#414: The Untold Truth About Heart Health: (Women, Genetics & the JOY of Longevity) | Dr. Regina Druz Reveals All

Welcome to Longevity. I'm your host, Natalie Nidham. I'm a nutritionist, a human potential and epigenetic coach, and I created this podcast to bring you the latest ways to take control of your health and longevity. We cover it all from new technology and ancestral health practices to personalized interventions and a very special interest of mine, peptides and bioregulators. Enjoy the show. Welcome back, folks. I'm Natalie Nidham, your host. Most cardiologists don't talk about joy, purpose, or the heart having its own kind of intelligence. But today's guest does. I'm joined by Dr. Regina Drews, a cardiologist who went from elite academic medicine to completely rethinking how we approach heart health. We talk about the moment traditional cardiology stopped answering the questions she was seeking in real patients, why prevention and personalization matter more than ever, and how vascular aging quietly shapes everything we call longevity. 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You can save 15% at bioptimizers.com forward slash bio nat and use code bio nat for 15% off any order. Look, it's not about knocking yourself out. It's about supporting your body in the way it was designed to work. Dr. Regina Cruz, welcome to the show. It is an absolute pleasure to have you here and very much looking forward to this conversation. Natalie, thank you so much for having me. Well, we met at a conference in New York, the Her Longevity Conference in the fall. But before that, I'd heard of you through one of the women who attends my longevity retreats in Sedona because you work with her, you treat her husband as a patient. Oh, wow. Yeah. And she had said to me, oh yeah, my husband's cardiologist. She's all over the stuff. You absolutely must meet her. And I was like, yeah, yeah, yeah. You know, everybody's always telling you that. And then when we met and I heard you, you know, I heard you speak at the conference. I was like, yeah, okay. She's right. We need to talk. And I think part of it for me also is we don't often get a female perspective in the cardiology world. I'm all about gender equality and whatnot. I think men have lots, obviously have so much to offer, but I think that when we have a lack of female voice in this space like this, it does women a disservice. Would you agree? I mean, look, a doctor is a doctor, a doctor, and a good doctor is a good doctor, but what are your thoughts on that, on bringing a female perspective to different topics like this one? Natalie, I think you're spot on because in cardiology, we sort of recognized quite a few years ago that women as patients, for example, were underrepresented in a lot of cardiovascular trials. So there was been an expanded focus on trying to figure out what might be different for patients for women versus patients for men. And sort of the, I guess, side effect of that, I don't know if we can call it a side effect, but related to that was a recognition that women as physicians are still not, don't have parity in cardiology, right? We still are the minority. And so American College of Cardiology, American Heart Association have been very active in promoting women cardiologists, creating opportunity for women in cardiology so that we could bring our perspectives and our life experiences to cardiovascular disease. And boy, oh boy, there are a lot of these experiences that we can bring for sure. Well, I mean, aren't women more likely to be underdiagnosed or misdiagnosed when it comes to cardiovascular, or at least they were. I don't know if that's changed much, but I know that in the past, like, you know, a woman presents at the hospital with cardiovascular symptoms or stroke symptoms and very often would be sent home. Like they just were missed. That's actually true. Although I think the pattern is changing, you know, a lot of work has been done to educate practitioners, to create initiatives, but a lot of academic institutions, for example, now have women-specific cardiovascular centers, right, or women health centers. So it has changed. It has changed to a degree. But, you know, I can tell you that at least on the institutional organizational level, the cardiovascular health, it's still not integrated the same way, for example, as breast cancer screening, right? So if you go to an institution, a health hospital organization, and you look up online and you see they offer women's health, right? There's a women's health center. The procedures offered there, for the most part, are diagnostics for breast cancer prevention, which, of course, is very important. But the fact remains that cardiovascular disease kills 10 times as many women as breast cancer. And so where's that level of screening? right? So I think we did a good job educating practitioners, physicians, and even some women, not all women, that symptoms that women experience may be atypical. That's what you're referring to. And they should be taken seriously, right? But we haven't really extended that into like, what happens before the symptoms, right? And we're going to get into that because menopause plays a big role in, in that evolution of, of, of how things change. But before we do that, I'm, I'm jumping ahead of myself, which I sometimes do. I want to go back to, to the beginning of Regina. And when, you know, if we go back even to your childhood, like when, when, when is it, you know, even in your childhood, what, can you think of the first moments where you became aware of the heart, whether it's emotionally or physically, Like even before you knew you'd become a cardiologist, like was there, was, was there something in your childhood that if somebody had been looking back then saying, ah, look at the direction you were going in even then? You know, there probably was in a world trajectory, not necessarily a childhood defining moment, more like young adult defining moment, which was a little funny, but you know, my parents are not physicians. we come from what used to be a former Soviet Union Republic of Ukraine, now an independent country of Ukraine. And my aunt and my cousin were physicians, but they were OBGYNs. And so, you know, in my family, it was always thought that, you know, if I'll become a doctor, I'll be an OBGYN. And so when I told them I am becoming a doctor, but I likely will be a cardiologist, they were absolutely shocked. They were horrified. They're like, cardiology for a woman? Are you insane? And I'm like, no, I'm not insane because there is a need for it. And that's what I like. And I think I honestly realized I'll be a cardiologist in my first semester of medical school. We had a lecture on patrophysiology, basically how things work and how things break when they're diseased. And a lecturer was giving us information on cardiac cycles, sort of relating the electrocardiogram to all the sounds and all the little pressure tracings. And I was so intrigued by this because the beauty of the elegance, how it's perfectly positioned to respond in health and disease states. And we take it, we don't think about it, it happens on autopilot. And yet this is such a system and, you know, anything later in life, as I transitioned more into integrative or personalized medicine, you know, the heart connection, not just physiologic, but emotional connection, right? Spiritual connection, you know, our heart has its own brain, right? And, and its own spirituality wiring. So heart has been at the heart of me and always intrigued by this and still having fun after nearly 25 years as a cardiologist. I love it. The fact that you get such joy out of your profession is we don't hear that often. People are motivated, they're inspired, but joy is not something that comes up very often. And that comes through when you speak. I have to say that when I heard you speak at Her Longevity, when we met, when we had dinner, wow, you bring a different energy to the space than we normally associate with doctors, which I think it's part of your passion for what you do, which really comes through. So if I'd met you as a young doctor at Cornell and New York Presbyterian, where you got your beginning, what was the standard cardiology playbook you trusted most at that time? And where has it changed for you? It's a great question. So back then, right, you know, we're going like, you know, in medicine, we say age of the dinosaurs, but maybe it wasn't that, you know, that, that long ago, I finished my fellowship in 2001 and New York Presbyterian Cornell was an amazing place. I have nothing but great memories. Most of my attending physicians were men, right? As is predicted. If there were women cardiologists, they were sort of hidden, you know, they were kind of like in the areas of cardiology, which are sort of like bread and butter areas, but not necessarily, you know, the sexiest top of the line, you know, they were not placing the newest stents or wiring the latest pacemakers. You know, they were more like, you know, doing clinical work or cardiac imaging, which was my area where I went into. And so what I remember is really, you know, those large portraits of esteemed physicians that were lining the holes of, you know, back then was Cornell University became while Cornell School of Medicine, all of them male and sort of trying to look up to them and trying to think like them and trying to emulate, you know, this pattern of very traditional cardiology, right? You know, and that traditional cardiology had accomplished extraordinary advances. It had saved countless lives, but pretty soon within five to 10 years of this, I began to realize that it also missed and continues to miss in many ways an opportunity that all of us as humans want, which is that opportunity for prevention and personalization. And so I realized, you know, 10 to 15 years down the road, which is sort of like that interesting space as a professional, you're good enough, you're experienced enough in what you need to do and you do it really well. and that when you're finally on top of that mountain, all of a sudden you start seeing that there are some other peaks that you have not even known existed before, right? There's other peaks that are yet to climb and once you see those peaks, you can't unsee them. And so I had a little bit of, I'm not gonna, not a crisis, but I had a realization that something is missing. And I realized over time that we made such tremendous strides in disease management and we continue to make those strides, but we have done next to nothing in health optimization. And so I think now in heading into greener pastures and taller peaks, especially with artificial intelligence and sort of NF1 approach, this is where that