The Link Between Heart Health & Diabetes

Joel Kahn, MD, FACC

I’m happy to be here. What an important topic!

Beverly Yates, ND

We’re going to dive in and have a discussion here and bring forward some of the things that are most commonly on people’s minds about this intersection between diabetes and In this case, we’re specifically looking at Type 2 diabetes and prediabetes, but all kinds of blood sugar, dysregulation, and heart disease. Unfortunately, there’s a lot of overlap. You and I both know that. Please, would you share with us in today’s world if there are any controversies that you might want to clear up for folks?

Joel Kahn, MD, FACC

What is the role of diet, genetics, lifestyle, and Type 2 diabetes? As far as we know, Type 1 diabetes is largely a disease of younger adults and younger children. Although it’s occasionally diagnosed in your twenties and thirties, it’s largely genetic or autoimmune, and you could, unfortunately, be raised in a family of good lifestyles and still develop Type 1 diabetes, although there is still that relationship described in a famous study called the China Study about introducing cow milk early in life to a child and a relationship. It’s not proven. It’s suspected that more cases of Type 1 diabetes may be an autoimmune reaction, at least as described in that very large, very famous study on Type 2 diabetes. It’s not God’s will. It’s not bad luck. It’s usually food choices, fitness choices, stress choices, and sleep choices. They’re not choices. It’s now socioeconomic equity, access to good food, walking sidewalks, gym access, safe neighborhoods, good sleep, good stress, and all the rest. The fact that Type 2 diabetes is a forever diagnosis when it can be largely prevented, halted, and reversed is something that’s still not appreciated. Doctors just don’t say, Hey, Joe or Jane, the 12-month goal is to reverse your diabetes and reduce your medication when in fact, that can happen.

Beverly Yates, ND

It’s one of those things where you just look at all the calamities and downstream problems that happen and realize it doesn’t have to be like this. People don’t have to lose the ability for their brain to function correctly, their hearts lose their body parts, be at risk, lose sexual function, or enjoy energy. There are just so many problems that arise from these issues with blood sugar. So whatever people can do to be healthier and feel better is going to matter in a profound lived experience for them.

Joel Kahn, MD, FACC

That’s the misconception. You’re stuck on meds, you’re stuck with diabetes because if you can make no progress, there are implications for life span, quality of life risk, cardiac disease, the risk to sexual health, risk of stroke and heart attack, bypass and stent, and losing legs. Do you want to? I hate to say it like a booger on your hand. You want to shake Type 2 diabetes off. A great analogy I guess.

Beverly Yates, ND

Compelling. People will remember it. Good for you. So what is a myth? What’s the number one myth, in your opinion, that people have about the intersection of Type 2 diabetes, pre-diabetes, and heart disease?

Joel Kahn, MD, FACC

Generally, they’re just unaware of it. The myth is that everybody understands that you see your doctor or your health care practitioner, and they bring it up right away. Do you know that your elevated hemoglobin, A1C, or fasting postprandial blood sugars are at a range that you’re in—a range we call Type 2 diabetes—and that may shorten your life by a decade? That may raise your risk of heart attack, stroke, erectile dysfunction, peripheral arterial disease, and amputation. Do you know we’re going to work to remove that from your medical list because that will also allow you to add years of quality to your life? The myth is that everybody understands that connection when, indeed, it’s not stressed enough. It’s not necessarily a scare factor, but the reality of the diagnosis has to be huge. The other co-myth is, that if I can make up a word, I don’t know that that’s a formal word. That pre-diabetes is all based on levels, but if you’re a hemoglobin A1C, which is a simple, inexpensive blood test, everybody should ask their primary care. Doctor, you don’t have to be fasting HbA1c or hemoglobin A1C if it’s 5.6% or less. You’re considered in a normal range, but optimal is way down to around 5%. If you’re 5.7 to 6.4%, you’re called pre-diabetic. If you’re over 6.4%, your diagnosis of Type 2 diabetes, and it’s a spectrum, 6.3 isn’t benign and 6.5 isn’t the end of the road, some people are 11% when they’re diagnosed are higher. But for pre-diabetes, there is a myth that it is pre-disease. It’s not a disease. Pre-diabetics are coating their arteries, coating their nerves, and coating their brain cells with layers of pathology that cause disease. It’s recently been shown that if you take a group of pre-diabetics, they might just get some warning from their health care practitioner, and you send them off for a very simple CT scan, everybody should have called a coronary artery calcium scan, but a $100 test at your local hospital is something you need a prescription for. But there’s no needle, there’s no injection, there’s no pain, and there’s no claustrophobia. If you send a pre-diabetic off for a coronary artery calcium score at age 40, 45, 50, something reasonable, they’re much more likely to have proven silent heart disease than somebody who’s in a normal range. So, pre-diabetes is a diabetic.

