Episode 159: Dr. Matthew Calkins on Transforming Healthcare through Direct Primary Care

In this episode, We welcome Dr. Matt Calkins to discuss his journey in the medical field and his dedication to promoting the potency of the ketogenic diet in preventing and reversing chronic diseases. 

Dr. Calkins shares his experiences and challenges in advocating for a lifestyle-based approach to healthcare as opposed to traditional symptom treatment. He also provides insights into Direct Primary Care (DPC) and its potential for revolutionizing healthcare by offering a more personalized, holistic approach to patient care. 

He details some available resources and explains how patients can take control of their own health by becoming more proactive and informed about their diagnoses and treatment options.

00:00 Introduction and New Year Wishes

00:15 Recap of Previous Episodes and Guest Introductions

00:54 Introduction to Dr. Matthew Calkins

02:19 Dr. Calkins' Journey into Metabolic Health

02:39 Dr. Calkins' Medical School and Residency Experience

05:34 Transition from Emergency Medicine to Family Medicine

06:14 Dr. Calkins' Current Role and Future Plans

07:29 Discussion on Metabolic Health and Healthcare System

14:21 Challenges in Mainstream Healthcare Acceptance for Low Carb and Keto

18:49 Patient-Physician Collaboration in Changing Healthcare System

20:05 Dr. Calkins' Patient Demographics and Future Clinic Plans

24:31 Closing Remarks and Future Aspirations

26:11 Navigating Traditional Healthcare Systems

26:57 Understanding and Discussing Differences in Healthcare

28:00 The Role of Metabolic Health Practitioners

28:58 The Impact of Low Carb Diets on Health

29:39 Challenges in Traditional Healthcare

32:03 The Future of Healthcare: Direct Patient Care

32:34 Understanding Direct Primary Care

36:40 The Traditional Healthcare Model vs Direct Primary Care

40:00 The Power of Lifestyle Changes in Health

45:37 The Importance of Patient Advocacy in Healthcare

46:38 Finding Low Carb Friendly Healthcare Providers

47:59 Connecting with Dr. Matt Calkins

Connect with Dr. Matthew Calkins

https://twitter.com/MattCalkinsMD

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Transcript

0:49

Welcome to a brand new year. Guys. Hope you guys had a Merry Christmas and a happy, happy new year. I certainly enjoyed the festivities and just being around family in this types of occasions, just gives you a boost to prepare us to the upcoming year. Also hope you guys enjoyed the last three reruns that we did with Dr. Phillip Dr. Joan and Dr. Mary Newport, all of which has given us such a valuable insight on how powerful the ketogenic diet is in both preventing and reversing chronic disease. This year will be so much fun. Guys. If you love these episodes so far, please consider giving your feedback. It is the easiest way to give me your support and lets me know that you're loving the show so far. But without further ado guys here is our brand new episode. Happy new year.

Lorenz: 1:41

So excited for this guys, stick around. We have an incredible guest with us today, Dr. Matthew Calkins. Dr. Calkins is board certified in family medicine and graduated summa cum laude from the University of Florida. College of Medicine with his mission to motivate and empower patients to take control of their own health through the power of the low carb diet. He also plays a pivotal role as a chair of the resources committee for the Society of Metabolic Health Practitioners or SMHC, where he curates invaluable resources on nutrition and metabolic health. I'm honored and excited. Dr. Matt Calkins, welcome to the ketones and coffee podcast, man.

Dr. Matt: 2:21

Thanks for having me. Glad to be here.

Lorenz: 2:24

We talked about this before we went live. I recently had your wife on the show, Dr. Laura Buchanan, I told her when she came on at such a young age, you guys are already at the forefront of change, already changing out of people's lives. I mean, how many doctors can you actually see? say that they have helped a patient reverse chronic illness, right? Like insulin resistance, right? It doesn't happen with traditional healthcare systems, that's why I'm so happy to have you on share your journey today, a young medical doctor trying to change the healthcare landscape is, is a tough task to ask. Right. But I bet, it's a fulfilling one and it may not have, started this way for you, but you certainly didn't brush it off. Right. And you continued to go on the search to find the truth. Right. So I wanna start us with, can you share with us how this transition happened? What sparked your interest and what led down this path of exploring the connection between, lifestyle and health?

