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Danielle Belardo: This Doctor Uses TikTok to Fight Heart Disease Misinformation | DSH #1695
00:58:31
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- [00:00]
A
I always tell patients of mine that the Internet's amazing because I love when patients come to me. You know, there's some memes out there where doctors say, like, your Google search doesn't equal a medical degree. I like hate phrases like that because the thing is is that I love when patients come to me with information that they found on TikTok or something like that because it's important to be able to sit down with people and explain what is kind of fact versus fiction when it comes to that. And there's a lot of misinformation out there about heart disease.
- [00:30]
B
Okay, guys, got Dr. Danielle Bilardo here today. Not a biohacker. We're gonna get the opposing side today. So thanks for your time.
- [00:38]
A
Thanks for having me.
- [00:39]
B
Yeah, I know I have on a lot of biohackers, but I wanna be fair as a host and get the other side of things. I know you've debated Dr. Steven Gundry and a couple other people, right?
- [00:47]
A
Yep, yep, yep. I'm here and hoping your audience is gentle with me.
- [00:51]
B
So could you first of all, for people that don't know who you are, explain what type of doctor you are and what you do?
- [00:55]
A
Yeah, sure. So I am a cardiolo, a preventive cardiologist. I'm, I work in Los Angeles, California and I focus on heart disease prevention, cardio, metabolic health, so things like hyperlipidemia, high cholesterol, pr, what we call primary prevention, so preventing heart disease as well as secondary prevention, so taking care of patients with heart disease. I'm very interested in nutrition and cardiovascular disease. So I was actually the lead author of our latest, our nutrition and cardiovascular disease prevention statement from the American Society of Preventive Cardiology. So very also interested in the lifestyle factors for heart disease prevention as well as, you know, evidence based medicine. So do a lot about evidence based medicine and how, you know, everyone can kind of advocate for themselves to get the best care on social media.
- [01:45]
B
Nice. Since you started, have you seen an increase in heart disease? Like I see these stats online, I never know what to believe.
- [01:52]
A
But yeah. So heart disease is certainly, you know, overall we've seen, you know, a reduction in somewhat in the severity of disease. But I think that of course heart disease is still present, the number one cause of death for men and women. I would like to actually even say it's probably the number one through, you know, five and then, you know, six, seven, eight, nine, ten, that's how far off everything else is. But I think it doesn't get enough press, especially in women because you know, it's one of those things where it generally we don't see heart disease super early. So people just kind of associate it as, you know, when we're young, when you're in your 20s and you're in your 30s and things like that, you're not thinking, okay, well when I'm in my 50s or 60s, am I going to have a heart attack or stroke or the putting those things into play for prevention then. So I think that because it's a slow growing process, not always, but generally that it kind of gets put in the back burner. But yeah, I would say that there's a lot of kind of confusion about heart disease progress, prevention and about certain things that cause heart disease online. Even to this day, I always tell patients of mine that the Internet's amazing because I love when patients come to me. You know, there's some memes out there where doctors say like, your Google search doesn't equal a medical degree. I like hate phrases like that because the thing is, is that I love when patients come to me with information that they found on Tick Tock or something like that because it's important to be able to sit down with people and explain what is kind of fact. Vers fiction when it comes to that. And there's a lot of misinformation out there about heart disease.
- [03:17]
B
Well, respect for first of all embracing that because certain doctors are a bit older and they would like see that as a sign of insult. I don't know.
- [03:24]
A
And it's. So we have to meet patients where they're at. Right. Like I actually literally any of my patients were even watching this are going to be like, this is so true. I literally say to my patients if I'm starting them on a new medication or we're talking about a different test. And I always say like, if you see something on TikTok or Instagram or X that is about this that concerns you, like please bring it to me because I would love to discuss it with you. So that way they're not just feeling like they're having to sort it out.
- [03:46]
B
Yeah, I got two friends right now, they're in their 30s. Both of them just got diagnosed with heart disease. Are you seeing younger people getting it these days?
- [03:53]
A
Yeah, well, I think it's, you know, kind of twofold. So you know, when it goes into heart disease there's. It's kind of like a wide bucket when we talk about coronary artery disease. So the plaque that builds up in the heart arteries, a lot of those risk factors are not, you know, necessarily controlled, especially for people that are younger, that aren't even getting their risk factors checks, things like their cholesterol, diabetes, their blood pressure. And then of course, we have, you know, an obesity epidemic. And, and that leads to a lot of these risk factors as well. I also think we're diagnosing it not in everyone, but in a substantial amount of people earlier because now our imaging and detection's gotten much better. Now we can use things like a CT calcium score to see if someone has coronary artery disease before they even have their first heart attack and stroke. So as the diagnostics have gotten better, so has the interventions earlier and earlier. And so I think that it may be like a twofold. But what's really interesting is that even some of our best medications for heart disease, you know, when you look at the data about even the uptake, people will be prescribed them. And then we find that like, you know, 40 to 60% of people at two years aren't even compliant or taking their medication. So, so it's kind of like we have a lot of the tools for heart disease prevention, both diagnostic and early diagnosis and early intervention. But whether or not we're actually getting people to do it is kind of the tricky part.
- [05:10]
B
Interesting. Let's dive into some of these myths because obviously cholesterol is a big one.
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A
Right.
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B
I just had on Vinnie Lingham. So he produced a animal based food diet documentary.
- [05:19]
A
Oh, goodness.
- [05:20]
B
And he said his cholesterol level doubled, but he feels the healthiest he's ever felt. So I guess could you explain?
