In Episode #28, Dr. Jill and Dr. Abid Husain discuss strategies to improve heart health in men and women through hormone optimization and the latest science on peptides.

Dr. Jill

Dr. Jill Carnahan is Your Functional Medicine Expert® dually board certified in Family Medicine for ten years and in Integrative Holistic Medicine since 2015. She is the Medical Director of Flatiron Functional Medicine, a widely sought-after practice with a broad range of clinical services including functional medical protocols, nutritional consultations, chiropractic therapy, naturopathic medicine, acupuncture, and massage therapy. As a survivor of breast cancer, Crohn’s disease, and toxic mold illness she brings a unique perspective to treating patients in the midst of complex and chronic illness. Her clinic specializes in searching for the underlying triggers that contribute to illness through cutting-edge lab testing and tailoring the intervention to specific needs. 

A popular inspirational speaker and prolific writer, she shares her knowledge of hope, health, and healing live on stage and through newsletters, articles, books, and social media posts! People relate to Dr. Jill’s science-backed opinions delivered with authenticity, love and humor. She is known for inspiring her audience to thrive even in the midst of difficulties.

Featured in Shape Magazine, Parade, Forbes, MindBodyGreen, First for Women, Townsend Newsletter, and The Huffington Post as well as seen on NBC News and Health segments with Joan Lunden, Dr. Jill is a media must-have. Her YouTube channel and podcast features live interviews with the healthcare world’s most respected names. 

The Podcast

The Video

The Transcript

#28: Dr. Jill Interviews Dr. Abid Husain, Integrative Cardiologist on Hormones & Heart Health

Dr. Jill 0:12 

All right, Dr. Husain, we're live, and it is great to have you here! We have known each other in the same functional circles for a while. But recently, I think it was last year, we had coffee, and I just loved getting to know you and what you're doing, and [there was] so much alignment with functional medicine. You're trained as a cardiologist, and I will share your official bio. 

Dr. Jill 0:34

Just a little housekeeping for those of you watching and listening: This will be recorded. You can watch it later if you don't catch it all. It'll be here on Facebook Live, and it will also be on my YouTube channel, which is just under my name, Jill Carnahan. So you can find us there. And you can feel free to share this if you find it interesting with your friends and family. 

Dr. Jill 0:55

So I want to introduce my friend, Dr. Abid Husain. He's an established cardiologist in the conventional healthcare system. But he realized, like we all do, the limitations of providing highly impactful preventative care. So he decided to educate himself in functional medicine and cutting-edge research in the biotechnologies of anti-aging. So if you stay tuned today, we're going to talk about some really cutting-edge things that we're doing in not only internal medicine but cardiology and pretty much all [other] realms. And what I love is that, just like you, Dr. Husain, you're trained in cardiology, so you obviously have this really wonderful specialty, but this functional realm applies to all of our patients, no matter if they have heart issues or not. So it'll be interesting to dive in there. He's among the revolutionary few who are changing the way cardiovascular disease is addressed. 

Dr. Jill 1:43

I always find it so fun to talk to specialists who are functionally trained because a lot of us are [in the] internal medicine or family medicine background. But when we find a colleague like you who's had the extra training—rheumatology, cardiology, gastroenterology—it's really, really special because you've got all this great conventional wisdom. And I always feel like we're adding to our toolbox, right? For me, I am still a great conventional doctor. I still want to make a great differential diagnosis using all the great tools we have. But what we have now is a bigger toolbox with more things to use at our patients' disposal. He's triple board certified, and he's an accomplished painter and mixed martial artist. And he has so many cool assets in his life. So thank you again for joining us. I'm so glad to have you here. 

Dr. Abid Husain 2:29

Yes, thank you for having me. This is a real honor to be here. 

Dr. Jill 2:33

Yes. So what I always like to start with is a little bit about your story, because we all have kind of a way that we traveled into medicine. How did you get interested first in just medicine, then cardiology? And then how did you find a way to functional medicine? 

Dr. Abid Husain 2:47

Well, my journey has always had this intertwined path with the arts. When I was in college, it was easier for me to go into the medical profession as my father was a physician and my brother [was] also. But I really wanted to do the arts. And I was considering being a comic book illustrator. Then I took a gross anatomy class, and then all of a sudden something just went off in my head that made me really interested. And I thought, “All right, this is something that I really love doing and, at the same time, satisfies a lot of other responsibilities in my life.” So it was a great fit. And then, 20 years later, I was in fellowship, finishing that up. And I got my training in cardiology and started to practice. 