Dr. Matt: 3:20

Yeah, of course. And Laura is certainly my greater half. So, I hope I can live up to, to her podcast with this one. And I think really my story starts in undergrad. I was a physics major also at University of Florida. So I went there for undergrad and med school and I was pretty. Pretty dead set on going to get my Ph. D. in physics and I just remember one day in my Senior year of undergrad. I was in the lab and I was like, I, I like the intellectual aspect of what I'm doing, but I really want to have more I just want to talk to people more. Like, I want to have more of that interaction with people and I shouted a medical doctor and I was like, this is pretty much it. It combines what I like about physics, the intellectual aspect, but also helping people, talking to people. So, knew nothing about metabolic health at that point I had been resistance training since about 7th grade, that was about the only thing, but I never really paid attention to carbohydrates, fats, or, or protein in my diet. Went to medical school, got into Florida, met Laura right before medical school started. And neither of us were on, really, the metabolic pathway yet. Studied hard for the first three years, and I think somewhere in the third year we both found podcasts and, essentially, the first one we found was Low Carb MB. And so, that's run by Tro Kalasian and Brian Lenski. And we started listening to these awesome stories of patients that were able to improve their health, get off of medications, which in med schools, I've heard of the first class we took really in med school that first couple of months was actually just an overview of diabetes. And the reason I think they did that is when you try to study type two diabetes, you have to learn about the endocrine system. You have to learn about basically every organ system because every organ system is affected by diabetes. So it's a very it's a very whole body view and not once during those three to six months where we were learning about all the different pathways and how diabetes affects the body. Were we ever told that it could be put into remission or you could improve it with really long term lifestyle alone? So I, before even listening to those podcasts, I was pretty dead set on going into emergency medicine because that's the first physician I shadowed way back when in undergrad. And so I ended up matching into emergency medicine. And I realized pretty quickly in the residency that it wasn't for me. So how, how it works in the U S is you have a undergrad. So you typically get a four year degree and then I would say 95 percent of people end up they'll go into medical school, which is four years. And then you match into a residency and residencies can be as short as three years, family medicine, some emergency medicine programs are three years, internal medicines, three years. Some can be as long as I believe like eight years for neurosurgery and stuff like that. And then after that you're truly a full fledged attending. Where you're out practicing on your own. So, I matched into emergency medicine. Decided it wasn't for me for a couple of reasons, which we can talk about. And then I was seeing Laura even month one of residency, which we call intern year. You're basically just getting your feet underneath you that first year. learning how to like navigate the health care system, put your orders into like the EMR and she's actually helping people. I think she had someone's a one C improved from like 10 percent down to 7 percent lifestyle loan, which is not heard of from, from medical school. And I was like, I want to do that. So made the difficult, but I think ultimately not a day goes by where I know I didn't make the right decision. Switch from emergency medicine to family medicine. And finished residency in June of 2023. So still this year as of for a few more days and now I have a job as essentially I'm doing urgent care. Plus I have a pilot metabolic health clinic. So what ended up happening, I signed a, signed a contract for urgent care, but it's for this really, it's a physician owned. Clinic system. And it's very nice. There's like 20 clinics in the Western North Carolina area. And I was really passionate about metabolic health. They already knew this at this point. I was already on the chair of the resources committee for the SNHP. And the person who hired me said, Hey, our CEOs, which are physicians, and they still see patients, the entire thing is, is run by physicians. They're like, you should go give a talk on what metabolic health is and how you can implement it. So I went down to Charlotte where we're headquartered and I gave like a 30 minute metabolic health pitch deck and it was to the five the five physician CEOs and unbeknownst to me, one of them had already lost about 150 pounds on South Beach, which is a form of ketogenic diet and he kept it off. And so, they already knew exactly what I was saying and they were already on board before I even brought it up, which was very. It was it was awesome, essentially, because they already knew the power of, of lifestyle changes and they're on board with trying to rein in this kind of sick care system we have where people tend to just progressively decline if you treat them with the standard of care, which is medications. And it becomes more expensive for both the patient and overall the, the healthcare system at large. And the only way to really right the ship. Is to try to try to improve things from the the underlying foundations, like try, try to get at the root cause of these problems and fix the problems, which is truly through the lifestyle, the diet, the diet, the sleep, the exercise and the stress mitigation.

Lorenz: 9:05

know, I love that story with you and Laura and how you got into metabolic health through just your own experience and same with with Laura and what are the odds of like you to have interest in metabolic health, meeting each other in school, right? That is something right. Um, when, when I had Laura on the show, we talked about the pushback she faced during med school, right? And I actually want to ask you the same thing. Ask her, yeah. Wow. Because outside of the low carb community of doctors, I know the pushback is intense. Asking, just asking for, um, additional testings are almost impossible and ego runs deep with, with the doctors practicing the traditional healthcare system. We can talk about that later. I have a story about that, but what, what does that, what does that like for you, um, practicing this way? I know, um, you, you did tell a story about when You got, after your, after med school, you, you, you're already practicing at a, at a clinic. But was there any pushback, um, that you faced, um, within school or after school?

