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Dr. Pradip Jamnadas: How fasting erases visceral fat

Why insulin damage actually starts decades before diabetes shows up; the fasting protocol that lowers insulin, mobilizes plaque, and resets arteries.

Dr. Pradip (Pradeep) JamnadasguestSteven Bartletthost
Sep 22, 20251h 54mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 2:23

    Intro

    1. PJ

      If you have a belly sticking out, you have a problem because the fat that's in the stomach, that's called visceral fat. This is very detrimental fat, and that's the epidemic that we have today. But the only thing that'll make you lose that fat very quickly is-

    2. SB

      Dr. Pradeep Jamnadas is a world-leading cardiologist... Who has treated more than a quarter of a million patients with chronic heart disease. Now, he's using his voice to help millions more prevent ending up on the operating table through simple lifestyle techniques.

    3. PJ

      This is crucial. Glucose actually is toxic inside the bloodstream, and the body pours insulin into the bloodstream to push glucose out. But frequent consumption of carbs, sugar, processed foods is causing insulin to stay up, which can lead to insulin resistance, and you're gonna be more prone to heart disease, which is the number one cause of death all over the world right now. But this is where fasting comes in because after 12 hours, you start pulling the fat out, and the first place the fat comes out of is gonna be visceral fat. But with modern living, we have lost this physiology of fasting, so we'll go into that.

    4. SB

      And there must be certain things which people aren't aware aren't healthy as it relates to my cardiovascular health.

    5. PJ

      Yes. So I see that people who overly do aerobic activity, they end up with more coronary artery disease than patients who do short sprints and resistance exercises. Then there's mold, and almost 70% of homes these days have some form of mold toxicity in them. But also one night of bad sleep, you become insulin resistant the next day. And there's calcium supplements, excessive fruit, white rice-

    6. SB

      White rice?

    7. PJ

      You'd be surprised how much arsenic there is in rice these days.

    8. SB

      I watch a lot of True Crime. People kill each other with arsenic.

    9. PJ

      Yes. And it'll slowly kill you. And lastly, this is gonna surprise you.

    10. SB

      I see messages all the time in the comment section that some of you didn't realize you didn't subscribe, so if you could do me a favor and double-check if you're a subscriber to this channel, that would be tremendously appreciated. It's the simple, it's the free thing that anybody that watches this show frequently can do to help us here to keep everything going in this show and the trajectory it's on. So, please do double-check if you've subscribed and, uh, thank you so much. Because in a strange way, you are- you're part of our history, and you're on this journey with us, and I appreciate you for that. So, yeah. Thank you. Dr. Pradeep Jamnadas, what is it you've spent the entirety of your career, especially the last few decades of your career, focusing on?

  2. 2:23 – 3:37

    The No. 1 Killer Worldwide

    1. SB

    2. PJ

      Prevention of heart disease, which is the number one cause of death all over the world right now. You see, the heart is made up of many parts. So this is important. It's a pump, so it's a muscle. So you have diseases of the muscle, and it's rampant these days. Cardiomyopathy, weakness of the muscle. Then you have the arteries on top of the heart, and that's called coronary artery disease. Diseases of the arteries, they block up. Then you have the valves. The valves tend to get damaged as well. For example, aortic stenosis. And then you have the peripheral circulation, all the blood vessels that go to your carotids, your brain, your legs, and to all the organs of your body. And then you have microvascular disease, which is the tiny capillaries, that they become dysfunctional as well.

    3. SB

      What's a capillary?

    4. PJ

      Capillary is the branch of the branch of the branch.

    5. SB

      Okay, so like the tiny little veins.

    6. PJ

      Final ones, yeah. So when they become dysfunctional, that organ becomes dysfunctional as well. So, cardiology affects all these aspects.

    7. SB

      And how long have you been operating on people's hearts?

    8. PJ

      About 35 years now.

    9. SB

      And how many hearts do you think you've treated?

  3. 3:37 – 4:36

    Young People Are Developing Heart Disease

    1. SB

    2. PJ

      In excess of 30,000.

    3. SB

      And what, uh, what's the age range of those patients?

    4. PJ

      They were used to be mostly older people over 65. Now, I would say 50% of them are under 65 and 50% are over 65. So the demographics is changing. The younger people are developing heart disease.

    5. SB

      So the youngest patient you've ever treated?

    6. PJ

      28.

    7. SB

      And what- what was the predicament in that case?

    8. PJ

      He was having a full-blown heart attack, so that means that one of his arteries was completely clogged up. It had a blood clot in it. There was no circulation past that artery, and therefore, he was having acute chest pain, sweating, blood pressure was low. He comes straight to the hospital. I rushed to the hospital, take him straight into the cath lab, and try to open up that blockage. And we did open up that blockage and put a stent in it and got rid of that blockage immediately to restore that blood flow to the heart muscle.

  4. 4:36 – 6:19

    Why Do Young People Get Heart Attacks

    1. PJ

    2. SB

      And at 28, how does one get a heart attack? You said it was blocked up.

    3. PJ

      There's a lot of nuance in that. Most people don't understand what a heart attack is. So in a nutshell, I'm gonna tell you what it is. When you have a plaque, a plaque is a buildup of a little fibrous material inside the artery, and that doesn't cause a heart attack. A heart attack is caused when one of those plaques cracks. Now, in this diagram, for example, it's showing that the plaque is closing up the artery, and this will cause angina. That means a lack of blood supply over here. So this patient may complain of chest discomfort, or he may not complain of chest discomfort, because remember, when you have a blockage like this, only 20% of the patients actually get chest pain. That means that you could have a blockage like this in a patient, and he may not have any chest discomfort. And the only way you're gonna pick that up is by doing a stress test or a car- coronary calcium score or some other modality to see whether he has blockage or not. A heart attack is when a minor blockage, which is not causing much flow disturbance, suddenly cracks.

    4. SB

      And what happens to the- the plaque that come- that cracks off?

    5. PJ

      And when it cracks open, the blood that's going past it sees the crack and wants to repair it and forms a blood clot on it. So the final thing that shuts down that artery is the blood clot. It's not the plaque that shuts it off. It's a blood clot. So a heart attack is caused by a blood clot at the site of a rupture...... and what causes rupture is inflammation.

  5. 6:19 – 10:04

    What Leads to Heart Disease

    1. PJ

    2. SB

      Okay. So, when people say that heart disease is the number one killer of people generally that are, that are diseased, is it that process that's causing it alone, or is there a multitude of processes that lead to heart disease?

    3. PJ

      There's a multitude of things that lead to heart disease. Look, the-

    4. SB

      So yeah, that was a heart attack.

    5. PJ

      That's right.

    6. SB

      Okay.

    7. PJ

      So, one, you're making plaque. You shouldn't be making plaque. A plaque is an inflammatory area inside your arteries. It's reacting to something. And I can go into the nuance of what's actually, what's the body reacting to? What's inflammation? Inflammation is reacting to something. What is that something? And I think it's important for your audience and everybody to know what that something is. Now, you've got this pimple. Think of it as a pimple on the inside of the artery. Now one day, when there's enough inflammation in your body systemically, that pimple is gonna crack open just like a pim- pimple on the skin breaks open. Now that artery has this little pimple on the inside and it cracks open and a blood clot forms on it, and that's a heart attack. So, you don't want plaque formation, you don't want plaque instability, which is rupture of that plaque, and you don't want a blood clot to form on it. There are factors that affect each of these processes and all three processes are going wrong today, and that's why we have so much plaque formation and instability of the plaque, which then leads, of course, to heart attacks. And our blood, in general, we have more coagulation issues today than we ever did before, which means our blood, because of inflammation, is more ready to clot more easily. So we're having the perfect triad. It's the perfect storm. That's why we're seeing an epidemic of this and that's why we're not making a dent in it. Yes, you can have a plaque rupture and have a heart attack and we put a stent in you. Okay, that's fine, but what did we do to look at the underlying reason as to why you formed that plaque and why did you rupture it and why was your blood so clotty in the first place that made you actually seal off the artery?

    8. SB

      Is this a, an increasing problem?

    9. PJ

      Yes. It's a, it's a huge problem because those factors have been identified now, and that's what we go for in my practice. We look for the factors. Why did you make this plaque? Why is there so much inflammation in your body? Inflammation is a reaction to something foreign. What is that foreign stuff? What is that abnormal physiology in you that your body's reacting against? 'Cause that's what inflammation is. And inflammation, of course, whenever there's gonna be inflammation, there's gonna be increased tendency to make blood clots. So we go in, we chase all these things in patients to find out, and that's the real prevention.

    10. SB

      That 28-year-old that came in, um, and you treated him, was it, was that a s- a surgery you did?

    11. PJ

      We call it a surgery, but it's not. It's a, it's a angioplasty. So we go in from the wrist-

    12. SB

      Yeah.

