Latest / Gladden Longevity Podcast / Preventing Heart Disease: A New Paradigm - Episode 354

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Preventing Heart Disease: A New Paradigm - Episode 354 · Gladden Longevity Podcast

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I was a morbidly obese pre-diabetic heart surgeon for most of my career.
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And I came to a realization that I was headed for my own operating tables.
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And more important realization was I didn't know what to do about it.
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The advice that I had been trained to give the patients wasn't working for me.
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It wasn't working for them. And that's what really got me asking some different
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questions.
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Welcome everybody to the Gladden Longevity Podcast.
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Dr. Gladden here. I just finished a conversation with Dr.
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Philip Ovieda, and he's a cardiothoracic surgeon that has had some real epiphanies
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and insights around the role of insulin resistance in cardiovascular disease.
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He's written a couple of books.
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stay off my operating table and stay off my kitchen table.
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We're gonna go down the rabbit hole a little bit on how to prevent heart disease,
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how to treat heart disease, and if you have it,
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how to
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Help reverse it. So you're gonna find this a really interesting conversation.
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It was ~ very fun, he styled a very like-minded colleague.
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From saving
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hearts as a cardiologist to rewriting the entire aging playbook.
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Dr. Jeffrey Gladden believes 100 is the new 30 and he's got the science
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to back it up. This is the Gladden Longevity Podcast.
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Hey Philip. Welcome to the Glide and Longevity Podcast.
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It's good to see another cardiovascular physician here.
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It's ~ kind of few and far between,
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quite honestly. So
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Good, yeah, for some reason the cardiac space doesn't seem to have
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the focus on longevity that I think we should.
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Yeah. You know what's interesting is I just I had co-founded a heart hospital here
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in in Dallas with people at Baylor and another cardiologist that's grown
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up into a quite an institution.
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But ~ I left all that in two thousand twelve and I just got an invitation
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to go back and give a lecture on longevity to some of the staff there this month,
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as a matter of fact. And I thought,
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wow, that's really a full circle moment to think about the fact that
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the cardiology staff is now starting to think about longevity.
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It's
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You know, when I left everybody was like,
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you know, what are you doing? I mean,
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you know, how can how can you leave what you built and they were doing
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and all this other stuff? And it's like,
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Well, you know, I I am asking different set of questions now and I've gotta follow
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my gotta follow my heart here.
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So
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Yeah, and I think that's a lot of my journey as well.
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You know, it's interesting. Obviously,
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if you want to think about longevity,
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right? I always say the the first piece of longevity is not dying.
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And the number one thing we die from is heart disease.
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So there should be a lot of consideration there.
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And unfortunately, I think our,
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you know, sort of healthcare system,
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you know, has been overly focused on taking care,
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right?
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of the people with heart disease and trying to keep them alive longer once they have
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the heart disease, but we've completely missed the opportunity
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for preventing the heart disease in the first place.
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And that's where the real longevity comes from.
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Because as a cardiac surgeon, what I've come to understand is doesn't matter
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how good I might be as a heart surgeon.
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That patient is never as good after they had the surgery as they would have been
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if they didn't need the surgery in the first place.
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Yeah. And that's what's led to the refocusing of my career.
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Yeah. Well that's an inter I mean,
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that's an interesting perspective that you came to that perspective.
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I think a lot of physicians intuitively know that,
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but they are so caught up in what they're doing.
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And you know, I mean, I loved what I did for a number of years,
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right? I mean, I thought we were doing good work and helping people
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and all that good sort of thing.
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And it was ~ you know, it was a very innovative time.
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It was kind of pre stent when I actually started my practice.
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So, you know, we went through a lot of different iterations of therapies and things.
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And I found all that very intriguing.
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But it's interesting to me that you kind of came to this realization
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and you're still practicing surgery,
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if I'm not mistaken. But walk us through a little bit wh where
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was the transition point for you?
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What kind of led to your epiphany here and then the implementation of that insight?
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Yeah, so the transition was really a personal one at first.
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Okay. Because I was a morbidly obese pre-diabetic heart surgeon ~
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for most of my the first part of my career.
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And I came to a realization, you know,
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and this is now going back ~ well over a decade,
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that I was headed for my own operating table,
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so to speak, right? I was following that path that so many of my patients
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and the patients that you would have been seeing.
