Heart Health Essentials: Tyler Earley on Keeping Your Ticker Strong

[0:00] Jason: All right, let’s be honest. If your Apple Watch told you your heart rate spiked while scrolling WebMD at 2 a.m., this episode’s for you.

Kathy: Or if you think you’re too young for heart problems while Door Dashing your third spicy chicken sandwich of the week.

Jason: Yeah. Well, today we brought in real-deal cardiologist Dr. Tyler Early to break down what your heart is trying to tell you and what Instagram definitely is not.

Kathy: Can you trust red wine? Do you really need 10,000 steps a day? And why does everyone freak out about cholesterol but

[0:30] ignore their blood pressure?

Jason: Yeah. Plus, we’re going to play a trivia game where the answer is always heart. Remember that for later, even if your cardiologist says otherwise.

Kathy: Stay with us. You’ll laugh, you’ll learn, and maybe, just maybe, you’ll start giving your heart a little more credit.

Jason: Okay, this is the PTCH Podcast. What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast?

Kathy: Chiropractors and physical therapists don’t like each other. Oh, think again.

Kathy: I’m Dr. Kathy Lynch, physical therapist who likes to help people move and get

[1:00] stronger.

Jason: I’m Dr. Jason Young, an evidence-based chiropractor who uses humor just as much as adjustments to help people get better. Welcome to the PTCH Podcast. Remember, there’s no I in PTCH. All right, everybody. Welcome back to the PTCH. Today, we are really excited to have Tyler Early here with us. I think that we decided that you are a RARD, which is really a real doctor, right? We talk a lot about being a NARD, but

Kathy: that’s not you.

Jason: We got a real doctor here.

[1:31] Tyler: That’s a new one for me.

Jason: Yes, exactly. So Tyler works at Samaritan, which is the local hospital, as a cardiologist. And I was told that a cardiologist is a doctor who does heart stuff. Yeah.

Tyler: Yeah, that’s true.

Jason: Okay. So it’s pretty close.

Tyler: The heart of medicine, right here. Sometimes I’ll say, “This is my area of expertise right here,” and someone starts asking me about something in their leg or their foot.

Jason: Yeah. I don’t care about your feet. Right. So, good. Well, we’re really glad to have you here.

[2:01] Everybody who listens to this show, I hear, has at least one heart. And so there’s going to be something here for everybody, I think. So really good episode to tune into. And I think in full disclosure, I should point out why we were able to get Tyler to come on the show.

Kathy: Yeah.

Jason: We’re actually related. Like, can we get a wide view so that you can see how much we look alike?

Tyler: Yeah, we are. Yeah. This is —

Kathy: I thought I saw the resemblance.

Jason: Yeah. So Tyler is married to my niece

[2:34] through marriage. So we’re related twice through marriage.

Kathy: Double marriage.

Jason: Double marriage. Double. I don’t know if that’s legal. It sounds weird, but yeah.

Kathy: Yeah, we’re in Oregon.

Jason: I had an infection in October. I had to stay like a night or two in the hospital and he came up to check on me and he’s like, “Yeah, my uncle’s in there.” And they’re like —

Tyler: in there?

Jason: Didn’t you mean on that side?

Tyler: Yeah. Like, okay, Dr. Early is lost, but

[3:04] you know.

Jason: Okay. No, but we’re really glad to have you here. So thank you for taking some of your sweet, sweet time to be with us.

Kathy: It’s going to be a great episode. Well, first question — why cardiology?

Tyler: Yeah. I mean, so if you look through kind of how medical training happens, you know, in your first couple of years you’ve got didactic training. You’re kind of learning a little bit about everything. And then the third and fourth, you start to get into actually going and seeing patients and shadowing doctors. And that’s when I really realized cardiology not only has tons

[3:37] of evidence. So when you’re giving someone a recommendation, it’s based on really good data, clinical trials, things like that,

Kathy: but also that’s paired with

Tyler: being able to save lives clearly when it’s critical, but then prevent disease with really simple but powerful lifestyle interventions. And so I loved the marrying of all three of those things — that you can make a huge difference when someone’s life is critically ill versus just helping them prevent that critically ill moment, you know, years in the future potentially.

Kathy: It’s kind of the whole package.

[4:08] Tyler: Yeah. Yeah.

Jason: Give our listeners just a slight idea of how much time you actually had to spend — now that you’re also fellowship trained.

Tyler: Yeah. Yeah. So it is a long road, and a lot of healthcare training is, but so you finish undergrad and then medical school is four years, and then if you want to do internal medicine, that’s three years, and then from internal medicine you can continue to branch out in various different directions. Cardiology is another three years. Okay.

[4:38] Jason: So that’s 10 years after undergraduate of ongoing training.

Kathy: Oh my gosh, Tyler, I think you might be the oldest person I know. That’s crazy. When did you pass me?

Tyler: I don’t know. Somehow it just happens along the way.

Jason: Yeah. Oh, that’s great.

Kathy: So you can’t go straight to cardiology. You’ve got to go to internal medicine first, then cardiology.

Tyler: Yeah. I kind of want you to have that basis of how it connects, because you know, the heart — I made this joke about how the heart’s right here. But really, everything’s interconnected, and especially anything related to an organ as important as

[5:09] the heart — it’s going to feed a lot of different things. A lot of other things are going to affect it. So you have to have kind of that background knowledge of —

Jason: That’s funny. I thought that only chiropractors said it’s all connected, but cardiologists too, I guess.

