Dr. Joel

Is it possible for someone with a stent to go plant based and eventually, safely, get off all of their heart medication?

Question:

Is it possible for someone with a stent to go plant based and eventually, safely, get off all of their heart medication?

Answer:

Aspirin is required lifelong and for the first year a second blood thinner is mandatory.  Others? Possible but must be monitored for vital signs and lab values. 

Joel Kahn MD

Is Juicing ok for a heart attack survivor?

Question:

I have been reading your book, The Whole Heart Solution. I was wondering what your thoughts were regarding Dr. Esselstyn's no juice or smoothies. I noticed that you encourage both in your book. Do you feel that ideally, someone who has had a massive heart attack would be better off staying away from the juice and smoothies and chewing their fruits and vegetables?

Answer:

I would not connect smoothies and juicing to actually having a heart attack. No way. Dr Esselstyn wants us to chew our veggies to activate a system that makes more nitric oxide in our bodies. I imagine if you chew juice or a smoothie the same thing happens. But ditch the fish and oil. 

Joel Kahn MD

Carrageenan, is it safe?

Question:

Hello, My question is about Almond Milk that has carrageenan as an additive. I was reading the ingredients on a container of Almond Milk recently and one of the ingredients is carrageenan. I have heard carrageenan is bad for you and it could even be carcinogenic. I looked up some research and see several papers agree that carrageenan could be risky to consume. I try to avoid carrageenan. I only buy products without it (including pet food). What are your thoughts on this?
 

Answer:

I searched and there is no new data.  Almond milk with carrageenan is a better choice than cow's milk unless you have GI issues.  Of course if you find a brand without it, even better. For my family, I have decided to purchase products that are free of carrageenan in order to avoid even a remote chance that they're pro-inflammatory and raise blood sugar.  

Joel Kahn MD

Dr. Kahn from Camp Reboot: Should I juice?

Dr. Kahn is the keynote this speaker at Joe Cross' Camp Reboot, but took a few minutes to discuss all things juicing with us!

To Juice or Not To Juice Your Veggies? Some thoughts from Camp Reboot

For more information on Camp Reboot, click here

If you haven't seen Fat, Sick, and Nearly Dead and it's sequel, they are worth a look. You can find them on Netflix. Here's a preview:

For a limited time watch the film free: http://www.rebootwithjoe.com/watch-fat-sick-and-nearly-dead/ 100 pounds overweight, loaded up on steroids and suffering from a debilitating autoimmune disease, Joe Cross is at the end of his rope and the end of his hope.

Joel Kahn MD

Chronic disease runs in my family. I think my genes are at fault. What can I do?

Is your health determined by the genetic code you inherited from your mother and father? Or do you have the ability to impact your fitness and longevity by practicing a healthy lifestyle? When completion of the Human Genome Project was announced in 2003 many expected that the paradigm that one gene for one malady would leave little control over our wellness.

Joel Kahn, MD

Joel Kahn, MD

That this concept was short lived was the center of conversation last night with my friend Evan. His belief was that there was heart disease in his family and it was inevitable that he would suffer the same fate. Evan was no lightweight. He had completed an advanced education degree years ago and was a successful business and community leader. The idea that his health was predetermined by his nature, or his genetic content, weighed on his mind.

The Human Genome Project determined that the human genetic code was smaller than expected, about 22,000 genes, which is "more than a chicken but less than a grape." Indeed, our genes, though not many in number compared to some species, are under the influence of our environment, and specifically our lifestyle. This scientific discovery is called epigenetics. The influence of diet, or nutrigenomics, plays a particularly potent role. While you may not eat your way into blond hair and blue eyes (genetically determined features that are not influenced by lifestyle) your risk of disease can be shifted dramatically and quickly.