- [05:26]
A
Yeah, so first and foremost that, you know, I have to start out by saying that when people, I have empathy for people that go on a carnivore diet or any sort of diet and they feel better. Right. So if you are someone that is going on a carnivore diet because you are like feeling, you know, unwell, you, they have autoimmune disease, they have whatever GI symptoms for whatever reason, and they go on a carnivore diet and they feel better. The reason why we see that often is not because a carnivore diet's beneficial. It's because it's essentially an elimination diet. Right? So this is a very strict elimination diet in which someone is really just focusing on eating a small group of foods and probably eliminating other foods that do make them feel unwell, such as like, you know, hyper palatable processed foods and things like that. But with regards to the actual evidence. So whenever we talk about whether or not, you know, what dietary recommendation we have for patients. When we wrote our nutrition clinical practice statement, we published it in 2022. You know, we essentially, you have to synthesize multiple levels of research when you're making a nutrition guideline for, you know, the general public. Because important to know that any study and things that we look at, there is no placebo nutrition because everyone eats. So you have to look at multiple levels of evidence, ranging from small randomized controlled trials to larger prospective cohorts that are longer studies where we look at essentially the dose of an intervention or a food and then the outcome with regards to heart disease or cancer risk or things like that over time. And then once you synthesize all of these levels of evidence with research and nutrition, we can really kind of tease out, well, what is the best dietary pattern? And that never points to an all animal based diet. And so there's a few reasons for that. One is we have a tremendous amount of research that shows us that foods that are high in saturated fat can raise your LDL cholesterol. This is one of those myths that is online that, you know, LDL cholesterol doesn't cause heart disease. And that could not be further from the truth. And actually this isn't just from one study or two studies. I mean, we have decades and decades of research that shows us that LDL cholesterol and apob. Apob is the atherogenic lipoprotein that people often refer to online, that this is directly related to atherosclerosis. It's actually the only substrate required. You could have no diabetes, no hypertension, no other, no obesity. The only thing that's required to develop coronary artery disease and heart disease is elevated level of cholesterol, LDL cholesterol. And so, you know, first knowing that that fundamental part, I mean, that's just science, that's just pure science, is a truth. That's actual fact. Then we go down the lines of, okay, well, what raises cholesterol versus what lowers it. We know that foods that are high in saturated fat, like an animal based diet, raises your cholesterol, makes your risk for heart disease increase. There's also things outside of cholesterol that eating an animal based diet do. And we have research that even shows us that by reducing some things like that red meat and processed meats and things that are very high in saturated fat and replacing them with foods that are lower in saturated fat, like replacing with fatty fish or plant proteins, can actually reduce heart attack, stroke, cardiovascular mortality in as little as two years.
- [08:36]
B
Wow.
- [08:36]
A
A great study that I encourage implore your listeners to check out. It's called the Leon Heart Study. This is a tremendous randomized controlled trial. So when we look at research we have different levels of evidence. And randomized controlled trials are, you know, one of the best levels of evidence because people are randomized to an intervention versus a control arm. And in this study they randomize individuals to people. These are people who have already had a heart attack or stroke. So they were called secondary prevention. They randomize them to either being on a standard diet which included red meat, butter, some amount of fruits and vegetables versus the, the intervention arm was a Mediterranean diet that was very high in fiber from fruits, vegetables, legumes. They reduced the amount of saturated fat from red meat. They replaced it with. They had more plant protein, more poly and monounsaturated fat. They replaced butter and high fat dairy with a higher polyunsaturated fat sort of oils. They had fatty fish and they actually the study was planned to be about four years and they had to stop it early. They had to stop at about two years because there was a 50 to 70% reduction in further heart attack. And so drugs so effective that these dietary changes that they. It was unethical for it to continue.
- [09:53]
B
Wow.
- [09:53]
A
And so that's one of the things that when you look at the research, it's kind of inarguable. That's just for heart disease. When we talk about carnivore diet and things like that, when you actually look at even the cancer research, we know that, you know, cancer develops over time.
- [10:06]
B
Yeah.
- [10:07]
A
And so you can't randomize people to one diet or the other and say who develops colon cancer first? Because over two years you're not going to see that difference. This happens over decades. But when you look at the cohort data over time, we know that people who eat more red meat and don't eat enough dietary fiber from plant plant foods have a higher risk of colorectal cancer, other certain kinds of cancers. And so one of the things that I think is great is that when you look at the nutrition recommendations from all the major medical organizations, so whether it's the cardiology organizations, endocrine organizations or the cancer organizations, there's actually synergy across all of the recommendations because the same sort of dietary pattern plants predominant Mediterranean diet does not need to be exclusively plant based shows a benefit for a multitude of disease prevention. Wow.
- [10:54]
B
Mediterranean diet sounds like the move then, huh?
- [10:57]
A
Absolutely.
- [10:58]
B
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- [12:11]
A
So great question. So the reason why we kind of don't focus on eggs too much is because it's the totality of the dietary pattern that matters. So one of the reasons why even in our clinical practice statement that we included, we recommend limiting saturated fat to about less than 7% of calories ideally. And that. And the reason why we don't talk about dietary cholesterol as much is because it tracks with the saturated fat. So if someone, if the only saturated fat someone's eating is egg yolks, but the rest of their dietary pattern is low in saturated fats, high in fiber, high in poly and monounsaturated fat, then that may fit into their dietary budget where they, you know, depending on, I don't know, you know, how many egg yolks that would include, but if they tracked it, it may still fit into their kind of dietary budget for what is the best lipid Right ratio with regards to fatty acids they're eating. Um, but the. Because you're not going to. Foods that are high in cholesterol are also high in saturated fat. So that's why we tell people it's not that dietary cholesterol doesn't matter. It's just that if you just focus on lowering saturated fat first, you can kind of get there. That kind of goes into the myth that we need cholesterol. So I'm not sure if Any of your biohacker guests have mentioned that people may say that you, well, you need cholesterol, you, you have to eat cholesterol or you, you can't lower your cholesterol too much. And in cardiology, you know, we live in these two worlds where I, I'm on social media and I see what people say on social media, yet I'm very involved in academic cardiology where I go to all of our conferences, we do research, we publish papers. And in cardiology, in the world of cardiology, whether you're at the European Society of Cardiology conference that was just this weekend, or the American Heart association conference or acc, no one argues that cholesterol can never be too low. We actually, there is no floor to LDL cholesterol.
- [13:52]
B
Really.
- [13:53]
A
And that's because every cell in your body, whether it's your nose cell, your toe cell, your, the cells that make your sex hormones, can all synthesize their own cholesterol. We do not need any exogenous cholesterol. Our body makes enough and all of our cells can generate it. So there is no floor to how much cholesterol you need. But that's a, a big myth that kind of goes into this where people say, well, you need to eat the cholesterol. It's actually not true. But at the same time, people don't need to be on a completely cholesterol free diet either. You, it just, it's the total dietary pattern that matters. And so that's why we focus most on saturated fat and fiber as our dietary intervention.
- [14:31]
B
Interesting. Have you done any research on fasting? Because in the biohacking community, that's a big trend right now.
- [14:36]
A
Yeah, so that's a great question. So I used to be agnostic about fasting and that's because I used to, you know, the research has shown for years and years and years that, you know, fasting versus non fasting, you know, when you look at the randomized controlled trials in humans, because a lot of studies that biohackers cite are in mice and we're not mice. So always important for your, for your audience to know, whenever someone is claiming something in a study, look at that study. Was it in humans? Was it powered appropriately? Important.
- [15:05]
B
Do you give any. I guess if it's a mice study, does that matter to you at all? Like, in terms of, like, would you take that literally?
- [15:11]
A
Yeah. So in the evidentiary hierarchy, right, you have at the bottom, animal models. I can't tell you how many times animal models have come up with these ideas that we think are going to be really robust. And then they do not, they don't translate. They do not translate to humans. You have anecdotes. You have, my neighbor's cousin's best friend told me, x, Y or Z.
