Woman Heart Attack Signs & Menopause Risk Explained |ft. Dr. Jeremy London

Summary

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The Neuro Experience Podcast

Episode: Woman Heart Attack Signs & Menopause Risk Explained

Host: Louisa Nicola (with Pursuit Network)

Guest: Dr. Jeremy London, Cardiac Surgeon

Release Date: July 24, 2025

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Episode Overview

In this insightful episode, Louisa Nicola sits down with renowned cardiac surgeon Dr. Jeremy London to unpack the gender-specific risks of heart disease, focusing on how menopause dramatically increases women’s cardiovascular risk and what can be done to mitigate it. The conversation ranges from foundational science—why women’s risk triples after menopause—to practical, actionable advice on monitoring heart health, interpreting biomarkers, and leveraging lifestyle interventions. The episode also touches on evolving diagnostics, the impact of COVID-19 on cardiovascular health, and the future role of AI in medicine.

Louisa and Dr. London’s dynamic exchange is rich in clinical knowledge, personal anecdotes, and memorable quotes that make this essential listening for anyone interested in heart and brain health—especially women concerned about midlife risk changes.

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Key Discussion Points and Insights

1. Why Women’s Heart Disease Risk Triples After Menopause

(00:00–04:28)

• Historical Gender Bias in Research:
  Dr. London highlights the late inclusion of women in cardiovascular studies, noting, "Women have not been included in many of these cardiovascular studies till the early 90s, which is unbelievable to me." (00:04).

• Role of Estrogen:
  As estrogen falls during perimenopause and menopause, full-body inflammation increases—a core driver of chronic disease, including cardiovascular conditions.

  • Estrogen functions as an anti-inflammatory; its decline intensifies risk factors like weight gain (particularly visceral fat) and higher LDL cholesterol.
  • “It's almost like a perfect storm … For some women, hormone replacement therapy can make a dramatic difference … and help mitigate risk.” – Dr. London (02:39)

• Cholesterol and Metabolic Shifts:
  LDL (“bad” cholesterol) rises as estrogen drops: “As estrogen levels drop, cholesterol levels rise in perimenopause and menopause.” – Dr. London (02:55)

2. Connection of Menopause, Alzheimer’s Disease and Heart Health

(03:40–04:28)

• Estrogen receptors are present all over the heart and brain; loss of estrogen removes neuroprotection:
  • “When that lock has nothing to attach to, it becomes scary … It's also neuroprotective, that hormone as well.” – Louisa (03:55)

3. Defining and Interpreting the Lipid Panel

(04:28–10:15)

• Total Cholesterol is Misleading:
  • Critical to break down HDL, LDL, and triglycerides, as each offers different insights.
  • “Anyone can take your blood. It’s about who’s interpreting it … are you trending upwards?” – Louisa (08:51)
• ApoB as the Best Risk Measure:
  • “I look at it as a 25,000-foot view of all cholesterol subgroups … If your overall ApoB is low, you fall in a lower risk.” – Dr. London (09:17)
• LP(a): The Hereditary Wildcard:
  • Lipoprotein(a) [“LP little a”] is highly genetic and not modifiable.
  • “You can’t lower this number … get this test once in your life, because it'll always be the same.” – Louisa (12:21)

4. Heart Imaging: How to Assess Your True Risk

(15:05–20:57)

• Calcium Scoring CT (CAC Score):
  • Fast, non-invasive, helps “screen for risk” (15:41).
  • Zero score is reassuring even with high LP(a); high scores call for more investigation.
• Cardiac Catheterization:
  • Gold standard if CAC questionable/high.
  • Now predominantly done through the wrist, decreasing complications: “90% of cases are done through the wrist … Patients can be discharged very quickly.” – Dr. London (18:51)
• Carotid Ultrasound for Brain Arteries:
  • Especially important in seniors or those at elevated risk.
  • Zero radiation and a valuable yearly baseline.

5. Atrial Fibrillation & Stroke: Hidden Dangers

(21:44–29:00)

• Atrial Fibrillation = High Lifetime Stroke Risk:
  • “There’s a 20% lifetime risk of stroke with atrial fibrillation … which is why patients have to be on blood thinners.” – Dr. London (24:10)
  • Diagnosis can be tricky—intermittent arrhythmias often missed by standard ECGs; wearables and Holter monitors becoming vital.
• Symptoms and Self-Awareness:
  • “Start with being aware of your body first … Anxious feeling, shortness of breath, fluttering in the chest.” – Dr. London (27:01)
  • Use wearables intelligently but trust bodily cues.

6. The COVID-19 Cardio Aftermath

(31:57–35:45)

• Worsening Inflammatory Responses:
  • “[COVID-19] patients with baseline coronary disease … did very, very poorly with bypass surgery and stenting, again probably from this overall inflammatory response.” – Dr. London (33:15)
• Surge in Cardiomyopathies Among Young People:
  • “Echocardiograms would show ejection fractions of 20, 25%. Yes, it was really dramatic. Again, the thought process was that it was almost like an autoimmune situation.” – Dr. London (34:40)

7. Blood Pressure—Why the Numbers Matter More than You Think

(35:45–41:41)

• SPRINT Trial Takeaway:
  • Even small rises above 120/80 cause harm at the capillary level.
  • “Just a small change in blood pressure can have a dramatic impact, particularly at the capillary level.” – Dr. London (36:53)
• Home Monitoring Tips:
  • Routine, calm, correct procedure is vital for accurate blood pressure readings.

8. Diet, Lifestyle, and the Non-Pharmacological “Pillars” of Heart Health

(48:06–60:01)

a. Exercise

• Dr. Ben Levine’s research showed two years of intense exercise can “turn a 50-year-old’s heart into a 30-year-old’s heart.” – Louisa (49:00)
• “VO2 max is probably one of the single most important indicators of longevity that we have.” – Dr. London (50:25)
• Resistance training is critical for muscle mass, which is “the organ of longevity.” (51:36)

b. Diet

• “90% of the outside world is through our body. And we literally are made of what we eat.” – Dr. London (53:29)
• Focus on whole foods, limiting processed foods, and alcohol.
• Exercise alone can't compensate for poor diet.

c. Sleep

• “Sleep is my personal Achilles heel … True growth, whether it’s our mental muscle or our physical muscle, occurs during sleep.” – Dr. London (57:03)

d. Consistency & Customization

• “Of these pillars of health, figure out which one you don’t do well, because that’s the one that’s most important for you.” – Dr. London (60:01)

9. AI and the Future of Cardiac Medicine

(41:41–46:44)

• AI-Enhanced Diagnostics:
  • “I think that AI is going to be transformative in medicine … It’s going to pick up on subtleties that we as human beings miss.” – Dr. London (43:20)
• Real-world AI Success Story:
  • “He took all of the physical findings … and put them into Open Evidence and it gave him the diagnosis. … The patient actually got better.” – Dr. London (45:24)
• AI is not yet replacing surgeons but is revolutionizing diagnostics and research efficiency.