The response that I got explaining this to Evan is one I share with many patients and inspires hope that nurturing our nature with a healthy lifestyle can determine the likelihood of years of health or disease. I explained to him some of the findings made by Dr. Dean Ornish in the last decade. For example, in a group of men with low-grade prostate cancer placed on plant based diets along with stress reduction and walking programs, 453 genes controlling tumor growth were less active and 48 genes related to tumor suppression were more active after only 3 months. In another study using the same program in 63 men with heart disease, 3 months after making lifestyle changes 26 genes were expressing different amount of proteins and after 1 year 143 genes were doing the same, reducing proinflammatory activity that harm arteries. Finally, if it is the fountain of youth you are after there is even more hope. Following the Ornish lifestyle program for five years led to measurements of relative telomere length, a marker of aging, disease, and premature morbidity, to increase favorably while a control group demonstrated the usual shortening or aging. Other factors that may play a role in controlling our genes included sleep, stress, exercise, and environmental exposures.

The power of understanding that we are not doomed to live out a pre-determined path controlled entirely by our genes is empowering and Evan responded with excitement. I could sense that relief and hope resulted from my brief scientific overview. While we have much to learn about the amount of control we have over the genetic input to our health, and the most effective methods of producing desired results, we should not wait. Clean food, air, and water along with sleep, and the avoidance of smoking and unmanaged stress is a powerful plan for nurturing our nature.

Are MD's telling me everything I need to know about heart health?

You said what most people have learned about LDL and HDL cholesterol is too simplistic to accurately assess their heart health. Would you explain?

JK: Let’s start with LDL cholesterol, the so-called "bad cholesterol." The standard blood test most Americans receive just gives you the raw LDL number, as well as your raw HDL number and overall cholesterol number. But that raw LDL number isn’t enough to ascertain your risk for heart disease. Two people can have the same LDL number, but one may have a much higher risk for a heart attack and the other may not have much risk at all.

The difference in risk largely depends on two other factors that the standard blood test doesn’t measure: the number of LDL particles and their size.

A good analogy is a stretch of highway with 100 passengers. If those passengers are driving 10 to a minivan, then the road isn’t congested—there are only 10 large vehicles on it. But if all 100 passengers are riding in individual cars, you have congestion.

The same thing happens with LDL cholesterol. If you have many LDL particles with only a small amount of cholesterol in each one, that’s of concern, because your arterial highway is very congested. But if you have fewer and more packed particles, your arterial highway might not be congested at all.

Two people can have the same LDL number, but one may have a much higher risk for a heart attack and the other may not have much risk at all.
— Joel K. Kahn, MD


This situation typically arises where people have a low LDL number, but it could also occur where someone has a higher LDL number. Let’s say your LDL is 160, and your overall cholesterol number is 240. Without further data, that isn’t looking very good. But if you have a relatively modest number of LDL particles, maybe 1200, the results aren’t so unfavorable. A second person with the same overall cholesterol and same LDL number who has 2500 or 3000 particles has a much higher risk of a heart event.


What LDL particle numbers and sizes are considered desirable, and which are of concern?

JK: So far, only a few large data sets have looked at these more advanced cholesterol panels, but here’s what we know: An LDL particle number close to 1000 is at the lower risk part of the spectrum, and numbers of 2000 — 3000, which routinely arise, point to a much higher risk.

When it comes to particle size, the bigger the better. Small particles are typically sized 19 nm or under. Hard and dense, they’re like small "golf balls" that knock into your arteries to cause plaque. Bigger particles are generally over 21 or 21.5 nm. They tend to be more spongy and much less likely to harden your arteries. And they’re changeable. Lifestyle changes particle size better than anything, though of course medications can do this too.

So, get an advanced cholesterol panel, at least once. These days insurance companies are covering it pretty routinely. Even when they don’t, the cost is way under $100.

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What is Vitamin L and why is it important to heart health?

What is Vitamin L and why is it important to heart health?


You say in The Whole Heart Solution that more than 75% of heart disease diagnoses could be prevented. That’s an outstanding figure. How do we know this is true?

