America's #1 Heart Risk & How You Can Prevent It

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The short answer is yes.

Really?

And there is an actual syndrome, broken heart syndrome.

Really?

It is a thing.

50% of Americans have high blood pressure.

Really?

And the majority don't even know they have it.

Most people, if you ask them, you know, what are you afraid of dying of, they all say cancer.

But it's really not the case.

It's heart disease.

He is a board-certified cardiovascular surgeon.

His tips for living well and protecting your one and only heart have racked up nearly 50 million views on YouTube.

I am super excited to introduce you to Dr.

Jeremy London.

What is the main cause of us having heart disease, heart attacks, heart conditions?

Nothing happens in a vacuum in our bodies.

It's all connected.

Everything is connected.

How much does vaping affect the heart health for Gen Xi?

Have I seen really life-threatening situations from vaping?

100%.

What have you seen?

The short story with vaping is

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I read a stat that said 805,000 people have heart attacks each year in the U.S.

One heart attack every 40 seconds, which seems crazy to me that this is such a big issue for us as Americans.

And it sounds like around the world as well.

So I'm curious then,

what is the main cause of us having heart disease, heart attacks, heart conditions that affect us living a healthy life or dying.

To zoom out just a little bit further to put the perspective on this worldwide, it's 20 million deaths a year.

So it's the leading cause of death of men and women worldwide.

And most people, if you ask them, you know, what are you afraid of dying of or what do you think the biggest killer, they all say cancer.

But it's really not the case.

It's heart disease worldwide.

Now,

of that group, the most common reason is blockages in the heart arteries.

And that's what causes heart attacks.

We have arteries that are on the surface of our heart that bring nourishment to the heart muscle, which is just a pump.

It's just, you know, that pump requires energy.

And in our bodies, that's nutrition and oxygen.

Well, if you get a blockage in there over time, usually from cholesterol buildup, that then

creates

basically a roadblock to the heart muscle below.

And if that gets tight enough or completely blocks, that's when you have heart attacks.

And

that's the single biggest bucket in that

20 million.

But there are a lot of different reasons why people get heart disease.

You can have valve problems within the heart.

You can have electrical problems.

Those are the three most common buckets.

And then there's, of course, congenital heart disease.

People are born with abnormalities and they all go in those numbers too.

But the majority of it is because people are getting blockages.

How much does stress affect heart health?

If someone's just feeling like overwhelmed, burnt out mentally in their head constantly, can that affect heart health or hurt you?

So, the way I would look at this is: nothing happens in a vacuum in our bodies.

It's all connected.

Everything is connected.

Our mind, our nervous system, all connected to our blood vessels, our heart, etc.

Is that a major risk factor?

No, it's not necessarily a major risk factor, but it definitely plays a role in heart disease.

It influences it.

100%.

It influences your body feeling sick.

And if your body feels sick, it puts stress on the heart.

And that could...

Yeah.

So what would you say then are the three biggest factors of heart disease?

Sure.

The first would be obesity.

Really?

Yep.

And along with that, you know, comes poor diet and insulin resistance,

high blood pressure,

diabetes,

high cholesterol,

sedentary lifestyle.

And we cannot leave out smoking.

Really?

Because that is the single worst thing you can do for your body.

Again, thinking about it like a vacuum.

Smoking affects the lungs.

It affects all the arteries.

And it's the leading risk factor, really, for heart disease.

Really?

Oh, yes.

So here's a question that most people are not going to like the answer to, probably.

How much does vaping affect the heart health for Gen Z?

Yeah.

The short story with vaping is unlike tobacco use, we don't have the years of data.

So it's hard to really say, you know, there's all the data of, oh, it's better than

we don't know what the long-term implications are.

What we do know is there's a lot of people doing it.

They're doing it all the time because unlike cigarettes, you don't have to go outside.

You're just smoking every seconds.

Right.

Yeah, yeah.

You constantly see the blue lights all the time.

You don't have to go to the room at the airport anymore that now they've actually taken those out altogether.

So the issue is we just don't know the long term, but the nicotine content in those vaping formulations is essentially unregulated.

So

they can have just multitudes higher levels of nicotine than cigarettes.

And again, because you can do it all the time, the exposure is all day long.

So nicotine in and of itself is a

vasoconstrictor.

So it constricts

not the valves, the actual blood vessels themselves to constrict.

And what does that do when it's pumping through the heart?

Right.

So if you think about it again as the heart as a pump.

You got a little example here.

Absolutely.

So the big chambers down here, you have the right and the left chamber.

The left chamber here is the main pumping chamber, and it's pushing blood out through the aorta.

That's why it's red because it's got lots of oxygen in it to the rest of the body.

So if all of these blood vessels are clamping down and this pump is trying to work against that system, what do you think that causes high blood pressure?

Interesting.

And that's one of the main causes of exactly.

Because high blood pressure over time

does two major things.

One,

you get decreased, what we call elasticity of the blood vessels.

They become stiff.

So they don't flex with each heartbeat.

And as they become stiff, they can then become damaged.

And the repair process from that damage is what causes atherosclerosis or hardening of the arteries.

So you've got direct damage from the higher pressure.

And then over time, because the left ventricle or that pumping chamber is just a muscle, what happens if you put any muscle time under tension?

It's going to grow.

It's going to get thick.

Well, when the muscle gets thick, it decreases the size of the cavity where the blood comes from, so less blood is getting ejected from the heart.

And then the end result of that, as it works against resistance, is eventual heart failure.

Interesting.

And so it's really a continuum timeline.

And that's why high blood pressure is such an important risk factor.

And, you know, 50% of Americans have high blood pressure.

really and the majority don't even know they have it and it's one of the single most modifiable risk factors that we can have how can we lower our blood high blood pressure if we have it well the pillars that we talk about all the time you know a solid nutrition yeah low stress that's right regular exercise

both you know with a aerobic training as well as resistance training.

All of those things are really, really important.

And you can modify your blood pressure significantly with just lifestyle changes.

Now, many people

do need medications, and that's not a failure, you know, but getting your blood pressure under control is really important from a heart disease standpoint.

How many heart surgeries do you feel like you've done in the last 25 years as a heart surgeon?

Yeah, we've estimated this on multiple different times because the beginning of my career, I was doing, you know, crazy, crazy numbers, probably somewhere around 6,500 to 7,000.

Wow.

Somewhere around 6,000 to 7,000 heart surgeries in 25 years or heart operations in 25 years.

What are the three things that all those people had in common that got them on your operating table with some type of heart failure?

So they don't all have heart failure.

So I think that's some heart condition.

Exactly.

Gotcha.

And depending on why they're there, again, the three buckets, either blockages in the arteries, problems with the valves, or problems with the electrical system, that's why they get there.

So let's go with the most common, which is blockages in the heart artery.

That's probably the most common when you see it.

That's the most common operation that

60, 70%.

Probably

Yeah, probably 60% would be a response.

It's a blockage.

