Know Your Physio

Dr. Joel Kahn: Unlocking Cardiovascular Longevity - Plant-Based Power, Genetic Insights, and Nutritional Mythbusting

• Andrés Preschel • Episode 123

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In this insightful episode, I'm honored to sit down with Dr. Joel Kahn, a world-renowned holistic cardiologist and a leading voice in the plant-based movement. With over 40 years of experience in cardiovascular medicine, Dr. Kahn has dedicated his career to preventing and reversing heart disease through lifestyle and nutrition. His expertise not only spans the intricacies of cardiovascular health but also encompasses the broader implications of adopting a plant-based diet for overall well-being. 

Dr. Kahn shares his personal journey toward embracing a whole food, plant-based diet, along with compelling insights from his clinical practice. His deep understanding of the relationship between lifestyle choices and health outcomes offers invaluable guidance for anyone looking to take charge of their well-being.

Dr. Kahn provides actionable advice on how to optimize your diet, manage genetic predispositions, and integrate holistic practices into your daily life. Whether you're a healthcare professional, a wellness enthusiast, or someone curious about the benefits of a plant-based lifestyle, this discussion offers a wealth of knowledge and inspiration to help you thrive. Tune in to discover how you can beat heart disease, enhance your quality of life, and achieve lasting health.

Key Points From This Episode:

Holistic approach to medicine. [00:06:11]
Top three KPIs for health. [00:10:25]
Genetic contribution to heart disease. [00:12:49]
Ancestral diets and caveman predecessors. [00:16:02]
Subjective feelings versus objective health. [00:22:51]
Plant-based diets reversing diabetes. [00:26:38]
Nutrition in Medical Practice. [00:28:52]
Plant-based diet nutrient needs. [00:32:53]
Plant-based diet with salmon. [00:37:17]
Plant-based diet and heavy metals. [00:41:30]
Genetic Influence on Cholesterol Response. [00:44:25]
Lipoprotein. [00:49:15]
Plant-based diets and health. [00:52:08] 

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Links Mentioned in Today’s Episode:

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People

Dr. Joel Kahn

Dean Ornish, MD

Dr. Caldwell Esselstyn

Dr. Neil Barnard

Dr. Walter Longo


Books and References

Diet for a New America by John Robbins

The Lancet (Medical Journal)

PREDIMED Study

CORDIOPREV Study

Support the show

Joel Kahn:
I could cut back and probably could go find a golf course to be on five days a week, but there's a huge need. I mean, heart disease is literally, without a question, the number one killer of men and women. And there's a long period where it can be a quality of life issue before it becomes a fatal issue. And number two, there is a real deficit in people interested in identifying people early in life. So we can change the trajectory. You're not going to come to my clinic and expect to walk out with a handout on how to adopt the carnivore diet for your condition. You're pretty much going to hear from me about using a whole food plant-based diet. So that's the kind of success stories I see.

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Joel Kahn: My why is really pretty simple, because I could cut back and probably could go find a golf course to be on five days a week, but there's a huge need. I mean, heart disease is literally, without a question, the number one killer of men and women. And there's a long period where it can be a quality of life issue before it becomes a fatal issue. And number two, there is a real deficit in people interested in identifying people early in life so we can change the trajectory and avoid impacting on heart disease. We're talking blood pressure, we're talking heart attacks, we're talking strokes, we're talking congestive heart failure. And it may sound dry, but we're talking 44-year-old chairman of companies and 39-year-old professors at college, men and women and 56-year-old owners of businesses. And they're all impacted tremendously by heart disease. But often, until they came to see me, I didn't have a clue about any of this. And again, I've got a 10, 20-year vision out there. And I've got to change that path that they're on. And I mean, it's wonderful stuff to do. And it's, I mean, one person, I try and see as many people as I can see, but we need to train a whole new generation of investigative cardiologists, you know, start at age 30, start at age 40.

Andres Preschel: How far into your medical practice did you realize there needed to be a holistic approach so that you can bring about that? Why?

Joel Kahn: Yeah, there's a quick, funny little story. I, at a very personal, quiet level at home, I adopted what we would now call a whole food, plant-based diet when I was 18. In my freshman year at University of Michigan, which was a long time ago, 47 years ago. I did it for a lot of reasons. I didn't think it had any relevance to my medical school and residency and fellowship at all. But I became aware with a little bit of medical school education on nutrition, not much, as everybody says. But I just started reading books. Diet for a New America by John Robbins. Whoa. Nutrition seems to have a major impact on a lot of conditions. And then really the big thing was I started cardiology practice. This is the end of this quick little story. July 1, 1990. You probably weren't even born then. I wasn't. And I was trained as what's called an interventional cardiologist. I really was an aggressive heart attack slayer. You know, three in the morning I could open your arteries and stop your heart attack. That was July 1, 1990. Three weeks later, Exactly, July 21, 1990, a paper was published. And what that meant in the time was you didn't open your laptop and read it because there were no laptops. You walked to the mailbox, brought the mail in, and there were paper medical journals that you subscribe to. And I read one. The journal was called Lancet. And there was an article by a very famous physician now, not so famous then, Dean Ornish, MD, talking about reversing cardiovascular disease with a holistic approach, nutrition, stress management, mind-body, yoga, group support. And it was really a well-done major article and it struck me, I wouldn't say like a lightning bolt, that's a little too common of a statement, but I said, geez, this diet that my wife and I have been following for 13 years now, because at that point that's how long it was, this is a therapy for people. So the real answer is I had three weeks as a cardiologist where I didn't take my holistic background and use it with patients. And then I had, from three weeks till today, which about, if I calculate right, 34 years, every patient got some instruction. We didn't have the internet, so read a book. I would write a handout, and I just would squeeze it into a busy practice. So it's really been the entire career. Now, 10 years ago, 12 years ago, I went back and got a lot of formal university education. I knew I wanted to take a real career shift, from just doing cardiac catheterization, stent, heart attack treatments to going what I would call way upstream and try and find people early your age, really, and just get started with some screening and testing and lifestyle information and, you know, make a dent there. And then, you know, by discussions like this and writing books and being on social media, trying to reach as many people as possible because I can't see them all. But, you know, we can reach a lot more than we can see in the office.

