Introduction Of Podcast
Dr. Philip Ovadia is a heart surgeon and has gone through an incredible journey from being obese to being metabolically fit. In this episode, Mohit & Dr. Ovadia talk about how heart health is related to metabolism and how overlooking this aspect can lead to metabolic disorders. Dr. Ovadia also shares his view on diet fads and what role does it eventually play in your metabolic health. Jump right in.
Timestamps
(00:00 – 01:24) – Introduction
(02:12 – 06:02) – Dr. Ovadia’s Journey
(07:35 – 09:50) – How Dr. Ovadia Busts Dietary Myths
(12:09 – 15:45) – Ultrahuman’a Role In Prevention of Metabolic Diseases
(16:26 – 20:34) – Relation of Heart Health and Metabolism
(23:19 – 26:45) – Which Diet Is Metabolically Healthy?
(29:02 – 31:46) – Top 5 Health Advice For People
(32:10 – 34:51) – Positive Effects of CGM
Key Takeaways – Transcripts
Intro (Mohit): When you talk and think about doctors, specialists and medicine experts, you have an assumption that most of them, given their access to knowledge, would have it easy health-wise. But that wasn’t the case with today’s guest who happens to be a cardiac surgeon. Today we have with us Dr. Philip Ovadia, who himself dealt with obesity at the age of 40. Dr. Ovadia subsequently lost more than 100 pounds. In the coming months, he realized that what helped him lose over 100 lbs was the same solution that could have prevented most of thousands of open heart surgeries that he had performed – metabolic health. With Dr. Philip Ovadia, I discussed his life’s journey and what brought him to embark on this transformation. He also discussed his views on preventive medicine and how it actually is better than reversal, which Dr. Ovadia himself had to go through. We deep dive further and discuss what’s the relation between heart health and metabolism and how both are interrelated. We also talk about one of the hottest subjects that is restrictive diet based approach versus a flexible biomarker based approach. Which of the two are credible and sustainable in the longer run. Dr. Ovadia then shares his views on health monitoring devices such as the CGM, like the Ultrahuman Cyborg, and what the future holds for everyone using it. Without further ado, let’s get to it.
Question (Mohit): Welcome Dr. Philip. Great to have you here. I’ve really been looking forward to this conversation. One of the things that struck me was basically the fact that right now when we think about the world of healthcare, there’s sort of like two different streams altogether, right? There is this mainstream healthcare and then there is what do you call, let’s say the new era of biohackers and you sort of like basically fall somewhere in between, right? You’re sort of like carrying the new wave of information for people and telling them that you can actually reverse or get to a better stage of your health via lifestyle and without medication. So that really intrigued me and I would love to first actually thank you for being here and also would love to understand what was the journey that led you here.
Answer (Philip): Sure thing. And it’s great to be here. I’m really a big fan of what you and your team are doing and putting the power back in the hands of the individuals to take control of their health. I think that really is the future of health care. My personal and professional journey certainly overlap and have come together to get me where I am today. So I am a heart surgeon and I’ve been in practice as a heart surgeon now for 20 years. And during that time I’ve taken care of over 3000 people with heart disease and I thought I knew what caused heart disease and what we could be doing to prevent it and why so many people were getting heart disease. But during much of that time, during the first 10 to 15 years of my career, I myself was becoming progressively unhealthy. I was morbidly overweight. I had developed type two pre-diabetes on the verge of type two diabetes. And that was despite the fact that I was following the advice that I was giving my patients and that I had learned in school, eat less, move more, eat according to the US Dietary Guidelines, the food pyramid. And it clearly wasn’t working for me. And over and over, I saw it not working for my patients. And thankfully, about six or seven years ago, I started to come across some alternative ideas about why we get unhealthy, why we get obese. I was fortunate to hear a talk by Gary Tobbs, who is the author of Why We Get Fat and Good Calories, Bad Calories. And when I heard him talk, it really kind of resonated with me. And it was the first time I heard these concepts that the types of food that we eat are more important than the amount of food that we eat, and that the types of food that we eat are going to influence the amount of food that we eat. And after reading Gary’s books, I started eliminating sugar and ultimately carbohydrates and processed food from my diet. I ultimately was able to lose over a 100 pounds. I have now maintained that weight loss for four plus years. And more importantly, I came to realize, you know, what we have gotten wrong in the health care system, what we have gotten wrong about health, how the advice that we’ve been giving our patients has been wrong. And I have now refocused my career on helping people to prevent the need for heart surgery and to stay off of my operating table. Although I continue to work as a heart surgeon, and I feel blessed every day to be able to help people who need that service, I realize that every patient I operate on as a heart surgeon is basically a failure of the medical system, and that we have failed those people by not educating them properly on what is going to keep them healthy. And I believe that heart disease in the vast majority of cases, is preventable. And as we’ll talk about as we go along, I think there are some simple strategies that people can implement in their lives that are going to help them to prevent getting not only heart disease, but most of the chronic diseases that are plaguing our society today.
