Cardio is not effective for weight loss.

Why isn't it helping me lose weight? It

seems like a bit of a head spin.

There are two reasons. Number one is

That's bad news, isn't it?

That is bad news. Dr. Philip Ovadia,

the world-renowned heart doctor,

has conducted over 3,000 heart

surgeries.

His book, Stay Off My Operating Table,

fighting to make America healthy again.

When you were 40 years old, you

described yourself as being morbidly

obese. I was 100 lb heavier than I am

today. I was going to end up on my own

operating table. I came to realize the

true root cause of our health problems.

Sugar is more addictive than heroin.

Processed food is addictive. 88% of

adults are not healthy, and 600,000

people die from heart disease every

year. If we don't change the course in

the next 50 years, we're not going to

have a society left. A very young woman,

a 30-year-old, ended up on my operating

table, and I had to go tell her young

children, "I'm sorry that we weren't

able to save

your mother."

Was her heart condition preventable?

Yes. The surgeries that I do shouldn't

need to be done in the first place. I

want people to be healthy again.

Dr. Ovadia, what is the diet that's

going to keep my health intact? That's

really the million-dollar question. So,

before this episode starts, I have a

small favor to ask from you. 2 months

ago, 74% of people that watch this

channel didn't subscribe. We're now down

to 69%.

My goal is 50%. So, if you've ever liked

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favor and hit the subscribe button? It

helps this channel more than you know,

and the bigger the channel gets, as

you've seen, the bigger the guests get.

Thank you, and enjoy this episode.

Dr. Ovadia.

Tell me the mission that you're on and

also tell me why you

chose to pursue that mission.

So, I am on a mission to normalize

health.

I want people to be healthy again.

And it really was my own personal

journey that set me off on that mission.

Um

I found myself at a spot that I was a

very unhealthy heart surgeon.

And that's going to sound pretty

surprising, I think, to people. You

know, they think that

here I was, uh here I am, a heart

surgeon

in many ways at the pinnacle of

medicine, um and trying to get people

back from the brink of death,

uh and yet

I was headed down that same pathway

myself. And I was so unhealthy myself.

And I had to figure out how

to save myself.

Um and that has really opened my eyes to

how much

we need to save society at this point,

cuz we are a very sick society, and we

need to be saved. When you say you were

an unhealthy heart surgeon, give me a

picture of what that looks like in

reality. Yeah, so, um I was morbidly

obese. I was 100 lb heavier than I am

today. I was pre-diabetic.

And I was in my late 30s and realized

that I was going to end up on my own

operating table, so to speak. I was

walking the same path that so many of my

patients had walked down.

I had family history. My grandmother

died of heart disease. My father has had

heart surgery,

um and I knew

the path that I was headed down, but I

didn't know how to change that pathway.

And that's the problem that I'm really

trying to solve for people. To get them

to realize how they can change

what many of them see as their destiny.

When we when you think about our

destinies, we often look at our parents

and think,

you know, that's probably the the

clearest indicator I have of where I'm

going because of, you know, genetic and

environmental factors. What what When

you looked at your parents, what did you

see?

Yeah, so my parents

uh were both um overweight,

uh had both uh struggled with obesity

their entire lives, and as I mentioned,

my father had developed heart disease,

and

I was under that same impression that

there really wasn't much I could do

because it was genetic. Um but I think

that's one of the biggest myths we need

to dispel around medicine today. Very

little of the sickness that we see so

prevalent in society around us is truly

genetic.

And the reason that we know this is

because

human genetics don't change that

quickly.

Um yet in the past 100 to 150 years,

we've seen this explosion, this epidemic

of chronic disease. Things like obesity,

diabetes, even heart disease, the very

condition that, you know, I have spent

my life treating,

was

relatively

rare, was almost undescribed

um 100 120 years ago.

And so we know that human genetics don't

change that quickly, yet we see these

diseases developing so quickly. And that

should tell us that it's not genetic.

Yet, almost everyone when they go to

their doctors and they ask, "Why did

this happen?"

the common answer they're going to get

is because it's our genetics.

Was there a Was there a

a moment, like a turning point, uh

a fork in the road, a moment where you

looked yourself in the mirror and

thought, "Today is the day where I have

to make a change."

You know, there were many times during

my life when I told myself that. And I

would make changes and I would have some

short-term success. I would

change what I eat. I would try and do

different activities. I would lose some

weight. Um but like many people have

experienced, it didn't last over the

long term.

Uh my turning point really came a little

bit unexpectedly for me. I was actually

attending a medical meeting,

a uh conference of heart surgeons, and

uh the speaker, one of the guest

speakers, was a journalist um by the

name of Gary Taubes. And uh he had just

written a book uh at that time called

The Case Against Sugar. Prior to that,

he had written um Good Calories, Bad

Calories, and Why We Get Fat.

And as I sat there in that audience

listening to Gary talk, uh and Gary

introduced some concepts to me that I

really hadn't heard before,

uh that the types of food that we eat

may be more important than the amount of

food that we eat.

And it made a lot of sense and it sent

me down a pathway where I started to

think differently about my health.

And so I read Gary's books and um I

eliminated sugar at first and started

changing the foods that I was eating.

And

I had the same short-term success that I

had had before. I was able to lose a

bunch of weight and I said, "This is

great.

But I realized that something was

different

because

month after month, year after year,

I was able to maintain it. And I was as

I learned more,

as I walked down this journey,

I came to realize what is at the true

cause, the true root cause of our health

problems.

And understanding those true root causes

of our health problems is what has now

led me to the long-term success. And I

can sit here now, you know, 8 years

later and say

that I know that I have truly tackled

my health challenges.

And now I can help others to be tackling

their health challenges as well. What

was the approach that led to short-term

but unsustainable success?

Usually it was the counting calories. It

was eating less, doing more.

It was eating a low-fat diet. It was all

of the advice that we have heard our

entire lives. It was everything that I

had been taught in school, in medical

school, about, you know, how to

educate people on being healthy.

And yet what I realized in retrospect,

and I didn't really recognize at the

time, admittedly, but I realize now, is

that it wasn't working for me and it

wasn't working for my patients. But I

had fallen into

I think one of the common traps that we

fall into. And when we give people

advice and the advice doesn't work, we

just assume it's because people weren't

following our advice.

And we as individuals, but certainly we

as the health care system, are not very

good at considering that maybe we're

giving lousy advice.

