MGU 57 | Cardiac Health

 

Many people don’t realize that their cardiac health is in really bad shape, and now, with so many people being forced to shift into a more sedentary lifestyle, it just might get worse. You always need to be on top of your cardiac health because if you don’t, it might just get worse farther down the line. Dr. Joel Kahn is a Preventive Cardiologist and a Clinical Professor of Medicine at Wayne State University School of Medicine. Jason Wrobel sits down with Dr. Kahn to talk about maintaining, even improving, your cardiac health in the midst of the ongoing health crisis. The health of your heart is certainly not something you should be trifling with, so heed Dr. Kahn’s advice today!

Listen to the podcast here:

Matters Of The Health And Heart With Dr. Joel Kahn

I’ve known you, Doc, for many years. We’ve had such a wonderful relationship for years both being Detroit natives and in the health and wellness field. You’re someone that I have consistently looked up to as a source of such wisdom, sound research, someone who is constantly being on the latest and greatest in terms of plant-based nutrition, and specializing in cardiac health. Having you on seems to be so perfectly timed with the massive amount of information and misinformation around health, immunity, and wellness. It’s the perfect time to have you on the podcast. Thanks for being available.

That’s an awesome introduction which means for 53 years, I wandered the planet looking for a smile coach and then there you appeared always brightening up the room, the Instagram, everywhere so right back at you.

I appreciate it. I wanted to jump into the deep end because here on the show, we have a tendency with all of our guests to fling off the floaties and jump in the deep end of the pole. I have many things I want to talk to you about especially everything going on with Corona, COVID-19, and general human health. Right off the jump, Doc, I’m curious and for our readers as well, there is such a dearth and deluge of information every single day from many news sources, so-called health experts, and medical professionals. How does a person, first of all, know what to listen to or how would you recommend a person sift through the litany of information that we are bombarded with every single day? How do we stay sane and know what to do for our health? The first question is, how do we know what’s real or not?

In a philosophical way, that’s a challenging question and it has a sub-question. How much time of day do you want to spend doing what you described? There clearly is a downside to being too plugged in. Some of us have more time than we had a month ago and spending it all browsing every site from traditional news outlets, alternative news outlets, holistic outlets, to conspiracy theory outlets of which there are a lot. It can be exhausting and is not to be recommended. I love the term high intensity as it applies to interval training. I joke, I’ve got my high-intensity yoga on days that are busy to get a Tibetan flow in. I’ve got my twelve-minute Kirtan Kriya meditation and I cannot approach news the same to stay up-to-date. I will browse but I won’t spend hours to be at least aware of what the topics are out there. It could be any channel. I tend for the science, I’ll visit MedicalXpress.com. These are all sites that don’t have any affiliation with Medical News Today.

There’s one called News-Medical.net, ScienceDaily. I will visit natural news and never ready to tick off some people because it can have a political viewpoint that I ignore but there are some natural health data as simple as the advantages of certain berries in your diet. I don’t find that too political. I will wander over there. If you want the conspiracies, you can get a quick look at what’s going on and I’m not going to read and get down into every one of them. I get a lot of emails from my friends in the conspiracy world. Is the government being upfront? Is Bill Gates being upfront? Was China being upfront? Is vaccination being upfront? At the present time, there has to be a little trust. Dr. Fauci has gotten a lot of credit for being a calming, authentic, science-based man, probably not on the take from pharma and vaccine makers and such. He’s been a wonderful source out there of credibility, integrity, honesty, and scientific process. We need to alter the scientific process a bit for urgency. We can’t do three-year randomized clinical trials when the next three, four weeks are going to be the toughest.

We all hope there will be the toughest and then we can see some sanity come back. We have to improvise and there’s a real tension. Do you support oxygen, look for problems, cardiac monitor, intubate, adjust oxygen? Do you use hydroxychloroquine and azithromycin? There are alternative protocol hydroxychloroquine and doxycycline, which is a common antibiotic like tetracycline with potentially fewer side effects and hydroxychloroquine or azithromycin. You get into even things that we can talk about this that are not considered standard but are available cheap and generally nontoxic like IV Vitamin C which is in certain university protocols. Some inhaled nitric oxide was announced at Massachusetts General Hospital. That puts a little stamp of credibility and research capability is going to be a demo-ing inhaled nitric oxide for lung benefit antiviral impact, but it has to be studied. It is, in fact, a hard road.

That’s where the basics will remain. Social distancing, wash your hands, gloves and masks are the norms, good sleep, amazing diet, stress management, and we have to keep up the data on the rest. I have my own personal protocol. I am a university professor, but I’m not a university professor who’s Chief and Journal Editor of Critical Care Medicine but there is such an individual in a Norfolk who’s put out his own suggested preventive protocols. I’d rather talk about that. It takes the heat off of me and puts the heat on a well regarded internationally known academic expert in such. We can talk about all those things. There isn’t an absolute way. Did the president respond quickly enough, not quick enough for masks and ventilators hidden in warehouses in New York where they’re not hidden? Honestly, love your family, love your pets, eat well, be kind to people, and follow all the CDC guidelines. I hope we’re through this in a month or less.

That was such a wonderful summary. You answered a lot of the questions that I was going to dig into. We can even dig in a few layers deeper on the hydroxychloroquine and some of the nitric oxide stuff you mentioned. In terms of the nitty-gritty because you have your personal protocol. I have mine. I’m curious because the readers are very much interested on a day-to-day because we’ve heard so many things about, “Take this much vitamin A, glutathione, and Vitamin C,” “Do elderberry, wait, don’t do elderberry.” In terms of supplementation and specific foods or nutrients, what are some of the top-level ones that you found effective or you’ve heard like, “These are the things that a person ought to focus on having in their nutritional regime?” What are some of those things you’d recommend?

