Heart Disease- Prevention Instead of Treatment: A Heart Surgeon Tells the Truth About the Risks of Cholesterol and LDL
Heart disease has been the number one killer of people in this country for 30 plus years. And it shows no signs of change.
There is a growing body of evidence that shows the predicators of cardiovascular disease are multifactorial. Measurements of HbA1c, insulin resistance, total triglyceride to HDL ratios, LDL specifics, and inflammation markers provide a much more accurate picture of cardiovascular risk than just LDL and total cholesterol. All these risk factors are significantly improved through low carbohydrate nutrition. Consideration of lifestyle factors such as physical activity, sleep, stress and social connections also important to consider in addressing overall heart health.
Philip Ovadia, MD is a successful cardiothoracic surgeon who is now trying to help patients avoid heart disease ( and his operating table) by addressing their metabolic health which is the key driver of heart disease.
Dr Ovaidia completed a residency in General Surgery at the University of Medicine and Dentistry at New Jersey, and a Fellowship in Cardiothoracic Surgery at Tufts – New England Medical School.
His latest book is “Stay off My Operating Table”. This is the book for any physician or patient who wants to prevent disease if possible and to otherwise improve outcomes. Dr. Ovadia understands the central role metabolic health plays in the body, knowledge which enables him to keep otherwise future cardiac patients off his operating table. I am sharing this book with other doctors at the USC Keck School of Medicine so they can learn how diet affects everything we do as doctors.
Eighty-eight percent of Americans are metabolically unhealthy. Please join us for this interview where we find out how to lower that number.
TAKE HOME POINTS:
Metabolic health is the risk factor we need to worry about for heart disease, not LDL.
‘the amount of risk for heart disease that’s predicted by LDL cholesterol alone is very low, we’re talking about a 1.3 1.4x. You know, for someone with a high LDL cholesterol as opposed to a normal LDL cholesterol. When you look at the risk associated with poor metabolic health, that risk is on the order of six to 7x. So it’s much more powerful predictor than LDL cholesterol is alone. ‘
‘Both HDL cholesterol being low, and triglycerides being high, are much more predictive of the risk of heart disease than LDL cholesterol being high. And, you know, for me, you know, triglycerides and HDL, specifically, the ratio between your triglycerides and your HDL is a very good predictor of metabolic health.’
Dr Ovadia is available online for consultation.
‘yes, I do everything via telemedicine all online. And patients can be anywhere, you know, certainly throughout the United States, and pretty much anywhere in the world at this point. ‘
CT Coronary Artery Calcium scans:
‘Yes. So I use CAC scans, coronary artery calcium scans frequently with my patients, I think they’re one of the best tools we have available to us. Again, you know, when you look at blood markers, whatever blood markers you’re looking at, whether it’s your LDL, or you know, we’ve talked about triglycerides and HDL, you know, these are still just trying to predict risk. But we have a way of actually measuring disease directly. And the coronary artery calcium scan does that.’
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Robert Lufkin MD 0:00
Welcome back to the health longevity secrets show with Dr. Robert Lufkin. Our guest today is an expert in treating people with heart disease on the operating table, who has now begun to treat patients before they have a heart attack and arrive on his table. 88% of Americans are metabolically unhealthy. Let’s find out what needs to change to lower that number. Dr. filipo VEDA is a cardiothoracic surgeon who also has a practice focused on metabolic health and reducing cardiac risk. He completed a residency in general surgery at the University of Medicine and Dentistry at New Jersey, and a fellowship in cardiothoracic surgery at Tufts, New England medical school. Before I begin, I would also like to mention that this show is separate from my teaching and research roles at the Medical School with which I’m currently associated. It is part of my continuing effort to bring quality evidence based information about health and longevity to the general public. Now, please enjoy this interview with Dr. Philip oveja. Phil, welcome to the show.
Philip Ovadia MD 1:10
Thanks, Bob, for having me on saying it to be here.
Robert Lufkin MD 1:13
I’m so glad you’re on the show. I mean, I’m excited to I can’t wait for your new podcast to start that’s going to be coming out right about the time this show is and also, your new book is dropping in November. I think it’s got a great title. Stay off my operating table. I love it.
Philip Ovadia MD 1:37
Yeah, I’m really excited to be able to, you know, connect with the larger audience with both of those. And I think a lot of a lot of people in your audience will find it informative and useful as well.
Robert Lufkin MD 1:51
Yeah, you have a unique position in this space in that you. You are a an expert, cardiothoracic surgeon practicing, who now has also chosen to rather than treat people on your table, give them the tools so that they can learn how to prevent and avoid cardiac disease and hopefully not wind up on that operating maybe table?