Dr. Jill 3:52

I love that. You know, what I really learned in medicine [is that] it's a very analytical, systemic field and very left-brained. But you're an artist, and you're an artist at heart. And I feel like I have the same kind of bent; I'm actually intuitive in a lot of more creative pieces. And those combined so beautifully because functional medicine, at its root, is problem-solving. So we use that left brain analytical part, but honestly, it's creative problem solving because you have to really take a whole different approach to this to really understand the complexities. So I bet you find that your artistic background brings a whole different level of skill to your cardiology and your integrative and anti-aging practice. 

Dr. Abid Husain 4:35

Yes, it does. Instead of it being protocol-based, which is what a lot of conventional medicine has become, it really brings the artistry back into it. And I think that's one of the things that functional medicine has really provided. You know, there's an element of artistry to it. Every person is different, and every treatment is individualized. So there's also a trial and error period, and that requires being able to understand and read what people are telling us [about] and their symptoms, knowing what to take as a priority and what not to. It brings the artistry back into it, for sure. 

Dr. Jill 5:13

Yes. I really found that because I remember in medical school being so ashamed of my creativity and intuition because that wasn't scientific, right? So I really learned to kind of push that aside. We can't trust our gut. And now, [after] the last decade in practice, I feel like that intuition—and there's science to back this—an intuitive sense of kind of the gestalt of where to go with a patient as you listen to their story, it's right on. And it's almost 100% of the time; I'm really in touch with that. Or even the sense of, “Oh, we're missing something” or “I need to know more”—direction, right? And I'm sure you navigate that way too. But as I've actually pulled back into the intuitive right-brain part of myself, I feel like I'm a much, much better practitioner. And I get a bigger [picture], and even a sense of how they're feeling, and what was the significance of that event in your life? And then you find out, “Well, that was the time their home flooded, and then there was water damage,” and then they had whatever kinds of things. So we're listening. So then cardiology—conventional cardiology—amazing. And triple board certified—tell me just a little bit more about that. What are your board certifications in?

Dr. Abid Husain 6:18

Well, there's internal medicine and cardiology. Those two go hand in hand. We have to go through internal medicine before we can finish cardiology. So those are two. And then there's my functional medicine board certification. I didn't get that until, I'd say, after about 10 years of practicing. I was practicing in Las Vegas, and that's probably one of the epicenters of cardiovascular disease in the country because you have unhealthy lifestyles, people getting cardiovascular disease at a young age, and then you have a lot of retirees that already have cardiovascular disease. So it's a bit of a heart sandwich over there. So it was busy, and I got burned out after about eight years. And there was a feeling of just sort of fixing the symptom. We were putting in stents. We were giving people statins. They were getting better, but they weren't really getting the outcomes that I wanted. And that, combined with a huge workload; I got burned out, and I decided to take a sabbatical. 

Dr. Abid Husain 7:29

I continued to work per diem, but I took the majority of my time off and was called back to the arts. I went to do three years of studying with a master painter in Santa Fe. I also did some traveling internationally to different places to study. But I did that for three to four years and was just continuing to practice medicine to keep my skills relevant. And then, after that, I created this sense of satisfaction in one part of my life, and medicine still wasn't really satisfying me in the way that it had when I first encountered it when I was young. I was searching around for different options, and that's when I ran into functional medicine. And that's what pinged me. It really brought back a lot of interest, and it brought back this sense of continuing learning back in my life. Now I really enjoy and search for the time to continue to do the research, whereas before it was more of an obligation. 

Dr. Jill 8:35

Yes. Oh gosh, there are so many pieces I want to talk to you about in your story. So first of all, you kind of went back into creativity. You still kept your license. You work up to keep that—I know how that goes. But what was interesting is that I bet that getting back into the creative [process was] really enhanced when you got back into functional medicine. First of all, I want to say that when I first sat down to lunch with you last year, I remember hearing about your artistic background and seeing some of your art. You are amazingly talented. I love what you've done. 