The caveat in your question is what had been found to be effective? We don’t know that. We assume social distancing, hand-washing, masks and gloves are effective, but we’re not going to wait for study. There was a serious study published on masks in viral illnesses in a major journal called Nature. We have to have a little faith and a little common sense on some of this. There is no proven protective protocol beyond that yet. I will quickly reference that in my searching to recommend to my patients and hospital, the best approach for good patient outcomes. Preventing illness as well as trying to treat these super sick people. We have clogging up hospitals from your time in Detroit that are overwhelmed.

There's a clear downside to being plugged into the deluge of information out there every day. Click To Tweet

There is an academic physician, the East Virginia Medical School who’s a Chairman of Critical Care Medicine. Rather bravely, he put out an eleven-page guide that they’re using in Norfolk, Virginia. His name is Paul Marik, MD, Chief of Pulmonary Critical Care Medicine. What does he suggest with limited data and his criteria where might help cheap, safe, and effective? His cocktail is Vitamin C, 500 milligrams twice a day. We can argue, you and I, want to get a lot of it and everybody should want to get a lot of it from cherries, leafy greens, oranges, tangerines and clementines. I urge everybody to get them from Whole Foods. Nobody’s going to run into trouble with 500 milligrams twice a day of Vitamin C. There are people doing more. Let’s say that wouldn’t be a bad place.

The interesting feature most people don’t know is humans can’t make vitamin C. All but four species on the planet have the ability to make Vitamin C and lots of it. The dog, cat, squirrel, and goat make all the vitamin C their body needs. In fact, they take glucose, it’s one enzyme. Glucose, enzyme, and Vitamin C. Our enzyme in every human has shut down tens of millions years ago, perhaps we were living in the Garden of Eden and eating leafy greens much like a gorilla. We didn’t need the enzyme anymore, so we lost it. We’re very subject to Vitamin C relative low intake, plant-based cedars undoubtedly get a lot more. Number two and people have heard about this, zinc. This particular Paul Marik, MD recommended 75 to 100 milligrams a day for no more than two months because the usual zinc, you might find a multivitamin as about fifteen milligrams a day.

I’m not even doing 75 to 100 and I do a lot of supplements. I am very happy with 25 to 50 but 75 to 100 was what he recommended zinc gluconate or zinc picolinate. There’s a lot of zinc in foods, plant-based foods. There’s zinc in oysters. I’m not an oyster promoter, you’re not an oyster promoter. I’d rather get it from sesame seeds and legumes. This may be a supplement and a molecule people are not familiar with. It can be called quercetin. It’s naturally found in onion, garlic, and apples plus other whole foods. It’s very useful in people that have seasonal allergies and a lot of natural seasonal allergy supplements at the health food store have quercetin. Dozens, at least, of studies showing it has a positive benefit on blood vessels, blood pressure, but now its immune function and the possibility of quieting down those cytokines.

We hear about those chemicals that may overreact to this virus and cause this terrible storm and lung damage. That’s 500 to 1,000 milligrams a day of Melatonin. If you talk to some natural docs that are in the oncology world and they may be MDs or NDs, Naturopathic Docs, commonly using significant doses of Melatonin for their immune altering effect, their ability to jack up our immune system are natural killer cells. This is a milligram at night. That’s a relatively modest dose. I can’t think of anybody that couldn’t take out one milligram of Melatonin at night. Amazingly, Dr. Marik thought it might be worth putting it in the program. Many people use a little more than that for sleep, some use it less.

Finally, Vitamin D. Everybody hears about it. They’re in the wonderful mushroom family as a natural source or in fortified plant milk for 1,000 to 4,000 units a day of vitamin D3. There are vegan versions. There are some that come from lanolin so they’re not vegan. You can find the tiny one. That is a five-component program and I’m happy with that. Elderberry might be a value. There’s been some discussion, it might be of concern but my reading says we don’t know and optional. Garlic comes up on the list. There’s a whole lot more that could be put on the list but I’m happy to keep it KISS if five supplements are even simple, I’m happy to stop there.

In terms of how people are treating their lifestyle, it’s so much information on rest, sleep, fitness, and the mental health side of this is such a massive component in regards to stress, hypertension, and elevated cortisol levels. Moving away from the nutrition and food side, we’ll come back to that because you’re such a wonderful resource of information on food and nutrition. I’m curious in terms of stress management, meditation, mindfulness tips, what would you recommend for people that are struggling with anxiety, stress, and the mental side of this epidemic? That’s a huge component too. 

Before we control the world, we have to control ourselves internally before we can control externally. Some of us are spending a lot more time at home, spouses, significant others, children, pets, elderly parents, whatever the situation might be or we’re not spending it with anybody. That’s even more distressing. There was a nice little article by Joe Dispenza. Some people love his writings. He’s the New York Times Bestselling Author on the impact of mindfulness on your immune system. That was in MindBodyGreen.com if anybody wants to look at it. I read it with interest. There are some hyperlinks to actual studies. I’ve been big in general and trying to teach simple skills to my patients. I’ve upped that game a lot. We’ve talked about something called 4-7-8 breathing, something that Andrew Weil, University of Arizona, made popular over the last many years.

Breathe in through your nose slowly for 4 seconds, hold it for 7 seconds. If you want to get fancy, put your tongue at the top of the roof of your mouth and then breathe out slowly for eight seconds and do that four times, 4-7-8 breathing times 4, it takes about 75 seconds. There is some data that it can calm down your autonomic nervous system. You want to use Headspace or Calm apps. Maybe you’ve done transcendental training as I have, perhaps you have, but the classes I’m sure are not open. There are many great online teachings. What I’ve been teaching just to get to the point, because there are many options, you need one like supplements. You need a short-list of supplements, you need to sleep, hand-washing, distancing and the rest. I teach the Kirtan Kriya, which some people will know. It’s a twelve-minute meditation. Everybody does the same thing. There’s no secret mantra like transcendental but it is mantra-based.

