#289: Joel Kahn, MD - Test, Don't Guess When It Comes to Your Heart Health
Did you know that heart disease remains the leading cause of death in the U.S. and, each year, over 300,000 people die from sudden cardiac death? The good news? You have the power to protect yourself—starting today.
Dr. Joel Kahn jokes that he’s been calling himself a “salad bar-a-tarian” since 1977 when he actually saw and felt the personal link between good nutrition and heart health. And, as a cardiologist he’s been preaching this link now for decades..
Today, Dr. Kahn discusses the alarming statistics surrounding heart disease, including the prevalence of sudden cardiac death and the growing number of individuals at risk due to poor dietary habits and sedentary lifestyles.
As a proponent of “test, don’t guess,” he also stresses the importance of regular health screenings, including coronary artery calcium scoring and lipid profile assessments to identify potential risks BEFORE they culminate in serious health issues.
This far-reaching conversation includes:
Dr. Kahn’s personal journey from childhood heart murmur to plant-based doctor
How a whole food, plant-based diet can help prevent and even reverse heart disease
The most nutritious vegetable on the planet!
A discussion of liporotein(a) - the heart’s quiet killer
Dr. Kahn's thoughts on coffee and tea
The screening tests that could save your life
The Impact of AI on Medicine
What Menopausal Women Need to Know about Heart Health
Why heart disease is more preventable than you think
This conversation is packed with life-changing tips that you can put into practice today!
Episode Highlights
10:41 America’s Healthy Heart Doc Discovers Plant-Based Eating
18:14 The Importance and Impact of Lifestyle Changes on Heart Health
32:23 Coronary Calcium Scans Explained
38:34 Understanding Lipoprotein(a)
58:07 Women, Menopause, and Heart Health
1:01:14 The Debate on Saturated Fats
1:11:28 Engaging with Different Diet Perspectives
1:15:21 The Future of AI in Medicine
About Joel Kahn, MD
At his core, Dr. Joel Kahn believes that plant-based nutrition is the most powerful source of preventative medicine on the planet. Having practiced traditional cardiology since 1983, it was only after his own commitment to a plant based vegan diet that he truly began to delve into the realm of non-traditional diagnostic tools, prevention tactics and nutrition-based recovery protocols. These ideologies led him to change his approach and focus on being a holistic cardiologist. He passionately lectures throughout the country about the health benefits of a plant-based anti-aging diet inspiring a new generation of thought leaders to think scientifically and critically about the body’s ability to heal itself through proper nutrition.
Shop this book (mentioned in the episode) and all of Dr. Kahn’s books here
Episode Resources
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Full Episode Transcription via Transcription Service
I'm Rip Esselstyn, and you're listening to the PLANTSTRONG Podcast.
Introduction to Heart Health
[0:04] Your heart health is in your hands. It's on your shoulders. And in this episode, Dr. Joel Kahn, America's healthy heart doc, delivers a powerful message on how to protect it. It's his first ever appearance on the PLANTSTRONGPodcast, and we're going to hear from him right after these messages from PLANTSTRONG. I have some big news for all of you PLANTSTRONG podcast listeners who are also fans of the PLANTSTRONG food line. Our gluten-free cornbread is back in stock. This classic southern staple is made with wholesome ingredients that you can feel good about. Gluten-free, oil-free, plant-based, and lightly sweetened with medjool dates. Whether you're serving it with a hearty chili, a comforting stew, or snacking on these cornbread muffins. This mix delivers moist, rich flavor without compromise. Don't wait. They're flying off the shelves. Grab your two 15-ounce packages today at PLANTSTRONG.com and take your meals to the next level. I want you all to know that our 2025 PLANTSTRONG retreats are now officially approved for continuing education credits for physicians, physician assistants.
[1:28] Nurse practitioners, and nurses.
[1:30] So whether you're a healthcare professional seeking credits or you're simply someone that's eager to deepen your understanding of plant-based living, our retreats deliver the latest evidence-backed research, practical tools, and hands-on experiences to transform your health and lifestyle. I would encourage you, join me and the team in April in Sedona or in November in Black Mound, North Carolina, and connect with like-minded individuals, learn from top experts, and feel the life-changing benefits of a plant-based lifestyle, all in a fun and inspiring setting.
Dr. Joel Kahn Joins the Podcast
[2:14] Visit liveplantstrong.com to learn more. Dr. Joel Kahn jokes that he's been calling himself a salad baratarian, love that term, since 1977 when he actually saw and felt the personal link between good nutrition and heart health. And as a cardiologist, he has been preaching this link for decades. Today, Dr. Kahn discusses the alarming statistics surrounding heart disease, including the prevalence of sudden cardiac death and the growing number of individuals that are at risk due to poor dietary habits and sedentary lifestyles. As a proponent of test, don't guess.
[3:00] He also stresses the importance of regular health screenings, including coronary artery calcium scoring and lipid profile assessments to identify potential risks before they culminate in serious health issues. Whether you're looking to prevent heart disease or even reverse it, this conversation is packed with insights from one of the OGs in plant-based
The Importance of Nutrition
[3:27] nutrition and lifestyle. Please welcome to the PLANTSTRONG Podcast, Dr. Joel Kahn.
[3:35] Dr. Joel Kahn, welcome to the PLANTSTRONG Podcast. It's great to have you on. I am truly fired up, excited, burning afterburners here. It's a great honor after more than a decade of knowing you and watching you explode in a great way to be part of this community. So thank you. Well, thank you. Right back at you. Where am I talking to you right now? Are you in Michigan? Are you in Florida? Where are you? Yeah, you're kind to even know my new life pattern. But 10 months a year, I'm where I am right now, southeastern Michigan, suburban Detroit. I am hiding in a home study.
[4:18] I usually see people four, four and a half days a week and take a little break to do fun things like this. And January and February, now I hide in Boca Raton. I have an elderly mother that loves the extra attention. I don't mind getting out of snow and ice from Detroit. And I do have an office in Boca Raton. So I just keep on working off and around a pool or in a brick and mortar office. Well, and now with telehealth medicine, I guess you can afford to do that, right? Yeah, I haven't figured out how to put my stethoscope through the screen and listen to your chest. But, you know, I have people make sure they have a home blood pressure cuff so they can add that to the mix. And I'm I'm legally licensed in about 20 states. You don't want to do this undercover. You're practicing medicine. You best have a proper license from California to New York. And. Minnesota to Florida, I can see a lot of people and it's fun. People are just great. And yeah, there's PLANTSTRONG people all over this country. Yeah.
[5:20] What you've been in Detroit a while, haven't you? Well, I was born here 65 years and four months ago. My medical office is about a mile from where I spent most of my childhood years. I wandered away to Dallas for cardiology training three years and Kansas City for a year. I'm never going back to Detroit, but the place grows on you and all the family, my wife's family was here. So yeah, most of my life has been here. All my professional career has been here. Well, having grown up there, then you probably, you know, you know, you appreciate Detroit and all that it has to offer. I know like growing up in Cleveland, which is about three hours down the road, I had a lot of people, you know, give me a hard time about Cleveland, but it is, you know, growing up there, I love it. It's magical. I know all the great places to go. And so I'm sure you feel the same thing about Detroit. Yeah, I walk around town, I bump into people literally all the time. And it's nice that Detroit's a real renaissance city that had this conversation with somebody at breakfast this morning. It just keeps getting better and better. And hopefully that trend will continue. So come visit us. We got a lot to offer.
[6:32] There you go. So you're a, you are a cardiologist. I know that you're basically, if I'm not mistaken, you're licensed in three different specialties, internal medicine, cardiology, and interventional cardiology. Is that right? That's spot on, legally appropriate to say that. Mm-hmm. And, you know, you kind of refer to yourself as America's healthy heart doc, which I love. But I want to understand, why did you...
[7:04] Joel Kahn decide to go into medicine in the first place? Yeah, my whole life were things I had no real control over. But, you know, I think there was a little divine providence here. I was born 65 years ago with a murmur, a little noise the pediatrician heard before I can remember. And I was referred to a childhood cardiologist, pediatric cardiologist. You know, when I was a few weeks old, my mother was very concerned. Uh, it didn't prove to be anything all these years later, but I spent a lot of time, uh, in cardiology offices. I actually had a heart catheterization before I was one years old. I have no memory of it in the early days and that little hole in the heart that healed up, sealed up, no problem, but it got me interested. I can very clear memory of being eight, nine, 10, 11 at a cardiology office at a major hospital in Detroit. And it was a good experience. I had a very keen interest in it all.
[8:07] And mixed with that, I grew up in a home where we kept kosher dietary laws, no meat and milk, no cheeseburgers, no pork. And when I went to University of Michigan in 1977, I was in this combined, you get into undergrad and medical school all at once. Great program. I had a challenge. Am I going to keep this up? And the salad bar was the solution.
