#1 Heart Surgeon: The WORST Food For Your Heart! (EAT THIS Instead)

welcome to the plant free MD podcast with Dr Anthony chafee where we discuss diet and nutrition and how this affects health and chronic disease and show you how you can use this to optimize your health and happiness both mentally and physically hey guys just want to take a second to thank our sponsor at carnivore bar I don't promote many products because honestly all you need to be healthy is to just eat meat for those times that you're out hiking road tripping or stuck at work and you want nutritious snack that is just meat fat and salt if you want it the carnivore bar is a great option so I like this product not because it's just pure meat but also because I want the carnivore Market to thrive as well and the more we support meat only products the more meat only products that will be available in the mainstream so if this sounds like something you'd like to get behind check it out using my discount code Anthony to get 10 off which also applies to subscriptions giving you 25 hello everyone it's Dr Anthony chafee here again with another episode of the plant free MD and uh today I have a very special guest Dr Philip avadia who's a cardiothoracic surgeon down in Florida and he has been someone who's just written a book called stay off my operating table trying to to coach people to get more metabolic health and uh and and stay away from from surgeons like himself and myself uh Dr vadia thank you so much for joining us oh it's great to be here with the Anthony really excited for this conversation um you know there are well there are certainly an increasing number of Physicians you know in the metabolic carnivore low-carb space um the surgeons amongst us are still somewhat rare and uh especially they're still actively practicing surgeons like you and I so uh great to always great to connect with another surgeon who's you know trying to keep people off of the operating table ultimately yeah well that's the idea you know it's like it's it's nice to have people there that can help you when they're in extremity but at the same time that shouldn't be the default yeah I I agree that that is you know our mission as Physicians you know as doctors we should be uh trying to keep people healthy first and foremost and unfortunately you know the Health Care System worldwide I mean here in the United States and and you know you're experiencing it internationally as well um that has not been the focus of the Health Care System you know we have gotten overwhelmed taking care of sick people and you know we're basically scrambling around trying to keep up with that and we've lost our focus on how can we keep people from getting sick in the first place yeah 100 absolutely and um and you know on that note you know can you tell us a bit about yourself and and your book and and how you think the best way of of uh accomplishing that is yeah sure thing well you know the important thing I think to understand about my journey is uh that like many of my patients I was headed down that pathway I was quite sick myself you know I was morbidly obese I was pre-diabetic and like so many of them I had you know failed at managing this many times I had tried all of the usual teachings you know eat less move more counter calories eat according to the food pyramid um and despite that you know I found myself getting uh sicker and sicker and thankfully you know I came across uh some different ways of thinking um I was extremely fortunate to be at a medical conference a surgical conference as it is and Gary Tobbs happened to be the invited guest lecturer and you know that was just when he had written the case against sugar and of course you know prior to that had written good calories bad calorie reason why we get that and Gary was really the first time I had heard these concepts of the type of food we eat being more important than the amount of food that we eat and the relationship between the two so you know um I read Gary's books I you know started eliminating sugar you know adopted a low carb diet and was able to lose you know 100 pounds uh keep it off you know this is now seven years ago so I've been able to maintain that weight loss along the way I learned about you know what metabolic health is and how it is at the root cause of not only heart disease the disease that I had you know spent 15 years prior to this focusing my career on that it turns out I didn't really understand but most of the chronic diseases that we face in society today and I you know as I learned the importance as I said my my role as a physician is to help patients help people any way I can and so that has you know really compelled me to add an additional component of my uh physician life and to try and help people to remain healthy try to keep them off my operating table and so that's that's really the focus of the book and I tried to write it in such a way that it's easily understandable easily digestible you know it's not one of these real heavily you know cited heavily scientific uh books which doesn't mean that those principles aren't behind it you know I certainly stand by everything that's in the book but you know it tried to bring it to uh so you know people can understand what they need to do to remain healthy and to stay off the operating table yeah and um in in your in other videos I've seen with you and and your book you talk about like the seven principles of metabolic Health what what are what are those yeah so you know again to try and make it uh actionable um I talked about the principles that people need to be integrating into their life uh to help them achieve good metabolic Health uh the first principle is really a mindset and I put it first because I do truly believe it's most important because if you're not thinking about this the right way if you're not approaching about a rare way the the sort of technical aspects of what you do aren't going to be important you know it's not going to matter because uh you're not going to sustain it and it's not going to have the results so the first principle is to view your health as a system not as a goal and that's kind of you know built upon the Scott Adams principle uh but essentially what I try and get people to understand is you know short-term goals aren't serving your health uh if you're only thinking around why you're making some change while you're going on a diet for instance is I want to lose 20 pounds one of two things happens in that situation either you you know you make all the changes you lose the 20 pounds and then you say great I met my goal and the natural inclination is then to kind of go back to your old habits and as we know from weight loss literature uh and you know everyone's experience you gain back the weight and usually more the other possibility is you don't lose the 20 pounds you get discouraged you're like why am I bothering and you go back to your old habits so it doesn't serve you well instead what I try and get people to do what I try and get people to understand is you know thinking about your the system of your health I want to be healthy and so I'm going to find the habits that support that and I believe that this leads to a more sustainable way to think and it's also going to lead you to look at the problem in a slightly different way and then we get into you know what does it actually take to build metabolic health and these are principles like eat real food sleep enough move more um deal manage your stress and then we finally I talk about