Dr. Tro Kalayjian - a formerly 350-pound doctor - had to unlearn much of what he'd been taught in medical school to get his health back.
Dr. Laura Buchanan - a former athlete - had the same sort of experience. She learned early on that she wanted to integrate metabolic health into her medical practice.
Despite having different backgrounds in both personal health and medicine, Dr. Tro and Dr. Laura now collaborate to give their patients the best care possible. To address the underlying reason for a patient's health issues, the healthcare team considers the patient’s strengths, weaknesses, failures, and even appetites. They call this "patient bonding." It's a way to establish trust and rapport with the patient.
In this episode, these two doctors share their perspectives on what drives the messaging for nutrition, their passion for establishing rapport and connection with patients, and the future of health tech.
Listen until the end to know their fantastic announcement to help your health improve.
Quick Guide
01:23 Introduction
12:08 Nutrition messaging and results dictated by funding, religion, dogma
22:12 Deep diving into research
24:32 Lessons from the CGM about nutrition
27:14 What sugar does to blood vessels
31:40 The importance and ways to make patient bonding happen
44:01 Scaling the health tech, culture, empathy, and critical thinking
48:20 Insights on intermittent fasting and metabolism
52:27 Questions you want somebody to ask you
54:00 Closing statements and contacts
Get to know our guest
Dr. Tro Kalayjian, MD and Dr. Laura Buchanan work together to make a difference in patient care. With their Doctor Tro app, they aim to build accountability and a community addressing metabolic health.
"I can tell you that we have CGMs and scales and coughs and ketone meters, and if you don't use them, it will nudge you into using them. And, yeah, there's all this fancy stuff. But I think, I almost don't, like the fancy stuff is helpful because eating is something we want to be subconscious about and we have to rip it out of the subconscious. So, the tools like the CGM are so irreplaceable, but it's the act of what's really replaceable is the act of taking something subconscious, and sparking change."
Connect with them:
Website: https://doctortro.com
Aging Successfully: https://agingsuccessfully.substack.co
Chances are, you wouldn't be listening to this podcast if you didn't need to change your life and get healthier.
So take action right now. Book a call with Dr. Ovadia's team.
One small step in the right direction is all it takes to get started.
How to connect with Stay Off My Operating Table:
Twitter:
Learn more:
Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings
Dr. Tro Kalayjian - a formerly 350-pound doctor - had to unlearn much of what he'd been taught in medical school to get his health back.
Dr. Laura Buchanan - a former athlete - had the same sort of experience. She learned early on that she wanted to integrate metabolic health into her medical practice.
Despite having different backgrounds in both personal health and medicine, Dr. Tro and Dr. Laura now collaborate to give their patients the best care possible. To address the underlying reason for a patient's health issues, the healthcare team considers the patient’s strengths, weaknesses, failures, and even appetites. They call this "patient bonding." It's a way to establish trust and rapport with the patient.
In this episode, these two doctors share their perspectives on what drives the messaging for nutrition, their passion for establishing rapport and connection with patients, and the future of health tech.
Listen until the end to know their fantastic announcement to help your health improve.
Quick Guide
01:23 Introduction
12:08 Nutrition messaging and results dictated by funding, religion, dogma
22:12 Deep diving into research
24:32 Lessons from the CGM about nutrition
27:14 What sugar does to blood vessels
31:40 The importance and ways to make patient bonding happen
44:01 Scaling the health tech, culture, empathy, and critical thinking
48:20 Insights on intermittent fasting and metabolism
52:27 Questions you want somebody to ask you
54:00 Closing statements and contacts
Get to know our guest
Dr. Tro Kalayjian, MD and Dr. Laura Buchanan work together to make a difference in patient care. With their Doctor Tro app, they aim to build accountability and a community addressing metabolic health.
"I can tell you that we have CGMs and scales and coughs and ketone meters, and if you don't use them, it will nudge you into using them. And, yeah, there's all this fancy stuff. But I think, I almost don't, like the fancy stuff is helpful because eating is something we want to be subconscious about and we have to rip it out of the subconscious. So, the tools like the CGM are so irreplaceable, but it's the act of what's really replaceable is the act of taking something subconscious, and sparking change."
Connect with them:
Website: https://doctortro.com
Aging Successfully: https://agingsuccessfully.substack.co
Chances are, you wouldn't be listening to this podcast if you didn't need to change your life and get healthier.
So take action right now. Book a call with Dr. Ovadia's team.
One small step in the right direction is all it takes to get started.
How to connect with Stay Off My Operating Table:
Twitter:
Learn more:
Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings
S3E21 Dr. Tro Kalayjian and Dr. Laura Buchanan
SUMMARY KEYWORDS
low carb, people, patient, tro, laura, eating, working, moment, metabolic, health, medical school, study, blood sugar, hear, cgm, question, blood vessels, talked, research, understand
SPEAKERS
Announcer, Jack Heald, Dr. Tro Kalayjian, Dr. Laura Buchanan, 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
We are live in 3, 2, 1. I think we're live. I've only done this about 800 times you'd think I'd have figured it out by now. This is the Stay Off My Operating Table podcast, Dr. Philip Ovadia and Jack Heald the resident idiot, and we are joined today by Dr. Tro Kalayjian, more famously known as Dr. Tro, and his sidekick, Dr. Laura Buchanan. Welcome y'all. Good to have you here.
Dr. Laura Buchanan 01:01
Thanks so much for having us.
Dr. Tro Kalayjian 01:03
Yeah, always a pleasure. Always a pleasure to be here. Thank you.
Jack Heald 01:06
A lot of times, Phil, you bring these folks on I get why the heck are these folks here. And then it ends up being an awesome conversation. But I think I know why Dr. Tro’s here. Nevertheless, I'll still ask the question. Why are these folks here?