Dr. Matt: 11:08

Excellent question. I for, for medical school. You basically keep your head down during your clinical years and we didn't bring it up a lot. Laura brought it up, I think, more than I did. For residency different story and it's a great question because I think it highlights the very important role that You're doing with the podcast and that others are doing to basically spread the word Because otherwise if low carb MD podcast didn't exist in 20 I think we started listening to it either 2017 or 2018 like pretty early on it was a pretty new podcast we would never have really even gone down this path because it's just not taught. Laura basically paved the way for me. So, every she was a year ahead of me because I switched from emergency medicine to family medicine, but we both went to the same family medicine program. So, by the time I came through, I could basically order my fasting insulins, and I could basically tell my attendings when I precept with them. Like, you'll see a patient, and if you have to go, Discuss the case with the attending before you can basically let the patient leave the clinic. And Laura had fought the good fought to get, fought, the good fight to get fasting insulins on patients. And the one pushback you would get from these labs is, well, how does it change management? Which is probably one of my least favorite phrases in medicine. Because the number one thing we have, the number one most you can look at in terms of time or expense or anything that we have for our patients is our time as physicians. Like we have generally 15 minutes maybe if you're lucky, 30 minutes and anything that allows me to show, I, I basically, every time a patient comes to me, I pull up all of their labs on the computer. And I go line by line to say, look, the triglycerides are this and your HDL is this. And this means that you have insulin resistance anything that can help me motivate the patient or further risk stratify them into maybe a higher risk. Like if they're fasting, insulin is 70, which I've seen before. That's a pretty high risk patient. And it's going to be harder for them to sustain their lifestyle changes. So they may need to follow up in two weeks rather than four weeks. That's, that's literally how it changes my management. It's. I think physicians have this tendency to discount their time and overemphasize medications because you don't start a medication based on a fasting insulin level, but it does change your management based on how you interact with that patient. So Laura was able to do that before me. So I was able to order the fasting insulins, like, with no problem from the attendings. She also fought the good fight to not automatically put somebody with an A1C. Of 10 to 11 percent on insulin, the patient that she had improved from the double digit A1C to lower to like 7 or 6. 5 guidelines would say that it's, you should start insulin on them, but they improved it through lifestyle and you just cut out the carbohydrates and then the A1C just came down and I could basically do that as soon as I got into residency, family medicine residency, because it's, Laura had already done that. So, paving, what you're doing, and what Laura did, and what everybody does as they kind of blaze these trails, is the trail is then paved and it's easier for the next person to walk on.

Lorenz: 14:27

Yeah. No, exactly what you said. And your patients are so lucky to be, to come across Laura and yourself and others who, you know, other doctors who practice a low carb lifestyle intervention way of treating conditions because, otherwise if someone's, if someone come across low carb, And their doctor is, dismissive about lifestyle changes. What are the chances of them, firing their doctor? Right. Um, chances are there they'll believe their doctor. And obviously, what, from my own experience, our doctor would say. I wouldn't recommend it. Something that hasn't been done, right? Um, along those lines, right? But your patients, Laura's patients, I am so happy for them because, my, my family, my dad, type 2 diabetic, my mom, pre diabetic. and their doctor is dismissive about lifestyle changes and, particularly low carb and ketogenic diet. So, um, as much as I would want to them to fire their doctor, never going to happen, right? They've been with them for so long. Um, that's why I love having you here. I want to ask you questions about, how, a patient and a doctor can really collaborate in. Changing their lifestyle and changing this healthcare system together. So, oh, I want to ask. Um, what's the biggest challenge do you think in getting more widespread acceptance in the mainstream healthcare for low carb and keto, do you think?

Dr. Matt: 16:05

It's also a great question. And, very The answer is pretty complex and I'll probably ramble here a bit, but I think we could start all the way, like, on the foundation, I think, of why we're in the current predicament we're in. Because if you look, if you look at the data, and you look at the guidelines, and you look at the major organizations, there's actually support for low carb, for, we'll just talk about type 2 diabetes because that has the best evidence behind it. But there's even recommendations for treating things like obesity, weight concerns with, with low carb. So, both the American Diabetes Association and the American Heart Association as well, the AHA, both say that reducing low, reducing carbohydrates in type 2 diabetes has the best evidence for improving basically glucose, glycemia, your A1c. So from, from that alone if somebody does have type two diabetes and a physician says they can't recommend it, they're not practicing true guideline type medicine. It is 100 percent reasonable if a patient wants to do a low carb diet and they have type two diabetes to recommend a low carb diet. The Obesity Medicine Association as well also basically has endorsed low carb diets in addition to the other types of dietary patterns. Like, it's on the same level as low fat diets, low calorie diets, low carb diets. There's basically 5 to 7 different diets that the obesity medicine association discusses in their in their conferences and basically has endorsements for in addition to their medications and their, their weight surgeries that they have. So it's, it's kind of written in there and I just don't think physicians, physicians are still stuck in the mindset of like the nineties where it's the Adkins diet and it's going to kill you, which is not, not what the data shows either. So the going all the way back to I think just medical education decades ago, we had this, we have this patient physician model called paternalistic medicine. And this was all the rage in the 60s, 70s, 80s, 90s, like maybe even through the 2000s, where for instance, if let's say you, you get cancer and you go to your doctor and the doctor says you have this cancer, you are going to do this chemotherapy. Regardless of how long you're going to live, what your quality of life is going to be, what your personal values are. And really it's, it's the paternalistic, the the physician is the father figure and you are going to do exactly what they say.

