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

Speaker 2 Hey, it's your friend Mel, and welcome to the Mel Robbins podcast.

Speaker 2 You know, there's something in your life that I bet you don't think about that often.

Speaker 1 And yet, this thing is constantly in the background.

Speaker 2 It is working as hard as it possibly can.

Speaker 2 All day, every day, it's there.

Speaker 2 In fact, a hundred thousand times a day, it shows up for you. What am I talking about?

Speaker 1 Your heart.

Speaker 2 And today, you and I are going to have a conversation about your heart.

Speaker 2 See, every second of every day, every week, every year of your life, your heart is there, just beating inside of you, doing its job. And it's so easy, isn't it, to take it for granted?

Speaker 2 You know, come to think about it. I think about time.

Speaker 2 the same way.

Speaker 2 See, there's this invisible clock that's always ticking in the background because time moves forward regardless of what you do.

Speaker 1 But your heart?

Speaker 2 Your heart is deeply impacted by what you do. So today, a world-renowned cardiac surgeon is here to talk to you about what he's learned after operating on people for 25 years.

Speaker 2 He's going to tell you what you and your loved ones need to know to keep your heart healthy, to understand the warning signs, and to keep you and the people that you love off of his operating table so that you can live as long and as happy and as healthy of a life as you can.

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Speaker 2 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.

Speaker 2 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.

Speaker 2 And because you hit play on this particular episode, here's what that tells me.

Speaker 2 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.

Speaker 2 And I'll tell you what, the conversation we're going to have today, this is worth your time

Speaker 2 because this could save your life or the life of somebody that you love. I'm not kidding around about this.

Speaker 2 I actually have this feeling that this is going to be one of those conversations that you and I have, and we're going to learn from the expert today.

Speaker 2 And it's going to be so inspiring that you're going to share this with all kinds of people in your life.

Speaker 2 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.

Speaker 2 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 want to thank you.

Speaker 2 I want to thank you for pressing play and being open to hearing what Dr. London has to say to you.

Speaker 2 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 going to empower you to take better care of yourself and to understand what you can do to live a longer, happier, and healthier life.

Speaker 2 Because today, you and I are going to talk about your heart.

Speaker 1 And maybe you're worried about it.

Speaker 2 Or maybe you're just kind of scared about where you're at with it.

Speaker 2 Or maybe you're just a little resigned because you don't think anything that you're going to do is going to make a difference in your heart health.

Speaker 2 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.

Speaker 2 Joseph Hospital in Savannah, Georgia. And he says he's on a mission to keep you off his operating table.

Speaker 2 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 going to to walk away from this conversation with just a mountain of tools and takeaways, and you're also going to be inspired because Dr.

Speaker 2 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.

Speaker 2 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.

Speaker 2 Jeremy London, thank you for hopping on a plane and being here in our Boston studios. I am so excited to meet you.

Speaker 1 I am honored and equally as excited to be here. I'm very appreciative.

Speaker 2 I believe you and I'm appreciative that you're here because I think you have such a unique perspective.

Speaker 2 to share and so much wisdom and expertise to help us better understand one of the most important things we have in life, which is our heart.

Speaker 2 And so where I want to start is, I would love to have you speak to the person who is listening right now.

Speaker 2 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.

Speaker 2 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.

Speaker 1 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.

Speaker 1 You know, our mission is to offer digestible, accessible healthcare, lifestyle information, really to anybody that has an internet access.

Speaker 1 And if I can in some way ease the process of this journey, then I feel like we've made an impact.

Speaker 1 If maybe we can take something that has been a push for many people and turn it into a pull, I think that that would be amazing.

Speaker 2 Well, Dr. London, there's that famous saying that when the student is ready, the teacher appears.
But you yourself found yourself on an operating table just a few years ago.

Speaker 2 And so this is now extremely personal. Can Can you tell us about that experience and how it has shaped the way that you think about your heart and health?

Speaker 1 Absolutely. Yes, there's nothing like flipping the coin upside down to change your perspective.
And that is exactly what happened to me.

Speaker 1 We were out in the country at a small cabin that we have about an hour from town.

Speaker 1 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?

Speaker 1 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.

Speaker 1 I mean,

Speaker 1 she's like, okay,

Speaker 1 I hear you. She's like, I'm just telling you, you just don't look right.
And so normally I'll sit down and I'll read and kind of left the room. I took a Pepsi and everything went away.

Speaker 1 Everything was great.

Speaker 1 We have four dogs. So we head out for a walk.
It's December, December 4th, because I remember very clearly.

Speaker 1 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.

Speaker 2 What does reflux feel like?

Speaker 1 So it created this like burning sensation in my chest, not formal chest pain, but almost like you had eaten some spicy food, for instance, and it wasn't agreeing with you.

Speaker 1 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.

Speaker 1 At which point Tracy says, hey, you sure you're good? Like we're just walking the dogs. I said, you know, I don't feel great.
And so we get back to the house.

Speaker 1 And this is probably a little TMI, but I came back in the house. I said, I got to use the bathroom.

Speaker 1 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.

Speaker 2 Really? That the symptoms went away when you sat down as danger?

Speaker 1 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

Speaker 1 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,

Speaker 1 no way,

Speaker 1 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.

Speaker 1 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.

Speaker 1 My wife and the rest of the family went back into town. You weren't worried? You know, denial is not a river in Egypt, apparently.
So I have learned. Denial.

Speaker 1 Yes, I was worried,

Speaker 1 but I wouldn't allow myself to go there at this point, which, again,

Speaker 1 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.

Speaker 2 Well, I appreciate your honesty 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

Speaker 2 that you experience because you just can't believe it, But then there's also the denial because you don't want to.

Speaker 1 Yeah.

Speaker 1 And it'll become even

Speaker 1 more apparent just how egregious all this was.

Speaker 1 But it's 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.

Speaker 1 I mean, smokers know it's bad for them. You're eating junk food.
You know it's not the road, but we do it anyway.

Speaker 1 And I think that that is really one of those huge gaps that we can talk about down the road of opportunities when we care for people and when we care for ourselves, like how to recognize that and how to navigate that.

