Dr. E Mixes Traditional/Functional Medicine for Better Results - #72

Immediately putting a patient on medication has been normalized. Dr. Efrat Lamandre (Dr. E) maintains that it should not be.

In this episode, she shares her story of how she started her functional medicine practice, how she has taken more time to listen to her patients than before, and why she'd check nutrition and sleep first before any exercise recommendation.

Healthcare professionals frequently overlook the initial course of treatment recommended by pharmacological guidelines — dietary lifestyle changes — because the system doesn't leave enough time for it.

She used to consider a patient "fine" if test results didn't point to any specific diagnosis. Now she knows better: symptoms meant something is wrong. So, her goal is to provide interventions before the symptoms develop into disease.

Dr. E believes there is a place for both conventional and functional medicine. That's why she practices both. She calls this the KNEW method, a reassurance for the patients that the symptoms they experience are not just in their heads.

Quick Guide:
01:21 Introduction
05:32 Her wife’s autoimmune issues
09:04 How her practice as a nurse practitioner changed
15:29 There’s a place for both conventional and functional medicine
23:29 Lifestyle modifications that lead to improvement
28:48 The self-selecting patients and the right patients for her
34:41 Inflammation is the root cause of the autoimmune disease
39:26 The process of treatment, from diet and sleep
54:20 Take the time to listen
55:55 Closing questions and contact information

Get to know our guest:
Dr. Efrat Lamandre is a nurse practitioner with a Ph.D. in integrative medicine. She practices both conventional and functional medicine.

Connect with Dr. E:
Website: https://theknewmethod.com/
YouTube: https://www.youtube.com/c/TheKnewMethodbyDrE/about
TikTok: https://www.tiktok.com/@theknewmethod
Instagram: https://www.instagram.com/theknewmethod/
Facebook: https://www.facebook.com/theknewmethod
Podcast: https://theknewmethod.com/podcast

Episode snippets:
11:33 - 12:25 - The symptoms count even if the labs aren’t showing

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Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings

Transcript

S3E18 Dr. Efrat Lamandre Ph.D

SUMMARY KEYWORDS

people, patients, sleep, symptoms, hear, nutrition, question, inflammation, conventional medicine, autoimmunity, happen, psoriasis, practice, method, diabetes, diagnosis, eating, medication, belly, exercise

SPEAKERS

Announcer, Jack Heald, Dr. E, Dr. Philip Ovadia

Announcer  00:10

He was a morbidly obese surgeon destined for an operating table and an early death. Now he's a rebel MD who is fabulously fit and fighting to make America healthy again. This is Stay Off My Operating Table with Dr. Philip Ovadia.

Jack Heald  00:35

Well, hey everybody, welcome back. It's the Stay Off My Operating Table podcast with Dr. Philip Ovadia. This is our last podcast of 2022. Although I realize you're probably listening to it somewhere in the third or fourth week of January 2023. I'm going to assume the world has not ended. We're joined today by someone whose name I had trouble pronouncing, but whose background, absolutely. I'm so excited to have this conversation. I don't want to steal your thunder, Dr. Ovadia. But we are joined today by Dr. Efrat Lamandre. And Phil, with that, tell us why you invited her and let's get this conversation going. Because I'm really looking forward to talking with her.

Dr. Philip Ovadia  01:21

Yeah, so Dr. E, as we have been instructed to go with, and I just came across each other on the magic of those interwebs. And, like you, Jack, I was fascinated by her background and her story. And I think in a lot of ways parallels some of my journey as well. So very interested to get into this with her. I'm gonna let her to give us her background and her story about how she got to where she is today. But she's another New Yorker, which was something that appealed to me as well. So, welcome.

Dr. E  02:05

Thank you so much. It's really an honor to be here. I appreciate it. Do you want me to tell my story?

Jack Heald  02:12

I read a little bit about you. And when I read that you professionally started your life as a nurse practitioner, I went whoo hoo. And well, and there's all kinds of reasons for that. But knowing where you started and understanding where you're at, I knew that was going to be a great story. So, tell us a story.

Dr. E  02:42

I appreciate. Okay, I'll tell you a story. And I have a feeling that Dr. Ovadia, you are in a similar place. So basically, I do think that anyone who ends up on this side of the vortex and the functional medicine world has either hit a health wall themselves or someone that they love has hit a health wall. And yes, I was trained as a nurse practitioner, family nurse practitioner. And I have a great primary care practice here in Staten Island, primary care, adults, pediatric, we serve over 20,000 patients, and we do the conventional thing. And my wife got sick a while ago, we can get into that a bit. I'll just give the macro. She's a medicine and medicine. Our friends are in medicine and conventional medicine really just offered us high dose steroids. And we just kind of felt that maybe there's something more. And this is like a million years ago before the interweb is what it is. So, someone said, hey, why don't you try functional medicine? We're like, okay, it's not gonna work. But like, whatever, we have nothing to lose. And this gentleman had the audacity to suggest that what she has going on has to do with her nutrition. And so, and mind you, right, we are relatively thin women. I'm not saying this because of body shaming. It’s just to paint a picture. We thought we were eating really well. We're both athletic. So, the concept that now nutrition is off was really just wild, let alone having to do with autoimmunity, it’s just insane. But we tried it because we had nothing to lose, and there's no side effects in trying it. So, we did it. And I did it as a supportive wife because there was nothing wrong with me of course. So, her autoimmunity reversed. And I found out how crappy I was feeling before and I didn't even know, as my joint pain went away and like my stomach stopped hurting all the time, which I felt was normal. Like it's crazy. 

Jack Heald  04:42

The amount of physical discomfort that we just get totally used to.

Dr. E  04:49

We get used to it. Yeah, I hear it all the time from my patients like I didn't even know I had brain fog, people will tell me. So, I brought it back to the practice, to primary care practice and I kind of dabbled in it. But I think you know that once you open up this can of worms, that's it, it's over. So, you take another class and another class and another class. And before you know it, you're like, I cannot practice this way anymore. It's not enough. It’s not bad. Not bad. It's just not enough. And so, The KNEW Method was born. And that's why if anyone's on social, The KNEW Method’s spelled with a K because you always knew there was a better way. There's like something in the back of your head that says, there's something else going on. So that's all right.