Lorenz: 18:37

Mm,

Dr. Matt: 18:38

We have, we have since moved to what we call the shared Patient physician decision model, which is where you take into account the patient's values. You take into account the patient preferences and the job of the clinician at that point, whether it's a physician, NP or PA, just whoever you're seeing for your health care. It's really to let you basically discuss the data with you, kind of let you know the options that are out there and what options are more reasonable than others. And honestly, the number one, the number one term I use in my visits with patients is reasonable. Like it is reasonable to do this and it is reasonable to do this. And sometimes I do say they asked me for my opinion and I would say, based on my personal beliefs, I would probably do this. Based on what I know, but other people are different. So, when you, when you frame it like this, combined with the excellent data we have from things like Virta Health, the, the Virta Health study, two year data, which shows that literally all metabolic markers except for one, which is LDL cholesterol, improve for if you treat type 2 diabetes with a low carb ketogenic diet. And even then, even though the LDL goes up by about 10 points, The APOB, which is a better marker of basically the LDL cholesterol, that lipoprotein particles doesn't change for these patients. So even that that's with that data, plus the, if a patient chooses to want to go on this diet, it's completely reasonable. And I just think that these physicians are stuck in both the old. Old style of thinking with paternalistic medicine and they're stuck in the old style of data with Thinking that the Atkins diet is going to kill you which was never true Anyways, and they're just not up to date with the most recent guidelines from the ADA The AHA and the OMA saying that low carb is a viable option

Lorenz: 20:33

I also think that the way you present it to, to your patient, right? You know how, Laura has this skill and you have it too. And how she presented it to, she talked about it and she told the story and how she presented it to the patient. And I find it so that the patient. Um, have all the information in front of him, right. And she explained it in a way that they understood, especially with, CGM minors and, just. Make sure that you don't go a certain marker and go up a certain marker and by presenting it that way and by presenting it In a way that the patient understands or your organization understands They're more you find that they're more reasonable, right? they can be reasoned with and so I think there's the power in presentation too as well and how you How you articulated your ideas is, important as important as the information itself. So, um, I believe you guys have that skill on, persuasion, right? That's, that's, that may be one of the key things, key points on why you were. You and Laura is very much successful in, promoting low carb diets, right? And I believe that's the case. Um, I want to ask you, do you, do your patients find you specifically from low carb community or do you always, do you also get sort of walk in patients too?

Dr. Matt: 22:02

almost all of my metabolic health patients currently because it's a pilot clinic are from internal referrals from our clinic system, so So I started we had our we had our first kid that was born a day before I finished residency and then I took three months off. So I started my my true attending job October 1st. And then so I've only been working at this point for about three to four months and I have probably 30 patients so far in my metabolic health pilot clinic. I'm hoping to get. Probably about a census of a hundred to 200. And then if I have 50 follow ups or so, I can finally bring data to the, the CEOs and say, look, here's what I'm doing. And I've already had a couple of patients follow up and they're doing, they're doing fantastic. Ideally longer term, we would open up a standalone comprehensive cardiometabolic health clinic. Where we would have basically, it would be me doing keto. There's somebody else in our clinic system that does veganism. If that's, if somebody wants to try to improve their health with that or vegan, vegetarianism. Honestly, my, I'm, I'm a very pragmatic person. And at the end of the day, I just, if I want to put hospitals out of business, and I'm good at low carb ketogenic diets, and I do believe that there are unique benefits to low carb ketogenic diets that other dietary patterns don't have. But if somebody were to fail a ketogenic diet and let's say they were to succeed on another diet, and if they were to put their diabetes into remission that way, I'm a, I will like high five them and shake their hand and hug them and, and like congratulate them. Because at the end of the day, I want the, the last 24 hour shift I did in the hospital during residency. So every, every other Monday on our inpatient service, you have to basically almost stay awake for a full 24 hours. You may get like 15 minutes of sleep overnight, but you have to, you're, you're basically admitting patients. You're putting out like any fires that happen to pop up. If somebody gets sicker on, on your service, And at 2 a. m. I was paged about somebody who had a pretty bad foot infection. It's called it's called necrotizing fasciitis. And it's basically the worst kind of skin infection you can get. And it has to go immediately back to the operating room. And it was it was on their foot and it was from a diabetic ulcer, right? So a longstanding complication of diabetes is people lose sensation in their feet. They also get poor wound healing. There was another type, there was another patient that had diabetes that to just give you an idea of how bad it can get one day they were noticing blood in, like, on their carpet when they were walking barefoot in their home. And they realized that their foot was bleeding and they had a nail, they were a construction worker, they had a nail in their boot for two weeks. And they're, that was a different person, but that they're basically, they had to also go back to the operating room. So this current patient I had had a really bad infection, went back to the podiatry OR at 2 a. m. and it was, they were the sweetest, sweetest couple, like 60 years old, 65 years old. And at that point I felt like it was my mission to put podiatry ORs. Out of business at 2am. I don't want a single podiatry OR in this country to be operating overnight. I want no more diabetic amputations overnight. I want, I want no more diabetic amputations at all. I want no more diabetic ulcers. So whatever, whatever a patient can do to do that, I'm on board with. And whether it is, I do believe low carb keto is what I, is what I practice. I'm just good at it. And I think there's benefits. But, other diets can work as well. So, long story short, there's somebody else in the clinic system that does practice like, whole food, plant based, which is perfectly fine. And then in this other clinic that we will hopefully create, you would have a an associated gym with it, right? Because that's one of the pillars. You would have exactly, exercise. So the, the four pillars, what we talked about earlier, is the, the diet, the exercise. The sleep and the stress mitigation. So hopefully there would, there would be a psychotherapist, there would be physical personal trainers, physical therapists there, and even maybe a special special agreements with like a CT scan, a radiology company where we can do calcium scans to fully evaluate somebody's cardiometabolic health and do advanced lipid markers, advanced cardiometabolic markers. That's like, that's the decade long dream of where we want to end up.

