WHOOP Podcast - Dr. Jeremy London: A Heart Surgeon's Tips to Live Longer

Episode Date: January 22, 2025

What small lifestyle changes can help you take control of your heart health? This week on the WHOOP Podcast, WHOOP Global Head of Human Performance and Principal Scientist Kristen Holmes sits down with Cardiothoracic Surgeon, Dr. Jeremy London. Dr. London is board certified in general surgery, vascular surgery, and thoracic surgery. He's gained recognition on social media for his ability to share important health information in a comprehensible way. Kristen and Dr. Jeremy London discuss how Jeremy became a surgeon and social media personality (00:52), the preventability of cardiovascular disease (03:11), the role of genetics play when it comes to heart health (04:14), lifestyle change non-negotiables (5:30) and the small changes Jeremy has made in his own life (19:20). Kristen and Jeremy dissect research on the effects of sleep, breathwork, and stress on the autonomic nervous system (21:18), the important role of sleep on overall health (22:34). How daytime habits influence sleep (25:15), the use of data in monitoring lifestyle changes (29:04) and the impact of sedentary time on cardiovascular health (33:37). Jeremy breaks down the common misconceptions of heart disease (39:30), the impacts of pre-diabetes on the heart (42:04), how patients can measure their own heart health at home (46:59), and why blood pressure matters (47:36).Resources:Dr. Jeremy London - Instagramdrjeremylondon.comFollow WHOOPwww.whoop.comTrial WHOOP for FreeInstagramTikTokXFacebookLinkedInFollow Will AhmedInstagramXLinkedInSupport the showSupport the showFollow WHOOP: www.whoop.com Trial WHOOP for Free Instagram TikTok YouTube X Facebook LinkedIn Follow Will Ahmed: Instagram X LinkedIn Follow Kristen Holmes: Instagram LinkedIn Follow Emily Capodilupo: LinkedIn

When a patient comes into you wanting to just get a handle on their overall heart health, where do you start? You start really simple for folks because what's the hardest part? It's starting for all of us, whether it's an exercise program, nutritional plan, then the reason is people are scared. They're scared of failure. And if you don't start, you can't fail. And I think that I try to have very general conversations before we even hone in on which

of the pillars, if you will, we're going to focus on that success in general is not a straight line. And to understand that, you know, life is going to take you in this kind of route as you continue this journey. It's not how you can continue to grind all the time. It's how you can figure out how you get out of those slumps so that you can pick yourself up by your bootstraps and continue down that road. Dr. Jeremy London, welcome. So happy to have you here. As you know very while at WOOP, we are all about providing our members with the tools and insights they need to take control of the trajectory of their health. And what I see you do on Instagram is literally just helping folks do that, you know, understanding how to not end up on your operating table.

It seems to be kind of the MO behind your messaging. And so I think in that regard, our mission is really synergistic. And I just want to say thank you for all of the good work you do, the advice that you're putting out there to folks. You have a massive following on IG for a reason is because you're giving really good advice. So just wanted from the start, just thank you for the work that you're doing in this world. Well, thank you. And I am absolutely honored to be here. And to have that type of accolade come from you really means more than you realized. So I really, really appreciate that. And, you know, it's interesting because for years, obviously, I can only take care of one patient at a time. You know, I'm in the office. I'm taking care of one patient. I'm in the

operating room. I'm taking one. I'm not in a scalable scenario. I mean, I can hire more people and what have you. But in the end, my goal is to take care of as many people as I can. And so the social platforms, and this was unintended, really, have allowed me to scale what I've been doing for 25 years. And it's like a 2.0 version for me as far as next steps in my career because it's given me the opportunity to do exactly that to try to share really meaningful information with so many people. And we get so much feedback, you know, simple things like, I didn't realize that I was having cardiac pain. And I went to my cardiologist and I got two stints. Thank you for making that post. I got a second golden ring. And so,

it's really been a meteoric experience for me in a very short period of time. And it's been really, really positive. It really has. You're saving lives and transforming lives, you know, extending lives. And I think all of that is so noble. So thank you. So I want to start by asking you a question. And it's a true or false question, perhaps. 80% of cardiovascular disease is preventable. I'd have to go false at 80% because I think that there are a significant number of people that have such a strong genetic predisposition that you can't run from your genes. Now, that being said, when you say preventable, modified, I think would be maybe a better way to look at it when we talk about, you know, we have this genetic predisposition, but what pressure do we put on those genes to express in a given way

that epigenetic kind of mindset. And so when you look at cardiovascular diseases in general, you know, I think that's really how we approach it, not necessarily that it's entirely preventable in those folks, but if you can modify it or slow, change the slope of that curve, you affect people's lives dramatically because that's health span and lifespan right from the get-go. So when we're talking about genetics, is it, is it hard-sized?

