Preventing Heart Disease with Dr. Joel Kahn: Rational Wellness Podcast 95
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Dr. Joel Kahn discusses Preventing Heart Disease with Dr. Ben Weitz.
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3:30 Heart disease for our purposes refers to atherosclerosis, narrowing of the arteries, that leads to strokes, heart attacks, erectile dysfunction, chronic kidney disease and even dementia. According to Dr. Kahn, “…if we could beat this problem, we would add tremendous amount of health to our life, and probably a tremendous amount of life to our life.”
8:09 Sometimes patients will see a doctor who tells them that they have significant risk or evidence of heart disease and this is caused by genetics and they need to take a statin. End of story. Dr. Kahn explained that this may be because they have seen a conventional cardiologist for their 12 minute follow up visit and the doctor has no time to really talk about diet or lifestyle factors in any meaningful way. Integrative cardiologists like Dr. Kahn take the time to inquire about and make specific recommendations for diet and lifestyle interventions.
9:31 Dr. Kahn wrote in a blog post that erectile dysfunction, going bald, gray hair, diagonal crease in your ear lobe, and calf pain when you walk can all be early warning signs of cardiovascular disease. These are soft signs that you may have atherosclerosis. Unfortunately, there are too many times when people do not have early warning signs and their first symptom is when they have a heart attack or stroke. These signs should alert you and your doctor to look into whether you have heart disease and besides an advanced lipid panel, you should consider getting a coronary calcium scan, (a CT scan that looks at the arteries of the heart) which is a direct way to see if your arteries are blocked. Dr. Kahn recommends watching The Widow Maker movie on Netflix.
18:08 Cleveland Heart Lab includes a test for TMAO as a risk factor for heart disease that was developed by Dr. Stanley Hazen. TMAO, trimethylamine N-oxide, is correlated with clogged arteries. They looked at TMAO in a lab and found that it caused your platelets to clump, which might trigger a clot. It caused your HDL cholesterol not to work well, which is not necessarily good for your arteries. And it caused your LDL cholesterol to get taken up into the wall of the artery more aggressively. So it seemed like in fact, this was now possibly a cause of artherosclerosis. And they went on to show that it seems to be in the blood after a meal that includes a lot of choline from egg yolk, and carnitine from red meat. Vegetables don’t cause it to rise, vegans don’t have it in their blood. Dr. Hazen believes that his research shows that if you eat foods like red meat and eggs that contain choline or carnitine or take supplements of choline or phosphatidylcholine or L-carnitine that you will increase your TMAO levels and increase your risk of heart disease.
But I have several problems with this TMAO test. For one thing, one of the foods that most increases TMAO is eating fish and eating fish has consistently been associated with decreased risk of various chronic diseases, esp. heart disease. Also, while eggs cause your TMAO levels to rise, many studies on eggs show that eating eggs does not increase your risk of heart disease. Also, taking supplements of choline is very helpful, esp. for brain function, while taking L-carnitine supplements is beneficial for heart health.
25:07 Dr. Steven Gundry is a prominent Functional Medicine doctor who says that grains and legumes and seeds and even certain fruits and vegetables contain lectins, which are harmful to our health. Dr. Kahn says that Dr. Gundry claims to have lots of published data but he has not published any papers on his diet. Dr. Kahn claims that many of the references in Dr. Gundry’s book are not really studies that back up what he says, that there are dozens of serious academic errors. Dr. Kahn said that there are some people with inflammatory diseases who feel better when they avoid foods with lectins and nightshades, like eggplant. But on the other hand, if you look at the blue zones, the areas in the world where people live the longest, the one food they all eat is legumes, so how can legumes be harmful? Here is the video clip of Dr. Kahn debating Dr. Gundry on The Doctor’s Show: https://youtu.be/e61XfKF_NpI
30:10 Some vegans who eat a lot of processed and junky carbs and follow a plant based junk diet are actually more at risk for heart disease than those following the standard American diet. So if you want to reduce your risk of heart disease with a vegetarian approach you need to make sure your diet is rich in fruits, vegetables, beans, peas, lentils, healthy sources of protein that can include the beans, lentils, organic tofu, tempeh, and such. It’s not a mac and cheese that happens to say vegan on it. But you should also supplement your diet with high quality fish oil and include 2 tablespoons of ground flax seeds anc chia and hemp seeds eat walnuts leafy greens to get good levels of omega 3 fats. Dr. Kahn also likes his patients to take chlorella and spirulina, and vitamin B12 and vitamin D.
35:16 A Mediterranean diet, which has been shown in many studies to be associated with lowered risk of heart disease, includes plenty of extra virgin olive oil. But Dr. Kahn is not a big fan of olive oil or of any added oils to the diet. Here’s a blog post where Dr. Kahn recommends against olive oil: https://drjoelkahn.com/this-doctor-says-olive-coconut-oil-are-bad-for-you-heres-why/ Dr. Kahn feels that a low fat diet is healthier and recommends cooking in water or vegetable broth or wine. This is especially the case for high risk patients who are especially at risk for a heart attack or stroke. He cited the work of noted vegetarian nutrition experts Nathan Pritikin, Dr. Dean Ornish, Dr. Esselton, and Dr. Joel Ferman and argued that added oils add extra, unnecessary calories that make it harder to lose weight, esp. since fat contains 9 calories per gram compared to carbohydrates that only contain 4 calories per gram. Dr. Kahn did say that if you were going to use some oil, he would rather have you use extra virgin olive oil than lard or ghee or coconut oil, since it has less saturated fat.
