 Thank you. Good afternoon everyone. It's an honor and pleasure to be here and I'd like to thank the organizing committee and volunteers for the opportunity to be here and talk about this topic I'm really excited to share this information with you and I look forward to a discussion and dialogue afterwards This is my disclaimer the comments and statements of this presentation are solely my own and in no way reflect my employer or other Medical establishment So what is a cardiovascular surgeon? This is a typical day for me seeing a patient. That's having a serious heart event Evaluating them and working with a team of physicians and nurses and actually operating on them to Help them and this is an example of an open heart surgery And this is what I'm looking at most of the time so I actually get the opportunity to touch and feel the manifestations of heart disease and Through that it's really intrigued me obviously about the causes of heart disease, but also Interventions we could possibly do to help patients that both have heart disease as well as to prevent heart disease So why am I here? Well, nothing is more rewarding to me than being able to help a patient That's in a very serious medical condition Do an operation and see them recover Over a several week period of time and get back into normal vigorous healthy lifestyle And that is very rewarding to me, but obviously there's probably more to the story than just physically Correcting surgically the situation. There's got to be more to the story about prevention as well as a treatment and so I think that there's This is where a great opportunity lies with the ancestral health society and symposium And I think there's more to bring to the table Literally than just our scalpel and other medical interventions And so there we're all familiar with farmed a restaurant or farm to table Concepts now, but I think there's a new concept in farm to table health care and that's where we can implement many of the nutritional advances Science and research that is being published and and many people are working on and try to integrate these in a constructive way Into health care to to make a difference for our patients. So this talk Is really I'm going to talk about evolving health care environment and how the whole Paleolithic ancestral health movement Works with this. I'm going to talk about the evolutionary origins of heart disease I'm going to talk about the emerging new paradigms for causing and understanding the cause of heart disease And then most importantly, I want to wrap up in this may be where's a lot of our discussion lies But answer the question of how we can help patients and physicians better communicate We with each other about emerging and ancestral health data For those of you who haven't seen this book aren't familiar with this as a new publication But it's it's a wonderful manuscript By dr. Eric Topol one of the leading Cardiologist in the United States, but he wrote this book recently called the creative destruction of medicine how the digital revolution Will create better health care, and I think it has huge implications about how health care is rapidly undergoing Evolution and I really encourage you to take a look at it not just from an ancestral health standpoint But from an overall health care environment standpoint in this Book or he mentions that in old mass medicine We treat all patients with the same diagnosis with the same drug at the same dose And we do screening tests for all patients for a condition even though only a tiny fraction are even at risk He also says when you can sequence a whole human genome or track every vital sign and physiologic metric Continuously via wearable biosensors, and we can make quantum steps forward to understanding the essence of what makes each individual tick The science of individuality and new and any new practice of precision medicine compared with today's population Medicine so this is where we're evolving, and this is where I think we need to begin to integrate A lot of these concepts into health care because they have the opportunity exists It's not just ancestral healthy obviously the digital revolution is changing the way we practice and it's certainly accelerating change But we also know that patients are no longer willing to just accept what the doctor tells them They are doing their own research and questioning everything so patients are coming in better informed and actually Questioning the doctor about why are you prescribing this or why aren't you doing something and we as as physicians and health care providers need to be knowledgeable about the type of a role that our patients are doing in driving their own health care And I think this consumer-driven health care the opportunity exists to engage physicians and other health care professionals in a dialogue Of the scientific merits of an ancestral health approach, and this is that precision medicine that doctor Topal Mentioned and I think this is where we can begin in that dialogue because that dialogue already exists and we can just Further enhance that Well, you've heard a lot in this conference in some from some of the previous speakers about many of the evolutionary origins of our health, but I think that many of us are familiar with the Advent of agriculture called the Neolithic transition that happened around 10,000 years ago and it began in the fertile crescent of Egypt and We knew that are we know from study that those that that agriculture revolution Led people to be more prone to disease. There was increased skeletal lesions perhaps from an increased infectious disease from study of Our ancestors they know that those patients are those people live shorter lives They were less well-fed. They had chronic malnutrition and smaller stature all as a result of the Neolithic transition in one of the very first descriptions confirm descriptions of heart disease began in ancient Egypt After the obviously an advent of the agricultural Transition and we know this from the papyrus Manuscript and this is a quote from that said if thou examines a man for illness in his cardio And he has pains in his arms in his breasts and on one side of his cardio is death threatening him And that description is actually quite accurate to what we have in many of our textbooks today Well, I want to highlight this study if you haven't