More False Claims About Keto- Bias and Lack of Evidence Beware!

There is a lot of “Fake Science” out there. It’s clear that we live in an age of misinformation and sensationalized headlines, and it’s often difficult to discern what contains real evidence, and what is lacking. This week, I’m motivated by a particular article by a “reputable” source. Aside from pointing out the specifics of this particular article, I want the larger lesson to be to understand how to read between the lines of an article and search for evidence, regardless of how credible a source may seem.

 

Who’s the Culprit?

 

Harvard Health strikes again with ignorance and false claims. I try not to respond negatively too often, but I couldn’t let this one go.

 

Does talking about an awful publication give it more attention than it deserves? Or is it more important to point out the fallacies for all to see? I don’t know that there is a “right” answer to that question, but in this case the critic and vocal dissenter won out. We can’t let flat out wrong claims perpetuate and become “truth” as happens too often in medicine.

 

Bias in Language

 

  • It starts right off the bat by the language use in this article. “The keto diet aims to force your body into using a different fuel.” Force your body? That assumes your body doesn’t want to burn fat, so we have to force it against its will to do so. That is certainly a “carb centric” view point!

 

Why not say “allow your body to use a different fuel.” The clear assumption/bias is that we are meant to be carbohydrate eating, glucose burning machines. But is that true? Is that how we were meant to be? Snackwells, Nabisco and Tony the Tiger sure think so, but I think evolutionary biology may differ.

 

  • “It requires that you deprive yourself of carbohydrates.” Deprive? There is certainly no deprivation on a wonderful array of veggies like cabbage, Brussels sprouts, cauliflower, broccoli, peppers, green beans, and so on. I also don’t think anyone would complain about the health risks of depriving ourselves of white bread, bagels, candy, cookies, cakes etc. Would Harvard also talk about how vegans deprive themselves the nutrient density found in eggs, fish and meat? I think not.

 

 

Lacking Evidence

 

Next comes the section on “Keto Risks.”

 

 

  • Saturated fat is the obvious one, and I have written enough about that one to not address it in this post. You can read more here, here, and here. The article also seemingly adds a source with what sounds like evidence, but provides no link to the study.

 

  • Liver problems. How could they reference “liver problems” with no references or specifics and fail to mention that LCHF is one of the best nutritional interventions to treat fatty liver, the fastest growing cause of liver disease in the country. And what does “liver problems” even mean? It seems clear that there is a clear lack of understanding here.

  • Kidney problems. The only concern of too much protein is in individuals with complete kidney failure. In healthy individuals, high protein consumption can increase the renal filtration rate, but there is no evidence to show resulting kidney damage. And where did they get the current recommendations for protein intake? 46 grams per day for women and 56 for men? Even using the lower estimates of 0.5 grams per pound would make this 90 grams per day for the average 180-pound man. And this is a minimum recommendation.

 

  • Fuzzy thinking and mood swings- This one is my favorite. Actually, LCHF keto diets are phenomenal at treating “fuzzy thinking and mood swings.” The article claims, “the brain needs sugar from healthy carbohydrates to function.” That could not be further from the truth. No matter how low our carbohydrate intake, glucose levels never drop to zero. I hope they have heard the term gluconeogenesis at Harvard because it is something our bodies have been doing for a few years. Well, maybe a few thousand years but let’s not be too picky. Yes, our brains require glucose. By no means do we need to eat that glucose.

 

  • Last, they get one more jab in to say how “restrictive” the diet is.

Eating all the meat and veggies you want is restrictive? I like how they don’t refer to vegetarian or vegan diets as restrictive. Bias is very hard to overcome.

 

Also, you have to love the part about the weight returning when you resume a “normal” diet. Let me get this right. We shouldn’t change from a standard American diet to a low carb diet because the weight will come back if we go back to a SAD diet? So, we shouldn’t even try? Great rationale. How’s that working for our country?

 

The Danger of These Biased Articles

 

Now let’s look at the bigger picture. An institution with a reputable name publishes this paper.  This paper has no scientific references, it is clearly biased, and has many statements that are blatantly false.

 

How are most people going to respond? I am afraid most people will accept it at face value. I mean, it’s Harvard for Pete’s sake!

 

My guess is most of my readers (you!) will say, “No way. People won’t fall for this garbage.”  And for that I am thankful. But the problem is that my readers (you!) tend to be more astute and more interested in these topics and by habit critically analyze what they read. My fear is that does not translate to the rest of the population.

 

That is why the publishers at Harvard Health should be ashamed of themselves to allow their name on such an obviously biased and tainted article. Whether you believe in a low carb diet or not should have nothing to do with recognizing the falsehoods in their article.

 

In the end, I hope this will serve as a cautionary tale to remind us that everyone has a bias. Some hide it better than others. Some can be more objective than others. And as Harvard has proven, notoriety has nothing to do with it.

 

Let’s strive to be better.

 

 Thanks for reading,

Bret Scher MD FACC

Is Aspirin Dangerous? New Evidence Sheds New Light

Is Aspirin Dangerous?

 

No medication is sacred. Doctors have long regarded Aspirin as an easy “no brainer” for potential benefit with minimal downside. Many of us don’t even notice when Aspirin is on a patient’s medication list. It hardly warrants our attention.

 

Now that needs to change.

 

Aspirin had a bad week earlier last month. Two studies yielded four separate publications, all casting serious doubt about the risk/benefit ratio for Aspirin in those at moderate risk for Cardiovascular Disease (CVD).

 

In brief, the ASPREE study investigated 19,000 US and Australian individuals older than 70 without a history of CVD. Half got 100mg of Aspirin and half got placebo. No other changes were made. After 4.7 years, they found the following:

 

Another study, The ASCEND trial, investigated 15,000 subjects with diabetes and likewise randomized them to 100mg of Aspirin or placebo. After 7.4 years they found a 1% reduction in vascular events in the aspirin group (8.5% vs 9.6%.) However, this was offset by a 1% increased risk of major bleeding (4.1% vs 3.2%).

