The Melanie Avalon Biohacking Podcast Episode #218 - Dr. Joel Kahn

TRANSCRIPT

Melanie Avalon: Hi, friends. Welcome back to the show. I am so incredibly excited about the conversation that I am about to have. So, the backstory on today's conversation, I think I was first exposed to the work of today's guest quite a while ago. Probably, I think it was 2018 when he was on Joe Rogan debating Chris Kresser, somebody else that my audience is probably very familiar with. Listeners, I've talked about this before, but I have a list of guests that I call them dream guests that I would love to have on the show. And it kind of just sits there because [laughs] now we're so booked out so far that I don't really actively reach out to people. And then so, this guest, Dr. Joel Kahn, was on the list. And then a few months ago, an article published in CNBC about this podcast and the show, and he reached out to me on Instagram about collaborating and I was so excited. So that was an immediate yes for me. We booked it. Here we are. I have since gone through quite a few of his books. A lot of the research, so I'm just so excited and so honored that you are here. Thank you for being here. Dr. Kahn.

Dr. Joel Kahn: Well, thank you. That's a heck of an introduction. I'm kind of sorry my mother wasn't sitting next to me to enjoy it with me. 

Melanie Avalon: I can be your publicist. I'll just walk around with you everywhere. A lot of my listeners probably are familiar with your work, but for those who are not, you are known as America's Healthy Heart Doctor. You've been on Dr. Phil and The Doctors, and you're a clinical professor of medicine at Wayne State University School of Medicine, founder of the Kahn Center for Cardiac Longevity. You have a restaurant, GreenSpace & Go, and you have so many books, an overwhelming amount of books, including The Whole Heart Solution, Vegan Sex, and then two that I have in front of me right now that I recently read, The Plant-Based Solution, as well as Lipoprotein(a), the Heart's Quiet Killer. So, I have so many different things I would love to talk about. I know we're both fan of wine, so we're going to have to talk about that at some point. But for listeners who are not familiar with your work, would you like to tell them a little bit about your personal story? What led you to being the legend that you are today?

Dr. Joel Kahn: Often a legend in my own mind, but still appreciate the kindness. I had a couple moments in my life that proved, in retrospect, to be important. I was born 64 years ago with a murmur. A murmur is a noise that the pediatrician hears made my mother nervous. I was found early in life to have a little hole in my heart. It is no big deal. I get no sympathy for it at all. Closed up, healed up, no surgery. I started seeing a pediatric cardiologist from birth. I don't remember that part. But I remember going when I was four and five and eight and nine and 13 and ultimately was told you don't need to come anymore. And I kind of fell in love with cardiology. Lucky for me, I had a murmur because if you would have asked me about age 10, "What do you want to grow up to be?" It would have been I want to be a heart doctor. So that's one little piece that was not preplanned but worked out. When you got lemons, you make lemonade, as they say. 

And then second thing was I grew up in a home in suburban Detroit where we honored certain dietary laws called keeping kosher. Most people are familiar with that. We didn't do cheeseburgers and we didn't do ham and pork and when I went to college because by no means, I highly observant person but that was one aspect of my culture I really enjoyed, actually, my mother was a very good cook. The only option if I wanted to keep that tradition was to mainly eat from the salad bar in the dormitory in Ann Arbor, Michigan. And I embarked on a salad bar diet for the first few months and had a girlfriend with me who was doing the same thing at the dorm. And that girlfriend is a wife of 42 and a half years now, so that stuck, and we both felt so good that we kind of quietly became vegetarian/vegans. It was no big deal back then. It wasn't like it was in the media all the time. 

At the same time, my parents, mainly my mother dragged my father. They went to California to the Pritikin Longevity Center and they spent a week and my mother came back and started making lentil loaf instead of meatloaf at home. And I would go home once in a while on a weekend. I said, "Wow, I'm getting salad in college. I'm getting lentil loaf on the weekend." And pretty much by age 18, 19 I was completely a plant-based human. I had no understanding of what that was, what it meant, if it was good, if it was bad. It wasn't ethical, it wasn't environmental. It was an easy way to maintain those religious observance. But as I got into medical school in Ann Arbor and cardiology training, which I did in Ann Arbor and Dallas and Kansas City, I was already totally committed personally to this and started learning about who was a Nathan Pritikin of Santa Monica and Santa Barbara, California. And very soon after who was Dean Ornish one of the world's most famous lifestyle doctors in promoting a plant-based whole food diet for heart disease reversal with science, with books, with interviews, debating Robert Atkins and sort of a famous guy.

So, when I finally got into cardiology practice in 1990, I was trained to do stents and heart attacks and very aggressive stuff and loved it and actually was out of state, but came back to Michigan. Just great job, close to family, as it turned out, four seasons a year and have stayed here ever since. 1990 when I began my first practice about six weeks later, Dr. Dean Ornish published the results of a one-year study called the Lifestyle Heart Trial. And it demonstrated that very sick and severe heart patients that adopted a combination of stress management, good sleep, regular exercise, and a whole food plant-based diet could actually be documented to reverse some of their atherosclerosis, could be documented to have less angina, chest pain and dramatically better stress tests. And it was like the first real lifestyle medicine paper or research, serious research, it was in major journals.

So, the coincidence was six weeks into my new cardiology career, I started teaching patients that I've been doing this for 13 years already and now there's some science. So, if you want to read a book, Dr. Ornish has a book. If you want to go to a place, you can go to the Pritikin Center if you want me to give you a little insight. And it might be three minutes of visit out of the 15 minutes of visit I had in the office where I found it was very effective. I was doing a heart catheterization on a patient which might be 20, 30, 40 minutes together, a very special and bonding time. I would give them a little information that this might be the last time you need to be in the hospital, in the cath lab if we get you focused on healthy lifestyle and that just snowballed to the last 10 or 12 years where I've gone back and done a lot of academic courses and university courses and Institute for Functional Medicine and the A4M Anti-Aging Society and University of South Florida and other places. So, I kind of left traditional cardiology about eight, nine years ago and now do completely kind of integrative holistic-oriented preventive cardiology. But it's very high tech, it's very detailed labs and imaging, and it's a really fun blend of Eastern, Western touchy feely and precision medicine. My patients know their physiology, their biochemistry, their genetics better than almost anybody around the country. And then we try and approach that with nonpharmaceutical approaches when we can and when it's safe.

Melanie Avalon: Oh, my goodness, [laughs] there's so much there. Did you often make a joke about having a hole in your heart? 

Dr. Joel Kahn: Actually, I'm a holistic cardiologist, so I haven't actually used that pun. But from now on I will thank you. The other pun in that regard and I steal it from Dr. Mark Hyman, a friend is he calls it being a holistic doctor because your patients bring you a whole list of problems, a whole list of supplements, a whole list of other doctors they've seen, a whole list of tests they've had. Being holistic is sometimes incredibly challenging and brain expanding, because we don't just do I call it your grandfather's Oldsmobile Medicine version 1.0. Either my patients bring to me or I introduce them to advanced testing. And there is a term, precision medicine, precision cardiology, which is not lip service. I think it's radical how more accurate we can be in early diagnosis of heart disease, avoiding heart attacks, characterizing heart disease if you have it and then obviously squashing it down, preventing, reversing the whole thing.