seen it because for me. This is a really important study in Where our evolutionary? History has impacted our health in modern society and This study called the Horus study looked at 52 Egyptian mummies and the reason that they used Egyptian mummies was this was the very first and earliest preserved Humans that we have obviously everything for that was Archaeological and bits and pieces out of the sand and dirt, but here we have the earliest preserved Humans and some of these humans from the mummies were dating back to about 3,500 BC So about 5,000 years ago and they took these mummies and actually put them through a CT scanner and with that diagnostic tool looked at the hearts of these mummies to see what what had what transpired or what shape those hearts were in and 44 of the 52 mummies actually had a preserved heart and 45 percent of those that had a preserved heart had cardiovascular disease and this is a 50 5500 years ago Here's an example or picture of this actual study and you could see here that this is very consistent with what I would see on a cat scan In in many of our today at population today, and you could see here Here's some disease in the left domain coronary artery As well as in the superficial femoral artery When they looked at these these mummies and you classified them you could see that Overall the age range was anywhere from 27.5 years to about 40 to 50 years at the age of death So these were relatively younger patients that have manifestation of heart disease And so obviously the lifespan was shorter, but think about it You know these people are developing heart disease at a very very early onset in our society It's about 60 to 70 years of age is a typical onset and here We're talking about a much younger age and you could see the the penetrance of this disease is quite Significant in these people. It's not an insignificant finding So my question is what are the implications for heart disease in the 21st century now that we've know that some of our earliest ancestors in the agricultural revolution developed heart disease so We know that heart disease is more frequent as we age and this graph obviously represents the the Penetration or the incidence of heart disease as we age, but what we're seeing now On the front line so to speak is we're seeing a higher incidence at a much younger age It's not uncommon for me to have to do bypass now on a bypass surgery on a patient 40 to 45 years of age and that in the past was never heard of or was very unprecedented But it's becoming much more frequent in the clinics And I think that many of you who are familiar with the literature may know that there are some alternatives to the Cholesterol hypothesis for the generation of cardiovascular disease and one of them is the inflammatory Hypothesis and this is from a major medical journal the Journal of American College of Cardiology so this is the epicenter of cardiac cardiology and cardiovascular publications in the literature right now and Here we have a nice review article from Dr. Libby about the inflammatory Hypothesis and atherosclerosis and really I think that this is very important to understand because This is an alternative Paradigm that is emerging and is getting a lot more traction It has not yet made its way to the clinic in terms of actual impacting daily practice But what it does show us is that that there are alternatives other than just monitoring and treating patients with the statins and cholesterol modification But from this the study or this paradigm Excuse me is the is that inflammation may be the source for much if not all of the Cardiovascular disease that we develop and here you could see that in this figure that we have something called the innate immunity Which is a cellular based and then this is the adaptive immunity Which has a different cell types and antibodies for the evolution of heart heart disease and cardiovascular disease you could see that many of the paradigms are many of the molecules that are involved in Looking at inflammatory diets and other health health problems actually overlap with the development of cardiovascular disease And so here's an example of Many of the markers as well as biochemical Functions that are going on on the cellular surface that are leading to atherosclerosis and Cardiovascular disease and we've heard many of the speakers talk about the oxidative Potential or the problem with oxidate oxidation and you could see here oxidative LDL So you take that LDL you oxidate it on the surface of a cell more likely to be involved in Implementing and developing cardiovascular disease. So this this whole inflammatory Cascade and inflammatory hypothesis is certainly evolving, but we need to study it more It's right now a paradigm that is being looked at but it's not yet something that is front and center in the practice guidelines And so here's the concept is that we all know that one of the benefits there are many But one of the benefits of an ancestral diet or paleo diet is an anti-inflammatory response that decreases a lot of the Generalized inflammation and so by decreasing inflammation you decrease the biomarkers For cardiovascular disease and then subsequently you prevent or slow the progression of heart disease So it may be that through many of the dietary Modifications that are being recommended. We can actually alter the inflammatory Cascade thence thus Minimizing cardiovascular disease build-up So what evidence do we have that this might be the case? Well, here's a recent publication once again from the Journal of American Cardiac College of Cardiology front and center epicenter for cardiology Dietary strategies for improving post-prandial glucose lipids inflammation and cardiovascular health and so here it's interesting to show that You could see that this shows a post-challenge glucose Relative to coronary atherosclerosis progression. You could see that if there is an elevated glucose response that there's actually a decrease In the amount of cardiovascular build-up So if you do not have that high glucose peak or spike after eating and so it's blunted Then you actually are preventing your risk for Cardiovascular disease and that may be why many of the type 2 diabetics or insulin resistant may be developing heart disease at a higher rate once again, here is a Figure that talks once again about many of