You You know you're just giving advice,

right? As a As a medical professional,

you're also giving medicine.

What's your perspective on

medicine, and how has that evolved as

you've learned more about what I guess

you define as

metabolic health?

Yeah, I think my view now is that

medicines should be necessary a lot less

often than we use them.

Um

when we look at our health,

we shouldn't really have the baseline

assumption that we have today that if

someone is in poor health, it's because

they're lacking

medicine.

It's because we haven't figured out the

right

treatment for them. Um

Usually pharmaceutical based treatments,

maybe it's going to be a procedure or

surgery. Um but there's almost a

sort of assumption built into that uh

that the human body is destined to

become ill. Um that we're destined to

develop these problems, and that the

only way that we are going to be able to

manage and head off these problems is by

advancing science, by coming up with

more pharmaceuticals and more surgeries

uh to treat the problems instead of

considering the fact that

it might be something we are doing to

ourselves.

There's a book in front of me that says

stay off my operating table by Philip

Ovadia. Why did you decide to write this

book? What was your mission? Yeah, I

wrote the book because

I struggled

to find this information. Um I as a

heart surgeon, I as a doctor, I as

someone in the medical system that is

supposed to be built around making

people healthy and keeping people

healthy, struggled to figure out the

information that's in that book. You

know, when you say healthy,

what what what is healthy?

Like what How does what How does a

doctor like you characterize health?

So, I define health today as our bodies

working the way they should. Um so, you

know, I talk about metabolic health in

the book. What's that? And the way that

I define metabolic health is that our

bodies are properly utilizing the inputs

that we are giving it. And the primary

input that we give our bodies is the

food that we eat.

And so, when we eat,

one of three things is really supposed

to happen to that food.

Some of it gets turned immediately into

energy

for us to fuel all of the activities

throughout our day.

Some of it gets broken down

so that we can build and rebuild the

tissues in our bodies, processes that

are always going on.

And then a little of it is supposed to

be stored for times when energy is not

available.

And what has happened in our modern

environment is

that system has broken down. And we end

up storing too much of the energy,

and we end up not being able to ever use

that stored energy. And that has a whole

host of downstream problems that it

creates. And these are things like heart

disease that I treat every day. These

are things like diabetes, cancer,

Alzheimer's disease. Um all of these

chronic issues that we see becoming so

common

in our society today. You're a

heart doctor.

What's been the um the most

emotionally challenging day of your

career

as a heart doctor?

Well, it's actually the opening chapter

of my book.

It was the day

uh

that

a very young woman ended up on my

operating table.

And she did not make it off my operating

table.

She came to me with a devastating

cardiac condition.

Me and my team

spent

over 10 hours trying to save her life.

But ultimately, we could not save her

life.

And I had to go tell her young children

that their mother

was not coming home to them.

That was

the most challenging day of my

career.

And that was a day that I realized

things had to change.

That was one of the days that set me

on this pathway. That set me

made me realize the mission that I

needed to be on

to keep people off of my operating

table.

Was her heart condition preventable?

Yes.

Can you give me some color in in terms

Yeah. So, she

developed a condition. It's called an

aortic dissection where her blood vessel

leading out from her heart tore.

And that comes from high blood pressure.

And she had high blood pressure that

wasn't adequately addressed, wasn't

adequately treated.

And I believe that her condition was

100%

preventable.

I believe that if her

physicians

had understood that her high blood

pressure was because of the food that

she was eating,

if they had given her better advice

around the food that she could be eating

and the impact that this was having on

her life,

um that her path could have been

changed.

She was metabolically unhealthy in your

view? She was metabolically unhealthy.

Clinically obese? Clinically obese,

high blood pressure.

I would say

she had

probably all five measurements of her

metabolic health ab- abnormal.

And no one,

although I don't know this for sure, no

one likely ever had that discussion with

her. And she was young, you said.

She was very young.

But under the age of 50. Yeah, she was

38. Jesus.

This is one of the most troubling

things that I have seen

uh during my career as a heart surgeon.

Understand that I started my career as a

heart surgeon 20 years ago.

And at that time,

we would operate on 70- and

80-year-olds,

60-year-olds.

It was rare that we would operate on

50-year-olds.

Today, just 20 years later, I routinely

operate on 40-year-olds,

and I occasionally operate on a

30-year-old like that woman.

Have you ever operated on a 20-year-old?

Not for

the

not someone who wasn't there um It's a

different condition than

atherosclerosis.

a congenital heart condition. I've

operated on 20-year-olds. I haven't

operated on 20-year-olds um with

atherosclerosis,

but I don't think we're far from that

point. When we look at the fact that a

third of the children

are obese

that we see

metabolic disease

increasingly in teenagers and even

children

as young as eight or nine years old

there were going to be 20 year olds on

ending up on my operating table in not

too long a time.

I was going to ask you Elly Ron why all

of this matters. You know, sometimes I

flick around in my head and

I think well, you know, if I live to

60 70,

you know, if I live to 60 but I just

have loads of fun and when I say fun I'm

kind of mischaracterizing fun as like

doing whatever I want and being driven

by my own physiological and

psychological like

compulsions basically which means just,

you know,

junk food, whatever, whatever. Or I go,

you know, I can live longer

and

avoid some of those compulsions that I

might have with as it relates to diet.

But I think that example you gave of why

it's so important because you you had to

walk out of that operating room and go

and speak to a family, presumably young

kids young young kids, right?

Yeah.

That were how old?

The youngest one I believe was three or

four, you know, the older ones were

eight 10 years old.

I'm guessing you'll never forget that

conversation.

How how how does how how do you prepare

to have that conversation with a 10 year

old and a three year old about their

mother not coming back?

Are you trained to do that is, you know,

There is no training to do that, you

know, unfortunately I've as a heart

surgeon, you know, I have

that conversation with family members

um,

not infrequently.

But having that conversation

um

with

children, with such a young family

members,

um

I don't know that there's any way to

prepare for that. I certainly wasn't

prepared for it.

One of the things that I've come to

realize

is no matter how good a heart surgeon I

might be,

no matter how good all the heart

surgeons out there are,

you're always better off if you never

needed the surgery in the first place.

And understand that, you know,

I'm essentially looking to

put myself out of business, you know, I

spent my entire life

becoming a heart surgeon,

preparing to be a heart surgeon. Um I

still

love being a heart surgeon.

Um

but

I realize in the back of my mind every

time I'm doing heart surgery essentially

that I shouldn't need to be doing this.

