All right everyone, I would like to welcome virtually to the summit for space sustainability director of NOAA's Office of Space Commerce. Again I think many of you are familiar with Rich who has had an illustrious career in our community ranging from the Clinton White House to Virgin Galactic and a number of other businesses. I am deeply pleased and honored to have this be one of his first public addresses in his new role. We also will be taking questions at the end of his session. So Rich is going to give us a keynote and then he has graciously agreed to have a few audience questions. We will still be using the Hoover app so please make sure you navigate over to this keynote if you'd like to be in the list for questions. Can we go ahead and bring Rich up? Stage is yours. Good afternoon all. I hope you are well and having a great conference. I'm sorry that I can't be with you in person. I actually this is a great time for an international gathering. The ideas, the challenges that we face, the ideas that I'm sure are circulating there at the conference are ones that I would very much like to hear. First of all my thanks to the UK Space Agency for their support of this conference. My thanks, my special thanks to Secure World Foundation. Secure World has been doing this for a long time. I mean their commitment to space sustainability, to the issues that we're addressing today started over 15 years ago and I think at the time everyone kind of said what's this small organization from Colorado talking about space for and what is space sustainability and now they have done they have an incredible body of work over the years and kudos to Cinda Arsino who's the founder of Secure World and the great team there who have been maintaining a focus on this issue for years. One of the reasons I'm sorry to miss this conference in London is that in many ways my own journey started in London at a conference. It was called improving our vision in 2006 and I remember like all good stories this one started in a bar in London and we were sitting around after the conference and the operators, the large geo operators were complaining about how hard it was to communicate to each other about their maneuvers, about their planned maneuvers and at the time they literally were calling each other on the telephone to talk about planned maneuvers and I think it was Teresa Hitchens who was then an analyst at the Center for Defense Information said you just need to invent a babble fish and of course that was a reference to the Douglas Adams book Hitchhiker's Guide but a universal translator and I remember Joe Chan who was the flight director of InnoSat said well yeah we could do that and from that conversation began a dialogue which led to the creation of the Space Data Association which was an industry formed attempt to start to come to grips with some of the issues that we're still dealing with today. How do you communicate? How do you communicate what you're doing specifically? How do operators communicate a maneuver? How do they talk to each other about potential problems and also how do they engage with governments? And I think honestly that experiment was not fully successful because I think the government wasn't ready. The governments weren't ready at that time to acknowledge the private sector as a full partner in this enterprise and I think one of the wonderful things that's happened over the intervening 15 years is that there has been a significant change and a desire to embrace the creativity and the dynamism of the private sector in helping to solve critical problems and I'll get more into that a little bit as we get into the remarks. But a little bit about my office I think some of you may know the Office of Space Commerce in the Department of Commerce. It aspires like the Secure World Foundation to a small office that aspires to have a large impact. We knew have a new role from the Space Policy Directive 3 from the last administration directed that the Commerce Department take over the current responsibilities being done by the Space Force. And those are the agreements to share information, create a catalog, warn of potential conjunctions and to work closely with private sector and our international partners. So that's a big job and I'll talk more about that in a minute. But in addition to those things, we also have a regulatory role. Initially our regulatory portfolio is limited to earth imaging. We are in discussion with the White House and we'll eventually be in discussion with Congress about perhaps expanding that role to what they refer to as Article 6 authorities under the Outer Space Treaty, which means things not the governments have a responsibility to do continuing oversight and supervision of the activities of their nationals under the Outer Space Treaty. And of course we have the FAA, which handles launch and recovery. We have the FCC, which is worried about spectrum and orbital position. But there are a lot of new activities coming along, low earth orbit commerce, CIS lunar activities, eventually rovers on the moon, and a bunch of future things that we need, which today seem far, far away, but which will be upon us soon enough. So that's a dialogue we'll have in the future. But those things are potential. So in terms of the our office taking over the responsibilities of the currently handled by the Space Force, the question is, well, what is it exactly that we're going to do? And so what the policy directive said is that you'll continue to provide the basic services supplied today. And I've been on kind of a listening tour to satellite operators asking them, well, what do you think the basic services are? And their first reaction is usually kind of glib. They go, well, it's, you know, what I'm getting today. And I say, are you happy with what you're getting today? And they say, Oh, no, no, I'm, there are many things we're not happy about. And I said, well, then, I'm sure you don't want me to do exactly what's happening today. So why don't we have a dialogue about what are the things that you're looking for? And once you prompt, I think the people who actually fly satellites for living and who live this every day have a really, they're really, it's easy to get a list out of them. And some of the things they are looking for are very practical things like more rapid cataloging of objects after launch that has has been and continues to be an issue. And the rate and latency of screening is is currently probably too slow for for commercial operators. So they'd like to see collision avoidance screening multiple times a day with very low latency. And one of the complaints that has been a long time complain of operators is operators say I'm willing to share my location information with you my ephemera. So I'm willing to share my location and my maneuver data, if you'll only ingest it into your system. And unfortunately, the the current systems are not agile enough to do that on a routine basis for all commercial operators. So the so a lot of the value of that sharing of information is lost. And then of course, operators would like special screening for maneuvers. And the simplest of all acts, they would like a web API for the exchange of information coming full circle back to our discussion in the pub in 2006, which is we still really haven't solved the basic fundamental issue of how do we effortlessly talk to each other. So this dialogue started with well established, well funded geostation area orbit operators. And they all had sophisticated flight dynamics teams and and but now we're in a totally different world operating in geo is like I always say operating in geos like living in the suburbs, you got lots of room, it's a nice environment, your neighbors are far far enough away to be friendly. And you come down to Leo and it's inner city living down there. It's it's a lot more dynamic environment. And so we need to have systems which are keeping pace with what is actually going on in the dynamic environment and lower thorbid, the mega constellations, the tremendous creativity and lower thorbid services. Eventually, as I said, lower thorbid, perhaps manufacturing commerce and things like that. So we have to have systems that are capable of doing that. So we need to we need to go to the next level. So I have been talking to not only the operators about what they need, but I have been on a listening tour with all the SSA providers, all the the folks who've got incredibly creative ideas for helping to manage this process. So what we'll be doing this summer and fall, assuming our partners in the United States Congress continue to give us the funding that we need. We will be doing some data buying, we're going to be doing some contracting for essential commercial services. And we will be doing hopefully we'll be able to be have some systems up and running very soon and comparing data quality. And again, all of this is targeted to to an NIOC initial operational capability in in 2004. So we have a lot of work this year to do. We're also staffing up the the office. You know, everyone always wants to talk about the the actual tools and technologies for SSA. And I always say, you know, that's like talking about the airplane. And that's important. I do need an airplane. But I'm really what I need to be talking about is the is the global air aircraft, the global air transportation system. So when it's great that there are all these great technologies, but they have to be in an international environment where we all agree on what's going on. So at the front end, back to the babel fish issue, we need standards, clarity on how we ingest data, what kinds of data we ingest the quality of data, how we validate data. So we need agreements there. There's some great work going on in the CCSDS, the standards group that's doing this tremendous work there and want to encourage that going forward. We need on the other side, we need rules of the road where there are developed generally understood principles by all space operators for how one handles various evolving situations in space. And then we probably need to have a pretty frank discussion about operation operator responsibilities. There are a lot of things that operators are willing to do today, like, for example, share their ephemera and their maneuver information. And the question is, should there be things that operators are are required to do? And the FCC give credit where credit is due here, put out a very, I think, bold and challenging document a couple years ago on they did a report and order on space debris and mitigation.  And about how we intended to manage this new environment. And I look forward to engaging with my colleagues at the FCC on those on those. But if you haven't seen that document, it's a bit long. It's not exactly a page turner. But I do highly recommend it if you're interested in this field. It does it does seek to raise some really important issues. So in terms of my priorities, we are biggest challenge is to get the tools in place to to do the transition that we've been instructed to do for the responsibilities that are currently held by the Space Force. The first step in that journey is a memorandum of agreement between the Commerce Department and the Defense Department. And we're well underway on that. And I hope to have that wrapped up this summer.  And again, I'm sorry, I can't be there today to actually talk to you in the context of this important conference. But we need we do need your ideas because this is as I said before, this is a much, much bigger picture than just we're going to have a really sophisticated fusion engine that's going to be able to do orbital determination and conjunction assessment. It's well beyond that. We need this in a global context, we need to have our international partners working with us on this, we need to understand how to exchange information and validate that information in a way that is safe, secure and and and accurate.  