Is it, you know, just your predisposition to build up plaque? Like, you know, what exactly is just the... There's kind of two major categories. I mean, you kind of have the really hard genetics like familial hyper-cholesterolemia, where people are just born with this predilection to have really, really abnormal cholesterol levels. And there's several others that are very, very specific genetic abnormalities. But most of the genetic profiles, if you will, are multi-examined. It's not just one thing that pushes them down that road. Obviously, though the first category is

fairly easy. Those people are on medications very early. Those are not the people that you're, you know, putting on an elimination diet and increasing their exercise. You're doing all that as well, but they require, they require, you know, kind of all knobs to the right to modify their risk factors before they get into trouble. But the ones that are multifactorial are, the majority of us. And it's a matter of kind of figuring out, you know, what your instruction manual is to help navigate that and to deal with those uncertain headwinds. And each of us are very, very different. When a patient comes into you and you've never seen them before, and they might be wanting to just get a handle on their overall heart health, where do you

start? Well, you have to realize where I am as a cardiac surgeon. I'm more of the in-game God. Okay. So you're not on the front end of that discussion, really. You're getting people who have already been diagnosed. Now, when I get that question, it's usually from a family member that's in my office. Right. How do I avoid this situation? I don't want to be this person, you know. So we do have those conversations, but most of my conversations are more of the endgame type of conversations. Like, where do we go from here? You know, and how do I now take this second golden ring and run with it in in a meaningful way. But I think to answer your question, I think that we start simple. You start really simple for folks because what's the hardest part? It's starting for all of us, whether it's

an exercise program, nutritional plan, mindfulness. I mean, we can we can go down the list. And the reason is people are scared. They're scared of failure. And if you don't start, you can't fail. And I think that I try to have very general conversations before we even hone in on which of the pillars, if you will, we're going to focus on that success in general is not a straight line. And to understand that life is going to take you in this kind of route as you continue this journey, it's not how you can continue to grind all the time. it's how you can figure out how you get out of those slumps so that you can pick yourself up by your bootstraps and continue down that road. So I think everybody is a little different

as far as where you start because there are some people that have their nutrition really dialed, but they don't move every day. There's some people that have their nutrition and their movement dialed and they're horrible sleepers. You know, that's me. Again, we each have our own instruction manual. You have to really personalize

those first steps. If you picked one thing, what would it be if you're a smoker? The smoking has got to go, obviously. You gave up alcohol. The single most important decision I've made as an adult, other than marrying my wife, incredibly transformative. I mean, I wish I had done it earlier. And it was interesting. I mean, I loved wine, loved wine and food. I, you know, I, I, I, And I don't have a problem with alcohol, like if people, your body, your rules, you know, like, go for it. Yeah. But I literally, this was even before I kind of really dove deep into the data, we had had a birthday party for a friend and we celebrated. And my wife doesn't drink at all.

She quit drinking in college, 21, 22, just don't like being out of control, not my thing, you know, not my DNA. and just quit. And so, you know, when I would take the trash out on Monday mornings, anything that was in there was mine from the weekend. There was no doubt. And I woke up on a Sunday morning and I looked at Tracy and I said, I'm done. I'm done. And she's like, there is no way. And from that Sunday morning forward, I just, I just walked away. And look, it was a process. Not so much that I had this, this urge, because I wanted. wanted to drink because I had decided between my ears, I was done. But socially, it took me a while just because, you know, we're all more fun when we drink. I think that's just, you know,

you think you're more fun. I mean, probably way more fun, actually, you know. I mean, it's, I just think it's true. And so navigating some of the social circumstances and what have you, but it's like the magic in my life. Every day is the same. aim every day. You know, I am clear-headed. I feel really good, you know, I just, I wish I had done it earlier. I have, I mean, I've lost some friends. I wouldn't say lost. I've marginalized some friends. It's very interesting. You know, alcohol is the only drug that your friends really push you just to go ahead and have that has that one drug. drink, have that, I mean, no one's offering me cocaine, you know, I mean, it's just not on the docket. But it's, you know. But it's somehow socially acceptable to try to pressure someone to drink. Exactly. That's exactly my point. But it's just it. And then, of course, the more that I

dove into it and realized, you know, for me to really work on my diet and really work on exercise and try to work on my sleep and all these things. And then to actively put something that's toxic into my body, it's like, okay, that doesn't work for me. It doesn't work for me. You know, now, maybe I've been a little too proselytizing about it, but it's like reading a good book or seeing a good movie. Like, I want to share it with my friends. Like, I want them to feel this good, too. And I've had a lot of your, you're being judgmental, you shouldn't, you know, and I'm like, I'm not. You can do whatever you want. I was like, I have no room, right? I got probably spilled more alcohol than people would drink in their entire lives, you know, if we were

honest about it. But, you know, it has just been a really good decision for me. And if you've been curious about it, I'd say at least why not give it a try? See how you feel. Just see how you feel. Like, it's worth that. And it's funny because it's like doing an elimination diet in a way because you realize that certain foods actually make you feel bad. So it's not a willpower to avoid them. It's an aversion. And now, like, I don't want to ever feel that way. The other comment I will make about it is I had a very close friend who has consequently passed that when we would be out to dinner and he would order a bottle of wine and we'd be talking about it and the sommelier would come over and said, well, what do you like?