[8:31] I had a very, very cute girlfriend at the time who also had the same cultural background and came to the same decision. We've now been married 43 plus years. So that worked out well. We didn't know what to call it. Sort of salad baritarians, panorborites, whatever you wanted to call it, hippies. But that started the process in 1977. So I had this interest in medicine and got into medical school kind of early. Had this interest in nutrition that really blew up when I found John Robbins and a diet for a new America. I took a couple of years to find that book. And the last part was I went on and trained in Dallas and Kansas City and really became a specialist in that field called angioplasty and stenting, which is why I'm board certified in something called interventional cardiology. But I returned to Ann Arbor, Michigan, 1990, this is the last part, July 1, 1990, I start practice and I'm just burning the place up in Ann Arbor, Michigan, blowing up people's plaque, blowing up hamburgers, blowing up cheeseburgers, blowing up ribeyes, blowing up bacon built up in their arteries.
[9:41] You can't actually see that in the plaque, but I'm telling you, plaque looks like butter, it looks like cheese when you take it out, because you can.
[9:49] And three weeks later, July 21, 1990, I walked to the mailbox because we didn't have computers, and I take out the mail, and there's my medical journals because I subscribe and I read. And there is a report by Dean Ornish, MD, because I did not know of your father at that time, and I don't think he had published a paper yet on cardiovascular disease. But there was Dean Ornish saying whole food, plant-based, plus meditation.
[10:15] Exercise, mind-body support reverses heart disease. So I always joke, I had three weeks of practice where I didn't give patients lifestyle education because it wasn't clear. But then I said, oh my God, you know, all my wife's recipes, all this stuff we've done, you know, we've dragged kids all over the world and figured out how to eat plant-based.
Discovering Plant-Based Eating
[10:36] This is a message I should share. So I apologize for those first three weeks of patients. I hope they got the message, but literally tens and tens and tens of thousands of cardiology patients, you know, at least have heard about you and your father and Forks Over Knives and websites and podcasts. And it's been a joy. And as you know, not everybody grabs on. We're still waiting for the real tsunami wave of veganism and whole food plant-based eating to take over the United States and the Western world and get rid of garbage
The Significance of Cardiology
[11:09] food and meat food, But we're making progress. And so I've really enjoyed being a lifestyle cardiologist in the midst of amazing technology. Yeah.
[11:20] With all the different paths that you could have taken in medicine, why did you decide to go into cardiology, the heart?
[11:30] Well, if you ask me now, with 35 years of practice experience, it's the need. You know, we have not made a dent in this awful statistic, number one killer of men and women in the United States and most of the Western world. I think the most tragic statistic is over 300,000 people a year in the United States alone suffer something that you don't hear a lot about called SCD, sudden cardiac death. Jim Fix out running, and you've got to be pretty old to remember the book of running, and Jim Fix, 52 years old, collapses and found dead. And more often you're found dead in the toilet. I mean, you know, cancer is a horrible disease, but that wonderful moment when the family's around you and you're sharing stories and you're kissing goodbye.
[12:17] 300,000 people a year, 52-year-old plumbers and 48-year-old accountants and, you know, 61-year-old housewives. And, you know, they're just, who did we just have, actually? Clint Eastwood, 61-year-old longtime girlfriend. Boom, dropped dead, sudden cardiac death. He never said goodbye. She never said goodbye. Autopsy shows advanced heart disease. So, you know, you couldn't pick a better field to make an impact, particularly if you have a preventive upstream, turn that faucet off like Dean Ornish talks about, you know, and if you already have disease, reverse it like your father talks about. It's the most rewarding career in the world without a doubt. And there's such a big need. I mean, you can talk about me and Rob Osfeld and Columbus Batiste and Baxter Montgomery. And I don't want to leave anybody out, but there aren't a lot of preventive cardiologists, particularly ones that favor lifestyle over just grabbing a pill bottle first thing. I'll grab a pill bottle, but, you know, show me you're serious about your lifestyle first. Mm hmm. You mentioned how these plaque formations are kind of like like butter.
[13:32] Um and you know you're as an interventional cardiologist how many different stents, angioplasties would you say you've done in your career yeah i had a robust career between it started in 1986 i did my first angioplasty in dallas texas with balloons the field started in 1977. So we're still talking fairly early, fairly crude. Still, the cardiac surgeons, particularly, you know, in Texas, where you're from, particularly in Houston, you know, ruled the world, the bakey and such. We hadn't proved ourselves yet. But, you know, I walked out of that career eight, nine years ago, and I'd done about 15,000 of these procedures. Now, I might treat three, four, five, six arteries spots in one setting. So that's tens of thousands balloons and stents. You know, some company like Abbott ought to give me a private jet for all the business I brought to them, but that never happened.
[14:37] And do you... Looking back on it, do you feel like those procedures were solving an issue? I mean, I think we both agree they weren't getting to the root causation, but was it somehow alleviating some symptoms that they had or improve something? Yeah. Well, I happen to have a very, very lucky career after training three years in Dallas, Texas, which is a wonderful experience. Very hard place to eat whole food plant-based with barbecue shops everywhere but we did it and we're talking the 1980s with little kids we made it through I can remember eating more okra, boiled okra in three years I don't think I've eaten okra since then although I have nothing against okra it's a pretty amazing vegetable if you read about it but we made it through, and then I was accepted into a program in Kansas City Missouri that was the number one it was like swimming at Stanford with Rich Roll or UT, you know, your career. I mean, getting accepted. There's only 12 cardiologists in the world that ever got to train with a pioneer named Jeffrey Hartzler, MD of blessed memory. And I learned at the time how to take a heart attack. You know, at the time we had beepers, not cell phones, but, you know, beeper going off 911, 90 miles an hour or two in the morning, you know, about 20 minutes to the hospital.
[16:05] Blasting plaque open and just watching the EKG return to normal, seeing the patient stop squirming, blood pressure come down to normal because they were in so much pain. And I did that so many hundreds and hundreds of times. I'd been trained to do it and grooved at it. So I know I helped a lot of people and some of them are still alive, you know, 20 plus years later. We have learned in my field, based on two really landmark studies, one called the COURAGE trial, one called the ischemia trial, that we shouldn't just see a blockage put in a stent. If you're not having that classic choking feeling called angina pain, if you haven't, you know, flunked the stress test miserably and been given a trial of medication and lifestyle first, you know, I tell that person all the time because people come to me for second opinion, third opinion, just like many, many one and still go to your father's Friday monthly seminars. You know, I tell them If you're well enough to have been discharged from the hospital, I don't think you need a procedure. You're walking, you're talking, you're not struggling. Let me work with you. You know, you got to be on board and be an equal participant, but I'll show you. And I'm going to have to use lifestyle and prescription drugs, occasionally some vitamins.
[17:23] So if you get out of the hospital, I think, do we do too much therapy? Bypass and too many stents? Of course we do. I, for a while, own the trademark prevent not stent. If you want to tick off your hospital administration, just wear a t-shirt in the hospital that says that. I think I'm going to use that as the title of my next book if I get down to my next book, because you really can.
[17:48] Stents have a wonderful role if you're really sick in the emergency room, really sick in the coronary care unit. They are miraculous. They have two lives. But we do a lot of cosmetic cardiology and we never give people the opportunity to take charge of their life and have a permanent or nearly permanent solution. Yeah.
Preventative Heart Health
[18:08] You mentioned potentially doing another book, Prevent, Not Stent.
The Importance of Lifestyle Changes
[18:15] Speaking of books, how many books have you written over the last 15, 20 years? Yeah, I've participated in six. I say that because our mutual friend Ellen Jaffe Jones really wrote one of them. I contributed a few chapters. It's a book with a fun title, Vegan Sex and some great recipes and some lusty language. But 85% of the book was Ellen Jaffe Jones. I contributed, why do men have erectile dysfunction with vascular disease and poor Western lifestyles? So I wrote it a little off color. I've had people read me back paragraphs and I blush what I wrote. I was kind of in an odd mood and said, let's have a little fun with this whole topic. And yeah, I'll say, cause you, I don't know if your audience is, you know, 50, 50 male, female, mostly, mostly, mostly female. Yeah. That's usually the case. And you know, there's still a message cause females, no males. I'd like to write a book one day called LYDD, which in small little letters would say, like your dick diet.
[19:22] I hope I didn't offend any children listening. But, you know, there still is that message, which is so poorly shared, canary in the coal mine. But, you know, I see it still. I'm an active doctor. I have, you know, thousands of patients. You know, men with erectile dysfunction never got referred for any kind of cardiovascular testing. And, you know, three years later, they're having their heart attack. So, you know.
[19:48] You know, and I know messaging is key. How do we grab attention to the vegan movement, the whole food plant-based movement, animal rights movement, and this kind of cardiovascular prevention movement when people are all, there's an interesting graph, this is relevant, that in 2016, but it's still true, 30.2% of Americans died of heart disease. Number two is cancer, about 29%. But the rest of the graph was, what are they Googling when they're reading about death? Homicide, suicide, terrorism, overdoses, 2% were reading about heart disease. What did the New York Times in 2016 report on for causes of death? 2% of the articles were on heart disease, not 30.2%. So people are getting messaging that's not proportionate to what they should care about, which is circling back L-Y-D-D. You've got to grab them. You know, humor, shock, Howard Stern, something to, you know, have 15 seconds you get on social media to have their attention, maybe eight seconds. I think I read recently. I don't think I'm going to actually do that book. But, you know, the message is clear.
