A Cardiovascular Surgeon Had a Heart Attack Here's What His Own Tests Missed

Key Takeaway

Your standard cholesterol panel might look normal, but that doesn't mean you're safe from a heart attack. What matters more are the biomarkers most doctors never test: apoB, insulin levels, and particle size. A cardiac surgeon who had a heart attack despite 'looking healthy' learned this the hard way—his apoB was 180 and fasting insulin was 40 (should be under 5). You can't fix what you don't measure. Start tracking the right numbers now, not after symptoms appear.

Episode Overview

Dr. Jeremy, a cardiovascular surgeon, shares his personal story of having a heart attack despite appearing healthy and being deeply knowledgeable about heart disease. He discusses the critical biomarkers most doctors ignore, the gap between knowing and doing better health practices, and how cognitive dissonance led him to dismiss warning signs. The conversation reveals why standard cholesterol testing misses the real risk factors and what actionable steps people can take to prevent heart disease through lifestyle changes and proper testing.

Full Transcript

Transcript of A Cardiovascular Surgeon Had a Heart Attack Here's What His Own Tests Missed from The Dr. Hyman Show. Auto-generated from episode audio; may contain minor errors.

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

You got to be so careful these days with the the more extreme choices because you always have to be careful what you're substituting things for because it's something that we have such control over. over. over. Jeremy, it's great to have you on the podcast. Thanks for coming all the way from Georgia. from Georgia. from Georgia. Thank you. You know, your story is quite compelling. You you know, we were just chatting a little bit before and you you're cardiovascular surgeon. You do bypasses and angio you know, fix arteries and do major big surgeries.

That's a cardiovascular surgeon and brain surgeon are like the two top surgical specialties that you know, really tough and hard to learn and and that take a lot of time to become expert at. at. at. And somehow in all that process, you discovered that you were kind of treating things at the wrong end of the stick. You were kept seeing over and over cases coming back over and over with bad habits that they never changed and needing another surgery another surgery. And and you did that for a while but then it sounds like you had your own epiphany in medicine where you realized you might be not thinking about things the way you should and should and should and you had your own health crisis.

You talk as a cardiovascular surgeon about how you want to make you know heart disease the number two killer in the world not the number one killer which is a great aspiration but the irony is you had a heart attack. So, tell us about that and I mean you look healthy, you you seem healthy. I'm sure you don't smoke. I'm sure you eat pretty good. You look fit, exercise like and you're kind of the you know, the the kind of person you wouldn't think would get a heart attack but here you you were and you had a heart attack and this kind of what I want to get into a little bit on the show which is why are so many people who seem and look healthy getting heart attacks?

heart attacks? heart attacks? It's an ongoing question, for sure. And to make it even more egregious from from my standpoint, the time frame between making that shift of treating the end point of disease and when I actually had my event was another 10 years later. So, I was already very dialed into you know, really really working on solid lifestyle choices. And I thought that I was doing a really really good job. I really did. And what I have come to learn is that none of us are immune to cognitive dissonance.

We know better, but so often we just don't do better. It can be simple things. You know, the smoker knows they shouldn't smoke, but they continue. continue. continue. You know, you shouldn't reach for the chips, but it's what's convenient. You're tired. You deserve them. However, you defend that. And no one knew better than me. than me. than me. Yeah. Yeah. Yeah. The signs The signs The signs and the lead up. I mean, I lived it. I taught it. I dealt with it. Yeah. Yeah. Yeah. And like I said, you miss?

you miss? you miss? Intellectual honesty. And I fell deeply into that gap of knowing better and not doing better. doing better. doing better. And what were the things you weren't doing that that led you to have a heart attack? It was only a few years ago, right? It was like It was 3 years ago. Yeah. Well, it it really it didn't hit me until after the event because it was really in the midst of it that I fell kind of first tripped into the space because I woke up one morning with what I thought was just reflux.

reflux. reflux. Heartburn. Heartburn. Heartburn. Heartburn. And I get up early. I was pacing around the room. And my wife's like, "Are you okay?" I'm like, "Yeah, yeah, I get a little reflux." She goes, "You don't look like you have reflux." I'm like, "Seriously, you're going to tell me tell me tell me I'm a doctor. that I don't have reflux. I mean, come on. on. on. So, I sat down, I read for a little while, while, while, felt fine, took the dogs out for a walk. It was December.

We get a quarter mile from the house, it's cold outside. I'm peeling my clothes at this point, sweating. And she looks at me, she goes, "reflux?" "reflux?" "reflux?" I was like, yeah, you know, it's just really She's like, okay. So, we go back to the house. Is she a doctor, too? She is not. She's just an incredibly brilliant woman. brilliant woman. brilliant woman. We get back to the house, and not to be overly graphic, I sit down on the toilet, and within 30 seconds of sitting down, down, down, symptoms went away.

And I immediately was like, no. no. no. Exertional symptoms relieved with rest? No, not me. It's not possible. Couldn't be. Couldn't be. Couldn't be. Could not be. So, at that point, I did what someone who is the poster child of cognitive cognitive dissonance would do, and that's explain it away. it away. it away. And through the course of that entire day, I would go upstairs, have it come back a little bit, and I'd sit down, and it would go away. Oh, yeah. Oh, yeah. Oh, yeah.

That evening, my family went back into town, and I was with my youngest son, and and and we were out in the woods that evening, dark, he's 14 years old, quarter mile from the truck, no cell service, and I go down on my knees with with with significant chest pain. Like, I knew what was going on, and my son's like, "Dad, are you all right? Like, what's going on?" I said, "Oh, it's just reflux." He goes, "you can't walk around when you have reflux?" I was like, oh, you're another smart one in the family.

So, I pull myself together, I get We get back to the truck, and I drive home. Oh, man. Oh, man. Oh, man. Oh, yeah. Oh, yeah. Oh, yeah. I'm going to lay it all out for you. I didn't say I was going to be proud. So, I get home, I take a beta blocker and an aspirin, and I go to sleep. Oh, wow. Wake up the next morning. Not the right decision, but good thing you woke up. I share it hoping that others I share it hoping that others will do will do will do Sometimes you need an example of what not to do.

they call you know the the usual the first symptom of heart disease is sudden death before 50% of people. And and I've had people I know who's had that experience and you're lucky you had some warning signs. They call it the silent killer, but it's in your case it wasn't so silent. And about five or six years prior we had a good friend who was a radiologist at 48 that that's exactly what happened to him. So, it's not like I'm not aware. I woke up the next morning.

We live in a a home with staircases. Went down to make my coffee, came up, same symptom. So, then I had to come clean. And my wife says, "This has been going on since last night. Why didn't you say night. Why didn't you say something?" She said, "Well, you would have made me go to the emergency room." And she's like, "Well, that's what you do when you're having chest pain." I said, "Well, I didn't like the cardiologist that was on call that night." She goes, "Are you kidding me?" She's like, "You're friends with all of them." Yeah.

