Full Transcript Summit Introduction and Guest Welcome 0:00 Hello, everyone. 0:00 Welcome to the Future of Menopause Medicine Summit. 0:03 I'm Doctor Ben, your co-host, and I am very excited to be here with you today 0:08 because we have a very special guest, Doctor Joel Khan. 0:12 Welcome, Doctor Khan. 0:13 Doctor Khan is an incredible 0:15 integrative cardiologist who has been practicing since 1983. 0:19 He lectures all over the country and hosts the Heart Doc VIP podcast, 0:24 where he shares his knowledge of both conventional cardiology 0:28 and evidence based, natural, holistic approaches 0:31 that address not only heart health but the whole person. 0:34 Welcome to the summit. 0:35 Doctor Khan, we are thrilled you were able to take some time out of 0:38 your schedule today to share your wisdom and experience with us. 0:42 Thank you. 0:43 I just want to say 0:44 you didn't say anything wrong, but actually graduated in med school in 1983. 0:48 If somebody is doing the math and they think I've been in practice 0:50 for 53 years, they might say, oh my God, the guy's 90. 0:54 I'm not 90, but I can practice is 1990 and it's a lot of time. 0:59 It's I mean, I'm energetic and going to keep going for quite a while, 1:02 but I love it. 1:03 I just want to clarify, I'm not 90. Totally. 1:06 That's a little back and forth to kick this off. 1:11 Sounds good. Sounds good. 1:12 All right. 1:13 So I'd like to just jump right into some of the questions I have for you. 1:16 I'm very excited to get started. 1:18 So and I just will say you've not sent them to me. 1:21 So this is spontaneous. 1:22 Yes. Oh, yes. 1:24 Very hard hitting questions coming your way. 1:25 So a lot of my patients are concerned with their cardiovascular health. 1:30 It's the number one killing of the people in the world. 1:33 As an integrative cardiologist, can you speak to what diagnostics 1:37 you would recommend for everyone to ask their doctors 1:40 for as sort of a routine screen of both cardiovascular and heart health? 1:45 Probably my favorite question, 1:46 because I'm so passionate on the topic and it's a great question. 1:49 And there's such a deficiency, I'll just point out, you know, it's 1:54 we have this thing called the US Preventive Task Force that dictates 1:58 the primary care doctors pretty much dictates, because it sets
Cardiovascular Screening Basics 2:02 what insurance will pay for and not pay for. 2:04 And there's, you know, mammography and colon copy 2:07 and cervical cancer screening and prostate cancer screening. 2:10 Although even PSA blood 2:12 testing has been controversial lately, it's back on the paid schedule. 2:16 Crazy. 2:17 The rise in prostate cancer diagnosis when they did not let primary 2:21 care doctors get a PSA level on men without paying cash. 2:25 Crazy crap. 2:26 There's nothing on the list that really would be called cardiovascular screening. 2:30 Even the humble EKG, 2:33 you know, sticky tabs on your chest test that maybe is a $35 test 2:38 that got booted as a paid screening test. 2:42 And it's not a good screening test, nor is it Red mill, a good screening test. 2:46 If you want to find people with the worst blockages on the planet, 2:49 do a stress test and look for 90% blockages. 2:52 I'm way upstream, you know I want to find you when you have no disease. 2:56 So I'll see you 20. 2:58 You probably have no, you know, atherosclerosis, but certainly 3:01 by 30 to 40, we should be taking the same aggressive approach 3:05 we do for education, lifestyle and actually testing. 3:10 So I don't need to be too promotional here. 3:13 I don't want to offend anybody. 3:14 I wrote a book 15 years ago with a title that execs don't get. 3:17 Bonuses can be men can be women. 3:20 You don't have to be an exact. 3:21 I give lectures called dead lawyers Don't tell bonuses. 3:24 Dead dentists don't get the bones. 3:26 It's just a shock term, like a Howard Stern thing. 3:28 But it pretty much it's been updated and it's pretty up to date. 3:32 It pretty much lays out the answer, the question. 3:34 But really, to get a bullet point, 3:38 you want to do one imaging test. 3:41 The only way to know I don't care what your lab values are, 3:44 what your lifestyle is like. 3:46 There's so much environmental and genetic influence on developing atherosclerosis. 