We also have some policy challenges ahead of us how we redefine our relationships. What are the responsibilities of the new generation of operators in space? And what things should we be doing and shouldn't be doing as we go forward? So it's a big, it's a big bunch of tasks. And I'm only heartened by the fact that I know in my dialogue with you all that you have incredible ideas. And I'm looking forward to hearing those and getting together on a routine and regular basis to discuss those ideas. I promised that I would leave a few minutes for four questions. And so why don't I wrap up there and see if there are any questions in the audience. But I warn you in advance that I've only been in the position a handful of weeks. So the answer to some of your questions, maybe I don't know I will check. So with that, if anyone has a question, I would very much be happy to answer it. Excellent and absolutely rich. I will keep that in mind as I select the questions. We do have lots rolling in. I'm going to start with, I don't know, either the hardest or the easiest one. This question came in early and it's about your vision for the future of your particular office, you know, how does the office of space commerce fit into the broader ecosystem, you know, with the Space Council and NASA and the Space Force, you've mentioned some of it during your speech.  Well, again, I think that I see the office and everything, of course, has to be cautioned by. It depends. We are guided by the principles articulated by the administration in conjunction with our colleagues in the United States Congress who fund and provide the authorities we need to do specific tasks, particularly regulatory tasks. But what my vision is and is that this is an office will first and foremost that we will execute on the on the on the task of implementing an open architecture data repository that that provides basic services to commercial and civil international entities for free. That's sort of our baseline. We also want to be advocates broadly for industry, but specifically also advocates for the SSA industry such that there is a robust, there is robust advanced services industry such that one of the things and again, one of the issues that we need to discuss about operator responsibility is should operators have a be required to have some sort of certified safety service to when they operate their fleets and that probably could be it could be handled externally or could be handled with with a sophisticated internal flight dynamics team. So but those are all dialogues that we need to have going forward. So an advocacy role that is both on SSA but but beyond it encouraging and trying to be a troubleshooter for for companies who are who are struggling either with licensing or regulation or with some challenge export control or some challenge with the government. And then finally regulatory we are today the regulator for earth imaging. That is a a tiny subcategory of the activities that will be going on in the future. And I think we are an open dialogue with the administration and with with the hill about whether we should fill that gap. What's the most appropriate way to fill the gap that we all see in the authorities in the U.S. So I see us playing a larger role in that in that space. Absolutely. Well, thank you. I think you're aware that the panel just preceding lunch. So right before you was led by Brian Whedon and we were having a conversation about transatlantic space traffic management in air quotes. So we have a question from the audience here saying how will your office work with the EU on matters related to STM practices and norms? Well, that's a very timely question. I believe next week we have a couple days in DC where we're having an ES EU dialogue and there is a large portion of the agenda focused on this issue. So I look I look forward to engaging with my colleagues in the EU on these topics and I look forward to those sessions next week. But I think it all starts with the willingness to to talk to each other and to identify issues that we are struggling with. And I'm sure that there's a lot of interesting concern about whether the services how the services currently provided by the Space Force will be will continue to be provided by my office. And I look forward to to addressing those anxieties and and hopefully beginning of an important multi-year dialogue. As I said previously, I mean, this is not something that the US can just do. It's not something that if we're super clever, we can solve the problem. This is something that requires the engagement of all nations. And again, without touching the third rail of politics these days, I mean, there we have some so we have some international. It is an internationally complex environment. And and right now, we think we need a full dialogue with all space fairing nations. And we can't have any major nation who's not participating in this dialogue. If we're going to be operating thousands of satellites in the same place, we have to have means of rapid, accurate communication. And so that's another level of the challenges that we'll be facing. Well, you know that secure world absolutely agrees with you when it comes to the need to have all countries and all actors who are affected at the table. So thank you for that. I want to turn to a question about industry. You mentioned that you've sort of been doing a listening tour. And so one of our audiences questions is delving a little deeper into that. So they said, What are the key barriers to industry and government working together to ensure space sustainability? And how can we overcome some of those challenges? You know, what are you encountering in your new role in that area? I think that if I can start out and without criticism, I think that, you know, the Space Force has done a very good job, given that, you know, 15 years ago, when we started this dialogue, the I think the reaction of a lot of folks in the then Air Force, the basic reaction we got was, well, this isn't my job. It's not my job to help you all in industry. I mean, I have other things I need to worry about. So so we went from that initial reaction. And that was the initial reaction quite frankly that the Space Data Association got was we don't have time, we we neither have time nor inclination to worry about your problems, commercial industry. And I think we've we've of course had a tremendous sea change there. And I hope with the transition to our office that that there is a level of service provided that is that is more timely and allows for the rapid increase. And also, I think that just from a, as we've seen the space become more and more complicated, I do think we'll see this differentiation between the military will have a more military focus and we will have we will hopefully be able to meet the needs of the civil and commercial entities. Excellent. Thank you. And obviously, you have a lot of insight into that from your previous role before this one. I have two more questions if that's all right for you. I think one is kind of taking a slightly different turn. How will human space safe, sorry, space flight safety protections figure into the DOC? I mean, that's obviously something that's also been shared among several agencies. I think that is the, as they say, that is the deep end of the pool, right? So we have been a regulator for imaging of the earth. And not that that's unimportant or or or simple. But it does not involve the complex layers of worrying about human safety. So if we were going to take over the so called article six authorities, the the responsibility for activities not associated with launch or recovery, we would eventually encounter the responsibility to start worrying about human safety and reliability of systems. That's not something that is on our agenda today or quite frankly, even next year, but it could eventually be. And the good news is that, just like our colleagues at the FAA, well, first of all, there's tremendous amount of knowledge amongst our colleagues at the FAA who've been dealing with this for years. And of course, we have NASA and the other space agencies who've been important partners in the development of the current rules that exist for launch and recovery. So I would see it as a as a complex partnership where if if we are tasked with that authority, and we have not been today, if we were tasked with that authority, I think we would have a lot of support and assistance in the interagency community. Absolutely. I'm going to talk about one question here that's after near and dear to my heart since my day job is focusing on Earth application policy. And as you said, that's one of the core duties that your office has always had. So our question is, can you speak to any coming changes to non-Earth imaging policy and how they may impact opportunities for on-orbit sensors for ATM? And I would treat this as an opportunity to just really share where you see the new policies going. I think that, I mean, just to observe a curious thing about our authorities, our authorities aren't for all imaging systems, like for example, electronic gathering systems, various systems for detecting radio frequency interference and other things, but don't fall under our purview. So there are some there are some curious gaps in even the the remote sensing regulations that exist today that I think we would need to re-look at. Where are we going as there is this multiplicity of new new systems being developed? I know that we have recently revamped the remote sensing guidelines, the rules, the regulations for remote sensing. And so I think the team is reasonably happy with where they are right now. We are also staffing up that group. And hopefully that if we were to get new authorities, that would be the place that we would put additional energy. But on the specifics of the actual remote sensing regulation and what things specifically we need right now, I'm just going to have to plead the new guy defense and say, I look forward to learning. Absolutely. Last question, I promise I want to sneak one more in since we are in an international conference and I really appreciate your willingness to do this. I know how hard it is to be a speaker to an audience you can't see, but I can assure you you have a room full of almost 300 people rapidly listening to everything you're saying. And I want to end on one that kind of acknowledges the global nature of this question of your work of the work of the UKSA as our co-host. And so the question is, how can regulators work more closely together across international borders to drive consensus around global standards, rules, processes and systems? This one specifically says for space traffic management, but I'm going to open it up broadly. Like, how do you see the international order working? You commented on this a little, but let's end on that note. Well, I think there's such a broad spectrum of the things you just asked about. I mean, at one level, very practically, we have the standards process, which is slow, it's time consuming, it's technically, you know, it requires detailed focus and it's but it's essential, right? But it's essential. And I think that there has been an effort by groups such as the CCSDS to engage globally initially. And so I think governments supplying their support for these standards processes is key. And then at the other end of the spectrum, there are, there is an important role for open forum, like the UN's Committee on the Peaceful Uses of Space, for the broad discussion of these ideas, for the for the sort of unrestricted dialogue about where the world is and wants to go. But I also believe that with the example, recent example of the Artemis courts, there is an there, there's an important role for like-minded nations to take immediate action together. So I think we need all the tools. We need the hard, the hard and painful work of standards processes that allow us to communicate better and allow our machines to communicate better. We need the broad dialogue of the international community, the involvement of the policy people and the space lawyers and the whole discussion. But then in the middle, we need an ability in the shorter term to take action when like-minded action makes sense. And so I think we need to keep all those tools at the ready. And I look like I said, I look forward to our dialogue next week with the EU on some of these really important topics and look forward to working with my colleagues internationally on this and related space commercial topics. Well, thank you, Rich. That couldn't have ended that on a better note. We need all the tools. And I think we see that in our other panels and I couldn't agree with you more. So again, I want to thank you as the conference chair for the Summit for Space Stannability. We've been delighted to have you. We will be sure to report back everything else we discussed since you couldn't make it here in person. And again, thank you for your time today. All the magic happens in the pub after the meeting. That's, oh, no, no, don't worry. We have a reception tomorrow night in the Exploring Space Hall. So we've got it covered. Alrighty. Have a great conference, everyone.