Dr. Jill 9:06

To me, that was so impressive because so often you have a very analytical left-brain [individual]—engineer, doctor, accountant—great, right? But they don't have the breadth or depth of talent. And again, like we talked about at the beginning, I think it's actually the heart of the intuitive artist that really brings that ability to see things at a different level with our patients and actually find answers to very complex problems. I always think of it as having a limited ability to process data in our analytical mind but an unlimited ability to process data in our subconscious, right? So we can take in a lot more data points and process them at that level. Going back to the arts and then coming back to medicine—what difference did that bring for you to medicine that you maybe didn't have as much of before? Was there anything that changed the way you practiced?

Dr. Abid Husain 9:57

Yes. Touching on what you were saying, there was a lot of integration of data. It was interesting. You know, the type of painting that I do is painting from life. And life, especially visual data—there's a tremendous amount of information we're taking in visually. And we're not aware of most of it. Most of it is subconscious. And there is an element of being able to understand what I'm seeing and then recreate it on a canvas. So by going through that process of recreating it, it helps me to really formulate and understand what it is that I'm seeing on a really fundamental level. After doing that, now you apply that to other areas. So whether it's movement in my exercises, studying clinical trials, or practicing medicine, there's an element of taking all of these volumes of information and filtering it down, distilling it to the important parts that I need to use to organize the picture I'm putting together. 

Dr. Jill 11:03

You have just so eloquently talked about how functional medicine works best because it really is observation and attention to detail, isn't it? Like, you're just watching. And you're watching when they flinch when you talk about a certain event in their life. Or you watch when they pause and are having trouble getting the words out about something. You're like, “There's something there.” But it's all those details that, if we're going at a fast analytical pace, we might miss. And I'll tell you what; patients know what they need. If we listen carefully enough, don't they usually kind of tell us what direction to go?—because they're the author, and they're the most important part of their story. Well, I love that. And then you mentioned functional medicine. Most people I've talked to, including myself and it sounds like you, when we really understand and find functional medicine, there's kind of an ‘Aha!' because the reason we really went into medicine, in general, is to solve problems, help people heal, and really understand the root cause. Did you have that kind of ‘Aha!' [moment] when you discovered functional medicine? Like, “This is what I've been looking for!”

Dr. Abid Husain 12:00

Yes, it did. I had the ‘Aha!' [moment] when I was studying functional medicine, and I realized it was making me a better physician overall because it was complementing both internal medicine and cardiology. And it continues to do so the more I study. And the more I study and the more impactful things I learn, the more I keep having these ‘Aha!' moments that just keep coming and getting bigger and bigger. It's not like it just happened once. It's like I've tapped into a vein, and now all of a sudden I just keep following that back, and it becomes more exciting. 

Dr. Jill 12:37

Yes. And like you said, the joy comes back because we actually went into medicine to help solve problems and help people heal. There's nothing wrong with drugs and surgery. I prescribe them frequently. But if that's the end point all the time when there's no actual solution-based medicine, it gets to be a little bit discouraging, really, for what we do. 

Dr. Abid Husain 12:57

Yes. 

Dr. Jill 12:58

So let's talk about some of the cutting-edge things you're seeing. I know you do a lot of anti-aging, so you deal with cardiology patients. But you're also looking at people like a lot of our listeners who just want better performance, whether it's [for the] brain, physical health, or optimal performance in sports and athletics. I'm assuming you see quite a few athletes too. 

Dr. Abid Husain 13:15

I do. Yes, I take care of a lot of athletes. I enjoy taking care of athletes, and that's where I started a lot of my practice and a lot of bioidentical hormone replacement. It's a rewarding way to help people because a lot of athletes are generally pretty healthy, and we don't have too much to tackle, so we can add on to what they're doing. And they have some sort of practice and consistency with what they're doing. But what's interesting is that after working with those people and deciding that: “All right, I'm prescribing testosterone; I'm prescribing estrogen and progesterone,” I've really got to know the nuts and bolts of what these are doing. 