It’s taught by a professor of neurology and psychiatry at Tucson, a Dr. Singh Khalsa. What I love about it is there are 25 publications. He finds people with early memory deficits or caretakers of elderly parents with dementia, which are high-risk stressed out people. He teaches them the simple twelve-minute meditation or simply has them listen to nice music like Mozart for twelve minutes. He schlepped some over to UCLA and does SPECT scans, telomerase measurements, and immunologic measurements, sophisticated science. In those 20 to 25 publications, this twelve-minute simple meditation, you sing out the same four tones that everybody uses Sa, Ta, Na, Ma. Your fingers are moving. That’s called a mudra as I’m sure you know. You sit quietly with your eyes closed and you’re done. Anybody can do it. A child could do it and an adult can do it. I made a little YouTube of it. It’s out there. AlzheimersPrevention.org is Dr. Khalsa’s research website and there’s a one-page PDF for free or you could find a number of YouTube. That’s what I’m having my patients doing because I love that intersection of science, eastern, and tool. I want to have a tool. It’s the HIIT, the high-intensity meditation. It’s the best I can find.

MGU 57 | Cardiac Health

Cardiac Health: If you find out you have an elevated lipid-protein, you should primarily work on your lifestyle to get that improved to a healthier level.

 

Doc, we go to these ideas of managing our mind and the presence practice. In history, Eckhart Tolle and a lot of the spiritual teachers, meditation teachers, we’re talking about Kundalini yoga and these ancient practices, there’s nothing new about them. The idea of presence and mindfulness, talk about Zen Buddhism, these are ancient things that seem to have been gaining momentum and coming into vogue in the last 40 to 50 years since the ’60s. Interestingly, you mentioned the intersection of spirituality and science. It’s not a woo-woo question per se but I’m curious as we divert from science, this situation with the Coronavirus and COVID-19, what do you feel like it’s here to teach us as a human species? What do you feel the lessons are that we can glean from all of this? We might not even know yet because we’re not even close to done. On a spiritual level, a humanistic level, or anthropological level, what do you think this whole situation is here to show us about ourselves and our relationship with the earth and each other?

I’ve been stretching my own personality to try and merge with Deepak Chopra perhaps or others. I’ve generally emailed my patients a little update, what’s going on in my clinic, my own lectures, writings, YouTube, or whatever twice a month. I accidentally did it two days in a row, third-day row, and they’re emailing, “Please continue.” A lot of times, I’m sharing either my experiences or I’m finding other uplifting findings. A lot has been on just that question. What are we going to learn from this? For sure, my main message to them has been gratitude for any gift you have that hasn’t yet been taken away and that’s mainly going to be your health. If you have gotten through this pandemic and you’ve not been hospitalized, you’ve not been acutely ill, and your loved ones are saying we always have to be mindful and thoughtful about the people that are doing poorly or have passed.

You have to wake up with a sense of gratitude if you can move your toes, your fingers, you don’t have a fever, and you’re breathing. I was taught as a child a two-line Hebrew prayer. I’m not promoting any particular faith here but it goes by two words in Hebrew Modeh Ani, which is I am grateful. There’s a traditional thing to say, “I am grateful for the fact that you’ve returned my soul to my body in much humility.” There are a few other words but that’s it. As I get older, I have more emphasized that very special 30 seconds my eyes have opened, I’m not going to look at my phone and I’m going to have that moment of gratitude. As a medical doctor, I know how fragile health is whether it’s a heart attack, a stroke, a motorcycle accident or a virus that we either know how we contacted or we didn’t.

Appreciating the small things in life. The fact that we’ve returned to the house to have home-cooked meals and around a dinner table often with family and unison is a gift. It’s a very big price to pay for that gift. We played game boards, we’re doing puzzles, and hopefully not on the internet all the time is a bit of a gift. The fact that we have seen pollution, water quality and the motion of the earth has diminished because trucks, planes, and trains aren’t vibrating. There is some benefit to the planet. I don’t think it’s going to be long-lasting because we have to get back to the level of insane commerce and activity that we had. At least we can ponder for a minute what the planet once was before we industrialize it all. A lot of good came out of the industrialization but not all good with global warming and other issues that are at hand.

Appreciating others the fact that we’re connecting and the distancing has let us do appreciate that. It’s more important to call an elderly person, a lonely person or connect by a technology. We see them and talk. These are additional gifts and lessons. Some of us have more time to read and study. I’ve heard a number of people taking up new hobbies, playing harmonica or ukulele. There’s undoubtedly a long list. Arianna Huffington has a weekly email if you sign up for it. I like her. She’s quite philosophical. She was writing more about the importance of sleep. She’s changed her focus and she had a beautiful piece that came about Frodo in The Lord of the Rings saying, “I wish it need not have happened in my time.” I wish that this whole thing went away but it’s here. Hopefully, it won’t be here forever but we were on such an insane spiral of wanting, needing, and buying. It’s not a plea against capitalism or for socialism or anything else but simple little things are important in our life, so that’s good.

Thanks for going there with me on that. In terms of healthcare and in zooming out to a more macro level with certain hospitals being overloaded. Before the conversation we had, you were telling me about how some of the hospitals back in Detroit are doing Metro Detroit. The thing that I’ve been having a lot of discussions with and I’m curious how deep you want to go into this is the conversation of socialized or universal healthcare. Not ascribing this to any political party having this conversation with you, but the idea of having a government-provided system of care versus a corporatized one. Do you see this moving us more in that direction or not at all? Generally, as someone who is in the healthcare system and providing the resources and care that you do, what is your opinion on one versus the other? Do you have a preference? Do you feel we should make a shift? Do you feel it would be better for this country? I’m curious what your opinions are on that and if this will feed that conversation at all, this situation.

