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Don’t Learn This Too Late: 5 Things Top Heart Surgeon Says You Must Avoid to Live Longer

Order your copy of The Let Them Theory 👉 https://melrob.co/let-them-theory 👈 The #1 Best Selling Book of 2025 🔥 Discover how much power you truly have. It all begins with two simple words. Let Them. — You’re about to hear what a heart surgeon wishes you knew sooner. If you’ve ever wondered what’s really going on inside your body, or what habits are silently destroying your heart, this episode could be a lifesaver. Dr. Jeremy London is a renowned heart surgeon with 25 years of experience. After performing thousands of heart surgeries, he’s seen what wrecks the human heart, and he has one mission: to keep you off his operating table. He’s not here to scare you. He’s here to tell you the truth about what’s wrecking your heart and how to protect it. And in this conversation, he’s breaking it all down: what to avoid, what to do, and how to make the changes that truly matter. You’ll learn: -The foods a heart surgeon refuses to eat, and what he eats instead -2 so-called “healthy habits” that could be putting you at serious risk -The real warning signs of a heart attack (and what to do if you’re alone when it hits) -The small daily changes that can protect your one precious heart and add years to your life. Consider this your personal appointment with one of the world’s top heart surgeons. It just might be the most important one you’ll ever have. For more resources related to today’s episode, click here for the podcast episode page: https://www.melrobbins.com/episode/episode-305/. Follow The Mel Robbins Podcast on Instagram: https://www.instagram.com/themelrobbinspodcast I’m just your friend. I am not a licensed therapist, and this podcast is NOT intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I’ll see you in the next episode. In this episode: 00:00 Welcome 6:02 Dr. London’s Personal Story: Surviving a Heart Attack 17:15 What You Need to Know About Your Heart Health 27:14 Everyday Habits That Quietly Damage Your Heart 32:49 Real Ways to Take Better Care of Your Heart 36:52 What a Heart Surgeon Eats — and Why It Matters 43:14 A Clear Explanation of Heart Disease and Treatment Options 50:02 What to Do If You Think You’re Having a Heart Emergency 54:50 High Blood Pressure: What It Means and How to Manage It 58:50 How Heart Health Is Different for Women — Follow Mel: Instagram: https://www.instagram.com/melrobbins/ TikTok: http://tiktok.com/@melrobbins Facebook: https://www.facebook.com/melrobbins LinkedIn: https://www.linkedin.com/in/melrobbins Website: http://melrobbins.com​ — Sign up for Mel’s newsletter: https://melrob.co/sign-up-newsletter A note from Mel to you, twice a week, sharing simple, practical ways to build the life you want. — Subscribe to Mel’s channel here: https://www.youtube.com/melrobbins​?sub_confirmation=1 — Listen to The Mel Robbins Podcast 🎧 New episodes drop every Monday & Thursday! https://melrob.co/spotify https://melrob.co/applepodcasts https://melrob.co/amazonmusic — Looking for Mel’s books on Amazon? Find them here: The Let Them Theory: https://amzn.to/3IQ21Oe The Let Them Theory Audiobook: https://amzn.to/413SObp The High 5 Habit: https://amzn.to/3fMvfPQ The 5 Second Rule: https://amzn.to/4l54fah

Dr. Jeremy LondonguestMel Robbinshost
Jul 7, 20251h 11mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 6:02

    Welcome

    1. JL

      Heart disease and heart attacks, 20 million lives worldwide per year.

    2. MR

      Wait, what?

    3. JL

      We're all trying to squeeze every ounce of juice out of this brief existence. Why not make choices that tip the scales in our favor?

    4. MR

      There's something in your life that I bet you don't think about that often. Every second of every day, every week, every year of your life, your heart is there. I am super excited to introduce you to Dr. Jeremy London. In his 25 years as a heart surgeon, he's seen it all. Dr. London's expertise is resonating with people around the world. His tips for living well and protecting your one and only heart have racked up nearly 50 million views on YouTube, and he says he's on a mission to keep you off his operating table. There are simple things that are within all of our reach that can keep us from ever meeting you on an operating table.

    5. JL

      It's that, that concept of we know better, but we just don't do better. Don't drink red wine because you think it's good for your heart. Shop on the outside of the store. Stay out of the aisles. All of the canned and jarred items are on the shelves. The longer the shelf life, the shorter your life. I cannot come up with one single thing that does as much damage to every organ in the body as... (clock ticks)

