Can Heart Disease Be Reversed? After His Own Heart Attack, This Surgeon Changed Everything with Dr. Jeremy London - Transcript

Dr. Mark Hyman
You talk as a cardiovascular surgeon about how you wanna make, you know, heart disease the number two killer in the world, not the number one killer. But the iron is you had a heart attack. What are the factors that people should be paying attention to? Because this is really a preventable condition. If a farmer looks out on his fields and all of your crops are sick, where's the

Jeremy London
first place they look? It's in the soil. Being mindful of what you're putting in your mouth, focusing on a whole foods diet, limiting ultra processed foods, limiting saturated fats in your diet, you gotta be so careful these days with the more extreme choices because you always have to be careful what you're substituting things Right. For because it's something that we have such control over. Yeah.

Dr. Mark Hyman
Jeremy, it's great to have you on the podcast. Thanks for coming all the way from Georgia. Thank you. You know, your story is quite compelling. You you know, we're just chitchatting a little bit before.

You're you're a cardiovascular surgeon. You do bypasses and and you, you know, fix arteries and do major big surgeries. Let's say cardiovascular surgery and brain surgery are like the two top surgical specialties that, you know, are really tough and hard to learn and and that take a lot of time to become an expert at. And somehow, in all that process, you discover that you were kind of treating things at the wrong end of the stick. You were kept seeing over and over cases coming back over and over with bad habits that they never changed and needing another surgery, another surgery.

And and you did that for a while, but it it sounds like you had your own epiphany in medicine where you realized you might be not thinking about things the way you should, and you had your own health crisis. You talked as a cardiovascular surgeon about how you want to make, you know, heart disease the number two killer in the world, not the number one killer, which is a great aspiration. But the iron is you had a heart attack. So tell us about that. And, I mean, you look healthy.

You you seem healthy. I'm sure you don't smoke. I'm sure you ate pretty good and got fit, exercise, like and you're kind of the, you know, the kind of person you wouldn't think would get a heart attack. But here you you were, and you had a heart attack. And that's kind of what I wanna get into a little bit on the show, which is why are so many people who seem and look healthy getting heart attack?

Jeremy London
It's an ongoing question for sure. And to make it even more egregious from from my standpoint, the time frame between making that shift of treating the endpoint of disease and when I actually had my event was another ten years later. So I was already very dialed into, you know, really, really working on solid lifestyle choices, and I thought that I was doing a really, really good job. I really did. And what I have come to learn is that none of us are immune to cognitive dissonance.

We know better, but so often, we just don't do better. It can be simple things. You know, the smoker knows they shouldn't smoke, but they continue, you know, you shouldn't reach for the chips, but it's what's convenient. You're tired. You deserve them.

However, you defend that, and no one knew better than me. Yeah. The signs and the lead up. I mean, I lived it. I taught it.

I dealt with it. Yeah. And like I said

Dr. Mark Hyman
What did you miss?

Jeremy London
Intellectual honesty, and I fell deeply into that gap of knowing better and not doing better.

Dr. Mark Hyman
And what were the things you weren't doing that led you to that point? It was only two years ago. Right? Was like

Jeremy London
It was three years ago. Yeah. Well, it it really it didn't hit me until after the event because it was really in the midst of it that I fell kinda first tripped into the space because I woke up one morning with what I thought was just reflux. Heartburn. Heartburn.

And I get up early. I was pacing around the room, and my wife's like, are you okay? I'm like, yeah. Yeah. I get a little reflux.

She goes, you don't look like you have reflux. I'm like, seriously? You're gonna tell me

Dr. Mark Hyman
I'm a doctor.

Jeremy London
That I don't have reef I mean, come on. So I sat down. I read for a little while, felt fine, took the dogs out for a walk. It was December. We get a quarter mile from the house.

It was cold outside. I'm peeling my clothes at this point, sweating. And she looks at me. She goes, reflux. I was like, yeah.

You know, it's just really she's like, okay. So we go back to the house.

Dr. Mark Hyman
Is she a doctor too?

Jeremy London
She is not. She's just an incredibly brilliant woman. We get back to the house, and not to be overly graphic, I sit down on the toilet. And within thirty seconds of sitting down, symptoms went away. And I immediately was like, no.

Exertional symptoms, relieve with rest? No. Not me. It's not possible. Couldn't be.

Could not be. So at that point, I did what someone who is the poster child of cognitive dissonance would do, and that's explain it away. And through the course of that entire day, I would go upstairs, have it come back a little bit, and I'd sit down and it would go away. Oh, yeah. That evening, my family went back into town, and I was with my youngest son.

And we were out in the woods that evening, dark. He's 14 years old, quarter mile from the truck, no cell service, and I go down on my knees with significant chest pain. Like, I knew what was going on. And my son's like, dad, are you alright? Like, what's going on?

I said, oh, it's just reflux. He goes, you can't walk around when you have reflux? I was like, oh, another smart one in the family. So I pull myself together. I get we get back to the truck, and I drive home.

Dr. Mark Hyman
Oh, man. Oh, yeah.

Jeremy London
I'm gonna lay it all out for you. I didn't say I was gonna be proud. So I get home. I take a beta blocker and an aspirin, and I go to sleep. Oh, wow.

Wake up the next morning.

Dr. Mark Hyman
Not the right decision, but good thing you woke up.

Jeremy London
I share it. I share it hoping that others will do. Sometimes you need an example of what not to do.

Dr. Mark Hyman
They call they call know, they they usually say the first symptom of heart disease is sudden death for fifty percent of people, and and I've had peep may people I know who's had that experience. And you're lucky you had some warning signs. They call it the silent killer, but it's in your case, it wasn't so silent.

Jeremy London
And about five or six years prior, we had a good friend who was a radiologist at 48 that that's exactly what happened to him. So it's not like I'm not aware. I woke up the next morning. We live in a home with staircases, went down to make my coffee, came up, same symptoms. So then I had to come clean.

And my wife says, this has been going on since last night. Why didn't you why didn't you say something? She said, well, you would have made me go to the emergency room. And she's like, well, that's what you do when you're having chest pain. I said, well, I didn't like the cardiologist that was on call that night.

She goes, kidding me? She's like, you're friends with all of them. Yeah. And then she stopped for a minute. I always kind of get goosebumps.

She looked at me and she said, that is the most selfish thing you've ever done to me and the boys. Yeah. And that really that hit hard, as you might imagine. And I said, I hear you. I am terribly sorry, but can we go can we go to the hospital?

So I called one of my buddies. He's like, there's no way, man. I said, I'm telling you. I said, I've tested it pretty good here. So he's like, come to the office.

I'm like, oh, I don't think that's a good idea. He goes, no. No. No. No.

Walking around the office. He took one look at me, and I was in the cath lab and, you know, one stent in the right coronary, you know, and and I was fine. So I wouldn't let him sedate me, you know, for the procedure because I wanna know what's going on. So he passes the wire across it, which occludes the coronary.

Dr. Mark Hyman
And you had severe chest pain.

Jeremy London
EKG changes, severe chest pain. And I'm like going, hey, man. Hey, man. He pulls the drapes, and he goes, I need you to shut up so I can get this done. Sedated me.

Got it done. Went out and told Tracy, I dream of stenting cardiac surgeons, but doing anything to your husband was an absolute nightmare. She goes, oh, I'm sure. I'm absolutely sure.

Dr. Mark Hyman
So so what were the things that you did that led up to that? Because you obviously have been in this field. You're aware of heart disease. You're not doing the normal bad thing.

Jeremy London
It's really only in retrospect now that that I was able to really unpack all of that for myself. Because the immediate response was, I do I have a stressful job, And certainly a component, but not enough to really lay your hat on. The second was after twenty five years

Dr. Mark Hyman
And you're still doing cardiac surgery.

Jeremy London
Oh, yeah. Yeah. I went back to work that that Tuesday after. I would as soon as they would let me. So, you know, my sleep was totally out of whack.

I was on DEFCON one all the time, so I was like, okay. That's certainly a risk factor. If if your sleep's off, everything's off. Certainly a risk factor. Well, it really wasn't until we started with the platforms, and my son Max was instrumental in all this.

You know, he said, dad, wouldn't it be interesting if, like, you put on a CGM? Wouldn't that be interesting? I was like, Max, if I need to show you what a great job I'm doing with my diet, with my exercise. That's fine. She's like, dad, I don't care what it shows.

I just think it'd be cool, like, show people, you know, the process and look at your numbers. Yeah. Yeah. Within forty eight hours, it became very clear that my baseline glucose was unacceptably high. Checked the a one c.

I was 5.7. Flipped into a, you know, a fasting insulin level, which

Dr. Mark Hyman
Which was what?

Jeremy London
I'm gonna I'm embarrassed to give you the number.

Dr. Mark Hyman
Come on.

Jeremy London
I'll say it was I'll Come on.

Dr. Mark Hyman
Give it to me.

Jeremy London
40.

Dr. Mark Hyman
No. 40? 40. Seriously. I mean, just for those listening, it should be less than five.

Life of range is 18, which is, I think, terrible. 40 is is high. You but

Jeremy London
you were what? You had a little belly or what? You know, not a lot of sugar. Really? No.

Bread, pasta, rice? Not really.

Dr. Mark Hyman
And So how come it was so high?

Jeremy London
I don't really have that answer. But I definitely retooled my diet as a result of it. You know, using the CGM, I was able to kinda see, like, and I added ten minute walks after meals. I tried to add more cardio, back off on some of the strength training. I used to do a lot of endurance work, and that made a difference for sure.

My a one c came down to 5.5. We got the, you know, the insulin level down to acceptable ranges. So more risk factors than were obvious. Again, look healthy Yeah. But you don't know until you know.

And we'll add the coup d'etat on top of it, which would be an APOB of one eighty.

Dr. Mark Hyman
Wow. And you had checked it or hadn't?

Jeremy London
LDLs oh, LDL C only, which was mildly elevated around my event. Know, mildly my triglycerides were a little high, which is in line, of course,

Dr. Mark Hyman
with the the Insulin resistance.

Jeremy London
Insulin resistance and all those things, but not shockingly so. You know, it wasn't 500. It wasn't in line with that.

Dr. Mark Hyman
What was your triglycerides?

Jeremy London
I don't remember. I wanna say they were probably upper 100, 200. So

Dr. Mark Hyman
Yeah. Yeah. I mean High, but not That's high. It should be under 70.

Jeremy London
Right. But

Dr. Mark Hyman
The lab reference ranges, you would say one fifty is

Jeremy London
the You're not gonna cut me

Dr. Mark Hyman
any slack

Jeremy London
today. Here I am pouring myself out to you to give you an

Dr. Mark Hyman
example It's for other amazing. You're this is important information because you're Exactly. Highlighting the fact that you're here you are a cardiac surgeon. Right. You're into functional medicine.

You're trying to do the right thing. You know, you maybe had a few things off of your diet, but was something going on. It could be other factors like your microbiome or toxins that can cause insulin resistance. But, like, your your numbers were numbers that most people don't look at. Right?

And you you hadn't even looked at. I didn't. Which is amazing. And, APO B is now which is basically a combination of all the we call atherogenic lipid particles, so triglycerides and LDL particles, and intermediate density particles and so forth, LP. These are all together in APOB, so it's it's now recognized by cardiologists as being the most important biomarker for predicting heart disease risk.

But it's almost never tested by traditional doctors. Just they check your regular cholesterol panel, and they'd say, yours was a little bit off, but not terrible. And here you are sitting on a time bomb, and you're lucky you didn't actually have a a clot and die. I mean, you could have.

Jeremy London
Absolutely. And, you know, it goes back to that you can't fix what you don't measure. And it really took me understanding that my priorities needed to change, that I truly needed to engage in secondary prevention. And to do that, I needed to know what my numbers really were. And the grace at this point is I have now normalized all those things.

My particle counts are really pretty phenomenal on Repatha and a little low dose Crestor.

Dr. Mark Hyman
And It's really important what you're saying is because, you know, looking at you, no one would say, oh, here's a high risk heart attack patient. You know, you don't smoke. You don't have high blood pressure. You're you know, you're you look fit. You seem to you know, into health.

But, like, these things are under the surface in a lot of people, and we're seeing this a lot with function health. We're seeing a lot of people who are now measuring this on. I mean, I've been doing this in my practice for thirty years. I've been measuring lipoprotein, particle number, particle size, even when before that was a what was a company called Liposcience, which did this particle numbers and size before LabCorp bought before Quest developed their tests. I've been doing this for decades, and measuring ApoB, and all these numbers.

And it's amazing to me that they've been available, but I mean, I sat with the head of the the executive physical at Cleveland Clinic, who was an older gentleman, whom my name was. And I was like, listen. I think your executive physical labs are a little dated. Maybe you should do, you know, particle number, particle size, you know, ApoB, and all this. He's like, well, you know, we don't like to do things before there's adequate research.

And I'm like, well, this has been around for forty years. Ron Krausz discovered this forty years ago, that particle size and number matter, and they track with your carbohydrate intake and not fat. So like the if you're eating more starch and sugar, you're going have more of these atherogenic particles, you're going to have high OPB, you're going to have more particle number and smaller particle size. These are all the things that no one's looking at. So I think, you know, getting these things tested is so important, and a function help, that's what we do with everybody.

And we're seeing it's huge, huge number of people who have particle numbers that are high. It's over ninety percent have really some degree of abnormality. And when you map it to like imaging, then you can actually see what's going on. Sure. And then, you know, you can treat it.

Like, you you might have some genetic factors. There's lipid genetics that play a role, I'm sure, you. I certainly have like a an inherited familial lipid disorder. It's not like class the classic one, but it's now we have more genetics we can do. I've done my full genetics for lipids, and and, you know, we're gonna be offering, you know, genomes whole genome sequencing soon and so forth.

Like, I think we're seeing a lot of of potential to really understand your unique biology and then how to customize treatments.

Jeremy London
I mean, I think you make some really interesting points. Like, take Lp for I mean, it has really been around for for decades.

Dr. Mark Hyman
A long time. And At least as long as I've been doing medicine. And if

Jeremy London
you look at the history of that, of of why it didn't come to center stage, and I'd be interested to know what your thoughts are on this, but it was that attitude of, well, we can't do anything about it, so why should we actually be testing for it? Mhmm. And I mean, that's that's such a misguided mindset because, you know, knowing something is is as is important even if you can't do anything directly about the thing you know.

Dr. Mark Hyman
Right.

Jeremy London
Like, having that information so that you can change everything else.

Dr. Mark Hyman
Right. You can reduce all the other risk factors.

Jeremy London
Exactly. And even with the inherited factors, the other inherited factors, that's such important information to be able to stratify people that otherwise look healthy that you know you need to get those numbers lower, that you need to be more thorough, that you need to be more engaged so that you don't end up in in the situation.

Dr. Mark Hyman
Yeah. I because I'm sure those numbers that you had, if you've been tracking them for decades, they would you would start to see the trend line going like this. For sure. That's what's available to help for people for a very low cost. Like, in function health, we basically do a dollar a day.

You can get all this stuff done. And, you know, twice a year testing and get a really deep view, not just of your, lipids, but also like metabolic health, which is you know, you're kind of you're a case in point that most heart attacks today are really aside from the small subset that's just inherited lipid disorders, is coming from metabolic syndrome, from prediabetes, from poor metabolic health, where we're eating so much sugar and starch that it's causing high insulin and high triglycerides and high ABO B and all these things that that are really from what we're eating.

Jeremy London
Things get misconstrued many times because they come in you know, patient two patients. Right? You have the healthy 50 year old that has normal standard panel. Physician shakes their hand and says, you're good to go. And eighteen months later, that patient's in the back of the ambulance with a heart attack, and the response is, see, LDL doesn't matter.

Cholesterol doesn't matter. None of those things matter. Then you have the other patient that had high cholesterol, was well treated, has LDL levels of a of a 15 year old also in the back of the ambulance eighteen months later. And that patient's response is, I was safe. I did all the things.

And they're both wrong. Why? Well, because the truth is somewhere in the middle. Right? Because LDL just doesn't tell the whole story.

Now before, you know, we break you know, before we attack LDL, clearly, LDL is causal. We have lots of data that supports that, but it's not the whole story. ApoB, LP, the metabolic components, you know, that that's a very, very important component. The the second arm of that is the things we can control.

Dr. Mark Hyman
I mean, we've over indexed on LDL because we have a drug that treats it. The truth is that that may not be the right target for treatment. And when you look at the data, like even things like triglyceride to HDL ratio is far more predictive than LDL. And and and and that's a reflection of metabolic health. So high triglycerides and low HL means you probably are heading towards prediabetes, and that's really the driver.

You're you sort of mentioned people have normal cholesterol and have a heart attack or have, you know, treated cholesterol and have a heart attack. There there was a big study that was, like, looking at think maybe you know this study. Think I'm looking at a hundred and thirty thousand people who were admitted to the emergency room with heart attacks. And I think seventy five percent had, quote, normal LDL. But only, like, I don't know, ten percent had normal triglycerides or something like that.

It was like You know? It so It's just

Jeremy London
not the only villain in the room. Yeah. And and for most of us, myself included, that certainly was the case. Yeah. You know?

And I think that that's that's the reality, and that's, you know, understanding that you've we can all fall into this gap, recognizing it before we do, understanding what we what tools we have available, whether you can move the needle with lifestyle changes, or you do all the foundational pieces. You eat well. You move. You sleep. You have your relationships in check, all those things, and you're still not right, you know, it may be time to consider a different lever.

You know, people today think that taking medication is a failure.

Dr. Mark Hyman
No. It's not.

Jeremy London
It's not. And it's both the fault of patients and physicians. Yeah. You know, I think about it like a like a scale. You know?

At the one end of the patient scale, you've got the individual who's like, just treat me, doc. I'll do whatever I'll do whatever you say. And at the other end is, I don't want anything to do with medication. I can do all this myself. Somewhere in the middle is where we need to be.

Well, the physician scale is not very different. You know, you've got on one end the physician that's giving out medication like it's a Pez dispenser. Yeah. And I think honestly more I'm

Dr. Mark Hyman
with Pez. I I I ate that when I a kid all

Jeremy London
the time. Depends on what's inside when you when haven't you

Dr. Mark Hyman
heard that phrase. You're you're You're I haven't heard that. I don't know. Do they still make those? I'm like

Jeremy London
I have not seen them nor have I looked for them.

Dr. Mark Hyman
Don't know what that is. A little thing you had when a kid was like a was like a little device that popped out a little candy, and you could just pop it in. It would pop out a candy. Was like

Jeremy London
And that's exactly how they hand them out. At the other end of the spectrum, and I think this is actually a much more dangerous mindset for physicians, is we'll just watch this and wait. You're doing great. Continue doing what you're doing with abnormal labs. And the problem is that's that's like patient centric care masquerading in this other form.

And in the end, these are risk benefit decisions. Right? Like, yes, do the foundational things. Do all the things that you need to do. But if that's not working, you don't leave your patient at risk.

So both of those things are really at centerline is where they belong, somewhere in the middle.

Dr. Mark Hyman
It's true. There's a real need to know what your numbers are and use those to guide you as opposed to, you know, just you look fine or your basic cholesterol panel's fine. Because that like you said, for you, yours was a little off, but it wasn't terrible. That's right.

Jeremy London
And I

Dr. Mark Hyman
think that's the way it is for most people. And so so I think the the key here is is tracking your trends over time. Because if you were 30 and you track your numbers, you'd probably start seeing them go a little Yeah. And then by the time you're 40 and then 50 and then, you know, you're getting into your upper fifties, then you really already have the disease. Like, you already had a problem.

So really, you wanted to start checking this earlier. Right? For

Jeremy London
sure. And I think that my personal mindset is that atherosclerosis is something we have. It's not something we get. You know? If you look at autopsy studies from three year olds, there's a fatty streak in the aorta.

If you look at the p day study, you know, autopsies from trauma in the field, 18 to 35 year olds have early changes in their coronary arteries. Now none of those things are causing any problems at that age, but the propensity for that is already there. Our goal is to get the runway out as far as we can to not have problems. How do we make choices that that push our body in the right direction, not the right do we stay in that

Dr. Mark Hyman
That's the thing. So right now, we we know enough. Like, we know enough what to track, what to measure, how to test people. For sure. We can talk about imaging a little bit.

But we we also know that cardiovascular disease is mostly preventable. I mean, I remember I remember learning about William Osler when I was in medical school, and he was one you know, the first textbook of internal medicine. He was at Johns Hopkins, this kind of very iconic physician we all learned about. And and I remember reading about how when they would have a heart attack patient, it was a huge deal, and they would have the whole staff run. The medical students, the residents, the doctors, the attendants would all come around and see this patient because it was such a rare condition.

It was rare to have a heart attack back in 1910. Sure. You know, maybe if you were eating really crappy diet

Jeremy London
Which was unusual.

Dr. Mark Hyman
You could yeah. If you were rich and had a lot of, you know, money, you could buy a lot of expensive, you know, starchy foods, whatever. I don't know. But the point is now it's so prevalent, and and we we have to sort of be more more diligent about actually helping people map out what their history is over time and tracking that. But what what what are the factors that people should be paying attention to?

Pay attention to because this is really a preventable condition. I mean, you you say you want to take hard decisions from number one and number two. What would be required to do that?

Jeremy London
Yeah. I think you started the foundation, and this comes back from, you know, my time with you at at at the functional medicine conference back in, you know, twenty years ago. Yeah. Yeah.

Dr. Mark Hyman
It was Baltimore. Bucks. Yes. Yes.

Jeremy London
I was I was going for early morning runs around Baltimore. It tells you I wasn't so smart then either. But really, start with the the foundational pieces. And, you know, I remember a friend of mine said he he was a wise is a wise gentleman. He said, you know, if a farmer looks out on his fields and all of the if all of the plants are sick, if all of your crops are sick, where's the first place they look?

It's in the soil. What are we feeding the plants? Mhmm. Sit in the airport and watch watch our fields go by. So I think that I think being mindful of what you're putting in your mouth, focusing on a whole foods diet, limiting ultra processed foods, you know, limiting limiting saturated fats in your diet.

You gotta be so careful these days with the, you know, the really kind of more fringe type choices, the more extreme choices because you always have to be careful what you're substituting things for. Right?

Dr. Mark Hyman
Right.

Jeremy London
And so I think that that's a great place to start because it's something that we have such control over. Yeah. Right? And I think our gut is such a primary source. Not that we understand the microbiome fully by any stretch of the imagination, but I think the principle really holds.

You know? Our our what we feed ourselves is our cells is the information that we're going to give our body to live on. It you can connect those dots. I think most of most of us can connect those dots. And when you're thoughtful about it, you just feel better.

I mean, I have had personal experience with that. Clearly, movement every day is critical, both aerobic training and strength training. They're great independently, but compound dramatically when they're put together. My personal Achilles heel, sleep. You know, I can tell you when your sleep is off, everything is off.

And for me personally, it's the hardest because, you know, I can control what I put in my mouth. I can push myself to go to the gym. The harder I try and control my sleep, the worse it gets. So I've had to change my relationship.

Dr. Mark Hyman
What have you done that's helped it?

Jeremy London
The biggest things I've done is changing my sleeping environment. Dark, cold, taking a hot shower before bed so that I know that my body temperature's gonna drop to help. Going to bed at the same time every night, setting alarm to make sure I'm going to bed at the same time, as well as waking up at the same time, trying to get outside as much as I can just to get sunlight in my eyes. And can I tell you that it's perfect? No.

Is it a lot better? Yes. And again, know your numbers. You know, I followed I've been following my HRV, my heart rate variability, which is a wonderful indicator of your autonomic nervous system. Since you are pushing me for my numbers, I will tell you what they were and what they are now.

Yeah. Yeah. My HRV was running between fifteen and seventeen.

Dr. Mark Hyman
Yeah. Yeah. Yeah. That's why.

Jeremy London
Yeah. Better. And now I'm running in the mid to mid to upper thirties, And occasionally, I'll hit a 50 if I really am well hydrated. So I'm on the right track, but is it is it no. It's not.

Dr. Mark Hyman
It's always a work in progress.

Jeremy London
I am definitely that.

Dr. Mark Hyman
So so really this whole epidemic of heart disease is is largely preventable. If you address diet, if you exercise, if you sleep, if you manage stress, if you avoid smoking Yeah. If you manage your blood pressure, which also is a big factor. Absolutely. And it's very much related to insulin resistance and prediabetes, and this whole same phenomena is what causes high blood pressure.

So these aren't all separate problems. Blood pressure and heart disease and high cholesterol, they're all like they're all kind of one thing.

Jeremy London
Nothing happens in a vacuum in the body. You know? It's one big ecosystem.

Dr. Mark Hyman
And so so when you try to start to knock off all these factors, you can start to really change things. And then also, you know, connection, community, stress is a big factor. I think a lot of people are lonely, and that it's like smoking 15 cigarettes a day in terms of its effect on your health. And and there's some interesting studies looking at the gene expression patterns under stress. When you're lonely or isolated, you produce more inflammatory genes expression.

So you have more inflammatory proteins out there in your body and causing more damage. And I and we know heart disease is an inflammatory disease. Right? For sure. Maybe talk a little bit about that because I think, you know, we used to think there was just plumbing problem.

You know, you were you're a plumber essentially. You're like, oh, I am. Do cardiac bypasses and open up arteries and fix aortas and fix, you know, femoral arteries and all these things that they get clogged up. And so it's it's kind of like a plumber going in and rerouting the pipes or opening up the pipes and cleaning them out. And and the truth is it's not necessarily just a plumbing problem.

It becomes a plumbing problem, but it starts off as an inflammatory problem, And there's ways to check that. So tell us about the role of inflammation in heart disease, and also about how do we measure that.

Jeremy London
So I I wanna separate the the roles of inflammation in heart disease because I think that there is a bit of a misconception in in the lay public when it comes to how we think about systemic inflammation versus specifically what's happening at the arterial wall. So when when we talk about the inflammatory process, specifically when a plaque or a blockage is forming, the wall of the artery is penetrated by an ApoB driven molecule lipoprotein, if you will. That then sets off a cascade of events, one of which is an intense inflammatory reaction in the arterial wall, which draws those inflammatory cells into that area, which then starts this cascade of collection of more cholesterol, a healing process that then starts, and it's that healing process many times where we start to see the the actual stenosis forming. So we have a local form of inflammation that's a result of an injury repair pattern, if you will. But the question is, what made the arterial wall vulnerable at the first place?

And that, I think, is a distinction that people don't truly understand. Right. So if if we break down what's actually happening, there's two components. The artery walls being attacked, and then it's the integrity of your endothelium or that in the intima, the inside lining that is either capable of fending that off, or it's vulnerable. So it's the balance of those two things.

I think that that you have to kind of separate what's happening from an inflammatory standpoint. Because if you talk to a pure lipologist, they're gonna tell you, CRP doesn't have anything to do with with, you know, creating a stenosis. Well, specifically, they're not wrong. You know? You're you can't having that inflammatory process in the wall of the artery isn't gonna show up on a CRP.

Yeah.

Dr. Mark Hyman
But what CRP tells you what the general environment is.

Jeremy London
What the general environment is. However, my my perception of how to utilize this is it's it's an indicator of your endothelial resiliency. What are the things that are keeping the endothelium intact that are guarding against those outside forces? And when you have insulin resistance and metabolic syndrome and inflammatory factors, those are look. We know that just elevated chronic glucose alone is impacting the vessel wall.

Yeah. Again, making it weak, making it more susceptible, and that's why it's it's it's an equation, really. It's very it's more of a heuristic than it is an equation because it's more of a guide, you know, just to understand that these are balances. So when we start to talk about those things, like what can we do differently, exactly what you said, How do we how do we put the fire out that is creating this vulnerability that then creates a a ripe environment for injury to the wall itself?

Dr. Mark Hyman
Yeah. I mean, that's I think that's an important distinction between, you know, the inflammation at the local level and systemic inflammation that sets the stage for things to go wrong. Yes. And and that that you talked about insulin resistance, you know, prediabetes insulin resistance, belly fat, those that belly fat's producing a whole cascade of inflammatory molecules that's spewing out through the whole body, and it's causing havoc everywhere, including on your arteries. And that that's, you know, that that's really people understand that sugar is inflammatory, that sugar and starch are inflammatory.

That's a lot of what's driving it. And, obviously, it's pollution. It's stress. It's, you know, microbiome. There's a lot of other factors, but but that's predominantly what it is.

And I think, you know, most heart attacks probably before the last, you know, sixty years were probably not metabolic syndrome. They were probably different. Yeah. You know, they were smoking. They were you know, people were thinner.

They didn't have all this sugar and starches. I think it's changed. I I I think if you look at it, it's changed. And what's interesting is that doctors aren't measuring insulin, and they're not measuring insulin resistance.

Jeremy London
Mine had never mine had never been measured. Yeah. Until until And here

Dr. Mark Hyman
you are, cardiac surgeon. And probably the most important predictor of whether you're gonna get a heart attack is your degree of insulin resistance, and yet it was never measured, which is just sort of staggering. There's actually a new test that we offer through Function Health, which is called the insulin resistance score, which is a it's it's the most accurate measure of insulin resistance that we have now other than more of an interventional lab test, which is called like a Uglycemic Clam test, which you wouldn't do as a research study. But it's it's better than the calculated version we used to call HOMA IR. Mhmm.

Much, much better than that. And you can now measure using a C peptide level and an insulin level using mass spectrometry, and we offer it through function health. And it's it's amazing to see how you know, where people are on the spectrum, and then you can actually monitor it like an a one c and see how it changes.

Jeremy London
And I think and I think that that's been one of the biggest limitations with the insulin level is the lack of standardization across across labs. You know? What do the numbers actually mean? What's the standardization? So I think to to have something that's got some real data behind it's gonna be really powerful and and something that we can actually actually count on.

Dr. Mark Hyman
Yeah. It it is pretty exciting. So now with the deeper diagnostics, with becoming more affordable, with accessible diagnostics, people can actually know what's happening. And I think people should start early, like, get a baseline in your twenties, see what's going on. You know?

And I think, you know, the heart imaging era is also changing. So before, you'd have to do an angiogram, you'd have to stick a big catheter in a guy's groin, you'd have to shoot dye up there, you'd put a lot of X rays on, it was a whole thing. And it wasn't that accurate a test. Often, you'd miss stuff that was, you know, concentric plaque or you'd miss some stuff. You know?

Then then they developed like more interesting tests like a CT angiogram, and they now have AI enhanced CT angiograms, which are really interesting. So you can look at soft plaque and hard plaque. Now we can do also a chest and heart CT scan, looking at calcium in the heart. How do you use the the imaging, like this coronary calcium score or the AI enhanced coronary angiograms on CT scan? How do you how do you use those?

Jeremy London
So I think that this is this is very much an evolving an evolving space very, very quickly. And as you pointed out, it kind of started with the early the early CT calcium scoring only then to CT angiogram, etcetera. Now I will say that coronary angiography is still the gold standard with FFR measuring measuring actual drop in pressure across stenosis or questionable areas using intravascular ultrasound. I think that there are ways there are ways that, again, like the imaging has progressed for the less invasive or noninvasive.

Dr. Mark Hyman
It's also progressed for

Jeremy London
the It's also progressed on the other side to address the things. So I think these things are are complementary. I think that for sure, until we added CT angiography, really knowing soft plaque is so important. Now knowing calcific plaque burden is helpful as a screening test if you're out totally normal or on the other end of the spectrum. It can get really gray and can really confuse things sometimes in asymptomatic patients without any symptoms that are in that middle ground, it can, you know, it can it can require further investigation.

But as

Dr. Mark Hyman
Like a CT angiogram.

Jeremy London
Exactly. Yes.

Dr. Mark Hyman
It's a good screening test. That's exactly abnormal, you wanna follow-up.

Jeremy London
Exactly right. And now with this AI component, I think it's gonna when you can digitize the information and you can actually not miss the calculation, It's not a it becomes less of a subjective reading and more of objective reading when it comes to actual measurements. The accuracy, I think, of those tests is gonna change dramatically. Now, how is that gonna look clinically? What is that gonna look like for outcomes?

All of those things are that's why I say I think it's just an evolving space right now.

Dr. Mark Hyman
And it's important because, you know, I'm sure you've seen patients like this, but, you know, I have patients who have perfectly normal labs but have plaque and clogged arteries, and people who have even the labs you would expect would be abnormal, or people who have terrible labs and whose arteries are normal. Yes. And and I'm like, wow. Well, you have high particle number. You have high APOB.

You have high LPA. I'm like, you should be having a heart attack right now, but you're 65 and your arteries are clean. Yeah. So I think for me, what it's taught me is that I can't really put people on a lifetime prescription or a medication unless I know the anatomy. Because cholesterol is a risk factor.

It's not the problem. Yeah. It's a risk factor. Sure. And sometimes it's high, and sometimes it's not.

Sometimes, you know, treat treating it isn't the real solution, it's figuring out what the other causes are, and and treating those like insulin resistance.

Jeremy London
I think you make a great point. I mean, it's like every decision we make in medicine is a risk benefit decision. And you you know, you have to make certain that you're maximizing benefit and minimizing risk, and you're you're you're mitigating in favor of of that patient. And you can't rely on just one number or even two numbers. You know, each patient is so dramatically unique and different.

Just because there was a pulmonologist who said to me years ago, he said, Jeremy, the protocols are the practice of medicine. Knowing when to and when not to apply those protocols is the art of medicine, and that's what you're talking about. Yeah. It's like if you followed the protocols and there's nothing wrong with that. We all follow the standard of care protocols.

Those are our guidelines. But if you plugged that patient into the protocols, you would have put that patient on medication right away without any additional information. If you would because but you were thoughtful about that particular patient. Yeah. And I think that that's so incredibly important.

You know? And one of the things that is of concern for me as I look at medical education moving forward, because there's such a high reliance on protocol driven medicine, which is wonderful.

Dr. Mark Hyman
What's the baseline? Not it doesn't doesn't go deep enough. Like, It's a place to start. The standard protocol, you're not getting lipid fractionation. You're not so you're checking.

You're not checking up. You're not checking in summary levels. You're not checking in some resistance scores. You're not checking all these other things that are so important that have to be part of a full clinical picture to make a decision. Right.

That's what worries me. It's not it's not that it's not a good starting place. It's just inadequate.

Jeremy London
Yeah. Yeah. It's I think that's yeah. I think you're right.

Dr. Mark Hyman
It's not that it's wrong. Right now is LDL is high, statin. Like, that to me is completely screwed up.

Jeremy London
It it's not wrong. It's incomplete. Yeah. You know, I think is is the way to look at it. You know, at some point, you know, maybe listen to the patient.

Yeah. Examine the patient. You know? Do the things that you be a doctor first, and then understand how to put all these things together to make to make the best decision. Discuss it with the patient, god forbid, you know, and let them be a part of that decision making.

And I, you know, I think that's one of the great things about about function health. Right? It it allows patients to regain a fair amount of agency in their own health care. And I think a lot of patients wanna do that in this day and age. You know?

I think that that people are frustrated because access is such a problem. You know, pick up the phone and try and get an appointment with your primary care physician. It's hard. And I'm not suggesting that it's intentional. They're busy, and they're seeing a lot of patients, and it and it's tough.

And I think that that to really regain that agency and to take full responsibility for your health care, you have to have options to be able to actually follow through with that. And I think that's one of the great opportunities that that function health offers.

Dr. Mark Hyman
It it addresses some of the gaps, you know, some of the gaps that are out there in terms of how we're trained as doctors, how we approach prevention. We're kind of in a reactive system, not a proactive system. And I think about heart disease, I mean, by the time you have pockets late in the game, when you have a like what you had with the symptoms of chest pain and needing a stent, I mean, that's kind of down the road. Yeah. And who knows what would happen if you would have found this when you were 35, and you'd done a heart c a heart CT where you did a calcium score, and you had your APOB checked and your insulin checked.

You're like, oh. And I think that's that's where we are now in medicine, which is that we have to have more agency as as individuals and not just rely on the health care system, because training's gonna take a few decades or generations to change. It takes a long time for medicine to change.

Jeremy London
It's turning a battleship. You know that better than I do.

Dr. Mark Hyman
Yeah. I tried. I was Cleveland Cleveland Clinic for ten years. It was a very big battleship. Yeah.

And they were very open. It was was great. We did a lot of great work there, but it was also, it was very hard to to get people to change how they think, you know, and to to really do more of a proactive approach. I want to sort of talk a little bit about this set of idea about this person who looks healthy having having a heart attack, and what you would advise people to sort of check. Because, like, you know, for me, like, I exercise.

You know, my body fat is 10%. I eat healthy. Like, I shouldn't really have a problem. So why would I bother checking? But actually, I did check.

And because of my family history, like everybody my grandfather said, I dropped dead in their fifties. I'm like, I got a problem. So I had to manage it. And I think, you know, I wouldn't have thought I would be a person who would have high risk. Right?

Because I've been running since I'm 14 years old. I've been eating healthy my whole life. I've been, you know, just I mean, yes, I have stress, like, and sleep issues because I'm a Right. Big doctor, but and life in general, but, like, I it was it was interesting. So what would you advise people who are listening who think they're healthy, what should they be doing?

What should they be checking? What should they know, and when should they start doing it?

Jeremy London
Let's start with the simple things first. Get a blood pressure cuff at home, and check your blood pressure. You know? If you can't do that, find a friend that has a blood pressure cuff and take it on a regular basis. You know?

It's it's really the silent killer for a reason because it's not a problem till it's a problem. Fifty percent of Americans have it, and many Americans don't even realize that they have it. And it's the most modifiable the most easily modifiable cardiovascular risk factor that we have. And it's just back to that same tenet. If you don't measure it, you don't know.

And it's so easy. And doing it once at your primary care visit is not is not enough. You know? You need the seven two two rule, you know, for seven days, twice a day, two measurements, record them, take an average. That's what your physician really wants to know and what they need to know to be able to to come up with an accurate number.

So I think that's a great place to start and to really potentially move the needle because it's it's such a significant component of cardiovascular. Yeah.

Dr. Mark Hyman
And then blood pressure is not just random. It it's caused by certain things.

Jeremy London
Absolutely. You

Dr. Mark Hyman
can actually figure out too.

Jeremy London
Well, that'll come to the next suggestion. And this goes along with the the how we look issue. It's not always your weight. It's the distribution of your body fat. And that's why I really recommend that people are checking their waist to height ratio.

Mhmm. Very simple to do at home. And that Tape measure is

Dr. Mark Hyman
a very cheap medical device.

Jeremy London
It really is. Be honest about where it is and where you're measuring.

Dr. Mark Hyman
Belly button.

Jeremy London
That's me at the belly button, and and you don't want your number to be greater than point five. And that's just an indicator again of, you know, the amount of intra abdominal fat, that visceral fat that functions really as an endocrine organ if we look at it for what it's actually doing. Again, what you're saying, there's drivers of all of these things, and they're also interconnected. So I think those are two very simple places to Blood pressure and waste to Blood pressure and waste. And then you get down to And waste to

Dr. Mark Hyman
height would be waist in inches and height in inches.

Jeremy London
That's right. Or centimeters in both. Yeah. You know, just keep the units the same Yeah. So that you make sure it's a it's an actual ratio

Dr. Mark Hyman
in less than point five.

Jeremy London
Exactly. And that gives you something to really follow and track progress, both blood pressure and something that you can do at home. You don't have to go to a physician's office. You don't have to do any of that. You know, from there, I think we we look at some of the specific labs that I think people should be checking.

I think an APO B is crucial. LP, sure, at least once in your lifetime because it is a genetic factor. I think that menopause may change those numbers slightly. So I think for women, it directed by your physician, it may be best to do it pre or perimenopausal and after after menopause as well.

Dr. Mark Hyman
There may be some ways to modify that. There's also new drugs that are coming around that might be helpful for that.

Jeremy London
Absolutely. And now they're they're coming out of phase three clinical trials. It'll be interesting to see where those end up because the question, of course, will be just because you can lower Lp, are the outcome studies that are gonna be as a result of that? But stories still to be told and and very promising, which is great. I think that that's that's very useful.

I think knowing your your hemoglobin a one c and some form of fasting insulin is is just really, really important. And I think if if those are really the core that are not on a standard panel at all, CRP is kind of plusminus. I think there are a lot of primary care to you. Who are starting to do it. Those are are really not.

Unless there's some trigger for hemoglobin a one c, they're just not

Dr. Mark Hyman
They're not checking it. They're checking just not checking it.

Jeremy London
Mine wasn't checked. No knock on my primary care physician because I'm sure No.

Dr. Mark Hyman
We're just not trained that way. So and these are these are really affordable tests. I mean, they're all included with with all the things you mentioned are included with a lot of other tests, like a 160 tests for literally just a dollar a day, $365 a year for twice a year testing. It's it's it's it's not free, but it's not that much considering what people spend money on coffee and whatever they spend loosely money on. It's it's investing in your health.

And and and you know, sometimes the doctors won't do it. I I met with the dean of medical school at at in Bentonville, the the Dallas Walton School Of Medicine. And she's she was she's a I think a gynecologic oncologist. And she said she's she's of Indian descent from India. She went to the doctor, to her cardiologist, said I want you to measure my insulin.

He's like, no. And he wouldn't do it. And he's like, yeah. Well, we know at lower body weights, we get more insulin resistance, so like, I wanna check it. And he's like, we don't need it.

I mean, just that level of just she said she went to her doctor and said, I I wanna get my vitamin d checked because I don't feel so great. I'm tired. So you don't need it. She said, I don't care. I want it.

She said, insurance won't pay for it. Well, she said, I don't care. Want it. She got the vitamin D, and it was zero. Oh, wow.

Because she was dark skinned, didn't work inside. Right. Didn't go out much, you know. So I think we're missing so much, and that's that's, you know, really why a company like Functional Health that I cofound has really started to give people agency to know what's going on. They'll not have to be someone like you who's, you know, at 57 has blocked arteries and wish they could have figured that out sooner.

Right? Absolutely. Hopefully, your son's getting all those tests.

Jeremy London
Oh, and then some. He's I think he is gonna be a lipologist before the end of all of this, I can tell you, because he probably knows more about lipid metabolism and genetics than I do at this point.

Dr. Mark Hyman
Is he in medical school?

Jeremy London
He is not. No. He is not.

Dr. Mark Hyman
Right. I know you spend a lot of time fixing damaged hearts, literally. And you now want to help people never have surgery. So how do you think about really move putting that mission and moving that into the world? Like, coming out my podcast is great.

You're writing a book. You have a website. You have a podcast. But how how do you see kinda doing this for yourself?

Jeremy London
Well, I hope that sharing my story and being willing to allow people to peek behind the curtain, if you will, that and admit that none of us are immune, it may not prevent people falling into that cognitive dissonance gap, but you will think about it. You know? So my hope is that I can raise awareness. And then by by really trying to communicate relatable, high quality health and wellness information that's really tactical in people's lives. You know?

And the world that we live in right now is so maximized, maximized, maximized, maximized that everybody feels like they're taking a test. And if they miss one thing on the protocol that they failed at that, and just give everybody an opportunity to let their shoulders down a little bit. Take a breath, and know that if you miss you're not if you miss one workout, you haven't failed. You're just gonna come back the next day and start over, and to help people really integrate that into their lives, the really foundational pieces. And then helping them understand, well, what's the next layer of that?

Okay. You've you've done the work. Check your blood pressure. Check your body fat distribution. Check your labs.

You can't fix what you don't measure.

Dr. Mark Hyman
Right.

Jeremy London
Be proactive about, you know, atherosclerosis, which is something that we know we're born with, something we have. It's not something we get. We get the problems.

Dr. Mark Hyman
Yeah.

Jeremy London
Can we keep inflammatory factors at at the lowest? Can we keep our insulin levels where they need to be so that we don't have problems at 57 years old?

Dr. Mark Hyman
Yeah. True. Very true. Alright. Let's do some rapid fire questions.

You ready?

Jeremy London
I'm ready.

Dr. Mark Hyman
Okay. So what's the single biggest mistake people make when it comes to heart health?

Jeremy London
They think it's not gonna be them. Yeah. They convince themselves that I'm fine. I'm fine. Yeah.

It's just not gonna happen to me.

Dr. Mark Hyman
That's that's an important one because a lot of people stick their head in the sand, they wait till it's too late, and medicine just doesn't seem to focus on prevention. So what's one heart health myth you wish would just go away?

Jeremy London
The one that I deal with on a regular basis is that patients that come in with heart disease and get a stent or bypass surgery think they're cured. And I always tell people, we're not treating the underlying problem. All we're doing is getting you out of trouble. You now have to do the work because the process is still going on.

Dr. Mark Hyman
I think when you crack somebody's chest, they'd change their lifestyle, but often often not.

Jeremy London
Most of the time not because I think there's a misunderstanding that they think we've cured the problem.

Dr. Mark Hyman
That's

Jeremy London
right. And really, all we've done is gotten them out of trouble. We can save we can save you. We can't heal you.

Dr. Mark Hyman
And when you tell them that, do they get it?

Jeremy London
It depends. You know? It it depends. I mean, I lay it out. I say, if you you're gonna continue to smoke, all bets are off.

We've taken all this upfront risk. I'm not gonna soapbox you about smoking. This is your decision. These grafts could be down in six months if you continue to smoke. We've taken all this upfront risk for an operation.

You don't wanna be back to do it again. But I think that's one of the things it's it's more of a misunderstanding than it is a myth, but it's become kind of the perception.

Dr. Mark Hyman
What's the most underrated habit for preventing heart disease?

Jeremy London
Ten minute walk after meals.

Dr. Mark Hyman
Ten minute walk after meals. Why?

Jeremy London
Because it keeps blood sugars under control. There you go.

Dr. Mark Hyman
It keeps your blood sugar and insulin. Yeah. Because your your muscles can take up glucose without actually needing insulin, which is amazing. Mhmm. But insulin obviously helps, but it's it's it's true.

I think it's a very simple habit. What's one food you wish people would eat more of?

Jeremy London
Fiber. Fiber. Why? Well, because it helps control blood sugars. It helps it helps with cholesterol metabolism.

It satiates you, and so you eat less. Look, it's not sexy, but

Dr. Mark Hyman
And it's good for your microbiome. And it's it's I agree with you.

Jeremy London
It's critical for your microbiome.

Dr. Mark Hyman
I agree. And the side the side effects of eating fiber is you're eating a lot of other plant foods

Jeremy London
that are good

Dr. Mark Hyman
for you. So it's it's like how about what do you wish people eat less of? Saturated fats. Saturated fats. Okay.

We didn't really go into that too much, but there's been a lot of controversy about saturated fats. Yeah. I'm a believer. I think it's I'd love to hear your perspective, because think my understanding in literature, and also treating thousands of patients, is that it's so individual.

Jeremy London
Yes. Yes. Like, I had

Dr. Mark Hyman
a patient who a patient who was an overweight woman. She had high triglycerides, like 300. Her HDL was like 30. Her particle number was high. She was insulin resistant.

She was pre diabetic. She had a one c that was up. And I said to her, look. She was struggling with weight loss and just couldn't knock it down. And I said, well, why don't you try a ketogenic diet?

And I put her on coconut oil and butter, saturated fat. Her LDL came down a 100 points. Her triglycerides came down 200 points. Her h two went up 30 points, and she lost 20 pounds, and her insulin resistance went away. And she went on basically a ketogenic diet with saturated fat.

Another guy was a thin biker. He's like, I heard this keto diet's great. I don't know. I wanna try it. I'm like, I don't think you need it, but like, okay.

But let's monitor what you're doing. And he was riding his bike 50 miles a day. He was like super healthy and ended up causing his cholesterol to go exactly the opposite direction. High particle number Mhmm. You know, lots of small particles, high LDL.

I was like, wow. Okay. So there's a lot of genetics involved here, and and different people respond differently?

Jeremy London
Exact exactly. And I think that that's why following the biomarkers are so important. Yeah. You know? But I my impression is that if we look at the bell curve, and we look at the majority of people and how they're gonna respond with saturated fats, they're gonna fall into a place of of concern.

I don't know that they're gonna fall into those those outliers. I think it's more of a more of a risk factor than not, but you don't know till you know.

Dr. Mark Hyman
Okay. What about saturated fat versus sugar and starch? Who's worse? Which is worse?

Jeremy London
I mean, I think it would depend on how much of each. I think if you're gonna eat only saturated fats, you better follow your biomarkers very closely. If you're gonna try to cut out all of those things and you're gonna shift to, you know, eating a lot of higher carbohydrate foods, you need to follow there too. You need to be following your blood I think I think there's a balance between those two. Yeah.

Check your numbers too. Yeah. Check your numbers because we all metabolize differently. What

Dr. Mark Hyman
about nonnegotiables in nutrition? It's just like something you never do?

Jeremy London
Mine's pretty general. I adhere to an eighty twenty plan. I do the best I can 80% of the time, and I know it's not gonna be perfect, so I grace myself for 20%. That's my non negotiable.

Dr. Mark Hyman
Percent is what? Is you're not having Twinkies.

Jeremy London
No. I'm not having Twinkies. It's bread or pasta or a piece of cake

Dr. Mark Hyman
and a birthday real food, but not ultra processed food.

Jeremy London
Exactly. Essentially removed ultra processed

Dr. Mark Hyman
food. I think I think that should just for you listening, that 20% should not be soda or or industrial processed food. Yes. Because those are deadly, and they're not actually food by definition. They're edible food product.

I mean, it's true. If food if you look up the Webster's dictionary definition, or funky and wildness of food, it's definitely not what what ultra processed food is. That's fine as something that supports the the growth and health of an organism, which none of those things do. What about in terms of exercise? Cardio or strength training?

Jeremy London
Individually, they're strong. Together, they're exponential. You know? I really if you look at the data, the v o two max and aerobic data is certainly very potent and and significant when it comes to decrease of cardiovascular events. There's no doubt about it.

We look at cardiovascular health, and when it's measuring how efficient our cardiovascular system is, what does that equate to? That equates to ejection fraction or how much heart is being pumped out of the heart with each beat. We know that ejection fraction is directly related to longevity and survival. So the data is powerful there, and, you know, a connect the dots very On the clear dots. Correct.

It really is. But when you look at strength training, we talk about muscle and it being the sink for glucose in our body, it's like they're so hard to separate. I get asked that question all the And and I just look. We're we're all drawn to one or the other. You know?

I'm working with this woman now. She is an endurance runner, and she hates to do resistance training. Yeah. I'm like, you have

Dr. Mark Hyman
to do resistance training. That was me. That was me. I was 40, skinny, could run a lot, but could bike a 100 miles, but like

Jeremy London
Well, because I couldn't couldn't do 10 pushups. And and I did the same thing. I was an endurance athlete, and I think that physiologically, we're very fit, but mechanically, we're not. And that comes to being able to do things as we get older, but more importantly, we know we lose muscle as we age. We know how important it is for our overall metabolism.

True.

Dr. Mark Hyman
I definitely I've indexed way more on the cardio for most of my life. In the last five, six years, I've been more on the strength

Jeremy London
training. Okay.

Dr. Mark Hyman
What about a piece of advice that every 30 year old should know?

Jeremy London
That it's it's never too early to start, because the deadlifts you're doing at 30 ensure that you're able to pick up your suitcase at 80. The the the aerobic training you're doing at 30 is what's gonna enable you to, you know, travel and have the endurance to be able to do the things. The decisions you're making now are not gonna just in in impact your overall cardiovascular health, but they're they're gonna change your your functional capacity later in life. It's it's just

Dr. Mark Hyman
If you wanna enjoy the fruits of your labor when you're older, you have to take care of yourself when you're young.

Jeremy London
That's right.

Dr. Mark Hyman
I see that often. People, like, run themselves on the ground, they retire, and then they just can't do anything. That's right. Yeah. What's one thing you wish every six year old would would know?

Jeremy London
I would flip that coin around. It's never too late to start exercising either. And we we know the data with that. Right? We know that you take 55 and 60 year olds that have never exercised in their life, and you watch how their heart function changes in a very consistent regimented program, it gets stronger.

So it's never too late, but start small. Yeah. Make it make it fun. Pick things that you wanna do. Pick things that are that are enjoyable for you.

Dr. Mark Hyman
I I love I love that sort of like the guy who's 65 never exercise, starts rowing, and now he's like fitter than most 30 year olds. You know? Like, he's 95 years old.

Jeremy London
Yeah. Well, and remember too, like, particularly in the beginning, that's when they see the biggest benefit. Yeah. When you've gone from never exercising to a consistent program, they get a huge so it's never too late to start.

Dr. Mark Hyman
Alright. Now as a heart surgeon, what's what's one thing you avoid?

Jeremy London
There's so many things. I gotta pick one.

Dr. Mark Hyman
Or maybe how about this? What's one thing you avoid that you actually like that you don't wanna avoid?

Jeremy London
Well, I'm gonna I'm gonna I'm gonna zoom out way way far on you. The one thing I I avoid is complacency because I think that that's a very, very dangerous place to be, and I think that's very much where I ended up because I felt like I was checking all the boxes. You know, I was doing triathlons. I was I was competing at the iron distance. I was doing all this doing all the stuff.

Right? But I became complacent in in how I evaluated things. And to me, the willingness to change is what allows you to grow and to change and to change paths as the road changes underneath you. So I avoid complacency.

Dr. Mark Hyman
That's good. I like that. I like that advice. And lastly, if there's one biomarker you get to pick as a heart doctor that everybody should check, what is it? ApoB.

ApoB. Okay. Everybody get their ApoB done. Yeah. Okay.

Great. Amazing. Well, thanks, Jeremy, for sharing your story. Thanks for your vulnerability and getting other people to think differently about this because you know, you've been at the the shit end of the stick of the plumbing problem in heart disease for a long time. I think, you know, waking up to the fact that this is actually a preventable disease, that we actually can move the needle on this, that if people actually knew what to look for, what to do, what to measure, and how to change their habits, that we could actually beat this thing.

Jeremy London
Well, thank you so much for having me. I really enjoyed

Dr. Mark Hyman
it. Thanks, Jeremy. Yeah, man. If you love that last video, you're gonna love the next one. Check it out here.