Overcoming Healthcare Barriers: Amanda Decker's Metabolic Health Approach #150

Amanda Decker, an experienced nurse practitioner, is revolutionizing metabolic health. She shares her journey from childhood obesity and psoriasis to discovering low carb lifestyle benefits. Decker discusses challenges implementing this approach in traditional healthcare, where medication is often prioritized over lifestyle changes. Her determination led her to pursue certifications in obesity medicine and ketogenic nutrition.

Decker stresses addressing food addiction and instilling hope, saying, "You don't know what someone's going to do until you give them the option." She offers practical strategies for low carb living, like using grocery delivery to avoid temptation. Decker also organizes the annual Low Carb for Better Health conference.

The discussion highlights the disconnect between standard nutritional advice and metabolic health realities. Decker and Dr. Ovadia advocate for a healthcare shift from symptom management to addressing root causes through lifestyle changes.

Resources and Links:
• Low Carb for Better Health conference
• Society of Metabolic Health Practitioners
• Dr. Jason Fung's books on low carb and fasting
• Gary Taubes' books on nutrition and health

Connect with Amanda Decker:
Instagram, Twitter, Facebook, and LinkedIn @DeckerLessCarbs
Website: www.dmaweightandwellness.com
Website:  Low Carb for Better Health

Guest Bio:
Amanda Decker is a nurse practitioner with nearly 19 years of experience. After struggling with obesity and psoriasis since childhood, she discovered the power of low carb eating and transformed her own health. Now, she's dedicated to helping others achieve metabolic health through her clinic, where she combines traditional medical practices with lifestyle-based approaches. Amanda is also the organizer of the annual Low Carb for Better Health conference, bringing together experts and enthusiasts to spread knowledge about metabolic health.

Chances are, you wouldn't be listening to this podcast if you didn't need to change your life and get healthier.

So take action right now. Book a call with Dr. Ovadia's team. 

One small step in the right direction is all it takes to get started. 

How to connect with Stay Off My Operating Table:

Twitter:

• Dr. Ovadia: @iFixHearts
• Jack Heald: @JackHeald5

Learn more:

• Learn more about Dr. Ovadia's personalized health coaching
• Get Dr. Ovadia's book Stay Off My Operating Table on Amazon.
• Take Dr. Ovadia's metabolic health quiz: iFixHearts
• visit Dr. Ovadia's website: Ovadia Heart Health
• visit Jack Heald's website: CultYourBrand.com

Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings

Any use of this intellectual property for text and data mining or computational analysis including as training material for artificial intelligence systems is strictly prohibited without express written consent from Philip Ovadia.

Transcript

: 0:35

He was a morbidly obese surgeon destined for an operating table and an early death. Now he's a rebel MD who is fabulously fit and fighting to make America healthy again. This is Stay Off my Operating Table with Dr Philip Ovedia.

Jack Heald: 0:56

Thanks for joining us folks. It's the Stay Off my Operating Table podcast. If you're looking for something else, you're in the wrong place. Stick around. Anyway, I think you'll enjoy this, Phil. Dr Philip Ovedia, tell us about who we're fixing to talk to today.

Dr. Philip Ovadia: 1:12

Always good to be back here. Today we have the honor of having Amanda Decker as our guest, a nurse practitioner, and Amanda and I met at a conference a while back. I had known of her for a while and we had kind of interacted a little bit on the social media interwebs there. But she's awesome. She's doing awesome work in Tennessee bringing metabolic health into her clinic. She's been able to introduce it and we'll talk about this into the traditional medical system, which I think is great and really excited to get into that with her. But before we get to that, amanda, why don't you give a little bit of your background, let the people know kind of what got you into medicine in the first place and then maybe what got you into metabolic health?

Amanda Decker: 2:07

Yeah, thank you. Thank you both for having me. I have been a nurse practitioner for almost 19 years. It'll be 19 years this August.

Amanda Decker: 2:16

I got into healthcare because it's kind of what I've always wanted to do. If you talk to my parents, they can tell you that from the age of five I knew I wanted to go into medicine. At that point I wanted to be a doctor. That's the only thing I knew. You could be a doctor or a nurse. Those were your only options and I was like I'm going to be the doctor. So that was what I was going to be my entire life. That's what I went to school to be. Entire life. That's what I went to school to be.

Amanda Decker: 2:39

And I met my husband in college. Actually, I met him and he was my brother's best friend, met him in my parents' house, but I was in college at the time and I decided you know, med school, that's going to take a really long time. That's going to be a lot of years out of my life. I'm not sure I want to do that anymore. But I want to go still into healthcare. I want to help people. I want to help people feel better, improve their lives, that kind of thing and I had a friend at the time said well, have you thought about being a nurse practitioner? I said nurse practitioner, what is that? So I did my research. Wait, I can go work in the clinic hands-on with people helping them get better, and not go through all that med school stuff. Sign me up, sign me up. That's how I got to be a nurse practitioner. I went to Vanderbilt University and got a degree there. I'm a family nurse practitioner. That's what I am trained in, that's what I worked in.

Amanda Decker: 3:30

And I worked as a family nurse practitioner for the first, probably 12 to 13 years of my career and I just kind of got burnt out and I'm sure you've heard that from many providers that you're working in the traditional medicine scenario and it's patient after patient, day after day, hitting the grind, barely having a lot of time to yourself, and at the end of the day you're just disgusted because nobody gets better. Everybody just got worse. I felt like the only people I was helping get better were the people who had sinus infection and urinary tract infections. Those are the only people I could really help. Everybody else I was a legalized drug dealer. Here's your next pill. Come see me in three months, three more months. Here's your next pill. See me in three more months and just got tired of it. I was about to leave medicine, I was about to step out and go find a different career doing something else.

Amanda Decker: 4:23

But I said before I do this, since this is something that has been in my heart, that I've always wanted to do since the age of five, I need to relook at things and I looked back at my own health journey and Bill, I had struggled with obesity from the age of five. When you look back at childhood pictures, at five years of age I was overweight. My siblings are both size zeros. They're skinny bean poles. I was the one of you know.