Jack Heald  05:32

I'm gonna jump in here real quick for our listeners. Dr. E has a website, we normally talk about this at the end of the show, but her website is called The KNEW Method, knew, K N E W. So, theknewmethod.com. And there'll be more information at the end of the show. So, I would love to hear, sorry, Phil, but I'm the resident idiot so I get to ask questions. I would love to hear, without violating any confidentiality, about your wife's autoimmune issues, how conventional medicine viewed it and how you viewed it until you started seeing it differently, and treatments that actually made the difference. Just go into some detail.

Dr. E  06:25

Yeah, absolutely. And this is actually relevant to anyone suffering for autoimmunity, honestly, forgive my allergies. So, she initially, when I met her, she had something called PMLE, polymorphous light eruption, which basically means she was allergic to the sun. So, when I speak on stage, I say when I met my wife, she was a vampire. So, talk about accommodating, we just assumed that was life. And we planned our days after four. And if we had to be on the day, we made sure to be not on the sunny side of the street. And you do what you have to do, like many of your listeners, when you get that first diagnosis you accommodate, like this is going to be fine. First medication, it's going to be fine, right? You chuck through it. And then and when I met her, that was it. That was just like no, obviously it took her many, prior to meeting me, many years before she was correctly diagnosed because she had atypical form. And she had to change. She used to be a division one softball coach nationally known. She had to change her career because she had to get out of the sun like it was really affected her life completely. So, a few years later, she develops a second autoimmune, which we did not realize why, when you get one, you get more and the reason is, because until you fix the root cause, you just kind of keep getting more issues, but we didn't know that. Her second issue was psoriasis, but her psoriasis was so severe that her feet would bleed when she would walk. She couldn't like open cans, because we would like to her hands couldn't handle. Yeah, it was a mess. And that's what finally drove us to look for answers, right? Because it's those that one thing they just can't handle anymore. So, for PMLE, there's not much to do, if you have a flare up, you just have to like, be in a dark room until it goes away and it's painful. And for psoriasis, it's basically steroids at the time, and now there's immunologic. But they don't solve the problem, right? Yeah. So, this gentleman at the time did this crazy bloodwork we never heard of, IgG IgA, we never heard this nonsense, right? And of course, I hope everyone knows I'm being sarcastic. It's not nonsense at all. So, he did this testing, and my wife was vegan at the time. And so again, back then, this is before Impossible Burgers and Beyond Burgers, it was corn and soy if you're vegan. So, corn and soy came up so high in her lab work. And we remove corn, soy, gluten, dairy, and just everything went away. It just went away. It's really that...

Dr. Philip Ovadia  09:04

So, look, I want to go back to something you said. You mentioned in your own story, like you didn't realize how bad you felt. And I say the same. I was just kind of dealing with life and I was a busy heart surgeon and lo and behold, when I changed what I ate, and I lost 100 pounds. And I realized that you're supposed to feel much better than most of us. But I wanted to get your perspective as a practitioner that we accept this for our patients, largely when patients come in complaining of this and that, the pains and the aches and the tiredness and we just say, well, that's just part of getting older, that's just normal. And I'd love to hear your perspective on kind of how your attitude towards the patient's problems have changed. Just as you realize, as you were able to overcome your own problems that you didn't even realize you had to start with.

Dr. E  10:07

Yeah, so this is the mea culpa moment. And again, this is true for anyone, and I'm sure you as well, you're trained in conventional medicine to find a diagnosis, and then treat the diagnosis. And everyone who's doing that is well-meaning, I mean, everyone went to school, everyone wants to help people, there's no malice. I know there's kind of this rhetoric of like the evil doctor, that's not what the case we're all, we've been trained a certain way and we're and if there's no diagnosis, then there's nothing wrong with you, I can't help you. And that's because the toolbox we're given in med school and P school, PA school is a toolbox that is limited, find the problem, treat the problem probably pharmacologically or procedure. But if there's no problem to be found, your symptoms don't count. If the symptoms don't point to a lab or a finding, there's nothing we could do for your symptoms. Right. So, I was guilty that how many women and men came to me and I did the annuals and their cholesterol’s fine or they're not diabetic. I'll see you next year. But E, I'm tired, But E, I have joint pain.  But okay, let me move on like an autoimmune penalty. Oh, it's negative. But I don't feel... Okay, go home, diet, exercise. I don't know what to tell you. And I really felt whole with my practice. I had no idea what a disservice I was doing. Until I realized what I realized now is that the symptoms count. The symptoms mean that something is wrong. Our labs may not know it yet. But something is cooking. So, I tell my patients, it's like diabetes, prediabetes. If I do a finger stick today, and I'm diabetic. Does that mean that last year when I wasn't diabetic, I wasn't cooking diabetes? Of course, I was cooking pre diabetes, I didn't get it overnight. Same is true for autoimmunity. There's a world of, I don't think I invented this term, but I haven't heard it use pre autoimmunity, where you feel autoimmune, your joint pain or your skin is off or things are just awful, you're exhausted. But when you go to rheumatology, there's no markers yet. But the symptoms count. And so, when I work my patients, we actually quantify them, and I use the software to quantify that symptom. And then we use those symptoms to track, to make sure their interventions are improving, because I have nothing else to track because their labs are fine. So, that is the biggest change, like understanding the symptoms means the it's cooking, let's get ahead of it. Let's not wait for it to become a disease.

Jack Heald  12:36

Is there a more common than not set of symptoms that people show up in your office with? You’re a general practitioner so, you're the front line of defense for most folks, right?

Dr. E  12:53

Yes, well, I would say the people who show up for The KNEW Method have already been through their general, their PCP, their GYN, their cardiologist, their rheumatologist, and then they show up with The KNEW Method. And so, The KNEW Method, the common denominator is fatigue. So even if they're able to sleep, the fatigue... Did someone sneeze, God bless you if you sneeze.

Jack Heald  13:18

My wife is sitting across the office.

Dr. E  13:23

God bless your wife. That's awesome.

Jack Heald  13:28

I love it when she sits in and listens live, because I don't have to say, oh my god, you should have heard this person. Then I have to sit and wait for her to listen to us so we can talk about it. So. 

Dr. E  13:39

I'm glad you're here.

Jack Heald  13:42

All right, sorry. Common symptoms. 

Dr. E  13:45

All good. So, fatigue, even if they're sleeping a lot, fatigue is an issue. Insomnia. People are having a really hard time sleeping. Joint pain and belly pain, like I'm bloated. This is like the main constellation. Everything hurts. I'm tired all the time. I'm bloated all the time. And brain fog, I would say. I mean, that's like the crux of it. And then we have like some differentiators. That's our starting point.

