Ep. 5: “Watch Your Breath” — Your Heart and Lungs Will Thank You — with Dr. Nina Maouelainin, Interventional Pulmonologist

What does your breathing have to do with your heart? In this episode, Dr. Regina Druz is joined by interventional pulmonologist Dr. Nina Maouelainin — founder of Lung Health Services and one of fewer than 500 interventional pulmonologists in the country — to explore the deep connection between lung and cardiovascular health. They unpack the alarming rise of lung cancer in people who never smoked (and why women are hit hardest), the startling discovery of microplastics inside artery plaque, the overlooked household risk of radon, how cooking oils and fumes raise cancer risk, and the simple message that ties it all together: watch what you breathe.

Watch on YouTube: A video version of this episode is available on the Own Your Heart Health YouTube channel. Subscribe to be notified of new episodes.

Episode Chapters

[00:00] Introduction & Meet Dr. Nina Maouelainin
[02:00] The Alarming Rise of Lung Cancer in Non-Smokers
[06:30] Why Women? Cooking Fumes & the “Cooking Index”
[09:30] Microplastics in the Arteries: The Heart–Lung Link
[12:30] How Your Lungs Work — and How Surfactant Protects Them
[16:30] What to Avoid: Oils, Cookware & Frying
[21:30] Screening & Advocacy: Low-Dose CT and the White Ribbon
[30:00] Radon: The Overlooked Lung Cancer Risk at Home
[34:30] Genetic Testing, Nodules & Risk Calculators
[48:00] Whole-Body MRI & Imaging Overuse
[50:30] “Watch Your Breath”: Closing Wisdom

Transcript

[00:00] Introduction & Meet Dr. Nina Maouelainin

Dr. Regina Druz (00:00): Welcome to Own Your Heart Health. I’m Dr. Regina Druz, your holistic cardiologist. This week we’ll dive into common heart health concerns, uncovering root causes and unpacking scientific discoveries and controversies. The information provided does not constitute medical advice. Please contact your healthcare practitioner before making any changes that may impact your health.

Dr. Regina Druz (00:30): Welcome, everybody. Today I have a special treat — a great friend who worked shoulder to shoulder with me building a multispecialty team for a large organization serving senior patients. Please welcome Dr. Nina Maouelainin. Nina isn’t just any pulmonologist; she’s an interventional pulmonologist who runs her own practice, Lung Health Services, and an educational foundation, Dr. Nina’s Lung Care Foundation. Welcome, Nina.

Dr. Nina Maouelainin (01:00): Thank you — it’s a pleasure to be here. I’m looking forward to a stimulating conversation and to sharing what we can all do to protect our lung health.

Dr. Regina Druz (01:15): And November happens to be lung health month.

Dr. Nina Maouelainin (01:30): Correct — November is both Lung Cancer Awareness Month and COPD Awareness Month. It’s a topic dear to me, because lung cancer is still the number one cancer killer of men and women worldwide, more than several other cancers combined.

[02:00] The Alarming Rise of Lung Cancer in Non-Smokers

Dr. Regina Druz (02:00): What strikes me is that we’re seeing progressively younger adults diagnosed with cancer. A very close friend of mine — who always assumed her risk would be cardiac because of family history — had a cardiac CT in her early fifties. There was no heart problem, but they found ‘a little something,’ and that turned out to be a lung adenocarcinoma. She never smoked in her life. So what’s going on in the lung cancer world?

Dr. Nina Maouelainin (03:30): It’s a fascinating and sad situation. Historically lung cancer tracked directly with smoking. But the TALENT study in Taiwan, presented at the World Conference on Lung Cancer, screened the general population — and the bombshell was that close to 3.8% turned out to have a stage one adenocarcinoma. When they dissected the data, nearly 60% of those diagnosed were non-smokers, and of those, close to 80 to 90% were women.

Dr. Nina Maouelainin (05:30): They screened using low-dose CT scans — simple and quick. In the U.S., screening is now recommended for anyone with a 20 pack-year history between ages 50 and 77. That’s a change: it used to be 30 pack-years from 55 to 70. The original criteria were built around a typical white male veteran and missed many African American and Hispanic patients who started smoking earlier, so lowering the threshold to 20 pack-years lets us catch many more.