    13. PJ

      ... or we go in from the groin, with a catheter, and we go into the coronary artery.

    14. SB

      A catheter being like a tube?

    15. PJ

      It's a hollow tube, and we put it into the coronary artery. We shoot the dye inside. We can see where the blockage is, and then we thread a tiny wire into that artery through the blockage and then bring in a balloon and squash the blood clot out of the way, restore the circulation, and then bring in a stent. A stent is like a spring-

    16. SB

      Yeah.

    17. PJ

      ... that opens the artery up. We leave the stent inside there, we remove everything else, and now you have an open artery and you have blood flow going down that artery.

  6. 10:04 – 12:27

    What Causes Heart Problems in Young People

    1. PJ

    2. SB

      And what had that 28-year-old done to end up in your surgery? What were the decisions that they had made that brought them there?

    3. PJ

      So he was, number one, he was overweight-

    4. SB

      Okay.

    5. PJ

      ... but he wasn't just overweight. The overweight was all in his belly, and he had a fatty liver and he had what is known as visceral fat. He was not a diabetic, but he was a pre-diabetic. That means he had a lot of insulin in his body and his glucose levels were good. So if you went to his family doctor, they would say, "Oh, you're not a diabetic. Your hemoglobin A1C," which is a blood test that you loo- do for diabetes, "is actually okay." But actually, that patient had a very high insulin blood level. Now, insulin is a very atherogenic molecule. It causes smooth muscle proliferation. Smooth muscle is in the walls of the arteries. It causes vasoconstriction. It makes your blood more clotty and it causes inflammation. So this patient was a pre-diabetic, and this is very important, this is what caught my attention, because when I looked at my patients that were coming in with heart attacks and hardening of the arteries, and when I tried to identify why they're doing this, none of them were diabetics. But then I did a glucose tolerance test on them, and what happened, it was just by chance that I happened to have these tests in my office where you can measure the blood glucose. So I had about 120 of them. So I said, "Look, let's just do some random testing on these patients." And I found that at least half of them had no diabetes, but they're glucose intolerance. That means that their sugars went up, but not enough to make them a diabetic, but it did go above the normal range. We did not have insulin testing at that time. About 10 years later, we started testing insulin in the office, and I bought a machine for this purpose in my office to measure insulin levels. And life was never the same again.

    6. SB

      Why?

    7. PJ

      Because it's all about insulin when it comes to the metabolic derangement. So I've found that these patients, their sugars were going up to 150, 160 after giving them a glucose drink.

    8. SB

      Mm-hmm.

    9. PJ

      So you say, "Okay."... he's not a diabetic. Look, the sugar didn't really go high. But when you measured the insulin level, the insulin was off the roof.

  7. 12:27 – 17:01

    The Link Between Sugar and Insulin

    1. PJ

    2. SB

      So when you say this is an insulin problem, can you explain this to me like I have no idea what glucose and insulin are? For, for any of my listeners out there that have a inexperienced understanding of these, these, these terms and what they, what they do and mean.

    3. PJ

      It's crucial. Everybody needs to understand the relationship between sugar, which is glucose, and insulin. When you consume sugar or glucose, the body has to get rid of that glucose very quickly from the bloodstream, because glucose actually is toxic inside the bloodstream. Even though it is what the body uses for energy, in the bloodstream, it glycates all the blood vessels and the walls and the components in blood and the hemoglobin as well, glycates it. That means the glucose attaches itself to that molecule. So now that molecule can't work properly. That is why the higher your blood glucose, all your chemicals don't work well. Your enzymes don't work well, your hormones don't work well, nothing works well, and you age prematurely because you getting glycation. Glyca- a glycated molecule can't work normally. It doesn't function normally.

    4. SB

      Mm-hmm.

    5. PJ

      So when you consume the glucose, the glucose has to come out of the bloodstream, and how does the body do it? It sends a message to the pancreas. The pancreas says, "Aha, I'll make some insulin." It pours insulin into the bloodstream, insulin comes into the bloodstream, pushes the glucose into the cells. And where does it pushing it? Into the liver, into the muscles, into every cell in the body. Insulin will push glucose out. Now, how much insulin is the question. If I'm eating every three hours and I'm consuming glucose, or I'm consuming starchy foods, or I'm consuming carbohydrates... Now watch where I'm going with this, because you're already beginning to know where I'm going with this. I'm consuming glucose and carbs every two, three hours, I'm stimulating my pancreas. I'm stimulating my insulin. My insulin goes up, it comes down. But before it even gets a chance to come down, it goes up again. So the repeated consumption of, and frequent consumption of glucose is causing my insulin to stay high, because insulin stays a little bit longer in the bloodstream than the glucose. The glucose will come down in about two to three hours, but the insulin stays higher for about four hours. Now what happens is that you continue this lifestyle for a few years. Now the body, because these are all hormones, will say, "Well, you know, it's, I'm gonna need to make more insulin now." You become insulin resistant. Any hormone that stays in your body for a long time, the body becomes immune to it. So the next time I eat the sugar, I'm gonna have to make more insulin to produce the same effect. That is called insulin resistance. So now you got this patient who's been eating carbs, sugar, processed foods. What does that mean, processed food? That means foods that are quickly absorbed into the bloodstream. Processed foods, these are products without fiber, so the absorption is very quick. So the poor pancreas has to react just like that, produces a whole bunch of insulin, and then the frequent eating and the frequent consumption makes you insulin resistant. So now you produce a whole bunch of insulin in order to bring that sugar level down. So then you say, "Okay, well it doesn't matter because the insu- the insulin is bringing the sugar level down." So what's the harm done? Because your A1C is still good, you're not diabetic. No, but it's that background high insulin that is destroying your metabolism. It's that high insulin level in the background. So insulin pushes glucose into the liver and you develop a fatty liver. It pushes the calories into production of new fats around your viscera. The viscera means in your belly, around your pancreas. You get visceral fat. Now, this fat is produced from glucose. It's a different kind of fat. Look, if I gave you a high calorie diet right now of all sorts of foods, you'll put on weight everywhere, okay? But if I give you glucose, you'll put it on mostly in your stomach, and your stomach will protrude, and that's called visceral fat. It's on the inside. You can't pinch it, it's on the inside.

    6. SB

      Around your organs.

    7. PJ

      Around the organs. This is very detrimental fat, and that's the epidemic that we have today.

  8. 17:01 – 19:45

    The Importance of Checking Insulin Levels

    1. PJ

    2. SB

      And that's the direct result of eating, you know, starchy, glucose, carbohydrates, which creates insulin, which creates this downstream effect on...

    3. PJ

      Wrong foods and eating too frequently.

    4. SB

      Too frequently, okay.

    5. PJ

      Because remember, it's also the frequency of eating, because before that insulin gets a chance to come down, you're already popping yourself with more food, and hence, you develop insulin resistance. You get a very high insulin, it takes this much insulin now just to bring that sugar level down. And then the one day when you cannot control that sugar, now that sugar will go out and now your doctor will say you're a diabetic. But by that time, you've already had 10 years of hyperinsulinemia. So what happens by the time you make a diagnosis of diabetes to say, "Well, now your sugar is really high," it is high because your body has not had the ability to keep it down. Why? Because even that high insulin could not keep your sugar level down, you became a diabetic. You lost that whole opportunity of prevention. It's those 10 years. Look, by the time you're a diabetic and you come and see Dr. J in his cardiac clinic, you already have coronary artery disease. Like that 28-year-old, that 28-year-old didn't have diabetes, he already has coronary artery disease. By the time you are diagnosed as having diabetes, you already have coronary artery disease. We have a great opportunity here to actually start screening these patients with insulin levels very early on. But most doctors don't have the ability or knowledge to do the insulin level testing, but it should be done.

    6. SB

      Can someone like me, I'm 33 years old now-W- when does the damage begin?

    7. PJ

      It starts right now. It starts right now. As soon as you're around 30, you're already starting to have trouble. You have to... But, you know, this is what I do. I look at that patient walking into my room, and if I see that he's got a belly sticking out, I already know he's probably got insulin resistance because all the fat is in here. Because the fat that's in the stomach, sideways he looks terrible, from the back he looks great. His waist is increased. Hmm?

    8. SB

      Mm-hmm.

    9. PJ

      He doesn't have all the fat everywhere else in his body. That's the phenotype of somebody who has hyperinsulinemia. That same person goes on a cruise, he'll come back five to 10 pounds more, because he's got so much insulin in his body. Insulin is a storage molecule, puts everything away, and it's very hard for him to lose weight.

    10. SB

      Wh- why is it harder?

    11. PJ

      You... The only thing that will make you lose that fat very quickly is to change your diet, of course, but you have to do fasting. Because fasting brings your insulin level... See, this is where fasting comes in. So

  9. 19:45 – 22:57

    Fasting vs. Calorie Deficit: Fat and Muscle Changes

    1. PJ

      what does fasting do?

