because three years ago before they're on that diet, their lipids were, quote, relatively normal. So those are the people that are sometimes challenging to kind of talk with because they're like, well, I feel great on this diet. I don't want to abandon it. I'm like, I'm not going to tell you not to do, but I'm going to tell you what's

going on with your arteries with this. If you're having significant endothial dysfunction with this, you're probably going to do something different. Either switch up the diet or you're going to have to take more nitric oxide promoting supplements or you're going to do something to protect your arteries from this potentially ethogenic milieu that came from the dietary choices that they're making. Yeah. Did you see the paper that Nick Norowitz published recently about like reintroducing carbohydrates was able to just dramatically lower the cholesterol. So it seems to be like responding to the cholesterol or the carbohydrate status of the diet in some way, which is interesting. Yeah. I think that was like the Oreo cookie experiment. Yeah. That's what we talk about. And as I said, I don't think I'm, I don't know if anybody's smarter to understand like how the body is all put together. You know, it's fascinating what the human body does. But it's most things are like, I think that's almost like it's a. party trick that you can do that. Is that going to be a problem for like the two weeks after lipids that were that high and then you drop them or whatever? No, but what is your like 40 year risk

if you left your lipids at that high? I think you're kind of gambling with fire at that point. Now, you know, we both understand how the biohacking ethos, you know, your own experiment or your end of one. But like that's one where like I think I probably would not experiment as much unless you were doing the type of testing I talked about. Like if you have healthy endothel function, you don't have a lot of vascular inflammation, you don't have salt plaque in your art, arteries, okay, keep doing whatever dietary invention you want. But if you have a lot of salt plaque or a heart plaque in your arteries, you're probably going to do something different. Yeah, that makes a lot of sense. How do triglycerides fit into this story? What do you see?

Like, what are your ideal cutoffs for you do like less than 100 milligrams per decilator or what's optimal in your eyes? And then also, what do elevated triglycerides typically signal for you? So when I look at a traditional lipid panel, that's usually kind of where my eyes, you know, dark do. Like, I mean, I'll glance at the total and the LDLC. mostly to see is this likely FH or not. I gloss over the LDOC. I'm like, we're going to talk about the LDL particles in April B because that's more predictive of risk.

But I always look at triglycerides because in many people, it is a rough estimate of their insulin sensitivity. And I generally like to see their triglycerides sub 80 in everybody. Now, in the person who's not insulin resistant, when you go looking at the deeper markers, you know, they're fasting insulin is five. They're fasting glucose in the 70s. They're A1C's 4.9.

Okay. Their triglycerides is not up. because they have a carbohydrate issue. They probably have an issue with lipoprotein lipase. And there's certain enzymes that are issues to certain genes that affect that enzyme. And so those are the people that you're like, okay, well, sort of bad luck that you're going to have these high triglycerides, depending on the cut point decides if you have to actually use pharmaceutical therapy to kind of lower the triglycerides in those individuals.

But the line chair, it's somebody who's, you know, they're not tolerating the carbohydrate load for the amount of muscle mass that they have or the amount of activity that they're doing. That makes a lot of sense. And with regards to lowering triglycerides, what do you recommend on that front, omega-3s or anything else? After you've done all the lifestyle things that could improve it, yes, omega-3s, you know, high-dose. I mean, I get, you know, the idea like we should not be supplementing with everybody with fish oil.

Yeah, I want them to be eating it and have the mother-the-lager package. Yeah, yeah, I understand quantum physics a little bit, but trying to explain, you know, that the triglyceride has to be in the S&2 position to pay. patients, it just, it hurts their brain. I'm just like, it's just better that you just eat it from Mother Nature. Like, just trust me, it's going to get into the cells better. But if people have very high triglycerides, you generally need to use about four grams of omega-3 to really kind of force down the triglycerides then. Is there an issue with like overthrinsing the blood in that case or only in people who are on blood thinners? Not generally. And it's, you know,