Speaker 1 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.

Speaker 1 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.

Speaker 1 And I immediately had crushing chest pain

Speaker 1 in the middle of this field, pitch black with my 15-year-old son, no cell service. And all I'm thinking, Mel, is he's not going to find one of those deer.

Speaker 1 He's going to find me dead in this field, you know? And like even, I just break out of the goosebumps even talking about it because it was like, you got to pull yourself together.

Speaker 1 Like you got to 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, it might be over, dad, what, what's going on?

Speaker 1 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 going to be okay.
I just, you know, need a minute.

Speaker 1 And so 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

Speaker 1 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 and I make coffee.

Speaker 1 I come back up the stairs and I immediately had this

Speaker 1 crushing chest pain again. And that's when I said, Trace,

Speaker 1 something

Speaker 1 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.

Speaker 1 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. And

Speaker 1 she stopped for a minute and she said, this is the most selfish thing you have ever done to me and the boys.

Speaker 1 And

Speaker 1 I just said, you are right.

Speaker 1 And I'm really sorry. And I'm having crushing chest pain right now.
I think we need to go. And

Speaker 1 I need to get to the hospital. So we went and I'm calling my friend who's a cardiologist on the way.
And I'm telling him this story. He's like, dude, there's no way you eat right.

Speaker 1 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, but I know what's happening.

Speaker 1 He's like, all right, just come to the office and see me first. I was like, okay, but that's an unnecessary stop.

Speaker 1 Literally, I was in the office for five or 10 minutes and we went straight to the cath lab.

Speaker 1 And

Speaker 1 what is the cath lab? The cath lab is where you get a diagnostic study where they go through, in my case, the wrist

Speaker 1 to actually put dye in the arteries. And when they did that, they found a 99%

Speaker 1 blockage in the artery on the back of my heart.

Speaker 1 Now, to continue my level of behavior, I would not let them sedate me fully for the procedure because, of course, I wanted to see what was going on and what was happening.

Speaker 1 And you see, that Tus said this gets more and more embarrassing and painful for me every time I tell this story.

Speaker 1 Thank goodness I was able to avoid my own operating room because he put a wire across there, which is how they actually get the stunt to go across the artery.

Speaker 1 And as soon as he did that, I said, hey, man, I'm having crushing chest pain again. And he pulls back the drapes and he's like, I need you to shut the up so I can get this done.

Speaker 1 And he immediately sedates me and puts me out, gets the stint in, and everything is fine. He goes out to talk to Tracy afterwards.

Speaker 1 And he said, I dream of stenting cardiac surgeons, but doing it on Jeremy London was a freaking nightmare. And she looked right at him.
She goes, oh, I'm sure. She goes, I can only imagine.

Speaker 1 He's like, I'd never want to do that again. She's like, he just will not let it go.

Speaker 1 But I'll tell you, Mel, you know, I woke up the next morning, first of all, incredibly grateful, but

Speaker 1 my entire perspective shifted in an instant.

Speaker 1 Things that were really, really important to me 24 hours prior didn't even make the list. My prioritization was,

Speaker 1 I mean,

Speaker 1 very easy.

Speaker 1 My family, my friends, the people that I care about, and the people that care about me. And that's it.

Speaker 1 And it was,

Speaker 1 it was a huge touch point in my life, not just personally, but again, professionally as well, because

Speaker 1 when someone comes in and tells me they were having crushing chest pain, like, I get it. I really get it.
And I had always considered myself an engaged listener with my patients.

Speaker 1 Like I've always prided myself on the fact that if you just listen to patients, they'll tell you what's what's wrong with them.

Speaker 1 The tuning on that went all the way, all knobs to the right after this event.

Speaker 1 And it just, it was, uh, it was a perspective shift for sure. And again, I'm not proud of that story at all.
But

Speaker 1 when I talk about not doing better even though you you know better

Speaker 1 i mean who shouldn't know better than me in that situation but we're all human

Speaker 1 and i'm no different i'm just a dude who's done a lot of heart surgery and taken care of a lot of patients but i want to share that experience because if it just helps one person say hmm I'm having those exertional symptoms and they go away when I sit down, then it's worth the moment of embarrassment and retelling this story and you wondering why Tracy didn't cut me off at the knees and I would have been deserving of such.

Speaker 2 Well, first of all, I'm really proud of you for telling the story.

Speaker 1 Well, thank you.

Speaker 2 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.

Speaker 2 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

Speaker 2 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.

Speaker 2 Like, cause I would have thought the opposite.

Speaker 1 Cardiac angina or pains associated with the heart are the great masquerader. Of what?

Speaker 1 In general. So in other words, it's not all the what I call the TV heart attack.
Yes. The Fred Sanford, Sanford, I'm coming, pain in the heart, down the arm.

Speaker 1 It can be 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.

Speaker 1 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.

Speaker 1 Any 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.

Speaker 2 All right. I want to make sure that we all got that.

Speaker 1 Yep.

Speaker 2 Because any kind of unusual symptom that is brought on by physical activity, but then relieved by rest is a red flag that something may be up with your heart.

Speaker 1 Worth investigating. It's not 100%, but that particular constellation is important.
Yes. Wow.
Yes. Huh.

Speaker 2 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.

Speaker 2 And if you're not watching this podcast on YouTube, Dr. London is a very fit guy.
And being from the Midwest, I'm a big hugger. We gave each other a big hug.
I hugged your son when he walked in.

Speaker 2 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 it, check it out.
Like you're taking good care of yourself. You're a happy guy.

Speaker 2 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 because you're a heart surgeon.

Speaker 2 And so I think one of the things that scares the hell out of all of us

Speaker 1 is

Speaker 2 not knowing if something's wrong.

Speaker 1 Yeah.

Speaker 2 And how often is that the case?

Speaker 1 So that's a difficult question to answer, right? I mean, it's very similar to what percentage of the population is pre-diabetic.

Speaker 1 Well, 80% of the population is pre-diabetic and they don't realize it because if you don't, if you don't check, then obviously you don't know.

Speaker 1 Well, it's a little more difficult to check if you have coronary disease. And thank goodness, it is a symptomatic.