Question (Mohit): Wow. While we were speaking, the entire history of the medical field played around in my head saying, that all the way from the Ancel Keys’ hypothesis around dietary fat, right? Exactly. It’s amazing. That how early the field still is. You’re talking about good calories and bad calories. And I think beyond calories restriction of any type, what I see around generally is the fact that people still believe, and especially in developing countries like India, for example, people still believe in the fact that saturated fats are bad because saturated fats are what lead to health issues around, especially heart issues and so called, let’s say you can say healthy oil companies. I’m marketing seed oils or processed oils as heart-healthy and sort of like pushing out the saturated oils out from the market. So what you just spoke about is still very modern to some extent for the medical industry. You’re talking about calorie restriction and evolving that to basically looking at other factors like the glucose load on the body and everything else. But I just wanted to understand from your perspective, when you see somebody like a patient walk in and they must have almost met everybody and anybody who have told them about the Ancel Keys hypothesis, or you should be consuming less accurate fat and you’re going to the standard American diet, how do you actually start explaining them that this is all wrong? And where do you start?
Answer (Philip): Well, a lot of times I think they kind of realize it themselves because they ask, why am I here? They say, I took my medicines, I ate my low fat diet, and yet I’m here in front of you needing heart surgery. Why am I here? And that’s when I explained to them that you’re here because we got it wrong. We meaning the health care system, we meaning the governmental advice about what to eat. And the food industry has led us all down a path where today the statistics show that in the United States, and they’re very similar for many developed countries in the world, 88% of the adults in the United States are not metabolically healthy. We have skyrocketing rates of diabetes, obesity, cancer, heart disease, all of these things. And again, we see this as a worldwide phenomena. It’s certainly not unique to the United States. So I think it’s time that we step back and say, we must have gotten something wrong. We can maybe still argue about what it is exactly. Is it the sugar? Is it the seed oils? Is it the processed carbohydrates? Or is it just the combination of all of them? But we must have gotten something wrong to get to this point because there’s no way that you can believe that we are supposed to be this unhealthy. And yet it’s widely accepted by the medical industry that this is normal. And when you go and see your doctor, typical visit with your doctor, they’re going to say you have all these conditions, you have high blood pressure, you have diabetes, and the only thing you can do about it is just take these medications. And this is just something that happens as you get older and be a little bit more careful about what you eat and maybe try and exercise a little bit more. But they really don’t think about this shouldn’t be normal and we shouldn’t be expecting people to become unhealthy as they get older.
