Naren: hello everyone. Welcome to our third episode of the Let It Flow podcast show. This is Naren, your host, and Doctor Kwan, welcome. How are you this afternoon?

Dr. Kwan: Thank you. I’m, I’m. Very excited to be here.

Naren: So let’s jump right in. We’re going to be talking about chapter two of your book, Let it flow. And the first question I have for you, Doctor Kwan, is. Can we actually Improve our circulation. In the last episode, you talked about all the things that we do to mess with our circulation. We talked about plaque buildup, We talked about the Impact of plaque and we kind of you broke down some of the myths around, you know, what we think was happening which is not true. We think that cholesterol is causing plaque, but really it’s the injury to the blood vessels that’s the heart of you know, the chronic inflammation, which then starts creating plaque. So in this one, let’s talk about what can we do now? Let’s say I’m in my 40s, which I am, and I have some challenges. I’m on some medication, so if I’m, you know, asking for me and probably millions and millions of other people out there who have some kind of a challenge with our circulation. What can we do to improve circulation?

Dr. Kwan: Well, you know, just to basically go over really, how do you, Define how your circulation Is right, How do how do you know how your circulatory system is doing, How do we know how well our blood vessels functioning? Well, there are a couple of important things that we can measure that can determine that. For instance, Blood pressure is probably one of the Biggest indicator of how your blood flow Is doing in your Body. If you have elevated blood pressure, your. Blood flow is compromised, so that’s one. Two, if your blood sugar is elevated, You’re compromising your blood flow, okay? If you are if your, Lipid and I talk about this, You lipid meaning cholesterol and triglyceride levels. If there are,if they are out of, if they’re out of proportion, And they are elevated in such a way then that’s going to impact your, that’s impacting your blood flow? So and if you come, so these are Some of the just as just some simple indicators Of how, How, We can measure our Blood flow is doing. So, Anyone could, If they go to a doctor, they know what their blood sugar level is, they know that their blood pressure is, They know what their lipid profile is. They can get a Sense of what, of what, Their sort of blood Flow is. So they are, at a Very basic level, okay Naren, You need to measure this.

Naren: Let me ask you a quick question and I can understand, you know, blood pressure, right? If it’s high That means, of course, the Flow is not happening as it should, But what’s the relationship between, you know, elevated sugars or lipids and blood flow?

Dr. Kwan: Well, just look over, again, the blood pressure, your blood pressure is high. That means your blood vessels stiffer. If your blood pressure is, if your blood vessels are stiffer, obviously that’s impacting with the way the blood flow is working. When you have an Elevated sugar level in your body, like a million people with pre diabetes or diabetes, it means that, there is elevated, There’s the sugar level in your body is high and then your body is making more insulin usually and These things, Impact how the blood flows because an elevated sugar itself blocks nitric oxide. We talked about this in our first podcast.

