Cardiologist: The Fastest Way to Get Rid of Visceral Fat & Reverse Fatty Liver | Dr. Pradip Jamnadas

Visceral fat is pathological, always. It should never happen. But we have an epidemic of it going on right now. Estimates are anywhere between 40 and 50% of the population may actually have fatty liver, including kids. There's a direct relationship between a fatty liver and coronary artery disease. Plaque buildup. Your vasculature developing plaques in it. And when these plaques rupture, of course, you can get a catastrophic stroke or a heart attack. But there is a direct correlation. This is not a benign condition.

When a patient walks in to the door, I can often tell whether they've got a fatty liver just by looking at them. If you leave that fatty liver there, you will become a diabetic. Just leave it the way it is, you will become a diabetic. It has been linked to obesity. If your body mass index is over 35, you already reduce your lifespan. It's related to, of course, the diseases such as hypertension, joint disease, obstructive sleep apnea. There's been a link between high insulin levels, fatty liver, and certain types of cancers as well.

I do a DEXA scan on my cardiac patients, and I'm always surprised at what I find. Some people are so thin, and yet they have such a fatty liver and they have visceral fat. And you can on a DEXA scan measure the amount of fat that there is. So, it's something that's actionable. You can see it and you can be motivated to change it.

>> Dr. Jay, what is visceral fat and why is it so much more dangerous than the fat we can see?

>> So, not all fat is the same. The fat that you can pinch on the outside on your body, that's subcutaneous fat. And that's the stored fat. The fat that is excessive um energy, basically your body is storing that energy in the form of fat to be used on a rainy day. Of course, those rainy days must come about so we can start using them. Often times it's a one-way street, but the visceral fat is a different animal. We should not be putting on visceral fat. Visceral fat is a detrimental pathological procedure. So what happens now? The body starts taking those energies and puts them into the wrong places. That puts it in the liver, around the pancreas, in your um, all around your intestines in the fat. So it's all in the belly. But another area where you get ectopic fat. Ectopic means fat where it shouldn't belong, is in your coronary arteries, in the walls. All that is ectopic fat, and visceral fat is of course one kind. So visceral fat is this abnormal fat, and the pathology that causes this to happen is a deranged metabolism in the body. This is not normal. If you have excessive calories, you put on subcutaneous fat. That's a normal pathology. Visceral fat is pathological, always. It should never happen. But we have an epidemic of it going on right now. And estimates are anywhere between 40 and 50% of the population may actually have fatty liver, including kids. We, you know, we we think that at least 10 to 15% of the kids also have fatty liver nowadays. And the problem is that people think it's ah, it's okay to have fatty liver, but it is pathological. And from day one, I've seen it in my practice and read about it and studied it, and those who have a fatty liver are at increased risk of a number of problems.

>> When it comes to accumulation of fat on the body, what is the difference when we're partitioning towards the subcutaneous where we want it to go versus visceral?

>> It's pathology. So if you have inflammation in the body coming from whatever source, you're going to get ectopic fat deposition. So inflammation. If you have a non-inflammatory physiology, you're just going to put on subcutaneous fat. And we see that all the time. And we know that obese patients, about 20% of them are metabolically healthy. So in them, there is no inflammation. So they take excess calories, they'll just put it into subcutaneous fat. And you do a biopsy of that fat, you will see the fat cells are increased. They are bigger than they should be because the number of fat cells you actually have is determined at the time of birth. And then when you get obese, you just basically grow those cells. And you can have a few increased numbers of adipocytes over the life, but not that much. Basically, your own cells just grow. And that's what happens under normal physiology. Now, throw in inflammation. Now you have inflammation, and that's the 80% of the people who are overweight. Now they have inflammation. They'll have a fatty liver. Not the metabolically healthy people who have a normal liver. They don't have a fatty liver. So it's inflammation. So what drives inflammation will drive visceral fat, and this visceral fat will come from a number of pathologies. So I'll name a few of them. The first thing that always comes to mind is hyperinsulinemia. So if you have high insulin levels, insulin will direct it into the liver. High glucose intake, eating too frequently, eating too much carbohydrates, modern western diets, processed foods, refined products, the glucose available immediately, lots and lots of carbohydrates, simple carbohydrates stripped out of the fiber, huge increase in the insulin levels. Now, you do that often enough, your insulin level is high all the time. That pathology, high sugar, high insulin is going to drive that fat into the liver, and this is called de novo lipogenesis. So the first thing we think about is what is your sugar status? What's your insulin status? Very important. Are you a diabetic? But more importantly, are you a pre-diabetic? That's the question because many of these patients who have fatty liver have a problem with glucose, but they say, "Oh, I'm not a diabetic because my A1C is fine." But when you measure their insulin levels, it's sky-high. So there's deeper knowledge that needs to be obtained there.

The second situation, so I'll just give you a round up first, is toxins. And of course, the biggest toxin you all know about is alcohol, right? So you you consume a lot of alcohol, you're going to get a fatty liver because alcohol is metabolized predominantly in the liver. It's an abnormal molecule. The pathways have been worked out, but basically lead to a fatty liver. So does fructose, by the way. Because fructose and alcohol are are cousins, except one intoxicates and the other one doesn't intoxicate. But what they do to the liver is the same. For example, I saw a patient just three weeks ago who had a fatty liver. And I was baffled as to why he had a fatty liver, but this man was literally just eating nothing else but sugary fruits five times a day. And um, he just loved it. But he had a fatty liver. So I said, "Well, that's why you got this fatty liver." So it's fructose. So fructose does the same thing. So that's toxins. Other toxins, any toxin can do it. So let's say that you have excessive um uh heavy metals in your body, pesticides, herbicides, plastics, forever chemicals, um even mold. Basically, the I call these xenotropic drugs. So these xenobiotics, these xenobiotic drugs. So what are xenobiotics? Xenobiotics are things that should not be in the body. These are molecules, man-made molecules or abnormal molecules. So who's going to process them in the body? You post it in your body. What's the post office going to do with it? It'll send it to the liver. The liver has to deal with it. So any toxin is is potentially going to cause a fatty liver because the liver is the main metabolizing organ. It detoxifies all these things. So if you have toxicities, you'll find a fatty liver.

The third thing is the leaky gut because things from the leaky gut should not be coming across, and you're supposed to have a nice intact gut barrier. So even these molecules come across, and they can include, there's a whole bunch of them, but lipopolysaccharides is the one that we've studied the most, which are dead bacterial wall products. They come across the gut wall through your portal vein and to the liver. Now the liver has to deal with it, and again, it will develop a fatty liver. So when you biopsy that fatty liver, it's going to be inflamed. So this actually, there's a little bit more nuance here. You can have a fatty liver with and without inflammation. So if you have inflammation in it, now you're in real deep trouble. But you can get fatty liver with less inflammation, and it will, but they're both pathological. But when you see inflammation inside the liver, then that's really pathological because if you do a biopsy, you will find that there's the equivalent of macrophages inside that liver, and those those cells are called Kupffer cells, with a K, Kupffer, and they are macrophages, and they are inflammatory cells. They're part of the immune system, and they produce lots and lots of cytokines, chemicals like interleukin-6 and tumor necrosis factor, and um, and other detrimental uh molecules, and they float into the bloodstream. So now the body becomes inflamed because these molecules go systemically and they cause havoc in the body. So a fatty liver is a source of inflammation. In 95% of the patients, if you have a fatty liver, it's a source of inflammation. And you measure the blood, and you will find that these markers will be elevated. You will find your liver enzymes may be normal. But liver enzymes only go up when you now have necrosis of the liver cells. When the liver cells are actually dying, that's a very late stage. So if your liver enzymes are elevated, that's a red flag. You you you better you better get those enzymes down. And and those are standard tests that all the doctors do. But the point is that many times you'll have a fatty liver and your enzymes are normal. That does not mean that you can sit back and just relax and take it easy. No, you still need to work up. You got to find out why you got this liver that's fatty, and these are the causes because they are going to cause downstream problems, which which I can tell you all the sorts of problems that they can get with fatty liver.

Okay, I want to make sure I clarify this piece about fatty liver can be inflammatory or not. When it is inflammatory, what's the difference there? The pathology. So, one will have mostly just a lot of fat in it, and there's not much inflammation inside it, and then if you do the blood test to look for inflammatory markers, they may not be particularly elevated. So, this patient's got a fatty liver. Like for example, with fructose, many times I've seen that patients who have very high fructose levels, their the inflammatory markers are not particularly elevated, but they got a fatty liver. I do see that. So I do look for complimentary biochemical changes as well. But that distinction again is not, it's, it's not absolute. So it's not like I'm going to do a biopsy on that liver, but there are cases where I've seen that the biomarkers are looking pretty good, but the patient still has a fatty liver. Then I'm going to look at lifestyle. How often are you eating? How much are you eating? What is your insulin level? Uh, is it just a matter of this patient having insulin resistance only, but hasn't yet developed inflammation? You see, when you're dealing with patients that you need to determine how am I going to treat this? Is it a problem of excessive calories, eating too frequently, an insulin problem, or is it that, but also this inflammation? Because if you have also inflammation, you're going to do different things. Where's your inflammation coming from? Do you have a fat, do you have a fatty liver because you have a leaky gut? What is your MO levels? For example, how much inflammation is going into your body? If you have inflammation, I need to know why you have inflammation. We're going to look for the source of your inflammation. Also, in addition to just trying to eradicate your fatty liver.

>> You mentioned there going downstream from fatty liver, the implications in the body. Take that story further and and talk about those.

>> The cause of the fatty liver will have systemic effects, but the liver itself is going to produce inflammatory molecules, and that will cause systemic inflammation. It's been directly linked to coronary artery disease. Also numerous studies have been done. There've been articles in the magaz- in our uh articles in Circulation, the European Journal of Medicine and Cardiology. There was a big study, one done on obese patients in 2013 also, and it, there's a direct relationship between a fatty liver and coronary artery disease. Coronary artery disease means plaque buildup, means atherosclerosis, which means the commonest cause of death in the western world is coronary artery disease. Your vasculature developing plaques in it, and when these plaques rupture, of course, you can get a catastrophic stroke or a heart attack. But there is a direct correlation. This is not a benign condition. A fatty liver is not benign. That's the message that people need to know. This is not a benign condition.

Then the second thing is that a fatty liver makes insulin resistance worse. So it's a double-edged sword. So you can have insulin resistance that causes a fatty liver, then fatty liver also causes more insulin resistance. So if you leave that fatty liver there, even if you're not a pre-diabetic today or a pre-diabetic, let's say, you will become a diabetic. Just leave it the way it is. You will become a diabetic. So yes, the fatty liver will cause coronary disease. It will cause fatty liver causing diabetes in the future.