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Notable Quotes & Memorable Moments

• On Female Risk Post-Menopause:
  • “As estrogen levels drop, cholesterol levels rise … It’s almost like a perfect storm.” – Dr. London (02:55)
• On Diagnostics:
  • “ApoB is very important because as you said, the panel kind of paints the broad brush strokes. Now we want to look at what those numbers truly mean.” – Dr. London (09:36)
• On Wearables:
  • “The wearable devices are really good at picking up irregular heart rate, so that’s a great place to start.” – Dr. London (27:34)
• On Lifestyle Change:
  • “You’re not defined by your past. … Small steps, because all those small steps compound to really get you where you want to be.” – Dr. London (56:24)
• On holistic health:
  • “What’s good for the heart is good for the brain. This is why this has been such a beautiful podcast today.” – Louisa (60:37)

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Timestamps for Important Segments

• 00:00–04:28: Why women’s heart attack risk rises after menopause
• 04:28–10:15: Understanding lipid panels, LDL, HDL, triglycerides, ApoB, and Lp(a)
• 15:05–20:57: Imaging the heart—CAC scores, cardiac cath, carotid ultrasound
• 21:44–29:00: Atrial fibrillation, stroke risk, and personal monitoring
• 31:57–35:45: COVID-19’s impact on cardiovascular health
• 35:45–41:41: Blood pressure—SPRINT trial, why the numbers matter, home monitoring
• 41:41–46:44: AI in medicine—clear scans, Open Evidence, clinical revolution
• 48:06–60:01: Lifestyle fundamentals—exercise, diet, sleep, and habit formation

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Final Takeaways

• Menopause is a pivotal event for women’s heart health, driving up traditional risk factors through estrogen loss and inflammation.
• Key biomarkers—especially ApoB and LP(a)—offer better insight into risk than a total cholesterol number alone.
• Screening tests (CAC, carotid ultrasound) are crucial for baseline risk, especially for those with genetic factors.
• Lifestyle factors—especially exercise, diet, and sleep—are powerful levers for prevention, but consistency and targeting your weakest pillar is key.
• AI is rapidly reshaping diagnostics but clinical judgment remains irreplaceable—at least for now.
• Knowledge, vigilance, and advocacy (especially for women who may be dismissed) are crucial in the early detection and management of heart disease.

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For listeners seeking actionable guidance or looking to understand their personal risk—especially women in midlife—this episode delivers clarity, inspiration, and a call to proactive health management, straight from the front lines of cardiac care.

Transcript

[Louisa]

Why specifically do women's risk almost triple after menopause?

[Dr. London]

Well, first to zoom out just a little bit, I think it's a shame that we're just getting to a point that we're recognizing these changes in risks for women in particular. But if you look historically, women have not been included in many of these cardiovascular studies till the early 90s, which is unbelievable to me.

[Louisa]

But we can blame the Women's Health Initiative for that.

[Dr. London]

Partly, yes. And I think a lot of the mindset was based on a male perspective, unfortunately. And as a result, women, I think, have suffered from lack of evidence because, yes, we're the same species, but clearly there are differences that occur at various touch points in our life, specifically perimenopause and menopause, which we all know is a change in the estrogen level. So let's look at what estrogen does specifically when it's low and how that affects cardiovascular disease. Well, at the outset, estrogen is a natural anti inflammatory. And as the estrogen levels start to drop, full body inflammation begins to go up, which we know is a driver for many chronic diseases, cardiovascular disease in particular. In addition to. If you talk to most women in perimenopause and menopause, weight control and maintaining a healthy weight is very difficult as the estrogen levels drop, particularly abdominal or visceral fat, which again we know is an engine for inflammation and chronic disease states and a direct risk factor for cardiovascular disease. We know that because measuring a waist to hip or a waist to height ratio, which gives you kind of a good indicator of where you are from a visceral fat standpoint, is a risk factor for cardiovascular disease. And finally, as you mentioned, cholesterol, which there's been a lot of discussion about cholesterol truly being important for cardiovascular disease or not. I would like to clarify, in my opinion, the burden of evidence that cholesterol, particularly LDL and some of the more granular things, and we can talk about that, are absolutely risk factors for cardiovascular disease, heart attack and stroke. And we know that as estrogen levels drop, cholesterol levels rise in perimenopause and menopause. So it's almost like a perfect storm. You know, we've got a direct regulator of inflammation in the body. We're now having more difficulty maintaining a healthy weight, which is also driving that, also putting us at risk for metabolic syndrome and poor glucose control and all of these things that we know are risk factors for cardiovascular disease. And I think that the Women's Health Initiative really did a huge disservice because the information regarding hormone replacement therapy derailed many of these conversations. And so when we look at all of these negative impacts that perimenopause and menopause have, yes, there are plenty of lifestyle changes that you can make, but it is. It's hard. And for some women, assuming that they're open to it and it's. And it's appropriate for them, hormone replacement therapy can make a dramatic difference in all of those areas, and it really help mitigate the risk of overall cardiovascular disease.

[Louisa]

Yeah. This is actually the same with Alzheimer's disease. 2 out of 3 Alzheimer's disease patients are female, and that's usually because women have estrogen receptors all over their heart and their brain. And when, you know, I describe receptors and hormones like a key and lock. Right. So when that key, when that lock has nothing to attach to, it becomes scary. And it's also neuroprotective, that hormone as well. So so many things, you know, I don't know. It's just so hard being a woman sometimes.

[Dr. London]

Well, I think it's a perfect example that nothing happens in a vacuum in our bodies. You know, when we're talking about cardiovascular disease and general inflammatory response. We have blood vessels in our heart, we have blood vessels in our brain. Everything is impacted.

[Louisa]

Oh, yeah, yeah.

[Dr. London]

In similar fashion.

[Louisa]

So you're a cardiac surgeon. Correct. So not a cardiologist. And I always like to distinguish between the two because there's also a very big difference between neurosurgeons and neurologists. Absolutely. You're dealing with two different things, and we're going to get into that. And I want to start by really defining for everybody what a lipid panel is. I think that we were talking offline about how many people are confused when they go to their doctor and they get their quote, unquote cholesterol tested. I've had so many of my close friends call me and say, louisa, I've got high cholesterol. And I'm like, well, what does that mean? Is your total cholesterol high? Is your triglycerides high? Why don't we explain together what the various things are on a lipid panel so everyone understands, and then we can talk more about, you know, how this affects cardiovascular disease, because, correct me if I'm wrong, your mission. So currently, worldwide, the number one cause of death is cardiovascular disease, and your mission is to make it the second leading cause of death. Right.

