Transcribed using AI transcription services, errors may occur. Contact Mikki for clarification.

00:03
Welcome, hi, I'm Mikki and this is Mikkipedia, where I sit down and chat to doctors, professors, athletes, practitioners, and experts in their fields related to health, nutrition, fitness, and wellbeing, and I'm delighted that you're here.

00:24
Hey team, Mikki here. You're listening to Mikkipedia. And this week on the podcast, I speak to Dr. Kwodwo Kyeremanteng about health in the time of COVID. So Dr. Kwadwo is an ICU and intensive care unit doctor in Ottawa, Canada. And he's also got his Master's of Health Administration. He's a podcast host solving healthcare.

00:49
and he runs a resource optimization network, which is a research institute with the goal of transforming healthcare and optimizing the use of healthcare resources. Dr. Kwadwo was frontline as the first cases hit Ottawa of COVID, and he shares his experiences and perspectives. And he was also a go-to for mainstream media. He talks about what he saw day to day versus what was being highlighted in the media and his realization that

01:18
underlying poor metabolic health was a big driver for the severity of the illness, yet this was not a message that was readily put out there by mainstream media. So we discussed that and while the dust has almost settled on COVID, the PTSD associated with it totally remains and we chat about how important that metabolic health piece is, not only to protect you in the here and now, but

01:45
ultimately in the long run for optimal health. And Dr. Kwadwo is so passionate about this and you get that from his sub stack, from his podcast and just from how he talks about this topic. And I just think his experiences of it is a really great take on some of the challenges that existed for not only him working on the frontline, but actually him as a messenger in and around that COVID times. So we talk all about this and more.

02:14
on the podcast and I don't know how many of you will be familiar with Dr. Kwadwo actually because I came across him at Low Carb Denver where I was a participant and also was an MC and I was his MC actually on that Sunday. So Kwadwo Kyeremanteng is a critical care and palliative care physician at the Ottawa Hospital. Dr. Kwadwo cares for the sickest of the sick patients in the intensive care unit.

02:44
And as a researcher, he's interested in using ICU resources more efficiently and improving access to palliative care in the ICU. To help do this, he founded the Resource Optimization Network, a multidisciplinary research group working to reduce health spending in this area without compromising care. In September 2019, Dr. Kwadwo launched his ever-growing podcast, Solving Health Care.

03:09
And these podcasts feature interviews and discussions on the topic of improving healthcare delivery in Canada, but also about healthcare at the individual level and metabolic health and what you can do to help yourself. Underpinned by the values of cost-effectiveness, dignity and justice, these podcasts will challenge the status quo, leaving no stone unturned as he explores gaps, assumptions and different perspectives in the pursuit of finding solutions to problems in Canada's healthcare system.

03:39
So Dr. Kwadwo Kyeremanteng can be found at the quadcast.substack.com and there are links in the show notes to that. And just before we kick off into the interview, which I think you're going to love, just a reminder that the best way to support this podcast is to hit the subscribe button on your favourite podcast listening platform. That increases the visibility of the podcast in amongst the thousands of podcasts that are out there that people could choose to listen to. All right, team.

04:08
Please enjoy this conversation that I have with Dr. Kwadwo Kyeremanteng

04:17
It's funny actually, I'm an early morning person and there's a real sort of like virtue signalling around being like an early bird, you know? Like, hey, am I the better person because I get up at five? Exactly, like all that productivity stuff about all these gurus waking up mad early. I know, except of course, the people like me that get up mad early are also mad tired at about four o'clock and do bugger all basically. A hundred percent, yeah. I think naturally I'm a...

04:47
a bit of a owl, but the kids have ruined that. Or improved that for you. I like that reframe. Yeah, it's always about the reframe, Quad Joe. So, hey, thanks so much, Tana, for taking the time to speak to me today. So, your talk at Low Carb Denver really resonated with me. And I think it was, you know, I've always seen Canada and New Zealand, we're like,

05:16
you know, cousin bros, you know, I mean, we love Australia because Australia is like our annoying older brother, but you guys have always sort of like, you're just there. And there were a lot of parallels I felt between New Zealand and Canada throughout the pandemic. And, and even though the pandemic is, you know, people could argue it's done and dusted and we should all move on. I just, I feel like there's a lot of PTSD still actually that, that is present and, and almost unrecognized, which

05:46
isn't really the topic of what we will potentially talk about today, but I just think it's worth acknowledging. And so I think that's one of the reasons why I was sitting there in February, listening to you talk. And it really just, yeah, that's the thing that I sort of thought about Quadro. So thank you for taking time to share that with my listeners. Well, you know, what you're describing is, we felt it.

06:14
Like I still see the PTSD, like people, yeah, like I completely agree. Yeah. And it's, you know, I speak to clients actually. And of course we're going to get into your background in a minute, but just because we're on it, like I talked to clients about their nutrition and, um, and every day, and there's just this element of stress that has yet to subside and it's this undercurrent. I mean, life is stressful anyway.