Then there are other things. It, it has been linked to obesity. So we know that it's related to obesity, and obesity carries an increase. If your body mass index is over 35, you already reduce your lifespan. So it's related to obesity. It's related to, of course, the um obesity-related diseases such as hypertension, joint disease, obstructive sleep apnea. So there are further downstream effects that are clearly been related.

Then there's also a link to certain cancers where patients who have a fatty liver, they found a higher incidence of certain cancers in these patients. So why? Because many times a fatty liver is due to high insulin, and insulin is a growth factor. So it promotes cell division and growth. So there's been a link between uh high insulin levels, fatty liver, and certain types of cancers as well. So the fatty liver is, is not, not something to be taken lightly.

And and remember also that the fatty liver also compromises your normal liver function. And the normal liver function, your liver does so many different different jobs. So now if you got a fatty liver from, let's say, eating too much um sugar or alcohol or fructose, and you got a leaky gut. Now you got this fatty liver. Now this liver cannot do its job normally. One of the jobs it's got to do is detoxification. So I found that these patients over time cannot detoxify properly. So they will develop other toxicities as well because our liver is supposed to be healthy. Ability to detoxify, get rid of toxins from the body, that's its job. That's part of the job of the liver, and it cannot do those things. So now you compromise your overall physiology. You're more likely to get toxic as well over time. And for one of the examples that I've seen a lot is mold, for example. And I found that patients who have uh a fatty liver are more likely to have a higher level of mold toxins in their body because normally the mold is supposed to get out of your body, the toxins, the microtoxins, through your liver uh mechanisms. And when your liver is already compromised, then those microtoxins don't get eliminated very easily, and then you have to help it along. And that you'll find that these levels will be high. When you have a nice healthy liver, our ubiquitous exposure to mold, the body takes care of it. It can handle it. But you have a compromised liver, you're going to have microtoxins build up as well. And microtoxins, what, 70% of homes have mold? A lot of people walking around with mold, and this has been an untapped area, but mold toxicity is a real problem. So that's just one example of, you know, the job that the liver is supposed to do and not able to carry out because it's compromised. You have a compromised liver, and and and this is a, this is a huge problem. I see this all the time. I also find increased toxicities in these patients. So one thing leads to the other. So yes, you got a fatty liver, and then I measure your toxins in your body. Which came first, the chicken or the egg? So then I find that they have very high levels of certain heavy metals. I find also that they have high levels of plastics, or they have high levels of uh pesticides and and volatile organic compounds in the body. Those are all supposed to be eliminated by the liver. So the liver is compromised. I think if you look at liver function tests in a regular blood work, you're going to underestimate the pathology because they'll come back looking pretty decent. "Oh, my liver enzymes are okay." And then that's the other thing that the upper limits for the uh SGOT and SGPT have been altered in the last 20 years because I think everyone's levels have been a little bit high. So they said that, "Oh well, you know, over 25 is is not abnormal anymore. It should be over 40." So some labs will only report it as abnormal if your liver enzymes are over 40. But in my book, it's still around 30. If your liver enzymes, SGOT, SGPT are over 30, then you need to pay attention because there may be a problem. Further testing is needed. And and it's a simple way to know whether you have a fatty liver. There are simple ways to find out.

And so basically, when a patient walks into the door, I I look at the physique and I can often tell whether they've got a fatty liver just by looking at them because I find that the the the abdomen is protuberant. And yet it's not full of fat because I can't grasp the fat. It's tight. It's tense. Um, that patient probably has it. And all the weight is carried right here in the belly. Everything's right here. And when we do the DEXA scan, for example, that's one test that I do. I do a DEXA scan on my cardiac patients, everybody. And I'm always surprised at what I find. So I find that some people are so thin, and yet they have such a fatty liver and they have visceral fat. And you can on a DEXA scan measure the amount of fat that there is. You can get the volume, the mass, and the area. And I love this because I can do it today, put you on a prevention program, come back again in a year or a year and a half, and I'll repeat the DEXA scan, and the DEXA scan will now show me that your volume has gone down, your mass has gone down, the area has gone down. So it's something that's actionable. You can see it and you can be motivated to change it.

So I usually used to do ultrasounds of the liver. It's subjective because the radiologist looks at it and says, "Oh yeah, you got a fatty liver." The other way that I look at a fatty liver, which is an incidental thing, is that when I do my calcium scores, that's a CT scan. It cuts across the upper portion of the liver. So, why not take a look at it? So, I just put my cursor on it and look at the Hounsfield units, and I can tell whether that's a fatty liver or not because CT is very accurate for fatty liver. So is MRI, but those are expensive dedicated tests. So I don't do those. Um, I just look at the coronary calcium score, and if I can get that liver on it, I can tell you whether you got a fatty liver at the same time. If you have it now, I want to quantitate it. To quantitate it, I'll get my DEXA scan. And the DEXA scan is a is a wonderful, wonderful way to find out how much visceral fat you got. So I'm always surprised. Some patients, you know, the the total body fat maybe 30%. And then the visceral fat is way off the chart. More than 1 kilogram of visceral fat or surface area greater than 160 square centimeters. I'm like, "Oh my goodness, this is so much." And look at the image, and you can actually see it, and yet the total body fat may not be that high. But then I can turn around to that patient and say, "That looks, your total body fat is not that high, but you have a lot of visceral fat, and that means something's driving it. So let's look at the causes. What are you eating? How often are you eating? What's your insulin level? Got to know the insulin level. Got to know the insulin level. I've been talking about insulin for years, so I'm not going to go into that into too much detail, but you got to know your insulin because that's going to drive everything into your. What what's your bowels like? Do you have intestinal leak? Do you have symptoms suggestive of SIBO? Do you have possible toxicity? What are you eating? What are you drinking? What are you doing? Um, I'm going to look at your entire lifestyle, and I'm going to look for other symptoms that you might have that will con, you know, drive me into the source of why you have this fatty liver.

>> So, if you do a DEXA scan on somebody, you find out they have a non-ideal amount of visceral fat, too much, what is the goal when you're working with somebody through diet and lifestyle? What are you trying to get that to eventually when they're metabolically healthy again?

>> You have to eliminate all that fat. So there's two parameters you can look at blood blood reports. So I'll follow you with the blood reports. Okay? So we look at inflammatory markers on your blood report. So I usually do a couple of um uh tests which look at all your inflammatory markers. Right? So these are called advanced lipid panels. So I'll follow those. But as far as the liver itself is concerned, my goal is you got to eliminate it. It's not normal to have visceral fat. You got to get rid of it. And this is not a, uh, something that's going to be ignored. So we'll keep repeating the DEXA scan every year until your visceral fat mass is going to be in the normal range, which is going to be less than 1 kilogram. So we have it quantitative for males, females, you know, I'll quantitate it and tell you that, yep, yep, your your fatty liver is now gone. Fatty liver is not easy to to to change in a matter of months. Uh, I've noticed that it takes me a good six months to a year before I see some changes. So it's, it's a process. It's a process. Um, it, it, it's not easily eliminated.

>> Because there is a number of different factors that can be at play here. Yeah. Whether it be insulin, toxicity, leaky gut. When you're working with somebody, is there a certain area you start with, see if you get results, and then say it's something like leaky gut, would that be a test you do later on if they brought down the insulin and they still weren't getting rid of the visceral fat?

