E74: Get Your Heart in Shape, The Natural Way to Metabolic Health with Dr. Philip Ovadia

Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week, I am joined by Dr. Philip Ovadia, a renowned cardiothoracic surgeon who has performed over 3,000 heart surgeries and now focuses on metabolic health to help people avoid the need for heart surgery. Dr. Ovadia will share his personal journey from struggling with obesity to adopting a low-carb, carnivorous diet, his insights on the current dietary guidelines, the role of statins and GLP-1 receptor agonists, and the importance of addressing insulin resistance. We'll also discuss his telemedicine practice, his book "Stay Off My Operating Table," and his work with the Society of Metabolic Health Practitioners.

Dr. Philip Ovadia, a board-certified Cardiac Surgeon and founder of Ovadia Heart Health. His mission is to optimize the public’s metabolic health and help people stay off his operating table. Dr. Ovadia, who once struggled with morbid obesity, has seen firsthand the shortcomings of mainstream diets and medicine. Through his personal journey of losing over 100 pounds, he discovered that improving metabolic health is the key to preventing many of the heart surgeries he has performed.

In his book, Stay off My Operating Table®: A Heart Surgeon’s Metabolic Health Guide to Lose Weight, Prevent Disease, and Feel Your Best Every Day, Dr. Ovadia shares a comprehensive metabolic health system designed to prevent disease and promote overall well-being. A native of New York, Dr. Ovadia graduated from the accelerated Pre-Med/Med program at the Pennsylvania State University and Jefferson Medical College. He completed his residency in General Surgery at the University of Medicine and Dentistry of New Jersey and a Fellowship in Cardiothoracic Surgery at Tufts – New England Medical School.

Through Ovadia Heart Health, Dr. Ovadia educates individuals and organizations on his complete metabolic health system to prevent and reverse disease, avoid early death, and live a healthier life.

0:29 - Introduction
1:00 - Dr. Ovadia's Background
1:38 - Transition to Metabolic Health Focus
3:00 - Personal Journey with Obesity
6:16 - Impact of Gary Taubes' Work
9:05 - Dietary Changes Before and After
13:52 - Results of Dietary Changes
16:28 - Misconceptions in Heart Disease and Cholesterol
22:16 - Issues with Low-Fat Diets and Statins
27:33 - Statins and Heart Disease
34:51 - GLP-1 Receptor Agonists and Insulin Resistance
39:21 - Addressing Insulin Resistance in Youth
42:13 - Educating Younger Generations
44:41 - Society of Metabolic Health Practitioners
45:01 - Where to find Dr. Ovadia

Connect with Dr. Ovadia
LinkedIn: https://www.linkedin.com/in/philip-ovadia-heart-health/
Youtube: https://www.youtube.com/ @IFixHearts  
Website: https://ovadiahearthealth.com/

Connect with Dr. Reller
My linktree: linktr.ee/kerryrellermd
Podcast website: https://gethealthytbpodcast.buzzsprout.com/
Facebook: https://www.facebook.com/ClearwaterFamily
Instagram: https://www.instagram.com/clearwaterfamilymedicine/
Clearwater Family Medicine and Allergy Website: https://sites.google.com/view/clearwaterallergy/home

Subscribe to the Get Healthy Tampa Bay Podcast on Apple podcasts, Spotify, Amazon music, iheartradio, Stitcher, Google Podcasts, Pandora.

Transcript

Kerry: 0:29

All right. Hey, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Carrie Roller. And today we have a very special guest, Dr. Philip Ovadia.

Philip: 0:38

Thank you, Kerry. It's great to be here with you. It was really good to connect with you a few months ago now we were at a conference together. And of course, we are local to each other.

Kerry: 0:52

Yes. I know. I thought that was super exciting. We were at that metabolic health conference in Clearwater and you're in St. Pete. Is that right?

Philip: 0:59

Yes.

Kerry: 1:00

Yes. Okay. Which hospital do you operate at?

Philip: 1:03

Well, so I actually don't operate out of St. Pete, out of Florida any longer. I did in the past. I now and we'll talk about my sort of dual professional life. I have my online telemedicine practice, which is based out of Florida. And then I do travel locums work as a cardiac surgeon. So I'm all around the country doing cardiac surgery.

