Integrative Cardiology with Dr. Trent Orfanos: Rational Wellness Podcast 363

Dr. Trent Orfanos discusses Integrative Cardiology with Dr. Ben Weitz.

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Podcast Highlights

1:33  Functional Medicine.  Dr. Orfanos was a conventional, interventional cardiologist. He has a daughter with cerebral palsy and he and his wife took a Functional Medicine approach to her health, using nutrition, supplements, exercises, and patterning. She went from unable to crawl to walking on her own. But he continued to practice conventional cardiology until 2010 when he was looking for a wellness program for hid cardiology practice and he went to a meeting on supplements and it was a real epiphany for him and he started applying it and his patients got better and healthier.  He was convinced.

3:06  The Mediterranean Diet.  Dr. Orfanos believes in the Mediterranean diet, which is one of the most well-studied diet and it includes fruits and vegetables, nuts and seeds, fish, and some meat. It also includes plenty of olive oil and legumes. He is also comfortable using olive oil to cook with and he points out that he is Greek and the Greeks have been using olive oil to cook and fry with for millennia.


Dr. Trent Orfanos is the Director of Integrative and Functional Cardiology at Case Integrative Health in Chicago, Illinois. Dr. Orfanos practices invasive interventional cardiology from 1982 to 2019 but he embraced preventative cardiology from the functional Medicine perspective starting in 2010 and exclusively from 2019.  Dr. Orfanos has board certifications in Internal Medicine, Cardiology, Integrative Medicine, Functional Medicine, and Anti-aging Medicine.  He is also an associate clinical professor of medicine at the Indiana University School of Medicine. His website is caseintegrativehealth.com/cardio.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.



Podcast Transcript


Dr. Weitz:  Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz. com. Thanks for joining me and let’s jump into the podcast.

Hello, Rational Wellness podcasters. Today, we’ll be having a discussion on integrative cardiology with integrative cardiologist, Dr. Trent Orfanos. Dr. Trent Orfanos is a director of integrative and functional cardiology at Case Integrative Health in Chicago, Illinois.  He practiced invasive interventional cardiology from 1982 to 2019, but he embraced preventative cardiology with a functional medicine perspective starting in 2010 and exclusively from 2019. Dr. Orfanos has board certifications in internal medicine, cardiology, Integrative medicine, functional medicine, and anti aging medicine.  He’s also an Associate Clinical Professor of Medicine at the Indiana School of Medicine. Thank you, Dr. Orfanos for joining us today.

Dr. Orfanos: Well, thank you for having me on. It’s great to be here.

Dr. Weitz: So maybe we can start with the transformation in your career. How did you decide to move from the dark side into the light?

Dr. Orfanos: Well, you know, the once you see the light, it’s hard to go back.  And so I can say that my story, excuse me, my story goes back. I have a daughter that’s I have four daughters, so I’m blessed. And the first one was born with cerebral palsy, which is a brain injury. She couldn’t walk or crawl even up until the time she was three. And we adopted what turned out to be a functional medicine approach to her health, not knowing what it was called. And it’s a lot of patterning, exercises, nutrition, supplements. She went from unable to crawl to like walking on her own, which astounded her doctors who didn’t expect it.  So that was a first aha moment. And

Dr. Weitz: That’s great to hear stories like that.

Dr. Orfanos: Wonderful. And so that was, she was, she’s now 43. And and then 2010, I. I was looking for a wellness program for my cardiology practice and I went to a meeting on supplements because I thought that I wanted to know more about them.  And it was just a real epiphany for me and it all came together.  It took a while but and I started applying it.  Patients just got better and healthier and they weren’t getting healthier before and now they are.  So I was convinced.

Dr. Weitz: That’s great. So maybe we should start with diet.  So what are your thoughts on a heart healthy diet? 

Dr. Orfanos: Sure my my background’s Greek; all my grandparents were from the old country.  And so the Mediterranean diet is probably one of the most well studied diets in the world. And it basically that’s, so that’s one of my favorite ways to recommend eating.  It’s not low fat. There’s plenty of olive oil and some animal fats in there too. Fruits and vegetables, nuts and seeds, fish. It’s and that encompasses so many healthy phytonutrients that are in there. It’s and it translates into less fat. Heart disease, less dementia, less diabetes longer life expectancy.  It just pays off all the way around.

Dr. Weitz: I liked the Mediterranean diet, but I will say that when you look at the studies, there’s a little squishiness around the edges, like one study will say it includes legumes. Another one will say it includes cheese or eggs. Another one will say it includes bread.  And there’s a little vagueness there.

Dr. Orfanos: Yeah. Yeah. And that just to me, that just [00:04:00] goes to show you that, you gotta be flexible, in your diet that growing up with this being just inherently part of my life, I never experienced like some people didn’t need legumes and some did, they all did.  They were all, we had, bean soup on Sundays.  But it was like a routine thing. I’d say it includes all of those things. I know carbs and bread and gluten are sometimes get a bad rap, in, in the, when you wrap it around that whole high olive oil, polyphenol diet, those things seem to be like be okay.

Dr. Weitz: Right. What about saturated fat? It’s been popular for the last number of years in the functional medicine world. There have been some prominent books that have come out saying that saturated fat, butter, egg, cheese, etc. don’t really contribute to heart disease, that it’s not really saturated fat, the real problem is sugar.  What do you think about that?