Speaker 1 process for the most part. So you typically do have warning signs on the front end.

Speaker 1 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 stress testing and evaluation.

Speaker 2 I think we all have somebody in our life that we're slightly worried about. And my husband recently is like, my like heart, a lot of pain right here.

Speaker 2 And I'm like, what's up? And he's like, well, it's typically after I telemark ski in the morning and I skin up the mountain and then I feel this little seizing right here.

Speaker 2 But again, like the healthiest person I know. And I'm like, maybe we should get this checked out.

Speaker 1 Yeah. And I think that obviously there's a spectrum of what I'm presenting as well.
I mean, that's, I understand what it takes to do that type of activity. And that is kind of an extreme load.

Speaker 1 But if he has predictable symptoms every single time he does those things, why not get it checked out?

Speaker 1 And let me add a little more texture to kind of my background as well, because I think that it might resonate with others that, yes, I am very conscious of what I put in my mouth.

Speaker 1 Yes, I love to go to the gym and work out, not just because I love the workout, but because it is my mental therapy and where I can de-stress and what have you.

Speaker 1 And yes, relationships are very important to me. But also on that list is sleep and recovery.
And that is my Achilles heel. And it comes from from several fold.

Speaker 1 One, I've been on call for 25 years and my thermostat is set now on DEF CON one,

Speaker 1 you know, all the time. I can never relax ever.

Speaker 1 And, you know, when you look at these individual levers, like I can control what I put in my mouth. I can control when I go to the gym.
The more I try to control my sleep, the worse it gets.

Speaker 1 And not sleeping and not recovering. And as we were discussing earlier, being able to take that time for yourself and gin down and allow your body to unwind.
And I'm not good at that.

Speaker 1 And I think that that is definitely one of my primary risk factors. And so I share it so that people can evaluate their own lives.

Speaker 1 Like it's not necessarily the really big, easy levers that you wish you would tug on. Sometimes it's the other ones that you need to examine more closely.

Speaker 1 And I don't know that entirely answers your question about, you know, how do you know, but I think that if you start to have some self-evaluation,

Speaker 1 you come up with some potential places that you can either improve or get help with.

Speaker 2 Dr. London, for someone who's just never thought about their heart or their heart health before, what do you want to say to them?

Speaker 1 First of all, it's the number one killer of men and women. You know, so

Speaker 1 what is the number one killer? Heart disease and heart attacks, 20 million lives worldwide per year.

Speaker 1 So it behooves us, just based on the statistics, that we prioritize our heart health in hopes of not being like me in one of those potential statistics. So I think let's start there.

Speaker 1 Like, why is it important?

Speaker 2 What is heart disease? You know what I mean? Like, if people are dying of heart disease, I don't even know what heart disease is.

Speaker 2 If I really stopped and if you had asked me that question, I'd be like, well, it's the disease of the heart. I don't know.

Speaker 1 Yeah. And it is a bit of a black box for people.
And you can simplify it into two buckets, really. Okay.
Okay.

Speaker 1 So if you think about the heart as a pump, that pump requires energy.

Speaker 1 It requires oxygen and nutrition and all of those things to be able to get you up out of your chair and get to the refrigerator and climb the flight of stairs and all those things.

Speaker 1 Well, there are blood vessels on the surface of the heart that feed that heart muscle, front, side, and back. Very simple.
Three territories that can be affected.

Speaker 1 Blockages in those vessels is what is known as coronary artery disease because those arteries are referred to as the coronary or heart arteries.

Speaker 1 So blockages in those arteries, which ultimately can result in these kind of symptoms or potentially a fatal heart attack, is one bucket of heart disease.

Speaker 1 So blockages of the heart vessels that cause heart attacks, bucket A. Okay.

Speaker 1 Bucket B is within the heart are the valves that help the pump work and make sure that the blood is moving in the direction that it needs to move in.

Speaker 1 In other words, oxygenated blood going to the body, being utilized, coming back to the heart, getting oxygenated again in the lungs, and then going back to the heart and continuing that loop.

Speaker 1 Well, if those valves are not functioning, one or a couple of those valves are either blocked or are leaking, you then affect the efficiency of that pump. Got it.

Speaker 1 And fluid, then, of course, if it's a closed pump, is going to start to back up

Speaker 1 or move in a direction that it's not supposed to. And over time, the heart becomes very swollen and the heart doesn't like to be swollen.

Speaker 1 And that's what causes heart failure and shortness of breath and all of those kinds of things that you hear about with congestive heart failure and a weak heart, if you will.

Speaker 1 And so that's really the second bucket of heart disease. Now, they can be combined and there can be crossover and these circles do intersect, but those are the two basic buckets.

Speaker 1 And then there's others of... diseases of the large blood vessels and what have you that are probably too far in the weeds to really to really get into.
But those are the two big categories.

Speaker 2 Oh, that makes sense. Thank you for explaining that.
I actually can like kind of picture it.

Speaker 2 And I think a lot of us probably find out about it when we're sitting talking to a heart surgeon because somebody that we care about is actually now needing a procedure.

Speaker 2 And so we're learning what's wrong.

Speaker 2 And what I love about what you're doing is I think you're able in this beautiful way to take your 25 years as a surgeon and now the deeply personal experience that you've had with your own heart and help all of us understand the things that we can do that will hopefully keep us from getting on an operating table.

Speaker 2 This feels like the perfect moment to take a pause. And I don't know about you, but I've got like four or five people I'm planning on sending this to just so that they hear that story.

Speaker 2 Because hearing Dr. London tell that story and hearing about those signs and then hearing what his wife said to him.
There are people in my life that need to hear that.

Speaker 2 And I know if they hear it from Dr. London, it's really going going to make an impact.
So thank you for taking a moment to listen to our sponsors.

Speaker 2 Thank you for sharing this with people in your life that you care about. And don't you dare go anywhere.
Dr. London has so much more to teach us when we come back.
So stay with me.

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Speaker 2 Welcome back. It's your buddy Mel Robbins.
And today you and I are getting to spend time with Dr. Jeremy London.

