Bonus: Dr. O – A Smarter Approach to Medicine


Jonathan: Hey everyone, Jonathan Bailor here and so excited about this week’s bonus Smarter Science of Slim podcast, because I have one of my friends — actually from my original hometown and where one of my wonderful brothers still lives, and that is the good old, greatest city in the Midwest, Chicago, Illinois — actually a wonderful plastic surgeon by the name of Dr. Ostric or Dr. O as he is known in the iTunes podcasting world.

This is a wonderful podcast where he talks about skin health and all kinds of other wonderful health things, and also his website midwestprs.com. We are joined, like I said, by no other than the Dr. Ostric, or Dr. O, here to talk to us about his awesome plastic surgeon experience but moreso how you become beautiful on the inside with proper and scientific and simple diet and nutrition, and then how that makes manifest on the outside. So Dr. O, welcome.

Dr. O: Hey, welcome! I thought that Omaha was the best city in the Midwest.

Jonathan: Oh, it’s a toss-up. It’s a toss-up.

Dr. O: No, thanks for having me on the show, Jonathan. It’s really a pleasure to be here with you today.

Jonathan: Oh well, it’s a pleasure to have you, Dr. O. The thing that I love about what you’re doing, not only that you’re from my old hometown, but rather that obviously you’re a highly trained specialist, and you’ve been in this field for years and years and years. You are out there on the front lines in the medical arena letting people know, especially individuals who are concerned about their external appearance, that a lot of this is coming from an internal source. You’ve got a unique story and a unique perspective, so let’s just go back in time, and tell us how you got to where you are today.

Dr. O: Yeah. It’s a long story in many ways, but I can sum it up in saying that the key thing for me was that I have two daughters that developed Type 1 diabetes, and that was a total shock that happened during my residency, and my wife had to stop her residency to actually take care of our children. Slowly but surely, we were exposed to dieticians and the conventional wisdom that was out there in regards to low-fat diets and whole grains and no food was restricted in diabetes, but in reality, when the rubber hit the road, we were actually managing blood sugars on young children.

We found out that a lot of those things, they simply didn’t work, because we’d find our children eating bread and pancakes, and their blood sugar would go up to 400 or 500, which your blood sugar’s supposed to be 100. Grace, my oldest daughter, when she was in the hospital with diabetic ketoacidosis, her blood sugar was 722.

Jonathan: Oh my gosh!

Dr. O: Yeah, obviously that was the worst. There are people that go in with 1000 we were told, and I’ve seen patients that sick during my training, but bringing it back to my own personal experience, I knew a lot of this stuff was wrong. So I started experimenting with things that were alternate hypotheses, which I found out were actually the original ways to treat diabetes in terms of carbohydrate restriction. , things like glycemic index.

Slowly and surely, we got to a point where we were getting things like wheat out of our children’s diet completely and using alternative flours like almond flour, for instance, to cook with and make pancakes and things that they liked with. I saw this movie called Fat Head, which has been a very popular movie for a lot of people who have been trying to lose weight, and it’s this underground movie, which was made by this guy named Tom Naughton, who I know you know as well.

Jonathan: Tom has actually been on the show, so his show will be airing here shortly, so…

Dr. O: Oh! Yeah, that’s wonderful. Yeah, so Tom’s a great guy, saw this movie, and I was like, “Wow! I remember learning this, but I kind of forgot it somehow.” When I saw the movie, I started experimenting with more fat in the diet and more foods that were “unhealthy for you” like eggs and high-fat dairy and meats that were not necessarily super lean cuts of meat, but meats that you like to eat, like a skirt steak, for instance, or a flank steak or something like this. Guess what, my kids’ blood sugar was a lot better controlled, and what I found is that I started to lose a lot of weight and in fact, when I cut out wheat, and I cut out all the bad carbohydrates that you have in a modern diet, and I also added the fats and proteins and the nutritious foods that were previously off limits, I found myself back at my high school weight. I found myself fitting into clothes I had not fit into for twenty years, so when I realized that, as a doctor, I realized I had to share that with people.

