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Most people think about their health when something goes wrong.
Next Phase Human is for everyone who wants to start thinking about it before that moment arrives.
Hosted by Dr. Sandhu — a cardiologist with a focus on prevention, longevity, and whole-body wellness — this podcast brings together physicians, researchers, and wellness professionals for honest, evidence-based conversations about the topics that actually move the needle on your long-term health.
Each episode covers the intersection of cardiovascular wellness, modern medicine, lifestyle optimization, and human performance — translated into practical, approachable conversations for professionals, business owners, and anyone serious about living better longer.Topics include heart health, metabolic health, sleep, stress, nutrition, longevity diagnostics, wearable technology, recovery, burnout, and the future of preventative care.
This is not clickbait wellness. This is a forward-thinking physician who believes the best healthcare happens before you need it.
New episodes weekly.
So welcome to Next Phase Human podcast.
I'm your host, Rashim Sandhu. I'm an interventional cardiologist by trade.
So a little bit about what Next Phase Human podcast is.
I became a cardiologist to help people, but time and time
again, the thought was we are putting a Band-Aid
on. Someone comes with a heart attack, I put a stent in,
but again, are we fixing the real problem?
We give medicines, but what about lifestyle?
What about the other things that matter? What about sleep?
What about how you live your life? What about the mental health that affects
everything? What about the supplements that have become an integral part of our
life? To have those conversations that don't
happen because obviously there's a finite time, these conversations
do not happen that often in a doctor's office.
So that's why Next Phase Human, where we talk about
not just medicine, but about all things health.
And in today's conversation, we will continue our conversation with Dr.
Ajay Patel
about
the diet and how it affects cardiovascular disease.
Just to bring you up to speed, Dr. Patel is an interventional
cardiologist and a structural heart disease specialist.
He's the director of structural heart
at Adventist Health and Dignity Health Bakersfield.
He's one of the highest volume operator for high-risk
interventions in patients with multi-vessel heart
disease who have weak hearts.
And
glad to have you here. Ajay, can you tell us a little bit more about yourself, what
you do, and
just so
I can get to know you a little more.
Of course, yes. Glad to be here.
So I'm an interventional cardiologist by trade, like Dr.
Sandhu,
and I focus more on the structural aspect
and high-risk PCI. But day to day, I'm a general
cardiologist. I see patients with heart disease.
We talk about prevention. And
one of the things that in my training that I was
exposed to in the beginning with medical school was prevention.
I went to East Carolina Medical School
in North Carolina, and one of the things they like to talk about their feather in
their cap is they're one of the top primary care residency
programs in the country year in and year out.
And that has echoed in our training, in our med school, in our
rotations to always put an emphasis on prevention.
So as I was
taken away by cardiology and the glitz and the glamour and the adrenaline
rush of saving someone with a heart attack and doing complex procedures, because
I'm an adrenaline junkie at heart,
I always remember my roots. I always think about how do I avoid these
situations. And when we're in the hospital at 2:00 a.m.
doing these procedures, sometimes I wonder to myself, there's got to be a better
way.
Mm-hmm.
And I always go back to how do we make things better.
Perfect. That's awesome. And in our last conversation, we
were talking about plant-based diet, and we touched up on Ornish
diet and whatnot, and the reversal of heart disease.
So just to continue that conversation,
sugar-
Mm-hmm
... that's become such a big part of our life.
What's your thought on cereal? It's like I know a lot of Americans
love cereal and breakfast,
and then to top it off with a glass of orange juice.
Sugar on sugar on sugar.
Exactly.
Yeah.
So is orange juice really good? Is any juice good?
Right. So when you put it in the idea of if you have the
option to eat an orange or have orange juice, I'd say the orange is better.
There's fiber, right?
Mm-hmm.
There's pulp. There's that stuff.
But when you think about growing up, most of us had cereal every
morning. It was healthy.
Mm-hmm.
It was the right thing to do. You get energy for the day.
But when you look at the other options on the table, maybe there's
something a little better. And specifically, I don't think carbs or
sugar are the enemy. I think in moderation, anything
is theoretically okay. I think it's the simple-
Mm-hmm
... refined, ultra-processed versions of it.
So like when you have, I don't know, Corn Flakes, that in itself is
not ideal, but it's okay. But then you get Frosted Flakes.
Now you have sugar on sugar on carbs.
Mm-hmm.
And then you're adding onto it, well, that's just chaos.
And people wonder why kids go to school hyperactive.
Well,
right? That's one of the pieces. So when you're talking about sugar and for
breakfast, one thing, like me and my brother and sister, we love cereal,
but we don't eat it for breakfast. It's a dessert.
Mm-hmm.
Because it-
It is actually a dessert.
It's a dessert, right? Yeah.
It is.
So that's what we do. We eat it as a dessert, and we don't eat it all the time.
It's an occasion.
Mm-hmm.
Because we have that nostalgia of being a kid eating cereal in the morning.
So now every so often, we'll
call each other on FaceTime and eat Froot Loops. I don't know.
But it's one of those things we know where it belongs. It's not a health product.
It's not a daily product.
It's an indulgence.
Correct.
That's what it is.
Correct, yeah.
So
I know in your last conversation, you mentioned you have gone to one
meal a day.
Mm-hmm.
But if you were having breakfast-
Yeah
... what is a good, healthy breakfast?
So I would say variety. I wouldn't eat the same thing every day.
Mm-hmm.
That's a big point that I think a lot of us lose.
Everyone's like, "I'm going to meal prep. I'm going to eat this.
It's high in protein. It's low in carbs." Sure, but you want to
rotate. I don't think any of our bodies were designed to eat the same thing day in,
day out, period.
Mm-hmm.
And I think if you do that, that's where people become deficient in X, Y, and Z
or this and that. It's when you roam around and graze the fields-
Mm-hmm
... you're going to get everything, you'll be okay.
But if you said, "Okay, what's your ultimate healthy breakfast?" I
think anything that's satiating, anything that doesn't have a lot of simple sugars-
Mm-hmm
...
would be ideal. So, to throw a couple of things out there that I would do,
sometimes II don't eat a lot of eggs.
Mm-hmm.
But if I were going to eat eggs, I do egg yolk. Right?
Mm-hmm.
I do the egg whites if I'm going to put it into something, maybe with veggies,
or if I'm going to do the oatmeal route-
Mm-hmm
... with fresh fruit.
Mm-hmm.
And then I try to avoid the fruits that are just pure sugar.
Mm-hmm.
Right? And make sure there's a mix of things in there.
So just for our audience, what is pure sugar fruits?
Grapes-
So, yes
... would be one.
Grapes would be awesome, right? Depending, so if you're going to do berries,
blueberries, blackberries, mix.
Don't just go with one that's just super sugary.
Mm-hmm.
Try to mix it up, and then nuts.
Mm-hmm.
If I can throw in some nuts, flax seeds, chia seeds, whatever, you
can throw in there, granola.
Is yogurt good?
Yeah. So I think, again,
what type of yogurt are you eating? Is it super flavored?
Does it have a bunch of sugars in it?
Non-flavored.
Yeah, like just basic?
