Full Transcript Introduction and Special Guest Introduction 0:02 Welcome everybody to the Eat Pray Faith podcast with Dr. Tracy. That's me. And 0:07 today we are going to be talking about a very interesting topic and one that I 0:11 wanted to provide my listeners due to my high respect of my very special guest 0:16 today, Dr. Joel Khan. We're going to be talking about the value of veganism and 0:20 cardiovascular health and just health in general. So, Dr. Khan, welcome. I'm so 0:24 glad you're here. I finally got you on my podcast and I'm always a big fan of 0:28 yours as you know. Very kind of you. I'm happy and excited to be with you and I 0:34 love the name of your podcast because that book Eat, Pray, Love, still remains 0:38 one of my favorite reads that uh I've ever had. So, if somebody doesn't by 0:44 chance know what I'm talking about, go enjoy reading that book. Great book, 0:48 great movie. Got to love Julia Roberts, right? It just was uh such a good movie 0:53 and yeah I was inspired by that because I felt the underlying like spiritualism 0:59 as well as the passion for life and I just was like that's a great thing. I 1:03 just turned the last word to faith for me. So we have an interesting topic 1:07 because prior to coming on Dr. Khan asked me am I a vegan and I have to say 1:12 I used to be a vegan. Uh I'm no longer a vegan but primarily I turned into a 1:17 vegan because my father couldn't cook steak well. So I think I was a forced 1:20 vegan because everything he cooked was just completely a hockey puck. So I'm 1:26 not now. But I do like to provide a different perspective and honestly I 1:31 want to learn. I mean if there is something that I can glean from this or
Dr. Kahn's Background and Journey 1:34 my listeners absolutely worth it to me. So Dr. Khan, can you give us your 1:39 background, your credentials just so we can set the precedent for the listeners? 1:44 Sure. Uh, and I'll be brief, but I grew up in suburban Detroit and 65 and a half 1:51 years later, I still live in suburban Detroit, although I didn't think that 1:54 was going to happen. Uh, I entered medical school in Ann Arbor, actually at 1:58 age 18. They had an accelerated program and graduated 6 years later with a 2:04 medical doctor. Did graduate sumakumlad found out I had an aptitude for 2:09 memorizing all kinds of stuff. some of which I still remember, most of which of 2:13 course is either wrong or I don't remember and always wanted to be a 2:17 cardiologist. So it was a straight and uh narrow shot to uh 1990 at that point 2:24 I was what's called an interventional or kath lab cardiologist. I had moved out 2:29 of the area to Dallas, Texas for three years in Kansas City for a year to get 2:34 what I thought was the best training. I still think it was the best training and 2:37 I've been back in Michigan since 1990. a couple years back in Ann Arbor in 2:42 suburban Detroit though I now have uh offices both in Detroit and in Boerbaton 2:47 Florida kind of a nice setup um I did again kind of straight and narrow 2:52 cardiology hospital kath lab coronary care unit for about 25 years very busy 2:58 wonderful practice wrote a lot of research papers taught a lot of fellows 3:02 uh even though I was at a private hospital in Detroit it was a very 3:05 academic hospital connected to um medical school so We did a lot of great 3:10 work, great publications. And then 10 years ago, I had already completed going 3:15 back for sort of functional medicine training, integrative training. Um, and 3:21 have been practicing on my own for 10 years in a preventive cardiology clinic 3:26 called the Khan Center, licensed in about 25 states, and do a lot of 3:31 wonderful work. I love what I do. A lot of my peers, I just heard of another one 3:35 today, retiring. Uh, I hope we can talk in 10 years and I still got an office
The Impact of Upbringing on Dietary Choices 3:40 full of people from all over the world, all over the country. Um, it's just 3:44 wonderful. Uh, the only other path worth mentioning because it's important to the 3:49 topic. I grew up in a home in Detroit where we kept certain dietary laws 3:53 called keeping kosher. We didn't eat cheeseburgers and pork. And when I got 3:58 to Ann Arbor at age 18, it was relatively important to me to keep 4:01 honoring that. I was pretty steeped in it. And um the only uh solution was the 4:07 salad bar. So you uh became vegan because your father was a horrible steak 4:12 cook. I became vegan because there was nothing but a really pretty amazing 4:16 salad bar. There was a restaurant in Ann Arbor called the pretzel bell with an 4:20 amazing salad bar. And the last part is my parents around that time went from a 4:25 traditional family to my mother dragged my father to the Pritikin Longevity 4:30 Center which at that time was in Santa Monica, California. and they took 4:34 classes and my mother started making lentil loaf instead of meatloaf. So 4:38 during the week I was eating the salad bar. The weekend if I drove 45 minutes 4:42 home from Ann Arbor I was eating lentil loaf and then I read books. I read John 4:47 Robbins diet for a new America. Many people know John Robbins and the food 4:52 revolution network. And then I read the amazing research of Dean Ornish. And I'd 4:57 been eating this way and now had raised a family with the option for the 5:02 children. But many of them you know they ate a lot of fruits and vegetables and 5:05 uh you know really have always taught patients that food is medicine. 5:10 Nutrition is a fundamental foundation for cardiology, health and uh treatment. 5:15 Um and it has been with a plantforward uh focus for my own life. 100% 5:20 plant-based now for 48 years. Uh literally nothing but plants for 48 5:25 years. my wife too. We were on the same track at the same location all the time. 5:30 But, you know, I'm very open with my patients. Uh they have to make their own 5:36 decision. I provide them education. Um uh some uh you know, follow the path and 5:41 really grab on to it. Some come to me already grabbing on to a plant, a vegan, 5:45 uh you know, lifestyle and others have no interest. So, uh, we keep them under 5:51 the fold and hope that one day I have a lot of faith as part of the title of 5:56 your podcast that at least they'll grab an apple over a donut and a salad over 6:01 French fries. And that's such a health upgrade. Except if the French fries are 6:06 in beef tallow, they have to be healthy now. No. Oh, Robert Kennedy Jr., don't