opportunity finally presents itself, not as an academic pursuit, but as something that each individual can do for themselves. They can create that change that they need in order to optimize their health. Yeah, I love that. So was there a particular patient or event that kind of in your career that secretly kind of haunted you or provided that crack in your faith that allowed you to see those? You know what I mean? Sometimes there's just there's something happens and you're like, yes, there's got to be a better way. Yes. So I had a patient and I had a drug rep. You know, a patient who I get, actually, there were a couple and I write about them in my upcoming book. So they were an older couple. They were not necessarily a couple of means, sort of, you know, in their 60s and 70s, each of them had some chronic conditions. And so they would come to us for cardiology evaluation. And usually that would involve what we typically do with patients, getting some imaging studies, physical exam, doing something called a stress test. And at the time I was directing this whole section in the hospital where I worked, this stress testing section. And it was amazing to me that those individuals, even though they were older, they were in their 70s, they actually did very well, better than expected based on their age and gender. right? Because we'll always look, you know, what should people actually do? It depends on person's age. It depends on cardiovascular fitness. So there are some norms in traditional cardiology. And so they did much better than that. And it intrigued me because the pattern that I was seeing was actually the opposite. I was seeing younger patients doing worse than expected. Here were older patients doing better than expected. So I started asking them and I learned that they were following some specific nutritional advice, nothing too crazy, just eating more vegetables, eating more fruits, daily walking, they were gardening, they were in relationship, they were together. And I thought to myself, it's interesting because these are not the type of things that most people shouldn't be able to do, but yet it's having such a profound impact. And at the same time, as I said, you know, drug reps were the norm in health institutions. I think right now it's a little bit more regulated. But, you know, back then it was, you know, they would come, they would, you know, present new medications, they would bring lunch to the whatever departments they were lecturing in or sponsor a conference. And so I met a drug rep who was just like me from the former Soviet Union. She was of the same age. Actually, our birthdays were exactly the same. And so she was like my sister from another mother that just surfaced. And she was representing a company that had one of the major cardiovascular drugs. But on her own, she was a supplement queen. So she would always bring me. I know some sort of first it was essential oils, then it was some sort of other supplements. And, and, you know, and her name was Alena. And I said, Alena, I said, we can't really have this here. This is like a hospital. This is not a supplement store. And I blew her off, you know, for, for a little bit. And then, you know, but I kept on thinking about this, this couple, and they sort of were percolating through my mind. And I listened to something, I think, online. It was Dr. Mark Houston. And so Dr. Mark Houston at the time, he was doing a lot of work for A4M. He was giving presentations. He was giving modules. And I looked through the whole roster of presentations and the only available module was the last one, the closing sequence. So I went to, you know, I went, there was no virtual education back then. And so I went in and, you know, I signed up for that last sequence. And so we were in the room with people and he approached me during the break and he says, who are you? He says, I have not seen you in my other modules. You know, a lot of the answers to my questions. And I know you, and I know you didn't take my other modules. And I said, well, you know, I'm a cardiologist and so-and-so. And he listened and he nodded his head and, you know, he's from Tennessee. so I won't be able to imitate the Southern droll, but he said something. And this is what he said, Regina, he said, once you drink an integrative medicine Kool-Aid, you will never look back. Now, this was Saturday and I thought to myself, what does he know? I'm a board certified cardiologist with multiple boards in the large academic institution. This, you know, this academic, you know, this, you know, integrative medicine Kool-Aid and my, you know, friend Alena with her supplements and essential oils. That's just like, that's just like, that's just not, you know, that's just not what's going to flow with my throat. And so I flew back home. Monday was my first clinic day. And that first clinic day on Monday, as if he were in a room with me, because every patient, what we discussed that weekend, that integrative medicine Kool-Aid would just appear out of nowhere. and once I started and my knowledge base was minuscule, but once in that regard, once I started even mentioning this, I had a clinic which was full and it was, you know, it was like being in a, you know, in the, in the Soviet film and being a spy because patients would come in and they would whisper to like, we hear you're a doctor who advises on supplements. I'm like, oh my God, just don't tell my chief because this is, this is going to get me in huge trouble. So that was the beginning of, you know, what became, I think, my purpose and my journey. And, you know, coming back to your comment on passion, and I thank you for recognizing that. This is why I'm passionate about it, because there is freedom in it and creativity, and there is an opportunity to change people's lives. And I fully embrace it, you know, even though I know that we are far from knowing everything. but guess what? The same is true for traditional medicine as well. So, you know, I think we are, we are more convergent now in the, in this approach than we have ever been before. Yeah. No, I think it's so, it is amazing how, and this is going to sound a little woo, but it is amazing how the universe moves sometimes. It's almost like, you know, you'd seen the peaks and you weren't exactly sure what to do with them. And then you go to this one talk with this one physician and it just cracks the door open and it changed the trajectory of your, of the way you practice medicine forever. You never went back. I never, I never went back. And, you know, I never went back because that vision that transpired in that room over the weekend and, you know, the concepts that he sort of, and he took all the concepts that, of course, we knew about those concepts as cardiologists or primary care physicians, but he brought it to a clinical level, to a patient level, didn't really exist in the traditional cardiology practice. And unfortunately, it doesn't exist even until this day. I just read an article and I'm writing a blog post on it on Substack about a discussion. There's a great debate amongst cardiologists that was published in European, I think, card journal on the approach to lipid management. And so I learned a new term. Yes, I learned a new term is called fire and forget. So I'm writing an article about fire and forget rebellion because fire and forget is a strategy where a patient comes to a physician, they have elevated lipids, high cholesterol, and they're given a prescription and told to show up whenever for the blood work, right? And that's fire and forget, right? There is nothing really personal about this. It's sort of like putting people in the box. And so the debate in the article is about fire and forget and personalized strategy. And just the very fact that we've been having this debate in a mainstream cardiology journal, because European Heart Journal is a very large cardiovascular journal that people read all over Europe, European Society of Cardiology is one of their main journals, written by people that are knowledgeable in lipidology. And, you know, I'm seeing people who are quite quitting their doctors over this fire and forget strategy. Yeah. Fire and forget means they're given something and then sent on their way. Nobody follows up. Nobody checks to see if it's working, really. They might check to see if it's working and then give another prescription. So in other words, what the patients want to know is the why. What the doctors are giving them is the what, right? So that's where the disconnect is. That's why, you know, what we do, our model at the Holistic Heart Centers is the opposite of that, right? You know, we look at the why first so that we know what to do, right? You know, the traditional cardiology is the reverse, you know, this is what it is and This is why we're giving you something. Right. So you basically got to a point in, you know, going from a national expert in cardiac imaging and a hospital-based cardiologist, you basically got to the point where you couldn't practice the cardiology you wanted to practice anymore. And that's why you started the Holistic Heart Centers. Right. And so, you know, the mental disconnect was there and also the cardiology at the time, sort of in mid-career, this was a challenging time for cardiology because reimbursements were falling. There were a lot of consolidation of cardiology practices. All of a sudden, this distinction between private practice community cardiologists and academic cardiologists was blurred and reversed because it used to be that academic cardiologists they would be just as I was speakers at national conference experts they would write articles and highly regarded. And of course, the community cardiologists were highly regarded too, but they were known as the worker bees. And virtually overnight, you know, the hospitals and healthcare system said, you know what, those worker bees bring in good revenue, let's shift the paradigm and the entire paradigm shifted. And, and I think it continued to shift even after that, that at that point, you know, my mind was paid up and, you know, some of my colleagues said, what are you doing? You're committing career suicide. And I didn't have an answer at the time, you know, and, you know, a big part of me thought that perhaps they're right because, you know, opening private practice in a location that is so saturated with cardiologists that you could literally, you know, have the same test 10 times in a span of one mile if you just wanted to have it done, you know. But division was there. And so I'm happy that it worked out. I don't think it's just luck. I think, you know, luck, you know, was that famous, no luck there. There is this famous saying, but Louis Pasteur, right? chance