Transcript of Episode #132 Featuring Dr. David Rizik! The Evolution of Cardiology! Overcoming cholesterol myths and facts, the TRUTH about conventional medicine, Testosterone polarization, Heart Metrics and more! New

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Go to qualialife.com/dylan for 50% off and use my code Dylan for an additional 15% off. That's qualia qualia.com/dylan and use my code Dylan. Thank you to Qualia for sponsoring this episode. All right everybody, welcome back to the Dylan Gemelli Podcast. I am very excited and when my guest got introduced to me, I found out he was a local cardiologist, which I was unaware of. I got a little bit even more excited and then when I got to meet him, I got more excited and then when I got his credentials, well, And here we are. I am going to try to do you some justice on your intro here, but there are far, far, far more to you and things that you've done that we're gonna get into that I can't wait to talk to you about because we're gonna get into my favorite topic that everybody knows I like to talk about, and that is the heart and cardiology. And my guest is at the forefront and I cannot wait to get into so many different things that interest me. So he is currently. The health system chief at Banner University and Medicine of Cardiology, and he's overseeing clinical quality and helps drive continued advancement in cardiovascular care and treatment.

But he's celebrated worldwide for his contributions in the field, and he has led many of the most influential clinical trials in coronary and valvular heart disease. He's had some groundbreaking, breaking research that's been instrumental in securing Food and Drug Administration approval for a range of innovative cardiovascular technologies. And he was actually named a master interventionalist by the Society of Cardiovascular Angiography and Intervention. So I can go on and on all day.

Sounds like an epitaph.

It, it does. It does. Couldn't have written it better myself. So my friends, I want to introduce to you my new friend, Dr. David Reisig.

This has been fantastic. You know, we were talking before we went on and this has just been wonderful getting to know you and hearing your interests and, and my own interests, how they, how they intersect. So let's have some fun.

We're gonna have some fun. I'm gonna get into a ton with you. We got conventional medicine, we got alternative medicine. You've been in doing this for so long and you've seen, done, and heard it all. Let's go back in time a little bit. And, and kind of when you started off, what drew your interest to cardiology in the heart?

They said you were gonna ask great and probing questions and you've hit it outta the park on the first question. In '85, I was in medical school in St. Louis and my, uh, my dean had a heart attack.

Oh.

And they put him to bed rest. They didn't do any type of, by today's standards, groundbreaking therapy, and he was forced to retire. It's been a meteoric evolution or revolution in what we do. And now if that same Dean had a heart attack today, we would open the blocked artery and have him walking around on the first hospital day. Out on the second hospital day, whereas in 1985 he was in the hospital for 2 weeks. Mm-hmm. And we would want him back to work within 2 weeks. So if you think about it, we had that 1985 heart attack patient in the hospital for 2 weeks, and in 2026 we want him back to work by then. It's been a meteoric Revolution.

So back then when that happened, is that what you were going to school for?

I was going to go into, I was gonna be an OB-GYN.

Oh wow.

I was going, I was going to be a perinatologist, a high-risk obstetrician. I figured that was it. And in a very short period of time, our dean got sick.. And then I went and saw my first early embryonic stages of catheter-based therapy of a balloon angioplasty. And that happened all within a week or two. And I knew I got bit by the bug, really. And I'm just, I just flipped. I just made a wholesale conversion to a whole new way of thinking about what I wanted to do with my career. I have not since then. I haven't worked a day in my life. Yeah, I have not worked it because this is incredible. It's an incredible journey. You learn something new every day. Every patient is like a fingerprint. It's every case is like a fingerprint. It's different, it's new, it's unique. It's been remarkable. And interventional cardiology, which is what I do, it's the greatest profession because it's constantly changing.

Mm-hmm.

What we did 5 years ago, A lot of that stuff we're not even doing. That's how quickly the, the field evolves.

Regret many years of not studying the heart as much as I did because I coached professional bodybuilders that were steroid users and I should have been more involved into the heart as opposed to liver, kidneys, things that were getting hammered by steroids. Right. But in actuality, the heart's getting the worst end of the stick.

It's getting the worst end of the stick.

Yeah. And I, and I would like to discuss some of that with you later, the effects, right? So that they can hear it, right? Uh, not just from me, from an actual doctor, because I preached it, but they don't want to hear it unless it's coming from someone like you. So I want to get into that. But, uh, you know, the fascination and what I've learned about the heart has like stimulated me for the rest of my life because it's so intricate. There's so much there, there's so much to learn. And I think when you get a greater understanding of what it does, how it functions, how important it is, and then how to actually take care of it properly, I think that's the key. And that's where I'm going with this, is I want to talk to you about care of the heart, right? For each individual. And I can't stand this whole, oh, you're too young, you don't need to worry about that. We need to be starting early to be preventative, to hopefully mitigate anything that could be occurring in 40s, 50s, and 60s and thereon. So if we start early protecting it, Michael, think about it for a minute.

The heart's about the size of your fist. Mm-hmm. This is the sum total of the size of this organ, and we've only scratched the surface, right?

It's amazing.

Now, a hand surgeon knows the hand inside and out, and while some treatments may have evolved, hand surgery is still hand surgery. The heart's the same size, but the evolution in cardiovascular care every year of this fist-sized organ is just remarkable.

I want your thoughts on diet. We're gonna start with there because that is one of the most polarizing things in my world.

Oh yeah.

Yeah. Especially, and I'm sure yours with when it comes to carbs and fats and this is terrible for you, but no, it's great for you. The low-fat diet. This, I want, I want to get into that right now with you.