[21:00] We have to look. We have to diligently search for clues and then use any clue you got to try and save a life. Yeah, so in that vein, I was on a panel with Dr. Robert Osfeld, and he mentioned how he recently did a study with the RIDGIS scan and all that stuff, but he refers to the standard American diet as the erectile dysfunction starter kit. Yeah, there you go. Yeah, yeah.
[21:37] I would love to fire at you a bunch of different questions and Jeopardy show $800. Go for it. But I, first I want to just frame this up as saying that.
[21:53] I've always been amazed at how up to speed you are with all the different research, the data. Do you spend an inordinate amount of your time reading scientific publications and keeping up with the research? Because it seems on the surface like that's the case. Yeah, you know, I often say my hobby is reading medical research. I gave up golf 10 years ago just out of boredom and time drain. And I've got a wonderful family, wife, kids, a granddaughter, and a few more on the way. I hope to God in the next few months. But I love doing medical research. And I mainly do it. I know where to scan. And I have a lot of Google alerts. If you ask my wife, what's the first 15 minutes of every day, I'm kind of going through about 80 articles that Google alerts gave me overnight. Wow. Yeah, on all the topics that I'm most interested in.
[22:45] And, yeah, so I'm up to date. And then I translate that into one patient care, of course, too. It's nice to have something recent to say on an interview like this. Three, I write a newsletter for docs for about 25,000 doctors, goes out once a week with a literature update on it. Holistic preventive cardiology. And finally, I have my own short little podcast every week. And it's mainly a literature podcast, you know, what's brand new and relevant. And that's where I you know, the conclusion is 98% of the science is whole based fiber, fiber, fiber, fiber, antioxidants, phytonutrients. And, you know, when you see an article on the ketogenic or the carnivore diet, it's usually a negative article. Boy, rarely is it ever positive. And now so, yeah, let's fire away. I do enjoy, you know, the game of staying up to date. Good, good.
[23:37] So in one of your recent Instagram posts, you mentioned a phenomenon called chewism. And at the speed at which you eat can potentially impact plaque in the carotid arteries. Is that like anything to that, you think? That was a fascinating topic. And I think, again, sometimes I will lift interesting little phrases off of other people. I think the term is actually no disrespect, Judaism, Judaism, because there is a very funny author named A.J. Jacobson. He wrote a book about a year of living. He tried to follow like 360 health prescriptions and one was chewing slowly. You know, your dad, I mean, that's totally in line with your father, chewing slowly to allow the interaction of dietary nitrates like your kale or your arugula with your facultative anaerobic bacteria in the grooves of your tongue. Chewing slowly, digestive enzymes begin in the mouth from your parotid salivary gland and then the whole digestive process. Chewing slowly to be mindful, maybe appreciative, maybe having gratitude, realizing there are people that are hungry in the world. And finally, maybe eating a little less. You know, you get.
[24:57] 1200 calories down before you even thought about it and you eat a little slower. I think part of it is there's this concept that it takes about 20 minutes for the brain to give gastric brain feedback to say, I'm full. And if you ate in eight minutes, you may not have enough time. So all that goes. And then this recent study linked rapid eating to more plaque and arteries. So, yeah, a lot of reasons to slow down, kind of the blue zone Mediterranean, sit around with people, laugh, enjoy your food as a social event. Yeah. A little bit idyllic for a lot. Got it.
[25:36] According to the CDC, this is the most nutritious vegetable on the planet. What is it and why? Do you know? This is funny. I'm glad you're asking me ones that aren't too distant. According to the CDC, I mean, it's always going to fall into the green vegetable family due to the density of nutrients and the minimal calories to take a Joel Fuhrman ratio. But it was watercress, that English green vegetable. Yeah. I have three children and three, you know, what do you call them? Married kids and that joined the family. Two of them were born in other countries, Croatia and Cuba. And my American citizen, but Cuban born daughter-in-law, that's what I was looking for, makes this watercress salad with parts of palm. And I think a little red onion mixed in and make some kind of vinaigrette. And she really introduced our family 11 years ago, maybe to watercress. And you start reading about it. A little tough sometimes to find in the stores. I think you can grow in your own garden.
[26:45] Some of the places you actually kind of like a basil plant, watercress grows. And there's still a little lump of soil and some roots. So it's actually like growing Doug Evans, you know, sprouts. You know, you're literally chopping it and eating it. It's got to be the freshest, nutrient-dense choice in the world. So, yeah, watercress, not exactly a household word. No, no. I can't remember the last time I had watercress.
[27:10] And I think you mentioned Joel Fuhrman. I believe that when he came out with his, you know, nutritarian scale. Yeah, the Andy scale. Thank you. The Andy scale. I think watercress might have been right at the top there as well. Kale was definitely the thousand point green. I'd have to go back and see. I wouldn't be surprised if watercress was another thousand pointer. Yeah. The Michael Phelps of vegetables. Yeah. Joel, tell me, what's your thoughts on coffee and tea? You give it a thumbs up, thumbs down. What do you like? Thumbs up as long as you're a little careful what you put in there, you know, and it's not a frappuccino, obviously, and it's not with whole milk, obviously. In fact, I had some patient email me this morning, just timely. Oh, my God, I read your, it was on my podcast, some praise of soy milk, organic soy milk. And she had never tried to make a cappuccino with soy milk, and she found it frothed up just like cow's milk. And she was fired up that you could do this. Of course, one of the companies, Oakley, made barista oat milk very popular in the coffee shops.
[28:27] So with that aside, I mean, don't dump garbage in your black coffee or your teas. Michael Greger has taught us that actually your green and black tea probably shouldn't have milk in it the British way because it actually lessens the antioxidant power of teas. But you talk about the wealth of the data, including just this week, this week, new research study, 400,000 people that surprisingly high amount, five or more cups of tea a day, three or more cups of coffee a day were associated with better cardiovascular markers, cardiovascular outcome. You see this over and over, and it goes beyond cardiovascular risk. Some people don't feel good on caffeinated products. Listen to your body. But if you can drink coffee in the morning and caffeinated teas like black tea and green tea in the morning, and probably by noon, cut them off. So go to herbal stuff. There's some really great like barley-based fake coffees, one called Oh From Dandelion. There's one I love called Dandy blend if you've never tried it. Chicory flavored, but no caffeine. And I might actually have a cup of that in the afternoon. I put nutmeg spice and others like pumpkin spice mix in my coffee, tons of antioxidants. And lately, this is a little relevant.
[29:48] Our vegan community has been beat up the last 10 years about bone broth and collagen powders from cows and fish. I found a couple of sources, particularly one from England of a vegan collagen powder. And I put in my coffee now. And, you know, there is some data for heart, for skin, for bones, for teeth, for hair. But it's 100 percent plant based. So I kind of it adds to the flavor of my coffee. So, yeah, coffee tea, two thumbs up. Tea maybe gets a little higher rating than coffee. And I would stress, if you got the bucks, try and buy an organic brand of tea and coffee. There's just, they're plants and they're getting bombarded with pesticides. Right. You mentioned collagen.
[30:36] How long and when did you start? Taking a collagen kind of powder in your coffee or tea? Well, I've actually kind of swung the pendulum. I always fought because the bone broth movement, I have friends that sell it, but, you know, it's kind of bogus science. People say they feel better and, you know, you can't deny some of that. And the collagen powder, you know, industry is huge. But, you know, a Nobel Prize winning scientist who's been gone about 20 years, Linus Pauling, taught us you make collagen from vitamin C. And we know that plant-based eaters, if you're eating fruits and vegetables, getting way more vitamin C than average American. Lysine and proline. The human body makes proline. Lysine's in lentils, for example. So if you're eating a mixed plant-based diet of fruits and vegetables and legumes, you've got the building blocks to make collagen. Collagen's the number one protein in the body statistically, critical for arteries, great for skin, keeping your hair on your head, nails, and the rest. And we get it in our diet. But now that there is a response of the, you know, community of the industry to provide a few. So this is actually relatively new in the past six months or less. Right, right.
[31:55] So how long have you been using a collagen? Yeah, I mean, maybe three months. Right. Have you noticed anything? I haven't. My wife talks about nails and hair and maybe just a little more observant. I mean, I don't really know the rate of my nails growing, but they're growing.
[32:14] You are a big fan of test, not guess. Right. And yeah, I hear you say it all the time.
Coronary Calcium Scans Explained
[32:23] Um i would love for you to talk to me about heart calcium cts uh a heart calcium ct scan and when you recommend people should start getting those i'm a 61 i've never had one i'm here i'm curious and okay you could just talk a little bit about that i'm gonna email you a prescription for one when we're done with this conversation i am licensed in texas So I'm going to go aboard, go Longhorns.
[32:51] And I can tell you all kinds of stories, being a fellow in Dallas, an Aggie versus Longhorn competition amongst the fellows. But let's get back to the question. Very few of your listeners and viewers have been eating whole food plant-based since they were, you know, 10, 12, 15, or 18. I actually started at age 18.