Andres Preschel: So, God bless Dr. Ornish.

Joel Kahn: Yeah, you know, he's certainly celebrated around the world, but he could be celebrated even more given, you know, he was in his early 20s when he started doing some of these really groundbreaking studies. He clearly had a very early passion for integrating East and West medicine. Quite a remarkable human being, without a doubt.

Andres Preschel: Have you had a chance to express your gratitude towards him and his work?

Joel Kahn: Yes, I have. I've been very fortunate. I actually wrote introductions to some of the books I've had, or endorsements, and we've had time together. He's on the other side of the country, so not as much time as I'd like, but yes, he is aware of my unending affection.

Andres Preschel: Lovely. And what would you say are the top three KPIs, key performance indicators that people can quantify at an early age to see, you know, what kind of disease they might be on track for and how they can prevent it?

Joel Kahn: Yeah, well, you know, my first thought is lab work, but maybe more fundamental key performance indicators would be the quality of your nutrition, the quality of your sleep, and the quality of your fitness, if you have some way to track that, whether it's, you know, really digitally or just some good sense that you're on track. Those, you know, I don't care. You can't start too early to try and hit those three benchmarks. They're so fundamental and there's always the constant don't smoke. We should always say that because we still got under 15% of people smoking. A lot of them are young, but it's much better than it was 50 years ago when it was 50% of people. Maybe talk lab values, and we could go deeper in this if you want, but at a young age, know your blood pressure, know your cholesterol, and there is a genetic cholesterol called lipoprotein little a that I have a big practice and a big passion for. Um, you know, if you found out when you were 18, God, mom and dad gave me something. I really don't think I want after reading about it, all the genetic cholesterol that could down the road. But because of that, I better hit the gym more and lead a healthier life. Starting even at age 18 or 20, that would be a smart move.

Andres Preschel: Lovely. Yeah, I definitely want to jump in and dissect the genetic predispositions for hypercholesterolemia and how that may influence, you know, heart disease and Lpa for sure. Where do you think we should start?

Joel Kahn: I'm going to let you run.

Andres Preschel: I'm going to make you sweat. Let's do it. Awesome. So why don't you tell me a little about what are the genetic predispositions for something like this and how does it influence every generation thereafter?

Joel Kahn: Yeah. And I'll keep it, you know, with a cardiovascular focus, there's obviously cancer, dementia, diabetes, obesity. Yeah. Uh, but it's pretty clear cut in cardiology, although there's still disagreement. There's some very, very intelligent people that will tell you, and again, we can use the term cardiovascular disease, but we're talking about mainly your risk of a heart attack, risk of clogged arteries requiring a stent or bypass surgery. Um, They risk a dropping dead suddenly, something called sudden cardiac death, one of the most tragic ways for a younger person to die, because you don't get to say goodbye. You're just dead and horrible, horrible frequent, hundreds of thousands of people a year in the United States. There are some very smart people that still say that the genetic contribution to those diseases is about 8%. 92% is lifestyle, but I think the better cut on the data is it might be 30 to 40% is genetic. It's bigger than we think. I see people all the time, extensive, broad history, physical lab panels. It scratched my head. you know, it isn't your blood sugar, it isn't your blood pressure, it isn't your cholesterol, it isn't your LB little a, it isn't. Um, although that's genetic, um, of course, uh, and you know, it's gotta be either there's things in the blood we don't know about and there are, there are clearly instigators of disease probably for almost every disease that we just haven't identified and made available for testing. Plus I think the genetic component is pretty big. So, If you tell me my dad had a heart attack at 48 and dropped dead, that's got to prompt a real deep genetic dive into trying to find out why, although not all of them are actionable. Might be able to explain it, but can't do much about it, and then we're just back to lifestyle. If you've got a high genetic risk, you better lead the clean life.

Andres Preschel: Right. And so, that 30 to 40 percent that you believe is a genetic component in, you know, heart disease risk, is that purely genetic or is that like an epigenetic component? Like, is there any play around that 30, 40 percent that is related to the way that you live your life?