I was on the Lisa Gibbons Show and Suzanne Somers was her guest and it was called Diet Wars. This was back in the, on 2000 or some, sometime around there. And they had 4 or 5 dietary experts on and she called it Dietary Wars because these 4 or 5 dietitians were absolutely at war because they couldn't agree. One said low fat, one said low carb. There was a, one said low calories. Doesn't matter what you eat, low calories. I can tell you this about, about diet. Let's start back when you were in grade school. When I was in grade school, the nuns showed us the food pyramid. Remember that? And God bless the nuns. They were, you know, from the old country. But 60% of the calories on that food pyramid was carbohydrates. I can tell you That's probably wrong. That's probably not in our best interest because there are countries, for instance, where the majority of the individuals are— don't eat meat. They're vegetarian. And yet in some parts of these countries that are vegetarian, they have the highest rate of coronary disease and not just coronary disease, but premature coronary disease, 30, 40, 50 years of age.

India is a great example, and a high rate of diabetes. Again, India is a great example of that. So let's start off by dispelling the myth that meat is bad and that we are not meant to eat meat. That's just not accurate. You have in the dietary world, you have the people that say Eat low calories. And I suppose there's some merit to that, but you can't— there's no one-size-fits-all for everyone. So the first thing I would say about, about eating right diet is you're going to have to tailor it to what you can do. And going to bed hungry is a bad idea. It's not sustainable. It doesn't work. You see people who do that and they lose weight. But very often in my profession, they don't sustain the weight loss. I am a believer of a low carbohydrate diet. I'm not a believer in a, let's eat bacon 6 times a day and lick the grease off the pan. That's, that's not correct, but low carbs and low carbs can include meat, lean meats. And if you're on the low carb diet, what you get rid of is the bread, the rice, the pasta, potatoes, and the sweets..

And sweets comes in a lot of different varieties, and that sweets could be the chocolate mousse or the Frosted Flakes, but you get rid of that. And I do like the low, low carb diet for vegetarians. If people choose to be vegetarians, they still have to figure out how to get a source of protein. There's a lot of protein malnutrition amongst vegetarians. So there are lots of good sources. Of protein that you have to get, but you can't rely on carbohydrates in that because that's just not healthy either. So I think that a person who is searching for a diet has to find something that A, works for them, B, that they're not going to bed hungry, that they are being filled, you know, that there's satiety and and that they can— the most important thing is that they can, that they can sustain that type of, that type of diet. There's no one size fits all. And I don't like the word diet. I like the word, it's a lifestyle. Yeah. It's a way of eating. So there's so much out there, especially with the internet. There's a lot of nonsense on the internet, but you can search for a lifestyle or a way of eating in your life that is sustainable and that it gets you to your goals.

And one of those goals, because you said we're gonna talk about the heart, is looking at— let's, let's, let's simplify it. Yeah. Look at your cholesterol profile and look at your hemoglobin A1C. Look at your sugars and your cholesterol profile. And cholesterol profiles are interesting because people look at their total cholesterol and they say, well, this is my cholesterol, but you have to put it in the context of your good cholesterol, your bad cholesterol, your triglycerides. Some people like to look at, you know, particle size and everything. So you have to look at the total cholesterol group of parameters and your sugars and your hemoglobin A1C, you know, and I would say find a doctor you trust or a practitioner you trust and discuss those numbers, those parameters, and put it in the context of How I eat, what's my lifestyle, man?

I was in the hospital and I had to do the cath lab and everything.

I, I, oh, you did?

I did. And, um, I wish I had this to show you. So me and my wife and my mom were up there with me cuz I started having weird heart palpitations and then they, you know, they did the catheter check, no blockage or anything like that, just a lower ejection fraction. And if I could show you what they gave me as a heart healthy menu, It would have blown you away. I said to my wife, I said, this is chicken parm. It did. Margarine, dinner rolls.

That old margarine. Margarine is like deadly.

Yes.

This was on the heart-healthy menu. Margarine is deadly. Where did we ever come up with this myth that margarine was an alternative to butter? I don't know.

I'm still trying to figure that out 40 years later.

Yeah. Yeah. I lived through that thing.

So when I started studying food labels and nutrition when I was 11, unfortunately due to an eating disorder. But I became a nutritionist and I was learning that low fat was the answer. And I lived that way for so long. And until I made the changes, I went from eating 10 to 15 grams of fat a day for years to now 130. And I can't tell— like, I just got a blood panel back today and I yelled at her to come in there. I said, look at this. I mean, it was the best blood panel I've had in like a decade. I'm getting chills even saying it.

So much of our body functions, they're going to be fat-dependent. Yeah. Brain function is fat-dependent. Yes. So, you know, there's been a lot of myths. Yeah. Internet hasn't helped it much. Mm-mm. Um, but I'm delighted to hear you did exactly what I said. You put your, your dietary or your eating style, your lifestyle, in the context of some objective piece of data. Yes. Well, that's your weight. That's your cholesterol profile, A1C and those types of things. That's very important.

And that's where I want to go next. So cholesterol is like one of the most polarizing topics in the world now. Oh yeah. I mean, it, it really is. Yes. Food, like we said, which I'm really glad that you did talk about it being personalized, by the way, because that is so key and important. And some of these people that get so angry about being a carnivore or eating a ton of carbs or this and that. Listen, you gave facts which are phenomenal. Low carb might be better, it might be more optimal, but there's no one size fits all for it. No one size fits all, right? So that is more needing to fit whatever profile you have, whatever allergies you have, whatever, et cetera, right? So then we get to this topic of cholesterol. I have data that shows the dangers of it being too low. I'm sure you do as well. And I, you know, that's the trouble that I have cuz we're gonna get into medications after we talk cholesterol cuz I really wanna talk to you about conventional, non-conventional. Yep. Because I have a lot of thoughts there. But when it comes to the cholesterol itself, the first thing I want to ask you about is LDL itself.

