Protect Your Brain By Guarding Your Heart

Joel Kahn, MD, FACC

Reversing Heart Disease Naturally 2.0.

Heather Sandison, ND

Amazing. You are a pro at this. I have to tell you that I’m personally and selfishly excited about this conversation because I don’t see a whole lot of cardio-metabolic health in my practice. Typically, by the time someone comes to a naturopath, they’re taking care of the diet and the exercise pieces, and they’re struggling with memory loss. But this week, I am working on a presentation for colleagues of mine about where brain health meets heart health. I’ve learned so much, so I’m excited to dig in and pick your brain about some things, I know that I am going to learn a ton, and our listeners are too. Let’s jump into the risk factors that are shared between brain diseases and heart disease.

Joel Kahn, MD, FACC

Well, everything, because 20% of the blood flow to the body goes to the brain, an organ that doesn’t occupy 20% of the weight of the body. We all know that amazing statistic. If you study linear biology and it takes healthy blood vessels, it’s not just blood vessels; it takes healthy blood vessels to support a healthy brain through all stages of life. We have, and we’re always evolving. We’re learning more and more all the time. But we got a pretty good idea of what promotes healthy blood vessels and what destroys healthy blood vessels. That’s important because one of the biggest causes of dementia—maybe we don’t call it Alzheimer’s dementia—is vascular dementia. Of course, for people who aren’t medically sophisticated, vasculature means blood vessels. Blood vessel, dementia is a major portion of all people who suffer this horrible disease that robbed me of my wonderful grandfather, Jacob Kahn, long ago. But I watched him go from a dynamic businessman to a shriveled older man in a nursing home in a wheelchair. Was horrible. I was a young person, and I remember it so vividly after years of a very close relationship—vascular dementia.

We should have multiple tattoos on our bodies. One of the tattoos should love our blood vessels. I mean, the basic five, if you go to a standard cardiologist and they’re good people and you should love your standard cardiologist, they’re going to say the big five are great blood vessels. Do you smoke or not? Do you have high blood pressure or not? You need a home blood pressure cuff. If you don’t have a home blood pressure cuff, you’re not serious about dementia because you want to know. Daytime, nighttime, weekend, weekdays. I feel dizzy. I feel short of breath. You need a home blood pressure cuff on your upper arm. Check your blood pressure three times in a row, a minute apart. It’s 140 over 80, goes down to 130 over 70 minutes later, and drops to 120 over 72. You’re probably pretty good. You’re just a little reactive, with white-coat hypertension at home. You want to know your blood cholesterol and your blood pressure. I know your blood sugar. Maybe you want to know your insulin level. Maybe you want to know your hemoglobin A1C. You need a smoking history. Finally, mom, dad, brother, sister, and maybe grandparents who had the early heart attack, the early stent, the early bypass, the early stroke, the early pacemaker. You want to find out about those factors. But that formula is lacking a lot. It’s better than not asking about the big five, but it’s not enough. Again, get a home blood pressure cuff. 

Nowadays, whether you are a functional integrative cardiologist as I practice or even if you’re just in a good clinic, you want to know your inflammation. Inflammation is at least a high-sensitivity C-reactive protein, Hs-Crp. Are your blood vessels to your brain and your heart on fire? Inflammation Aortitis flame. Such a simple blood test, but there are about four other inflammation blood works if you can get them. Myeloperoxidase MPO, Lp-PLA2, it’s a tough name but it’s LP-PLA2, ADMA. These are available at Quest LabCorp you can get these are not exotic you don’t need to do an advanced genetic panel you have to know. I’m just going to show up real quick because it’s such a bad word. There you go. Lipoprotein-a, it’s a genetic cholesterol that affects about 25% of the population you inherited from mom, dad, or both. If you’re elevated and you can measure it in two different ways, which is a problem, it can cause vascular damage.