Joel Kahn: Yeah, 100%, it is related. I don't know if this little box I've got in my mind makes sense, but you got a high genetic risk and excellent lifestyle and high genetic risk and poor lifestyle, that would be the worst combo without a doubt. These things have been researched and reported on. And then you got low genetic risk with a great lifestyle and low genetic risk with a poor lifestyle. Yeah, that would be the most ideal if you had an overall low genetic risk and had a great lifestyle. You stack the odds for a good long-term active life. Not guaranteed, but very likely.

Andres Preschel: Right, and I know as of late there's been just so much information out there as far as carnivore diet and vegan plant-based and there's a lot of conflicting thinking around this topic. My question for you is, You know, how can we look at this objectively and understand based on our DNA, what is the best diet for us? I know it's a loaded question, but are there any tests that we can do that will prove to us what's right and what's wrong?

Joel Kahn: Well, I do not believe there's a genetic test available. I don't think it's blood type and the blood type diet that will guide a person to say, you know, I've got to eat in this pattern or that pattern because my genetics dictated, you know, obviously very familiar with the sexy concept of ancestral diets and eating like our caveman predecessors. But my read of the data is cavemen had a whole variety of diets. There's a rather interesting publication this year in Morocco where the cemetery they found was about 15,000 years old and was very much in the middle of the Paleolithic era, I believe. was giving, they used isotopes. I'm trying to remember what they did, but the isotopes revealed that these predecessors had a very plant-based diet, much more than is often given credit for before agricultural living became more common. I mean, there were just more plants to grab and eat than there were wildebeest to catch and barbecue or something. So I think there are a variety of diets. And I don't think we can predict. We don't know. I'm a big advocate, as many people who know my background, for whole food, plant-based diets of the highest quality. And in my case, more than four decades of it being the only foods I eat. And fortunately, both my wife and I and children have experienced very good health. But that doesn't necessarily dictate a plan for everybody on the planet in the entire world. I don't know if everybody ate at my house day after day, week after week, if they'd feel as good and be as joyful about it all as my family's experience has been and many, many of my patients. And on the other hand, is there something about people doing a ketogenic and a carnivore diet approach? Is there something that attracts them to that and it works out for them? I don't deny it seems to work out for a whole number of people. Largely through social media information, there's very, very little published research on short or long-term outcomes of the carnivore diet. A few more about the ketogenic diet, but they're not all favorable in terms of the ketogenic diet. A recent one, recent like the last week, the ketogenic, it was a very carefully done study, probably in Nature, but one of the very prominent medical journals, something called the Atherogenic Risk Index. The odds of driving your potential for having a heart attack or stroke went up considerably and quickly with the ketogenic diet. seem to be rather unbiased authors without any funding conflicts. So it's not all pretty about dropping your carbs and adding your higher fats and proteins from animal sources and assuming that's a winner for everybody. So I don't know. I mean, either you How would you do it? For four weeks, you'd eat one diet style, see how you feel, get some lab work, maybe a little bit more than four weeks. I don't think it's going to take much more. Move to the next one, move to the next one. I don't think it's really possible for somebody to necessarily do that unless they're really a serious food biohacker. And I'm not sure I've ever even read anybody tried to do that. You know, vary their diet so much and vary the- Oil-wise need to do. What's that? Probably a wise thing to do. Right. You know, people that aren't feeling well often, you know, struggle and hop from diet to diet to diet, whether they're doing it systematically or, you know, somebody with psoriasis trying to figure out which diet is, you know, that would be a simple one to. And there are people on the carnivore diet that says they've cleared up their psoriasis and there clearly are a lot of plant-based eaters that have seen tremendous improvements in their psoriasis. Obviously we all agree, get rid of the unprocessed junk that makes up such a huge portion of our diet. More fiber, less sugar, I mean these are all simple concepts for most every diet except the carnivore diet, not much fiber in steak. Yeah.

Andres Preschel: Yeah, and it seems like the overwhelming evidence as far as fiber goes, it is that more fiber is definitely correlated and also causation involved there as far as, you know, preventing heart disease and reducing blood pressure and having these incredible health outcomes. My question is, as far as the benchmarks that we see in the testing, so when we get routine blood work, those benchmarks, how good are those benchmarks at establishing what, let's say, optimal health is on an individual level? Do you think that they reflect the specific needs and desires of an individual?

Joel Kahn: I think you can identify some, you know, benchmarks that are important. I like to give credit where credit's due. There's a wonderful MD, PhD in Virginia near Washington, D.C., Russell Jaffe, J-A-F-F-E, genius, a guy with so many, he's an older man with so many. medical degrees and certifications of Western medicine, Eastern medicines, mind boggling. Plus runs a big vitamin company, runs a big lab testing company. He's just an amazing guy. And he's got his eight foundational biomarkers that have data to predict longevity. You know, vitamin D, that's easy. High-sensitivity C-reactive protein, that's easy. Hemoglobin A1C, that's pretty easy. Homocysteine, that's pretty easy. A urinary measure of antioxidant status that you can do with either isoprostanes or something called oxyguanidine, I think is the way he does it. I do isoprostates. and a couple others. So you can find in the literature, if you really were going to go on this, I'll do 12 different diets in 12 months, and at the end of every four weeks, I'll run a panel and systematically come up with some data. You could probably pretty quickly identify that you know, which one works best for a glycemic control and lipid control and inflammation control and Optimal omega-3 would be another one in there having an optimal omega-3 index for brain function as such

Andres Preschel: Lovely. And I mean, it seems to me like, and especially on social media, a lot of people will just absolutely, you know, they get so excited about their diet because of the way that they feel or the immediate relief, but they don't seem to do, you know, the systematic or routine blood work that reflects objectively how it's really working for them on a biological level. It seems like people will just really just go balls to the wall, excuse my French, on the subjective benefits that they may experience in a short period of time. Do you think that is absolutely irresponsible, or do you think that the subjective feelings are also a key predictor of how successful a diet is long term?