Melanie Avalon: So many things I want to ask you. So, I guess to start things off, the audience for this show, they're very health conscious, a lot of paleo, lot of keto. There are probably a lot of I should do a poll, actually, and see the actual percentages. I'm sure there are a lot of vegans listening as well. So, when we step back and look at the longest-lived populations like the blue zones, we see heavily plant-based diets. We do see, with the exception of Loma Linda, a little bit in all of those, a little bit of animal products. What I'm wondering is, because in your books, you advocate entirely plant-based vegan approach for cardiac health and longevity and everything overall, do you see a big difference in health-conscious patients who are completely vegan versus vegetarian versus paleo? Do you see an actual difference in their heart? 

Dr. Joel Kahn: First of all, good for you for knowing some of those subtleties of the blue zone locations and the differences between those five. Semi-academic, I'm a big fan of Dan Buettner, and a friend of his, and it's not exactly university research, it's his own personal mission to have visited and reported back to all of us. But the Loma Linda people do publish a lot of research out of the university there and all. Number two, I would call myself a builder of bridges between these food camps. I've been on Shawn Baker's podcast a few times and can text them and chat with him. Paul Saladino, carnivore, we've been on national TV together. I won't call it the friendliest of interactions. It was set up to be a bit more of a debate, and it was a debate, and you said that, Joe Rogan. But my first line in the stand for patients is anti-junk, anti-crap, anti-process, anti-fast food, frozen diet. And I think all the disciplines, the Mediterranean diet, the paleolithic, the ketogenic, the carnivores, and the healthy, whole food, plant-based, vegetarians and vegans have eliminated the most toxic choices to put in your body, which is the processed foods with chemicals and additives and dyes and coloring and plastics and microplastics and all the rest.

So, we're all elite eaters, we're all picky eaters, we're all demanding eaters. And I think I've been to Paleo f(x), I've been a panelist. I don't think any other vegan doctor [chuckles] has ever been a panelist. Then COVID came, so I didn't go back, but I would go back if invited and I had a hell of a good time with Mark Sisson and some of the others, they respected I'm not completely wacko. When you get to the science of it and I don't want to go too long, but it's such an important question you asked me, "Do I see a difference?" I mean, I only have a couple of carnivore patients in my practice. I welcome them. I'll still take good care of them, but they are aware that I don't beat them up about their diet but I'm not the doctor you go to say, "Rah, rah, go, go." And because I do such advanced blood work on vitamin levels, inflammation levels and certainly cholesterol levels, there are some pretty godawful findings. But it's only an N of 2, and frankly there aren't that many published lab values on any carnivores. 

Shawn Baker, the famous orthopedic surgeon, MD, published his own blood work about 2017 and I would call it very concerning blood results. And maybe I missed it. I've never seen him publish updated blood work. He certainly looks like a stud, but his testosterone was low, his hemoglobin A1c was high, his creatinine and kidney function was elevated. Cholesterol wasn't ideal and I wouldn't use it as a perfect example, but you don't try and take one person and base an entire conclusion on nutrition and longevity based one person. I mean, I'm pretty healthy guy in every aspect of holistic lifestyle. But you know, God forbid something can happen. It doesn't mean that every research study on whole food plant-based diets was bogus because Joel Kahn got, God forbid, prostate cancer or some other calamity, and I hope I don't get it. But all things are possible, even when you take precautions. When you look at the-- so in my practice, of course, I would say I've never done a survey either less than 50%, but a sizable portion are either really good whole food plant-based eaters or 95% plus with their own little version of a little fish or seafood here or there, occasional piece of meat here or there. But they're largely plant based.

And I'm almost numb to the fact when patients come to me and say, "Doc, and I changed my diet eight weeks ago and I'm down 14 pounds or three months ago and I'm down 24 pounds." I mean, it's so common. And of course, it depends where they came from, how horrific a version of the standard American diet to conversion. They often read a book by me, by Dr. Esselstyn, by Dr. Ornish, by Dr. Fuhrman. They're usually in the health crisis situation. They found out they had bad heart disease or blood pressure or diabetes, and they really jump in and man, there's quick and amazing and important transformations with diet alone. Now, it probably could happen with paleolithic and ketogenic and even a Mediterranean diet. You go from garbage to good, you'll see transition, but yeah, it really works. There is some randomized studies that particularly inflammation, when you do extensive blood panels, responds better to whole food plant-based diets with all the fruits and the vegetables, and the nuts and the seeds. And I'm an extra virgin olive oil snob and fan and I include that in a good whole food plant-based diet and avocados, some of the plant-based doctors exclude those, but there is good data that you'll lower inflammation and improve your biomarkers.

When you look at the science, I just want to point out one of my gurus in the nutrition science world is Dr. Valter Longo of University of Southern California and the prolonged fasting mimicking diet and had a lot of exposure to him and a lot of feedback from his research interests in his company. And maybe your audience has heard this before or not. But he points out that because there're so few randomized studies in nutrition that go beyond six hours or six weeks or occasionally six months, it's so hard to do randomized studies of nutrition, unlike pharmaceutical agents, unlike surgical procedures, that you're dependent on other kinds of science and they're imperfect. He calls them the five pillars of nutritional longevity that you have to pay attention to case reports, amazing examples of just one person who did well, didn't do well. You have to pay attention to biochemistry. Does it make sense that eating lots of fruits and vegetables, nuts and seeds, complex carbohydrate foods like beans and legumes from the blue zones, that they might improve health and longevity. Does a biochemistry support it? Does a biochemistry support they eat lots of meat, might be good for your health or bad for your health. You have to look at what do centenarians eat? That's the blue zones approach.

Dr. Longo puts that as a critical pillar. He's actually done a lot of his own centenarian research from southern Italy, where he spent half a year growing up, the other half a year was in Genoa and has studied hundreds of super elderly in southern Italy particularly, and has gained scientific in sight And then of course, you include the randomized clinical trials of which there's a few on the Mediterranean diet, like one called PREDIMED and one called CORDIOPREV. When you take all that together, you end up with the food wars. Everybody can pick what they want, but my own inclination is you know rule number one, clean. Rule number two, very plant forward. And the last piece is if you have serious heart disease, the only data for serious heart disease is plant-based diets. I mean, then we have to get to anecdotes and Twitter and YouTube and case reports. But if you want to shrink plaque in your arteries, we have don't amazing dozens and dozens of randomized studies, but we have lots of good data that you can do that with a plant-forward whole food diet as did Mr. Pritikin and Dr. Ornish and Dr. Caldwell Esselstyn of the Cleveland Clinic and Dr. Joel Fuhrman of Great New York Times bestselling book fame and the others have shown.

And we still need lots more research, but it's an overwhelming flood of data that we can nourish the body. I mean, I've been vegan and really totally plant based, no eggs, no dairy, no nothing but plants for 46.5, 47 years now. And that's a case report. I'm alive. I'm not in the protein deficiency ward of the hospital. I believe you take supplements. I don't think that's even a topic that causes you gray hair. I mean, most longevity biohackers, Bryan Johnson, a friend of mine that most people have heard about by now spending $2 million a year to lower his biologic age with a plant-based diet, takes 100 supplements a day and he publishes what they are. And you can buy the same supplements if you want. He actually buys a lot right off Amazon. It's pretty humorous that he makes it pretty available to most people. So, I do think a whole food plant-based diet is an intelligent choice. 