If you have vascular damage, you could develop vascular dementia. If you have this problem, it’s difficult to bring it down. This is a book I wrote, but there are many good references all over the web, and things like Lipitor and Crestor don’t help us. They might lower your regular cholesterol, but not this very common second cholesterol that everybody should know. If you’re out there listening and you don’t have a home blood pressure cuff, if you don’t know your Hs-Crp, or if you don’t know your lipoprotein-a, you need to step up from amateur to professional heart expert and dementia prevention expert. Ben Franklin once said An ounce of prevention is worth a pound of cure. You should know your homocysteine level, through simple blood tests. Genetically driven, nutrition-driven. Make sure it’s not elevated, because if it’s elevated, it can impact your blood vessels, and that can lead to vascular dementia. How’s your omega-3 level, and your vitamin D level? But omega-3 in particular. In my clinic, which is in Detroit, Michigan, the number one abnormal lab is low omega-3 in the blood. Simple blood test. Many labs provide it. But if you’re not eating flaxseed, chia seeds, hemp hearts, walnuts, leafy greens, salmon, sardines, mackerel, and anchovy and herring, the smash fish, you’re probably low in omega-3 and your brain is going to suffer. Do you want to amp that up? I amp flaxseed up because I’m plant-based and some algae-based omega-3. But you can do it anywhere you want. 

Let’s just cover some basics, and I’ll say one last thing. We check. We screened for breast cancer with a mammogram. We screen for colon cancer by colonoscopy. We screen for prostate cancer with a rectal examination and a PSA, and we screen for cervical cancer. Nobody’s screens. How are my blood vessels doing? No, there’s a statistic out there that says the number one cause of death is blood vessel disease. There are carotid ultrasounds you can get at church fairs, hospitals, and better clinics. You can also get this CT scan of the heart, called the heart calcium CT scan, for about 100 bucks. You have to go talk to your primary care providers. I want a heart calcium CT scan. If your arteries in the heart are aging, I’d be worried about vascular dementia. If your heart arteries come out with zero calcium, you’re probably doing pretty well. It depends on your age, and you are probably at a lower risk. Scientific studies are showing that as the heart arteries age, so do the brain arteries and the future risk of dementia. Those are a few little tidbits. I just occupied five or six minutes’ worth. But that simple process of better blood work than average, a better lifestyle than average, and a little better cardiovascular testing would transform health care. But nobody wants to do it.

Heather Sandison, ND

It’s so frustrating and yet so tangible. Thank you. That was helpful. There are a couple of other common risk factors that I came across, as I was kind of digging into that and this, and I want to dove into them. Obstructive sleep apnea is another one where there’s a lot of risk. Again, it’s kind of a plumbing problem. What you were talking about is a plumbing problem: the arteries are clogged and not getting enough blood flow to the brain, or enough blood flow to the heart if it’s heart disease. Now, when we talk about oxygen, obstructive sleep apnea becomes a plumbing problem in the airway. Can you talk about how that relates to both cardiovascular disease and brain disease?

Joel Kahn, MD, FACC

Thank you for bringing that up as a brilliant thing to do. As I can remember, I’m just a couple of years older than you, probably old enough to be your father. But when I was in medical school in Ann Arbor, University of Michigan, we probably had 5 minutes of sleep apnea. I can remember it because it was called the Weekend Syndrome after Pickwick in papers that Charles Dickens wrote. There was one character in there who was so overweight that he suffocated himself every night, and it had a bad outcome. Nowadays, there’s a study that says that if you just take a cross-section of Americans who are overweight and obese, you’ll find that about 50% of adults, if tested, have obstructive sleep apnea. This is, I mean, we don’t want to call the sky falling on every single topic in the world, but obstructive sleep apnea is a huge medical problem.

The clues might be disrupted. Sleep, snoring, dry mouth—a partner that has to sleep. I mean, I have so many patients who have had sleep disturbances or divorces when sleeping down the hall once we’ve been in the regular bedroom for a variety of reasons. But snoring and disruptive signals one or more of the following: if you have moderate or severe obstructive sleep apnea and episodes at night where your oxygen saturation is dropping, your heart rate may be accelerating, and you’re sympathetic nervous system is going cuckoo, and your cortisol is being released because your body is under stress. You may age your brain and your cardiovascular system faster, and you may have a shorter lifespan. There’s no doubt. The good news is old-fashioned. I have to go to the hospital, and the office building, have wires in my head, spend $7,000, and have a sleep study that I’m never going to sleep at because I don’t sleep in uncomfortable situations. 