Philip Ovadia MD 2:20
Yeah, exactly. You know, I think both my personal and professional sort of journey has led me to this point, you know, that I’ve really come to appreciate that preventing these health problems is a much better strategy than treating them. And as much as we’ve made advances and gotten better at treating all these conditions with whether it be you know, pharmaceutical interventions or surgical interventions, we still have not gotten to the point that, you know, preventing the disease in the first place isn’t better than treating the disease.
Robert Lufkin MD 2:58
Yeah, I would love to hear more about that about your story for our listeners, because it’s very compelling. I think you and I share a similar background. Not only that, we’re both medical doctors, but I think growing up my mom was a dietician. And so she she religiously followed the USDA guidelines, and we ate margarine. Diet, so the low fat milk and avoided sugary cereals. Anyway, but yeah, tell us tell you tell us how you got involved in this interesting space.
Philip Ovadia MD 3:38
Yeah. So as you said, you know, a very similar background, I grew up in a household, you know, with, you know, both my parents were obese. I had a brother who was a type one diabetic from a young age. So, you know, we were certainly very mindful. My parents were very mindful about what we were eating. And as I said, it was right in line with the US dietary guidelines. It was, you know, low fat, everything it was, you know, but it was margarine instead of butter and it was skim milk. And we had no sugary cereals, we had all the you know, what we were told were the healthy Cheerios and Wheaties and, and all the wheat based products. And despite that, you know, and I was a very active child, I played sports here around I, you know, I rode my bike, everywhere I walked to school often, and despite all that, I just, you know, was obese of the child and it continued to worsen. And I went through college and medical school, and, you know, just got, you know, heavier and heavier and, you know, the, I tried many things along the way. I did all the things, you know, the extent of what we’ve learned in medical school, around weight loss, which is, you know, eat less, move more And eat a low fat diet and count calories. And I did all of that. And at times I would have successes and lose weight. But as I think a lot of people, you know, experience, I would then gain back the weight and usually more. And I found myself about five years ago as a morbidly obese, pre diabetic cardiac surgeon. And I realized that, you know, I was going to end up on my own operating table, if I didn’t, you know, do something. But again, I was kind of at a loss as to what to do. And I was very fortunate, you know, through a series of events that first started with my wife, she had had our two daughters at that point, and was struggling with heartburn. And one of her practitioners suggested that she tried eliminating gluten from her diet to help with the heartburn. And honestly, I was skeptical at first, you know, kind of mainstream cardiac surgeon and I said, Well, you don’t have celiac disease, what is gluten have to do with any of this, but I am a very supportive husband. So um, you know, I’ll give it a try with you. And we did that. And I noticed right away, I felt a lot better, I had more energy, I wasn’t getting tired in the afternoon. And I started to lose a little bit of weight. And you know, honestly, it still didn’t really click. And then a few months later, Gary Taubes was the guest speaker at one of the medical meetings I was attending. And he had just written the case against sugar. And, you know, he was really the first it was the first time I’ve heard about low carb, low sugar, and its influence on health, and specifically on weight. I, you know, immediately you know, on plane ride home, and within a couple of days had read, you know, all of his books, good calories, bad calories, and why we get fat. And immediately, you know, at this time started doing low carb, you know, sort of intentionally, I realized, in retrospect, by going gluten free, I had been doing lowish carb unintentionally, but so I lost a bunch of weight, I started to feel a lot better. And then I started to ask the questions of why didn’t I hear about this before, you know, I spent my whole career, you know, treating the end product of obesity and poor metabolic health, I myself had gone through the struggle, and I had never heard this information, you know, about, you know, low carb and getting into the whole, you know, sort of alternative ideas around weight loss and metabolic health. And as I asked more and more of those questions, and got deeper deeper into it, it obviously has led me to discover a lot more information about how important metabolic health is to our overall health. And so now, I’ve kind of, you know, although I continue to work as a cardiac surgeon, I have a, an additional focus a new, you know, kind of passion in helping people prevent heart disease and prevent chronic disease, rather than having to operate on them, you know, to treat their heart disease.
Robert Lufkin MD 8:20
So, so for heart disease, how does your thinking differ from sort of conventional, conventional teachings in the medical profession, that so many of our colleagues are following now?