    6. MR

      Hey, it's your buddy, Mel Robbins. Welcome to the Mel Robbins Podcast. First of all, I am so excited that you're here. It's always an honor to be able to spend time with you, to be together. And if you're a new listener, I wanted to personally take a moment and welcome you to the Mel Robbins Podcast family. I am thrilled that you're here today. And because you hit play on this particular episode, here's what that tells me. It tells me that you're the kind of person who values your time and you're spending it on listening or watching something that could help you improve your life. And I'll tell you what, the conversation we're gonna have today, this is worth your time because this could save your life or the life of somebody that you love. I'm not kidding around about this. I actually have this feeling that this is gonna be one of those conversations that you and I have and we're gonna learn from the expert today and it's gonna be so inspiring that you're gonna share this with all kinds of people in your life. Because if you haven't been able to get through to somebody that you care about, about taking better care of themselves or their cholesterol or their blood pressure or their heart, I know Dr. Jeremy London will get through to them. And by the way, if you're listening to this because someone sent this to you, well, first of all, I wanna thank you. I wanna thank you for pressing play and being open to hearing what Dr. London has to say to you. And second, it's really cool that someone cares enough about you to send this to you and ask you to listen to something that's gonna empower you to take better care of yourself and to understand what you can do to live a longer, happier and healthier life. Because today, you and I are gonna talk about your heart and maybe you're worried about it or maybe you're just kinda scared about where you're at with it or maybe you're just a little resigned because you don't think anything that you're gonna do is gonna make a difference in your heart health. Well, that's why I'm super excited to introduce you to Dr. Jeremy London. In his 25 years as a heart surgeon, he's seen it all. He is a board certified cardiovascular surgeon at St. Joseph Hospital in Savannah, Georgia, and he says he's on a mission to keep you off his operating table. And as you're about to learn, he has a way of explaining things that's just so clear and so insightful that you're gonna walk away from this conversation with just a mountain of tools and takeaways and you're also gonna be inspired, because Dr. London's expertise is resonating with people around the world. His tips for living well and protecting your one and only heart have racked up nearly 50 million views on YouTube. And today, he hopped on a plane, he flew to Boston and he is here for you in our Boston studios to help you take better care of your heart. Dr. Jeremy London, thank you for hopping on a plane and being here in our Boston studios. I am so excited to meet you.

    7. JL

      I am honored and equally as excited-

    8. MR

      (laughs)

    9. JL

      ... to be here. Very appreciative.

    10. MR

      I believe you. And I'm appreciative that you're here because I think you have such a unique perspective to share and so much wisdom-

    11. JL

      Mm-hmm.

    12. MR

      ... and expertise to help us better understand one of the most important things we have in life, which is our heart. And so where I wanna start is I would love to have you speak to the person who is listening right now, and this is somebody who has no time, but they have found time and made time to be able to hang out with you and me and to learn from you, Dr. London. And I would love for you to share what they might experience that's different in their life or the life of somebody that they love if they truly take to heart, like literally to heart everything that you're about to share with us today.

    13. JL

      Well, my hope would be that I can maybe shine a light in a corner that you haven't explored or give you a slightly different perspective that you haven't considered. You know, our mission is to offer digestible, accessible healthcare, lifestyle information really to anybody that has an internet access.

    14. MR

      Mm-hmm.

    15. JL

      And if I can in some way ease the process of this journey, then I feel like we've made an impact. If maybe we can take something that has been a push for many people and turn it into a pull, I think that that, that would be amazing.

    16. MR

      Well, Dr. London, there's that famous saying that when the student is ready-... the teacher appears.

    17. JL

      (laughs)

  2. 6:02 – 17:15

    Dr. London’s Personal Story: Surviving a Heart Attack

    1. JL

    2. MR

      But you yourself found yourself on an operating table just a few years ago, and so this is now extremely personal. Can you tell us about that experience and how it has shaped the way that you think about your heart and health?

    3. JL

      Absolutely. There's nothing like flipping the coin upside down to change your perspective and that is exactly what happened to me. We were out in the country at a small cabin that we have about an hour from town. I wake up very early in the morning and I was in the bedroom and my wife, who is a very bright, intuitive woman, looked at me and said, "Do you feel okay?" And I said, "Yeah, just I feel like I've got some reflux." She's like, "Are you sure you have reflux?" I said, "Seriously?"

    4. MR

      (laughs)

    5. JL

      (laughs) I mean, she's like, "Okay. I- I hear ya." She's like, "I'm just telling you, you just... You don't look right." And so normally I'll sit down and I'll read and kind of left the room. I took a Pepcid and everything went away, everything was great. We have four dogs, so we head out for a walk. It's December, December 4th, because I remember very clearly, and we head down the road and we got about a quarter mile from the house and the reflux came back. And I was like, "Hmm."

    6. MR

      What does reflux feel like?

    7. JL

      So it created this, like, burning sensation in my chest. Not formal chest pain, but almost like you had eaten some spicy food-

    8. MR

      Got it. Okay.

    9. JL

      ... for instance and it wasn't agreeing with you, like something was wrong in my stomach is kind of how it felt, with the exception of the fact at this point I'm out on a walk, it's 30 degrees outside. I'm sweating, I'm peeling my clothes off, at which point Tracy says, "Hey, you sure you're good? Like, (laughs) we're just walking the dogs." I said, "You know, I don't feel great." And so we get back to the house and, um, this is, uh, probably a little TMI, but I came back in the house, I said, "I gotta use the bathroom."

    10. MR

      Mm-hmm.

    11. JL

      And I immediately sat down on the toilet and the symptoms went away instantly. And unfortunately, my insight into coronary disease told me immediately, danger.

    12. MR

      Really? That the symptoms went away when you sat down is danger?

    13. JL

      Be- right, because the way coronary disease works many times is it's a symptomatic disease process. In other words, if you have a fixed blockage in a heart artery and you have a set amount of exertion, it brings on symptoms that then is relieved with rest because that portion of the heart muscle that was heart starved is then no longer under any stressor. So I was like, "No way. This isn't happening." And didn't say a word. So through the course of the day, I tested it. I would go up the stairs, have a little pain, sit down, it would go away. I was like, "You have got to be kidding me. All right. It's not that. I'm positive it's not that." So my youngest son and I stayed that evening in the country. My wife and rest of the family went back into town.

    14. MR

      You weren't worried?

    15. JL

      You know, denial is, is not a river in Egypt, apparently. So I have learned-

    16. MR

      (laughs) Denial. (laughs)

    17. JL

      (laughs) Yes. I was worried. Uh, but I wouldn't allow myself to go there at this point.

    18. MR

      Mm-hmm.