Dr. Abid Husain 14:08

And there are a lot of myths about testosterone out there [regarding] what it does and what it doesn't do. Does it help the cardiovascular system? The same thing [happens] with estrogen. There are these trials that are from 30 years ago that say we shouldn't be taking hormone replacement, and then we have trials that say we should. I was compelled to say: “All right, I'm prescribing this, and I'm a specialist in this arena. I have to know the nuts and bolts of what's going on and really find out definitively for myself what it is.” So that has led to a real kind of gold mine in understanding what hormones can do for our cardiovascular health and how they're being underutilized. 

Dr. Jill 14:53

I'd love to talk a little bit about that because I do the same. I think you probably use them even more to an extent. I feel the same way—they are powerful when used appropriately, as long as we know those guidelines. So let's talk about a typical, say, 55-year-old woman with no history of breast cancer, no high risk, just going through menopause, starting to have menopausal symptoms, and worried about her heart health. How would you consult her? And would you consider estrogen, testosterone, or progesterone? How would you look at that kind of a case? And then I want to talk about a man too. 

Dr. Abid Husain 15:24

Yes, definitely. So for a woman coming in with menopausal symptoms—premenopausal leading up to or even in full-blown menopause—I would start by doing a full blood panel. That would also include the thyroid because the thyroid is just as important for cardiovascular health. That's what I do for most of my patients—actually, all of them. I start with at least a sex hormone panel and a thyroid panel. And assuming that their numbers would come back consistent with what we expect if they're having symptoms of menopause and their progesterone and estrogen are low, as is their testosterone, there's a lot of data to support not just replacing the three hormones but replacing them up to physiologic levels. I started using topical estrogen in the beginning, as we were trained in an A4M. And then a lot of the research that I've been looking into recently says that oral estradiol is safe. Oral estradiol is probably more powerful and allows for better delivery as well as easier testing. So I've shifted to oral estradiol and then oral progesterone; these are all bioidentical. 

Dr. Abid Husain 16:47

That's a very important point because all of the old studies—and this is where things have gotten confounded—are using synthetic estrogen or estrone, or they're using equine estrogen, which is ridiculous. We're talking about horse estrogen for women and then synthetics, which have a longer half-life and are also stronger when they bind the receptors. So naturally, it's going to cause an abnormal reaction or side effect. But if we use bioidentical estrogen, our bodies can manage the half-life and lifespan of these and then use some sort of feedback mechanism to use them appropriately. The same thing goes for progesterone. And then, often under-recognized, is testosterone for women. It's so important; it's part of their lean body mass. Lean body mass is important for maintaining cardiovascular health in the sense of insulin sensitivity, vascular health, and things like that. Not only that, but [it's also important for] recovery. We talked briefly about muscle mass and then libido—important. Bone health [also]. So I usually give all three to my patients. But I don't often give straight testosterone to women. I give DHEA, which is well converted to testosterone. 

Dr. Jill 18:05

Yes. I love that overview because people are so afraid. And of course, we do this with informed consent and with the patient's understanding because there's always some risk with everything we do. But I agree with you 100%. And what I've really found is that, if I look at the research, the surprising thing in the last maybe five years is the data on testosterone and autoimmunity, and why women get autoimmune [conditions] at least four or five times more than men, testosterone is one of the factors. And I've actually used that, especially with clear serum levels that are basically undetectable in women, to start to reverse autoimmunity. You know, we're dealing with the gut, and we're dealing with all the other functional medicine pieces, but I've seen testosterone be a key component in helping women reverse autoimmunity. So I couldn't agree more. 

Dr. Jill 18:51

And like you said, I love DHEA. Once in a while, if they're really pushing stress hormones in the cortisol pathway, they're converting that to cortisol, or they'll have breakouts, or they'll have some conversion issues. And I'm assuming that in the blood work, you're checking free and total testosterone, DHEA-S, and maybe even DHT to make sure that they're not having pattern baldness or any of those kinds of things. 

Dr. Abid Husain 19:10

Sure, sure, yes. Yes, I do that, especially for the men. I mean, of course, women, yes. I mean, hair—both—yes, I check DHT in all of them.

Dr. Jill 19:19

So let's talk about the men, then, because clearly there's a similar pathway. But what do you look for in men? And are you looking for estrogen to make sure it doesn't go too high? Tell us a little about the typical man. 

