Today we are joined by physician Dr. William Li to talk about heart disease, (and how to prevent it), tips to handle erectile dysfunction, how to take care of our oral microbiome, and so much more! This conversation has so many insights and tools to help you take care of your heart health today.

Who is Dr. William Li?

I'm a physician (MD) trained in internal medicine, with a dedicated focus on vascular health - the health of blood vessels that span the entire body. Our bodies contain about 60,000 miles of blood vessels, which serve as the essential highways and byways for oxygen and nutrients, fueling every organ and cell. I am also a vascular biologist so I study the science of blood vessels. These vessels are a critical foundation for both health and disease. When blood vessels are healthy, they support overall well-being. On the contrary, sick blood vessels can undermine your health, making optimisation nearly impossible. Recent studies have even shown that vascular health is connected to our gut health.

A few years ago, I wrote two New York Times bestselling books, Eat to Beat Disease and Eat to Beat Your Diet. These books allowed me to step into the public sphere, sharing insights about food and health. Through television appearances and other platforms, I’ve embraced the opportunity to communicate the science behind food as medicine.

When it comes to food and health, it’s not just about the food itself. The fascination with “superfoods” and “super supplements” can be compelling, but the real story lies in how the body responds to what we put into it. Food science is a two-sided equation, there’s the science of the food itself, and then there’s the science of what the food does inside the body. That is really what I studied and I consider myself a “food as medicine” researcher.

Why Do We Die From Heart Disease?

So why is heart disease one of the leading causes of death in the world? It all starts with the heart itself - the engine of our body. If we think of our body as a vehicle, the brain is like the computer system that manages everything, but the heart is the part that makes movement possible. Shortly after our circulation system forms, when we’re still a ball of shapeless cells, the heart begins working. Every pump fuels our body, sending oxygen and nutrients through blood vessels to every organ and cell. Without the heart, life simply cannot happen.

Just like when your car engine is running healthy you have a comfortable ride and you can get from point A to point B easily - the same thing goes for your heart. Those who are mindful about maintaining their engine by changing the oil regularly, avoiding misuse, and using the best fuel can have a car for life. The same thing applies to our hearts. People who live to 100 or more, often owe their longevity in part to having well-functioning hearts. Every drop of blood in our body passes through the heart, meaning that whatever we consume directly affects how well it operates. Food acts as fuel for our heart and our fat cells are our fuel tanks. When we choose high-quality, nutrient-rich foods, we are essentially treating our engines well.

Unfortunately, many of us have been unconsciously filling our bodies with poor-quality fuel for a long time. This has contributed to heart disease becoming the world’s number one cause of death. Throughout our lives, we are not treating our hearts well by eating nutritious food. Recent research also highlights how environmental factors play a role. Microplastics, tiny particles found in water bottles and the air we breathe, can enter our bloodstream and accumulate in the fatty plaques that narrow our blood vessels. These plaques (which are already harmful due to poor diet and lifestyle), become even more dangerous when embedded with plastic particles. The research showed that this combination of plaque and plastic has been linked to a fourfold increase in the risk of heart attack or stroke.

How Do We Prevent Heart Disease?

Prevention is the best cure and it has been starting since the day each one of us was born. When we are born, it’s like opening up a brand-new laptop straight out of the box. Every unit starts with the same pristine operating system. You plug it in, charge it, hit the power button, and everything runs smoothly. If you want this laptop to perform smoothly for a long time, you need to take care of it. This means shutting it down occasionally, running antivirus programs, avoiding spills, and protecting it from extreme conditions, These preventative steps are essential, and that’s exactly what needs to happen for our hearts. We’re born with incredible, healthy hearts, and then from day one our journey begins & our differences emerge. The divergence between someone who develops heart disease and someone who stays heart-healthy into their 90s starts much earlier than we realise.

Diet, for example, is just one of many factors that influence this path. How many moms are feeding their kids healthy plant-based, protein-rich foods? The foods that allow our bodies to be able to gain all those bioactive, phytonutrients and polyphenols, that allow our cells and hearts to thrive. Those natural compounds help our blood vessels and endothelial lining stay healthy.

In contrast to this, if a child is exposed to junk food all of the time they are going to be in trouble down the line. Our bodies are resilient and if we eat junk food every once in a while, it is not bad. But constantly consuming fatty foods, artificial preservatives, artificial sweeteners, flavourings, and colourings - has a big impact on our health. The biggest opportunity for prevention is when we are children. Parents should be focusing on healthy nutrition because they have control. There is a massive toll on our bodies when we eat poorly for decades. When we look at who has heart disease and we trace it back throughout their lives, we can see this process began early on.