The last statement is you know there is the animal rights issue and yes, some animals are killed when they harvest soybeans and whole grains and fruits and vegetables, perhaps, but we're not talking about the cruelty of factory farming and the disease spreading of factory farming, which is still where most people are getting their animal sourced foods. And when we address the environment, another point of argument, but just in the last couple of weeks, Oxford University published a major headline study got press all over the world. That a vegan creates 75% less stress on the environment, greenhouse gases, CO2 emission than a heavy meat eater. That's the words of the study. So, a lot of people are concerned about what we're doing to our planet as we're going to have 10 billion people on it in the next 20 years and the movement towards lab meats and more efficient ways to feed people. It's a very hot topic and a very controversial topic. I mean, is Bill Gates going to be in charge of our food supply in United States around the world? I wouldn't vote yes for that plan, but he's certainly heavily involved in it. But there seems to be almost a governmental and worldwide push towards more plant-based feeding for lowering greenhouse gas emissions. So that's the last little piece of it. Long answer to a great question.

Melanie Avalon: For listeners, so a lot of people you mentioned have been on the show, so I'll put links to it to Shawn Baker, Paul Saladino, Mark Sisson, Valter Longo. And actually, when I had Valter Longo on something, I asked him at the end. So, the diet I follow and I'll be super curious to get your thoughts on my cholesterol blood work from this. So, I eat very high animal protein diet, lean animal protein. And then historically I've always done either high carb or higher fat with it. So, when I do high carb, which is what I am doing right now, what I've done for the longest portion of that, lots of fruit, lots of cucumbers, I drink wine and then when I do the higher fat side of things, I don't have all that fruit. And I do actually MCT oil. And the effects on my blood work are fascinating. But actually, the question I asked Valter Longo was because he's very much about the low animal protein for not stimulating IGF-1 and mTOR and things like that. And so, I asked him if-- because I fast daily, every day, so I asked him if it offset the high protein diet by doing the fasting. And his answer kind of relates to what you were saying in the beginning about hard to do certain studies, but he was like, "Well, we just don't know." So, we don't know [laughs] erring on the side of caution.

Dr. Joel Kahn: Yeah. It's very interesting to listen to him. One of the most sophisticated, highly published, highly funded nutrition scientists in the world. It's also a little hard sometimes [chuckles] to capture his Italian version of English. So, you have to really focus. But he's very cautious about what probably a lot of your audience is into. I mean, NMN and NR and peptides and any other version of kind of very advanced, cutting-edge biohacking because he always says we don't know, might stimulate mTOR, might stimulate cancer cells, we simply don't know. And as you know, he's more of a fan of eating in an 11- or 12-hour window, not a 2 or 4- or 6-hour window based on some data. There is some cardiology data. I mean, repeatedly that we surveyed 4500 people with heart disease who skipped breakfast and we surveyed those that ate breakfast, and in follow up there was less heart events in those that ate breakfast. 

And it's typical science, it's associations. You got to do multivariate analyses and the smokers skip breakfast. And the major factor is the smoking, not the skipping breakfast. And again, really difficult to do randomized studies on it, but yeah, we simply don't know. Of course, his version is largely plant-based with two or three servings of fish a week, salmon. And I've actually written a few blogs about what he eats every day. I've interviewed him on the topic. It's usually breakfast and dinner and often coffee for lunch. But if he's in Italy, he won't skip a little pasta at lunch because it's too good and it's too traditional, but it's a very small portion of pasta. It's not Cheesecake Factory, fettuccine alfredo, 2500-calorie bomb. It's literally a little tiny side dish of pasta with marinara and lentils and probably under 500 calories. It's a very European, non-American approach to it all.

Melanie Avalon: I mean, I will say, just speaking of the studies, I went down the rabbit hole, like trying to read all the studies I could about all of this. And it just seems like you can find whatever you want to find if you're looking to either demonize animal products or not or vindicate certain things or not. And it's just very confusing. And I feel for people for being overwhelmed. 

Dr. Joel Kahn: I agree. And a lot of us call it the food wars. And at some medical meetings and functional medicine meetings, these are popular. A lot of us have gotten a little tired of it, because you do leave people confused. Right before COVID maybe 2018, I was pretty excited. I got invited to Googleplex, the headquarters of Google, and the second panelist made the movie Conspiracy, and I'm apologizing for now and not remembering his name, but the third panelist was Dave Asprey. 

Melanie Avalon: I just saw him at his conference.

Dr. Joel Kahn: Yeah. And you know, they specifically I give them credit, said, "We're going to have a real lively conversation, and we're going to have questions from any of the employees of Google," of which, when they beam it worldwide, obviously was an enormous audience. But we're not going to confuse people. You guys have to come up with some commonality and some bridges and I have no trouble with that because let's just talk about sweetened beverages and cookies and cakes and eating at 11 o'clock at night chips and salsa and opioid abuse and alcohol abuse and factory farm meats. Maybe there's room that there's a diversity of diets, but I still carve out that little tiny piece. You give me a patient that I have characterized with serious heart or other vascular blockage, you got to save that for the only science that's available. And not all my patients will do it. I mean, I have patients with very advanced heart disease, and I've presented them the data, and they all watch Forks Over Knives, and they watch What the Health, and they watch Game Changers movie and read my book or other people's book, and I steer them towards credible podcasts, and they don't want to do it 100%. So, I work with them at 80%, 85%, 90%, 95%. People that go to the Pritikin Center, which is now in Miami Beach, they do serve two, three meals a week of venison or bison or salmon and the rest are whole food plant-based. So, there are examples of people doing very well with a little slight wiggle room in the dietary approach. 

Melanie Avalon: I will say probably the biggest paradigm shift I had and it was years and years ago, but it was when I was reading about somebody you mentioned in a lot of your books, which is Kempner. And I was reading about how his diet of basically like, rice and sugar would reverse diabetes. And I was like, "Okay, I think [laughs] I need to rethink some of my thoughts here." 

Dr. Joel Kahn: Yeah. Very few bring up Walter Kempner anymore, a German physician, came over before the war, landed at Duke University when Duke was a pretty backwater North Carolina Institution, not famous like it is nowadays. And a lot of the reason people credited Duke got on the map all over the world was Kempner had been doing work in Germany and set up work in Duke, the famous rice diet. Basically, it was an inpatient program for diabetes, obesity, heart disease, congestive heart failure. I mean, it's published research. It's insane, fantastic, almost unbelievable research, but it's multiple papers of taking people off their standard diet and putting them on strange foods like rice and chicken scraps and a little sugar on top for flavor. And people like Elizabeth Taylor used to go for weight loss. And some of the people from the Bonanza Show, if anybody's old enough to remember that show, it became such a hot ticket to go there that it really put Duke on the map. And he became quite a controversial figure because he was quite abusive to the people. He was a real stern policeman to the people in his program. But these kids with advanced kidney disease swollen with edema and four, five, six, seven, eight weeks later, it was like their kidneys were working. Nobody now really talks about him much anymore. I give you credit for bringing them up. There are biographies of him that are just fascinating. Michael Greger, MD of nutritionfacts.org does a whole series of videos on him if people are intrigued to learn. But it sure makes you pause if anybody says there's only one diet that's therapeutic for reversal of disease, go study Walter Kemptner and try and figure that one out. 