I believe I know that the vast majority

of

heart disease is preventable. The vast

majority of the surgeries that I do are

preventable, shouldn't need to be done

in the first place.

And that's why

my mission is so important. That's why

I'm doing what I do. That's why I wrote

the book.

Um that's why I'm here talking to your

audience today.

Because it doesn't need to be this way.

When you

when you go into that

that waiting room, what do you say?

I said, "I'm sorry."

I said,

"I'm sorry that we weren't able to save

your mother."

I said that

your mother came to us

came to me

with a devastating problem,

and I did everything I could

to try and save her.

But her

situation

was not

saveable.

And I just said that I'm sorry

that your mother

is no longer with you.

Do you carry Do you carry a weight

from having to have that conversation

over and over and over again? Yeah, I

definitely carry that weight from all of

the times that I've had that

conversation.

And you know,

whether it's

an 80- or a 90-year-old

that many people would say they lived a

good life,

they did everything they wanted to do,

um

or whether it's

a 30-year-old young mother who

did not get to see her children grow up,

and whose children need to grow up

without her,

the conversation is never any easier.

And especially

recognizing

that most of the time they didn't need

to be there in the first place,

that they could have

made changes in their life that would

have kept them from getting there.

That their doctors

could have given them better advice

to help them make those changes. How

common is heart disease?

Heart disease is the number one killer

um here in the United States and

worldwide. Here in the US, 600,000

people die from heart disease every

year. Um about a quarter, 25% of the

deaths every year are due to heart

disease. So, heart disease is incredibly

common.

But, it wasn't always that way. Um it

really only became that way within the

past 70 years or so.

And we have to ask why.

Um because if we're going to take the

view, which the health care system

largely has, that health disease that

heart disease is inevitable,

um

it's so common it must be inevitable, uh

then why wasn't it always a problem?

And those are the questions that I think

we don't do a good job of asking.

Um we as physicians

have become so busy

taking care of all the sick people that

we've kind of lost the time and the

ability to think about why there are so

many sick people to start with.

And so, when I look at something like

heart disease and I start to think about

why is it so common, why has this

become, you know, everyone knows someone

with heart disease. Uh everyone knows

someone probably that died of heart

disease, that has is suffering from

heart disease. It literally is all

around us. And I want us to step back

and start asking, why is that?

Why is that?

It's because of the food that we're

eating. Um

I it's that simple. Uh, when did this

change? Like, you know, so there must be

a point in in history where you see a

correlation between our diets changing

and heart disease increasing.

Yeah, so here in the United States, you

know, starting right around 1950, there

was a sharp increase in the incidence of

heart disease.

And at the time,

um, we actually our sitting president

while in office had a heart attack. And

this set off the alarm bells and

everyone started asking, "Why, you know,

where did all this heart disease come

from?" Uh, because it's real

interesting. You go back to some of the

medical reports from 1900, 50 years

before,

and heart disease is incredibly rare.

The leading physicians of the time would

go their entire careers without really

seeing heart disease.

So, something changes in a in a pretty

short period of time. And

when we, you know, what does that

correlate with? It correlates with the

introduction of processed food. Um,

things like,

uh, you know, sugar,

the consumption of sugar starts rising

dramatically along with the incidence of

heart disease.

Um, packaged foods, uh, processed foods,

whatever you want to call them. Um,

these are the things that we see being

introduced widespread into society

around that time.

I am an I am an idiot when it comes to,

uh, cardiovascular health. So, when I

ask this question, please explain it as

if you're talking to a monkey. Um, what

is heart disease? Like, from a

physiological standpoint, what what is

it? Is it my heart just

not feeling so good? Or is it my the the

I'm going to think of a big

cardiovascular word here.

Atrium?

Pretty big one. Ventricle, bigger, but

Ventricle, atrium. Are they Are they

blocked? With with I almost If I was to

guess what heart disease was

from a monkey mindset, I'd say that the

it becomes blocked by something.

Is that

a bad a guess? Yeah, no, that's down the

right pathway. So, realize that there

are a number of different forms of heart

disease, but when most people refer to

heart disease, they're referring to what

we call atherosclerosis.

And what that big fancy word means is

exactly what you were getting to.

Something gets blocked. The blood

vessels on the heart get blocked. So,

realize that the heart is a muscle.

Um like any muscle, it needs oxygen. It

needs blood to carry that oxygen to it

so it can work.

Now, the unique thing about the heart as

a muscle is that it never stops working

until the day we die. Um so, it needs

that constant supply of oxygen and

blood. And when the blood vessels that

are carrying that oxygen to the muscle

of the heart uh start to get blocked,

start to get clogged,

um

there may not be enough oxygen making it

to the heart anymore. Um that's what we

call a heart attack. Basically, that

there's not enough blood flow, that

there's not enough oxygen getting to an

area of the heart. Um and that's the

most common cause of heart disease.

That's what most people are referring to

when they say heart disease. What is

blocking the flow of oxygen to the

heart? Well, you know, that's really the

million-dollar question. So, when you

look at it under the microscope, what

you see is uh plaque builds up in the

blood vessel. And that plaque is

composed of uh cholesterol, fatty stuff,

and it has calcium in it. And you know,

when you really get into the microscopic

levels, it has uh some of the blood

cells,

both the red blood cells, which are

oxygen-carrying cells, and white blood

cells, which are our immune cells, uh

are all involved in these plaques.

So,

when we were first trying to figure out

what was causing heart disease, and the

early

scientists, the early physicians were

looking under the microscope, and they

were seeing that there was cholesterol

in these plaques, and they said, "It

must be cholesterol

and fat in the foods that we are eating

that are causing these problems." Made a

lot of sense,

and we set down a pathway to try and get

people to eat less cholesterol.

We set down a pathway of developing

drugs that lower cholesterol, and it

would make perfect sense that that would

take care of heart disease.

And yet, here we are 70 years later, and

people are eating less cholesterol, and

people are taking medications to lower

their cholesterol,

and yet, heart disease isn't going away,

and it's actually getting worse.

Uh so, we have to step back and say,

"Maybe we were wrong

about it being cholesterol that was

causing the heart disease in the first

place."

And maybe it was And maybe it was

something else.

Uh so, you know, when we look at what

else might it be? And again, when we go

back to the early days of this science,

the other thing that was talked about

was sugar.