3:50 By the time you're in the 2030s, and definitely by age 40, 3:55 that I see yoga women every day. 3:58 And they proved to have advanced heart disease. 4:00 I had one in the office yesterday. Tragic. 4:03 I mean, 118 pounds, perfect diet, 4:06 yoga, fitness, actress, model, I mean unbelievable 4:12 burden at age 53 of atherosclerosis without symptoms 4:16 because somebody finally said to her, here's the key. 4:19 Get a coronary artery calcium CT scan. 4:24 This a test that I'm going to show you a picture in a second. 4:26 But a test that's been around developed in 1990. 4:29 It's tragic how long ago that is widely available. 4:32 Since about 1995. 4:34 Inexpensive in the last 25 years, like about would you pay $100 to know 4:39 if you're carrying a burden of the number one killer in all day, $100? 4:45 You know, you can't get a urinalysis for $100. 4:48 Really? 4:49 And this CT scan, the only regret I have is it is a CT scan. 4:53 It is equivalent radiation exposure to basically a mammogram. 4:58 Although CT scanner are improving 5:01 and the radiation dose is dropping dropping, dropping. 5:05 It's painless. 5:05 There's nothing injected. There's no IV. 5:08 And in a very five second scan kind of equivalent to a mammogram 5:13 or call, be almost perfect, not perfect, almost perfect can end up 5:18 and maybe big book and see this is from that book with a totally normal scan. 5:23 No calcified plaque found in the heart arteries. 5:27 These white spots are a small amount of calcified plaque. 5:30 And the woman I saw yesterday. 5:32 I hope she's not watching this, but it's like a 90 year old's calcified. 5:37 We call it hardening of the arteries because it's arteries 5:41 that were once young and supple and now are hard and inflexible and leads 5:46 to limitations of getting blood flow to the heart rise and blood pressure, 5:50 and ultimately the risk of events like heart attack, strokes and death. 5:53 So this little test is calcium score. 5:57 You sure would like to be in the Zero Club. 6:00 And I'll tell you that 67 I am in the Zero club. 6:03 I'm lucky because there's a good family history of heart disease. 6:06 It's a good marketing tool in the cardiology world to be able to say 6:10 you are a member of the calcium score of zero club, so beg your primary care. 6:15 Doc, can I get a script? 6:17 Because usually you do have to show up at a hospital or a CT center 6:21 with a prescription. 6:22 Beg them to get a coronary artery calcium scan cakes. 6:27 Awesome. 10,000 research articles. 6:30 The last thing I'll say is about six weeks ago, the American College of Cardiology, 6:35 the American Heart Association, updated guidelines. 6:39 What do you do with your cholesterol and what's the cutting edge? 6:42 And this skin has been in the guidelines for about seven years. 6:47 It got a big upgrade 6:50 that if you don't want to go on closed on medicine, get a scan. 6:54 If you come back a zero, there's almost no justification 6:57 to use prescription drugs, you know, eat oatmeal and make a little. 7:00 I know I have several patients who would be over the moon to hear that. 7:04 Would you be able would you be able to. 7:06 Sorry, I take them off. 7:07 I mean, if they go to the scan and they have a score of zero, 7:10 I take them off their statin 7:12 and I'm not, you know, I'm not the guy that hates every statin in the world. 7:16 Like a cardiologist in Scottsdale is always on 7:20 social media saying, I don't hate statins, but I sure don't want to. 7:23 I don't take one because I've got arteries have been checked. 7:26 The second part to answer your question is get better than average 7:29 blood work like you and your mother. 7:31 Do you know, get a cholesterol, get the thing primary care doctor does. 7:35 Definitely. And a sorry. 7:37 Again, another commercial moment. 7:39 Be sure you have this flood test checked. 7:41 This is a blood test with a horrible name, light bulb protein. 7:45 And you got to call it little A or LP little A. 7:48 I mean, it's a horrible name because nobody can pronounce it. 7:51 LabCorp doesn't matter who. 7:53 Everybody runs his test. 7:55 There is a billing code. 7:57 Go as your primary care doctor or your specialist.