Yes, it would be a blockage in the artery that would be picked up either because patients were having symptoms or because they were in a high-risk category and their internist or cardiologist recognized that and intervened before there was a problem.

What are the main symptoms someone might have

if they have that restriction?

Sure.

So

heart symptoms from blockages

is frequently referred to as the great masquerader because not everybody presents with what I call the TV heart attack, where it's clutching the chest, pain into the jaw, pain down the, now many people do, but the symptoms can be very subtle even in that pre-heart attack phase.

There are warning signs.

Well,

if you have a blockage in one of the main arteries that's supplying, again, the pump, and that blockage gets significant enough, as you exert yourself, you outstrip the amount of nutrients and oxygen that can get to that portion of the heart.

What happens in your calf when that happens, when that occurs?

You get a Charlie horse.

What happens

in your heart muscle is you have tightness in your chest, or it can be shortness of breath, or it can be abdominal pain even.

And the symptoms can be very subtle.

The key is that the symptoms come on with activity and then when you sit down, it's relieved with rest.

That's referred to as stable angina or stable chest chest pain.

In other words, warning signs of something potentially bigger to come.

If someone's having that type of a warning sign, what should they do?

That is a red flag and you should be evaluated by a qualified health care.

Call 911 right away or is it?

Not necessarily 911.

As long as the pain goes away.

Got it.

If the pain continues, absolutely 911 is the answer.

But if it's the kind of thing where you notice, for example, every time I take the garbage out, I get this little tightness in my chest and I have to stop for a minute.

The pain goes away and I go walk back in the house and it kind of comes back.

But every time I rest,

it's relieved.

That stable angina, it is definitely something that needs to be evaluated, but not necessarily an emergency.

However, if you're ever concerned, that's the safest route to take.

Wow.

Okay, so.

Again, I heard you in the beginning say obesity with poor diet is one of the main causes or the main reasons why people have heart conditions, heart diseases.

High blood pressure and diabetes also influences heart conditions or failures in a big way.

Sedentary lifestyle.

And you also mentioned smoking.

We were talking about vaping a little bit, which we don't have the data, it sounds like, yet of how it actually influences the heart.

But are you seeing or noticing

signs or patterns of people coming in who also vape that are

just happen to also be vaping that have heart conditions?

So, think about the demographic of people that are vaping primarily.

It's usually younger people.

Yeah, yeah, yeah.

So, folks under the age of 40 that don't have a family history, they're not diabetic, you know, the risk of heart disease there is certainly lower.

Now,

have I seen really life-threatening situations from vaping?

Absolutely, which is why

100%, which is why

what have you seen?

Well,

there is a

syndrome called E-vali, which is

e-cigarette vaping associated acute lung injury.

And this is an injury that can occur from vaping one time

from an inflammatory process that happens in the lungs in these really young folks.

They come into the hospital, they're so sick that even the ventilator, the breathing tube, is not adequate to nourish their body with oxygen.

And we have to put them on something called ECMO,

which is an external lung circuit where we take blood out of the body,

put blood back, oxygen back into the blood, and return it to the body.

And these can be 18, 21-year-old, 23-year-old individuals.

And unfortunately, we've had several that haven't survived.

Really?

Absolutely.

So these are all patients who have vaped.

It was caused from the vaping?

Absolutely.

What's the youngest patient you've had to operate on?

To place them on ECMO for the...

Just as like a heart failure or heart disease.

So for heart disease, 23 years old is the youngest patient I've ever operated on for bypass surgery, for blockages in the arteries.

23 years old.

Had a very

strong family history of heart disease.

And they had a genetic propensity for very high cholesterol, which is not common, but it does occur, and their cholesterol was in the thousands, whereas normally

you want it around 90 to 100, theirs was in the thousands.

Was this person healthy in general, or were they not, they were more obese or more

poor diet as well?

Absolutely.

So they weren't influencing the reversal of that.

They were not, and they would have needed medication to help do that because they had all of the genetic force behind them then to get to that spot.

And then they didn't take care of themselves on top of it.

So we don't have a lot of the data yet, I'm hearing, or the research around how vaping causes heart disease yet, is what I'm hearing.

But you've had to operate on many people who have come in because of vaping.

Is that correct?

Yeah, it's not many, I would say.

Yeah, I don't think that.

Handful.

Yeah, for sure.

But I mean, you see three, four, five young adults not survive from an addiction and something that has become normative in our society today,

you know, and I have three boys.

Wow.

And so it hits really close to home for me.

I am really on a personal quest to get the information out about vaping.

And look, in the end, you're about to your rules.

Like, I get it.

But at least know the facts, at least understand

that we really don't know the implications of this.

All of the chatter about this is a safe alternative.

We don't know that.

You know that old saying, it's not what you say, it's how you say it.

I think that goes for how we live, too.

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Do you think those people that came in, if they weren't vaping or weren't smoking, do you think they would have also been there because of other lifestyle choices?

Or do you think the vaping or smoking heavily influenced the heart failure?

So, for sure,

the cardiac patients, 100%,

it's like a, you know, 10, 12, 15x factor when people are smoking cigarettes in particular.

Wow.

Yeah, for sure.

I mean, if you're going to examine, like, if we're going to take a step back for a second and say, am I healthy right now?

You know,

how would you do that?

Number one would be, do you smoke?

Let's start there.

The next on the list would be.

Alcohol or.

Well, yeah, we can leave that one off for just a minute.

It can even be broader than that.

There's a real powerful tool just to put yourself in a category like, how healthy am I?

Excellent, good,

you know.

Average, fair, poor.

Believe it or not, they use that in research and it just kind of puts you in the mindset of where do I fall?

Interesting.

Then, what are you going to do next?

You're going to weigh yourself, right?

Uh-huh.

Put your body mass index, which is not a great indicator of longevity.

We can talk about the better ways to do it, but it's a good place to start, right?

Then, just measuring your abdominal girth to your height, that ratio is very meaningful.

Again, we talked about obesity, this overconsumption problem.

Well, we know that visceral fat or the fat that's in your belly around your organs is the engine for inflammatory diseases, diseases, particularly heart disease.

Yeah, and if you have a lot of excess belly fat, then you probably have fat around your heart too, I'm assuming.

You do, but it's this fat in particular.

The external fat, the visceral.

The visceral around your organs, not the fat that's in, you know, under your skin in between here.

Inside that you can't see inside that you really can't.

Keep

it's the beer belly.

Gotcha.

Is really how I would describe it

that really influences the overall inflammatory process in your body.

And it's a known risk factor for metabolic syndrome and type 2 diabetes.

What would be next on the list?

Resting heart rate.

You know, kind of where am I on that scale?

And start with those things.

Then

you start to look specifically at lifestyle.

You look at diet.

You look at alcohol.

You know, where am I on the scale?

You look at your sleep.

Simple things with sleep.

Am I going to bed at the same time every night?

Am I getting, you know, six to eight hours?

Am Am I waking up at the same time?

