Ep. 580 Why Women’s Heart Disease Skyrockets After 40 – The Shocking Truth About Hormones, Toxins & Testing with Dr. Christopher Davis | Menopause & Heart Disease

Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives. They add the honor of recording with Dr. Christopher Davis, who is a triple board certified physician in internal medicine cardiology and interventional cardiology, and also a specialist in functional medicine and regenerative medicine. He's also the chief cardiologist at Human, a science-backed, plant-based heart health supplements company. Today, Dr. Davis and I talked about why women's heart disease risk accelerates after 40, challenges to our current prevailing medical model, the impact of toxins, including xenoestrogens and specific testing that he likes to utilize as well as infrared sauna. Why labs and imaging matter and specifically which labs he likes to look at and diagnostic modalities, including clearly why women have unique physiology and anatomy for small vessel disease and the impact on the reduction of nitric oxide production in perimenopause and menopause, the importance of the glyco-calix and our endothelial health, why personalized medicine is so important, as well as challenges of the traditional allopathic model, why we see more cardiomyopathies in women and specifically what Takasobo or broken heart syndrome cardiomyopathy originates from, the impact of GLP1s and recent research. And last but not least, specific supplements that Dr. Davis likes to utilize with his patient population, as well as the importance of nitric oxide production and specific Goldilocks effects that he likes to consider when treating patients. This is an informative and valuable and very detailed packed podcast, one of which you will probably want to listen to more than once. Dr. Davis, such a pleasure to bring you on the podcast. I've been really looking forward to this conversation diving deep into heart-related challenges for women as they are navigating middle age and beyond. Yeah, well, great. Thank you for having me. I'm happy to be here. Can't wait to get started and have some fun conversation. Absolutely. Let's start the conversation about why women's risk of heart disease actually accelerates in that perimenopause to menopause transition. Do you think it's just about hormones or is lifestyle an equal contributor to why we see more and more heart disease related complications for women in middle age and older? Yeah, I think certainly the hormones are a big part of it. And I think that we hear over and over and I think most of your listeners understand the importance of hormones, particularly the role of estrogen or estrogen, estradiol in vascular health, in how that vessel is much more compliant or stretchy, if you will. When blood vessels are very stiff, blood pressure is much higher. And so we know that that's a major driving factor for cardiovascular disease, both heart attacks and strokes. And so certainly the hormone part is important. That hormone part then tends to affect things like obesity and metabolic syndrome as well. Metabolic syndrome simply meaning your body's ability to utilize the fuels that we take in the fats and carbohydrates, sugars, they are impacted negatively. And so people develop this metabolic syndrome and women typically start to develop metabolic syndrome around the same time perimenopausal type ages as well, which is then another contributing factor. I think that also during those years, stress, one of the things I can't overlook at all. And I don't think people understand the role of, we talk about stress and we think about it from an emotional component a lot, but that same emotional stress is the same as the chemical stress, physical stress on the body. I always tell my patients, we all have a stress bucket and that stress bucket is a certain size. And when that stress bucket is overflowing, that's when chronic disease develops, whether it's heart disease, diabetes, Alzheimer's, dementia, cancer, when the stress bucket starts to overflow, that's when inflammation and oxidative stress occurs. And so certainly, as women get older, the stresses of life and children and jobs all take effect as well. And so that stress plays a major role as well. And it's so interesting to me because I think that kind of that traditional lens doesn't necessarily take into account a lot of these lifestyle pieces. We know that women start, well, and men too, they start losing muscle mass or sarcopenic obesity becomes an issue. And as we're losing muscle, we're losing insulin sensitivity. So that can worsen that metabolic derangement that we're seeing. But also understanding chronic stress, it's not the acute stress of, oh, I almost got into a car accident or I had an argument with someone, it's the chronic unrelenting stress. And those high cortisol levels, and I remind patients, if your cortisol goes up, guess what also goes up physiologically, your glucose and your insulin. And in an acute situation, that's what allows us to focus in and work through whatever has occurred. But chronically, over time, can lead to small intestinal hyperpermeability, can impact your immune system, can certainly impact brain health and cognition. And so I'm so grateful for work like yourself, where you're helping educate your patients beyond that kind of very narrow lens that, you know, traditional allopathic medicine can be very siloed. And we were alluding to this prior to recording. And you mentioned that you were talking to a patient of yours just prior to this recording. Would you share with the community what you were talking to me about? Because I think this really typifies a lot of the challenges that clinicians and patients are experiencing right now in our kind of current medical model. Right, absolutely. Now, this is very interesting because, you know, for years and years after the WHO study, we all felt like we were told that hormones were bad and hormones were going to cause increased risk-reduced heart disease and clotting disorders and things of that nature. And so there was this kind of just abandonment of all women's homo, recommending hormones for women. It's interesting because this case was a little bit different. It was the pendulum swung way too far in the other direction. And what she was telling me was that there was a doctor who had come to her community and the doctor came in and said to them that, hey, hormones are great for women. They make you feel better and every woman needs hormones. And so we, you guys just start taking hormones. Okay. So this is true story. Now, this just happened. So they were just writing prescriptions for hormones with no labs, no nothing. Each individual woman has their own story and where they are in their journey and whether they mean there's so many pieces, right? So literally they gave her an estrogen, an estradiol progesterone and testosterone hormone replacement therapy with no labs. Now, meanwhile, the lady had already seen me and I'm going over her testing and she had had a Dutch test, which is a urinary hormone test. And she was massively estrogen dominant, massively estrogen dominant. Estrogen was through the roof, progesterone, she had none, testosterone was fine. And so now she has a prescription for an estrogen, progesterone and testosterone. Now let me put the icing on the cake. She also had, I mean, I will talk about this, I'm sure a little bit later, but I do a lot of environmental toxin testing my patients. I think that environmental toxins are the root of all chronic illnesses. And but she had massive levels of BPA, which is a Zeno estrogen and massive levels of a mycotoxin called xialinol, which is a Zeno estrogen. So not only did she have high estrogen levels, she had things in her blood, she had toxins in her blood that actually act as estrogen. So the last thing she needed was more estrogen. So my point to you is that how