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The mindbodygreen Podcast
647: The new rules of heart health | Giovanni Campanile, MD & Sandra Cammarata, MD
00:52:17
Dr. Giovanni Campanile and Dr. Sandra Cammarata are the founders of CorAeon, the only functional medicine practice founded and led by a husband-and-wife team of a functional cardiologist and functional psychiatrist. Campanile is a Harvard-trained cardiologist, Associate Professor of Medicine at Rutgers, New Jersey Medical School, and former cardiologist for the President of the United States, George H.W. Bush. Cammarata is a Tufts-trained psychiatrist with 36 years of experience and multiple Castle Connolly Top Doctor honors. Together, they treat cardiovascular health and mental well-being as one inseparable system. They are co-authors of The Sicilian Secret Diet Plan and hosts of the international podcast The Rest is Health.
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- [00:00]
A
Welcome to the mybodygreen podcast. I'm jason wakab, founder and co CEO of mindbodygreen and your host. This podcast is sponsored by Corion. The heart, the mind. We tend to think of them as separate systems, sometimes even in conflict. We say follow your heart or use your head as if they're competing entities. But the science tells a very different story. Your cardiovascular system and your brain are in constant communication. What impacts one directly shapes the other. Emerging research reveals these connections linking cardiovascular events and depression or circulation to cognitive performance. That's what we're talking about today. I'm joined by Dr. Giovanni Campanilli and Dr. Sandra Camarada, the founders of Corion. Corion is a physician led functional medicine practice built around this heart mind connection. Dr. Campanilli is a Harvard trained cardiologist, former physician to President George H.W. bush and a researcher with institutions like the Framingham Heart study and the NIH. Dr. Camarada is a Tufts trained double board certified psychiatrist. She's been recognized as one of Castle Connolly's most influential women in medicine. A prestigious list voted on by fellow physicians. Together they've created a truly integrated approach to longevity, combining advanced diagnostic testing with Mediterranean based lifestyle strategies designed to support both biological and psychological health. It's also a practice I trust personally. My own mother, yes, my mom goes to Coriander. That's not a strong endorsement. I don't know what is. If you want to learn more, head to corion.com that's C O R A E O N dot com. Let's dive in. So you're a very unique combo, functional psychiatrist and functional cardiologist. And it's a really incredible mind body approach when it comes to our health and wellbeing. So why, why this combo when it comes to cardiovascular health? To me it makes a lot of sense, but I think it's new to some people. So let's start with the why.
- [02:12]
B
So why mind and body? Because we are connected. We're strongly connected right there. Our brain, our heart, our gut is all connected. And signals come up and down consistently from our gut into our brain, from our heart into our brain into our gut. So we need to pay attention to everything. And we know from a functional medicine perspective and from a lifestyle perspective that there are certain pillars that we need to protect in order to build the fundamental health designs for our body to continue to survive well. So we take a good listening to how you sleep. It's a very important first step. Sleep is the foundation for everything. Then we ask you how do you relate to others? How are your relationships? How is your sense of stress? Where do you land with that? Because that we know will affect the heart. He's going to pay attention to that very much. Your heart is a function of how well you relate to others. The biggest longevity happiness study done at Harvard has shown that the number one reason for people to live long is the relationship that people have with their spouse or partner. By age 50, if that relationship is strong, you're going to live longer than if you have a low cholesterol. Low cholesterol and unhappy marriage is not going to give you a healthy life. So that is, so that is fundamental. Then we ask you about your nutrition and then we ask you about your exercise and your activity levels. So we don't really get the health history before we get your pillar of longevity histories. How are you doing with all of this?
- [04:35]
A
So in other words, if your relationships are falling apart, your stress levels are insane and you're not sleeping, but you've got great apob. It doesn't. Maybe it doesn't matter.
- [04:46]
B
Maybe doesn't matter.
- [04:48]
A
So let's talk more about that. So, so do you think, and I want let maybe just go, go to the testing piece too. Like so, so when someone comes in, so there's this conversation, let's talk about lifestyle. And I think we sometimes lose sight of that in culturally longevity is having such a moment. There's all this exciting lab work and testing and we'll touch on that. But it feels like our, some of the low hanging fruit, if you will. Our relationships, our stress levels, our sleep can kind of get lost in the narrative. And this is critical for our cardiovascular health, isn't it? Tell me this is true. So many people die of heart disease. I want to say a significant percentage of heart attacks occur on Monday morning. People are stressed about work.
