Plant-Based Secrets For Weight Loss

Joel Kahn, MD, FACC

Thank you so much. Great pleasure.

Carolynn Francavilla, MD, FOMA, D-ABOM

Let’s start talking a little bit about the relationship, if we can, between weight and heart health. Can you talk a little bit about what that relationship is?

Joel Kahn, MD, FACC

It’s quite profound and extensive. I’ll try to be efficient and succinct, so people can learn more. But it is not, as I’m sure you do in your practice in Colorado. It’s not fat-shaming; it’s science. But in many people, not every person, as body weight gets into the overweight and certainly the obese and the markedly obese ranges, which is just so common throughout the Western world, there’s a lot of things that go with that. There’s inflammation, for example, particularly if there’s a waistline that’s extended, excess excessive visceral fat around the internal organs, and, detectable by just measuring, waist-hip ratio. But we know that many factors are manufactured in that visceral fat. We can measure some of them, but we can always measure the simple inflammation markers, such as high-sensitivity C-reactive protein. In my clinic, I do two or three more. There’s one. These are widely available Myeloperoxidases that were patented at the Cleveland Clinic and another one is called Lp-PLA2.  There are 150 years plus of data showing that increased inflammation detected on these simple blood tests raises your risk for atherosclerosis and other forms of heart disease. Atherosclerosis leads to heart attacks, strokes, loss of life, and loss of kidney function.

There’s a whole lot to unpack just by bringing up inflammation. Obesity raises the risk of perturbing glucose metabolism. If you become pre-diabetic, insulin resistant, or have second-type diabetes, that is at least doubling your risk of atherosclerosis. There’s a special risk if you’re obese and diabetic. There’s a special risk for something called congestive heart failure and cardiomyopathy, a weakness and enlargement of the heart, a very serious condition, a life-shortening condition. All of these that I mentioned can be life-shortening conditions.  They’re all related to weight gain. As our weight goes up, as you well know, the risk of sleep pathology, particularly obstructive sleep apnea, goes up. People may snore, gasp, and stop breathing. In my clinic, we are very aggressive about doing home sleep. Studies are very inexpensive, safe, and accurate. We diagnose so many cases of unknown, obstructive sleep apnea. We encourage people to lose weight. We refer to special dentists; we refer to sleep board-certified specialists who come from pulmonary and neurology and other disciplines. Weight loss can be tremendous in reversing sleep apnea.

With increased weight and sleep apnea comes a terrible problem called atrial fibrillation. There just was a study published that your lifelong risk of ablation, an estimate in a country in Europe, was 22% risk during your whole life. But that’s increased now. That’s a point I want to make. It’s now 31%, and when they looked at factors, it has gone up to 50%. It’s largely weight, weight, weight. There are more obese people. More people are developing atrial fibrillation. An atrial fibrillation, an irregular heartbeat is a direct path to strokes. It’s a direct path to congestive heart failure. We’re getting there again. obesity and high blood pressure, no doubt related to obesity and cholesterol are lipid disturbances that put you at risk for a risky process. There’s nothing joyful about this whole cascade that affects head to toe from all the perturbations that can go along. Now, there are healthy, overweight people, and they can be tested and distinguished. They don’t have sleep apnea. They don’t have insulin resistance. They don’t have inflammation. If they’re exercising, it may help. But this propagation that it’s cool to be obese. You can think of some Instagram, Twitter, and pop stars who have promulgated that it’s just not medically correct.

Carolynn Francavilla, MD, FOMA, D-ABOM

One thing I try to emphasize with my patients and with the education I do is that we have to look at the individual. Because there are some people, and I’m sure you see this for cardiovascular disease, for whom a small amount of weight gain has a big impact on their health. Then there are people who, based on their BMI, are overweight or obese. But when we look at their blood work, their exercise tolerance, and other markers of health, they are healthy at that weight. So the weight that’s too much for any one of us can vary from person to person. Cardiovascular disease is personal to me. My grandfather died of a heart attack, and he had metabolic disease. His weight wasn’t that high, but he had that extra weight around the belly. He had diabetes. He had all those things. I do think it’s important that someone see their their doctor and figure out how much of an issue their weight is.  Because again, it doesn’t always have to be these high weights before weight becomes an issue for someone.