And he would say, I want a bottle of wine that hasn't been tampered with. I want it to taste like it was meant to taste the way the grapes were grown and what have you. And I flip that the other way. I want to live my life untampered. I want to live the highs and the high and deal with the lows because that's the way I think we're built. And what I have found is my anxiety with the lows and being able to maneuver them with less emotion has been exponentially better. And I'm much more stable overall. And so those are just really positive things in my life.

And so as much fun as I had, I am way happier now than I was than I was when I was drinking. Well, thank you for sharing that. Absolutely. I know, you know, I get a lot of messages from folks who are considering, you know, not drinking. And but I think to your point, it's not, it's not easy, you know, because it comes with second and third order effects that you don't even intend. participate, you know. But I think it does go back to how do you want to feel and how do you want to be in the world? And, you know, I think when you remove alcohol from the table, like you do have to sit in some discomfort because you recognize what void that was filling. And now of a sudden you have to deal with that void. But I think that's like such an important source of insight to understand the role alcohol. is serving in your life and whether that is truly upgrading, you know, versus maybe not. It is an invitation, I think, to a deeper understanding of yourself and, and I think can lead

to potentially, you know, a more fulfilling kind of happier life, potentially, you know, and it's worth the exploration to your point. Yeah. I mean, for me, yes. And when you talk about that, those opportunities, it's just like growth in a way that I never experienced because, again, I filled those times drinking. And I didn't allow myself, you know, to deal with the discomfort or whatever it may have been that I needed to really solve the problem. If it works for you, like it works for you. Like, not judging here. Not even, not even a little

bit. Like, I can hang out with people all night and they're drinking and it's fine with me. It's a personal choice. It really, really is a personal choice. It's just been so powerful for me that I almost feel like it's, again, like my duty in a certain respect to at least share it. You know, take it, take away as you will. That's all good to me. So when you think about protecting your own heart, what's an overview of the behaviors that are kind of your non-negotiables or what you're focused on? So for me, it has been nutrition and fitness. And that's been a real part of my life for a long time. And those things come pretty easy to me because I can control them. I can push myself to work out. I can control what I put in my mouth. And really what I have struggled with. Falling asleep and staying asleep. I can't stay asleep. And a lot of that's from 25 years of being on call. And my, you know, my sympathetic nervous system is, like on DefCon 5 all the time. And what I found was I just, I was one of those all I'll sleep

when I'm dead kind of guys. That's how my mindset has gotten me to where I am. And that was really foolish because, you know, I've got a stint in my right corner that I had three years ago. And I don't really have any risk factors. But when we look back at it, this has been my risk factor probably all along. The reason that, again, I was scared and fearful because I couldn't control it. And the harder I worked to control my sleep, the worse it got. And so I've- The anxiety around it.

Absolutely. And so I've really had to change my relationship with sleep and really change my mindset kind of bottom top. And it has been a real struggle for me, just because my body is so ginned up. from all these years. But again, I think that when we look at, you know, how do you approach your day-to-day, like control the things you can control. Like, I want to at least get those things in my corner and make sure that I've got those maximized. And I've definitely been through lots of different nutritional waves in my life. Dietary strategies. Exactly. Yes. I mean, even back in the

90s when it was all no fat, you know, you're eating pasta and no fat yoga for, we all went through it. But, you know, I think really once I got exposed to functional medicine in probably about 10 years into practice, I had a huge pivot in my mindset, both for me personally and for the way that I took care of patients. Was that due to the exposure to your blood biomarkers and really be able to see what actually is happening? This was well before the biomarkers were even in vogue. What happened was it was that taking care of the end game

for 10 years, I really felt like I was fighting an exercise in futility essentially on a day-to-day basis, you know, fix me doc, and we accept all this risk, you send them out and they go back to doing the exact same things that they

were doing before. And it just felt like Sisyphus pushing the rock you know, up the mountain. And I realized we're doing something. and we're doing something wrong. And that's where my mindset really shifted. Again, I kind of tried it on myself and my wife got very engaged as well. And we're like, this is awesome.