things, I mean, there's so much miseducation and confusion about these hormones that, you know, even we go from not needing them at all to just everybody needing them is absolutely insane. So at the end of the day, we need a lot more education. And what she told me was that when she asked whether the way they need a testing, she was told that they don't need testing because it just hormones are just so complicated, we don't need to have testing. That's exactly what she just said. Okay. So I told her, like I told you, I said, I'm doing a podcast in about 15 minutes, I have to save this story for that podcast, because it's just a testament to the fact that, I mean, either way, you mean, we can't do me. There's so much confusion and what we're hearing, I truly feel sorry for people and where they get any information. So now this lady has a prescription for hormones and I could keep going. She's metabolizing her hormones down a pathway that we really are going to be more concerned about for producing things like breast cancer. Right. So it was just a perfect storm, not to just be given this lady hormones, but yet she has now, she has hormones they to take, but fortunately, she didn't take them. So well, it's interesting because testing of hormones seems to be super controversial with people having varying opinions. I'm very much, I'm quantitative focused and driven. I'm like, I like having baselines. I like seeing how patients respond. I think that's very important. And to your point, the Dutch hormone test can be a valuable component. And one of the components of the Dutch that I think is very valuable is looking at how someone breaks down their estrogen metabolites, which is what you're referring to the 408 pathway is the one that has the potential to bind to and damage DNA. And in a patient like this, this is where lifestyle needs to come before we start adding hormones, because if someone's detoxification pathways are not optimized, if they haven't dialed in on sleep and stress management, and they have a garbage diet and they're not physically active, I mean, it makes it that much more challenging to get the results ultimately that we want for our patients. And I love that you brought up toxins. Can we talk about how these, you know, estrogens can offset our normal physiologic receptors sites for some of these hormones and how it can magnify you were mentioned this estrogen dominance. So this relative imbalance between progesterone and estrogen, how that can magnify the symptoms that women are experiencing in this middle age transition. I mean, when I say magnify, magnify them times 10. Absolutely. You know, that it's, it really is there's so many of these like, so to speak, xenoestrogens that we talk about these, these toxins that act like estrogen and the body, they actually bind estrogen receptors. And you can get similar type responses when people are estrogen dominant, when women are estrogen dominant, they typically have issues with weight gain and moodiness and fatigue. These are things that, and it typically, this is kind of when I see women that are in their late 40s, early 50s, this is kind of the typical presentation, right? The first stage is the estrogen dominance phase. And the progesterone levels are lower and so the, and the estrogens are higher in proportion to the progesterone. But so yeah, we, some of the toxins that are out there that we see that I see a lot of every patient that comes through my door gets toxin testing. And I think that I will say this, and you're going to hear me say this over and over throughout this podcast, probably the most underutilized testing with respect to our health and wellness is environmental toxin testing because it's what drives inflammation and oxidative stress. And our mitochondria don't work normally because of the pesticides, herbicides, metals, plastics, mycotoxins, all of the things of that nature, PFASs, VOCs. Once you start to do it for the past four years, I've been doing this and unequivocally, I know that this is the cause of lots of chronic disease. I'm a cardiologist, but I see patients with everything now because people come here as a last resort, we don't know what to do with the last resort. And when you look under the hood and you start to pull away these pieces, you start to see these toxins and detox pathways and detox genetics that are not allowing them to detoxify glutathione genes, methylation genes, acetylation genes, sulfation genes. And all of a sudden, you have a pretty little picture to tell them why they're sick. Okay. And honestly, at this point in my career, it's not rocket science. Okay. When they come here, you can pull apart the pieces between toxin testing, genetic testing, and micronutrient testing, organic acid testing. I can put a nice little package together and tell you exactly why you're sick. Okay. So anyways, back to where the question was, are these toxins, the ones we see most commonly, BPA, the mycotoxins, xeolarnone, insecticides and pesticides, those are the ones we see most commonly that can act like estrogen. And I will guarantee you that most of your listeners don't know whether they have those things or not because most people have not been tested. And I ask this question every time I do a podcast, I always ask, raise your hand and then I wish I could see how many people have actually had environmental toxin testing done. And it's not many, right? We talk about it all the time. And our government now, for our bikini, we're kind of having all these conversations. And hopefully we're getting to a point where we will make a difference and start to have this test. But let's not talk about it. We don't have to talk about it. When you get those tests, all these conversations will be done. All the conversations will be done, I promise you. If you're in perimenopause or menopause and are feeling more fatigued, dizzy, lightheaded, struggling with headaches or noticing your workouts feel harder than they used to, electrolytes may be part of the missing piece. As estrogen declines, we lose some of the fluid regulating and vascular protective effects that hormones once provided. That means blood pressure regulation can shift, cortisol can run higher, and many women become more sensitive to dehydration, especially if you're strength training, walking more, intermittent fasting or reducing processed foods. That's why I love Element. It is my favorite electrolyte formulation. And I've exclusively used their products for the past six years. Element contains a science-backed ratio of sodium, potassium, and magnesium without sugar. Artificial ingredients are unnecessary fillers. It supports hydration at a cellular level, helps reduce muscle cramps, improves energy, as well as recovery, and can even support better stress resilience. This is particularly helpful in midlife when we're prioritizing metabolic health and muscle preservation. I personally use Element throughout the day, and it's become a staple in my routine as well as my household. If you'd like to try it, go to drinkelement.com slash Cynthia to receive a free sample pack with any purchase. Stay hydrated, stay strong, especially in midlife. If you're in your 40s and 50s and feel like your body suddenly stopped responding the way that it used to, you're not imagining it. Bloating, waking, sleep disruptions, food sensitivities, and unpredictable energy are incredibly common in perimenopause and menopause. But here's what most people aren't told. Your gut microbiome is changing right alongside your hormones. And those changes can influence everything from how you store fat to how well you sleep to how your body processes estrogen. That's exactly why I wrote my new book, The Menopause Gut. In this book, I walk you through the science of how the microbiome, metabolism, immune system, and hormones are all connected during midlife. But most importantly, I give you