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Today’s podcast is the first of our four-part series with Dr. Mark Houston. Dr. Houston is selected as one of the top physicians in hypertension in the United States; selected as one of the most influential doctors in the U.S. in both hypertension and lipidemia and the author of over 250 medical articles, scientific abstracts, and seven best-selling books, including one of my favorite books. It’s What Your Doctor May Not Tell You about Heart Disease. He is an internist, a cardiologist, he’s an associate clinical professor of medicine at Vanderbilt University.
Dr Daniel Amen: Welcome, everybody. Tana and I are so excited today to have one of our friends, Dr. Mark Houston. If I read everything about him, we would take up the whole podcast. He's an assistant clinical professor of medicine at Vanderbilt University. He's also a clinical instructor at George Washington University. Tana and I met him at A4M, where he is in charge of the cardiovascular modules, which is a place that both Tana and I have taught. He is selected as one of the top physicians in hypertension in the United States; selected as one of the most influential doctors in the U.S. in both hypertension and lipidemia. It could go on and on.
He is the author of over 250 medical articles, scientific abstracts, and seven best-selling books, including one of my favorite books. It's What Your Doctor May Not Tell You about Heart Disease. Mark, we are grateful and honored to have you with us.
Tana Amen: We really are, Mark.
Dr Mark Houston: Thank you. It's an absolute pleasure. Thank you so much.
Tana Amen: I just want to say one thing really quickly, on a personal note about, Dr. Houston was, we did meet you at the American Academy of Anti-Aging Medicine. I think I actually got to meet you first, because I was attending one of your classes, one of your modules. I love your modules because you have this very no-nonsense approach, which, you might imagine, I like very much.
It was really interesting. I just think you have some great information. I'm really excited to have you share with our people, because there's a lot of myths out there. We're excited to have you share that.
Dr Mark Houston: Thank you for the compliment.
Dr Daniel Amen: This is the first of four podcasts, and we are going to talk about how critical your heart and blood vessels and fat are to the health of your brain. Mark, let's get right to it. When we talk about the heart-brain connection, what are the things you think our listeners should know?
Dr Mark Houston: I think the most important thing is to realize that there's an immediate, direct connection that is bidirectional between the heart and the brain. You really cannot dissociate these two organs in any way. They are interrelated, intimately, in virtually every process related to brain health or heart health.
There's two big mechanisms by which that occurs. One, which is obvious, which is the neural connections. Everybody understands that one. They're related to heart rate, and heart rate variability, and heart rate recovery time, and all that. The one that people don't really know about or think about is this new concept of the immunological directions between the brain and the heart. We can get into this more detailed, but just to set the stage for, I think, your audience, there is actually direct neural connections on T-cells. There are direct receptors on T-cells, and indirectly on B-cells, that determine an instantaneous response to whatever is going on in the brain, to the immunological system and therefore sets off an autoimmune reaction, literally, both in the heart, in the vascular system, but also backwards, perhaps in the brain, which is tied into this whole concept of inflammation, which I'm sure we're going to talk about.
Dr Daniel Amen: Right. We're going to talk about that next, because it is one of the major risk factors of Alzheimer's Disease and Depression.
Tana Amen: So interesting. When I was a nurse, I worked in a trauma/neurosurgical ICU unit. I had the pleasure of working with both cardiothoracic surgeons and neurosurgeons. There was always this sort of, I want to call it "in fun," but it wasn't always in fun, this little turf war over what was more important: the pump or the computer. Right? In truth, they are connected. We can't disconnect them. I don't know if that has been your experience, but I think we could do a better job of working together and really paying attention to the fact that we are one system, and not disconnecting that. Now we know that we have to really be looking at both aspects.
Dr Mark Houston: You make a great point, in that the new catch word for that, of course, is "systems biology." We realize this is, even more than spokes on a wheel, the interconnections are enormous, interrelationships; not between every organ, just between the heart and the brain we're talking about today, but they are very important.
