I’m sharing information from an interesting interaction with Dr Ovadia in today’s blog.
If you follow my YouTube channel or read my book “Prevention Myths”, you might be familiar with what I think about stress tests; they don’t predict heart attacks and often lead to stents, which don’t prevent heart attacks either.
You’ll be surprised at how well-aligned the messages are. Dr Phil Ovadia has written a book that sounds like the kind of book you might hear me write about lifestyle. It’s titled “Stay Off of my Operating Table.”
His podcasts are interesting as well. One of the things that impressed me was his position on stents and heart bypasses.
WHO IS DR. OVADIA?
Dr Ovadia is a cardiothoracic surgeon with a personal story regarding his health.
His journey has been on the professional and the personal side. He struggled with obesity my entire life. Despite that, He went through medical school and training to become a cardiac surgeon.
He went into practice and spent many years caring for people’s sick hearts. He has performed over 3,000 heart operations.
For much of that time, He was becoming progressively unhealthy. He got to a point about seven years ago where he was morbidly obese was prediabetic.
He told us he realized he would end up on his operating table. He was going down the same pathway that many of my patients had.
More concerning is that in following the advice that he had been educated to give them, he was getting sicker and sicker; he saw the same pattern as in his patients.
It was the standard advice:
• Eat less.
• Move more.
• Eat a low-fat diet.
• Eat according to the US dietary guidelines in the food pyramid.
It failed me, and it was failing them.
Dr Ovadia started to ask some different questions and learned some additional information. He figured out how to improve his health; started using that to help friends and family and, ultimately, help patients.
He realized that our entire approach to heart disease was wrong. He didn’t understand the illness that he was treating every day.
When you understand the true causes of heart disease, you come to different approaches as to how best to treat it.
As he continued to work as a cardiac surgeon, he continued to do heart surgery actively on the people that needed it.
But, at that moment, he already had another mission, a bigger mission in life, which was to keep people from needing heart surgery, to keep people off his operating table. That’s what led him to write the book.
He told us we, as physicians, need to educate people that it should be expected for them to stay healthy. Things like heart disease and diabetes, many of the things we battle against, are preventable, reversible and should not be a part of everyday life as they are today.”
DR. OVADIA’S TRAINING
Dr Ovadia didn’t just go to any cardiothoracic training program. He went through training at an Ivy League School, Tufts, in Boston, MA. It was a rigorous training program, as is all cardiac surgery training.
Going into surgery is undoubtedly one of the more difficult training paths. Going into cardiac surgery is a step above and among the most challenging training that you can go through.
He spent seven long years learning all that one needs to learn to practice this surgery. You’re still learning once you get out and into practice. This becomes very relevant as we get into this conversation around nutrition and preventative medicine.
Just realize that you should continue learning as a physician when you finish medical training. Being a good physician involves that authentic lifelong learning. We pay lip service to that in the healthcare industry. We don’t put it into practice as physicians as much as we should.”
DR. BREWER’S STORY
When I started med school in South Carolina, MUSC, we did a rotating internship at Charity Hospital in New Orleans. At that time, I had had some interest originally in surgery.
It became clear that I didn’t think surgery was the place to change people’s health. I just couldn’t put my finger on it.
So, I decided to try ER. At the time, in 1981, you could go into emergency medicine. I was becoming a specialist at that point. So, I started in emergency medicine.
I had some of those moments you imply in your book, where there must be something more if you want to focus on patients’ health.
In the emergency room, it was yet another patient with a heart attack or stroke that they should not have been having. Your actual claim to fame in the ER is to do a code on somebody.
It was way too much and way too late. It has some characteristics similar to most surgical procedures that are being done.
This might require me to become a couple of things I never wanted to be. One is a bean counter. The other is a teacher.
I went to Hopkins to learn prevention medicine. And I became a bean counter. At Hopkins, we always talked about denominator medicine. That means we looked at what drives disease. We focused on the underlying risk factors.
In cardiovascular disease, the things that are killing us have to do with the patient lifestyle more than it has to do with anything else.
I got into becoming a bean counter, looking at epidemiology denominator medicine and educating patients.”
CLINICAL TRIALS
Let’s take a minute to discuss some important trials before getting back to Dr Ovadia’s story. I’ve mentioned these trials many times on my YouTube channel.