 

Does Aspirin Increase Risk of Cancer?

 

The most shocking finding for me was that those taking Aspirin seemed to have a higher risk of cancer. This is in stark contrast to the studies showing that aspirin reduces the risk of cancer, especially colon, breast and prostate cancer.  One study does not necessarily disprove an accumulation of data, but it sure does suggest a problem, especially when the new study is a randomized trial and the prior studies are mostly observational trials. For me, that is enough to stop thinking of aspirin as protective for cancer until we have more solid randomized data.

 

Of note, while some of the data comes from randomized studies, most of it comes from observational trials (more on this later). Large meta-analysis of randomized trials demonstrated a very small 0.6% reduction in cancer deaths for those taking Aspirin. Should we view this as caution against very small outcome differences? (More on this later)

 

Is Aspirin Beneficial?

The big picture take home, however, is that in a primary prevention setting, Aspirin is not protective for death, cardiovascular disease events, or risk of dementia and disability. At least not without any benefit being off-set by an increased bleeding risk.

 

Again, the randomized trial finds contrary evidence to what prior observational trials suggested (although some randomized trials were also negative, such as this one and this one, although they were twisted to promote a beneficial finding despite the statistics not supporting that). This is such a powerful lesson on why we need randomized studies and cannot rely on observational trials or trials with miniscule differences to make definitive recommendations.

 

 

Importance of Randomized Studies Over Observational Trials

 

Does this sound familiar? I have been harping on this when it comes to low fat vs. low carb eating for years. The statistical counter argument is that, sometimes, it is just obvious. Smoking should not need a randomized trial to see if it causes lung cancer. Parachutes don’t need a randomized trial (this is my personal favorite anecdote, as it shows how absurd people can get).

 

And that is true. The observational trials in smoking had a hazard ratio of over 3. That means there was over a 300% increased risk of developing cancer if you smoked.

 

The differences we talk about with animal protein intake and risk of cancer or cardiovascular disease tends to be a 10-20% increase at most (with many trials refuting that completely). But the point is that small differences like this may be simply noise or chance when it comes to observational trials. Small differences, especially in observational trials, are not causative or conclusive results. They are suggestions that require further follow up studies before drawing conclusions.

 

Last, we also need to consider the outcomes. Are we measuring a marker that may be important in the long run? Or are we measuring what really matters to people, like living and dying, or life free of dementia and diasbility. Reducing one risk while increasing another is hardly a victory. That is why measuring the right outcome is so important.

 

That is when we need the randomized trial to answer the question. ASPREE and ASCEND have done that for Aspirin.

 

May Aspirin for primary prevention rest in peace.

 

And may science live on, with randomized controlled trials and meaningful outcomes leading the way.

 

Thanks for reading,

Bret Scher MD FACC

 

Food Appreciation through Fasting on Yom Kippur

I still remember Yom Kippur 2013. The year I had to fast.

 

I know I am “supposed” to fast every year, but in my mind that ship had sailed long ago. I am not the best rule follower, especially when I don’t see the purpose of the rule. What does not eating have to do with being a good person?

 

But in 2013, my son was old enough to ask, “Why isn’t daddy fasting for Yom Kippur like we are supposed to?” That was the end for me. I had to lead by example, and fast. Back then fasting was a four-letter word. It was something I was forced to do. It was uncomfortable, it made me grouchy, and it seemed like a waste of a day.

 

How times have changed. Now I practice intermittent fasting on a regular basis. I regularly experience the physical and psychological benefits, and I know that science supports even greater long-term benefits. Plus, it’s easy now. 

 

This year I learned that like with most things, I have started take fasting for granted.

 

A good friend of mine unknowingly reminded me of this when we met for lunch the day after Yom Kippur. He does not fast regularly, so the Yom Kippur fast is a big deal for him. I was fascinated listening to him describe his experience. His focus wasn’t the hunger, or lack of energy, or the headaches some people experience. Rather, his was the appreciation he had for cold, crisp water. The joy of his first taste of food in 24 hours. The smell, the texture, the flavors. He had taken food for granted and fasting helped him appreciate it all over again.

 

I felt the same appreciation as my friend when I did my five-day fasting mimicking diet. But on a regular day of fasting, I don’t experience the same appreciation. It made me wonder, why not? Why had I lost that heightened appreciation?

 

I eat high quality, minimally processed, real food that comes from the ground or from an animal. It is food as nature intended it to be. It nourishes my body and is delicious. I should celebrate it every day.

 

Yet, I learned that I can sometimes take my food for granted.

 

A prolonged period without it is a stark reminder of how much I should appreciate my food. But why don’t I appreciate it to the same degree every day?

 

This reminds me of the comedian, Louis CK, who tells the story of someone sitting next to him on the plane complaining that the WiFi wasn’t working at 30,000 feet in the air. The comedian responded that every time a plane takes off and is in the air, we should all scream “Holy $&!% we are flying! I mean literally flying!! Can you believe that?!?!?” Again, that is a perfect example of something we easily take for granted.

 

So, what is the secret? How do we not take for granted the things we experience every day, regardless of how amazing or awe inspiring they may be? How do we appreciate what can easily become mundane?

 

In our family, we say a short prayer every meal. Maybe prayer is the wrong word. It is more of a thank you. We try to remember to thank God for growing the food, the field workers for harvesting it, me or my wife for cooking it, and all of us for appreciating it. But I would be lying if I said that we did that at every meal.