Joel Kahn, MD, FACC

Now, I agree; even just being in that group,  it’s common to be in that overweight group. If you believe BMI has any value, and even at that level, there may be some insulin resistance. I left one off the list. I’m sure others will speak about it, but obesity, and what some people term an epidemic of fatty liver disease or nonalcoholic fatty liver disease, there are about five different terms for the same condition. I get a lot of heart CT scans now. a lot of them are 10 or 20 patients a week for their calcium score and their CT angiogram. You very often see about half of the liver on a heart CT scan. The report commonly mentions mild-to-moderately advanced fatty liver disease. Or people may be getting a CT or ultrasound for other reasons, and it is now the number one cause of progressive liver damage and can lead to cirrhosis and a shortened lifespan. That’s all tied in with cardiovascular disease and fatty liver disease, which is a risk for early heart events.

Carolynn Francavilla, MD, FOMA, D-ABOM

I was recently at a presentation about fatty liver disease by a gastroenterol allergist. He quizzed the audience, and he said, What’s the number one thing that kills people with fatty liver disease? I was like, heart attacks. He was like, All of these medical conditions go together. The good news is that they can all be reversed or improved together through the same strategies. Even though it can feel like doom and gloom when someone is struggling with their weight when we make even small improvements in weight or metabolic health, we often see big rewards, and it improves all of those things in one fell swoop. Let’s talk about what people can do if they are struggling with overweight, or obesity, are at risk, or even have cardiovascular disease. One of the things that you’re known for is talking about plant-based diets. Can you tell us about the role of plant-based diets in weight and metabolic health?

Joel Kahn, MD, FACC

Number one is discussing it with a patient and charting it in the chart. I’m always surprised that I do a lot of second-opinion consultations. I look at my colleague’s notes, and they’re all good cardiologists and internists. But very often, internists, more likely cardiologists, are very generous and overlook in their charts that obesity is one of the medical problems. There are billing codes for it—ICD ten codes. It’s easy to add it to the chart. That’s step one: recognition. It’s a problem. discussion with the patient. It’s a problem. They’re aware but having a frank talk is important. Number two, it shows that there are multiple reasons, and you’re more schooled than me on obesity as an obesity specialist, but I am good friends and follow closely with Dr. Joel Fuhrman, a multiple New York Times bestselling author and PBS specialist. who has an equation: health equals nutrition over calories. If you can get lots of nutrients, that’s a top equation over relatively small amounts of calories. You’ll feed yourselves the cellular nutrition they need, but you won’t necessarily give them an excessive amount of calories to get there. Nothing does that better than plants.

Plants are packed with fiber, they’re packed with vitamins, and they’re packed with special nutrients you find only in plants, like phytonutrients, some of the antioxidants, etc. vitamin C, and on and on. You don’t have to eat that many calories to get a lot of the nutrients you need to fuel your body. You can be a weightlifter, you could be a runner, and you could be an athlete on plants, but you can do it with that equation. Health equals nutrients over calories, and pack in the nutrients without jacking up the denominator in that equation. We encourage people, but I’m very low-key about it. I give them a list of four or five documentaries to watch at home with their spouse or significant other. Forks over knives. Game changer movie. There’s a new documentary that a lot of people will hear about in 2024 on Netflix called You Are What You Eat. and encourages them to read a book and watch a couple of other free resources. It’s amazing how many people get it. They just get that they’ve been eating wrong. For a long time, they visited doctors who had brought up nutrition. With one change, moving from, and I’m not a big fan of intermittent fasting as people call it. I would call it more time-restricted eating—skipping breakfast, one that is a proponent of eating breakfast for my patients and myself too.

Carolynn Francavilla, MD, FOMA, D-ABOM

We can agree. I’m a team breakfast. I always say:

Joel Kahn, MD, FACC

Yep. If you’re going to skip a meal, eat your dinner early and get your meal, your days, and your calories done by five six, or even earlier. It is the upside-down pyramid of what most people are doing. But I do encourage them to start somewhere with a giant green smoothie in the morning with flaxseed, hemp hearts, or chia seeds. Maybe that’s not their thing, and maybe they’ll be willing to have access to a big salad bar and have one very large salad. But we’re going to watch and maybe do it without what everybody calls protein. There’s plenty of protein, umami, kidneys, beans, and chickpeas. You get plenty of protein. Get them away from animal foods. and certainly get them away from processed foods. Maybe it’s one big salad a day to get started.

