Stay Off My Operating Table

Metabolic Health and Heart Disease - #18

November 23, 2021 Dr. Philip Ovadia Episode 18
Stay Off My Operating Table
Metabolic Health and Heart Disease - #18
Show Notes Transcript
In this episode, Dr. O goes deep into the mechanism of heart disease and its relation to metabolic health or, (to be more accurate), the lack of metabolic health. In this episode we learn about the mechanism of heart disease and heart attacks, the role of inflammation, what is actually happening with cholesterol, and how Type 2 diabetes is related to heart disease. One of our most detailed, technical medical discussions ever.

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Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings

Jack Heald:

Welcome back to the Stay Off My Operating Table podcast with Dr. Philip Ovadia, his sidekick wing man, whatever Jack Heald. Doctor O., I think you are in a different place than you were the last time we talked.

Dr. Philip Ovadia:

Traveling once again, as always had a great, great time recording in person with you for the last few episodes.

Jack Heald:

That was good. That was really fun. So now you're back to "have scalpel will travel", I guess, huh?

Dr. Philip Ovadia:

Correct.

Jack Heald:

I'm sorry. I cracked myself up sometimes. I wanted to talk today about some some things that I see on your website that I personally, I just want to ask about. So I get your website Aveda heart health calm. Down on the bottom of the homepage, you've got a question,"what makes Ovadia Heart Health different?" and you list a bunch of benefits that come from improving metabolic health. And of course, the ones the obvious ones are lose weight and gain energy, which nobody's going to complain about that. But there are some, some much more specific things here that I thought it'd be worthwhile to, to unpack a little bit, if that's alright with you.

Dr. Philip Ovadia:

Yeah, I think that would be a great discussion point. Because I think that people don't fully realize the impact that or metabolic health has on them. You know, as we've mentioned earlier, and many times, in the episode 88% of the adults in the United States are not metabolically healthy. And we therefore look around us and we see a bunch of people that are not metabolically healthy. And some of the things that come along with that are there for infants interpreted as being normal. And so I think as we go down this list, a lot of people are going to be thinking to themselves, Oh, that's just something normally that, you know, comes with age. And they don't realize that if you remain metabolically healthy, if you improve your metabolic health, that a lot of these things can be reversed or prevented in the first place.

Jack Heald:

So if 88% of those are not metabolically healthy, that's one important statistic. I pulled up the CDC is leading causes of death. So since since we know that life is 100%, fatal, your chances of dying from one of these are very, very high heart disease, cancer, stroke, Alzheimer's, diabetes, those are five of the top 10. And not coincidentally, on your list. Something about all of those is is listed here. So I'd like to start anybody who's listened probably has heard a good bit of this, but let's let's dig into some of the mechanisms. How is improving your metabolic health reduce your heart disease, even after you've had a heart attack?

Dr. Philip Ovadia:

Yeah, so you know, we know that the primary event that leads to heart disease, atherosclerotic heart disease, you know, buildup of blockages in the arteries, is inflammation and damage to the blood vessel walls, that occurs from poor metabolic health. And the resulting, you know, elevated sugar levels in the blood elevated glucose levels in the blood, which are directly damaging to the wall of the blood vessels.

Jack Heald:

Whoa, whoa, whoa, so there's two things happening there. I just want to make sure you don't go you're you're the expert, and I'm the dummy. So so you've got inflammation and excess blood sugar, both of which damage the, what the arteries leading to the I mean, the the veins, vessels leading into and out of the heart, am I

Dr. Philip Ovadia:

Yeah, actually, we're talking about the arteries. On the heart itself, the arteries on the surface of the heart that supplied blood to the heart itself, realize that the heart is a muscle and it requires a lot of blood supply oxygen to keep it going. And so the There were blood vessels, arteries, you know, called the coronary arteries on the heart itself. That can is the primary place where you know this damage occurs and these blockages build up that ultimately end up leading to a heart attack.

Jack Heald:

Oh, and the first you know, okay, so the heart is a pump and the the fluid that it pumps is blood, but the fuel that it uses to, to run comes also from blood, not the blood that it's that's inside the chamber that's being pumped, but the blood that's actually flowing into the fibers of the the heart muscle itself.

Dr. Philip Ovadia:

Correct? Yeah, you know, so actually, when you look at our, you know, kind of circulatory system, when the blood gets pumped out of the heart, the oxygenated blood that gets pumped out of the chamber of the heart, the first place it can actually go to is to these blood vessels that supply the heart itself to coronary arteries.