- [15:30]
B
Right?
- [15:30]
A
You know, these are the lowest forms of evidence, but for something to be clinically meaningful, it needs to be studied in humans and demonstrate a clinically meaningful outcome in humans. And so with regards to fasting, you know, we've have lots of human randomized control trials that have showed for years and years and years that there's no difference in weight management for fasting versus non fasting, no clinically significant difference in weight management. As well as the biomarkers. There's very. When calories are, you know, contained, controlled for, biomarkers don't change much. So I used to be agnostic about it. Meaning I used to say to patients, well, if you fast and it works for you, that's great. But that changed once. Actually, one of my friends, his name is Ethan Weiss, he did a randomized controlled trial at the University of UCSF called treat. And it was the largest randomized controlled trial done in humans for intermittent fasting versus just a regular three meals a day diet. And what he found was not only he found the things that we expect, which is that there was no difference in weight at the end of it. There was no difference, significant difference in any biomarkers. But the concerning thing was that in the fasting group, they lost more muscle mass.
- [16:36]
B
Really.
- [16:37]
A
And so one of the things, you know, to keep in mind is, well, muscle mass is worth its weight in gold, right? Especially as our, you know, patients get older, we want them building muscle mass, not losing it from fasting. And so I no longer am agnostic about it. Now I would say, listen, it's a benefit risk discussion, right? If someone feels really good in fasting and it works for them, great. But they should be, you know, making sure that they're not losing muscle mass. But if someone just comes to me and says, I have no dog in this fight, I heard that fasting's great, I would just give them the evidence and say, listen, the evidence shows it's not that it's not more beneficial than just general caloric restriction and there's this potential that it could make you reduce muscle mass.
- [17:19]
B
Because I've seen some crazy graphics about fasting. I'm sure you have to about like how 72 hours in or kill cancer cells and stuff like that.
- [17:26]
A
Yeah. So there is, you know, people will use like extrapolate biomarkers for X, Y or Z that and extrapolate that to like, hard outcomes. But there isn't anything that's like really significant and robust in clinical trials with hard outcomes that are like, sustained. That makes, you know, a difference. Which is why the, all of the cancer society, so if you follow, you know, any of the oncologists and the major guidelines that go into like dietary recommendations for cancer patients, it's actually a more of a plant predominant Mediterranean diet, which can look many ways too, by the way. Like, whenever I say Mediterranean diet, people think like, oh, like it's like an exact dietary pattern. There's actually a lot of room within a healthy dietary pattern. You could be on a truly. You could be on a low carb plant, predominantly Mediterranean diet. You could be on a high carb plant, predominant Mediterranean diet. There's a lot of ways to do it, but the, the same principles apply. We do see a reduction over time in incidence of certain kinds of cancers for people who eat a higher fiber plant predominant diet that's lower in saturated fat. But yeah, with regards to fasting, you know, a lot of those things that are in 72, 24 hours, things like that, those short biomarkers do not translate into actual whole heart outcomes like a reduction in incidence of cancer. Wow. And there's even fasting. You know, there's anecdotes of fasting and people having like a tumor shrink, but then as soon as people reintroduce eating, their tumor size may change. So these anecdotes and go back up, you know. So these anecdotes for fasting are just that, they're anecdotes. And, and I think one thing for your audience to understand is people will say, why are you so obsessed with the levels of evidence and things like that? And it's because it's confusing, right, for patients to know, well, do I trust. Do I trust your. Your recommendations, which are based on multiple levels of evidence, or do I trust the anecdote or something that's worked for. You know, my cousin, my neighbor and I always use this example. I have a wonderful patient. He allows me to, to tell this story, but he is a patient with coronary artery disease. And he actually tells me that when he puts his left shoe on in the morning, first, every day he puts his left shoe on first, he gets no chest pain. But the days he puts his right shoe on first, he always gets chest pain. What kind of doctor would I be if I took that anecdote and I told all my patients with coronary artery disease, you now should be putting your right shoe on first every day. And I know that sounds ridiculous, but that's what these anecdotes are, right? Even if someone makes it sound sciencier than that. That's why anecdotes are just, you know, anecdotes inform ideas and hypotheses to study in a study. Right. So you're seeing multiple anecdotes that may form a randomized control trial. But am I going to take my patient's anecdote about putting his left shoe on first and design a randomized controlled trial about putting patients with coronary artery disease put their left shoe on first versus their right shoe? Likely not. Yeah, but that's what an anecdote is. And that's why it is important to kind of understand. I always go back to understanding the levels of evidence and for people to listen and who are listening, who are interested in really knowing what kind of studies are being put before them. Because you can actually use this tool, understanding evidence based medicine. Any person listening can arm themselves with this information and it can apply to anything. It could apply to, you hear something about, you know, cancer or heart disease or dermatology or, you know, any sort of area of science because the standards of evidence based medicine are consistent across the board.
- [20:45]
B
That makes sense. I'd love to see you on a Jubilee one on 20 debate.
- [20:48]
A
Oh, no, see, I can't. I don't think I could handle it.
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B
You don't think so?
- [20:51]
A
I'd be a little too.
- [20:52]
B
Dr. Mike did well in his.
- [20:53]
A
He did great.
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B
I got to give it to him.
- [20:55]
A
He did amazing. I give him so much credit. He's just who stayed very patient. I would, I would get a little, a little, a little shy.
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B
I think the anti vaxxers are growing in numbers. It seems like these days.
- [21:04]
A
It's growing. And I think that, I think that a part of that is that there's some reasonable distrust in the medical community.
- [21:10]
B
Right.
- [21:10]
A
I think that alternative medicine and things like in this space, the reason why all of these people take off, I think in, you know, a lot of the biohacking and a lot of the reason why a lot of this takes off is in general is because people are looking for health. I think that everyone's looking for health and wellness and happiness and wants the same thing. And I think that there's a lot of distrust in our medical system and some of it's for very good reason. And so I would never gaslight someone to say, you know, someone that found Some like holistic X, Y or Z situation and started to believe it because a lot of times people are pushed towards these alternative pathways because they feel they're not heard by the traditional medical system. They feel like they've been ignored, they're still having symptoms. And so I think that generally this medical complex which I am a part of is partially to blame. Right. There is distrust that's earned. At the same time, it's tricky because even though, you know, overall we're trying to, I think most doctors are trying to do the best on their daily basis. That doesn't mean just because something, you know, someone has had one individual, you know, poor experience that, that the person who's coming to sell you their supplement or telling you not to take the vaccine but then take their X, Y or Z by link in bio, by my, you know, course for whatever it is.
