Latest / NHA Today Podcast / The Future of Heart Disease Prevention with Joel Kahn, MD, FACC
Transcript
- Stephan Esser MD: Hi, it's Dr. Stefan Esser, and welcome to another edition of the NHA Today podcast. Today I'm thrilled to have Dr. Joel Kahn. Dr. Kahn of Detroit, Michigan is a practicing cardiologist, a clinical professor of medicine at Wayne State University School of Medicine. He graduated sumacum laude from the University of Michigan Medical School. Known as America's healthy heart doc, Dr. Kahn has triple board certifications in internal medicine, cardiovascular medicine, interventional cardiology. And he is the first physician in the world to certify in metabolic cardiology with the A4M MMI and the University of South Florida. He founded the Kahn Center for Cardiac Longevity in Bingham Farms, Michigan, and now sees patients both in Michigan and in Florida, and also does teleconsults for folks all over the place. And one of the coolest things I think about Dr. Kahn is he's a lifelong learner. You just heard that list there of an amazing array of different certifications in education. And you Dr. Chan, I want to jump right in, real quick question. Speaking of learning, have you always loved to learn? Joel Kahn MD: Yeah, you know, I don't recall coming home well, that's not true. I came home and we'd open the you know, I'm from the era we had the world book. And if you really fancy you had the Encyclopedia Britannica, we w we were more a world book family. But yeah, I actually did remember now, you know, as a child opening, enjoying, reading. I mean, I wasn't certainly a bookworm, not that there's anything wrong with being a bookworm. Stephan Esser MD: Ha ha. yeah. Joel Kahn MD: but I think I always did enjoy the challenge of learning new things and still do. Stephan Esser MD: You know, you could I well that's what I was gonna say. You could clearly sit back on your pedestal and be like, you know, I'm done, I've done all these things. Why do you push yourself to keep learning now? Joel Kahn MD: Yeah, well really, you know, one, I feel an obligation, professional obligation. I'm still seeing patients. They're coming to me, they're entrusting me. And I have a lot of the older knowledge that goes back. Actually, this is the 37th year I've been practicing cardiology started this week. So there's a lot of OG, you know, material that I can remember, you know, things that came out in the seventies, eighties, and nineties. But you know, we're in a whole new era. The pace of progress is great. Patients depend on good data. They ask interesting, tough questions. Now I gotta compete with Claude and Chat GPT and Grok and all the rest. I can't possibly contain, you know, every tidbit, but I you know usually know the literature right up to that week. So it's it's all that's responsibility. It it's a hunger. It's really a hunger to you know, I thi I do truly believe as great as medicine is, you know. Stephan Esser MD: Well that's what I always love. 'Cause on social Joel Kahn MD: you hear the statement fifty percent of what you learned in medical school is wrong. I nobody did that to be bad professors or bad mentors. But I also think about fifty percent of what we're doing nowadays will be questioned and will improve. I just wanna stay as up to date as I can for my professional satisfaction and for the patients. Stephan Esser MD: I love it. Yeah, I mean you're on social media and whenever I see you posting, you post new articles and then you review them, which is awesome. It always makes me go, man, I need to get in the literature in my area and stop, you know, just slacking as well. So thank you for that inspiration. You know, I did you always want to be a doctor? Joel Kahn MD: real quick story since you asked. At age fifteen, I had a choice to make. I had a family business in Detroit, Michigan that was growing and now it's very large. And I was very close to my father and grandfather, and I worked there since I was a kid, retail furniture. And then I actually had an interest in my Jewish background, and I actually spoke to several rabbis about that career path. But I had a great biology teacher in 11th grade. I started dating a girl in 11th grade whose father was a doctor. She's been my wife for 45 years. And that and you know, ultimately it wasn't a coin flip, but they had this thing at University of Michigan when you applied for your undergraduate, you know, application. If you check the box, you got interviewed to go right into med school out of high school. So I figured, I'll check the box. And ended up, I got accepted. I saved my parents. Stephan Esser MD: Ha ha. Joel Kahn MD: two years of tuition. because I did everything in six years, not eight years. And I d I don't regret those careers that I didn't follow. I've loved every day