Reversing Heart Disease With Precision Cardiology: The Kahn Center Method

Joel Kahn, MD, FACC

Two Dr. Joels get to talk more about heart disease. Thank you, I’m looking forward to it.

Joel Fuhrman, MD

Right, right. And I’m, you know, it’s always been a pleasure to have doctors, to have like-minded physicians, especially a person with your experience, being a cardiologist, treating heart patients, utilizing, you know, nutritional methods. ‘Cause there’s so few people like us across the United State, you know? It’s really been a pleasure.

Joel Kahn, MD, FACC

I started in the stent world, I was the heart attack doc. And I wondered how long these people were gonna do well, and have reformulated my cardiology life to align completely with the kind of work you’ve been doing for decades, so, thank you, great mentor.

Joel Fuhrman, MD

Right, so in your practice over these years, what kind, like, how have you, like, diagnosed heart disease in the past versus now? Give me a little information about how you actually had used your cardiovascular expertise to work with these people.

Joel Kahn, MD, FACC

Happily, and there’s so much going on. There’s a term that I love that didn’t exist 10, 15 years ago, precision medicine, precision cardiology. You know, it may be shocking to people, but in my field as a specialist in coronary angiography, cardiac catheterization, stents, everything’s an eyeball estimate. So if we’re gonna talk on a summit about reversing your heart disease naturally, one would hope we actually have the precision to measure it. Of course, we can measure it by symptoms, which is key. People walk further, people feel better. People can demonstrate on a treadmill test that they have better capacity. But you know, let’s get back to an artery. Can we actually show that an artery’s improving, that we have changed the course of natural history of cardiology? And until just recently we relied on visual estimates. You would never build an airplane, or a house, or a car, by saying, “That’s about 6 feet of metal, and that’s about 100 feet of airplane wing.” You need precision, and we didn’t have that. 

I’ll share with you, Joel, a really fascinating but shocking statistic. Even back in the 1970s, they published a series of papers, “they” being some of my mentors in the field when I was just entering medical school, that if you took a heart catheterization that had disease, spots of plaque, and gave the same catheterization to 10 world experts. And had them write on a piece of paper what they saw, the numbers were incredibly wide in the results. The same area of narrowing could be judged by one expert is 30%, and another expert is 80%. And at 30% you’re going home, and you might be told you have nothing wrong with you, because cardiologists tend to overlook mild disease, even though we know mild disease can erupt as a heart attack at any time. And similarly, the 80% narrowing is gonna be more likely to be treated with either increased medication, balloon, or stent, or even bypass. 

And these were experts looking, because we didn’t have precision. There was a technique used by our colleague, Dr. Dean Ornish, and his co-authors, using a computer to analyze these, but it never got into practice. It never really became a routine in my 30-plus years of cath-lab experience. So it would actually be very hard. So what we’ve developed in my clinic, and what is available, one, is a technique that you use, but I don’t think the listeners are gonna be super familiar with it. We do a carotid ultrasound, right and left artery to the brain, which is routinely available at health fairs, synagogues, churches, schools, hospitals. But that’s not the one we do, we do the one, like you, where you use computer digital measurements. If you’re gonna be precise, you need to really digitize, and use even increasingly now, the language artificial intelligence. So my patients bring me a report from the hospital that says their carotid arteries are less than 50% narrowed. 

But we unfortunately have to repeat the study with better equipment. And with time you’re 11% narrowed with a 1 millimeter by 2 millimeter plaque. You’re 22% narrowed with a 2 by 3 millimeter plaque. And that’s of course called carotid intimal-medial thickness ultrasound. There’s a measurement of the thickness of the arteries that’s precise in sub-millimeter measurements, hopefully sub-millimeter. And utilizing that, we really have seen hundreds of examples, that a year later, and two years later, using precision measurements. Now it’s a carotid artery, but it’s a surrogate for all arteries in the body. We can actually talk about reversing arterial disease, measure it, and be precise in it. So that’s one very effective tool. And the other one’s even newer, I’m not a fan of applying radiation procedures to patients. The most common stress test cardiologists order, called the stress nuclear treadmill scan, is a very high radiation procedure, and it’s not precise. I was quite an expert in that field and wrote many papers. But the reality is it’s still eyeball evaluation. We now are utilizing CT angiography. You have to get an IV dye, and you get pictures of your heart arteries. But utilizing artificial intelligence, these computer algorithms, we are now talking in a language with patients about how many cubic millimeters of plaque they have, whether it’s calcified or soft noncalcified. It is finally, finally a reality that we can be precise in the field. And if you can’t measure it precisely, you can’t document the reversal, other than by the very important clinical criteria. So we are seeing case after case after case of actually documenting reversal of atherosclerosis in the carotids, in the arteries, and validating that what you’ve taught for decades and showed, you know, in such large papers about clinical improvement, we can actually, in a single patient, document it too. Now give me a year, we gotta work with somebody for a year before we’re gonna subject them to a assessment. But that’s the core of what we’re doing, reversing disease and identifying in a highly precise way of their burden and the improvement over time. And these are all backed by multiple academic studies. It’s a little easier to do it in a clinic like mine, a specialty clinic, than actually trying to access this information at a university or major medical center. These things are often not available there.

