Longevity / Metabolic Health Is the Quiet Foundation of Longevity
Longevity is often presented as a future-facing pursuit. New diagnostics. New molecules. New promise. Yet the foundation remains deeply practical: how well the body handles energy, inflammation, and repair today.
Longevity / Metabolic Health Is the Quiet Foundation of Longevity Transcript
You know, the number one killer for both men and women and postmenopausal women is coronary artery disease. You know, we got a million people die every year from it, 20 million globally. So, this is a big big problem. We look at traditional risk factors like smoking and hypertension, high cholesterol. But, the atypical risk factors are equally important and that includes toxins, but also hormones, women postmenopausal state, stress, you know, no connection with others, isolation. All these things are super important in terms of identifying which patients are at risk and and then [music] determining what happens. You know, cholesterol is not the the problem. The cholesterol happens as a reaction to things, but the problem is the way we expose ourselves. You know, this is a completely preventable disease. [music] [music] Welcome to the Vibrant Wellness podcast. I'm your host, Dr. Brooke Steps, and I'm here today with Dr. Giovanni Campanile, a Harvard-trained cardiologist board certified in internal medicine, cardiology, interventional cardiology, integrative and holistic medicine, and anti-aging and regenerative medicine. He's a pioneer in the prevention and reversal of heart disease and formerly served as the director of the Dean
served as the director of the Dean Ornish Reversal of Heart Disease Program for the East Coast. Today, he integrates advanced imaging, biomarker analysis, nutrition, and lifestyle medicine to help patients not only prevent, but truly reverse cardiovascular disease. He's [snorts] also the founder of the Functional Heart, a practice focused on merging cutting-edge diagnostics with holistic healing. Dr. Campanile is deeply passionate about mitochondrial health, inflammation, and the science of longevity. Dr. Canfield, thank you for being here today. Oh, it's my pleasure. I can't wait to talk to you. So, we have so much in common. Uh I did also internal medicine, which you did a year of, and left traditional bedside medicine to pursue lifestyle medicine. And so, I can't wait to hear about your journey and what led you from what is a very robust traditional Western background in medicine. You were on research for the Framingham Heart Studies, the things that we use every day to help assess risk for cardiovascular disease that every medical student in the whole country learns, to now integrating things like nutrition and lifestyle factors, which we very rarely learn about in medical school. Can you tell me a little bit about that transition? How you came from all that tradition to now helping helping with preventative care? Sure. I mean, I I trained in Boston
Sure. I mean, I I trained in Boston in a very traditional way in cardiology. And I was uh and I trained to be an interventional cardiologist, meaning I put in a lot of stents. Uh and I put in thousands of stents. And uh and I saw over and over again how we're treating a disease and not really curing anything. And um I became I was fortunate enough to meet Dr. Joseph Pizzorno very early on in my training, who enlightened me to the area of naturopathic medicine, which I never even heard of. And um and me and my partner at the time, we we created a program to teach allopathic physicians naturopathic medicine. And of course, in this journey, we had to learn naturopathic medicine as best we could. But we became fascinated with, you know, what is out there both from a natural standpoint and from a research standpoint that augments, you know, what we do. And you know, I think that you know, I practice a form of medicine like you do, functional medicine, integrated medicine. I think all these words really don't mean much. I mean, you just practice the best kind of medicine you can do and and this has opened our horizons to things that we can use for our patients that are fundamentally important like nutrition, you know, like lowering inflammation, like stress reduction. Yeah. And I also had the good fortune of becoming friends and and I was the program director for the Dean Ornish Reversal of Heart Disease Program. Right. And as many people know, Dean is the one
And as many people know, Dean is the one who discovered that you can actually reverse heart disease by lifestyle change. And the four pillars of his program are nutrition, exercise, stress reduction, and interactions with with people, you know, community uh with loved ones and friends. The interesting thing about that that really fascinated me was that if you take out any one of those legs, you don't get the reversal of heart disease. So, it's a it they're equally important. Connection is equally important as the nutrition. We We tend to focus more on one thing, but all these things are, you know, holistic, very important. And I think every physician I think every specialty needs to incorporate a little bit of this in their practice, you know, you can think of any specialty like urology, orthopedics, even plastic surgery. You need to be healthy from a mitochondrial, inflammatory, uh oxidative state state standpoint in order for to have success. So, I think this is, you know, fundamental to medicine. Right. And so, when you How do we help physicians integrate what you're talking about? So, when I and I'll just give you kind of my background, when I transferred from working as a hospitalist in a very busy bone marrow transplant service, I then realized, okay, yeah, like you did, we're not doing a lot to prevent. Uh I also had
doing a lot to prevent. Uh I also had other um patients on my list, people who we would do heroic measures in order to save their lives post myocardial infarction, and the next day I would see them with, you know, bacon and biscuits and gravy. And so then, you know, with a I had a background in nutrition and lifestyle medicine, the American Board of Lifestyle Medicine was put in my lap, and we have all this evidence around these pillars, those four pillars Dr. Ornish talks about. American College of Lifestyle Medicine adds a couple, like reducing toxins, which you talk about a lot. Um and they also add sleep, which we know is incredibly important to overall lifestyle. And those are evidence-based. And then we have this whole world of integrative health, where, you know, we have a lot of practitioners who are pushing the boundaries of what can we integrate and adopt early, and what is it that we need to really rest on in terms of evidence? Where do you stand in that, and how do you navigate that, kind of being in between these two worlds? Well, I think that again, um looking at the patient holistically is very important. And what we know about risk factors, now, we're we're very much Everyone knows the traditional risk factors for heart disease. And when we talk about heart disease, we're talking about coronary disease, atherosclerosis. You know, there's a lot of other things with heart disease, but we're we're mainly, you know, the number one killer for both men and women, and postmenopausal women, is coronary artery
