Dr. Ovadia was quoted in a Huffington Post article. The headlines were mostly accurate, but the body of the article was a comical mish-mash of misinformation, mal-information, and outright ignorance.
In this recording from a live Twitter Spaces, Dr. O sets the record straight. He also takes questions from the audience.
A few excerpts on The 5 Harmful Myths About Food's Effect on Heart Health:
Myth 1. A low-fat diet is best for heart health.
While trans fat and hydrogenated fats found in processed foods should be avoided, saturated fat, which has been historically linked to heart disease, is not the real culprit. It's the polyunsaturated fat that’s more harmful to your health.
Myth 2. Eggs are bad for your heart.
Despite eggs' high cholesterol content, our blood cholesterol levels are not much impacted by the cholesterol in our diet.
Myth 3. Red meat should be avoided at all costs.
There is no strong evidence of red meat affecting heart health.
Myth 4. If you're on medication for your heart health, it means you can eat whatever you want.
Statins have little effect on weight, but a nutrient-poor diet increases the risk of heart disease. Improving your diet won't need you to take any more medications.
Myth 5. Changing your diet isn't enough to reverse the damage already done to your heart.
It’s never too late to start looking after your heart. A change in your diet and lifestyle can still improve your situation.
Quick Guide
01:33 Introduction
03:21 Myth 1. A low-fat diet is best for heart health
08:34 Myth 2. Eggs are bad for your heart
11:55 Myth 3. Red meat should be avoided at all costs
19:18 Unpacking the myth about salt
28:01 Myth 4. If you're on medication for your heart health, it means you can eat whatever you want
34:22 Myth 5. Changing your diet isn't enough to reverse the damage already done to your heart
38:29 Hotdogs as part of your diet
41:26 Why are there numerous myths about this
46:13 Why is it hard to reduce obesity in the country
58:09 Diet is good, but cholesterol is up
“I just disagree with sort of their thinking that you need to take the medication and improve your diet when the real answer is just to improve your diet and you won't need the medications. And in a lot of these cases, the medications aren't doing what we're told they're supposed to do and that's not because of what people are doing with the medication. That's really beca
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. Ovadia was quoted in a Huffington Post article. The headlines were mostly accurate, but the body of the article was a comical mish-mash of misinformation, mal-information, and outright ignorance.
In this recording from a live Twitter Spaces, Dr. O sets the record straight. He also takes questions from the audience.
A few excerpts on The 5 Harmful Myths About Food's Effect on Heart Health:
Myth 1. A low-fat diet is best for heart health.
While trans fat and hydrogenated fats found in processed foods should be avoided, saturated fat, which has been historically linked to heart disease, is not the real culprit. It's the polyunsaturated fat that’s more harmful to your health.
Myth 2. Eggs are bad for your heart.
Despite eggs' high cholesterol content, our blood cholesterol levels are not much impacted by the cholesterol in our diet.
Myth 3. Red meat should be avoided at all costs.
There is no strong evidence of red meat affecting heart health.
Myth 4. If you're on medication for your heart health, it means you can eat whatever you want.
Statins have little effect on weight, but a nutrient-poor diet increases the risk of heart disease. Improving your diet won't need you to take any more medications.
Myth 5. Changing your diet isn't enough to reverse the damage already done to your heart.
It’s never too late to start looking after your heart. A change in your diet and lifestyle can still improve your situation.
Quick Guide
01:33 Introduction
03:21 Myth 1. A low-fat diet is best for heart health
08:34 Myth 2. Eggs are bad for your heart
11:55 Myth 3. Red meat should be avoided at all costs
19:18 Unpacking the myth about salt
28:01 Myth 4. If you're on medication for your heart health, it means you can eat whatever you want
34:22 Myth 5. Changing your diet isn't enough to reverse the damage already done to your heart
38:29 Hotdogs as part of your diet
41:26 Why are there numerous myths about this
46:13 Why is it hard to reduce obesity in the country
58:09 Diet is good, but cholesterol is up
“I just disagree with sort of their thinking that you need to take the medication and improve your diet when the real answer is just to improve your diet and you won't need the medications. And in a lot of these cases, the medications aren't doing what we're told they're supposed to do and that's not because of what people are doing with the medication. That's really beca
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
SOMOT LIVE: Dr. Ovadia Responds to Inaccuracies in HuffPo Article
SUMMARY KEYWORDS
medications, people, salt, eat, heart disease, article, obesity, red meat, diet, problem, studies, sodium, health, processed food, agree, talking, cholesterol, myth, point, food
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.
Dr. Philip Ovadia 00:36
So, thank you, everyone, for joining us today. And, as I said, we're going to be going through this article that the Huffington Post published the other day entitled, 5 Harmful Myths About Food's Effect on Heart Health. Hold on sorry, again, just trying to work through the technical details here, of getting people up as speakers.