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you know, had gone down. And more important realization was I didn't know what
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to do about it. I didn't know how to fix it.
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Right. The advice that I had been trained to give the patients wasn't working.
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Wasn't working for me. It wasn't working for them.
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And that's what really got me asking some different questions.
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And ultimately, you know, I was able to r first improve my own health.
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I lost a hundred pounds or reversed my pre-diabetes.
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And then I came to realize that,
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you know, the what I had done to do that really challenged some
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of the fundamental beliefs, right?
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The the fundamental things that I was told to be true about heart disease.
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So walk
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us through that. How did you actually diagnose yourself as being pre-diabetic?
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I mean, the obesity, I can understand you stand on a scale.
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Did you just intuit that hey, I have insulin resistance or you did some testing
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or just walk us through a little bit of the mechanics of that.
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And then, you know, the standard,
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you know, calories in, calories out,
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exercise more doesn't always work,
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right? And so you obviously press beyond that.
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So walk us through that as well.
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Yeah, so you know, like you said,
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the obesity was obvious and something I had struggled with since you know,
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childhood essentially. And then,
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you know, it was getting my annual blood work one year and my hemoglobin
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A one C was, you know, five point nine.
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And I realized, you know, I was headed down ~ a bad pathway.
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I fortuitously started to come across some information on things like
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low carb diets. This all actually started indirectly.
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~ my wife had seen a practitioner who suggested to her that eliminating gluten
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might help with some of the symptoms she was having at the time,
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~ real bad heartburn and stuff after she had had our daughters.
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And being the supportive husband I am,
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I said, ~ you know, sure, I'll do this with you.
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Now in the back of my mind, as the cardiac surgeon I was,
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I was thinking, Well, this makes no sense.
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You know, you don't have celiac disease.
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But, you know, so we went gluten free.
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And this was, you know, 2013 ish.
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They didn't have all the gluten free stuff.
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So we sort of unintentionally went low carb.
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We stopped eating bread and pasta,
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right? And we went kind of low carb and I started to feel better.
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And you know, honestly, even at that point,
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I didn't really think much about it.
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And then fast forward a few months,
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and I'm at the Society of Thoracic Surgeons annual meeting.
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You know, 2,000 heart surgeons,
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and it's the big meeting for cardiac surgeons.
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And there happened to be a guest speaker that year by the name of Gary Tobbs.
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He had ~ written a book, The Case Against Sugar.
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And he was up there talking about how it's not.
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how much you eat, it's what you eat and the hormonal influences.
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And really, you know, yes, of course I had heard somewhere in my medical school,
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you know, training about insulin resistance,
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right? But it's not something we were talking about,
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you know, it it's not something that was looked at commonly,
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as you know, in patients with heart disease.
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But, you know, he started talking about it.
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It made sense. It kind of explained what I had already started to
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~ experience from you know gluten-free.
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And that's when I really intentionally went on a low carbohydrate diet.
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And then as I got more and more into the understanding of the role that insulin
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resistance does play in heart disease,
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in most of the chronic disease that we face.
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And that was really, you know,
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what has refocused me both professionally and personally.
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The good news is is
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I've been able to maintain the weight loss,
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which is not something I had ever been able to do in the past.
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And I am much healthier today,
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you know, at fifty two than I was at thirty two.
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No, that's become my passion.
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Yeah. That's wonderful.
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Mm-hmm. Yeah, that's great. So it sounds like you've stayed on this low carb diet.
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You know, permutations on that are of course ~ intermittent fasting,
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five day fast mimicking diets,
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people going ketogenic, people measuring ketones,
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take people taking exogenous ketones.
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I'm just curious in your own trajectory here.
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Were any of those dabbled with or tried or become part of the the routine
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or not felt to be necessary? Or how d how did you navigate that landscape?
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Yeah, I would say all of the above and more.
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So I have landed on a largely,
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you know, carnivore diet, a meat-based diet,
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which of course, you know, very much flies in the face of again what I
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had been told to believe that red meat is bad for the heart and bad for our health.
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And I've settled on a point where I have achieved the best health of
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my life eating almost nothing but red meat.
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Now, I don't think that's the only way to do it.