Kerry: 1:29

That's cool. I didn't realize you were doing that. Not locally. Okay. Well, yeah. Why don't you tell us a little bit about who you are and what you do since I kind of jumped the gun with a normal question, but

Philip: 1:38

Yeah, sure thing. So, you know you kind of, I guess, gave away the ending because we met at a metabolic health conference and that really has become a major focus of my professional life. But going back before that I've been a cardiac surgeon now over 20 years. And, you know, I've done well over 3, 000 heart surgeries during that time. And I think the relevant personal information is for most of that time, I was a very unhealthy heart surgeon. And I reached the point this is now going back about 10 years where I was morbidly obese. I was pre diabetic and I recognized that I was headed for my own operating table, so to speak. You know, I was certainly. traveling down the same path that so many of my patients had gone down and like so many of them, I really didn't know what to do about it because I was following the advice that I was taught to give that we all have heard, eat less, move more, eat a low fat diet, watch your cholesterol and kind of follow the food pyramid. And I saw how that wasn't working for me and how it wasn't working for the patients that were ending up on my operating table. So fortunately, I started getting exposed to some different information. My journey really started with my wife who after she had had our children was really struggling with heartburn and had seen a number of practitioners and someone suggested to that she go gluten free. She eliminate gluten from her diet. And, you know, being at that time, the sort of traditionally educated and kind of mainstream thinking cardiac surgeon that I was, I said, well, that doesn't make any sense. You don't have celiac disease. Why would you need to eliminate gluten? But I was also a supportive husband. And I said, if you want to try it, I'll try it with you. And so this is about eight or nine years ago at this point. And they didn't have a lot of the gluten free, you know, options that are certainly available today. And so we kind of went low carb unintentionally, you know, we stopped eating bread, we stopped eating pasta. And I noticed pretty quickly that I felt better. Just had more energy, you know even before I started losing weight. And so. I kind of filed that away and said, that's interesting. And then a few months later after kind of just doing the gluten free thing for a little bit, I was at a conference, a society of thoracic surgeons. So this is the biggest meeting of heart and chest surgeons. And there happened to be a invited guest lecturer by the name of Gary Taubes. And of course, Probably much of your audience is familiar with Gary. Gary is an investigative journalist who at that time had just written the book, The Case Against Sugar, and prior to that had written Good Calories, Bad Calories, and Why We Get Fat. And I heard Gary talk and, you know, really for the first time heard these concepts of low carb and the types of food that we eat being more important than the amount of food that we eat. And so, you know, at that point I kind of cut out sugar, you know, I read Gary's books, cut out sugar went low carb and saw amazing results, you know, lost over a hundred pounds. And really. Got in the best shape of my life, felt better than I had you know, at this point I was in my early 40s and, and felt better than I did in my 20s. Got back to wearing smaller clothes than I did in high school. And that really opened my eyes and I started asking questions like, Why did I learn about this from a journalist? No offense to Gary. Hadn't ever heard of this from my colleagues in medical school and training or anything, and it also led to some additional questions about heart disease in particular, the disease that I had dedicated my life to fighting against. And maybe we, you know, what we had been told about the causes of that and and how to manage it weren't. weren't the full story. So, here I am now you know, 80 or so years after that. And like I said, I now have a telemedicine practice where I help people not to need heart surgery. Wrote my book called Stay Off My Operating Table about two and a half years ago now, and are really on a mission to educate people on how they can avoid the need for heart surgery.

Kerry: 6:16

Yeah. Amazing story. I have so many questions. Obviously we're both kind of coming from mainstream medicine. How did they get, Gary Taubes to speak at a cardiothoracic conference? You have any idea?

Philip: 6:28

Well, that's pretty interesting. And I've actually asked Gary and he honestly says, I have no idea. You know, he was kind of on his book tour and I guess someone in the leadership of the organization must've been interested or, or maybe knew him somehow and thought it would be an interesting lecture. The ironic thing is, you know, I'm at the meeting and you've been at the conferences and you know how this goes, you're going through sort of the program book and you're like what can I maybe skip out on and go enjoy? We were in Phoenix, Arizona. You know, I can go enjoy the weather. My family was in town with me, you know, go hang out with them. And I'm looking at the program and I'm like, who is this journalist? What is he talking about? Like, this has nothing to do with heart surgery. So, you know this is maybe I can skip this one, but for whatever reason I didn't. And obviously I'm, I'm very glad that I did. But I still, to this day have no idea how he got invited. And I also kind of wonder, like, you know, I was in that room with 1, 500 other heart surgeons or, you know thoracic surgeons, like how many of them did it have the same effect on?

Kerry: 7:38

that's what I was

Philip: 7:39

that as well.

Kerry: 7:41

So you, I'm assuming you have no idea. Is that true? Like, why do you think other people like pulled the same information that you did and changed everything?

Philip: 7:51

I mean, what I can say is I'm the only cardiac surgeon I know of really out there talking about preventative health and in the metabolic health space. The one other I guess I can point to would be Steve Gundry. You know, he's been doing it for a long time a very long time as maybe a slightly different focus, but we certainly overlap on a lot of issues. so Steve would be the only other one that I would point to in the cardiac surgical world doing this. And of course, As you know from being at the metabolic health conference there even in the cardiology, the broader cardiology space when it comes to heart disease the concept of metabolic health and insulin resistance is still very much ignored.