Greek yogurt-
Yeah
... basic yogurt, that's good, but we're not talking about the ones which come with
21 grams of sugar in a cup-
Right
... which are flavored. That's-
And then to play devil's advocate, I've always wondered, never done the research,
and maybe I'll ask ChatGPT tonight, you get these yogurts with such high
protein content. Are they fudging the numbers?
Are they putting whey protein in there? What are they doing?
Mm-hmm.
How do you get protein so high in your yogurt?
True. Yes.
I wonder.
Some of those you would think those are strained yogurts like Greek yogurt
or-
Yeah, Icelandic
... Icelandic yogurts.
Yes.
They are strained, and they are pretty dense.
Yeah.
So
that could make sense. But
that just brings up to, you talked about the whey protein and whatnot.
What's your thought on the protein shakes?
That question comes up often in talking to patients. Which ones are good?
Are they good? Are they not? How would you rate that?
So I think your body tells you. So 90% of the people I talk to
who drink protein shakes eventually hate them because they're disgusting, and they
do something to your gut, and you get side effects and all of these things.
So I think it goes in moderation. If your goal is to become an athlete and you're
working out for a goal and you're trying to hit certain macros to make
sure you hit protein goals, makes perfect sense.
If you're a normal person living 8:00 to 5:00 and you have to avoid a meal and you
don't want to eat junk food and you substitute a protein shake, great.
Mm-hmm.
That is awesome, right? It's going to satiate you. It's going to keep you low.
If you're drinking protein every day just because, horrible idea.
Mm-hmm.
Right? Because if you're not replacing a meal, if you're not working out, if you're
just taking it because you think it's healthy, bad idea in my opinion.
Mm-hmm.
Right? If you're eating normal meals, yeah, it doesn't add anything to your life, I
don't think, assuming you're eating a variety of food.
If it's replacing fast food, for sure.
Yes.
So it's-
It's what you compare it to.
Compare, yeah.
And then there are protein shakes which come packaged and have
preservatives in them-
Yes
... versus the ones you will kind of make from
non-denatured, cold pressed or whatnot, non-denatured,
non-preservative,
without any of that artificial junk, that kind of whey protein.
Correct.
That's better.
Right. And there was that article I forgot.
It was a consumer report published like the top
50 proteins and how much mercury and arsenic-
Mm-hmm
... and blah, blah, blah, blah, blah, blah, blah.
So sometimes you have to watch what you buy.
You just trust a brand, but you don't know truly what's in there.
And there are brands now which actually take pride in their purity and-
Right, they test it
... actually go batch by batch testing, and if you could, that'll be the
right way to go. So you can-
Yeah, especially if you're doing it often. Yeah.
Exactly.
Yeah.
Because all that, again, as with heart disease, what we talked
about, it's not what you did in the last six months.
Yes.
The arteries keep a score of what you do all your life.
Right. Exactly. It's like the rings on a tree.
Yes, exactly. You could tell what you've been eating if we were ever that
sophisticated to cut that artery at some point and see.
And figure it out. Yeah.
Exactly. So just to kind of go into, there is a
lot of talk online on seed oils.
Mm-hmm.
Tell us a little more. They provoke inflammation.
Inflammation we know is a problem. So are all seed oils bad?
Yeah.
Where do they fit?
I think seed oils, it's a misnomer or misrepresentation
people don't understand. Seed oils are safe.
Mm-hmm.
It's not the seed oil. It's what you buy it in.
Mm-hmm.
Seed oils are seen in every ultra-processed food.
Mm-hmm.
Right? So if you are looking at all this ultra-processed food, and you see the seed
oil, we're blaming it as a red herring.
Yes, it's true, if you eat an insane amount of seed
oil, your body can then take a small fraction of it, like
less than 1%, and convert it into a pro-inflammatory marker.
Mm-hmm.
But all things being equal, we're not taking cups full
of whatever canola oil or whatever your favorite seed oil is and
drinking it.
Mm-hmm.
We're adding it to food. We're cooking with it.
Mm-hmm.
Right? For most people.
Mm-hmm.
But if you are getting seed oils primarily by ultra,
like Oreo cookies or whatever your favorite cookie is, or
palm oil or whatever it is-
Mm-hmm
... that's the thing that's causing your inflammation.
That's the thing that's ruining your life.
It's not the seed oil as a seed oil. I don't think the
seed oil itself is bad. I think that's where everyone is getting this whole
conversation confused, is that you're taking one ingredient in a bad
product when the product itself is ultra-processed, and we're
just blaming this guy because we want someone to blame.
Yeah, it's just simplifying life a little bit too much.
Yeah.
You want a villain, you found a villain.
Correct.
Let's just go after-
It's in all these bad products. But if, for example, there are certain dishes like
you look at Asia, you look at these countries that do stir-fry, you look at people,
they're using seed oils all day long.
They don't have all this crazy inflammation disease, arthritis.
They have lower rates-
Mm-hmm
... than Americans. Right? So the math isn't mathing there when people
jump and say seed oils. If you look at any study
who look at longevity studies, like the best one is the Danish study looking
at canola oil specifically, it reduced heart attacks.
Mm-hmm.
Not increased inflammation. It decreased inflammation.
So when you look at population studies, it doesn't pan out that seed oils cause
inflammation. Yes, it's true as an individual, if you're drinking seed oils,
probably a bad move.
Mm-hmm.
But it's really where you're getting it from, the processed food.
But stands to reason that if you're into healthier diet and you have
a choice-
Yeah
... perhaps olive oil or avocado oil-
Way better
... may be a little bit better.
Way better, right?
Way better.
You get essential oils. Yes, way better.
So that would be a better option.
Yes.
But if youMust eat.
Yeah
Then seed oils are not the be all and end all-
Correct
... of all problems, as long as it's in the right context or in the right food.
Is that-
Yeah, and variation, like moderation. You're not eating it often.
Mm-hmm.
And then the other, I don't know, I guess a shout-out to canola oil, right?
Though it does have omegas, right?
It's good-
Mm-hmm
... in that sense, it has good fat. So,
painting all seed oils as bad and this, everyone
has their virtues.
Right.
Right? So, I think it depends.
So life is not that simple. You can't find one villain and shoot it- ...
and life is good. So Oreo cookies will be fine if you kill the seed
oils.
Right. It's vegan, apparently.
That probably won't be the case. Yeah.
So, what about butter?
Yes. So, I think butter is delicious.
I love butter, that it tastes good.
I don't think it's healthy in any way, shape, or form, and the frequency to which
we are accustomed is dangerous. So, I tell all my patients, butter is
delicious. Have it on your birthday, special occasion, when you're cooking a
special meal. It should not be a staple in your cooking
habits or your intake. It's whenever you make it a daily habit, you get
in trouble.
Mm-hmm.
Same thing when I tell people about egg yolks.
Yeah, you can have eggs for breakfast. Take the whites every day.
Avoid the yolks every day because it is saturated fat. Just spread it out.
Just-
But what about the nutrients that you have in the yolk?
This so often comes up. There is a bunch of nutrients in the
yolk.
Yeah.
And how do you kind of account for that?
It is a-
You get it
... nutritious product.
Right. I would say take it, but not every day.
That would be my thing, be moderate about it because the good comes with the bad.
You get the nutrients with the saturated fat.
Your goal is to decrease as much as you can overall because there's other yummy
things you want to eat.
