Summary
Steven Bartlett interviews Dr. Praep Jamnadas, a world-leading cardiologist with 35 years of experience treating more than 30,000 heart patients. Dr. Jamnadas explains how heart disease — the number one cause of death globally — is largely preventable through lifestyle interventions. He discusses the root causes of cardiovascular disease, particularly the role of insulin resistance, visceral fat, inflammation, and gut health, and shares practical strategies including fasting, diet modification, stress management, and targeted supplementation to reverse metabolic dysfunction and prevent heart attacks.
Key Takeaways
Heart attacks occur when inflammatory plaques in coronary arteries rupture and form blood clots — not simply from blockages. Inflammation, plaque instability, and blood clotting tendencies have all increased dramatically in modern populations, creating a perfect storm for cardiovascular disease.
Insulin resistance is the hidden epidemic behind most heart disease. Years before diabetes diagnosis, elevated insulin levels drive visceral fat accumulation, fatty liver, chronic inflammation, and arterial damage — yet most doctors never test insulin levels in their patients.
Fasting is fundamentally different from calorie restriction. While calorie deficit slows metabolism and breaks down muscle, fasting triggers a distinct physiology that burns visceral fat first, stimulates autophagy, increases growth hormone and brain-derived neurotrophic factor, and improves cardiovascular health.
The gut microbiome directly influences heart health through multiple pathways. Leaky gut allows bacterial toxins into the bloodstream, causing fatty liver and systemic inflammation, while poor oral health and chronic sinusitis — including mold colonization — contribute to premature coronary calcification.
Inflammation is the common thread linking mental fog, depression, joint pain, skin conditions, autoimmune disease, and cardiovascular disease. By addressing root causes including processed foods, toxins, poor sleep, and gut dysfunction, patients often see dramatic improvements across all these seemingly unrelated conditions.
Many "healthy" habits and foods are actually harmful. Excessive aerobic exercise, calcium supplements, seed oils, white rice, excessive fruit consumption, charred foods, and even too much caffeine can all accelerate cardiovascular disease through various mechanisms.
The vagus nerve is the communication superhighway between gut, heart, and brain. Gut dysfunction damages the vagus nerve, disrupting the balance between sympathetic (fight-or-flight) and parasympathetic (rest-and-repair) nervous systems, leading to palpitations, high blood pressure, and poor healing.
Standard cholesterol testing misses the real problem. Total LDL cholesterol is less important than whether LDL particles are small, dense, and oxidized — a marker of inflammation driven by sugar, omega-6 fatty acids, toxins, and leaky gut rather than dietary cholesterol.
Full Transcript
Steven Bartlett interviews Dr. Praep Jamnadas.
Dr. Praep Jamnadas: I've spent the entirety of my career, especially the last few decades, focusing on prevention of heart disease, which is the number one cause of death all over the world right now.
The heart is made up of many parts. It's a pump, so it's a muscle. You have diseases of the muscle — cardiomyopathy, weakness of the muscle — and it's rampant these days. Then you have the arteries on top of the heart, called coronary artery disease. Diseases of the arteries, they block up. Then you have the valves. The valves tend to get damaged as well, for example aortic stenosis. Then you have the peripheral circulation, all the blood vessels that go to your carotids, your brain, your legs, and to all the organs of your body. And then you have microvascular disease, which is the tiny capillaries that become dysfunctional as well.
Steven Bartlett: What's a capillary?
Dr. Praep Jamnadas: A capillary is the branch of the branch of the branch — the tiny little veins, the final ones. When they become dysfunctional, that organ becomes dysfunctional as well. Cardiology affects all these aspects.
Steven Bartlett: How long have you been operating on people's hearts?
Dr. Praep Jamnadas: About 35 years now.
Steven Bartlett: How many hearts do you think you've treated?
Dr. Praep Jamnadas: In excess of 30,000.
Steven Bartlett: What's the age range of those patients?
Dr. Praep Jamnadas: They used to be mostly older people over 65. Now I would say 50% of them are under 65 and 50% are over 65. The demographics are changing. Younger people are developing heart disease.
Steven Bartlett: The youngest patient you've ever treated?
Dr. Praep Jamnadas: Twenty-eight.
Steven Bartlett: What was the predicament in that case?
Dr. Praep Jamnadas: He was having a full-blown heart attack. One of his arteries was completely clogged up. It had a blood clot in it. There was no circulation past that artery, so he was having acute chest pain, sweating, his blood pressure was low. He came straight to the hospital. I rushed there, took him straight into the cath lab, and opened up that blockage. We put a stent in it and restored blood flow to the heart muscle immediately.
Steven Bartlett: At 28, how does one get a heart attack?
Dr. Praep Jamnadas: There's a lot of nuance. Most people don't understand what a heart attack is. In a nutshell, when you have a plaque — a buildup of fibrous material inside the artery — that doesn't cause a heart attack. A heart attack is caused when one of those plaques cracks.
In this diagram, it's showing that the plaque is closing up the artery, which will cause angina — lack of blood supply. This patient may complain of chest discomfort, or he may not, because when you have a blockage like this, only 20% of patients actually get chest pain. You could have a blockage and no chest discomfort. The only way you're going to pick that up is by doing a stress test or a coronary calcium score.
A heart attack is when a minor blockage suddenly cracks. The plaque ruptures, and the blood flowing past it sees the crack and wants to repair it by forming a blood clot. The final thing that shuts down that artery is a blood clot, not the plaque. A heart attack is caused by a blood clot at the site of a rupture, and what causes rupture is inflammation.
Steven Bartlett: When people say heart disease is the number one killer, is it that process causing it alone or are there multiple processes?
Dr. Praep Jamnadas: There's a multitude of things that lead to heart disease. That was a heart attack. You're making plaque — you shouldn't be making plaque. A plaque is an inflammatory area inside your arteries, reacting to something. Inflammation is reacting to something. What is that something? I think it's important for your audience to know what that something is.
You've got this pimple — think of it as a pimple on the inside of the artery. One day when there's enough inflammation in your body systemically, that pimple is going to crack open, just like a pimple on the skin. A blood clot forms on it, and that's a heart attack.
You don't want plaque formation. You don't want plaque instability, which is rupture. You don't want a blood clot to form. There are factors that affect each of these processes, and all three are going wrong today. That's why we have so much plaque formation and instability, leading to heart attacks. Our blood, because of inflammation, is more ready to clot more easily. We're having the perfect storm. That's why we're seeing an epidemic.
Yes, you can have a plaque rupture and have a heart attack, and we put a stent in you. But what did we do to look at the underlying reason why you formed that plaque, why did you rupture it, and why was your blood so prone to clotting in the first place?
Steven Bartlett: Is this an increasing problem?
Dr. Praep Jamnadas: It's a huge problem. Those factors have been identified now, and that's what we go for in my practice. We look for the factors. Why did you make this plaque? Why is there so much inflammation in your body? Inflammation is a reaction to something foreign. What is that foreign stuff? What is that abnormal physiology that your body is reacting against? That's what inflammation is. Whenever there's inflammation, there's increased tendency to make blood clots.
We chase all these things in patients to find out. That's the real prevention.
Steven Bartlett: That 28-year-old that came in — was that a surgery you did?
Dr. Praep Jamnadas: We call it a surgery, but it's an angioplasty. We go in from the wrist or the groin with a catheter — a hollow tube. We put it into the coronary artery, shoot dye inside, and see where the blockage is. Then we thread a tiny wire through the blockage, bring in a balloon, and squash the blood clot out of the way, restoring circulation. Then we bring in a stent — like a spring that opens the artery up. We leave the stent inside, remove everything else, and now you have an open artery with blood flow.
Steven Bartlett: What had that 28-year-old done to end up there? What decisions brought him there?
Dr. Praep Jamnadas: He was overweight, but not just overweight — the weight was all in his belly. He had a fatty liver and visceral fat. He was not diabetic, but he was pre-diabetic. He had a lot of insulin in his body, and his glucose levels were good. If you went to his family doctor, they would say you're not diabetic, your hemoglobin A1C is okay. But that patient had a very high insulin blood level.
Insulin is a very atherogenic molecule. It causes smooth muscle proliferation — smooth muscle is in the walls of arteries. It causes vasoconstriction, makes your blood more prone to clotting, and causes inflammation. This patient was pre-diabetic, and this is crucial.
When I looked at my patients coming in with heart attacks and hardening of the arteries, none of them were diabetics. But I did a glucose tolerance test on them. I had about 120 of these tests in my office to measure blood glucose randomly. I found that at least half of them had no diabetes but were glucose intolerant — their sugars went up but not enough to make them diabetic, yet it did go above the normal range.
We didn't have insulin testing at that time. About 10 years later, we started testing insulin in the office. I bought a machine for this purpose, and life was never the same again.
Steven Bartlett: Why?
Dr. Praep Jamnadas: Because it's all about insulin when it comes to metabolic derangement. I found that these patients' sugars were going up to 150, 160 after giving them a glucose drink. You'd say he's not diabetic, the sugar didn't go very high. But when you measured the insulin level, the insulin was off the roof.
Steven Bartlett: Can you explain glucose and insulin to me?
Dr. Praep Jamnadas: It's crucial. Everybody needs to understand the relationship between sugar, which is glucose, and insulin. When you consume sugar or glucose, the body has to get rid of that glucose very quickly from the bloodstream because glucose is actually toxic inside the bloodstream. Even though it's what the body uses for energy, it glycates all the blood vessels, the walls, the components in blood, and hemoglobin. Glucose attaches itself to molecules. Now that molecule can't work properly.
That's why the higher your blood glucose, all your chemicals don't work well, your enzymes don't work well, your hormones don't work well, nothing works well, and you age prematurely because of glycation. A glycated molecule can't function normally.
When you consume glucose, it has to come out of the bloodstream. The body sends a message to the pancreas. The pancreas makes insulin and pours it into the bloodstream. Insulin pushes the glucose into the cells — into the liver, into the muscles, into every cell in the body.
