353: REWIND | Journey from Surgeon to Plant-Based Advocate: Unveiling the Vascular Specialist's Path

Hi Friends Maya here again, over I welcome back to another episode of the segment we call doctor in the house. Today, you're gonna hear some of the highlights some of the insights as to what Dr. Riz comes on the show to share about. And just in case you're not familiar with Dr. Riz, he is my husband. He's a vascular surgeon here in the Dallas area. He has been practicing now, gosh, probably over quote close to 30 years. And he has a vascular practice. But he also services to hospitals in the mesquite area in Sunnyvale. And so, our goal with having this segment of doctor in the house is to give you nuggets, soundbites, important tips that you can do to take control of your health. As always, my friends, I thank you so much for tuning in. And I hope that you enjoy this segment. This is the healthy lifestyle solutions podcast and I'm your host Maya Acosta. If you're willing to go with me, together, we can discover how simple lifestyle choices can help improve our quality of life, and increase our longevity in a good way. Let's get started. So I am a first generation American, my parents came over in the 60s My dad was also a vascular surgeon. He's passed away a few years ago, but he had come over to do his training in surgery. And so I was born here and as a first generation American, there's often these expectations that you're going to excel or and the son of a doctor, he you're gonna become a doctor. So there was always this kind of thing in the background as I was growing up. And, you know, I was a pretty studious kid is, and you know, did well in school. And so even by the time I got to college, there was this kind of expectation. Now, funnily enough, I got to college, university around the time that computers were starting to become a big deal. Back in the late 80s. Apple Computer was there the PC was there. And I had a strong interest in computer. So I kind of summed thumb, my dad by saying, hey, no, I'm not going to be pre med, I'm going to go computer science. And so I was computer science major for about a semester, before I, you know, really did decide that I did want to go into medicine. So I became a pre med guy and, and later on later on in college, and then went on from there. And it was always this kind of thing where, yeah, I guess I have my father's son, there's some characteristics of a surgeon, I'm pretty obsessive compulsive, which is good, you know, when you if you want to be a surgeon and

and I enjoyed the concept of where if I did something that made a difference immediately. Surgeons kind of enjoy that cutting out disease or fixing something. And so I enjoyed that concept. So I did naturally evolve into surgery. And then then the next natural step was to follow in my father's footsteps, and I became a vascular surgeon. And then I came back to Dallas. This is where doubt my dad had done his vascular surgery training. And this is where he had settled down. And so I came back to Dallas in the late 90s. And joined him the pathway to a specialist is you have to do general surgery first. So I did five years as a general surgery and, and if you want to, yeah, if you want to specialize, it's pretty competitive. And you have to do well. And that's kind of the way it is, at every step of the game is if you want to go to the next step, you have to continue doing well. So then I did a two year fellowship in vascular surgery.

And so seven years, I so I, you know, the Met my medical education was four years of med school, five years of general surgery and two years of vascular back when I did vascular, there was a one year fellowship and a two year fellowship. And the one year fellowship was a more straightforward, just a surgical fellowship. And so when you when you finished, as a vascular surgeon, you just had those that skill set to operate. And I chose to go to one of the few places in the country, that was a two year fellowship, because they had incorporated some of the newer cutting edge technologies in minimally invasive vascular stuff. Our mentors are everything in our lives. And I had some very good guidance. And one of my mentors had kind of, you know, when when we were sitting around and talking about what should I do one year, should I to two years, and you know, by the time you're in your mid 30s or early 30s? You know, you can go gosh, do I really want to do another year? Or do I just want to finish and finally start making a living, but he had said, No, go do the two years, you're still young, and you'll appreciate the new technologies that you're learning, it'll prepare you for the rest of your career. And he was absolutely right. And,

you know, one of those mentors was my dad, but I had other people who were helping me and so I chose to do the two year fellowships where I learned some of some of the newer cutting edge technologies and, and and that just allowed me to get the foot in the door back in the late 90s because things have just changed tremendously in the last two and a half decades. If I hadn't done that training, I would have been so far behind. It always allowed me to take the next step and do and take on the next technology and the new developments that were coming in a vast

