Dr. Kwajo: Poor Metabolic Health Means Poor ICU outcomes - #59

Dr. Kwadwo Kyeremanteng wants you not to end up in the ICU.

An ICU doctor and a department head at the Ottawa Hospital, Dr. Kwadwo knows metabolic disease is a massive driver of poor outcomes. Studies even established the link between poor metabolic health and COVID outcomes. But what do we do to treat that? When doctors focus primarily on sick care, they hardly ask anymore why the patient landed there in the first place.

And that's what we need. We have to talk about the root cause to find the solutions.

The inefficiency of the healthcare system prompted him to start his podcast "Solving Healthcare" which aims to empower healthcare workers to think out of the box. There's always a way to provide better care. The patients deserve that. Maybe the needle is yet to be moved, but the message is getting there.

Quick Guide:
01:37 Introduction
04:52 To solve our healthcare system
12:08 The Canadian healthcare system
16:41 The message of being metabolically healthy
24:05 Is there progress in propagating the message?
38:16 Personal fitness and nutrition journey
44:41 The story behind Kwadcast
47:38 To encourage others to think outside the box
49:52 Studies inside the ICU
53:57 What evidence-based medicine means

Get to know our guest:
Dr. Kwadwo Kyeremanteng is a critical care physician and researcher at the Ottawa Hospital in Canada. He hosts Solving Healthcare podcast that focuses on improving healthcare delivery.

“You gotta be able to look yourself in the mirror, like, your compass for making decisions is in your values. And my values are always personally along do the right thing. Justice. Be courageous. And I don't feel it felt the same. We both have taken heat in different ways. And yeah, but at the end of the day, I can honestly say we both can look at yourselves in the mirror and say we were doing our best.”

Connect with him:
Twitter: https://twitter.com/kwadcast
Tiktok: https://www.tiktok.com/@kwadcast
Instagram: https://instagram.com/kwadcast
YouTube: https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Website: drkwadwo.ca

Other sites mentioned on the show:
Virta Health (reverse type 2 diabetes): https://www.virtahealth.com/
Society of Metabolic Health Practitioners: https://thesmhp.org/

Episode snippets:
8:41 - 9:50 To increase awareness about the issues
14:21 - 15:13 Making an impact in a four-year cycle
12:24 - 13:08 The goal is to make the patients healthy
19:29 - 19:59 Give less pro-inflammatory food to the patients
37:45 - 38:14 The compass in making decisions is your values
45:12 - 46:15 How doing a podcast has been life-changing
48:18 - 49:52 Approach to thinking outside the box

WEBSITE: Stay Off My Kitchen Table

Like what you hear? Head over to IFixHearts.com/book to grab a copy of my book, Stay Off My Operating Table. 

Ready to go deeper? Talk to someone from my team at IFixHearts.com/talk.

Ready to take control of your health?  Grab Dr. Ovadia’s brand new book Stay Off My Kitchen Table now! 

This isn’t just another diet book; it reveals why it’s not just what you eat, but what your body actually absorbs that determines your health.

If you’re struggling with low energy, stubborn weight, or feeling like “healthy eating” isn’t working… this book shows you exactly how to fix it.

• Learn how to reset your gut
• Eliminate hidden foods sabotaging your progress
• Unlock real energy, metabolism, and longevity

Don’t wait until it’s too late. Take action today. Get your copy of Stay Off My Kitchen Table now.

Learn More:

• Take Dr. Ovadia's metabolic health quiz: iFixHearts 
• Dr. Ovadia's website: Ovadia Heart Health

Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings

Any use of this intellectual property for text and data mining or computational analysis including as training material for artificial intelligence systems is strictly prohibited without express written consent from Dr. Philip Ovadia.

Transcript

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S3E05 Dr. Kwadwo Kyeremanteng 

SUMMARY KEYWORDS 

patients, people, phil, physicians, icu, question, hear, jack, low carb, podcast, metabolic, studies, Kwajo, thinking, medicine, healthy, happening, health, message, problem 

SPEAKERS 

Dr. Kwadwo Kyeremanteng, Dr. Philip Ovadia, Jack Heald 

Announcer  00:10 

He was a morbidly obese surgeon destined for an operating table and an early death. Now he's a rebel MD who is Fabulously Fit and fighting to make America healthy again. This is Stay Off My Operating Table with Dr. Philip Ovadia. 

Jack Heald  00:34 

Yow, okay, so we're live. This is the Stay Off My Operating Table podcast. We have today a special guest. I'm looking forward to Dr. Kyeremanteng. Phil, are you are you impressed with me pronouncing it that way? 

Dr. Philip Ovadia  00:56 

I am. And I'm not gonna try and recreate it. So. 

Jack Heald  01:01 

Okay, so for those of you who are reading his name, you're gonna say Oh, Jack, you pronounced it wrong, but I did not. Did I? 

Dr. Kwadwo Kyeremanteng  01:11 

You nailed it. I told you earlier. My mom would be so proud of you throwing that down. There's like 22 million Ghanaians that are cheering in the hearing you pronounce that they're Jack, you're a legend right now. 

Jack Heald  01:24 

Well, my mastery of Ghanian is legendary. Okay, Phil, tell us why this dudes on your show? 