You know, like clean up your diet and things get so much better. And it was really transformative. So I thought that I could actually integrate that into my practice. Easier than it sounds, right? Well, it requires a lot of moving parts because the level of patient engagement is tough. Compliance is just getting humans to do things is hard. Yeah, that whole concept of we know better, we just don't always do better, you know, that cognitive dissidence.

And I think you pulled on a really important thread about changing your relationship to that thing. You know, I feel like that is just such a fundamental aspect of behavior change that's often overlooked or people don't necessarily. take the time to think about their current relationship and think about how that needs to change. But I think that's at the really the foundation of being able to kind of create almost a new identity around that thing. All right. I'm going to become a person who eats healthy food. You know, like it's just like you kind of have to change your relationship to that and then change the way you interact with that change, you know? There's no question. Because again, you know, once you kind of get through that starting point,

you have to have those day-to-day motivations that makes sense and feel right to you. And that's kind of the middle phase. And then after that, you have to have the validation. Right. Whatever that is, whether it's, I feel better, you know, the number on the scale is different. I look better. I'm following my biomarkers. I'm following my HRV.

Whatever those things are for you, you know, we all need that validation at various points to know that we're making progress to again kind of reinforce that, that change in, that change in perspective. And that's what I'm needed for sleep, you know, number one, that I feel so much better, you know, as I'm moving that needle. And I've seen it in patience, too. Yeah. And you probably are seeing that in your HRV data, right? You're having more autonomic balance or? Not yet. Okay. Not yet. So how long have you been working on your sleep? About three months now. Oh, you're kind of a newbie. Yeah. Wow. I'm very, I am. That's why, you know, I feel like this is a very cathartic process for me to have this conversation with someone who's such an expert. You know, I feel like the HRV, you know, I heard Todd Anderson make a comment on one of his podcast that he felt like breath was kind of the steering wheel for the autonomic nervous system, which I think is a really cool way to look at it.

What I have found personally is I find it a little more like a sailboat where you kind of turn the rudder and kind of get into the wind. it's not as one to one as a steering wheel is. And yes, I'm seeing the kind of the fluctuations and the differences, but I'm feeling the difference as well. And I think that that's really where I've really focused by my energy and understand that that's going to be the foundation to get my sleep back on. I think that's a beautiful analogy. And there's no question that, you know, when we are accumulating stress throughout the day and not managing it proactively, that will rear its head in our sleep. You know, I do a lot of research with shift workers, frontline health care clinicians, acute care surgeons. We did a really big study, 27 different hospitals all over the country,

and it was 270 acute care surgeons. And it was really interesting to look at their data in that, you know, the mean age of that group, pretty even gender split, was 43 years old. their resting physiology looks like 60-year-olds, 17-year difference, right? So, and what we see is just HRV that is in, you know, again, you know, they look like a 60, 70-year-old, you know, human, right? So we know the toll of your profession is massive, right? So it becomes even more critical that you're thinking about these other levers to be able to control and manage stress. And, you know, a lot of that management needs to take place during the day, you know, in between the surgeries, presuming you do more, maybe sometimes more than one a day. And just

all the other lifestyle things that you're managing, right? But I think the connection between your breath and controlling your autonomic nervous system throughout the day and its relationship to your sleep at night is a really important one. And I'm glad that you've kind of surfaced that for yourself. Well, I think it circles back, too, to your original question of like, okay, if somebody comes in and says, you know, where do I start? And I said, well, it's different for everybody. I mean, sleep is so foundational. And it impacts really every system in your body. The list of disease processes is unending that are impacted. That's the idea when we're talking to patients. First, you have to listen to them. You know, if you listen to people, they'll

tell you where they're struggling. They'll tell you what's wrong. And I think that that's where you start. What's up, folks? If you are enjoying this podcast or if you care about health, performance, fitness, you may really enjoy getting a whoop. That's right. You can check out whoop at whoop.com. It measures everything around sleep, recovery, strain. And you can now sign up for free for 30 days. So you'll literally get the high performance wearable in the mail for free. You get to try it for 30 days, see whether you want to be a member. And that is just at whoop.com. Back to the guests. Do you see the sleep profile in, you know, patients who come to you, or do you have a sense of kind of what that looks like on average for people?

So a lot of my patients, because most of them have either borderline or full on metabolic syndrome, have some degree, if not documented sleep apnea. And so again, I'm in that kind of in-game arena when it comes to these kinds of patients. I would say 25 to 30 percent of the patients I operate on are actively utilizing CPAP at home and we require it in the hospital. And I think that connection with cardiovascular disease is undeniable for sure. I mean, I love the idea of kind of focusing on breath as a place to start, you know, learning how to breathe properly is relatively low barrier to entry. I think when you consider other modalities that people can engage in or other, you know, or trying to take on a new dietary strategy or, you know, all of a sudden ramping up exercise, you know, getting the breath under control is a place to start just literally can someone breathe through their nose, you know, for extended periods of time and not have to open their mouth. I mean, that is a really easy test, right, to see if people are capable of breathing properly.