or surgeon is, is a surgeon who operates and treats diseases of the blood vessels, which would be the arteries, veins and lymphatics everywhere in the body except the heart and except the brain, the heart surgeon and the cardiologist treat the heart. And the neurosurgeon would treat the stuff inside the brain. So I take care of everything else. And so that might mean a carotid artery for someone who's had a stroke or an aneurysm in the belly, or blockages in the leg arteries for someone who has gangrene or you know, might be losing their leg or has leg pain, and then also a treat disorders of the veins and lymphatics for people who have varicose veins and, and leg swelling. And then I mean, that's the kind of the gamut of what a vascular surgeon treats many of us then focus our time and and sub specialize in things. And my my area of focus is limb salvage. So the majority of the work I'd say about 70% of the work I do has to do with the lower extremities, the legs, and cleaning out arteries, bypassing arteries trying to save people's legs, the rest might be an aneurysm in the belly, or a carotid artery surgery or something like that. So all of my patients are are very sick, in the sense that they all have chronic disease. Because it's a constellation of chronic diseases that leads to atherosclerosis, at least 50% are diabetic, maybe more, every single patient who walks in my door has either diabetes, or hypertension, or hypercholesterolemia, or some combination of those things. So atherosclerosis means hardening of the arteries. Anthro means artery and sclerosis means hardening. And that's

basically the atherosclerosis, the medical term for the deposition of plaque into the arterial wall. And as that plaque gets thicker and thicker, it narrows down the opening of the artery and restricts blood flow. And so whatever that artery is supplying is then affected by the blood flow. So atherosclerosis is kind of a slow, indolent, insidious disease, it starts when we're very young, and but it doesn't have impact on our lives until we're older. Because it's like sludge building up on the inside of a pipe. At first, a little bit of sludge isn't going to slow the flow down. But as more and more and more builds up, you kind of reach a critical point where the pipes get clogged up, we used to kind of characterize it as a disease of older people. And that's because that's the ones who get treated. But it is a disease that starts when we're very young. And I like to talk about this because, you know, in educating people about their lifestyles, and how you can make changes I want them to understand it starts when they're young. And so if they make those changes when they're young, they can affect the impact, the long term impact. And a lot of this wasn't really taught to me and my fellowship, a lot of this was stuff I learned afterwards. And when I started to learn about lifestyle, and its impact on on chronic diseases, but one thing I learned about it was a study done on Korean war vets who had been killed in action, darn near 80% of these vets had beginnings of atherosclerosis in their arteries. What and these were, these were autopsies not on Korean war vets killed in action. And the surprising thing about that 80% Is that the average age was 22 years old. So what we learned from that study is that atherosclerosis is present by the time you're 22. And of course, these were called what were called fatty streaks and the beginnings, but that's where the disease begins. So it's starting back in our 20s. At that point, that's what we thought that's in the 1950s. Because that's when the Korean War was. And actually, you know, I like to make this point is that our diet wasn't that bad back then, if you fast forward 70 years now to where we are today, our diet is so much worse as a as a society than it was then. So if if they were getting diseased in their 20s Back then think about what people are getting today. And that has been confirmed in various ways. There's been some autopsies on pre pubescent kids who were killed for one reason or another. And they there's we've seen fatty streaks in them. And then I learned something from a colleague of mine. She's a maternal fetal medicine specialist, MFM. She's from Houston, and she was giving a lecture one time, it's something that we were both talking at. And she talked about how they're seeing fatty streaks in utero. So basically, the child while the woman's pregnant is getting fatty streaks based on the diet of a woman. And this is reflected in what I see, in that when I started my practice back in the in the 90s. The average age of my patients was in the 60s and 70s. Now you fast forward 25 years, and it's not unusual for me to see patients in their 50s and 40s. I've been treated treated people in their 20s. And I'd say the average age has decreased by nearly a decade. In just the 25 years I've practicing. I'd say the average age of my patients is now in their early 60s. I can distinctly remember a 28 year old who who I had to treat. Wow. And she uh, you know, she had been afflicted with juvenile diabetes. So she was already behind the eight ball, but she was also very non compliant in her

Her lifestyle in treating her diabetes. And then she developed hypertension and a constellation of diseases. And before you knew it, at 28, she had

limb threatening. I remember her very distinctly this was a decade ago, but limb threatening issues with with both her hands and her feet. Yeah, I think many people think of these things as a disease that is of that person of that age, but they don't realize that it started a long, long time, the building blocks with the foundation of it started a long time ago, in in our habits and the way we treat ourselves when we're younger, by the time they get to me, their arteries are so bad, you know, lifestyle changes aren't going to make the gangrene go away, or the stroke go away. So they do need oftentimes continue to need the the intervention or treatment that I can provide for them as an emergency stopgap measure, and I do call it filling, filling holes and putting out fires.