Beverly Yates, ND

Thank you for drawing out those distinctions so that people can clearly understand where the mortal threat lies. I’ve often felt that people who say, It’s not a big deal, or I will just watch your numbers, whether it’s the person who has pre-diabetes or a health care professional who is serving them, are all missing the mark. Thank you for making it clear that people need to pay better attention to that and take it seriously. Is there another myth that’s common in your experience that people have about the intersection of heart disease and diabetes?

Joel Kahn, MD, FACC

Another one I got to bring up is the connection between diabetes in the brain and nerve disease. I just finished earlier today giving an hour-long lecture on the topic of something called heart autonomic neuropathy. Now, a lot of people may be aware that there is a condition that can complicate diabetes. That’s a disease called neuropathy. Maybe you lose this sensation in your hands or your feet from feeling hot and cold. Maybe you have painful, tingling fingers and toes. Those are common examples of neuropathy, but there’s a heart neuropathy, and I’m not sure if it’s a myth, a misconception, or underappreciation, where the heart itself is just bathed in all kinds of nerves. Nerves from your sympathetic nervous system and nerves from your parasympathetic nervous system make the heart immune to neuropathy. It’s very ominous to have autonomic neuropathy. 

My clues are that if you’re a Type 2 diabetic and your resting heart rate is 98 or 105, that’s not a normal resting heart rate. It should be 65, 70, or something down in that range that’s occluded. These nerves have been damaged and should worry you. There are certain findings on the electrocardiogram. If you’re a doctor, check your blood pressure lying and check your blood pressure standing and it drops a lot. Maybe you get dizzy. Maybe you won’t get dizzy. Your nerves are getting damaged. The misconception and myth is that neuropathy is your hands and feet tingling, but your heart just doesn’t give you a tingle. But it’s ominous, and you better get that diabetes under control.

Beverly Yates, ND

Thank you for calling that forward. I agree with you 100% on this. I think people underappreciate the impact and the systemic seriousness of all of this and the fact that we hear about the tingling and shooting pain in things like fingers, toes, and, strictly, the toes and feet. But we rarely hear about the heart. Being able to tie that together, particularly with changes in heart rate or blood pressure, makes sense. Because the nerves and the heart muscles have to work together to keep us alive.

Joel Kahn, MD, FACC

I agree.

Beverly Yates, ND

What are some common misconceptions that people have about healthy nutrition for both their hearts and diabetes? Because you both know as well as I do that food is medicine, and medicine is food.