Dr. Orfanos: I think probably back in the, what, in the sixties, I think the speaking of that kind of thing, the seven, yeah,

Dr. Weitz: Those big studies and those studies have been criticized and

Dr. Orfanos: I’m more on the side of, saturated fat in and of itself is not bad. You’re eating in the context of.  Of these healthy animals were raised healthy. You’re eating it with olive oil and and, boiled greens sprinkled with olive oil and lemon juice. And

Dr. Weitz: And this kind of, in other words, eating some grass fed meat or some organic chicken that has saturated fat is not really a problem because it’s in the context of a healthy diet with olive oil and these other healthy fats.

Dr. Orfanos: That’s the way I see it. It’s a holistic approach. It’s everything that you’re doing that’s going to make you better. It’s hard to isolate. I’m just going to have some saturated fat today by itself.

Dr. Weitz: But people do have questions like, What should I be using to cook my eggs in? Should I use butter? Should I use coconut [00:06:00] oil? Should I use, olive oil? Should I use avocado oil?

Dr. Orfanos: I can tell you that even though you get this, Oh, don’t fry things in olive oil because the olive oil gets ruined by doing that we Greeks have been frying things in olive oil for millennia.  And I just can’t, I don’t buy that, that I understand what you’re saying. It gets maybe trans fatty or whatever, but that’s just, isn’t the way people live. Okay. They use olive oil for everything. They don’t go out and buy avocado oil or coconut oil. They use olive oil for everything. And they do pretty well.  There’s blue zones in Greece,

Dr. Weitz:  What about coconut oil?  Is coconut oil a healthy oil?

Dr. Orfanos:  I think you can use coconut oil for high heat situations. It is, of course, a saturated fat, but I think it, I feel like it’s okay to use it. I wouldn’t like make that your exclusive fat, right?  I think olive oil is probably where I’d like it to go. Maybe avocado oil. If I had,

Dr. Weitz: I know myself, I switched to coconut oil for a while for high heat cooking for like when we bake vegetables. And when I started using it consistently, my small, dense LDL started to go up and my LDL particle numbers started to go up.  So I switched over to avocado oil for high heat cooking. And then I use olive oil for lower heat cooking.

Dr. Orfanos: I think that sounds really wise.  And some people that may have, you’ve probably heard of the APOE genotype. If you’ve got the E4, you probably should go low fat, low saturated fat, because those people respond like that. They, their LDLs and particles go up too high.

Dr. Weitz: Okay. When let’s go into testing. When we take more of a functional integrative approach and we’re trying to assess the cardiovascular system usually we want to do more detailed testing than a standard lipid profile.

Dr. Orfanos: Yes. I, I routinely do advanced lipid panel testing. So what is that? So beyond the usual LDL cholesterol total triglycerides and HT l we do we look at the lip, the LDL particle number. So LDL cholesterol is gets the name bad cholesterol, but depends if it. If it’s oxidized or not.  So we look at how many particles there are in there, the more particles, the more risky it is. We look at the size of those particles, so small particles are more dangerous. So big particles are like beach balls bouncing around inside your arteries. They don’t cause much damage, but small ones are, they’re like golf balls, They can hurt, when they hit the walls.  And that’s relatively what the way I like to think about it. We’re looking for beach balls instead of golf balls. And we want them, we want, we look at inflammation markers too. And we want to make sure that everything is

Dr. Weitz: What are your favorite inflammation markers?

Dr. Orfanos: High sensitivity C reactive protein is like pretty universal. It’s not specific, but, if that’s high, that goes along with all kinds of risk for bodily chronic disease you can imagine. 

Dr. Weitz: Right.

Dr. Orfanos: There’s oxidized LDL, ox LDL, that’s the hot inflamed golf ball LDLs. And there’s a Lp(a), Lp(a), the one that’s that you can check. And if that’s up, that implies inflammation actually within the vessel wall.  And then you do things that are common to lower inflammation. And a lot of it circles around the foods that we eat, like the Mediterranean diet, that’ll bring those down.

Dr. Weitz: And what other components of testing are included?  Do you, are you running like homocysteine levels?

Dr. Orfanos: Yep, I routinely run homocysteine levels.  I’ll check hemoglobin A1c, which is a marker of how high your sugars have been for three months. And fasting insulin levels. I’ll check uric acid because it’s a risk factor too.

Dr. Weitz: Yeah. We can thank Dr. Perlmutter for bringing that on the radar screen as a metabolic marker.

Dr. Orfanos: Yeah. He’s, I really appreciate that he brought that up.  I check the RBC levels of omega 3 fatty acids or fish oil. That’s, if there’s one thing you can do. If your Omega 3 Index, your RBC Omega 3 Index, that’s DHA and EPA, if that’s at the highest levels, at 8 percent or more, compared to those, most of us running around at 4 ish or so.  When you’re up here, there’s less death from any, from all causes. That’s death from heart disease and cancer.

Dr. Weitz: Yeah, I try to target above 10 if I can.

Dr. Orfanos: Oh, that’s tremendous, yeah, if you can get up that high. If you’ve got the E4 genotype, Dr. Bredesen’s Alzheimer’s guy says, It 10 percent your goal, but if you can get it a 10 fine.