favors a prepared mind. So that was a situation, I think, of a prepared mind. A hundred percent. So you went on to create Fit in Your Genes as a precision cardiology program. What problem does this program try to solve that standard cardiology just doesn't, it misses, doesn't even see, doesn't even acknowledge it really? Right. That's a great question. Thank you for asking. And going back to that, you know, fire and forget versus personalized approach. That's exactly the gap that the program is poised to solve, right? So instead of trying to fit a patient to some sort of a framework system that puts them in a box, fit new genes, personalizes patient's assessment of cardiovascular risk, and gives them a pathway toward health optimization so that we can pick the right strategy that it's going to lower their risk and of course optimize their health and longevity. So this is a 180 degree reverse of how traditional cardiology is practiced, certainly from the preventative strategy. And it's interesting because it also may work, of course, and it's beginning to, even in cases where the management is really disease management, like for example, picking the right medications after a person had a heart attack, we're beginning to bring some of the philosophy of this strategy even into that domain. But it's primarily focused on prevention and personalization. And what that means practically is that if a patient has elevated lipids, they don't get an automated statin plus ZEA plus PCSK9 inhibitor, which is what cardiologists are doing now. And each of those medications has their role. They're very important medications. And for each person, there might be a specific need for a specific medication, but we don't start there. We start with figuring out what is going on with this person genetically. What is going on with this person with regard to their metabolism? How are they measuring up with regard to their hormones? What's their stress is like? What their sleep is like? What their microbiome is like? And can we create a personalized map that gives us guidance? Because the goals are still the same. We want a healthy vascular endothelium. We don't want them to have cardiac events or ischemic events. We want good blood pressure. We want optimal lipid profiles. We want lowering of inflammation. So our goals between traditional and integrative cardiology are, we are aligned, you know, we're not going to argue over our goals, you know, it's just how you get there. And these are very different strategies. It brings meaning to the word holistic and integrative, because I think one of the big shortcomings, if you will, of conventional, any conventional specialty and then the allopathic model is that they have a tendency to act as silos and the body doesn't work. No system in the body works as a silo. And what you're saying here is we can't treat lipids. We can't treat a cardiovascular condition if we don't understand what the contributions are that are being made by every other system in the body. It just sounds so logical. It's almost, it's almost, it's almost hard to imagine how it doesn't make as much sense to anyone. And I, and maybe the problem, or maybe the issue is it starts in the beginning in med schools where the way that med schools were designed, the education was designed was to help to create real true specialists in each one of these disciplines. And, and it's almost like it ends too soon because the next stage should have been maybe, and here, now we're going to bring everybody together and let's talk about where, what, what feeds in to each one of these, these models. Like it, it, it makes so much sense. It's so, it's so incredible that people like you are doing the work, but it's so sad that it's still such a small part of how the profession's being, this medicine's being practiced. And I guess change takes time. You know what? Change takes time, but creating change is actually quite quick. And so I think we are now at an inflection point. And a big reason why we are at the inflection point is sort of convergence of, you know, direct to consumer service offerings, whether it's blood tests or genetic tests, emergence of digital tools. You know, you and I are wearing at least one or two of them at any given time. Right. And democratizing access to medical knowledge, whether you agree with it or not, but, you know, generative AI, all these chatbots that are popping up on our screens, basically 24 seven. You know, I don't think I have met a patient recently who have not uploaded their laboratory data into chat GPT, you know? And so this is an example of that democratizing access and providing an opportunity for patients and for practitioners to shift their focus. So I think, you know, the next decade, most likely, at least in my mind, it will become less sort of professional physician-centric and much more individual and patient centric because with technology enablement and the demand, that's the shift that's already happening. And I think that will redefine our training models, right? It will take us out of that. Well, this is what the population based metrics are, which is how cardiology still practices. These are what, you know, large randomized clinical trials show us. Again, And it's, you know, populations of these patients versus those patients. It is, you know, the pendulum is already shifting to trying to personalize risk and personalize the intervention. And we're going to get there faster than most people realize. Yeah. Well, I think, I mean, the rate of change, it was fast before. It is becoming, it's becoming blinding at this point. And, you know, being a physician, kind of stepping into this now, you are being, you're positioning yourself and your colleagues who are with you to meet patients where they are and to walk with them on this journey. And I think what's happening, the other shift that's happening is that the patient that's stepping into this role now is taking agency over their care and they're looking for a partner. They're not looking for someone who's going to dictate, this is what you do and don't ask any questions. which is exactly what you said earlier. So let's try to bring this into a more concrete space for the audience. Can you walk us through a concrete example of when a patient whose labs technically looked fine, that four letter F word, in a conventional office, but whose genomics, advanced lipids, or inflammatory markers told you that there's something completely different undergoing about their cardiovascular age? So great question. And I think there are countless patients like these, but I can tell you that we see patients like these every single day. So I can give you, for example, one of the most recent patients, and it's not unique to men. It could be women as well. But for men, very often they tend to be athletic and doing a lot of things that they perceive as very beneficial to their vascular health, right? And so they, you know, various exercise routines and various fasting routines. And, you know, we routinely get patients who, if you just look at them sort of physically in terms of physical appearance, they appear to be in phenomenal shape and their blood pressure is excellent and they don't smoke. So in other words, they don't have any of the standard traditional cardiovascular risk factors. And then, of course, we go ahead and we measure their vascular age. And there are a couple of ways we can do this. One of the well-known ways is to essentially get something called coronary artery calcium score or CAC. And, you know, it's easily accessible technology. It's not tremendously expensive. There are some places that actually give it for free because that's the way that, you know, practices or groups build up new patient referral basis. but it's no more than, you know, a few hundred dollars that, you know, that you spend. It's completely accessible. You don't need to even do it every year. It's, you know, so the point is, is that I used to get, as a traditional cardiologist, I used, before I sort of developed the integrative mindset, the holistic mindset, I used to get very surprised when patients like these who are so invested and committed to their effort and to have perfect lipid profiles and perfect inflammation markers, maybe a few things here and there stand out, I was surprised to find extensive coronary artery disease. But I'm not surprised anymore because we know now that whatever we do lab-wise, for example, certainly the very basic standard panels, they don't really give us the full picture, right? We're not asking what is the level of inflammation in the blood vessels? What is the metabolic profile of this individual? Do they have enough of nitric oxide to protect their coronaries? Are they oxidizing a little bit too fast, right? Is there high oxidative stress going on? Is their immune system not quite doing what it's meant to be doing? Are their hormones of balance? Are they drinking themselves into something? Are they not sleeping themselves into something? So, uh, and that actually opens the opportunity for change, right? Right. Yeah. Well, it's interesting because, uh, just this summer in my, my friend community, there's a guy who was an avid cyclist, very fit. I think 60 years old, exactly the person you're talking about, dropped out of a heart attack. Right. Which is terrible. Of a massive. And everybody walks around saying he was so healthy. And I'm sitting there going, but he wasn't. He looked healthy. Right. You know, he was walking the part and talking the talk and probably doing everything he could that he knew to do, but there was something underlying. There was some other drive. So let me ask you this. In genetics, what are some of the things that you look for that give you an indication that a patient might, you know, things might start to go sideways without, when people think they're doing the right thing. I have two questions. I have that one. Okay. And then the other one, which is, well, start with that one. And then the other one is a more loaded. So let's start on the genetic front, because I think that there's things like the way that people handle saturated fat. And then there's a narrative out there, everybody needs to eat saturated fat. Like, what are you seeing in these disconnects that people are trying to do their best, they're doing the best they can, and yet they're so unaware of their own personal settings that's changing the outcome? So I think Natalie, what you were saying about these personal settings, you know, let's start sort of backwards, right? Because one of the things that I want to make sure that listeners are really understand is that people tend to simplify cardiovascular health or vascular health in general, right? They