← The Dylan Gemelli Podcast
The Dylan Gemelli Podcast
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!
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- [00:17]
Sponsor/Host Dylan
Creatine, one of the most proven and
- [00:20]
Dylan Gelli
studied compounds in existence, yet still one of the most confusing.
- [00:24]
Sponsor/Host Dylan
Most people think creatine is only for muscle, but creatine is for energy. Not caffeine type energy. Actual cellular energy, the kind that your body uses for strength, focus and recovery. If your workouts feel flat, if your brain feels slower than it used to, and if your recovery is not where it should be, there's a high probability your energy system isn't supported. And creatine will help fix that. It essentially gives your body a reserve so when your demand spikes, you don't crash. But here's where most people mess this up. They grab the cheapest creatine they can find and assume it's all the same.
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Dylan Gelli
But it's not.
- [00:56]
Sponsor/Host Dylan
If it doesn't dissolve, well, it. If it's not supported by the right cofactors, and if your body can't actually use it efficiently, you're wasting your time and money. And that's why I switched to Qualia Creatine. Plus, it's designed around how your body actually produces and uses energy, not just dumping in creatine and hoping for the best. Cleaner mix, better utilization, noticeable difference. If you're going to take creatine, take one that actually works with your body. Go to qualialife.comdylan for 50% off and use my code dylan for an additional 15% off. That's qualia life.com backslash dylan and use my code Dylan. Thank you to Qualia for sponsoring this episode.
- [01:36]
Dylan Gelli
All right, everybody, welcome back to the Dylan Gelli 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, 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 going to get into that I can't wait to talk to you about because we're going to 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 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 Interventions. So I can go on and on all day.
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Dr. David Rezik
Sounds like an epitaph.
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Dylan Gelli
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 Rezik.
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Dr. David Rezik
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.
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Dylan Gelli
We're going to have some fun. I'm going to 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
- [03:48]
Dr. David Rezik
were going to ask great and probing questions and you've hit it out of the park on the first question. In 85, I was in medical school in St. Louis and my, my dean had a heart attack.
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Dylan Gelli
Oh.
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Dr. David Rezik
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 two weeks and we would want him back to work within two weeks. So if you think about it, we had that 1985 heart attack patient in the hospital for two weeks and in 2026 we went back to work. By then it's been a meteoric revolution.
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Dylan Gelli
So back then, when that happened, is that what you were going to school for?
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Dr. David Rezik
I was going to go into. I was going to be an ob gyn.
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Dylan Gelli
Oh, wow.
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Dr. David Rezik
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. 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. What we did five years ago, a lot of that stuff, we're not even doing, that's how quickly the. The field evolves.
- [06:29]
Dylan Gelli
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. But in actuality, the heart's getting the worst end of the state.
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Dr. David Rezik
It's getting the worst end of the state.
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Dylan Gelli
Yeah. And I. And I would like to discuss some of that with you later. The effects. Right. So that they can hear it.
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Dr. David Rezik
Right.
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Dylan Gelli
Not just for 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, 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 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 they're on. So if we start early protecting it.
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Dr. David Rezik
Think about it for a minute. It's about the size of your fist. This is the sum total of the size of this organ. And we've only scratched the surface, Right?
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Dylan Gelli
It's amazing.
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Dr. David Rezik
Now a hand surgeon knows the hand inside and out. And while some treatments may have evolved, the hand surgery is still hand surgery. The heart's the same size, but the evolution in cardiovascular care every year of this fist size organ is just remarkable.
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Dylan Gelli
I want your thoughts on diet. We're going to start with there because that is one of the most polarizing things in my world 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.
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Dr. David Rezik
I was on the Lisa Gibbons show and Suzanne Summers was her guest and it was called Diet Wars. This was back in the, on 2000 or some, sometime around there. And they had four or five dietary experts on and she called it Dietary wars because these four or five 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. 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 six 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, on carbohydrates in that because that's just not healthy either. So I think that A, 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, 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?
- [13:26]
Dylan Gelli
I was in the hospital, and I had to do the calf lab and everything. I, I.
- [13:30]
Dr. David Rezik
You did.
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Dylan Gelli
I did. And I wish I had this to show you. So me and my wife and my mom were up there with me because I started having weird heart palpitations. And then they, you know, they did the catheter check. No blockage or anything like that, just a low rejection 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,
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Dr. David Rezik
this is chicken parm.