That became a passion of mine, and I wanted to try to find a way to integrate it on a daily basis. The best way that I really was able to do that is, as a plastic surgeon, people are always looking to look younger and feel better about themselves, and they want better-looking skin, and they want to look better. The key to that is actually on the inside with the food that you eat, because one of the things that I say is that if your eyes are your windows to your soul, then the skin is the window to your general health, because so many medical diseases express themselves through things like rashes and certain types of things on the skin.

I don’t want to go too deeply, I’m going to get too wonky, but there are certain things that happen to the skin which are signs of, for instance, thyroid disease or liver disease or cancer or autoimmune disease. I realized that I had to really focus on my little band of narrow knowledge, because everybody has a little narrow band that they’re really good at. Mine was surgery and plastic surgery and trying to integrate diet and nutrition through the skin and through skin health.

I also do some hand surgery as well, and I also realized that a lot of my patients were actually suffering not necessarily from carpal tunnel syndrome; they were suffering from Type 2 diabetes which was causing carpal tunnel syndrome. Once again, I could apply diet and nutrition and lifestyle to help them as well.

Jonathan: That’s amazing! I love so many things about what you just said. I actually took almost a half-page of notes here, so just lots of good stuff. Let’s start from the end and work our way backwards.

Dr. O: Sure.

Jonathan: So what you mentioned there about individuals coming in with “carpal tunnel syndrome” actually discovering, “Wait, no. You actually have a broken metabolic system, and one of the effects of that is causing you this pain in your hands.” How much of that do you see where individuals are coming in with a so-called acute problem, but it’s actually just a manifestation of this much deeper, chronic metabolic breakdown?

Dr. O: Oh, I think that’s happening more and more. I would say the majority of patients that I see for carpal tunnel syndrome — not the majority, but I would say one-third to maybe one half have Type 2 diabetes. As you age, you’re at higher risk of developing Type 2 diabetes, whether you’re skinny or not, because the modern diet that you’ve been eating for fifty years, and there’s a lot more people who are obese. So yeah, I think that’s one of the big problems with medicine today is that, as a doctor, I was trained to identify and diagnose a problem, but I wasn’t necessarily taught on how to think about why that problem was there.

We spent a lot of time studying pharmacology and pathology in medical school. Basically identifying disease and treating disease, but when the toothpaste is out of the tube, you’ve got to clean it up. What you wanted to is avoid spilling all the toothpaste, and so that’s, I think, the philosophy, and that’s really the challenge of 21st century medicine, because the costs of medicine are high, the diseases are chronic. We’re spending a lot of money. We have to really look back and see what’s causing these diseases and what can we do to help prevent these diseases.

Jonathan: Well, I’m going to clap over here. I hope that I didn’t screw up the audio too much, but I think everyone should just print out the last three minutes of dialogue from Dr. O and just paste that on your wall, because I couldn’t agree any more. Dr. O, I want to unpack that a little bit, because one thing I’ve found fascinating is just talking about your training as a physician, a highly trained specialist, plastic surgeon, in one of the largest cities in the country, so obviously at the top of your field.

What I hear medical professionals telling me is that what they are often taught from a nutrition perspective and an exercise perspective in school is essentially the same thing that people were being taught forty years ago, which is eat a low-fat, low-protein, high-carbohydrate diet and do as much aerobic exercise as you can possibly do, and that literally was written down as the truth forty years ago and continues to be taught as the truth today. How accurate is that?

Dr. O: Well, it’s funny, Jonathan, because what I think happened, I have a theory on this. Obviously, the movie Fat Head explains a lot of the politics in terms of the scientific data getting out there and which scientific theory won out in the end, but I think really what it all boils down to in regards to — doctors are simply not…

Our job is to identify and treat disease, and that model was good for a long time, because the biggest killers were infectious disease, things like trauma. Things that killed people were not cancer, they were not diabetes. And now, we, for all practical purposes, really got a handle on infectious disease, not only because of the antibiotics that have been developed and some of the vaccinations that have been developed, but just simply because our quality and our standard of living has gone up.

We have access to clean water, we understand concepts of hygiene and washing your hands. We have generally better nutrition in terms of calories. People are not starving, let’s put it that way. But things changed, and medicine simply did not change with it, because now the challenge is how do we keep the horse in the barn? How do we prevent illness? It’s two competing paradigms, and you’re basically applying what’s called rescue care. That’s a fancy term for it. Rescue care — we’re very good at that in the United States.