practical, realistic strategies you can start using right away without extreme diets or complicated protocols. You'll learn why the same diet that worked in your 30s may not work now, how your gut influences hot flashes, mood, and weight, the truth about fiber, protein, and blood sugar in midlife, and the daily habits that help your body feel safe, stable, and resilient again. If you're tired of blaming yourself for changes that are actually biological, this book will help you understand what's really happening and what to do about it. You can pre-order The Menopause Gut wherever books are sold. And when you do, be sure to check out the special pre-order bonuses I've put together for you. Again, you can go to www.CynthiaTherlo.com. You'll click on the banner. It'll take you to multiple options for where you can order The Menopause Gut in pre-sale. Well, and I think it's really interesting because I'm married to a very smart, wonderful human being. But because he cannot see it, he assumes it's not problematic. And so I recall probably 15 years ago, we became much more conscientious about plastics in our environment and the type of athletic wear we wear as an example. And you just start to understand that making small changes do have a large net impact. But to your point, I would imagine most people have not been tested for environmental toxins. Do you have a special company that you like to work with or do you work with several in terms of testing? Because inevitably the question will be, what type of testing does Dr. Davis like to use with his patients? Yeah. So I actually, there's a couple of companies out there. I prefer Vibrant Wellness. Vibrant has a toxin test that is the most comprehensive that I know of. Vibrant has a total toxin test that actually looks at mycotoxins, heavy metals, plastics, PFASs, peripheral alcohol substances, forever chemicals, they just added on recently as well. So really, they have a pretty comprehensive battery of the environmental toxins. Now, it's not every toxin that's out there, but I think it's comprehensive enough that you capture most of the stuff that's problematic. And so that's the company that I use. And I will say one other thing about that test. Anytime I get environmental toxin testing now, I always have my patients do an infrared sauna or sauna prior to doing the toxin testing. Okay. And that is because for the longest time I was doing the Vibrant testing and a lot of the heavy metals and Vibrant, I was getting normal results for the first two years of kind of utilizing that test, everything was normal, normal, normal, normal, normal, normal. And in my head, I'm thinking myself, I don't know about this test. I think I'm going to start doing something else. But then I watched some webinar somewhere I can't remember, and the doctor was talking about doing a sauna before you did the environmental toxin test. I did it one time. Okay. And from that moment on, my entire practice changed. Like this, my concept that me talking to you about environmental toxins right now would not have happened had I not started having patients do a sauna before they do the environmental toxin test. So I would encourage, if anybody decides that they want to go to Vibrant and get that test, do a sauna the day before you do your toxin test. It's a first morning boy test. So first thing in the morning, you do catch the first urine, but do a sauna anytime the day prior. Okay. And then do your first morning boy. Okay. You will be appalled. Okay. And again, there's not, there's, and some people will say, well, you kind of put them in the sauna. That's why you're seeing it. Well, isn't that what I want to see? The toxins are provoked. Yeah. Toxins are stored in a fat and bones and organs. I don't want to just have you go do a urine sample and just say, okay, well, I don't see anything. Right. I want to know if I have some body burden that's stored in places that where these, I mean, and we can mobilize it with the sauna. So that really has changed my practice in a couple of different ways. It changed it in fact that I can, I don't miss these things now. And two, just the concept of doing the sauna and we can now detect it. Well, what do you think the number one treatment to get these toxins out? Infrared sauna. Right. And I say that when I have hyperbaric chamber, red light beds, molecular hydrogen, but the number one tool in this office to get people better is infrared sauna because of the toxins that they're exposed to. I think it's absolutely fascinating because as I was listening, I was like, oh, it's provoked. You know, when you get into the infrared sauna, you get warm, you sweat. And so with that, you're provoking the likelihood that you're going to get better results. And so Vibrant is a company that I do work with and I do think highly of their testing. And if listeners are interested, obviously talk to your functional integrative medicine provider about that. Let's pivot a little bit and talk about imaging and labs. So this is something that I find particularly interesting. There are still practitioners out there. And I know this because I see it across social media in groups, questions that are sent to the podcast, there are practitioners out there that are basing drug therapy on a total cholesterol, traditional LDL, HDL and triglycerides. And I would be the first person to say, no one should be basing medical therapy on those metrics. For you, when you're evaluating your patients for risk stratification and who you need to be more or less aggressive with, what are some of the other labs? And I'm sure we're in 100% agreement. What are some of the other labs you like to look at to help with determining risk stratification for your female patients in particular? Yeah, I think that you nailed it first and foremost on the value of regular lipid pound that tells you your total cholesterol, LDL, HDL, triglycerides. It's minimal at best. I mean, I think that if I had to look at those numbers, the triglycerides to HDL ratio is probably the most important in looking at your insulin sensitivity, so to speak. But when I look at those numbers just by themselves, I don't really do a whole lot with them. If your cholesterol is 250, what does that mean? Am I been out of shape? Not necessarily. What we need to have is some type of particle fractionation where we can look at the number of particles and the particle sizes. We know that small dense LDL particles are much more atherogenic than just a normal size or larger LDL particles. We look at same thing with respect to HDL being our good cholesterol. We say LDL is the bad cholesterol and HDL is the good cholesterol. Not necessarily. How LDL is bad and not all HDL is good. So we're looking for these larger HDL fraction as well, which serves the function of HDL to take cholesterol out of the body, out of these tissues, right? And so not all HDL is good. Looking at other markers, and I'm sure we've talked about this a lot, this lipoprotein little A. Lp little A has been around for a long time and finally it's making its way into some of the guidelines. And it is a real marker for premature heart disease. No question, full stop. That's the marker where my brother had a heart attack at 51 and his dad had a heart attack at 47. And those type of stories when lipoprotein little A levels are elevated. And unfortunately, there are no magic bullets to lowering Lp little A right now statin certainly don't lower Lp little A. There's some data that they may even raise Lp little A. PCSK9 inhibitors can lower Lp little A some. So that is one option we have out there. But pretty much you can't eat your way up or down with Lp little A either because it's 90 plus percent genetic. And that is a real risk factor. But you do need to know because understanding what that risk is and trying to making sure you minimize. And this is what I say to my patients, we know that Lp