July 30, 2025 ā¢ 21 mins
Cardiothoracic surgeon Dr. Mustafa "Dr. Kurk" Kurkluoglu joins cardiologist Dr. Michael Koren to discuss three mechanisms that affect heart health:
- Oxidative stress, dangerous charged particles that can damage cells
- Inflammation, an immune process that can get out of control
- Endothelial dysfunction, cells that line blood vessels stop working properly
The two doctors discuss what can be done to address some of these issues, including supplements and the evidenceĀ (or lack thereof) supporting their use. Finally, they talk about Dr. Kurk's upcoming book, The Three Musketeers of Heart Health, which is availableĀ here.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Announcement (00:00):
Welcome to MedEvidence, where we help you
navigate the truth behindmedical research with unbiased,
evidence-proven facts hosted bycardiologist and top medical
researcher, Dr.
Michael Koren.
Dr. Michael Koren (00:11):
Hello, I'm Dr .
Michael Koren, the executiveeditor of MedEvidence, and I
have a unique privilege today totalk with Dr Mustafa Kirk,
who's a surgeon in Chicago, andhe's a super interesting guy,
and I say that because not allcardiothoracic surgeons are
interested in cardiovascularprevention and Mustafa is one of
(00:34):
those people that is interestedin prevention.
So I'm super interested to talkto him a little bit about that,
how he came to that perspective, and, secondly, he's had an
interesting journey in hiscareer path that hopefully he'll
share with us.
So, mustafa, welcome toMedEvidence!
Dr. Mustafa Kurkluoglu (00:51):
Thank you very much for having me here
today.
Dr. Michael Koren (00:54):
Yeah, I'm excited about our conversation.
So, as you know, a lot of thepeople that view these podcasts
are people in the medicalprofession and they're really
interested in knowing theprofessional pathway of our
guests.
So why don't you tell us howyou ended up becoming a
cardiothoracic surgeon inChicago and your pathway to get
there?
Dr. Mustafa Kurkluoglu (01:14):
Yeah.
So first of all, my journeystarted, as usual, in medical
school and I remember at somepoint in medical school I
watched the surgery,cardiothoracic surgery and when
I saw that the heart has stoppedthere, so it says, oh, I want
to do this, no, it attracted myattention.
And then, after medical school,I went into cardiothoracic
(01:37):
surgery training.
Dr. Michael Koren (01:39):
-quick question Did you have family
members who are physicians or itwas just something that you
became interested in as you weregrowing up?
Dr. Mustafa Kurkluoglu (01:47):
No, actually no family member, I
just you know no family member,I just you know, didn't know
actually what to do.
But after going to the medicalschool and trying the medical
field, I became interested moreand more every day.
So it was just something I wasdrawn to maybe.
And after watching the surgery,and then I wanted to do this, I
(02:13):
said in my mind, and then Ifirst started the training in
Turkey and then I did thefellowship training in
Washington D.
C.
, especially in congenital heartsurgery, the birth defects of
the heart, and then pediatricsas well.
So, and then I moved to back toTurkey.
(02:33):
I wanted to start a program, infact, for the babies which has
congenital heart defects, and weachieved good results there.
In fact we were on the programwhich were doing these kind of
procedures in some region, andthen after a while but you know,
things initially work well, butafter a while it became very
(02:58):
difficult for me to maintainthat and then, because I was the
only surgeon there, I burnedout literally.
Maybe most of our colleaguesare living the same here and
then I moved back to Chicago.
Now I'm yeah.
Dr. Michael Koren (03:17):
Are you doing congenital surgeries in Chicago
or not?
Dr. Mustafa Kurkluoglu (03:21):
Yeah, I work in transplant team now.
Dr. Michael Koren (03:23):
We're doing heart transplants.
Dr. Mustafa Kurkluoglu (03:25):
I exclusively work in the
transplant team.
Sometimes we do congenitalheart surgery, so exclusively in
transplants.
Dr. Michael Koren (03:37):
Interesting.
So in my experience, peoplethat have had that career path
aren't necessarily interested incardiovascular prevention,
particularly the mechanisms ofatherosclerosis.
So tell me about that journey alittle bit.
How did you get interested?
Dr. Mustafa Kurkluoglu (03:54):
Yeah.
So actually the thing startedwith myself, because I was not.
Yeah, because I initially, youknow, when I was in my 40s, I
was not feeling well and youknow I was not able to keep up
my daily responsibilities.
(04:15):
You know, it was very difficultfor me I mean getting out of
bed, you know it's.
So I searched for ways to fixit.