Dr. Philip Ovadia  01:37 

Well, as you can already tell, he's a lot of fun. So that's reason number one. He is a, and I'll let him do the full introduction, but he is a critical care physician, north of the border in Canada and I was just real fortunate to meet him at a conference not too long ago. And we got to talking and Kwajo has the mindset that we talk about so much on this show, and the outside the box thinking when it comes to lots of things around medicine and nutrition. And I'm going to be excited to dig into all that with him. But first, let's give Kwajo a chance to introduce himself to the audience and tell us a little bit about what he's been up to. 

Dr. Kwadwo Kyeremanteng  02:31 

Oh, man, well, I'll just tell you straight up, Phil, that intro was legendary. I feel like I can’t do any better than that. But yeah, essentially, I'm an ICU doctor at the border, department head at The Ottawa Hospital, hosted podcast myself called Solving Healthcare and what got me into this space was the pandemic and seeing how metabolic disease was a huge driver of poor outcomes. When you start to dig into people, like learning on ways that people can reverse disease, which is foreign to me, and that's why when I heard Phil on a podcast, and hearing his story, and we just had so much in common that idea that was novel to hear how you could reverse type two diabetes and, and with all these different lifestyle approaches, and seeing the benefit for himself and for his patients. I just got super passionate about this. And yeah, so for me, it was really the pandemic that was a big driver, in terms of learning about a lot of this content. And I also do a lot of research on healthcare utilization, like looking at ways to reduce healthcare spending. And so, I do a lot of focus within ICU. So different medication, different approaches to care, how you save money that way and improve outcomes. But then when I look at this, the most efficient way of saving dollars is preventing them from landing in the ICU. Really, if you can prevent yourself from walking in the door and not get significantly disabled, malnourished, have mental health issues that many of our patients have and that kind of overall the impact that you have on family because they have to take time off work. All these things if you could prevent them from walking in the door, that's where the money's at. And so, when even the title of the Phil's book and everything I when I when we got a chance to sit down in Santa Barbara, I'm like this is my man right here. This is my boy. And so, we had to connect. 

Dr. Philip Ovadia  04:52 

Yeah, definitely a lot to jump into. But let's start with your podcast, is called Solving Healthcare, and it's a great podcast, certainly recommend it to everyone. But tell us about the title, what are you trying to solve? 

Jack Heald  05:11 

Exactly, I was wondering the same thing? 

Dr. Kwadwo Kyeremanteng  05:14 

Phil and Jack, when you are involved in healthcare, you realize it is extremely inefficient. There's so much to remedy, the delivery of care, as I mentioned, the efficiencies, lack of innovation, there's so many gaps. And so, my whole purpose was to kind of empower the healthcare provider, empower the patients to say, hey, there's a lot you could do for yourself. There's a lot you could do to improve your situation, what you eat, exercise. And in terms of healthcare providers, how do we educate our patients? Like how do we reach them? How do we have that individualized approach to medicine and give people the tools to be able to provide better care? And so really, a lot of it is awareness, like putting the lens on some of our soft spots, and then having that discussion on how we remedy these things. And I'm a doer, like I recently started as a department head for our department of critical care. And the whole my whole mandate is we're going to make some changes, we're going to improve care delivery, we're going to be more efficient, we're going to reach out to more of our patients and provide better care that we are providing now. And so, like that's the anthem of the show. 

Jack Heald  06:51 

You've got two classes of listeners to this show. You've got folks like me, who’s just a guy who's interested in being healthy, but no health care background, and then you've got healthcare professionals. So, I would like to ask a question, as a guy, to two health care practitioners about what you just said. You're in an ICU and intensive care unit. And you've had this revelation, that the best way to have better outcomes is to never end up in the ICU. And the best way to never end up in the ICU goes back to what Dr. Ovadia talks about metabolic health. I would like each of you to comment about, and I want to be careful how I frame this because I don't want to get anybody in trouble, but that perspective is not the majority opinion amongst health care providers. How does that affect your practice of medicine? Each of you, I'm interested for both of you. 

Dr. Kwadwo Kyeremanteng  08:12 

So, I’ll jump first. So, I mean, this is why we're having a conversation now. Like I think this is not common practice. It's not a common mindset of really focusing on prevention, a lot of our studies, our lectures, our treatments, everything is surrounded by sick care. Like how do you deal with the patient when they're sick? And don't get me wrong. This is vitally important. I got off ICU yesterday, and we resuscitated a bleeding patient and our skills is what saved that life, to be able to intubate, put lines in and do all the things that the patient needed. Super important. But the question is, let's talk root cause. Let's talk about why that patient landed there. What can we do to prevent that from happening? And it's a pivot. And this is why platforms like this, about going on, doing a podcast, going on social media and talking about these issues, in my opinion, could serve to inspire, to bring awareness to some of these issues. And the thing about someone like Phil and myself, we got the street cred. We’ve seen the damage that people go through when they land on his table or they land in ICU. So that voice is so important. And my goal is to motivate other clinicians to see the same like realistically ask yourself, why is the patient landed here? Like we've given up in so many ways. We've just said, oh, you know what, let's add some more insulin. Let's add more insulin, even though this is making them more... Perpetuating the problem. Let's start thinking again, like, I feel like we've lost the ability to think critically, and take a step back and say, what is actually happening here? And let's look at this root cause and attack it that way. And it starts now, it starts with conversations like we're having today. 

Jack Heald  10:24 

I want to know are you getting static from within the healthcare industry? Before taking this step? I know Phil does. 