>> Great question. As a general rule, I, you know, it's all, I'm very much into the gut. I'm telling you, most of the pathology, most of the inflammation that I have seen over the course of years, which has molded and changed my practice, has pointed me towards the gut. So, right from the get-go, I'm always going to question your gut. I'm always going to ask you about your gut. Right from the beginning, I'll start right from when you were born. I'm going to be asking you questions about whether you were C-section or not, whether you received multiple courses of antibiotics as a kid or not, whether you uh, you had major GI illnesses as a kid, uh, did you have a sentinel event when you had a major bowel problem that could have altered your microbiome? For example, I'm going to ask you about your your eating habits and how often you're having a bowel movement, what does your bowel movement look like? Uh, what do your, what does your belly feel like after you eat with your? So no, all these questions I'm going to ask from day one. You got a fatty liver, okay, fine. I'm going to ask you about everything else too, but the gut is a major focus because that's where I have found that most of the derangement actually starts in the gut. So these patients will come to me, for example, I'll just give you a typical example. I'm just going to digress a little bit. Uh, two, two, three weeks ago, he has a calcium score of 2500, and he's been on good statins for 20 to 30 years now, and everything looks perfect on his blood work, and he doesn't have high blood pressure. He's not an alcoholic, and yet he has all this coronary calcium. And then as we take the history, we say, "Okay, so why do you have so much coronary calcium? There's obviously been a problem here that's, you don't just get coronary calcium." So it turns out that for years, he thought he had a normal gut, but he doesn't, 'cause every time he eats, he has to go to the bathroom. He has to go run very quickly, and he thought that was normal. And his bowels are always loose, and he after he eats, he gets bloating, he gets gas, he gets distended, and he thought that was perfectly okay. And when I took a deeper history, I found out that throughout his young days, he's had major gut problems, and he's been on multiple courses of antibiotics before. And obviously, this guy was having symptoms suggestive of dysbiosis, and the dysbiosis causing a leaky gut, and the leaky gut causing what we call metabolic endotoxemia. So I ended up measuring his uh, stool examination, and I found that the the gut microbiome was, of course, off off the chart, but he had a lot of LPS antibodies, which is lipopolysaccharide antibodies, very strongly positive. The markers for inflammation in his gut were all positive as well, and we nailed it. We said, "This is where your inflammation all came from." And then of course, we do regular blood work. We found that his CRP was elevated. We found that his um, uh, MO levels were elevated, which is an enzyme that's in your white cells. So there was inflammation. He was having ongoing inflammation. When we looked at his LDL particles, and his LDL particles were small and dense particles, and he also had a lot of oxidized LDL particles. His ferritin level was also elevated. So you see, I'm building a picture here that he's got inflammation in his body, and the inflammation was coming from his gut because all the other parameters were okay. So I changed his eating habits, made him go on my diet plan, and um, now we'll see. I mean, I just saw him, so we'll, we'll, because what we want to do is to stop this process. If we don't stop this process, his calcium score will continue to rise, and one day when you get inflammation, you're going to get a plaque rupture in one of those vulnerable plaques, and then you get a blood clot in, and you get a myocardial infarction. So you see, it's inflammation. The problem in atherosclerotic disease is this is an inflammatory condition, and the source of inflammation must be found. And when you go deeper as to what is the cause of this inflammation, it comes down to reactive oxygen species. Then you say, "What is reactive oxygen species?" Well, it's a problem with electron transfer. So, wait a second. You're talking about electron transfer. Yes. This is all about your redox. So, there's this thing called redox medicine now. And this redox medicine is crucially important because ultimately, that's the mechanism by which the disease is actually happening at the microscopic level. It's all to do with the electrons. So to explain that a little bit more, your reactive oxygen species that is being produced from this invasion from the gut, for example, or by all those chemical reactions going on in your liver, what do they do? What, what, so what if you have reactive oxygen species? Well, these reactive oxygen species, they destroy your glycocalyx. Now, what is a glycocalyx? Well, the glycocalyx is those little hairlike structures that are lining your arteries, H, especially your coronary arteries, but they're actually all over your body, including your brain. They have a negative charge on them. Now, these redox uh molecules, they come along and they destroy that glycocalyx. And how does it do it? Through charge. Because it's electron transfer. This is negative. These things also are radicals. So they're going to grab electrons out of the glycocalyx. The glycocalyx gets destroyed. Now you have a bare area in the lining of your artery, and it exposes the endothelium. Now, these endothelial cells, which are the lining of your cells, get activated. They get activated because the protective layer was taken away. When they get activated, they start expressing vascular cell adhesion molecules, intercellular adhesion molecules, um, and other receptors on the walls, which then grab macrophages as they're going by, and normally those cells wouldn't be exposed to them because the glycocalyx would be protecting them. They bind to them. The macrophages get inside, and once they get inside and pass the first layer, they get inside there, and then oxidized LDL comes along, and they grab it, and they become foam cells inside the plaque. So the process started because of a change in your charge, negative charge, positive. So our inability to to to optimize our redox. So we say, if you're making too many reactive oxygen species, we have mechanisms to counteract them. But those mechanisms are compromised today because of of our lifestyle. So today, the the model that I'm seeing in my patients that have atherosclerotic disease is a disease of a problem with electrons at the level of the glycocalyx, and glycocalyx damage caused by a change in the redox potential of your body because of too much reactive oxygen species and an inability to produce enough reducing agents in your body. My own body should be producing reducing agents to counteract that, and those are also being compromised. So you're absolutely right. There's things that increase reactive oxygen species. There's things that are diminishing my ability to make react uh reducing substances. So there are multiple causes for all this. There's no one single cause. They all come together, and then you end up with the atherosclerotic process. So in that same patient, yes, he's got a leaky gut. Yes. So what happened to his own defenses of producing reducing agents? Antioxidants. Your endogenous antioxidants. I call them reducing agents. You can antioxidants. What happened to them? They also compromised. They compromised for a number of reasons. They get compromised. It's the way we live, the way we sleep, our environment. So our own antioxidant levels go down. We're getting oxidant damage. You're getting oxygen damage, and we don't have enough endogenous antioxidants, and hence now this is causing these problems that we are seeing with uh all these diseases. So ultimately, where do they all work? They all come down to the mitochondria of your cells. So your mitochondria, when they become dysfunctional, they produce reactive oxygen species. See, so all these reactive oxygen species we talk about, say, "Oh, yeah, you know, you got a fatty liver. You're making you, it's inflammatory." It's fine to say it's inflammatory. What do you mean by inflammatory? Inflammatory means that you are producing reactive oxygen species. That's what you're doing. And you're producing them where? Where do you produce them? There are many places you produce them. Main place is your mitochondria. Why are your mitochondria making reactive oxygen species? They shouldn't be making reactive oxygen species. They're making reactive oxygen species for a number of reasons. Number one, too much substrate overload. So, you basically have all the glucose that you're throwing into the mitochondria, and too much substrate, and there's a bottleneck. And when you get that bottleneck, the mitochondria can't work very well. So they become dysfunctional and they produce reactive oxygen species. So, right right there. Number two, toxicity. Where does the toxicity all occur? At the level of the mitochondria. Nutritional deficiencies. Why would a nutritional deficiency cause reactive oxygen species? Because the nutritional deficiencies work right there at the level of the mitochondria. So mitochondria are not working very well because they don't see enough vitamin B's, for example, not enough omega-3, or the proteins have been o damaged by oxidative stress, then your mitochondria don't work very well. So they produce more reactive oxygen species. So there are so many things that cause the mitochondria to become dysfunctional. So ultimately, it is your mitochondria that are producing all these reactive oxygen species, and the repair processes are compromised, and they compromise. So we don't look at the lifestyle and say, "Well, why are they compromised?" And we see that we have all these deficiencies in the body. That, for example, for example, your liver's mitochondria work best at noon time. So given the same substrate, they'll produce less reactive oxygen species than the same substrate, the same meal at 9:00 at night. So this is the circadian. So how does the circadian pattern work? This is how circadian rhythm works. Because your car works on six cylinders at noon time, but if you take it for a ride at 4:00 in the evening onward, it drops down to three cylinders. That's how the body is. So your mitochondrial function is not the same throughout the day. So we have created a situation through our lifestyle, what we're eating, but also when we're eating, that is compromising our mitochondria because they cannot handle that substrate load at 10:00 at night, and they'll produce more reactive oxygen species at 10:00 at night, but not at noon time. So lifestyle, what we're eating, when we're eating, do we have enough nutritional value to the food that we eat, all this is affecting our mitochondria. Ultimately comes down to the mitochondria. A lot of the diseases we talk about come down to the mitochondrial function. And the manifestation of that is going to be your fatty liver, uh, your coronary artery disease, your hypertension, your your joint disease, your premature aging. It's ultimately comes down to mitochondria. If you take care of your body, your mitochondria will be working efficiently. And that's why I've always said that you got to do some fasting and change your diet because fasting changes your mitochondria. Fasting gives you mitophagy. Fasting improves mitochondrial function. It is the most anti-inflammatory thing you can do because it reduces your reactive reactive oxygen species production right there. Why? Why does fasting do that? Because it improves mitochondrial function. That is why patients who fast, they say that, "Oh my gosh, I had so much energy. I feel so good." So part of the reason is, of course, they're running on ketones, but the main reason is because your mitochondria are working better. So when your mitochondria work better, they produce less reactive oxygen species as they go through the electron transport chain, and you make more ATP. A badly functioning mitochondria will make lots of reactive oxygen species and they'll make very little ATP. How would you feel? Drained. No energy. I feel lousy because your mitochondria are making very little ATP in spite of the fact that you've got all this energy in the world. You've got all this stored energy. I've got six months worth of stored energy in my body. But I feel tired. And I feel fatigued because your mitochondria are not working very well. So, it's what we've done to our physiology, not this old idea of calories in, calories out, health is all related to calories coming in, food coming in. No, no, no, no. It's with what we've done to our physiology. What have we done to our mitochondria? What have we done to them? There in lies the the problem that we've deranged our energy systems. So the new concept is coronary artery disease is a breakdown of the energetic system of the body whereby we're producing more reactive oxygen species, less ATP, more and more inflammation, and less reducing capacity that we have because of our lifestyle. So it's a whole new concept when you think about it that way. And when you go back and look at the pathways of what reactive oxygen species do, it comes back also to this whole issue about nitric oxide that people talk about all the time. It's all linked. This is all linked to nitric oxide. We can dive into nitric oxide if you'd like. But um, I I did digress there a little bit because I was talking about the coronary aspect of all this inflammation because ultimately my interest is to reduce the um atherosclerotic plaque and the burden and inflammation within your arteries because this is what causes death. This is what's causing premature um death in the United States. But it's also linked to premature aging.

>> Okay, we're going to get to nitric oxide. This was incredible what you got into there. To continue on that rant, let's talk more about the mitochondria and fasting. You mentioned to improve their function, we want to fast. How do we get that dose right?