[33:12] And even those, you know, and if you do, if you can raise, you know, whole food plant based children and also teach them fitness and stress management and all the rest, you know, you're building stronger, healthier children that probably are going to fight off a lot of diseases in their 40s, 50s, 60s. Most people came to this, you know, 80, 90, 100 percent whole food plant based movement. Sometime after that. And they are at risk, of course. We're relatively bulletproof with this diet. We're definitely not completely bulletproof against heart disease and cancer.
[33:50] Just pause. This is the main message. Write this down, everybody. If you pause for a minute and say, why at age 45 at my internist, primary care doc, obstetrician, gynecologist visit, that they tell me to schedule a mammogram, a prostate check, a colonoscopy, a cervical cancer check. Why'd they tell me to do that? And nobody brought up screening for heart disease. It only leads to two conclusions. There can't be a screening test for heart disease because it is the number one killer in men and women. It takes years to develop. So there's a period to find it when it's asymptomatic. So that's the one conclusion or two. Doctors don't care about heart disease. We make so much money in the medical world with bypass and stents. And I don't think it's the latter. I think it's the former. So turn the clock back to 1990, this test called coronary artery calcium score, CACS.
[34:45] Functionally, you're on a stretcher in a hospital, maybe at an imaging center. You go on a CT scanner. There's no needle. There's no injection. There's no iodine. There's no claustrophobia. for about five seconds. You hold your breath, might hear the machine go on and off and you go home and there's no Band-Aid. And when this was introduced in 1990 at the University of California, San Francisco, they demonstrated, yeah, we can see silent atherosclerosis on a CT scan. It took a new generation of CT scans. In Michigan, that technology arrived in 1995 and it was not covered by insurance and it was $1,500, but a lot of people still did it. But now when we're talking 2024, it's generally a $50 to $100 scan. The scanners have gotten much better. So it actually takes less time, very, very little radiation because of the way the scanners are so lightning fast nowadays, painless. But the concept's the same. Detect atherosclerosis of your heart arteries when there's no symptoms. So we have time to work on it. You want to be a zero. Well, as of six weeks ago at age 65, I'm still maintaining my zero score status. I've done it about three times in the past 25 years. My wife at age, I have to say secretly, always 39. But since we went to elementary school together, she might be in the same ballpark I am.
[36:10] Is a zero. It's a great thing. I think our decades of whole food plant-based eating has helped because we both had family histories of heart disease.
[36:18] Score comes back 100, 200, 600.
[36:22] 1800. It's all the extent of hardening of your arteries, calcification. You need a program. You need, you know, you need an evaluation in a program. Rarely does it lead to bypass or stenting, but, you know, whole food plant-based diets, aspirin, cholesterol-lowering approaches, fitness rehab programs. Even, I'm a big fan of garlic in my food, but there actually are capsules of aged garlic that at the University of California, Los Angeles, UCLA, they've shown actually helps lower plaque. So I use a whole bunch of tools in people with bad tests. But, you know, the reason you just can't assume, you know, we don't really fight it when the colonoscopy, colo guard question comes up. Okay, I understand colorectal cancer is a problem. And at least a couple approaches to it now beyond just the scope.
[37:14] But you know some of us inherit genetic risk for heart disease that has nothing to do with watercress arugula yeah big breakfast bowls of healthy food with soy milk or almond milk some of us inherit the genetics and as a just a side corollary to your question and maybe one you were going to ask test not guess 20 to 25 percent of us inherit a cholesterol that you can't feel but you got it in your blood from birth called lipoprotein little a. It's the worst marketing name in the world.
[37:48] Lipoprotein little a, lowercase a. And from birth, you've got this extra cholesterol circulating through your body. And by the time you're 30, 40, 50, you may have very, very badly clogged arteries that are causing no symptoms, even in the pool, even in workouts. Heart disease is a tricky little devil and it's silent for so long. So you say, God, I'm so low risk. This is crazy. I mean, I got 32 inch waist and my fitness is good. But you don't know you've been marinating in a potentially dangerous substance in 20 to 25 percent of people. And that includes vegans. And it doesn't get better with a vegan diet. It doesn't get better with a workout schedule. And those things will improve everything else, your blood pressure,
Understanding Lipoprotein(a)
[38:30] your blood sugar, your LDL cholesterol. So test, not guess. Take the same approach. age 45 to 50, get your first coronary calcine scan. And if you're a zero, do it again in five to 10 years and, you know, take it a challenge. I'm going to stay a zero. The research, six to 7,000 research studies, is if you're a zero, you're going to end up with a better brain, better lungs, better kidneys, lower cancer risk, lower diabetes risk. It's really a good marker of overall excellent health. So I have some follow-up questions on everything you just said.
[39:06] So that calcium score that you get back, it's kind of an indication of obviously how much calcium you have in your arteries, right? There's no way to reverse that once you have calcification. Is that correct? Yeah, I think that's a correct statement. If you're a zero, you stay at zero.
[39:24] If you know, things work out well, if you're 500, you're not going down to 200, even with the diet, you and I eat, even with fitness, you and I follow even with all the drugs on the planet. There's really no accepted science. And the actual twist on it is there's more than one kind of plaque in arteries. The calcified plaque is the easy one to find, but it may be the lowest risk plaque. So the fact that it stays there is like a tattoo of heart disease. You'll always see it, but it may be the low risk. There's a second devilish kind of plaque called soft plaque You can't see, and that may be the, you know, the scary one, actually. Well, that was actually my next follow-up question is, is there a test that you can see what kind of that, you know, juvenile plaque, the soft plaques you have in your arteries? Right. You know, all of this is the last five years, really. If you were to come to my clinic, we do an ultrasound of your arteries, your brain, your carotid arteries. You can see soft and calcified plaque and it's stroke risk, but you still aren't seeing the heart. So in the last five years, and I have many people in Austin, Dallas, Houston have done this.
[40:40] Now we're up in the game, and this is not, you know, for the entry-level heart evaluation, but you can go to a center, a hospital, a freestanding imaging center. You got to now have an IV get injected with iodine. Iodine is not radioactive. It causes this bizarre warm feeling through your body for 20 seconds.
[41:00] You hold your breath. They take the IV out. You got a Band-Aid. You go home, drink a lot of water to flush the iodine out. But that's now called a heart CT angiogram. And using that famous word, artificial intelligence software, we now, I do this all the time with my patients, I can tell them with precision, like I'm designing, you know, aerospace vehicle, how many cubic millimeters of soft plaque, how many cubic millimeters of hard plaque, there's actually a third kind called low density pre heart attack, scary plaque, how much do you have? Where is it? How much is it narrowing your arteries? And that is something that even if we went inside your body with a catheterization, we don't have that precision. We will. There will be artificial intelligence software for heart catheterization. But right now, these CT scans rule the world. And I've ordered probably about 1,000 of them. I've had one even. I was kind of optional because my score was zero. But when it came to Detroit, I used the technology just to try it out. That now becomes about a $1,500 test that very often is not covered by insurance, but there's a lot of motivated people.
[42:08] There's an executive fitness center in Dallas. A lot of people know the Cooper Clinic. That's a great place. There's a place called Fountain Life. And for $15,000 head to toe, they'll do every fancy test in the world and they offer it, but I can set it up in any city anywhere. Yeah. Well, the Fountain Life isn't Tony Robbins a part of that whole. Tony Robbins and his book Life Force of a couple of years ago. Quite a good book. I mean, I think he nailed most of the topics. Yeah. No, I had him on the podcast and read it kind of kind of wild. Yeah.
[42:46] Um i want to go back to the that calcium score for a second because i know just through my father that he's had patients they go whole food plant-based hardcore and they have another one of those calcium scores done and it actually will go up but that my understanding is that's actually not a bad thing it's a good thing because that soft has now turned into hard which is a lower risk than the soft. Is that your interpretation? Yeah. Professor Ripp is nailing it pretty good. And, you know, these are all observations from large academic research studies published in the medical literature that you can get that baseline measurement, which we obtain in our patients. You can institute a dietary program, fitness program, a supplement program like aged garlic, and very often prescription drugs.
[43:42] We can talk about it. The new goal of cholesterol management is much more aggressive. It's not really based on financial revenue for the companies. It's based on data. So we're really shooting for LDLs lower than anybody's ever thought of before. There are natural genetic influences where you run a low LDL cholesterol your whole life, and strokes and heart attacks are very rare. Now we're reproducing that, but we're reproducing it with people in their 50s, 60s, and 70s. If you could keep your cholesterol low from your teens and your 20s, you'd be in awesome shape. That's been shown over and over. But you're right.
[44:21] You can get a baseline CT angiogram with artificial intelligence, institute a program, and one to three years later, depending on the severity of the disease, repeat the test and watch that soft plaque shrink, shrink, shrink, shrink, watch it disappear. It does disappear like Dr. Dean Orna showed and your father on those famous androids. But some of it's also converting to hard plaque. So in my clinic, everybody gets a calcium score unless they've had a previous stent or bypass, you don't need it.