You do a home sleep study, and some of the devices are just a simple little watch-based apparatus on your arm. They’re very accurate. They’re very inexpensive. We do a dozen home sleep studies a month, and we pick up on them, causing so much unknown sleep apnea. Then I will refer it out to a good sleep doctor, a good sleep dentist, or maybe a good sleep air, nose, and throat specialist. Occasionally, there are people in town. They do laser therapy. People can lose weight and resolve their sleep apnea. That’s kind of the natural route. But you do not want to ignore that because your brain will just shrink, which will promote future dementia. Such a good preventive step. It’s so simple. Find somebody in your community who does a home sleep study that you can just pay a few hundred bucks for and get it done. Don’t wait. You can get it done tomorrow if you find the practitioner, who might be a dentist. That’s the interesting thing. Many dentists are competent, well-trained, and able to help you with potential obstructive sleep apnea.

Heather Sandison, ND

I even read some mouth tape. Taping your mouth shut at night can help with mild sleep apnea. If you’re waiting on a sleep test or a sleep study, that might be something worth trying.

Joel Kahn, MD, FACC

I am a mouth taper in the year 2020. During the peak of the pandemic, a book called Breath by James Nestor came out. A lot of people read it, and that was fascinating. I got quoted in the book; I don’t even know why. I’ve never met Jane Nestor, but if you read it carefully, you’ll see my name is there. It’s just a little bit of self-promotion. I apologize for that. But the mouth-taping thing became hot. I’m a big fan. If your dry mouth is sleeping with your mouth open and bugs, dust, and bats fly in your mouth, you might think about taping your mouth. The interesting thing is that I’m a kid who grew up with a stuffy nose and allergies. When I taped my mouth, my nose suddenly became as clear as day. But from a cardiovascular standpoint, if you’re breathing through your nose, you have a system that makes nitric oxide. 

The Nobel Prize-winning molecule of 1989, I think, might be 1998. It might have inverted them. I think it’s 1998. But you make nitric oxide, which lowers your blood pressure and improves blood flow throughout the body. If you breathe through your nose, if you’re lying in bed with your mouth open, waiting for a 747 jet to land in there, you may not make nitric oxide because there is no nitric oxide system. You literally either go to your online store and buy a little bit of special tape or you get a little bit of soft surgical tape, which could be a little careful. It can be a little tough getting it off, but some people tape their mouths. There’s a tape out there I don’t know any connection with called the hostage tape. I hate that name, but it’s just duct tape over your mouth, and some people will sleep great. But it’s not a therapy for moderate or severe sleep apnea. Get your test, and don’t rely on that. But for the rest of us, my sleep is enhanced by mouth-taping, a little crazy habit. My wife loves it because I can’t talk to her all night.

Heather Sandison, ND

You also mentioned Lp-PLA2, and I want to talk about gingivitis and the infections that can increase both brain health risk and heart health risk.

Joel Kahn, MD, FACC

Yes, absolutely. You could throw in the Hs-CRP high-sensitivity protein myeloperoxidase but at the mouth, we all know that the mouth is very vascular. You go to the dentist, and there’s blood while they’re working. It’s very well supplied. That’s a good and a bad thing because it heals quickly, just good circulation. But if you have a root canal that has a little infection under it or a cracked tooth as well, infection, gum disease, gingivitis, or periodontal disease, You go to the dentist if you ever had that exam. If they’re calling out two millimeters, three millimeters, you’re happy. If they’re calling out, I get six millimeters, five millimeters, and I’m crying. You’re a little concerned about why I have those deep pockets. I can breed certain types of bacteria as Porphyromona and others. You don’t want to get it. I think the pandemic caused a lot of disruption to people’s dental care. They stopped going every six months, and they never got back on track. That’s a standard question that I ask people.