The COURAGE trial was started in January 1999 and completed in June 2006. It was before Tim Russert died in 2008. The doctor that cared for him mentioned the trial. He said it’s becoming clear that stents don’t prevent heart attacks.
There would be a significant decrease in stents. It’s not the case. They continue to increase.
Then there was the ORBITA trial which would never have been done in the US; it was done in the UK. The researchers only used people who had indications of a stent. They completely randomized them. The standard group had the stent. The other group had a placebo procedure. The results showed stents did not prevent heart attacks.
Stents can be lifesaving, but only at the right time, usually when you’re having an event.
Based on those two studies, 90% of stents would go away. They didn’t. You would expect to see the use of stents decrease, but they increased.
THE PROBLEM IN TRADITIONAL MEDICINE
While he is in the industry, Dr Ovadia doesn’t do stents. However, his colleagues do. In one of his videos, he states: “I think the medical community needs to apologize to patients.” What does he mean by this?
What we see around cardiovascular disease and these procedures, whether you’re talking about stents or you’re talking about heart bypass surgery, is symbolic of our entire medical system. We’ve focused on treating these diseases’ acute problems and end stages.
We’re treating the symptoms without addressing the underlying causes. Unless we start addressing underlying root causes, it’s foolhardy that we would even think that these procedures would be helpful in the first place.
Our medical system has primarily evolved around doing procedures. As a surgeon, he was trained to do surgery.
Interventional cardiologists that put in stents are trained to put in stents. It’s natural for the system to say we should find as many people as possible to try and help them with these procedures.
We’ve lost sight of the underlying problems that lead to someone “needing” a stent. The medical system perceives justifying a procedure that is not necessarily the same as someone that’s going to benefit from that procedure.
He also shares with us that, in general, we need to step back in medicine and focus more on the root cause issues. This is specifically true with the management of heart disease.
Heart disease has been the number one killer in the United States for 50-plus years. Worldwide, it remains the number one killer.
Looking at our whole treatment paradigm around heart disease, we look at stents, bypass surgery, and pharmaceutical therapy. They are supposed to reduce our risk of heart disease, but it becomes hard to see any significant impact.
There has been a slight decrease between about 1990 and the early 2000s. The incidence of heart disease in the United States was going down.
It was mainly attributable to decreasing smoking rates. Over the 10-15 years, it has levelled off and is on the increase again.
In the last five years, there’s been a noticeable increase in heart disease deaths and the overall incidence of heart disease.
We must step back and look at everything we’re doing and failing. What do all of these things have in common? They are trying to cover up the symptoms of end-stage disease. We need to address the primary root causes of heart disease.
The root causes are well known. In the medical literature, going back to the late 1970s – early 1980s, the role of insulin resistance in the development of heart disease was demonstrated.
We still don’t have the easy drug. We don’t have a surgical procedure to fix it. We’re not telling you to do the hard work of diet and lifestyle changes to address the underlying insulin resistance. We’re just going to keep treating the symptoms of this disease’s end stages as best as we can.
Unfortunately, it’s not specific to heart disease. This is what our medical system has evolved to. We’ve become a sick care system. We only focus on putting band-aids on the symptoms. We do a very poor job of identifying and treating the root causes of these diseases.
LIFESTYLE IS THE KEY
It reminds me of a saying that I repeat over and over. “You can’t out prescribe a lifestyle issue, you also can’t out supplement a lifestyle issue, and you certainly cannot out stent a lifestyle issue.”
It came as a result of the COURAGE and ORBITA trials. They decided that stents aren’t preventing heart attacks; they will have to use a bypass.
Then the ISCHEMIA trial came out.
The ISCHEMIA trial largely mirrored the results of ORBITA and COURAGE, looking at surgery as opposed to a stent. It showed that for people with “stable angina”, the surgery is not of many benefits. It does not prevent fatal heart attacks.
DR. OVADIA’S TAKE ON HEART SURGERY
Heart surgery has more risks associated with it than a stent does. It’s a more effective procedure. We’ve improved at heart surgery over the years, but it’s still not a low-risk procedure. We should be thinking long and hard before we do it.
Dr Ovadia comments that today, he thinks a lot longer and a lot harder about performing heart surgery these days than he did in the early part of his career.
