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Inflammation, Insulin, and Heart Prevention

Dec 12, 2025

Overview

  • Interview with Dr. Praep Jam Nadas, world-leading cardiologist focused on prevention of heart disease.
  • Main themes: inflammation as central cause of cardiovascular disease, role of insulin and visceral fat, benefits and protocols of fasting, gut microbiome and toxins, exercise and vagus nerve, nutrition and supplements, practical screening tests.

Heart Disease Fundamentals

  • Heart comprises muscle (cardiomyopathy), coronary arteries (atherosclerosis), valves, peripheral circulation, and microvasculature.
  • Heart attack mechanism: plaque rupture → blood clot forms → artery occlusion; inflammation causes plaque rupture.
  • Three interrelated problems driving current epidemic: plaque formation, plaque instability (rupture), and increased blood coagulability.

Insulin, Glucose, And Visceral Fat

  • Glucose is toxic in bloodstream; pancreas releases insulin to clear glucose.
  • Frequent consumption of carbs/processed foods keeps insulin chronically high → insulin resistance.
  • Hyperinsulinemia drives:
    • Fatty liver formation
    • Visceral (intra-abdominal) fat deposition (pro-inflammatory, hard to pinch)
    • Smooth muscle proliferation, vasoconstriction, pro-thrombotic state
  • Many patients with coronary disease are pre-diabetic or hyperinsulinemic even if A1C appears normal.
  • Early insulin testing is important but underused.

Fasting: Physiology, Benefits, Protocols

  • Fasting lowers insulin; different physiology versus simple calorie restriction.
    • Calorie restriction can slow metabolism and cause muscle loss.
    • Fasting transitions body from glycogen use (first ~12 hours) to fat mobilization and ketone production (after ~12 hours).
  • Visceral fat preferentially mobilized early in fasting; reduces inflammatory adipokines (IL-6, TNF).
  • Ketones: cleaner fuel, reduce reactive oxygen species, increase BDNF, stimulate stem cell mobilization and autophagy.
  • Autophagy: cellular recycling of redundant organelles, improves mitochondrial function.
  • Fasting protocols (examples, tailored to goals):
    • 12:12 (start) → progress to 18:6 (18 hours fast, 6-hour feeding window).
    • For severe obesity/diabetes: weekly 48-hour fasts, three-day water fasts every 9 days, or OMAD (one meal a day) blocks.
    • Long supervised fasts shown (examples: 72 days, 183 days) with major clinical improvements.
  • Recommendations:
    • Most healthy people: at least one 36-hour fast monthly.
    • Exercise during fasting: resistance or HIIT near end of fast improves muscle retention; do gym near peak fast (e.g., 2 hours before breaking fast).

Exercise For Heart Health

  • Excessive long-duration aerobic exercise (marathon-like) may increase inflammation and coronary disease.
  • Optimal mix:
    • Short aerobic sessions (15–20 minutes) for endurance.
    • Resistance training and HIIT (30–45 seconds intense, 30–45 seconds rest).
  • For women: resistance and HIIT are preferable when training fasted; prolonged aerobic fasted sessions risk muscle breakdown.
  • Over-exercise can cause relative gut ischemia → vagus nerve dysfunction → palpitations/arrhythmias.

Gut Microbiome, Leaky Gut, And Fatty Liver

  • Gut contains ~100 trillion bacteria plus viruses; microbiome produces micronutrients and maintains gut lining.
  • Dysbiosis → leaky gut → translocation of bacterial products (LPS) to portal circulation → fatty liver and systemic inflammation.
  • Major causes of fatty liver: excessive alcohol, leaky gut, and hyperinsulinemia.
  • Fixing gut (fiber, fermented foods, targeted supplements) can flatten progression of coronary calcification and reduce systemic inflammation.

Toxins And Mold

  • Toxins defined as harmful exogenous molecules: pesticides, herbicides, plastic-related chemicals (BPA, PFAS), heavy metals, and mold.
  • Mold toxicity common; estimated ~70% of homes have some mold exposure; chronic exposure causes low-grade systemic inflammation detectable in bloodwork.
  • Gut and liver overwhelmed by modern toxin load → impaired detoxification and increased inflammation.
  • Assess toxicity via blood, urine, and stool panels when indicated.

