Transcript: Heart Surgeon Dr. Jeremy London on The Mel Robbins Podcast

I’m just telling you, you just don’t look right.”

And so normally I’ll sit down and I’ll read and kind of left the room. I took a Pepcid and everything went away. Everything was great. We have four dogs, so we head out for a walk. It’s December, December 4th, because I remember very clearly. And we head down the road, and we got about a quarter mile from the house, and the reflux came back.

MEL ROBBINS: And what does reflux feel like?

DR. JEREMY LONDON: So it created this burning sensation in my chest. Not formal chest pain, but almost like you had eaten some spicy food, for instance, and it wasn’t agreeing with you. Like something was wrong in my stomach is kind of how it felt. With the exception of the fact at this point, I’m out on a walk. It’s 30 degrees outside, I’m sweating, I’m peeling my clothes off.

At which point Tracy says, “Hey, you sure you’re good? We’re just walking the dogs.” I said, “I don’t feel great.” And so we get back to the house, and this is probably a little TMI, but I came back in the house, I said, “I got to use the bathroom.” And I immediately sat down on the toilet, and the symptoms went away instantly. And unfortunately, my insight into coronary disease told me immediately: Danger.

MEL ROBBINS: That the symptoms went away when you sat down as danger.

DR. JEREMY LONDON: Right. Because the way coronary disease works many times is it’s a symptomatic disease process. In other words, if you have a fixed blockage in a heart artery and you have a set amount of exertion, it brings on symptoms that then is relieved with rest, because that portion of the heart muscle that was heart starved is then no longer under any stressors.

So I was like, “No way. This isn’t happening,” and didn’t say a word. So through the course of the day, I tested it. I would go up the stairs, have a little pain, sit down. It would go away. I was like, “You have got to be kidding me.” It’s not that I’m positive. It’s not that. So my youngest son and I stayed that evening in the country. My wife and rest of the family went back into town.

MEL ROBBINS: You weren’t worried?

DR. JEREMY LONDON: Denial is not a river in Egypt, apparently. So I have learned.

MEL ROBBINS: Denial.

DR. JEREMY LONDON: Oh, God, yes, I was worried, but I wouldn’t allow myself to go there at this point, which, again, quite honestly, I’ve told this story quite a bit. And each time I’m more embarrassed by my behavior, each telling of this, including right now.

MEL ROBBINS: Well, I appreciate your honesty because I think when something’s happening to you, even if you’re not a heart surgeon who is now recognizing the signs of a heart issue, there’s both the denial that you experience because you just can’t believe it, but then there’s also the denial because you don’t want to.

The Power of Denial and Cognitive Dissonance

DR. JEREMY LONDON: Yeah. And it’ll become even more apparent just how egregious all this was. But it’s that concept of we know better, but we just don’t do better. The cognitive dissonance and how we are able to spin that in ways that we abdicate ourselves of going down a road.

I mean, smokers know it’s bad for them. You’re eating junk food, you know it’s not there, but we do it anyway. And that is really one of those huge gaps that we can talk about down the road of opportunities when we care for people and when we care for ourselves, how to recognize that and how to navigate that. And I really think this whole episode really kind of taught me that.

So my family goes back into town and my youngest son and I went out to deer hunt for the evening and we’re together and he ends up harvesting two animals. It’s pitch black. We’re a quarter mile from the truck and we down out of the stand to load up. And I immediately had crushing chest pain.

MEL ROBBINS: Oh, God.

Dr. London’s Heart Attack Experience

DR. JEREMY LONDON: In the middle of this field, pitch black with my 15-year-old son, no cell service. And all I’m thinking, Mel, is he’s not going to find one of those deer. He’s going to find me dead in this field. I just break out into goosebumps even talking about it because it was like, you got to pull yourself together, you got to figure this out.

He’s like, “Dad, what’s going on? You need to be over here.” I’m like, “No, I might be over.” “Dad, what’s going on?” I said, “Well, I had that reflux.” He goes, “Well, stopping helps reflux. You’re down on your knees in the field.” And I was like, “I’m going to be okay. I just need a minute.”

So I pull myself together, we get in the truck, and we drive home. Once I’m in the truck, everything settles down and I get home and I take an aspirin and a beta blocker and I went to bed and did not say a word to my wife.

So I wake up the next morning, my normal routine, I go down, I make coffee, I come back up the stairs, and I immediately had this crushing chest pain again. And that’s when I said, “Tracy, something really bad is wrong. This happened to me last night in the field.”

And she looked at me, she goes, “Let me get this straight. You had chest pain last night and you didn’t tell me? And why didn’t you tell me?” I said, “Well, because you would have made me go to the ER.” She goes, “Yeah, you dumbass. That’s what people do when you’re having crushing chest pain.”

And she stopped for a minute and she said, “This is the most selfish thing you have ever done to me and the boys.” And I just said, “You are right, and I’m really sorry. And I’m having crushing chest pain right now. I think we need to go and I need to get to the hospital.”

The Diagnosis and Treatment

So we went, and I’m calling my friend who’s a cardiologist on the way, and I’m telling him this story. He’s like, “Dude, there’s no way you eat right. You take such good care of yourself. There’s no way that this is going on.” I was like, “I don’t know what to tell you, but I know what’s happening.” He’s like, “All right, just come to the office and see me first.” I was like, “Okay, but that’s an unnecessary stop.”

Literally, I was in the office for five or ten minutes, and we went straight to the cath lab. And what is the cath lab? The cath lab is where you get a diagnostic study where they go through, in my case, the wrist to actually put dye in the arteries. And when they did that, they found a 99% blockage in the artery on the back of my heart.

Now, to continue my level of behavior, I would not let them sedate me fully for the procedure because, of course, I wanted to see what was going on and what was happening. This gets more and more embarrassing and painful for me every time I tell this story.

Thank goodness I was able to avoid my own operating room because he put a wire across there, which is how they actually get the stent to go across the artery. And as soon as he did that, I said, “Hey, man, I’m having crushing chest pain again.” And he pulls back the drapes, and he’s like, “I need you to shut up so I can get this done.” And he immediately sedates me and puts me out, gets the stent in, and everything is fine.