Dr. Philip Ovadia 01:23
Yeah, the real question for this episode is what took us so long to get these folks here. So, to start with, Tro really has been one of my mentors and guiding forces through this metabolic health journey. He was instrumental in helping me set up my medical practice, and really just someone who is leading the way in making metabolic health a part of the healthcare system. And Laura is one of those shining, bright, young lights in the space as well. I first met her, I think it was last year, maybe two years ago at one of the conferences. She was still in her training at that time. And, but knew already that she wanted to integrate metabolic health into her practice. And she was fortunate enough to get hired to work with Tro now. So, they are now partners and excited for our audience to hear about everything that they are doing. Why don't we start with, we want to certainly get both of your backstories. And, Laura, why don't we do ladies first? Let's hear about how you got here.
Dr. Laura Buchanan 02:45
Absolutely. So, I grew up loving plan sports. And that was really where my passion was in undergrad, kind of high school, undergrad, I started seeing some of the people in my life I love age very differently. Some were aging really well. And some were not. And it was clearly driven by the lifestyle that they were living. And so, by the time I had finished undergrad and decided I want to go to medical school, I knew I wanted to help people age successfully. And then it was kind of the path of how do I best do that. And very fortunately, I came across the low-carb MD podcast, Nina Teicholz’s Big Fat Surprise. And then Jason Fung’s books, and just really started diving deep into that literature, and realized what I was taught in medical school regarding nutrition and chronic disease was wrong.
Jack Heald 03:39
How? I'm going to jump in here more because I have the opportunity to do it. How did you respond to realizing that your education was wrong?
Dr. Laura Buchanan 03:58
I was very frustrated. I didn't actually, during medical school, couldn't really do much. And I might ask one or two questions during the lecture. But that was pretty much the extent of my pushback or my questioning of it. But it was, I got a continuous glucose monitor during my fourth year of medical school.
Jack Heald
Really?
Dr. Laura Buchanan
Uh-hum. And so fortunately, I had a mentor, one of the docs there, and I told him why I wanted it, and he was willing to prescribe me one. And I learned some of the things I was eating because I had sort of transitioned to a more what I believed was low carb diet. I thought that was the healthier lifestyle, I realized I was not eating things that were actually low carb. It was false advertisements. My sugar was going to 180. And so quickly made a few more...
Jack Heald 04:45
Alright, I'm the dummy. So, tell us what healthy should be. Because giving me a number doesn't mean anything. I know you guys know what it means, but I don't and the people who listen to this usually don't.
Dr. Laura Buchanan 04:59
Yeah, so, I mean ideally, I wouldn't want a blood sugar really to go above 120. There's some data now, if from your baseline blood sugar, if you have an increase by more than 65 points, then that is damaging to your blood vessels. So, if you're at 80, you really don't want to go above 140.
Jack Heald 05:17
Okay. All right. So, you've got the CGM. Continue.
Dr. Laura Buchanan 05:23
Yeah. So, continue to tweak and improve my lifestyle. And then when residency started, right out the gate I had all these, I started watching the low carb USA conferences virtually. And I started practicing low carb and residency. And so, my patients when they would come in with their diabetes, I would start talking to them about what they're eating, rather than just adding on additional medications. And the results were great. And so initially, I got a little bit of pushback, I ordered fasting insulin on patients, and it's like, why are you getting an insulin on this patient, their A1C’s normal, or you already know what their A1C is, how's that going to change management? And so, but I explained my logic, the reasoning, and the research, and eventually, I stopped getting pushback. And people were more interested and ask questions and I think some people actually, I see more fasting insulins being obtained. And so, there's been a transition or more of acceptance of low carb actually within the residency.
Jack Heald 06:27
That makes me happy.
Dr. Philip Ovadia 06:31
Yeah, it's really, really great to hear that you were able to start off this way, instead of having to unlearn a lot of things that guys like Tro, and I have had to unlearn. So, Tro, I think many in our audience are going to be familiar with you. But for those that aren't, let's get a little bit of your backstory.
Dr. Tro Kalayjian 06:57
Yeah, absolutely. I just want to add that Dr. Laura is being so humble about it. I mean, she's done two major poster presentations on a low-carb intervention that she's presented at the Society of Metabolic Health Practitioners, she's on the board now for the Society of Metabolic Health Practitioners, and she's leading several committees there. And she's volunteered at a nearby clinic, a federally health care center, to educate them on low carb, I mean, she is the real deal. So, I'm honored to be able to have somebody to buy in enough that we can change medicine come join me, and I just want to reiterate that she's humble, she won't say all this, Phil, so I gotta say it, because she definitely won't be saying it. So, she's the real deal. And I gotta do one more thing to embarrass her. She beat me on both board exams. So, I always tout, I'm the guy who went to this Yale-affiliated internal medicine residency, scored on the 90th percentile on my board exams. And she's like, Tro, you know, I scored on the 99th percentile. So, I definitely found somebody smarter than me. If she won’t say any of this, so, I'm gonna say it.
Jack Heald 08:29
She’s doing you a favor by coming to work with you is what I'm hearing.
Dr. Tro Kalayjian 08:32
Basically, that's the case.
Dr. Laura Buchanan
I'm the lucky one.
Dr. Tro Kalayjian
If you don't know my story, let's see, I'm a 350-pound x doc whose wife inspired him to figure this out, like, you'd figure out which surgical technique to use, or which antibiotic on pneumonia. And you go to the literature and to just kind of, so, I went to literature, I'm inspired to kind of figure this out. And what I found out quickly I had no skin in the game. I was an ex-vegan. I was a calorie-counting kind of...
Jack Heald 09:18
Wait, what, you were a 350-pound ex-vegan?
Dr. Tro Kalayjian 09:22
Well, it's a checkered past. But yeah, I had to, at least one year in my life that I ate just plants, right, as a kid. It’s probably, it’s a complicated story, but yeah, I was an ex-vegan vegetarian. Then eventually, when I say a kid, I mean, like, 15, 16, and then eventually it was standard diet. That's where I landed, but standard diet is still whole-grain bread, brown rice.
Jack Heald
The good stuff.
Dr. Tro Kalayjian
That kind of thing.