If you’re in a car accident, and you go to a trauma center, the chances of you surviving today are much better than they would have been a hundred years ago or even fifty or even forty years ago, but you can’t apply that rescue care paradigm to the chronic illness explosion that we’re having. You need a different paradigm, and that paradigm is prevention. As a plastic surgeon, one of the reasons why I got into it, why I can see things this way is because plastic surgeons are basically professional jacks of all trades, and we basically take from a lot of different surgical specialties.

We operate from head to toe. We have to innovate and solve problems, and that’s one of the reasons why I was able to stand back and say, “Hey! Something’s wrong with the way we’re looking at the problem.” I think that’s a short long answer, I would say.

Jonathan: I love that! What you just described is really, I think, on point, at least in my experience, which is certainly not nearly as deep as yours, but that we’re practicing in the model of a half a century ago. It’s not necessarily to say that model is bad or wrong, just like after World War II, our government meant well.

They thought our country would not have enough food, so they went out of their way to provide subsidies for nonperishable foodstuff, so that people wouldn’t starve to death, and they had a noble intention. That worked after World War II, but that was an old model. We don’t need more starches and sweets. We don’t need to encourage people to consume them anymore.

Dr.O: Right.

Jonathan: This rescue model, it’s fine. If you have a car accident, and you need to apply it, then that’s great, but to just take what we did fifty years ago and to blindly apply it today, I can only imagine that’s not the way other fields of medicine work. I can imagine when you’re performing many of your surgeries, those surgeries are not performed in the same way they were performed forty or fifty years ago.

Dr.O: Absolutely. The technology has improved immensely in terms of whatever you look at; anesthesia, hospital care. Whatever you look at, the technology has improved immensely, and as a result, the rescue care paradigm when it’s applied to rescue care like trauma or a liver transplant or something like this works beautifully well. But guess what? It doesn’t work that well when you have diabetes or hypertension or whatnot. People put you on a medication, or they treat you in a certain way. They put a stent if you have a heart attack, but they’re not treating the underlying cause.

Jonathan: Well, it’s almost like double-layered problem. So it’s like one, where someone comes in, and they have this chronic condition such as diabetes or hypertension, and first, it sounds like we look at them and we do the rescue model, like what can we do now? What can we prescribe? How can we try to jam the toothpaste back into the tube, for lack of better terms. But then there’s even a second level where it seems like for a lot of physicians, the “prescription” they would write to a diabetic patient is you need to eat more whole grains.

Dr. O: Yeah.

Jonathan: So it’s like they come with the wrong paradigm, and then they actually get the wrong practical advice, because that’s the advice we had forty, fifty years ago.

Dr. O: You’re absolutely right about that. The thing is it’s because doctors don’t have the time, necessarily, to sit back and think about this. For me, I probably would have been in the same situation if I didn’t have a kid that had diabetes. It took a shock to the system, because you can have this, I guess what they call cognitive dissonance, or just basically two conflicting ideas in your head, because if you really think about it, as a doctor, you studied anatomy.

You studied physiology. You studied biochemistry. You know that if you eat sugar, it raises your insulin. It raises your blood sugar. It’s not a good state to be in. On the other side, you are saying a low-fat diet that’s the ADA diet, that’s the AHA diet. It’s the diet that’s prescribed. Eat less, exercise more. It’s like you have these two conflicting things, and you don’t have the time to reflect on, “Hey, these are not meshing together, and maybe there’s another way to think about this.”

That’s part of what I do as a plastic surgeon, because really, when somebody comes to me looking for improvement on their skin, their health, their face, their body, whatever it is; if I took a cookie cutter approach and just said, “Hey, I’m going to just do this,” I wouldn’t have very many happy patients. But I have to step back, I have to look at the big picture, and I have to individualize, so in a way, I’m lucky that my kids developed diabetes. It was like a blessing in disguise. It’s one way to look at it. I mean it’s a horrible disease to have.