Um and there were many leading

scientists, again, going back to the

1950s, who were saying that it was sugar

that was causing this problem, because

sugar damages blood vessels. Again, we

know this,

uh that sugar damages the lining of the

blood vessel.

And maybe the cholesterol is there to

repair that damage.

That

theory, that hypothesis,

um makes a lot of sense. We have a lot

of scientific evidence to support that

theory. Um yet that theory got buried.

It got the other theory won out that it

was the cholesterol in the diet. And

like I said, it makes sense to go down

that pathway, and we can see how we

started pursuing that. Um but we need to

step back now 70 years later seeing that

it's not working, and maybe saying that

maybe it was sugar all along. Maybe it

was sugar in the first place. Do you

believe it was sugar?

Um I don't think it's only sugar. I

think sugar plays a large part in the

process. Um and the way that I look at

it is um we have to look at what leads

to sugar building up in our bloodstream.

And this is another important concept to

understand. Cuz most people think, "Oh,

well, the reason that we get high

amounts of sugar in our blood is because

we're eating too much sugar."

And that's indirectly true.

Uh but the reason that we end up really

getting high amounts of sugar in our

bloodstream is because our metabolic

health, what we kind of started talking

about earlier, gets broken. So we have

to look at what's breaking our metabolic

health if we really want to get to the

root of this problem.

Okay, let's let's look at the what are

the markers then that my metabolic

health is broken. How do I know sat here

now cuz I there's a girl scout outside

the studio and I just bought some

cookies off her. So I'm trying to figure

out whether I should eat them or go get

a refund. Um

so how do I know if my metabolic health

is intact? Cuz there's often been a

debate, you know, people might think

it's just based on my my waistline, the

circumference of my waist. But I I

remember reading once upon time that

like sumo wrestlers are significantly

healthier than like most most Americans.

So, what are like how does one look

by looking at themselves understand if

they are metabolically healthy or not?

Yeah, so, you know, there is

just by looking at yourself, you may not

be able to tell. Um but, it turns out

that your waist circumference is one

good thing you can look at in yourself.

And in general, um having a larger waist

circumference uh is an indicator of

being in poor metabolic health. Is that

the biggest indicator? Um it's

one of the five indicators. Um it's the

easiest one for us to

tell just looking at it by ourselves.

The other indicators are our blood

pressure. Um so, you know,

almost everyone when they go to the

doctor, they get their blood pressures

checked every time. And the reason that

we check people's blood pressure so

commonly is because it is an indicator

of

health of metabolic health specifically.

Some other measurements you can't tell

just by looking at yourself.

Uh you need to get your blood work

checked. You need to see what the level

of sugar in your blood is, what we call

the fasting blood glucose level.

And then you do need to know uh what

some of your cholesterol levels are. Uh

but, importantly, and this is one key

thing that I want people to understand

is we're not focused on the cholesterol

measure that most doctors talk to you

about, what we call the LDL cholesterol,

or nicknamed bad cholesterol,

which is an inaccurate nickname, but not

important right now. Uh we want to look

at two of the other measures of

cholesterol, what we call the HDL

cholesterol, again nicknamed good

cholesterol, and we want to look at your

triglyceride levels. And when you look

at those five measures, uh those five

measures will tell you whether or not

you're metabolically healthy or not. Um

but the problem is, as you were talking

to, you can't just look at yourself and

know what those measures are. You have

to

put the effort in to figure out if

you're metabolically healthy or not. The

statistics are actually pretty shocking.

Um because we have statistics again here

in the United States uh looking at data

from 2016

that show that 88% of the adults in the

United States are not metabolically

healthy. So, when you look at those five

measures, they can't meet all five

measures of optimal metabolic health.

That's nearly everybody. That's nearly

everybody.

And you can say, "Well, maybe it's all

of the obese people."

Um but when you look at people who

aren't overweight, who aren't obese, 50%

of them are not metabolically healthy.

You talk about this concept of being

skinny fat. Yep. In your book. Yep. I

think my friend called me that one day

when he was trying to insult me. Um

couple of years ago. What does What does

skinny fat mean? What is What What is

that? Yeah, so skinny fat um it will

often times be referred to as toffee,

thin on the outside and fat on the

inside. And what that really means is

that we have internal fat around our

organs, specifically in our abdomen,

around our liver, around our pancreas,

around our kidneys, um that may not be

obvious from the outside. Um many of us

kind of know what this looks like, you

know, someone who's got skinny arms and

skinny legs, not a lot of muscle, but

they have a little bit of the pouch in

the middle.

Um that is skinny fat. Uh and again,

unless you're measuring it, unless

you're looking for it specifically, you

might not pick up on that. And

it is a big problem. Many people you

know,

hypothesize

that actually getting fat, getting obese

on the outside is a protective

mechanism.

Cuz it's really when you get fat on the

inside that we see the damage start to

occur. Things like diabetes, things like

heart disease really start to manifest

when you get fat on the inside. So do

you think being skinny fat is worse from

a metabolic health standpoint than being

fat

on the outside? It very well can be and

often times the problem with the people

who are skinny fat is they don't get

picked up on until we're much later in

the process, until they're much sicker.

So that's one of the issues with being

skinny fat. And one would only know if

they were skinny fat really by going and

getting some of those key metabolic

health markers checked in terms of their

triglycerides, their their blood glucose

levels, etc. Exactly.

Okay.

So

I'm trying to be in that 12%

that of of people

that are metabolically healthy and that

meet at least all five of the criteria

for metabolic health. There's I've had

so many guests on this podcast recently

that I've talked to different diets, the

carnivore diet, keto, you know, we

talked about the Mediterranean diet, a

gluten-free diet, vegetarian, veganism.

It's a lot. Yep, there's a lot. You

know, and

my question to you, and I know this

isn't necessarily an easy question to

answer, but what is the diet that's

going to avoid my

metabolic health breaking down, going to

keep me off your operating table,

and keep my health intact?

Which diet should I go for? Dr. Philip.

Yeah, so you know, I go into it in the

book and what I really tried to look at

was what are the common things amongst

all those diets that will keep meta

people metabolically healthy or make

people metabolically healthy. And really

it comes down to eating whole real food.

Um elimination of processed food I think

is the most important step if you want

to get metabolically healthy and remain

metabolically healthy.

And within that framework, there are

lots of different possibilities. Some

people have great success as a

carnivore. Some people have success as

vegans.

Um you can do keto, you can do

Mediterranean.