I've always get that kind of pushback from some of the surgeons that like, oh, it's such a bad blood thinner. I'm like, there's data that, you know, they were using up to like 20 grams of omega-3 in patients who had bypass surgery and they actually had bypass scraps, stayed paid longer when they're at high doses. Now, most people are not going to supplement or eat 20 grams of omega-3s a day. So I think, you know, if you were consisting on like a high seafood diet that was 20 grams a day, which almost nobody in the world is doing, then you might need to be more careful at times, but the average person is not going to get in trouble with that. Yeah, that makes a lot of sense. I had a question earlier that I totally

spaced on, but it just came back to me. What are your thoughts on the role of, well, we talked about blue light a little bit, but blue light and other non-native EMFs on mitochondrial function. Do you have any thoughts on it? I mean, I talked to with patients that, you know, this mitochondria behind me, you know, it's representative. It's like your mitochondria are like RF detectors. You know, they're absorbing all frequencies of light. And if you're bathed and non-native EMF, it basically acts as a radar jammer to the mitochondria sensing what's really going on. in the environment. And so it's essentially impossible these days to get away from non-DMath completely.

But you can at least find places in your home, your bedroom, where you can kind of do some mitigation. You know, you can put fair day cages up if you need to. You can have leadlined walls like Jack has down at his farm, you know, like you can build a fair day cage if you have to to at least have a ability for your body to recover at nighttime. And so even if you're not going down that route, you can at least shut off your Wi-Fi routers at night and keep your cell phones out of your room and keep all the tech out of your room so that your room is as electrically silent as possible. Yes, I went down the rabbit

for a while and bought a bunch of the EMF meters and I sort of know how to use them, but it's like, how do you mitigate? That's the biggest challenge. But it is kind of fascinating as if you get these meters and you can travel and you go to a hotel room, you can figure out like where they hide the Wi-Fi routers and they can unplug the things because I've been in places where they hid the Wi-Fi routers in the headboard of the bed. And you're sleeping there and you're like, my sleep is really not that good this night. And then you figured out where it was and then had to flip around and put feet up by the headboard so that the head was further away from the router. So that is something that at least I'm not super electrically hypersensitive, but it is one of

things where I see a lot of patients that are. I mean, I often joke with patients that like, you know, they're not going to ever catch me with any type of smart watch on. And if I'm wearing an oerring, it's always in airplane mode. I never keep electrical devices on myself. I mean, I talk to patients like, it's like a radar jammer. I mean, I've seen so many men and women, you know, they keep their phone and their breast pocket. And they're like, man, I got a lot of palpitations. Like, yeah, I bet. Yeah, you're drawing all these EMMAFs directly into the myocardium. And then they get their tech away from them. And the palpitations usually calm down. Wow. Yeah. I mean, especially for the heart, which is, I mean, between the heart and the brain,

the most mitochondrally dense organs, they are really requiring that, like, signal to keep them online and and just the immense amount of electrons flowing through there that require the signals to be coherent within those mitochondria. And it really frustrates me a lot because there's so many people, let's say, in the mainstream that will just write off EMFs as or non-native EMFs as being like this woo-woo thing. When there's actually, even though the research quality is pretty bad, even among the bad research, there's still quite some signal showing that there can be harms to human health, increase. resprice of cancers in rodent models, changes to the way calcium is moving in cells in mitochondria, changes to mitochondrial membrane potential. None of these things are good if we're talking about optimizing mitochondrial function. And it just seems like this constant insult to our mitochondria in modern living. And the other problem I also often think about with regards to the non-AVMF research is that it's not like we're only just exposed to 5G or Wi-Fi, but it's like 5G, Wi-Fi.

Bluetooth, then we have all of the blue light artificial environments, plus all the garbage foods, and it's like the symphony of chaos from a mitochondrial standpoint. Correct. I mean, it's, you know, the mitochondria are relatively healthy. They can kind of repel some of this stuff as kind of talk to the patients, but like, if you're really sick, everything's kind of leaking out. You know, those voltage gave a calcium channels. They're wide open.

This, you know, cell danger responses, firing, firing, firing. And yes, I agree. There is not great scientific articles that are fully. supporting this at time. But it's kind of the precautionary principle, like at least biologically, you know, physics-wise, makes sense. And, you know, when I was in the cath lab, you know, we wore lead-line outfits to protect ourselves from the ionizing radiation. Well, why would not the same precautions be made at times? Like, there's no harm shutting off your Wi-Fi at night. It's no harm in keeping your rings and devices in airplane mode. Yeah, there's no harm in

in doing that. Do you sleep better? Do you have less palpitations? start with some of the simple things. And then I'm sure the science is probably going to ultimately kind of catch up and be like, oh, we probably shouldn't have been bathing ourselves in this much non-native EMF all the time. But the people really sense of it. I mean, you know, go do a trip to the beach sometime. People think that they just feel great because, hey, they're not at work. But no, it's just you're more connected to the earth.