- [05:32]
C
Not only Monday morning at 3 o' clock at 3am on Monday morning. So there's definitely a circadian rhythm. You know, our bodies are, you know, just to go back a little bit about what we believe in. You know, we believe we're part of this ecosystem. You know, our son is a regenerative farmer and it made us realize that, you know, how important the earth is. The, the soil, you know, the health of our food, even from animal protein comes from the health of our soil. So he's a regenerative farmer. What he does is he creates like beautiful healthy soil. So we are, you know, starting from the sun coming down through our bodies, through our plants, through our gut microbiome, into the ground. We're part of this ecosystem, and we, we can't separate ourselves from this. And we, we have to nurture everything about us. Sandra mentioned the microbiome as that's becoming more and more apparent, that it's fundamental for good health. You know, we have these microbes that are incredibly sophisticated, incredibly changed over evolutionary time. You know, they create, like, more serotonin than our brain creates. They create things like 55% of the
- [06:50]
B
serotonin is produced in our gut. And that is pretty remarkable.
- [06:55]
C
And the. And they produce, like, a very important thing. Like, just to emphasize the fact that certain foods were meant to eat, like cruciferous vegetables, they have a chemical called glucoraphan in it. And our gut microbiome has myrosinase that changes glucoraphan into sulforaphane. And sulforaphane is the most potent antioxidant in our body. It increases glutathione in our brain and throughout our body. So this is just one example of why we're so connected to the earth and to our microbiome.
- [07:33]
B
And the microbiome becomes more diverse, which is what we want. But the greater the diversity of microbiome is, the healthier our body is. But it becomes healthy and diverse when all the pillars are in good shape. We cannot have good microbiome if we don't sleep well, even if we eat well. We cannot have good microbiome if our relationships are not good, because high stress levels, high cortisol levels will impact our microbiome and will make it less efficient and less diverse. So that's why we stress not just. We don't have just a conversation at the beginning of our intake about all the pillars of longevity and health span, but we also have a very detailed questionnaire. We don't miss any questions to really dive deep into the health of your pillars and what we need to do to optimize, because our job is to just optimize your sleep, optimize your nutrition, optimize your exercise, optimize your stress level, optimize, you know, your toxin burden, if you have some. So we'll do a lot of, you know, a deep dive into that because that will affect your microbiome. So essentially, the job is to protect the microbiome in order to protect your heart, protect your brain, and protect the health of every cell.
- [09:04]
A
So when someone comes to see you, let's say, you know, our audience is, I would say, probably relatively healthy. I think they're doing a lot of the right things in Terms of exercise, diet, you know, maybe stress levels, you know, they're, they're not smoking, they don't have high blood pressure. If someone were to walk in to see you, where do you find people who are quote, unquote healthy, are getting tripped up. They're not realizing, oh, this is a miss. And this is impacting my cardiovascular health. Like, what do you find in your intake process from a lifestyle perspective or testing that you uncover, and it's this wow moment. What do you, what do you see a lot in your practice?
- [09:43]
C
Well, we approach patients, you know, unfortunately in, in. I was in corporate medicine for a number of years and corporate medicine is full of excellent healthcare practitioners. They're really good healthcare practice. They just, the way it's designed for sick care is not, it's not great for preventive medicine or the kind of cardiology like I practice. I, my focus of my practice, you know, I'm a functional cardiologist, so I like using natural lifestyle methods if I can. I do use procedures and medicines, but I also, my focus is prevention. And then if there's established disease, I try to reverse that disease. So I start with a complete evaluation of the patient. You know, I ask them things like, you know, what, how they're eating in a very detailed way. You know, what, what are they eating? Because every diet, there's no one diet that's good for everyone. So we need to know how the patient is eating and if we need to, some modifications. We asked them how they're exercising in very specific detail because certain types of exercise are better for certain things. We now have recent evidence showing that high intensity, as an example, high intensity interval training offsets the aging effect on the heart. The, the heart gets stiffer and smaller as we get older and, and high intensity interval training is particularly good to offset that process. And also there's a more recent article that came out showing that there's regression of coronary disease with high intensity interval training. So we, we, we try to emphasize the quality not only of their food but of their exercise regimen, of their sleep. Because as Sandra mentioned, sleep is very important. You can't be healthy if you're not sleeping well. So there's a number of factors that could be related to this and also the connection with your loved ones, with friends and loved ones. As Sandra mentioned, this is very important. There's a study looking at people getting a stent or angioplasty. And it was a very simple study. It looked at men only getting a stent and if they had their Wife there with them, giving them a kiss before they had their, their stent person or partner they would do. Their outcomes were significantly improved than a person going in there without anyone help, you know, you know, giving them a kiss. And so it's a, you know, our connection with other one that others with our loved ones is super important. You know, there's studies looking at dementia and one of the main risk factors for dementia is not having this connection. So you know, being, having gratitude, having forgiveness, being connected with loved ones, you know, and this is, you know, why we do this deep dive into patients. It takes us, you know, a while to do that, like an hour kind of interview where we, we try to find out all of these details where we can intervene because a lot of people don't realize they may have some subclinical problems. And then we get into the testing to, to really determine this.