[Dr. London]

Any impact that we can have, if we can move the needle significantly like that, when we have 20 million deaths a Year attributed to cardiovascular disease. If it's one patient that sends us an email, thank you. I didn't realize I was having these problems. I got a stent and got a second golden ring. We consider that a win, right?

[Louisa]

Yeah.

[Dr. London]

And you're. You know, you're right. I think there's even a misconception that it's actually the number one killer. If you ask most people, they think it's cancer, women in particular, because breast cancer has been in the forefront, as it should be. But I think that unfortunately, the light needs to be shifted back to cardiovascular disease just from an actuarial standpoint, you.

[Louisa]

Know, and when we say cardiovascular disease, we're talking about diseases of the heart.

[Dr. London]

And that's a great. And that's a great question, because when we talk about death from heart disease, what does that mean to people? And we can really put it into three buckets. The first is coronary disease, which simply means blockages in the arteries to the. The heart, where nutrients and oxygen are brought to the heart muscle. The heart's just a pump, and it requires energy to work. That's the leading cause. Heart attacks. That is a leading cause. The second bucket is valvular disease. In other words, the valves that keep the blood moving in a forward direction in the heart. And that can come in many forms, either blockages of those valves or leakages of those valves. And then the third bucket is electrical abnormalities. Most people are familiar with things like atrial fibrillation. That's one of the most common diagnosis in medic in this country. And so those are the three common buckets. Then there's others that fall pretty far behind. Congenital heart disease. In other words, things you're born with cancer of the heart, which is very, very rare, and infections and things of that nature. But when we're talking about heart disease, really, what we're talking about is heart attacks, taking people's lives.

[Louisa]

Yeah. And those blockages can occur from cholesterol buildup in the.

[Dr. London]

Absolutely.

[Louisa]

Okay.

[Dr. London]

Absolutely.

[Louisa]

So let's talk about that. You go to the doctor, you get your cholesterol tested, Something will come up as total cholesterol. So that means the amount of. What is that? Are we talking about the amount of fat?

[Dr. London]

So no, they're talking about the combination of two things. High density lipoproteins and LDLs, or the bad cholesterol, low density lipoproteins. And those two things together is the total cholesterol level. And then the third thing that most people get on that standard panel is triglycerides which is separate from the total number, but also a risk factor for sure. And so it is important to know then what that breakdown is, because HDLS are typically not what we refer to as atherogenic or causing the blockages in the arteries, whereas the LDLs have been given the moniker of the bad cholesterol. And triglycerides are almost the forgotten stepchild, but they tend to be a very common risk factor for people when they're actually checked. So the breakdown of that is important. Now, I am not a cardiologist, I am not a lipidologist, so my level of understanding of this is from a risk standpoint, not so much from a treatment standpoint, because it's not what I.

[Louisa]

Do every day, lipid panels. And this is what I learned from Dr. Dayspring. Cholesterol and lipids tell a story.

[Dr. London]

Yes.

[Louisa]

And they tell a very big story. And it's not about who takes your blood. And you and I know that to become a phlebotomist, it's a two day course. Anyone can take your blood. It's about who's interpreting it and who understands the ratios and the trends. That's what you want to look at. Like, are you trending upwards?

[Dr. London]

Absolutely.

[Louisa]

And so when you're looking at these three values, you also want to look at something called apob, which I think is more of a direct indicator.

[Dr. London]

The way I look at apob, and I'd be interested to know your opinion of this as well, is I look at, look at it as like a 25,000 foot view of all of the cholesterol subgroups and total to determine how much dangerous cholesterol do you have?

[Louisa]

Yeah.

[Dr. London]

And I think that's how APOB is valuable because if you have one elevated number and a low apob. Yes. You may have to work on that one number with like lifestyle changes or whatever it may be. But if your overall APOB is low, you definitely fall in a lower risk because you've got less cholesterol particles that can actually cause damage to that inner lining of the blood vessel. So I think APOB is very important because as you said, the panel kind of paints the broad brush strokes. Now we want to look at what those numbers truly mean.

[Louisa]

And so what ends up happening? Let's just say you've got elevated APOB and LDL and your cholesterol's all over the place. You tend to end up getting plaque along the walls of the arteries, right?

[Dr. London]

Yes. And it's more likely to get plaque. It's not a death sentence. And it doesn't mean that it's absolutely going to happen. It's a red flag.

[Louisa]

Yes.

[Dr. London]

And the other thing to remember is this doesn't happen at one point in time. This happens over the course of our lives. The important thing is to check.

[Louisa]

Yes.

[Dr. London]

So that you can intervene at the earliest point possible.

[Louisa]

Then there's this other little secret marker that a lot of people didn't really know about, I think until probably the last 10 years. And that is called LP, which is more of a hereditary risk factor.

[Dr. London]

Absolutely. And that's lipoprotein little A. And it's. Think of it as a variant of the cholesterol molecule. It's got a funny little tail off of it. What does it do? Well, if you have lp, if that's been passed to you in your genes and you get a blood test and measure it and it's high, then you have an increased risk of clotting as well as injury to again, that inside lining of the blood vessel. I keep using this example of injury, the inside lining. Why is that important? Well, it's the repair process that ends up causing the blockages in the artery. So when there's a injury, cholesterol and our normal inflammatory cells aggregate or collect there trying to repair that injury. And in doing so, that's what lays down the plaque. And so if you have a lot of cholesterol, you're getting a lot of injury. And this repair process then gets out of, can get out of hand, particularly if you're perimenopausal and you have high inflammatory markers as well. It then can, can actually exponentially increase this process.

[Louisa]

And what's sad is you can't lower this number.

[Dr. London]

That is true or not right now. Yes, not right now.

[Louisa]

You can. This is a test that you can get once in your life because it'll always be the same.

[Dr. London]

That's correct.

[Louisa]

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[Dr. London]

Happy birthday.

[Louisa]

And I'm an unconventional daughter. Every year on her birthday I get her a very extravagant blood test and she's always, you know the 16 vials of blood. Right. And we just did it. And unfortunately, the true sign of love. Yeah, that's what I think. But her LP came back as 144 nanomoles, which is higher.

[Dr. London]

Yes.

[Louisa]

We should be looking at less than 75. And so that was cause for concern for me. So I'm now going through and urging her to okay, let's look at your apob because if we can't do anything about that LP number, then we have to look at everything else and aggressively manage ldl. Absolutely, apob. But what I'm also doing, this is where your expertise really come in, is imaging, imaging of the heart. And we described three tests and I really want to go into what those three tests are so you can image the heart and look at it and see if there's any calcified plaque.