[06:30] Why Women? Cooking Fumes & the “Cooking Index”

Dr. Regina Druz (06:30): So why is this hitting women so much harder than men?

Dr. Nina Maouelainin (06:45): When investigators interviewed patients, family history mattered — but the new factor, now a screening criterion in Taiwan, was cooking habits: deep frying, the type of oil fumes, and how much ventilation there was in the kitchen. As this kind of screening expands into Europe and beyond, oncologists are seeing more patients under 50, most of them women. There’s even a ‘Hear Her’ campaign now recruiting young, newly diagnosed women with no traditional risk factors.

Dr. Regina Druz (08:00): A quick note before we go on. I know the opinions on nutrition for heart health and longevity are contradictory and confusing — low-fat versus ketogenic, plus many voices for vegan or vegetarian eating. To cut through the clutter, my team and I created Holistic Heart University: on-demand courses and resources, open office hours, and a Q&A where you can put us in the hot seat. The link is in the show notes — use promo code OWNER20 for 20% off an annual subscription.

[09:30] Microplastics in the Arteries: The Heart–Lung Link

Dr. Regina Druz (09:30): As an integrative cardiologist, I practice with functional medicine in mind — systems biology, detoxification, and toxic exposures all play a role. So I was as shocked as everyone when, in early 2024, a study in the New England Journal of Medicine examined plaque removed from patients’ carotid arteries during surgery. A proportion of those patients had microplastics and nanoplastics — tiny plastic particles — embedded in the plaque. On follow-up, those patients had roughly five times the rate of cardiovascular events and were about twice as likely to die from any cause.

Dr. Nina Maouelainin (10:30): That’s staggering when you consider how much plastic surrounds us — water bottles, disposable products, microwaving food in plastic, even the lining inside coffee cups. We’re consuming it and inhaling it. Microplastics interfere with the biophysical function of the lung’s surfactant, and we’re seeing more interstitial lung disease and low blood oxygen as a result, because these deposits disrupt the alveolar barrier.

[12:30] How Your Lungs Work — and How Surfactant Protects Them

Dr. Regina Druz (12:30): Let me have you translate that out of doctor-speak. What is surfactant, where does it live, and what does it do?

Dr. Nina Maouelainin (12:45): Think of your lungs as an upside-down tree. The main windpipe comes down and branches right and left, all the way out to tiny twigs. At the end of each twig is something like a clump of grapes with the fruit removed — just the skin. Those are the alveoli, little sacs that inflate and deflate every time you breathe. They’re wrapped in blood vessels: the right side of the heart pumps blood to the lungs, the blood picks up oxygen around those sacs, and carries it back to the left side of the heart, which sends it to the body.

Dr. Nina Maouelainin (15:00): Surfactant is a product made by cells lining those sacs. Picture a birthday balloon — it’s hard to start inflating, but easy once it’s going, as long as it never fully deflates. Surfactant gives the alveoli that elasticity and smoothness so they stay open easily. Anything that disrupts it — mucus, viruses, bacteria, or microplastics — makes the sacs stiff and hard, so oxygen can’t pass as well and you feel heavy and short of breath.

[16:30] What to Avoid: Oils, Cookware & Frying

Dr. Regina Druz (16:30): Going back to Taiwan — was it the cookware, like Teflon, or the smoke and fumes? What should people actually try to avoid?

Dr. Nina Maouelainin (17:00): They built a ‘cooking index’ based on oil-fume exposure. When I started asking my own adenocarcinoma patients about it, I was surprised how many had no idea that certain oils can’t be used at high heat — some are for salads, others for high-heat cooking. Frying with the wrong oil, especially recycled oil in a closed, poorly ventilated space, means breathing in carcinogenic fumes, similar in spirit to a chemical exposure. My advice: avoid frying, ventilate well, and be careful with spray oils.

Dr. Regina Druz (19:30): I use extra-virgin olive oil, which has a high smoke point, and a touch of butter to brown things — often less problematic than many plant oils. Many patients also don’t realize they’re getting an excess of pro-inflammatory omega-6 fatty acids, and some have genetic variations that make them more vulnerable — which is testable, and we test for it.