Question (Mohit): Yeah, well, this is a huge problem and sort of like a needle in a haystack problem for a lot of people getting a lot of conflicting nutritional advice all around. So this is healthy. Eating fruits is healthy. I can give you an example from our side. A lot of people who start wearing a glucose monitor for the first time in their life, there are two big surprises for them. One is the fact that basically eating fruits the way they are, the way that we are consuming our fruit juice, which is sort of like fruit removed from all their fibers, is not healthy, it’s just sugar, right? And there is this notion in the head that if it comes from natural source, it should be healthy, right? And that’s why it’s marketed as well. Like the fruit juice companies will write, oh, this is healthy for you, this has vitamins. And similarly home cooked food, for example, in India and in some Asian countries as well, we are very carb heavy, right? We don’t have enough proteins and fibers in our diets, especially proteins. And what you’ve seen is that home food is almost always considered healthy. So when people consume rice and pulses together or a combination of carbs, it gives them like a mega spike and keeps them above a certain healthy glucose zone. Essentially. It’s a surprise for a lot of people. So when you say 88% of people are metabolically unhealthy, it’s not a surprise to me anymore because when we started building this, we thought that this doesn’t seem right because almost 100% of the world, it’s almost straight towards 100% of the world being metabolically healthy. But now seems like there’s a mega reason why the medical industry and the food industry have been missing some of these links between themselves. That what’s healthy and what’s not. And what’s getting communicated is not right. So that way it’s a little unfortunate today when you talk about cure tip. Yes, people have a problem and then they come to people like yourself and then they can change their mind. But it’s preventative when people don’t have a problem and when they are slowly turning towards a problem in the body. They might as well listen to all the crazy marketing done by the food companies versus somebody who’s talking sane so that’s a huge problem. So, what are some of the things that companies like us can do in this space? Like basically on the preventive side, we are trying to make people believe in the power of glucose monitors, but then we believe that we will eventually hit a ceiling with the preventive population because today they don’t see a problem yet in their body. So what would your advice be?
Answer (Philip): Yeah, well, I think what Ultrahuman is doing is going to be so insightful because it does give that immediate feedback. You eat the food and you see the response. Whereas as we go through our daily life and we’re eating these foods and they’re not harming us right, away in any way that we can see. It’s only years later that you develop the diabetes and the heart disease and the cancers that go along with poor metabolic health, but by then it’s too late. And because we’re not looking at the right things early enough, we don’t see these things. So I think getting that immediate feedback from a tool like a CGM is so powerful. I think doctors having an eye towards preventative health and looking at metrics that can actually predict future problems is another key change that we need to normalize. For instance, I check fasting insulin levels on all my patients. I check the breakdown of the size of their cholesterol particles, what’s called the NMR panel, and you can get insights from that as to future risk of disease. And I educate patients on what that means and what they should be doing to improve these measures. But both of those things that I just mentioned, the insulin and the NMR panel, are not standard. Most doctors don’t check them, don’t know what they mean, don’t know how to interpret them, and they’re just looking at these markers that only become bad late in the process, the fasting blood glucose. And even then, when it does become bad, they still don’t know what to do about it. They just know to write medications. And just to be clear, I’m not blaming the doctors. The doctors are trapped within the system. The doctors are educated a certain way. They don’t know. I admit that I didn’t know for many years. For the first part of my career, I didn’t know any different, and I was just the same. And it was only when I had my eyes open because of my personal health problems that I was able to figure this out and see what should have been obvious all along, because it really does make a lot of sense. And none of this is really all that new. You mentioned about modern and modernizing, and it’s really not a matter of modernizing. It’s a matter of rediscovering what we forgot or what was intentionally suppressed. But this information about metabolic disease goes back 100 years. We find reports from the late 1800s, so almost 150 years ago now that the way to treat obesity was to cut carbohydrate intake. And these things were known. They just got pushed aside or forgotten.
Question (Mohit): That is fascinating because I think you mentioned the size of cholesterol particles. And when we speak to labs all around and what we figure out is that it’s not that it’s more expensive to capture this information. So it’s the same amount of money that you need to pay to actually get this information. It’s just that this awareness that your lower, essentially your smaller cholesterol particles are different from your larger ones, that understanding or awareness essentially isn’t actually there. And on that, I would love to actually deep dive a little bit more on like they’re talking about being metabolically healthy or metabolic health. And then there is this cardiovascular correlation to it, right? Or basically heart health correlation to it. So how are these two related? Because in general, understanding for people, metabolism is essentially about energy. It’s about ability to metabolize food, et cetera. How does that really lead to or essentially connect with your cardiovascular health?