Dr. Philip Ovadia 01:33
And at the end of this, we'll certainly do some questions and answers as well. So, or as we're going along, if anyone wants to ask some questions, please feel free to request to speak and I will bring you up. So, this article, the title is 5 Harmful Myths About Food's Effect on Heart Health, and it says doctors want to clear these up because some of them are flat-out wrong. So great title and I really like the approach and the first image in the article and the caption under it, I love. It says eggs have gotten a raw deal. And yes, they have. So, article starts off great. Heart disease is the leading cause of death. Interestingly, they quote, an American Heart Association report that estimated 80% of cardiovascular disease, including heart disease and stroke, can be avoided when the right diet and lifestyle habits are put into place which is great advice. The unfortunate thing is that the American Heart Association messaging around diet and lifestyle, I believe, gets this very wrong. And the diet and lifestyle, particularly the dietary advice that the American Heart Association is giving, not only isn't reducing the risk but may actually be worsening it. So that's a key thing that we'll discuss as we go along. So, myth one, a low-fat diet is best for heart health, love it, it's a total myth. But what they talk about under the headline, under this sort of sub-headline, really has a few issues with it. So, they start off by talking about that we've kind of evolved past the 90s when just putting low fat on anything from frozen yogurt to cookies was thought to be a good thing. And then, they have a physician from the University of South Florida, Dr. Steven Masley quoted, and basically, the gist of this myth is, according to Dr. Masley, that we should be avoiding trans fats, hydrogenated fats, and then he goes on to say that unsaturated fats are actually beneficial for heart health. And so, I completely agree with Dr. Masley that trans fats and hydrogenated fats, which are commonly found in over-processed foods should be avoided. We differ a little bit on the unsaturated fat issue because I think what Dr. Masley was implying, and what the article goes into a little bit later is that saturated fats are bad for us. And I don't believe that to be true at all. Saturated fats, which are natural fats that occur more so in animal products than plant products, but they incur in plant products as well, have traditionally been associated with the risk of heart disease. But really, that data is very weak. And I see no real good evidence that saturated fat is associated with the development of heart disease, and in fact, there was a comprehensive review done a couple of years ago, it was published in the Annals of Internal Medicine, I believe it was end of 2019 or early 2020, where they did a full review, and did not find any evidence that saturated fat was associated with heart disease. And in fact, both the American Heart Association and the US Dietary Guidelines have removed the limits on saturated fat from their recommendations. They just don't publicize that they have removed those recommendations. So, whether or not unsaturated fats can lower the risk of heart disease I would say is very controversial as well. And it really gets into whether you're talking about monounsaturated fat, versus polyunsaturated fats. And without getting too deep into the science here, the difference between saturated fats, unsaturated fats, which then get broken down into mono and polyunsaturated fats is in their chemical structure. And essentially what I try to get people to understand about this is any place that fat, the structure of the fat, the chemical structure of the fat is unsaturated, is a place where that fat can get oxidized and damaged. Hydrogenated, they kind of mentioned it is another term for that. So, the more unsaturated the fat is, the higher the risk of it becoming damaged. And those are the types of fats that ultimately contribute to us developing heart disease. So polyunsaturated fats like vegetable and seed oils, I think should be avoided and/or a main contributor to heart disease and much of other chronic diseases that we face. Monounsaturated fats like occur, olive oil is high in monounsaturated fats. It turns out red meat is a fair balance between saturated and monounsaturated fats, you're not going to get polyunsaturated fats from red meat. Avocado nuts, they mentioned in the article, are more monounsaturated fats are probably not harmful for your health overall, but polyunsaturated fats clearly harmful for your health. And these primarily occur in things like vegetable and seed oils, and really should be avoided at all costs. Myth number two is that eggs are bad for your heart. And again, I agree. Total myth that needs to be dispelled. They talk about, so they continue to quote, Dr. Masley and he references basically two large studies done in the past that associated or found that eating one egg a day was not linked to raising the risk of heart disease. And then he goes on to cite another study that find that people basically compared the Japanese diet to US diets, and they found that people in Japan actually eat more eggs than in the US and have a lower risk of coronary heart disease. So again, this one, I basically agree with them, the kind of final part of this discussion is around
Dr. Philip Ovadia 09:54
the fact that eggs are high in cholesterol. And again, what I would put as another myth is that the cholesterol in the food that we eat affects our blood cholesterol level, and then our blood cholesterol level then affects our risk of heart disease. So, Dr. Masley properly points out that that is not necessarily true. The amount of cholesterol that we eat only has a minimal effect on our blood cholesterol levels. I agree with that. But Dr. Masley then goes on to blame saturated fat as the big culprit in raising our blood cholesterol levels. And he says this includes things like sausage, bacon, fatty meats, fried foods, butter, and dairy products, but not eggs. And that's a very interesting distinction that he makes. Because eggs do contain saturated fat, probably as much as butter and dairy products. And I would divide that list very differently. Butter, dairy products, eggs, not harmful to our health. Unprocessed meats - not harmful to our health, despite their containing saturated fat. So, I see no reason to be avoiding fatty meats as Dr. Masley recommends, this article recommends. I do believe that we should be avoiding fried foods, because fried foods are primarily fried in vegetable and seed oils, which are high in saturated fat. So that takes us through myth one and myth two. And then we get to myth three, and myth three is kind of where I guess I come into the article. And myth three is that red meat should be avoided at all costs. And again, this is definitely a myth. And I certainly agree that this is a myth. So, this is the section like I said that I get quoted in and they start off the section by saying that in moderation, red meat itself may not be as bad for your health as the foods you're eating alongside it. And they cite a number