finding a physician or a partner in this journey who understands this and can guide you and I think that's another very important step and the final principle that I talk about is you know making these sustainable changes and making them one at a time so that you can properly assess kind of what's working and what's not working yeah well he and I think that that every single one of those uh makes perfect sense and is very very good advice I've I've seen people have spoken to people and tried to help people walk through every single uh one of those principles and trying to to better themselves one of the one of them that is is very difficult is exactly what you say the having a physician that is is willing to work with them and help them through that process whether or not they are bought into the idea or or not it's it's important for them to at least be on your side and they say okay well I don't know what you're doing I don't agree with it but I'm here to help you and support you and we'll do your blood tests and we'll see what's going on with it um and people find those sometimes but uh you know they also find the doctors that basically say if you don't do what I tell you you can't come see me anymore which is which is pretty confronting for people yeah and that's a challenge that I hear about often from patients you know they reach out to me and they say how do I find a doctor who you know understands this and much like you said you know my response is your doctor doesn't need to understand it completely they just need to be supportive of it um and hopefully you know they're going to see the results you're getting the changes that are occurring and you know I see those as positives now we get into this situation um all too often that people have a bunch of positive changes they lose weight they get off their diabetes meds they get off their high blood pressure meds they're feeling great yet you know one particular blood metric and uh for me of course LDL cholesterol is the one that comes up uh most commonly uh may move in a direction that many Physicians perceive to be harmful and they will you know because of that they'll say whatever you're doing you've got to stop um and you know that is just a uh it just amazes me that um Physicians can think like that but I understand you know the the programming that has gone into positions that LDL cholesterol sort of Trumps it all and I'm sure we'll get into that at some point during this conversation but ultimately yeah you know if if your physician is not willing to at least work with you on this that's a problem you know I always say you know Physicians are there to help the patient to serve the patient to educate the patient we are not here to tell patients what to do um I've been in the situation I'm sure you've been in the situation where you know we are seeing a patient and it is clear that they will benefit from surgery yet the patient doesn't want surgery for whatever reason uh and it's not my role and it's not your role to you know basically force that patient to have surgery to browbeat them into having surgery it's there it's first of all we should try and understand why they might not want the surgery and see if there is some education or something that can go into it to help them better understand the benefits of surgery but ultimately if they decide they don't want the surgery my role now becomes what else can we do to help you and I would hope that most Physicians take that approach but sadly I know that a lot of Physicians don't take that approach and their view of it is I'm the doctor you do what I say and that is not being a good doctor in my book and if you're a patient dealing with a doctor with that attitude unfortunately you know the answer becomes find another doctor yeah I agree and that was one of the refreshing things I saw in uh you know Dr Ken Berry's book you know lies my doctor told me uh in a lot of those things in each of the chapters basically one of these things that were these misconceptions that have been passed around for decades and he showed the evidence of why these aren't this is you know really not the case and or at least strong very strong arguments why they aren't the case and then you know at the end of it it's like okay so what do you do if you have a Doctor Who's really pushing for this well you can approach it this way and you can talk to him that way and but at the end of the day it's just like you know if you get to this point you're just you know you know kindly and politely walk out the door and never come back you know and just uh and that's something that people have to to be able to do as well you know it's um it's uh I guess it's a bit different in uh you know public systems like here in Australia or in Europe or Canada you have you have less choice on who you get to go to um you can you can just say you want someone else some times you get the choice sometimes you don't but certainly in you know places like America like you know you know we we work for that for them and uh and we can be fired just like any other employee and should be if we're not if we're not doing our job to their satisfaction and um you know it is their health it is their life and if they're not happy with how we're helping them with that then they should absolutely go somewhere else and that should hopefully uh you know give us a wake-up call if we're if we're driving people away then then that should be a wake-up call for us as well yeah I think you know the way that systemic changes happen are that you know basically enough people become unhappy with the system and you know one of the themes I see sort of playing throughout society today this isn't necessarily limited to medicine is that just people are no longer willing to stand up for what's important to them people may not even know what's important to them and again when it comes to your health you know one of the first steps to success is declaring is acting in such a way that demonstrates that your health is important to you and you know for a lot of people they are very passive about their health they don't think about it they don't act on it um they they kind of take the attitude my doctor is going to keep me healthy you know the government guidelines are going to keep me healthy but the evidence is all around us that that isn't working we just become more and more unhealthy so health is not something you can Outsource health is something that people need to actively be engaged in and you know of course in a lot of ways we're reaching to the uh choir here you know anyone who's listening to this podcast obviously has some sort of interest in their health um unless they just you know think Anthony's a good-looking guy and uh like the sound of your voice they came to this podcast for a reason and that's because they care about their health and that that is the first step um you know Finding positions like myself finding Physicians like you uh all the other you know great Physicians that are in this uh you know Community um that is the first step and yes it takes a little bit of effort it's not as easy as you know waiting for your insurance company to assign you a doctor or waiting for the government to assign you a doctor um it might cost you some money you know you might have to pay out of pocket instead of your insurance covering some things but these are all investments in your health and if your health is important to you you know you're going to start making those decisions in a different manner