- [12:53]
B
So when you say where do people trip the most? You know, usually sleep. You know, most people are under slept. Most people tend to exercise, but might not be doing the right kind of exercise for their disease. You know, one of the things we check when everybody comes in is the body composition. Because visceral fat has a great impact on mental health, possible dementia and definitely heart disease. So we really spend a lot of time evaluating that because again, recent studies have shown that visceral fat is actually associated with the potential risk for dementia, definitely heart disease and possible cancer and aging, faster aging. So these are where you can have a healthy person that actually once goes into the in body of the style, which is in 3D body composition that we test, they might have visceral fat.
- [13:56]
A
And then of course, I haven't heard of that one. Tell me more. I've heard of inbody.
- [14:01]
C
We use the inbody 970 which is very. And we, we use that because it accurately measures visceral fat and, and measures phase angle, which is a measure of cell health. So that's very important. And, and we follow that consistently. STY is another body composition evaluation. It measures you from the outside. You know, it looks at your body composition as your body is, you know, out. It measures multiple different sites around each arm, each leg, your abdomen, your thorax, your neck and it, and it. We follow this over time because we, you know, we don't like fads in this realm of medicine, but we do use, we do use several machines and one of them is Emsculpt. It's a incredible FDA approved machine that reduces visceral fat and increases skeletal muscle. And we follow patients with the Styku to follow their body composition as they go through this magnetic treatment that reduces visceral fat and increases skeletal muscle mass.
- [15:05]
A
The emsculpt helps reduce the visceral fat, correct?
- [15:09]
C
Yeah, well, in conjunction with lifestyle change, of course.
- [15:12]
A
So what other. I think our audience, myself included, loves some of the advanced testing that is now available. What else is tried and true in your practice with regards to testing? Maybe walk us through genes, advanced labs, screening, imaging. Like what, what should one expect? What, what do you really value in 2026?
- [15:36]
C
Well, we do advanced markers, biomarkers to. And the reason why we use advanced biomarkers is not to over test, but because advanced biomarkers assess future risk better than the average biomarkers. So if you look at the old way of good and bad cholesterol, that's adequate, but it's not great in terms of future risk. What we look at is for cholesterol is the apolipoprotein B, LP lipoprotein A. It's confusing because LP little A is really bad and LP capital A is really good. But you know, we look at the, at all these markers because by looking at this just adds to the risk evaluation of the patient. You know, there's traditional risk factors that we look at like smoking, hypertension, cholesterol, but then there's non traditional risk factors. For instance, women, women that have hormonal issues, that have been under radiation for breast cancer, that's a risk factor for heart disease, that have stress, you know, that have exposure to toxins, other risk factors. These are the maybe even more important risk factors. So this leads to, if they're, if a patient has multiple risk factors, then that leads to different types of personalized testing. What we do in the office, in terms of testing, because we want to get to the underlying cause is we do endothelial function testing. You know, the endothelium, as you probably know and your audience probably knows, is the inner lining. We have 60,000 miles of arteries in our body and the inner lining of those arteries are, it's called the endothelium. And then there's another layer that was recently discovered called the glycocalyx. It's a hairy like protective layer. And there's this new theory called the protective layer theory of atherosclerosis, where these layers, the glycocalyx and the endothelium, protect us from atherosclerosis. And that's why it's important for us to assess particle sizes and particle number because it's. If you have Big fluffy of cholesterol. If you have big fluffy particles, they can't get into the artery. So if you have a lot of big fluffy cholesterol, we, we're less worried than if you have a lot of little tiny, dense cholesterol particles that can make their way through. And that's why we, that's one of the reasons why we look at that. And then there's some lifestyle things that we can do to, to correct that. For instance, lowering carbohydrate intake, increasing high intensity interval training, well corrects some of these things.
- [18:18]
A
So to unpack that a little bit. So in terms of the lab, so here you loud and clear APOB lp more important than cholesterol in terms of assessing risk, are you to, to get to the interventions and in terms of lifestyle or potent or potentially pharmaceutical, are you still a believer in Boston Heart in terms of testing?
- [18:43]
C
I use Boston Heart quite a bit. I think it's up to recently I felt it was the best advanced lip lipid marker there was. Then I got involved with Vibrant and I helped design their new test, the Vibrant Cardio Zoomer. Vibrant America, Vibrant America Labs. And I think now that is the best there is because it includes, it includes other biomarkers that Boston Heart doesn't include. Like for instance, it includes ceramides. We now know that ceramides, which are these waxy type of molecules that are found in our skin and help protect our skin, if they're found in, in the blood, they're markers of plaque stability or plaque instability. And also some advanced, you know, we're worried about not just cholesterol. We know that atherosclerosis is an inflammatory process. So we really want to know, is your body making the inflammatory markers that are coming out of the plaque? For instance, the myoperoxidase is a inflammatory marker that's actually very interesting because it creates bleach inside your cells. And what it's trying to do is trying to, you know what, what the body is trying to do is trying to fix a problem. And by having too much of this plaque buildup, it becomes a problem in and of itself. So this is a molecule that, that's designed in our evolutionary history to clean our arteries from pathogens like viruses and bacteria. Now we have cholesterol that's building up and it sees the cholesterol as a foreign object and it creates these inflammatory. So these are all markers that tell us if your plaque is stable, unstable, that kind of thing.