    2. SB

      Do you mean fasting or a calorie deficit? Is it... Or is it the same thing in your view?

    3. PJ

      No, they're not the same thing. They are not the same thing. You see, when you don't eat, your insulin levels come down, because you're not stimulating your pancreas anymore. So you wanna bring your insulin levels down, the best thing you can do in the world is to do fasting. Because there's no... Look, if I just simply cut down on my calories, then there's a different physiology that's gonna take place in the body, and when you fast, there's a totally different physiology. When you cut down on calories, the body senses that there's caloric deficit. Your metabolic rate changes, actually slows down, and the body will start breaking down everything, muscles included. So you lose fat and you also lose muscles. On the other hand, when you're fasting, it's a different physiology. Fasting is, "I've put on fat. Now I'm gonna take it out of the bank. Now the bank is gonna be available for me to pull out my calories and use it now," and you start burning the fat. So in the first 12 hours of a fast, you take out all the glucose in the form of glycogen from your muscles and your liver. After 12 hours, you start pulling the fat out. And the first place the fat comes out of is gonna be visceral fat. That is why fasting benefits you so much, 'cause it gets rid of that worst fat, the fat that is very inflammatory. You see, if I did a biopsy of your visceral fat versus a biopsy of, let's say, a fat from on your buttock-

    4. SB

      Mm-hmm.

    5. PJ

      ... two different types of fat. One is full of inflammatory molecules, the other one is not full of inflammatory molecules. One is producing interleukin-6 and tumor necrosis factor, and this other fat is not. These are two different fat storages. Visceral fat is very toxic, it's very inflammatory, and that is why patients who have visceral fat make all these molecules. So when I do the blood test, I see that, "Oh, you've got so much inflammation. You've got interleukin-6 is high, tumor necrosis factor is high, your CRP is running high. And one of the reasons for this is not just leaky gut and other things that I look at, but in your case, it's also because you have a lot of ectopic fat." Ectopic fat. Ectopic fat is now we're realizing is not just only around the liver and around your pancreas, it's also around your heart. So when we look at the coronary arteries and we see all those fat around the coronary arteries... You had a very nice diagram right there, and you can see that around each artery, there's that yellowness. That yellow is all plaque. Fat, that's fat around that, and it's plaque forming. It's plaque forming. It stimulates pla-... It's inflammatory. And now we can do CT scans that will actually detect how much inflammation is in the fat around the arteries as well. Ectopic fat is in the... Around the coronary arteries, it's in your liver and in your pancreas, and it is very inflammatory.

  10. 22:57 – 25:54

    Fasting for Women vs. Men: Key Differences

    1. PJ

    2. SB

      On this point of fasting, so if you have someone come to you and they're, you know, they have that physique where there's a bit more of that protruding belly fat, you said that fasting is a much better approach than just sort of a calorie restriction. I was looking at some studies that said research shows that calorie deficits of any kind can reduce visceral fat, but fasting will give it an edge because of the insulin sensitivity stuff that you talked about as well. What kind of fast should one be doing? Because there's so many different names for these fasts. People do these 40-day water fasts and they do intermittent fasting.

    3. PJ

      That's a great question. So there are many, many different types of fasting, depending on your goal, on what do you want for that particular patient? So, if a patient is just simply looking to reduce his visceral fat, then I start with 12:12, which means 12 hours you don't eat anything, you just drink liquids with no calories in it, and then 12 hours is your feeding period. We start with that, and we do that for about two to three weeks. Then we quickly move to 18:6. 18:6 means six hours you get to eat. 18 hours it's only water, black tea, black coffee, green tea, no calories. 18:6. 18:6. And then, that's one type of fasting. Now, if a patient is very overweight, a patient has diabetes and your goal is to reverse the diabetes, the patient needs to lose 60 pounds, then those patients have a special type of need. For them, I will take them to a 48-hour fast once a week. Sometimes I'll go to a three-day water fast every nine days.Every nine days, you will do OMAD. OMAD means one meal a day only, every day for nine days, and then you're gonna give me a three-day water fast.

    4. SB

      Is the same advice applicable to women? Because obviously they're contending with a variety of hormone fluctuations and estrogen and I know that the, that the female body responds differently to these kinds of stresses, like fasts.

    5. PJ

      I've been asked that question so many times from patients as well. Most of the women can actually handle it. The only women that cannot are those who are trying to become pregnant or, or they have, um, uh, or they're already pregnant. But I, I think that women are not that different when it comes to the fasting programs. So in my experience, I've been able to get women to fast. I just finished a fast on one lady just now for 72 days. 72 days. She was terribly overweight. She had diabetes, she had hypertension, she had hyperlipidemia. She was having hip replacements, knee replacements, joint problems. She had skin problems and we fasted her for 72 days.

  11. 25:54 – 29:02

    The Power of Fasting and Allowed Liquids

    1. PJ

    2. SB

      What did she have in those 72, 72 days in terms of drinks, electrolytes, coffee? What, what was she...

    3. PJ

      Great question. So she would have black tea, black coffee, water. And in the water, once a day, I tell her to put some electrolytes in there. So there's an electrolyte called LMNT or sometimes I just tell them to go buy some Celtic salt and put half a teaspoon in there, and once a day you take that. If you get cravings and you feel really, really hungry, take some MCT oil, a teaspoon, and put it in your water and you can drink that as well.

    4. SB

      I think it's worth saying that probably you shouldn't try this at home, ladies and gentlemen, because obviously medical supervision's crit- critical here. But in the case of that lady, what was the before and after of that 72-day fast?

    5. PJ

      So diabetes, gone. Blood pressure, normalized. Weight loss, tremendous weight loss. I mean, I think she lost about 55, 60 pounds.

    6. SB

      Wow.

    7. PJ

      Okay? And not only did she lose all that weight, yes, all that weight from her belly was gone, but even her face, under the arms. So when you lose weight in a fasting program, it's very different from losing weight when you are restricting calories. You actually retract your, your skin, so you get real changes in your entire body. These patient... I had one patient that fasted for 183 days, under supervision, okay? So he went from 400 pounds to 210 pounds and when he walked into the office you would not recognize that he's just lost all this weight because he did not look like skin on top of bones and then having to have surgery to remove all that excess skin. Fasting is a totally different physiology. In fasting, you, you, you, you, you... The body is doing a whole lot of things that are very different, and we can go into the physiology of fasting because that's fascinating. It's a physiology that has not been used by us. We've lost it. So one of the things about modern living, modern living, we have lost this physiology of fasting. First of all, why do we still have that physiology in us? It's because it's supposed to serve a purpose, because we're supposed to be fasting and feasting, but now we're only feasting all the time and we're not fasting. In order to go back to normal, you should be fasting. Fasting is supposed to be a normal part of your existence. That's the way you were designed. Not this modern industrialized living that we've been doing in the last fraction of a millisecond in the total existence of the human race. We've changed our lifestyles so much, modern man has, but our genetics and our physiology has lagged behind. We are supposed to use fasting and feasting as part of our normal program, as our normal physiology. That's why we still have it. That is why after 12 hours, you start making some more ketones in your body, and ketones come from fat. You're moving that fat out of storage.

  12. 29:02 – 32:46

    The Benefits of Ketones and Should We Always Be in Ketosis

    1. PJ

    2. SB

      What is a ketone?

    3. PJ

      Ah, ketones. So ketones are a energy molecule produced by the liver. How does it make it? It makes it from fat, so the fat gets liberalized and by the way, the fats only start moving when your insulin levels are down. So because of fasting, your insulin levels are really low now, okay? Because you've been fasting, right? So now the fats start dissolving, so you get free fatty acids. The free fatty acids float into the bloodstream. Free fatty acids are fat products. They float into the bloodstream, they go to your liver. Your liver converts those into ketones. Now, ketones are an energy source of the body, an alternative source to glucose. So in general terms, you are either gonna be running on glucose and glucose metabolism or you're running on ketones. Okay?

    4. SB

      And so ketones basically show up in the... when glucose isn't around.

    5. PJ

      That's absolutely right. So ketones, and ketones are actually a cleaner fuel for the body and in terms of producing reactive oxygen species in the metabolism, the way your mitochondria work, you actually produce less reactive oxygen species, which is damaging to your physiology when you're in ketones. And ketones are signaling molecules that also change your physiology in a number of ways. Number one, it causes the production of brain-derived neurotrophic factor that occurs under ketogenesis. Brain-derived neurotrophic factor, which means that you become smarter, you're growing new cells, your reflexes are better, your visual acuity is better. Why? Because nature wants you to become a better specimen so you can go out and get your next kill.

    6. SB

      So why don't we all just stay in a state of ketosis then if it's so miraculous?