06:44
You know, there are so many things going on, but then layering on top of it, they talk about these habits that they developed in lockdown. Yet lockdown was, you know, over 18 months ago now, yet they still, they have yet to sort of get back to, I guess, a sense of balance within an already sort of unbalanced life. And I don't know if that's what you've also experienced. Oh, 100%. The mental health side, like the people are just, it's like, I feel like the...

07:11
underlying tone, they're hypervigilant. And then their ability to also get back to where that we've been, like socially and all these things has been restricted or it's been impaired, I should say. I definitely concur. Like I definitely agree with what you're saying. I see it on a regular basis. Even personally, I'll be honest with you. I'm not as social of a butterfly as I normally was. And-

07:38
I think this is because I haven't had to exercise the muscle to the same degree. Yeah. Oh, and isn't that it? Right. If you, you wasn't use it or lose it. Yeah. Kwadwo, can we take a step back and start with a little bit of your background? So sort of professionally, what is it that you do? What is your sort of day to day? All right, Mickey, I'm Kwadwo Care Manager. I'm an ICU doc, also department head of critical care at my hospital. I have other jobs in palliative care and

08:08
When I'm not working in the ICU, I do podcasting, I do research. Uh, and so busy and you know, the day to day of the intensive care life is, is, is wild. Like I, I start tomorrow in the ICU, start off bright and early. We'll do some teaching to the trainees. Start seeing our patients and the challenge of the intensive care unit is you're not sure what to expect that you sometimes the patients are super stable.

08:37
All of a sudden you'll get somebody that's really sick, bleeding, that needs intervention sooner than later. So that's part of the challenges of working in the intensive care unit. You're not sure what's gonna walk through the door, but also that's part of why a lot of us are drawn to it. Yeah. Every day is a bit different. And so yeah, you spend your day managing the sick patient's communications, a big piece of our job, but.

09:06
Yeah, it's a heavy job, but I would not want to do anything else, Mickey. I love it. So interesting, Kwadwo, because you've got that aspect of the acute sort of, you know, life or death situation. Yet a lot of the content that you put out there in your podcast and your sub stack is about health and wellness and nutrition and exercise and lifestyle and metabolic health. So of course.

09:34
In your talk, you talked about how you were frontline in COVID with the first COVID patient, really, that came through Ottawa. That's right. Hey. Yeah, through our hospital was the one that first. Yeah. Yeah. Can I ask, Quadro, like that other, this other element of your interest around metabolic health and nutrition and wellness, was that sitting in the background as the pandemic sort of kicked off or was this something that developed after? Like, what is that timeline like?

10:03
Yeah, Mickey, great question. It was actually, if I'm being honest, it was during the pandemic. I always had an affinity for like healthy living. We were always trying to be example for our kids, but it wasn't something that was of peak interest for me. And then the pandemic hit, and then you realized how metabolic syndrome was a massive driver. Like, I don't know if people still don't

10:33
in my three years of taking care of COVID patients, I still haven't taken care of somebody that was completely healthy. And I'll give that caveat, I'm sure it's happened elsewhere, but even the young patients we saw were extremely obese as an example. And they were deemed healthy because they weren't on medication, but these were unhealthy folks. And my area of research has been typically on how we can be more effective with our resources. And it all clicked together with

11:02
to me that if we emphasize prevention, then people aren't coming into the intensive care unit and suffering from the PTSD, their anxiety, depression, their deconditioning, how it affects the family, because often if you land in ICU really sick, you're not coming out the same and your family's gonna have to mobilize resources. But it was a big aha moment for me to say, why don't we focus on prevention?

11:30
But then the crazy thing for me, Mickey, was as a guy that trained in, first it's internal medicine, so you learn nuances of organ function and such, I did not know you could reverse type two diabetes. I did not know, that's not something we learned about in medical school. So then you're telling me there's ways that people can improve, like reverse their metabolic syndrome, reverse their type two diabetes? I was like, okay, why are we not

12:00
preaching this. Yeah. Do you know what I mean? Yeah, yeah. 100% know what you mean. It's crazy, right? And there are so many like misconceptions out there. Like I was actually doing a talk, it's a little bit of a tangent, doing a talk a couple of nights ago with a group of people for my sort of fat loss program and I was talking about protein and how there are meta-analyses to show that, you know, even people with the very, you know, who

12:25
You know, people at the very end stage, kidney disease, they're people that we need to think about with protein, but protein is entirely healthy for everyone else. And there are doctors on the call and they're like, hang on, my colleagues would really sort of challenge that. And I'm like, the information is there, but it's just not consumed by people I feel need to consume it, much like the fact that type two diabetes can be reversed. 100%, this is where I'm, this sounds dramatic, but my mind is completely

12:56
Like I'm questioning everything now. Yeah. Because the way we educate, the fact that it's so hard for colleagues like myself to comprehend or to have that information available despite there being several studies to illustrate the benefits of, or whether it's low carb, high protein, keto, and reversing metabolic syndrome. Like we're so slow to adapt and we're...