tend to think of it in a very linear fashion and linear fashion being if I exercise more, if I restrict my carbohydrates more, if I lose more weight, I am going to be essentially, you know, age-proof in the nothing's going to touch me. Right. And so, but we know from clinical studies, and this is where the major disconnect is, is that first of all, there is no such thing as you will have a zero risk, right. To being alive means that the risk is never zero. Right. So, you know, so that's, you know, the risk is only zero when you're done, but you know, when you're alive, the risk is never zero. So let's start there. You know, Our derivatives of risk, what we think are the components of risk is not personalized. It's population-based. And a person may or may not be representative of their population because the population-based characteristics, like that 60-year-old man, he may have been told by his physicians that the typical population metrics are good, right? Lipids may have been good. Inflammation may have been good. Blood pressure may have been good. But nobody had taken the next step to personalize it. And, you know, cardiovascular disease, atherosclerosis, the process of aging of the arteries, which is, you know, you heard me speak. And, you know, we say this is that aging is cardiovascular. This is, you know, a lot of people are running around and they're saying, well, it's all about muscle. It's all about protein. Muscle is the currency of aging. And I always tell them muscle is the currency of aging, but it's your vascular system that sets the interest rates. Because if the vascular system interest rate is too high, you cannot, cannot, cannot. You won't be able to build muscle. You won't be able to maintain it. So I think, you know, and that brings us to, so what is that, you know, what is that thing that allows us, as you mentioned, to personalize the health trajectory of an individual? And genetics is the blueprint. Genomics is the interaction of environmental inputs with the genetic blueprint. And that's the area where interventions could actually change a person's trajectory. So, you know, these statements that, you know, saturated fat is bad, saturated fat is good. I just saw an article in passing that major study came out looking at incidents of dementia and they found that people who ate more saturated fat had less dementia. But again, they excluded some of the high risk genetic variants. So I think as we go into the future, we're going to become more precise and more personalized beyond these superficial, because right now these metrics, as important as they are, lipids, blood pressure, sugar control, obesity, smoking, sedentary, these are really impactful metrics, but they're population level metrics. They're first base, so to speak. Not about you. Not about you. It's not about you. So tell us a little bit about what are the genetic lines people need to look at that's going to really help them to take it out of that population because there's still a population for you. It's just not the general population. Correct. Right? There's going to be a population of people who, like for me, in my genetics, saturated fat will drive inflammation. Exactly. So I have people in that population that relate to me. We're just not part of the whole population. Correct. Your parts. So this is, you know, this is interesting because this is actually, this line of thought, believe it or not, comes from mainstream traditional cardiology literature. And when I spoke in London in June at the Integrative Health Symposium, I showed the papers and I showed, you know, the article and the definitions, and this is called deep phenotyping, right? So we are moving away, or at least we're trying to move away from these superficial phenotypes. Is a person overweight? Is the person hypertensive? Do they eat too much salt? Do they eat too much fat? It's sort of like these dichotomous, very superficial phenotypes to deep phenotyping. And for example, the way that we do it, if we stick with the lipids, because that's what most people could identify with, or let's say high blood pressure is that there are numerous lipid pathways. At least six to seven lipid pathways are interacting in your body at any given time. And so, you know, when people say, oh, just take a statin, or just take Repatha, or just drop your saturated fat, they're basically, you know, looking for the lowest common denominator that potentially could control the situation. They're not looking at this entirety of this lipid universe or what I call a lipid dome. So genetic pathways, we want to know, do you have genetic pathways that predispose you to making more aderogenic cholesterols, right? Do you have genetic pathways that make you more likely to also have insulin resistance? Do you have genetic pathways? Doesn't mean you're going to have it, but that's the genetic machinery, which is what you mentioned, right? Do you have genetic pathways that make you more pro-inflammatory, give you some immune predispositions, potentially make you less efficient at clearing cholesterol from the circulation, right? So this is actually redefining the paradigm. There was an article in The Economist recently, and I was chuckling because I never expected this in The Economist. The article was about how there is no more good or bad cholesterol, right? Thank God. Oh my God. Hallelujah. I've only been saying this for almost 10 years, but at least it's good to see it, you know, in print. So the point is, is that there are well-validated, known, scientifically described pathways that tell us about what is shaping vascular health, the ability of the blood, you know, genetic markers that make it more likely for an individual or increase their risk of cardiovascular disease because they have less protection of their blood vessels. So, you know, so this is what starts to fit. And when we try, you know, the particular thing that you mentioned, you know, kind of saturated fat avoidance with your response to it, this area is a very interesting area. It's called nutrigenomics, right? Where we can give a patient an opportunity to understand how to fine tune their diet, at least on the macronutrient level, so that they could mitigate some of those genetic predispositions, right? And so that goes way beyond just like, you know, eat low salt, eat low fat. You know, it's exhausting, but it also explains, right? I think that because, you know, you have the diet wars, right? You've got the vegan camp versus the carnivore camp versus any other camp. And I think that the Mediterranean camp wins more battles because it allows for more normalcy. But we would be foolish to discount the fact that there are people who thrive on a carnivore diet. Exactly. The problem I have with the carnivore people is when they run around talking about how everybody needs to be on a carnivore diet because it works so well for them that surely the whole world would be saved. Of course. And same with the vegans. And, you know, finally a voice of reason that's saying, just stop. Like, yes, maybe there is a subset of the population that will thrive on a carnivore or a vegan or a whatever. Or even ketogenic diet. Or ketogenic diet. So there are all these like, you know, you open YouTube and, you know, and you see like a bunch of people and say, my LDL is 500. And I'm like, you know, and they are well-known people. They have tremendous amount of following their MDs, their PhDs. And I always think to myself, OK, your LDL is 500 now. You're in your 30s. Let's speak in 20 years. So there is so much, I think, misrepresentation and, you know, kind of this sensationalizing approach that the whole message is sort of lost in translation. And the message that needs to be is that vascular disease, vascular aging are not linear phenomena. We know that from old studies, we know that 50% of patients who present with their first heart attack have normal lipid profiles. This is not new data. We have known this data for decades. We also know that when we lower lipids, there is so-called 30% relative risk reduction. Well, 30% still leaves 70% untouched. And cardiology has a very cute name for that 70%. They call it residual risk. And I'm thinking to myself, Well, any sixth grader probably knows that in math, residual is what remains of the whole. It's not two thirds of the whole. So, you know, so it's that residual risk, which I think is now really become the forefront of investigations, post-clinical investigations, translational investigations. And this is where, this is what patients want. And this is what, you know, where the opportunity is. But it's not an opportunity that is cheap and it's not an opportunity that is widely available. And that's where we're going to have, of course, a lot of friction in delivering this personalized intervention to whoever wishes to have it because the insurance companies are still, you know, and the traditional medicine, they are basically crisis management aligned business enterprise, right? they manage a crisis. And it's great because if you had a crisis, if I had a crisis, you know, I want all of these resources to be available, right? But when you dedicate so many resources to crisis management, you don't really have much left. Well, there's no prevention. No prevention. There's none. None. So, you know, and, you know, the business model is not aligned to give people, you know, an opportunity at prevention, you know, what is the reason that insurance companies are refusing to pay for a medical grade genetic test that costs $500? You know, what is the reason for it? And person is getting it once in their life, right? Why do, why, you know, like, like there is no good explanation So we done close to 200 genetic tests you know in our various individuals in our practice And I can tell you that we don have any discussions with patients with regard let say to lipid and metabolism management without genetics, because there is no context. Genetics is the context that we need. So if you want that personalized management, you need to have the right tools, the right information to actually get that personalized management off the ground. Otherwise, you know, you can do fire and forget. Have your doc give you NRX and then off you go. Yeah. Yeah. No. And it's, yeah. I mean, it's, anyway. All right. Let's go on to a different question. So how do you explain to patients the difference between treating a blocked artery and treating the underlying biology that caused, made that artery vulnerable in the first place? I think, again, you know, what you're talking about is in the conventional model, we wait for the blocked artery to happen. And then we deal with the fallout with any luck. The person lives to tell the