little A is not only more athrogenic, but it also just makes your blood more sticky. So more likely to clot, right? And so if there are other things that are other things from a biomarker perspective, homocysteine, for example, phybrinogen is another one. If I see other markers that I can manipulate, right, that I can bring down homocysteine by just giving B vitamins and other moda, other ways to bring it down, then I'm going to make sure that I try to address all these other risk factors that are going to cause an increase in subclotting when somebody has Lp little A levels that are quite elevated. Other markers that I look at, inflammation markers, at the end of the day, vascular disease is an inflammatory disease, an inflammatory disease that results in more oxidative stress and damage to the vessel. And so measuring things like lipoprotein, phospholipase A2, Lp, PLA2, myeloperoxidase, C-reactive protein, F2 isoprostanes, oxidized LDL, these are all inflammatory markers that truly drive heart disease. I'm giving a talk in a couple of days in Austin on residual risk. And the residual risk is all those things we just named, but the residual risk that most people still miss is what we talked about earlier, the actual environmental toxins. But that's kind of my panel that I use most of the time now. And I'm pretty comfortable saying this. I can look at the advanced lipid testing with inflammatory markers and I can tell you who has heart disease. And why I can tell you that now is because we have other imaging modalities as well. The days of stress tests are gone. I don't know if anybody's still getting stress tests, but they're kind of gone. But we have imaging modalities and we can see the heart, we can see the inside of the arteries and we can actually characterize the plaque in those arteries. We can look for soft plaque or non-calcified plaque. We can look for low density plaque, that sticky plaque that's more vulnerable, more likely to cause a heart attack. That has changed the ballgame. Stress tests are designed to detect blockages that are 70% or more. I tell my patients, now, if I have a 40% blockage, would you want to know now? Most people say yes, right? So doing a stress test and saying everything's okay, but yet I still have mild to moderate disease, that doesn't make any sense. When we have a technology that allows us to look into the heart, see what the blockages are, but not only see what the blockages are, see what that plaque is consisting, what type of plaque morphology that is, and then you can start being more preventative years prior to developing that 70% blockage. So two things, the biomarkers and the imaging have really changed the game as how we assess from a preventative perspective with our patients. Well, and it's so interesting because I was in clinical cardiology for 16 years, both inpatient, outpatient management. Do you know how many stress echoes, stress thalliums, et cetera, we were ordering and doing? And I would always say to the patient, you need to understand there are limitations to this test because people would walk away and they would say, oh, I just had a stress test. I can't possibly have a blockage. Oh, yeah, you can. It's just not significant enough to limit blood flow that we're seeing irregularities. Are you speaking to or cax and CT angios or are you integrating clearly testing, which is probably what you're alluding to? So I use clearly on most of my patients as well. So clearly is AI overlay of the data from a CT scan, from a CT angiogram. So that really has changed the game. And my opinion, it's my gold standard now because you're looking at the plaque morphology and how we change. Like, for example, on these scans, there's this red appearance of low density plaque. And that's the high risk plaque. That's the plaque where people do have heart attacks. What I look at is when I see low density plaque that's there, I know that there's vascular inflammation and most of the time it's going to be that LPPLAT, lipoprotein, POSFAL, life-based A2 is going to be elevated. Some of the other vascular inflammation markers are elevated. And then the question becomes, why are these vessels elevated? And then we're going to go full circle back to these things we just talked about, lead and mercury and all those other things. And so at that point, when you see somebody that they have a hot plaque, if you will, okay, you have to use a bandaid. And my band, I call these things band aids. Stadens in this case are absolutely warranted because they have other effects than lowering the cholesterol, right? We always talk about the pleiotropic effects of stads and those effects that things like they are anti-plakelet agent, they're anti-sticky, they are anti-inflammatory. And so when you see inflammatory plaque and you see biomarkers that are consistent with that, right now I need a band aid until we can fix the underlying problem. The problem in the past with traditional medicine is we don't go back to find the underlying reason. That they have it in the first place. And so that's kind of my approach to every patient. When I see that there, and that really has allowed me to detect cardiovascular disease much earlier and be much more proactive about my approach. It also has allowed me to say this, clearly it's also allowed me to prove, prove for principle that we can reverse plaque in arteries as well with certain strategies, you know, and improving the glyco-calyx function or vascular function, improving the phospholipids or using phospholipids that upregulate HDL, not that we can take plaque out of the artery. So we have, I have several patients now that we've reversed the amount of plaque in the artery simply by addressing what all the issues are in the toxins out, improving fatty acids, membranes, proving the vascular wall with the glyco-calyx product. That's the whole, we put the whole kit and caboodle together, if you will. This is really exciting. And, you know, my listeners know what my background is like. And so I think clearly is the direction things are absolutely moving in. And, you know, for those of us that have the genetic lottery from our parents, it's about 20% if we're looking at a pro, at a population distribution, 20% of us have elevated LP little A, not amenable to drug therapy in the most part. And PCSK9 inhibitors are exceedingly expensive, oftentimes not covered by insurance, which I think is criminal. And then the other piece of it is understanding that there are practitioners like yourself, they're utilizing this technology to go in and address underlying root cause elements that may allow these patients to then go on and not end up having events. Perhaps one of the things that's important to discuss at this juncture is what is different about women's physiology that we tend to have, as an example, more small vessel disease? What does that mean? What are some of the things as an interventionalist? So you have a very unique perspective on this. Share with listeners what makes us unique as women in terms of our physiology and anatomy that sometimes, you know, an interventionalist may not even be able to go in and intervene on a blockage, some of the unique aspects of being women. Yeah. So I mean, I think you again nailed it. And one of the biggest things with women is that they have this, what we call microvascular disease, the small vessels, not the epicardial cornea artery. So typically when we go in, we do an angiogram, we are injecting dye into the arteries on the heart and we can see all the major arteries on the heart. The problem in women is that they can have heart events and the epicardial arteries when we do an angiogram all look normal. And so what we sometimes see is that there's just sluggish flow of the contrast or the dye that we use down those arteries, suggesting this microvascular damage. And microvascular are the little small vessels that at