He goes out to talk to Tracy afterwards, and he said, “I dream of stenting cardiac surgeons, but doing it on Jeremy London was a nightmare.” And she looked right at him. She goes, “Oh, I’m sure. I can only imagine.” She’s like, “He just will not let it go.”

A Life-Changing Perspective Shift

But I’ll tell you, Mel, I woke up the next morning, first of all, incredibly grateful, but my entire perspective shifted in an instant. Things that were really, really important to me 24 hours prior didn’t even make the list. My prioritization was very easy: my family, my friends, the people that I care about, and the people that care about me, and that’s it.

And it was a huge touch point in my life, not just personally, but again, professionally as well, because when someone comes in and tells me they were having crushing chest pain, I get it. I really get it. And I had always considered myself an engaged listener with my patients. I’ve always prided myself on the fact that if you just listen to patients, they’ll tell you what’s wrong with them. The tuning on that went all the way, all knobs to the right after this event. And it was a perspective shift for sure.

And again, I’m not proud of that story at all. But when I talk about not doing better, even though you know better, I mean, who shouldn’t know better than me in that situation? But we’re all human, and I’m no different. I’m just a dude who’s done a lot of heart surgery and taken care of a lot of patients.

But I want to share that experience because if it just helps one person say, “Hmm, I’m having those exertional symptoms and they go away when I sit down,” then it’s worth the moment of embarrassment and retelling this story and you wondering why Tracy didn’t cut me off at the knees and I would have been deserving of such.

MEL ROBBINS: Well, first of all, I’m really proud of you for telling the story.

DR. JEREMY LONDON: Well, thank you.

MEL ROBBINS: Because you could revise the story to just be about the symptoms and then what ended up happening. But I really appreciate the fact that you blow by blow, expose the humanity and the story and the truth. Because there’s a number of things that happened for me as I was listening. First of all, I didn’t even know that that was a thing in terms of if your symptoms feel like heartburn and then you sit down and they go away, that that’s actually a warning sign. So that’s number one. Because I would have thought the opposite.

Understanding Heart Attack Symptoms

DR. JEREMY LONDON: Cardiac angina or pains associated with the heart are the great masquerader in general. So in other words, it’s not all what I call the TV heart attack. Yes, the Fred Sanford “I’m coming” pain in the heart, down the arms. It can be as simple as an upset stomach or jaw pain or elbow pain or subtle shortness of breath or easy fatigability. It can be very, very nebulous. It doesn’t have to be what we think is the classic.

For me, it just happened to be reflux type symptoms. So I just want you to know that it’s not just reflux symptoms that can be unusual. Any type of unusual symptoms that are brought on by activity and relieved with rest should be a red flag. It doesn’t mean 100% that you have a blockage, but it’s worth checking out.

MEL ROBBINS: All right. I want to make sure that we all got that.

DR. JEREMY LONDON: Yup.

MEL ROBBINS: Because any kind of unusual symptom that is brought on by physical activity but then relieved by rest is a red flag that something may be up with your heart.

DR. JEREMY LONDON: Worth investigating. It’s not 100%, but that particular constellation is important. Yes.

MEL ROBBINS: Wow.

DR. JEREMY LONDON: Yes.

When Healthy People Have Heart Problems

MEL ROBBINS: The other thing that really struck me about that story is the fact that you didn’t have any of the boxes other than the symptoms to check. I’m sitting across from you, and if you’re not watching this podcast on YouTube, Dr. London is a very fit guy. And being from the Midwest, I’m a big hugger. We gave each other a big hug. I hugged your son when he walked in. And you’re a very fit guy.

And so you don’t strike me as somebody who would have any of the check this box, check. You’re taking good care of yourself. You’re a happy guy. You’re fulfilled by your work. You’re connected to your family. You eat good food. You probably are not hitting the cigarettes and the vape because you’re a heart surgeon. And so I think one of the things that scares the hell out of all of us is not knowing if something’s wrong. And how often is that the case?

DR. JEREMY LONDON: So that’s a difficult question to answer. I mean, it’s very similar to what percentage of the population is pre-diabetic. Well, 80% of the population is pre-diabetic, and they don’t realize it, because if you don’t check, then obviously you don’t know. Well, it’s a little more difficult to check if you have coronary disease, and thank goodness, it is a symptomatic process for the most part. So you typically do have warning signs on the front end.

But I think that obviously the folks that have the risk factors, family history, high blood pressure, poorly controlled blood sugars, all those things, those patients need and individuals need more vigilance, stress testing, and evaluation.

MEL ROBBINS: I think we all have somebody in our life.

DR. JEREMY LONDON: Sure.

MEL ROBBINS: That we’re slightly worried about. And my husband recently is like, “My heart, a lot of pain right here.”

DR. JEREMY LONDON: Yeah.

MEL ROBBINS: And I’m like, “What’s up?” And he’s like, “Well, it’s typically after I telemark ski in the morning, and I skin up the mountain, and then I feel this little seizing right here.” But again, the healthiest person I know, and I’m like, “Maybe we should get this checked out.”

The Hidden Risk Factor: Sleep and Stress

DR. JEREMY LONDON: Yeah. And I think that obviously there’s a spectrum of what I’m presenting as well. I mean, I understand what it takes to do that type of activity, and that is kind of an extreme load. But if he has predictable symptoms every single time he does those things, why not get it checked out?

And let me add a little more texture, too, to kind of my background as well, because I think that it might resonate with others that, yes, I am very conscious of what I put in my mouth. Yes, I love to go to the gym and work out. Not just because I love the workout, but because it is my mental therapy and where I can de-stress. And yes, relationships are very important to me.

But also on that list is sleep and recovery. And that is my Achilles heel. And it comes from several fold. One, I’ve been on call for 25 years and my thermostat is set now on DEFCON 1 all the time. I can never relax, ever. And when you look at these individual levers, I can control what I put in my mouth. I can control when I go to the gym. The more I try to control my sleep, the worse it gets and not sleeping and not recovering.