Um you can do paleo, you can do lots of

things in between. But when you really

look at what is the one commonality that

we can point to that will

predict the best success of being

metabolically healthy, it's eating real

food, eating whole real food.

What is whole real food? Yeah, great

question because sometimes it's hard to

tell these days.

Uh so the rule that I you know the the

kind of rule that I give people around

eating whole real food is eat the things

that grow in the ground and eat the

things that eat the things that grow in

the ground.

Um so these are going to be your plant

products and these are going to be your

animal products. So you're pro animal

products cuz there's

very pro animal products. I actually

think that when you look at the balance

between the two,

um you're probably better off eating

more animal products

uh than more plant products. And again,

that's something that goes very counter

the mainstream narrative.

Um understand that as human beings we

evolved eating animals, we evolved

eating meat.

Our bodies are uniquely designed to

process that meat.

Our bodies are not well designed to

extract nutrients from plants.

Um and in fact, when you really look at

the sort of evolutionary system, what

developed is that the the animals,

especially ruminant animals with

multiple stomachs, they are designed to

extract nutrients from plants.

Those nutrients end up in their muscle,

in their meat, and then we are designed

to get the nutrients from the meat. So,

I do think that

meat animal proteins are essential to

human health. And

yes,

being a vegan is going to be healthier

than eating a diet full of processed

food, the sort of standard Western diet,

but I don't think it's optimal for human

health ultimately.

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know what you think. Back to the

podcast.

In your medical practice, have you seen

any recurring trends based on

people that have consumed a vegan or

vegan diet?

Yeah, so I think a well-constructed

vegan diet, a

what, you know, probably should be

better called a, you know, whole food

plant-based diet is a significant

improvement over the Western diet, over

the standard American diet, over a diet

with a lot of processed food. And that's

really what you see when you look at the

scientific literature around vegan

diets. It's an improvement over

the standard American diet,

but it's not necessarily optimal

and especially over the long term. So,

the story that I see

on a recurring basis is that someone

will be eating, well, really not being

paying attention to what they're eating.

They'll just be eating the food that's

around them, the standard Western diet.

And they'll be in poor health because of

that.

And they'll decide to make a change and

because there's a lot of messaging

around it, oftentimes a vegan diet is

going to be the first one that they try.

And they're going to feel better

initially. They're going to improve

their health initially. Their metabolic

health markers will improve.

Over the long run, it becomes

fairly difficult to maintain a good

vegan diet. You have to be

supplementing. There are certain

essential nutrients that we cannot get

from plants. Um and no one argues that.

The vegans don't argue it. They just

say, "Okay, I'm going to take my

supplements."

It's hard to get the right amount and

the right balance of proteins and amino

acids from plants. Um and again, if

you're supplementing, you can do it. Uh

so, the people that I see having

long-term success on vegan diets are

often working very hard at it. And

they're very carefully planning um and

like you said, it becomes hard to do on

a day-to-day basis unless you're really

putting a lot of energy into it.

In In chapter three of your book, you

say, "Our ancestors didn't evolve to

take supplements, so we shouldn't be

taking them, either." Yep.

You believe that? I do believe it. I do

believe that any diet that's optimal for

humans shouldn't require

supplementation.

Um and so, when I look at the opposite

end of the spectrum, when I look at

people who are doing a carnivore diet um

and eating

all, or at least primarily,

uh animal proteins, uh they usually

don't require supplementation.

Um and they

uh

are thriving on long-term carnivore

diets. And I think it's a more

ancestrally consistent diet. And I think

that it is

um

in a lot of ways easier to maintain. Uh

you don't have to quite do all of the

planning that goes into a vegan diet.

But ultimately, I'm happy

as long as someone is getting

metabolically healthy and staying

metabolically healthy on whatever diet

they're eating. And so, I don't I'm not

dogmatic. I don't tell all my patients

you need to be carnivore. I work with

people on vegan diets. Ultimately, I

want to help people understand

how to get metabolically healthy, how to

maintain metabolic health. And if they

do it as a carnivore, if they do it as a

vegan, if they do it somewhere in

between,

um

I'm happy for that.

And I believe that should be our measure

of success. When talking about metabolic

health, you know, you lay lay out these

seven principles that will help us

achieve that that optimal metabolic

health. One of them, and the first one

you say is to reframe health as a

system, not a goal.

What does that mean? Yeah, so I think

this is a real important first step in

this process. Um it's really the mindset

behind it. And when I say I want you to

think of your health as a system, not as

a goal, um what I mean is that I don't

want us so focused on the short term,

which is one of the mistakes that I

often times see around health.

So, many people, you know, we kind of

talked about it earlier, will say

they recognize that they're unhealthy.

And they want to make a change.

Often times this is around their weight.

And they'll set a short-term goal.

They'll say I want to lose 20 lb. And

one of two things is going to happen in

that scenario. You're going to make a

bunch of changes.

Hopefully, you're successful. You lose

the 20 lb. And you say, "Great, I

accomplished my goal.

Now I can go back to what I was doing

beforehand because

that's just the natural

uh inclination I think that we have as

human beings.

Um we don't want to continue to put that

work in.

Um the other possibility is that you

don't meet your goal. You don't lose the

20 lb because it's actually hard to lose

20 lb and you get frustrated and you

give up and you go back to your old

habits. So, instead what I encourage

people to do is think about their health

as a system and think about the habits

that are going to support that system.

It's a more positive way to think. Um,

what are the habits that I can adopt to

support my health?

More sustainable. People can do that

over the long term because when we're

doing positive things to improve

ourselves, we can do that over the long

term.

If we're taking away things, if we're

restricting ourselves, we aren't very

good at doing that over the long term.

Number four of your seven principles for

metabolic health is about exercise. Um,

in the book, if I remember correctly,

you say that exercise isn't the best

approach, isn't the only approach one

should consider when thinking about

dropping weight and reducing waist size.

A lot of people might be surprised by

that.

Yeah, so, um, some of the concepts that

I talk about in the book around

exercise, um, the way I uh, phrase it is

I want you to get more activity. Um, one

of the mistakes that I see people making

is that they um, focus on doing periods

of exercise. They say, "I'm going to go

to the gym and work out for an hour. I'm

going to go run and, you know, for an

hour." And they don't pay attention to

getting enough activity throughout the

rest of their day. Uh, so, um, I try to

get people to refocus on just getting

more activity throughout your day.