the end of these bigger epicardial vessels, the microvascular are actually the little vessels that supply the heart muscle itself with the oxygen, with the blood supply and oxygen. And so they typically have more microvascular disease. And so what that tells me is a couple of things. I mean, that's largely related to nitric oxide issues. And that nitric oxide issue is largely related to the health of the vessel wall. And we talked about, I mentioned earlier glycol calyx. The glycol calyx is something that everybody should be familiar with. And what the glycol calyx is, is it's a layer, it's much easier to describe when we have a picture of it. So maybe, I don't know if you ever do video of me or images, maybe in the background. The glycol calyx is a layer of what I like to call this mesh like network that actually, and it's a gel like network that's inside of our arteries that's on top of the endothelium. The endothelium is the inner lining of all of our arteries. And that endothelium is responsible for producing nitric oxide and some other antithrombotic or anti-clot forming agents as well. But it's protected by the glycol calyx. And that glycol calyx is a bunch of polysaccharides and glycoaminoglycans, a bunch of big words that basically sugars that coat the top of the endothelium and protect that endothelium from damage. Damage from metals, damage from smoking, damage from other things that actually can damage that vessel wall that eventually cause plaque formation to occur. Now, we learned a lot about the glycol calyx with COVID in 2020 and 2021 because we know the spike protein damages that glycol calyx. And thus, we have all these issues with uncontrolled hypertension. We have issues with clotting that we've all heard about with respect to COVID, COVID vaccines, and that's largely generated by the fact that spike protein totally obliterates the glycol calyx. And so women, and this is theoretic, I don't know if this is out there yet, but just because of the fact that we know they have so much more microvascular damage, my suspicion is that it has to do with more issues with the glycol calyx. And why? I can't really tell you that right now. I don't have a great answer, but we know that's what drives an appropriately functioning microvessel is the nitric oxide production. And so that's something that we know you mentioned earlier as estrogen levels go down, the nitric oxide production, and how nitric oxide is produced is not as efficient. And so that becomes an issue with those smaller vessels. One of the things I thought was very interesting is that in men, the most common cause of cardiomyopathy or weak heart muscle is ischemic or having a heart attack. Whereas in women, the most common cause of a cardiomyopathy is actually hypertension, uncontrolled blood pressure, not having blockages in the artery. And again, going back to this whole concept of the microvascular and the nitric oxides. It's so interesting because I think about, I'm embarrassed to admit this, but I believe in no better do better. But I was always taught to my patients that we're getting older, stiff arteries are just a normal function of aging. So even if you do everything right, you're going to develop hypertension or high blood pressure. And now understanding that this very important signaling molecule is intricately interwoven into our physiology in a way that as we have less circulating nitric oxide production, we are more likely to have insults to the endothelium, the glycocalyx, and understanding why it's so important that we're just being conscientious about this awareness. And I think for listeners, kind of big takeaway is not to panic. That is not what we're advocating for. It's just with this information, making decisions in conjunction with your provider about what are the things you need to be doing as you're moving forward. I think one of the things that was incredibly frustrating for me when I was taking care of cardiology patients, how many of my patients would come in their blood work would show they had a heart attack, we sent them to the lab, the interventionist would say, you know what, this 55, 60, 65 year old female, I have nothing to stent. So they just go home on maximized medical therapy because they cannot intervene. And what we're talking about now is diagnostic testing that is going to allow us to have a little bit of a sneak peek into what may manifest or happen in the future for these patients. And I think that is incredibly encouraging. I also want to echo what you were talking about with statins. I think that statins in many instances, they are good drugs if used judiciously. I think that there are many prescribers out there that have just thrown them at everything. And by that, I mean the total cholesterol that's quote, unquote, high, the LDL that's just high without looking a little bit more deeply. And we know most of the benefits of statins are garnered at a starting dose, not the 80 milligrams of Lipitor or Zocor or some of these drugs where at those maximized doses, we get maximized side effects. When you're talking to your patients about drug therapy, when it's appropriate, do you have kind of a stepwise approach? I know that obviously you're looking very comprehensively at your patients, but when you're having conversations around drug therapy, what are some of the indications that you are looking at when you have to introduce medical therapy and it appropriately utilized? And very transparently, I was here, I'm on Zedia, and that is what's been helpful for me. How do you start those conversations? Because I think there's so much fear about medicine and helping patients understand there's a time and a place, and it should not come from a place of fear. I think that I'm also a huge believer in personalized medicine. And I think that this is for men, women in general, my approach has become much more personalized for every single patient. Because one of the things that I don't like about medicine, we have these huge randomized controlled trials that essentially me as a person, I may not fit into any of those inclusion criteria for those for the recommendations, yet those recommendations are applying to me as well. And so when I'm having conversations with my patients, I mean, I think I do so much testing and trying and explaining that I can show them kind of where the risk is, why it's there, and right now, why this medication is beneficial. And so I think for me, it's fairly easy because I have so many pieces of the puzzle to have them understand, okay, look at these levels of the vascular inflammation, you do have some coronary disease going on right now, there is a likelihood that this coronary disease is going to continue to evolve if we don't address this inflammation issue and oxidative stress issue. And this is what we need to do to start that right. And the medications may be part of the plan, certainly supplementation is going to be part of the plan, lifestyle is going to be part of the plan. And so they understand that point. And I think that when they come to me, there are lots of people who come here to they come to the door saying, I don't want to be on a statin and they've heard so much and statins are the, you know, the evilest thing that we've ever dealt with. But they come here knowing that and some people may think that I'm just anti medicine, right? And I am far from anti medicine because there's a commonplace. And certainly, like you said, I think they are I mean statins and many other medications are very much overused. But when you go back to onion, I like to say or look under the hood is what I actually say a lot of the times, I mean, look under the hood, you can start to put those pieces together and really come up with a personalized plan for each individual. And I think that's the key to truly getting results. Because no, I mean, we can talk about diet, right? I mean, the