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Dylan Gelli
It did margarine dinner rolls.
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Dr. David Rezik
That. 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.
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Dylan Gelli
I'm still trying to figure that out 40 years later.
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Dr. David Rezik
Yeah. Yeah, I lived through that thing.
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Dylan Gelli
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. 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.
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Dr. David Rezik
So much of our body functions, they're going to be fat dependent.
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Dylan Gelli
Yeah.
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Dr. David Rezik
Brain function is fat dependent.
- [14:50]
Dylan Gelli
Yes.
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Dr. David Rezik
So, you know, there's been a lot of myths.
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Dylan Gelli
Yeah.
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Dr. David Rezik
Internet hasn't helped it much. 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. Well, that's your weight. That's your cholesterol profile, A1C, and those types of things. That's very important.
- [15:18]
Dylan Gelli
And that's where I want to go next. So cholesterol is, like, one of the most polarizing topics in the world now. I mean, it really is 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 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 because we're going to get into medications after we talk cholesterol, because I really want to talk to you about conventional, non conventional, 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, this is terrible. When I got those blood markers back, you know, when I first found plaque of 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?
- [17:02]
Dr. David Rezik
Well, you know, if this were 15, 20 years ago, the guidelines and the recommendations had just 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 nine 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.
- [18:38]
Dylan Gelli
Sure.
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Dr. David Rezik
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?
- [19:26]
Dylan Gelli
Sure.
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Dr. David Rezik
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 their 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, 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.
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Dylan Gelli
Yes. So when, when I was on first put on the medications. Yeah, I declined.
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Dr. David Rezik
What were you put on?
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Dylan Gelli
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 stat. I started taking it. Did not care for it. And I had enough that. Yeah. And I. And the data that I had from so many people was that it really wasn't going to be for me or what I wanted because I had an elevated lp, I had a family history of cholesterol, but mine wasn't terrible. But it was great. It was like 1:30 LDL and my HDL was always kind of stuck in like the 48, 50 range.
- [21:00]
Sponsor/Host Dylan
Not great.
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Dr. David Rezik
HDL?
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Dylan Gelli
Yeah, not great. And that's due to diet.
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Dr. David Rezik
Average male in this country is about 45. So you're not awful, but that's about average.
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Dylan Gelli
Yeah, but my diet was just strictly like so vegetable related, where it was like 15 servings of vegetables a day, two servings of oatmeal, egg whites and peanut butter and yogurt. Fat free. Like I was terrified of fat.
- [21:22]
Dr. David Rezik
It was the fat is the boogeyman. Yeah, right. Oh, yeah.
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Dylan Gelli
No, terrified. But I was teaching people the opposite. But I had in my head, oh, you're the exception. It's gonna make you fat.
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Dr. David Rezik
Right.
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Dylan Gelli
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, 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 repath of the vascepa. I did some niacin, I and I implemented some nanokine.
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Dr. David Rezik
You also exercise?
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Dylan Gelli
Oh, yeah. Like a beast. Probably too much.
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Dr. David Rezik
Maybe too much.
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Dylan Gelli
Yeah. So I ended up getting the LP down to 94. Oh, 330. Which they told me was impossible. You know, they, they young. Yeah, right. But when I changed to the high fat diet and I increased my calories by 1300 because I was severely undereating, my HDL went up to in the 80s.
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Dr. David Rezik
But that's beautiful.
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Dylan Gelli
Oh, it's just awesome. My particle sizes went. My one of my particle sizes was 6000, went down to 2200. 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 azetamib.
- [22:43]
Dr. David Rezik
Is that. Yeah, yeah, yeah.
- [22:46]
Dylan Gelli
I just got a blood panel back. I've been on it 30 days and my LDL went from one 28 to 69.
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Dr. David Rezik
Yeah.
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Dylan Gelli
APOB went from 96 to 67.
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Dr. David Rezik
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.
- [23:44]
Dylan Gelli
Yes. And that's where I was going with it, is everything you 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. 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.
- [24:09]
Dr. David Rezik
You have to.
- [24:10]
Dylan Gelli
Yes.
- [24:11]
Dr. David Rezik
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 four 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.
- [24:43]
Dylan Gelli
Absolutely. I love you, man.
- [24:45]
Dr. David Rezik
I do.
- [24:46]
Dylan Gelli
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.