Melanie Avalon: Yeah. It was just such a paradigm shift, because it was when I was very much in the low-carb keto sphere, and I read that, and I was like, "Okay." I mean, that's just the antithesis of [laughs] everything right now that I'm experiencing. So, yeah, definitely recommend listeners look more into that. So, I would be super curious on your thoughts on my I know it's N of 1, but my cholesterol panel right now-- because I've seen that when I do those stints of adding in the fat, which is typically MCT oil, all my cholesterol, HDL, LDL go up. But right now, I've been doing, for a long time, high animal protein. And I'm talking lots of animal protein, like pounds, a lot of fish, a lot of scallops, chicken though, some steak, salmon. And right now, I almost wonder if it's too low, because right now, my cholesterol is 104, my LDL is 49. my HDL is 40, my trigs are 69, my ApoB is 70. And what I find so fascinating by this is I have a graph for the past, like, two years of all these blood work tests I've been doing, I've been regularly testing this panel every three to six months. And I don't really add in animal fat, I add in plant fat and remove the carbs, everything will go up, like the cholesterol, the HDL, the LDL. I don't know if the trigs really do. The trigs probably do too. What do you think that says about animal products and cholesterol. And again, I know I'm N of 1.

Dr. Joel Kahn: Yeah. You know, you go back and I so much like that structure that Longo has five pillars, and you look at all the science. I think I just had a little interaction on Twitter in the last 10 days, and I pulled out of my head a study that I had talked about on the Rogan Show when I was on 2018. It was a study published in 1998 in what are called metabolic ward studies. You volunteer for four weeks to go to the National Institutes of Health, and maybe each week you're fed a different diet, and they analyze your blood work or some other measure of health, and it's all controlled, so you're not sneaking out and having bags of chips on the side. So, it's about the best metabolic science that can be done. These are usually paid volunteers. And in 1979, a paper was published that I think looked at over 350 metabolic studies on the relationship between diet and cholesterol and the overwhelming line of identity, the R-value, the statistics, was saturated fat higher, LDL cholesterol higher.

I mean, it wasn't one study. It was literally hundreds and hundreds of studies. And when they lumped them all together, they were even more powerful and unanimous. But even if you look at a graph like that, there is a wide amount of scatter amongst that dark, solid black line that's in the middle that catches your eye. Your microbiome isn't like some other microbiome, and your LDL SNPs aren't like another person's LDL SNPs. All I ask these people that do diets that aren't naturally low in saturated fat is just do your blood work eight weeks later. Like you've done, you've responsibly done. We know there's a panel of blood work on a lab that a lot of people run called Boston heart labs. It's not your standard labs. You find it in an advanced clinic. Boston heart labs has analysis of what I call blood sterols like the end of the word cholesterol. And you can get a sense from analyzing sterols. Is your physiology a hyperproducer of LDL cholesterol or a hyperabsorber of LDL cholesterol in your gut or both?

You clearly are not Melanie, a hyperabsorber, because if you're a hyperabsorber with all that saturated fat that's in your diet, at times, your LDL cholesterol should skyrocket up. You might just biologically be kind of geared to handle saturated fat without a rise in cholesterol. But I'm absolutely telling you, there're lots of other people that would eat your diet, including one I'm thinking of right now, a delightful 60-year-old woman in my clinic who eats your diet, and her cholesterol runs 480. Like a lot of people on Twitter that post biohacking numbers, like Dave Feldman and others that come to mind. And I found in her chart times when her cholesterol was 200 before she came to see me and said, "What the heck was going on six years ago when your total cholesterol was 200, and now it's 480," which goes, "I was eating a largely vegan, vegetarian diet back then." I just didn't stick with it and wanted to proceed on to this. This particular woman's not really treating any illness. It's not like she's doing a carnivore diet for rheumatoid arthritis or autoimmune disease. She's just doing it. She likes it. But she clearly has a different physiology than you. I just posted on social media about five days ago, because we are advancing on this, that with a little cheek swab, you can get some SNPs run and you can find out if your LDL cholesterol SNPs favor a high LDL cholesterol on a genetic basis favor, a low LDL on a genetic basis.

A lot of people change their diet anticipating they will be able to lower their LDL cholesterol with a whole food plant-based diet, with other dietary approaches. And some of them hit a home run and some hardly see any improvement, and they're so frustrated by it and they're authentically eating. Is there something out there called the portfolio diet? I would even offer that probably most of your listeners don't know it, but it's a dietary approach developed at the University of Toronto to lower cholesterol without becoming a full born vegan, but by adding in four food groups that are known to lower cholesterol. High fiber groups like soy-based foods like tempeh and tofu, lots of nuts and seeds, lots of sterol-based foods like sunflower seeds and sesame seeds, like on the last group, I think it's oats. But anyways, some people adopt this portfolio diet that in the published research tended to drop cholesterol about 25% to 30% in eight weeks. And other people do it and don't see a 5% drop in cholesterol. It's either the microbiome, it's these LDL SNPs, it's your propensity to make and hyperproduce cholesterol in your liver or not, and your gut's ability to absorb that saturated fat you put in your gut or not. 

So, you have to do that N of 1 experiment you did and that's all I ask people. Change your diet eight weeks later let's see what's happening. And certainly, my experience is the trend will be more people will get in a healthy cholesterol range with lots of fiber rich whole food choices than they will with a lot of animal food and MCT oil. But you're a stunning and interesting example. In my opinion, your cholesterol is not too low in the last five years to 10 years in the cardiology world for people with serious heart disease. Yeah, we had statins, and we got a drug called Zetia. Then we got a PCSK9 injectable cholesterol inhibitors that were released about eight years ago. We've got a new drug out in the last four years called Nexletol. We got more advanced drugs called Latvia. We can make a bypass patient's cholesterol 90 or 100 and their LDL 25 or 30. And there's vast amount of data that is perfectly safe, perfectly fine. They make their pregnenolone, they make their testosterone, they have vitamin D in their body, they have brain function that appears to be quite intact. And you don't need to do that for the routine patient. But there are people like you that do it and feel fine. And there are people that we create it and they feel fine.

So, the new international goal for LDL lowering for advanced heart disease patients is an LDL less than 55. That's a very aggressive goal compared to previous goals of LDL cholesterol less than 100 or less than 70. But as you do that, a lot of them end up in that LDL cholesterol 30 range and they feel fine. And if you're tracking the plaque and we should talk about, how do you track plaque in arteries, but if you're tracking the plaque of the arteries, it's pretty dramatic how you can see resolution in a lot of the plaque over six to 12 months. So, we're crazy but the crazy seems to be safe and effective.

Melanie Avalon: Those low numbers that I have right now, that's when I'm doing really high animal protein with lots of fruit, but low fat. And so, in the past when I would do-- I would add basically just MCT oil, so medium chain fats rather than saturated, but that's when it would go higher. So back then I was just looking like my total was 205, my LDL was 131, I think was the highest I went 61 for HDL, 74 for trigs. So, I do respond to that shift. I just find it interesting how low it can get when I do low fat, high protein sorry-- low fat, high carb, high protein. And I love that genetic test, I'm going to have to look into that, that cheek swab.

Dr. Joel Kahn: I'll give them a shout out. I don't have any conflict. There's others out there. But this was one called GENinCode pretty well priced and seems quite accurate. 

Melanie Avalon: I'm going to look into that. Major question for you that relates to all of this and you touched on it a little bit with statins and things like that. So, I read your newest book, Lipoprotein(a): The Heart's Quiet Killer. I'm so fascinated by this and it sounds like do you think Lp(a) is one of the primary reasons that statins may or may not work for people?