thing we can talk about diet, right? Let me just give you a couple examples. I mean, how can you have groups of doctors, some groups of doctors are plant based, Keto, Paleo, Carnivore, and, and everybody is just in their camp, right? At the end of the day, none of the camps are right. Okay. And there are a lot of things, your genes are not your destiny, but they certainly give you a lot of propensity. Okay. And I can tell, I mean, there's there, I had a guy who came in, this is another funny story, I got great slides on these, but I had a guy who came in, he had had a heart issue and decided he wanted to go on the carnivore diet because he had read a bunch of stuff about how it's going to improve his insulin sensitivity and improve his overall heart condition. And when he came in, I said, I wouldn't do that right now until we kind of got some laughs, because there's some things that could happen that would get you in some trouble with respect to kind of going carnivore here. So while I just started last week, why don't we kind of just kind of, let me go ahead and finish this out. So I told him, I said, okay, you go ahead and do this carnivore diet, but in one month, I'm going to check your labs. Okay. We're going to check labs. And again, we got the advanced lipid testing that we previously spoke about. And so when he came, when he initially saw me, his initial labs were okay, his cholesterol was 206 and so I was over concerned. All of his inflammatory markers were normal. All the LPPL A2, myeloperoxidase, everything's normal. I mean, other, I mean, he was pretty healthy at that point from a biomarker perspective. Well, a month and a half went by and I got his labs back. He had gone carnivore. And his cholesterol went from 206 to 534. Okay. Wow. The lipoprotein phospholipase A2 inflammatory marker went from being normal up to 280, like three times normal. Okay. The oxidized LDL, okay, the rusty cholesterol, I like to call it, was not measurable. It was higher than the upper limits of normal measurable. Okay. And he had an APO and he had all the genes. There are genes that will tell you this, right? There's APOE gene variant. If you have an APOE4 gene, there's something called APOA2. There's another gene called TCS7L2. You can, I can tell like this, if you eat a lot of saturated fat, it's not going to go well. Okay. And so, and that's exactly what he had. He had all of those gene variants and exactly what the genes suggested would happen, now the good part about this is we've changed him back to kind of a Mediterranean diet and over a course of about four months, his numbers all came back down to normal. But that's the kind of mistake people, I mean, you're, you're, I mean, each individual is, and it's different. And so, for all of these people, you're getting these bandwagons, it's wrong. I mean, I don't know what else to say. I mean, I did it, I did it when I first started this functional medicine thing, I got on a keto bandwagon. Little did I know, I almost killed a couple of people and then you have to figure out, right? You have to figure out why. Okay. And then once I kind of figured out why I started doing it and testing everybody. So when I make recommendations, I'm not making it, I'm making it off of educated, what I see in front of me, no, you shouldn't do keto. Right. So anyways, one thing I want to say really quickly about women too, I think this is really important when I don't want to go past this, because this is a very interesting concept that women and heart disease and women and heart attacks, okay, we can't skip over this whole broken heart syndrome, Takasubo's cardiomyopathy thing, right? I remember back when I was in fellowship, man, 2000, I will never forget it, early 2000s, 2004, 2005. And we used to have, I mean, I don't know how many women showed up and their EKGs looked like they were having the heart attack of heart attacks or standard regular heart attack, and we get in, we do our angiograms and nothing. Okay. But the heart wasn't moving normally, the heart was stunned, right? So she had a heart attack, okay. But the arteries are okay. And at that point, we didn't know what this was. Like I distinctly remember like what in the world now after this happening over and over again, you know, we know that it's this whole catecholamine surge that's driven by stress, okay. Broken heart syndrome. Broken heart syndrome or catecholamine derived cardiomyopathy or Takasubo's cardiomyopathy. Bottom line is stress hormones cause these vessels to constrict. Okay. There's no blood flow to those specific area. I mean, it's a very, very unique pattern of wall motion after matter where the heart doesn't squeeze normal. But I want to say, I wanted to bring that up because that 90% of the time is women. Okay. And again, I'm not sure if that just has to do with whether it's hormones, neurotransmitters. I can't, I don't really know why we see it mostly in women, but clearly that happens mostly in women that we see this, this catecholamine derived cardiomyopathy. And that's something again too, that, and I've seen it multiple times. And so dealing with stress, we talked about that at the very outset of this podcast, being able to have stress mitigation techniques, whether it's breath work or finding yoga, Tai Chi, whatever floats your boat with respect to this stress mitigation, it's really important because it's not just an emotional thing, right? It actually drives these stress hormones, drive vasoconstriction of the arteries, the stress hormones drive the clotting effect as well. Platelets are more sticky when women, when the stress hormones are higher. So it's a real part that we need to take a heed and pay some attention to with respect to the stress. What does good sleep actually feel like? The carmer you wake up and you don't want to get out of bed. This Mother's Day, cozy earth is making it so much easier to give that feeling to the people who matter most. Buy a sheet set for yourself and get one to give because the moms in your life deserve a bed she genuinely looks forward to getting into. 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This Mother's Day, give the gift that shows up every single night, head to cozyearth.com and use my code syntiabogo for an exclusive buy one, give one offer running from April 12th to April 18th on sheet sets. And if you get a post purchase survey, mention you heard about cozy earth right here on everyday wellness. Again, cozyearth.com, use code syntiabogo for an exclusive buy one, give one offer for the person who makes everything feel like home. If you're in midlife and you've started to notice that your energy, your strength or even your recovery just isn't what it used to be, I want to share something I've been thinking more and more about lately. For many women, we assume it's all about hormones and hormones are absolutely part of the story. But there's another layer that often gets overlooked and that's about cellular energy. As we get older, our mitochondria, the energy engines of ourselves become less efficient. They accumulate damage over time and when that happens, it can show up as a very specific kind of fatigue. You're doing all the right things, you're eating well, you're strength training, you're prioritizing sleep and yet something still feels off. That's why I've been incorporating timelines, might appear into my routine for the last five years. What I appreciate about might appear is that it works at the level of the mitochondria, helping your body clear out damage ones to yourselves can function more efficiently. And clinically, this matters because mitochondrial health is tied directly to energy, muscle strength and resilience. For me, this has been a foundational part of my routine as well as my husband's. Not something extra because something that supports everything else I'm already doing. And for women in perimenopause and menopause, this