Calcium Scans vs CT Angiograms 8:00 You know, I just heard that everybody should know 8:03 if they inherited this is a genetic cholesterol. 8:07 If they inherited this from mom, dad or both. 8:09 And about 20% of people inherited it. 8:12 This wonderful woman yesterday with this horrible Bernard disease inherited it. 8:17 And I think it's the major factor since her diet and her labs 8:21 otherwise were excellent in her early, early advanced heart disease. 8:25 Then you want to know your inflammation panel like high sensitivity 8:29 C reactor protein, your home assisting methylation panel. 8:32 Awesome. 8:33 You want to know you know, your insulin resistance. 8:35 These are so available whether you just pay cash through my life 8:39 force or function health or Woohp has a lab panel 8:44 life extension magazine and vitamin company has had lab panels. 8:47 You just pay cash for. 8:49 They were probably the pioneers in that field. 8:51 Or I just run these through insurance. 8:54 And my patients 8:55 you know insurance I don't ask my patients to pay cash for most labs. 8:59 And once you have those two things how old are you are. 9:03 And a little better snapshot than general, then you really know where you're at. 9:07 And you then you can say, I'm nearly bulletproof. 9:12 It's pretty awesome. 9:13 So much better than just running, lying on the basic lipid panel that we see most. 9:18 I'll say conventional doctors running, 9:19 kind of an offshoot of the first question or your answer. 9:23 As far as doing the CT calcium score, can you talk about the importance 9:27 of running that versus knowing 9:29 when it's time to run a CT angiogram or a clearly analysis? 9:33 Because as I'm sure you're aware, the CT calcium score is only going to show us 9:37 hard plaques. 9:38 It's not going to show us the soft plaques that are a little bit 9:41 more prone to breaking off, 9:43 traveling down the bloodstream and causing a blockage somewhere. 9:46 When would you say you you want to opt more for that more detailed test? 9:51 Yeah, and I don't have a beautiful picture to show you of a clearly coronary 9:55 CT Andrew Graham. 9:56 But I think as a single practice cardiologist, I'm 9:59 probably number one in the country for ordering them. 10:01 I know a lot. 10:03 I will tell you, the biggest problem is 10:06 people don't get any screening and I'm talking now imaging. 10:09 So if I were working with Bobby Kennedy and my and the government, 10:15 I would get insurance coverage for the Coronado calcium scan. 10:19 I would get the US preventive task force to say at age 45 to 50, 10:24 and certainly a woman by menopause, whether it's early menopause nerd time 10:28 or a woman who's had some obstetrical problems 10:31 like preeclampsia, clamps, a pregnancy, hypertension, pregnancy 10:35 loss, these are now established risk factors for early heart disease. 10:39 Absolutely. Surely early menopause is there. 10:42 I would get oh yeah buddy to get access to Coronado calcium score inexpensive. 10:47 Safe. 10:47 Quick. 10:48 Recognizing I said it's an almost perfect test. 10:51 And the reason it's not perfect is there is something called soft plaque. 10:56 Non calcified plaque. 10:57 Under 10% of people that have that wonderful calcium score 11:01 zero have a significant soft plaque burden. 11:05 I'll tell you 30 years in practice and I've been ordering calcium scores 11:09 since 1995 on everybody. 11:13 One patient in 37 years had a calcium score is zero, and eight months later 11:18 got a stent because he developed some burning 11:20 and went to the emergency room and he was ticked at me. 11:22 But there were no clearly studies back then. 11:25 So if you have to be almost completely certain, you're in good shape. 11:30 I'm very happy if you come back a zero, but anything other than a zero 11:35 if you're a 12 or 18, these are numbers or 118. 11:40 I'll talk to them about spending. 11:42 Now we're talking about spending 1500 to $2000 using insurance covered. 11:47 You do have to be injected with iodine. 11:49 A few people are allergic. 11:51 You have to have a very low heart rate. 11:53 So you got to take a beta blocker or be very calm. 11:56 You got to have good kidneys because you're going 11:58 to give value dying, die, and you don't want to harm kidneys. 12:01 So there are nuances to this advanced cardiac testing. 12:06 But is it a breakthrough? 12:07 Oh my God, this again I hate to say it, but this woman I saw yesterday by age 12:12 53, other cardiologists, she's already had two of them about two years ago. 12:17 And recently as an ability to diagnose in detail 12:21 the disease and then try and evaluate if it's getting worse or better. 12:25 But it's a little more radiation than a calcium score that is also changing fast. 12:30 Better. 12:31 That's really the only was that 12:33 CT scanners are getting more and more advanced and lower radiation. 12:37 But it is, I think, the biggest advance in cardiology really better than any drug. 12:42 If you can't make an accurate diagnosis, 12:45 a accurate, objective diagnosis, who cares what tools you have? 12:49 You got to make a proper diagnosis, so I agree. 12:53 You got a patient 12:54 who's been a bit resistant to lifestyle change, joining the gym, changing the day. 12:59 Show all those bumps in their coronary arteries 13:03 that show up on a clearly CT engineering report. 13:06 They become very motivated to get better compliance that way. 13:10 For sure. It's actually been studied. 13:12 Even putting a picture of your coronary calcium scan, if abnormal 13:16 on a refrigerator, has been studied as a motivational step to get people 13:22 a little more think in 24 over seven about healthy lifestyle. 13:26 I try not to scare people, but I don't want them eating, 13:29 you know, turkey sausage every morning and that's what they tell me they're doing. 13:33 I gotcha screen. 13:35 You mentioned when you showed your book earlier, lipoprotein 13:38 A is a very important cardiovascular genetically related marker. 13:42 Could you speak to the importance or you know, 13:45 I'll say the the more abundance of information 13:48 you get running a fractionated lipid panel like the cardio IQ, NMR, 13:52 Lipo profile versus the standard, you know, five item 13:56 lipid panel that most conventional doctors are going to run as your routine screen.