You're soaking up electrons. You're soaking up all the frequencies of light, all the healing wavelengths of light. So you generally feel better. That's how you're supposed to be pretty much all the time. but we decide electively not to do that. And we think it's wrong that like it only happens on the beach. We have that choice all the time. Yeah, I mean, every day feels like vacation to me.

And I always encouraged all my clients to feel that way too because, you know, a lot of money tends to be spent on things like supplements and gadgets. But what I always prefer to recommend and what I do myself is spend money building like a beautiful outdoor space that I can enjoy spending time, that I can, you know, do my home office work at, that I can enjoy lounging. and exercising in the yard. And I feel like it's just from like a foundation's principle. It's just a way better outlet to spend your money because the payoff is going to be immense relative to maybe the 0.5 to 1% benefit

you might get from some really good supplement if you're lucky. I mean, a lot of supplements just won't do anything at all. If you're doing it a more targeted way, like you were talking about the nitric oxide builders and maybe some fish oil, those things make a lot of sense. But a lot of the supplements on the market, it's just like expensive pee. I mean, I always put it through the lens like, what's the mitochondria going to do with this? Like if the mitochondria are going to make more ATP, is it going to make more, you know,

deuterim to play water with it? Is it going to, you know, how's the mitochondria going to handle whatever supplement or gadget you're hooking yourself up to you? And so if it passes that test, then I'm like, yeah, maybe try it. You know, I know you probably got the question. It's like, what about the, you know, the PMF mats? I'm like, I'd be very, very careful with those. I mean, you know, if, you know, you know exactly what you're doing with it and you're using it for very limited time, maybe. But just general well-being, it has in the word, it's EMF. Your mitochondria,

you know, the electrons are getting knocked out of the mitochondria and you're not as energy efficient with that. So I'd be very careful with those type of devices. But like a sauna, very good for the structured water in the body. Red light panels, generally pretty good. Yes, it's a little bit challenging to know exactly what dose you're going to get. I understand, but you're probably not going to hurt yourself with the red light panels. But the PEPMATs, you do have to be careful. Yeah, I think so too, especially because those frequencies aren't really what we would encounter in nature. So our bodies may not even know how to interpret that versus getting your bare feet on the ground and, you know, spending some time in nature.

So you're encountering the natural magnetic field of the earth, the sun, the grounding force, getting electrons from the earth. Those are like natural exposures that our bodies evolved to experience versus a lot of the tech that's kind of made in a very intellectual way that sounds good on paper. But we don't actually know what it's doing, especially with some of them, like the PMF mats, like there's basically no research on it. Right. And, you know, as you said earlier, I mean, like, the majority of the things that we're talking about today are free. You just have to make time or, you know, find a way to build it into your life.

It's not complicated. It's just, you just have to set up a day where it's like it's ground dogs day. I mean, I definitely like, you don't want a day to be boring, but it should be relatively, you know, rhyming. Like you get up at the same time every day. If you're up before sun, protect your eyes from artificial light or have your house set up where it's more natural. lit by sunlight or you can have some red bulbs or, you know, candles if you need them in the morning time, go out and get a full big dose of sunlight in your eyes in the morning time with nothing between your eyes and the sun. Get outside for sun breaks out of the day, crack your windows inside if you're able to, you know, wear blue blockers if you absolutely

have to be in front of the devices at nighttime, reverse the process, have a dark spell. Stop eating when it's, you know, dark out so the body knows that it's nighttime and repeat this cycle. you add in whatever other things you want to do. If you want to be doing cold plunges or saunas or red light, you know, those are all augmented to optimizing the things that are doing your circadian biology management every day. And once you get that dialed in, everything else has become so much easier. Like exercise, you know, becomes easier.