And then when it comes to your exercise

and your metabolic health, the most

important part of building metabolic

health through exercise is going to be

building and maintaining your muscle.

Um muscle is very unique when it comes

to

our metabolic health.

Muscle

is

metabolically active

throughout your day.

And so, when you focus on building and

maintaining muscle, it's going to better

support your health, your metabolic

health, um than if we're just trying to

do

uh the cardio exercise and burning the

extra calories during that time that we

are exercising.

Cuz you say here on page 72,

keep in mind that research shows cardio

is an unreliable tactic for fat loss.

That's a shock to most people because

we've been taught that cardio is

everything. Right.

So, when we look at the science around

cardio, um you know, chronic cardio

exercise, uh what most people think of

as jogging or running at the gym, um we

see that it doesn't help for weight

loss. Doesn't help for fat loss. And

that's why I don't want people

to focus on cardio.

Um and you know, when we look at the

macro level of this,

we have more gyms today than we ever

have.

People spend more time at the gyms doing

cardio than they ever have.

And yet, we have a worse obesity problem

than we ever have. Uh so, cardio

is not effective for weight loss.

Science is pretty clear on that. Doesn't

mean that cardio doesn't have benefits,

and I'm not telling people stop all the

cardio that you're doing. I just don't

want people to think that only by doing

cardio are they going to be able to lose

weight and lose fat and have long-term

success around that. Why you know,

I think that surprises people because,

you know, when I do cardio, um I sweat.

Yep.

And I can feel it just It feels like the

fat is melting and it's pouring off my

skin.

So, I'm like, you know, I must be losing

weight. Right.

But so, it it seems like a bit of a head

spin that that that's not helping me

lose weight. Why isn't it helping me

lose weight? Yeah, there are two reasons

that it doesn't help you lose weight.

Number one is uh for most people, after

they do a lot of cardio, they get hungry

and they eat more.

So, they kind of counterbalance whatever

extra calories they may have burnt off

uh doing the cardio.

Is that Is that inbuilt or is that just

you know, is that the brain I think it

is. I think it's our body's sort of

homeostatic mechanism.

Um and the other problem

um with, you know, thinking you're going

to

uh lose weight

just by doing cardio is it's really

relying on the

calories in, calories out model.

Uh so, again, the underlying assumption

there is that if we just

burn more calories,

um that will compensate for the extra

calories that we've been eating. And

again, we see that that doesn't work

over and over again. We know that our

body actually adjusts the amount of

calories that it burns. And if you go

and you do that hour at the gym,

during that hour, you're going to have

burnt more calories, but during the

other 23 hours of the day, your body is

actually going to burn less calories to

make up for that.

Well,

that's bad news, isn't it?

That is bad news.

Uh and you know, the extra point there

is when we build muscle, muscle built

muscle burns more calories throughout

the day. So, that's the other reason

that the focus on muscle building

is really the most effective way

uh

to exercise your way to weight loss. So,

okay. So, weightlifting you would advise

as a

preferential way to

lose

fat and improve our metabolic health

versus just like going for a jog. Right.

Even if I'm burning 500 calories on my

jog versus 500 burning 500 calories

doing weightlifting, you think that the

weightlifting calories burned are more

important for weight loss than the

jogging calories?

Yeah. So, when we look at the science

around uh

building muscle, resistance exercise, um

as I said, we see two unique benefits to

building muscle. Um number one is that

that muscle is going to be more

metabolically active tissue that we're

going to have on us all the time. So,

we're going to be burning more calories

throughout the day

despite, you know, the activity that

we're doing.

But But aren't we just going to get more

hungry?

Um we don't seem to get more hungry from

those uh

I guess from that metabolic activity.

It's not the same as doing the cardio

making us more hungry.

The other unique thing about muscle

though to understand is that as we age

the more that we are able to maintain

muscle

the better quality of life that we have

and the longer we are going to live. And

again, this has been shown in uh

repeated studies, many different areas,

uh heart disease included, uh that

building and maintaining muscle as we

get older is one of the best strategies

for living longer and for living better.

It's a bit of a downer with spiral

though, isn't it? Because, you know, I

get older, maybe I'm a little bit more

inactive, maybe I retire,

um and then I lose muscle. And as I lose

muscle, I become more inactive, and the

spiral

the cycle continues.

So, that, you know,

But, it doesn't need to be that way. We

can maintain muscle uh throughout our

older age. And the key is to doing that

is to maintain your metabolic health. Is

to be eating enough protein. Is to be

eating whole real food. And is to be

continuing to do resistance

exercise, resistance activities

throughout your lifespan. And we can

actually maintain muscle as we get

older.

One of the ways in your book that you

assert we should um

maintain our metabolic health, one of

the tactics to maintain our metabolic

health and stay off your operating

table, is to sleep more. And I wondered,

why why does sleeping more improve my

metabolic health?

Yeah, so sleep um really has, again,

unique benefits related to metabolic

health.

Um

when we sleep, um that's the time that

our body is really doing that rebuilding

uh process that is so key to us

maintaining health. Um

we see

a unique

sort of uh

two-way relationship between sleep and

metabolic health.

And uh this is important for people to

understand this.

Um when we are metabolically unhealthy,

our sleep suffers.

If you're not sleeping well, it can be a

key indicator that you may not be

metabolically healthy.

We also know that people who sleep less

are more prone to being metabolically

unhealthy. Um

many different reasons why that might

be.

Uh but ultimately, what I focus on is

that in order to be metabolically

healthy, you need to be getting enough

sleep.

And if you're not getting enough sleep,

it very well may be a sign that you are

not metabolically healthy.

Can you give me maybe one hypothesis as

to why that is? Why my metabolic health

will cause my sleep performance to

decline?

Well, one obvious

uh thing that we can point to is sleep

apnea.

Uh sleep apnea becomes very common as

you get metabolically unhealthy. What's

sleep apnea?

Uh so, sleep apnea is basically when you

stop breathing for short periods of time

while you're sleeping. And uh we know

it's very closely related to

uh metabolic disease.

Um

I now have worked with many patients

who have improved their metabolic health

and their sleep apnea goes away.

Uh and again, the traditional view on

sleep apnea in medicine is that it needs

some procedure.

Um sometimes that's a surgical

procedure, or it's things like wearing

masks

uh to treat the sleep apnea. And what we

don't do is ask why we have that sleep

apnea in the first place. And again, it

seems to be related to our metabolic

health. And one of the

fairly consistent things that I see in

people as they improve their metabolic

health um is their sleep gets better.