But you do want to do your brushing, do your water picking, do your flossing, eat healthy food that is all sugary, and don’t walk around all day with blood in your mouth. I like the xylitol-based gum. The dentists tell me that’s an okay thing when I can’t quickly get a toothbrush, but I get those examinations. If you want to go beyond that, you can measure what kind of bacteria you have in your mouth. There’s a company called Oral DNA, and there’s another one called Direct Diagnostics. Pretty inexpensively, you can get a report that says warning, warning, because those bacteria, at the point of the vascular system by mouth, can get into the bloodstream and circulate. They can cause a wave of inflammation and a high inflammation state, which helps lead to Lp-PLA2 inflammation tests that promote cardiovascular disease, cerebrovascular disease, and dementia. That’s a warning. 

Another one we haven’t talked about, and probably because you’re asking great questions, you have to mention atrial fibrillation. Again, atrial fibrillation is the transition from a regular, normal heart rate that cardiologists call a normal sinus rhythm to a chaotic, irregular heartbeat bubble all over. You might feel it. You might not feel it. Many people have asymptomatic atrial fibrillation. The problem with atrial fibrillation is that there’s usually some underlying heart pathology that could be simply high blood pressure, an enlarged heart, a leaky heart valve, thyroid disease, or alcohol abuse. These are common causes: blood clots may form inside the heart. If you have repetitive and prolonged atrial fibrillation that could be symptomatic and you’re getting medical attention. Could be unknown. Those little blood clots are little Jell-O pieces, and because the heart’s always moving, the heart’s sides are moving. They can break loose and fly up to the brain. There’s a very strong connection between atrial fibrillation and stroke on the one hand, but there’s also a strong connection between dementia. It’s probably little, tiny showers of micro clots that are going at times up the bloodstream to the brain and causing little microinfarcts, microstrokes, and microwhite matter destruction. Many studies have said that in a population of people with atrial fibrillation, and a population without it, you’ll find dementia at a higher risk.

If I may say something a little controversial, we have a president of the United States who was diagnosed 20 years ago with atrial fibrillation, and he’s on a blood thinner, according to his medical records. Some of us are a little concerned that the president of the United States has suffered a little bit of cognitive decline. I’m not saying anything and one political party or another, but there is a written record of that disease or that observation that we have. It’s one of the reasons that if you have atrial fibrillation, you do want to work closely with a specialist called an electrophysiologist and maybe try and do your best to get rid of atrial fibrillation, drop the weight, treat the sleep apnea, watch the blood pressure and correct it, and correct your thyroid disorder. Cut back or eliminate your alcohol intake, and do everything you can to end up with continual episodes of persistent atrial fibrillation. That’s a big one.

Heather Sandison, ND

That makes a lot of sense. I’ve had an outsized number of patients with both dementia and AFIB now, and the corner they get backed into is usually by the time they’re in my office, they’re doing everything. They’re at a good weight. They’re trying to exercise, but exercise can sometimes trigger their AFIB, and they’re on medications. They’re worried about doing an ablation, which is one of the potential treatments for AFIB because it’s a procedure that has a risk associated with it. Of course, anesthesia is toxic to the heart of the brain. Many people will have a procedure and feel that their cognition never returns to baseline. I’m curious if you have other alternative treatments or ways to navigate those tough decisions.

Joel Kahn, MD, FACC

People with atrial fibrillation do need to work closely with a well-trained specialist in cardiology, and that is called an electrophysiologist. Ablation is getting better and better and safer and safer, just in 2024, a type of ablation called Pulsed field ablation (PFA) has just been FDA-approved. We’re hopeful that it was approved because it looks like it’s safer and more effective to eliminate. One would hope that if you’ve been having episodes of atrial fibrillation and you get an ablation, your risk of dementia will go down. There are suggestive studies that are not definitive. But alternative approaches to atrial fibrillation. You mentioned weight loss. We talked about alcohol reduction. We talk about blood pressure control. We talk about thyroid regulation. Yoga has been studied in randomized studies and can reduce episodes of atrial fibrillation. Acupuncture has been studied in certain observational studies and can reduce the risk of episodes of atrial fibrillation. It may not be enough, but it’s certainly worth pursuing. 