absolutely and um so you know on that on that note what are you eating now as a heart surgeon what's your what's your diet like yeah so my diet is I would say very heavily carnivorous um I you know not going to say I'm a hundred percent uh but I am mostly carnivore you know on a day-to-day basis it's going to be Animal product uh it's a lot of meat uh fair amount of seafood living where I do them in Florida uh we have that benefit uh eggs um and you know some Dairy um and you know occasionally I'll have something else I'll have a baked potato here and there I'll have a you know some dark chocolate here and there um you know once a month uh you know I'll be out to dinner uh and you know have a bite of cake or something with the kids I mean I am human but it is um carnivore focused animal protein Focus uh protein really has become my priority and this this is an evolution and I think this highlights the importance of individualizing our approach to nutrition with people because what I needed to do to lose a hundred pounds is different than you know what I need to do now to maintain it and also what uh you know my current focus on you know continuing to build more muscle uh dictates that protein you know needs to be the priority uh so you know the way I think about what I eat today is you know I want to get a certain amount of protein in throughout the day and um you know I kind of take what comes with it and again that's that's primarily in the form of animal protein which I do believe is the most beneficial uh thing but you know in the book and when I'm working with patients um I am not dogmatic I don't think carnivore is the only way to do this I think it has some very unique advantages that I talk to people about but ultimately if they say you know I don't want to do it that way you know like we were talking about before I'm not here to convince you you know to make you do a carnivore diet because of course that's never going to be successful I'm here to work with you within the framework of metabolic health and that's where I think the conversation needs to start the first thing I do with my patients is help them to understand what metabolic health is how we're assessing it and you know those are going to be the metrics that we're now going to judge is it working for you is it not working for you uh and uh that that sort of the the thinking that I put into you know what I should be eating and what my patients should be eating yeah and well I I 100 agree with that too you know I mean carnivores is certainly not the only way to reverse a lot of these metabolic issues I I think that it um is is I think personally I think that is probably the best way but uh if you want like full full results because you're just eliminating everything that can cause these problems but there's there's you know there's a it can be done in a graduated fashion as well and when I when I talk to patients that are you know sort of coming around to this I just basically just try to make them not afraid of meat not afraid of fat and um and then just sort of talk about some of the the bigger offenders like sugar alcohol carbohydrates in general and night shades and then and then just sort of just try to sort of eliminate out like the the outer Circles of evil and then sort of get them you know closer into you know the core and and you know I certainly don't uh begrudge my patients when they want to eat whatever they want I really don't care I just you know I I'm just trying to help them out and I just try to sort of you know display that you know the best evidence I can for them and then they get to make their own decisions and I'm fully on board with that and um you know so I've even patients that they're just like for religious reasons or cultural reasons they're like well I can't I can't eat meat I can't eat beef you know people from uh you know India and having a religious um convictions in that way you know I still work with I still work with these people and say okay well let's let's cut out the carbs cut out the the nightshades let's cut out the sugars and uh can you eat eggs you can eat it great eat a lot of eggs and um you know just sort of work with them where they're at you know yeah exactly yeah um you know it's uh obviously you know the the um meat issue the red meat issue um is a frequent topic of conversation with my patient you know because they're coming from the history of heart disease many of them um and they have heard their entire lives you know red meat that's causing your heart disease and it you know there's a lot of undoing uh that needs to be uh worked on there there's a lot of Education around that and it you know it's exactly that it you know this is what the data actually shows and more important than that um it's you know this let's look at your results you know uh you're you're here for the patients that I'm operating on you're here on my operating table uh for a reason you know what has led you there um was it really you know was it red the red meat that you have been avoiding um isn't what led you here you know uh so let's look at you know everything that's gone into it and then as we you know go through metabolic Health changes um you know with my patients who are you know in my private practice who haven't you know ended up on my table yet um it's uh but you know a lot of them have evidence of heart disease you know let's start making the changes let's start looking at these metrics of metabolic health and if they're getting better then what you're doing is working for you and uh ultimately you're right more times than not the answer is eat more protein eat more animal protein uh and then you know and with that comes less processed food less carbohydrates uh you know uh less of the toxins uh that uh unfortunately or so so prominent in our food these days yeah absolutely and then so so the the heart surgeon's not worried about saturated fat then the heart surgeon is not worried about saturated fat and no one else should be you know we have to we have to acknowledge that even the you know American Heart Association and the U.S dietary guidelines have both said that saturated fat is not a nutrient of concern um and yet you know that message hasn't uh intentionally I would say uh but you know saturated fat is not the problem and especially you know the saturated fat that naturally occurs in animal products is not the problem um and but unfortunately you know until we get past that problem um we have a major challenge because all of the downstream thinking that has come from that problem uh we then need to acknowledge it's flawed uh and again you know the LDL cholesterol comes up all the time and what I tell people is it's not that LDL collectoral is meaningless it's just not the most meaningful metric we should not be judging People's Health based on one number on your blood panel um and honestly I don't care what that number is LDL is the most common one that we seem to get fixed that we get fixated on uh but you know our health is a very complex system and to think that we can reduce that to one number is just you know foolhardy and again this is where I challenge the doc the doctors to start pushing back to start thinking for yourself you know do we really think that we can adequately manage something as complex as heart disease based on one number on one blood panel typically check once a year uh you know it's it I I it just on many levels it amazes me that Physicians have allowed us allowed this to happen to us but I do step back