Amanda Decker: 4:48

One of these things doesn't look like the other kind of thing, but I lost weight, you know, throughout my early childhood, teenagehood, early adulthood. It was calories in, calories out, restricting, sometimes almost to the detriment of my health, restricting things, and I'd always gain the weight back and then somewhere around the age of 30. I thought, if I just do what my grandmother or my great grandmother told me to do and cut out the cakes and the cookies, maybe I can lose weight. I haven't tried that yet, so I cut out cakes and cookies and white things. And lo and behold, I got leaner and I wasn't quite as hungry as I was and I maintained that weight for a while.

Amanda Decker: 5:27

And then I was chatting with a nurse practitioner friend of mine. She said you know, you're doing low carb. I was like, no, I am not doing low carb. That is not what this is. All I did was cut out the cookies and cakes and stuff like that. She goes huh, you really are doing low carb. Fine, I'll go look into this and see. So I read several books, read some of Jason Fung's work, read some of Gary Todd's works, which most of us have in this space, and I was like, dang it, I'm doing low carb and it actually makes sense that I'm getting healthier and this is why this is the pathophysiology, this is the reasons why I'm getting healthier. In addition to weight, I also had psoriasis from the age of five and at one point it covered about 80% of my body, had plaques on it and I noticed that, okay, I'm not a medical professional, so I've heard the term psoriasis, but I don't.

Jack Heald: 6:21

80% of your body had what on it.

Amanda Decker: 6:23

Plaques. So psoriasis is an inflammatory condition and a plaque is like a circular area or area that's raised on the skin. It's red and irritated and has crusting over the top of it.

: 6:34

So it's not.

Amanda Decker: 6:35

You don't have to have a complete covering it for that area to be a percentage. If it's on one part of your arm, that's a percentage. That's there. So 80% of my body had some type of plaque on it Heavy in my scalp, heavy in my lower legs, heavy on my arms and it did improve while I was getting healthier on this low-carb diet. It was the first time that I had seen anything improve my psoriasis other than heavy dose steroid type treatment.

Amanda Decker: 7:04

Move along further in back to that time when I was in primary care and getting burnout. I was like wait, I got healthier through low carb. My body's healing. Why can't I do that for my patients? I can't do that for my patients because it's against the standard of care. It's against what I'm told to do for my patients. So I kind of secretly started sneaking it in Little handouts here and I'm like I didn't really tell you to do this, but I'm telling you to do this. Why don't you give this a try? Or why don't we just try cutting back on these things and, as my patients started to get a little bit healthier and a little bit healthier, not tell people openly to eat this way. If it's changing me and I'm seeing it change people when I'm enacting it in a small way. It's wrong of me to not do this on a bigger scale. That, to me, was like that would be against the Hippocratic oath. It would be against medicine for me not to give that to them. But I also felt inadequate to give them that information.

Amanda Decker: 8:12

Yes, I had a nurse practitioner degree. Yes, I had all these years of experience behind me, but I didn't feel like I had the credentials that I needed to back this up. Yeah, I've read some books too, but it needed to be more than that. So I went back and got some certifications and I kind of have this alphabet soup thing going behind my name right now. So I went to the Obesity Medicine Association and got a certification through them as a advanced practice provider. I was approved through the SMHP as a metabolic health practitioner. I was the first female to achieve the metabolic health practitioner certification behind my name. I also went to the American Nutrition Association and I'm a certified ketogenic nutrition specialist. I have a couple other smaller things, but those are my big credentials that are behind me. I have a couple other smaller things, but those are my big credentials that are behind me and armed with that, I said, okay, I am now ready and credentialed to give this information to my patients and say I really know what I'm talking about.

Amanda Decker: 9:09

And so I changed the practice focus, not just from primary care. I didn't drop my primary care people and tell them to go find somebody else. I kept seeing them. But I started a medical weight management program where the basis of that program is lifestyle teaching people how to change what they eat, to change how they move, change how they address their stress levels, change their sleep habits we call them the four pillars of health at my clinic and to truly transform their lives. Now we will offer medications if they want that for weight loss.

Amanda Decker: 9:41

But everyone that comes in gets a heavy dose of education and is supported through my team to make lifestyle changes, because without it it doesn't matter what you do, you're not going to be successful. You got to change your life. Long story short, phil. I got into healthcare because that's what I've always wanted to do. It's always been my drive. I got into metabolic health because I made myself healthier and I was burned out in practice and I took the two of those and went with metabolic health because it reignited my passion for medicine to help people feel better and to truly see their lives changed.

Jack Heald: 10:17

We could almost just stop right there Just an amazing episode already.

Dr. Philip Ovadia: 10:26

Let's let's dig in a little bit more.

Dr. Philip Ovadia: 10:28

So you know, one of the criticisms that oftentimes gets levied against, you know, low carb and maybe this is true of lifestyle change in general is that people won't follow it. You know it's, you know it's only the you know, privileged few that can do it. You know and you know, and I think the one of the one of the reasons that it doesn't get more widely accepted in mainstream medicine is, you know, just the general concept of people just won't do it. So why should I bother, you know, trying to teach them this.

Dr. Philip Ovadia: 11:08

So here, you are, you're in a clinic. You know you're in, you know, the middle of Tennessee. I, you know I don't think you have what would be considered a very privileged clientele and yet you're doing it. You know talk about, you know how well it works, how open people are to this and what the experience has been around it.

Amanda Decker: 11:39

Yeah, so I'm about an hour west of Nashville. It's semi rural. So I have some patients who are extremely rural, that live an hour, two hours away from any type of city without a lot of health care around them, and then I have people that are coming from Nashville and Franklin. So I've really got a mixture of patient population here Through my clinic time and with helping people get healthier. At first I thought nobody would do this, that nobody's going to want to do this, and then I thought some people can't do this because of their means. They're what they can afford.