 

We are quick to point out when something is from a factory or packaged in a box or bag.  That helps us recognize the simplicity and pleasure of eating real food (in fact, my kids were freaked out when they saw me eating food from a box during my 5-day FMD).

 

Yet I feel like there should be more. I feel like I still underappreciate the treasure that is our food. Is that setting too high of an expectation? Or should I strive for a greater appreciation?

 

What are your thoughts? What are your rituals? How to you remember to appreciate what you have? It doesn’t have to be just food either.  We should be thankful for anything we are fortunate enough to have. Please comment below so we all can benefit from our collective knowledge and experience.

 

For now, I am going to appreciate my freshly steamed veggies and my grass-fed steak. I don’t want to have to wait for my next FMD to appreciate that!

 

Thanks for reading

Bret Scher, MD FACC

 

 

Why a Fasting Mimicking Diet (FMD) is the Key to Longevity

 

I found it! I found the one thing vegans, vegetarians, carnivores, paleo and keto enthusiasts can all agree with.

 

Fasting is possibly the most important intervention for longevity.  The science supports it, and now it is gaining popularity among the masses.

 

Yet the question remains, how do we best accomplish fasting? What’s the best duration, frequency, and does it have to be a complete water fast? Or can it be a calorie restricted fasting mimicking diet (FMD)?

 

Just when I thought I found a consensus; the details rear their ugly heads to divide us once again. But there is hope! The hope comes from realizing that there is more than one way to accomplish a goal.

 

Health Benefits of Long Term Calorie Restriction

Some would say you can accomplish the key to longevity with drugs like metformin, others say time restricted eating is the way to go. All of those have tremendous potential, but when it comes to science backed interventions, longer term calorie restriction takes the cake (sorry for the pun).

 

Even though it is challenging to perform, long term trials with calories restriction in humans, the consensus is clear- some version of calorie restriction helps us live healthier. Calorie restriction increases autophagy, lowers stimulation of key nutrient sensors and growth factors like IGF-1, mtorc1 and AMPK, improves insulin and glucose sensitivity, and more.

 

But who wants to live their life restricting their calories all the time? That is a miserable way to live. Therein lies the power of intermittent fasting. We don’t have the exact methodology down to a science, but it seems that a five day fast 2-3 times per year can have significant health benefits. Now that is something people can do without being miserable!

 

Making Fasting Easy

 

Even then, however, fasting is challenging. Personally, I have a hard time getting past day 3 in a water-only fast and have noticed the same in a number of my Boundless Health Program clients. Then I found the Fasting Mimicking Diet from L-Nutra.

 

They made fasting easy (at least easier)! In brief, for $250 they send you five boxes each with everything you will eat for the day. Day 1 is about 1,000 calories and days 2-5 are around 700 calories. It is a mix of bars, soups, olives, crackers and a glycerin-based drink in addition to a daily vitamin supplement. It is all veggie and nut based, low protein, and fairly palatable as far as processed and packaged “food” goes.

 

And here is the best part. It is backed by research. Valter Longo, one of the world’s leading longevity researchers, happens to be one of the company cofounders.  They have peer-reviewed studies demonstrating decreased IGF-1, improved insulin sensitivity, improved CVD risk factors, and possibly the biggest benefit of all with improved stem cell regeneration.

 

Science backed, convenient, and potential for improved longevity? I was sold and knew I had to try it. Here are some of my take home lessons from the Five-Day Fasting Mimicking Diet.

 

General FMD Takeaways

 

  • Overall I had a positive experience, but I am quick to admit that this isn’t the “best” way to fast. If you can safely do a water only fast for five days, go for it! It’s much cheaper and has all the benefits without any question. Just make sure you are doing it safely, preferably under the guidance of your healthcare provider or experts such as those at IDMProgram.com.
  • You can do your own fasting mimicking diet. I didn’t love how the food was processed, packaged food-like-products. In fact, it freaked out my kids that I was eating packaged food from a box. They have probably never seen me do that before, and they have heard me denounce such fake food for years. You should have seen their faces when I sat down to dinner with my box of “food”! If you have the time and energy, you could likely recreate this program with real food.
  • ProlonMD is the most convenient way to go. Once I got past the processed nature of it, I realized: What could be easier than simply opening the box and knowing exactly what you are eating for the day? No preparing, no planning, no shopping.  This is the biggest benefit to L-Nutra’s program. I loved the convenience. It made it easy to stick with and easy to implement.

 

Day-By-Day Thoughts

 

  • Day one was a breeze. The novelty, the excitement of the experiment, plus 1,000 calories made it easy with minimal hunger or cravings. The bar is tasty (although a little sweet for me), I love the olives, the soups are palatable, and the kale crackers are pretty tasty too.
  • Day two was still pretty easy. The novelty was still there, hunger increased a little but was completely manageable. Since I had started already in ketosis, I found I quickly went deeper into ketosis and noticed improved focus and thinking, and my energy level was still great. Plus, I slept much deeper starting day two.
  • Day three was the toughest. Just as it is for me with water fasts, day three is the big hurdle. But it was a much smaller hurdle since I still had some calorie intake.  The novelty was wearing off at this point and I was tiring of the processed food. Watching my family eat scrambled eggs, veggies and avocado for dinner made me crave real food! I knew for maximal benefit I had to charge through, and thus I was motivated to continue.
  • Day four was pretty easy once again. I was deeper in ketosis, my hunger abated, and I knew the toughest part was behind me.  I even went to the gym and felt pretty good lifting (at about 80% intensity).
  • Day five was again easy during the day, but that evening I was done. It wasn’t that I was overly hungry or tired, I just missed real food! Watching my family eat real veggies, real salmon, real avocado, real nuts… I didn’t want to do it any longer!!! But I only had 12 hours to go so I hung in there.
  • Day six was the refeeding day, and I took it easy and gradual and had no trouble. I did try to go for a mountain bike ride with my usual weekend crew and they kicked my tail feathers! They all thought I was crazy to come out considering my caloric restriction, and they were right. But I am glad I tried, and I’ll be back next week to show them who is boss!