    7. PJ

      Well, that's a great question.You don't want to be in ketosis all the time, 'cause that's not what ketosis, what, what our physiology was made for. Because then, you'll just be burning fats, burning fats, burning fats all the time, and that's not a good state to be in constantly either. So, you want to be able to do both. You're supposed to get your current account and your deposit account. You're supposed to bo- work with both of them. That's normal physiology. So, not only brain-derived neurotrophic factor increases, but also stem cells. Stem cells are amazing and in my patients, of course, I see that-

    8. SB

      What, what is a stem cell?

    9. PJ

      Ah. Stem cells. So, stem cells are ... We all have stem cells and we all still make stem cells, and they're produced by the bone marrow. These are pluripotent cells, cells made that will then go out and become whatever they need to become. So, they can go out into your circulation and become a muscle cell. They can become a retinal cell, a skin cell. They can transform into anything. So, what happens then, when you break your fast-

    10. SB

      Mm-hmm.

    11. PJ

      ... you get a surge of stem cells coming out of your bone marrow. Some of them become immunocytes. That is why we know that fasting also boosts your immunity. People who fast get less infections, they get less sore throats, and coughs, and colds, and the viruses that are going around. The immunity is better. The stem cells are not ... I'm particularly interested in the stem cells because of a thing called the progenitor cells, endothelial progenitor cells. Progenitor cells are ... You see, you're always hurting your blood vessels, the lining of the blood vessels, and the lining of your blood vessels have to be constantly repaired. And they'll be re- they are repaired by the progenitor cells. When you do intermittent fasting and time-restricted feeding, you will produce more, and this has been shown in numerous studies, more progenitor cells, and these progenitor

  13. 32:46 – 38:52

    Building Muscle While Fasting

    1. PJ

      cells go and repair your blood vessels. So, I would do, what ... Why am I interested in this? Because I'm a vascular doctor. I want my blood vessels to constantly be repairing themselves from the damage that we do in day-to-day life. So, stem cell mobilization, brain-derived neurotrophic factor, growth hormone. You make more growth hormone in fasting. So, when should you exercise when you're fasting? At the peak of your fast. So, if I'm going to break my fast at 6:00 PM, I tell patients to go to the gym at four o'clock in the afternoon. They say, "But Doc, how can I do that?" You will find that you have put on more muscle and you'll retain more muscle as well 'cause you have higher growth hormone. The fastest way and the best way to actually increase your growth hormone production is to do intermittent fasting.

    2. SB

      When I s- sat with, um, Dr. Stacey Simms, who does a lot, a lot of, um, work on women's physiology and women's performance, one of the things she said to me is that if a woman in particular tries to do a workout fasted, the body will break down the muscle in a woman, because s- she said a woman's body is much more, the hy- hypothalamus is much more sensitive to changes in a woman's glucose levels 'cause it's trying to defend against, you know, pregnancy and, you know, all these kinds of things, so it shuts down the menstrual cycle if there's not enough glucose in the blood, and, and so she said for women in particular, you do, you do want to have, eat something before you work out, or it will, y- your body will take from the muscle and it definitely won't ... The body's very sensitive. It won't want to, to help you build muscle if there's not enough glucose energy in the body. She said for men, it's slightly different because we're a little bit more robustin. We were meant to hunt, so if we were fasted, our body is, you know, designed to kind of keep up its normal processes to help us complete a hunt per se. So, I guess I throw this question out to you about, about women, exercise and fasting.

    3. PJ

      Yeah.

    4. SB

      What do you think?

    5. PJ

      I, I think that's a great observation. So again, it's what kind of exercise is the woman doing, you see? Now, there's two kinds of basic exercises. One is aerobic activity.

    6. SB

      Mm-hmm.

    7. PJ

      And one is, uh, resistance exercises. And you can also throw into that high-intensity interval training.

    8. SB

      Mm-hmm.

    9. PJ

      So, when it comes to the training that I'm talking about in a fasting state, I like resistance training. So, in re- resistance training, that glucose issue's not going to become a problem. Now, if you're gonna put that female patient on a treadmill and make her run for a long period of time, let's say you're gonna make her run for 40 minutes on the treadmill, I think that yes, you're absolutely right. You are going to deplete her glucose and you may cause some problems, and then the muscle will start breaking down. But I do believe, from all the experience that I've had with my patients, that when I tell them to do HIT, which is high-intensity interval training, all the women do just as well as the men. Because all you're doing is you're intensely m- working the muscles and you're doing some resistance exercise, and then you're totally resting as well. And I see fantastic results with that.

    10. SB

      In terms of ketosis, do you cycle in and out of a ketogenic diet? And just for anyone that doesn't know what, know, a ketogenic diet is a diet that's very, very low in carbohydrates, so less than 50 grams of carbohydrates a day typically. Do you cycle in and out of that diet?

    11. PJ

      Yes. Yes. You have to. Because I don't want them to stay in a ketogenic state all the time, so I do, I do, I do. I tell them, "Look, look, what is your goal here? What is your goal?" If your goal is that, "Okay, I need to lose 70 pounds," then you're gonna do this till you get to your goal. Once you get to your goal, then you're gonna go back to time-restricted feeding, which means 18:6. So you'll still make some ketones, and then intermittently, you can still do a 36-hour fast. That means normal, healthy people, you and me, we should still be doing one 36-hour fast at least once a month. So, we'll go to that. We'll go to that. Fasting must still become part of your program, but you don't need to stay in ketogenesis all the time. Remember also that when you are in ketogenesis, you are, you are also in autophagy.How much autophagy can you do? That means you're recycling all your, your partic- uh, all your organelles inside your cells.

    12. SB

      What does that mean, in, in simple terms, for someone that doesn't know the term, autophagy?

    13. PJ

      Okay. So bottom line is, the cell senses that there is no new parts coming in here, so it takes the redundant organelles inside the cells and breaks them down, packages them up into these little packets and exports them out of the cells. So these cells, all your cells in the body, now are functioning at a much more efficient level. So, mitochondria also have autophagy. So you're getting new mitochondria, you're repairing your mitochondria, and you know it's all about mitochondria, right? Your energy. Mitochondria are those organs, organelles inside each cell. And we just think of them as only an energy source that, "Oh, yeah, my mitochondria, they make ATP." That's not the whole story. Yes, they produce ATP, but they also produce this thing called reactive oxygen species, and thereby, they influence the metabolism of your wh- of your cell as well. They send signals. They send signals to your, to your chromosomes, so that you start producing new proteins, you start producing new molecules. So your mitochondria are very important. If you have old mitochondria, you're gonna have fatigue, tiredness. But when you get mitophagy, one reason why you feel so good after a fast, because you have new mitochondria. They are much more efficient in producing ATP and less reactive oxygen species. So you have mitophagy, recycling of your parts, cellular function improves, toxins get out of your cells as well. Toxins.

  14. 38:52 – 41:40

    Best Exercise for Heart Health

    1. SB

      Do you think there's a preferable or a best exercise for heart health? Like if you were gonna say, Stephen, to make... You know, my, my, I think my family has a history of heart-related issues. One of my, my uncle died from a heart attack, so I'm very aware of my own susceptibility to heart-related illnesses. I think there's other people in my family, um, that have heart-related issues as well. Is there a particular exercise that is best for the heart? 'Cause I'm guessing resistance training, i.e. strength training, might not be the, the number one recommendation for good heart health. You mentioned HIT, I'm wondering if that's...

    2. PJ

      Yes. So I'm just gonna tell you broadly speaking, what I see in my practice. I see that people who do a, overly do a, uh, aerobic activity, that means they cycle 100 miles a day or they're running on the treadmill for two hours at a time every day, or they're doing a lot, a lot of marathon training all the time, they actually end up with more inflammation in their body, and they end up with more coronary artery disease than patients who do short sprints and patients who do resistance exercises and patients who do HITS. So, in terms of cardiology, you... Look, you need some aerobic training. Why? Because you want to develop some endurance, right? You don't wanna be running behind a bus and, and get short of breath just in a few hundred feet. So, for some endurance, you do aerobic activity. How much aerobic activity? Which is running on the treadmill, for example, or just sprinting, only about 15 to 20 minutes. That's it. So I tell patients, "You wanna run on that treadmill, you're on a bicycle, 15 to 20 minutes." And then you gotta go into resistance exercises. The resistance exercises that I have seen work best in my patients is simple things. You don't have to go crazy. You do floor exercises, use your own body weight as resistance. So you can do the planks and leg lifts and all these other exercise, and you can do HIT, but they have to be very specific. So you exercise really hard for about 30 seconds to 45 seconds, and then you completely rest for another 30 to 45 seconds.

    3. SB

      Okay.

    4. PJ

      And that's allowing your body to clean up the reactive oxygen species you just created through that exercise, because your rate-limiting step in cleaning up the metabolic mess that you get when you get too much exercise, it's a rate-limiting step. Your glutathione production, your superoxide dismutase production, these are chemicals that clean up the metabolic mess that you get when you get too much activity. That's the rate-limiting step. So when you rest, you exercise, then you rest, you exercise, you rest, you are gonna get a cleaner physiology.