The only real change I’ve seen happened because of the pandemic is they’re graduating medical students about four months early to get their degree and get them into the trenches hopefully with excellent personal protective equipment. They are at the least risk possible. At the beginning of all this clearly, people were walking into at-risk settings with less than complete Personal Protective Equipment or PPE as it said in the field. It hasn’t changed the dynamics of insurance. One change is Telehealth. The fact that at least temporarily, a doctor can consult across state lines. A doctor can provide care by video or other secure links. Something that I have done for a number of years and found to be highly effective. There are situations, it’s clearly not appropriate, but there are many medical interactions these are going to last on. They will be very hard to take away because of the reception by both physicians and patients and the whole thing.

It will be returned to prior but is this going to shift us more to one payer? Not a political statement, but what has the government taken over and done well with the post office or the IRS? On the one hand, this is a whole different topic than Corona, but billions of dollars of excess testing, excess cover your butt ordering of procedures either the malpractice risks and also greed. The fact that there’s greed when you’re a solo or entrepreneurial physician in your own practice and all is, these are huge problems. A lot of people say, I don’t remember the exact number, but three-quarters of all tests ordered potentially could be done without. When you go to a Cleveland Clinic or a Henry Ford Healthcare System in Detroit where it’s all single staff employed, you have more control and more institutional protocols. You still got to rely on good people. A single-payer system has the potential to diminish the variability in treatment.

Why does a person in New Orleans get totally different treatment for a condition? The first time they have evidence of diabetes and a person in San Francisco might. There is such a range and wrapping your hands around a single electronic medical record system so we could share information for efficiency and avoiding duplication. I can’t tell when I order cholesterol on you if it wasn’t done by the family doctor and can I ever get the result? I do ask, I do strive, and I get things to fax over but all of that can be eliminated. Dollars would go down, efficiency would go up, quality care would go up, unnecessary procedures would go down but you’ve got the pushback of the last 60 years of entrepreneurial medicine and investments. It’s a revolution.

We need to alter the scientific process a bit for urgency. Click To Tweet

Looking at how Obamacare took a few steps forward and it’s dismantled. I don’t see it happening. Those docs that have been entrepreneurial and own their own clinics, outpatient clinics are empty and it’s not a good time. It’d be a time that a lot of docs might say, “Give me a salary.” I spent a lot of years building buildings, putting in equipment, and trying to develop the highest quality setting but like a restaurant owner, how long can you hang on with what overhead? It’s also true to dental practices. That might be the pushback. Some people say they throw up their shoulders as many family practice docs if not, and give me a stable hospital’s salary and benefits. I’m happier than taking the risk because those that take the risk, including my own clinic, it’s edgy.

In terms of that with your patients and perhaps beyond the patients that you’re seeing, do you see them taking this as an opportunity to reevaluate some of the underlying health conditions or lifestyle choices that they’ve been facing? The one thing that certainly I’ve seen over and over on the news and the information out there is that people with preexisting or underlying health conditions are at higher risk. First of all, what kind of underlying conditions do you think put people higher at risk and related? Do you see this situation as helping people to take their health more seriously?

We all have seen some funny humor amongst a very tragic overall setting. What’s the first thing you’re going to go to, the A-class or the Weight Watchers class when this is all over is a common one? We are concerned that being overweight, that’s new. There’s some data that the death rate from COVID-19 in New Orleans is much higher than the death rate in New York. Rates of obesity in the South are much higher. There’s obesity everywhere but they are the highest in the South. They’re awful in Michigan. It’s the King of the Northern States, but Louisiana, Mississippi, Georgia and such traditionally have the most obesity. That’s a big one. Hypertension is about 100 million people in the United States and it’s a lethal disease for many but statistically, there’s a concern in coronary artery disease, clogged arteries, heart failure, diabetes, and certainly, if you are on immunosuppressives for rheumatoid arthritis.

There is the possibility we are going to be able to rebound and truly have an audience that has to listen to the fact that healthcare at home may be more powerful than healthcare in the office. Healthcare in the grocery store is more important than ever. Some people have gravitated their lifestyle, fitness, sleep, stress management in a positive direction out of either fear, extra time or many comments everywhere about the importance of this. Unfortunately, a lockdown also means there are the Oreos, chips, and the Coca-Cola case. Not everybody is gravitating to healthier. In my own life, I’m eating better and it was always great but there’s more purple cabbage and sprouts in my diet now than there were a couple of months ago.

I’m working out a little bit more. I put a little more emphasis on it. I hope more people adopt that approach. If we can take the message that the risk was increased with diseases 1 through 10 and as Michael Greger lectures in his annual lecture, diseases 1 through 10 have a major lifestyle component whether we talk heart disease, cancer, diabetes, lung disease, autoimmune conditions. Even Alzheimer’s and all. If we can appreciate that for the next pandemic, we might be able to approach it with a healthier public. That would be an amazing rebound. It’s all pharma which thank God for some pharmacologic agents, they help us but it isn’t the only answer and it’s the one that gets the most press at national press conferences over and over.

In terms of pharma, you mentioned at the beginning of this episode the hydroxychloroquine and the nitrous oxide and some of the other things. Without getting too political or getting into conspiracy theory, this idea of vaccines coming. The notion that potentially the government or health officials would come out with a vaccine at some point and recommend everyone get it. Not just the Coronavirus but in general, for something on this scale, would a vaccine typically be something you would say would be last resort rather than a first option?

I think it certainly. It’s going to take a drastic response to the fact that the ease that this disease is being spread, multiplying, and exponential. It may be the rebound of this virus and it might be the next virus. There are eight different kinds of Coronavirus that are spreading around the world. We can’t afford it from every standpoint, illness, death, social connection, and the financial destruction of many economies, hopefully temporarily. I don’t know what it’s going to be. Is it to close these live animal markets in China where more than once, it looks like these viruses from MERS to SARS and now Corona has eruptive from? I hope that the Chinese government does that. Is it going to be some international response the next time this happens, we jump on it with open communication? That’s to the conspiracy idea that the Chinese government reveals the full extent of this as early as possible in all. Is it going to be a vaccine?

