Naren: hello everyone. Welcome to an amazing episode of the Let It Flow podcast show. In this episode we are going to be talking about two important questions. the first one is around your skin and the second one is around heart attacks. This is a continuation of what you heard in our last recording. So this is part two of chapter two in the book let it flow. So welcome, welcome everyone and welcome Doctor Kwan

Dr. Kwan: thank you very much. I think this will be really an exciting topic to discuss

Naren: I have a question for you Doctor what’s the best way to improve our appearance in regards to skin quality

Dr. Kwan: hi that yes that’s a really good question. I think traditionally what many people think is that they need to change the to improve appearance they need to do things from the outside while this can help, like to like applying certain peals to your skin to smooth out the skin or even apply certain antioxidant cream and even doing surgery, obviously to tighten and lift skin can can improve the appearance of the skin and the appearance of the just in general the face and the body but really if you really want to get a long-term change in the appearance and the and really affect the quality of your skin and the tissues underneath it, really the best way single best way is to improve the blood flow and so you know what is it what do you mean by increasing the blood flow? The reason for this is because, if you could imagine a plant, if the plant gets good amount of water and Sun then it’ll grow well. If you don’t if you take away those things obviously it’ll die but if you give it a little bit it’ll grow but not so well. Well the skin is very similar in this way and the thing about the skin is you need good amount of blood flow to keep the skin quality really good because it’s bringing both oxygen and nutrients to the cells of the skin and the skin is made up of of what you see on the outside that’s called the epidermis, and epidermis is usually a thinner is usually a layer that is above the dermis and and the dermis generates the epidermis. So really the epidermis is what we see and this is what protects us from the outside elements and and really so what we want to do is to really improve the quality of the dermis and dermis is where the blood vessels are. This is where really the skin the outer skin is generated from this dermis. So you want to really optimize dermis. And in order to do that the dermis needs good amounts of oxygen and nutrients and and interestingly there’s a, there was a recent study done, to to show just how really important blood flow is to the appearance and the quality of the skin. It was done out of Canada Ontario Canada from University McMaster University and what they did in the study was look at people of all ages from 20 up to 80, and they looked at the skin quality under the microscope. So they looked at the skin, actual histological skin quality under the microscope and since the face is facial skin is exposed to the Sun and other elements. So different people have different sort of exposure they decide to to look at the skin in the buttock. That’s pretty consistent. It’s not Sun exposed area. So when they did this took a biopsy of that skin, the buttock skin from all these age groups they found that the people in their 20, 20s obviously had great skin 20 year old skin really thicker dermis and thinner epidermis. So they had really good quality skin with with the skin quality and under the histology under the microscope they looked very well organized and with good amount of blood flow. As the age increased 40 year old had decent skin but a little worse than the 20 year old and by the time they reached 80 they had the poorest skin the outer the epidermis was fairly thick and the dermis thin. So the important part of the skin the Dermis thinned and also it became more disorganized and irregular pattern. So there’s definitely severe damage by the time they reach 80. However every once in a while, they saw in patients that were in the 60s and 70s and their skin looked like that of under the microscope looked like a 30, 20 and 30 year old and they were amazed and they said, wait a second why do these people have skin that’s so good, and they found that these people or people who exercised. In other words they increased the blood flow the so the people who exercised regularly had great quality skin and even under the microscope and both under the microscope which translates into external appearance, obviously, right, and so they went back and they they further did the experiment where they took the 70 year old’s, who are not exercising who had skin quality of of a 70 year old they exercised them twice a week for three months just three months about 80 percent moderate exercise for three months twice a week, and at the end of three months again they took a biopsy of the skin from their buttock and looked under the microscope. To the amazement they found that the skin now from a 70 year old skin looked like that of a 30 year old 30 to 40 year old. So they were amazed. Again they they were actually surprised to find that just three months reversed the effects. So what I’m saying is really anyone can start at any age and really reverse the reverse the effects they you know subjected to their skin and their entire lives but what really matters in the appearance of the skin is obviously, what’s supporting it and really the supporting structures are really the blood vessels that are bringing the vital nutrients to each of the skin cells.