But that's what I'm doing. And so the then the real change I talked to him about is you know, start changing your lifestyle very, very much very, very central that is nutrition even my patients before I operate on on my tell him if you can change your lifestyle before I operate on you, you're going to be in a better place and and better health and have less complications. So for for me making those changes is important.

At any any age in life. So you know, I've always been very focused on my, my personal fitness. And but I had this kind of

same thing that most Americans do thinking that fitness and health are mostly related to exercise. So for all of my life, I've been a big time runner weightlifting since I was in high school and running. I used to run 30 miles a week on a regular basis. For many, many years, I've always been very health conscious, I've maintained a good healthy weight. So I had some ideas about what health was. But it was mostly related to fitness. I never had really understood the nutrition component of it. There was a funny story where I took my girls to Cancun every summer for our summer vacation, there had been this kind of period where I had gained a little bit of weight. And I took my shirt off in front of my older girl, she was nine at the time. And that the first time she'd seen me shirtless since the previous summer, when we were at the pool or something. And she said, Daddy, you're fluffy. And I love I love the honesty of children, you know, just noticed that, you know, I was 20 or 30 pounds heavier than I had been the previous year. So that kind of got me motivated to get back into shape. I started doing this thing by Tony Horton called p90x, I did that faithfully for three years, I just was not, and probably part of my obsessive compulsive personality. But one thing that Tony Horton kind of pushed real hard was that he would say that nutrition is 80% of the game. And he I was really surprised that a fitness expert, who was in really good shape and doing these really hard workouts was talking about how the workout was only 20% of the deal. And, and nutrition was the most important impact. And so that kind of got me thinking about more how important nutrition was. And I did make some changes. But I still was doing kind of a standard American thing. I was doing a high protein, low fat diet. So it's a 40% protein, 40% carbohydrate, 20% fat diet, even as a physician didn't understand that all of that protein was really going to waste and wasn't helping me, because I wasn't some sort of huge person who needed high protein aids or a big time bodybuilder who's building lots of muscle. I was a very slight guy who was just working out a lot. But for some reason I went with that. And so for many years, I went with the kind of high protein lean meat. And but I understood the need for carbs as an energy source, because I didn't think the protein was an energy source, but and then the low fat diet. So I was kind of evolving in my processes, and then also beginning to think about how nutrition was really more important. But the bigger impact was when my wife came into my life. Over a decade ago, she was largely a pescetarian she was always doing a lot of reading and getting information about health. She's very focused on health. She might even say at one point, she was a hypochondriac. You know, I'd be the the basis for her. But there was a time about seven or eight years ago, where she you know, the funny thing is we moved into an apartment high rise that was right next to a whole foods because we thought that's where we're gonna get healthy foods. And so I enjoyed the fact that we just walked out the bottom of my high rise and across the street and we were at the at the whole foods because that was easy to shop there. She one day said, Hey, there's this guy coming to speak at Whole Foods and I want you to come and I was like, Oh really? What who? And she said it's a fireman named rip Esselstyn.

Why would I want to go watch a fireman and she said he's gonna give a talk on nutrition. I really she had really lost me there because a fireman coming to give a talk on nutrition. He's part of a family Esselstyn family and his father wrote a book on how to prevent and reverse heart disease, which is