We need to explore a vaccine and we need to move forward. I’m not sure I want to be the first person to volunteer for it. I am very much interested that we work hard to develop one because we need a drastic response. We know how viruses mutate and change. How we develop flu vaccines at some times or in target and sometimes hardly addressed the strain that ultimately gets out there. I’m going to leave it to the vaccine developers and I hate to say to the pharmaceutical industry and governmental panels to try their best. The Israelis have been digging in for a few months and I followed their progress because they often are cutting edge. I hope we can come up with one that we can believe is safe, effective, and available but I know there’s a lot of skepticism I’m sure amongst your readers that we’re going to let the government do this. I’m all for it.

You’re such an incredible researcher and you go deep into many facets of not only this particular situation but health in general. In looking at our history and what we’ve overcome, what lessons do you think that we could glean and take into this from the Spanish flu, the polio epidemic, or some of the other influence outbreaks that we faced in say the last century and a half? Looking back at that and how humanity prevailed from those things, what philosophies, tactics or mindsets do you think could be useful to apply to our situation from those historical moments?

I haven’t heard a lot of people talk about this. There’s a famous book in the Italian literature about what it was like to live in the black plague in Milan in the 1400s called The Betrothed, I Promessi Sposi. I’m not Italian. I love everything Italian, like lots of people. It’s required reading for all high school students in Italy. It’s a great book. Trying to get a handle when you didn’t know what a bug was and you certainly didn’t have the internet to spread news, all you saw is death everywhere. You always wouldn’t say Satan, God, sin, or something. In the Spanish flu, how much sophisticated understanding of the transmission of viruses, therapies, hand-washing, and all that?

MGU 57 | Cardiac Health

Cardiac Health: People have been gravitating their lifestyles – fitness, sleep, stress management – in a positive direction out of fear, extra time, or an acknowledgment of the increased importance of those things.

 

I don’t think we’re at the pinnacle of all knowledge but we’ve never had times like these where we have a pandemic, hopefully not to the magnitude. Our response has been much more rapid and draconian than in 1918 because we do have a much more advanced medical system, virology, and communications. We’ve learned our lesson. The old casta nata, if you don’t remember your history are doomed to repeat it. What have we learned from those experiences that we have to take massive organized action? Even if it’s a full, complete national shutdown for two weeks, we’re almost there but there are exceptions and politically it’s smarter to shut down the hot areas like Detroit and not shut down Wyoming where there are not a lot of cases. That may be a better choice.

It’s hard to assume. We’ll only know at the end. We have alert systems for a nuclear attack. We monitor for seismic changes that might indicate the next earthquake or a volcano erupting and such. We’re going to have to develop the same watch systems for the next wave and attack as quickly as possible. That’s why I don’t put a lot of blame on people. I’ve been in medicine for many years. This is so unprecedented. We could have said MERS was more prevalent in the Middle East, not that those lives are any less valuable than ours. The SARS was a little bit more in Canada but at least the United States. None of us. I don’t think anybody is alive but there are a few people that were alive in 1918, not too many. We’ve never seen this. The risk isn’t the battle of the bulge in Europe where young people were dying. The risk is your neighbor and your gas station attendant. It will challenge everybody how do we prepare for the next time this comes up, which I hope is a long time away.

I want to touch on some of the cardiovascular components of this being that that’s a huge area of focus for your practice and your expertise. One thing that I’m seeing that is a bit concerning to me is how there seems to be a little bit too much overconfidence with certain people that say, “I don’t have any underlying health conditions,” or “I’m taking all my supplements and I’ve got all these things.” People in some areas are not doing social distancing and not doing some of the recommended protocols. What would you say to comment on people that are being a little too egotistic or overconfident about their level of health in all this?

You can understand, for most of us, the first time in our life that we’ve been asked to restrict our activity to this degree. There isn’t complete alignment with it. Unfortunately, young people are dying, twenty-year-olds. My friends are healthy. They eat well, mostly medical, healthcare professionals, nutritionists, nurses, CCU people. The healthcare workers are at risk but this is 32-year-olds and 34-year-olds, they’re runners, responders and meditators. I don’t think plant-based diets. Not all my friends are plant-based eaters exclusively. Hopefully, at least partially. It’s bold to suggest that a whole food plant-based diet prevents this illness. I wouldn’t say that and I don’t see too many people saying it either. We should stay away from that. It’s a real deal. Young people are getting sick and are at risk. This is not a time to have excessive confidence and bravado. Everybody is on the line.

I want to talk about your book Lipoprotein(a), The Heart’s Quiet Killer. This is an extension of you with risk reduction strategies. Talking about these estimates that 1 in 5 people have these elevated levels of this type of cholesterol called lipoprotein(a), which can increase the risk for cardiovascular disease, blocked arteries, blood clots and stroke. How can you dig deeper into that? This particular protein and general cardiovascular health, why is that important to focus on especially now?

It’s not a complete segue and you already alluded to that. Let me explain cardiovascular disease or heart disease. It’s a broad term. It includes high blood pressure, tens of millions of people. It’s the number one cause of death in the world, according to something called the Global Burden of Disease Study. High blood pressure and the disease is related to high blood pressure like heart attack, strokes, congestive heart failure, loss of limbs. It’s not a cause of death but erectile dysfunction and sexual dysfunction from blood pressure related to blood vessel damage. Cardiovascular disease, hypertension, congestive heart failure, the clogging of arteries requiring medicines, stents, bypass, or creating a heart attack, strokes, blockage in the legs and kidney arteries. It’s broad.

What we mainly focus on is the risk of clogging your arteries and one day suffering a heart attack or dropping dead from clogged arteries, which occurs in general up to 2,500 times a day in the United States alone. There is this little race. Is there going to be a day when the number of deaths from COVID-19 exceeds cardiovascular disease briefly and it might happen? It’s number three. Every day, heart disease is number one, cancer is number two and COVID-19 is number three in the United States. It’s on an accelerated path. People are saying April 15 or April 16, 2020, the number one cause of death in the United States will be COVID-19. That’s horrible. That alone should educate people to get back and follow the rules. It’s scary data.