[21:30] Screening & Advocacy: Low-Dose CT and the White Ribbon

Dr. Nina Maouelainin (21:30): Fume exposure and frying were the correlating factors, and risk was much higher with a family history of lung cancer, up to third-degree relatives. By my read of the data, a striking share of newly diagnosed lung cancers are now in non-smokers — yet we don’t routinely screen women, and uptake of low-dose CT even among eligible smokers is under 10%. My message: advocate for yourself. A busy 30-something woman with a nagging dry cough is far more likely to be told it’s postnasal drip or reflux than to get a scan.

Dr. Regina Druz (24:00): A quick note: many of us are seeing patients arrive with self-ordered labs, which too often create confusion. That’s why we created HeartWell Toolkits — curated at-home blood and genetic markers focused on heart and brain health, available at the holisticheartcenters.com shop. Use code TESTING10 for 10% off and free shipping.

Dr. Nina Maouelainin (25:30): Low-dose CT is covered by Medicare for eligible patients with documented risk factors, no preauthorization needed. Private insurance is another story — much like the early fight to get mammography covered, which is what drove the pink-ribbon movement. There’s now a White Ribbon Project for lung cancer awareness, started by a non-smoking woman who struggled to get a scan and biopsy before finally being diagnosed. With current guidelines we still miss 30 to 50% of cases — and we have essentially no strategy for the new, non-smoker risk factors.

[30:00] Radon: The Overlooked Lung Cancer Risk at Home

Dr. Nina Maouelainin (30:00): Beyond the cooking index, the thing people ignore at home is radon. I ask patients when they last checked their radon level, and most have no idea.

Dr. Regina Druz (30:15): Tell our listeners — what is radon, and why should they check it? It’s relevant here because microplastics and many toxins reach the arteries through the inhalational route, and some are endocrine disruptors, which may be part of why we see younger breast and colon cancers too.

Dr. Nina Maouelainin (31:00): Radon is a naturally occurring radioactive gas from the breakdown of uranium in soil and rock. Outdoors it’s harmless, but indoors — especially in basements — it can become highly concentrated. The good news is you can install a mitigation system that evacuates it and monitor the level daily. The EPA has strict regulations, and radon is typically measured before a home sale. Even in a house without a basement, measure it in closed, low-lying spaces and bedrooms. Radon is still the second leading cause of lung cancer — and it’s highly preventable. Order a test kit (the American Lung Association has a link), send it in, and if needed a radon-mitigation company installs a system.

[34:30] Genetic Testing, Nodules & Risk Calculators

Dr. Regina Druz (34:30): I do a lot of genetic testing in my practice — from simple genotyping for known variants, to next-generation sequencing that looks for things we don’t already know about, to polygenic risk scores. There are now direct-to-consumer companies offering this. For a younger non-smoker with a family history of lung cancer, does it make sense to pursue genetic testing? And what counts as a worrisome family history?

Dr. Nina Maouelainin (36:00): A worrisome lung cancer history extends to third-degree relatives — parents, siblings, aunts, uncles, grandparents. But we’re not yet at the point where lung cancer has a clear actionable gene the way BRCA works for breast cancer. There are familial patterns with EGFR and ALK mutations, but a low-dose CT really should only be done when risk factors accumulate — say, frequent deep-frying without ventilation, secondhand smoke, plus a close relative with lung cancer.

Dr. Nina Maouelainin (41:30): When we do find a nodule, we don’t guess. We calculate a pretest probability with the Mayo Clinic pulmonary nodule risk calculator — it’s on MDCalc, and anyone can use it — entering age, nodule size and location, prior cancer, and smoking status. For nodules roughly 8 to 30 millimeters we add the Nodify blood test, which looks at genetic markers to refine the risk. For larger nodules a PET scan helps, since cancer cells take up tagged sugar and ‘light up.’ Combining these tells us whether to relax and monitor or proceed to biopsy or removal.