Now, how much insulin is the question. If I'm eating every three hours, consuming glucose or starchy foods or carbohydrates, I'm stimulating my pancreas, stimulating insulin. My insulin goes up, comes down, but before it even gets a chance to come down, it goes up again. Repeated and frequent consumption of glucose causes my insulin to stay high, because insulin stays longer in the bloodstream than glucose. Glucose comes down in about two to three hours, but insulin stays higher for about four hours.
You continue this lifestyle for a few years. The body — because these are all hormones — will say it needs to make more insulin. You become insulin resistant. Any hormone that stays in your body for a long time, the body becomes immune to it. The next time you eat sugar, you have to make more insulin to produce the same effect. That is called insulin resistance.
You've been eating carbs, sugar, processed foods — foods that are quickly absorbed into the bloodstream, products without fiber. The absorption is very quick. The poor pancreas has to react immediately, produces a whole bunch of insulin. Frequent eating and frequent consumption makes you insulin resistant. Now you produce a whole bunch of insulin to bring that sugar level down.
You say it doesn't matter because the insulin is bringing the sugar level down, your A1C is still good, you're not diabetic. But it's that background high insulin that is destroying your metabolism. That high insulin level in the background is the problem.
Insulin pushes glucose into the liver, and you develop a fatty liver. It pushes calories into production of new fats around your viscera — in your belly, around your pancreas. You get visceral fat. This fat is produced from glucose. It's a different kind of fat.
If I gave you a high-calorie diet of all sorts of foods, you'd put on weight everywhere. But if I give you glucose, you put it on mostly in your stomach. Your stomach will protrude — that's called visceral fat. It's on the inside, around your organs. You can't pinch it. This is very detrimental fat. That's the epidemic we have today.
That's a direct result of eating starchy glucose, carbohydrates, which creates insulin, which creates this downstream effect. Wrong foods and eating too frequently. Before that insulin gets a chance to come down, you're already consuming more food. You develop insulin resistance, get very high insulin. It takes this much insulin just to bring that sugar level down.
Then one day when you cannot control that sugar, the sugar goes out. Now your doctor says you're diabetic. By that time, you've already had 10 years of hyperinsulinemia. By the time you're diagnosed with diabetes, your sugar is really high because your body hasn't had the ability to keep it down. Even that high insulin couldn't keep your sugar level down. You became diabetic.
You lost that whole opportunity of prevention. By the time you're diabetic and you see Dr. Jay in his cardiac clinic, you already have coronary artery disease.
That 28-year-old didn't have diabetes. He already had coronary artery disease. By the time you're diagnosed as having diabetes, you already have coronary artery disease. We have a great opportunity to start screening patients with insulin levels very early on. Most doctors don't have the ability or knowledge to do insulin level testing, but it should be done.
Steven Bartlett: In someone like me, I'm 33 years old now — when does the damage begin?
Dr. Praep Jamnadas: It starts right now. As soon as you're around 30, you're already starting to have trouble. I look at that patient walking into my room. If he's got a belly sticking out, I already know he's probably got insulin resistance because all the fat is there. The fat in the stomach — sideways, he looks terrible. From the back, he looks great. His waist is increased. He doesn't have all the fat everywhere else in his body. That's the phenotype of somebody who has hyperinsulinemia.
That same person goes on a cruise and comes back 5 to 10 pounds heavier because he's got so much insulin in his body. Insulin is a storage molecule. It puts everything away. It's very hard for him to lose weight.
Steven Bartlett: Why is it harder?
Dr. Praep Jamnadas: The only thing that will make you lose that fat very quickly is to change your diet, but you have to do fasting. Fasting brings your insulin level down.
Steven Bartlett: Do you mean fasting or a calorie deficit? Is it the same thing?
Dr. Praep Jamnadas: No, they're not the same thing. When you don't eat, your insulin levels come down because you're not stimulating your pancreas anymore. You want to bring your insulin levels down. The best thing you can do in the world is to do fasting, because there's no stimulation.
If I simply cut down on my calories, there's a different physiology that takes place in the body. When you fast, there's a totally different physiology. When you cut down on calories, the body senses that caloric deficit. Your metabolic rate changes — actually slows down — and the body will start breaking down everything, muscles included. You lose fat and you lose muscle.
On the other hand, when you're fasting, it's a different physiology. Fasting is: I've put on fat, now I'm going to take it out of the bank. The bank is going to be available for me to pull out my calories and use them now. You start burning the fat.
In the first 12 hours of a fast, you take out all the glucose in the form of glycogen from your muscles and your liver. After 12 hours, you start pulling the fat out. The first place the fat comes out of is visceral fat. That's why fasting benefits you so much — it gets rid of that worst fat, the fat that is very inflammatory.
If I did a biopsy of your visceral fat versus a biopsy of fat on your buttock, two different types of fat. One is full of inflammatory molecules. The other is not. One is producing interleukin-6 and tumor necrosis factor. The other fat is not. These are two different fat storages. Visceral fat is very toxic, very inflammatory.
That's why patients who have visceral fat make all these molecules. When I do the blood test, I see so much inflammation. Interleukin-6 is high, tumor necrosis factor is high, your CRP is running high. One of the reasons is not just leaky gut and other things I look at, but you also have ectopic fat.
Ectopic fat — we're realizing now — is not just around the liver and pancreas, it's also around your heart. When we look at the coronary arteries, we see all that fat around them. That yellow is all plaque fat. There's fat around that, and it's plaque-forming, it's inflammatory. Now we can do CT scans that detect how much inflammation is in the fat around the arteries.
Ectopic fat is around the coronary arteries, in your liver, in your pancreas, and it is very inflammatory.
Fasting Protocols and Physiology
Steven Bartlett: On fasting, research shows calorie deficits of any kind can reduce visceral fat, but fasting gives it an edge because of insulin sensitivity. What kind of fast should one be doing? There are so many different names for these fasts.
Dr. Praep Jamnadas: It's a great question. There are many different types of fasting depending on your goal. If a patient is looking to reduce visceral fat, I start with 12/12 — 12 hours you don't eat anything, just drink liquids with no calories, then 12 hours is your feeding period. We do that for about two to three weeks. Then we quickly move to 18/6 — six hours you get to eat, 18 hours it's only water, black tea, black coffee, green tea, no calories.
If a patient is very overweight, has diabetes, and needs to lose 60 pounds, those patients have a special need. For them, I will take them to a 48-hour fast once a week. Sometimes I'll go to a three-day water fast every nine days. Every nine days, you do OMAD — one meal a day only, every day for nine days. Then you give me a three-day water fast.
Steven Bartlett: Is the same advice applicable to women? They're contending with hormone fluctuations, estrogen. I know the female body responds differently to stresses like fasts.
Dr. Praep Jamnadas: I've been asked that question so many times. Most women can actually handle it. The only women that cannot are those who are trying to become pregnant or are already pregnant. Women are not that different when it comes to fasting programs. In my experience, I've been able to get women to fast.
I just finished a fast on one lady for 72 days. She was terribly overweight. She had diabetes, hypertension, hyperlipidemia. She was having hip replacements, knee replacements, joint problems. She had skin problems. We fasted her for 72 days.
Steven Bartlett: What did she have in those 72 days in terms of drinks, electrolytes, coffee?
Dr. Praep Jamnadas: She would have black tea, black coffee, water. In the water once a day, I tell her to put some electrolytes — an electrolyte called Element, or sometimes Celtic salt, half a teaspoon. If you get cravings and feel really hungry, take some MCT oil, a teaspoon, put it in your water and drink that.
Steven Bartlett: Probably shouldn't try this at home without medical supervision. But in the case of that lady, what was the before and after?
Dr. Praep Jamnadas: Diabetes gone, blood pressure normalized, tremendous weight loss — I think she lost about 55 to 60 pounds. Not only did she lose all that weight from her belly, but even her face, under the arms. When you lose weight in a fasting program, it's very different from restricting calories. You actually retract your skin. You get real changes in your entire body.
I had one patient that fasted for 183 days under supervision. He went from 400 pounds to 210 pounds. When he walked into the office, you would not recognize he'd just lost all this weight. He didn't look like skin on top of bones. Fasting is a totally different physiology.
The body is doing a whole lot of things that are very different. We've lost this physiology. One of the things about modern living — we've lost the physiology of fasting.
Why do we still have that physiology? Because it's supposed to serve a purpose. We're supposed to be fasting and feasting, but now we're only feasting all the time. In order to go back to normal, you should be fasting. Fasting is supposed to be a normal part of your existence. That's the way you were designed, not this modern industrialized living we've been doing in the last fraction of a millisecond in the total existence of the human race.
We were supposed to use fasting and feasting as our normal program. That's why we still have it. That's why after 12 hours you start making ketones in your body. The ketones come from fat. You're moving that fat out of storage.
Steven Bartlett: What is a ketone?
Dr. Praep Jamnadas: Ketones are an energy molecule produced by the liver from fat. The fats only start moving when your insulin levels are down. Because of fasting, your insulin levels are really low. Fats start dissolving. You get free fatty acids — fat products. The free fatty acids float into the bloodstream, go to your liver. Your liver converts those into ketones.
Ketones are an energy source of the body, an alternative source to glucose. In general terms, you are either running on glucose and glucose metabolism or you're running on ketones. Ketones basically show up when glucose isn't around.
Steven Bartlett: That's absolutely right.
Dr. Praep Jamnadas: Ketones are actually a cleaner fuel for the body. In terms of producing reactive oxygen species in metabolism, the way your mitochondria work, you actually produce less reactive oxygen species, which is damaging to your physiology, when you're in ketones.
Ketones are signaling molecules that also change your physiology in a number of ways. They cause the production of brain-derived neurotrophic factor. That means you become smarter, you're growing new cells, your reflexes are better, your visual acuity is better. Why? Because nature wants you to become a better specimen so you can go out and get your next kill.
Steven Bartlett: Why don't we all just stay in a state of ketosis if it's so miraculous?
Dr. Praep Jamnadas: That's a great question. You don't want to be in ketosis all the time because that's not what our physiology was made for. You'd just be burning fats, burning fats all the time. That's not a good state to be in constantly either. You want to be able to do both. You're supposed to work with your current account and your deposit account. Both of them. That's normal physiology.