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Like you said, there's lots of flavors of this.
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I think at a high level, what we need to help patients to understand
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is eat real food, right? That's where it starts.
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We are in an environment where ninety percent of what is put forth as food
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is not really food, right? It's chemically manipulated,
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it's highly processed, it's got carbohydrates and fats that our bodies just don't
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recognize because they did not exist.
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For the vast majority of our existence as human beings.
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And then I think once you get within that,
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right, there's some latitude to understand the relative balance between plant
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products and animal products. And,
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you know, my bias is towards animal products.
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Animal products are the most nutrient-dense bioavailable foods.
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And I think the reasons that we have demonized them in the past,
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we need to acknowledge, are not really,
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you know, solidly grounded in.
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Science, right? Fearing saturated fat and fearing dietary cholesterol.
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I think we now have an understanding that that is not the primary driver
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of heart disease. Does cholesterol as a you know particle,
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as a molecule, play a role in the development of heart disease?
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Yes, it does. And we need to understand that,
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but we need to understand the nuance of it.
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And, you know, again, what was put forth as the diet-heart hypothesis?
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You eat cholesterol and saturated fat,
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your blood cholesterol level goes up,
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and then that cholesterol gets stuck to your artery walls,
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and that's what causes heart disease.
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We know it's more complex than that.
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We know it is not as simple as that.
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And that's what we need to, I think,
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really start to acknowledge more in the world of cardiology,
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if we're going to truly start to make some progress against this disease,
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that quite frankly, we've been failing to make progress against.
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for the past forty or fifty years that we've been operating under that hypothesis.
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Yeah. Yeah, a thousand percent.
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I think it is interesting. We've kind of come to understand in our view here that
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it's not about cholesterol numbers per se.
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It's really about reverse cholesterol transport.
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What's the body's ability to move it around,
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right? And some of that's genetically influenced,
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let's say ApoE four people have dip more difficult time doing reverse cholesterol
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transport than ApoE two people.
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And so understanding people's genetics and there are other genes that actually point
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towards HTL.
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capacity for reverse cholesterol transport,
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which is a considered the good cholesterol,
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the HGL cholesterol, because it's associated with reverse cholesterol transport.
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So we know that Apo A1, for example,
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that SNP is very, very important.
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So understanding some of the genetic underpinnings for reverse cholesterol transport
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is important. And then trying to manipulate that and improve it with,
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you know, different supplements and things like that.
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So we know that, you know, we can we can move that around.
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And it's not just using statins or liquid lowering
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drugs, you can actually use other things.
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And I'll mention some of those in a minute.
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The other thing that we found is that the glycocalyx that lines
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the arteries is critical to arterial health.
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And really on some level is kind of the holy grail of arterial health.
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And the problem with the high carb diets is that sugar destroys that glycocalyx very
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quickly in a matter of minutes,
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quite honestly. And then processed foods will do it as well.
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So, you know
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being able to we can now measure in the clinic the glycocalyx.
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We can actually look at it directly and which is pretty interesting with
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the scope that we put at the base of the tongue.
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And then from there there are supplements we can use to actually rebuild
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the glycocalyx also, particularly if they're taken with meals and things like that.
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So there's a lot that goes that goes into the whole cycle of it,
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from genetics to healthy fats actually like plasmalogens that improve reverse
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cholesterol transport to, you know,
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I think
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certain plant-based foods also are very helpful,
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right? Because they they're anti-inflammatory,
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et cetera. We know inflammation's a big driver.
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We know insulin resistance is a big driver.
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And so there's lots of different things there.
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Insulin, what we've seen is it increases senescent cell formation
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in the vascular wall, which stiffens it up and you know thickens up
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the cells and the and the vascular wall,
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the sort of hardening of the arteries to some extent,
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which leads to hypertension and things like that.
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So
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We're kind of more on the side of a plant based diet with healthy meat kind
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of thing. It's kind of more where we've settled.
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But there are different ways to kind of,
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you know, skin a cat, if you will.
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So but it's it's much more complex than statins,
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that's for sure.
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Yeah, definitely so. And you know,
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I love right what you were just talking about,
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you know, the glycocalyx, right?
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The endothelium. That's where the disease is.
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And understanding what leads to the breakdown of that,
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right? That's what really leads you to,
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you know, what causes this disease.