But I think that's, that's kind of a under leveraged potentially, kind of lifestyle change. I don't even think it's included in many of the contemporary pillars. Isn't that wild? Yeah, it is. I mean, obviously, I think some of the real kind of tip of spear folks that we're all familiar with are dialed in to how important this is. But I think, you know, things like sleep or even oral hygiene and the impact that it has on our cardiovascular systems that, you know, they seem so simple and they seem like they should be things that are taken for granted. But that's the problem. They are taken for granted. Or they're pushed into a lower priority because they're not the sexy things to be doing, like, you know, running 100 mile races or whatever it is. But they are so important. And I'm living proof of that, you know, as much as I feel like I know better, sometimes I also don't do better. Well, it's hard.

You know, when you're focused on trying to make your sleep better, it just creates anxiety. And oftentimes it's, you might be carrying so much sleep debt that you're exhausted and you fall asleep, but you can't stay asleep. And that is a product of a lot of the stress accumulation throughout the day. It's a product of your light behavior. You know, it's kind of some of these other things that really impact our ability to fall asleep, but oftentimes to stay as well. sleep. And I think when we consider cardiovascular health, it seems like, you know, that's the thing to figure out, you know, and understand, like, what are our daytime behaviors need to look like in order to kind of facilitate a healthy, restful sleep. Sure. I mean, I think if we look at

nutrition, clearly, I think, you know, a whole foods based type of diet, whether, you know, you're putting protein at center stage based on your goals or not, those are all very very, you know, very personalized kinds of things, but clearly a good common sense, whole food diet with a reasonable glycemic index is important, making sure that you're timing your meals not too close to when you're going to sleep and what have you as far as, you know, taking that energy from your autonomic nervous system towards your gut as opposed to where it should be when you're asleep and what have you. And then the idea of sleep pressure, you know, as far as your activity level during the

is so important, you know, and I'm learning that. I've got plenty of, plenty of sleep pressure, but I tweak that because I take a nap because I have to or whatever. And I do fall asleep very easily because I'm exhausted, but I don't slay asleep because I think I'm modulating that sleep pressure in a way that's not allowing me to stay asleep. So I think that activity level, both physical and mental, is really, really important, you know, for people. And then the mindfulness and breath work piece. However you find that, you know, just getting out and going for a walk or interestingly, my parents began meditating in the 70s. I was maybe seven or eight years old when I learned transcendental meditation. Wow. And so it's been kind of a part of my life

off and on for a long time. So I'm very comfortable with it, but I underutilize it in this way. But that's something that I definitely talk to talk to patients about for sure. And I think that's where the feedback from the data can be really helpful, you know, is just looking, you know, we've got the feature stress monitor, which I found really valuable for instances like that to understand, you know, what impact does meditation versus mindfulness versus a walk in nature have on my autonomic nervous system. And, you know, and stress monitor, of course, is kind of an algorithm that's taking in both resting heart and heart variability. So it's, it's really this, I think, nice.

robust view of just what's happening with your heart, you know, 24-7, you know. And I think that lends into the heart and the nervous system, how responding and adapting to stress, I think is really is really powerful. But how much do you use like that type of biofeedback to kind of decide which modalities are working for you versus maybe not or, you know, which where you're getting the most bang for the buck? Yeah, I am a data guy. And I really, I have been involved. even in the late 90s when heart rate training, anaerobic threshold, wadage on the bike, all of that. My friends used to call me Jeremy Neutron because I was such a geek about my data, but it enabled me to finish, you know, some really long distance endurance, you know,

iron distance races and what have you because I knew my, I knew my anaerobic threshold. If I hit 147, I slowed down and I finished without injury and finished strong. So I, I, I saw the immediate success early on with this data. Now, I think that I do have to be careful getting too focused sometimes on my data. I have to take a little bit of a holiday at times with it. But I, again, I think that this validation is really important. It's really important for me. And in this day and age with the instantaneous information that everybody has at their

fingertips, you know, with phones in their hands, there's a expectation that we're going to do something and we're going to know if it's working or not working fairly quickly. And that gives personally and many other people motivation to kind of continue down that road. I think that the stress monitoring is awesome. I mean, it is in line with what I am doing every single day. I mean, I can see. Yes, I agree. That is what my stress says, I didn't work that hard today. I see that. You know, it's, you know, again, it's an accountability tool for me for sure. But the biggest one, as you mentioned earlier, has been the HRB, because I think that that is really where the magic lies for someone like myself who's kind of been on