Amanda Decker: 12:14

I learned pretty quickly that I should stop assuming things for other people. You don't know what someone's going to do until you give them the option to do it and at the end of the day it's more costly to get sick and have diabetes and be disabled and to have all these health conditions than it is to change what you're eating. And most of the time it just takes time. It takes someone sitting down and showing concern and care for investing in their life. You know, when I walk into my first health care consult for an obesity visit, my first question has nothing to do with their health. My first question is tell me about you, tell me about who's in your household, tell me about your lifestyle, tell me about the things that make you happy, the things that bring you joy, because I want to know about you, I care about you, and all these things actually feed into your journey. You know, if you don't have ways to relieve your stress, if you don't have good family support I need to know that because it's going to affect your journey so one you have to invest.

Amanda Decker: 13:19

It takes somebody investing time and then someone who's going to start thinking outside the box. You know, someone comes in and they don't have great financial means. I'm not going to be suggesting that they go buy the best cut of steak that's out there. Rib eye is not going to be on their menu every night as much as they want it to be. But we can still make a plan that's healthier whole foods. We can include things like canned anchovies and tuna. We can look at boiled eggs. We can, you know, look at different things that are on sale that week and I shop in the same stores that they do. So I can tell them what's on sale, because half the time I'm buying that stuff too. I got kids. They eat a lot of food. You know one. It just some people are not there.

Amanda Decker: 14:07

You have to assess the patient and if they are not ready to make changes, then you have to meet them where they are and say what are you willing, if we're not willing, to rip the bandaid off and go cold turkey and change everything about what's one thing we can change and then build on that change, and other people are ready to make the complete change. They just need the tools to do it. They need to understand the why they're doing it and then they need help figuring it out, and that's what we do here at our clinic. That's why we have health coaches that are posting recipes and calling patients and giving them information. That's why they're having frequent contact with me. You know, when they walk in my clinic there's a book full of recipes that they can pull from and look from. It's just about that connection and giving them the tools, and I feel like anyone can make the changes if they're given the right tools and they have the right motivation to do it, and it's really wrong of us to assume that they can't.

Jack Heald: 14:57

It's very judgmental that it's wrong of us to assume they can't make the change. So I we've talked to enough healthcare providers and you know Phil lives with it in his profession to know that attitude that people aren't going to do that is is pretty common. So I want to. I want to kind of put a pin in that particular issue healthcare providers not bothering with it because they prejudge people not going to do it and go back to a comment you made about. You found it morally objectionable not to tell people about this, and yet there's something in the requirements of your profession that kept you from doing it. I'm a non-professional, remember. I'm just a guy who goes to the to see a healthcare provider. I don't know what you're talking about. What? Why couldn't you tell me about this? What is it that prevented you from telling me about this?

Amanda Decker: 16:07

We kind of have this standard of care. You know what we? The standard of care is what we're expected to deliver to patients day in and day out. For example, if they come in with high blood pressure, you're supposed to tell them to eat a low salt diet and that they're to go on a particular medication and they should probably exercise. Those are standard of care type things. The standard of care here in America is a very low fat diet which in turn turns into a high carbohydrate diet because you're supplementing the fat with something, and that's a whole different rabbit hole that you've probably already went down multiple times with other providers of how we got to there. But the standard of care is a low fat diet that I'm obligated to tell people to do that standard of care and if I don't, I'm going against that and it can set me up for liability and things down the road.

Jack Heald: 17:07

All right, I guess I've never actually asked anybody this question that directly, but what I hear you saying is that there is some sort of professional pressure and it sounds like a threat if you don't tell people who present with a particular problem what did you say? High blood pressure? If you don't tell people these things which there is a overwhelming mountain of evidence tells us is the wrong thing to tell them, but if you don't tell them that, you're risking censure or even license.

Amanda Decker: 17:54

If there's negative outcomes, you're risking malpractice, You're risking scrutiny from the people that employ you, the places that employ you, your licensing boards all of that can come under scrutiny.

Jack Heald: 18:07

So if you tell them, yeah, go ahead and reduce your salt, go to a low-fat, high-carb diet and exercise a little and they get rid of the fats, eat a lot of carbs, may or may not pay attention to their salt and go for a walk twice a week after dinner and fall over and have a heart attack. You're free and clear.

Amanda Decker: 18:34

Absolutely. Yeah it's kind of mind blowing.

Dr. Philip Ovadia: 18:42

Yeah, it is kind of mind blowing that you know it's not. And if you do the opposite and you get great outcomes, you know you can still, as Amanda said, you know come under the attention of, you know forces that you don't want to be under the attention from. You know whether it's your employer, your health care system, whether it's a licensing board, and unfortunately we've seen some examples of this. We have practitioners who have gotten in trouble for doing this type of stuff. Now, to my knowledge, all of the ones that it has gotten to that level, they've all been exonerated because there is a lot of evidence for what we're talking about and it does get good outcomes. But that's the environment, unfortunately, that medical practitioners are under these days. You know independent thinking is thoroughly discouraged in medicine these days, and so that can apply to lots of things, but it is what it is.

Amanda Decker: 19:44

It is, and you know it even goes further into insurance, because I'm an insurance-based practice where I'm at. And so if I have a client who has diabetes, you know I'm required to check their A1C every three months, which that's, you know, understandable. But I'm also required to put them on a statin. I'm required to give them metformin or another drug, you know, and follow down these lines of things. Even if I don't feel like that is the best option for them, I'm required to give that to them. And if I don't, you know the insurers look at did I meet these metrics? And if I didn't meet those metrics, then my score goes down and eventually your scores stay down long enough, your reimbursements go down. It's hard to stay in practice if your reimbursements don't stay up. So you're incentivized to give more medications to patients and counsel in certain ways because of insurance companies.

Jack Heald: 20:37

I don't get incentivized for getting too often so that's a bad thing.

Amanda Decker: 20:41

Let me make sure I understand what you just said.