Well, hello everyone. Thank you for joining us again for another episode of Resiliency Radio with Dr. Jill. Today I have special guest Dr. Howard Elkin, who I'll introduce in a moment. We're going to talk about medical advocacy, but we have an integrative cardiologist with us today. So we're going to talk a little bit about heart health as well. Before we begin, let me introduce you, Dr. Elkin. So Dr. Howard Elkin has practiced cardiology in Whittier, California since 1986. He graduated with highest honors in the Medical College of Virginia in 1979, completed his internship in residency in internal medicine at Michael Reece Hospital and Medical Center in Chicago, followed by a fellowship in clinical cardiology at Northwestern University. We share some Chicago roots too. Dr. Elkin moved to Southern California in 1984, where he completed an additional fellowship in invasive cardiology at the Los Angeles Heart Institute. He realized in the early 90s that mainstream cardiology focused on diagnosing and treating patients and patients were not staying healthy long term. In 1984, I'm sorry, 1994, he added a preventative component to his practice with the HeartWise Fitness Institute, combining sound nutrition, exercise, and stress management. His patients are empowered to live happier, healthier, and less stressful lives. Welcome to the show, Dr. Elkin. Thank you. Thank you so much for having me. I'm delighted to be here today. You're welcome, and I'm delighted to talk to you about all things cardiology, about your own journey, about your new book, about everything there. But I always love to start with story, as far as where did you grow up? How did you get interested in medicine? Were there any other doctors in your family? And then how did you get interested in integrated medicine? Yeah, no one's asked me that. That's a great question. Well, I grew up in Richmond, Virginia. And no, I didn't have a medical family. I mean, my father didn't go into grade high school. My mother did. And I'm the one, I'm the second of four children. And I never had a doctor's kit when I was a kid growing up, you know, I didn't have any of that. But I was fascinated in anatomy. I remember that. Remember the world, I don't know if you remember the world book and media, those little cellophane pages? I would like study all the layers, right? You put that in there. You know, so, and then I didn't really know, I was, I really was going, I went to be a writer. And I said, well, maybe you should be a lawyer because that kind of goes hand in hand. But then I think I really didn't like law. So I then became, I got interested again in medicine, but it really wasn't to my senior in high school. Did I decide to really pick that? So in college, I was kind of double major in biology and also in English. So it was good. And so how I got into cardiology, when I started my medical school training, you know, they take you through the various medical, various organisms for the first year, it's normal physiology and anatomy. Second year, it's pathology. And then the third year on is clinical. And when I, when I got to the cardiovascular system, like it just made sense to me, I didn't have to memorize things like an endocrinology and infectious disease. It just made perfect sense. So I was always interested. I didn't make the final position until I was getting close to actually my internship in residency, but I always had a penchant for the heart. Then I came out to California, I was married at the time, had a child and started, I actually was brought out here for a group, a large multi-specialty group in cardiology, but it really wasn't my thing. So after a year, I went back to training in invasive cardiology and then subsequently started around practice in 1986. And here was his young cardiologist. And I was traditionally trained. We did nothing about functional medicine. I don't even think the term was coined then. Right. But by the time, and that was in 86, by the time, then early 90s, I saw the writing on the wall, people were flocking to HMOs. And I saw the same patients come back. You know, they'd had a heart attack, then they'd have a stent, then they'd have another stent. And something's not right about the system because patients aren't really getting better. We're putting a band-aid on and then they come back with the same problem within a few years. And it goes along with cardiac rehab and people that choose exercise programs because 50% of these people are no longer exercising within six months. So there's something about lifestyle that I saw was truly lacking. So I then had advice and I called it the Heart-Wise Fitness Institute back then. And I incorporated a trainer and made a nutritionist and we counseled people. We even had group meetings once a week to kind of base on Dean Ornish's group studies on having cardiac patients talk about issues that they don't normally talk about. So that was exciting. Then I got into longevity side. We're almost finished. And then I took the fellowship and I added basically hormones and longevity medicine in the early 2000s. And that's what I'm at.  So I use the functional medicine principles that we all use. But most of them are cardiologic standpoint. But you can't spray the gut. I'm really interested in gut because most of the patients that come to see me as a cardiac patient about 60% of them have a gut issue. So that's what I love about functional medicine. You have to be versed in almost all the specialties, at least the internal medicine specialties, because there's an integration that goes on that we just don't see in traditional medicines. Oh, no, there's a heart problem. Oh, no, you got to go to the pulmonologist. It's a lung problem. And I see the spaddling happen all the time. And so this gives me a lot of pleasure to be practicing how I am now. And that's the beauty of being in your own practice. If I was in a large group, I couldn't do this. Yeah, the joy. I see this a lot of time with colleagues who are kind of getting burnt out and frustrated. The joy of why we went into what we're doing is really revived when we do functional and integrative medicine, because we're actually really usually connecting deeply, having these relationships, helping people to heal. And again, there's nothing wrong if you're not, you know, have a heart attack, or you have a car accident, or you have a, in fact, you were in one of the best realms for conventional medicine, because you could intervene and save a person's life, really. But like you said, then when they come back, and they're not doing better after several years, as they fall off the bandwagon, we both realized there was a lot more. So good for you. I love that. So let's start with just, obviously, you're interventional. So you're doing stents and all of that. And again, there's a place for those as lifesaving, but as far as the real life, the life's having band-aid. Yeah, exactly. Exactly. Let's maybe talk just a little bit about, because I feel like, as I'm understanding the heart and the endothelium and all this, there's so much more. And really at the root, it's kind of the endothelium that matters. Do you want to talk a little bit about what you've learned and the kinds of things that we can do to actually heal endothelium and the nitric oxide and those basic tenants versus just put a stent in an emergency? That's such a great question. Thank you for asking. So the endothelium is everything. It's just for your listeners that all your vessels, we have 60,000 miles of blood vessels in our body. Can you imagine that? 60,000 miles. And every one of those vessels is lined with one cell thick called the endothelium. Endo means inside in Greek. One cell thick is very, very important because it, first of all, it can make nitric oxide, which helps these vessels to dilate. And number two, it's semi-permeable. So it disallows things like we don't want like oxidized LDL cholesterol and other harmful substances to enter the endothelium. And that's when inflammation begins. And that's really when you have heart disease. But in traditional cardiology, they don't talk about endothelium, they don't talk about, it's not about prevention. You have high cholesterol, you're going to statin. I mean, I'm simplifying things and generalizing, but that's basically how it is.  So that's just how it's done. So looking at the endothelium, and also I'm very much interested in blood pressure control, because I think it's still the number one risk factor. And what I forgot the number is it keeps on rising. When I wrote my book, it was like 70, 70, I mean, there's like 100,000 people out there more, usually 50% of the population is hypertensive. Why? Yeah. And so I try to look at the preventative side and, you know, weight issues, you know, definitely weight loss. If someone loses 10% of their current rate, they'll drop their blood pressure. Almost, I can guarantee that. But, and, you know, it does get more prominent as we get older. There's a genetic tendency, but that's all about the endothelium.  And there's one test that I do that most people don't know about. It used to be called the pulse test, PULS. And now it's called smart vascular DX. And it's a fascinating test because it's the only test that I know of that actually looks at the health of your endothelium. And so it's a great test. Most doctors don't know about it, but it can actually, you get seven different biomarkers specific for the endothelium. And I tell patients, I'm not, we're not treating your biomarkers. I'm treating your risk. But if you, and you found out when this test, whether you're high, medium or low risk, and it's really helpful because then I can intervene with certain supplements before they have a problem. So it's all about prevention and getting at the beginning of the start. Is this a blood test or an ultrasound or what kind of a test? It's a blood test. It's a simple blood test. They're out of Irvine, California. And again, the name was PULS. But now if you look up smart vascular DX, you can, you know, the website, it's just an unusual test. Most doctors don't do it. I don't think most doctors even know about it. But, you know, I do it. In other words, when I have a patient come into my office, I tell them from the beginning, my plan is to assess your risk, not just treat you with drugs, less assess your risk and let's figure out what you need. So it's custom care. It's customized care. And I think it's the optimal way of doing it. So I will often do certain tests. I won't usually do this as test number one, but I will do things like Cleveland Heart Lab, a Boston Heart Lab, which we can talk more about. And also, oftentimes, a coronary calcium scan. Yeah. So anyway, that's kind of the way. No, I love this because I couldn't agree more and things that maybe let me talk a little bit about some of these labs. Like you said, MPO, TMAO, PLAC, HSC, or if you've many people know about, but some of these, especially that Cleveland and Boston Heart Labs both have a lot of these inflammatory markers. And you don't have to start with all of them and maybe pick a few of your favorites. And let's talk to the person listening about why they might want to ask their doctor for some of these tests. Because it really does give us, like you said, with functional medicine, we're looking at, where is someone on the trajectory of wellness or disease? And are they walking towards a possible stroke or heart attack or incident? And if they are, then you and I can say, hey, you're at risk. And this is what we can do to actually reverse your trajectory. So maybe talk a little bit about some of your favorite inflammatory marker or tests that maybe the patient isn't aware of. Now, Cleveland Heart Lab and Boston Heart Diagnostics are both excellent labs. They're very comprehensive cardiac labs. Cleveland is a little more easily available because it's not was bought out by Quest a few years ago.  