of what I do. Stephan Esser MD: Love it. So Well, that's what I always feel from you is a passion for it. Did but why cardiology? What attracted you into this field? Joel Kahn MD: That's another little story. I was born 67 years ago with a heart murmur. And somebody talked to my mom and dad about it. They got a little nervous. I mean, I went home, but I actually was seeing a pediatric cardiologist my entire childhood. ultimately just once a year for a checkup. It was a little VSD, a little hole in the heart. It closed up. I never needed anything special, had no limitations. But you know, I can remember being eight, nine, ten, eleven, being in a cardiology office at Henry Ford Hospital in downtown Detroit. And I'm sure that, you know, put some inspiration into the idea that it's a pretty cool organ. Stephan Esser MD: Right. I mean, outside of your personal experience, what's your take? I mean, how important is heart disease in America today? Is it really that important? Joel Kahn MD: It is so important. It literally, and I mean this from the heart, it pains me. I see people every day and they're forty-five and they're thirty-eight and they're fifty-one and they have advanced heart disease. I'm talking one after another after another. And you know, I only got five people in my practice with several thousand patients. I only got five that are smokers. you know, most everybody else has had the sense or the ability or the help to quit. Stephan Esser MD: Wow. Joel Kahn MD: So it's all those other things. It's the genetics, it's our environment, it's the food, to quote Michael Clapper, of course. And we have an enormous amount of work to do to try and get heart disease off the list as number one cause of death for men and women. And I think it's possible, but we're not doing it. We don't talk to patients with rare exception at age 45. Like we talked to them about colon cancer, breast cancer, prostate cancer. Stephan Esser MD: So it sounds like you know, the historical way of looking at heart disease was l waiting for symptoms, waiting for problems to occur. You know, you bring that up there. You know, what's evolved over time? Are there some new tests out there that reveal more of the silent heart disease before a heart attack? Joel Kahn MD: Yeah, you know, the number one form of heart disease to discuss is when your arteries were always born with clean arteries, and at least half of us by our middle of life have diseased heart arteries as well as other parts of the body. And we have no formal system to screen for that. Why would you wait till you're ninety percent blocked and you know, feeling awful and going to the emergency room when 15 years earlier you could have found this disease earlier? I mean, who wants stage four cancer? If you're gonna get it, let's find it stage one to use an analogy only. So, yes, in fact, there's nothing that new. We've had this test. I'm a big, big advocate called a coronary calcium CT scan, developed in 1990. I mean, who the heck was president in 1990? Is that Clinton? That was long time ago. Test became very available 25 years ago, very inexpensive. And in under 10 seconds, a 45-year-old man. A 48-year-old woman can learn if they're on a path that they seem to be preserving healthy arteries or they're developing disease, literally 15 years before the emergency room, or worse. And we just don't do it. There's no reason we shouldn't. I've been, you know, literally lecturing and posting and teaching for a good 20 years that this is basically the heart's mammogram: coronary artery, calcium, CT scan. Yes. We have other stuff more advanced, but everything else is more expensive or more radiation or more involved. This simple, simple test would take two buckets right away. You're 45, you're going in the heart disease free bucket, pretty much free, and you're 45 and you're going into the you're a future heart disease patient bucket. And obviously we're gonna put a whole lot of love and attention here, just like somebody with colon polyps, somebody with a precancerous cervical lesion, we're gonna follow We're gonna try and intervene. We're gonna use all the data we have. But we don't do that. We could do that starting fifteen years ago or starting tomorrow. Stephan Esser MD: So that test, at what age do you recommend most people get it? Joel Kahn MD: Well, there's, you know, on the one hand, the pressure is we are seeing atherosclerosis, heart attacks earlier in life. Still the prime age for a heart attack is maybe early sixties, but that disease has been there for fifteen years. I'd much rather find out when I'm forty-eight that I have the development of early heart disease, and at age sixty three, I'm in the emergency room. So I really feel most people around age forty-five. Should have some artery in their