Naren: Yeah

Dr. Kwan: Nitric oxide is very important in dilating our blood vessel. Well, sugar, elevated sugar actually blocks this enzyme that that sort of produces nitric oxide in or blood vessel wall. So now if elevated sugar your oxygen, your blood vessels not going to dilate up as much because it’s blocked, the nitric oxide is blocked. So that’s how we’re going to impact Blood flow one way. Or the Other is sugar itself. Elevated Sugar is a major inflammatory agent in Our blood vessel. It causes increased free radical formation by our mitochondria in ourselves and it’s going to lead to, as we talked about before, increased inflammation, Means, means, a compromise blood vessel. In addition, when you Have elevated blood sugar, Most people have elevated insulin level as well, because that’s the only way our body can take care Elevated blood vessel, blood sugar, I’m sorry. When you Have elevated blood sugar, Our pancreas produces more insulin, elevated insulin, in Our body is what will pro inflammatory agent and it causes increased inflammation. So increase inflammation means, Your Capillaries are blocked off. You have more inflammation and damage to the blood vessel wall means that the blood vessel blood flow is compromised. So that’s how sugar can impact the blood flow, And and and Many more other ways that sugar can also impact, including elevated sugar means, That you’re probably going to increase that that position in your body. As you gain more weight, The obesity itself is a major inflammatory agent for our body and it will add to ongoing inflammation, And so again that’s going to impact the blood, blood, flow. So patients are obese, By the way, Have marked a compromise to the circulatory system. We know that Clearly, when I operate on patients who are obese, they clearly don’t do as well. The blood vessel blood flow just doesn’t flow well. When I move tissues around those tissues are, doesn’t do well. So that’s Clear. Now lipid, What about the lipid? Well, lipid is More of an indicator rather than an agent that Causes problem. When your cholesterol is elevated, You know, we talk about elevated cholesterol, People are generally, Talking about, Elevated LDL they called LDL cholesterol, although it’s not, cholesterol, Again, I could talk a lot about this LDL. When that’s elevated It’s telling us there are body or Liver is making a lot of it. Why is LDL elevator? It’s because the liver has to produce a lot. Why does liver produce a lot. By The way it’s Not due to dietary cholesterol. Dietary cholesterol, This is clear, This is absolutely clear, Major studies have come out in the recent five years showing that dietary cholesterol has no, virtually no impact on your blood cholesterol. Are you following that Naren?

Naren: Can you repeat the last sentence Doctor dietary Cholesterol has no impact?

Dr. Kwan: all the cholesterol that you need in your diet has almost no impact on blood cholesterol. They set up to only 4%, period. That’s it, Okay. So amount of cholesterol that you need? You eat all egg York’s You want you eat all the cholesterol you want. It’s not going to elevate your cholesterol in your body. And the reason it doesn’t is because your liver adjusts for it, and most of the cholesterol you eat gets not absorbed by your intestine. It’s poorly absorbed. Okay, so it gets flushed out in our body. So that’s again, agnostic. So cholesterol. What I’m looking at is when the LDL goes Up and your cholesterol Goes up, It’s telling me that you have inflammation. You have, you have a higher inflammatory point, do you follow that because you, you, literally have to make more cholesterol to deal with the ongoing inflammation. So it’s telling me that you’re at a higher inflammatory point, And that so it’s only an indication, it’s not The state you should go out and take a drug that’s going to artificially lower your cholesterol level, But what it’s telling me is stop the inflammation, stop with causing inflammation, right? That’s What this means?

Naren: Makes sense. So why does the liver Have to make More cholesterol when there’s a lot of inflammation?

Dr. Kwan: Well, the liver is one of The most important and active working parts in our body. People don’t know much about the liver. Liver has five hundred separate functions, over five hundred separate functions including its involved in adjusting sugar levels in your body, It really is involved in active actively or homeostasis of sugar, you know, the pancreas and the insulin actually can lower the sugar, but the liver actually tells our body how much sugar to produce or what sugar should be stored to Fat. That’s the liver. The Liver does that, But also the liver has all these enzymes, it produces all the enzymes, and it produces cholesterol. Liver does that. So the any cholesterol you eat or naturally existing or bought, deliver through various chemical reactions and is producing cholesterol. Okay, and it does this because, When the when our body. Is injured and sustains inflammation, then the liver pumps out more LDL. LDL is called low density lipo-protein, or type of cholesterol They say it’s not really cholesterol, but it’s a transporter, but it carries a lot of cholesterol. So it produces a lot of LDL to be transported to cells that Need cholesterol because when we make new cells, When our body makes new cells, it needs lots of cholesterol because why? 37 trillion cells, that’s what an average person has in our Body. Every cell has tons of cholesterol in it. Our brain is made-up of tons of cholesterol. Our nerve cups cholesterol. So we need cholesterol. When cells are Damaged and we Want to make new cell or repair a cell, We need cholesterol. So the yes liver makes more cholesterol.

Naren: Makes sense. So step one, you go to the health care provider, your doctor, and you figure out, you know, if you have a problem with your circulation. And these three are the indicators, and Of course, your health care provider may not be thinking the way, Doctor Kwan you’re thinking, But at least you know if you have some kind of an issue and if your sugars are high or your LDL is high, or you know you have High blood, That’s a pretty good indicator. You, you. Have some circulation challenges.