Jack Heald: 20:41

Yeah, that's a valid thing. Let me make sure I understand what you just said yeah. You are incentivized to prescribe drugs. Yes, and if you, granted, totally ignorant about all of this, but I wanted to understand this, but I'm wanting to understand. So somebody comes in and if you can put them on three different drugs, all of which fit inside this wackadoodle standard of care, and they don't get well, but they keep reordering their drugs, you get a nice high score from your insurance company and they make sure you get lots of money.

Amanda Decker: 21:24

I get. My reimbursement rates don't go down. I don't get penalized. I guess I should say the incentive is that my reimbursement rates don't get reduced, not that they get more.

Jack Heald: 21:34

I realize we're talking business and not medicine here, but I'm wanting to understand the business of medicine. So when you say your reimbursement rates, does that mean they ordinarily would give you 85%, but now you're only going to get 80 or something like that? Is that what it is?

Amanda Decker: 21:47

They can reduce your contracted rates. Every employer has a contracted rate with individual insurance companies or each business has a contracted rate for services. So, like a level three, office visit has a certain dollar amount that's associated with it, and then you get a percentage of that.

Jack Heald: 22:04

Now, if this exact same patient who keeps re-upping their prescription and not getting well starts doing something different, eliminates their insulin resistance, starts dropping the way, their internal inflammation goes down and their need for all these drugs begins to drop or even just go away completely, Do you get any credit for that at all? I mean, is there anybody who says yay, you're a good doctor?

Amanda Decker: 22:43

yay, you're a good doctor. The patient does. But no, the insurance companies know and in fact when you look at my star ratings, you know where it used to be a level four. Slowly, as I'm helping people get healthier, they get less. So now I'm like a three and a half or three, because my patient doesn't need that drug anymore so I take them off of it, but the diagnosis still there. That doesn't go away. Once the diagnosis is there, it's there, so yeah.

Jack Heald: 23:13

Comment please, phil. I realize this is not news to you.

Dr. Philip Ovadia: 23:18

Yeah.

Jack Heald: 23:19

I probably heard it before, but it's kind of it's all the penny is dropping here for me before, but it's kind of it's all the penny is dropping here for me.

Dr. Philip Ovadia: 23:28

Yeah, it's really kind of baffling when you sit back and you look at the system.

Dr. Philip Ovadia: 23:30

And this is a large part of why we're in the situation that we're in, you know, and people they ask why don't doctors just change what they do? You know, because it seems so glaringly obvious. You know how to solve these problems seem so glaringly obvious. You know how to solve these problems and this is a lot of the reason that it doesn't happen is because the system is set up in such a way to discourage this from happening. And you know, the system isn't really geared towards the patient outcomes. Ultimately, the patient outcomes, ultimately it's geared towards doing things for patients, which usually means prescribing medications or doing procedures is really what our medical system is centered on. So when people wonder because the people that listen to this podcast, let's say and now here we are, they've heard 150 episodes of, you know, doctors and other practitioners and everyone talking about this there is a simple solution to all of our problems and they wonder why hasn't it happened? Yet? I guess today we're getting into a little bit of why hasn't it happened.

Amanda Decker: 24:40

Yeah, yeah, cause our system is definitely a sick care system. It's not a wellness system. It's not there to make people well, it's there to manage illnesses.

Dr. Philip Ovadia: 24:50

And notice, I said manage not improve, figure out ways to make it work within the system and figure out maybe a little bit of how to work around the system and still make it work. You mentioned that your practice has largely shifted towards obesity management, weight management.

Dr. Philip Ovadia: 25:23

A lot of that these days of course, is drug centric and I'd like to hear a little bit, since you're, you know, kind of in the trenches as it is, you know how you, how you've approached that kind of you know I'm sure you have patients coming to you saying you know, I heard the best way to lose weight is to go on medications. So how do you approach that? And, you know, do you use the medications at all? You know, how do they kind of fit into your overall philosophy?

Amanda Decker: 25:47

Absolutely yes, we do prescribe and offer medications to patients because I believe ultimately it's the patient's choice, it is their journey. It's not my journey. It's my job to give them the information. When patients come in, a lot of them are coming for just the prescription, but, me being me, they start with an hour-long consult with me. So each new patient it's an hour-long consult getting a full history, obesity history, psychosocial history, that type thing. They do some tests.

Jack Heald: 26:23

What does psychosocial mean in your?

Amanda Decker: 26:25

context. You know their family support their financial stability. Do they have any mental health illnesses that are confounding our journey or that might change our journey? That type thing?

Jack Heald: 26:38

You're finding out what's going on in their life.

Amanda Decker: 26:43

Yeah, so you want to get the complete picture of the individual. They are given nutritional information on the macronutrients and how macronutrients affect their body and how important it is to change your lifestyle. And how, if you don't rest well and don't get good quality sleep, how that affects your ability to burn fat in your body. How stress affects the ability to burn fat in your body. How exercise can improve things but you can't outrun the bad diet because you can exercise and then out eat it in about five minutes after your exercise and outdo it.

Jack Heald: 27:18

Is this news to people?

Amanda Decker: 27:20

Some people yes, some people have no idea, especially when I sit down with a food label and my food label example is oatmeal. You know something we've been told for years that is a very heart healthy food and that we should all eat this to lose weight and make our heart healthy. So I use just old fashioned oats, the kind you cook on the oven, not the kind that you put in the microwave, that already has the sweetener to it. And we look at it and I say I need you to look at the serving size. And then I want you to see how much protein is in something and then go to the total carbohydrate and I give them a protein goal that I want them to hit. So I'm like your bowl of oatmeal has maybe five grams of plant-based protein. Plant-based protein is not as absorbable as animal-based protein, so you're only getting a couple of milligrams or grams of that protein. Then, when we look at the carbohydrates, that all turns to sugar. So a bowl of oats turns to five and a half teaspoons of sugar, and that's before you put the teaspoons of sugar in it to make it taste worth eating. So this is just a whole bunch of sugar.

