Stay off my operating table (Philip Ovadia & Casey Means)

Dr. Philip Ovadia is a board-certified cardiac surgeon, the founder of Ovadia Heart Health, and the author of “Stay Off My Operating Table.” He also used to be morbidly obese. Things finally clicked when he stopped focusing on special diets and exercise routines and started focusing on metabolic health. Now, he’s turned it into the focus of his career. In this episode, Levels’ Chief Medical Officer, Dr. Casey Means, sat down with Dr. Ovadia to discuss the key factors that lead to poor metabolic health.

Medicine will not fix metabolic health

The only thing that can improve metabolic health is making healthy life decisions.

When I say in the book that medicines are never going to fix your health problems, realize that we’re referring specifically to metabolic health diseases. And those are most of the chronic diseases that we face, things like type 2 diabetes, heart disease, many forms of cancer. And medications in that situation are only trying to minimize the effects of these diseases, they are not undoing the root cause of that disease, and therefore, they don’t actually treat the disease itself, they only help to minimize the end effects of that disease. And I think that that is largely the wrong approach. We know that these metabolic diseases are almost exclusively related to our diet and our lifestyle. And therefore, those are the things we need to focus on if we want to have a meaningful impact in terms of reversing these diseases once they occur, or preventing these diseases from occurring in the first place, which is really the best approach.

The benefit of continuous glucose monitors

CGMs are a fantastic benchmark to kickstart anyone’s metabolic journey. The problem is that they are not widely available.

I think continuous glucose monitors are a great kind of example of what’s wrong with healthcare. The fact that they are not more readily available and not more widely utilized in medicine, I think is very emblematic of the problems we have. So, I use continuous glucose monitors in a number of ways. For the patients who are coming to my practice and they don’t know much about metabolic health, they have not focused on metabolic health beforehand, it is a great introduction to what is metabolic health. It gives them the real-time feedback of I eat a certain food or I do certain activities, and I can see a number, a response to that, that will help me guide whether that might be something that I want to incorporate more of in my life or want to incorporate less of in my life, as I try and get healthy. For other patients who are kind of into their metabolic health journey and understand some of the basics, it can really be used effectively to fine-tune the foods that they’re eating and other things like stress and exercise and all of that.

Why are CGMs not in hospitals?

Dr. Ovadia is mystified by the fact that CGMs are not even prevalent in hospital settings, where it’s been proven they would do a world of good.

Continuous glucose monitors are not approved for use in hospitals, which is kind of interesting. We know in cardiac surgery we have unbelievably good data on this, that the better you control a patient’s blood sugar around the time of surgery, the better the outcomes of the surgery are. Things like infection and just overall outcomes have been dramatically improved. It’s probably one of the biggest developments in the management of heart surgery patients over the past 20 years is that realization. And yet, we don’t continuously monitor the patient’s blood sugar in the hospital. Every hour the nurse is actually drawing off some blood from the patient and putting it into the machine and checking the blood sugar. It’s one of those things I look at that I think is crazy, that I can have a patient walking around outside the hospital that continuously knows their blood sugar, but I can’t have a patient inside the hospital continuously know their blood sugar, when we know it is so important to their outcomes.

Eat whole foods

If you do nothing else, Dr. Ovadia recommends prioritizing whole foods. Even the food in hospitals is not ideal for a healthy metabolic diet.

Ideally, I would love to see hospitals serving whole real food. Just like I talk about in my book, I think it’s the biggest concept around metabolic health is that if we just ate more whole real food and eliminated the processed foods, all of our health would improve. And I think that should be done in the hospital and out of the hospital. From a practical standpoint, I no longer eat in the hospital. I literally, if the choice is between eating in the hospital or fasting, I’m going to fast until I get out of the hospital and can get some good food to eat. It is very rare that I can find what I consider to be whole real food in the hospital.

It’s time to talk about what we eat

The time is long overdue for diet and metabolism to take a front-row seat in the healthcare conversation.

When 88% of the adults in the United States are metabolically unhealthy, we obviously are doing something wrong. And we can start to argue about what that might be and maybe the nuance of how to fix it, but when we start to look at diet, which is obviously a major impact on our health, we at least need to start admitting that as the healthcare system. Like right now, most people when they go to their doctor, their doctors do not talk to them about what they eat. And if we could just start that conversation, if we could just acknowledge about what we eat being the primary influence on our health, maybe we can start to move forward.

Take one step at a time

If you try to tackle everything at once (food, exercise, sleep, and stress) you’ll set yourself up for failure, and you also won’t know what’s making the biggest impact.

If you go to the average person who is not metabolically healthy and you say, “Okay, tomorrow we’re changing the way you eat and we’re changing your exercise and we’re looking at your sleep and your stress, and trying to do all this at once,” it just becomes overwhelming. So what I have found to be most successful with people is focus on one thing at a time, change one thing at a time. And what I usually find happens is that then becomes kind of self-reinforcing. I will talk to people about how to eat better and eat whole real food, and they’ll start to do that. And then all of a sudden, the person who never felt like exercising before, now will want to start exercising. As opposed to if I say, “Go exercise and change the way you eat,” that oftentimes is too much and they don’t have success at either. And the other reason I think it’s important to focus on one change at a time is so that you can know what’s working and what’s not working. If you change a bunch of things at a time and you have success, you don’t really know which of those things was important for the success and maybe which ones weren’t necessarily useful.

Substitute, don’t eliminate

There are ways to make the foods you love healthier so that you don’t feel deprived.

I also talk about substituting instead of eliminating. So if there is something that you like, that you enjoy eating, that maybe doesn’t fit within your dietary strategy, it’s a processed version of something, find a way to make it in a more healthy manner. There are all sorts of diet websites out there, all sorts of recipe books out there that you can pretty much make anything, a whole real food version of just about anything that’s out there. And oh, by the way, it usually tastes better and is more nutritious, and is going to support your health. The only reason we tend to get the processed versions of all these things is because they’re easy and cheap. And ultimately, that’s not serving our health.

Read your food labels

If a label has more than several ingredients or he doesn’t recognize them, Dr. Ovadia won’t eat it.

For the most part, your food shouldn’t require an ingredient label, because you should be able to look at it and know what’s in it. It should be one ingredient or a couple of simple ingredients that have been combined, and you can still recognize what’s in it. But if it has more than three ingredients on a list and those aren’t all each whole real food, don’t eat it. And the final kind of tip I give people is, if your grandparents or great grandparents, depending on how old you are, didn’t eat it, you shouldn’t be eating it. If it wasn’t in our food supply 100 years ago, it is probably not something that we should be eating now.

Don’t rely on exercise alone

Working out 1x per day won’t make a huge dent in metabolic health if you are sedentary for the rest of the day.

When you look at the literature around weight loss and exercise, it is clear that exercise alone is not an effective weight loss tool. And the old adage that you can’t out exercise a bad diet is very much true. Is exercise helpful? Yes. Does it have utility and do I encourage people to be more active? Yes, I certainly do. But the two problems I see are what you just mentioned. If you go to the gym and you do whatever exercise you like, whether it’s cardio, weightlifting, whatever it is, for let’s say an hour a day, and then you spend the rest of your day sitting around not being active, ultimately, that is not going to be a net benefit. So I would rather people incorporate movements throughout their day, then do the dedicated exercise sessions. You can do both even better, but I think it’s more important to just be more active throughout the day.

Pay attention to the metrics of metabolic health

When metabolic fitness is your guide, you will be the healthiest version of yourself.

Your measuring stick needs to be your metabolic health. So this gets back to the intentionality, the paying attention to the metrics that we are using for our metabolic health. Using something like a CGM can be a great tool for helping someone figure out the nuance of, I should or shouldn’t be eating this food, or I can eat a certain amount of this food before it becomes metabolically problematic for me. Like you and the same that, I am very obviously predisposed to metabolic disease, I cannot tolerate a lot of carbohydrates, but I can tolerate more carbohydrates today than I could three years ago, when I was kind of in the early stages of this journey. And so, again, I think paying attention to these metrics, to the metabolic health measurements, are what should guide us ultimately about what we should and shouldn’t be eating.

