Must-Hear Health Hacks From the Doctors who Saved My Life

0:28So, hey, guys, are you frustrated with where you're at right now?

0:33This is The Admirate Show. Okay, welcome back to the show, everybody. I am joined today by my two incredible doctors. And when I say incredible, I mean they're among the most important people in my life. And so they've both been on the show before. Let me introduce them properly. Dr. Amy Donine is the medical director at the Prevention Center for Heart and Brain Health. and she's got a book that just came out recently called Healthy Heart, Healthy Brain. She had a previous book called Beat the Heart Attack Gene and I credit her with me being alive. I think she saved my life and I've referred her many friends whom I also believe are alive because of her work and care.

1:16She's a treasured human being in my life. The other wonderful woman is Dr. Gabrielle Lyon. She's a Washington University fellowship trained physician. Postdoctoral training was combined with research in clinical medicine, fellowship in nutritional science, obesity medicine, and geriatrics. She's also board certified in family medicine. She just had a book come out that was on New York Times, bestselling book called Forever Strong. And she treats some of the most influential people in the world. She also treats warfighters that have been under tremendous stress. So she treats people under great stress.

1:51And so we're going to talk about your health today. Before I do that, just a little thing on my health. They've sort of done an intervention, these two on me recently and have been for years, kind of asking me to downshift. Yes. And step away a little bit. And so I'm going to step back a little bit from some of the things that I'm doing. One of the easiest things to step away from is this phone right here and put that down, which means I'm going to step away indefinitely for social media and some other things. Go ahead, Gabrielle, you wanted to say So Amy and I have been caring for you for years and the pace that you are up against, you know, and again, I take care of war fighters and you're traveling roughly 321 days a year.

2:33It's a lot. You've got multiple businesses. You have a TV show podcast. I mean, what people see on social media is just the tip of the iceberg. You have Arte, you have all of these things. And an individual can't keep up that pace. you know, war fighters go on a deployment and then they come back and then they settle in and you're not deployment after deployment. There's a pause. And, uh, both Amy and I, as your physicians have really been at you for well over a year to take a little bit of a pause. So, um, I think it's the best thing for you. Thank you. Yeah. We're proud of you. Yeah. Thank you, Amy.

3:15I made a promise to my dad before he passed away that makes me emotional, but I made a promise to my dad if I got a little bit worse health-wise that I would downshift a little bit and take a pause. And so just do a little bit of that, you know, bag social media for a while, a little bit less speaking, strategic in my businesses, and everything will be just great. So anyway, guys, excited. We're proud of you. So let me also add to this. You've been dealt with some genetics from your parents who are lovely and they handed you some cards and you've dealt with those beautifully throughout your lifetime.

3:50And we know that stress, which is sort of being in an environment for which you don't have a sense of control over, can actually cause oxidative stress and inflammation in the arteries. and with your genetic predisposition to arterial disease, having this just overhang of stress and workload. And Gabrielle, what did you say? 300? Ed, you told me this too. 300? He travels 321 days a year. And do you know how I know this? Because, well, number one, I'm his doctor. I keep track of him. And number two, I will see him again. We are at mutual events. We have mutual friends. I will see him one day in Las Vegas, then going to Dubai.

4:32We're not talking about to Ohio. We're talking about to Dubai the next day and then back again. And this, I think, reaches out to the listeners and the viewers as well, is that also community and being with family is really important. And this community here is like an extension of my family. So I have the two most brilliant people that I know in my life right here with you today, guys. So we're going to talk about your health a little bit and just some things. And by the way, this is every single age because what Amy referenced about genetics is really important. And so we're going to talk a little bit about that today.

5:08Let's start out just talking about something that most people don't do, but they should. So, Gabrielle, I'll go to you first. What's the importance of getting your labs drawn on a regular basis? And is there an age of any age that you recommend somebody begins to do that? How often should they do it? I'll mention for adults. Children are on a pretty rigorous schedule as to when they're being checked for anemia or lead, even vitamin D nowadays. For an adult, after individuals go to college, it seems as if things fall away. I definitely recommend individuals at 18, if you are listening to this and you are inspired by Ed and you just happen to have a leg up and are involved in the entrepreneurial world, 18, great.

