Dr. Kwan and Clint Paddison discuss in this podcast:

• Blood flow and its importance for our health
• How lack of oxygen and nutrients can lead to diseases
• Red and white blood cells
• Blood vessels and the function of cholesterol
• Chronic inflammations and immune response
• Hypoxia inducible factor and RA
• The role of food and a correct diet
• The real dangers of smoking
• Physical and mental stress

Clint – This is going to be a fabulous and interesting interview. I have an author today of a book called Let It Flow. I bought this book about a month ago and was fascinated by its content because I believe that our bodies inability to heal with rheumatoid arthritis and for that matter, a lot of chronic disease is the lack of blood flow and oxygen to our cells. And I’ve become much more enlightened about this topic. After reading this book by Dr. Kwan, it is a fascinating read. And today I’m blessed because he’s joining us on this podcast episode. Dr. Kwan, thank you so much for coming and joining me today.

Dr. Kwan – Thank you very much, I’m so glad to be here to talk about this issue. I believe that to see these issues of blood flow affect just about everyone that we know, you know, in different forms, different diseases. So I’ll be I want to go into real depth and actually discuss what really blood flow is and (inaudible) people on what really what is blood flow.

Clint – Yeah, absolutely. And I think a wonderful way for us to go through this interview is to dive into what’s happening in our body, how blood flow travels through our body, what affects it, what we can do about it to improve our blood flow. And then we’ll talk specifically about, how blood flow might affect our body with rheumatoid arthritis or autoimmune in general. And then we’ll talk about some tips and you can give us some tips on ways to have better blood flow. But before we get into all that, I just want to give our audience your introduction, because you have a very, very prestigious career and I don’t want to overlook that. Let’s get started with a little intro here. You were born in Seoul, in Korea, and your family immigrated to the United States when you were only nine years old. So you grew up in the United States. You graduated from Georgetown Medical School in Washington, D.C., and completed a residency in general surgery, followed by plastic and reconstructive residency at New York Presbyterian Weill Cornell Medical Center. And as a clinical professor of surgery at NYPH, you regularly teach plastic surgery residents and medical students. You volunteer on a medical missions team, and each year for the past decade, you’ve traveled to South America and Africa and served over there. Your passion for healthy living and total body wellness has led you on a journey to teach and research and advise essentially the community and anyone who listen and our brief chat prior to getting started here. Boy, am I excited because you and I share the same exact passion, which is maximum health, minimum disease. So let’s get into it.

Dr. Kwan – Well, you know what? This whole journey started for me, I would say about a decade ago, maybe little, little, little after that. What happened is I treat after training, doing all these training, I’m a plastic surgeon. So what does a plastic surgeon have to do with any of this stuff? But as a plastic surgeon, I see a lot of my patients that come to me. Mostly for elective surgery to make themselves look younger, better. So but then even during my training and in reconstructive part, a plastic surgery involves it involves really reconstructing someone after injury or after cancer surgery. And during the surgery, I realized that when patients have poor blood flow, meaning if they have chronic disease, that means like diabetes, high blood pressure or heart disease, they end up not doing as well. The surgical outcome is not as good, meaning that for what I do as a plastic surgeon is very different than a thoracic or heart surgeon or other surgeon, because for us, what we do is try to repair the damaged area. And it usually involves what we call rotating flaps, moving tissues. it’s called tissue transfer. So we’ll get a tissue from nearby structure and move it. When we do that, we actually disconnect some of the blood vessels and rely on the remaining blood vessels to carry. So if patients have some diseases, it doesn’t heal well. The tissue that was transfer part of it dies or even do a of free tissue transfer, where we take different parts from different parts of the body and try to fill in the whole. You know, a long time ago, plastic surgeons, the prestigiousness of plastic surgeons is measured by how big a hole we can fill that at once upon a time, that was what plastic surgeons sort of mark with what kind of great plastic surgeon you are, depending on how big a hole you can fill. So for us, yes, our job is to take care of the defect, and in so doing, I realize that patients with chronic disease don’t have good blood flow because the tissues don’t heal. And we plastic surgeons unbeknownst to many people, we live and die by blood flow, meaning that when we disconnect the blood vessels, we’re depending on a few other blood vessels to carry the load. And you know what? We’re always checking for blood flow with what we call capillary feel, we’re touching it, we’re doing to making sure that the blood is refilling. We measure the temperature, we do probes, we measure oxygen saturation to that little tissue that we transfer. So we’re always concerned about blood flow.So as naturally as a plastic surgeon, it’s something that I’ve been thinking about for a long time. And then I came upon sort of this and I said, maybe health, our health is completely dependent on blood flow.

Dr. Kwan – Just to describe what blood flow is. Basically, it starts with a heart, the heart is the pump, so it’s going to pump the blood. Blood comes through the heart, it gets oxygenated in the lungs, and then it gets sent out to the big blood vessels called the aorta. And then that goes down into smaller artery, smaller a smaller artery to smallest arterial. And then it goes to finally to the capillaries, and capillaries is where all the action occurs, because that’s where the cells are going to receive oxygen and nutrients. So blood flow basically exists for the capillaries to pass off oxygen and nutrients to the cell. And if any of these things are interrupted, the cells will not get adequate amount of oxygen and nutrients. And that’s going to lead to all the disease that we know today. And so blood flow to me is the most important thing. And I’ve basically, when I look at the commonality of all these diseases and you talk about heart disease, you talk about diabetes, we talk about even things like Alzheimer’s and even cancer. These are all diseases of the blood flow ultimately. And I can go into very, very deep length about why blood flow is what determines these diseases.