Mm-hmm.
There's a scorecard, I guess, at the end of the day.
Right.
Try to figure out how to get the things you want and the nutrition you want.
So if you eat a yolk and not eat the cookies-
Right
... the chances are you're going to be okay, right?
You don't get the butter from the cookie and yeah, exactly.
Right.
So you try to minimize it as best you can.
Okay. And then, the old staple, the clarified butter and whatnot, the same
rules, I would presume, would apply to that also.
100%, right? There's some health benefits, they say, when
you take it, like ghee, clarified butter versus just butter, but same thing.
It's fat.
It is.
Yeah.
So now, another name that comes up often
when you go about listing the villains is TMAO.
Mm-hmm.
Especially associated with red meat.
Right.
So, can you tell us a little bit about that, what your thoughts are on that?
I know we established plant-based diet probably a little better.
Mm-hmm.
But we're not going to have everyone stop eating meat like we talked, everything
in moderation.
Right.
And there is people where you need meat, and yes, they're going to eat it.
Right.
And at that point, just to kind of recap and summarize, will
prefer lean meats,
even if you eat beef and avoid processed meats, which is bacon, sausage,
and all of that.
Right.
But if you do, where does this TMAO story
fit in?
So, I'm not an expert on anything meat, to be honest.
It's just never been my purview, something I'm super interested in.
But anything that causes inflammation or anything in that
wheelhouse that's there, you always worry about it.
So, my understanding is certain gut
bacteria will metabolize meat in a certain way, and you end up with
TMAO, which again, has adverse health effects
in relation to that.
So,
could stand to reason that some of the effects could come from that.
Is it a misnomer, is it a real villain, or is it just a misunderstood marker, or is
there just too much of it that's a problem?
I wonder, like the quantity game, definitely.
So, one of the things I did in preparing for this
talk was I looked up meat consumption.
Like, how many people really eat and how much, and that sort of thing.
It's sort of like the economy.
Mm.
Like 1% of people have all the money,
right?
Mm-hmm.
And the rest of us have very little.
Ironically, beef consumption follows in that pattern, which
I didn't realize.
Huh, interesting.
So, there's 12% of Americans that eat a boatload of meat.
Mm-hmm.
The rest of the people eat, whatever grading scale they were using, they were
quantifying,
and they had that. They said 12% of Americans.
Out of Tulane, they did a study looking at people, and they were just
shocked. They were like, "Actually,
not all Americans eat that much meat.
It's only 12% that are like," I guess you would say people are
carnivore-esque people who go after meat with every meal, versus most
people don't.
Mm-hmm.
So, it's kind of very interesting to put that in perspective, like, yeah, maybe
it's those people who are seeing such high rises and you see the diseases in those
groups. I don't know. But I was kind of shocked by that.
And in the Harvard study, you mentioned the whole map on where you actually can
live track into how things are being-
Yes
... affected.
Does it kind of follow the pattern of meat eating on that map?
Like more meat equals more heart disease?
Yes. So, they said
it's all-cause mortality, but cardiovascular death was number one for
all-cause mortality in that study, yeah.
So, in looking at some of the smaller study datas,
carnivore diet.
Mm-hmm.
Now, that's become a thing.
Yes.
And it's essentially to define it, it is a lot of
meat in the diet with very little fiber-
And fat
... or vegetables.
Right? It's meat and fat, yeah.
Yeah. It's meat and fat.
Yeah.
So, essentially you're going between paleo and carnivore and whatnot.
So, there's been some small-scale data as to reduction in inflammation,
improvement in insulin resistance, and
perhaps there's a couple studies even in inflammatory bowel disease, which is
Crohn's disease or ulcerative colitis, as to improvement in symptoms
and markers there.
How does that make sense?
Exactly.
That's what I'm trying to ask. How does that make sense?
And granted, the studies are small.
Agreed, yeah.
Their small follow-ups are small.
Yeah.I have a hypothesis. I don't know if it's accurate.
Mm-hmm.
So
whenever you go from one extreme to another extreme,
your body adapts or changes or something, right?
So, for example, if I go to one meal a day for a period
of time, my body will adapt. I may lose some weight, I may have some changes, and
then once I'm there, I'm kind of static.
Mm-hmm.
And then once I add another change, let's say I go only plant-based for a period of
time, my body will change and adapt.
Mm-hmm.
I would argue the same thing will happen whether you do a good or a
"healthy thing" or not, or let's say you go heavy into fats.
Mm.
Let's go all keto, or if you go into a carnivore diet.
Mm-hmm.
For these people who are suffering from said disease, they're eating a certain way,
maybe ultra-processed food, maybe too many donuts, whatever their diet
is, and then if you shift
to a completely different mode of intake, whether it's good, bad, or different,
your body will adapt. And I wonder if it's just that adaptation,
because a lot of these studies that look at it are very, like we've talked
about in the past, short-lived. They don't give you long-term data like all the
data, like we're talking about these, you have eight years of data or
three years of data.
Mm-hmm.
So I wonder, is it just a shock hypothesis where you go from one to the other?
Am I going from a sauna and then into an ice plunge, and then that's what changed
my life? Or is it the actual thing that I'm doing?
Is it truly just the ice plunge that's changed my life? I don't know.
So it stands to reason that when you go to carnivore
diet-
Yeah
... you're actually likely to be eating non-processed
foods. It will not have-
Correct
... a lot of cookies and processed carbs-
Right. Exactly
... and whatnot.
You're walking away from the seed oils, right?
Exactly. So is it the meat that's doing it, or is it the lack thereof
that's doing it?
Yeah.
I don't know. That's the question because
overall, from a bird's eye view,
inflammation, I associate inflammation with red meat.
So
when you see changes of the contrary, you have to beg the question, what
is it that these people, why is it different?
Why doesn't it follow the bigger, grander studies that looked at these
people? How do you make sense of it?
But
granted, most of these studies are measured in weeks and months at this point.
Right.
You don't have the five, eight, 10 years data or the endpoint data of how
many died, how many lived, or whatnot.
Right.
That's still the jury's out on that.
100%.
So, if you had to take home one point from
this, you would say it's
not necessarily that you're eating a lot of meat, it's perhaps what
you're stopped eating.
The processed food. Yes.
That's what's-
I think so
... creating the effect.
And I think you're making your metabolism work in a different way.
Mm-hmm.
So you're literally shocking your system, but through a diet.
So you're not eating processed carbs, your insulin is going to go down.
Correct. But I think if you keep down that train, it'll be interesting to see where
you end up. Probably in a dangerous place, I would suspect.
We don't know that yet, though.
Exactly. Yeah.
So tell me your thoughts on keto diet.
So it's very interesting. A lot of people have come
out, physicians included, right?
You see these social media doctors coming out saying, "People don't
understand diabetes. They've been doing it wrong all these years.
You just have to be on a high-fat diet."
I think that may not be the whole truth, but I think the keto
diet used
in certain instances makes sense.
I think if you look at the data-
Mm
... it's not a healthy diet, period.
Mm-hmm.
Unfortunately. I wish it was.
Why is that?
So basically, it has to go down to the same things we talked about,
why whole foods win, is that it's
very low on fiber, right?
Mm-hmm.
And it's really high in fat, saturated fat.