Dr. Joel Kahn: Yes. In fact, again, my life isn't all about social media. But I did post this morning, yesterday morning, that if you take large statin trials and people with serious heart disease, of course, I know your listeners know statins are like Lipitor, Crestor, the prescription drugs that block an enzyme in the liver and lower your production of LDL cholesterol. So, your blood LDL cholesterol goes down, been used for about 35 years and have side effects, muscle aching, raise your blood sugar, give you brain fog, a little liver enzyme bump, but largely are quite safe and tolerable drugs if you use them intelligently. When you look at the trials across the spectrum that have been done and there are big trials, 30,000, 20,000, 40,000 people, you add them all up, some of the largest studies ever done in medicine, you drop the risk that the patient has for heart attack, a stent, a bypass, a death by about 40%, but that leaves 60%. That's actually called residual risk. And it may be that we're doing better than that now because we're not relying only on statins, we're relying on these combinations of various approaches and hopefully healthy lifestyle.

And we may be reaching LDL cholesterol reductions of 50% to 60%, which may translate into even better results for the patients. But it's called residual risk. And it has been estimated that the biggest piece of the pie of residual risk why don't we eliminate 90% of a heart patient's risk for future events. Maybe this genetic cholesterol called lipoprotein(a) that still is in its infancy for being well known and for being practiced by practitioners in terms of a simple blood test and counseling a patient. Which is why I went out and wrote a simple but available book, because nobody else in the world had written a book on what lipoprotein(a) is. It's a molecule very similar in structure to LDL cholesterol, but there's one extra piece added onto it that makes it totally different and totally unique. And 100% of people, their liver makes LDL cholesterol for survival. But 20% to 25% of people get a genetic ability on chromosome 6 if I remember. That they're now able to make two cholesterols, they're able to make LDL cholesterol and lipoprotein(a) cholesterol. And lipoprotein(a) cholesterol in some people is a really bad actor. And it's 20% to 25% of people and everybody's one blood test away of knowing if their parents gave them the ability to make it or didn't give them. You only need to do the blood test once if it's negative. But it can cause clotting of blood thrombosis, it can cause atherosclerosis, it can easily be taken up by the lining of cells and become part of plaques, and it causes inflammation. 

And if you had a plan, a heart attack or stroke, you drive up clotting, inflammation, and plaque formation. So, lipoprotein(a) can cause heart attacks, cause strokes. It also uniquely can cause one of the four heart valves called the aortic valve to become damaged, calcified, and narrowed. And a lot of people have to deal in their 50s, 60s and 70s with a condition called aortic stenosis that may require surgery or other procedures. And lipoprotein(a) is the reason for the season. And yet the estimates are 1% or 2% of patients seeing their doctor may get a lipoprotein(a) blood test, which Quest Lab, LabCorp, your local hospital everybody runs it. It's neither expensive nor exotic. It's harder to get the genetic test. It's simple to get a lipoprotein(a) blood test, so everybody should get it checked. The statins do not treat lipoprotein(a). They do not lower it. They either leave it neutral or they unfortunately, actually cause it to go up and go higher, and potentially become more dangerous. And so, statins are-- I think that's the reason there's residual risk, because in these large studies, lipoprotein(a) wasn't measured. It turns out they were giving statins to 20% to 25% of the group that had lipoprotein(a) and driving lipoprotein(a) up while they were driving LDL cholesterol down.

Now, you mentioned because you're a sophisticated person and your audiences, you can still do the blood test called ApoB or Apolipoprotein B, which is a combination of all the bad atherogenic particles in one blood test and lipoprotein(a) will show up in your ApoB blood test and LDL cholesterol will show up in your ApoB blood test. So, if you have a serious heart patient and you put them on a statin and their LDL goes way down, which is the plan, and their lipoprotein(a) goes up a little bit, but the ApoB goes down, you've probably done them a net benefit. You've made one atherogenic particle better, you've made one atherogenic particle worse, but you can use the ApoB to say, "Overall, I helped my patient."

But I only can imagine what would have happened in those big statin trials if we would have segregated out those that had really high lipoprotein(a) and not included them in the trials. You probably would have seen, who knows, projecting a much bigger drop in risk and then, you know, there is no FDA-approved treatment for lipoprotein(a) but a drug company out of Switzerland called Novartis, a drug company, Amgen, and a startup, I think it's called Silence Therapeutics, if I remember, all have drugs pretty far along in testing, probably going to be out in 2025 or so. That will be very expensive but very helpful additions to the toolbox. For those that don't have lipoprotein(a) will use this group of cholesterol-lowering drugs and lifestyle. And for those that have cholesterol and lipoprotein(a) will have new tools that seem to be very effective. We just have to wait for the FDA to say they also prevent stroke and heart attack because that's the criteria for drug approval nowadays. 

Melanie Avalon: Oh, my goodness. Okay, I have questions. I mean, the implications of this seem huge, even beyond just the statin trials, because if it has that much of a profound effect on everything and that factor wasn't being accounted for, really, historically, in most of the studies on cholesterol levels and heart disease and mortality. I just feel like you would need to bring in AI to go and rework the studies. 

Dr. Joel Kahn: I agree. It puts a lot of questions and I just encourage those listening. Ask your practitioner for the blood test. Find somebody capable of giving you some decent counsel to read on your own. Don't throw your statin down the toilet necessarily. I will tell you; I don't know how much you want to talk about pharmacology, but on a lot of natural-oriented podcasts, you don't talk a lot about pharmacology. I like to use lifestyle and supplements, but when we have sick people, we use whatever tool we need. There's a really interesting group of studies out of Korea in the last two years, and they all get called the RACING trials. It's an acronym for something. And instead of doing what cardiologists like to do, which is Mrs. Jones, Mr. Smith, here's your Lipitor, 40 mg. Here's your Crestor 20 mg. They've been doing. And part of it is a large randomized study, small dose statin with a second drug that used to be called Zetia, but now it's generic, so it's called as ezetimibe. That really provides great synergy. Statins work in the liver as ezetimibe works on a receptor in your intestinal wall. It prevents the uptake of cholesterol from your diet or from your bile. And when you put the two together at very low dose, what the randomized studies in heart patients in Korea show is you get better LDL cholesterol reduction, because they really work well synergistically. 

Even though the statin dose is very low, you get half the side effects because the statin dose is very low. So, blood sugar rises, muscle aching, brain fog, liver enzyme rise. And when they actually do advanced CT scans of people's heart arteries, you get more plaque reduction and shrinkage with a combination. So, there're so many things we need to start over again, like stop writing medium and high-dose statins as your first choice. We've got data now that this combination low-dose statin plus Zetia is a better approach. And they actually just published a study two to three weeks ago with 100,000 patients in Korea where they verified that this combination approach was safer and better. And the thing is, for lipoprotein(a) in my own clinic, people come to me and their lipoprotein(a) is 250, normal is less than 75, and they're on 40 mg of Lipitor. And I say, "Look, you need therapy, but let me drop you down to 10 mg of Lipitor and add the Zetia in. I bet you I'm going to have the same cholesterol and LDL cholesterol you've got now, but I bet you we can drop your lipoprotein(a)." I think your high-dose statin is stimulating more production.

And sure enough, eight weeks later, we get the labs and they're excited. Wow, my lipoprotein(a) is down to 175, which is still high, but it's 40% lower than it was. And my total cholesterol, my LDL cholesterol are just as good or even sometimes little better. But we're all creatures of habit and my colleagues are great creatures, but they're creatures of habit. So, trying to innovate, trying to educate and help people and we do need these new drugs to come out. There's a little data that hormone replacement therapy in a recently menopausal woman who has a high lipoprotein(a) is  effective at bringing it down. There's a supplement called L-carnitine that's mildly effective at bringing it down. Very little data, but a little data that a natural agent called amla, Indian gooseberry, a powder or capsule or a tea can bring it down. CoQ10 maybe a little bit. My favorite cardiovascular supplement is CoQ10 for a lot of reasons.