Joel Kahn: I mean, it's good to feel good, but I don't think it's good enough. You can feel good and have a very high blood mercury and you'll love your tuna and then you'll love your tuna sushi like so many of my patients and they're literally walking around with a brain toxic blood panel that, you know, very simple to perform. Just as one example. You could be, you know, have a feel great and have an incredibly deficient omega-3. index and long term, you know, the issues with nutrition is long term. So, yeah, I'd like somebody to feel good and actually have a reasonably optimistic biomarker biochemistry panel, too, if we're going to do some nutrition evaluation.

Andres Preschel: And how many patients do you see on a weekly or monthly basis?

Joel Kahn: It's about 50, 60 patients a week. It's a slightly boutique exclusive clinic, but I used to see 40 patients in a day. Now I see 50 to 60 in a four-day work week.

Andres Preschel: Over 40 years, that's tens of thousands of people. Yeah, right. Easily. And do you think, have you seen in your practice with these patients that the folks that are on a whole food, plant-based diet, that they have significantly better markers from a cardiovascular perspective?

Joel Kahn: There are so many remarkable, remarkable stories of people who do feel good, A lot of people, to be honest, I do too. I like that when I eat the way I eat, I also sense it's good for the planet. I also sense it's a kind diet for the animals. I may not think about it at every meal, but it permeates my life. I may sound like a weirdo, I don't like spiders, but if I get a little housefly in my house, I'm pretty good at catching those suckers and letting them go. I just say that as an example. I don't know that it makes me a kind person in every situation. I think that's a little Pollyannish. But when you do it long enough and you stay in touch with the community, I mean, it spills over. So there's a lot of people that feel good. But what I'm more excited about is both the published data, Mr. Nathan Pritikin, Dean Ornish, Dr. Caldwell Esselstyn at the Cleveland Clinic, Dr. Neil Barnard, Dr. Joel Fuhrman, and a growing cadre of younger investigators. Had a publication in the last 10 days by a younger cardiologist, Dr. Monica Agarwal at Gainesville, University of Florida. Published in a premier journal on whole food plant-based diets and their impact on lipid control and biomarkers of cardiac risk. It's just nice to see some new fresh faces pop up. And really, the bottom line, though, is preventing disease and enhancing quality of life. And those are always tough studies to do. We've got a couple big ones like the PREDIMED study, which was 7,000 people for seven years with the Mediterranean diet, randomized to a few different approaches. And One of my favorites, if people listening have never heard of the Cordioprev trials, C-O-R-D-I-O-P-R-E-V, 1,002 heart patients randomized to two different diets for seven years. That's tough stuff to do and get people reasonably committed to following the pattern they were assigned to and do that for five, six, seven years. They were pretty successful in this Cordioprev trial. The Mediterranean diet with a lot of olive oil worked out very well for heart patients. But in my practice, whole food, fat-based eating, a lot of people have lost weight to a goal that they're comfortable with. Some have improved and some have reversed their type 2 diabetes. Dr. Ornish just published about six weeks ago, I'll say, a study on whole food plant-based diets and his holistic lifestyle, which includes stress management and exercise and group support in early Alzheimer's, early cognitive impairment. It was a very impressive 50 patient trial. So I've seen people improve their memory. Now psoriasis and a variety of conditions. a whole lot of the autoimmune conditions like lupus and rheumatoid arthritis. Yeah, you know, you're not going to come to my clinic and expect to walk out with a handout on how to adopt the carnivore diet for your condition. You're pretty much going to hear from me about using a whole food plant based diet. So that's the kind of success stories I see. They're not all successful. People get frustrated. People don't like beans. People are allergic to whole grains or something. Some of the fundamental food groups that we eat in the plant based world. But, um, It still astounds me how many people walk into my clinic. and they've seen five other cardiologists and they've had zero nutrition education. I mean, either they didn't get it from the medical community, but they also didn't seek it out on their own. And that's just virgin territory to me to fill them up with, you know, podcasts and, uh, documentaries and books and, you know, get them educated. And a whole lot of them get really excited. This idea that, you know, they can make some changes at home and see some health advances.

Andres Preschel: Yeah, maybe back then when you were first starting out as a physician, it was maybe somewhat reasonable to deny the influence of nutrition, but nowadays, I mean, there's just no denying that nutrition works synergistically with any outcome in a medical practice as far as, you know, supporting the body and regulating itself and giving it what it needs to thrive. Nowadays, it's probably irresponsible for doctors to deny that. Would you agree? I agree. Cool. And what could more doctors do to incorporate this in their practice? I mean, what's the most responsible thing that most doctors can do within reach, reasonably?