The Importance of Home Cooking 6:12 talk about French fries and beef tallow. Teach them how to eat a baked potato for 6:17 God's sakes. Well, yeah. I mean we can go down that rabbit hole and you know my 6:21 whole thing is if we can help people be more educated in their choices you know 6:26 and I mean it the issue with our entire society as I feel I don't know how you 6:32 feel but the convenience is just overplayed so much that we have taken 6:39 food out of the home and put it into restaurants and fast food and I think 6:43 that's where primarily the issues start is that we're not cooking you know 6:48 tradition traditionally like you were like you came out of a kosher family. I 6:51 came out of a bad steak cooker. But you know our reasons were different but we 6:56 it it shaped how we then chose next steps in our life. And that's the 7:01 biggest thing we have to take out is what you do in the home matters. I 7:05 actually completely agree. the loss of the art and the time to cook, slow 7:12 cooking and you know fresh cooking and you know and might have to compromises 7:18 of batch cooking on weekends and all and you can find some nice ready to go meals 7:23 to pick up. You have to be pretty picky about it and all but I didn't grow up in 7:28 a fast food home. I didn't grow up in a pepperoni pizza home. And you know those 7:32 lessons stuck with me and of course I agree with you. I hope some of the next 7:37 few years of making America healthy again without political implication is 7:42 that lesson. You know, spend your dollars at home, not to hurt the 7:46 restaurant industry, but if you're looking for health, it's pretty hard to 7:49 find it. Uh certainly in the convenience restaurant world, and I'm a former and 7:55 reformed restaurant owner. I thought that would be a cool combination to be a
Plant-Based Nutrition and Heart Disease 7:59 plant-based cardiologist and a plant-based restaurant owner. And been 8:02 there, done it, and can talk about it. Um, right. People don't want healthy 8:07 food in a restaurant. They're in a restaurant not to be judged. Even though 8:11 we were providing about the healthiest food on the planet. Yeah, they don't. 8:16 They want convenience. They want quick. They just didn't want to cook. So, 8:19 totally get it. Well, let's get into this whole plant-based uh nutrition that 8:25 you have kind of built your entire Instagram around. I mean, I follow you 8:29 on Instagram. You have quite a following there. Your videos are so great. 8:34 Let's talk about, you know, plant-based. Let's talk about with it reversing heart 8:38 disease. Let's start there. And then we can actually just maybe start at the top 8:42 and roll down with how does it impact inflammation because you're not just I 8:46 mean you are a cardiologist, but you're not just that. You are a longevity 8:50 practitioner, a preventative cardiologist. You don't just stay within 8:53 that title. So, I watch you and I watch your patients and the people who come to 8:58 you. So, just give me a little insight on what have you seen in all of your 9:02 years of practice implementing this plant-based concept? Yeah. Well, first 9:06 of all, you know, it's a personal choice that I've chosen to eat 100% whole food
Historical Studies on Plant-Based Diets 9:13 plant-based. I mean, uh I don't eat Impossible Burgers and Beyond Meat 9:18 burgers. Once in a while, a new product comes out and I'll literally try it just 9:22 to say I tried it. So, I tell my patients why they should stay away. But, 9:25 I eat whole food. And you know, that's a personal choice, but one of the reasons 9:30 I've stuck with it um because I could cook kosher chicken uh in my home if I 9:36 wanted to. Um is uh the science. And really quickly, I'll just hit maybe five 9:42 bullet points that are all out there, but way back way back way back. in 1948 9:48 49 1950 in Los Angeles was a very forward-thinking internal medicine 9:54 doctor named Lester Morrison MD and he had this whole big practice of 9:58 cardiology patients and there was nothing really to offer people in the 10:02 late 40s there was a lot of heart disease post World War II all the 10:06 smokers were coming back young people having heart attacks and he actually did 10:10 a randomized study not double blinded of a plantforward low-fat diet it was a 10:16 published onepage sheet eat this not that would be very similar to Dean 10:21 Ornish and uh Joel Ferman kind of foods um and the other group it was a hundred 10:28 heart patients we're just told keep eating like a typical Los Angeles person 10:32 ate and he published the data the weight loss was phenomenal on this plantforward 10:36 diet the cholesterol drop because there were no meds was like 300 down to 200 10:41 with this plantforward diet and at the end of 12 years half the plant four diet 10:47 people were alive and zero of 50 of the standard Los Angeles diet people were 10:52 alive cuz there were no bypasses there were no stances there were no statins 10:57 um aspirin was known I don't even know if it was being used widely back then um 11:01 and that caught the attention of Nathan Pritikkin who was an engineer in Santa 11:07 Barbara but a brilliant man and he went down and met with Dr. Morrison he was 11:12 about 40 years old said Dr. Dr. Morrison, there's this thing called 11:15 cholesterol in the blood. You're checking. Can you check mine? And is 11:18 like a typical American was about 350. And Dr. Morrison had him do a little 11:23 walking stress test upstairs, downstairs, upstairs, downstairs. Very 11:27 simple. He actually flunked it. And Dr. Morrison said, "Here's a sheet of paper. 11:32 If you don't follow this, you'll probably be dead like the rest of my 11:35 patients." And he wasn't really a heart patient yet. It was maybe the first 11:39 preventive program in America. And Pritikin got so excited about it, he 11:44 kept doing aerospace engineering, but he opened first in Santa Barbara, then in 11:49 Santa Monica, and now it still exists in Miami as a beautiful preventive wellness 11:54 clinic, the Pritikin Longevity Center. Uh he started teaching people, but he 11:58 knew without doctors around he was going to get push back. So he got doctors 12:02 around him. And um it was, if you look at what they teach, it's 95% plus whole 12:08 food plant-based. There is even to this day a little bison, a little salmon um 12:13 and all but uh you know the power and then you jump to Dean Ornish MD who is a 12:19 very young medical student took a semester off and did a study combining 12:24 whole food plant-based diets to be honest with a little egg white and a 12:28 little non-fat yogurt because it was 1979 