Can Heart Disease Be Reversed? After His Own Heart Attack, This Surgeon Changed Everything | Dr. Jeremy London

21:36Dr. Mark Hyman:We've over-insected on LDL because we have a drug that treats it. The truth is that that may not be the right target for treatment. And when you look at the data, like even things like triglyceride to HL ratio is far more predictive than LDL. And that's a reflection of metabolic health. So high triglycerides and low HL means you probably are heading towards prediabetes. And that's really the driver. You sort of mentioned people can have normal cholesterol and have a heart attack or have, you know, treated cholesterol and have a heart attack. There was a big study that was like looking at, I think maybe you know the study, I think like 130 ,000 people who were admitted to the emergency room with heart attacks.

22:11And I think 75 % had quote normal LDL, but only like, I don't know, 10 % had normal triglycerides.

22:18Dr. Mark Hyman:like it was right. It was like, it was so, it's just not the only villain in the room. Yeah. And, and for most of us, myself included, that certainly was the case, you know, and I think that that's, that's the reality and that's, you know, understanding that you, we can all fall into this gap, recognizing it before we do understanding what we, what tools we have available, whether you can move the needle with lifestyle changes or you do all the foundational pieces, you eat well, you move, you sleep, you have your relationships in check, all those things, and you're still not right, you know, it may be time to consider a different lever.

22:58You know, people today think that taking medication is a failure.

23:01Dr. Mark Hyman:No, it's not. It's not. And it's both the fault of patients and physicians. Yeah. You know, I think about it like a scale. You know, at the one end of the patient scale, You know, you've got the individual who's like, just treat me, doc. I'll do whatever. I'll do whatever you say. And at the other end is, I don't want anything to do with medication. I can do all this myself. Somewhere in the middle is where we need to be. Well, the physician scale is not very different. You know, you've got on one end, the physician that's giving out medication like it's a Pez dispenser. Yeah. And I think, honestly, more dangerous.

23:37Dr. Mark Hyman:What's wrong with Pez? I ate that when I was a kid all the time. Depends on what's inside when you, when you heard that phrase. You're, you're about my age. I haven't heard that. I don't know. Do they still make those? I'm like. I have not seen them, nor have I looked for them. No, no, no, no. What that is. It's a little thing you had when you were a kid. It was like a, it was like a little device that popped out a little candy and you could just pop it in and it would pop out a candy. It was like. And that's exactly how they hand them out. And at the, you know, at the other end of the spectrum, and I think this is actually a much more dangerous mindset for physicians is we'll just watch this and wait.

24:08You know, you're doing great. Continue doing what you're doing with abnormal labs. And the problem is that's like patient-centric care masquerading in this other form. And in the end, these are risk-benefit decisions, right? Like, yes, do the foundational things. Do all the things that you need to do. But if that's not working, you don't leave your patient at risk. So both of those things are really at center line is where they belong, somewhere in the middle.

24:36Dr. Mark Hyman:It's true. There's a real need to know what your numbers are and use those to guide you as opposed to, you know, just you look fine or your basic cholesterol panel is fine. Cause that, like you said, for you, yours was a little off, but it wasn't terrible. That's right. And I think that's the way it is for most people. And so, so I think the key here is, is tracking your trends over time. Cause if you were 30 and you track your numbers, you'd probably start seeing them go a little off. And then by the time you're 40 and then 50, and then, you know, you're getting into your upper fifties, then you really already have the disease.

25:05Dr. Mark Hyman:Like you already had a problem. So really you wanted to start checking this earlier, right? For sure. And I think that my personal mindset is that atherosclerosis is something we have. It's not something we get. You know, if you look at autopsy studies from three-year-olds, there's a fatty streak in the aorta. If you look at the P-Day study, you know, autopsies from trauma in the field, 18 to 35-year-olds have early changes in their coronary arteries. Now, none of those things are causing any problems at that age, but the propensity for that is already there. Our goal is to get the runway out as far as we can to not have problems.

25:47How do we make choices that push our body in the right direction? How do we stay in that? That's the thing.

25:55Dr. Mark Hyman:So right now we know enough, like we know enough what to track, what to measure, how to test people. We can talk about imaging a little bit, but we also know that cardiovascular is mostly preventable. I mean, I remember, I remember learning about William Osler when I was in medical school and he was one, you know, the first textbook of internal medicine. He was at Johns Hopkins, this kind of very iconic physician we all learned about. And, and I remember reading about how when they would have a heart attack patient, it was a huge deal. And they would have the whole staff run the medical students, the residents, the doctors, the attendants would all come around and see this patient because it was such a rare condition.