Kerry: 8:35

absolutely. I, I agree. And it's sad, but I think that, you know, the research is coming out and hopefully we'll all catch up I think for sure. Otherwise, you know, I think I'm going to ask you some questions later that, you know, what do we do with these current guidelines and recommendations that were given? And I just want to hear your opinion on that. But first I wanted to have you unpack a little bit of what your diet looked like before and after this change, like what kind of things you were eating, what were you doing? And then what about afterwards?

Philip: 9:05

Yeah. So, before this I certainly wasn't eating the typical, you know, what we think of as a standard American diet full of junk food. I was raised in a household. My brother, my older brother is a type one diabetic, so we had no sugar in the house. We had all of the low fat, low sugar, we had margarine instead of butter. We drank skim milk on our Cheerios or our Wheaties every morning for breakfast. You know, and it was very much, I would say in line with the guidelines. And despite that, you know, I battled with obesity since childhood. And you know, many times I would do the standard thing. I would, you know, really get serious about counting calories or really go on the low fat diet and I would lose some weight. And then like most people I would gain it back and more because we now know that these approaches just aren't they're not sustainable because they're really not compatible with human nutritional needs when you go on a very low calorie diet and you're trying to starve yourself, that just isn't going to work long term, and when you go on a low fat diet, you're not getting the essential nutrients that you need And so we know that these approaches don't work in the long run, yes, you can get some short term success and I did, you know, I can think of two or three times in my life that I lost, you know, 50 pounds, but gained it back within a few months. And so it was particularly powerful when, a, I was able to lose all of that weight. But now here I am eight years later maintaining that weight loss and it's really easy for me to do it. I don't have to struggle in battle. After hearing Gary talk after, like I said, I, I really, you know, cut out sugar, had cut out gluten, really got low carb, I guess what most people would think of as keto and did that probably for a year or two. And then I heard a crazy orthopedic surgeon by the name of Shawn Baker talking about the carnivore diet. And again, I said, Well, that sounds really insane only eating meat. Even though at that time I was exceedingly low carb, I was probably under 20 grams of carbs a day. And the reality is, is that I was eating a lot of meat and eggs and, you know, animal products with a little bit of vegetable. But I said, Well, let me give this a try for 30 days and see what happens. And I felt even better. The interesting thing for me was I you know, so I lost the weight. I picked up running, as a activity and I developed plantar fasciitis in my right foot. And for probably a good year or so, I just could not get rid of it. I did all the stuff, I would rest, I would stop exercising, all the physical therapy things, changing your footwear, all of that, just couldn't get rid of this plantar fasciitis. And I went carnivore and my third day on carnivore, I get out of bed and for the first time in about a year, my foot didn't hurt when I, you know, kind of put it down for the first time, getting out of bed after a night of sleep and the plantar fasciitis went away. And early on if I would kind of stray a little bit, maybe have something with some sugar or whatever it is, I would feel it in my right foot. But you know, so I was able to finally get my plantar fasciitis to go away. So that was another improvement. And then it just, I've stuck with a carnivore approach since then, because it's just the easiest thing for me to maintain. I really don't have to think about it. You're not counting anything. And so it works well for me. I always tell my patients like carnivore isn't the only approach that works but I want people to understand it's an option. And that of course brings up the whole discussion around, well, isn't red meat horrible for your heart? Like we've all heard our entire careers and lives. And the reality is, is that no red meat is not damaging to your heart or your health. And so. In some ways carnivore is also a demonstration, I guess, of this that, you know, you kind of take it to the extreme of only eating red meat. And we have now this large community of, of people doing that. And they're, they're overwhelmingly seeing great improvements in their health. And I can even zero in on the heart health aspects of this and say that, you know, we are seeing great results with this.

Kerry: 13:52

what kind of results are you seeing? And before that, I wanted to, what do you think? Is it just decreased inflammation? And why plantar fasciitis might've resolved with the carnivore diet? Hmm.