Amanda Decker: 28:17

And then I have some other examples on the side. I'm like you know that banana that you love to eat every morning and you think it's doing you amazing things. Well, a small organic bananas 30 carbs that's six teaspoons of sugar and next to no protein in that banana. So your blood sugar is doing this all day long and your insulin levels doing this all day long. And as long as your insulin's up, you can't burn body fat. If you don't, if I don't control that, I'm not going to control your weight loss. So that part is shocking to them. People don't realize how much sugar they're truly eating, even if they're eating what they consider to be a healthy, more whole foods type approach of diet. That part is very shocking to them.

Jack Heald: 29:01

Is that more people than? Is that a small percentage? A majority, I mean how?

Amanda Decker: 29:06

I'm going to say at least 80% of people have no idea how their body metabolizes macronutrients, and the other 20% that come in have probably already been following me or Dr Berry or Dr Avedia or someone on social media and they already know about it and they're just needing more help. They're needing reassurance and want somebody to kind of take them along and help them further along their journey.

Jack Heald: 29:28

So you're doing a lot of education.

Amanda Decker: 29:31

I do a lot of education, yes, and then at the very end of all of this education time, I said all right, we're a medical weight loss clinic. I'm going to talk to you about meds and I'm going to tell you about all the pros and cons that are related to them, and the first one is drug side effects. They all have side effects and you have to decide if you're willing to risk those side effects and see how severe those side effects are. You also have to think about the cost and you have to consider that most drugs used for weight loss are lifelong drugs. So if you're not into adding another drug for the rest of your life, then we need to table this conversation for another time and then, if they are interested in medication and they are interested in a specific medicine, we'll talk about the side effects and the risk and the benefits of that particular one. If they decide to use it, we do offer drugs.

Amanda Decker: 30:22

I am very clear with them from the very beginning that you still have to change. These days. It is meant to be lifelong. It is extremely hard to come off of If you stop it. Most people gain their weight back very rapidly, within three to six months because of the hunger that comes in and hits them afterwards. It does have a lot of side effects and a lot of risks that I don't think that we fully know and understand yet. If they still decide that is their patient choice, you know they have free will to decide what they want. I'm just here to help them in their journey.

Dr. Philip Ovadia: 31:13

What I was just going to ask, following up on you were kind of talking about patient types. But what do you find more challenging? So the patient that comes to you and they've just been basically not following any advice, you know, just eating junk food and just know they need to make a change, versus the patient like you were describing who thinks they've been eating healthy, they've been following the advice, they've been eating their you know, six to 11 servings of whole grains a day and their fruits and vegetables like they've been told. Which one do you find to be these days more of a challenge to now say you know, low carb is the way to go?

Amanda Decker: 31:54

Yeah, probably the people who think they're doing everything right and have tried everything, because a lot of times then I'm having to really convince them that they're feel like they've tried everything, but they really haven't tried everything and what they thought they were doing they're not quite doing. But that particular patient is, more times than not, coming in specifically looking for the medication, and so I'm having to convince some buy-in you know, got to buy into this lifestyle because they came in with the intention of medication.

Jack Heald: 32:32

Look back on your own story. Look back on that moment where you said maybe I'll do what my grandmother suggested, and then think about your clients who've taken your guidance. Is there a common factor? Is it? Do people just and, phil, I mean, you had a moment like that too what is it that's missing when people get all the information and still do nothing with it?

Amanda Decker: 33:04

Yeah, you know, and Phil, you may find this too, but I think a lot of it is two things. One is hope. I think somewhere along the journey people give up and they feel like they've really tried everything. They feel like they've exhausted everything. They may not have the great support to help them make changes, and every time they've lost weight they gained it all back, and so they at some point they just lose. They lose hope, and you've got to give them back that hope and let them know that it is possible.

Amanda Decker: 33:35

So I think that's one, and then the other is food addiction and how powerful food addiction truly is, and trying to convince people that you cannot moderate certain foods, even certain foods that you may think are very healthy. That if you are a food addict and your drug of choice is sugar or carbs that turn to sugar, just trying to eat less of them is only going to end up back in heartache and back on that hamster wheel that puts you back where you were starting. Hope and food addiction are probably the two things there that are different, and there are probably some of my most difficult things to address in clinic too.

Jack Heald: 34:17

Phil, did you have a similar experience?

Dr. Philip Ovadia: 34:20

Yeah, I was really going to say about you know, you got to get the person who hasn't given up yet. They're still kind of desperate, they want to address the problem but they haven't given up yet because, unfortunately, a lot of people you know just have given up. I mean they, like you said, they've tried what they think is everything and it hasn't worked and they're like, why am I going to try yet another thing that doesn't work? But hopefully you can convince them and you know again, I think that's where your personal story helps, that's where you know being able to point to all the success that your patients are getting and hopefully you can still give them the hope that they need and, you know, give this a try.

Dr. Philip Ovadia: 35:08

So that certainly has been my experience as well. Talk a little bit about you know implementing this in your life, you know, and your experience around. You know you're a busy professional. You're a mom, you know, and a wife, and you know how it works with your family. And you know, I mean again, a lot of people look at a life like you live and like I live and say, you know, I mean it was just too busy to do this, so talk a little bit about how it's worked for you personally.

Amanda Decker: 35:45

So when I first started out, I was the only one in my household eating this way, and so we. How we made it work is we had a meat and veggie and everybody else had a starch with it. It would just kind of I didn't eat certain things and I had to use a lot of internal gumption to not eat the starches at times when I wanted to. And then slowly over time, my family joined with me. So my husband came on board and he feels he felt amazing. Then I slowly convinced my parents to eat this way after many times of having to turn down their lovely desserts that they were putting in their face, and they're like you're really serious about this stuff. I'm like, yes, I am, it's making me healthier, it can make you healthier too. So then they came on board and even my little beanpole sister came on board. She uses it to treat her. I shouldn't call her a beanpole If she's watching. I'm sorry, danny, I really do love you, but she's one of those people that's always been a size zero, except for when she was pregnant. But she had migraine, headaches and IBS and so she used this way of life to treat that. And my brother came along too, and so it's just kind of slowly weaved out into my family. But at first it was extremely difficult and it was a little bit more expensive because I was doing my food and I was doing their food and just over time slowly and persistently converting.

