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“Health isn’t about luck — it’s about intentionality. But even if you’re doing and saying all the right things, you might not be any closer to your goals.
I know because I was there.
As a heart surgeon, I was very good at following the rules.
But I was still morbidly obese.
I followed the food pyramid to a T.
I exercised for the recommended amount of time each day.
I thought I was doing everything right. And yet, my heart was at its breaking point.
I knew there had to be something more. So in 2015, I started digging into what modern science had to say about maintaining metabolic health.
And it changed my life.”
Philip Ovadia is a cardiothoracic surgeon and author of Stay off My Operating Table: A Heart Surgeon’s Metabolic Health Guide to Lose Weight, Prevent Disease, and Feel Your Best Every Day.
He shares his story and discusses his KevinMD article, “How to stay off my operating table.”
This episode is sponsored by the Stanford Physician Leadership Certificate Program.
For the aspiring physician leader, leadership skills are one of the most important and influential traits that will elevate your overall success.
Leadership impacts nearly every aspect of your career in a complex and diverse health care system. Including how you effectively communicate and influence those around you, how you respond to conflict and make important key decisions, how you develop your team, and even how you navigate social dynamics in your workplace.
Stanford Medicine recognizes the need to foster physician leaders in health care. That is why they developed the physician leadership certificate program. This 6-month cohort-based program includes live virtual sessions, self-paced learning modules, professional coaching, a capstone project, and much more: Providing C-suite education for the non-C-suite physician leader.
They encourage all early career and aspiring physician leaders to apply. To find out more about the program or apply, visit physicianleadership.stanford.edu.
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we have Philip Ovadia. He is a cardiothoracic surgeon, and he’s the author of the book Stay off My Operating Table: A Heart Surgeon’s Metabolic Health Guide to Lose Weight, Prevent Disease, and Feel Your Best Every Day. And there’s an excerpt from the book on KevinMD. We’ll talk about that and his book. Philip, welcome to the show.
Philip Ovadia: Great to be here with you, Kevin. I love your platform and all the messaging you’re getting out there around health.
Kevin Pho: All right, we’ll get into your book and article in a little bit. First off, briefly share your story and journey to where you are today.
Philip Ovadia: Yeah, so it was a pretty standard journey, I guess, to becoming a cardiac surgeon: medical school and general surgery training, followed by a cardiothoracic surgery fellowship, and I have now been in practice for 15 years. But what’s really important is that during much of that time, I was becoming progressively unhealthy myself. I had gotten to a point where I was morbidly obese. I was prediabetic, and I realized I was going to end up on my own operating table.
I started asking some different questions and realizing that the standard advice that we are taught in medical school and that we give our patients was failing me and was failing my patients. I asked different questions, came across some different information, and ultimately was able to improve my health. I came to realize that much of the disease that I had spent my career treating, heart disease, we were taking the wrong approach to, and we should be teaching people how to avoid this, and it is largely avoidable. And so now, while I continue to work as a cardiac surgeon, I also focus on helping people to not need heart surgery and to stay off my operating table.
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Kevin Pho: All right, before we get into that, I don’t have very many cardiothoracic surgeons on the show. Tell me some of the rewards and challenges of the field today.
Philip Ovadia: Well, it’s largely rewarding. You meet people kind of at their worst moments. They’ve oftentimes had heart attacks, or they’re having symptoms that are severely limiting their life, and you can offer them that chance to get their life back, to make them better. And what’s most rewarding about cardiac surgery, and largely about surgery in general, is that you see immediate effects of what you do, and so that is very rewarding.
The challenges of the field today are pretty much like the challenges in all of medicine. It’s very corporatized. Almost all cardiothoracic surgeons are employed by hospitals and hospital systems. Obviously, you can’t be doing heart surgery in an office, so that becomes a challenge. And there are not enough surgeons to do all of the volume of surgery that needs to be done. That is another reason why I’ve become so focused on preventative efforts, because the reality is that there aren’t enough heart surgeons to do the amount of heart surgery needed these days in the United States.
Kevin Pho: And let’s talk about some of those preventative measures. Your KevinMD article is titled “How to stay off my operating table.” Now, for those of you who get a chance to read that article, just walk my audience through it. Share the story of why you decided to write it.
Philip Ovadia: Yeah, sure thing. So the main focus of my book is on metabolic health and staying metabolically healthy, and I give seven principles in the article about how to stay metabolically healthy. And staying metabolically healthy is going to keep you off my operating table. We know that poor metabolic health, and whether you measure that as insulin resistance or diabetes, there are a number of ways to look at that, but no matter how you measure it, we know that poor metabolic health is the number one risk factor for developing heart disease. So I think if we can refocus people on improving and optimizing their metabolic health, we have a much better chance at keeping them from developing heart disease.
Kevin Pho: So let’s go into more detail. What are some ways that we can do that?
Philip Ovadia: Sure thing. The first principle I talk about is really a mindset, and that is reframing your health as a system rather than a goal. Briefly, what that means is don’t be focused on the short term, “I’m going to lose 20 pounds,” but focus on the bigger picture: “I want to be metabolically healthy, and I am going to find the habits that support my metabolic health.”
The next principle is to make one sustainable change at a time. It’s hard to change everything, and the problem when you try and change everything at once is that you really can’t tell what works and what doesn’t work. So I advocate for people to kind of focus on one area at a time and make the changes, and then measure if they’re improving or not. And if they’re not improving, then you start to make other changes.
Getting into the specifics, I think the most important thing is eating whole, real food. Eat the things that grow in the ground, and eat the things that eat the things that grow in the ground. That’s kind of my simple rubric for people.