And more importantly, we need to recognize surgery is a band-aid. It’s necessary for the right situation. It can be lifesaving.
It can significantly benefit the patient with their quality and quantity of life. But it does not address the root cause of the problem.
We need to start marrying the two approaches for people with advanced heart disease who need heart surgery. He can perform the surgery, but we must also address the diet and lifestyle issues.
We need to address the root causes of what led to you getting the surgery in the first place so that you’re not going back on an operating table or catheterization table getting a stent.
These are common occurrences. Hopefully, we can prevent you from dying of that same disease. We try to “fix” you with surgery. We know that surgery doesn’t actually “fix” heart disease; it just improves the symptoms of heart disease.
THE MAIN ROOT CAUSE: INSULIN RESISTANCE
Over half of the patients who come to me have lost 30 pounds.
I see the plaque in their studies, but I don’t see nearly as much insulin resistance. We must go back and rebuild from 30 lost pounds. They were significantly insulin resistant or even diabetic. Now they have lost body fat.
The other thing I see with my patients is I get folks where a doctor, a cardiologist, or a surgeon tells them they need surgery, a procedure, or a stent.
They want to confirm with me that they don’t need it. They may say, “I don’t need to have this, or I’m getting ready to have this surgery, but I want you to tell me that I shouldn’t.”
They often disappoint me because I tend to have more of a position aligned with Dr Ovadia’s. Stents and I wrote a book about the dangers associated with stents, which are not that great.
There is more danger associated with a procedure that opens the chest. In my mind, the real threat of stents and heart procedures is not the surgery but the risk of thinking your plumbing is fixed, and you don’t need to do anything else.
We see it with medications, too. Whether looking at cardiovascular disease or type 2 diabetes, most physicians view it as ‘let’s put you on medications, and that’s going to take care of the problem, that’s going to eliminate the danger’.
When you look at type 2 diabetes, for example, you start medications and know the natural history that you will need more medicine over time. You will still be at high risk for complications such as vascular disease, amputations, blindness, and kidney disease.
Maybe the medications do a little bit to push them back. But unless you address the root cause of why you developed type 2 diabetes in the first place and what you can do to reverse type 2 diabetes, you’re still putting
yourself at risk for long-term problems.
We should talk about that more in medicine.
MEDICATIONS & LIFESTYLE
A co-worker who worked with me in managed care 30 years ago became a hospital executive. He ran a couple of hospitals and ran a lot of large operations for hospitals. He was diagnosed with type 2 diabetes. He went on one of the new “miracle” drugs – GLP-1.
He went on Trulicity for a year and a half. He lost little weight. It was helping with diabetes but not weight loss. Then he committed to changing his lifestyle and lost 45 pounds. It made a massive change in his health.
It goes back to the comment that surgery and stents will not fix the problem. We have some blockbuster new drugs coming out. They help a lot, but they will fix the problem once the patient commits to changing their lifestyle.
THE STORY BEHIND THE ADVICE
A couple of comments are essential to understanding how a heart surgeon is not promoting stents for prevention.
Dr Ovadia had his healthcare challenges. The healthcare system failed him personally. It can fail the practitioners, and many of us are unhealthy. Physicians are very unhealthy as a group.
What chance do we have of helping others to be healthy and preventing people from being sick if we can’t do it for ourselves?
He lost over 100 pounds. More importantly, he has maintained weight loss for five-plus years. All of my markers and my prediabetes got better.
His health markers are good, like insulin sensitivity, and they continue to be good. Lipid markers may not be considered ideal by mainstream medicine, but he had coronary artery calcium scans on a repeated basis. He has not seen evidence of coronary artery disease on those scans.
Most importantly is that he feels the best he has in his life. He is wearing smaller clothes than he did in high school.
He has endless amounts of energy now as opposed to when he used to fall asleep in his office every afternoon after completing a surgery. He would need a nap and a lot of coffee to get through the rest of the day.
Now he has endless energy – just what he needs to continue as a busy cardiac surgeon. He also runs a telemedicine practice and hosts his podcast. He is more present in his life for his family.
These are side effects of addressing root causes, improving metabolic health, and focusing on diet and lifestyle issues.