and realize that for the first 15 years of my career I thought exactly that way because that is what we're surrounded by that is what the system you know mandates of Physicians uh but I'm hopeful that more and more Physicians will start to wake up to this and and quite frankly more and more Physicians are waking up to it yeah I think it's I think it's funny um you know every you know all of us in America you know doing pre-med we all had to take organic chemistry we all had to take biochemistry we all know how just bloody complex the body is and and yet we think that just this one marker like that that explains everything like really is that really what you think if you did you think about it you know and the hba1c comes down you're you're high you know High sensitivity CRPS come down you know all these other markers they they all uh come into optimal levels HDL goes up trigly strategy going down but oh your ldl's a little bit up stop it just shut it down you know and then okay go back to doing this other thing that made you obese made you sick made you diabetic major HP A1C well but at least your your cholesterol your LDL cholesterol is okay yeah but your triglycerides are worse and your HDL is down and everything else is awful and it's um it's it's not very insightful is it no it really isn't and it's not serving the patients well and it's not serving us this position as well because you know the insiduous uh message behind that is you know if we can truly reduce Health to you know this one number then what do we need Physicians for um you know and you know so if we say heart disease is all about LDL cholesterol well you know then you don't need a physician to you know read your blood you know to look at that number on the blood panel uh we're really you know again as Physicians when we're just you know kind of blindly following these guidelines we're not even interpreting the blood work anymore we're just you know compare the blood work to the recommendations and you know do what the algorithm tells us uh then we're not needed as Physicians and you know that that again is a very dangerous precedent that quite frankly we're already seeing you know lead to uh some bad places uh for Physicians and unless we as Physicians start pushing back against this um we are going to find ourselves in a bad place uh but you know again specific to the LDL cholesterol issue you know we really do need to look at you know all of the flawed science some of it fraudulent science that led us to this point and we need to you know talk about that and expose that um and then we need to look at the failures of this Paradigm you know um and those failures are uh apparent every day you know I operate on a lot of patients who have a low LDL cholesterol level full stop so how can I you know how can I as a you know logical person look at that and say well it's all about LDL cholesterol and like I said I'm not trying to say that LDL cholesterol is meaningless we just have to realize that LDL cholesterol isn't the only part of the story um and unfortunately we don't and you know it's interesting when I get on social media and I say something like that I'll have a handful of Physicians who you know come back at me and say well no one thinks that it's only LDL uh you know of course it's more complex than that but I'll have 10 maybe a hundred times more patients you know who will say yeah the only thing my doctor tells me is take a Statin and that's how you know that's the only conversation around heart disease is lower your LDL cholesterol take a Statin you know uh eat a low-fat diet whatever it is that's you know uh the tool that they're using but that is singular Focus that the patients are perceiving at least so there's that disconnect uh between you know what doctors think we're doing and what patients are getting from us yeah and and and the funny thing is too is they may say that but it but like you're saying like in in practicing in reality they're they're doing they're they're focusing on this they're very myopic and we go we get my optic we look at cholesterol this is the only thing that can be wrong we just focus everything on fat and cholesterol and and then you have aisles full of fat-free candy and it just blew my mind as a kid and you know that one didn't get past me even as like a small child I'm like I don't know that that doesn't make any sense you know like who cares but doesn't have fat it's candy there's no what you can't tell me that candy is good for me even though I like candy I'm a kid but no and um I was in I was in the debate with um well there were six of us I was the only non-cardiologist and so there were three on on the side of saying arguing that we got it wrong as far as you know just cholesterol being the only the end-all be-all and then the three three people against us were arguing that no no no this is this is absolutely right in fact it's more right than ever and we have all this information and they were they were arguing exactly that that just LDL cholesterol which was just the end-all be-all and that that was it and they were just reciting the same same studies that were just you know regurgitated ad nauseum and uh and you know we know we're fraudulent and I made the entire argument I was just like this isn't even an argument it's not a debate it's a matter of record there are all these things these were fraud these were set up we have hard evidence that these were fraud we have the contracts that these people were paid to you know fraudulently make these claims and um you know the guy that that wrote that was head of the USDA and and wrote the 1977 declaration that cholesterol caused heart disease this guy was in the pay of the sugar companies we we know that for a fact we have their own records on it so I just argued I was like look this isn't this isn't uh even a debate this is this is a matter of record this was a lie this was fraud and you know if you have something based on on a you know misconception or false premise you have to just throw it all out and start from the beginning and I sort of made the case okay so what is going on it's an inflammatory pathway and all these sorts of things you know and and and just showed with the evidence and and biochemically like hey this is not cholesterol in heart disease out as evidenced by the fact like one study it was like 140 000 people with heart attacks in America uh half of them had low cholesterol it was 50 50 it wasn't even like 52 48. it was 50 50. you know there's just no correlation in any direction and and in fact the people that then but then their doctor's like well you still need to get your cholesterol down even the people that had low cholesterol the people that either maintained a low cholesterol or lower their cholesterol from high to low they they were dying at twice the numbers as the people who had higher cholesterol uh over two years and so you know what's going on there and um these guys who had literally just spent their entire time talking about how it's LDL LDL LDL LDL um they got so pissed at me when I made this argument just because I just think that they don't have an argument when you just understand that this was all based on fraud and they got all mad at these things oh well you know obviously it's not you know just you know it's more complex than that I I was making an argument it's more complex than just you know cholesterol and then they're like they're like trying to bad mouth my I had seven minutes to make this entire claim I then did an expanded