Naren: so let me ask you a question doctor. So you’re saying just in three months just by exercising a little bit and you believe it’s because of blood flow

Dr. Kwan: it’s absolutely due to blood flow because what blood flow did was it brought we know for sure that when you exercise you increase the blood flow to the skin. We we know that there’s clear clear really experimental evidence showing that when you exercise, you do increase the skin there’s vasodilation at the skin level your skin becomes flush, and that’s the sort of exercise that the post-run sort of glow that people get it’s because the blood flow is optimized to the skin but that translates that’s temporary but after repeated exercise that that that sort of glow stays and the skin because think about it if you’re bringing more oxygen nutrients to the skin, it obviously is going to do better. I think that’s just a really just a logical thing right if you’re bringing more oxygen nutrients it’s going to do better as opposed to people who typically smoke. Smokers have the worst skin and they don’t have because good amount of oxygen and nutrients that are going to the skin, right, so the skin becomes really leathery it becomes wrinkled and they look much older their premature their Skin’s prematurely age and you look at the typically they’re just like external appearance not only histological examination but external appearance look a lot older than same people of their same age.

Naren: so this is a good segue into my next question which is you are an expert in you know blood flow you have written a book about blood flow. can you share some information about heart attacks?

Dr. Kwan: yes well this is really when we talk about the heart this is really the essence of really the blood flow, right, because why because heart is an organ that is pumping blood to every cell in our body right and so this is if your heart doesn’t work it doesn’t matter what happens you’re not going to survive you’re not going to do well right, so you need a strong heart.

Naren: so what is the heart well heart is the heart is really a muscular pump I think most people understand that it’s mostly a muscle meaning that when I say muscular pump it’s made up mostly of it’s called myocardium. It’s made up of mostly heart muscle. It’s muscle. So what it does is it contracts and relaxes by doing that it’s moving blood through the chambers and out into our circulatory system. So the heart is the central, the pivot the focus really, it’s I call it it is the conductor of our Orchestra, our circulatory system it is conducting it’s it’s orchestra, it’s orchestrating this entire sort of circulation through our body. So it both the heart synchronizes the blood flow through its electrical impulses as well as the muscle. So muscles are all Contracting in perfect synchrony so the blood will flow from one chamber to another and out to the rest of the body, but we have to also remember that heart itself is Mostly is Mostly is mostly muscle and when the heart is Contracting and especially when it’s working harder it needs more blood flow itself too. The heart muscle itself needs oxygen and nutrients right? That I think is that that’s that should make really intuitive sense to anyone not only do the muscles of our body and the organs need good blood flow the heart itself needs blood flow. So we’ve developed these little best vessels in our body called coronary arteries right? So we have coronary arteries and people hear what coronary arteries are but what coronary arteries are is are essentially the blood vessels to the heart the carrying oxygen and nutrient to heart muscle so coronary arteries means blood vessels that are carrying oxygen nutrients to all the all parts of the heart and so what happens? Well coronary arteries just like every other arteries in our body, blood vessels in our body and I’m using arteries and blood vessel interchangeable arteries or blood vessels. So basically the arteries will suffer damage. Why does it suffer damage well we subject it to various toxins right including smoking is one of the big ones processed food excess sugar and chronic inflammation. These are and I’ll go for chronic inflammation later but these things cause damage to the blood vessel and the Heart the coronary arteries are no different than any of the blood vessels in our body but they when they suffer damage they form basically plaques. Plaques are just wait for the way for the blood vessel to heal. It’s like a patch so these plaques are literally patches on the on the blood vessels areas that’s been injured but if you repeatedly injure the blood vessels, it eventually become thicker and those blood vessels become stiffer and they no longer are flexible and as I’ve talked about in my previous sort of discussion blood vessels need to be flexible. It needs the flexibility allows it to dilate up expand and then contract it expands when you need more more blood flow, contracts when you don’t need as much so what happens is when you’re when your heart is working hard when does heart work hard. When you’re exercising right or exerting yourself. So if you’re running you’re shovelling your driveway you’re lifting weights anything these things require more oxygen and nutrients for the rest of our body so the heart starts pumping hard when the heart starts pumping hard it needs more blood flow so when the hard blood vessels are blocked up or can and can expand then the heart muscle suffer damage and so typically we’ve heard of what we call angina right and you’re aware what angina is right?

Naren: can you explain that to Doctor, doctor because

Dr. Kwan: Angina, angina, is basically chest pain.