Jack Heald
Heart-healthy Cheerios.
Dr. Tro Kalayjian
Bananas. Yeah, I got a strawberry, dried strawberries in my brand cereal. I would eat boxes Akashi whatever, like I was, quote unquote healthy and healthy eater. But what I didn't know at the time was I was probably predisposed to gain weight from high carbohydrate eating like most people are. And so yeah, I found myself at 350 pounds. And basically miserable. I mean, you could have mirrored Phil's story with mine. I mean, we're, we could have been brothers, in fact, we kind of look like brothers. But I think...
Jack Heald 10:39
I went to your website, researched and I was like, this is the same story.
Dr. Tro Kalayjian 10:45
Yeah, very similar story.
Dr. Philip Ovadia
It really is. Yeah.
Dr. Tro Kalayjian
And so, when I started like this, I had no skin in the game, people are like Tro, you’re selling this, that, like, I had never cooked a steak. I didn't go to low carb because I thought I'm gonna become some low carb up, I went to low carb because I went to the literature, and low carb always was better even if I am couple pounds, it always did better. That was it. That was it. I was an evidence-based doc, went to the head-to-head data, like, I'm just gonna pick the one that does better. So, and then, once you get into the data, you start to see the narrative unfold. So, we talked about like this nutritional kind of matrix where low carb does better, but somehow in the conclusion, but LDL is up and you go further well, but its meat-based, and then you go into the meat observational data, and you see that it's all bogus, and BS, and it's healthy user bias. So, once you start to read and like really just have an ounce of a brain, an ounce of critical thinking, and just a bit of questioning, that's all you need. It's not, you don't need much. You just see it all unravel. And once you see it all unravel...
Jack Heald 12:04
By it, you mean?
Dr. Tro Kalayjian 12:08
This current, the messaging of eat seed oils, and a bunch of grains for the environment, climate change, and overall health, right, you see the nonsense, right? That somewhere between religion, industry, industry messaging, and dogma, right? And it's tough for people to understand what I'm saying right now, but this is the truth. Okay, your nutritional messaging from the government all the way to your cardiologist is a composite of industry funding, religion, and dogma, right?
Jack Heald 12:48
What's the religion?
Dr. Tro Kalayjian 12:51
So that, I mean, other people could probably talk to it better than I could. But our whole Dietetics Association comes from the Adventist, Red Sunday Adventist, who are profoundly vegan, and it's sort of like a sin to eat animal meat. So, they're Loma Linda, which is a huge kind of, like, Nutrition Center for Research, Harvard's public, these are all very plant-based narratives. I'd say Harvard is more dogma based. And Loma Linda is very much religion based and you can track that through to dietetics and how Kellogg's basically Seventh-Day Adventists. And you can see kind of how they all morphed into one. And then industry, you can track how Procter and Gamble basically started the HA. So, you have the Seventh Day Adventists and Kellogg's and their influence in dietetics, you have industry Procter and Gamble, the vegetable oils, and the HA, and then you have sort of the dogma, the observational research that's just touted by Harvard, so these are like the epicenters of misinformation right now, when it comes to nutrition. And it's tough for the average person to like to really understand this all because it, the doctor down the street is like, yeah, you should eat, meat, it’s going to kill you. So, but where I started as a 350-pound doc was just going back to the research and saying which antibiotic is better, which surgical technique is better? That's it. Right? And it was low carb. So that's where I started. I got no skin in the game. I didn't know all this. I just found that out as I kept looking into, kept reading textbooks and research studies and saying, wait a second, we just put out a... Phil, I know I'm yapping away here. You should...
Jack Heald 14:45
This is good. Actually. No. Yeah.
Dr. Tro Kalayjian 14:47
So, we just put out a, so we analyze the recent study, right? So, me and Eric Westman, we looked at a recent study. And David Ludwig and Dr. Adrian Soto-Mota, they looked at another study. So, what we did was we looked at the same author, by the way, so we're both challenging the same author. And what we found was this particular author of this well-known nutrition author, his name is Christopher Gardner, who works, is a self-proclaimed vegan. He did a study looking at keto versus Mediterranean. And what he did was very interesting. He stopped all the diabetes medications in the Keto arm and he didn't stop them as much in the Mediterranean arm. And then he said, look, the A1C’s the same. And you know what? Eating vegetables is better. So Mediterranean is better. Right? And what he didn't say was, he stopped more meds in the Keto arm. Right? So, we put out a letter to the editor saying, this is blatant bias. You can't do this. Right? So, and then, the same group of colleagues that we have, Dr. David Ludwig and Dr. Adrian Soto-Mota, they’d reanalyze the diet fit study, another low fat versus low carb study, and they found that a significant portion of that weight loss, right, came from just being lower glycemic. Right. So, these researchers, people don't understand, they publish their studies, and they say their results. But the bottom line is there's so much design and engineering crafted to try to equalize the results. And the layperson doesn't understand. We have to write a letter to the editor saying we're calling BS. So, this is the nature of our nutritional landscape right now is there's a lot of interest. And that's just the way it is. I don't blame them. They're smart, they're good at what they do. So that's my story, went from a 350-pound guy to a 200-pound guy. And I've had struggles in between, but I had to unlearn everything just like Dr. Phil.
Jack Heald 16:58
I just want to summarize what I heard because we've got three physicians and adult on this call. Yes. And I want to make sure that I got it. And that the people like me who are listening, got it as well. What I heard you say is, there are studies that get published that support a position that is really the result of religion, dogma, and corporate interests, all driving toward a particular conclusion. And yet, without somebody being a cop, like you guys are being these studies go, they get entered into the literature as if they were legit. Did I say that right?
Dr. Tro Kalayjian 17:56
Right? Yeah. So that study like one, let me give you a concrete example. We had a Keto versus Mediterranean study. And into the books, if you read the conclusion, no diet is better is what it said. But buried in it is that they stopped more diabetes medications in the group that was ketogenic versus Mediterranean.
Jack Heald
Do you mean they were able to stop more?