[Dr. London]

Remember too just to back into LP just a little bit. It's not a death sentence. It's another red flag. It's a wake up call to say, okay, I am at increased risk with this marker. Now what are the options? And as you mentioned, you want to tip the scales in your favor by controlling the things you can control. What you're doing, you're checking your cholesterol and her apob. I think that's great. Now the next step is to say, what's our baseline now? Where are we from a cardiovascular risk standpoint outside of blood test? Well, one of the easiest ways and non invasive ways, meaning it doesn't require entering the body in any way, is a calcium scoring CT scan, CAC score. Exactly what this is. It's a CT scanner. Most people have seen that it's not enclosed, so it's just a donut. It takes literally 30 seconds to be run through. The amount of radiation that you get from this is low to moderate. It's not zero. But the information that we get is really powerful. It is a screening test. Remember that it is a screening test. And screening tests are helpful if they're totally normal or if they're really abnormal. Where it can get a little confusing is in that gray area. So let's take your mom, for instance. If she gets her calcium scoring CT scan and her calcium score is zero, I think we can feel really confident that her cardiovascular risk is not significantly elevated in spite of her LP. If it's 500 and the scales are a little bit different in every.

[Louisa]

That's a huge jump, 0 to 500.

[Dr. London]

It's a relative indicator. And they have these really fancy equations, but they run anywhere from like 0 to 6 or 700 in most radiology practices. But let's say it's 400, which would be really high. Well, that would be, you know, a real indicator that we need to do something different. And we'll talk about what that is in a second. Where it can get confusing is if it was like 180 or 200. Well, what do we do with that information? And that then requires stepping to a gold standard test, which is a cardiac catheterization, which would require a small catheter to be placed in the artery, die to be placed in the heart. Then to determine if there are any blockages, it gives you a roadmap on X ray. If there are any blockages there to then delineate where you truly are. Because this, again, it's a screening test, but it is a great place to start. But I do feel like you have to be willing to take that next step.

[Louisa]

Exactly.

[Dr. London]

If you fall into that gray area. But more importantly, if you do fall into that area of really high calcification, then that's an indication to have a cardiac catheterization.

[Louisa]

I've been in the cath lab before and we've gone through the femoral artery.

[Dr. London]

So the femoral artery has always been the mainstay. But now the catheters have gotten so small that probably 90% of casts and interventions, meaning the stenting procedure as well, are done through the wrist. And it's wonderful because, as you know, there are some risks going through the groin, particularly with bleeding or with getting what we call pseudo aneurysms, which are little pockets of blood that typically have to be fixed. So there's risk going through the groin. This is really easy to control. And patients don't have to lie flat for four hours after they have the catheterization done.

[Louisa]

Okay.

[Dr. London]

So they can be discharged very, very quickly. The risks of the catheterization are the same. There's about a 1% risk of a stroke because you are, you know, maneuvering a catheter through the aortic arch and those connect to the blood vessels to the brain. But the risk benefit there, if you fall into that gray area or the high risk area, is well worth it. The benefits far outweigh the risks.

[Louisa]

And now you also mentioned another test or. I did, at least.

[Dr. London]

Yes. Yeah. And I think that this is an age dependent test and that is a carotid ultrasound, because as we discussed earlier, none of these things occur in a vacuum. Blood vessels in the heart can be affected, as can blood vessels in the. In the head and neck and in the legs as well. And a carotid ultrasound is done just very similar to an ultrasound that's done during pregnancy. It's just a small probe that's placed on the neck and it can actually pick up very clearly if there's any narrowing or beginnings of plaque in the carotid arteries. If, if you're younger, typically, and the calcium ct scoring is 0, the likelihood of having carotid plaque is pretty small. And it's. The yield there will be pretty low. But I think in your mom, who's had her 70th birthday, irrespective of her calcium score. And it's also nice to have that as a baseline. There's zero radiation with that test. So it's something that's easily repeated every year without any concern of additional radiation exposure.

[Louisa]

It's also very non invasive, so very easy. Absolutely, yeah. This whole world is very interesting. I'm very tied to my parents and their medical world as well. In 2019, I was here in New York. I was actually in a neurology department, and it was New Year's Eve and my mum called me and she said, your father's acting weird. I said. I said, well, it was New Year's Eve there? I said, well, he's had a few beers. She's like, no, he's just acting really weird. You know, he. His leg wasn't coming into the car, and he closed his. I said, okay. And then. Then they weren't calling me for a while because they didn't want to disturb me. I thought, what is going on here? So it turns out he had a stroke, and it was a right parietal lobe infarct. You know what the underlying cause was? He has atrial fibrillation.

[Dr. London]

Yes.

[Louisa]

So I don't know how common this is in, you know, worldwide, but I'd love to talk about what it actually is and why it's concerning and how we can diagnose it.

[Dr. London]

Yeah. So as I mentioned earlier, atrial fibrillation is one of the most common diagnoses in our Medicare population. That and heart failure are the two most common. What is atrial fibril? Let's start there. Atrial. Normally, our heart beats in a very regular fashion. The top chambers beat and the bottom chambers beat. We call that normal sinus rhythm. And it's a very predictable heart rhythm that is efficient because you want the top chambers to push the blood down to the big pumping chambers and the big pumping chambers to push the blood. So it's a very concerted effort that this pump is making. Well, what happens in atrial fibrillation is the electrical path. The top chambers get haywire, and they start going in circles, and the heart starts beating in a very discoordinated fashion. When you look at it in the operating room, it almost looks like a bag of worms. That's like wiggling. I mean, literally, that's what it looks like. And then the transmission of the top chambers to the bottom chambers, as opposed to being very regular, is intermittent and irregular. Well, from a stroke standpoint, when the top chambers are not beating, blood begins to pool. And that is a scenario where clotting is more common. You know, just like on your skin, if it's bleeding a lot, it doesn't clot quickly. If you hold pressure on it, it. It'll make a clot, and it'll stop bleeding. Well, there's an area, particularly in the left atrium, which is called the appendage. It's. It has no function, but it's like a little cove, if you will, in that chamber. Well, blood's not flowing through there. Blood tends to collect there, and clot forms. And there is a 20% lifetime risk of stroke with atrial fibrillation, which is why patients have to be on blood thinners. If they remain in atrial fibrillation and they try to get that heart rate back into a normal sinus rhythm, we have ways now that if there's no clot formed in there at time of echocardiogram or some investigation, that we can go through the blood vessels and block that little area in the heart that way. If patients are going in and out of atrial fibrillation, the risk of clot formation and stroke goes down to almost zero. And when we're in the operating room, we can put an occluding clip from the outside to then block that area and decrease the risk. The goal is to get patients back into normal rhythm. And many people have heard of ablation therapy where we cardiologists will go in and actually try to block those abnormal electrical pathways and redirect them. And we do it on the outside of the heart in the operating room as well. So the goal is to get patients back into a normal rhythm because it's a much more efficient way for the heart to beat. And when patients are in atrial fibrillation for a long period of time, unfortunately, that can lead to heart failure, which is a real devastating problem in patients.