And then, as you mentioned earlier, like, what is my mental health status?

Where am I with that?

And that can be tough, but there's some great online questionnaires that you can do.

And that's a great place to start.

Like, how healthy am I?

Not just from a cardiac standpoint, but in general.

And sometimes just kind of knowing where you are currently as an opportunity opens that door.

I mean,

we're in a society right now that

people praise those who are, you know, plus sizes or don't shame someone for how big they are or things like that.

And I'm all for not shaming or judging people.

But when it comes to people's heart health or just overall quality of life,

if they're extremely obese and they're not taking accountability for their lifestyle decisions, they might be causing a lot of physical harm to themselves, more medical bills, medications in the future, and also putting strain and stress on the people around them

by not taking care of their health.

I'm not saying you have to have a six-pack and be perfect.

That's not what this is about.

But what do you say as a doctor to society that says, you know, celebrate anyone for how big they want to be?

It's a good thing.

You know, let's not shame anyone.

How do you navigate that to support people's emotions and feelings and how they feel or

their own personal experience in life, versus

leading them to take accountability in their life and take responsibility for their health.

Not being perfect, not being a cover model or something like that, but like

making sure you're responsible for your health, for your future, the family you have in the future, the people around you.

How do you navigate that, people's emotions versus practicality?

You've touched on so many things there, but let's try to slide down the first slippery slope,

which is, you know,

how do you enter that conversation and potentially change that narrative?

Because I agree with you that I think that it's dangerous to

validate a lifestyle that we know from the data.

is not healthy on so many on so many fronts.

So how do I do it personally when

a patient comes in and you start that conversation, right?

Like they tell you, I don't have any risk factors and they're 70 pounds overweight.

You're like,

okay, let's take a step back.

I think many times

allowing people to understand that

the life they've lived to getting to that point doesn't necessarily define what their path is forward.

And

when you kind of give them a new set point of, okay,

you've gone down a road and it's gotten you to a place where now you're potentially in trouble, or if you're seeing me, you probably are.

How do you picture yourself five years, ten years?

Who's the person you want to be?

And almost invariably, it's not who they are

at that point.

And each individual person is so different on how you have that conversation.

But I do think that that overall narrative is

dangerous

because it creates an insulation in a way that you're really abdicating a potentially very unhealthy scenario.

And so

I think that

backing into it from that perspective, from a non-emotional way, not totally non-judgmental, and then break down each of those things that you just talked about into really small steps for people.

Because most of the time, folks are really overwhelmed.

They don't really know where to start.

They're scared.

They're scared that they're already at a deficit.

They're worried they're going to fail.

They're already in shame.

100%.

Food relieves some of the shame feeling in the middle of the day.

Many times.

many times.

And I don't know who said it, but I love that quote, you know, that fear is ocean wide, but only an inch deep.

And I think that if you can help folks take that first step, and it can be simple stuff, just walking.

Yeah.

Like

many of those folks are just really uncomfortable walking into a gym, and you can appreciate that.

And all of the, you need to be comfortable with the body that you are, that doesn't help.

Now, do I think it's about finding, as you point out, the healthy weight for you?

That doesn't mean that you're a swimsuit model necessarily.

And so, you have to set appropriate goals.

So, I think allowing people to identify where they are and the person they want to be, and then helping them break that down into really small steps has worked really well for me in the practice.

Yeah, it really has.

I guess it's challenging because if someone is

70, 100, 150 pounds overweight,

it's not just a

physical, practical thing for them that got them there.

If there's some type of emotional or mental trauma or blockage also, not just a heart blockage, but an emotional or mental blockage that has allowed them to get to that place of not taking care of themselves in a certain way around health.

Maybe they're like amazing people and they're good for other people and they're smart and they're talented, but something has been blocking them emotionally or mentally to want to create that for themselves.

And I can imagine how hard it is to reverse it, especially if it's been years of living in a familiar pattern.

So it must be extremely hard.

But how do we,

how does someone watching this get through to someone in their life who is extremely overbeast and is just allowed year after year,

10, 20 pounds a year to pack on every year, and they're not making any changes?

It's almost like you need to be completely obsessed for a whole new identity and lifestyle.

If you're going to reverse 100 pounds, 70 pounds, it's almost like you have to think a different way and you have to start healing and mending certain things that caused those actions to get there, I'm assuming.

But how does someone who's watching this,

who has someone in their life they care about, who's struggling with this, that's afraid for their heart health,

how can they communicate to the person they love in a way that doesn't judge them, but holds them accountable to start taking action.

Yeah, and I think that that certainly is.

That may not be your expertise.

Yeah,

you're stretching out outside of my wheelhouse, but not entirely.

I mean, from my perspective, I have the benefit that if they're in my office,

they're having a touch point in their life that we are at a new crossroads.

And so it enables me to utilize that as life is a series of choices, right?

There's many times where we know better, but we don't do better.

You now have a real reason to do better.

And here's why, and here are the things that I recommend.

And sometimes when folks fall into a level of complacency, as you've described, to break that pattern can be really tough.

And so I think that obviously from a supportive place always makes the most sense.

But when in doubt, fall back into the data.

Share the the data.

How you started, how we started this conversation.

It's not cancer that's going to take you most likely if you continue down this road.

Yeah.

We know what the number one killer is of men and women.

What do we need to do so that you don't get there?

Yeah.

And how much does alcohol affect heart disease?

So

Obviously, this has been a hotly debated topic that,

you know, when we start talking about nutrition or alcohol,

it rivals religious conversations with many people with the emotional

embodiment of how people step into this.

But just on the data alone,

let's society,

let's talk about what happens when you drink.

Okay.

Alcohol is broken down into two things, acetyldehyde and acetate.

Not to give you a bunch of chemical names, names, but acetyldehyde is what makes you feel good when you're drinking, if you find that to be good.

It's also what's toxic to every single cell in your body.

So poison.

100%.

And that is an undeniable fact.

And acetate is basically empty calories.

If you don't burn the acetate, you're going to turn that into fat.

essentially.

So those are the two major components.

So when we look at this from a stepwise fashion, number one, it's directly toxic to cells.

Number two, additional acetate goes to fat.

Where does that fat go?

It's visceral fat, abdominal fat driving this engine.

Not to mention the fallout is typically speaking when you're taking in extra calories, when you're drinking, you're not mindful of what you're putting in your mouth.

We've all been guilty of such.

You know, so your overconsumption then becomes more of an issue.

So there's a lot of ramifications to alcohol.

But in the end,

alcohol is a personal choice.

Of recent, even moderate alcohol use has really been questioned.

And I think that data is going to come out very strong in the next two to three years.

Personally, I think alcohol is going to be the new cigarettes in the next five to 10 years.

I think there's going to be warning labels on alcohol very similar to cigarettes.

I hope so.

I mean,

I'm sure there's a lot of people in business who run alcohol businesses or restaurants that probably don't like me saying that, but I just don't know the benefit.