DefCon 5 for so many years that I got to get from here to here soon. Yeah. What I love about HRV is it kind of helps you understand if you just, if you might be adapting just to a lower level of functioning. You know, if you're not responding and adapting to stress in a functional way, you know, your HRV isn't going to rebound, right? That source of insight, I think, can be really powerful for folks, you know, to make change and to know when to kind of pull back. And I think for someone, you know, for people who are really hard charging, like it can be hard, you know, to take rest days. But I think the evidence is really clear that when you are really strategic about your rest, you have the ability to modify your HRV, you can increase your ability to respond and adapt

to stress in a functional way. And that should be reflected in increases in heart rate variability over time. You know, if you're thinking about your training and all the inputs that are going, you know, into the body, you know, are they working for you or not? Yeah, recovery is as important, if not more important than whatever the activity is that you think is going to move the needle. Yeah. And, and that, That certainly is something that I have had to come to grips with. You know, more is not always better. I've gotten myself into overtraining cycles many times over the years, you know,

where you just start to see this plateau in your progress and, you know, a friend to say, well, yeah, when was your last day off, you know? Right. Bustles have to recover to grow. Our brains need sleep to go through the appropriate recovery phase. That's where we, you know, our deepest memory. and ability to memorize comes from, you know, when we're in deep sleep. Like, those are all recovery pathways. And I think that having the ability to objectify those things is really good

for a person like me. Because when I see my HRV where it is, and I'm embarrassed to even tell you what my baseline number is, it really, it motivates me on a day-to-day basis. And that's what's nice about it, too, unlike resting heart rate, which is a great tool for kind of your basic fitness level, HRV is right now, you know, even though it takes time to change those things. It's where is your autonomic nervous system today. Yeah. And it's just, it's really tactical in that sense. Yeah. That's so well said. I want to talk about sedentary behavior. We know that's an independent risk factor for cardiovascular disease. And I want to talk about too much exercise, if that's even a thing. From the sedentary behavior standpoint, like, I think you can

exercise, but be sedentary, right? So I can wake up, I can run for five miles, and that I can literally sit unbroken for eight hours, which is the behavior of a lot of folks, right, in the world. So, and it's kind of the nature of being a knowledge worker, like we're sitting in front of the laptop. I mean, I have to really be conscious of breaking up my sedentary time. What do we know about sedentary behavior and its impact on our heart. Well, I think you are probably even more versed in the study that was done, was it in the 90s that, you know, coined the term the sitting disease and the fact that it is as dangerous or potentially even more dangerous than smoking when we look at a risk factor, independent risk factor for cardiovascular disease. And I think that's so

interesting and I think the point that you that that you elucidated that you can in your mind feel like I got my workout in right now I'm cool just to go and sit all day that kind of all or nothing is not really how our bodies work and I think a lot of it is related to maintaining really stable glucose levels through the day too because that was one of the other things that I really I was just astounded by was we would eat dinner and take the dogs for a walk and I would watch and I would watch my glucose level drop by 10, 15, 20 points with a 10 or 15 minute walk. And I think that that's one of the pieces that's so important to have that glucose stability during the day as opposed to the spikes without additional control. And that's one way to train our metabolic

system, right? And I think that's, you know, the walk after dinner is probably one of the best hacks, you know. No question. It's not even a hack, you know, just one of the best behaviors that we can take on board to get better control of our cardiometabolic health. Yeah. We talk about it as it's the brushing your teeth. Yes, I love that. It should be, yeah, it should be just part of the bedtime routine like that's just added because it's good for you. Yeah. You know, and it really is. And I think that that data is really well established. I think that's, That's why the standing desks and the treadmill desks have gotten so, you know, so popular.

And I'm kind of like you, too, like when I get really focused on something, I have to remind myself. I mean, I can sit for, my kids are like, you have a focused problem. You know, like I can sit for like four hours and just like, you know, I have to be really careful. I share that plague as well. As far as the overindulgence, you know, I think that there is really good. good data that the extreme is also in question. When we look at the data in some of the elite marathon runners and some of these ultramarathoners, and most of that comes from, again, the heart is a muscle. And you get this what we call left ventricular hypertrophy or a thickening of the left

ventricle. And this is characteristic of endurance, ultra endurance. Super, ultra guys. And, you know, do they get blockages in their heart arteries? No, not normally, but they have different problems. They can have heart rhythm problems. They can have obstructive type problems where the blood actually comes out of the heart from where the muscle has become overgrown. I call it a hypertrophic myopathy. There's a lot of different possibilities there. And again, I think it just leads to anything in the extreme, unless you are in that small percentage of individuals that clearly function there, tolerate it, live for it, and they're just made to function in that space. I think that for the average human being, it's probably not a healthy lifestyle to live in that