5:51We can get a baseline testosterone. We can get just baseline, even as Amy will mention, LP little a baseline cholesterol screening. And I know it sounds early. However, diseases of aging and metabolic diseases like Alzheimer's, like cardiovascular disease, they begin decades earlier. And those are things that people don't recognize. Typically, individuals will wait until I've never been to a doctor. Now I'm hitting 30. Maybe I should go. The best time to start was yesterday, but the second best time to start is today and getting not even yearly labs. The younger you are, and if everything is metabolically healthy, every six months to a year would be okay.

6:37But as individuals mature, that window of opportunity to correct things from an underlying perspective that can do damage over time, this could be quarterly labs. It's very challenging for people, but orderly labs, in my opinion, and I think Amy's opinion at some point is really ideal. Yeah. I got to tell you, and also everybody, you know, this is why I care about you all so much. Just because you feel good doesn't mean it's great under the hood, right? Because this river of life is your blood and you can feel good. And in fact, when I met Amy, I don't know what was Amy, 10, 15 years ago, I didn't really feel that bad.

7:14But I had known that there's a genetic history. I didn't have the test yet, but I knew there was a genetic history in my family of different things. My dad's brother died very, very young. And so when I went to see Amy, I was very shocked by what was going on in my blood. And there are markers, everybody, that I think, Amy, most people do a generic lipid panel. But things have advanced significantly that should be tested for now. the last 10 years, even five years. What are some things, this is going to be so good for all of you, everybody. What are some things that most, like markers people should be getting tested for, Amy, and what, why, what they indicate and what we're looking for in those markers that probably most people don't get tested for?

7:55Yeah, absolutely. One of the things to remember is that arterial disease, whether it be the small vessels that leads to things like memory loss, vision changes, kidney disease, decreased blood flow to the toes, is the same disease state that also drives your risk of heart attack and stroke. So the little vessels and the big vessels are telling the same story. So part of the most critical thing that is not, things that aren't done is looking for inflammation. So if we are able to monitor inflammation, some of the inflammatory labs have what we call biovariability, and those can be thrown off if you hurt your back, if you're, you know, have an infection and so forth.

8:36But some are very, very specific for arterial wall health. And they're not skewed by things that life can throw at us. So those are things, if I want to be specific, there's one called LP-PLA2 that is indicative of stroke risk. There's one called myeloperoxidase. There's some simple things that are out there for everyone. One is called HSCRP. These labs are easy to get. They're very cost effective. And if there's inflammation, we want to pause and ask why. And when we look at, and Gabrielle, at all the root causes of arterial disease, the ones that are just kind of touched on right now that we hear about are blood pressure, cholesterol.

9:19And if you smoke, stop. You know, if you're exposed to nicotine, stop. Those are the three that we're evaluated with. Matter of fact, we take our age, our gender, we smoke or not, or blood pressure. cholesterol and that's it but in the in reality there's so many others there's genetically inherited lipids like lipoprotein a there's a lipid that everyone needs to know about called apob which is like a collection of all the bad guys we need to know gabriel you touched on this metabolic health so pre-diabetes which is the fasting growing condition in young adults it's terrifying so doing glucose tolerance testing and and oral health ed you and i have talked about oral health and sleep and stress management over the years.

10:03And those may not seem quite as tangible, but they're equally important as everything else. Okay. Can we go back for a second, Amy, and then I'll throw it back over to Gabrielle. I want you to talk about the LP little a, it's something that you and I have talked about forever. And then why I know why, and I get tested for regularly. Wow. I'm behind. I need to get tested again, but why dental health is correlative, why there's a correlation with dental health. So LPA talk about that a little bit because I found, you know, I had Bob Harper on my show. I've had other people on the show similar to me that have some form of, uh, you know, heart disease or cardiovascular disease.

10:37And it seems as if this LP and people that I've referred to you seems that that is a very common marker that's elevated in people that struggle with these things. So why that, um, this APOB maybe a little bit too, and then the why dental health matters. Absolutely. So Liboprotein A is a genetically inherited lipid abnormality. We either have it or we don't. You can't make it go away. You can't make it part of your system. It's found on chromosome number six. 23 % of adults have it or people have it in general. The challenge with it is really threefold. One, statins don't necessarily treat it. We've known that.