tale. The medicine you're practicing is assessing what are the vulnerabilities. So how do we explain this to people without freaking them out so that they understand that this is empowering, not frightening? Well, it probably still will be frightening somewhat, it. But, you know, and in cardiology, even in traditional cardiology, we have transitioned from sort of forwards and backwards because everything initially was very plaque-based, right? You know, doing procedures, opening to areas which are blocked, which of course, if somebody is having acute myocardial infarction is life-saving, right? So absolutely has to be done. Tremendous procedures. They saved countless lives, as I said before. And then slowly we transition from this sort of plaque-centric concept or what is known as a vulnerable plaque to a concept where we look at the patient in their entirety called vulnerable patient, right? And so little did we know that in making this transition from vulnerable plaque to vulnerable patient, we have to go back to vulnerable plaque to understand full patient vulnerability, right? And that only happened because artificial intelligence tools gave us this window of opportunity from cardiac imaging, for example, cardiac CT, some of these new AI quantification methods that allow us to see plaque composition and measure its impact are now adding to our concept of patient vulnerability. So the way that I tell patients is this, if you have plaque in your arteries, consider it a dumb deal, right? Let's say there is some calcium buildup, right? Calcium buildup, that's a dumb deal. We might be able to shrink these plaques somewhat. There's something known as plaque regression, but the calcium is not magically, it's not going to evaporate or clean out of your arteries. And so I'm sure your listeners, I'm going to flood you with comments and said this cardiologist said that there is nothing that's clearing out calcium and I've been using this supplement that has done that. We'll have a separate discussion, but biologically, calcium cannot really leave the arteries. It's the process that is finished. So imagine if you, let's say, scraped your skin and eventually there's a scar. The scar is not automatically going to disappear from your skin. Maybe you'll do some procedures like lasering and it will faint, but it will always be there. The molecular changes, cellular changes will always be there. So I try to shift their perspective from focusing so much on that coronary calcium or known areas where they receive stents and to impart upon them that they have control now if we figure out exactly what's going on with them to prevent this from happening ever again. And that means that we have to unravel the root causes that are putting vessels into that inflamed situation in the first place. And that's more complicated, right? We already spoke about genetics, certainly metabolic, microbiome, hormonal influences. You know, this all has to come into place to slow the process of vascular aging because it's that vascular aging, the end result being inflammation immune system reaction that actually is giving people plaques, is giving people advances, giving them unfortunately procedures because they can't avoid, right? And it's, you know, and I especially, you know, I feel bad when patients say, but doc, why did this happen for the past five years? And let's say this is a patient who is 55. For the past five years, I stopped, you know, eating fat. I go to the gym. I don't eat any gluten. I don't drink. You know, I don't smoke. Why did it happen? And, you know, and it's heartbreaking to tell patients is that, you know, vascular disease is not disease over five year time horizon. It's a disease that starts at birth. We know this, we know this, right? So, so unless you were doing all of those things when you were 18 and you, and you continue to do them, you know, sort of repeatedly, you, of course there is an impact, but it's not the level of impact that people expect. And I think that's where the major, you know, emotional sort of problem is that, you know, people feel crushed. They say, you know, why am I doing all of this? Why have I been doing all of this? You know, they feel that there's no validation to their efforts, you know, and that's because I try to give them a sense that they can be in control. They can absolutely reverse it. But that linear, you know, I've done everything right for five years. Why am I having blockages? That's just not biology. It doesn't compute. It doesn't compute. January makes you want to detox, but not hate your life. Listen up. Most people think detox means suffering, but the truth is your body already knows how to detox. All it needs is the support. When your liver is overloaded from alcohol, from sugar, from inflammatory foods, it stays stuck in survival mode instead of performance mode. This is where Complete Liver Complex by Level Up Health comes in. January is a great month to introduce this supplements so that you can support your liver's natural detox pathways. No fasting marathons, no weird teas, and no white knuckling. This formula supports hormone clearance, blood sugar regulation, cholesterol metabolism, and fat processing. All the things that tend to get a little, you know, kind of stuck after the holidays. And a supported liver means better energy, clearer skin, and a body that feels ready for what's next. January isn't about pushing harder. It's about clearing what's holding you back. I love this liver complex, you guys. I do 30 days every few months, every year, and it never fails to deliver. So to get your hands on your own, go to leveluphelf.com, LVLuphelf.com, and make sure to use code NAT to save 20% off your order. There's a narrative that there are major aging inflection points at the age of 40 and the age of 60. You might say that the age of college is another major inflection point. Because if you think about it, some of the greatest assaults on our physiology first happen in those years where you're sleep deprived, you're drinking, you're not eating well, you're stressed to the nines. It's the fun years. And we often say, oh, they're young, they're resilient, they'll get over it. But I think that the body, the impact on the physiology nevertheless is registered. Right. For sure. For sure. There's no forgiveness. And this isn't to freak everybody out, but it's just to say, now, if you do this while you're in college and then you come to your senses in your 20s and 30s, you can slow things down. You can probably reverse stuff. You will not. But unfortunately, that can often start patterns that get carried through young adulthood. And then life takes on and you've got new stresses and all that stuff. And so it just builds up so that that five years you were good, unfortunately, wasn't enough to undo the 30 or 40 years that there was accumulation of effect. And there is a concept, you know, it's a concept in gyroscience. And I, you know, looked a bit into that concept of a concept of hormesis or hermetic threshold, right? And that's what you're referring to is that, you know, in simple human language, it's basically whatever doesn't break you makes you stronger. That's what hormesis is. So when we exercise, for example, we do, you know, induce some wear and tear on our system, right? But why is exercise so beneficial? Because there are hormetic effects where it leads to improvements in cardiovascular, you know, tolerance in drops, you know, vascular resistance, promotes some muscle growth, you know, and has a lot of other benefits, you know, reduces inflammation, improves insulin sensitivity. So, you know, however, too much exercise, right, for specific individuals will have the opposite effect. So, you know, so I think as we go in this line, this more individualized line, you know, the possibility there is that each individual will have the tools. And I do believe that those tools, just as it happened with human genome, which initially was super expensive to sequence. And now you can, like I mentioned, you can get this medical grade genetics for like $500. And, you know, if you want more, you can get it maybe like for certainly under like, you know, 2000 for sure. But the point is, is that we will give each person an opportunity to understand where they are and what they may or may not want to be doing. So it is empowering. It is patient agency because it's giving each individual a choice, right? You can be like Brian Johnson, who made himself into a huge science project, and he feels, you know, very empowered by it, reversing his biological age, you know, or you could be, you know, as I don't know, as my grandparents used to be, who actually had a healthy lifestyle, but, you know, they would always do the same thing, not listening to any fads. And they lived into their late 90s, you know, and they had a pretty hard life. So, you know, so, so this is sort of, uh, and, and all things in between. A hundred percent. I feel like genetic testing should almost be offered as a pediatric foundational source of information, because if we knew as parents, and I don't think most people are ready for this to be fair, but to the parent that is particularly enlightened, how great would it be to have, because your genetics don't change, how great would it be to understand that this child will do exceptionally well with, I mean, we're talking about fat and carbs, let's say with a higher fat, lower carb diet, right from the beginning versus this child who actually can do really well with higher fat and like the opposite. If we believe that aging starts from the day that we're born, then how soon is too soon, you think, to get those kinds of insights without being neurotic about it, but just taking it? Because now lifestyle really can take a real role here in how we age, do you think? So it's an interesting question. And I have to tell you from the ethical perspective, there's, of course, going to be challenges and issues because, you know, what if it's a situation where resources are very scarce, right? And you can't really get to these resources and individual, you know, just trying to survive. You know, there was a study in cardiology. I believe it was called PURE. It was a very interesting study because it was specifically looking at the impact of meat consumption over multiple countries. The countries were spread over seven continents. And so the premise of this study was that the expectation, the hypothesis was that the less meat people eat, the better cardiac outcomes we're going to get, right? Because the idea was that it was really was plant-based diet. So what they found was actually the opposite. And the reason why this was the opposite is because in some of the countries that participated in