talk on this was 45 minutes long it's like so I'm trying to Crunch in a lot of stuff here in seven minutes and they you know then say that you know oh well it's more complicated what you're doing oh you're just really simplifying this my guys that was my point that you know just saying that just just LDL being the being the pro the answer here is far too simplistic even if it plays a role which it does in a roundabout sort of way involved in inflammation and damage to the LDL um that it's not it's not a one-to-one it's not the more your your CL your LDL cholesterol is the more heart disease you'll have we know that you know and but that is exactly what people do and and of course they're passing this on and you know for these people to say well you know everyone no one no one is saying that trying to make trying to make it seem like you're passing a straw man argument is just not the case because that is in practice is exactly what uh is being portrayed yeah exactly right and you know what we also need to start acknowledging is you know the systemic um harms that have come from that thinking and you know the most obvious is you know below fat food uh which by nature is highly processed food and you know again I I try and always zoom out and look at the big picture and the big picture is this you know since 1977 really since 1957 we have been focused on saturated fat as the cause of heart disease we have changed our whole food system around it we um have a class of medications statins that are the most widely prescribed class of medications worldwide um the macro data all shows that you know we eat less fat and especially less saturated fat today than you know we did 70 years ago and what has happened during that time heart disease is still the number one killer worldwide obesity diabetes you know all of these other things metabolic disease has skyrocketed so any logical person you know has to step back and say this isn't working uh now unfortunately many people look at that and say well the reason it's not working is because we're not doing it enough we need to push this even more you know roll out the pcsk9 Inhibitors Drive people's cholesterol levels down to zero uh you know go go on a zero fat you know esselstein you know diet and you know clearly that that is not the answer because those people uh get very sick uh and uh you know I I I have a few of them who you know thankfully have had their eyes open and they've come and you know found me and and are open to taking a different approach uh but ultimately you know again we have to acknowledge that we are losing the battle we're losing this war against heart disease and so it's time to start thinking differently about the problem yeah and so so what is your typical patient these days you're obviously you're still you know very involved in cardiothoracic surgery are you able to to coach people I mean sort of at that stage it's sort of you know the horse is out of The Barn at that point you just sort of have to deal with the problem at hand but are you able to address their metabolic health or do you have a an area of your practice where you do that yeah so I actually have uh two separate you know uh professional lives you could say practices these days uh so I continue to work as a cardiac surgeon um I actually do that at a Locum surgeon I travel all around and go to different places heart surgeons are actually in very short supply in the United States which should be another scary realization to people uh that if you end up needing the heart surgery um there's a chance these days that you know the hospital you end up at doesn't have a surgeon to do that surgery and that's a very real problem these days so um and then I have a telemedicine practice online it is a full Medical Practice where I help people you know to stay off my operating table I help people to improve their metabolic health and honestly some of them are you know um uh some of these patients in the telemedicine practice have already been on the table they already have parts of these uh and they're trying to figure out how best to you know keep that from being an ongoing problem in their lives how to stop the damage from getting worse but that is the full telemedicine practice I provide full Medical Care to people through that um as an offshoot of that I also have a coaching program uh that I am actually uh launching as we record this episode um you know I'm trying to find as many ways as possible to work with people and of course the book is out there and you know my own podcast which um you know will put a little plug uh you are the guest uh this upcoming week for we had another great conversation it's called the stay off my operating table podcast uh so I have a lot of ways that I work with patients um but circling back to my heart surgery role it's you know I approach heart surgery a lot different today than I did you know 10 years ago because I now realize that you know the surgery is a Band-Aid it fixes the acute problem it deals with the acute problem but it doesn't address the underlying cause of why that patient ended up on my operating table so I have that come conversation now with patients I sit down with them and say listen you know we're going to do the operation or you know we did the operation um but we need to address why you ended up needing this operation and let's talk about you know what you're eating your habits all of those principles let's talk about what metabolic health is I know this is not something you probably heard from your doctors before I know that some of this advice is going to you know you're going to get different advice from some of your other doctors but again look at the evidence because for many of these patients you know they end up on my table they've been taking the Statin they've been eating the low-fat diet and they ended up on my table and so I just you know I say to them and and they understand this you know when I talk to patients about metabolic health I talk to them about processed food they they they get it uh you know they they understand that you know my great-grandparent uh was eating a lot of butter a lot of lard uh and a lot of bacon and they didn't get heart disease and yet I'm here having heart disease and I I've stayed away from that stuff my entire life so you know it makes sense to them it's just that again they've been sort of they've heard this messaging all around them from their Physicians from the government uh from everyone else and they you know they need the education the re-education I guess we call it uh to you know to give themselves permission to basically live in what is a more instinctual way um is really what it comes down to yeah and then um so speaking about all that like so so presumably you know addressing this and you know the best way to keep people off your table is by being metabolically healthy and by eating the right things and going through all the the tennis the seven principles uh that you have if um is that right or is there more to it than that uh you know I think that the vast majority of it you know as always there's going to be individualization there's going to be particular circumstances um but you know uh kind of uh high level you know Pareto Principle uh if you start there you're probably going to get at least most of the way if not all of the way to where you need to be um but yeah you know again this is in the data um you know all of all of Gerald riven's work uh you know throughout the 1980s um and uh you know into