So does that mean our fate has been decided so early on that there is no hope? This is where the exciting research is, we can reverse heart disease. We can reverse the blockages in our blood vessels, repave the lining of our blood vessels, and regenerate heart tissue with our stem cells. We need to be mindful of how we eat, how much food we eat, and what we eat. Once you realise it's time for you to get your act together and get heart healthy, taking those proactive measures can reverse heart disease.

What is The Current Medical Paradigm for Heart Disease?

It all starts with seeing a doctor. You may be healthy and feel okay but when you go for a physical exam, a doctor has already started assessing before they even speak to you. The moment a doctor walks through the door and sees the patient sitting there, they have thought of what questions to ask and what they want to assess to get them healthier. Then it is usually followed up with these things:

- An EKG, which measures the electrical rhythm of your heart. This is the original biohacker since we can measure your heartbeat by beat.

- Blood pressure

- Weight

- A blood test. We call them blood chemistries which is a complete blood count.

- Cholesterol because in the 1970s, we started to realise that if you have high cholesterol, you're more likely to have heart disease narrowing. The cholesterol being fat narrows the width of your blood vessels so you will not get as much blood flow. This could lead to a heart attack or stroke.

These are all starting points of how we assess but then we have to look at the treatments. It wasn't too many decades ago that we had no real good treatments for our heart. We could lower blood pressure by dilating the blood vessels or we could slow the heart rate down. It was in the 1980s that statins came out. Statins are a pill that works in the body to lower the level of cholesterol in your blood. But not all cholesterol is bad, some is good. So even if you have higher than normal cholesterol, you have to determine how much good (HDL) vs bad (LDL) cholesterol you have. If your bad cholesterol is higher, the standard of care is to write a statin. In reality, you can take some preventative and reversal steps before that such as:

- Exercise

- High-fiber diet

- Cut down saturated fat

I like to personally give my patients a shot to be able to kind of reverse their bad blood profile and get back to who their body wants them to be. Behaviour, mindfulness, and exercise are all proven to help do this. A body in motion stays in motion and the couch potato stays on the couch. You want to stay in motion and eat healthier foods - most people can lower their blood lipids just like that. High blood lipids, lack of exercise, and a bad diet often set up metabolic syndrome which is a pre-diabetic state. This has a domino effect on other cardiovascular diseases downstream. I like to allow the body a chance to heal itself and revert to its natural state before writing a statin.

When people experience symptoms that suggest they’re at serious risk of a heart attack, we take them to the catheterisation lab, a specialised facility in the hospital. A cardiologist will inject dye into the heart and pinpoint where blockages or narrowing might be. If they find something, they can thread a small device into the blockage and expand it. They might place a stent, a tiny mesh-like basket, to keep the vessel open, or even use tools to remove the plaque altogether. This is typically performed before a heart attack occurs. In more advanced cases, patients might require bypass surgery or treatments for heart failure, which often involve medications.

While medical advancements over the past century have provided incredible mechanical and pharmaceutical tools to address heart disease, it’s important to recognise what’s missing from the toolbox. Beyond these interventions lies the opportunity to prevent heart disease by enabling the body to maintain its natural balance. This is where heart-healthy foods, lifestyle choices, and preventive measures come into play. Armed with modern science and ancient knowledge, we can empower the body to restore and protect itself long before disease takes hold.

“Wow, I love that approach. It’s so important to acknowledge and celebrate the incredible advancements of modern medicine while also recognising the value of ancient healing wisdom. Combining the two creates a more holistic approach emphasising diet, lifestyle, and exercise as preventative measures. Instead of seeing it as a binary choice, we can embrace both, allowing modern medicine and nutritional knowledge to work together. This integrated approach not only fills the gaps in our current healthcare system but also empowers us to take a proactive role in our well-being, I completely agree.” - Kriben Govender

What is APOE?

APOE is a protein that comes from a gene that is set up for accumulating lipid blockages. It is a telltale sign that can be measured to identify your risk and it is genetically associated. APOE is a gene and if you have a mutation in it, you're more likely to have blockages. This does not mean you need a statin, it just means you are more likely to have a problem and should take care of yourself more carefully. Each one of us has our risk factors, and APOE is just another one of those. Smoking and other behavioural factors make it worse. There are a lot of different kinds of genetic oddities (like Marfan syndrome and connective tissue diseases) that also increase your risk. But regardless of what your genetics are, how you live your life can make a difference in how long you live.