this study. The population's access to food was primarily focused on ultra-processed foods. And yes, they technically were not meat foods. And you could even say they were plant-based, right? Potato chips are plant-based. But the point is, is that they found that there was another variable that they didn't expect that actually showed that less meat consumption led to worsening of cardiac outcomes because people who did consume meat were most likely had better access to resources and they ate cleaner. Oh, so they're better off. They're better off. So I think, you know, so this is where I think we are going to draw a lot of difficult issues that need to be resolved. And, you know, another, you know, as somebody who is a mom, you know, reflecting, thinking about my children, when were my children receptive? to the idea that they need to do certain things differently. Right. Oh yeah. Yes. It didn't really happen until they were sort of in high school, their late teens. And even then, you know, there had to be some sort of a motivator, right. You know, for sure. But at least there was some insight into that. So, so I think it would be, I think for, for sure, you know, I'm hopeful that now that people have more access to direct to consumer genetics, not that I, you know, if they have access to medical genetics, which is what we do, that's so much more valuable. But if that's not the case, and there is some direct to consumer genetics access, you know, now with the AI tools, there is actually the beginning of the opportunity to personalize. Yeah. I mean, I guess I was thinking more in an ideal world, not realistic. You know what I mean? In an ideal world, we might come into this world with an understanding of what will be best for us. Right. And so that we could start acting on it sooner. But obviously it's not realistic. But I think as these tools become less expensive and more easily accessible, you know, people will actually, you know, I call them citizen doctors, right? So, you know, citizen doctors will redefine how we practice medicine. For sure. So if someone says I'm into longevity, but they really haven't seriously evaluated their heart health, what do you wish you could tell them quite bluntly? I ask one question of every patient, whether they're referred from longevity doctor or not. And I ask them, do you know your vascular age? And if the answer is no, then I know that they have not even scratched the surface of the most important factor. Because longevity, let's face it, longevity in many ways is a business. It's a lucrative business. It's growing very rapidly. you can call yourself longevity anything at any time. Uh, I think, I think I'm actually know, uh, uh, who the patient is, whose wife told you that he is working with me because I believe it's the same person who told me, Dr. Drews, you can call yourself anything you want in longevity, just, just go for it. You know, so that's, that's what she told me that, you know, uh, exactly. So, So, you know, but longevity is, one has to be very deliberate with regard to longevity. And the number one priority is vascular health. Why? Because vascular health, not only telling us about the opportunity for optimization for vital organs, such as heart and brain, but it's also a window of opportunity to understand the fundamental processes that drive aging, right? You know, that inflammation, chronic low level of inflammation that people start to get in their middle years and sort of accelerates as they get older, it plays out first and foremost on the vascular surface. And so we know how to measure this. There are good techniques, whether it's scanning the carotid arteries or measuring, you know, arterial stiffness, or even if calcium score could give us some idea where a person falls. So that's so fundamental that if you don't know it, everything else that you're doing is sort of superfluous. And another reason why it's so fundamental is that the ways to improve that vascular age, and we can measure vascular age, which is dynamic. For example, VO2 max, right? One of the most, if not the most impactful metric for aging is VO2 max, and it is cardiovascular. cardiovascular. So, you know, and again, there are plenty of tools, you know, that you can measure it, you know, even the aura ring right now, you can go run for six minutes or walk fast. It's going to give you your VO2 max. But the point is, is that the way to change these parameters are fundamentals, exercise, nutrition, stress, resiliency, building, reducing sleep fragmentation and sleep disruption, eliminating toxins. And these are so fundamental that they are not only there to reverse vascular aging, but these are impactful for lowering the risk of neurodegenerative diseases like Alzheimer's. These are impactful for lowering the risk of cancer. A person has cancer, lowering their risk of recurrence. These are impactful for overall health trajectory. And so that's why if they tell me they don't know their vascular age, then it doesn't matter how expensive the peptides are. It's just not getting there. I love it. So genetics and what you just mentioned, the metabolic health, the hormones, the inflammation, the toxicities, the stress and the sleep, what's more important? Or are they on an equal footing? You basically need that genetic insight and that. If we can put those two things together, how much trouble can we really stave off, do you think? You know what? We probably could stave off anywhere from 70 to 80 percent of age-related deterioration, right? It doesn't mean necessarily that a person and, you know, clinical data and research data supports that. You know, it doesn't mean that we necessarily, nobody's going to get, you know, let's say heart disease, but people make it heart disease in its much milder forms where it's not impairing their activities or leading, let's say, or get fewer heart attacks and things of that nature. So genetic is that foundational layer that we need to have because it gives us an understanding what are the most impactful areas where we need to go. But genetics is tricky and it goes back to your earlier question. Should there be a genetic opportunity for children when they're young so that we can learn what's the best nutritional strategy for them to prevent them from developing diseases when they're adults. Well, genetics is the blueprint, but it's not the entire house of health because people may have genetic variants. And despite those genetic variants, they don't have any evidence that those genetic variants are actually impacting their health at all. Right? And that's actually more common than people who have diseases and then we find genetic variants. So genetics is complex. It's not, you know, when people come and say I had genetic testing, most of them don't understand that there is a tremendous difference between direct to consumer and medical grade genetic testing. They don't understand that, you know, single evaluations of single genes are not the same as looking at multitude of genes as called allogenic genetic scores are not the same as looking at the interaction of environment with your genes, which is where the opportunity really is. So until that complexity is simplified, I don't think we can have an easy sort of rule of thumb. Yeah. I mean, it's just part of the puzzle. So, okay, let's move on to something else. Ectopic and epicardial fat. Fat stored around the heart and organs. So people are starting to get their heads around this, right? We've talked to it, speak to it very often as visceral fat, I think, certainly for the fat around the organs. So how do you explain what it is and why the heck it's so dangerous from a longevity perspective? So great question. And, you know, maybe like these are almost medical terms. So let's educate people on what those medical terms are. So ectopic sort of means elsewhere and epicardial means on top of cardio and, you know, your heart, right? Your your cardiomyocardium. And I talk a lot, you know, with my patients and in my book about something called sick fat disease. And that's what I want, you know, the listeners to remember that sick fat disease is the inflammation of fat. And this is a newer concept, right? Because before we thought, well, you know, people, they start to pile on that fat internally in between the organs, You know, that's your visceral fat, you know, in the organs, that's your fatty infiltration, for example, liver fatty infiltration. And of course that damages the organs if there's too much of it because they're just not functioning properly. But now we also know that the reason for that damage is that it creates these areas of inflammation locally, and that's how the damage happens. So there is an inflammatory, yes, there's an inflammatory phenomenon happening. And what we started to understand with regard to heart disease, for example, and you know, heart disease is not just coronary artery disease. Heart disease could also be structural. Valve disease, for example, heart disease could be electrical, like HL fibrillation, right? A very common arrhythmia. So what we've begun to, and of course, heart disease, a big part of structural heart disease is heart failure, which is one of the most devastating types of heart disease, very much under the rise, especially in women. And that specific type of heart failure that's under the rise in women, so-called obesity phenotype heart failure is very difficult to treat because the kind of mainstay medications for heart failure, the older medications were for a different type, So what we learned from some of the recent literature is that there is fat infiltration of the heart muscle. There is fat that surrounds the coronary arteries. This fat is not inert. This fat actually is sick. And so sick fat disease, because this fat secretes a variety of inflammatory mediators that lead to critical inflammation, whether it's in coronary arteries or in the heart muscle itself. Inflammation leads to plaque progression, leads to fibrosis. And so we see these clinical phenomena emerge. And this is one of the reasons why I actually changed my opinion on GLIPS and GYPS, the medications that are basically making pharmaceutical manufacturers richer than ever, right? So you call them glips and gyps just for the audience. These are GLPs and GIPs These are the peptides of the decade at this point The peptides of the decade And so or the peptides of millennium But, you know, so I changed my opinion on these medications because the clinical trials have started to report that there are effects which are independent of weight loss. And these effects are due to anti-inflammatory properties of these medications, including their ability to turn off the inflammation in that ectopic or