the 1990s showed that insulin resistance is the number one risk factor for heart disease um and you know that that again that data is there it's in the studies if uh you know all of those people that you were debating uh you know want to you know feel uh you know are so tied to the science to the studies well then actually go and read the science read the studies and it's clear um I was unable to find I put together a talk uh last year for uh one of the low carb meetings um and I looked for every study that compared insulin resistance to LDL cholesterol as a risk factor for heart disease and there is not one study that shows uh that it's even close I mean we're talking about five six x differences between insulin resistance and LDL cholesterol is a risk factor for heart disease so even if we accept you know that LDL is a risk factor for heart disease insulin resistance is a much bigger risk factor so if we're doing an intervention that fixes insulin resistance even if it and again only in some cases raises LDL cholesterol that is a net positive trade-off uh so you know these are the types of conversations that I have with people and like I said most of them understand it at an instinctual level it makes sense to them and uh therefore they're able to implement it and you know they have great success with it yeah and it reminds me I was reading uh today actually there was um there's a paper on uh heart disease and metabolic disease in India and you know people say there's like well you know people in India they're very slender and they're very skinny and they there's a big vegetarian component to their diet but they have some of the highest rates of type 2 diabetes in the world they also have some of the highest rates of heart disease and I I saw some pretty shocking numbers that I believe that uh 50 of the heart attacks in India happen in people who are under the age of 50 and um and I think 25 happened under the age of 40. which is pretty crazy that uh yeah massive massive heart attack rate yeah and this does a you know I am seeing this trend uh in you know here in the U.S I mean I've been in practice 20 years it's not that long a Time on the grand scale of things yet there has been a very clear shift in the age of the patients I operate on um you know when I was training and when I was early in my career if I was operating on a patient in the 50s in their 50s that was like a shocking event today I I am routinely operating on patients in their 30s and their 40s um and we're talking you know open heart surgery they have very Advanced heart disease um by their 30s and their 40s and you know that Trend uh should be shocking to everyone um so you know it's yes we're better you know we do a better job at keeping people alive longer with heart disease but heart disease is clearly getting worse it is striking younger uh it is having more effects you know on people and uh like I said you know uh heart surgery remains you know one of the most common procedures done in the United States um you know we put in more and more stents um we have people on more and more medications you know we are doing more to treat heart disease uh but we are losing the battle against preventing heart disease and that should be clear to any physician and that should be a wake-up call to you know any physician that we got to we need to do something different yeah well I mean and clearly whatever we're doing whatever the reason is it's not what we're claiming it is we can't be because we're it's not it's getting worse and um it doesn't matter what your what studies say what and how smart you know these people from anywhere are it's not working and um you know I was of the very common sense approach that uh Richard Feynman the physicist said which was it doesn't matter how brilliant your theory is and it doesn't matter how smart you are if it doesn't agree with experiment it's wrong and it's wrong and you know and and that and that's something we can't we really can't escape from and and I'm I'm thankful that when I do point this out to doctors and and just lay people and just point out the numbers like Hey we're doing this and things are getting worse what's going on here they go like damn it that's right you know and then you can you have a you have a foot in the door and you can sort of uh go from there um speaking of Gary taubs um you know someone who also wrote very very interesting books was uh Nina Thai Schultz and um who's done a lot of great work and I just had her on the show as well actually and um I watched one thing that she was talking about on seed oil she did a great talk on seed oils and and she showed there was a graph and it was as as the consumption of seed oils in America went up the rates of heart disease went up and it tracked perfectly it was this perfect correlation and at the same time animal fats were going down and you know saturated fat and animal fats were going down and so how can we even say hey how can we begin to say that saturated fat animal fat and cholesterol is the culprit when it when it's literally going in opposite directions yeah again just looking at macro trends like that you know should lead you to this conclusion so um you know then you start to ask well why you know how did we head down the other pathway how would we I can understand you know starting down the other pathway um you know we can go back to the 1950s and we can say okay we truly don't know what's causing heart disease and you know it was a possibility you know uh you can you look under the microscope at the plaques and the arteries you see cholesterol you say oh it must be cholesterol I I don't fault people for starting to head down that pathway uh but then you start to see all the evidence that spoke against that and um you know and again there what you know into the 1970s this sugar versus fat debate essentially around heart disease was very active even into the early 1980s and then all of a sudden you just see this point where you know the literature completely changes and it becomes all about cholesterol all about fat uh and of course this was the same exact time that statin drugs were being developed and you know the U.S dietary guidelines came out and uh and then again we've all seen the curves of what happened to obesity what happened to hypertension uh what happened to diabetes you know it's a straight trajectory up from that point you know there's a clear hinge point in those graphs that we have to point to so uh you know you look at that and you just have to say you know what what happened here the results of the experiment are clearly failing uh but you know we're just the system the system is always slow to change and you know I'm not going to sit around and wait for the system to change you're not going to sit around and wait for the system to change so what can we do we can work with the individuals who want you know want different want better and when enough of those people start speaking up and when enough positions like ourselves you know keep speaking up the system will respond ultimately but we can't wait for that to happen we have to do what we know is right for the patients what is getting the patients good results and I am seeing them every day um you know I see people stabilize their heart disease I see some reversal in some cases again very controversial but I have patients whose coronary artery calcium scores have gone down 15 20 percent year over year so you know I see the evidence that this is working and therefore you know I'm obligated