And then I want to get more intricate into the, like the Lps, the ApoBs, the, the particle sizes, like you said. But let's just look at LDL specifically and total. Where for you do you think it's a good idea range-wise to be? Because you know, some people will say that you need to be in the hundreds because it, you, brain needs it. I know your cellular membrane needs good fats and cholesterol in the body to protect it. But then there's people like, they drained my cholesterol down to 30 and I panicked. I said, I, this is terrible when I got those blood markers back, you know, when I first found plaque in my arteries. Where do you fall in that gap of where you think LDL is necessary and how, how important is it for our function?

Well, you know, if this were 15, 20 years ago, the guidelines and the recommendations had just achieve, achieve an LDL of 130. And we've learned that it depends who you are. It depends on your risk. If you're somebody who's never had a heart attack and your mom and dad are 100 years old and they've never had a heart attack, that might be a different LDL than the person whose, you know, dad and every male member of their family has died at age 45. That would be a different LDL target to achieve. Or if you have had a heart attack, if you have coronary disease, if you've had bypass surgery, if you've had stents, if you've had a heart attack, or if you have a high plaque burden, let's say you've done a CT scan and you have a high plaque burden, that's a different LDL than the person with no substrate or family history for heart disease. When you were born, your LDL was like 10. Then again, you were drinking amniotic fluid for the last 9 months. I, I have, I have evolved my thinking and I don't get crazy on every single person who comes in and say your LDL needs to be, you know, single digit.

It's just not accurate. Now I have patients who've had coronary disease and recurring coronary disease, and we really do push the LDLs down to less than 50. The new cholesterol guideline recommendations really talk about getting it down less than 50. Pharmacologically, but there are— there's a spectrum of who you're treating. Sure. And for some people, the LDL of 100 is just fine, and a cholesterol of 150 is just fine because they're not at risk. For others who've demonstrated risk or who have a genetic familial substrate for risk, those are the people we do have to be more aggressive. There are medications There, there is this thing called exercise. Everybody wants better living through chemistry, through pharmacology, through statin drugs, Repatha, some of the injectables. Everything needs to be tailored to the person sitting in front of you. If you were, do you, when you were dating before you were married, did you use the same line on every girl you dated or did you tailor your conversations to the person you were talking to? Sure. You have to tailor what you discuss. To the person sitting across from you. It all depends on who they are and what their, their DNA and their biology and their physiology is.

There are many, many patients that have to be treated with statin drugs, and you need to, to really drive that LDL significantly down because the risk is there. There are many patients whose risk is not there. And you don't need to be aggressive with pharmacology. You can use alternatives. You can, you know, give them time when they come in. You can give them time to try and get it down by weight loss, exercise, dietary modifications, and then monitor what kind of diet they're on and see what the effect of that is.

Yes. So when, when I was on first put on the medications.

Yeah.

I did.

What were you put on?

So initially I went to Mayo Clinic with the thought and the plan of what I wanted to do, which was PCSK9 inhibitors, which was Repatha, and I wanted to take Vascepa with it, and I did not want to take the statin. I started taking it, did not care for it, and I had enough data.

The statin you didn't.

Yeah. And I, and the data that I had from so many people was that it really wasn't gonna be for me or what I wanted, is that I had an elevated LP little a. I had a family history of cholesterol, but mine wasn't terrible, but it was great. It was like 130 LDL and my HDL was always kind of stuck in like the 48, 50 range.

Not great.

The HDL. Yeah. Not great. And that's due to diet.

Average male in this country is about 45, so you're not awful, but that's about average.

Yeah. But my diet was just strictly like so vegetable related where it was like 15 servings of vegetables a day, 2 servings of oatmeal, egg whites. Peanut butter and yogurt fat-free. Like I was terrified of fat.

It was the fat is the boogeyman, right? Yeah.

Oh yeah. No, terrified. And, but I was teaching people the opposite, but I had in my head, oh, you're the exception. It's gonna make you fat. Right. Even though I know, anyway, so I went in there, they told me it would be bad practice to put me on the, the stack that I wanted. Then the statin was the only thing. And you and I know statin increases your LP little a, which was my major problem. 3:30, right? And my dad had a heart attack when he was 59. So I went and did what I wanted to do, which was what? The Repatha, the Vascepa. I did some niacin. I, and I implemented some nanokine.

You also exercise?

Oh yeah. Like a beast. Probably too much. Maybe too much. Yeah. So I ended up getting the LP little a down to 94, 0.330, which they told me was impossible. Okay. You know? They, they young. Yeah. Right. But when I changed to the high-fat diet and I increased my calories by 1,300, 'cause I was severely undereating, my HDL went up to the 80s.

But that's beautiful.

Oh, it's just awesome. My particle sizes went, my, one of my particle sizes was 6,000, went down to 2,200. My LDL medium or small, but it's right in range anyway. The LDL, which I had gotten pretty low, did go up. So did my ApoB. So they put me on ezetimibe.

Yeah, yeah, yeah, yeah.

I just got a blood panel back. I've been on it 30 days and my LDL went from 128 to 69. Yeah. ApoB went from 96 to 67.