Philip Ovadia MD 8:34
Yeah, you know, as you know, I’m sure most of your audience knows, you know, the traditional thinking around heart disease, or I shouldn’t say the traditional The, the recent thinking around port disease, is that cholesterol, specifically, LDL cholesterol, is essentially the causative factor behind heart disease. And therefore, if we can lower people’s LDL cholesterol, we’re going to prevent them from getting heart disease. And this has been the prevailing hypothesis, basically, you know, since the late 1980s, early 1990s, corresponding to the release of statens, and other medications that were targeting the lowering of LDL cholesterol. And honestly, you know, again, I’m sort of a big picture guy, simple concepts. I look all around me, and I see that it is not working, you know, I continue to be a very busy cardiac surgeon, and at least half and actually some of the data suggests up to 75% of the patients that end up needing cardiac surgery have a low or normal LDL cholesterol level, some of that because they’re on medications already. Some of them just because, you know, their diet in their genetics and whatever else it is, you know, keeps their LDL cholesterol low, and yet they’re still showing up on my operating room table to have heart Surgery. And, you know, again, I went through the first 10 plus years of my career as a cardiac surgeon and never really thought about that. But now I, now I kind of kick myself and say, How did I not think about that. So, you know, LDL cholesterol just by that sort of fact alone cannot be the causative factor, it may play a role in the process. But obviously, there’s got to be something else that’s driving the epidemic of heart disease. And when you really look at the data, and you look at the literature, it becomes obvious that metabolic health is, you know, the root of all poor metabolic health is at the root of heart disease, and much of the other chronic disease that you know, plagues our country, our world, currently. And, again, when you look at the data that’s out there, and this shouldn’t be controversial at all, but it is the, you know, the amount of risk for heart disease that’s predicted by LDL cholesterol alone is very low, we’re talking about a 1.3 1.4x. You know, for someone with a high LDL cholesterol as opposed to a normal LDL cholesterol. When you look at the risk associated with poor metabolic health, that risk is on the order of six to 7x. So it’s much more powerful predictor than LDL cholesterol is alone. And so then you have to step back and just to say, why do we focus so much on LDL cholesterol? And honestly, the only answer that makes any sense is because we have a medication that treats LDL cholesterol, we don’t have a medication that treats poor metabolic health.
Robert Lufkin MD 11:53
So if we don’t follow the LDL, or if if it is, is secondary and important, what about triglycerides and HDL? In the Yeah, so
Philip Ovadia MD 12:05
again, the data around that is is pretty, you know, straightforward. Both HDL cholesterol being low, and triglycerides being high, are much more predictive of the risk of heart disease than LDL cholesterol being high. And, you know, for me, you know, triglycerides and HDL, specifically, the ratio between your triglycerides and your HDL is a very good predictor of metabolic health. And so that makes a lot of sense. And in fact, and, you know, we’ll get into how do we define metabolic health. But, you know, the official definition of metabolic syndrome, there are five measurements that are looked at to determine if someone has metabolic syndrome, and HDL cholesterol and triglycerides are both, you know, are two of those measures, LDL cholesterol is not one of those measures. So you know, it all it all starts to make sense. But again, you know, we don’t have medications that effectively modulate HDL cholesterol or triglycerides. And so therefore, we have come to focus more on LDL cholesterol. And as I said, the results of that are becoming very obvious, we are not making a meaningful impact in the prevention of heart disease with that strategy.
Robert Lufkin MD 13:32
How about the role of inflammation and heart disease? You know, we we hear about brushing our teeth, as a as a not brushing our teeth as a risk factor for heart disease? And how do you integrate that into your practice? Or how do you view inflammation in the whole picture of heart disease and metabolic disease?
Philip Ovadia MD 13:54
Yeah, ultimately, I think inflammation First of all, is very strongly associated with metabolic health. We know that people who are metabolically unhealthy have more inflammation in their body. But outside of metabolic health, there are some unique things that sort of cause inflammation. And really what this comes down to is damage to the blood vessels. So you know, in my mind, the way we should be viewing this process is something damages the blood vessels of the heart, and then cholesterol, LDL cholesterol, is part of the repair mechanism. It’s basically you know, you picture you damage your wall, and then you take the spackle to, you know, patch up the wall. But if you keep doing that, you know, pretty soon you got a sort of, you know, this big patch of spackle that’s sticking out from the wall. And that’s essentially what’s happening inside the blood vessels of our heart. But you know, the way to prevent that process isn’t by getting rid of all the spackle because then you still have the hole in the wall. wall, the way to do it is not put the hole in your wall in the first place. And the things that damage our blood vessels are inflammation, you know, specifically from smoking from high blood sugar levels on a, you know, repeated or a constant basis. And then, you know, high blood pressure, which is a basically a side effect of poor metabolic health, these are the things that really, you know, set the process off. So we can go back and start focusing on preventing the damage in the first place, then the cholesterol a part of it, the LDL cholesterol, part of it becomes, you know, very small and maybe even meaningless.
