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Justin Brady: From Iowapodcast.com, I’m Justin Brady, so we’re talking about chronic diseases today. They’re on the rise at a very fast rate, and to break this down, why it is happening, and how to best treat that, that’s what we’re gonna talk about today with Jon, Dr. Jon VanDerVier, the CEO and founder of Hy-Vee Health Exemplar Care here in Iowa. Thank you so much for coming back, and obviously, we really appreciate the partnership to get this information out to

Dr. Jon Van Der Veer: Yes. I, I appreciate the opportunity. It’s good to see you again

Justin Brady: and it’s something I’m really passionate about is health. Um, and that’s why it’s, it’s really been great to work with you guys. Um, diabetes, high blood pressure, high cholesterol, as-asthma. I mean, the list, that’s like a tiny little

Dr. Jon Van Der Veer: sliver of chronic disease

Justin Brady: Why is this stuff just continually on the rise? It seems like we can’t chip away at it.

Dr. Jon Van Der Veer: So all of the headwinds that, that you’re looking at are lifestyle issues. Every one of these chronic disease-Every one. Not every, but the vast majority of chronic diseases are completely lifestyle related, uh, preventable, and yes, there are some, like your, your cholesterol level has a huge genetic component. Okay, you can’t outrun that. But I, I like to start with where’s the first issue? The first issue is with activity levels, and we all know historically we were an agrarian society. People were out working in the fields and doing, doing manual labor or moved into the industrial age. Then we kind of moved to this sedentary lifestyle, more desks, office work, things like that. And I, I’ve joked that we’ve actually moved into a stationary mode. Like most of us think, “Oh, if I can do X, Y, and Z, I can sit on my couch, I can, I can run my TV, my radio, I can have my kid pick up my beverage for me.” I mean, it’s, it’s really crazy how inactive America has become as a population. Um, there are pockets where people are really active and moving and making good decisions. So that’s the exercise component, the activity side, and then there’s the dietary side. Everything comes in a plastic wrapper. Everything is, uh, processed. Everything comes off of large scale production. Uh, this isn’t going to the, uh… I always remember going to the farmer’s market in Pella growing up, and you sit there and my dad would pick tomatoes off that he, that he thought looked good and peppers and things like that. Now, now you go in and, yeah, you might get those things when you, you hit the outer portion of a, of a grocery store. Uh, and I’ve learned a lot about this working with Hy-Vee is sure, the perimeter has a bunch of really healthy things, but so much of, of a grocery store has stuff that comes in boxes and plastic wrap and, and are largely industrial made processed goods. Um, so that is the diet. I always call it the standard American diet, also known as SAD, S-A-D, for the standard American diet. That’s it. Standard American diet. Standard American diet.

Justin Brady: SAD. No

Dr. Jon Van Der Veer: happens to have that, yeah I, um, don’t make these things up. Yeah, it, it’s, uh, it’s always ironic how these things work out.

Justin Brady: word

Dr. Jon Van Der Veer: and then you have, uh, additionally, you have all these other components, the stress levels, your sleep levels indicate a lot of these, these components of health as well. So, uh, sleep’s disrupted ’cause we’re all on our phones until two minutes before bed, and you should be winding down. There’s all these, these different things that mess up your body’s innate metabolism and how you function. Um, and all of these things at a cellular level slowly build up over time, and it can be 10, 20, 30 years. Uh, but suddenly your cells aren’t as efficient. You become insulin resistant, which is a precursor to becoming pre-diabetic, to then being diabetic. Uh, blood pressure creeps up. It’s like, “Oh, it’s a tiny bit elevated,” and all of a sudden it’s been a little bit elevated for 30 years, and you start having the sequela that go with this. I mean, hypertension or high blood pressure is known as the silent killer. You don’t get any symptoms from it, so you gotta go check and, and aggressively manage these things. All of these things, again, are diet and exercise, lifestyle modifiable, uh, diseases

Justin Brady: Because it’s so much stuff that we’ve just accepted over decades, and now there’s so many things working against our health, it’s almost, it, it, well, not almost, it’s very overwhelming for people. But let me summarize this. All those things, uh, processed food, activity, food in general, sleep and stress, if we were able to magically correct a bunch of those things individually, w-there are exceptions, there are cancers, there are all these things, but you’re saying almost the wide, a crazy majority of these chronic issues that we have listed off just poof, they’re just gone

Dr. Jon Van Der Veer: They are gone or they are back to their natural history progression, which you can look

Justin Brady: extremely manageable or something like that

Dr. Jon Van Der Veer: I mean, all you have to do is look at a, a magazine from the ’50s or ’60s, and very few people are obese.