[44:54] And if it's zero, we'll do it again in five to 10 years. But if it's 400, 600, 700, dime a dozen around America, I see 45-year-olds all the time with these horrible numbers. Those are pretty horrible numbers when you're 45. I'm not going to repeat the calcium score. Tell the patient, we can't lower it. It may not be bad news that you've got it. I mean, it's concerning. The real player is how much soft plaque do you have? And we have to go talk about this second test. And right, the calcium score going up is an age-related phenomenon. It's whether you're on Lipitor, Crestor or not, they sort of drive the calcium score up. And you just look at the number in three years and it's higher and you say, well, you're older and it didn't teach me anything. So I tell them that they're usually even, you know, people have modest financial resources. They'll say, OK, doc, I'll, you know, have a bake sale, hopefully some goodies and I'll come up with fifteen hundred dollars. Now, I don't own the CAT scanner, so this is all patient care without any conflict. One more question about the calcium.
[46:01] What's the earliest outside of somebody that maybe has a hypercholesterol familiar that you see a calcification in somebody's arteries? Can you see it under the age of 20, or is it usually 40, 50, 60? I wouldn't order a calcium score on somebody 20-25. I might do that carotid ultrasound for the reasons that the soft plaque is there before the hard plaque. We call it juvenile plaque. But by mid-30s, there are published, there's a research project called the CARDIA study that takes people from age 18 to 40 and does calcium scoring and follows them. And, you know, by early to mid 30s, you'll see some it's still arguable if that's really a good test in your early 30s. If you're seeing me at age 35 and like you said, you've got a familial cholesterol disorder or I checked and you've got a high lipoprotein A inherited cholesterol or you're a type one diabetic or you spent the last 20 years smoking. Yeah, I'll order the test on you, you know, for seventy five dollars or go to your hometown of Cleveland. University Hospital will do it for free. They have an amazing program. People actually travel just to get it for free. Wow. You wrote a whole book on lipoprotein. Little a came out in 2020. And I had never even heard the term until probably 2021.
[47:27] Like, when did you become familiar as a cardiologist with lipoprotein little a? Yeah, it's this little molecule in the blood of 20 to 25 percent. It was discovered in Europe in 1963. So it's not all that old. I heard about it about 13, 14 years ago in lectures and started ordering it on people. And, you know, what I see over and over is patients scratching their head, you know, doc, why do I have a heart attack? I mean, I'm not in that bad of shape. Why do I end up with bypass at age, you know, 47? I'm not in that bad of shape. I see these people all the time. Kaboom, you know, six days later, the labs are back and they've got Olympic level lipoprotein little a. Now, it's not the only thing. There's something called homocysteine that can be under genetic control. And there's some fancier ones. But boy, lipoprotein A is a big deal. Now, you know, it's almost comical because nobody was teaching about it. Nobody was talking about it. There is not an FDA approved drug released for lipoprotein little A and specifically Crestor lipitor statins.
[48:33] They do not help. They actually cause the blood levels to go higher, not lower. So you can use those drugs in lipoprotein A patients, but you got to be aware it's a good, bad story. But three companies now have drugs that are one to four years away from FDA approval anticipated. They're going to be very expensive injections to lower lipoprotein A. So now doctors are being detail in advance of a multi-billion dollar pharmaceutical program, doctors are starting to order lipoprotein A. They're scratching their head what to do about it. Hopefully they'll go read my book or something. It is challenging, but I'm hopeful that we're going to help a lot of people.
[49:15] But I will say if somebody listening knows they have an elevated lipoprotein little A or goes and does, it's a simple blood test, $30 blood test. You can order it on yourself and finds out they have an elevated level. I have hundreds of people that have that inheritance and their arteries are fine. Their calcium scores are, and I can't tell. That's why I test, I guess. I just got to check everybody. Right. Okay. You know, and that's why your parents never had strokes and heart attacks. And that's why your siblings seem to be without stents and bypass. You must have a version that's not as toxic as others. And we don't know how to separate that on the simple blood test. Give me an idea. I consider myself very illiterate with cholesterol levels, HDL, LDL, triglycerides, all that stuff. I know that total cholesterol is HDL plus LDL plus one-fifth triglycerides.
[50:08] Lipoprotein little a, I have no idea. Give me an idea. What's a high level and what's a number that you'd like to see with that?
[50:16] Just to confuse all of us, there's two units of measurement. You know, it's like a patient comes to you and says, I weigh 75. You know, you might ask pounds or kilograms, although you'd probably know just by looking at them. Right. And there's that older unit called milligram per deciliter. Under 30 for lipoprotein A is normal. Over 50 is considered higher risk.
[50:41] That's how all the papers in the past measured it. And many labs still use that. My hospital still measures it that way. The newer one, a little less familiar, called nanomoles per liter, a little more of a mouthful, N-M-O-L slash L. And under 75 is considered normal, though some people it's just undetectable. They just have none. And over 125 is at risk. So I ordered the nanomole per liter second version when I ordered it. And, you know, people, I have some people that it's so high, it's undetected, it's unmeasurable, over 600, 500, 400. And the level probably, and we're talking, you know, 25% of the population in this unit is over 75, the lower lids than normal. But maybe 5% to 10% are really in that upper stratosphere. And we work to bring it down in my clinic. We're pretty successful getting it down, although the standard literature says it doesn't happen. You can't get it down. Just have a person eat healthier and take lots of pharmaceuticals. But there's ways to get it down.
[51:52] And just so I can get my brain really wrapped around this, is the lipoprotein little a at all related to or part of the LDL? Or is it a completely different substance?
[52:08] Well, it's both. It's a good question. Yeah, you know, I'm from Detroit, so we got to talk auto industry analogies all the time. It's like having two factory production lines. You're over here in your liver and other parts of your body because your whole body makes cholesterol. And most importantly, people need to know your brain makes cholesterol. So you can have a low blood cholesterol. And why is my brain still working? Because your brain's making all the cholesterol it needs. That's one production line. And LDL cholesterol, particularly in the liver, is the end product. Turns out lipoprotein A is LDL cholesterol with a wicked little tail on it. The tail is called lipoprotein A. So lipoprotein A is LDL plus a tail that creates one molecule. But it's not made in the same pathway. It's made over here in the liver if you have the genetics. That's why... Statins could lower lipoprotein A, but they don't impact the second production line. They just don't for reasons that aren't completely known. And I don't know anywhere in the body. It's a fascinating molecule. I think there's only four species on the planet that make lipoprotein A.
[53:22] Primates, I think there's a bat, and hedgehogs. And even people 25 times smarter on lipoprotein little A than me, can't figure out any reason that the hedgehog and the fruit bat have lipoprotein A. We don't even know why it's in our blood. There's a theory, if you're hemorrhaging, and particularly a woman delivering a baby 10,000 years ago, hemorrhaging, if she was one that inherited lipoprotein A, it helps blood clot, which is really bad for strokes and heart attacks, but might be really good if you're delivering a baby and you're bleeding.
[53:58] There's way more harm than help is the overall picture. Just interesting to finish it up. We all have four heart valves, little doors open, close 100,000 times a day, billion times a year. They're miracles. The last valve of the heart is called the aortic valve. And for reasons nobody really gets, a stinking lipoprotein, little a, loves to stick. Aortic valve, cause irritation, inflammation, and you end up with a murmur and a disease called aortic stenosis. And if you start checking lipoprotein, little a, as soon as a patient tells me mom had an aortic valve replacement, I'd put 50 bucks down. We're going to find lipoprotein, little a in the blood because it's just that common.
[54:44] While we're on the subject of cholesterol, what are your thoughts on cholesterol levels, you know, people that are young getting checked. I saw on one of your Instagram videos, you mentioned furry arteries that I'd never heard before, but I really like that term. Yeah, furry arteries as a way to describe early artery disease in young people. Yeah, I think we'd make a big impact.
[55:10] Occasionally, patients will bring their 18 to 20 year olds to the clinic and have a quick little visit, talk about lifestyle and get a few labs. If we started checking, even pediatricians will check, a cholesterol, make sure that one in 250 people, not as common as this lipoprotein A, inherit a genetic ability to make a lot of total cholesterol, LDL cholesterol. You might want to know if your 18 to 20-year-old has a cholesterol of 450 at that young age. There is therapy. There's ways to watch them. Might want to eat better, of course. So check a cholesterol at age 18. I see so much vitamin D, D-like David, deficiency. I'm talking meat eaters, plant eaters, it doesn't matter. Kids have really crappy diet, and they're all vitamin D deficient. And it's not good for your immune system. What's your definition of deficiency in vitamin D? Officially under 30, but I'm talking blood levels of seven or nine. I mean, I'm talking ultra low. And mushrooms probably aren't going to cut it. You're probably going to take 5,000 a day is my standard vitamin D recommendation. Omega-3, there's a blood test. Of course, Joel Fuhrman gets a lot of credit for popularizing this aspect of plant-based medical world.