"So, imagine someone undergoes genetic sequencing and discovers they carry a particular gene, this is essentially just a risk factor. However, epigenetics comes into play with factors like diet and lifestyle that influence whether this gene is activated. That makes perfect sense to me because you can also activate your body's other health defences, which can help protect your heart. In the nutrition and wellness space, it’s tempting to look for specific causes and effects thinking we can simply turn something on or off. But in reality, it’s more like a dynamic system with many moving parts. The goal is to find that balance where everything works in harmony for better health." - Kriben Govender

Dietary Recommendations to Prevent Heart Disease

My approach begins with helping individuals facing health challenges take an honest look at their diet. Many of us go through life thinking we know what we’re eating but we don’t know what we are eating. That’s why I emphasise the importance of a food diary whether that is on paper, on your phone, or even taking pictures of what you are eating. Most of us always have our phones so this is a great way to have a record of what you are eating.

I also like to ask people how much plant-based food they are eating. You want to mostly eat plant-based because all the healthy polyphenols are good for your circulation. Dietary fibre found in plant-based foods is crucial for feeding our gut microbiome. The gut microbiome has a community of about 39 trillion bacteria and these bacteria live in harmony to help control your blood cholesterol. If you have better gut health, you may not have to be on a statin.

Your gut microbiome also controls your stress levels because your gut sends a “text message” to your brain to release serotonin, dopamine, and oxytocin. Your gut has a big influence on your brain. If you have ever had a crampy stomach, you are in a bad mood not just because of the pain, but because your gut is not sending happy signals to your brain. Your gut microbiome also controls your insulin sensitivity which is metabolic to bring glucose into your muscles and your fat so you can have enough energy. Plant-based foods feed your gut which is good for your brain and heart as well. Then I see how many things people are eating that aren’t good for the heart such as:

- Soda, which has 9 teaspoons of sugar in one can.

- Artificial sweeteners. We often think that non-caloric soda is good for us but those artificial sweeteners damage your gut microbiome. You damage your gut microbiome even though you haven't raised your blood sugar levels. Diet soda is not good for you

- Red meat and how much-saturated fat you eat. Having some of it is probably not bad for you; it might be a good source of protein, iron, and other minerals. But in our world of abundance with food, we are overstuffing ourselves with everything.

Food is the fuel that powers our bodies, much like gasoline powers a car. When you load your body with good fuel, it runs efficiently and lasts longer. Think of metabolism as the process of using food as fuel, just as we measure fuel in gallons or litres at the gas station, we measure food energy in calories. It’s simply another way to quantify the energy we consume. Just as a car performs better with high-quality gasoline, your body thrives on high-quality food. Plant-based foods rich in dietary fibre and polyphenols are like premium fuel for your body’s engine. They not only enhance overall performance but also support critical systems, including your gut microbiome. A healthy gut microbiome is absolutely essential for maintaining optimal health, influencing everything from digestion to immune function. By choosing the right fuel for your body, you set the foundation for long-term wellness!

Dietary Supplements for Heart Health

Most of us cannot get enough Omega-3s - even if we live by the shore. Seafood is a source but of course, you can take supplements. Omega-3s are so beneficial for longevity, heart health, brain health, and metabolic health. That's a no-brainer to be able to supplement. Another very important supplement is vitamin D. It helps build strong bones, lowers the risk of heart disease, and lowers the risk of cancer. It also builds your immunity. Research is still underway on many probiotics but that would be another thing I recommend along with dietary fibre.

Berberine is a powerful compound, but it’s crucial to pay attention to both the dose and the quality of the product you’re using. Always check the packaging to see what else might be included, as many supplement formulators add additional ingredients to enhance their products. Be an informed consumer - know exactly what you’re taking. When it comes to dosing, remember that with most natural compounds, a little can be beneficial, a bit more might be even better, but too much can lead to problems. This concept is known as hormesis, which reflects the idea that our bodies thrive on finding just the right amount.

I couldn’t agree more, Dr. Li. Many herbal supplements can act very much like pharmaceuticals, so it’s essential to approach them with care. My recommendation as a practitioner is always to prioritise high-quality, practitioner-grade products and work with someone knowledgeable in this space, such as a trained practitioner, naturopath, or nutrition expert. This helps ensure you're using the right doses and avoiding poor-quality products that could lead to problems. A great resource for consumers is examine.com, where you can search for supplements like berberine and find a breakdown of studies supporting their claims. The site even grades the evidence (A, B, C) based on the strength of the research, making it a valuable tool for informed decision-making. - Kriben Govender

Statins and The Microbiome

A few weeks ago, a study was published discussing the impact of heart medications, particularly statins, on the gut microbiome. Do you have any insights into what it revealed? The study suggested that statins and other heart medications might have downstream effects on the gut microbiome, influencing which species of microbes are suppressed and which are allowed to flourish. Interestingly, some of these effects may be more beneficial than others, depending on the microbial shifts they induce. - Kriben Govender

I have heard of the study but I have not read it in depth yet. I think that prescription medicines and probably even non-prescription medicines (especially the ones that we swallow as pills) affect the gut. We are at the beginning of actually understanding what the consequences are. We also have to remember that something that might be good for one organism might be bad for another microbe.