Dr. Nina Maouelainin (46:00): And if there’s no nodule at all, those tools don’t apply — so for a younger person with family history, the best move is to advocate for a screening low-dose CT. Keep in mind most nodules are benign: tiny scattered nodules from things like bronchiectasis or old valley fever are far less concerning than a single solitary 10-millimeter lesion.

[48:00] Whole-Body MRI & Imaging Overuse

Dr. Regina Druz (48:00): There’s growing interest in direct-to-consumer whole-body MRI, and some companies are now adding a CT for calcium scoring and CT angiography. Would whole-body MRI catch early lung cancers, or is low-dose CT still the right tool?

Dr. Nina Maouelainin (49:00): I’m not sure I’m a big fan of whole-body MRI — the jury’s still out. You risk chasing your tail over incidental findings. For the general population, imagine getting a report full of abnormalities and not knowing which to worry about. As physicians we have a better grasp of what matters, but for most people it can create more anxiety than answers.

[50:30] “Watch Your Breath”: Closing Wisdom

Dr. Regina Druz (50:30): Closing thoughts — what’s your number one message for protecting our lungs?

Dr. Nina Maouelainin (50:45): My biggest message is: watch what you breathe. We say ‘watch what you eat,’ but you also have to watch what you breathe. If you can see it, it’s getting deposited in your lungs — and be even more aware of what you can’t see. Clean up your indoor air, especially your bedroom, where you spend six to eight hours breathing in a closed space. Avoid burning scents and candles, cut the fabric softeners and dryer sheets that steam chemicals into your clothes, and reduce the microplastics in what you wear and sleep in. And for women especially: look at how many aerosol cans are in your bathroom — dry shampoo, hairspray, sunscreen spray. It adds up.

Dr. Regina Druz (53:00): I use zero sprays — no cooking sprays, no personal sprays — in my home. In functional medicine we can even test toxic exposures through urine metabolites and trace them back to a source. It’s the scariest test I’ve seen, because I have yet to find a person with nothing concerning. Either the test is very sensitive, or we truly are bombarded daily — which means we have to take active steps to reduce exposure. We don’t want microplastics in our arteries or trapped in our alveoli. So: watch your breath. Nina, it’s been a delight — thank you.

Dr. Nina Maouelainin (54:30): Same here — thank you so much for having me.

Dr. Regina Druz (55:00): And to the professionals listening: if you’re thinking of launching a cardiometabolic or integrative cardiology program in your practice, we can help you expand into hybrid or concierge services. Head to the show notes and click the application link — your intro call is free. Ready to schedule a practice review? Use code DOC10 for 10% off our Practice Power Hour, a 60-minute coaching session. Thank you for tuning in to Own Your Heart Health with Dr. Regina Druz. This podcast is powered by Holistic Heart Centers. If you enjoyed the show, please rate and review us on your favorite platform, and visit holisticheartcenters.com. See you next week.

Frequently Asked Questions

Why is lung cancer rising in people who never smoked?

While smoking remains the biggest cause of lung cancer, a growing share of new diagnoses are in people who never smoked — and women are affected disproportionately. Population screening studies such as the TALENT study in Taiwan found that a meaningful percentage of those diagnosed had never smoked, with many being younger women. Researchers have pointed to several contributors: long-term exposure to cooking-oil fumes (especially deep frying with the wrong oils in poorly ventilated kitchens), secondhand smoke, indoor radon, other environmental and airborne toxins, and family history extending to third-degree relatives. The takeaway is not to panic but to be aware and to advocate for yourself: a persistent dry cough or strong family history is worth raising with your doctor, since non-smokers often don’t fit current screening criteria and can be reassured prematurely. This episode is educational and not a substitute for personalized medical advice.

What is radon, and how do I check my home?

Radon is a naturally occurring radioactive gas produced by the breakdown of uranium in soil and rock. Outdoors it disperses harmlessly, but indoors — particularly in basements and other closed, low-lying spaces — it can build up to dangerous concentrations. It is considered the second leading cause of lung cancer after smoking, and exposure is largely preventable. You can buy an inexpensive radon test kit (the American Lung Association provides guidance on where to find one), place it in the lowest livable level of your home, and send it in for analysis. If levels are high, a radon-mitigation system can be installed to vent the gas, and the level can then be monitored over time. Radon is commonly measured during home sales, but if you’ve never tested your current home — especially bedrooms and basements — it’s a simple, worthwhile step.