You recover better from exercise usually. Food, I know you come from the world that you came in. Like, food is like so much easier when you understand, like, it's just electrons and protons that your mitochondria are going to use. Like, it's just energy and information. You know, and you have other sorts of electrons, you know, it's grounding, there's light, you know, you don't have to do just food. And then, you know, generally health happens as the consequence. You're just getting out of the way and the mitochondria take over and do what they need to do.

Yeah, absolutely. I saw a reel of someone earlier that has quite a few followers. I want to say around 400,000. And he was mocking seasonal eating as being like completely ridiculous and insane. And like it doesn't matter. Just, you know, eat the banana any time of year. and fine, but the more I think about and learn the quantum biology aspects of things, the more it just makes sense that we're probably, our systems are yoke to eating certain

food that specific times of year depending on the latitude that we live at. And, you know, we can muck around with that because we live in like a global economy, but that doesn't mean we necessarily should. Right. And that's why I doubt it was like, you know, the healthier are, the more you can get away with things. Yeah. But at some point, when you're super sick, you've got to be pretty strict at the way that

Mother Nature put these rules together. Absolutely. Do you think about heart rate variability a lot in your practice? Is it something you measure with patients? I measure it every day with every single patient. The one chance I will say is that I'm not fully convinced that the HRV measurements that come off these rings and watches or is accurate is wearing a chest strap because HRV was initially done in the clinical setting, mostly in the cases where patients had had malchardine infarctions and they're being monitored after the mild cardiac infarction on preliminary wards. And they're doing, you know, Holter monitors, you know, from, you know, their hospital back. And so they're measuring from the chest wall where you're actually getting the electrical signal directly off the myocardium.

When you're wearing a ring or a watch, it's inferring it by the pulse wave velocities or the PPG. Like how fast is the blood expand the artery? Well, that's a heartbeat. Well, heart rate variability is the millisecond difference between the heartbeats. I don't know if the fidelity is truly there to have it on every single beat that's coming from a ring-based device. it may be. At least in my own case, my HRV always, always reads low on these rings. What does that mean? I feel my brain's working as good as it can. My sleep feels awesome. I can do all the things I want to do every day. I'm not getting sick right now. So HRV really doesn't track well for me on the rings.

The chest straps may be a little bit better. But it's one of the things where I tell people's like, whatever your HRV is, use the device and get your own baseline. But you're going to want your baseline be two to four weeks before you start making a lot of, you know, oh my God, it's low type of, you know, comments. And then you can start trying to figure out like, what are the things that are potentially breaking it, you know, often you'll see is they're eating too late. They're getting too much, you know, bright blue light late at night. You know, they are over-training. I mean, I come for the world where a lot of patients are, you know, doing 75 hard or doing other things where they're working out twice a day and, you know, they're just overtaxing system and not allowing

the body to recover well enough and those have this crushed HRV all the time. It doesn't mean that you can't exercise if your HIV is low. That's probably a day that you're probably not going to set person the best. You know, you probably want to try to do some things that have a more active recovery in those instances. Yeah, that makes a lot of sense. And also there, there's a link right between HRV and like nervous system regulation sympathetic to parismpathetic tone is like the self-regulation piece, something that you also talk about with patients or do you refer them out to, I don't know, therapists or other other practitioners that can help them with that piece? No, it's a great thing that I do kind of lead patients towards.

It's like, you know, the grounding thing that we're talking about earlier, that's one of the fastest ways to start balancing that sympathetic and parasympathetic nervous system. It's just go outside barefoot. And then this is where the whole, you know, amit of meditation, box breathing, you know, biofeedback. There's a device called heart math. It has a lot of data in science behind it. You know, it's, you know, color-coded. And you breathe with this little ball going across the screen.

Because you're breathing, you're activating your diaphragm, you're activating the parasympathic branch of your nervous system. And you'll see the colors change and then the hardware variability improves with that. So, you know, people are used to going to the gym or outside and exercising their muscles and their cardiovascular system, but they're not so used to exercising their nervous system. And it's, you know, very important as well. Like it's very easy to get stuck in the fight or flight response for many people. So you had to teach people how to kind of calm themselves back down.