Dr. Kwan: And, and honestly, Naren, How many people have those Issues in America?

Naren: I don’t know the exact stats, but I know it’s tens if not hundreds of million’s. Of people.

Dr. Kwan: Very high, in the United States, just To give you a figure about 2/3 of Americans are either overweight or obese, probably about a. 150 Million Americans have some sort of sugar problem.

Naren: Wow

Dr. Kwan: And so I’m I’m telling many of them are on cholesterol lowering medication. I believe that’s wrong, but they are on cholesterol lowering medication.

Naren: Right, So it’s like they keep breaking the the engine which is our the human body and then they take medication to kind of, Somehow make it go away, which doesn’t happen.

Dr. Kwan: Well A lot of it is because they Were also given, You know, bad advice

Naren: Yeah

Dr. Kwan: and and and people themselves don’t know what To do really

Naren: yeah

Dr. Kwan: and As I told You, this is a problem of injury. It’s an injury. It’s not a cholesterol issue, it’s an injury And sugar, unfortunately, will injure the blood vessel wall.

Naren: Got it. So now that you know that you have a like you are one of the, you know, these 2/3 of Americans or 2/3 of the people in the western world, who have these, you know, issues right now, now what can you do to improve your circulation Doctor?

Dr. Kwan: Oh, there. Are lot of things I Mean Number one, Number 1, one Way you could improve your circulation is by not pumping in so much toxin into your body, which is causing the inflammation, right?

Naren: Right

Dr. Kwan: It wasn’t injury, so you want to take away The source of the injury. How do we do that? Well, There’s a lot of Ways you can do it. You have to,

Naren: Can I give you a few, That that kind of that come to My mind and you tell me if I’m missing, Missing anything?

Dr. Kwan: Yes,

Naren: so number 1 is, Be active, right, because you said.

Dr. Kwan: Well then, your physical Activity is a different issue. Yes, so you Certainly want to be active because physical activity is one of the best anti-inflammatory agents that we know and it also lowers our blood sugar. Yes,

Naren: Awesome, awesome.

Dr, Kwan: Physical activity does many, many things. It it turns out an enzyme called BMPK, which actually increases the metabolism of sugar and it builds more muscle, physical activity which increases at metabolism and lower Your blood sugar. It lowers inflammation, it increases blood flow that every cell, by causing blood vessels to dilate up, it increases nitric oxides. Yes, physical activity does A lot more than any of us can Ever imagine? Right

Naren: And I mean of course 1000 years we’ve active everyday all day, but now we are told to be active three times a day. What’s your recommendation of how active you should be, you know, if you will?

Dr. Kwan: Well, you know, if you are cut, if you have a type of job which manual and you’re walking around the lot and you’re very active, then you work with your arm And then you probably don’t need to then that that’s that may be enough. I mean there are a lot of people that the manual work and people who work in the farms and and so forth they’re working quite a bit. So that that that maybe not, I mean, if some people walk all day, the brisk walking, just slow walking is not enough, brisk walking, They walk upstairs, they do all that. That may be enough. Some people like to do gardening, some people like to clean houses As a living. Those people making enough physical activity. However, many of us in this civilized Western culture, we have a desk job, which means we’re not physically.

Naren: Right.

Dr. Kwan: We drive toward, we take some sort of transportation, and then we go right to our task and we set it at the desk for hours and hours. So we need to really schedule, A some sort of. Real physical activity in terms of gin or some sort of a regular exercise, right? So we need To do that on purpose. And we’re going To do that I haven’t personally about 150 minutes Of active exercise a week, 150 minutes a week, which means about 30 minutes five times a week. I think that’s or 15 minutes three times Week something like that, but at least I, Believe in like 30 to 40 minutes 5 times a week, It’s a really good sort of a Sort of thing, but most people can start a couple times a week and then sort of increase that. But we need the recommendation is generally about 150 minutes a week of Pretty decent, vigorous type of exercise.