epicardial fat. And does it reduce the ectopic and epicardial fat as well? Some earlier studies using cardiac imaging techniques have started to show that. So the point is, is that, you know, I sort of changed my mind on this because I said, well, this isn't just about weight loss, although weight loss is certainly, you know, part of it has its benefits. But, you know, as cardiologists and a lot of longevity physicians will tell you that, you know, weight loss in and of itself is not enough to reverse a lot of cardiac conditions or even cardiac risk factors, right? So it's just not a magic bullet that people think it is. Again, it's sort of the example of that linear thinking. If I lose weight, I'm going to be better. For some people it works very well and for other people, not so much, you know, but what we find is that these medications appear to have other effects that are more powerful than weight loss and that's silencing or turning off the visceral and, you know, inflammation and inflammation, which is vascular inflammation, which is in that, you know, fat tissue, that sick fat tissue. So that's the properties that, you know, will, are responsible for a lot of their effects. That's unbelievable. I also think that fat loss, losing excess fat, and we're not talking necessarily the last 10 pounds, but if it can help to resolve sleep apnea, if it can help to resolve blood pressure, the satellite benefits of those things, I think is what can pay off in huge dividends. But this lowering and reducing inflammation is going to be a massive piece of the puzzle. I want to get into women and menopause and those particularities. I think that one of the ideas that maybe you talk about is that menopause doesn't create new risk factors. It amplifies the ones that are already there, which I don't think is something that is commonly talked about. So what does that mean in practical terms for blood pressure, lipids, and fat distribution. Basically, I guess as women are coming into menopause, yeah, is there anything we should be aware of or how is this all playing out from what you're seeing? It's basically exactly what you said, right? So women that we know that menopause is going to change metabolism, it's going to change vascular reactivity, it's going to change sleep, It's going to change body distribution or body fat distribution to be exact. And of course, menopause, unfortunately, is the time of increased inflammation and stress in the cardiovascular system. So if women come into that menopausal transition already with pre-existing cardiovascular risk factors, metabolic dysfunction, poorly controlled blood pressure, obesity, or high concentration of that visceral or sick fat, these will of course worsen with menopausal transition, not the other way around. And they believe that just sprinkling hormones on it will reverse it is not true. No, no. So, okay, here's another one. Many women are told that their symptoms are atypical or it's anxiety driven. When you're listening to a midlife woman describing chest discomfort, palpitations, or exhaustion. What are the red flags that make you say, this is cardiac until proven otherwise versus the current, which is, oh, that's just anxiety. And don't even look at a possibility that it's cardiac. Simple answer here. She is reporting these symptoms. This is cardiac until proven otherwise. There is nothing else to do because Yes, we have great testing. It's not invasive. We can have an answer super quick. And even if it's not something sinister like a heart attack, and hopefully it's not, we could give an individual important things that they need to know about themselves to make sure that they don't have a heart attack. Yeah, I love it. Where do you see hormone therapy, lifestyle medicine, and cardiology needing to talk to each other more intelligently if we're serious about protecting women's hearts and their longevity? Another great question. So years ago, when I was speaking at the American College of Cardiology, I was in the little lounge area for the faculty and one of the very well-known, esteemed women cardiologists who was somebody that we all looked up to told me that just asking about hormone therapy is malpractice. So I think that we've come a long way since then. I do think that there are pros and cons to the recent FDA removal of black box warning, because hopefully it will open the door to an informed discussion and personalized management because appropriately started hormones when additionally women's risk, metabolic risk and inflammation risk is managed as well, could definitely make an impact, clinical impact. I think the downside might be that women will rush to hormone therapy without recognizing the fact that it is not a magical solution. And I see a lot of the women like this, whose lipid markers, metabolic markers continue to be misaligned with the degree of hormonal therapy. So hormonal therapy needs to be individualized. Yeah. It's like everything else though. I mean, it's not a silver bullet, but it's part of the puzzle. So, so I, I mean, I think I know the answer to this question, but should all women consider getting some kind of cardiac checkup at some point? And what age do you think? Like when, when, when should we start to look at it? Do we wait for menopause? Do we do it ahead of menopause? Like, what do you think? And yeah. I think the answer is yes. I think the same paradigm that we use for breast cancer screening with examinations that start in a certain time frame and continue annually will be something that we will need if we want to get ahead of cardiovascular disease in women. The question of when is an interesting question because I answer a lot of these questions based on genetic and laboratory markers, right? You could have a 25-year-old whose genetic and laboratory markers are very worrisome or a 55 year old where they're not, and you're more worried about sort of age related progression of cardiovascular disease. So this is something that we will find out, but as a rule of thumb, you know, I would absolutely say that any woman who is considering having children or had children, especially young children needs to know her cardiovascular risk because she wants to be there for her children and for her family. And that's the time when it's going to be most challenging for her to actually mitigate the factors that down the line will accelerate that vascular age. Yeah. Yeah. Well, I think we all aged through early childhood years. Lack of sleep, stress, not taking care of ourselves. Hopefully we mitigate it down the road. But yeah, I mean, I think the concept of getting a baseline earlier in the game. Maybe you don't need to be checked as often, but to have a baseline of what your normal is, and then if anything comes up, start to increase the number of times you look at these things would make sense. Okay. Let's move into another one of your pet lovely areas, which is AI wearables and the future of precision cardiology. So you are not just a clinician. Part of your zone of genius is that you're a digital health entrepreneurs. So when you look at AI and wearables, what excites you the most for heart-based longevity and what really worries you? Interesting. So I think what's exciting to me is that for the first time, we can actually measure a lot of things that people know they need to be doing, but they're not doing, right? And so let's talk, for example, about stress and sleep. We have great wearable devices right now, multiple executions that can actually provide good measurements and give us a window of opportunity to intervene. And some of these devices have actually gone additional step and they're able to give us metabolic age and vascular age. And this is sort of the area that I would love to see more investigations and linking that to the outcomes because these are great markers and great opportunities. But it worries me that we don't know exactly how to fit it in. You know, most of our data is a bit old and, you know, companies are coming out there providing all these metrics. But, you know, the validation sometimes is just not really there. Yeah. I mean, people get very excited about this stuff, right? It's a number, right? You can relate to a number. Yeah. But, you know, so the approach that we've taken is that we follow our patients, obviously, longitudinally over time. And so we're looking for degrees of change as opposed to just the number itself, because the number itself may or may not be robustly validated. In your own podcast, you've talked about pocket-sized ECG devices and AI analysis that could change how we monitor rhythm issues. Like, do you have a story of a patient where something got picked up out of a pocket? I have to say that, you know, Dr. David Albert, he's a great friend and, you know, cardiologist entrepreneur. And that was one of the, I truly loved having him on my show. But, you know, I was an early adopter of this device and I made it available to all my family members. And we were driving, you know, from a long distance trip. My children were still young and my son started feeling unwell. And, you know, we had to make a decision. Should we stop and, you know, let him out or, you know, he was sort of feeling dizzy or should we continue? We're in very thick traffic, you know, not a very good road situation. Actually, we're on the bridge. and so I whipped out my little device and I said okay let's take a reading and you know and I could see that you know there were no unusual signs his heart rate his heart rhythm were entirely normal and so you know it was probably just a reaction to sort of you know being on the bridge being in the car being a little hot being dehydrated so we were able to talk him out of it and you know and I thought to myself well that that's really something because you know otherwise I may have just, you know, taking him to the emergency room, right? You know, like, because you don't know, but information is power. And, you know, and I think Dr. Albert with his 1 million plus ECGs has, you know, I know, I know there are cardiologists who use this mid-flight, you know, to diagnose myocardial infarctions. There's just so many uses, but, you know, it is yet another great opportunity to smartly use available tech, you know, for, for health and disease. So this is a device that's actually available? Yeah. One can go online and buy it. Now they made it the size of a credit card. And so you can go ahead and just, it's called Cardia. So you can basically carry it as if it were a credit card in your wallet and get it out and just put your fingers on it and it gives you your ECG tracing. So they actually now did a device which is a full electrocardiogram, but that's not for patient use. that's for