And those that have sleep apnea, it

often times improves or even goes away

completely when they improve their

metabolic health. And there's a weight

loss component to that. Um but we even

see this in people who aren't

overweight, they have sleep apnea,

they improve their metabolic health,

they don't even necessarily lose weight

as part of that process, and yet their

sleep apnea goes away. When you were 40

years old, you described yourself as

being morbidly obese.

Yep. Did you have sleep problems? Um I

probably did. I was never really uh

diagnosed with it.

Uh but um my wife would certainly tell

you I I used to snore a lot.

Right.

And you still have those

any sleep problems at all now?

No, I don't. Um I no longer snore, and I

feel well-rested every morning when I

wake up. Uh so I no longer have sleep

problems. You think you no longer snore.

We can never be certain for sure. Uh

chapter two of your book you say that

that there's 12 deadly food lies.

And you highlight the 12 deadliest of

those food lies. Um one of them we've

talked about already, which is and

that's the first one in the book, which

is that only obese people are

metabolically unhealthy.

Um we've talked about that a little bit.

One of the the surprising ones um out of

the list is that

you seem to have a have had a real

I guess perspective change over the

years about the role of the profession

that you're in.

And at at times in your book you seem

quite critical of

doctors. I think even when you when you

talk about the seven principles of

metabolic health,

number seven of those principles is

you're encouraging people to get a

doctor

that understands it. Get a doctor who

gets it.

Yep.

Do you ever receive pushback from your

own industry for being somewhat critical

of the way that this the system is

designed and the perspective they have

towards medication and medicating things

and whacking them all once they've all

reared its head versus

preventative measures?

Yeah, I certainly do get pushback. Um

but um and as you said, I am

critical of my own profession because

we as a we as the health care system, we

as medical practitioners, need to be

asking ourselves, are we doing good

enough? And when we look at a society

um that everyone is unhealthy, we

touched on the statistics before, um

we can't

absolve ourselves of that responsibility

for getting us to this point.

Big food.

Big food is part of it. What is big food

in your view? Like what's how do you

define that? Um it's the processed food

industry uh that's all around us. It's

the vast majority of what is presenting

presented to us as food these days. Um

when we walk into the

grocery store, when we walk into the

supermarket, the vast majority of what's

in there is not whole real food. It is

not designed to support our health.

What's it designed for?

Profits for the food industry.

That's um that's pretty much alludes to

point number four in your 12 deadliest

food lies. You say the people who

produce our food want us

to be healthy. You say that's a lie.

They do not want us to be healthy.

Well, it's not that they do not want us

to be healthy. It's that the our health

is not a concern of theirs.

Um

they are an industry.

As an industry, their goal is to

increase their bottom line. It's to

support their profits.

They don't care whether or not we're

healthy as part of that.

And quite frankly, they don't have a

reason to. Um if you are a food company,

your goal is to get people to buy more

food, to eat more food. So, what are you

going to do? You're going to design

foods that make people hungry more

often. And that's exactly what processed

food does.

The problem with these processed foods

is that they're supplying us with

calories, they're supplying us with

energy.

They're doing that

look basically cheaply.

And yet they're not providing our bodies

with the nutrients that they need. So

our bodies are constantly seeking those

nutrients

and therefore we find ourselves always

hungry.

And that is the main problem with

processed food. That we end up taking in

an abundance of energy without meeting

the nutritional needs that our body is

looking for. What about fasting? You've

talked, you know, I I I've often been, I

think recently cuz we've had a few

health food related, fitness related

guests on the podcast, I've started

thinking a lot about fasting. So for

example, yesterday I had one meal for

the whole day.

Um

and I've start because I sometimes

reflect, I go and search of answers by

looking at how I assume our ancestors

used to live.

Right. And I can't imagine that we were

necessarily grazers. Do you know what I

mean? I can't imagine that we were like

cows in fields just eating all day

every, you know, throughout the entire

day.

Exactly. So is that accurate in your

view? Yeah, I think that's very

accurate. And we, you know, ancestrally

and even, you know, again, we don't have

to go that far in history. If most of us

ask our

grandparents or our great-grandparents,

depending on how old you are,

um how often they ate, they're usually

going to tell you two times a day, maybe

three times a day.

The average person today consumes

calories eight times a day. Um and you

know, do the math. If you're asleep for

eight hours and you're eating eight

times a day, you're eating every couple

of hours. What's the harm? Um the harm

is that our bodies

uh never get the opportunity to burn the

stored energy that we have. And so, we

just end up building up more and more

stored energy, and we reach that point

where our bodies

can't do that any longer, and the

metabolic processes start to break.

How good are you How good are you at

following your own advice?

Um, I think I'm pretty good at it these

days because I'm giving myself better

I'm giving myself better advice. In the

past, I wasn't good at following my

advice. Like I said, you know, I would

tell myself all the time, "Eat less,

move more, count your calories, eat a

low-fat diet." And I wasn't good at

maintaining that. Today, I'm good at

maintaining the advice

because it's better advice that I'm

giving myself. So, I'm not going to sit

here and tell anyone that I'm perfect.

Um, you know, this isn't 100% of the

time,

uh but it's pretty darn close.

One of the things that I often hear when

we have um you know, health experts or

doctors or anybody that understands kind

of our physiology, um our health at a

deeper level or is qualified in that

department, uh what I hear often in like

the the comment sections or from our

audiences

um I think they search for nuance in the

advice that they're being given. Like

they want to know, you know, it can feel

like

you could feel like an expert or health

expert is saying, "Don't eat the [ __ ]

birthday cake. Your birthday's

canceled." Yeah. You know, and no one

wants to cancel their birthday. Everyone

wants to have the cookie from the Girl

Scout that I just bought earlier on.

Yeah. Like what where is the like, you

know, it is there is there a middle

point

If we're talking about this

cardiovascular epidemic and this heart

disease epidemic, where is the like

middle middle ground where I can live my

life, I I

eat the cook from the Girl Scout, but I

can still be metabolically

healthy.

Yeah, so I think um that's going to vary

uh depending it's going to vary person

to person. This is why I think the

metabolic health measures are so

important. Um this is why tools like a

continuous glucose monitor can be so

powerful

uh because depending on your situation,

that answer's going to be different. Um

I can certainly tell you that, you know,

9 years ago when I was morbidly obese,

every Girl Scout cookie I ate uh was

making me more metabolically unhealthy.