Joel Fuhrman, MD

Yeah, that’s fantastic, that’s great. And then people love when they can see the improvement, like in the IMT measurements getting better. It gives them more reinforcement for they’re doing the right thing. Personally, it helps them, you know, get stay motivated, you know?

Joel Kahn, MD, FACC

Yeah, ideally it works both ways. This carotid ultrasound, carotid IMT, intimal-medial thickness measurement. You know, when the report comes back and it says, “You’re a 64-year-old man with the carotid arteries like an 80-year-old man,” because of the pathology, it’s very distressing and very upsetting. But it actually does spark compliance with the diet, with the fitness, with the supplements, and if needed prescription drugs. And when a year later it no longer says, “80-year-old carotids,” they’re a year older, but their carotids are 5 years younger, 9 years younger. ‘Cause that’s not uncommon to see a big shift in the amount of arterial plaque. We think it’s probably what’s called soft noncalcified plaque shrinking and reversing. But you know, to know now that this is a reversible disease documented to precise levels, backed up by the decades of clinical improvements that you get great credit for and your peers. I mean, I’ve never been more excited as a cardiologist than now.

Joel Fuhrman, MD

That’s so cool. I remember I had one person who lost 80 pounds, and then they had their 80% occlusion, which went to 40% in one year. And the second year after that they couldn’t detect anything, so it went 80 to 40 to zero. And they lost 80 pounds, you know?

Joel Kahn, MD, FACC

Yeah, you know, the vascular surgeons that these patients might also be seeing… Or many of my patients see another cardiologist in the community, or they’ve come out of town and they look at these results, and you know, they’re puzzled. You know, they just, it’s not the standard paradigm to try and alter the disease. Of course, you have to alter the basic pathophysiology, the stress, the nutrition, the sleep, the fitness, their genetics as much as you can. But then to be able to actually say, “It’s getting better,” and that’s why you’re seeing people live to long lives, even with the burden of heart disease, and I am too.

Joel Fuhrman, MD

Right, fantastic. So give an overview of the nutritional approach at the Kahn Center.

Joel Kahn, MD, FACC

Yeah, you know, I think the biggest challenge is reading the patient. I spend a lot of time with patients. Often there’s a spouse there or a significant other, I always encourage that. Or if it’s telemedicine, I want them online. You know, not everybody’s willing to jump in full-force day one. I mean, I have been whole food plant-based for over four decades. I mean, there’s no difficulty, challenge, or thought about it anymore and there hasn’t been for a long time. But for a lot of people, the scariest part is the idea that their breakfast, lunch, dinner, and snacks have to be rethought. Their grocery list, their pantry, their refrigerator, their freezer, their recipes. Maybe they’re the ones responsible for cooking, maybe the spouse or the significant other is. What do we do at restaurants? So, I mean, it’s a lot of information, and truly the kind of center that you’ve established in San Diego, Eat to Live resort, I mean, gives people a chance to get out of their environment. 

But I’m dealing with people that aren’t out of their environment, and they’ve got these challenges. So I mean, they will always leave with a curriculum of, you must watch “Forks Over Knives,” you must watch “What the Health,” you must watch “The Game Changers” movie. You must read a book, a book that has both the science and some easy recipes. It might be my “Plant-Based Solution,” might be yours in reversing heart disease. They have to commit, and they’re gonna be quizzed on this stuff. I want some commitment from them, that at a minimum, they’re gonna do that. I usually suggest a podcast or two, I have a podcast. 