body looked at accurately. You can use these arteries called carotid arteries and a special ultrasound, but the proper test is not widely available. This CT scan, since there's no injection, there's no allergy, there's no kidney function issues, there's actually no claustrophobia. You just gotta lie down and hold your breath for five or ten seconds. The biggest limitation is in most states, a doctor has to take out a prescription pad. Stephan Esser MD: Mm-hmm. Joel Kahn MD: And write the order. And they're not used to doing that. They'll fight. They'll fight my patients. Cause I asked them, why did you get that abnormal CT scan that you're seeing me about? Well, I heard you on a podcast and I decided to ask my doctor, and it can be quite challenging. I really, I just am so passionate. I want to shake these people and say, screen them for heart disease. Stephan Esser MD: Right. Makes total sense the way you're making the comparison to mammogram, right? It's just get the data. That's one of the things I've heard you say that I like this line of yours. Test, don't guess, right? And so a lot of people get their annual lipid screen, their total cholesterol, HDL, LDL, triglycerides. But what are some of the other lab tests that we should be thinking about for ourselves? Joel Kahn MD: Yeah, and lab tests are always the next thing I would have brought up, but you brought it up because you're sharp as attack. And lab tests are great. And that's what the American Heart Association is sort of recommending is that you take all these numbers, put them in a calculator now called the prevent calculator. It's pretty cool. It includes kidney function, never used to include that. Actually includes your zip code because there's very large differences in heart disease. Events across various regions of the United States. the South is always number one, probably because of their diet and some of their environmental toxins around the cotton industry and all. But the studies say when you put all those numbers in and get a calculation, you're low, medium, high. And then you go do that hundred dollar CT scan. Man, it's like shifting the the chessboard all over the place. Low-risk people become high risk, high-risk people become low risk. People on statins come off statins. People not on statins might need to consider statins. Of course, we'd always go whole food plant-based first and enjoy it. So, but the blood test should include all the ones you mentioned. What's your fasting blood sugar? I usually include a fasting insulin, a hemoglobin, and A1C. You I gotta know your kidney function, your liver function. Kidney function, just to stay really up to date. 40% of my patients are taking creatin powder for their. Strength building. And creatin can interfere. It doesn't harm the kidneys, but it interferes with the kidney test everybody gets called creatinin. And your doctor may tell you, wow, what's going on? Your kidneys look weak. Very concerning message from your doctor or your nurse. But there's a different kidney test called cystatin C, C-Y-S-T-A-T-I-N-C. It's been available. The data is it's more accurate, and it isn't affected by the creatin powder. So You don't have to stop your creatine powder. Just be sure you're really getting an authentic and accurate kidney function. But going beyond that, you want to know inflammation. I mean, we've been talking about inflammation for 25 years in cardiology, the famous high sensitivity C reactive protein, HSCRP. There's three or four others I won't belabor because most people don't even get that one called the CRP. Actually, some new data. I've been drawing one called Intraleuin 6. And it sounds fancy in Star Wars. It's available at Quest and Lab Corp, but for people with lipoprotein little A inherited cholesterol, which I'm to mention in a minute, Intraleuin 6 seems to be a really good second test to even further determine. If you're if you're high in both, it's concerning. If you're low in both, it's ideal. And then I gotta give a shout out. this is a little promotional, but This is a book that has the name of a cholesterol particle on it. How exciting. I write boring books. It's my book. But lipoprotein little a, also known as LP little A, and it has to be a little A. It can't be a big A. And we don't say lowercase A. It's just so confusing. and that is an obstacle. Is an inherited cholesterol by Stephan Esser MD: Mm-hmm. Wait, wait, hold on a second. Yeah, but where do we get the book before you go away from that? Joel Kahn MD: Well books on all the booksellers, of course. And more important than that, there's about fifty amazing plant-based recipes. So I think my patients enjoy they enjoy that even more than the content. But lipoprotein little A is inherited. So you walk out of your doctor's office and you were