Yeah. Yeah. And then she stopped for a minute and I I always kind of get goosebumps. She looked at me and she said, "That is the most selfish thing you've ever done to me and the boys." Yeah. Yeah. Yeah. And that really that hit hard as you might imagine. And I said, "I hear you. I am terribly sorry. But can we go Can we go to the hospital?" So, I called one of my buddies. He's like, "There's no way, man." I said, "I'm telling you. I said I've tested it pretty good here." So, he's like, "Come to the office." I'm like, "I don't think that's a good idea." He goes, "No, no, no, no.

Just walking around the office." He took one look at me and I was in the cath lab and you know, one stent in the right coronary, you know, and and I was fine. So, I wouldn't let him sedate me, you know, for the procedure cuz I want to know what's going on. So, he passes the wire across it which occludes the coronary. And you had severe chest pain. EKG changes, severe chest pain and I'm like doing hey man, hey man. He pulls the drape and he goes, "I need you to shut up so I can get this done." Sedated me, got it done, went out and told Tracy, Tracy, Tracy, "I dream of stenting cardiac surgeons, but doing anything to your husband was an absolute nightmare." She goes, "Oh, I'm sure.

I'm sure. I'm sure. I'm absolutely sure." So so what were the things that you did that led up to that? Because you obviously been in this field, you're aware of heart disease, you're not doing the normal bad things. It's really only in retrospect now that that I was able to really unpack all of that for myself because the immediate response was response was response was I do I have a stressful job. And certainly a component, but not enough to really lay your head on. The second was after 25 years, and you're still doing cardiac surgery.

Yo, yeah. Yeah. I went back to work that that Tuesday after I would soon as they would let me. [gasps] [gasps] [gasps] So, you know, my sleep was totally out of whack. I was on DEFCON 1 all the time. So I was like, "Okay, that's certainly a risk factor. If this if your sleep's off, everything's off. Certainly a risk factor." Well, it really wasn't until we started with the platforms and my son Max was instrumental in all this. You know, he said, "Dad, wouldn't it be interesting if like you put on a CGM?

Wouldn't that be interesting?" I was like, "Max, like, "Max, like, "Max, if I need to show you what a great job I'm doing with my diet, with my exercise." That's fine. He's like, "Dad, I don't care what it shows. I just think it'd be cool like show people, you know, the process and look at your numbers." Yeah, within 48 hours it became very clear that my baseline glucose was unacceptably high. Checked a A1C, I was 5.7. Flipped into a, you know, a fasting insulin level, which Which was what?

I'm going to I'm embarrassed to give you the number. I'll say it was I'll Come on, give it to me. 40. No. 40. No. 40. No. 40? 40? 40? 40, seriously? I mean, just for those listening, it should be less than five. The lab reference range is 18, which is I think terrible. 40 is is high. You You were What you had a little belly or what? what? what? You know, not really. No. Bread, pasta, rice? Not really. And come it was so high? I don't really have that answer, but I definitely retooled my diet as a result of it.

You know, using the CGM, I was able to kind of see like and I added 10-minute walks after meals. I tried to add more cardio, back off on some of the strength training. I used to do a lot of endurance work. endurance work. endurance work. And that made a difference, for sure. My A1C came down to 5.5. We got the Yeah, the insulin level down to acceptable ranges. So, ranges. So, ranges. So, more risk factors than were obvious. Again, look healthy, Yeah. Yeah. Yeah. but you don't know until you know.

And we'll add the coup d'état on top of it, which would be an apoB of 180. Wow, and you had checked it or hadn't? LDLs or LDL-C only, which was mildly elevated or around my event. You know, mildly elevated. My triglycerides were a little high, which is in line, of course, with the the glucose insulin resistance and all those things, but not shockingly so. You know, it wasn't 500. It wasn't in line with that. that. that. What was your triglycerides? [sighs] [sighs] [sighs] I don't remember.

I want to say they were probably upper 100-200, so Yeah, yeah. Yeah, yeah. Yeah, yeah. I mean, high, but not That's high. Should be under 70. Right, but Right, but Right, but 70. The lab reference range is, you know, would say 150 is the You're not going to cut me any slack today. today. today. Here I am pouring myself out to you and being an example for other people. You're I This is important information because you're you're highlighting the fact that you're Here you are a cardiac surgeon.

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

So triglycerides and LDL particles and you know, intermediate density particles and so forth. Lp(a) These are all together in apoB. So it's it's now recognized by cardiologists as being the most important biomarker for predicting heart disease risk. But it's almost never tested by traditional doctors. It's just they check your regular cholesterol panel and that's it. And yours was a little bit off, but not terrible. And here you are sitting on a time bomb and you're lucky you didn't actually have a a clot and die. I mean, you could have.

Absolutely. And you know, it goes back to that you can't fix what you don't measure. measure. measure. And it really took me understanding that my priorities needed to change, that I truly needed to engage in secondary prevention. And to do that, I needed to know what my numbers really were. And the grace at this point is I have now normalized all those things. My particle counts are really pretty phenomenal on Repatha and a little low-dose Crestor It's really important what you're saying is cuz you know, looking at you no one would say, "Oh, here's a high-risk heart attack patient." You don't smoke, you don't have high blood pressure, you're you know, you're you look fit, you seem you know, into health.

But like these things are under the surface in a lot of people and we're seeing this a lot with Function Health. We're seeing a lot of people who are now measuring this on I mean, I've been doing this in my practice for 30 years and I'm measuring lipoprotein little A, measuring particle number, particle size even when before that was a when it was a company company called LipoScience which did those particle numbers and size before a LabCorp bought the before Quest developed their test. I've been doing this for decades and measuring apoB and all these numbers and and it's amazing to me that they've been available but I mean I sat with the head of the executive physical at Cleveland Clinic who was an older gentleman who remain nameless and I was like, "Listen, "Listen, "Listen, [snorts] [snorts] [snorts] I think your executive physical labs are a little dated.

Maybe you should do you know particle number, particle size, you know, apoB and all this." He's like, "Well, you know, we don't like to do things before there's adequate research." And I'm like, "Well, this has been around for 40 years. Ron Krauss has discovered this 40 years ago that particle size and number matter and they track with your carbohydrate intake not fat. So like that if you're eating a more starch and sugar, you're going to have more of these atherogenic particles, you're going to have high apoB, you're going to have more particle number and smaller particle size." These are all the things that no one's looking at.