postmenopausal women, is coronary artery disease. You know, we get a million people die every year from it, 20 million globally. So, this is a big, big problem. And um and we look at traditional risk factors like smoking and hypertension, high cholesterol. But the atypical risk factors are equally important. And that includes something the things you said like toxins. Mhm. But also hormones. Mhm. Women in postmenopausal state. Yeah. Stress, you know, no connection with others, isolation. All these things are super important in terms of identifying which patients are at risk. And and then determining what happens. You know, cholesterol is not the the problem. The cholesterol happens as a reaction to things, but the problem is the way we expose ourselves. Okay. You know, this is a completely preventable disease. It you know, if you look at studies like um in the Vietnam War for instance. Right. I don't know if you know about these studies. Yes, I do. I love these studies. Where they you know, they looked at these you know, tragically unfortunate GIs, young men 18 years old. Uh every single one of the Americans had a fatty streak or some form of atherosclerosis. Well, then they looked at the Vietnamese boys, which all you know, they had they didn't have it. So, it's not it's a disease that occurs because you know, we have a very advanced society, you know, and we we we're very
society, you know, and we we we're very stressed. We're in front of computers. We take kids and we get them out of bed in the morning to make them go to school. You know, those are all stressors that you know, add up at the end of your life or in the middle of your life to create problems. And then we get a reaction. And one of these reactions is increasing of some of these lipoproteins. And the lipoproteins are like little fire trucks that go around trying to put put things out, you know, like toxins. We're exposed to a lot of toxins. They did a study in Italy looking at carotid endarterectomy specimens. Mhm. 100% of them had some form of microplastic in it. So, you know, some of these things are very hard to avoid, but you have to look at the entire picture in order to get an idea about where a person stands and how to approach Right. what they do. And you talk about it being so individualized because we can have certain markers for cholesterol that will predispose you to having these smaller particles of LDL versus not having those. And tell me a little bit about that. How do you individualize your care and what approach do you take towards these each patient you see? Well, the uh patients usually have some sort of predominance of a problem. You know, either they have inflammation going on. Mhm. And let's say their gut is inflamed, Mhm. then I focus in on their gut. You know, a lot of patients think I'm um you know, they wonder why I start asking them questions about their gut.
asking them questions about their gut. It's because, you know, I view them being in this field, the gut is a primary source of inflammation. So, if you don't take care of that, like if you just give them a statin and say get your cholesterol down, it's never going to get better. You know, the inflammation is going to continue and it's going to continue causing the arteries cuz the inflammation travels from one part of the body to another part of the body and will continue. So, you need to find out what's going on. Is it a um you know, a metabolic problem like insulin resistance? That's a huge problem. And if someone has an insulin resistance problem, if they're overweight, if they have a lot of visceral fat, if they have a fatty liver, you know, you have to take care of that or no matter how much you get their cholesterol down, how many how much statins or drugs you give them, they're not going to get better. So, you have to address all these issues if their mitochondria, you know, which are the little powerhouses in the cells are not working properly, you have to get them to work properly. And if they're if they have oxidative stress, then this affects the heart, affects cancer risk, you know, this sort of thing. So, it's a you know, you have to be able to differentiate all these things. Yeah, I always think of cardiovascular disease as like a one-two punch. You have to have the cholesterol, but you also have to have the inflammation. So, let's start with the reversal. Let's tell me about that and tell me about what people if they're thinking, "Okay, if infants and young men in the Western culture already have plaques, am I doomed?" No,
No, because it's a you can reverse the disease, you know, it has a factor to it that can be changed and for the better. So, and as you said, you know, that that goes to primordial prevention. You know, when a patient when a there's been studies looking at babies in utero with ultrasound, they if their mothers didn't have a good lifestyle, then the babies could already have some plaque in utero. So, if that baby, and it's very likely if the mother doesn't have a good lifestyle, that the baby then growing up won't have cuz it's connected. In fact, it's connected back to grandparents. If the grandparent doesn't have a good lifestyle, it affects the child. And so, we just have to be aware of these things. The The fortunate thing is that problems like mitochondrial dysfunction, endothelial dysfunction. Endothelium is the lining in the inside of the arteries. You know, this is a fascinating concept and then there's the glycocalyx that's more recently discovered. And talk to us about that. So, the endothelium, you know, we have 60, 000 mi of arteries throughout our bodies. Okay. You know, it can you can run around the world once. And the inner lining is called the endothelium. And the endothelium is a very active organ. It it vasodilates and can vasoconstrict. And it depends on a chemical called nitric oxide. And how you live your lifestyle, exercise, foods like L-arginine, L-citrulline, these are precursors.
L-citrulline, these are precursors. You have to have, you know, good foods like arugula is a good source of that. Almonds, beets. So, they they help form the nitric oxide into a good amount so that the endothelium works well. And then on top of that, there's a hairy-like structure. You can only see it with a electron microscope. It's called the glycocalyx, which is also dependent on these lifestyle factors. So, the current thinking is whatever's going on in your body, any inflammation, any problems, it breaks down these layers, these protective layers, and then the cholesterol can get through more readily. Now, we look at cholesterol like apolipoprotein B, the sizes of the particles, only because if they're smaller and more and bigger number of them, they're more likely to find their way into little breaks into these barriers and then start causing plaque. So, one of the good things is the lifestyle factors that we do to protect you for mitochondrial disease, oxidative stress, inflammation, they're they overlap. So, you know, if you do a good diet of some sort, like a Mediterranean-style diet, which basically is just a sensible diet. You eat a lot of plants, all the colors in the rainbow cuz every color is a different phytonutrient, polyphenol, flavonoid. Every color is very important have in your repertoire of food. Have a lot of fiber. Fiber is there's a direct correlation