- [22:29]
B
Yeah.
- [22:29]
A
Is also going to be giving you, you know, that doesn't mean that that's the solution either. So I, that's why I focus a lot of my social media on people understanding evidence based medicine. So that way they can actually use that critical, the same critical eye that they use for vaccines which may or may not be reasonable depending on what their concern is. They use that critical eye for every single thing else for the supplements that are being sold, for the nutrition plan that's being sold to them, use that same critical lens for everything and make it consistent. And they oftentimes once people bring that into their repertoire, they end up coming back kinds of towards the guidelines and the evidence based medicine hierarchy that, you know, which was what makes science what it is today.
- [23:09]
B
I also think price is a factor for a lot of people. Like I'd imagine affording your services is not cheap for the average family.
- [23:15]
A
Yes. And so the thing is, is that there's, you know, of course there are physicians, so I happen to be, you know, in my own private practice. But there's of course amazing physicians who are in network with insurance. And so I think that, you know, it depends, I think that there's plenty of doctors. I mean all of our major medical systems take all insurances. And so there's plenty of good physicians that are, I think, available. But, but it is a little bit of trial and error because in the same health system you could find 10 doctors who, you know, someone may not feel heard by someone who feels like that they're not getting, being listened to. And that dismissiveness can unfortunately, I think, push people towards alternative, you know, kind of pathways. That's why I think it's so important for people to. I think it's like dating. People need to do trial and error. If you find a doctor that's not listening to you or you don't feel heard, it doesn't mean that you need to just go sit down, start listening to, you know, a random person who's spouting stuff on social media. I would say find a second opinion, find a third opinion. You know, find a doctor that you feel heard from, that you feel listened to, and that can actually go through the evidence.
- [24:18]
B
Yeah. And you are preventative, which I love, by the way. Is it true that most insurance companies won't cover preventative stuff?
- [24:24]
A
Yeah, so, you know, it is. It's just the insurance, like, structure is really kind of screwed up with regards to the way, you know, people always think that doctors are the demons in the process, or even pharma is the demon in the process. But, you know, in, in. In reality, I would think most physicians would agree that across the board that insurance companies are really the ones that have gatekeeped most of health. And that's because a lot of insurance reimbursement. One of the reasons why I am out of network with insurance is that a lot of insurance reimbursement is just strictly based on procedural things. Ordering more tests, doing more things, rather than focusing on the things like diet, exercise, nutrition. The things that we know that really work, that doctors would love to counsel their patients on, but that when you are in this like, RVU insurance kind of setup, you're limiting your time. You may have to see six patients or five patients an hour, and you're kind of just putting out fires rather than being able to focus on prevention. I think that every doctor in, you know, across America would really wish that prevention would be more of a focus. And that's, you know, really out of our hands. In many ways, it's a lot of it's dictated by insurance. And even when you do, you know, need a medication for patients, uh, cause, you know, even for me, when I'm prescribing medications that patients need based on guideline, you know, indicated reasons that they'll benefit, they'll have mortality benefit from, we're still fighting insurance tooth and nail to get those medications covered, really. Um, and so the system. That's why, you know, I think the important point is, is that the system as a whole is not perfect. And so I don't even blame people for looking for alternate pathways. But I guess it's. It's tricky because, you know, at the same time, I want to say that our system is not perfect and, and we certainly have a lot of work to do, but it doesn't mean that that person selling you like $1,000 worth of supplements is the right pathway either.
- [26:06]
B
You know what I mean? I saw you say on the show 99% of supplements are expensive urine.
- [26:10]
A
Well, so, yeah, so I, you know, my, my quote that I've been quoting in quite a bit is that I say, like, you know, 99% of supplements are either expensive urine at best, or end organ damage, so kidney liver damage or worse. So the truth is, is that outside of deficiency. So outside of a diagnosed deficiency. So if you have a diagnosed B12 deficiency or a vitamin D deficiency, outside of a guideline indication, so this is folic acid for women of childbearing age, vitamin D. If you live in a certain zone, so a certain region, there are certain guideline indications for certain supplements. But outside of deficiency, most supplements are expensive urine at best. So at the best case scenario, it's not going to cause harm. So one of the top reasons why probably any physician like myself in California sees abnormal liver enzymes is because someone's on a new supplement that causes them to have elevated amino transferases. Their, their LFTs are abnormal or their kidney functions abnormal due to a supplement. That's why, you know, one of the first things I ask new patients is what supplements are you on as well, because it interacts with medications and things like that. And one of the greatest examples of, uh, you know, cause sometimes the counter argument to that will be, well, pharma just doesn't want these supplements to work, right? So they, they aren't going to study, you know, X, Y or Z because they don't want to make money off of it. But one of the best examples for why that's not true is fish oil. So fish oil. Pharmaceutical companies, huge pharmaceutical companies have spent gazillions of dollars studying fish oil. So much money studying fish oil, which has failed. You know, every single randomized controlled trial to show any random robust outcomes, you know, eating fatty fish is incredibly healthy. But once you make it into a fish oil supplement, they've done dha only dha, EPA combos, you know, all of them. These clinical trials have failed with the exception of one, which is called icosapent ethyl, which is a specific kind of EPA only fish oil. And it's only beneficial for a very small segment of the population. So it's people with either diabetes or high triglycerides with, you know, for coronary artery Disease prevention, but otherwise. So pharma has tried to make it happen. Like that mean girl thing, like, stop trying to make fetch happen. Right. Like they've tried to make fish oil happen. And so trust me, if there was a signal that berberine or turmeric was beneficial for in, you know, insert X, Y or Z claim, pharmaceutical companies would be on it, they'd be studying it, which they do. You know, they look at the preliminary research and they decide, is there a signal for this? And they, and it would, it would come to market if it worked. But that's the thing about supplements, is that, you know, you don't need to make any sort, you don't have to have any data to make a claim because it will literally say this is not evaluated by the Food Drug Administration for any sort of claim that you make. But you can make. You know, it's a multi trillion dollar industry. And, and so it, it, it's huge industry.
- [29:00]
B
Yeah, I've fallen victim to it. They make them in India, they make them in China. There's no quality control. I tried the Brian Johnson stack, I tried taking 30 a day. It was the worst I've felt. I've tried taking the beef liver. I felt terrible. I think it was from Paul Saladino's company, actually.
- [29:14]
A
Yeah. You know, one of the things too, I think that's interesting is that it's not to say that I'm not here as a, you know, a representative from pharma, as you and I were talking earlier.
- [29:23]
B
No.