the biomarkers that are involved in the cardiovascular stress And so here's a comment from the paper and once again, this is a recent publication This is in the epicenter of a cardiology medicine saying that the modern calorie dense nutrient poor Diet of processed foods, especially when combined with a sedentary lifestyle and abdominal obesity Produces exaggerated post-pandial increase in glucose and lipids which leads to an inflammation and atherosclerosis And they go on and talk about the dietary aspects of this their their dietary Prescription is a little bit different than what many of the ancestral health people would recommend But it's certainly a connection between the dietary and cardiovascular with myth So how do we talk? How do we move forward together in today's health care environment? So as physicians, we're obligated by many many regulatory bodies to Follow standard guidelines and these guidelines are evidence-based and here's an example for a coronary Revascusation and so these are published peer reviewed. They've reviewed They're based off of the latest scientific evidence in the literature and it takes many many years to generate the data and then implement Some studies have shown that it takes about 10 10 years for the Implementation of something being published in the literature to it actually making it to a guideline in the clinic that physicians can use And that's a long time and that level of inertia is probably unacceptable But that's where the the creative destruction of health care that we're evolving to will probably expedite that situation So for example for many of you who know CPR are been updated recently that there's a new Paradigm of hands-only CPR so the breathing component has been eliminated in many situations And so it's taken many many years to even just change the CPR and you can imagine what it's going to take to change many of these other recommendations that are currently in the literature and so the existing guidelines represent the standard of care and health care and Really this is monitored and affected by professional certification of the physician The malpractice is affected by this This is peer review within your local institutions and also your institutional privileges So there are some very important professional reasons why many physicians are obligated to follow the guidelines But that may be frustrating if you go into your doctor's office and you Have read some interesting updated literature and you want to begin a dialogue And so you just got to remember that when you go in the office all physicians are bound to perfect to practice within the professional guidelines But they don't yet include the latest research Including many the ancestral health and diet lifestyle stuff that we're actually learning about at this conference So as a patient you may be better informed about the science of a paleo diet and ancestral health And many of the physicians that you go see and I think you just have to accept that But I think it will lead to a nice dialogue that you can have with your physician And so I think the immediate Concept would be begin this dialogue and don't expect your physician to immediately get it I don't think this is something that intuitively they're gonna understand And it's gonna take some time and remember that it took you a lot of time to get to this point as well It took a lot of study a lot of research and a lot of time on your own to understand this And I think the physicians that are treating care of you need that as well And so I think if you can provide relevant resources when you go into the clinic to to help your physician I think that would be important and try to use peer reviewed or medically published Articles or references as a way of beginning that dialogue. You can certainly expand out of that But just to accept that over time your doctor will have that dialogue with you and likewise on the on the flip side We as physicians need to be careful in recommending this to patients who may not be familiar with this And so we need to kind of choose our references wisely as well and have those discussions and Document them appropriately. So in conclusion, I just want to remind you that we were all familiar with farm to table restaurants But I think what we're looking at in the future is a dawn of a farm to table healthcare environment where nutrition and exercise and lifestyle Play an even larger role in preventing patients from ending up on these types of tables. So thank you very much for your attention Great presentation. Thank you Obviously, you know, there are a lot of constraints to your practice the government regulatory bodies try to keep a hands-off approach for not regulating the practice of medicine I know that because I work at the FDA Get a lot of booze in here Specifically I do work on cardiovascular devices on the pre-market side So I'm curious as to if you've done any if you've Implemented any of this in your clinical practice specifically, you know You have someone come in presenting with like a five and a half centimeter aortic aneurysm, and you know Do you tell this diabetic 70 year old man? Oh, hey, why don't you follow a paleo diet instead? Or are you treating with an endovascular graft? You know, what is your course of action? Have you seen any benefits to implementing this in the clinic? That's a great question and I've Begun to implement this conservatively in the post-operative care So if somebody has a cardiovascular disease that needs conventional surgery or treatment I'll treat it and take care of the immediate problem But on the flip side, hopefully we can make this intervention that can prevent future developments in that in that same patient And so I begun having a constructive dialogue with many of the patients because many of them have the risk factors of diabetes hypertension and hyperlipidemia and so I think they're prime for this type of of Opportunity and and diet so I've had that dialogue with many patients many of them Are resistant because they first of all that some of them won't even stop smoking So I don't think that they're going to adopt many of the ancestral lifestyle that we're recommending anyway But but there are some that are getting it and obviously having very positive results It's actually all the time we have let's thank dr. Weasley again. Thank you