Dr. Philip Ovadia  14:18

And how long do you have people typically been experiencing these symptoms before they get to you?

Dr. E  14:27

So, most patients are coming in around their late 40s and 50s. It's usually between 15, 20 years because what generally happens is at first, it's mild, and in your 30s, generally speaking, in your 30s, maybe early 40s, you're busy raising kids or starting a career so really takes a back burner, and you push through, you also have more resiliency to push through when you're younger. Cortisol levels are better. Your stomach can handle things a little more. You still have a few more digestive enzymes. So, things are not really like, falling apart yet. They're there. But other things are a priority, then 40s and 50s, sometimes 60s, kids are a little bit older, your career was kind of on a path and the symptoms are getting worse. By this point, you've had health insurance for a while, you've been to a few doctors, and everyone tells you you're fine.

Jack Heald  15:25

Or I'll bet they put you on antidepressants of some kind.

Dr. E  15:29

Antidepressants. A lot of people are on antidepressants, or, yes, you have diabetes, I put you on medication for diabetes and blood pressure, what do you expect? I mean, of course, you're not going to feel optimal. So, there’s a group, that’s you're fine. There's the group that’s you're crazy, here's some antidepressants. There's a group that just completely like, it's just your age, it's your hormones, it’s not there, we cannot help you. And then there's the group that's like, well, since you have this disease, and we put you on medications, like there's not much more we could do for you, let's just monitor your A1c. And again, I really don't think anyone has an evil intent, I really want to say that. I really think that’s the model is, how the model is built. And I think, Doc, I think you coming from your background, I mean, I'm really curious to hear how you got to this, because I'm sure that you know the model is well-meaning. There's no one going into med school to be mean.

Dr. Philip Ovadia  16:24

Yeah, and I guess maybe before I'll get into that, I do want to, I'll throw this at you that E, we've had these billions of dollars that the pharmaceutical industry has spent. We've had this this model of allopathic medicine that has been in place since essentially the early 1900s. And we do all these great things, we do open heart surgery, and we save people's lives every day. So how is it that you have figured out how to crack all these mysteries that no one else can solve? You must be blowing smoke up our butts, quite frankly, and selling snake oil, right?

Dr. E  17:19

Yeah, so I’m a quack. I want to look back. So, I mean, it's a really good question that you're asking. And I think this is precisely why I love that I am both conventional and functional because there is a time and a place for both, right? If you have an infection, I bet your butt I'm taking antibiotics, I'll be the first to prescribe it, I'll be the first to take it. If I have pneumonia, if I have cellulitis, I'm so grateful for conventional medicine for that. If I need chemo, I'm so grateful. If I need open heart surgery, I'm so grateful for all of it. So, I think where allopathic medicine excels also isn't acute medicine for sure. It's necessary. And I wouldn't know the first thing how to do open heart surgery or any or anything on that level. And there is a place for it. But what I'm saying doesn't undermine it. In fact, that strengthens it right? Well, how can we get outside of structural issues, a lot of heart disease has to do with lifestyle. So how awesome would it be if they never got to your table, they didn't need to be stented, if they didn't need to be cut, because we took the time to do lifestyle. And by the way, if you read any pharmacological guidelines, the first line is always recommend dietary lifestyle modifications first. It's like one sentence, and we are designed to skip it and then go and then prescribe this and then prescribe this and then prescribe this. But it's always there. The dietary lifestyle modification piece is part of every single evidence-based practice guideline. It's just we skip it, because the system doesn't allow time for it.

Jack Heald  19:05

I'm sorry, but just the irony here, that the very first thing is diet and lifestyle. Not item 13 on the list of 22. But item one on every single friggin list.

Dr. E  19:23

Every single day. And lifestyle modification first, for diabetes, blood pressure. Right? In fact, in our charting, do we not have to also write that in our charting that we discussed the Mediterranean diet or the necktie whatever, we have to put it in our charts. So, we actually discussed and we suggested, we should handout. So, it's all there. So, I haven't discovered anything new. I'm just spending time on it. I'm spending time on part one, to avoid two and three or to taper down two or three. So, it's actually in my opinion, it's quite the opposite. And I know that's not, it's the opposite of cracker snack? Well, first of all, I'm not selling you anything. But second of all, it's actually conventional medicine done, right? That's what it is.

Dr. Philip Ovadia  20:10

No, I mean, yeah, definitely. And you can go all the way back to Hippocrates. It's actually kind of the first line in the Hippocratic Oath is that diet, it should be the focus of our...

Jack Heald  20:25

Is that the food be your medicine and medicine, your food is that...

Dr. Philip Ovadia  20:29

Essentially, yeah, that sort of translation of the Hippocratic Oath. And so, yeah, it's very interesting that then when people like you and I are out here talking about diet and lifestyle, and we get labeled quacks, even though as you said, it's in every guideline, and it's improving people.

Dr. E  20:51

Yeah. And it's helping people. Yeah. And it's, yeah, it's really funny. It's one of the reasons I am often approached by, I don't know, if you've seen me on Tiktok, I have a bit of a following there. I'm approached a lot for sponsors. And I've said no, so far, I don't want to say I'll always say no, because who knows the future? I've said no, so far, because I really am trying to distance myself from this concept of like, take this and you will be okay. Sure, I sell supplements. And they're customized depending on what my patients need. But I want to get out of this mindset of like, there's this magic pill, there's this magic cure. In fact, when I work my patients, I'm like, this is going to be hard. Are you sure you want to do this? Like I almost talked them out of. It is not going to be easy. I'm gonna give you a lot of support, but it's not going to easy. So, it's anything but as I'm sure you know.

Jack Heald  21:40

I went through this 17 years ago, and I was blessed to have a functional medicine doctor. And we spent 90 minutes working through his intake interview. And he didn't tell me what I had. I had been trained at that point, if what have I got doc? And he just, he's very skillful at circumnavigating those kinds of questions, because in his model of health, you don't “got something.” Your health is out of balance. His goal is to figure out what is your body saying that it needs to help it? And so, I just, okay, well, whatever. And my next question was, well, how long is it going to take? I remember this very clearly. He said, well, I had severe adrenal fatigue, I was about that far from dropping dead. He said, well, you didn't get in this overnight, and you're not gonna get out of it overnight. And I was really grateful that he said that, because he set me up for, we're understanding this lifestyle change doesn't create immediate results. But you will see results. And it took me about, I know, it took about eight months before I could look at it and say, and I was rigorous as I followed his lifestyle changes, took about eight months. But he saved my life.