Advanced Lipid Testing and Risk Markers 14:00 Yeah. Well it's interesting. It's a good question. 14:03 You know, a lot of research out there still relies on total cholesterol, 14:09 like when you go to something online called the Framingham Risk Calculator. 14:14 Why do they put in your total cholesterol? 14:16 Why not your LDL cholesterol? 14:18 Because it turns out next time you look at your standard lab panel, 14:22 it'll say LDL cholesterol and it'll say calc calculated. 14:26 It's actually directly measured number. 14:29 It's a 60 year old formula. 14:31 It's a little tricky to actually measure LDL, but every cardiology 14:35 guideline around the world is about LDL cholesterol control. 14:39 And we're still approximating it on standard lab panels. 14:42 Whereas these advanced cholesterol panels, called NMR Lipo profiles been available 14:48 at least 20 years, maybe 25, three of them for 2025 14:52 years, a few extra dollars, maybe $4,045. 14:56 So it's not out of range and I run them again. 14:59 My patients use their insurance if they have an abnormal calcium score. 15:03 They have corner disease and you know they will directly measure 15:08 LDL, the directly measure the number of particles. 15:11 They may, if check the box, get a test that's 40 years old. 15:16 But all of a sudden it's hot called apolipoprotein B or a Bobby. 15:20 You know, really, if you got a calcium score of $100 15:23 and then a Bob lab test a ball lipoprotein B lab test, 15:28 those two tests will tell you 90% of what you know. 15:31 Now, they're not going to tell you about homocysteine and C reactive protein. 15:35 But if you're able lipoproteins be as high. 15:38 It's either you got a really ugly LDL cholesterol or 15:41 you got a really ugly lipoprotein, a inherited cluster. 15:44 Oh, you got both. 15:45 Then you got to do, you know, if you really wanted to be cost efficient, 15:49 those two tests will tell people a dramatic insight into where they're at. 15:53 So the actual research, like there's something called the Mesa study, 15:57 a big research group and Framingham study said the advanced 16:01 lipid profiles are mainly of value in people with metabolic syndrome 16:06 overweight, inflamed waistline, visceral fat. 16:10 Well, estimates are that's 93% of Americans. 16:13 So you could argue everybody should get advanced 16:16 testing because there's something called discordance. 16:20 The LDL in the family doctor's office isn't bad 110, 16:25 but they're one of these pre-diabetic metabolic syndrome, 16:29 visceral fat overloaded people, fatty liver people. 16:32 These all go together because of system biology networks. 16:37 And that's the group where you might find that LDL of 100 or 110 16:42 isn't really representing the full abnormality in the LDL 16:46 particle number it's called can be sky high 16:48 and lead you to make a more accurate risk assessment. 16:52 Gotcha. I love that answer. 16:54 I know I end up running a fractionated lipid panels on every patient 16:57 that comes in the practice. I always want to see it. 16:59 Homocysteine, high sensitivity, crp. 17:02 I just always get such good information. 17:04 I had a patient just yesterday. 17:05 She ran a basic lipid panel a few months back with one of her 17:09 other doctors, and I fairly confident she has what we call familial 17:13 hypercholesterolemia, just genetically predisposed to higher cholesterol. 17:17 And I run the fractionated lipid panel with the homocysteine with the CRP. 17:21 And yes, her cholesterol is higher than, you know, we'd prefer in a vacuum. 17:25 But a lot of these other risk factors look perfectly normal. 17:28 And I told her, hey, let's get a coronary CT calcium score. 17:31 We'll do a bilateral carotid ultrasound. 