So it's going to make all these other metabolic markers worse.
Mm-hmm.
So it's going to increase your risk of heart disease.
It's going to increase your risk of metabolic syndrome.
It's going to increase your risk of fatty liver, all of these things.
But again, it could matter how you do it.
So let's say you did it like intermittent fasting, plus you're doing that, well,
you're not getting a lot of calories, maybe your body's going to burn through all
of it and not store any of it. Maybe the effect will be less.
But if you look at a normal person eating three meals a day, it's really bad for
you because you're going to get some wins where you lose a lot of
weight because you avoided all the ultra-processed stuff.
Your body's metabolism will shift. Your sugars will completely level out.
Your numbers will look pristine in the beginning.
But when you look at that same person in three months and six months,
there have been studies to look at the keto diet specifically.
Mm-hmm.
It all comes back, the weight, right?
The weight.
So it's kind of interesting if you look at weight as a marker, but then if you
follow these people long-term, their LDL goes up, and that's a marker we talked
about with heart disease. And then eventually, there's
that idea that fat makes diabetes worse.
So when you put fat into your muscles, you become insulin
resistant.
Mm-hmm.
So I'm talking about overeating, but I think in America that means
normal eating, right? Overeating is the norm in our culture.
Mm-hmm.
We eat three meals a day when you don't really need three meals a day, so you're
just storing fat. You're storing fat.
And then when you store fat into muscle, now you become really
insulin resistant.
Mm-hmm.
And I think you're probably setting yourself up for a really bad case.
So all these people who are really
disciples at the keto diet, there's a
lot of people online who swear by it. Their numbers are fantastic.
I'm like, "Be careful. Keep up with your numbers. Your numbers look good today.
I'm happy for you, but make sure that train is still going the right way
a year from now."
And there may be some people where this
may be the right way of life. Everyone's microbiome is different.
That's fair.
Stand to reason maybe there are some winners out there who have figured out-
Right
... the right diet for them.
Yeah.
But when you talk about most of us-
Yes
... the masses-
Yes
... then perhaps one size does not fit all.
Agreed. I think at the end of the day, you got to test.
If you're going to do something where you're going to make a big change in your
life,
don't guess. Test, right? Go see a doctor, get a lab test.
Make sure the changes you're doing are going your way, and then keep up.
Don't forget.Right, because you don't know what's happening unless you look.
Right. And in terms of timing of meals, you talked a little bit about you
feel great when you go to one meal a day or two meals a day.
Mm-hmm.
In terms of timing of meals, what's the right timing of meal?
It's pretty common notion,
eat late, eat heavy. Dinner is generally for a lot of Americans is the heaviest
meal of the day.
Mm-hmm.
And you eat dinner, you watch TV, you sit down
with family, and then you go to bed.
Yeah.
And pretty much most of the times when
your stomach is still full.
So what's the general thought process on that?
How many hours before going to bed should the dinner be?
So is this for someone eating three meals a day or just one meal a day?
Let's go with the standard two to three meals a day because that's what most of our
listeners might be.
Yeah. So then I think that's unfortunately what we all do, and it's the worst thing
we can do for ourselves is to go to bed with a full gas tank because
your body is just going to add it to your fat reserves.
Mm-hmm.
Because you're not about to burn it.
If you are starving all day like me, and then you eat a big meal like I do because
I like to sit and watch TV sometimes, right, I am restoring all the things
that I burned through my day.
Mm-hmm.
So I'm just refilling my gas tank. I came on E.
So I think you have to put that in perspective.
So if you were going to have dinner, it'd be better to eat it at-- You definitely
don't want to have a big meal and go right to bed in an hour or two.
Mm-hmm.
I think that's a bad move. I think being more European, air
quotes, or being more like people who are more active after
a meal would make the most sense. So let's say you do have a big, rich
dinner. Fine. Maybe you have it at least four hours before bedtime, so
like an hour after you can go for a stroll.
Mm-hmm.
Go for a 30-minute walk, burn some of that energy you put in, and
prime your muscles so it's going to your muscles and it's not going into your gut
and becoming visceral fat, right? So I think that's one of the life hacks.
One of the cool things that you see and what influencers always like
to throw these things out there to confuse you.
One of the big things I think a while ago was like Hong Kong eats a lot of
meat, but they have longevity explained that they're eating the carnivore
diet, right? And one of the things you see is, well, no, they're not
eating a lot of meat all the time.
Mm-hmm.
They're eating meat with meals, but what they're doing is walking.
On average, every person in Hong Kong is walking north of 10,000
steps every day baseline.
It's baked into life.
Correct. Right? And that's not something the average American does.
We drive 10,000 steps a day, right?
So it's a very different view on that.
And then the way they eat and the times they eat, it's all very different.
So you have to put things into context.
So, you can take things like that and say, "Well, they eat a lot of meat.
They are super healthy. Why can't I do that?" Well, they're not you, right?
Life is different around us.
Correct. Yeah.
And in terms of, you just mentioned visceral fat, so
can you tell us visceral fat, what is it? What's the right amount?
How does it impact us?
So visceral fat is something that develops around our
organs. It's basically store-
It's not the fat that I see here on the stomach.
No, it's not the one that's visible to us, right?
Okay.
That's actually safe adipose fat,
brown fat, right? So that storage, a rainy day, you're
starving. There's a famine that hits.
You can utilize that. The visceral fat is fat around our organs, and
it's highly linked, unfortunately, to, you heard
the term skinny fat.
Mm-hmm.
So some people are predisposed genetically to it.
It's where you can look thin, but you actually have a lot of fat around your
internal organs, and these are the people that have the highest risk for
cardiovascular death and these things,
because it's like your body is basically confused as to
where to put the extra storage, and it's putting it in
a location where it wasn't designed to store long-term fat, is basically the
way I think about it. But the utilization of it is not also great because
it requires higher insulin usage, so your body can't even move it
quickly. So it's the worst place to store fat.
Basically, when you're getting visceral fat, your body has decided
you are a full gas tank, and now it wants to store extra
calories in a place it shouldn't be, is the way I look at it.
And that's how I kind of make sense of it.
But basically, it's a marker that you are in a
very bad metabolic state. So that's where you hear the terms,
what's it? Metabolic syndrome.
Mm-hmm.
Right? And then you hear the term NASH or fatty liver.
Mm-hmm.
Right? These all are kind of on the same spectrum.
Basically, your body has too much
energy in this form of fat, and it's just putting it somewhere where it shouldn't
be.
And how does one measure it?
There's different ways, right? So,
there's different scans to look at it.
DEXA scan.
DEXA scan's one. There's this, I forget, fiber scan.
If you go to see a GI doctor, they can do that.
For liver fibrosis.
Correct. Or ultrasound of the liver that can also-
That'll tell you about fatty liver.
Right.
And then,
of course, there are these impedance scans that, like the
impedance scales, are they any accurate on that, but gives you a ballpark-
Yeah
... sort of speaking, the microcurrent impedance scans.
I haven't seen too many of those. Have you?
Like I-
That's like the home usage on this
primarily. So these weighing scales, they'll send a
microcurrent and kind of based on the resistance and
whatnot, they'll calculate how much subcutaneous fat, how much visceral fat, and
whatnot. They don't-
Oh, wow
... fully correlate, but-
Yeah
... sort of gives you a ballpark.