I mean I was thinking what pillcan fix my situation?
So, and then I talked to afriend who introduced me to the
you know some other things thatI can do and I really tried that
(04:40):
and it worked.
It was just antioxidants andnitric oxide, increasing nitric
oxide and, you know, addressinginflammation, and those things
really worked.
And when I felt it in myself, soand I tried to learn more about
it, and then when I learnedmore, I saw that.
So we saw see the plaquespretty late, and when people
(05:05):
come to us, it's almost, youknow, their options are very
limited.
However, the plaques start withthe basic three mechanisms.
So one of them is oxidativestress, one of them is
endothelial dysfunction and oneof them is inflammation.
So if we can address thoseissues at first place, before
(05:29):
something happens, we can fixthe problem and they don't have
to have the complex treatmentsand stuff like that.
Sure.
Yeah that increased myattention on the subject.
Dr. Michael Koren (05:44):
So, out of curiosity, which medications
slash supplements were you usingthat were antioxidants that
helped you feel betterpersonally?
Dr. Mustafa Kurkluoglu (05:53):
Yeah, first of all, I used nitric
oxide, increasing Like I wasusing a noni fruit which I took
on an empty stomach, and I usedantioxidants, kind of a small
fruit juice, antioxidant supportand with multivitamins.
(06:18):
And then I used omega-3 toaddress inflammation, with
vitamin D and E as well.
So this helped me.
Dr. Michael Koren (06:28):
Did you remove anything from your diet
during that process?
Dr. Mustafa Kurkluoglu (06:33):
Yeah, further along the way I moved,
but initially I did not becauseI did not know that actually at
that time the metabolicdysfunction part.
But then when I went into thatpart, I saw that metabolic
problems and then which actuallyis coming out of the food that
we eat in general, and so I hadto.
(06:57):
You know, yeah.
lot of processed foods, as youknow a lot of processed foods,
as you know, arepro-inflammatory, so sometimes
it's what you remove rather thannecessarily the supplements
you're taking.
But interesting journey.
So break it down a little bitmore for our listeners and
viewers, and especially forthose who are not of a medical
(07:20):
background.
So when you say things likeoxidative stress, what do you
mean?
Listeners and viewers, andespecially for those who are not
of a medical background?
So when you say things likeoxidative stress, what do you
mean?
I mean you talk aboutendothelial dysfunction.
Give people a little bit moreof a sense for what that all
means.
Yeah, that's a good question.
So, first of all, oxidativestress is a mechanism that we
see In medical school we learnin a cellular basis, but we
(07:40):
don't know in general, we don'tsee the big picture there.
So I think you know oxidativestress is basically the damage
of the cells by the freeradicals.
So free radicals are electronsbasically just wandering around
and just damaging the othercells and it is just like
(08:01):
rusting in the body.
However, you know it's acontinuous process and it can be
prevented by antioxidants.
Antioxidants are naturaldefense mechanisms of the body.
Like I mean, when you thinkthat there are oxidative foods,
(08:22):
there are antioxidant foods.
So some foods increase theoxidation, some foods increase
this process of oxidative stressand some foods decrease it, but
not only foods.
But I also delved into that.
The stress is actuallyincreasing the oxidative stress,
the normal stress that you'rehaving your day-to-day life,
Dr. Michael Koren (08:45):
The psychological, yeah, yeah.
Dr. Mustafa Kurkluoglu (08:47):
Yeah, it's one of the- Actually,
stress is a predictor of heartdisease that we don't see and
nobody can, you know, assess itin a regular doctor-patient
relationship.
We just look at the numbers and, you know, prescribe some
medications, but we don't assessthe stress level of the patient
(09:08):
or the individual.
So the stress is another, youknow, problem that's causing the
oxidative stress as well.
So these are the molecularbasic mechanism and the second
mechanism is endothelialdysfunction.
The endothelium is the innerlayer of arteries, as you know.
So endothelium is known as oneof the, by surface area, the
(09:33):
largest organ Because it cancover like five ten score
distance when you lay it on theground.
And then, for example, we haveblood vessels which carries
blood to every part of our bodyand our blood vessels can, if
you stretch the blood vesselsand add them, end to end, you
(09:54):
can encircle the world two and ahalf times.
So we have enormous web ofblood vessels and the inner
lining is covered withendothelium.
And endothelium, protecting theendothelium, is the first
defense mechanism against heartattacks.
And there's a molecule which isa miracle molecule, I say, and
(10:16):
it was the first founders aftersmall molecule have gotten Nobel
Prize in medicine 1998.