    19. JL

      Which, again, quite honestly I've told this story quite a bit and each time I'm more embarrassed by my behavior, each telling of this, including right now.

    20. MR

      Well, I appreciate your honesty.

    21. JL

      As so, yeah.

    22. MR

      Because I think when something's happening to you, even if you're not a heart surgeon who is now recognizing the signs of a heart issue, there's both the denial that you experience because you just can't believe it, but then there's also the denial because you don't want to.

    23. JL

      Yeah. And it'll become even m- even more apparent just how egregious all this was, but it's that, that concept of we know better but we just don't do better. The cognitive dissonance and how we are able to spin that in ways that we abdicate ourselves of going down a road. I mean, smokers know it's bad for them. You're eating junk food, you know it's not good, but we do it anyway and I think that that is really one of those huge gaps that we can talk about down the road of opportunities i- when we care for people and when we care for ourselves, like, how to recognize that and how to navigate that. And I really, I think this whole episode really kind of taught me that. So my family goes back into town and my youngest son and I went out to deer hunt for the evening and we're together and he ends up harvesting two animals. It's pitch black, we're a quarter mile from the truck and we come down out of the stand to load up and I immediately had crushing chest pain-

    24. MR

      Oh, God.

    25. JL

      ... in the middle of this field, pitch black, with my 15-year-old son, no cell service and all I'm thinking, Mal, is he's not gonna find one of those deer. He's gonna find me dead in this field, you know? And I even, I just break out (laughs) into goosebumps even talking about it because it was like, "You gotta pull yourself together." Like, "You gotta figure this out." And, you know, he's like, "Dad, what's going on? Like, you need to be over here." I'm like, "No, I might be over..." "Dad, what- what's going on?" I was like, "Well, I had that reflux..." He goes, "Well, stopping helps reflux? You're down on your knees in the field." And I was like, "I'm gonna be okay. I just, you know, need a minute" until I pull myself together, we get in the truck and we drive home. Once I'm in the truck, everything settles down and I get home.And I take an aspirin and a beta blocker and I went to bed and did not say a word to my wife. And so I wake up the next morning, my normal routine, I get out, I make coffee, I come back up the stairs and I immediately had this-

    26. MR

      Oh my God.

    27. JL

      ... crushing chest pain again. And that's when I said, "Trace, uh, something really bad is wrong. This happened to me last night in the field." And she looked at me, she goes, "Let me get this straight. You had chest pain last night and you didn't tell me. And why didn't you tell me?" I said, "Well, because you would have made me go to the ER." She goes, "Yeah, you dumbass. That's what people do when you're having crushing chest pain."

    28. MR

      Mm-hmm.

    29. JL

      And I- and she stopped for a minute and she said, "This is the most selfish thing you have ever done to me and the boys." And I just said, "You are right and I'm really sorry. And I'm having crushing chest pain right now." (laughs) I think we need to go and I need to, I need to get to the hospital. So we went, and I'm calling my friend who's the cardiologist on the way and I'm telling him this story. He's like, "Dude, there's no way. You eat right, you take such good care of yourself. There's no way that this is going on." I was like, "I don't know what to tell you-"

    30. MR

      Yeah.

  3. 17:15 – 27:14

    What You Need to Know About Your Heart Health

    1. MR

      first of all, I'm really proud of you for telling the story.

    2. JL

      Well, thank you.

    3. MR

      Because you could revise the story to just be about the symptoms and then what ended up happening, but I really appreciate the fact that you blow-by-blow expose the humanity in the story and the truth, because there's a number of things that happened for me as I was listening. First of all, I didn't even know that that was a thing in terms of if your symptoms feel like heartburn and then you sit down and they go away, that that's actually a warning sign. So that's number one. Like, 'cause I would have thought the opposite.

    4. JL

      Cardiac angina or- or pains associated with the heart are the great masquerader.

    5. MR

      Of what?

    6. JL

      Like in general. So in other words, it's not all the, what I call the TV heart attack.

    7. MR

      Yes.

    8. JL

      The Fred Sanford, um, coming pain in the heart, down the arm.

    9. MR

      Yes.

    10. JL

      It can be as- as simple as an upset stomach, or jaw pain, or elbow pain, or subtle shortness of breath, or easy fatigability. It can be very, very nebulous. It doesn't have to be what we think is the classic. For me, it just happened to be reflux-type symptoms. So, I just want you to know that it's not just, "Oh, it's reflux symptoms that can be unusual." Any type of unusual symptoms that are brought on by activity and relieved with rest should be a red flag. It doesn't mean 100% that you have a blockage, but it's worth checking out.

    11. MR

      All right, I wanna make sure that we all got that.

    12. JL

      Yeah.

    13. MR

      Because any kind of unusual symptom that is brought on by physical activity...

    14. JL

      Mm-hmm.

    15. MR

      ... but then relieved by rest...

    16. JL

      Yes.

    17. MR

      ... is a red flag that something may be up with your heart.

    18. JL

      Worth investigating. It's not 100%, but that particular constellation is important, yes.

    19. MR

      Wow.

    20. JL

      Yes.

    21. MR

      Huh. The other thing that really struck me about that story is the fact that you didn't have any of the boxes, other than the symptoms, to check. Like, I'm sitting across from you and if you're not watching this podcast on YouTube, Dr. London is a very fit guy. And being from the Midwest, I'm big hugger. We gave each other a big hug. I hugged your son when he walked in. And you're a very fit guy. And so, you don't strike me as somebody who would have any of the, okay, check this box, check this, check... Like, you're taking good care of yourself, you're a happy guy, you're fulfilled by your work, you're connected to your family, you eat good food. You probably are not, like, hitting the cigarettes and the vape 'cause you're a heart surgeon.