Boston is a smaller lab and you have to have a phlebotomist and we have very phlebotomists that can do this, that can go to your house and actually draw the blood. But they both are very similar. So number one is the lipids, the cholesterol and your average doctor is still getting cholesterol, triglycerides, HDL, LDL. That's basically it. So with Cleveland, you're not only getting those values, you're getting the size of the particle and the number of particles. So it's probably actually more important. Like, and I want your listeners to know, just remember one thing when it comes to LDL, low-density cholesterol. We think about it as lousy and HDL is healthy, but it's not quite that simple. So low-density or LDL cholesterol can be, it really depends on the particle size. So we want large fluffy particles and that small dense ones because the small dense LDL particles can get easily oxidized and then it can get into the walls of the endothelium, if the endothelium is not healthy, and then you've got the beginning of inflammation. So that information, you get right off the bat with Boston or Cleveland. Then you have the inflammatory markers. And so some of the ones, everyone in my practice gets HSCRP, which is highly sensitive C-reactor protein. A lot of doctors don't even draw that, but you have to know where the patients are. At least, and you can follow it, it's inexpensive to us. You can follow it sequentially. Then I do a couple other inflammatory markers that you can get both with Cleveland and Boston. It's called the LPPLA2. Anyway, that's looking for vascular inflammation. Is there inflammation in the vessel itself? CRP is totally not specific, but very sensitive. LPPLA2 and also myeloperoxidase, those are two markers that you get with these tests and they help determine if you have any systemic inflammation. They also have a test to see whether you have any oxidized LDL. That's the LDL we worry about. It's not LDL. It's not some kind of villain. Because I mean, if we didn't have LDL cholesterol, we wouldn't get to the brain. Not a good part with a bad brain. Yeah, I always say cholesterol is not the bad guy. Cholesterol makes our hormones. It makes up our brain. Cholesterol is the thing we absolutely need. However, if the endothelium lining is sticky, there's inflammation, there's all these other things. Even autoimmune disease, which people don't typically associate with heart disease, then that cholesterol, like you said, the oxidized LDL gets sticky. That's the issue. Not cholesterol itself. Cholesterol itself is neutral, right? Right. But even most cardiologists I do, I don't really get into this, because it does involve education.  And it's just very fascinating. So I did leave out one thing. Besides, when you go back to the lipids on these sophisticated labs, you also get what's called LP-little-a. The little-a is in parentheses. And that is a fragment of LDL. And it doesn't bode well for heart disease, because it's very sticky, very inflammatory, can easily get oxidized. Again, start the inflammatory process if it goes into the damaged endothelium. So there's been no treatment thus far for this, which is probably why to talk cardiologists are interested in it. Actually, I've had quite a bit of success using niacin, which is actually vitamin B3. But probably within two years, a biologic will be coming out that will deal with LP-little-a, which is really important, because it's about 27% of the population. It's not small. And with this biologic, we'll be able to decrease LP-little-a by as much as 50% or more in a period of six weeks. Hey, everybody. I just stopped by to let you know that my new book, Unexpected, Finding Resilience through Functional Medicine, Science and Faith, is now available for order wherever you purchase books. In this book, I share my own journey of overcoming life-threatening illness and the tools and tips and tricks and hope and resilience I found along the way. This book includes practical advice for things like cancer and Crohn's disease and other autoimmune conditions, infections like Lyme or Epstein Barr, and mold and biotoxin-related illness. What I really hope is that as you read this book, you find transformational wisdom for health and healing. If you want to get your own copy, stop by readunexpected.com. There, you can also collect your free bonuses. So grab your copy today and begin your own transformational journey through Functional Medicine in Finding Resilience. A period of six weeks. So if that's going to... You find that... I'm just going to ask you about that because I feel clinically the same way. It's hard. I always say this is a little bit more difficult to change. So the nice and potentially, but do you find that's more genetic or is it more lifestyle inflammatory that you see elevated? Opulotoi, it's definitely genetic. Okay. That's what I thought. It is genetic because, and again, you don't know you're having unless you do the test and it's automatic in the Boston and in the Cleveland Heart Lab. And I think it's important to know because patients need to know the risk. And I tell them about it. Even if we can't get it down to optimal levels, I'm going to try to do everything else. It's like the best of all possible worlds, you want to lower everything, but you can unless they respond well to niacin. And I would say over 50, 60 percent of my patients do, but I really know niacin well. So I know how to dose it correctly and how to start people on it. Then we've got the lipids, we've got the inflammatory profile, then we have the metabolic profile, which is really important. So yeah, they do a fasting blood sugar and they do the hemoglobin A1c, which gives you an idea of how well your blood sugar has been controlled in the previous three months. It's a marker on the red blood cell and red blood cells live 90 days. So then it tells you other tests that I really think are important, you're fasting insulin level, which should be, I think less than eight, less than 10. And that's why the thing about being a bodybuilder is that most strength athletes have are very insulin sensitive. So we tend to have really low levels of insulin. So we want to know what that is because, and let me just digress for one second and we also do what's called a C-peptide. So C-peptide tells me how well your pancreas is, how hard your pancreas is working because you could have a normal A1c, an elevated insulin, and an elevated C-peptide. And that's telling me that your body, your pancreas is working really hard to not make you a full-fledged diabetic. But eventually, if the insulin level doesn't come down, your the pancreas will poop out. It just can't keep on producing insulin for years or in years. So I really like, so everybody gets the insulin inflammatory markers and the metabolic markers because really only about 5% of the country's population is metabolically healthy, which is, we were not a healthy country. And I think that worse in COVID. And the other one is genetic markers. And that's what I like. So there's about five that I follow. One is KIF6, which is kind of, I like that because I spent some time in Berkeley Heart Lab with Dr. Soprko several years ago. So KIF6 is associated with premature heart disease or coronary heart disease. NP21 seems to be, they call it the heart attack gene. And it's really common. And about 50% of it have at least one carrier. So it's very, it's very, it's rapid. Then I do the, there's 4Q25, you know, it's on the fourth chromosome. And it, that pretty, that lets you know that you could be predisposed to having developed cardiac atrial fibrillation, which is the most common arrhythmia that we see, especially in people over the age of 70. And then I'm leaving something out. Oh, ApoE. ApoE is really important because ApoE tells me, cardiac-wise, if you, and if it's, if, if it's elevated, if you have one or more marker, one or more of the alleles, then that means you're at risk of coronaries because that means these people tend to absorb more cholesterol from their diet. And it's also associated with Alzheimer's. So it's, and it's, I think it's good to know this because then I talk to people about brain health and what they do to obviate, you know, problems on the line. And I'm in agreement with, with Dr. President and Perlman of that. I, I think we can put a damper on Alzheimer's disease, but it's active process. It's like heart disease. It's not going to stop in its tracks unless we become proactive. So that's what you get from these tests. So you get the lipids, including opioid A, you get inflammatory profile, you get a metabolic profile and you get genetic profile. Amazing. And you've got a nice, you know, potpourri of information that discuss the patients. Yeah. And then you can really look at where is the risk because it died, is it lifestyles, is it genetics, is it the oxidized cholesterol? And like I mentioned before, I always love saying this because we see like Celiac massive increased risk of heart disease. You would never associate those two things, but autoimmunity and inflammation are massive triggers in otherwise healthy women or people that would typically not maybe healthy weight or healthy body mass. That autoimmune component can be a huge trigger. So I love, and you might see that on some of these labs because like MPO or plaque or some of these would show up potentially. Yes. And I have seen it because, and I tell people this inflammation of any cause, it's persistent. It doesn't bode well for aging. So I don't care whether it's heart disease, cancer, autoimmunity or Alzheimer's, all four have inflammation at their base. So that's why in functional medicine, you make a big deal about it. And we try to identify where it's coming from. We try our best. See the difference between like traditional medicine, symptoms, treatment. Yeah. And usually pharmaceutical or procedure. Again, those are appropriate for the right case. There's more. There's so much more. Well, let's shift to men and women.  And do you want to talk just briefly about men and women differences in heart disease, how they present or what you look at with a woman versus? First of all, when you look at symptoms, they can be completely different. And I have my own little dictum in place of that. If it's a woman and it's anything above the belly button, it's hard to prove otherwise. Right. Because you can masquerade as a gallbladder plant. Women can have no chest pain at all. Very common is shortness of breath and also fatigue and dizziness. So they don't usually have that pain that goes on the left arm, blah, blah, blah, crushing. You have to have a really high index suspicion. So presentation is different because the symptoms tend to be different. Even the diagnostic criteria are different. I'm just sorting this out. The last couple of years is that the test that we look for, whether a person's had a myocardial infarction or a heart attack, is the troponin level. Yet the troponin levels are lower in women than in men. Maybe it's higher. I forget which is which. They're different than two genders. And that's really important because before we never, this is kind of a new finding. So now we have to know what is arranged for men and what is arranged for women. And it's, you know, it's pretty well that you'll find out when you do the test. Even when you do the angiograms on these patients, now women tend to have smaller hearts and they tend to have smaller arteries. And so, and you might not see anything major when you do your angiogram on these patients. I mean, you may, but you may not because they also have a higher intensity, what we call microvascular angina, which means the plaque is in the tiny vessels that you can't see on angiogram. Yet it's very common in women. So, and they, you know, it's still totally different. Let's talk about the menopause. But one thing I want to just mention first is that I find this so, so it just, I can't believe it still exists, but about 52% of women in this country still think that their biggest issue is breast cancer or cancer in general. And just to refresh everybody's memory, there's about 250,000 women dying each year of heart disease and 80,000 of breast cancer. Yeah. You know, I mean, I think it's a kind of work that I try to do. It's like women have to know that it's just, it's making women die of heart disease