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And again, it's not cholesterol that does that,
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right? Cholesterol is the secondary player that comes in.
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after the glycocalyx and the endothelium is damaged.
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And what's so interesting about insulin resistance is there are so many pathways
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by which it contributes to the atherosclerosis ultimately,
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right? You mentioned the effects that it has on the endothelium.
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And then we can look at things like how it inhibits nitric oxide production,
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how it changes
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Right, the nature of our cholesterol,
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right? It shifts you towards more of these small,
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dense, you know, oxidized particles that are so problematic.
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And ultimately, you know, we go back to the great work of,
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you know, Dr. Joseph Kraft, right?
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And in the nineteen seventies,
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him demonstrating that essentially every patient with heart disease
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had insulin resistance if you knew how to test for it properly.
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Yeah.
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And unfortunately that message got lost,
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right? It got overwhelmed by the lipid lowering ~ messaging.
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And here we are 50 years later.
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And again, lipid lowering has not really gotten us much in terms of
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~ improving this you know, preventing the disease.
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And that's what I think we need to talk more about.
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Again, because my vision, my goal is by the time you know,
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I leave this earth.
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I don't want heart disease to still be the number one killer,
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right? It's been that way for a hundred years,
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and I'm sure you feel the same.
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It shouldn't be. And as I as we started off by discussing,
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right? If you want to improve longevity,
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you have to not die. And the number one thing we du we die from remains heart
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disease. So we gotta take that one down if we're really going
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to make meaningful improvements.
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Yeah. And I I think to your point we can actually.
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I like that you brought up nitric oxide.
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We also know that as we age that eating plants that are high
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in dietary nitrate actually give us a substrate to be able to make nitric oxide.
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So that's that's super useful to understand also.
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Things like kale and arugula and beets and
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spinach and things like that, if you're not oxalate sensitive.
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Those things, some of those things,
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irugula, you can get away with no matter what.
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But having those things in your diet,
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and then the Mediterranean herbs,
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really, the the magic in the Mediterranean diet is not so much the red wine
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or it is to some extent the olive oil for for sure,
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but it's the fresh herbs that they use,
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~ the basil, the tarragon, the summer savory.
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Those have properties that basically neutralize oxidative stress inside
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the the arteries as well.
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Which decreases senescence. So again,
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we're we're kind of we like plants for the dietary nitrate.
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We like it for the antioxidant effects from the fresh herbs.
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And then there's a molecule in olive oil called hidoxy tyrosol,
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which actually is very important for reverse cholesterol transport.
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So we like that as well. And berberine,
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curcumin, resveratrol all can be important.
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bergamot, EGCG.
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polyphenols from pomegranate are also good and cocoflavonoids.
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So getting those those things that are I mean,
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all these things are coming from plants,
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quercetin for that matter, omega 3s,
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all these things will help keep the arteries healthy in our in our book.
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So yeah, it's cool. I'll tell you this,
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we do two hour glucose tolerance tests on everybody that comes into the clinic.
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And it's stunning to see how many people have insulin resistance that don't know
17:57
they have it. Hemoglobin A1C five point three,
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fasting blood sugar eighty nine.
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You do a stress test on the pancreas and the next thing you know,
18:05
boom, right? The insulin goes up to sixty and at two hours instead
18:10
of coming back down it's now at eighty.
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You know, I mean it's really phenomenal to see,
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to look behind the curtain, so to speak,
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and actually see what's going on.
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And it helps us ~ I think help people ~ understand how to manage what's going on.
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Exactly, because the earlier you pick up on that,
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right? That's where the huge opportunity lies to prevent the damage.
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Because we know by the time that you show up with the pre-diabetes,
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right, you've already had decades of this insulin resistance.
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And in many cases, you have the damage to the arteries,
18:43
the plaque has already built. And yes,
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we can still make some headway.
18:48
We can try and slow that down and maybe get some reversal in that,
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but if we pick this up.
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Up earlier, right? We have a much better chance of not letting it
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get to those advanced stages. And so I aggressively screen
19:03
for insulin resistance as well.
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And again, I think it is really the key
19:10
to effective prevention of heart disease is going to come from that early diagnosis
19:16
of insulin resistance and then knowing what to do to change it.