And then their vascular system responds in kind. Yeah. So I always will check it because that is, for the most part, the underlying reason when people have, quote, quote, hypertension. Like, I'm just, yeah, I'm just stressed out, getting my blood pressure checked here. I'm like, I bet you're stressed out other places too. And your body doesn't know the difference. Your blood pressure is going to go off. So maybe you don't need a blood pressure medication. You need to learn to meditate. You need to do biofeedback. You need to do breathing exercises. And so if they can do it on their own or use an app grade, if not, there's a lot of great meditation counselors out there that can kind of coach people into a better

practice. Yeah, absolutely. And to that end, I'm thinking about stimulant use and how many people are like mainlining coffee and adderol and nicotine like all day to keep them going. That's, of course, increasing their blood pressure. But if they're, you know, staying in that stay for eight hours a day, that's really adding up over time. Do you provide any guidance or think a lot about the use of stimulants as it relates to like cardiovascular health? I mean, I have a lot of patients that, you know, obviously use a lot of caffeine. And it's really comes down in part to their ability to break it down. You know, there's a gene called CYP 182 and you get one copy from each pair.

So you're either a fast metabolizer, an intermediate, or a slow metabolizer of caffeine. And if you're a slow metabolizer of caffeine, it takes 12 hours for the half life for the caffeine to be cut in half. So those are the people that should minimize caffeine and keep it very early in the morning, probably before 9 a.m. So they have a better shot that it wears out of the system. Because we talked a lot about light affecting your circadian biology, but the stimulants, particularly caffeine, well, that's affecting the dynosine receptors. So as you're working out throughout the day and also as your body's, you know, making energy throughout the day,

the A part of ATP, adenosine, that's building up. And as that builds up throughout the day, at certain point, there's enough sleep pressure that you're going to go to sleep. But caffeine blocks that adenosine receptor. And it's a lot. And it's a lot of the endosine receptor. And it delays that sleep pressure. And when the caffeine wears off, then you go to sleep. So if you're a real slow metabolizer and you're pounding energy drinks in the afternoon, you're going to have a very hard time going to sleep. But it's also tending to affect your arteries in a more negative way.

You tend to get stiffer, less elastic arteries when you're a slower metabolizer of caffeine. The other one's nicotine. You know, some people are more sensitive than others. Yes, if it's coming in through like a gum or a patch, I'm less opposed to people using it for those reasons. you know, it is a very powerful neotropic in those people. But, yeah, you got to be careful with the dose. I mean, you go too high. Most people know, like, you're going to get pretty nauseous using this stuff.

And the addictive factor of it, it does depend. I haven't seen as much data that, you know, using a gum or patch is that addictive. It's much more when it's coming through a inhaled mechanism of action. That is probably what's actually driving some of the dependencies of it. But nicotine and some people at a certain doses, they can start raising their blood pressure. So, you know, it's a test-on-guess philosophy is like, you know, get a baseline, you know, do whatever an invention and retest and see what's going on with it because, you know, everybody does have a little bit different metabolism for these compounds. Yeah, that makes a lot of sense. I know people who are slow metabolizers of caffeine versus fast, and it's really striking to see the differences between like how they respond to, you know,

the difference between responding to one cup in the fast versus slow metabolizer. It's like one person is really feeling it. The other person needs like three cups to even get there. So it's definitely a thing. And people can find that unlike any normal genetic test, right? Like 23 and me. Correct. Yeah.

Amazing. So with regards to exercise, you mentioned before, but do you have any specific recommendations you typically give to people for supporting heart health? I think like the American Heart Association says like 150 minutes per week of like aerobic activity. I don't think they make it. any strength training recommendations, I could be wrong. Do you have any personal recommendations that

you use? So, you know, usually, you know, for the cardiorespiratory that, you know, they do at least 150 minutes. You know, I do tend to like the kind of the breakdown of, you know, 80% of that time. Should ideally probably be a zone two type of exercise where it's kind of the lower and slower cardio where you're basically training the mitochondria just to be more efficient at bad oxidation or fat burning. And then for the people who've been exercising for a while. So this wouldn't be for somebody who's just like couch potato, then that's when you start getting into more interval type training. You know, if you're just doing it for like whole span purposes, probably once a week is plenty. Now, if you're training for event, this is not recommendations for those people. There's people