Clint – Yes. Let’s go there in just a moment. Let’s just remind our audience and myself what’s in blood. What do we what have we got inside blood? And you mentioned oxygen being probably the most important aspect of what’s being transported in blood. But what else is in blood?

Dr. Kwan – So blood is made up of the color is the red color is determined by the red blood cells. The red blood cells are sort of this kind of discoid looking circular, discoid looking kind of tissue, and it’s about eight microns in diameter. And this has all these hemoglobin molecules attached to it. All of those hemoglobin, those hemoglobin molecules are what oxygen binds to. So when the red blood cell goes to the lung, the oxygen that we breathe goes and binds to the hemoglobin. So that’s red blood cell, obviously the most important component of the blood. But there is also white blood cells. These are the now these are components of the immune system. White cells are used to as a defense mechanism if there is bacteria, viruses, any kind of foreign material or even toxins. So (inaudible) cells are involved in the immune system. And then there is a plasma which contains various hormones and all the stuff that travels in the blood. So that’s pretty much the most important part of the blood. So this is now all flowing, including nutrients, obviously nutrients. So basically from the heart, it goes to the lung to pick up oxygen and then from the GI system through the liver, it picks up nutrients and then that gets all mixed in the blood, in the heart. It’ll pump that blood to all the cells.

Clint – Yes. Great. Okay. Thank you. Now, you mentioned earlier you went over arteries. I think you mentioned veins, capillaries. So far we’ve learned that we’ve got all of these crucial components in the blood oxygen being the most important that needs. All of our cells need this oxygen and we have the heart pumping the blood and then becoming oxygenated through the lungs and then being delivered through the rest of the body, eventually getting into the capillaries. Now, in short, in the near future, we’re going to talk about how the capillaries can become damaged and broken. You’ve spoken about in your book, and that’s fascinating because I think that is close to some of the issues with joints that we experience with, you know, broken down capillaries and things that we’ll talk about that in a minute. But you talked about disease can impair blood flow. How can our blood flow become impaired? And is the cause of disease or is the disease the outcome of impaired blood flow? How can this impairment occur?

Dr. Kwan – Well, you know what? Earlier on in my sort of research in writing my book. I thought really cholesterol was the devil, you know, we hear the cholesterol blocks, the blood vessels, right? So I think most people are familiar with that high cholesterol, diet or cholesterol in the blood or if the cholesterol is elevated and it’s going to affect you’re going to end up with these plaques. And the plaques can, of course, block the blood vessels. And when you block the blood vessels, you’re going to cut off the oxygen. So I thought it was all about cholesterol, so I chased that cholesterol for a while. Personally, I was on a vegan diet and I thought that you could not eat anything that contained cholesterol. And I realized that that was not right, that was not right. It’s not the cholesterol. Cholesterol is a vital substance that’s made by the liver about a thousand milligrams every day. And it is very important because what does cholesterol do? Well, from we make vitamin D, we make all the hormones and all of these important hormones like sex hormones, like testosterone, progesterone, and it even makes cortisol, which we need in times of stress, and I already talked about vitamin D. So these are absolutely necessary substances that we need for our body. So you can’t just cut off cholesterol, cholesterol is very important. So cholesterol is not an evil substance that many people have dubbed it. But then they say all this bad cholesterol and there’s good cholesterol. Right. And they said bad cholesterol is there what deposits in the blood vessels and they cause problem. But these LDL cholesterol, which are considered to be bad cholesterol, they don’t actually cause these problems because LDL is how our body carries cholesterol. So our liver makes LDL. It carries to our cells, and our cells use the cholesterol. But by the way, LDL is called low density lipoprotein. It’s LDL, low density lipoprotein. They’re both triglyceride the other fatty acids, phospholipids and cholesterol. All of these are used by our cells and it’s absolutely necessary. But the plaques, so what does what causes plaques? And because plaque is very important, because this is what ends up causing problems with heart disease, with strokes, with so many so many other problems.

Dr. Kwan – So plaque is what’s a big issue. And the plaque is not necessarily caused by cholesterol. The plaque is actually caused by lack of oxygen to the blood (inaudible). Plaque caused by lack of blood flow because you see our blood vessels, although it carries see, this is a hard concept or blood vessel itself carries the blood right inside. But the blood vessel is made up a wall, it’s got a covering and it’s a tube. It’s basically our blood vessels are tubes. And it’s a there is a blood vessel wall in this tube. So and there’s a layer and there’s three layers called the intima, media and the adventitia. So there’s three there’s a thickness to the blood vessel wall, and the blood vessel wall itself doesn’t get enough oxygen. When it doesn’t get enough oxygen, then that causes the blood vessels to have problems and when they have problems that progresses to Plaques because it’s trying to heal itself, it’s trying to heal, it’s not getting enough oxygen. So even the blood vessel wall itself, blood vessels itself. The problem is lack of oxygen and nutrients. The blood vessel it does is really it’s really fascinating. So and so, blood vessel wall. I felt that blood vessel wall is even hypoxic. I want to use the word hypoxia. Hypoxia is low in oxygen or lack of oxygen, hypoxia.

Dr. Kwan – So blood vessel wall gets hypoxic and that leads to plaques, (inaudible) plaques, leads to heart disease, strokes and so many other diseases in our body, including high blood pressure. All these are manifestation of plaque and plaque, again, is not due to necessarily elevated cholesterol. And you were talking about veins before arteries or blood vessels that are carrying blood to the tissues. Veins are the blood vessels that carry blood from the tissues back to the heart. So that’s the veins and the arteries are much thicker than the veins. And interestingly enough, arteries only develop plaque. Certain arteries only develop like veins will never develop plaques, viens will never develop plaques it’s just very interesting. Veins are by the one eight to one tenth thickness of artery it’s much thinner than artery, than an artery, and it’ll never develop plaque, arteries do.