Dr. Kwadwo Kyeremanteng  10:38 

Maybe, I guess one of the approaches that we've done, like one of the reasons my research program is focused on cost savings is because that's the currency, no pun intended, that people the decision makers like. So, when you can show that an intervention will reduce spending, it's hard for them to ignore that, it's hard for them to say no to an approach, and frankly, I'm sick and tired. Like, I don't care what people think, like when we often we talk about like one of the things that, I don't know if you've experienced much of this, Phil, when you talk about the poor metabolic health amongst our patients, like when I was saying, like, we were seeing tons of obese COVID patients, and people would be like, you stopped fat shaming. I'm like, it's not fat shaming, it's reality. If I was obese, and I have a clinician had a chance to tell me this is a risk factor for landing in a hospital with COVID, I would want to know this, okay? And that was my approach. And so, you can say all you want. I mean, you can't please everybody, there's gonna be haters, no matter what you say. But I gotta, at the end of the day, look myself in the mirror and say, am I making the right call here? Am I making the right statements? And I have no problem approaching it this way. 

Dr. Philip Ovadia  12:08 

Yeah, I agree, and I think that physicians have abdicated their responsibility on many fronts, and, we saw it with the pandemic, and we see it with the whole metabolic health issue. And this whole concept that physicians shouldn't, or physicians can't help people to be healthy is just mind blowing, I mean, people, I get pushback because I'm trying to keep people off my operating table. And it's like, well, isn't that what every doctor should be trying to do? Every doctor should be trying to make themselves less busy. Because that means that people are staying healthy. And people don't need our services as much. And that really should be the goal. And really, from the healthcare system perspective, that should be the goal. And I'd actually like to hear your perspective, because you're in the Canadian system which is a socialized system. And so, there is a set pool of resources that can be used, and that needs to be distributed amongst all of the people who are using health care services, where as opposed to here in the United States, we are driven, our healthcare system is driven by revenue, the more we do, the more everyone makes, and the happier everyone is. So, there may not be that same incentive to keep people from needing health care. But it would seem that a system like Canada has, like the UK has, they should be very much in tune with these preventative efforts, because that fits in their model perfectly. So, I'd really like to hear what your perspective has been on that, from the Canadian healthcare system. 

Dr. Kwadwo Kyeremanteng  14:14 

It's a great point, Phil. I think people are... They buy in on paper, they like the idea of making your city more walkable, having more access to quality foods, really thinking about being more active. All these things on paper people want to see. The problem is for any government that lasts usually about four years, a lot of this upfront investment takes years to pay dividends and so, they're trying to make their focus is on how do we reduce surgical waste wait times, how do we improve Qantas Reading and all these things, which obviously are really important. But I think a lot of the attention is still on the acute care because they want to be able to show some impact in a four-year cycle. So, it's still well-received. It's just a matter of us being a little bit more long sighted or farsighted, I should say. But, like, for example, a classic thing that we see in hospitals frequently is, I always say, one of the most important allied health professionals is your physiotherapist, and unfortunately... 

Jack Heald  15:40 

What’s a physiotherapist? 

Dr. Kwadwo Kyeremanteng  15:44 

A physiotherapist is a health care provider that helps you rehabilitate to get you stronger again, to get you out of bed, to get you breathing better. And unfortunately, they're one of the first positions that get cut often when budgets are tight. And in my opinion, they're gonna get you out of hospitals quickly, they're gonna get you out of hospital faster than if you didn't see a physiotherapist. I see the magic of their job daily in acute care and in the intensive care unit. But we want to balance that budget. So, to answer Phil's question directly, there is engagement, it’s just we're not seeing the level of commitment that is going to really put a dent into things yet. Yet. 

Jack Heald  16:41 

So, I'd love to hear, what Phil's doing, this Stay Off My Operating Table stuff, exists entirely outside of how he practices medicine. When Phil's practicing medicine, he's got a scalpel in his hand and somebody's laying on a table. So, this mantra of get metabolically healthy really has... It doesn't involve his practice of medicine. I'm saying that right? Aren't I, Phil? 

Dr. Philip Ovadia  17:15 

Somewhat, yeah, I mean, obviously, when I'm doing surgery, that's a whole different thing than trying to keep people from having surgery. When they come to me for surgery, it's time to do the surgery and do the best job we can do whit that, and then my hope is after that we can then address what led to them needing the surgery in the first place. 

Jack Heald  17:43 

Okay, well that probably dovetails with the question I want to ask Kwajo is which is in the ICU, how does this this message of get metabolically healthy manifest, in how you practice, in the type of care that's delivered? I've heard horror stories from Phil, I don't remember if we talked about them on air or off, about walking into a patient's room after he's done surgery and seeing this carbohydrate bomb sitting on their cafeteria plate. How does metabolic health, how do you deliver that in the ICU? What's step one? And how does it work its way through? 