Fiber is there's a direct correlation between fiber and reduction of inflammation and reduction of cancer. The short-chain fatty acids. Yeah. Yes, and then the gut also comes into play with that, too. Right. You know, the butyrate is a very important factor because of these fibers. And the gut microbiome is another huge area of research. You know, the the variety of bugs of good bugs is so important. But the way to get a variety of good bugs you have to have a variety of good fibers. So, again, all these things are interconnected. So, if your um diet is good, you're exercising properly, you know, and exercising properly means uh you do some sort of aerobic exercise where you get your VO2 max up, some form of high intensity interval training, and that sounds a lot harder than it is. You just have to go fast and slow. Uh there's a lot of good studies showing that as the heart ages, it gets it shrinks and it gets stiff. And high intensity interval training offsets that aging process on the heart. Because of the nitric oxide. That's one of the factors. Yes, it's one of the very important factors. And then resistance training because muscles is you know, one of the most important anti-aging organs we have in our body. It's a glucose sink. So, again, all these things, you know, we can have a dis - we can have a whole podcast on each and every one of these topics, but I'm just trying to give a picture of how holistic it is. It's so everything's so interconnected. I'm going to talk about
interconnected. I'm going to talk about them separately, but they they're probably more like one in the same. But let's talk about mitochondrial health, what goes wrong there, and let's talk about what is what are some of the common things that cause full body systemic inflammation. So, again, the mitochondria are the little powerhouses of the cell. They they produce ATP, which is the basic energy block. And um if you um have a lot of visceral fat in your body, if you have a lot of a fatty liver, if you're not eating well, if you're not exercising. The main thing is not exercising, not moving. Uh the more you move, the better your mitochondria. And uh so, one of the main things to maintain mitochondrial function is exercise. And, I think the statistic is about 80% of Americans don't do, basically, any exercise. Yeah. And, even just standing for a couple hours a day helps to lower your mortality. It's like we're so sedentary, it's sad that we even have that data, right? So, the standing or walking 10 minutes, even any interval increase in exercise helps to improve these outcomes. Absolutely. I, you know, my practice is in New Jersey and New York, you know, I have a lot of Wall Street, uh, guys and gals that come to me. And they sit in front of their desk, you know, this is not just Wall Street, but I, you know, a lot of desk jobs are, you sit in front of your computer for 10 hours a day, 8 hours a day. And, that's completely unnatural, you know, we're not designed to do that. We're designed to be hunter-gatherers, out in the sun,
to be hunter-gatherers, out in the sun, walking around, minimum amount of clothes on if it's warm enough. And, uh, you know, if you sit in front of a computer for all those hours, some studies have shown that that risk is a similar to smoking, cigarette smoking. So, but you can offset it, you know, that's, you know, we're in this age of awareness of, uh, what we can do with lifestyle. And, one of the things you can do is every hour do 1 minute of some kind of exercise. And, that offsets the bad biomarkers that come up when you sit too much. So, it's a, uh, you know, it's a little thing, but it's a very powerful thing to offset that, uh, that sedentary lifestyle. Yeah. And, that's like a really good actionable step. I want to go back to something you were talking about with butyrate and all this fiber. So, the biggest gut study that we've ever done is the American Gut Project, where they took 11, 000 people's stool from the UK and the US, mapped out the genome of these microbes, and they determined that of 83 questions on their lifestyle, only one correlated to their risk factors for having a bad gut microbiome versus a very healthy, diverse gut microbiome. And that was the amount of plant foods that you have in your diet. That variety is key. So, an apple on Monday and Tuesday still counts as one, but then an apple and a peach that counts as two. So, it's the variety. And it had nothing to do with if you ate meat or if you did not eat meat. But, presumably some of these things would be um if you're having a robust plant diet,
um if you're having a robust plant diet, then you know, maybe some of these things there's not room for other things. And other things being processed foods or excess of saturated fat. Tell me talk to me about those things in the diet and how you see those and how much of that your body can handle. Well, I think your body can handle quite a bit. And I think it uh And I I that study came up with a number of how many foods different foods you have to eat. 30. Well, let's talk about the answer the question. So, cuz it was a questionnaire survey, right? So, the question was and I pulled it up and I have it somewhere on my computer and it's how many plant foods do you have in your diet per week? And the first it was A is less than 10, B is 10 to 20, C is 20 to 30, and then D is 30 or more. Well, the people who answered D had the best and the people who answered A had the worst. Well, does that mean that 30 is a magic number? To me, it just means whoever thought they had a ton of plant foods in their diet and could answer that question at the highest level, then they had the best gut microbiome. So, are they eating 30 or they eating 60? And so, I say more is better when you're shooting for that variety of plant foods. Absolutely. And again, the the reason for that is it makes sense because you're eating a variety of fibers and you're eating a variety of uh phytonutrients, polyphenols, flavonoids. So, your overall your your gut microbiome, the good bugs in your gut, they eat these polyphenol they eat the fiber and the polyphenols. And you In fact, you can do
polyphenols. And you In fact, you can do organic acid tests and measure polyphenols, and that's an indication of of a dysbiosis. If the polyphenol levels Are too high? Are too high or too low, you know, that's one way to look at it. So, it's a um it's very important to have a diet that doesn't have processed foods or ultra-processed foods. Now, when we talk about processed foods, there's all you know, that's a big category. There are some processed foods, like a lot of things are processed and are still good. You know, some whole grains, organic whole grains, and things like that. They're processed. But, you know, it's the ultra-processed food with added sugar and added salt and added fats that are bad. And unfortunately, children in the United States, 70% of their diet are these ultra-processed foods. So, they're they're a setup for um That was me. [laughter] And me. Uh I ate a You know, when I was small, I ate a box of Cocoa Puffs every day. Yeah, same. You know, but we didn't know. But, now we know. And so, we have to change as we, you know, again, I think that we're living in an age of awareness about all this. We didn't we weren't aware of this stuff in the past. Now, we're aware, so we have to work on it. And we have to implement the know better, you do better. That's right. So, and and you don't have to And I always tell my patients, you don't have to do everything, you know. Any incremental change makes a big difference. Right. You know, I I think that, you know, again, the Mediterranean diet, you don't you know, some fish, you don't eat a lot of saturated fats, and um but you do it