1980 1981 there were barely any 12:35 whole food restaurants no Trader Joe's he was worried his people would never 12:38 stick in the study if they didn't have a little variety of food. And um he 12:42 combined it with yoga, meditation, and group support. And he showed in a study 12:46 in 1983, nobody remembers, that serious heart patients started to feel better in 12:52 3 weeks. And then he did a a randomized study, that's the very famous lifestyle 12:57 heart trial published in 1990, the year I started practice, had a huge influence 13:01 on me. Oh my god, I can teach heart patients what I've been doing and 13:05 actually quote them peer-reviewed, you know, highlevel science published in 13:10 Lancet, one of the better journals in the world. Um, but he showed actually 13:15 using cardiac cathization that blockages very slowly can get better better over 13:21 time with a lifestyle program, but the diet was food plant-based forward. And 13:27 then there's the famous Cleveland Clinic doctor Caldwell Esselston who 13:31 independently developed at the Cleveland Clinic. He went to the surgeons. He 13:35 actually was a breast and thyroid surgeon, but he's just one of these 13:39 guys, a huge brain, huge curiosity, and he developed a food program. Ultimately 13:45 was totally plant-based and actually famous for being very low in fat. He's 13:50 not a fan even of extravirgin olive oil. I am a fan of extra virgin elbow but he 13:54 went to the surgeons and the cardiologists give me your worst 13:57 patients the ones you can't treat and let my wife and I cook for them and talk 14:02 to them and published you know dramatic reversal he's sort of a folk hero now at 14:07 age 91 because he's just he's this handsome former Olympic athlete major 14:14 surgeon who you know is now a preventive doc and you can add a few people on Joel 14:19 Ferman and others that's you know famous PBS, a real doctor, but very successful 14:24 on PBS specials on health. You just can't find that database with any other 14:29 food program. You can't find it in the Paleo, Keto, Carnivore. You really can't 14:34 find it in the Mediterranean world. I mean, I'm all a big fan. My patients 14:38 tell me they're eating a real Mediterranean diet. You know, I got to 14:42 ask them what that means. Um, you know, pepperoni pizza is not very common in 14:47 Naples, Italy. It's a margarita pizza with almost no cheese on it actually. 14:51 Um, and you know, or the MIN diet, which is more a a brain preventive diet, but 14:57 they just take the Mediterranean diet and throw more blueberries and walnuts 15:01 and salmon or um uh lately I really really like Dr. 15:06 for Walter Longo in general, the gerontology expert at University of 15:11 South Car uh South Southern California, USC, but he's got he calls it the 15:16 longevity diet. And he basically took the Mediterranean diet and critically as 15:21 you know, the most funded researcher in nutrition in the United States. I mean, 15:26 a major academic force. Cut out all red meat and all chicken and all dairy and 15:31 left fish and vegetables. uh fish about three times a week and vegetables all 15:36 the other meals. I really like Dr. Longo's longevity diet, but you can't 15:39 even say that's got data to prevent heart attack, strokes, bypass stance and 15:46 all. Whether these prolonged life is always a tougher issue. I mean, there's 15:52 no doubt if we could really nail it down, the ideal diet for longevity has 15:55 to involve a lot of colorful, whole plant-based foods providing tons of 16:01 fiber. I'm a big fan of fermented foods. You know, we want to feed our 16:05 microbiome. Fiber, fiber, fiber for all the short- chain fatty acids and 16:10 protecting our gut wall and polyphenols like crazy. Those are all the brightly 16:14 colored foods and vegetables. Now, whether 10% animal foods, 5% animal 16:20 foods, you know, what would it look like if we could actually do a 25 year study 16:25 of uh all plants versus, you know, nearly all plants? I don't think the 16:31 ketogenic and the paleo and the carnivore a paleo could there's 16:34 obviously very healthy versions of the paleo diet. Why is the vegan diet work 16:39 so well? I mean number one it's what it doesn't have. I mean and let me say 16:43 Harvard School of Public Health and others have done a great job doing 16:46 something called the UPDI remember the unhealthy plant dietary index and the 16:52 HPDI the healthy plan plant dietary index. Meaning, if your plant diet is 16:58 largely processed food, that would be the unhealthy pattern. It doesn't work. 17:02 It actually may be worse than what the average American is eating, you have to 17:06 do the HPDI, the healthy plant dietary index. That's what we're talking about. 17:10 What you eating, I eat whole foods, hopefully home-cooked, brightly colored, 17:14 some fresh, raw. That's a salad. I mean, a giant salad every day. Eat a giant 17:19 green smoothie every day. I'm more a salad guy than a smoothie guy. So, you 17:22 got to do it healthy. Um uh but I you know the longevity diet of choice when 17:29 the research is done or maybe AI will solve it for us is got to involve tons 17:34 and tons and tons of plants. I don't think it's going to be the all meat 17:38 diet. It's clearly not the standard American diet. We know that. Um you know 17:43 why does it work so well? It's as I say it's the fiber. It's the you know 17:47 phytonutrients plant-based nutrients you can't get out of animal products. It's
Vitamin C and Cardiovascular Health 17:52 also, you know, it doesn't have the processed junk food if you do it right. 17:56 Um, still the weight of the evidence controversial, but is that a lower 18:01 saturated fat diet is more associated with freedom of cardiovascular disease. 18:07 And plants, with the exception of coconut oil and palm oil, which aren't 18:11 really plants or processed foods. They're very low in saturated fat. Olive 18:15 oil, olives, nut seeds, all have some. Most your fruits and vegetables have 18:19 nearly none. That's where the beef tallow discussion gets in again. Why are 18:23 we telling America to up their saturated fat content when 99% of academics and uh 18:30 a large number of just general cardiologists would agree that avoiding 18:34 saturated fat is a good idea. So, you know, a vegan diet can be low in 18:38 saturated fat. It's high in fiber. It's high in plant-based nutrients. I think 18:43 one of the un and this is the last thing I have to say one of the unsung 18:47 advantages of a whole food plant-based diet is the vitamin C content and I've 18:52 really been a student particularly in the last 6 months of reading old 18:55 literature on vitamin C and you know it's this amazing uh observation that 19:01 few people know that humans are one of the very few species on the planet like 19:06 99.9% of all animals on the planet make their own vitamin C dogs cats squirrels, 19:12 elephants, tigers, lions, and bears. Oh my. Humans can't make one milligram of 19:17 vitamin C. We lost the ability 40 million years ago. There's a little uh 19:22 enzyme in our liver called glow, glow, and we don't have it working anymore. 