as men. It just happens later in life, about 10 to 15 years later, and that's CO estrogen connection. Yeah, excellent. So great. Thank you for that overview. So I want to go to medical advocacy, but before we do, because that's one of the things you stand for is in your book. But before you do, yeah, yeah, we are both the medical advocates in a good way. Diet. This is a big can of worms and I don't think there's one size fits all, but there's certainly principles. What principles do you find most helpful for your cardiology patients that are trying to improve their health? First of all, I'm not going to say don't eat eggs. That's the last century. I don't make a big deal about cholesterol because cholesterol in your food is not really a quick to cholesterol in your blood. So although, and I really differ with the American Heart Association on this, I mean, I give them credit recorders due. They've been around since 1926, but when it comes to diet and risk factors, they're way behind the disease. So even things like, I basically believe in the Mediterranean diet or variation of, like, I guess you can call me on between Mediterranean and paleo because I try to agree 100%. I just want to say right on with, even with me with cancer inflammation, I find this area is so powerful. Yeah, it really is. And so I don't really, patients are amazed when, why don't you tell me about cholesterol and what I should avoid eating what? I said, I'm going to try to devoid one thing, sugar. Because eating sugar is like pouring gasoline over a fire. And that's what happens in arteries, right? And cancer and autoimmunity and Alzheimer's. There's fire going on. We want to get rid of it. So that's where diet plays a big role. So I'm much into, you know, low starch, low carbs, low starchy carbs, and definitely very low sugar. That should be a treat. So it's Mediterranean, low carbs. Those are my basic principles. Because, and again, if it doesn't grow, if it doesn't grow in the, if it doesn't run in the wild or grow in trees or bushes, it probably has no place on your plate. So I tell people, if it's a box bag or can, forget it. I love that because really it is processed foods that contain more additive, sugar, chemicals, glyphosate, and like you said, sugar inflammation. Before we go into advocacy, I thought one more thing I think is important is hormones. We're both in the realm, we have been at A4M, that's where we met first, and lots of anti-aging principles and hormones. And I do believe, obviously you mentioned this, that the major risk factor for women after menopause is their loss of estrogen. My, I have a listener's probably 50, 80% women and the rest men. But let's talk a little bit about women and hormones. What's your thoughts with heart disease and estrogen replacement? Okay, I'm biased. I admit it because I'm anti-aging. But so I do believe whether you're a man or a female, you look better, feel better, and think more clearly on hormone replacement therapy. Does that mean I encourage every patient? No, it's an individual choice. But with women, it's very important. Women live in the average way, 30 years post-menopause. I mean, they have a nice long lifespan. And so estrogen is very important. First of all, I give hormones, not just for symptoms.  And that's still an indication. I mean, that usually is what a lot of women have as they go through the menopause. I look at the health benefits. Okay, how can it improve the longevity and quality of your life? Heart, no, no, but no doubt about it, because estrogen is very helpful in producing and preserving the endothelium. And you lose that when they go in the menopause. But no more such endothelium starts to have problems. And that's when you start seeing coronary disease. They could have cholesterol elevation their whole life. And I don't care about it until they hit menopause. And if they're not being protected with estrogen. So the estrogen factor is important as far as heart bone health. No question about it. And also brain health. So I'm in accordance with most gynecologists are not functional medicine or really proactive. So I mean, I've had patients come to me because I treat a lot of women with biotechnical hormones being that I'm anti-aging as well as cardiac. And they tell me that they're, they're QA and says, well, you better get on and off as fast as possible, because it's really dangerous. Well, and then they asked me, how long should I be on it? Probably rest of your life. Why would you want to stop? But they're encouraged by their gynecologists to stop it as soon as possible. And, you know, we're still quoting the women's health initiative from 2001, I believe it was. Well, first of all, the average age group, the average age in that group was 71. You know, I'm sorry, 61, which is pretty late in the game. You know, we've not even been looking at premenopausal, premenopausal. We're looking 61. The average age for menopause in this country is about that. So there probably were a lot of patients with heart disease that was undetected. So that was one thing they also used oral estrogen, which we don't recommend, because it goes straight to the liver and you can develop an inflammatory metabolite, which we don't want. We don't want inflammation. And also, come on, they use premarin and premprobe. I know, right? The fake alternative, not natural, not biodegradable. Well, for example, if you look at mares and horses, right, they have 27 different estrogens. Women have three. Yeah. I mean, we're not comparing apples to apples here. They're very good at controlling symptoms, but the long-term side effects. And I do believe the Women's Health Initiative did prove that. There's more heart attacks, more strokes. So all that was true. It's just they didn't give women any alternatives. And this is how I got into it. I swear to God, after the Women's Health Initiative, gynecologists all over this country were like stopping, abruptly stopping hormone. They didn't want to get sued. So all of a sudden, I had teachers and nurses come to me and said, you've got to help us out here because gynecologists in this town know nothing. And I said, okay, I'm up for the challenge. And then we learned. And that's really how I got started because I provided a need that wasn't being handled by the traditional doctors. And I've never had a woman, because I know how to follow hormones, I've never had anyone develop cancer while they were on bio-identical HRT. I'm sure it's happened, but I've never seen one. And I've been doing hormones since 2000, so 23 years. I've said this before, but as a breast cancer survivor, I couldn't agree more with you. 2001, that was the year I got cancer at a very young age. And I am obviously studying this for my own health. And I really, really believe that the benefits far outweigh the risk. Even now, I wouldn't say within the first five years, you need to be a little tiny ways out from cancer to safe. And in that sense, and you obviously, we're not giving medical advice here, you need to talk to your doctor. But if you're getting good information, find a functional, find an integrative trained doctor, because there are ways to test, like you and I am sure test metabolites. So we know where these are. And like you said, the brain, the heart, the bones, there's so many organs that absolutely need. And then the other thing I want to emphasize, you mentioned oral versus transdermal. It's a really big difference in clot risk. The oral metabolites do potentially increase clot risk. So I rarely, if ever use oral estrogens, progesterone is different oral progesterone is safe, biogenical, but transdermal. So creams or patches have a very different risk profile for women for clot or heart attack or stroke. So I love that you said that.  Absolutely. It's a discussion to say, because if someone's terrified, I never add to that fear. I get to, I let, I give them the information and then let them choose what they feel best with, because they know their own body is better than me. And they get to choose and I will just support and give them all the information they can do to make the best decision. Sorry. And I'm totally with you. I'm in the same school. Because like when I started in 2000, 2000, before the women's health initiative, so I would like find one sheets on biogenical hormones, which no one even knew about back then. I learned from my 4M. And then I'd give it to the patients. Then when Suzanne Summers came out with her book, The Sexy Years, I said, you know what, just read her book. Because, you know, it's, it's written from a late person standpoint. And that, and that really did help, you know, during the bandwagon, as far as biogenical hormone. So yes, I am pro hormone and the right patient. And I think discussion is really important.  And women are great about women research things all the time. So I mean, because I have a population of patients that are bright and, you know, and they really concerned about their health, they do the research and they come back and, you know, and we, like I said, I've never had any problems. I'll have to adjust things with men. It's one size fits all but not with women. Women is more complicated, but we were rewarding in the way. So let's shift in our last little bit here to medical advocacy and your book, which is from both sides of the table. And we'll talk about where to get that later. But tell us a little bit about how did you become a medical advocate? What does that mean? And why is it important for our listeners? Well, one of the reasons why I kind of relate to you is because you have your own backstory.  So it really like the first time I was hospitalized twice. And it's been 19 months. The first time I had a very small heart attack. I mean, I might have no risk factors. I'm not hypertensive. I always worked out. I've never been overweight. I've never smoked. You know, even when I went to Cedars, they said, well, you don't look like the profile, but it doesn't matter because it can happen to anybody. And so I had a stent and then, and then this would have me change the, with the cardiologists who did my procedure, when the discharge me says, well, Dr. Alcott, I don't know what to tell you.  I said, okay, I can do that. And then he said, but you know what, now this guy was about 20 years younger than me and was about 60 pounds overweight and it wasn't muscle weight. He said, but you know what, everything's going to be great because you have the stent and you're going to do great. And he left and this is when I knew what's going to write a book. I said, okay, he said, I'm good. I'm everything's fine now because I have the stent. First of all, if I, if I'm so healthy, why did this happen to begin with? Number one, number two, what can I do to prevent it from me happening again? And those are the unanswered questions. And then my daughter came up a few minutes later with the writing tab, a dad, it's time to write your book. What happened? So, you know, I did very well at a very small heart attack, but then 19 months later, I ended up in the hospital again, Cedars, Sinai, with an immediate emergency back surgery. I had this condition called spinal stenosis that I knew from 1996. At that time, I was doing triathlon. I wasn't bodybuilder yet, but I knew about it. So I'd have a relapse every, let's say two years or so. But this time, it was so bad, I went through rehab and chiropractic, nothing more. I got worse. I woke up one night and I was, I was reading a book and I'm numb from the knees on down. And I stood up and I just collapsed. I had, I couldn't walk. I crawled until my best friend Barry came to pick me up and bring me to the hospital the next day. And I ended up eating surgery. But here's the thing about it that I'm sure you can relate to is that I just didn't have surgery. I had a botched up surgery. And I have permanent nerve damage as a result of that surgery. And not only was it botched up and I had permanent nerve damage that I'm still dealing with today, 15 years later. But I have, it was incomplete. So he didn't complete the job. So over a period of years, you know, I'm bending over more and more with the waist because stenosis, like flexion, it does not like extension. And it got to be the point in which it was hard to walk mechanically, not because I was short of breath or anything, just mechanically.  