Ep31 Dr Aseem Malhotra on Calcification and Heart Disease Reversal - Buy Bentyl

Ep31 Dr  Aseem Malhotra on Calcification and Heart Disease Reversal

Ep31 Dr Aseem Malhotra on Calcification and Heart Disease Reversal

By Bryan Wright 22 Comments July 12, 2019



you know it's interesting you say it would be a paradigm shift in but you know we we say the same thing about type 2 diabetes type 2 diabetes is a chronic irreversible condition that will gradually get worse over time we know that's not true anymore so that's what the heart disease reversal next welcome to the five Emperor podcast I'm your host ivar Cummins we're supported by the Irish heart disease awareness charity which advocates a simple CT scan to reveal your CAC score so know your score and take action to prevent that premature heart attack everything you need to know will be right here I'm here in the Royal College of General Practitioners at the ph c UK conference and i got to catch up again with dr. c Malhotra great to see you there it was good seeing me absolutely and you were in Australia recently and you messaged me about a doctor over there he's doing a lot of calcium scanning and some really interesting stuff you were learning from him yeah absolutely so I was on a speaking tour of Australia and my topic was really about too much medicine and statins etc one of my somebody I've become very friendly with who I met last time I went to Australia is a cardiologist called dr. Ross Walker he's been a cardiologist for for many years at least three decades a very experienced cardiologist and very well known very well respected and he uses calcium scores a lot in fact he has treated and utilized calcium scores in tens of thousands of patients so he's probably as far as I know there's certainly the person I know more than anybody else as a clinical cardiologist has used them and I think that's really interesting useful to see what his what experience what impact that's had on his knowledge and how that he can you know he what he shared with me I'm fully behind like with anything in medicine of course it's about using the right tests in the right patient but certainly when it comes to assessing cardiovascular risk and you this is the best tool we've got it's the best way you SERPs anything usurps cure risk calculator tells you whether you've got diseases you know either and it also tells you about the the risk and also what we can do serially and I you know I've started using some my patience is to see about rate of progression of disease as well and risk and I think that that is definitely a useful potentially very useful role for patients for me personally one thing I found I found very interesting about calcium scores is the use of calcium scores in patients who may be deemed a particular high-risk for mercury score or have high cholesterol and are not particularly keen on going cholesterol on drugs or statins for example so I'll just give you one example and this has been repeated a few times as I've seen a number of patients with familial hyperlipidemia who first diagnosed in their late 50s and as you know familial hyperlipidemia is a genetic condition which has a very strong association with the development premature heart disease but that doesn't mean everybody with FH is going to get heart disease and these patients you know ladies in their late 50s come to see me first diagnosis of cholesterol you know we're talking about total cholesterol of 20lb ELLs of over 10:15 I mean very high LDL cholesterol but otherwise extremely fit normal blood pressure knowings markers of insulin resistance normal glucose slim active and they have come see me because they've been told unless they go on a statin or a class rolling drug in in quotes one of the doctors told them they wouldn't be around for much longer almost giving them a kind of death sentence like terminal cancer of course you and I know that's not a very ethical or kind of scientific way of having a discussion with patients necessarily but one thing that's been very useful in each of these patients is use of calcium score and sometimes even a CT corny angiogram all of them have come back as zero so clearly logically if cholesterol was a risk factor for them for them personally they would have at least some if not extensive coronary disease by their late 50s and the fact they've got nothing is clear indication it's not a problem for them and therefore they can be reassured they do not need to lower their cholesterol ya know that is another excellent use for the scan and actually I'm getting a lot of people coming out of the woodwork now if a gentleman of 62 with the LDL of I think around 340 American units and up near nine total cholesterol to 12 or you know 500 for an American units and he got a scan and he got his zero score and also a family of familial hypercholesterolemia have been on drugs but they are in their 60s and to at least of three siblings have zero score zero heart disease registered now they are on on lipid lowering drugs but the reality is they still got enormous cholesterol so it just shows that cholesterol is very much an association that may indicate a problem or it may not be a problem and you need to look deeper to find out which it is absolutely right absolutely right and I think I think this is about the evolution of the science so we can identify the right patients for the right treatment unfortunately our healthcare system is being run by more profit-making industries and how doctors make decisions rather than actual good science you know and treating individual patients so I think the calcium score is a very useful tool for that I think the other thing as well I know either you've looked at this in a lot of depth and you know we've shared information on all of this and obviously I see the patients in it it's very useful to have very spits of information that can inform patients but one of the things that's interesting as well is how the progression of calcium score to DES and the serial calcium scores can also predict risk of event and I think you you told me that you know that if it's more than 15 percent in three years then it's a much the the increased risk of events is much much higher than if it's less than 15 percent in terms of increase of calcium score yeah the serial calcification I mean there's no some noise in the data but the rhaggy study I showed you was was really good and it was 17 times more likely to be heart attack if you were progressing rapidly rather than slowly very fair study in fact it was 50 percent of entry modeled for people who are progressing rapidly and 3 percent for the same high scores