Justin Brady: Right. Right, right

Dr. Jon Van Der Veer: I, I’ve had patients who’ve traveled to, to Europe, and they’ve come back and said, “I, I noticed two things. One, they don’t have even a half size trash bin that’s half the size of what I fill every week ’cause they don’t have things in wrappers and processed cardboard boxes.” Mm-hmm. “And everything’s fresh from a local market, and the bread’s fresh made.” Um, so they’re like, “Well, there’s a lot less trash.” And then they always say, “Well… And then when I hit the, uh, the airport in Des Moines, I’m like, ‘Oh my goodness, everybody here is morbidly obese.’” I mean, it’s just visually shocking to people, uh, when you get out of this environment because such a high percentage, almost, I think it’s 40% now in the United States are, uh, deemed obese, which is really, really high

Justin Brady: Yeah, the challenge I know you struggle with, or probably struggle with, is that people come into your clinic and they’re like, “Hey, I have this thing. Fix it.” And we’re, we’re still in this mentality, I think, that you go to your doctor and their job is to write a script, prescribe a surgery, put something into place, m-stick a needle in you, and fix it. And mean, can you fix a chronic condition? Is that even possible? Or must you go to reverse some of these lifestyle things?

Dr. Jon Van Der Veer: Well, foundationally, and if you look at every guideline recommendation from every specialty, whether it’s diabetes, heart disease, blood pressure, everything starts with this little line in the guideline that says, “Lifestyle changes.” Mm-hmm. Like, it’s number one. Everyone seems to skip over that, and then it moves into here’s a bunch of medications, here are the things we can do to treat, not cure, and certainly not make go away. Uh, it’s interesting in the, the GLP-1, the Ozempic, Wegovy-type medications, those have done a lot on the obesity side, um, by suppressing appetite and kind of that craving. And they see other things downstream, lack of alcohol consumption, drug use, some, some other behavioral stuff that’s, that’s really interesting and, and an evolving field. But all of these other things, blood pressure medications, those aren’t fixing anything. They’re making it so the number comes down. You take the medication away and your number goes back up. I’ve had tons of patients who will be like, “Oh yeah, my blood pressure was great, so I stopped it.” Well, today it’s not so great again ’cause you needed to be that. You didn’t, you didn’t, uh, start following a DASH diet or some Mediterranean thing. You didn’t make the dietary changes. Um, you didn’t increase your activity. It’s, it’s really interesting, and if you look at the physiology of, of hypertension or high blood pressure, um, it’s the arterioles are these little tiny… So it goes heart, aorta, arteries, and then you get to these arterioles right before capillaries where things become venous, and they, they have muscle in them, and they contract and open and close. Well, in adipose or fat, there’s a higher percentage of those, and so it makes all the pressure go up. So the more

Justin Brady: Oh,

Dr. Jon Van Der Veer: you have, it’s related to this. I mean, all of these things are–And that’s the problem. These aren’t multiple chronic diseases anymore. They’re overlaps of multiple together. There’s a water there. Um, so they’re all overlaps of these chronic diseases, and that’s s-it’s a nice thing in some of the medications that they treat kind of multiple things at once. But you’re still, none of those are hitting the root cause of I don’t hit the 150 minutes of recommended exercise, uh, weekly. I well exceed, um, my caloric intake for my masil-basal metabolic rate, which is just what your body would burn just sitting there. So you’re always in excess calorie consumption. And then the types of foods, whether they’re highly processed, refined sugars, sugars that are added versus, I mean, eating an apple. Everyone knows an apple has sugar in it, but it has sugar that your body can handle. It also has components of fiber that decrease-Right the effective amount of sugar. There’s all these different things in play, and if you don’t get time to sit and have conversations and really work through understanding these things… I, I remember early in my career, I’d be like, “Yeah, go change your diet and exercise,” and three months later, they’d come back, nothing has changed.

Justin Brady: Mm-hmm. Yeah. Right, right

Dr. Jon Van Der Veer: Gee, I wonder why. I mean, there’s no additional education, there’s no additional support there, and that’s where having teams of dieticians or, uh, health coaches, I mean, there are all these different, uh, things that come in, or having a, a group that can take care of you and can answer your questions here and there and support you in that. I always call it the interstitium, which is that area in between everything, ’cause an appointment, an appointment, and an appointment are all great, but most of your life is lived in between there, and that’s where you’re going to change the disease

Justin Brady: one of the things you guys have been doing at Hy-Vee Health Exemplar Care is this, that you’re basically disrupting the tradit-traditional model, which is you guys get paid if people stay healthy. Can you break this down why it’s so different and why you guys were able to work on long-term health outcomes?