JK: Predominantly from studies that were designed this way: Let’s take 20,000 people that on entry have no detectable heart disease—no chest pain, no bypass, no stents, etc. Then let’s take detailed histories of their lifestyle—do they smoke, what do they eat, do they sleep well, etc. Let’s follow them for 15−20 years, and at the end of that time period, reassess: Who’s had a stroke, a heart attack, a bypass, a stent. And let’s look at the lifestyle that predicts freedom from having a heart event.

Many of these studies have been done and reported on in the last 10 years. They’re from all over the world: from England, Sweden, the U.S. They encompass well over 100,000 people, and they all have remarkably similar findings, which are: With a simple pattern of habits that are not expensive and not exotic, you can achieve more than 75%, an even up to 85% heart-attack free, stroke-free life.

Joel K. Kahn, MD - Holistic Heart Doc

Joel K. Kahn, MD - Holistic Heart Doc

The results are pretty conclusive, and personally I think we’re likely to get even better results, higher than 85%, if we add in medical evaluations, which these studies didn’t require.

I’m very excited that lifestyle, or what I like to call Vitamin L, is the key factor in heart disease prevention.


What’s the protocol for "Vitamin L"— the healthy lifestyle habits that give up to 85% heart disease protection?

JK: Five essential lifestyle habits consistently appeared across all the studies:

Don’t smoke. We don’t know and still debate what about smoking is so dangerous, but all the studies reinforce the now 40-year-old notion that smoking is an extremely bad habit.
Be active. We’re talking moderately active. These studies didn’t ask how many pounds you can clean jerk or how many spinning classes you took last week. They asked, "Do you walk 30−40 minutes a day on average?"


Control weight. The weight parameters aren’t extreme either. The general guideline is to maintain a relatively healthy weight. The most consistent finding is a prediction of freedom from heart attack for men who keep their waists under 40 inches and women who keep theirs under 35. These also predict freedom from diabetes, and, to a lesser extent, freedom from stroke and cancer.


Consume alcohol in moderation. This finding is very controversial, but the data is the data: Almost every study showed that some consistent use of alcohol was favorable in predicting up to 85% freedom from heart attack. And it’s interesting, because different countries have different alcohol cultures, but the results indicate that one ounce of hard liquor, five ounces of wine, and eight ounces of beer are relatively equivalent in protection. Some studies showed positive results with a few drinks a month; others supported as much as daily ingestion of one drink.


Seven hours of sleep on average. This relatively novel finding, assessed in just a few of the studies, is that if you average fewer than seven hours of sleep a night, you’re at significant increased risk of heart attack. The Morgen Study of 1,000 people, for example, found that the people who did all the lifestyle habits we’re talking about but typically slept under seven hours had about a 65% chance of being heart attack-free, compared to up to 85% for those who got seven hours. Good sleep offers a substantial amount of heart attack freedom.


Five or more servings of vegetables and fruits a day. I saved this habit for last because it’s the one people hit the least--only 1−3% of Americans do it—but it’s the most important. Every single one of these studies said that five plus servings of vegetables and fruits a day is that "special sauce" in achieving the up to 85% number. And there’s no reason we can’t do it. It’s simple and very doable. It’s not expensive, no one specified you have to eat organic produce, although we could talk about whether or when going organic might be helpful in some instances.


That’s the program. And we should be teaching it as the "holy grail" of heart disease prevention in this country, where heart disease is the #1 killer of both men and women over 30.

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I sit the majority of the day. Is this unhealthy?

Dr. Joel - Holistic Heart Doc

Dr. Joel - Holistic Heart Doc

I took a plunge into the modern world this weekend by using my Uber app for the first time in Boston to navigate my daughter's university graduation schedule of events. Without the glass barrier normally found in NYC cabbies, I had a chance to talk with the drivers and the conversation turned to the amount of time spent sitting on the job. Fortunately, most of these drivers were doing it part time between other jobs and school schedules but it prompted me to pause and consider the masses of persons who do sit all day in order to make a living. Does their health suffer?

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Is juicing OK on a plant-based diet?