of saturated fats, and um but you do it every you do eat everything. And I tell my patients to eat fish as much as they can. You know, the acronym SMASH is the one I like because it's uh the the fish with high omega-3 fatty acids and very low mercury, so you can get away with eating the fish without getting mercury in your system. And and omega-3s is another marker of health and nutrition. You know, my wife is a functional psychiatrist and she measures these things in all her patients and it's, you know, it's surprising how many children have low omega-3 fatty acid indexes, very low, and very low vitamin D levels. Yeah. And I think these are markers of just poor nutrition. Okay. Yeah, and when you think about well, I like the fish analogy where it's like if you're thinking like plankton all the way up to a big really large fish on the food chain and I kind of keep it in that middle rung cuz the more you eat, the more you have the plastic toxins and the mercury and all those things. So, kind of in that trout salmon range is where I tell my patients to kind of Salmon is great, you know. That's what most people eat. Yeah. So, tell me when you are Okay, let's go to inflammation next. Let's talk about inflammation cuz we mentioned processed foods. Talk to me about NF-kappaB. What is that? Talk to me about the inflammatory process when you eat some of these things. Talk to me about what else is happening that can create inflammation in the body. Well, NF-kappaB is an interesting marker, you know, it's one of the many markers of inflammation. It's also a marker of cancer risk. And they did an interesting study uh
interesting study uh looking at one of these McDonald's breakfast burgers, McMuffin, Egg McMuffin. [laughter] And uh and they measured NF-kappaB and it rose and stayed up for about 2 hours and then went down. So, NF-kappaB is associated with a lot of different problems. It's a very big marker of inflammation. It's a very big marker of you know, cancer risk and LPS and all these other issues that are you know, very dangerous. But the point of this is that you know, you can get away with eating something like this. If you do it like you know, once a month Sure. your body can deal with it. If you're doing two of these every day and then having another burger for lunch and then having some other fast food for dinner, that's the problem. It's like when you continuously uh stimulate your body to have these inflammatory uh markers go up and stay up for hours and days, uh then it's a problem. And uh and then you're not exercising, you know, it's a perfect storm of bad things. You know, you're you're you know, you're not sleeping well because if you're not, you know, sleep is another big risk factor for everything, including heart disease. And uh so, these things are connected. And maybe drinking too much alcohol and not sleeping well because of that. So, all these lifestyle issues go hand in hand, you know. And so, whenever I uh get a new patient and they're living this kind of lifestyle,
this kind of lifestyle, I don't I used to give them I used to want them to do everything. Right. When I first started doing it. still in that. I've I've gotten this like kind of green energy about me. I'm like, we could we can change it all. What I do now is I sit down, you know, I have my clinical manager, and we talk about nutrition, and we talk we find out what is it that you can do. What is it you can really do? What's realistic? And let's do that. Next time we meet, we ask them, "Did you do those things?" And then we take it a little step further. And over time, that seems to be the best approach. Because they reach they see that they're getting better, you know, and we do a lot of testing, Uh-huh. you know, I think the Vibrant Cardio Zoomer is a great test. I do too. I really love that test. to use uh the Boston Heart. Okay. I think this is now as good. I didn't have we didn't have a test that was good as Boston Heart. Now we have a test that as good as Boston Heart. Wonderful. A lot of my patients I would do Boston Heart like every 6 months. And we can follow them that way. And I find it to be very motivating for the patient cuz we we have a big screen TV in our office. We show the patient what where they're going, how their biomarkers are getting better. Oh, yeah. I also do the advanced uh testing of their coronaries with a something called Clearly. I don't know if you've heard of clearly. I think I have. Tell me more though. Clearly is a CAT scan with contrast Uh-huh. with artificial intelligence over read. Okay. And it's pretty much revolutionized preventive cardiology because you can find it it characterizes the plaque into calcium and it color codes it. So blue's calcium. Uh-huh. And then yellow is soft plaque. And then
And then yellow is soft plaque. And then very importantly, it can see if it's inflamed soft plaque. Very nice. at pixel by pixel and and that's how you can be aggressive or not aggressive in terms of their their heart disease prevention. Because if they for instance have a very good test and they don't have a lot of disease or they don't have any subclinical disease then you can take the time to do the lifestyle factors. If on the other hand they have inflamed disease which is is an indication of vulnerable plaque. And vulnerable plaque means a plaque that's prone to rupture and cause a heart attack. Yes. You know, that could be life threatening. Absolutely. So we have to be a little bit more aggressive in that case. So you mentioned a dichotomy of patients. Ones that are very high risk and then ones with clear scans. So do you do these clearly scans? Because a lot of people right now in the wellness space are considering coronary artery calcium score test. Is that something that you reserve for high risk patients or is that something that you run on all your patients? I rarely do calcium scores. Okay. Because I I find them not to be that useful. Okay. Uh because you could have a zero calcium score and and maybe 15 to 20% of those patients have soft plaque and the scan is blind to the soft plaque. Yes. So what I want to know is do you have soft plaque? Because I don't Calcium is an indicator of atherosclerosis but the calcium itself is stable. Right. You know, unless the calcium is so much that it's blocking the artery so you
that it's blocking the artery so you need a stent or bypass surgery, it's usually benign. Yeah. So I think that's the message people need to hear is that sometimes it can give you a false sense of security when we really do need to be looking into maybe some lifestyle things. But tell me about the clearly. Do you do that on the majority of your patients? Well, I have a pre-selected patient population. Okay, yeah. They come to you after they They've had risk factors or they've had something. But uh I do it on most of my patients. And I even do it on some 30-year - old patients that have, you know, if they have a lot of risk factors, a big family history, familial hyperlipidemia, LP little A elevation. You know, if they have these kind of risk factors that are very, very dangerous. And And the reason why I do it is because it's such a dangerous disease. In about 60% 50 to 50% of women, their first sign of a heart attack is cardiac sudden death. Yes. And about 40 to 50% of men. So, you know, this is not a little benign disease we're talking about. We're talking about something that could be life-threatening. If [snorts] you're ready to take control of your own health, visit vibrant-wellness. com to learn how advanced integrative lab testing can uncover root causes and guide your path to vitality. Vibrant offers one-stop shop testing solutions including the recent launch of Gut Zoomer giving you actionable insights you can use with your healthcare provider or with your patients to support targeted effective healing. I want to talk about women for a minute. You know, I have female patients. That's my popu - the