Philip: 14:03

Yeah, I think the plantar fasciitis was related to inflammation. There was something that I was still eating. In retrospect, I can look back and say, well, at that time, I wasn't really paying attention to the vegetable and seed oil issue. You know, I would eat the sort of keto treats that you see now. Or maybe it was something from, you know, the plant kingdom that I was still consuming in, in small to moderate amounts. That was, causing this inflammation to be persistent. And that was a demonstration of the inflammation going away. I can also point to inflammatory blood markers like C reactive protein that we see, uniformly improve when people go on you know, low carb carnivore type diets. So, and of course that has relevance to heart disease. Inflammation is. one of the driving factors of heart disease. Broader than inflammation, I point to insulin resistance. And, you know, insulin resistance, we know, is a primary driver of heart disease and heart disease risk. And every study I've looked at, that looks at insulin resistance as a risk factor for heart disease it is a much larger magnitude risk factor for heart disease than LDL cholesterol elevation is. And yet somehow we just ignore that. And we've got in the messaging and, you know, you alluded to the guidelines. The guidelines say control cholesterol and they do not mention insulin resistance at all. And I look at that now and say, you know, hold on a second. We have all of this data. And again, this isn't new data. Gerald Riven did the seminal work around insulin resistance and heart disease in the 1980s 1990s and clearly showed that insulin resistance is a major risk factor for heart disease. Now that doesn't mean that, you know, cholesterol is meaningless. It just, what I'm trying to get people to understand and this includes my colleagues, you know, to understand, is that insulin resistance is a much bigger risk factor, so let's pay attention to that one, and then we can have the discussion around, you know, what is the real impact of cholesterol.

Kerry: 16:28

No, I, I think that's a really, really good point. I think that you said a couple things. You mentioned they have keto treats, right? So I feel like there's those processed, more processed foods. I don't know what's all in a keto tree, but you know, they're still keto, but they still have some sort of processed food, I'm sure. And hopefully not those seed oils you were referring to. And then there, when you were back doing gluten free, like you said, they didn't have as many products as now, but now they have all these other substitutes products to be gluten free that still are highly processed and have a bunch of junk in them that probably are not as good as, you know, they should be. So it's going gluten free doesn't really give you the results of what you're describing here, like any more, I would say. Right.

Philip: 17:10

I would agree with that completely, you know, and really my thinking around, you know what we should be eating has has really come around to, you know, first and foremost, we need to eat real food and whole real food. And I, I describe it to people as the things that grow in the ground and the things that eat the things that grow in the ground. You know, basically plants and animals. And then, you know, I am open to variations within that. I work with people who are kind of, you know, on the vegan vegetarian side of things. And of course, I work with a lot of people who are on the carnivore side of things. And they both can work. As long as you're eating real food because, you know, one of the things I talk to my kind of vegan vegetarian leaning patients about is you can't be eating that junk food either. And there's a lot of vegan vegetarian junk food, just like there's a lot of keto junk food that you mentioned and, and all of these things. The food industry finds a way to kind of, you know, bastardize them. And honestly, that's another advantage of carnivore is that they haven't quite figured out how to make processed carnivore food. I mean, I guess you can point to some things like beef jerky or sausages that are loaded with sugar. And so, yeah, you, you gotta be careful on that front as well. But it hasn't quite gotten to that point yet that we see you know, sort of what I would call carnivore junk food. And so that's another advantage of it. All of these things that we point to, you know, is it sugar? Is it vegetable and seed oils? You know, what is it about the food processing? You know, ultimately I find that carnivore really helps to eliminate all of those issues.

Kerry: 19:00

So comment on fiber intake when you're carnivore. How does that work?

Philip: 19:06

the answer is that fiber is not essential to the human diet. And again, it's one of those interesting things that you look at that we've been sold this narrative that fiber is essential for health and really when you look into the science behind fiber, the only thing that's been demonstrated is if fiber replaces processed food, junk food in the diet then fiber is beneficial. But outside of that, I would say that you have, you know, no one's ever demonstrated that fiber in and of itself is beneficial. And we now have a large carnivore experience both modern carnivores, people that are doing it now, but we can also go back through the literature and we see You know, meat based diets being promoted going back to the 1800s. And, and probably even, you know, many people would say it was our ancestral diet. And you know, people do just fine without fiber. And so I don't consider fiber to be essential. No one's ever demonstrated fiber to be essential. And so the answer is you don't need it. And I can personally say, and of course the large carnivore experience community around me can say that they do just fine without eating any fiber.

Kerry: 20:29

So what I was explained at that conference actually was that if you're not, if you're in ketosis, your body can create butyrate, which is what is needed to feed the gut. So you don't need the fiber to feed the gut. That's what I was kind of told. Is that

Philip: 20:43

Yeah, I mean it's interesting the whole, the whole concept of fiber is that, you know, it basically Is it undigestible? You know, we as human beings cannot digest fiber. And they'll talk about digestible versus undigestible fibers. The reality is, is that all fiber is undigestible to humans. So, you know, it's supposed to somehow kind of pass through your GI tract and help give bulk to your stool, which is an interesting concept. Like, why would we need that? And then, like you said, maybe, you know, have some effects on the microbiome and kind of feeding some of the gut bacteria. But again, the gut can do just fine without it. And I think there's still a lot we don't understand about the microbiome. And we're not quite at the point yet that we can use that I think to truly guide our, our nutritional advice. And I think there's a lot of bias within the microbiome literature that they basically started with the concept of, you know, a, a heavily plant based diet was the ideal one. And so whatever that microbiome looks like, you know, that's the ideal microbiome that we should all be pursuing. And again, we don't have the, the outcomes data, I would say to really support that at this point.