and basically was a a recipe for how to work on heart disease from a plant based standpoint. But anyway, so she took me there. And he, he gave a talk, which challenged a lot of my current concepts on atherosclerosis, and heart disease, he was saying things like, you know, you can prevent this from happening. And by the way you eat and you can even reverse this disease, by the way you eat as a vascular surgeon, I'd never heard that stuff that wasn't taught to me, I was pretty skeptical when I walked out of there. But it did open my mind to the idea. And I did do some research. And that's when I went on to finally read something called The China Study, which you're obviously well aware of, and I did go and I did read the book, How to Prevent reverse heart disease. And I started to learn about the work of Dr. Ornish, which was done well before my fellowship, in vascular surgery. And yet, none of that was presented to me, he published some of his work in the Lancet 1990, I think it was, and I did my fellowship in 9697, or 98. And that stuff wasn't, you know, despite the fact that he was, I think, times, one times 100 People of the year or something and well known and, you know, well recognized for his work is concepts were not taught to us. So I started to get exposed to that being a scientist, the data was there, the science was there. And suddenly, I realized how important our nutrition is in our overall health, how our, what our diet contributes to chronic disease, especially the chronic diseases that are the risk factors for what I treat, hypertension, diabetes, obesity, hypercholesterolemia, and all these were preventable, to a great extent, I couldn't have that cognitive dissonance where I knew the data, and then continued to ignore it. My wife, when being presented with this information, she went, she became plant based overnight, she was already most of the way there, because at that point, she was really only eating fish, I did make the conscious decision to do so. And I made a transition over the course of a few months to becoming a whole food plant based. There's a backstory to this too, is around that time, I was applying for life insurance, as many of you know out there, when you apply for life insurance, especially larger policies, they might require physical and blood work, I had become fully plant based sometime in in December. And I had this bloodwork drawn in February, the backstory is that I was kind of pre hypertensive, my blood pressure was always in the 130s, over 80s, I was pre diabetic at the time with a hemoglobin a one C of like, six, I had a cholesterol, which was in the 220s to 27, something like that. So I was kind of already on my way to being, you know, getting those chronic diseases that you get around the age of 50 is that that was what it was, which is then not uncommon for about one in two Americans, by the time they're age 50 are on some medication for a chronic disease, whether it's diabetes, or hypertension, or cholesterol or something. So I was willing on my way to being one of those people. And then when I got my blood drawn for the insurance exam in February, and I had my blood pressure done and everything. Funny thing is here's a doctor around blood pressures every day, so I hadn't had my blood pressure tested while and if my blood pressure was normal, like cholesterol was less than 150, my hemoglobin a one C had got dropped down to 5.6. And I attribute that those changes, I kind of had my own personal test, I had some tests done from six months before and everything had changed. I was a believer, just on my own personal experience of Southeast Asian descent subsequently learned that I I'm at higher risk for some of these things, cardiac disease, diabetes, hypertension, these all very, very much in our, our society. And we're seeing that now in Pakistan and India, as their diet has become more westernized over the last three decades. There's an explosion in obesity and type two diabetes, as well as heart disease. Our incidence of heart disease is around 40% in the United States. And I think their incidence is approaching 52% 40% of people in the United States succumb to cardiovascular disease. And I think it's about 52%. There. Now many of us know what the right thing to do is I mean, there are still people who smoke knowing it's bad for them. And I think that most of my patients, if you ask them, they'll tell you that their diet is bad, that they eat too much processed food that they do too much meat, I use this expression, if if the only reason to do something the right way was knowing the right thing to do, we'd all do it. But most of us don't. Because there's so many other things that impact our choices. When I did finally make that change a few years ago, and I became whole food plant based diet. I had this agenda at the hospital, I work in a smaller size hospital and they there was it was very clear in the doctors lunch line that I was eating differently. I mean, people would ask me, Hey, why is that? You know, you're skipping the meat and was such a small medical community that became very quickly known that Riz has given up eating meat, you know, that's all they cared about. It's not why Okay, and I would tell him why for my help, I'm a cardiovascular specialist, right telling you these things. The science is there, it shows you this and this and this and this and if you make these changes, you can have all these improvements, you know, in your heart age and diabetes and your cholesterol and it's proven, you know, we got paid

version at cetera, and they didn't care about that it was just really resist, you know, not not eating meat anymore. And so I was kind of a crazy doctor, you know, oh, look at this crazy guy, he just suddenly, you know quit eating meat. But the funny thing is, is, you know, it was yeah ingest but and it wasn't an amine situation either but now fast forward several years. And it wasn't long before people were looking to me as the healthy doctor, I think there's that deep down, there's that wreck and their initial response was one way but then when deep down inside, these other physicians also understood that this is a healthier lifestyle, I alluded to earlier that the artery supplies a certain area of the body and that area of the body is what's affected by the disease. So if you have an eye don't treat the heart but if you have atherosclerosis in your coronary arteries, then that can cause heart attacks, or even death. Okay, chest pain is a one of the symptoms that people have.