Dr. Weitz: What do you think about HDL? For a while was considered super important High HDL was supposed to be protective and I would say in the last five years the importance of LDL has been somewhat called [00:11:00] into question and then we now see that high HDL above 80 is actually often considered to be non functional and actually not good.  And so we’re trying to assess more HDL functionality these days, but it’s hard to assess that.

Dr. Orfanos: Yes, you can do myeloperoxidase, which is a sort of a surrogate marker for dysfunctional HDL. So that’s something that can be done. Also it’s if you’re making a lot of HDL, I heard somebody’s HDL was like, I had this one patient of mine.  She was an elderly woman. Here, HDLs were like, 110 and she was, she had terrible vascular disease. Your body’s making more of a dysfunctional that doesn’t an HCL doesn’t work. So it just keeps pumping out more trying to make up for it. And it’s a sign of, like you say, dysfunctional HCL that don’t, that doesn’t work.

Dr. Weitz: What do you think about TMAO? 

Dr. Orfanos: Oh, that’s a, yeah that’s a tough one because TMAO goes up with eating fish, for instance. So I’m like, I’m thinking, wait a minute, if you eat fish, you’ve got less heart disease. I’m more with eat the healthy diet. It should contain fish.  And I don’t say ignore the TMAO, but to me that’s. I’m going to say, maybe it’s heresy, but I’d say that’s secondary to, to the healthy diet idea.

Dr. Weitz: When you look at the data on TMAO, a lot of it’s dependent upon the gut microbiome. And I’ve had I was running TMAO regularly for a while and a lot of patients, if they had a healthy gut, Would have a normal TMAO no matter how much fish or meat they were eating.  So I think it might be a marker for an unhealthy gut more so than really for cardiovascular disease.

Dr. Orfanos: And that sounds like the old functional medicine axiom, start with the gut.

Dr. Weitz: [00:13:00] Exactly.

Dr. Orfanos: Somebody just go for their gut and get that working good. And the other things fall in line.

Dr. Weitz: So if we discuss some of these markers that you see tell me, what are some of your favorite strategies to address?  So for example what’s the first thing you think about doing for a patient who has an elevation of LDL particle number? And if they have a lot of small dense LDL.

Dr. Orfanos: Okay. Usually it starts, it starts with food. So those people are, generally eating a high carb, high sugar, inflammatory food type diet.  And you need to start turning that around. It’s hard to change people’s food. They’re very much attached. We all are. We’re attached to what we like, so we don’t want to change. But if you can eat low carb Mediterranean you’re going to, and perhaps do some intermittent fasting, which I think is overall a good idea.

That can turn around just with that. And then things like omega 3 fish oil they’ll flip that too. [00:14:00] You’ll get your particles, number goes down, your particle size goes up, your HDL goes up, inflammation comes down. It’s just a win. Those are good. I’ll use I’ll use some I’ll sometimes use berberine as far as berberine is insulin sensitizing and lowers LDL cholesterol.  It’s It works like these shots called PCSK9 inhibitors. It’s got that kind of function.  That’s cool.

Dr. Weitz: It’s one of the few things that’s been shown to reverse plaque.

Dr. Orfanos: I didn’t, I’m not sure about that. Did you see that?

Dr. Weitz: Yeah. Yeah. There’s at least one or two studies showing that I’ll send them to you.

Dr. Orfanos: Okay, that’ll be great. I’d like to see that. There’s there’s other there’s another supplement out there that’s made that, that comes from seaweed. This is secondary but actually it’s pretty good. That can actually reduce plaque and especially the vulnerable.

Dr. Weitz: You talking about like the Arteriosil

Dr. Orfanos: yeah, Arteriosil. Yeah. I think that’s amazing. Yeah. Endothelial function. Function and glycocalyx. The linings of the artery. Yes. All that gets [00:15:00] better. We forget about, there’s strategies to try to heal all that, which is gonna help that artery work better. Of course you gotta get your lifestyle right.  You got to be eating right, you got to be exercising, you got to be sleeping correctly. You got to watch your stress. You can’t be walking around, wired and angry and all that all day long because that’s going to, that could distort everything you’re trying to do. What else can I tell you?

Dr. Weitz: Let’s see. What if you have small dense LDL? How do we make that LDL particles larger?

Dr. Orfanos: Those will change all those strategies I mentioned, they that’ll flip that the LDL particles will become bigger, fluffier and less dense.

Dr. Weitz: Okay. So you mentioned some supplements, any other supplements you use for LDL?  Do you use red yeast rice?

Dr. Orfanos: I use red yeast rice. That’s one of the more effective ones because it, as it contains a statin, basically, that’s where they found it. Those monoclones are where they purified the statin. They took it out, purified it, made a drug out of [00:16:00] it. So those, that works pretty good.  You gotta use enough, but you can get LDLs down.

Dr. Weitz: Yeah. You got to use at least 2, 400 milligrams.

Dr. Orfanos: Yeah. Yeah. You can go up to 4, 800 if you need to.

Dr. Weitz: Yeah, exactly. Citrus bergamot. Have you used that one?

Dr. Orfanos: I don’t use much of that. Doesn’t seem all that effective. I think Red Yeast Rice has got an edge, got a, it’s better.  It’s better.

Dr. Weitz: Yeah. Yeah. I definitely think on the supplement side, Red Yeast Rice is one of one of the supplements that’ll move the needle the most, or the supplement that’ll move the needle the most.