And it's called nitric oxide.
Nitric oxide is the naturalprotector of endothelium and it
opens up blood vessels.
It relaxes the smooth muscleswithin the blood vessels so that
(10:38):
blood can easily flow, thesmooth muscles within the blood
vessels so that blood can easilyflow.
And and, by the way, it'snatural and it's, it doesn't
require a synthetic medication,in fact, for the body to produce
it, although there are somesynthetic medications, but it's.
You can use it the natural way.
And the third mechanism isinflammation.
(10:59):
Inflammation is, as you know,the battle between the body and
the foreign objects.
However, the body can sometimesuse inflammation against its
own cells and that causes thedamage its own cells and that
(11:22):
causes the damage.
So, as you mentioned,inflammatory foods, these are
also a big problem in today'ssociety, I believe, and it can
be a reason why heart attacksare increasing, because no one,
you know almost very few people,talk about these mechanisms and
very few people know about them.
Dr. Michael Koren (11:41):
Right, yeah, so interesting.
You know, one of the challengesis that clearly these
mechanisms that you discussedare mechanisms that are very
important to atherosclerosis butthere's still a debate about
how to prevent those mechanismsfrom taking hold of our
vasculature and some of theclinical trials that I've done
(12:05):
have had sort of mixed results.
So I remember as a youngcardiologist I was very eager to
recommend vitamin E and then welooked at vitamin E in clinical
trials and it really didn'thelp as an antioxidant.
I actually worked in a labduring college, in medical
school and the famous actorClint Eastwood actually came to
the lab because he wasinterested in some of the
(12:26):
theories about free radicals andoxidative stress.
And you said very nicely how wehave these extra electrons that
cause damage to our cells and wehave some internal mechanisms
to prevent that damage fromcausing a huge problem.
And at that time we werestudying SOD sodium oxygen
(12:47):
dismutase as an intrinsicantioxidant and seeing whether
or not it could be medicalizedand we had some interesting
animal models that looked atthat.
But it was very hard to showthat worked in day-to-day human
life and for our patients.
So such an interesting issue,and it's both something that we
(13:09):
should be thinking about interms of those food substances
that actually cause theseproblems, and doing more work
and high-level clinical trialwork looking at different
antioxidants to see if they makea difference and I don't know
if you agree with that concept,but somebody that has a lot of
clinical trial work, I'm veryeager to do more of these
dietary studies and studies thatlook at things like
(13:30):
antioxidants.
Dr. Mustafa Kurkluoglu (13:32):
Yeah, absolutely.
And in today's world, you know,in the system that we're in
right now, very few studies arebeing done, except the drugs and
which are related to drugs orsome new drugs or anything like
that, because they are the oneswhich can be patented and which
(13:55):
can be labeled and which can besold at high prices.
But the natural solutions arethey're cheap, they're easy, so
they are not being dwelled on orthey're not being.
They're not much studies beingdone about that, those things,
because I don't know the exact,you know it's.
There are many reasons.
(14:16):
Actually, we cannot just pointa single reason, but this is the
issue now.
Dr. Michael Koren (14:21):
One of the reasons could be is that the
manufacturers of nutritionalproducts and food products don't
want to spend the money to dothe clinical trials to look at
it critically, knowing that it'spossible that the studies will
not show that their product issuccessful at preventing
atherosclerotic complications.
So that's the trade-off thereis.
(14:42):
The pharmaceutical industrydefinitely is developing
higher-priced products, but theyare spending the money on the
research to determine what works, and I know that there have
been certainly studies lookingat nitric oxide enhancing drugs
and whether or not they make adifference, and again, those
studies have had sort of mixedresults.
But it's an interesting dilemma.
I wish there was morenutritional research that looked
(15:05):
at some of these issues.
Dr. Mustafa Kurkluoglu (15:07):
Yeah, I agree.
Dr. Michael Koren (15:10):
Yeah, certain proteins, I believe, have been
theorized to be nitric oxideproducing agents and enhance the
concentration of nitric oxideat the endothelium level, and so
those are the type of thingsthat would be super interesting.
Like L-carnitine, do you everlook at that or use that?
Dr. Mustafa Kurkluoglu (15:33):
I haven't used it, but I've seen
it.
L-carnitine yeah, it's one ofthe enhancers.
Dr. Michael Koren (15:40):
Yeah, yeah, it's interesting.
I have treated some patientswith that that have chronic
ischemic conditions that are notamenable to revascularization.
So it's again an example ofsomething that I wish had more
well-conducted clinical researchevidence, because it's very
fascinating from a theoreticalstandpoint.