[56:27] Kids have no omega-3. I mean, they're not eating salmon. They're not eating ground flaxseed, chia, hemp, walnuts. I don't know how their brains are working during college exams. I'm talking to normal blood levels over 5.5% by the most common test. These kids are under 1%. I mean, I do not know how their brains are working. It's a simple thing. Yeah, I might get a homocysteine on an 18 to 20 year old, another blood product that's under genetic input and just put them on a B vitamin and all of a sudden, you know, they're feeling better, their brain fog's better. So those are a few of the biggies I would order on an 18 to 20 year old and check their blood pressure. More and more kids are showing high blood pressure. It goes along with more and more kids having metabolic disease and being overweight. Yeah. Well, I know that I saw this. I don't know if it was from you or somebody else that you posted, but the heart attack at 50 began at 20. Yeah, that was me.
[57:24] I lifted it from somebody, but I thought it was so well said. And that's why we've got all these years to do these test, I guess, labs. Even if you're in the whole food plant-based plant-strong world, just don't, you're not guaranteed bulletproof. I have too many examples. And same thing, do the heart imaging at least by age 45 and definitely by age 61. And hopefully we'll be able to have a follow-up interview and talk about your zero score. I'd love to do that. You know, since most of the listeners are women between the ages of 40 to 65, what are your thoughts on women that are going through menopause and heart health.
Women, Menopause, and Heart Health
[58:07] Yeah, it's a good question. And it's a really important timeframe.
[58:12] You know, the statistic women have to know is that they're just as much as risk for heart disease as men, although it's about a decade later. And most of that begins around menopause, you know, your hormones drop 98% within, you know, six to 12 months, you're sleeping poorly, maybe gain a few pounds, your cholesterol goes up, your LDL cholesterol goes up. If you have lipoprotein A, it tends to go up at menopause because hormones lower it. That is one approach to lipoprotein little A in menopausal women to put hormone replacement therapy.
[58:49] So you become at risk. So if a woman age 45 is in my clinic and everything's good, we're going to hold off on the CT scan a little bit, unless there's some dramatic family history. But by age 50 to 55, menopausal years, we want to get that baseline. And you want to intensify your heart prevention approach, all the things we've talked about. You know, it's not your primary question, but there's at least some suggestive data that at menopause, getting on properly done hormone replacement therapy, you'll sleep better, you'll feel better, your brain fog goes away, but your cholesterol often returns closer to normal, your lipoprotein A, 25% of women may drop, and your overall heart risk goes down. And of course, we all got scared in 2002 by the Women's Health Initiative that these were toxic, toxic substances, but they appear not to be so toxic if you start them right around menopause.
[59:45] Have you seen in your heart patients, if a woman is legitimately whole food plant-based, Do they get to kind of go through that?
[1:00:00] Perimenopause, menopause phase, a little bit smoother sailing than those on the standard American diet? Yeah, I think, you know, symptom wise, hot flashes, yes, that's been nicely shown. And certainly, I think Dr. Neal Barnard wrote a whole book about that. Their cholesterol tends to be a little more optimal. Blood pressure tends to be a little more optimal. Their weight control tends to be a little bit more optimal. So yeah, it's a it's a if you haven't done it by menopause, jump on board the plant's drug movement at menopause would be very wise. And I think if you did it earlier, even during the pandemic, we learned there's pretty clear cut. I know Dr. Kim Williams, everybody's favorite cardiologist, started asking the question about 2021. Does anybody know any prominent plant-based influencer that's really had bad COVID? None of us could come up with the name. I hate to bring the topic up. And then there was medical science. You know, don't be silly about the topic, but that whole food plant based eating with an emphasis on vitamin D and omega three and fiber may be a great way to, you know, anything that's thrown at should be a little bit more resistant, but not completely bulletproof. Yeah.
The Debate on Saturated Fats
[1:01:15] I'd love to talk to you for a little bit about saturated fat, your thoughts on saturated fat in the diet. Is there an optimum level? The less, the better. What do you think? Yeah, less, the better without and very low, the best. You know, it appears to be a controversy. And any day you turn on, you know, YouTube, Twitter, you'll see lots of noise and some with MD after the name. Some are engineers. There's this little crazy movement now of some engineers interested in heart disease, driving their cholesterol over 500 and their LDL over 300 with, insane, you know, carnivore saturated fat rich diets and claiming short term, they're not seeing any, you know, detriment to their health. And there actually is one small study that hasn't shown a detriment. But you take the whole body of literature from 1950, at least on, and you synthesize all the data, you'd say, there's a clear line between how much saturated fat in your diet, butter, meat, egg yolk, cheeses.
[1:02:22] Fowl, fish, saturated fat in your diet, and raising your total in LDL cholesterol. And if sustained long enough, because those furry arteries don't create heart attack in a week, they create heart disease over years to decades, you are raising your heart disease risk. So every medical society, the last one that repeated the message was the UK Medical Society, their goal, eat less than 10% saturated fat in your diet. You know, and we have an enormous advantage there as long as we're a little attentive to coconut oil and palm oil, the tropical oils that dramatically have saturated fat and can raise your cholesterol, stay away from them. And there are so many plant-based baked goods and plant-based ice creams and some of the cheeses. So if you're going to go there, go there with a pinch, not, you know, a pailful.
[1:03:17] We don't use coconut oil in my house. Yeah. Yeah. Well, I think you and I both know that coconut oil is about what, 91% saturated fat. And if I'm not mistaken, range sort of crazy. And there just hasn't been that much long-term research on it. So you can sort of say what you want to say, but we all know there's lots of voices out there. I listen to the podcast and hit my head when they start talking about beef tallow and lard and butter being I mean, there may be margarine in the 1960s. Those might be a better choice. But when we fast forward to 2024 with trans fats out of the picture. Well, you know, one of the one of the hot topics that's come up in the last probably two or three years and love to get your thoughts.
[1:04:00] I think you know how the Esselstyn cohort feels about oils in general. We're not a fan. We prefer that people eat the whole food and then get all the vitamins, minerals, fiber, etc.
[1:04:15] But seed oils have obviously been vilified as of recently. Love to hear your thoughts on that.
[1:04:23] Yeah, well, I'll touch on both. I mean, extra virgin olive oil has been a traditional food in the Mediterranean basin for, you know, thousands of years. And yes, there's olives, but they ingest a lot of extra virgin olive oil. And the classic Mediterranean diet, when it was brought over to the United States in the 1970s by the infamous Dr. Ansel Keys, and certainly probably the most celebrated diet in America, the Mediterranean diet, It depends on extra virgin olive oil, not butter, not lard, not beef tallow. The Harvard School of Public Health has done lots of studies. And you can find individual studies of extra virgin olive oil with brain outcomes that are beneficial. And this very large Spanish study called Cordioprev, not in a vegan population, but in a sort of healthy Mediterranean population that actually proved to be pretty good for cardiovascular patients.
[1:05:15] Tough to integrate that with all the other data, but it's there. You get to seed oils and it's, you know, they call them the hateful eight. That's a term I've just learned recently because there's eight famous seed oils, canola and soybean and sunflower and safflower. And, you know, everybody hates them because they're processed and some of them are extracted in ways that sound very chemical and dangerous. Hexane, hexane extract. I know, but the problem is, and, you know, Will Bulewicz probably just butchered his last- Bolshewitz. Bolshewitz. Bolshewitz. FiberFuel was just on PCRM podcast.
[1:05:54] And there's another podcast that he's medical director of, the Zoe podcast, and a different scientist. And there's another one on Twitter, Gil Carvajo, that's pretty good at science analysis. You really look at the studies- doesn't hold up that these are the most dangerous oils in the world. So it's just the case. And, you know, the classic Harvard School of Public Health study, they have these big databases and they model. If you replace your butter, people are going to throw tomatoes at me with organic canola oil. You just dropped your heart disease risk by about 25% and your cancer risk. So, you know, I'm much more in your family's camp, no or low. And I got to give a shout out a plant-based cardiologist in Jacksonville, Monica Agarwal, published this short-term, volunteer study of a whole food plant-based diet in people that were eating a standard diet with either low olive oil or, you know, I call four to five tablespoons a day, pretty monstrous olive oil. I don't partake in anything like that.
[1:07:03] Everybody benefited, But the low olive oil group seemed to have a better cholesterol after eight weeks. And it wasn't a seven-year study looking at heart attacks and strokes. Did you say four to five tablespoons a day was the – and that's very common in many of these studies, four to five tablespoons a day versus a teaspoon a day. I think that was the structure of Dr. Agarwal's study. But you do the math on that. And, you know, 600 calories a day added. Yeah. Without any alteration in the diet. Well, a whole food plant based diet. But, you know, if you really don't change your eating habits, I mean, you're probably going to gain a pound a week. Oh, yeah. I mean, do the math. I mean, if you're getting 2000 calories a day, at a minimum, that's 25% of your calories are coming from 100%, you know, fat there. Interesting.