>> Great question. The biggest problem is that we tell people to start fasting, and then they come back to me and say, "Doctor, you made me miserable." No, you got to understand that you got to look at where you're coming from. You've been eating three times a day. Okay, fine. You got to, the way you got to do it is you got to stop one meal a day. So you're going to eat two meals a day. And I've been telling everybody that for a long time, that you got to do this gradually because your body's metabolism has to change gradually from a glucose-centric to start producing more ketones as well with time and have an alternative source of energy that you're going to make. So you got to do it carefully, and when you do this, you will start changing your metabolism. Now, the goal is that when you have metabolic flexibility, that means using glucose at times, using ketones at time, that's when your mitochondria are going to get better. You get mitochondrial improvement when the energy management in your body is optimal. You see, it all comes down to energy again. It's how the body is handling energy. Nothing to do with calories. It's how your mitochondria are behaving. Your mitochondria are going to behave better when they have adapted to a immune system where they can use glucose, they can use fats. So, how do we do that? Well, you got to reach a point in your day when you are making some ketones. You're not going to make ketones so long as your insulin level is high. So, who's wanting to do the fast? You got to know your insulin level. You got to know whether you're a diabetic. If your insulin level is running very high, you will never be able to get into some degree of ketogenesis because the insulin blocks the fat pads and stops them from breaking down and giving you an energy source. So we know that. So the only way to bring that insulin level down is to do the fasting. So the first thing you do is you cut out one meal, and then you have your other two meals. Those two meals should be within six hours of each other. If you cannot wait that long, make it eight hours. I don't mind. But you got to do that for at least two, three weeks, and then you can do more serious fasting. So in female patients, I do 12:12. That means I do 12 hours of fasting, 12 hours of feeding window. Do that for about a month or so because when I take my female patients, especially right before their cycle comes in, they can't tolerate the 18:6 right off the bat. So 18:6 means 18 hours of fasting, six hours of feeding. So I do it a little bit more gradually with my female patients, but with the men, they seem to be able to get into it a little bit faster. So I go into an 18:6 if I can for at least a good month. And then I'll say, "Okay, now once a week, I want you to cut out that meal as well, the the one of the meals." So now you're doing a 24-hour fast. And do that for a couple of weeks, and then twice a week. Then three times a week, you're eating one meal a day. Now you're going to OMAD, which is one meal a day, five days a week. Two days, Saturdays and Sundays, I let you have two, two, two uh meals. So, that's the pattern that I get into. And when I do that gradually, now I notice that when they do the ketone sticks on the urine or they can do a Mojo test, they're making ketones very quickly now. So, my point is that you need to get into some degree of ketone production. Now you're telling your mitochondria, "Hey, you can run on gasoline, you can also run on diesel, you can run on anything." Those are going to be the best mitochondria. So now when you do that, you already know that your mitochondria are working better. And now I tell them to do more prolonged fasting. And when you do prolonged fasting, that means three-day water fast. Depends on your goal. Now, if you're terribly overweight, you want to do the three-day water fast. If you're terribly hyperinsulinemic, you want to do the three-day water fast. If you have severe inflammation in your body, biomarkers are all off, you got a big fatty liver, you got to do a three-day water fast. And then the rest of the week, I make them do OMAD, one meal a day for seven days. Check your urine sticks, take electrolytes on the days that you are fasting. Make sure you have some MCT oil at home. I give them these little tricks to do. And we gradually do this. Now, mitophagy kicks in. Mitophagy means that your old mitochondria die because you're getting into autophagy. Autophagy means that your your cellular contents are already cycling. And when does that happen? Autophagy starts in all of us at about 18 hours, 19 hours, but in small amounts. But if you want major autophagy, most people have to fast for about 30 to 36 hours. So if you want autophagy where you're doing recycling of your bodily parts, rejuvenating, in other words, and your old mitochondria die, and you make new fresh mitochondria. Why? Why? Why do you want to make fresh mitochondria? Because they produce less reactive oxygen species. So now when you have mitophagy, you have a full set of new mitochondria in your body. They're going to produce less reactive oxygen species. When you have less reactive oxygen species, you're going to feel better. That's why they say, "My joint pains got better. My headaches got better. Um, I feel I feel less sluggish now. I have more energy." What's that all a reflection of? It's not psychological. It's a physiological basis for it. The physiological basis is that you have made better mitochondrial function, less reactive oxygen species. And we can actually measure those too. Actually, we can measure how you're doing. um, show that you have less inflammation going on in your body. So mitophagy occurs in fasting. It's the best way to do to to produce mitophagy. Now, there are a few supplements that will help you along the way if you want to produce some mitophagy um more easily. For example, in some patients I use urolithin um as a supplement. Um, but you see, the idea is don't take corners. Don't don't cut corners. Do it the proper way. Do the fasting because fasting has other benefits. Mitochondria get better, reactive oxygen species go down. Sugar levels go down, insulin sensitivity is better. Insulin, insulin levels come way down. Insulin comes down automatically. You're going to lose weight. You, the point is not to lose weight. When the insulin level comes down, automatically you're going to get a side effect of low insulin, and that side effect is weight loss because you don't have insulin to store away. So the the weight loss is really a side effect, and and all patients who do fasting will lose some weight, and and and I like that. We do it according to your your goals. What are your goals? I want to lose 100 pounds. Well, then let's let's talk about how we're going to do it. Um, so it, it reduces all these markers. Fasting also detoxifies you. Fasting changes your gut microbiome. Fasting allows your leaky gut lining to get better. Fasting, you're going to get less toxins coming into your body. Your fatty liver is going to get rid of that fat because when you do fasting, which fat gets out of your body first? It's the visceral fat. It's the toxic fat that goes out. So another place where you get a lot of fat is your tongue. So you know, did you know that your tongue is mostly fat? That's why it can wiggle in all sorts of directions. So the first 20 pounds that you lose, your sleep apnea gets better. How come? Because your tongue just shrunk, and the patients will come and tell me, "Hey, my husband's not snoring anymore." 20 to 25 pounds. You want to sleep with that mask for the rest of your life, or do you want to just get rid of your mask? Well, many ways to do that, but fasting is a very effective way to eradicate obstructive sleep apnea, which causes all sorts of problems. So there you go. So fasting has so many advantages, and I specifically made that one video.

on how to harness the mental energy to do the fasting, to stick to your plans, to to to not give in to social pressure, friends around you, uh environmental triggers, um walking into your house and your your pantry doors there and and and now it triggers you to go in there and pick up something, you know, how do you overcome these?

And and I teach people how to do the the silence. Um, and that that gives you more energy, mental energy, um, to to be able to overcome your your bad habits and and over and and understand who you really are and who's in control, put you back in charge.

But, you know, many patients who fast, they also find that they're they they're clearer. They they're mentally clear as well because they get brain derived neurotropic factor. So actually the more fasting they do the more it empowers them to do more because they have more willpower. They have better willpower because they're actually reshaping their brain. Fasting changes your brain as well. So yeah, fasting. So fasting is so important for me. It's it's like the pillar of getting better. Changing your diet and then you have to do the fasting. That is a no no. You have to do that every time. You have to do it. And then we talk about the supplements and other things that we we we look at.

>> So you talked about ketones being part of the benefit from fasting. Compare and contrast benefits you'd get from doing these fasts versus just being on a ketogenic diet and producing ketones that way. Obviously, we could do both, but somebody who is new to this and we want to start them out slow, will they get a lot of the benefits just from being keto and eating that way?

>> Yeah. So, when you're on a ketogenic diet, first of all, let's define a ketogenic diet. It's very difficult diet to do because you got to have more than 70% of your calories coming from fat. So, it's usually a modified ketogenic diet. But even then, yes, when you do a ketogenic diet and then you do some fasting, you'll make even more ketones. So yes, it is of value. So ketogen is definitely of value.

So let me explain what I do with some of my patients. They come in and they're very inflamed and they have all these gut issues and a big fatty liver and they have all this coronary artery disease and they get bloating and gas and distension and they don't know what they're allergic to. They're just miserable eating also. Then I do the most efficacious elimination diet. The most efficacious elimin diet is just not to eat. But then I do number two, which is okay, you can eat fish, chicken, turkey, eggs, and some cruciferous vegetables. And I do this literally every day on some of my patients.

So So what does that do? That eliminates a lot of your plants. And I know a lot of people don't like to hear that, but you can still have cruciferous vegetables, but you're producing less inflammatory onslaught in your gut, especially when when you have a gut problem. So on those particular patients, they're already going to be on a modified ketogenic diet because immediately the insulin productions go way down. Immediately their gut becomes anti-inflammatory because they they react much less to fish, chicken, turkey, and eggs than to vegetables because often times they they're having reactions to things that are in the plants. And until I fix the gut, eating plants causes problems for them.

So what I do is I do this for approximately four or five months maybe and then I say, "Okay, now reintroduce some of your plants that you really like to eat." But the cruciferous vegetables should always be there because cruciferous vegetables are amazing. They produce a lot of sulforophanes in the body because they come packed with glucaraphen and then that mixes with myronese that's in it already. When you chew it, it releases it and makes into sulfurophanes and sulfurophanes are needed because they turn on your nrf2 pathway which is your body's own endogenous anti-inflammatory pathway. You see a food turns on your own inner anti-inflammatory pathway which is the NRF2 pathway. Sulurophines do that. So take your cruciferous vegetables and then reintroduce the other foods as you want to later on in life. But I think that we do do this.

So a modified ketogenic diet um will help the patients to get into ketosis quicker. So, when they start their diet, they're doing the 186 and then they want to do the uh OMAD for three or four days. Change what you're eating. You have to cut out sugars. You got to go to cup carbs. You got to cut out all the Look, I don't like grains cuz grains just cause too many problems. I've seen that over and over again. When I cut out the grains already, they start feeling so much better. It helps with my SIBO patients getting better so quickly. Uh the bloating, the gas, and the mental fog. Um, so I I do this type of diet on the worst patients. Wheat is a huge problem and I never believed this until I started doing all my blood tests on the patients and I found that the patients who have the most inflammation are most res having a problem with wheat. So when I eliminate the wheat, they they come back saying I feel so much better. My my belly also feels better now. Eliminating the wheat, that's a huge source of carbs. So, they're going to go into ketogenesis a little bit faster as well.

So, both of them are helpful, but but I got to tell you that there's something different about being in ketogenesis because you're eating a ketogenic diet every day. And there's a difference in someone who does prolonged fasting. There's something more that you're going to get in a prolonged fast. In a prolonged fast, there's homosis. Homsis, which means it's total stress on the body. It causes far more changes in your body than simply being in ketosis. When you are fasting, you're getting stem cell mobilization. You're getting brain derived neurotropic factor production. You're getting real autophagy and your gut totally the microbiome changes completely because you've knocked out all those bad guys. Um that and you you you're basically going to heal the the lining of your gut as well. It gets a chance to heal itself. So, I think that there's a difference because on the one hand, you you're thinking just ketones, ketones, ketones. But wait a second, fasting does other things also besides giving you some ketogenesis. Fasting changes your body. It gets rid of all the fat from the wrong places. It does all these other chemical. It does much more autophagy than just a simple ketogenic diet. So, I agree it's nice, but you have to do fasting. Also.

>> Earlier you mentioned this patient that had gut issues and you changed their diet. I think you said you were still waiting to see what that did. You just mentioned this diet of a lot of animal products and cruciferous vegetables. Is that the diet you put that person on?

>> Yeah, I did actually. So, now he's going my prediction. Okay. He's going to come back in about 3, four weeks saying that, "Oh my god, the bloating is much better. My bowels are so much better. Uh my my belly's gone down. I've I've lost a lot of weight around my waist. It's I didn't know that this is how I'm supposed to feel. This is how I'm supposed to feel." So, he's going to come back saying all these things.

Now, I do introduce some fermented foods in these patients as well. So even though you're eating meat, you got to eat some fermented foods because fermented foods are so incredibly healthy for you because they not only replenish your gut microbiome, but they also have postbiotics in them. And these postbiotics are amazing. So I always tell patients to eat some yogurt, but kefir is my favorite one. Sauerkraut and kimchi, of course, are fantastic, but I love kefir. So I put these patients always on kefir. So even though he was he's going to be mostly on meat for a couple of months until he comes back to see me, he will take kefir every day. Every day. Everybody. Everybody. Everybody listening should be on kefir. Take a bowl of kefir. Add five blueberries, five raspberries, five um um um any berries that you can find. Basically, I love the berries because they're going to give you the phytonutrients. And you only do five. I told once a patient that you got to put some blueberries in there. And he put in a whole bowl in there. I said, "Listen, you only need five or six blueberries, five or six blackberries, five or six raspberries. That's it." Put it all in there. Then I put a sprinkle of fish oil. H. So I have liquid fish oil. So I put a tablespoon over it over it. Then I take my inulin, which is my powder, and I put one scoop in there and I mix that up. And that is a daily ritual. The inulin is going to feed my good microbiome because it's all soluble fiber. I got my my berries and it's going to give me my phytonutrients. I need them. I need them. My polyphenols, they are amazing. I need them. The same polyphenols that you find in your olive oil, for example. Amazing. By the way, that's why olive oil is good for you, right? It's not good for you for any other reason. It's got nothing to do with the fats. It's got to do with the polyphenols. You see that's a it's and why why okay so that that blends in again with what we were talking about earlier your mitochondria and inflammation in the body.