  15. 41:40 – 43:12

    What's the Solution to Heart Problems?

    1. PJ

    2. SB

      With your patients, how many patients do you think you've treated or worked with in your career?

    3. PJ

      Ooh. Uh, it's a-

    4. SB

      If you had to guess, into the nearest thousand, ten thousand.

    5. PJ

      Uh, it would have to be at least, uh, nothing less than, nothing less than quarter million.

    6. SB

      How do you deal with the heartbreak? And that's no pun intended, but I'm saying, like, how do you deal with the heartbreak of watching people's lives, either them losing their life or their, their lives being changed permanently forever, or dealing with the families of, of people who lo- lose their husband or wife or, or son or daughter?

    7. PJ

      It, it, it's very difficult, especially when we've been trying everything and still things can go wrong. Based on that, I've realized that sometimes you can do everything to try to extend life, but you cannot. Life is still finite. We will pass, yes, but we want gr- better health span and we want a longer lifespan. I wanna give the patients a better quality of life also. I can't make you live forever. I will see people die. Sometimes they die in front of me while I'm even holding their hands. They'll pass away in the hospital, right there. But what I do want to do...... is to give them a quality of life until then that's gonna change. And in all this education, it's all so that you can live an optimal life and then (snaps fingers) pass away just

  16. 43:12 – 44:56

    Do Healthy People End Up With Heart Problems?

    1. PJ

      like that.

    2. SB

      Have you seen many people that made all the right decisions, they were healthy, they had a good diet, they were doing exercise, and they still end up passing away on your hospital table because of heart-related illnesses?

    3. PJ

      Yes. Yes.

    4. SB

      Can you give me one such example?

    5. PJ

      Well, uh, uh, a typical example, a fellow in his 60s, his coronary calcium score was over 1,000. So you know that's a CT scan that we do, and it looks at calcium on the arteries of the, of the wall. So all this plaque that you, you, you, you, you are shown o-, th-this yellow stuff, yeah, all that has calcium in it. So the more calcium you have, the more plaque you have. So he had a calcium score of over a thousand. So sit down and talk with him and say, "Okay, so tell me, why do you have all this calcium? No diabetes, no high blood pressure." "Doc, I don't even drink. I don't do anything. I don't smoke. I exercise regularly. I go to the gym." And then the question is, "Why do you have all this coronary calcium in your coronary arteries now?" And it turned out that ever since he was a kid, he had a bad microbiome. And in him, I found that that was the reason why he got it. So he was shocked when he left the office. He was totally shocked 'cause he thought that being constipated and having a bowel movement every three or four days is just normal 'cause it was always like that for him, until I dug into it and found out that he's actually got a lot of GI problems. And that's what probably caused him to have inflammation, and that's what's probably caused him to have coronary artery disease. That's why he's got all this coronary calcification.

  17. 44:56 – 49:18

    The Link Between Gut Microbiome and Heart Health

    1. PJ

      Yeah.

    2. SB

      So let's talk about the gut microbiome then. You, you mentioned earlier that that's really pertinent in c- cardiovascular issues. Can you explain to me exactly why and how that happens?

    3. PJ

      The biggest difference between you and your outer environment is actually your gut. Not outside your skin. It's actually the gut. There's 100 trillion bacteria sitting in there, and there's probably 400 trillion viruses sitting in your gut. And they're not just hitching a ride for you. They are there doing something. There's a symbiotic relationship between the gut and you. They produce micronutrients which get absorbed into your bloodstream. If the right microbiome is not present, you are being deprived of those micronutrients. For example, short-chain fatty acids, which are special kind of, uh, thing. But also, they maintain the integrity of the lining of the intestines. If the lining of the intestines is breached, then bacterial wall products get into the bloodstream, and the first place they'll get to is the liver. Hence, you get a fatty liver. There are basically three reasons for fatty liver. Either you're drinking too much alcohol, or you get a leaky gut, or you have too much insulin, 'cause the insulin causes the conversion of glucose into fat, right? So you get a fatty liver.

    4. SB

      When you say leaky gut...

    5. PJ

      So that's a leaky gut.

    6. SB

      Oh, okay. So leaky gut is when the microbiome is dysfunctional.

    7. PJ

      The microbiome that is dysfunctional causes the integrity of your intestinal lining to be compromised.

    8. SB

      Ah, okay.

    9. PJ

      Yeah. So now molecules that are supposed to stay in the gut, dead bacterial wall products they call lipopolysaccharides, they're supposed to stay in the gut. But now they get into the bloodstream, they go up the portal vein, and up the portal vein, they'll end up going straight to the liver. And when they end up in the liver, they cause that fatty liver. Now you get this big fatty liver which causes a lot of inflammation. A fatty liver, there's an epidemic of this going on today. At least 25% of the population now have a fatty liver.

    10. SB

      And, uh, what is upstream from that? Is it, is it alcohol and all these processed foods and things like that?

    11. PJ

      Well, it's basically processed foods, sugar, and leaky gut. And of course toxins, alcohol being the biggest toxin.

    12. SB

      Okay.

    13. PJ

      This is the seat of metabolism. So as a cardiologist, I became interested in this because I found that if you have a fatty liver, you are gonna be more prone to inflammation, and you're gonna be more prone to coronary artery disease. When we fix the fatty liver, we change the diet through fatty, by, by changing your diet, and now you start eating real food and not processed foods and products, when we increase the fiber intake so that the good bacteria start coming back into your gut, hmm, and when I give you certain supplements to restore all your nutrition in your body, then all of a sudden, the progression of coronary calcium flattens out. You see, let's say you came to me for a test and I did a coronary calcium score and it's 500, and two years from now, it's 800. That means, wait a second, something's not right here, right? Your coronary calcium should not be going up. Now I can't get rid of the coronary calcium because that's plaque in the walls of your arteries, but it shouldn't keep going up because one day it's gonna be 2,000. So how do I follow how well my treatment for you is, is I follow the coronary calcium score.

    14. SB

      And again, the coronary calcium score is a marker of the amount of plaques...

    15. PJ

      Correct.

    16. SB

      ... around the heart, and in the vessels of the blood?

    17. PJ

      Yeah, in the walls.

    18. SB

      In the blood vessels. Okay, so you want low c- coronary calcium.

    19. PJ

      Like, my calcium score is zero. You shouldn't have any coronary calcium in the walls of the arteries. So we have the yardsticks now to see-

    20. SB

      We should probably, we should probably differentiate between calcium supplements and the calcium that you're talking about.

    21. PJ

      So pertinent. Calcium supplements actually increase the risk of cardiovascular events. Calcium supplements should not be taken. The problem is not calcium supplements, the problem is lack of D3 and lack of K2.

  18. 49:18 – 51:41

    Could Calcium Supplements Hurt You?

    1. PJ

    2. SB

      So we shouldn't be taking calcium supplements?

    3. PJ

      Absolutely not.

    4. SB

      Hmm.

    5. PJ

      Absolu- I stop all calcium supplements on all my cardiac patients and I tell them, "You should take vitamin D3 so you'll absorb calcium better into your gut, and you take vitamin K2." Because vitamin K2 is gonna make sure that you don't get the calcium buildup in the wrong places, in your vasculature, for example.

    6. SB

      Just to give some context to the research, some, some large observational studies suggest that high-dose calcium supplements, which is especially, um, above 1,000 milligrams a day from pills, may increase the risk of heart attack and stroke, while others find no clear link.

    7. PJ

      Yeah.

    8. SB

      Okay.

    9. PJ

      Yeah, no, I, look, also they advise high calcium supplements in women to prevent osteoporosis, for example, right? And ostepenia. And I live in Florida and all these young women that come to me in their 30s, they all have osteopenia. And the question is that they got calcium supplements put inside the milk and the orange juice has calcium in it, and they're taking calcium supplements, then why would they... And they have sunshine, and why would they have osteopenia? And the reason is D3. You need D3 and K2. That's what you need. It's a hormonal thing, it's not the elemental thing.

    10. SB

      So when people are on blood thinners, do they typically have low vitamin K1?

    11. PJ

      If you're taking Coumadin, Coumadin is a type of blood thinner-

    12. SB

      Yeah.

    13. PJ

      ... that lowers your, your vitamin K1 levels, and it will also lower K2. So Coumadin will lower K2 as well. So you will get increased coronary calcification, and that's been documented. So patients who have, who are taking warfarin, for example, or Coumadin, have been shown to have increased coronary calcification because of the fact that the K2 levels come down, as well as the K1 levels. Both come down. Both. So you need vitamin K2.

    14. SB

      And do you s- do you supplement that or do you get it from dietary?