 

Specific Thoughts:

  • We have a complicated relationship with food- The taste, the texture, the enjoyment, the anticipation, and the disappointment are such strong feelings and connect to so many emotions. It’s clear that what we eat is only part of the equation. Why we eat is a much stronger and more difficult issue to understand. I am a big proponent of everyone doing a five day fast or FMD simply for the psychological awareness that results.
  • Our portion sizes are out of control- Really! They are seriously out of control. I pride myself in having already known that and taken steps to make sure my portion sizes are controlled. But eating the tiny portions in the FMD and not being that hungry when I was done brought this in to a whole new light. I have heard it and said it many times. We should eat until we are 80% full and then stop. After doing the FMD, I think we should stop when 60% full. I know that is near impossible to feel and measure, but the point is the same. We need to drastically cut our portion sizes down, get rid of the multiple serving buffet, and understand that we will be just fine with the smaller portions.
  • Hunger is relative- Anyone who practices time restricted eating and short fasts knows that hunger is a feeling we can easily tolerate. Five days of calorie restriction highlights that point even more.  We don’t need to reach for snacks every time we feel a pang of hunger. Rather, we can still perform at high mental levels despite mild hunger.
  • Ketosis is awesome– I have been in ketosis for the better part of a few years, and consistently in ketosis for at least six months, so I went into this experiment thinking I would not get much benefit from the ketosis part of the FMD. But the FMD brought me even further into ketosis, to levels I haven’t achieved on my own. And I felt it. I was hyper-focused, I slept like a baby, and I simply felt sharper.  That has encouraged me to find ways to intermittently go deeper into ketosis to get those benefits on a more regular basis.
  • Athletic performance is better than therapy– The one part that kind of stunk with the calorie restriction was the hit my athletic performance took. The humbling mountain bike ride with my friends was a stark reality check. It was completely expected, but it still hurt. It highlighted for me the psychological importance of feeling great, performing well, and pushing my physical limits. It’s better than therapy. I love it. I thrive off it. And I hate it when I don’t get it. I am now more thankful than ever for my physical abilities, and you can bet I am going to kick @$$ next time I ride with my buddies. They better watch out (I hope they don’t read this)!
  • We can do anything when there is a clear start and stop day– Overall the fasting mimicking diet was not that difficult. That being said, there were definitely a few tough times when I wanted to break it. Knowing that it would only last five days, and I only had to do it 2-3 times per year made it much easier to tolerate. Temporary pain is much easier than pain without an end.

 

Have you tried a fasting mimicking diet? If so, please comment with your experience and what your protocol was. I am searching for the most convenient way to help my Boundless Health Program clients succeed with their intermittent fasts and experience the biggest benefit. The ProlonMD FMD is one easy way to do this, but it is not the only way to do it.

 

Thanks for reading.

Bret Scher, MD FACC

www.LowCarbCardiologist.com

 

 

Health Benefits of Bone Broth

This week I am so excited to share with you a guest post from my friend and colleague Rachel Gregory, board certified nutrition specialist, strength and conditioning coach and creator of KillinItKeto.com. I hope to have more collaborative posts coming soon! If you enjoy this post, please let me know. -Bret

Health Benefits of Bone Broth

Bone broth is one of the most nutrient dense foods that you can consume. It’s rich in vitamins, minerals, and jam packed with nutrients that are rarely found in other common foods consumed nowadays. The reason for this is because the process of making high-quality bone broth utilizes parts of an animal that cannot otherwise be consumed, such as tendons, ligaments, bones, marrow, skin, and feet. When these animal parts are simmered in hot water for long periods of time, they release powerful nutrients like gelatin, collagen, amino acids, and tons of vitamins and minerals needed to optimize overall health and longevity.

 

Here are just a few of the common health benefits associated with bone broth consumption:

 

Bone Broth Health Benefits

  • Boosts Immune System
  • Protects Joint Health
  • Strengthens Bones, Teeth, Skin, Hair, and Nails
  • Aids in Hydration and Electrolyte Balance
  • Supports Gut Health

 

Boosts Immune System

 

Remember when you were a kid and your mom used to give you chicken soup if you were feeling under the weather? Well, it was for good reason! The broth in that soup contained vitamins and nutrients that your body needs when it’s trying to fight off a common cold or sore throat. Bone broth is like chicken soup on steroids (for lack of a better term). It not only contains large amounts of beneficial vitamins and minerals but is also packed with amino acids and collagen that help support immune system function and provide easily digested nutrients.

 

Protects Joint Health

 

As we age, the cartilage and connective tissues that make up our joints naturally begin to degrade and it’s very important to protect and restore these as best we can. Bone broth helps make this possible because it contains the very compounds that form connective tissues in our bodies – collagen and gelatin. You can think of collagen as sort of the glue that holds our bodies together and gelatin as the cushioning between our bones. Consuming real bone broth is one of the easiest ways to make sure you’re restoring and absorbing these essential building blocks needed to promote the growth of new cartilage and maintain healthy joints.

 

Strengthens Bones, Teeth, Skin, Hair, and Nails

 

The abundance of amino acids found in bone broth play a major role in helping to support bone mineral density and improve your body’s ability to grow and maintain healthy muscle tissue, teeth, hair, nails, and much more. Additionally, collagen is one of the most powerful anti-aging nutrients that forms compounds in your skin (such as elastin) that help to increase skin elasticity, maintain youthfulness, and reduce the appearance of wrinkles. Why spend hundreds (or even thousands) of dollars on supplements or skin rejuvenation treatments when you can make the ultimate anti-aging elixir right in your own home?