Lorenz: 26:40

that's, that's an ideal way to, That's probably five to ten years, five years,

Dr. Matt: 26:46

I'm hoping, I'm hoping, I'm hoping.

Lorenz: 26:49

man. That's, that whole spiel that you said there, it's, it's so powerful, right? Because, um, I, I can see your passion for helping your patients, man. I mean, I, I'm, I'm with you, I'm with you on this fight, brother. If I can, however I can help you, to, push your message, I will, um, that's why I want to want you to these questions that I'm asking you is for our listeners to empower themselves, right. And maybe teach them to stand up to, the system, the healthcare, the traditional healthcare system, um, not all are, we, we cannot. Talk about, bad doctors, not all are right. The ones that I know at least can be very dismissive about lifestyle, but you know, they're all well meaning. Right. So, and also they are sometimes get very egotistical in terms of asking for help. testings and so forth, right? I had an experience where a doctor, my mom, I told her to ask for a CAC scan, right? Um, for a calcium score test. And she started asking for, where did you get the information? She started she was triggered by, by the question. Um, but, um, this is why there's a barrier within the system where a patient really has a hard time of it's either I fire this doctor, they have conflicting information about lifestyle and, traditional medicine. And it's, it's so confusing for a lot of people here who has, especially those who are chronically ill. Right. And, um, this is, I want to help them navigate, traditional healthcare systems at the end of the day. Um, many patients are concerned about, right, like I said, conflicting information between medical guidelines and their lifestyle change, right? How can, I want to ask you, Matt, how can individuals better understand and discuss these differences with their, maybe, healthcare providers, do you think? Mm hmm.

Dr. Matt: 28:54

Yeah, and to reiterate your point, you're doing, you're doing a fantastic job with just, with the podcast alone. Like, if there's anybody listening to this, it doesn't matter if you're a medical student, a resident. Personal trainer somebody like an engineer or anybody else in any other profession. There's actually been more engineers in this space over the past five to 10 years who decide to get interested in health that have probably changed the landscape more than 99 percent of physicians or PhD researchers. So whatever you're doing if you're listening to this and you're just like, well, I'm just I'm just X, Y, or Z, don't, that's. That's not, that's not true. The, like we got into this, Laura and I did through a brand new podcast in 2018 and it can just, it kind of snowballs, propagates forward and the inertia eventually just kind of takes over. In terms of talking with your physician or your clinician a couple of low hanging fruit would be at the SMHP, so the Society of Metabolic Health Practitioners. We do have some handouts that you can download to take to your physician. Basically one is a, an intro to low carb for a clinician that isn't totally aware of what it is. So, if you go to the SMHP if you Google that and then there's the resources tab and one is for providers and one is for patients. And if you click on for patients, then there's a handout that you can take to your clinician. And it has Virta Health data on it with improvements in A1c for type 2 diabetes. It has Dr. Tro's medical weight loss data with, he has a pilot program for a self insured company, factory company, and basically the improvement in weight in A1c for them and also Dr. David Unwin. Who is another low carb practitioner over in the UK and his data. So we have three different kind of clinics. that have shown remarkable improvements in lifestyle alone in a nice little table there. And then it has, what is a low carb diet? And then finally it has information on is a low carb diet going to kill somebody with a heart attack. And that basically the improvements in all of those studies of every cardio metabolic marker basically hopefully should assuage those fears for those clinicians. Otherwise, I think that at the end of the day, it does, it has to come back to just reframing, I think, how that this is important to you. And it's, it's hard for me to really, I have seen this so often on, on like Twitter, social media, where patients say, I saw my doctor today. And actually Laura deals with this a lot too because she works for Dr. Tro and so they see a lot of patients who have improved their A1C markedly with low carb, but then they go to another doctor, like a consult, maybe a cardiologist or an endocrinologist or even their own primary care doctor. And they say, Oh, it's great. You've lost 30 pounds and your, your diabetes is in remission, but low carb or high fat diets are going to kill you. Going to cause a heart attack and that it's sad. I don't know. I think the best thing is just grassroots continue to educate as many people and it will kind of percolate through the medical community as well. It out on average takes about 10 years for the latest data to reach the community, like primary care doctor anyways. So we're well on the way. I do have a lot of hope though, because there's, Laura, Laura and myself are evidence that, the, the younger generation gets it. All of our co residents are totally on board with low carb. They, they may not know how to recommend it, but they know that if a patient is on low carb and they're improving their health, that they wouldn't, they wouldn't have to tell them to stop it. Like, they wouldn't dis, they wouldn't dis disregard the improvements that they've experienced. And there are even a few co residents that do practice low carb as well. Whereas, I would venture to guess 5 to 10 years ago, it was, it was much worse than that.