19:27 It's there, but it's been turned off. Uh some people say we were living in the 19:32 jungle, and we had so much access to vitamin C rich uh tree foods, plants, 19:37 you know, fruits and veggies that we had no need to make our own. But we don't 19:41 live there anymore. And vitamin C is critical for good vascular health 19:45 because of its important role in producing collagen, the substance that's 19:50 makes every organ an organ but makes our arteries uh intact. So we are, you know, 19:56 relatively vitamin C deficient compared to a dog which never has a heart attack 20:00 or a bear. A bear has a cholesterol of 500 in the winter. They don't have a 20:04 heart attack. And it's an interesting theory promoted more by Lionus Pauling, 20:11 PhD, double Nobel Prize winner, uh, in an article in 1992 called the unified 20:17 theory of cardiovascular disease where he said, you know, it's all due to weak 20:21 arteries and the weak arteries are all due to vitamin C deficiency. And he, you 20:26 know, I've read that the average American gets about 100 milligrams a day 20:30 of vitamin C in their diet. The average vegan gets two to 300 milligram. You can 20:34 get more if you really up the vitamin C rich fruits and vegetables. There's not 20:39 much in, you know, legumes and whole grains. There's some, but I have been 20:45 teaching and it's a different topic. It's not food, but I have most my 20:49 patients supplement into the multi-g level of vitamin C. But even if you just 20:54 have a big salad every day, have an apple every day, eat an orange, you're 20:59 going to do better than having another chicken breast or another tilapia filt 21:04 where you're not going to get vitamin C at all, you know, essentially. Yeah. No, 21:08 I completely agree and I remember watching your video on that on vitamin C 21:13 where we had lost the enzyme functionality. Yeah. I want to 21:17 volunteer. If anybody's listening to this and they have crisper 9 technology, 21:22 take my body and turn that enzyme on. I really would like to see what a human 21:27 would be like if we were making it's estimated 10 to 20 grams a day of 21:32 vitamin C if we were if we didn't lose this enzyme. And when we're sick, then 21:38 you got a a cold, a flu, and pneumonia, we may make 30 to 40 grams a day. It's 21:42 estimated um to compensate. And I do that. I take my multi-gram amount of 21:48 vitamin C and I double triple it if I get sick. And I tell you, 12 hours 21:52 later, you're not sick anymore. So, uh, you know, just a few little tips from an 21:57 old, uh, you know, natural oriented cardiologist, right? Don't be scared of 22:02 good nutrition, right? I think, right, will call me and say, "Wasn't that too 22:06 high?" And I'm like, "No, because if you actually had correct levels, you 22:10 wouldn't be sick right now." Right. reminder. Well, you unpacked a lot and I 22:17 have a few questions because, you know, I'm going to play devil's advocate 22:20 today. There's a lot of stuff and do ask me about inflammation because I didn't 22:25 mention that specifically, but questions listed, but I do want to know um you 22:30 know, what do you think a plantforward diet does with hormones? I think a lot 22:36 of men and here's what I found out about researching peptides. Lentils are one of 22:42 the best forms of a peptide that helps youain and attain muscle mass. Right. 22:47 That's strong comes from which is a patented peptide that is made from 22:52 lentils. And so I'll always use that. Is that pep strong? Is that what you just 22:56 said? Right. Yeah. Familiar with that. Yeah. So I always use that as an example 23:00 of like I don't care if you're a vegan and you get your macros that way. just 23:04 make sure you're getting complimentary, your B12 levels are good, right? He's 23:09 more compliant that you So, you know, you you you are bringing up good points 23:14 and I um you know, there's a lot of trails to go down, but um 23:19 go down. Many many people would argue, and I bring up the name of Dr. Valter 23:25 Longo again, that it's very hard to um dot every eye of nutrition with food 23:33 alone. Therefore, supplementation has a role. Now, of course, there are 23:37 anti-supplement people in the uh academic world, there's not too many 23:41 anti-supplement people in the natural health world, but a person like me that 23:46 eats nothing but plants, should be aware that obviously the famous ones, and B12 23:51 is the most famous, you know, either get your blood level checked after 3 to 6 23:56 months of eating this diet or just take a B12 supplement, sublingual, oral. 24:01 Don't you don't need shots unless you have pernicious anemia. It's kind of 24:06 crazy. Um, you know, look at vitamin D levels, but everybody should look at 24:10 vitamin D levels. Look at omega-3 levels. I think that's the one people 24:14 miss. Um, omega-3 uh sufficiency, and I try and 24:19 get it through chia, flax, hemp, walnuts, chlorella, spirulina. Um, but 24:25 you know, I like ALA, but I still got to convert my ALA over to EPA, DHA. uh you 24:31 know check that um check your homocyine level. If you're not getting enough B12, 24:36 your homoyine level may go up. You should be getting enough folate if 24:39 you're eating big salads because leafy greens. You know, magnesium should be 24:43 more abundant in a plant-based diet, but um you know, it's the soil quality and 24:48 the rest. So either check a magnesium level or I take magnesium before bed and 24:54 trying new ones all the time, different threeates and different glycinates and 24:59 different acetates. But uh at any rate um so you know there are some companies