Not only does brain-derived neurotrophic factor increase, but also stem cells. Stem cells are amazing.
Steven Bartlett: What's a stem cell?
Dr. Praep Jamnadas: Stem cells are pluripotent cells produced by the bone marrow. They can go out into your circulation and become whatever they need to become — a muscle cell, a retinal cell, a skin cell. They can transform into anything.
When you break your fast, you get a surge of stem cells coming out of your bone marrow. Some become immunocytes. That's why we know fasting boosts your immunity. People who fast get less infections, less sore throats, coughs, colds, viruses. Immunity is better.
I'm particularly interested in the stem cells because of progenitor cells, endothelial progenitor cells. You're always hurting your blood vessels. The lining of blood vessels has to be constantly repaired by progenitor cells.
When you do intermittent fasting and time-restricted feeding, you produce more progenitor cells. This has been shown in numerous studies. These progenitor cells go and repair your blood vessels. As a vascular doctor, I want my blood vessels to constantly be repairing themselves from the damage we do in day-to-day life.
Stem cell mobilization, brain-derived neurotrophic factor, growth hormone — you make more growth hormone in fasting. When should you exercise when you're fasting? At the peak of your fast. If I'm going to break my fast at 6:00 p.m., I tell patients to go to the gym at 4:00 in the afternoon. They say, "But doc, how can I do that?" You will find that you will put on more muscle and retain more muscle because you have higher growth hormone.
The fastest way and the best way to actually increase your growth hormone production is to do intermittent fasting.
Steven Bartlett: When I sat with Dr. Stacy Sims, who does a lot of work on women's physiology and women's performance, one of the things she said to me is that if a woman in particular tries to do a workout fasted, the body will break down the muscle in a woman because a woman's body is much more sensitive to changes in glucose levels. The hypothalamus is trying to defend against pregnancy, so it shuts down the menstrual cycle if there's not enough glucose in the blood. She said for women in particular, you do want to eat something before you work out or your body will take from the muscle. The body's very sensitive. It won't want to help you build muscle if there's not enough glucose energy in the body. She said for men it's slightly different because we're a little bit more robust and we were meant to hunt. If we were fasted, our body is designed to keep up its normal processes to help us complete a hunt, per se.
Dr. Praep Jamnadas: That's a great observation. What kind of exercise is the woman doing? There are two kinds of basic exercises: aerobic activity and resistance exercises. You can also throw in high-intensity interval training.
When it comes to training I'm talking about in a fasting state, I like resistance training. In resistance training, that glucose issue is not going to become a problem. If you're going to put that female patient on a treadmill and make her run for a long period of time — let's say 40 minutes on the treadmill — I think yes, you're absolutely right. You are going to deplete her glucose and you may cause some problems, and then the muscle will start breaking down.
But I do believe from all the experience I've had with my patients that when I tell them to do HIIT — high-intensity interval training — all the women do just as well as the men, because all you're doing is intensely working the muscles, doing some resistance exercise, and then totally resting. I see fantastic results with that.
Steven Bartlett: In terms of ketosis, do you cycle in and out of a ketogenic diet — a diet that's very, very low in carbohydrates, less than 50 grams a day?
Dr. Praep Jamnadas: Yes, you have to. I don't want them to stay in a ketogenic state all the time. What is your goal here? If your goal is that you need to lose 70 pounds, then you're going to do this till you get to your goal. Once you get to your goal, then you're going to go back to time-restricted feeding, which means 18/6. You'll still make some ketones. Then intermittently, you can still do a 36-hour fast.
Normal healthy people, you and me, we should still be doing one 36-hour fast at least once a month. Fasting must still become part of your program, but you don't need to stay in ketogenesis all the time.
Remember also that when you are in ketogenesis, you are also in autophagy.
Steven Bartlett: What does that mean in simple terms for someone that doesn't know the term autophagy?
Dr. Praep Jamnadas: Bottom line is the cell senses that there are no new parts coming in. It takes the redundant organelles inside the cells, breaks them down, packages them up into little packets, and exports them out of the cells. All your cells in the body are now functioning at a much more efficient level. Mitochondria also have autophagy. You're getting new mitochondria. You're repairing your mitochondria.
It's all about mitochondria, right? Your energy. Mitochondria are those organelles inside each cell. We think of them as only an energy source — oh yeah, my mitochondria make ATP. That's not the whole story. Yes, they produce ATP, but they also produce reactive oxygen species. Thereby they influence the metabolism of your cell as well. They send signals to your chromosomes so you start producing new proteins, new molecules. Your mitochondria are very important.
If you have old mitochondria, you're going to have fatigue, tiredness. When you get autophagy, one reason why you feel so good after a fast is because you have new mitochondria. They are much more efficient in producing ATP and less reactive oxygen species.
You have autophagy, recycling of your parts. Cellular function improves. Toxins get out of your cells as well.
Exercise for Heart Health
Steven Bartlett: Do you think there's a preferable or a best exercise for heart health? My family has a history of heart-related issues. One of my uncles died from a heart attack. I'm very aware of my own susceptibility to heart-related illnesses. There are other people in my family with heart-related issues as well. Is there a particular exercise that is best for the heart? I'm guessing resistance training might not be the number one recommendation for good heart health. You mentioned HIIT. I'm wondering if that's—
Dr. Praep Jamnadas: I'm just going to tell you broadly speaking what I see in my practice. I see that people who overly do aerobic activity — they cycle 100 miles a day or they're running on their treadmill for two hours at a time every day, they're doing a lot of marathon training all the time — they actually end up with more inflammation in their body. They end up with more coronary artery disease than patients who do short sprints, patients who do resistance exercises, and patients who do HIIT.
You need some aerobic training. Why? Because you want to develop some endurance, right? You don't want to be running behind the bus and get short of breath in a few hundred feet. For some endurance, you do aerobic activity. How much aerobic activity, which is running on the treadmill or sprinting? Only about 15 to 20 minutes. That's it.
I tell patients you want to run on that treadmill, you want to bicycle, 15 to 20 minutes, and then you've got to go into resistance exercises. The resistance exercises I have seen work best in my patients are simple things. You don't have to go crazy. You do flow exercises. You use your own body weight as resistance — planks, leg lifts, all these other exercises. You can do HIIT, but they have to be very specific.
You exercise really hard for about 30 seconds to 45 seconds, and then you completely rest for another 30 to 45 seconds. That's allowing your body to clean up the reactive oxygen species you just created through that exercise. Because your rate-limiting step in cleaning up the metabolic mess when you get too much exercise — it's a rate-limiting step. Your glutathione production, your superoxide dismutase production — these are chemicals that clean up the metabolic mess when you get too much activity. That's a rate-limiting step.
When you rest, you exercise and you rest, you exercise, you rest, you are going to get a cleaner physiology.
Steven Bartlett: How many patients do you think you've treated or worked with in your career?
Dr. Praep Jamnadas: Nothing less than a quarter million.
Steven Bartlett: How do you deal with the heartbreak — no pun intended — but the heartbreak of watching people's lives, either them losing their life or their lives being changed permanently forever, or dealing with the families of people who lose their husband or wife or son or daughter?
Dr. Praep Jamnadas: It's very difficult, especially when we've been trying everything and still things can go wrong. Based on that, I've realized that sometimes you can do everything to try to extend life, but you cannot. Life is still finite. We will pass.
But we want better healthspan and we want a longer lifespan. I want to give the patients a better quality of life also. I can't make you live forever. I will see people die. Sometimes they die in front of me while I'm even holding their hands. They'll pass away in the hospital right there.
What I do want to do is to give them a quality of life until then that's going to change. In all this education, it's all so that you can live an optimal life and then pass away just like that.
Steven Bartlett: Have you seen many people that made all the right decisions — they were healthy, they had a good diet, they were doing exercise — and they still end up passing away on your hospital table because of heart-related illnesses?
Dr. Praep Jamnadas: Yes. Yes.
Steven Bartlett: Give me one such example.
Dr. Praep Jamnadas: Typical example of a fellow in his 60s. His coronary calcium score was over 1,000 — that's a CT scan that looks at calcium on the arteries. All this plaque has calcium in it. The more calcium you have, the more plaque you have. He had a calcium score of over a thousand.
I sit down and talk with him: "Tell me why you have all this calcium. No diabetes, no high blood pressure. Doc, I don't even drink. I don't do anything. I don't smoke. I exercise regularly. I go to the gym." The question is, why do you have all this coronary calcium in your coronary arteries?
It turned out that ever since he was a kid, he had a bad microbiome. I found that was the reason why he got it. He was shocked when he left the office. He was totally shocked because he thought that being constipated and having a bowel movement every three or four days is just normal because it was always like that for him. Until I dug into it and found out he's actually got a lot of GI problems, and that's what probably caused him to have inflammation. That's what's probably caused him to have coronary artery disease. That's why he's got all this coronary calcification.
The Gut Microbiome and Heart Health
Steven Bartlett: So let's talk about the gut microbiome then. You mentioned earlier that it's really pertinent in cardiovascular issues. Can you explain to me exactly why and how that happens?
Dr. Praep Jamnadas: The biggest difference between you and your outer environment is actually your gut, not outside your skin. It's actually the gut. There are 100 trillion bacteria sitting in there and probably 400 trillion viruses sitting in your gut. They're not just hitching a ride. There's a symbiotic relationship between the gut and you.
They produce micronutrients which get absorbed into your bloodstream. If the right microbiome is not present, you are being deprived of those micronutrients — for example, short-chain fatty acids, which are special. They also maintain the integrity of the lining of the intestines.
If the lining of the intestines is breached, then bacteria wall products get into the bloodstream, and the first place they'll get to is the liver. Hence you get a fatty liver. There are basically three reasons for fatty liver: either you're drinking too much alcohol, or you get a leaky gut, or you have too much insulin, because insulin causes the conversion of glucose into fat.
Steven Bartlett: When you say leaky gut, what does that mean?