female patients. That's my popu - the majority of the population I see, and I try to educate them that their symptoms are going to present very differently from the men, and they're twice as likely to die if they have a cardiovascular event. How do you approach women in your office? Is it a different approach? Do you Do run different tests or Yeah, I think the It is a little bit of a different approach because women uh tend to have more microvascular disease That's right. and more atypical symptoms. Mhm. And uh a woman is somewhat protected before menopause and then quickly after menopause, you know, their estrogen levels go way down, they get endothelial dysfunction, they get stiff arteries, they get high cholesterol, they get palpitations. So, they have to be approached a little differently and uh and you have to pay attention to subtle things in their history Right. that you know, a man usually presents with more classic symptoms. He walks a certain distance, he gets chest pain, stops, chest pain goes away. Women, that doesn't always happen. They may get fatigued. You know, they're getting some kind of unusual fatigue. And uh and we get fatigue for a lot of reasons, but you have to put that into context with all the risk factors or they're getting some shortness of breath, you know, mild shortness of breath sometimes is a tip-off that something's going on. And uh so, you know, women are unfortunately, you know, we have treatments that are for men and women, but they won't don't work as well in women. And you know, when we do a stent
women. And you know, when we do a stent in a woman, there's a more high likelihood that a woman will get problems. And that may be because of the size of the artery. It may not be a conspiracy theory that we've done things for men only. It's just the way it is. You know, our stents are, you know, a certain size and even in men, they don't work well when the artery is very small. So, it's it may be a size issue. Uh but uh you know, women get other things like uh spontaneous coronary artery dissection, SCAD. Yeah. You know, that's a breakdown of the um of the lining of the artery. In fact, to this day, that is the one intervention I did that really the threw me for a loop. You know, I did a there were woman came in in third trimester pregnancy Okay. having an inferior wall myocardial infarction. You know, and so, you're you have this woman who's pregnant, the baby is she's about to deliver, and she's having a heart attack. It's probably one of the the scariest things I ever done. I uh so we brought her in and we had to you know, and you can't use a lot of radiation either. So you had I had to decide which artery cuz when you do a heart catheterization, you look at the left coronary artery and then the right coronary artery. She looked like she was having a heart attack in the right coronary artery. And we almost never do a procedure when we don't look at everything. But in her I just looked at the right coronary artery because I didn't want to give her more radiation, more contrast. So
more contrast. So uh we looked at the right coronary artery, we had to shield the baby, shield her from with lead, and uh do a very quick stent. And luckily it turned out okay. Good. And but yeah I was very uh nervous about that one. Wow. think about it to this day. Yeah, I would say so. and women tend to get things like that, spontaneous coronary artery dissection. Then there's something called broken heart syndrome, takotsubo's cardiomyopathy that women tend to get more than men. And this is an adrenergic uh response to some kind of emotional stimuli. So, you know, women um will get this something that causes them to become emotionally upset. And this will cause such a surge of ad you know, their sympathetic nervous system that it causes the coronaries to all go into this prolonged spasm which causes a major myocardial infarction. The whole heart basically. We don't see that with a regular with a atherosclerotic heart attack because you see in a atherosclerotic heart attack is in one artery. This is all your arteries are constricting. So women get very sick, you know, they can easily die from this, you know, this is The good thing is that it usually reverses, you know, the cardiomyopathy or the weak heart muscle does usually get better. But the women are, you know, more prone. But it's a very serious problem. Right. And do you ever follow up with their endocrinologist or their OBGYN
their endocrinologist or their OBGYN about hormone replacement therapy because of the risk when we decline in estrogen levels? Yes, that's a big factor. And it's something that needs to be looked at carefully. Because postmenopausal women, if they have vasomotor symptoms due to their postmenopausal state, can benefit greatly from estrogen. And estrogen's great for osteoporosis prevention and it's good for their for your brain, it's good for sleep, especially when you use it progesterone. But the one proviso about that is that women have to be assessed properly. One of the things that happens with postmenopausal estrogen therapy is that there's for the first year, there's a higher risk of heart attacks, of myocardial infarction. So, that's where this clearly test comes in is very helpful for that situation. I can if I take a look and I see their arteries look okay, then they're free to go, get their hormone replacement therapy, feel better. But if they have an unusual looking plaque in their coronary, then it's more risky. And in which case they can still get it, but we go much lower dose, we do transdermal instead of oral. Absolutely. So, we we use these, you know, a little bit of a different approach. So, it has to be you know, you have to be a little careful about that factor in in women. Right. And what monitor them very closely. Yeah. I mean, once they get past the first year, they usually stable. But it's the first year of therapy. Yeah. And is that because they've been without hormone therapy? Maybe they should have started earlier? Or is that
should have started earlier? Or is that would that be the case with anyone starting that even if they were in a perimenopausal state? Or we just don't have that data. We don't have that data, but more more likely, you know, as you know, earlier you start hormone therapy after menopause the better. All right. So, if you let too much time pass where their cardiovascular risk goes up and they develop a plaque that may be unstable, that's the situation where you have to be very careful. For sure. If you start a very early, usually there's no plaque. So, you know, that's an easier way to do this. But let's say you're 5 years post menopause Mhm. and you have risk factors for heart disease. Right. You really have to be evaluated properly. Yeah. And so, it's and women still you know still benefit. You know, I you know, there's we don't have a lot of good non-hormonal therapies for these vasomotor symptoms that are Yeah. you know, they're debilitating for women. So, we we want to give women these things. They're very helpful for women to get Yeah. hormone therapy. Same with testosterone. Testosterone is the same thing. I mean, men it actually testosterone we used to think testosterone was a risk factor Mhm. for heart disease. It's actually the opposite. If you have low testosterone, that's a risk factor for heart disease. Right. So, and testosterone does the same thing. You know, it helps endothelial function. It helps insulin resistance. It helps muscle growth. So, you know, we We do it in our women, too. Yeah. because we're orders of magnitude, you know, higher concentration of testosterone than estrogen. So.