Joel Kahn, MD, FACC

I come from a very long, plant-based food tradition where I believe the healthiest diet on the planet is either completely or nearly completely plant-based. We’re not talking about a frozen pizza with rice, cheese, and fake pepperoni. That’s a plant food; that’s a chemical; that’s bull. But it is a plant food. That’s junk platform food. We’re talking about whole foods like nuts and seeds, whole grains, fruits, and vegetables. The misconception is that since blood sugar goes up when I eat a bowl of oatmeal, I have to avoid all carbs, as if Skittles in a plain bagel is the same as a bowl of brown rice or oatmeal or 100% whole grain bread with some hummus spread that you make yourself, and that these are all the same. They’re all carbohydrates. That is a huge misconception. The misconception is that they all should be avoided by diabetics. I don’t want to just go to the literature and quote, but I do keep up with the literature. There was just a big study on a database in England that happens to be called the UK Biobank. It just made the point that they looked at a condition called fatty liver disease, which overlaps so much with pre-diabetes and diabetes. 23,000 people. When you eat white flour, white sugar, processed food, and carbohydrates, you raise your blood sugar and your risk of fatty liver disease. But when you ate whole foods, whole grains, whole legumes, and made simple things like rice and beans, a traditional dish made for years and years, cornbread and greens, there we go, a traditional dish made for years and years, I would eliminate the ham hocks and the turkey tail personally, but when you ate all foods, there wasn’t an association with fatty liver disease and with diabetes, and another massive study, and then I’ll stop talking about publications, but it’s a fun game. I was just in an online debate this week with a cardiac surgeon who promotes a diet called the Carnivore Diet. Nothing but meat. 

We debated, but we didn’t have much to talk about because I could talk for hours about the science and he could talk for minutes about his experience. you don’t throw away the experience is worthless, but you have to go to the medical literature first. That’s why we go to naturopathic and medical schools. But just recently, a massive study of a huge number of publications was lumped together. That happens to be called a meta-analysis. If you’re eating meat, and I’m including fowl and even fish, and certainly processed meats, the bacon, the pepperoni, the hotdogs, and you substitute nuts, legumes, and whole grains. In this massive study, your risk of heart disease goes down, but your risk of diabetes goes down. The misconception is that a diet that emphasizes legumes, beans, peas, and lentils could be mashed up like hummus, foods like 100% whole grain bread, or even 100% whole grain pasta, as opposed to white flour, grains, nuts, and seeds. I think everybody loves nuts and seeds, although a few people take exception. But you can reduce and even treat your diabetes with plant-based foods rich in the keyword. Everybody is complex. Carbohydrates are whole carbohydrates. Nobody’s a fan of added sugar. Nobody is a fan of added white flour. If you want to know if it’s working for you or not, you ask your doctor to get a continuous glucose monitor. You can get a prescription. It won’t be very expensive, and every time you eat, you can check your smartphone so your sugar will rise and fall. It’s supposed to rise and fall, but hopefully not to 250 following a meal. That’s a meal that’s not working for you. If it rises to 140, it’s no big deal. Anyway, that’s a misconception that you cannot possibly treat a diabetic and that they’re carbohydrate intolerant. I mean, everybody is processed, refined, and carbohydrate intolerant to a degree, but you can properly design a meal. Our diet preferences between your program, Dr.Yates, and mine are not identical. There are a range of approaches, but my patients are taught not to be carbohydrate-phobic. They’re educated on what smart carbohydrates are.

Beverly Yates, ND

The idea of complex carbohydrates that are slow-burning and resistant starches is the way to go because those are real foods and they are nutrient-dense. That’s certainly something that you and I agree on. then, as you say, a test not guess uses a CGM Continuous Glucose Monitor or, if you prefer, a fingerstick at the drop of blood with test strips inserted into a glucometer. But whatever, find out what your actions are to your meals because you might have some healthy meals you’re eating, you may have some things you’re eating that you think are healthy but that is not, and then you have stuff you’re eating that is not good for you. There’s a range there.

Joel Kahn, MD, FACC

If people understand how I like my Pringles or pick whatever you want to put in as your processed food of choice, I have to have my Little Caesar pepperoni pizza. that drives your blood sugar up and, over time, dries your hemoglobin A1Cup and drives you to a diagnosis of Type 2 diabetes. Are you willing to give up your sexual performance, your longevity, and your ability to have normal nerves in your legs and heart versus abnormal ones? Are you willing to give that up? You love that pepperoni pizza so much that you know you’ll take joy and days out of your life. If you realize that that’s a consequence, that’s death food. You’re eating. Get over it.