19:19
And the good news is that you can reverse it.
19:23
Right. Yeah. And there's some medicines out there that help too,
19:25
right? Like I mean, metformin can be helpful in addition
19:28
to berberine or hydroxyberberine.
19:30
SGLT twos have shown a nice impact for cardiovascular events and even the GLP ones,
19:36
ones and twos have been helpful.
19:38
So yeah, I think I think we're in an age,
19:40
quite honestly, Philip, where you know,
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if somebody is actually willing to,
19:45
despite their genetics or family history,
19:47
if someone is willing to actually deconstruct who they are.
19:51
And understand how they're built and where they are in the process,
19:55
that we can actually create a plan,
19:58
and it's an individualized plan because it's not a one size fits all,
20:01
but to actually steer clear of heart disease virtually all together.
20:05
I mean, we were able to show plaque regression in carotid arteries
20:08
and things like that, right? I'm sure you've seen this as well.
20:11
So the therapies we're talking about,
20:13
the interventions we're talking about,
20:14
are not just kind of niceties.
20:16
They're actually, they're really having an impact for people.
20:19
VO two max goes up, you know, we can measure stroke volume increase
20:23
as workload increases and we see it taper off in people that have endothelial
20:27
dysfunction. We see it restored when we get the endothelium and
20:30
the glycocalyx and the nitric oxide systems working again.
20:33
So I think it's the most exciting kind of cardiology to practice when you're
20:36
actually making somebody better as opposed to fixing a problem.
20:40
Yeah, I agree. And I think the other exciting thing we have available to
20:45
us today is the fidelity with which we can actually measure the disease,
20:50
right? The advanced CT angiographies with the AI technologies now.
20:55
And so we don't have to guess,
20:57
right? You know, we don't have to sit here and argue about this blood marker versus
21:01
that blood marker, none of which actually measure the disease itself.
21:06
We can now measure the disease.
21:08
We can do this on a repeated basis.
21:10
And then we can see, you know,
21:13
whatever it is, right? Whatever you've been recommended,
21:16
whether you've been told to go on the statins and the,
21:19
you know, PCS K nine inhibitors,
21:22
or you've been told to eat a plant based diet,
21:24
or you've been told to eat a carnivore diet,
21:26
right? We can measure is it working?
21:30
And that's something that I think is vastly underutilized these days.
21:34
We can see the disease early and we can follow its progression over time.
21:39
And I think that's something else that we're on the precipice
21:42
of it really revolutionizing how we approach heart.
21:45
Disease.
21:46
Yeah. No, I agree. I think you're referring to the clearly CTA
21:50
for the audience listening to this.
21:51
I think a lot of people have heard about the clearly CTA.
21:54
You know, when I was doing the interventional work,
21:56
the first intracoronary ultrasound catheters came out in the early nineties.
22:00
And I was a early adopter of those because all of a sudden,
22:03
even though it was kind of like putting a garden hose down a coronary artery,
22:06
all of a sudden you could see things that you couldn't see on an angiogram.
22:10
And I'm like, ~ my gosh, this two-dimensional
22:13
you know, image of a three-dimensional structure is really limited,
22:17
right? And so it's really interesting.
22:19
It was we used ultrasound to guide all kinds of procedures and ended
22:24
up starting STEMI programs in hospitals with no backup surgery and
22:27
all kinds of things because we could actually see what was going on.
22:31
And what's beautiful about the clearly CTA is that they basically,
22:35
you know, their their strategy was to emulate intracoronary ultrasound.
22:39
And so they they would take a CT angiogram and then construct it and get
22:44
it back to where they could actually correlate it to what we would
22:46
see with an ultrasound. So I'm saying that to tell people that if you
22:50
get a clearly CTA done, you're getting a really the Dr.
22:54
Avedia's part point, you're getting a really high fidelity look
22:57
at your coronary arteries. You're not only seeing,
23:00
you know, the opening, but you're seeing the walls of the arteries
23:02
and you're seeing what's comprised.
23:04
the walls. Is it soft plaque, hard plaque,
23:06
calcified plaque, you know, things like that.
23:08
So it is a very, very good test.
23:10
Yeah, and there are some even more th exciting things coming,
23:14
right? Being able to actually see the inflammation in the blood vessels.