I also think it’s important for people just to get more activity. That doesn’t necessarily mean going to the gym for two hours a day and doing cardio or doing weight lifting. I think if we just incorporate more movement into our daily lives, take the stairs instead of the elevator, park further away, take that 10-minute walk after you have lunch or dinner, simple things like this can actually have very large impacts on our health.
Some of the other principles are paying attention to your sleep, making sure you get enough good-quality sleep, and dealing with your stress. I never say you can get rid of stress, but you have to have a mechanism for dealing with it, and that can be meditation, that can be religion, that can just be having a good community around you.
And finally, and this may be one of the most important principles, is find a doctor who understands this. Find a doctor who’s going to work with you on this. Unfortunately, many physicians are sort of trapped within the system, and they’re not given enough time with each individual patient to talk about concepts like this. It’s quick visits, 15-minute visits, write the script and move on. And finding a physician who can partner with you to improve your metabolic health and improve your overall health is essential.
Kevin Pho: So you mentioned earlier, as part of your story, that a lot of this wasn’t necessarily taught during your medical training. Can you contrast what you were taught during medical training with what you just said?
Philip Ovadia: Yeah, so what we get taught in regard to nutrition specifically during medical training is very little, and what it was was basically the U.S. dietary guidelines and the science behind what is a carbohydrate, what is a fat, what is a protein, and kind of the biochemical processes that our body uses when we give it these foods. But we have to realize that the U.S. dietary guidelines have been in place now for 40 years, and during that time, our health has only worsened. So we really need to take a step back and start questioning those.
Specifically, when you look at heart disease, obviously my area of focus, the main messaging has been low-fat diets and keeping your cholesterol low, whether through pharmacology or dietary interventions to lower your blood cholesterol levels. And again, we don’t see a lot of evidence that that’s working. That has been really the mainstream advice, the focus, for 70 years now, and heart disease remains the number one killer in the United States and worldwide. So I think it’s important that we as doctors, we as a health care system, take a step back and say, “We have to be doing something wrong if we’re not making an impact on these diseases that we’ve been fighting these wars on for 50-plus years.”
Kevin Pho: And from that policy standpoint, why do you see such inertia when it comes down to that? Why not incorporate some more of the things that you just talked about?
Philip Ovadia: Yeah, well, you really have to start to look at who is influencing the policy, and unfortunately, that’s not physicians, and that’s not patients. It’s the bigger entities within the health care system. It’s the pharmaceutical industry. It’s the food industry. When you look at the committees that decide the U.S. dietary guidelines and revise those every five years, you see a large influence from the food industry.
And we have to recognize that the food industry isn’t focused on keeping people healthy. They’re focused on selling more food, and I don’t blame them for that. They’re in business. That’s what they’re in business to do. But to think that they have some sort of responsibility for our health simply isn’t true. And it’s not that they are, I don’t have this big conspiratorial mindset that they’re acting against us. It’s just that they’re not really paying attention to the outcomes of the recommendations that they make.
And then, like all large institutional decisions, they kind of start down a pathway, and it’s hard to change course. It’s hard to steer that ship in a different direction. So when we see poor outcomes, usually the reaction is, “Well, people must not be following our advice,” or, “We must need to do whatever we’re doing more.” And at some point, we have to take a step back and we have to say, “What we’re doing is not working, and it’s time to start thinking a different way about all of this.”
Kevin Pho: You mentioned earlier that a lot of primary care physicians have only 15 minutes to spend with patients, and I’m certainly one of them. So what are some high-yield phrases, high-yield things that I can do in those 15 minutes that can impart some of these metabolic pieces of advice that you share?
Philip Ovadia: Yeah, well, I think on a high level, just mentioning metabolic health. Most doctors don’t mention it. A lot of doctors don’t even really understand what it is or how to measure it. So at least if you’re mentioning metabolic health to your patients and you’re thinking about metabolic health, that’s going to steer you in the right direction, because you’re going to start checking the right lab tests. You’re going to start thinking about the influence of the things we mentioned, what you eat, what you do, how you sleep, on that patient’s life.
And perhaps it’s not going to completely change you right away. You’re not going to stop writing all the prescriptions. But at least we can start thinking more about, “OK, I’m giving them the prescription, but let’s also talk about their metabolic health, and let’s help them to improve their metabolic health.” And what you may find, what I have certainly found working with patients, is that the patient may not need the prescription anymore after a while. That’s kind of an amazing thing, because again, we don’t get taught in medical school how to take patients off medications. We only get taught how to put them on the medications, and there really isn’t a lot of thought about how we can get patients off of these things. I think we should be thinking more about that.
Kevin Pho: We’re talking to Philip Ovadia. His KevinMD article is titled “How to stay off my operating table.” Philip, what are some of your take-home messages that you want to leave with the KevinMD audience?
Philip Ovadia: Yeah, so for all of the patients out there, my take-home message is take charge of your health. You are in charge of your health. Your physician should be helping you, but they’re ultimately not the one making the decisions in your day-to-day life. So take charge of your health. Figure out if you’re metabolically healthy or not. I have a great free tool. It’s at ifixhearts.co, and it’s just a quick quiz that will take you through “Are you metabolically healthy or not?”
And then for the physicians out there, like I said, focus more on metabolic health. Let’s help our patients to get healthy and to stay healthy instead of just managing their diseases.
Kevin Pho: Philip, thank you so much for sharing your time and insight. Thanks again for being on the show.
Philip Ovadia: Thank you, Kevin.
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