- [20:23]
B
And interesting enough, these are markers that detect if someone has a Higher chance of form or depression or not. So the higher the inflammation is, the higher is your chance to have depression. And people who have diagnosis of schizophrenia bipolar tend very often to have elevated inflammatory markers and also insulin resistance. So you can, you know that now they're doing all these studies on ketogenic diet and reversal of bipolar schizophrenia while on the diet.
- [21:00]
A
Like what's so great about the testing is you can action it. So you mentioned Boston Heart. I'm going to try this vibrant one. It sounds up my alley. With Boston Heart we discovered that I was an over absorber of an ultra absorber of saturated fat. So no matter how much we tried collectively to lower my APOB, I just couldn't get it below 70. I just couldn't. And then I started Ezetimibe and I was over the holidays and it had drifted a little higher prior to 91. Over the holidays when the diet, you know, wasn't as clean as it probably could have been. You know, we've got little kids, you know, holidays, cookies, you know, ribs. 59. I went from 91 to 59 ezetimibe. But it's the finding, it's the insight of, hey, ezetimibe. 10 milligrams can be game changing for me because we know I'm an ultra absorber of saturated fat.
- [21:51]
C
Yeah. And that's a, that's a huge benefit of these advanced mark lab tests because not everyone is a producer. Some people are hyper absorbers like you are. Some people have a combination and it helps us personalize what we do. You know, if you're a hyper absorber, then you're going to be the type of patient that's going to respond better to dietary management, you know. You know, I was the, I worked with Dean Ornish, he's a good friend. And I was the director of the Ornish program at Atlantic Health for the East Coast. And we would put patients in that program on a 10 fat vegetarian diet. Every single patient we put on that same diet. And it's interesting how some patients, a lot of patients did respond well, but some patients didn't respond at all. And that's because of this issue, you know, do you have, do you have Nieman pick receptors in your gut that are hanging on to every last morsel of saturated fat? And this evolutionarily goes back to when we were hunter gatherers. Some people came from parts of the world where we would starve for long periods of time. So we developed these Niemann pick receptors in our gut so that when we found the rodent and we ate it. We would, we would absorb every little speck of that saturated fat so that it goes, it goes. And now that we have, now that we have hyperabundance of food, we don't need those receptors anymore. And that's what, that's what the problem is.
- [23:18]
A
This podcast is sponsored by Corion. True Longevity is about more than just chasing symptoms. It's about prevention of disease, prevention of symptoms before they arise. And it's about reversal of established disease. That's the mission of Corion. They move beyond the surface by utilizing personalized diagnostic testing and 100 plus biomarker panels to uncover what your body is actually telling you. Whether through biology or psychology. Their Mediterranean based strategies are designed for a longer, fuller life. My mother goes here and if that's not an endorsement, I don't know what is. Explore their practice@corion.com that's C-O-R-A E O N.com and the personalization, I think speaks volumes to the work you're doing and where we are in 2026. Because there are some people who could just eat, go vegetarian or vegan, it's not going to move the needle. And for others it will. And until you really so that it's so critical with regards to imaging. I'm curious. So some people will, you know, say I got a zero calcium score, but they could be in trouble because of soft plaque. Can you talk about that? And like some of the other scans that are more accurate because just because you're zero, not all good, because it's. Let's talk about that.
- [24:28]
C
About anywhere from 15 to 25% of people with 0 have soft plaque. And what's more important, you know, the calcium score is important. It's important in the way I use calcium score is in young patients, if they have any plaque whatsoever, it's important. Or in older patients they have no plaque in between, it's not that helpful. What's more helpful to know is do you have soft plaque? And there's these newer tests like clearly heart flow and now Karista, which is a very good inflammatory test marker. But clearly is the one I have most experience with and clearly is a CAT scan with contrast with AI overread and it differentiates the plaque into calcified plaque, soft plaque and very importantly inflamed soft plaque. So if you have inflamed soft plaque to a significant degree, that plaque is prone to rupture and that's what gives you a heart attack. It's the soft Plaque that's inflamed, that ruptures, it's like a pimple inside your artery. And a pimple inside your artery is not like a pimple on your face. It's very dangerous because it forms a blood clot and that's what a heart attack is. So it very much helps guide management, you know, either if it's very good pristine, we don't have to be overly aggressive in lowering cholesterol. On the other hand, if it's abnormal, if you have a lot of inflamed plaque, then we need to be aggressive, you know, then I do resort to using drugs like statins. I don't like using high dose statins. I like using low dose statins in connection with ezetimibe like you're taking. But also the newer drugs like the PCs canine inhibitors, which are remarkable drugs. The researcher that discovered the PCSK9 inhibitors, she was studying a group of people that had no heart disease. She couldn't find any heart disease in these people. And she tried to figure out why. And she discovered that they had very little PCSK9 molecule in their body. Genetically, they had a good genetic aberration. And what the PCSK9 molecule does, it degrades the LDL receptor. So if you have too much PCSK9 in your system, your LDL receptors go away. So by blocking the PCSK9 molecule with the drug, what you're effectively doing is you're increasing LDL receptors. Your body naturally just gets rid of cholesterol. It just gets rid of it. It's a different mechanism from statins. So it has very little side effects and super effective. It can reduce cholesterol up to 50%, 60% sometimes. And most of my patients that have reversal of disease are on a PCSK9 inhibitor.