26:28Dr. Mark Hyman:It was rare to have a heart attack back in 1910. Sure. You know, maybe if you were eating really crappy diet. Which was unusual. Because you could, yeah, if you were rich and had a lot of, you know, money, you could buy a lot of expensive, you know, starchy foods, whatever. I don't know. But the point is now it's so prevalent and, and we, we have to sort of be more, more diligent about actually helping people map out what their history is over time and tracking that. But what are the factors that people should be paying attention to? Because this is really a preventable condition. I mean, you're saying you want to take heart disease from number one to number two.

26:59Dr. Mark Hyman:What would be required to do that? Yeah, I think you started the foundation and this comes back from my time with you at the Functional Medicine Conference back in 20 years ago. So yeah, yeah, it was in Baltimore. We were young bucks. Yes, yes. I was going for early morning runs around Baltimore. It tells you I wasn't so smart then either. But really start with the foundational pieces. And I remember a friend of mine said, he was a wise, is a wise gentleman. And he said, you know, if a farmer looks out on his fields and all of the, if all of the plants are sick, if all of your crops are sick, where's the first place they look?

27:45It's in the soil. What are we feeding the plants? Sit in the airport and watch our fields go by. So I think that, I think being mindful of what you're putting in your mouth, focusing on a whole foods diet, limiting ultra processed foods, you know, limiting, limiting saturated fats in your diet. You got to be so careful these days with the, you know, the really kind of more fringe type choices, the more extreme choices, because you always have to be careful what you're substituting things for. Right. And so I think that that's a great place to start because it's something that we have such control over.

28:27Right. And I think our gut is such a primary source. Not that we understand the microbiome fully by any stretch of the imagination. But I think the principle really holds. You know, what we feed ourselves is our cells is the information that we're going to give our body to live on. You can connect those dots. I think most of us can connect those dots. And when you're thoughtful about it, you just feel better. I mean, I've had personal experience with that. Clearly, movement every day is critical, both aerobic training and strength training. They're great independently, but compound dramatically when they're put together.

29:08My personal Achilles heel, sleep, you know, I can tell you when your sleep is off, everything is off. and for me personally, it's the hardest because, you know, I can control what I put in my mouth. I can push myself to go to the gym. The harder I try and control my sleep, the worse it gets. So I've had to change my relationship. What have you done that's helped it? The biggest things I've done is changing my sleeping environment. Dark, cold, taking a hot shower before bed so that I know that my body temperature is going to drop to help. Going to bed at the same time every night, setting alarm to make sure I'm going to bed at the same time, as well as waking up at the same time, trying to get outside as much as I can just to get sunlight in my eyes.

29:56And can I tell you that it's perfect? No. Is it a lot better? Yes. And again, know your numbers. You know, I followed, I've been following my HRV, my heart rate variability, which is a wonderful indicator of your autonomic nervous system. Since you are pushing me for my numbers. I will tell you what they were and what they are now. My HRV was running between 15 and 17. And now I'm running in the mid to upper 30s. And occasionally I'll hit a 50 if I really am well hydrated. So I'm on the right track, but is it, is it? No, it's not. It's always a work in progress. I am definitely that.

30:38Dr. Mark Hyman:So, so really this whole epidemic of heart disease is largely preventable. If you address diet, if you exercise, if you sleep, if you manage stress, if you avoid smoking, if you manage your blood pressure, which also is a big factor. And it's very much related to insulin resistance and prediabetes and this whole same phenomena is what causes high blood pressure. So these are all separate problems. Blood pressure and heart disease and high cholesterol, they're all like, they're all kind of one thing. Nothing happens in a vacuum in the body. You know, it's one big ecosystem. And so when you start to knock off all these factors, you can start to really change things.

31:14Dr. Mark Hyman:And then also, you know, connection, community, stress is a big factor. I think a lot of people are lonely in that it's like smoking 15 cigarettes a day in terms of its effect on your health. And there's some very interesting studies looking at the gene expression patterns under stress. When you're lonely or isolated, you produce more inflammatory genes expression. So have more inflammatory proteins out there in your body and causing more damage. And I, and we know heart disease is an inflammatory disease, right? For sure. Maybe we can talk a little bit about that. Cause I think, you know, we used to think that it was just plumbing problem.

31:47Dr. Mark Hyman:You know, you were, you're a plumber essentially. You're like, Oh, I am do cardiac bypasses and open up arteries and fix aortas and fix, you know, emeral arteries and all these things that they get clogged up. And so it's kind of like a plumber going in and rerouting the pipes or opening up the pipes, cleaning them out. And the truth is, it's not necessarily just a plumbing problem. It becomes a plumbing problem, but it starts off as an inflammatory problem. And there's ways to check that. So tell us about the role of inflammation and heart disease and also about how do we measure that. So I want to separate the roles of inflammation and heart disease, because I think that there is a bit of a misconception in the lay public when it comes to how we think about systemic inflammation versus specifically what's happening at the arterial wall.