- [25:13]
Dr. David Rezik
Oh, that's fair. Do you think?
- [25:16]
Dylan Gelli
And I'm going to 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 over prescribed?
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Dr. David Rezik
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 over prescribed? A person walks in to 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 got to put you on statin drugs. I've seen that. I have seen people who are not at significant risk get put on statins because, well, I think you asked the perfect question. What's your number? What's your parameter? 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 three or four 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 a 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 three therapies, bypass catheter based therapies or stents, and medical therapy. Not everyone, 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 going to stent it right or you're going to 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, 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. They're game changing. So the most fun part of my day, my wife always says, people say, what does your husband do when he gets 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 two 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.
- [28:41]
Dylan Gelli
So is plaque reversible?
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Dr. David Rezik
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 zero 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 want to develop the liquid Drano, if you will, for the arteries, and we don't have that yet.
- [29:53]
Dylan Gelli
But you can, like you said, you walk in, you got 40% blockage, you can sustain that, right?
- [29:59]
Dr. David Rezik
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. 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.
- [31:08]
Dylan Gelli
Right?
- [31:08]
Dr. David Rezik
Of course, we're just learning so much about this little organization 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 going to sit here with a lot more gray hair and we're going to be talking about this again. And we'll say, God, remember when we thought cholesterol and diet were the only things right?
- [31:33]
Dylan Gelli
Oh, yeah. Well, we won't be sitting here with gray hair because I'll color mine. Don't you worry 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?
- [32:08]
Dr. David Rezik
Okay, let me put it in the
- [32:12]
Dylan Gelli
simplest terms possible, please.
- [32:14]
Dr. David Rezik
It downregulates through the liver, your cholesterol production. It down regulates 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.
- [32:47]
Dylan Gelli
So does a statin then say you have a combination of soft and stabilized plaque. Does it harden the. The soft plaque?
- [32:57]
Dr. David Rezik
No. Think what you're. Does it cause the plaque to become
- [33:01]
Dylan Gelli
harder plaque, like stabilize the soft plaque?
- [33:04]
Dr. David Rezik
Absolutely. It doesn't.
- [33:05]
Dylan Gelli
Okay.
- [33:05]
Dr. David Rezik
That is. There are some people who think that's true.
- [33:09]
Dylan Gelli
Yeah, they do.
- [33:09]
Dr. David Rezik
I'm going to give you the David Rezik theory of that.
- [33:13]
Dylan Gelli
Please.
- [33:15]
Dr. David Rezik
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 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.
- [33:57]
Dylan Gelli
Got it.
- [33:57]
Dr. David Rezik
Let me ask you a question. Why is it that smokers who present with a heart attack have a better prognosis than non smokers? 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 non smokers, why do smokers have a better prognosis, hospital prognosis with a heart attack? Because they're 10 years younger when they have their heart attack. It used to be a myth that if you smoke, you're going to have a better prognosis if you have a heart attack. Well, it's not actually accurate. It's just you're younger when you have your heart attack.
- [34:34]
Dylan Gelli
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 and 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?
- [34:58]
Dr. David Rezik
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.
- [35:14]
Dylan Gelli
Yeah.
- [35:14]
Dr. David Rezik
You know, recently, I think Robert Kennedy was actually right when he is trying to re institute 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 all our 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. So that's going to be generational. A few generations from now, you're going to 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 health care 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 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 1/3 of the world's diabetics will be in India by the year 2040.
- [37:04]
Dylan Gelli
Wow.
- [37:06]
Dr. David Rezik
That's going to be a crisis. That is going to be a crisis.
- [37:09]
Dylan Gelli
Yeah.
- [37:09]
Dr. David Rezik
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 and 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,
- [37:45]
Dylan Gelli
we
- [37:45]
Dr. David Rezik
are seeing valve disease. Remember, the life expectancy has gone from mid-50s to late-70s in a hundred years. That's just spectacular.
- [37:54]
Dylan Gelli
Yeah.
- [37:54]
Dr. David Rezik
So we're seeing more diseases. Velvety, for instance, prostate cancer. Prostate cancer is the 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.
- [38:40]
Dylan Gelli
Is heart valve disease then, is that related to heart failure?
- [38:44]
Dr. David Rezik
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. 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.
- [39:14]
Dylan Gelli
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?
- [39:22]
Dr. David Rezik
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 one of the most common things on that I see in my practice.