13:25
maybe we don't seek the information. I'm not sure where the barriers are, but to me it was almost concerning that, you know, if I'm someone that I feel is relatively in the know or relatively attuned to what's the latest and greatest in my field, and I was clueless. It took reading Jason Fung's book, or somebody gave me Jason Fung's book. It took listening to more podcasts, and then hearing the likes of

13:54
Rob Wolf, the likes of Brad Sher, and saying these things, I was just baffled. And I almost didn't believe it. So I had to do my own digging to say, are these guys really know what they're talking about? So Quadro, when was that for you? Because first of all, actually, can you, if it's all right, can you describe the experience of what it was like to be frontline in COVID at that time where...

14:20
No one really knew what was going on. No one, all we heard, like, do you know what I actually remember? You know, Peter Attia. Yeah. Yeah. So I was following a long term follow of his. And I remember we were at home here in New Zealand and it was like February. And I remember him sort of coming online and talking more. I had seen a little bit in the paper. Wasn't a big deal. But then he gave this massive, like, live about how he had been up all night for for like the last seven days because of this.

14:49
this thing coming out of Wuhan and I'm like, oh my God, I think this is something that we need to be concerned about. But then of course, you're in ICU, you come across the first sort of COVID patient for your hospital, like, was there a lot of fear for you at that point? Like, what was it like in that situation? Yeah, Mickey, it was scary. We all were trying to put on our courageous faces on and being included.

15:20
But we all saw what was happening in New York, Italy at the time, even Seattle seemed to be going through something. And you were concerned about just being overwhelmed. You were concerned about your own safety. You were concerned about bringing COVID home to your family. Like at the time, an immunocompromised caregiver, my mother-in-law who was, you know, at the time in her late 60s.

15:49
you worried that there's gonna be risk here. And so we were all walking on eggshells. Like I can't describe that feeling when that first patient came in, because we were all, well, quiet is the word. And I personally, those that know me well, I'm not a quiet person, but when I get anxious or when I get nervous, I just quiet down. And I felt that was the general.

16:19
But then we realized soon after that we were able to protect ourselves. In Ottawa, where I'm from, we were getting overwhelmed in that first wave. And then we saw, like anything, you try and look to try and find some trends. Like what were the common threads amongst the patients? And it became abundantly clear that there was a link with

16:47
either being extreme age, immunocompromised, or metabolic syndrome, obesity, active diabetes. Was that, and in terms of the general information that the public was getting at the time, was that congruent with what people were hearing, or was it this climate of fear? And I think I asked that because in New Zealand, that was not the message. The message was, we are all at risk, and we all, you know,

17:15
And it was a real climate of fear. What was it like for you guys in Canada? Same thing. That was part of the reason I became more vocal when it came to the pandemic. My wife's a psychologist, and I remember sitting down for dinner, or post-dinner, maybe even when the kids were down already, and we were talking about all this fear messaging. We'd have this conversation like,

17:44
I told her, like, our kids, I'm not worried about our kids, I'm not worried about us from what I'm seeing. Like, unhealthy folks are getting sick from this. And like, the literature was there, but that wasn't a common thread coming through the media at all, right? Like, it was, we all need to be fearful. And then we sat down and we said, like, we need to be that, a balanced voice. We need to be able to come out and say what we're actually seeing and why.

18:14
we need to have a holistic approach to this thing, because there's gonna be some consequences to our lockdowns, our restrictions, the way we're approaching this. And we knew there was a risk of putting ourselves out there. And for those that, I should have prefaced this, those that are listening that are not from our area, I did a lot of mainstream media locally and nationally to give COVID updates as an ICU doc. And I would often preach

18:43
saying like, this is what we're seeing, and try and create a little bit of balance and less fear. Like we control what we can control, right? And sometimes it was, most of the times it was well received, but the conversation though about metabolic health, nobody wanted to bite on that. Yeah, interesting. And were your colleagues in the same boat, Kwadwo, in terms of, you know, you had this sort of realization of, you know, these are-

19:11
people who aren't healthy, maybe what we need to do is sort of focus more on that sort of health, even though obviously ICU is not an area of prevention, but could you have these conversations with your colleagues or was there a little bit of a disconnect for, in some way? Yeah, no, good question, Miki. It was a mix. Like most of the ICU docs at some point realized that this wasn't a disease of healthy folks. Like they...

19:41
they came to the same conclusions at differing timing. The perception of obesity being a risk factor, I think, was somewhat a bit slower to acknowledge that. And the nature, though, of most of my colleagues was we realized that there was less to be...

20:10
anxious about as time went on, because we were in it every day. We had the exposure, because I mean, think about it, I don't know about for you, Mickey, in that first year, or say six months, did you know many people that had COVID at that time? You know? Yeah. No, we had like, yeah, not at all. Like we were very, like I think we got into, I remember someone being blown away that New Zealand got locked down, because there was one case.

20:37
of, I can't remember which wave it was, I get confused about the waves, but yeah, no, very few people. And if you did have it, there was something seriously wrong with you. It was almost that sort of mentality. Yeah, no, there was a lot of COVID zero talk in New Zealand now that I think of back. But yeah, so we had the perspective of seeing it and being more familiarized with it. So it was less of a phenomenon, less scary.