    22. JL

      (laughs)

    23. MR

      And so, I think one of the things that scares the hell out of all of us...

    24. JL

      Mm-hmm.

    25. MR

      ... is not knowing if something's wrong.

    26. JL

      Yeah.

    27. MR

      And how often is that the case?

    28. JL

      So, that's a difficult question to answer, right?

    29. MR

      Mm-hmm.

    30. JL

      I mean, it's very similar to what percentage of the population is prediabetic. Well, 80% of the population is prediabetic and they don't realize it because if you don't- if you don't check, then obviously, you don't know. Well, it's a little more difficult to check if you have coronary disease. And thank goodness it is a symptomatic process for the most part, so you typically do have warning signs on the front end. But I think that obviously the folks that have the risk factors, family history, high blood pressure, poorly controlled blood sugars, all those things, those patients need and individuals need more vigilant...

  4. 27:14 – 32:49

    Everyday Habits That Quietly Damage Your Heart

    1. MR

      As a heart surgeon, what are the things you absolutely avoid?

    2. JL

      Smoking's top of the list. I mean, I cannot come up with one single thing that does as much damage to every organ in the body as smoking cigarettes. And now look, it's incredibly addictive and I know that, and I pass no judgment because I know how difficult it is. I've been dealing with patients that, that are chronic smokers for years. I, I, I understand that. That doesn't change the fact that it is the single most dangerous thing you can do for yourself. And from a heart disease standpoint, you're talking about a magnitude risk of 100X or, or greater. Um, not to mention the causal relationship with lung cancer and I, I could keep, keep going. So it's probably one, two, and three on the, on the list to begin with. Um, I think next is, you know, avoiding excess sugar and this idea that our glucose metabolism is so foundational to our existence as a species, and I think that that is something that, that really should be limited. Processed or ultra-processed foods, we've heard this over and over and over and over again, and it's hard because it's convenient and it's easy-

    3. MR

      But why does sugar and processed food hurt your heart?

    4. JL

      Yeah.

    5. MR

      You know what I'm saying? Like-

    6. JL

      Sure.

    7. MR

      ... I can understand how it might like, make me-

    8. JL

      Absolutely.

    9. MR

      ... heavier or make my blood sugar like whacked or cause inflammation-

    10. JL

      So-

    11. MR

      ... in my brain, but what does it have to do with the heart?

    12. JL

      A, a big portion of it is those foods are made to taste really good and to be really accessible and, you know, you're filling up with gas and there it is and I don't even have to stop anywhere else, and it's convenient and easy, but it's edible food product and, you know, our bodies don't process that well. It's this additional engine for an inflammatory response, and again, to store this as, as fat in our bodies that, that drive that forward. The mechanism of inflammation directly on the blood vessel wall, I think is, is probably a drill down that isn't necessary-

    13. MR

      Yeah.

    14. JL

      ... but just understand that, that it sets up a, an environment where it can be damaged more easily.

    15. MR

      Got it. So it's almost like you make those kinds of choices in terms of the sugar intake or the processed food, it makes your heart have to work even harder and harder and harder and under more stressful conditions because the body is inflamed and like you're kind of talking about, the overall impact.

    16. JL

      Yeah, I don't even... Yes, I mean, I think it does. As you carry more weight and then you-

    17. MR

      Yep.

    18. JL

      ... you put yourself in risk of high blood pressure and all those-

    19. MR

      Yep.

    20. JL

      ... all those fault things. Absolutely. It's, none of these things happen in a vacuum.

    21. MR

      Yep.

    22. JL

      And so you start here and then it, and then it continues to cascade. Um, you know, I think that, that alcohol falls in that same key.... category of something that's toxic to every cell in the body. So I think limiting or en- ent- entirely avoiding alcohol just makes good sense.

    23. MR

      But Dr. London, you, you just said alcohol, but what about red wine? I mean, what about the antioxidants? Like, isn't that supposed to be good for my heart?

    24. JL

      The truth is, red wine, and in fact the grapes, the skin of the red wine, do contain polyphenols which are antioxidants and think of them as kind of anti-inflammatories as we kind of have this whole conversation. Specifically, resveratrol is what this compound is called, and it has been found to make blood cells slippery and dilate blood vessels. The amount of red wine that you would have to drink to get a therapeutic level of resveratrol however, would be astronomical and the risks of the alcohol would far outweigh any benefit that you got from the resveratrol. That being said, there are compounded products of resveratrol and there are human studies now that are starting to show a trend that there may be something positive. What would be the takeaway? If you enjoy red wine, drink red wine. But don't drink red wine because you think it's good for your heart.

    25. MR

      So one of the things that I see a lot of people in my life doing is the Zyn-

    26. JL

      Sure.

    27. MR

      ... and the nicotine pouches.

    28. JL

      Sure.

    29. MR

      You know, as a heart surgeon, what's your opinion about those? Are they dangerous for your heart?

    30. JL

      Yeah, I mean, obviously nicotine in general is a constrictor and so any time you are exposing your body to nicotine it can really be an additional risk factor. Is it as bad? Probably not, but again it's that level of accessibility. My personal experience with the Zyns is that I used to dip tobacco-

  5. 32:49 – 36:52

    Real Ways to Take Better Care of Your Heart

    1. JL

    2. MR

      So we've talked about some of the stuff that's a little obvious, right? Obviously don't be smoking, don't be slamming the wine thinking it's good for you.

