The Hidden Link Between Metabolic Health and Heart Disease You Need to Know | Dr. Philip Ovadia

**Benjamin Hopkins** (0:04)
Welcome back, everyone. We have the pleasure of having Dr. Philip Ovadia with us today. Thanks so much for joining us.

**Philip Ovadia** (0:10)
Yeah, it's great to be here with you, Ben. Happy to have a conversation with you and your audience.

**Benjamin Hopkins** (0:16)
First place to start is, how do we stay off your operating table? And I'd like to frame it in a slightly different way, which is, what would the consensus opinion be to stay off your operating table as a heart surgeon? And then, what would your opinion be?

**Philip Ovadia** (0:30)
Yeah, so I'll start with the consensus opinion, and I'll tell you that the consensus opinion has failed, is failing. And the evidence of that is how busy I am as a heart surgeon. I've now been a heart surgeon for over 20 years. And it was interesting when I was doing my training, which was late 1990s, early 2000s, and I was deciding what specialty to focus on. And when I decided on heart surgery, many of my mentors told me that I shouldn't go into that, because this was right around the time when, you know, statins, you know, had come on the market, were the most widely prescribed class of medications. And it was believed that heart disease was going to be significantly reduced and essentially eliminated over the next 20 or so years. And they said, you know, you're going to find yourself without anything to do. Here I am 20 years later, busier than ever. Here in the United States, we actually have a shortage of heart surgeons. There aren't enough heart surgeons to go around and do all the surgery that needs to be done. So heart disease remains the number one killer far and away in the US, in the UK, worldwide. And obviously, we're not making great progress against heart disease. Now, again, the consensus opinion is centered on cholesterol. They believe that cholesterol is the driver of heart disease. It's what's causing the problem. And the solution is lower your cholesterol, either with pharmaceutical approaches, statins, PCSK9 inhibitors, all those medications, and or lifestyle interventions. Eat a low-fat diet, avoid dietary saturated fat and dietary cholesterol to try and keep your blood cholesterol levels down. And that's been the prevailing consensus for really the past 50 or 60 years that we've been talking about cholesterol as the cause of heart disease. And clearly, that is not working. And that's part of what led me to, I guess you could call it my alternative hypothesis around heart disease. And again, I didn't discover this. I didn't make any groundbreaking discoveries. I just started to put the pieces together in what I was seeing in my practice. And even as it comes to my personal health, which we can talk about at some point. But I now realize that the root cause of heart disease is insulin resistance, metabolic health, and inflammation. And those are the things that we need to address to be able to keep people off my operating table. And the important thing I want people to understand, I want your audience to take away from this, is heart disease is preventable. You can stay off my operating table. I now realize that the majority of the operations I do are failures. And they're not failures of the patient, they're failures of the medical system. Because we should have been able to prevent it from getting to the point where they now need a major intervention like open heart surgery.

**Benjamin Hopkins** (3:41)
Well, it's a really interesting journey because I imagine the medical world you trained it when you were up in, when you were coming through as a young doctor was very much, we treat you when you have a problem. And there's been this fundamental shift and it's happening quite quickly over the last five to ten years, right, where it's moving away from that reactive to more towards acknowledging this preventative side of the equation. Another question for you, slightly broader before we dive into your own story, which I'd love to get into. Do you believe most diseases are metabolic in nature? Not all, but most.

**Philip Ovadia** (4:13)
Yeah, certainly when we look at the chronic diseases that people suffer from, right, and the big ones, heart disease, cancer, Alzheimer's disease, these are all metabolic related. Even when we start getting into things like the neuropsychiatric disorders that people are suffering from, those we are discovering are metabolic in nature. So I do believe that metabolic disease, metabolic, you know, health is the key to preventing and managing chronic diseases. Now, when you look at acute diseases, things like infections, they may not be metabolic diseases per se, but having poor metabolic health certainly puts you at greater risk of those things. We all, of course, you know, are hopefully at the tail end of the COVID saga, right? But one of the things that was most apparent earliest on, those first cases out of China and Italy and New York, if people remember back, was that the people that were metabolically unhealthy, the people with diabetes, the obese, these were the people that were most likely to get COVID, and then most likely to suffer the severe consequences of COVID. Die, get very sick, need to be in intensive care. It was metabolically unhealthy people. So metabolic disease really does underpin the vast majority of what we deal with in medicine. And again, if we're going to solve a problem, we need to understand the root cause of that problem.