Answer (Philip): Yeah, so the link between metabolic health and cardiovascular health has been well established and is quite strong. And when we look at the studies that actually directly compare poor metabolic health, which is usually measured as insulin resistance, versus the traditional sort of risk factors for heart disease, mainly LDL cholesterol, we consistently see that insulin resistance is a much more powerful predictor of the risk of heart disease than elevation in your LDL cholesterol level. And I’ve been looking for a single study that shows the opposite, that LDL cholesterol is more predictive than a metabolic health measure. And I have been unable to find it. But consistently, for instance, about a year ago, the Large Women’s Health Initiative study showed that the cardiovascular risk associated with insulin resistance was about six times the risk that was associated with an elevated LDL cholesterol level. So that part of it I don’t really think is debatable by anyone who understands the science. It’s just a matter of we don’t really know how to it’s not widely known within the medical system how to improve metabolic health. Metabolic disease syndrome, x, insulin resistance, whatever you end up calling it, these things are all pretty similar directly leads to cardiovascular disease in a number of different ways. I would say probably the most important ways are the inflammation that goes along with metabolic disease and insulin resistance. And this leads to inflammation in the blood vessels. This leads to damage of the blood vessel walls. And that is what ultimately starts the process of atherosclerosis and plaque buildup within the vessels that then leads to the blockages that lead to heart disease. We also know that insulin resistance and the metabolic syndrome change the types of lipid particles that are within our bloodstream. As you mentioned before, as we become more insulin resistant and more metabolically unhealthy, we get more of the small, dense cholesterol particles that are prone to forming atherosclerotic plaques as opposed to the healthier, large, fluffy cholesterol particles. So that’s just actually two of the ways. There are about seven or eight other ways that metabolic disease and insulin resistance has been tied to cardiovascular health. But there’s clearly a very tight relationship between the two. And, you know, one of the things, again, when you go back in the literature before we became so obsessed with cholesterol and LDL cholesterol, and when you read the studies about heart disease from the 1970s and 80s, they show that almost every patient with heart disease has some degree of insulin resistance and some degree of metabolic disease. And you cannot say the same about cholesterol and heart disease. So that’s why I choose to focus so much on metabolic health and why I think focusing on metabolic health is the key to preventing heart disease as well as the other chronic diseases that result from poor metabolic health.
Question (Mohit): Got it. So it’s sort of like the core of why inflammation actually happens in the body, right? And while LDL, you can say, is at the crime spot to some extent, somebody who’s accidentally there might not only be the reason why the problem is actually happening, it might be a combination of your elevated insulin levels leading to inflammation of your blood vessels and leading to atherosclerosis eventually, right? That is extremely new. Like, if I would recollect just five to six years back, even ten years back, this wasn’t very common in terms of knowledge to a lot of people. And it’s surprising that some of this knowledge actually takes a lot of time to percolate in the system, even though, like, as you mentioned, you have to find a study which basically says that only cholesterol is independently responsible for heart health and not insulin resistance. So I think that’s one way to actually think about this space as well, that anything that is, unless we create something that is extremely marketable and essentially is backed by what you’re saying, essentially is rediscovered research in some ways as a combination of both, it’s very hard to scale it to different geographies like we’re talking about every day when we look at different new geographies. There are parts of Latin America that we were looking at where there is actually first of all, we are talking about ten years from now, which is basically like doctors and companies there, and people there not being even aware that sugar is bad for them. Or basically what they’re aware right now is that white sugar is bad, but brown sugar is okay. So I think this is really interesting when people realize that it spikes at insulin levels equally, whether you consume white sugar or brown sugar or whatever sugar you’re going to consume, whether it’s coming from fruits or coming from essentially your processed sources as well, there might be some micronutrient differences, but it’s probably the same. But that also brings us to another. So we spoke about the medical industry. We spoke about the food industry, sort of like working in conjunction there and how these two need to essentially change for the betterment of people all around. But then there is just like the medical industry, there’s this mega divide between people when they think about different types of diets in their head as well. And I must admit that it’s been really confusing for me as well sometimes, and that’s why I chose to just believe in the biomarker instead of any sort of diet. So there is this carnivore diet, there is a vegan diet, and basically there are specialized versions like paleo, keto, et cetera. So from that perspective, what seems to be the right approach. Because what I found really interesting is that in your book, Stay Off My Operating Table, you mention that both of them could actually be metabolically healthy. So that’s really new to me because most people in this space take one side. How do you see that?