Dr. Praep Jamnadas: Leaky gut is when the microbiome is dysfunctional. The dysfunctional microbiome causes the integrity of your intestinal lining to be compromised. Now molecules that are supposed to stay in the gut — dead bacterial wall products called lipopolysaccharides — they're supposed to stay in the gut, but now they get into the bloodstream. They go up the portal vein, and they end up going straight to the liver. When they end up in the liver, they cause that fatty liver.
Now you get this big fatty liver, which causes a lot of inflammation. A fatty liver — there's an epidemic of this going on today. At least 25% of the population now have a fatty liver.
Steven Bartlett: What is upstream from that? Is it alcohol and all these processed foods?
Dr. Praep Jamnadas: It's basically processed foods, sugar, leaky gut, and of course toxins. Alcohol being the biggest toxin. This is the seat of metabolism. As a cardiologist, I became interested in this because I found that if you have a fatty liver, you're going to be more prone to inflammation and you're going to be more prone to coronary artery disease.
When we fix the fatty liver, we change the diet. You start eating real food and not processed foods and products. When we increase the fiber intake, the good bacteria start coming back into your gut. When I give you certain supplements to restore all your nutrition in your body, then all of a sudden the progression of coronary calcium flattens out.
Let's say you came to me for a test and I did a coronary calcium score and it's 500. Two years from now it's 800. That means wait a second, something's not right here. Your coronary calcium should not be going up. I can't get rid of the coronary calcium because that's plaque in the walls of your arteries, but it shouldn't keep going up because one day it's going to be 2,000.
How do I follow how well my treatment for you is? I follow the coronary calcium score.
Steven Bartlett: The coronary calcium score is a marker of the amount of plaques around the heart and in the vessels of the blood.
Dr. Praep Jamnadas: In the walls. In the blood vessels. You want low coronary calcium. Like my calcium score is zero. You shouldn't have any coronary calcium in the walls of the arteries.
Steven Bartlett: We should probably differentiate between calcium supplements and the calcium you're talking about.
Dr. Praep Jamnadas: Pertinent. Calcium supplements actually increase the risk of cardiovascular events. Calcium supplements should not be taken. The problem is not calcium supplements. The problem is lack of D3 and lack of K2. We shouldn't be taking calcium supplements. Absolutely not. I stop all calcium supplements on all my cardiac patients. I tell them you should take vitamin D3 so you'll absorb calcium better into your gut, and you take vitamin K2 because vitamin K2 is going to make sure that you don't get the calcium buildup in the wrong places, in your vasculature, for example.
Steven Bartlett: Just to give some context on the research, some large observational studies suggest that high-dose calcium supplements — especially above 1,000 milligrams a day from pills — may increase the risk of heart attack and stroke, while others find no clear link.
Dr. Praep Jamnadas: They advise high calcium supplements in women to prevent osteoporosis, for example, and osteopenia. I live in Florida and all these young women come to me in their 30s. They all have osteopenia. The question is that they've got calcium supplements put inside the milk, the orange juice has calcium in it, and they're taking calcium supplements. Then why would they have osteopenia? They have sunshine.
The reason is D3. You need D3 and K2. That's what you need. It's a hormonal thing. It's not the elemental thing.
Steven Bartlett: When people are on blood thinners, do they typically have low vitamin K1?
Dr. Praep Jamnadas: If you're taking Coumadin, which is a type of blood thinner, that lowers your vitamin K1 levels and it'll also lower K2. Coumadin will lower K2 as well. You will get increased coronary calcification. That's been documented. Patients who are taking warfarin or Coumadin have been shown to have increased coronary calcification because the K2 levels come down as well as the K1 levels.
You need vitamin K2.
Steven Bartlett: Do you supplement that or do you get it from dietary sources?
Dr. Praep Jamnadas: I supplement it on all my patients because diet comes from fermented foods. We don't eat enough fermented foods to contain enough vitamin K2. One of the reasons why I do like my supplements is because today's food is not as rich as it was in the past. We're not eating the variety of foods, but also we're not getting enough vitamin K2 in our regular diet.
Steven Bartlett: If you want to give me advice then on having a great gut so that I don't end up with leaky gut which will cause all of these downstream effects, what advice would you give me to have a perfect gut?
Dr. Praep Jamnadas: Number one, lots of fiber, because the fiber is going to be eaten by your bacteria. You're going to get a wide variety of good bacteria eating fiber. If you eat a lot of sugar, you'll get bacteria too, but they are the bad ones, the ones that you don't want. You're going to get a condition called SIBO, for example.
You want to eat lots of fiber. Because our diets today don't give us enough fiber, I do advise all my patients to take inulin with FOS. It's a powder. It's a soluble fiber. I just tell them to take one scoop in your water every day or put it in whatever liquid you're going to have.
Number two, fermented foods. The fermented foods will give you not only the bacteria themselves — for example, kefir has so many different strains of good bacteria — but they also have the postbiotics.
Steven Bartlett: What is a postbiotic?
Dr. Praep Jamnadas: A postbiotic, for example, vitamin K2. It's a product that the bacteria make. Short-chain fatty acids — that's a product that the bacteria make. You want bacteria. You want good bacteria in your gut, and they will stabilize the ratio of all the other bacteria in your gut. The keystone species have to come back into your gut.
Steven Bartlett: I was reading some research around fiber, and it says that in the United States women are 40% fiber deficient and men are roughly 50% fiber deficient. In the UK we're about 40% fiber deficient. I don't think people know that. Where do I find fiber? What do I need to be eating to increase my fiber?
Dr. Praep Jamnadas: Fiber is found in anything that's non-processed, because the very act of a processed food is to take out the fiber so that you can increase the shelf life. Any processed food, anything that's manufactured in a factory, anything that already comes ready-made, they've taken the fiber right out of it.
You've got to eat real food. You're going to eat real vegetables, a variety of vegetables. You're supposed to eat 30 to 40 different types of vegetables a week, and we don't tend to do that. You want fiber from a variety of sources. We've got to eat a little bit of all these different vegetables including spices. They all count as one vegetable.
That's something I stress to everybody: you've got to have variety. You've got to have all these different fibers because they will foster the growth of different types of bacterial species in your gut.
Steven Bartlett: What about lifestyle recommendations for improving my gut? Things like stress, sleep, exercise?
Dr. Praep Jamnadas: Sleep — absolutely important. The next thing is actually sleep and stress. Because lack of sleep causes a change in your gut microbiome. You've got to sleep seven hours a night. Cutting down on sleep is going to affect your entire physiology in your body, your repair processes, your vagus nerve, your delta sleep. But also your gut microbiome.
One night of bad sleep, you become insulin resistant the next day. If you're changing time zones very frequently, the liver dysfunctions and the gut microbiome also dysfunctions. We've got to be more cognizant of that. Lifestyle is very important.
We have to have plenty of omega-3 in the diet.
Toxins and Heart Health
Steven Bartlett: You talked earlier on about toxins. What do you mean by toxins and what role are toxins playing in my physiology and my heart health and my gut health?
Dr. Praep Jamnadas: What is a toxin? A toxin is a molecule that should not be in your body. You should not have been exposed to it. Let's take a pesticide or a herbicide. These are chemicals which man has made and not perhaps adequately tested in rigorous studies. These chemicals get into the body, and we know that many of them are estrogen receptor disruptors. That causes inflammation as well.
If you look at pesticides and herbicides, we look at plastics, forever chemicals — for example PFAS and other chemicals, BPA. These chemicals all disrupt our metabolism in our body. Then of course mold is a toxin. Lastly, heavy metals are toxins.
When the gut is not working properly, you're going to be more prone to toxicity because the gut bacteria normally grab a lot of those things and take them out in your stools. When we look at toxicity, we look at gut health and the liver health. The liver is supposed to get rid of a lot of toxins.
But in today's day and age, because of the foods that we're eating, the environment that we breathe, the environment that we walk out into, we're getting too many toxins. This poor organ is getting overwhelmed and cannot detoxify adequately.
When I do a blood test, urine sample, and a stool sample, I get a very good bird's-eye view of what's going on with their ability to detoxify and which levels are high. I'm finding that many of my patients who have gut issues and liver issues are very, very high with not only heavy metals, but they also have a lot of pesticides, herbicides, and mold in their body.
Mold — I'm finding a lot of mold. Mold and all these extraneous toxicities cause inflammation. Inflammation is a reaction to something that your body shouldn't have.
Steven Bartlett: Where is the mold coming from?
Dr. Praep Jamnadas: Mold is very interesting. I've only started researching it in the last one year. Basically, almost 70% of homes these days have some form of mold toxicity in them, either from previous water damage or exposure. Mold is ubiquitous. It's just about everywhere. It can reinoculate you every time you're in that environment.
It causes your innate immune system to start reacting to it and causes low-grade inflammation in your body. When I get rid of the mold, all of a sudden I'm noticing that the patients are not only feeling better, but the rate of progression of coronary artery disease flattens off.
Steven Bartlett: I have this steam room in one of my houses. I went in there the other day and I could smell it — it smelled a bit funny. I recognized that smell from when I was younger as being mold. I googled it: what is that earthy, strong, pungent smell in my steam room? I think part of the seat has come away from the wall so it's not sealed anymore. I think the moisture has got in there with the water and I think it's moldy.
ChatGPT said smell near the cracks. If it smells really strong near the cracks, then that's mold. I smelled near the crack and it was really, really strong. I remember thinking, had I not known that, I would have been sitting in there 30 minutes a day inhaling all of that strong mold smell. From doing this show, I've learned that the downstream impacts that can have on your body and your cardiovascular health and everything in between is really, really bad.
I had a team come over and just fix everything, repair it, and do a deep clean. But I don't think people are very aware of how mold — which we kind of think of as like the bread has gone green, whatever — can have a chronic downstream impact.
Dr. Praep Jamnadas: Also, this mold can come in and then become part of your microbiome. It can actually come into your gut. Let's say you get out of this place. But if the mold is still in your gut or if it's in your sinuses, for example, and you get chronic sinusitis, you're reinoculating yourself over and over again with this mold.
This is an area of great interest and a lot of research needs to be done. It is real. We've known about it for a long time. The medical profession as a general has not really taken this and run with it, but it is very important. We're certainly looking at mold toxicity in our practice because we find that it is actually more prevalent than we ever imagined before. We know the chemistry. We know that it causes a systemic inflammatory reaction in the body and it's reflected in the blood work. We see that the CRP is up, we see that the complement levels are high, we see that certain ratios of certain inflammatory molecules are off.