    15. PJ

      I supplement it on all my patients because diet comes from fermented foods, and we don't eat enough fermented foods to contain enough vitamin K2. So one of the reasons why I do like my supplements is because today's food is not as rich as it was in the past. So we're not eating a variety of foods, but also, we're not getting enough vitamin K2 in our regular diet.

  19. 51:41 – 53:16

    How to Improve Gut Problems That Affect Heart Health

    1. SB

      So if you wanna give me advice, then, on having a great gut so that I don't end up with leaky gut, which will cause all of these downstream effects-

    2. PJ

      Mm-hmm.

    3. SB

      ... what is, um, what is the advice you'd give me to have a perfect gut?

    4. PJ

      Number one, lots of fiber. Because the fiber is gonna be f- eaten by your bacteria and you're gonna get a wide variety of good bacteria you're eating fiber. If you eat a lot of sugar, you will get bacteria too, but they are the bad ones, the ones that you don't want. So you're gonna get a condition called SIBO, for example. But you wanna eat lots of fiber. So because our diets today don't give us enough fiber, I do advise all my patients to take inulin with FOS. It's called inulin with FOS. It's a powder, it's a soluble fiber, and I just tell them to take one scoop in your water every day, or put it in your, in whatever you're gonna have, whatever liquid you're gonna have. Number two, fermented foods. The fermented foods will give you not only the bacteria themselves, because, uh, l- for example, kefir has so many different strains of good bacteria, but they also have the postbiotics. What is a postbiotic? A postbiotic, for example, vitamin K2, it's a product that the bacteria make. Short chain fatty acids, that's a product that the bacteria make. So you want bacteria, you want good bacteria in your gut, and they will stabilize the ratio of all the other bacteria in your gut. So the keystone species have to come back into your gut.

  20. 53:16 – 55:34

    Are We Fiber Deficient?

    1. PJ

    2. SB

      I was reading some research around fiber, and it says that in the United States, women are 40% fiber deficient and men are roughly 50% fiber deficient. And in the UK, we're about 40% fiber deficient. I don't think people know that. Where do I find fiber? What, what, what do I need to be eating to increase my fiber?

    3. PJ

      Fiber is found in anything that's non-processed. Because the very act of a processed food is to take out the fiber so that you can increase the shelf life of it. So any processed food, anything that's manufactured in a factory, for example, anything that already comes ready-made, they've taken the fiber right out of it. So you've got to eat real foods. You're gonna eat real vegetables, and that too, a variety of vegetables. You see, you're supposed to eat 30 to 40 different types of vegetables a, a week, and we don't tend to do that. So you want fiber from a variety of sources. So we gotta eat a little bit of all these different, different type of vegetables, including spices. They all count as one vegetable. So that's something I, I stress to everybody, that you gotta have variety. You gotta have all these different fibers because they will foster the growth of different types of bacterial species in your gut.

    4. SB

      What about lifestyle recommendations for improving my gut? Things like, I don't know, stress, uh, sleep, ex- exercise?

    5. PJ

      Oh.

    6. SB

      Anything like that?

    7. PJ

      Sleep is absolutely important. So the, the, the next thing is actually, actually sleep and stress, because lack of sleep causes a change in your gut microbiome. You got to sleep seven hours a night, and cutting down on sleep is gonna affect your entire physiology in your body and your repair processes and your vagus nerve and your delta sleep and... But also your gut microbiome. One night, you'll get insulin resistance. One night of bad sleep, you become insulin resistant the next day.If you're changing, hm, if you're changing time zones very frequently, the liver dysfunctions and the gut microbiome also dysfunctions. So we gotta be more cognizant of that, that lifestyle is very important and we have to have plenty omega-3 in the diet.

  21. 55:34 – 56:37

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    1. PJ

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    2. SB

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  22. 56:37 – 1:04:20

    Modern Toxins Living in Our Bodies

    1. SB

      You talked, you talked earlier about toxins.

    2. PJ

      Yeah.

    3. SB

      What do you mean by toxins and how, what role is toxins playing in my physiology and my heart health and my gut health?

    4. PJ

      Yeah. So-

    5. SB

      And what is a toxin?

    6. PJ

      A toxin is a molecule that should not be in your body. You should not have been exposed to it. So let's take a pesticide or a herbicide. These are chemicals which man has made and not perhaps adequately tested it in, in, um, i- in rigorous studies. And yet these chemicals get into the body and we know that many of them are estrogen receptor disruptors and that causes inflammation as well. So if you look at pesticides and herbicides, we look at plastics, forever chemicals, for example, PFAS and other chemical, BPA. These chemicals all disrupt our metabolism in our body. And then of course, mold is a toxin. And lastly, heavy metals are toxins. When the gut is not working properly, you're gonna be more prone to toxicity because the gut bacteria normally grab a lot of those things and take them out in your stools. So when we look at toxicity, we look at gut health and the liver health. The liver is supposed to get rid of lot of toxins, but in today's day and age, because of the foods that we are eating, the environment that we breathe, the environment that we walk out into, we are getting too many toxins. And this poor organ here is getting overwhelmed and cannot detoxify adequately. So when I do a blood test, urine sample, and a stool sample, I get a very good bird's eye view of what's going on with their ability to detoxify and which levels are high. And I'm finding that many of my patients who have gut issues and liver issues are very, very high with not only heavy metals, but they also have a lot of pesticides, herbicides and mold in their body. And mold, I'm finding a lot of mold, and mold and all these extraneous toxicities cause inflammation. Inflammation is a reaction to something that your body shouldn't have.

    7. SB

      Where is the mold coming from?

    8. PJ

      Mold is very interesting. I've only started researching it in the last one year. Basically, s- almost 70% of homes these days have some form of mold toxicity in them, either from previous water damage or exposure. And mold is ubiquitous. It's, it's just about everywhere and it can reinoculate you every time you're in that environment and it causes your innate immune system to start reacting to it and causes low-grade inflammation in your body. And when I get rid of the mold, all of a sudden I'm noticing that the patients are not only feeling better, but the rate of progression of coronary artery disease flattens off.

    9. SB

      I have this, uh, steam room in one of my houses and, uh, I went in there the other day and I smelled, I could smell, it smelled a bit funny. And I recognized that smell from when I was younger as being mold. So I, like, I googled it. I typed in, "What is that, like, earthy, strong, pungent smell in my steam room?" And I think what's happened is part of the, like, seat has come away from the wall, so it's not sealed anymore. And I think the moisture has got in there with the water and I think it's moldy. And ChatGPT said to me when I was asking ChatGPT, said, "Smell near the, like, cracks."

    10. PJ

      Yes.

    11. SB

      And if you smell, if it smells u- really strongly near the cracks, then that's mold. And I smelled near the crack and it was really, really strong. I remember thinking, "Oh, like so I... Had I not known that, would've been sitting in there 30 minutes a day inhaling all of that strong mold smell." And from doing this show, I've, I've learned that the downstream impacts that can have on your body and your cardiovascular health and everything in between is really, really bad. So I had a team come over and just, uh, fix everything, repair it, and do a deep clean. But I don't think people are very aware of how mold, which we kind of think of as like, oh, the, the bread has gone green-

    12. PJ

      Yes.

    13. SB

      ... whatever-

    14. PJ

      Yes.

    15. SB

      ... can have a chronic-

    16. PJ

      Mm-hmm.

    17. SB

      ... downstream impact.

    18. PJ

      And also this mold can come in and then become part of your microbiome. So it can actually come into your... So let's say you get out of this place-But if the mold is still in your gut or it's in your sinuses, for example, and you get chronic sinusitis, you're reinoculating yourself over and over again with this mold. And this is an area of great interest and a lot of research needs to be done. It is real, and we've known about it for a long time, but the medical profession as a general has not really taken this and run with it, but it is very important, and we certainly w- looking at more toxicity in our practice because we find that it is actually more prevalent than we ever, ever imagined before. And we know the chemistry. We know that it causes a, a systemic inflammatory reaction in the body, and it's reflected in the blood work. We see that the CRP is up. We see that the complement levels are high. We see that the certain ratios of certain inflammatory molecules are off, so we w- do wanna treat mold. Um, we wanna treat sources of mold toxicity, both in the gut as well as in the sinuses. And yes, people are surprised when I tell them that that affects their cardiovascular health.

    19. SB

      When we talk about the clogging of arteries, w- why is it that healthy people still end up sometimes with these clogged arteries?

    20. PJ

      I think it's because they have sources of inflammation that we have not identified. For example, we say, "Oh, you have no cholesterol. You have no smoking. You have, you're, you're exercising. You're not overweight. You don't have diabetes. Well, then I don't know why you got all these art." No, there's always. If you dig deep inside, there's always something, and we'll find the source of the inflammation w- there's always a reason why you get hardening of the arteries.

    21. SB

      What's in that list?

    22. PJ

      In that list is mold.

    23. SB

      Mold, yeah.

    24. PJ

      Leaky gut.

    25. SB

      Yeah.