Tyler: There you go.

Kathy: And the heart is internal.

Tyler: It is.

Kathy: So it’s part of the internal medicine part.

Tyler: I hear it’s supposed to be internal, like, all the time. Yeah.

Jason: Very true. That’s cool. So do you have any sort of specialty within cardiology? Like, how is your kung fu different than other cardiologists, or is it

[5:39] Yeah. So there’s various different aspects of cardiology. So there’s people who are basically heart rhythm specialists, those who do a lot of more procedures like catheter-based procedures, stents, things like that. My training is in general cardiology. I did some extra training in cardiac CT. So being able to actually look at people’s hearts with the CT and make certain analyses related to that. But generally what I like about cardiology is general preventive cardiology and then you know there’s a little bit of this, a little bit of that. So

[6:10] Sweet. I like it. Yeah. So I think it’s a good time for the disclaimer that we talked about — that he’s not on here giving like healthcare advice. Unless it works. And then that was all Tyler. It was. Yeah, it totally was. But yeah, we’re just doing entertainment here today, folks. Just entertainment. All right. If you have questions, call your cardiologist. Yes. Yes. Not our cardiologist — call yours. Unless he is already yours. Yeah, he might be yours. There you go.

[6:41] Yeah. All right. Well, give us kind of the state of the cardio union then. Like, what is it that people need — what’s kind of the biggest thing that we should be talking about whenever it comes to heart health and things like that? Yeah. I mean, some of the things that we touched on in the opening, I think are important — that cardiovascular disease starts early on and you usually don’t have a lot of symptoms early on, but you’re starting to develop, you know, problems

[7:12] potentially much earlier than you know. And so there’s certain risk factors that you really need to be aware of that can make a huge difference in kind of blocking or preventing future cardiovascular disease like heart attacks, things like this. Okay, you’re making me nervous. So give me some examples. Yeah. So I mean, these are things that you’ve heard of and a lot of people know about. So having your blood pressure checked — hypertension is one of the biggest factors. If you look at kind of healthcare economics, putting a dollar into treating

[7:42] hypertension makes a huge difference downstream from hypertension and all the things that it can cause — not only heart disease but strokes, things like this. So making sure that your blood pressure is well controlled, your blood sugar, your cholesterol being one of those factors too. So as far as things that you can measure with your healthcare provider, those make a huge difference in reducing the risk of cardiovascular disease. So would you say the most of the heart monitors or blood pressure monitors you get at like Rite Aid or

[8:12] CVS are relatively accurate, close enough so people can check it every week, every month? Yeah. I’d say that most of the monitors do a pretty good job, and as technology continues to advance, you know, you get a drop in price for things that are working pretty well. And so if you’re getting numbers that seem kind of wacky, maybe then see your primary care practitioner and get it checked against that. So that can help to make sure it’s accurate. Yeah. I think that one of the things I

[8:43] found is that a lot of people have no idea what blood pressure means, right? And so they’re like, “Oh, I got some numbers. Great. Good. I got numbers. I got numbers. Means I’m alive, right? When I have numbers.” Yeah. And so how do you explain — because I have my way that I do it, which is probably wrong — how do you explain to people blood pressure? Because it’s not always supposed to be like 120 over 80, which is like the

[9:13] middle of the target. I mean, there’s times when it should be higher, it should be lower. So how do you have that conversation with patients who don’t know much about what blood pressure should be? Yeah. I basically — one of the biggest things I say is we need to look at average numbers over time, right? Because having blood pressure very high or very low is very unlikely to cause you harm like in that moment. It’s really about long-term exposure to especially elevated blood pressure that causes problems. And so, yeah, it’s going to fluctuate and respond as it

[9:44] should. If you’re, you know, running away from a bear, you need to pump up your blood pressure and get it out to your organs so you can escape the bear, right? So in times of stress, your blood pressure is going to go high. You don’t want to have long-term chronic stress because obviously that’s a risk factor that’s going to cause problems. Your blood pressure is going to dip lower when you’re more relaxed, when you’re doing meditation or prayer, something that’s kind of bringing you down — and so you’re going to know that there’s going to be fluctuation and that’s your body responding appropriately. Yeah. Like I saw a guy today who came in

[10:16] and his blood pressure is pretty high, and so the question I asked is like, what did you do right before you came here? Oh, I had three coffees. Okay. Right. So then it’s like, maybe we’re not so worried about the fact that it’s super high because you did some stuff to make it super high. Yeah. And I’m sure for both of you, times when people are in significant pain and you’re trying to treat the pain — yeah, your blood pressure is going to be higher. Yeah. Yeah. What’s the danger of having long-term high blood pressure? Yeah. So basically the pressure is

[10:47] affecting the blood vessels. And so the inner lining of the blood vessels — it’s not just kind of a static thing like a pipe that just sits there and doesn’t do anything. It’s interactive. It’s creating small hormones that are interacting and talking to each other. And so that high stress means that that inner lining isn’t working as well. And it can become calcified and thickened to try and protect itself from the high blood pressure. And that’s part of that process that we call atherosclerosis, or stiffening of the blood vessels, that can

[11:17] happen over time. And that puts them at risk for rupturing or opening up or causing clots to form. Man, atherosclerosis really sucks. Yes, it does. We don’t like it. We do not like it. It sounds like it could contribute to like one of the leading causes of death. Yeah. You know, I think I’ve heard that. Okay. So, atherosclerosis bad. We’re going to make a judgment here. Okay. Yes, we’ve judged you