So what you just said, what you just said is I, I personalized, I, I, I looked at what my body biology is and I changed it based on that. I used to think that exercise and a low-carb, significant protein diet had no possibility of changing all of these cholesterol parameters. And I was young and naive and I was just wrong. Right. And that's the— as cardiology has evolved with all of the wonderful invasive and interventional therapies we have, it has also evolved in terms of our understanding of how to modify cholesterol and therefore modify risk. And what you're saying is you are a perfect example of how I started this when I answered your first question. Personalize it, individualize it.

Yes. And that's where I was going with it, is everything you've said falls in line with what I do and what you stand for, which is it's person to person. And I always, I say this all the time. I know when I'm talking to somebody brilliant because they say that. Otherwise, the people that get stuck in their ways, it's like the 60-year-old coach that used to win all the time that doesn't change with the times and gets fired. Right. They can't win. You know, because he doesn't relate with the players anymore and doesn't adapt. Clearly, you've adapted over time.

You have to. Yes. There's an expression that I use. I say retool or retire. If you don't do that as a physician and you have to do that as a coach, you have to retool as a coach. You have to retool in every discipline of life. As a parent, you need to retool. I have 4 daughters. How I connected and communicated with, other than loving them unconditionally, how I connected and communicated with them when they were 6 and 8 and 10 is different than when they were teens and now they're in their 20s. Retool or retire.

Absolutely. I love you, man. I do. I love this kind of conversation because we relate so well, but I like to hear it from somebody that's been doing it a long time that is open-minded and that sees the, the validity and the benefit and both sides of the equation, which you clearly do. And that's, that's why I want to try to get a little bit deeper then into the medication side, because once again, it seems like everything around the heart is so polarizing anymore. And I think fairly, I do.

Oh, that's fair.

Do you think, and I'm gonna say this and I hope that you can answer it precisely without worrying about anything, which I'm sure you can. Do you think statins are overprescribed?

Yeah, I think statins are overprescribed because are they wonderful drugs and are they life-saving drugs? They are. That wasn't your question. Your question is, are they overprescribed? A, a person walks into a doctor's office and gets a panel of blood tests, thyroid studies, you know, chemistries, et cetera. And the minute some physicians see this LDL of 110, they say, oh, we gotta put you on statin drugs. I've seen that. Yeah. I have seen people who are not at significant risk get put on statins because, oh, I think, I think you, you asked the perfect question. What's your number? What's your parameter? Which, when do you put people on these drugs? It's more complicated than gee, it's a number. Okay. And so if you have a person at low risk who has an LDL of 100, that's different than the person who's had triple bypass surgery and 3 or 4 different stent procedures who has an LDL of 100. Those are different beasts. So if you go to a doctor and without having this complete discussion, we are treating a number. And I always tell young physicians, don't treat a number. Treat the patient. If all you're doing is treating a number, then it's being overprescribed, potentially overprescribed.

But do I think statins work? Well, yeah, I think statins work for the right people. I think ezetimibe works for the right people. I think Vascepa, EPA works. And then I think there's a bunch of alternative agents that work for the right people for the right indications. You know, it's, it's sort of like saying, when do you bypass someone? That is such an individualized question. We have medical therapy, which in some people with coronary disease works. We have stents, which in some people with coronary disease works, and we have bypass surgery. We have 3 therapies: bypass, catheter-based therapies or stents, and medical therapy. Not everyone— I, it's funny, I tell people, well, we did a cardiac catheterization on you and you have a 40% blockage. In your one artery and they say, oh, you're gonna stent it, right? Or you're gonna bypass it. And my answer is 40% blockages are not going to hurt you. They are not going to kill you. That's individualizing invasive therapies. That's medical therapy. Mm-hmm. That's control of high blood pressure, control of diabetes, control of cholesterol, walking, stop smoking. There's a whole bunch of therapies for people short of bypass and stents.

But when appropriate, when you individualize it appropriately, bypass and stents are life-saving. Mm-hmm. They're game-changing. So the, the most fun part of my day, my wife always says, if people say, what, what does your husband do when he gets, you know, frustrated or tense or, and she says he goes in and he operates. And there is something very relaxing about being in that operating room theater, the cath lab, and doing that. But the most fun I have. It's just talking with patients. We have an office, I have 2 nurse practitioners, and we sit down with a patient and we provide them their therapy options, and it's always more than a single strategy.

So is plaque reversible?

Yes, no, maybe. There were a bunch of CT scan studies in the '90s. They were taking people with elevated cholesterols and LDL cholesterols, and they would do a CT scan at time 0. And then they would really drive their cholesterol down with drugs. What we found is at minimum, you can arrest progression. Your question is, is there regression? There were some studies in the Midwest where they infused, you know, high-density lipoproteins. That was promising, but not sustainable. It's hard for me to give you a hard yes on that. Because I don't think we've investigated that. But based on the best science that we have right now, I would say at minimum it's arrestable. You can arrest progression of disease. Whether or not you get actual regression, I don't think we have the science to say that. But I think that's, you know, we, we want to develop the liquid Drano, if you will, for the arteries, and we don't have that yet.

But you can, like you said, you walk in, you got 40% blockage, you can sustain that, right?

You can keep it there. But Mother Nature's a bitch too. Yeah. She can, you know, people get worse even who play by the rules. You keep asking about statins and it's a, these are great questions you're asking. If I said to you now, when you drive home, put a seatbelt on, please put a seatbelt on. That's a probability. If you put a seatbelt on and you drive home and you get in a car accident, the probability is with a seatbelt on, you are unlikely to have a fatal event in a car accident. Okay. That's a probability. I can't tell you if you wear a seatbelt, there's no way you can die in a car accident. I can't tell you, cannot tell you that if you exercise, eat right, diet, and, uh, and take statins, that you will never have a heart attack. It's a probability. And that's where Mother Nature, number one, Mother Nature can play a role. There are people who do all the right things but still get worse. But the probability is if you do the right things, you won't. And then there's about probably 10,000 things that we still don't understand, right?