- [29:23]
A
Is that you can actually look up any doctor online. You Google Sunshine act, there is a website where you can put in the doctor's name, you can see how much money they've taken from pharma. You will see that I've taken zero. And so I'm not here, you know, just shilling for pharma by any means. I do not take money from any pharmaceutical companies. But I'm actually a huge fan of diet and lifestyle and that's why I was the lead author of our nutrition clinical practice statement. Because nutrition and lifestyle, the things that actually work. We have, we have actual evidence that shows us that exercise, that strength training, that cardio, that eating a healthy, well balanced, you know, Mediterranean plant predominant diet, which can look many different ways. We have true evidence with hard outcomes showing that it helps prevent dementia, prevents, you know, frailty as we age, helps to prevent heart disease and stroke and erectile dysfunction. We actually even published a paper on the lifestyle interventions for erectile dysfunction showing that the vast, the vast amount of erectile Dysfunctions related to underlying vascular disease and that can be used, know, prevented or improved through dietary and lifestyle interventions. These things someone cannot sell you. Right. So that's why I cannot sell you a diet per se, you know, because these are things that are just in our guidelines. And so no one can market this off of you. It's just the diet and lifestyle things that we know through the science for years that are incredibly beneficial. But supplements kind of lead to an area where people feel like they can pay for something that may make a claim for it being beneficial. When in reality the stuff that really is truly demonstrating the science to be beneficial are the stuff that is actually free information that's out there.
- [30:57]
B
Yeah. I'm still shocked at the fish oil one because first of all, it tastes like shit. So people are eating that they can, they're helping themselves.
- [31:03]
A
Right. Actually, I'm more if it was just benign fish oil in general. And this is keeping in mind, this does not include the one FDA approved fish oil that we do sometimes use for high triglycerides and cardiology. That's Icosa Pent Ethyl. But outside of that. So for the general person buying fish oil, if it was just benign, I would say, listen, if it's, if someone's taking something that's generally benign, that's a supplement that's not going to do anything, I wouldn't worry. But we have data after study after study that shows us that fish oil, there's people who take fish oil, there's an increased signal for something called atrial fibrillation. This is an arrhythmia that can cause stroke.
- [31:35]
B
Chase.
- [31:36]
A
And so you're trading if it had, you know, whenever you're discussing anything with patients, whether it's a medication, whether it's to take a medication versus not taking a medication, whether it's to do a test versus not do a test, whatever the intervention is, you always have to have a benefit risk discussion. There's always going to be benefits and risks. If there is no benefit in all of these trials for just taking over the counter fish oil of any kind, then why take the risk of getting an arrhythmia that causes stroke?
- [32:02]
B
Yeah, the risk to reward's not there for me.
- [32:03]
A
Right.
- [32:04]
B
Yeah. With the whole statin debate.
- [32:06]
A
Right.
- [32:07]
B
I'm sure you see that online. What do you think of that?
- [32:09]
A
Yeah. So this is so. It's so interesting because I feel like I live in two worlds. I see the Internet and then, you know, actual academic cardiology and what we discuss. And there is no Debate about statins being beneficial and the thousands of cardiologists across the world, we have so much tremendous data for showing they have tremendous mortality benefit. I wish that one of the biohackers would actually just start spreading the rumor that statins are like the ultimate longevity drug, because that would be the best thing that they could do. But unfortunately, here's the problem. Statins are generic. They cost $4. And so no companies are making a ton of money off of statins. Right. And so there's no company paying to market them. Right. And they're genetic, they're, they're low cost. So the only people that are really defending them are the physicians that know and the scientists that know that they reduce heart attack and stroke risk. They're incredibly beneficial in the populations for which that they're prescribed. But you're kind of fighting an uphill battle, right, because someone will sell you, someone can make money selling you a supplement that they claim is going to help your cholesterol. But you know, they're not able to make money off of this generic $4 statin. So they're incredibly beneficial. And a lot of the fear mongering on those medications about them is, is really disheartening because they're really preventive. I recently saw a patient, little heartbreaking, in his early 40s who has had high cholesterol for quite a while. He's done the carnivore diet, he has done the keto diet, he's done various different dietary patterns. Plus he had baseline high cholesterol, no diabetes, no heart disease. And so when he did my intake before he came to see me, he had, you know, had a whole list of supplements, no medications. But I was curious in my, in my mind, okay, I wonder why specifically he came to see me because I would think that I wouldn't be the right fit for him. Someone that he would be necessarily interested in hearing my take, knowing that I always mention guideline directive medical therapy. He came to see me because he got a calcium score done, which is a CT scan, and it showed his calcium score was over 1300, which is very high. So I sent him for a diagnostic coronary angiogram. He has over a 95 occlusion of his left main coronary artery and triple vessel coronary disease. Without a bypass surgery, he will die.
- [34:21]
B
Holy cross.
- [34:22]
A
Five years with, I mean, maybe even sooner, maybe in the next two years, he will die. Without guideline directed medical therapy, he will die. And so why my heart breaks for him is because he's been completely misled for years about the dangers of statins and why you should be on X, Y or Z supplement and why you should be doing the carnivore diet and why LDL cholesterol doesn't matter. And at the end of the day, those are the patients that sit in front of me in my office that I have to be having this discussion, discussion about their mortality. And the people who are selling this misinformation are never held accountable. And they are not the ones that are in the room with this individual that's in their 40s that's supposed to have 60 years of amazing life yet left, but yet they may be staring down the barrel of a shortened life expectancy now, thankfully, because of guideline directed medical therapy and procedures. I know that if, you know, he gets his bypass surgery and if we get him on the right medications and very aggressive, he, he can live a long and healthy life. But why did he get there in the first place? And it's not his fault. The purveyors of misinformation are the ones who are to blame, not the people who are the innocent bystanders, the consumers of it. They are not to blame at all.
- [35:34]
B
That's horrible. So in the future, do you want to see some sort of, I guess, social media regulation when it comes to those that are giving medical advice?
- [35:40]
A
You know, I think it's tricky, right? It's so tricky. I actually don't even. I actually think that's a great philosophical discussion that I actually don't even think I'm equipped for because I don't know what the right answer is. Is regulating information. Then who's the, who's the correct. Who's the, like, arbitrator? Right. You know, I'm not sure. Like, you know, there's people at major academic medical centers who, you know, have spread misinformation too. So it's kind of tricky because once we start limiting or regulating information, I think that that makes it tricky too. I think that there should be a lot more education across the population starting in school. But truthfully, even in adults, on learning what science is, on learning what evidence based medicine is, people should be able to arm themselves with understanding. Okay, if this person's making this claim, what, what study is that coming from? Oh, it's a rat study, It's a fruit fly study. Okay, is this something I'm going to integrate into my life? View every intervention that you do, whether it's a supplement, it's not benign just because it's a supplement. View every intervention Whether it's a medication or a supplement. The benefits versus risks. What are the known benefits documented in a randomized control trial in humans versus the. The risks? You know, these are things that are important. I think that education, I think, is more valuable than censoring because the information is always going to be out there. And so I just. I think that once you get into the censoring arena, it's kind of its own mess.