Naren: Right, If you have a dog. Take the dog for a walk Everyday at once or twice a day.

Dr. Kwan: Yeah, but then you got to walk the dog and you got to be good, you know? Most people do it. They could be Just like slow walking, that’s not enough.

Naren: Oh, I see. It’s. Slow walking is not enough, You have to get your heart Rate up to at least.

Dr. Kwan: You got to be heart rate up and down. And and and move, sustain the level of your muscle. Otherwise your muscles can atrophy, becomes smaller. So you need to sort of keep that up. We don’t do that enough. Yes, physical activity is very important.

Naren: Right. Second thing, drinking water. I think many of us don’t drink water. We drink coffee between TV. You know other? Kind of. You know, you know, Liquids with sugar, but we don’t really drink water. What’s your take on water, Doctor is that.

Dr. Kwan: Well, well, I mean obviously coffee and tea, they do have quite a bit of water in it too. So that’s, that’s that’s reasonable. But sometime caffeine can also cause us to, you know, cause us to urinate, And and and, and actually do so you got to be careful about. That right? I don’t know. How many cups of coffee most people drink but tea you know, just sort of regular sort of decaf tea that’s that’s considered water. I I think we should drink about 8 to 10 cups of water every day. We have to be conscious about that because most of us don’t do it, and as visually as, We get older, Our sort of sense of, Thirst disappear. So older people tend to become more dehydrated. Many people are also on all kinds of medication. Any medication can cause dehydration, You know a lot of these, you know the blood pressure medication to, Birth control pills to there’s so many medications that can sort of cause dehydration, And certainly alcohol, Causes dehydration. So these are all the things that we have to be careful about. So we need To be aware of that, And be really conscious and. Really purposeful in consuming water and you need To plan it out. You need to drink on a regular basis and remind yourself, really. Drink water, drink water, drink water and then you’d be in bed without doing this to keep your blood volume up and that’ll get the blood flowing nicely.

Naren: Right. What about food, doctor, what’s your recommendation? And we talk about processed food versus you know, plant based food. So tell us about what can you do to improve?

Dr. Kwan: Well, I mean we I think in the later podcast we’re going to Talk, Really Do a deep Dive into various nutrition and all that, right?

Naren: Yeah

Dr. Kwan: This but this I believe really simple is, simple is better. I think there are all kinds of Diets out there that People get confused. They don’t know. What to eat. One they decide is good one day, that diet. Is good. Oh, Atkins diet. That’s good, you can lose weight. I think all That is really a lot of noise for me and I think it gets people confused and they don’t know what to eat . So I think a fat diet should Be sort of, But it should be sort of reserved for those few people who are obsessed about that. I mean, even, you know, some of this the alkaline diet that some people are on and they’re obsessed with, You know, while that. May be it may have beneficial effects. Really, what’s the main benefit in any one of these fat diet is that it’s Based on whole food and mostly plants. Okay, so now to me. Best diet that people could be On is sort of Mediterranean style diet. What that, What is? That some needs lot of vegetables, no processed foods. That’s it. Simple, really simple. If you can, stick to That, you will get good nutrition, you decrease inflammation, And of course, along with food you need to consume Food in moderate, moderation, And that’s the, that’s the, you know, that That’s another thing that many of us have hard time doing. You need to, not Over eat because eating too much, Eating too much will Cause inflammation will call the inflammation. So you want To eat enough? I’m not asking. I’m not telling people to. Eat to a point of Anorexia or eat, eat, so you’ll be hungry. You want to eat full meals But not and full Meals full of nutritious whole food diet. That way you’ll be full, you eat good food, and you’ll be, you’ll be rewarded with healthy. I want people to focus on sort of eating good food, for this section and these eating good food and not eating to their soulful. I mean, I feel like Americans and generally western culture, many people in the West come cultures Western culture Eat to excess.

Naren: Right.

Dr. Kwan: Really, we need anything. We, you know, we basically, Really celebrate holidays around Eating food to until we are soulful that we can’t move. I think we need to sort Of take that you know and change that culture. That sort of culture with that Kind of eating behaviour.