 

Aids in Hydration and Electrolyte Balance

 

One of the most common issues that many people face on a daily basis is the lack of proper hydration and imbalance of electrolytes within their body. Many of us have been taught that in order to replenish these electrolytes and stay hydrated, we need to be consuming sports drinks or adding squirts of processed chemicals to our water. This is completely false and can actually do more harm than good, especially when these products are jam packed with sugar and other unnecessary preservatives. Skip the processed junk and reach for nutritious bone broth that contains essential electrolytes like calcium, magnesium, and potassium that help to support proper hydration, cellular health, and so much more.

 

Supports Gut Health

 

Gut health is one of the most talked about issues in today’s society and there are millions of people who are struggling with a condition known as leaky gut syndrome. This condition occurs when the lining of the small intestine becomes damaged and causes bacteria, toxins, and partially digested food particles to “leak” into the blood stream causing increased inflammation and other problems within the digestive tract.

 

But what if there was a way to help protect the lining of the gut and prevent this “leakage” from occurring? Enter bone broth! The collagen and amino acids found in bone broth, particularly proline and glycine, are major players when it comes to healing damaged cell walls within your gut and reducing inflammation within the intestine.

How to distinguish between “real” and “fake” bone broth

 

It’s very important to understand that many of the broths and stocks that you find on your average grocery store shelf are NOT considered real bone broth. Most of those cartons and cans are filled with ingredients that have never even come in contact with real bones. Usually these products contain water, spices, and some type of preservatives or thickening agents – definitely not what you want!

 

Your best bet is to make bone broth at home because it saves money and ensures you are getting all the good stuff, minus the junk! (See below for how to make homemade bone broth). If you’re really pressed for time or don’t have access to the ingredients/cookware to make it at home, there are some brands like Kettle & Fire or Osso Good that you can purchase and are made from the real thing (bones!).

 

 

 

 

 

 

Homemade Bone Broth Recipe

Makes 4 to 5 quarts/Prep time: 10 minutes/Cook Time: 24 to 48 hours

 

I always cook a big batch and store it in individual containers in the freezer. When a recipe calls for bone broth, just defrost one container the night before in the refrigerator and you’re good to go.

 

4-6 large beef bones (about 4 or 5 pounds) or 1 whole chicken or fish carcass (with skin)

4 celery stalks, roughly chopped

1 large onion, cut into quarters

6 garlic cloves, smashed

1 bunch fresh parsley, rosemary, or other herbs of choice

2 tablespoons sea salt

1 tablespoon peppercorns

3 tablespoons apple cider vinegar

4-5 quarts water, or enough to fill the pot

 

  1. Preheat oven to 400 Fahrenheit
  2. In a large roasting pan or baking sheet, arrange celery, onion, and garlic in an even layer.
  3. Place bones on top of the vegetables and roast in the oven for 30 minutes.
  4. Remove bones and vegetables from the oven and transfer to a slow cooker.
  5. Add fresh herbs, salt, peppercorns, and vinegar. Pour enough water to cover the bones and vegetables.
  6. Simmer on low for 24 to 48 hours. The longer the broth cooks, the more nutrients will be extracted from the bones.
  7. Let the broth cool completely, strain it, and then store in glass containers with airtight lids in the refrigerator or freezer. Make sure to only fill the containers ¾ of the way full to allow room for the liquid to expand in the freezer and prevent containers from cracking.

 

Bone Broth Making Tips:

  • Add chicken feet and fish heads to boost the collagen and flavor of your bone broth.
  • Add Apple Cider Vinegar to help draw the nutrients out of the bones and other animal parts.
  • When possible, use animal products that are pasture raised and free of antibiotics and hormones.
  • The longer it simmers, the more nutrients will be extracted (aim for 48 hours).

 

Get more recipes by Rachel here.

Rachel Gregory, MS, CNS, ATC, CSCS, is a Board-Certified Nutrition Specialist, Athletic Trainer, and Strength and Conditioning Coach. Rachel is the Founder and CEO of Killin It Keto, LLC and creator of the 21-Day Keto Challenge. Get more recipes like this in her book, 21-Day Keto Challenge.

What is a Functional Cardiologist?

I am a functional cardiologist and I hate it.

 

Let me rephrase that. I hate the term functional cardiologist. And don’t get me started on holistic or integrative cardiologist. Those are even worse.

 

Why do we need a special term to say that a doctor wants to do more than put proverbial band-aids on symptoms? Why is it so unusual for a doctor to want to fix and reverse the underlying causes of disease? Why should that require a unique identifier?

 

And holistic? Does anyone believe that the heart exists in isolation and is not influenced by every other aspect of our health? I find it hard to believe that any doctor would admit they feel this way, yet all too often cardiologists act this way. 

 

How Cardiologists are Viewed

 

The best example is the perception of cardiologists as “plumbers,” using coronary stents to open blocked arteries.  If you are in the midst of having a heart attack (an acute myocardial infarction- AMI), you want a plumber.

 

An AMI is caused by a sudden and complete blockage of a coronary artery (one of the arteries that supplies the heart with needed blood flow), and interventional cardiologists can stop the heart attack by opening the blockage with angioplasty (balloons) and stents. For that, you want the best plumber you can get to unclog that vessel as quickly as possible.

 

But here is the problem. The hundreds of thousands of patients who undergo elective stenting for partial coronary blockages do not benefit in the way they think. Almost uniformly, patients believe stents reduce their risk of heart attacks. Yet, there have been at least 12 randomized trials involving over 5,000 subjects that have shown that stents do not reduce the risk of future heart attacks or the risk of dying.

 

Despite this, one study paradoxically showed that patients and physicians alike believe that stenting does prevent heart attacks and reduce the risk of dying.  How can our perception be so counter to what the literature shows?