of studies that have linked the consumption of red meat to increased risk of heart disease. But they point out that those numbers are not as drastic as people are led to believe. They point to a 2020 study from the Northwestern University and Cornell universities that said that eating two, three and a half-ounce servings of red meat per week was linked to a 3% to a 7% higher risk of cardiovascular disease and a 3% higher risk of death. Now, the important thing to understand about this study that they are talking about is that it is what we call an epidemiologic study. And basically, all of the studies of this sort, what they do is they ask people what they eat in some fashion. The better studies of this kind have people actually track it sort of in real-time. Most of these studies are done using what are called food frequency questionnaires, where you ask a person to guesstimate over the past couple of months, typically three, six, sometimes they say over the past year, “how often have you eaten red meat?” will be a question. And you can all probably think back that if I asked you to estimate what you ate over the past six months, you would probably have a pretty difficult time doing it. Except for the known carnivores that I see out in the audience with me, who it's pretty easy for me to tell you what I eat because it's pretty much the same. It's somewhere around 12 to 15 pounds of red meat a week with very little else. So, for me, it's easy for most people, though, really being accurate with what they ate is difficult. They then go on to cite a scientific report published in 2019. And this is that Annals of Internal Medicine article that they're referring to, that I mentioned, or actually I'm sorry, this is a different one that they're referring to. But they basically looked at research from seven different countries and red meat consumption. There were 61 studies and 73 articles they say, and basically, ultimately, they found the evidence lacking to try and associate red meat with heart disease. So again, the evidence that has been put forward to associate red meat and heart disease or really any health negative health outcomes. I have been weak studies that are shown weak evidence. Now, they then go on to quote me. And it's very interesting, I guess, we'll say how they quoted me. So, they say according to Dr. Philip Ovadia, cardiac surgeon, author of Stay Off My Operating Table, the real problem is pairing your red meat with a lot of sauces, fries, and soda. It's these things he said that negatively impact heart health, not so much the meat. And that's definitely a quote I stand by and agree with. But interestingly, they have a picture above it. And the caption under the picture says, “what's potentially worse for your heart than red meat, the butter you put on it, and the fries you eat alongside it.” And this could not be further from the truth. Again, there is nothing wrong with putting butter on your red meat, it is not contributing to heart disease in any way. The fries, again, if they're fried in vegetable and seed oil, are definitely contributing, the soda definitely contributing. But putting butter on your red meat is not harmful to your health. They also go on, and they put this as a quote, but I can assure you this is not something that I said to the reporter that sauces and fries can both be high in sodium, which can increase blood pressure. Again, the link between dietary sodium and blood pressure is very questionable. And I don't necessarily, I don't tell people that you need to avoid salt in your diet. I think if that salt is coming in processed food, it could be a problem. But I would not attribute these things to the sodium in the sauces. It's not really the problem. It's what else is going in that sauce, that can be the problem. And with french fries, like I said, the main problem is that they're fried in vegetable and seed oils. So, she then goes on to say, the author of the article, then goes on to say additionally fries are high in trans-fat which are linked to increased risk of heart disease. I do agree with that. She says as for soft drinks, regular soda, which is high in sugar, and diet soda with artificial sweeteners are both linked to increase in the risk of heart disease. And again, I agree with that as well. They then wrap up the section by saying when you do eat red meat, remember to avoid high-fat cuts, which again is not something I would agree with. And a wrap-up by saying as previously explained, fatty meats are high in saturated fats, something that does negatively impact heart health. Again, a statement that I absolutely do not agree with. And not something I would have said when I was being interviewed for this article. So, I'm going to take a pause there. Jack has finally joined me up on stage here. So welcome, Jack.
Jack Heald 19:04
Hey, Phil. I forgot when we started it. If I want to talk, I have to be on my phone.
Dr. Philip Ovadia 19:11
Yes, indeed. The technical challenges of Twitter Spaces.
Jack Heald 19:18
Hey, I'd like you to back up and unpack this myth around salt. That has been, good lord, I mean, I can think probably at least 30 years we've been living with this oh my god, don't salt your food. Salt’s bad for you. Salt’s gonna give you a heart attack, blah, blah, blah. Where did that get started? And why is it... How did it get such traction? And what do you say to folks?
Dr. Philip Ovadia 19:54
Yeah, so when we look at the studies around salt again, really a lot of it is epidemiologic data. Some of it does come from animal studies. But there are a couple of things to unpack there. In terms of the epidemiologic data around salt, so again, going to these food questionnaires and asking people what they eat, and then looking at their health outcomes. The problem is that the majority of the salt that Americans get in their diet, and these days we could probably extend when we say the American diet, it largely extends to the Western world in general. So, we could say, the Western diet. The majority of the salt in people's diet usually comes in processed foods. So, if your food has a label on it, and you're reading those labels, you can see where a lot of these processed foods, they tend to be high in salt. And therefore, when people consume a lot of salt in the form of processed food, it certainly can contribute to high blood pressure, and poor metabolic health in general, because processed food containing salt, and sugar, and vegetable and seed oils, and highly processed carbohydrates, when you put that all together, it's certainly going to cause issues. But it's not the salt that I would blame in that scenario. And it's interesting, when you look at scientific studies on people who come to the hospital with high blood pressure, with very high blood pressure, what we call a hypertensive crisis. Your blood pressure is 180, or 190, or even 200. And we're really concerned that you're going to have a stroke or some other negative outcome related to high blood pressure. One of the treatments is to give you what's called hypertonic saline solution, which is a high-salt solution, and it actually brings blood pressure down.