Kerry: 22:05

Okay. So you alluded to one of the biggest misconceptions in the current healthcare system regarding heart disease. I think with the low fat diet, what would you say are some other ones?

Philip: 22:16

Yeah. So everything that's kind of around the low fat, you know, you know, so what we can call the diet heart hypothesis or the lipid hypothesis. And, you know, again, many might be familiar with this, but the history might be new to some people. This really started in the 1950s. So, you know, when you look back here in the U. S. In the early 1900s and certainly the late 1800s, Heart disease is basically undescribed. It is a very rare occurrence, and we have, you know, kind of the lifetime reports of the leading physicians of the time, and they hardly ever saw cases of heart disease. And, you know, starting in the early 1900s, we start to see this rise in heart disease in the U. S. And it really kind of reaches a crisis point in 1955 when our president Eisenhower has a heart attack while in office. And this appropriately sets off the alarm bells and everyone's, you know, kind of trying to figure out what's causing heart disease. And there were two prevailing theories of the time. One was basically championed by Ansel Keys. And Ansel Keys, who you know, is a, Physiologist, a researcher is promoting the hypothesis that dietary cholesterol and specifically dietary saturated fat is leading to increased blood cholesterol levels. And those increased blood cholesterol levels are then leading to the plaque buildup that we see in the arteries, atherosclerosis as we call it. And, you know, this makes a little bit of sense because you look at these plaques and you see cholesterol in them. And so you then say, okay, well, you know, this cholesterol has to be coming from the bloodstream and, you know, there was some, I would say, poorly done science at the time that correlated eating cholesterol with your blood cholesterol levels. And really it was just conceptual, There's cholesterol in our blood. There's cholesterol in the food. So, you know, the more cholesterol you put in from the food, it makes sense that, you know, the more is going to end up in your blood. So that was one hypothesis. And the competing hypothesis, which was, you know, championed by physicians like Dr Yudkin was that sugar was really the primary driver of this increased incidents that we were seeing in heart disease. And I will just say that for reasons that weren't completely scientific the cholesterol hypothesis won out and that became the prevailing hypothesis around heart disease. Now, there have always been some problems with it. And the early scientific studies, show an inconsistent relationship between the amount of cholesterol and or the amount of saturated fat that someone eats and their blood cholesterol levels. And then inconsistent relationships between blood cholesterol levels and heart disease. You know, we can go back to some of the early data. So the Framingham study very large, famous study that many people are familiar with. And this was really the first study that suggested that there was a relationship between blood cholesterol levels and heart disease occurrence. But interestingly, that was only shown to be the case at very high levels of cholesterol. You know, we're talking about total cholesterol levels in the above 300 range. And what we now recognize, but they didn't fully understand back then, is that the people that had those levels of cholesterol a lot of them have genetic issues what we call familial hypercholesterolemia. And those genetic changes don't only affect your cholesterol levels, but they also have a lot of other effects in things like your blood clotting system. And this has influence on heart disease. So anyway, we get set down this pathway and then it just becomes really a kind of self feeding proposition because it just becomes the baseline assumption that cholesterol is the problem when it comes to heart disease. And of course, you know, that leads to the U. S. Dietary guidelines suggesting low fat, low cholesterol dietary approaches with the unintended consequence of when you take fat out of food, A, you're processing it, and B, you've got to substitute something in to make the food palatable, and that becomes basically sugar and processed carbohydrates. So that's problem number one. And then of course the pharmaceutical company gets involved and comes along with medications to lower cholesterol, increases our focus on this even more.

Kerry: 27:18

Yeah, in medical school, you know, we learned to treat the disease with medications and everything instead of preventing them. So obviously statins are one of the big things that we learned to treat cholesterol with. So what is your I guess, opinion guidelines with using those?