- [39:51]
Dylan Gelli
I see that talked about over the past five to 10 years, more than ever, it seems like it. There's more monitoring of it, there's more discussion of it, more cardiac.
- [40:01]
Dr. David Rezik
The cardiac 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.
- [40:13]
Dylan Gelli
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.
- [40:24]
Dr. David Rezik
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 ventricle. So it's one to one, 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 while the lower chamber is still not beating in synchrony with it. So atrial fibrillation is a rhythm disturbances disturbance where the electrical wiring of the heart is, 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.
- [42:17]
Dylan Gelli
I see.
- [42:18]
Dr. David Rezik
And that's where you can have a stroke related to atrial fibrillation. And as the, and it's a, it's
- [42:27]
Dylan Gelli
a,
- [42:29]
Dr. David Rezik
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.
- [42:46]
Dylan Gelli
Is that fixable and treatable?
- [42:49]
Dr. David Rezik
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.
- [43:01]
Dylan Gelli
Really?
- [43:01]
Dr. David Rezik
Yeah, 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, radio frequency 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.
- [43:36]
Dylan Gelli
Okay.
- [43:37]
Dr. David Rezik
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.
- [43:54]
Dylan Gelli
If somebody has afib, that's something that happens frequently, right? To them.
- [43:59]
Dr. David Rezik
Yeah. If you have afib once, your chance of having AFIB again is pretty significant.
- [44:03]
Dylan Gelli
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.
- [44:13]
Dr. David Rezik
Isn't that funny how you feel?
- [44:15]
Dylan Gelli
Dude, I went to the cooler at Olive Garden. First waiter job I had, and I just sat in there and I mean, I was stone cold because I freaked out. It happens to me, like, once every six months. And now I know, it's like. Okay, okay.
- [44:28]
Dr. David Rezik
So you have what's called a very good warning system. Now, can you imagine? Some people have no idea they're in a fiber. Their 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 developing damage to the heart muscle goes up. So you have a great warning system.
- [44:56]
Dylan Gelli
That's good, man. I'm telling you, I was scared 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. I don't.
- [45:05]
Dr. David Rezik
It's amazing how rhythms can.
- [45:07]
Dylan Gelli
Oh, it's scary. Yeah. It's like. I have recently had quite a significant amount of heart palpitations and found out it was like severe dehydration. Severe jardians had drained me.
- [45:17]
Dr. David Rezik
Yeah.
- [45:18]
Dylan Gelli
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?
- [45:27]
Dr. David Rezik
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, counseling you is individualizing your therapy. You are my favorite patient. You are informed, and you are constantly looking to understand either what's new or what works for you.
- [45:56]
Dylan Gelli
Yes.
- [45:56]
Dr. David Rezik
That's great.
- [45:57]
Dylan Gelli
You have to. You have to understand your own body, and you have to ease into it and be willing to trial and error. Because really, honestly, what you do, what I do, what we do in life, is trial and error. Absolutely everything.
- [46:08]
Dr. David Rezik
Yep.
- [46:09]
Dylan Gelli
And the quicker you understand that, I think the. The more likelihood you have of being healthier and teaching people a better way.
- [46:16]
Dr. David Rezik
Absolutely.
- [46:16]
Dylan Gelli
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, well, I want to run the stack of seven things. And I'd say, brother, if you do that and you start having this problem and this problem that all of them cause the same problem. I don't know what's doing what. I don't know if you could get by with just using two of these instead of seven, you know.
- [46:40]
Dr. David Rezik
Right.
- [46:40]
Dylan Gelli
And so it, everybody lives on the concept of more is always better.
- [46:45]
Dr. David Rezik
Yeah. Right.
- [46:46]
Dylan Gelli
You know, and oftentimes more is often worse.
- [46:49]
Dr. David Rezik
Way worse.
- [46:49]
Dylan Gelli
Yeah. So, and, and Pete, you know, you know this too. We want it right now.
- [46:54]
Dr. David Rezik
Well, right, for gratification.
- [46:56]
Dylan Gelli
Yeah.
- [46:56]
Dr. David Rezik
That's who we are.
- [46:57]
Dylan Gelli
It's a marathon and it's not a sprint in all of this. Well, let me ask you this because 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, but I want to talk about the impact that anabolic steroids can have on the heart directly.
- [47:32]
Dr. David Rezik
Direct toxin.