Dr. Abid Husain 19:30

Yes. So for a man of a similar age, I'll do the same panel, and I'm checking the same markers. Primarily, they're concerned about testosterone, and rightfully so. I'll check the free and total testosterone. And if their numbers are low, meaning around 350, depending on the lab, then that means they meet the criteria to start right away without even worrying about their symptoms. But if they're within the low/normal [range], like below 500, and they have symptoms, then I will start them anyway, because that also meets the criteria, as long as you have symptoms. So [I'm] starting them on testosterone. This is an injectable because it's the most effective way to give it, unfortunately, through injections. Once you get used to it, it's not a big deal. Once a week is what I prefer. 

Dr. Abid Husain 20:30

And then I add another agent to help stimulate the body to make its own testosterone. So what ends up happening is that if we give testosterone, it's going to suppress our body's capacity or desire to make testosterone because if it's already there, why do we need to make it? So what I want to do is give them something that'll stimulate the brain to send the neurohormone to create a little more testosterone. The reason for that is that we don't suppress the ability of the testes to make testosterone overall, because if you do that for years at a time, then restarting your ability to make testosterone can be difficult. So that helps boost the testosterone a little bit and keep your physiology working the way it's supposed to. 

Dr. Jill 21:16

Yes. And clearly, in both of these situations, there's a clear heart benefit, right? Can you tell us what [to expect] for a woman optimizing hormones? And is there any cutoff age? Should we be concerned after 70 or after 65? What's your threshold for men or women [taking] hormones? And is there a concern with informed consent? Where would you take us with that?

Dr. Abid Husain 21:37

Yes. Well, let me finish with men, and then I'll take you to that. So the second part of men is estrogen. Estrogen and progesterone—I will replace their estrogen and progesterone if they're low. Oftentimes, giving testosterone, because it gets converted to estrogen, means that we don't have to do that. But that's where their cholesterol panel comes in. I check their cholesterol panel, and if they have high LDLs… Or, I also check inflammatory markers. If they have markers that look for oxidized LDL, F2 isoprostane, or elevated Lp(a). These are all extra markers. These are markers that look at bad plaque being created in your arteries. And I look at others too. If those are elevated, then we need to act on their cholesterol aggressively. And that means if they're open to it because sometimes a discussion of starting estrogen for men is not something they want to hear. 

Dr. Abid Husain 22:37

But when they start it, there is great data to show that estrogen actually helps improve your HDLs, lower your LDLs, and then improve what's called cholesterol efflux, which is the ability of our body to pull cholesterol out and then get rid of it. And then progesterone will help them sleep. If their sleep is off, it helps everybody sleep, so why not give it to men also? So, there is that discussion—

Dr. Jill 23:06

[inaudible] GABA, I was just going to mention for people listening. That makes GABA. The same thing; it's in alcohol or benzodiazepines. But naturally, you make this GABA when you take progesterone orally, which is amazing for sleep. So go ahead, sorry. 

Dr. Abid Husain 23:20

So I'll start with about one milligram for men, sometimes half a milligram. It's not that much estrogen. Generally, it's tolerated very well. And if they do get some symptoms, then we ease back on it and monitor it to see how they feel. If we need to, we can add some DIM or some other sort of supplement to help the metabolism drive it the way we want to. And then, if they are on a lot of hormone replacement [therapy], I'll do a hormone metabolism study also. Usually, there are some salivary or urine tests that look at the metabolic pathway to see how they're metabolizing their hormones. And that can be helpful to see if they need supplements to guide the metabolism in the right way. 

Dr. Jill 24:09

That makes a lot of sense.

Dr. Abid Husain 24:10

Yes. So that's how I would finish up with men. So then, if we're looking at cardiovascular health, like if somebody's coming to me and they're middle-aged and they don't have a family history and they've never looked at their cholesterol, then I'll do that. I'll do a thorough cholesterol panel. If they've already looked at that and their primary care physician has said, “Okay, your cholesterol is good,” I will ask for the numbers and the data to verify it. And if it's okay, I don't necessarily need to do anything in their middle ages, unless they want me to dig into it further [or] unless there's a need to. If somebody comes to me who's a little older and they've already passed the phase of menopause, or if they're older men, I will still recommend starting the hormones because no age is too late. 