Dr. Orfanos: For LDL, sometimes you can use like Annatto E it’s gamma delta tocotrienols. Those will do it too.

Dr. Weitz: Yes. Yeah. I’m a big fan of those. Dr. Bertie Tan, we’ve had him on the podcast a couple of times.

Dr. Orfanos: He’s wonderful. He’s great.  Real kind guy too. Yeah. So that’ll work.

Dr. Weitz: And then when do you use medications?

Dr. Orfanos: If I have people that come in and they’ve got [00:17:00] established coronary disease, I had a lady come in today and she’s got, she just had a heart attack in February and she’s got a stent in the very heavily calcified coronary artery. I said, I, this is where statins, this is where pharmacology, the benefits outweigh the risks. If you’re a 40 year old guy with a cholesterol of 230 and somebody puts you on a statin and there’s nothing else going on, I don’t think that’s, the payoff is pretty small there.  But for her, the payoff I felt was good. So I put her on a low dose of the statin.

Dr. Weitz: Which, which statins do you prefer the most?

Dr. Orfanos: I like Crestor or Resuvastatin. It’s Pretty potent. It’s one of the more potent ones as far as Statins go. It it’s got a pretty long half life, so you could use it like, three times a week instead of every day, if you’re people are having trouble with it and still you get pretty good results.  And it’s water soluble, now that’s arguable, but that may, it may be less side effects with the water soluble ones than the fat soluble ones. Yeah,

Dr. Weitz: I know a number of cardiologists who feel that way.

Dr. Orfanos: It’s worth doing. And then they got these new drugs out. I mentioned the berberine like drug, the PCSK9 inhibitors, those are shots that just, all they do is there’s these receptors in the liver that suck out the LDL and when you take the shot, you get more of them they don’t break down, so they persist.  So your LDL comes out. Very few side effects, people get by pretty good with those compared to statins. There’s another one that’s Bempedoic acid, that’s a drug that just works in the liver, seems to have really low side effects and does the job.

Dr. Weitz: Yeah, some doctors I know, some cardiologists who want to use the medication and for patients who don’t tolerate a statin they’ll sometimes use Bempedoic acid and Zetia.

Dr. Orfanos: Zetia, yeah, it’s a combo, they come as a combo, which is nice. So one side. The Bempedoic acid stops the production side, which is what most people concentrate on, but the Zetia stops the absorption side. So you get it from both ends, so you can get a pretty substantial drop with that.

Dr. Weitz: [00:19:00] Right.  Have you run that cholesterol absorption versus production test?

Dr. Orfanos: I haven’t done that.

Dr. Weitz: Yeah.  Boston heart.

Dr. Orfanos: Boston heart does that. I’m not against it. I just haven’t done it. I just try stuff, yeah. I’ll try the statin or slash, or one of the others, and then I’ll add Zetia, and then sometimes you get some profound benefits.

Dr. Weitz: You usually recommend CoQ10 with statins?

Dr. Orfanos: Oh, yeah. So you get, the CoQ10 gets depleted with the statins so does vitamin K2, so does fish oil, so does vitamin D. A lot of things get

Dr. Weitz: Yeah.

Dr. Orfanos: drug nutrient interaction thing. And you want to get that CoQ10, if you can, above three. That’s the goal for a good, for best cardiovascular outcomes.  Okay. I measure those two and see where they’re at and supplement.

Dr. Weitz: So what’s your best strategy for a lipoprotein A, LP little A?

Dr. Orfanos: That’s a tough one. I’ll still use niacin in spite of this Article that kind of was condemning it. Maybe [00:20:00] that’s a strong word.

Dr. Weitz: Why don’t you, why don’t we talk about that article for a minute?  So for those who are not aware, there’s a recent paper in Nature by Dr. Stanley Hazen, and he argues that when we look at niacin consumption. There’s a couple of downstream metabolites, one in particular that he claims might be dangerous.

Dr. Orfanos: Yeah, the 4PY and 2PY, yeah, and those down there, , actually, Dr. Houston sent me an article right when the, some of this niacin stuff came out that just showed the opposite, that people that were put on niacin had better cardiovascular outcomes.

Dr. Weitz: Yes.

Dr. Orfanos: They may say this trumps it, because it’s a more recent article, but I don’t know. I, I’ve been using it for For years for a decade or more, maybe more than that since I was doing conventional cardiology and although I’m just me, I haven’t noticed any ill effects as far as cardiovascular outcomes from using [00:21:00] it.  Think it does so many good things raises a LDL particle size decreases LDL particle number increases HDL and HDL functionality lowers triglycerides. I mean that all that’s. going to pay off. I guess one of the questions is if you’re genetically predisposed to make more of these inflammatory metabolites, maybe you’re at some risk.

Dr. Weitz: But that’s one of the points I think one of the critiques I have of that article that Dr. Houston mentioned when I talked to him, which is that that paper is indicates that only certain genetic subtypes are going to produce those metabolites. And in order to see if those metabolites are really dangerous, I was just reading the article last night.

They tested to see if there was a correlation between 2p y or 4p y and heart attack or stroke or [00:22:00] Other cardiovascular disease and it was really no correlation. So all they have is this in vitro analysis that’s associated with certain inflammatory factors And so I think it’s very weak evidence and especially for a nutrient, niacin, which is commonly found in all these healthy foods.  Yes, it’s in animal products, it’s in salmon, it’s in avocado, it’s in all these healthy foods. And it’s really hard to think that this common B vitamin is potentially dangerous.