Jack Heald 22:26
Okay, I just want us all to pause and absorb that. So, on the one hand, the official nutrition spokespersons of the government have told us that salt is bad for us. It's going to increase, lead the risk of heart disease. Don't salt your food, low salt everything. And yet, when you have somebody who comes into the hospital, in an emergency situation with dangerously high blood pressure, one of the ways that it has alleviated, this acute condition, is with salt.
Dr. Philip Ovadia 23:11
Yes, one of the many inconsistencies that we tend to kind of sweep under the rug in medicine, that inconvenient fact. There is a small percentage of people with high blood pressure that have what we call salt-sensitive hypertension. And these are people that usually have issues with their kidneys as well. So that is one of the effects of, one of the things that happens if you raise the amount of sodium, okay, realize that sodium is one of the components of salt, but sodium and salt are not quite the same things. But if you put extra sodium into your body, into your bloodstream specifically, the body water flows with sodium and again, without getting too technical, if we all remember back to our chemistry days, and concentration gradients and basically water is going to go where there's more solvents if you have two solutions next to each other, and you make one very salty, the water will flow over to the higher the solution that has the higher concentration of dissolved ions in it, of which sodium is a major one in the body. So, if your sodium level goes up, you're going to then bring more fluid, basically into your blood vessels. And that's going to cause your blood pressure to go up. And you can do that on a chronic basis. If your kidneys aren't working properly, if your kidneys are working properly, your body's going to get rid of the extra sodium. So, there is a small subset of the population that has what's called salt-sensitive hypertension. And those people, dietary salt can worsen their blood pressure, but it's a very small effect even in those people. So really, there is no good evidence. I've tried to kind of go back through the historical literature and figure out how we really got to this point of thinking that eating salt is causing high blood pressure. And it's really hard to reconstruct how that argument even came to be in the first place. So, bottom line, if you're consuming salt, and I always tell people, differentiate good quality salt from processed salt that's most of the table salt that's going to be around you in a restaurant or that you might buy in the supermarket is actually a processed food. They've taken that natural salt from the ground. They've oftentimes stripped out a lot of the minerals from it. And then they've sometimes added back in things, you'll see iodine added to salt, for various reasons, other things added back in, but it's really far away from the salt as it comes out of the ground. If you get out of the seas, if you get a good quality sea salt, that's a lot different than the shaker of salt that's going to be on your restaurant table, and a lot different than the salt that's getting put into your processed foods. So, no real evidence that high-quality salt is bad for your health. And I really do think it is probably good for your health. There's many scientific researchers and clinicians out there who make the argument that we don't consume enough salt, enough good quality salt, James Dinic... I always have trouble with his name, DiNicolantonio has written a book called The Salt Fix, just look up the title of the book, The Salt Fix. And what he professes is that we should actually be eating more sodium, more high-quality salt, and for our health, and many of us are actually salt deficient, because similar to the low-fat craze, and what it did is it got everyone eating low fat, this low sodium craze has gotten everyone eating less sodium.
Jack Heald 27:57
All right, well, I appreciate that, you wanna move on to myth four?
Dr. Philip Ovadia 28:01
Let's move on to myth four. And again, I agree with the myth, as it's in the headline, that it's a myth that if you're on medication for your heart health, it means you can eat whatever you want. And we kind of circle back to Dr. Masley here. He talks about that people have the misconception that if they are on cholesterol-lowering medication, for instance, they can pretty much eat whatever they want, because the medication is going to kind of be sucking the cholesterol out or blocking it. And again, I would agree with that statement. They talk about a study here, where they looked at 69,000 people that were taking statins for what's called “primary prevention of heart disease,” which means preventing heart disease before it happens. And they correctly point out that, in that study, they did not find statins to be associated with a lower risk of heart disease-related death. And they say a major reason for this is because statins do not impact weight. And scientific studies show that a nutrient-poor diet can cause obesity, which is a major risk factor for cardiovascular disease. So, my problem with this section of the article, and really with the conclusions of the scientific study, is that they were trying to blame the fact that statins don't have any benefit to lowering the risk of heart disease-related death, which is what they are primarily supposed to be doing. And they're trying to blame it on the fact that people are still eating a crappy diet with the statins. And I would just point to the fact that it probably shows that the statins don't work to start with. And especially if you're eating a crappy diet, it's not going to overcome the effects of eating that crappy diet. So, this one I sort of give a half score to. I mostly agree with what they're saying in this section. I definitely agree with the myth. I just disagree with sort of their thinking that you need to take the medication and improve your diet when the real answer is just to improve your diet and you won't need the medications. And a lot of these cases, the medications aren't doing what we're told they're supposed to do and that's not because of what people are doing with the medication. That's really because these medications are ineffective. And we have a lot of data to support that.