32:36So when we talk about the inflammatory process, specifically when a plaque or a blockage is forming, the wall of the artery is penetrated by an APO-B-driven molecule, lipoprotein, if you will. That then sets off a cascade of events, one of which is an intense inflammatory reaction in the arterial wall, which draws those inflammatory cells into that area, which then starts this cascade of collection of more cholesterol, a healing process that then starts. And it's that healing process many times where we start to see the actual stenosis forming. So we have a local form of inflammation that's a result of an injury repair pattern, if you will.

33:26But the question is what made the arterial wall vulnerable at the first place. And that, I think, is a distinction that people don't truly understand. Right. So if we break down what's actually happening, there's two components. The artery wall is being attacked, and then it's the integrity of your endothelium or the intima, the inside lining that is either capable of fending that off or it's vulnerable. So it's the balance of those two things. I think that you have to kind of separate what's happening from an inflammatory standpoint, because if you talk to a pure lipologist, they're going to tell you CRP doesn't have anything to do with creating a stenosis.

34:15Well, specifically, they're not wrong. You can't, having that inflammatory process in the wall of the RD isn't going to show up on a CRP. But CRP tells you what the general environment is. What the general environment is. However, my perception of how to utilize this is it's an indicator of your endothelial resiliency. What are the things that are keeping the endothelium intact that are guarding against those outside forces? And when you have insulin resistance and metabolic syndrome and inflammatory factors, those are, look, we know that just elevated chronic glucose alone is impacting the vessel wall.

35:05Again, making it weak, making it more susceptible. And that's why it's an equation, really. It's more of a heuristic than it is an equation because it's more of a guide, you know, just to understand that these are balanced. So when we start to talk about those things, like what can we do differently, exactly what you said, how do we put the fire out that is creating this vulnerability that then creates a ripe environment for injury to the wall itself?

35:38Dr. Mark Hyman:Yeah, I mean, I think that's an important distinction between, you know, the inflammation at the local level and systemic inflammation that sets the stage for things to go wrong. Yes. And then that you talked about insulin resistance, you know, pre-diabetes insulin resistance, belly fat, those, that belly fat's producing a whole cascade of inflammatory molecules that's spewing out through the whole body and it's causing havoc everywhere, including on your arteries. And that's, you know, that, that's really people understand that sugar is inflammatory, that sugar and starch are inflammatory. And that's a lot of what's driving it.

36:06Dr. Mark Hyman:obviously it's pollution, it's stress, it's, you know, microbiome, there's a lot of other factors, but, but that's predominantly what it is. And I think, you know, most heart attacks probably before the last, you know, 60 years were probably not metabolic syndrome. They were probably different. Yeah. You know, they were smoking, they were, you know, people were thinner, they didn't have all the sugar and starch. I think it's changed. I, I, I think if you look at it, it's changed. And what's interesting is that doctors aren't measuring insulin and they're not measuring insulin resistance. Mine had never, mine had never been measured.

36:34Dr. Mark Hyman:Yeah. Until, until. And here you are a cardiac surgeon and probably the most important predictor of whether you're gonna get a heart attack is your degree of insulin resistance. And yet it was never measured, which is just sort of staggering. There's actually a new test that we offer through Function Health, which is called the insulin resistance score, which is a, it's, it's the most accurate measure of insulin resistance that we have now, other than more of an interventional lab test, which is called like a euglycemic clamp test, which you wouldn't do as a research study, but it's, it, it's better than the calculated version we used to call HOMA-IR, much, much better than that.

37:07Dr. Mark Hyman:And you can now measure using a C-peptide level and an insulin level using mass spectrometry. And we offer it through function health. And it's, it's amazing to see how, you know, where people are on the spectrum and then you can actually monitor it like an A1C and see how it changes. And I think, and I think that that's been one of the biggest limitations with the insulin level is the lack of standardization across, across labs, you know, what are the numbers actually mean? What's the standardization? So I think to, to have something that's got some real data behind it, it's going to be really powerful and, and something that we can actually, actually count on.

37:43Dr. Mark Hyman:Yeah. It's pretty exciting. So now with the deeper diagnostics, with becoming more affordable, with accessible diagnostics, people can actually know what's happening. And I think people should start early, like get a baseline in your twenties, see what's going on, you know, and I think, you know the heart imaging era is also changing so before you'd have to do an angiogram you have to stick a big catheter in a guy's groin you'd have to shoot die up there you put a lot of x-rays on it was a whole thing and then you wouldn't that accurate a test how often you'd miss stuff that was you know concentric plaque or you'd miss some stuff you know then then they developed like more interesting tests like a ct angiogram and they now have ai and ct angiograms which are really interesting.