(16:00):
So this has been a fabulousdiscussion, so tell us a little
bit more about your intentionson getting the word out.
I know that you're verypassionate on this issue, so
talk to us about how you'rehelping people understand these
mechanisms of atherosclerosisand how you want to articulate
your message.
Dr. Mustafa Kurkluoglu (16:29):
Yeah, first of all, I wanted to
communicate these things becauseI wanted to help people before
they present to a hospital,because what I see every day is
that people are presenting invery difficult conditions, even
for heart transplants.
Most of them are for ischemicheart disease, which is
preventable.
And you know, even peoplereceiving heart transplants or
(16:53):
people who are receiving complextreatments like bypass surgery,
everything, are not fullysatisfied with the results,
because this is a temporarysolution.
In fact, the bypass surgery orother surgeries, we put extra
blood vessel in the distal part,in the farther part along the
(17:14):
line, so you make an extra way,let's think about this, and so
it does not fix the underlyingmechanism and it can occlude as
well.
So prevention, an ounce ofprevention is better than a
gallon of treatment.
That's my model, and, so, ifyou can just stick to simple
things and do some research,some of your own research, make
your own routine and you caneven get some personalized help
from people who are in thisinformation and so that you can
(17:58):
set yourself for a healthierlife, I believe.
Dr. Michael Koren (18:02):
Absolutely, absolutely.
So I know that you're workingon a book.
Why don't you tell our audiencea little bit about that, and
when they can expect it and whatto look for?
Dr. Mustafa Kurkluoglu (18:12):
Yeah, actually, my book is coming out
soon.
It will be on Amazon ThreeMuscketeers of Heart Health.
So it's basically I wanted toexplain the three protective
mechanisms which we can addressthe heart attacks, heart disease
, before they even present.
(18:32):
So I wanted to mention thosethree mechanisms in my book.
I just resemble it into themovie Three Musketeers, and so
it's the three mechanisms, like.
One of them is the endothelialdysfunction and nitric oxide,
one of them is inflammation andoxidative stress.
(18:54):
So if you can have a chance toread the book, you will see the
strategies to prevent thosemechanisms before they
Dr. Michael Koren (19:05):
So interesting,
yeah.
Will there be any dietaryinformation or your
recommendations about the use ofsupplements or pharmaceuticals?
Dr. Mustafa Kurkluoglu (19:14):
Yeah, I don't want to go deep into the
dietary recommendations, butwith simple ones, and I
personally believe that themaking things complex will not
work, because people do not,cannot just fit into their busy
schedule.
They cannot just cook foods acouple of hours, you know, just
(19:37):
try to eat healthy.
They just eat whatever they canfind.
But if you can prevent certainfoods, if you can prevent just a
couple of foods to take out ofyour diet, you can be well ahead
of most people.
That's my belief and I don't.
So I'm not recommending diet indetail or, you know, exercise
(19:58):
even.
You have to do cardio, this andthis, but you can just put
small exercise routine, what Icall exercise snacks in your day
, and that's also helpful and sowell.
I want to be as simple aspossible and as scientific as
possible.
So these are my two edges thatI want to keep while doing this.
Dr. Michael Koren (20:22):
Fascinating.
So it's going to be called theThree Musketeers of
Atherosclerosis by Dr MustafaKirk.
Is that correct?
Dr. Mustafa Kurkluoglu (20:30):
Yeah, three Musketeers of Heart Health
is the name of the book.
Dr. Michael Koren (20:35):
Yeah, Very nice.
Well, we'll look out for it forsure, and I can't wait to read
it myself.
So fascinating, fascinatingstuff.
Anything else you want to addto our discussion?
So far, mustafa?
I think it's been really,really valuable for the
listeners.
Dr. Mustafa Kurkluoglu (20:51):
Nothing else.
Thank you for having me again.
And one thing I mentioned isthat if someone is watching this
podcast, I think they are on awellness journey.
They want to be better.
They don't want to be- BecauseI think you are.
If someone is watching this,you are ahead of the game,
because most people are notthinking of that and most people
(21:13):
think that, oh, if I havesomething, I go to the doctor
and they fix.
But it's not working that way.
Dr. Michael Koren (21:20):
Yeah, I would agree with that 100%.
MedEvidence listeners andviewers are way ahead of the
rest of the pack.
Dr. Mustafa Kurkluoglu (21:27):
Yeah.
Dr. Michael Koren (21:27):
And we want to keep them there.
So thank you for helping us andhelping our audience, and we're
all working together towards ahealthier lifestyle.