Dr. Kwadwo Kyeremanteng  18:31 

So, Jack, I'm gonna unfortunately not have great news for you, but it doesn't play out easily. Really the priority when our patients walk in, come through, is just really, like often they're on the brink of death. So, we're trying all that we can to recover them. But as they're getting better, my personal opinion is where we could benefit is how we feed our patients, for example, and just represent the change we want to see. So, for example, I think you hit the nail there Jack, we feed our patients like the food. So, when you're in the intensive care unit, you obviously can't eat. So, what we do is we put a tube that goes from your nose into your stomach, and then we put we put nutrition in that way and it's heavy in seed oil, it's heavy and carbohydrates. And we just accept that as the norm. And as you're getting better if you're getting, you're able to eat your own food or whatever, it's not going to be the healthiest thing you've ever seen. It's going to be focused on carbohydrates. I've seen even some diabetic menus; I swear I've seen French toast on there. And so, I think this is where I want to see us pivo. As you're leaving, as you're getting better, that we have that kind of educational piece and give less pro-inflammatory food. Ironically, Jack, when you land in, in hospital, or specifically in the intensive care unit, for most reason, it's driven by inflammation, COVID. Like, for example, you come in with COVID. And in the second wave, third wave, if I were to swap your lungs and try and find COVID, you probably won't wouldn't find a live cell, a live virus, but it's just the inflammation response is what caused you to be so sick. Same with pneumonia, same with even other like brain conditions, all driven by inflammation, and what we do? We feed you pro-inflammatory foods. So, we've worked, our research group is starting to kind of push the idea of seeing if we could, for example, have some fasting time during their care in the intensive care units, seeing if that would have any impact. We're also looking at a lower carbohydrate feed to see if that could maybe have a more positive impact on patient outcomes. All this is very slow moving, but it's on our agenda. But it's gonna be a while before the needle is moved on this one, though, unfortunately. 

Jack Heald  21:19 

Phil, throwing the ball over to you. I want to hear the same comment. Well, comment on the same question. 

Dr. Philip Ovadia  21:26 

I think similar to what I was talking about around surgery, the other opportunity is, for us, as physicians, to have that conversation with the patients, with the families about why did you get here not just, oh, you have COVID, or, oh, you have pneumonia. But what was the root cause for that, and we just don't do that as physicians. You could say, we're too busy trying to save your life. it's certainly, when I'm in there doing the heart surgery, my focus is the heart surgery, and no one expects me to then sit down with the family and say, okay, we did the heart surgery, we got you through that. We have basically put a band aid on the problem. So, it's not going to be as a life-threatening issue for you anymore. But if we don't talk about why you got here in the first place, you're going to end up back here. And Kwajo certainly knows that patients who are in the ICU once are at high risk of ending up in the ICU again, and it can be for the same problem, it can be for different problems. But the fact that you ended up in the ICU means that you have significant underlying health issues. And then you got something on top of that, that tipped you over the edge, and now you ended up in critical care. But if you don't address the underlying problems, something else is going to come along and tip you over again. And you're going to end up back in the critical care unit. 

Jack Heald  23:14 

So, what's happening in medical care? And here's where my ignorance of the entire thing is going to display itself. But as a guy who has been interested in staying out of hospitals and staying off of operating tables for a long time, I'm deeply interested in how this message will get through. Is it getting through? What's happening to get it through? Are these podcasts, are these kinds of things the best way to make it happen? Is it starting to propagate throughout the system? Are you seeing progress from your colleagues? How is this working? 

Dr. Kwadwo Kyeremanteng  24:05 

I mean, I must say this is one of the unintended blessings of COVID is that, really, it was undeniable that this was a huge driver. And a lot of people were, because of how COVID was... 

Jack Heald  24:22 

Undeniable by who? Was it the people there working in ICU who could just, it was just obvious as health care providers?  

Dr. Kwadwo Kyeremanteng  24:35 

Yeah, it was a good question. So, it all like the health care providers by the medical literature like now, it's very well-established studies showing a link between poor metabolic health and COVID outcomes. And this has been the center of attention for so long. This is one of the spin offs, how do we get healthy? How do we talk? Why is it so important to get us healthier? And then on top of things, Jack, over the last, whatever, a couple of years as well, people have gotten worse in terms of their metabolic health. They consider the COVID, 15 or 20 pounds at a lot of people added on. I recently even had a patient that just, you hear these stories about when they isolated themselves in and just haven't been able to get back to where they were. And so, I do think that the message is getting out there. I think it's trickling down, I do think these formats, by even presenting some of this stuff in medical conferences, formal medical conferences, I think it's hard to deny, and automatically, when would you present this kind of data people always... It's our nature to say like, what are the solutions? Even though it might not be asking about root causes, but people will still be asking, like, what do we do? So, is this enough to move the needle? I don't know. But I know personally, up here in Canada, been highly motivated that I've connected with as many public health figures as I can to talk about these issues. I've encouraged them to talk about, for example, making our city more walkable and making it... Invoke to talk about health and wellness, 

Jack Heald  26:42 

You live in Canada, it's cold in the winter. Nobody wants to walk. Oh, my goodness, come on. 

Dr. Kwadwo Kyeremanteng  26:51 

I make the joke, because I'm like, the only I don't know how PC, this is but I'm the only black person I've ever seen cross country ski. But he's like, when in Rome. You know what I’m saying? 

Jack Heald  27:06 

Didn't mean to take us off course there, but I hate cold weather. 

Dr. Kwadwo Kyeremanteng  27:11 

it is pretty challenging to keep moving in the winter. But, as Phil I'm sure would allude to, there's other things. I get in the winter. If you're not outside, maybe we were thinking about what we eat, making sure we have good connection with folks because all these things, I think, contribute to our overall well-being. Get to the gym, if you can, I'm a huge fan of resistance training. But yeah, I'm hoping this movement is moving the needle, and certainly it's not slowing me down. Regardless. 