at that portion of the curve. Do you think it's worth kind of getting genetic tests to understand if you're in that, you know, if you have a predisposition for being able to respond and adapt to endurance type of effort. You know, like I know, like, you can kind of see, you can look at your genetics. You can see, you know, if you're more geared to power or to, you know, to kind of short versus long. And I find that interesting. Yeah. I mean, I honestly, I don't know that there's a correlation there. I'm not aware of that. And I'm not aware that the genetic testing would give you that kind of inside. That's not, that's a little outside of my wheelhouse to really be able to to swim in

those waters. But yeah, it would be great to be able to do that because I would love to know if I could or not, assuming my knees would hold up to something like that. And I think it would be important information, you know, for people to have before you embark on, on something like that. But I'm not sure that it exists. But from a health span perspective, it's your take that for most folks, really long, ultra kind of endurance efforts are probably not great for the heart long term. I would say it's unnecessary. Yeah. I think that the data that shows benefit is very clear.

And it's typically way less time per day, per, you know, workout than we ever thought it needed to be. And it's really more just the consistency piece that really moves the needle for most folks. And so I think that that's where the sweet spot is if we're looking at 65 to 70% of the population. Perfect. I think people have a vision of the folks who end up with an unhealthy heart. You know, they're the smokers or the drinkers. They're the folks who are eating too much or obese. Those are independent risk factors, right, for cardiovascular disease. But then there's also folks who look really healthy, right? I'd love for you to talk about, you know, what do you see in those different kind of phenotypes?

And how do we think about that? That's a really common conversation these days, I think. And I'll start it by saying, you know, I think there's three misconceptions. First is that heart diseases for old people, not true. The youngest heart operation bypass I've ever done was 28 years old, right? Number two, that your cholesterol is normal so you can't have heart disease, not true. You can certainly have a normal lipid panel, but the kind of the next layer of that lipid panel, which there's lots of information out there about right now, particularly if you look at APOB and

lipos small A and those kinds of things, and just not to get too far in the weeds so that people understand, this just looks at really the more pathologic portion of the cholesterol panel. So, in other words, you can have normal cholesterol levels, but a high percentage of the dangerous cholesterol particles within that. That's the LDLC, right? Yeah. Those are kind of the bad. Yeah, and there's a group of the APOBs that are kind of the atherogenic ones.

some that you can control with diet and exercise, some that are genetically sourced. And then I think the third is that if I'm exercising, I'm healthy and it doesn't matter what I eat. And I think you and I both know that you can out eat in the exercise that you do. Truly. You know, I mean, whether it's from a caloric standpoint or from a health span standpoint as well. I mean, you know, obviously in the lab, a calorie is a calorie because it's a heat measurement, but from a nutritional standpoint, that that's not true. So I think there's that kind of basic misconception right from the start that people kind of get down this road of convincing themselves, you know, that I'm okay. Then there's the kind of next layer, which is this pre-diabetic layer of folks that 80% of

pre-diabetics don't know. Now, I will tell you a story about myself. My son, who runs all of my social platforms and is very engaged. He's a genius, obviously. He's just like his mother. Good. he is he is very bright and i give him a great deal of of credit for for all of our success quite frankly but he said to me dad you know why don't you put on a continuous glucose monitor and i said nice i don't i don't need to do that he said it would be interesting you know you eat right you take great care of yourself i was like max if i need to put one on to prove to you what a great job i am doing fine i'll be like

I can't wait to hear. Yes, I'm putting it right on the tea. I'm happy to do it. I said, and it's a great idea. I think I should do it. So I put it on, and within 48 hours, I realized that things that I was eating that I thought were really dialed, were not only spiking my blood glucose,

which is a normal physiological response. People get really freaked out when they eat. That is what is supposed to happen. That's normal, but my mind. was spiking and staying elevated. Yeah. And I'm good. What was your fasting? Sorry, hopefully I'm not getting into punchline here. No, no, no, not at all. Not at all. So my baseline to give you was 121. Oh, you wake up in the morning with a 121. Well, that was average. So I'd wake up in the morning. It'd be 98 or 101. Yeah. You're pre-diabetic. So I'm good friends with my

internist, who I work out with, and I started to show him my numbers. He looked at me, he was like, you have to get an A1C checked. He's like, are you kidding me? And it was 5.8. And so, look, I thought that I was on the right track, but that which is not tracked cannot be improved upon. And until you know, you don't, you don't know. And so I sell into that 80% of exactly the kind of person that you asked the question about. And I, now, if you went to a clinic, if you went to a doctor with the 98, would they say, well, come back to me when you have diabetes? Would they treat? You mean a 5.5.5.5.5.5. 5.8, yeah. So it would depend on who you saw, right? That's what I think is kind of problematic, right? It is part of the problem. Now, you're at a point where you're like, well, okay, that's too close for comfort for you, right? But for