Speaker 2 And we are learning all about our hearts and how to take better care of our hearts so that we can live a long and healthy and happy life. I'm so thrilled that you're here.
And Dr.

Speaker 2 London, I'm so thrilled that you're here. And so the very next question that I want to ask you is, as a heart surgeon, what are the things you absolutely avoid?

Speaker 1 Smoking's top of the list. I mean,

Speaker 1 I cannot come up with one single thing that does as much damage to every organ in the body as smoking cigarettes. And look, it's incredibly addictive.
And I know that.

Speaker 1 And I pass no judgment because I know how difficult it is. I've been dealing with patients that are chronic smokers for years.

Speaker 1 I understand that. That doesn't change the fact that it is the single most dangerous thing you can do for yourself.

Speaker 1 And from a heart disease standpoint, you're talking about a magnitude risk of 100x or greater,

Speaker 1 not to mention the causal relationship with lung cancer. And I could keep going.
So it's probably one, two, and three on the list to begin with.

Speaker 1 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

Speaker 1 really should be limited. Processed or ultra-processed foods.
We've heard this over and over and over and over again.

Speaker 1 And it's hard because it's it's convenient.

Speaker 2 But why does sugar and processed food hurt your heart? Yeah. You know what I'm saying?

Speaker 2 Like, I can understand how it might like make me heavier or make my blood sugar like whacked or cause inflammation in my brain, but what does it have to do with the heart?

Speaker 1 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.

Speaker 1 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.

Speaker 1 And again, to store this as fat in our bodies that drive that forward.

Speaker 1 The mechanism of inflammation directly on the blood vessel wall, I think, is

Speaker 1 probably a drill down that isn't necessary, but just understand

Speaker 1 that it sets up

Speaker 1 an environment where it can be damaged more easily. Got it.

Speaker 2 So it's almost like you make those kinds of choices in terms of the sugar intake or the processed food.

Speaker 2 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.

Speaker 1 Yeah, I don't even, yes. I mean, I think it does as you carry more weight and then you put yourself in risk of high blood pressure and all those

Speaker 1 fault things. Absolutely.
It's none of these things happen in a vacuum.

Speaker 1 And so you start here and then it and then it continues to cascade.

Speaker 1 You know, I think that

Speaker 1 alcohol falls in that same key category of something that's toxic to every cell in the body. So I think limiting or

Speaker 1 entirely avoiding alcohol just makes good sense.

Speaker 2 But Dr. London, 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?

Speaker 1 The truth is, red wine, and in fact, the grapes, the skin of the red wine, do contain polyphenols, which are antioxidants.

Speaker 1 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.

Speaker 1 And it has been found to make blood cells slippery and dilate blood vessels.

Speaker 1 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.

Speaker 1 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?

Speaker 1 If you enjoy red wine, drink red wine, but don't drink red wine because you think it's good for your heart.

Speaker 2 So, one of the things that I see a lot of people in my life doing is the Zen and the nicotine pouches. Sure.
You know, as a heart surgeon, what's your opinion about those?

Speaker 1 Are they dangerous for your heart? Yeah, I mean, obviously, nicotine in general is a constrictor. And so, anytime you are exposing your body to nicotine, it can really be an additional risk factor.

Speaker 1 Is it as bad?

Speaker 1 Probably not. But again, it's that level of accessibility.
My personal experience with the Zens is that I

Speaker 1 used to dip tobacco.

Speaker 2 So did my husband. Yep.
Right in there. A little skull, right in the cheek.
Yep.

Speaker 1 Yep. Again, Ben, you're bringing up all the things that I'm not proud of.
But again, I'm willing to share this

Speaker 1 because it's something that we can all fall prey to. And so I think the Zens minus the tobacco certainly removes the cancer risk.
Can you get oral problems from that as well? Absolutely.

Speaker 1 Look, it's better than some, but not good for you.

Speaker 2 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.

Speaker 2 Get rid of the vaping. But what about the things that are not so obvious?

Speaker 2 Like, are there things 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?

Speaker 1 Well, I think let's split that into two categories. One, you bring up the eating.

Speaker 1 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.

Speaker 1 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%.

Speaker 1 The rest is through our lungs and of course through our skin, but the majority is through our mouths.

Speaker 1 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 very critical eye can bring to light very easy opportunities that maybe don't 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.

Speaker 1 So I think that that is really an important area for people to focus on because we can out eat any exercise we do.

Speaker 2 It's true.

Speaker 1 We've all done it.

Speaker 1 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 going to go in cycles.

Speaker 1 You're going to get really tight and then it's going to be the holidays or whatever it is. And that's, that's life.
And that's okay.

Speaker 1 But I think that, I think that the diet is a place that you can find those hidden, even though you know you're doing them.

Speaker 1 One interesting one that I think people don't realize is alcohol containing mouthwashes.

Speaker 2 Wait, what? Mouthwash?

Speaker 1 I know. You sound like my dad friend.
You sound like my 88-year-old dad. I use it every day.
That's what my dad does.

Speaker 2 And I use it every morning and every night.

Speaker 1 Yeah. Well, alcohol-containing mouthwashes.

Speaker 1 I've never even looked. Worth a look.
Why?

Speaker 1 Because

Speaker 1 the gut microbiome starts, obviously in the mouth. This is the beginning of our, of the, of the swallowing tube.

Speaker 2 But isn't that why I have bad breath? I mean, I thought I was supposed to brush that stuff out of there. So I think for real.

Speaker 1 Let's handle one issue at a time.

Speaker 2 I have a feeling your wife and I would get along very well.

Speaker 1 I think I'm going to keep you separated. That's kind of what I've decided.

Speaker 1 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.

Speaker 1 It keeps your blood pressure down. So, if you end up killing this bacteria in your mouth, you decrease that level of nitric oxide and can actually induce high blood pressure as a result.

Speaker 1 And they've done some really eloquent studies on this. There's a lot of connections between oral health and heart health.
This is a really interesting one.

Speaker 1 Now, when it comes to bad breath, there are very specific ways to deal with that. You know, tongue scrapers and flossing and non-alcohol, non-alcoholic mouth was.

Speaker 1 And there are multiple choices and they work just as well, but you need to avoid the alcohol-based.