 

It actually makes sense. We show patients the dramatic before-and-after pictures of the narrowed blood vessel and the miraculous post-stent result of the vessel now looking wide open. We usually don’t show them all the other plaque building up in the other arteries.

 

The Most Common Cause of Heart Attacks

 

It turns out, most heart attacks are the result of so-called vulnerable or unstable plaque. Unstable plaques have higher levels of inflammatory components and are more likely to rupture acutely, setting off a cascade of events that completely blocks the blood vessel. The problem is that on an angiogram pre-dating the attack, these plaques are barely recognizable and certainly not of concern.

 

That is difficult for many to understand. It isn’t the severe arterial narrowings that cause most heart attacks. Those cause chest discomfort (angina) from temporary reduced blood flow to the heart but rarely cause life-threatening heart attacks. The life-threatening heart attacks come from the 20%, 30%, and 40% narrowings that become unstable. What makes them unstable? Inflammation, oxidation, smoking, diabetes, and more.

 

Paradigm shifts take time, especially when the paradigm goes from a simple one (i.e. a blocked artery is the problem, therefore open it and the problem is solved) to a complex one. Coronary artery disease is a multi-factorial problem that can only be treated with a whole-body approach focusing on inflammation, blood sugar and insulin control, nutrition, exercise, stress management, and much more.

 

To complicate matters even further, we now have studies questioning if stents can help relieve chest pain any better than medical and lifestyle management. And this makes sense too. There may be one narrowing worse than the others, but by the time someone develops narrowings they also have endothelial dysfunction – impaired ability for the vessels to dilate and allow more blood flow when needed. If that is severe enough and widespread enough, it too can cause chest pain/angina. Once again, treating one blockage won’t solve that problem.

 

How to Treat Cardiovascular Disease

 

Looking at the data, it becomes clear that there is only one way to treat cardiovascular disease. Treating this disease requires a holistic, functional, integrative approach that considers the whole patient, the patient’s lifestyle, and every aspect of their health.

 

So where does cardiology stand? Are we plumbers? Or are we doctors? I am afraid of what the answer is for most cardiologists today. But I am hopeful that the trend is moving in the right direction. I am hopeful there will be a day when all cardiologists will be functional, integrative, holistic cardiologists.

 

Thanks for reading.

Bret Scher, MD FACC

www.LowCarbCardiologist.com

Does Fasted Cardio increase Fat Burning?

There is a lot of information out there around fasted cardio and fat burning. I’ve personally received a number of questions about whether or not fasted cardio increases fat burning, and I wanted to review the existing literature as well as add my thoughts.

 

Understanding Articles and Studies

 

I recently came by an article on Medium that reviewed recent studies about fasted cardio and concluded that fasted exercise does not reliably increase fat burning. Paradoxically, they did include a review of 27 studies that concluded “there was a significant increase in fat oxidation during a fasted state.” However, all the other studies reviewed concluded the opposite.

 

Their conclusion? “Fasted cardio does not work. At best it delivers results comparable to fed state exercise. At worst, it decreases intensity and performance, lowering total energy expenditure, and resulting in less overall fat loss. Fasted cardio seems to be more effort than it’s worth. It includes a lot of extra work without any added benefits.”

 

Is that true? Should we forget about exercising in a fasted state since it has no benefit?

 

No! The key is understanding who was investigated in those studies and if the results apply to you.

 

To their credit, they start the article by saying, “the body is a complex and dynamic system working on many variables. Simply exercising on an empty stomach may not be enough to increase fat loss.”

 

The Respiratory Quotient

 

That statement I can agree with.  The body is complex and dynamic. In general, the body will use available glucose and glycogen first for energy. If those are in short supply, only then will the body change to fat burning.  We can measure this by the respiratory quotient or RQ (see this video I did with Ken Nicodemus to learn more about cardiorespiratory testing and RQ).

 

If someone is eating a high carbohydrate diet, they are a requisite carbohydrate burner. Simply fasting for 12 hours is inadequate to turn them into a fat burner for a 60-minute exercise.

 

If, however, someone is following a healthy low carb lifestyle and has adapted to becoming a fat burner, then an overnight fast can greatly enhance the fat burning capacity of exercise.

 

The aforementioned studies, therefore, need to control for baseline diet and RQ, as that will greatly affect one’s ability to burn fat.

 

 

Duration of Exercise in a Fasted State

 

Also, duration of exercise matters. Longer exercise durations that deplete glycogen stores can help you transition to fat burning. This can be difficult, however if you have not cycled in and out of fat burning mode before as there is an adjustment period.

 

What’s the take home?

 

Be a fat burner at baseline. The better you burn fat at rest, the better you will burn it with exercise. If you follow a low carb lifestyle with time restricted eating and/or intermittent fasting, then you will train your body to burn fat. Exercising in a fasted state will enhance this capacity.

 

Hello fitness, good bye body fat.

 

Do you exercise in a fasted state? Let us know your experience and how it works for you!

 

Thanks for reading,

 

Bret Scher, MD FACC

www.LowCarbCardiologist.com

Low Carb USA San Diego 2018 Recap

      

 

This year, I was lucky enough to attend (and speak at!) the Low Carb USA 2018 conference held in San Diego.

 

What conference! From the moment it started until the very last Q&A panel, this conference was packed with knowledge, energy and an amazing community. There is no way I can capture all the highlights, but here are my experiences from the conference.

 

Opening Comments

 

The conference began with Low Carb USA organizer Doug Reynolds welcoming everyone. He asked how many physicians or medical providers were in attendance, and approximately 60% of the hands in the room went up. That’s incredible! It shows how strongly LCHF lifestyle is making its way into mainstream medical practice. It may not be used by every doctor right now, but the tide is certainly moving that way, which I'm very excited about.