Dr. E  23:27

And then since then, I'm sure you've done even more modifications and more optimization. It's never ending.

Jack Heald  23:34

Yeah. Yeah. Absolutely.

Dr. Philip Ovadia  23:39

Yeah, along those lines, what are some of the, I would say, what are some of the most common things that you find people need to modify in their diet or the modifications that oftentimes lead to successful improvements?

Dr. E  24:01

So, I have a bit of a method, right, The KNEW Method, and I created a structure because coming from the space of conventional medicine is if I need structure, right? I need there to be some trackability and a plan. And of course, it gets customized, which is very different than allopathic. But there has to be something that we start with. So, the first part of it, I have to say, as I mentioned, is the software, the software that we use. And that's really, really important because we have to track that. We checked that monthly, and then every single...

Jack Heald  24:32

You take some measurements, here's where we are today. And then?

Dr. E  24:37

The patient fills out the form. How's your headache? How's the ringing in your ears? How's this? It's the same form each time, they don't see the results from last time. So, they come to it fresh, which is great. Both sides, like things got worse, I have to help figure it out. If things got better, it's great. And then we graph it. And then we can also kind of oh, everything up better except the headache. So now we know okay, maybe it wasn't this intervention and it’s time to start doing different intervention? Did we lose Dr. Ovadia? Has that happened?

Jack Heald  25:10

Nope. His screen just went away. But he's there.

Dr. E  25:15

So, the very first thing that I do is I change nutrition first. The reason I say that is because there are a lot of tests out there. There's so many tests, small testers, there's hormone testers, there's stool tests, there's food sensitivity tests, and you can really get lost in the world of tests. And also, you can have a lot of positives, but they're not necessarily the thing that's bothering you in a positive way. And then some dysbiosis, and your hormones can be off and all this is happening, but which one do you go to first? So, the method is always and I also put this in my book, because for people to start on their own. The method’s always, let's start with the standard American diet. Let's start with healing the belly. So, I start off rather restricted with the intent for that to be short term, not forever. So, I eliminate grains, dairy, grains, so that automatically includes gluten because I don't think it's enough to go gluten free because you can eat gluten free Oreos. That's a problem.

Jack Heald  26:16

So, wait, there's gluten free Oreos?

Dr. E  26:19

Exactly. So, dairy-free, grain-free temporarily. Dairy-free, grain-free, legume-free because there's a lot of cross reactivity, starchy vegetables for a while, off of that. And for most people, so we start there, is believe it or not a segment of population that has to go even stricter for AIP, right, I'm sure you've heard autoimmune protocol where they also eliminate nuts and eggs if they're really like super flare. So, you start there, and you hang tight for like and with minimal supplements, nothing crazy, some NAC, multivitamins, just basics, you don't want to walk out with 4000 things. Because it's not a supplement game. It can't be a supplement game, so and you hang tight for like 30 days, and then you do a check in. If in 30 days, almost all their symptoms went away, well, then you won the game and now you're just like tweaking a little bit and you could slowly start repairing the belly, reintroducing. Awesome. If, in 30 days, 50% got better and the patient's really compliant, depending on what the what symptoms are left, you will know where to go next. Like if their belly still a mess. Okay, and maybe now it's time for stool testing. You know if something, I just had a patient. She was super compliant. Her chief complaint was psoriasis. She had fertility issues; she had a lot of endometrioses. Like month three, she has lost weight, everything was looking great. But there was one area of psoriasis that really was not budging no matter what we did. This is a patient that definitely requires food sensitivity testing, because there's something that we still left on her plate that’s still irritating her because all of us who have the psoriasis like responded, right? In fact, we discovered it was avocados, I would never have told her to come off avocados, it's a superfood, right? Remove the avocados, the bad. So, you always kind of want to clear the weeds first. And then you can kind of see what's next. So, Nutrition has to be first. Now every once in a while, like do get a patient who's super, super, super clean. So, I'm obviously going to leave that alone and start working other areas. But generally speaking, you have to start there because that's the thing you putting in all day long. It's like putting in toxins all day and then like worrying about, I don't know, something that's not top of mind.

Jack Heald  28:32

I got the wrong size shoes. Well, you could stop eating poison.

Dr. E  28:37

Exactly. Exactly right.

Jack Heald  28:40

Oh, my Lord, do you have self-selecting patients?

Dr. E  28:46

What do you mean by that?

Jack Heald  28:48

We've talked to a lot of frontline practitioners who have had the same revelation that you had. And they fairly regularly say that when they changed the way they practiced medicine, the types of patients who came to them changed as well. They tended to get people who were a lot more inclined to want to fix, to get to the root of the problem and fix it rather than just take a pill and make the symptom go away.

Dr. E  29:17

For sure. I mean, I still have both practices. So, I only spend one day a week at this point in my primary care practice, because I have some patients with me from day one. And so, I love them. But it's run by other MPs who are comfortable in conventional medicine. So that and they all know because in my social media, like there's a lot of, and so they all know that in the same building, I practice this and they're not coming. So, they're happy here. They're happy coming every three months for their medication and they're good. I'm glad that they're compliant. And at least we're managing it and no judgment like at least this is happening right? At least we're not walking around with blood pressure out of control. At least we're doing the things that we can here but they're not coming. And they all know I do this, especially locally, like, everyone knows what I do. So, and the people who are coming at this point are not even just local, like it's a national, and they are finding me. And they're coming from all different. So yes, they're like finding me from places I didn't even know existed in the country. And they're just like, oh, my God, we've been searching for this. So, 100%. If that's what self-selected means then yes, that is, that is where it's at.

Jack Heald  30:30

I2s there a particular type of person who ends up with you? And I'm asking that question, because Dr. Ovadia has got a big audience here. And we talked to a lot of frontline caregivers, many of whom will serve folks anywhere in the country. So, what I'm asking now is somebody's listening, and they're asking themselves, is this the right physician to help me? Who's that right patient for you?