[11:48] Jason: And we judged it as bad. Kathy: Okay. Okay. Jason: Yeah, I’ll take that. So how do we stop atherosclerosis then? Like, because when my blood vessels get hard, can’t you just go in there and scoop out the calcium or something like that? Because people don’t understand — like, what are my options once I’m into kind of trouble territory. So what do you do for that? Kathy: Yeah. And so there’s kind of like early versus late stage, and

[12:18] you really want to catch it early, of course, because then there’s some more reversibility that we can do. And so you again need to take a step and say, “Hey, let’s look at the landscape of what’s going on for me and get, you know, a real look at what’s going on with my health. What’s my blood pressure looking like? What’s my blood sugar looking like? What’s my cholesterol look like? But even more than that, like what are my habits? Like how am I moving? What am I putting in my mouth?” Like those seem like simple things, but they make a huge difference in what’s affecting your blood vessels there and

[12:48] how you can reverse and turn around those things that are starting. Jason: So why do blood sugar and cholesterol matter then when it comes to that stuff? Kathy: Yeah. So cholesterol specifically — the particles get deposited into the lining of the walls of the arteries, and that’s what can slowly build up over time and then rupture. And that’s what a heart attack is — is when you have that plaque that’s built up and then it ruptures and blocks the flow of blood and then, you know, the classic thing that you see on TV of people

[13:18] clutching their chest and everything. I mean, that’s basically your heart muscle not getting any oxygen and being starved of blood. Jason: So that also sounds bad. Kathy: Also a bad thing. We can make a judgment there. Also not — Jason: Two bad things that we don’t want to happen. Kathy: Two wrongs definitely don’t make a right. Jason: No, we don’t want any — Kathy: Exactly. Jason: Any of those. Kathy: And blood sugar does a variety of things. One of the things it does is it basically can attach to multiple areas. And this is something that one of the labs that I worked in in undergrad studied — advanced glycation end

[13:50] products. Sounds like a crazy term. It’s basically — you have — Exactly. Yep. Yep. So yeah, you age and you get AGEs. And so basically it becomes a very pro-inflammatory state for that inner lining of the blood vessels, again increasing their risk for rupturing and causing more problems that way. Jason: And one of the things about inflammation that I don’t think people know is that inflammation is sticky. And the more inflammation you have, the more likely you are to have some of these things come and like stick to a blood vessel

[14:20] wall or anything like that. Kathy: Yeah. Jason: Yeah. Absolutely. So what are people still getting wrong when it comes to, you know, on the Instagram? What are — what — can you fix Instagram for us real quick? Kathy: I mean, we love Instagram, right? I mean, if they want to sponsor this — Jason: It’s not Wikipedia. Kathy: No, no, no. It’s not. Yeah. What’s out there? Yeah, I think the most common thing that I get, you know, questions about in the clinic is related to like fad diets, right? I mean, I

[14:52] think we all in healthcare get asked about these things. And so they’ll say like, “Oh, but what about, you know, this diet, or I had this friend that did this diet and, you know, they look great and they feel great, so that must mean it’ll work for me, too.” Kind of a thing. And so I, you know, basically have to say, well, let’s — we have to just look at the data that we have. And the data is that the Mediterranean diet is probably the strongest data that we have for

[15:22] long-term cardiovascular health. And that’s, you know, broken down simply, whole food, plant-based diet. Again, decreasing that inflammation, decreasing excess amounts of processed foods, things like that. I mean, that’s the simplest way to put it. Jason: So by Mediterranean diet, don’t you mean the carnivore diet? Kathy: Indeed. That’s another common one, right? Yeah. Exactly. So yeah, I mean, you just have to say, hey, look, you know, the other thing is you have to just look at

[15:52] where is someone getting this information? They’re getting it from someone who’s trying to make a lot of money by promoting this specific way of eating, when we just have to go back to the basics of kind of what makes sense. Jason: Yeah. So what you’re saying is — keto — were you gonna say keto is bad? Kathy: We can’t make that judgment. Jason: Am I going to say that? Kathy: Yeah. Jason: So I don’t think that keto is bad. I think that insanity is bad — is what it is.

[16:22] Because I mean, really, it goes back to like your blood pressure thing, you know? It’s like you can eat carnivore for, you know, a week and you’re going to be fine, right? You can also eat ice cream for a week and you’re going to have a great time, but you’re not going to — I mean, the thing is that it’s really about your habits over time. And that is where some of the fad diets really fall down, is because they’re not habits over time. They’re like short sprints of “I’m going to do this,” and you’ll see some

[16:52] physiological changes, but you need to go back to just fueling the machine properly. Kathy: Yeah. Like when people are like, “Oh, carbohydrates are bad.” And it’s like, well, then why is our physiology tuned to deal with carbohydrates? Jason: You know, what you’re doing with carbohydrates might be bad, you know, but it’s like — we tend to oversimplify things. And you talked about how there’s some people that have their ulterior motives where it’s like, oh, they’re trying to make money off of this, and

[17:22] I think that really used to be the case when you had like books and stuff like that where it’s like, “Hey, get my diet book.” Like the Atkins diet. Kathy: People still come and talk to me about — I still get questions about that. I think the environment that we live in today is even a little bit different, where people don’t have to stand to gain money, because like you get people that are just meaning well and they just don’t know enough. They don’t know that — that definitely happens as well. Jason: Like it’s that Dunning-Kruger curve. Have you seen that? So it’s like when