Jack Heald 30:45
I think it's worth noting that there is an assumption, a set of axioms that are foundational to these types of articles that we see in places like Huffington Post and that foundational assumption is the drugs that are being prescribed work. They do what we're told that they do. And if you're not getting the appropriate results, it's not the drug's fault.
Dr. Philip Ovadia 31:20
Right, yeah. No, I think that is very much a default way of thinking that if medications, and honestly, I'll extend this beyond medications, interventions, if they're not getting the proper results, usually, the default is to blame the user shall we say. So, this same argument we see around the food guidelines, the food pyramid, the US Dietary Guidelines, it's often said that the reason that they haven't had the effects that they were designed for lowering obesity, lowering heart disease, is because people don't follow them correctly. Yet again, the macro level data shows us that people do follow the US Dietary Guidelines. If you look over the past 40 years, the consumption in the United States has been in line with the US Dietary Guidelines, the amount of fat that we eat, especially the amount of saturated fat that we eat, has gone down. The amount of red meat that we eat has gone down. The amount of whole grains that we eat, and the amount of carbohydrates that we eat, in general, has gone up. And the amount of polyunsaturated fats which we talked about before has gone up. And during that time, our health has gotten worse. So, you always get the argument from the people who put forth these guidelines, that just people aren't following the guidelines and that's why they don't work. And again, you see that from pharmaceutical companies as well on a frequent basis. The reason that the medications aren't doing what they designed them to do, and what the trials showed them to do is because people must be doing something wrong. And in reality, it's usually because the trials were misleading in the arrow, oftentimes in the magnitude of the effect of the medication. Yeah, it's something we really need to continue to discuss and point out.
Jack Heald 33:49
That would be a fascinating spaces for us to do, to talk about how these trials ended up being misleading, because of the magnitude of the effect. I don't want to go down that particular rabbit hole right now. But we ought to ask the audience if that sounds like something you guys would like to explore.
Dr. Philip Ovadia 34:12
Yeah, definitely, I’d put that in the chat. If that's something you would like to explore sometime. And let's move on to myth number five, the final myth in this article. And the myth is, at some point, changing your diet isn't enough to reverse damage all already done to your heart. Again, I agree that this is a myth. And they quote me in this section as well. And basically, what I say and what they said in the article is that it's never too late to start looking after your heart. If you've been diagnosed with heart disease, if you already have suffered a heart attack or had heart surgery, or a stent placed or something like that, you can still improve your situation by changing your diet and lifestyle. And so, this one, I think I got quoted accurately on and I really don't have an issue with. I talked about how I've had patients who have performed heart surgery on and they then greatly improved their health afterward by paying attention to their diet and lifestyle. And they conclude by saying what's empowering about heart health is that so much of it is in our control, and again, I would agree with that. No one is destined to experience a heart attack, regardless of your family history, or even your own history. All you have to do is take these words of wisdom to heart. So, I agree, it's never too late to start this. I always say the best time to start paying attention to your metabolic health was yesterday. But the second-best time is today, and start paying attention to your metabolic health, start changing your diet and lifestyle. Listen to maybe a few of these recommendations from this article, but certainly not all of them. And I just thought this was a good opportunity to kind of have a discussion around one of the other problems that I see in medicine today, or in society today that we sometimes recognize that these things aren't true. But we don't quite recognize the real reasons that they're not true.
Jack Heald 36:44
Very good. Well, let's give it a grade. As a source of reliable, actionable, and effective information, this article from the Huffington Post rates on a scale of A to F, what would you give it?
Dr. Philip Ovadia 37:03
I think I'm gonna give it a, I'm gonna say a C+. And what I'm gonna say about the article is, this is one of the situations where it may be beneficial that people only read the headlines. Because you read the myth. And like I said, all five myths that they lay out are, in fact, myth. And if you don't go into some of the details under those myths, you're probably going to be all right. So, like I said, I'm gonna go with a C+ on the article here.
Jack Heald 37:44
All right, well, I guess it's time to open it up for questions, comments.
Dr. Philip Ovadia 37:56
Yep, your cohosts now. Very good. So yeah, certainly love to hear anyone's thoughts. We have wolf already up on stage. I don't know if he's been, if wolf wants to make any comments. He always has insightful things to say. All right.
Guest 1 38:29
I'm actually out in a public place right now. But really quickly, Dr. Ovadia I would like to know whether you have any opinion about for example, my what my wife says, I've been dating Hebrew National hotdogs lately, the quarter pounders and does that count as something that you would discourage people from eating as a form of processed meat? Or can that actually be integrated into a carnivore adjacent diet, which is what do I say I'm doing right now?