testosterone than estrogen. So. That's women need testosterone. I've had a really good success with low-dose GLP-1s with my women who can't be on hormone replacement therapy and their hot flashes. Dramatic. So, for what it's worth, I don't know. Maybe to if you ever talk to somebody who's in that world, maybe lead them in that direction. that brings us to GLP-1s and these drugs. They're incredibly effective for cardiovascular prevention. Absolutely. So, a lot of my patients that have heart disease, I have a very low threshold to starting GLP-1 agonists because of the you know, effect on the heart, effect on the kidneys, effect on the brain. Uh in fact, I think they're not yet considered neuroprotective agents, but I think they are in a sense because they they reduce all these factors that are part of the, you know, the health span issue. You know, they they reduce your risk of heart disease and and kidney disease. So, they're they're very very effective for that. So, we we use them quite a bit. We use uh a lot of these drugs in heart failure patients. They're part of the um the the guideline therapy. And so, we That's nice to know. And for there's a condition called heart failure with preserved ejection fraction. That means the heart is working normally, but it's stiff and you can get heart failure from that. Right. It's the only drug that's been shown to really help that. Speaking of some other things, you already mentioned your wife. She's a
already mentioned your wife. She's a functional psychiatrist. You all wrote a book together, The Sicilian Secret Diet Plan. There we go. And tell me about that diet plan. Tell me about what your wife does, right? We already talked about how much the gut is connected to your heart and your brain health and your full body health. But we also know we have that brain gut connection, that emotional, you know, you feel it in your gut. That's an emotional state, right? So, your wife is probably very keen on this. I'm sure you realize that emotional states and mindset, all of that's really important, too. Talk to me about your book and talk to me about what have you learned from your wife in terms of how much the emotional mindset piece goes into heart health or general health. It's fundamental. I mean, it's it's just as important as everything else. Uh-huh. And maybe more important in some sense. There are a lot of studies showing uh uh patients that have a heart attack, if they're depressed, they have a six-fold increase risk of dying. That's how important it is. There's studies looking at people going into the cardiac cath lab for an angioplasty. If and this is men mostly, but if their spouse is there with them, then they have better outcomes than if no one's there with them in the beginning. So, you know, our physical connection to others and our emotional health is very important and and our emotional
very important and and our emotional health is also related to all the other lifestyle factors. My wife is a, you know, she's a child, adolescent, and adult psychiatrist and her, you know, the children she sees, you know, a lot of them have a lot of the psychiatric children things like ADHD and depression and anxiety and many, many of these things are connected to lifestyle, you know. For one of her one of the things she recommends as first line for anxiety and depression is exercise. It's it's a an incredible therapeutic for that. And uh so, again, uh you know, living a life that's uh good for risk factor reduction is probably a good way to live because not only do you avoid all these diseases and the good news is a lot of them have the same risk factors, but you feel better, you know, you want to feel good. You want to feel vital. You want to uh You know, uh I have a patient who's 95 years old. He still he can do a 1-minute plank. Wow. That's great. lived an incredible life his whole life, but Yeah. and I just read in National Geographic about a woman who picked up weightlifting at age 60. Uh-huh. She became a champion in her class and now is 90 Ah. and still is lifting pretty heavy weights. Yeah. So, we can stay healthy for a long period of time. Are you familiar with Vondra, right? Oh, yeah. She just we're on this longevity network kind of
we're on this longevity network kind of group chat and she gave us this article how we nobody actually loses their strength until age 75. There's no reason to lose your strength. It's just you basically laziness. Like you do got to work at it. You got to work hard at it. But just you know, that there's no reason that you can be strong into your later life and Oh, yeah. I have many patients that are in incredible shape. You know, 75-year - old patients that are in better shape than a lot of my 40-year - old patients. Uh-huh. You know, these this is so that's inspiring. Absolutely, yes. Because if we see that's how we wrote the book. We went to Sicily and we studied centenarians and supercentenarians and we saw what they did, you know, how they lived their life and you know, the simplicity of their life, the being active all the time. And one of the factors that we came across is that uh you know, these centenarians and supercentenarians the thing that really helps them more than anything is that if they're they're respected by their family and friends. If if their grandchildren come up to them and ask them questions and are interested in what they have to say and and they're passing their life experience onto them. Mhm. It gives them a will to live more than you know, if you're in a nursing home and you don't really do those kind of things. So, you know, the will to live is a very important thing. So, your physical health is connected to that. You know, if you have a good physical health, you have a good will to live, you connect with others, you know, and the process
with others, you know, and the process goes on and on. I love it. So, let me switch gears from all this feel-good stuff. Talk to me about toxins. What should we be avoiding? How can we detect their toxin load and what do you consider a detox? Well, first of all, I believe in measuring things. You know, I think if you don't it, you don't know what you're treating. Okay. And that's, you know, again, one of the things, you know, we're we're at Vibrant here, but I like The reason why I'm here is because I like Vibrant. [clears throat] I think Vibrant is a great company. Exactly. And uh and I think and I use the the testing quite a bit, including, you know, toxin testing and that sort of thing. And if you know the the you know, the person has problems, then you can deal with it. Mhm. And, you know, we're in this milieu of toxins around us. But, you know, we could do a lot of things to be detoxed. I'm not a big proponent of, you know, detoxes in a box kind of thing. I think that using food as a detoxification agent, you know, eating good things like uh asparagus, artichokes, you know, uh uh parsley, you know, in our book we have a um this is an ancient recipe. It's uh olive oil, garlic, parsley, uh that you put on fish. And one of the interesting things about it this is that this combination, it not only tastes good, but it it chelates out the mer - mercury. Okay. And then it binds it in a way that you can't really absorb it. So, it takes the mercury a little bit out. And mercury's