Inflammation and Diet: The Connection 25:04 out there making multivitamins for vegans makes it very simple um allin-one 25:10 or just be aware of it. But the broader topic is our government says most people 25:16 over age 50 should take vitamin B12 for their brain and nerve health, whatever 25:20 their diet is. And those of us in the functional medicine world that do 25:24 extensive lab panels know most people have 1 2 3 4 very easily identifiable 25:30 vitamin deficiencies. And then if you get into the what's called and it's not 25:35 a term I ever used till a couple months called the orthomolecular world which is 25:39 the highdosese vitamin C world and the highdosese vitamin B6 world or the 25:44 highdosese vitamin B3 nascin world with fascinating data you know it's not just 25:49 about avoiding deficiency about it's about hitting optimal targets which
Hormones and Plant-Based Diets 25:54 could be really quite high like vitamin C really quite high so um the vitamin 25:59 replacement approach is a common soft belly for veganism. Well, you guys got 26:04 to take a vitamin. Well, I don't find there much of an argument. None of them 26:08 are expensive or particularly dangerous. You might have yellow urine from 26:14 rioplavin, but you know, it's kind of cool. I always want to be more yellow 26:18 than the guy next to me in the public bathroom, baby. And then let me just say 26:24 inflammation. Um, you know, generally a whole food plant-based diet should be a 26:29 low inflammation diet. Of course, you can check blood tests like high 26:33 sensitivity C reactive protein. There is a randomized study published, I think it 26:39 was 2018 out of maybe it's New York University, it was one of the Manhattan 26:43 hospitals of heart patients given a standard American Heart Association diet 26:48 or a plant-based diet. the end point 12 weeks or so was high sensitivity C 26:53 reactive protein and it did fall on the um kind of an orangeish style low-fat um 27:01 whole food plant-based diet. It didn't fall in the course of the weeks on the 27:05 others. So we at least have some actual academic data that um you know there's 27:11 many reasons you have inflammation, your dental health and your heavy metal 27:15 burden and your sleep apnea. But from a food standpoint, there should be a 27:19 rather uh anti-inflammatory diet if you don't have a a food allergy to something 27:24 you know you didn't identify. So, you shouldn't be aarian. 27:29 Yep. Right. 27:31 Talk to me a little bit about hormones and plant-based diet because I think 27:38 right men with their testosterone, women with hormone balance and then I want to 27:42 get into a little bit of insulin resistance and metabolic health because 27:46 that always is the big Yeah. Right. Right. The big one. 27:51 is so I do I check a fair number I mean extensive 27:57 thyroid panels a lot of male and sex female hormone panels on my patients um 28:02 certainly if there's symptoms but sometimes otherwise just as part of a 28:05 health and wellness check. Yeah, I think the literature doesn't say there's any 28:10 consist there's two issues eating plant-based and hormones and eating a 28:14 low-fat plant-based diet and hormones. Um, you know, I work with very good, 28:20 very famous functional medicine doctors around even the Detroit area who tell 28:24 me, "Boy, you got Mr. Smith's cholesterol down to 125 with your 28:29 plant-based diet and he can't make enough pregn to support his hormone 28:34 pathways." And I told him, "Back off and add in lamb." And I've said, "Where's 28:38 that data that, you know, a whole food plant-based diet drops your pnegnolone 28:44 and your whole, you know, cascade of hormones?" And honestly, the answer was, 28:48 well, somebody told me it happens. And from the person this came from, and I'm 28:52 going to keep my lips zipped on who I was rather surprised there wasn't an 28:57 academic, you know, publication reference, uh, you know, word of mouth 29:02 isn't enough when you're teaching doctors around the world. So, um, I 29:05 don't see it. I mean, I see lots of guys with very low testosterone panels and 29:10 all, but you know, they're of any diet and it's usually really 29:14 unclear. One yesterday, you know, that's he's a Mediterranean eater, but there's 29:19 plenty of fish and chicken in his diet. Total testosterone is 220 and, you know, 29:24 he's got some symptoms, so I'm getting them referred out for proper uh hormone 29:29 replacement therapy. Um, I don't see it. I mean there I would say the best doc 29:34 who's written on this is Dr. Neil Barnard MD. He's in Washington DC. He's 29:41 head of an organization called Physician Committee for Responsible Medicine. He's 29:46 very plant-based doctor, but he's very academic. He he writes some of the he 29:51 funds some of the best double blind randomized food studies that are coming 29:55 out, 16week studies on insulin resistance, on weight. But he's got a 30:00 book out about plant-based diets and hormonal status. And there's a lot of 30:04 women PCOS, PMS, menopausal, hot fleshes, 30:10 particularly if you're not soy adverse organic soy products. A lot of benefits 30:15 of phytoestrogens, not animal estrogens on a lot of these 30:20 syndromes. You know, there's data about men with erectile dysfunction. I'll go 30:24 back to Dornish, you know, data, Dr. data. There's actually an ongoing 30:30 randomized study at Montafior Medical Center in New York on whole food 30:35 plant-based diets like an Ornish type diet on male erectile dysfunction, but 30:40 the studies underway. There's no results to report. Um, but there are certainly 30:46 many examples of erectile function coming back. We haven't talked about it, 30:51 but a benefit of a very plantstrong diet or plant only diet is more dietary 30:58 nitrates to make more nitric oxide uh via your oral pathway. If you don't use 31:05 listerine and you don't use scope and you don't use fluoride toothpaste, then 31:09 you shouldn't use those three products. And if you're not on a acid blocker like 31:13 Protonics and uh Nexium because uh if you're not on the acid blockers and 31:19 you're not on the scope and you're not on the fluoride toothpaste, if you eat a 31:22 big salad, you make a lot of nitric oxide and uh you can see guys erectile 31:28 function return uh just with diet alone. So uh that's the old you know nitric