23:18
There's a another company working on that and has demonstrated good data
23:24
and good ability to do that. And this is all,
23:27
like I said, I think the more that this gets used,
23:30
the more it points us towards who really
23:33
you know, is at risk and what can we do to start to lower that risk
23:38
and intervene at those earlier time points.
23:41
Because again, you know, patients ending up on my operating table these days,
23:46
I consider that to be a total failure.
23:49
And it's not the patient's failure,
23:51
right? It's the the healthcare system that has failed them because there's really
23:55
no reason for that to happen. We have these tools,
23:59
we understand the root cause
24:02
you know, true root cause factors that lead to the disease.
24:06
And so we just need to do a better job at,
24:09
you know, now utilizing these and getting this information out to the patients.
24:13
And quite frankly, getting this information out to our colleagues,
24:16
the physicians, who are still just locked in the old paradigm
24:21
of if their cholesterol level is X,
24:24
you know, we're doing okay. And it just doesn't work.
24:28
And it just isn't the standard by which we should be
24:32
holding ourselves as physicians to and trying to deliver to our patients.
24:37
You know, I'm thinking as I'm listening to you talk about this
24:40
and understanding that you're still,
24:42
you know, performing surgery for people,
24:44
that it must really change your concept of what adequate cardiac rehab looks like
24:50
for an individual that's gone through surgery,
24:52
right? Because it's not just the exercise program and taking the meds.
24:56
You must have work with the people in the hospital or whatever where you're working
25:00
to really push on the whole insulin resistance piece,
25:03
get cardiologists involved with that,
25:04
the dietitians involved with that.
25:06
think that that the rehab elements of this,
25:09
I found when I when I stopped doing the interventional work,
25:12
I still sort of stayed on and directed the cardiac rehab at the hospital
25:15
for a couple of years before I left that all together.
25:18
But I found that in lecturing to the cardiac rehab people as they came in,
25:24
that it's a very receptive audience,
25:26
right? I mean, they've just come through something that don't ever want to
25:29
go through again and they became very receptive.
25:32
We didn't have as much success orchestrating even at the Heart Hospital
25:35
all the different elements that I would have liked to have orchestrated for them.
25:39
But I'd I wonder if in your situation if you've had an opportunity
25:43
to orchestrate that better than we were able to,
25:46
or whether or not it's still sort of stuck in its old ways.
25:49
Yeah.
25:49
Yeah,
25:49
it is the frustrating part of ~ still sort of,
25:53
you know, having to ~ function within the hospital and ~ therefore within
25:58
the traditional system because even running up against the simple thing of,
26:03
you know, I walk in the morning after surgery,
26:06
the patient has the insulin drip going in one arm and they're using their other
26:11
arm to eat their, you know, pancakes,
26:14
right, which are heart healthy.
26:16
low fat, right? And is obviously,
26:19
you know, driving their glucose up that ~ the insulin is required.
26:23
And challenges like that are still,
26:26
you know, we need to work on. The patients themselves,
26:29
I find, are very receptive, right?
26:31
When I can now explain to them,
26:33
we did the surgery, right, to deal with the blockage,
26:36
the problem that was in front of us,
26:38
the problem that was maybe, you know,
26:40
life threatening or at least causing you symptoms,
26:43
right? And so we've taken care of that.
26:46
But if we don't now address the reason you got the blockage,
26:50
the underlying problem, you know,
26:53
you're gonna be back. And and we know the again,
26:56
the data, right? The vast majority of patients that have bypass surgery
27:02
or they have a stent placed, they're gonna die of heart disease.
27:05
They're gonna die years later than they would have without the surgery
27:09
or without the stent. But we've done absolutely nothing to address
27:13
the underlying root cause.
27:15
By doing the surgery or putting the stent in.
27:17
And that's where, again, the opportunity is.
27:20
You know, my my my first book is called Stay Off My Operating Table,
27:25
right? But I still give it to all the patients that I've operated on.
27:28
And I tell them, you know, I don't want you back on the operating table.
27:32
And this is what we need to do to accomplish that.
27:36
Yeah. No, I think that's really genius on your part to give them
27:39
the book because they are going to be very receptive at that point.
27:42
It does it does help though if they can step into a system that can support them.