at the start but not progressing but I think the best I can say about that is professor bulldog who's the world's leader in imaging in general he is a huge paper in covering progression and generally regardless of the parenting score fast progression is six to eight times more risky even for people who have a same starting score so cereal is powerful and I think dr. Walker was discussing that you as well yeah and I think this is again an area which I don't have a lot of expertise in specifically but one thing that he point out to me which was interesting as well as as I know as many people know and cardiologists knows that it's you know it's it's plaque rupture that's the problem when it comes to cardiovascular event in terms of heart attacks and cardiovascular mortality of course if you've got significant stenosis over time it may well give you symptoms okay but the real issue in terms of of death and heart attacks is plot rupture and that often happens in plaques are none significant it may not be particularly calcified you know it's a softer plaques that prone to rupture so one of the interesting things that Ross also highlighted to me as well is that even if you get increase in calcium score if the overall plot volume reduces that's a result because actually hyper you know hypothetically speaking certainly a more calcified plaque is also a more stable one and I've seen that when I've been doing angioplasty is when I was in the cath lab and we'd see people that you know the the plaques are the most difficult and most most challenging to stent you know to stick the metal coil to stretch the artery to improve the the lumen diameter improve blood flow are the ones that the most calcified so actually the the paradox a little bit is that calcified plaques are probably less likely to rupture but I think more calcium also indicates small soft talk that's precisely it and I still years many years later still get this argument about soft black but the people simply don't understand so more calcium calcium means proportionately more soft plaque on the surface so that's why it's a very accurate measure of risk just because it's soft or plaque or the the kind of join or interface between calcified plaque and soft plaque is often a weak point just because that's where the rupture happens doesn't take away in any way from the fact that higher calcium means higher calcified plaque and higher soft plaque proportionately exactly exactly exactly and we actually oh you're aware we did with Donal O'Neil of serial killers we did a documentary's Donal don't he's he's kind of a he's a nice guy he's a funny guy you'd like him but he yet we did a documentary which we already released for free and I'll link it again on this podcast a half-hour documentary with Irish sporting heroes who are the top heroes in 1991 in Ireland and we scand 45 men in their 50s most of them slim in great shape for men their fifties very impressive big man and we scanned them all and all of them were deemed to be healthy by their doctors and all their blood markers looked fine there was nothing suspected and 20% of them had from a hundred and fifty up to 3200 scores so how to immediate followup with doctors and cardiologists in some cases so just showed there's 20% of super high risk guys in there in a group of 40-something who were all deemed as low risk so when people drop dead of a heart attack in the 50s and they're slim and fit like some of our guys were huge guards or slamming fish and then people say oh you know it's kind of like a bolt from the blue or you know what it's funny he didn't smoke he was slim but there's a trend as well that when you measure their blood glucose after a meal our guys were the big problem it's jumping up really high I was a really good point I think that highlights that weight and activity so being a so-called normal symptom weight and being active should not give people the illusion of protection having said that I think there needs to be a more specific research about whether these are a separate groups so our athletes with high calcium scores you know are they at the same risk as somebody who's a non-athlete with a similar calcium score and other risk factors and my guess is they're probably not at the same risk but certainly there is Morris and being completely zero you want your calcium score to be zero you don't want anything in your coronary arteries so I think that's probably a more of a nuance there but certainly it's it's it's it's it's it goes against what most people probably believe they think that if you're a footballer and you're middle-aged and you're slim and you're active that the chances of heart attacks is extremely small or there's almost no chance of having corn disease but clearly and I think the data that's there suggests that isn't the case either that you do get a significant proportion of athletes who have significant calcium scores yeah and events and actually I do have one paper on that very topic and while it is true that the athletes are a little better off in general and they seem to calcify in a more more towards density and less volume as you mentioned earlier they have a little bit more safety but when you look at the actual heart attack rates between low and high scoring athletes and the high activity group they're not that much different than other people so a high score still means an enormous relative risk so yeah the our guys who got the high scores and in the movie we're gonna go back and rescan them and it's gonna be really interesting data coming out of that but one of the guys we rescanned he said he's lost several friends from the sporting community in their forties and so I think so the question then as I suppose it's important to work out what may have caused it in these people and then what to do about it it could be stress in certain people the stress of exercise you know exercise does cause stress on the body the lots of amazing effects on the body but it could be that it causes a certain stress or the certain amount of exercise in certain in sub septa Belinda vidual z– could cause him to have coronary disease so that's one mechanism it could be something that in a phrase that I used in an editorial she became very well known which I wrote with Tim Noakes and Steve Finney is that it could be because of the diet you can't outrun a bad diet and certainly one of the studies that we cited was looking at the availability of sugar and and it's in its correlation with prevalence of type 2 diabetes independent of weight and activity showed a very increased prevalence of type 2 diabetes in certain groups in populations suggesting