Dr. Orfanos: Yeah, I feel the same way. And it’s also difficult to apply these sort of the drug mindset.  How do I test a drug? I test, this one molecule for this one disease, and I see what happens. And then I make broad claims about the drug. Okay, but nutrients are a whole different problem. Animal, they’re, they interact with everything that you’re doing. You’re, the [00:23:00] air you’re breathing the activities you have, the other vitamins and nutrients you’re taking.

So that’s, I don’t think you can draw those kinds of strong conclusions like that. But like you say in vitro and then he brings up like he says in this study niacin didn’t help and maybe even increased risk in another study. So he’s combining them and making a claim that because that other study showed something.  That therefore this this this concept that he had must be true, yeah,

Dr. Weitz: He brings up a couple of old studies that in my mind have already been refuted like eight years ago, but he brings up the HPS thrive study and the HPS thrive study didn’t just use niacin. He used niacin combined with a drug Laparipant.  Yeah, it was a drug developed by Merc and the laparapant was designed to reduce the flushing that some people get with niacin.  Which by the flushing is not harmful. It’s just some people don’t like it and that drug had a bunch of side effects and that study The patients had the side effects that were already attributable to that drug.  And then they said that showed that niacin might have these side effects and wasn’t effective. So that wasn’t a very accurate way to assess the effectiveness of niacin. And we got a bunch of other studies that have shown lots of benefits of niacin.

Dr. Orfanos: Yeah, exactly. And I believe was it thrive or aim high?  I can’t remember what aim high. Yeah.

Dr. Weitz: Aim high. They found that there was no benefit, but if you actually go back and read the study, it significantly lowered LDL. It significantly did all these positive things that we know are associated with increased cardiovascular health.

Dr. Orfanos: And one of them was, I forgot which one, was using a drug that was, the idea was to raise HDL, I believe, if I got that I think it [00:25:00] was to raise HDL, and it turned out to be, have a worse cardiovascular outcome, and then they tied it to niacin.

Dr. Weitz: Yeah, I think that’s that lap, laparapan, yeah.

Dr. Orfanos: Yeah, that one there, so I think. So anyway it’s like guilt by association kind of a thing, niacin, niacin was even combined with what was, what did they call it? There was a drug out that combined niacin and never core.  I think one of the first stands.

Dr. Weitz: Yeah. I think both those studies, HPS thrive, in addition to that laparapan that was included in the HPS thrive, Both of those studies had patients on statins and niacin, and they were testing to see if statin plus niacin was better than statin without niacin.

Dr. Orfanos: So I’ll still use, I still use niacin for people with high LP, little now having said that, those PCSK9 shots like Repatha, they’ll lower LP little A probably by a third, by 30 percent or something like that.  Whereas statins, if anything, they might raise it a little bit, [00:26:00] 10%. They really don’t do anything. And then there’s a new, there’s these new drugs coming out, siRNA drugs that are like, they’ll knock it down 90%. They’re, if they come out, then they’ll, that’ll be the answer for people with LP little a that’s I have a patient who’s serious with sputum.  450 today.

Dr. Weitz: Even yeah it’s interesting. I sometimes talk to primary care doctors and they don’t want to run lipoprotein A. And when I tell them that we should run it, They tell me it’s a genetic factor, so why run it? But lipoprotein A, Lp(a), is typically not being run in most patients, unless they see somebody like yourself or like me, who has a functional medicine approach, because there’s no drug for it.  But once that drug is out, everybody will be running it.

Dr. Orfanos: Everybody will be checking it. Yeah. And, if you know it’s high, to me, to be forewarned is to be forearmed. So if I know you’ve got high LP little a, I’m going to be real aggressive in managing your LDLs [00:27:00] and your other risk factors, because whatever I do, I’m going to blunt the negative effect of that LP little a.

Dr. Weitz: And niacin can get you 30, 40 percent reduction. You can get a little more from from L carnitine, there’s several other agents that can help push it down a little more as well.

Dr. Orfanos: I did, I don’t get that much out of niacin. I may get 20 maybe 30, if I’m lucky.

Dr. Weitz: Okay.

Dr. Orfanos: Then I just, I haven’t checked this out yet, but one of my, I was at a functional medicine meeting and I was talking to Dr.

One of the cardiologists there that probably won’t know, and you may know her, Mimi Guarneri, she’s out on Oh yeah,

Dr. Weitz: yep, I’ve

Dr. Orfanos: met her and talked to her. Talked to her about niacin and she said, oh no, I’m using niacin. And she said also that aronia berry, which is an herb,

Dr. Weitz: What’s it called?

Dr. Orfanos: Aronia berry, A R O N I A.  Can also lower LP little a I didn’t get a chance to research it but be something to look into as another.

Dr. Weitz: Yeah, I want to say [00:28:00] I think ortho molecular has a product that has that in it. Okay, they have some cardiovascular products that they have pioneered in the last few years. Yeah, they’re there.

Dr. Orfanos: They’re stepping up there. That’s good.

Dr. Weitz: All right. I’m do you ever test genetics? Thanks.