most Americans, unfortunately, they don't get flagged as aggressively, right? And they're like, oh, can't find. And you know how I answer that is, first of all, think about it. You know, the A1, see is a percentage number. So what you're looking at is the percentage of hemoglobin that has glucose attached to it. Well, you're talking about 5% is normal. That's a pretty small number. Right. 5%. Well, then the distinction between pre-diabetic and diabetic is 0.1. If you go from 5.8 to 5.9, you're then diabetic. So I would argue that that is exactly the time. that there needs to be intervention because this is like an f1 race right i mean like people are winning by by milliseconds it's not two laps you just don't have that kind of latitude in a situation like

this so you know we can all do better we can all do better with our diet i mean things that i didn't realize rice i really i like rice i don't like rice as much now i have i'll give you marispe to reduce the resistance starch by 16 percent do you know how to do that well i'll tell you it's been a game changer for my family. Interesting. Yeah. I mean, and it's been, you know, since we've been following it so closely, I mean, I've been able to really dial it back so that now my average runs anywhere between 99 and 101, which isn't perfect. I'd love to get it closer down to 90. I'm going to have my A1C check next week because I've kind of at that, at that three-month window, and we'll see, we'll see what it is. So I think that a big part of it

is being willing to have some intellectual honesty about. things as well. And that's part of this piece that I think has to be included as we move into the next wave of health care is patient engagement. You know, that's so critical. Now, that has to be met halfway from physicians that are refocused on patients as well, right? I mean, they have to feel like that relationship is there because you made the comment like, that's the problem. You go in And they're like, ah, because a lot of them don't exercise themselves and aren't, don't believe that this is the path. You know, I think that there's some really basic things that people can do at home to kind of start. Like, where am I? You know, just a waist to height ratio.

It's really simple because we know that that adipose tissue, particularly in the midsection, is a direct risk factor for cardiovascular disease. And it's really simple. you measure your waist in centimeters and your height in centimeters. It's either 0.5 or less. If you're greater than 0.5, it is an exponential increase in risk. So it's like without a single blood test, check your blood pressure. What is blood pressure and why does it matter in terms of cardiovascular health? Super simple, you know, just to kind of the bare bones, is that blood pressure, to think about it as a risk factor is the amount of resistance that the heart, is seeing with each beat. Now, that's not the whole picture, but I think that that is the way

you should think about high blood pressure in particular, because that's where the risk comes from. Because as you get this kind of hypertoned in your blood vessel systemically, that's what's cranking up. The blood pressure, the heart is having to work harder with each beat. It's seeing more resistance. Well, the heart is a muscle. just like any other muscle. And over time, that muscle is going to become thickened and less efficient over time. And so when you have untreated high blood pressure, not to mention kidney problems and- That's the thing. It's not just, doesn't just impact your heart, high blood pressure impacts your kidney just as much. None of these things happen in a vacuum.

Yeah. Yeah. Everything is, everything is interconnected. But specifically, if we're talking about cardiac involvement, that's really where it comes from is the workload that the heart is seeing. An increased workload over time is dangerous because at some point, the heart is going to start to fail. And when we look at longevity, when we look at single elements in a workup that determine, like, how long is this person going to live? It's fairly simple. It's how strong is the heart pump? Patients with strong hearts do much better than patients with weak hearts. Ejection fraction, which is what measures the amount of blood that's ejected from the heart each time, is the indication of whether the heart is strong or not.

Interestingly, we don't eject 100% of the blood with each heartbeat. A normal ejection fraction is somewhere between 60 and 70%, because some blood does stay in the heart with each beat. But that really is kind of the timeline that we see when we talk about untreated high blood pressure and why it's so important that it's treated early. Thank you to Dr. Jeremy London for all the insight on heart health and cardiology. For more tips on how to live healthier and longer, check out Dr. London's social channels. If you enjoyed this episode of the Woot Podcast, please leave a rating or review.

Check us out on social at Woop at Will Ahmed. If you have a question to us and answer it on the podcast, email us, podcast at whoop.com. Call us 508-443-49-5-2. If you think about joining whoop, you can visit whoop.com, sign up for a free 30-day trial membership. Newmevers to use the code Will W-I-L to get a $60 credit on Woop Accessories when you enter the code at checkout. That's a wrap, folks. Thank you all for listening. We'll catch you next week on the WOOP podcast. As always, stay healthy and stay in the green.