Again, this is Dr Michael Korenand Dr Mustafa Kirk signing off
for MedEvidence on anotherfascinating discussion about
heart health.
Thank you so much.
Announcement (21:46):
Thanks for joining the MedEvidence podcast.
To learn more, head over toMedEvidence.
com or subscribe to our podcaston your favorite podcast
platform.
Welcome to MedEvidence, where we help you
navigate the truth behindmedical research with unbiased,
evidence-proven facts hosted bycardiologist and top medical
researcher, Dr.
Michael Koren.
Dr. Michael Koren (00:11):
Hello, I'm Dr .
Michael Koren, the executiveeditor of MedEvidence, and I
have a unique privilege today totalk with Dr Mustafa Kirk,
who's a surgeon in Chicago, andhe's a super interesting guy,
and I say that because not allcardiothoracic surgeons are
interested in cardiovascularprevention and Mustafa is one of
(00:34):
those people that is interestedin prevention.
So I'm super interested to talkto him a little bit about that,
how he came to that perspective, and, secondly, he's had an
interesting journey in hiscareer path that hopefully he'll
share with us.
So, mustafa, welcome toMedEvidence!
Dr. Mustafa Kurkluoglu (00:51):
Thank you very much for having me here
today.
Dr. Michael Koren (00:54):
Yeah, I'm excited about our conversation.
So, as you know, a lot of thepeople that view these podcasts
are people in the medicalprofession and they're really
interested in knowing theprofessional pathway of our
guests.
So why don't you tell us howyou ended up becoming a
cardiothoracic surgeon inChicago and your pathway to get
there?
Dr. Mustafa Kurkluoglu (01:14):
Yeah.
So first of all, my journeystarted, as usual, in medical
school and I remember at somepoint in medical school I
watched the surgery,cardiothoracic surgery and when
I saw that the heart has stoppedthere, so it says, oh, I want
to do this, no, it attracted myattention.
And then, after medical school,I went into cardiothoracic
(01:37):
surgery training.
Dr. Michael Koren (01:39):
-quick question Did you have family
members who are physicians or itwas just something that you
became interested in as you weregrowing up?
Dr. Mustafa Kurkluoglu (01:47):
No, actually no family member, I
just you know no family member,I just you know, didn't know
actually what to do.
But after going to the medicalschool and trying the medical
field, I became interested moreand more every day.
So it was just something I wasdrawn to maybe.
And after watching the surgery,and then I wanted to do this, I
(02:13):
said in my mind, and then Ifirst started the training in
Turkey and then I did thefellowship training in
Washington D.
C.
, especially in congenital heartsurgery, the birth defects of
the heart, and then pediatricsas well.
So, and then I moved to back toTurkey.
(02:33):
I wanted to start a program, infact, for the babies which has
congenital heart defects, and weachieved good results there.
In fact we were on the programwhich were doing these kind of
procedures in some region, andthen after a while but you know,
things initially work well, butafter a while it became very
(02:58):
difficult for me to maintainthat and then, because I was the
only surgeon there, I burnedout literally.
Maybe most of our colleaguesare living the same here and
then I moved back to Chicago.
Now I'm yeah.
Dr. Michael Koren (03:17):
Are you doing congenital surgeries in Chicago
or not?
Dr. Mustafa Kurkluoglu (03:21):
Yeah, I work in transplant team now.
Dr. Michael Koren (03:23):
We're doing heart transplants.
Dr. Mustafa Kurkluoglu (03:25):
I exclusively work in the
transplant team.
Sometimes we do congenitalheart surgery, so exclusively in
transplants.
Dr. Michael Koren (03:37):
Interesting.
So in my experience, peoplethat have had that career path
aren't necessarily interested incardiovascular prevention,
particularly the mechanisms ofatherosclerosis.
So tell me about that journey alittle bit.
How did you get interested?
Dr. Mustafa Kurkluoglu (03:54):
Yeah.
So actually the thing startedwith myself, because I was not.
Yeah, because I initially, youknow, when I was in my 40s, I
was not feeling well and youknow I was not able to keep up
my daily responsibilities.
(04:15):
You know, it was very difficultfor me I mean getting out of
bed, you know it's.
So I searched for ways to fixit.
I mean I was thinking what pillcan fix my situation?
So, and then I talked to afriend who introduced me to the
you know some other things thatI can do and I really tried that
(04:40):
and it worked.
It was just antioxidants andnitric oxide, increasing nitric
oxide and, you know, addressinginflammation, and those things
really worked.