People with cardiovascular disease seem to be at more risk if they’re getting exposed to the COVID-19 virus. Getting the disease, getting it badly and dying, there is an overlap in a segue of lipoprotein(a). Let’s go into what lipoprotein(a) is. There have already been warnings from myself and others that it is a liability to learn that you’ve inherited this genetic cholesterol in terms of the COVID virus. Some of the university experts have warned, take even extra precautions if you happen to know you’re a family that’s inherited this. To break it down because it’s simple. In the 1960s, 1970s, the National Institutes of Health in the Framingham study and the Adventist health study answered the questions in a preliminary way.

Why do people have heart attacks? Why did people have strokes? It’s because in the 1940s, they thought it was aging. That’s what a textbook would have said. There weren’t that many heart attacks prior to World War II. When FDR had a stroke and when Eisenhower had his heart attack, a lot of dollars started funding into research. Why? We said smoking, high blood pressure, high cholesterol, and high blood sugar. If mom, dad, brothers, sister, have had an early heart attack, stroke, cardiac death, bypass, you’re at risk. It’s five little simple factors. The problem was when you calculate all that, there’s something called residual risk. It doesn’t nearly explain all the heart attacks, strokes, and bypasses, it explains a large portion of them. Subsequently, we found certain substances in the blood that may be involved with the development of atherosclerosis we hadn’t even heard of.

It turns out when you do these studies, this molecule that was identified in 1963 with a hard to pronounce name, lipoprotein(a). Little means lowercase a, so when you write it out, you don’t put a capital A because there’s another kind of cholesterol with a capital A. The HDL cholesterol that people hear of. We call it the good one when you break down its structure, it has a capital A. We have this cholesterol lipoprotein(a). Lipoprotein(a) was discovered in 1963. It was unknown until then and it took a couple of decades to fully appreciate that it is the most common reason that goes beyond smoking, diabetes, high blood pressure, high cholesterol, family history to explain why a young or middle-aged person has a stroke, heart attack, bypass or stent.

There's obesity everywhere, but the rates are highest in the South. Click To Tweet

It’s the biggest piece of the residual risk put all together. One out of every five or 1 out of every 4 people inherit this cholesterol from their parents. It’s a gene, emits a family of genes and it’s a blood test. The sad state is it doesn’t show up in the standard cholesterol panel. Most readers have had either at a wellness fair, at a church synagogue fare, at your doctors, at your workplace, total cholesterol HDL there. That’s not lipoprotein(a). You have to check the next box at the family doctor, at the nurse practitioner, at the gynecologist and such. It’s covered. It’s $25, $30, they’ll run this test, and it will come back. If you’re less than 75 nanomoles per liter, you have a normal level of lipoprotein(a) because it’s genetic. You only need to check it once in life.

It’s almost like a blood type. If you’re type O, it’s not going to change. If you’ve checked your lipoprotein(a) level at your family doctor, after reading this or because you read my book and you find out you’re normal, you’re done. It’s happy news. You didn’t get it. You’re there in 75% of people. Twenty-five percent of people is about 1.8 billion people or 90 million Americans. By the time you’re one-year-old, if you’ve inherited this, it’s in your blood above normal. It can range a bit above normal to traumatically above normal because there’s more than one gene involved. It’s a little complex but that’s the problem that it might be circulating in your blood. It’s a form of LDL cholesterol with added components to a structure that makes it stick to the wall of arteries and heart valves even more than the standard LDL.

It’s often called sticky cholesterol. That was the title I was thinking about for the book, but I didn’t win the battle with the editors so we didn’t call it the sticky cholesterol book. It’s a bad actor and it’s on the verge. If we can get past the Coronavirus, I say lipoprotein(a) is being able to buy Apple stock at $10 a share or something. In the next five years, you’re going to hear about it over and over. You’re going to see your family doctor and internist suggest you get it done once. It will become part of the routine panel because pharmaceutical companies are finally getting focused on specific therapies for genetically-inherited lipoprotein(a). The range of prescription drugs like Lipitor and Crestor do not lower lipoprotein(a).

They sometimes cause it to go up which isn’t the direction you want it to go. Exercise doesn’t do much for it. We do have some data that the whole food plant diet research project by Baxter Montgomery in Houston in 2018 may lower lipoprotein(a). A woman who goes from menopause and decides to get a hormone replacement therapy and has an elevated lipoprotein(a) may see it come down some. This is a risk factor. You can have high cholesterol and live to 100. You can smoke and live to 100. You can have elevated lipoprotein(a) and not have a stroke, heart attack or valve replacement, but you are at much more risk and we need an agent.

I have a practice full of patients. There was a great guy who was jogging in Central Park in New York at age 45. He had what we call sudden cardiac death but miraculous, the EMS revived him. He had a heart attack. Nobody would know why he had a heart attack at age 45. He was jogging and a healthy living guy but a high level. One after another after another like that. It’s estimated 1 out of every 14 open-heart bypass surgeries is driven by the genetic inheritance of lipoprotein(a) as the only factor. One out of every seven valve replacements, there was a valve called aortic valve which is the most commonly operated on the valve for becoming calcified, degraded and able to open called aortic stenosis.

The same cholesterol particle lipoprotein(a) particularly likes to attack and scar the aortic valve. It’s unusual because most other cholesterol particles don’t do that. One out of every seven valve replacements is felt to be due to this previously undetected elevated lipoprotein(a). If we could screen people at age 18, 15, or 20 and certainly institute healthy lifestyles, but hopefully have effective agents for the rest of their lives, we’ll ultimately have gene technology, something called CRISPR 9 technology. We’ve identified your family with this gene and we can manipulate it so it’s no longer active. That’s a little space-age but it’s being done for certain cancer diagnoses and it is possible that we’ll be able to do that similarly for this particular disease in the next decade. It is unknown.