Dr. Philip Ovadia 38:52
Yeah, so I would say that hot dogs are probably, and again, I think you want to be careful with hot dogs in general. And you really want to be looking at sort of the, you want to be looking at the ingredient list. I think all beef hot dogs, which I believe Hebrew National are, are probably going to be better than hot dogs that are made with mixed meats, oftentimes incorporating pork, and sometimes even things like chicken and turkey. Beef in general, even if it's lower quality beef, which probably ended up getting used in hotdogs if we're going, to be honest. Lower quality beef probably isn't as much of a concern as lower quality, non-ruminant animals, so things like pork and chicken. And then you want to be careful what else are they putting in those hot dogs? What fillers are they putting in? How much salt which again, is going to be processed food salt essentially, are they putting in there? But a good high-quality hotdog, and I would probably put Hebrew National on that list, I don't have much problem with. Should it be the mainstay of your diet? You might...
Guest 1
Well, I'm often having those for lunch, but my dinner is still a good size of ribeye.
Dr. Philip Ovadia
I don't doubt that and so I don't have a problem, I wouldn't have a problem having that as part of your diet. Like I said, you probably don't want to make it a mainstay, although I think I saw something. And I see Nick in the audience, he might be able to comment on this, I think I think Dave Feldman is currently doing one of his N equals one experiments around hotdogs. I think I saw something to that effect. But yeah, like I said, good, high-quality hotdogs, I think, are fine to consume. I wouldn't consider them processed food. But you do want to be careful maybe about some of the lower quality hot dogs that are going to be sort of more processed food.
Jack Heald 41:19
Thank you so much for your expertise. We thank you. Owen Gregorian, it looks like it's requesting us to speak.
Guest 2 41:26
Yeah, thanks. My question is, why are there so many myths about this? Like, it seems like these, from everything, you're saying the science is kind of pointing in the direction that a lot of these things that we've held to be true or not true. Is it just a matter of, there's been more recent science, and the mainstream hasn't caught up to communicating that? Or is there some other agenda going on that they're trying not to let you know what the truth is, what do you think's going on?
Dr. Philip Ovadia 41:54
Yeah, so I certainly think there were a number of things going on here. I think that people in institutions... So, the reality is when you dig into the scientific literature, you can probably find a study, or sometimes even multiple studies that are going to support whatever conclusion you want to make. And oftentimes, I find that today, we start off by deciding what conclusion we want to make, and then go finding the evidence to support that, as opposed to what is the true scientific method of making a hypothesis, sort of designing the experiment, to test that hypothesis, and then going with what the experiment shows, and then being able to repeat that experiment and get consistent results. This is what the scientific method was really based on, and we don't do a good job of adhering to those principles these days. I think people largely bring their conclusions, and then they we'll find a study to support it, and they're going to ignore the quality of those studies because as long as it supports their conclusion. And this even extends to within scientific studies that get published today, it is not unusual, to find that the conclusions that are sort of put into the abstract or sort of put into the headline aren't even really supported by the data that's within that study. And we've seen many examples of this. And it seems to be more of a problem. We then have a secondary problem today, or maybe this is now a tertiary problem, that the mainstream press will report on a scientific study and oftentimes, they'll kind of misquote the conclusion, or they'll just misrepresent the conclusion of the studies, again, to kind of support their preconceived notions. I think we do see agendas, there's certainly institutional bias, institutional capture, and you can see this from governmental level to the private industries, obviously, if you're a pharmaceutical company, you're going to want to promote your pharmaceuticals. That's what you're supposed to be doing in business. If you're in the food industry. You want to promote your foods, Again, I don't necessarily blame them for that. You just have to realize where your information is coming from, and what motivations may be behind the sources of the information that's being put out there. I think we all have to be a lot more. We have to be a lot more careful. And we have to be a lot more thoughtful about the way that we're evaluating the information that's being presented to us. And you have to really say where is this information coming from? What are the motivations? What are the biases of the sources of that information?
Jack Heald 45:39
Sounds like a good time to wrap our friend Michael Guimarin’s Sensemaking Course. How do you make sense of all that nuttiness out there?
Guest 2
Yeah, definitely.
Jack Heald
Does that answer your question, Owen?
Guest 2 45:58
Yes, thanks. It was great. I mean, if I had one other question, which is just I know there's a terrible percentage of people that are obese right now and want to lose weight. And it seems like there's not much success in reducing that. Do you have any general advice like, why is it so hard to get obesity down in this country? And for anyone who's looking to do that? What, what's the secret?