Philip: 27:33

Yeah. I look at high level evidence and the high level evidence shows us that statins have been, you know, one of the most, if not the most widely prescribed class of medications in the United States now for over 30 years. And heart disease is not changing. It's not going away. And in fact, it's getting worse despite this. And, you know, the corresponding data is that our cholesterol levels on a population, you know when we look at population wide, our cholesterol levels are lower than they've been and heart disease isn't going away. So that's, you know, kind of red flag number one for me when it comes to statins in particular, and really the whole cholesterol based hypothesis of heart disease. I alluded to earlier the numerous studies that we have showing that insulin resistance is a much bigger risk factor for heart disease than cholesterol is. And so again, my focus is let's address the insulin resistance. Clearly, the cholesterol approach in and of itself is not adequate, is not working. And then we have to acknowledge the potential harms that come from trying to lower cholesterol. And this really applies to both You know, the diet and lifestyle approach to lowering cholesterol, as well as the pharmaceutical based approach to lowering cholesterol levels because as I've mentioned earlier, you know, if you're going to take a dietary approach to this, and that centers around lowering the amount of fat in your diet in general and shifting the fats that you consume from saturated fats to polyunsaturated fats. And I would say that neither of those has shown to be beneficial. And really you can point to harm. There have been you know, three large interventional trials substituting polyunsaturated fats for saturated fats. And they have all failed to show benefit, and they you know, point towards harm. And again, we can look at the Minnesota Coronary Experiment, we can look at the Sydney Diet Heart Study, and we see that the outcomes were worse in the groups that were getting the polyunsaturated fatty acids, as opposed to the natural saturated fats that we've been consuming as human beings for our entire existence. So, you know, the dietary approach. ends up not being a good approach. And oh, by the way, when you lower the fat, you increase carbohydrate intake and particularly processed carbohydrate intake. And you make people more insulin resistant and more prone to things like type two diabetes that increases their risk of heart disease even more. So that doesn't seem like a good approach to me. And then, you know, on the pharmaceutical side of things it really comes down to the benefits are disappointing their small magnitude at best, and the long term effects of it. being on these medications are really concerning to me. You know, when I look at data that shows, for instance, that, you know, if you're on a statin for more than five years, you have a significantly increased risk of developing insulin resistance and type two diabetes. Again, the two primary drivers of heart disease. That's why I don't think we see the magnitude of benefit that you would expect to see if it was all about cholesterol. Because the reality is even in the best statin studies and understand that a lot of this science is kind of corrupted by the fact that it was done by the pharmaceutical companies. They don't, you know allow the data to be scrutinized by third parties, especially early on in the statin experience. You know they're very selective about how the studies get done and what gets published. But even if you accept at face value, the best data we have around statins. In the primary prevention setting. So someone who has not yet had a heart attack or a stroke or needed a stent or bypass surgery. The absolute risk reductions that we see from taking statins over a 5 to 10 year period are on the 1 to 2%. You know, reduction. And so again, when you look at the data that way and you say you can take these medications, you know, for 10 20 years and you can reduce your chance of having a heart attack by one or 2%. Most patients aren't too excited about doing that. And again, that's with the trade off of You're probably increasing your risk for things like diabetes insulin resistance, and maybe some other things as well.

Kerry: 32:27

Do you know mechanistically why the statins induce like diabetes?

Philip: 32:32

Yeah, they're basically a mitochondrial poison is the way that they work you know, and so they interfere with metabolic efficiency and metabolic processes. And that is what leads to their, you know, increased risk of insulin resistance and diabetes.

Kerry: 32:50

I see it all the time when a patient comes to me on a statin and you know, guess what? Now you have prediabetes or diabetes and It's ironic because anytime we have a patient with diabetes, we're supposed to give them a statin,

Philip: 33:03

Yeah,

Kerry: 33:04

which is part of risk reduction, which apparently is one to 2%. So that's not very helpful. Yeah. And we get dinged on it if we don't. Yeah.

Philip: 33:12

Oh, yeah, no, exactly. You know, it's the way the guidelines are written. And, and, you know, the other concern I have is that it also is giving that message to the patient of, you know, don't worry about what you're eating. The medication fixes it, you know, go on living your life and eat whatever you want. We have medication for that. And so that whole thing. pharmaceutical based messaging, forgetting about the specific medications, you know, again, we need to get back to diet and lifestyle being first and foremost. And in order for that to work, we need to be giving people good diet and lifestyle advice. And we have now again clearly demonstrated that, you know, therapeutic carbohydrate restriction is the best way to deal with insulin resistance. We can reverse type 2 diabetes in the majority of cases. And again, this is published literature from things like Virta Health you know, showing this. And that should be our focus because if we eliminate the insulin resistance, that is going to have the most powerful effect if we're trying to prevent heart disease, along with many of the other chronic diseases that we're battling against as well.

Kerry: 34:25

The stands definitely, you know, give that permission to eat whatever you want as well. And that's probably also part of the downfall speaking of insulin resistance and that everything and improving upon that. What is your thought on the G. L. P. 1 receptor agonists that are used for insulin resistance treatment? And how does that role play a role into the cardiac health too? Since now they are approved for that as well.