One of the other essential things is that there is only one correct answer for some. This is a complex problem. I’m not selling “The Dr Ovadia 28-Day Diet Plan.” There is no “Dr Brewer 28-Day Diet Plan.” This is a process that people need to work through.
We didn’t intend to become teachers, but we really can’t separate medicine, being a physician, from being a teacher. Dr Ovadia mentioned he didn’t think of himself as a teacher at the beginning of his medical career. He certainly is today.
Our role is to educate the patients, guide them through this process, and help them figure out what works for them and what’s best for them.
In the book, Dr Ovadia talks about how we are humans. We do have basic physiology that we all share, which dictates what’s going to be good and bad for the majority of us. But there’s a wide range within that.
As individuals, we need to seek what is truly optimal for us. And individual needs are going to change over time.
He needed to do some lifestyle interventions to get healthy. They are not necessarily the things he does today to keep himself fit. It’s an important realization we need to accept. It requires self-experimentation with proper guidance.
THE ‘ONE SIZE FITS ALL TREATMENT
Sometimes I irritate people. Some say, “would you just quit talking about facts and evidence and all of that and tell me what to do.” I used to try to figure out what worked for them.
But then, I became clear on my YouTube channel and decided, “if that’s what you want, this is the wrong place for you. I’m not going to tell you what to do because the one right answer doesn’t work for everybody.”
It’s different when you’re my patient. Then I know the science and the medicine from the testing we’ve done. The hard part is for me to figure out what works for you. It’s a different kind of process.
When I read Dr Ovadia’s book, it became clear that surgery is not the answer for everybody. I needed some personal answers and found them in the book.
EXAMPLES OF CHANGE
Another personal story from Dr Ovadia involves diet and gut health. One of the earliest steps in his process was eliminating gluten from his diet.
This was first suggested to my wife, who was dealing with some issues. In retrospect, they were inflammatory. She had day-to-day aches, pains, and heartburn- those were her symptoms. Her practitioner suggested she should go gluten-free. He was skeptical of that at first. He was still in my mainstream medical thinking.
He thought, “she doesn’t have celiac disease. How is this going to benefit her?” But he was open and supportive enough to say, “I’ll try it with you.”
It was their first foray into health improvement-going gluten-free. He immediately noticed a significant improvement. He felt better. He stopped falling asleep at his office.
It made him think about how he was not someone with the overt signs of celiac disease. Yet eliminating gluten was beneficial to his life. This ultimately led him down the low-carb pathway. He destroyed processed food in general.
It’s interesting how we, as the healthcare system, look at something like celiac disease. People with celiac disease should avoid gluten, but we must realize that most of us don’t react well to gluten. It shouldn’t be a standard part of our diet.
It’s an interesting anecdote. Along my journey and many others, there are similar experiences.
I shared Dr Ovadia’s skepticism about a gluten-free diet. It was a fad. It was probably not worthwhile. Then I started looking and discovering some things. One of the things I learned was about zonulin.
Zonulin is an apoprotein. That means it’s a protein before the last part of an amino acid chain has been cleaved off. It’s an apoprotein for haptoglobin 2-2. What does haptoglobin 2-2 have to do with any of this?
Our bloodstream gets peppered with some oxidative stress regularly. It comes in the form of iron which is carried by hemoglobin. Hemoglobin comes from red cells that get old and blow up.
We have a mechanism for cleaning up the hemoglobin and iron. That mechanism is a molecule called haptoglobin. There’s a genetic variation for it. Let’s go a bit deeper and use the scientific term “allele frequency”.
“Allelic frequency”- allele means the wild type or “normal” allele, which doesn’t create risk. But there is a high-risk allele. The high-risk allele, in this case, is haptoglobin 2-2.
There’s a fellow named Alessio Fasano. He’s a pediatric gastroenterologist from Italy stuffed into the back of the library at the University of Maryland. Then people saw his research about leaky gut. Some of us thought it was silly.
With haptoglobin, they now have the genetic location of the genes associated with leaky gut. They’ve mapped the entire amino acid sequence for both the protein and the apoprotein.
One of the things they’ve demonstrated is, for that group, it appears it may be associated with more of the cardiovascular inflammation oxidative stress that you see with people with diabetes than anything else. Why would it be so prevalent?