We do want to treat mold. We want to treat sources of mold toxicity both in the gut as well as in the sinuses. Yes, people are surprised when I tell them that that affects the cardiovascular health.
Steven Bartlett: When we talk about the clogging of arteries, why is it that healthy people still end up sometimes with these clogged arteries?
Dr. Praep Jamnadas: I think it's because they have sources of inflammation that we have not identified. For example, we say, "Oh, you have no cholesterol, you have no smoking, you're exercising, you're not overweight, you don't have diabetes." Well, then I don't know why you got all these issues. No, there's always — if you dig deeper inside, there's always something. We'll find the source of the inflammation. There's always a reason why you get hardening of the arteries.
Steven Bartlett: What's in that list?
Dr. Praep Jamnadas: In that list is mold. Leaky gut — huge. Food sensitivities. Let me tell you about food sensitivities. Another reason for the leaky gut is that certain foods punch holes into your intestines in a sense and cause a leaky gut.
I've had at least one patient in the last six weeks that I can remember who actually has celiac disease, and he didn't even realize he had celiac disease because he had no constipation, diarrhea. He had premature coronary artery disease. We identified that he had celiac disease. We cut out all wheat from his diet, and that's going to stop this inflammatory process from occurring.
See, it's all about inflammation. We need to get rid of inflammation in order to get rid of coronary artery disease. Any source of inflammation, get rid of the source. If the pesticide levels are high, herbicide levels are really high, get off that source. Maybe you're living on a golf course and you smell those chemicals every day. Maybe you're using it yourself in your yard. Maybe you have toxicity coming from mold as you mentioned.
We've got to find the source of it. A thorough evaluation of the gut microbiome, a thorough evaluation of toxins in your body, and a nutritional status. Your body is able to work and get rid of this type of pathology if you have good nutrition. We don't have good nutrition today.
Nutrition and Foods to Avoid
Steven Bartlett: Let's talk about nutrition then. If I wanted to end up on your surgical table, if that was my goal, what would you recommend that I ate and consumed?
Dr. Praep Jamnadas: You should eat nutrient-deficient processed foods every day.
Steven Bartlett: Give me some examples.
Dr. Praep Jamnadas: Pringles. Things made out of wheat, refined wheat — biscuits, cookies, cakes, lots of bread. Basically, fast foods, foods that come in a box, ready-made food with labels. Anything that comes in a packet that you open up, including some of these high-protein bars or some of these bars, because they have all sorts of other chemicals in them.
I would have lots and lots of artificial colorings in my food, in all those processed foods. Artificial sweeteners, lots and lots of diet drinks and sugary drinks. Orange juice. Orange juice is certainly on my list because that produces such a profound increase in my glucose level, and then my insulin spike that I'm going to get afterwards will cause me to become very hungry three to four hours later.
Yeah, I would not eat real food, and you'll end up on my table. Alcohol, smoking, alcohol. No fiber because none of those foods will have fiber in them. None of those processed foods have fiber.
Steven Bartlett: Your patients must come to you at times and tell you what they're doing in terms of what they're eating and lifestyle choices. There must be certain things which people aren't aware aren't healthy. You actually mentioned bread.
Dr. Praep Jamnadas: Is all bread bad?
No, not all bread is bad. Most bread is bad. I don't mind some sourdough because it's fermented. It's going to get rid of some of those lectins that are already in the flour. Those lectins are gone out because they've been fermented. So it's probably a little bit okay. But again, not large amounts of it. A slice once or twice a week is fine. Really, it's a survival food. Bread is a survival food. Just empty calories. That's all it's going to do.
Steven Bartlett: Is there a worse bread?
Dr. Praep Jamnadas: Yeah. Pure white bread. Simple white bread, pure light white bread. It's pure calories, 70 calories right there. You're talking about just eat — have 10 teaspoons of sugar instead in one slice. It just doesn't make any sense whatsoever.
White rice.
Steven Bartlett: White rice?
Dr. Praep Jamnadas: White rice is a staple food of many people, and they cannot live without it. I run into this problem all the time. I tell them this is what you're going to do: you're going to first and foremost soak your rice in water and then discard the water after an overnight soak because it contains arsenic and other heavy metals. You'll be surprised how much arsenic there's in rice these days. The problem we have is our sourcing of our foods. Here, as a cardiologist, I have to talk to my patients about how to cook rice.
Steven Bartlett: What is arsenic for people that don't know?
Dr. Praep Jamnadas: It's a heavy metal that is found in the soil and the water, in contaminated soil and water. In these paddy fields are now fullof arsenic. It's a poison, isn't it? People — I watch a lot of true crime. People kill each other with arsenic.
Dr. Praep Jamnadas: It's a very, very strong poison and it'll slowly kill you.
Steven Bartlett: Is there anything else on that list of misconceptions?
Dr. Praep Jamnadas: So, the rice has to be soaked. Then you get rid of the water. Then you cook it with lots of water. Throw away the water again — I mean throw away the water, not the rice. And then you cool the rice in the refrigerator and then you eat the rice the next day by reheating it. Now what you've done is you've created resistant starch. What's going to happen is that that rice is not going to have the same insulin effect in your body and weight gain effect and changes in your metabolism because it's now got resistant starch. Resistant starch means that those molecules have all bound to each other. They resist absorption and digestion until they get to your colon. And then who's going to eat it? Your bacteria. So, you're basically feeding the bacteria with your rice. If you're going to have rice, this is the way you're going to do it.
Steven Bartlett: Is there anything else on that list that people should be thinking about that they probably consider to be healthy right now?
Dr. Praep Jamnadas: Yes. It's also what you do to your food. Look, you take a nice piece of fish, for example, and if you burn it and you blacken it really bad, you're creating what is known as advanced glycation end products. You fry something, you're creating advanced glycation end products. Let me define that for you. Nature does not have the ability on its own to take glucose, protein and fat and combine them at very high temperature, but you can do it in your air fryer and you can do it outside when you're blackening your food and over-blackening your food. It's called advanced glycation end products. So when you over-burn your food, when you overcook your food, you're creating these molecules. Now you're consuming these molecules and they have been shown to cause a radical increase in the inflammation in your body because your body reacts to those products. There's receptors to get rid of those — they're called RAGEs — and they get rid of these products. But you overwhelm them and now you get inflammation.
Steven Bartlett: And is there any other watch-out foods that people think are healthy but maybe if I was trying to have an optimally healthy heart, I should avoid?
Dr. Praep Jamnadas: Is this going to surprise you? Excessive fruit, because I'm not a very big follower of fruit. Fruit should be eaten only in season because it has too much fructose in it.
Steven Bartlett: Fructose being the sugars?
Dr. Praep Jamnadas: Fructose is sugar and fructose causes fatty liver. So our overconsumption of fruit is another factor that is contributing to coronary artery disease and diabetes and fatty liver. And we think of fruit as being a healthy thing. But fruit should only be consumed really in the fall and in season and in small amounts because that high fructose level really causes major changes in your metabolism. So, I'm not too fond of fruit. You can eat fruit in season, small amounts of it, but people go crazy about fruit. I had a patient who was having mental problems as well as cardiovascular disease. And that's all he lived on — fruit morning, lunch, and dinner. And the moment we stopped that, his health changed completely. He got so much better. So excess of fruit is also no good. Excessively cooked foods, processed foods, refined products. And another one, vegetable seed oils. So any food that you prepare or you buy that contains vegetable seed oils is a no-no because vegetable seed oils are a product. And if you look at all of them, they're exceedingly high in omega-6. And the ratio of omega-6 to omega-3 is the problem we have today. We have far too much omega-6, very little omega-3. So anything that contains vegetable seed oils.
Steven Bartlett: So I always tell my patients, get rid of that vegetable seed oil bottle from your home.
Dr. Praep Jamnadas: So what oil should I use instead?
Steven Bartlett: The oil at home, if you're going to use any oil, is going to be olive oil, extra virgin olive oil for your salad. And if you're going to do high temperature, put a little pat of butter or use a little bit of ghee or you can use a little bit of coconut oil.
Assessing Cardiovascular Health
Steven Bartlett: This is a bit more of a different question, but you said earlier on that when a patient walks into your office, you can kind of look at them and generally see if their cardiovascular health is intact. And we're generalising here, but if I'm sat at home right now and I'm trying to figure out if I'm healthy as it relates to my cardiovascular health, what are the symptoms of cardiovascular poor health? Throughout the whole body, what should I — obviously don't want anyone to self-diagnose at home, but what kind of symptoms should I be looking at when you look at me? Let's do this on me to make it easier.
Dr. Praep Jamnadas: So number one, look at your weight. If you're overweight, that's one strike against you already. Number two, if you're overweight, where is it? It's mostly on the belly. I'm overweight according to the BMI. But again, you've got to look at BMI — it's a little crude. It's not a very accurate way of actually looking at it because some people are very muscular and the BMI of 28 is actually perfectly okay for them. It's the constitution I look at and it's visceral fat. Now, I can't measure your visceral fat by looking at you, but I can tell if your belly is protruded. Now, in my office, I do visceral fat analysis.
Steven Bartlett: So, what else? I don't have a protruding belly per se. What else should I be looking for to understand if my cardiovascular health is intact?
Dr. Praep Jamnadas: Is there — I know just by looking at you physically. That's it basically — your BMI and your overall weight and you must not have a belly. Just don't have a belly. If you have a belly, you have a problem.
Steven Bartlett: And what about my joints and stuff like that? Is that an indicator?
Dr. Praep Jamnadas: Yes. If you have joint pains, people think, "Oh, it's just degenerative joint disease." In my experience, what I have seen, it's all inflammation. Because when I change the diet, when I fix the gut issues, when I fix the inflammation in the body, they all come back and say the joints got better. All of them, uniformly. Especially patients who have autoimmune disease. For example, many patients have rheumatoid and the moment we change their diet, their lifestyle, the frequencies of eating, introduce a little bit of fasting — we do everything right. We've changed the gut microbiome. We've made the liver better by giving them some supplements. We do intermittent fasting, we do some exercises, we give them some stress management, we improve their sleep. All of a sudden the joint pains get better, rheumatoid gets better, skin diseases get better, psoriasis gets better because the fundamental underlying part is all inflammation.