Dr. Abid Husain 25:02

The caveat is that for women, the more years they have in menopause, the more their risk starts to equal [that of] men of the same age. So once they lose the protective effect of estrogen, they start to develop plaque. Adding estrogen at higher doses can cause the plaque to become unstable in the first year, and that's it. So that's why, in studies, we see that the first year may have higher levels of heart attacks, angina, and acute coronary syndrome. And that's because they've been getting really high doses of estrogen, so the plaque gets a little bit weaker and more prone to rupturing. So what we do is start out low, or we start with cream, get them used to it, and then increase it slowly. Generally, one milligram to two milligrams is still within a range that doesn't cause the plaque to get too unstable. So start with maybe one milligram or half a milligram for the first year, as their system has time to really stabilize. And then the next year, we increase it. But we look at those inflammatory markers at the same time and measure them to see where they're going. And the one that I'm looking at in particular is called myeloperoxidase. 

Dr. Jill 26:15

Ah, yes. Yes. There's an oxidative stress marker, right?—which a lot of doctors don't look at. So it's MPO for short, if you're asking your doctor for that. Now, I know I can get specialty panels with that. Can that be done at a traditional lab like at hospitals, Quest, or Labcorp—MPO—or is that just specialty? 

Dr. Abid Husain 26:33

No, that's actually [what] Quest has. So, Cleveland HeartLab was doing that before, but they got bought out by Quest. And they maintain themselves as a separate entity, but you can get MPO or all these markers through Quest anywhere now. 

Dr. Jill 26:51

Is that the cardio IQ panel that they have? Is that what [inaudible].

Dr. Abid Husain 26:33

Yes. It used to be called an NMR. I think it's called a ‘Smart Lipid Panel' with particle sizes. That's the one I use.

Dr. Jill 27:03

This is great. Yes, me too. So I have a question, because again, as a clinician, you're the expert here for me to learn [from] too. The Lp(a)—I have the understanding that there's a much bigger genetic component to that. And for me, it's a little bit harder to budge. Is there anything else? So Lp(a)—patients who have that high, obviously there is a big genetic piece. What else could we do for that? You might be able to shed some light on it. 

Dr. Abid Husain 27:30

Well, estrogen is shown to be effective with Lp(a) to help reduce some of that. You know, Lp(a) is a little bit of a conundrum. There are some folks who have elevated Lp(a) who don't have premature coronary disease. So it doesn't necessarily mean that you're going to get coronary disease. So I think that's a caveat that should be said. But it should be taken seriously because that's the minority instead of most patients. But estrogen helps. And then we start looking at other potential options. There are some peptides that may be able to help with Lp(a) or at least help the utilization of fat more effectively. And when we talk about peptides, we're talking about protein molecules that help the body do the things that it normally does, but more efficiently. 

Dr. Jill 28:26

Yes, I'm a huge fan of peptides, so we can talk a little bit about that if you'd like. I use some of the main ones that are super common for raising human growth hormone, some other ones that help the immune system, help natural killer cells, [and] a lot of the ones that help repair and recovery—injuries, tendons. And for me, the thing that I need to know as a clinician is: Are any of these causing rapid cell division growth?—because those are the ones you usually want to use for a specific amount of time, not overdoing them. Because, of course, they could lead to the unrestrained growth of cells, which could lead to cancer. But I feel like with the types of ways we're using them, like either Monday through Friday off on the weekend or for six months off… I know CJC ipamorelin is one of our classic favorites. That's one that you would probably use for six months and then take a break. Any caveats on using that? 

Dr. Abid Husain 29:23

There's no real caveat. I guess I will say one caveat about cell division. I don't really know of any studies specifically that look at what growth hormone does to tumor tissue. This is just theoretical. The only study that we know of that actually looked at what growth hormone did was tesamorelin in AIDS patients that had Kaposi sarcoma, and that actually reduced the Kaposi sarcoma load. So even that is to be questioned. We're stimulating our body's ability to do what it normally does. And giving growth hormone—it's what we made a lot of when we were young. When we were young, we could fight off a lot of diseases. We could fight off cancer, you know? So it makes sense that this may be able to help fight those things off in adulthood too. 

Dr. Jill 30:18

Yes. No, I totally agree with you. And I've seen just such impressive results with peptides, like you as well, I know. Any new and upcoming ones that we might want to be thinking about or [that are] on the radar? 