Robert Lufkin MD 15:43
So, really, the stats are not that valuable, in your opinion for this, correct?
Philip Ovadia MD 15:49
Correct. I think they play a role. You know, I’m not saying that no one should be on statins, but I think they’re very much overused. And again, you know, it’s interesting, when you go back to the cholesterol guidelines, the management for the, you know, the the guidelines from all the official organizations, the American Heart Association, and, and, you know, regarding the management of hypercholesterolemia, lifestyle intervention is always in there before standards, it’s just we skip that, that no one pays attention to it. And what they, you know, the usual, you know, response to that is, oh, you know, patients don’t follow it, or, you know, they don’t follow the advice on lifestyle. So we have to go through the standards. And what I, you know, push back is, is that patients will follow advice that works. Unfortunately, most of the advice we’ve given around lifestyle, again, going back to the, the food pyramid, USDA guidelines, low fat diet, that advice doesn’t work. So patients don’t follow it. It didn’t work for me personally. And, you know, you know, so I stopped following it. But when we find what works, and again, I think, you know, we’ll get into this a little bit more, but focusing on metabolic health via lifestyle, that works, it’s worked for me personally, it’s worked for, you know, many of the patients I work with now. And you know, if you sit down with a patient, and you say, Listen, I can start you on a medication, you’re going to need to be on this medication for the rest of your life. We don’t know all of the effects that come from being on the medication the rest of your life. And despite putting you on that medication for the rest of your life, you’re still going to have a pretty good chance of developing, you know, the end result heart disease, or something else. Or we can change your lifestyle, change what you eat, you know, and this is what works. 99% of the patients are going to take the lifestyle change, you know, if they are offered a lifestyle change that works. But we don’t even do that anymore. You know, in the past, we offered lifestyle changes that didn’t work, the patients didn’t follow it. And then we as physicians stopped offering the advice and just went straight to the medication. And I think we need to kind of get back and reset and say, let’s find the lifestyle interventions that work. And let’s start offering news first, before we go to the medication.
Robert Lufkin MD 18:23
Yeah, that’s such a good point about lifestyle. It’s almost as if the notion of lifestyle modification has gotten a bad bad name, just as you say, because it doesn’t work. And anytime you mentioned lifestyle, people sort of shrug their shoulders and you know, walk away but if we do the right lifestyle changes, it can be life changing and transforming as as, as we’re seeing, going back to the coronary arteries and blood vessels. Do you find coronary artery CT coronary artery calcium scores to be valuable in managing your patients?
Philip Ovadia MD 19:03
Yes. So I use CAC scans, coronary artery calcium scans frequently with my patients, I think they’re one of the best tools we have available to us. Again, you know, when you look at blood markers, whatever blood markers you’re looking at, whether it’s your LDL, or you know, we’ve talked about triglycerides and HDL, you know, these are still just trying to predict risk. But we have a way of actually measuring disease directly. And the coronary artery calcium scan does that. And it’s, you know, obviously, as you know, it’s a fairly inexpensive non invasive test. You don’t even need an IV for it. It’s very low dose radiation. It’s online, you know, with a chest X ray, and it’s quick and it can be done inexpensively and it actually shows Do you have disease in your arteries or not? And again, is a much better predictor of risk, then, you know, any of our blood markers, you know, so anyone with a CAC score of zero has a 10 year risk of developing, you know, a cardiac event of one to 2%, depending on their age. So if we have that test, which does a much better job of predicting risk, then the blood markers, again, you start to ask why don’t we use that more frequently? And I think, you know, again, you have to go back to it would end up with a lot less people taking medications to lower cholesterol?
Robert Lufkin MD 20:39
Yeah, the so if a patient has a coronary calcium, CT, coronary calcium score, and it is it is elevated, say it’s above 100? or so? How do you? How do you view follow up scans to manage their response to it? I know Ivor Cummins is a big proponent of this and following him up, do you like to see the calcium actually the number getting smaller? Or do you just want to see a slowing of progression? What’s your, what’s your view on that? Yeah,
Philip Ovadia MD 21:15
so I’m a big fan of ivers work. And, you know, we do know, again, from the data that, you know, if you slow the progression 10% a year, essentially, that kind of puts you back into a low risk group. So that’s always the goal I talked about with my patients. You know, we don’t have good data yet on reversal, and lowering CAC scores, there’s been some scattered reports a bit with various interventions, you know, all lifestyle focused, by the way that have shown those reversals, but you know, I don’t think it’s a reasonable expectation quite yet. I just tell my patients that our goal is to stop the progression. And if, you know, we can get, you know, a year and then two years with, you know, very little to no progression that puts you back into the low risk group. And, again, I think the way to do that is with a lifestyle intervention that’s focused on metabolic health.