told your sugar, your blood pressure, your cholesterol, your LDL are all pretty good. Now you probably didn't have your high sensitivity C reactive protein. Maybe you did. Stephan Esser MD: Okay, okay. I like it. Joel Kahn MD: But you could have been born with the ability to make a lot of this. So when you were two years old on the playground, when you were 13 years old having your bar mitzvah, you had a cholesterol in your bloodstream that could cause damage to your arteries and one of your heart valves. And it's been recommended now for seven years that everybody on the planet, even children, get this tested once. It's every lab does it. It's very inexpensive, covered by insurance. But about one or two percent of doctors have. Done that. I started actually about 20 years ago. So I have so many patients that see me to manage this genetic cholesterol, even if it's only one out of every five patients. And interestingly, statins don't work for this cholesterol at all. They're actually maybe possibly adverse. Montgomery Baxter of Blessed Memory did a paper that plant-based eating may help control this, and it certainly controls regular cholesterol. You got to deal with regular cholesterol, you got to deal with lipoprotein A in 20% of patients. So walking out of your doctor's office is usually an incomplete experience. And as you know, a lot of patients now are buying these massive lab panels online for cash. And my phone is ringing nonstop because people are learning that they inherited this and they go to the web and they find me, which is fine because it's a challenge and I enjoy working with people. Stephan Esser MD: Right. Joel Kahn MD: We'll have drugs one of these days or gene editing that will take care of this problem. But right now it's a challenge. It's interesting. Stephan Esser MD: And so that genetic inheritance of that lipoprotein little A is in your mind s loading the gun? What I mean, you what the to use that phrase that Esselston sometimes like to use. I mean, is that what you're thinking there? That's that's what the data shows? Joel Kahn MD: Yeah, it was a genes load the gun and lifestyle pulls the trigger. But the only problem here is the genes you inherit may load the gun, but this little particle is not as conducive to lifestyle changes as total cholesterol, LDL cholesterol, fasting blood sugar, blood pressure, waistline. Yeah, you should follow a very, very healthy plant forward ornish, Esselston, Fermin. you know, lifestyle program of food and fitness and stress management. But this may take a little extra. I'm one of the last cardiologists in the world that still uses niacin. This happens to be a brand. It's not my brand. This is a brand, extended release niacin, because it actually does a very nice job to lower the genetic cholesterol. And it used to be used all the time. It's just fallen out of favor. So I brought it back. Yeah. Stephan Esser MD: Right. So it it almost what I'm hearing from you here, which is fascinating, right, is that we're we're seeing multiple aspects of kind of heart disease risk and you're breaking them down piece by piece. The classic cholesterol levels on LDL, now the lipoprotein A. Can you talk a little bit about apolitoprotein B for us as well? Joel Kahn MD: Yeah. you know, in the news is the fact that a standard cholesterol panel at your doctor's office is very important, but it is not complete. And you can have two people with an LDL cholesterol, let's say a hundred and fifty. Your doctor might say, you know, I'm a little concerned about that. Now, number one, get the CT scan. Because if you don't have any calcium, you're in good shape. If you got a lot of calcium, you're not in such good shape. that'll determine also what kind of treatment you might need. It's always going to be lifestyle and plant forward diet, but it might be prescription drugs. APOB, basically four letters, A P O capital B, is another blood test, another cholesterol test that performs better than just getting LDL cholesterol. And what I see in some people, I'll give you an example. I see a patient, their LDL cholesterol is 100, pretty typical. But we do this APO B and it's really high, like 150. I scratch my head. Well, it turns out APO B captures your LDL cholesterol and your lipoprotein A in one number. And it's immediately a clue. Why is that APOB so high? And then we run this test if we haven't done it already, and we find out that they've got double trouble. And it doesn't, you know, I'd really try not to worry people. There's always something we can do. And like everything else, not every smoker gets lung cancer, and not every high cholesterol or high lipoprotein A patient has you know a heart attack. But since we don't do a very good job of predicting the future, we take it all seriously. Now, if you