[17:54] you know a little bit, your confidence is super high. So high that I’m going to go on Instagram and I’m going to tell everybody what I know, right? But then during your — what was it, 45-year journey of becoming an internal medicine doctor and a cardiologist — you, the first place you go is way down here where it’s like, oh yeah, I don’t know anything. I don’t know anything. How do I not know all this stuff? Yeah. And then you start to kind of know the difference, and then when you’re over here where it’s like you do

[18:24] know some stuff, then you get to look back and just be really pissed off at the people that are up here trying to tell everybody this is how it is. Gosh, I can’t even — and you can’t even explain to them why they’re wrong, because when you do that, they’re like, you’re part of the system. You are. How dare you? Deep state. Yeah, deep state. Yeah. Let’s go back to Atkins for a second. Did he die of a heart attack? I don’t know. I feel like he did, poetically. He probably did. I think he did, actually. We’ll Google it sometime. Yeah. Hey, Siri. No kidding.

[18:54] That’s right. Yeah. Well, we’ll just go to Wikipedia, which is, you know, one of our sponsors. Actually, with Wikipedia, it’s like a reverse sponsorship. I give them like nine bucks a year or something like that. You know, they always put up that yellow box. Give us some money. Give us some money or we’ll take away all the knowledge. Right. That’s what I read. But don’t take it away. So, should we bust some myths? Let’s bust some myths. Okay. Sounds good. Red wine is heart healthy. Yay or nay?

[19:25] So, yeah. Again, from the data that we have, red wine isn’t all that it was propped up to be. Well, they’ve actually even come to some consensus that alcohol is a carcinogen. So, it’s like — I tend to tell people alcohol, no go. I mean, there are heart rhythm disorders that are increased with alcohol. And then, you know, the things that they talked about, the polyphenols and things like that —

[19:56] pretty small amount, actually. And so if you look at those kind of anti-inflammatory — resveratrol — so I mean, I tell people, go get some berries. Those have a lot of anti-inflammatory, antioxidant properties. And you really don’t need the alcohol. So it maybe was the grapes all along. It was — dang it, I love grapes, so that’s good for me now. Is this a myth? This is one I haven’t heard. Running is bad for your heart. I heard that. Is that a myth? I can think of a way that it would be. Actually, I want to hear what you have to say. Yeah. So I would say in general,

[20:27] running, good for your heart. Now there is some correlation with those really ultra marathoners that kind of really hit it hard and are always hitting it hard for, you know, years and years, sometimes even decades. There’s a link to some heart rhythm disorders like A-fib. A-fib has some — also supraventricular tachycardia, so fast heart rhythms. So there’s certainly a link there. Are people going to die earlier from that? Probably not, but there are some adverse effects that can happen.

[20:57] So I usually tell people moderate intensity exercise tends to be better. You can even do some interval training with some high intensity in there, too. But that long-term cardiovascular — you know — ultra marathoners kind of things. Yeah. So it’s like a 99th percentile. Yeah. This is like the ultimate of the ultimate — like there’s some risk. Yeah. Yeah. Like — gosh, there was this book, I can’t remember the name of it, but really popular book, and the guy, he was like a barefoot runner, he ran all over the Andes and everything like that. That guy

[21:28] ended up dying of a heart attack because of A-fib. And so — but yeah, it’s true. It’s like — you know, if you’re sitting on your mom’s couch listening to the PTCH Podcast, ‘cause that’s where most people listen to the PTCH, I guess — in the basement on your mom’s couch, right — you should probably run. You should run, right. Don’t just start running. Yeah. If you’re listening to this while you’re just about to finish an ultramarathon and you’re thinking about hopping in your car and driving up the street to the next ultramarathon. Yeah.

[21:58] Yeah. Maybe you should think about laying off a little bit. Yeah. Give yourself a break. Yeah. All right. What about this one? Cholesterol doesn’t matter anymore. Yeah. Yeah, there’s certainly — again, like we talked about, whether it’s fat diets or it’s, you know, the swing of kind of what we’re focusing on, what macronutrient we’re focusing on. There is a little bit of a swing away from carbohydrates, like we talked about, and people are like, protein, protein, and maybe even, you know, cholesterol doesn’t really matter. It still does, certainly, and I would say

[22:29] that sometimes it gets overemphasized, but it’s still an important risk factor. If your cholesterol is high and remains high over the long term, you’re going to build up plaque in those arteries, and that can cause a problem down the road. Right. Because dietary cholesterol has a limited effect on our overall cholesterol — well, I should say a temporary effect. Right. So if I eat a meal that’s high in cholesterol, my blood cholesterol is going to go up, but I’m going to tend to clear it. But if I’m doing that all the time,

[22:59] then you’re exposing your body to that. It’s going to keep absorbing those, because, hey, it’s nutrients. Your body’s looking to fuel itself. It’s going to say, “Hey, here’s what’s available. Let’s bring it on.” And if it’s always there, then, oh well, that’s what’s going to be available and go floating around there. Let’s go store it in your heart. Yeah. I got a place for this. Yeah. Wait a second. Come with me, cholesterol. There it is. Yeah. But you know, I think sometimes people get a little hyper-reactive to even the word cholesterol, and they don’t realize that the two main places we get cholesterol are from our

[23:29] liver and from our brain. And if it’s in the brain, it’s not all bad. It’s like one of the main structural molecules for our brain. If your cholesterol goes too low, which is extremely rare, then you start to get dementia and things like that. But again, if you’re listening to the PTCH Podcast because you’re in your mom’s basement — we’re going to lose a lot of listeners. Yeah. They’re going to be like, “He thinks that I’m just some lazy guy.” No, we know you. You’re fit. You’re super fit.