Naren: Alright

Dr. Kwan: it’s an it’s all right chest pain basically chest pain is angina is chest pain basically when you’re exerting and you have heart disease then the heart is not getting enough oxygen since heart doesn’t really have sensor sensory nerves in it that’s so it transmits it to the chest wall and you end up with the chest pain. It’s a way for our body to signal that something is wrong with the heart right. So it’s telling us when you have this angina. Stop what you’re doing right because you’re exerting and the Heart cannot keep up with the heart muscle cannot keep with keep up with what we’re doing. So you must stop that’s a way to that’s that’s a signal that the heart gives. So that angina or chest pain is a signal that the heart is not getting enough oxygen so typically when we have chest pain we stop and we may even collapse collapse now because the heart just simply cannot pump any pump the appropriate amount of amount because heart itself the coronary arteries are not delivering enough oxygen to the heart do you understand that, did you follow that?

Naren: yeah, so what you are saying is the minute the oxygen flow stops, pretty much you are in angina

Dr. Kwan: no no well no no oxygen flow will continue to the heart but the coronary arteries cannot keep up with because heart is not pumping really hard. If it’s pumping hard just like any muscle in the body when it’s working really hard it needs more blood flow right to bring more oxygen but then it can’t keep up with it no they they could so this is angina and which is different from a heart attack. So I’m going to go over the heart attack this is a precursor to heart attacks. So what happens is a signal that you have a heart disease you go to see doctors and you end up doing tests and find out that you have heart disease and then you go from there but what so this could this could sort of progress onto hard attack. So angina is doesn’t do it’s not a permanent damage to your heart. It just signal to your body that the that the

Naren: When you say, right, when you say heart disease I’ve heard the term a lot doctor can you is there a definition for what what is that, heart disease?

Dr. Kwan: heart disease is generally when you’re coronary arteries I just describe coronary arteries right, coronary arteries are the blood vessels that are carrying oxygen and nutrients to the heart muscle. These coronary arteries get blocked up. They get stiff. They don’t not only have to get blocked up but they get they do get clogged but they also get stiff and they become very stiff and less flexible. So what happens is the blood doesn’t flow through it properly. So it’s in some heart and many people with heart disease they may have 50 we’ll say 50 blockage of their coronary artery, 70 blockage of coronary arteries okay, so that means there’s diminished blood flow to the heart muscle and really so to so that’s what’s happening but in a hard attack there is a complete this is different now. There’s a complete Interruption of blood flow to the heart muscle. That’s heart attack. So angina is just that that there is not enough blood flow but the heart attack is that there is no more blood flow to the that part of the heart. So it doesn’t happen throughout the entire heart because we have a bunch of coronary arteries but those diseased coronary arteries those disease blood vessels that are blocked up enough and usually heart attacks occur in combination. It’s not only the plaque but it’s majority of the heart attacks occur when these plaques actually break off, they break off they used to think it was just a progressively got clogged up more and more and then it stopped but that’s not what happens. The majority of heart attack what happens is that these plaques literally break off. They become as they as these plaques grow they also become what we call calcified we developed calcium deposits on the coronary arteries and it becomes more brittle as it becomes more brittle and has less oxygen as their more injury occurs to the coronary arteries from inflammation and all the bad things that we do to the heart, to our body the the heart those coronary arteries get further injured and finally these plaques become fairly unstable and they rupture. I don’t know if you’ve heard of rupturing of the plaque. When the plaque ruptures then the contents of the plaque sort of gets Spilled Out into the bloodstream and the way our our body responds to this is, when there this is foreign to the bloodstream the way the body responds to something like this is it perceives it as a cut. It thinks that the blood vessel was cut or lacerated and it forms a clot. It’ll form just like when you cut your skin and blood vessel you end up actually clotting it we end up clotting that part right, that’s the way we feel and prevent too much blood loss right, that’s what Supply both platelets and the red blood cell Clump up platelets activate and various clotting mechanisms are triggered. We have all these clotting factors and we form a clot. That clot is what causes complete blockage of the flow of blood. So when you get a clot in the blood vessel game over that means the whole blood vessel that that coronary artery supplying that part of the heart it no longer oxygen and nutrients getting there. Now heart muscle is very sensitive to lack of oxygen it cannot live without oxygen for more than five to ten minutes okay, it’s very sensitive like the brain tissue. So heart muscle is exquisitely sensitive to to the oxygen and and nutrient flow so that part of the heart if you don’t Supply blood then it will die and that’s what we’ll call heart attack. So a medical term for heart attack is called myocardial infarction myocardium again is the heart muscle infarction mean death. So death to the heart muscle so patients who sustain heart attack that portion of the heart muscle dies forever and that’s what I think people quite don’t understand when you actually have a heart attack, you’re actually losing part of the heart muscle. So what happens when part of the heart muscle dies that muscle cannot be replaced. It it’s replaced with scar tissue so it no longer contracts like a normal heart muscle. No longer behaves like a normal heart muscle. Now it’s dead and it gets replaced with scar tissue so now the heart cannot pump as efficiently like our usual other heart, a regular normal working heart. So really heart attack is an irreversible injury luckily for many people even if they they call it minor heart attack or whatever when you have a severe heart attack, it means that you may really lose the function of a big part of the heart and the part of the heart that that’s really that we focus on mostly is the left part of the heart. I don’t know Naren, if you understand there’s a left part of the heart and the right heart right