Dr. Tro Kalayjian
Correct, to get the same A1C level. So, look, they said, look, we stopped, we put half these people on keto, we put another half on Mediterranean, and they said the A1C at the end is the same. But they stopped five meds the in the Keto arm, and they didn't stop those five meds in the Mediterranean arm. So, what they're doing is they're saying, oh, look, the A1C is the same, the level of diabetes improvement is the same. Right? And that's their conclusion. But what they buried is we got five people off meds on the ketogenic arm. So, that's not anywhere to be seen in the study or on the front page. So, this is a very smart tactic for somebody who has an interest in the Mediterranean diet and making it look good. And wanting to, it is biased. Whether it's implicit or explicit, I don't know,
Jack Heald 19:22
It's presented as objective science. And in fact, there was an objective behind the study, but it wasn't just to follow the data wherever it led.
Dr. Philip Ovadia 19:36
Yeah, and I think this is something we see repeated often these days in that the studies are designed to get the result that’s desired. Instead of going at science as trying to answer, trying to find the answers to unanswered questions. Oftentimes today, they start with the answer. And then they say, how do we design the studies to support this answer? And that's a problem that I think we see so often. I wanted to highlight something kind of in all of our stories here. And it's interesting to me that Tro being the smart guy he is, he has a problem, and he can't solve the problem. So, he goes to the literature. And without bias, just looking for an answer to his problem, he comes to a conclusion, and he tries it, and it works. And he now continues to get more data and try it with more people and publish the results, like science should be done. It was interesting that I sort of came at it in a different way. I had a problem. I just kind of, I knew what I was doing wasn't working. I was presented with an alternative solution by a journalist, very well-known journalist, we all know, Gary Tubbs. And I said this makes sense. Let me try it. And I tried it, and it worked. And then I went to the literature to figure out why the hell it worked. Because everything I had learned previously said it shouldn't work. And it worked. And we ended up at the same spot. But what's most interesting to me, I think about this metabolic health thing is that we see all of these different specialties, all of these different people who start with different problems, and yet they end up at the same place. And I think that's ultimately what's most powerful about this. And I just love everything that Tro and Laura are doing to get the data out there about this does work, why it works, and then to be dispelling the myths, essentially, that the dogma that we all learned. So, Laura, talk a little bit more, though about it. Typically, when you're going through medical school, the approach is just kind of put your head down, memorize what they're telling you, be able to spew it back on the test. And yet you were able to recognize pretty early on that it wasn't matching up with sort of your life experience, and be able to challenge that to not just accept that, I should say. So, what was that like for you? Why do you think you were able to do that? I imagine you probably tried to get some of your classmates involved with this. And they were like, nope, they're telling us something, we gotta listen to what they're telling us.
Dr. Laura Buchanan 23:00
No, so I did have, besides Matt, who is my husband, who is also in family medicine, now, he was my partner in all of this, and just really started diving deep into the research as well. And we're both very fortunate in that we love researching this topic. We love nutrition and physical activity exercise. So, for us, besides our workout in the morning, we were probably basically just studying or reading literature, books, podcast, pretty much all day until we went to bed. And then it was rinsed and repeated. So, we're just taking in as much as possible and enjoyed it. So that was obviously lucky. I did have another friend in med school, who was also super interested in this stuff. And so, it was great to go back and forth and have discussions with him. And he still had some differing viewpoints, which was made for healthy debate. But there are other people who saw what we were doing, they saw our meal prep, we're always known for the meal prep and would get questions about that. And we actually ended up making a website to show what we were doing in medical school between our meal prep, the glucose monitors and testing out different foods and beverages and putting that information out there for people to see. And even started doing some review articles and writing up different topics. So, it's just kind of been a passion of ours to try to take what we've learned and help others spread that to other people.
Jack Heald 24:31
On what surprised, what do you have any memories of significant surprises for yourself as you're wearing the continuous glucose monitor and, and preparing your own food, and what was shocking to you that was either shockingly good or shockingly bad that you were putting in your body that you made a change as a result of doing that?
Dr. Laura Buchanan 25:00
Yeah, well, it's kind of I'll answer that. And then one other thing kind of related. After reading Nina Teicholz' book, The Big Fat surprise, I started eating red meat on a regular basis and reading some of the research, where I have barely touched red meat for almost a decade because I was concerned about the health effects. So that was just very liberating to actually read the research myself and no longer feel scared or bad about eating red meat and enjoying it, and realizing how nutritional good is for you. But with the glucose monitor, specifically, the third of these healthy oatmeal fiber bites, because at one point, I was all about trying to get 50 grams of fiber in every day. And so, they only had two grams of sugar, and eight grams of fiber. And there's also these millet flax chips, which again, very low net carbs, most of the entire flagship was fiber. And my sugar on a daily basis was again, it was going above 161, 180, I even hit above 200 once. And so, this was I mean, I don't know where I would have waited had I not gotten a continuous glucose monitor, because I probably would have gotten doing that thinking on a low carb eating healthy high fiber diet.
Jack Heald 26:17
I know you three all understand what it means when the blood sugar is high. But unpack that for the layman.
Dr. Philip Ovadia 26:29
And just before you even do that, Laura, one thing to point out is you were in your assuming your 20s, you were athletic, you weren't overweight. And yet here you are having blood sugars that basically diagnosed you with diabetes. those are meeting the criteria for type two diabetes, essentially.
Dr. Laura Buchanan 26:54
Yeah, it was crazy. I was could not believe it.
Jack Heald 26:59
So, what does it mean that you talked about inflammation and damage to the blood vessels? I mean, explain that like I’m five?
Dr. Laura Buchanan 27:11
So, Tro, do you want to take that?
Dr. Tro Kalayjian 27:14
Yeah, I'll do it. Yeah, imagine your piping, every blood vessel in the body is like a pipe, and you have smaller and smaller pipes. So literally having sugar in the blood vessels attacks the walls of those pipes. Right? It literally binds to those walls; it binds to a bunch of proteins. And that binding causes basically damage to those pipes. So, the first pipes to get damaged are the pipes, these very small pipes going to the eyes. Right?