Beverly Yates, ND

Do what works. If there is one thing that you can make sure that everyone who has diabetes understands about heart health, what would it be?

Joel Kahn, MD, FACC

Why would that be what you just said? Hashtag test not guess. That’s just a little cute way to remember it. I mean, again, I’m going to stop quoting literature. We just had a nice study published in the past week where they took about 400 patients at a major university who had heart attacks. They asked them if they had had a heart attack. Do you have the big five established risk factors: smoking, blood pressure, high cholesterol, high blood sugar, diabetes, and maybe a mom, dad, brother, or sister with an early heart attack? About 25% of people who have a heart attack don’t fit the medical model that a doctor could sit in the office six months before and tell that patient you’re on the road to a heart attack. These patients would be told by their doctor, You don’t have the big five; you’re doing Joe or Jane. You have to test. You can’t just estimate. There’s this simple heart CT scan that everybody should get, but particularly everybody who’s got a diagnosis of pre-diabetes or diabetes. I mentioned it once already: a coronary artery, a calcium CT scan, or a heart calcium CT scan takes 10 seconds. There’s no needle, there’s no claustrophobia, there’s no pain, and there’s no allergy. It may cost you about $75. Usually, insurance won’t cover it, which is the most insane and frustrating situation. But you want to be diabetic with a calcium score of zero. You’re in pretty good shape. You don’t want to be like I just did yesterday with a patient email, that your CT scan came back. 684 You’ve got a silent, unknown plaque. The message is don’t assume because you feel and you went to the gym today, which is a great thing to do that you are without a heart disease test not guess. It’s simple. It’s available. Just ask your doctor. I got to get one of those heart calcium CT scans. Write me a prescription. Please, I’ll pay for it.

Beverly Yates, ND

That’s fabulous advice, insight, and coaching. I feel like up underneath there, there’s a few things I want to tease out here with you. One of them that I think goes along with this is that if someone is diabetic if someone is obese or overweight, or something like that—known metabolic disorders—people are more likely to get tested and assessed. What about people who are too thin on the outside and fat on the inside who are struggling with metabolic issues and maybe are not getting correctly assessed because they aren’t being tested? Therefore, they left the guess, and people said, “You’re healthy, you look good, or just whatever.? Again, assuming because, like you said, 25% of the people who are showing up with these heart attacks did not have a prior workup or profile. It pointed to that risk.

Joel Kahn, MD, FACC

That goes along with what I said. Maybe I’m aggressive, but I assume everybody might have heart disease. If it was a $5,000 test, if it caused serious side effects, like allergic reactions, if it was painful, we’re talking a coronary artery calcium scan, and you can be thin on the outside and fat with liver disease and pre-diabetes on the inside. There’s a lot of environmental influence, genetic influence, and the rest. I would never stop testing just because somebody is on the thin side now at age 30. A little early to look, although you’ll find some heart disease at age 30, but by 40 to 50, a diabetic closer to 40, a pre-diabetic closer to 40, and all the rest, they should be tested, and like a colonoscopy, they should come back perfect. Do it again in five to 10 years, maybe five.

Beverly Yates, ND

That only makes sense. Thank you for walking us through that. Let’s change gears a little bit and just talk about this issue because it’s on people’s minds. We both know; everyone listening, I’m sure, knows that the heart is made of mostly muscle tissue. Now, there are popular prescription drugs that are available right now like Ozempic, Wegovy, Mounjaro, GLP-1, and peptide drugs. Do you have concerns if people are using those medications and using them appropriately? Not people for vanity weight loss, but people who meet the criteria diagnostically for what’s the medicine that was developed, whether it was diabetes or obesity. Do you have concerns about them being able to preserve that precious cardiac muscle mass?