 

The Diet Doctor and Dr. Nasha Winters Blew Everyone Away

 

After Doug finished his welcome, the Diet Doctor himself, Dr. Andreas Eenfeldt kicked things off with The Food Revolution. He clearly outlined the obesity and diabetes epidemic we face as a society, and showed how LCHF is an easy and effective solution. As their motto says, they are "Making Low Carb Easy." His talk did just that. It was very motivating and educational, and I know people walked away ready to jump in.

 

 

Later that same day, Dr. Nasha Winters dropped some serious knowledge bombs about mistletoe, moonbathing, marijuana and more. If you haven’t heard Dr. Nasha speak, you have to seek her out. She is a powerhouse of information, of energy and of clear caring and compassion. I was fortunate enough to have recorded a podcast with her and it is definitely one of my favorites.

 

 

Concluding the First Day with Interviews

 

I spent the rest of the day running around doing my initial podcast interviews for my new upcoming project, The Diet Doctor Podcast. I am beyond excited to be part of this team! My initial interviews with Garry Taubes, Dr. Peter Attia, and a joint interview with Dr. Jeffry Gerber and Ivor Cummins really set the tone for how incredible this podcast is going to be. I will keep you updated when they are released.

 

Day Two of the Conference

 

Day #2 Was a powerhouse day! Starting with Peter Ballerstedt dispelling the environmental myths that ruminants are bad news for the environment. His talk shows how limited and short sighted that argument is, and it boggles my mind how pervasive it has become. Thanks Peter for setting the record straight!

 

 

Later that day Gary Taubes and Adele Hite led a discussion to help develop a defined standard of care for using a low carb diet in clinical practice. This is exciting. This is what our medical profession needs to safely and effectively initiate low carb lifestyles for our patients.  The goal is to educate all providers on the benefits and practical implications of low carb nutrition and help them help their patients. It doesn’t get much more powerful than that!

 

My Turn on Stage

 

Then it was my turn to speak, which was fun! I really enjoyed giving my talk on what the evidence says about LCHF diets and impact on our heart health. The question in the contemporary medical community is, “Is the LCHF diet harmful to our cardiovascular risk?” I think the evidence clearly answers that – NO!

 

 

Instead, we need to reframe the question and ask, “Is the LCHF diet beneficial for our cardiovascular risk?” There the answer is most likely yes. Reducing glucose and insulin, improving visceral adiposity, raising HDL, lowering TGs, improving LDL size and oxidation, reducing inflammation, lowering BP, reducing the need for medications, and more! LCHF does all these, and all these positively contribute to reducing our cardiovascular risk. It’s hard to imagine there is still debate about this.

 

The Interviewer Becomes the Interviewee

 

I then had the privilege of being interviewed by Vinnie Tortorich for his upcoming documentary Fat, and by Brian Sanders for his documentary Food Lies.  Seeing the overwhelming interest and the clear production quality encourages me that we will continue to see high-level documentaries exploring the benefits of LCHF.  The public needs a counterbalance to the overly dramatized and misleading documentaries that have populated this space to date, and Vinnie and Brian are both motivated to provide the answer.

 

The Low Carb Community

I could keep going raving about the speakers, but it's one of those conferences you need to attend to see the speakers for yourself. Instead, I want to finish by raving about the community. The energy and buzz from everyone attending was palpable.

 

Whether it was from individuals with a tremendous success story, newcomers eager to understand how their future may be different, or healthcare providers excited to start using these techniques with their patients, it was clear that lives were changing for the better. It is rare to see this level of excitement and energy at a medical conference. I knew right away this conference was unique, and this was going to impact everyone there.

 

In fact, a nutritionist I know came away so charged up that she immediately contacted me saying she "was ready to be part of something bigger!” She was ready to reach more people and help more people. That is exactly what a conference like this should do. Educate us. Inspire us. And help us take action. Bravo Doug Reynolds and the whole Low Carb USA staff. You hit this one out of the park.

 

Thanks for reading.

 

Bret Scher, MD FACC

www.LowCarbCardiologist.com

Does Weight Loss Depend on Calories or Hormones?

 

Why do people have such a hard time losing weight? Anyone who has tried it before knows the challenges. It frequently goes one of two ways:

  1. Initial success followed by a stall and eventual regaining of the weight leading to frustration and giving up.
  2. Difficulty changing habits enough to see a meaningful difference. Life seems to get in the way to prevent success.

 

Let’s be honest. There are numerous ways to lose weight. You can hardly go on the internet without seeing an ad for a magic weight loss solution or the one food you need to finally burn that belly fat.

 

As long as we are being honest, let’s also acknowledge that those don’t work. Ever.

 

The seemingly elusive weight loss holy grail would look like this:

  • We can easily maintain for years if not decades- it’s enjoyable!
  • Helps us maintain a healthy weight- losing mostly fat while preserving muscle
  • Helps improve our overall health, longevity and health span

Low Carb vs Low Fat Diets

 

If you have read some of my prior posts, you know where I am going with this. I think a low carb high fat (LCHF) lifestyle is likely the closest thing we have to the holy grail.

 

This isn’t just my opinion. As presented by DietDoctor.com, there have been 60 studies comparing LCHF vs low-fat diets for weight loss. The running score board shows 30 wins for LCHF, 30 ties, and exactly zero wins for the low-fat diet.

 

I’m the first to admit nutritional science is messy and we have to be careful with interpreting the data. But when there have been 60 studies and a low-fat diet has not been more beneficial in a single one, that speaks volumes.

 

This leads us to the next question:

 

Why is an LCHF diet better for weight loss?

 

Some would counter: Does it matter why? If we know it works, people enjoy the lifestyle and feel good on it, and we have evidence that it improves diabetes, metabolic syndrome and cardiovascular risk factors, then what more do we need to know?