as a physician to keep doing what I know to be working yeah well and that's the thing you're you're doing the experiment and it's and is working and so it you know you so it is right and and you have to trust that I mean you do have to trust your own eyes um so that's um well certainly you know atherosclerosis would be preventable in the sense that you don't do the things that we're going to cause the development of atherosclerosis but you know you're suggesting there that where you you've stated there that uh you've seen uh according already calcium scores come down so is this is this something that we can reverse as well with with these metabolic changes you know I I I do believe it is you know I I don't think that we can undo everything um you know I'm not gonna say I've had people THC scores go back to zero uh but I think we can you know the body has capacity to heal uh everywhere else you know everywhere we look at we have capacity to heal so why do we think that the heart uh that the blood vessels would be uh any different um and you know but the key point that I you know make the patience is that if you just stop it from getting worse uh you know that's a win uh for most patients um you know you and again you look at it at two levels you know we're looking at their heart disease in particular and then we're looking at their overall metabolic health and so again one of the other things that I see is people who have significant heart disease you know they're in heart failure they have damage to their heart muscle um when they improve their metabolic health they feel better uh and maybe their heart function doesn't change maybe that damage is not fixable their rejection fraction you know stays the same but they still feel better uh at that level so again that's another win why wouldn't we want that for our patients yeah absolutely and and what are some of the things you look at for metabolic Health as far as has blood tests and things like that yeah so I always start with the basics and and uh you know when we go through the five measures of metabolic Health those are your waist circumference your blood pressure your you know fasting blood glucose or your hemoglobin A1c level your HDL cholesterol and your triglycerides and again I always point out to people LDL is not on that list uh so you know that's where I start now obviously with my patients I get a lot more uh it gets a lot more complex and we're looking at things like insulin levels we're measuring insulin resistance um you know based on uh you know my favorite metric is probably the lpir the lipoprotein insulin resistance uh score which is based on the distribution of the size of your lipid particles because again it's not that lipids aren't important is that LDL doesn't tell us what we need to know about the lipids we need to know whether these lipid particles are damaged whether they're atherogenic and that's where you get into particles sizes Advanced lipid panels that I think are very important but ultimately you know it becomes all about insulin resistance and inflammation like you mentioned earlier is part of it as well so see reactive protein uh there are sometimes some other you know again more advanced metrics that I look at like myeloperoxidase um or lppla2 activity you know you can you can get very deep in the woods and oftentimes we do uh but you know be for people at home the message is start with the basics you know know those five numbers of your metabolic health and uh they will you know they're going to give you a pretty good indication of whether or not you're metabolically healthy and unfortunately the data shows us the answer more often than not is you're not metabolically healthy now your audience has skewed my audience is skewed when I've told them uh but you know 88 of the adults in the United States cannot meet those five basic metrics of metabolic health and that's where we need to start yeah definitely and so how have your your colleagues in um you know cardiothoracic surgery and Cardiology how have they uh you know come to accept this or you know if you you got some converts on the way or how's that like um you know I I would say I have some uh so it's interesting you know many of my colleagues say oh yeah you know low carb diets are great um but they won't tell their patients that uh and that's that's the struggle you know I I see more and more Physicians who just they do it for themselves they know it for themselves uh but they just you know can't uh get past that uh you know the influence of the system you know that they perceive won't allow them to you know kind of talk to their patients about that so uh you know that's a lot of the education that I end up doing with my colleagues is this is supported by the data this is you know within the community standards um we can be telling our patients about this um but but yeah that isn't very uphill battle and uh you know um uh it just like I said I I think the best approach to this problem is working with the patients who you know want and need this education um and it's going to be a ground up movement but I'm always encouraged you know going to the low-carb medical meetings um you know we see more and more Physicians there more and more Specialties of Physicians there uh and so they are starting to wake up to it you know we have the younger Physicians uh that are waking up to this we have medical students like Nick norwitz who's you know doing a just a bang-up job uh getting this message out about metabolic health and so that that is where I see the encouragement that is where I See the Light uh that ultimately you know it the logic the science um the um instinctual uh thing about all of this um is going to win out in the end yeah well I think so too I think I think the the truth will out and that this the results are too dramatic for people to ignore forever and as as we're sort of hitting a critical mass now where a lot of people have have to take uh pay attention and take notice and so we're starting to get on on bigger platforms and and and and and at least get you know the the different larger you know authorities if you will in diet and nutrition at least coming out and and speaking out against a carnivore diet or a high fat animal based diet because you know it's it's big enough that they have to start talking about it whereas before if they just ignore it um you know that that means that it's just it's not even on the radar well now it's it's grown enough that people have to take notice and at least try to detract it from it and I think that's a very positive sign and um you know and and uh you know um any any publicity is good in a sense because it at least raises a question and people go like well okay well what is what is that why oh yeah that's crazy why are people doing that and they go wait a minute why are people doing that and why does that guy look way more jacked than the other guy who's saying uh you know you should do do the other thing you know I mean I think um you know there are a lot of people I mean there are some pretty fit you know people that that push uh you know like a plant-based diet but uh they're pretty fit but some not all of them and and uh you know like like you know Dean ornish doesn't look healthy uh Michael Greger is not in the best you know physical specimen um and even um Dr Fuhrman who wrote the book um was it like Eat to Live or something like that you had the Gomes diet yeah you know he's he's not aging well I I I actually sort of feel a bit concerned