[Louisa]

If not managed well. But I mean, how do you even pick up on this? Because I think it's hereditary.

[Dr. London]

Right, because atrial fibrillation.

[Louisa]

Yeah. Is it hereditary?

[Dr. London]

We really don't truly know the cause. There are hereditary components, but we don't really know the. There are certain scenarios where the connection is fairly obvious. For instance, if someone has a leaky heart valve and those top heart chambers are getting very swollen, the heart doesn' like to be swollen and it stretches. And as it stretches, the, the electrical pathways can't connect properly. So if you have a leaky mitral valve, let's say, which is fairly common, you are at higher risk of atrial fibrillation. It's many times how people present with a leaky mitral valve is with atrial fibrillation. In addition, coronary disease or blockages in the heart arteries can also be an inciting event. So many times patients that have atrial fibrillation will ultra ultimately end up with a catheterization. And then there's a lot of neurohormonal hormonal aspects that can affect perimenopause. And menopause is certainly one of them. Alcohol, nicotine, lack of sleep, lifestyle can all put people at risk. I don't know that other than a structural problem in the heart that we've been really Good at delineating the cause, which is exemplified in our treatment. It hasn't changed.

[Louisa]

Yeah.

[Dr. London]

For many, many, many years.

[Louisa]

But also diagnosis because I'm mid-30s and I wanted to get an EKG when I heard this. This was in 20, 20, 19. So. And I remember the doctor saying, you're too young, you can't get an EKG. What's the indication? I said, well, and they're like, we'll just have to, you know, the EKG might not pick up on an atrial fibrillation.

[Dr. London]

That's true. So atrial fibrillation can be intermittent.

[Louisa]

That's exactly right.

[Dr. London]

And so getting just one moment in time, you may miss it. I would start with being aware of your body first because that's always the best place to start. So what does atrial fibrillation feel like? Fluttering in the chest, Anxious feeling sometimes can be how it's described, a little shortness of breath. So if you have that, what do you do next? Feel your pulse. And feel your pulse now. So you know what, regular or just.

[Louisa]

Wear an OURA ring to know what you're.

[Dr. London]

I was getting, gonna get to that next. I want to do the free stuff first, the no cost stuff first. And, and it's also important to listen to your body even if you have a wearable device because again, sometimes like with the Apple watch, you, you have to have to put your fingers on something to, to check it and what have you, but see if your pulse is regular or not. And I think that if you were to go to your internist or a cardiologist and say, hey, every once in a while I had this really funny feeling and I checked my pulse and it's not regular. There's your indication for further workup. Now the wearables have really just expanded our ability to evaluate where our health is on a day to day basis. You know, when we look at all kinds of parameters, even just resting heart rate, for instance. But the wearable devices are really good at picking up irregular heart rate, so that's a great place to start. What would be the next step if from a standard of care perspective, and that would be some sort of halter monitor, which is basically a continuous EKG that you can wear anywhere from two weeks to a month in hopes of picking up this intermittent atrial fibrillation, then that information is transmitted to your cardiologist and they can review you days of data to see if you're actually having atrial fibrillation, which is way more accurate than a single akg.

[Louisa]

God. There's just so much to to consider with that.

[Dr. London]

Absolutely.

[Louisa]

Thank you Mud Water for sponsoring today's episode. If you're like me and coffee jitters disrupt your focus, then Mud Water is the solution you've been searching for. This unique blend includes cacao chai, turmeric, and adaptogenic mushrooms like lion's mane and cortison, providing sustained, smooth energy without the crash. Scientifically formulated to boost cognitive function and immune function, Mud Water has truly enhanced my productivity and my clarity. Actually guys, fun fact. I used to have my second coffee of the day at 2pm Now I've switched it for Mud Water. Their Matcha blend is equally impressive. Deliciously smooth, earthy and pure, completely organic, sugar free and vegan. It's the perfect clean energy alternative. So if you are ready to ditch the afternoon coffee crashes, then go to mudwtr.com use code neuro for 43% off your order plus shipping and a complimentary frother. That is MUD WTR. Thank you David Protein for sponsoring today's episode team between hospital rounds, intense podcast sessions and training, I'm always on the move and I struggle with finding quick snacks that don't sabotage my nutritional routines. This is why I found David Protein bars. Now cake batter is my favorite flavor and let me tell you, it feels like indulging without any guilt. Each bar is packed with 28 grams of high quality protein, just 150 calories and 0 grams of sugar. Scientifically speaking, that's 75% of its calories purely from protein, which is about 50% higher than any other bar I've tried. So it's ideal for lean muscle growth, effective appetite control, and faster recovery after workouts. David Protein is generously offering my Neuro Experience listeners to an exclusive deal. Buy four cartons and get your fifth completely free at davidprotein.com neuro because humans might not be perfect, but David definitely is when it comes to your world. What I think is really interesting. I want to ask you what Covid was like. The COVID Times because you know, I and by the way, I I supported the initial rollout of the COVID 19 vaccine because we saw that it reduced hospitalization and death amongst those who were at high risk. What happened that with the masking of healthy children and keeping them indoors, I didn't really, I don't think was was medicine and science. It was more politics. But just sticking with that theme. What we saw was a rise of cardiomyopathy, especially in young boys. Did you see a lot during your I'm guessing You were on call.

[Dr. London]

It was. Yeah. And it was, as we all know, our own personal nightmares. We all have our stories. For me, I was very frontline with COVID And let's take it from the acute to the subacute to something like cardiomyopathy. Most of the patients that got really, really sick came in with bad, bad lung problems. In other words, they were unable to adequately get oxygen in their body and carbon dioxide out. They were put on breathing machines, and that was even inadequate. So we were involved in these early patients to put them on something called ecmo, which is basically an external lung machine where we take the deoxygenated blood out, oxygenate it, and put it back in the body, which at the surface makes really good sense because that's how we deal with patients with this really severe form of lung failure. But what we didn't realize with COVID patients is because the inflammatory response with COVID was such an important component, which is why patients got better with steroids and a lot of other items that you may or may not read about in the news. Unfortunately, when you take the blood out of the body and run it through these plastic tubings, even though they're coated with blood thinners, it increases this inflammatory response. And we were actually making patients worse with ecmo. And it took about six weeks for us to realize, actually the folks at Brigham were the ones that identified that we were actually hurting patients with ecmo. So we were very, very involved with a lot of those patients. And then we weren't as involved. And then we started to see patients with accelerated coronary disease, patients that had baseline coronary disease and then suddenly were being admitted with heart attacks, and they did very, very poorly with bypass surgery and withstanding, again, probably from this overall inflammatory response. You know, Covid was kind of the first hit, and then we would operate on them, we kind of second hit phenomenon. And as you well know, when the inflammatory pathways are already primed and then you activate them again, that. That cascade is. Is really, really bad. So we were trying to not even operate on these people and, and limp them through with medications and other methods in hopes of allowing that inflammatory cycle to quell a bit and then reevaluate the them. As far as the cardiomyopathies, I don't. And this is a little out of my wheelhouse because although I saw a lot of those patients, it's really a cardiology diagnosis. And the way that. That's diagnosed what a cardiomyopathy means is a weak heart. And the way that we evaluate that is with an echocardiogram, again with an ultrasound, it can give us something called an ejection fraction. And what that means is the amount of blood that is ejected from the heart with each beat. Interestingly, it's not 100%. That's not normal. Normal is between 60 and 65%, because there's some blood that's left in the left ventricle with each beat. And what we were seeing in these really young patients is they would come in very short of breath and with these almost flu like symptoms. And their echocardiograms would show ejection fractions of 20, 25%. Yes, it was really dramatic. Again, the thought process was that it was almost like an autoimmune situation where their inflammatory pathways were so primed that there was an attack, particularly on the heart muscle cells or myocytes that then caused this. Thank goodness, in the majority of these patients, it was temporary but very scary for these young kids and their parents.