Jack Heald:

So it's kind of like a gasoline powered pump. That is pumping gasoline.

Dr. Philip Ovadia:

Yes, that would be a way to think of it. I'm not sure if there's actually a, a mechanical example of that. But that's exactly it. That the, that the heart needs to supply itself with blood.

Jack Heald:

So a heart attack occurs when the vessels in the heart itself that the the, the fuel line, as it were, that's going to the engine when that gets clogged? Correct? Man, I can't believe I never do this until now. Okay. Sorry, to slow you down. Let's keep going.

Dr. Philip Ovadia:

Yeah, so again, the, you know, primary inciting event that leads to blockages occurring in those blood vessels are damage to the wall of the blood vessels themselves. And inflammation. And I blood sugar levels are two of the things that can lead to that damage. So those are hallmarks. Those are things that occur with poor metabolic health. And that's why for metabolic health has been found to be the largest risk factor for heart disease.

Jack Heald:

So I want to drill down a little deeper into the high blood sugar damaging the vessels of the heart. What's the mechanism of damage? Because we've, we've always got some amount of sugar in our blood. Right,

Dr. Philip Ovadia:

right. But when that amount of sugar becomes excessive, we know that it is directly damaging to the heart. So there was a kind of classic experiment that's that been referred to, that was done in many different animals, where they'll put a, you know, an IV into each leg of the animal, let's say. And in one IV, they'll just put plain, you know, what we call saline salt water, essentially. And then the other leg, they'll put sugar water, and you can see would be a glucose drip, right? Glucose, right? A glucose. And you can see damage that occurs in the leg in the blood vessel that's getting the glucose drip the sugar drip put into it that you don't see from the saline alone. So having high concentrations of sugar in the blood, leads to inflammation, you know, leads to damage to the blood vessel wall.

Jack Heald:

Okay, so then let's back up one step and talk about the mechanism of high blood sugar. Obviously, we're eventually going to end up talking about diabetes. But, but right now, let's just talk about somebody who doesn't have or hasn't been diagnosed with diabetes, what is the mechanism that gets your blood sugar too high? What's going on there?

Dr. Philip Ovadia:

Well, basically, it's that you're, you know, ultimately, what it comes down to is that you are overwhelming your body's ability to clear sugar from the bloodstream. So you are taking in too much sugar. You know, eating too much sugar. And realize that, you know, all the carbohydrates that we eat, get converted to sugar, the processed carbohydrates more quickly get converted to sugar. And when you exceed the body's ability to clear blood sugar, to clear sugar from the blood, you're going to end up with more sugar staying in the blood and an elevated blood sugar.

Jack Heald:

So if I understand this correctly, you're going to have that blood sugar whether you're drinking Cokes, eaten candy bars, having a bowl of pasta, even eating something that's considered healthy, like an apple or a bowl of berries, you're that that's still putting. It's still it's starting the process that that dumped sugars into your bloodstream, is that correct?

Dr. Philip Ovadia:

That's correct. You know, there is some difference in you know, the rate that that sugar sort of gets released, you know, into the bloodstream. And that's why things like berries that you mentioned, or you know, fibrous vegetables, five fruits that have fiber in them can slow, how quickly that blood, you know that sugar gets into the blood. And you know, the body is better able to deal with that in some ways, but ultimately, it's all sugar, that's all going, you know, that's going to end up in the bloodstream, and the body is going to need to clear that from the bloodstream somehow. And we have a number of ways that we can do that. But

Jack Heald:

what to talk about that? How do we clear that sugar from our bloodstream? Yeah, so a couple of things. I I, obviously, this is a little more technical conversation, right. But it for people like me understanding what's actually going on, can kind of help to make better decisions. So that's, that's why I want to, that's why I'm asking these questions.

Dr. Philip Ovadia:

Yeah. So ultimately, you know, a couple of things can happen to that sugar that we eat, and then gets, you know, into our bloodstream, it can be immediately used for energy. And that can be, you know, that's on the cellular level, the cells need energy, it can be stored, and we have a couple of storage mechanisms, we have what's called What sort of a short term storage, which is called glycogen. And we can store glycogen in the liver, and we can store glycogen in our muscle muscles. So that's a limited, you know, sort of amount of storage. And the rest, we basically shove into our fat cells. And the body, you know, which is more long term storage, which is more long term storage, exactly. But at some point, you know, we can't keep shoving sugar into our blood cells, one of the analogy, or it's, I'm sorry, into our fat cells, one of the analogies I like for that is, you know, you picture the train, and you know, people are getting on the train. And then more and more people are getting on the train. And all of a sudden, it's looking like, you know, that sort of classic meme that you see of that train from India, where, you know, there are people on the roof of the train, and there are people hanging out the windows of the train, and you just have no more places to put, you know, people on that train. But we keep trying to shove more and more, you know, sugar into our fat cells, more and more people onto that train. And eventually, you know, you can't anymore and now the sugar is just backing up into our blood.