And when I felt it in myself, soand I tried to learn more about
it, and then when I learnedmore, I saw that.
So we saw see the plaquespretty late, and when people
(05:05):
come to us, it's almost, youknow, their options are very
limited.
However, the plaques start withthe basic three mechanisms.
So one of them is oxidativestress, one of them is
endothelial dysfunction and oneof them is inflammation.
So if we can address thoseissues at first place, before
(05:29):
something happens, we can fixthe problem and they don't have
to have the complex treatmentsand stuff like that.
Sure.
Yeah that increased myattention on the subject.
Dr. Michael Koren (05:44):
So, out of curiosity, which medications
slash supplements were you usingthat were antioxidants that
helped you feel betterpersonally?
Dr. Mustafa Kurkluoglu (05:53):
Yeah, first of all, I used nitric
oxide, increasing Like I wasusing a noni fruit which I took
on an empty stomach, and I usedantioxidants, kind of a small
fruit juice, antioxidant supportand with multivitamins.
(06:18):
And then I used omega-3 toaddress inflammation, with
vitamin D and E as well.
So this helped me.
Dr. Michael Koren (06:28):
Did you remove anything from your diet
during that process?
Dr. Mustafa Kurkluoglu (06:33):
Yeah, further along the way I moved,
but initially I did not becauseI did not know that actually at
that time the metabolicdysfunction part.
But then when I went into thatpart, I saw that metabolic
problems and then which actuallyis coming out of the food that
we eat in general, and so I hadto.
(06:57):
You know, yeah.
lot of processed foods, as youknow a lot of processed foods,
as you know, arepro-inflammatory, so sometimes
it's what you remove rather thannecessarily the supplements
you're taking.
But interesting journey.
So break it down a little bitmore for our listeners and
viewers, and especially forthose who are not of a medical
(07:20):
background.
So when you say things likeoxidative stress, what do you
mean?
Listeners and viewers, andespecially for those who are not
of a medical background?
So when you say things likeoxidative stress, what do you
mean?
I mean you talk aboutendothelial dysfunction.
Give people a little bit moreof a sense for what that all
means.
Yeah, that's a good question.
So, first of all, oxidativestress is a mechanism that we
see In medical school we learnin a cellular basis, but we
(07:40):
don't know in general, we don'tsee the big picture there.
So I think you know oxidativestress is basically the damage
of the cells by the freeradicals.
So free radicals are electronsbasically just wandering around
and just damaging the othercells and it is just like
(08:01):
rusting in the body.
However, you know it's acontinuous process and it can be
prevented by antioxidants.
Antioxidants are naturaldefense mechanisms of the body.
Like I mean, when you thinkthat there are oxidative foods,
(08:22):
there are antioxidant foods.
So some foods increase theoxidation, some foods increase
this process of oxidative stressand some foods decrease it, but
not only foods.
But I also delved into that.
The stress is actuallyincreasing the oxidative stress,
the normal stress that you'rehaving your day-to-day life,
Dr. Michael Koren (08:45):
The psychological, yeah, yeah.
Dr. Mustafa Kurkluoglu (08:47):
Yeah, it's one of the- Actually,
stress is a predictor of heartdisease that we don't see and
nobody can, you know, assess itin a regular doctor-patient
relationship.
We just look at the numbers and, you know, prescribe some
medications, but we don't assessthe stress level of the patient
(09:08):
or the individual.
So the stress is another, youknow, problem that's causing the
oxidative stress as well.
So these are the molecularbasic mechanism and the second
mechanism is endothelialdysfunction.
The endothelium is the innerlayer of arteries, as you know.
So endothelium is known as oneof the, by surface area, the
(09:33):
largest organ Because it cancover like five ten score
distance when you lay it on theground.
And then, for example, we haveblood vessels which carries
blood to every part of our bodyand our blood vessels can, if
you stretch the blood vesselsand add them, end to end, you
(09:54):
can encircle the world two and ahalf times.
So we have enormous web ofblood vessels and the inner
lining is covered withendothelium.
And endothelium, protecting theendothelium, is the first
defense mechanism against heartattacks.
And there's a molecule which isa miracle molecule, I say, and
(10:16):
it was the first founders aftersmall molecule have gotten Nobel
Prize in medicine 1998.
And it's called nitric oxide.
Nitric oxide is the naturalprotector of endothelium and it
opens up blood vessels.
It relaxes the smooth muscleswithin the blood vessels so that
(10:38):
blood can easily flow, thesmooth muscles within the blood
vessels so that blood can easilyflow.