professional use. Right. Well, I have something sitting upstairs called Connect Q. Have you heard of it? I use Connect Q. That's your arterial stiffness measurement device. I know. That's part of that vascular age estimate, right? Well, we'll have to check it out because it's been hard getting me on the app because I'm in Canada where it's not approved, but they finally figured out a workaround. So you and I can have a conversation about that another day. We have to talk about arterial aging. Yes, for sure. Specifically. Okay. Stress trauma and the heart brain longevity axis. Do you want to talk about that at all? Yes. Yeah. So we had, you know, several discussions on my podcast on that. So, you know, it's interesting because your heart or your blood vessels rather and your heart is part of a echo phenomenal loop, you know, and that loop was described by investigators at Harvard Medical School, Dr. Peter Libby and his group done a lot of investigations into that. And what they basically, they linked the activation of stress response in the brain, right, amygdala activation, to recruitment of the inflammatory immune system cells into the vasculature and ensuing immune and inflammatory response, right? So there is a biochemical chemical and physical connection. And, you know, they described this phenomena in patients who had a heart attack because first of all, heart attack is painful. And second of all, emotionally, it's very distressful. And, you know, I learned from this early on because when I was in the cardiology fellowship training, one of our fellows was from overseas. He was trained in Europe, actually in Ireland. And so he was part of our group of fellows. And when we were admitting patients with heart attacks, he would always tell us, how come you're not prescribing morphine? And we said, why should we be prescribing morphine? Like, what's the cardiovascular indication? And he said, because you want those patients to feel less pain. You want them to be a little bit more relaxed in their brain. So because, you know, you need to manage that whole emotional surge. And, you know, I thought it was whatever. And then, you know, research came out and said, oh, you know, the kind of other country techniques may actually be applicable here. So huge connection. And I think there are a lot of interesting wearable devices in that regard, right? So we're talking about vagus nerve stimulators, of course, there's a very interesting one that stimulates auricular branch or vagus nerve. Yeah. Is that what? Yeah, exactly. And so that could be something that people can actually use consistently to, you know, turn, turn the stress dialed out. So, yeah. So speaking really to the heart brain connection and stress and trauma, we'll do another podcast episode just on that because I feel, yeah, this one is its own, but it's interesting that it is still not fully accepted in conventional cardiology circles. I think that it's, I actually spoke to a cardiac surgeon who's devised an artificial heart and it's brilliant. And I'll be doing a podcast about it. You and I can talk about it offline. But when I asked him, but what about losing that emotional center? He poo-pooed me. He blew me off completely. No, no, no, no, no. It's there. And of course, you know, we practice a lot with our patients. We use heart math, which is heart coherence technique in addition to the biggest nerve stimulators. You know, and we know, for example, that the connection between what the brain is feeling or thinking and your heart is very close. You know, we know from the literature that people who experienced adverse events in childhood, so-called adverse childhood experiences or ACE have a much higher incidence as adults of hypertension, heart disease, metabolic disturbances, right? So this, there is an echo phenomenon that, you know, these investigators describe that I think goes beyond just, you know, here's the coronary plaque and, you know, your brain recruits immune cells to go there and clean it up. That's the biological pathway. But I think we have wiring that is meant to connect our brain and our heart on levels that we cannot fully understand, but we can modify at least to a degree. And for example, why is loneliness is not a recognized cardiovascular risk factor? There's been a lot of literature on that and it should be. Yeah, a hundred percent. A hundred percent. Okay. For someone in their mid forties or mid fifties, who's worried that they may have missed the boat. What are the first three numbers you want them to understand about their heart health? Oh, good one. So I would start with blood pressure. Yeah. Because it continues to be still the number one most impactful risk factor for heart disease. I would start, you know, Additionally, I would have them check their ApoB, which is, let's think of it as a sum total of all atrogenic cholesterols, cholesterols that could cause atterosclerosis. And if they don't have access to ApoB, they can just stick with LDL-C or non-HDL cholesterol as surrogates. Not the best surrogates, but that may do, if they could quickly calculate non-HDL cholesterol from a standard panel. And where should it be? Where would you like to see it? Anything less than a hundred is good. So if that's where they are, because if they truly have an optimal profile, they will have LDL cholesterol somewhere around 70 and HDL, non-HDL cholesterol is usually 30 points higher. So it's around a hundred and their APOB will be somewhere 80 or less. And that would be pretty close, very good optimal profile. And I would ask them to know, they're like, protein little a, because, you know, this is definitely emerged as a very powerful risk factor, has a little bit of a different biology, possibly in women versus men. So, you know, has a very heavy genetic predisposition. So there is a lot to be said about its impact on vascular health. Love it. Okay. And what does a simply weekly routine for heart-driven longevity look like for a busy adult? Movement, nutrition, recovery, and connection, which we just talked about. That's right. We talked about, so I would say that prioritize sleep because sleep is an opportunity for recovery at multiple levels. Build stress resiliency, which means, you know, build techniques or opportunities not to be somebody who reacts to stress, sort of manage it proactively. avoid situations which are likely to compound your stress, whether it's time constrained or some other situations such as like that. Do embrace time-restricted eating. It's a great strategy underutilized by a lot of people for whichever reason. People don't necessarily understand the difference between intermittent fasting and time-restricted eating, but there is a difference. And make meaningful relationships count because, and you know, your family, your friends, those relationships are the lifeline. They are what your heart needs and what your brain needs in order to be healthy. They give you purpose. And so those would be my quick tips to the busy people. So just quickly, because people will be scratching their heads very quickly, what's the difference between intermittent fasting and time-restricted eating in your mind? Right. So intermittent fasting is essentially refers to a period where a person doesn't eat, but it could be any period. For example, typically we don't eat at night because we're asleep. So we have, each of us practices intermittent fasting to a degree when we're asleep. Time-restricted eating attempts to restrict the eating window around or in more alignment with your circadian rhythm, which basically means that people would eat, let's say, from 10 a.m. to 7 p.m. during the daytime hours. They essentially restrict themselves to eating a little bit after the sun comes up and they stop when the sun goes down. So that's the time restricted eating period. Perfect. Perfect answer. Thank you. All right. Quick fire. Okay. No, one more. What are the seemingly normal symptoms or test results that would make you say to a listen, don't ignore this. It's your heart asking for help. Seemingly normal. Yeah. Symptoms or test results? So symptoms, I would say, you know, because the cardiac disease could be devastating and because there are people who unfortunately drop dead without, you know, as a friend that you mentioned, who don't have seemingly any red flags, heart disease tends to be silent. Anytime somebody has a symptom, whether it's chest pain, palpitations, shortness of breath, they shouldn't really ignore it. If it was something that was a one-off and there's a good explanation, perhaps. But if it comes back, it's meant to be evaluated. And we have really robust evaluations and there is no need to guess because we can know the answer. Well, and once you've knocked it out, you've knocked it out. All right, last four quick fire questions. So these are quick. One lab marker you'd never want to lose access to. high sensitivity to reactive protein inflammation got it one wearable or device you actually trust for heart and longevity my aura ring beautiful one daily habit you think is underrated for protecting the heart gratitude love it one question you wish every patient would ask their cardiologist doc is it going to work for me oh my god um all right when you think of extending health span rather than lifespan what does a long good life look through a cardiologist's eyes it's a life where you can still walk talk and do things that you want without limitations love it dr regina druz this has been an epic interview thank you for this conversation you have a book coming out yes so i would love to invite you to let people know where they can follow you where they can learn more about the holistic heart center and find your book when it's available or maybe pre-order it by the time this podcast comes out that's right so thank you so much, Natalie. So Holistic Heart Centers is super easy. It's holistichartcenters.com. And you will see all of our programs and all of the things that we do. And there is even a page on there that refers to Holistic Heart University, where if you want to learn more about this type of information that I speak about, you could go ahead and sign up and learn more. And the book is coming out sort of late 2026. It will be called, the tentative title is Longevity Code, and you can find more information at drreginadrews.com. So just type it all in. Thank you so much, Dr. Drews. This has been fantastic. Thank you for having me. Hey folks, just a quick reminder that all of the information presented in this podcast is for information purposes only. No medical advice, no diagnosing, no treatments suggested here. Before you try anything that you hear about or learn about here, make sure that you check with your medical provider.