Naren: Right, I mean, if you go to a restaurant, most restaurants, the meals are like enough for three people. Mean they’re like Massive, right? I mean 16 pound meat?

Dr. Kwan: That’s what people are demanding, that that’s all we used to, But if we change that, we can Certainly change that.

Naren: Right. Makes sense, Can you describe the relationship, Let’s say you’re improving your circulation and your circulation is getting better. Can you describe the relationship between blood flow and mental health, Because that’s a big challenge into the 2019.

Dr. Kwan: Well, well, well. The blood flow is very related mental and we know that people who, Are depressed and, Depression have decreased blood flow through their brain. These brain scans are clearly identified that, so when you depress the blood flow is is diminished. When, for instance, when, When you suffer sort of stroke in your or people with atherosclerosis who suffer stroke. You have depression. Blood flow when they study people, when you actually lower the blood Flow to the. Brain on these researchers research articles basically lower. You know you become confused. When the blood flow is lower than you, You’re basically. Getting less onto Your brain. Your blood flow and your oxygen level goes Down you become more confused They become depressed, you become anxious, all these thing. Are part of blood flow. So I believe that Many of the All these new of degenerative disease that we talk about Alzheimer’s and all these other disease dementia all related to blood flow. So mental health when we discussed mental health both our cognitive Function the way we function. What we think is absolutely related to blood flow. Our brain Demands 20% Of the blood flow above our body. It demands 20%. It means a lot of calories and lot of oxygen. To function because. Cause it is carrying out many many function it’s. It’s it’s not a Muscle, but it also uses all that Oxygen in order to process To create energy to Process all the things and and and wrong it’s. It’s a major Centre, right. It’s essentially a central processing unit Of our body. So we need really Adequate blood flow in if you don’t have it, you can become depressed. Your cognitive function could go down and and really research articles show that in patients we even with depression when they exercise. Exercise has been shown to be actually more effective in curing people with depression Than medication. However, I do agree it’s sometimes very difficult to exercise when they’re super depressed, right?

Naren: Yeah,

Dr. Kwan: but. But if you will exercise your Latin less likely to become depressed. You exercise because why? When you exercise your increasing the blood flow to your brain, you’re increasing the blood flow to your brain. So this is very important blood. Flow,

Naren: I’m sorry, I don’t. Understand when I exercise, my body is working. How does that increase blood flow to the brain?

Dr. Kwan: Well, when you exercise, the blood flow increases To all parts of the body.

Naren: Oh, I see. Because it’s pumping pumping, okay.

Dr. Kwan: All parts of body except the intestines, yes, except the intestines, but what happens with exercise is the blood vessels dilate up and it not only the muscles put it in muscles in your arms and Legs but everywhere and With exercise, the blood vessels dilate up. It pumps more blood and you know that you exercise you You feel your neck. Yeah, and that blood is pumping hard.

Naren: And I notice even drinking water, like a lot of water Like I I try to drink 3 1/2 litres of water a day. It seems to, you know, give me good days when I’m. Drinking a lot Of water versus not drinking And just, you know, cause like you said, as you get older, we don’t, we don’t. Feel thirsty?

Dr. Kwan: Yes. I think mental health is vitally dependent on the blood flow.

Naren: Perfect. Thank you so much Doctor Kwan for taking the time and of course for writing the book And anyone who’s interested, you can grab this book. It’s called let it flow. You can grab it on Amazon, You can get a printed copy, a Kindle copy, and you know, so please read the book and start sending us questions and of course also share this podcast With your friends, you know, forward it to them posted on social media, right review for us on iTunes. Thank you so much for listening and thank you so much for Doctor Kwan, for what you’re doing for the for the people at large and of course, You know, people in the profession, the health care providers, so that we all can start thinking about, you know, really having this conversation with patients and really having this dialogue as a, as a species. Thank you so much, Doctor Kwan.

Dr. Kwan: Thank you. I look forward to more episodes.