Dr. Orfanos: I check I’ll check MTHFR. Okay. To see if they’re methylating or not. And then I’ll, that kind of may or may not, it goes along with homocysteine. Homocysteine is high if the MTHFR is off. So sometimes that’s a clue.

And I’ll check I’ll check APOE4. I’m checking that more now. Why would you check on me? Because, like I say, it’s back to the forewarned, forearmed idea. If I know you got it, I’m going to be more aggressive in treating your risk factors so that you don’t get dementia and Alzheimer’s.

Dr. Weitz: Yeah. Dr. Houston helped develop a panel, a genetic panel through Vibrant America.

Dr. Orfanos: Cardia, CardiaX, I know. Yes. Yeah, that’s I [00:29:00] like that one too. I’ve done that even on myself. And that can also help direct you if you see if you have more cardiovascular risk genes, there’s one, I have some people with difficult to manage hypertension,

Dr. Weitz: right?

Dr. Orfanos: I have these, this one snip and that responds to an old and an old diuretic called amelioride. It’s been like, it’s 40 years ago, this thing came out.

Dr. Weitz: Oh, really?

Dr. Orfanos: And this just hits this epithelial sodium channel and eliminates the hypertension. People like they’re on four or five drugs.

And you put them on amelioride and slowly peel off everything else and pretty soon that’s all they’re on And that’s on that test, by the way.

Dr. Weitz: Oh, okay.

Dr. Orfanos: That’s cool wow, here’s a drug that’s just made for this condition,

Dr. Weitz: right?

Dr. Orfanos: And I thought that was neat.

Dr. Weitz: So now besides labs What are some of the other testing that you’ll use in your practice to assess?  coronary artery disease and cardiovascular risk [00:30:00]

Dr. Orfanos: Okay I’m limited here. I don’t have anything else. Yeah, but, when I what I learned about was another test called endopat. And that’s a a way to check endothelial function, slap a cuff on your arm and you blow it up till you cut off the blood supply for five minutes.  It sounds hard on you, but it’s not that bad. And then you have these little sensors in your finger, then you see how much you dilate your blood vessels when you release them, release the cuff and the blood, the better that is, the more resilient and healthier arteries are, and you can get judge your treatment by doing that.  Okay. That will be a nice tool to have.

Dr. Weitz: Yeah, I know Mark Houston uses that regulation.

Dr. Orfanos: Yeah, he does. Yeah, he does. Yeah. But again, you have to buy these things and ultimately, if you’re doing all these things, what I’m suggesting to do here with people, their endothelial function got better.  That’s that that, that should happen as part of the right treatment.

Dr. Weitz: As part of the endothelial function, do you [00:31:00] use nitric oxide stimulators?

Dr. Orfanos: I use I use one I used to use, there’s one that has a lot of beet juice, beet root juice in it. That’s a lot of oral stuff. Like the Neo 40.  Correct. Yeah, exactly. And now there’s one that Calroy makes it’s called Vascunox.

Dr. Weitz: Yes.

Dr. Orfanos: Works pretty good. It trip, it triples nitric oxide production. And which persists for 24 hours. So it’ll last the full day. So you just take two capsules once a day and that, that’ll crank up your nitric oxide production.  And if you’re hypertensive, it’ll lower your blood pressure, which is a lot of ways.

Dr. Weitz: I like now what about coronary calcium scans?

Dr. Orfanos: Yeah, I do them. I do them on just about everybody, for 49 bucks, you get a lot of information, meaning do you have calcium or not? That’s the information you get.

But sometimes you pick up aneurysms because they do a CAT scan of the chest, the aorta is [00:32:00] dilated, or you might pick up a nodule outside of the cardiac stuff. Use them routinely. And, if I have a 46 year old guy with coronary calcium, not a lot, but I should just, me. To be aggressive and for coronary calcium, it’s vitamin K two.

Yep. So that can slow coronary calcification and and increased bone mineral density. So it works, puts the calcium where it needs to go. And the aged garlic or IC is the brand, K-Y-O-L-I-C. And that was slow chronic calcification. The H garlic does is good for a lot of vascular things, endothelial function, stuff like that.

Dr. Weitz: And for the K2, are you using the MK4 or the MK7?

Dr. Orfanos: I use the MK7. That’s the one that I’ve been using. I know there’s some controversy over it, but that’s longer, longer lasting. And. I think has more efficacy.

Dr. Weitz: So what do we, since you mentioned those two, let’s say somebody, one of your patients has significant amount of plaque.[00:33:00]

Dr. Orfanos: Yeah.

Dr. Weitz: Do you have a plaque reversal program?

Dr. Orfanos: A K2 aged garlic, omega 3 fatty acids.

Dr. Weitz: How much k2?

Dr. Orfanos: I usually, I use at least 360 micrograms, if not more. 40 to 7 20. I just make sure they got plenty. Okay, box laid all those sites that need to be done like that. I just want to make sure I’m maxing it out.

Dr. Weitz: Some of the patients are nervous about vitamin K because they heard that vitamin K can be related to clotting.

Dr. Orfanos: Not you don’t get excessively coagulable by taking vitamin K, but this is K2. It’s that one that’s for coagulation. Even that, you can take a lot of that. They give people, big shots of it to reverse their coumadin and they don’t like clot up because they do that.

Dr. Weitz: Right.