    26. PJ

      Huge. Food sensitivities. Oh, let me tell you about food sensitivities. So, another reason for the leaky gut is that certain foods punch holes into your intestines in a, in a, in a sense, and causes a leaky gut. And I've had at least one patient in the last six weeks that I can remember who actually has celiac disease, and he didn't even realize he had celiac disease because he had no constipation, diarrhea, and he had premature coronary artery disease, and we identified that he had celiac disease. We cut out all wheat from his diet, and that's gonna stop this inflammatory process from occurring. See, it's all about inflammation. We need to get rid of inflammation in order to get rid of coronary artery disease. Any source of inflammation, get rid of the source. So, if the pesticide levels are high, herbicide levels are really high, get off that source. Maybe you, may, maybe you're living on a golf course and you smell those chemicals every day. Maybe you're using it yourself in your yard. Maybe you have toxicity coming from mold, as you mentioned, but we gotta find the source of it. So, a thorough evaluation of the gut microbiome, a thorough evaluation of toxins in your body and the nutritional status. Your body is able to work and get rid o- of this type of pathology if you have good nutrition. We don't have good nutrition today.

  23. 1:04:20 – 1:06:08

    The Harmful Foods We're Consuming

    1. PJ

    2. SB

      Let's talk about nutrition, then. So if I wanted to end up on your surgical table, if I, if that was my goal, what would you recommend that I ate and, yeah, consumed?

    3. PJ

      You should eat nutrient-deficient processed foods every day.

    4. SB

      Give me some examples of, of things. Pringles and...

    5. PJ

      Correct. So it'll be things made out of wheat, refined wheat. Biscuits, cookies, cakes, lots of bread. Basically, fast foods, foods that come in a box, ready-made food with labels. Anything that comes in a packet that you open up, including some of these that are high protein bars or some of these... Because they have all sorts of other chemicals in them. And I would have lots and lots of, um, artificial colorings in my food, in all those processed foods. Um, artificial sweeteners, lots and lots of diet drinks and sugary drinks.

    6. SB

      Orange juice?

    7. PJ

      Orange juice is, is certainly on my list because that produces such a profound increase in my glucose level, and then my insulin spike that I'm gonna get afterwards will cause me to become very hungry three to four hours later. So, yeah. I would not eat real food. And you'll end up on my table.

    8. SB

      Obviously alcohol, smoking.

    9. PJ

      Alcohol. No fiber, 'cause none of those foods will have fiber in them. None of those processed foods have fiber in

  24. 1:06:08 – 1:15:06

    Daily Foods You Thought Were Healthy

    1. PJ

      them.

    2. SB

      Your patients must come to you at times and tell you what they're doing, uh, in terms of what they're eating and lifestyle choices, and there must be certain things which very people aren't aware aren't healthy. You actually mentioned bread.

    3. PJ

      Yeah.

    4. SB

      Is all bread bad?

    5. PJ

      No, not all bread is bad. Most bread is bad. I don't mind some sourdough because it's fermented, so it's gonna get rid of some of those lectins that are already in the flour. So those lectins are gone out because they've been fermented, so it's probably a little bit okay. But again, not large amounts of it, you know. A slice once or twice a week is fine, but really it's a survival food. Bread is a survival food. Just empty calories, that's all it's gonna do.

    6. SB

      Is there like a worse bread? Is there like one bread which is...

    7. PJ

      Yeah, pure white bread. Simple white bread. The simple white, white bread. It's pure calories. 70 calories right there. You're talking about just eat, have 10 teaspoons of sugar instead in one slice. I mean, it just doesn't make any sense whatsoever.

    8. SB

      White rice?

    9. PJ

      White rice. I...White rice is a staple food of many people, and they cannot live without it. So, I run into this problem all the time. So, I tell them that, "This is what you're gonna do. You're gonna, first and foremost, soak your rice in water and then discard the water after an overnight soak because it contains arsenic in it and other heavy metals." You'll be surprised how much arsenic there is in rice these days. You see? See the problem we have? Our sourcing of our foods. I mean, here is a cardiologist has to talk to his patients about how to cook rice.

    10. SB

      What is arsenic, for people that don't know?

    11. PJ

      It's a heavy metal that is found in the soil and the water. It's in contaminated soil and water, and in... these paddy fields are now full of arsenic. So-

    12. SB

      It's a poison, isn't it? People-

    13. PJ

      It's-

    14. SB

      I watch a lot of True Crime. People kill each other with arsenic.

    15. PJ

      It's a very, very strong poison, and it'll slowly kill you.

    16. SB

      Is there anything else on that list of the misconceptions 'cause-

    17. PJ

      Yeah. So, so, so the rice has to be soaked. Then you'd get rid of the water. Then you cook it with lots of water. Throw away the rice again. I mean, uh, uh, throw away the water, not the rice.

    18. SB

      (laughs)

    19. PJ

      And then you cool the rice in the refrigerator. And then you eat the rice the next day by reheating it. Now, what you've done is you've created resistant starch. Now, what's gonna happen is that that rice is not going to have the same insulin effect in your body and weight gain effect and changes in your metabolism because it's now got resistant starch. Resistant starch means that those molecules have all bound to each other. They don't... They resist absorption and digestion until they get to your colon. And then who's gonna eat it? Your bacteria. So, you're basically feeding the bacteria with your rice. So, if you're gonna have rice, this is the way you're gonna do it. So-

    20. SB

      Is there anything else on that list that people should be thinking about that they probably consider to be healthy right now?

    21. PJ

      Yeah, yeah, yeah, yeah. Yeah, yeah. So, it's also what you do to your food. Look, you take a nice piece of fish, for example, and if you burn it and you blacken it really bad, you're creating what is known as advanced glycation end products. You fry something, you're creating advanced glycation end products. So, let me define that for you. If nature does not have the ability, on its own, to take glucose, protein, and fat and combine them at very high temperature, but you can do it in your air fryer and you can do it outside in, in when you're, when you're blackening your food and over-blackening your food, it's called advanced glycation end products. So, when you overburn your c- food, when you overcook your food, you're creating these molecules. Now you're consuming these molecules, and they have been shown to cause a radical increase in the inflammation in your body because your body reacts to those products. There's receptors to get rid of those, they're called RAGEs, and they get rid of these products, but you overwhelm them and now you get inflammation.

    22. SB

      And is there any other watch-out foods that, you know, people think are healthy but maybe if, if I was trying to have a optimally healthy heart I should avoid?

    23. PJ

      This is gonna surprise you. Excessive fruit, 'cause I'm not a very big f- follower of fruit. Fruit should be eaten only in season 'cause it has too much fructose in it.

    24. SB

      Fructose being the sugars.

    25. PJ

      Fructose is a sugar, and fructose causes fatty liver. So, our overconsumption of fruit is another factor that is contributing to coronary artery disease and diabetes and fatty liver. And we think of fruit as being a healthy thing. You see? But fruit should only be consumed really in the fall and in season and in small amounts, 'cause that high fructose level really causes major changes in your metabolism. So, I'm not too fond of fruit. You can eat fruit in season, small amounts of it. But, you know, people go crazy about fruit. I mean, I had a patient who was having mental problems as well as cardiovascular disease, and he, that's all he lived on is fruit, morning, lunch, and dinner. And the moment we stopped that, his health changed completely. He got so much better. So, excessive fruit is also no good. Excessively cooked foods, processed foods, refined products. Another one, vegetable seed oils. So, any food that you prepare or you buy that contains vegetable seed oils is a no-no 'cause vegetable seed oils are a product. And if you look at all of them, they're exceedingly high in omega-6, and the ratio of omega-6 to omega-3 is what the problem we have today. We have far too much omega-6, very little omega-3. So, anything that contains vegetable seed oils. So, I always tell my patients, "Get rid of that vegetable seed oil bottle from your home."

    26. SB

      So, what oil should I use instead?

    27. PJ

      The oil at home, if you're gonna use any oil, is gonna be olive oil, extra virgin olive oil for your, for your salad. And if you're gonna do high temperature, put just a little pat of butter or use a little bit of ghee, or you can use a little bit of coconut oil.

    28. SB

      This is a bit more of a different question, but you said earlier on that when a patient walks into your office, you can kinda look at them and generally see if their cardiovascular health is intact. And, uh, you know, we're generalizing here. But if I'm sat at home right now and I'm trying to figure out if I'm healthy as it relates to my cardiovascular health, what are the symptoms of cardiovascular poor health? Like, what... throughout the whole body, what, what should I... can I sort of s- obviously, I don't want us, anyone to self-diagnose at home, but what kind of symptoms should I be looking at when I j- you, even when you look at me? Let's do this on me to make it easier.

    29. PJ

      Yeah, yeah. So, number one, look at your weight.

    30. SB

      Okay.

  25. 1:15:06 – 1:16:52

    Is Our Oral Microbiome Linked to Heart Health?