Dr. Philip Ovadia  27:45 

Yeah, I would just say that I'm optimistic by seeing the increased presence of doctors at some of the conferences, the metabolic health conferences, the low-carb conferences, just seeing the number of physicians' online that I interact with now, and that are contributing to the conversation. And we look at the organizations like this society, and metabolic health practitioners, which is doing a great job of bringing together the physicians that are interested in this and getting resources for those physicians to draw upon. So that certainly gives me hope. I think on the patient side of things, for the people, they’re increasingly getting the message as well, and the message is resonating with them. So, I now have people who come to me, who end up seeing me as a heart surgeon, and they're already talking about metabolic health and some of them have read my book, a lot of them haven't. And they'll come to me, and they'll be like, oh, I know, I have heart disease. And I've been reading and its sugar and carbohydrates that are causing this, and we're starting at low carb diet. And then, so I do think the message is getting out there, and I think it's getting to the people that need to hear it, but we certainly need to be doing a better job of it. And quite frankly, I think one of the biggest barriers that I see, which is the challenge for Kwajo and I is that it's oftentimes other physicians who discourage patients from doing this. And we have to try and increase the acceptance that at least this is a valid treatment option. And get that acceptance from our colleagues to be able to support these patients. 

Dr. Kwadwo Kyeremanteng  29:54 

Okay, give it a quick example, like if you were to ask, I don't know 100 dogs, including dogs that specialize in diabetes, if you could reverse type two diabetes with lifestyle modifications, low carb, keto, what have you, I don't I don't think many of them would think it's possible. I know I didn't. And these are the ones that are managing the patients. So, yeah, there's still a lot of work to be done. That's for sure. 

Dr. Philip Ovadia  30:31 

I do want to get into how you sort of came around to this, Kwajo? Because it is so interesting that you didn't really come at this from the nutritional standpoint, you were seeing all of these patients with COVID and seeing the effect that poor metabolic health had on them. And then, kind of tell us what happened from there that got you gotcha here today. 

Dr. Kwadwo Kyeremanteng  30:57 

Yeah, so, I guess I was... It wasn't... In the first wave, we weren't getting a lot of information about risk factors, and so forth. But it was abundantly clear within the first couple of weeks, like every single patient, most of the patients are either extreme of age, immuno comp, I have a poor immune system, or they have poor metabolic health, and despite age. And so, this was, to me, such a loud message, to the point that even one of our docs, or one of our ICU docs lost 30 pounds through mostly fasting and low carb, because of what he was seeing on the front lines. 

Jack Heald  31:48 

Someone's at the front door. So, this is live folks. 

Dr. Kwadwo Kyeremanteng  31:54 

Because of what he was seeing on the front lines, and so as I'm seeing this, as I'm learning about this, and then I started to interview some folks that were mentioning things that never heard of. Reversing metabolic disease. Think about intermittent fasting, think about low carb. So, I started to interview Jason Fung, Rob Wolf. Sorry, I'm totally brain farting. 

Jack Heald  32:27 

Yes, even physicians can brain fart. 

Dr. Kwadwo Kyeremanteng  32:31 

Yeah. And I was like, why don't I know this? And why aren’t we telling everybody this? This is a time... Like the time is now. Would I... for vaccines. I'm like, want to reduce your chance of getting sick? Let's talk about getting healthy. Collectively. I was thinking, the summer of 2020. What if that was the public health message? Get outside. Let's get healthy. Think about what we're eating. Think about focus on whole foods. Let's do this together. What a powerful message. You're gonna reduce your risk of COVID, cardiovascular disease, strokes, cancer, all these things are being impacted by us being motivated to get healthy. What a beautiful movement that could be. But it was crickets. It really was crickets. And so I was, tell me we can't do some get me motivated. I was like, hell yeah, let's go. So, coverage on the show, any media outlet that would hear me out, I would let them know what we're seeing. And once you see it, you can't unsee it. That's the thing. Like when and so you do your own research, you do your own deep dive into some of these topics. And it's hard not to get excited about it. It's hard to not preach. And so, I was a man possessed and by no means that we put a significant dent in a lot of this. But when you have a platform and you know this message can impact lives, not only just the, like the direct patient, but when people get healthy, it amplifies. When our loved one, oh, hey, last time I saw you like, you were like 30 pounds heavier. You look so good. What are you doing? Oh, I started to do some low carb. Have you listened to that podcast with Dr. Phil? You know what I mean? This is what we got to do, especially in light of COVID and all these things. Yeah, it just amplifies. And so that's a long-winded way of answering that but it's just like, I must say I was just, it was so eye-opening. I couldn't believe what I was hearing. I couldn't believe that people are reversing type two diabetes weeks. In weeks. I'm gonna talk about this. It's crazy. I still think it's crazy. That is not common knowledge. 

Dr. Philip Ovadia  35:09 

Oh, yeah. I mean, and the data, again, is out there. Virta has published their results; they've published now their longer-term results. And that should have been front page on every newspaper. And like you said it was crickets. I mean, it ended up in some in a journal that's not as highly regarded, and there was no media coverage of it at all. And, again, then you have to start asking the questions why that is? I mean, why wouldn't this be publicized? Why wouldn't certain institutions, let's say, want this information to get out? And, like I said, I think it's incumbent on us, as the physicians, to step up, to take responsibility to make sure that we are serving the patients first and foremost. And unfortunately, I think for a lot of physicians, if they took a long, hard look in the mirror, they wouldn't be able to say that. 