Answer (Philip): Yeah, and I think it’s kind of unfortunate that we’ve gotten into these sort of diet wars and on social media, the vegans are fighting with the carnivores. And in the end, when you’re looking at a diet, at a way of eating, you have to realize that there’s always two components to it. There is what you’re eating and there’s what you’re not eating. And oftentimes in our current food environment, what you’re not eating is kind of the more important part because so much of the food that’s around us is this highly processed food that contains the highly processed carbohydrates, the sugar in all its different forms, and the vegetable and seed oils that are inflammatory and damaging to our metabolism. And so when you cut that out, what you’re left with, and what I talk about in the book is just eat whole, real food. And the breakdown between how much of that is going to be plant matter and how much of that is going to be animal matter, I think is really up to individual preference. I think there are some things you need to pay attention to. You need to make sure that you’re getting enough protein because that is vital for optimal health. And you need to make sure you’re getting the array of kind of micronutrients and vitamins and minerals that you need. And the vegan diet poses some challenges on that front. I don’t like to say the vegan diet because the vegan diet can be very unhealthy because there are a lot of processed vegan foods. So I usually go with a plant based diet versus an animal based diet. And I think you can mix them as well in various sort of combinations. And I think the key for each individual is to figure out what’s going to work best for them. Because another simple reality is that there isn’t one right diet for everyone. I think there is a framework that we should be working within. And within that framework, each one of us should find what’s going to work best for us and also realize that that is going to change over time. I just think back over the past six years or so that I’ve been on this journey, and what I eat has gone through that evolution. And the majority of it the past three and a half years, I’ve been largely carnivore, and I eat mostly animal based products. But again, I don’t think that’s the only way to do it. And when I work with my patients, I truly do work with vegans and carnivores and lots of things in between. And we figure out what is working best for that person, and we set up a framework that is going to be sustainable over the long term for them.
Question (Mohit): It’s an interesting one personally as well. What I’ve felt is that for a good quality of life where I can meet people, socialize with them, essentially have a little bit more flexibility. Sticking to a diet is extremely hard, even if it works for me. For example, I stayed on a complete vegan diet and I enjoyed it as well. It was great. It’s amazing. I was on a non-processed vegan diet overall and it was a diet. But the problem was that certain point in time, beyond five years, it got really hard to manage it logistically. Plus I was completely antisocial for some time. Like I can’t meet anybody and everybody around myself. And I realized that having little bit of food flexibility is actually okay, it’s not bad, it does not affect my health in a bad way. So why build these silos and boundaries? Unless there are some ethical concerns that people are talking about, which is debatable. But then purely from a food perspective, like as you mentioned, you mentioned this is the right way, that it’s really unfortunate that people have to be in one camp, whereas they could be quite flexible in terms of not building a diet but a strategy for themselves. Because what people ignore mostly is that what they can’t do something for 20 years, they might as well not do it. Because from a food perspective, changes compound over a period of time. You can change your body for three months by going on a different diet, but then you can also unchange ir by getting off that diet. You’ll probably spend more time unchanging it or basically being in the flexible zone instead of being in the strict zone for most parts of our life, the strictest heart. So that’s an interesting way because that essentially makes it more available to your preventive population, people who don’t have a problem as well. Because when I have a problem in my body, I’ll probably commit to it. I’ll probably go for the best possible solution for myself and in a precise way when I don’t have a problem or we haven’t discovered a problem essentially in my body, I might as well prioritize the quality of my life over everything else. Anything that you would want to add to this? Basically in terms of there is this food strategies that you spoke about that people should look at non processed, nutrient dense foods, get proteins and micronutrients. But when you look at an individual, like by definition of medical healthcare, a healthy individual today, but sort of like facing general problems around their health, like inability to lose weight or sometimes energy levels, etc. What would be the top five things that you might actually tell them today?
Answer (Philip): Yeah. So again, I think it’s important that people are focused on actual metrics of health and all too often we’re focused on the wrong things. We’re focused on our weight in and of itself. And the reality is that you can be what’s considered a normal weight and still be very unhealthy and very metabolically unhealthy. I end up doing heart surgery on a lot of people who aren’t overweight or obese, and they end up being some of the most confused people as to why they are there. So you need to be focused on the metrics of your health. So there are five basic measures of metabolic health that we use. There’s your waist circumference, there’s your blood pressure, there’s your fasting blood glucose level, there’s your HDL cholesterol, the so called good cholesterol level, and there’s your triglycerides. And I try to educate people to focus on those five numbers, first and foremost. And that way you don’t get trapped into a diet, a short term diet, that you lose a lot of weight, but those measures aren’t getting better, and in some cases, they’re even getting worse. And that ultimately, is not going to serve you over the long run. Ultimately, in the book, I lay out like seven principles of metabolic health, and a couple of them we’ve sort of touched on. But eating whole real food is first and foremost, viewing your health as a system, not as a goal. So again, not focused on the short term goals of just losing weight. You want to be looking at the overall picture. And you want to figure out a system that is going to support your health and then finding a partner. A practitioner. Whether it’s a doctor. A nutritionist. A dietitian. A health coach. Whoever it is that’s going to be helping you on this journey. Make sure that they understand this as well. Because unfortunately. Many of them don’t. And they are going to just lead you down that same wrong path that the system has been leading us down for such a long time now.