Clint – And is that because of the order in which the blood moves through the body?

Dr. Kwan – No, it’s because that’s because, as I said, the arteries thicker and the walls can become hypoxic. Lack of oxygen at all has to do with oxygen. So the arteries are much more susceptible to developing oxygen shortage. The veins don’t have that. So all the diseases that we talk about will have this.

Clint – Ok, so the big question is, how can the body become so deficient in oxygen that even the arteries themselves are oxygen deficient?

Dr. Kwan – Well, that’s yeah, it’s a and that’s an interesting and a great question. And I think this has been debated about what causes a problem, what really caused this problem. And then basically it comes down to chronic inflammation. And it’s a big word, and I think there has been a lot of things about chronic inflammation, people talk about it. Chronic inflammation is. And when I ask honestly, when I ask some of my friends, what is chronic inflammation, even doctors, they don’t even think they said, well, it’s a little redness. It’s that they can’t even really they can’t really describe it. You know, they have a hard time pinpointing what exactly what chronic inflammation is, you know, but chronic inflammation is simply an immune response That’s all it is. Chronic inflammation is just an immune. So inflammation itself is a fancy way of saying immune response. So why do we have immune response when there’s injury? So it’s first of all, this has to be a damage and injury. When there’s a damage or injury, then inflammation ensues after that. Because why when there’s a damage to our part of our body, the only way our body can fix that damage, guess what is inflammation? It’s a true immune response. So let’s say a bacteria enters your body. The way our body can take care of the bacteria is the immune system. It neutralizes it. And then the damage that the bacteria does to our body it heals it by inflammation. Inflammation means it brings in all these cells that’s going to repair that process. And then when that repair finishes, everything leads. Problem with chronic inflammation that’s causing all these problems is that chronic inflammation occurs because our body is getting constantly damaged, it’s getting damaged every day. And why does it get damaged every day? Well, you know, a lot of the bad food pollutants, I mean, things that are happening in our body, we’re doing it to our body over and over and over again. And many of us don’t even realize it, right? When you’re eating processed food, you don’t realize that that’s causing problems, but that processed food enters your body through the GI system. And then it ends up you know, your body has to respond to that because this is bad food and toxins enter it tries to neutralize that. So it turns on the immune response. Well, that immune response will stop soon as you stop eating that. But do people really stop eating the food? They’ll say when they eat it and it’s the next day. Oh, OK. I’m not going to eat the rest of my life. Yeah. If we decide to do that, that’s where, as you see, that’s where things will start improving.

Dr. Kwan – Chronic inflammation is so important. I think we have to really understand what chronic inflammation is actually contrary to, again, what people think chronic inflammation is an important process. Again, you know that we blame chronic inflammation for being bad, but chronic inflammation is absolutely necessary because it’s necessary to take care of the injury. So if there’s injury, we have to stop the injury, but once the injury occurs, we need an immune response to that injury. It just when the injury keeps happening, the chronic inflammation keeps turning on then it becomes bad. Then it becomes bad because it’s a constant immune system is constantly turned on when the immune system is constantly turned down and the damage turns on. And where does the damage occur with chronic inflammation? Guess what? The damages. It’s in the capillaries in the very smallest of the blood vessels, the capillaries gets destroyed. And I’ve looked at a number of research articles on this capillary density studies, and it’s called micro circulation and tissue perfusion. These are all measuring how much oxygen and nutrients are getting to the cells when they look at those smallest vessels. When you have chronic inflammation that completely damage, they’re plugged up to damage that destroyed and they disappear, they shut down. That’s what happens with chronic inflammation. So when you think of chronic inflammation, you’ve got to think in your head. You’ve got to equate that, and I equate it as cells aren’t getting oxygen and nutrients. That’s how you have to think.

Clint – No, it’s absolutely fascinating. And I just wanted to let you know, as you probably don’t know this, but with rheumatoid arthritis, probably 19 out of 20 people, if they don’t eat the three, four, five days, all of the joint pain disappears. And this totally reaffirms what you’ve just said. So this is something that even many rheumatologists don’t know, is that when you actually stop consuming food, the inflammation disappears. And so what you’re saying about this constant abuse to the body is completely accurate. And so you’ve described how and where the body reacts to, say, a bacteria entering the blood. And I think that, you know, all these pollutants are coming in through maybe gut permeability through our digestive system. And we’ve got high fat foods, processed foods, creating dysbiosis and liver problems, which is something you touched upon in your book. And so we’ve got all this going on, and then you talked about how this chronic inflammation just doesn’t stop because the body’s consuming these foods all the time. And when we talk about exercise and some other tips that you’ve got for shortly, we can learn about what we can try and do to offset this and also with diet and so forth.