[24:00] You’re running your ultramarathon while listening, right? Most of you are. There’s a couple people that are just sitting in mom’s basement, but yeah. So it’s like we can always find outliers, but I think that what you’re saying is like that kind of right down the middle advice that we’ve been hearing for a long time that people just choose not to follow — that’s probably good advice. Yeah. And if you look again, if you look across, if you take samples of people’s cholesterol, the majority of people are going to have cholesterol that’s too high, higher

[24:31] than it needs to be, and they need to bring it down. And the first step in that is diet, lifestyle, exercise, things like that. Is that the American diet? Would you say — when you say most people, are we talking mostly here? Yeah. In Western Europe and in America, there’s certainly higher amounts — too high — of processed foods, fattier foods. Yep. Alcohol use. Yeah. Absolutely. All those factors certainly. Mhm. Okay. Pure butter diet.

[25:02] That diet. That’s one. Oh, I lost so much weight. Yeah, it was great. I didn’t. Okay, I have to say this about weight loss because then it segues into the next question. Yeah. I had a patient who came in and I was asking about medications he’s taking and things like that. And you know, we ask about like how much you weigh, how tall are you, all those sorts of things. And he’s like, “I’m trying to lose some weight.” And so he’s like, “I’m using meth for that.” Methamphetamines. I said, “Yeah, there’s

[25:33] nothing better for weight loss than that.” Again, this is an entertainment show. That’s not my advice. So I was like, “Wait, like you’re doing drugs.” “This is your strength.” Yeah. And so he’s like, “Yeah.” He’s like, “It works really good.” I’m like, “If you want to lose teeth — like if you’re trying to cut down on tooth weight or something — but no.” He’s like, “Yeah, I use it. I’m not addicted.” Of course, I’m not addicted, but I’m just using it to cut some weight. It’s like, “Well, how much weight have you lost?” He said, “I’ve gained six pounds.”

[26:03] Yeah. Yeah. We had exactly one visit. Yeah. Somehow we didn’t align. We didn’t align in terms of our healthcare philosophies. And that’s also very bad for your heart. Is it bad for your heart? Oh man, I didn’t know this. Okay. Can’t be good. Can’t be good. Yeah. Guys, we’re going to put that in the — we’re going to put that in the bad column, too. We’ve judged you. You’ve been found lacking in heart health. All right. Okay. So if you’re thin, your heart must be healthy.

[26:33] So that is — it’s not necessarily true. I mean, there’s a lot of factors that can make people thin, right? So if you think about it, some people are chronically ill, there’s chronic inflammation and things that are going on, or certain habits — smoking can make people lose weight, right? Smoking cigarettes, tobacco use, meth. Yeah. Well, do you lose weight on meth? Well, he didn’t. He very didn’t. There you go. So there’s certainly factors that can

[27:03] keep your risk high, and so yeah, it doesn’t necessarily mean that you’re going to be heart healthy. Yeah. Okay. Is it better to be thin though? So you definitely want to have a healthy weight. That’s important. Yeah. And there’s a lot of information going around about these new drugs that can help you lose weight. And certainly some of them have some cardiovascular benefits. So we know that there’s a correlation there. I saved this for the PTCH Podcast. Oh, you did? Oh my gosh. Exclusive secret. Everybody

[27:33] is gonna start leaning forward in their seat. Yes. Tighten up the shot — tighten up the shot. What is the secret to how you will lose weight? There’s one word. Luck. Exhale. So how do you lose weight? What’s the method by which you lose weight? Right. Yes. Exhale. I think Jason’s picking up what I’m putting down, so I’ll let him pick

[28:03] it up. Okay. So they wanted to know — when you lose weight, where does it go? Like, are you pooping it out? Are you peeing it out? But no, the majority of the weight that you’re losing, you’re exhaling, because the carbon — carbon dioxide — that’s where, you know, the things that you’re taking in, those macronutrients, carbon-based, right? It’s carbon that’s going in there. So you’re losing your carbon by exhaling it out. Carbon dioxide. This makes so much sense. So my son Griffin, he just started driving this week. Yes. Scary.

[28:33] I know. Stay off the sidewalks, ladies and gentlemen. So, and I just got to point out my family loves it when they get call-outs on the PTCH Podcast. Oh, they love it. They think it’s — they actually specifically asked me not to do this anymore. So — no. So we’re driving, right? And Griffin’s driving for the first time, and my method of teaching kids to drive is you’re going to verbalize everything — like you’re going to tell me, “I’m looking at this, I’m turning here, I’m signaling, my foot’s over the brake,” you

[29:04] know, whatever. And so he’s sitting there, and it’s a rolling conversation, but with him more than any of my kids I’m like, “You need to breathe or we’re all going to die,” right? Because he’s over there turning blue. And so now I’m going to say, “You need to — wait, while you’re driving.” Right. Exactly. Exhale. Let that carbon go, son. Yes. Let it out. Oh yeah. That’s such a good point. I like that. Yeah.