Question (Mohit): It’s amazing that it almost seems like the next revolution will be consumer led revolution right in this space, which is people taking and you started by saying this, that people taking control of their own health in their own hands. So that’s going to be really interesting. You mentioned the waist circumference, blood pressure, fasting insulin, HDL, triglycerides. How does managing healthy glucose levels via a continuous glucose monitor fit into this equation? And speaking more from a Cybirg perspective, by the way, have you been on the platform yet?
Answer (Philip): Yes, I’ve looked at your platform, and I’m a frequent user of continuous glucose monitors. I use them with all of my patients here in the United States. You guys, unfortunately, aren’t available yet, but I know you’re working on it. But I think the continuous glucose monitor is an important step forward because one of the other problems we have is that if you just go to your doctor once a year and get your glucose level checked, it’s really not that informative and you don’t know. What’s happening to your glucose the other 99.999% of the time. So having a continuous glucose monitor, I think, is so, such an important tool. And putting that information in the hands of people so that they can get that immediate feedback, like I said, on the things that they’re eating is so essential. And the other reason that I think they use fasting blood glucose as the metric in the metabolic health system scoring system, but the reality is that I don’t even think that that’s a very good measure because it’s so late in the game that that becomes abnormal. But much earlier in the game, you can start to see those abnormal glucose responses where your sugar goes sky high and then it dies down, and then you’re kind of going up and down all day. And again, that’s part of what contributes to us being hungry all of the time. So, again, you can see that with the continuous glucose monitor, and you’re going to miss it if all you’re doing is checking your blood glucose once a year at the doctor’s office. And I’m a big believer in giving people tools and educating people. One of the things I always tell people is that I’m not going to make you healthy, you’re going to make yourself healthy. My job is just to guide you and educate you. And that’s what a physician should be. We’re here to educate people. We’re here to guide people. We’re not here to tell them what to do. And we are not the ones that should be fixing their problems. They need to be involved in their health. They need to be invested in their health, and they need to be curious enough to say, how do I fix this problem that I have?
(Mohit): It’s really novel and inspiring, Dr. Philip. And I really appreciate this perspective of yours. It stems from the book that you wrote to some extent. Like, I read some components of it, and I’m going to finish it very soon, saying that essentially I’m not here to give you something that you don’t need. And it’s a really interesting and fascinating perspective in the space, and I really appreciate you making time here. It’s been such a pleasure. And what I would love to do, apart from this podcast and this conversation, is, of course, we’re launching in US, so we’d love to give you access to the platform when we’re there finally. And at the same time, we’d love to engage and figure out if there are any long term synergies to explore as well, given that there is a lot of alignment in terms of our mission and we are sort of like the platform and we could really benefit from the awareness that you’re creating for people around you. So that would be two action items from our end.
(Philip): Definitely. I look forward to working with your company and helping further the mission that we’re all on, which is to help people to take control of their health and to get more healthy. All right.
(Mohit): Thank you, Dr. Philip.
(Philip): Thank you.
Outro (Mohit): Dr. Ovadia’s journey is extremely intriguing, isn’t it? The most critical message that we can take from his life’s journey is that it is never too late to take corrective measures and adopt a healthy lifestyle. Along with being inspired, I also hope this episode was informative, specially since this account is from the length of a cardiac surgeon. I hope you were able to take back insightful tidbits and you’re looking forward to implementing them in your day life. As always, please share this podcast with your loved ones and show us some love on social media by tagging us @UltrahumanHQ. I’ll see you soon in the next episode.