- [37:00]
B
I'm with you on that. You know, the crazy part is how fast information spreads these days. So let's take an example. Like if RFK goes on Joe Rogan, it gets 10 million views. Each person goes home and tells their family not to get the vaccine. The whole country just heard what RFK had to say about it.
- [37:13]
A
It's tough.
- [37:14]
B
It's crazy, right?
- [37:14]
A
It's crazy. It's tough. And I think that the. The issue is, is that, you know, we're kind of in a place where I think there's so many benefits of the Internet and of social media and being able to find really good information. I've literally had people who have found me who said, I refuse to take a statin for 10 years. And then I started following you, and you post all the trials and all the information, and now I'm finally taking it, and you've saved my life. And, you know, all these things. But at the same time, bad misinformation travels fast, too. This is actually my pitch for people who are in science, doctors that are younger, that are coming out, to try to have a presence on social media to some degree. I think that it's almost like, you know, people will say, why do you. Why do you even care to, you know, debate people or be on social media about it? And it's because, to me, I'm the only doctor in my family. I'm the first and only doctor in my family. And I used to not really bother or care about misinformation because I would say, listen, that's not affecting me.
- [38:07]
B
Yeah.
- [38:07]
A
And then my niece was diagnosed with leukemia when she was five. And being the only doctor in my family, I was helping to triage a lot for my niece. And I remember seeing, even though my sister and her husband are incredibly intelligent, I remember seeing them get, like, kind of swarmed with a lot of misinformation for pediatric cancer. Take this supplement, eat this diet, do this X, Y or Z for people to prey on kids with cancer and their families is so sick. Right. My niece is now five years out of remission, doing amazing. And why is that she was treated with guideline directed medical therapy through a pediatric, you know, cancer hospital that treated her with the correct medications, that had the randomized control trials that went into it. And after that I thought like, man, thinking of how lucky I am that I am my sister's sister and that I was able to like, help guide them through this. But how many people exist out there that are just looking for health solutions? They're just like anyone else. There are people that are just looking for answers. And then you have someone that comes up to you and says, I have the answer. You can buy it, link in bio, 10% off. You know, it's, it's, it's tricky. And so since then, I felt like I really would hope that, you know, as many doctors that understand evidence based medicine, because that's a caveat too. Just someone having an MD after their name. Paul Saladino exists. Hey Paul, if you're listening to, you know, they're out there still spreading tons of misinformation too. And that is of course called authority bias. And so, yeah, learning philosophy, learning debate, learning a lot of these things can, can really help people to understand what's behind what someone's saying too.
- [39:39]
B
I agree. I think more of you should get on social media because I have on a lot of biohackers and it's hard to find their counterparts, to be honest. Like, it's easy to find a biohacker. I could scroll on my feet right now and find five.
- [39:48]
A
Right.
- [39:48]
B
You know what I mean? But you're, you're a rare breed.
- [39:50]
A
Well, I, I'm happy to debate anyone. Dave Asprey, if you're listening, happy to debate you. I, I, a lot of times, Paul, you know, Paul Saladino was going to debate me on Dr. Mike's podcast and then he backed out. I'm happy to debate any of them because if we want to just talk about the science, I'd be happy. Let's, let's talk about the randomized control trials. Let's talk about the mechanistic studies that you, you know, claim to back your claims. And oftentimes they back out and they say no. And I think that, you know, we should all be able to stay on the science. And, and I think one other important thing to do to, to explain too is that when your listeners are saying, oh, you're just, you know, part of this industrial complex, I think it's really important. Not until I started to get involved in the, you know, the, from the academic level, seeing what goes into actual medical guidelines, there's actually a, you know, there's no one decision maker of, like, what is the truth in science? When scientific consensus from major medical organizations like the American Heart association, the American College of Cardiology, the American Society of Preventive Cardiology, you know, the American College of Gastroenterology, any disease process, you can name their major medical organization. When guidelines come into play, there's actually a huge clause with regards to conflicts of interest. So at least 51% of people on any guideline committee have to have zero COIs, no money from pharma. And then there's a debate that goes on about the different levels of evidence. It's graded in a systematic and rigorous way. And then that's how you come to your conclusions for people's, you know, recommendations for a certain disease process and what the recommendation is, whether it's diet, et cetera. You know, the problem is, is that you can have people that are selling supplements. There is no Sunshine act equivalent. Right. How much is that person making from selling a gazillion dollars worth of sales?
- [41:35]
B
Liver King made a lot of tons.
- [41:37]
A
Right. And. And based on what evidence? Right. So, you know, I think the same way people reasonably question doctors, they should be questioning also these.
- [41:45]
B
That's a valid take. There should be some more, I don't know, disclaimer or something.
- [41:49]
A
And there's, you know, there's, there's, you know, there's. And I'm selling nothing. You know, I'm just here out of.
- [41:56]
B
I'm trying to help people.
- [41:57]
A
I. I just truly believe that this is. And by helping people, I think it's just empowering people to actually, you know, you know, when people say the one thing I always get back is do your own research. Well, I do do research. I publish research. I do research. And I think people should be doing their research. Use the same critical lens you use for every person that you follow who's making a recommendation, what is that based on? Yeah, is there going to be more benefits than risks? Has this even been studied? Do you want to be the guinea pig? You know, that's a question. Some people may say, yes, I do want to be the guinea pig. That's fine. You know, I think that it's just. It's too much and too often that people are just kind of pulled in but not thinking critically enough about it.
- [42:35]
B
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- [43:47]
A
Oh, and this is the other thing too too, is that there's like, you know, there's even physicians. I see. This is like one thing I kind of. Your, your listeners may find this boring, but one thing I think is incredibly important is the understanding what's called critical scientific appraisal. This is a lifetime process, right? Not everyone is going to spend their career working on learning critical scientific appraisal. This means being able to look at a research study and saying, does it? Is it a valid research study? Is it a valid research design? Are the methods done well? Is it statistically power to show you the endpoint that it is? I do not expect all of my Instagram followers or anyone that's, you know, listens to this podcast to be able to do that critical appraisal. That's actually what guidelines are, right? Guidelines are people that actually do this for a living evaluate research and can evaluate and say, does this end up in a clinically meaningful endpoint that we care about? Is it power appropriately? Is it designed correctly? The reason why that's so important is because there you can find on PubMed a study that will support absolutely anything in the abstract. The most important part of a research study is the methods. If it starts with mouse and you are about to buy a supplement, throw it away. If it's a randomized controlled trial and 12 people, throw it away. You know, there's just things that I, I just think people should feel empowered to learn. You know, Ask ChatGPT even tell you, how do I become better at Critical scientific appraisal. And then how do you evaluate this lens of, you know, every single headline you see or every claim through the lens of, well, is that actually good science?