17:34 Let's see if we really have to worry about this and consider, you know, 17:38 the end, you know, the last resort, statin medications. 17:41 Or if this is just not actually an issue for you. 17:44 So that's a great answer I love to hear it. 17:47 Oatmeal since. Absolutely. 17:49 So since we are the Future of Menopause Summit here, I'd like to ask you 17:53 what, in your opinion, is the biggest lie that women have been told 17:57 by a conventional medicine in regards to their cardiovascular health? 18:02 Well, well, 18:03 I mean, you know, one area is the risk benefit of hormone replacement therapy. 18:08 In the last years, the biggest lie was that the risks outweighed the benefit. 18:13 And if you ever go down that route, get off of it as quick as possible, 18:17 use low doses. 18:18 You can. 18:19 And I don't personally write the scripts for hormone replacement therapy, 18:23 but I think everybody in my practice who's a female has read the book. 18:26 Estrogen matters is just resource. 18:29 And, you know, and then I got to refer them to somebody like 18:32 you and your mother and others that can actually do it well. 18:35 And so that's that's a lie. 18:37 I mean, the second one is true of men and women is just I feel good, doc. 18:41 I played pickleball for two hours, you know, but they've never had, 18:47 you know, advanced lab and events, vessel imaging. 18:50 And you have no idea where you're at. 18:52 People drop dead a thousand. 18:53 This is the statistic that should be on every headline 18:57 in an error times and in the Washington Post and anywhere else. 19:00 Is that a thousand people a day in the United States drop dead suddenly. 19:04 It's called sudden cardiac death. 19:06 Most of its due to advanced blocked arteries, sometimes 19:10 with heart attacks that were unknown or silent. 19:13 And it's all easily diagnosable. 19:16 A month, six months, five years before. 19:19 And it's tragic. 19:20 There's you know, there's no wonderful family gathering in hospice 19:24 to say goodbye to grandma and grandpa. 19:26 Just 51 year old person drops dead. 19:29 It's tragic. Yeah. 19:30 And that includes women. 19:32 It you hear headlines about men dropping dead a bit more, but women drop dead. 19:36 And we need to get really upset, really aggressive about it all. 19:40 So that's a lie to I feel good. 19:43 And I've had a routine visit and my doctor said, see you in a year. 19:47 That's enough. It's not enough. Gotcha. 19:50 Kind of continuing along that line, would you be able to speak to the role 19:54 that estrogen specifically plays with cardiovascular health for women and men? 20:00 Yeah. 20:01 You know, prior to the Women's Health Initiative study published 20:04 2002 2003, again topic of their book, Estrogen Matters, 20:09 which is not the only book, but it's a good resource. 20:12 Yeah. 20:13 Groups actually recommended hormone replacement with estrogen and others 20:17 as a proven path to improving cardiac health. 20:21 In addition to 20:22 talking about future brain health and bone health and sexual health and the rest. 20:26 And then it all just blew up for 20 plus years. 20:29 But we're coming back a little bit to more time. 20:32 Estrogen tends to be very good. 20:35 You know, your arteries are are supposed to be making a lot 20:38 of a wonderful chemical called nitric oxide in the end of the. 20:41 And estrogen helps with that. 20:43 And that helps relax arteries better blood flow throughout the body. 20:47 You know, if you have better blood flow, 20:48 you've got a healthier, better body from head to toe. 20:52 And then even if you talk about, you know, cholesterol 20:55 tends to go up at menopause. 20:58 Lipoprotein this genetic cholesterol.