38:26Dr. Mark Hyman:So you can look at soft plaque and hard plaque. And now we can do also a chest and heart CT scan, looking at calcium in the heart. How do you use the imaging, like the coronary calcium score or the AI enhanced coronary angiograms on CT scan? How do you use those? So I think that this is very much an evolving space very, very quickly. And as you pointed out, it kind of started with the early CT calcium scoring only then to CT angiogram, et cetera. Now, I will say that coronary angiography is still the gold standard with FFR measuring actual drop in pressure across stenoses or questionable areas using intravascular ultrasound.

39:18I think that there are ways that, again, like the imaging has progressed for the less invasive or non-invasive. It's also progressed. It's also progressed on the other side to address the things. So I think these things are complementary. I think that for sure, until we added CT angiography, really knowing soft plaque is so important. Now, knowing calcific plaque burden is helpful as a screening test if you're out totally normal or on the other end of the spectrum. It can get really gray and can really confuse things sometimes in asymptomatic patients without any symptoms that are in that middle ground.

40:01It can, you know, it can, it can require further investigation.

40:05Dr. Mark Hyman:But as a CT engeogram. Exactly. Yes. It's a good screening test. That's normal. You want to follow up. Exactly right. And now with this AI component, I think it's going to So when you can digitize the information and you can actually not miss the calculation, it becomes less of a subjective reading and more of an objective reading when it comes to actual measurements. The accuracy, I think, of those tests is going to change dramatically. Now, how is that going to look clinically? What is that going to look like for outcomes? All of those things, or that's why I say I think it's just an evolving space right now.

40:43Dr. Mark Hyman:And it's important because, you know, I'm sure you've seen patients like this, but, you know, I have patients who have perfectly normal labs, but have plaque and clogged arteries and people who have, even the labs you would expect would be abnormal or people who have terrible labs and whose arteries are normal. Yes. And, and I'm like, wow, well, you have a high particle number, you have high APOB, you have high LPA. I'm like, you should be having a heart attack right now, but you're 65 and your arteries are clean. So I think for me, what it's taught me is that I can't really put people on a lifetime prescription or a medication unless I know the anatomy because cholesterol is a risk factor.

41:20It's not the problem.

41:22Dr. Mark Hyman:It's a risk factor. And sometimes it's high. Sometimes it's not. Sometimes, you know, treating it isn't the real solution is figuring out what the other causes are and treating those like insulin resistance. I think you make a great point. I mean, it's like every decision we make in medicine is a risk-benefit decision. And, you know, you have to make certain that you're maximizing benefit and minimizing risk, and you're mitigating in favor of that patient. And you can't rely on just one number or even two numbers. You know, each patient is so dramatically unique and different. just because there was a pulmonologist who said to me years ago, he said, Jeremy, the protocols are the practice of medicine.

42:10Knowing when to and when not to apply those protocols is the art of medicine. And that's what you're talking about. It's like if you followed the protocols, and there's nothing wrong with that. We all follow the standard of care protocols. Those are our guidelines. But if you plugged that patient into the protocols, you would have put that patient on medication right away without any additional information. If you would own, because, but you were thoughtful about that particular patient. And I think that that's so incredibly important, you know, and one of the things that is of concern for me as I look at medical education moving forward, because there's such a high reliance on protocol driven medicine, which is wonderful.

42:58Well, it's the baseline.

42:59Dr. Mark Hyman:It doesn't go deep enough. It's a place to start. If you follow the standard protocol, you're not getting lipid fractionation. You're not necessarily checking APB. You're not checking LP-A. You're not checking in some levels. You're not checking in some resistance scores. You're not checking all these other things that are so important that have to be part of a full clinical picture to make a decision. Right. That's what worries me. It's not that it's not a good starting place. It's just inadequate. Yeah. Yeah, I think that's, yeah. I think you're right. It's not that it's wrong. My medicine right now is LDL is high, statin.

43:28Dr. Mark Hyman:Like that to me is completely screwed up. It's not wrong. It's incomplete. Yeah. You know, I think is the way to look at it. And, you know, at some point, you know, maybe listen to the patient. Yeah. Examine the patient, you know, do the things that you, be a doctor first and then understand how to put all these things together to make the best decision. Discuss it with the patient, God forbid, you know, and let them be a part of that decision making. And I think that's one of the great things about function health, right? It allows patients to regain a fair amount of agency in their own healthcare.