Dr. Philip Ovadia:

When 88% of adults in the United States are metabolically unhealthy, we obviously are doing something wrong. And we can start to argue about what that might be and maybe the nuance of how to fix it, but when we start to look at diet, which is obviously a major impact on our health, we at least need to start admitting that as the healthcare system, most people when they go to their doctor, their doctors do not talk to them about what they eat. And if we could just start that conversation, if we could just acknowledge about what we eat being the primary influence on our health, maybe we can start to move forward.

Ben Grynol:

I’m Ben Grynol, part of the early startup team here at Levels. We’re building tech that helps people to understand their metabolic health, and this is your front row seat to everything we do. This is A Whole New Level. When thinking about metabolic health, one of the biggest things to address is the root of the problem. Going so far upstream that you really identify what are the key factors, the key inputs, that lead to poor metabolic health. Well, if you can address those, then you really get to the core foundation of optimizing healthspan and lifespan.

Ben Grynol:

And so, in this episode, Dr. Casey Means, Chief Medical Officer and Co-founder of Levels, she sat down with Dr. Philip Ovadia, author of Stay Off My Operating Table. They did a deep dive on everything pertaining to his new book coming out in early November, and everything pertaining to metabolic health. So, no need to wait, here’s Casey with the intro.

Dr. Casey Means:

Hey there, everyone, this is Casey Means, the Co-founder and Chief Medical Officer of Levels. I am so excited to introduce Dr. Philip Ovadia for A Whole New Level today. Dr. Ovadia is 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. As a heart surgeon who used to be morbidly obese, Dr. Ovadia has seen first-hand the failures of mainstream diets and medicine. He realized that what helped him lose over 100 pounds was the same solution that could have prevented most of the thousands of open-heart surgeries he has performed, and that thing is improving metabolic health.

Dr. Casey Means:

Dr. Ovadia grew up in New York and graduated from Penn State University in Jefferson Medical College. He did his residency in general surgery, followed by a fellowship in cardiothoracic surgery at Tufts-New England Medical School. In his new 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 the complete metabolic health system to prevent disease, and we are going to be talking all about it today on the episode. Welcome to A Whole New Level, Dr. Ovadia.

Dr. Philip Ovadia:

Thanks, Casey. So great to be here with you.

Dr. Casey Means:

So, you are a practicing heart surgeon doing massive life-saving surgeries in major hospitals. So by no means are you on the fringe of the medical world, you are right in the thick of it. But you say something in the book that could be slightly controversial, which is that, “Meds will never make you better.” This statement might come as a surprise to people since nearly 70% of American adults use prescription medications. And I bet many of them think or are led to believe that these medications are actually making them fundamentally healthier. Can you unpack why this might not be true, why medicines will not make us fundamentally healthier, and help listeners gain a framework for thinking about medication?

Dr. Philip Ovadia:

Sure thing. And while I would like to think that I’m not on the fringe of medicine, I hope that I’m at the forefront of medicine. And we have to realize that oftentimes those two look very much the same. But all of the progress that we make in medicine and science comes from challenging the ideas that are thought to be accepted, thought to be the mainstream. So, we shouldn’t be afraid to do that.

Dr. Philip Ovadia:

When I say in the book that medicines are never going to fix your health problems, realize that we’re referring specifically to metabolic health diseases. And those are most of the chronic diseases that we face, things like type 2 diabetes, heart disease, many forms of cancer. And medications in that situation are only trying to minimize the effects of these diseases, they are not undoing the root cause of that disease, and therefore, they don’t actually treat the disease itself, they only help to minimize the end effects of that disease. And I think that that is largely the wrong approach.

Dr. Philip Ovadia:

We know that these metabolic diseases are almost exclusively related to our diet and our lifestyle. And therefore, those are the things we need to focus on if we want to have a meaningful impact in terms of reversing these diseases once they occur, or preventing these diseases from occurring in the first place, which is really the best approach.

Dr. Casey Means:

Absolutely. And for someone who goes to the doctor, and their doctor says to them, “Oh, your cholesterol is this level, your blood sugar is this level, we need to put you on a medication.” What should someone sort of be thinking about when they get that statement? What kind of questions can they ask? And how should they be thinking about what the medication is doing if it’s not actually really reversing the disease process?

Dr. Philip Ovadia:

Yeah. And I think those are exactly getting at the questions that people need to be asking of their doctors. They need to be asking, “Why did this occur? Why is my cholesterol high, and why is that a concern? Why is my blood pressure high?” And then what are we going to do to address the why, not just address the number we’re looking at? Your blood sugar level, or your blood pressure number, or your cholesterol number. Let’s address why this occurred and what is the actual problem with that.

Dr. Philip Ovadia:

Because realize that people aren’t concerned about their cholesterol number being high, people don’t feel that, it doesn’t affect them. They’re concerned about developing heart disease. Now, we can certainly get into whether or not cholesterol is the cause of heart disease, but if for a minute we think that cholesterol is the cause of heart disease, does that medication prevent me from getting heart disease, not does that medication lower my cholesterol? Because, again, that’s meaningless.

Dr. Philip Ovadia:

What we care about is, “Am I going to get heart disease? And is this medication going to help me not get heart disease or improve the heart disease that I already have?” And the more that we ask those questions, the more that we can get to the root cause of these problems, the better we’re going to find the useful solutions for them.

Dr. Casey Means:

Definitely. I think one of the biggest questions that could shift healthcare in a positive direction is exactly what you said, which is just more people asking the question, why? “Why did this happen? Why have I developed this disease?” Doctors asking, “Why are healthcare costs going up, but chronic diseases increasing?” All of these why questions send us down I think a really fulfilling path, and definitely a path that you and I both share in terms of training as surgeons and sort of really stepping back and observing what’s happening and asking the question why, which I know has led both of us on really fulfilling journeys.

Dr. Casey Means:

And so, I’d like to dig into your journey a bit more. Your personal story is amazing, being a cardiac surgeon to really becoming a metabolic health evangelist. And you have both a personal story, but also it’s very much impacted your professional life. So, can you share with people a little bit about that journey, and what inspired you to devote your life to improving metabolic health in both yourself and your patients?

Dr. Philip Ovadia:

Sure. Ultimately, my personal journey and my professional journey are very tightly intertwined. And while I think the outcome of them has been amazing, the process that I went through is very demonstrative of the problem with healthcare. My background is I was overweight and obese as a child and essentially my entire life. And that’s something I had struggled with. And as I went through college and medical school, it got worse. And I tried to address it by using those tools that I’ve been taught in medical school, eat less, move more, count my calories, eat according to the food pyramid, and eat a low fat diet.

Dr. Philip Ovadia:

And I had some short-term success like many people do, but ultimately, I would gain back any weight I had lost and more. And I was really at a crossroads about five or six years ago when I realized that I was going to end up on my own operating table, so to speak. I was morbidly obese, I was pre-diabetic, and I didn’t have an answer. I was strongly considering getting gastric bypass surgery. But thankfully, I came across some new concepts and new ideas. My introduction to all this was from Gary Taubes, and he happened to be the guest speaker at one of the medical conferences I was attending. And thankfully, I actually listened to him. What he said resonated with me. And I read his books, and I eliminated sugar from my diet at first, and then went low carb, kind of have evolved through that. And over the past five years, by doing that, I personally have been able to lose over 100 pounds, and I have optimized my metabolic health.

Dr. Philip Ovadia:

And more importantly, on the professional side of things, that got me asking questions. It got me asking, “Why didn’t I hear about this in medical school? Why don’t we discuss these concepts?” And then seeing and realizing that the patients I was operating on every day as a heart surgeon, the patients that I take care of, were not there because their cholesterol level was high, they were there because they have poor metabolic health. And if we address their metabolic health, we can prevent their heart disease.