There's got to be another way to sell product that people can enjoy that doesn't hurt them.

Yeah.

You know what I mean?

There's got to be something else like that society can come up with, but I've never been drunk in my life.

So I've never known what that feeling is.

I've had sips of alcohol, but I've never been, had a full beer.

I've never had like

a glass of wine.

I have only had one sip of wine one time.

It was with Gary Vaynerchuk because I told him I'd do it like 10 years ago.

And I was like, this is the one and only time I'm doing this.

And I've never been drunk.

And I don't feel like I'm missing out because

I just, I know what it does to the body.

I know how it impacts the mind and how being around people who are extremely drunk is different than being around people that just drink a little bit.

But when you're around really drunk people and you're not drunk, it's not enjoyable.

It's different if it's like, I'm having a glass or two.

It's like, cool, I can be around around that it's fine but it's like if you're just unable to think clearly we're not having fun yeah and it you don't look like your body is having fun the next couple days either so how is there a benefit to this you know i get it culturally religiously for some religions societally there's benefit for bringing people together but you can come together and play war games out you can come together and yeah have fun and talk and open up vulnerability versus needing the courage of alcohol to start sharing the truth yeah Knowing that the damages are way stronger.

Now, I might die of some random thing and be like, oh, well, if you died of this, you could have been drinking your whole life and whatever, but I just don't think there's benefit to it, personally.

There's not benefit.

And it hurts your heart.

It sounds like it.

It hurts every cell of your body.

So I had a little different path than you.

Didn't you used to drink?

I did.

But I want to validate that.

You were like a good southern boy who's like, let's drink every few nights.

And, you know,

tell me your drinking experience.

I'm not going to admit to too much.

No, no, no.

I don't judge.

I'm just.

I enjoyed alcohol.

I enjoyed wines.

I enjoyed pairing wines with food.

I enjoyed the whole experience like you discussed.

Yes.

I did.

It was very much part of my lifestyle.

No question about it.

And

when

I started to not feel well prior to my own cardiac situation, I said to myself, well,

I mean, the one thing you can do at least is quit drinking.

At least remove that from your life and make sure that, because I didn't really know what was going on.

See what happens.

See what happens.

How old were you?

I was 55 at the time.

It was like a year ago or what was this?

No, thank you.

That was three years ago.

And it didn't really make a lot of difference because I had something else going on.

It made some difference for sure.

But once I knew what was happening and I got a stent and I felt much better, the first thing my wife said to me, she's like, and she doesn't drink, by the way, she said to me, are you going to start drinking again?

I said, this has been a year at this point.

I said, no way.

I don't even want to

because of all the things that you just mentioned.

I like to live my life untampered.

You know, the good times are the good times.

I deal with the bad times accordingly.

And with alcohol, people drink it both times

to celebrate

and when you're sad.

And it's the one drug that your friends will encourage you to continue to do.

Let's have a beer, yeah, yeah.

And one of the other things that really got my attention that you said is that it's really not fun to be around a bunch of drunk people.

If you're sober.

And I didn't realize that for a long time.

Interesting.

And

it, I can tell you that removing alcohol from my life was probably the single most transformative decision I've made as an adult.

That's great.

No, there's no question about it.

And, you know, I heard Lance Armstrong say on a podcast not long ago when he was talking about, I guess, he's removed alcohol recently or in the last year or two.

He said, I've never heard anyone say,

I regret moving alcohol from my life.

I wish I hadn't quit.

And I was like, that's so true.

And for me, it is like the, this, this magic sauce of every day is the same.

Every day is predictable.

I'm clear.

Yes.

And, you know, people feel like I'm very judgmental when I talk about it this way.

I'm not at all.

Like when I say your body, your rules, like go for it.

Live your life.

I don't have any room to be judgmental,

nor do I want to be.

But it's kind of like when you read a good book or go see a good movie, you want to like share that experience.

And that's kind of the sense I got from you when you were sharing, you know, your experience without alcohol.

I have seen the contrast of that

and just how powerful that change has been for me.

And so.

Life has gotten better for you.

No question.

Yeah.

On all fronts.

Yeah.

Health-wise, relationship-wise, you've saved me money, like all these things.

Absolutely.

Yeah, yeah.

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Now, do you wish you could go back and quit sooner?

Or do you feel like, okay, it served a purpose for 50 years of my life and now...

Well, yeah, I mean, I do because it's been so powerful

that I...

I do wish I had realized it sooner, but it just wasn't my path.

Yeah, exactly.

It wasn't wasn't my path.

And I'm okay with that.

Yeah, of course.

You know,

I'm enjoying it now.

Yeah, yeah.

I'm curious about this.

You've done over 6,500 plus heart operations, heart surgeries.

How many hearts have you held in your hand?

Well, all of those.

You put them, you like take it out of the body or some of them you leave.

No, it's everything

remains in the body, but you have to manipulate the heart.

So the arteries that I was talking about on the front of the heart are these red,

the red lines.

So if we're operating on the front of the heart, the heart can kind of sit here.

Focus on the back.

Right.

So we stop the heart for the majority of these operations.

Stop it.

Utilizing a heart-lung machine.

Holy cow.

So the blood continues to go around the body.

But not through the heart.

We put a clamp here.

Otherwise, there's blood coming out of the body.

Exactly.

And then we infuse the heart with a high-potassium-containing cold solution that puts the heart muscle in a hibernating state.

And then we can actually maneuver the heart, open the heart.

That's how we fix the valves.

That's how we do all of that.

And then we maneuver the heart.

So you're actually handling the heart when you're doing all those things.

But no, we don't remove it like that.

Yeah, yeah, but you're kind of adjusting absolutely the chest cavity.

Sure.

Yeah.

What is that like holding the heart of a human being?

You know,

I look at what I do as an honor and a privilege, honestly.

And it starts well before I ever get into the operating room.

And that's the relationships that I develop with my patients.

And that is just one component of it for me.

For the patients, it's like, you've had my heart in your hand.

I get that comment a lot.

You know, I think it's, and I don't, I don't want to,

I don't want to deprioritize or belittle the comment that they're making, but when you're doing something every day,

it becomes part of the routine.

But again,

to develop a relationship that there's enough trust

that

I'm given that opportunity to do that, that's what's meaningful for me.

Yeah.

Now, this may be a very sensitive topic.

We don't have to talk about it if you don't want to, but I'm assuming.

You've been a surgeon for 25 years.

There's been people that haven't made it from surgery, right?

Sure.

Have you ever talked about that stuff of what that is like when you're invested in a person and you know how high risk it is?

Like they may not make it either way and you've got to go in and operate and then they don't come out of that alive.

How does that

impact you either emotionally, mentally, confidence-wise?

Just kind of how do you deal with that in general?

And I know a lot of doctors have to face this, unfortunately.

Yeah.

You know, brain surgeons, heart surgeons, this is, this happens, unfortunately.

Sure.