Carolynn Francavilla, MD, FOMA, D-ABOM

They like that mentality. You don’t have to do everything all at once. Can you change your breakfast? Can you change your lunch? Like, sometimes some people are all or nothing. They like to dive all in, but sometimes just changing one of your three meals a day is going to have an impact on your health.

Joel Kahn, MD, FACC

We know that if you’re eating processed foods, you’re getting way too much salt, way too much sugar, very little fiber, and a lot of other environmental junk that comes with it that is obesogenic and endocrine disruptors. They all go together. We have two simple habits: cooking our meals and meal-prepping on weekends. saving some dollars at restaurants and carry-outs and learning at home. We try to teach all of that in a very simple way. This has been studied. There’s been an organization in Washington DC, the Physicians Committee for Responsible Medicine, and Dr. Neal Barnard, MD, heads that up for many decades. They do randomized studies on standard diets and whole foods, plant-based, simple, and inexpensive. You don’t have to be on a cordon bleu Chef. You have to diet, and sustain weight loss is certainly superior to a whole-food plant-based diet. That’s generally naturally low in fat. They’re lenient about it. You do want to watch nuts, seeds, avocados, and oils to some extent just because the calorie density is so high in those foods. But there’s a good amount of published science to support the idea that eating plant-based foods can help sustain. You might do it for a week or two, but we’re talking about sustained better. 

Carolynn Francavilla, MD, FOMA, D-ABOM

The point you made about it. Being whole food is probably very important as well. Because someone could eat a very processed plant-based diet. They could eat vegan mac and cheese from the box, crackers, cookies, chips, and other things that are plant-based but not whole foods—vegetables, beans, fruits, and things like that. They may not get all of the same benefits, particularly with weight loss. If they’re eating those ultra-processed foods that just happen to be vegan.

Joel Kahn, MD, FACC

Some people are challenged because they have gone so far away from cooking at home. For many of my patients, I talked to them about where’s the meal from. Whoever cooks this and that, 70–80% of their food comes from a restaurant, so it’s always going to be a problem. To talk about fitness as an adjunct. I don’t know that you’re going to have sustained weight loss. You’re going to have to work out 90 minutes a day or something to get major sustained weight loss. But the combination of moving towards a whole-food plant-based diet and exercise is a powerful one. Get a home sleep study. If you’ve got sleep apnea, find a treatment that may help you lose weight. Simple things like thyroid studies and liver studies,  in a cardiology clinic more and more, and you’ll be talking about this with other, experts, but we’re bringing up the topic of, GLP1 agonist and the rest because we’ve got data now.  All are funded by Novo Nordisk and always a little bit worried about, conflicts, but, in people without diabetes who are obese, that start to lose weight with these injectable drugs like wegovy and zepbound, and the rest, there are cardiovascular benefits, there are fewer cardiac events that occur like heart attacks, admissions and if somebody just can’t, bridge the gap with exercise and diet and sleep apnea therapy,  I relatively conservative in my use of these drugs. But since the select trial came out at the end of 2023, and now that there is an FDA-approved indication for using these drugs for cardiovascular risk reduction, we’re going to see a big uptake.

If people can get insurance approval and if there’s a supply, I’m not sure it’s a great long-term answer because of the enormous Yo-Yo effect when people go off of this. But, for some who have just struggled with cardiovascular disease, congestive heart failure, atrial fibrillation, and atherosclerosis, it may be urgent to get some weight off and get them feeling better. Then maybe we can teach them all the lifestyle habits too.

Carolynn Francavilla, MD, FOMA, D-ABOM

I will say that this is pretty prevalent for my patients. What it often does is let them stick to the plan. There may be someone who has been intentional. They would like to go plant-based; they would like to eat more salads, but they struggle for reasons they sometimes can’t articulate. Then, for many people, once they’re on the medication, they’re just able to do it all of a sudden. So it all comes together, and then they’ve lost some weight and feel better. Now, all of a sudden, they’re walking every day. Some of them have even started running at like 50 years old, which is pretty cool. Sometimes it does let it all come together. Then, as you said, the data for cardiovascular disease prevention that came out at the end of 2023 was a 20% risk reduction for people at risk, which is pretty good.