Dr. Philip Ovadia 46:27
Yeah, so I think the reason that it's so hard to get obesity in this country is we are our environment is obesogenic. And so, the food, the majority of the food that is put in front of us promotes obesity. The information that we have as to how to avoid or prevent obesity is outdated, lousy information, it's still largely focused on the calorie and calorie out model, which just is not a useful framework for battling obesity. And I say this as someone who battled with obesity my entire life, up until about seven years ago, when I started consuming different information, and therefore consuming different food, and was finally able to overcome my obesity. And I've been able to maintain weight loss now for the last five-plus years. My real message to anyone that is struggling with obesity is to understand that obesity is a symptom of poor metabolic health. And you really have to focus on addressing the poor metabolic health, if you're going to make a meaningful impact against your obesity. And when you look at it in that framework, it really leads you to different conclusions. You get away from calories in calories out, and you start evaluating the quality of the food that you were eating. And so, when you eat high-quality food, when you eat whole real food, when you avoid processed food, you're going to naturally become less hungry. You're giving your body the nutrients that it wants. You're going to get less hungry, and it then becomes easier to eat less and to overcome your obesity to lose weight and overcome your obesity. But if you just start with, I want to eat less to overcome obesity, that becomes very difficult. And study after study has shown that that just does not work in a sustainable manner. We now have a lot of controversy over the last couple of weeks, especially over medications for obesity. And again, I point to the fact that we've had many, many, many attempts at medication therapy for obesity, none of them have worked in a sustainable manner up until this point. The newer drugs that are all the rage to talk about, I don't believe are any different we already have the studies showing that the weight loss that is achieved with those medications is not sustainable unless you make the dietary and lifestyle changes in conjunction with the medication. So, these medications may be a useful tool to help kind of people get started and make diet and lifestyle changes. But if you don't make the diet and lifestyle changes, we already have the data showing that once you go off these medications, you're going to gain back the weight. So, I don't think they're a good sort of primary tool for weight loss. They might be a good adjunct in certain situations, while you're making the dietary and lifestyle change.
Jack Heald 50:20
All right. We've got Nick Norwitz, who we've actually had on the show at one point, has requested to speak. So, Nick, you ought to be well as soon as you're connected here.
Nick Norwitz 50:34
Hi, can you hear me?
Jack Heald 50:35
There you go.
Dr. Philip Ovadia
Yes, indeed.
Nick Norwitz 50:36
It's good to hear you guys’ voices. I'm just jumping on while I'm having some dinner. Quickly, I just want to respectfully, I think this is a very, very interesting topic on the new GLP1 receptor agonists. And I want to like, respect, kind of like add a little bit of at least my opinion in terms of like the nuances around these data and how these drugs are different. And the pros and the cons, generally, just to kind of set up the preface, I'm more with you, I’m more skeptical of them.
Jack Heald 51:13
That's real quickly, Nick, it would be worthwhile to our listeners who don't know you to just pointed out that you've got to, you currently... You know what, you do your bio. You're better at it than I am. My point is, with Nick Norwitz, he's talking about this stuff. He's not just some guy talking about his but he knows what he's talking about. I'll give
Dr. Philip Ovadia 51:36
The real short bio for Nick. He's a very smart guy, Ph.D., working on his MD. And yes, he's not just some guy talking out of his butt. So, with that go on, Nick.
Nick Norwitz 51:50
I appreciate that. Yeah, I think I've done a few threads on this. If you look at the data, I've given them credit where they stand, there are multiyear, randomized placebo-controlled trials. Yes, as you mentioned, they're generally coupled with lifestyle intervention, but it's still a placebo-controlled trial. So, it's lifestyle intervention plus the medication or placebo, plus lifestyle. So, in that sense, like, you have an appropriate control group, and it still shows after two years, you have usually weight loss of about 15 to 18%, depending on what paper you're looking at. The one that just came out, it's the most controversial one recently, the step teams' trial in the New England Journal was I think, like 16%, weight loss in kids with improvements in cardiovascular risk factors, metabolic health markers. And there was a really cute table where they were actually, I shouldn't say cute, I don't mean to be demeaning the data, but where they did psychology assessments of the kids and showed how it improved their self-confidence X, Y, and Z. So, I think what needs to be given this credit where they're due that the drugs work, the data are strong. Where I started to have issue is we need, I agree with you, like you need to reconstruct the food environment, this obesogenic food environment, and change social norms to actually get at the root of the problem. And even if 15% body weight is impressive, there's a broad population problem if we get into the tendency of, oh, you turned 12 and you have obesity. Now we need you to go on medication. How does that change our relationship with food as individuals and more broadly, as a society? It allows for the further slippage and normalization of really terrible food norms. And why I think that's such an important thing to kind of reflect upon is because if you think about the individual level, the individual doctor treating the patient or the individual parents, like if I was a kid, if I was a parent of a kid with a, I wasn't able to help them lose weight with lifestyle alone, I'd be advocating everything I had for that kid, like, I'd go to the doctor and say, yeah, I want my kid on Ozempic, because it's going to improve their health. And so, if every doctor is looking out for every patient, every parent’s looking out for every kid, the incentive structure is set up such that if this is available, it's going to be opportunities that are taken, you have to understand that at a clinical level. I know you do as a doctor, but then the question becomes, what is the broader impact on society, social norms, and how does it affect our motivation to actually change the food environment? And I think that's like a really difficult discussion that we need to have because those things kind of necessarily do buttheads. So, the thing that scares me about these drugs, just to kind of sum up, is how they could more broadly impact social norms? Not necessarily challenging the data upon which the approvals are based because I don't think we'd actually make any ground there because the data are pretty strong in and of themselves. Anyway, that's my opinion.