27:46
It would be be great to be able to create that system,
27:49
either virtually or, you know,
27:51
it's hard to do it inside the confines of the hospital because it's
27:54
so married to the way it goes about things.
27:56
But if there was a virtual cardiac rehab,
27:59
I've thought about this frequently.
28:00
It would be very interesting where people could actually get really good information
28:04
and, you know.
28:05
Stay stay off your operating table,
28:06
essentially. So yeah. So what are you what are you most excited about these days
28:11
in terms of where this is leading you now?
28:13
You wrote another book about stay off my kitchen table.
28:15
Tell us a little bit about that.
28:16
Yeah, so the the new book Stay Off My Kitchen Table,
28:20
very proud that it made the New York Times bestseller list recently.
28:24
And you know, it goes a little deeper,
28:27
right? I I understood that there was still this gap of some patients
28:33
do the right stuff and don't get the results we're expecting.
28:36
And then, you know, why some patients respond differently,
28:40
right? And as I started to think about more about things like gut health.
28:45
Right. And again, as a cardiac surgeon,
28:47
I never thought I would be talking about gut health and ~ leaky gut
28:52
and things like nutrient density,
28:55
bioavailability, ~ talking about anti-nutrients that are in certain foods that
29:00
can cause trouble, even though you know those might be thought of as healthy foods.
29:05
And so that's what we really go into more in stay off my kitchen table.
29:10
We kind of wanted to give people
29:13
the understanding of what should stay and what should come off their kitchen tables,
29:18
you know, of course, playing on the title of the first book.
29:21
And that's what, you know, we do these days.
29:24
So along the lines of what you were talking about,
29:27
I've established a nationwide telemedicine practice where we can help people
29:32
do this and practices like yours.
29:35
And thankfully there is more and more opportunity for this.
29:39
But, you know, as you mentioned,
29:41
you sort of have to get out of the mainstream system.
29:45
The mainstream system still doesn't understand this and just,
29:49
you know, w what I really say is the average doctor out there is
29:54
too busy taking care of sick people to really think about how do I keep people from
29:59
getting sick in the first place.
30:01
That's right. Well, great. Well,
30:02
I really congratulate you on all your insights,
30:05
you know, your personal progress,
30:06
but then all the impact that you're having on all the people that
30:09
you come in contact with, right?
30:11
All the patients that you see.
30:12
So it's an unusual journey, right?
30:14
And there's very few surgeons or cardiologists for that matter that that make that
30:18
transition or start to see it through that set of lenses.
30:21
And it's ~ it's very, very powerful.
30:23
So congratulations on all that.
30:25
Yeah, thank you. And hopefully,
30:27
you know, you you and I can be two examples to our colleagues that there is
30:32
a ~ way to do this and that again,
30:36
these goals are achievable at a high level.
30:39
Like I said, there's no reason that heart disease still needs to be
30:43
the number one killer. And if we reshape our focus a little bit,
30:48
if we think more about how do we prevent this rather than just what can we do to
30:53
manage it and make it a little better once patients are already sick.
30:57
As physicians, I think it really gets us close it it really gets more
31:03
to the heart of why most of us became physicians.
31:07
You know, we really didn't go into this to maybe make people a little bit better.
31:13
You know, we went into it to really change people's lives.
31:17
That's right.
31:17
This is how we can do that. And hopefully,
31:20
you know, again
31:22
what I'm doing, what you're doing,
31:23
right? This can all be examples to our colleagues that they can do it as well.
31:29
And that's how we're really going to change the whole nature of the medical system.
31:33
system.
31:34
Yeah, I agree. I I think our strategy is to build a a parallel system
31:39
and then let the success speak for itself and then all of a sudden people,
31:43
you know, because things get so ingrained,
31:45
right? And it there's so much financial incentive now built around,
31:49
you know, particular payment structures and things like this.
31:53
It's everything gets kind of it's incestuous in a way.
31:56
And it's very difficult for people to break out of that model,
31:59
particularly when it's financially reinforced.
32:01
So yeah, interesting stuff.
32:03
Well Philip, thanks for ~ taking the time to chat with us.
32:06
Really enjoyed the conversation.
32:07
Thank you.
32:08
Yeah, it's great being here with you.
32:09
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