Pulsed electromagnetic field therapy, or PEMF therapy, particularly. Some people think of big pads that you lie in, but there are little pocket devices, or PEMF pocket devices, that you can put there. You don’t want to put your cell phone there. Those are EMF devices. But pulsed electromagnetic frequency devices have been fairly helpful in anecdotal case reports of dramatically reducing atrial fibrillation. But you have to be sure you’re checking your Apple Watch recording or some other measure of knowing if it works. Now CoQ10 and Magnesium, Meditation would help. Berberine is a supplement many of us use for blood sugar, cholesterol, and GI health. There are some published data about Berberine having beneficial effects for a variety of heart rhythms, including atrial fibrillation. These are all things we can pull out. Some people have an unusual habit, of going back to the mouth. Maybe they have a titanium post next to a gold filling next to an old silver filling. Some currents can be developed that seem to be able to trigger atrial fibrillation. They’ll go work with a holistic cardiologist and make some modifications to what’s in there—all these different metals—and see some improvement. I think they’re called galvanic currents. Yes, it’s been a little while since I read about that.

Heather Sandison, ND

Fascinating. Early identification of silent heart disease might be a clue for future memory issues. Additionally, erectile dysfunction comes up, as well as some of these early things that are, of course, meaningful systematically, but they might even mean something more insidious isn’t going on in the blood vessels in the vasculature. Can you speak to that?

Joel Kahn, MD, FACC

Sure. The current medical model, as good as it is, is very deficient. Most people find out they have advanced heart disease when they start suffering from angina, chest tightness, shortness of breath, or a heart attack. Unfortunately, a substantial portion of people find out they have advanced heart disease the day they drop dead suddenly with no warning. Horrible thing. I guess it saves you from having dementia down the road, but it’s a horrible ending to your life. It’s called sudden cardiac death. I don’t think these are adequate. But if a man has erectile dysfunction, they need a big time. It’s a big part of my practice. They need bloodwork; they need a heart calcium CT scan and other measures. Because poor blood flow to the pelvis may cause poor blood flow to the heart. We’re worried about poor blood flow to the brain. That may come a few years down the road. You never ignore that. Premature graying of the hair has been reported. Premature balding on top of the head has been reported.

A very unusual but very common finding called the earlobe crease. You’re a 46-year-old man or woman, and you look in the mirror and say, Why do I have a deep groove in my ear? It’s usually called the diagonal earlobe crease on both sides. Crease was reported 50 years ago to suggest the presence of silent heart disease. Multiple studies have confirmed that it’s pretty good. It’s about as good as a stress test for predicting whether you might have clogged arteries. Now some people have it and don’t have heart disease, but people come to my office and say, Look at my ear lobes; I want to see you and get some of those heart tests and a substantial portion of heart disease diagonal earlobe crease. Just put it in your browser, take a look at some pictures, and take a look at your ears. Don’t freak out because it’s not predetermined. 

Recently, men with benign prostate hypertrophy (BPH) have been up at night peeing, and it’s hard to be related to early heart disease, but that’s down the road. The real upstream medicine is at ages 40 and 35. Get those labs, get the inflammation labs, get the lipoprotein labs, get the blood sugar and the vitamin levels, and maybe at ages 40 and 45, get a carotid ultrasound, a heart scan, or a calcium CT scan. There’s a more advanced test called the heart CT angiogram. Don’t wait till you’re 55 years old and you need a stent; it could easily have been found a decade ago. When you introduce the exercise program, the nutrition program, the sleep program, the stress management program, and the weight management program, I and all the rest will protect your brain. Secondarily, while you’re protecting your heart, protect your sexual health. I mean, it’s one giant system that’s related to this 50,000 miles of wonderful blood flow.

Heather Sandison, ND

You mentioned the coronary calcium score a couple of times. If someone has an abnormal coronary calcium score, is there a way to reverse that?