    3. JL

      Mm-hmm.

    4. MR

      Get rid of the vaping, but what about the things that are not so obvious? Like are there things that, that people do every day or that they may be eating or whatever or using that you don't realize can be damaging to your health?

    5. JL

      Well, I think let's split that into two categories. One, you bring up the eating. A food journal, as painful as that thought process is for many people, myself included, can be so illustrative of where you actually are and truly identifying what you are actually putting in your body every day, and I think that that is a great place to start because if you think about it, we internalize the majority of the outside world through our mouths, 80% to 90%. The rest is through our lungs and of course through, through our skin, but the majority is through our mouths. And so if you look for kind of hidden opportunities, I think that something as simple as a food journal and really looking at that with a, a very critical eye can bring to light very easy opportunities that maybe don't even mean that much to you because it's just kind of filler during the day, either, you know, just empty calories or soft drinks or whatever it may be. So I think that that is really a, an important area for people to focus on because we can out-eat any exercise we do.

    6. MR

      It's true.

    7. JL

      There's no q... We've all done it.

    8. MR

      Mm-hmm.

    9. JL

      I've, I've done it, and I think that to start there and to really get that as tight as you can... And look, it's gonna go in cycles. You're gonna get really tight and then it's gonna be the holidays or whatever it is and that's, that's life, and that's okay. But I think that, I think that, that the diet is place that you can find those hidden even though you know you're doing them. One interesting one that I think that people don't realize is alcohol-containing mouthwashes.

    10. MR

      Wait, what? Mouthwash?

    11. JL

      I know, you sound like my-

    12. MR

      It's bad for you?

    13. JL

      You sound like my, my 88-year-old dad.

    14. MR

      Well I use it every day.

    15. JL

      That's what my dad said.

    16. MR

      And I do us- use it every morning and every night.

    17. JL

      Yeah. Well, alcohol-containing mouthwashes? It might be an-

    18. MR

      I've never even looked.

    19. JL

      Worth a look. Why? Because the gut microbiome starts obvious in the mouth. This is the beginning of our, of the, of the swallowing tube, if you will.

    20. MR

      But isn't that why I have bad breath? I mean, I thought I was supposed to brush that stuff out of there.

    21. JL

      So...

    22. MR

      (laughs) I mean for real.

    23. JL

      Let's handle one issue at a time.

    24. MR

      Okay. (laughs) I have a feeling your wife and I would get along very well. (laughs)

    25. JL

      (laughs) I think I'm gonna keep you separated-

    26. MR

      (laughs)

    27. JL

      ... is kind of what I've decided. Um, so there are bacteria, good bacteria in your mouth, just like there are in your gut, that produce a compound called nitric oxide which actually helps regulate your blood pressure, it keeps your blood pressure down. So if you end up killing this bacteria in your mouth, you decrease that level of ni- nitric oxide and can actually induce high blood pressure as a result, and they've done some really eloquent studies on this. There's a lot of connections between oral health and, and heart health. This is a really interesting one. Now when it comes to bad breath, there are very specific ways to deal with that. You know, tongue scrapers and flossing and...

    28. MR

      Non-alcohol-

    29. JL

      Non-alcoholic-

    30. MR

      ... mouthwash.

  6. 36:52 – 43:14

    What a Heart Surgeon Eats — and Why It Matters

    1. MR

      But once I got the list-

    2. JL

      Mm-hmm.

    3. MR

      ... I don't even, like, I think you and I may know, okay, that's good, that's not, but what actually are you looking for? And I wanna use what you eat from the moment you get up until you go to bed on a good day. We're not talking the holidays.

    4. JL

      Mm-hmm.

    5. MR

      We're talking on a good day, what is heart-healthy food look like?

    6. JL

      Okay. So my day typically starts with hydration first because I don't drink enough water. That's something I definitely need to work on so I just start with it first thing in the morning. Um, my morning meal is typically a protein heavy meal, um, protein center stage, you know, with usually a couple of eggs and some fruit and cup and a half of coffee as I try to dial that back with sleep being such an issue for me. Some mornings, if I'm not hungry, I skip breakfast and I just listen to my body.

    7. MR

      Mm-hmm.

    8. JL

      I don't like to eat when I'm not hungry. I figure that's something that, you know, your body's telling you one way or the other. For lunch, I typically do greens with protein as well 'cause I, again, try to make sure that I get all of the necessary vitamins, keep it colorful as they say. Midday, before a workout, I will do either fruits and a handful of nuts or a smoothie. And then for dinner, I typically go kind of that same protein center stage with some more greens. But I tend to eat fairly light in the evenings 'cause I find that I just sleep better.

    9. MR

      Mm-hmm.

    10. JL

      I use intermittent fasting as a tool. I don't use it as an absolute-

    11. MR

      Mm-hmm.

    12. JL

      ... you know-

    13. MR

      Mm-hmm.

    14. JL

      ... for- for myself. I think that there is value there, but I just kinda listen to my body. If I feel like I've fallen off the edge or feeling, you know, like I'm just not myself then I'll skip a few meals and- and just hydrate through. But that's- that's kind of a- a common day for me, I- I would say.

    15. MR

      Uh, you know, if I were to follow Dr. Jeremy London, the heart surgeon into the grocery store-

    16. JL

      Mm-hmm.

    17. MR

      ... h- what do you buy? Like- like, if you- if you were to teach somebody-

    18. JL

      Yeah.

    19. MR

      ... how to grocery shop for your heart.