Robert Lufkin MD 22:24
Yeah, so. So now metabolic health, it seems so fundamental to to heart disease, and as we’ll see later, many other diseases, what exactly is metabolic health? And what how do patients achieve this?
Philip Ovadia MD 22:39
Yeah. So you know, as with everything, you know, you have to be able to measure it, and define it, and then you can work on improving it. So the official, you know, definition of metabolic health has five parameters. And I think that these are essential numbers that every patient needs to know, you know, if they’re truly care about their health. So the first measurement is waist circumference. And, importantly, this is not your pant size. But this is, you know, the circumference of your waist, right around the level of your belly button, just take a tape measure. And if you’re a woman, your goal is for that to be under 35 inches. If you’re a man, it’s your it’s for it to be under 40 inches. And I tell people, you know, an even simpler way to go about it is you just want it to be less than half of your height. But the official measurements are 35 and 40 inches for women in that measurement. Number two is your blood pressure, and you need your top number your systolic blood pressure to be less than 130, you need your bottom number, your diastolic blood pressure to be less than 85. And that is without being on blood pressure medication. If you’re on blood pressure medication, you’ve already failed that measure. And then the the other three are all lab tests. So you have to go get a blood draw your fasting blood glucose level, and the goal there is for it to be under 100. Again, without being on any, you know, blood glucose lowering medications, and then your HDL cholesterol. For women, you want that to be above 50. For men, you want that to be above 40. And finally, your triglyceride level, you want that to be under 150. So those are the five measures of metabolic health. And more important than the numbers themselves. I think a great starting point for most people is just finding out those five pieces of information. If you you know, take the measurement of your waist go get your blood pressure protected, right your doctor or you know, at the at the grocery store and the pharmacy, there are blood pressure cuffs available these days, those little kiosks and then go get those basic blood works done to you know, find the other three numbers. That’s it A great starting point. And if anyone you know, doesn’t remember that or want some help with that, actually, I have a tool on my website, if you go to I fix hearts.co, it will take you right into the, you know, the metabolic health calculator, and it will give you your score 88% of the adults in the United States, as of the data from 2016, did not meet all five criteria of those. So the flip side of that is only 12% of the adults in the United States as of a few years ago. Were metabolically healthy. I think that should be a very scary number for everyone involved in medicine. And yet, we don’t talk about it. Most doctors don’t talk to you about metabolic health for some reason.
Robert Lufkin MD 25:49
Wow. Yes, that is a that is a dramatic number. And it underscores the importance of not not trusting normal, or not seeking normal lab values as your goal but rather seeking optimum lab values. Because if 80% of people are metabolically unhealthy, then the normal lab may even be may include some abnormal people in that range, as well, that’s really striking. What about any What about other lab tests you use to look at metabolic health for example, insulin,
Philip Ovadia MD 26:23
yeah, so I’m, I do tend to go beyond that with my patients and do an even deeper dive, the fasting insulin level, I think is a great, you know, is another lab test that’s very, you know, underutilized. And the reason that the fasting insulin is so interesting and important is that we know that the fasting insulin levels will rise up to a decade before some of these other metrics will, you know, will start to go awry. So again, we can get an early predictor, you know that you’re on your way to poor metabolic health, even though you might not be there yet, by looking at the fasting insulin level. Another marker that I think is a very good reflection on metabolic health is vitamin D levels, you know, we hear a lot about vitamin D, we hear a lot about, you know, the involvement of getting sunlight. And, you know, more recently, you know, it’s become a hot topic around COVID, because the data around COVID showed that if you had a low vitamin D level, you were at more risk from COVID. And, again, I think that just reflects for underlying metabolic health. What I see, you know, in the patients I work with both on the heart surgery side of my, you know, practice and my metabolic health practice, is that patients who are metabolically unhealthy have low vitamin D levels. And I think, you know, there’s a little bit of influence of how much sunlight you get, but it’s mostly your metabolic health that’s, you know, influencing your vitamin D levels. And that makes sense because vitamin D is actually a hormone, as we know, it’s not really a vitamin, and your body needs to, you know, synthesize, it needs to make it and metabolic health really reflects your body’s ability to, you know, carry out the functions that it’s supposed to be doing well. So processing the food you eat, building, and you know, maintaining muscle, repairing tissues, making hormones, all of this stuff is metabolic health. So it makes sense that if you’re not metabolically healthy, you’re not going to make you know, the hormones that you need in proper levels. And vitamin D, as you know, one of the key markers is that,
Robert Lufkin MD 28:39
yes, that’s such an important point that although it’s it’s it’s useful to check the five markers for metabolic syndrome, it’s possible to have to be metabolically unhealthy and still have normal markers for metabolic syndrome. In other words, a normal fasting glucose, but an abnormal fasting insulin, like you say, could predate that by 10 years and also that, that you don’t have to be obese to be metabolically unhealthy, you can be a normal way and things like vitamin D need to be checked as well.