That way, while they’re driving in their car, or walking, or exercising, they’ve got education streaming in. I tell you, that step alone has been so impactful. If you can find a support group, and we’ve had the pleasure, and you’ve had the pleasure of speaking many times to the support group we have in Detroit, the Plant-Based Nutrition Support Group. Any time, whether live or now, unfortunately more so digitally, if you can get people around others and get ’em into a community, very helpful. Now, sometimes I will take a step and say, “When we visit in four weeks, we’re gonna discuss all these concepts, but I’m gonna make it easy for you for four weeks.” And what I will present to them is David Jenkins’s research study, sometimes referred to as a portfolio diet. If you can’t transition to completely whole food plant-based nutritarian diet today, you can add four food groups that will naturally lower your cholesterol; the nuts and the seeds, the high-fiber foods, the soy-based foods, I get edamame and tofu. 

And then healthy sources of plant steriles, like sunflower seeds and sesame seeds, and occasionally even avocados. I’m gonna give them a low bar so they don’t fail. And when they come back and we get lab work, and they’ve seen the difference, and their weight’s improved, and maybe their bowel function’s improved, we’re gonna go for the next step which is the complete transition. I have to make that judgment. And to some degree, the patient has to make that judgment. But you know, so many of them, the day you show them their carotid study, their coronary data, their lab data, of course some of these are very long-standing cardiac patients. And you, for the first time, bring up the idea that they can get better, that they can halt, that they can reverse. I mean, many of them don’t need much more than opening the door, and they’re ready, to not just walk through, run through. So they come back and they’re 15, 20 pounds down in 6 weeks, 8 weeks. And it isn’t, I do have a local dietician who gets all this and is familiar with nutritarian diet. I do use health coaches, plant-based health coaches occasionally, to get some credibility with the patient. And accountability is the word I’m looking for, so that they commit to small little bites. If they’re sick, if they’re facing bypass, if they’re facing stenting, if they’re recently post-heart attack, we’re gonna really jump in harder and not accept much more than complete commitment to the program.

Joel Fuhrman, MD

Fantastic, and you use other lifestyle inputs as well?

Joel Kahn, MD, FACC

Always, always, you know, what has been supported by the medical literature are sleep disorders being so crucial for overall health and for cardiac health. We take the time to ask, we take the time to do home sleep studies. And then we refer out those with real sleep pathology, and doing all the sleep hygiene and all simple sleep support. Maybe magnesium at night or melatonin at night. A lot on stress and using aids, whether they’re phone apps or meditative yoga classes. I give a very simple 12-minute meditating program called the Kirtan Kriya that anybody can learn. Yes, you have to have stress management tools. We talk a lot about dental care, you know, with the last few years of the pandemic, a lot of people have not seen their dentist. 

The deterioration in your gums, or maybe old root canals and implants, is connected to inflammation and heart disease. So we’ve gotta approach, you know, that sense of community, purpose, joy, the whole range. But we’re doing also very advanced lab work. I want to show them, I think they get very… Before they’re gonna see their carotid improve, before they’re gonna potentially have a repeat CT of their arteries. And I’m not talking this simple calcium score, unfortunately I don’t anticipate calcium scores going down, but we’re using more advanced CT’s, and we’re only gonna do that every few years. Before they’ll see improvements in the vessels, they’ll feel better and they will see improvements in the lab work. So they will see their inflammation panel dramatically improved, their cholesterol panel dramatically improved, their blood-sugar parameters dramatically improved, that oxidized LDL measurement.

Joel Fuhrman, MD

You do oxidized LDL, any other type of interesting labs you do that aren’t, you know, conventional cholesterol tests, and hemoglobin A1C, and what else do you do?

Joel Kahn, MD, FACC

TMAO, I got TMAO. We’re gonna be interviewing Cleveland Clinic expert, Stan Hazen, as part of the summit. But TMAO, Trimethylamine N‐oxide, which is elevated in the blood with excess red meat, excess egg yolk, some supplements, and so strongly related with heart outcome. That’s one of the quickest to turn around, “Doc, it wasn’t easy, but I changed my beef burger for a portobello burger, and I changed my three-egg omelet Sunday mornings to the bowl of oatmeal, walnuts, and flaxseed.” And then their TMAO level goes from 40 down to 4, and it’s just reinforcing that their physiology is a healthier physiology.

Joel Fuhrman, MD

That’s very motivating to get them off the animal protein, to see that pushes the level down.