Dr. Kwan – Yes. Well, there you know, there are so many things that we can do, obviously. But just to just to finish off, I mean, just to reiterate what the rheumatoid arthritis basically is, basically, I think most people kind of know the rheumatoid arthritis is some sort of a disease to the joint. Right. I think lay people would understand it. People with arthritis obviously suffer from joint pain, joint disease, meaning their pain, chronic pain, and they have problems with it literally disabling. They can’t turn or they can’t grab what they can’t do, exercise, they can run, they can walk, right? And basically, when you look at the joints of these rheumatoid arthritis, you can see that the joints are a hypoxic. And we know that there’s hypoxia there. Why do we know that? We even know there’s a special protein called hypoxia inducible factor. It’s a effect, it’s this is a fascinating subject of its own hypoxia inducible factor. Our body triggers it and activates it when the cells are hypoxic, meaning that if there is low in oxygen, we automatically activate this thing called hypoxia inducible factor. And hypoxia inducible factor, we know in rheumatoid arthritis is way elevated where it had been real that it was way, way hell of it. And what’s interesting is in twenty nineteen, the Nobel Prize for Nobel Prize for Medicine Physiology went to a group that discovered hypoxia inducible factor, which is pretty wild, you know, and I’ve been working on the book and I published this book in twenty eighteen, coincidentally. I mean, this is what I study, you know, the oxygen to the cells. And this is basically saying come in confirming what I believe that the oxygen really to the cells is everything in and the oxygen gets there through blood flow. Right.

Dr. Kwan – And this hypoxia inducible factor is way elevated. So you know what happens to rheumatoid arthritis when the hypoxia inducible factor is elevated? What our body does is it tries to compensate. Right? It has to because there is now low oxygen, the cells are going to die. There’s low oxygen, nutrients, blood flow is not so good. So this hypoxia inducible factor, when there’s low oxygen gets triggered and it starts making it starts doing a couple of things. It starts making energy without using oxygen, it’s called glycolysis. So it’s pretty fast and it makes energy and it makes sense because if we in order for our body, our cells to make energy in a very efficient way, we need oxygen. It’s called respiration. It does in the mitochondria, we absolutely need oxygen, if we don’t have oxygen, then the cells will switch off, switch off to making energy in the cytoplasm of the cells outside of the mitochondria, and it makes energy without oxygen.

Clint – That’s incredible.

Dr. Kwan – And the byproduct, however, is lactic acid. And you could get lactic acid acidosis. The other thing that it does, which is fascinating and you see the rheumatoid joints is in our body starts making new blood vessels, it’s called angiogenesis. So in rheumatoid joints, you see all these new blood vessels that are forming because why the joint is hypoxic, there’s lack of oxygen and lack of oxygen is going to destroy the joint and it’s destroying the cartilage and destroying the bones. So our bodies think, oh, it’s being destroyed. So we need more oxygen here. We need more blood flow. Where we can do it is to make new blood vessels. However, the only downside of these new blood vessels that are formed in rheumatoid joints is that it’s formed under hypoxia, and those blood vessels are not any good. They don’t function properly. That’s the that’s the bad thing about this, the blood vessels are not good. The whole idea of making the blood vessels seems like it’s a great way to get more blood flowing there. However, the blood vessels that are formed under that kind of situation, it’s our bodies inate mechanism to do that in order to compensate for this lack of oxygen. However, the new blood vessels that are made in rheumatoid joints, these blood vessels are not good and there’s angiogenesis. So what they’re thinking is, see, immediately the medical community thinks, OK, so if these blood vessels are no good, why don’t we just shut them off? Why don’t we just make a medicine, make a medication that’s going to shut off this angiogenesis and support antiangiogenic medication, antiangiogenic medicine. So they’re just given artificially and you shut off those blood vessels from forming. The problem is, though, it ends up affecting the rest of our body and it doesn’t help to join the joint, doesn’t get any more blood flow because of this. Necessarily what the joints need or what the rheumatoid joints need is oxygen. To me there are right now, as we know and we’ll discuss this, there are a number of good ways to get oxygen into it. And again, again, I think most in the medical community don’t really emphasize this part.

Clint – Can I hold you there? It’s like a dam, and we want to break that dam and go into all of that information. And that’s going to be fantastic. But I just want to just for completeness, I just want to ask you interesting question here, the hypoxia inducible factor. And this is just your opinion. Do you feel that a person’s severity to rheumatoid arthritis could be measured by that factor without seeing the patient, you could tell whether or not that person is going to be terribly symptomatic or only low symptoms? And do you think that in the future it may even be one of the quantitative measurable markers like C reactive protein to monitor a patient’s progress?

Dr. Kwan – Absolutely. Hypoxia inducible factor is something that we can measure. Yes and yes, we’ve found that in other diseases and there even could be some paper even that exists out there about this, because hypoxia, in fact, itself was discovered in 1994, that was twenty six years ago. And doing a lot of work with this, because this is really, I believe that this hypoxia inducible factor is earth shattering discovery really. The Only thing is its application, I believe they’ve been slow on its application because they’re using I believe they’re using sort of old theory and old model. They need to use new model. Hypoxia inducible factor I believe if we use this properly in rheumatoid joints or anybody, anybody with any diseases, I believe if we measure it hypoxia inducible factor and see that it’s way elevated, that the disease severity is higher. By the way, when you actually introduce oxygen to them, guess what happened to hypoxia induicible factor, it starts going down on its own. So, yes, when obviously if the hypoxia inducible factor goes down, then you’re going to that means that the joint is getting more of that tissue is getting more oxygen. Yes, repair and healing is occurring. Yes, absolutely. So I believe hypoxia is and I think I believe they’re already doing to some degree trying to measure hypoxia inducible factor and following disease severity based on hypoxia inducible facor. And this actually also for cancers as well. It’s funny, every just about every disease, if you look at it, hypoxia inducible factor is elevated in cancer and in patients with AMD, it’s called age related macular degeneration, diabetic retinopathy. There’s so many diseases because hypoxic disable factor, basically all it is, is it’s a sort of knee jerk response by a body when the oxygen level is low in our cells, it’s activated automatically.