And as we were discussing earlier, being able to take that time for yourself and wind down and allow your body to unwind. And I’m not good at that. And I think that that is definitely one of my primary risk factors. And so I share it so that people can evaluate their own lives. It’s not necessarily the really big easy levers that you wish you would tug on. Sometimes it’s the other ones that you need to examine more closely.

And I don’t know that entirely answers your question about how do you know? But I think that if you start to have some self evaluation, you come up with some potential places that you can either improve or get help with.

The Importance of Heart Health

MEL ROBBINS: Dr. London, for someone who’s just never thought about their heart or their heart health before, what do you want to say to them?

DR. JEREMY LONDON: First of all, it’s the number one killer of men and women, so what do you mean?

MEL ROBBINS: What do you think is the number one killer?

DR. JEREMY LONDON: Heart disease and heart attacks, 20 million lives worldwide per year. So it behooves us just based on the statistics that we prioritize our heart health in hopes of not being one of those potential statistics. So I think let’s start there. Why is it important?

What Is Heart Disease?

MEL ROBBINS: What is heart disease? If people are dying of heart disease, I don’t even know what heart disease is. If I really stopped and if you had asked me that question, I’d be like, “Well, it’s the disease of the heart. I don’t know.”

DR. JEREMY LONDON: And it is a bit of a black box for people. And you can simplify it into two buckets, really.

MEL ROBBINS: Okay.

DR. JEREMY LONDON: So if you think about the heart as a pump, that pump requires energy. It requires oxygen and nutrition and all of those things to be able to get you up out of your chair and get to the refrigerator and climb the flight of stairs and all those things. Well, there are blood vessels on the surface of the heart that feed that heart muscle, front, side, and back, very simple, three territories that can be affected.

Blockages in those vessels is what is known as coronary artery disease, because those arteries are referred to as the coronary or heart arteries. So blockages in those arteries, which ultimately can result in these kind of symptoms or potentially a fatal heart attack, is one bucket of heart disease. So blockages of the heart vessels that cause heart attacks. Bucket A.

MEL ROBBINS: Okay.

Understanding Heart Disease Categories

DR. JEREMY LONDON: Bucket B is within the heart are the valves that help the pump work and make sure that the blood is moving in the direction that it needs to move in. In other words, oxygenated blood going to the body, being utilized, coming back to the heart, getting oxygenated again in the lungs, and then going back to the heart and continuing that loop. Well, if those valves are not functioning, one or couple of those valves are either blocked or are leaking, you then affect the efficiency of that pump.

MEL ROBBINS: Got it.

DR. JEREMY LONDON: And fluid then, of course, if it’s a closed pump, is going to start to back up or move in a direction that it’s not supposed to. And over time, the heart becomes very swollen, and the heart doesn’t like to be swollen, and that’s what causes heart failure and shortness of breath and all of those kinds of things that you hear about with congestive heart failure and a weak heart, if you will.

And so that’s really the second bucket of heart disease. Now, they can be combined and there can be crossover. And these circles do intersect, but those are the two basic buckets. And then there’s others of the diseases of the large blood vessels and what have you that are probably too far in the weeds to really get into. But those are the two big categories that makes sense.

What Heart Surgeons Absolutely Avoid

MEL ROBBINS: Thank you for explaining that. I actually can kind of picture it, and I think a lot of us probably find out about it when we’re sitting talking to a heart surgeon, because somebody that we care about is actually now needing a procedure. And so we’re learning what’s wrong.

And what I love about what you’re doing is I think you’re able in this beautiful way to take your 25 years as a surgeon and now the deeply personal experience that you’ve had with your own heart and help all of us understand the things that we can do that will hopefully keep us from getting on an operating table. As a heart surgeon, what are the things you absolutely avoid?

DR. JEREMY LONDON: Smoking’s top of the list. I mean, I cannot come up with one single thing that does as much damage to every organ in the body as smoking cigarettes. And look, it’s incredibly addictive and I know that and I pass no judgment because I know how difficult it is. I’ve been dealing with patients that are chronic smokers for years. I understand that.

That doesn’t change the fact that it is the single most dangerous thing you can do for yourself. And from a heart disease standpoint, you’re talking about a magnitude risk of 100x or greater, not to mention the causal relationship with lung cancer. And I could keep going. So it’s probably 1, 2 and 3 on the list to begin with.

I think next is avoiding excess sugar and this idea that our glucose metabolism is so foundational to our existence as a species. And I think that that is something that really should be limited processed or ultra processed foods. We’ve heard this over and over and over and over again and it’s hard because it’s convenient.

Why Sugar and Processed Foods Damage Your Heart

MEL ROBBINS: But why does sugar and processed food hurt your heart? You know what I’m saying? I can understand how it might make me heavier or make my blood sugar whacked or cause inflammation in my brain. But what does it have to do with the heart?

DR. JEREMY LONDON: A big portion of it is those foods are made to taste really good and to be really accessible. And you know, you’re filling up with gas and there it is. And I don’t even have to stop anywhere else. And it’s convenient and easy, but it’s edible food product.

And you know, our bodies don’t process that well. It’s this additional engine for an inflammatory response. And again, to store this as fat in our bodies that drive that forward. The mechanism of inflammation directly on the blood vessel wall I think is probably a drill down that isn’t necessary. But just understand that it sets up an environment where it can be damaged more easily.

MEL ROBBINS: Got it. So it’s almost like you make those kinds of choices in terms of the sugar intake or the processed food. It makes your heart have to work even harder and harder and harder and under more stressful conditions because the body is inflamed and you’re kind of talking about the overall impact.

DR. JEREMY LONDON: Yeah, I mean, I think it does. As you carry more weight and then you put yourself in risk of high blood pressure and all those things. Absolutely none of these things happen in a vacuum. And so you start here and then it continues to cascade. I think that alcohol falls in that same key category of something that’s toxic to every cell in the body. So I think limiting or entirely avoiding alcohol just makes good sense.

The Truth About Red Wine and Heart Health

MEL ROBBINS: But Dr. London, you just said alcohol. But what about red wine? I mean, what about the antioxidants? Isn’t that supposed to be good for my heart?