So I think, you know, getting these things tested is so important and at Functional Health that's what we do with everybody and we're seeing it's huge huge number of people who have particle numbers that are high as over 90% have really some degree of abnormality. abnormality. abnormality. And when you map it to like imaging, then you can actually see what's going on and then, you know, you can treat it like you you might have some genetic factors. There's lipid genetics that play a role I'm sure for you.

I certainly have like a an inherited familial lipid disorder. It's not like class the classic one but it's Now we have more genetics we can do. I've done my full genetics for lipids and and you know, we're going to be offering you know, genomes whole genome sequencing soon. So for like I think we're seeing a lot of lot of lot of potential to really understand your unique biology and then how to customize treatments. treatments. treatments. One thing I've learned over the years is that healthy eating is a lot easier when you have better options available before you're starving.

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Like, take LP little A for instance. I mean, it has really been around for for decades. time. time. time. And And And long as I've been doing medicine. And if you look at the history of that of of why it didn't come to center stage, and I'd be interested to know what your thoughts are on this, but it was that attitude of well, we can't do anything about it. So, why should we actually be testing for it? for it? for it? Mhm. Mhm. Mhm. And I mean that's that's such a misguided mindset because, you know, knowing something is is as is important even if you can't do anything directly about the thing you know.

know. know. Right. Right. Right. Like having that information so that you can change everything else. You can reduce all the other risk factors. factors. factors. Exactly. And even with the inherited factors, the other inherited factors, that's such important information to be able to stratify people that otherwise look healthy that you know you need to get those numbers lower, that you need to be more thorough, that you need to be more engaged so that you don't end up in in the situation that Cuz I'm sure those numbers that you had, if you'd been tracking them for decades, they would you would start to see the trendline going like this, for sure.

That's what's available to you for people for a very low cost. I get function health basically doing a dollar a day, you can get all this stuff Sure. Sure. Sure. and you know, twice a year testing and get a really deep view, not just of your, you know, your lipids, but also like metabolic health, which is, you know, know, know, you kind of you're a case in point that most heart attacks today are really, aside from the small subset that's just inherited lipid disorders, is coming from metabolic syndrome, from pre-diabetes, from poor metabolic health, where we're eating so much sugar and starch that's causing high insulin and high triglycerides and high apoB and all these things that that are really from what we're eating.

Things get Things get Things get misconstrued many times because they come in, you know, patient two patients, right? You have the healthy 50-year-old that has normal standard panel, physician shakes their hand and says, "You're good to go." And 18 months later that patient's in the back of the ambulance with a heart attack, and the response is response is response is "See, LDL doesn't matter. Cholesterol doesn't matter. None of those things matter." Then you have the other patient that had high cholesterol, was well treated, has LDL levels of a of a 15-year-old, 15-year-old, 15-year-old, also in the back of the ambulance, 18 months later, and that patient's response is, "I was safe.

I did all the things." And they're both wrong. Why? Why? Why? Well, because the truth is somewhere in the middle, right? Because LDL just doesn't tell the whole story. Now, before, you know, we break, you know, before we attack LDL, clearly LDL is causal. We have lots of data that supports that, but it's not the whole story. ApoB, Lp(a), the metabolic components, you know, that that's a very, very important component. The the second arm of that is the things we can control. control. control. You know, we over index on LDL because we have a drug that treats it.

The truth is that that may not be the right target for treatment. And when you look at the data, like even things like triglyceride HDL ratio is far more predictive than LDL. LDL. LDL. And and I and and and that's a reflection of metabolic health. So, high triglycerides and low HDL means you probably are heading towards pre-diabetes, and that's really the driver. You sort of mentioned people can have normal cholesterol and have a heart attack or have, you know, treated cholesterol and have a heart attack.

There there was a big study that was like looking at, I think maybe you know the study, I think like 130,000 people who were admitted to the emergency room with heart attacks. And I think 75% had quote normal LDL. But only like, I don't know, 10% had normal triglycerides. I don't know like that. It was like Well, you know, it was so It's just not the only villain in the room. room. room. Yeah. Yeah. Yeah. And and for most of us, myself included, that certainly was the case, you know?

And I think that that's that's the reality, and that's, you know, understanding that you we can all fall into this gap, recognizing it before we do, understanding what we what tools we have available, whether you can move the needle with lifestyle changes, or you do all the foundational pieces. You eat well, you move, you sleep, you have your relationships in check, all those things. those things. those things. And you're still not right, you know, it may be time to consider a different lever. lever. lever. You know, people today think that taking medication is a failure.

No, it's not. It's not. And it's both the fault of patients and physicians. Yeah. Yeah. Yeah. You know, I think about it like a like a scale. You know, at the one end of the patient scale, you've got the individual who's like, "Just treat me, doc. I'll do whatever you say." And at the other end is "I don't want anything to do with medication. I can do all this myself." Somewhere in the middle is where we need to be. Well, the physician scale is not very different.

You know, you've got on one end one end one end the physician that's giving out medication like it's a Pez dispenser. Yeah. Yeah. Yeah. And I think honestly more than with Pez? I I I ate that when I was a kid all the time. on what's inside when you when you phrase you're you're about my age. I haven't heard that I don't do they still make those? I'm like I have not seen them, nor have I looked for them. for them. for them. No, no, no, no, what that is.

A little thing you had when you were a kid. It was like a it was like a little device that popped out a little candy. And you could just pop it and it would pop out a candy. It was And that's exactly how they hand them out. out. out. And at the you know, at the other end of the spectrum, and I think this is actually a much more dangerous mindset for physicians is "We'll just watch this and wait. You know, you're doing great. Continue doing what you're doing with abnormal labs." And the problem is that's that's like patient-centric care masquerading in this other form.

And in the end, these are risk-benefit decisions, right? Like, yes, do the foundational things. Do all the things that you need to do. But if that's not working, you don't leave your patient at risk. So, both of those things are really at center line as where they belong, somewhere in the middle. middle. middle. It's true. There's a real need to know what your numbers are and use those to guide you as opposed to you know, just you look fine or your basic cholesterol panel's fine. Cuz that like you said for you, yours was a little off, but it wasn't terrible.

That's right. That's right. That's right. And I think that's the way it is for most people. So so how I think that the key here is is tracking your trends over time cuz if you were 30 and you track your numbers, you'd probably start seeing them go a little off. Yeah. Yeah. Yeah. And then by the time you're 40 and then 50 and then you know, you're getting into your upper 50s, then you really already have the disease. Like you already had a problem. So really you want to start checking this earlier, right?

right? right? For sure. And I think that my personal mindset is that atherosclerosis is something we have. It's not something we get. get. get. You know, if you look at autopsy studies from 3-year-olds, there's a fatty streak in the aorta. If you look at the P day study, you know, autopsies from trauma in the field, 18-year-old to 35-year-olds have early changes in their coronary arteries. Now, none of those things are causing any problems at that age, but the propensity for that is already there. Our goal is to get the runway out as far as we can to not have problems.