Joel Kahn, MD, FACC

And then, you know, one of your favorite blood tests will always draw an omega index, a simple blood test that measures the amount of EPA and DHA, omega-3 fatty acids. Knowing humans can’t make omega-3, we have to eat it, or supplement with it. And whatever diet they’re coming from, a poor quality plant-based diet, junk food, vegan, American diet, they’ve been doing keto, paleo. A lot of my patients show up with, “I tried the keto-paleo before I came and saw you,” thing. They’re often just so severely deficient in omega-3. And I’ll work with food for a little bit, but it’s usually food plus supplements. And if they’re on the plant-based pathway, of course it’s algae based, EPA and DHA, which get them to healthy brain friendly. And of course it helps their cholesterol panel dramatically, their triglycerides tend to come down quite nicely when we get their omega-3 levels back in a healthy bountiful range.

Joel Fuhrman, MD

Yeah, of course. Well, you do more things right, it facilitates people getting well faster, and assurance in giving more probability of making a dramatic recovery. So one of the main-

Joel Kahn, MD, FACC

They came for their heart, but their brain fog goes away, you know, because of the omega-3, so it’s full of joy. Yes, sorry.

Joel Fuhrman, MD

That’s right, you can’t, you know, it’s this… And the nice thing is you’re dealing with people with heart disease, but you’re also, at the same time, lowering the risk of cancer, and of all-cause mortality, and reducing the risk of dementia. So, you know, you’re not giving a statin, for example, that’s just gonna increase the risk of diabetes, or you know, slow their weight loss. It’s the holistic approach is so much more effective, and so exciting what you’re doing. What are the, which supplements, what are the supplements you might add, use the most, let’s say, to people with cardiovascular disease in your practice?

Joel Kahn, MD, FACC

Well, after a pretty extensive panel lab work, of course if there’s clear cut deficiencies, if they’re ultra-low in Vitamin D, or they’re very low in Vitamin B12, or the Omega index, you know, we’re gonna work to correct those as soon as possible. But it’s interesting, I’m very strict with my practice. I wanna see science and although, you know, Mouse data and basic science is how it all starts, I’m looking for human data. And there actually is some human data that some unusual supplements support the rate and the complete reversal of plaque in the artery. So for example, we had a chance to chat with Dr. Matthew Buddoff, Chief of Cardiology at UCLA Harbor, but he has orchestrated six randomized studies in humans using aged odorless garlic. 

And that sure doesn’t sound like a strong therapeutic approach, but in studies based on science in Japan, and then studies repeated at UCLA over the last, maybe 12 years, if you have coronary plaque, particularly if you’ve had one of those advanced CT angiograms and have a lot of bulky soft plaque, and you just simply take an aged odorless garlic tablet daily… And it is really odorless, it’s very easy to take and it’s very inexpensive. A year later in research studies, double-blind or randomized, there’s improvements in coronary plaque. Now I found when you combine that with the rest of the program, it’s more powerful than the data that’s published in the literature, because most people were not asked to change their lifestyle, they were just asked to take a supplement or a placebo supplement. Powerful, powerful simple stuff. The other studies about aged odorless garlic show it naturally lowers blood pressure, which is a joy, ’cause patients are looking to reduce or eliminate their medications. 

And it tends to lower cholesterol in double-blind randomized studies. And the other one that I tend to go to is equally unusual, but there are a few products out there that combine two natural antioxidants. One is called Pycnogenol which comes from the bark of a French pine tree, of all things. And one an Indian herb called gotu kola. These would be of no interest to me, but a research center in Italy has been studying patients with plaque in their carotid arteries. And 400 patients randomized to a placebo, or to a combination Vitamin with very safe, inexpensive antioxidants that I mentioned. And consistently and repeatedly, in about half a dozen studies, again, there’s an improvement in plaque volume, plaque size, severity of the thickness, the CIMT measurement. So I will readily add them in because they’re safe, they’re inexpensive, they’re available. And fortunately, there’s multiple studies using them. The last one I’ll mention, and again I-

Joel Fuhrman, MD

You’re saying that’s some propaganda and Coca-Cola?

Joel Kahn, MD, FACC

We are not encouraging sugar-sweetened beverages. The last one that I think is interesting is a citrus from Italy called bergamot. And bergamot looks like a lemon, but it’s concentrated into tablets or capsules. And there’s at least one good randomized study in humans about bergamot reducing and shrinking carotid plaque compared to placebo. It also tends to drive nitric oxide production up, improves athletic ability in some studies, randomized double-blind. So, I mean, that’s three supplements out of hundreds and thousands.