42:23 Dr. Kahn’ focus in his practice as a cardiologist is the early identification and early reversal of heart disease. He wants to protect his patients from becoming one of the 2,000 people a day who die of a heart attack. He calls his approach “Prevent not stent”. Dr. Kahn says that he did a lot of stenting in his day, but he prefers to practice upstream medicine by going to the root cause and fixing the problem before you’re sick, old, and nearly dead.
Dr. Joel Kahn is an integrative Cardiologist, internationally known speaker, and best selling author. He has a weekly podcast, Heart Doc VIP and he’s written 6 books, including Your Whole Heart Solution, Dead Execs Don’t Get Bonuses, The No BS Diet, Vegan Sex, and The Plant Based Solution. Dr. Kahn’s goal is to prevent heart disease by promoting a plant based diet, exercise, and a healthy lifestyle. His website is DrJoelKahn.com
Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com.
Dr. Weitz: This is Dr. Ben Weitz with the Rational Wellness Podcast. Bringing you the cutting edge information on health and nutrition from the latest scientific research, and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube, and sign up for my free ebook on my website, by going to Dr. Weitz.com. Let’s get started on your road to better health. Hello Rational Wellness Podcasters, thank you so much for joining me again today. And for those of you who enjoy the Rational Wellness Podcast, please go to iTunes and give us a ratings and review. That way more people will find out about our Rational Wellness Podcast. Today, we are going to talk about the early detection prevention, and reversal of heart disease. With our very special guest, Dr. Joel Kahn.
If a patient has existing heart disease, or has had a heart attack, stroke, shortness of breath, or any other symptom of an existing heart problem, they should see a cardiologist before they do anything else. For patients who don’t have a heart problem, don’t have symptoms of a heart problem, early detection and prevention should start with a careful history, and an advanced lipid profile, such as a cardio metabolic test from SpectraCell, or the Boston Heart Lab that I often run, or the Cleveland Heart Lab, or some of the other great tests that Dr. Kahn uses. Though there are many other tests like this on the market. Such an advanced lipid profile will look not only at the basic lipids, which are total cholesterol, estimated LDL, HDL, triglycerides. But it will also look at LDL particle number and size, and specific atherogenic particles, like Lp(a), and remnant lipoprotein. It’ll also look at inflammatory factors, like Homocysteine, Omega 3 levels, HsCRP, oxidized LDL, it’s also important to screen for the risk for diabetes by looking at blood sugar factors like glucose, insulin, Hemoglobin A1C, and it can also be helpful to test for some of the genes, such as the APOE gene, and some of the clotting factors.
Dr. Joel Kahn is an integrative cardiologist and internationally known speaker, and best selling author. He has a very popular weekly podcast, Heart Doc VIP, and he’s written six books, including Your Whole Heart Solution, Dead Execs Don’t Get Bonuses, The No BS Diet, Vegan Sex, The Plant Based Solution, which I just read recently, it’s a great read, and Young at Heart By Design. Dr. Kahn’s goal is to prevent heart disease by promoting a plant based diet, exercise, healthy lifestyle. Dr. Kahn, I’m so glad that we met at the anti-aging conference in Vegas in December, and that you’re joining me today.
Dr. Kahn: Oh, thank you very much, happy to beam out from gray and cloudy Detroit. So I imagine sunny Santa Monica.
Dr. Weitz: No, no, no, it’s raining like crazy.
Dr. Kahn: Oh wow, wow, wow, okay. Come to Detroit, bring your bathing suit.
Dr. Weitz: Yeah, we’ve had an unbelievable amount of rain. So since we’re talking about preventing heart disease, what exactly do we mean by heart disease? What is happening in the body anatomically, metabolically?
Dr. Kahn: Yeah. So the very broad term that ranges from babies being born with congenital holes, and defects, to irregularities in the heartbeat. But for the purpose of this conversation, really for the purpose of your listeners, the one that should dominate 99% of the combination on heart disease, I just have a little model, is when our arteries, whether they supply our brain, our heart, our legs, our sex organs, our kidneys, become narrowed. Become full of a term, people have heard the term, atherosclerosis, which is basically Latin for gruel, I think a little bit like oatmeal, or porridge. That’s what the word means. It’s appearance on an autopsy. And that is not something we’re destined to have happen. There are people that are 90 and 100, and don’t have that process. And there are people that sadly are in their mid to late twenties now. In fact, you find teenagers, you can find the earliest trace. And we’ve spent easily 50, 60, 70 years in the scientific world trying to identify why that happens. We know a lot more than we did 50, 60, 70 years ago. I think in the late 1940’s, it was just thought to be aging inevitable consequence of aging. But why does somebody 89 years old not have it if it’s an inevitable consequence?
So the reason that’s important is that’s the substance of strokes. That’s the substance of heart attack. That’s the substance of erectile dysfunction. That’s the substance of progressive kidney weakening, which is no joy at all. And to some degree, that’s the substance of dementia, because there’s a very broad group of people that have what’s called vascular blood vessel dementia. So if we could beat this problem, we would add tremendous amount of health to our life, and probably a tremendous amount of life to our life. And that is the focus of what we’ll talk about, and a whole lot of serious science.