Philip Ovadia MD 29:15
Yeah, that’s a very key, you know, point of inflammation as well as that, you know, obesity isn’t the same thing as poor metabolic health. People who are obese are more likely to be metabolically unhealthy, but there are a number of you know, there are people who are overweight and obese who are metabolically healthy. And the flip side is that there are many people who are not overweight or obese, who are metabolically unhealthy. And this is the you know, in medicine, we call them the trophies that then outside fat on the inside. But, you know, being lean does not protect you from being metabolically unhealthy and in fact, you know, there are some examples where You know, essentially the ability to get overweight, the ability to put on subcutaneous fat, you know, as opposed to visceral fat is somewhat protective against, you know, metabolic syndrome and metabolic damage. So, you know, being, you know, not being overtly overweight or obese, does not guarantee that you are metabolically healthy. And again, that’s why you need to go get these measures check.
Robert Lufkin MD 30:28
Yeah, this is such an important concept back when I went to medical school, metabolic health really wasn’t wasn’t on the radar. And instead, we focused on things like diabetes, heart disease, stroke, cancer, dementia as as the main the main diseases that we face, but now our thinking is really changed about their relationship to metabolic disease.
Philip Ovadia MD 30:57
Yeah, you know, I think it’s starting to change, you know, I think in the mainstream, we, you know, mainstream medicine still very much focuses on those diseases, and, you know, not the common, you know, root cause of those diseases, which is poor metabolic health. So, when we look at the, you know, the reasons that people die, the top 10 causes of death, or, you know, recently the 2020 data came out, and we had an 11th, you know, top cause of death, because COVID was in there. But when you look at those seven out of the 10, top 10 causes of death in the United States, and the data is much the same for, you know, the rest of the world, or, you know, seven out of the 10 causes are clearly related to poor metabolic health. So heart disease, the number one killer has been for, you know, 30 plus years is clearly related to poor metabolic health, as we discussed earlier, answer is number two, and many forms of cancer have been linked to poor metabolic health, you know, not all but many, you know, forms of cancer are related to poor metabolic health. Number three on the list this past year was COVID. And the data around COVID is very clear, you know, being metabolically unhealthy made you 90% more likely to get COVID, if you were exposed to it get sick with COVID and 90%, more likely to suffer, you know, severe complications, like being intubated or dying, you know, or, or being in the hospital from COVID. So, you know, COVID, I have been talking about for a long time, and you know, a few others have been that COVID is a pandemic of poor metabolic health. And yet, none of the public health, you know, discussion around COVID, you know, is on metabolic health, not one public official has come out and said, you know, if you get metabolically healthy, if you eat a little better, you start exercising a little bit more, you can significantly reduce your risk of COVID. And, you know, that just has not been part of the discussion. And then as you go down the list, you know, the things you mentioned, stroke, diabetes, or Alzheimer’s disease, you know, emphysema and chronic obstructive pulmonary disease, although that’s related to smoking, again, it’s also very, you know, it’s an inflammatory disease of the lungs, essentially. And it is, you know, there are some clear relations to metabolic health there, and you just keep marching down the list and you end up you know, the only ones that can’t be clearly attributed to metabolic health are basically accidents, trauma, and, and suicide. Although even suicide, I push back on a little bit, because there is data showing that mental health is related to metabolic health. And Chris Palmer, he’s the psychiatrist from Harvard, has, you know, spoken and published extensively on his experience treating, you know, severe mental health disorders, with metabolic health improvement. So, you know, get even, you know, you might be able to say that eight of the 10 clauses are related for metabolic health.
Robert Lufkin MD 34:11
Yeah, metabolic health is is truly foundational to the majority of the diseases that we face. So I’d love to hear about Aveda health and what you’re doing to help patients with metabolic with their metabolic health.