Jack Heald  36:24 

On behalf of the patients, let me just say, thank you guys. I love it that that's because with demand from the patient side, people like me, and supply from the physician side, people like y'all, the external pressures that are keeping this message suppressed are going to begin to crumble and corrode and fall away. And yes, it takes time. But I'm just deeply appreciative that you guys are doing this. It's so much fun to see. It's like it's gaining momentum. we've been doing this podcast a little over a year, Phil, is that right? And it's just extraordinary to see lives changed. People transform themselves as a result of physicians like you, and Dr. O exhibiting the moral virtue of courage, and standing up and saying, hey, this is the truth. I thank you. I appreciate it. 

Dr. Kwadwo Kyeremanteng  37:38 

That's very kind of you. I just, at the end of the day, I think, Phil, you feel the same way, you gotta be able to look yourself in the mirror, like, your compass for making decisions is in your values. And my values is always personally along do the right thing. Justice. Be courageous. And I don't feel is felt the same. We both have taken heat in different ways. And yeah, but at the end of the day, I can honestly say we both can look ourselves in the mirror and say we were doing our best. 

Jack Heald  38:16 

I would like to make it a little more personal. I only know you now at this point from the chest up. But from what I can see you're fit. Yep, yep. He's fit farther down. Oh, look at that. Got a Gun Show going on here, folks. Have you always taken care of your body? And the reason I ask is because Phil’s story. He was an obese heart surgeon. So, he had to he had a “Come to Jesus” moment. And had to take extraordinary steps to change his life. What about you? What's your story? Personally physically? 

Dr. Kwadwo Kyeremanteng  38:54 

Yeah, to me. Thanks for the question because it's actually being functional and fit and active has been just a cultural for me. It's been part of life. I grew up playing hockey. Tons of sports growing up and 

Jack Heald  39:11 

Lots of hockey in Ghana.  

Dr. Kwadwo Kyeremanteng  39:18 

Yeah, but I was actually born and raised in Edmonton, which is a huge hockey town. I don't know if you know much... There you go. So, we had a lot of cups coming our way growing up, but being active and being able to perform was huge. 

Jack Heald  39:35 

And you couldn't have played hockey very long. You've got all your teeth. 

Dr. Kwadwo Kyeremanteng  39:39 

They're not real. But that he still played with a cage. But yeah, being active is so important. And always asking yourself how you can optimize performance and be as ready to play in the net. After you stop playing, you still want to be active; you still want to be able to go on that hike, you want to be able to ski with your friends. And so, fitness and nutrition, sorry, fitness was always a priority, nutrition wasn't a priority till you get to that age where I think it was residency really where you realize you can't just eat whatever you want anymore. And you realize, hey, what you're eating can affect your mood and your energy levels. And so, I started probably soon after I finished residency to actually be more thoughtful in what I ate. So, I maybe wasn't fully low carb, but I would be lower carb. And then about five years ago, I started intermittent fasting as a father of three, busy lifestyle. This was just the best way to maintain, I thought, my weight, it was just skip breakfast time restricted eating. But yeah, my being mobile, being fit is like almost part of my identity I feel. And I love it because I have three young sons and like we do everything together in terms of the oldest wants to work out with dad, that you might hear some basketballs being shot outside or shooting the puck outside. We like to move, keep the boys moving. So, it's so important to me to be functional. And so yeah, that's been a huge part of my life. I love it. And I could talk fitness and nutrition all day. All day. 

Jack Heald  41:43 

Was there an aha moment for you? With your own personal health? And this revelation of metabolic health in the ICU? Or was it all just kind of? Did it just happen slowly? And organically? 

Dr. Kwadwo Kyeremanteng  42:04 

It was a bit organic, like it was a bit slowly, and I guess it's relative, I guess it was in a matter of weeks really. After being like... Yeah, fair enough. Like when you're in the ICU, dealing with the COVID stuff, especially in that first wave, like we were all pretty frightened. Like I wasn't sure am I bringing COVID home, you see all this stuff happening in New York and Italy, you're wondering, are we going to have a similar situation. So, your head is there. And then as you've noticed, like, you're protecting yourself, you're not bringing COVID home, you're not seeing healthy people getting sick. That's when it started. When you got to reflect it, the wheels start to turn. And, and really, once you see it, as I said you couldn't unsee it. And then you hear about these ways of reversing disease. And so, it was just it was almost like an obsession. And I've done some modifications to my own diet over the since being woke, if you will, in terms of... 

Jack Heald  43:13 

Awakened, they're really the other word for other people. Yeah. 

Dr. Kwadwo Kyeremanteng  43:18 

I really liked that. But yeah, it was like I tried to two weeks of keto for example. It didn't jive with me, but I've maintained a lower carb approach. I've continued to intermittent fast. I just feel like my body is a well-oiled machine on that way. I haven't done carnivore yet. I might want to try it out. Just to see what it's like from me, like we have a resident expert. Absolutely. Because one of the things, Jack, that also has been enlightening in my opinion and this took some time to really refine for me is thinking that really when it comes to nutrition, it is personalized. Like what works for Jack might not work for Phil and really trying to find what works best for you I think is where the expertise and the what makes a good commission. Not just having that cookie cutter approach saying everybody needs to be low carb or keto or it's what actually works best for Jack and that was another enlightened revelation as we I've been navigating through all this nutrition journey. 

Jack Heald  44:41 

Tell us about your podcast. I love this... I love that. I'm gonna say this and this information will be on the show notes but your Twitter handle is well, kwadcast. I love that. 