I hate it, but I learned so much, and I was able to integrate this knowledge as a plastic surgeon in the skills that I’ve been taught into something that I could try to share with other people to kind of illuminate them, so they could find their own way to health, and they could see some of the things that they were doing wrong and why they were coming to road blocks in their life.

Jonathan: Well, thank God that you have. Talk about taking lemons and making some lemonade — some low-sugar lemonade.

Dr. O: Yes.

Jonathan: You certainly have. I’m curious, Dr. O, since being someone who’s in or at the top of the medical profession, here’s another example. You give the great example of cognitive dissonance of you know what sugar does in the bloodstream, and yet you know the diets you’re prescribing, but something is not connecting those two bits. A great example, I was speaking with a Dr. Donald Layman over at the University of Illinois, so relatively close.

He’s one of the premier protein researchers in the world, and a quote during our conversation that I just loved that he said that I’d like to share here and get your take on is as follows: “All starches from grains are simply a long chain of simple sugars connected together. The term complex carbohydrate just means a long chain of sugars. As soon as the food is digested and absorbed, the body does not know the difference between a simple sugar and a whole grain.”

Now, just to distil that down, if you eat these magical whole grains as we’re taught, when it leaves your stomach, truly it is the same as if you drank a can of Coke. Now that is a fact. That is a biological fact, but why do we still get these recommendations? The USDA doesn’t say ‘fill a quarter of your plate with Coca Cola,’ but they still insist that a quarter of your plate has to be healthy whole grains. What’s going on?

Dr. O: I’ve thought about this for a long time, Jonathan, and I’m not particularly one who has conspiracy theories in the sense that there’s a man behind a curtain pulling all the strings, but I think really what happens is that you have the USDA that’s incentivized to promote grains, because they protect the interest of farmers and big corporations who produce a lot of grains. That’s where the subsidies go, so they are incentivized in a particular way. That’s trickled down through the scientific information and the guidelines of some of these bodies like the ADA for diabetes and AHA, The Heart Association. I think you have that going there. I also think you have a problem with just the average guy or even the average doctor understanding when you say the word complex carbohydrates, what does that connote? It connotes that it’s complex. It’s interesting. It’s good, it’s complex. It’s hard to digest, and that’s the imperfection of language.

I see this all the time in the sense that — not to go off too much on a tangent — but when we talk about the process of inflammation in our bodies, and the process of healing in our bodies, everybody thinks all inflammation is bad. The fact is you can’t live without inflammation. People think that when your body heals that it’s regenerating. In fact, it’s very interesting, because humans do not necessarily regenerate much of their bodies. The bones, to an extent, can regenerate, but the rest of your body heals with scar tissue.

It’s replaced, actually. So part of it, I think, has something to do with misaligned incentives, and part of it has to do with just conveying what the idea is through the imperfections of language. That’s kind of a double-edged sword. It’s hard to convince some people that complex carbohydrates or sugar or fat is not bad for you. Part of it is also the fact that — and this is probably the third part of the double-edged sword — we’ve been told so much that fat is bad for you that we just accept it.

This whole process of reiterating the same thing over and over again until someone believes it. It’s a complex psychological process. I think a fourth thing would be just the fact that people don’t always eat for nutrition. People eat for religious reasons or spiritual reasons or environmental reasons, and that’s some of the reasons why people would like to have more grains and vegetables in their diet, because they think that’s more on whatever level it is spiritually. Those are the main reasons that I think, and there are probably many more.

Jonathan: Absolutely. Well, this is an area where I think we could definitely talk for quite some time, but there’s one other area that I wanted to touch on before we wrap up today, Dr. O, and that is you mentioned something right in your initial story, which I really love, and it was something along the lines of this idea of everything, and I mean everything, in moderation is promoted as the only, let’s call it non-fanatical approach, to nutrition. Everything in moderation. If you talk about eliminating anything, that’s perceived of as fanatical. Call me crazy, but my opinion is that continuing to recommend a way of eating that has caused the worst healthcare crisis in the world — that is fanatical, but that’s just me. What do you think?

Dr. O: Yeah. Basically, in regards to everything in moderation, that had to do with the fact that with the diabetes educators and the nutritionists, there’s no forbidden food for diabetics. In one sense, I understood what they were trying to say, because the psychological weight of having this disease all the time and always having to watch what you eat and always being the only kid at a birthday party not having cake or a cupcake is a bad thing. But to say that there’s not foods that you should cut out in your diet? It’s ridiculous.