[1:08:00] You, I think there was a study. That you highlighted, uh, on your Instagram channel about a connection, a correlation between constipation and having cardiac events. Yeah. And I, I found, I didn't find that surprising because if you're constipated, you're probably not eating right. Right. But, but if you, if you could like, uh, expand on that a little bit. Yeah. You know, again, with the main theme being, You know, find heart disease before it finds you, whether it's erectile dysfunction, is your canary in the coal mine. There's an unusual crease in the earlobe called the diagonal earlobe crease. And I can't see you up close and personal here, but people that have a diagonal earlobe crease may have clogged arteries before their symptoms. And there's actually quite good science for this. There's a little theory why that might be. Steven Spielberg, just go look up his picture. You'll see this deep groove. Everybody uses him as an example, even though he's not a patient of mine. So I can say that. But constipation is just another one on the list. And you're right. It's probably reflects your diet choices, your fiber content, your hydration. Have you ever heard of a prune? You know, eat a prune, for God's sakes.
[1:09:19] Eat something out of the CRISPR, for God's sakes. So, yeah, that was just recently reported. But if that'll get a person to get a heart calcium CT scan or check their lipoprotein A level while they're straining on the toilet, God bless them. Hopefully they're Googling it and going to find that new connection.
[1:09:37] About maybe a month, a month and a half ago, you had a debate or I should say a conversation with Ken Berry, who's a fan, obviously, of I don't know if it's the carnivore or the lion or the paleo or the keto. But how did that debate go? I didn't see it. How did it go? Yeah, you know, Canberry MD, I want to say in Tennessee, I hope I got that right. Is a family doc who developed something he calls the perfect human diet.
[1:10:08] It's carnivore-ish. Certainly, he has bacon for breakfast every morning. He has an MD. He's a very kind Southern man. No, he hasn't published any data. There's no prospective studies. He has 3.3 million followers on YouTube, so there's a fair number of people eating bacon for breakfast. That's true. He does. Yeah. I will participate in these conversations. I mean, again, I think Dean Ornish was famous in the 70s for debating Robert Atkins of the famous Atkins diet many times on national TV. You know, we always agree, cut crap out of your diet. So we end up spending about half the conversation on why is crap so bad? You know, processed food, chemical food, gas station food, frozen food, fast food. We all agree. And then we disagree for the next half an hour. He was quite a gentleman.
[1:11:01] Did I influence his followers? I'm sure not. You know, if you look at the comments under the YouTube, you'd say they didn't like that plant based guy very much, even though we did keep it very Southern gentleman like I'm not Southern. But yeah. And I've done it with Sean Baker, the huge orthopedic surgeon who wrote a book about carnivore diet.
Engaging with Different Diet Perspectives
[1:11:23] Yeah, I did have fun. I was on the doctor's show in the last decade. That was with Gundry, right? I was on with Gundry, and I only had six minutes, but that was an epic takedown of the plant paradox. I was also on with Paul Saladino, a wildly popular. He was a carnivore. He's backed off and changed his diet a little bit, which he eats some produce now. And you also, and you also, Joel, you, I think Joel Rogan pitted you against his little, you know. Chris Gresser, I forgot about that one. You know, that was 20 million people watched that in 2018. I want to applaud you. I want to applaud you for being willing to get in the ring and kind of, you know, duke it out with these people. And I think that, you know, you've got, you're armed with the science and the research, and that must be very comforting. But it takes somebody to know the science and the research and the studies to and then to be able to lay it out in the appropriate way.
[1:12:23] Right. You know, realizing, you know, you might change 0.5 percent of the viewership. You know, it's nutrition and politics. You're not changing many people's minds. But you're right. You know, you can't just let them go forward without calling them to task. Do the research.
[1:12:41] Prove the point. We can go back. I can quote you a physician in Los Angeles in the early 1950s, late 1940s, who started creating a diet. Not so dissimilar from your father's program, Lester Morrison, MD. So we can go from 1948 to the present day and just line up, you know, by now thousands of studies. And they got a lot of popularity. I mean, tell people to eat what they love to eat, like bacon in the breakfast. I was just, I reignited my fascination with a topic called advanced glycation end products, a chemical reaction. You take a piece of chicken, not me, and you boil it and you measure this chemical group. It's very low. You take a piece of chicken and you barbecue or you grill it. We create a chemical reaction. We drive up the creation of AGEs. And they're associated in 60,000 research studies with cancer, dementia, diabetes, heart disease.
[1:13:39] And the number one on the list is take a piece of bacon, fry it for five minutes and eat it. It creates the most amazing and unhealthy chemical reaction. And, you know, I am actually bringing a little instrument to my clinic now that you put your arm on it and measures your tissue advanced glycation end product level because I want to have more ammunition to smack these people into oatmeal for breakfast. Wait, wait. So it'll measure the amount of AGEs that you have in your body? In your skin. In your skin. Skin fluorescent. Yeah.
[1:14:14] Now it's kind of a useful abbreviation because it is advanced glycation end product, but it's pronounced ages.
[1:14:22] It clearly is a toxic aging chemical compound that binds and destroys proteins in your bodies. And you go to the literature and you look at the list. How's a lentil and a chickpea and a pear and a grape and an apple, it's almost non-existent. And if you take a portobello burger and you grill it, a portobello and you grill it, you're probably creating a little bit, but you can't create anywhere near a grilled chicken breast. So I know that you, you know, you recently read a book. I think it was about the singularity in. Let me see if I can just find this in my notes here because I want to I want to get this right.
[1:15:07] About AI, AI in medicine. Wow, wow, wow. You are a good student of my Instagram post. Yeah, yeah. And I'm just wondering, how is it? does it scare you? Does it excite you?
The Future of AI in Medicine
[1:15:19] Are there going to be all kinds of advancements? What are your thoughts of AI in medicine? The author of that book is Ray Kurzweil, who's the head of Google research for AI. He's in his mid-70s and he goes back, you know, decades on this topic, probably, you know, the brightest person on this topic. And, you know, there's some aspects of medicine. I think medicine would be better if you described your symptoms to an AI computer that looked at, you know, 35 million studies in the National Library of Medicine. Yeah. If you have odd symptoms, like some of my patients, and came up with a list for the doctor or the nurse practitioner, you should be thinking about these 15 diagnoses. And then you have a human interaction. And a lot of our CT scans, echocardiograms, soon to be our catheterizations will be assisted by artificial intelligence. But when you talk on the global level of, you know, you're never going to die, you're going to download your brain with, you know, Neuralink or some other feature and somebody is going to be able to access it. Yeah, it needs to be regulated. And I have no faith that governments are going to regulate it. Yeah. Yeah. Yeah.
[1:16:33] It's interesting to me because we're, as we go towards this, you know, open source of, of information and AI, how long is it going to be before it just becomes clearly, absolutely 100% apparent that a whole food plant-based diet is the diet that humanity needs to go in case shut. Right. Because we have every research study, every bit of data that's been accumulated for the last 200 plus years. Yeah. And for the human, for the planet and for our animals, millions of animals and their refuse and all. I don't know. I mean, there seems to be some political momentum. It's obviously going to be a political solution. and I'm a little frustrated, you might be too, that you look across the vegan restaurant move in the United States. I can't really claim that it's a big growth industry right now. There's even been... A couple of restaurants in Los Angeles closed this past weekend.
[1:17:43] Kevin Hart, I was trying to think of his name. We had a plant-based restaurant. You know, COVID helped us decide not to continue that. It was a tough time with employee hiring and all. Same thing. And, you know, just the statistics. Why aren't we 5% to 10% of the U.S. population by this point?
[1:18:00] You know, Margaret Mead, anthropologist, said it's easier to change a man's religion than change their diet. And I think we're dealing with these deep rooted, maybe epigenetic lusting for blood and flesh.
[1:18:14] Certainly isn't my constitution. And I don't know if it's because I'm blood type A and I'm not blood type O. I think that's all bogus. But people bring it to my clinic all the time. I don't know. You know, you see governmental figures and industry figures. I hate to bring up the name like a Bill Gates that talks about, you know, eliminating meat as a political and governmental thing. I mean, there's going to be so much pushback and so much economic fall over. So I don't think we're going to quickly be turning off that faucet, which is the root cause of so many chronic metabolic diseases. Because it's going to have to involve McDonald's and KFC and every Sunoco gas station in America. It's just such a Herculean. We can't build electronic vehicle charging stations. We're talking about transforming a multi-trillion dollar industry. I'm not optimistic. I think we're going to stay fat and unhealthy and fat, not in a shaming way, fat in the fact that it's inflammation driving all kinds of diseases. But the reality is 75 percent of adults and 40 percent of children are just tragically drowning in their own waistline. I don't see it ending soon. Yeah, speaking of the waistline.
[1:19:32] How much does extra weight contribute to the potential for some form of cardiovascular disease? Do you have an idea? Yeah, it's huge. It's huge. I'm struggling to come up with a statistic, but I think recently it was estimated that about 70%. If you really talk, I mean, if you really go root cause, you're talking, what's the food you're eating? How much are you sitting during the day? Are you sleeping four hours or eight hours? And how much are you out in the fresh air getting fitness?
[1:20:03] That's the real root cause. That's, you know, we've known that for decades. David Katz has been lecturing medical doctor on that root cause analysis for decades. Good for him. But when you just take, The bare statistics on obesity and overweight in America, it drives heart disease through, you know, abnormal insulin, abnormal triglycerides, abnormal ratios, low HDL, high sensitivity C-reactive protein.