Give you an idea.
Gives you a ballpark.
And if you're actually actively trying to lose weight, it'll give you a change.
Right.
Which is what you're looking for.
If you're using it, I wouldn't take that as an absolute value.
I would follow the trend that you have over time.
Correct.
That may be useful.
So,
switching gears a little bit. So I know meat is not your
specialty, but
you talked about our animals. They have become processed animals, really.
Yeah.
The farm-raised beefSo would stand to reason grass-fed
beef is better?
I think anything-
The pasture-raised.
Yeah, or wildlife, or if you go hunting, that's probably way better, I
suspect, because their fat content will be less.
Mm-hmm.
I think that would be it. I think if you truly went
to that lifestyle, like they say, hunter-gatherer paleo-
Mm-hmm
... well, you have to eat like them. They didn't eat every day.
Yep. That is true.
Right?
They didn't.
They didn't eat every day. They ate maybe once a week, maybe. I don't know.
Their meat content was probably, one would guess, a couple times a
week. There were no refrigerators to store it.
Correct.
You have to eat it. You kill, you got to eat.
Exactly.
And then, the cured meats, that's another thing that kind of became common around
that time.
Mm-hmm.
So
again,
it's moving away from processed. And you can eat raw beef, but
if the whole animal is processed and inflamed and fatty-
Correct
... it won't make a difference.
Mm-hmm.
Now, in terms of supplements, fish oil,
good, bad, needed, not needed?
Yeah. So I think,
going back to that talk where we were talking about certain
diets, when you restrict yourself from certain foods, maybe it's like going down
the supplementation thought process with fish oil.
If you're avoiding foods that are fatty and you're avoiding even good fats, maybe
taking things like that that have omega-3s and 6s, you want to make sure you get
those.
Mm-hmm.
If you can, I would advocate getting it from a meal-
Mm-hmm
... because that's always the best way to do it, like canola oil or whatever the
heck-
Salmon.
Right. Yeah.
Is a great source.
Flaxseed, chia, anything. But if you can't get that on
a routine basis, yes, I think doing the supplementation for those, it
makes sense.
I don't know. Have you ever seen anyone deficient in it?
I have yet to find a human being deficient in it.
How do you define deficiency? So the way I look at it is there
is a limit to survive, and there's a limit to thrive.
Okay. Yeah, that's fair. Okay. Yeah.
So I've kind of always looked at it, I just don't want to survive.
You want to thrive.
I want to thrive.
Correct. Okay.
So-
But that's a different context. Yeah.
Exactly. So I would
go for fish oil. It's going to be helpful for me, I feel.
Yes.
So that's a supplement on my must list.
There's a bunch of them that I take, but fish oil-
Is one
... would come in the top tier one.
Yeah.
Vegan diets.
So this is
kind of a showdown between the vegan diet and-
Yeah
... the meat diet.
So the diet with meat would give you
these supplements. Fish oil would be a part of it if you eat fish, of course.
Yes.
That is a part of it. Then certain vitamins, then creatine, which we
know is useful or-
To work out. Yeah
... at least believe. Workout or even for the brain.
There is data on the cognitive enhancing effect of
creatine.
Those are the things that you will miss
in a purely plant-based diet. So would you recommend someone who
is on a predominantly plant-based diet, like
yourself, to supplement it with certain things that might be missing some B
vitamins, some creatine, some fish oil?
Does that become a part of it?
I think if you're strict on your diet and you truly exclude those things, yeah,
I think you should look into that. So I cheat a lot.
So on weekends, I'll eat... I'm vegetarian.
I will have products that will have B12, vitamin D, all this stuff.
So I don't tend to supplement much
because I try to have a meal that will cover my bases.
But if my goal was to work out, and we've talked about this, I barely go to the gym
anymore, so I'm trying to get back into the gym and I'm trying to motivate myself,
so creatine I think is awesome. It
allows you to lift heavier, have more endurance to do more.
That's an easy cheat code. I love that.
So I go to that personally to use it if I'm working out.
If I'm sitting on the couch all day, I'm probably not going to do it because I
don't know. You said the cognitive benefits are there, and
anecdotally, when I've done it, when I do travel to the East Coast and back to
visit my family, I do notice when I take it,
it's not as bad for me. So I do it on those occasions.
So I definitely like creatine for that.
It works great for sleep deprivation. It works great, actually.
Yeah. Like when you have a night where you get called all night and then the next
day you have to be functional? Yeah.
Yeah. It does work for that.
Yeah. So I think in those cases, those are wonderful. Yeah.
And what's your thoughts on intermittent fasting in terms of 16
off, 8 on, or
when do you do 72-hour fasts if you do it?
Or longer fasts, is there any benefit? Do you do it personally?
What's your thoughts on those?
Very interesting. So there's so much research on fasting that people have forgotten
about. It's so weird because we got into the fasting thing, so I went down a rabbit
hole. So as far as the
daily fasting, I basically say whatever is comfortable to you.
When you put yourself into an uncomfortable situation, it's not going to work.
Mm-hmm.
So if your goal is to eat one meal a day, play around with the hours and see what
works for you. But I can't say one way is the best for any individual
because we're all a little different. You got to figure out your flow.
But then when you talk about prolonged fasting beyond 24 hours,
it takes effort, takes planning. Make sure you're hydrated, all those things.
You don't want to get dehydrated. You don't want to faint.
You don't want to put yourself in a sticky situation.
Maybe using caffeine to help augment it so you're alert and energized,
which we did,
may be important. But when you look at the health benefits,
when you talk about 72 hours, that's when you get into autophagy?
Autophagy.
Autophagy, right? And you're talking about that. It's very interesting.
I don't know of any randomized control trials.
I don't know of any longitudinal studies.
All we have is a bunch of rat trials, a bunch of animal experiments, and
very small cohort studies that say it's really
good.But we don't have the long-term data on it, but it's
kind of cool to see what happens to your body when you do that, right?
Your body's defense mechanism goes up.
Mm-hmm.
They claim it could potentially help fight cancer.
Mm-hmm.
They're doing clinical trials today in America, randomized control trials at
major universities on people getting chemo with fasting.
Mm-hmm.
So, there's a lot of belief in that this is going to be potentially a game
changer for people's health, because if you do it every so
often, you're basically priming your body.
So, can I put a wrench in this talk?
Mm-hmm. Go for it.
So, here's something new that I learned while researching diet, which I didn't know
existed. So, in March of this year,
AI, through data scientists, discovered that
vaccines seem to be linked with decreased
incidence of dementia, which blew my mind.
I did not know-
Which vaccines? Any in particular?
Great question. So, two in particular have been studied, the flu-
Mm-hmm
... and shingles.
Why is that?
Great question. So, these are the questions. People don't know why.
They only know what the data says. They looked at
100,000 lives in the United States, and then they looked at the world, because then
they got a world database. This is out of University of Texas.
Their neurology department and their bioscience data department somehow got
together. They don't talk to each other. They found each other through AI.
Mm-hmm.
And they figured this out. They're like, "Hey, we have this huge data set.