Joel Fuhrman, MD

Yeah, sure. What do you think of pomegranates?

Joel Kahn, MD, FACC

Yeah, I think the pomegranate data is interesting. Of course, Israelis, I say “of course,” because many listeners won’t know this. The Israelis took, again, people with carotid artery plaque, ’cause it’s a simple test to do and repeat in six months in a research study. And drinking about eight ounces of unsweetened pomegranate juice, you know, has a very powerful impact on cholesterol measurements, particularly HDL function, oxidized LDL. And they reported a decrease in carotid plaque with pomegranate. There are pomegranate tablets out there, whole pomegranate, concentrated pomegranate. I know there have been other studies that couldn’t confirm the original Israeli data. So I’m a little mixed on it right now, and I’m not a big fan of fruit juices. I think you’re probably-

Joel Fuhrman, MD

Yeah, it’s better… I have a whole pomegranate trees here, I have the whole tree, so it’s…

Joel Kahn, MD, FACC

Wow, we’ll all come visit you. Not all of us do, although my grocery store, in season, you know, it’s a messy-

Joel Fuhrman, MD

You can buy the aerials frozen, and you can get the pomegranates and open ’em up and keep ’em in your freezer too.

Joel Kahn, MD, FACC

And the other trick is if you clean a whole pomegranate, do it in a sink with water. ‘Cause as you take the seeds out, there are gonna destroy your clothes and make you swear off ever eating pomegranates again. But I am still looking for a little more data on pomegranates. You know, there’s a lot of products out there that are miraculous for hardened arteries. There’s no human data, and I do stay away from those.

Joel Fuhrman, MD

Sure, so what’s the, like, the new most exciting findings that you’ve found in the last five years? Or new, exciting approaches you’re using in your practice?

Joel Kahn, MD, FACC

Yeah, I think it’s the introduction of artificial intelligence. You know, we’ve had superpower computers for years, but we haven’t applied ’em in clinical practice. And this lack of precision which just, you know, there aren’t many tests a heart patient will go through that are more impactful than having a heart catheterization, what’s called coronary angiography. And getting results on the status on arteries, which may determine their lifespan, their therapy, their need for surgery, their need for stenting. And it’s all been visually assessed. And understanding even more than that, that you may see a 50% narrowing. 

Some of it may be calcified, older, burned out, stable narrowing, and some may be soft noncalcified plaque that recent data says is that a higher risk for leading on to a future heart attack. And that we now can, in any patient who isn’t allergic to iodine and has good kidney function, but we can measure and we can assess, in such a precision, and such a advanced manner, I think we’re just starting to get good at cardiology, to be honest, we’ve had-

Joel Fuhrman, MD

What’s the name of that test you’re talking about now?

Joel Kahn, MD, FACC

Yeah, and there’s no involvement financially between myself and the company. And we will be speaking to a world expert on that during the summit. That particular company is called Cleerly Health. But what they do is they take a CT of your heart arteries that maybe you’ve had done in your local hospital, and in New York City they will analyze and report out to you. You know, you have 288 cubic millimeters of plaque, that 100 cubic millimeters is calcified, and 188 cubic millimeters is noncalcified. This is one recent patient of mine, 97% all the plaque in his heart arteries, and it was a lot of plaque in a 49-year-old man, it was a lot of plaque. 97% of it was what’s called noncalcified soft plaque. If we had done that simple, inexpensive calcium-scoring CT scan, a wonderful test to do once, you wanna avoid radiation of course, but once and it’s low dose, we would’ve missed 97% of his plaque, ’cause it wasn’t calcified.

Joel Fuhrman, MD

He would’ve looked okay, and he’s a high-risk patient.

Joel Kahn, MD, FACC

Well, no, you’re not that much beyond average. And then because of a lot of risk factors and challenges, he was having . So yes, the biggest advance is precision, precision, precision.

Joel Fuhrman, MD

Cool. Well, so glad that you invited me to be part of the summit with you. And I think this information is gonna benefit humanity, and a lot of people are gonna benefit from this information. Everybody in America has to know that they don’t have to just be sick, and just wait till they die of heart disease, ’cause obviously it’s still the number one cause of death for people over the age of 65; it’s still heart disease and strokes. And it doesn’t have to happen.

Joel Kahn, MD, FACC

Just two Joels can make a difference, but we need a whole lot more people on board, and that’s what I think the summit will help us introduce. So thanks for asking some really great questions.

Joel Fuhrman, MD

Terrific, thank you.