[29:34] Kathy: Well, interesting. Jason: What about this one? One more myth. Kathy: You don’t need to worry about your heart until you’re older. So, like until you’re exactly my age, you don’t need to start worrying about— Jason: Exactly. It’s like, what number are we going to put on this? Right. When should you start worrying? So I have some information about this. The answer is no. You shouldn’t wait till you’re older. Obviously there’s lots of things you can do when you’re younger and throughout your life to keep your risk as low as possible, because some of the studies

[30:04] that were done — you know, they did autopsies on young military soldiers. Kathy: Yep. And in these autopsy studies they looked at their aorta and their other blood vessels and saw that the first parts of plaque that were starting to develop were happening there in their early 20s. And so we know this is a process that starts very early on. And so the approach to work on systemic factors of, you

[30:35] know, what foods are available for people and education about what foods are healthy, and starting that early, and routine exercise — things like that also early on help to prevent decades and decades later cardiovascular disease that then you actually have to worry about from the standpoint of dealing with the effects of it. Right. Jason: Right. Kathy: So— Jason: Okay. So you’ve got to start early. Kathy: Too late. Jason: Dr. Early tells you you’ve got to start early. Kathy: Early says start early. I like that. Jason: All right. So, what are the

[31:06] screening tools that everybody should be using in terms of knowing how healthy their heart is? Kathy: Yeah. So I think the big ones are, you know, know what your blood pressure is, know what your cholesterol is. I mean, there are guideline recommendations that you should even screen kind of young children, specifically to pick up a genetically related very high cholesterol that can put your risk of having a heart attack in your 20s or 30s. I mean, that can happen. And so that’s why you want to have at least a screening to check for that, so

[31:37] that you can act on it if it’s some genetic thing that you’re very highly predisposed to. And then yeah, again, blood sugar — things like this are all important as far as screening. But even regardless of those screening things, everyone should get information about, and from the PTCH Podcast, know that you should be moving and putting healthy things into your body Jason: from the time you’re young. Kathy: Got to take care of it. Jason: Yeah. Okay. I know that there’s — it’s not a new test, but I feel like it’s getting more

[32:07] play in the media — called the calcium— Kathy: Yeah. Jason: The CAC. Kathy: Yep. Can you talk about that? Kathy: Yeah, it has a role, and I think there’s maybe it’s being utilized in places kind of beyond where the data has shown it has benefit, but it is useful. So a coronary calcium score is basically a CT scan. It’s actually fairly low in radiation — about a millisievert of radiation, which is similar— Jason: Yeah. Yeah. Exactly. Kathy: Yeah. We were talking about millisieverts —

[32:39] I don’t think — I mean, if you’re doing kind of a long flight, it’s somewhat similar to that. So it’s not a lot of radiation. It’s very quick — it’s seconds. You just take one deep breath and then they do the scan, and it’s to visualize calcium, which is advanced plaque that is already present in your heart arteries. And so it can be useful in a few scenarios. So if you have cholesterol that’s kind of borderline, with a risk score — if you take different factors

[33:10] about your health and your health history — that risk score puts you in an intermediate risk. Then you want to say, “Oh, is this high enough risk that I should be starting medication therapy, or should I continue aggressive lifestyle?” Jason: Or should I build a time machine, Kathy: go back 20 years, Jason: slap myself around a little bit? Kathy: Drop that chip. Drop it. Jason: That’s right. Kathy: Drop those chips. Jason: Absolutely. We should go with that one. And so if your calcium score — again, in this specific scenario — then a

[33:41] calcium score may be helpful in saying, “Oh, you’re at a higher risk because your calcium score is high.” Okay? And so we should probably start medication therapy in addition to the other things that are recommended. Versus if your calcium score is zero — there’s pretty good data that if you have a zero calcium score, over the next 5 years, and some studies even out to 10 years, your risk for a heart event is very low. And so you can continue to be aggressive about lifestyle management, and you have an overall pretty low risk. And that’s, you know,

[34:11] depending on your baseline risk— Jason: you just got to look out for things like buses. Runaway buses. Kathy: Yeah. Cougars. Oh gosh. Jason: That’s been going around here in Corvallis, right? Yeah. So you’re talking about medicines, and I feel like recently statins are getting a bad rap with influencers. Kathy: Yes. Jason: So talk about statins — good and bad. In my case, I do ask some of my patients, when they do have Kathy: systemic pain — are you on a statin? Did you just start a statin? Because there

[34:42] are some that cause muscle pain. And so I usually just ask them that. So yeah, can you talk about statins? Kathy: Totally. Yeah. So statins — one of the probably the most studied medicines in the world. So that’s good in the sense that we know that there are benefits — clear benefits — and we are aware of potential side effects that can happen, right? Overall, statins for people that are in the appropriate risk group category are very beneficial in reducing their risk of a heart attack, right? We know that

[35:12] very clearly. And if you have side effects, then work with your practitioner. There may be alternatives — either an alternative statin or a different medication that can help. And so yeah, in the influencer arena there’s a lot of people like, “Oh, statins — they’re terrible,” and, “This deep state — people are just trying to get you to take the statin,” or whatever. And I would say— Jason: because they’re such high-ticket items. Yeah. How much does it cost? $4 for a month? Or maybe even more. Kathy: You know, $4 spread out over enough people— Jason: they’re going to get you.

[35:42] Jason: Yeah. Kathy: Yeah. Well, and you know, like I see what you see in terms of people who have musculoskeletal pain that’s related to long-term statin use. It’s not like if you take one atorvastatin like, “Oh my gosh, all my joints.” That’s not how it works. It’s like over years. And a lot of times I’m having people supplement coenzyme Q10 because — there are some statins that will suppress your body’s ability to make that, and then that can lead to that. But I mean, then you’re taking the coenzyme

[36:12] Q10 which also has heart health benefits, right? And it’s just like, you know, it’s one of those things where it’s like, are there side effects? Yes, because there’s side effects to every treatment, to every medication, and statins are no different. But there’s smart ways to kind of handle those and balance them out. And then when you look at the overall Jason: risk versus reward, Kathy: yeah, Jason: that’s what you have to take into account. Everything has trade-offs. Kathy: Yeah. It’s like — so seat belts, you know,

[36:42] and there’s people like, “Oh, I’d never wear a seatbelt. If I’m wearing a seat belt and my vehicle catches on fire and the seat belt fails and I get stuck in it, I’m going to burn to death.” It’s like, okay, I have literally flown out of a vehicle as a child and, man, if I could build that time machine, I would have told, “Get your seatbelt on, dude.” Yeah. So, it’s like it’s a seatbelt thing. It’s like, you know, is it best to need a statin?

[37:12] Probably no. But could you use one? Jason: Well, yeah. If you could use one, you could use one. Kathy: Yeah. Jason: So, Kathy: that’s why it’s individual risk. You know, you have to kind of determine and take those factors into play. There are certain risk calculators that are out there that are based on, you know, good large observational data, and take that and discuss with your provider if that’s the right thing for you, of course. So, Jason: yeah. Kathy: Yep. Jason: Definitely. Kathy: So, I alluded to supplements. Are there supplements that you think are like, “Yeah, people should be taking this because it’s going to be really good for their heart health.”

[37:42] Yeah, I’d say as a general kind of across the board, I don’t say like there’s one specific supplement that’s, “Hey, that’s right for you.” Usually the supplement that I say is an extra apple or an extra vegetable. That’s usually how I put it. Jason: Supplement some fruits and vegetables. Take that fruit and vegetable flavor — that PTCH-branded CoQ10. Kathy: Yeah, we’re just going to Jason: not going to just push.

[38:12] I’m going to call and get our white-label supplement company. Kathy: Kyle’s going to be a big seller. Jason: Yeah. Shoot. Kathy: All right. Well, I think it’s probably time to play a game. Anybody down for a game? Jason: I’m always ready for a game. Ready for it? Kathy: I have the brown paper bag of game pieces. So, this is going to be — I can’t remember the name of the game, but it’s like you give clues and somebody’s trying to guess, and like I can’t

[38:43] remember. It’s killing me. I’m going to remember right after we get done, but yeah, that’s basically what we’re going to do. Okay. Now, you remember at the beginning of the episode, I said that the answer to everything is Jason: heart. Kathy: Heart. Very good. So, that is what we’re doing. We’re going to take turns giving Tyler clues. Okay. And whoever gets Tyler to guess the right thing the most is the champion. Jason: Of the world Kathy: according to Queen. In this bag is the clue. Jason: There’s the clue. Kathy: Is that the only word I can say? Jason: No. No, you can’t say that word. Okay.

[39:15] You can’t say that word. Kathy: Oh yeah. Jason: What is — Kathy: But you’re trying to give him a clue. Just one clue. Jason: He can only say one word. Kathy: No, you can say as many words as you want, right? But just one clue and he gets one guess. Jason: Okay. High stakes. Kathy: All right, like just to show how it’s done, I’ll start. Does that sound okay? Jason: Yeah, that’d be great. Kathy: All right. Here we go. Okay. If you have somebody that you really feel affectionate towards, this is a nickname that you might

[39:46] call them. Oh my goodness. Okay. A nickname for someone you feel affectionate towards. And remember, they all have the same word in them. Tyler: Oh, heartthrob. Kathy: No, we’re looking for sweetheart. Jason: Yes. Okay. Kathy: Now, I don’t cheat for her just ‘cause, you know, we don’t want the nepotism thing coming through.

[40:16] Jason: Okay. All right. Okay. What? Oh, okay. This is a candy that you give out at Valentine’s Day. Tyler: Oh, I want to say sweetheart, but that’s right. Um, oh, what are those little — they’re little heart-shaped. Kathy: Mhm. Tyler: What are they called? Jason: And what are they on? What are they? You hand it to somebody if you want to

[40:46] have a — Tyler: take a guess. Jason: have a — Tyler: Oh my goodness. Jason: something with them. If you want to have a talk, if you want to have a talk with them, Kathy: instead of a talk, you have a — Tyler: I’m just totally — Kathy: What are we doing right now? We’re having a — Tyler: Okay, Kathy: chat hard. Tyler: That wasn’t it? Conversation. Kathy: Oh, conversation heart. Tyler: Cardiologist, are you — Kathy: I know. I can’t think of the candy. Jason: That’s a hard clue. I should have given you a better clue.

[41:16] Kathy: Okay. Somebody is really kind and generous and like giving and just like a really good person. They have a — not going well. I know. I have the same — I have — Jason: Okay. They’re kind and generous. They have a tender heart. Tyler: Oh, close. Heart of gold. Heart of gold. Tender heart. Kathy: I feel like there’s many words that are similar. Hey, we got the easy one. The easy ones are the only ones left in the bag. Here we go. All right. Now we’re

[41:46] setting ourselves up here. Okay. Okay. If I make a decision to do something else — if I make one decision and then I decide I’m not going to do that, I’m going to do something else — so I’m going to have a — has to do with the heart. Tyler: Mhm. I want to say like a split heart or a something similar to that, but I can’t think of the heart. Jason: Change of heart. A

[42:16] Jason: Change of heart.