- [45:14]
B
Yeah. What do you think of people that ask ChatGPT for health advice, medical advice?
- [45:18]
A
So I would say, you know, I actually am a huge proponent. I think there's some people that are like scared of AI and things like that. I think that if you are, you know, terrified of AI, then you are going to be left behind. You know, AI is going to be a part of our future no matter what. But I think that we have to at this time, I think, really agree that the enthusiasm is outpacing the evidence. I have was an early adopter and still am of ChatGPT. I pay the highest price for ChatGPT Pro, the maximum you can for the model. I love it, I think it's great. But it's got limitations. And for example, I'll tell you the limitations that I've noticed on a daily basis. When I use it for some like certain things I use it for more of like sometimes some grammar correction and, and some like generating a paragraph for a patient, patient packet and things like that. But where I started to see it was constantly off was when I was asking it, you know, I was like having it give me like a differential diagnosis for something like high calcium or something like that. And it was completely wrong. And then I realized, wait, wait, ChatGPT is constantly getting things wrong. I realized I can only now use ChatGPT for things that are within my expertise because I can immediately tell when it's within my expertise that it's hallucinating, it's making up citations, it is literally making up facts. And so when I consider it now to be like a fourth year college student applying to med school, that's working for me. That's like the level at which it is like it can kind of gather some information. Sometimes it makes some of it up. Not even quite a med student yet. Sometimes it makes stuff up, but I can, I know when it's making things up because it's my area of expertise. I wouldn't dare use ChatGPT for endocrinology or oncology or things that are outside of my area of expertise because it is wrong. So often even open evidence, which is a AI that is created for doctors. I mean you can go on open evidence and say, what, what should I take for a detox? Every physician knows there's no such thing as a detox. That's a made up thing. Our Livers and. Our livers and kidneys detox.
- [47:12]
B
So when you see, like the parasite cleanse videos and completely made up.
- [47:15]
A
Right. So our livers and kidneys detox themselves. If you need something to detoxify you more than your kidneys, you need dialysis. Right. So that is not. There is no such thing as a detox that is built into our bodies.
- [47:28]
B
People sell these kidney cleanses, these colon cleanses.
- [47:30]
A
Absolutely. And it's, you know, it's completely, completely just made up.
- [47:33]
B
Coffee enemas.
- [47:34]
A
Coffee enemas. And we can go into how dangerous the colonics are and all those things that you can perforate your colon. But these detoxes are made up. Right. But you could ask open evidence, what do I need to. What herbs should I take to detox? And it'll give you a bunch of PubMed studies that are trash. Because here's the thing. Just because something's published and peer reviewed, we have plenty of predatory journals out there. That's the other issue. We have predatory journals out there that are. When I see a study from some of these journals, I literally roll my eyes. It's a journal that just publishes predatory information by predatory scientists that make things up. And so it's. It's kind of like just because it's on PubMed doesn't mean.
- [48:12]
B
Right. Because you could frame a study how you want, right?
- [48:15]
A
Oh, 100%. And you can, you know, and when it's in a very predatory journal, you know, it's. The peer review is done by predatory scientists. So it's kind of like it feeds into its own little machine. And so that's why the critical scientific appraisal portion is. Is so important. Right. Even knowing what a good study is. And that's why I'm not saying everyone has to be able to do that, but that's the reason why I always say rely on guidelines. Like, for example, for women that are, you know, trying to have a baby or they're in. They're going through infertility or women that are going through menopause, you can go through the guidelines for the American College of Obstetrics and Gynecology, the Menopause Society, and you can see, well, what are the people whose entire lives are spent doing critical scientific appraisal? What have they valued in the evidence that I should be doing as the next step? You can do this for blood pressure, for cholesterol, for any disease process. Ibd, the American College of Gastroenterology, has guidelines as well. And so it's kind of a Safeguard against. Yes. You yourself don't have to become a critical scientific appraisal expert. I am in a lifelong process of getting better and better at it, and it's a lifelong journey. But at the same time, it's. It's a guardrail to be able to say, well, wait, so if I have high blood pressure and then this person that I'm following online, or even if the doctor you're seeing was like, take this supplement. For it, you could go to the American Heart association guidelines, the ACC AHA Guidelines, and see hypertension.
- [49:33]
B
What.
- [49:33]
A
What are the first line recommendations? First line recommendation is diet and exercise. Even though people want to say doctors only want to prescribe drugs. First line recommendation in every cardiology guideline for primary and secondary prevention of heart disease, for cholesterol, for hypertension is diet and exercise, get good sleep, sleep, social, you know, interaction, community. These are all in our guidelines. But then after that they have the different, you know, first, second line, third line medications. And so it's a guardrail, because otherwise, you know, you have 10 people selling you a detox or a cleanse. And the parasite cleanse is the funniest thing about the parasite stuff. Okay? When I started to see all this parasite stuff online, I was like, where. Where did I. I did to become a cardiologist. I do four years of med school, three years of internal medicine residency, and three years of cardiology fellowship. And I was like, how, in 10 years of medical training had I not seen any parasite infections, literally. But we have such a preponderance of them that we're selling parasite cleanses online now. And I was like, this is so ridiculous. I was talking to one of my friends who's actually an infectious disease physician at Emory, and she was cracking up because she's like, it's obviously all a ridiculous scam, right? Like, it's not. It's not that parasites don't exist. Of course parasites exist. People can have a true parasite infection that they got from traveling abroad, they got from a certain area that is treated with a medication. Right.
- [50:49]
B
For.
- [50:50]
A
Specifically for that parasite. But what's so funny about these parasite cleanses is that a lot of them have, like, inulin fiber in them or they have, like, certain fiber in them. So it actually makes your bowel movement, not to be tmi, but it makes the individual's bowel movement look stringy afterwards. So they think that they are excreting out the.
- [51:07]
B
No way.
- [51:08]
A
It's such a scam.
- [51:09]
B
What? Because I've seen those videos.
- [51:11]
A
Yeah. It's such A scam. So it's literally like the inulin fiber or the psyllium husk or whatever they put into these cleanses that. That makes them think that they are excreting out the parasite when it's literally just what they. What they took in.
- [51:25]
B
That is madness.