a high sugar diet despite if you even if you're active or slim is likely to increase the risk of type 2 so I think that it's important if we if we understand those concepts and the science is there then that may explain why some of these people are developing current disease despite being active and slim it could well be that they had a high sugar high carbohydrate diet I don't know it could be something else yeah and we'll exactly as you say with more use of calcification not only will the most important happen that a recent paper showed that of the foreseeable heart attacks using the risk algorithm or and or the calcium scan a third of the heart attacks that happened were only predicted by the calcium scan so if you've got millions of heart attacks out there and tragedies a third of those could only be seen by a calcium scan and these are middle risk people so it's huge but you're right with more use the scan we get to tease out as well more round causes and our guys definitely there's a trend towards very high blood glucose after a meal even though they're fasting is good they're a Muncey's good their metrics look fine their ratios look okay how interesting yeah I think the metabolizing lots of sugar and carb intensive I think what would be useful if you've got that sample of patients is to see if there's any correlation with liver fat and are you going to be speaking to Robert Lustig soon and these people that have a so-called carbohydrate intolerance from their glucose monitoring so if you're able to get MRIs or DEXA scans to look at the visceral fat it may well be that they are tophi they are thin on the outside and found the inside that these are swim a fleet but actually they have excess liver fat I would be particularly interested because it would be that would also make sense what wouldn't make sense and would need further explanation is somebody that has normal metabolic markers doesn't have any visceral fat yet their coronary arteries are full of calcium now that would not make sense to me yeah it could be I guess there could be an intermediate stage where there's not a huge amount of liver fat but the dysfunction has established but we have we don't really have extensive analysis of these people but I think if we could start looking at doing trials of this type we base but even it's an observation either I think if you could if you've got a handful just in those people it'd be very useful just to scan them with an MRI and actually see you know it's non-invasive it's safe have they got any liver fat especially if they've got you know exaggerated glucose responses to to high glycemic index foods true and the only challenge is the same that we are now post filming so all right some of these guys that we've rescanned they've doing the right thing for six islands fine so we may have lost and originally we just did a kind of blood test there were some limitations but interestingly their liver markers which I went through did not were not notable in any way so interesting a little but yeah but yeah next time maybe great stuff yeah fantastic and you are you looking into some kind of trial I think yeah I think so I'm designed to trial randomized control trial that we want to make sure is well for sure has to have no commercial influence no one's going to profit result from the results other than the public but really design it I've designed a randomized control trial to actually look at true coronary disease reversal is as possible and can lifestyle interventions specifically reduce hard outcomes as in reduce heart attacks strokes and death and I think we've got the science to test that we have observational data there has been some other studies done showing this this is chrony regression or reversal of core diseases is certainly plausible but it hasn't been tested in a rigorous randomized control trial and that's why I've designed so that's my next bit of work excellent well that that is truly a first yeah there are associational studies I think William Wheat Belly Davis just looked at his patients and on his treatment regime which would be quite similar I think to what you're probably thinking about and they had regression and stabilization relative to the population but it's not controlled it's not randomized exactly but the observation itself is still fascinating but it's not something that's well-known or discussed in cardiology circles at all it's all based upon medical therapy and reducing event rates but coronary regression is something that I in my whole career you know and I've rarely seen I mean it's not something that you you know routinely necessarily come across but you know and wife I've probably managed well over 10,000 maybe 20,000 patients in my career so you know it's yeah it's it's it's it's it's fascinating it's worth investigating it's the Holy Grail I think my genuine view is I think that it is possible and there is almost certainly I think that it can be done but we just need to work out what exactly you know to prove that what interventions can do it absolutely and you know just a reminder to the audience on opeing the aunty are holding a hostage to fortune here the Heinz Nixdorf study and many other studies have clearly declared the calcification is inevitable progressive and can be mathematically modeled for any score or age you are they've mathematically modelled it will go up X percent per year that is how interesting on the record the medical world so if you show you know to Paris on top isn't it it's part of the regression and I drew it's based upon also the editorial that you met you remember I wrote in 2017 with Pascal Mayan reach a red book about you know coronary heart disease is a chronic inflammatory condition linked to in some resistance so really the scientific basis behind it you know and that can be managed by lifestyle interventions that is the next stage which is the RCT but you know it's interesting you say it would be a paradigm shift in but you know we we say the same thing about type-2 diabetes type two diabetes is a chronic irreversible condition that will gradually get worse over time we know that's not true anymore so let's look a hot disease reversal next it's a perfect analogy absolutely so game-changing stuff which is always great to be involved in so thanks a lot thanks may be always good see I'll take care thanks for tuning in guys if you're watching on YouTube you can see my subscribe button in the middle of the screen a free viewing of the Widowmaker movie on the far right and myself and dr. Gerber's book each rich live long on the left otherwise please do subscribe to the audio podcast thanks