Menopause, Estrogen, and Heart Health 21:01 So we're talking again one out of every four one of every five women. 21:05 A little bit more common than African-American women. 21:07 So it's easily can be even a little more 21:09 than one of every four African-American when it goes up protein and menopause. 21:13 And it actually comes down with estrogen not to normal, but it comes down. 21:17 So, you know, just multiple pathways by which estrogen 21:22 and other components of heart can be so cardiovascular supportive. 21:28 Absolutely. We see that all the time. 21:30 I always end up having the conversation 21:32 with my male patients who end up going on testosterone, your testosterone. 21:36 Some of it will convert to estrogen via the aromatase pathway. 21:40 And they always go, well that sounds horrible. 21:42 I don't want to be all weepy and anything like that. 21:44 And I have to explain to them, no, this is very important 21:47 for your cardiovascular health, the same way I have to have, you know, 21:50 the women have to have some testosterone in their body. 21:53 Males need to have some estrogen in their body. 21:56 It's very important. 21:56 We always say hormones are a symphony. 21:58 It's not just one magic bullet. Correct. 22:01 That's very nice to hear. 22:02 Let's see. 22:02 Are there any supplements that you like to rely on as a go to 22:07 for moving the needle? 22:08 As far as some of the cardiovascular markers that we've been talking about? 22:13 You know, in my lab panel, I draw a lab that I think 22:17 everybody should have, and it's available in omega three index. 22:22 You know, again, I would probably should write a children's book. 22:25 Why do mommy and daddy take fish oil? 22:28 And I would love to see children taught that. 22:30 You know, we don't make omega three. 22:32 We have to eat omega three rich foods. 22:35 And let's educate. You know about that. 22:38 And they'd be on a much better path to life. 22:40 But boy, these people show up in my office, 22:43 you know, dramatically deficient in omega three. 22:45 People don't like fish. 22:47 People are vegetarian or vegan like me. 22:49 Whatever the reason is, people eat tuna, which is not particularly rich 22:53 in omega three. 22:54 Salmon, sardine, mackerel and Jovian herring are rich in omega, 22:59 so we use a lot of food based support for omega three. 23:04 Once we check it and find, it is dramatically low. 23:07 But we have to use supplements and there are good fish based, high 23:10 quality, pure supplements that have been third party tested for toxicity. 23:14 And they're also from algae or even you really want to go deep. 23:19 There's a flower called the ahi flower age that provides 23:23 a vegan source of EPA da. 23:27 And also that's commonly used because it's such an obvious deficiency, 23:30 along with vitamin D would be another one. 23:33 The two that I mentioned and I, you know, shouting out, these are not companies 23:36 I own. 23:37 There's some really interesting research 23:39 that started in Japan and then moved over to Los Angeles, 23:42 that an aged garlic extract and used usually the company is called Cheo. 23:48 Like colic, there are many, many good companies that make garlic or age. 23:54 Garlic specifically can lower plus lower blood pressure, lower homocysteine. 23:59 And they're actually our double blind randomized studies that they can help 24:03 shrink plaque and arteries. 24:05 And you can eat all the garlic on your diet. 24:07 And you should it's a sulfur rich, 24:11 glutathione supportive food darkly, 24:14 along with things like ginger and onions and brassica like broccoli. 24:19 But these age garlic tablets, they're a little funny shaped, 24:23 sometimes hard to swallow. 24:24 It's a routine in my practice. 24:26 They're so inexpensive too, which is pennies a day. 24:29 There just was a really interesting 24:32 you don't see too much new research on age garlic. 24:34 There are a lot of stuff, human size, but there was a really interesting study 24:38 that age. Garlic supports healthy muscle function. 24:41 This was then within the last couple of weeks and may promote 24:46 the NAD+ pathway without taking NAD+, you know, direct supplements. 24:52 And kind of an interesting twist on so many people. 24:56 I read an article on mine today. 24:57 What supplements do the billionaires stake in Men's Health magazine or somewhere? 25:02 And, you know, it's first on the list is always NAD+ supplements. 25:05 I don't think the data is completely perfect. 25:08 I think more data, but I'll give age garlic to anybody. 25:12 There's also an interesting supplement. 25:14 Again, I'm not tied financially from life extension 25:18 a big company and for luck called Arterial Protect. 25:22 And it's two supplements in one capsule called picnic and all maritime 25:26 pine bark and go to cola bush from India, also called central. 25:31 But there's data from Italy that in humans with carotid disease, 25:36 you can see the plaque diminish over time, several years from a very inexpensive, 25:42 super safe supplement and a good amount of science 25:45 in terms of how can that happen and why does that happen? 25:49 So, you know, those are a couple odd ones. 25:51 But I never hesitate because the science is actually pretty strong. 25:56 Oh yeah, I love using go to Cola, 25:58 one of my absolute favorite herbs for so many different things.