    20. JL

      And I think that's actually probably a more useful way to- to couch this than actually what I eat because some people may not like what I eat (laughs) every day. But like the general thought process, we like to keep it super simple, you know. Our bodies run on proteins, fats and carbohydrates. I mean, that's what our bodies run on and, you know, whether you believe in a carnivore diet or you believe in a vegan diet, look, if that- if that works for you, your body, your rules, run with it. Like I don't have any problem with it, but that's not how our bodies are made. And so, we want our grocery cart to reflect that when we go into the grocery store. So what- what we can do? Well, in other words, make a list-

    21. MR

      Mm-hmm.

    22. JL

      ... before you go in. That kind of prevents that impulse buying and- and just picking up things you've thought through. Do I have my protein? How am I getting my carbohydrates? Am I getting enough fiber? What- Where are my- where are my healthy fats? Have a plan before you walk into the store. It just keeps you on track.

    23. MR

      And saves you money. (laughs)

    24. JL

      100%.

    25. MR

      Yes. (laughs)

    26. JL

      Shop on the outside of the store.

    27. MR

      What do you mean by that?

    28. JL

      People do that. Stay out of the aisles. The whole foods, single ingredient foods live on the outskirts of the store, primarily at the produce department. You know, think about the- the meats department, think about where those places are located. Whereas all of the canned and jarred items are on the shelves. And not that all of those are bad, and look, you have to be realistic, like 80... if you can get 80% whole foods and- and it's 20% processed to some degree, we consider that a win.

    29. MR

      Mm-hmm.

    30. JL

      You know?

  7. 43:14 – 50:02

    A Clear Explanation of Heart Disease and Treatment Options

    1. MR

      What are the biggest problems that patients still come to you as a cardiac surgeon for?

    2. JL

      Yeah, they fall in the two buckets that we discussed earlier of what defines heart disease.

    3. MR

      Mm-hmm.

    4. JL

      The most common is the blockages in the heart arteries, that is the most common. So, when we refer to, you know, there's the big category of open heart surgery, which addresses both the blockage problem and valve problem, and then there's bypass surgery. Now, bypass surgery is open heart surgery just like valve surgery, but bypass surgery simply means identifying where that blockage is-

    5. MR

      Mm-hmm.

    6. JL

      ... again, with the dye study like I had in the cath lab, and then using tubes from your body, either the artery that lives behind the breast bone or veins from the leg, to create a new pathway around that blockage. Now, the thing to understand about this, or stents, is it doesn't treat the underlying problem of the hardening of the arteries.

    7. MR

      Wait, say that again?

    8. JL

      When you bypass the blockage-

    9. MR

      Yeah.

    10. JL

      ... you're getting the patient out of trouble to avoid a big heart attack, but you're not treating the actual problem of the hardening of the arteries. The work starts for that patient afterwards to make lifestyle modifications to impact the rate at which this problem continues, or not at all if they're really aggressive. In other words, you could do a bypass beyond the blockage here and things could happen below where you've done that bypass if you continue to smoke, if you don't make dietary changes, if you're not moving every day, if you're not prioritizing your sleep, and all of those things that, that we know that we should be doing. So, that's kind of the bypass surgery piece and that either treats a big heart attack or prevents big heart attacks from occurring and changes the quality of the life of that patient because that exertional symptom that they were having goes away.

    11. MR

      What exactly is a stent? I hear people talking about that all-

    12. JL

      Yeah.

    13. MR

      ... "I just had a stent put in." "Here's a stent." And you mentioned a stent.

    14. JL

      Mm-hmm.

    15. MR

      What is a stent?

    16. JL

      So, a stent is, uh, think of it this way, as a scaffolding, very small scaffolding, that is loaded on a balloon, okay?

    17. MR

      Okay.

    18. JL

      It kind of looks like the old Chinese finger traps-

    19. MR

      Oh, yeah, yeah-

    20. JL

      Okay?

    21. MR

      ... where you get your fingers-

    22. JL

      Yeah.

    23. MR

      ... stuck in them. Yeah.

    24. JL

      So, imagine that crimped down onto a balloon that goes through the blood vessels and through a blockage over a wire.

    25. MR

      Okay.

    26. JL

      And when they expand that balloon, it expands within that artery and that stented structure, if you will, that scaffolding, holds the artery open in that specific spot, so instead of bypassing it, you've actually gone in-

    27. MR

      Reinforced it almost.

    28. JL

      ... and pushed that out to the edges, but again, doesn't treat the underlying problem of the hardening of the arteries, gets the patient out of trouble, and mitigates the risk of having something terrible happen as a result of the lack of blood flow to the heart muscle.

    29. MR

      So, how do you actually know if your heart is having a problem?

    30. JL

      So, there are, again, within those two buckets, signs that you should respond to. They're not 100% that you have a heart problem because there's other reasons that these things could occur, but they're enough of a concern that they warrant investigation as follows. First, shortness of breath with kind of low-level activity. What do I mean by that? Taking a shower, taking the garbage out, you know, things out of proportion to the activity.

  8. 50:02 – 54:50

    What to Do If You Think You’re Having a Heart Emergency

    1. MR

      home alone and you think you may be having a heart attack, what should you do?

    2. JL

      So this is, I- I really like reviewing this because this happens, you know? It really, it happens to people. So first, you call 911. That's, you know, let's start there. Now, when we did this post, the most popular response was, "Call 911?" "No, I'm gonna clear my browser history before I call 911." I was like, "Are you kidding me?" (laughs) We're talking about having a heart attack. So number one, you're gonna call 911. Number two, if it is nighttime, you are going to turn on the lights on your porch so that EMS can identify your house and you're gonna open or at least unlock the front door so EMS can access your house because if you are incapacitated, they have no way to get in. Lay down or sit down.