Of course, we, we're just learning so much about this little organ Every day, every week, there's leapfrogs in our understanding, but we still don't know a lot. And 20 years from now, you and I are gonna sit here with a lot more gray hair and we're gonna be talking about this again and we'll say, God, remember when we thought cholesterol and diet were the only things, right?

Oh yeah. Well, we won't be sitting here with gray hair cuz I'll color mine if I keep worrying about that. So you know what I think would be really sweet if you would do, because One of the things I can't stand, and I used to do this, I don't do it anymore, and there's a reason why I don't do it anymore, is talking out of our backside in terms of we make these comments because so-and-so said something was good or something was bad, but we don't know how it works or what it does and why it does it. It would be great if you could just give like a little short mechanism of action explanation on what a statin actually does. Like how does it even work?

Okay, let, let me put it in, in the simplest terms possible. Please. It downregulates through the liver, your cholesterol production. It downregulates cholesterol production through this very complicated cascade of events that ultimately comes back to the liver. That's the simplest way to think about it. I can give you complex mechanisms. And that's why you go to medical school. But for an audience, for a lay audience, I think the best way to think of it is it's, it's turning off cholesterol production through this cascade of events that is ultimately liver dependent.

So does a statin then, say you have a combination of soft and stabilized plaque, does it harden the, the soft plaque?

No, I think what you're, Does it cause the plaque to become harder plaque?

Like stabilize the, the soft plaque?

No, no, absolutely it doesn't. Okay. That is, there are some people who think that's true. Yeah, they do.

Okay.

I'm gonna give you the David Ryzik theory of that. Please. People may start on a statin at a young age and then they don't have a heart attack, but by the time they present to their doctors, they're now older. They're like 10 years older than those who didn't lower their cholesterol. And one of the body's natural processes is, is to develop calcium. Okay. And as you develop calcium, I think a lot of that's because patients who are on statins and on a lot of these other medications don't have heart attacks. So when they do present to their doctor, they are older and they have more of a tendency to have produced calcium or harder plaque, but it's not the statin doing that.

Got it.

Let me ask you a question. Why is it that smokers who present with a heart attack have a better prognosis than nonsmokers? Now, wait a minute. Did you just really say that? If you take two people or groups of patients who have heart attacks and some are smokers and some are nonsmokers, why do smokers have a better prognosis, hospital prognosis with a heart attack? 'Cause they're 10 years younger when they have their heart attack. It used to be a myth that if you smoke, you're gonna have a better prognosis if you had a heart attack. Well, it's not actually accurate. It's just you're younger when you have your heart attack.

Yeah. Okay. That makes sense. Well then let me ask you this. So one of the other things that everybody always says is that heart disease is just getting worse and worse and worse and worse as time goes on. Like more people are encountering that. Having more problems and it's just getting worse. Now, A, is that factual? You tell me. And B, what do you believe if, say, that is true, is the cause?

Well, I'm going to tell you, we are going to have an epidemic if you— in this country because we sit around on computers like this and our young people are not exercising.

Yeah.

You know, recently I think Robert Kennedy was actually right when he is trying to reinstitute some of these physical fitness things. I know he's a polarizing figure in some ways, but on this issue, he's absolutely correct. We're not doing enough activity. Our young people are not. And there are, you know, we, you and I watch football. There's a lot of great athletes out there, but that might be a smaller proportion of the entire population of young people. Young people are sitting on those cell phones in front of TVs in mom's basement, on computers. I think we're going to get to an explosion in heart disease. Mm-hmm. So that's gonna be generational. A few generations from now, you're gonna see that. I think one of the reasons some people think that we have more heart disease in this country, the baby boomers, those born between '49 and '64, 1949 and 1964, they're getting into the coronary disease age. They are going to— you're going to see their healthcare needs, cardiovascular therapies explode. So as the population ages, and remember the baby boomers, that was that 15-year period after World War II to the early '60s. As they get up into their 70s and especially their 80s, yes, you're going to see an explosion in, in in healthcare needs and cardiovascular disease.

In India, if you take certain parts of India where diabetes is rampant, I have a couple of really good friends who are cardiologists in India. And as diabetes increases, I heard a statistic, something like one-third of the world's diabetics will be in India by the year 2040. Wow. That's going to be a crisis. That is going to be a crisis.

Yeah.

Considering their population, it's going to be a crisis. And there are other types of heart disease. I mean, right now you and I are talking about coronary disease, heart attacks, and bypass and stents. There is a whole population of people with valve disease. We haven't even talked about that yet. You know, when the life expectancy after World War II was a little bit over— or after World War I was a little bit over 50. We didn't see diseases of the elderly. People died between 50 and 60. Now that we are living longer, we are seeing valve disease. Remember, the life expectancy has gone from mid-50s to late 70s in 100 years. That's just spectacular.

Yeah.

So we're seeing more diseases of elderly, for instance, prostate cancer. Prostate cancer is a disease of elderly men, not 50-year-old men in general. And so we are seeing a higher proportion of prostate cancer patients because we're living longer. And that's true for heart valve disease. The valves of the heart, these one-way doors that allow blood to go in and out of the different chambers of the heart, they degenerate, they wear out. We're seeing a lot of that and we're going to see an explosion in valve disease. And, you know, I mean, it's good that we have therapies because it's hard to prevent valve disease. It's not like coronary disease where you can do preventative things. So, yes, there is going to be more heart disease for a number of different reasons.