Dr. Kwan – It has to be activated because it’s trying to adjust and adapt ourselves to live with lower levels of oxygen because the consequences otherwise it’ll die right? Or it can live with low oxygen. And our I think our cells choose to live with lower oxygen right? And it has adapted, it has to adapt and how it makes its energy, and it also has to adapt in many, many other ways. And really hypoxia inducible factor, what’s fascinating is it actually goes hypoxia inducible that when it’s activated, it attaches to the DNA, it attaches to the DNA, it goes right to the DNA attaches, it shuts off part of the DNA and turns on different parts of DNA. This is what’s fascinating, it is incredibly fascinating. So it literally it has what we called epigenetic effect, epigenetic effect. And I don’t know if you’re familiar with epigenetics, you know, genetic. Literally the environment is actually shaping the way the DNA. So am total, I am a total believer that through environment we could actually change the way our DNA behaves. We could actually modulate the behaviour our DNA, we thought the DNA you’re born with the set of DNA, that you’re stuck with for the rest of your life. I believe that literally we can modify the way DNA because we could shut on and off the DNA. Without changing, without causing a mutation, meaning changing the DNA right? We’re just simply turning off different parts of DNA and turning on different parts of DNA. And we can do that, and we know it occurs. And this is what I think this will take to stop this HIF for short hypoxia inducible factor is called the transcription factor. And to just go back to rheumatoid patients, rheumatoid patients have way elevated hypoxia inducible factor and I bet you, like you said, if you want to follow rheumatoid patients as they’re healing with on a certain diet or whatever they’re doing right? Whatever they do to try to get more when they get more oxygen, I bet you it’s clear the hypoxia inducible factor is going to go down.

Clint – Ok, now I’m just buzzing because I’ve never come across this before you. And so is this something that our audience can go and ask their general practitioner for a blood test?

Dr. Kwan – No, You know what this is the early phase of this right now. If they can right now, they can right now. And honestly, right now. General practitioners are a little behind in this right now because I think they’re still pretty much for they have a garden variety treatment for arthritis. And it’s basically it’s all about modulating the immune system, right?

Clint – That’s right.

Dr. Kwan – So what the medical community is using right now, right? Whether Methotrexate or any other immunosuppressants or some sort, whether it’s all of us sort of changing it, treating this sort of the symptoms right? So I don’t think they’re ready for this right now, but I think this is coming on the horizon. And that’s the good news, I think, for a lot of the patients. This is coming right here. And I believe that this kind of stuff right here, this can really change really the course of the disease, not only in diagnosis, treatment, but really curing, I think, even curing patients.

Clint – And it’s really, really interesting. So before we get into and this will be the last thing I know, our audience is like, come on, Clint, just tell him what we need to do about this stuff. And I promise you, just give me one more question here. The question is around the capillaries and capillaries. Sorry about the pronunciation. I’ve just always learned as capillaries. Maybe it’s an Australian thing or maybe I’ve missed learnt. So with that part of the blood delivery, in your book, you spoke about how the capillaries are only the same diameter as a red blood cell, that blew my mind. So so it means that you say that that you explain how therefore the blood flows through the capillaries is very slow to be able to both deliver oxygen, but also withdraw some of the toxins and clean the area in which it’s passing.

Dr. Kwan – It’s fascinating this the amount of capillaries that we have in our body, because that’s really all these blood vessels exist for the capillaries basically. This is where all that is occurring right? That’s I call this the most important swap system in our body. It’s the most important swap. We have just about almost unlimited amounts of capillaries because the blood vessels essentially at the end diverges out into millions and millions of capillaries to reach every single cell in our body. And then these capillaries, they’re so tiny that literally one red blood cell, which is about eight microns wide in diameter, eight microns of capillaries are just about that. And sometimes even those smaller than that, the red blood cell literally has to shape reshape itself to squeeze through. And it’s designed specifically that way because the blood flow right there, right there through that, it’s slower pace and it’s allowing the exchange occurring. That’s where then the hemoglobin from the red cells can actually exchange through the capillary wall, which is very thin endothelium, a very thin lining through the cells. It could pass off its oxygen and then also the nutrients from the bloodstream and then, of course, from the cells, the carbon dioxide will come into the capillaries as well as some of the waste products. So it’s a great swap system that’s what occurs. And it’s very it’s a very slow rate, very, very slow movement right there, all the other parts of fast and then it slows down in the capillaries. Then, of course, it shuts right back in a speedy fashion, you know. So, yes, capillaries are the most important system. And this is where, as I just want to reiterate again, this is where inflammation really affects these capillaries are easily destroyed by their very thin wall and the capillaries are very sensitive. So it’s easily damaged, it’s easily damaged. So even high blood pressure, for instance, if you have high blood pressure to stay for a while, capillaries shuts down. Capillaries can’t withstand that higher pressure. So people with high blood pressure, his is one of the big problem, Capillaries literally shut down. So they end up having oxygen problems to their cells as well, people with high blood pressure. That’s why high blood pressure must be treated in all patients. And so many people have high blood pressure that’s untreated. And so many people, even age of starting age of 50, 60, so many percentage of the population have high blood pressure, some of capillaries, we must preserve the capillaries. So we need to protect it and we need to really optimize it. And that is stopping inflammation.