Diet, Foods To Avoid, And Food Preparation

  • Foods that promote inflammation and cardiovascular risk:
    • Highly processed foods (refined grains, packaged products, many protein bars)
    • Sugary drinks and excessive fruit (high fructose can promote fatty liver)
    • White bread, white rice (arsenic concerns in rice)
    • Vegetable seed oils (high omega-6); imbalance omega-6:omega-3 increases inflammation
    • Overcooked/burnt foods producing advanced glycation end products (AGEs)
  • Practical rice handling to reduce arsenic and create resistant starch:
    • Soak overnight, discard soak water, cook in excess water and discard cooking water, cool and reheat later.
  • Preferred oils: extra virgin olive oil for dressings; butter/ghee or coconut oil for high-heat cooking.
  • Bread: most breads are poor choices; fermented sourdough better in moderation.

Supplements And Nutrients Mentioned

  • Important: ensure adequate vitamin D3 and vitamin K2 (prevents ectopic vascular calcification); avoid unnecessary calcium supplements.
  • Omega-3 (DHA/EPA) for vagus nerve and anti-inflammatory effects.
  • Other supplements used by Dr. Nadas:
    • Vitamin C (1 g)
    • Magnesium
    • Inulin + FOS (soluble prebiotic fiber) daily
    • Probiotic (spore-based, e.g., mega-spore formulations)
    • Nattokinase (enzyme to reduce fibrin; used by clinician, dose example ~8,000 units/day)
    • Consider K2 supplementation especially if diet low in fermented foods or when on warfarin patients may have increased calcification risk.

Vagus Nerve And Autonomic Balance

  • Vagus nerve: major parasympathetic nerve with extensive gut, heart, and lung innervation; central to repair and anti-inflammatory signaling.
  • Dysfunctional vagus (reduced parasympathetic tone) → relative sympathetic dominance → palpitations, tachycardia, reduced heart rate variability.
  • Ways to improve/vagal-hack:
    • Improve gut health (primary)
    • Omega-3 supplementation
    • Breathing practice: inhale count 4, exhale count 8, 10 minutes daily
    • Cold stimulation to neck/eyes, gentle eyeball cold rinse (stimulates dive reflex)
    • Humming, singing, laughing (stimulate vagus via vocal cord vibrations)
    • Valsalva maneuver judiciously for acute vagal stimulation
    • Local neuromodulation devices (clinician-provided) can stimulate vagus in some patients.

Lipids And Small Dense LDL

  • LDL carries most cholesterol; small dense LDL particles are the atherogenic, oxidized form that promotes endothelial damage and plaque formation.
  • Causes of small dense LDL: hyperglycemia, excess omega-6, AGEs, toxins, and leaky gut.
  • Clinically useful tests:
    • Coronary artery calcium (CAC) scoring to quantify plaque burden.
    • Advanced lipid testing / LDL subfractionation (e.g., Cleveland Heart Labs) to identify small dense LDL and inflammatory markers (CRP, IL-6, TNF).
  • Statins: effective at lowering LDL but have side effects (muscle symptoms, mitochondrial effects, possible cognitive effects in some). Goal should be to reduce damaged small dense LDL and inflammation, not only total LDL.

Screening And Tests Recommended

  • If >30 or concerned:
    • Coronary calcium score (CAC) — zero is ideal; any calcium indicates atherosclerosis.
    • Comprehensive inflammatory/metabolic panel (particle sizes, CRP, IL-6, TNF, A1C, insulin if possible) — Cleveland Heart Labs suggested panel.
    • Investigate gut health, toxins, and fatty liver when clinical indicators present.

Action Items

  • For individuals:
    • Evaluate eating frequency; implement time-restricted feeding (start 12:12 → 18:6).
    • Consider periodic longer fasts under medical supervision if overweight/diabetic.
    • Increase diverse fiber intake and fermented foods; consider inulin + FOS supplement.
    • Replace vegetable seed oils with olive oil / butter/ghee for cooking; boost omega-3 intake.
    • Improve sleep (aim ~7 hours) and stress management; one night poor sleep causes transient insulin resistance.
    • Screen with CAC and an inflammatory/metabolic blood panel if age >30 or risk factors present.
    • Reduce exposures to toxins and investigate mold in home if suspected.
    • Practice vagus-supporting techniques daily (breathing 4:8 for 10 minutes, humming/singing, cold face/neck stimulation).

Decisions

  • Clinical approach emphasized by Dr. Nadas:
    • Prioritize identifying and treating sources of inflammation (gut issues, toxins, hyperinsulinemia).
    • Use fasting and time-restricted feeding as a central tool for reversing metabolic derangements.
    • Supplement D3 + K2 + omega-3 and targeted gut support where diet alone is insufficient.
    • Reserve medication decisions (e.g., statins) for contextualized use, monitor side effects, and focus on addressing root causes of small dense LDL formation.

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