Cholesterol: Understanding the Nuances 31:34 oxide pathway. So that's a hormone pathway too indirect. Yeah, absolutely. 31:38 You know, I usually tell men, you know, ED is a combination of vascularity, 31:44 nitric oxide, and insulin resistance. Yeah, correct. 31:48 your first signs of cardiovascular disease, right? And you know, going back 31:52 to the hormone pathway, whether you eat a lot of protein, a lot of fat, or whole 31:58 plant food diet, moving forward, the stress that most people are 32:03 under is really what creates the hormone disruption at the core, right? It's a 32:09 cortisol dominant environment within the body, which is going to steal your 32:14 pregnenolone. It's going to steal your progesterone. It's going to use that to 32:18 create cortisol versus creating DHEA and your androgens and your testosterone and 32:24 for women your estrogen. So, there's a lot more than just this diet creates 32:29 great hormones, but I like to address it just so people have a path as to what 32:34 would adding in more plant-based nutrition do for you, right? Just like 32:40 you said, nitric oxide. It's interesting you me mentioned Listerine and PPIs. I 32:44 mean, I think you just eliminated 88% of the United States probably. They're all 32:48 like, "Oh, no." Because it is. It is a very, very high percentage 32:55 that have got some reason that they're blocking their body's ability to make 33:00 optimal nitric oxide and, you know, it won a Nobel Prize in medicine. There's 33:05 just no easy blood test. There's no pharmaceuticals. So we ignore, you know, 33:10 a pathway in the body that promotes health throughout the body, not just the 33:14 heart, but brain, sexual health, vascular health everywhere. And 33:19 um uh we could do it with diet and a couple little modifications like we just 33:26 said. Yeah. Well, let's go down the cholesterol path. It's a big topic 33:33 today. I see a lot of people talking about it. I personally look at 33:36 cholesterol and I ask more questions. You know, I'm not always trying to 33:40 repress it. You know, for me, I'm looking at why is that cholesterol 33:44 elevating? Is it vascular damage? Is it a need for brain regeneration? Is it a 33:50 hormone imbalance? You know, what is it? But we're getting really granular on the 33:55 testing. And so I would like if you would as a professional in the space of 34:01 cardiovascular health explain to us how you look at cholesterol and then can we 34:06 get into APOB and what that means particle size 34:11 because there's just so many questions that come around it if you don't. Yeah 34:15 for sure. And you know, I think I spend a third of my life ordering lab panels, 34:21 big lab panels on patients and uh looking at them and reporting them back 34:26 to patients with recommendations and you know some of it reading what's new, 34:31 what's the latest science. Um certainly the traditional and everybody knows 34:36 this. traditional cardiology framework for about seven 34:40 decades maybe five decades uh 1970s 1980s is the higher the level of LDL 34:49 cholesterol the greater the risk and risk is the key word because risk 34:54 doesn't mean you're going to get the condition and talk about risk of 34:57 atheroscerosis risk of coronary disease risk of heart attacks bypass stent 35:01 sudden death the greater the LDL cholesterol the greater the risk we know 35:06 it in the plaque of diseased arteries, you will find cholesterol. That's 35:10 undeniable. Um, uh, you know, you don't find a lot of other things like sugar, 35:15 which may be a very bad thing to eat in excess, but you find cholesterol. Um, 35:20 and there's just so many studies that there's a straight line between the 35:24 higher the LDL. But when you get down to one patient in your clinic, I can tell 35:28 you from, you know, hundreds of thousands of 35:31 patients, terrible lab values and no disease and relatively modest lab values 35:36 and disease. So it's it's not the line may be straight when you've got 30 35:41 studies in a meta analysis. But on a single patient, it's very difficult to 35:45 know and you got to test the patient. I'll talk about that in a second. And of 35:48 course we used to say of course HDL highdensity lipoprotein the protective 35:53 the one that did something called reverse cholesterol transport low HDL 35:57 was bad. So we call it the happy healthy cholesterol because high was good. But 36:03 in the last 1015 years there's without a doubt complete confusion about HDL 36:08 because high is also a risk. I see people in my clinic all the time. I saw 36:14 one yesterday with an HDL of 135. Now, some people will say there's something 36:19 wrong with that person. Maybe it's a response to chronic silent infection. 36:25 This person doesn't seem to have that. It's, you know, it's clearly genetic 36:28 also. And she just had a major heart attack. So, uh, HDL is now a sweet spot. 36:34 Uh, we don't want too low, we don't want too high. We don't have a drug that 36:37 modifies it. So, most of us ignore HDL right now because there just is 36:41 confusion and lack of therapeutic clarity. we, you know, we don't really 36:46 know that we want to lower it and there's no really effective way to lower 36:49 it. Um, the one we have to mention, everybody has to have their lipoprotein 36:54 little a cholesterol checked, a genetic cholesterol that's on every lab slip 36:59 panel, lab corp, quest, hospital panels, but it's the particle that everybody 37:05 needs to know and nobody gets checked. you know, maybe one or two or 3% of 37:10 clinicians will order it because it's therapeutic nealism. What do we do about 37:15 it? We don't have anything to do about it. In reality, that's what I do. I'm 37:20 sort of a lipoprotein a guru. Uh I see people all over the world with that. 37:24 There's a lot you can do for it. And we don't have drugs yet. We will have drugs 37:29 in the next 5 years. Many studies ongoing. Hopefully, they'll be helpful 37:34 because we need ways. Uh I have patients who have had massive heart attacks, 37:38 strokes, open heart surgery solely because they inherited from their 37:42 parents uh lipoprotein little a and they need a really powerful therapy that 37:47 works. And yet same thing, it's a risk factor. I have 78-year-old patients 37:53 who've got skyhigh lipoprotein A levels, meaning they've had it since birth and 37:57 they don't have any disease. So you just got to unpack people one by one. So, you 38:02 know, I don't promote any particular lab. Uh, Dr. Mark Heyman has introduced 38:07 the functionhealth.com, you know, $500 38:11 extraordinary lab panel, but it has lipoprotein A in it. So, my office phone 38:16 rings a lot because people are finding out and my lifeforce.com I think offers 38:21 labs like that. Life extension has offered labs like that for decades. You 38:26 can find out and you should know. Uh, you know, and then you can do the 38:30 advanced lipid particles. I still do them on everybody cuz it's really just a 38:34 couple extra dollars. So instead of knowing total cholesterol, HDL 38:37 cholesterol, triglycerides, um, and u LDL cholesterol, I think I 38:44 didn't mention you get LDL particle number. You can have two people with an 38:49 LDL cholesterol of 120. One is lean, exercises, eats clean, and one does the 38:56 opposite. And by doing the advanced cholesterol panel, you can see 39:00 significant differences. If you look at the LDL particle number, one person with