Clint – Yes, right. I say, OK, well, let’s talk about that. How do we stop this inflammation? You and I have spoken about diet before and there’s so much opportunity and stuff we haven’t talked about yet. You’ve got many, many tips in your book on how we can improve our blood flow. And I’m happy for you to just give us some of those in whatever importance you believe to be the hierarchy. If I may take a guess, it would appear to me that exercise going to be quite near the top of that list,

Dr. Kwan – Right? Yeah, well, you know, as you found out yourself in your journey, a diet is a very important diet is medicine, food is medicine. And again, I think many of the doctors and medical practitioners sort of don’t take this as seriously and maybe some of them are coming around to this. But we know that food is medicine. I mean, in and out of that medicine does a lot of bad food out there, as we know, a lot of food that are inflammatory foods. So when we talk about like food in general, as you’ve been on it is what we call sort of quote-unquote, “anti-inflammatory” food. And these are unprocessed, not unprocessed food that a whole food diet, basically, that we get from Earth right into our mouth and into our stomach, right? Unprocessed, untouched by man or maybe lightly changed, but we don’t want to add all kinds of chemicals in all of these processed food. Honestly, it’s not even food, it’s chemical. So we’re actually consuming chemicals and they’re highly inflammatory. Soon as they enter into our bloodstream. And not only for people with rheumatoid arthritis, but every patient out there, every person out there, when they consume this kind of diet, it’s going to cause inflammation. And inflammation manifests itself, maybe not in joints, in non-rheumatoid patients, but it’s going to manifest itself in the blood vessels can manifest in their vision, in the brain and in their heart, every part of the body, so they can end up with diseases. They’re going to end up with diseases because of inflammatory food. And again, it’s one thing if we eat inflammatory food one day and then say, OK, that was it, maybe I’ll cleanse myself and not eat this for rest of the year. We don’t do that, though, we continue to consume the same inflammatory food day in, day out. And the result is basically we stay in an inflammatory state. And so, yes, food diet is number one thing, number one.

Dr. Kwan – And the other thing that I think also is a very big trigger for rheumatoid patients is smoking. Smoking is a major no no. And I believe smoking is probably one of the worst things that you can do for yourself voluntarily. Sometimes food, we’re eating it. We don’t even know that it’s damaging us. But we clearly I think most of us understand that smoking is clearly not good for us. It robs our every cells in our body of oxygen, it robs every cells. And it does it in a number of different ways, and I talk about in my book, Nicotine Causes Vasoconstriction, meaning it tightens the blood vessel so the blood doesn’t flow properly. Carbon monoxide, that’s in the smoke itself, Carbon monoxide will bind to our hemoglobin and lower the oxygen in our bloodstream. And then there are 7000 chemicals that are in each cigarette. And which of 70 of them are known to be carcinogens, 70 are known clearly to cause cancer. So seven thousand chemicals, and these things are massive inflammatory agents. And we know that in medicine, when I was training, in surgery, in my specialty in surgery and plastic surgery, we know that you know what? When patients have many of these patients who are smokers had heart disease, strokes, they end up with limb amputations, they have kidney disease, they have all and they have cancer everywhere in their body because smoking again, people think smoking only affects the lungs, no smoking affects the blood vessels, it affects the blood flow. Smoking really affects the blood flow. And for any patients who suffer from rheumatoid smoking, it is going to rob their joints of that much. They’re already suffering from low oxygen in their joints. Smoking is going to even lower there and it’s going to cause even more inflammation. So when I see people smoke, I kind of cringe because then and it’s not even smokers, it’s secondhand smoking. So if your father, your brother, your wife, whoever smokes around you, it’s going to affect you as well. So it’s not even smokers themselves, it’s even secondhand smoke. So I really this is a this is something that I know the smokers have a difficult time because they’re they have certain addiction or habits and it is very difficult to break. I know in certain cases, but it’s better not to start this just the smoking habit to begin with. Right. That’s the best. It destroys every blood vessel. So just remember, it’s not the lungs. People say, oh, you know what? No blood vessels that they’re destroying circulatory system. And that leads to just about every disease known to man. And especially it destroys the blood vessels in our cells will be deprived of oxygen and it ends up leading to all kinds of cancer. Just about increases risk for every cancer that we know.

Dr. Kwan – So diet, good diet, smoking, not smoking. And, of course, stress. And again this is a sort of a hidden, I think, hidden thing and you touched on this, you know, stress causes Leakey syndrome and problems with our gut, as you know, and obviously we know that it’s going to affect our GI system. And it’s going to cause depletion of our good, good bacteria and it’s going to change the microbiome of our gut. So we know that that’s going to be an issue, stress does that. And people, again, don’t really give stress enough credit. And pretty much I think all of us have stress one form or one of the right one form. So we navigate this society and it’s difficult to live without stress. You know, and I myself, living in New York area, there’s a lot of stress due to many different things right? Whether it’s financial, marital, there’s everything going around to relationships. So there’s a lot of stress. But so I don’t think we could eliminate stress is that I think what we can do is to try to minimize it, doing it, I think through yoga, meditation, prayer. I think this is a great strategy in trying to minimize the stress that we have. You know, and I think this is really more important than people think. And stress clearly stress, you know, that when we have stress, it increases cortisol and blood sugar in our body. People are stressed, the blood sugar goes up, you know, because stress, remember, is an old mechanism. It’s a fight or flight response to stress mechanism. It’s a fight or flight response, meaning the stress is actually good, you know, in our caveman sort of our ancestor cavemen, they used stress to their advantage. You know, when they’re attacked by a predator, they had the stress and everything went up, including the blood pressure went up. They did all this and the sugar went up. You know, cortisol levels went up so they could deal with that immediate, right? They’re trying to fight off this animal. And it was good.