Bad Breath and the Oral Microbiome
Steven Bartlett: This is a random one, but I'm just connecting dots from different podcast guests I've had on the show. What about bad breath? Is my oral microbiome linked to my heart health?
Dr. Praep Jamnadas: Yes. There's a microbiome that goes all the way from your nose, mouth, all the way down to the anus. And each one is specific and can predict whether you're going to get cardiovascular disease or not. There's unequivocal data to show that if you have bad teeth, bad dental hygiene, bad bacteria in your mouth, you're going to get valvular disease such as aortic stenosis, premature calcification of your aortic valve, and you're going to get coronary calcification. That's been proven unequivocally. Patients who have chronic sinusitis — you think that that's benign? If you have chronic sinusitis, infections inside your maxillary sinuses, frontal sinuses constantly and you get these headaches and you get the cold and your blocked nose and you constantly cough up inside here. That's inflammation. And often times that's also linked to premature coronary artery disease and inflammation in your body. Especially when it's fungal. There's a condition called fungal sinusitis. Again it comes down to mould. And this mould causes that low-grade inflammation in your body. And this has been linked to coronary artery disease. See, what's happening is we're transforming the whole definition of the causes of coronary artery disease. We have been so myopic in our definition of what causes coronary artery disease, whereas everything — your entire lifestyle, mental, physical, eating — everything will affect your coronary arteries. Everything.
Caffeine and Stimulation
Steven Bartlett: Do you think much about overstimulation? I really mean like too much caffeine. Does too much caffeine play a role? And I say this in part because I think there's been a few times where I've had like a pre-workout or too many glasses of coffee and I've got like heart palpitations and you almost like feel like you're dying.
Dr. Praep Jamnadas: Yes. Caffeine is very similar to the adrenaline molecule. Now, why would you want to have too much adrenaline in your body? Because then you're living in a state of existential threat constantly and then what happens? You don't get the offset either. So, you don't get the parasympathetic. You're only in sympathetic all the time. Fight or flight all the time. So caffeine generates that and the physiology — look, caffeine is not as benign as we think it is. Now there's nothing wrong with having one or two coffees a day. That's fine. But I know people who drink about six cups of coffee a day and I think that's toxicity. You see, that's toxicity. Too much caffeine. And it's a diuretic. And a diuretic will cause intravascular volume depletion and that also turns on your neurohormonal activation. So you become more sympathetic. So it's a vicious cycle. Makes you dehydrated. I was reading about this earlier because I did have heart palpitations one day because I think I drank too much coffee. And what I see here in the research says that moderate caffeine is safe and even heart protective for most people. But excessive caffeine when you get, you know, above 600 milligrams a day, can raise blood pressure, trigger arrhythmias.
Dr. Praep Jamnadas: Arrhythmias and stress the heart. Yes. Now, I want to tell you why coffee is good. It's not good because of the caffeine. It's not good that, oh, I'm getting that caffeine, so it's good for me. No, because believe it or not, coffee has a lot of soluble fibre in it. So, there is some soluble fibre in it and it has polyphenols. So, coffee has polyphenols just like how cocoa has — you know, cacao, 85% cacao, chocolate, that's fantastic. It's got soluble fibre because who's going to consume the soluble fibre? It's actually the bacteria. So, a coffee a day is actually good for you for a different reason. It's good because it's good for your bacteria because it's getting soluble fibre and it's getting polyphenols and all those polyphenols are consumed by your bacteria. They call cacao, don't they, the something of the heart?
Steven Bartlett: My girlfriend's quite spiritual and in her practice they call it like the heart medicine.
Dr. Praep Jamnadas: Cacao. It is because it has a lot of antioxidants and it has a lot of soluble fibre.
Steven Bartlett: So wait a second. It's a soluble fibre.
Dr. Praep Jamnadas: Yes, because that's fostering the growth of the good microbiome. The good microbiome is then going to produce postbiotics and the postbiotics are going to give you all the benefit that you're going to need. So, it's going to cause less leaky gut, less inflammation and your enteric nervous system, your vagus nerve is going to be protected because we're destroying our vagus nerve right now with the leaky gut.
Heart Palpitations
Steven Bartlett: When people get heart palpitations, I imagine a lot of them message you because it's quite scary, isn't it, when you feel your heart beating. What is typically going on and when is it cause for concern if you've got heart palpitations?
Dr. Praep Jamnadas: If you have underlying structural heart disease, let's say you have blocked arteries, let's say you have a cardiomyopathy, a valvular disease, and you're having an arrhythmia, which is palpitations, that is definitely life-threatening. They need to come straight to the office and we need to monitor you and find out what's going on. But let's say you're otherwise perfectly healthy, young person, perfectly healthy, no heart disease whatsoever, and you're having palpitations, then it's usually an imbalance of your sympathetic and parasympathetic nervous system. You're too stressed. It's basically either too much sympathetic or not too much sympathetic, but you have too little parasympathetic. And that is one thing that I want people to realise — that if you've knocked your vagus nerve off because you have a leaky gut or because of your lifestyle and your vagus nerve is not working very well, you will have this imbalance because the imbalance is not with absolute levels. It's the relative levels of sympathetic versus parasympathetic. So for example, I see a lot of young women in their 30s and 20s who come to me with tachycardia. They have a rapid heartbeat all the time and especially when they stand up, they get a rapid heartbeat. This is called postural orthostatic tachycardia. And when they come to me, I find out that it's actually the gut. I fix their gut and the tachycardia gets better because by fixing the gut, I'm fixing the vagus nerve. By fixing the vagus nerve, the heart rates come down.
The Vagus Nerve
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Let's talk about the vagus nerve then. Before we do that, I had a little incident actually caused by Jemima who's out there. Jemima, we were in this little fitness competition and Jemima decided that she wanted to beat me and so she cycled 100 kilometres one day. She cycled for 4 hours which meant that she had more minutes in this fitness competition than I did. So my rebuttal was to do the same but more. So the next day I cycled just over 100 km on my Peloton at home. Funny enough, it took me like 4 hours to do it. And then I came off the Peloton. I was celebrating whatever, you know, won this gold medal emoji as my reward that month, but also I won heart palpitations that stayed with me for a little while. And I was wondering like why that happened. So I did this big vigorous exercise which was kind of outside of my usual exercise regime and then for a couple of weeks I could like feel these heart palpitations and is that because of what you were saying about my parasympathetic? What do you think happened there?
Dr. Praep Jamnadas: Yes. Yes. Yes. Over-exercise. This has been shown — when you do what you just did, you're diverting blood from your gut to your muscles because your muscles at that point really need all that blood supply. And this has been well documented. So what happens when you overly exercise like that? You're causing relative ischaemia to your gut.
Steven Bartlett: Ischaemia.
Dr. Praep Jamnadas: Ischaemia. What does ischaemia mean?
Steven Bartlett: Lack of circulation to your gut.
Dr. Praep Jamnadas: Lack of circulation to your gut. So your poor gut at that point had lack of circulation — relative. Not to the point where it's going to go gangrenous. No, don't don't get me wrong. But it affects your gut and in the gut is the enteric nervous system. The vagus nerve ends in your gut lining and the vagus nerve got affected. So your vagus nerve didn't work very well. When you get vagus nerve not working well, you get too much sympathetic. You're going to get tachycardia. You're going to get arrhythmias, palpitations.
Steven Bartlett: So tell me what the vagus nerve is and what I can do to get my vagus nerve in check. By the way, Jemima, it was totally worth it. But just tell me what I can do to get my vagus nerve in check and like what role my vagus nerve plays. I've got this photo here of the vagus nerve.
Dr. Praep Jamnadas: You know, the vagus nerve is fascinating. It is the largest nerve in the body and it basically is sending messages from the brain to the whole body and receiving messages back to say what is the state of affairs and the largest distribution, believe it or not, is all in your gut. Now that tells you something right there — that what is the brain most concerned about? It's most concerned about the most treacherous border in your body which is your gut. Your gut health is so important that the body has dedicated a huge nerve called the vagus nerve just to take care of your gut because your gut is that important. That is why, by the way, it also has endings on the heart, in your lungs, in your face. So there's lots of endings of the vagus nerve and what is it doing? It's basically the communication channel between all your gut, your heart, your brain — state of affairs. What is going on in the gut? What should I be doing? Back and forth traffic, information going back and forth. So the body is supposed to be in a state of sympathetic followed by parasympathetic. What does that mean? You run away from the tiger. You hide behind the rock. The tiger is gone now and now you're supposed to be parasympathetic. So sympathetic is the fight, parasympathetic is the relaxation, rest, relaxation, repair. Guess what? We're not getting enough repair these days because we're constantly in the fight, flight, fight. We never give ourselves a chance to go into repair. That's the problem with the vagus nerve that we have today. So we don't get a chance. So why don't we do it? Well, one is our lifestyle. Two, our gut is not right because it has disabled our vagus nerve function. When I fix the gut, one of the things I notice is heart rate variability gets better.
Steven Bartlett: What does that mean? Heart rate variability.
Dr. Praep Jamnadas: That means your pulse with each breath in and each breath out, there's a little variation in your heartbeat. That's called heart rate variability. Now, when you've lost your heart rate variability, it means that your vagus nerve is not working very well. In all patients, when I fix the gut, the heart rate variability gets better as well. When you fix the gut, your vagus nerve will be able to work more efficiently and you'll be able to repair yourself after the sympathetic drive. So you get the yin and then you get the yang as well. And the nice thing about the vagus nerve that I find is that you can repair it through the gut but you can also hack it and you can give it some nutritional supplements. The nutritional supplements are omega-3 which right now 50% of the population is very low in omega-3 and you need DHA and omega-3 to make the vagus nerve work optimally. You need to fix the gut and thirdly you can hack the vagus nerve.