Jack Heald:

Okay, so I'm going to, I'm going to walk through my understanding of this, and you let me know where I've got it right and where I've got it wrong. I swallow I go eat a Snickers bar, I'm the the sugar that's in that Snickers bar gets broken down in my digestive system, and the component elements end up in my bloodstream. If there's sugar there in my bloodstream, my pancreas recognizes that and dumps creates insulin, which helps to move that sugar to all the various places you talked about, either directly burn it for fuel, or move it into short term storage in my muscles are my liver, or move it into long term storage in my bad cells. However, my pancreas has a limited capacity to produce insulin, and the more demand I place upon it for creating insulin, the less efficient it gets eventually, and at some point it's not it is overwhelmed with the amount of sugar that's still circulating, and it's not able to provide the the the passenger trains space for for the sugars to jump on to to get into all the various places that it needs to go. When that happens. That's when is that what is that what creates inflammation in the blood vessels?

Dr. Philip Ovadia:

Yeah, you know, having too much sugar in the blood is ultimately what's going to damage the blood vessel walls and lead to that inflammation. And, you know, the only real kind of step that you that we didn't cover in that is that at some point the, the cells themselves, you know, the fat cells, the muscle cells, even the liver cells to some degree Responding to the insulin. So the power

Jack Heald:

Yeah, that's right, I'd forgotten about that. That's where insulin sensitivity comes in.

Dr. Philip Ovadia:

Exactly, that's what insulin resistance is, is when these cells are no longer. So the pancreas is still making a lot of insulin to try and get all this sugar out of the bloodstream. And the cells themselves are just not responding to that insulin anymore, because they are getting too full, essentially, there, they are basically sending back the signal that we have no more room on the train. And, you know, ultimately, ultimately, yes, the pancreas stops making enough insulin, and you can no longer make enough insulin. But before that, what happens is that the cells themselves stop resisting, stop, you know, responding to the insulin and we become insulin resistant.

Jack Heald:

Okay, so so that is one of the mechanisms of heart disease. Obviously, we were leading to diabetes as well. But I don't want to I don't want to jump on the diabetes subject yet, I want to make sure that I've understood and we've worked through how changing your metabolic health for the better reduces your heart disease. So let's assume I've spent my life abusing myself with too much sugar. And I've got this inflammation in my myself and my, my blood vessels. And, and my insulin sensitivity is greatly reduced, my insulin resistance is high. And I may or may not have ended up with a heart attack, but I clearly am on the road to heart disease. What happens when I reverse course, and start following the recommendations that you make to get metabolically healthy talk about how it affects us? Yeah, so I really,

Dr. Philip Ovadia:

I think the most important thing is that we stopped doing that damage, you know, there's still some debate about you know, whether we can undo the damage that was done. But it's clear that if you at least stopped doing the damage, you stopped or causing further damage, the body does have capacity to, you know, regenerate itself in in some ways. But even if we, you know, even if we can't undo the damage that's already been done, if you've had a heart attack, and there's a you know, permanent scar on your heart, and a portion of your heart is no longer working as it should, which which occurs. If you improve your metabolic health you get, you stopped doing damage to the rest of your heart, you can get the rest of your heart working better, then you can minimize you know, the effects that you're going to have from that heart attack so you can improve your overall health, improve your overall heart function, even though you might not be able to undo the specific area of damage that may have occurred from a heart attack that you already had. And obviously, the sooner you do this, you know if you get to it before you have the heart attack, you're going to you know be able to prevent that heart attack from occurring and prevent the damage from occurring in the first place.