Joel Kahn: I mean, I'm not criticizing anybody. You know, it's a confusing world out there to try and find some reliable and adoptable nutrition, you know, plan. But, you know, number one, they have to educate themselves. You know, they have to treat themselves first. Number one, they are at risk for all the series of chronic and acute diseases everybody else is at risk for. We sadly know, you know, physicians contacting and dying from the diseases we're talking about right now. So, you know, just don't fall for the trap. I've eaten in so many doctors' dining rooms where all there is is fried food everywhere. You know, just go hungry. Skip. They should be curious enough to read a book or watch a documentary and learn something for their own health. And then number two, constant education. Problem is there's so few grand rounds at hospitals and the medium by which there's education going on, on nutrition, so they're not sinking much in. And number three, if they don't really have the ability to grasp all that, just find a good dietician in town to refer to on a routine basis or bring one into your practice. But we got so much work to do after all these years to try and get any of that on board. I'll just give you a quick example. You've had a heart attack and you've recovered. There's a program most people get referred to, or at least should get referred to, called cardiac rehabilitation. And the typical cardiac rehabilitation might be a sizable room in a hospital or in an office building near a hospital. And there's ellipticals and treadmills and weights and recumbent bikes. And there's supervised exercise to accelerate and optimize your recovery from a heart attack. But since 2010, there's been two Medicare-approved programs that are very special cardiac rehabs. They're called intensive cardiac rehab, ICR, paid for by insurance companies, and now mostly insurance companies, not just Medicare. And those two programs, one is called the Pritikin Intensive Cardiac Rehab Program, one is called the Ornish Intensive Cardiac Rehab Program, same guy, Dr. Ornish. um you know instead of one hour of getting a little sweaty you get four hours you get a cooking class you get a yoga meditation class you get groups of more and yeah it's covered by insurance too and i don't think 10 percent of hospitals in america have added the upgraded cardiac rehab that actually would be more profitable to them to do it. So we have this stunning and powerful opportunity, but hospital administrators are just not fired up about this. And it must be some of the physician staff are not fired up about it either. But slowly, slowly, slowly, we're making inroads. There's just so much work to do, as I said.

Andres Preschel: Yeah, and as far as making those introductions and getting hospitals to consider something like this, what does that effort take? What does it take to bring that effort forward?

Joel Kahn: It's going to take some physician champion who really gets fired up about it and willing to go to all the committee meetings and make the presentations and create the budgets and hire the people and get the footprint set out and all. And it's going to take a board or a CEO that's opened the idea that we might actually end up with healthier people and healthier people use less hospital resources. That may not be aligned with our budget goals, but it's obviously the right thing to do.

Andres Preschel: Well, maybe we can ask our listeners. I've got lots of medical professionals in my audience and lots of folks that seek physicians on a regular basis. Maybe we can ask them to carry this message forward. I'll make sure to link to this in the show notes so that people can come prepared and have these conversations with their doctors. And hopefully, we get this system built into more hospitals. If it's all right with you, I'd like to shift gears and have a conversation about The nutrients that we can get from a plant-based diet as far as vitamins minerals nutrients Do you believe with the research that you've come across? that a Strictly plant-based diet fulfills all of our nutrient needs from a biological perspective

Joel Kahn: If that means that if a person takes a vitamin with a diet, it means the diet is defective or deficient. I think all diets are optimized with supplements and vitamins. You won't know if your diet is providing optimal nutrition unless you do a pretty broad lab panel. And I'll tell you right now, do an omega-3 level because about I mean, more than half the patients in my practice are not vegans. Some are so far away from that, it's ridiculous, you know, that still cannot connect with them to stop pulling into McDonald's, even that level of nutrition. But I think a whole food plant-based diet provides all necessary ingredients, but would be optimized with a small number of supplements. And this has been responded to by multivitamins for vegans. Basically, you pop one, a handful of little vitamins that come in a packet, and you've covered all the bases. Pretty simple stuff. I have carnivore patients. Their lab panels are bizarre. They have literally no vitamin C detectable in their lab panel. They don't seem to really be suffering a clear clinical scurvy. It sounds like they should be bleeding gums and weak bones and thin skin. And I don't think anybody's really explained how that is. But I find nutritional deficiencies in almost every one of my patients, and they are following- Plant-based or not? Yeah, plant-based or not. It might be a subtle deficiency. A lot of people are iodine deficient across the board. Morton's salt, iodized salt isn't as popular as it used to be, and people don't eat a lot of- Or seaweed. A lot of nori and seaweed, exactly. If you test, you're going to find that there's a lot of, you know, how important they are and how much illness these deficiencies cause isn't really clear. I mean, there are people that advise take a multivitamin, three times a week or something. Just fill in the bases, no matter what your diet are. One of the people that says that is Dr. Walter Longo at University of Southern California, and I have tremendous respect for him. Again, I don't know that the ideal diet has to, line in the sand mean, if you're taking a supplement, it's no longer an ideal diet.