go do the CT scan and it comes back zero, you've moved your risk down. No matter what the labs say, you've moved your risk down tremendously. And that's where we started my clinic. Stephan Esser MD: Nice. And now what about homocysteine? Is that still a lab that you look at or not really? Joel Kahn MD: Yeah, homocysteine, another, you know, almost unpronounceable, difficult to spell chemical in the blood, is partly under dietary and partly under genetic control. A lot of us inherit a gene with a funny name called MTHFR. I call it the mother-father gene, but other people use a different slang for MTHFR. And you may have no clue that both your parents gave you a gene. That one of the most important cycles in the body is called the methylation cycle, is something you don't do very well. And amazingly, all you got to do is take the proper kind and amount of a B complex vitamin. And all our plant-based friends should be taking B12, anyways, but you may have to add on a few more components. In fact, vegans are at risk for a high homocysteine because some of us don't take that B12 that we're supposed to take. And if you're B12 deficient, Homocysteine goes up. And homocysteine is not very friendly to your endothelium, the interlining arteries. it can raise blood pressure if your homocysteine's off. it can cause all kinds of vascular abnormalities. And for a 30 cent a day B complex vitamin, if you find out you're one of the people with a high level, it's worth checking and worth correcting. We know that correcting it reduces the risk of stroke. It's not as clear cut. if correcting it reduces the risk of heart attacks. that's been a little less clear cut from studies. But if all we do is prevent stroke by giving a thirty cent a day B complex vitamin, good enough for me. Stephan Esser MD: I like it. You know, for our listeners who want to prevent heart disease from developing or progressing, what are some of the most important steps in your mind? Joel Kahn MD: Well, I think number one, start as early as possible in life. And if you're listening to this and you happen to be by some coincidence in your twenties, thirties, early forties, don't wait. Jump in now with the same diet that you, Dr. Esther, and I follow, the same fitness, sleep, stress management. You know, the earlier in life you can gain all of this, the better. But most of us start to get serious when we're in the emergency room. That is not the best place. Or we're in our fifty my I was born in nineteen fifty-nine. It's very funny, but I think fifty percent of my patients I see were born in nineteen fifty-nine. It's like we're a club. That's already we're in our, you know, mid to late sixties. there's so much you can do, but you also are fighting the last 20, 30 years of a lot of pathology in many people. So, you know, don't wait. Start early. There's a series of Heart studies called Cardia, C A R D I A, which is evaluating heart disease initially in people 18 to 30. And you find heart disease and you find homocysteine and you find cholesterol and you find lipoprotein A. That's a great target. I love when my patients bring in their kids, 21, 22. We I do a short little visit. How much are they gonna tell me about their past medical history? I'm still very interested in their diet and their lifestyle and toxins and the rest. But we do blood work and we correct, you know, horrible vitamin deficiencies, homocysteine, starting early in life, you know, largely with lifestyle and vitamins, very little of it is prescription drug. But that is really a gift when a parent says to a child, I'm gonna get you checked out because I got checked out and I wish I knew this stuff 30 years ago. Stephan Esser MD: That's awesome. what a beautiful message that is. You know, there's a growing body of science that sleep, right, and particularly sleep quality and depth, is a risk for heart disease. how can someone know if they're sleep? Like, what do you recommend to patients to kind of figure this out? Joel Kahn MD: Yeah, sleep has risen the ladder since you were in medical training. I was in medical training. To many people would say it may be the most important lifestyle habit, because when you're tired, you don't eat well. And when you're tired, you don't go to the gym. And when you're tired, you gain weight and the whole cascade. So it may be if you're gonna correct one thing, I want you to go plant-based yesterday, but maybe working on your sleep is even more urgent, and then we can Stephan Esser MD: Mm. Joel Kahn MD: deal with the other issues when you're feeling a little better. So you know, I'm at I'm at war right now with my Apple Watch. I took it off because it keeps telling me I'm sleeping poorly and I think I'm doing fine. So I'm trying to use some other wearables and figure out. And you don't