are way, way fitter than me that I can't coach. Like they're training for, you know, Olympic level event. I have no idea what volume of training that they need to do to maintain their level of fitness. But for just health span purposes, 150 minutes is a pretty good starting point for most people. And then I definitely recommend people focus on the resistance training. I think Dr. Lyon, would yell at me if I wasn't going to talk about that with patients. But, you know, patients that are doing it, I just want them to start slowly, go to their local gym, get a trainer if they don't know how to do a program, and this slowly build themselves up for it. Because, you know, I do often see it. You know, I'm seeing these patients with insulin resistance. Like, if you really hammer it down right now,

get your muscles healthy, you're not going to end up on a bunch of medications. You're not going to go down the route that you don't want to go down. Like, okay. And they come back in six months later. and usually resistance is much improved. And they're not on a bunch of medications like they didn't want to be on. Yeah, that's great. And it's making me think also of Uncle Jack, Jack Cruz's position on building muscle. I actually heard him talk about this in a more nuanced way on a more recent podcast. And it really, like, got me thinking that so we see like anabolic resistance that happens

as you get older where it's like harder to put on the same amount of muscle mass that you would have put on much more easily in your younger years. and it got me thinking, what if that's actually an adaptive mechanism to avoid pulling mitochondrial density away from the brain and the heart possible? So that would actually, you know, that would suggest that prioritizing strength training in the first five decades of life, let's say, is probably the move and then maintaining that muscle mass and really focusing on your cardiovascular and your brain health after that period of time might be ideal from a mitochondrial health standpoint. Do you have any thoughts on that?

I think that's true. And just from my experience, you know, I trained at St. Louis University. I did a lot of rotations in geriatrics. And just from experience, you do not see a lot of super fit 90-year-olds, you know, but I've seen many of them whose brain is extremely as sharp, is, you know, a 30-year-old's brain would be. So I think that's what, you know, I would want to be optimized for is brainpower at that age. You know, you don't see hugely muscular people at that age. And so it is probably right that I've also heard Dr. Cruz talk about, you know, you know, gorillas, you know, they store their mitochondrial density in their muscle. That's why they're enormous. This is why most, you know, giant bodybuilders don't live past 60 years old. Like,

they are probably stealing mitochondrial energy from the heart brain to have that large of a muscular load. Fortunately, for most people, that's not their problem. They're on the sarcopenic side. Like, they just need to get up from where they're at. So, I know there's kind of nuance in this, but the average person is probably not that person who has too much muscle on. But that is a great question. I don't know at what age does somebody be like, maybe I should not keep trying to add more muscle. Maybe I need to try to maintain and not lose, and then just really focus on trying to keep my VO2 max, at least average range, but ideally above average range. Yeah, I think that makes a lot of sense. Is VO2 max something that you measure in your

clinic, or do you kind of defer to other practitioners for that? there's a facility here in St. Louis that does it. So that's why I send people out. They also do the Dexas scans and the resting metabolic rate cards for patients who really want to, you know, a little bit be more data oriented. And the VOTOMX, it's not the BOL, end all, but it's a good reference range of like how fit that person is. Like you don't get a high VO2 max on accident. It's kind of like it's the A1C of exercise. You've been doing a lot of a rover work for many years to have a high VO2 max. Do you see a VO2 max increase just even from like, supporting these more foundational aspects of health, or is it only really from training that you see

that number increase or also like from the metabolic health standpoint? I haven't seen it from just doing the kind of the quantabology hacks so far, but I do think that you don't need as much work to get off the couch and get a average V2 max. You know, you're not going to get these Olympic levels, you know, in most people's lifetime. But the data is just like, if you can get out of being like the lowest quartile, the benefit on like mortality reduction is so significant. So I think that the person who's more sedentary, if it is start with some zone two type training and then start layering in some, you know, zone five interval training once a week,

they're going to get up there within six, 12 months to hopefully average. And that just is, you know, good enough for most people. If they want to go better, you're going to have to do interval training a couple times a week and really kind of scale it up. But I do encourage patients to go get the VOTU max at least once. It's not that much fun of tests to do. I've done a couple times with myself and I used to do a lot of stress test. Yeah, it is an uncomfortable situation to be running straight up a hill, breathing in a mask.