44:07And I think a lot of patients want to do that in this day and age. I think that people are frustrated because access is such a problem. Pick up the phone and try and get an appointment with your primary care physician. It's hard. And I'm not suggesting that it's intentional. They're busy and they're seeing a lot of patients and it's tough. And I think that to really regain that agency and to take full responsibility for your healthcare, you have to have options to be able to actually follow through with that. And I think that's one of the great opportunities that Function Health offers.

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45:48Dr. Mark Hyman:Cozy Earth's bamboo sheet set has been a game changer for me. The fabric is soft and noticeably cooler, so I'm not waking up overheated in the middle of the night. I've also been reaching for their all-day tea a lot lately. It's soft, it's lightweight, and it still feels comfortable even on long, hot days. Sometimes the small things in your life can have a bigger impact on how you feel than most people realize, especially when it comes to comfort and sleep quality. If you're looking to upgrade your daily essentials, head to cosier.com slash hyman and receive 20 % off it addresses some of the gaps you know some of the gaps that are out there in terms of how we're trained as doctors how we approach prevention we're kind of in a reactive system not a proactive system and i think about heart disease i mean by the time you have plaque it's late in the game when you have a like what you had with the symptoms of chest pain and needing a stent i mean that's kind of down the road yeah and who knows what would happen if you would have found this when you were 35 and you'd done a heart uh see a heart CT where you did a calcium score and you had your APOB checked and your insulin checked.

46:47Dr. Mark Hyman:And I think that's where we are now in medicine, which is that we have to have more agency as individuals and not just rely on the healthcare system because the training is going to take a few decades or generations to change. It takes a long time for medicine to change. It's turning a battleship. You know that better than I do. Yeah, I tried. I was at Cleveland Clinic for 10 years. It was a very big battleship. Yeah. And they were very open. It was great. We did a lot of great work there, but it was also it was very hard to to get people to change how they think you know to really do more of a proactive approach i want to sort of talk a little bit about this set of idea about this person who looks healthy having having a heart attack and what you would advise people to sort of check because like you know for me like i exercise i'm you know my body fat is 10 i eat healthy like i shouldn't really have a problem so why would i bother checking but actually i did check.

47:39Dr. Mark Hyman:And because of my family history, like everybody, my grandfather's side dropped dead in their fifties. I'm like, I got a problem. So I had to manage it. And I think, you know, I wouldn't have thought I would be a person who would have high risk, right? Cause I've been running since I'm 14 years old. I've been eating healthy my whole life. I've been, you know, just, I mean, yes, I'm stressed like sleep issues cause I'm a doctor and life in general, but like I, it was, it was interesting. So what would you advise people who are listening, who think they're healthy, what should they be doing? What should they be checking?

48:09Dr. Mark Hyman:What should they know? And when should they start doing it? Let's start with the simple things first. Get a blood pressure cuff at home and check your blood pressure. You know, if you can't do that, find a friend that has a blood pressure cuff and take it on a regular basis. You know, it's really the silent killer for a reason because it's not a problem till it's a problem. Most 50 % of Americans have it, and many Americans don't even realize that they have it. And it's the most modifiable, the most easily modifiable cardiovascular risk factor that we have. And it's just back to that same tenet.

48:47If you don't measure it, you don't know. And it's so easy. And doing it once at your primary care visit is not enough. You know, You need the 7-2-2 rule for seven days, twice a day, two measurements, record them, take an average. That's what your physician really wants to know and what they need to know to be able to come up with an accurate number. So I think that's a great place to start and to really potentially move the needle because it's such a significant component of cardiovascular. Blood pressure, yeah.

49:17Dr. Mark Hyman:And blood pressure is not just random. It's caused by certain things that you can actually figure out too. Well, that'll come to the next suggestion. and this goes along with the how we look issue. It's not always your weight. It's the distribution of your body fat. And that's why I really recommend that people are checking their waist to height ratio. Very simple to do at home. And that - Tate measure is a very cheap medical device. It really is. Be honest about where it is and where you're measuring it. That's the - Belly button. Be at the belly button. And you don't want your number to be greater than 0.5.

49:54And that's just an indicator, again, of, you know, the amount of intra-abdominal fat, that visceral fat that functions really as an endocrine organ, if we look at it for what it's actually doing. And again, what you're saying, there's drivers of all of these things, and they're also interconnected. So I think those are two very simple places to—

50:16Dr. Mark Hyman:Blood pressure and waist to height. Blood pressure and waist. And then you get down to— And waist to height would be waist in inches and height in inches. That's right. Or centimeters in both. You know, just keep the units the same so that you make sure it's an actual ratio. It should be less than 0.5. Exactly. And that gives you something to really follow and track progress, both blood pressure and something that you can do at home. You don't have to go to a physician's office. You don't have to do any of that. You know, from there, I think we look at some of the specific labs that I think people should be checking.