Melanie Avalon: So, to clarify, it sounds like since the Lp(a) is produced by the liver, then dietary cholesterol itself, I'm guessing wouldn't affect that number. But the food you eat, I mean, if you eat like a high carnitine food, could that affect it? So, what role will diet play?

Dr. Joel Kahn: You go back about 25 years, there're some studies, the lipoprotein(a) was discovered 60 years ago and there have been quite a few studies over the years. We need more. There was some data that a high saturated fat diet may help lower lipoprotein(a), but it was in the range of 20%, 25%. And if you have a high lipoprotein(a), you'd like to lower it 75%, 80%, 90%. So, it was modestly effective. And in 2018, a colleague of mine in Houston published an observational study, far from perfect, but it was still data that a whole food plant-based diet lowered lipoprotein(a) about 20%. So, you can pick either end of the spectrum. And maybe the key is, again, just getting rid of crap in the middle. But generally, lipoprotein(a) is frustrating because unlike people who effectively lower their total cholesterol with diet and exercise and fasting and weight loss, lipoprotein(a) is like this. If you know the videos about the honey badger. The honey badger don't care about nothing, there's some really interesting motivational videos about this animal out there in the world. Don't care about nothing. And that's kind of what I feel lipoprotein(a) is like. It just doesn't care what you do with your lifestyle. 

Melanie Avalon: So now I'm just hypothesizing. But say you were taking in no dietary cholesterol, and then you did take in dietary cholesterol. Would that make your liver produce less cholesterol because you're taking in dietary cholesterol and then produce less Lp(a)?

Dr. Joel Kahn: Yeah. You know dietary cholesterol very long series of studies, 70 years, source of a lot of argument. It really depends if the question is dietary saturated fat or dietary cholesterol. Dietary cholesterol is usually a very small amount. Even if you eat eggs and animal products, you measure dietary cholesterol in the milligrams, where you usually measure dietary saturated fat in the grams and grams and grams that an average American eats. There's just much more in the cheese and in the meats and egg yolks and the rest. Dietary cholesterol does not consistently raise blood cholesterol. Vegan myself, I eat nothing that has cholesterol in it because I don't eat any animal foods of any kind. If I started eating animal foods again, I'd have to eat cholesterol, not saturated fat. So, if I start taking cholesterol tablets, which are available, I don't use them of course, you might see minimal change in my blood cholesterol. If I were to start eating a high-saturated fat diet, maybe coconut oil, but certainly animal foods, I would anticipate my cholesterol would trend up pretty readily.

Melanie Avalon: Well, speaking of the honey badger, I do love that [laughs] he's so funny.

Dr. Joel Kahn: Such a funny video. I had the pleasure about 10 years ago to spend some time at some of the marketing courses with Joe Polish and-- maybe you know Joe Polish of Phoenix or don't. There're a lot of medical people that participate in his training programs, but he just would play the honey badger YouTube over and over and you know be like a honey badger don't care about anything but success in your business. And it's just a funny analogy for anybody that hasn't watched it, go Google or you do whatever search engine DuckDuckGo for honey badger video. 

Melanie Avalon: I love the honey badger. And speaking of the honey badger, not the same animal, but I'm wondering, why do you think Lp(a) is produced only in humans, some primates and then the hedgehog.

Dr. Joel Kahn: The hedgehog? Yeah, you're a very good student and nobody actually knows that question. The world's expert, I think it's fair to say, in lipoprotein(a) is a professor of Greek origin at University of California, San Diego. Dr. Sam Tsimikas, he's a medical doctor maybe with a PhD. And he's clearly the shaker and the mover currently of most research and trials and wonderful guy, very active on Twitter. If you want to learn about lipoprotein(a), you follow @Lpa_Doc on Twitter. And he does great educational symposiums on Saturdays, very friendly, approachable guy, but he doesn't know the answer to it. And another question that's often asked is, "Why do we have it at all?" It sounds like it's a bad thing. And there is a little data, very little data, that if you're bleeding and you have inherited lipoprotein(a), which has a tendency to cause blood to clot, there might be some small chance that at that moment it might actually be of some value.

There's been a little theory that perhaps during child delivery, a woman who's bleeding that happened to be amongst the group that had lipoprotein(a) might have had a slightly better chance of survival. And I've seen at least one paper that patients with, like, a brain bleed, a subarachnoid bleed that have lipoprotein(a) might have a slightly smaller bleed than people that don't. So that's theory that-- There're other molecules in the body we don't know why they're there. We have a group of cholesterol drugs called PCSK9 inhibitors that are in a monoclonal antibody to a particle in the blood called PCSK9. But we don't know why we have PCSK9. They're just very effective drugs. So, we got much to learn.

Melanie Avalon: Yeah. And what I'm really fascinated by this and I think it's another speaking of, like, paradigm shifts, because I think people will often go from conventional medicine, standard American diet to this really holistic approach like we're talking about, but then they want to be all like, it's only diet and lifestyle. There's no room for pharmaceuticals. And it sounds like with this, if you have this gene to make Lp(a), you possibly would benefit if there is in the future a pharmaceutical intervention.

Dr. Joel Kahn: So, it gives me a little segue if it's okay.

Melanie Avalon: Yeah, please.

Dr. Joel Kahn: What I do in my clinic, and this is what I would love your listeners to do is you give me two patients, and their cholesterol is 250 and their lipoprotein(a) is 180, both of which are high numbers. And I look at them, and they're nice people, and I have absolutely and I would say no cardiologist or no clinician has any ability to actually say that on paper, these look concerning. But I can't tell you if you're aging internally, there's a concept called arterial age or vascular age. In the 1600s, an English physician, Thomas Sydenham, said, "You are as old as your arteries." And a lot of us do telomere and glycan age and epigenetic age testing, but we ignore completely. And I hear so many longevity experts go on and on and never mention blood vessel age, which you're more likely to die prematurely of stroke, heart attack, ruptured aneurysm than you are of a whole lot of other conditions.

Let's talk about vascular age. So, I will take those two people, and I will do my menu is largely one of three tests, and I will reassure a lot of people and I will worry some people when those tests are done. I will do a carotid ultrasound, a painless simple non-radiation test ideally done with a version called a CIMT, carotid intimal-medial thickness assessment. It takes special software that even good universities and good vascular centers often don't have, some longevity antiaging doctor clinics do have. The concierge chain that some people use called MDVIP tends to make it available. My clinic makes it available. And I'll be able to tell you, you know Melanie, you're 29 years old, but your vascular age is 21 and your lipid particles at this point aren't bothering you. Or your vascular age is 49 and your lipid particles are apparently causing you vascular aging and we need to work on it as an example. That's one option and it's nice. It's not covered by insurance to have this advanced vascular ultrasound of your carotids. It may be $200-$250 range. It's not incredibly out of range and it's just not easy to find a place that does it. 