Philip Ovadia MD 34:28
Sure, so Aveda heart health is a telemedicine practice that I launched last year, and I work with people to prevent, you know, heart disease and other chronic diseases. I work with them to optimize metabolic health. So, you know, we the patients that come to me, you know, first step is kind of, you know, a little bit what we went through which is getting a very good assessment of where they’re at in terms of their metabolic health. You know, what diseases are they at risk for And then what can we start to do to improve their metabolic health. And, you know, my almost singular focus is on metabolic health. And what I tell people, you know, because the patients that come to me oftentimes come to me saying, I want to lose weight, or I want to, you know, I’m worried about heart disease, or I have heart disease, and I want to improve that. And I tried to, you know, oftentimes reframe it to, you know, you want to improve your metabolic health, and all those other things are going to be side effects of getting metabolically healthy, you are going to lose the weight, you are going to lower your risk of heart disease and other chronic diseases. But you know, we need to be focused on the proper sort of root cause issue, which is metabolic health. And so I work with patients via telemedicine, I see patients from all over the country. And we, you know, mostly use dietary and lifestyle interventions to improve their metabolic health, it achieves great success, you know, the patients are happy, you know, I oftentimes hear you know, this is the first time I’ve ever heard about this, and this is the first time that, you know, physicians have given me you know, useful interventions that I can actually stick with, and, you know, and they work, and once they work, the patients want to stick with them.
Robert Lufkin MD 36:24
So patients can can join this practice, from from really anywhere in the world, they don’t need to travel to Florida or a certain location, correct. They covered all, telemedicine,
Philip Ovadia MD 36:36
yes, I do everything via telemedicine all online. And patients can be anywhere, you know, certainly throughout the United States, and pretty much anywhere in the world at this point. And that’s one of the the miracles of technology, these.
Robert Lufkin MD 36:54
Yes, what kind of response? Have you seen in some of your patients? Yeah, so,
Philip Ovadia MD 36:59
you know, great example, I have a, he’s actually a nurse anesthetist that I started working with, you know, that a year ago, he was one of my earlier patients, and he had, you know, you know, kind of typical story, maybe, you know, kind of mid 40s, early 50s, you know, the gradual creeping weight, just, you know, not enough energy to play with his kids and, you know, get through, you know, demanding work day, and we started working on these metabolic health issues. And within four months, he was able to put on his uniform that he wore during basic training when he was 18 years old. And that was the first time in 30 years, he was able to put that on. But more importantly, you know, again, that’s, like I said, the weight loss is the side effect. More importantly, he was able to, you know, he had more energy, he couldn’t, you know, he was sharper, more focused at work, he was able to keep up with his, you know, with his son better, and he just, you know, felt much better overall. So, you know, that that’s a good example, other patients that come to me, it is not unusual that within, you know, a fairly short period of time, 30 to 60 days, we are getting them off their blood pressure medications, we are getting them off their diabetes medications. And, and then obviously, you know, a large focus of the practices on heart disease, and we’re starting to see, you know, those patients, like I talked about who had an elevated CAC score, and you know, we’re at the one year point, and their scores are staying stable, which is exactly what we’re looking for. So, you know, those are some of the common issues I deal with. And then, you know, other people come to me that they’re hesitant, you know, they’re worried about their risk of heart disease, based on sort of the traditional measurements and the discussions they’ve had with physicians, they’re a little hesitant to start statens. And so, you know, what do we do with those patients, and that’s when I do the real deep dive on heart disease with them. We do the CAC score, we do the advanced lipid testing, beyond the basic cholesterol panels, and we really talk about what are you know, what is your risk for heart disease? And our statens going to help, you know, lower that risk, maybe significantly? And sometimes the answer is yes, it makes sense. And many times the answer is no. And, you know, we focus on the metabolic health improvement, and you know, they’re they’ve significantly lower their risk for heart disease without the medications.
Robert Lufkin MD 39:50
Wow, that’s, that’s, that’s beautiful. Well in the last few minutes, as an expert in in heart disease and lifestyle modification, For metabolic disease, perhaps you could share with us what personal choices you’ve made in your own lifestyle.
Philip Ovadia MD 40:09
Sure, so, you know, I, as I mentioned, you know, after hearing Gary Todd’s talk, I went, you know, look kind of low carb, low sugar at first eliminated sugar, and then kind of got into low carb, and I went through, you know, what I would call traditional keto. And ultimately, I ended up, you know, basically sort of at the, you know, carnivore end of things, although, you know, I’m not strictly carnivore, but you know, my basic principles, my guiding principles, for, you know, the way I eat, is eat whole real food. And most of that is animal products. So, you know, and that has worked great for me, I’m now five years in, I’ve, you know, lost and maintained a weight loss of over 100 pounds. As I said, I reversed my, you know, pre diabetes. And, you know, I’m a, I’m a very low risk of heart disease, I’ve gotten to see a FICO score, which is zero, despite my elevated LDL cholesterol level. And so and it’s, you know, as I said, you know, as I’ve talked about with some of my patients, it’s the most important thing is, I’m able to keep up with my children, I’m not tired. I, you know, I maintain, you know, I’ve worked as a cardiac surgeon, I maintain my telemedicine practice, you know, just finishing up writing the book, launching a pod podcast, all of that stuff, obviously, very busy days. And I just find myself with, you know, essentially unlimited energy and truly feel better than I’ve ever felt in my life. I wear smaller pants, and shirts than I did in high school. So you know, and like I said, I maintain this effortlessly, I do not feel, you know, I don’t do the dieting thing that I feel restricted. I love the food I eat, I eat when I’m hungry, I eat until I’m full. And, you know, I really, in the end, I think, and I worry a lot less about food today than I ever did in my life. So it’s not a struggle to maintain this. And I think that’s the bottom line, when we feed our bodies, nutritious food, with the goal of keeping our bodies healthy, our bodies respond to that, you know, and as opposed to fighting our bodies, which is sort of what you know, traditional dieting does.