How do we make choices that that push our body in the right direction, not the right we stay in that in that in that That's the thing. So right now we we know enough. Like we know enough what to track, what to measure, how to test people. people. people. For sure. For sure. For sure. We can talk about imaging a little bit, but we we also know that cardiovascular disease mostly preventable. I mean, I remember I remember learning about William Osler when I was in medical school and he was from you know, the first textbook of internal medicine.

He was at Johns Hopkins, this kind of very iconic physician we all learned about. And and I remember reading about how when they would have a heart attack patient, it was a huge deal and they would have a whole staff run. The medical students, the residents, the doctors, the attendings would all come around and see this patient cuz it was such a rare condition. Mhm. Mhm. Mhm. It was rare to have a heart attack back in 1910. in 1910. in 1910. Sure. Sure. Sure. You know, maybe if you were eating really crappy diet.

Which was unusual. Cuz you were you could yeah, know, you were rich and had a lot of you know, money you could buy a lot of expensive you know, stretchy foods whatever I don't know but the point is now it's so prevalent and and we we have to sort of be more more diligent about actually helping people map out what their history is over time and tracking that. But what what what are the factors that people should be paying attention to pay attention to because this is really a preventable condition.

I mean you you're saying you want to take heart disease number one number two. What would be required to do that? Yeah, I think you start at the foundation and this comes back from you know, my time with you at at at the functional medicine conference back in you know, 20 years ago. Yeah, yeah, it was in Baltimore. bucks. bucks. bucks. Yes, yes, I was I was going for early morning runs around Baltimore and tells you I wasn't so smart then either. Um Um Um but really start with the the foundational pieces and you know, I remember a friend of mine said you he he he he he was a wise is a wise gentleman.

He said, you know, if a farmer looks out on his fields and all of the if all of the plants are sick if all of your crops are sick. Where's the first place they look? It's in the soil. What are we feeding the plants? Mhm. Mhm. Mhm. Sit in the airport and watch watch our fields go by. So I think that I think being mindful of what you're putting in your mouth your mouth your mouth focusing on a whole foods diet, limiting ultra-processed foods you know, limiting limiting saturated fats in your diet.

You got to be so careful these days with the you know, the really kind of more fringe type choices, the more extreme choices cuz you always have to be careful what you're substituting things for, right? And so I think that that's a great place to start cuz it's something that we have such control over, right? And I think our gut is such a primary source. Not that we understand the microbiome fully by if any stretch of the imagination, but I think the principle really holds. You know, our our what we feed ourselves is our cells is the information that we're going to give our body to live on.

It you can connect those dots. I think most of most of us can connect those dots. dots. dots. And when you're thoughtful about it, you just feel better. I mean, I've had personal experience with that. Clearly, movement every day is critical, both aerobic training and strength training. They're great independently, but compound dramatically when they're put together. put together. put together. My personal Achilles heel, sleep. You know, I can tell you when your sleep is off, everything is off. And for me personally, it's the hardest cuz you know, I can control what I put in my mouth.

I can push myself to go to the gym. The harder I try and control my sleep, the worse it gets. So, I've had to change my relationship. relationship. relationship. What have you done that's helped it? The biggest things I've done is changing my sleeping environment. Dark, Dark, Dark, cold, taking a hot shower before bed so that I know that I'm my body temperature is going to drop to help. Going to bed at the same time every night, setting alarm to make sure I'm going to bed at the same time, as well as waking up at the same time.

Trying to get outside as much as I can just to get sunlight in my eyes. And can I tell you that it's perfect? No. Is it a lot better? Yes. And again, know your numbers. You know, I followed I've been following my HRV, my heart rate variability, which is a wonderful indicator of your autonomic nervous system. system. system. Since you are pushing me for my numbers, I will tell you what they were and what they are now. My HRV was running between 15 and 17. Yay, yay, yay.

That's low. Yeah. And And And And now I'm running in the mid to mid to upper 30s. And occasionally I'll hit a 50 if I really am well hydrated. So, I'm on the right track, but is it is it No, it's not. it's not. it's not. It's always a work in progress. I am definitely that. So, so really this whole whole whole epidemic of heart disease is is largely preventable. If you address diet, if you exercise, if you sleep, if you manage stress, if you avoid smoking.

avoid smoking. avoid smoking. Gosh, you manage your blood pressure, which also the big factor. Absolutely. Absolutely. Absolutely. Uh and it's very much related to insulin resistance and pre-diabetes. This whole same phenomena is what causes high blood pressure. So, these aren't all separate problems. Blood pressure and heart disease and high cholesterol, they're all like they're all kind of one thing. Nothing happens in a vacuum in the body. You know, it's one big ecosystem. And so so when you turn them start to knock off all these factors, you can start to really change things.

And then also, you know, connection, community, stress stress stress is a you know, a big factor. I think a lot of people are lonely and that it's like smoking 15 cigarettes a day in terms of its effect on your health and and uh there's some interesting studies looking at the gene expression patterns under stress. When you're lonely or isolated, you produce more inflammatory genes expression. So, you have more inflammatory proteins out there in your body and causing more damage. And I mean And we know heart disease is an inflammatory disease, right?

For sure. For sure. For sure. May- Maybe you can talk a little bit about that cuz I think, you know, we used to think there was just a plumbing problem. You know, you were you're a plumber essentially. You're like Oh, I am. Do cardiac bypasses and open up arteries and and and fix aortas and fix, you know, femoral arteries and all these things that they get clogged up. And so it it's kind of like a plumber going in and rerouting the pipes or opening up the pipes and cleaning them out.

And and the truth is it's not necessarily just a plumbing problem. It becomes a plumbing problem, but it starts off as an inflammatory problem. And there's ways to check that. So, tell us about the role of inflammation in heart disease and also about how do we measure that? So, I I want to separate the the roles of inflammation and heart disease because I think that there is a bit of a misconception misconception misconception in in the lay public when it comes to how we think about systemic inflammation versus specifically what's happening at the arterial wall.

So, when when we talk about the inflammatory process, specifically when a plaque or a blockage is forming, the wall of the artery is penetrated by an apoB-driven molecule or a lipoprotein, if you will. That then sets off a cascade of events, one of which is an intense inflammatory reaction in the arterial wall, which draws those inflammatory cells into that area, which then starts this cascade of collection of more cholesterol, a healing process that then starts, and it's that healing process many times where we start to see the the actual stenosis forming.