[Louisa]

Oh, I can imagine. Well, since we're on the topic of ejection fraction, let's talk about blood pressure and I'll tell you why. Have you, did you ever read the sprint trial?

[Dr. London]

Yes, of course.

[Louisa]

It's one that I'm very fond of, especially as it relates to dementia and Alzheimer's disease. What we know about the brain is it's the most vascular, rich organ in the entire body and it's comprised of everything that you speak about. The blood vessels, you've got the arteries, the veins, and you've got these tiny little capillaries. Capillaries always are.

[Dr. London]

I love the way you say that, actually. Capillaries, I prefer that.

[Louisa]

And these are, even though they're so tiny, they're like one cell thick, right?

[Dr. London]

Absolutely.

[Louisa]

They don't have any smooth muscle, but they tend to be the first things to die during elevated blood pressure. Now, that word elevated is really interesting right now due to the sprint trials, because what we know is that literally the gold standard is 120 over 80 and nothing, you know, and you think, well, what about 125 over 85? It's like, well, that's a huge difference. And we kind of get scary. And I think now hypertension is what, 130?

[Dr. London]

Well, that's still. There was that large study that just came out and my take on. And I've only read commentaries because they haven't. They're still battling about this is from the, the real, the real hypertension. High blood pressure gurus in the country are still, are still maintaining 120 over 80. Because there's more margin for, for safety at that lower number. Because, again, as you well know from the Sprint trial, just a small change in the blood, as in the blood pressure, can have a dramatic impact, particularly at that interphase at the capillary level, which is really where the nutrients and the oxygen are transferred from the blood into the brain or the heart of the kidneys or whatever the end organ may be. And that tends to be the most sensitive to that change, because there's no protective layer there. It literally is one cell thick. It has to be to allow those nutrients to pass.

[Louisa]

Exactly. And I, I, you know, I, I've gotten my parents onto a blood pressure monitor, right? And so when I was home, I was home just last week, right, in Australia, and I said, show me how you're doing it, right?

[Dr. London]

It's so important.

[Louisa]

It's so important. You know, my dad was, you know, had his coffee, okay, Running around in the morning, sat down. My mum, it was like this. And I, and it was really high. I said, all right, let's just take a breather. Let's just sit you down. We did the correct way, you know, with measuring the blood pressure, you know, and it came down by about five or seven points. Absolutely. So there's often, you know, I think it's a really great way if you can get into measuring your blood pressure every single morning the correct way and graphing it, you know, if you can do this point, which is what we do with my parents, you know, every single day, you've got the date and where it sits, you can see a trend over time.

[Dr. London]

And it's so important, you know, and it's important because particularly in this country, 50% of people have high blood pressure. You know, I mean, the numbers are staggering, and most people don't know they have it because they don't measure it at all. And what's really, what's really devastating about that is that that from a lifestyle management standpoint, it's the most modifiable risk factor that you can have. And so if you don't measure it, you don't know. And if you don't measure it correctly, then you're not basing it on valid data. Now, for your parents, who are at a different age, measuring it on a daily basis is great. But I don't think that's necessary for everyone. If you can pick, pick, you know, a week, period every 4, 5, 6 months to document several blood pressures actually through the day is even more meaningful. Sit down, relax for five or 10 minutes. Uncross your feet. Believe it or not, that can impact blood pressure as well. Have your arm resting on a surface. Place the cuff just above the elbow. There's usually an arrow that shows you exactly where it should be placed. And again, document those like you've pointed out. Then you're basing your decision on real information.

[Louisa]

Yeah, well, what about on the other end of the spectrum, which is where I sit with low blood pressure? Like, how low? Because everyone's like, oh, I'm super healthy then, which, by the way, I've got a great resting heart rate and it's in 40. I think it's 45, 48. But my blood pressure is low.

[Dr. London]

Yeah, yeah. So in the normal state, particularly folks that are small framed like you are and work out and are otherwise very healthy, low blood pressure, as long as you are feeling good and strong and can do all the things you want to do is typically not anything to worry about and actually may be protective. If, however, when you get up out of a chair or you bend over, you are lightheaded or feeling like you're going to pass out, that may be something that needs to be investigated. And obviously, if you have a dangerously low blood pressure, meaning less than 70 or 80 with the systolic or top number, you probably are going to have symptoms relating to that. Like my wife, who's also very petite and works out all the time and is very fit. Her blood pressure runs in the upper 80s, low 90s routinely.

[Louisa]

Okay, yeah, that's fine. Mine's about 101 systolic. Yeah, I'll just carve it down to me being really fit and healthy.

[Dr. London]

Well, I think it's. And it's also your overall all physiology and your body mass and all of those things go into play. So you're not hypertensive, you don't have high blood pressure. So you're fortunate.

[Louisa]

Before we move into some of the things that we can do to have a healthy heart, as we go on, I want to ask you specifically about if you're doing anything related to AI. So I told you my experience in the OR and where we're doing a lot of. I'm seeing so many new things happening. Right. Specifically in neurosurgery. We've got robotic surgeries taking place, but even diagnosis now is changing. I don't know. Have you seen the clearly scan?

[Dr. London]

Yes.

[Louisa]

I don't know what you think of it, but I think it's phenomenal.

[Dr. London]

I think it is the next iteration of a combination of the calcium scoring CT scan and now actually putting contrast into the arteries so we can identify both hard and soft plaque. I think it is still a screening test, which is wonderful because it does add that component of soft plaque, which is a real concern in many patients. Do. I think it's to a point where I would take a patient to the operating room based on that information. Not yet, but that's where AI is. I think the slope of that curve has changed in the last four or five years dramatically. I think that AI is going to be transformative in medicine. I think we have to be very careful about the rollout of AI. I think we have to be very careful about our reliance on AI because I think that we're still in a very transitional phase, but I do think that it is going to streamline medical care. It's going to reduce redundancy, and it's going to pick up on subtleties that. That we as human beings miss. Most commonly, for what I do particularly, there really hasn't been a lot of direct integration, reading, EKGs, X rays, CT scans, things that can be easily digitized. I think that that's where I have seen the most benefit and crossover for what I do. But directly in cardiac surgery, we're not really utilizing it yet.