Dr. Philip Ovadia:

And knowing that as a physician I can’t keep quiet, I can’t keep that information to myself as much as I love doing heart surgery and continue to do heart surgery and enjoy doing heart surgery, I realize the importance, and I would much rather help people to prevent the need for having heart surgery, developing heart disease, and keep people off my operating table. And so that’s why I’ve added this additional sort of dimension to my career, and I started my telemedicine practice, and wrote the book, and I’m trying to work with like-minded physicians like yourself and thankfully our growing community to get this word out to the people who need to hear it.

Dr. Casey Means:

Such an amazing journey. And now, from what I understand, you have two practices, you have your metabolic telehealth practice and then you also are practicing hardcore cardiac surgery. Tell us a little about how you split your time, how those practices differ, and how you’d sort of like to see principles from your metabolic health practice ideally kind of move into the mainstream cardiac surgery world.

Dr. Philip Ovadia:

Yeah. So, I ended up changing the way I practice the heart surgery side of my professional life. I ended up leaving my employed heart surgery position, and I now work as a… what’s called a locum surgeon. For those in the audience that don’t know what that is, I basically travel around the country to hospitals that need additional heart surgeons for periods of time, and do sort of either short-term or recurring assignments there. That gives me a little bit better way to control my schedule. And then I have my telemedicine practice as well, that is certainly a non-traditional medical practice, it is completely online, everything is done via telemedicine. And that is done at the convenience of the patients, they kind of schedule their own appointments within my availability, and we work together one-on-one doing that.

Dr. Philip Ovadia:

So, it’s certainly a very different model of practicing healthcare. As you said, I guess it sort of puts me on the fringe of healthcare in some ways, but I like to think of it as the forefront. We have seen that telemedicine is becoming more and more important. The COVID epidemic, the COVID pandemic, certainly accelerated that. But even before that, telemedicine is more convenient for the patients oftentimes. It’s actually more convenient for the physicians a lot of times, when we look at it. It can be a more efficient way to practice medicine, and it also breaks down some of the barriers that stood in the way of traditionally delivered medical care. So I’m excited to be on the forefront of doing that.

Dr. Casey Means:

In your book, you talk about how you use continuous glucose monitoring upfront for all your patients in your metabolic health practice. So I’d be curious to hear how you find that data stream is helpful for people in moving the needle on their diets and their lifestyles. And do you see it contributing to improving the health outcomes of your patients?

Dr. Philip Ovadia:

Yes, and I think continuous glucose monitors are a great kind of example of what’s wrong with healthcare. The fact that they are not more readily available and not more widely utilized in medicine, I think is very emblematic of the problems we have. So, I use continuous glucose monitors in a number of ways. For the patients who are coming to my practice and they really have not… They don’t know much about metabolic health, they have not focused on metabolic health beforehand, it is a great introduction to what is metabolic health.

Dr. Philip Ovadia:

It gives them the real-time feedback of I eat a certain food or I do certain activities, and I can see a number, a response to that, that will help me guide whether that might be something that I want to incorporate more of in my life or want to incorporate less of in my life, as I try and get healthy. For other patients who are kind of into their metabolic health journey and understand some of the basics, it can really be used effectively to fine-tune the foods that they’re eating and other things like stress and exercise and all of that. We see the effects of all this with the continuous glucose monitor.

Dr. Philip Ovadia:

So, I think it is unbelievably useful. I think it is incredibly underutilized in medicine. There are too many barriers to getting them in the hands of patients who could benefit from them. And quite frankly, there aren’t enough doctors around to understand how to effectively use them. And so therefore, they don’t get used nearly as much as I think they should in medicine these days.

Dr. Casey Means:

Yeah, I think when we spoke on the phone a few months ago, you’d mentioned that it is a challenge to get these on your patients in your cardiac surgery practice. Why do you think there’s still a barrier to using these tools that I think we can both attest to the fact that they can be very, very helpful for people? Why do you think there’s still a block there?

Dr. Philip Ovadia:

Yeah, quite frankly, it’s hard for me to figure out why there is a block there, but the blocks are that insurance won’t cover it. And on the heart surgery side of my professional life, I am beholden to the insurance companies. All the patients, obviously… Heart surgery is expensive, and you need insurance to pay for that. And so, those patients if they want something like a continuous glucose monitor, oftentimes, they need to pay for it themselves out of pocket, and that’s not feasible for a lot of them.

Dr. Philip Ovadia:

Continuous glucose monitors are not approved for use in hospitals, which is kind of interesting. We know in cardiac surgery we have unbelievably good data on this, that the better you control a patient’s blood sugar around the time of surgery, the better the outcomes of the surgery are. Things like infection and just overall outcomes have been dramatically improved. It’s probably one of the biggest developments in the management of heart surgery patients over the past 20 years is that realization. And yet, we don’t continuously monitor the patient’s blood sugar in the hospital. Every hour the nurse is actually drawing off some blood from the patient and putting it into the machine and checking the blood sugar.

Dr. Philip Ovadia:

It’s one of those things I look at that I think is crazy, that I can have a patient walking around outside the hospital that continuously knows their blood sugar, but I can’t have a patient inside the hospital continuously know their blood sugar, when we know it is so important to their outcomes. Why that is, gets into all of the various financial and kind of political aspects of healthcare, that I don’t want to get off on too much of a tangent, but it just it’s a barrier, and it’s unfortunate because the patients ultimately suffer.

Dr. Casey Means:

So you mentioned post-op blood glucose management. And something you talk about in your book, which is a great section is kind of the absurdity of hospital food. And after surgery, you’re seeing post-op patients on the ward, we have great data, as you just mentioned, that blood sugar control after surgery is deeply related to surgical outcomes. And yet, we’re walking into patients rooms in the morning and seeing… our diabetic patients no less, and seeing French toast bites and bread rolls at lunch and potentially juice. Talk to us a little bit about what is so problematic about hospital food, why we’re serving this. And if you were like the hospitals are, what’s your vision for how food in the hospital could be shifted to sort of really support patient healing?

Dr. Philip Ovadia:

Yeah, so ultimately the way to sum up the reason of why the food is what it is in the hospital is because the hospitals are beholden to the US Dietary Guidelines, and they need to follow them at an institutional level. And the US Dietary Guidelines themselves, it’s in like one of the first paragraphs, if you actually sit down and read the report that comes out every five years, it says, “These recommendations are not intended to treat any disease.” And yet, we serve that food in the hospital where all we’re doing is treating disease.

Dr. Philip Ovadia:

So the fact that hospitals need to pay attention to the US Dietary Guidelines is kind of crazy to start with, because the US Dietary Guidelines specifically say we shouldn’t be using this to treat disease. Leaving that aside, the other aspect of it, quite frankly, is that the processed foods that largely get incorporated into the US Dietary Guidelines are inexpensive. And hospitals are like any other business, and they need to look at their bottom line, and one of the places they do that is with the food that they serve. And they try and do that as inexpensively as possible, they don’t factor into the equation what effect that food is having on their patients. And again, I think that’s very unfortunate.

Dr. Philip Ovadia:

So, ideally, I would love to see hospitals serving whole real food. Just like I talk about in my book, I think it’s the biggest concept around metabolic health is that if we just ate more whole real food and eliminated the processed foods, all of our health would improve. And I think that should be done in the hospital and out of the hospital.

Dr. Philip Ovadia:

From a practical standpoint, I no longer eat in the hospital. I literally, if the choice is between eating in the hospital or fasting, I’m going to fast until I get out of the hospital and can get some good food to eat. It is very rare that I can find what I consider to be whole real food in the hospital. And I think that’s unfortunate.

Dr. Casey Means:

Agree completely. And it’s really helpful to hear the perspective about the dietary guidelines and how that’s really driving a lot of this. Just for fun after reading that chapter, I just Googled… I pulled up one of the diabetic menus for just a hospital in the US, and I’m sure they’re very similar all around. And just for people listening, so this is a menu for people with diabetes at a major hospital. What’s funny is I noticed… I mean, I noticed this in residency in medical school, they don’t call them a diabetes diet, they call them a consistent carbohydrate diet.