Dr. Weitz: You know, I’ve increasingly had patients come in and say, “Well, I have some existing heart disease, but genetic, it’s genetic.” And it seems like that’s being thrown out quite a bit. Why do you think that is?
Dr. Kahn: One, it’s not in any way casting a stone at anybody. It’s a convenient excuse to say, “My weight, my blood sugar, my blood pressure, my heart disease is genetic.” Because until we have crisper 9 technology like an ATM machine, you just go stick your finger in and get your genome changed. Which I wouldn’t be surprised 20 years from now you can’t just dial in what you want, maybe 10 years from now. But right now you can’t. So you’re stuck with the genes mom and dad gave you.
We’ve learned on another layer, that your genes aren’t destiny, because there’s something called epigenetics. And I’m sure your listeners have heard the term. But that’s where lifestyle gets it. Something as simple as air pollution, which is worldwide, in some areas worse than others, can dramatically change which genes are turned on, which genes are turned off. Sleep. Good sleep, bad sleep can turn on, turn off. And then the core of what we’re talking about, fitness, choices in diet, smoking, not smoking, and such. So we can be handed a genome by our parents at the time of conception. But probably as or more important is what are we bathing our genome in? In some kind of visual there. And what’s actually turned on and turned off. I’m very excited, we’re just breaking into an era, we’re going to be getting reports. I just launched this in my clinic, where I’ll actually be able to know not just somebody’s genome, but which genes are methylated, which aren’t methylated, which are turned on and off.
So we’ll get more into that. And the ultimate conclusion is if you take a disease, very complex disease, like hardening of the arteries. Maybe 80, maybe 85% of the development of the disease is lifestyle and epigenetics, and 15% is just some hardcore genetic risk that you’ve inherited. Genes load the gun, but lifestyle pulls the trigger. So it’s never hopeless in the cardiovascular world, that your genetics will inevitably lead you to have a short life span, or a cardiac event. Just you may have to work much harder than the person who was gifted good genes, and a good epigenetic profile. But you’ve got influence. When there’s influence, there’s hope, you’ve just got to do the hard work.
Dr. Weitz: I think unfortunately, some patients are in a doctor’s office, there’s some evidence of heart disease, or some risk for heart disease, and some of these doctors don’t really have the time to get into a long discussion of diet and lifestyle. So it’s easy to say, “Hey, it’s genetic, take this statin, and end of discussion.”
Dr. Kahn: Right, and that’s … I was in that world where I had 12 minutes for a cardiology follow up appointment. “And Mr. Jones, your blood pressure is 170 over 105, let’s just double your drug du jour. It’s efficient, it often works. Some of these drugs do indeed have rather beneficial long term advantage. But what it doesn’t get at is, “How’s your sleep Mr. Jones? What’s your diet, breakfast, lunch, dinner, snacks? What’s your alcohol intake? What’s your waist line? Now you’re going to the gym.” Or the advanced labs you just checked. Are you severely deficient in Omega 3 and CoQ10, and vitamin D, and such? And gives you targets to correct, so that maybe on the next visit, you don’t need to double the blood pressure. So I find it like you find it, much more interesting, gratifying. It’s just very hard to do it in 12 minutes, which is why I’ve had to lengthen my office visits, just to accommodate more teaching, result review.
Dr. Weitz: Right. Great. So what are some of the best ways to detect some of the early signs of heart disease so we can prevent the progression of this condition? In a recent blog post of yours, you mentioned erectile dysfunction, going bald, gray hair, diagonal crease in your ear lobe, and calf pain when you walk can all be early warning signs of cardiovascular disease.
Dr. Kahn: Right. Well it would be a better world if every time our arteries got 80%, 90% blocked, we had warnings. We felt poorly, we got short of breath, we felt an elephant weight on our chest during exercise. And many people get those, and they should go seek urgent medical attention, emergency room, or cardiology office, see if they can get it quickly. Unfortunately, even that’s not reliable, and people just die. They die, and autopsy shows they’re 95% blocked and they had no warning. And that happens 2,000 times a day in the United States, and that’s largely preventable. So given the nature of heart disease, number one, it doesn’t reliably give symptoms and warning signs, and some of which can be misinterpreted as heartburn, or just fatigue.
Number two, do you really want to pickup this disease when you’re 80 or 90% blocked? We’ve got this crazy medical system that takes care of you when you’re about to die pretty efficiently, but has very little focus … Although, we have other disease models, I mean why do people get a colonoscopy? If you believe in that, at age 50? Or cologuard when you’re perfectly fine? Because we believe early detection is valuable, why do you get a thermogram or a mammogram of the breast? Same thing.
Heart disease, the number one killer of men and women, 2,000 people a day in the United States alone. We don’t share that. So you just mentioned, I’ll go through real quickly, but succinctly, or efficiently. There are some, I’d call them soft signs, never to ignore. Men, it’s as we’re recording this, the day of love, it’s heart month, it’s February. I’m wearing my pink dye, and all that. Men are having difficulty getting an erection, maintaining an erection, performing a sexual act that didn’t used to be a problem, may have clogging of vascular issues. And if the answer isn’t necessarily vague, or zealous, or horny goat weed, the answer is Mr. Smith, let’s know your cholesterol, your blood pressure, your blood sugar, your lipoprotein A. The whole gambit of the blood panels you mentioned.