- [27:12]
A
Yeah, that's my next question. So if someone's listening and they go for a clearly and they've got some soft plaque, it's not, it's not imminent, potentially catastrophic, but they've got some. And I'm in this bucket too, where I've got, I've got a little bit. I don't want more. I want to reverse this. What do you recommend? Is it ezetimibe alone or what would you pair ezetimibe with? It's not a statin because a lot of people I think, have concerns with statins, but we could talk about that. To reverse plaque.
- [27:42]
C
The bottom line is your biomarkers. You know, the APOB A1 ratio is probably the most. If you're going to look at one thing, you look at that APOB is the bad marker that causes disease. APO capital A1 is the good thing that causes reverse cholesterol transport. So the ratio of those two is a very important marker. There's meta analysis of randomized controlled trials of thousands and thousands of patients. There's a direct correlation of that number with heart attacks and major adverse cardiac events, you know, heart attacks, death. So the lower that number, the more likely it is to get reversal of disease. And I, I find.
- [28:19]
A
Where do you want that? What's the number where you start to see?
- [28:22]
C
Well, you want it below 0.6, but closer to 0.2 as possible if you have disease, if you have no disease, you know, below 0.6, 0.6 is fine. But if you have some disease, and especially in certain locations, like the left anterior descending widowmaker area, if you have disease in that area, then I'm a little bit more aggressive. And I get the. I try to get that APOB A1 ratio down to as close to 0.2 as I can. And usually that takes a PCSK9 inhibitor.
- [28:51]
B
And also you have people who have lipoprotein little a elevation that is a genetic predisposition for high cholesterol or heart disease independently from lifestyle. So with those people, you also tend to be more aggressive, right?
- [29:07]
C
Yeah.
- [29:07]
A
I'm curious, when you're working together, when someone comes in, when do you find, oh, wow, their relationships are really driving this versus their diet? Like, it's, oh, when they open their mouth, I can hear it. And you can almost like. Can you talk about that? Because there's the biomarker piece, which are pretty straightforward to some degree. But in your view, what is the connection, the relationships, the mental health, really, the driver, where you look at each other and say, oh, wow, we can, we can medicate this all up and down, but until they get this squared away, we've got a high. We got someone who's very high risk.
- [29:49]
C
I'm going to let Sandra respond to that because she's the expert on this. But I just want to give you an example of a patient of mine. He was a dentist, and he had a lot of soft plaque in a bad area. And we did a lot of different things and we got his biomarkers down. The plaque came down just a little bit. But he was incredibly stressed out from his practice. Like, he couldn't sleep at night. You know, like, he had a really big problem. Then he, in the middle of all this, he got divorced, he retired, he got a girlfriend. He saw me and he was the happiest person in the world. And after that, I did another clearly on him and his plaque. I use his. His image of his plaques in my. In when I give a talk as an example of incredible reversal of heart disease. So I think it had a lot to do with his stressful life and unhappiness.
- [30:39]
B
So I think that explains it all right, that the level of stress that we are under. So a little bit of stress is actually helpful and necessary. There is a healthy stress that allows for you to feel motivated. Right? You are on a podcast. There is a little bit of stress. You prepare yourself and actually starts to motivate you. And that is because your cortisol level actually does go up in a way that allows for dopamine to. To start to be released, for norepinephrine to start to be released. And so there is this peak, and then it stays there, gives you enough motivation, and then comes down a little, and then you move on through your day. The stress that is not beneficial is the stress that is chronic stress. The stress that goes up and it stays up. So what happens is that your cortisol level goes up. Dopamine, norepinephrine, serotonin, all the neurotransmitters actually do increase, but then because they stay elevated for long periods of time, they get depleted. So now you empty, now you're tired, now you're depressed, now you can't focus. Now you have no mental clarity. And of course, there is all the stuff that comes with it. I can't get up in the morning. My sleep is not restorative anymore. I worry about all. All the time. I ruminate. I don't have the strength. I can't exercise because I'm too fatigued. I can't prepare my meals because I'm too fatigued and too stressed. So those are the times where you really need to help someone say, Dino, you're stuck. You're stuck in this place. Depletion. And you need to start to slowly recharge and come back.