Lorenz: 32:55

Mm. Yeah. Yeah. I believe so. I believe we are on our way. And I've, if it takes 10 years and, um, then it takes 10 years, right? But right now, what you can do right now, you can take, you can take control of your own health, right? There are, practices that exist today, like Dr. Trost, like, um, your practice as well. Right. That's our help already helping a lot of people reverse chronic illness today. So you don't have to wait 10 years, right? It will happen hopefully, right? And, um, there's a lot of people working together. The podcast, experts, um, who are in the forefront of changing the landscape of. Traditional healthcare systems, um, and hopefully we are on our way, right? Um, I want you to talk about, um, the I don't know, is that DBA that you talk about? Or the direct patient care, DPC. Sorry. Yeah. If you can talk about that a little bit and what, what's the difference? Because, um, this is. The future, I think of, of healthcare and which is a lot more sustainable, a lot more, um, direct to patient, um, and patients actually learn a lot when going into programs like this. So if you can elaborate on that program, that, that DPC method if you can explain.

Dr. Matt: 34:17

Oh yeah. Yes, I love DPC practices. I'm not in a DPC practice. And we're gonna, I'll talk about the differences. Because I think it's one of the most fascinating areas of medicine. is likely to change the most within the next five to ten years. So, DPC is direct primary care which means that there's no insurance company. So, you have a we'll just say physician, but it could be any clinician, which is an NP or PA. You have a physician, and they have a practice, and they can have a brick and mortar store, or they can just be telehealth, really, it doesn't, doesn't have to be in person. And they're, they generally have a patient panel of maybe 600 to a thousand patients. And those 600 to a thousand patients pay, I think on average it's about 50 a month in order to see that physician. And the beauty of that is, in the old model, which we'll talk about in a second, you generally have three to five thousand patients. So imagine being one physician, you have your EMR, which is your electronic medical record. And it's like on your computer screen and everybody has access to you through the in basket. They can just send you messages and imagine trying to respond to like sometimes 50 messages a day. It just doesn't, it's, it's these, it's a burden placed upon you by the current healthcare system and more specifically the administration of the healthcare system. But that's like a whole other. It's a whole other rant that we could go on. So you have smaller, more, I guess, intimate kind of environment with the direct primary care model. And you generally see about maybe six to eight patients a day, as opposed to 20 to 30 patients a day in the older model. The pay is a little bit better for direct primary care. And we'll talk about why that is too for the physician themselves. But the beauty is there's no insurance company to come between the care from the clinician to the patient. So the visits are generally 30 minutes to an hour long and you have time to fully discuss like, should we get this lab? Should we get this? labs don't go through insurance, typically what the clinician's job, the clinician's job is to go to LabCorp or Quest and say, Hey, how much is it going to cost for a comprehensive blood count? How much is it going to cost for a comprehensive metabolic count? How much is it going to cost for a fasting insulin? And you do that. And you essentially are able to give your patients a sheet that tells you how much each lab is, which is unheard of. In current medicine because you don't know how much any lab is for any patient in the current medical system through insurance because it's all different for every single insurance. So patients know exactly how much they're going to pay. They get way more time with their physician. And they have the ability to get same day appointments as well, which is also something incredibly hard to do in the current system. Those patients should still have catastrophic insurance. If they were to just travel on the highway, get into a car accident, have to go to a trauma center at the emergency department, then that is something that they need to have, should have covered. They should have like maybe a 3, 000 deductible or something like that just to just in case something catastrophic were to happen. But the whole point of DPC is We're going to decrease your overall health care utilization because you're going to be healthier You're not going to die. You're not going to get diabetes in the first place if you have high blood pressure We're going to follow up and we're going to we're going to get your blood pressure better Just by losing weight the best blood pressure medication we have is weight loss period so if you can Decrease somebody's medication burden decrease the side effects Just by not putting on the medication in the first place you're going to save money so then that, that's direct primary care, essentially no insurance to come between clinician and patient longer visits. You know exactly what you're going to pay and overall it's cheaper for the patient even with the catastrophic insurance because insurance is so expensive nowadays. So then how, how does that compare to the old school? Like what we do now? So we have each, each physician has about two to 3000 patients. And you generally get 15 minute appointments with those with the physician and half of that is really just like a lot of a lot of administrative type stuff if that makes sense. Basically screening and the physician doing the note and things like that. And then you don't know how much your visit is going to cost because each insurance is different. The co pays are different. Your deductible is different. They may or may not cover the, the lab test that you want to get, the calcium scan, things like that. And the incentive, I think, for the clinician is the biggest difference between these two. So, in the traditional model, Um, if you're, you're, you can be salary, but it's a little bit more common nowadays to be paid by what's called RVU, which is revenue value unit. And these, this was a system created in the eighties and nineties where they tried to normalize the unit of work that let's say a primary care doctor does and an orthopedic surgeon, right? So just making it easy, let's say one primary care doctor visit is one RVU. And then they could basically kind of equate that to maybe 100 RVUs for an orthopedic surgery. Which takes 5 hours and it's a very, it's a very complicated process and there's a lot of things that could go wrong. But they wanted to basically have one standardized scale to where they could pay all physicians based on this unit. And so, the thing that drives up the RVUs for primary care physicians specifically, it could be time. So you, you can build by time. So a 40 minute visit is like maybe 3 RVUs. And a 30 minute visit I think is like 2 RVUs. And a 15 minute visit is 1 RVU. But the other thing you can do to increase RVUs is manage medication. Which essentially means prescribe or change doses. It could mean deprescription as well, but in reality for 99 percent of what we do in medicine, it's adding on medication or changing, upping the dose of the medication. And so you end up with a lot of very short patient visits where you manage a medication and that gets you the most RVUs per unit time in the old model compared to the direct primary care model where there is no additional cost. Or there's no additional benefit for the physician at all of putting people on medication. There's actually benefit for keeping their patients healthier. Without medication because it keeps them happier and it keeps them out of the hospital and everybody everybody's happy, at that point