mercury a little bit out. And mercury's been in fish for a long time. Mercury's a natural substance that's been in fish for a long time. So, somehow, you know, years ago they they discovered that this is uh or they use this. You know how traditional uh cultures can use things that uh that have come up over thousands of years. So, this is a it's a perfect combination for our health. Fiber, too. Fiber's an a very important part of the diet. You don't Not only does it feed the microbiome, but it helps detoxify. Right. You know, keeping your gut mo - motility going quickly, you know, you tend to not absorb things. And and then we're big proponents of sauna. I think there's great data on sauna. Mhm. Um and I usually recommend doing sauna three times a week. And uh and doing some kind of shower with uh you know, right afterwards to get the detox the the heavy metals off your skin. So, you know, there's data showing that you have a 30% reduction in heart disease if you sauna, you know, three times a week. So, very good thing to do. Are you a proponent of infrared or is just a standard Finnish sauna your preference? There's a controversy about that. Okay. [laughter] So, I think they're they're equivalent. You do? But um the data, the studies in Finland, that's where the most of the data comes from, is on traditional saunas, not infrared. Mhm. But um you don't have to do a head-to - head trial to be able to know that. I don't think that's ever going to happen. I do think like the American College of
I do think like the American College of Cardiology has run some studies on infrared sauna and they can see that cyclic AMP pathway that leads to the nitric oxide through, you know, even before the heat is reached, so. Um Yeah, I think that uh you know, it's And it also augments your exercise. Sure. So, the biomarkers that we measure when we exercise get uh expanded when you do a sauna. So, it promotes that part of your, you know, lifestyle change. Absolutely. So, then putting all this together, what's a perfect ultimate heart health day look like for you? Like if you were to stick to the foundational things and do everything right, what would that look like? I usually recommend my patients to exercise like they brush your teeth. Okay. You can't go a day without brushing your teeth, right? So, you brush your teeth and exercise for an hour. Okay. And mix it up when you exercise. Do a little bit of aerobic exercise, high-intensity interval training, and some very important, do some resistance training. Okay. And then uh try to get uh components in your diet. Uh first of all, do a a time-restricted eating pattern. Okay. Which is also helpful for insulin sensitivity. Mhm. And uh and also there's some studies showing that it reduces uh other biomarkers. You know, we in our podcast, we interviewed Walter Longo. I don't know if you know him. I'm not familiar. He's the uh person who discovered uh intermittent fasting and the benefits fasting mimicking diet. He's behind
fasting mimicking diet. He's behind ProLon. Oh gosh, I do know. Yes, I love ProLon. Yeah, you know, he has a tremendous amount of data showing how beneficial this is. So, Is he at the Longevity Institute? Is that what it's called? He wrote a book called the Longevity Diet. Yeah. And he's a big proponent of, you know, this kind of Mediterranean diet with a lot of legumes and that sort of thing. Sure. So, um So, after you do your 14-hour fast, you break your fast. Usually what I recommend is some sort of smoothie cuz a lot of my patients are on supplements. Okay. And the way I do it, I wash down my supplements with smoothie. My smoothie has, you know, I like to get some upfront protein. Okay. Some whey protein. Okay. Uh good collagen. Okay. Creatine, which is good for your muscles and good for your brain. Uh flaxseed. Uh-huh. Cuz flaxseed is a a great source of alpha-linoleic acid, which is really good for your arteries. Absolutely. plant-based omega-3. It is. And and a good cocoa powder. You know, like your high-quality cocoa powder for the effect on your brain and muscles, the BDNF. use that as a you know, there's a lot of these components, it's hard to put in your diet the rest of the day. Uh-huh. But no fruits in that? Add some fruits. Okay, great. [laughter] Blueberries. I like berries. I do too. Cuz I uh I think they have a low glycemic index. Uh-huh. And they're full of uh you know, polyphenols, so they're it's a good source. I mean, you can eat the other, you know, I eat all the fruit, but I eat the high glycemic index fruits like the tropical fruits in very
fruits like the tropical fruits in very low quantities. Sure, me too. Because I'm very sensitive I mean, I'm very cognizant of the effect of the fructose on your liver. So, I don't want did just hear a podcast with Dr. Don, I don't know how you say your last name, um and she's at Mayo Clinic. She said kiwi helps reduce cancer risks. So, Oh, kiwi's great fruit. Helps you sleep, too. It does. Okay, good. I don't think kiwi's very high glycemic index. It isn't. Okay, it seems sweet to me in in terms of sweet. Yeah. Uh but I I think kiwi's great fruit. Okay, great. So, you know, pomegranate. I'm you know, pomegranate is a good source of urolithin A and urolithin A, as we were talking about before, is one of the things that helps your mitochondria. Right. That and coenzyme Q10. So, um you know, putting Again, mix it up. It's always a good idea not to do always exactly the same thing. You know, pomegranate, you know, citrus fruits. Okay. Somewhat high in glycemic index, so you can't eat them a lot, but I you know, I think they're great. Yeah. And uh the pectin Mhm. in the citrus fruit It's a binder. It has anti-cancer properties. It's a fiber. So, it's a very good thing to eat and when you eat some of the fruits is eat that. So, I would again, mix them up, but the mainstay of fruits, I think, are berries. And um and then lunch I usually recommend having a salad. Perfect. Mixed salad, you know, different colors as possible. Uh-huh. And then I recommend to my patients to make a uh salad dressing. Make your own
make a uh salad dressing. Make your own salad dressing. Okay. And the way to do that is you take some garlic cloves and you crush them. Okay. And that makes the allicin turn to allicin. Okay. And that allicin is very, very and it increases like a hundredfold by crushing it. You wait 10-15 minutes, put it in a small jar of olive oil, Okay. really high quality glass jar, and then put a tablespoon of capers in there. Mhm. High quant - super high concentration of quercetin. Okay. And mix that up and use that as a salad dressing. 4 Tbsp of that a day. I find that to lower cholesterol Okay. and improve endothelial function. So, you use that as your salad dressing both at lunch and dinner. Okay, I want to mention something while we're on quercetin because I get patients in my office that they really want NAD supplements. And we know that increasing NAD either through the precursors or however they try to get it whether NR NMN can increase CD38 which is that transmembrane enzyme that can break down NADs. And that's harder to get rid of. So, when the when you stop taking NAD, those levels go down, CD38 rema - remains and it can break down your natural NAD. But, the thing that breaks down CD38 is quercetin. And so, instead of just taking these supplements, let's have some capers. That's right. Yeah, and it goes back to a lot of times I find plant foods. So, okay. I usually try to be food first. Uh-huh. You know, I do use supplements. Right. Limited number of supplements or supplements