Speaker 2 So since we're talking about things you put in your mouth, Dr. London, I would love to know as a heart surgeon, what do you eat every day? Like take me through the day.

Speaker 1 Yeah.

Speaker 2 What do you eat? Like, cause

Speaker 2 we can make the list. And by the way, there's unbelievable research about how food journals help

Speaker 2 you lose weight because you're actually conscious of what you're eating. And most of us don't realize what we're putting in our mouths.

Speaker 2 And so I love that you brought that up as like the first place to start.

Speaker 2 But once I got the list, 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?

Speaker 2 And I want to 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.
We're talking on a good day. What is heart-healthy food look like?

Speaker 1 Okay.

Speaker 1 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.

Speaker 1 My morning meal is typically a protein-heavy meal,

Speaker 1 protein-center center stage, you know, with usually a couple of eggs and some fruit

Speaker 1 and

Speaker 1 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.

Speaker 1 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.

Speaker 1 For lunch, I typically do greens with protein as well because I, again, try to make sure that I get all of the necessary vitamins, keep it colorful, as they say.

Speaker 1 Midday before a workout, I will do either fruits and a handful of nuts or a smoothie.

Speaker 1 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 because I find that I just sleep better.

Speaker 1 I use intermittent fasting as a tool. I don't use it as an absolute, you know, for myself.
I think that there is value there, but I just kind of listen to my body.

Speaker 1 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 just hydrate through.

Speaker 1 But that's, that's kind of a common day for me, I would say. Well, you know, if I were to follow Dr.

Speaker 2 Jeremy London, the heart surgeon, into the grocery store,

Speaker 2 what do you buy? Like, like if you, if you were to teach somebody how to grocery shop for your heart.

Speaker 1 And I think that's actually probably a more useful way to couch this than actually what I eat, because some people may not like what I eat every day, but like the general thought process, and we like to keep it super simple.

Speaker 1 You know, our bodies run on proteins, fats, and carbohydrates. I mean, that's what our bodies run on.
And

Speaker 1 you know, whether you believe in a carnivore diet or you believe in a vegan diet, look, if that, if if that works for you, your body, your rules, run with it.

Speaker 1 Like I don't have any problem with it, but that's not

Speaker 1 how our bodies are made. And so we want our grocery cart to reflect that when we go into the grocery store.
So what we can do, well, in other words, make a list before you go in.

Speaker 1 That kind of prevents that impulse buying 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?

Speaker 1 Where are my healthy fats? Have a plan before you walk into the store. It just keeps you on track.

Speaker 2 And saves you money.

Speaker 1 100%.

Speaker 1 Yes. Shop on the outside of the store.
What do you mean by that?

Speaker 1 Stay out of the aisles. The whole foods, single ingredient foods live on the outskirts of the store, primarily the produce department.
You know, think about the meats department.

Speaker 1 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.

Speaker 1 Like if you can get 80% whole foods and it's 20%

Speaker 1 processed to some degree, we consider that a win.

Speaker 1 You know? Yes. But what happens with those canned foods? There's hidden preservatives, hidden colorings, hidden sugar, all of those things.

Speaker 1 And I heard someone say years ago, the longer the shelf life,

Speaker 1 the shorter your life.

Speaker 2 Oh, wait a minute. That's good.
The longer the shelf life

Speaker 2 on the boxed or canned food, the shorter your life. That is a fabulous rule of thumb.

Speaker 1 Yeah. I thought so too.
And we use that all the time. But again, you know, are there certain items? Yes, but read the labels.
Pick the best that you can choose choose from when you have those options.

Speaker 1 There's always choices.

Speaker 2 So if the person that's listening is like, okay, I want to take better care of myself. And this is a lot of information and there's a lot to do.

Speaker 2 If somebody doesn't know where to begin as a heart surgeon and somebody that has been really in the field taking care of people and now you've got a very different approach for yourself and a reason why you're taking care of yourself.

Speaker 2 What do you think is the best simple, small step forward that a person can take if they feel overwhelmed?

Speaker 1 Yeah, I mean, I go back to the diet. We've all got to eat.

Speaker 1 And I really think that that before you do one push-up, before you go out for a run, before you spend the money on that expensive gym membership, as good as those things might make you feel, I think.

Speaker 1 from a foundational standpoint, I really go back to the food journal and starting there because it's something that we're all already doing.

Speaker 1 The question is, how badly are we managing that for ourselves? So that is.

Speaker 2 I once heard somebody say that abs are made in the kitchen,

Speaker 2 not in the gym.

Speaker 2 And I didn't fully understand that until I started learning from medical experts like you about the impact of positive whole food choices and the negative impact of having a very processed, high-calorie, high-sugar diet.

Speaker 2 So, that makes a lot of sense to me. What are the biggest problems that patients still come to you as a cardiac surgeon for?

Speaker 1 They fall in the two buckets that we discussed earlier of what defines heart disease. The most common is the blockages in the heart arteries.
That is the most common.

Speaker 1 So, what 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.

Speaker 1 Now, bypass surgery is open heart surgery, just like valve surgery.

Speaker 1 But bypass surgery simply means identifying where that blockage is, 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 breastbone or veins from the leg, to create a new pathway

Speaker 1 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.

Speaker 2 Wait, say that again?

Speaker 1 When you bypass the blockage,

Speaker 1 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.

Speaker 1 The work starts for that patient afterwards to make lifestyle modifications to impact

Speaker 1 the rate at which

Speaker 1 this problem continues or not at all if they're really aggressive.

Speaker 1 In other words, you could do a bypass beyond a 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 we know that we should be doing.

Speaker 1 So that's kind of the bypass surgery piece.

Speaker 1 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.

Speaker 2 What exactly is a stint? I hear people talking about that all the time. I just had a stint put in.
I hear the stint. And you mentioned a stint.
What is a stint?

Speaker 1 So a stint is, think of it this way, as a scaffolding, very small scaffolding that is loaded on a balloon. Okay.
Kind of looks like the old Chinese finger track. Oh, yeah, yeah.