Obviously, you hope it doesn't happen that often, but what has that been like for you?

So, for elective operations, lowest risk operations, the risk of patients dying is 2%, 1 to 2%,

which sounds like a small number until you put it in the perspective of 6,000 patients, right?

Right.

And so, if you ask me what the single most difficult part of what I do is, it's patients dying.

Wow.

And that's no easier today

than it was when I started 25 years ago.

It is absolutely no easier.

And, you know, you mentioned the patients that are really high risk and aren't going to make it.

You know, honestly,

from a mindset standpoint, if it's a real Hail Mary operation, the expectations with that patient and the family are very low.

Oh, man.

But for elective operations, when someone walks into the hospital

and they're a mother, a husband, you know, what,

and they fall in that one to two percent.

Oh, my gosh.

It is, it is really, really, really difficult and remains so to this day.

And I still wake up in the middle of the night thinking about some of those losses over the years.

But, you know,

in the end,

when and if that were to ever go away,

I would quit what I do.

What do you mean?

Because

if

that sense of attachment

and the importance of that event occurring and the way it impacts me personally

was never,

then I don't think I should be doing what I'm doing.

If it didn't bother you or affect you.

Exactly.

Exactly.

And, you know, you do, as you mentioned, have to compartmentalize because you can't take that home.

And you got to get up the next day and you got to come back.

You can't do it at a heart surgery the next day and thinking about that.

Right.

I mean, obviously you're thinking about it, wanting to do the best job you can,

or you're taking the right actions, but you can't.

I hope this doesn't happen again.

You cannot go into the operating room with that mindset and you have to compartmentalize.

How did, did anyone teach you?

I don't know if they teach you this in med school, but did anyone teach you how to navigate when you lose a patient?

Like how to process that emotionally?

Or is it more you have to just

compartmentalize, do the job, and almost like not stuff it, but stuff the emotions so you can show up your best self the next day.

So the first part of your question, can you teach that?

No.

And it doesn't really happen until you're technically out of training entirely.

Yeah.

And the responsibility is 110% on your shoulders.

You're like 10 years in as a doctor, training student.

You're like, you've done so many reps.

But you're not

truly the responsible.

The buck doesn't stop with you.

Yes.

And until you get into that situation, it's very difficult.

It's like trying to instill ownership into someone as an employee, right?

Like you can't really do that until they're there and they're part of your business and what have you.

And they either have that or they don't.

Same thing as a physician, as a surgeon.

You know, until you show up and all of that responsibility is on you, you don't have that emotional attachment, even though you see it and are part of it in training.

Because you've seen other doctors

that you were helping or guiding.

Absolutely.

And you're still, of course, I mean, you feel badly in those situations.

Not that you're non-emotional.

But you're not the one in there doing the job.

You don't have to go out.

and look family in the eye and have that conversation.

I don't know how you do that.

Yeah.

it's not easy.

And it's never gotten any easier.

Oh, my goodness.

Yeah.

It's never gotten any easier.

It has not.

It is not the fun part of my job.

It is not.

Has there ever been a patient that has come in on the operating table that you said, this is the biggest long shot of success?

Like, there's a 1% chance this will work

or something like that.

And they have

somehow recovered and lived a longer life because of that operation.

Absolutely.

I mean, yeah, absolutely.

I think most cardiac surgeons would identify with that too.

Just like miracles.

Yeah, I mean, look, we never walk in the operating room alone.

That's the bottom line.

We're just people operating on people.

And there's certainly, you know, we always do the best we can, but the end

is not up to us.

That's that ultimate,

the ultimate outcome is not up to us.

But we certainly have taken patients, particularly younger patients that come in with really grave problems.

We're going to give them an opportunity, even if it's a very low percentage, because why wouldn't we?

Of course.

You know, if somebody's lived a long life and they're in their 90s and they have multiple medical problems, they come in with that same problem, it's a different conversation with the family.

Yeah, yeah.

Wow.

But absolutely, that does occur.

Do you have a ritual before you go into surgery?

And do you have a relationship with God where you bring God to

the room with you?

So I go through

very much

a process.

It doesn't necessarily happen right before the operation, but days leading up potentially.

And much like

military or sports where I visualize the operation that I'm going to do.

I then identify the three or four worst possible scenarios that I can get into

and how I'm going to get out of it.

That's smart.

Because, you know, we never rise to the occasion.

We always fall to our level of training.

I mean, that's just human nature.

Military 101.

Exactly.

I mean, I like to occasionally believe that we do rise to it occasionally, but that's under duress.

You can't count on that.

No.

And so.

Unless you train for it, you're going to fall to the level of your training.

Every time.

And so that's absolutely what I do.

And then I always bring it back the morning of when I see patients before surgery to the patients that we're actually going to be operating on that day.

Because I tell patients in the pre-op conversation that I can't guarantee them that we're not going to have bumps in the road.

But what I can guarantee them is they're going to have 110% of my attention at all times.

And I'm going to care for them like they're my own family.

Wow.

And that I truly mean.

That's great.

And I think that that's how I express to them that

I'm truly going to be a part of this and fully engaged.

Do you bring God into

your ritual at all, or is that not part of your life?

I don't specifically.

Some doctors are full faith-based, and other doctors are.

Absolutely.

I'm a very spiritual person.

I'm not a very religious person.

And I also find that with the breadth of religions, that, you know,

there's times when it's appropriate and there's other times when it's uncomfortable for patients.

Of course.

And so my job is to try to make them as comfortable as possible.

And so I want them to know that I'm coming to them fully engaged

and open and fully responsible.

You know, a lot of the topics that we talk about on the School of Greatness is around relationships.

I think relationships is one of the keys to either living a fulfilling life or suffering in life based on the quality of your relationships.

I'm curious from a heart surgeon standpoint,

do you think someone can die from a broken heart

based on relationships, not like

the mind and the emotions impact the heart so much if they feel devastated from a loss, grief, a breakup, a divorce, where the heart just cannot go on?

The short answer is yes.

Really?

And there is an actual syndrome.

What is that?

Tokosobu's cardiomyopathy or broken heart syndrome.

Really?

It is a thing.

Come on.

So you can be a healthy human being, have none of these, you know, workouts.

Absolutely.

No body fat.

Now, it is most commonly occurs in women over the age of 55 or 60.

Most commonly, it happens in men too.

You've seen this.

Oh, absolutely.

We see it multiple times during the year.

Typically, as you pointed out, it's after the death of a loved one, financial loss, major emotional stress.

So we think, and we don't truly know the cause, that it is an overstimulation of the autonomic nervous system, which is that fight or flight or the rest or digest.

It's like an imbalance of that that then causes like acute heart failure and patients present just like they've had a heart attack.

And many times they end up being evaluated by a cardiologist actually having the dye put in the arteries, the catheterization, and they have no blockages.

But the heart function that was before normal is now down to like 20%.

Now,

here's the good news and bad news.

The majority of these patients get better just with support.