Joel Kahn, MD, FACC

Good question. It’s an evolving target; if you had asked me that question five years ago, I would have said you can’t reduce the calcium score. It’s pretty much the same answer, but we can still reverse heart disease to some degree. That’s based on data from 1990 by the famous Dr. Dean Ornish, M.D., and others. Mr. Pritikin, The Pritikin Center. We have the technology now, and this is a little esoteric in terms of Alzheimer’s risk, but it’s called a coronary CT angiogram. Read by artificial intelligence software. You come to my office, and I get a calcium score back. I knew that it was quite abnormal, and I say I was concerned, but there are certain limitations to this. $75 CT scan you have; you’re a little causal.

It doesn’t tell me how clogged the arteries are. It doesn’t tell me what kind of plaque you have in your heart arteries. We’re going to schedule you, and you might have to pay out of pocket more than $75—quite a bit more, maybe a thousand or 15 hundred dollars. We’re going to put a little iodine in your I.V. and we’re going to do a C.T. angiogram. It’s a one-minute, simple test, but it’s a little bit more expensive, and it’s a luxury item to choose to have if your insurance doesn’t pay. I’m going to be able to tell you exactly how much plaque you have in your heart how much soft, non-calcified, younger plaque there is, and how much hard-calcified older plaque there is. What we’ve learned to answer your question now is that you can shrink the soft, non-calcified plaque with diet changes, exercise changes, prescription drugs, and supplements. We can treat the plaque. The calcium may not go away. We don’t have a good way. It’s unproven if chelation with EDTA and other agents reduced the calcification; it’s very unclear if that happens. I’ve seen examples in my clinic where it has been a disadvantage to go forward with our plaque X people. I’ve heard of an infusion you can get for a coronary disease that’s relatively unstudied but somewhat popular. But the soft plaque can go away, which usually means getting your cholesterol under control, along with your blood pressure, inflammation, and blood pressure. 

Which leads to an interesting point. People are so scared of statins, Lipitor, Crestor, and others because of the dementia risk. There’s no reason to take Lipitor, Crestor, or statins. If you have a calcium score of zero or if you have a nice carotid ultrasound, it’s clean and or, of course, if your cholesterol is good. But there are now, just in the last couple of months, multiple news studies that say statins reduce your risk of dementia. Patients come to me, and I’m not here to push pills on them, but I have to give them the science. There’s a study in the last two weeks and a study in the last six weeks and growing evidence because of vascular dementia if statins are needed and lower your numbers significantly if you can’t do a diet, and if you can’t do it alone with exercise because a lot of cholesterol is genetically driven. The problem is this little bugger. I come back to statins and do nothing for this. Statins do not treat this genetic cholesterol in 25% of people. That’s a real problem. The pharmaceutical industry has some new agents that will hopefully be available in a couple of years after clinical trials are finished. But do not fear if you need Lipitor, Crestor, and other statin drugs in terms of your brain going to hell because the study says the opposite.

Heather Sandison, ND

Thank you for clarifying that because it’s a question we get often. I have had patients say, Hey, I got off my statins and now my brain works better, or I stopped having that fatigue or muscle pain. There are anecdotes. I feel like I’ve heard reports of the opposite. Maybe there’s an individual experience that is meaningful there. I don’t know.

Joel Kahn, MD, FACC

I would just separate brain fog from actual dementia, no doubt. There’s no doubt people experience brain fog from statins; at times, it’s in the package insert. It’s a secret that only a few of us know that that can happen. But brain fog isn’t, grandma is in a nursing home, and she doesn’t know her grandchildren’s kind of situation, and sometimes brain fog can reduce the dose change agent. I always have people on coenzyme Q10 if they’re on statin 100% of the time, and a lot of it’s a very safe supplement. It’s not too expensive. There’s an interesting supplement called GG – Geranylgeraniol. It’s a supplement that also helps protect the body if you’re on a statin, and a few different supplement companies make it, Geranyl, or GG is one brand called GG Pure. Some clinical trials are showing that it does prevent statin-induced side effects while also allowing you to have statin-induced benefits. 