- [51:26]
A
And then why is this confusing for people? Well, Mark Hyman, like one of the biggest purveyors of misinformation, sells tons of supplements for things like adrenal fatigue. The Endocrine Society literally came out with a statement saying adrenal fatigue is not real. Okay. People who have symptoms of adrenal fatigue, these are like, very vague kind of. They feel tired, they feel brain fog. I always say, just because your symptoms are real, your symptoms are real, it does not mean we need to make up a diagnosis for that. We just may not be able to put exactly what you're feeling into a bucket. But the solution to that is not making up a diagnosis and then selling you something. And that is what Mark Hyman does. And he's affiliated with Cleveland Clinic. So why is this so confusing? Because our own system perpetuates it. Right. And so he sells detoxes, adrenal fatigue supplements, things for diseases that we literally know do not exist.
- [52:17]
B
Yeah.
- [52:17]
A
And so, you know, it's. It's everywhere.
- [52:20]
B
Would you consider Andrew Huberman evidence based?
- [52:23]
A
I would say that, you know, a broken clock is right twice a day, and he is right sometimes, and he's wrong quite a lot. And I think that he promotes a lot of things that have absolutely no evidence.
- [52:34]
B
Wow. Because he's the number one health podcast, I believe.
- [52:37]
A
Absolutely. And I think that, you know, it's one of those things where he is right sometimes. And that's like almost the most tricky misinformation when people are right sometimes. Right. They tell you eating a healthy diet's beneficial. Oh, they're right about that. They tell you sleeping well is beneficial. Wow. They're right about that, too. They can't be all wrong. Right. It's easy for everyone to know Paul Saladino is wrong. But, like, it's really. It's tough with people like Andrew. Andrew Huberman, because he will say some things that are right. Having good relationships is really important. Having a healthy, you know, working on your mental health is important. But then he has things that are completely, you know, off the mark. He markets supplements that are not beneficial. Athletic greens is one of them. There's no benefit to eating a green powder when we know that the benefit is truly in things like eating fruits and vegetables. Themselves. Right. There's no data that that's going to reduce cardiovascular mortality, things like that. He has, you know, been off about quite a lot of things like various different things about cholesterol and things about, you know, sodium intake before. So I just, I think that in general people are allowed to be wrong sometimes, but there's a pattern recognition matters and. Yeah, and so I think that it's tough because the, the real science unfortunately is not super sexy and sellable.
- [53:52]
B
Yeah, it doesn't get as many views.
- [53:53]
A
It's not, it's not as super sexy and sellable for me to tell your audience, go to the American College of Cardiology website, take a look at our guidelines and see that they recommend getting good sleep, sleep, exercising, doing cardio, doing strength training, eating healthy, Mediterranean diet, because that information is free.
- [54:10]
B
So when you say Dave Osprey saying going to the gym is a waste of time and he hasn't worked out in 10 years, that's terrible advice in your opinion.
- [54:16]
A
Right? I didn't even know that. I was just talking about his terrible advice about cholesterol and saturated fat. I didn't even know that that was a new thing.
- [54:21]
B
Yeah, he doesn't go to the gym anymore.
- [54:22]
A
I mean, that is, you know, obviously so against the science. You know, all of our hovers, all of our scientific information tells us that being active is very beneficial. A mix of cardiovascular training and strength training is beneficial, helps with reducing frailty as, you know, as individuals age. Building lean muscle reduces risk for heart disease, cancer, diabetes. So yes, that's just added to the list of the things he's incorrect about because his idea about saturated fat and, you know, cholesterol is been completely wrong forever. Him and I have gone a little bit back and forth on, on X when it was Twitter about it, but, you know, it's, it's tricky though, because they get these cult late followings and I sometimes think that people take it personally when you try to give them the actual science, which is why I say even to your, your listeners don't actually listen to me. I don't even want you to just take what I say as, as correct. Just use the framework in which I mentioned by looking at the science that they are making a claim next time Andrew Huberman says this, is that based on a study in humans that was powered appropriately, that shows more benefit than risk? Is it a clean, clinically meaningful endpoint? And answer that question for yourself because I think that that at the end of the day is going to get more people to change their minds than just saying to them, no, you have to listen to a different authority. You know what I mean? Although at the same time, I say that, you know, even though heart disease develops, generally we see it, you know, when people are in their 40s and 50s and things like that, you know, I don't love being the person to diagnose someone with triple vessel coronary artery disease that needs a bypass surgery that could die knowing that this is so preventable. When I tell you heart disease should not exist. Actually, really, absolutely not. So coronary artery disease should not exist. We live in an era where we know the risk factors for developing coronary artery disease. And the best news is that the same risk factors for coronary artery disease, so high blood pressure, high cholesterol, LDL cholesterol, apob, high lipoprotein A, elevated blood sugar, diabetes, obesity. We know that these risk factors cause not only the vast majority of coronary artery disease, but also the vast majority of dementia, the vast majority of heart attack and stroke. So by preventing just one, you can prevent a plethora of things that not only just reduce the length of time you're on earth, but also the quality of life you have while you're alive. And it shouldn't. Coronary artery disease should not exist. People that are young, you know, if they get screened appropriately, they're treated appropriately, need not develop plaque. You can only develop cholesterol in your arteries, you know, through having your LDL cholesterol above a certain threshold. And we can, you know, evaluate and treat that. Additionally, erectile dysfunction, as I mentioned, if anything younger people may listen to is that the vast majority of erectile dysfunction. We published a research paper on this, and the vast majority of ED is actually, we call it the canary in the coal mine for cardiovascular disease. It is the first sign that someone may have outside of a. Outside of it being psychogenic, there may be some underlying vascular disease because the same way the vessels in the coronary arteries develop plaque buildup, or the same way the tiny vessels that go to the genitals develop plaque buildup and lead to ed. What is Viagra doing? It is a vaso. It's dilating the arteries to increase blood flow. That is why the same dietary changes we recommend for cardiovascular disease prevention may also help with ED and preventing and as well as improving, you know, and so it's tough, though, because there's. You want to get people in before they develop coronary artery disease. And when people are younger, they sometimes just feel like that's not going to happen, right?
- [58:00]
B
Dr. Danielle, thanks for your time. First of all, I learned a lot. I hope the next time I see you is in a debate setting.
- [58:04]
A
That'd be great.
- [58:04]
B
That'd be great. Where could people find you, like, learn from you and become a client if needed?
- [58:09]
A
Yeah. So I'm on Instagram at Danielle Bilardomd. I'm on x D Velardo, MD, and not really on Facebook much, but.
- [58:18]
B
Awesome. We'll link below. Thanks for your time.
- [58:19]
A
Thanks so much.
- [58:19]
B
Yep. Check her out, guys. See you next time. Peace. I hope you guys are enjoying the show. Please don't forget to like and subscribe. It helps the show a lot with the algorithm. Thank you.