And let’s make sure that this isn’t a warning sign, not just of sexual difficulties, but of an impending heart attack or they could even be fatal. And the science says that should be performed, but sadly, family doc, nurse practitioner, you get a blue pill, you don’t get blueberries. And a blue lab slip to really dig deep. There is premature gray hair, premature balding, there is this very unusual … You mentioned it, called diagonal earlobe crease. And if you want to just Google Steven Spielberg and take a look at his earlobes. He’s the most famous resident of LA that has a diagonal earlobe crease. I don’t know if he knows about it. I would imagine, because I use him as my example all the time. Somebody by now has gone to his mother’s deli in Los Angeles, and said, “Check Steven’s ears,” or something.
But a physician in New York City 50 years ago identified, a very bright physician, Dr. Frank. That in my patients who have heart disease, I noticed this unusual physical finding. And he said, “I think it’s a sign of silent heart disease.” And in the last 10 years, multiple studies say that was one smart guy in New York. When we actually can study heart arteries much easier now, and that’s the last thing I’m going to talk about. And it’s about 70% accurate. If you have a deep diagonal earlobe crease. You may have seriously clogged arteries. Take it as a clue, don’t ignore it, just like erectile dysfunction. Take it as a clue, there’s a common and serious disease, you want early clues wherever you can find them. And finally, why even wait? Why wait until your earlobes look funky, and your sex organs don’t go straight? And all kinds of other further down the road. We have had a test for more than 15 years that can tell a person very quickly and accurately, and inexpensively, if their heart arteries are clogged. It’s often called the mammogram of the heart. But the majority of primary care doctors, not teaching it’s availability or its utility, it’s a heart artery calcium CT scan. CT scan. You make an appointment at your hospital in Los Angeles, Good Sam, Cedar Sinai, UCLA, Torrance Harbor. You go in, you lie down for 15 seconds, you hold your breath, and you go home. No IV, no injection, it’s a CAT scan. There’s a very small amount of radiation when the machine’s on. And you get a report that says your heart artery calcium score is zero, you are golden for five, 10 years in terms of risk. Almost all. And your heart artery calcium score is 642, you’re 95 years old inside, even though your driver’s license says you’re 52 years old. And you need to get to a preventative cardiologist who can dig deep, and help you with the parameters measured in your lifestyle, and your diet, and all the rest. And maybe if we work on reversing that process, that’s been available, and was developed at UCSF and other places. Used to be $1,000, now it’s often $50, $75, $100.
The real breakthrough, November 2018, after years of this being available. Fantastic documentary called The Widow Maker movie on Netflix, the Widow Maker Movie, everybody should watch it. American College of Cardiology, the American Heart Association, which previously had said this is a good test, really elevated their recommendation. Primary care docs managing somebody 45, 46, 47 cholesterol, weight, blood pressure, blood sugar, should consider this test. Because if it’s a zero, you have really dropped somebody down in terms of risk, and you have time to work with them on diet, fitness, exercise, like that. Somebody comes back loaded with calcium hardened arteries, you need to intensify your therapy, they’re now high risk. And the fact that they endorsed it, and actually said, “Primary care docs, you gynecologists, you family docs, you internists, you nurse practitioners, you PA’s, put this in your toolbox as a test.” So we aren’t yet ready to say everybody at age 50. I would actually say 45, get this like, like they get a colonoscopy. But in my practice, and in my experience, don’t miss out. Almost everybody has some reason to consider doing it once, and maybe 10 years later.
Dr. Weitz: It’s interesting, there seems to be a push back actually in medicine now. I’m assuming it’s coming from the insurance companies. Actually, against doing some of these screening tests. Recently, they’ve been pushing back against mammograms, and PSA testing, and they’re saying you don’t really need it. It’s not going to change care.
Dr. Kahn: Yeah, that’s where this heart artery calcium scan is finally finding its niche. Because it is pretty clear, if you’re in this middle risk, you’re 48 years old, you’re tired, your cholesterol is 220, your blood pressure is 142, you’re just not picture perfect. That your physician might run a little calculator and say, “You’re medium risk for heart disease over the next 10 years.” Well that’s where the calcium score, if it’s normal, you’ve just dropped that. It’s called reassignment. You’ve reassigned that patient to a very low risk. No, you don’t recommend french fries and milkshakes. You say, hey, it’s all lifestyle, maybe you can add to your health. And if it comes back abnormal, you’ve reassigned them to high risk. Where it’s lifestyle, plus depending on your perspective, it could be prescription, it could be referral to exercise lifestyle change programs. So we’re seeing this turnaround. What we’ll never have is a 10,000 patient study where 5,000 got the scan, 5,000 didn’t get the scan. 15 years later, it’s not going to be done. There’s no money in the game. And the tests can be … University hospital in Cleveland just announced they’re doing these tests for free. They got some research grant, so you can go and find out the truth about your heart like you’ve never been able to. The Widow Maker movie, if you want to learn the specifics for free in Cleveland. And in my city, it’s $75. Most people can afford to pay out of pocket $75 once every 10 years.
Dr. Weitz: Can you talk about this newer TMAO test that’s being offered by Cleveland Heart Lab as a risk factor for heart disease?