Luckily, most of the people that you and I associate with have got that connection down. We don't have the turf wars as much.
Dr Daniel Amen: For a long time, I have talked about whatever is good for your heart is good for your brain, and whatever is bad for your heart is bad for your brain, because your brain uses 20% of the blood flow in your body. Then I read this study from Boston University, and I went, "Oh my goodness. Whatever is good for your heart is good for your brain is good for your genitals, because it's about blood flow. And whatever is bad for your heart is bad for your brain is bad for your-" ... And you have to wonder, why is Cialis commercials, Viagra commercials, on TV so much? This study said 40% of 40-year-olds have erectile dysfunction, and 70% of 70-year-olds have erectile dysfunction.
What that made me think is, probably 40% of 40-year-olds have heart dysfunction or vascular dysfunction, and brain dysfunction. To get people really interested about what we're talking about is, it can affect your sexual function, your overall well-being, your heart, because if it's not right nothing is right; and how you think and the decisions that you make, which is your brain.
Tana Amen: If I just heard you correctly, you think that you're going to get people more interested by talking about their sexual function.
Dr Daniel Amen: Absolutely.
Tana Amen: I see. Okay.
Dr Mark Houston: I think everybody will be up for this story. You make a great point, and it's related it blood flow, which is more or less endothelial function, which ties into nitric oxide bioavailability. One of the parameters that we use in the Hypertension Institute in Nashville is, ED equal ED. That is, endothelial dysfunction is erectile dysfunction. If you ask a man does he have erectile dysfunction, it's almost a 100% correlation with endothelial dysfunction, because the nitric oxide levels in the penile arteries are very low, erections are very improbable, or they don't happen at all, and it's tied directly to testing that you can do for nitric oxide in our office.
Tana Amen: So interesting.
Dr Daniel Amen: And so important. I learned about the heart-brain connection in a very sad way. I'm named after my grandfather. He was my best friend growing up. He was a candy maker, and so he was overweight, and he had his first heart attack at 49. When he got his second one, he got depressed. That's when I was in medical school, and I learned about the connection between heart attacks and Depression.
Can you talk about that connection and what you've seen over your career?
Dr Mark Houston: Absolutely. Most traumatic events, whether it's a heart attack or someone that goes on bypass graft, or even a stent, part of it is just the stress of the event. Part of it is, if you have surgery, this is no surprise, it's the anesthesia that absolutely destroys your brain for a long, long time. If you just talk about the heart attack issue, there's a lot of different [inaudible 00:08:24]. These are chemicals that cause inflammation all over the body.
When you have that much heart damage, you are inflamed for a long period of time. What that does, it sets off instantaneous inflammation in the brain, which then sets off this depressive mood affecting your neurotransmitters. The other part of it is just the inability to perform your normal activities, so people get depressed because they have to change their diet, they have to change their activity level, they have to stay at home more, they're depressed because of other things that they can't do the normal activity.
It's a complex issue, but Depression is almost universal after a myocardial infarction. It can last for a long time. I've had people still depressed a year after their heart attack, unless they get some help.
Tana Amen: Interesting. If I'm hearing you, just to recap this for our listeners because this is a question we get a lot, people don't understand. Anesthesia from almost any surgery, bypass surgery definitely we see that a lot-
Dr Daniel Amen: Also increases the risk of dementia.
Tana Amen: Right, and, heart attacks increase your risk of Depression, but you can get help. You should get help if you're going through that.
Dr Daniel Amen: What I really like is the connection with inflammation. If you can be on an anti-inflammatory diet, that can be really helpful. What about omega-3 fatty acids and people ... We often measure someone's omega-3 index here, a test developed by my friend Bill Harris.
Tana Amen: They're usually terrible.
Dr Daniel Amen: I did 50 consecutive patients who came to Amen Clinics that were not on fish oil supplements. 49 of them were sub-optimal. It's shocking to me how much it was, and it's sort of a simple fix.