The second test and I wouldn't do it on a young woman usually. I did order it today on a 36-year-old I saw in the clinic today. But it was a heart calcium CT scan literally a five-second test at your local hospital where you lie in a stretcher, go in a CT scanner, no needle, no IV, no injection, no iodine. The same radiation exposure as a woman gets from a mammogram, which is generally considered low, not zero, but low. And you can determine if your heart arteries are getting calcified, a very reliable marker of atherosclerosis. That's why we call it hardening of the arteries or whether you have a calcium score of zero. And your heart arteries are not getting calcified. The only drawback to getting the wonderful result that your heart calcium score is zero, which I have done this on 15,000, 20,000 patients, I have a calcium score of 0 at age 64 I'm grateful for is you can occasionally have a little plaque called soft plaque. It won't show up in the calcium score. In studies that are done, it seems to be quite benign because people with a calcium score zero have an incredibly low risk of stroke and heart attack or hospital admission. But that's something we'll do and I'll suggest to these two people now, that's about $100 test not covered by insurance. And you don't do it every year. You don't want a CT scan every year, but if you're a zero, you might do it again in five to seven years. 

The real current buzz is a test that I resisted for a long time. It's called a coronary CT angiogram. It does involve an IV. It does involve administering iodine dye. You get hot for 20 seconds. You can't be allergic to iodine dye. You get a Band-Aid, you go home. So, the test is maybe 45 minutes. But the real portion that's important is about 30 seconds because you inject dye, you can fill the heart arteries, you can see them and interpret them. And there is now you mentioned already, AI, there's a company I'm not an investor in sadly, cleerlyhealth.com. And they will take those images whether they're done in San Diego or New York, or Miami or Seattle or Detroit, Michigan and they will analyze. I mean, you get a report back exactly how much hard calcified plaque in your coronary arteries and where, how much soft, non-calcified invisible plaque is in your coronary arteries and where, what percentage narrowing is in each of the coronary arteries. And they've introduced a new concept that if you get diagnosed with cancer, the first thing you do is they stage your cancer. You got stage 2B breast cancer, or stage 4 metastatic prostate cancer. We don't do that with heart disease. We just say you got heart disease. 

So based on this artificial intelligence of the CT scan, we're now telling people you are stage 0, 1, 2, or 3 coronary artery disease. This is all in the last two years, I've ordered 250 of these. I've had one on myself. Probably there's been 20,000, 30,000, but it's still infantile. Most cardiologists are not aware that they could arrange for their patient to have a Cleerly Health CT angiogram with artificial intelligence interpretation. The basic CT part may or may not be covered by insurance. The Cleerly Health at the present time is not. So, the combination can be $1,500. Some people find that no big deal. Some people find that a stretch. They're trying to get insurance coverage. It's radically changing the precision of what we do in preventive medicine.

And the cool thing is, so now we're back to these two people in front of me with the numbers I mentioned. One person has no carotid plaque, no carotid thickening, no calcium score, no CT angiogram soft plaque. I ignore their numbers. I mean, I encourage them to follow a healthy lifestyle, and I'll see them back and recheck them in a few years. And the other person has vascular aging and vascular senescence going on, and we're going to attack them with everything available. That's the state-of-the-art cardiology preventive care. And it's not just salad. It's very high-tech precision measurements. But, God, is it exciting. The cool thing is, Cleerly Health has been available a little more than two years, and all of us that are using it are starting to see some people back. They go for a repeat study 48 months later something, 24 months later, 36 months later, and we're seeing the amount of plaque shrink dramatically, the soft plaque by lifestyle, by blood pressure control, by supplements, because there're randomized studies that taking an Aged Garlic tablet, Kyolic Garlic, you can buy it anywhere, shrinks soft plaque in coronary arteries. So, there are natural supplements with now peer-reviewed studies that support them. And all these drugs, we got to lower LDL cholesterol, but we need better lipoprotein(a) lowering and then we'll really have a powerful toolbox across the board. 

Melanie Avalon: So, because I know I've heard an argument in the carnivore sphere specifically where they'll say that they go in for just a normal scan for plaque and it's completely clear. But then I've heard the counterargument being that it should be clear if you're a certain age, that basically that's not really saying much. So, are you saying that this new angiogram, like a person might go in for the normal scan and not find anything, but if they go in with this, it would find more? 

Dr. Joel Kahn: It could find more. I mean, I'll say out loud, I've had a calcium score when I was 40, 50, and 61. They were all zero. But when this technology came out and was available in Detroit, I went and had a coronary CT angiogram. I don't do that with patients. I would rarely ask them to cough up $1,500 and get a little extra radiation but I wanted to go through the process, and I had 7 cubic millimeters of noncalcified plaque in one of my arteries, which is about the lowest amount the company had ever seen. And at that point, I was about 62 years old. But it did show sign. I wouldn't necessarily do that. If your carotids are clean, because you can see soft and hard plaque in the carotid ultrasound and your calcium score is zero, you're in very good shape.

And again, Shawn Baker in 2017 had a calcium score of zero. It's time that he repeats it and I hope it's still zero. And it's not inevitable that it's going to transition to a higher and higher number. I do know some of our favorite health leaders around the country clearly have come up to me over the years, and they don't have a calcium score zero. But it's not necessarily a slam on the diet they follow. It could be, it could be that it's a slam. It's such a complex formula of your genetics and your lifestyle and your stress and your sleep and some people used to have unhealthy lifestyles and maybe for the past three, four years have transitioned and are famous for it. But people should get checked, whether you're a celebrity Instagrammer or just somebody learning and wanting to know. 

Currently, you need prescriptions to get the coronary artery calcium score and to get the coronary CT angiogram, you can't just go get one. So, you got to find a doctor that understands it and will play the game with you that can be frustrating for some people. Do something, don't assume your arteries are fine. It's, I think, the biggest deficit in American medicine that we don't screen for silent atherosclerosis like we screen for colon cancer, breast cancer, cervical cancer, and prostate cancer. We screen for four cancers. We don't screen for heart disease. And we're a $100 away or $200 away from having precise data to assist you. 

Melanie Avalon: And one more question about the Lp(a) since it's like yes or no? I did get it tested back in, I think, 2018. The result just had less than 50. So, does that mean that I could still have it? 

Dr. Joel Kahn: No, you really don't need to worry about it. You're not going to develop it. You would have had an elevated lipoprotein(a) blood level when you were two years old and-

Melanie Avalon: More than 50. 

Dr. Joel Kahn: -yeah, every time after. But if you had a result in the normal range, you don't need to repeat it. You can cross that one off the things to worry about list. 

Melanie Avalon: Oh, wonderful. Well, I want to be really respectful of your time. One last question I can't let you go without talking about. What are your thoughts on wine for heart health? 

Dr. Joel Kahn: Aha, actually, I also have a podcast and it comes out on Fridays. And that was the topic this week because there's been so much data back and forth. And the point I made on the podcast I'll make here is you have to pull out Dr. Longo's five pillars of nutritional longevity for wine discussion, because we don't have randomized studies, so we got to talk about centenarian studies. Are there many people that lived into their 90s and 100s and enjoy wine? And you got to probably go to Sardinia as the best example, the Greek island, Ikaros, what their wine consumption, but they drink a lot in Sardinia, and Sardinia is a blue zone. They have a famous wine there called Cannonau, that's felt to be one of the two healthiest grapes on the planet. The other one is a grape called Tannat from Madiran, France. That's another great grape. 

Melanie Avalon: I got to get a bottle of that somewhere. 

Dr. Joel Kahn: Yeah, it's widely available. Madiran is the style of wine and the grape is called Tannat. And your local wine shop probably has a bottle for $15. And Cannonau is widely available for $15 or more if you want. So, you got to do that whole analysis. I think it was in the last six months, maybe less, there was a massive meta-analysis of studies over 40 years that concluded that there's no health benefit to wine and more than a drink a day correlates to health detriment. It actually wasn't exclusively wine, it was alcohol in general. But they didn't find any different signal for wine than not wine. And it creates a lot of headlines. Wine and spirits are not health foods. If they're neutral, if we really knew that they were neutral to our health, a lot of us might enjoy a great glass of wine or a cocktail now and then. 