Amanda Decker: 37:12

My son was about eight when we started eating, trying to get him to eat more low carb. That was a struggle. It really was, because when your kid reaches the age of eight they've already got their food preferences kind of set. And I did it to myself. I wish I'd never given him the first Cheeto, never given him the first Dorito, never given him the first cookie. It would have been so much easier. But I got his buy-in by saying I sent him down in front of diet doctor website I said take me some recipes that you want mommy to make for you and let's do that. And so he picked a slew of different recipes. He helped me make them and he tried every single one of them because he picked them.

Amanda Decker: 37:52

So I used a little bit of reverse psychology there with him and then slowly it was all right. I'm not going to buy this candy anymore. We're going to buy blueberries this time, or we're not buying this treat, we're going to have some special pecans this time that we haven't had in the house, and so it's slowly trading out and making changes. My kids still have a little bit more carb than my husband and I do. They're young, they're healthy, they can tolerate those. We still try to stick to mostly whole foods, but they have more fruits than my husband and I do, and then they have some like gummies that are made out of fruits, because I'm not making everything from scratch like Maria and Rick does. There's no way I can do that. I don't. All these has a great selection of no sugar added and dye free type stuff, and so that's where they get their gummies from and kids like to eat things from packages.

Amanda Decker: 38:46

I don't know what it is about packages, but they just think that they're Wait, whoa. I know, I know.

Jack Heald: 38:52

Kids liked oh my God, I hadn't ever thought of that. Phil, phil, we got to jump on this buddy.

Dr. Philip Ovadia: 39:00

Steak in a package. Steak in a package.

Jack Heald: 39:05

Oh my Lord.

Amanda Decker: 39:06

Now when kids go to school, you know they have plenty of opportunity to eat things, but I try to control the stuff in my house. I can't control everything. I try to control the stuff in my house. I've learned that I have to grocery shop one week at a time because fresh food goes bad sooner. So you only buy the foods that you can eat in this week and I have my standard grocery shopping time that I go before when I work four days a week. Now I was working five days a week at one time. I had to do click list and pick up type things then, but now that I'm four days a week, I go every Friday and I pick up the food for the next week, which ClickList is an amazing tool for people that struggle with food addiction, because then you can go in and you can pick your foods and someone else does the shopping for you and you're not tempted to buy the other things that you don't see. So if you use Instacart or ClickList or whatever, that's a great tidbit. That's there.

Amanda Decker: 39:59

Let me see how is the Institute in my family? My daughter. She's nine. She is 100% on board with eating low carb and low sugar, but unfortunately it's because she got the IBS side of things that my brother and sister had and grain. She's very gluten intolerant, but she can read a food label and tell you exactly what should be on there she's. But she's into cooking and making things differently. I've been posting more pictures with her lately doing her own cooking. It was arming her with the knowledge and once she knew how to read the label and search for certain words she's. She took it and run with it and yeah, so I may have gotten off track there. I'm not sure what else you want to know about personal. How did I implement it in my family?

Jack Heald: 40:44

But it's they actually just gave some really good information.

Jack Heald: 40:48

Yeah you know, I think of a number of things Clicklist, for example, which I hadn't heard of before. Instacart, yes, but I hadn't heard of Clicklist and how that can help with the food addiction thing and frankly I, to me that's a tool. Hey, if you're struggling every time you go down a grocery store aisle, here's how to get what you need without going down the grocery store aisle. Okay, that's hope. And then it's really cool to consider the possibility of the nine-year-old. This is not rocket science or rocket surgery in phil's case, this is a nine-year-old has can do this and granted, she's probably a precocious nine-year-old, but still that and I would think that would be that would give people hope.

Jack Heald: 41:37

Yeah, that's would be that would give people hope. Yeah, that's I'm, I'm, just I'm. I'm looking for all these little things that it's bad enough that our bodies love the stuff that isn't good for us, and we've got it. We've got to deal with that, but I guess it hadn't ever quite hit me to what extent the entire system was actually arrayed against us. So anything that can give people that hope, that's I guess that's what I was looking for. What is it? What happened? Where's the? Is there some kind of lever? And I hadn't thought about it being something like hope, but anything I think that that can. Just a little drop of hope in the murky water of trying to get and stay healthy is going to help people, so I'm grateful.

Amanda Decker: 42:27

We've had a couple of patients or clients here that they work at McDonald's. That's their job. They go to their McDonald's servers and when you work at McDonald's you get to eat the food at McDonald's for free, like it's just free, yeah, like it's just given to you, and they don't. They're not the highest on the wage earner type scale. So our complete plans have been around how to eat low carb at McDonald's yeah, and that's something I guess we had to implement, in our household too, is when we did eat out.

Amanda Decker: 42:58

We don't eat out much anymore because, honestly, it's just it's more expensive and you don't know what all is in your food. But in the beginning it's when I go to this restaurant what can I eat? What can I order? Instead of just always ordering the thing that I've always ordered. And when they sit down it's almost like a panic sets in. I don't know what to do. All those foods that Amanda told me to eat I just can't think of a single one of them. So instead, like our app that we have has all the chain restaurants in it, so you can go here.

Amanda Decker: 43:24

This is what you order. Don't even open the menu or go look at the menu ahead of time when no one else is staring you down and waiting for your order, so that you can make a good choice and write it down and tell the waiter what you want, or have someone else order for you, so that you're not having to stay strong and make that decision in that moment. But really and truly, a lot of times that hope is just figuring out. All right, how do you eat McDonald's? How do you eat Burger King? How do you eat Taco Bell and still stay on track during all this? How are you a over the road truck driver? And what do you pack in your cooler? Because what you've always packed is not what you can still have.

Jack Heald: 44:02

Do you have a favorite patient story?