And and, by the way, it'snatural and it's, it doesn't
require a synthetic medication,in fact, for the body to produce
it, although there are somesynthetic medications, but it's.
You can use it the natural way.
And the third mechanism isinflammation.
(10:59):
Inflammation is, as you know,the battle between the body and
the foreign objects.
However, the body can sometimesuse inflammation against its
own cells and that causes thedamage its own cells and that
(11:22):
causes the damage.
So, as you mentioned,inflammatory foods, these are
also a big problem in today'ssociety, I believe, and it can
be a reason why heart attacksare increasing, because no one,
you know almost very few people,talk about these mechanisms and
very few people know about them.
Dr. Michael Koren (11:41):
Right, yeah, so interesting.
You know, one of the challengesis that clearly these
mechanisms that you discussedare mechanisms that are very
important to atherosclerosis butthere's still a debate about
how to prevent those mechanismsfrom taking hold of our
vasculature and some of theclinical trials that I've done
(12:05):
have had sort of mixed results.
So I remember as a youngcardiologist I was very eager to
recommend vitamin E and then welooked at vitamin E in clinical
trials and it really didn'thelp as an antioxidant.
I actually worked in a labduring college, in medical
school and the famous actorClint Eastwood actually came to
the lab because he wasinterested in some of the
(12:26):
theories about free radicals andoxidative stress.
And you said very nicely how wehave these extra electrons that
cause damage to our cells and wehave some internal mechanisms
to prevent that damage fromcausing a huge problem.
And at that time we werestudying SOD sodium oxygen
(12:47):
dismutase as an intrinsicantioxidant and seeing whether
or not it could be medicalizedand we had some interesting
animal models that looked atthat.
But it was very hard to showthat worked in day-to-day human
life and for our patients.
So such an interesting issue,and it's both something that we
(13:09):
should be thinking about interms of those food substances
that actually cause theseproblems, and doing more work
and high-level clinical trialwork looking at different
antioxidants to see if they makea difference and I don't know
if you agree with that concept,but somebody that has a lot of
clinical trial work, I'm veryeager to do more of these
dietary studies and studies thatlook at things like
(13:30):
antioxidants.
Dr. Mustafa Kurkluoglu (13:32):
Yeah, absolutely.
And in today's world, you know,in the system that we're in
right now, very few studies arebeing done, except the drugs and
which are related to drugs orsome new drugs or anything like
that, because they are the oneswhich can be patented and which
(13:55):
can be labeled and which can besold at high prices.
But the natural solutions arethey're cheap, they're easy, so
they are not being dwelled on orthey're not being.
They're not much studies beingdone about that, those things,
because I don't know the exact,you know it's.
There are many reasons.
(14:16):
Actually, we cannot just pointa single reason, but this is the
issue now.
Dr. Michael Koren (14:21):
One of the reasons could be is that the
manufacturers of nutritionalproducts and food products don't
want to spend the money to dothe clinical trials to look at
it critically, knowing that it'spossible that the studies will
not show that their product issuccessful at preventing
atherosclerotic complications.
So that's the trade-off thereis.
(14:42):
The pharmaceutical industrydefinitely is developing
higher-priced products, but theyare spending the money on the
research to determine what works, and I know that there have
been certainly studies lookingat nitric oxide enhancing drugs
and whether or not they make adifference, and again, those
studies have had sort of mixedresults.
But it's an interesting dilemma.
I wish there was morenutritional research that looked
(15:05):
at some of these issues.
Dr. Mustafa Kurkluoglu (15:07):
Yeah, I agree.
Dr. Michael Koren (15:10):
Yeah, certain proteins, I believe, have been
theorized to be nitric oxideproducing agents and enhance the
concentration of nitric oxideat the endothelium level, and so
those are the type of thingsthat would be super interesting.
Like L-carnitine, do you everlook at that or use that?
Dr. Mustafa Kurkluoglu (15:33):
I haven't used it, but I've seen
it.
L-carnitine yeah, it's one ofthe enhancers.
Dr. Michael Koren (15:40):
Yeah, yeah, it's interesting.
I have treated some patientswith that that have chronic
ischemic conditions that are notamenable to revascularization.
So it's again an example ofsomething that I wish had more
well-conducted clinical researchevidence, because it's very
fascinating from a theoreticalstandpoint.
(16:00):
So this has been a fabulousdiscussion, so tell us a little
bit more about your intentionson getting the word out.
I know that you're verypassionate on this issue, so
talk to us about how you'rehelping people understand these
mechanisms of atherosclerosisand how you want to articulate
your message.