- [32:30]
A
I completely agree. And one of the tools that's kind of a hybrid here that you use, I wanted to talk about, which I think is interesting, is Exomind. Can you talk about that to bridge the gap? I think that's fascinating.
- [32:44]
B
So it's a transcranial magnetic stimulation and is a newer version of it. BTL is a great company that makes a lot of these machines. One is the emsculptor that we use for the visceral fat that still Uses the magnet. So this is the left dorsal frontal prefrontal lobe that has this magnet position in your left dorso, frontal temporal lobe, prefrontal temporal lobe. And the magnet starts to stimulate that part of the brain at a frequency that allows for neuroplasticity. And neuroplasticity is the ability that the brain has to form new connections to regenerate and increase the amount of neuronal connections in the brain. When that happens, you can learn different things. You're more open for learning. You're more able to manage stress because the connections, you know, that part of the brain with the amygdala, that is the fear, the fight or flight, the response, the hippocampus, you know, memory, motivations, all these connections increase, improve and actually stress level goes down, the ability to focus and improve. So there are a lot of studies that have been done on TMS and children who have attention deficit disorder with very good results, very promising. So we can decrease the amount of medications that we use. We have a lot of studies on OCD, on addiction that is coming from tms. So TMS is also used for overeating disorder, for alcohol use disorder, for nicotine. So we're using for a lot of these things with. And we see very, you know, I've been actually, I have to say, impressed more than I anticipated with the results that we see.
- [34:47]
A
Could you walk us through what this looks like? Is it like a helmet we put out? Like walk us through what this looks like.
- [34:52]
B
All the TMS machine used to be like a helmet. You know, it was a little bit tight and people were complaining of headaches post treatment. Headaches. This is more like an arm that sits very gently on your head. So side effects are minimal. I really haven't seen much except for a lady having a migraine headache. And you know, on one occasion during the treatment, some people say they might have a mild headache after treatment, but has been probably a couple of people, not significant. So people lay down or you can sit on a comfortable chair. You can. We have people laying down, soft, light, relaxing and last for about 25 minutes. And the way we're using, the modality that we're using the most is twice a week, 25 minutes for three weeks. So it's not time consuming. The, the, the more traditional TMS is 30 days every day. So much more time consuming and that is used more for treatment resistant depression.
- [36:01]
A
Interesting. So it feels like there's wide ranging benefits. We're just starting to learn it. Learn about for, for 20 minutes, twice a week.
- [36:06]
C
That's like pretty easy, doable, and it's also wellness. You can use it in a, in a wellness setting to just improve your mental clarity. You can use it for sleep and that kind of thing. So it's, you don't have to have a pathological diagnosis to use it.
- [36:21]
A
Again, I think of where we are in 2026 and the pioneering work you guys are doing. And I think about where we were or maybe some people still are. You know, when they walk into a cardiologist office and let's just say they're, they're, they're kind of stuck in the past. What are some of the things in your view just like, drive you bonkers? When someone walks into a. You, you hear a story. I'm sure a lot of these people come to you. They say, I went to my doctor and they did X, Y and Z. And I'm not happy with it. And here I am. What's still being practiced, which is you consider to be a complete waste of People's Times in 2026 as it relates to someone's cardiovascular health.
- [37:01]
C
There are a lot of things like that. And it's, again, not, you know, I don't, I don't like criticizing other practitioners. You know, there's a lot of really, really high quality doctors and cardiologists out there, but they just don't have the time. You know, they, you know, when I was with a medical system, they wanted me to see like 50 to 75 patients a day. And when you have, when you see that many patients, you just don't have the time to really ask questions. You know, you, you can. If their cholesterol is high, you give them a statin. If their blood pressure is high, you give them a blood pressure milk. You can't, you can't really dive into. This is the sort of thing I see on a regular basis. I have patients that come to me, they're on high dose statins, I do some kind of testing, they have no coronary disease. And you know, I, you know, one of my favorite things to do is take patients off or reduce their medications, you know, because they sometimes just don't need these things, you know, when the, you know, studies are based on general population studies. So if, if a doctor is going by guidelines, it's not really personalized. This is, guidelines are made for, you know, general populations. But there's, most of us are outliers. You know, we, we outlay either in the, in the top or the bottom part of that bell shaped curve. So if Someone is under stress, for instance, they're going through a divorce and they're, they're stress at work. You know, we, I see a lot of Wall street guys. These guys are incredibly stressed out. You know, they're in front of a computer for 12 hours a day and or 10 hours later, they're not sleeping well, they're drinking a lot of alcohol and they have high blood pressure. You know, surprise, surprise. So we, you know, we go through carefully what their lifestyle is like, try to, you know, dissect it so we can maybe deal with things, you know, get to the base of why things are happening. You know, I use a lot of biofeedback, for instance. I use particularly heart math biofeedback, which is very simple. You learn how to coordinate your breathing with your own heartbeat. And it's incredibly helpful to improve, you know, the, the parasympathetic nervous system, which we measure with heart rate variability. So we measure the heart rate variability. That gives us an idea. If you're too parasympathetic, I mean, you're, you're, you're too low on the parasympathetic system or too high on the sympathetic fight or flight. We like the parasympathetic rest and digestion that does that.