11:20We've measured it for 20 years. It's not a new factor. There are new meds on the horizon, and that's why it's getting a lot of attention right now, which is fantastic. The second thing is that it can really drive plaque development and cholesterol trapping in the artery wall, which is a major problem for early plaque development or atherosclerotic disease development. The third thing it does is make your body really, really good at clotting. So if someone has vascular disease and they inherit a lipoprotein And they're traveling all over the country in planes, trains, and automobiles. And things you add to that like dehydration, sitting, all the things that can also drive a pro-plotting state.

12:04It makes people particularly vulnerable. So one, it can be treated. It just needs to be identified. And three, there are tons of new developments. So people are going to hear a lot about this. And it's a good thing that we're hearing about it. But it's not new. It's not. So, Gabrielle, there's also genetic testing that can be done, too.

12:53And so the first of that I heard about was, I think, when it came to women with breast cancer. I remember hearing about that years ago. But now I know, you know, that it's far more expansive than that, that can be predictive that somebody's got a, you know, a predisposition to whether that be, I think, cancer, heart disease, et cetera. So there are tests correct for genetics that one can do now as well. And by the way, some of these things, folks, I think are not, you know, unfortunately, medical care isn't even in our world. And so some of the things we may talk about today aren't part of basic labs and there may be an added expense.

13:28Correct me if I'm wrong about that, you guys, because I want to be fully transparent with everybody. But the expense, am I wrong? Can you get that done like anybody else? And two, what tests are there? There are two main tests that I use in my clinical practice. And we actually use this as well for warfighters through the Seven Foundation. And it's called the gallery test. And this is an early detection cancer screening test. And it's really interesting because there's only five types of cancer that have recommended screening tests. Breast, cervical, colon, prostate, lung. But there are many different kinds of cancers.

14:01And when you detect a cancer early, there's a four times higher survival rate, of course, depending on the cancer. There's two main ways in which we can look at early detection cancer. Number one is something called what was used in research as the Grail test, now available to the public, called the gallery test. And each cancer has its own footprint. And this can test for, you know, multiple different, I think it's 68 or 70 different types of cancers at the very early stages. If you detect a cancer, you can treat it. most, you know, depending on what it is, that survivability is much higher. The other way in which an individual can be proactive on the offense is something called a ProNovo scan, a full body MRI.

14:53It's definitely getting more publicized. I strongly recommend a scan like that because again, if you catch cancer early, you can do something about it. Very good. Amy, in the heart world, what are the genetic tests that one can do? I think you're having me, I'll be too personal, but like if you have, if you knew your parents had heart disease or cancer, there are tests that you can do now that will show that probably you have a genetic predisposition as well. Or did I just completely butcher that? Can I, can I jump in here really quickly? Because this isn't for the listener. Cancer risk increases for everybody as individuals age, but only a small percentage, maybe five to 10 % of cancers are inherited.

15:35the majority um are either they don't know or environmental exposures and i think that that's where lifestyle comes into play so i don't want people to listen and think oh well this person had cancer my family i'm gonna get it that is not true it really there is a way that you can live a lifestyle uh for example we know after heart disease um cancer is the second leading cause of death. And one of the main drivers of that is obesity. So people can do something about this. Yeah. I want to talk about once we get through these tests, we're going to talk about it. Go ahead, Amy. Yeah. Well, I was just going to say on the heels of what Gabrielle said, which is so, so important in that if we inherit a gene, it doesn't mean we're going to get that disease state.

16:19It means we want to make sure we're screening, we're taking good care of ourselves to make sure that genetic profile doesn't manifest itself into disease. When you also think about cancer and you think of heart disease, there's so much crossover. As Gabrielle so brilliantly said, there's so many lifestyle factors that drive both cancer and arterial disease. We want to know with your family history, do you have disease? No different than a cancer screen, right? We have these screens for early detection of cancer. We have the same screens for vascular disease. The trick is historically in medicine, all the screens to look for heart disease look at blood flow where the disease is sneaky.