for him because he looks he looks quite frail he does he's not healthy yeah and again you know show your metabolic Health markers I mean you know as as much as I love uh you know all the uh physique Friday posts and stuff like that we really got to get like maybe metabolic Health marker Monday you know we just don't start posting our metabolic Health markers because ultimately you know that's what it comes down to and uh you know again I agree with you now that that as at least we're talking about it you know it's uh the progression is first they call you crazy and then it becomes we agreed with that all along uh and so we got a lot of work to get there um but um we are making progress and um you know if we just can start having the conversation about you know the majority of our health is related to what we eat um and let's just start there you know so you know the plant-based doctors uh you know at least they're getting people to eat better in some cases than the standard American diet you know we have to realize that plant-based diets are often very processed uh and you know so that's not going to be any better but if you're truly doing a whole food plant-based diet and you're you know eating a whole real food okay that's going to be better um and you know you and I have seen it many times because uh you know I've there are all these people that have now spoken to and there are these patients in my practice who you know say exactly that you know I got off the standard American diet I started doing the whole food plant-based diet I felt great for a while um my health got better for a while and then it stopped uh and then it started getting worse again and you know maybe of them have switched you know that 180 switch to carnivore uh from uh you know Whole Food plant-based diet and now they're like you know and now it's many years later and they truly are thriving um and so those you know those are probably some of the best Arguments for It ultimately uh but again at least acknowledging that what you eat is the primary determinant of your health if we can just get that conversation in the Health Care System truly not you know just lip service but in the Health Care system that we're going to talk about what you eat before we write that script um that's going to get us a long ways yeah oh I think so I think that's um so important and that would just be amazing like if I I think if if I had an influence in getting us there and we actually got there I would consider that um very I would be very satisfied with that I'd be thrilled with that I don't know if it's going to happen I hope it happens and that's definitely what I would I would like to have happen and I think I think it really needs to because what we're doing is isn't getting us there you know we're coming up with very very very interesting novel and intelligent Innovations on how to like you say uh maintain a state of disease for longer and perpetuate that for longer but it is still maintaining perpetuating a state of disease as opposed to getting out of a state of disease which I think is that I think that is what we're supposed to be doing as doctors and and what we could be doing as well um I did want to ask a couple questions uh these are these are questions that I get quite a lot um specifically in heart disease does anything does all this change like with familial hyper hypercholesterolemia um with like uh does that change the metric should you avoid uh you know fat and cholesterol if you have that yeah you know we really don't uh I I don't believe that it does change it um you know I think it just doubles down uh it kind of you know leads us to okay we need to be more careful about uh the inflammation we need to be more careful about the metabolic Health uh but again when you look at the FH data um you know uh and uh you know Malcolm Kendrick has gone through this in detail David Diamond uh has gone through it in detail um you know when you look at the FH data um one of the interesting data points is that there's no difference in mean cholesterol levels between FH patients that have heart attacks and don't have heart attacks um you know so uh again it's you know FH seems to be more about the inflammation the um the uh they're more prone to you know blood clotting to thrombus formation uh and it's probably not about the cholesterol you know even though that's obviously the focus of uh FH so I don't believe it really changes uh what you should be doing um if you have FH I think it really should be prompting you to be even more uh you know focused on your metabolic Health yeah anything that makes perfect sense you know we're still humans and you know there's still going to be an optimal way of eating and I don't think that changes to any significant degree based on you know a condition like that or or anything else we are still humans and this is there there is an appropriate way to eat and there are inappropriate ways to eat and I think that um you know having a high fat meat-based diet is the appropriate way to eat and so if that premise is true then it should be true in in all of these situations in conditions options yeah yeah exactly yeah um great well Dr Valley I know that um uh you know you have rounds to do in the morning so I don't wanna I don't want to keep you all day but I really really appreciate you coming on I'm really glad that we were able to to schedule this I know we're both we're both busy and we're both on the opposite side of the world so it can be difficult so I I really do appreciate you taking the time out to speak with me today it was an absolute pleasure yeah thank you Anthony thank you for everything you're doing um as I said at the beginning you know it's just great to see uh more and more Physicians more and more surgeons you know speaking up about this uh that uh you know we we truly are in many ways looking to put ourselves out of business and I think that's a very Noble Pursuit uh and you know ultimately we have to do what's going to help people to be their healthiest and that is typically going to need not needing surgery and you know I've said it many times it will be a great day if I get to a point in my career where there's just no more surgery for me to do um unfortunately the evidence is that that's very unlikely but uh maybe if all this longevity stuff uh you know ends up working and I can be a surgeon until I'm 150 we'll get there yeah yeah well that'll be well something to shoot for anyway um yeah yeah how do we get a hold of you and uh and where can people find you and follow your work yeah so uh I fixed heart uh that's my uh handful on Twitter and ifixwork.com is uh my website um you can go there you can find out about the uh programs the group coaching program which I'm launching um my medical practice um is at ovadiaheartthealth.com so any of those places uh or uh or where you can find me fantastic and the book the podcast book called stay off my operating table and they're on all the usual platforms awesome we'll put uh links for all that in the description and people will uh be able to find you there so great well thank you so much it's been it's been an absolute pleasure and hopefully we can do it again and I think we'll be seeing each other on the the reverse show are you going to be able to go to that uh yes that's uh I'm just making my uh Arrangements now yeah I look forward to seeing you there oh perfect yeah well I will definitely see you there man looking forward to it awesome okay all right we'll see you later [Music]