- [39:29]
B
We have another machine that tests that, the sympathetic versus parasympathetic system together with.
- [39:36]
C
Yeah, this is a PNOE machine that measures a lot of different things through the breath analysis. It measures, and it measures the heart rate variability. It also measures VO2 max, which we think is very important to know because I, you know, and that's another reason why we do the in body. We want people have maximum amount of muscle mass because of sarcopenia, maximum amount of VO2 max. But, you know, simple things like if you're drinking a lot of alcohol, we now know alcohol is not great. We just, you know, make recommendations to lower incrementally what you're doing. You know, not eating enough plants in your diet. For instance. If you're eating just things that are not plant based, then you're not getting the benefits of the plants. You know, the plants have the, you know, it's really, we look at sodium, but it's really the potassium sodium ratio that's more important. And plants have a very high potassium sodium ratio. And getting more potassium into your system lowers your blood pressure. Or L arginine, which increases nitric oxide, which helps that endothelium. Again, certain foods have very high levels of L arginine, like almonds, arugula, beets. So this is unless you do a deep dive into a, you know, finding out how a person lives their life, there's no way you're going to know these things.
- [40:54]
B
That's do these testing and figuring out what happens. And the examine by the way does help also with heart rate variability because increases the parasympathetic response. So that's another helpful thing that, that, that it does.
- [41:10]
A
So you mentioned hrv. Do you also look at resting heart rate as something you want to keep an eye on?
- [41:15]
C
Resting heart rate is very important because some people have a high level of, you know, and this goes back to the sympathetic tone. If your sympathetic tone is high and norepinephrine is being produced, your, your resting heart rate is going to be higher. In fact, the higher your resting heart rate, the shorter your lifespan. So you want to really make sure that you're in check as far as that's concerned. You know, we're other things that we usually recommend to augment. This is, you know, sauna therapy. We're big proponents of sauna. Sauna reduces, if you do sauna like three times a week, it reduces cardiovascular risk 30, 40%. You know, it's detoxifying, it helps the endothelial function again, it helps heart rate variability and it augments all the biomarkers that go up like heat shock proteins when you exercise. So it's an augmentation of exercise.
- [42:10]
B
And we, we brain derived neurotropic factors.
- [42:13]
C
Yeah, BDNF is very important and usually what I recommend just to be efficient about time is red light therapy has become another modality that increases mitochondrial function. Our mitochondria are, you know, in every one of our cells it produces ATP, our energy. So by increasing the mitochondrial function, you're increasing your body's energy. And this is fundamental for longevity, you know, having good mitochondrial function. So I, I usually recommend to my patients, get into a sauna, get a red light therapy panel in front of you and do some biofeedback or meditate while you're in there. It's, it's a great efficient use of your time for you know, 30 to
- [42:55]
B
45 minutes and, and sauna treatment in general four to six times a week. It reduces all cause mortality by 65%. And we really don't have anything else that we know that is that powerful. So if you put all these modalities together also there are studies on depression and anxiety and sauna, very, very helpful. So this is all add on to optimize health Spanish that is what we want to focus on. Right. Because eventually, if you have a good health span, which is a number of healthy years in your life, you will most likely have a little bit more longevity. But the goal is really health span and that's what we want to optimize to live well in the time that we have.
- [43:45]
C
Actually, everything we do is dedicated for health span. Everything we study, everything we recommend to our patients is to augment healthspan and healthspan. There's a lot of people that talk about healthspan, but basically what healthspan is, is by reducing your risk for the major chronic diseases, dementia, heart disease, cancer, you're going to improve your health span. You know, those are the things that, you know, make your life miserable for the last 10 years of your life. You know, the way our parents and our grandparents experienced aging is different than what it needs to be. You know, we don't need to be on 10, 20 different medicines and we don't need to be in the hospital every so often. We need to, we could, you know, the goal is to live to 99 and die in your sleep. You have sex with your wife and then you die in your sleep at 99, or your husband or whatever.
- [44:36]
A
You know, you mentioned dementia. What's good for the heart is good for the head and vice versa.
- [44:41]
C
Correct? Exactly. You know, that's the beauty. It's the same risk factor. So everything we do is the same risk factors. And it's, you know, and then that, that's what makes it easy because if you start living a certain way and a lot of patients think they can't do it, but I'm always surprised, and my patients are always surprised how much change they can make and how much better they feel.
- [45:05]
B
It's a small, small, small hanging fruit like to be able to do, okay, I can take a walk after dinner for 10 minutes. That alone is as powerful according to certain studies as, as taking metformin for, to lower blood sugar. So just a 10 minute walk after dinner is better than taking metformin to regulate your blood sugar spike and your overall UA1C over three months.