[Louisa]

No, not just yet. I mean, you're not at the point where you're at home sipping your coffee and doing robotic surgeries on hearts.

[Dr. London]

No, but that sounds very interesting.

[Louisa]

I know, right? I think the first thing that they should definitely do is an appy. Let's just see if we get the appendectomy.

[Dr. London]

Yeah, let's see if we get that right. Yes, I truly agree, but I think that the technology is going to accelerate much more quickly as a result of AI, as you just gave a great example.

[Louisa]

I mean, your son. We were all having dinner the other night. He introduced me to open evidence.

[Dr. London]

It is a.

[Louisa]

It changed my life in 48 hours.

[Dr. London]

It's unbelievable.

[Louisa]

Which is AI.

[Dr. London]

It is. It's an AI generated, you know, but it's very specific for what we do.

[Louisa]

Yeah.

[Dr. London]

I'll tell you a great story about open evidence, just to give you an idea of the power. I mean, for us, it's great, great. Because we're trying to make sure that we're staying within the guardrails and our information is correct and what have you. There was a nephrologist, a kidney doctor, who was seeing a very complicated patient in the intensive care unit. And he is an incredibly bright guy. I mean, he's one of the smartest, I think One of the smartest physicians in the hospital. And he said that no one could figure out what was going on. This patient. He took all of the physical findings, the vital signs, everything, all of the laboratory data and the X ray findings and put them into open evidence and it gave him the diagnosis.

[Louisa]

You are kidding me.

[Dr. London]

This patient had spent almost three weeks in the intensive care unit and they could not make a diagnosis. He's like, why not just put all the information in? He said, we just didn't even have it on our differential because it was so unusual and the treatment was fairly simple and the patient actually got better. Isn't that crazy?

[Louisa]

Oh, that is so crazy.

[Dr. London]

And I think that that is a really powerful way, that interface of the physician to patient evaluation and then utilizing AI as such an incredible resource that we've never had at our fingertips to really help people like in seconds.

[Louisa]

Yeah. It's also good for somebody like me who first authors papers, right?

[Dr. London]

Absolutely.

[Louisa]

Let me tell you, in my time doing a systematic review, looking through 1500 papers on PubMed and having to do the them manually, if you will, having this now is an absolute game changer.

[Dr. London]

And I'm sure he told you about consensus AI as well.

[Louisa]

He, he told me about, you know, can we. I was. I've got to sit down a bit more.

[Dr. London]

And you'll like that one as well because the nice thing about that is it really kind of sets up the contours of the data that you get from open evidence and it does it in a really nice way. So the combination of the two, I think is. Is awesome.

[Louisa]

Thank you Branch Basics for sponsoring today's episode. Maintaining a toxin free environment is crucial for optimal health. Branch Basics has transformed my home cleaning routine. They're all in one. Concentrate is plant based, fragrance free and made safe. Certified. Unlike conventional products, Branch Basics transparently lists all of the ingredients. No hidden endocrine disruptors, dyes or harmful chemicals. It's versatile, powerful, and simplifies cleaning everything from laundry to countertops. Switching to Branch Basics has genuinely improved my peace of mind regarding environmental toxins. To be completely honest, I was so used to using the wipes that are no longer in my household anymore that contained so many toxins that I had no idea about. So neuroexperience. Listening listeners, you can now upgrade your home cleaning routine with 15% off the premium starter [e-mail] use code neuro. Trust me, when you get away from these Clorox wipes that I was literally going through every single day, you will thank me. So go to branch basics.com, use code neuro for 15% off. Okay. So now we're going to move on to some happy things.

[Dr. London]

Okay.

[Louisa]

We're not going to always be morbid on my podcast. Right. What are some of the things we can do that are free to us, that are going to minimize coming to see you?

[Dr. London]

Yeah.

[Louisa]

And I will start with exercise now. I don't know. Are you familiar with Dr. Ben Levine?

[Dr. London]

Yes.

[Louisa]

And so you know about his world famous study where he took a group of 50 year old patients and you know, imaged their heart and put them on a protocol over a two year period where he got them exercising at a very intense state. So that zone five, which is, you know, I call it the, the sting phase or the, the spew sessions. Right. Where you're going hard out efforts as hard as you can. And what he did over the course of two years was he turned from pure exercise, he turned these 50 year old hearts into 30 year old hearts. So literally reversing the signs of a declining heart by 20 years. And one of the most pronounced effects of that was what happens as we age is we get left ventricular hypertrophy, where the left ventricle, the muscle around that gets a bit thicker. Correct. And it doesn't allow for a lot of blood flow to be protruded to the rest of the body. And he was able to reverse that. And when I read that study and I tore that study apart, I thought, thought, oh my God, like without a doubt, we all should be exercising at that maximum at least once a week.

[Dr. London]

It's so crucial. And again from a brain health standpoint as well. It's really the only lifestyle modification or intervention that we really have that impacts brain function statistically across the board. And it's the same way from a health span and lifespan standpoint as well. I put exercise into two buckets, as I'm sure you are familiar with aerobic exercise, which you're referring to, and VO2 max, which is just a fancy way of delineating cardiovascular efficiency or how efficient your heart is at getting blood and nutrients to your end organs. Now to do that you do have to replicate that study a bit. Just walking at a reasonable pace, although a great form of exercise, and I have no problem with walking, there have to be at least one or two sessions a week where you are getting into that uncomfortable zone because that's how you really shift that curve. So when we look at VO2 max or cardiovascular efficiency, it's probably one of the Single most important indicators of longevity that we have. The most powerful, I would say, when we're comparing individuals that exercise versus individuals that don't, it's magnitudes. The second, of course, is resistance training. Muscle mass is so important. After the age of 30, we lose 10% of our muscle mass every decade. And it's really important that we work to prevent that from happening. How do you do that? It's with some sort of resistance training. You don't have to be in the gym moving heavy weights if that's not your thing. Simple body weight exercises on a regular basis will have a huge impact. And again, regular basis is the key. Consistency is the magic sauce here. Finding what works for you and what you like, that you're gonna be looking forward to doing is what is going to move the needle most effectively. Muscle mass is important not just from skeletal stability and avoiding falls, but as Gabrielle Lyon loves to say, muscle is the organ of longevity. Why is that? Because it's a glucose sink. And our bodies, it's a way for our bodies to really chew up any extra energy that is left in our bloodstream and not be stored as fat. Keeping our glucose well managed is, again, another indicator of our overall health. So exercise is crucial. Move every day, literally every day.