22 Comments found

User

flhtcui2

Ivor

Thank you for doing this. I have a score of 1278

Thanks to you I convinced my Canadian md to get this test done

You have given me the drive to reverse my disease best I can.

Thank you

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User

Suzi Kirby

Thanks for this one. Love the science. Wish I could foist this info on my 76 yr old sister's Dr. ☹

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User

Luis Miguel Toscano

Thanks Ivor for your work.

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User

Nemo Letov

Dr. Malhotra one of the docs in Europe who openly against statins. Stupid drugs – did not reduce any ivents. You need chew this things for 40 years to reduce few heart attacks – its pathetic.

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Art Blackwood

2 smart guys. Perfect.

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User

Di

I'm 63 female. Score 276. Extreme stress and inflammation in my childhood up to my 30s and 40's and some undiagnosed cardic event as a late teen. Athlete for 17 years. Now fit well and otherwise healthy ( all tests including insulin assay done). I eat Keto and by doing 16:8 I have , recently, this year, lost a further 4kgs mostly abdominal fat as part of my quest to reverses the calcification. I think my calcification was caused years ago and it is now 'healed' I believe I'm on the right path and will only know the rate of progression in 2 years when I have another scan. I have no carotid soft vulnerable plaques I was scanned…. But what other tests could I do to see if I do have vulnerable plaques anywhere else?

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openbutterflies Epperson

I didn't really hear any suggestions on reversing heart disease in the talk. And I went and watched the new movie and really didn't see anything there, either. My score is 534 (I'm 72 and was told my arteries are that of an 84 year old) so I keep looking for ways I can improve things. Can you direct me??? Thanks.

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Svend Svin

thanks love you ivor, two very intelligent men, really like aseem. Very intelligent.

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Maybe Not

Excellent video, lots of very helpful information!

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BradleyT2p2

I could listen to these two for about 6 hours straight. Great stuff.

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User

Eileen Reed

fascinating video, thank you both so much.
Good luck with all your research.

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User

Johm Gant

Ivor, is it possible to send you an email?

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User

James King

Thank you for what you do to allow countless people learn how to live healthy lives, until death by old age and not chronic disease!!!!!!!

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User

Dr.Thangadurai R.R

Dr. Malhotra.. the possible explanation from my view point is that coronay calcium is hardly reversible ( scar of the past ) without lifestyle modifications where as liver fat is readily reversible over a few weeks time… coronary calcium may reflect the past vs metabolic markers, visceral fat reflects the present status. Obviously you cant compare the present with the past…

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Bob Axford

It would be interesting to know what Aseem proposes as the key interventions he intends I his RCT. I for one would like to follow those interventions too, as I have been continually modifying my nutrition and lifestyle on what I am learning since a very high CAC score of 1580 and then bypass surgery 5 years ago.

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W S

Anticipating the clinical trial results from Dr. Malhotra. I never miss a post.Thanks for what you do Ivor.

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Ralph Taylor

All very well and useful for those that haven't been diagnosed with CHD. But, what if you have CHDCVD how do you then assess your coronary health. You can do all the right things, reverse your metabolic syndrome etc. but apparently CAC tests are not reliable if you have stents due to scatter (so I have been told by cardiologists). So what can you do to assess plaque especially the soft stuf?

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Dr.Thangadurai R.R

CV risk by Calcium scores are better replaced by carotid intima thickness or even a simple ophthalmic examination of retina where u can see capillaries. The condition of vascular system is universally affected and hence it is more feasible, acceptable, free of radiation risk. U dont have to repeat CT scan just for reassurance… not even ethical is what i suppose….. the contraversy is exposed in this conversation itself about hard (calcium) vs soft plaques….

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Artur Seredziuk

What would be "technical" description of athletes in these terms? Athletes – that's a wide range of internal body composition variety and tissue mechanism. I don't see how that can be capture into one group.

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Victor Da Silva

outstanding

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User

Bart Robinson

Ivor.. please share your thoughts and opinions about CIMTultrasound in a future podcast.

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Aqua Fyre

This is how medicine should work. The irony of it – is that – yes – it may take a little more time & tests —
Long term cost savings to the Health Budget – as well as individual health benefits are beyond measure.

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