Andres Preschel: I mean, nowadays, you know, we have poor soil, you know, it's depleted of nutrients, so any diet is going to be lacking in some nutrient. How about, you know, a plant-based diet, but once a week you've got a nice medium-rare grass-fed steak? You know, is that so terrible?

Joel Kahn: Well, I have a lot of people that do that. Probably the most popular variation in my practice on a whole food, plant-based diet, talking 100%, is people will have one or two pieces of salmon a week. And I generally, it depends on the patient, but I would say the vast majority, I do not fight them. I tell them, you know, quality, quality, quality. I do warn them if you're gonna start eating a lot of fish, we probably want to check a mercury level because I don't know how many of your audience have had their heavy metals checked. It's very common to see really, really high blood mercury levels. And then if you do it in more advanced ways, like provoked urine, you'll see that almost in everybody. There is a diet pattern that I do think is rather attractive called the longevity diet, also designed by Dr. Walter Longo, University of Southern California, which is 17, 18 meals a week that are plant-based and two to three pieces of salmon a week. That's what he teaches, that's what he eats. Pretty hard to argue that that's a toxic diet, and by no means is that a toxic diet. So why have I not added in salmon two to three times a week? I have no desire to do that. I have no lust for bringing fish back in. I take a plant-based omega-3 from algae and a lot of flax, chia, hemp, walnuts, other sources of omega-3. So for my own personal life, I don't find it necessary. But if I could get just like that became the diet that everybody with cardiovascular disease adopted, I think we have made huge advances. I just had a patient this week, once a month he has a big steak. I mean, yeah, he's not gonna leave here with me screaming at him. I didn't tell him to do it and I'm not praising him for it, but generally, There's a couple people that are really fragile. I mean, there are some type two diabetics that put their diabetes in remission with a whole food plant-based diet. And they will, whether they're wearing a CGM or other ways of monitoring their glucose, they will see when they go back to one meal that's meat-based, they'll see their blood sugar really not respond well. And there's a few people- With the meat? Yeah, there's a few people with very advanced heart disease. I mean, talking about very advanced, that have brought their heart disease, again, kind of into remission with the Ornish program, the Pritikin program, or this famous doctor at the Cleveland Clinic, the Esselstyn program. And even a little variation, they'll start to get symptoms back. It must be the endothelium, the lining of their arteries has shifted to making a lot of nitric oxide and resisting plaque. clotting and one rich greasy fettuccine alfredo meal and you can you can actually tip that back into a bad place so you know I hear that but that's a relatively small piece of the entire pie even in my clinic.

Andres Preschel: Right. And I mean, just to speak on behalf of the salmon, I mean, it's beautiful that salmon have, there's so many fish, right, that people enjoy eating on a regular basis, but salmon specifically and the forager fish, the small fish like anchovies, sardines, and herring, it seems like they have a very high selenium therapeutic index that will cataract and compete with mercury and other heavy metals. And then they just generally have lower heavy metals because they're smaller fish. You know, they're lower on the trophic levels of the food web, so there's less bioaccumulation, biomagnification of that mercury. And then they're also, they happen to be very rich in omega-3 because they're colder water fish. They have generally more fat, very omega-3 rich fat, and that can have a nice anti-inflammatory effect. So, but again, I want to emphasize that the quality is so important because not all, you know, salmon is made the same, not all forager fish are made the same, especially when they're packaged and they're processed, et cetera. I love eating fish and I just want to take this as an opportunity to say, you know, I have a lot of spear fishermen, I'm a spear fisherman, I have a lot of fishermen and spear fishermen that tune into this podcast and I can't tell you the number of guys and girls that I know that love eating their fish but they get certain symptoms, they get blood work done and boom, heavy metals. So, it is just unbelievable. So, as far as the plant-based diet goes, what are some of the compounds in plant-based diets that can actually help counteract some of this heavy metal toxicity? Is it the binding factor, like the chlorophyll binding?

Joel Kahn: Filling your gut with fiber, you know, I can't tell you that we know for sure, but I think on average colon transit times, eating to pooping time is a little shorter in people eating a fiber-rich whole food plant-based diet. You know, move it out before it can get absorbed would be a good way to deal with it. You know, there are a few specific foods. Cilantro, I mean, not necessarily the most commonly used green, but if you're eating a lot of homemade salsa or purposely putting cilantro in a salad, it's famous for binding heavy metals and facilitating removal from the body. It's not a food you prepare, it's a food you just take, but chlorella tablets. That was what I was saying, yeah. Some data for binding heavy metals and removing them from the body. That's more of a strategy, I'll just take, and chlorella's a food, it's not really a manufactured vitamin like a multivitamin, but chlorella has a tremendous amount of protein and about 40 minerals and vitamins. has some special ability to also bind and remove heavy metal toxins. So those would be some strategies.

Andres Preschel: Chlorella is the first living organism on our planet. I actually had Catherine, what's her last name?

Joel Kahn: Yeah, Arnstein.