DR. JEREMY LONDON: The truth is red wine and in fact the grapes, the skin of the red wine, do contain polyphenols, which are antioxidants. And think of them as kind of anti inflammatories as we kind of have this whole conversation. Specifically, resveratrol is what this compound is called and it has been found to make blood cells slippery and dilate blood vessels.

The amount of red wine that you would have to drink to get a therapeutic level of resveratrol, however, would be astronomical. And the risks of the alcohol would far outweigh any benefit that you got from the resveratrol. That being said, there are compounded products of resveratrol and there are human studies now that are starting to show that there may be something positive.

What would be the takeaway? If you enjoy red wine, drink red wine, but don’t drink red wine because you think it’s good for your heart.

Nicotine Pouches and Heart Health

MEL ROBBINS: So one of the things that I see a lot of people in my life doing is the Zyn and the nicotine pouches. You know, as a heart surgeon, what’s your opinion about those? Are they dangerous for your heart?

DR. JEREMY LONDON: Yeah, I mean, obviously nicotine in general is constrictor and so anytime you are exposing your body to nicotine, it can really be an additional risk factor. Is it as bad? Probably not, but again, it’s that level of accessibility. My personal experience with the Zyns is that I used to dip tobacco.

MEL ROBBINS: So did my husband. Yep, right in there. Little skull right in the cheek.

DR. JEREMY LONDON: Yep, yep. Again, you’re bringing up all the things that I’m not proud of. But again, I’m willing to share this because it’s something that we can all fall prey to. And so I think the Zyns minus the tobacco certainly removes the cancer risk. Can you get oral problems from that as well? Absolutely. Look, it’s better than some, but not good for you.

Hidden Heart Health Risks

MEL ROBBINS: So we’ve talked about some of the stuff that’s a little obvious, right? Obviously don’t be smoking, don’t be slamming the wine, thinking it’s good for you. Get rid of the vaping. But what about the things that are not so obvious? Are there things that people do every day or that they may be eating or whatever or using that you don’t realize can be damaging to your health?

DR. JEREMY LONDON: Well, I think let’s split that into two categories. One, you bring up the eating a food journal. As painful as that thought process is for many people, myself included, can be so illustrative of where you actually are and truly identifying what you are actually putting in your body every day.

And I think that that is a great place to start because if you think about it, we internalize the majority of the outside world through our mouths, 80 to 90%. The rest is through our lungs and of course through our skin. But the majority is through our mouths.

And so if you look for kind of hidden opportunities, I think that something as simple as a food journal and really looking at that with a very critical eye can bring to light very easy opportunities that maybe don’t even mean that much to you because it’s just kind of filler during the day, either just empty calories or soft drinks or whatever it may be. So I think that that is really an important area for people to focus on because we can out eat any exercise we do.

MEL ROBBINS: It’s true.

DR. JEREMY LONDON: We’ve all done it. I’ve done it. And I think that to start there and to really get that as tight as you can and look, it’s going to go in cycles, you’re going to get really tight and then it’s going to be the holidays or whatever it is and that’s life and that’s okay. But I think that the diet is a place that you can find those hidden even though you know you’re doing them.

One interesting one that I think that people don’t realize is alcohol containing mouthwashes.

The Surprising Danger of Alcohol-Based Mouthwash

MEL ROBBINS: Wait, what? Mouthwash?

DR. JEREMY LONDON: I know you sound like my 88 year old dad. I use it every day, that’s what my dad said.

MEL ROBBINS: And I use it every morning and every night.

DR. JEREMY LONDON: Yeah, well, alcohol containing mouthwashes, I’ve never even looked worth a look. Why? Because the gut microbiome starts obviously in the mouth this is the beginning of our swallowing tube, right.

MEL ROBBINS: But isn’t that why I have bad breath? I mean, I thought I was supposed to rush that stuff out of there.

DR. JEREMY LONDON: I think, for real, let’s handle one issue at a time.

MEL ROBBINS: I have a feeling your wife and I would get along very well.

DR. JEREMY LONDON: I think I’m going to keep you separated. Kind of what I’ve decided. So there are bacteria, good bacteria in your mouth, just like there are in your gut, that produce a compound called nitric oxide, which actually helps regulate your blood pressure. It keeps your blood pressure down.

So if you end up killing this bacteria in your mouth, you decrease that level of nitric oxide and can actually induce high blood pressure as a result. And they’ve done some really eloquent studies on this. There’s a lot of connections between oral health and heart health. This is a really interesting one.

Now, when it comes to bad breath, there are very specific ways to deal with that. You know, tongue scrapers and flossing and non alcohol, non alcoholic base. There are multiple choices and they work just as well, but you need to avoid the alcohol based.

What a Heart Surgeon Eats Every Day

MEL ROBBINS: So since we’re talking about things you put in your mouth, Dr. London, I would love to know, as a heart surgeon, what do you eat every day? Take me through the day. What do you eat?

Cause we can make the list. And by the way, there’s unbelievable research about how food journals help you lose weight because you’re actually conscious of what you’re eating. And most of us don’t realize what we’re putting in our mouths. And so I love that you brought that up as the first place to start.

But once I got the list, I don’t even know what actually are you looking for? And I want to use what you eat from the moment you get up until you go to bed. On a good day, we’re not talking the holidays, we’re talking on a good day. What is heart healthy food look like?

DR. JEREMY LONDON: Okay, so my day typically starts with hydration first because I don’t drink enough water. That’s something I definitely need to work on. So I just start with it first thing in the morning.

My morning meal is typically a protein heavy meal, protein center stage, with usually a couple of eggs and some fruit and cup and a half of coffee as I try to dial that back. With sleep being such an issue for me some mornings, if I’m not hungry, I skip breakfast and I just listen to my body. I don’t like to eat when I’m not hungry. I figure that’s something that, you know, your body’s telling you one way or the other.

For lunch, I typically do greens with protein as well, because I again try to make sure that I get all of the necessary vitamins. Keep it colorful, as they say. Midday before a workout, I will do either fruits and a handful of nuts or a smoothie.