    1. PJ

    2. SB

      This is a random one, but I'm just connecting dots from different podcast guests I've had on the show. What about bad breath?

    3. PJ

      Bad breath. (laughs) Bad breath is real.

    4. SB

      But what, is it, is my oral microbiome linked to my heart health?

    5. PJ

      Yes. There's a, there's a microbiome that goes all the way from your nose, mouth, all the way down to the anus. And each one is specific and can predict whether you're gonna get cardiovascular disease or not. There's unequivocal data to show that if you have bad teeth, bad dental hygiene, bad bacteria in your mouth, you're gonna get valvular disease, such as aortic stenosis, premature calcification of your aortic valve, and you're gonna get coronary calcification. That's been proven unequivocally. Patients who have chronic sinusitis in your... So you think that that's benign? If you have chronic sinusitis-

    6. SB

      What's chronic sinusitis?

    7. PJ

      Chronic sinusitis, infections inside your maxillary sinuses, frontal sinuses constantly, and you get these headaches, a- an- and you get the cold and your blocked nose and you, you're constantly clogged up inside here, that's inflammation. And oftentimes, that's also linked to premature coronary artery disease and inflammation in your body, especially when it's fungal. There's a condition called fungal sinusitis. Again, it comes down to mold. And this mold, it causes that low-grade inflammation in your body, and this has been linked to coronary artery disease. See, what's happening is we're transforming the whole definition of the causes of coronary artery disease. We have been so myopic in our definition of what causes coronary artery disease. With everything, your entire lifestyle, mental, physical, eating, everything will affect your coronary arteries. Everything. Everything

    8. SB

      Do

  26. 1:16:52 – 1:19:52

    Is Coffee Good or Bad?

    1. SB

      you think much about overstimulation? Uh, so, I mean, really mean, like, too much caffeine. Does, does too much caffeine play a role? And I say this in part because I think there's been a few times where I've had like a pre-workout or too many glasses of coffee and I've got, like, heart palpitations and you almost, like, feel like you're dying.

    2. PJ

      Yes. Yes, yes. Caffeine. Caffeine is very similar to the adrenaline molecule. Now, why would you want to have too much adrenaline in your body? Because then you're living in a state of existential threat constantly. And then what happens? You don't get the offset either, so you don't get the parasympathetics, you're only in sympathetic all the time. So caffeine-

    3. SB

      That fight or flight.

    4. PJ

      All the time. So caffeine generates that, and the physiology it'll do... Look, caffeine is not as benign as we think it is. Now, there's nothing wrong with having one or two coffees a day. That's fine, okay? But I know people who drink about six glasses or six cups of coffee a day and, and I think that that's just, that's toxicity. You see? That's toxicity, too much caffeine. And it's a diuretic, and a diuretic will cause intravascular volume depletion and that also turns on your neurohormonal activation, so you become more sympathetic. You see it? So it's a vicious cycle. Makes you dehydrated.

    5. SB

      I was reading about this earlier, 'cause I did have heart palpitations one day because I think I drank too much coffee. Um, and what I, what I see here in the research says that moderate caffeine is safe and even heart protective for most people, but excessive caffeine when you get, you know, above 600 milligrams a day, um, can raise blood pressure, trigger arrhythmiums?

    6. PJ

      Arrhythmias, yeah.

    7. SB

      Arrhythmias, and stress the heart.

    8. PJ

      Yes. Now, I wanna tell you why coffee is good. It's not good because of the caffeine. And so it's not good that, "Oh, yeah. I'm getting that caffeine, so it's good for me." No. Because believe it or not, coffee has a lot of soluble fiber in it. So there is some soluble fiber in it, and it has polyphenols. So coffee has polyphenols, just like how cocoa has. You know, cocoa, cacao, 85% cacao, chocolate, that's fantastic. It's got soluble fiber. 'Cause who's gonna consume the soluble fiber? It's actually the bacteria. So a coffee a day is actually good for you for a different reason. It's good because it's good for your bacteria, 'cause it's getting soluble fiber and it's getting polyphenols, and all those polyphenols are consumed by your bacteria. So-

    9. SB

      They call, they call cacao, don't they, the, something of the heart? My, my girlfriend's quite spiritual and in her practice they call it, like, the heart medicine. Cacao.

    10. PJ

      Cacao. It is. Because it has a lot of antioxidants and it has a lot of soluble fiber. So wait a second, it's the soluble fiber? Yes, because that's fostering the growth of the good microbiome. The good microbiome is then gonna produce postbiotics, and the postbiotics-... are going to give you all the benefit that you're gonna need. So it's gonna cause less leaky gut, less inflammation, and your enteric nervous system, your vagus nerve, your vagus nerve is gonna be protected because we're destroying our vagus nerve right now with the leaky gut.

  27. 1:19:52 – 1:21:27

    When Are Heart Palpitations a Sign of Concern?

    1. PJ

    2. SB

      When people get heart palpitations, imagine a lot of them message you, because it's quite scary, isn't it, when you feel your heart beating? What is typically going on, and when is it cause for concern if you've got heart palpitations?

    3. PJ

      Yeah. If you have underlying structural heart disease, let's say you have blocked arteries, let's say you have a cardiomyopathy, a valvular disease, and you're having an arrhythmia, which is palpitations, that is definitely life-threatening. They need to come straight to the office, and we need to monitor you and find out what's going on. But let's say you're otherwise perfectly healthy. Young person, perfectly healthy, no heart disease whatsoever, and you're having palpitations. Then it's usually an imbalance of your sympathetic and parasympathetic nervous system.

    4. SB

      You're too stressed.

    5. PJ

      It's basically either too much sympathetic or not too much sympathetic, but you have too little parasympathetic. And that is one thing that I want people to realize, that if you've knocked your vagus nerve off because you have a leaky gut or because of your lifestyle and your vagus nerve is not working very well, you will have this imbalance, because the imbalance is not with absolute levels, it's the relative levels of sympathetic versus parasympathetic. So for example, I see a lot of young women in their 30s and 20s who come to me with tachycardia. They have a rapid heartbeat all the time, and especially when they stand up, they get a rapid heartbeat. This is called postural orthostatic tachycardia. And when they come to me, I find out that it's actually the gut. I fix their gut, and the tachycardia gets better because by fixing the gut, I'm fixing the vagus nerve. By fixing the vagus nerve, the heart rates come down.

    6. SB

      I've

  28. 1:21:27 – 1:25:38

    Ads

    1. SB

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    2. PJ

      (laughs)

    3. SB

      So the next day, I cycled just over 100 kilometers on my Peloton at home. Funnily enough, it took me like four hours to do it, and then I came off the Peloton, I was celebrating, whatever, you know. Won this gold medal emoji as my reward that month, but also I won heart palpitations that stayed with me for a little while, and I was wondering like why that happened. So I did this big vigorous exercise which was kind of outside of my usual exercise regime, and then for a, a couple of weeks, I could like feel these heart palpitations, and is that because of what you were saying about my parasympathetic vagus nerve? Wh- what do you think happened there?

    4. PJ

      Yes, yes, yes, yes. Over-exercise, this has been shown, when you do what you just did, you're diverting blood from your gut to your muscles, because your muscles at that point really need all that blood supply, and this has been well-documented. So what happens when you overly exercise like that, you're causing relative ischemia to your gut. Ischemia, ischemia. What does ischemia mean? Lack of circulation to your gut. So your poor gut at that point had lack of circulation, relative, not to the point where it's gonna go gangrenous. No, don't, don't, don't get me wrong, but it affects your gut, and in the gut is the enteric nervous system. The vagus nerve ends in your gut lining, and the vagus nerve got affected. So if your vagus nerve didn't work very well, when you get vagus nerve not working well, you get too much sympathetic, you're gonna get tachycardia. You're gonna get arrhythmias.... palpitations.

  29. 1:25:38 – 1:31:40

    The Power of the Vagus Nerve

    1. PJ

    2. SB

      So tell me what the vagus nerve is, and what I can do to get my vagus nerve in check. By the way, Jemima, it was totally worth it. But just tell me what I, what I can do to get my vagus nerve in check, and like, what role my vagus nerve plays. I've got this photo here of the vagus nerve. Um...

    3. PJ

      Yeah. You know, the vagus nerve is fascinating. It is the largest nerve in the body, and it could, it basically is sending messages from the brain to the whole body, and receiving messages back to say what is the state of affairs. And the largest distribution, believe it or not, is all in your gut. Now that tells you something right there, that, what is the brain most concerned about? It's most concerned about the most treacherous border in your body, which is your gut. Your gut health is so important that the body has dedicated a huge nerve called the vagus nerve just to take care of your gut. Because your gut is that important. That is why. It, by the way, it also has endings on the heart, in your lungs, in your face. So there's lots of endings of the vagus nerve.

Episode duration: 1:54:26

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