Robert Lufkin MD 42:44
So yeah, that’s such a powerful concept, the food choices you’ve made are not really a diet, but it’s rather a lifestyle and, and it’s not something that you’re going to do for six weeks, and then get off of it. But it’s a way
Philip Ovadia MD 42:58
of being. Yeah, exactly. And I think that’s a very important part of it is that mindset, and then the other things that play, you know, come into play exercise, you know, stress reduction, you know, getting out in the sun, those types of things are all important as well, but I think die. Yeah, I think what you eat is the primary determinant of metabolic health. And, you know, so that’s probably 90% of it. In terms of exercise, you know, my goal again, and you look at the data around longevity, you know, the number one predictor of living a long and living a healthy long life is maintaining muscle mass as we age. So I am very big fan of resistance exercises. I am also very time constrained. So I’m a fan of efficient resistance exercises. And so for me, you know, I end up doing three to four sessions a week, about 20 minutes, I use, like a resistance band setup. And, you know, my goal there is to, you know, maintain my muscle mass as I age. And I think the data supports that, you know, that’s a very good predictor of both, you know, quantity of life, but I think more important is quality of life. You know, again, I think most people don’t want to necessarily live longer if they’re not going to be healthy for you know, a major, you know, portion towards the end of their life. And I think building muscles the way to both live longer and have a higher quality of life, you know, during those, you know, ending years. Yeah, it’s
Robert Lufkin MD 44:42
it’s nice to be able to actually pick up your grandchildren and lift them up. Yeah, exactly. As far as your nutrition, do you practice any sort of time restricted feeding or intermittent fasting? Any of those strategies?
Philip Ovadia MD 44:56
Yeah, so I am a big fan of intermittent fasting all Again, I don’t really do it intentionally, you know, just because of the way I eat. Because I eat such nutritionally dense foods, I’m just not hungry that often. So I end up eating, you know, usually twice a day. And it’s usually within about probably a six hour window or so. So it ends up being sort of an 18, six intermittent fasting. But again, when I start working with my patients, you know, I don’t tell them, you know, you should intermittent fast, you know, 16, eight, or 18, six, or 24, whatever it is, I tell them, you know, eat whole real food that’s nutritionally dense. And over time, you’re just going to be hungry a lot less often. So you’ll start fasting. And, you know, so I think fasting is a very useful tool, but I I usually not the first tool, you know, the third goal is making sure you’re eating the right foods, and then you’re just naturally going to eat them less often. So another one of my guiding principles is, you know, eat in a way that makes you hungry less often. And so that that works out well, for me.
Robert Lufkin MD 46:10
That’s a great concept. So how can people follow you Phil on social media and see what you’re doing? They want to do want to know about the upcoming podcast as well as the book coming in November?
Philip Ovadia MD 46:23
Yeah, sure thing. So most active on Twitter. I fix hearts there at I fix hearts. And then like I said, you can go to AI fix hearts.co. And that will take you to my it will take you to the metabolic health quiz. First and foremost, determine if you’re metabolically healthy. And from there, you can sign up to be on my newsletter, you can get the information about joining my practice. But the most important thing that I want people to do is figure out if you’re metabolically healthy or not. So I fixed hearts dot CEO, figure out if you’re metabolically healthy, and take it from there.
Robert Lufkin MD 47:01
Thank you so much, Phil, for spending an hour with us and sharing your knowledge about the great work. Great work you do.
Philip Ovadia MD 47:10
Yeah, Adam, thank you for putting this together. I think, you know, this seminar series is going to be a great asset to people. So thank you for pulling this all together to get this done.
Robert Lufkin MD 47:22
Great. Well, we’re definitely going to stay in touch and can’t wait to see the book and the podcast and all the other great things you’re doing. All right. Thank you.
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