Today,

uh now that I am metabolically healthy,

yeah, I can have an occasional Girl

Scout cookie and it's not going to break

the system. Do you want one? Um

not right now.

I bought three packs. She was so

persuasive. Anyway, sorry. Yeah, they

are. Um so,

you know,

ultimately, this is why I rely so much

on the metabolic health measures. Um

this is why I want people to be paying

attention to these things

uh

because

each of one of us needs to figure out

how we can improve our metabolic health.

Um

what I find what's most interesting, I

guess I'll say about this

um and this is personal experience and

this is also the experience that I have

uh with my patients is the more

metabolically healthy you get,

the more you want to remain

metabolically healthy.

When we figure out how to properly fuel

our bodies and we figure out what we

should be feeling like on a day-to-day

basis,

we don't want to go back to being

unhealthy. We don't want to go back to

feeling

like we used to. When I think about what

the struggle it used to be for me to get

through

a day as a busy heart surgeon, I would

be tired all the time. I would be in a

bad mood. Um I would be hungry all the

time.

And today

being metabolically healthy, that's no

longer the case. I have abundant energy

to make it through my day. People will

listen to this advice, the information

you give, your book, you know, this

podcast. They'll listen to it. And then

a lot of people will make zero changes

as a result of it. I mean, you must have

seen that in your practice over and over

again where maybe you have recurring

patients who you're saying the same

thing to every day. And you you know

that them

their health markers as it relates to

metabolic health are getting worse and

worse and worse.

Why don't we listen?

Ultimately, I think we don't listen

because we don't believe that it's

possible to be healthy anymore. I think

one of the biggest

problems I see is we look all around us

and we see that everyone's unhealthy.

And we just assume that we can't be any

different. Well, if you're if you're one

of those 88%

who look around and see, you know,

people every I mean, everyone you must

look at

nine in 10 will be metabolically

unhealthy. So, you must think that's the

norm. The bar must be lowered per se.

Exactly.

Um what I want ultimately, you know, we

started talking about the mission that

I'm on. And the mission that I'm on is

to give people hope.

For them to understand that they can be

healthy. That they don't need to end up

on my operating table. That they don't

need to be relying on the pharmaceutical

industry uh for the last half of their

life.

On on that point though, if the forces

that stop us from heating the advice

we're given and that we know to be true.

It's not that I think a lot of time

people know this stuff. Like they know

that certain foods are good, certain

foods are bad. We're at that point now

in the kind of public consciousness as

it relates to health where if you walk

me through a supermarket,

I think I'm probably at the point now

where I can say listen, I know that's

bad. I'm going to get it anyway, but I

know it's bad. Um but also you could

walk me through and say you know

the aisle where you have whole foods

that have been grown in the ground or

the aisle where animals who eat the

stuff that's grown in the ground are and

I know that's good for me.

But as it relates to like the forces,

the psychological forces that are

stopping me from eating that food every

day,

what are those forces? I'm assuming

there's a chemical component to it.

There certainly is. We we have the data,

you know, that processed food is

addictive. You know, sugar is addictive.

Um you've probably heard, you know,

uh that sugar is more addictive than

heroin and that comes from studies

uh where they looked at uh you know, the

addiction centers in the brain and how

much they light up

uh with these different chemicals and

there's evidence that sugar is as

addictive if not more addictive than

heroin. And sugar is like in everything.

Sugar is in everything. The food

industry again, they know this.

Um it's not

an accident uh that the most addict what

may be the most addictive substance uh

on the planet is in everything they're

trying to sell us.

Um it's there for a reason. If I if I

give up sugar today,

like a drug, like heroin, is does it

does the

desire for me to have it again wane

over over time to the point where I

won't

have the compulsion to go grab

the cookies anymore. My personal

experience is yes it does. You know, I

can I can certainly say today

it you know, 10 years ago if you had

asked me do you want the Girl Scout

cookies? The answer was always yes.

Today I can say I can live without the

Girl Scout cookies.

So yes, I I

I do know that that

like any other addiction

um

after a period of time

it becomes

less of a temptation.

We'll see how you respond to the cookies

when the cameras stop rolling.

Um we have a

a new little tradition that we have

started on this podcast. These are

called the Diary of a CEO conversation

cards, right? So at the end of every

podcast our guests for the last couple

of years have written a question for the

next guest in this book. We've now

turned them into these conversation

cards. You can see on the back of the

conversation card a QR code where if you

scan it you can watch the answer and

find out who answered it. And on the

front it has the question written and

the name of the person that wrote the

question. So you can play these at home

with your friends if you want to have

the kind of conversations we have here

on the Diary of a CEO, get a little bit

deeper with them and hopefully build

your connections with them. Now usually

what I do is I spread them out in front

of you and I let you pick one. But I'm

actually going to stitch you up. So I'm

going to pick one for you to answer.

Are you up for it? I'm up for it. Okay.

it. Let me go for one that I think will

be

difficult.

Okay, here we go. This is the one I've

picked for you. I might pick another

one, we'll see.

So the question is tell me something you

have never told anyone before.

And that was asked by Gary Neville.

I

am not sure that I can

solve the problem that I'm trying to

solve.

I'm not sure that I can complete the

mission

that I now know

I was put here

to fulfill.

Our problem

around health

um

might be too big for me to solve.

But I'm not going to stop trying.

Do you think it's too big for us to

solve?

Like at your core, do you think we're

going to change direction as a society?

Do you do you do you honestly believe

that? Based on everything you know, big

food, big farmer, the way the human

brain is wired, the direction of travel

of humanity.

Do you really believe people are going

to stay off your operating table?

Yes or no answer.

Yes, I do believe it.

But I am concerned.

The effort

I'm concerned that

we have gotten too far down the pathway

that we may not be able to

truly solve this problem. I think

ultimately

not everyone is going to be able to

extricate themselves

from the situation that they're in. Are

you married? I am married. Have you you

you live in Florida, right? I do. You

got a nice house in Florida. I imagine

you do as a heart surgeon. It's pretty

nice house. If I had if I asked you to

bet

the person you love

and your house in Florida

on whether we'd be in a better position

in terms of the health crisis

and our overall metabolic health in the

Western world in a better or worse

position

in 50 years time.

Which way would you place your house and

your wife?

In 50 years I'm going to bet we're going

to be in a better position because

if we're not in a better position in 50