Some medications, support, and time, and it gets better.

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Women,

it's much more common, but the death rate is very low, somewhere around 1 to 2%.

Men, it happens much less commonly, but the death rate is much higher,

5% to 8%.

There was some research early on that this maybe has something to do with the decrease in estrogen, which is why we're seeing it in perimenopausal and menopausal women more commonly.

But men get it too.

So

those theories aren't holding water across the board.

So we don't really understand it.

But yes, you can die from a broken heart, and we see it, and we see this syndrome.

I have had patients that I have operated on that have been really sick, and then their family member comes in two weeks later with broken heart syndrome.

And they're both in the hospital.

Come on.

Oh, yeah.

It's crazy.

But you can't operate on broken heart syndrome.

No, you don't have to.

There's no blockages.

There's no blockages.

And the valves are working fine.

It's just that the heart function that heart pump that normally is strong is now weak

and with time and support thank goodness

the majority of them come yeah wow don't start drinking when you have a broken heart it is don't start overeating and drinking that's that's that's good advice yeah that's good advice what is the difference you know i hope i never witnessed this and i hope no one has to witness this but what is the difference between someone having a stroke or stroke like symptoms sure versus a heart attack or heart attack-like symptoms.

What do they do?

How do they respond?

What are they saying between the two?

That's a good question.

And I think that it's not an uncommon confusion because people think that

there's a lot of overlap.

And sometimes there can be.

But let's start with stroke first, okay, so that you understand what's happening.

Basically with a stroke, it's lack of blood flow to a portion of the brain.

And does the heart influence the blood flow to the brain?

Not typically in standard stroke symptoms.

And I don't want to get too far in the weeds.

There are cardiac sources that can cause strokes.

It's not a blood flow issue, though, from a heart problem most of the time.

Where's the most common places that strokes come from?

It's blockages in the carotid arteries that break off, pieces break off and go north and cause blockages in the small arteries in the head and then cause a lack of oxygen and nutrients to the brain, just like a heart attack in the heart.

So the essential problem is the same, but the symptoms are very different.

So when someone's having a stroke, what are the symptoms that you'll see or notice?

The things that you want to look for are changes in speech,

drooping of the mouth, weakness, typically on one side of the body and not on the other, but it can be, you know, there can be some crossover, but it's usually

facial changes, slurred speech, visual changes, and one side of the body, meaning upper extremity, hand, and or leg, not moving properly, weakness.

So that's a stroke, and that is a medical emergency.

911 now.

Absolutely.

Stop what you're doing.

100%.

Call a paramedics.

Get them to the hospital.

Absolutely.

That's a medical emergency, as is a heart attack.

And what are the main main symptoms of a heart attack?

So the main symptoms are going to be crushing chest pain, typically described as like an elephant sitting on your chest, shortness of breath, radiation of pain into the arms or up into the jaw.

That being said, as I mentioned earlier, can be the great masquerader.

Patients can have intense abdominal pain that doesn't go away.

It can be difficult to discern, but those symptoms of crushing chest pain that does not go away, pain that radiates or into the jar, shortness of breath, 911.

911.

911.

Absolutely.

I hope I never have to witness that, but that's good information to know.

So you're taking action as opposed to, ah, you'll be fine.

And always when in doubt,

you're never going to be, you know.

You're never going to be criticized for calling 911 and going to the hospital when there's a concern.

The commodity is too great to not do that.

Yes.

Yeah.

You got to take care of your life.

And what would you say are the

three biggest things then everyone should be adding to their life to help their heart?

And the three biggest things people should be removing from their life to support their heart health.

Okay.

We talked about some of them already, but if you're like, here's the three things you need to add to your life and three things to remove and you'll improve the quality of your heart health much better.

What would you say those things are?

So let's talk about the things that you should add because I think people are much more willing to add things to their life than to remove things that they've

gotten accustomed to or they've enjoyed.

So I think the first is to move every day.

Yeah.

and not live a sedentary lifestyle.

And that comes in a lot of forms.

Ideally, like if we're following the data, what do we want that to include?

We want that to include aerobic training, where you are getting your heart rate up at least two to three times a week significantly so that you can move what's called your VO2 max.

Again, a fancy term.

What does it mean?

It just simply means how efficient your cardiovascular system is working.

So the better your VO2 max,

The more efficient your heart is working.

That increases your health span and lifespan.

Probably the single most important predictor, honestly, is VO2 max.

Then along with that is resistance training.

Yep.

So important.

As Gabrielle Lyons says, muscle is the organ of longevity.

Why does she say that?

Well, obviously,

having

a solid muscular mass as we age, because we know we're going to be losing muscle mass after the age of 30, it's dramatic.

Having that in place, you're more stable, you're less likely to fall,

you're able to pick up your grandchildren and pick up suitcases and function, have a functional life.

In addition, muscle is a glucose sink or a sugar sink in our bodies.

And maintaining stable blood glucose levels is critical, not just for cardiovascular health, but for chronic disease in general.

So I think exercise is so important to add.

I think the next one would be a solid sleep hygiene program.

Because

you as an athlete understand that the biggest gains happen during recovery.

And it's hard for guys like you and me that just want to go harder to get those results, right?

Just push harder, harder.

sometimes to take the step back and actually allow your body to recover.

And it's not just your heart and your muscles.

it's our brain too.

Our brain rejuvenates when we sleep.

That's when all of the waste products that have occurred in the brain during the day get washed out.

So sleep is important across the board, both from a cardiovascular standpoint and whole body.

And then I think the third is what you mentioned earlier.

I think relationships are really, really important

to

longevity.

You know, my dad's about to be 89 years old this month, actually, and he called me one time and said, you know, I'm going to give you one piece of advice as you age.

He said, keep your friends really close to you.

He goes, because you're not sure which ones you're going to lose, which ones are going to be able to communicate, because having someone pick up the phone and just say, hey, what you doing?

Yeah.

Or how are you doing?

He goes, not that you have to make any great plans, but just that connection, I think is a really, really important factor.

That's cool.

In

the reasons we get up every morning.

And that really stuck with me when he made that comment.

Good wisdom.

Particularly on the eve of his 89th birthday.

And he said this actually years ago.

It wasn't recently.

Wow.

So three things to add to increase your heart health is to move every day, aerobic and resistance training, have a healthier, better sleep hygiene program, you know, get quality sleep every night, and improve the quality of your relationships.

And what would be three things to remove to improve your heart health?

Okay.

So

the first would be be conscious of what you're putting in your mouth.

Remove

the processed and ultra-processed foods

and added sugars

because glucose management, sugar management is such an important risk factor when we look at things like type 2 diabetes, metabolic syndrome, all of these things that drive coronary disease, as we discussed earlier.

Obviously, ultra-processed foods, again, driving this inflammatory engine.

So removing those, focusing on a whole foods diet, and really just being thoughtful about about what you're putting in your mouth.

The next one is obviously smoking.

We've got to remove that from the list.

And vaping, right?