Joel Kahn, MD, FACC

I do have concerns. I think we’re learning about the drugs that you correctly call: Ozempic Wegovy, Mounjaro, and now there’s a new name, Zepbound. What a great name! Someone came up with that. If you use the drug known as Mounjaro, if you use it just for weight loss because it was developed as a diabetes drug, this company, Novo Nordisk from Europe, has so much money because of the success of this drug and other drugs. They are the number-one most valued company in all of Europe. Bigger than any other company in all those countries. They are, to their credit, organizing very expensive and very large research studies, but they’re just slamming down one more win after another. We had some data that if you were diabetic and overweight and put on this class of drugs, injectable drugs would be called Ozempic for the fun of it. You followed up: who’s going to develop heart disease? That risk goes down over three or four years. The company funded the study. It was very expensive, and it came out for them as a win. More recently, they went over to the drug called Wegovy and they took a group of, I think, nearly 20,000 people that didn’t have diabetes, but they were overweight, and they were at risk for heart disease. Half got Wegovy and half got a placebo shot, and they had a big win because they were able to identify that the risk of heart events in these overweight people went down by about 20%. I’m sure they’re going to get FDA labeling that Wegovy reduces heart disease in diabetics. That’s Ozempic. And Wegovy reduces heart disease in non-diabetic overweight people, I assume Mounjaro and its sister drug Zepbound will follow soon after they are reaping enough dollars to spend on research. That’s not all bad. Some people will say, How can you trust the research when it’s company-funded? But truly, these people have independent monitoring boards, and nobody else is going to do this study. We’re learning. I lean toward the lifestyle, but we do know not everyone can reverse their Type 2 diabetes. Not everyone can do it with diet and exercise alone. I’m keeping open-minded. I put very few people on these medications, but I have put them on, and they’re just frustrated. No, it shouldn’t be used for cosmetic reasons, for sure.

Beverly Yates, ND

I agree with you about this. I’ve been longing to see that trend, for sure.

Joel Kahn, MD, FACC

Now, if people like the media, Sharon Osborne has been in the news because she feels she had a pretty serious side effect from using Wegovy just to slim down to get into a size six dress instead of a size eight dress or something in those terms. She’s been in the news. Some people are being harmed. There are, however, millions of diabetics and overweight people in the United States who are in a rut. They need to listen to Dr. Yates and Dr. Kahn first and work hard on their lifestyle. But I’m not opposed to having options down the road.

Beverly Yates, ND

For those of you in premium, we’re going to continue this conversation. Those of you who are not in conversation stop here. Dr. Kahn, what is your clinical experience regarding whether people with unfriendly cholesterol profiles should reduce their intake of high-cholesterol foods such as eggs? I’ve been asked this. I don’t know how many times over the years. I’d love to hear your thoughts.