Lorenz: 41:12

Yeah, both sides are happy, right? It just helps both sides, the medical doctor and the patient. Um, and also gives a lot, you. The doctor has a lot more time to educate their patient on, my big, my biggest thing is to educate the patient on what the diagnosis is because most of the time people get diagnosed, but when they go home, they don't know what they have, right? They would search online. But, um, what are the chances that what they find is accurate, right? So, with this model, I believe that, for, a minuscule amount a month helps a lot because there's so much that the patient can do and with, with empowering them with education and what they have and how, how they can navigate. Lifestyle intervention, um, to reverse their symptoms. It just helps. Everybody. Um, Mm

Dr. Matt: 42:11

what 100 percent if a patient leaves my office and if they don't understand What either new diagnosis that we had that visit or they don't understand the actual? Reason why that happened I explained to every patient Why they have high blood pressure I explained to every patient why they have a weight concern, or even mental health or even type 2 diabetes. Like, these are all these all have underlying, at least some of the underpinnings, and I would, I would venture to guess even more than traditional medicine says at this point, as, as you're aware, that they have their underpinnings in metabolic health. And the way we're going to improve that, if, like, because I'm just good at it, they can do Any diet they want, but like low carb ketogenic diets for me, I think even for mental health concerns now that we have Chris Palmer's doing excellent work. Georgia. Georgia, Eid is doing excellent work. In fact, I had one patient. Follow up. I've had probably five patients so far. Follow up. One patient followed up, lost no weight. One month follow up on a ketogenic diet, lost no weight and I was like, Oh my goodness, I'm gonna go into the room. She's gonna say she hates it. She's not losing weight. She's gonna be mad at me. And I go into the room and I'm like, so how are things going? And she's like, it's going amazing. She's like, I feel great and she never even brought up the weight. She's like, I feel so much better over the past month than I have in

Lorenz: 43:42

Mm hmm.

Dr. Matt: 43:43

And that was a light switch, like a light bulb for me and I realized that the, it basically solidified the fact that it's not always about the weight or the A1C. The improvements in mental health can be so profound that the patients, like the patients don't even care about the weight at that point. Dr. Eric Westman, Laura and I worked with him during residency. He's at Duke Keto Medicine Clinic. And he's a, he's a mentor of ours. And he has my most favorite phrase about the ketogenic diet, which is it's so unbelievable. It's unbelievable.

Lorenz: 44:17

Mm hmm. Yeah.

Dr. Matt: 44:18

you have, you have to be careful if you're not talking to somebody who's like in the know of a low carb dieting, that you can't really go out and say, Hey, I got a patient who's, who lost 20 pounds. And I got another patient who's A1C improved by 3 percent and I got another patient. Who's PHQ 9 or their depression or their anxiety or these other like screening things. They've all improved like within the first month because you seem, it seems crazy. But we just see it every single day in clinic and you see it all the time on basically testimonials on the internet. It's almost like from the internet's perspective, it's like crowd, crowdsourcing data at that point and it just works.