    3. MR

      Lay down?

    4. JL

      Lay down. Lay down on the couch or sit down, whatever's comfortable, wherever you're breathing the easiest. Laying down and elevating your feet typically gives people the most relief, but put yourself stationary so if you do pass out, you don't fall and add a head injury now to an already bad situation. And last but not least, call your family or friends to let them know what's happening so that somebody knows that EMS is coming and you're gonna be taken to the hospital.

    5. MR

      I've heard take an aspirin. Like, is that something you should do too or is it not as important as-

    6. JL

      It is-

    7. MR

      ... 911 and-

    8. JL

      It is- it is important, and not only do you wanna take it, you wanna chew it.

    9. MR

      Chew it?

    10. JL

      You want a 325 milligram aspirin, yep, you wanna chew it, uh, 'cause that's the fastest way to get it into your system. Um, you know, I think the thing to be aware of and the- the reason that I don't always put it directly on the list is that there are people that have, um, uh, GI bleeding problems that aspirin is- is not appropriate for them or allergies to aspirin but they think, "Well, I'm having a heart attack and I should do this even though I have these problems." So that's something that you definitely need to clear with your- your physician before you make that plan of utilizing an aspirin in that setting.

    11. MR

      I am so glad I asked you that question. I never would've thought turn on the porch light and unlock the front door. I mean, I would've been so panic-stricken calling 911 and trying to find aspirin, I wouldn't have even thought of that. I am so glad you shared that, Dr. London. Uh, Dr. London, what is the widowmaker blockage?

    12. JL

      The widowmaker blockage is a blockage that occurs in this main artery on the front of the heart, the left anterior descending artery, right at the mid to beginning portion. That's the one that really controls the big pumping chamber. And it's a blockage that occurs very far upstream, if you will, so that there's a big territory typically that's affected. Many times, this blockage actually starts with what we call soft plaque. So the- the blockage itself may not be that severe, but the soft plaque can be very unstable and it ruptures, it gets blood behind it, and then blocks that artery. So what happens is you get an immediate interruption of blood flow to a-

    13. MR

      Ah.

    14. JL

      ... huge territory of the heart, which is extremely dangerous, unlike potentially a blockage in this- in this area that has happened over time and the heart then can- can acclimate slowly. Doesn't mean that you're not gonna ultimately have symptoms and have something be done to it, but you start to develop those collateral pathways, those alternate pathways so that if this goes down, even though you still may have a big heart attack, there's alternate ways for the blood to- to get there. So it's that acute blockage in a very, very, um, upstream location.

    15. MR

      You know, as we were, um, preparing for you to come in, one of our colleagues who's 37 years old-

    16. JL

      Mm-hmm.

    17. MR

      ... told us that he was experiencing headaches for a number of weeks and he ultimately went to the emergency room, this was like a couple weeks ago, and they discovered that he had dangerously high blood pressure.

    18. JL

      Yes.

    19. MR

      He had no idea.

    20. JL

      Yeah.

    21. MR

      And he's now, you know, on medication for it and, you know, he was saying, you know, "I- I'm learning that, you know, this is something that's genetic."

    22. JL

      Mm-hmm.

    23. MR

      "And that feels very discouraging." And so I'm wondering, Dr. London, if you could talk a little bit about the connection

  9. 54:50 – 58:50

    High Blood Pressure: What It Means and How to Manage It

    1. MR

      between high blood pressure, the health of your heart and what if, you know, the person that's been listening...... feels like, "Well, God, like my dad had a heart attack, like high blood pressure's in my family." Like what is it that you want someone to know?

    2. JL

      I'll start by saying you can't run from your genes, you know. And, and that's just a fact that we all have to come to grips with. That doesn't mean that we can't have an impact and move the needle, whether it's on high blood pressure or high cholesterol that people can be born with as well-

    3. MR

      Mm-hmm.

    4. JL

      ... because there's this concept of epigenetics. And what does that mean? Well, you're born with the genes you're born with. But the stressors that we place on those genes many times affect how they are consequently expressed in our bodies. So by, by really making solid lifestyle decisions and being consistent with those things can have a huge impact on that. Now, there are some forms, particularly of these familial type of processes, that are really difficult to, to impact with just lifestyle changes, and they require medication.

    5. MR

      Mm-hmm.

    6. JL

      Let's talk about high blood pressure and why that is so important to treat. The way to think about high blood pressure and the negative impacts on the heart, think about the pump working and everywhere that the heart is pumping to is clamping down, trying to maintain the blood volume in the body. Even though it may be adequate, the tone in those blood vessels is real... So every time the heart's beating, as opposed to seeing these relaxed blood vessels where it's trying to get blood flowing to it, it's seeing this. So it's seeing resistance out of proportion to what it would normally expect. Well, the heart's just a muscle. So what does a muscle do when you then stress it with resistance over time? It gets thicker and thicker and thicker.

    7. MR

      Oh.

    8. JL

      And so the cavity then can become smaller and the efficiency of that heart muscle at some point will start to slip.

    9. MR

      That makes sense.

    10. JL

      And that's when patients start to develop heart failure as a result of heart blood pressure. The other consequence is that elevated blood pressure, and I think this makes good intuitive sense too, has a physical damage to the inner lining of the blood vessels that again make it a, a just breeding ground for cholesterol and all of that to accumulate in. It sets up injury. So it kind of comes from this multifaceted approach of how it negatively impacts the body.