I wear a few different hats in life. For the past 25 years, I have taken care of a large number of heart patients. I’m a professor at Wayne State University School of Medicine, the largest medical school in the United States.

I also educate the public through articles, videos, and TV messaging. And I own a plant-based restaurant in suburban Detroit. My various endeavors all serve the same purpose: to spread the message that health begins at the end of your fork (or as some restaurateurs might say, I put my money where my mouth is).

I have incorporated juicing of vegetables and fruits into my own health practice over the years, and have advised and demonstrated it to many patients. At Wayne State, I am required to teach medicine in a manner that can be supported by research and human physiology.
Can I sway the medical school faculty to support this juicing practice? There may not — yet — be a randomized study of fresh green juice versus placebo, demonstrating clearer arteries or superior mitochondrial health. But I maintain that the practice of drinking juices containing vegetables and fruit — particularly unpasteurized, in order to preserve as many nutrients as possible — is a sound habit. Let’s take a look at my reasons.


1. American adults are not eating enough vegetables and fruits.


(Shocked?) Of all the health habits recommended by the American Heart Association (AHA) to achieve a 20% improvement in overall heart health by 2020, we are failing miserably at achieving an ideal diet. For example, about 20% of American adults smoke, only half regularly exercise, and while 30% have an ideal body weight, fewer than 1%  maintain a diet rich in vegetables and fruits. The goal of the AHA is to increase this all the way to a whopping 1.2% by 2020. How embarrassing!


2. American children are not eating enough vegetables and fruits, either.


Surveys of dietary patterns in children show zero increase over the last decade in the number of daily servings of vegetables eaten by children. No group studied met the AHA’s goal of 1.1 servings of vegetables per 1,000 calories. On the plus side, at least children’s fruit intake increased slightly over the past ten years.


3. Our sodium to potassium ratio needs a makeover.


Our western diet has way too much sodium, particularly in processed foods, and is deficient in potassium. This flip of the normal ratio that’s found in whole foods and plant-based diets leads to hypertension and arterial disease. Vegetables offer a means of restoring this ratio to a healthier balance.


4. We are missing out on dietary magnesium.


Magnesium is a cofactor in more than 300 enzymes in the body and is crucial for heart, brain, respiratory, reproductive, and GI health. It is estimated that over 80% of American diets are lacking in enough magnesium. Fruits and vegetables, as well as nuts and seeds, are rich sources of magnesium, and increasing our intake will improve our overall health.


5. Drinking even “poor quality juice” has health benefits.


While we lack good scientific studies on cold-pressed juices, many of us can attest to seeing improvements in our clinics. However, even juices produced under less than ideal conditions have been shown to boost antioxidant status, assist in weight loss, and reduce blood pressure.
The scientific facts I’ve reviewed here would bolster my defense to my university colleagues of the practice of fresh vegetable and fruit juicing as a path to optimum overall health, for adults and children alike. Juicing is one way to hack the sad shape of the Western diet, by efficiently boosting the intake of vitamins, antioxidants, minerals, and phytonutrients.


I always strive to motivate my patients to eat as many whole, plant-based foods as they can on a daily basis (both raw and cooked), and juicing can put them over the top, enjoying the best odds of health and longevity in a society that favors nutrient-poor, processed, and fast food diets. I look forward to the day when fresh fruit and vegetable juices replace donuts and bacon in hospital cafeterias. 

Joel Kahn MD

Do I need to take any vitamins on a plant-based diet?

Can you believe that some people promote plant-based whole foods, vegan diets, but still tell you to take vitamins? If vegan diets are so healthy, then why didn’t Mother Nature provide every single cofactor and supplement we need? 

OK, I admit it! I'm one of those folks who considers a vegan diet to be the best blend of health and kindness. In fact, I recommend it to patients with heart disease hoping to reverse atherosclerosis and to anyone who wants to avoid blockages in the blood supply to their brain, heart, and sex organ arteries. (Eating healthy for erections proves to be a more compelling argument in my clinic than eating to prevent a heart attack!) 

