How to Prevent Heart Disease with Mitochondria, Muscle, and the Endothelial Glycocalyx | Dr. Michael Twyman

**Dr. Gabrielle Lyon** (0:00)
Most people think heart disease starts with a bad cholesterol number. But the truth, the damage often starts decades earlier, before you feel it, before you see it, and before your doctor catches it. And once that early damage begins, it's silent, but it's not inevitable. You just need to know where to look and what to do next. Most cardiologists don't talk about nitric oxide. They don't measure VO2 max. They don't ask about grip strength or muscle mass. But they should. Because muscle is one of the most powerful protectors of your heart and mitochondrial health. That might be the key to your entire cardiovascular future. In today's episode, you'll learn why standard cholesterol labs are incomplete, how the loss of skeletal muscle speeds up heart disease, what biomarkers matter more than LDL, and why diagnostics, not guesswork, are the future of prevention. This is the medicine of what's possible. And my guest today is one of the few cardiologists practicing it. Dr. Michael Twyman, expert in mitochondrial optimization, arterial imaging, and a bio-individual muscle-centric prevention approach. So, if you could prevent a heart attack before it starts, wouldn't you want to know how? Let's talk about what it really takes to become heart attack proof with Dr. Michael Twyman.
Dr. Michael Twyman, welcome to the show.

**Dr. Michael Twyman** (1:49)
Thank you for having me back.

**Dr. Gabrielle Lyon** (1:51)
Has it been 40 seconds yet?

**Dr. Michael Twyman** (1:54)
Not yet.

**Dr. Gabrielle Lyon** (1:55)
Okay. Well, as soon as it reaches 40 seconds, someone in the US had a heart attack. And every 33 seconds, someone dies of cardiovascular disease.

**Dr. Michael Twyman** (2:05)
It's a horrible stat.

**Dr. Gabrielle Lyon** (2:07)
You know, it makes me think, how have we not gotten better at treating that?

**Dr. Michael Twyman** (2:15)
I think we're getting there, but it's still the number one killer. You know, we did this episode three years ago. The stats haven't changed that much since then. And I think we're going to dive into a lot of the topics today that I think might be beneficial to really help people become more heart attack proof.

**Dr. Gabrielle Lyon** (2:30)
Can someone actually die of a broken heart?

**Dr. Michael Twyman** (2:33)
Absolutely. It's known as Takasubo syndrome or broken heart syndrome. Takasubo is a Japanese kind of fishing vessel, or fishing pot that they catch octopus in. And that's what the left ventricle looks like when people have this broken heart syndrome. So they present after an emotional event, somebody in the family dies or in a car accident, they smoke cocaine, something happens where their sympathetic drive is very high. And they present to the hospital like if they're having a heart attack. And we would rush them off to the cath lab, find out that they didn't have any significant blockages in the arteries. And then when we did the left ventricular gram, the heart wasn't pumping very well. And so kind of supportive care. After a couple of days, usually, the heart function returns to normal. But it's a high risk of sudden cardiac death when you have that.

**Dr. Gabrielle Lyon** (3:17)
Is it mostly women or men?

**Dr. Michael Twyman** (3:19)
Generally women, older women particularly.

**Dr. Gabrielle Lyon** (3:22)
We hear the term heart disease all the time. But what is heart disease?

**Dr. Michael Twyman** (3:28)
That's the umbrella term. I mean, there's corneal heart disease, there's heart failure, there's valvular heart disease. So you really have to do defined terms. But vascular disease, 60,000 miles of blood vessels, you got to go looking where the disease is at.

**Dr. Gabrielle Lyon** (3:46)
As I was preparing for this episode, cardiovascular disease, as you had mentioned, is still so prevalent and it's not getting better, which is surprising. It makes me think, okay, what do we know that drives heart disease?
Again, it is an umbrella term, so perhaps we start with, I don't know, take your pick, stroke.

**Dr. Michael Twyman** (4:14)
Stroke can be either ischemic or thrombombolytic. Ischemic means there's not blood flow coming to the tissue and without oxygen nutrients coming to the tissue, that tissue starts to die. Embolic event is where more of a blood clot forms. Many times in heart patients, it's due to atrial fibrillation, a clot forms in their left atria. That clot breaks free, gets lodged in the brain and steals blood flow from the territory downstream and that tissue will die unless it's revascularized. So stroke, honestly, is probably more scary to many people because heart attacks, if you survive to get to the cath lab, you usually do pretty well, but a stroke can be debilitating for the rest of your life. But the same risk factors for heart disease are the same things that contribute to stroke in most people.