And then for dinner, I typically go kind of that same protein center stage with some more greens. But I tend to eat fairly light in the evenings because I find that I just sleep better.

I use intermittent fasting as a tool. I don’t use it as an absolute for myself. I think that there is value there, but I just kind of listen to my body. If I feel like I’ve fallen off the edge or feeling like I’m just not myself, then I’ll skip a few meals and just hydrate through. But that’s kind of a common day for me, I would say.

MEL ROBBINS: If I were to follow Dr. Jeremy London, the heart surgeon, into the grocery store. What do you buy? If you were to teach somebody how to grocery shop for your heart?

Heart-Healthy Grocery Shopping Strategy

DR. JEREMY LONDON: I think that’s actually probably a more useful way to couch this than actually what I eat, because some people may not like what I eat every day, but the general thought process, and we like to keep it super simple.

Our bodies run on proteins, fats, and carbohydrates. I mean, that’s what our bodies run on. Whether you believe in a carnivore diet or you believe in a vegan diet, look, if that works for you, your body, your rules, run with it. I don’t have any problem with it, but that’s not how our bodies are made. And so we want our grocery cart to reflect that when we go into the grocery store.

What we can do is make a list before you go in. That prevents that impulse buying and just picking up things you’ve thought through. Do I have my protein? How am I getting my carbohydrates? Am I getting enough fiber? Where are my healthy fats? Have a plan before you walk into the store. It just keeps you on track and saves you money. 100%. Shop on the outside of the store.

MEL ROBBINS: What do you mean by that?

DR. JEREMY LONDON: Stay out of the aisles. The whole foods, single ingredient foods live on the outskirts of the store. Primarily the produce department. Think about the meats department. Think about where those places are located. Whereas all of the canned and jarred items are on the shelves.

Not that all of those are bad. And look, you have to be realistic. If you can get 80% whole foods and it’s 20% processed, to some degree, we consider that a win. But what happens with those canned foods? There’s hidden preservatives, hidden colorings, hidden sugar, all of those things. And I heard someone say years ago, the longer the shelf life, the shorter your life.

MEL ROBBINS: Oh, wait a minute, that’s good. The longer the shelf life on the boxed or canned food, the shorter your life. That is a fabulous rule of thumb.

DR. JEREMY LONDON: Yeah, I thought so too, and we use that all the time. But again, are there certain items? Yes, but read the labels. Pick the best that you can choose from. When you have those options, there’s always choices.

Starting Your Health Journey: The Simple First Step

MEL ROBBINS: So if the person that’s listening is like, okay, I want to take better care of myself, and this is a lot of information and there’s a lot to do. If somebody doesn’t know where to begin as a heart surgeon and somebody that has been really in the field taking care of people, and now you’ve got a very different approach for yourself and a reason why you’re taking care of yourself, what do you think is the best simple, small step forward that a person can take if they feel overwhelmed?

DR. JEREMY LONDON: I go back to the diet. We’ve all got to eat. And I really think that before you do one push up, before you go out for a run, before you spend the money on that expensive gym membership, as good as those things might make you feel, I think from a foundational standpoint, I really go back to the food journal and starting there because it’s something that we’re all already doing. The question is, how badly are we managing that for ourselves?

MEL ROBBINS: So that is, I once heard somebody say that abs are made in the kitchen, not in the gym. And I didn’t fully understand that until I started learning from medical experts like you about the impact of positive whole food choices and the negative impact of having a very processed, high calorie, high sugar diet. So that makes a lot of sense to me. What are the biggest problems that patients still come to you as a cardiac surgeon for?

Common Heart Problems and Surgical Solutions

DR. JEREMY LONDON: Yeah, they fall in the two buckets that we discussed earlier. Of what defines heart disease, the most common is the blockages in the heart arteries. That is the most common. So what we refer to, there’s the big category of open heart surgery, which addresses both the blockage problem and valve problem. And then there’s bypass surgery.

Now, bypass surgery is open heart surgery, just like valve surgery. But bypass surgery simply means identifying where that blockage is. Again with the dye study, like I had in the cath lab. And then using tubes from your body, either the artery that lives behind the breastbone or veins from the leg, to create a new pathway around that blockage.

Now, the thing to understand about this, or stents is it doesn’t treat the underlying problem of the hardening of the arteries.

MEL ROBBINS: Wait, say that again.

DR. JEREMY LONDON: When you bypass the blockage, you’re getting the patient out of trouble to avoid a big heart attack, but you’re not treating the actual problem of the hardening of the arteries. The work starts for that patient afterwards to make lifestyle modifications to impact the rate at which this problem continues or not at all, if they’re really aggressive.

In other words, you could do a bypass beyond the blockage here, and things could happen below where you’ve done that bypass if you continue to smoke, if you don’t make dietary changes, if you’re not moving every day, if you’re not prioritizing your sleep and all of those things that we know that we should be doing. So that’s the bypass surgery piece, and that either treats a big heart attack or prevents big heart attacks from occurring and changes the quality of the life of that patient because that exertional symptom that they were having goes away.

Understanding Stents

MEL ROBBINS: What exactly is a stent? I hear people talking about that all the time. I just had a stent put in. Here’s a stent. And you mentioned a stent. What is a stent?

DR. JEREMY LONDON: So a stent is, think of it this way, as a scaffolding, very small scaffolding that is loaded on a balloon.

MEL ROBBINS: Okay.

DR. JEREMY LONDON: Kind of looks like the old Chinese finger traps.

MEL ROBBINS: Oh, yeah, yeah. Where you get your fingers stuck in them. Yep.

DR. JEREMY LONDON: So imagine that crimped down onto a balloon that goes through the blood vessels and through a blockage over a wire. And when they expand that balloon, it expands within that artery. And that stented structure, if you will, that scaffolding holds the artery open in that specific spot. So instead of bypassing it, you’ve actually gone in, reinforced it almost, and pushed that out to the edges.