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

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

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

It's very It's more of a heuristic than it is an equation. Um because it's more of a guide, you know, just to understand that these are balances. So, when we start to talk about those things, like what can we do differently? Exactly what you said, said, said, how do we put the fire out how do we put the fire out that is creating this vulnerability that then then then creates a a ripe environment for injury to the wall itself. Yeah, I mean, that's I think that's an important distinction between, you know, the inflammation at the local level and systemic inflammation that sets the stage for things to go wrong.

Yes. Yes. Yes. And then the that you talked about insulin resistance, you know, pre-diabetes, insulin resistance, belly fat, those that belly fat's producing a whole cascade of inflammatory molecules that's spewing out through the whole body, and is causing havoc everywhere, including on your arteries. And that that's, you know, that that's really people understand that sugar is inflammatory, that sugar and starch are inflammatory, and that's a lot of what's driving it. And obviously, pollution, it's stress, it's, you know, our microbiome, there's a lot of other factors, but but that's predominantly what it is.

And I think, you know, most heart attacks probably before the last, you know, 60 years were probably not metabolic syndrome. They were probably different. Yeah. Yeah. Yeah. You know, they were smoking, they were you know, people were thinner, they didn't have all the sugar and starches. I think it's changed. I I I think if you look at it, it's changed. And what's interesting is that doctors aren't measuring insulin. measuring insulin. measuring insulin. Yeah. Yeah. Yeah. not measuring insulin resistance. Mine had never been measured. had never Mine had never been measured.

Yeah. Yeah. Yeah. Until until And here you are, a cardiac surgeon surgeon surgeon Yeah. Yeah. Yeah. and probably the most important predictor of whether you're going to get a heart attack is your degree of insulin resistance. resistance. resistance. And yet it was never measured, which is just so disturbing. There's actually a new test that we offer through Function Health, which is called the insulin resistance score, which is a it's it's a the most accurate measure of insulin resistance that we have now other than the more of a conventional lab test, which is called like a euglycemic clamp test, which you wouldn't do except in a research study.

But it's it it's better than the calculated version we used to call HOMA-IR. HOMA-IR. HOMA-IR. Mhm. Mhm. Mhm. Much much better than that. And you can now measure using a C-peptide level and an insulin level using mass spectrometry. And we offer it through Function Health, and it's it's amazing to see how, you know, where people are on the spectrum. And then you can actually monitor it like an A1C and see how it how it how it And I think that that's been And I think that that's been one of the biggest limitations with the insulin levels the lack of standardization standardization standardization across across labs.

You know, what do the numbers actually mean? What's the standardization? So I think that to have something that's got some real data behind it's going to be really powerful and and something that we can actually actually count on. Yeah. Yeah. Yeah. It it it's pretty exciting. So now with the deeper diagnostics with becoming more affordable, with accessible diagnostics, people can actually know what's happening. And I think you all should start early. Like get a baseline in your 20s, see what's going on. You know, and I think, you know, the heart imaging era is also changing.

So before you'd have to do an angiogram, you'd have to stick a big catheter in the guy's groin, you'd have to shoot dye up there, you put a lot of x-rays on. It was a whole thing. And then you would it wouldn't that accurate a test that often. You'd miss stuff that was, you know, concentric plaque or you'd miss some stuff. You know, then then they developed like more interesting tests like a CT angiogram. And they now have AI AI AI enhanced CT angiograms which are really interesting.

So you can look at soft plaque and hard plaque and now we can do also also also a chest a chest a chest [clears throat] [clears throat] [clears throat] and heart and heart and heart CT scan looking at calcium in the heart. How do you use the the imaging like at this coronary calcium score or the AI enhanced coronary angiograms on CT scan? How do you how do you use those? So, I think that this is this is very much an evolving an evolving space very very quickly.

And as you pointed out, it kind of started with the early the early CT calcium scoring only then to CT angiogram etc. Now, I will say that coronary angiography is still the gold standard standard standard with with with FFR measuring measuring actual drop in pressure across stenosis or questionable areas using intravascular ultrasound. I think that there are ways that again like the imaging has progressed for the less invasive or non-invasive. non-invasive. non-invasive. It's also progressed. It's also progressed on the other side to address the thing.

So, I think these things are are complementary. I think that for sure until we added CT angiography really knowing soft plaque is so important. Now, knowing calcific plaque burden is helpful as a screening test if you're out totally normal or on the other end of the spectrum. It can get really gray and can really confuse things sometimes in asymptomatic patients without any symptoms that are in that middle ground. It can you know, it can it can require further investigation. investigation. investigation. But as But as But as CT angiogram.

CT angiogram. CT angiogram. Exactly. Yes, which But it's a good screening test. That's exactly right. you want to follow up. Exactly right. And now with this AI component, I think it's going to when you can digitize the information and you can actually not miss the calculation, it's not a it becomes less of a subjective reading and more of an objective reading when it comes to actual measurements, the accuracy I think of those tests is going to change dramatically. Now, how is that going to look clinically?

What is that going to look like for outcomes? All of those things are that's why I say I think it's just an evolving space right now. And it's important cuz you know, I'm sure you've seen patients like this, but you know, I have patients who have perfectly normal labs, but have plaque and clogged arteries. And people who have even the labs you'd expect to be abnormal. abnormal. abnormal. Or people who have terrible labs and whose arteries are normal. Yes. Yes. Yes. And and I'm like, wow, you have high particular number, you have high apoB, you have high lp(a).

I'm like, you should be having a heart attack right now, but you're 65 and your arteries are clean. Oh, yeah. So I think for me, what it's taught me is that I can't really put people on a lifetime prescription of a medication unless I know the anatomy. Because cholesterol is a risk factor. It's not the problem. Yeah. Yeah. Yeah. It's a risk factor. Sure. Sure. Sure. And sometimes it's high, sometimes it's not. Sometimes, you know, treat treating it isn't the real solution. It's figuring out what the other are and and treating those, like insulin resistance.

I think you make a great point. I mean, it's like every decision we make in medicine is a risk-benefit decision. And you you know, you have to make certain that you're maximizing benefit and minimizing risk and you're you're you're mitigating you're mitigating you're mitigating in favor of of that patient and you can't rely on just one number or even two numbers. You know, each patient is so dramatically so dramatically so dramatically unique and different. Just because there was a pulmonologist who said to me years ago, he said, "Jeremy, the protocols are the practice of medicine.

of medicine. of medicine. Knowing when to and when not to apply those protocols is the art of medicine." And that's what you're talking about. It's like if you followed the protocols, and there's nothing wrong with that. We all follow the standard of care protocols. Those are our guidelines. But if you plugged that patient into the protocols, you would have put that patient on medication right away without any additional information. If you would only because only because only because but you were thoughtful about that particular patient.

particular patient. particular patient. Yeah. Yeah. Yeah. And I think that that's so incredibly important. You know, and one of the things that is of concern for me as I look at medical education moving forward. Because there's such a high reliance on protocol-driven protocol-driven protocol-driven medicine, which is wonderful. And baseline? It's not It doesn't It But it doesn't go deep enough. Like it It's a place to start. Follow the standard protocol, you're not getting lipid fractionation, you're not necessarily checking any but you're not checking LP little A, you're not checking insulin levels, you're not checking insulin resistance scores, you're not checking the all these other things that are so important that have to be part of a full clinical picture to make a decision.