So what's the difference? The difference is that your polyphenols are anti-inflammatory. Why? Because they are signaling molecules. Why? Because they get into your gut and through the gut into your system and they turn on your genetic mechanisms. And we know this. We've worked this all up. NRF goes up way up. Your own endogenous anti-inflammatory uh mechanisms are increased. So the more polyphenols you have, the less inflammatory you're going to be. Your olive oil, for example, has to be smelly. It has to be green. It's got to have a bitter taste. It's got to make you cough if you put two drops in the back of your throat. It's got to feel peppery. Now you have the real olive oil you're supposed to have and it's the polyphenols and those tests have all been done already. If you take those with low amounts of polyphenols versus high amounts of poly, they're all olive oils. They have different physiological effects in the body. So everything's to do with polyphenols and so food is medicinal. These are the different foods, the polyphenols. So I reintroduced those in the patients who have the worst bowels. But I got to fix the bowels first. So we do fix their gut. Eventually they'll be on good variety of polyphenols, some vegetables depending on what uh allergies they have. Um, but I have no problem with meat and and many people look at me and say you're a cardiologist and you have no problem with meat. I have no problem with meat. Fish, chicken, turkey, eggs, no problem. Source it right and and have it. It's there's nothing wrong. And I've seen beautiful results on these patients.

So then they worry about the LDL. And then I have to shake my head and say, "Yes, your LDL is going to go up, but it's not the LDL I'm looking for. I'm really looking at inflammation in your body." And your LDL will tell me about your inflammation. And it's not the total, it's your quality of your LDL particles. If you have small dense particles, if you have oxidized particles, now I have a problem. Now I have to find the cause of that. So I'm not just going to bring down your total LDL. I'm going to get rid of your small dense LDL and your oxidized LDL. You see it coming down to those electrons again, right? So you see we're coming to the redux model again because it is that abnormal redux model that's creating this problem.

So what's happening here? Well, the lipids, this is very important, the lipids that are on your cell membranes of every cell in your body and in your LDL particle, they get oxidized when you have excessive reactive oxygen species. Now, these oxidized fats h these oxidized fats, they are the ones that are causing the problem. So, watch what happens. Let's say I have lots of reactive oxygen species being produced in one part of my body. How does my whole body get inflamed? Well, these molecules are aldahhides. They're lipid aldahhides. They float into the bloodstream and the oxidized LDL particle also floats in the body. These molecules are now oxidized and wherever they go that redux potential of theirs is going to cause problem. it's going to cause oxidative stress and that may be in your brain, in your eye, in your coronary arteries, in your joints, everywhere. So you see that it is the lipids that become oxidized and that oxidation is what's causing the problem. So I'll look at your LDL. Yes, I will. But if it's oxidized, you have a problem with oxidative stress. If they're small and dense LDL particles, you have a problem in your liver. because your liver is throwing out small dense particles and these small dense particles are going to get oxidized as well. So again it's coming down to look at what's causing this is too much reactive oxygen species. Where are you making all these reactive oxygen species? Why are you making so many reactive oxygen species? And then we back engineer to find out where it's all coming from. Is it from toxins? Is it coming from your leaky gut? Is it coming because you have nutritional deficiencies or do you have other toxins in your body? It's your lifestyle. What's causing this? It's your diet. What are you eating? What is causing this to happen? So there you go. So it's all coming down to that model of the redux medicine. This is this most of my colleagues don't seem to understand what this redux thing is all about. But it is utterly important and ultimately ultimately most of the body's reactions occur as a result of electron transfer. So that's how reactions all occur in the body. It's all these electron reactions. So the oxidative stress is our major problem today and our inability to uh quench them because we don't have enough reducing capacity. What is a reducing capacity? Reducing capacity means what? Reducing capacity means your ability to donate electrons. I want to be a body that is able to donate electrons through my physiology. Reactive oxygen species are going to be produced in day-to-day activities. So long as I'm alive, I'm going to make reactive oxygen species. But if I have great reducing capacity, I will be very healthy. Today we make too much reactive oxygen species and our ability to make these reducing agents is destroyed because of multiple factors. our lifestyle, our diet, our circadian rhythm disturbance, our pollution, our everything all these issues and they can destroy your balance. This neat balance of our and of course this is anti-aging as well although I'm not really an anti-aging doctor but this is very important any specifics practical things we can do on the reducing side to build that up in the body. Obviously we want to be careful with the amount of oxidation we have but also to support it from the other end as well. What can we do practically there?

>> So the question is how did we lose this reducing capacity and one of the problems is our diet because your diet today is impoverished. We are not getting enough reducing agents in our diet. Our food itself is impoverished. So take for example co-enzyme Q10, take for example vitamin E, take for example vitamin C. So these are agents that are sitting. You remember I told you your plasma membranes h all your plasma they're made of fat. So now you get lipid peroxidation. The lipid gets oxidized. Now you get this oxidized lipid membrane sitting there. And once you get one molecule oxidized and you create one free radical there, it's like a chain reaction, the whole cell now will change. So this causes a chain reaction. But if you have lots of co-enzyme Q10 which is fat soluble and you have lots of vitamin E in your body which is also fat soluble it sits in the in the wall lining or in your LDL for example and it quenches this so that you don't get this chain reaction because one free radical creates another free radical creates another free radical see so we have a problem so our diets are impoverished with CoQ10 we don't have enough we are impoverished with vitamin no vitamin Vit C is different because it's a water soluble that's outside the the cell. It's not in the wall and it's not inside the cell either. So, but it does help to replenish vitamin E in your cell membranes. So, what I'm saying is it's a little complicated, but the point is that our diets are the problem. We don't get enough nutrition. We don't get enough our if we give our body all the nutrition that really needs, it'll take care of the physiology. It has the built-in intelligence to do that. So today, unfortunately, I never started out like this, but unfortunately today, I do give some supplements to my patients. For example, if I see that they have small dense LDL particles, yes, almost all of them are going to be on anatyl sustain for your liver. Alpha lipoic acid. Yes, it's small amount of vitamin E. Vitamin C, a small amount, co-enzyme Q10. Some of the worst patients that have a lot of lipid peroxidation or put them on L carnosine carnosine because that is a scavenger aldahhides, the lipid peroxidation products. They're really bad products. So I give them that um methylated folate, right? Methylated folate because what does that do? That also scavenges those bad lipid peroxidase molecules, resveratrol. So I do reseratrol one month on one month off. So we know that resveratrol is very good for you uh in that regard. And then I work with the lifestyle as well. So the diet is one thing that we don't have enough uh nutrition uh substances the polyphenols for example. So there are some polyphenols that you can supplement with as well but I tell them to take those using things like olive oil, fresh green vegetables and our food is stripped of all of these today. So it causes a huge problem and then our lifestyle itself as well. If we on the go go go all the time we having excessive sympathetic overload all the time all the time and we never get the parasympathetic huge problem causes reactive oxygen species. You're supposed to be in sympathetic get reactive oxygen species and then you're supposed to quench them away with your coneric system. The colonergic system is your parasympathetic. We don't do it. We're constantly in the sympathetic mode all the time. Which comes down to that question you asked in the beginning that you know what about the Vegas nerve? Where does this all kick in? Well, that's the problem. We have a western lifestyle today that is vagolytic. We just don't have enough vagus nerve function because we're constantly in synthetic synthetic synthetic synthetic. And we know that also we've knocked off our vagus nerve. So take the leaky gut for example. In the leaky gut scenario, you're producing reactive oxygen species a lot in the gut because you have that leaky gut. And then all that chemistry is going to produce reactive oxygen species because all those white cells and all lymphosytes are producing reactive oxygen species both in your liver and in your gut lining. And we can measure those. Where's your parasympathetic? It's also dead because the entic nervous system which is your gut nervous system comes from the vagus nerve. So 80% of the signals from your vagus nerve go from your periphery which is mostly your gut to the brain stem and then 20% go outward. Well the signals are just not coming in and therefore the apherant signals which are the signals going out which are the colonergic endings because they have the acetyl colon at the end right. So there's receptors on your white cells, on your lymphosytes, on your endothelial cells and these aelcholine receptors are supposed to be fed right by the estylcholine and they are anti-inflammatory. So they drive everything down again. You restore, you come back to normal. It's a homeostasis, the ying and the yang. So this is called the colonergic system, right? The anti-inflammatory system. And today I can tell you there's an epidemic of vag nerve dysfunction. And it starts for multiple reasons. It's lifestyle. Let's talk about lights. That's a different issue. But there's lifestyle, there's lights, there's circadian disorders, and there again your gut. You got to have a good gut. Then your vagus nerve is going to work well. If your vagus nerves works well, you're going to get the repair process. The Vegas nerve is all about rest, relaxation, restoration, and reproduction. And we're suffering from that today. And when I fix the gut, one of the biggest things that I see is my vagus nerve function gets better. And why am I interested in the vagus nerve? I'm a cardiologist. I'm interested in the vagus nerve from your gut because ultimately arrhythmias as well arrhythmias in your heart are an imbalance of your sympathetic parasympathetic system. So there are many factors that go into the membrane potential that is in your heart cells. One of the things about membrane potential are all the things we talked about reactive oxygen species because now look you're coming on that chemistry again. It changes the membrane. Your membranes in your heart cell membranes is supposed to have a charge minus 90 mill volts. When you have all this information drops down to around 70. So now there's a current between parts of your muscles and another part and you're going to get these extra recurrent rhythms that are going to occur in your body. And the vagus nerve is another big one that affects the sympathetic parasympathetic system and thereby the membrane potential of your myioytes. Very important. That is why when I fix the gut arhythmias get better. Patients who have parox fibrillation when they come to me the first thing I'm going to do is get rid of the inflammation in the body and ask them where the inflammation is coming from and fix it. And I find that the atrial fibrillation frequency goes down because atrial fibrillation is an inflammatory problem. It's a problem due to inflammation and an imbalance of the redux and that's what's throwing the patient into atrial fibrillation. So I fixed the metabolic underlying condition and the frequency of atrial fibrillation improves. That does not mean that they may not need an ablation because a few patients need ablation therapy. But my point is that you are not born with ablation deficiency. You are born to have a normal physiology and the abnormality is created by your abnormal pathology. Fix the pathology and the electrical system will take care of itself. We are electric beings. Our body is electric. Our membranes are all electric. This potential and electronic changes that are occurring as a result of reactive oxygen species and our inability to have enough reducing agents. Our imbalance of sympathetic parasympathetic system is driving this process. So the vagus nerve is extremely important because it is in anti-inflammatory. Our most important anti-inflammatory organ that is now dysfunctional is a vagus nerve.

>> Well, tying to all this, you mentioned earlier your silence practice. I'd love for you to explain that protocol and how to go through it as a tool for people to help balance out that sympathetic parasympathetic.