Joel Kahn, MD, FACC

This says that high-cholesterol foods, egg yolk would be common. One observation is number one: plant-based foods have no cholesterol, and it takes a liver to make cholesterol. I’ve never seen broccoli that had a liver in it. There are no high-cholesterol plant foods. then we got to get a biochemistry degree because the other topic was saturated fats and saturated fats are a particular chemical class that exists in mainly animal foods like meat, cheeses, butter, and whole-fat dairy, including white meat, pork, and turkey and chicken. They all have saturated fat, and finally, a couple of plant-based foods have a lot of saturated fat. That’s where it gets confusing. That’s mainly coconut oil and palm oil. The data over the years can largely conclude that dietary cholesterol doesn’t exist if you’re on a plant-based diet like I am, and it’s relatively small in most people’s diets if they’re eating a typical American diet. It’s hard to show that dietary cholesterol raises blood cholesterol, and therefore, it’s hard to show that dietary cholesterol directly causes heart events. It’s a much different story for saturated fat. Going back to a proposal 70 years ago and solid science for 60 years, saturated fat is one of the major causes. People are eating a lot of egg yolks, a lot of cheeses, a lot of dairy products, a lot of butter, and a lot of meats of all kinds, whites and reds, particularly processed meats, for sure. The pepperoni is in the hotdogs that they are raising; their cholesterol is in their blood. people a lot. There are differences based on their gut and their genetics; some people are less so. However, there is undeniable data that the high-saturated-fat diet group generally raises their cholesterol. If you wait long enough, because heart disease does not develop overnight, you will raise your risk of both heart disease, like heart attacks and strokes, and Type 2 diabetes. Saturated fat and Type 2 diabetes go together like mac and cheese. your best to have a big salad, chickpeas, red peppers, and an apple. That’s another myth that fruit raises the risk of diabetes. Eating an apple has been studied, and it does not raise the risk of diabetes. Drinking cans and cans of Mott’s apple juice might. But the magic of the fiber, the water, and the nutrients in an apple, an orange, a peach, or even a banana offset any natural fruit sugars. But I got off track. That’s the dietary cholesterol answer.

Beverly Yates, ND

This brings to mind the adage that an apple a day keeps the doctor away. It sounds like you agree.

Joel Kahn, MD, FACC

I eat an apple a day. I prefer organic apples. one of the most pesticide-coated foods on the planet. Our apples just spray on the tree, so they make it to the end and can be sold. But that’s not the apple I generally choose to eat.

Beverly Yates, ND

I hear you about that apple snob. I’m sorry. Again.

Joel Kahn, MD, FACC

I’m an apple snob.

Beverly Yates, ND

I hear you. The world that our great-grandparents were in, in terms of chemical exposure, is so different from the world we’re in. We just have to be smart about what we do as much as we can. Going back for a moment to the medications and the things that go with them, are there any common adverse interactions that you’re aware of between the medications and supplements that tend to go with diabetes and heart disease? Like Lipitor, and Metformin, Ozempic, Mounjaro supplements. Are there any cautions there?

Joel Kahn, MD, FACC

But the one that comes to mind quickly is that I am not an anti-statin cardiologist, but I use them much more sparingly than most cardiologists and at lower doses. But there’s no question: if you read the package, insert it says it, your blood sugar can go up on a statin. Not everybody’s, but you can go from normal to pre-diabetic. You could go from pre-diabetic to diabetic; you could go from diabetic reasonable control to diabetic worst control. Many of my patients have observed that. I’ve observed that. Both of them have worn their continuous glucose monitors and have said that when I’m on my statin, my fasting sugar is 128. When I’m off my statin, my fasting triggers 94. These are real, solid observations. Recently, a study suggested that a popular statin called Crestor Rosuvastatin is a little bit more likely to raise your blood sugar than another popular statin called Lipitor or Atorvastatin. I will follow up if I start a patient on a statin and recheck their sugar, which may be fasting sugar, insulin, hemoglobin, or A1C. I put these people on coenzyme Q10, CoQ10. There are some animal studies that say that will keep their blood sugar under control, and it’s a wonderful vitamin to be on anyway, in my opinion. But we haven’t had that big study to prove it. That’s one aspect. Metformin can interfere with the absorption of certain minerals. I think it can affect B12 levels and occasionally magnesium. It’s not that you can’t use metformin, but you probably ought to do some blood work in addition to the diabetic blood work. Ozempic, Wegovy, and Mounjaro and Zepbound. I’m not aware of any clear-cut drug interactions. They can affect the gut and the pancreas. There’s a need to monitor them with clinical exams and lab work. But in terms of an actual drug, I can’t think of one offhand.

Beverly Yates, ND

Thank you for that update. This one is on the check-in list because I feel like this is all a real-time experiment as we gather more data about the interaction of these things. We have so many more people on these drugs now. 

Joel Kahn, MD, FACC

I agree.