Right? That's what worries me. It's not It's not that it's not the good starting place. It's just it's inadequate. Yeah. Yeah, it's I think that's Yeah. I think you're right. Like my my medicine right now is LDL's high, statin. Like that's to me is completely screwed up. It's not wrong, it's incomplete. Yeah. Yeah. Yeah. You know, I think is is the way to look at it. You know, at some point, you know, maybe listen to the patient. Yeah. Yeah. Yeah. Examine the patient. You know, do the things that you be a doctor first.

first. first. And then understand how to put put these things together to make to make the best decision. Discuss it with the patient, God forbid. You know, and let them be a part of that decision-making. And I, you know, I think that's one of the great things about about functional health, right? It It allows patients to regain a fair amount of agency in their own health care. And I think a lot of patients want to do that in this day and age. age. age. You know, I think that that people are frustrated because access is such a problem.

You know, pick up the phone and try and get an appointment with your primary care physician. It's hard. And I not suggesting that it's intentional. They're busy. And they're seeing a lot of patients and and it's tough. And I think that that to really regain that agency and to take full responsibility for your health care, you have to have options to be able to actually follow through with that. And I think that's one of the great opportunities that that functional health offers. health offers. health offers.

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Yeah. Yeah. Yeah. And who knows what would happen if you would have found this when you were 35 and you'd done a heart uh see a heart um CT where you did a a calcium score and you had your apoB checked and your insulin checked. You're like, "Oh." And I think that's that's where we are now in medicine, which is that we have to have more agency as as individuals and not just rely on the health care system cuz the training's going to take a few decades or generations to change.

It takes a long time for medicine to change. change. change. It's turning a battleship. You know that better than I do. Yeah, I tried. I was Cleveland Cleveland Clinic for 10 years. It was a very big battleship. battleship. battleship. Yeah. Yeah. Yeah. And they were very open. It was It was great. We did a lot of great work there, but it was also it was very hard to to get people to change how they think, you know, and to to really do more of a a proactive approach.

And I want to sort of talk a little bit about this sort of idea about this person who looks healthy having having a heart attack and what you would advise people to sort of check because like, you know, for me, like I exercise, I'm you know, my body my body my body fat is 10%, I eat healthy, like I shouldn't really have a problem. So, why would I bother checking? But, uh actually, I did check and because of my family history, like everybody in my grandfather's side dropped dead in their 50s, I'm like, I got a problem.

So, I had to manage it and I think, you know, I wouldn't have thought I would be a person who would have high risk, right? Cuz I've been running since I'm 14 years old. I've been eating healthy my whole life. I've been, you know, I just I mean, I yes, I've stress, like sleep issues cuz I'm being a doctor but and life in general, but like I it was it was interesting. So, what would you advise people who are listening who think they're healthy, what should they be doing?

What should they be checking? What should they know and when should they start doing it? Let's start with the simple things first. Get a blood pressure cuff at home. home. home. And check your blood pressure. You know, if you can't do that, find a friend that has a blood pressure cuff and take it on a regular basis. You know, it it's it's really the silent killer for a reason because it's not a problem till it's a problem. Most 50% of Americans have it and many Americans don't even realize that they have it.

And it's the most modifiable the most easily modifiable cardiovascular risk factor that we have. And it's just back to that same tenant. If you don't measure it, you don't know. And it's so easy. And doing it once at your primary care visit is not is not enough. You know, you need to the 722 rule, you know, for 7 days, twice a day, two measurements, record them, take an average. That's what your physician really wants to know and what they need to know to be able to to come up with an accurate number.

So, I think that's a great place to start and to really potentially move the needle because it's it's such a significant component of cardiovascular cardiovascular cardiovascular Yeah, and in blood pressure is not just random. It is caused by certain things, right? You can actually figure out, too. Well, that'll come to the next suggestion. suggestion. suggestion. And this goes along with the the how we look issue. look issue. look issue. It's not always your weight, it's the distribution of your body fat. And that's why I really recommend that people are checking their waist to height ratio.

Very simple to do at home. And that And that And that Tape measure is a very cheap medical device. device. device. It really is. Be honest about where it is and where you're measuring it. That's the That's Be at the belly button and And you don't want your number to be greater than 0.5. And that's just an indicator again of, you know, the amount of intra-abdominal fat, that visceral fat that functions really as an endocrine organ if we look at it for what it's actually doing.

And again, what you're saying, it's it's a There's drivers of all of these things and they're also interconnected. So, I think those are two very simple places to Blood pressure and waist to Blood pressure and waist. And then you get down to And waist to height would be waist in inches and height in inches. That's right. Or centimeters in both. Yeah. Yeah. Yeah. You know, just keep the units the same. Yeah. Yeah. Yeah. So, that you make sure it's a it's an actual ratio in there.

than 0.5. than 0.5. than 0.5. Exactly. And that gives you something to really really really follow and track progress. Both blood pressure and something that you can do at home. You don't have to go to a physician's office. You don't have to do any of that. You know, from there I think we we look at some of the specific labs that I think people should be checking. I think an apoB is crucial. Lp(a) for sure at least once in your lifetime because it is a genetic factor.

I think that menopause may change those numbers slightly. So, I think for women it it it directed by your physician, it may be best to do it pre- or perimenopausal and after after menopause as well. There may be some ways to modify that. There's also new drugs that are coming around that might be helpful for that. And And absolutely. And now they're they're coming out of phase three clinical trials. It'll be interesting to see where those end up because the question, of course, will be just because you can lower LP little A, what are the outcome studies that are going to be as a result of that?

But story still to be told and and very promising, which is great. I think that that's that's very useful. I think knowing your your hemoglobin A1C and some form of fasting insulin is is just really really important. And I think if if those are really the core that are not on a standard panel at all. CRP is kind of plus minus. I think there are a lot of primary Who are not doing it. who are starting to do it. Those are are really not. Unless there's some trigger for hemoglobin A1C, they're just not.

They're not checking it. They're just not checking it. They're not checking it but they Mine wasn't checked. No knock on my primary care physician. No, it's just we're just not trained that way. So and these are these are really affordable tests. I mean, they're all included with with all the things you mentioned are included with a lot of other tests like 160 tests for literally just a dollar a day, $365 a year for twice a year testing. It's it's uh it's it's not free, but it's not that much considering what people spend money on coffee and coffee and coffee and they they spend loosely money on.