Dr Mark Houston: The omega-3s are essential for brain and heart health. There's an amazing study, it's a meta-analysis, just published about two weeks ago, from Mayo Clinic Proceedings, reviewed 600,000 patients that were on high omega-3 diets or omega-3 supplements. There was no question at all that, depending on the dose, depending on a lot of other factors, there's a huge reduction in both primary and secondary prevention of coronary heart disease and myocardial infarction.
That's one of the top supplements that I use. You are right; here in Nashville, if you're not taking a supplement, people that are eating their normal sad diet, are the ones who have very low omega-3 indexes. Like your population, I don't see normal omega-3 indexes unless I've already put them on an omega-3 supplement and they come back for checks.
Tana Amen: Do you tend to use a higher ... What would you consider to be a normal dose that you put people on?
Dr Mark Houston: I start with a range, depending on the clinical problem I'm trying to address. If it's a prevention, in a healthy person, you can get by with maybe one to two grams of DHA and EPA per day, but if you've got a patient who has had a myocardial infarction, bypass graft, PCTA with a stent, [inaudible 00:11:52] coronary heart disease, angina, or some other cardiovascular problem like hypertension or dyslipidemia, or maybe even Diabetes, they're going to go up to high doses of about five grams a day of a DHA and EPA.
I usually put it in with GLA, which prevents a depletion on the two sides of the chain, and also a gamma-delta tocopherol, which prevents the oxidation of the omega-3s in the cell membrane, which is absolutely crucial.
Tana Amen: It's like a type of E, right? They would find that over with E vitamins?
Dr Mark Houston: Yeah. There's [inaudible 00:12:25] forms of vitamin E, and this is the gamma-delta tocopherol, which is the one that is actually used most commonly by humans. We don't actually have that much of the alpha tocopherol in our diet, but that's one all the studies that have been done with, that's why we get mixed results.
Tana Amen: It was when I listened to your lecture that I really changed my intake of my fish oil and added those other two, the GLA and the gamma-delta tocopherol. I just want to [crosstalk 00:12:55] that.
Dr Daniel Amen: What this brings up to me is a really important point. That is, if someone has heart disease, they are often also on a blood thinner. Common wisdom among physicians is, if you're on a blood thinner, don't take omega-3s.
Tana Amen: Which I have been told.
Dr Daniel Amen: How would you respond to that?
Dr Mark Houston: I have been asked that question many times. I have actually looked in the literature for an answer, and I have the answer. It does not significantly increase the risk of any major bleeding event. You can be on aspirin, you can be on Plavix, you can be on Brilinta or Eliquis, or any of these new Factor X inhibitors, and yeah, you may bruise a little bit more, but as far as GI bleeding or hemorrhagic strokes, or any other typical major bleed, there is no significant increase in risk.
In fact, if you put people on omega-3 fatty acids either after a heart attack or after a bypass graft, or after a stent, you reduce the secondary heart attack significantly, you decrease stent restenosis, and you decrease bypass graft restenosis.
Tana Amen: Wow.
Dr Mark Houston: We actually have a program that we use, it's a combination of omega-3s with high-dose curcumin before, during and after surgery. Sometimes I can't tell the cardiothoracic surgeon that I have them on either of those two supplements because they get all bent out of shape about whether they're going to bleed.
We've been able to show dramatic results using those two together.
Dr Daniel Amen: Curcumin is another one we love for the brain. We're running out of time for this-
Tana Amen: Let me just recap that one thing for people. What I heard you say is, they might have bruising for superficial-type treatments or whatever, but they're not going to cause bleeding, significant, any type of blood thinning.
Dr Mark Houston: That's correct.
Tana Amen: Got it.
Dr Daniel Amen: So important. Stay with us. We're going to come back with Doctor Mark Houston. We're going to talk about inflammation. Pick up his book, What Your Doctor May Not Tell You about Heart Disease, and also, Mark, tell them your website that people can learn more about your work.
Dr Mark Houston: It's a pretty simple one. HypertensionInstitute.com.