We're seeing that people who got the flu vaccine year after year have less dementia
than the people who don't." Now, it's like, well, maybe those are just different
lifestyle peoples. People who get the flu shot obviously take care of
themselves, and people who don't, don't care about themselves, maybe.
Could be, yeah.
And maybe that's why they get dementia. Maybe they're smokers.
So, these guys said, "Well, that's a great question." They propensity matched-
Mm-hmm
... freaking 100,000 humans, and they went down the
list. Smokers, they were equal number. Diabetes, equal numbers.
Statins-
So, can you tell for our listeners what propensity matching is, just in layman's
terms?
Yes. So, they basically found a group of people who got the flu vaccine and the
people who didn't, that are equal in every single characteristic.
So, they matched-
So, they matched one to one, just-
Exactly
... matching essentially, for the lack of a better word.
It's one to one-
Yes
... matching across boards.
Exactly. So, if there's a smoker on this side of the team that got the flu vaccine,
there's a smoker on the other side. And they did everything you can imagine.
Men, women, Parkinson's, diabetes,
everything, medicines they were taking. They went down the list.
So then they were like, "Okay, how do we know that this isn't just some lifestyle
thing?" Maybe these people just happen to be more active, they go to the gym
more, and it's not truly the vaccine.
So, first they matched them, and they showed a major difference.
They said, so if
50,000 people got the vaccine,
20,000 people won't get dementia.
Mm-hmm.
It's crazy numbers. These are mind-boggling numbers.
I want to see if it gets verified with repeat studies.
So, they did it first with the flu vaccine.
Then they saw the people who did it year after year had even
lower chances of getting dementia.
And then they said, well, they have two different types of the flu
vaccine, which we have the live and the other one, so one's higher dose, one's
lower dose. The people who got the live dose, the higher dose,
had less dementia than the people who just got the regular dose.
So, clearly it's
defined by some immune process.
Mm-hmm.
That when we activate the body's immune system to fight the flu, it activated
something else that helped us protect against dementia.
Then they replicated it in shingles vaccine.
Mm-hmm.
And they saw the same curve.
Yeah, I saw that. Yeah.
So, I'm like, whoa, this is amazing.
If you ramp up the immune system, we're seeing something here.
And obviously, it's interesting, the reason these guys went down this path, I think
they were worried about what's happening with vaccines-
Right
... COVID, blah, blah, blah. There's a lot of concern of vaccines.
And then AI flipped the script on them, and they're like, "Well, actually it
prevents dementia."
Interesting.
Right?
So, I think it kind of goes along the same path, like hormetic stressors.
You go to for a cold plunge, you go for-
Yeah
... a sauna, and you basically put the body in short-term
stress,
and that's great for long-term as long as that stress stay as
short-term.
Yes.
And you rev up the system, and then let it rest.
What's killing us is the long-term, low-level stress that we
live under, and the body's in this constant state of low-level
stress.
Yeah.
That's what's killing us, but these short-term stressors, perhaps that's how we
evolved.
Right.
We were built for that.
Yeah. We can handle the big things. It's the death of a thousand cuts, right?
Right. That's what's
kind of been-
Yes
... the detriment of health.
Now,
there is some data on the genetic effects of fasting
also, some genes that turn on and off-
Yeah
... at 24 hours, like the sirtuins
kind of repair mechanisms that turn on.
So, is fasting, should it be a regular part
of diet for everyone-
I think-
... or like, and if yes, how much?
Yeah. So, I think my answer is yes, and mainly because of the same thing like I was
trying to say with the vaccines. You are basically augmenting your
inflammatory system. You're forcing your body to deal with stress.
You're fighting these things, and our bodies were designed to
adapt.
Mm-hmm.
So, when you do the same thing day in, day out, you're doing slow things, you're
not really forcing your body to basically rise to the
occasion, we're basically, unfortunately, putting ourselves at a
disadvantage. It's
weird. We think discomfort is bad. Sometimes no pain, no gain, right?
Yep.
But that's the way I look at fasting. You got to put yourself in that moment.
How much? I think it's got to be with the variety of life.
If you live a very active life,
and you do these things often, maybe you don't have to do it that often.
But if you are basically a couch potato and you eat the standard
American diet, and you're not very active, maybe you should do it every month.
I don't know what the right answer is to that, but maybe you should increase the
frequency to help.
And there's no real data-
Correct
... sort of for that.
Right? This is just a guess.
This is basically just what we are thinking.
Correct. There's no science to frequency on that.
But I would say, if you're doing nothing, if you're saying, "I want
to start being healthyThat's the one thing you could probably start with without
putting a lot of effort.
And autophagy is a big part of it.
Yes.
So just to clarify for our listeners what autophagy
is, it's the cells which are not functioning that are still sitting there.
So essentially, they are junkyards in your body.
Yes.
They're cells which have kind of finished their lifetime of work, and they are just
sitting there and creating inflammation.
So
your own cells eat up that debris or junk-
Mm-hmm
... and free up the raw material for body to use and take away the junk that's
sitting there and creating inflammation. Is that fair?
Exactly. Your immune system goes out, eats up all the junk that it needs to, gets
it out of there. Yeah.
Perfect. Now, there's a lot of talk.
We touched up a little bit on this, on calcium scoring.
Mm-hmm.
And calcium in the arteries, bad deal for most of us.
Now, calcium scoring in your practice,
is that a standard test that everyone should have?
And if yes, when do you get it?
So yeah, I think if you're coming to see a cardiologist and we're talking
about prevention, there's like a 99.9% chance you're probably going to get a
calcium score, because it's one of the few tools that is minimally invasive
that gives you so much information so quickly.
Mm-hmm.
So I think it's very, very powerful in that sense.
And then I think it has to do in the context of family history, which is a
big part. So if you have a family member that has had a heart attack at age, let's
say, 40, and you're 30, I think it's a great test for you
because you can see, especially if it's your father or your brother or
someone in that age group, you can say, "Well, do I have that same disease, and
where do I fall in that spectrum, because I feel great today?" So for you, it's
amazing.
If you're someone who's had open heart surgery and you've seen a cardiologist,
now you already know you have heart disease. It's not really helpful.
That's already established.
Yeah.
So nothing groundbreaking-
It's not for you
... coming for that.
Yeah.
And then a couple new markers. So everyone knows about cholesterol-
Mm-hmm
... that LDL and HDL. Now, there are two things that
we want our listeners to kind of look into, the ApoB-
Mm-hmm
... the apolipoprotein B as a test, and lipoprotein A.
Yeah.
Where do they fit in?
Yeah. So
LipoA specifically, right?
So the way I think about it, I like to make things a
little more simple than they truly are.
So LDL is a marker that's been studied for a very long time, and we know it's
associated with cardiovascular death.
But if you drill it down and look at the markers in there, LipoA and
LipoB
kind of show you how bad that inflammatory process is and
how likely you are to get it.
We don't have today medicines specifically
targeting
this test, meaning we know that you may be high on A or B, but
we know that all the lifestyle things that we talked all day, right-
They still work
... about. Yeah, exactly. They can help lower these things potentially.
So we always say, hey, it's good to know because let's say you're
one of these people walking around and maybe your cholesterol panel is so-so, but
your LDL is not too high, but then you get your LipoA and it's sky high.