21:05
And so a lot of my colleagues had that perspective with time, but the talk about prevention, it was a safe conversation to have. Most of them saw what, you know, acknowledged eventually about the risk factors. But I mean, even I think of one colleague, he lost 30 pounds as a result of what he was seeing in that first wave. He was like, I'm not gonna be, I'm not gonna be a stat.

21:34
Yeah, wow. Through fasting and low carb, lost 30 pounds in a relatively short period of time and knew that it significantly reduces risk. Yeah, do you know here in New Zealand, Kwadwo, there was never a talk about, if I think about that, we had daily updates, I'm sure everyone's the same, daily updates with COVID numbers and stuff. And all of the messaging was around washing your hands and six feet away or...

22:03
I can't remember, something else about these sort of like three things that, you know, this would keep you safe. And there was never, check your vitamin D. There was never get out for a walk and there was never think about your health at all, actually. And in fact, it almost became taboo to talk about health as if it was blaming people for getting COVID and it was on them and it was their personal responsibility. It was just this very strange...

22:32
environment where as a nutritionist, if you said anything about, hey, here are some things you can do to help prevent the possibility of you getting really sick, it was seen as irresponsible and it was seen as white privilege and, and all of these things, like it was very strange. This was, this drove me nuts. Yeah.

22:58
I've never seen anything like it. It was like we lost our minds. I mean, we did lose our minds. You're telling me because you weren't staying exactly on message, you're dangerous? That was the gist of it all. Like you're not talking about either getting, if your first few messages weren't, you know, stay home, six feet away, mask, get vaccinated. Like if you didn't mention those things out of the gate, you were controversial and.

23:26
This is such a disservice to the population. Like, think about the opportunity. Like, people were so fearful and they wanted to be empowered. And you provide them with the knowledge or the skills to get healthier and also put an emphasis on not only you reducing your COVID risk, but you're reducing your risk of cardiovascular disease, stroke.

23:57
cancer, all these things, you're gonna improve your risk for, dementia, like why won't we just talk about that? Why don't we talk about getting healthy? And it's not mutually exclusive. You're not gonna over complicate the situation by people saying, hey, this is also something that you need to take care of. But...

24:25
I don't know, I really felt like this was a missed opportunity. And, um, hopefully in the future we, we, we learn from it. Yeah. I'm not as optimistic about that actually, if I'm honest, I just think about, you know, public health just the way that is like, we're like, we've known for years about, um, the, the risks sort of associated with obesity and, um, carrying excess body fat, but also there is that sort of, um, alongside that is this.

24:55
you know, fat shaming idea. And if you're talking about obesity, then you're not, then you're making people feel bad about themselves. And I don't know, if I think about the population, like nothing is, like we've, nothing has changed in terms of those health stats. Like everyone just, you know, I don't know how you're gonna turn the, how people turn the tide on this stuff, because it certainly, I don't think things have changed or been better.

25:22
over the last, I don't know, 20 years compared to say, you know, 20 years earlier. I don't know. It's true. It is an uphill battle. I guess when I was saying, I hope we learn from this, it's more that next time something like this comes around that we're not going to be so, like we're not going to just restrict the messaging. We're not going to just be so antagonistic. But you're right. I mean, if you look at the...

25:52
BMI is in most people now, you look at the rates of obesity, it's all gone up, courtesy of the pandemic. So you're right. We're not talking about it. This fat shaming culture, I mean, I might get in trouble for this, but I think you do, I'm just more of being honest with people. If I know you're at risk because of your weight, I will tell you. Like if you, like I see it on a daily basis.

26:21
the risk of obesity and what it leads to. Even if you come in for this simple problem, you risk the complications, infections, blood clots, everything gets more complicated, just death. Like, I mean, I think about some of our patients, we had trouble ventilating them, like getting enough oxygen and clearing their carbon dioxide because of their obesity. You know what I mean? Like, this is the reality. So if...

26:51
I'm not gonna sugar-coat it if you're putting yourself at risk. But it's one thing to just say, don't eat donuts. The other thing too that both of us could hold our heads up high is that we want to provide you with the tools on how you can get healthy and create healthy habits and staying positive and being in love with the process.

27:21
as opposed to being more focused on the outcome. Like all these things we want to be able to deliver to our clients or our patients so that they can achieve their goals. Or it's one thing just to complain about it and shame people, but at the same time, we're providing tools, we're providing access to folks to get healthy. Nina, Quadro, I've heard you talk on another podcast just about the...

27:51
how you and of course your wife as a psychologist as well, like it's in her area, how the, what you notice in terms of the impact of the strategies taken with regards to say school lockdowns and gym closures and things like that. Like have you noticed a shift or a change in like children and kids as a result of those tactics because here in New Zealand, like, so we had,

28:19
Here in Auckland, particularly the latter half of 2021, we were still holding strong to those lockdowns. Like we had 108 days lockdown in Auckland, kids not at school for all of that time. And now what it appears like, schools are very quick to close for things that I couldn't have imagined they'd close for. It rained the other day, we had school closures, and I'm like, it's just too, it's...