>> I did it for two reasons. One was that patients would say to me that doc I don't have the willpower. How am I going to get the willpower? So part of this is to get willpower. Okay, so I'll explain that part first. The willpower part has to do with the following. If you get a thought and you follow up on that thought that oh yeah you know I I did not pay that bill blah blah blah and then another thought another thought another thought now you're stuck in that thought and you become a slave to that thought and my point with my patients is that no you don't have to take up that thought you can come back to your nose feel the breath going in and out and your ability to pull away your attention from that thought and come back to this is the exercise of willpower. You will develop your willpower because every time a thought comes, you will not follow up on it. So go into silence and know that these thoughts are not something you invited. They just come into your consciousness. And when they come into your consciousness, now you take possession of it. And when you take possession of your thoughts, they'll follow up, follow up, follow up, and the next thing you know, you're down the rabbit hole. That's why people complain to me that, you know, I've got this monkey in my head. He's talking all the time. I can't go to sleep all the time. I have all these these wretched thoughts all the time. And I said, did you invite them? Did you tell them to come? Did you deliberately say, "I want to think this, this, this, this, this." No, you didn't. They just pop up. They pop up from your subconscious. You do not need to entertain them. And the ability to pull away your attention, your consciousness from that thought and come back to your breathing and I make them learn how to do that is the exercise of willpower. Because very soon you will notice total silence. When a thought will come but you're not going to even act on it and the thought will just fade away and then you'll be in total silence. You because the silence is not physical. The silent is mental. Now when you have no thought, now comes this part two. When you have no thoughts whatsoever, you can't be in the past because that's a thought. You can't be in the future because that's another thought. So where are you? You're in the current moment. You're in this moment now in total silence. So what has that got to do with all this? That means that the very source of your stress is going to be gone because stress comes as a result of past rumination, regrets or anxiety and stress about the future. But when you don't have a thought, when you don't have an emotion, when you are nothing but a blank slate, what's going to happen to your chemicals in your body? They're not going to react. You see emotions, thoughts are not in here. Your whole body is thinking it. Every emotion, every thought creates physiology in your body. Changes your chemicals in your body. Having angry thought, your platelets are going to get jittery. All of a sudden, they're going to degranulate. Your norepinephrine levels are going to go up. Your nitric oxide level goes down. You get vas constriction. You your blood pressure is going to go up. Your heart rate has gone up. Your vagus nerve has gone down. all these things. So thought. So wait a second. Who's thinking here or is your whole body thinking? See this is important. There's no separation. You feel everything in your whole body. So I'm trying to teach my patients that that your thoughts are very important. Don't think that oh it's just in my head only and it it stays here over here. No. Every thought affects everything in your whole body. your entire physiology. So going into the silence that I'm trying to teach people to do teaches them how to be in the present moment. And when they're in the present moment, not in the past, not in the future. Then now you got to deal with something. The doorbell rang. Now you just deal with that. And you are there. I use this phrase, you are there with your full bandwidth. You're not thinking of the past. You're not thinking about the future. Whatever activity that you're dealing with, you do it with your full attention. And how were you able to do that? Because you did the silence. Because you did that exercise. You learned how to get into the silent mode. Not in the past, not in the future. You were able to turn off that monkey in your head. Stop thinking about the past and the reminiscence of because all those things generate bad chemistry in your body. Ultimately, what does that do? Changes your redux potential. Ultimately, changes your sympathetic parasympthetic system. Ultimately, when you are in this mode, it's anti-inflammatory because that's all I'm interested in. I'm interested in inflammation because inflammation is the driver of disease and premature aging. So, this is another tool, the silence is. So, I teach my patients how to do that. And this is you know people say about what's a cardiologist talking about silence. It has everything to do with it because it changes your physiology. It changes your whole thinking pattern. Changes your thought patterns. Your thoughts it changes them. And there's so many studies to show that we have an influence on our health by our social factors in our life as well. And that's all to do with thoughts. So if your thoughts change your physiology will change. If your physiology changes you will acrew all the benefits. So I did teach that. Yeah. And I think it's very valuable extremely valuable to and then so the willpower improves. It's anti-inflammatory because in that moment in your silence that's it. All your levels come down. Everything comes down. Your heart rate variability increases. It's function of your vagus nerve. Blood pressure comes down. pulse rate comes down, inflammatory markers all go down. Ultimately, that's what I want. You see, you can create this inflammatory substrate through your thoughts and your emotions. You can do it. So, it's not just the food that you're putting in your mouth. It's the thoughts that you're entertaining also that can be extremely inflammatory. So, it gets so muddy here because here's a guy talking about the mind body stuff and he's talking about toxins and environment, the food and chemistry and medicines and supplements as well. And it's true. You have to look at the whole picture. You got to look at the whole thing and how we got there. And when patients come, they don't have one factor that's doing all this. They have multiple factors going on in their life. So, I do try to address all of them. And that's why my first interview with my patients that I do, it takes me a good hour and a half because I got to know everything what's going on in their life. It's it's not easy.

So is the idea with this silence practice when somebody learns it to take a period of time each day and practice it and then do you find somebody like you that's been doing this, does it transfer into day-to-day life?

>> Absolutely it does. Absolutely it does because then like I said I'm coming here with my full bandwidth. Look, we're having this interaction. What matters right now, Jesse and Dr. J. That's it. That's it. I'm not having any thoughts about the past. I have no thoughts about the future. I'm fully engaged. That ability to be fully engaged. my focus, my attention only on this task over here is very important because you wouldn't want me to operate on your heart and I'm thinking about my car that needs to get a new tire put on there and then tomorrow I got to go to an engagement. You don't want me to be doing you want me to concentrate on your surgery only. So in our day-to-day life, we need that. So I always tell patients that if someone distracts you or there are other things that really don't matter at that moment, you don't need to deal with it. You just simply tell them, hey, not now. Don't use up my bandwidth. Don't use up my bandwidth. Not now. The time come, I'll deal with it. And then you take one task at a time. And doing that, it makes the patients, and I've said it, it makes them stronger. They have more willpower. They get more focused. they're going to do it. Whether it's the fasting, whether it's the supplements, whether it's the exercise program that I put them on, um, whatever it is, or dealing with their dysfunctional relationships, their sleep patterns, their habits, losing their habits, you know, still going through their phones at 10:00 at night. They can get rid of all that. Harness the willpower. And you can do it this way, harnessing willpower through silence. Because silence will give you that. When you come out of it, you also come out with clarity. So when you're in silence, then you get clarity as well. When you're in silence and you come out of the silence, your ideas are different because the background upon which those ideas and thoughts are now coming come from a blank slate. They're not adulterated from thoughts that you were just having right now. They're fresh. And you'll notice it. you you'll see you can do that. So, this is very important. So, I brought it up at a thing and I was really apprehensive about putting it on the on the video, but I found that already I've had thousands of people saying that they've had so much benefit from doing it.

>> We got to teach kids this, too.

>> Abs. Absolutely. And um I think it starts with the kids. It really does these days. It starts with the kids. We got to teach them. And that's why give them silent moments to be on their own and do creative uh activities on their own instead of constantly stimulating them in company and conversation all the time. I think it's really important and of course the eating habits have to start at a very very young age and um no very important.

>> Okay. Earlier when we talked about liver fat, I believe you said it takes a while to clear that, but you also mentioned that when somebody's fasting that that is going to target the visceral fat. So, somebody taking on what we're talking about today, they're trying to get rid of that visceral fat as quickly as possible. What's a realistic timeline?

>> Six months. Six months we'll do it. Yep. Yeah, definitely. We're going to start with changing the diet and then doing the uh intermittent fasting and then prolonged fasting. You have to get into prolonged fasting. You know, I I don't think that prolonged fasting is as difficult as we think. Now, on a healthy person, let's say there's who should be fasting when they don't have a fatty liver. I'm just a healthy guy. Let's take Dr. J. I'm healthy. Okay. I got no problems. I don't have a fatty liver. I don't have coronary calcium. Okay. So, what should I be doing? Well, I literally I do OMAD at least three to four times a week. That's what I do. So, that's it. OMAD. And then um probably the ideal way to do this is to do two days a month, do a 24-hour fast for the normal people. 186 for most people most days of the week. Do 186 twice a month. Go for a 24-hour fast. That's for normal people. people who are otherwise perfectly healthy and they want to remain healthy. That is the pattern that I've seen that gives the best long-term results. 186 on a daily basis, twice a month, do a 24-hour fast. And that's not too difficult to do. And that should be baseline for everybody. Now, on top of that, if you have a fatty liver, you're overweight, you got coronary artery disease, you got inflammatory markers on your blood tests, you need to do more.

>> Let's come back to nitric oxide. Let's start with the 101. What it is and then why it matters.