Dr. E  31:05

Okay, that's a great question. So almost everyone, almost everyone, because there's always something that we could do. So, who's the right person? I would say, generally speaking, there's two categories that I mentioned earlier, the patient who is not feeling optimal, has been to a thousand places and is either told there's nothing wrong with you, or some version of it's in your head, right? It's in your head could be as direct as it's in your head and take that medication. Or subtly, like what do you expect, you’re stressed? What do you expect, you’re 50? What do you expect by, so that's still a subtle way of saying it's in your head? Yeah. So, but they know that they remember a time where they felt better. It's like, why is this happening? Right? So that's one group. And then the other group are people who are already have a diagnosis. A lot of them are autoimmune, Hashimoto’s, PCOS, a lot of autoimmune issues, and maybe they are already on some medications, maybe they want to try with that medication. And they just want to overall move the needle on their health. And they don't have to have autoimmune. I mean, it could also be diabetic, hypertension. But it's usually, I have to say, most people who have more of a chronic issue that are more ready to make the change, because there's a lot of normalization around diabetes and hypertension, that everyone's ready to opt out of that. And it's really kind of not normal because everyone has meds. So is it really so bad, like there's so, that tends to be a smaller group of people who have come and say, I'm diabetic, I've hypertension, I want to be off those meds, they usually have something else that makes them come to me.

Jack Heald  32:43

I want to highlight that. There are people, there's a lot of Americans out there who have a diabetes diagnosis, or hypertension diagnosis. They are, quote, unquote, managing it with medicine, with medication. And the conventional view is oh, that's perfectly normal, you're fine. And Doctor E, and I know Dr. Ovadia, you guys would say, that ain't fine. I'm not putting words in your mouth, am I?

Dr. Philip Ovadia  33:16

Yeah, no, certainly not. I mean, it's something we've discussed previously. And it ends up being a large part of my practice that people come to me for their heart disease. And we ended up fixing their diabetes and their high blood pressure while we're lowering their risk or managing their heart disease, something that quite frankly, and I admit this, and I have admitted this, for the first 15 years of my career, I didn't think diabetes or high blood pressure were reversible either. They’re lifelong chronic conditions is what we're told, is how we're educated. And so, I didn't know it until I knew it. And like, Dr. E has been saying, it's not that doctors are evil, it’s just that we don't know what we don't know.

Dr. E  34:10

That's exactly right. And Dr. Ovadia, don't you know a lot of colleagues who are on medications? They think they’re fine. It's very normalized to be in your 50s. And to have one or two pills and for that, and as long as your A1C is fine, and your blood pressure is fine, they feel like they're in control, and they can continue eating whatever. And it's fascinating. It's fascinating to see I have colleagues who completely think it's normal.

Jack Heald  34:41

So, as I understand it, under the heading of autoimmune disease is a whole host of diagnoses. I have been running into people who've been given a diagnosis of Hashimoto’s, it seems the last 10 years, everywhere. I don't know if there's a rise in Hashimoto’s. Or it's I bought a red pickup truck, and now everywhere I see red pickup trucks, but one way or another, I've become more aware of it. And under this, with all these different types of autoimmune diseases, is there fundamentally a single root cause or a collection of root causes that will make all of these things basically make your body heal itself? I don't know if I'm asking that question right. But I think you get where I’m coming to that.

Dr. E  35:38

Yeah. I do. I think, I mean, you're right. On the one hand, it feels like we're surrounded by it because it’s what we do, right, you're on these podcasts, and so, you're surrounded by it. And we do tend to see people who are sicker because they're coming in a way. But the numbers also speak for themselves. And truthfully, there are more cases in the world and in America. And part of it is because the whole system is constantly under assault. It's just and I am not trying to be like overly like Doomsday, but we were just not, we weren't designed to filter as many things that we're being asked to filter from in all directions. Right? So, I'm focused on the standard American diet, which is I'm saying American but it’s worldwide at this point. It's super processed, doesn't have a lot of nutrition, calorie dense, high fructose dense, chemical dense to preserve freshness, like it has a lot of stuff that we're taking it in that way. Everything has to smell good. Everywhere you go, that's an assault, like we weren't meant to have like, scented everything. Again, I want to say if you come to my house, I have a scented candle. So, I'm not saying don't do it necessarily. But I'm just saying there's an assault in every direction, I have scented candles everywhere, your water is full of things, your air is full of things, your clothes are full of things, the plastics that we need to stay alive and our IVs and our infusions, and our catheters is like we just weren't designed to filter all this. So, like, we didn't evolve as quickly as an organism, as the industry did. And so, we are asked to filter all these things. And the immune system is on overload. I mean, we're seeing kids younger and younger with allergies, more and more asthmatics, more and more eczema, more and more IBS, aka my stomach can't handle it. We're on overload. We're on overload. So, I say the nutrition to start with, because honestly, it's the thing that is the most ubiquitous and easiest to control, it'd be hard for me to control your environment, what you're exposed to. So, if at the end, right, if I come back to this, like, if I clear all of your nutrition, and you're still unwell, and we have to go into environment, did you just have a renovation your house? Are you living in a moldy house? That's so much harder to manage, but that also could be there. So, the point is, is just it's a lot to ask your system to handle causing inflammation, the root cause is inflammation. What causes the inflammation are all these things that we're just assaulting the body with. So, the game is to find out what's causing inflammation, calm down inflammation. And Dr. Ovadia, I know, since you're a cholesterol man, and it's all about inflammation at this point, not that you're a fan of statins, I don't know. But that statin’s really an inflammation game, and I really, right? So, inflammation is at the heart of it. And our job as detective, as a functional medicine detective is to figure out what's causing the inflammation.

Dr. Philip Ovadia  38:43

Yeah, no, I think you've said that very well, that inflammation is the root cause. And it's really a matter of figuring out what's causing the inflammation. What I guess the question would then be...

Jack Heald  38:55

Well, you blew past that way too fast, Phil. Remember your question. No, no, you said inflammation is the root cause.

Dr. E  39:06

Yeah, yeah.

Jack Heald  39:09

And audience, inflammation is the root cause. I realize I'm the least qualified person here to say this. But we can't just blow by that guys.

Dr. Philip Ovadia  39:26

Yeah, I mean, it is at the root cause of the majority of chronic diseases that we face today, and it’s heart disease that I treat every day and it’s Alzheimer's disease and diabetes, and it's many forms of cancer and everything else. And I think that's what more and more of, and it's interesting whether you look at the functional medicine space or you look at the metabolic health space that I would say I'm more in. It all leads you to the same place, which is really what's most interesting about this, and you just keep coming back to inflammation. So, my question for you, E, is we talk all about diet and diet is largely my focus as well, diet and lifestyle. But how much is not diet? How often would you say it is that you do all the changes, you take the second step, you do the testing, you find out specifically what in the diet it might be for that person, and then you're still not better? And now you have to start looking at the other stuff.