28:45
I don't know, there's just this, it feels to me like there's a real sense of panic and fear not just around this, because this is sort of largely sort of, you know, gone now, but in other things as well. Is that, have you noticed something similar or what's it like for you? A hundred percent, there's so much to say here. So for more of the serious concerns, we know that childhood obesity, type 2 diabetes were on the rise.

29:13
We know that eating disorders were on the rise and the fact that all these mental health services for children have been overwhelmed means that a lot of people aren't getting access. So this problem is not minor. I can look at my own kids, like I've seen them bounce back personally. Like I think they bounced back from the impacts that they had in terms of their mood and their energy.

29:42
But that took some time and we have resources, right? Like we're, you know, we have parents in, their parents are in healthcare and are like on it, right? And the impacts to me have been, I'll just say it's unforgivable. I, you know, even little things. When we'd, we had this approach of this, you know, let's stop COVID at all costs, the risk to the kids. Think about even the RSV.

30:12
RSV surge. None of these kids had exposure to a cold, like no kids were getting sick. And that lack of exposure, you know, you'll see some people with differing opinions. And just, from my humble opinion as not an immunologist, but as someone that went through medical school is, your lack of exposure to pathogens is not healthy.

30:40
whether it's wrapping up your immune system, maturing your immune system, people who differ, have different opinions about that. But the lack of exposure to pathogens, to me, is not healthy. The fact that you would have two-year-olds that have never played with another child before, maybe, who knows how that's gonna impact their development. We'll find out. The impact on the kids, this is where...

31:09
I'd like to think of myself as a bit of a forgiving person, but this to me when we knew their risk was so low was unjustifiable how we treated our children. Yeah, yeah. So interesting. And I feel like the, that despite there being again information out there on the risk associated with children, it was almost, it was a...

31:36
I don't know if ignored is the right word, but it certainly wasn't acknowledged, you know, like, particularly here anyway, you know, that was, and it was very much a, that sort of culture of, you know, we must protect everyone. But then also, when the vaccine was available, you know, there was that

31:56
I don't know again what it was like in Canada, but in New Zealand, if you didn't get vaccinated, then basically there were two tiers of society. So that was one thing. And regardless of how you feel about vaccination or not, because vaccinations, I mean, they've saved people for hundreds of years. I don't know how actually what the history of vaccines are like, but yes, they save lives for sure. But then when it became clear that it didn't stop transmission.

32:25
the messaging on the, I don't know, on the media was still, protect your family, get vaccinated, but nothing about go for a walk together and, you know, get some exercise. Yeah. This is where I found it troubling as well. And I want people to understand this perspective. At some points during the pandemic, I'm having our staff, all of us sleeping in the hospital doing hours that we

32:55
that were insane to be able to provide care for our patients. That being said, the fact that we didn't give people the rights when it came to a choice about the vaccine, to me is wild, like wild, especially as we learn more and more about the transmission side. But I come from a country really where you give people choice. And

33:24
When you had a situation where, like in my country, this is where I think we lost our way and lost our values. Someone chose not to get vaccinated and they had a loved one across the country. There was no, they weren't allowed to travel to go see their loved one. And the thing that people would say, oh, they're so selfish and what have you, but.

33:49
Listen to this story. Some people, it's not as black and white as you think. There's going to be the people that you hear about on Twitter, on the news that are like, don't ingest me. I'm anti-vax or whatever. Anti-vax. I'm not going to take any vaccine or whatever. But then there's the people that had an immune disease. I knew a guy that had a neurologic disorder that they were worried would ramp up if he took the vaccine. I know somebody that had anaphylaxis, needed to close to be on a ventilator because of the vaccine.

34:19
and if it was forced to take a second dose. You know what I mean? I know, being in, I don't know how common knowledge this is in New Zealand, but the black communities, indigenous communities are often, they don't have trust in the system because of historical mistreatment. And so when somebody comes in and tells them that you gotta take this, they're naturally hesitant because of the way they've been treated in the past.

34:48
Now you're going to punish them for wanting to take time and think about their decision? No, man, what country is this? Where are our values? And the thing that we knew about the vaccine at the time is if I take the vaccine, regardless of your views on transmission, if I take the vaccine, I will protect myself. So that is what matters. Yeah, yeah, that should be your choice. I don't care.

35:16
with the person beside me has done. Because I know I've protected myself. Do you know what I'm saying? So like, why are we losing our minds over this? Didn't like, it was beyond reality. I kept on thinking I'm in the Twilight Zone. I'm like, how are we treating people like this? When have we ever treated people like this? It's 2020 at the time, 2022. Stop. Oh my God. Very similar, very similar.

35:43
And I wondered what it was like in Canada as well. But again, there are so many similarities between New Zealand and Canada. Like you couldn't necessarily share the views publicly, like particularly at the time. And even now actually, like when I see things in the media around something I'm not as, I went through a spate of being a little bit quick probably to share my opinions and I...

36:10
Definitely like, and afterwards I questioned whether or not that was necessarily, um, uh, whether I should have done that. And now I'm just a little bit, um, I don't want to focus and dwell on it, I suppose, but I, I, I like having this conversation now about sort of reflecting back on just how strange the whole thing was. Oh, and I don't get me wrong. I do the exact same thing. I, I had to, I can't count how many times I got slack for it.