Lorenz: 44:58

hmm. And I'm still in awe of this. it used to, it used to be devastating to be diagnosed with insulin resistant type 2 diabetes, prediabetes, because it's a view that's chronic, right? And that means that you'll be on medication on, um, management. Drugs, right. To manage your blood sugar levels, gives a lot of people help now. Right. That's, that's my thing is to, all right. Give them an option of lifestyle change. And if medication is an option, then give that option. Right. But if, if you have an option to change our lifestyle and reverse or. Reverse type two diabetes, for example, then I want that on the table, right? For everybody, right? And that's, that's, that's the only, that's our only ask. I believe at the end of the day, right? Um, you can't ask everybody to make a lifestyle change, right? Um, but realistically put it, if we have both options on the table, then those people who are ready to make that change. Have an option, right? And that's why I love your practice. That's why I love what you guys are doing. You, Laura, Dr. Tro. Um, I, I'm really honored to, interview you, Laura, and other experts who have, you guys are so young and you guys have a lot of things to you'll see it through till, to the end and I believe it's going to change and it's only a matter of time at this point because you know the evidence is there right and you said this is already endorsed and you know it's just taking time to reach other physicians and if we can keep working keep improving and keep keep the message going. Then we'll, we'll be there one day, right?

Dr. Matt: 46:46

Exactly. Hopefully sooner than later.

Lorenz: 46:48

absolutely. Absolutely. Um, man, this is so great. Um, if we miss anything Matt if, if you want to say something, this is your chance. Um, but like I said, you guys are already at the forefront of change, and this is such satisfying work for you, and I believe that, you, you and Laura Um, has a great career ahead of you guys.

Dr. Matt: 47:14

Yeah, it was, it was great to be here. I think the, the theme of our discussion is perfect. And I think it's just the number one takeaway I always have for patients, which is you have to be an advocate for yourself. You're absolutely right. The, there. There is a I think it's the physicians, you, you ask for certain blood tests cause you're interested in your own health or you, you take initiative and you do the lifestyle changes yourself and the physician or the clinician comes back and says, no, we're not getting that lab test or they get defensive, like you said, for sure. egotism reasons or things like that. But at the end of the day, you're in charge of your own health. And it's the, the model is really a shared patient physician decision making. And if they're not relaying the data, you need them to relate to you. There are direct primary care clinics out there. There are clinicians out there that will have those discussions with you, will give you the data, and then you can come to a decision together rather than unilateral, Unilateral agreements.

Lorenz: 48:22

Where can they go to find that? Any sort of examples or, um, any you can recommend to our listeners today?

Dr. Matt: 48:30

I know TRO, full disclosure, Laura, my wife, works with Dr. TRO. I know Dr. TRO is licensed in 50 states and Laura's licensed in She's licensed in whatever state you need her to be licensed in. So right now, right now I think she's licensed in like 35 states, but it could be 50 if they hit the need to be there's there are a lot of physicians in the low carb space. And I'm hopeful. We do have a repository of some low carb practitioners for the SMHP. So if you go to their website, you can see who's a metabolic health practitioner. And if they're an NP, a PA, or a physician, then they can see patients. And you can try to see if there's one of those in your area. I think one of the things we should do next on the docket for the Society of Metabolic Health Practitioners is have a, just basically an interactive map of the U. S. where people can say, I am a low carb friendly cardiologist, low carb friendly endocrinologist, low carb friendly primary care physician, OB doctor. And you can go easily search it and just sign up for somebody who, Will actually have those discussions with you.

Lorenz: 49:36

Awesome. Well, that's a great information. Thank you so much, Dr. Matt Culkin for sharing your story with us here today. Um, I want to be able, I want our listeners to be able to reach out to you, connect with you online. Um, how can they, where can, where can they find you?

Dr. Matt: 49:52

I am mostly on Twitter and you can just send me a tweet or, or I guess X now or send me a direct message. I am Matt Kalkins, that's M A T T C A L K I N S M D is my Twitter handle.

Lorenz: 50:07

Awesome, guys. Thank you so much, Dr. Matt, for coming on and sharing your story with us today and insights. We, um, I hope you guys have, have your notes out. Um, I'm going to relisten to this, um, so that I make sure I don't miss anything. There's a lot here. There's a lot of information. If you want to follow Matt it will be linked in the description box below. Um, and you can connect with him and maybe work with him. If you have, see. a chronic illness that you want to reverse. Um, it is the best time because, um, healthcare is about to change and you can control, take control of your own health, um, today. So thank you, Matt, for coming on and sharing your story with us today.

Dr. Matt: 50:49

Thank you, Lawrence. Thanks for having me. It was great to be here.

Lorenz: 50:51

right. Bye bye.

50:53

Thank you for joining me for another episode of the ketones and copy podcast with Dr. Matthew Hawkins in discussing his experiences and challenges in advocating for a lifestyle based approach to healthcare. And providing insights into their rec primary care. And it's potential for revolutionizing the healthcare system. I have provided links to Dr. Matt Calkins work and his socials. Please see the show note, captions below. If you are learning from or enjoying the podcast. Please subscribe to wherever you listen to your podcast, which is a great zero cost way to support the podcast. And you can also leave us up to five star reviews on both Spotify and apple. If you have any questions, please reach out to me on Instagram or our new website at keto. Coach lawrence.com.