Amanda Decker: 44:06

I got lots of patient stories I've got, so I have several favorites. Now one of mine, and it is actually one that I have used medication with. But this gentleman and I've talked about him on previous podcasts he was about 300 pounds overweight when he came to see me and when he walked through the door there's no steps, no incline to go up. But he had to stop twice from the lobby to the exam room to catch his breath because his congestive heart failure was so bad that he could barely breathe, broke a sweat just getting to the exam room. He was on four different diuretics. So diuretic is things that pull fluid out of your body, because heart failure makes you retain more fluid and you essentially feel like you're smothering. So he couldn't breathe on poor diuretics. He had no hope. When he came into the clinic you know this man was already diabetic. His heart doctor said you're dying, you're going to die soon. You have to change something. And he was like I don't know. I don't know what to do. So we sat down. We went through our first whole hour of education and the look he had at me. I walked out of the room and I looked at my girls and I said he's not going to do anything. I just told him I was like he's not coming back, he's not going to do anything. I just told him. I didn't have hope for him at that point and I've talked to him about this since. You know, after that visit I see my patients back about two and a half to three weeks after that first consult, just for a telehealth kind of check in. How are you doing, how are you adjusting, are you taking your electrolytes, are you hitting your protein goals, things like that. And he was in tears on the other end, which put me in tears on the other end because he said, amanda, I can breathe. He lost 20 pounds in two and a half weeks. And he said for the first time in a long time, I can breathe because I feel like my life actually might be saved. Wow, okay, evidently something I said stuck, so let's keep going. I think he's lost maybe 150 pounds total to this point.

Amanda Decker: 46:24

He does struggle. Still he has some food addiction issues. We've identified that he cannot go to an all you eat buffet because there's too many temptations there, so we just don't even go to restaurants like that. Doesn't have a lot of support at home. So we're his main support, encouraging him to keep going, and, like I said, he does have that medicine on board, but he's gotten down to having one fluid pill as needed, and as needed is only when he goes to the buffet, but every time he comes in we're through different struggles. I need you to remember, man, I didn't know that you were going to do this and you couldn't breathe and thought you were going to die. And two weeks in you were saying I might actually live. And now we're two years later and you can do most everything that you want to do and breathe and reduce your medicines, and so I don't know if we're going to get all the way to our goal, but we've gotten somewhere and we've added years to his life and we've added quality to his life, and that's important to me.

Jack Heald: 47:26

So my other favorite story.

Amanda Decker: 47:29

Yeah, my other favorite story is another guy, and it's not favorite for the amount of weight that he's lost. But this guy's a vet, he's a veterinarian. He actually takes care of large animals he takes care of my dad's cattle, to be honest but he came in and needed to lose weight and I was like, oh, this is going to be fine, this is going to be a fun consult because he's got a lot of this knowledge, this pathophysiology, in his head. This how does the body work? How does metabolism work? Cause he's a vet and he listens to my story and he's like I don't know about this Really. How?

: 48:01

do you not?

Amanda Decker: 48:01

know about this. That's just not what we're told to eat. And I looked at him and I said dude, you're a vet. When your animals get sick, when your dogs are getting diabetes, what do you do? And he just looked at me and he said curse words oh man, you're right, I put them on protein.

Amanda Decker: 48:25

I'm like, yeah, I put them on protein. And it's when you want to give advice to your farmers to fatten their pigs, what do you do? He said I feed them corn and molasses and grain. I said, okay, so what are we going to do? We're going to eat meat. Okay. So two different, completely different stories. They both are being very successful, but yeah, those are two of my favorites.

Jack Heald: 48:54

I'm digging those stories too.

Dr. Philip Ovadia: 48:56

Great stories and you know with the. You know when we talk about and I know you kind of have we didn't even get into this, but I know you have some family background in farming and ranching and taking care of animals and you just again, this is obvious. This is stuff that we've known going back generations and yet somehow here we are struggling to get people to understand it again. And that's really what it's all about. You know, getting people to learn what they already knew is really the challenge that we face today.

Amanda Decker: 49:33

Yeah, you know, we've gotten into this cycle of thinking that everything's genetic. I'm diabetic because I'm genetic. I have heart disease because it's genetic. I have high blood pressure because it's genetic. I have rheumatoid arthritis because it's genetic, whatnot. And it just baffles me because even when I started practice, you know, 19 years ago, these conditions were not at the amounts that they are today, and let alone when you look 200 years ago. And our genes just don't change that quickly. So something else has changed to trigger it. These things, they may have genetic tendencies, but they're not genetic conditions. But it's almost like a learned helplessness that's been put into our society of oh, there's nothing you can do about this, you got it from your genes, which I don't know.

Amanda Decker: 50:19

If you've read Michelle Hearn's children's book that has been out, my daughter and I did a podcast on that one a couple weeks ago. We were out. Willow did a review of the book and Willow got to the part she was reading the part where the fox got fox 2 diabetes, type 2 diabetes and the doctor comes in and oh, it's your genetic. Then you shouldn't you just keep eating these foods? The dietician will tell you how much of these foods you can eat and we'll give you this medicine. And Willow stopped mid book and she goes why, mama? Why would they tell them that that makes no sense? His grandpa doesn't have Fox two diabetes and these foods that he's eating is giving him Fox two diabetes. So why in the world won't they just tell them to eat less of that food? I know, baby, I feel your pain, I feel it.

Amanda Decker: 51:05

Oh my gosh all right it's obvious, but yet it's not so, so we are part of the revolution here yeah, trying to be.

Jack Heald: 51:20

It's wow. I'm slow to pick these things up, but if I hear it enough times it eventually gets into my noggin. So before we started recording, you mentioned that there's a conference that you have organized and host, and I think you said you're in year three or four on this. Yes, this is our what's the dealio.

Amanda Decker: 51:41

Third year, so about three, no four years ago now and I was at Locard Boca with Dr Ken Berry, and Ken lives about an hour from me. We were having a conversation and I said, ken, we got to do an event. We got to do an event to our hometown because I'm doing a great job here in my clinic I'm reaching one patient at a time, but there's only so many people I can see in a day. We need something bigger. We need something to get the word out and to let anybody who comes because it's a three month wait, four month wait to get in to see me. I was wondering when you were going to do that. I was wondering when you were going to ask me. So we partnered up and we created an event called Low Carb for Better Health. It is open to anyone and is designed for anyone who's interested in using a low carb approach to better their health in any way, shape, form or fashion.