And despite all these wonderful benefits of a plant-based diet, I still recommend vegans take supplements. If this is a flaw, then, to be fair, we should also consider the processed food and animal-rich diets eaten by most “civilized” societies as seriously flawed. Unfortunately, the “supplements” of Western diets are called insulin, statins, and chemotherapy. 

If you choose to shun eggs, meat and dairy, and exist on the cornucopia of vegetables, legumes, seeds, beans and nuts, then consider the following additions to your diet.


1. Vitamin B12

Vitamin B12 is important in brain, nerve and hematologic health and is a factor in a key process called methylation, which regulates homocysteine levels and plays an important role in the control of DNA regulation called epigenetics. It's well known that animal products are richer in Vitamin B12 than plants. Actually, neither plants nor animals make B12. It's produced by bacteria that reside in the gastrointestinal tract of animals other than humans. When animal products are eaten, often  B12 is ingested as a bystander. 

By some estimates, 50% of vegans 10% of vegetarians are deficient in Vitamin B12. I recommend taking about 3,500 ug once a week of Vitamin B12, ideally as a liquid, sublingual, or chewable form for better absorption or 500 ug daily if that schedule works better for you.  

2. L-carnitine 

This is an amino acid that has been in the news of late for its possible role in promoting hardening of arteries. L-carnitine plays an important role in shuttling fatty acids across membranes to fuel the production of energy in the heart and other muscles. In vegans, the ingestions of L-carnitine did not raise levels of factors promoting blocked arteries.  

L-carnitine is found mainly in meat (think carne as in chile con carne) and vegetarians have lower levels of L-carnitine in their muscles. There are reports of heart disease in patients lacking this amino acid. Although long terms studies of L-carnitine supplementation in vegans are not available, I consider supplementing vegans with 500 mg a day as a recommendation for optimal health, particularly in those who are athletic or with heart disease.

3. Taurine

Taurine is the most abundant amino acid in the body and you've probably never heard of it beyond the world of energy drinks. But taurine is important to your cardiac health, immune system, insulin action, hearing, and electrolyte balance, and it's typically found in meat and seafood. Vegans often have low levels of taurine. 

Supplementation with 1,000 mg a day is a reasonable option, although a dose of 15 to 3 gm a day are used in diabetic and cardiac patients. Energy drinks often contain taurine, but they're not advised due to the caffeine, sugar, and other components.

4. Vitamin D

The last, but not the least, supplement to consider for optimizing a vegan diet is Vitamin D. This is known to promote bone health but is proving to be essential in blood pressure and blood glucose control, in heart function, and in brain function. Measurements of blood levels are the best way to assess adequacy of Vitamin D. 

In a study of over 65,000 residents of England, researchers found that vegans had higher levels of fiber, magnesium, and Vitamins E and C compared to their carnivorous counterparts. Vegans, however, had lower levels of Vitamin D. 

Direct sunshine on exposed skin for 20 to 30 minutes a day can provide adequate Vitamin D, but for many of us (especially those further from the Equator!), oral supplementation is necessary. Vitamin D3 is the form most commonly recommended, but is usually derived from animal sources such as lanolin. If this is not acceptable, vegan versions of Vitamin D3 are now available. 

Vitamin D2 comes from plant sources and is rich in mushrooms, but is not as reliably absorbed. While the standard recommendation is to supplement with 800 IU a day, I started routinely adding 4-5,000 IU a day in order to reach blood levels of 50 -70 ng/ml.

Scientific research has shown that plant-based, whole foods, vegan diets reduce the risk of obesity, dementia, diabetes mellitus, heart disease, cancer, erectile dysfunction and arthritis among other benefits.  

Animals are not harmed and the carbon footprint of a vegan is a fraction of an omnivore. The multiple benefits of a vegan diet supplemented with four inexpensive nutrients a day for optimal health is a lifestyle that I hope you will bring to your mat and life.

Joel Kahn MD