Andres Preschel: Ernst and yeah from energy bits. She's got the best the world's best chlorella and spirulina. I love her products Yeah, it's actually I developed a smoothie menu at a Mediterranean restaurant here using her products and I was testing these smoothies over the course of two weeks You know perfecting the recipes I'll tell you I've never felt better in my life like I was having these shakes all day every day and they were You know plant-based shakes almost exclusively Yeah with the exception of a little bit of whey protein here and there and I felt so clear so energized just absolutely Amazing every day and there's no other changes in my lifestyle that I made that was it I was just having more of that stuff every single day. It was great But anyway going back to a conversation that we were having early on in this podcast the the influence of cholesterol on cardiovascular disease I read, and please correct me if I'm wrong, that there is about 2% of the population that has this predisposition for hypercholesterolemia. So, meaning, you know, they respond to cholesterol in the diet more so than most people and that can influence, negatively influence, their heart disease risk. Is that 2%? within the benchmarks that you've seen, or are more people responding to cholesterol in negative ways?

Joel Kahn: Yeah. And you're asking specifically cholesterol in the diet, which is a little different. You know, they're lipoprotein A, LP little a, you know, so 20 to 25% of people, but largely unaffected by diet. And then there is Familial hyperlipidemia, which is one in 250, you're born with this ability to grossly overproduce LDL cholesterol and you can get cardiovascular disease at a very young age, particularly if you inherit the very rare homozygous version, but fortunately that's only one in a million person. You know, You can do a blood panel, you can do an analysis of sterols, as you may know, and it will tell you if you're a hyper-absorber. I think that's really the question you're asking. I eat a higher saturated fat or a higher cholesterol-laden meal. Am I probably on a genetic basis more able to absorb it efficiently, but that may not be a good thing because your blood cholesterol level may skyrocket more than the next person. I don't know if that number's 2%. I think it's higher than 2% because I've run a lot of the panels just randomly and they come back as these hyper absorbers of cholesterol and diet. It's more than 2%. Um, you see that, uh, you know, whether you believe it's good or bad, you know, the whole lean mass hyper responder research being done by Dave Feldman and other people online, um, where they don't mind driving their total cholesterol to 500 or 600 as part of these shorter term experiments. But there's a fair amount of literature that people adopting a ketogenic diet and they go get their blood rechecked in six weeks. it looks like about a third of them will have a really excessive rapid increase in total cholesterol and LDL cholesterol. So I think that number would be closer to a third. I had, again, about two weeks ago, one of these patients that cholesterol traditionally ran about 240 and I just drew blood on him and came back all of a sudden 390. I called him up and said, what the heck is going on in your life? I hadn't seen him for a while. He just stopped in for labs and I was, yeah, I'm doing the carnivore diet for the past six weeks cause my wife's doing it and I want to be supportive. It goes, I stopped, you know, he's clearly a hyper responder to the diet change. I know whether that would have hurt him in the long run or not cause he doesn't have much cardiovascular disease actually, but, uh, he backed out on his own.

Andres Preschel: And is that something that he felt like outside of the objective data? Can you feel when you're a hyper responders to cholesterol?

Joel Kahn: Um, I think any signs and symptoms actually felt pretty, pretty good on his carnivore diet. Like a lot of people. I mean, I'm not, not going to say it's, uh, makes people quickly sick. I mean, I'm sure there's some are, but make me sick quite.

Andres Preschel: And as far as LP little A goes, is that something that, so you're saying 20-25% of the population has high LP little A, they're just born with it? Right. And how does that work mechanistically? What is LP little A, how does it work, and why is it an issue?

Joel Kahn: Yeah, it's largely manufactured in the liver. It's a different production line. You've got one production line that results in making LDL cholesterol, and that's where the statins work to reduce that production. And then 20 to 25% of people get the ability in their liver to make a second, I'm from Detroit, so we talk about things that go out in the factories, a second production line. And although it looks a lot like LDL cholesterol, lipoprotein A is very different, and they can make it, and they can make a lot of it, and it's a very easy blood test to get. And we think there's three major reasons, really two predominantly. It's a very inflammatory particle. and lipoprotein A can settle on your aortic valve, a heart valve, right before you eject all the blood from your heart, and it can really cause inflammation on the aortic valve, ultimately calcification, and ultimately scarring, and ultimately real pathology. And it seems also to be able to enter the sub-intimal space of your arteries, like LDL cholesterol can also. They share that they both have an apolipoprotein B moiety circling around. So it can cause atherosclerosis, there's no doubt. There's actually interesting paper in the last six months that if you have one particle of lipoprotein little a and one particle of LDL cholesterol, lipoprotein little a can incite atherosclerosis about six times more efficiently than LDL cholesterol. Now, I have many patients with a super high lipoprotein little a genetic cholesterol, and they don't have atherosclerosis. No idea why, but they don't. It's good, and their heart valve's fine. And I have other people, and they're 35 and 40 years old, they're already showing significant signs of cardiovascular disease. The bottom line, you just have to test each person, test each person. and hopefully reassure a lot of people. But remember, we said 20 to 25% of people, I mean, that's 100 million people in the United States. That's 1.8 billion people in the world. It's an absolutely enormous, and you have a very sophisticated audience, but average people have not heard much about lipoprotein lily. They will, there's three big drug companies working on new pharmaceutical products, because there is no FDA approved treatment of lipoprotein at this point. And because of the interest of big pharma, now there's articles in the Wall Street Journal and New York Times, they're all over the place about lipoprotein because we're sort of preparing the audience that there's going to be drugs released and you're going to hear a lot about it. And I welcome all that. We need solutions.