But you can see what your body's built to do. And then you realize, oh, I'm not nearly as fit as I thought it was after you do that type of test. Yeah, I always wonder if, like, we were able to do those tests outside instead if we would see a market increase in VL2 Max just from like the red and infrared light stimulation. at the very least of mitochondria. I mean, it would be easy enough to test, right? Hopefully in my future lab, we can look into it. I'd be awesome. I'd be happy to help with that.

Yeah, there are definitely companies that make the V-O-2 max gear that they can be strapped to the person. They can do whatever their normal activity is. So the track runner, they put them on a track or ice skaters. So there are gear that you can take out or portable. So I'm sure you could easily test an outside workout versus indoor workout and see what the difference is. Yeah, I think it would be a really cool experiment to do.

do you know how closely correlated the V02 max estimate from like let's say Apple Watch is to like the legit V02 Max testing? Have you seen any of that data in your practice? That's such a good question is that the whole reason I end up getting the new Gen 3 URRRang was that they added that VO2 Max assessment about a month ago. I don't know yet how sensitive the watch and the rings are compared to a formal study. that's some I'm actually looking at. So for anybody who's listening to this one, if they've done it, let me know. Is it like, is it five points under or five points over? That's the thing I want to know because patients are going to use these things.

They're good trackers, but they're not as clinically, you know, sensitive as the gear that you're going to have in a lab. But you just want to know is it roughly headed in the right direction. But I've definitely seen some of the things where it's overcalling it and people think they're super fit. I'm like, it's not going to be that good. Yeah, I'm always curious about it because, I mean, I've been training for, like 14 years now and I'm my my V-O-2 max on the watch always says hi but I'm like I want to go get

it checked to see if it actually holds up there yeah um one more question before my final question I was just curious have you heard it all about like the magnetico sleep pads and if you have do you have any opinions on them I've heard of them I have a couple patients who've had them I don't personally have one yet but you know they're magnets that you didn't sleep on they come in different gauces. So usually, you know, most people will go for the highest one, the 20 gous magnet. So the reason you would potentially want to sleep on one of these things is that magnetism is another zykeiver, it's a time giver. It tells you, is it daytime or nighttime. So when the sun is out, the magnetic fields are low. When the sun goes away, the magnetic fields

go up. But now with the ubiquitous non-80m, we're exposed to, those magnetite fields are kind of lost in the mix. So by sleeping, on a magnetic opad, you're actually giving the body another signal. Oh, it really is nighttime. And then when you're sleeping in this magnetic field, that is going to help pull the electrons through the respiratory proteins of mitochondria a little bit more efficiently. I've not yet had the pleasure to try to sleep on one of these mattresses, but the patients that have used it generally do notice better sleep quality with it. Yeah, I'm really curious. I would like to test one out, so I'll let you know if I do and I'll let you know my thoughts on it.

you just made me think of one other question. With people that have sleep apnea may be diagnosed or undiagnosed and snoring issues, is this something that you largely see traveling with high blood pressure and other cardiovascular issues? Absolutely. Yeah. I mean, it's one of things where, yeah, it's a chicken and egg thing that, you know, patients, if they don't sleep well, they tend to have more cardiovascular diseases. And, you know, that's not always top of mind when somebody's coming into a cardiology office, but I ask so many questions about sleep, it's like, if there's sleep, not well, and then they have evidence of a lot of information on their blood work or their blood pictures up. I'm like, I bet they may have more than just mild sleep apnea. So I do a lot of

sleep studies in patients. Yeah, there's different variants that you can do. I tend to like to do a lot more home sleep studies because you could do like have a normal night of sleep that you're going to have. But, you know, typically it's better to do more than just one night because maybe it's not a representative night of sleep for you. So there's companies that can do, you know, 7, 14 nights and then kind of average out the results. But if you have sleep apnea, you got to try out if you can find a root cause for it, if you can't treat it. But if you can't figure out the root cause of it and, you know, weight loss isn't improving it,

then, you know, mandibular positioning devices, CPAP devices, you know, there's the inspired device that then, you know, is basically like a pacemaker that then, you know, basically electrically stimulates the posterior pharynx to basically stay open. So there's a whole lot more novel ways to treat sleep apnea. these days, but you have to sleep well to age well. And so, yes, it's one of those things where I'm looking at routinely. But back to the magnetica one, you do definitely need to make sure that your subfloors can tolerate it because these things are like five to 800 pounds. So you've got to be careful with these things. Whoa, that's massive. With regards to some causes of sleep apnea,