is an important part of the conversation because supporting your energy at the cellular level can make a meaningful difference in how you feel day to day. And my friends at Might-a-Pure are doing a big price cut. There's a one time purchase is going from $125 per month to $99. With subscriptions, it will now start as low as $75 a month. The hope is that this will make Timeline more accessible to folks in my community who've been on the fence or tried it and lapsed. You can go to timeline.com slash Cynthia to learn more. Again, timeline.com slash Cynthia to learn more. Yeah, I'm so glad that you brought that up. And what we it's called broken heart syndrome. And we would see patients that would lose a spouse or have a terrible cancer diagnosis or some other catastrophic stressful situation. And in most instances, they would recover their heart muscle function. Let me preface this. But in most instances, they would then feel like this additional pressure of like, okay, so stress did this to my heart. Now what do I need to do? And I used to always say and would still say, we have to take care of ourselves. You know, when you're on a plane and they talk about oxygen masks, if they drop down to take care of yourself before everyone else around you, women are the caretakers. We generally present late with symptoms because we are so busy taking care of everyone else. And it really just reaffirms why it's so important to report symptoms and to get them evaluated. I definitely want to touch on GLP ones, because they're not just a weight loss medication. We're seeing all these other benefits are using GLP ones. I would assume so with your patients. What are some of the indications that you're using them for beyond just the weight loss benefits? Yeah. So in the cardiovascular realm, I think one of the for me in the past, I've never been I have a health and wellness practice here and I've never been a weight loss drug type of physician. However, with the GLP ones, the benefits that we've seen in multiple studies now from a cardiovascular perspective and MI risk was pretty compelling. And so now as a cardiologist dealing with people who want to lose weight, we have metabolic syndrome and possibly even some history of vascular or cardiovascular disease. Now I have a drug that can help them lose weight, help with the metabolic syndrome slash diabetes and help with minimizing the risk of another event. So I had to kind of get on board with that. Now, having said that, I think it's very important that lifestyle still trumps everything. And I call a lot of these, I call the GLPs, which are peptides and other peptides, I call them tricks up my sleeve. And so I make my patients understand that they have to do the work first. They have to do the work with eating, I mean, the clean diet, removing the toxins from their lifestyles. So I think that it's important if we're going to use these medications to make sure you're still doing the fundamentals first. I can't emphasize that enough. I just, I really have a thing about just the whole weight loss thing. I remember, you know, people using some of the other, the other weight loss drugs, what is the side that I can't even think about it? Because I don't think for me, the thing people come in and want to be on phentrum. Now, how is a cardiologist am I going to put somebody on phentrum? Right? So I kind of really had this thing about the whole weight loss drug thing. But again, because of all the other additional benefits of the GOP ones, I think that, I mean, I, and I started to use them, we're using them very, I mean, successfully. The thing that I learned early on, as we all did, it is very important that you're watching protein intake and making sure that we're not having a lot of muscle loss, sarcopenia, as you mentioned earlier. And then early on, that's exactly what, that early on, that's what happened. I do a lot of body composition with DEXO or in body. And I started to see, yeah, we're losing 20 pounds, but 17 of it was muscle mass. That's not a good thing, right? So I am using it. And I think they certainly have a place. Absolutely. I'm interested to see long, I think the problem is once people get on them, how do we use them and not be stuck for life? That's a tough one. I'll be honest with you, even when you have a practice like mine, when people are trying to do the right thing, it's been hard to kind of just pull people away. Or if we do pull them away and they're still doing the right things, they still tend to gain a little bit of weight back. I'm navigating the waters right now myself, trying to figure this out so that when we start, I'm not starting people on GLP ones and it's for life. Yeah, I think you bring up so many good points and really reaffirming how I view them as peptides or the icing on the cake. When we've done all the foundational work, the lifestyle in particular, to your point about echoing the protein intake and strength training, unfortunately, body composition is really a huge driver of transparency. And I will say to patients, I know you're not happy with the number on the scale, but let's figure out what's your fat-free mass to muscle mass because muscle is king or queen, depending on who you're speaking to. And we want to maintain as much muscle mass as we can for as long as we can because it's not just about vanity metrics, that insulin sensitivity, it's about avoiding falling because you become frail. How many patients, I'm sure you took care of in the hospital who couldn't get off a bedside commode and they were 50 years old. I was like, that's not a good sign if you don't have enough muscle mass and or strength. And the irony is strength precedes the muscle loss. So if you suddenly start finding that you can't open the pickle jar or you can't lift your suitcase into the overhead compartment, that is a sign that you need to change things and fast. I just had a couple questions that came in around specific things. As an example, getting back to statins, if I'm statin intolerant, does that mean no lipid therapy? So do you have any tips for people if they are finding that they get a lot of muscle aches, myalgias, even on the lowest doses of statins? For someone who has a clinical indication, what are some of the things that you will do? Again, not medical advice, but kind of broad approaches to statins given the fact that there are people who actually have actual indications and need to be on them. Yeah. I think the first thing we would be neglecting a very important concept if we didn't speak about the rule, absolutely having to be on coenzyme Q10, CoQ10, Bikwinon, Bikwinon, when you are taking a statin because that same statin interferes with the production of coenzyme Q10, which is a cofactor and the mitochondrial electron transport chain in producing energy. How we use and convert our fats and carbohydrates to energy, our whole metabolic state is determined by the mitochondria and that mitochondria has a very important molecule called CoQ10 that if we don't have it, doesn't work for it well. And so making sure you're taking CoQ10 and I typically tell my patients between 200, maybe even 400 of CoQ10 when you're taking a statin, that would be one thing that I would look at. The other thing that I look at, you've heard me say this a couple of times, the personalization of it all. There are specific pharmacogenomics and looking at genes for a CIP 3A4, CIP 3A5, and if you know specific statins are metabolized down a pathway that I have a gene variant in, then I need to move to a statin that doesn't use that pathway. So that's one that I use that a lot. Again, I get environmental toxin testing on every patient. I get genetic testing on every patient. So I really am navigating you. And so that's one of the things that I would think. You can also predict the people who are not going to tolerate these statins as much. I mean, the genes for