The other strange heart-brain connection dementia that’s come up maybe in the last year and a half. It used to be easy in the 1970s and eighties. Ma’am, you’ve got very high HDL cholesterol or high-density lipoprotein cholesterol. You’re never going to have a heart attack. Your blood vessels are great. Don’t worry. That has changed in the last decade. In the last decade, multiple studies have said HDL cholesterol is a sweet spot on a tennis racket. You don’t want to be low, but all of a sudden, you learn. You don’t necessarily want to be high. You don’t want an HDL of 90, 110, or 120. There are several people aged 40 to 80; 50 to 80 is that sweet spot. Being very low is a vascular risk for dementia and heart attacks, but it is also super high. 

Just recently, papers were saying that high HDL cholesterol is a risk for dementia. We don’t fully understand it. It seems it promotes atherosclerosis and poor blood flow to the brain and the heart. At the low levels and the high levels, the problem is that there isn’t a drug that brings it down. There isn’t a lifestyle measure that brings it down. I have patients with super high HDL cholesterol that have no vascular disease, but I do have some that have pretty significant vascular disease. That’s next year when we come back and do this summit again. Because it’s such a popular summit, maybe we’ll have more insight. But in the past couple of months, a hot topic has been super high HDL. What do you do? Make sure your Omega 3 is good. Make sure you exercise, make sure your weight is good, and make sure your blood sugars can get home. Blood pressure cuff and check. Do all the other measures to optimize your brain health.

Heather Sandison, ND

I want to talk a little bit about treatment quickly. One of the treatments that I am a huge fan of for cognitive support is the ketogenic diet. Many people will say, Well, I have high cholesterol, so maybe this isn’t meant for me. I found this paper, and I laughed out loud when I read it.

Joel Kahn, MD, FACC

Is that the Oreo paper?

Heather Sandison, ND

No.

Joel Kahn, MD, FACC

Okay.

Heather Sandison, ND

I have to read you some of this, and I know you should bear with me, everyone. If you appeased for a moment because I was just so surprised by it. In the abstract, the ketogenic diet has been shown to have a multifaceted effect on the prevention and treatment of cardiovascular disease. Among other aspects, It has a beneficial effect on the blood lipid profile, even compared to other diets. It shows strong anti-inflammatory and cardioprotective potential, which is due, among other factors, to the anti-inflammatory properties of the state of ketosis, the elimination of simple sugars, the restriction of total carbohydrates, and the supply of omega-3 fatty acids. In addition, ketone bodies provide rescue fuel for the diseased heart by affecting its metabolism. They also have a beneficial effect on the function of the vascular endothelium, including improving its function and inhibiting premature aging. The ketogenic diet has a beneficial effect on blood pressure and other cardiovascular disease risk factors through, among other aspects, weight loss. I think I have never read a more emphatic endorsement of the ketogenic diet. I had to scroll down immediately and say, Is this the ketogenic diet lobby? Who’d paid for this? The authors had no, and nothing was declared.

Joel Kahn, MD, FACC

Work the other and shoot the other.

Heather Sandison, ND

When you define this, you would know if these people have conflicts of interest.

Joel Kahn, MD, FACC

Yes. It sounds like a nice marketing piece. I was going to do something inappropriate to go, what’s it? But I wouldn’t do that on your summit. Is that science, and is that safe for heart patients? The science seems to suggest not everybody, but it may be that 30 to 40% of people have a genetic predisposition called they’re hyper-responders. You add saturated fat to their diet through meat, fish, and other sources, and their cholesterol goes crazy. Then, it goes 180 to 450. I know there’s a very tiny segment out there, and I can name the names of those who believe that super high cholesterol levels crazy 500 are LDL, but 250 is not necessarily risky. But no credible cardiovascular specialists would take a person with dementia, bypass, stents, known blockages by calcium score, known blockages by these computerized coronary angiograms, and drive their cholesterol to two, three, four, or 500. Number one, anybody doing a ketogenic diet eight weeks later should get a good lab panel and see if you fit the profile of this marketing, come to the Jesus moment. What is your cholesterol, what’s your LDL, what’s your C-reactive protein, and what’s your hemoglobin A1C? Make sure you’re not a hyper-responder zooming your cholesterol. If you’re a cardiovascular patient or a cerebrovascular patient, I’d be concerned. 