Dr. Kwadwo Kyeremanteng  44:58 

There they go. 

Jack Heald  45:01 

Tell us about you tell us about your kwadcast? 

Dr. Kwadwo Kyeremanteng  45:04 

Yeah, no, I appreciate the love. It's spawned in 2019, it came from our research program, when we noticed that, you're producing all these research papers, but nothing is moving the needle, nothing's changing. So, we like thought to ourselves, what's a way of amplifying some of these messages? And so, we thought, hey, I like doing, I love podcasts. Let's try doing this. And I won't lie to you, Jack, ever since September 2019, my life has completely changed. The people I've met, the topics we've covered. Being department head, being on a board of governors for our kid's hospital, starting a charity called Bridges Over Barriers, all spawned from spawned from the show. Meeting Phil at the metabolic health summit, all were derivatives of being passionate about healthcare and talk about ways to empower patients and healthcare providers to provide optimal care and think outside the box. Remember, again, to think critically, and don't shy away from thinking outside the box and encourage thinking outside the box. That's what we're passionate about. And honestly, I mean, you guys are about a year deep into this. So, you could probably say the same thing. But wow, what a life changing event from deciding to go on this journey. 

Jack Heald  46:30 

It's been huge for me, and I'm just, I'm the talking hairdo. It's so much fun. So, who's the target? Who's going to enjoy your... Sorry, Phil, I’m yammering here. Who's, who's the target audience for your podcast? Is it healthcare practitioners? Is it average Joe's like me, what is it? 

Dr. Kwadwo Kyeremanteng  46:49 

The ideal population that we were targeting is healthcare providers, but we speak in that language that your mom can understand what we're throwing down, like, I really wanted to make it universal language, even though the topics I really want to target healthcare providers, because in my opinion, they're amplifiers. If you have a family doc, all of a sudden, that buys into low carb. Wow, that's like how many patients now that can be impacted. So, that's when we've marketed the show is to medical students, residents, family docs, nurse practitioners, all the people that could potentially we call it on the show change in the boogie, you know what I mean? 

Jack Heald  47:36 

Changing the boogie. I love it. 

Dr. Philip Ovadia  47:39 

Yeah. Yeah, getting to medical students, I think is a huge part of this, getting the early career physicians. So yeah, how do you encourage your colleagues to think outside the box? You’re a leader, you’re a department chair, how... But so much of the training in medicine these days, so much of the mindset is staying within the lines, evidence based and following the guidelines. So, what do you think we can be doing to get our colleagues to think outside the box more? 

Dr. Kwadwo Kyeremanteng  48:18 

So, there's two things, two approaches that I use to try and get more of us to think outside the box. One is just constantly asking tough questions, like when it comes to cholesterol, for example, if you just ask the tough questions and say, like, what study are you referring to? And I'm like, have you looked at that study? Why don't we go over it and show me where you think, these cholesterol figures really are correlate with poor outcomes, like really pushing the envelope into, and then at the end of the day, saying, like, well, maybe it's not as obvious as we think it is, or the picture isn't as clear as, as we think it is. That's number one. Number two, I don't know if it's lazy or what, I just act, I just like, try and be the example. I'll be like, yes, you're hearing this. You hear what these problems are. I often will propose or do a pilot project to try and prove that our approach will work. I just lean on action over like, trying to change people's mind through data, I just, let's you don't want to say like, I hear you, we're just gonna do this, we're gonna hustle we're gonna show that it's going to be effective. And always, as I mentioned before, have a cost twist on it, show that whatever we're doing is gonna save money and improve lives. 

Jack Heald  49:52 

So that brings back a question that I wanted to ask earlier, but didn't. You talk about your research? You're actually conducting studies in the ICU, is that right? I had no idea that was even a thing. 

Dr. Kwadwo Kyeremanteng  50:11 

Oh, yeah, big time. Like, even those approaches to say when if you had COVID, or pneumonia, there's ways that we know to... Settings on the ventilator that we know that will improve your likelihood of survival. So, studies have been done on that. Studies have been done on types of medication, if you're really sick with an infection, different medications, and medical infusions to see if they will improve your outcomes. Giving, for example, steroids, that's a common one that we've studied many times to see if that will improve your outcomes, when whether it comes to pneumonia or severe infection. So, we do studies all the time. In fact, once again, I just finished ICU yesterday, we enrolled two patients in separate studies, it's heavily studied specialty for sure. 

Dr. Philip Ovadia  51:18 

So yeah, and Jack's question, it actually kind of shows revealed, I guess, maybe one of the problems that we have, in that people think, people expect that everything we do in medicine is like, proven and kind-of textbook, I guess you would say, that we all just have the textbook, and doctors are so good at being doctors because they read the textbook, they memorize the textbook, and that's what makes you a good doctor. And the reality is that every patient is unique, every situation is unique. And in order to be a good doctor, you need to be creative. I mean, no two operations are ever the same for me. And sure, they were the basic skills and the knowledge and the anatomy and the physiology and all of that, that is common to humans. But every patient that shows up in front of you is a new situation, is a new patient. And this is what has made doctors so successful. And yet in today's environment, that is now being actively discouraged, that we shouldn't be thinking outside the box, we shouldn't be thinking for ourselves, just follow the guidelines, is the mantra. So, I think that's such an important point. And I think, Jack's question just revealed that people... Jack was thinking, I'm assuming and I won't speak for Jack, but that you shouldn't need to do research in the ICU because you should have all the answers, we should know what to do. But the reality is we don't and things that we think are the best way to go about things. Again, we saw this early in COVID, there were things that were tried and things that were assumed to be good because for other similar diseases in the past, these are the things that worked, and all of a sudden, we saw that they weren't working. And they were harming people. And that meant we had to pivot and think of some other things to try and to experiment on and see what worked and now thankfully, two years, two plus years into treating COVID, we're a lot better at treating COVID than we were two years ago. 