Dr. Philip Ovadia 54:57
No, and I would agree with that, my concern becomes so when you're looking at using this, in children, for instance, and really even in adults this applies, what becomes your endpoint? Because, again, we also have that data showing that when you stop the drugs, there tends to be significant weight regain. And so, if you're talking about putting teenagers on this, are we going to keep them on it for life? Obviously, I would say that's probably a bad idea. Although, honestly, we don't have data on the long-term use of these medications really beyond a year. I think our longest studies, or maybe there's some two-year data now, but still pretty short-term. So, I agree with you and this maybe is the same way of saying what you're saying, what are the long-term implications? What are those societal implications? What is the mindset of these patients? When we stop these medications, what happens then? That really becomes my concern.
Nick Norwitz 56:12
Can I say one more thing? Yeah. I don't think there's intense... The incentive structure isn't set up to get people off these medications. The incentive structure is set up to continually be innovating in pharma. There's already basic science papers on what's beyond the GLP1 agonists like the GLP1 combination, GDP15 agonist, stuff like that. So, the idea, I think, is to just make more and more potent drugs and have people be dependent on them because you have a fatalistic perception that in this obesogenic environment, people with a predisposition just will be obese, and they're going to need medication. And that's kind of the narrative. So, I don't think the idea is to get people off of drugs, which I think we're saying the same thing. One of the problems, you're not addressing the root cause. As a final note. And it's just totally random fun fact where the medications come from the GLP1 agonist, where they're derived from in nature?
Dr. Philip Ovadia 57:16
That I do not know. No.
Nick Norwitz 57:19
No. Just a fun fact. They're derived from Gila monster venom. 1995, Dr. Drucker. I think it actually was at MGH. He was studying how the Gila monster Venom really screws up the metabolism of its prey. So, I think it was 1995, he started doing the extractions and then the drugs were approved for diabetes in the early 2000s. That's just the fun side of the topic.
Dr. Philip Ovadia 57:46
That may be better than the medication that I use on a daily basis that's derived from fish sperm, right?
Jack Heald 57:55
Oh, but I want... I’m desperately resisting the urge to hear more about that. But we've got one more speaker requested to speak. Help me out here. Dhaba Danny?
Guest 3
Yes, yes. Can you hear me?
Jack Heald
Yeah, sure can.
Guest 3 58:09
Okay. I just had a question. I have a family history of heart disease. My father went through a bypass just a few years ago. He was diabetic. And so, what happened with me was that a few years ago, they diagnosed... They did not diagnose me with diabetes, but they said I had pre-diabetes. So, I went on intermittent fasting, I cut out all kinds of sugar. I ate once a day, and I made myself this big bowl of greens and microgreens and fermented food like kimchi and apples and beans and some fish, some beef kebabs sometimes. There was one protein every time, no sugar, no bread, and I lost like 40 pounds. And my A1C went down from a six to a five, and everything was good. But then my cholesterol stayed up. Last couple of years, my cholesterol levels have come in really high. And I don't know what else to do. The doctors say that because my diet is so good. And I've lost so much weight and everything. So, I need to go on statins. That's the best thing that they can do for me.
Dr. Philip Ovadia 59:28
Yeah. So, no, I'm just going to, I guess, say, not an easy answer, not a quick discussion to have. And this isn't a forum really where I'm going to be giving medical advice. But my general, I'm going to point you to some resources to start with. And what I'll say is that it's not clear that having an elevated cholesterol level, and I'm assuming you're talking about either total cholesterol or LDL cholesterol. But it's not clear that having an elevated cholesterol level in the context of good metabolic health, being insulin sensitive, which it sounds like you've made great strides to improve those measures that there is negative health outcomes associated with that. So, to be clear, and say that again, it's not clear that having an elevated cholesterol level in the context of insulin sensitivity and good metabolic health that there are negative health consequences associated with that. And therefore, it's not clear that lowering your cholesterol level with medications in that situation is going to be of any benefit. It's a very complex topic to get into. I would say the best place to start with that discussion is there's a website called cholesterolcode.com. I believe it is it might be .org But David Feldman, who many in the audience know, has theorized extensively on this, written extensively on it. I would also point to resources like Dr. Aseem Malhotra, he has a book called A Statin-free Life that goes into a lot of this. It's a very complex topic. And my number one piece of advice for people in this situation is to find a doctor who understands this topic well and can have the nuanced discussion with you. There are lots of typical kind of high-level advice I give people...
Jack Heald 1:01:51
What happened there? Oh, we lost you. Sorry, he's back.
Dr. Philip Ovadia 1:01:59
You want to be doing a deep assessment of your metabolic health. You want to be assessing your cholesterol particle sizes, doing some advanced testing, and really be working with a practitioner who understands this topic well and can help you work through it.
Guest 3 1:02:21
Will exercise help?
Dr. Philip Ovadia 1:02:24
Exercise, in my experience, can help raise your HDL cholesterol, it typically isn't going to do much to lower your LDL or your total cholesterol. With that being said, I actually have to hop off to see a patient. So, I am going to thank everyone for joining us in this space. I think this is a good discussion. Be on the lookout. Jack and I are getting in the habit of doing more Spaces. And we'll be doing more so keep an eye on our feeds. And I look forward to talking with and interacting with everyone. More in the future. Thank you everyone.
Jack Heald 1:03:14
Thank you, Phil. We'll see y'all.
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 specifics 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