Dr. Philip Ovadia:

Right.

Dr. Casey Means:

And I think that’s really interesting. And they are meant for people with diabetes. But in that title, it really implies how much the diet is focused on actually just managing their insulin, because if you keep someone with a consistent carbohydrate at each meal, like 75 grams of carbs per meal, it makes it potentially easier to dose their medication. So it’s almost like the diet is focused on how to make it easier to dose the medication in the hospital, which I think is a strange approach.

Dr. Casey Means:

And on this menu for people with diabetes, the breakfast entrees are whole wheat pancakes, buttermilk pancakes, French toast, whole wheat French toast, French toast sticks, breakfast burritos on a corn or flour tortilla, white bread, whole wheat bread, whole wheat English muffins, blueberry muffins, salmon, bagel, cornflakes, Cheerios, Rice Chex, frosted flakes, raisin bran, and strawberry yogurt. And then of course, the juice options are orange, apple, grape, prune, and cranberry. And that’s just breakfast.

Dr. Casey Means:

I mean, there’s not a single thing that I just read that it supports metabolic health, or actually supports someone with diabetes. It’s sort of hard to believe. And so I just think, for anyone listening, certainly it’s like, take this into your own hands. Like if you’re in the hospital, see what you can do about bringing your own food, having someone bring you food. It’s pretty abysmal.

Dr. Philip Ovadia:

Yeah, it really is. And like I said, it’s one of the most striking examples of what is wrong with our healthcare system. We just look at the system as a whole and we look at the outcomes that we’re getting, and we have to step back at some point and say, “We’re doing something wrong.”

Dr. Casey Means:

Yeah.

Dr. Philip Ovadia:

When 88% of the adults in the United States are metabolically unhealthy, we obviously are doing something wrong. And we can start to argue about what that might be and maybe the nuance of how to fix it, but when we start to look at diet, which is obviously a major impact on our health, we at least need to start admitting that as the healthcare system. Like right now, most people when they go to their doctor, their doctors do not talk to them about what they eat. And if we could just start that conversation, if we could just acknowledge about what we eat being the primary influence on our health, maybe we can start to move forward.

Dr. Casey Means:

And one of the things that’s so fantastic about your book is you give people such practical tips for them to start taking diet into their own hands. And it can be really hard and overwhelming to do that. And so, the way that you break down things into just like very specific tips and strategies is hugely beneficial. And so, I’d like to drill into a little bit of this for people listening. You talk about seven principles of metabolic health. And four of those are things we love. At Levels we talk about them all the time. Eat whole real food, move, sleep enough, and relieve stress.

Dr. Casey Means:

But then there’s three principles that are more about framework and processes. And one of them I loved was to make one sustainable change at a time. So, talk to us about why making one sustainable change at a time is important. And within that, you have four suggested changes relating to food. And can you walk us through those and sort of talk about why it’s important, and how to get started with these principles?

Dr. Philip Ovadia:

Yeah, so I think the sort of mindset piece of this, the framework is very important. And making one sustainable change at a time, I think there are two sort of important reasons to do that. The first is that you don’t want to overwhelm yourself or you don’t want to overwhelm the people you’re working with.

Dr. Philip Ovadia:

If you go to the average person who is not metabolically healthy and you say, “Okay, tomorrow we’re changing the way you eat and we’re changing your exercise and we’re looking at your sleep and your stress, and trying to do all this at once,” it just becomes overwhelming. So what I have found to be most successful with people is focus on one thing at a time, change one thing at a time. And what I usually find happens is that then becomes kind of self-reinforcing.

Dr. Philip Ovadia:

I will talk to people about how to eat better and eat whole real food, and they’ll start to do that. And then all of a sudden, the person who never felt like exercising before, now will want to start exercising. As opposed to if I say, “Go exercise and change the way you eat,” that oftentimes is too much and they don’t have success at either. And the other reason I think it’s important to focus on one change at a time is so that you can know what’s working and what’s not working.

Dr. Philip Ovadia:

If you change a bunch of things at a time and you have success, you don’t really know which of those things was important for the success and maybe which ones weren’t necessarily useful. And opposite, if you don’t have success, again, you don’t know was it because of the first thing I changed or the second or the third? So if you do it in a more sort of mindful matter, if you’re intentional about doing it kind of one thing at a time and then reassessing and seeing the effects on your health, you can better figure out what you need to be doing to support your health or not.

Dr. Philip Ovadia:

And so, in the book, some of those changes we talk about are setting your priorities in terms of what you eat. I think the most important thing for us to prioritize is getting enough protein in our diets. And so, if you make that your priority and then you kind of construct the rest of what you’re eating around that, that ends up being a very helpful and useful intervention.

Dr. Philip Ovadia:

I also talk about substituting instead of eliminating. So if there is something that you like, that you enjoy eating, that maybe doesn’t fit within your dietary strategy, it’s a processed version of something, find a way to make it in a more healthy manner. There are all sorts of diet websites out there, all sorts of recipe books out there that you can pretty much make anything, a whole real food version of just about anything that’s out there. And oh, by the way, it usually tastes better and is more nutritious, and is going to support your health. The only reason we tend to get the processed versions of all these things is because they’re easy and cheap. And ultimately, that’s not serving our health.

Dr. Casey Means:

Yeah, and in the prioritize section, as one of these suggested changes of how to make one sustainable change at a time, you also mentioned a great tip that I loved, which was to before even changing what you’re putting on your plate or what you’re buying, just start by changing the order in which you’re eating the food on your plate. So, this might mean like let’s say you have a bread roll and some potatoes and some chicken and some vegetables, like start with the vegetables, whole real food, then eat the chicken, whole real food, then eat the mashed potatoes, probably getting a little bit more towards processed food in there, because you know… And then whatever is added to it. And then eat the bread roll. So just change the order.

Dr. Casey Means:

And what people might find I think is that by the time they get to the bread roll, they’re not quite as ravenous, maybe they don’t want it as much. But I loved just that sort of type of simple approach that’s not even about changing what you’re doing or how you’re shopping, but just the order in which you’re eating. Are there any other really high yield tips like that that have been helpful for you or your patients as they approach like really just dipping a toe in and starting to get started on this process?

Dr. Philip Ovadia:

Yeah, so I think, again, the eat whole real food and really kind of breaking down what that means ends up being very useful to people. So, I have two sort of kind of rules that I give around that. The first is that you should be eating things that grow in the ground, and you should be eating the things that eat the things that grow in the ground. And if you stick to those, that is your whole real food.

Dr. Philip Ovadia:

For the most part, your food shouldn’t require an ingredient label, because you should be able to look at it and know what’s in it. It should be one ingredient or a couple of simple ingredients that have been combined, and you can still recognize what’s in it. But if it has more than three ingredients on a list and those aren’t all each whole real food, don’t eat it. And the final kind of tip I give people is, if your grandparents or great grandparents, depending on how old you are, didn’t eat it, you shouldn’t be eating it. If it wasn’t in our food supply 100 years ago, it is probably not something that we should be eating now.

Dr. Casey Means:

Yeah, those are great tips. And I think you mentioned in the book that it’s like, just because it comes in a package, doesn’t mean it’s necessarily horrible. We have to read the ingredients, though. Are the ingredients in there, real food, unprocessed food? And it’s going to be few and far between finding a packaged food that really meets that criteria, but it’s worth getting familiar with the labels and making sure we’re looking at every ingredient and sticking to that principle of eating real food as much as possible.

Dr. Philip Ovadia:

It’s always amazing to me what they can slip into food, you know?

Dr. Casey Means:

Yeah.

Dr. Philip Ovadia:

And the things that you look at and be like, “Oh, this is just…” bacon is a great example. And you might pick up a package of bacon and you say, “Looks like it’s just bacon,” and then you flip it over and now they have like eight things on the ingredients list, between the preservatives and the sugar that they added and flavoring. And you’re just like, “I just want bacon.” And so things like that.