Niacin: A Deep Dive 39:06 an LDL of 120 doesn't have that many particles in the blood, but the 39:11 particles that are there are all chuck full of cholesterol. So the LDL particle 39:14 number is pretty low. And studies say that person's at lower risk for 39:19 aththeroscerosis than the other LDL120, not such a great lifestyle, probably 39:24 insulin resistant person who has these small little and very prolific number of 39:30 LDL particles. So you have LDL particle of 800 in one and 2200 in the other. And 39:36 the one with the 2200 LDL particle number is at greater risk. And there's 39:41 certainly a few large long-term studies that say the LDL particle number 39:46 performs much better than LDL cholesterol. Apo B is a great test. It's 39:53 a blood test. Apo lipoprotein B. Cost a few dollars. It's been around for 30 to 39:59 40 years. And there are certain people like the famous Dr. Thomas Daypring, MD, 40:05 a lipid expert in New Jersey. They've been talking about this for decades. But 40:10 every LDL cholesterol particle in the blood has an apo lipoprotein encircling 40:18 it. But also of key importance, every lipoprotein A particle in the blood has 40:25 an apo lipoprotein B encircling it. So by one number you can measure the two 40:30 most atheroscerotic particles that might be in the blood. 25% of people have 40:36 both. So I track apo lipoprotein B in everybody but particularly in the 20 to 40:41 25% of people that we identify have inherited lipoprotein little A and you 40:47 know if I do an intervention maybe I start extended release nasin maybe we 40:52 start hormone replacement therapy maybe we put in a food and exercise program 40:57 maybe god forbid we add a statin which does not work for lipoprotein little a 41:02 but sometimes is needed because of other pressing cardiac issues. 41:07 uh following and tracking the APOB is the best way to know if we probably 41:12 benefited or did not benefit that patient. Interesting. Talk to me about 41:17 nascin and the impact on those numbers. Yeah, niacin is a little pet project of 41:23 mine. Um talk about it for a long time, but briefly it is vitamin B3. Some 41:29 people argue it's not a vitamin. Some people argue it's an amino acid because 41:33 if I remember you can make some nascin in the body from tryptophan 41:38 um and um it has this distinctive reaction of causing if you take enough 41:43 of it particular if you take lane nasin uh it releases prostaglandins in the 41:48 skin and there's a hot flush that might last 10 minutes 30 minutes some people 41:53 enjoy it I kind of like it some people uh do not enjoy it and once in a while 41:58 it's more than a flush you can get a rash from nin 42:01 a very safe drug that in 1955 was discovered during studies that were 42:06 being done to use highdosese niain for schizophrenia and mental health which 42:10 works. It's published there's books written on it. It was used widely in the
Top Plant-Based Foods for Heart Health 42:14 50s and 60s but when prescription drugs like held doll came out u you know 42:19 orthomolecular psychiatry sort of fell out of favor there's still people doing 42:23 it but it was discovered in 1955 that it lowers cholesterol and it does 42:27 everything right. It lowers total cholesterol, LDL cholesterol, 42:30 triglycerides a lot. Um, raises HDL cholesterol, and it took a few more 42:36 decades, but about 20 years ago, it lowers lipoprotein little A. So, it's 42:41 about the only single pill out there that hits all those targets favorably 42:46 with a very safe liver profile. It can raise homocyine a little bit. I track 42:52 it, but it's been very minor. Um, it doesn't do much to blood sugar. Some 42:56 people ask that question, but so I still use a lot of extended release nascin um 43:03 particularly in my lipoprotein a patients and it can be dramatic. We 43:07 don't have a long-term outcome study. So I have to tell people I don't know that 43:11 this is going to reduce your future heart attack and stroke but man I sure 43:15 made your numbers on paper look a whole lot better and you're feeling fine and 43:19 I'm you know it's costing you 25 cents a day instead of uh some other you know uh
Misconceptions About Heart Disease Prevention 43:24 not so reasonable number. So I still think there's a role for nascin um uh 43:29 there's an interesting old data about using non flushing nascin for 43:33 degenerative arthritis. So we do some of that in my clinic. You got to read these 43:37 old papers. Um yeah, the real lab testing though, 43:42 and it's not lab testing, people need to know their arterial age. They need to 43:47 get a really good corateed ultrasound called a CIM ultrasound, which is hard 43:52 to find. And and although I do not like CT scans, there is a $100 coronary 43:58 artery calcium CT scan, which is the equivalent philosophically of a 44:03 mammogram or a thermogram or a colonoscopy. you feel fine, but are you 44:08 at age 45 to 50 developing early signs of a disease that we can jump in and try 44:14 and squash or reverse with a lot of what we've talked about. So, um if you have a 44:19 high cholesterol and a high lipoprotein A, but your curate and your heart 44:22 arteries are clean, I'm very permissive and I look for, you know, root causes. 44:27 Can't always find root causes. Genetics is a lot of it. It's 100% of it for 44:31 lipoprotein li. And if you're developing, you know, early 44:35 aththeroscerosis, we got to really work hard. Yeah, absolutely. So, what are 44:42 your top plant-based foods you would say to our audience today that every person 44:47 needs to eat more of? Yeah, there. I'm going to steal two 44:52 acronyms because they're so good. Dr. Joel Ferman created an acronym Gbombs. 44:58 Some people have heard of it. G for greens, B for beans, O for onions and 45:02 mushrooms. Well, M's for mushrooms. B's for um berries, and S is for uh seeds 45:09 and nuts. G B O M B S. Um as a you know, that's not all you eat, but that would 45:16 provide a lot of these critical phytonutrients and fiber. And one of my 45:21 favorite health gurus is Dr. Russell Jaffy in Washington DC, Virginia. He's 45:27 got one at GG OB ginger, garlic, onion, brassica, because those are sulfurrich 45:32 foods and that may not only augment your nitric oxide production, your immune 45:37 health. So, ginger, garlic, onion, brasacica, well, brasa 45:42 being broccoli and, you know, um, kale and bok choy and, um, Brussels sprouts 45:49 and all those wonderful things, right? All the foods nobody eats. So, as we 45:55 finish up the podcast here, um, what do you think is the biggest misconception 46:01 about heart disease prevention? 