Jack Heald
Which is why?
Dr. Tro Kalayjian
You get blurred vision. Yeah, blurry vision is one of the, right? And then some of the fluid changes also can affect that blurriness of vision, right? And then you get issues with the kidneys, the small blood vessels in the kidneys. And the place where most people probably feel it is they'll lose sensation in their toes and their hands in a glove and stocking way. And that's called diabetic peripheral neuropathy. And that's the small pipes to the nerves basically being damaged by blood sugar. So, and not just that, I mean, it's not just chronically elevated, but also those spikes have a little bit more damage to the endothelium. The endothelium is that the layer of the piping on the inside of the pipe? So, bottom line is this...
Jack Heald 28:37
Is that why the cholesterol builds up? There's damage to the endothelium and the body's response to the damage is to send cholesterol to help.
Dr. Tro Kalayjian 28:46
Well, I’ll let the expert take that one.
Dr. Philip Ovadia 28:48
Yeah, no, that's exactly it. I mean cholesterol cannot get into the blood vessel wall unless the endothelium is damaged, unless the lining of that blood vessel is damaged first. And so, this is why trying to address the cholesterol is an ineffective approach if you're not addressing the damage to the blood vessel wall.
Jack Heald
Okay.
Dr. Tro Kalayjian 29:15
Yeah, I mean, bottom line is high blood sugar is not good at some point. It can even affect the arteries in the carotid and the heart for example. The first places to get attacked are the small blood vessels, eventually those big blood vessels to the brain and the heart aren't too happy. So, you don't want those high blood sugars.
Jack Heald 29:43
Okay, that makes more sense to me. All right, so positive was you’re eating red meat, Laura. What surprised you that you thought was good that turned out to not be?
Dr. Laura Buchanan 29:58
So that was fiber, basically, processed fibers.
Jack Heald 30:00
Those things spiked your blood sugar?
Dr. Laura Buchanan
Yeah, like crazy.
Jack Heald
Though their net carbs are super low?
Dr. Laura Buchanan 30:11
Yep. So, there's and now we're seeing a lot more products on the market actually, where I've had other patients were in continuous glucose monitors. And they will have similar things happen where they're like, but there's only a couple of net carbs and their blood sugars will spike up. And it's interesting. I've even seen some patients' certain protein shakes, where they will drink the protein shake, which I know I have witnessed another patient have and not affect their blood sugar. And yet, they will have an increase in blood sugar. And so, there's some, there's person-to-person variability, which is one of the reasons I love continuous glucose monitors so much, is the CGM doesn't lie. Like if your sugar's going up, it's going up. If so, there's nothing like that personal feedback that you can get otherwise in medicine.
Jack Heald 30:58
So, the message I'm getting and I've never actually asked this direct question. And I feel stupid that I haven't asked it. But I do want to ask it. The message I'm getting is keep your blood sugar down. Is that right? That's just kind of the rule.
Dr. Tro Kalayjian
Down and stable
Jack Heald
Down and stable. Okay. Can I follow up with a question that was provoked as I read your website? And Dr. Tro, I'd like, I'd like to hear your thoughts on this first. You talked about something that is not food based, but his health that has to do with the health of your patients. You talked about your journey, realizing that you weren't spending enough time to get to the root cause of patient health problems. And that's why you wanted to change your practice, in addition to changing your own health. And you talked about patient bonding, bonding with patients, and how important that was. And I just wanted to know more about that. What have you learned? Both from both on a negative and a positive side? And what kind of positive responses can you report?
Dr. Tro Kalayjian 32:24
Yeah, so actually, what Dr. Laura and I, we were talking about this, we had the luxury of meeting some real greats over this past weekend, and this concept of bonding with a patient being able to almost instantly establish rapport, and trust, and being able to motivate, right in a very short amount of time, how do we do that? Right, so the ideal, like, solution for a doctor, right is to be able to, one, establish rapport, trust, and to be able to motivate, right? And to be able to do it at the right exact time, like your patient is in the most vulnerable moment of their life, they're about to eat that one thing, it's going to make them feel like crap and shame and guilty, and they're gonna go off plan forever, right? At that one moment, we want to be able to intervene. So, our ideal solution is actually being the best possible medical team at that one moment. Right? And in fact, our job can be super easy if we get very close to that one moment. Right? So how do you get close to that one moment, right, the first beer or the first cupcake, whatever, right? Or the time when they're ready to quit the gym. So how do you get there? Right? How do you get to have the impact you need in that moment? How is it possible? That's the ideal, right? That we're all striving for is to be able to get to that patient at that moment. So, we need to just focus on that moment. That is your goal. That is all of our goals. Right now, in that moment, that moment of weakness, that moment of loneliness, the moment of boredom, the moment of happiness, whatever it is that's going to drive them. The moment of stress or coping, depression, doesn't matter what it is, there's that moment. Right? And so how do you get to a patient in a moment? It's a radical thought, to be able to meet them at that moment. Right? Because we're used to thinking like visits, come see me for a visit, blah, blah, blah, all this stuff, blood pressure, check this, check that, check this lab. It's all nonsense. It's all bullshit. Right? If you want to affect change, you need to get them in that moment.
Jack Heald
In that moment.