36:38
retweeting something or commenting on something. You know, I had attacks on our family online. I've experienced it all. And, you know, it was all often would stem from Twitter. If I'm being honest, it's almost always with Twitter, which I always said was so medieval how people would treat each other on that platform. But I kept on saying, like for the most part,

37:07
Most of the people that would have the loudest voices when it came to Twitter, the Twitter mob or COVIDians, had never treated a COVID patient, or at the time never seen a COVID patient. So with all due respect, walking a day in my shoes or coming to our ICU and then tell me that my perspective isn't valid. And to be honest with you, I don't mind differing opinions. I've been with other intensivists and we've...

37:36
or infectious disease docs and had civil disagreement. And I've been wrong about certain things. Like I, in April, 2021, with the vaccines out, I did not think our third wave was gonna be massive. And it was really massive. Yeah, yeah. And I thought because of us vaccinating the most vulnerable that we would be okay, but the metabolic disease component was

38:04
I didn't factor in and publicly said, you know, I got this wrong. I'm okay to call it out because that's what leaders do. You own it. And, but there were many times where we were on the right side. And I think overall, I think when history has been shown that we've, many of us that we're advocating for balance were justified.

38:33
Yeah, yeah, for sure. And you know, out of all of this, I think it's what I saw from how you talked in at Locarb Denver and what I've seen of your work. Actually, what you want to do is have a message of resilience, right? Like we are not as fragile as what we've been, not led to believe, but you know, like that whole fear messaging, I feel like people then start feeling more vulnerable than what they need to, but actually you can be resilient and...

38:59
You are anti-fragile and that's a lot of what your messaging is out there for now, right? It's to give people tools so they can look after themselves and know that, you know, if there is in the future any, and everyone talks about, oh, and this is, you know, the first of, you know, this is just how it's going to be from now on, you know, whatever. But at least now that you're now in this position to share that information of.

39:24
good metabolic health, of being active, of exploring diets that might work for you that are different from those mainstream sort of recommendations and things like that. Oh yeah, I couldn't phrase it any better, Miki. This idea of being anti-fragile. I mean, think about how important it is to feel empowered, to feel that you could have a voice in your destiny. Like, that's...

39:53
That's vital, it's fuel, it's what many people need to hear. And it's true. Like I give this story once in a while where I was treating a guy who was in his 70s and had an accident, fell off, had a triptan fell, hit his head and died for two to five minutes, somewhere in there. And...

40:22
When you're in your 70s and you have any cardiac arrest, when you die, you usually don't leave hospital. So what made this man different was the fact that he went to the gym five days a week. He was fit for his age. Because of that, he was one of the first patients to get up in terms of how, like physically get up. He was walking on a ventilator.

40:50
He was highly motivated and had that reserve, that body armour to withstand all the complications that happened during his care. And he went home. And he is functional and he now is in his 80s and still be able to travel, play with his grandkids. Like all of that is a possibility because he took care of himself. Because that is not the norm. The norm is even if you survive that cardiac arrest or if you die.

41:19
You either don't leave hospital or you end up in a nursing home at that age. That's the norm. And so even from, yes, on the preventative side, less likely to land in hospital or an ICU, but if the worst thing happens to you, you're that much better shape to recover. Same thing with one of my colleagues' wives, Cindy Hooper, pancreatic cancer back in 2012. Triathlete.

41:48
The will of Ultra Champion did an Ironman on chemo. Oh my God. And she's 10 years out of her cancer. Oh my God, pancreatic cancer too. Yeah, the story's evolved. She got a, unfortunately got a recurrence and is on palliative treatment now, but. Yeah.

42:14
the longest pancreatic cancer, one of the longest pancreatic cancer survivors that I've ever heard of. And because of how her willingness to be fit, but also what that also does too is the under appreciated aspect of this is the mindset. Like you know, you've gone through the ringer whether you're doing your marathons or you've been to the gym, you go to the gym even though you don't feel like it.

42:43
You exercise that resilience muscle. You exercise that, I could do this even if I don't feel like doing it muscle. And it leads to survival. It leads to being functional. And that's the power of healthy living. That's the power of getting up to working out. That's the power of thinking about what you eat. It's, I see it on a regular basis and that's, that's

43:11
It's effective, it works. And that's why we want to encourage people to do it themselves. Totally. And then if I think about children, like this is what we want for our kids as well. Obviously, but you know, cause I think of people who are in the position of that 75 year old and that is quite rare, but that is something to aspire to be when you're our age. You know, I don't know how old you are, Quad Joe, like I'm 45 and I'm like, hopefully when I'm 75.

43:39
Oh, there you go. Yeah. And but then also, what about the 25 year olds who aren't even thinking like this? Like, and, you know, the 18 year olds, like, actually, I mean, it's never too late, but it's also, you know, it's never too early. And I just feel like some of this cotton walling that's gone on in with teenagers these days could have changed the trajectory of how they how they view the importance of this stuff. I don't know. Like in some circles, of course.