Dr. Abid Husain 30:31

A lot of what's on the radar is looking at cellular senescence and mitochondrial efficiency. 

Dr. Jill 30:40

Like FOXO5 and one of those? 

Dr. Abid Husain 30:43

Yes. Everything seems to be pointing to that sort of link—the bridge between the nucleus and the mitochondria and how that communicates with the rest of the cell. There's a whole list of mitochondrial peptides. There's MOTSC. There's 5-amino-1MQ. There's the FOX that you were talking about—FOXO4. And then there's also something called humanin, which is really interesting. All these are designed to bring health back to mitochondria, make them into these really powerful energy-producing organelles, and then help them communicate with the rest of the body and the nucleus effectively and efficiently. And there are so many ways it's being done. I mean, one of them looks at the bioelectric current in the inner membrane and puts these peptides into place to make the potential bioelectrically stronger. So if you imagine that, if we're going to close our eyes and visualize this, that's a really powerful sort of image or something that's electrically moving along the surface of our organelles. I guess that's just the artist in me talking.

Dr. Jill 32:06

No, I love it because it's just so fascinating to see that the potential of some of these therapies is really powerful. I have a young woman who has an unknown cause of cardiomyopathy. And with peptides, we've seen some massive reversal. The 40-something-year-old dentist, you know? And I'm assuming you've seen some of the same kinds of things. Because, really, the heart is probably the biggest purveyor of mitochondria and energy. The heart and brain, right? So, I'm assuming that with heart conditions, you're looking at mitochondrial peptides because that's where the power is. 

Dr. Abid Husain 32:41

Yes, definitely. 

Dr. Jill 32:43

Yes. How exciting that we have these things! So I'm getting a few questions on Facebook on fish oil and some thoughts because that went all different ways. I know we use it. What are your thoughts on EPA and DHA [and their] benefits for the brain and heart? Do you still use them? 

Dr. Abid Husain 33:00

Yes, I do. Yes, I don't use supplements unless they're really indicated, and DHA-EPA is definitely one of those that I still recommend. It helps triglycerides at high doses; [it has] fundamental building blocks for brain health; [and it is] important for our hormones because we use the fats to make our hormones. And EPA and DHA are great. I would like to make the caveat that omega-6s are also important. Linoleic acid is also an anti-inflammatory omega-6, and we need that to help membrane health. Omega-3 is definitely very important and very healthy. Don't forget the omega-6s. And a great source is evening primrose. You can get that pure, and it can help augment the omega-3s. 

Dr. Jill 33:58

Oh, I think there's more, especially if you have eczema or some of the skin conditions—asthma, eczema—atopic stuff. Typically, GLA is deficient. And it's interesting: Arachidonic acid is an inflammatory pathway of fatty acids, so we don't want that high. Sometimes fish oil can bring that down. Have you ever seen arachidonic acid low? And is there anything you would do if it was too low?—related to fish oil. I don't know if you've ever come across that. 

Dr. Abid Husain 34:25

I haven't really seen it that much because, most of the time, fish oil is something that's so ubiquitous right now. And most people take it—they take it just as a reflex. In fact, what I see is the other end, where arachidonic acid is often too high and suppresses the use of the omega-6s and the ability of the omega-6s to get into the cell and improve membrane health. 

Dr. Jill 34:55

Awesome. So what are any upcoming things that you've seen that you feel might be really game-changing in cardiovascular disease, especially in the realm of integrative and functional medicine? Any other tips or tricks?

Dr. Abid Husain 35:08

Well, I'm still working on getting people to want to take the estrogen. The trick is to combine that with peptides. And there are a lot of peptides that help insulin sensitivity, and they also help lean body mass. There's one that's used by big pharma. It's called Victoza. It used to be available via compounding pharmacists. It's not anymore, but in patients with diabetes, or even if we can get it approved, you don't have to have diabetes, and it's a great medication to use because it can actually help vascular health significantly. 

Dr. Abid Husain 35:55

It can reduce intima–media thickening. When we get older, if we have hypertension or an aged vascular anatomy, it gets thicker. And getting thicker is a sign; it gets stiffer and then promotes hypertension. Well, Victoza, or their glutide, is one of the few medications that's actually shown to reduce intima–media thickness and help insulin metabolism very well. It can reduce the effect of hypertension and improve vascular health. So, I think being able to add that and use it more liberally is something that I'm trying to do when I can with patients. It's difficult because it's an injectable. It's an inexpensive medication. 