What are you going to tell a celiac patient, just have wheat in moderation? Or when you’re going to have somebody who has a deathly allergy to shellfish or eggs, and you’re going to say, “Oh, just have those in moderation, and you’ll be okay.” The fact is, metabolism and your health and your wellness, it doesn’t lie. You obviously cannot tell somebody who has celiac disease or allergies or something else that they can eat that food in moderation, because they can’t. And for diabetics, carbohydrate restriction is very important.

It’s a very good tool for a lot of diabetics to use and for most people as well, because one of the things that I learned because of my own personal story and eating like my daughters do, because I realized that the best thing that I could do for them was be an example, was that if it’s good for a diabetic, it’s probably good for you.

The only thing that’s different between you and a diabetic is that you don’t make insulin, but that doesn’t mean that when you eat wheat, your blood sugar doesn’t get jacked up, and you have to control it, and there’s not an inflammatory process and a whole hormonal cascade that’s going out of whack because of what you’re eating because you can make insulin.
Jonathan: What you just said is a spot on. If it’s good for a diabetic, it’s probably good for you. too. In some ways, I like to think of an individual who has diabetes as someone who’s walking on a balance beam that simply doesn’t have a net underneath them, whereas an individual who doesn’t have diabetes is walking on that balance beam but does have a net underneath them. Meaning for the diabetic, it’s just a lot worse if they fall. They have to be much more careful, but we all, even if you fall into the net, you could still hurt yourself, and if you fall in the net too many times, eventually the net’s going to break, and then you don’t have a net anymore. So your guidance is absolutely spot-on.
The thing that I think is also interesting, and I bet especially with your focus on skin health, I’m curious to get your take on so when people say, “We have to eat something, so when you eliminate these starches and sweets, what do we eat?” By and large, many of those calories are replaced with fats, which my research shows — it’s not my research, it’s really just human biology — is that we know it is a fact.
It is an undisputed fact. Even the USDA document that precedes the guidelines, this giant, long document that they have, on which this is all based acknowledges that the absolute human requirement for dietary carbohydrate is zero, which doesn’t mean we should all eat zero grams of carbohydrates. It just means it is not an essential thing for the body to have, or if you replace many of your starch and sugar calories with some protein and natural fats, because fat is required for hormone production and for cell production and for skin health.
That men, your testosterone levels are better. For women, your estrogen levels are better. Your skin heals. That essential nutrient, those essential healthy fats. When we increase the proportion of those in our diet, magic happens. Has that been your experience?

Dr. O: Oh yeah. I think one of the things that got me thinking about skin health and health in general in regards to fat is that after I saw Fat Head, I thought about something. When I was younger, we had a dog growing up, and it was a Yorkshire Terrier. One of the things that the person who sold us the dog told us is that if you want the dog’s coat to be really shiny, feed it a few eggs with his dog food. That just came into my mind after I watched Fat Head.
I was like there has got to be a connection here between humans, because when you look at us, we’re different, but in so many ways, we’re not different in terms of our physiology and metabolism. Yes, that’s one of the things that happened to me and especially to my wife that she noticed right off the bat is that — she thought I was crazy when I was doing all this stuff, because I was totally the proselytizer of the house for a little while. She was like come on, you’re crazy.

We started doing this, and she started getting all these — first of all, her tennis game improved immensely, so she loved that. She had way more energy playing tennis. All her friends were complimenting like “your skin looks radiant, what are you doing?”, and she’s like I’m not doing anything. I just cut wheat out of my diet and added things like coconut oil and eggs. “How many eggs do you eat?” Oh, we eat a couple of eggs every morning for breakfast. “Oh my God, aren’t you afraid of heart disease? Blah-blah-blah,” and you know how it went. My wife saw that her skin improved. She tells some of her friends, and their skin improved, and everybody became interested. Now my wife is the big person like, “Is this gluten-free? Let’s double check. Is it certified gluten-free?” and I’m like, I don’t know, I just bought it. It said gluten-free. “Let’s double-check.” She has become totally converted now.