I used to work at a human genetics lab. As you go deeper into the science behind haptoglobin and zonulin, it’s clear that haptoglobin appears to have been a mutation in the tropics, a little bit north of India, around 30 generations ago.
When I was working on that subject with several people in this human genetics lab, I asked the question: so why would it become so prevalent?
The allele is found in at least 50% of situations. Since we have two alleles, we have two sets of genetics, two copies of our genetic information.
If an allele is seen 50% of the time, three-quarters of us have at least one of those genes. It’s very prevalent.
Why would it be so prevalent? I asked my friend, a lab epidemiologist from Vanderbilt, who was in the room with me. He said there was genetic pressure because increased oxidation decreases the risk of malaria. This was a discussion of human evolution I had with three devout Christians.
What does this have to do with celiac disease? Zonulin appears to be a causative component of celiac. Zonulin opens the toll receptors. There are ways for our intestines to stay intact.
It is important to keep the barrier and prevent this leaky gut that we see so commonly these days. Some of these foods usually contain proteins our bodies wouldn’t get exposed to when the gut is intact and working correctly.
The gut becomes inflamed. These proteins can now start to leak across this barrier. Our bodies recognize them as foreign substances. It sets off the inflammation cascade.
When looking at these different disease processes, such as heart disease, Alzheimer’s disease, many forms of cancer, and type 2 diabetes, you might think there’s no relationship between them.
If you’re looking at the end products of these diseases, we know that they all start in a commonplace. The commonplace is inflammation. This manifests itself in ways like insulin resistance and poor metabolic health.
These are the root cause issues that we discuss and recognize as significant. There are interventions that we can target with diet and lifestyle.
When we get at the root causes of these diseases, we can, in many cases, reverse them. We can stop them from progressing. We can have a meaningful impact on patients’ lives.
When you look at all of the different dietary strategies, you look at things like a gluten-free diet; an Atkins, low-carb type diet; vegan diet, you look at the carnivore diet. Most people say they don’t share anything in common; they are opposites. The reality is that they do share a lot in common.
They eliminate processed food first and foremost. One of the things I did in the book was to connect those dots and find the basic tenets of improving our metabolic health, the basic principles. Then educate people on how to implement these things in their daily lives.”
THE BURDEN OF INSULIN RESISTANCE
The most common situation, in terms of our bodies and our ability to eat foods, is that starting at age 30, over half of us develop insulin resistance. We used to think it was age 60 and a third of us.
On their website, the CDC says it is 33% of us, but if you look at the new information from UCLA and now from national JAMA studies and national surveys published in the JAMA network, it’s not age 60; it’s as early as age 30.
It’s not 33% of us; it’s 50%. If half of us are at a point where we have some insulin resistance, i.e., we cannot healthily eat carbs as well as we used to, we need to back from that just a little.
To your point, you don’t have to worry so much about the diets you just mentioned. Every one of the diets I heard you say will result in you eating fewer carbs. You’re cutting out the first source of carbs in the standard American diet: grain products.
The statistics are even more alarming than you mentioned. When you look at Brown’s statistics around metabolic health and cardiometabolic health, we know that 88% of adults in the United States, as of the 2016 NHANES data, do not meet all five criteria of metabolic health. Eighty-eight per cent of us are sick.
When you look specifically at heart disease, we have data from the 1970s-1980s that show the vast majority, or 90% of patients, who end up with a heart attack, are insulin resistant. They may not have been formally diagnosed as diabetics, but if you look at the suitable markers, you can demonstrate that they are insulin resistant.
Cardiovascular disease equals insulin resistance.
Dr Ovadia comments that there are two types of patients with heart disease. The ones that have been diagnosed as diabetics, and the ones that don’t know that they’re dying.
We need to recognize that more. It leads us down the wrong pathways regarding how we should be treating these diseases.”
INSULIN RESISTANCE AND CARDIOVASCULAR DISEASE
Once again, there are two types of cardiovascular patients; ones that know they have insulin resistance, diabetes, and prediabetes, and those that don’t know they have it. There are some exceptions. They’re not very common.
The first step when seeing a cardiovascular patient is finding their insulin reaction. People ask me the most important thing you do in looking at patients. It’s very lab driven. When a patient calls our practice, Michelle gets them registered and sets them up for labs.