Supplements for Cardiovascular Support 26:01 You got scar tissue. 26:02 It's great for you know you can do fantastic anti fibrotic. 26:05 Absolutely. Yeah absolutely. 26:08 All right I did want to ask this is a little bit more for my knowledge 26:11 because I see this all the time with lipoprotein 26:13 A since you brought that up specifically 26:15 the range that I typically see on blood work is 0 to 30. 26:19 And what I've noticed with a lot of my patients is, you know, 26:22 whether you're, you know, eating fast food 4 or 5 times a week 26:27 or you're like that patient you described earlier, you know, the yoga 26:30 lady, 118 pounds, you know, outwardly very, very healthy appearing. 26:34 And yet it just seems so hard for most people to fall under 26:38 that 30 range where they're going to flag you as normal on blood work. 26:41 So I'm just curious if you could speak to if you agree with that range, 26:45 if you have more of a range that you would consider optimal 26:48 and you know if it is truly elevated, what are some things we can do to 26:52 start to go after it and lower it? 26:53 I know it's a genetic thing, 26:55 but we obviously also want to consider epigenetics as well. 26:58 And I got to say, the very beginning 27:01 was the questions about lipoprotein little a yeah. 27:05 So lipoprotein little a and if you could speak to the range okay. 27:09 Good. Yeah. 27:10 So you know lipoprotein literally 27:13 the molecule was discovered by a Dutch 27:16 I think it was Dutch researcher in 1963. 27:19 Right to that. 27:20 We didn't know it, but really 27:22 it didn't hit the discussion until the last 15, 20 years. 27:26 If you went to advance or integrative lectures. 27:29 And really right now is when primary care docs might start to be hearing 27:33 about it, because the drug companies got drugs in the pipeline. 27:37 And that's how we funded for doctors. 27:40 You know, Doctor Smith, you really should start drawing this lab on your patients 27:44 to get them ready for the new drugs coming, maybe next year. 27:48 So good or bad, that's how it's happening. 27:50 So one way to measure it. 27:52 The older way it's called milligram per deciliter. 27:55 And under the is normal and over 50 is high. 27:59 Over 75 is really high. 28:01 Most labs have transition. 28:02 And unfortunately I tell my patients it's like stepping on a scale. 28:06 Is it going to measure you in pounds or kilograms. 28:09 You're going to get two different numbers. Don't get confused. 28:12 You didn't just gain, you know, 80 pounds. 28:15 You just have a unit. 28:16 So there's a unit called nano mole per liter. 28:19 Nemo l most of the advanced labs do it that way. 28:23 Now, we say under 75 is considered a low risk. 28:27 Normal range over to 125 is considered a high risk range. 28:31 But a very recent analysis last three weeks said 28:35 really over 175 nano mode per liter for lipoprotein 28:39 literally that might be 2 or 3% of the population are that high. 28:43 And it can go up to 4 or 5 600 at the highest end. 28:47 That's where the real risk exists. 28:49 It's a tough one. There's no FDA approved drug. 28:52 The absolute bottom line is statins, lower cholesterol. 28:56 They actually raise they go the wrong direction with label protein. 28:59 Little I I've seen it not dozens, hundreds of times. 29:03 I'll take a patient who comes to me. 29:05 I like a protein age 200 and animals per liter and they're on 40mg of a stat. 29:11 I'll take them off for four weeks. Absolutely. 29:14 You reject the whole lab panel and they're like protein a failed 110. 29:19 You know, it can fall that much. 29:20 Academic lipid doctors tried to downplay that because we don't have much else 29:25 other than statins. 29:26 But it is a tricky role that statins have in a person 29:30 who inherited a high level of lipoprotein. 29:32 Little a we have a drug expensive called 29:37 inject every two weeks. 29:39 And probably they will lower cholesterol if needed. 29:42 And lower lipoprotein a modestly that's recently had a big price drop. 29:47 It's still patented name brand drug. 29:49 So it's expensive but the prices dropped by about 6,070%. 29:54 We have these drugs in development five six of them, 29:57 but they're going to be very expensive if they get approved 30:00 and they're going to be limited to people 30:02 who've had heart attacks and bypass surgery. 