That’s been very cool to see. Our kids’ health has improved a lot, too. I think that’s a really, really wonderful thing about the diet is because when your family eats healthy and everybody’s healthy, that makes your family life a lot better as well. That’s an important thing, too, because it’s not just about diet, but if diet can help you with that, then it’s worth it.

Jonathan: I think you hit the nail on the head there where it’s like everyone is happy, and the thing that’s great here is because you have things like these almond flours and coconut flours is that actually when you go on a SANEr lifestyle or a lifestyle where you’re getting your calories and your nutrients from things you can find directly in nature — these are savory, delicious. It’s not like you can’t eat sweet things anymore. You just get your sweet tastes from different substances. It’s not like you can’t eat anything that has a bread-like consistency anymore. You just make your bread-like things with different ingredients, and you have this wild palette of colors which paint a beautiful picture. It’s not like this low-fat, bland, boring, dry — It’s delicious! And it’s good for you, which is helpful.

Dr. O: You are absolutely right. It forces you to be a little creative, too, because I think a lot of people become very complacent. We live in a culture where we’e expected that if you take five minutes to microwave something, that’s dinner. That is so unusual to compare to the whole of human history. We’ve become spoiled with all these 7-11s thinking that you can just grab your food. It’s important. You’ve got to prepare your food a little bit and take a little investment into your food. You’ll see the results pay off, because I’ve got kids now — my daughters eat smelt.

They eat tuna fish. They eat sardines. They eat all of these wonderful things that most kids in their class are just like, “I would never even touch that,” or “That’s gross.” You know how it is. You really end up expanding your palate, because if you think about a low-fat diet or people who are obese, either they are very monotonous eaters — they’ll eat just hamburgers and French fries all day — very picky eaters or a low-fat diet. It’s all just grains and flavors. There’s no real variety to it.

Jonathan: In some ways if individuals could just stop eating off the children’s menu, and that’s so sad. The fact that a children’s menu is characterized by garbage food is a travesty in and of itself, but in a lot of ways, you’re exactly right. If we just don’t eat like a child, and we eat like an adult, health takes care of itself a little bit.

Dr. O: Yeah. No, you are absolutely right, Jonathan, without a doubt. That’s a great way to put it is eating off a kid’s menu. That’s something that we had to overcome when we ate out with our daughters, so our daughters would always pick out something from the regular menu and just split it. The kids’ menu was toxic with French fries, chicken strips, tater tots, hamburgers that have no meat in them even. It’s just a little sliver of beef, and it’s all bun. It’s terrible, and then you put a bunch of ketchup on it.

Jonathan: That’s no good at all. Well, Dr. O, this is just awesome stuff. I really appreciate what you are doing from an integrative perspective I think is brilliant. Certainly you’re providing a great service to all the wonderful inhabitants of Chi-town, as I fondly call it.

Folks, if you haven’t listened to Dr. O’s show, please go up onto iTunes and right next to your subscription to the Smarter Science of Slim podcast, search for the Dr. O Show. It’s a wonderful resource. Check him out at midwestprs.com. He’s got a wonderful blog up there, and I’m sure you’re going to continue doing good stuff, Dr. O. Thank you so much for all that you do and all that you represent and for joining us today.

Dr. O: Jonathan, thank you for having me on the show. It was a real pleasure and also thank you for all the wonderful stuff that you do. Your book Smarter Science of Slim is something that I recommend to a lot of my patients and a lot of people that I know, because it is so well-written and so easily accessible and dispels some of these ideas that have been engrained in us, in terms of grains and fat and calories, in a way that’s really accessible to the person who has not necessarily a scientific mind, but wants to know this information. So thank you once again for all that you do.

Jonathan: Oh, my pleasure, Dr. O. Well, and thank you, listeners for listening. Please tune in next week. We’ll continue to tell how can you eat more and exercise less but do that smarter. Talk to you soon.

This week we have the pleasure of hearing from S. Andrei Ostric, MD. “Dr. O” is a Plastic & Reconstructive surgeon practicing on the Northwest side of Chicago, the host of the “Dr. O Show”, and is here to tell us about a smarter approach to medicine.