The one lab that’s by far the most important is an OGTT with insulin response. Most diabetes and prediabetes are not picked up, not even through hemoglobin A1c.
Most doctors think that they do. When you look at the numbers, most often, it’s just discovered on a fasting glucose that happened to be drawn for something else. If you ask doctors if you go to HEDIS and some quality organizations, they’ll say you need to look at A1c.
The science is out there. It’s been shown that doctors miss at least 20%, probably a lot more. This is for diabetes alone. They cut a lot more cases with prediabetes or insulin resistance.
We need to look at a snapshot of how your body reacts to a challenge from glucose. We’ve just been talking about diet. When you look at the standard American diet, you’ll see stacks up to six times a day.
People are stuffing food that has carbs in it into their bodies. That creates a whole metabolic response. We need to know what that metabolic response is.
I enjoyed reading Dr Ovadia’s book and watching his videos. Dr Ovadia went further than I did in the surgical training process. But now he’s ended up in a similar place; we need to be teachers. We need to go back and focus on lifestyle.
IDENTIFYING AND SOLVING INSULIN RESISTANCE
Dr Ovadia’s practice is entirely telemedicine-based. You can find it at ovadiahearthealth.com for anyone interested in working with me. We need to identify the root causes that create insulin resistance. Most patients find me because of my background as a heart surgeon.
But, interestingly, we end up looking at their diabetes, looking at their thyroid disease, looking at their general hormonal health. All these things come into play because they relate to metabolic health.
I also do a deep dive into uncovering insulin resistance. I use the OGTT with insulin response. The Kraft test can be helpful. It is cumbersome. One of the shortcuts I use is the lipoprotein insulin resistance score.
Some people think that while on a keto/ carnivore diet, an OGTT test may trigger a false positive for diabetes. I went into that urban myth. When you look at it, the evidence would indicate it doesn’t impact it either way.
I found some studies in the New England Journal from a couple of decades ago. They said you must do a carb load for three days before the test.
We put that in our instructions. But the objective evidence indicates our body does not need a three-day carb load. It will recognize the carbs immediately and react the way it usually does.
It’s not as valuable a test- when you’ve improved your metabolic health, you’re doing well, and all your other markers look good.
It’s helpful to understand your level. One of the things people find as they drop body fat is that the level of resistance drops dramatically.
I have quite a few patients who say, “I’m an addict. I fall off the wagon if I start eating carbs again, even if I take the OGTT with the sugary drink. I go crazy, start eating carbs and go into a destructive tailspin. My advice is it’s not worth it. Don’t do it.
It’s an instrumental test if you’re starting this journey and need clarification on your metabolic health.
I do a lot of advanced lipid testing with patients, and you know it’s ironic because I talk about how lipids are the wrong focus for heart disease. This is true, especially in how most physicians look at lipids and only focus on LDL cholesterol.
We can get a lot of helpful information from looking at lipids. We need to look at it in the right way.
When you look at the advanced lipid panels, the nuclear NMR (nuclear magnetic resonance) panels show you the size distributions of these lipid particles.
You can look at that pattern and determine a person’s degree of insulin sensitivity from the lipid size distribution. This is where we get helpful information. Then we track this over time.
My baseline assumption is that if you’re coming to me with heart disease, you are insulin resistant. We need to demonstrate it; then, we need to track it. We look for improvement with diet and lifestyle interventions.
That tends to be my approach. We certainly use other metrics. I’m a big fan of the coronary artery calcium (CAC) scan because, for people who don’t have established clinical heart disease, we want to be again able to track that disease process early.
It’s similar to how insulin allows us to track the diabetes continuum early.
The coronary artery calcium scan lets us track the heart disease continuum early. That’s when we have the best chance of intervening. The CAC score becomes an excellent tool for measuring progress.
The second most important study is the fractionation of the lipid. It’s very analogous to the lipid in NMR that we’ve done.
I have several videos on the impact of insulin resistance on HDL size. We follow the amount of HDL that affects the population. With the bell curve on LDL, we see how it gets smaller. Everybody knew there was a small, dense LDL risk factor, but they needed to see how that happened.
We found it’s driven by our insulin responsiveness and our metabolic profile.