Dr. Philip Ovadia:

And I always give good examples, because people say, “Oh, are you telling me I should never eat bread again?” And I say, “Well, not necessarily.” But realize that there’s a big difference between the packaged bread that you go get in your grocery store that is made who know where, shipped from who know where, has all of these ingredients, and almost 99% of those have some sort of vegetable or seed oil in them, versus either make bread yourself at home with flour, water, maybe some butter, and some salt, that’s really all it should be in bread, or go to your local’s farmers market on the weekend and talk to the people there that are selling bread and say, “What’s in it?” And if they list off those same simple ingredients, then I have no problems for people who are metabolically healthy. You know, this is a big caution, because people who are not metabolically healthy clearly need to avoid carbohydrates as much as possible.

Dr. Philip Ovadia:

But once you get yourself metabolically healthy, there are healthy carbohydrates that are still whole real food you can eat, you just have to be very intentional about this, very careful about it.

Dr. Casey Means:

Those are fantastic tips. And I think it gets back to one of the most… Which is a really useful section of your book, which is talking about swaps and how you can really find healthy swaps for anything, especially bread, by just doing a little Googling. I mean, one of my favorite breads that I eat now and make regularly is a Keto naan bread that is basically just organic coconut flour, a little bit of psyllium husk, water, salt, and some olive oil. And it makes a virtually, I mean, not zero carb, but very low carb bread that can be used for really anything. And there’s dozens of those recipes out there, whether it’s almond flour or whatnot.

Dr. Casey Means:

And so, lots of great options for people who are carb intolerant, but it does take a little extra Googling, maybe buying a slightly different flour. But once you get the hang of it, pretty straightforward. So, I’d love to shift gears a little bit and talk about another section of the book, which was 12 myths that they want us to believe. And these are amazing. This is really like a primer of sort of why a lot of our thinking about metabolic health and disease is wrong. I want to get into a couple of these specifically, but the first question I have is, who is they in this 12 myths they want us to believe?

Dr. Philip Ovadia:

Yeah, I think ultimately they is the system, and that’s the healthcare system, the sort of the governmental policies around health, the pharmaceutical industry is part of this, the food industry. They is not you, ultimately. And one of the things I was trying to convey in this book is that you need to take charge of your health, ultimately.

Dr. Philip Ovadia:

We talked about earlier, 88% of the adults in the United States are not metabolically healthy. That is the result of the system that has been built around us. So if you want to continue following that system, there’s no reason to expect different results than that. And if you want different results than that, you need to get out of that system. One of my main messages to people is that you need to take an active role in your health.

Dr. Casey Means:

Absolutely, yeah. And I think reading books like this book is one of those steps. I think it’s so many things. It’s educating yourself, it’s listening to podcasts, it’s asking your doctor tough questions. And one of the seven principles of metabolic health that you mentioned, kind of shifting gears here for one second, was that you need to find a doctor who gets it. Just briefly, what does that mean? And how can someone find a doctor who gets it? To support them on this journey where they the patient, they have to be the driver of this, but you do want someone who can support you in this self-empowered movement towards good health. How should people even approach finding that type of doctor?

Dr. Philip Ovadia:

Yeah, I think ultimately networking comes into play here, and connecting with people who are getting similar outcomes that you’re looking for, who are getting healthy, and asking them who are the medical professionals that they interact with. You know, this isn’t just doctors, quite honestly, it’s kind of the whole healthcare system and all the medical practitioners, but one of the best tools I always tell people to utilize is finding people who are getting good health outcomes around you, and talking to them and finding out who they work with, is a great way.

Dr. Philip Ovadia:

There are a number of good online resources that I talk about in the book, some directories, some communities that are built around health that have started to assemble directories of physicians who think along these lines. So I encourage people to use those as well.

Dr. Casey Means:

Definitely, those are really great tips. And the directories I think can be really helpful, things like directories of low carb-focused doctors, or the Institute for Functional Medicine, ifm.org, has a huge provider directory of people practicing functional medicine, which is more of a root cause approach. So, there’s several out there, and I think those are a great resource. So jumping back to these 12 myths, one of them is that only obese people are metabolically unhealthy. So, why is this not true? And why should someone who may be of a “normal BMI” still be thinking about metabolic health?

Dr. Philip Ovadia:

Yeah. So when we look at those statistics that we were talking about, 88% of adults in the United States are metabolically unhealthy, if you look at the subset of patients in that study, this data comes from what’s called the NHANES database, the people who were normal or underweight, 40% of them were not metabolically healthy. So, it’s almost a 50/50 shot there, that if you are not obese, you may or may not be metabolically healthy. And the only way you’re going to know is to actively measure that.

Dr. Philip Ovadia:

From a medical standpoint, this is what’s called the thin on the outside fat on the inside, the TOFI. So, we know that for various reasons, a lot of this gets into genetics, there are certain people who will not get obese, but instead they’ll get metabolically healthy quickly. Whereas other people, it turns out that obesity is a little bit of a protector against getting metabolically unhealthy initially, because our bodies use body fat as a way to shove all this extra energy we’re taking in, and so it can be somewhat protective against being metabolically unhealthy for the short-term, not over the long-term.

Dr. Philip Ovadia:

Ultimately, we know that the vast majority of people who are obese are metabolically unhealthy, but just because you are not obese it’s not a guarantee that you are metabolically healthy, and you need to assess it, you need to measure it, in order to know.

Dr. Casey Means:

So for those people out there who are of thin or a normal weight, based on that NHANES data we know that it is possible that 40% of them are actually metabolically unhealthy, which is amazing, because we have a culture very focused on weight, which we know is a poor predictor of metabolic status if you are of a normal BMI. So, what are the things that those people should be looking at in terms of their health metrics and health data to determine where they fall on the metabolic health spectrum?

Dr. Philip Ovadia:

Yeah, so I always start with the five basic indicators of metabolic health. And these are basically the official criteria that we use as physicians. The first one you can measure at home, it’s your waist circumference. You take a tape measure, just above your belly button, you measure your waist circumference, best to measure it first thing in the morning. And if you’re a man, you want that to be less than 40 inches, if you’re a woman, you want it to be less than 35 inches.

Dr. Philip Ovadia:

The next measurement we look at is your blood pressure. Again, you can check it at home these days, you can check it at any pharmacy or grocery store, or you can go to your doctor and get it checked. If you are on medication to lower your blood pressure, that’s already an indicator that you are not metabolically healthy. Without medication, you want your blood pressure to be less than 130 over 85.

Dr. Philip Ovadia:

And then the final three metrics, you need to get some blood work checked, your fasting blood glucose level, and you want that to be less than 100 and you want it to be without the use of medications. So again, if you’re a type 2 diabetic, you’ve been put on medication, you are not metabolically healthy. And then we look at the cholesterol. But interestingly, we don’t look at the number that everyone focuses on for cholesterol, the LDL, the bad cholesterol level, as it’s called. We actually look at the other two numbers that are on your cholesterol panel.

Dr. Philip Ovadia:

Your good cholesterol, your HDL level, and as the name implies, the higher the better for that. So if you’re a woman, you want that to be over 50, if you’re a man, you want that to be over 40. And then we look at the triglyceride level, lower the better, under 150 is the official cut off for that. So, that’s a great place to start. If you know those five numbers and they are all in those healthy ranges, congratulations, you’re one of the 12% in the United States that’s metabolically healthy. If three or more of those are not healthy, you actually have the diagnosis of metabolic syndrome. And we know that metabolic syndrome puts you at very high risk of developing diabetes, heart disease, high blood pressure, cancer, Alzheimer’s disease, all of these chronic conditions that plague our society.

Dr. Philip Ovadia:

And I tell people that if one or two of those are abnormal, it’s a warning sign, because we know that people that have one or two abnormal are likely to progress the metabolic syndrome, and have three or more abnormal if you give them enough time. So, it’s a warning sign that you need to start making some changes to avoid metabolic syndrome.