Speaker 1 Where you get your fingers stuck in them. Yep.
So imagine that crimped down onto a balloon that goes through the blood vessels and through a blockage over a wire. Okay.

Speaker 1 And when they expand that balloon, it expands within that artery and that stinted structure, if you will, that scaffolding holds the artery open in that specific spot.

Speaker 1 So instead of bypassing it, you've actually gone in in

Speaker 1 and pushed that out to the edges.

Speaker 1 But again, doesn't treat the underlying problem of the hardening of the arteries, gets the patient out of trouble and mitigates their risk of having something terrible happen as a result of the lack of blood flow to the heart muscle.

Speaker 2 I have so many more questions, Dr. London, but I want to take a quick pause so we can hear a word from our sponsors and so that I can give you, as you are spending time with Dr.

Speaker 2 London and I, a chance to share this with people that you care about. And don't you dare go anywhere because because Dr.

Speaker 2 London has more specific things he wants you to know and symptoms that he wants you to understand when we return. So stay with me.

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Speaker 2 Welcome back. It's your friend Mel Robbins.
Today you and I are getting to spend time learning from the amazing Dr. Jeremy London.

Speaker 2 He's a cardiac surgeon, and he's teaching you and me and your loved ones how to take better care of our hearts. So how do you actually know if your heart is having a problem?

Speaker 1 So there are, again, within those two buckets, signs that you should respond to.

Speaker 1 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,

Speaker 1 shortness of breath with low-level activity. What do I mean by that? Taking a shower, taking the garbage out, things out of proportion to the activity,

Speaker 1 not being able to lay entirely flat and sleep without feeling shortwinded.

Speaker 1 Okay.

Speaker 1 Again, signs of the heart not working effectively and fluid backing up. Same thing with swelling in the legs.
Same kind of scenario.

Speaker 1 These are clinical signs that maybe the heart isn't working properly or not working efficiently. Swollen legs, lots of reasons that legs can swell.

Speaker 1 Need to make sure it's not something that needs to be addressed. And then that red flag category, exertional symptoms relieved with rest.

Speaker 1 That is like, if there's one takeaway today, when you start to examine, do I have blockages or not? You know what?

Speaker 1 I can still go for my brisk three-mile walk and I don't have to sit down and I don't have to stop. Great.

Speaker 1 It can be something as simple as shortness of breath and something as dramatic as the elephant sitting on the chest to something as minor as reflux or a pain in your elbow.

Speaker 1 I had a woman that every time she took the garbage out, she had a pain in her elbow that would not go away. She would sit down.
People told her she was crazy.

Speaker 1 And there was one cardiologist who said, let me get this straight. Every time you do the exact same activity, it aggravates this particular symptom.
And she said, yes, every single time.

Speaker 1 And he said, I'm taking you to the cath lab. And what did it show her? And he ended up putting a stent in her, in the artery in the front of her heart.

Speaker 1 She was having coronary angina that showed up as elbow pain. She had gone to the orthopedist.
I mean, like, that's why I say it's the great masquerader. And you have to listen to your body.

Speaker 1 You, you know, we have to be accountable for doing that.

Speaker 2 What are the kind of classic but important signs to know that somebody is having a major heart incident?

Speaker 1 So we've talked about exertional symptoms that are relieved or threaded, symptoms that occur at rest and don't go away. Think of it this way.

Speaker 1 Whereas before you were having to stress the heart muscle down below the blockage, now at rest, you're not giving adequate nutrient and blood flow to that. So it's really in danger.

Speaker 1 And so pain and symptoms at rest or pain that escalates, that's a 911 call.

Speaker 2 Okay. And is it the pain in the heart? Is this the arm thing? All the above.

Speaker 1 Okay.

Speaker 2 All the above. Dr.
London, if you're home alone and you think you may be having a heart attack, what should you do? So.

Speaker 1 This is, 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.

Speaker 1 Now, when we did this post, the most popular response was call 911. No, I'm going to clear my browser history before I call 911.
I was like, are you kidding me?

Speaker 1 We're talking about having a heart attack.

Speaker 1 So number one, you're going to 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.

Speaker 1 And you're going to 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.

Speaker 1 Lay down or sit down. Lay down.
Lay down. whatever's comfortable, wherever you're breathing the easiest.

Speaker 1 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.

Speaker 1 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 going to be taken to the hospital.

Speaker 2 I've heard take an aspirin. Like, is that something you should do too? Or is it not as important as 911?

Speaker 1 It isn't. It is important.
And not only do you want to take it, you want to chew it. You want a 325 milligram aspirin.
Yep. Because that's the fastest way to get it into your system.

Speaker 1 You know, I think the thing to be aware of and the reason that I don't always put it directly on the list is that there are people that have GI bleeding problems that aspirin 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.

Speaker 1 That's something that you definitely need to clear with your physician before you make that plan of utilizing an aspirin in that setting.

Speaker 2 I am so glad I asked you that question. I never would have thought turn on the porch light and unlock the front door.

Speaker 2 I mean, I would have 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.

Speaker 2 Dr. London, what is the widow maker blockage?

Speaker 1 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.

Speaker 1 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.

Speaker 1 Many times this blockage actually starts with what we call soft plaque.

Speaker 1 So 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.

Speaker 1 So what happens is you get an immediate interruption of blood flow to a huge territory of the heart, which is extremely dangerous. Unlike potentially a blockage in this

Speaker 1 area that has happened over time,

Speaker 1 and the heart then can acclimate slowly, doesn't mean that you're not going to ultimately have symptoms and have something to 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 get there.

Speaker 1 So it's that acute blockage in a very, very upstream location.

Speaker 2 You know, as we were preparing for you to come in, one of our colleagues who's 37 years old told us that he was experiencing headaches for a number of weeks.

Speaker 2 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.

Speaker 1 Yes.

Speaker 2 He had no idea. Yeah.

Speaker 2 And he's now, you know, on medication for it. And, you know, he was saying, you know, I'm learning that, you know, this is something that's genetic

Speaker 2 and that feels very discouraging. And so I'm wondering, Dr.

Speaker 2 London, if you could talk a little bit about the connection between high blood pressure, the health of your heart, and what if the person that's been listening feels like, well, God, like my dad had a heart attack, like high blood pressure is in my family.