supplements supplements like if you do a micronutrient panel and someone is deficient. Right. Then I use supplements. Otherwise, I don't you know, willy-nilly just use supplements. And um But, uh you know, and then you have some protein in that salad, you know, that could be legumes, okay, great source of protein. Good. Or, you know, uh chicken or fish or, you know, even meat. I think the, you know, there's a big controversy about eating red meat. But, the deal with red meat is that you can eat red meat uh if you're metabolically healthy and you're exercising you can really deal with saturated fats. It you're it's usually there's a couple of problems with meat studies. One is that uh in most meat studies, it's processed meats. There's never been a study where they look at really high quality meats, you know, like grass-fed, no hormones, uh range meat, and it's risk. But, I think most of the data points towards if you're metabolically healthy, you can eat meat and get and not have any problem with it. If you're metabolically unhealthy, then it becomes a problem. So, another reason to become metabolically healthy. So, [laughter] you need meat. And then, you know, you can use that as your protein source, you know, have a fruit, have a lot of water, stay hydrated. Um and and I like using fermented foods for the microbiome. Okay. You know, I like natto. I think I'm the only person in the world that likes it. Yeah. But, I think it's a great fermented foods or kimchi or sauerkraut or pickles
foods or kimchi or sauerkraut or pickles or dairy like a yogurt. Kefir or you know, yogurt with some live cultures. And usually we recommend the whole milk yogurt, not the low-fat. Cuz the whole the the processing of dairy into low-fat I think is worse than the fat. Yeah, we see that with fertility, too. Yeah. And the whole milk also has the fatty 15 in it. So, when you make it make whole milk into low-fat milk, you get rid of the fatty 15. Fatty 15 is like the first omega that we've discovered I think in 50 years and it has a lot of incredible properties for the heart and other, you know, other things. So, you know, whole milk, not huge quantities, live cultures, and and then dinner, similar kind of thing. You know, have roasted vegetables if you like for dinner instead, have some kind of protein source, whole grains, you know, small amounts of whole grains. So, this is basically I use a lot of olive oil. Okay. Like I said, the garlic, artichokes, you know, foods that help detoxify you naturally, asparagus. These are all really good foods and um limit I don't think you should be drinking too much alcohol but limit your alcohol. Okay. And then what time do you go to bed? I should go to bed at 10: 00. Okay. And you wake up 6: 00. Okay, so nice 8-hour time frame. Perfect. Yeah, I try I I've become more sleep-focused
sleep-focused sleep-focused uh now than I was before just knowing how important sleep is. Yeah. Absolutely. Well, we see that just shifting time either time zones or daylight savings when we spring forward and lose that hour, heart attack risk goes up. That's right. Every year, it's pretty consistent. Yeah. And uh so it's uh you know, that's related to loss of sleep and we know like lack of sleep is related to a lot of different problems. So, that's one of the things we focus in on our patients. You know, we make sure you know, again, we try to make some incremental changes. If they're sleeping 5 hours, you know, sleep 5 and 1 / 2 hours. You know, if they can't do it, then we implement some CBTI, that kind of thing to make them start sleeping a little bit better. Yeah, great. And do you work on their stress management with either meditation or yoga or are are we trying to help them set boundaries? What do you do for them? No, we do a lot of that work. One of the modalities I use is the HeartMath biofeedback Okay. because that's been shown to improve heart rate variability. Okay. And heart rate variability as you know is is a marker of sympathetic tone. Okay. So, and it's a very simple thing to do and what patients like about HeartMath is that you have a you know, you can see if you're doing it correctly. Okay. But I also encourage other things like pranayama universal breathing. It's an app and it's very easy to do, very important for diaphragmatic breathing. So, it's you know, all these things you can only do so much. I don't want to over you know,
over you know, when we see a patient for the first time, we put everything down on paper. It looks overwhelming but we tell them just do these three things. Perfect. How can people find you? Are you on social media? How do they get to your podcast? Uh well, everything is in our website. So, Coreion and it's spelled kind of unusually. It's c o r a e o n. Okay. That means heart age in Latin. Love it. And I'm a big uh Latin buff. [laughter] Anyway, coreion. com, everything's there. Okay, wonderful. Well, thank you for being with us today. And thank you so much for joining us today on the Vibrant Wellness podcast. Don't forget to check back each Wednesday to hear more insightful conversations with leading experts, inspiring health journeys, and the latest in integrative medicine and wellness. Follow us on Instagram at Vibrant Labs and be sure to like and subscribe to the Vibrant Wellness podcast for more conversations with these leading voices in health, longevity, and personalized medicine. [music]
Transcript auto-generated by YouTube. Verbatim — duplicates intentionally preserved.
In this conversation, Dr. Giovanni Campanile places metabolic health at the center of prevention. The message is direct. Chronic disease rarely arrives without warning. It usually builds slowly, through insulin resistance, vascular strain, inflammation, stress, poor sleep, hormone shifts, and missed signals.
Metabolic dysfunction is not one marker. It is a pattern. Blood sugar rises. Insulin works harder. Triglycerides shift. Blood pressure creeps upward. Inflammation becomes background noise. Together, these signals shape cardiovascular risk long before a dramatic diagnosis appears.
The useful shift is moving from reaction to awareness. When you know your baseline, you can change the inputs early: food quality, movement, sleep, stress regulation, toxin load, and recovery. Prevention becomes less abstract. It becomes measurable.
Inflammation is part of repair, but chronic inflammation changes the terrain the body has to live in. It can make vessels less resilient, disturb metabolic signaling, and pull energy away from restoration.
This is where longevity becomes a daily practice. A meal, a walk, a night of sleep, a sauna session, or a deliberate pause may look ordinary from the outside. Inside the body, those inputs help restore order.
Dr. Campanile argues for earlier risk stratification and better data. The point is not to chase every number. It is to understand which levers matter for the person in front of you.
Good medicine and good self-care meet here. Test intelligently. Interpret with a clinician. Then choose the few rituals that you can repeat with precision.
"Metabolic health is not separate from longevity. It is the ground longevity stands on."
"Metabolic health begins with measurable signals, not symptoms."
"Insulin resistance and inflammation can quietly shape cardiovascular risk."
"The best longevity protocol is built from repeatable daily inputs."
Know your baseline: glucose, lipids, blood pressure, inflammation markers, and body composition tell a clearer story together.
Treat sleep, movement, nutrition, and recovery as metabolic medicine, not optional extras.
Use testing to guide decisions, then return to the rituals that create resilience.