Before we get this more advanced space-age gene modifying or gene detecting technologies, you briefly touched on some solutions. For someone who finds out that they have this lipoprotein(a), what are the top-level recommendations for someone to manage it if they find out they do have this?

First of all, simply it’s a blood test. If you’re going to your doctor or in September, the world is back to normal, it’s your annual physical, it’s your worksite wellness checkup, ask your doctor, “Can you order a lipoprotein(a) with my standard cholesterol panel?” Many family doctors, gynecologists, nurse practitioners, PAs and such have not done that. It’s their quest, LabCorp and hospital labs. They have to send it to the lab. You’re not going to find too many clinics that are going to be able to run it there on-site unless it’s a bigger clinic. Let me talk about that a bit. If there’s a family history, if you have a brother, sister, mom, dad, aunts, uncles, and there’s a lot of heart disease, strokes, you know that you had a grandparent with a valve replacement, particularly ask for it.

That’s been the accepted reason to have your lipoprotein(a) checked. In Europe, they’ve come to the point where they’re recommending everybody get it done once in life, earlier the better just to push somebody into a healthier lifestyle, put a little carrot at the end of the stick. You’ve got this inheritance. More important to follow a whole food diet, exercise, sleep, don’t smoke, and know the rest of your numbers. It is simply a blood test. It’s inexpensive. There’s nothing exotic. It’s the knowledge that hasn’t been out there about what it is, the risk. That would be the first response to your question and I’ll let you go with the next question.

We hear a lot about epigenetics, how our lifestyle choices and our nutritional choices affect the gene expressions. Is this something that you would say falls under the category of we can manage the expression of this gene and how it proliferates or how it expresses in the body through lifestyle choices? How do we manage this from a genetic perspective?

MGU 57 | Cardiac Health

Cardiac Health: We don’t know if they actually help, but we assume that social distancing, hand-washing, masks, and gloves are effective against the spread of coronavirus. We’re not just going to wait for a study.

 

It is a challenging concept. I had a patient who had a cholesterol of 259, three months, on an almost completely plant-based diet. It wasn’t completely, it wasn’t draconian. The cholesterol came down to 150. Not everybody can do that, but a lot of people can drop their cholesterol 100 points with diet. We can throw in exercise. We don’t see in lipoprotein(a). A whole food plant diet, according to one study may drop it but nowhere near that degree. LDL cholesterol may drop like a rock if you modify your diet. It doesn’t in everybody. Some people get frustrated, “Doc, I’ve changed my diet, and my LDL and total cholesterol haven’t moved much. Why?” You’ve got to go through what their diet is, thyroid status, sleep and stress.

Lipoprotein(a) doesn’t respond to diet like this, fitness, or Zen meditation as far as we know. There are a couple of things that are available that lower it. I mentioned hormone replacement therapy if a woman’s going to do that anyway. Testosterone doesn’t lower it. It’s more the balancing of estrogen, progesterone, and testosterone in a woman. Coenzyme Q10 is a popular and expensive supplement at the big box stores. People seem to buy it and throw it in their basket, and lowers it some. Niacin is vitamin B3. It’s been around for 50 years as an agent to lower your total cholesterol and your triglycerides. It can lower lipoprotein(a) dramatic. It’s a bit of a roll of the dice. I have a lot of my patients on niacin. It’s not approved for lipoprotein(a), but it’s also an over-the-counter vitamin.

It doesn’t exactly require an approval. Some of my patients will drop their lipoprotein(a) by 75% significantly and some a little. I don’t think we understand why that is. Is that genetics? Is that the brand? Is that the absorption? There are downsides in niacin flushing. You have to watch for gout, the blood sugar and such but it can be used. The standard academic and an official statement is if you have one of these family histories, have a lot of heart disease and if you find out there’s a lipoprotein(a) in your family and that you also have it, get your numbers, blood sugar, blood pressure, LDL, and total cholesterol optimal, get them great. That’s usually a statin in the traditional world knowing that a statin like Lipitor doesn’t affect this particle, but it may still affect so much of the risk.

You’re better off down the road to use it. There are people where their cholesterol is 300 and they have a high lipoprotein(a). You have to go there to try and minimize the risk even if it can’t make it perfect. It’s a tough little bugger which is why it’s almost like the conversation about in a lot of vaccines and the virus. We may not necessarily want one but we need one. I don’t want another pharmaceutical agent for treating cholesterol but lipoprotein(a) needs one. Bring it on, let the science and the big pharma companies put their best hats on and come up with one.

There is an antibody to lipoprotein(a) that has been tested in 200 humans with good results and safety from a preliminary. It’s called the Phase 2 trial. There’s a 7,000-patient trial. It was supposed to have launched but it’s all on hold because people can’t go to research centers and enroll. Some people get the real antibody and will get the placebo and we’ll see. That’s how medicine happens. I welcome that. It’s going to take another few years. If you find out you have an elevated lipoprotein(a), what you’ve got is to get the rest of the numbers in shape and lifestyle is certainly what you should work on primarily to get that improved.

I have a few more questions for you. My observation of you is you have such a wonderful balance of whole food nutritional holistic based approaches to treating your patients, the wisdom, and the information you share publicly on your social media and your website. You also have mentioned the efficacy of pharmaceuticals, Western science. It seems to me that you have a great balance of the more holistic or shall we say Eastern approach, but also subscribed to the effectiveness of the use of Western remedies as well. My curiosity in an overarching umbrella question for you is how you would summarize your philosophy or your mission as a physician? What’s your true north? What’s your guiding light? What’s your philosophy?