But when you have permanent nerve damage, it changes you, especially if you're an athlete, I cannot do anymore. And it's not because of my age. It's because I have limitations. So with those two hospitalizations, it really inspired me to write a book, because I had to become a medical advocate. Because when he said, you're going to be fine because you have a new step. I said, this BS is absurd. And then when I had, here's the other one I want you to hear about is that when I was hospitalized at Cedars for the back surgery within the second day, the discharge planner says, well, doctor, we tried everything we could to get you into rehab, but your insurance was to go to a nursing home. I said, a nursing home?  I said, and we tried everything we could. So here I am in bed, bedridden, with opiates, in pain, and I spent two hours on the phone with Aetna insurance determined. That's really being your own medical advocate. Because the hospital was not going to go out of their way. And the next day I was, I was wheeled over to the rehab unit. So that's, yeah.  Of course you figured it out. It's not true. Not necessarily true at all. In fact, that's why one of the chapters in my book is entitled heroes. Because I interviewed about seven or eight people, both men and women, who had no medical background, yet they became their own medical advocates. It made some important decisions that affected their lives in a positive way. I want people to know you don't have to be a doctor or a nurse. You just have to have the desire to, it's work. And I'm still doing it. I'm still doing it today. So that's how I got into it. And I was inspired to write the book. And although the book starts off with my story, most of the book is really about how you can become a medical advocate. So we talk about nutrition and supplementation and exercise, stress management, and how to not age ungracefully ever after. What a great message. And I could not agree more. I know we have this such in common because the truth is whether it's the insurance denial, which happens as a matter of fact.  I literally requested a completely different drug, a completely different protocol. I did a completely different type of radiation. I basically created my own plan that fit for me. And thank goodness I had doctors that went along with it, but it was completely not the standard. I said, I want to do this and not this. And I want to have my chemo in two days instead of one day. And I want to do this to mitigate side effects. And I'm going to take some antioxidants during chemo, even though it's not recommended. And again, talk to your doctor. I'm not advocating that without your doctor's permission. But I did a lot of things that weren't advocated because I knew that it mattered to my own personal journey in health. And I agree with you. I love empowering patients. And even when you and I sit with them, part of it, whether it's bio-dental hormones or whether it's diet or lifestyle, I give them as much information as I can. And then they still get to make the decision. But I'm there helping them and saying, do you have questions? Is there a way I can help? Because the truth is, we all know our body's best. And even if I believe this supplement or this intervention is going to be best for the patient, if they don't believe it or they're afraid of it, it's not going to do them any good, right? And that's why I related to you so much in your writings and your postings and so forth because you're about patient advocacy. Not many people are. They pontificate about what they know. And I get in some of these arguments, not arguments, but I just against people in social media because it's really not backed by science, some of the things they're saying. And I will interrupt and say, you know what? I understand what you're saying, but your readers need to know this. I mean, if it's really against my grain, I will intervene. But you're absolutely right about it. I did the same. When I had my back surgery on recovering in rehab, I had a friend of mine bring my supplements that they had, Coke U10 and fish oil, vitamin D. And so they make their rounds. The doctors, the interns, the residents, the fellows, and the attendings. They said, what's this? I had everything in a shoebox. I said, well, this is this. And I said, and they looked at me like I was Mars. And I said, do you guys not know about this stuff? Some of the people are like 20 years younger than me. Oh, no, no. All we do here is rehab and pain. Unbelievable. Yeah, exactly. Like you said, the basic, the Coke U10, you can't imagine someone doesn't know the science on Coke U10, but the truth is a lot of doctors still don't. Well, I love the path that you've taken. I love that you've given us some really, really valuable information about the heart, about aging, about biological hormones, and especially about patient advocacy. So obviously, here's your book. Where can people find you, get a copy, both sides of the table? Okay, well, actually, I have two websites. One is HeartWise.com. But if you have my own website for that, it's called, it's a little long name, but it's BeYourOwnMedicalAffecate.com. So although it's my story on both sides of the table, it's really about patient advocacy. So BeYourOwnMedicalAffecate.com. It tells, it's specific about the book. There's a praise page for people that read the book before it's published. And also, it goes straight to my Amazon page, but you can buy it. It's, I think it's like $9.95 for the electronic or? Thank you. Okay. That's all it is, more screen time. So I know. I know. Or the book, I like turning pages. I'm old school. Me too. Me too, as I have the copy there. Again, for your time today, thank you for your information. Thank you for the great work you're doing. If you're listening out there, wherever this podcast is being shown, heard or watched, you'll see the links to the websites that Dr. Elkin mentioned. And thank you again, Elkin, for your work in the world. Joy to be here with you. Thank you. You too.


All right. Good morning everybody and welcome to the book map special event webinar here today with Oliver sparring On order flow this webinar will be in German I will give a brief introduction here as you guys can see. Well, this is our first introduction to foreign language Well, actually we've done a few before but we're going more in this direction foreign language webinars and content So we're very happy to have Oliver and In the German language here. I will be putting his contact information. He has a website as well as Instagram He is a mentor and educator Put this into the chat for you I'm going to read the risk disclosures. I'll let Oliver introduce himself because it is in German and I cannot read that General disclosure all book map limited materials information and presentations are For educational purposes only it should not be considered specific investment advice nor recommendations The risk disclosure trading futures equities and digital currencies Involves a substantial risk of loss and is not suitable for all investors past performance is not necessarily indicative of future results So Oliver once you go ahead and share your screen and I will share it from there Perfect Okay, for those of you joining just another note if you're just joining now this will be in German Okay Pop this out. I'm sorry. Hold on a minute. This looks good. Okay. Yeah, we're all set It looks special right now. I'm not sure if you see the same as me. I'm seeing an infinite mirror Let me let me just start it again Okay, so this is strange. I still see the infinite mirror. Hmm. Okay. Hold on a minute It worked like a minute ago. Yeah, it's let me try this again here. Hold on. This is yours Okay, maybe maybe you are Streaming from Another screen I Am not this is my main screen and let me just start it again. Okay, I Mean it worked like a minute ago. Why shouldn't it work now? Yeah Okay, if I close this court, can you see my Desktop now I do still an infinite screen. No, no, I see a spying investment Academy Okay, I just put Book I've just put discord aside man. Yeah, hopefully this will work. Okay.   Das war gerade der es spricht der s und p 500 future Okay But Then would I say we're going to continue with the situation in gold I think that was my first trade The one that was gold so today morning also he was slowly on the way Now we have a full picture He was slowly on the way As you can see we also have a slightly longer side-up phase which has been going on for over half an hour We have both liquidity on the ask side as well as greater liquidity on the bit side We have kept us here with the course inside this channel The depot of the day was up to this point And in this case you can see that in contrast to the last trade in the s We have here the Liquidity in balance on the bit side That means in this case The majority of the larger limit orders Bit what does that tell us That tells us that the course probably in the mid-term area of the day will tend to go down So now we are in gold, yes, anyway, more in a downward trend He's been running for a long time now And that also does something like that here, somehow physical gold Uh to lie had or in gold invested is uh Because he was just after that as if the whole thing would repeat and go towards 2,000 Now we have, as I said, here again the slightly larger Yes Corrections in this market and accordingly the whole thing in the intraday area here anyway rather on the short side interesting What happened here? We are up here at this level Here we had a somewhat unobtrusive order Had that here, however, already in the course of the day always made noticeable again In addition, this was a zone that I have already described in my Tomorrow's analysis, which is exactly what I mean by that. I'll show you that myself Of course, when it comes to the market structure So the course has come to this level. We have here again in the trade finder The volume spike had, that is, here was bought by a time frame of 30 seconds very, very much in the market G but you can already see here, before this limit order, a small side Consolidation Let's take a look down here at the market volume stop line. You can see how it has been quite volatile Had here was so to this two points still very, very massive market G bought buyers are here but somehow not further through and while this Consolidation here forms, you can already see how this Mv stop line here is strongly Disappeared as well as the buyers here simply and fluently the air goes out and not only that There are now also the first market buyers in here because you can see as quickly as the line is here She just falls back and that is of course our advantage, the whole thing this time in the direction of the imblance So I opened my short trade here stop order Was here pauschal at 10 ticks. I pull it right away. Actually, there were eight ticks meant. I pull it right here A little closer to the limit order so that it is like two three ticks over here And I chose the liquidity as a target down here. Basically, it makes my experience always sense As between targets bigger limit orders to choose If you are here with several contracts in the market, then of course you can scale out very, very nice Go in and out again. That means you could set up your position here step by step And accordingly, as soon as you reach your first target here, maybe not the whole position, but First of all, go out with a share sale, see how the market behaves. Maybe we'll get a correction where you can Pull the stop nice If the market then continues, then you can try to hold the trade for a little longer time. Just like in this situation here Where we have the imblance line on our side, which tells us that we are here Tendentially go down. So That first of all to the basic situation that this trade has gone out. When lila file was again The opening of my trades. I am in this case here only with one contract short. And here too, we see a wonderful follow through That of course always makes a lot of fun. That's not always the case in trading. I think you all know that The market is going through First of all at such limit orders for a while to run sideways. That's not unusual. Maybe we can do a retest again You can then look very nicely See if possible divergence in relation to mv stop lines So now we have a little orange box here