Steven Bartlett: So how do you do that?
Dr. Praep Jamnadas: You do the breathing exercises. So when you do the deep expiration, you stimulate all those parasympathetic nerve endings and your heart rate goes down, blood pressure goes down.
Steven Bartlett: What kind of breathing exercises?
Dr. Praep Jamnadas: Breathe in to the count of four, breathe out to the count of eight. Very simple. I tell that to all my patients. Breathe in to the count of four. Breathe out to the count of eight. It's a deliberately long expiration. You do that for about 10 minutes a day. And when you do that, your vagus nerve is getting stimulated. And any nerve that is stimulated frequently enough will work more efficiently.
Steven Bartlett: What about this eyeball thing that I've heard you talk about?
Dr. Praep Jamnadas: The eyeball does affect the vagus nerve function too. So when you look to the right, look to the left at the top, look down, look left, it stimulates the vagus nerve. There's a nerve on the ear. There's also the vagus nerve that can be stimulated here in the neck that can be stimulated. The facial nerve also has branches that go to the vagus nerve. So there are a few hacks that people can use. I even have a small contraption that I give patients that they wear around the neck and it releases little signals onto the vagus nerve over here and I've placed it on patients and they'll say, "Oh my God, I really feel so relaxed and nice." And I was shocked when they did that.
Steven Bartlett: I heard you talk about massaging the eyeball.
Dr. Praep Jamnadas: Yes. And cold water on the eyeballs. I don't advise massaging too often, but cold water and gentle massage on your eyeballs stimulates the vagus nerve. And you can do it yourself. You'll notice that if you're on a monitor, you do that, your pulse rate goes down. It's the deep dive reflex that we have in all of us. We dive into water.
Steven Bartlett: What about putting an ice pack on the back of your neck?
Dr. Praep Jamnadas: I think that's fantastic. Back of the neck, but I prefer the front of the neck because the front of the neck, the vagus nerve is very close to the carotid sheath over here. And when you put ice packs on it, the vagus nerve is stimulated.
Steven Bartlett: Humming for 10 minutes.
Dr. Praep Jamnadas: 10 minutes. Both sides.
Steven Bartlett: What do you mean by humming? Give me an example.
Dr. Praep Jamnadas: Humming. That sound is transmitted to the vagus nerve. So, it's like shaking that vagus nerve and it creates electrical impulses in the vagus nerve. That's been shown. Singing, singing, humming, laughing. You know that there are laughing clubs. Maybe you should start a laughing club. Laughing clubs. Laugh for no reason. Just sit there and laugh. So that diaphragmatic movement, that constant diaphragmatic movement in laughing stimulates the vagus nerve.
Steven Bartlett: I heard you talk about this Valsalva manoeuvre.
Dr. Praep Jamnadas: The Valsalva is when you breathe in and then you breathe out, but don't let the air out and you're straining. And that straining compresses the thoracic cavity but also the abdominal cavity and stimulates the vagus nerve. And that is also found to be very, very helpful.
Steven Bartlett: And remind me again if I have a healthy vagus nerve, if I have a calm healthy vagus nerve, what is the downstream impact going to be across my life?
Dr. Praep Jamnadas: Downstream impact is going to be faster healing, less coronary disease, less high blood pressure. Your blood will not be so sticky and make blood clots, less inflammatory markers. The blood tests that we do, the interleukin-6, the tumour necrosis factor, the CRP levels, small dense LDL, we didn't even talk about LDL, but LDL, the bad cholesterol, all those get better.
Understanding Cholesterol
Steven Bartlett: And what is the role of LDL as it relates to heart disease? Because I've heard this word cholesterol. I really don't really understand what it is. I know there's good cholesterol, there's bad cholesterol. I guess that bad cholesterol comes from fast food and processed foods and stuff, but simply what do I need to understand about the role cholesterol plays in heart disease and how to not have bad cholesterol?
Dr. Praep Jamnadas: The LDL carries most of the cholesterol in the body. It's not complicated. LDL is a lipoprotein. And you have HDL which is good cholesterol. LDL, bad cholesterol, total cholesterol and triglycerides. These are the four tests. So the LDL is a reflection of your cholesterol. Now cholesterol is a normal molecule in your body and you should have cholesterol because if you don't have cholesterol, I don't think you'd live too long and you need to move this cholesterol around your body. Every cell in the body makes cholesterol. Your liver makes most of the cholesterol actually. Now what happens is that when that LDL molecule becomes damaged, it becomes a small dense LDL particle. A damaged LDL causes inflammation because now you have a molecule that's floating around your body. It's been damaged. It's small. It's dense. Now your white cells, your macrophages, see that and want to gobble it up. That's number one. Number two, these molecules get oxidised in the lungs and then the first place they come out from after the lungs is the coronary arteries. So it's the small dense LDL particles which are now oxidised — they destroy the glycocalyx which is the lining of the coronary arteries and they activate the endothelium. When they activate the endothelium which is the lining of your coronary arteries, that's when you're going to start getting atherosclerosis. So atherosclerosis and LDL are related but it's not the total cholesterol. It's when you have small dense damaged LDL. So let me explain the impact in my practice. Patients come to me because they either cannot tolerate cholesterol medications or they don't want to take cholesterol medications. What I do then is I look and say okay, your LDL — is it high or low? Is that what I'm really concerned about or is it that it's small dense LDL? So I do a subfractionation and this is important for you to understand because they don't do it in every country in the world. It's very difficult to get some of these blood tests abroad. But in the United States it's easy to do it. It's called subfractionation of your LDL. So it tells you whether you have small dense LDL or not. So let's say you came to me and your LDL is 150. But if it's all made up of large, fluffy, good, normal LDL, it's not going to be implicated in your inflammation or in your coronary artery disease. I leave that alone. But if you have small dense LDL, that also is a problem because it's pointing me towards inflammation. Because what causes small, dense, damaged LDL are glucose, omega-6, advanced glycation end products, toxins, and lipopolysaccharides that come from the gut, leaky gut. So now I just gave you the primer for treating coronary artery disease. These five things promote coronary artery disease and it's small dense LDL. Those macrophages engulf small dense LDL and those macrophages become foam cells. The endothelium has already been activated. So they bind to the endothelial lining.
Steven Bartlett: What's the endothelium?
Dr. Praep Jamnadas: The endothelium is the lining of the artery in your coronary artery. So these white cells that are full of fat, the bad fat, attach themselves to it and then become endothelialised. That means they become part of the wall.
Steven Bartlett: So they become a plaque.
Dr. Praep Jamnadas: That's it. Now you got it. That's making the plaque. You just hit it right on the head.
Steven Bartlett: So how would I naturally lower my LDL without taking statins or any of these other medications? Is there a way to do it naturally?
Dr. Praep Jamnadas: You stay away from meat.
Steven Bartlett: Yes.
Dr. Praep Jamnadas: You've gone on a vegetarian diet.
Steven Bartlett: Yes, it'll come down.
Dr. Praep Jamnadas: But there's no need to.
Steven Bartlett: Or meat.
Dr. Praep Jamnadas: Or meat because they'll all have cholesterol. Even chicken.
Steven Bartlett: Even chicken.
Dr. Praep Jamnadas: Yeah. If you want to bring it down. But the question is, do you really want to bring it down? Do you really want to bring it down? The most recent data is very scary. It shows that patients who have the highest LDLs actually make it into the 90s and live a healthier life. It's not the LDL, it's the damaged LDL that's the problem. So the medical profession as a whole and all of us are having a problem grappling with this. Is it the total LDL that we should be concerned about? Pertinent to your question. What is a normal cholesterol and should we be lowering cholesterol and the answer really is not that simple. What we should be doing is not to have small dense LDL. So the question is that's the issue and small dense LDL — five things. Sugar causes it. Omega-6, advanced glycation end products, toxins, and leaky gut. They make your cholesterol become small, dense particles.
Steven Bartlett: A lot of people are concerned about eating eggs because they think it might raise their cholesterol levels.
Dr. Praep Jamnadas: Absolutely no concerns whatsoever.
Steven Bartlett: And what about statins? So a lot of people are prescribed statins when they have heart related issues. Are they safe in the long run? Are they effective?
Dr. Praep Jamnadas: Okay, first part, are they safe? For the most part, they are. But at least 20 to 30% of patients will suffer from sarcopenia which is loss of muscles. So they'll get weakness, aches, pains. They'll get diabetes because it causes mitochondrial dysfunction. So they'll develop sugar problems and many of them also develop cognitive diseases. So I've seen that they become forgetful and they just can't think right and I stop the statins and all of a sudden they start feeling better. So no, not all statins are safe. You need to monitor statins also. They can cause liver dysfunction. So you need to watch that. Number two is that the statins — are they effective? Effective in what? If the end point is to reduce your LDL, yeah, statins will bring your LDL down. But does that translate to a decrease in cardiovascular event rates? That's a totally different question. You see? So, is your goal just to reduce the LDL or is your goal to reduce the damaged, oxidised, small, dense LDL levels?
Blood Pressure
Steven Bartlett: And when people say they have high blood pressure, that's because there's potentially a narrowing of their blood vessels. So, the blood has less space to go through. So, it's kind of like squeezing a hosepipe so it shoots out faster. Is that typically what it means by high blood pressure?
Dr. Praep Jamnadas: Sort of. Let me explain. When your insulin levels are running high, all your blood vessels and your capillaries all don't vasodilate properly.
Steven Bartlett: And vasodilation is the expansion and shrinking.
Dr. Praep Jamnadas: Yeah. So, they don't vasodilate properly. So, you will get high blood pressure. So, one of the biggest things I've noticed with diabetes patients is when I bring the insulin levels down through my fasting programme and dietary changes, the blood pressures go away. See, that's another thing — there's no such thing as essential hypertension. Essential hypertension meaning that you just have high blood pressure. There's always a cause. Either you have sleep apnoea or you have hyperinsulinaemia because sleep apnoea also causes hypertension. So hypertension does not always necessarily mean that you're going to be committed to blood pressure medications for the rest of your life.