It is, and you’ve heard it before. Not everybody reading this has. The incredible ability of the body to prevent disease and to reverse disease by removing what’s irritating and replacing it with what’s healing. We rushed to drugs, surgery and exotic approaches, but we really can tame Type 2 diabetes. We can prevent it. We can reverse many cases. We certainly can diminish its impact in almost all cases. Let alone some aspect of improving Type 1 diabetes. We can prevent and reverse existing heart disease of atherosclerosis in many cases. We rushed the medicine and surgery instance, that ship is changing. It is that we cannot overlook and we must implement strategies and methods to teach medical students, nursing students, and dental students.

Every aspect that lifestyle medicine is the preventive, economic, and it’s the kind strategy that has to become built into the system. There has to be reimbursement for doctors, nurses, and systems to teach. It doesn’t all have to be the exact same diet because we’ll not come up with that unity. I want to bring up so your readers know. All of your readers are sophisticated. They know of Nathan Pritikin and his amazing ability as an engineer to change the medical system to recognize that diet and fitness can reverse many serious diseases like heart disease and diabetes. Dr. Dean Ornish, Dr. Caldwell Esselstyn, Dr. Joel Fuhrman, Dr. Neal Barnard, and Dr. John McDougall are lifestyle pioneers. If you lump all those studies together, it’s a few hundred people which is something that the Paleo and meat community will remind us often of the small size.

In November 2019, a study was announced and published called the ISCHEMIA Study. Briefly, our government and a few other international studies spent the most money ever on a heart trial, $100 million over a number of years to recruit over 5,000 people with badly blocked heart arteries. There were symptoms of angina and chest tightness. They flunked their stress tests. These would have been absolutely bullseyes for stent and bypass. They had the courage to put half of them on medication and a naturally low-fat diet. It wasn’t as completely whole food plant-based as you and I eat but it was better than the average diet. It was by definition a low saturated fat diet, some fitness, and the other half went right to the catheterization, the stent, and the bypass in the first 30 days.

When the results were added up, there was no difference in death, in need for hospitalization, and such by going more conservatively with medication, this was a medication study, plus lifestyle. To me, with over 5,000 people with the International Press this has gotten, it confirmed. The results would have been even more astounding if we could have taken half of those 5,000 patients and put them on a nearly or completely whole food plant-based diet as we’ve learned from the smaller studies. It confirmed the body could truly reverse the damage done before there was an awareness or a plan even at the later stages of these patients. I’m very encouraged by this ISCHEMIA Study published in the New England Journal of Medicine in April 2020.

Dr. Kahn has done some incredible debates and high-level sharing of information on some wonderful platforms. Doc, your book Lipoprotein(a) is the number one release in cardiology on Amazon. For all the readers, if you guys want to check that out and all of Dr. Kahn’s wonderful books that he’s written over the years, those are all available on Amazon. Dr. Kahn, where can people find you on social media and your website? Where can people hunt you down and get more wisdom from you?

A lot of people can drop their cholesterol up to a hundred points simply by changing their diet. Click To Tweet

You’re very kind. The website is DrJoelKahn.com and it will take you to my clinic and other places, including my social media. I’m on Instagram and Twitter every day, @DrJKahn. I still show up on Facebook. I have a Joel Kahn MD Facebook page I post every day.

For the locals in Metro Detroit, are you still doing the to-go? Is GreenSpace To-Go serving up food now? Are you guys still feeding the people of Detroit?

It is creating meals that we are bringing to the hospital and donating to the fire department and the police. We are not open for retail. It was an interesting conversation with our employees and their own health risk. They voted that we’re going to pull back. They didn’t want to involve themselves with customers face-to-face. It will reopen I hope soon.

Thank you for doing what you’re doing to support the healthcare professionals and providing that nourishment in their incredible battle. To all the readers, we thank you for being here. For anyone who wants to share your comments, you can go to the comment section. For free health resources on physical, mental and emotional wellness, you can go and sign up for our newsletter at Wellevatr.com and enjoy all of the free health resources we have there. Any questions you want, feel free to comment and find us on social media, Instagram, Facebook, and Twitter. Dr. Kahn, it’s always a pleasure. You’re always such a wealth of love, information and sanity, especially in an often confused and crazy world. I want to thank you for taking the time to connect here and share your wisdom with everyone.

I’ll give you a shout out. One of my friends told me I made an amazing recipe from Jason Wrobel’s book, Eaternity. It clicked in my brain and I remember you were kind as to ask me to write that introduction. It’s not something I get asked all the time. The bond is strong. You’d keep healing the world the way you do and I’ll do it mine, which is very much overlapped. Hopefully, we’ll see something good out of this very dark time.

Hopefully, I’ll be home to see you and see the family because I miss all you guys, my fellow Detroiters and we’ll see each other in the flesh.

Important Links:

About Dr. Joel Kahn

MGU 57 | Cardiac HealthJoel Kahn, MD, of Detroit, Michigan, is a preventive cardiologist and a Clinical Professor of Medicine at Wayne State University School of Medicine. He graduated Summa Cum Laude from the University of Michigan Medical School and trained in interventional cardiology in Dallas and Kansas City. Known as “America’s Healthy Heart Doc”, Dr. Kahn is a diplomate of the American Board of Internal Medicine and maintains sub-specialty board certification in Cardiovascular Medicine. He was the first physician worldwide to complete the Metabolic Cardiology curriculum in conjunction with A4M.com/MMI and the University of South Florida.

Dr. Kahn has authored scores of publications in his field including articles, book chapters and monographs. He writes articles for MindBodyGreen, Thrive Global, and Reader’s Digest and has six books in publication including Your Whole Heart Solution, Dead Execs Don’t Get Bonuses, The Plant Based Solution, and Lipoprotein(a). He has regular appearances on Dr. Phil, Dr. Oz, The Joe Rogan Experience, and The Doctors Show. He has been awarded a Health Hero award from Detroit Crain’s Business. He owns a health restaurant in Detroit.

Dr. Kahn can be found at www.drjoelkahn.com.

Love the show? Subscribe, rate, review, and share!

Join the This Might Get Uncomfortable community today: