Subscribe
Share
Share
Embed
Tyson Popplestone is a Comedian from Melbourne Australia. Join him for a brand new interview each week.
Tyson (00:00.65)
I'll, I'll edit this first part out. I've made that mistake before, where I've thought I've hit record and a couple of actually only once I've made the mistake of at the end of the recording, going to end of the session and hitting record and not having the heart to tell the guest that it's happened, but I can see that we're recording now. We're good to go. All right. We'll, we'll jump into it. So, it's so great to have the opportunity to sit down with you as I was just saying of.
Listen to quite a lot of your stuff outside of this. It's always nice to be able to take the selfish route and get to ask some questions that can be responded to in real time. But it's, it's interesting with the subject of heart disease. I find I'd be interested to hear your perspective on this, but I think a lot of the time when the subject comes up as prevalent as it is, one of the first things that I noticed people speak about is the genetic factor of it. People go, your heart disease, runs in the family. I guess I just have to buckle myself up and
Expect the inevitable but it seems as though there's some caveats to that and I thought maybe that would be a nice place to Kickstart the conversation because it seems there's maybe a lot more we can do about it than what we may have previously thought
Ron Krauss (01:12.617)
Well there certainly are genetic factors that predispose people to...
Ron Krauss (01:20.745)
and that's often indicated when there are family members, close family members who have had heart disease that they're transmitting the genes down the line. And there's just, as we go into the genetics, it's just quite a large number of those variations in genes across the population that contribute.
to this susceptibility to heart disease. And it's not often that it's just one gene, actually. It's more often that there's a cluster of genes that interact in some way. And the important point that you touched on is that most of those genetic factors can be overcome by appropriate treatment, either diet and lifestyle or as needed medication.
because the gene itself is not a guarantee that there's going to be a bad outcome. It's just a susceptibility factor that is underlying what we look at when we try to assess heart disease risk, for example. In particular, I think for today's discussion, lipids and lipoproteins, which can predispose to heart disease, can be treated effectively despite genetic predisposition.
So it's important when there is a family history to be alert to the possibility that this might be affecting you as an individual. And that can be determined not necessarily by doing a lot of extensive genetic testing, but simply by profiling the lipids and lipoproteins and looking at other factors of blood pressure, perhaps.
predisposition to high blood sugar, all of those things are affected by genes. And what's important is how those genes are working. And that can tell us, know, medically how we might approach overcoming those genetic effects.
Tyson (03:22.892)
Yeah, when you say profiling the lipids and lipoproteins, how do you go about doing something like that?
Ron Krauss (03:28.711)
Well, there's various levels that we can use. The conventional criteria, the guidelines that we currently have in place for assessing abnormal lipids that involve checking what we call a lipid panel, and I'm sure many people are familiar with what that consists of. It starts with a total cholesterol, but that total cholesterol is really the sum of cholesterol in several other
of lipids in the blood. HDL cholesterol is perhaps next important on the list. And then LDL cholesterol. So HDL cholesterol generally is associated with reduced heart disease risk, whereas LDL cholesterol is generally associated with higher heart disease risk. And the third measurement that's commonly used is triglyceride, which is another form, it's a form of blood fat that can be disposed to heart disease.
Those four tests, cholesterol, total cholesterol, ATL cholesterol, LDL cholesterol, and triglyceride, comprise what's almost universally considered to be the standard lipid panel. We can discuss either now or later that that is still scratching the surface in terms of what's really going on that can affect cholesterol metabolism that goes beyond those simple measurements. That gets into more of an understanding.
of how lipids and lipoproteins get circulating in the blood and how they can lead to the buildup of plaque in the arteries, which is where heart disease starts.
Tyson (05:11.564)
Yeah, so when you're talking about a genetic predisposition to some people, are we talking about increased or decreased numbers? I'm not sure which direction it goes with the four factors you just mentioned.
Ron Krauss (05:23.037)
Well, all of those factors can be affected by genes up and down. So there's, as I said, there's just a wide range of genetic variants and some of them predisposed to healthy profiles. The ones we're concerned about medically are the ones that predispose to high levels of LDL in particular. That's really the most important genetic effect that could be.
deleterious to heart disease risk, raising LDL levels. But there can also be genetic traits that raise triglyceride. And often those occur in conjunction with low HDL. So higher triglyceride and lower HDL cholesterol tend to form kind of a little correlated unit that also predisposes to heart disease. And I'll just mention that we can talk about treatment approaches, but the...
nature of this lipid profile, even at this level, this lipid panel testing, which I consider just the first level of testing, that can be enough information to guide people to try to lower levels of LDL by diet. And perhaps their physician would have to move in with medication if lifestyle diet is not sufficient. And the same is true for triglycerides. So,
So those measurements can be used as a first pass at guiding people to either behaviors, diet that could be beneficial to the lipid profiles or the physician might then move on to medication.
Tyson (07:08.61)
Yeah, the diet is a really interesting subject to me because I'm not sure, maybe you're a little more immersed in the field than me, but one thing that I find fascinating and frustrating at the same time is there seems to be so much so -called research which points in the direction of whatever the fad diet of the moment is. Like forever, it had been a correlation between the consumption of, well, I don't know if this is forever, but at least in recent memory for me, the correlation between consumption of red meat and the increased chance of heart disease.
And then now you have a lot of people speaking about the impact of inflammation on, you know, not only the heart and other parts of the body, but how that can potentially contribute or be like a main factor in disease. And then you have the carnivore diet now, which has become quite popular amongst people speaking about the benefits of, you know, brain health and the reduction of inflammation and
you know, so many other benefits. I mean, you could do podcasts and podcasts on this subject alone, but I don't know if there's any research that's been done on like what an effective approach to diet really is when it comes to reducing the likelihood that, know, that your chances of heart disease, you know, sort of kick in.
Ron Krauss (08:25.645)
Well, that depends on the lipid profile. So there are general dietary principles that I subscribe to, and I think most people involved in prevention of heart disease would support, and that is a diet that includes vegetables, fish, and, you know, and...
potentially whole grains as sort of the basis for general dietary health. But if there is an elevation of LDL cholesterol, if it's high enough, that would point to limiting saturated fats as a means of lowering the LDL cholesterol. The issue, and one that I've been deeply involved with for many years, is that
Nowadays, the main problem that we're seeing in relationship to lipids and heart disease is not so much high LDL levels, but much more commonly we're seeing the other side of the lipid profile being abnormal. That is higher triglycerides and lower HDL. And the work that I've done and others have followed up on has shown that those two measurements
can also be related to other features of health and health risk, which we call metabolic syndrome, which is a much broader collection of traits, one of which is a form of LDL particles. This is now the way that LDL cholesterol circulates in the blood is in the form of particles, and there are different forms of those particles in the blood.
and others have shown is that there's a particular form of LDL that is actually a small LDL particle as compared with others that are larger. And that small particle is part of this metabolic syndrome. It's associated with high triglyceride and low HDL, although it's not commonly measured. There are specialized tests for that which are widely available in the US, but unfortunately not so much globally that can sort of fill out that third component of what we
Ron Krauss (10:52.937)
called the lipid triad, and that's embedded in this larger syndrome, the metabolic syndrome. And you brought up inflammation, which is indeed a very important component of heart disease risk. We now know that when plaques build up in the artery, they can progress to more serious damage in the artery, leading to blood clots and ultimately heart attack and stroke as a result of inflammation.
And that is not necessarily related to the lipid levels. That is sort of a separate axis. But the metabolic syndrome, this larger collection of traits, does include a tendency towards inflammation. And so we've been, and many others have been interested from the standpoint of diet, should we be worried about saturated fat when it comes to this syndrome? And the answer is interestingly no, because what we've...
shown mostly in our own work, but some others as well, is that saturated fat does not affect that profile. It doesn't affect preglycerides. If anything, can raise HDL, which may or may not be a healthy thing to do. And it doesn't affect levels of those small LDL particles. So reducing saturated fat is not necessarily the antidote.
to that trait. Again, going back to genetics, this is often something that runs in families. But very importantly, it's associated also in this larger context with our increasing waistlines, fat around the middle, a tendency for blood sugar to be on the high side, what we call insulin resistance, which can predispose some people to diabetes. All of that is, all of that
collection of traits tends to come together even with high blood pressure as part of that as well. And so from a dietary standpoint, the overwhelmingly most important consideration is not necessarily what kind of food you're taking. And we can talk about some of the diets you mentioned. But really, it's a matter of trying to lose weight because that is the best antidote.
Ron Krauss (13:16.371)
to this syndrome on all counts. You can prove all aspects of this, the lipid profile, the blood pressure, the glucose, et cetera. And so putting that in one category, say, well, we should be encouraging weight loss. Then the question is, if we're still talking about diet, what's the best approach for doing that? And there we move, and I would advocate moving away from focusing on saturated fat.
Tyson (13:19.031)
Huh.
Tyson (13:25.485)
Thank you.
Ron Krauss (13:45.829)
to considering carbohydrates because what we and others have shown is that starches and particularly processed starches, white grains, which the fiber has been ground up, and certainly sugar are the real culprits for many individuals. And we find that we can dramatically improve aspects of metabolic syndrome.
in some studies at least, it can help promote weight loss. And that limitation of carbohydrate can be taken to varying degrees. And this is where it gets a little bit complicated because there are many ways of defining a low carbohydrate diet ranging from just avoiding the kinds of carbohydrates I just mentioned, the white starches and sugar.
all the way down to trying to take the carbs out almost completely. This would be something in the range of the Paleo diet you mentioned. It's part of what we call the ketogenic diet, you are generating blood ketones. And that's a more extreme form of carbohydrate restriction, which may be beneficial in many patients. One of the issues that we confront though is that it's not always easy for patients to sustain these more extreme diets.
Somewhere in that range from moderate to more extreme carbohydrate limitation, much more so than worrying about animal fat is really where we now need to pay more attention because of the growing epidemic really of metabolic syndrome.
Tyson (15:32.75)
Yeah. And do you think that growing epidemic, you mentioned the refined wheat or the refined grains. I can't remember which one you said, sorry. And the sugar. mean, in the West, you look at any average supermarket shelf and I mean, you don't have to look far to see how absolutely saturated they are with refined sugars. And it's perhaps no surprise that it's interesting like forever. I was born in 1987 and I've always been interested in health.
And I remember from about the age of 10 or 12, the news of the day was, all right, do your best to avoid fatty food. And I thought, okay, I subscribe to that. And I mean, I've got the fillings and teeth removals to prove it. Like I did it consistently for close to 10 or 12 years. And so hang on a second. Like it's strange that this is the healthiest way to approach diet and it's ripping my teeth apart and I didn't feel overly healthy.
But the average person I still feel is completely unaware of just how packed so many of the so -called healthy foods are with these things you're saying should avoid.
Ron Krauss (16:36.861)
I'm afraid so. since you brought in a little of your own historical perspective, let me go even farther back from my historical perspective, because I've been involved with nutrition research for most of my career. And I started really in the era where the mantra for healthy diets was, as you mentioned,
Tyson (16:44.406)
Yeah.
Ron Krauss (17:03.773)
low fat, those two words, low fat, was what was advocated. It was felt that that's the simplest and most important message for patients to reduce heart disease risk in particular without considering what one would be substituting for that fat. And by the time I got into the field, I had basically inherited this approach.
which had backfired in ways that you've described, where the food industry and even nutrition guidance was comfortable with substituting carbohydrate for fat as sort of the way to achieve a low -fat approach. And that, in retrospect, it was just completely wrong because it pushed the diet
in that direction and some people think and I think there's some merit to this argument that the substitution of carbohydrates and sugars for fat as result of those recommendations in the food industry was very happy to comply by advertising their foods as low fat when they were loaded with sugars and carbohydrate. All of that, I think to some significant degree, probably pushed the obesity epidemic as well because
sugars in particular cause the body to synthesize fat. It just drives increasing body weight if one is just overdoing it on sugars, not to speak of the fact that those foods generally lead to people to be hungrier and want more of those foods and so they eat too many calories. So all of that was happening at the time I came into the field.
And then I became chairman of the American Heart Association Nutrition Committee, which was charged with developing guidelines for Americans for reducing heart disease risk. And as I say, I inherited this dogma and this low -fat mantra. And in my own research, I was beginning to discover that this was really the wrong direction for reasons that I've mentioned. This just pushes metabolism in the wrong direction. So I...
Ron Krauss (19:29.993)
worked very hard to try to get the guidelines to be more cognizant of the carbohydrate end of things. We made some progress along those lines, this was already 20, probably the time you were, well, maybe it was after you were born, but it was a long time ago. And we're still not there yet because guidelines continue to be very focused on saturated fat reduction.
I think have given insufficient attention to the potential benefits of limiting carbohydrates. But even more importantly, and I think this is a direction that we are now headed in, which is a positive direction, is considering not just individual components of the diet, not this or that type of fat or carbohydrate, but the overall dietary pattern in which those...
kinds of food components are consumed because they don't act in isolation. After all, generally don't, most people don't just gobble buckets of sugar, they're eating foods. And on the other side of the equation, there are healthy aspects of foods, which dairy is one actually, that really depend on the nature of the food itself and the nature of the diet that people are eating.
when they're consuming certain dairy foods, that matters a lot. So we're coming around kind of late in the game to considering the importance of understanding what dietary patterns might be. And again, that will differ across individuals and in relationship to the lipid aspect of heart disease risk, as I mentioned.
Those individuals who have features of metabolic syndrome are, and certainly those individuals who have had some vascular problems already, I'd say the great majority of those individuals, and this is what I can see in the literature, I see it in my own clinical practice, really would benefit from focusing on carbohydrate restriction. And that really should be much more of a focus in the overall dietary pattern. And you can substitute fats.
Ron Krauss (21:54.473)
It's not, know, there's plenty of healthy fats and even saturated fats are not, the amounts usually consumed, not in the more extreme diets, but in the general population, the amount of saturated fat that most people are eating these days is really not as important an issue as the amount of carbohydrates that they're consuming.
Tyson (22:16.8)
Yeah. So I know you mentioned before that there's certain tests that you can do to see the levels to test for things like metabolic syndrome. But if someone's sitting here now and thinking, you know, I don't have the healthiest lifestyle necessarily. Are there any external or other factors that they can sort of do just in their living room to see if they're perhaps headed down the road of metabolic syndrome?
Ron Krauss (22:37.575)
Well, there are some simple rules that have been developed. It requires very limited information. It really consists of five general components that either in combination, if you have two or three of them, you qualify for having metabolic syndrome. So those are excess body fat around the middle. That is a high waistline.
Ron Krauss (23:10.267)
in particular, a high level of glucose in the blood, which doesn't have to be diabetic, it can just be sort of in the borderline high range, high blood pressure. But then the lipid component represents the last two features. So I've just given you three. The last two are high triglyceride and low HDL. So those five factors, most people can...
that information you have to quit and get a blood test for several of them but so you can't do it exactly in your living room but it doesn't require much medical information to determine whether you have this syndrome and then depending on what the features are some people will have the blood pressure as the main concern others will have the lipids as the main concern but as I mentioned
overwhelmingly the majority of individuals who have this cluster of traits start out by having too much fat in their belly. we now feel that's really probably the most important factor to be aware of and to try to deal with. of course, weight loss has been a preoccupation of the diet for ages. And we're now in an era where we've got some...
snazzy new medications that are capable of achieving weight loss. And I think they're going to start to help augment the struggles that many people have. Because gaining weight is easy, losing weight is very hard. We sometimes beat our patients over the head if they're not losing weight on diet. But I think we're beginning to see that
excess body weight once it's acquired, it's very difficult to take it off again and to keep it off. There's a very high failure rate for dietary approaches, whether it's low carb, whether it's paleo, the long -term success of diets alone has been very frustratingly low. And so having pharmacological approaches
Tyson (25:11.148)
Yeah.
Ron Krauss (25:31.419)
is certainly not ideal, you don't like to have to rely on particularly expensive medications which are now currently expensive. But for some people who are at the highest risk, it can offer a very important medical treatment that could help turn things around.
Tyson (25:50.294)
Yeah, yeah, it's really interesting conversation. This whole, a change of lifestyle versus medication. It's one that I'm really interested in. It's, cool to hear your perspective on that from the chair that you sit in, because I think forever, my frustration had been that there was a real lack of focus paid on so many lifestyles. I felt growing it like a classic example for me that I mean, the listeners heard a few times, but I'll say it again.
was I had two sinus surgeries in my younger years. I was 22 for the first one, about 26 for the second one. And I went back in to see the, the ear, nose and throat doctor. And he said, yeah, unfortunately, this is just going to be a part of your lifestyle. You can go on this medication and then we can get this surgery done, but it's going to be something that you'll probably have to hit repeat on for quite a long time. And I thought, it's so interesting. That was my, my wife's grandma, who I always thought was a bit of a hippie.
She gave me a list of things to cut out my diet for a month. And she goes, hey, try this. If it doesn't work, go get your surgery. But one of them was dairy. And I consumed dairy like it was going out of fashion. Like it was, I was a yogurt fiend and a milk fiend and whichever way I could get my dairy, know, take it. And it seemed for me that that small lifestyle change was the answer. I never went back for a third sinus surgery. I haven't had trouble with my sinuses since.
And that was my real entrance into the conversation around, like I don't think I quite realized the impact that a small lifestyle change like that could have on my overall levels of health. But I mean, I'm sure you see this every single day, people coming in and you've got the answer of, right, lifestyle is leading to this and just the lack of, I don't know. I know it's hard to form new habits when you've been stuck in the trenches of what you've been doing for so long. But that seems like an approach that I wish so many of my doctors.
Ron Krauss (27:36.605)
All
Tyson (27:41.43)
in my earlier years knew about. Because I think one thing I've learned about the medical scene as well is a lot of the time the nutrition factor is not something that a lot of doctors are really heavily educated in.
Ron Krauss (27:52.861)
Right. And particularly because it's a very diverse set of nutritional factors that we need to consider and that individuals differ in how they respond to nutrients. So your experience with dairy is not necessarily something shared by the majority of people in the population. You discovered it as something that is impacting your system adversely. But that's not.
necessarily the same approach that would work for people who have other concerns with their health. And so it does take a fair amount of inquiry into both what people are consuming to understand what their dietary habits are and then determining systematically what can be achieved by making changes in the diet. We don't yet have real
ironclad approaches for telling a person off the bat that he would be better off on this diet versus that diet. We often have to use empirical information, making the change and seeing how that affects symptoms or some of the things we are measuring. And along those lines, I this is something I've been interested in. This is clearly a work in progress, but it has to do with
the effects of carbohydrates that we were talking about a moment ago. one of the things, of course, that one wants to avoid is having big spikes in blood sugar after one consumes foods that contribute to those that are high in sugar or processed carbohydrates, because that can lead some people down the path towards pre -diabetes or potential for developing diabetes.
by having those continual spikes in blood sugar that eventually wear down the pancreas, which makes the insulin, and there's not enough insulin to go around, that's bad. So that's been known for quite some time. And it's been assumed that one can sort of predict what kinds of foods would raise the blood sugar based on...
Ron Krauss (30:13.021)
the type of food and the composition. was something called the glycemic index, which is still exist, something called the glycemic index, which is just a term for a calculation that can be made from one's dietary intake across different forms of carbohydrate. It supposedly predicts the degree to which the blood sugar would go up after consuming those foods. Well, it turns out
that when one goes more deeply into how people are responding to diet by measuring the blood glucose, which can now be done very easily through a gadget called continuous glucose monitoring that can record blood glucose over the course of the day or weeks. people have studied how the blood glucose level is measured by this technique.
changes after eating certain foods. And what we've found and what has been reported now quite widely is people differ enormously in how they respond to individual foods in terms of what their blood sugar is doing. So some people, and I wouldn't recommend this, but some people can get away with eating a very, you know, pecan pie or something, which you think would be the worst thing for blood sugar.
but not always. And so there's some people who have a very specific metabolism that does not respond to that food, whereas other people will get increases in blood sugar with foods that have not been previously thought to be. So that variability is just one window into this more generalized issue that we really need to consider. And this gets into what we call personalized medicine or personalized
Tyson (32:03.044)
Mm -hmm.
Ron Krauss (32:07.197)
guidance for diet, the fact that we all differ as individuals. And this gets back to the very first topic we had, which is we talked about, which was genetics. Because the genetic profile affects most of what happens in our body. And this includes how we respond to foods. And we're learning that there's even more to the genetics. I don't want to get too much into sort of
know, space age science, but there's a whole other arena that we now recognize as having a big effect on our metabolism, which may contribute to a significant extent to variation how people respond to foods. And that is what's going on inside our gut. This is called the gut microbiome, which has become a very active area of research where we're carrying in our, everybody is carrying our test in trillions of
organisms that we've known about for years. But as we studied them, we know that there's thousands of different species of these organisms that exist and they would differ across individuals. And we're beginning to understand how important that variation may be. We don't yet fully know how to overcome the effects of differences in the microbiome. That's where we're getting into sort of the
scientific horizon, but it's one of the candidates for the kind of differences in response to foods that I just talked about. It's just another factor in addition to our genes in our body. We've got all the genes coming from the microbiome, because all those bugs have genes that's well.
So we now have a huge universe of genetic factors that we can't necessarily control easily, except by making changes in diet and determining how that affects the things we can assess, the blood tests and how we feel and other aspects of metabolic health.
Tyson (34:24.206)
Yeah. I don't know why I'm still constantly amazed at how nuanced all this is. mean, it was not that long ago. I was like, all right, well, if you want to have a good heart, just don't eat meat. And if you want to have a good heart, just go for a walk. And it's, it is amazing. Cause every now and then you'll see someone's posts say, okay, my grandma lived till she was 107 and she said her secret was she had a cigarette every evening at 5pm, glass of whiskey, and she loved a donut. And you're like, all right, that sounds like it would work for me. But I guess.
Ron Krauss (34:35.464)
Yeah.
Ron Krauss (34:51.057)
What was it?
Tyson (34:51.672)
Yeah, like that ignores everything you've just said about the genetic factor.
Ron Krauss (34:56.379)
Exactly. Those are the genes. We've left, you there's a whole universe of people studying genes to try to see if we can nail down what genes are operating in individuals with healthy long lives who are resistant to all the things we just talked about. So we're, you know, there's, I can't tell you how many inquiries I get from both patients and colleagues who are interested in longevity as, as
As some of us are getting into those later years, we get more more focused on how can we keep going?
Tyson (35:30.796)
Ha ha ha.
It's a really interesting point. There certainly has been a theme of longevity experts who are approaching their later life. You're right. It's very funny to hear. I mean, I'm 37 and I'm already quite interested, but the deeper these wrinkles get, the more interested I become. Ironically, it's a funny correlation. It's interesting hearing you speak about the obesity factor as the one standout feature that seems to be universal when it comes to an increase in your likelihood of developing.
some form of heart disease. What's going on there? I'm assuming it's got something to do with inflammation and fat, but I'm not 100 % sure what it is. Why is there that correlation between heart disease and obesity?
Ron Krauss (36:14.991)
That's a question. And there's really multiple factors. Just thinking about the fat that is in that particular part of the body, it's really very specific to fat in the belly, because we have fat elsewhere. People can get fat in their rears. They can get fat in their legs. that fat is not what's harmful. What's harmful is what accumulates in the belly. And we don't often
recognize that because even small amounts can be detrimental and that's why measuring waist circumference is a window that can be more specific as to at least where the problem is. Now in answer to your question, there's a lot of work in this area but that fat tissue secretes various substances and we know that many of them are inflammatory.
as you mentioned, that fat tissue is a very pro -inflammatory type of fat. That is, it has many chemicals that can be released from that fat tissue that are inflammatory. And there are also pathways that originate in that fat tissue that go to the liver from that fat. It feeds the liver with chemicals that can then
produce more fat, so it becomes a vicious cycle, is that that fat tissue tends to promote more of the bad guys and contribute to inflammation. And also it contributes to another feature of the metabolic syndrome related to blood sugar. And I touched on this briefly, insulin resistance. That is the failure.
of insulin to adequately lower blood glucose, that can be worsened by having too much fat in that region. So there's, so it's really a whole cluster of factors, not a single mechanism. And all of those are heart disease risk factors, every single one of them. The inflammation is, the lipid changes are, and the changes in glucose and insulin, not just heart disease, but...
Tyson (38:17.644)
Hmm.
Ron Krauss (38:39.091)
but specifically each of those and together collectively represent a very substantial predisposition to heart disease. And that's not all genetic. think a lot, as much of that is really acquired. I there are people that are more prone, I shouldn't say it's not genetic at all because there certainly are people that are genetically prone to having too much of that bad fat.
Tyson (38:50.528)
Yeah, so I do it. Yeah, for sure.
Ron Krauss (39:09.171)
But what we really are recognizing is something I touched on earlier. And that is, if that excess fat is acquired at any stage in life, even early life, it can grow much more easily than it can be shrunk. It tends to have a life of its own, if you will, because it turns on all of these mechanisms that tend to promote its own.
well -being of your way, more fat makes more fat. And so that makes the important target, in my view at least, for healthy preventive diet should be in childhood, should be before the fat accumulates because that is, I think, the most effective way of preventing this buildup of excess fat and all the things that go with it.
And we're finding that if that's going to work, it has to start very young. You used to think, well, maybe, you know, adolescence, but no. We're seeing more and more in society that these changes are beginning to appear much earlier in life, age four, five, six. And that's where we really need to be much more attentive to healthy dietary practices to prevent the later...
accumulation of fat and all the metabolic problems that go with it. But that's easier said than done. We're facing a food environment that does not make it easy to keep kids lean and healthy. Physical activity, course, which you touched on, extremely important. That is the other side of the equation from diet, of course, because if we're active and kids and young kids are
Tyson (40:45.773)
you
Ron Krauss (41:07.771)
constitutionally rather active. They tend to run all the time rather than walk. And that factor is often lost as they get a little older. They start literally slowing down. And if one doesn't keep the physical activity going, that tends to worsen the excess calories accumulating as fat.
Tyson (41:15.533)
you
Tyson (41:34.894)
Very true. It's 8 .45 where I am now. I was up at just before six with my boys. My wife got up just before we started speaking. And I think for that two hour block, I don't know how many laps of the house my four year old and two year old did, but my wife got up and goes, isn't it just amazing how much energy needs to be released? I mean, they've got the physiques to prove it. It's really interesting looking at the young kids who my boys eat very well. We live in a cool part of the world where they're outside a lot running around, but.
Ron Krauss (41:51.24)
Right.
Tyson (42:03.042)
Yeah, it's really interesting to see just that picture of health in the young years. And I know what you mean, how it does start to disappear. I've got a background in middle distance running or more long distance running now. And someone I've become friends with through the podcast in recent years is Dr. Phil Maffetone. I don't know. I know he's in a different world to you, but I don't know if you know who he is. He's very interested in. So in the seventies, he came up with a method of sort of like a slower aerobic
Ron Krauss (42:24.457)
No,
Tyson (42:33.302)
style of training for endurance sports. Whereas in so many groups around the world, the middle distance runners, they love to just absolutely smash themselves, run as hard as they can for as long as they can, which obviously sees benefits over a short period of time. But a lot of the time it's quite short lived because it leads to injuries and niggles and fatigue. This guy came in in the seventies with this approach of, right, let's focus more on
Ron Krauss (42:54.343)
Nice.
Tyson (43:00.556)
This zone to heart rate style of training where we keep the actual heart rate down a little bit, but we run for a longer period of time. And that long, slow distance seems to be a standout feature of improvement, not only in my own running, I'm. Over the last couple of years, I've been really interested in the, the, the blue zones. Dan Boutin is a book like so many people interested in the world of health. And it seems to be a standout feature of the longevity of some of these communities as well. Particularly I'm thinking of, of Sardinia.
Ron Krauss (43:08.392)
V
Tyson (43:30.05)
like a lot of the shepherding community walking through mountainous regions for hours a day. And I mean, I would guess, I actually don't know for a fact, but I would guess the incidence of heart disease in this community is a lot lower to what it is in Australia or in America. Is this a factor of improvement for heart disease that long, the slower? I feel like I know the answer to the question, but I guess I'm more interested in knowing how much of an impact it has in
in prevention and even reversal.
Ron Krauss (44:00.489)
Yeah, well, you know, there's been a lot of work in this area. This is not my own specific area of expertise, but what I can say is that longer, slower, more endurance type of exercise involves burning fat more than carbohydrates. So you're really now turning on...
the fat burning machinery much more efficiently. The engines in the muscle tissue mitochondria that create energy use fat and that is where you get the best impact in terms of some of the factors we're trying to reverse. You know, high levels of fat in the blood and all of the metabolic things that go along with that tend to be
favorably affected by this sort of fat burning in the red muscles, the ones that are the endurance muscles. And so I do recommend that for patients, although there's been evidence now that for healthy metabolism, a mix of endurance, this type of endurance exercise, you know,
And slow is fine. And some in muscle strengthening, particularly as one ages and one loses muscle mass, that combination is more effective than either alone. So things change as we get older. You're entering a phase of life where your metabolism is going to change. I don't want to be at all discouraging, but you're going to probably slow down a bit at some point.
And that's the point where we unfortunately have to run faster to stay in the same place as Alice in Wonderland has taught us. There's a famous line in that book that says we just have to run faster to stay in the same place. And that's where we get older.
Tyson (46:08.206)
I keep being warned of that. And as I said, my interest in longevity has been getting more and more intense over the last couple of years. It's funny. And there's no better way to reflect on your energy levels than as I said, having a four year old show you just how much it is possible to have.
Ron Krauss (46:16.841)
you
Ron Krauss (46:24.829)
Yeah, so my experience is I took up running nothing like yours, although I did once complete a half marathon, which to me was a great success. But it's been kind of slowing down ever since despite all my efforts. And so now I go to a local track where there's all ages of people around the track.
As I'm sort plodding along, I hear these rapid footsteps behind me and it's some little child who's just zipping past me, the feet flying and the legs pumping. I said, how do they do that? And there's a certain point where I just realized, well, I'm not programmed anymore to be able to, maybe I did that at that age, but I certainly can't do it now.
Tyson (46:57.634)
Ha ha ha!
Tyson (47:12.398)
So outside of that, I know we've sort of really established the fact that it is nuanced and it's quite different for everyone, but just out of curiosity, like what kind of routine do you have for your own personal life in terms of health and prevention of things like heart disease?
Ron Krauss (47:29.284)
Well, certainly diet is a big part of it. One thing I've done personally, I'll just say publicly, that when I was going through my education and medical school, even though I was supposed to be thinking about nutrition, I was thinking more about buckling down and getting my studies done, and I gained a lot of weight. I gained probably 30 pounds.
And I kept that on for probably too long. But when I started to realize that this was something I got to do something about, I actually started really focusing heavily on my diet. And I've been able to keep that weight off now for a long time by being very careful about portion size, which to me still is, for me at least, and I think for many people, the biggest...
culprit for weight gain. And then following, I've been sort of a proponent of a Mediterranean style diet, which the sardinians you mentioned would qualify for that. And focusing on vegetables, a variety of fruits, whole grains, limiting sugar, although I repeat myself now and then.
Fish, I think is an important part of the diet, which I eat fish twice a week. So from a dietary standpoint, it's the weight loss and that balanced so -called Mediterranean diet that I've found to be my secret for health. And then with exercise, I moved from the East coast, the US to California many years ago.
at about the time that I had all this excess weight and I decided that I was going to test some of my own studies where we showed that people that are heavy runners appear to have very healthy lipid profiles.
Ron Krauss (49:41.737)
low triglycerides, high HDL. I thought, well, that's very interesting. was seeing these data. thought, well, maybe I should really start running. So, and this was, I must've been 30 or so, 30 years old. And I live in the Hill area of Berkeley, California. And I started to do some running. And I realized as I was going up a slight incline, I felt like I was going to die of heart failure after half a block. And I realized this is not good. And so I took up
Tyson (50:03.18)
Ha ha.
Ron Krauss (50:09.837)
Seriously, I took up running and that's actually led to me peaking at half marathon and trying to stay active. now try to, it's really more walking fast than running these days, but I try to do that a couple times a week. And then I go to the gym three times a week. And so for me, the exercise is really important, particularly as I get older.
Tyson (50:34.606)
For sure. It's really interesting hearing people who take up running, especially when they haven't had a history in running speak about how they just can't understand that there could ever be any joy that you could take out of that. even as someone, I mean, I started running when I was 12 and as I mentioned, I'm 37 and for a great part of that, I've been running consistently and even still, say if I run five days a week, I would say three of those days, I feel horrific during the run. But the, always say that the post run feeling.
is my favorite feeling post exercise. I spend time in the gym as well, nothing comes close to that. Something about getting the heart rate up, feeling yourself sweat, having that little shake in the legs that suggests you've had a workout. It's the one workout I like to wake up from the next day and feel a little sore just because I know it's done something.
Ron Krauss (51:03.239)
Yes. Yes. Yes.
Ron Krauss (51:10.951)
Yeah.
Ron Krauss (51:14.247)
I agree.
Ron Krauss (51:19.623)
Yeah. And there was a time when I was getting the endorphin rush from the exercise. I'm feeling euphoric. I haven't gotten that so much recently, but that's another feature that keeps you going.
Tyson (51:27.821)
you
Tyson (51:32.436)
Yeah, for sure. Stress is something that often comes up in the conversation of heart attacks, especially as well. I don't know how much research has done on the correlation between the two factors, but it seems as though from what I've heard, there is some instance or some correlation between the two. I don't know if you can talk to that.
Ron Krauss (51:51.965)
Well, I think probably depression is actually been more extensively studied. Depression can be a risk factor for cardiovascular disease. Sleep disorders, which can be aggravated by stress, are definitely related to metabolic problems and heart disease risk. But as far as stress is a general category,
It's a little hard to pin down because there's so many different forms of it, but I think if it results in inadequate sleep or depression, that stress is definitely harmful. Of course acute stress, acute physical stress, if you already have underlying heart disease, unfortunately many patients only find out about having heart disease after they've developed a heart attack and unfortunately some of those people...
don't survive the heart attack. So because it's a silent condition, an acute stress can sometimes trigger a clinical episode that could be quite harmful. that's more physical stress than emotional stress. So there's various ways of considering stress. I don't think that field is sufficiently clear on exactly.
how stress fits into the risk equation. not because it's so difficult to, you it can't be measured easily. I personally think sleep is to me the most important index of stress that could be improved to reduce heart disease risk.
Tyson (53:32.127)
So interesting. So this is one thing that I've been discussing a lot because as I mentioned, the age of my kids suggests you probably know there's not as much sleep going on in my house as what I would like there to be. So the last, I've been listening to a book called Good Energy by Casey Means that just come out relatively recently, I think. And one thing she talks about as well is just the importance of a high quality sleep routine to maintain so many areas of health.
Ron Krauss (53:57.448)
Yes.
Tyson (54:00.194)
But this is something that every parent that I speak to at the moment is like, you know, we're really struggling with it as well. Like, I don't know how you navigate that or is it excusable for a period of your life or is it just part of the package of having kids that you have to just accept the consequences of? Because I'm really trying to, I mean, if it was up to me, I'd be sleeping well every night, but my boy Charlie just doesn't want to hear about it.
Ron Krauss (54:22.638)
Well, kids can probably get away with a certain amount of shenanigans, late night stuff. As we get older, that gets much more serious as an issue. I understand what you're dealing with. have a granddaughter who has gone through that phase as well. Whenever we get together, which is every week or two, I see her tending to doze off a little bit because she hasn't gotten much sleep tonight before.
Tyson (54:50.306)
Yeah
Ron Krauss (54:51.209)
Maybe these kids catch up somehow, I don't know.
Tyson (54:55.362)
For sure. Yeah. It's interesting to watch. Hey, I've got one eye on the clock. I know I'm about to take our kids out to the zoo. I know you've got plenty to get on with for your afternoon, but I was really looking forward to this conversation and really appreciate you making the time to come on. It's a subject that I'm fascinated by and I've loved hearing you speak from a distance for a long time. So yeah, really appreciate you coming here to speak to me about it.
Ron Krauss (54:58.557)
Yeah.
just yeah.
Ron Krauss (55:20.199)
It's been a pleasure talking with you, Tyson. So all the best to you.
Tyson (55:26.86)
Yeah, you too. Thanks a lot. We'll leave that there. We'll see you later, everybody. Awesome. Dr. Krauss, really appreciate it. Thanks so much.
Ron Krauss (55:33.587)
Thank