Is heart valve disease then— is that related to heart failure?

It can be if the valves get bad enough. If the valve— if you get— have you heard of mitral valve prolapse or mitral regurgitation? If the valve, the mitral valve leaks or the aortic valve leaks, The heart will enlarge over time if not treated, and that will result in heart failure. Heart failure is the blood backing up basically into the lungs. Yeah. Bad analogy. You flush the toilet, doesn't work, everything backs up under the floor. If the heart doesn't work, everything backs up into the lungs.

Yeah. So what's the most prevalent form of heart disease? Is it heart failure? Is it clogged arteries? Like, what do you see the most of?

Actually, and I'm not a rhythm specialist. I see a lot of rhythm disturbances of the heart. I mean, the simple stuff like hypertension, elevated blood pressure, and elevated cholesterol. Anybody can manage that. Really, you don't need a cardiologist. However, yes, we see a lot of coronary disease. Yes, we're seeing an increasing amount of valve disease, but we haven't talked about atrial fibrillation, rhythm disturbances of the heart. It's probably the one of the most common things, Ellen, that I see. In my practice.

I see that talked about over the past 5 to 10 years more than ever. It seems like there's more monitoring of it, there's more discussion of it, more on Cardia.

The Cardia app on your phone, you know, they've created a whole technology that you get from Amazon over atrial fibrillation because it can lead to stroke.

Explain what that is, because we always hear AFib, AFib, AFib. And I don't— I swear to you, 95% of the people that say AFib, All they know is that you get it on your Apple Watch or an app and don't know what the hell it is.

Exactly.

Seriously.

The heart is this beautiful organ. I mean, think about it. If your heart rate is 70 beats a minute, that means 70 times a minute times 60 minutes in an hour times 24 hours in a day. And let's say you're 60 times 60 years that heart beats and the upper chamber of the heart, upper chambers, the atria. Beat in synchrony with the lower chambers, the ventricles. So it's 1 to 1. You're asleep, you're awake, you're exercising, and you get bum bum bum bum bum bum. This synchronous, beautiful organ. Well, like you can have a 60-year-old home and the brick and the mortar on the outside of that home is in great shape, the electrical wiring in the basement gets a little old. The electrical wiring of the heart ages. It gets a little old. And what happens in atrial fibrillation is the upper chamber of the heart starts fibrillating. It has an electrical current that is causing the upper chamber of the heart to fibrillate, fibrillate, while the lower chamber is still not beating in synchrony with it. So atrial fibrillation is a rhythm disturbance, disturbance where the electrical wiring of the heart is a little off and you are actually fibrillating.

So because it's the upper chamber, the atrium, and it's fibrillating quickly, it's called atrial fibrillation. Now, why is that a problem? Because as it fibrillates blood, when it works in synchrony, upper chamber, lower chamber, upper chamber, lower chamber, blood moves smoothly through the heart. When you fibrillate, blood can pool and stagnate in that upper chamber of the heart and a clot can form. I see. And that's where you can have a stroke related to atrial fibrillation. And as the— and it's a, it's a, um, uh, a disease that increases higher prevalence with age. So again, like everything else, as the population ages in this country, as the demographics are shifting to an older population, We see more AFib.

Is that fixable and treatable?

What we have done, what rhythm specialists have done with atrial fibrillation, from drugs to devices, is one of the great success stories in cardiovascular medicine. Really? Yeah. It's been, it's been incredible. They, rhythm specialists, and I'm not a rhythm specialist, but I see a lot of AFib. They have Drugs, blood thinners to prevent stroke. We have medications to suppress atrial fibrillation or convert you back to a normal rhythm. And then they have these devices, radiofrequency ablation devices, where you can go up to that area where that abnormal electrical focus is and basically zap it or ablate it and put you back into a normal rhythm.

Okay.

The, the rhythm specialists, And I would say industry, the companies with whom they work, have just done a spectacular, spectacular job of treating atrial fibrillation. There's so many great therapies out there for AFib.

If somebody has AFib, that's a something that happens frequently, right? To them.

Yeah. I, if you have AFib once, your chance of having AFib again is pretty significant.

So like in, I remember the first time I was actually waiting a table, I was 19 years old and I was walking and I felt that happen where it went and it stopped for a second and then went right back in. And I panicked, man. Like, I went to the cooler.

Isn't that funny how, how you feel, dude?

I went to the cooler at Olive Garden. That's the first waiter job I had. And I just sat in there and I mean, I was stone cold cuz I freaked out. It happens to me like once every 6 months. And now I know it's like, okay, okay.

So you have what's called a very good warning system. Mm-hmm. Now can you imagine some people have no idea they're in AFib? They're heart rate can be 150 or 160 beats a minute and they have no idea. And that can be bad because over time, if you have uncontrolled atrial fibrillation, your risk of stroke goes up and your risk of, of developing damage to the heart muscle goes up. So you have a great warning system.

That's good, man. I'm telling you, I was scared just sitting in the cooler. I was just, I went in there, I didn't know what to do. I thought, man, I'm toast. You know, like, I don't know.

It's amazing. Yeah. How rhythms can—

Oh, it's scary.

Yeah.

They can be scary. Like, I have recently had quite a significant amount of heart palpitations and found out it was like severe dehydration. Yeah. Severe Giardia had drained me.

Yeah.