Dr. Kwan – However, that stress, by the way, that our caveman ancestors dealt with stress that we have may not be physical stress necessarily. It’s a mental stress, but our body processes exactly the same way, same way. So it affects the blood flow. Stress ends up actually reducing oxygen to our cells, because it affects the blood vessels and it destroys our blood vessels. So it’s important, I think, to try to minimize or deal with stress, whether you and again, there are different ways. And lastly, I think one of the best ways, the way I deal with stress is exercise. Yeah. And it’s sort of like mimicking. I say in my book, it’s sort of like exercise sort of tricks. It’s like when you exercise, it’s like running away from stress, you know, running away from that danger. So it’s kind of I feel like exercise does two things. You know, it literally during exercise, your blood vessels open up, your body pumps more blood flow and oxygen clearly gets to your cells much better. We end up lowering the blood sugar in our body. When you exercise, the sugar levels go down, that’s clear. It’s one of the best way to control sugar, by the way, exercise. So the sugar is again, you know, high sugar is what can cause problems with blood flow, excessive sugar. And, you know, we have in our society way too much sugar consumption, everything sugar. So having a high sugar diet is a major, major problem with the blood flow. And so exercise can actually counteract a lot of that. It even lowers the sugar, even exercise opens up the blood vessels and actually opens up the capillaries. It actually opens up the capillaries and it actually induces angiogenesis, increases blood vessels in our body. So we end up even getting more blood flow, more blood vessels. So exercise is good and so many ways, you know. And on top of that exercise obviously makes you feel better right. Through those I mean I mean, you could argue about this whether it really causes mood elevation through this sort of neurotransmitters in your brain. But I mean, there’s been both argument, but any which way you look at if you get increased blood flow to your brain, you know, that exercise increases blood flow to your brain.

Clint – Well, that’s brilliant. So we want to get our diet right. We want to make sure we don’t smoke, which fortunately most of our audience won’t be smoking because they’ve been you know, they’ve got a high level of consciousness. We’ve got to reduce our stress, which plays such a massive role. And it’s underappreciated that you’ve pointed out leads to leaky gut and all sorts of reduction in blood flow and then exercise. We want to do to open up those capillaries and have all the other benefits you say. I like to say that exercise gives you stress reduction for free because you’re exercising. And I read a book by a guy who talks about Ultra Marathon running and he says, you show me one person that’s stressed when they’re 10 kilometers into an ultra marathon, know like it’s just not possible, right? So I love those four big sort of headline sort of areas. And I know in your book you go into a lot more detail as to why. And the book is fascinating as to how each one of these aspects plays such a crucial role in restoring our blood flow.

Clint – finish up with just some sort of you know, these might not be sort of short answers, but just I just want to get your opinion on some of these concepts that I’ve had in my mind for many, many years that I would like you to sort of refine or correct or give me a tick and see whether or not I’m on the right path here. One of them is that with joints, when you create a tourniquet effect and cut off the blood flow to a joint foot, by way of example, I’ve always found that I have recovered from some creeping or developing inflammation in my fingers by hanging from an overhead bar. And by doing this, I guess I’ve had to develop a really good grip strength to be able to hold my bodyweight. If I hold longer and longer periods, I noticed that my joints in my fingers start to let go of any sort of creeping or trying to develop inflammation. And in yoga classes, often teachers will say that if we sit on our knees in a Japanese style where our now our heels are touching our buttocks, if we’re lucky enough to be able to do it, that the tourniquet effect again applies through the knees where there is a whitening or a, you know, a sort of a lack of blood flow to the knees. And then when we relax and lie down, then quickly we get a fresh flow of blood through, in this case, the knee joint. And so this long set up is just to say, do you feel that when we cut off blood flow by through our fingers, by hanging or by sitting down and then we open up that joint and allow a complete relaxation through the joint, does there is there a flushing effect of joint of blood flow?

Dr. Kwan – I bet you there is. I mean, there are, I mean, it’s called the reflow phenomenon. You know, when you apply a tourniquet, for instance, and then you go, then you’re literally opening up and the and the blood vessels and the vessel dilating. Yes. So there is I mean, when you come in from the cold, for instance, you know, your blood vessels or the dilate and you get increased blood flow. And some people believe that going from hot water to cold water sort of and that really affects the blood flow. Yes, I believe that there is such a thing as reflow phenomenon where literally you’re going from cutting off the blood flow to letting it go and then you get a rush of blood flow. Yes. You know, there is some merit for that.

Clint – Okay, wonderful. My next question is we talked about diet. One of the specifics that I’ve observed personally and with virtually everyone that I work closely with inside my support platform. Oils, particularly heated oils, oils that have been used in restaurant cooking and stuff cause a lot of inflammation in the body. One theory I have around that, as well as oxidative stress, one theory that is relevant to you. Do you think that some of the fat from the diet is getting into the blood and causing the blood to become, for want of a better word, more sluggish or slower? And this can slow down the oxygen delivery?

Dr. Kwan – You know, I’m not sure about that. Honestly, I’m not sure about that. But I do believe that it can lead to inflammation to certain types of oil, yes. Can lead to more exaggerated chronic inflammation. And I believe, obviously chronic inflammation is going to cut off the blood flow. So absolutely. I think, you know, so that’s I think it depends on the oil. I think that’s why there is certain I mean, when you talk about, you know, omega three different types of oil out there that come in. So I think there is some merit again to that. So I think we have to be careful about, you know, exactly what we eat can’t just eat everything we want, right?

Clint – Yes. OK, thank you. And then what about if we have cold extremities? You know, the lay understanding of this is that you’ve got bad circulation because your feet are cold and your hands are cold in winter. What’s really going on there? And is that really actually a health problem? Is that a lack of blood flow or is that something else?