Dr. Kahn: Fascinating topic, controversial as I’m sure you’ll bring up. But you and I both know, I do believe that blood cholesterol is important, and it predicts the development of aging of arteries. But it never was the only predictor, smoking, diabetes, weight, stress, sleep. We’ve known this for years. So that list has expanded a lot. And you mentioned some of them in your introduction. Lipoprotein little A, Homocysteine, inflammatory markers. Well even that list is clearly not complete. We’re going to continue to add, and at the Cleveland Clinic in 2011, Dr. Stanley Hazen, MD and cardiologist, and his team, identified three molecules they felt might be either markers of clogged arteries, or maybe actually cause clogged arteries. Like we believe some versions of cholesterol do. And they set out to examine yes, no. They developed a blood test for a molecule in the blood called T-M-A-O trimethylamine N-oxide. They found that the more clogged your arteries, the higher was the blood level in a group of more than 4,000 patients. That’s called an association, that doesn’t prove. But maybe this is a good bio marker. Then they spent a couple years in basic science labs with a whole team, showing this molecule caused three findings. It caused your platelets to clump, which might trigger a clot. It caused your HDL cholesterol not to work well, which is not necessarily good for your arteries. And it caused your LDL cholesterol to get taken up into the wall of the artery more aggressively. So it seemed like in fact, this was now possibly a cause of artherosclerosis. And they went on to show that it seems to be in the blood after a meal that includes a lot of choline from egg yolk, and carnitine from red meat. Vegetables don’t cause it to rise, vegans don’t have it in their blood.
Then they showed that if you happen to be taking supplements, and they’ve done this mainly with carnitine supplements, it can also lead you to develop TMAO in the blood. And then the whole mechanism of absorbing choline, carnitine, through some enzymes in the wall of the gut called lyases that can birth those precursors to TMA. And the liver converts it to TMAO. It’s a fascinating group of science, that it only eight years, now there’s way more than 1,000 papers.
So what we do know, it is clearly a pretty good marker. If you’re a diabetic, and your TMAO is up, your prognosis is not as good as normal. If you have congestive heart failure, if you have coronary arteries, if you have kidney disease. And it can predict the risk of brain disease. Does it cause the disease or not? We don’t have a blocker, we don’t have a trial that we can say, “Here is 500 people that we lowered or blocked TMAO, and their arteries remain healthy, the patient remained healthy.” We think it’s the case, and I kind of practice that way. I’ve been able to drop TMAO blood levels since 2015 in probably three or 4,000 patients. And if it’s sky high, I want to know their supplements, I want to know their diet. I’m going to see if I can change their diet to at least a Mediterranean diet, which has been described to lower TMAO. And maybe even more of a plant diet than that. And I’ll stop their supplements for a little bit.
Now you and I both know, we need carnitine for proper muscle function, heart function. We need choline. It may be a matter of how much we need, and cutting back rather than cutting out. So there’s much to be learned. I know the Cleveland Clinic wants to find a blocker. Here’s your TMAO blocker prescription drug that becomes a several billion dollar a year drug. They’re going to have to do enormous and long term outcome studies, so we’re a ways away from that. But anybody can get their blood level checked at a Quest Lab, by asking for a TMAO blood level. And if you read the science, if you’re a heavy meat and egg eater, you might want to do that, and ask if your micro biome is producing a lot of this metabolite.
Dr. Weitz: Yeah. I’m wondering if this is really a marker for an unhealthy microbiome. Some of the problems I have with this test is one, one of the foods that most increases this, is eating fish. And fish has been associated in a ton of studies with decreasing cardiovascular risk-
Dr. Kahn: Right.
Dr. Weitz: And other chronic diseases. And likewise, eggs really, we used to think that they were really atherogenic, and it seems like all the studies recently really haven’t shown that eggs increase your risk for heart disease. I know you don’t necessarily agree with that.
Dr. Kahn: That may be quantity. But yeah, the fish story isn’t clear. And it’s just like there are all only certain fish that are really rich in Omega 3, like salmon, deep cold water fish. There’s only certain fish that intrinsically in their fish have TMAO. And if you eat them, your blood level goes up by a completely different mechanism than meat and egg yolk, because there’s no metabolism. It’s just you’re absorbing TMAO. And I think it’s very deep water fish, like some unusual fish on your plate. They wouldn’t be the bulk of the fish eaten in the Mediterranean based, and where studies suggest it is part of a healthy diet. So yes, we need to learn more. It would be premature to say never eat meat, never eat bread, egg yolk, never eat fish based on TMAO. You might choose to do that based on other parameters. But I think it’s good that we’re learning new and interesting pathways. We’ve not … Heart disease is still the number one killer of men and women in the United States. I’m not sure if it’s because we haven’t defined all the parameters, or nobody is following a heart healthy lifestyle. There’s so much data that even what’s called the simple seven.
American Heart Association, you can say good group, bad group. They endorsed Fruit Loops in the past as heart healthy. All that stuff is the shameful episode in their history. But yeah, they have a little thing you can go online, do you smoke? Your cholesterol, your blood pressure, your blood sugar. How many servings of fruit and vegetables a day? How many minutes of exercise a day? What’s your weight? Simple seven measures almost everybody knows. That simple seven calculator correlates to your coronary artery calcium score. Correlates to whether your coronary artery calcium score is going to go up. Or whether you’re a zero, and you’re going to transition to somebody who has heart disease. So you can control, do you smoke, what’s your fitness, how many fruit and vegetable servings a day. I mean we need the fancy new bells and whistles, like TMAO. But God knows we have too many people that smoke, don’t exercise, and eat Tim Horton donuts during the day. We don’t want to lose sight of simple measures that mean a lot to health and longevity.