16:5999 % of early plaque grows in the wall of the artery. So if we're on a stress test and you pass that stress test, that doesn't tell you if you have plaque or not. It tells you you don't have a blockage at that moment. So there are some wonderful tests. And as you said, we want to be very transparent with the audience. Insurance does not cover these, but we're talking tests that are a few hundred dollars. Some as low as 50. You can get a CT scan of your heart and look for calcification of arterial disease in the heart. That runs anywhere from$50 to maybe$200. We use a workhorse tool. We use this ultrasound a lot because it's not just having plaque in the arteries.

17:43And in Gabrielle, it's having active disease in the arteries. And that's the trick. If I know you have plaque because, let's say, you have a calcium score, I really want to know at the end of the day, are you treated and that disease is stable or is it active? So when we use ultrasound, we can depict that. What does the plaque look like in the artery wall? Same with the heart. We can do scans of the heart now and do artificial intelligence overlay on those images and find out what does the plaque look like? Are you and I, Ed, together? are you and Gabrielle together, the three of us doing enough to make sure that if you have vascular disease, it is stable because secrets out, you can live a long and healthy life with plaque from head to toe, as long as it doesn't misbehave, as long as it stays in the artery wall, because our bodies are built to survive.

18:35The plaques in the artery wall, we are going to maintain blood flow and things that would cause it to misbehave are the things we've talked about, like inflammation caused by a periapical abscess, an old root canal that's inflamed. To Gabrielle's point, a metabolic dysfunction, whether it be gut health or hormonal balance, insulin resistance, prediabetes, blood pressures over 120, over 75, lipoprotein A, ApoB. Those are all factors that need to be treated because if you have disease, we want to know if you're inflamed. We want to know why you're inflamed. We see the inflammation go down and see the disease stabilize and you go live your life.

19:18I'm thinking about there's a lot of tests and I don't obviously want to give too much information, but there was a lot of tests that Amy and I both want you to do that you simply just haven't had time to do. And people have to understand that they really, this, if you fail to do the practical, the practical become impossible. And one test that Amy and I both agree on is something called the sleep apnea test. Amy is talking about labs. She's also talking about, again, because the number one killer is cardiovascular disease, talking about labs, talking about a scan CT or clearly scan, very valuable.

19:54I mentioned early cancer detection. We cannot forget sleep apnea and you do not have to be overweight to have sleep apnea. Many of my fittest entrepreneurial patients have sleep apnea. And as Amy will mention, it contributes to metabolic syndrome, contributes to obesity. It affects your ability to put on muscle. It affects, you know, from a muscle protein synthesis response, but, you know, kind of like nerdy. Also, it impacts atrial fibrillation, blood pressure. I mean, it's a big deal. Alzheimer's disease. Yeah. Really, really good. I, uh, so one of the things, you know, Amy, when I tell people that we do that ultrasound of my carotid artery and the other things that you and I do, um, just want to point that out to everybody.

20:45Cause they're throwing a lot at you. And by the way, I started to have that done with Amy in my early thirties, you guys, I think. And, um, I have to tell you, maybe it was mid thirties, but, uh, I have to tell you, as I tell friends of mine that really have great doctors that we do that, They don't know what I'm talking about. So they have done some of these CT scans, these plaque scans, but most of them have not done that ultrasound. And one of the reasons that I've learned that it's important is because now you've got something that can be measured over time and see if something's progressing.

21:13Where performance is measured, performance can improve or at least be altered, at least be mediated, maybe reversed in some cases. Amy, the thing I'm doing Friday, is that a unique thing I'm doing Friday? just share what's that scan that I'm doing Friday? I don't think I've done this particular one before. You haven't. So the scan you're having Friday is a CT angiography, which is basically an image, takes an image of all the arteries that feed nutrients to your heart. And rather than just look at narrowing or blood flow, we want to look at the wall of all those arteries and find out what does your plaque look like?