Andres Preschel: Lovely. And I know we only have a few minutes left, so I'd like to ask you just two more questions. Sure. I'd like to make a distinction. You know, we've spoken a lot about how a plant-based diet can help us prevent disease and extend, you know, our quality of life and our lifespan. But is that what a healthy person needs to thrive?

Joel Kahn: I mean, can you thrive on a whole food plant-based diet or call it a vegan diet? Sure. Look at the athletes at the Olympics. There's quite a few that are vegan. There's a whole community of world-class athletes of every kind, long-distance running to weightlifting to powerlifting to You know boxing on their whole food plant-based and they're natural. They're not using, you know Hormones or illegal substances or doping and all the rest. So you absolutely know Scott Jurek ran the Appalachian Trail It's at a world record on nothing but beans and bees and lentils. I mean, it's just one example and of course if anybody watches that documentary, the Game Changers movie, you'll see a whole lot of people. And, you know, I know most of the people that were in that movie, they're real stories, real case studies. And of course, some athletes that saw a tremendous uptick in their athletic performance, including powerlifting and all, when they made the change, they recovered from, you know, the post-exercise inflammation much quicker, were able to get back to workouts much quicker. I'm not gonna say it worked for everybody, but it certainly is compatible that you can get everything you need from just, we talked about fruits, vegetables, whole grains, and the legume family. I think I eat more lentils than any human in the world. They seem to work just fine.

Andres Preschel: I just got my fresh new shipment of jovial cannellini beans. I don't know if you're familiar with those.

Joel Kahn: Uh, cannellini beans for sure. What was the first word?

Andres Preschel: Jovial. It's a brand. It's like Italian organic after cook comes in a glass jar.

Joel Kahn: I love that stuff. Nice. Nice. Nice.

Andres Preschel: Yeah. Yeah.

Joel Kahn: Yeah. But so yeah, I interrupted you. No, no. I was coming to the end of a statement. Yeah.

Andres Preschel: Well, the last question for you here is if you could put a word, a message or phrase on a billboard somewhere in the world, what would it say and where would you put it?

Joel Kahn: Well, just reflecting, I've had the honor to grace some billboards around the city of Detroit for a number of years that were actually paid for by a plant-based organization. And it said, beat heart disease, beat cancer, beat diabetes, go plant-based. So my face has been on the big freeways of Detroit over the years. I don't have it hanging behind me. I have it hanging at home. And I might just stick with that. I mean, you know, that would be a good message. Is it not necessarily the only way to beat heart disease, cancer, and diabetes? Probably the most scientifically supported way to beat those conditions would be with whole food, plant-based eating over other dietary patterns. I think people should be aware we just, nutrition and health, It's so obvious to you, it's so obvious to me, but we got so much work to do. I think I've said that a few times. We still pale and we got fast food restaurants. I mean, there's no equity going on on making good, clean, healthy food available to the public and gotta get back to home cooking, get back to teaching, cooking skills. If I were in charge of the world, I'd shut down fast food restaurants tomorrow. It looks like Governor Newsom in California is doing a pretty good job of that. We said we weren't going to talk political, but it is unfortunately for some of the employees that are losing jobs. A lot of the fast food restaurants have shuttered up because of just no way to make it work out with what they're paying employees.

Andres Preschel: Well, that's an incredible answer. I mean, I think you're the second person I ever had on the show that's been featured on a billboard, and so it comes in handy with a question like this. It's a great answer. You know, if that's working well, I'd certainly like to see more billboards going up about, you know, plant-based diets, beating all kinds of disease. I thought it was gonna, as you were describing this, I thought it was gonna be like a punny thing, like, you know, beat this, beat this, eat beets, because beets just are so good for your cardiovascular health. You know, lowering our blood pressure.

Joel Kahn: I have that T-shirt. A friend in L.A. makes that T-shirt, so that also exists in my collection of various phrases. I got Joe Rogan T-shirts. I mean, I'm open-minded. I'll wear his T-shirt.

Andres Preschel: Yeah. Awesome. Well, Dr. Khan, it's been such an honor and pleasure, man. Thank you so much for your time and for your very important work. Thank you. Thank you, sir. And where can people find you?

Joel Kahn: Yeah, I'm in suburban Detroit, as I've alluded to. I do have an active practice. I see people from all over, either by telemedicine or they come here. And the website would be drjoelkan.com. D-R-J-O-E-L-K-A-N.com.

Andres Preschel: Lovely. Thank you so much. Thank you. So that's all for today's show. Thank you so much for tuning in today. For all of the show notes, including clickable links to anything and everything that we discussed today, everything from discount codes to videos, to research articles, books, tips, tricks, techniques, and of course, to learn more about the guest on today's episode, all you have to do is head to my website, Andrespereschel.com, that's A-N-D-R-E-S-P-R-E-S-C-H-E-L.com, and go to podcasts. You can also leave your feedback, questions, and suggestions for future episodes, future guests, so on and so forth. Thanks again for tuning in, and I'll see you on the next one. Have a lovely rest of your day.