I would love to include both.

If I could support it with the data, I would definitely put it on there.

But I think that ultimately, yes.

Well, the data, if you've seen young people come in your operating room

from vaping

that has impacted their heart.

I mean, that's your personal data.

You haven't seen the data in the literature, I guess, right?

Exactly.

And the third thing to remove?

Yeah, I would have to put alcohol on that list, both from my personal experience and from my clinical experience.

That the patients that I, you know, the patients that I care for that don't drink are a different group of patients

than

the ones that do.

Interesting.

Just because typically the rest of the pieces of that lifestyle also go in line

with that mindset.

Yeah, it's hard for someone to be healthy with their sleep and prioritize sleep,

move their body, eat really clean,

have good relationships, and then also be an alcoholic.

Right.

Like it's hard to have, you know, it's like if you're doing all these things well, you see the effects of alcohol.

It's hurting my sleep.

It's hurting my relationships.

It's hurting my fitness levels.

I can't train as hard.

So you're probably more mindful.

Maybe you drink every now and then, but you're not drinking every night.

You know, you're more mindful.

If you're conscious of all these other things, but not here, something's off.

You know,

I think that brings up a point.

You know, we all have our own instruction manuals.

Yeah.

Right?

Like, yours is different than mine.

Your diet is going to be a little bit different than mine.

It's about what works for you.

And I think a big part of this whole journey is figuring out what that instruction manual is.

These are kind of the major levers.

And then you need to figure out

how and where and when you're going to

work after those i mean and i and i speak with a lot of conviction but i hope that people watching or listening to both of us you know if people want to drink drink you know my yeah i know i don't live a perfect healthy lifestyle i have too much sugar i probably have too much processed foods and i know that but i'm conscious of it and i have more whole foods than I do processed most of the time.

But I also know when I'm doing it, I'm like, you know, I need to be doing better.

That's right.

Let me pause this.

What did I say here?

We know better, but we don't do better.

So it's about being, you know, being conscious of it.

If you are drinking, it's about like, okay, I'm only going to do this once a week, maybe, or once every now and then, or something like that.

And really try to limit it if you can.

No one needs to be perfect.

You don't have to worry about that.

And I'm not here to judge people, but I am here to elevate myself and others to living a better life.

And if that means calling people up, then that's what I want us to do.

Absolutely.

And it's about progression, not perfection.

Exactly.

And you're right.

Like even for me personally, if I'm eating Whole Foods 80% of the time

and 20% of the time I fall off, that's a W for me.

That's a win.

It's a big win.

And

I'm comfortable with that for me.

Yes.

And when you talk about, you know, like, how do you evaluate where I start with my health or, you know, what's the one thing I would say, do

it's very difficult when we talk about all of us as individuals to give that one thing.

Because if I came to you and said, well, you need to move every day, you'd be like, well, I do that.

It's like, I don't need to do that.

I don't need to do that.

What we need to do is we need to identify what we're bad at.

Yes.

You know, I'm a terrible sleeper.

Right.

Yeah.

So I need to work on my sleep.

That's my Achilles heel.

You know?

And so first, having the intellectual honesty to identify those things that you don't do well is the greatest opportunity to move the needle with your health span.

That's amazing.

And I want to ask you, I know a lot of people are confused about this.

What is the difference between a heart attack and a panic attack?

Because some people have a panic attack and they think, I'm having a heart attack.

What is the difference?

It's tough to tell the difference many times because the symptoms can be so similar and panic attacks can be very physical as well.

Of course.

And, you know, so what are those symptoms?

Well, some of the things we've already talked about, shortness of breath, sweating,

chest discomfort, you know, nausea,

changes in vision, you know, all these things.

They can be panic attack.

They can be heart attack.

How do you tell the difference?

Well,

panic attacks typically are brought on by emotional scenarios, not always, but typically speaking.

They'll typically last 10 to 30 minutes, self-limited, and then they'll ease off.

Heart attacks, on the other hand, are typically,

you typically have some warning signs of the progression of the discomfort before it comes on and doesn't go away.

It's crushing chest pain, not a sharp chest pain, and it doesn't get better with time.

And that's a key, and that is a true medical emergency.

Now, if you're in one of those scenarios and you're not sure,

then you need to go to the hospital because that's always the safest thing to do.

Because with an EKG and a simple blood test,

you know, that can be, that can be delineated pretty easily.

So it's a difficult, it's a difficult scenario.

It really is.

And people frequently during panic attacks will say, I'm having a heart attack.

Now, the other important thing is panic attacks do not cause heart attacks.

And I think that's a spin that a lot of folks will get into.

Yes, I'm having a panic attack, but now I'm having a heart attack.

That would be very, very unusual.

Very rare.

Very, very rare for that.

Panic attacks, you know,

don't make you feel good, but it's not killing you.

Correct.

Right.

Exactly.

It might be influencing your overall health, but it's not creating a heart attack.

Right.

Right.

And you may fear for your life during a panic attack.

I've seen that many, many times, but you're not in danger.

What's the best thing someone can do to recover from a panic attack?

Yeah, so it doesn't happen again, you know?

Yeah, well, so it doesn't happen again requires coping skills.

But to break a panic attack, what you really want to do is divert your nervous system in some way.

The fastest way that I have found to do that is take a bag of ice, fill it up and put it on the back of the neck, and it just kind of changes your whole focus.

If you don't have a bag of ice, you can, you know, just put your face under cold water, whatever, whatever opportunity you have.

If you're driving, please pull over, you know, get a get a cup of ice from the convenience store and put your hands in it, or just hold on to some ice is usually enough.

And it'll frequently break a panic attack.

Now, treatment of panic attacks is way outside of my wheelhouse as far as long-term coping skills and things of that nature.

But I think the good news is, in most cases, with appropriate support and guidance, people can get over panic attacks.

I mean, I really think, and anxiety in general, I think that it's not, it's not something that people have to live with forever.

Okay, so I'm going to ask you one through 10,

10 being the best,

one being the least best.

One through 10, how valuable is saunas for helping heart health?

So, I am a huge believer in sauna therapy.

Now, all of the data has been done in

traditional Finnish saunas.

I don't have a problem with the other alternatives

with the infrared type saunas, and there's some other ones out there.

But if we're going to talk about the data and what I personally use,

that's where I think the money lies, if you will.

So the numbers are dramatic.

That if you are utilizing sauna four to five times a week, sessions of 11 to 12 minutes each, that 11-minute mark seems to be important, somewhere over 175 to 180 degrees Fahrenheit.

Your decrease in cardiovascular events is greater than 50%.

And all-cause mortality is in that same level as well.

In addition, now the neurocognitive benefits of sauna are starting to come out as far as being protective from Alzheimer's, dementia, and what have you.

Why does all of this happen?

And

I don't really have the capability to dive deeply into the science, but the basics is that we release something called a heat shock protein.

When you're in the sauna, particularly when you get to that uncomfortable place in the sauna, seems to be where you really have this release.