Speaker 2 Like, what is it that you want someone to know?

Speaker 1 Well, I'll start by saying you can't run from your genes, you know, and that's just a fact that we all have to come to grips with.

Speaker 1 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, because there's this concept of epigenetics.

Speaker 1 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.

Speaker 1 So by really making solid lifestyle decisions and being consistent with those things can have a huge impact on that.

Speaker 1 Now, there are some forms, particularly of these familial type of processes, that are really difficult to impact with just lifestyle changes, and they require medication.

Speaker 1 Let's talk about high blood pressure and why that is so important to treat.

Speaker 1 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.

Speaker 1 trying to maintain the blood volume in the body, even though it may be adequate, the tone in those blood vessels is real.

Speaker 1 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's seeing this.

Speaker 1 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?

Speaker 1 It gets thicker and thicker and thicker. And so the cavity then can become smaller and the efficiency of that heart muscle at some point will start to slip.
That makes sense.

Speaker 1 That's when patients start to develop heart failure as a result of heart blood pressure.

Speaker 1 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 just breeding ground for cholesterol and all of that to accumulate in.

Speaker 1 It sets up injury. So it kind of comes from this multifaceted approach of how it negatively impacts the body.

Speaker 2 So by relieving the high blood pressure with medication or if lifestyle changes are something that's going to impact you based on genetics or based on the diagnosis or both, you relax the system so that the heart isn't having to just pump so darn hard through a system that's clenched.

Speaker 2 You relax it, and then the heart can actually ease off and do its job.

Speaker 1 Absolutely correct. 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.

Speaker 1 So we're changing the slope of that survival curve by saying, okay, well, what are the mechanisms that then result in this problem?

Speaker 1 Let's relieve those or mitigate those to the best of our ability to extend this person's life.

Speaker 2 Yeah, just like you do with somebody who has diabetes.

Speaker 1 Identical.

Speaker 2 Yeah, that's so helpful to understand.

Speaker 1 We know the natural history. How can we alter the natural history?

Speaker 2 You know, one question I didn't ask you is the difference between men and women and heart disease. Is there anything that you think is important for us to know?

Speaker 2 Because I hear heart attack and I think man.

Speaker 1 The short answer is yes.

Speaker 1 You know, I love that Marie Claire doesn't say, what she says is that women are not little men, you know, and that's so true, just like children aren't little adults, like their physiology is very, very different.

Speaker 1 And part of it is that the medical literature has been fraught with male bias for years and years. And that is slowly, slowly starting to transform.
But in addition,

Speaker 1 There is

Speaker 1 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 a panic attack or something of that nature.

Speaker 1 And the reality is, is that the nature of the way blockages occur for women can be very different, as opposed to in men happening in these very large blood vessels.

Speaker 1 In women, they can occur there and frequently do, but they can also occur in the smaller blood vessels.

Speaker 1 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

Speaker 1 mitigate, you know, or actually lead to heart disease. So, yes, there is significant differences between the two.

Speaker 2 Now, you said, according to the CDC, that heart disease and heart attacks are the number one killer worldwide, like

Speaker 2 in both men and women. But is there statistics in the rates in terms of how heart disease impacts men versus women?

Speaker 1 I still believe the rates are higher for men than they are for women, but I think it's still, it's pretty close.

Speaker 1 I don't know for sure.

Speaker 2 Well, what's interesting is that I, like, I, I just am thinking, like, generally in my own experience, like, you think about men having heart disease and you think about women having high blood pressure.

Speaker 2 Like, we tend to talk about it differently.

Speaker 1 And that's part of the problem, I think, too. I think that

Speaker 1 the mindset around evaluating women has not been the same.

Speaker 1 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.

Speaker 1 And that, you know, in this circuitous route, it ends up back. It ends up back in the heart.
And that is changing. It really is.
I feel like that is changing rapidly.

Speaker 1 That mindset is much better, even than since I've been in training.

Speaker 2 Well, I guess what's interesting and what I would love to have you speak to, because I'm realizing my own bias here,

Speaker 2 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.

Speaker 2 It's just that we're not seeing the symptoms and connecting the dots as quickly as we do with men.

Speaker 1 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.

Speaker 1 I don't know that that discrepancy even now is quite as

Speaker 1 blatant, but I think a lot of that too, the focus on women's health now is gotten so, so robust.

Speaker 1 And I think it's wonderful because it has put a different light on overall women's health, not just, oh, they're menopausal.

Speaker 2 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 women's body.

Speaker 2 Have they done any research about the increase in heart disease and heart attacks with women?

Speaker 1 Absolutely. Yeah.
I mean, and I think that they have clearly shown that,

Speaker 1 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 heart attack symptoms.

Speaker 1 And I think the ones that maybe are not picked up on are the more perimenopausal that may have dramatic changes in their estrogen levels.

Speaker 1 I think the interesting data is going to come out with now all the estrogen replacement, particularly earlier on. How is that going to change the tail of this as we look at it over the next 10 years?

Speaker 1 I suspect it's going to be dramatic.

Speaker 2 Fascinating. That's really helpful.
Thank you, Dr. London.
Sure.

Speaker 2 So if you're going to have heart surgery or you're the loved one and somebody that you love is undergoing heart surgery, what do you want the patient and their family to know?

Speaker 1 So when you're starting to have this general conversation about an operation, there are several things that you need to know. First, what's wrong with me?

Speaker 1 Like really explain and have the physician explain and you need to understand your diagnosis and what that truly means. Start there.
What do I have? Next is explain the procedure in detail.

Speaker 1 What are you going to do to me? Like, what are you going to do to me? How bad is it going to hurt? How long am I going to be in the hospital? What are my expectations afterwards? Next,

Speaker 1 risk. What are the potential bumps in the road if I do decide to undergo this procedure?

Speaker 1 Very clearly. And make sure you understand each of those.

Speaker 1 Just as important, what are the benefits? of having this operation. Why?

Speaker 1 Because every decision we make in medicine is a risk-benefit decision. What are the pros and cons of going down road A versus the pros and cons of going down road B? And how do I make this decision?