46:06 Sadly, most people still don't uh realize that it is preventable and 46:10 reversible. It's not perfectly reversible. You know, you're not I can't 46:15 make your bypasses disappear, your stances disappear, but you can shrink 46:20 plaque. There no doubt about it. And you can prevent plaque. The earlier in life 46:24 you start, the better. Even if you've been handed a genetic high-risisk 46:28 profile, you can hugely influence it by, you know, we've talked about food, but 46:33 obviously sleep and don't smoke and good fitness and stress management and 46:38 optimal nutrition in the north. Uh, so that's sadly people I mean 98% of my 46:44 patients coming to see me for the first time have seen cardiologists and have 46:48 never gotten 5 seconds on nutrition. I just have them watch Forks Over Knives. 46:53 I mean, I don't I have good dietitians in Detroit. I don't employ them here. 46:57 You know, watch What the Health. Watch Forks Over Knives. Read a book and let's 47:02 have a little discussion. Listen to Tracy's podcast. Do something. But, um, 47:06 you know, don't wait for your cardiologist or primary care doc to 47:10 probably give you a nutrition seminar. I hope that improves in the future. Yeah, 47:15 certainly a misconception. And I mean soy, the whole soy topic, I don't know 47:18 where you stand on that, but largely phytoestrogens are not dangerous. The 47:24 the substances found in soy and some other products and they seem to have 47:28 some pretty protective aspects. That's the second one comes to mind.
Conclusion and Resources 47:34 Well, that's an interesting topic. probably we could go down a whole rabbit 47:38 hole there that started with the entire you know estrogen dominance breast 47:43 health but I I I see as we move forward Dr. Jen Simmons, who is a former 47:49 surgeon, she's a good friend of mine. She's going to be on the podcast later, 47:53 but you know, her entire functional medicine practice now is all about 47:58 breast health and she's a big proponent of soy, right? Yeah. Yeah. I've 48:03 interviewed her, she's interviewed me, and you know, I agree with her. I would 48:06 say number three, and I've done whole grains. You know, people like Bill Davis 48:10 and David Pearl Mutter are wonderful people, but they made people grain 48:14 phobic. And for many of us, you know, forget about how I feel eating whole 48:19 grain. The research says over and over longevity foods, nuts and seeds, 48:23 legumes, and whole grains go around the world. It's the same equation. Actually, 48:28 fruits and vegetables come up lower on the list than nuts and seeds, legumes, 48:32 and whole grains. So, if you like Ezekiel bread or you make a homemade 48:36 whole wheat bread, uh I tell my patients, you know, go for it. It's 48:41 right more fiber, more short chain fatty acids, more butyrate, all the good 48:47 stuff. There's more danger in how our food how our raw ingredients that we're 48:51 using to cook are processed and poisoned versus the food itself that you know I 48:56 always say we're so foodhobic now. We we just put people in food prisons and 49:00 we're like that we think we're good practitioners and that's not what every 49:04 person needs. What works for one doesn't work for another. And I have clients 49:08 right now that I'm thinking of that I'm gonna go back and say, you know, from 49:13 listening to Dr. Khan, I think you need niacin. And I after listening to Dr. 49:17 Khan, I think you should explore a vegan or at least plant-based 49:23 diet because of the numbers and they're not moving. So, you know, a good 49:28 practitioner is going to take in the knowledge and turn it into a powerful 49:33 play. You know, it's about me thinking one way and you thinking one way. what 49:37 works and what what does the science say? So I do appreciate that you are 49:42 always well researched. I can count on you to bring three or four studies to 49:46 any you talk about which we need to have that because there's a lot of 49:51 influencers and I I look at you as an influencer Dr. Colin. I mean you have a 49:55 really wide reach but there are many influencers out there that a are not a 49:59 clinician. They don't sit in the chair with people. They're not looking at 50:02 functional testing. They're just saying things. And number two, they have no 50:06 science to back it. Nothing. It's just opinion. So I think that is where a lot 50:13 of the confusion is now coming in with a lot of people that are trying to be 50:17 healthier. So do appreciate that's how you process. Thank you for having me on 50:23 your wonderful podcast. Absolutely. So how can people find you? Are you taking 50:27 new clients and patients? Also, do you have any resources, books, anything 50:31 where we can find out more about your research? I usually have some of my 50:37 books in my study, but one of my kids has taken over my study for a couple 50:41 months, so I don't have any of the show and tell, but um yeah, I take new 50:45 patients from about 25 states, all the big ones, California, Texas, Florida, 50:49 New York, and Michigan, Ohio, all the ones around here. um 50:53 druelcon.com djelk 50:58 ahn.com there's a link to my podcast my blog but my clinic and I I love patient 51:05 care yeah my colleagues are retiring and I'm just gearing up just getting going 51:10 just going to open a few more clinics right well I'll put your link in the 51:14 show notes plus any other resources that you have including your book so that 51:18 people can find out more over your 40 plus years in the industry 51:23 and I want to say thank you so much for your heart and for your faith and for 51:27 just being there and you know taking a different approach to preventative 51:32 cardiology uh than what we see in mainstream medicine which I really think 51:36 we need. So thank you. Be well. All right. You too. Thanks everybody for 51:41 joining us today. Uh make sure that you like and subscribe to this podcast and 51:46 also to any other social channels. Make sure you connect with Dr. con because 51:50 he's always such a wealth of information. And thanks for joining us 51:54 today.
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