Beverly Yates, ND

Another question for you. When it comes to exercise and strength training, I’ve thought of them as two-pronged treatment strategies. Would you agree? What are your thoughts about exercise and strength training as an effective treatment strategy for improving both blood sugar control and heart health at the same time?

Joel Kahn, MD, FACC

It’s pretty commonly said by many online experts, good ones included. because they’re not all good. But perhaps the most important habit to develop in life is a regular fitness program, which unfortunately includes strength training. I prefer to gravitate toward cardio. I never was a weight room guy, but I forced myself every other day to do some weights, usually at home or if you belong to a gym, to maintain your muscle mass. Muscle is an important organ in glucose metabolism. When you eat and your body releases insulin, if you’re healthy, that glucose tends to be taken up by muscle more than any other organ. If you’re thin and frail and losing your muscle as opposed to being a little bit more muscle-bound, which generally takes exercise, you’re better off in terms of your blood sugar. You don’t want to be jacking up your muscles with steroids and other unnatural things because you’ll end up on the opposite end of the spectrum with promoting diabetes. But now you want to exercise. The thing is, exercise isn’t just for diabetes; it’s for your brain, your heart, and your sexual health. It’s for your parents, your aging. There just isn’t any way around it. You have to create home or gym time. Some of it’s easy. We’ve learned the worst thing you can do, as silly as it is, is sit for prolonged periods. It’s healthier to sleep than to sit. Nobody knows quite why. But that is an observation from science. Of course, we know sleep is healthy, but when you look at the risk of heart disease there, you’re better off taking a nap than sitting at the desk for some reason. Both have their pros and cons, but I have a standing desk in my office. I’ve had that, probably for a decade. I have one at home too, and I’m pretty well known because I have a weekly podcast and I have treadmill desks. That’s a little exotic. But I took my standing desk and bought a $400 treadmill that goes underneath, and you just walk 1.3–1.4 miles an hour. It’s slow enough. You can type, and you can talk. I’m doing this all day long when I’m seeing patients, and they think I’m nuts. They’re largely right. But it is one way because I’m not a mailman. I’m not walking all day long; I’m not delivering packages by jumping up and down. Most doctors sit most of the day. You have to avoid that at all costs. Don’t sit. Move around and shake. I’m sitting right now, it’s for 35 to 40 minutes. But generally, what you want to build is that any motion in your body is better than sitting for long periods. Of course, the worst situation is truck drivers and people at desks, in cubicles where they can’t move as easily, but then take a little of what they call an exercise snack, get up for 5 minutes an hour, and do a little jumping jack or some squats, walk around the office, or take a phone call standing because standing is great. Standing is good stuff.

Beverly Yates, ND

I hear you about that. I have a standing desk and a walking treadmill for the same reason I just find it a sitting thing. It’s unnatural. that people think of sitting as the new smoking. enough said about that.

We haven’t talked much about this topic, and I want to get to it before we conclude our interview here. What role does stress play in this overlap of heart health issues, heart disease, the expression of heart disease, and diabetes?

Joel Kahn, MD, FACC

Stress is a big factor and a tough one because we all have it. Some people manage it better, while others do not. Some people breathe and laugh and have music and get over it, and some people are stuck in a stress cycle where they’re just trapped in it due to their personality, background, or lack of tools. You have to have tools for stress. There’s no doubt. There was a famous study, I’m going to say, 20 years ago called the Inter-Heart Study Factors that Predict the Development of Heart Disease. It was a fairly large study, largely in Europe, and like psychosocial stress was up there, smoking and diabetes were predicting heart disease. Dr. Dean Ornish has been an advocate of learning about and managing stress to manage heart disease. His program for reversing heart disease includes stress management, breathing exercises, meditation, and yoga. There’s something called four, seven, or eight breathing. Go look it up. There’s box breathing; go look it up. There are various ways to manage stress without just completely freaking out. Also, it’s a big deal. It’s underestimated. It’s hard. I ask all my patients about stress and what tools they have to deal with it, but you need a tool, and the tool is invaluable. The tool is invaluable. The tool is an add-on, and the tool probably isn’t a bong. The tool is going to take a walk in nature, get a puppy, learn to meditate, and get eight hours of sleep. That’s probably the best diabetic prevention and stress management program combined.