30:04 So they're going to be patent protected for a while. 30:07 Unlike you can buy, some of them died at your corner grocery store for some reason, 30:12 even though it does seem that way these days. 30:14 Absolutely. 30:14 Take a six pack of Diet Coke and Semaglutide 30:18 on your way home from, you know, your local grocery store now. 30:22 It's crazy what's happening there that's not going to happen. 30:24 So we're going to be limited. 30:26 I'm old school. 30:27 I'll just make two comments. 30:28 There's a theory. I'm sure you're familiar with it. 30:30 With the double Nobel Prize winner Linus Pauling. 30:36 Absolutely. 30:36 The Roth Pauling protocol. 30:38 If you take enough, here's my vitamin C, you take enough vitamin C 30:43 and enough lysine and proline to amino acids. 30:47 You may block lipoprotein A and make it basically inactive on your arteries. 30:53 Absolutely. 30:54 Very little data to say that's proven. 30:57 But he's such a powerful figure in the world
Lipoprotein(a) Treatment and Closing Remarks 31:00 of what's called ortho molecular medicine or integrative medicine. 31:03 I will use that because it's cheap and expensive and safe. 31:07 Vitamin C plus probably. 31:09 And the other one is I do. 31:12 Oh, good. 31:12 For me, I didn't prepare, I just got some flying around. 31:15 I still use niacin. 31:17 This happens to be very inexpensive over the counter brand. 31:21 The only brand I use made in Portland, not my company, but niacin was identified 31:27 to lower cholesterol 70 years ago and identify the lipoprotein 31:31 a about 20 years ago and a cardiologist have just run away. 31:35 They do not use niacin anymore. 31:37 Now, $0.20 a day, I can show you dozens and dozens. 31:42 And I have to write that paper up. 31:44 A major cholesterol drops, major lipoprotein a drops. 31:48 I have to watch the liver enzymes. 31:50 They tend to go up a little bit, 31:51 watch the insulin sensitivity, make sure it isn't being harmed. 31:56 But at least on paper, you can get insane advances with niacin. 32:02 I don't like using niacin with statins. 32:05 I use it as monotherapy and I'll do an eight week trial. 32:10 And if we love what we see, we'll stay on it. 32:14 Yeah. 32:14 All right, I love it. 32:15 Well, this has been great, Doctor Khan. 32:17 I really do wish we could keep talking, but unfortunately, we are out of time. 32:21 I've got a patient to get to. 32:22 I'd just like to thank you 32:23 one more time for joining us today and sharing your experience. 32:26 Go ahead and share where our listeners can learn more about 32:29 you and your very excellent approach to cardiovascular health. 32:33 Well, that's kind of you. 32:34 And I mean this I'm going to tell you where you can find me. 32:37 Don't find me, please. 32:38 I have so many patients, I am like, 32:42 I am licensed in 20 states, including Arizona, New York, California. 32:46 I'm in Michigan and Florida. 32:48 I spend the winter in Florida, but I have an office down there. 32:51 It's a nice situation you can do when you're an integrated doc, 32:55 and I'm fully licensed, so I do it, you know, totally kosher. 32:59 But the best places go to a website. 33:01 Doctor Joel Kohn, drug 33:06 K and I'm on Instagram 33:09 ten times a day, TikTok a couple of times a day, Facebook couple times a day. 33:13 I try and be, you know, keep my media time 33:17 relatively low because I wouldn't call that quality family time. 33:20 But I'd like to put out the new information 33:25 as much as there is, and there really is. 33:28 I'm kind of a geek about new literature, new data, kind of remember right now 33:34 what I posted this morning, but it was some new, exciting. 33:37 Did I know about Alzheimer's disease screening? 33:41 And so, you know, I like people let people know what 33:43 the latest solid sciences and and they can decide where they want to go. 33:49 I'll say, as a fellow geek, I know that approach will serve you well. 33:53 Amazing. 33:53 Well, everyone go follow him on Instagram Facebook ASAP. 33:57 Once more. 33:58 Thank you, Doctor Khan, and thank all of you for being here as well. 34:01 We are very grateful 34:02 for you taking the time to learn about and advocate for your own health. 34:06 We will see you all for another important conversation next time. 34:09 But until then, everyone take care and be well. 34:12 Thank you. Thanks, doc.
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