Dr. Casey Means:

That’s a great, great overview and I think really useful for anyone listening, because you can just go check these things out right now. People probably have access to almost all these numbers from their recent physical. What’s interesting to me about some of these criteria, though, is that I think we know that these numbers are actually fairly lenient. Triglycerides of 150, for the average patient I’m trying to optimize, would be very high. And an HDL of 40, I’d be pushing them hard to get that way up towards 70, 80, 90. A blood glucose in this criteria of 99 would be considered metabolically healthy, when we know that actually probably lower than that in the lower normal range is better, like in the 70s to 80s.

Dr. Casey Means:

So, it’s interesting to me that even though this is that landmark study that showed… The study that we’ve been talking about of the 88% of people who are metabolically unhealthy is looking at these criteria. And the 12% are fitting the optimal range for all five not on medication. But if we really looked at optimal metabolic health, triglycerides under 100, glucose in the 70s, 80s, I bet that number, the 12%, would decline quite a bit. So, it’s profound. It’s profound where we are right now in this country in terms of metabolic dysfunction.

Dr. Casey Means:

And I want to drill a little bit deeper into some of the labs. Those are kind of the five standard criteria for metabolic syndrome. What about other tests that you use and like to actually get a little deeper about metabolic health? What are some of the other tests that you order if you could kind of get the optimal panel for testing?

Dr. Philip Ovadia:

Yeah, so the first one that I add for all of my patients is a fasting insulin level. And I think, really, if I could only look at one blood test on people, that would be it. And I really struggle to understand why we don’t check that level on a routine basis on people. I’ve made the comment, and looking through the kind of literature around heart disease, it is almost unheard of, and quite frankly in my personal practice now that I’ve been looking for this for over three years, I am yet to find a patient who has a normal fasting insulin level, triglyceride to HDL ratio less than two, and is not a smoker, who develops heart disease. It really… It just doesn’t happen. And again, we have medical literature looking at this as well.

Dr. Philip Ovadia:

So, I think insulin is a very important marker, and I think we should be checking out more. I think the markers of inflammation, things like C-reactive protein, is another very simple, easy to check blood test that can give us an idea about risk. And then, I obviously with my background in heart disease, patients oftentimes come to me with concerns around heart disease, and I do those deeper dives on lipid profiles. More than just looking at your simple LDL cholesterol level, we want to know about the size of your cholesterol particles, we want to know if they’re the inflammatory oxidized type particles. Things like that I think are important and they’re probably underutilized, because we just stop at, “Your LDL cholesterol number is over X, and therefore you need to be on a medication to lower it.” And again, I think that’s the wrong approach.

Dr. Philip Ovadia:

I base that on the outcomes we are seeing from that approach, realize that statins have now been the most prescribed medication for going on 20 years, they’ve been ubiquitous in our society, and we are not seeing any meaningful reduction in the incidence of heart disease over that time. So, there’s got to be something wrong again with the approach that we’re taking.

Dr. Casey Means:

That’s awesome. So, just to summarize for people listening, it sounds like for you inflammatory markers like CRP, a triglyceride HDL ratio, ideally, less than two to one, fasting insulin in an optimal range, and potentially advanced lipid testing, looking at the actual particle size and oxidation status of those LDL particles so we don’t just look at the blanket sort of catch our LDL number and make potentially wrong assumptions. And I’m just curious, for people… A lot of our listeners are familiar with fasting insulin, what would you consider to be that optimal range for fasting insulin?

Dr. Philip Ovadia:

Yeah, so I tell people that under 10 is acceptable. I ideally like to see it under seven, but I think under 10 is acceptable. And again, it’s going to depend on where the person is on their journey. But clearly, a level of 15 to 20, which is actually considered within the normal range on most laboratory reports, I think is unacceptable and is not reflective of good metabolic health. That’s one of the things that I run into a lot, that even though a patient may have gone to a doctor who checked their insulin level, that is rare, but when they do check it, oftentimes it will be high, 15 to 20, and the doctor will say, “It’s fine,” because it is in the normal range as reported by the laboratory. But I think it needs to be under 10 for optimal metabolic health.

Dr. Casey Means:

Awesome. That is such a great practical tip for people to kind of be armed with, if they do or are able to get this lab test ordered. And it’s pretty interesting what you said about how you have rarely, if ever, seen people on your operating table for cardiac surgery who have a healthy insulin level. That’s pretty fascinating, because it’s not something we check in standard practice. And I’d be curious like, what about LDL levels about people that you’re seeing on your operating table? So, most of them have elevated insulin, what do you see in terms of LDL?

Dr. Philip Ovadia:

Yeah, the LDL level really is a big variation. About half of the patients that I see have LDL levels that would be considered normal, under 120. Some of those because they’re on medication, many of them without medications. And again, this is supported by the data that we have. There has been many large studies looking at this. And when you look at all the patients that come in with heart attacks, for instance, half of them have normal cholesterol levels. So, that really begs the question and should prompt people to ask, “Is cholesterol the true cause of heart disease if we see many people who come in with heart disease that have low cholesterol levels, and on the flip side, we see many people walking around with high cholesterol, high LDL cholesterol levels, who have no evidence of heart disease?”

Dr. Philip Ovadia:

Full disclosure, I’m one of them. I have a high LDL cholesterol level, I have gotten the CAC scans, and I have no evidence of heart disease. So, I think that there’s a definite problem with that narrative that cholesterol is the cause of heart disease. Does cholesterol play a part in the process of heart disease? Yes, it does. But I don’t think it should be our central focus. And again, the literature or the data support this.

Dr. Philip Ovadia:

A couple of months ago there was that study out of the Women’s Health Initiative that looked at risk factors for heart disease. And having an elevated LDL cholesterol level, increased your risk of heart disease. The risk factor was like 1.2. Whereas being metabolically unhealthy, having insulin resistance, raised your risk six times the baseline. So, why do we focus so much on cholesterol and we have zero focus on metabolic health?

Dr. Casey Means:

So interesting. Well, I think that’s a really empowering message for people to ask their doctors to really drill into their insulin sensitivity. And there’s a number of tests, many of which you’ve talked about right now, which can help people figure that out, fasting insulin levels, triglyceride to HDL ratio, obviously, you need to also understand some of the further context like the inflammatory status of the body and what’s actually happening to your LDL. So, really, really helpful tips there.

Dr. Casey Means:

So going back to those 12 myths, we talked about sort of only obese people or metabolically unhealthy being a common myth. Another one that you talk about that is a myth is that the best way to burn calories is exercise. I’d love to dive in just a bit more and talk about why it’s important to focus on moving more throughout the day, rather than maybe just one big workout at the end of the day.

Dr. Philip Ovadia:

Yeah, again, when you look at the literature around weight loss and exercise, it is clear that exercise alone is not an effective weight loss tool. And the old adage that you can’t out exercise a bad diet is very much true. Is exercise helpful? Yes. Does it have utility and do I encourage people to be more active? Yes, I certainly do. But the two problems I see are what you just mentioned.

Dr. Philip Ovadia:

If you go to the gym and you do whatever exercise you like, whether it’s cardio, weightlifting, whatever it is, for let’s say an hour a day, and then you spend the rest of your day sitting around not being active, ultimately, that is not going to be a net benefit. So I would rather people incorporate movements throughout their day, then do the dedicated exercise sessions. You can do both even better, but I think it’s more important to just be more active throughout the day.

Dr. Philip Ovadia:

And so practically, that can be as simple as taking the stairs instead of the elevator or the escalator, parking further away and walking to get into work or to get into the store, taking that break every hour, take five to 10 minutes, and get up and walk around your office, use a stand up desk instead of sitting all day. These are just some practical examples that are going to have more benefit, ultimately, than trying to carve out an hour of your day, which for a lot of people becomes very difficult, and then just sitting around the rest of the day not being active. That’s one tip I talk about.

