Michael Roizen, MD: You're listening to you the Owner's Manual Radio Podcast on Podcast Health. That's where you really should get all the medical podcasts you want, as well as Radio MD or iHeart. Thank you very much for downloading us. No matter where you got. Us from, I'm Dr. Mike Rozen, your host.

This is podcast 1267 B, And the bees are great guests And we have one for you today if you're interested in preventing a stroke. And of course I am very interested in that topic myself. It's one of the things we try and get for all our executive health patient's, as well as probably everybody we see, and our guest is a expert, is a triple boarded neurologist, a vascular neurologist, and a interventional.

neurologist, Jeremy Lif, LIFF, who practices on Long Island, but is an expert at NYU in this subject by the way. You can find more about him at www jeremy L-L-I-F-F md.com. No punctuation. Jeremy l md.com. Jeremy, how did you get into this field? What drove you to to get into vascular neurology?

Jeremy Liff, MD: thank you for having me. First of all, I guess I was always interested in the brain as a kid, and, when I eventually went to medical school and decided to become a doctor, the all of the brain courses were the ones that were most interesting to me. I actually, before I went to medical school, I, was able to, Participate as a research assistant up at Columbia And the Neurological Institute, and they were doing a lot of research in terms of strokes and cerebral localization.

meaning how do we figure out what parts of the brain, control what parts of activity based upon people that have had strokes? And I was absolutely fascinated by it. So I was kind of primed when I went to medical school. And then from there I just trained in neurology And then, just went on to formal training in, in vascular neurology.

So, and here I am.

Michael Roizen, MD: Fantastic. so if you had to say what's the. Key. we know that blood pressure is important, but what are the other keys?

Jeremy Liff, MD: Yeah, certainly blood pressure. I think, eliminating toxins and eating the right thing. So obviously, smoking a cessation of smoking is, the big one. I think in terms of younger patient's, vaping now is a big deal and it would be great if people just stopped vaping and looking at it as if it's some sort of, benign way to switch out your cigarettes.

It's not. but then in terms of, diet, I think, more and more. The importance of. Eating foods which do not, lead to insulin resistance, so low on the sugar, low on the processed foods, and really, being in a, situation in which you don't develop pre-diabetes or diabetes. And if you do, making sure that it's totally under control.

I think the patient's that I have seen, we've had the most strokes, especially the small strokes, and had their brains riddled with, small strokes are. Really the ones who have diabetes and don't have it controlled at all. So I think that's probably the most important thing after blood pressure.

Michael Roizen, MD: Now there was an article, I think just, a week or so ago on, even sugar substitutes being associated with. Mini vascular strokes in the brain, is that due to inflammation or is there a specific vascular phenomenon?

Jeremy Liff, MD: it's interesting, it's like the, substitutes that we've developed and thinking that Those are healthier ways because maybe they don't spike your insulin, they actually can lead to certain metabolic dysfunction, which ends up. Leading to inflammation and ended up leading to atherosclerotic disease in, in a similar fashion. and sometimes it could be even worse.

I remember even when I was a kid and they talked about NutraSweet, they were talking about it in terms of, leading to possible cancers. But now, like 30 or 40 years later, we know that even the substitutes that we use can lead to, inflammation. And some of them, I think Truvia, has, additives to actually make the, substance into it looks more like sugar and actually can make you hypercoagulable, actually can lead to, clotting.

So you have to be very, very careful.

Michael Roizen, MD: Right. That's some of the sugar. Or alcohols increase the clotting risk. what role does baby aspirin play? So we have a series of questions people often ask us about preventing strokes, and they talk about the, GLP ones, the statins and baby aspirin. Can you cover those? Should everybody think about any, everybody who.

doesn't do dangerous, activities such as skiing without a helmet, should be everybody like that. Be on baby aspirin for stroke prevention, who was over the age of 50.

Jeremy Liff, MD: not necessarily. I think first of all, it needs to be a case by case. Your doctor should be the expert in deciding. Even if you take a baby aspirin, there really is not much recommendation in terms of primary stroke prevention. Meaning you've not had a stroke or TIA before and you're trying to prevent the first-time.

in terms of taking aspirin, certainly, secondary stroke prevention, oftentimes the bedrock of medication is aspirin. Although if the reason for your stroke was something like atrial fibrillation where you had a large cardio embolic event, then you might. End up being on something like anticoagulation, and not aspirin and not the combination of the two.

so I wouldn't just start taking it per, prevention. It can lead to side effects like, gastritis and like bleeding, as you know. and if there's no indication, you shouldn't initially start taking it in terms of statins. You know, the recommendation certainly is that, most people that end up having a, thrombotic event, whether it's cardiovascular or cerebrovascular, end up on a statin.