You stay just a couple of minutes.

A little bit.

a little bit longer is where you really get the benefit.

And that

is where the cardiovascular, all-cause mortality, and neuroprotective benefits come from.

So, one through 10, what do you think?

Is that a 10 for you?

Is that an eight, nine?

It's a 10 for me.

I sauna at least three to four times every single week.

Okay, one through ten, ice therapy, cold therapy.

So, personally speaking, I am a huge believer in cold plunges.

It's my morning routine.

Every single morning, 4 a.m.

You know, I like to start the day with something hard.

It puts my whole mindset in perspective.

It wakes me up because you get this cortisol release and it really sets the tone.

Plus, as I'm peaking at 60 here and like to stay really active, you know, when I get out of bed in the morning, my wife will say to me, what hurts?

And I'll say, look, it'll be quicker for me to tell you the things that don't hurt right now.

She's like, well, that's not good.

But cold plunging really helps on a day-to-day basis to keep all of that

under control.

The data from a cardiovascular standpoint and really overall longevity standpoint is not as powerful as it is with Sauna.

Gosh, sure.

I can't tell you specifically what it is off the top of my head, but from a cardiovascular standpoint, I would say that I would have to put that on the lower end of the spectrum, one to 10.

But for personal impact impact

and the way that i've utilized it it's an 11.

now what about

over

seven hours of sleep

yeah on one to ten scale for heart health it is it's a 10 plus really it really is because again

if we look at the recovery piece what does that really impact well

The risk of type 2 diabetes and metabolic syndrome and how your body metabolizes glucose all changes when you're recovered and well rested.

Sleep apnea, where your oxygen level is changing during the evening, again, affecting the hours of sleep that you have, is a direct risk factor for high blood pressure, which we know is a risk factor consequently to heart disease.

Yeah, I guess the only thing I could, you know, I've never been drunk, so I don't know what that feels like, but I have been on a lack of sleep at different times in my life.

Yeah.

And I can almost sense that it feels like you're drunk.

So if you're not sleeping well,

you're not performing well the next day.

And it's starting to stack if you don't sleep well every night.

And so I can only imagine how much it could be hurting your physical health and creating excess fat and therefore impacting your heart.

Absolutely.

I think it's, I think it's one of the

pillars that people miss many times.

You know, it's not a new gym membership.

It's not whatever, PR lifting or cold plunging or whatever.

It's like, you know,

you need to prioritize your sleep.

We all have to sleep.

That's great.

Dr.

London, this has been powerful.

I've got a few final questions for you, but I want people to follow you.

You've got amazing content on Instagram,

Dr.

Jeremy London on Instagram, also drjeremylondon.com, your website.

You've got a podcast as well, right?

We do.

We do.

So you have a lot of the insights, the information.

If people want to learn more, where can they go to get the podcast?

YouTube, Spotify, Apple Podcast.

We've got a newsletter that usually tries to parallel many times.

Okay.

So whatever format you enjoy getting this information, we like to get it out to you so that

we're spreading the word and

hopefully giving folks insight into

things that is going to allow them to live longer and live better.

dr jeremylondon.com for the newsletter as well right that's correct and you're working on a book right now so in the future we'll get a book book from you.

Hopefully we'll have more of this stuff for people, more research and data as well.

This is a question I asked you if you could go back right before you started medical school.

I don't know where were you?

Where did you go to medical school?

I went to medical school in Augusta, Georgia.

Okay, cool.

So how old were you when you went to medical school?

Do you remember?

It was 21.

21.

Yeah.

So you make the decision, I'm going to medical school.

You're getting your plans together.

You go for the first day, whatever.

You're in class or you're in the clinic wherever you are i don't know if you can remember that first day of medical school uh nearly 40

that old nearly 40 years ago i didn't remember that i know yeah i mean 40 years ago almost 38 39 years ago right if you could remember the excitement and the joy and the unknown of what was about to happen

and now almost 7 000 surgeries

thousands of lives impacted in a positive way, the influence you've had on people's life personally, their families, the miracles that have happened

if you could go and give three pieces of advice to the younger you going into med school for the first day what would you share wow first one would be don't take yourself so seriously

for sure

be willing to live in the gray

man that's hard and always trust your gut

that's that's good advice Would your 21-year-old self have any advice for you currently for this next season of life as you're rounding into 60, would he give you any advice on what to expect for the next decade or two?

Get outside,

relax, enjoy the day.

Let go.

Yeah.

That 21-year-old was pretty good at all that.

Yeah, yeah.

Yeah.

You got to remember some of that, huh?

Yeah.

Yep.

Well, hopefully your son will remind you of that every day, too, because he's working with you.

Got lots of people to remind me.

But listen to that inner voice inside of you.

Absolutely.

He's your gut.

Yeah.

That 21-year-old's still in there.

Yeah,

there's no doubt.

He's still in there, man.

There's no doubt.

I want to acknowledge you, Dr.

London, for the work you've done to inspire millions of people around the world, helping people, even if just one video you shared has helped someone change their life and live better, healthier, happier life.

You're saving lives with the content you're sharing.

So I want to acknowledge you for your 40 years of experience, hands-on, literally helping people's hearts heal, but also now using your wisdom to share with others.

So hopefully they can make better decisions in their life and impact the families and friends around them to live better as well.

I want to acknowledge you for the gift that you are.

Well, thank you.

And you may not be holding people's hearts literally in the future, but you're doing it, you know, spiritually, emotionally, mentally through the content you're sharing, through this conversation.

So I acknowledge you for all the work you're doing.

Thank you.

That means a lot coming from you.

It really does.

And I think you really touched on what's important with the platforms and the effort that we're making.

If we can just touch one life,

it's all worthwhile.

That's it.

And we get so much feedback that it's been so much more than that, that it has really,

that's the motivation for us to continue in doing this.

So thank you for acknowledging it.

Of course.

I appreciate that.

Final question, Jeremy.

What's your definition of greatness?

Always being willing to change.

That

I don't ever feel like I've arrived.

And I feel like.

I'm always open to change.

And that is one of the things that I think has enabled me to

accomplish many of the things that I have in my life.

And I hope to accomplish many, many more as a result of maintaining a very open attitude towards opportunity.

I love it.

Thanks so much for coming on.

Appreciate you.

I hope you enjoyed today's episode and it inspired you on your journey towards greatness.

Make sure to check out the show notes in the description for a full rundown of today's episode with all the important links.

And if you want weekly exclusive bonus episodes with me personally, as well as ad-free listening, then make sure to subscribe to our Greatness Plus channel exclusively on Apple Podcasts.

Share this with a friend on social media and leave us a review on Apple Podcasts as well.

Let me know what you enjoyed about this episode in that review.

I really love hearing feedback from you and it helps us figure out how we can support and serve you moving forward.

And I want to remind you of no one has told you lately that you are loved, you are worthy, and you matter.

And now it's time to go out there and do something

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