Dr. Tro Kalayjian
Right? And you need to be able to pick them up at that moment. So, all of this shit that we do is like if you think about it over a lifetime, so, right. So, I view it when the patient comes to me that they're establishing care for lifetime, right? A lifetime. I'm responsible for them for the rest of their life. So how do I, right, to be the best possible? You be a doctor and the way we're taught, check labs, do routine screenings, stuff like that, get a CAC, all that. But really what I want is to get to them at that moment. And to get them at the moment, sometimes it's discussing their labs. Sometimes it's making yourself vulnerable so they can relate to your vulnerability, right, and share their vulnerabilities. Sometimes it's just we called it, this weekend Eric Westman called it well, knowing when to spend more time with a patient. And Dr. David Unwin, called it wiz-surgery, right? He called it wiz-surgery, right? And it's funny in our office, we call it Jedi mind tricks. Sort of like these are not the droids you're looking for, right? These are not the problems you care about. You care about the moment you don't really care about your triglyceride level of 60 to 50. You don't really care about that. Right? You don't really care about an A1C of 5.1 to 5.3. Right? These are not the droids you're looking for. The droids you’re looking for in that moment. That moment could last five months, we’re eating terribly, you're miserable, you're depressed, you're not exercising. So yeah, bonding is recognizing there's going to be a time where that moment happens and you need to establish the rapport, the connection, everything possible to get to the patient in a moment. Right. And that is our mission. Our mission is that second of time, that minute to say, don't worry about it, you got this, and we got you right in that moment. And I've prevented disease, that's prevention. Right? Because I prevented months of them eating off plan, I prevented a year of their depression, and now they've gained weight, and they're depressed about gaining weight, and whatever they had that one drink, that one drink led to 10 drinks, those 10 Drinks led to whatever it is so that's patient bonding is like...
Jack Heald 37:09
I’m sorry, but that is that's just an extraordinary story as a guy who's never sat on y'all side of the table, I'm always on. I'm the guy on the table. The thought of I'm very fortunate that I have a naturopathic physician who's cared for me for 17 years. And we have that kind of bond. But I realize that's wildly unusual. And I've never heard anybody articulate it this way. And as the guy sitting on the table, the thought that there are physicians out there who consciously, intentionally have that as at the front of mind when I walk into the office, I think that's really exciting. Okay, editorial done.
Dr. Philip Ovadia 38:07
And well, yeah. So, to follow up, tell us a little bit about some of the, I guess, the innovative ways that this manifests in your practice because I know you're using tools and technology in really uncharted ways so, you can be there at that moment. And you can recognize what that moment is.
Dr. Tro Kalayjian 38:30
Yes, so I could tell you about all the technology and I think it's cool, but I think honestly, it's upfront time, a caring staff, right? A caring staff like a staff that believes. I've practiced medicine in a way where it's, that is my family member. Right. And I care about my family. That is a celebrity. And the New York Times is going to do an interview on how I performed after that interaction. Right? That's the level, every interaction, pretend the New York Times is going to come to interview that person. Right? So even if you deliver bad news, you better make sure you did it in a motivating way and uplifting way. Even if you want to deliver mundane news, here's your A1C, or is this or that, you better find a way to make that so interesting as a patient. So, I think that the idea here is its culture, and you can't scale culture. So that's tough. And then all the tech stuff is cool. And that's cool. It's cool stuff, and I can get into it, but, I mean, it's like, most of it is just thinking differently. And communicating that to a patient. Like what it is, whatever your objective is, I mean, I could tell you we have a binge eating hotline. We have a binge-eating hotline. We have a binge-eating, we have a going off your lifestyle plan, get help now, button and board, you can go to and get help now from volunteer people. You don't have to interact with anybody that you don't want to interact with because of shame or guilt, you can just go to volunteers who are powering a place just to get you back on track, wherever you are. Right, I can tell you that we have CGMs and scales and coughs and ketone meters, and if you don't use them, it will nudge you into using them. And, yeah, there's all this fancy stuff. But I think, I almost don't, like the fancy stuff is helpful because eating is something we want to be subconscious about, and we have to rip it out of the subconscious. So, the tools like the CGM are so irreplaceable, but it's the act of what's really replaceable is the act of taking something subconscious, and sparking change.
Dr. Laura Buchanan 41:00
I’ll jump into something that I think, again, with the technology, but it's the culture of everyone that is there. I won't use any patient names. But there is a patient who sent us a message on us basically a way you can text us back and forth, it's HIPAA compliant, and kind of reached out and said, hey, I'm having these stomach pains. So, I just immediately called her up and found out she had gone out off plan. And she knows, she goes back to eating certain types of carbohydrate-rich foods that it does cause abdominal pain and distress. And there's guilt about having gone off plan. And it's like, no, don't feel bad about it ever. That happens all the time. Let's figure out what we're going to do next time you feel like you're about to go off plan so that we can plan in advance how that won't happen, what we're going to do instead when that craving hits, and get rid of that guilt and the shame, let's write a card, have a note card that you write down, hey, I'm having a craving, I know if I eat this thing, my stomach will hurt, I want my body to feel good. And so, she did that. And then Tro and Amy and Brian have created amazing articles and resources in the app, some about your relationship with food. And so, I recommended that she'd go check out some of those articles about understanding your relationship to food. And so that was last week. Today, I got a message from her saying I read these articles. And she had written in a journal kind of some of the things that really touched her and had a really big impact on her when she read them. And just was so excited to, like, have that deeper understanding about her relationship to food, and it could really relate to what was said. And she was just so grateful for that. And so, I said, awesome, I'm so glad and it was just this great interaction. And that was all pretty much virtual. I mean I did call her, but then after that, we're just communicating and she's doing great. And there instead of having that time where she went off plan become this spiral-like Tro was talking about. Instead, she now has this new, deeper understanding of her relationship with food, and is excited about this journey now.
Jack Heald 43:10
I gotta say, this model of healthcare that I'm hearing you describe as the guy on the table, that's so exciting to me. And I know that people listening are having the same kind of thought, I would love to have a doctor, I would love to have the health care team who looked out for me this way, who saw me as a human being with strengths, weaknesses, appetites, failures, all the standard equipment that all human beings come with and helps me become a better version of myself. Not just what we're all used to. How do you scale this, Dr. Tro?
Jack Heald 44:08
I realized that's a big question. But
Dr. Tro Kalayjian 44:12
Okay, I'll tell you how you scale it. You build up like 5 or 10 doctors with reasonable practices. Okay, you set up a medical organization, you have those 5 or 10 Doctors serve as mentors to about 300 doctors, you loop in personal trainers, health coaches, dietitians, nurse practitioners, PAs to become members, so they educate them, so they influence them. And then when you get to a point, you scale the tech, right? You have to scale the tech and you have to scale the empathy. And the critical thing.