- [45:33]
C
And that's something we didn't talk about. You know, insulin resistance and metabolic syndrome is a major problem. You know, when the vibrant cardio zoomer does a very deep dive into markers that indicate insulin resistance. And it's a, it's a major epidemic in this country, in the western world in general, to have problems with insulin because, and, and that creates a number of problems downstream, including heart disease. And it affects cholesterol, it affects the cholesterol by making cholesterol particles small and more plentiful. So you have, you know, this, this issue of having a lot of small little LDL particles is related to our eating habits and insulin resistance.
- [46:20]
B
And there is insulin resistance specifically in the brain also that it might be a different, slightly different from overall insulin resistance. So we're learning a little bit more about that and how even small doses of lithium supplements can be helpful in regulating that and actually helping to prevent dementia.
- [46:43]
C
In fact, some people call Alzheimer's type 3 diabetes because of that.
- [46:46]
A
So are you looking at hemoglobin A1C? What do you, as it relates to that test? Are you looking for fasting insulin or what are you looking at?
- [46:54]
C
Yeah, we look at, you know, hemoglobin A1C is one marker, but, you know, we look at the actual insulin level, the C peptide level, the markers like homa ir, which is based on a check of insulin and glucose. And it, it's, it's directly related to development of diabetes and to development of heart disease related to insulin resistance. So we look at many different markers in, in of insulin pathway because insulin is anabolic. So you don't want to have a lot of insulin in your body because it can cause cancer. And so not only can it affect your lipids, but it can cause cancer. So it's a, it's very important to, you know, do certain things that may lower, you know, like Sandra mentioned, activating your muscles is, you know, your muscles. That's one of the reasons why muscles are so important, is that it's the biggest glucose sink we have in our body. So if you activate your muscles regularly, you suck up all the glucose in your body better than any other way, and it lowers your, your glucose and your, and your insulin.
- [48:02]
A
And so where do you like to see someone's insulin or A1C?
- [48:08]
C
Well, insulin, I like to see it below 10, optimally at 5. Hemoglobin A1C around 5 and a fasting glucose around 75, 80. You know, these are, these are ideal. Yeah, these are ideal levels. You know, we, we frequently don't see them like that, but we, we work on, you know, exercise and diet and that sort of. And even stress. You know, like Sandra mentioned before, high cortisol levels. If high cortisol levels are chronically elevated, that's going to result in a lot of problems, including insulin resistance.
- [48:43]
A
Sure. So where do you think this conversation is going in a couple years? Where's the future headed? What are you excited about?
- [48:49]
C
I think what I think about this era that we're in, in wellness is, we're in an era of awareness. You know, we're much more aware. Even when I started my practice, you know, I was not aware. And of many of these things, Sandra and I, we read, you know, we're kind of nerds about this. We read about this stuff all the time. We, we send each other papers. But, you know, the awareness of how lifestyle and diet and exercise and things like sauna, things like red light therapy, you know, affect us in a good way is, is, you know, mind blowing to me. You know, how we, we can change our metabolism, we can change our genes. Actually, you know, that's another one of the tests that we do on the vibrant America is the 8 hydroxy deoxyguanosine. It's a, that's just one test of oxidative stress. And it tells us if the DNA is actually being attacked by free radicals. And it's a risk factor for not only heart disease, but also cancer. So we now have tools at our disposal that are incredible, you know, that we can do a deep dive. You know, we can do a whole body mri, we could do some liquid biopsies, we can do these in depth advanced panels. We can do it clearly, you know. Now this other imaging technique called karisto, looks at the inflammation in the walls of the, of the arteries themselves. Incredibly incredible detail how much inflammation is going on in the walls of your arteries and, you know, all these factors, you know, put together help us improve, you know, your healthspan because we can, we can prevent problems. And that's the whole idea here, is to prevent problems. We, you know, we love America. We love the, everything that happens in America. Few things we don't love, but something most things we love. And, but America is a, is a, is a epitome of Western lifestyle and Western lifestyle is not always the best for health. And, and that's why we have a lot of epidemics of diseases in western country, you know, and just in America, there's a million heart attacks a year in the Western world, 20 million heart attacks a year. So these are, and it's completely preventable, you know, 100% preventable. It's. And, and that's the, the awareness part of it that's so encouraging because we can, you know, when we sit down with our patients and we see that they're getting better and we see that we're reversing disease, it's like the happiest moments for us.
- [51:35]
A
I love it. And one learning for me is next time I do my blood work right before I'm going to get a hug from my wife or my kids to boost my numbers,
- [51:44]
B
and that will work.
- [51:47]
A
Giovanni, Sandra, thank you so much.
- [51:50]
C
Jason, thank you.
- [51:51]
B
This is great for inviting us, and thank you for being here.