Naren: yeah

Dr. Kwan: we call it right and left ventricle and the right and left atrium. So we have four chambers two Chambers on each side and the reason why left part of the heart is so important is this is much thicker than the right part of the heart because this is the heart that’s pumping the blood to the rest of the body. The right of the right part of the heart pumps the blood to the lungs only. Left part of the heart is doing the biggest workload of the heart. So it’s much thicker and much it’s a bigger chamber and usually we’re talking about suffering or you know although we suffer heart attacks on the right side, when you suffer heart attack on the left side this is the part now that’s pumping blood to the rest of the body and if that part of the heart is compromised because of a heart attack, then you have severe problems and this is some people really become hard cripples because they have a massive heart attack, good portion of their especially the left part of the heart dies. That means it’s just Scar Tissue. It no longer contracts like it should and so really the only solution for these people is to have a heart transplant and you’ve heard of heart transplant and these mechanical Hearts right

Naren: yeah

Dr. Kwan: this is where they go on to become having a heart transplant because their heart no longer functions but most people luckily when they suffer heart attack it’s not as severe and they’re able to do restore the blood flow to the heart through various procedures including angioplasties and and bypass surgeries. Bypass surgery angioplasties and bypass surgeries are simply just unclogging that part of the coronary arteries that are clogged and you’re restoring the blood flow to the heart okay, and the reason why obviously we for and this this kind of clog clogging occurs every part of the body by the way it happens in the in your kidneys, it happens in the neck, and that’s it causes stroke it happens in the lower left in the legs causes a gangrene at the leg and and foot amputation and leg amputation. So it happens but obviously if you have a footer amputation you could live right

Naren: Yeah

Dr. Kwan: if a part of your foot dies you just get an amputated and you can live and if kitten something happens to kidney you could Salvage that and you still have another kidney or you know you go on a dialysis but when you have your heart muscle actually dies, it’s game over right because it’s hard it’s pumping the blood to the rest of the body right and the and the organ that’s pumping the blood is is not functioning then the rest of the body suffers right. So this is why it’s so important to protect the heart and I emphasize in my book, you must be careful all the signs of of heart disease if you have chest pain if you have nausea light-headedness and women may have different symptoms. They may get stomach pain there is they may get nausea instead of it or they may have pain radiating to the neck or or the arm. So all these signs if you have heart disease you must not ignore them because you don’t want to go on to full-blown heart attack, right, you want to take early intervention. So this is why and so heart attacks are are crucial. We need to guard against heart attacks and the way to prevent heart disease heart disease, now is not the way for these chest pains and and have heart attack. The way to really treat heart disease is to prevent it. Prevent it so your heart your coronary arteries those arteries that are feeding blood and oxygen and nutrients your heart muscle must stay healthy and the way to stay healthy is not get them inflamed and not cause injuries by feeding toxins to them, like sugar excess sugar like like smoking. Smoking is one of the biggest toxins you know and that really damages every blood vessel and especially. So people smokers end up getting a lot more heart attacks diabetics get a lot more heart attacks people who are overweighted heart attacks because they’re because they’re the toxins are floating and damaging the coronary arteries. So the as we say in in medicine also prevention is is is is key and you know that’s going to go a long way and we need, we need to really when it comes to heart protecting okay, does that answer the question is there anything more about the heart attack you would like to to learn

Naren: I think that’s a very long and detailed explanation doctor. I really appreciate that thank you so much

Dr. Kwan: Okay, thank you