44:07
You know, we run in circles where it's the norm. There, of course, children need to be active. Of course, they need to eat healthy. Of course, they need to do all these things. And we need to be in the gym and lifting weights and whatnot. But it's a small bubble compared to like, you know, the I don't know what the stats are like in Canada, actually, for metabolic health. I always hear the US stats and they are horrific. I wonder what Canada is like. But so many people just still like this message isn't penetrating, I don't think.

44:36
Yeah, I actually, I worry for, yeah, the demographic that went through high school years and so forth, not having to move as much. They're on their phones, they were stuck doing home schooling as a result of the pandemic. Those are formative years, not only socially, but also physically. You're tied to play your high school sports. Some of my fondest memories are playing

45:07
City finals in basketball, volleyball, track, whatever it might be. And I'll be honest with you, this is one of the areas where my wife and I took very seriously, like the healthy living, we wanna be the example for our kids. Like we don't have to always preach it, they see it. You know, dad's in the gym again downstairs, right? Where mommy's doing another yoga session. Where we're talking about, we celebrate having a significant amount of protein on their plate.

45:36
You know, we do this tradition in our house, we call it going beast mode. So if you finish your, you know, we don't get me wrong too, but by the way, like my kids will eat junk, but we still want to emphasize that, you know, if you eat better, you feel better and then you're, you're, you're more likely to thrive. And so one of the things we do is whenever

46:03
especially the younger two, if they finish off their meals, you get to take off your shirt, stand on the chair and say beast mode and flex your muscles, right? And so that's the tradition. And I'll go beast, you're gonna go beast mode today? Gotta finish off that chicken breast before you go beast mode, son? And then yeah, the shirts come off. And I mean, daddy always finishes his meal so he doesn't have to go beast mode, but every once in a while, I almost shy away from it either. But.

46:31
Yeah, so you make it fun, you make it part of culture in the house, but we make a real point of being the example. And I don't know, we'll find out years from now if it's effective, but always be the change. Better to show it than to preach it. 100% agree with that. So Kwadwo, as I understand, your sort of platform that you are...

46:58
that you sort of educate on this stuff isn't just for the general public, you're doing it for your colleagues as well, like people who are interested in it. Am I right in thinking that? Yeah, in a way we frame it in a wellness space where during the pandemic we did see a lot of burnout and we on our own platform and through a grant, we produced a project called Solving Wellness which provided online tools for people to...

47:28
improve their wellness and the pillars were nutrition, movement, community and oh my goodness, why am I forgetting? Sleep. Yeah, stress manager. Thank you. Yeah, which is for health care providers is almost always sleep is one of the key pillars. So yeah, we often get to give talks to other

47:57
the ways to address these things. And just naturally through my job and the platforms we created, a lot of healthcare providers reach out or connect with me, which is really exciting from my perspective because they're amplifiers, right? Like if you have a nurse practitioner, family doc, can bring some of these concepts to their practice, people often go to them for advice because you're in the healthcare field. So...

48:26
Anytime that you can reach out and connect with someone that's in the field, the healthcare field, to me, that's a massive win. And so yeah, that's been an area that we've been tackling for sure. Yeah. And what about personally for you, Kwadwo, when you, obviously you've always, you and your wife have always valued health and wellness through your own practices in your family, but did your own...

48:55
habits change after coming across low carb fasting and all of that? I'm really interested to see like, what have you sort of tried and explored? Because everyone wants to know what, you know, what are those people, what are they actually up to? Yeah, I love that question. So the, I started doing intermittent fasting maybe five years ago. I jumped on the train with, I think it was Peter T, I think I heard him on Rogan and.

49:23
about the benefits of fasting. So I tried it out mostly for convenience and the ability to essentially like eat whatever I want. The quantity of the, maybe not the type of food, but the quantity I want during my eating window. And I thought it was so convenient. And then I liked the way I felt when I was working out in a fasted state. And so I really,

49:52
harness that. Sorry, the baby just entered the building and he's... That's okay. He's allowed, I'm sorry. But since learning about a lot of this, I've tried, so I tried, my carb ingestion is down for sure. I try to approach it as during a work week, if I'm, my first meal is I'll have carbs but it will be less...

50:20
Less than I would have at night. I find that could help you wind down a little bit if you there's more of the carb Nocturnally and sometimes it I Don't know if this is true, but sometimes at least psychologically I feel like it helps with improve my sleep But no that is true because it's the serotonin thing right carbs help produce serotonin help produce melatonin Yeah, yeah, so ever since doing that I've noticed that

50:48
2, 3 p.m., I'm less likely to need a coffee because I'm just more, I'm just less sluggish. So I've tried that. I tried keto for a two week period and I did not like, I didn't like myself on keto. I lost like five pounds and I didn't need to lose five pounds. I was crampy and I tried the electrolytes. Like it just wasn't for me, but obviously I still advocated.

51:17
for people depending on what their circumstances are. And those are the main things I've tried. I mean, you learn more stuff, little hacks too. Like I tried, I had a CGM on for, what was it, about two or three years ago. I found that fascinating. I suggested for everyone, I mean, I'm sure you've mentioned this before, but I think everyone should try a CGM for a period of time, continuous glucose monitor.