need to wear a wearable to figure out how you're sleeping, although it's very common and the patients are doing it. And some of them out there are really frankly quite helpful. you know it's a set schedule. The data is more and more go to bed at the same time. Wake up at the same time. Of course, somebody's gonna have a wedding and you're gonna change your schedule, but largely go to bed. Try and stay in bed for eight hours. So you might get seven hours of sleep. You know, nobody in bed for five hours gets eight hours of sleep. There's no accelerated AI you know, application that helps you with it. You gotta figure it out. Dark room, cold room. We have an eye mask for by my wife's side of the bed and mine. We have a white noisemaker. Stephan Esser MD: Ha ha ha. Joel Kahn MD: we have dogs, that's actually a problem, not an advantage because they're moving around. But I use sleep I use, you know, natural sleep aids. I take a very small amount of melatonin, some magnesium, and I've even dabbled in a little THC edibles, which is legal here in Michigan. Cause honestly, I've found that a very tiny amount has helped me. And I've tried, you know, other things first. I'm actually a pretty good sleeper. The last comment is sleep apnea. Stephan Esser MD: Ha ha. Joel Kahn MD: again, 45 years ago in medical school, we got about 10 minutes on sleep apnea. The Pickwickian papers by Charles Dickens, because there was somebody in there that snored. I think Mr. Pickwick. But now we have these home sleep apnea tests, fancy watch, disposable rubber, computerized, one night in bed, three days later, you get a very detailed report, very inexpensive. And the amount of sleep pathology, actual sleep apnea. Stephan Esser MD: Right. Joel Kahn MD: In a cardiology practice of high blood pressure, atrial fibrillation, congestive heart failure, coronary artery disease, phenomenally frequent. And these people need attention. They need a dentist who knows the airway. They need a sleep doctor that knows the airway. Maybe an air, nose, and throat surgeon that knows the airway. Maybe, I hate to say it, they need to get on some zepp bound injections and lose 30 pounds and stop snoring. And that is an FDA approved use. of you know the peptides. I'd rather they do it with, you know, peaches and grapes, but sometimes we gotta accelerate the process if needed. So sleep is a a big one and you just gotta keep working at it and working at it. I mean, I'm I'm a little cuckoo. Somebody sent me I'm wearing a EMF blocker right now. People say it helps your sleep. Other companies are selling EMF blocking caps, beanies. 'cause we all live in such a heavy Wi Fi EMF world. Maybe you'll sleep better. Whatever you need to do that's safe and non toxic, stay away from prescription drugs. If it helps you sleep better and it's natural, give it a try. Stephan Esser MD: Right. I was gonna say, so for you, right, we talked a little about all these different lifestyle measures, the nutrition, the exercise, the sleep. And let's not forget emotional stress, right? Or balancing stress, emotional poise, et cetera. Which one of these primary four, if you will, kind of legs of the chair is the hardest for you right now in your life? Is it nutrition? Is it exercise? Is it sleep? Is it emotional poise? Which one do you struggle with the most? Joel Kahn MD: For me as a human being, just talking about N of one, sleep is still my biggest challenge. I work out every day. I can get it done. It could be twenty minutes and on a weekend it could be, you know, fifty five minutes. a lot of hit, a lot of kettlebells, some some dumbbells. I do cardio, you know, cardio's falling out of favor. I mean, I still do, you know, some elliptical treadmill stuff. Stephan Esser MD: Nice. Right. Well, and and I love it. Be and what about were there other times in your life where other areas were more difficult? Joel Kahn MD: you know, as you know, I've been vegan, plant based since I was eighteen, forty eight years or something. so, you know, I'm in such a groove and I have such a wonderful wife who makes such amazing meals. I'm one of the lucky people walking the door and I got homemade meals. It's just fantastic. So I don't find the nutrition part challenging. You know, eating out, which I don't do a lot of can be, but you know, that's not common. Stephan Esser MD: Mm-hmm. Joel Kahn MD: stress management. I mean, I'm a bit of a goofball. Do I feel stressed? Sure. Do I take Xanax? No, of course I don't take Xanax. I you know, have breathing and faith and religion, and there's always something dire straits or kid rock or MM or something's playing, Metallica. I don't know. All that noisy music actually calms me down. it's the sleep. And it hasn't gotten easier. Sometimes three dogs on the bed, as I said. And you know, I pay