Dr. Weitz: There’s a prominent Functional Medicine doctor, Dr. Steven Gundry, and he’s been out there saying that grains and legumes, and even certain fruits and veggies, and seeds contain lectins, which are harmful to our health. What do you think about that assertion?
Dr. Kahn: Yeah I don’t know, I’m not making a promotion for an LA based TV show at Paramount. But I had the pleasure and the heartburn of being on the show, I think it was around September 2017, debating Dr. Gundry. I learned of his book, I had read his previous book, but his book Plant Paradox came out March 2017. I’m actually pretty open minded, I bought the book and I read it, and I thought some of it was interesting, and some of it was somewhat insane. And subsequently, just to fast forward, because it’s really not me versus him. He is a University of Michigan trained heart surgeon, I’m a University of Michigan trained cardiologist. He likes to call himself a cardiologist, I don’t know why, I don’t call myself a cardiac surgeon. It’s just the first little chip in the otherwise seemingly perfect argument that Dr. Gundry has. He states that he’s published enormous data of his dietary program in patients with auto immune disease. Indeed, he’s published no articles on his diet, it’s just a matter of fact. He published one paragraph called an abstract, and it has more spelling errors than a third grader trying to write Shakespeare. It’s insane.
And then his book itself, and this is the biggest problem. He has no actual data published. His book is riddled with serious, serious errors. I mean doc, if you write a book, and I write a book, and I say in chapter two, remember, these are books that are recommending health treatment strategies for people with potentially serious disorders. Putting their trust in Dr. Gundry, Dr. Kahn, Dr. Weitz. And he’s saying in chapter two, third paragraph, a little highlight study research number seven. And you go to the back of the book, you wouldn’t believe that it’s actually a real study on the topic that actually was represented appropriately, and fairly, and honestly. Dr. Gundry’s book doesn’t believe in that rule. Why not just create a piece of fiction that’s called nonfiction? So I’m not making this up, there are dozens of serious academic errors. And I challenged him that on national TV, as well as the lack of publication. I do believe he really is the emperor that wears no clothes. Now, taking personalities aside, do legumes cause inflammation in one person in 100? Are there people that have inflammatory diseases that stop eating beans, peas, and lentils, and either feel better, or some bio marker is better? Maybe. It’s not reported consistently in the literature. Of course, Tom Brady will tell you during the season, he avoids lectin rich foods, and deadly nightshades, like eggplant. Well Tom Brady is not a scientist. But he’s cute, and we all listen to him. The answer is we don’t know, and have I ever recommended a legume free lectin low diet to a patient with a serious auto immune disease? I have if they’ve tried everything else and they’re struggling. You do what you need to do. But it’s way premature to recognize Dr. Gundry as a Nobel Prize winner for fiction and nonfiction. Nor is it … The flip side of course, just to finish, is if you study longevity, which I know your patients are interested in, and my patients are interested in. And you study the areas where people live to age 100 or more in excess, the blue zones. The single food group shared amongst five regions around the world that are very different is legumes. Beans, peas, and lentils are the central food of the areas where people live long and healthy. Now, their water is better, their air is better. They exercise, their lifestyles are different. But to call these food groups killers, when indeed, the science says the opposite, is just reason number 37 when Dr. Gundry comes on, you throw tomatoes at the screen. Was that subtle?
Dr. Weitz: Hey, that’s … Yeah. It’s-
Dr. Kahn: He knows how I feel, I debated him several times in meetings and in the public.
Dr. Weitz: Yeah.
Dr. Kahn: But he’s got one big ass vitamin company, and you and I would like to be CEO of that enterprise. You know, the public is looking for quick fixes.
Dr. Weitz: Right.
Dr. Kahn: And they’re being misrepresented.
Dr. Weitz: Yeah. He tells a good story. I think the reality is, is if beans are properly prepared and cooked, that really inactivates most of the lectins.
Dr. Kahn: Right. Yeah, and it’s like 10 minutes of cooking. So it’s true, don’t eat raw red kidney beans, it’ll upset your stomach. It won’t kill you, but it will upset your stomach.
Dr. Weitz: Right, and you know, ricin that comes from castor oil beans, and that will kill you. So you know, but anyway. So in my practice, when I had vegans who were overweight, I have found that a lot of people don’t follow a vegan diet properly. It’s very easy to follow a vegan diet, and end up hardly eating any vegetables. You know? They just end up eating a lot of processed and junky carbs.