Breakfast Advice
Steven Bartlett: I've heard you talk quite a lot about breakfast. People ask you about what they should have for breakfast because everybody wants to know how they should be starting their day. What is your advice on what we should be eating for breakfast to have a healthy heart and cardiovascular system?
Dr. Praep Jamnadas: Breakfast is a tough one. I tell most of my patients that if you absolutely have to have a breakfast, have a couple of eggs and if you are a vegetarian, it makes it a little bit more tough. But you can have some kefir with two to three strawberries, two to three blackberries, and about four blueberries in it. And then you put your inulin powder in it and that's your breakfast. That's all you should have. But a heavy breakfast — and also breakfast in my opinion — breakfast should be — we should skip breakfast for most adults and just go for lunch and dinner only because then you can do your 18–6. If you absolutely are going to have breakfast then you have breakfast and lunch and then no dinner. But you've got to plan 18 hours. 18 hours is optimal and we can do it. A lot of people say they can't do it, but most of us can do it. You will notice how much more energy you have. You know, when I do my OMAD, which I do at least 3 to 4 times a week, which is one meal a day, at 6:00 in the evening, I actually have more energy than I do in the morning.
Dr. Jamnadas's Personal Diet
Steven Bartlett: What does your diet look like, doctor?
Dr. Praep Jamnadas: My diet? I do eat meat and I do eat fish, chicken, and turkey but I source it right. Always make sure that it's grass-finished. Always make sure it's organic and I'll have small amounts of it.
Steven Bartlett: Grass-fed, grass-finished. What does that mean?
Dr. Praep Jamnadas: Grass-fed just means they took it out one day and put it out in the field and they fed it some grass. So, this advertising that industry does is a little deceiving. And I had to investigate this to find out. It's a lie. It has to be grass-fed from beginning to end. So then it's going to have more omega-3 in it. It'll have more K2 in it. It'll have more nutrition and have less toxins also in it. Less omega-6 because if your cows are eating corn, then you're going to get all that omega-6. And the cow is not supposed to be eating corn. Cow is supposed to be eating grass. So I do eat some meats and I eat some vegetables with it. Coming from a background, my great-grandfather's from India. We do eat Indian food as well. So we have some lentils and some curries of course. We can cook the meats in a curry form as well. I don't eat much chapatis because those are very full of carbs. I love the taste of it. I love naan once in a while.
Steven Bartlett: And what do you supplement with? What's your supplement stack look like?
Dr. Praep Jamnadas: I take D3-K2, omega-3 fish oil. So I take two capsules every day. Vitamin C 1 gram, inulin, kefir. I drink that every day and I count it. Magnesium and I take nattokinase. Nattokinase I take about 8,000 units a day. What it is is that it does thin the blood a little bit so that you're less likely to make blood clots. Part of metabolic syndrome is a tendency to make blood clots and have a high fibrinogen level. My fibrinogen level was at the upper limits of normal. So I just take nattokinase. It doesn't cause any bleeding or any problems like that. And then I also take a probiotic and it's basically called Megaspore Probiotic. So it's spores. There's no real bacteria in there. It's all spores.
Steven Bartlett: What's a spore?
Dr. Praep Jamnadas: A spore — a bacteria can survive by sporulating. So it becomes a spore. So it's no longer a bacteria, it's a spore, but it'll germinate under the right circumstances. So these little things, they are the spores of the bacteria that are in soil. So soil has certain species of bacteria, the Bacillus species. The spores I consume, they go in my gut because remember if I take a probiotic, the acidity in my stomach is going to kill most of the bacteria. So what does a spore do? The spore passes through the stomach, goes all the way down to your intestines and then it germinates there. It grows there. So now the spore becomes a bacteria. So it gets past that acidity of your stomach. So, I do take that as a supplement as well.
Final Questions and Testing
Steven Bartlett: Dr. Jay, what is the most important thing we didn't talk about that we should have talked about for the people at home that have clicked on this episode? And you know, I guess one way that you might tackle this question is just by thinking about the most popular questions you get asked from your audience on a daily basis that we might not have covered today.
Dr. Praep Jamnadas: How can I screen myself right now? What test should I do right now to see at what stage of inflammation and coronary artery disease am I in? Because coronary arteries is the number one cause of death and inflammation is the underlying cause. So what test should I be doing right now? That is an important question. If you're over the age of 30 and you have concerns, one, get a coronary calcium score. If your coronary calcium score is zero, you have no calcium, then you're in a good place. If you have coronary calcium, you need to go see a good cardiologist that's going to do a prevention programme because it means you already have atherosclerosis.
Steven Bartlett: Atherosclerosis meaning plaque?
Dr. Praep Jamnadas: Hardening of the arteries. Number two, you need a good blood test to look for inflammation. The blood test that I order is called a Cleveland Heart Lab. In it you get your HDL, LDL, cholesterol. But you look at particle sizes. Is my LDL small dense? If it is small dense particles, is it oxidised? Yes, I have a problem. My CRP level, other inflammatory — interleukin-6, tumour necrosis factor, haemoglobin A1c, sugar level, all these are part of that panel of tests. So you should get a good inflammatory panel which is the Cleveland Heart Lab. So those are the two things that everyone must do. Get a coronary calcium score, all adults, and do an inflammatory panel. Inflammation — you've got to know whether — look, you know, you may not feel inflammation. It's not like you get a big pimple and it's going to hurt you but if you have inflammation in the body, yeah, you could know about it. How? You have mental fog. I'm not optimal, doc. My memory is going down. I'm depressed. Depression is inflammation. Depression is not something psychological. Now, this I have to stress to you and I tell all my patients, you come in, I'm depressed. You're depressed because that very symptom of depression is a symptom of your inflammation. You can't be depressed about something — oh my car is not working very well. That's a difference from depression. Depression is inflammation in the brain. So you'll be surprised how many patients go on my anti-inflammatory diet, which is I change the diet and fix them all up, and the depression goes away. So ask yourself not just questions about physically how you're feeling but mentally also. And if the answer is that doc I'm not optimal, I'm forgetful, I'm depressed, I'm having sleep disturbance, I'm having relation things, my body — you have inflammation.
Closing Question
Steven Bartlett: We have a closing tradition on this podcast where the last guest leaves a question for the next guest not knowing who they're leaving it for and the question that's been left for you is what was the most difficult day of your life and how did you overcome it?
Dr. Praep Jamnadas: The most difficult day of my life was a very personal one for me, you know, when my dad passed away and you know, and I'm Dr. Jay and when he was sick and he didn't want to go to the hospital and then he passed away in his sleep and then you always ask yourself, could I have done something differently? You second-guess yourself and that second-guessing happened with him — of course it was very, very painful — but it happens with patients as well. But how did I overcome it? It taught me a lot about my own limitations as well as a physician, as a son, as a scientist, as a reader and that's why I'm motivated to do what we are doing here also — is to do the best you can to educate people.
Steven Bartlett: What was he sick with? What was his predicament?
Dr. Praep Jamnadas: He was a cardiac patient already and he's got a very interesting story actually. He was told that he only had a few years to live after he had bypass surgery. But then I put him through all the things we talked about today. He lost a lot of weight. He went from 185 lbs to 135 lbs. He changed his diet and he lived another 30 years and he did another six world tours and travelled and he had a wonderful life. The impact of simple things that we can do to change his life. So he stopped drinking all alcohol as well and he really had a very clean diet and everything else. But that night he came down with some sort of infection. He had massive diarrhoea and massive explosion. And I think that what really happened is he got overwhelmed. You see it's the gut. He got overwhelmed with a toxin from his gut and then he passed away. But here's a man who lived to 89 who was supposed to have passed away in his 60s and the impact — but the thing is that we shouldn't second-guess ourselves. We don't want to live in the past. I want to live in the present moment, not even in the future. So all these things have taught me to live in the moment. And one of the skills I've developed is just that — that when I'm with you, I'm only with you. If I'm doing your surgery, I'm only doing your surgery. If I'm having a conversation with you, you and I are the only people that matter right now. And this being in the moment, that ability to be — that is something I learned over time because before, you know, something bad happens, your next case, you're still reminiscing about that and you're regretting that. You can't do that. Life is only expressed in this moment right now. So learning how to live in the moment applies not only to me but to everybody. We're all living in the past otherwise or we're worried about the future. So how do you learn present moment awareness and live in this moment so that we will be happier? We can do what we want to do. Make the changes we need to make. Get the courage and make and have the willpower to go out and make a difference to yourself and to everyone around you starts with you being here. Are you here or are you in your past or have you gone off into the future? That's a skill that medicine has taught me and I've become humbled by it. And this is something that I have learned and I want to pass on to all my patients too as well — that okay you've got all these things going on but learn to live in the moment.
Steven Bartlett: Dr. Jay, thank you so much. Thank you so much for the wisdom that you've shared with so many people. If people aren't familiar with you, you're extremely prolific and well loved across the internet for the public education work you've done and the heightening of awareness of people's heart and their cardiovascular health more broadly. And until really before you started making videos online, a lot of this stuff was opaque. It was a mystery to a lot of people. And your YouTube channel has almost a million subscribers now. And you go through some of these subjects that we've talked about today in even greater detail. So I'd highly recommend people go and check you out there. But also just thank you for saving so many people's lives because, you know, that's what you do day in day out and that's an incredibly — I mean there's probably not a higher calling one can answer. So thank you for doing what you do and I can see now why people love you so much online and on YouTube because you're so incredibly engaging, I guess is the word, engaging, wise, and you make the information accessible in a way that I don't think has been done before. So, thank you so much. It's a pleasure to meet you and to have this conversation with you, and thank you for enlightening my audience.
Dr. Praep Jamnadas: The pleasure was mine. Thank you.
Steven Bartlett: This has always blown my mind a little bit. 53% of you that listen to the show regularly haven't yet subscribed to the show. So, could I ask you for a favour? If you like the show and you like what we do here and you want to support us, the free simple way that you can do just that is by hitting the subscribe button. And my commitment to you is if you do that, then I'll do everything in my power, me and my team, to make sure that this show is better for you every single week. We'll listen to your feedback. We'll find the guests that you want me to speak to, and we'll continue to do what we do. Thank you so much.