Holistic Heart Doc

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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