that. Slow-Cost SLCO is a gene that most people have some issues with statins. More of those people have issues with statins if you have a gene variant there. Other things that I use, we can try to use other natural, I use a lot of natural products. I'm big into the integrative space. I use a lot of nutraceuticals, but the nutraceuticals that I use are all ones that have been researched. And I will talk about, I'm actually the chief cardiologist for a company called Human. And Human is a supplement company who makes nitric oxot products, glyco-calix products that we talked about. But some of our products, actually, one of our products, actually, a glyco-calix product has aged garlic, grape seed extract. Both of these have been, they have many, many functions. When we get down to the scientific level of what they're doing, I mean, it's, I mean, down to the mitochondrial level, I mean, these grape seed extract and aged garlic have a lot of functions. But when it comes to just the numbers, they help to lower cholesterol. They can lower triglycerides. And so I use a lot of those type agents as well. When I'm thinking about other modalities to lower cholesterol, but remember, okay, it's not just about lowering cholesterol. Okay. The cholesterol is just a number, right? So we're looking at inflammation, lowering inflammation and oxidative stress. And so what I'm doing when I'm utilizing these nutraceuticals is I'm trying to get at, how do I address this oxidative stress and inflammation that's going on and which one of these supplements is going to be helpful for that? Let me see. Other things that I use a lot of, I use some red yeast rice, but not a whole lot of that. I mean, these other two products I use mostly, it's grape seed extract and Berberin is another one that I use a lot of. Berberin is, when it comes to metabolic syndrome, I mean, we know that Berberin is as effective as drugs, as it is as effective as a glucophage, metformin, right? And so a lot of people who have metabolic syndrome, insulin resistance, I use a lot of Berberin, that's another great product. And it can also lower triglycerides pretty significantly. Those are kind of my go-tos when it comes to kind of some of the supplements. Well, let me just talk about one thing I want to talk about really quickly, nitric oxide, because I want to, and we probably don't have a lot of time to talk about, I want to talk about, we know about the benefits of nitric oxide from a vasodilation, opening up the arteries perspective and helps prevent, again, clotting or stickingness of the vessels and helps with the immune system. And so nitric oxide has a lot of great properties. I think one of the things that's going to come to the forefront and that has not yet been talked about, and I'm doing a lot of talking about it, because as part of my role with human, I had to really dive into this nitric oxide thing and understand the benefits of nitric oxide. Well, in understanding the benefits of nitric oxide, I also began to realize that nitric oxide at physiologic levels is great, but high nitric oxide levels is problematic. And what do I mean by that? There are three different enzymes that make nitric oxide. And the one that we most familiar with is called enos, endothelial nitric oxide synthase that makes the nitric oxide that we know causes all those things. I just talked about dilation and all those things. One of the molecule, one of the enzyme forms that I think most people are not talking about very much, and it's going to come to the surface real quickly soon, I think. I'm going to keep talking about it. And one of the guys that I've learned this from is Bob Miller. Bob Miller does a lot of genetic stuff, and him and Jill Carnahan do a lot of talks on NADPH oxidase and inos, and they are on to something and nobody's listening. But inos produces micro molar concentrations of nitric oxide, whereas enos produces only nanomotors, thousands of times, thousand times less nitric oxide. And enos is produced by monetized macrophages as an immune response and causes more oxidative stress by forming peroxynitrite. Nitric oxide combines with superoxide to form a very, very reactive agent called peroxynitrite. Nobody's talking about it. It kind of got swept under the rug in the 90s, but a lot of the toxins that we're exposed to are stimulating inos, stimulating NADPH oxidase, and there are a lot of the illness that we have is being driven by up-regulated, this good nitric oxide, whereas we still have, and I think we got some work to do to figure out, well, enos is good, and inos is bad, I got a lot here, and a little bit, how does this all kind of play out, and is there or are there mechanisms by which we can individually up-regulate enos while down-regulating inos? And there's some suggestion that there's some things out there, and this is all stuff that's out there, but nobody's talking about, but it's important. It's very important because the mycotoxin illness, the toxins are all driven, those inflammatory responses are driven through inos, which is driven through NADPH oxidase. So I know it's a bunch of scientific words, but there's more to nitric oxide than we even think we know right now that we need to put these pieces together. Yeah, it's so interesting. It's really the Goldilocks effect of figuring out, you know, in the right amount at the right time, and I believe that I was listening to a podcast that you did for A4M, and that's where you were introducing some of these concepts in preparation for this conversation. So definitely, emerging research, hopefully there will be more that's applicable to our patient population. Please let listeners know how to connect with you if they would like to become a patient of yours, learn more about your practice, or connect with you outside of the podcast. Yeah, sure. I'm in Sarasota, Florida, and my practice is reveal vitality. If you go to www.revealvitality.com, and you can learn all about our practice, very unique practice, feel free to just, there's an information button there if you guys are interested in hearing more, hearing more about kind of the services we offer. I think the website does a good job of kind of covering a lot of the things that we offer. I have an Instagram handle, cjdavismd. Hopefully, we'll start to get more of my, I don't like posting myself, my, I absolutely, in fact, I despise it, but every time the things that get the most views and garner the most attention are when I do that. So I'm going to start doing that more right now. The things that are up there when people, when I'm at talks and when I give, doing events and stuff, they put those things up there. And you can hear a lot of my philosophies, a lot of the stuff that we talked about today are the same things you're going to be talking about on some of the things that are on my Instagram site. But my goal is really just to change the way medicines practice. I mean, we all have to wake up and take responsibility for our own health. I think that as a physician, you know, you go through all these years of training, and then you start to realize that, okay, there's more, there's more, right? And my goal is for to educate the people, the patients that are listening, but also to educate other doctors. I mean, there are many, many doctors who thought I was crazy, but now the same doctors are listening and they're asking me, well, how can I do this? And how can I do that? But if we can get more doctors who are truly interested in actually helping and the things that they went into medicine for, then we can start to change this whole atmosphere of like the lady who was told to take hormones and not even being tested. I mean, some of this stuff is just crazy. We got it, we got to change it. Absolutely. Thank you for all the work that you do. I've really enjoyed this conversation. Yeah, well, thank you so much. And thanks for having me. I appreciate it.