But again, doesn’t treat the underlying problem of the hardening of the arteries. Gets the patient out of trouble and mitigates their risk of having something terrible happen as a result of the lack of blood flow to the heart muscle.

Warning Signs of Heart Problems

MEL ROBBINS: So how do you actually know if your heart is having a problem?

DR. JEREMY LONDON: So there are again, within those two buckets, signs that you should respond to. They’re not 100% that you have a heart problem because there’s other reasons that these things could occur. But they’re enough of a concern that they warrant investigation as follows.

First, shortness of breath with low level activity. What do I mean by that? Taking a shower, taking the garbage out. Things out of proportion to the activity. Not being able to lay entirely flat and sleep without feeling short winded. Again, signs of the heart not working effectively and fluid backing up. Same thing with swelling in the legs. Same kind of scenario. These are clinical signs that maybe the heart isn’t working properly or not working efficiently.

Swollen legs, lots of reasons that legs can swell. Need to make sure it’s not something that needs to be addressed. And then that red flag category, exertional symptoms relieved with rest. That is like if there’s one takeaway today when you start to examine, do I have blockages or not? If I can still go for my brisk 3 mile walk and I don’t have to sit down and I don’t have to stop. Great.

It can be something as simple as shortness of breath and something as dramatic as the elephant sitting on the chest to something as minor as reflux or a pain in your elbow. I had a woman that every time she took the garbage out, she had a pain in her elbow that would not go away. She would sit down and people told her she was crazy. And there was one cardiologist who said, let me get this through. Every time you do the exact same activity, it aggravates this particular symptom. And she said, yes, every single time. And he said, I’m taking you to the cath lab.

MEL ROBBINS: And what did it show?

DR. JEREMY LONDON: And he ended up putting a stent in the artery in the front of her heart. She was having coronary angina that showed up as elbow pain. She had gone to the orthopedist. I mean, that’s why I say it’s the great masquerader. And you have to listen to your body. We have to be accountable for doing that.

Signs of a Major Heart Attack

MEL ROBBINS: What are the classic but important signs to know that somebody is having a major heart incident?

DR. JEREMY LONDON: So we’ve talked about exertional symptoms that are relieved with rest. Symptoms that occur at rest and don’t go away. Think of it this way. Whereas before you were having to stress the heart muscle down below the blockage. Now, at rest, you’re not giving adequate nutrient and blood flow to that, so it’s really in danger. And so pain and symptoms at rest or pain that escalates. That’s a 911 call.

MEL ROBBINS: Okay. And is it the pain in the heart? Is this the arm thing?

DR. JEREMY LONDON: All the above. All the above.

What to Do If You’re Having a Heart Attack

MEL ROBBINS: Dr. London, if you’re home alone and you think you may be having a heart attack, what should you do?

DR. JEREMY LONDON: So this is, I really like reviewing this because this happens to people. So first you call 911. That’s, let’s start there. Now, when we did this post, the most popular response was, Call 911. No, I’m going to clear my browser history before I call 911. I was like, are you kidding me? We’re talking about having a heart attack.

So, number one, you’re going to call 911. Number two, if it is nighttime, you are going to turn on the lights on your porch so that EMS can identify your house, and you’re going to open or at least unlock the front door so EMS can access your house, because if you are incapacitated, they have no way to get in.

Lay down or sit down. Lay down, lay down. Lay down on the couch or sit down. Whatever’s comfortable. Wherever you’re breathing the easiest. Laying down and elevating your feet typically gives people the most relief. But put yourself stationary so if you do pass out, you don’t fall, and add a head injury now to an already bad situation.

And last but not least, call your family or friends to let them know what’s happening so that somebody knows that EMS is coming and you’re going to be taken to the hospital.

MEL ROBBINS: I’ve heard take an aspirin. Is that something you should do, too, or is it not as important as 911?

DR. JEREMY LONDON: It is important. And not only do you want to take it, you want to chew it. You want 325 milligram aspirin. You want to chew it, because that’s the fastest way to get it into your system.

I think the thing to be aware of and the reason that I don’t always put it directly on the list is that there are people that have GI bleeding problems, that aspirin is not appropriate for them, or allergies to aspirin. But they think, well, I’m having a heart attack and I should do this even though I have these problems. So that’s something that you definitely need to clear with your physician before you make that plan of utilizing an aspirin in that setting.

MEL ROBBINS: I am so glad I asked you that question. I never would have thought turn on the porch light and unlock the front door. I mean, I would have been so panic stricken calling 911 and trying to find aspirin. I wouldn’t have even thought of that. I am so glad you shared that. Dr. London, what is the widowmaker blockage?

The Widowmaker Blockage

DR. JEREMY LONDON: The widowmaker blockage is a blockage that occurs in this main artery on the front of the heart, the left anterior descending artery, right at the mid to beginning portion. That’s the one that really controls the big pumping chamber. And it’s a blockage that occurs very far upstream, if you will, so that there’s a big territory, typically that’s affected many times.

This blockage actually starts with what we call soft plaque. So the blockage itself may not be that severe, but the soft plaque can be very unstable. And it ruptures. It gets blood behind it and then blocks that artery. So what happens is you get an immediate interruption of blood flow to a huge territory of the heart, which is extremely dangerous.

Unlike potentially a blockage in this area that has happened over time. And the heart then can acclimate slowly. Doesn’t mean that you’re not going to ultimately have symptoms and have something to be done to it. But you start to develop those collateral pathways, those alternate pathways, so that if this goes down, even though you still may have a big heart attack, there’s alternate ways for the blood to get there. So it’s that acute blockage in a very, very upstream location.

Understanding High Blood Pressure and Heart Health

MEL ROBBINS: You know, as we were preparing for you to come in, one of our colleagues, who’s 37 years old, told us that he was experiencing headaches for a number of weeks, and he ultimately went to the emergency room, this was like a couple weeks ago. And they discovered that he had dangerously high blood pressure.

DR. JEREMY LONDON: Yes.