Food as Medicine or Poison

Before we start to have black-and-white thinking on certain medications, we need to pay attention to the benefits or damage things have on us. We know that pharmaceuticals are very potent in terms of having multiple good and bad effects - but food can do the same thing.

A great example I like to give is yoghurt. Most people who buy yoghurt go to the grocery store and pick up low-fat yoghurt because we have to train to think that this is better and healthier. The truth is, low-fat yoghurt does us a disservice because it raises our blood cholesterol, and increases our risk of heart disease - all because of the process this goes through.

When the manufacturer makes low-fat yoghurt and pulls all of the fat out of it, it completely collapses in its texture. No one would eat that so the manufacturers add emulsifiers and thickeners back into it - such as polysorbate 80. It has now been discovered that the emulsifiers that are put into low-fat yogurt damage our gut microbiome. That means your blood lipids start to rise. This is why it is important to pay attention to the details. It is important to have unsweetened, undyed, whole yoghurt.

So I relate this to the question about statins and our gut microbiome. Statins have been shown in large clinical trials to lower cholesterol for many people. We now know that one of the other effects of statins is impacting our gut microbiome - some studies show benefits others show harm. We need more research in this area.

“I couldn’t agree more. The microbiome, and microbiota, offer two fascinating ways to understand this intricate system. What makes it even more compelling is how highly individualised it is since no two microbiomes are exactly alike. This individuality means that the effects of pharmaceuticals or even natural supplements can vary significantly depending on a person’s baseline microbiome. It’s why applying study findings broadly across populations can be tricky, everything depends on what’s already happening in your gut. There is much more to uncover, we need to watch this space.” -Kriben Govender

What are Plant Sterols

Plant sterols are one of these vogue additives going into margarine and other products as a way to prevent heart disease. Do you have any thoughts or opinions on that particular compound? - Kriben Govender

People will recognise steroids from bodybuilding and hormones, plants also have a similar system and we call them plant sterols. They have been known for a long time but only recently have we begun to realise the benefits of them. They improve physical performance and mental performance. They are in different foods like spinach. I do not know enough about them yet to be able to find a commercial application conclusively.

In the supplement industry, it’s common for developers to get excited about compounds like these and create products before sufficient research has been conducted. While their intentions may be good, further studies are usually needed to fully understand how to best utilise such compounds (and to identify any potential side effects). Plant sterols are exciting, important, and have been underappreciated. It’s only in the last four or five years that researchers have begun to recognise their potential significance for health. As we learn more, it’s becoming clear that these compounds deserve closer attention for their possible influence on well-being. However, the word "influence" is key here because it can be positive or negative.

green leaves and spinach

Tips to Handle Erectile Dysfunction

Erectile dysfunction is an emerging issue that we are hearing a lot about. To break it down into simple terms, the erection of erectile dysfunction (or lack thereof) is really blood that flows into the penis and is trapped there for some time. As men, our bodies are naturally built to handle this process, with testosterone playing a key role. But the key is getting the blood to where it needs to go. Your blood vessels need to dilate to let the blood in and then constrict to keep it there. That’s exactly what you want, and it’s a carefully coordinated function connected to your nerves.

What many people don’t realise is that erectile dysfunction is both a blood vessel problem and a nerve problem. No one doubts how important nerves are for the penis - if it’s numb, it doesn’t matter if you can get an erection, right? Every nerve in your body comes with its own blood supply, known as the mesodermal network, which ensures that the nerve gets the circulation it needs to function properly. This nerve-blood supply connection is critical, and any condition that damages it, like diabetes or even pre-diabetes, can lead to problems.

Diabetes, for example, impairs both the blood vessels and the nerves, setting the stage for issues like erectile dysfunction. Pre-diabetes is a warning sign that you’re heading in that direction, which is why it’s so important to take steps to protect your metabolic health. Exercising regularly, eating healthy, and avoiding foods that contribute to metabolic dysfunction are key strategies to keep your blood vessels and nerves in top shape. Maintaining good blood flow is essential not just for erectile function but for overall health.