Dr. Orfanos: So you’re it’s not a risk.

Dr. Weitz: Yeah. Yeah. I totally agree with you. I think the word on vitamin K is if you don’t have enough vitamin K, you won’t be able to clot, but once you have the needed amount, having [00:34:00] more is not going to make you clot more.

Dr. Orfanos: Now, if you’re on Coumadin or Warfarin, they’re called, it’s called a vitamin K antagonist.  That’s how you deplete vitamin K. You shouldn’t be taking vitamin K. Or if you do, you better balance it between the Coumadin dose and the vitamin K. Properly thinned, work it out with your doc.

Speaker: Okay what about a ct angiogram with artificial intelligence to assess soft plaque?

Dr. Orfanos: Yeah, I haven’t, I personally haven’t gotten into that.

It’s called clearly, yes. I think, okay, what would I do if I had somebody I’m just assuming people have some soft plaque. It’s not just all a little bit of calcium that I think they go together. That’s why the calcium was there in the first place because there’s some plaque rupture and which is soft plaque that’s gotten calcified.

So I, I would do what I’m doing. I think the possible plus is if you find somebody with a high grade blockage and doesn’t have any symptoms, [00:35:00] or maybe I’m just going to make an assumption. Then you might catch somebody at a, at the right time to intervene, but right.

Dr. Weitz: You might have somebody with a low coronary calcium scan and they think they’re home free, but if they have soft plaque is even more dangerous than hard plaque.

Dr. Orfanos: Yeah. Yeah. Because it can rupture. I think that’s right. That’s the connection. But if you got but, when you look at the literature, the more calcium in your arteries, the more likely you’re going to have an event, so it’s tied to that 49 really cheap test, and so that’s predictive.  I know it’s sexy to do the whole thing. And I can understand that. And I wouldn’t stop anybody from doing it, but I, but the more calcium you got, the more likely you’ve got coronary occlusion and, I’ll do stress tests on people and do stress echoes or nuclear stress on people with calcium scores.

And, then if it’s negative. Then I know for right now, they don’t [00:36:00] have obstructed seas granted, they can rupture plaque and all that, but if you’re doing all this other stuff you’re changing that risk, you’re moving that risk down. You wouldn’t have, you wouldn’t, let’s say somebody had vulnerable plaque and they were asymptomatic and had a normal nuclear stress.

Those people are low risk to have something happen in spite of worrying about worrying about vulnerable plaque, there’s still low risk. So that’s still, I still being a cardiologist in my mind here, what’s, what are the symptoms? What are my functional tests show?  And then I use the coordinate calcium score just to probably get me to the point where I’m going to do some testing or to inspire the, my patient to change. Hey, you got calcium, you’ve got to do something. Or, in 10 years, you’re going to be in some hot water, so I try to motivate them.

Dr. Weitz: That’s good. So what are some of the other lifestyle factors like exercise that can affect cardiovascular disease risk?

Dr. Orfanos: Sure. If you just, I tell my patients, you don’t have to, you don’t have to get a gym membership and, go to the, we’ll work out six days a week, [00:37:00] if you just get out and walk for 10 minutes, that 10 minute walk.

And that’s in the literature, 10 minute walk will lower your risk. It doesn’t take a lot. And that kind of gets people off the couch, let’s say, and gets them outside. And then, being in nature is actually healing in and of itself. So I get them to do that. I think resistance training, if you want, I think people need to go farther than that.

They need to do more than the 10 minute walk, but still that’ll help, but they need to do resistance training because they got to keep their lean body mass up because muscle is the currency of aging. Thank you. more, the more muscle mass you got, the longer you’re going to live,

you know, just, it’s not just all about falling.

It’s about the metabolic benefits. You’re a muscle, you’re not insulin resistant. You’re insulin sensitive when you got more muscle, but one thing, blood pressure is lower. The other thing is sleep, you’ve got to sleep. Sleep apnea is like overlooked a lot, nobody asks.

And those people with sleep deprivation, their [00:38:00] cortisol levels are high, they’re stressed out, their blood pressure is too high, they’ve got AFib, they’re they’re cognitively impaired. Just look for these things and, people will start to get better and better just by fixing these individual things.

for your attention. And they all work together for the best for the good.

Dr. Weitz: Do you give people a home sleep study?

Dr. Orfanos: I don’t, I, I think in my practice I just, I usually send them to these, one of these sleep center guys and they’ll work them up.  They know how to appropriately get Their tests covered, a lot of times I’ll do it and the insurance company goes you didn’t do the right diagnosis or rights.  So I looked in that way. I let them do it. I want them to get it done and to the sleep doctor to do it.

Dr. Weitz: Yeah, sounds good. So any other topics that we haven’t covered so far that you’d like to tell our listeners about?

Dr. Orfanos: I’ve got this one kind of little passion that I’ve come up with. It’s these it, there, there are these cell membrane [00:39:00] particles that are called plasmologens.

I don’t know if it’s new to me. But the plasmologens are in the cell membranes and they’re, there’s they’re 30 percent of your brain and your heart And they get depleted after you pass about 50. And that alone can lead to cognitive decline and cardiovascular disease and neurodegenerative diseases.

So these can be tested for and you can replace them with a with a supplement basically, by the way, exercise works and muscle building works, but you can take the precursor supplements and build them up. And

Dr. Weitz: What is the test for plasmoligins?