Now, there are a couple of anecdotal case reports for certain kinds of brain tumors. Of course, in seizure disorders, there’s no doubt that, for decades, resistant, recalcitrant seizure disorders may respond to the ketogenic diet. You do what you have to do to get your seizures under control. But is that ready for primetime? I mean, show me the randomized study that meets that hype. Now, Dr. Dean Ornish, famous for his cardiovascular work, is doing a randomized study for pre-dementia, a mild cognitive impairment of whole-food plant-based diets versus standard diets. We’ll have to wait for the results. These things need to be studied very carefully before we can embrace the Messianic fervor that was in that paragraph.

Heather Sandison, ND

Yes. It’s just that the Institute of Health Sciences in Poland. I sent you the link to the citation. But yes, the language was so emphatic that it didn’t feel like it belonged in a scientific paper. I was surprised by it.

Joel Kahn, MD, FACC

I do think the journal that it’s published in, I don’t want to be critical. Please by your way into that journal. I mean, I think you pay your way into one of those. I don’t know these people and all, but I’d say my favorite nutritional professor of extremely high standing is Dr. Valter Longo, M.D. in southern California. I said M.D., his Ph.D. But he talks about the five pillars of nutritional science. You have to have basic science that supports your hypothesis, case studies that support your empathy, and randomized studies that support your empathy. What happens in centenarians, the healthy 100-year-olds plus, in which there’s quite a bit of science overall? That diet wouldn’t meet those five pillars of longevity. You’d have to go back to the baseline and the lab and say, Look, we’ve got to do some studies to support that.

Heather Sandison, ND

Yes. potentially a predatory journal is what you’re saying there.

Joel Kahn, MD, FACC

But I don’t want to, damn them to hype and that science. But it sounds like it’s not ready to embrace without questioning the whole field. I don’t want to go off on a tangent, but the last book I read was on the sordid nature of pharmaceutical research and the collusion between the FDA and drug journals or medical journals and researchers. It’s very hard to parse out science and try to figure out what’s credible. One stat, which is a disadvantage for all practitioners, disadvantage to patients, and is a bonus for the pharmaceutical industry because they can pretty much distort things to their profit. We’ve all seen that.

Heather Sandison, ND

Yes. It’s hard to make sense of things sometimes. Well, do you have any final parting suggestions for what people can do for a healthy brain? Healthy heart?

Joel Kahn, MD, FACC

No, just go back to the basics. If you do nothing else as this interview and again, get a home blood pressure cuffs, get your labs done, but get more than average and read about yes, there are some good services now that you can pay 300 or $500 and get these insanely in-depth panels and know your lipoproteins-a and your homocysteine and your C-reactive protein and your hormone levels. If your doctor won’t or you don’t need your doctor anymore, and I think that’s a good thing that we’ve democratized the set order to use a lot, the access to these extreme lab panels, get a little idea of your vascular age. Position in the 1600s some assign them said you are as old as your arteries, and that applies to the brain too. If you get a carotid ultrasound or a heart CT scan and find out your arteries are aging, odds are your brain is aging too. Don’t take that lightly. But, follow that dictum. I use test, not guess. I don’t just say I assume I’m going to be okay. I mean, prove the point, and if it’s not going well for you, get with somebody like Heather who can help you. Ride the ship and get it in the right direction, either with a plant-based diet or maybe a keto diet. Now, fitness, sleep supplements—the whole package.

Heather Sandison, ND

Dr. Kahn, it’s such a privilege to have you here, as always. Entertaining and informative. I am so grateful for your time.

Joel Kahn, MD, FACC

Well, thank you. I’m so glad that I can participate in this important summit you’re doing.

Heather Sandison, ND

Please share with our audience where they can find out more about you.

Joel Kahn, MD, FACC

Sure. I spend most of my time in Detroit, a little bit in southeastern Florida, where I have a clinic, but drjoelkahn.com. I have a weekly podcast, blogs, and newsletters, and I am a pretty much busy doctor because I love what I do.

Heather Sandison, ND

Fantastic. Thank you again.

Joel Kahn, MD, FACC

Thank you.