It's it's investing in your health. And that and and you know, sometimes the doctors won't do it. I I met with a dean of the uh medical school at um at in Vanderbilt who the the Dallas Walton School of Medicine. And uh she's she was she's a I think a um gynecologic oncologist and she said she's she's of Indian descent from India. She went to the doctor to a cardiologist and I want you to measure my insulin. He's like, "No." And he wouldn't do it. Really?

Really? Really? And he's like, "Yeah, well, we know at lower body weights we got more insulin resistance. So like, I want to check it." And he's like, "You don't need it." And it was just that level of just She said she went to her doctor and said, "I I want to get my vitamin D checked cuz I don't feel so great. I'm a little tired." He's like, "You don't need it." She's like, "I I don't care. I want it." She said, "My insurance won't pay for it." Well, she said, "I don't care.

I want it. She got the vitamin D and it was zero. was zero. was zero. Oh, wow. Oh, wow. Oh, wow. Cuz she was you know, dark-skinned, and didn't work inside. You know, she didn't go out go out go out much. You know, so I think we're missing so much and that's that's you know, really why a company like Function Health that I co-founded has really started to give people agency to tell them what's going on, that they don't have to be someone like you who's, you know, at 57 has blocked arteries and wish they could have figured that out sooner, right?

sooner, right? sooner, right? Absolutely. Absolutely. Absolutely. Hopefully your son's getting all those tests. tests. tests. Oh, and then some. He's I think he is going to be a lipidologist before the end of all of this. I can tell you because he probably knows more about lipid metabolism and genetics than I do at this point. in medical school? He is not. No, he is not. And when I look at skin aging, I'm thinking about it at the cellular level from mitochondrial function, collagen synthesis, cellular repair. And that's exactly why I was interested in red light therapy for the skin.

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You know, you spend a lot of time like fixing damaged hearts, like literally. Uh Uh Uh and and you now want to help people never have surgery. So, how how do you think about really move putting that mission and moving that into the world? Like coming on my podcast is great, you're writing a book, you have a website, um you have a podcast, but like how how do you see kind of doing this for yourself? for yourself? for yourself? Well, I hope that sharing my story and being willing to allow people to peek behind the curtain, if you will, that and admit that none of us are immune, immune, immune, it may not prevent people falling into that cognitive dissonance gap, but you will think about it.

You know? So, my hope is that I can raise awareness raise awareness raise awareness and then and then and then by by really trying to communicate relatable, relatable, relatable, high quality health and wellness information that's really tactical in people's lives, you know? And the world that we live in right now is so maximize, maximize, maximize, maximize that everybody feels like they're they're taking a test. And if they miss one thing on the protocol that they failed at that, and just give everybody an opportunity to let their shoulders down a little bit, take a breath, and know that if you miss you know, if you miss one workout, you haven't failed, you're just going to come back the next day and start over.

And to help people really integrate that into their lives, the really foundational pieces. foundational pieces. foundational pieces. And then helping them understand, well, what's the next layer of that? Okay, you've you've done the work. Check your blood pressure. Check your body fat distribution. distribution. distribution. Check your labs. You can't fix what you don't measure. Right. Right. Right. Be proactive about, you know, atherosclerosis, which is something that we know we're born with. Something we have. It's not something we get. We get the problems. the problems. the problems.

Yeah. Yeah. Yeah. Can we keep inflammatory factors at at the lowest? Can we keep our insulin levels where they need to be? So that we don't have problems at 57 years old. Yeah, and true. Very true. All right, let's do some rapid-fire questions. You ready? First and foremost, okay, so what's the single biggest mistake people make when it comes to heart health? They think it's not going to be them. Yeah. Yeah. Yeah. They convince themselves that I'm fine. I'm fine. Yeah. Yeah. Yeah. It's just not going to happen to me.

That's that's an important one cuz a lot of people stick their head in the sand. They wait till it's too late, and medicine just doesn't seem to focus on prevention. Well, so what's one heart health myth you wish would just go away? The one that I deal with on a regular basis is that patients that come in with heart disease and get a stent or bypass surgery think they're cured. And I always tell people, we're not treating the underlying problem. All we're doing is getting you out of trouble.

trouble. trouble. You now have to do the work. Cuz the process is still going on. You'd think when you crack somebody's chest, they'd change their lifestyle, but it often often Often not. Most of the time not. Because I think there's a misunderstanding that they think we've cured the problem. That's right. That's right. That's right. And really, all we've done is gotten them out of trouble. We can save We can save you. We can't heal you. And when you tell them that, do they get it? it?

it? It depends. You know, it it depends. I mean, I lay it out. I say, if you you're going to continue to smoke, all bets are off. We've taken all this up-front risk. I'm not going to soapbox you about smoking. This is your decision. These graphs could be down in 6 months if you continue to smoke. We've taken all this up-front risk for an operation. You don't want to be back to do it again. But, I think that's one of the things that it's it's more of a misunderstanding than it is a myth, but it's become kind of the perception.

the perception. the perception. What's the most underrated habit for preventing heart disease? Uh 10-minute walk after meals. Why? Cuz it keeps blood sugars under control. There you go. Keeps your blood sugar and insulin. Yeah, cuz it your your muscles can take up glucose without actually needing insulin, which is amazing. Uh but, insulin obviously helps. But, it's it's it's true. I think it's a very simple habit. What's one food you wish people would eat more of? Fiber. Fiber. Fiber. Fiber. Why? Fiber. Why? Fiber. Why? Well, Well, Well, because it helps control blood sugars.

It helps It helps with cholesterol metabolism metabolism. It satiates you. And so, you eat less. It's It look, it's not sexy, but And it's good for your microbiome. And it's it's critical It's critical for your microbiome. your microbiome. your microbiome. I agree. And the side of the side effects of eating fibers are eating a lot of other plant foods. Exactly. Exactly. Exactly. So, it's it's like What How about what you wish people would eat less of? Saturated fats. Saturated fats. Okay. We didn't really go into that too much, but you know, there's been a lot of controversy about saturated fats.

saturated fats. saturated fats. Yeah. Yeah. Yeah. And there's been I think it's you know, I'd love to hear your perspective, cuz I think my my under standing in literature and also treating, you know, thousands of patients is that it's so individual. Yes. Yes. Yes. Like I had a patient who patient was a overweight woman. overweight woman. overweight woman. Um she had high triglycerides like 300. Her HDL was like 30. Her you know, particle number was high. She was insulin resistant. She was pre-diabetic. She had A1C that was up.