Jack Heald:

So these are all we're talking about things that a person can't see with the naked eye we're not talking about losing weight or getting stronger or having more energy we're literally talking about the mechanical and the chemical aspects of abusing yourself metabolically and the and the benefits of getting it straightened out. I have one at least one more question that I want to I want to understand when a heart attack happens it's the blood flow into the or through the vessels that are acting as fuel for the heart rather than as the gasoline that's being pumped what what is happening in the heart when that fuel supply and I'm that may not be the right metaphor, but it's the best I can come up with what actually happens in the heart when that fuel supply is diminished and choked off what's going on that ends up causing the muscle itself to be scarred

Dr. Philip Ovadia:

Well, yeah, the muscle dies, you know the muscle that is served by that blood vessel that is blocked off now. That area of muscle is no longer getting oxygen. And the the medical term for it is it becomes ischemic But basically, it means it's no longer getting oxygen. And if that goes on for too long, ultimately, you know, though, that area of muscle is going to die. It's just like, you know, any other muscle in your body without oxygen, you know, is not going to survive. If you put a tourniquet on your arm, and you cut off the blood supply. You know, ultimately, the muscle in your arm is going to die. Wow.

Jack Heald:

So I'm assuming this isn't something that happens. Quickly, the heart attack itself, I guess seems like it's fast. But but the the lead up to it takes quite a bit of time. Are there signs and symptoms?

Dr. Philip Ovadia:

Well, there can be. So there, there are kind of two ways that heart attacks can occur. Sometimes it's a gradual, you know, it's a pretty gradual build up of the blockages in these arteries, but the artery doesn't become completely blocked. And when people exert themselves, and there's more demand for blood flow to the muscle of the heart. And the blockage won't allow enough blood flow to go through it with that increased demand, we oftentimes get a warning sign, that's what we call angina, where people will describe, you know, chest pains are tightness in their chest, sometimes they'll get short of breath. But that, you know, that's sort of a gradual event. Other times, for reasons, again, that are a little bit debated, but the blood vessel will block up all of a sudden, it's its, and the, you know, it will go from maybe a minimal blockage, maybe no blockage at all, to all of a sudden being 100% blocked, and truly no blood supply. And that's, you know, a very sudden heart attack that can occur as well. So,

Jack Heald:

you know,

Dr. Philip Ovadia:

a lot of times there are warning signs. Now, sometimes people ignore those warning signs or don't realize what those are recognize them. Right, exactly. But sometimes there are warning signs, but sometimes there are not warning signs. And people can have, you know, significant heart attacks without any prior warning signs from their heart. But, again, most of those people are not metabolically healthy. And if they're looking at their metabolic health, the markers that you know, we talk so much about for metabolic health, those can be your warning sign

Jack Heald:

traccia. Chemically, what is the what's the lab tests or tests that you're looking at? That warned about this blood sugar situation? And I guess it's blood sugar that you were talking about? What are the lab tests you're looking at?

Dr. Philip Ovadia:

Yeah, so blood sugar is an important one. And the insulin level, your you know, we usually look at your fasting insulin level can be, you know, is a very good marker to be looking at that, unfortunately, isn't looked at very often, it's not one of the standard, the blood sugar is a standard sort of marker. But the insulin level is not a standard marker. And the reason that that's so important is because, you know, we talked about that pathway that we become, we ultimately get the build up in the blood sugar that leads to the inflammation and heart attack. But before that, we said that the cells are becoming insulin resistant, and there'll be very high levels of insulin in the blood. Ah, and so if you check the insulin level, you can, you know, get warned about that process much earlier in the process.

Jack Heald:

So fasting, it sorts of fasting insulin test, a fasting insulin, you haven't had any anything in your system, that would trigger the release of insulin from the pancreas for, I guess, 12 hours or whatever the standard is. So that should if you're if you're in relatively good shape, those insulin levels should be pretty low.

Dr. Philip Ovadia:

Yes, they should be. So

Jack Heald:

don't they're not that means that you are in a state of insulin resistance. Am I my stating this correctly?

Dr. Philip Ovadia:

Yes, if you have a high insulin level, when you're fasted, that is an indicator that your body is working Coming resistant to the effects of insulin. And you are, you know, you have started down this pathway that ultimately is going to lead to you having a heart attack or other chronic conditions, which we're going to talk about.

Jack Heald:

Okay. And then I realized I have other questions about inflammation. So the inflammation in the vessels is the primary cause of that inflammation, the excess blood sugar, are there other causes,

Dr. Philip Ovadia:

there are other causes. But you know, I would say in our society today, that's probably the most common cause. But things like smoking can directly cause inflammation and damage to the blood vessel walls, chronic stress, can, you know, cause in and of itself, although there's some overlap there, because one of the effects of chronic stress is raising your blood sugar. But, yeah, there are other things that can lead to, you know, the inflammation that damages the blood vessel walls, but I would say for most people that have this problem today, it is, what they're eating, and what that you know, the effect on their metabolic health that most commonly leads to this.