Philip: 34:51

Yeah, so I think the data around GLP one agonists and you know, cardiovascular disease is, is interesting. And I think we have to, first of all, you know, make some distinctions between you know, the way that the way that these medications are getting used for weight loss versus the ways that they have been used. I mean these medications have been approved for a decade to treat for diabetics. The dosage is different. You know, we are using higher doses when we're talking about weight loss versus diabetes management. And I think that may be very important. And you know, again my hesitation comes with the drug focused approach. So but I do acknowledge that there is a role here. And if you have a patient that's insulin resistant I think that GLP 1, you know, and there's concern for cardiovascular disease or they have diagnosed cardiovascular disease, there's probably a role for these GLP 1 agonists. But, you know, again, with the patients that I'm working with, that goes along with The message of this is what we need to do to reverse your insulin resistance from a diet and lifestyle approach. And once we accomplish that, now these medications aren't going to be of any benefit for you. So, you know, we don't want this to be a lifelong just stay on the medication. It may be useful as an adjunct in the short term. And let's get your insulin resistance reversed with This you know, proper diet and lifestyle approaches. And then we don't need these medications anymore.

Kerry: 36:29

Yeah, I agree. I think, you know, they are supposedly meant to be used long term and forever potentially. But if you're really making those lifestyle change in habits, which it can be helpful for, especially getting the motivation in the beginning to go, because it really helps quiet that noise, then they can make those changes to go, you know, whatever way they need to go on their lifestyle thing. So I think they, they do have a role at least like for starting out as well. And then, I mean, I, I just. I assume that there's cardiovascular benefit because it's the overall weight loss and reduction of insulin resistance in the first place, right? I don't necessarily think it's some sort of direct mechanism.

Philip: 37:07

Yeah, no, I agree completely that, you know, those are the that's where the benefits are coming from. And again, you know as we oftentimes make these same mistakes, I guess, you know, because I look back at the stat and data and you know, the stat and trials and say, okay over a 1 year, 2 year, 5 year, you know, or really the longest trial, you see benefit. That doesn't mean that lifelong is a good idea, and especially, you know, we are also seeing with these GLP 1 agonists many of the problems that are coming, you know, long term with them. And again, I, I admit that a lot of that is more with the high dose use that we're you know, for the weight loss purposes versus the treatment to diabetes. And like everything in medicine, you know, There's no perfect answer. We're always been. We're always balancing those risks and benefits. But I do have concerns about any really medication that we're saying, you know, now you're going to be on this for the rest of your life. And especially when we're talking about you know, starting them earlier and earlier. So, you know, one of the other mistakes I think we've made around statins is, you know, there was just, Okay, you demonstrate that this has some benefit over a short term and let's say, you know, 50 and 60 year olds. And somehow that we're now in the situation where there were many leading cardiologists and cardiology societies that are promoting statins for teenagers because the concept has become the norm. you know, the earlier we start this and the lower we keep your cholesterol level throughout your life, you know, that's the answer to preventing heart disease. And so and GLP one agonist again, the same conversations are having the, you know, the, the rise in childhood and, you know, teenage obesity that we're seeing. And the answer is, well, let's start giving them all these, you know, these medications with the intent that they're just going to stay on this medication for the rest of their life. And I think that's a very, very bad approach to be taking.

Kerry: 39:21

Yeah, I agree. It's a little concerning with the starting of the medicine. So really, I had no idea they did statins in teenagers, though. That's

Philip: 39:28

Yeah. You know, we're seeing it and again, it's because we have teenagers that are being diagnosed with type two diabetes which is scary in and of itself. And like you said, the guidelines say, if you have diabetes, type two diabetes, you know, you should be on a statin. And so Kids, literally kids and teenagers are getting started on these medications.

Kerry: 39:50

And your expert professional opinion, how do you, how do we fix this whole problem? Especially like at the young age, how do we fix our food supply? How do we, how do we fix this? Any

Philip: 40:00

Yeah, I think it really has to be a ground up movement. You know, this is, you know, we can't sit back and expect that the food companies are going to change that the pharmaceutical companies are going to change really that the health care system is going to change. And so I think this starts with educating our patients. And the way I look at it is, When I'm teaching, my adult patient about this that's going to translate to their children. You know, and honestly, I see it in my children and you know, because they at least are thinking about this. And I'm not saying that they're perfect and they don't do a carnivore diet. But, you know, when we go out to eat they order steak most of the time they order their burgers without the bun a lot of the times, and they're kind of cognizant of these issues and thinking about it. And honestly, I do see more hope in the younger generation because I think for you and I and, you know, my parents, right? We were raised in this environment of low fat, low carb food pyramid. And it was just kind of the dogma. And it was just accepted as this is the best approach. And now we're trying to change people's minds about that. But kids, I think, are seeing it already and realizing that this doesn't make sense. And we can get to them early with the message of You know, processed food is not good for us. And so I do see hope out there. There is a high school she's, she's just about to graduate high school as we're filming this. And she produced a documentary on cancer as a food borne illness and talking about processed food and cancer. Her name is Grace Price. I recommend everyone go out and read, watch that documentary. Again, it's called cancer, a food borne illness. And so I see things like that, and I certainly get hope for the future. And I think if we get to the Children early enough, we're Before they've kind of undergone the brainwashing of low fat, low cholesterol, processed food based approach that's where we're going to really start to have an impact on this.