>> So nitric oxide is fundamentally a gas that is made inside your blood vessels and it allows your blood vessels to vasoddilate. Okay. So it allows vasoddilitation. But in addition to that what nitric oxide does is that it's anti-inflammatory. It's anti-athoscerotic. So when you have nitric oxide depletion, you're going to get vasoc constriction, inability to vasoddilate. You just can't vasoddilate that blood vessel because there's no nitric oxide in there and it's vasoc constricted and it's athoscerotic. So it's got more redux problems in there and it's going to get a lot of inflammation and you're going to get aththeroscerosis in that artery. So that's what nitric oxide is. And the question is it's produced it's a gas it's very short acting. So what destroys nitric oxide? We all were born that's what gives us the flush the nice glow in your face and it's vasoddilation. You walk into a room you vasoc constrict. You go out you vasoddilate again. That inability to vasodil and vasoc constrict is called endothelial dysfunction. The first step in athoscerosis is endothelial dysfunction. And the endothelial dysfunction is because there's a signal produced by your inima which is the lining of the artery. Now I told you that there's another layer called the glycoalix. And when the glyicoalix is destroyed it stops nitric oxide production in the in the inima. The nitric oxide is supposed to diffuse into the smooth muscle which is the next layer and make it vasoddilate. So we have a problem. We have a problem. So stop destroying your glycoalix. huge problem because that's going to drop your nitric oxide levels. So what destroys the glycoalix is all these reactive oxygen species, glucose. So glucose, advanced glycation end products, toxins, metals and lipopolysaccharides, oxidized LDL. All these things carry charge. They have a molecule that's got a charge on it and that charge goes against that negatively charged glycoalix. Why is it negatively charged? Because it repels the red cells that are flowing in the vessels. So that's why they don't stick to each other, right? They repel each other. You get rid of the glycoelics. Now that negative uhly charged red cells are going to bind and and it's going to cause clumping of red cells on the walls and and then you activate the inima as well. So we have a problem. So nitric oxide if you denude the endothelium you take out that one single layer then the muscle is not going to vasodilate nitric oxide. So what's destroying nitric oxide? This is a very important one. What's destroying our nitric oxide comes down to many things but the most important one 90% of the problem is lipid peroxidation. This is very important. You got to remember this. So it's the lipid peroxidation, the oxidation of your lipids. Why is this so important? Because all your cell membranes are made of fat. So everything, every cell in your body has fat in it. So does the LDL molecule. But every cell membrane is fat. Now along comes a re reactive oxygen species of any kind comes and it attacks one and I told you that it attacks one it destroys one lipid moy in it and that causes a chain reaction in that cell. So now the entire membrane is dysfunctional and you know that now the outside of the inside of the cell won't won't communicate very well. the ion channels get affected. um molecules going in and out get affected. So you get a dysfunctional cell. But the other thing is that when you get this lipid peroxidation that's occurring, they go and they attack the the the the poffers, you know, the the the omega uh six in the walls of the cells. They attack them. Yeah. Sure. Sure they do. But in the process when they're doing that they start this chain reaction where hundreds and hundreds of damaged lipid uh par um particles are being produced and then you start producing more and more two molecules one is called the aldahhide one is called uh MDA and the other one is 4h and when you produce these two molecules they actually cause even more damage. they completely shut down the nitric oxide production that whole chain. So these molecules attack the nitric oxide destroys the nitric oxide but more importantly there's a thing called enos which is the enzyme that generates the nitric oxide. It destroys that. Not only does it do that but when it breaks that molecu into more pieces into two pieces those pieces cause even more damage. So now they produce more reactive oxygen species and then these molecules also block the receptor of nitric oxide. So now basically you're done. You're not making any nitric oxide inside that particular cell. So if that cell is in your in your blood lining now your blood lining it cannot vasodilate properly. The problem today is we have nitric oxide deficiency because mostly because of lipid peroxidation lipid peroxidation is occurring damage to your lipids because of reactive oxygen species. So again if you back engineer you need to get rid of the reactive oxygen species. Where they coming from? They're coming because they are not being destroyed because we don't have reducing capacity and we're making too much reactive oxygen species. Where are we making most of them? In your mitochondria. Which mitochondria? All over the place. But the worst ones are in your liver and in your gut. See? So reverse engineered. Where are the mitochondria most dysfunctional today? They and producing lots of reactive oxygen species. They starting in the gut and the liver. Then they're going to cause all the other mitochondria to also dysfunction. When your mitochondria in your brain doesn't work too good, you get mental fog. When your mitochondria in your coronaries don't work very well, then you're going to get vasoc constriction. When your mitochondria in your heart muscle doesn't work very well, you get diastolic dysfunction. That CHF, oh yeah, I got CHF with normal ejection fraction. That's just an energy problem. That's because your myioytes don't have enough energy to vasod because of mitochondrial dysfunction. So mitochondrial dysfunction will start occurring and the phenotype of mitochondrial dysfunction will depend on which organ it's affecting. But coming back to to the nitric oxide. So the nitric oxide deficiency that we are now seeing these days is it's a huge problem mostly because of the lipid peroxidation. If you have too much omega6 in your cell membranes because they have a double bond they are prone to oxidation. That is why I like omega3. That is why I'm also not against saturated fat because saturated fat does not have that double bond and it's not going to undergo oxidative stress. But when you have excessive omega6, omega6 from seed oils, that is why you'll see in all my talks I talk about omega6 from seed oils. You need to get rid of seed oils. They're industrial. They are made in a power plant that actually looks like it's in Saudi Arabia somewhere. It looks so amazing and it's making something you're going to eat. I'm not eating anything out of that plant. So, they are all made in industrial plants. They're full of hexane. They're full of other chemicals that decolorizes them and deodorizes them. And they're all omega6. And we don't need that much omega6. Our omega6 is supposed to be a small part of our caloric intake. Today in some of our parts of our country, 40% 30% of our calories are coming from omega6 oils. They're very inflammatory. They're very prone. So you see, they're very prone to oxidation. So you're making reactive oxygen species. Now you got a fat in your cells that is so susceptible to oxyg uh to oxidative stress. You're basically becoming rancid. So if you eat vegetable seed oils, you are becoming rancid. Then you wondering why you're sick because once your lipid membranes become oxidized, your entire cellular machinery is not going to work very well. So I already told you about nitric oxide lipid peroxidation affecting your entire cellular membranes and this will cause a huge problem. Now there are ways that we actually detect this that this is happening in your body. There are blood tests like for example the this thing that I order um ADMA levels right? It's part of my advanced lipid panel. If it's high I know your nitric oxide production's shot. So, I back engineer and I see that. Yep. Yep. Yep. It's because you're eating too much vegetable seed oils. And let's try to restore some of this cellular function. I'm going to give you things that are going to make your cell membranes less susceptible to lipid oxygenation. So, I'm going to give you some supplements and then I'm going to turn over your fats quickly. Now the trouble with omega 6 when they are in your cell walls they can stay in there for 6 months 9 months. So those changes don't occur very quickly. They can take a long time to turn over. That's why patients sometimes come to me and they say that oh but look at look at this. My omega6 level is still high but I stopped eating vegetable seed oils. I can take 6 months or a year to change. And in the meantime I give them lots of omega-3. So why am I giving them so much omega-3? Because ultimately it's not the omega 6 absolute level, it's the ratio because they all omega 3 and omega 6 fight for the same substrate. So give them more omega3, they're going to get far there's going to be competition and then omega3 is less susceptible to oxidation. So that's how I deal with the omega 6es. But yeah, it's omega 6. So fats are important. So there's no doubt fats are important. Fats are important but not for the reasons that we've been taught. The lipids are very important. It's because we are damaging our lipids in our body and we're damaging them because we have too much reactive oxygen species and inability to reduce themselves and therefore our enzyme systems don't keep up and we have way too much oxidative stress in our body. And these molec look you produce reactive oxygen species in a tissue but when these aldahhides the lipid molecules when they travel around the body they create inflammation all over the body all over so you say that how come I got in my coronaries how come I got in my car how come I got it in my brain and yet it all started for example in your

Gut. It's a problem. It's because you, you're getting lipid peroxidation. This is the word you got to remember. It's called lipid peroxidation, and they're occurring all over the body, and and we can't have that. So, we got to get rid of that. Yeah.

So, nitric oxide is so sensitive to superoxides. I can't tell you how sensitive they are because it's a gas. It binds to it immediately. All these free radicals bind to nitric oxide, destroy it, and then they produce this thing called reactive nitrogen species. Reactive nitrogen species, which is the product of what happens after a superoxide and nitric oxide has interacted. These reactive nitrogen species, they're even worse than the reactive oxygen species. They're terrible. They cause even more problems. They cause more vasoconstriction, more um oxidative stress because it's a very, very bad radical. A radical one that will attack another, another, another, and before you know it, you get this whole cascade of inflammatory substrate that's occurring. So, this is very, very important.

>> High level, practically, what's the best way for somebody who just learned all the physiology to support their NO production?

I'm going to answer that, but I just want to say something else about the clinical manifestations of an inability to vasodilate, and you can measure that by the way. Um, so the manifestations can be things like mental fog, of course. But the other one that is erectile dysfunction, and I find this very disturbing because people are just thinking that, oh, they have some ED, so they'll just go ahead and take those drugs, and yeah, it'll improve that. But it doesn't take care of the root cause of the problem, and they will become cardiac patients sooner or later. They will have manifestations of vascular disease elsewhere because the earliest stage is an inability to vasodilate. So, ED is very, very important. You're having mental fog. You probably have an inability to vasodilate again because, remember, in your brain, the way one part of the brain, the other part, the other part works is through vasodilation, right? You vasodilate in this part, you vasoconstrict in this part, you vasodilate here, and that's called the cerebral autoregulation. That's all dependent on the ability to instantaneously produce nitric oxide in different parts of the brain in the vasculature. So, this is very important to mental firation problem. So that's why inflammation, you get problems with mental fog as well because inflammation decreases your nitric oxide levels. See how it all ties in. So, mental fog, mental fog is not to be taken lightly. It's not because you didn't sleep enough last night. It could be, but mental fog is a problem. It means you're toxic. You have too much reactive oxygen species, and your physiology is not right. Mental fog is not to be taken lightly.

So, coming back to how we can best improve our nitricum. Look, people will give you supplements. Yeah, fine. But you need nitrates in your diet, okay? And stop using mouthwash. Of course, the nitrates need to be absorbed in your gut, and they need the right pH. What's that got to do? It's all electrons again. It's all the charged particles, you see. But you need nitrates in your diet. That's why I like to still leave my patients on some cruciferous vegetables because you need nitrates. Nitrates are found in the green leafy vegetables. So, you need enough of those. That's one thing.

The second thing to to improve is you need to knock down your reactive oxygen species production. So, you need a nice healthy gut that's not leaking. You need lots of good microbiome so that you get a nice mucin layer so that you don't get translocation of lipopolysaccharides, which then meet your immune system. Your immune system is in the gut, 80% of it. And when they get stimulated, they produce a lot of reactive oxygen species. H, they produce a lot of ROS because that's what cells do. Immune cells, immune cells produce a lot of reactive oxygen species. They all then filter into, go over to your liver together with the lipopolysaccharides to cause more inflammation in the liver. The liver wants to attack these things, makes more reactive because that's all it knows how to do. It kills things through reactive. How does your white cell, how does your white cell kill a bacterium? How does it do it? How does it do it? Well, there are many ways. One of them is that they produce chemicals, especially the T-cells, for example. They'll make chemicals that will destroy that foreign particle, but the reactive oxygen species are produced in macrophages. And we measure that in the MO levels and maybe do the advanced panel. So, your ability to, you need reactive oxygen species because that's how they work. And you always need a little bit of reactive oxygen species. Why did the body make it? Because they're signaling molecules. They actually do other things as well. So, in the mitochondria, a normal amount of reactive oxygen species is always produced. Where do they go in day-to-day life? In a healthy person, where I'm making ROS, I'm making it, but only a small amount. What do they do? Even though they're small amount, why did we design it like that? Because they actually go to the mitochondrial DNA and your somatic DNA, and they send signals there, and there's a feedback that's telling the energy machinery, which is your mitochondria, and telling your cells what the situation is. So that your nucleus, which produces all the proteins, h, the translation of proteins because the histones unwind, make new proteins, they close up, they close them, and then of course, the methylation and epigenetics also is all controlled by these reactive oxygen species. Reactive oxygen species produce not only inflammatory damage, but when you have too much of it, it affects your chromosomes. So, it turns on genes, turns off genes, makes new proteins, makes different types of proteins. So, it's a cell signaling molecule. Too much reactive oxygen species is no good for you. Small amount will give the right signal to the nucleus and keep it posted as to what the energy state of the body is. So, we always need some. That's why in the past, we used to hear that you mustn't take too much antioxidants, not too much, because you don't want to quench it all completely. So, we got to be a little bit careful here because I've seen people who've taken massive amounts of antioxidants and they're still not very well, and they're just taking too much. See, because you need some reactive oxygen species.