But, certainly I don't think it's something you should just start taking, without knowing much about your cholesterol picture or having had any previous issues, especially not before you consult with your own physician who should know a lot more about you specifically.

Michael Roizen, MD: And people always ask now about the GLP ones. Since the articles have come out that independent of weight loss, they prevent some serious problems, is stroke one of them?

Jeremy Liff, MD: Yeah, because, you're talking about increasing your ability to process glucose, decreasing insulin resistance. So just as we said before, at the very least, indirectly, that could lead to a decrease in stroke risk. it's funny, I was just seeing a patient today who was wondering if they were suffering from, they were having some eye issues.

And, and as we know and as we learn a little bit more about the side effects of, these medications, a very, atypical form of eye changes, can occur. I said, well, you know, you do need to see an ophthalmologist, but, both myself And the cardiologist and he had lost about 70 pounds and his A1C had dropped.

I said, I would make sure that that's actually what's going on before you change this because it's done so much good for you already. know, in any medication it's, risk benefit. But yeah, it's been a pretty large game-changer in terms of lowering the risk of, diseases that come from insulin resistance.

Michael Roizen, MD: We're talking with Dr. Jeremy. Lift website is Jeremy, J-E-R-E-M-Y-L-I-F-F md.com. Who practices on Long Island, a vascular neurologist, about stroke prevention. so the hallmarks you've said are some lifestyle changes. if you are overweight, but avoid sugar syrups, added sugars, processed food, how much does that decrease your risk, compared to being overweight and having a sugar habit.

Jeremy Liff, MD: good question. it speaks to the idea that you could have subcutaneous fat and overweight, but not have. Potentially visceral fat. There are healthy obese people and there are non-healthy, normal weight people. And it has more to do with the amount of visceral fat or the fat that you've packed around your organs, like your liver, and your heart, than it has to do with how you actually look on the outside.

I think that if you're overweight, there's no question that. Losing weight or doing whatever you can to lose more weight. Can't be hurtful if you do start to exercise when you haven't. But there's also no question that there are much more refined ways of looking at your metabolic function than just knowing how much you weigh.

And if you are eating better, and you're laying off the sugar and you're laying off the high-fructose corn syrup And the other things that poison our liver, then you're doing better. Than if you are doing those things, even if you're at the same weight.

Michael Roizen, MD: I always feel like, maybe there's something I haven't asked you that you wanna talk to us about. Is there.

Jeremy Liff, MD: I guess I would just say in the spirit of, stroke awareness day, that, if you do, End up experiencing the signs or symptoms of a stroke, which essentially are the painless onset of sudden dysfunction, painless and sudden, like visual changes, weakness or, numbness on one side or sudden imbalance that you should seek, medical attention immediately, even if it went away with after a few minutes, or it is.

Hasn't gone away, but it's minor. You should still seek medical attention as if it's major because it could become major very quickly. And, getting to treatment, is the most, helpful getting to treatment as soon as you can is most likely to, lead to a good result.

Michael Roizen, MD: That's such a great point because as we say, time saved is brain saved, so thank you very much for bringing that up.

Jeremy Liff, MD: Sure.

Michael Roizen, MD: You've been listed. To, Jeremy li LIFF md.com is his website. He practices on Long Island. He's out of n nyu. talk about. Stroke prevention, and I think we talked about lifestyle changes that involve things that reduce your sugar consumption and your sugar substitute consumption, managing blood pressure and cholesterol, and working through your primary care physician to talk about cholesterol management And the GLP ones One of the great points he brought up is remember if you have painless, lack of function of one side or another, or, difficulty speaking or funny face on one side, get help fast.

And so you should know where your nearest stroke. Treatment center is, especially if you're over the age of 45 or caring for someone who is, this has been Dr. Mike Rozen, you, the owner's manual podcast 1268 B the Bs are always, wonderful guests like Dr. Jeremy Li, the a's the latest medical news of the week And what it means to you.

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