MEL ROBBINS: He had no idea. And he’s now on medication for it. And he was saying, I’m learning that this is something that’s genetic and that feels very discouraging. And so I’m wondering, Dr. London, if you could talk a little bit about the connection between high blood pressure, the health of your heart, and what if the person that’s been listening feels like, well, God, my dad had a heart attack. High blood pressure’s in my family. What is it that you want someone to know?

DR. JEREMY LONDON: Well, I’ll start by saying you can’t run from your genes. And that’s just a fact that we all have to come to grips with. That doesn’t mean that we can’t have an impact and move the needle, whether it’s on high blood pressure or high cholesterol that people can be born with as well. Because there’s this concept of epigenetics. And what does that mean?

Well, you’re born with the genes you’re born with, but the stressors that we place on those genes many times affect how they are consequently expressed in our bodies. So by really making solid lifestyle decisions and being consistent with those things can have a huge impact on that. Now, there are some forms, particularly of these familial type of processes that are really difficult to impact with just lifestyle changes, and they require medication.

Let’s talk about high blood pressure and why that is so important to treat. The way to think about high blood pressure and the negative impacts on the heart, think about the pump working, and everywhere that the heart is pumping to is clamping down, trying to maintain the blood volume in the body. Even though it may be adequate, the tone in those blood vessels is real. So every time the heart’s beating, as opposed to seeing these relaxed blood vessels where it’s trying to get blood flowing to, it’s seeing resistance. So it’s seeing resistance out of proportion to what it would normally expect.

Well, the heart’s just a muscle. So what does a muscle do when you then stress it with resistance? Over time it gets thicker and thicker and thicker, and so the cavity then can become smaller and the efficiency of that heart muscle at some point will start to slip.

MEL ROBBINS: That makes sense.

DR. JEREMY LONDON: That’s when patients start to develop heart failure as a result of high blood pressure. The other consequence is that elevated blood pressure, and I think this makes good intuitive sense too, has a physical damage to the inner lining of the blood vessels that again make it a just breeding ground for cholesterol and all of that to accumulate in it sets up injury. So it kind of comes from this multifaceted approach of how it negatively impacts the body.

MEL ROBBINS: So by relieving the high blood pressure with medication, or if lifestyle changes are something that’s going to impact you based on genetics or based on the diagnosis or both, you relax the system so that the heart isn’t having to just pump so darn hard through a system that’s clenched, you relax it and then the heart can actually ease off and do its job.

DR. JEREMY LONDON: Absolutely correct. And I think that that’s a good way to think about it because again, we’re not really treating the underlying problem of this genetic abnormality. So we’re changing the slope of that survival curve by saying, okay, well, what are the mechanisms that then result in this problem? Let’s relieve those or mitigate those to the best of our ability to extend this person’s life.

MEL ROBBINS: Just like you do with somebody who has diabetes.

DR. JEREMY LONDON: Identical.

MEL ROBBINS: Yeah. That’s so helpful to understand.

DR. JEREMY LONDON: We know the natural history. How can we alter the natural history?

Heart Disease in Women vs. Men

MEL ROBBINS: You know, one question I didn’t ask you is the difference between men and women and heart disease? Is there anything that you think is important for us to know? Because I hear heart attack and I think, man.

DR. JEREMY LONDON: The short answer is yes. You know, I love that they say women are not little men, and that’s so true. Just like children aren’t little adults. Their physiology is very, very different. And part of it is that the medical literature has been fraught with male bias for years and years, and that is slowly starting to transform.

But in addition, there is certainly a mindset that when women come in with these masquerading type symptoms that they’re not taken as seriously, that it’s an anxiety or panic attack or something of that nature. And the reality is that the nature of the way blockages occur for women can be very different as opposed to in men, happening in these very large blood vessels. In women, they can occur there and frequently do, but they can also occur in the smaller blood vessels.

In addition, with perimenopausal women with changes in estrogen level. Estrogen is such a powerful anti-inflammatory, it can change again your cholesterol levels and all the risk factors that then mitigate or actually lead to heart disease. So yes, there is significant differences between the two.

MEL ROBBINS: Now, you said, according to the CDC, that heart disease and heart attacks are the number one killer worldwide in both men and women. But is there statistics in the rates in terms of how heart disease impacts men versus women?

DR. JEREMY LONDON: I still believe the rates are higher for men than they are for women, but I think it’s still pretty close. I don’t know for sure.

MEL ROBBINS: Well, what’s interesting is that I just am thinking generally in my own experience, you think about men having heart disease and you think about women having high blood pressure. We tend to talk about it differently.

DR. JEREMY LONDON: And that’s part of the problem. I think too, I think that the mindset around evaluating women has not been the same. And that’s why a lot of times women are either sent home and then they come back with a bigger problem or they’re taken down these roads of oh, it must be your gallbladder. Oh, it must be this. And in this circuitous route it ends up back at the heart. And that is changing, it really is. I feel like that is changing rapidly. That mindset is much better even than since I’ve been in training.

MEL ROBBINS: Well, I guess what’s interesting and what I love to have you speak to because I’m realizing my own bias here that I didn’t even really think about heart disease impacting women. You’re suggesting that women may be experiencing heart disease at the same rates. It’s just that we’re not seeing the symptoms and connecting the dots as quickly as we do with men.

DR. JEREMY LONDON: Yes. And I think, I think that there is a much different awareness even in the last five to six years than there was when I started and trained. I don’t know that that discrepancy even now is quite as blatant, but I think a lot of that too. The focus on women’s health now has gotten so robust and I think it’s wonderful because it has put a different light on overall women’s health, not just oh, their menopause.

Menopause and Heart Disease Risk

MEL ROBBINS: So once a woman is perimenopausal or menopausal and there’s that drop off the cliff in estrogen. And you just mentioned that estrogen is a wonderful hormone in terms of its anti-inflammatory nature and it’s in every part of a woman’s body. Have they done any research about the increase in heart disease and heart attacks with women?

DR. JEREMY LONDON: Absolutely, yeah. I mean, and I think that they have clearly shown that which is why that age group of women, it’s not surprising the 65 plus are the ones that tend to come in with the heart attack symptoms. And I think the ones that maybe are not picked up on are the more perimenopausal that may have dramatic changes in their estrogen levels.