Speaker 1 And not that this discussion makes surgery any less scary,

Speaker 1 but I do think that

Speaker 1 truly understanding that you're making the best possible decision for yourself based on the actuarial, the statistical numbers is comforting.

Speaker 1 And finally, you want to know what the the alternatives are. Like, what else can I do? Do I have to have this? What if I don't have it? What does that look like for me?

Speaker 1 And you know this as an attorney. This is informed consent, right? That's what this is called.
I don't like that term. This is educated consent.

Speaker 1 My job isn't to inform a patient. This is a relationship.
And it's a two-way relationship. Like patients have to engage in this conversation as well.

Speaker 1 But to have a patient sign an informed consent piece of paper is meaningless if educated consent hasn't occurred.

Speaker 1 And so I think that that process allows you to gain so much knowledge of kind of what you have, what we need to do, and what that means that

Speaker 1 you can really be comfortable that you're making the best decision for yourself.

Speaker 2 So, Dr. London, you've shared so much with us.
If the person listening does just one thing out of everything

Speaker 2 that you shared, what would be your top recommendation?

Speaker 2 Other than I think my recommendation would be share this with somebody in your life who needs to hear the story at the top so that if signs come up, they don't do something selfish. Sure.

Speaker 1 I would say understand that we all have our own instruction manuals. And mine is going to be different than yours and different than your husband's.
And

Speaker 1 approach this with some real intellectual honesty so that you can figure out where

Speaker 1 your opportunities truly exist. Clearly, starting is the hardest because we're all fearful that either we're going to fail or it's just not worth it or whatever it may be.

Speaker 1 And we need to understand that success is not a straight line, but a series of picking ourselves up multiple times.

Speaker 1 And then I think that, you know, really getting even more granular, like consistency and understanding that making those small steps, whatever you choose for yourself, are what are going to compound on a daily basis.

Speaker 1 And then how do you validate those things? You know, how do you, how do you validate those changes? Well, is it a number on the scale? Is it the way you look in the mirror?

Speaker 1 Is it, it's all of those things.

Speaker 1 But, you know, I've been thinking about this recently that I think the ultimate form of validation to know that you're on the right track is to know that if you miss doing those things

Speaker 1 that it really upsets you like you you didn't do them and you really really miss them because it's such an integral part of your life that you know that you've kind of you're on the right journey in other words you don't have that if i only get to this number on the scale i'm going to be happy because you're going to get there and you're you're not going to be happy but if you know that if you don't do those things you feel like you've really missed out i think that that's a level of validation that that you're on the right course.

Speaker 1 And so I have really broadened your question of one thing intentionally, because that one thing is so different for everybody that I would hate to say one thing.

Speaker 1 And then someone listens to this and thinks, well, I'm good at that one thing. I don't need to worry.
But that's not necessarily the case.

Speaker 1 I think that we all have to approach this in a very individualized way.

Speaker 2 And I can also tell that one of the reasons why

Speaker 2 you are now coming out of the operating room and sharing more and more on social media is because you know that there are simple things that are within all of our reach that can keep us from ever meeting you on an operating table.

Speaker 2 And that if you start to understand the power that you have in your hands, that you will

Speaker 2 also take the steps to take care of your heart.

Speaker 2 Dr. London, what are your parting words?

Speaker 1 Well, I think right in line with what you just said, you know, we're all just like trying to squeeze every ounce of juice out of this brief existence that we've been blessed with.

Speaker 1 And it's like, why not make choices that tip the scales in our favor?

Speaker 1 And look, you know,

Speaker 1 we're all human and inherently flawed, but just those little steps each day and watch them slowly combine into this wonderful experience and understand that

Speaker 1 it's not about perfection. It's just about progression for all of us, me included.
And I think that that's ultimately what I hope to get across. Well, you did.

Speaker 2 Dr. London, thank you for being here.
And, you know, I also want to thank you. Thank you for taking the time to listen to something that is not only going to make you smarter about your health.

Speaker 2 I mean, I learned so much today. I didn't know about half of the things that he shared with us.

Speaker 2 It's not only going to make you smarter, it's going to empower you to make better choices, which is going to lead you to living a longer life.

Speaker 2 And I'm also thrilled that you have this as a resource to send to people that you care about, because as I've already shared, I am sending this with four people that I can think of immediately.

Speaker 2 And I'm sure more people are going to come to mind. So thank thank you for listening.
Thank you for sharing. Thank you for being here with me.

Speaker 2 And in case no one else tells you, I wanted to be sure to tell you that I love you and I believe in you and I believe in your ability to create a better life.

Speaker 2 And everything that you learned today is going to help you do that. Alrighty, I'll see you in a couple of days in the very next episode.
And I'll be waiting to welcome you in the moment you hit play.

Speaker 1 I'm ready.

Speaker 2 So am I. To help us.

Speaker 1 Whoop.

Speaker 2 Do you you need me to stop? Okay, hold on. It's garbage day.

Speaker 1 Oh.

Speaker 2 I'm getting a note that there's a prop. I almost asked, and I'm like, I bet everybody knows.
I'm the only idiot that doesn't know what a stent is. I'm spent.

Speaker 2 I'm ready for a burger and a glass of wine. And

Speaker 2 was that good?

Speaker 2 You sure? Yeah. Okay.
Wasn't too long. Wasn't too like much of a downer.

Speaker 1 And I immediately sat down on the toilet and the symptoms went away instantly.

Speaker 2 When you sat down?

Speaker 1 Yes. I don't like the way you're talking to me right now, Mel.
I don't like your tone.

Speaker 1 I'm going to stick to my story right now. I'll get down that road later on.

Speaker 1 All right, everybody, Dr. London Gentleman.

Speaker 2 Oh, and one more thing. And no, this is not a blooper.
This is the legal language. You know.
what the lawyers write and what I need to read to you.

Speaker 2 This podcast is presented solely for educational and entertainment purposes. I'm just your friend.

Speaker 2 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.

Speaker 1 Got it? Good.

Speaker 2 I'll see you in the next episode.

Speaker 1 Serious Access Podcasts.

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