Dr. Kahn: It’s a real struggle, and I agree with you, and I’m on your account. There actually is a study from the Harvard School of Public Health looking at cardiovascular disease, heart disease. And if you eat plant based junk, they had a way to analyze your diet, and calculate healthy plant based diet, unhealthy plant based diet. They actually did worse than the average American eating what seemed to be correlated as an unhealthy plant diet. And you did much better if you ate a whole food healthy plant diet than the average American. So yeah, the word vegan to me is somebody who is into animal rights, and the environment, and is an ethical standpoint. But vegan food, Tyson just announced they’re creating meats and cheeses that will be plant based, Tyson, the biggest producer of chicken products in America. I mean, the grocery store is going to be filled with non animal products that look like former animal product. Doesn’t mean they’re healthy. It’s actually probably ethically and for the environment, a bit of a move forward. But my heart patients use the word whole food plant based. I mean it’s got to look like the recent Canada food guideline plate. Rich in fruits, vegetables, beans, peas, lentils, healthy sources of protein that can include the beans, lentils, organic tofu, tempeh, and such. It’s not a mac and cheese that happens to say vegan on it. That’s going to move you towards where you want to go.
Dr. Weitz: How do you get adequate Omega 3 levels with a vegetarian diet? Because the best source of Omega 3’s is from fish, and fish oil, and the type of Omega 3’s that’s found in vegetables and plant foods is linoleic acid, and it has to be converted into the DHA, and EPA, and that’s done very inefficiently.
Dr. Kahn: Yeah, yeah. Although, it’s been reported on Twitter that I secretly go to Alaska with Dr. Ornish, and Dr. McDougall, and gorge on salmon once a year. And I’m not joking, that is the language of the beautiful world of Twitter that we have our secret meeting. And I haven’t done that. … Right.
Dr. Weitz: It’s just fake news.
Dr. Kahn: Yeah. It’s yeah, it’s a challenge. Like you, because you mentioned those labs, I do actually get blood levels of Omega 3. There’s a lot of data, the higher your blood level, the better your long term brain health. And it maybe the better your overall health span. Dr. Russel Jaffe, you may know of a Perque Labs that makes a big deal about Omega 3 blood level of 8% or higher for long term health and brain health. So it’s a challenge, and the only people in my clinic that routinely have really good Omega 3 levels either eat salmon five nights a week, or they’re taking four grams of a high quality Omega 3 fish oil a day.
And my meat eaters are low, and my plant eaters are low, very often. And yes, it is important to try and get two tablespoons today of ground flax seed, and make some chia pudding, and use some hemp seeds on a salad, and eat walnuts as your preferred nut, because they and Brazil nuts are the only ones really rich in Omega 3. And leafy greens, now, I’m a big fan of chlorella, and spirulina, particularly chlorella. There’s so many benefits to chlorella. Detoxifying and cholesterol and blood sugar lowering. But because it’s algae based, it actually has EPA and DHA in chlorella. And it’s a wonderful handful that I do every morning, and many of my patients do organic chlorella. And now there are capsules, you may say we’re mimicking the fish oil business. But there are EPA, DHA capsules. And the highest I’ve seen so far is about 600 milligrams of EPA, DHA in a capsule. Getting close to a good quality fish oil capsule, that might have 850 to 1,000 milligrams. So whatever it takes, I try and get my patients’ levels up. But for the person on a new vegan diet, I’m teaching about chia, hemp, flax, chlorella, walnuts, and I’m probably going to encourage them to take one capsule a day. There’s an interesting couple of startups now that have a spray that has B12, vitamin D, and EPA, DHA. One spray a day, you’re a plant eater, you covered your bases. And there’s a new company out of Australia that has a tiny little capsule for $22 a month that has those three things in a capsule, if you don’t want to do a spray. So I think the solutions are there, but they do apply outside the vegan world, too, if you do the labs.
Dr. Weitz: I tend to be a big believer in a low glycemic, Mediterranean eating style. And olive oil is a big part of that program. And I know that olive oil is highly recommended by a lot of people in the Functional Medicine community, including your friend, Dr. Mark Houston. And I recently read one of your blog posts, that you are not in favor of olive oil.
Dr. Kahn: There’s a small niche, with number one. You’re absolutely right, there’s a small niche of patients. I had a guy gentleman in my office this morning who has had previous stinting, he’s having angina every time he walks to the mailbox. It’s what we call chronic, able angina. He just had a stress test, and documents lack of oxygen to the heart. This is not a low risk patient. This man could go on to have a heart attack, could drop dead. He will not go through another procedure. He wants to work on lifestyle reversal of heart disease. He’s aware of data from the 50s, 60s, 70s with Nathan Pritikin. Dr. Ornish in the 80s, 90s, Dr. Esselton of the Cleveland Clinic, Dr. Joel Ferman. People that have published data that this gentleman might be able to stop having symptoms, and improve his stress testing coronary status. All those data, which are published peer reviewed, and actually government paid for programs, have used whole food plant diets without added oil. It actually goes back into the 40s, and some data from an internist.
If you go, Ben, to the Cedar Sinai cardiology department, the auditorium where I gave grand rounds about a year ago is called the Lester Morrison MD auditorium. Dr. Morrison did studies in 1948 using oil free diets in heart disease patients, and published dramatic benefits. So the problem is, if you’re the rare patient I took care of this morning, I would … with my knowledge of what’s going on, feel obligated to tell them. It is possible to steam, and saute, and cook with water, and cook with wine, but you don’t have to add oil everywhere. It’s a challenge in restaurants for sure. And I feel obligated to tell, so far that’s the only guy we know that can reverse your advanced symptomatic heart. When we’re talking to people listening that aren’t like that gentleman, is olive oil of a good extra virgin source better than lard? I mean in my world, much better. Better than ghee? I would say yes. Better than coconut oil? There is about 15% saturated fat in olive oil, and there’s 85% in some coconut oil versions. I’d rather people use olive oil. But if you’re struggling with your weight at 4,000 calories a pound per olive oil, and a salad is 100 calories a pound, if you don’t put olive oil on it. I mean my patients that are challenged by weight, I do also recommend them that they recognize the calorie density of olive oils is not favorable to their calorie in/calorie out struggle they’re having every day.