There is some data about cancer, but you can find just like food because I just did this. There's some breast cancer studies that show lower rates of recurrence with one drink a day or less of alcohol. There are some crazy dementia studies and I'm not talking 42 people; I'm talking databases of thousands of people that Alzheimer's risk goes down with modest alcohol consumption. And we're always talking responsible and limited. We're not talking about people with addictive tendencies or liver disease or 12-step programs. I honor my friends who've quit and their willpower in social settings and their comments of how better they feel and how better they sleep. There was a report in the last 10 days that for every ounce of alcohol you drink, your blood pressure may creep up a little bit. It was like 2 mmHg, 3 mmHg. But if your blood pressure goes up a small amount every day for years and years, it can have a health consequence. 

So, one of my major messages is get a darn home blood pressure cuff and use it correctly, sit quietly, measure your blood pressure three times in a row about a minute apart. Focus on the third number, and make sure you're not a silent hypertensive, because more people die of elevated blood pressure than any other specific medical condition on the planet around the world. Bottom line is, I have been a good regular imbiber of a variety of alcohol, predominantly red wine. I have cut back in the last couple of months as a self-experiment, I'm sad to say. like, I dropped 8 pounds in four weeks. I was so pissed because I was hoping I'd notice nothing. 

Melanie Avalon: I cut it out for a year and then at the end I was like, "I'm never doing this again." 

Dr. Joel Kahn: Well, that's the thing. If you see no difference, I sleep well and I didn't really notice any difference in my sleep. But I do think it's responsible to probably focus on from zero to two to three days a week. The standard statement is a drink a day for a woman, one to two drinks a day for a man. In most of the studies, four drinks or more a day is nothing but trouble, but trouble, but trouble. But that's 28 drinks a week. That's pretty hardcore drinking. And people should realize that that is not consistent with their longevity and antiaging program, so it should be low. What I find now, since I drink a little less, I'm opening the better bottles I have, and I'm having more fun with it. [laughs] And I'm a snob. I like to drink Italian and French and Spanish, tend to be lower sugar wines. Of course, there's some fun companies out there, like Dry Farms that sells very-- 

Melanie Avalon: It's all I drink, Dry Farm wines. 

Dr. Joel Kahn: Yeah. They're great wine, low sugar wine. There are some interesting companies now, and I have no relation to any of these companies. There's a CBD-based drink called Aplos that makes you a little cocktail. It's an interesting little mix, a little pricey. And I just ordered a few nonalcohol wines off the web. So, on Instagram, I can't comment on them yet, but those things are available out there if you still like the idea of a glass of something that's red in your hand with a meal and doesn't necessarily always have to give you a buzz. So, I mean, be cautious. It's clearly irresponsible for a physician to blow off the fact. My neighbor died five weeks ago of alcoholism at age 65 and was a friend and I saw his brain go down the tube. I didn't know his liver was the next organ. And you're 65 years old, but the power to disrupt a life with alcohol is clearly real. But if you're cool with it and you can handle it, just keep it clean, keep it healthy oriented, and keep it relatively modest. 

Melanie Avalon: I find it interesting that or fascinating that the MIND diet includes, I think, a glass of wine as like, part of what you're supposed to have.

Dr. Joel Kahn: Yeah. You know wine at five part of the blue zones. Glass of wine has been a part of every Mediterranean diet pyramid since I was described by Ancel Keys in the 1960s and 1970s. That is why you go to those five pillars of longevity, what's consistent across the planet with healthy long lifespan and apparently, just like there's nutritional variability and genetic differences, we probably got the same for our ability to handle, metabolize, and tolerate some alcohol, but be careful. 

Melanie Avalon: Yes, exactly. And I do want to emphasize, I think a lot of people don't really realize with a lot of conventional wines, all the high alcohol, the high sugar. 

Dr. Joel Kahn: The sugar, the sugar, the sugar. Yeah, that's why if you're drinking rum and coke, if you're drinking margaritas with simple syrups, Manhattan's, they're sugar bombs. And if you're wearing a CGM, you'll see what-- You wear a continuous glucose monitor and have a glass of red wine, you see nothing. I mean, it does nothing to your blood sugar. You do that with a Manhattan, you'll see a big old spike. 

Melanie Avalon: I actually see a longer-term beneficial effect when I have wine versus not. 

Dr. Joel Kahn: Yeah. Yeah, that's a pretty universal observation with a CGM. 

Melanie Avalon: Just one rapid fire question. Do you take daily aspirin? 

Dr. Joel Kahn: I don't. Real quick cardiology answer is if you get that heart calcium score and it's well over 100, there are now two large university studies that say a baby aspirin is a good idea. If you have a calcium score of zero, there's no need. And previous studies have kind of dispelled the idea that everybody should just take one at age 50 or 40. So I don't take aspirin. I do occasionally take a supplement people have heard of called nattokinase. It's a little bit of a natural blood thinner.

Melanie Avalon: I have to send you my first supplement that I launched was Serrapeptase, and I love it. I'll have to send you a bottle. 

Dr. Joel Kahn: Yeah. I think the enzyme anticoagulants for the general public, if you have an artificial heart valve and you're supposed to be on Xarelto, stop your Xarelto and start taking nattokinase or Serrapeptase. But for the general public, there is a role for these things. You know a lot of COVID vaccine injured people are taking nattokinase, particularly right now it's kind of hot topic. 

Melanie Avalon: Awesome. Well, thank you so much, Dr. Kahn. This has been a pleasure. Such a joy. I'm so honored to have you on the show. How can people best follow your work? Are you writing anymore books? 

Dr. Joel Kahn: I do want to write a book about how to manage calcium scores and CT angiograms. It's a big empty spot in the literature right now, and it needs to be done. I've been doing online summits lately, and I've been enjoying those interviewing other people and posting reverse heart disease summits. I'll have another one coming out in early 2024, but I'm over at my website, drjoelkahn.com. I am a real doc still, I am licensed, I think, in 27 states. So, see a lot of people by telemedicine and a lot of people live in Detroit. And so honored to join your great list of previous people you've interviewed. It's a real honor. 

Melanie Avalon: Awesome. Thank you. Well, the last question, it's really easy, I ask every single guest on this show, and it's just because I realize more and more each day how important mindset is. So, what is something that you're grateful for? 

Dr. Joel Kahn: I am very grateful. I'll give a shout out. I couldn't do what I do every week, every day without an amazing partner, my wife of 42 and a half years and somebody I met when I was nine years old in elementary school. [chuckles]

Melanie Avalon: Really? [laughs] 

Dr. Joel Kahn: Karen gets the shout out, absolutely. Because today I'm supposed to be off on these days, end of the week, and I just fill it with activities [laughs] all day long because I'm nuts. But anyways fortunately found somebody that understands. Some of us are on a mission and a passion and supports that. 

Melanie Avalon: Well, thank you so much. And thank you for being here on your day off. And just thank you for all the work you're doing. It's really wonderful. And I love your, like you said at the very beginning, about building bridges. And I just can't thank you enough for that. 

Dr. Joel Kahn: Thank you. 

Melanie Avalon: I will talk to you in the future. 

Dr. Joel Kahn: Bye, bye.

Melanie Avalon: Bye. 

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