Dr. E  40:41

I would have to say it's a smaller percentage of my patient. And the reason is, because let's just say it's mold or Lyme kind-of threw you over that edge. Nonetheless, who you are as a host prior to that Lyme will help you recover from that Lyme, right? So, let's just take Lyme, like ever since I had Lyme, it's been like this. True, but how come Joe Schmo who has Lyme, he's fine. And he's camping. And he's getting Lyme again. And again, I have 90 year olds who are they've been positive with Lyme forever, and they're fine. So, who are you as a host that helps you contend with this Lyme, contend with the COVID, contend with a mold, is really important. And so, for most people, even though there are other things at play, once we fix their nutritional component and their belly, many of them now are strong enough to recover from the from the last assault, right, and I say the last assault because people will say ever since x. So, whenever that x is, a lot of times, we don't necessarily have to totally address x, if we can make you strong enough to manage it. And sometimes we do, sometimes we do need to do a little bit more with Lyme, and you need to do like mold remediation. But now you have a host that can handle the treatment. Because like to do mold, or like any of these remediations, we do it holistically, So, it’s a lot of herbs, its binders, it's hard on the belly. So, we can't do that on top of, right, the inflamed system. So, I would say it, as we clear the weeds, it becomes smaller and smaller and smaller. And then yes, of course, I have those patients. And those patients have to be even more committed, because their progress is so slow. I had one patient that I mean, clean as can be. There was nothing left to remove from her. And really the conversation with her is just that her belly at this point was so, right, so, this is not my ours, this is functional medicine, but there's remove, there's repair, there's replace, there's reinoculated, there's reintroduce, four- or five-hours Institute of Functional Medicine, I didn't create it. So, the removal part for most people, once we remove it, they start feeling better. With her, the repair took so long. What I mean by that, I mean, I couldn't give her supplements, every time I gave her supplements, it set her back, her stomach will be back. She'd have it flare up. This is somebody that for months, all we could do is a few drops of vitamin A. We did that for a while. And then eventually we got to vitamin A, and short chain fatty acids, like once a week, because two times a week was too much. So, there are some people where you have to move very, very slow. But I would say in my practice now, if you go to another practice that only deals with the sickest of the sick, they're gonna say 100% that there are people like that. But in my practice, it’s a smaller percentage that require additional testing and more of like a figuring out what's next.

Jack Heald  43:43

There's a poster on the wall of my doctor's office, I was just trying to find, I took a photo of it because it was so cool. It's a pyramid. And I wish I could remember what it's called because I put it in the show notes. But it's basically how health is built. And at the very tippy top of the pyramid is the interventional medicine, drugs and surgery and you work your way down. And at the foundation is I think they call it like the word I keep thinking of is terroir, like what the ground that grapes grow in. What is the ground of your health that, what is the ground your health is growing in? And my doctor is constantly looking at what's the ground like. If we can get the soil right, if we can get the stuff that everything else comes from, if we can get that right, the rest of it will likely take care of itself. And that's such a different model of medicine for me. Like I say I've been seeing this guy for 17 years, and he refuses to even use the terminology of Western medicine. He just, he doesn't do diagnosis. He doesn't say you've got this sickness. He just is saying, well, right now your body says you don't need to be eating dairy.

Dr. E  45:13

Hmm. People asked me how long is it gonna take? Or what's next? And like, I have no idea. I'm going to start here. And then your body's going to tell me if this worked or not. I have no idea. I have a structure that I tried to but what if I start this in, Like, none of this works? Right? So, we have to wait for your body to tell us what's next, what worked, what didn't work. So, your body doesn't want this for now is really good. I do want to say if I may that I know I focus a lot of nutrition, standard American diet. But just as important, is sleep. We're not sleeping. You could be eating gluten free ice for the rest of your life. If you're sleeping an hour at night, it's not gonna work out for you.

Jack Heald  46:01

I'm stealing that one. Gluten Free ice.

Dr. E  46:06

Sleep, lack of sleep is causative for dementia. If you're not sleeping, there are certain processes in your body that are not happening and you need them to happen. Right? So, there's a lot of metabolic waste that is a very metabolically active area. And there has to drain, it has to process. It's the only time that growth hormone as adults is released is when we're sleeping. You have to sleep; you have to prioritize sleep. So, I'm sorry. 

Jack Heald  46:39

So, what, the growth hormone is released when you sleep, if you're not getting sleep, the growth hormone is not. So as an adult, what do I need growth hormone for? I’m grown.

Dr. E  46:49

It's repairing. It has other uses. Great question. It's repairing. So, you need time to repair. You have to shut the computer down a little bit. And let it repair. There are certain things that have to happen to your brain at night. And if you're not sleeping, it doesn't happen. It doesn't have the opportunity to get rid of waste. There's a cleanup system. It's called like lymphatic drainage system. There's a whole sanitation department that comes out at night. There's things that have to happen at night that if you are skipping it for the sake of your productivity, for the sake of your phone, for the sake of whatever, you are not going to optimize your health without it. I don't care how well you eat or how well you exercise. This is a critical piece it has to be it's not after nutrition. It's like here.

Jack Heald  47:37

Same time, nutrition and the sleep right.

Dr. E  47:41

Yeah. So, we always talk about optimizing sleep. And now, a lot of times when we fix nutrition, sleep gets optimized, why? A lot of people, bowl of pasta, glass of wine, nice dinner, they get sleepy. I think this is great. I'm gonna go to sleep. Two, three hours later, they're awake, heart palpitations. They're sleeping, nightmare, sweating. Oh, I don't know, must be my menopause. No, it's your wine and your pasta, right? So, a lot of times, fixing the nutrition fixes the sleep a lot of time, distancing your last meal from when you go to sleep at least three hours can also help it. Making sure your last meal is not carb heavy. So, a lot of times that fixes it. But then sometimes no, I certainly have patients where everything's perfect and not sleeping. So now let's talk, now's a good time for supplement game. Maybe we need to give melatonin, some L-theanine. So, there's some things that you might want to give but you have to find what's going on. Is it to too hot in your room? Is it too cold? Was your partner listening to the TV, and you never realize it’s bothering you? Are you really worried about your kids coming home? Maybe you need a white noise maker. Whatever it takes to get your sleep, we have to have that conversation. Super important.

Dr. Philip Ovadia  48:50

Are you a big fan of sleep trackers like do you think this is something we need to measure or people should just know I sleep well or I don't sleep well?