Of potassium and glucose and everything else. And I kept— I'm taking this medication to improve my ejection fraction and I'm going, why is my heart so disturbed?

We need more patients like you, people who take this seriously. People who read and people who insist that— you've obviously insisted that whoever is providing care or counseling you is individualizing your therapy. You are, you are my favorite patient. You are informed and you are constantly looking to understand either what's new or what works for you.

Yes.

That's great.

You have to, you have to understand your own body and you have to ease into it and be willing to trial and error. 'Cause really honestly, what you do, what I do, what we do in life is trial and error. Absolutely. Everything. Yep. And the quicker you understand that, I think the, the more likelihood you have of being healthier and teaching people a better way.

Absolutely.

I mean, what do I do with diet? What do I do with bodybuilders and training? I take in one thing and subtract it. Otherwise I'd have these guys that come to me, I'd be coaching and they say, Well, I wanna run this stack of 7 things and I'd say, brother, if you do that and you start having this problem and this problem, that all of 'em cause the same problem. I don't know what's doing what. I don't know if you could get by with just using 2 of these instead of 7, you know? Right. And so it, everybody lives on the concept of more is always better.

Yeah.

Right. You know, and oftentimes more is often worse.

Way worse.

Yeah. So, It, and, and Pete, you know, you know this too, we want it right now.

We're right now gratification. Yeah. It's who we are.

It's a marathon and it's not a sprint. And all of this. Well, let me ask you this, 'cause I brought this up earlier and I'm very curious about this and I'm doing this for my, my former bodybuilding community friends here when it comes to the anabolic steroid side of things. Because the problem with those guys is they, they have this one-track mind and they don't really think about tomorrow. All they care about is getting big. Now I've talked with some brilliant minds about the dangers of being too heavy for too long, eating too many calories. Right. But I want to talk about the impact that anabolic steroids can have on the heart directly.

Direct toxin. Yes.

So direct toxin for the people that think, oh, it's safe, or oh, it's fine, it's not a big deal. Direct toxin. Okay.

Cyanide. I mean, direct toxin to the heart. I have seen in my years, I have seen champion bodybuilders, household names in that world, physicians. I have seen physicians who went from these lanky, thin people when we started practicing together to these thick guys who can't scratch their head or something, who become very plethoric. They're red-faced and the acne.

It is—

I can give you all the things it does to the liver, erectile dysfunction. I can go through all that.

Oh yeah.

But your question was about the heart, and all I can tell you is it is directly toxic to the heart. And over time you run the risk of developing a cardiomyopathy. Cardio, heart, myopathy, muscle pathology. You run the risk of causing the strength of that heart muscle, that good squeeze of the heart muscle to diminish. And often once steroids cause a myopathy, damage to the heart muscle, it's irreversible. And now you're, you know, the one bodybuilder, you know, he ended up getting a heart transplant that I took care of. I sent him over to Mayo Clinic and he got a transplant. I'm simplifying steroids. Simplifying it, it's directly toxic to the heart. Okay? That's all. What doesn't get any better than that?

What about a normal dose of testosterone replacement therapy?

Testosterone replacement therapy as guided by a responsible physician who reviews your testosterone numbers. One of the problems, it's, it's sort of like our predisposition to excess. People get a little bit and they want more and they want more and they want more and they want more. You have to avoid that and you have to go, you have to be, um, your, your care has to be overseen by a responsible physician who is basing this on science data, numbers, blood tests, and not just, um, you know, if, if you said, I'm gonna smoke one cigarette a day, I'd, I'd have a hard time arguing with you that you're going to die from that one cigarette a day. Our problem is we smoke 2 packs of cigarettes and, and, and this is the excess that we're prone to.

I did all the coaching all the time.

Yeah.

I, I, I did like a 4 or 5 year run of steroid use and stopped. And my cardiologist now thinks that that could be part of what caused the lower ejection fraction potentially. And I, you know, I got it up from 44 to 50 in just a couple months. Mind you, I had to stop taking the Chardiance that was helping me. I, I started some more natural things. But it, it, and I don't know if that's the full cause or not. There's no way to really know at this point. Couple that with cocaine use and eating disorder and all of that.

Cocaine is also directly toxic. Right. And that combination seems to be a particularly malignant species of cardiomyopathy when you mix agents like coke and steroids and crystal.

Yeah.

I had this, you know, you remember the saddest cases. I had a 15-year-old girl who was doing coke and crystal methamphetamine after school. She was, I think she was like a latchkey child or something. She was by herself. Parents both worked and she and her friends were smoking cigarettes and doing coke and doing crystal. And she came in with a heart attack, 15 years old. Wow. Because her blood vessels spasmed so incredibly. That a blood vessel in spasm is like a blocked artery. She just, she had an awful ejection fraction by the time this was done. Really a lot of irreversible damage to her heart muscle. Those are the ones you remember.

I mean, I think where mine was sitting at 45 and now 50 is not end of world by any stretch.

Is that— Oh, let, let, let's explain that then. Yeah. Ejection fraction is what percentage of blood that goes into the heart is squeezed out with every contraction of the heart. Well, it's not 100%, it's about 55 or 60. Yeah. 55 or 60% of the blood that enters the heart leaves the heart with each contraction. So if it drops down to 30 or 35, that's pretty serious. Yeah. If you're at 45 or 50, you should live a normal life expectancy providing you're doing all the other right things.

What about overtraining in terms of damage to the heart? How significantly bad can that be?