But it's not the only symptom a people can have feel like just fatigue or they can feel chest pressure, or they can feel shortness of breath, they can feel pain radiating to their left arm or shoulder pain radiating to their neck, or the carotid arteries, which is a very another common area to treat. Tas which are called transient ischemic attacks are a very common way to people present. And that's a mini stroke in the sense that it's something that where they have some sort of deficit, facial droop, slurred speech, numbness in their fingers, or, or weakness in their arm or hand. And but that goes away very quickly, they usually recover within a few minutes to a couple hours. And that's what's called a TIA. And that's a bad sign, that's a harbinger of a possible stroke in the future. That's one way present. Another way people present was actually having a stroke. So what they'll do is they'll have a blockage in the carotid artery and then blood clots form on it, they break off and go to the brain and cause strokes. And the type of stroke you have, whether it's your speech, or movement or sensation depends on what part of the brain that blood clot goes to, or that plaque. So those are that's the way strokes present. And then for the the thing that I treat the most is lower extremity disease. And most one of the some of the most common presentations are foot wounds, non healing wounds, you know, for people with normal circulation who don't have, you know, diabetes, if you get a cutter or scratch a bug bite, whatever, most typically heal on their own without much care. But people who have non healing wounds

present with the concern, you know, oftentimes that's that's a sign for us to look into whether they have diabetes, or do they have peripheral arterial disease, or atherosclerosis wounds, there is one way people can present with caught something called claudication. And claudication is pain in the legs, which is similar to chest pain. When you have blockages in the coronary arteries, you can get chest pain with exertion, well in the legs, if you get leg pain with exertion, that's called claudication,

or vascular angina legs. And that's a presentation for people who have blockages. So there's a progression of symptoms that can occur. As the blockages get worse, at first, there's no symptoms when they're not bad. And then you start to have symptoms with exertion. And then you might have symptoms at rest. And then or you might develop wounds. So those are some of the some of the symptoms. There's something that I talked about that's not very well known but impotence in men, it can be a very significant sign of atherosclerosis. They say about 40% of IUC, I quote these numbers, it's as easy 40% of men in their 40s 50% in their 50s. And 60% of men in their 60s have some form of impotence, oftentimes that impotence has to do with a problem, or lack of blood flow. And so impotence can be a sign that you have atherosclerosis going on, when we have people with disease. And this has to do with flow dynamics and hemodynamics. Though in the way blood flows as you got in the lumen that's narrowing and narrowing and narrowing, there comes a critical point where suddenly there's not enough flow

and impotence occurs. Okay. And so all you have to do is reverse that disease just a little. And you've gotten them back to that point where there's enough flow, you're not necessarily reversing all the disease, but you're reversing it enough and doing enough that it makes an impact, but it's multifactorial with Edie. It has to do with basal delimitation, healthier arteries, less oil causing stiffening. So there's I mean, but also, maybe you are reducing the atherosclerotic burden just enough, two or three or four or 5% to and you put all those things together and you've got better function. When I first saw Forks Over Knives. I was blown away. You know, when they were talking about addressing three major issues, but there was a myriad of other secondary issues that went away.

Oftentimes, you're probably not talking about Edie, when you're addressing their issues. But that's just one of the other things that can improve. So my wife, Maya, and I, and Maya Acosta, and I do do our, you know, we, we teach this stuff to my patients, but we also have wanted to increase our reach our outreach, and I want to get to people earlier on in life, and teach them a better way to live so that they don't end up on my table, my operating table, and in a sense, I joke that I'm trying to put myself out of business. And if that were true, and if it happens, that's great, I'll find something else to do. I'll retire and right off into the sunset.

But, you know, so we do, we do a lot of outreach.

And we pre pandemic, we were quite active with potlucks, movie screenings, guest speakers, I do a week, a monthly Walk With A Doc, which I work with the national organization called Walk With A Doc. And so these are a lot of things that we did do when the pandemic hit, we kind of slowed down, did a lot of zoom based activities. I kind of would used to joke during the pandemic that I was all zoomed out because we were doing so much zoom stuff. And now, I call it now in post pandemic era

is that we're starting to become more active again, but my Instagram is probably my social media where I'm most active. And that's Dr. Underscore Riz ri Z underscore Bukhari is my Instagram Maya. My wife has a very well respected podcast and in the lifestyle community, and that's healthy lifestyle solutions. So I would encourage people to do go check that out. Lastly, I do have a guide to cardiovascular nutrition, which it's a PDF which you can download and bi T dot L Y. Forward slash join Dr. Ribs. You've been listening to the healthy lifestyle solutions podcast with your host Maya Acosta. If you've enjoyed this content, please share with one friend who can benefit. You can also leave us a five star review at rate this podcast.com forward slash H L S. This helps us to spread our message. As always, thank you for being a listener.