What’s the connection between microplastics, my lungs, and my heart?

Microplastics and nanoplastics are tiny plastic particles we now inhale and ingest daily from sources like bottles, packaging, food containers, textiles, and even some cup linings. In the lungs, they can interfere with surfactant — the substance that keeps the air sacs (alveoli) elastic and open — contributing to stiffer lungs, inflammation, and lower oxygen transfer. The cardiovascular link drew major attention in 2024, when a New England Journal of Medicine study found microplastics and nanoplastics embedded in the carotid-artery plaque of some patients; those individuals had markedly higher rates of cardiovascular events and death on follow-up. While research is still evolving, it’s a strong reason to reduce exposure where you reasonably can — avoiding microwaving food in plastic, cutting down on single-use plastics, and improving indoor air quality.

Who should consider lung cancer screening, and what tests are used?

Current U.S. guidelines recommend annual low-dose CT (LDCT) screening for adults roughly 50 to 77 years old with about a 20 pack-year smoking history, and it is covered by Medicare for those who qualify. Beyond that, screening becomes a personalized discussion when risk factors accumulate — strong family history (to third-degree relatives), heavy cooking-fume exposure, secondhand smoke, or radon. If a nodule is found, clinicians don’t jump to biopsy: they estimate the probability it’s cancerous using tools like the Mayo Clinic pulmonary nodule risk calculator (on MDCalc), add a blood test such as Nodify for indeterminate nodules, and use a PET scan for larger ones. Most nodules turn out to be benign. The right path depends on the nodule’s size, location, and your overall risk — decisions to be made with your physician. This information is educational and not medical advice.

Show Notes & Resources

Guest: Dr. Nina Maouelainin, DO, FCCP, MBA

Dr. Nina Maouelainin is a board-certified, fellowship-trained interventional pulmonologist — one of fewer than 500 in the United States — and the founder and CEO of Lung Health Services in the Greater Philadelphia area. Originally from Morocco, she trained in France and the U.S., earning her degree from the Philadelphia College of Osteopathic Medicine and completing a pulmonary and critical care fellowship at Drexel University–Hahnemann and an interventional pulmonology fellowship. She is President of Women in Interventional Pulmonology (WIIP) and founder of Dr. Nina’s Lung Care Foundation, and a leading advocate for early lung-cancer detection — especially in women and non-smokers.

Lung Health Services: lunghealthservices.com
Dr. Nina’s Lung Care Foundation: drninalungcare.com

Resources Mentioned in This Episode

TALENT study (Taiwan) and the NELSON trial — landmark low-dose CT lung-cancer screening studies
Low-dose CT (LDCT) lung cancer screening — covered by Medicare for eligible adults ~50–77 with a 20 pack-year history
Mayo Clinic Pulmonary Nodule Risk Calculator — available on MDCalc
Nodify lung-nodule blood test — used for indeterminate nodules (~8–30 mm)
American Lung Association — radon test-kit guidance and lung-health resources
The White Ribbon Project — lung cancer awareness
Young Lung Cancer Initiative — nonprofit raising awareness of lung cancer in younger adults
New England Journal of Medicine (2024) — study linking microplastics/nanoplastics in carotid plaque to cardiovascular events
Holistic Heart University — on-demand courses and resources (use code OWNER20 for 20% off annual)
HeartWell Toolkits — at-home heart and brain health lab panels (use code TESTING10 for 10% off and free shipping)
For clinicians: Practice Power Hour coaching with Holistic Heart Centers (use code DOC10 for 10% off)

Holistic Heart Centers

holisticheartcenters.com
HeartWell.ai — AI-powered cardiovascular risk assessment
Address: 55 Bryant Avenue, Suite #6, Roslyn, NY 11576
Phone: 877-511-5166
YouTube: @reginadruzmd
Instagram: @dr.reginadruz
Podcast: Own Your Heart Health — available on Apple Podcasts, Spotify, and all major platforms

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