that has been formed. That was here just Let's do it back again That was just our trade finder again. He shows us that a native iceberg order has been placed in the market So here someone has transferred a hidden order to the comax, a larger institution of the hindler in the rule That here in one piece, that means contract for contract, builds up its larger position The 38 here shows us that he has already bought 38 contracts on this level in one piece And every time the market is here on this line, it would enlarge its position. In this case, that was obviously here at 40 contracts in the case of the case And accordingly, this order then disappeared again You can see here, for example, there is a bit. If it had reached a size of at least 50 contracts, then it would have stayed here in my chart for a long time And it would still have been shown That can be configured in this way and you have to configure all this market for market, depending on the liquidity of the market So now we have the first major sideways phase I have a tick over the limit order for the stop Meanwhile, here we get the next smaller breakout in the microstructure down. Accordingly, I have changed my stop order again Now you have to pay attention to this Such things are always very interesting. We had a larger limit order in the ask here It is filled here, that means the larger order has been taken from the market, is therefore filled by market purchases The market does not turn at this point, but continues to break through If the market is filled to such levels, where such larger liquidities have been filled before, back Then these levels often work in the other direction, in this case as support And we can now see that relatively precisely here. The market falls to this level and starts to rise again in a short time So the market rises again We don't want the market to be large again over our previous rise In the market, the MW Stop Line shows us that the tendency is to buy R-Market-3G So here the sellers seem to be going out of the air, which is counterproductive for our trade In addition, we have this little histogram here. Maybe you have noticed that already. Here we see a 251 to 36 That means in this case, that here in the visible area, in the visible area of the course, 251 orders have been filled in the shopping area as hidden iceberg orders While on the other side only 36 orders have been filled on the ask side, i.e. on the market Sorry, on the limit sales side The tendency is that here more institutional shopping positions are built, which is not necessarily ideal for our trade So here I have been more aggressive with my trade management At this point, however, not yet necessarily the reason to not trade So from our initial follow-through, here is now a little bit of a sideways phase But the whole thing is not too bad. Our original trade idea of course exists here Before we go from the correction and now we see the breakout from this sideways range We see how the MW Stop Line is going south again And now we have the breakout from this microstructure What has now left me to do is to pull the stop back a little more aggressively I don't necessarily want the sellers to be able to get out of this sideways range I don't want them to give up when the course goes back to this breakout level But I want them to have their prices, which they have just established, to defend them So the stop here makes me over this level Depending on how aggressive you want to manage your trade from the situation If I were a little more optimistic, I would have left it up here In that case, I am a little more aggressive here, as I said before Now the market is making the pullback here at this breakout level and taking our stop order In this case, no huge trade We had an 8 ticks risk, won 12 ticks, so CRV 1.5 to 1 is okay There was also much more in the end of the course, it actually went pretty far south But as I said, you have to discipline yourself and make sure that you get used to it Even if you don't get it all the way away, not when you're as ticked as I am Okay, let's take a quick look at the Discord channel If there are any questions, there is nothing here Let's take a look at YouTube Supertrade in the WC and the EES, I liked it Yes, Bernie, those were really nice trades, they made fun of me As I said, I was a little under pressure this morning I had to show you something, I knew that today is the session in the last week But as I said, I wasn't able to trade or trade there, only because the internet connection is not the most stable So today, in the morning session, I prepared a little bit and did a little bit And of course it went really well that we got these great trades here So, now I would like to continue with the pure market structure analysis That means, let's take a look at what the EES has done today And probably will do the same today I use this both as a software bookmap But I also use SierraChart to define the zones here, such as medium, volume profile and market profile In which I look at trades for the first time Maybe a word for that You have to always answer two questions in the modern day trading From my point of view and my experience That is, where and what In the past, in the good old days, there might not have been so much algorithmic trading Or there was no algorithmic trading Everything was a little easier And there it was often enough for a functioning trading system If you only answered one of these two questions Maybe you know the Turtle Trader They have a very, very detailed and very, very simple system In the 80s and 90s They also added a lot of inexperienced traders That earned a lot of money They traded just over 52 weeks And adjusted their position size to the volatility They earned a lot of money with it And as soon as the regular work of this system has become public In the mid-90s, the strike has stopped working Because too many people traded it after the same regular work And that leads to a statistical system that simply fulfills its advantages And doesn't work anymore from now on What did the guys do? They only answered one of these questions What does the course have to do? What has to happen to open up a trade in some form? Nowadays, as I said, the whole thing is Because of the millions of billions of trading algorithms in the market There is something more complex We always have to answer two questions Where does the course have to go So that a trade comes into view for me And what does the course have to do there So that I click on buy or not click on buy It can be that I have a classic set-up Because I thought it would happen in some form And I would advise you to open up trades in such cases You always want to define where the interesting opportunities are Where have big market participants built up their positions Where is it to calculate liquidity And when the course comes to that And only when it is there Then you want to think about a trade I do this with my customers and students We take market profiles as well as volume profiles The whole thing looks like this in Sierra Charts I always use the very useful replay function of Sierra Charts And put the market back to zero on today So I can't see what happened today If I start my session at 9 o'clock in the morning Then I already have the whole course And the accumulated volume from the Asian session And I don't want to see that I want to start fresh and draw my levels I don't want to get too deep into this matter Of course it can be our customers We want to deal with trading with BookMap Basically a few levels that belong to every good market We have the target market profile In any case, I would always pick the advantage And choose the advantage level I personally like to mark turkeys on the advantage level And gold on the advantage level Then I see a market profile A TPO mountain And I would like to be active in this lower part of the course This lower edge of this mountain Then I would like to be active here with a trade And also for the case that the course slides down And this is just relatively likely in the ES Because as I said, we are in a stronger correction And we had a very strong trend day On Friday I would like to draw one or two levels On which I would look at trades For this we have to go back to the chart And take a look at the market profile From the 23rd to the 7th This is the last time that the price was around 4000 Of course, it is also a very, very marked round number The 4000, which of course is found by many market participants Especially institutional market participants So definitely one area And then I would look at this area Where this upper edge of this TPO mountain Again as a potential trading location To refine the whole thing now I take a volume profile again Because I would like to draw these levels Which I would like to define as both volume profile And also in the market profile Very important, at least for my trading style So now it's taking a look A lot of data Let's zoom in a little bit To our zones This is how it all fits And then we would like to see the whole level To refine the whole level again So here we have the advantage The upper edge of the TPO mountain I would place it here on the upper edge of the TPO mountain Then we see here Wonderful value area low Of the previous week And this one curve here in the volume profile Then we have the current value Here we now have A possibility To see a small volume edge Always pay attention Always pay attention to such edges In volume mountains Because they show us That this location is absorbed In some form And accordingly in some form Also built larger institutional Sprayers their positions Also built their positions Here we can already see the location Is a little messy from the market profile Also here we would like to Move the lower edge And then Are really good in the area Of the 4000 points And only When I have drawn this Level image here I always make a screenshot For our customers And then we can see How the whole thing would have developed In the course of the day So that's just standing here Tonight 0 o'clock What did the course do here in the future And then I always posted A screenshot at the end of the day To see how our levels And our trading locations actually worked How the course reacted to it And where could you find Potential trades First of all to the market structure analysis Now we can take a look At our course Before we go back to the bookmap And we see We have a really nice Long-term side day Until now We already had the U.S. market opening 10 minutes ago Let's take a look at the bookmap in a moment But we see we had this strong Trend day on Friday Here the gap tonight Then the course today in the morning Here near our advantage Came down That was the place where I turned the trade I showed you earlier in the bookmap And since then it has been rejected The trading idea is basically At the advantage Deep here we are looking for In such a day The short trades And here in the area of 4,000 points Of course we can also calculate with strong liquidity We would now look for the long trades Should we Break this level sustainably And stabilize us above this level And accumulate volume there Then of course the whole thing Has to be evaluated again There are basic questions About market structure analysis So, if Fluence is asking Why is there a larger limit Orders in BitAsk Unlike the return of the course Other than resistance in BitAsk That can have Very, very many different reasons Depending on what the intention Of the other time frame participants That is, the institutional handler Who just built this position Or built it We cannot say at this point Did someone Eventually build a new position Did someone take profit there And closed a existing position So that can have Very, very many different reasons And reasons It can be trap traders Who try to To close their positions That they opened on the wrong side And quickly get out of their Break even So that cannot be answered So easily But try to Observe in the market When you see this We really have this situation again and again And try To build up your own statistics And observe the whole thing What happens when the market After a breakout By a level of liquidity At this level of liquidity Often we also see so-called flipping That then The order on the one side Is filled and then On the other