And I said to her, look, she was struggling with weight loss and just couldn't knock it down. And I said, well, why don't you try a ketogenic diet? And I put her on coconut oil and butter. butter. butter. Saturated fat. Her LDL came down 100 points. Her triglycerides came down 200 points. Her HDL went up 30 points. I went like And she lost 20 pounds and her insulin resistance went away. And she went on basically a ketogenic diet with saturated fat. Another guy was a thin biker.

He's like, I heard this keto diet's great. I don't know. I want to try it. I'm like, I don't think you need it, but like, okay, but let's monitor you what you're doing. And he was riding his bike 50 miles a day. He was like super healthy and ended up causing his cholesterol to go exactly the opposite direction. High particle number, you know, lots of small particles, high LDL. I was like, wow, okay. So, there's a lot of genetics involved here and and different people respond differently.

Exactly. And I think that that's why following the biomarkers are so important. important. important. Yeah. Yeah. Yeah. You know, but I my impression is that if we look at the bell curve and we look at the majority of people and how they're going to respond with saturated fats, they're going to fall into a place of of concern. I don't know that they're going to fall into those those outliers. I think it's more of a risk think it's more of a risk factor than not, but you don't know till you know.

you know. you know. Okay, what about saturated fat versus sugar starch? sugar starch? sugar starch? Who's worse? Which is worse? I mean, I think it would depend on how much of each. I think if you're going to eat only saturated fats, you better follow your biomarkers very closely. If you're going to try to cut out all of those things and you're going to shift to, you know, eating a lot of higher carbohydrate foods, you need to follow there, too. You need to be following your blood I think I think there's a balance balance balance Yeah.

Yeah. Yeah. between those two. Yeah, check your numbers, too. Yeah, check your numbers because we all metabolize differently. metabolize differently. metabolize differently. What about non-negotiables in your nutrition? It's just like something you never do. never do. never do. Mine's pretty general. I adhere to an 80/20 plan. 80/20 plan. 80/20 plan. I do the best I can 80% of the time and I know it's not going to be perfect, so I grace myself for 20%. That's my non-negotiable. non-negotiable. non-negotiable. And that 20% is what? Is You know, having Twinkies.

having Twinkies. having Twinkies. No, I'm not having Twinkies. It's bread or pasta or a piece of cake at a birthday party. birthday party. birthday party. food, but not ultra-processed. Ex- exactly. Essentially removed ultra-processed foods. ultra-processed foods. ultra-processed foods. Yeah, I think I think that should just for you to listen that 20% should not be soda or or industrial processed food. Yes, cuz those are deadly and they're not actually food by definition. So They're edible food products. I mean it's true. If you If I you look up the Webster's dictionary definition or Funk and Wagnalls of food, it's definitely not what what ultra-processed food is.

It that's defined as something that supports the growth and health of an organism, which none of those things do. do. do. What about in terms of exercise, cardio or strength training? Individually they're strong, together they're exponential. You know, I really If you look at the data, the VO2 max and aerobic data is certainly very potent and and significant when it comes to decrease of cardiovascular events. There's no doubt about it. We look at cardiovascular health and when it's measuring how efficient our cardiovascular system is, what does that equate to?

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

And and I just Look, we're we're all drawn to one or the other, you know, I'm working with this woman now, she is an endurance runner and she hates to do resistance training. Yeah. Yeah. Yeah. I'm like, you have to do resistance to That was me. I was 40, That was me. I was 40, skinny, could run a lot, but bike 100 miles, but like Well, because I couldn't couldn't do 10 push-ups. And and and I did the same thing. I was an endurance athlete and I think that physiologically physiologically physiologically we're very fit, but mechanically we're not.

And that comes to being able to do things as we get older, but more importantly, we know we lose muscle as we age. We know how important it is for our overall metabolism. have indexed way more on the cardio for most of my life. In the last 5-6 years I've been more on the strength side. Okay, what about a piece of advice that every 30-year-old should know? That it's it's never too early to start because the deadlifts you're doing at 30 ensure that you're able to pick up your suitcase at 80.

The the the aerobic training you're doing at 30 is what's going to enable you to, you know, travel and have the endurance to be able to do the things. The decisions you're making now are not going to just impact your overall cardiovascular health, but they're they're going to change your your functional capacity later in life. It's It's just If you want to enjoy the fruits of your labor in your older you have to take care of yourself when you're young. That's right. I see that often people like run themselves in the ground, they retire, and then they just can't do anything.

anything. anything. That's right. That's right. That's right. Yeah. What's one thing you wish every 60-year-old would would know? I would flip that coin around. It's never too late to start exercising either. And we we know the data with that, right? We know that you take 55- and 60-year-olds that have never exercised in their life and you watch how their heart function changes in a very consistent regimented program. It gets stronger. So, it's never too late. But start small. Yeah. Yeah. Yeah. Make it make it fun.

Pick things that you want to do. Pick things that are that are enjoyable for you. you. you. I I love I love um that story of like the guy that's 65 never exercised starts rowing and now he's like fitter than most 30-year-olds, you know, like he's 95 years old. Yeah. Well, and remember too, like particularly in the beginning, that's when they see the biggest benefit. When you've gone from never exercising to a consistent program, they get a huge So, it's never too late to start. All right.

Now, as a heart surgeon, what's what's one thing you avoid? There's so many things. I got to pick one, huh? one, huh? one, huh? Or maybe how about this. What's one thing you avoid that you actually like that you don't want to avoid? Well, I'm going to I'm going to zoom out way way far on you. The one thing I I avoid is complacency. Because I think that that's a very very dangerous place to be and I think that's very much where I ended up. Because I felt like I was checking all the boxes.

You know, I was doing triathlons. I was I was competing at the iron distance. I was doing all this doing all the stuff, right? But I became complacent in in how I evaluated things and to me the willingness to change is what allows you to grow and to change past as the road changes underneath you. So, I avoid complacency. That's good. I like that. I like that advice. And lastly, uh if there's one biomarker you get to pick as a heart doctor that everybody should check, what is it?

is it? is it? ApoB. ApoB. ApoB. ApoB. Okay, everybody get their ApoB done. done. done. Okay, great. Amazing. Well, thanks Jeremy for sharing your story. Uh thanks for your vulnerability and uh getting other people to think differently about this cuz you know, you've been at the at the [ __ ] end of the stick of the plumbing problem in heart disease for a long time and I think, you know, waking up to the fact that this is actually preventable disease that we actually could move the needle on this that if people actually knew what to look for, what to do, what to measure, and how to change their habits, that we could actually beat this thing.

Well, thank you so much for having me. I really enjoyed it. Thanks, Jeremy. Thanks, Jeremy. Thanks, Jeremy. Yeah, man. Yeah, man. Yeah, man. If you loved that last video, you're going to love the next one. Check it out here.