Dr. Mustafa Kurkluoglu (16:29):
Yeah, first of all, I wanted to
communicate these things becauseI wanted to help people before
they present to a hospital,because what I see every day is
that people are presenting invery difficult conditions, even
for heart transplants.
Most of them are for ischemicheart disease, which is
preventable.
And you know, even peoplereceiving heart transplants or
(16:53):
people who are receiving complextreatments like bypass surgery,
everything, are not fullysatisfied with the results,
because this is a temporarysolution.
In fact, the bypass surgery orother surgeries, we put extra
blood vessel in the distal part,in the farther part along the
(17:14):
line, so you make an extra way,let's think about this, and so
it does not fix the underlyingmechanism and it can occlude as
well.
So prevention, an ounce ofprevention is better than a
gallon of treatment.
That's my model, and, so, ifyou can just stick to simple
things and do some research,some of your own research, make
your own routine and you caneven get some personalized help
from people who are in thisinformation and so that you can
(17:58):
set yourself for a healthierlife, I believe.
Dr. Michael Koren (18:02):
Absolutely, absolutely.
So I know that you're workingon a book.
Why don't you tell our audiencea little bit about that, and
when they can expect it and whatto look for?
Dr. Mustafa Kurkluoglu (18:12):
Yeah, actually, my book is coming out
soon.
It will be on Amazon ThreeMuscketeers of Heart Health.
So it's basically I wanted toexplain the three protective
mechanisms which we can addressthe heart attacks, heart disease
, before they even present.
(18:32):
So I wanted to mention thosethree mechanisms in my book.
I just resemble it into themovie Three Musketeers, and so
it's the three mechanisms, like.
One of them is the endothelialdysfunction and nitric oxide,
one of them is inflammation andoxidative stress.
(18:54):
So if you can have a chance toread the book, you will see the
strategies to prevent thosemechanisms before they
Dr. Michael Koren (19:05):
So interesting,
yeah.
Will there be any dietaryinformation or your
recommendations about the use ofsupplements or pharmaceuticals?
Dr. Mustafa Kurkluoglu (19:14):
Yeah, I don't want to go deep into the
dietary recommendations, butwith simple ones, and I
personally believe that themaking things complex will not
work, because people do not,cannot just fit into their busy
schedule.
They cannot just cook foods acouple of hours, you know, just
(19:37):
try to eat healthy.
They just eat whatever they canfind.
But if you can prevent certainfoods, if you can prevent just a
couple of foods to take out ofyour diet, you can be well ahead
of most people.
That's my belief and I don't.
So I'm not recommending diet indetail or, you know, exercise
(19:58):
even.
You have to do cardio, this andthis, but you can just put
small exercise routine, what Icall exercise snacks in your day
, and that's also helpful and sowell.
I want to be as simple aspossible and as scientific as
possible.
So these are my two edges thatI want to keep while doing this.
Dr. Michael Koren (20:22):
Fascinating.
So it's going to be called theThree Musketeers of
Atherosclerosis by Dr MustafaKirk.
Is that correct?
Dr. Mustafa Kurkluoglu (20:30):
Yeah, three Musketeers of Heart Health
is the name of the book.
Dr. Michael Koren (20:35):
Yeah, Very nice.
Well, we'll look out for it forsure, and I can't wait to read
it myself.
So fascinating, fascinatingstuff.
Anything else you want to addto our discussion?
So far, mustafa?
I think it's been really,really valuable for the
listeners.
Dr. Mustafa Kurkluoglu (20:51):
Nothing else.
Thank you for having me again.
And one thing I mentioned isthat if someone is watching this
podcast, I think they are on awellness journey.
They want to be better.
They don't want to be- BecauseI think you are.
If someone is watching this,you are ahead of the game,
because most people are notthinking of that and most people
(21:13):
think that, oh, if I havesomething, I go to the doctor
and they fix.
But it's not working that way.
Dr. Michael Koren (21:20):
Yeah, I would agree with that 100%.
MedEvidence listeners andviewers are way ahead of the
rest of the pack.
Dr. Mustafa Kurkluoglu (21:27):
Yeah.
Dr. Michael Koren (21:27):
And we want to keep them there.
So thank you for helping us andhelping our audience, and we're
all working together towards ahealthier lifestyle.
Again, this is Dr Michael Korenand Dr Mustafa Kirk signing off
for MedEvidence on anotherfascinating discussion about
heart health.
Thank you so much.
Announcement (21:46):
Thanks for joining the MedEvidence podcast.
To learn more, head over toMedEvidence.
com or subscribe to our podcaston your favorite podcast
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