could you list a couple that people might be familiar with? The most common one that people would experience is obstructive sleep apnea. It's the posterior ferrances collapsing. And, you know, it's often, you know, seeing patients who are obese and have large necks, but it can happen in people who are skinny as well. One thing that I learned from a sleep doctor was if you've had any type of oral work where teeth have been extracted, your oral palate has kind of collapsed. And so you're then restricting the airflow in, even though you're not obese and you have

a normal, you know, airway. So it's one of the things where it's like you have to kind of go more by the sleep quality than just the kind of the physical exam for the people. And then there's people that have central sleep apnea. It's a problem in the brain. The brain isn't actually sending the signals to take a breath. That's a little bit more dangerous and rare. Those ones are the ones that have to get picked up in a sleep lab. And those ones are treated by the sleep specialist.

Those ones are often challenging to optimize. Yeah, that was very insightful. Thank you for sharing. So my final question, is there anything that you're really excited about in medicine and quantum biology that you're really looking forward to seeing how it develops over the next five, 10, 20 years? There's many things, but I think just that the understanding of how important mitochondrial health is going to be, I think that's the key, and that a lot of these things are free. It's just you have to build your lifestyle around it. Yeah, I'm pretty patched about using red light therapy with my patients. I use it routinely for myself, but I don't think it's to be all end all. The sun is free. You can get all the healing wave lengths from sunlight.

But I think some of the things that I know you're involved with, you know, the devices that are going to have more red screens and not as much blue light, I think is going to be fascinating. I think we're going to design the world that we can still use technology, but it's not going to be taking this negative health toll as much. The biohacking scene is always fascinating to look at. I mean, some of this stuff is really, really stupid and they're really going to hurt themselves. And there's other things that they're doing that, like, oh, I need to think about that. that. I mean, that's essentially how we got into space. The biohackers were talking about blue-blocking glasses back in 2017. And I was like, okay, what are these things? So I think we're always

going to keep learning and evolving, but I think it's really going to have to be down to what happens with the mitochondria. If it's helping that, I'm on board for it. I love that. Thank you so much. This was such an interesting conversation. Where can people find you? And do you take, are you actively taking new patients if people want to work with you? Well, first off, thank you for the opportunity. This was an outstanding conversation. I don't always get to. mix the quantum biology with the preventive cardiology stuff. But my practice is located in St. Louis, Missouri. My practice is Apollo Cardiology. Quick side note, the reason it's Apollo is, Apollo is the sun god. So that's the whole reason it's named Apollo cardiology. But I am taking new patients,

you know, my focus is on the early detection of subclinical atherosclerosis. So basically, I'm trying to find what's going to potentially cause this person, heart attack or stroke, and reversing those risk factors. So my office, you know, has a lot of, you know, has a lot of has a process where if you want to work with us, you go to my website. It's Dr. Twyman.com. There's an application on there. And then a member of my team will set up a kind of onboarding call with you, make sure we can help you with the issues that you're concerned about and that were a right fit for you.

And then I'm mildly active on social media, mostly on Instagram. I do an Instagram live every Monday, 6 p.m. Central time. It doesn't ask me anything. I answer almost any questions that are, you know, fundibology, preventative cardiology focused. Yeah, I'm not answering specific medical advice questions, but it's general not that people understand that like, okay, this is why I need to focus on nitric oxide or this is why it's not like exposure this time of day is important. I'll give people the basics that they can empower

themselves to optimize their health. Amazing. And do you see both virtual and in person or only in person? It's both. The first visit is in person because then we do all the non-invasive testing in our office the same day. We can send out all the advanced cardiovascular labs. And also it's just better to physically be around somebody and sense their, you know, kind of aura, if you sense their energy levels. And then the follow visits can be done via Zoom and we can go through the results. Amazing. Oh my gosh, Dr. Twyman, thank you so much. Hopefully we can have you on again sometime. I think this is a great conversation. I'm really excited to see how we're both learning and growing as we continue down this rabbit hole. It's really exciting. And I really

appreciate your time. I very much appreciate as well. Thank you.