So how can you optimise blood flow? Viagra and Cialis help produce nitric oxide which makes your blood vessels get larger. When your blood vessels and your penis get larger, more blood goes in there, and that is how it works to help an erection. You also have to be in the right mental state for it to give you an erection. This is because the nerves are involved too so it is a complex system.

Nitric oxide is also created by certain foods such as beets and spinach. They both are grown close to the ground and the soul has a lot of nitrogen that goes into them. Tasting and chewing your spinach is an important step here - you don’t want to just swallow it whole to get it off of your plate. I like to have it with a bit of extra virgin olive oil, chopped garlic, golden raisins, toasted pine nuts, and white wine. When you chew it, your tongue microbiome interacts with the nitrogen and converts it into a form that can be absorbed into your body and produces nitric oxide, the same thing Viagra produces.

Is spinach a substitute for Viagra? Probably not, but it can lower your blood pressure by dilating your blood vessels, as shown in clinical studies. Beyond that, spinach also protects the lining of your blood vessels, making it doubly beneficial for your circulation. Beets have a similar effect. Both foods help your body produce the same substance that Viagra does, which supports and protects blood vessels throughout your body, including those in the penis. When it comes to prevention, adding spinach and beets to your diet is a proactive way to support healthy blood flow. These foods don’t just benefit one area, they protect vital organs and your overall cardiovascular health. This is a perfect example of how food can act as medicine.

I completely agree with you, it’s all part of an integrated system. When we talk about something as specific as erectile dysfunction (ED), it naturally connects to broader benefits for the circulatory system. After all, the same blood flow dynamics that impact ED also play a crucial role in heart health. A couple of additional things come to mind from my experience that might help. Certain species of lettuce and celery seem to have potential benefits for circulation. On the supplement side, arginine and citrulline malate are worth mentioning as they can support nitric oxide production, which helps improve blood flow. - Kriben Govender

Nitric oxide is incredibly beneficial for women too because it helps dilate blood vessels, leading to lower blood pressure. This is crucial because high blood pressure is a silent killer, contributing to strokes and other conditions like hardening of the arteries in the brain. Nitric oxide plays a vital role in maintaining vascular health and is considered a hero substance in the body. While our bodies naturally produce some, certain foods can boost their production even more, such as spinach, beets, and leafy greens.

Oral Microbiome

When it comes to the oral microbiome, antiseptic mouthwash can cause significant damage. Over-the-counter mouthwash is fine but if your dentist prescribes one after a procedure, it can wipe out the healthy bacteria on your tongue. This is problematic because these bacteria play a crucial role in generating nitric oxide, which helps regulate blood pressure. Studies have shown that if you use antiseptic mouthwash before consuming spinach, beets, or beet juice (foods known to boost nitric oxide production) your body’s ability to lower blood pressure is impaired. Instead of the expected health benefits, your blood pressure remains unchanged because the essential tongue microbiome has been wiped out.

So, what’s a better approach to maintaining oral hygiene? Focus on regular, simple practices like brushing your teeth, flossing, and keeping your mouth clean to prevent debris buildup that could lead to harmful bacterial overgrowth. Remember, the mouth is an extension of the gut, and its health is vital to overall well-being. Interestingly, research suggests that simply brushing your tongue and rinsing with water is enough to reboot the microbiome, allowing beneficial bacteria to grow and dominate. If you’re looking to take it a step further, tongue scraping is another effective tool. It helps remove bad bacteria and resets the healthy balance on your tongue.

How Viagra Was Discovered

Sometimes some drugs are created and have an unanticipated effect. Take Viagra for example, it was developed as a blood pressure medicine and anti-hypertensive medication because it dilates the blood vessels. When your blood vessels widen, your blood pressure comes down. So in the clinical trial for lowering blood pressure for Viagra, they noticed that the men in the study all had erections. Some clever pharmaceutical executives said, “Never mind the blood pressure part, let's go for this.” If you take really high doses of Viagra for men and you are also taking nitrates, your blood pressure can plummet which will lead you to get lightheaded and possibly faint. So be careful if you are taking both!

Dr Li's Top Gut Health Tip

I would say enjoy a handful of tree nuts a couple of times a week. Tree nuts, almonds, macadamia, pistachios, cashews, walnuts, and pecans are great sources of healthy fats. They have dietary fiber that feeds your gut microbiome and they are satiating so you're less likely to overeat the next meal. My mission is to really get information out that people can use. So much of the information behind drug development will not see the light of day for many years. I want to share this info so you can implement it today. Make sure to follow Dr. Li on his YouTube, Website, and Social Media and share this with a friend who would benefit from this information!