[1:20:31] MAO levels going up, risk of sleep apnea as you gain weight. And then your brain's deprived of oxygen all night long. And it's like you're dumping epinephrine and norepinephrine in your blood adrenaline all night. You're in a hypersympathetic state. And, you know, just multiple blood pressure goes up. So, you know, diabetic risk goes up dramatically. And, yeah, we know that we got the shots now that can make you thin again. And short term, there's amazing data for them. But I hope that's not the solution. and we're all going to have GLP-1 pumps or patches or, you know, trochias, or we're going to have chewing gum. You know, it could be any and all these things down the road. Yeah. You had a really, I thought, intriguing post, Instagram post, where you had a photo on the left and it was somebody that was 250 pounds and a photo of somebody on the right that was maybe 150 pounds. And it it was able to basically you could see their bones it was one of those shots and you said white fat because the white the white in the photo of each person showed where the fat is accumulating on their bodies and it was it was so absolutely obvious to me the amount of visceral fat in that person on the left the 250 was.
[1:22:00] 10 times what it was in the other person. Yeah. And if somebody comes and does a visit with me live in my office, cause I do Fairmont telemedicine, first thing every patient picks up is I have a blob of fat. It's a model, five pounds. Five pounds of fat is like a log you're going to put in the fireplace. It's a, it's a big chunk. And these people are 40 pounds overweight. They're just, I can see them immediately thinking I got eight of those around my waistline, but you can, that photo you're talking about was an MRI of the body. Yeah. Thank you.
[1:22:30] And, you know, we talk about visceral fat, fat around your liver, fat around your intestines, fat around your pancreas. And actually, a lot of it now is fat around the heart. We all have a little bit for insulation and we don't want to encourage people to go too deep on the other end at all. But even fat around the heart is just there's inflammatory chemicals. There's one good compound called adiponectin, there's the name, that comes out of fat that's anti-inflammatory and dozens that are pro-inflammatory. And they're just driving our physiology to disease. And, you know, you can get a DEXA scan, which people do for bone health, but it will measure your total body fat, your visceral fat. It's very safe and inexpensive, maybe about $130. A total body MRI, you could do it. There are software now to measure how much visceral fat. But I agree, that is so graphic. And you talk about how many people are walking around 250 pounds on a 5'8 frame, and that's what their internal organs look like. They're just, it isn't so much that fat, but fat is not inert. Fat is just this bubbling brew of inflammatory chemicals. and driving you to have dementia early and erectile dysfunction early and.
[1:23:55] Prostate cancer early and breast cancer early and the whole spectrum and heart disease. Yeah. Well, and what is the latest stats from the CDC? What, 75% of us are considered overweight or obese? Overweight or obese and 40% of kids, which is so tragic that they're starting at that age. They're just at such a disadvantage for long-term health. I think I read 77% of people recruited for the military flunked out because of largely obesity and orthopedic issues, physical fitness. A lot of these companies are using these low-calorie sweeteners in just about everything. Erythritol is one of the most famous. There's a recent study, I think, showing that it can be potentially very, very dangerous. Can you speak to me about that? Yeah, there's this really, really interesting researcher, physician, cardiologist at the Cleveland Clinic. Father may know him. Stanley Hazen. Yeah. Stanley, H-A-Z-E-N. And he's sort of, I call him the Indiana Jones.
[1:25:04] He dreams at night that there's got to be things in the blood we don't know about. And I know he's right. There are causing diseases, including heart disease. And he's on this trail to go, you know, through the forest and find them. So in 2011, he brought big attention to a chemical you can measure in the blood. Go to Quest Lab, have a blood test called TMAO. Yeah. Miracle for plant-based eaters is if you eat egg yolk and red meat, and even some fish, like fish sticks, your TMAO level goes up. And I check it in the blood on everybody, thousands of people since 2015 when we got the blood test. And it really shakes them up, and it really causes them to change their diet. And it comes right down when they change their diet. There's really no probiotic or vitamin that's perfectly effective to bring it down. But now he's on the hunt on these substitute sweeteners, polyols. And the two he studied so far are both erythritol, which is found in so many foods. And you can just buy a whole bag of it on the big block cellars. And also xylitol. And these are preliminary studies. These are in the last 18 months. I think there's two erythritol studies and one xylitol study. But it appears that if you give a person a slug of erythritol, it causes your platelets to start clumping.
[1:26:24] And if you're sitting there with a 50% carotid irregular lesion and you clump your platelets, you may instigate a stroke. And that needs to be further research. So we didn't have much erythritol in my house. I like chewing xylitol gum, keeps my teeth a little cleaner during the day. I don't swallow it, but I probably get a little bit in. But, you know, you talk toothpaste and baked goods.
[1:26:49] Interestingly, many, many keto products, keto baked goods, keto cookies, keto chocolate are just, you know, largely erythritol and can't be good for that community. So, you know, read the package, follow the research. I think it's a little early to abandon them all, but honey and white sugar are better. Just a little maple syrup or nothing is the best choice, probably. As we as we wind this down, Joel, I want to let you know how much I appreciate your time today and all your expertise. Yeah.
[1:27:27] You what are life's essential eight? If you can and I can prompt you if you want, but it needs to be simpler. The American Heart Association, an organization people love or hate. If you watch the movie, What the Health? And you find out how they're funded, you will hate them. Although that's a 2017 documentary and they teach people CPR. And, you know, I'm a member on the board, so I got to say largely good things about the American Art Association. But they had something called Life's Simple 7. Know your blood pressure, know your cholesterol, know your blood sugar.
[1:28:06] Know your BMI, your way to judge you're overweight or not. Know how many minutes a day you exercise and how many servings of fruits and vegetables you get. And don't smoke. Those were the seven. They upgraded about a year and a half ago to this life's essential eight because overwhelming data that sleeping seven to eight hours beat the heck out of sleeping four hours. So the eighth parameter is now get good sleep at night. And if you need to see a sleep specialist, do a home sleep study, tape your mouth, you know, stop sleeping on your back, stop drinking booze before you go to bed or eat a big meal before you go to bed. Just do sleep hygiene. And it's now a series of publications that it's a simple program. Anybody can do it online. If they search out Life's Essential 8, you can score yourself. And it correlates heart attacks, strokes, diabetes, metabolic diseases, sleep apnea. It's just another simple teaching program based on pretty good data.
[1:29:11] Yeah. Well, Life's Essential 8 should be the simple 8. And it's amazing what percent of this country probably isn't even doing four of them correctly. Well, if you talk, you know, five or more servings of fruits and vegetables a day, the statistic I know is about three percent of America. Right. Does that. So that one everybody drops out of. And adequate exercise is probably half of America. So, yeah, we we got to keep teaching these messages. So, Joel.
[1:29:43] Where can people go to find out more about you if people want to have a telehealth appointment with you? Give me that information. Kind of you. And again, after 35 years of doing this, I have no plans of slowing down, having too much fun and too much positive impact. But people can see me in Detroit or people can see me in Florida or very often see me by Zoom. I have a central website, www.drjoelkahn.com, D-R-J-O-E-L-K-A-H-N.com. Take you to my clinic, take you to my podcast, take you to a bunch of blogs I've written, and my social media. These are very interesting questions you ask based on my posts, and I appreciate it. That's a very good way to know what does Joel Kahn care about.
Conclusion: Heart Health Awareness
[1:30:34] Yeah, very much. um well i haven't seen you in a while it's been really nice seeing you catching up with you i appreciate all the the information and wisdom that you've imparted on all of the PLANTSTRONG audience today and on the way out would you mind giving me a PLANTSTRONG virtual fist bump.
[1:30:59] Music.
[1:31:06] I really hope that you found this conversation both educational and informative as we bring awareness and information to National Heart Health Month here at PLANTSTRONG. Heart disease, it doesn't need to be America's number one killer. You guys, you know that we have the knowledge and the technology. And most importantly, we know the correct foods to eat to take proactive measures in the quest for a healthier culture. But remember, it all starts with what's on the end of your fork. And that, my PLANTSTRONG friends,
Outro and Next Episode Preview
[1:31:47] is a whole food, plant-based diet where your food is super strong. As in, PLANTSTRONG. Thanks so much for listening, and I look forward to seeing you next week for another episode celebrating National Heart Health Month when I bring my father, Dr. Caldwell B. Esselstyn, Jr. , to the PLANTSTRONG Podcast. See you then, and in the meantime, always, always keep it PLANTSTRONG.
[1:32:18] The PLANTSTRONG Podcast team includes Carrie Barrett, Laurie Kortowich, and Ami Mackey. If you like what you hear, do us a favor and share the show with your friends and loved ones. You can always leave a five-star rating and review on Apple Podcasts or Spotify. And while you're there, make sure to hit that follow button so that you never miss an episode. As always, this and every episode is dedicated to my parents, Dr. Caldwell B. Esselstyn Jr. And Anne Crile Esselstyn. Thanks so much for listening.