Dr. Jon Van Der Veer: So I’m gonna take the, the jaded kind of business side of healthcare view first, which is the way that most of healthcare works is someone is sick, they come in and they get seen. There’s an transaction that occurs, some insurance process, whatever, something is billed, and, uh, you may get better, you may not. You’re gonna come back if you don’t. The incentive isn’t aligned to make them healthy because then no one will come in and no one will get paid. Um, I’ve always liked the direct primary care membership model where the incentive… So Justin, let’s say you’re a member. You’re paying a monthly amount with a goal of being healthy. That’s why you’re paying this, for access-Mm-hmm. and, and to be healthy. And I’ve, I’ve told patients this before, my goal is to collect that membership fee, get you all the things you’re wanting, which is to be healthy, and then you may actually need me less. And-Right you’re okay continuing to be a member because, A, I’m gonna be there when you do need me, but more importantly, you know that I’m aligned in making you as healthy as you can be and helping you on that journey so that you don’t have to come back and see me. And I–And you don’t care that you’re paying a membership. It’s just like, uh, I always say like Amazon Prime or, or car insurance or any of those things. Like, you pay them happily because you know they’re there when you need them, but they’re not there, they don’t have a misaligned incentive with you. People said, “Well, if you get people too healthy, they’ll stop coming back to you and they’ll stop paying membership.” I was like, “No.” When, when you actually do right by people, which is one of our four core values-Yeah if you do the right thing for people, that’s how you build rapport and that relationship, and that’s what people really want out of this. They want someone they know is in their corner to do what’s best for them. And once you prove that and do that, they’re not gonna go away-Yeah back to a system that hasn’t done that for them.

Justin Brady: one concern people have is that they go to see the doctor and it’s gonna be like a billion dollars, and so they don’t go as much, which creates a bigger problem. So is one of the, the fact that you have that low monthly model and people can see you whenever, does that just by itself ward off a lot of future

Dr. Jon Van Der Veer: It does. It in–So there’s something called being functionally uninsured that means you have insurance. You should be able to go get your preventive services. You should be able to do these things. But because you know, “Okay, I have some high deductible, and I don’t know if what’s gonna happen is gonna be covered, and I’m gonna end up paying more than I think I am. It’s not gonna be the $10 copay,” I quote, “It’s going to be an office visit and blood work and imaging and all these other things that are gonna come in, so I’m gonna ignore it and I’m not gonna go at all.”

Justin Brady: I think it’s hopeful that if people get that stuff under control, they can reverse a lot of these chronic issues they thought were just going, they’re gonna have to live with.

Dr. Jon Van Der Veer: Yes. Things that people think are like, “I’m aging,” like this is just part of getting older, those things shouldn’t exist. Right. If you take care of… I always say it’s the four-legged stool. You’ve got your diet, your exercise, your sleep, and controlling your stress and the other components. Those four legs of the stool, if you get those taken care of, you shouldn’t feel like you’re aging. We all know somebody who’s 65 and they run around like they’re 40. Yep. And it’s because they’re taking care of those things. And it’s–there’s a point, not of no return, but, but the earlier you are, 30s, 40s, uh, by mid-50s, you better have started to get your act together, ’cause it does get harder each

Justin Brady: Sure true

Dr. Jon Van Der Veer: to lose weight and to be more active ’cause things hurt because you’ve been carrying extra weight around. All these things pile up over time. So, uh, I mean, today is the best day to start it.

Justin Brady: no kidding

Dr. Jon Van Der Veer: it. I, I’ve, I’ve clearly struggled with this, for anyone who’s watching on video. Um, but I’m down 40 pounds in about the last 18 months, and I feel drastically better. I still have a long ways to go, but it’s the first thing I, I started fixing was the sleep habit. And when you do that, and you’re getting seven to eight hours of sleep instead of the five to six I used to pride myself on running on, your body is automatically under less stress. You’re less hungry. You’re, you make better decisions throughout the day. Um, so it’s, it’s really time to, to buckle in and look at these things if you haven’t.

Justin Brady: Yeah, absolutely. Dr. Jon Vandivier, the CEO and founder of Hy-Vee Health Exemplar Care. If people wanna turn their life around and they want, like, a guide to get them on the right track, they want to work with your team, what’s the easiest way to do that?

Dr. Jon Van Der Veer: http://www.exemplar.care. Um, that is the easiest way to go learn about who we are. Uh, you can sign up, you can book your first appointment, um, and you can start to get these things under control

Justin Brady: Dr. Jon Vanderveer, thanks so much for coming on the show

Dr. Jon Van Der Veer: Thanks, Justin