50:50I think an ApoB is crucial. LP little a, for sure, at least once in your lifetime because it is a genetic factor. I think that menopause may change those numbers slightly. So I think for women, directed by your physician, it may be best to do it pre or perimenopausal and after menopause as well.

51:13Dr. Mark Hyman:There may be some ways to modify that. There's also new drugs that are coming around that might be helpful for that. And absolutely. And now they're coming out of phase three clinical trials. It'll be interesting to see where those end up because the question, of course, will be just because you can lower LP little a, what are the outcome studies that are going to be as a result of that? But story still to be told and very promising, which is great. I think that that's very useful. I think knowing your hemoglobin A1C and some form of fasting insulin is just really, really important. And I think if those are really the core that are not on a standard panel at all, CRP is kind of plus minus.

51:58I think there are a lot of primary care who are starting to do it. Those are really not. Unless there's some trigger for hemoglobin A1C, they're just not. They're not checking it. They're not checking insulin. They're just not checking it. Mine wasn't checked. No knock on my primary care physician because I'm sure.

52:13Dr. Mark Hyman:We're just not trained that way. And these are really affordable tests. I mean, they're all included with, all the things you mentioned are included with a lot of other tests, like 160 tests for literally just a dollar a day, $365 a year for twice a year testing. It's not free, but it's not that much considering when people spend money on coffee and whatever they spend loosely money on, it's investing in your health. And sometimes the doctors won't do it. I met with the dean of the medical school in Bentonville, the Dallas Walton School of Medicine. And she's, I think, a gynecologic oncologist.

52:53Dr. Mark Hyman:And she said she's of Indian descent from India. She went to the doctor, to a cardiologist, said, I want you to measure my insulin. He's like, no. And he wouldn't do it. And he's like, yeah, well, we know at lower body weights, we get more insulin resistance. So like, I want to check it. And he's like, we don't need it. And it was just that level of just, she said she went to her doctor and said i i want to get my vitamin d checked because i don't feel so great i'm tired so you don't need it she said i don't care i want it she said my insurance won't pay for it well she said i don't care i want it she got the vitamin d and it was zero oh wow because she was you know dark skin lived and worked inside you know i didn't go out much you know so i think we're missing so much and that's you know really why a company like function health that i co-found has really started to give people agency to know what's going on to not have to be someone like you who's, you know, at 57 has, uh, blocked arteries and wish they could have figured that out sooner.

53:45Dr. Mark Hyman:Right. Absolutely. Hopefully your son's getting all those tests. Oh, and then some he's, I think he is going to be a lipologist before the end of all of this. I can tell you, um, because he probably knows more about lipid metabolism and genetics than I do at this point. Is he in medical school? He is not. No, he is not. You know, you spend a lot of time like fixing damaged hearts, like literally. And you now want to help people never have surgery. So how do you think about really move, bringing that mission and moving that into the world? Like coming out of my podcast is great. You're writing a book, you have a website, you have a podcast, but like, how do you see kind of doing this for yourself?

54:24Well, I hope that sharing my story and being willing to allow people to peek behind the curtain, if you will, and admit that none of us are immune, it may not prevent people falling into that cognitive dissonance gap, but you will think about it. So my hope is that I can raise awareness. And then by really trying to communicate relatable, high-quality health and wellness misinformation that's really tactical in people's lives, you know? And the world that we live in right now is so maximize, maximize, maximize, maximize that everybody feels like they're taking a test. And if they miss one thing on the protocol that they failed at that, and just give everybody an opportunity to let their shoulders down a little bit, take breath, and know that if you miss one workout, you haven't failed, you're just going to come back the next day and start over.

55:30And to help people really integrate that into their lives, the really foundational pieces, and then helping them understand, well, what's the next layer of that? Okay, you've done the work. Check your blood pressure. Check your body fat distribution. Check your labs. You can't fix what you don't measure. Be proactive about, you know, atherosclerosis, which is something that we know we're born with, something we have. It's not something we get. We get the problems. Can we keep inflammatory factors at the lowest? Can we keep our insulin levels where they need to be so that we don't have problems at 57 years old?

56:11Dr. Mark Hyman:Yeah. True. Very true. All right. Let's do some rapid fire questions. You ready? I'm ready. Okay. So what's the single biggest mistake people make when it comes to heart health? They think it's not going to be them. They convince themselves that I'm fine. It's just not going to happen to me. That's an important one because a lot of people stick their head in the sand and they wait until it's too late and medicine just doesn't seem to focus on prevention. So what's one heart health myth you wish would just go away? The one that I deal with on a regular basis is that patients that come in with heart disease and get a stent or bypass surgery think they're cured.