side Let's see if we can find it somewhere At the moment Not yet The limit order Has already come to an end What I mean When we get this limit order out We stabilize In this case Of course the market was rejected But we would have walked up here The market buyers would have been Active, had pushed the course up And then this limit order Would have been moved directly In the bid With so-called flipping That is always a very good sign If you had opened a long position To keep the trade in its direction Now we see here What the market is doing The market Has some of our big limit orders Purchased We see Here was already a whole while in the market So someone filled the limit short The market then went up briefly Here However, the market buyers did not want The course is further down Here it came now To the second run Strong market purchases again We see here below Wonderful on the MB stop line But also here again We do High, high, high High, high, high But in the MB stop So here in our Sailing cumulative delta I'll call it that now Is not confirmed So the further the course goes up That you are weaker At this point the market buyers And accordingly there is no wonder That they could not pass here And the course again Nevertheless We still have the liquidity On the ASK side Means the chance is Still at least First bigger That the market, these big limit orders You see, they are all here Very, very long already all day Somewhere in the market Partly that the market The earlier or later still gets Because the reason behind it We always have to assume How such limit orders here In the market That they first of all Have a very, very big potmoney Because you don't just lay As private small trader Here somewhere 261 limit orders In the market Then you say broker No, you don't do that So that means These limit orders that are here They are now spoof, whether they are fake Or whether they are real Several institutions in the market Which are also available About the corresponding capital Now we have to assume That these institutions More knowledge About the whole market structure And about the whole market event Than just private traders So they put their orders up here Always only from a specific Reason there No matter if they have a longer Limit order here They try with short-term orders To spoof the market in a certain direction They always have a certain intention And this intention Which is based on the fact That they know something So if they So up there Place these big limit orders At 4050 points Then they go out of For some reason That the market with very high Probability comes there Get rid of What the intention is behind And whether the market does that That's on another page But basically We have to assume That these limit orders are from a certain reason And that they want to be spoofed Especially if they are longer In the market Now we have seen Our retracement The Sellers have the course That these bigger orders Have been filled Now they have The upper hand You can see here In our price dynamics plot line In short PDP line That in this area The market buyers were on the route We had the breakout Under this microstructure That was defended several times We had a beautiful signal Which one In the short-term Could be somewhere If we look at it Then zoom in Of course Everyone has to develop their own style But I am always a friend Of having very, very tight stops And when I see that Right over this signal Here This limit order is still Two more very big limit orders Then I go out of it That the market Tendentially also wants to To these limit orders In this case Of course it was like that You could have run it front That means you could have With a limit order Right before this limit order Can put the stop one tick over it Then you would have a stop of two ticks Then you would have a few ticks That works again and again More often But it is not But as I said If you already see that here Right in the middle of this signal Which we get here There are more orders Then I go out of it To wait and see Maybe the market still has this order In this case it would have made sense You would have had two options If you already wanted to trade this signal Then the stop belongs Definitely over the liquidity Just too big that the market This limit orders is still missing Then you have a relatively big stop And then you have Not the ideal CRV Because Let's take a look at the market Let's go out of it Here we got our signal We are here In a sideways range That means we have to With greater resistance The lower edge of this sideways range Needs Once we have the imbalance Still on the ask side That means the greater chance Is still above Now you have to think about whether it is worth it If I go short here And up here What are these Here in the area of 41 Here we are in the area of 45 Four points 16 to 20 ticks Stop But then I definitely want the potential That the trade goes a little further Because I say CRV from 2 to 1 I basically always turn on First of all Now we have seen the breakout So the course would have done exactly what we expected It would have been better Wait to wait What happens if the market Needs these two orders up here And we see everything here Here the market speed A little slow We have made a little higher Here are the orders Here is the bigger limit Order has already been taken out That means here the intentions To let it be filmed It was obviously not necessarily there The stop line is already deep down here That means There is no more So much convincing power Of the market buyers After this breakout Here we see How the buyers go at least The order has been taken So if then Up here in this area The better option was to get into the trade And then we also have From possible chance risk The relationship is already a completely different Because then we may talk here From the tick stop And that feels In the ES already much better What did the market do here so nicely Since this situation Here we were just That is the situation we just Have promised, then we are back here At the lower edge This sideways range that we just talked about Here we have Wonderful a market volume Stop signal Whether you would have got it I dare to doubt Because basically It would have been a location That you could have seen here In trade If we look a little bit to the left We see how here This big spoof limit order in the market Which has not been filled here Which has been pulled out when the market came Accordingly here with a lot of energy The breakout over there Pullback at this limit order In this case again Then it went up and now we come back here In this area where this spoofing order was And as I said Then the market volume stop signal But That was already very fixed So who gets the trade so fast And is replaced He has a finger and I personally I didn't do it anyway Because I am rather a friend Of such trades really only then To implement when I also see The market sellers bite the teeth They don't come further down I want a bigger limit order In the immediate vicinity of this trade signal And I would like to see That this line is green here That means that on the other side Now the market sellers Will be active again and push the price up Because basically we have In such a sideways phase Is always to do with two situations We have up Wait So we can see a little more We have up here in some form The sellers sitting There is a very, very expensive price To sell it That is a so-called premium And we have down here In such a sideways range the sellers Who assume that these prices are low That this is a discount That is both for the micro structure As well as for the macro structure And if we now In the lower area Such a sideways range We want to look for our long trade What makes sense Is that our market sellers Our aggressive sellers will be active And push the price up In this case it was simply absorbed That the movement Was very, very intensive here But we do not really see here That the sellers take the Zepter in their hand And accordingly it is not wonderful That the course here Not so far in our direction And then even here Makes a deeper depth And finally this larger order Fills So we throw one last look On the current Band of things Maybe a short look On our chart We see how nice our trading location Has worked here, the course is here After the end of The pre-cash sessions In this zone We have seen how much liquidity Is here, the limit orders Were filled again and again The conviction of the market seller Or generally the seller The course here maybe again To catapult in higher needs So my dear That would be it For our first session The last five minutes Maybe again for your questions Or remarks I'll take a look At the moment We'll do your discord again Sorry, bookmap and on the other side Discord So far nothing new Came in, then I'll take a look at youtube If there are new questions If you still have something on your mind Then feel free to start If you are lucky Yes, absolutely The night gap is now completely closed And here we have The one or the other good trading In the course of the day Definitely possible As I said, the trade today In the near future The advantage is deep It has worked very well You can realize a very nice CRV Definitely even more than Than I Then here the situation That we just talked about Here would definitely have been A trade as well And let's see What will happen if the course Now reaches this area I'm actually going out Orders now here in the next A few minutes will be filled And that we then tend to move Up to today Now we have here again The market volume stop signal from the trade finder Nice situation The course is noticeable That we call As an exhaustion situation So as a creation So next to the Limit orders that were filled here Probably there are still some Failed Then, however, in the moment No market buyers have come To make sure that this breakout Stopped, now they seem to Come in again Here we can see Here is definitely a algorithm At the start, it also shows here very, very nice The equality of the piggy plot line Here is definitely Interesting algorithmic trade Now you can definitely Keep watching Interesting situation Especially if you zoom in a little bit And look at the microstructure of the whole I personally would To tend more That this price range here around the 4050 today still falls And that we tend to run up Also on The whole Balances and the whole liquidity That we currently have on the Basque side I'll see Nieder, great that Buckment also does something in German Yes, Bernhard, that is a very, very good question We will definitely In the course of the week Talk again together As far as we do it here regularly We will hopefully do it regularly But whether the whole In the week or two weeks We will still discuss that in the Buckment team And then definitely give you again Maybe at the end The word in your own thing As you certainly have already I'll take a moment to My image and my stream Again In your own thing As you certainly have We are A trading school We offer different training programs For interested traders The whole For the area of long-term investors But of course Swing trading and what the day trading Is about At the beginning our website Blended www.sparing-academy.de There you will find us Of course also on Various social media channels On Spotify, on YouTube Under the Sparing Investment Academy So if you are interested To learn day trading Especially day trading with Buckmap And the Heatmap Then we would be very happy To meet you. You can About our website www.sparing-academy.de A free consultation With us books I am also personally there And do that with you And then we can definitely About your goals and wishes Break That would be from my side Thank you for being here today Thank you for listening. It was a lot of fun Everything was worth it And in this sense I would give the word to Bruce At this point We are finished I hope you are still there Yeah, I caught all of that Perfect Excellent Oliver, that was I hope we can get it translated In subtitles In English That would be fantastic And over and showing So, you know Maybe we can do some in English Anyway Really enjoyed having you here For the first Foreign Language Bookmap webinar We will do more of these I hope so. It was really fun Thank you We will catch up next time Bye everybody Bye