Beware of what you eat. Sometimes you’ve been 40 or 50 years into the problem. It might be partially undone in two years. It’s going to be significantly improved in my experience. But I know people who have been doing a clean diet and still have some insulin resistance.
Sometimes the diet could be cleaner. When people talk about being on a ketogenic diet, I still ask them how much-processed food they eat. What are the sources of fat in your diet?
If you’re getting a lot of the fat fueling your ketogenic diet from vegetable and seed oils, that will be a problem. Explicitly talking about vegetable and seed oils, we know these things can persist in our fat cells for years. It can take years to get them out and overcome insulin resistance.
We also need to realize that we can get into different terms besides people with advanced type 2 diabetes. We use type one and a half, where you have a degree of type one diabetes because you cannot make enough insulin. It can be a complex problem to overcome. It can be very persistent.
The unfortunate answer to this is yes. You can have an immaculate ketogenic diet and remain insulin resistant for years.
You see it with two different issues. Most often, one is the assumption that you can eat all you want as long as you don’t eat any carbs.
It goes back to the issue that even a low-carb diet will not overcome a lifestyle issue. It’s a lifestyle issue if you’re eating too many calories. Even though they may be low carb, they can cause a problem.
Look at one of my videos: “The Secret Life of Fat Cells.” It covers an award-winning lecture of the same name. We used to think fat tissue was inert energy storage tissue. Now it’s become clear that it’s anything but that.
Fat drives this problem. Using a keto diet means eating only some of what you want. It would help if you were a healthy weight.
The other issue is genetics. I’m a poster boy for a healthy lifestyle. My BMI was 21- 22 when I discovered my prediabetes, and I documented a couple of blood sugars over 200. Therefore, I met the full-blown type 2 diabetes criteria, even though I’m pretty skinny.
It’s not all just your diet. It’s not all just body fat. Genetics play into it, too.
When we comment on a healthy life by today’s definition, it’s a variable thing: non-smoker, non-drinker is a good start. They are two habits that are going to support good health. Not eating processed food for the first half of your life will significantly impact you.
I’m not discounting the role of genetics, but, in general, genetics play a minor role in this than we perceive. We tend to blame genetics because the problems are so ubiquitous.
It’s easy to say, “my dad had heart disease, my brother has heart disease, I have heart disease, it must be genetics. But the reality is that you know your dad and your brother, and you all have the same habits. Habits get passed down in families.
When we look at the simple fact that heart disease was essentially non-existent at the turn of the 20th century, around 1900, it became ubiquitous by 2000. Genetics don’t change quickly on the population level in a hundred years; genetics change over thousands of years.
They don’t change over 100 years, so genetics can’t be. It explains why heart disease went from non-existent in 1900 to ubiquitous in 2000.
For anyone who needs more clarification about their metabolic health, please start now. Dr Ovadia has a free resource on his website ifixhearts.com.
It’s a metabolic health calculator. We’ll take you through the basics of assessing your metabolic health. Then we will give you some tips for improvement.
Also, you can visit our website prevmedhealth.com and access care, courses and other resources to help start your cardiovascular prevention path.
If you found this article helpful and want to start taking steps toward reversing your chronic disease, Dr. Brewer and the PrevMed staff are ready to serve you no matter where you’re located.
To find out more, schedule a consult here: prevmedhealth.com
REFERENCES:
1. https://prevmedhealth.com/effects-of-intermittent-fasting-on-aging-and-cv-disease/
2. https://prevmedhealth.com/do-statins-prevent-heart-attacks/
3. https://prevmedhealth.com/thinking-about-getting-a-stent-or-a-bypass-read-this-first/
4. https://prevmedhealth.com/how-to-identify-and-handle-chronic-inflammation/
5. https://prevmedhealth.com/understanding-your-heart-attack-risk-mendelian-randomization-crp-obesity/
6. https://prevmedhealth.com/the-secret-life-of-fat-cells-is-it-the-secret-to-longevity/
7. https://prevmedhealth.com/alzheimers-should-be-called-type-3-diabetes/
8. https://prevmedhealth.com/stress-tests-cardiac-cath-stents-the-unnecessary-triad/
9. https://prevmedhealth.com/reducing-arterial-plaque-is-it-possible/