21:53Because of your family history, you are predisposed to have active disease. And so what you and I want to determine is, is the treatment you're on right now effective to stabilize that disease? We have two vantage points. We have the carotids, which we can look at the wall with ultrasound, which is excellent, and no exposure to radiation. So this is one we can use annually, and it is a major workforce tool. It's been around and back since the year 2000. It's not a new test. Insurance doesn't cover it, so people think it's new. The one you're having Friday is to piggyback on that and actually look at your arteries of your heart and determine is the disease stable or not.

22:32And we overlay, as Gabrielle said, an image company, one of them is called Clearly, which looks at the analysis of the plaque composition. And that's what we really want to know. Okay, very good. So Gabrielle, what about hormones? So and hormone health, let's just talk about that. That's one of your go zones. Yes. A, if you're on hormone replacement therapy of any type, should you be mindful of any markers that can be impacted by that? And B, how important is having your hormones in whatever the normal or regulated range? How important is that? Hormones. Now, again, this is my perspective. I really feel that hormones are everything.

23:13It's the thing that people feel. And actually, this is for both men and women. Often people will say, oh, testosterone is just for men, but actually that's not true. Women also make testosterone. It is when we think about the labs that I'm looking at. I'm looking at free testosterone in both men and women. I'm looking at total testosterone. I'm looking at something called sex hormone binding globulin. There are certain things that increase or decrease this. If you think about hormones like children, they can't go anywhere alone. They need to have someone that holds their hand. And that's what sex hormone binding globulin does.

23:53So I look at that. I look at estradiol in both men and women. I look at prolactin, FSH, LH to see how well the modalities that we're utilizing are. And also PSA. This is, I'm sure that I'm missing one or two, but really from a hormonal perspective, these are the things that I'm looking at. and they're both critically important for both men and women. And women, we'll just start there. There's something called female sexual dysfunction, and it's really a common condition for women. And it can affect nine to, there's some data that shows nine to 43 % of the female population. Testosterone is not FDA approved for that because it's not approved in women.

24:39I eventually believe it will be, but testosterone can be used for women that are struggling with low sexual function. And on the flip side, for men, when a male's testosterone is low, and the way in which we look at it in labs is they'll get two morning markers of 300, a testosterone of 300 or less, that would be considered low testosterone. But the reality is that would mean that if someone is 310, does that mean that they're feeling great? No, and this is really the challenge with how we interpret labs. So the signs and symptoms for men of low testosterone would be decreased libido, increase in body fat, individuals also might have lower bone density or mild anemia.

25:25and there was a great trial that has come out recently called the Traverse trial. I just sent it to Amy because it's all about cardiovascular disease and testosterone. There are certain myths that are out there that I think stop people from initiating hormone replacement therapy, but hormones are critical. And then if we take lifestyle into account, a surefire way to go through and have hormonal imbalance, ready? So I'm gonna give you the ways in which you can do that. don't sleep, eat poorly, potentially do drugs, a lot of alcohol, and I guarantee you, you will not have a good hormonal status in your body.

26:07Very good. This is so good, you guys. We're going to go a little longer than I thought, just because this is too good, and I have these two huge brains here. So, Amy. Can I add to what Gabrielle said? Because from my perspective, there's a lot of thought that in a cardiovascular world, hormones are bad or they're good. There's this line of division and it really is not appropriate because whether we're talking about women or men and hormone replacement, it's all about finding that balance. I'll speak to women because I just spoke about the Women's Heart Health Month. And what we learned from the Women's Health Initiative, which was a trial years and years ago that really put this negative spin on hormones in women, really has been a real problem for us because that trial took women who had been in menopause, whether it had been surgical or natural menopause for upwards of seven to 10 years and gave them hormones that were matched to a 25-year-old healthy female.

27:05Well, no surprise that they didn't do well. They had clotting factors, they had strokes, and it became this feeling of hormones are bad, stay out of them in the cardiovascular world. Studies are coming out now that tell us that's not really true. What's appropriate is what Gabrielle is talking about. And that is, if we catch people early and we make sure their hormone balance is stabilized to an endogenous, a natural level, as early as a woman starts to go through that perimenopausal state. So if she's under 60 and she's starting to have hormonal changes, it's a very appropriate time to make sure her hormones are regulated and for her bone health and even for cardiac health and even in conditions like lipoprotein A.