Dr. Kwan – You know? No, I have cold extremities myself here and there. It’s just that, yes, what happens is we’re trying to. But when it’s cold outside, what we’re trying to do is or in a cooler room, especially if you’re thinner. We’re trying to preserve the heat to our core. So we want to maintain a central core temperature. So we do that at the cost of our peripheral circulation. So, yes, just because you have cold hands and feet, fingers and feet. Is not indicative of poor circulation. However, if you have bluish finger, you have blueish finger where it’s numb and you have a certain that could be a poor circulation. Yes, not necessarily cold though. Cold is because I think of many of us are cold intolerant, and especially as you get older, you become cold intolerant. And that doesn’t necessarily reflect the poor circulation.

Clint – Right. Right. OK, great.

Dr. Kwan – Only, you know, what I do want to talk about is one thing I do want to talk about is what’s in the future, sort of.

Clint – Yes, please.

Dr. Kwan – As I say I’m on oxygen. I think oxygen is one of the most important thing. We’ve all done oxygen. And I think oxygen is absolutely necessary for us, therefore, to talk about just getting how to get more oxygen. All these things that we talked about are hard things, you know, changing your diet, exercising, stress reduction. All these things are not something that you can do overnight, and it’s very difficult for many people to do. So how else can we do it? I think we can there could be on the horizon right now. So some people even ask me, can I try hyperbaric oxygen therapy?

Clint – Yes, please

Dr. Kwan – Healing oxygen, right? Is that going to help or can I go and just inhale oxygen and get an oxygen tank and do that? Well, the problem with that is, while it may help a little bit to the tissues that are suffering from lack of oxygen, it’s actually hurting other parts of the body, especially like hyperbaric oxygen. For those people who don’t understand, hyperbaric oxygen is infusing hundred percent oxygen in a high pressure environment. So essentially forcing oxygen into your body. While that may help with somebody who has like a wound that’s in the leg, who’s a smoker or a diabetic who has a wound, you obviously get more oxygen to those area. However, it’s at a cost. You’re actually damaging to the airway and all the other tissues because they’re getting way too much oxygen. There is such that we talk about hypoxia, but there is such a thing as hyperoxic injury, too much oxygen, and that damages cells as well. So it’s not such an easy answer just to say let’s infuse us with, with or inhale high oxygen and that’s going to help us. And these oxygen bar called the oxygen bar where people can go and inhale oxygen, those kind of fads back in, I think the 80s and so forth. So that’s not really a remedy for this. However, what is on the horizon is what we call oxygen micro bubbles. This is to me what’s going to be the wave of the future in some way, oxygen, micro bubbles. It’s a way of delivering oxygen to your tissues, bypassing this method. Which means that what they’re doing is in the lab and they’re doing this right now. They’re actually making these micro bubbles that are almost a size just smaller than the red blood cell to smaller than the red blood cells. But there may be quarter the size of the red blood cells, half the size of the red blood cell, the line lined with like this lipid layer. And they infuse oxygen inside and they bubble this stuff and they actually make these little bubbles and they inject it into your body. And these can safely traveling your bloodstream without causing oxygen injury. So it’s traveling like it’s sort of disguised and hidden and it travels to all the cells. If you don’t use it, if you don’t do anything, it just gets it disappears. It is about body washes it out. However, if you point the ultrasound device that you could burst these bubbles by bursting these bubbles, it releases the oxygen to those areas that are lacking.

Dr. Kwan – So I believe that this to me is going to be a solution, part of the solution for many people, for even for patients with rheumatoid arthritis, I’m thinking about this. And I was thinking about this, literally injecting this into our bloodstream. And it’s going to go to the joints by releasing these oxygen microbubbles we’re actually delivering the oxygen. And what the studies have found, real scientific studies have found this, it’s not so much the oxygen is more oxygen is getting there.It’s just that what when you introduce oxygen to those areas that have low oxygen, the blood vessels gets fixed, the blood vessels that’s been damaged now becomes normal. Then our body can use our circulatory system and blood flow to deliver oxygen to that area. So do you follow me?

Clint – Absolutely.

Dr. Kwan – So we’re fixing the damaged blood vessels that the like rheumatoid arthritis have damaged blood vessels in the joints, clearly damaged blood vessels. If you could fix those damaged blood vessels, then blood flow will carry oxygen and you’re going to end up repairing and reversing that rheumatoid joints. I believe that this is the way this is sort of the future for the audience. I think they can read about this if they (inaudible) bubble, but they can read about this. But I think this is coming in the future.

Clint – Yeah, that is awesome. What a positive way to wrap up. You know, I really have gotten so much out of this, our time has flown. I appreciate it, we’ve gone a little over what we agreed. And it’s because I’ve just been so engaged and so interested. What a fascinating book you’ve put together. And thank you for sharing some of this information with us on this podcast. I would love to invite you into. Have you come back at a later date, perhaps as part of the summit? We might do or something like that if you’d be interested

Dr. Kwan – Absolutely I will be there.

Clint – Thank you. I think what you’re doing is absolutely fantastic and I encourage everyone to go and buy Let It Flow by Dr. Kwan, it’s on Amazon. The content, if you like what we’ve talked about, then you will love what’s in the book, it just goes into more detail. Dr. Kwan’s written it in a way that’s easy to understand, even for us without medical backgrounds. But having said that, he also has a huge reference collection at the end of the book. So if you want to cross-reference or go and research further some of the things that he has mentioned, you can go and find the scientific studies on PubMed and see them for yourself. And it’s just a fabulous mix between medical science, his own personal observations and research and application and what you can do about it. So, Dr. Kwan, thank you so much I’m just so pumped. Thank you.

Dr. Kwan – Thank you very much for having me here.