Dr. Jill 36:49

I love that you're talking about liraglutide. I wrote an article a few months ago on liraglutide. It's a GLP1 agonist. And what I wrote about was, yes, it's for diabetes, but if you look at the studies on lung function, heart function, diabetic reversal, insulin resistance, et cetera, et cetera. There are so many different areas where it acts on so many different tissues. So, it's very pleiotropic in its nature and how powerful [it is]. And you talk about cell senescence. The same thing; there are some studies with liraglutide and cell senescence, which basically means that the cells that are programmed to die start to come back to life and give you some energy and traction. So, I'm a huge fan. 

Dr. Jill 37:28

And for me, my population has a lot of environmental toxicity and mold-related illnesses. What I see there [is that] men and women will get toxic mold exposure and then go right into a very severe leptin resistance. So, they'll have 20, 30, 40, or 50 pounds of weight gain [with] no change in activity. They're not quite diabetic. Or they'll even start to become metabolically resistant and insulin-resistant because of the toxic exposure. And they're [at a] healthy weight, they're exercising, and they're eating right, but they can't lose weight. So, that weight-loss resistance, that leptin resistance, is just a sign that metabolically they've got some dysfunction. And it's because those toxins hit the leptin receptors on the cells and basically block the ability to burn fat. So, I found liraglutide to be a huge reversal agent for that. But, like you said, the difficulty is that it's very expensive. And we used to be able to compound it, [but] now getting it approved is really difficult. So, that's always my rate-limiting factor in using it: If the patient can afford it or if we can find a way to get it. But I love it. I love using it off-label for these other indications because it really does work. And with peptides, it's amazing. So, I love that you mentioned that. 

Dr. Abid Husain 38:37

Yes, I mean, there are a lot of valid on-label uses. I mean, it's indicated for weight loss. 

Dr. Jill 38:44

It is. For obesity and for diabetes. Yes. So, that's exciting. Well, any last tips or advice? So if patients are looking for a more integrative approach, you are taking new patients, right? 

Dr. Abid Husain 38:58

I am. 

Dr. Jill 38:59

Fantastic. And where's your office? Is it Denver? 

Dr. Abid Husain 39:02

It's south of Denver, in Englewood. 

Dr. Jill 39:05

Okay, fantastic. Where can people find you? What's your website? 

Dr. Abid Husain 39:09

Yes. My website is interlinkedmd.com. 

Dr. Jill 39:19

Awesome. And I'm going to make sure, you guys, that we have those links posted so you can jump right on there [at] interlinkedmd.com. Thank you so much for your time today. It's so fun to talk to you about peptides, heart health, and all of these things. Any other bits of just basic advice for the patient who has heart disease or who's struggling even with their conventional doctor? Where could they get started? What would you recommend if they don't yet have someone like you in their corner? What are some of the very basics that they should be doing? 

Dr. Abid Husain 39:49

The basic things they can do are: Make sure they're taking their omega-3 fatty acids, coenzyme Q10, and magnesium. Those are the three big ones that I would recommend for heart health. Make sure you're walking after dinner. Get up and walk around. Move around a little bit. You don't have to go to a gym, but improving how your body metabolizes your food right after you eat is one of the most important things you can do. So after you eat, do not sit down and watch TV. If you've got a yard, go outside and do some yard work. If you can go for a walk, then go for a walk. But that's probably the first and most important thing you can do because that will help your body metabolize the sugar better. And then it'll give you a little bit of fitness too. Movement is so important. Yes. 

Dr. Jill 40:49

Oh, that's great advice. And I'm assuming then you don't want to do like the sumo wrestlers and eat and then go straight to bed either, right? 

Dr. Abid Husain 40:54

No. [laughter] Unless your job depends on it. Their job depends on it. 

Dr. Jill 41:01

Yes, exactly. Well, thank you so much for your time. It has been a pleasure to have you. We'll have to do this again. 

Dr. Abid Husain 41:07

Yes, thanks for having me. 

Dr. Jill 41:08

You're welcome. Bye-bye.