Dr. Howard Elkin discusses Coronary Artery Disease and How to Prevent it with Dr. Ben Weitz.

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Podcast Highlights

3:55  Myocardial Infarctions.  A myocardial infarction, aka, a heart attack, is the end result of a plaque in an artery becoming unstable and rupturing, resulting in no blood going beyond that clot.  Plaques build up in the arteries over time and we don’t know what makes a stable plaque into a stable plaque.  While it was thought that about 25% of heart attacks are silent, a recent analysis published in a Harvard Health letter found that up to 40-45% of heart attacks are silent. [The Danger of “Silent” Heart Attacks]  Such silent heart attacks are usually smaller, which means that a smaller amount of damage occurs to the heart muscle. But a small heart attack will often presage a larger heart attack. We actually don’t know why or how chest pain occurs, since there are no sensory nerve fibers in the heart. Diabetics have a larger percentage of silent heart attacks and diabetes is still on the rise in the US, which is why the number of silent heart attacks is increasing.

8:35  After taking a careful history, if you suspect coronary heart disease as a result of a constellation of symptoms, including chest pain, shoulder pain, arm pain, jaw pain, shortness of breath, fatigue, nausea, and it could present as digestive symptoms, then Dr. Elkin will employ stress testing.  Stress testing means doing either a stress echocardiogram or a nuclear stress test, which adds about 15% more sensitivity to stress testing.  A stress echo is more accurate than just doing a treadmill test.  A stress echo involves doing an echocardiogram to see how the heart functions while at rest and then how if functions after exercise.  If an area of the heart wall is not contracting well, then that indicates that there’s not enough blood flow going to the heart.  A nuclear test involves a nuclear (radioactive) pharmaceutical and it is done at rest and if there’s an area of the heart that doesn’t take up that pharmaceutical, then that’s another suggestion that there is a blockage.

10:40  Given that our body is designed (through evolution) to help us survive, why would our body form these cholesterol plaques in our arteries that can kill us?  The body is responding to inflammation in the artery walls and the cholesterol plaque is coating the arterial wall and protecting it from the inflammation. The inflammation could result from food sensitivities or toxins or chronic infections.  Dr. Elkin explained that when he was studying cardiology in school there was no knowledge of inflammation. They were taught that cholesterol was bad and that you had cholesterol plaques that would get more and more narrow until they led to choking off the blood supply, causing a heart attack. But that really isn’t the true story and most heart attacks are usually with blockages that are less than 50% of the width of the inside of the artery.

13:13  About 50% of those with heart attacks have normal results on standard lipid testing, which is why we want to do advanced lipid testing to pick up additional cardiac risk factors. A number of labs offer advanced lipid testing and Dr. Elkin prefers to use the panels from Boston Heart Diagnostics and Cleveland HeartLab. The standard lipid panel (total cholesterol, estimated LDL, HDL, and triglycerides) is very limited.  An advanced lipid profile will include the standard, plus LDL particle number, aka LDL direct, which actually counts the number of LDL particles,

Dr. Vincent Pedre discusses Small Intestinal Bacterial Overgrowth with Dr. Ben Weitz.

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Podcast Highlights

4:37  Dr. Pedre had gut problems himself for years that he believes stemmed from taking many rounds of antibiotics–two or three courses of antibiotics per year as a child for various infections, such as a throat infection, bronchitis, or sinusitis. They would also sometimes give him a gamma globulin shot and this would make him feel better for a while.  By the time he was 17, Dr. Pedre had taken 21 courses of antibiotics, which took a toll on his microbiome.  Dr. Pedre developed dysbiosis that led to leaky gut that led to becoming reactive to foods like gluten and dairy.  When Dr. Pedre became a doctor, he wanted to figure out why he felt so sick, which is what led him to focus on gut issues.  As he treated patients with gut issues, he came to realize how many other health issues are connected to the gut.

10:30  Taking a thorough history is the most important factor in patient care.  The history can then help guide your choice of testing. Should I get a breath test to confirm a suspicion that the patient has SIBO. Should we also order a PCR based stool test because there might also be a parasite or yeast overgrowth. Or should I order an organic acids test to get a broader look at metabolites and better be able to rule out fungal overgrowth.  For stool testing, Dr. Pedre switches between both Diagnostic Solutions GI Map and Genova’s GI Effects, which both have their strengths.

23:20  Treatment protocols for SIBO.  Dr. Pedre believes in starting with diet first. He used to use the low FODMAP diet, but now he uses Dr. Siebecker’s SIBO Specific Diet, which is a little less restrictive than the strict low FODMAP diet. Intermittent fasting can also be helpful to have periods when the gut can rest. Dr. Pedre will often put SIBO patients on Rifaximin at the same time as the SIBO diet but he will also put them on Slippery elm bark as a prebiotic to make the bacteria easier to kill.  This avoids Dr. Pimentel’s concern that placing patients on a low fermentation SIBO diet will starve the bacteria and make them harder to kill. Dr. Pedre has found that patients with SIBO tend to be type A personalities, high achievers, who tend to be anxious, and this tends to affect vagal tone and decrease gut motility.  He recommends patients improve vagal tone through things like gargling, humming, and he recommends spore based probiotics.

29:44  Spore based probiotics. Dr. Pedre has found that many of his patients with SIBO do not tolerate typical probiotics, such as acidophilus, esp. at higher dosages, but they tend to do well with spore based -probiotics. One reason that spore based probiotics may help SIBO patients is that many also have fungal overgrowth (SIFO).  He believes that this may be why patients who get treated with Xifaxan get better and then a month later, their symptoms come back.  Spore based probiotics do quorum sensing to group together, and they produce other active compounds, enzymes that can break down biofilm, called bacteriocins, which are like local antibiotics that inhibit other species from growing.

32:45  Biofilms. If you have a treatment resistant SIBO patients, then you should consider biofilms and you can use things like Serrapeptase to break down the biofilm and use that on an empty stomach.

34:41  If Dr. Pedre does not use Rifaximin, he may use natural anti-microbials like Candicid Forte. But yeah, they include berberine, caprylic acid sometimes mixed in with some artemisinin and black walnut.  Kind of broad spectrum herbals, olive leaf extract, all these things.