56:47And I always tell people, we're not treating the underlying problem. All we're doing is getting you out of trouble. You now have to do the work because the process is still going on. I think when you crack somebody's chest, they change their lifestyle, but often not. Most of the time not, because I think there's a misunderstanding that they think we've cured the problem. And really all we've done is gotten them out of trouble. We can save you. We can't heal you. And when you tell them that, do they get it? It depends. You know, it depends. I mean, I lay it out. I say, if you're going to continue to smoke, all bets are off.

57:22We've taken all this upfront risk. I'm not going to soapbox you about smoking. This is your decision. These graphs could be done in six months if you continue to smoke. We've taken all this upfront risk for an operation. You don't want to be back to do it again. But I think that's one of the things, it's more of a misunderstanding than it is a myth, but it's become kind of the perception.

57:43Dr. Mark Hyman:What's the most underrated habit for preventing heart disease? A 10-minute walk after meals. 10-minute walk after meals. Why? Because it keeps blood sugars under control. There you go. It keeps your blood sugar and insulin. Yeah, because your muscles can take up glucose without actually needing insulin, which is amazing. But insulin obviously helps, but it's true. I think it's a very simple habit. What's one food you wish people would eat more of? Fiber. Fiber. Why? Well, because it helps control blood sugars. It helps with cholesterol metabolism. It satiates you. And so you eat less. Look, it's not sexy, but - And it's good for your microbiome.

58:21And it's critical. I agree with you.

58:23Dr. Mark Hyman:It's critical for your microbiome. I agree. And the side effects of eating fiber is eating a lot of other plant foods. Exactly. So it's like, how about what do you wish people eat less of? Saturated fats. Saturated fats. Okay. We didn't really go into that too much, but you know there's been a lot of controversy about saturated fats yeah and i'm a believer i think it's you know i'd love to hear your perspective because i i think my my understanding in literature and also treating you know thousands of patients is that it's so individual yes yes like i had a patient who a patient who was a overweight woman um she had high triglycerides like 300 her hdl was like 30 her you know particle number was high she was insulin resistant she was pre-diabetic she had a1c that was up and i said to her look she was struggling with weight loss and just couldn't knock it down and i said well why don't you try a ketogenic diet i put her on coconut oil and butter saturated fat her ldl came down 100 points her triglycerides came down 200 points her hdl went up 30 points i was like and she lost 20 pounds and her insulin resistance went away and she went on basically a ketogenic diet with saturated fat another guy was a thin biker he's like i heard this keto diet's great i don't know i want to try it i'm like i don't think you need it, but like, okay, but let's monitor what you're doing.

59:36Dr. Mark Hyman:And he was riding this bike 50 miles a day. It was like super healthy and ended up causing his cholesterol to go exactly the opposite direction. High particle number, you know, lots of small particles, high LDL. I was like, wow. Okay. So there's a lot of genetics involved here and, and different people respond differently. Exactly. Exactly. And I think that that's why following the biomarkers are so important. But my impression is that if we look at the bell curve and we look at the majority of people and how they're going to respond with saturated fats, they're going to fall into a place of concern.

1:00:14I don't know that they're going to fall into those outliers. I think it's more of a risk factor than not, but you don't know until you know. Okay.

1:00:23Dr. Mark Hyman:What about saturated fat versus sugar and starch? Who's worse? Which is worse? I mean, I think it would depend on how much of each. I think if you're going to eat only saturated fats, you better follow your biomarkers very closely. If you're going to try to cut out all of those things and you're going to shift to, you know, eating a lot of higher carbohydrate foods, you need to follow there too. You need to be following your blood. I think there's a balance between those two. Yeah, check your numbers too. Yeah, check your numbers because we all metabolize differently. What about non-negotiables in nutrition?

1:00:56Dr. Mark Hyman:It's just like something you never do. Mine's pretty general. I adhere to an 80-20 plan. I do the best I can 80 % of the time, and I know it's not going to be perfect, so I grace myself for 20%. That's my non-negotiable. And the 20 % is what? You're not having Twinkies. No, I'm not having Twinkies. It's bread or pasta or a piece of cake and a birthday party. So real food, but not ultra-processed food. Exactly. Essentially removed ultra-processed food. I think that should, just for people listening, that 20 % should not be soda or industrial processed food. Yes. Those are deadly, and they're not actually food by definition.