Controversial. Yeah, controversial. I, you know, it's hard for me to say that overtraining is bad for the heart. I, some people say it is. We don't, we're not, we're not armed with convincing scientific data that overtraining is bad. Probably worse for your joints than for your heart.

I want to touch on one more thing that we, that we missed. And that was on the blood panel side.

So.

I understand the importance of LDL, HDL, triglycerides, and total cholesterol. Totally. You have to know those numbers. Personally argue, and if I'm wrong, you correct me, that, that you need to look at that Cardio IQ panel and look at your ApoB and look at your LPa and these markers that I feel like I don't understand why we don't need to have someone knowledgeable.

And then you also have to recognize that we don't completely understand The, the entire panel and what each one of those individual numbers— we think we understand it. This very smart cholesterol specialist, one of the smartest in the country, I was trying to impress him with my knowledge of that. And he said, you know, that's great. He said, but we don't completely understand all those numbers. And you have to put that in the context of the whole, and that is your entire blood test. So I caution people to just be a little bit careful about all of those other markers, because in a lot of ways, the treatment for it is the same as if you just have an elevated LDL and you have coronary disease. You, you, you should look at your numbers and you should have a target for those numbers. Always know what the number is, but what's the target that you're shooting for? And you have to be careful. Like the LDL of 110 or 100 in a person with no risk factors. You know, I'm not sure we completely understand everything we need to understand.

So before we wrap things up, I go, you know, and I, and I hate this because these conversations go by so quickly.

I could talk about this all day.

What you have found out, I will invite you back to do a part 2 with me. All right. So we can accept. Absolutely. So before we go, You'd worked on a new supplement line that you've had coming out. You sent me a hat and a sweatshirt, but you, nobody really filled me in on the supplement at all. Just kind of gave me the swag. So why don't you talk about real quickly what your product is?

You know, people don't listen to doctors like they should, but I have a young man that I have partnered with. Ashley Parker Angel, you know him from O-Town, and he and I have been working on a supplement called Heart, Body, and Mind. And it is a supplement that the cardiovascular supplement is CoQ10, it's omega-3s, and it's also vitamin E. And I wanted to team up with someone to do this that people would actually listen to. And when you look at Ashley Parker Angel, I mean, he's an influencer. He's an iconic figure, uh, from when he was with O-Town. And people look at me and they're not gonna listen to me, but when you look at him and when you look at his body and you look at what he has done and you see the sort of cultural influence that he has, I knew I had met the right person. In patients, especially heart patients who are looking for a good supplement, I think Heart, Body, and Mind is a great supplement. CoQ10. Has been shown to have great benefit from the mitochondrial level, from the cellular level to the production of energy. For those who are on statins, you know, your CoQ10 is depleted by statins, and sometimes you have muscle aches and whatnot when you're on a statin drug, and the CoQ10 improves all of those, uh, parameters.

In fact, very often when we have someone who has, who's on statins and they have muscle aches, we say take CoQ10. Well, Heart, Body, and Mind, one of the things it has in it is CoQ10. One of the other things it has is omega-3s, the same thing that is in Vascepa.

Mm-hmm.

And Vascepa was shown in the famous New England Journal study in 19 to lower cardiovascular events. And it also has vitamin E, which has been shown in at least one study to reduce cardiovascular events. So if you are looking at a supplement, okay, if you are thinking, gee, should I be on a supplement? I think looking at a truly science-based supplement like Heart, Body, and Mind, I think is, that's extremely important. Don't just take a supplement because someone told you to take a supplement, but look at the ingredients and make sure there is science and experience behind that. And, and so I've teamed up with Ash and he has just done a terrific job of creating, you know, I create the science, he creates the culture, he creates the message. And we've had a fun, fun, fun time with this. And you know, it's available now at GNC. And when you talk about You know, a place where supplements are, are, have great credibility. GNC is, they're fantastic. They're really in my mind without peer. So we're very pleased that GNC is, is carrying Heart, Body Mind. We're, we're excited about where we're gonna go with this.

Well, yeah, I mean, that's my whole world, man. And a company of that size, when they carry something, they have to be very careful. Right. They, they are very difficult to get into that store. I can tell everybody firsthand. Network.

So, and they're right, we're in every GNC store in there. It's, it's really been a remarkable run. It's been fun. And getting to know him, you know, you're walking down the street and I used to think that I was a cardiologist of some note and people run past me to get to Ashley Parker Angel. It's, it's a lot of fun.

Well, we'll link that in the description for everybody to check it out and, and buy it. And we'll link where to come and see you and follow you, which would be where?

Well, I'm at Banner University. Our clinic, this is a great clinic, is over on the 101 and Dobson in Scottsdale, right in front of Topgolf and Talking Stick. You see our— it says Banner Physical Therapy, but we take up the second floor of the cardiology. And we've got a great practice and a great group of clinicians and physicians that have all been handpicked because they subscribe to this individualizing healthcare that's so important to me.

Well, man, I really appreciate the time and the conversation. I've enjoyed this.

Yes. Can we do this again?

We are going to do it again for sure. We'll get working on that and get us scheduled again because it was great and we didn't get through a fraction of what I wanted to get through. So as information filled as this was, we got plenty for another one or even two. So we'll do it again. I appreciate the time. And since you're local here, we'll make it happen.

That sounds great. Appreciate it. Congratulations on you being local. You shed the winter and and your overcoat, huh?

Yeah, we're trying, we're trying. So it's a blessing, man, just like all of this and these conversations. And so I really appreciate the time and I hope everybody learned a lot about the heart, improving your health, and we are going to cover more of this. So stay tuned for plenty more to come. Dylan Gemelli signing off.