[Louisa]

And as I tell my parents. Right. You know, the nomenclature actually has to change. The CDC guidelines state physical activity. And I always, always. I'm trying to lobby against that and say exercise, because then you've got my mother who tells me that she did the washing.

[Dr. London]

Yeah.

[Louisa]

And she hung them on the line.

[Dr. London]

Right, right. Yeah. And look, there's going to be individuals that you're going to have to redirect.

[Louisa]

Yeah.

[Dr. London]

You know, and there's even. There's even individuals that think they're doing a really good job where they get up every morning and they go for a run and they work out really hard, and then they go to work and they sit for five or six hours during the day. That still is a sedentary lifestyle. You have to make sure that you plan movement throughout the day in addition to that morning workout, because the sitting disease is a real thing. And leading a sedentary lifestyle is a cardiovascular risk factor.

[Louisa]

So that's the most important one. Right. And then if we.

[Dr. London]

Well, it's an important one.

[Louisa]

That's not pharmacologically driven.

[Dr. London]

Fair. Okay, I'll take that.

[Louisa]

Because we know that statins. And we could do it. I think you and I could do an entire podcast on statins, but we're not going to. Okay. Now let's move into something else. Is it. What do you think the next one is?

[Dr. London]

Sleep. So I would go with diet next.

[Louisa]

Wow.

[Dr. London]

Yeah, I really would. And here's why. You know, we internalize 90% of the outside world through our mouths. Sure, we're bringing in air through our lungs and we absorb air and toxins and what have you through our skin as well. But 90% of the outside world is through our body. Body. And we literally are made of what we eat. And I'll give you a great example, and this was actually told to me years ago that if a farmer looks at his crops and all of the crops are sick, where is the first place that they look? In the soil. This is our soil. And I think that maintaining a solid whole foods diet. Diet, really trying to avoid or limit processed and ultra processed foods, limiting or removing alcohol, whatever works for you, makes a tremendous difference when we're talking about the development of chronic disease and things that we are doing to ourselves, even if it's subconsciously doing to ourselves again to kind of drive this inflammatory injury and drive ourselves down this journey towards chronic illness. So I think that exercise without being conscious of what you're putting in your mouth is not going to work as well. And I've even told patients, before you get that fancy gym membership, before you pay for a trainer, let's look at your diet because we can change that today.

[Louisa]

And correct me if I'm wrong, there is actually supplements out there, right. That can, you know, that promise, which I don't think is the correct way, but they promise to eliminate plaque.

[Dr. London]

But that's not possible, not with the current. No. And there have been instances of plaque regression with certain of the statins and some other drugs, but there is no data to support that once you have formed plaque, that we can actually somehow create a scenario or environment for regression or improvement of that. So the key is to get it before it starts.

[Louisa]

That's why everything you're speaking about is so important for 30 year olds. Because even like with Alzheimer's disease, it is non reversible. I actually, you know, Alzheimer's disease comes in four stages and I say if you are diagnosed with the disease, not mild cognitive impairment, but actually Alzheimer's disease, that is comparable to end stage cancer. There is no reversal of it and that, that's at the time where it's a very scary diagnosis. So. And there's no, you know, there's no stopping it, there's no medications for it. So it is very much all of the things that you're talking about is driven through lifestyle. And we have to get onto it very fast in our 30s and our 40s to prevent coming to see you.

[Dr. London]

Yeah, well, and I think it's important for folks that they're hearing this maybe for the first time or they haven't been willing to. To take the steps that they know better, but they don't do better, which we're all guilty of so many times. And that's that you're not defined by your past, that don't. Don't allow yourself to fall into that. Into that deep, dark hole, if you will, decide on where you want to be and the person that you want to be, and then decide on which of these levers you want to pull on first, which ones make the most sense. And small steps, because all of those small steps compound to really get you where you want to be. So when we start talking about diet, that can be as emotional as a religious conversation with many people. And it's about figuring out what works for you. And I'm cool with that as long as it's within certain parameters. But people feel like it's hopeless. And it's never too late to start exercising. It's never too late to think, think, do I want to eat that? Should I really eat this? What are my other alternatives? Just be mindful. And then the last category is sleep, which is my personal Achilles heel and probably one of my risk factors, quite frankly. And sleep is just. It's not sexy and it's not cold plunging and saunas and all of these really fun things that people want to integrate in their lives, but we all have to do it. And true growth, whether it's our mental muscle or our physical muscle, occurs during sleep. You know, our true memory occurs during sleep. Our brains rejuvenate. They get the full washing of all of the toxic metabolites from the day. And the same occurs for the rest of our body. In addition to really stabilizing our hormonal swings during the day, which helps us with glucose management and all of these other pieces that go into this. Not to mention we feel better. Our mental state and emotional state is better. I'm certainly.

[Louisa]

We look better. Our skin health.

[Dr. London]

Absolutely.

[Louisa]

It's the secret to beauty.

[Dr. London]

Absolutely. And as someone that really struggles with sleep, it's interesting because unlike exercise, which I can motivate myself to get out and go for a run and work out in the gym. Gym. And be mindful of, you know, and controlling of what I put in my mouth, the more I try to control my sleep, the worse it gets.

[Louisa]

Really?

[Dr. London]

It. Absolutely. Because there's not, you know, there's not one thing that I can do to improve my sleep. I have had to change my relationship with sleep. But I really. I'm so motivated to get this back to center line because I know and listening to many of your podcasts, just how pivotal this is for my overall health. I mean, I really worry just from an Alzheimer's standpoint and dementia standpoint, like, you know, can I work out and run enough to offset that? The answer is probably not. Probably not. You have to pull all of these levers. And, you know, you made a comment earlier about exercise being the most important, and I'm really sensitive about. About delineating one as the most important. Because if I tell you that exercise is the most important, you're like, okay, great. Check that box. I do this regularly.

[Louisa]

I don't have to sleep or eat well.

[Dr. London]

Exactly, because I've checked that box. What I like to tell people is of these pillars of health, figure out which one you don't do well, because that's the one that's most important for you. And that's really where you need to. To focus your efforts, because you got the other ones dialed in pretty good. I mean, honestly, we can all do better with our diet at certain points in our lives. I think I certainly can. But if you identify where your weaknesses are, that's really where the opportunity for the most growth and the most benefit, I feel like, exists.

[Louisa]

I couldn't agree more, Dr. London. What's good for the heart is good for the brain. This is why this has been such a beautiful podcast today.

[Dr. London]

Absolutely.

[Louisa]

And I look forward to having you on for a part two.

[Dr. London]

I cannot wait. This has been an absolute honor and a joy.

[Louisa]

Thank you.

[Dr. London]

Absolutely.