Joel Kahn, MD, FACC

I agree; it’s important data. then, and you’re going to be having conversations again with other experts, but in my clinic, where we take a food-first preventive approach, we try to minimize prescriptions when possible, but that’s not always possible. We have used a lot of the five-day fasting-mimicking diet. I came across it in early 2017, just about when it was launched. I did it myself and found it to be a wonderful program. I’ll make an admission. I was a chubby kid. I wore a husky bar mitzvah suit. I’m not a naturally BMI 21 guy. Even though I’ve been plant-based for decades and healthy whole-food plant-based, almost all home-cooked meals. I happened to be married to a very good cook. She’s very healthy cook for years and years. It’s still a challenge. I found that three or four times a year, taking five days and hunkering down and doing Prolon fasting-mimicking diets, was a great assistance. I started sharing it with patients. I have some just wonderful success stories of people maybe doing their five-day best mimic diet three months in a row, then back off to maybe three or four times a year, and just a lot about portion size. They learn about their previous food addictions and their Clean the Plate Club. Here’s the first time that they’re getting through almost a week at 800 calories a day, and they didn’t drop dead.

Carolynn Francavilla, MD, FOMA, D-ABOM

There are lots of cool things about Prolon. The data is compelling. The fact that it’s five days and then you can go back to eating a generally healthy diet the rest of the month is doable for a lot of people. If you’re like, five days, I can do it. I’ve played around with it myself. and I’ve used it for patients, it’s a unique and evidence-based solution that can work for a lot of people.

Joel Kahn, MD, FACC

I agree. The last little thing, and I don’t know if anybody else is going to bring this up. We’ve been using it in my clinic, there’s an interesting research program in New Zealand funded by the government, but with big funding like $15 million and $20 million trying to identify natural substances to curb appetite. It turns out that after 800 substances, bitter hops activate a receptor in the small intestine. That receptor leads to the release of GLP1 and CCK. The third one is PYY, and now human data is showing that taking a little capsule of bitter hops. It’s a commercially available vitamin. It’s not a prescription drug; it can suppress appetite and cravings during fasting and long-term use. There’s an ongoing white trial right now, so it’s a little premature to claim that we know for sure you can lose weight with this stuff. But when I combine the five-day fasting-mimicking diet, which I do pretty well, you get hungry and combine it with this little, naturally available supplement. It’s been magic because I just don’t seem hungry at all.

Carolynn Francavilla, MD, FOMA, D-ABOM

The fact that it’s bitter hops makes it pretty low-risk. It’s a low-risk supplement for someone to try if it helps them.

Joel Kahn, MD, FACC

It is, and I’ve read that the pharmaceutical industry is aware of this well-documented pathway of a bitter taste receptor in the small intestines. They are hard on the search for pharmacologic agents. However, the natural supplement is quite inexpensive.

Carolynn Francavilla, MD, FOMA, D-ABOM

Wonderful. Any final thoughts about this connection between heart health, weight, weight loss, and plant-based diets?

Joel Kahn, MD, FACC

Never stop. Keep trying something new. It’s important. It all starts with the proper mindset, conviction, and maybe frustration. Baby steps are great. That’s fine. It doesn’t have to be rapid. I do share with people a couple of books. I love the book by the comedian. The book is called Presto. He’s the tall comedian in Vegas who’s done comedy for 40 years. Penn and Teller. Penn. lost over 100 pounds almost a decade ago. A very funny book about the mindset to lose weight. He did it through a rather bizarre but whole-food plant-based approach, continuously that way. There’s a new book out called Escape, which is about food, alcohol, and drug addiction and overcoming it to become a pretty famous athlete. That was just published. These are interesting. There are people out there struggling and probably thinking, I’m the only one out here with this mindset, this difficulty, or this addiction, and reading books like that and realizing that there are a lot of people out there just like you.

Carolynn Francavilla, MD, FOMA, D-ABOM

If someone wants to connect with you further or learn more about what you do, how can they connect with you?

Joel Kahn, MD, FACC

I realized I’m a very busy cardiologist doing integrative natural cardiology in Detroit, but I’m licensed all over, so I do a lot of telemedicine in Colorado. I have a central website, drjoelkahn.com, DRJOELKAHN dot com, and I love seeing new people even though we’re very busy. A small, boutique clinic would take very good care, take a lot of pride, have good accessibility, and provide quick responses to patients. But we hope, and weight has to be one of our targets because of all these connections. We talked about it. It’s a very important summit. You’re doing.

Carolynn Francavilla, MD, FOMA, D-ABOM

Thank you. I appreciate you being a part of it.

Joel Kahn, MD, FACC

Thank you.