1:01:32Dr. Mark Hyman:They're edible food product. I mean, it's true. If you look up the Webster's Dictionary definition or a funken-wagin of food, it's definitely not what ultra-processed food is. That's defined as something that supports the growth and health of an organism, which none of those things do. What about in terms of exercise, cardio or strength training? Individually, they're strong together. they're exponential. You know, I really, if you look at the data, the VO2 max and aerobic data is certainly very potent and significant when it comes to decrease of cardiovascular events. There's no doubt about it.

1:02:07We look at cardiovascular health and when it's measuring how efficient our cardiovascular system is, what does that equate to? That equates to ejection fraction or how much heart is being pumped out of the heart with each beat. We know that ejection fraction is directly related to longevity and survival. So the data is powerful there and, you know, connect the dots very literally. It really is. But when you look at strength training and we talk about muscle and it being the sink for glucose in our body, it's like they're so hard to separate. I get asked that question all the time. And, and I just, look, we're, we're all drawn to one or the other.

1:02:49You know, I'm working with this woman now. She is an endurance runner and she hates to do resistance training.

1:02:55Dr. Mark Hyman:I'm like, you have to do resistance training. That was me. That was me. I was 40 skinny, could run a lot, but bike a hundred miles. But like, I couldn't do 10 pushups. And I did the same thing. I was an endurance athlete. And I think that physiologically we're very fit, but mechanically we're not. And that comes to being able to do things as we get older, but more importantly, We know we lose muscle as we age. We know how important it is for our overall metabolism. It's true. It's definitely, I've indexed way more on the cardio for most of my life. In the last five, six years, I've been more on the strength training.

1:03:25Dr. Mark Hyman:Okay, what about a piece of advice that every 30-year-old should know? That it's never too early to start because the deadlifts you're doing at 30 ensure that you're able to pick up your suitcase at 80. The aerobic training you're doing at 30 is what's going to enable you to, you know, travel and have the endurance to be able to do the things, the decisions you're making now are not going to just impact your overall cardiovascular health, but they're going to change your functional capacity later in life. It's just... If you want to enjoy the fruits of your labor when you're older, you have to take care of yourself when you're young.

1:04:02Dr. Mark Hyman:That's right. I see that often. People like run themselves on the ground, they retire, and then they just can't do anything. That's right. What's one thing you wish every six-year-old would know? I would flip that corner around. It's never too late to start exercising either. And we know the data with that, right? We know that you take 55 and 60-year-olds that have never exercised in their life and you watch how their heart function changes in a very consistent regimented program, it gets stronger. So it's never too late. But start small. Make it fun. Pick things that you want to do. Pick things that are enjoyable for you.

1:04:39Dr. Mark Hyman:I love, I love, um, that's sort of like the guys at 65, never exercise starts rowing. And now he's like fitter than most 30 year olds, you know, like he's 95 years old. Yeah. Well, and remember too, like particularly in the beginning, that's when they see the biggest benefit when you've gone from never exercising to a consistent program, they get a huge, but so it's never too late to start. All right. Now as a heart surgeon, what's, what's one thing you avoid? There's so many things I got to pick one, huh? Or maybe how about this? What's one thing you avoid that you actually like that you don't want to avoid?

1:05:07Well, I'm going to zoom out way far on you. The one thing I avoid is complacency. Because I think that that's a very, very dangerous place to be. And I think that's very much where I ended up because I felt like I was checking all the boxes. You know, I was doing triathlons. I was competing at the iron distance. I was doing all this, doing all the stuff, right? But I became complacent in how I evaluated things. And to me, the willingness to change is what allows you to grow and to change and to change paths as the road changes underneath you. So I avoid complacency.

1:05:52Dr. Mark Hyman:complacency. That's good. I like that. I like that advice. And lastly, if there's one biomarker you get to pick as a heart doctor that everybody should check, what is it? ApoB. ApoB. Okay. Everybody get their ApoB done. Yeah. Okay. Great. Amazing. Well, thanks Jeremy for sharing your story. Thanks for your vulnerability and getting other people to think differently about this. Cause you know, you've been at the, at the shit end of the stick of the plumbing problem and heart disease for a long time. And I think, you know, waking up to the fact that this is actually a preventable disease that we actually can move the needle on this, that if people actually knew what to look for, what to do, what to measure, and how to change their habits, that we can actually beat this thing.

1:06:27Well, thank you so much for having me. I really enjoyed it. Thanks, Jeremy.

1:06:30Dr. Mark Hyman:Yeah, man. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to The Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on The Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic, and Function Health, where I am Chief Medical Officer.

1:07:02Dr. Mark Hyman:This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness Center at ultrawellnesscenter.com and request to become a patient.

1:07:35Dr. Mark Hyman:It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public, so I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.