Dr. Philip Ovadia:

And the other thing I talk about is the sort of cardio versus resistance exercise, what should your priority be when you are exercising? And again, I think it’s clear from the data that we have that building and maintaining muscle as we get older is one of the best predictors of health and longevity and our quality of life. So, I think the priority should be resistance exercise, that can be bodyweight exercise, that can be resistance bands, it can be lifting weights if you want, but do something that’s going to help you build and then maintain muscle as you get older. And then if you have more time, feel free to do the cardio

Dr. Casey Means:

It’s helpful to hear that and the research behind it, because I think a lot of us think about exercise as cardio. It’s like we got to jump on the elliptical, we got to jump on the Peloton, we got to go take a run. But the data really support resistance training as very, very important for metabolic health.

Dr. Casey Means:

And one line in the book that really I thought was interesting and I wanted to just ask a follow-up question on, was about how doing even just one set of a resistance training to complete exhaustion or fatigue, like where your arms give out from under you, that that can maybe be enough to kind of get where you need to go. So I’m thinking about like, okay, I’m doing push-ups, is just doing one set until I actually can’t do a single additional push-up, is that kind of what you’re saying is… Or doing a wall sit until your legs are shaking, you have to stop. That is enough to sort of get some benefit?

Dr. Philip Ovadia:

Yeah, that has actually been shown to have a lot of benefit. Doing resistance exercise in that style can be very beneficial. That is the stimulation basically to your body to make more muscle. When you do things to failure, it signals your body that we need to build more muscle so we’re not failing at this anymore. For people who are time restrained, I know I certainly am, I think that is the most effective form of exercise you can do in short periods of time is resistance exercise with basically one set done to complete failure, again, is going to be more effective than spending an hour kind of… A lot of people just sort of they go and they lift some weights, and they don’t really push themselves to that kind of limit, and it ultimately doesn’t have great effects then.

Dr. Casey Means:

I think that’s welcome information for anyone who is time-crunched, which I think is everyone really, the pushing really hard for short durations can have a very positive impact. And that if you don’t have the time for that hour long Peloton session at the end of the day, that actually just moving a little bit throughout the entire day, building that into your day, can be a really effective strategy. So, a lot of efficiency in what you’re saying, and I think that’s welcome recommendations.

Dr. Casey Means:

So I’d love to talk a bit about diet, because in your book, one of the key features of sort of the latter half of the book is talking about what we should actually eat to optimize our metabolic health. And you present several different strategies for really achieving the principles that you lay out in the book. And you actually talk about how you can be metabolically healthy on a carnivore diet, a low carb keto diet, a Mediterranean diet, a vegetarian or vegan diet, and a gluten-free diet. But you have to be really thoughtful about each one. And my sort of big picture question is, how is it possible from your perspective for each of these very different diets to all lead to optimal metabolic health? What are the features that need to be true across all of them that allow them to all work?

Dr. Philip Ovadia:

Yeah, so you know, when I was writing the book, I really wanted to make it so that pretty much anyone could use it. I didn’t want to give the Dr. Ovadia 28-Day Diet Plan, and say that this is the only way to get metabolically healthy, because quite frankly, that wouldn’t be honest. I think when we look at, again, the seven principles that I lay out about metabolic health, and then we look at how we can apply those to many of the common dietary strategies that are around us, it will guide us towards everyone can find a way of eating that supports their metabolic health.

Dr. Philip Ovadia:

And again, I think the common feature, when you look at vegans and carnivores who are metabolically healthy, and either one is certainly doable, the common feature there is elimination of processed foods, eating whole real food. There’s just no way to get around that, ultimately. And all the other things in between, Mediterranean, paleo, Atkins, keto, they get all of these names from marketing standpoint, but the reality is, is that if you eat whole real food, whatever balance between animal and plant products you want that to fall on, you’re going to get metabolically healthy.

Dr. Casey Means:

That is a super empowering message. And I think this call is a testament to that. We’ve got you who I think follow mostly a carnivore type diet, and I’m 95% plant-based, and both achieving metabolic health and both I think very committed to this exact thing that you said, which is eat real whole food. Just get rid of the refined stuff, it takes you a lot of the way there.

Dr. Casey Means:

For me personally, it’s been… Even I think even more of a refinement, I think I’m fairly predisposed to metabolic dysfunction. I grew up very, very overweight. And so, for me actually reducing some of the grains, even if they are a whole food, is important for me to kind of keep things in check. So even within a plant-based diet, moving away from some of the higher carbohydrate plant-based foods is definitely a part of my journey to achieving the best metabolic health I can have.

Dr. Casey Means:

And sort of going off that a little bit, when you look at these different diets, people might look at a Mediterranean diet and say, “Oh, okay, so I can have lots of whole grains, or if I’m on a vegan diet I can have lots of rice and bulgur and all this stuff.” Do you tend to have people try and zero in on sort of a lower carb version of each of these diets, or is it really just come down to sticking with the unrefined foods?

Dr. Philip Ovadia:

Yeah, so, again, the bigger concept that I get across to people is that metabolic health needs to be your ultimate measuring stick. And so, any dietary strategy that someone employs that keeps them metabolically healthy or makes them metabolically healthy, I’m going to ultimately support. The carbohydrates, I find very variable. I think depending on your level of activity, the amount of muscle that you have and how metabolically healthy you are to start with, is going to determine how much carbohydrate you can ultimately tolerate.

Dr. Philip Ovadia:

The types of carbohydrates is also important. The less processed carbohydrates are clearly better from a metabolic health standpoint. So things like sweet potatoes, the cruciferous vegetables, these are going to be better than your fruit juices, for instance. But ultimately, as I said, your measuring stick needs to be your metabolic health. So this gets back to the intentionality, the paying attention to the metrics that we are using for our metabolic health.

Dr. Philip Ovadia:

Using something like a CGM can be a great tool for helping someone figure out the nuance of, I should or shouldn’t be eating this food, or I can eat a certain amount of this food before it becomes metabolically problematic for me. Like you and the same that, I am very obviously predisposed to metabolic disease, I cannot tolerate a lot of carbohydrates, but I can tolerate more carbohydrates today than I could three years ago, when I was kind of in the early stages of this journey. And so, again, I think paying attention to these metrics, to the metabolic health measurements, are what should guide us ultimately about what we should and shouldn’t be eating.

Dr. Casey Means:

Yeah, I think it speaks to the point that there is not a one-size-fits-all diet. And we do have to be aware of how the diet is affecting us, and make iterative changes. And I love the point that you made about how it can change over time. You’re more carb tolerant now, it sounds like, than you were previously, as your metabolic health improved, as your insulin sensitivity improved.

Dr. Casey Means:

And this is something we talked a bit on another recent episode with one of our Levels members, Betsy McLaughlin, who lost 81 pounds using Levels. And what she realized is that at the beginning of the journey, there were a lot of foods that would spike her to the moon, that were healthy foods, sweet potatoes. But after eight months, as she dropped her insulin levels from 30 to five, and became more insulin sensitive, she was able to tolerate those without going to the moon in terms of her spike.

Dr. Casey Means:

And so, really context matters. And a carb is not a carb. The carb interacts with the physiology of the person. And so, I think that’s a hopeful message, because as we shift, it’s not like we’re stuck in one place forever, we may be able to bring in other foods, but also just really speaks to the importance of that there is not a one-size-fits-all diet, and we have to be our own advocates for understanding how food is affecting us, so we can make the best choices for our own bodies.

Dr. Philip Ovadia:

Yeah. And the other caution I give in the book around a lot of these popularized diets is realizing that keto, for instance, there’s lots of products that are labeled keto that are clearly not going to be good for our metabolic health. They are just junk food with a different label on them, basically. And they’ve been reformulated to fit within the macros of keto, but they’re not whole real food and they are not metabolically healthy. And that is the other reason that I don’t like giving people diet plans. Again, I like setting up a framework for metabolic health.

Dr. Philip Ovadia:

And you get back to the seven principles, principle number one is you need to view your health as a system, not a goal. You can’t just be focused on, “I want to lose 20 pounds,” or, “I want my LDL cholesterol level to be this,” you have to be thinking about your health as an overall system, metabolic health, to keep me healthy, to prevent me from getting these chronic diseases, and let that be the guide of the choices that you’re ultimately making.