Jack Heald
That's the part I've been thinking about.
Dr. Tro Kalayjian
You have to scale the tech and then you have to scale the empathy, the culture, the critical thinking. So, and you have to hire people smarter than you. So, I've got, we're working on them. We're working on it. There's a lot of long term plan here but we need help. We need funding. We have funding, but we need help with tech, we need help. It's not easy. It's not an easy thing when you're scaling health tech. Right? So, you get into the business of it, but health tech is very difficult. There’s APIs, there's HL7 communication, fire standards, and databases, and it's just not an easy thing to... Everybody's looking to do that, right, everybody's looking at it, and the people get close, they get bought out. The people get close to, like, one medical was just bought out. So, it's not an easy thing. Scaling the tech is one thing, scaling the culture and empathy and knowledge that's another thing.
Jack Heald 45:49
It's the culture that I'm wondering about.
Dr. Philip Ovadia 45:51
Yeah, and one of the things that struck me about the culture, I guess, you could say is when I interact with my colleagues in this space, in the metabolic health space, in the low carb space, you see them thinking like this. They have the empathy that Tro is talking about. They're excited about their jobs. And then you go around the hospital, and you go to traditional medical meetings, and it's just a whole different approach. Everyone is kind of defeated, and they're just trying to get through the day. And it's unfortunate, I think that the health care system has kind of beaten down doctors so much. And really everyone involved in the health care system, it goes beyond the doctors, but ultimately, the low carb space, the metabolic health space, you do start to see the light. And I know Tro has talked about this, and many others. Many of our colleagues now have talked about it, how it's reinvigorated their careers because they're actually helping patients, they're helping people. And I think this, whatever you want to call it, holistic approach, it works.
Jack Heald 47:25
Great. I have a couple of other questions that come out of this idea, I don't want to just drop that last thing, but it's huge. It is huge. And those of you who are listening to this podcast or watching us on YouTube, who are like me, who are the guys who sit on, guys and gals who sit on the table, and look across at these doctors and want them to help us with our health, I know you feel what I feel, yes, this is what I want when it comes to health care. I refuse to call the normal stuff healthcare anymore. I call it disease management. And I don't want to be involved in the disease management industry. All right. So, this is a question that has nothing to do with what I just talked about, but it is related to intermittent fasting, and the differences between male and female metabolism. Do you guys have any insight into that? I practice intermittent fasting. I basically eat two meals a day. I don't eat until generally sometime afternoon, and then I'll have dinner and then I don't eat again for another 16 hours. As I understand it, that's certainly an effective approach for the male metabolism. Is there a difference for females?
Dr. Tro Kalayjian 49:00
Now I'll tackle it first. I think that the individual struggle is different, right? When your estrogen or progesterone are surging, right, your metabolic needs are different. We know that estrogen for example definitely increases metabolism and drives lean mass tissue, for example. So, you have different sorts of energy needs throughout the month as a female, and maybe certain certainly during the sort of most the times of the month where there's peeking out estrogen. I imagine the metabolic needs are different and the energy needs are different. So, I think that with that said, outside of that small little window of surging hormones, for the most part, anybody can intermittent fast. I think the problem becomes and I've seen this many times people with, let's say and it happens to affect women more, although I've been affected by this weight stigma, body image issues, right and excessive restriction can manifest through and any way, from anorexia to a desire to fast, right? And so, people could be very much energy restrict, right? And when your energy restricts enough, you can cause hormonal dysregulation both for men and women. The issue with women is they see it right away, right? Men, it may take months until they feel the effects of low testosterone and thyroid downregulating. But women will see their period, kind of they get the clinical feedback, you've done too much. So, I think it's not really a male versus female thing outside of sort of cyclical issues for a couple of days. There's not major differences in the need and the ability to fast but some of these other issues, I think play a factor. I don't know, Dr. Laura, what do you think?
Dr. Laura Buchanan 51:05
Yeah, so I have not looked at the research actually within intermittent fasting, specifically in female metabolism. But from a clinical perspective, kind of what I've seen, and I'll just say my personal anecdote, as well, the first few days, or first days right before the start of the cycle, the appetite does go up a lot. And I think for me, it would be more difficult to intermittent fast. I have done it, but it's definitely it's a lot more mental work. And so typically, I'll just go have some protein and not worry about the fasting because of that. Now, in patients I have seen a lot of people get huge benefits from intermittent fasting and their cycles remain regular, which is a good sign, but they actually have a significant improvement in maybe there hadn't been a menorrhagia, or meaning like very heavy menstrual cycles, that would be considered abnormally heavy, and they actually go become less into what would be considered normal. And so, which is wonderful for the person you can imagine. And then I've also seen women who get migraines with their cycles that go way with intermittent fasting and low carb. And so, I think it is kind of like Tro was saying is more person-dependent because there is...
Jack Heald 52:19
It's not gender dependent?
Dr. Laura Buchanan
Yeah.
Dr. Tro Kalayjian 52:25
Outside of the small kind of issues.
Jack Heald 52:27
Right. We're coming up on an hour here, which is where we generally try to end it. But before we, before we do, are there questions that you wish somebody would ask you that haven't been asked yet?
Dr. Tro Kalayjian 52:49
Yeah, I wish a programmer, full-stack programmer would come to me and say, please, can I help you in any way? So, a full stack with MySQL experience and experience with Power BI and data analytics, and programming. So, I wish they would come and say, how can I help you? That's what I wish somebody would ask me. That's my New Year's wish.
Jack Heald 53:18
We can make anyone.
Dr. Laura Buchanan 53:20
I think it'd be amazing if I had medical schools or residency programs come up and say, hey, do you have a low carb or therapeutic carbohydrate reduction, nutrition curriculum to actually teach our medical students, our residents so that they can actually prevent and reverse chronic disease rather than just manage it? And I would tell them, I'm working on it. And so, get back to me in a couple of months, or maybe a year, and hopefully, we can actually do that. But that would be awesome.