Kerry: 42:13

I definitely think it's when the kids are more able to make those decisions. Cause in right now I feel like they're just over flooded with abundance of everything, snacks all over the place and they're full of added sugar and everything. And it's still, There, but maybe it's just my kids ages. I don't know, but hopefully when they're old enough, I'm teaching them that they, you know, see these things too, because I'm trying to do that, but it is not easy when it's everywhere.

Philip: 42:38

Yeah, no, I mean, it is scary and it is a very difficult environment for us to be in. But again, you know, going to things like the metabolic health conference, seeing the increasing number of practitioners that are aware of this, you know, because I think ultimately doctors are We we know doctors are getting very frustrated and getting burned out because they're not seeing results from their patients and the health care system is really failing. And so more and more of them are looking for alternatives, I guess you could say. And you know, things like metabolic health which are growing and going to these conferences. I see more and more practitioners from more and more different specialties that are becoming aware of this and are implementing it into their practices with great results. You know, I look at something like the large focus at that conference on metabolic psychiatry. And you know people like Christopher Palmer and Georgia Ede you know, and all the great work they're doing to show that much of the psychiatric epidemic that we are up against can be attributed to poor metabolic health as well. And so The message is starting to spread, but like I said, it's going to be very much a grassroots bottom up effort. I'm not expecting the American Heart Association to turn around anytime soon and say, we were wrong. But clearly they are wrong. They've been wrong. You know, again, I look at an organization like the American Heart Association who, you know, their singular focus for the past 70 years has been to battle heart disease, and they are very clearly failing in those efforts. Heart disease has done nothing but increase under their watch, under their guidelines, under their recommendations. And I think it's time that we as physicians partner with our patients to start pushing back against this.

Kerry: 44:41

Oh, I love it. Absolutely. I completely agree with everything. I just want to thank you so much for your time. I know I could probably keep you here asking you a million questions, but I know you're a busy guy. So how can people find you? And then tell us a little bit about the I think you started the metabolic health for practitioners society, or is that right? Is that the name of it?

Philip: 45:01

Yeah, so I am one of the founding members of the Society of Metabolic Health Practitioners. I think for any practitioner that's interested in metabolic health that is where you should start. And they have certification programs, they have educational programs. And really they're giving You know the practitioners what they need in terms of writing guidelines and now there's a journal that they're publishing and just that community support I think that we all need as physicians as we're trying to maybe incorporate this into our practices. So definitely a plug for the Society of Metabolic Health Practitioners. Personally I can be found at iFixHearts everywhere. So all the social medias at iFixHearts and then you can go to iFixHearts. com and find out all the ways that my team and I are working with patients. I do have a telemedicine practice. I see patients all throughout the United States to try and keep people off the operating table. That's largely my focus on more broadly educating people on metabolic health. And then the book is called Stay Off My Operating Table, and it is widely available on all the usual places.

Kerry: 46:18

And your podcast stay

Philip: 46:21

Yes, also called stay off my operating table. I

Kerry: 46:25

And did you have a TEDx talk on the same topic? I haven't seen it yet, but yes.

Philip: 46:30

it. I was very honored to be actually invited back to my medical school alma mater Jefferson to deliver a TEDx talk. And so the talk has now been brought out on the TEDx YouTube channel now for about two months over 300, 000 views. So it's been very well received. And I get excited about the advantage we have today is social media and the internet. So these concepts can spread, you know, I look back on my career as a heart surgeon. And like I said, I've done, you know, over 3000 heart surgeries. But you're only impacting kind of one person at a time. And I look at some of these other avenues, you know there are large podcasts that I've been on that have two million views. You know, the book has sold at this point, I think over 50, 000 copies. And I just look at the scale that we can get this information spread at. And that, that's what I'm passionate about.

Kerry: 47:30

Yeah. Well, congratulations on all your achievements. And, you know, thank you for doing what you're doing and spreading the word. And yeah, and thank you for educating me. And I think, like you said, we need this community and I definitely need more friends and people on this same pathway as, as I am just, you know, kind of starting out on. So I appreciate that. I appreciate your time and thank you so much for being on the podcast. And if anybody is interested in having a primary care provider that does do insurance and try to, I guess, break some of the rules, but follow them too. I'm, you know, passionate about helping everybody's metabolic health as well, and they can come find me.