I think the interesting data is going to come out with now all the estrogen replacement, particularly earlier on. How is that going to change the tail of this as we look at it over the next 10 years? I suspect it’s going to be dramatic.

MEL ROBBINS: Fascinating, that’s really helpful. Thank you, Dr. London.

What to Know Before Heart Surgery

MEL ROBBINS: So if you’re going to have heart surgery or you’re the loved one and somebody that you love is undergoing heart surgery, what do you want the patient and their family to know?

DR. JEREMY LONDON: So when you’re starting to have this general conversation about an operation, there are several things that you need to know. First, what’s wrong with me? Really explain and have the physician explain. And you need to understand your diagnosis and what that truly means. Start there. What do I have?

Next is explain the procedure in detail. What are you going to do to me? What are you going to do tonight? How bad is it going to hurt? How long am I going to be in the hospital? What are my expectations afterwards?

Next, risk. What are the potential bumps in the road if I do decide to undergo this procedure? Very clearly and make sure you understand each of those. Just as important, what are the benefits of having this operation? Why? Because every decision we make in medicine is a risk benefit decision. What are the pros and cons of going down road A versus the pros and cons of going down road B? And how do I make this decision?

And not that this discussion makes surgery any less scary, but I do think that truly understanding that you’re making the best possible decision for yourself based on the actuarial, the statistical numbers is comforting. And finally you want to know what the alternatives are. What else can I do? Do I have to have this? What if I don’t have it? What does that look like for me?

And you know this as an attorney, this is informed consent, right? That’s what this is called. I don’t like that term. This is educated consent. My job isn’t to inform a patient. This is a relationship and it’s a two way relationship. Patients have to engage in this conversation as well. But to have a patient sign an informed consent piece of paper is meaningless if educated consent hasn’t occurred. And so I think that that process allows you to gain so much knowledge of what you have, what we need to do and what that means that you can really be comfortable that you’re making the best decision for yourself.

Dr. London’s Top Recommendation

MEL ROBBINS: So Dr. London, you’ve shared so much with us. If the person listening does just one thing out of everything that you shared, what would be your top recommendation? Other than I think my recommendation would be share this with somebody in your life who needs to hear the story at the top so that if signs come up, they don’t do something selfish.

DR. JEREMY LONDON: Sure. I would say understand that we all have our own instruction manuals and mine is going to be different than yours and different than your husband’s. And approach this with some real intellectual honesty so that you can figure out where your opportunities truly exist.

Clearly, starting is the hardest because we’re all fearful that either we’re going to fail or it’s just not worth it or whatever it may be. And we need to understand that success is not a straight line, but a series of picking ourselves up multiple times. And then I think that really getting even more granular, consistency and understanding that making those small steps, whatever you choose for yourself, are what are going to compound on a daily basis.

And then how do you validate those things? You know, how do you validate those changes? Well, is it a number on the scale? Is it the way you look in the mirror? It’s all of those things. But, you know, I’ve been thinking about this recently that I think the ultimate form of validation to know that you’re on the right track is to know that if you miss doing those things, that it really upsets you, that you didn’t do them, and you really, really miss them because it’s such an integral part of your life that you know that you’re on the right journey.

In other words, you don’t have that if I only get to this number on the scale, I’m going to be happy because you’re going to get there and you’re not going to be happy. But if you know that if you don’t do those things, you feel like you’ve really missed out, I think that that’s a level of validation that you’re on course.

And so I have really broadened your question of one thing intentionally, because that one thing is so different for everybody that I would hate to say one thing. And then someone listens to this and thinks, well, I’m good at that one thing. I don’t need to worry. But that’s not necessarily the case. I think that we all have to approach this in a very individualized way.

Final Thoughts on Heart Health

MEL ROBBINS: And I can also tell that one of the reasons why you are now coming out of the operating room and sharing more and more on social media is because you know that there are simple things that are within all of our reach that can keep us from ever meeting you on an operating table. And that if you start to understand the power that you have in your hands, that you will also take the steps to take care of your heart.

DR. JEREMY LONDON: Yeah.

MEL ROBBINS: Dr. London, what are your parting words?

DR. JEREMY LONDON: Well, I think right in line with what you just said, you know, we’re all just trying to squeeze every ounce of juice out of this brief existence that we’ve been blessed with. And it’s like, why not make choices that tip the scales in our favor?

And look, we’re all human and inherently flawed, but just those little steps each day and watch them slowly combine into this wonderful experience and understand that it’s not about perfection. It’s just about progression for all of us, me included. And I think that that’s ultimately what I hope to get across.

Closing Remarks

MEL ROBBINS: Well, you did, Dr. London. Thank you for being here. And, you know, I also want to thank you. Thank you for taking the time to listen to something that is not only going to make you smarter about your health. I mean, I learned so much today. I didn’t know about half of the things that he shared with us.

It’s not only going to make you smarter, it’s going to empower you to make better choices, which is going to lead you to living a longer life. And I’m also thrilled that you have this as a resource to send to people that you care about, because as I’ve already shared, I am sending this with four people that I can think of immediately. And I’m sure more people are going to come to mind.

So thank you for listening. Thank you for sharing. Thank you for being here with me. And in case no one else tells you, I wanted to be sure to tell you that I love you and I believe in you and I believe in your ability to create a better life. And everything that you learned today is going to help you do that.

Alrighty. I’ll see you in a couple days in the very next episode. And I’ll be waiting to welcome you in the moment you hit play.

Related Posts

• Mel Robbins Podcast: w/ Dr. Brennan Spiegel on Gravity Intolerance (Transcript)
• FO518 Raj Shamani: w/ Neuroscientist Vidita Vaidya – Billionaire Brain & Addictions (Transcript)
• The Forgotten 5,000-Year-Old Science of the Human Body w/ Dr. Vasant Lad (Transcript)
• Mel Robbins Podcast: w/ Dr. Tara Narula on Building Resilience (Transcript)
• How to Maintain Optimal Blood Glucose Levels – Dr. Michael Snyder (Transcript)