Jack Heald 53:51
I think both of those things are gonna happen.
Dr. Tro Kalayjian
I hope so.
Jack Heald
We know people.
Dr. Philip Ovadia 53:56
We’ll get it, we'll get there.
Jack Heald 53:58
We know people.
Dr. Philip Ovadia 54:00
Laura, before we wrap up, I just wanted to ask you what it's like now that you're started your career in this manner, and I'm sure again, you talk to your classmates from residency, from medical school, and most of them have probably followed different paths and or employed physicians. As most the vast majority of physicians are these days. They're basically working either for a healthcare system or an insurance company or in many cases, both. So, what's it like for you, not sort of being entrapped in that system?
Dr. Laura Buchanan 54:43
It's incredible. I actually made a tweet about this the other day, but I go to work, and I don't feel like I go to work, I love what I'm doing, and that's the best thing you can ask for. And I love working with Tro. The whole team is great and we see, I see on a daily basis when I follow up with patients, the improvement in their lives and the stories they tell. And it's just, it's exciting. It's fun.
Jack Heald 55:13
Well, let's wrap it up. Tell us a little bit about the business side of your healthcare. Geographically, who do you serve? How do you serve them? And where is it going from here?
Dr. Tro Kalayjian 55:37
I'll take that. So, the practice is in 50 States. Dr. Laura is seeing all new kinds of primary and metabolic health patients. So, she'll be seeing those. I'll certainly be available to consult. We're in all 50 or I'm sorry 48. States, Hawaii, and Alaska can just wait. Okay. Hawaii and Alaska can just wait. But we're in 48 states and we do full metabolic care, sort of virtual primary care. We have a flagship program or weight loss program, which is very intensive, several health coaches, personal trainers. We have an app, if you don't need us, just join that. If you don't need us, and you have a good medical team and you don't need that medical care, you want a community, you want regular meetings, we have several weekly meetings. We have an intro low carb course. We have an intro to fasting course. We have, they are live and kind of with health coaches and foster that community feel. We have a full curriculum on there on our app, Dr. Tro app. I don't know. Did I miss anything? That's where are we going. We're gonna be launching and we're gonna be selling CGMs nationwide in about 48 hours. So, we're going to be selling CGMs nationwide in about 48 hours.
Jack Heald 57:00
How's that going to happen?
Dr. Tro Kalayjian 57:03
It's happening. We're doing it.
Jack Heald 57:05
Well, no. What, is it 48 hours from now?
Dr. Tro Kalayjian
Yeah, 48 hours from now.
Jack Heald
It’s only 2 weeks ago when people start hearing this. So.
Dr. Tro Kalayjian 57:15
So yes, you go download the Dr. Tro app, and you can purchase a CGM. You get an informed consent done. And then you can purchase a CGM. And it's now freely available, democratized to anybody who wants that. And we have a curriculum on CGM is right on there that you can follow and get access to it with videos guiding you on how to understand it, the pitfalls, and everything you should know about it. So, Dr. Laura, did I miss anything?
Dr. Laura Buchanan 57:54
As far as some other things we're working on that hopefully will be up and running in the not-too-distant future. We're translating the entire app into Spanish so that we can hopefully help that community as well.
Dr. Tro Kalayjian 58:06
Yeah, I forgot about that, translating that to Spanish. We're working with an IRB with Stanford, which is going to be huge in the metabolic psychiatry space. So, look out for that. And yeah, we're doing a research project with Stanford to analyze the I can't go too much into it. But we're working with Stanford on the field of metabolic psychiatry. Very good. Yeah. So, while we're full steam ahead, love it. So, we need your help, Jack and Phil, we need to we need some wind in our sails. Maybe one day, right?
Jack Heald 58:50
Well, as a guy, as just a guy, I love this. I have been so I like to tell folks before I met Phil, I was deeply cynical about the field of medicine in general. And I had been working to get less cynical. And then the more I talked with Phil, the more I realized I wasn't cynical enough. And no slam against him. He just confirmed my worst fears. And it's been wonderful to know that there are physicians like him, and that hearing your model for patient care. Oh, my God, there is nobody who wouldn't love that, who doesn't stand to benefit financially from it staying the same. All the rest of us, all schmucks down in the dirt and muck who just want to have a good life. That's wildly exciting. So, we need to make sure folks know how to get ahold of you as I see it. Doctortro.com. Doctor spelled out, not Dr. but D O C T O R.com. Doctortro.com T R O. Any other ways folks should track you down?
Dr. Tro Kalayjian 1:00:03
Dr. Tro app. Doctor Tro spelled out at our app. We're there every day of the week. There's something for you. So, our goal is like I said, trying to get as close to that moment as possible.
Jack Heald 1:00:19
I love it. And there looks like Facebook, Twitter, YouTube, Instagram, and LinkedIn as well. So, we'll make sure all that information is available in the show notes. Sorry, Dr. Laura, I interrupted you.
Dr. Laura Buchanan 1:00:33
Oh, no worries. I was just gonna say, in addition to Twitter and Instagram, we have agingsuccessfully.substack.com for some more information on very topics that I'll have to relate to aging well.
Jack Heald 1:00:45
I need to make sure that one gets noted because I don't remember that with agingsuccessfully.substack.com All right. Very good. Well, for Dr. Philip Ovadia, I'm Jack Heald. Phil, go ahead.
Dr. Philip Ovadia 1:01:00
Yeah, I was just gonna say it's been a pleasure. Talking with both of you and bringing this conversation to the audience. I think they're really going to love it. And I look forward to seeing where it leads next and what we can do to build it together, guys.
Dr. Laura Buchanan
Awesome. Thanks so much for having us.
Jack Heald 1:01:21
Well, we'll talk to y'all next time.
Jack Heald 1:01:29
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.
Jack Heald 1:01:57
This has been a production of 38 atoms