You're like, "Oh, you're actually a ticking time bomb we didn't
know on the baseline test." So we look at the ocean, we
didn't see any icebergs, but we didn't go a foot deep and see, holy crap, there's a
big iceberg right there, and we're headed toward it.
So it can kind of inform you that no, truly this, it does matter.
So about 16% of people have it.
Right.
And
right now, as you said, there is no medications.
But if so,
sufficient to say one time check in life, that's reasonable.
Either you have it or you don't have it.
Yeah.
That's reasonable.
I agree.
And then ApoB,
where does that fit in? The
way I kind of broke it down as the LDL
is like all the bad actors in your arteries.
Yeah.
But every cholesterol particle has an ApoB attached to it.
So it's like counting how many cars are actually there.
You may have a lot of bad actors, but very few cars.
They are all packed into
many into one car each, and it may not be as bad-
As you think it is, yeah
... as you think it is. So it's perhaps a little more accurate marker
as opposed to just LDL.
Yeah. And I think it's especially important when you have these-- Sometimes you see
it where people have really high numbers-
Mm-hmm
... and they're trying their hardest.
They're doing all the lifestyle things, and you're like, "What's happening?" And
then you get that blood test, and you're like, "Oh, okay.
This makes a little more sense. It's not as bad as we think it is."
Fair.
And then other times it's the opposite, and you're like, "God dang it."
Exactly.
It cuts both ways.
Correct.
And once you have calcium score, this is a question that comes up often.
You have calcium in your arteries. Can you do anything about it? Does it go away?
Or is your fate sealed?
No.
I don't think our fate is ever sealed on anything, I hope.
Mm-hmm.
But specifically for cardiovascular disease,
like we talked about with the Ornish, if you went extreme whole
food, plant-based diet, you could reduce it. If you go on medicines, right?
We have the statins. We didn't even talk about the PSK9 inhibitors.
They can help regress plaque by just dropping your cholesterol to super
low levels beyond even guidelines, and you can see sometimes people
get lucky, and you see regressions.
For those patients that we talked about how sometimes I do these high-risk PCIs,
these procedures on people who cannot get open heart surgery because their
disease are too bad, and they're just risky.
I really focus with them, and I say, "Hey, we're going to take these medicines,
we're going to change our lifestyle, and we're going to really drive down these
numbers as low as we can with the hope we see some regression."
Mm-hmm.
So to the point of calcium score. Calcium score is a marker that plaque is
building.
We could definitely freeze it. We can stop it, but to regress it, to
actually remove it, takes effort.
So with diet, lifestyle, exercise, medication, it's usually all of the
above, to be honest, and just try to bring it down.
Fair. So as long as
you have a high calcium score, but if you start hitting all the right
markers-
Mm-hmm
... which is clean,
non-processed foods, mostly plant-based or to an extent plant-based.
Mm-hmm.
And of courseQuality lifestyle, exercise,
good sleep, that's underrated.
Mm-hmm.
And
then the medications come in.
But once you have that amount of disease,
you get this pushback every so often, "But I want to do it with
lifestyle." But your calcium score is already 800, or
you've had disease.
In my mind, that ship to do it with lifestyle has already sailed.
Lifestyle is a must, but it alone won't do it.
Correct.
Is that correct?
I think, yeah.
20 years ago, we could have had that discussion to prevent, but when you see a
positive calcium score, we're not preventing it anymore, we're protecting.
It's already there.
Right. We're not on the offensive, we're defensive now, right?
Right.
It's already happened, we got to protect. Yeah.
So
you can't complete a discussion about plant-based diet without talking
about Beyond Meat-
Yes
... or fake meat.
Yeah.
So what do you think about it? What is it? Let's just define first, what is it?
So it's basically highly processed food.
Let's be very, very clear. And it's usually made out of
soy or,
what's the other things? It can be
lentils, it can be brown rice, peas.
And it's highly processed. They put oils, which are not good for you,
other additives. And basically what they're trying to do is they're trying to mimic
the macros, so the energy level you'd get from, let's say, beef.
Let's just use beef as a comparison.
They have chicken version and everything else you can imagine, right?
But just if you do the comparison arm,
so the fake meats, if you will, Beyond Meat, Impossible, they're trying to
give you the same sensation of eating meat and the same
energy level with theoretically less saturated fat,
right? So the question is, we know ultra-processed foods are bad for us.
Mm-hmm.
And basically, everyone would agree across the board, it doesn't matter what you
pick,
processed food's probably worse than real food, right?
Mm-hmm.
So then let me ask you a question that's kind of interesting because it's
interesting they've done a little bit of research on this, not a lot, but they
said, well,
what about red meat? So if we have an
ultra-processed version of red meat and you gave it to somebody
versus the real thing, is the real thing better?
Is the natural thing better for your health
than a highly processed version of it? What do you think?
I would guess, as long as it is pasture-raised, grass-fed beef, I'll take
that any day.
Right. But what is healthier for you based on,
let's say, saturated fat markers or things like that?
Because if you look for a one-for-one comparison, it's way lower on saturated fat.
Mm-hmm.
And so obviously The Impossible people, the Beyond people, that
industry-
Mm-hmm
... obviously are going to fund studies.
Right.
They did. And they looked at the one-to-one comparison, and it's interesting.
It's the only time a,
quote unquote, "evil corporation" did a study of highly processed food
and showed a benefit, where they showed literally LDLs come
down. They showed all these markers of inflammation coming down
across the board because what they did is they just basically took highly
processed foods, plants, and oils, right-
Mm-hmm
... away from the thing that they knew had a lot of it.
Mm-hmm.
And they did a one-to-one swap. So basically, if you're eating X amount of meat,
you got the same amount of Impossible or whatever.
And was it a well-balanced study in terms of-- Because you
and I both know studies can be-
It just compared an apple to apple.
All they said is, "This arm, you're going to get real meat.
This arm, you're getting the fake meat." Or they didn't even tell them, but they
could probably tell the difference if they really paid attention.
And they just followed that one meal, and they showed all those markers
going down.
And they lived similar lives, both arms?
Besides that one meal, I don't think they
really controlled anything.
They didn't control anything else.
But they couldn't pick. So when
they did the study, they're like, "You get A or B." It's like a placebo.
It's randomized.
Mm-hmm.
You're getting real meat. Maybe not. Who knows?
It's a-
But what you ate for lunch or breakfast didn't matter.
Yeah. They could eat-
That was not controlled. They could eat whatever.
Right. So they could eat meat for breakfast in that arm or either arm.
So they just kept it the same.
Mm-hmm.
But they showed that that one change
for, it was one meal a day that they controlled, and they did it for two weeks, and
they did markers before and after, and they showed a huge reduction in LDL.
25%.
Why do you think that's the case?
It's probably because of the intervention, no?
Do you think it's some other variable?
Could be. Again, I haven't read the study.
Yeah.
I think we must put it in our show notes-
Yeah
... for everyone. That'll
be good.
Yeah. It's kind of interesting. It's like the only time someone ever talked good
about ultra-processed food.
Well, that may be the one event in history.
Yeah.
Perfect. What about eggs,
in terms of if you eat them?
Mm-hmm.
We talked a little bit on that. What's a lot? What's a little?
Again, does it go with lifestyle?