Dr. Orfanos: This one researcher, his name is Goodnow, G O D E N O W, Dan.

He’s a Ph. D. Canadian. He’s come up with a test that, that has, that can measure these and a bunch of other risk factors too. And he’s very scientific about the whole thing, yeah. Struggling to go through all this to learn all that he’s got to say, but the fact that you can, for instance, if your [00:40:00] plasmogens are low, and you’re an E4, an APOE4, and you get them up to like well repleted numbers, you can turn your risk of Alzheimer’s From a, from an APOE 4, which is a 30 percent lifetime risk.

If you got one to just the average risk of if you had three, three, it makes the four risk. You might say

Dr. Weitz: it’s I’m trying to think, I think I’ve heard something about this, is it some sort of a fatty acid type supplement?

Dr. Orfanos: Yeah, it’s a, it’s, there’s a DHA one. which is which is one of them.

And the other one that’s an omega three and the other one’s an omega nine supplement. It’s not olive oil. It’s not fish oil, omega threes are fish oils, omega nines are olive oils, more or less. But you take those precursors, he puts them on the right backbone. So when you eat it, it can get into your system and it gets incorporated into the paroxysomes, which are the little organs in the cells that make these plasmologens.  Ah, it’s.  It’s really cool. That’s all I can say. [00:41:00] I’m really

Dr. Weitz: what’s the company that makes a supplement.

Dr. Orfanos: It’s called Prodrome Sciences.

Dr. Weitz: Okay.

Dr. Orfanos: He named it because he thinks about the program of the disease. Before you get dementia, you’ve got the plasmodium deficiency issue that can be corrected. Huh.

Dr. Weitz: Interesting. Yeah. We’re all concerned about reducing the risk for dementia and keeping your cognitive faculties as sharp as possible as we age.

Dr. Orfanos: Yes, very much

Dr. Weitz: yeah, no, I’ve had Dr. Bredesen on several times. He’s his,

Dr. Orfanos: oh, yes, it’s

Dr. Weitz: brilliant.

Dr. Orfanos: Oh, I love the guy. And I that’s I tell him to read the, read his book, the end of Alzheimer’s program, the people with anything in cognitive decline or whatever, or the risk of it.  And and then I just started telling people, this is all fairly risk, like two months, two months old. This other thing with the plasmologists to read the other to read Dr. Brown. Good now’s book called Breaking Alzheimer’s, which is really pretty technical [00:42:00] reticence, easier easier on the lay persons and the doctor’s mind and the other guy but it’s the stuff’s there, the literature’s there, the studies and all that.

Dr. Weitz: That’s great. And of course, managing stress is super important for cardiovascular health as well.

Dr. Orfanos: Yeah yeah, the more stress you’re under the worse you do. You’re talking about cognition that goes down, cortisol levels go up, blood pressure goes up, blood sugar goes up. Oh there’s other things like a heart math.

You probably know, I don’t know about heart math, where it’s it’s trying to increase your heart rate variability. So we measure on monitors. We didn’t, and it turns out you can, that’s all you can change that by just practicing gratitude, feeling gratitude. So gratitude, appreciation, love, those positive emotions.  up your heart rate variability and guess what? Your blood pressure comes down your heart rate comes down you’re smarter, you do better on tests, your cholesterol [00:43:00] drops, your cortisol level it’s wow, one thing like that can do.

Dr. Weitz: So do you use heart math in your practice?

Dr. Orfanos: I do, this is more peripherally, I tell people about it more than I, I used to have these little devices and I have one at home where you you plug it into your iPhone, it’s a program and you click it on your ear and then you can measure your heart rate very, you can watch it go from red to green, red is like K, green is coherence,

Dr. Weitz: yeah, I measure it with the aurora ring.

Dr. Orfanos: The Oura ring does it? Okay. Okay. So yeah, it’s gives you an idea of where you’re at emotionally, psychologically.

Dr. Weitz: Absolutely. Yeah. It’s some cool wearable devices and they’re getting better and better. Yeah. All right. Great. Any final thoughts for our listeners and viewers?

Dr. Orfanos: You’re never too old to get better. So don’t let the years get in the way of you’re improving your overall health and. And [00:44:00] health span and probably lifespan.

Dr. Weitz: Absolutely. Dr. Ofanos, how can listeners get a hold of you?

Dr. Orfanos: You can contact us at Case Integrative Health, CASE, Integrative Health in Chicago.  And and through that website, you can get a hold of me and if you’d like to see me, I’d be glad to see you. So

Dr. Weitz: what’s the exact website?

Dr. Orfanos: It’s called, if you just Google case integrative health, it should pop up.

Dr. Weitz: Okay, great. And, and do you do remote consults as well?

Dr. Orfanos: Yes we do, but we, we see people in person for at least the first visit and once a year.

Dr. Weitz: Okay, great. Thank you.

Dr. Orfanos: You’re very welcome.



Dr. Weitz: Thank you for making it all the way through this episode of the rational wellness podcast For those of you who enjoy Listening to the Rational Wellness Podcast, I would appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review.  If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. Some of the areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, autoimmune diseases, cardiometabolic conditions, or for an executive health screen and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way.  Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111. And we’ll set you up for a new consultation for functional medicine. And I look forward to speaking to everybody next week.

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