Dr. E  49:00

I'm not a fan of sleep trackers because I feel it creates a learned behavior. Right? Like people say to me, I wake up every day at 3:30. How the hell do you know you wake up every day at 3:30? Because you get up and you check. So now your brain is ready to wake up at 3:30 tomorrow. It’s a learned behavior. So, there's, sleep is multifactorial, right? There's the food I described, there's melatonin described, there's the phone, but then there's also learned behaviors, like why 3:30 every time because you're almost used to getting up at 3:30. So now sleep trackers, it sets an expectation. I have some patients I've actually talked to please take it away, like just have your alarm clock on the other side. Don't look at it, put your alarm clock on the other side of the room. Take it away. Take the sleep tracker off. They have the worst night's sleep for the first week because they're like so anxious. What time is it? How do I know what time it is? Like there's so much anxiety happening there. So, I found that if you're sleeping well, and you're tracking, it doesn't bother you, and you just want the information. Great. But I think if you have insomnia, I have never seen it actually help, it creates great anxiety around it. What do you think about it?

Dr. Philip Ovadia  50:16

Yeah, I'm really not a huge fan of them, either. I think that first of all, I think the data is all over the place even when you look at what should be a simple measurement, HRV, and depending on what device you're using, and it's going to report it in a different way. And it becomes that self-feat, like, people wake up, and they say, oh, look, my HRV is low so I'm going to have a crappy day, and it becomes that kind of self-feeding, self-fulfilling prophecy. And sleep again, you should be able to answer the question do sleep well or not? It's not really, it's not the time. It's not how long do you sleep. I don't know that that's all that useful of a question. If it's extreme, one way or the other, it's useful, but is six hours enough? Is seven hours enough? Is eight hours enough? And it's always, it depends. Yes. And no. You should know, when you wake up, basically, do you feel rested or not? And that's kind of where I start with on the sleep question.

Dr. E  51:26

Yes, the quality of the sleep and restorative, right, because, as with adrenal fatigue, you could sleep for 10 hours and be exhausted, so the hours doesn’t count, and then some people at seven or six are fine, if it's a solid and they wake up, and they're ready to go.

Jack Heald  51:42

I can actually I can confirm that. I've learned how to kind of self-diagnose what's going on with my adrenal system, based on the combination of the amount of sleep and how rested I am. And one of the things I know when I'm in an optimal health state, I sleep deeper and I don't need as much. Six and a half, seven hours, I pop out of bed, I'm good for 15,16, 17 hours. When I start to get depleted, I've observed that 9, 10,10 and a half, 11 hours, and I still can't, I'm dragging myself around by the collar. It's kind of weird that, that when I'm healthier, I don't need as much sleep. Is that

Dr. E  52:38

There's I mean, there's a balance, right? Because you don't want to be like well, now I need less and less. The early bird gets the worm and that whole mess. So, you'd want to be careful to go the other side and I know, you're not. Yeah, you might be like well, I can maybe I could do five and wake up earlier to go workout.

Jack Heald  52:51

I'm past that point in life.

Dr. E  52:55

A lot of people do that. Like please do not forego sleep for a workout. Yeah, do not wake up at four o'clock to get your workout in because it's not. It doesn't work that way.

Jack Heald  53:04

Jaco does. The people who know and otherwise don't know.

Dr. Philip Ovadia  53:13

So, before we wrap this up. I got a fun little question for you. So, Dr. E, the nurse practitioner from 15 years ago is looking at Dr. E today. And what would you say would be the craziest thing what you would have thought back then was the craziest thing that you now kind of do every day or integrate into your practice every day.

Dr. E  53:43

I'm laughing for so many reasons, but I'm gonna stay medical stay in medical, 15 years because a lot of things.

Dr. Philip Ovadia  53:50

Yeah. That's why I said Dr. E, the nurse practitioner, we're staying medical.

Dr. E  53:57

I had to like move a lot of things out of my periphery. Okay, so what is, sorry, now you asked me that last question. What is, what am I practicing before?

Dr. Philip Ovadia  54:08

What do you like do every day now as a practitioner that 15 years ago, you would have thought was absolutely crazy?

Dr. E  54:20

Really take the time to listen. And I had to create a model that allows it, right because again, not because I didn't want to listen, I thought I was listening. Right? I thought it was listening for what I needed to hear to make the diagnosis, and also the speed in which I need to see in our patients in order to meet some parameters. Like it's all normalized. It was normalized. It’s just normalized that a five-to-seven-minute meeting here, wanting to hear listen for red flags, right? It's about listening to red flags. Make sure you don't miss in the red flags. Make sure I hear everything Need for my old cards to document. So, it's a different listening, right? And so, I'm make sure that I did right by the patient and then it's done. I sometimes do discovery calls my patients. And without any labs, we're talking for an hour, because I have to hear the whole story from beginning to the end to connect the dots because no one's connecting the dots because you can't connect the dots in five to seven minutes. And so, in something that happened in 20 years, I just had a patient this morning with what happened to her mom, I'm watching it happen to her and I'm already seeing her kid Iike, who can have that kind of conversation? Or so time understanding that there's a different kind of listening. And then creating a model that can sustain that kind of time needed. So, I never I never saw that coming.

Jack Heald  55:55

This is a perfect time to announce, to talk about contact information because at this point, people are saying, Okay, I got to know more. What's the best way for people to find out more Dr. E.

Dr. E  56:09

Okay, so The KNEW Method, knew spelled with a K because you always knew there was a better way. The KNEW Method on every platform, except for Twitter because I talked too much. So, website and new reddit.com, Instagram, Facebook, Tiktok. Wherever you are, there's a clickable link, there is a free consultation with my team. So, you can ask all your questions, you click on the link, you choose a time that works for you to talk to my team costs you nothing. Ask your questions, how much does this cost? What do I get what? Ask all your questions. And then if there are no sales, we do not operate under pressure. I only want people who want to work with me, no one's going to pressure you into anything. If it works for you, then you make a consult with me. And then we take it from there. So yeah, nothing to lose.

Jack Heald  56:56

Are you limited in locales where you can help people?

Dr. E  57:02

So really great question, The KNEW Method is separate from my medical practice. And this allows me to practice, to not practice, to consult and coach anywhere because it is under the umbrella of coaching. I cannot prescribe in your state, I can make recommendations, which will take to your PCP. But the beautiful thing about functional medicine is that I don't need to prescribe. So, if you are in New York, New Jersey, I can also manage your medication. But if you're not in New York, New Jersey, there's so much that we're going to do and then I'll make recommendations that you can bring back to your doctor. So, there's no limit. Secondly, I can meet you talk to you wherever you live.