I think so. If you look at your total calories.
Certain people love to eat eggs every day, and I tell them
moderation's the key to life. Don't do it every day.
But they're like, "Well, I do a lot of activity." Well, if your activity justifies
that caloric intake and you don't get a lot of saturated fats from the rest of your
diet, let's say you are eating a whole food, plant-based diet otherwise,
okay. I guess that's fair, as long as you're keeping it rational.
But most people don't do that. So I think what's the right
amount of eggs? Not every day-
Mm-hmm
... I think would be my answer. I think you have to do it in moderation.
Right? If you're just saying, "Okay, no, no, no, I'm just going to do the egg
whites for the protein." Okay. Well, then you could do that every day.
I don't see what's wrong with that. It's just a source of protein for you.
Mm-hmm.
But if you're doing it with the yolk, for those nutrients and that saturated fat,
you kind of have to put it in the right space.
Because I think anything you do often and always
can lead to trouble, unless it's a whole food.
Mm-hmm.
Like a plant. I don't know. Because those things you can eat all every day, but
most people do a variety. They change it up.
They're not eating the same plant every day.
Right. They're switching it up.
Correct.
Is there any supplements that you take daily?
Not always. So right now, if I'm trying to work out, creatine, I'm doing
that for sure.
Beyond that,
not anything in particular.
People talk about if you do a strict, I'm talking about strict vegan
diet, B12.
Mm-hmm.
Right? You can be low on that. And some people say iron.
Again, that's only if you're being very strict on those type of things.
But beyond those, not a lot.
Would you take fish oil if you were a strict vegan?
Yeah. I think if I'm not-
Then you're not being a strict vegan because that's, again-
Right
... coming from an animal source.
So they have the kale, is it off algae?
Mm-hmm.
So you can get it through algae. You can get your omegas through, there's an algae
oil that you can get. So if you want to be, you can go down that
route. So if you have religious beliefs or you have some other
belief as to why you do that, there's a route to get it.
So if I were to be a strict vegan-
Mm-hmm
...
some of the things I could consider, the B complex of vitamins.
Mm-hmm.
The vitamin D.
Yes.
And of course, the creatine and fish oil.
Would that be reasonable?
Yeah.
Am I missing anything?
No, I think so. I guess, yeah, defining the person.
If you're going to be an active person, and you want to work out, and you want to
have endurance and strength, yes.
I think you hit all the highlights on all the supplements you want to make sure you
take to make sure you're putting all the right things in your body
to get that energy level.
So if you were a cardiologist who's eating everything-
Yeah
...
give me three foods that you absolutely would never touch, not with a 10-foot pole.
That would cause heart disease, right?
Yes. That would cause heart disease.
We're not doing this based on how delicious they are.
We're talking about just health, right?
Right.
So, unfortunately, I don't eat it, but I think red meat's on the
top. I think underneath that would be butter.
You said specific foods, right?
Mm-hmm.
So it would be butter and then unfortunately, underneath that would be ice cream.
Right? Because these are high-yield foods for saturated fat.
Mm-hmm.
Right? That's basically what it is.
I'm not saying you can't eat any of those things.
I'm saying if you eat any of those things frequently,
you're going to have-
You're going to have problems
... correct. Your cholesterol profile will go up.
Fair enough.
And so let's project 20 years from now.
So if you go back 30, 40 years-
Mm-hmm
... smoking wasn't so bad. They brought cigarettes in the hospitals also-
Right
... in the '70s and-
Camels are the preferred for physicians, right?
You saw those ads, right?
Yeah.
So
if we were able to peer into 20 years in future-
Mm-hmm
...
what is couple things you think we'll be talking, "You know what?
This was ridiculous, man. Can't believe we thought it was good."
It's probably going to be something with our cellphone.
I'd put a lot of money. It's either going to be how much we use it,
social media, whether it's just having it close to us all the time.
I think that's going to be a big one.
And then I think the other thing about lifestyle and how much we
under prioritize sleep
for efficiency, just to have the phone in the bedroom and things that go
around basically our phone. Our phone keeps us connected to the world 24/7, and we
kind of need a disconnect cord sometime.
I recently
started talking to a person, and something that she does often is at 9:00
PM her phone goes off. And I'm like, "What's this about?" And she's like, "Just
got to disconnect from the world because I'm up at 8:00 AM, I'm working all day."
Has an intense job, very demanding, does a lot of things in an admin
role. So a lot of things going on in her world.
So she's like, "I'll keep my phone on all day.
I won't use it after 5:00 unless I'm called, but after 9:00, it turns
off until 6:00 AM." And I'm like, "That's an interesting way to live your life."
Most people don't do that.
But that's probably the right way to live your life.
I think so, right? Yeah, you disconnect yourself.
But I think that's a
great
observation on her part to look at that and then walk away from it because I
bet you we're going to realize we're using this guy way too much.
I have to agree.
Yeah.
Where does alcohol fit in?
So
my favorite myth of all time is wine is good for you.
Mm-hmm.
And I think cardiologists, we invented it.
And a lot of cardiologists own wineries, so there's probably some-
Right
... yeah. There's probably
not a great look, but I think it came from a place of honesty.
People truly believed when that data came out that this is a
miracle, this is why the French live forever, it's why the Italians live
forever.
It's why Americans don't. It's because we don't drink enough wine.
That whole French paradox has a lot more to it-
Correct
... than just red wine.
Yeah. So, it's not one thing.
Right.
But I think that's where the myth grew, and then it just kind of
bloomed. But really, at the end of the day, unfortunately, I think we all
can agree as cardiologists, it's a dose matter, but there's something
called alcohol-induced cardiomyopathy.
It's truly poison to the heart. I think it matters on the dose,
like how much and how frequent you're doing it.
A special occasion, your birthday, you drink here and there socially.
But not even just heart health, cancer risk and all
these other things-
And brain health, there is a lot of-
Yeah
...
for dementia, even one drink a week perhaps-
Right
... is a bit too much.
Exactly. You're killing cells. So
the way I look at it, it's poison that we do for fun.
Yeah, and just out of interest, there is a very interesting sort of
analogy that I read on this. So
it's not just empty calories, it's the calories that your body will metabolize
first before it metabolizes anything else it wants to get rid of at first.
Yeah.
And then we glamorize red wine, like you said, for
resveratrol. That was the magic compound in it.
But
as it turns out, if you want the daily dose of resveratrol from red
wine-
To die
... you have to go north of somewhere around 1,000 glasses of wine or perhaps even
a more ridiculous number.
Yeah.
So
alcohol, it affects your sleep also.
Yeah.
It affects every part of your body.
I think from your sleep to your mentation, to your mood, to your
appetite.
When people drink, they eat more.
Yeah.
So it's right down the list.
So is alcohol healthy? The answer is no, I think is the
short answer. And even though we all tend to enjoy it socially or what
have you, it cannot be a staple because if it's a staple, it's probably going to
hurt you in a really bad way.
Agreed. Well, this has been a lot of fun.
Yeah.
I think we should do it again.
Oh, definitely.
Or perhaps with a little more controversy to it next time.
What other topics can we pick? Yeah.
Exactly. Thank you. Thank you so much, Ajay.
Of course.
This has been fun. Thank you.
Yeah. This has been fun.