Jack Heald  53:57 

Alright, I have one last question. And this, I heard you use the phrase “evidence based” and I used to date a nurse, she was actually an ICU nurse. And I heard the phrase come out of her mouth. And I had a critic of Dr. O DM to me on Twitter. And his criticism was that he used evidence-based medicine and Dr. O doesn’t or something to that effect. And as a layman, my assumption is that evidence-based means there is evidence that this works or there is evidence that that doesn't. I'm not altogether sure my understanding of how healthcare practitioners use that phrase, however, is accurate. What do you mean when in medicine, you say we use this as evidence based? What does that actually mean? 

Dr. Kwadwo Kyeremanteng  54:56 

So, what it means is if there is... They’re using, quote unquote, the best data available to guide their decision. The problem with just evidence-based decision making is couple of things, it depends on the quality of the data, like, is it a randomized control trial? Meaning like, is it the highest quality of studies that we're using? And second part that we're, I think as the years go on, we're going to approach this a little bit different. A lot of the people in the study, for example, in ICU might not be exactly that patient in that study, if that makes sense. So, yeah, like they might be slightly older, they might have another medical issue. So, it's the way I always say it's a guide, it's always a guide, evidence-based practices is a guide. But is that, does it apply to your patient? Is the data that supporting it old, new, high quality? Is there going to be exceptions? Because often we don't ask in research, we don't ask the right questions. So, say, for example, if you have high blood pressure, you could be given a medication, you could be given an ACE inhibitor, which is a type of blood pressure medication, it's gonna work for you, but it won't work for me, based on my genetics. And we don't ask that question enough. Like maybe it works well on specific groups, but not others. When you do a study, it's a general group of people. They're not asking, we're not asking ourselves, is there some nuance to that patient group, and so, I'm giving a long-winded answer to this, but the gist of your question was that it’s based on the best data we have available, we're using that to guide that decision, is evidence-based medicine. 

Jack Heald  57:10 

Okay, that's it. That clarifies it for me. Okay. Thanks for that. Well, Phil, we're about an hour here. And I hate to make folks go longer than absolutely necessary. Anything else that we want to want to address with Kwajo or more questions to throw his way. 

Dr. Philip Ovadia  57:32 

Yeah, I think this is a great discussion. And yet another one that we will need to continue in the future as well. And like I said, I'm just, I'm thankful that we came across each other. Kwajo, I think, originally reached out to me. And I know, my life has been better for it. And my thinking around medicine has certainly evolved from interacting with them. And really, it needs to be said that what Kwajo is doing in the system, he is a leader in the medical system, and he's trying to enact this change, and we need more like him to continue doing that. 

Jack Heald  58:22 

Oh yeah. Absolutely. All right, Kwajo, give us how folks can follow you get a hold of you, all that kind of stuff. We'll make sure that shows up in the show notes as well. 

Dr. Kwadwo Kyeremanteng  58:31 

Before I do that, I just want to say keep doing what you're doing, folks. It's changing lives. It's impacting lives. And we're gonna, like one step at a time. We're making headway and so I just really appreciate what were you guys doing. Phil, I had to step up and talk to you at that conference, because I was so excited after hearing you on the podcast and hear about your own podcast. And Phil did make an appearance on our show, too, which was killing it. But yeah, you can follow me on Instagram, TikTok, YouTube, Facebook @kwadcasts. That's K W A D C A S T. Our show is called Solving Healthcare. And you'll find that anywhere you listen to podcast and go to solvinghealthcare.com. And we also lastly, have a wellness community for healthcare providers because all the burnout that we were seeing, so that's called solvingwellness.com. We also have a Facebook group with the same name. Just trying to make a difference, put a dent in all of this and we’re trying to do it together. 

Jack Heald  59:36 

Kwajo, it is such a pleasure to meet you. I hope we hang out together somewhere sometime just as long as it's not Canada in the winter. 

Dr. Kwadwo Kyeremanteng  59:46 

Oh my God, I'll find you. Where you at right now, Jack? 

Jack Heald  59:49 

I’m in Phoenix. 

Dr. Kwadwo Kyeremanteng  59:51 

Oh my god. That's yeah, that's where we gotta go. 

Jack Heald  59:53 

We had a cool front come through this week where we're only going to hit the high 90s. So, and I liked that 

Dr. Kwadwo Kyeremanteng  1:00:00 

Amazing. 

Jack Heald  1:00:02 

All right, Phil, any last words for I sign us off? 

Dr. Philip Ovadia  1:00:06 

Another great episode. Great conversation 

Jack Heald  1:00:09 

Alright, good stuff. All right for Dr. Philip Ovadia. I'm so worried about pronouncing Kwajo's name right that I've got yours wrong. Doctor Philip Ovadia and Kwadwo Kyeremanteng, I’m Jack Heald. This is the Stay Off My Operating Table podcast. Subscribe, follow, all that kind of stuff. If you listen to podcasts, you know how to do this. You don't need directions from me. I will talk to y'all next time.