- [47:32]
Dylan Gelli
Yes. So for the people that think, oh, it's safe or oh, it's fine, it's not a big direct toxin. Okay.
- [47:40]
Dr. David Rezik
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 go through all. 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 is 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 a Mayo Clinic and he got a transplant. I'm Simplifying steroids, simplifying it. It's directly toxic to the heart, that's all. It doesn't get any better than that.
- [49:11]
Dylan Gelli
What about a normal dose of testosterone replacement therapy?
- [49:15]
Dr. David Rezik
Testosterone replacement therapy as guided by a responsible physician who reviews your testosterone numbers. One of the problems, 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, your, your care has to be overseen by a responsible physician who is basing this on science, data, numbers, blood tests, and not just, you know, if, if you said I'm going to 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 two packs of cigarettes and, and, and this is the excess that we're prone to.
- [50:05]
Dylan Gelli
I did all the coaching, all the time. I, I, I did like a four or five year run of steroid use and stopped. And my cardiologist now thinks that that could be part of what caused the lower rejection 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 Chardians. 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.
- [50:36]
Dr. David Rezik
Cocaine is also directly toxic 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 smoking cigarettes and doing coke and doing crystal. And she came in with a heart attack. 15 years old because her blood vessels spasmed so incredibly that a blood vessel and spasm is like a block target. 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.
- [51:34]
Dylan Gelli
I mean, I think where mine was sitting at 45 and now 50s, not end of world by any stretch.
- [51:40]
Dr. David Rezik
No. Let's explain that then 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 a hundred percent. 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. If you're at 45 or 50, you should live a normal life expectancy, providing you're doing all the other right things.
- [52:11]
Dylan Gelli
What about overtraining in terms of damage to the heart, how significantly bad can that be?
- [52:17]
Dr. David Rezik
Controversial. Yeah, controversial. You know, it's hard for me to say that over training 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 over training is bad, probably worse for your joints than for your heart.
- [52:37]
Dylan Gelli
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 you need to look at that cardio IQ panel and look at your APOB and look at your LP and these markers that I feel like I don't understand why we need
- [53:03]
Dr. David Rezik
to have someone knowledgeable. And then you also have to recognize that we don't completely understand 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.
- [54:14]
Dylan Gelli
So before we wrap things up, I go, you know, and I, and I hate this because these conversations go by so quickly.
- [54:20]
Dr. David Rezik
I could talk about this all day.
- [54:22]
Dylan Gelli
Once you have found out, I will invite you back to do a part two with me. All right, so we can. I 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 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?
- [54:44]
Dr. David Rezik
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 from when he was with O Town. And people look at me and they're not going to 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. Inpatients, 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 stand drug. And the CoQ10 improves all of those parameters. In fact, very often when we have someone who, who has, who's on statins and they have muscle aches, we say take Coq 10. Well, heart, body in mind. One of the things it has it is CoQ10. One of the other things it has is Omega 3s, the same thing that is in Vascepa. 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 in mind. We're excited about where we're going to go with this.
- [57:51]
Dylan Gelli
Well yeah, I mean that's my whole world, man. In a company of that size, when they carry something they have to be very careful.
- [57:56]
Dr. David Rezik
Right?
- [57:57]
Dylan Gelli
They, they are very difficult to get into that store. I can tell everybody firsthand work. So.
- [58:02]
Dr. David Rezik
And they're right. We're in every GNC store and 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 Angels. It's a lot of fun.
- [58:19]
Dylan Gelli
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?
- [58:29]
Dr. David Rezik
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 had a great practice and a great group of clinicians and physicians that have all been hand picked because they subscribe to this individualizing healthcare that's so important to me.
- [58:57]
Dylan Gelli
Well man, I really appreciate the time and the conversation.
- [59:00]
Dr. David Rezik
I've enjoyed this.
- [59:01]
Dylan Gelli
Yes.
- [59:01]
Dr. David Rezik
Can we do this again?
- [59:02]
Dylan Gelli
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.
- [59:19]
Dr. David Rezik
That sounds great.
- [59:20]
Dylan Gelli
Appreciate it.
- [59:21]
Dr. David Rezik
Congratulations on you being local. You shed the winner and. And your overcoat, huh?
- [59:27]
Dylan Gelli
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 Jelli signing off.
- [59:51]
Dr. David Rezik
Sa.