Jack Heald:

Okay, so when you say inflammation to the vessel walls, when I think of inflammation, what I think of is, you know, I play basketball, I roll my ankle, it swells and it gets hot, which I assume means there's more blood flow to it or something. What is inflammation in the blood vessel? What's actually happening when you say inflammation in the in the vessel itself?

Dr. Philip Ovadia:

Yeah, so basically, what's happening is that the blood, the the, the wall of the blood vessel itself is getting damaged, and the body is attempting to repair that, which is basically what inflammation ultimately comes down to inflammation is our body's attempt to repair damage. So it's

Jack Heald:

not really the problem isn't really the inflammation, the problem is the damage, correct, that the inflammation is the body's response, trying to help?

Dr. Philip Ovadia:

Right, that's exactly it, you know, in the example that you gave, you know, when you injure your ankle playing basketball, the inflammation is the response to the damage that you did to the you know, let's say the ligament, you know, because you twisted your ankle, you landed on it wrong, or whatever you did that, you know, led to, oftentimes a small tear to the ligament. And then the body's response to that is the inflammation.

Jack Heald:

So treating inflammation without addressing the underlying injury is, at best, not very helpful, and at worst, probably can make the problem worse. Is that an overstatement?

Dr. Philip Ovadia:

No, that's it, that's a very true statement. And so, you know, again, going back to the example of your ankle, and the basketball, you know,

Jack Heald:

if you keep

Dr. Philip Ovadia:

damaging your ankle, if you keep, you know, let's say overstretching that ankle and keep damaging that ligament, it doesn't matter how much anti inflammatory therapy, you're you're, you know, using, you got to stop doing the damage in the first place. And that's the analogy with heart disease, is that, you know, when we are trying to lower our cholesterol, with medications, or with dietary changes, let's say, all we're doing is, you know, trying to minimize cholesterol is part of that response to the damage of the blood vessels. And, you know, lowering the cholesterol is just trying to basically lessen that response and, and damage to the blood vessel. But metabolic health and addressing or metabolic health is what's going to stop the damage from being done in the first place. And that's why metabolic health is so much more of a powerful tool when trying to prevent heart disease.

Jack Heald:

So you said something there that that triggered a thought my dad had seriously bad heart disease. And in the process of going through his long decline into that good night, I heard folks talking about his levels of cholesterol like he had. He was, I think one cardio cardiologist said that he was cholesterol manufacture manufacturing machine. I didn't understand what that meant at the time, but it occurs to me that what was really happening was my dad, who had I assure you is not metabolically healthy had severe damage to his vessels as the result of a lifetime of all kinds of stuff. And the body's response was cholesterol attempting to protect those damaged areas in the vessel? Is that correct? Yes,

Dr. Philip Ovadia:

that is correct. You know, the cholesterol is sent as a repair mechanism to fix the damaged wall.

Jack Heald:

So if cholesterol is a repair method, or is it is part of what's the body uses to repair, taking medicine to reduce cholesterol. I don't even I don't have a good analogy. It's just that's you're trying to stop the body from helping itself. And thinking that what you're doing is healing the problem just simply because the markers of of the repair process, which would be the elevated cholesterol, I guess. You're changing the elevated cholesterol, so it's lower. Which if you were actually healthy, it would be but you're not actually healthy. You're artificially reducing the cholesterol levels through chemical intervention. Again, I'm a complete novice here. So that's Well, yeah. Am I Am I in the ballpark?

Dr. Philip Ovadia:

Yes. You know, and I think that's the central problem with our current, you know, the current mainstream approach to heart disease is only to deal with the high cholesterol problem, and it's not to address the underlying metabolic health problem. And so we may, you know, that may have some small benefits to it. And in some situations, we do see some benefits from lowering cholesterol, but it's not having the major impact that addressing our metabolic health problem would have.

Jack Heald:

Okay, well, this has been this has really helped me understand the mechanism of what's going on with heart disease, and how it's related to what I stick in my mouth. I feel like we've just we've pretty thoroughly covered this issue, and I think that makes for a good show all by itself. Can we talk about some of these other things in the next episode?

Dr. Philip Ovadia:

Yes, I think we definitely should. Alright,

Jack Heald:

well for Dr. Phillip Aveda I'm Jack Heald for the stay off my operating table podcast. You can follow Dr. O on Twitter at I fix hearts and see his website at OBEDIA heart health calm that's fo VA dia. We'll talk to you next time.