51:45
Because the things you've learned were fascinating. Like if I was on call, if I had the two or three hours of sleep, my glucoses were all over the place. If I was doing a big leg day, I could eat anything. And there was nothing, and my glucose was nice and steady. The idea of like if I had a carby meal and you add a bunch of protein to it, level things off, walking off, walking post meal.

52:15
I noticed it would stabilize your blood sugar. Like there was so many little things that you learned that you didn't worry. I know, so I learned like there are these protein bars which I used to love and I still love them. These, they're low carb, apparently low carb. They're these vegan, I'm not vegan, but these are vegan. And the fibre in them totally spiked my blood sugar. Really? So even though they say it's like one gram of sugar and three grams of net carbs, the type of fibre they use spiked my blood sugar.

52:43
When I have wine and hot chips, you know, I love a hot chip, like a nice pub chip. Like, oh, like a, like French fries? Like, yeah, yeah, yeah. French fries, but fat ones. Um, not the skinny ones. Um, uh, stable, really stable blood sugar. Cause the alcohol brings your blood sugar down. I'm not advocating this as a healthy thing to do, but I just found it. I agree with you. I think it was really fascinating and people can learn so much about.

53:09
how food impacts them because it's so individual. Like we can come out with these guidelines and these recommendations, but until someone sort of tries it on for themselves, they're never gonna know. Exactly, and it just, to me, it's not to get too philosophical, but it's where I hope my research platform goes is more personalized health, like really thinking about who's in front of you and what's optimal for them despite what the...

53:38
studies on a general population might tell you, because we approach our research studies with often with the general public in mind. You know, if this patient group X versus Y when they come into a hospital for their heart attack, and this works 20, or like three increases your absolute risk of reduction by, you know, two, 3%.

54:06
But we never ask ourselves who's gonna get the most benefit from it. Like we never approach research that way, which I think is where we need to go. Cause really that's what matters. It's you and I might take the same drug because of the same, because a study said it'd be more effective, but because of my genetic background, because of my gender, I might be less likely to respond to it and we need to be asking those questions more often.

54:35
But yeah, when it comes to nutrition, anybody that comes telling you is the cookie cutter, like everybody needs to do X, Y, or Z, that's when you got to walk out the door. Yeah, 100%. Kwadwo, I really loved our conversation. Like, I really wanted to just really get a feel for your work and also what you saw and also your approach now. Like, I think that that's...

55:01
Um, it's, it's great. And you're so available with regards to the information you put out with the podcast and the sub stack. So can you just let us know where people can find that information? Oh, thank you once again, Mickey, for just being a monster advocate for health and wellness and everything. Beautiful. The easiest place to find us is the sub stacks of quad cast K W A D C A S T dot sub stack.com.

55:29
And we house everything there. We have our eBooks, our podcasts, video posts, meal plans. I'm hoping to have our book out, it's a book on leadership out that hopefully by the, that'll be out soon. And we'll obviously have that information there. But, and then anywhere on social media is at Kwadcast, the biggest ones on TikTok or IG. So.

55:57
Yeah, we're welcome to hear people's input and we aim to deliver to, once again, with that goal of just getting folks healthy. Yeah, awesome. And Kwadwo, are you speaking at any conferences coming up in the near future? I'm trying to figure out if we're going to Omaha or not. Omaha? It's a refit and fabulous.

56:24
Oh, yes, it will be. It is, isn't it? Nebraska? Nebraska, yes. Right now I'm supposed to be working, so I'm seeing if I could finagle that one. Otherwise, I don't think that... There's a couple non-conference talk, like speaking engagements I'm doing, but yeah. I love those conferences, by the way. Like the low carb, the energy, the lack of...

56:52
dry content, it's so different than a typical medical conference. So it's, yeah, I look forward to, I think the next one I'll probably go to is Red Wallet College Summit in Florida. I think that'll be- Yeah, I'm booked to go there as well, just because they are the best conferences. Like that in the low carb Denver, like that was it.

57:12
You do, you learn so much. And even like when you know stuff, like, you know, often you think, I'll go to a conference, won't really learn that much. You just are blown away by the content and this stuff is awesome. Yeah, yeah. Awesome, Kwadwo. Well, thank you so much. I will put links to your sub stack and your Instagram account in the show notes. And I really appreciate your time. Thanks for taking time to speak. Thanks so much for having me.

57:51
Alright team, hopefully you enjoyed that conversation and I'm sure you got a sense for just how passionate Dr. Kwadwo is in this area so I'd certainly recommend checking out his website that is in the link and of course his podcast. He had done an interview just in the end of May with Lara Bryden who you know is a good friend of mine and that was a fantastic talk as well so you will get a lot from the information that Dr. Kwadwo shares.

58:19
Alright team, next week on the podcast I speak to Dr Ted Naiman all about my favourite topic, protein and protein to energy ratio and satiety. Until then though, you can catch me over on Facebook at Mikki Williden Nutrition, over on Instagram and Twitter at Mikki Williden or head to my website mikkiwilliden.com where you can book a call with me or sign up to one of my meal plans. Alright team, you have a great week.