Jack Heald  57:43

Well, as always, we will make sure that information is with links is in the show notes. For those of you who are listening, no point on wrecking the car trying to write it down. It'll be there. Phil, if you don't mind, I've got two more quick questions that I'm dying to ask. What's fascinating to me, Dr. E is what you really haven't talked about, you've said almost nothing about exercise.

Dr. E  58:12

I'm glad you asked.

Jack Heald  58:14

And there's a follow up question to that. But I don't want to get into deep.

Dr. E  58:20

Exercise. So let me just say this, movement is important. But exercise has to be done at the right time. So, one of the things that I find so annoying is that my well-meaning colleagues and I used to do the same as like, well, if you just exercise, you’d be fine. You know that, Jack, that with adrenal fatigue, you tell someone to exercise they can't, they're exhausted. And so, all you do by telling him to exercise is you make them feel bad about themselves, because they've tried to exercise and everyone said it's going to energize them and instead, they need a nap. So, yes, we're going to talk about exercise, but not in the beginning. I first have to make sure that you can get through the day. And then usually around month three or four, my patients will come to me and say guess what I did this weekend, I walked down the park and I didn't need a nap. That's when we're going to talk about exercise. And when we talk about exercise, I'm not going to tell you to go do an hour at the gym. I'm gonna say what was that nine minutes? Was nine minutes good for you because maybe 10 minutes is too much? I don't know what exercise is for you. Do I want everyone moving? Of course. But I have to first make sure you can move. Because if moving depletes you, then I'm just sending you back. So yes, movement is important. I discuss nutrition, sleep. always discuss exercise, always discuss sleep, and then there's like I'm sorry, and stress, right? But exercise. While movement is so important for so many reasons. I can't start there if my patient is depleted.

Jack Heald  59:58

You’ve just given hope to a lot of people. No, you have. 18 years ago, somebody would have said that to have said, no, please, please, please tell me more. And then you alluded to my follow up question which had to do with stress, what I was really thinking of was kind of the non-physical aspects of restoring health, I'm thinking more of a spiritual practice, your social connections, those kinds of things. And I realized that may be outside your scope of coaching and or practice, but it just occurred to me how.

Dr. E  1:00:34

So, I talk about it all the time, and you, right, I may not be the one. I might I have colleagues out. I'll refer to if we really need to go deep. But getting a practice of something, some sort of stress relief is really important. I'm going to come back to social connections in a minute. But like, in the hierarchy of needs, if my patients aren't in pain, and I talk to them about let's meditate. I can't. So, I kind of talked to my, this is why I work on patients for at least a year because they're, I got to get you out of the crisis mode of whatever's going on. And then in my opinion, this is part of the optimization. Okay, we're pain-free, we’re calming down now. What else can we do to take us to the next level? Because it's really hard to meditate and deep breathe. And when you're like, this wang wang wang of pain all the time. Or if you're so worried that maybe something's wrong with you, like, it's really hard, and most people's anxiety is so high, because they're feeling so unwell. And when things start not hurting so much, and this energy, again, anxiety comes down, and it's a good place to take that. So, it is important to me. So, what I usually do, I do a check in, is there anything I need to know like, is there a divorce going and did you just lose your job, like, I do need to know that I need to know the biggest I ask every time. If everything's status quo, I kind of gauge a patient where they are because if I go to woo woo too early, I'm gonna lose them. Because that's not why they came to me for right. But it is really important. I personally have a practice every morning to wake up. and meditate, it doesn't have to be long, and journal. But I didn't start that way. It took me years to get here. So, I think it's a big jump for other people. Social connections, very important. It is so important that I will talk to my patients and say, it's Christmas, we do not want you to be on this diet. I need you to be with your family at the table, enjoying everything that everyone's eating, not being the guy on the corner, again, the gluten free ice and not connecting. There are traditions, there's foods that come once a year, are you going to feel crappy tomorrow? Sure. But what you're gaining from this togetherness and the cooking and the eating together is so valuable on the molecular level that we have to have it so I always encourage that whenever possible. We put it in there. I do not say at all costs, you must stay on this Christmas, birthday, be that no, absolutely not. Because the interconnectedness is really, really important. I'm so glad you asked those questions.

Jack Heald  1:03:12

You just poured a great big heaping helping of hope, into the ears of somebody right now who really needed to hear that.

Dr. E  1:03:24

Thank you. I appreciate that. That means a lot to me.

Jack Heald  1:03:26

Well, it means a lot to me that I get to speak with folks coming out of conventional medicine, who have had their eyes opened, and their minds open and their hearts opened to get out of the what I call the disease management business and into the health care business. And it's all because I get to hang out with Dr. O every week. But it's a blast for me. Okay, we could go on and on and on. Because I'm insatiably curious, Phil, but you’re read wrap it up?

Dr. Philip Ovadia  1:04:01

I think that's another great discussion. So glad we connected. And so glad you're out there doing the great work that you're doing.

Dr. E  1:04:09

Thank you. I really, really appreciate being here on this podcast. It was it was amazing. Thank you.

Jack Heald  1:04:14

Yeah, it was it was good for me too. It was really, really good. So, Dr. Lamandre at theknewmethod.com. No. Is that right? Yeah, the theknewmethod.com. And on all the places except Twitter because she doesn't, because she talks too much, which means I'm dying to get her on Twitter just to enjoy that. All right. Well, this is a Stay Off My Operating Table podcast. Go ahead and click on the subscribe button. We drop a new episode every Tuesday and sometimes more often than that, go to Dr. Phil's, Dr. Ovadia’s, it's so easy to call you that, you need a different name. Go to Dr Ovadia’s website at ifixhearts.com and take that metabolic health quiz. It's a good place to kind of get a baseline for where you are and kind of know where to start. And that's it for today. We'll talk to y'all next time.

Jack Heald  1:05:08

America is fat and sick and tired. 88% of Americans are metabolically unhealthy and at risk of a sudden heart attack. Are you one of them? Go to ifixhearts.co and take Dr. Ovadia’s metabolic health quiz. Learn specific steps you can take to reclaim your health reduce your risk of heart attack and stay off Dr. Ovadia’s operating table. This has been a production of 38 atoms