Kathy: Change of heart. Okay. Trying to make it one word. The phrase. Okay. There’s a phrase. Yeah.

Jason: Here we go.

Kathy: Yeah.

Jason: If I’m really in love with this girl and she decides to go out with another guy instead, even though like I was really in love—

Kathy: Broken heart. No.

Jason: I will be—

Kathy: Go ahead. Brokenhearted.

Jason: Broken heart. We’ll take it. Heartbroken.

Kathy: Heartbroken. Broken. All right. Now we’re in the game. Now we’re in the game.

Jason: All right. Better clues. Whoops. Okay.

Kathy: Here, I’ll take this one. Oh, if this person’s really

[42:48] mean and you think that person is so — it has to do — and it’s not warm. They’re not warm.

Jason: They’re cold-hearted.

Kathy: I need to get better. I had to get better with that. This is a movie

starring Mel Gibson and a kilt, or—

Jason: Braveheart.

Kathy: I say you start going down the movie route, it’s not going to go well. Okay. But it worked out. Okay. God, how many you got in here?

Jason: A bazillion. We’ll just edit to the ones that we

[43:18] really want.

Kathy: If we can make you look like you got them all.

Jason: That’s right. So, when your daughter comes to you and says, “I want another strawberry, daddy,” she’s pulling on your heartstrings.

Kathy: No.

Jason: Very good. That’s a good one. Which — actually, that’s actually a piece of anatomy, right?

Kathy: On the inside of the heart.

Jason: Yes. Okay. Man, that story was so sweet. It was — like, one way that you could think of it is that it was very

[43:52] Kathy: heartwarming.

Jason: There we go. Yeah. Turning into — yes, I know. Yes.

Kathy: Yeah. A little action there.

Jason: All right. Oh,

Kathy: we’ll do one more each, ‘cause I think we know that I’m winning. This is the — this is the central idea.

Jason: So, it is the — the one thing we’re going to talk about. I need to get to the bottom of this. So, this is the

[44:22] Kathy: Oh, it’s also the central idea. It is. It’s the title of the episode.

Jason: The heart of the matter.

Kathy: Very good.

Jason: Okay. I love it.

Kathy: Very good. Okay. Well, I think that I started — so that should be our last one. Okay. Appropriate. I said he did good. He warmed up to it. Got warmed up. We’re going to blame the clue givers, right? Because you were our guest here. So,

Jason: all right. Well, let’s kind of get to our part where we do our takeaways, right? Our final thoughts. So, I think let’s do

[44:55] our takeaways first and then we’ll let him kind of wrap it up with like the one thing that people should know. Like if everybody’s just like, I’m just going to jump to the last two minutes of this podcast — you know, this is what I want to tell them. So I’ll start with my takeaway, and I think that the thing that stood out the most is that most of the good advice out there is just good advice. You know, just do the things, people. It’s like — you know, if this seems like something where it’s like, oh yeah, that’s not good for your heart, it’s like

[45:25] Kathy: duh, right? So just do those things and start early.

Jason: Mm-hmm. Yeah. There’s no quick fix.

Kathy: Mm-hmm.

Jason: And there’s no supplement — except a supplement like — I’m going to supplement an apple. How about you supplement maybe a carrot or a habanero

Kathy: instead? I like that.

Jason: Yeah.

Kathy: There’s no — what supplement would you use? How about another apple?

Jason: Yes. How about a bushel of apples? Right.

Kathy: Yes.

Jason: I like it. I like it. All right, Dr. Early, give us — what’s the one thing

[45:56] to save somebody’s life right now?

Jason: Yeah. I think my takeaway is

everyone can do something to help their heart — if they have coronary artery disease, heart disease already, or if they don’t have heart disease, there’s something you can do to help your heart today. And that’s mostly with how you move and what you eat.

Kathy: Love it.

Jason: Pretty simple.

Kathy: That’s good. I like it. So,

Jason: excellent. Well, that’s our episode of the PTCH Podcast. Thank you so much for being here.

Kathy: Thanks for inviting me. Thanks for taking time out of your day. Good stuff that I think will make a difference for

[46:27] a lot of people. Maybe saved a life today. Maybe saved a bunch of them. Hopefully, right? So, as always, this is the part where we’re going to open our hearts and we’re going to beg you — literally beg you — to subscribe to this podcast, y’all. Yeah. Um, we’re doing really well and if we get to certain levels in terms of involvement, we can actually offer more like subscriptions and things like that. So, it’s going to be dope.

Kathy: Yeah.

Jason: Yeah.

Kathy: Hit that subscribe button. Yeah. Hit it. Hit it. Right. Like, follow,

[46:57] comment.

Jason: Come on. Comment. Send us questions.

Kathy: Yes. If you have questions about like hearts and like where they are and how they work — is meth really good for you? — leave it in the comments. I’ll make sure that Tyler gets those. So,

Jason: yeah, maybe we’ll have him on again. Answer your questions.

Kathy: Yes, totally. Absolutely. If we get enough of those questions, we’ll get Tyler back on for Q&A. Get him to talk about feet and hands and stuff.

Jason: Yes. Yes.

Kathy: Oh, but there is one more important thing we need to cover.

Jason: What’s that? There’s no “I” in PTCH.

[47:28]