So at a very high level, doctor, could you describe each of them?

Sure.

Well, I would introduce that this is all evidence-based, and I didn't arrive at this overnight.

This was decades of understanding my own work and the work of many others and just following what was going on.

But early on, I became very interested in my medical career as to really defining what is health.

I knew what disease was, but I thought we were very vague about health.

And I came to this realization that we can be extremely objective about this.

So what does the science tell us about social isolation and how it affects the heart and the cardiovascular system?

[laughs]

But [laughs] that was, let's say, the first thing unintended.

But in my third year there, there was data that had come out which was stunning at that time in the cardiology world.

We had this new opportunity to look at people's electrocardiogram, not while they were in the hospitals, you know, lying down, but actually while they were engaged in their daily life activity.

It was called ambulatory electrocardiography.

And this new data was showing to gene-- that it was patients who were having these abnormalities on electrocardiogram, which signified lack of blood supply to the heart occurring transiently while they were driving the car, while they were doing household activities and, and other things that did not appear to be at least physically stressful to patients.

So I got this idea.

[laughs]

What's changed biologically, culturally that's transformed heart disease into the metabolic and behavioral crisis that we're seeing today?

Yeah, well, that's a great question.

If you look back in the 1960s, maybe your listeners don't know today, but heart disease grew in epidemic fashion throughout the 20th century.

And by the 1950s and 1960s, it was at its peak.

And at that point in time, sudden death was very common, and we had very few tools for treating heart disease.

In the 1960s, close to 50% of men in the country were smoking.

I think it was like 38% of women and often, you know, many pack years of smoking.

Can you can you walk us through this model and and maybe even when did you start putting this together? Was that I'm assuming this was over some period of time or maybe it came to you in a flash?

Where did you sort of start to come up with people are lacking this sense of purpose? Yeah.

Yeah, so that's a great question.

So what happened was that for maybe a decade or so, I was just focused on what are the negative things that can damage the heart or impair your health.

And we weren't looking at the flip side.

What are the positive things that can protect your health? And then I realized, gee, you know, you can use the body as an objective Geiger counter.

The body testifies as to what's unhealthy or what's unhealthy.

What's healthy are those things that protect the physiology, decrease the risk of disease, and enhance longevity.

Physical

I'd love to hear a little bit about these six domains that you put together.

Sure.

So I define these six domains of health, and they're based on just a simple understanding that I, again, evolved over years, which was to say, we don't have to have a debate.

You know, everyone can create a health model and say, this is important or that is important.

And that's actually what many people do, and it's confusing to the public.

But I realized that you can just use the body itself to testify as to what's healthy.

Anything that promotes longevity, that decreases your risk for disease, that protects your physiology is healthy.

uh summarize from from the conversation

That's number

one.

But it's very important to understand why this was happening.

So I had access to my nuclear cardiology technology to look at this.

Just for your audience, what we do with nuclear cardiology, we'll inject patients with an isotope that either can look at the wall motion of the heart.

or look at the blood flow to the walls of the heart.

So in this particular case, we're working with something called exercise radionuclide ventriculography, where we would put people on a bike, and when they would exercise, the walls of the heart will be more vigorous.

holistic, you know,

Soft,

yeah.

And that's important, but actually obstructive disease, in terms of something that might limit blood flow to the heart, with exercise is maybe seen in 2% of patients who have a calcium score of zero.

So it's a pretty fantastic test.

Now, the gray zone is, okay, I got a somewhat elevated cholesterol, but my calcium score was zero.

Should I go on the cholesterol medication? That's your question, correct? Yeah.

So here it's a gray zone because if you take people, and this was actually work done by James Min a number of years ago, where he took people I don't know how he got the study done, but he did calcium scores every single year for five years.

And is that a misapplication of the screening? Is that something that is advisable for people to do past a certain age? Or should it be used as the occasion dictates? If someone says, I'm getting shortness of breath as I walk up my driveway, or my exercise capacity is decreasing, or I get these funny twinges in my left shoulder, how do you know when to do it?