Dr. Weitz: Yeah, on the other hand, fats are a good source of long term energy, and having a person feel satiated, and not craving a lot of carbs is also an important factor.
Dr. Kahn: It’s a matter of quantity. I mean a half a teaspoon of olive oil versus four tablespoons, or Dr. Gundry talked about 12 tablespoons a day I think, I don’t want to misquote him, in his book. I mean that’s 1,500 calories a day, what else are you going to eat? Well if you cut all your legumes out, I guess you might just make it on olive oil. But I think recognizing that the highest calorie density of any food source on our plates is oils, whether they be standard vegetable oils, extra virgin olive oil, it’s just worth being aware how calorie dense they are.
Dr. Weitz: One more question for you. I wonder if perhaps now the time has come for individualized medicine? Maybe the time for making any kind of sweeping recommendations for society for the best way to eat, maybe the focus should be on what’s the best way for each person to eat?
Dr. Kahn: Yeah.
Dr. Weitz: Look at their parameters, do some testing, see how they’re eating. If that’s not working for them, find a modification that’s going to work for them.
Dr. Kahn: I’m intrigued by the idea, as you know, there are ways you can send stool specimens, and get advanced microbiome testing. You could get reports back that tell you your microbiome likes arugula, or doesn’t like arugula. We don’t have any long term studies to say that this action makes a difference. But that’s available. You can do certain genomic studies to say if you metabolize Omega 3 rapidly or not. That very caffeine rapid or not. I mean can we guide, we’re going to spend a lot money for individual, but could we guide an individual to their ideal diet? It’s an interesting concept. I think we’re not quite there, or certainly don’t have long term data to say that they’ll feel better, or live longer.
The other just comment is I mean there’s always two people in the room when we’re talking about diet. There’s the patient, and there’s the earth. And we’ve had two very strong statements in the last four weeks. One by a large group that’s spent two years across Europe called Eat Lancet. Looking at a statement, how do we feed 10 billion people in 2050 nutritiously? But also on a planet that isn’t polluted by rain forest destruction, and landfill destruction, the rest. And their conclusion was shifting towards more plant based diets for the planet will also benefit health. Those are called plant based. Those are called eating more fruits and vegetables, because there is still such an under representation of adequate … attainment of fruit and vegetable consumption. And then the Canadian government, after 12 year absence of the shared food recommendations, very similar frankly, to the USDA, with the food plate that’s half fruits and vegetables, whole grains, healthy proteins. And they brought in the conversation about the planet. So those are the two factors. Do we have to, as individual practitioners, worry about the health of the planet when we’re recommending a diet to an individual patient? Or do we just worry about individual patient? These are long and deep discussions. Largely, there are words out there. Plant predominant, plant flexitarian, plant based. Doesn’t mean you’re committed to not enjoying a nice piece of grass fed beef, or a nice line caught salmon, or a nice free range organic piece of poultry now and then. And I’m not going to yell at you if you’re doing that. But if your Mondays are meatless, or your breakfasts are meatless, or your plate, just like the USDA, Harvard Public School of Health, Eat Lancet, and Canadian Food Guide is largely a plant based plate, with your choice for a quarter of the plate. I think we’re all moving towards a healthier place for the both planet, and the patient.
Dr. Weitz: Great. Excellent. Thank you for spending the time with us. How can the listeners and viewers get a hold of you, find out about your programs, and tell us about the restaurants that they can visit as well that you own?
Dr. Kahn: Well first they gotta Google my great debate with Dr. Gundry on the Doctors Show. If the clip is there, I don’t want you to think I’m completely insane. I did go a little Hollywood on him. But it was a TV show. Here it is on YouTube: https://youtu.be/e61XfKF_NpI
Dr. Weitz: That’s okay, we just had a Functional Medicine meeting a few weeks ago, and Dr. Vojdani, he also critiqued Dr. Gundry.
Dr. Kahn: Bravo, I love it. Yeah, I’m all over the web on Instagram and Twitter. Dr. Joel Kahn, D-R-J, K-A-H-N. There’s a Dr. Joel Kahn, America’s Healthy Heart Doctor Facebook page. And I’m very active. There’s new postings every day on Twitter, many, many a day. And I have website, Dr.JoelKahn.com. I’m a real cardiologist, I saw patients this morning, I’m seeing patients all afternoon. I see patients, I have a license in California, and Florida, and Georgia. I see people from all over the world. Really with the orientation, early identification, and early reversal of heart disease. So you’re not a statistic of 2,000 people a day. So go watch that movie, the Widow Maker movie, and get educated on what I call “Prevent not stent”. I did a lot of stenting in my day, and I know the field, but upstream medicine. That’s what you do. Let’s go upstream to the root cause, and fix the problem before you’re sick, old, and nearly dead.
Dr. Weitz: Excellent, excellent. Thank you so much, we’ll talk-
Dr. Kahn: Thank you.
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