So, nitric oxide, if you want to preserve nitric oxide, what's going to destroy it is lipid peroxidation. Watch what lipids you're consuming. Have more omega-3 in your diet. Karate omega-6, which comes to you not only vegetable cereals but also, for example, the meat. If your meat is from cows that are mostly eating the the stuff they feed them these days instead of grass, right, then you're going to get a lot of omega-6 because if they're eating grains, they're eating corn, they're going to get omega-6 in them. So, we got to be a little bit careful about that as well. So, less omega-6, more omega-3. And then eating foods with lots of phytonutrients in it, lot of polyphenols, because they're going to turn on your endogenous NRF2, which is going to be the, it knows what to do. It has its own feedback mechanisms. So, it'll give you just the right amount of anti-inflammatory, uh, activity. Fix your gut. Get rid of the fatty liver. Don't put toxins in your body. Get rid of toxins in your entire life. That means stop putting unnecessary creams on your body, unnecessary shampoo, unnecessary makeup, unnecessary underarm deodorant that contains toxins in it such as aluminum, because these are all xenobiotics. They're not supposed to be there. And when they go to the liver, what they going to do in the liver? They're going to produce what? They're going to produce reactive oxygen species. So, all xenobiotics produce reactive oxygen species, and when they do that, they're going to destroy nitric oxide levels. When I tell my patients to clean up their act, that means they go home and they stop putting unnecessary creams on them, and they look at the wardrobe, even the washing liquid. They clean up everything. ED gets better. Clean up their diet. ED gets better. Start doing some intermittent fasting. ED gets better. They also detoxify very easily because they don't realize how toxic they were. ED gets better naturally if you make all these changes, understanding that ultimately they got ED because they have nitric oxide dysfunction. There's some ED that is actually secondary to vascular disease itself, but those are older people where the artery may be narrowed, but that's very rare. Most of them, it's functional. It's metabolic. You have ED, you have nitric oxide deficiency. You have nitric oxide deficiency, you have too much oxidative stress. If you have too much oxidative stress, you better find the cause of it and increase your reducing capacity to do that. To increase your reducing capacity, you need to do some exercises, change your diet and lifestyle. Exercise, we don't talk about, but the exercise that Dr. Jay likes to do is HIIT. I like high-intensity interval training. And I did a little video on it where you run real, real fast for a few minutes, and then you literally just stop and just relax, and then do it again after a few minutes. And so you're doing short bursts of activity with total relaxation in between. And that has been shown to actually improve your mitochondrial resilience and your ability to to to take care of your, uh, reactive oxygen species because you're stimulating also new mitochondria, better mitochondria, which are going to produce less reactive oxygen species the next time you exercise. So, you do need to exercise. Exercise is part of this. You need to get plenty sleep. You got to drink plenty clean water, filtered water. You got to look for every source of contamination in your life. Don't think that just because your house is looking clean that it's not contaminated. If you're living in an old home, you may have lead. Get tested. Get your water source tested. Get yourself tested. I'm surprised how many people are toxic. Do a simple urine test that tells you whether you have toxicity. If you have toxicity, that does not mean you're going for chelation each time. No, there's simple supplements that you can do. Tox, look, toxicity is not talked about by the regular MD. Toxicity, oh yeah, that's somebody else going to take it. No, this is a medical problem. If you think you're toxic, it's very simple. Do a toxicity test. Find out what, what's in your body that shouldn't be in your body. It gets there inevitably. I find patients. I had a patient the other day who had an arsenic level that was 10 times higher than normal, and he didn't know where the arsenic came from. And I said to him, "Are you sure someone's not trying to knock you off?" And he laughed and he said, "No." But I don't know where his arsenic came from, but probably water, maybe some of the food sources that he's having. But you see how important, he is now looking at the food sources where he's getting his arsenic, how he's washing his rice every day and then throwing throwing out the water because that's a very common source of arsenic. So, he's going to source his food, right? He's going to wash his food, right? But he's going to make changes. He's going to make some changes in his life. And by the way, where does arsenic affect you? Right at the mitochondrial level. So, I think that doing, um, toxicity testing in patients who have coronary artery disease, inflammation, fatty liver, is an important part of my workup, which I never used to do before. But now I order a toxicity test on all because it's very, very helpful. Yeah.

And the other thing is, you know, the quality of the food that you eat, that it changes the way you look at your food because I know that 20 to 25% of spices have mold in them because they get grown in a country with hot, humid climates and stored in not the best way, and by the time they get packaged and sent over here, they have mold in them. Because I often wonder where the mold came from. They don't have chronic sinusitis. They don't have other problems, or that they got mold. And it's because every day they're eating these foods that may have mold in them. So, I think toxin testing has really opened my eyes as to another factor that deranges your metabolism because your body has to deal with it. So, xenobiotics are very, very important. So, I just define them all as xenobiotics. Things that are not supposed to be in your body, don't need to be there because your body has never seen that postal code before. Doesn't know what to do with it.

All right, Dr. J, we have shared a lot here today. In wrapping up, because a big part of the thesis today has been our mitochondria and supporting those, let's wrap up with three practical takeaways for people to support their mitochondria. First thing to improve your mitochondrial function, your energy source, because that's what mitochondria do. Make sure that you cut out simple glucose, excessive carbohydrates. So, follow my diet. Eat real food. So, that's the bottom line. Number one, eat only real food. If it looks like that in nature, put it in your plate. Eat that. Eat some cruciferous vegetables every day. The sulfate is going to help you detoxify in that, and it's going to give you antioxidants. So, eat real food with cruciferous vegetables. That's rule number one, right? So, that's going to, when you do that, you're going to get all the fiber as well. So, you're going to do one.

Number two, today's world, today's world is toxic. And the organ that's under major attack is your liver and your mitochondria. The organelle is your mitochondria. Your organ is your liver. That's where most of our danger is today. Save these. How do you do that? For most patients, I'm going to advise you to take N-acetylcysteine, alpha-lipoic acid, a fiber supplement, omega-3, which is the fish oil, magnesium every day. If you do these simple ones that I already mentioned, they're going to help you overcome all the adversities in today's modern lifestyle. So, that's going to help you with your mitochondria.

The third thing is, be aware that your mitochondria are not the same throughout the day. Respect it. Don't expect your mitochondria to be driving at 90 miles per hour at 10:00 at night. They'll only do that at midday. So, honor your mitochondria. That means eat at noon time. Stop eating so frequently so that you're taking those poor mitochondria and just shoving them with calories all the time and electrons. Basically, it's called electron substrate. You're giving it too much. Stop abusing your mitochondria because they will respond by making lots of reactive oxygen species. So, do time-restricted feeding. Eat at noon time. Have two meals six, six hours apart. Respect your mitochondria by giving it all the new micronutrients it requires. H, so good diet and all that. And give it sunlight. So, what's that got to do with all this? Well, you know, light also affects your mitochondrial function, and we know that light actually, that's why some of my patients do red light therapy because it helps boost the mitochondrial function. So, we know the first complex is actually a chromophore, and it improves mitochondrial function. It produces less reactive oxygen species. So, I can do red light. How? I just go outside. I was not born with red light deficiency. I was born to be outside. So, the third, third pillar is you have to go outside and get red light naturally. I'm sitting in this room right now. I'm only getting about maximum a thousand lux of light. But the moment I go outside, and it'll look just as bright as it is in this room, I'll get 10,000 lux of light. And I'm only seeing a narrow spectrum of it. The rest of it is actually helping me. And how is it helping me? It's helping to time all my mitochondria in different parts of my body. My signals that I get from the light resets all my clocks. And every organ has its own clock. I just told you about the mitochondria in your gut and in your liver that it's midday. But there's a mitochondria for every organ, and it's got its own timing cycles, and it's all reset by day and night. So, there you go. So, I know it's hard to say in three, but these are the three things that I would recommend everybody to do.

>> Okay. Because of the sheer number of topics we covered, far-reaching conversation, any open loops we need to close before we part ways?

Early detection, detection of pathology is very important. So, just because you're feeling good right now does not mean you don't have pathology. A regular physical examination and a regular physical check will get you a pat on the back and saying you're fine. The answer is no. It starts early. Everybody by the age of 40 needs to start getting tested. At the very least, you should do the special test. It's called the advanced lipid panel, that doesn't, that goes beyond just your regular lipids. It looks at all the inflammatory markers in your body. I mentioned them already. H, LP PLA2, MO, ferritin levels, oxidized LDL, small dense LDL. You can actually measure your malondialdehyde levels. You can't measure your 4H and E levels, but you can measure your isoprostanes, which will tell you whether you got lipid oxidation going on or not. These fundamental and CRP, of course, need to be done as a prevention model in everybody because just because you're feeling fine is fine because the next time you're going to feel something, you'll be already far deep into disease. Don't wait that long. So, the only parting thing I would say that prevention starts early, especially in today's day and age, you must start early. When you turn 50, you should get a coronary calcium score. You have to do that because by that time, if you have coronary calcium, that's your warning that you already have vascular disease. You are as old as your vasculature, and you're going to die because of your vasculature. Take care of your vasculature. So, you need a coronary calcium score when you turn 50. And that applies to everybody. If you're getting ED, you're already vascular disease. I already mentioned that. In fact, if you get it, that's a very early sign, an opportunity to take care of it. You got to go do it now. So, don't ignore things. Just because you're feeling fine doesn't mean anything. And pay attention to the diet that I mentioned. Invest in your health now. You'll have lots of it later on. Don't invest in your health when you turn 65 and retire. That's too late. The damage is done. Start early. Start when you're in the 40s.

All right, Dr. Jay, good place to end it. This was another great conversation. I really appreciate it. We covered a lot of new ground. We're going to link up your YouTube channel, your website, everything in the show notes. Thank you again, Doc.

>> No, thank you. Thank you. It's my pleasure. Thank you.

>> Thank you for watching. Stick around here for this other great interview. You don't want to miss it. I'll see you over there.

>> High blood glucose is one part of the problem. High insulin levels is a bigger part of the problem. High glucose causes swelling, microvessel damage, blindness.