Amanda Decker: 52:33

The very first year we held it in a high school auditorium. My husband's a high school teacher, so we held it in his auditorium, tickets for 10 bucks, and I said, all right, if I get 50 people here, it's going to be amazing. We sold 178 tickets. Covid hit the week of that, so we only had about 134 show up, but it's like for the first year, this is pretty amazing, but we got to go bigger. We need to do, we need to do more. So I moved to a local venue. It's in a beautiful state park here in Tennessee, montgomery Bell State Park, and last year we had year two of the event. It's a great time.

Amanda Decker: 53:09

We had around 300 people attend in person and had about 40 people on a virtual format that were attending. Craig Emmerich spoke, dr Eric Westman spoke, ken spoke, nisha spoke, we had a diabetes specialist. It was a great time, had great feedback, and so I was bold enough to go for year three. Year three is going to be a little bit even bigger and better than last year. We're hoping for an attendance around 325 people. Dr Ken Berry and his wife will both be back with us. I'm not speaking, I'm just the host, so I'm the DJ, so to say, and the happy face that bounces around and keeps everybody interested. We have Dr Christopher Palmer coming who does?

Amanda Decker: 53:51

psychiatric type things. We have Dr Mark Kukazela, which is his story and the things he's done in his career is pretty amazing to me. Talk about somebody trying to buck the system and implement low carb. That was exactly what he did. We've got Zane Griggs, who is a personal trainer. I wrote a book with Dr Ken Berry. I won't say the name of it because it has curse words in it but it's something about being fit after the age of 50.

Amanda Decker: 54:18

Amy Berger is coming. Amy's been in this space for a long time, has a lot of good information about hope in general and keeping going, and then Tia Reed will be there. Tia Reed is another person from the Society of Metabolic Health Practitioners and she's a health coach with Dr Tro Collation and Roxanne Stouffier. I don't know if I'm saying her name right. I've got to ask her exactly how to say her name. She's also with the SMHP and they're going to do a co-presentation together.

Amanda Decker: 54:46

Our theme this year is called Never Give Up, so all the talks are going to be centering around not giving up and changing your life. Yeah, it's going to be a great time. If anyone is interested in coming, the website is lc4BHcom. So that stands for Low Carb, for Better Health and you can click to get tickets there. It's a two-day event. Friday is going to be a nice VIP dinner Sit down, open, question and answer with the speaker panel, mingling with other people, and then Saturday we'll have a more formal talk schedule where each speaker will be given about an hour to speak. So it's a great time. I can't wait.

Amanda Decker: 55:24

And Montgomeryville is beautiful, it's like a resort there. So talk about stress relieving, just getting out in nature and connecting with other people. You know when people, when we go to conferences, when I've been to conferences, I come back with nuggets to use in my own life, but also just feeling rejuvenated of, hey, we're in this together and I've got other people to do this with me and it just. It's a very uplifting experience and I hope this year will be too.

Jack Heald: 55:49

Who's the target audience?

Amanda Decker: 55:51

General public, but anybody. Last year we actually had several healthcare providers who were interested in getting more into low carb, like we had one. She was a GYN fellow in Nashville and she just heard of the event and came to learn more about it. Like we had one, she was a GYN fellow in Nashville and she just heard the event and came to learn more about it. And it's like I got to do this. I got to do this. Yes, you do. How can I help, you know? So it's open to anyone. It's more I would say the talks are geared more for the everyday person, not the healthcare provider.

Amanda Decker: 56:19

So there's no continuing medical education that goes along with this. But we get into the studies because what I find is everybody wants to know that. They want to know that what we're telling them is backed up by literature, is backed up by knowledge, and it's not just us shooting the breeze out there. Anyone can benefit from it, but it is geared towards general population.

Jack Heald: 56:40

Very good. So that is low carbs for better health.

Amanda Decker: 56:46

And the website is lc4bhcom lc4bhcom.

Jack Heald: 56:53

That's pretty. I'll bet there wasn't anybody else who was trying to get ahold of that particular five character sequence of letters for a website.

Amanda Decker: 57:01

No, it works well for hashtags and all that yeah.

Jack Heald: 57:04

Congratulations, congratulations.

Dr. Philip Ovadia: 57:07

Awesome. And then for people who want to get in touch with you, follow you in general, tell them how they do that.

Amanda Decker: 57:14

I am on Instagram, twitter, facebook and LinkedIn, all under Decker less carbs. So my last name D E-E-C-K-E-R Less Carbs.

Jack Heald: 57:27

Very good, phil. It's funny how this stuff I can hear this stuff over and over again and then something happens and I finally get it, and today was one of those days. I don't think I'd really quite grasped the how. What a serious catch 22 you guys are in and you know I salute both of you for hanging in there and continuing to have the health of your patients as your primary concern and on behalf of the patient population, thanks, we appreciate it. It's good to have folks like you out there. Thank you, turning on the light where things are kind of dark. Any last words, phil?

Dr. Philip Ovadia: 58:16

Just love what Amanda has been doing and really inspired me to see everything she's been doing and honored to get to know her and chat with her on an occasional basis, and it was great finally having you on the show.

Amanda Decker: 58:32

Thank you. Thank you for having me.

Jack Heald: 58:34

It's good to have you here. All right For Amanda Decker and Dr Philip Ovadia, this has been the Stay Off my Operating Table podcast. All the contact information for Amanda will be available in the show notes, so go there if you want to find any more information. Thanks for listening. We'll talk to you next time.

: 58:53

Chances are you wouldn't be listening to this podcast if you didn't need to change your life and get healthier. So take action right now. Book a call with Dr Ovedia's team. One small step in the right direction is all it takes to get started. Contact us at ifixheartscom slash talk. That's ifixheartscom slash talk.