Dr. Casey Means:

So we’re heading into the holidays right now. We’ve got Thanksgiving, we’ve got Christmas coming up. And there’s a great section of the book that talks about how to set ourselves up for success when we go to parties, events, and restaurants. I’d love for you to just give people a few pearls and takeaways, a teaser maybe, because they should definitely get the book and read the whole thing, but how to not just totally tank our metabolic health between November and December?

Dr. Philip Ovadia:

Yeah, so again, this gets back to the intentionality around how we eat, and planning in advance, putting some effort into this. So, it might look like eat before you go to the party. The food doesn’t necessarily need to be the focus of our social interactions. Enjoy spending the time with people, eat what is going to be metabolically healthy at the party, kind of plan that out in advance, or at the restaurant, look at the menu and say, “This is what is good for me to eat.” Don’t be afraid to ask questions when you go to restaurants, “What is in this dish? What is it made with?”

Dr. Philip Ovadia:

Because as I said, they find surprising ways to take foods that should be simple, and make them processed and unhealthy. So, don’t be afraid to ask questions, I think restaurants respond well to that. If you’re going to a party and you’re not sure what the options are going to be there, eat before you go to the party. And then when you get to the party, you don’t have to be rude and say, “Oh, I’m not going to eat any of this food,” but you can have a little bit of this and that, and find the stuff that is metabolically healthier in there to eat, and then stick to that. And I think those are some good strategies that can help people get through those situations.

Dr. Philip Ovadia:

The other key tip that I give in the book that I think people should realize is that, again, you are in charge of your health. We’ve all been in those situations where you’re out with people, and you’re doing your thing to stay healthy, and they’re like, “Oh, come on, enjoy yourself, try a little bit of this, try a little bit of that.” And you just have to have the confidence in what you’re doing and the intentionality in what you’re doing to be able to say, “I know that those foods are not going to support my health long-term, and therefore, I’m choosing not to eat them. And instead, I’m going to eat this.”

Dr. Philip Ovadia:

I enjoy everything I eat, I never really feel deprived. I eat when I’m hungry, I eat until I’m full. And when you’re eating whole real foods, you really can do that. Your body can actually tell you, “Okay, you’ve had enough, you’re not hungry, you don’t need to eat again,” as opposed to these processed foods that literally hijack our hunger sensors, make us more hungry, but don’t get us the nutrition that we need. And so people are always surprised that when they eat whole real food, they end up being hungry less often, they don’t feel deprived, you enjoy the food you eat, you can actually taste the real food, as opposed to the other stuff that’s in all this processed food.

Dr. Casey Means:

Absolutely. I mean, there’s no question that it’s that. It’s that upfront investment of doing something different, and then things shift in your body. I mean, I think anyone who’s been on a healthy whole foods diet for a long time, anyone I know at least, it’s like they love the food they’re eating. And a lot of us used to be totally addicted to processed food. I was completely addicted to processed food growing up and, I mean, would eat Nutella by the spoonful… I could eat an entire bag of chips. I literally don’t want it.

Dr. Casey Means:

And I think that that’s incredible that our bodies can really shift their preferences, but it takes these steps towards training our body to do that by exposing it to these flavors over and over again. And I think by getting off that glucose roller-coaster of the up, down, up, down, up, down, we know that will prevent the cravings, because it’s that big spike in dipping glucose that we know really drives our hunger hormones and our craving, as does of course sleep deprivation and many other things you talk about in the book.

Dr. Casey Means:

So, that’s a… Yeah, very empowering tips there for going to parties and events and restaurants. And one of my favorite strategies is to just actually show up to the event with a few metabolically healthy things that I can eat and share with others. So it’s both selfish, but also to inspire others of like what a healthy passed hors d’oeuvre can look like, or something that you don’t add to a table at a holiday party.

Dr. Casey Means:

So I’ll usually ask the host if they want people to bring stuff, and then bring one or two things, maybe it’s like a big bowl of mixed nuts that are like dry roasted and not covered in oils. And then some sort of cooked appetizer, like I’ll do a mushroom cup with hearts of palm and cashew cheese, a stuffed mushroom cup, or a crab cake, or something like that, that doesn’t have any breadcrumbs in it. Just something that I know I can eat, that’s going to be delicious so I don’t feel deprived at the party. So that’s kind of one of my go-tos. Takes a little bit of work, but I think what you’re talking about is so clear. This takes preparation. I mean, for us to achieve our goals and work towards metabolic health, it does take having to think ahead of time, and that’s just the reality, but the pay-off is definitely worth it.

Dr. Casey Means:

One of your 12 myths about metabolic health is that health problems come with age. And you really give a compelling case of why that’s not true. Why a slow decline or death is not something that’s in our fate. Can you just speak to that a little bit, and what your vision of sort of healthy aging looks like?

Dr. Philip Ovadia:

Yeah. So again, we have normalized being unhealthy in our society. And when you look around you and everyone is unhealthy, 88% of us are unhealthy, the statistics show that by the time you’re 50 years old, more than half of people are going to be on multiple medications, not just one medication. So, we’ve just come to assume that it’s normal to be unhealthy as we get older, but there’s really no reason that should be. And when you look at our grandparents, our great grandparents’ generation, that wasn’t the case. When you look at the few sort of still ancestral kind of tribal populations we have in this world, that’s not the case for them either. And I think we need to get back to that expectation of being healthy for the majority of our lifetime.

Dr. Philip Ovadia:

One of the other things I see around me, the people that come to me say, “It’s not even that I necessarily want to live longer, it’s I want to live healthier, I want to have a better quality of life for whatever time I happen to live.” In the end, we can’t predict how long we’re going to live, there are things that happen unexpectedly that can cut our life short, but we just want to be healthy to be able to enjoy our life, our children, our grandchildren, our families, enjoy whatever activities it is that we choose to do to have the energy to be able to do that, to not be in constant pain all the time.

Dr. Philip Ovadia:

And these are the things that have been normalized in our society, but I don’t think they should be and they don’t need to be. And if you’re intentional about the choices that you make, if you take back control of your health and you start to do the things that are going to support your metabolic health, you can be functional and healthy for the vast majority of your life. And I think that should be everyone’s goal.

Dr. Casey Means:

I love that. I’m just curious, I know that we can’t have an exact number here, but in your estimation, how much of the heart surgery and cardiac procedures that are happening in the US every year do you think is totally preventable if diet and lifestyle were fully dialed in?

Dr. Philip Ovadia:

Yeah, I think when you’re looking specifically at coronary artery bypass grafting, so again we’re not talking about the congenital malformations and stuff like that, when you look at coronary artery bypass grafting, I would say that probably 90 to 95% of that is totally preventable if we had the proper focus on health and lifestyle.

Dr. Casey Means:

Wow, that is amazing, especially because, obviously, heart disease right now is one of the leading cause of death in the United States. I believe we have around 600 to 700,000 people per year who die of heart disease. Since COVID started, have had almost twice the deaths from heart disease as we’ve had from COVID. And to know from someone who’s literally in there doing these surgeries, that it is possible to greatly reduce this mortality and morbidity, I mean, that’s huge.

Dr. Casey Means:

And what is so wonderful about your book, there are so many wonderful things about your book, the practical tips, the frameworks-based thinking, but really the thing that hits home in the book is it’s about personal empowerment, it’s about us taking control of our health and being our own advocates, and then you give people tools of how to do that. So, I just want to encourage every single person listening to buy the book, read it, it could save your life, it could save a family member’s life. Thank you so much for being here, Dr. Ovadia. And where can people find you or follow up with you online?

Dr. Philip Ovadia:

Yeah, so the book again it’s, Stay Off My Operating Table. It’s available for pre-order now on Amazon and the other online sellers. The release date is November 11th. My website, ovadiahearthealth.com, O-V-A-D-I-A hearthealth.com, has all of the information on my practice. And I’m very active on social media, mostly on Twitter @ifixhearts. My website also has my links to other places as well.

Dr. Casey Means:

Great. Thank you so much.

Dr. Philip Ovadia:

All right. Thank you.