Beverly Yates, ND

100%. I agree with you about that. I think that those tools are things that we can do that are simple and within our purview, things that don’t cost us any more money. We just need the information, and doing it is underappreciated. There’s not necessarily a pill to take for that. It’s just these lifestyle things that, although they seem simple, maybe aren’t easy. So we just need to give ourselves grace. I was talking with a patient yesterday about this. You resolve grace, take action, and build that habit the same way you have the habit perhaps of not caring for yourself, or you’ve got a situation that’s gone completely out of control. Do what you can to prioritize. Make your health your number one topic for yourself.

Joel Kahn, MD, FACC

I agree.

Beverly Yates, ND

As we wrap up here, I have one more question for you, which is this: When we talk about metabolism and metabolic illnesses in this regulation, diabetes, and heart disease unfortunately have this in common around inflammation issues. What are the best things people can do to lower their levels of inflammation?

Joel Kahn, MD, FACC

Number one, get checked because you may feel inflammation in just stiff joints and pain, but you can ask your primary care doctor specialists to do a simple blood test widely available and covered by insurance. It’s called five letters hs-CRP, High-sensitivity C-reactive protein. If you’d like to be under 1.0, that would be a really good place to be. 3.0 is a risky place to be, but you can lose weight. You can get checked for sleep apnea, and you can do a home sleep apnea test, particularly if your snoring or sleep is irregular. If you have sleep apnea, go find a specialist and get treated. It could be a sleep doctor. It could be a sleep dentist. But don’t ignore sleep apnea. It’ll ruin your brain, cause your blood sugar to go up, and shorten your lifespan, potentially. You can avoid inflammatory foods like processed garbage, added salt, and added sugar and eat whole foods, clean foods brightly, colored foods, clean foods, get out of restaurants and eat, and certainly get out of fast food restaurants. Eat more at home. Exercise is anti-inflammatory. Plant-based diets are an anti-inflammatory approach. There are supplements called CoQ10, turmeric, curcumin, and alpha-lipoic acid. You’re a fan of some of those things Dr. Yates does that are anti-inflammatory. But you can do it with natural approaches, too. You can see that blood level coming down. You can see your hs-CRP of 5.2 has come down to 1.9. That’s a huge, enormous reduction in your cardiac risk.

Beverly Yates, ND

It’s completely worthwhile, friend. Every word that Dr. Kahn has shared with us. It’s based on science; it’s based on clinical experience. It’s what’s working for humans right now. As we bring this interview to a conclusion, Dr. Kahn, thank you so much for being such a wonderful guest answering these questions and bringing clarity and light and science and facts along with your sense of humor here. I’ve had the opportunity to interview you before. It’s been a great time. Where can people find out more information about you and your work?

Joel Kahn, MD, FACC

You’ll find me in the produce department of your local grocery store, picking out my cucumbers and lettuce. You won’t find me there. Look for me online. The most central place would be where www.drjoelkahn.com. DRJOELKAHN.com. It’ll link it to my office, where I do telemedicine and live visits in Michigan. about 27 states’ weekly podcast books. I’ve written articles; I’ve written all kinds of fun stuff.

Beverly Yates, ND

Thank you so much for being a colleague and linking arms with me here around, helping people live healthier lives, and having quality, credible information that’s actionable so that they have the clarity to make the decisions they need to make so they have the healthiest possible life. Their life span equals their health span, because for a lot of people, they’re overliving in terms of health, and it’s miserable as they get older. We want people’s health span to overlap 100% with that life span.

Joel Kahn, MD, FACC

I agree.