attention to my sleep. My, you know, my wife, I'm a mouth taper. Maybe some of you out there are mouth tapers. I mean, I was a nose breather. Now I tape my mouth, I breathe through. I was a mouth breather, I tape my mouth. You know, all these little tricks. As long as they're harmless or find somebody who's a sleep expert and talk to. Matthew Walker is a famous PhD from Stanford, has a book on sleep that I would highly recommend. Stephan Esser MD: Awesome. Yeah, I mean, I think that's often under appreciated. I just actually gave a talk to the NHA community. We were talking about sleep and going through all that sleep hygiene and all those good measures. There's so many people just kind of walk right past instead of maximizing it, like laying in their bed looking at their cell phone, right, late into the night, instead of you know, putting those good measures into effect. And then when those fail, like you say, test don't guess, right? Find out exactly what's going on and come up with a game plan for it, which can be so effective. people want to connect with you, where can they connect? Joel Kahn MD: Well, I spend I had a you know, ultimately join you in the great state of Florida. So I spent about nine months a year in southeastern Michigan. I'm licensed in twenty states, so probably about seventy percent of the practice is from local Michigan and about thirty percent is coast to coast and had people today in Canada and people in Malaysia. I mean I get calls all over. It's very nice. And I spent about two and a half, three months a year in Boca Ratan and I have an office. So I'm very easy to find. And I do find for what I do, if it has to be a telemedicine call, it works well. I just Stephan Esser MD: yeah, so let's let's I just want a quick apples to oranges comparison here. So I go to a standard cardiologist, let's say, and they order a standard lab panel. What am I gonna get different when I come interact with you as a holistic and you know health health-minded heart doctor? Joel Kahn MD: Well, you know, the the average person I see born in nineteen fifty nine i and and if you're born in nineteen sixty nine, I can see you, or even nineteen seventy-nine I can you. But it is it always makes me chuckle when I meet a new patient and look. Yeah, it's just something on my horoscope or something. But number one, for the average patient that sees me, that's you know, they have reason to be worried about their heart health. Stephan Esser MD: Ha ha ha ha. They're attracted to you. Joel Kahn MD: Maybe they the standard cardiologist isn't usually all that helped up in seeing these people. You know, they want to see people that need to be, you know, procedurized, as we say, with a catheterization with a stent. You know, you're probably going to see a nurse practitioner, a physician's assistant. And I don't believe in that. I mean, I love nurse practitioners and physician assistants, but there's no filter. Patients walk right in and they're with me for their entire visit. And I enjoy it and I think they enjoy it. So that's different. Number two, and please, if you're a cardiologist listening to this, I mean no disrespect, but it's a pain in the rear to do labs, even limited labs. So most specialists leave it to the primary care doc to get that done. There's this misconception, you can't reorder the cholesterol for another six or 12 months. You can do whatever you want, and it gets covered. So, you know, I've got to fill out the lab slip, I've got to arrange the lab draw, I gotta look at the labs, I gotta contact the patient. This is a lot of work. I would say easily twenty percent of my professional life is managing data that I've ordered. And my, you know, people will get eighteen tubes of blood when they visit my office or I send them to Quest or Lab Corp. I am going deep on their biochemistry, and trying to understand why they have heart disease and how risky it is. And it's getting better and better. I you know, we do draw too much blood. We need to be able to do it in those little Stephan Esser MD: Right. Joel Kahn MD: samples and urine and speedum, but right now it's mainly blood. what else are they going to get different? And they're gonna get a physical exam. I mean, that should happen. I, Joel Kahn, had mitral valve repair in March of 2026 at the Cleveland Clinic. I developed mitoval prolapse. I went and saw several cardiologists. Nobody took a stethoscope out. Okay, that's a little bit of a problem when you're seeing your peers for a leaky heart valve. Stephan Esser MD: No. Joel Kahn MD: we still need to remember that there is some value, even if it's the emotional connection with a patient. I know they love when I put a stethoscope in my ears and move it around. And I do really try and listen. what else are they gonna get? We're