    11. MR

      So by relieving the high blood pressure-

    12. JL

      Mm-hmm.

    13. MR

      ... with medication or if lifestyle changes are something that's gonna impact you based on genetics or based on the diagnosis or both, you relax the system-

    14. JL

      Mm-hmm.

    15. MR

      ... so that the heart isn't having to just pump so darn hard through a system that's clenched. You relax it and then the heart can actually ease off and do its job.

    16. JL

      Absolutely correct.

    17. MR

      Huh.

    18. JL

      And I think, and I think that that's a good way to think about it because again, we're not really treating the underlying problem of this genetic abnormality.

    19. MR

      Right.

    20. JL

      So we're changing the slope of that survival curve by saying, "Okay, well, what are the mechanisms that, that then result-"

    21. MR

      Mm-hmm.

    22. JL

      "... in this problem? Let's relieve those or mitigate those to the best of our ability to extend this person's life."

    23. MR

      Yeah, just like you do with somebody who has diabetes.

    24. JL

      Identical.

    25. MR

      Yeah, that's, that's so helpful to understand.

    26. JL

      We know, we know the natural history, how can we alter the natural history?

  10. 58:50 – 1:11:48

    How Heart Health Is Different for Women

    1. JL

    2. MR

      You know, one question I didn't ask you is the difference between men and women-

    3. JL

      Yeah.

    4. MR

      ... and heart disease. Is there anything that you think-

    5. JL

      Yeah.

    6. MR

      ... is important for us to know? 'Cause I hear heart attack and I think man.

    7. JL

      Um, the short answer is yes. You know, I love that, that Marie Claire doesn't say... Sh- what she says is that, uh, women are not little men, you know? And, and that's so true. Just like, like children aren't little adults. Like their physiology is very, very different. And part of it is that the medical literature has been fraught with male bias for, for years and years. And that is slowly, slowly starting to transform. But in addition, there is, um, certainly a mindset that, you know, when women come in with these masquerading type symptoms, that they're not taken as seriously, that it's an anxiety or panic attack or something of that nature. And the reality is, is that the nature of the, of the way blockages occur for women can be very different. As opposed to, in men, happening in these very large blood vessels, in women, they can occur there and frequently do, but they can also occur in the smaller blood vessels. In addition, with perimenopausal women with changes in estrogen level, estrogen is such a powerful anti-inflammatory, it can change, again, your cholesterol levels and all the risk factors that then mitigate, you know, or actually lead to, um, heart disease. So yes, there is significant differences between the two.

    8. MR

      Now, you said according to the CDC that heart disease and heart attacks are the number one killer worldwide, like in-

    9. JL

      In both men and women.

    10. MR

      ... in both men and women. But is there statistics in the rates in terms of how heart disease impacts men versus women?

    11. JL

      I, I still believe the rates are higher for men than they are for women.

    12. MR

      Mm-hmm.

    13. JL

      But I think it's still, it's pretty close.

    14. MR

      Well, what's interest-

    15. JL

      I don't know for sure. I have to-

    16. MR

      Well, what's interesting is that I... Like I, I just am thinking ca- like generally in my own experience-Like, you think about men having heart disease and you think about women having high blood pressure. Like, we- we tend to talk about it differently.

    17. JL

      And that's part of the problem, I think too. I think that- that- that- that the mindset around evaluating women has not been the same and that's why a lot of times women are either sent home and then they come back with a bigger problem or they're taken down these roads of, "Oh, it must be your gallbladder. Oh, it must be clearly..." And that, you know, in this circuitous route it ends up back, it ends up back at the heart. And that is changing. It really is. I- I feel like that is changing rapidly. That mindset is- is much better even than since I've been in training.

    18. MR

      Well, I- I guess what's interesting and wha- what I would love to have you speak to because I'm realizing my own bias here.

    19. JL

      Mm-hmm.

    20. MR

      That I didn't even really think about heart disease impacting women. You're suggesting that women may be experiencing heart disease at the same rates, it's just that we're not seeing the symptoms and connecting the dots as quickly as we do with men.

    21. JL

      Yes. And I think, like I said, I think that there is a much different awareness even in the last five to six years than there was when I started in training. I don't know that that discrepancy even now is quite as- as, um, blatant, but I think a lot of that too, the focus on women's health now-

    22. MR

      Mm-hmm.

    23. JL

      ... is gotten so, so robust and I think it's wonderful because it- it has put a different light on- on overall women's health, not just, "Oh, they're menopausal."

    24. MR

      So once a woman is perimenopausal or menopausal and there's like that drop off the cliff in estrogen and you just mentioned that estrogen is like a wonderful hormone in terms of its anti-inflammatory nature and it's in every part of a woman's body, have they done any research about the increase in heart disease-

    25. JL

      Absolutely.

    26. MR

      ... and heart attacks with women?

    27. JL

      Absolutely. Yeah, I mean, and I think that they're, they have clearly shown that- that, well, which is why that age group of women, it's not surprising, the 65 plus are the ones that tend to come in with the- the heart attack symptoms and I think the ones that maybe are not picked up on are the more perimenopausal-

    28. MR

      Uh-huh.

    29. JL

      ... that may have dramatic changes in their estrogen levels. I think the interesting data is gonna come out with now all the estrogen replacement, particularly earlier on, how is that gonna change the tail of this as we look at it over the next 10 years? I suspect it's gonna be dramatic.

    30. MR

      Fascinating. That's really helpful. Thank you, Dr. London.

Episode duration: 1:11:48

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