gonna talk about. I mean, I tell them if you got heart disease, every day of your life, you're gonna work on it, you're gonna think about it, we're gonna be optimistic, we're gonna beat it. But this is a long road. Stephan Esser MD: Right. Right. Joel Kahn MD: And we don't have a cure. We have day to day habits that can dramatically lower your risk. But we don't have a cure. And I try and educate them, you know, they all watch Forks Overnives, they all watch What the Hell, they all watch Game Changers and on and on. And hopefully they'll go to an NHA meeting and you know, meet all the big shots like you. And you know, that's why I do a weekly podcast because I'm always teaching, always teaching. And Obviously if I can reach ten thousand people with a podcast, it's easier than emailing ten thousand people one at a time. Stephan Esser MD: Love it. So they get a very comprehensive approach to their health and very personalized, individualized. And what I love is it's a combination of kind of the traditional approach of cardiology with a most cutting edge science and medicine and lab testing and the calcium CT score and all this other stuff. And I think that's what people need to recognize. There's so much more out there than just here's my lipid panel and you know, and we're done. Right. And it looks okay. so you know, I'm taking away from this, and I actually did years ago. I think actually after a conversation with you. I ended up getting my calcium C T score, right? And now having been plant based my whole life, I'm proud to say it was zero. and you know, so that's good. you know, and so, you know, I think, you know, I'm walking away from this conversation saying, Hey, everybody out there over the age of forty, forty five, right? Make sure you've got that calcium C T score. And right, and then make sure you've got a competent individual getting the right labs for you to look at so you can make informed decisions. And if you need somebody solid and amazing, Doctor Khan's your man to kind of connect with. So yeah. Joel Kahn MD: Yeah. Yeah, it's I'm glad, you know, you had that experience and you came out with such a fantastically optimistic result. You know, repeat it again in five to seven years, make sure you're staying a zero. That's what I've done since I was forty, and I am still a zero at sixty seven. so I don't I don't take a statin, I don't need to. I mean, I don't have plaque. So not everybody can say that. yeah, you know, I take a lot of fiber, I take a lot of Stephan Esser MD: Zero is the new hero. Joel Kahn MD: you know, cholesterol lowering Michael Greger, you know, daily twelve cholesterol lowering foods that he just wrote about for sure. But you don't need medication when you've checked your arteries to, you know, very precise degree. Stephan Esser MD: I love it. Hey, final things that you want to share with our audience? Any final tips, tricks, encouragements, inspiration that you can share as we close down our podcast for today. Joel Kahn MD: well, I just want to go back to what I just said. You know, and we're talking a little bit about technology. We're not just talking about learning how to cook and eat and shop and you know and stress. The technology is a part of this, but technology also helps get people off medication. There's something called deprescribing. If you're on a statin and you've never had a calcium score and we go ahead and arrange it and it comes back zero, I will take you off your statin. Because that's actually what the science says. I'm not being rogue. I just know what the American Heart Association has said. And, you know, people appreciate if I do your echocardiogram and you don't have any thickening called hypertrophy, and we can use beets and pomegranates and big giant salads and maybe stop your scope and your listerine that's killing your nitric oxide oral production and all and I can get your blood pressure down naturally. We'll get you off prescriptions. So deprescribing, and I certainly try and de-prescribe proton pump inhibitors like protonics if possible, because they're actually pretty bad for your endothelium. actually, Prozac fluoxetine was just described as being rather bad for your endothelium. But talk to your doctor, don't you dare stop your medicine because you're listening to this conversation. So I mean I might put them on saffron instead of something prescription. So Yeah, that's you know, I wanna give people it's not all about testing leads to drugs, leads to lifelong pharmacotherapy. It's sometimes quite the opposite. And I love that part too. Stephan Esser MD: Very cool. Well, Dr. Cod, thank you for your encouragement, inspiration. Thank you for all the great work that you do, and thanks for joining us today on the podcast. Joel Kahn MD: Thanks, Doctor E. It was a pleasure.