 

This is where the science gets murky regarding two theories for weight loss

 

1.    Calories in/Calories out.

This theory states that weight loss is a simple equation. Take in fewer calories than you expend and you will lose weight. If you burn 2000 calories in a given day, then it doesn’t matter if you take in 1500 calories of bread, pasta, soda, cake, cookies, or vegetables and steak. You will lose weight. Period.

 

2.    Carbohydrate-Insulin Model.

This theory states that the hormonal response to calories is more important than the absolute number of calories. Simply put, insulin resistance and hyperinsulinemia prevent us from losing weight. Insulin’s “job” is to shuttle glucose into cells and prevents us from breaking down our fat stores, thus impairing weight loss attempts.  By following a LCHF diet, we can lower insulin levels, improve insulin resistance, and allow our body to break down fat stores and lose weight in a healthy and sustainable way. Absolute calories matter little in this theory.

 

Studies Around LCHF Diets

 

A series of trials funded by NUSI recently caused waves of controversy regarding the mechanism of LCHF diets and the carbohydrate-insulin hypothesis.

 

The Ketogenic Diet Study

 

The first study published in 2016 investigated 17 overweight men and their response to two diets. For the first 4-weeks they ate a “high-carbohydrate baseline diet,” followed by 4-weeks of an isocaloric ketogenic diet. Each week they spent two days in a metabolic ward where investigators measured everything they consumed along with their resting energy expenditure.

 

In theory, if our insulin response is the primary driver of weight loss, then our resting energy expenditure should increase on a ketogenic diet as a reflection of breaking down our natural fat stores for use as fuel.

 

Here are the basic highlights of the study:

  • Subjects lost weight on both the control diet and the ketogenic diet
  • Fat loss continued but slowed after transitioning from baseline to ketogenic diets
  • Resting energy expenditure increased on the ketogenic diet by about 100kcal/day.

 

Now comes the interesting part. How do we interpret these results? Resting energy expenditure went up on the ketogenic diet, suggesting the carbohydrate-insulin model works, right?

 

Not so fast. The lead author of the study, Kevin Hall, concluded that his study disproves the CIM, claiming that the resting energy expenditure change wasn’t high enough. As part of their research protocol, they estimated the dietary change should have resulted in a difference of between 300 and 600kcal per day. So even though the trial “worked,” it fell short of expectations.

 

Kind of like if Amazon predicted a 20% revenue increase for the quarter. When their increase is only 15%, their stock price falls, even though their revenue still went up!

 

To be honest, this is where I tune out.  Switching to a ketogenic diet lowered insulin and increased resting energy expenditure. What’s wrong with that? That sounds like a good result to me.

 

The Healthy Low-Fat Diet Study

 

Which brings us to the second trial.  I wrote about this trial shortly after it was published, and will summarize it again here.

 

600 subjects were randomized to a “healthy low fat” or a “healthy low carb” diet (this was not a ketogenic diet as they ended up eating 130gram carbs per day). Both groups were advised to maximize veggies, minimize sugars and processed flour, minimize trans fats, and focus on nutrient dense whole food prepared mostly at home.

 

In the end, both groups lost the same amount of weight, and they saw no difference in genetics related to fat metabolism and insulin sensitivity. Does this also disprove the CIM and show restricting carbohydrates is of no value? Does it mean we can support drinking sodas and eating cookies as long as we keep our calories low?

 

This study compared a control diet is much healthier than what most Americans eat (remember, they still restricted sugars and flour and focused on home prepared nutrient dense meals), to a moderately low carb diet (not a very low carb ketogenic diet). In the end, it was not well formulated to answer the question of the CIM. But it does add to the ongoing score card of 30 wins for low carb, 30 ties, and zero wins for low fat.

 

Again, this is where I tune out of the debate.

 

I am a cardiologist. I care about what is going to help the client I am working with at that exact moment. These clients don’t live in metabolic wards where their meals are provided for them, and they don’t exist in study formats where they know they are under constant observation.

 

Dieting in the Real World

 

My clients live in the real world just like you. Thus, I care about what works in the real world.

 

In the real world, we cannot ignore human behavior and psychological responses to food. Robb Wolf’s book Wired to Eat is one of the best resources explaining the minefield we encounter on a daily basis, how carbohydrate rich foods stimulate our brain to crave more, how food companies purposely create foods we cannot resist, and how why we eat may be more important than what we eat.

 

In this environment, does your brain care if the carbohydrate-insulin model has scientific backing or not? No way. It just wants its reward centers triggered by the next chip/cookie/cracker.

 

Don’t get me wrong. How we interpret science is important.

 

As long as people feel calories in/calories out is the only answer, Coca Cola can keep promoting their sugar filled drinks and Nabisco can keep promoting their sugar filled snacks as part of a healthy diet, just so long as we exercise enough to burn the calories.

 

How has that worked for us so far? Just look at our obesity and diabetes epidemics to answer that question.

 

I strive to find a balance between the science and the practical question of what really works for most people.  Hunger, energy, mood, cravings and enjoyment are very powerful motivators. For that, I have found nothing more effective than an overall healthy lifestyle which incorporates a LCHF diet.

 

 

Thanks for reading

 

Bret Scher, MD FACC

www.LowCarbCardiologist.com

5 Reasons We All Should Fast, and 1 Reason Why We Shouldn’t

I wanted to write this article to address a question I hear often:

Do I need to Fast to Be Healthy?

 

In short, probably. But what exactly does that mean?

 

Thanks in large part to Dr. Jason Fung and others, intermittent fasting (IF) has emerged from the shadows of the health movement to now being discussed every day on social media, as if we have been doing it for decades.

 

And here’s the secret: We actually have been doing it for decades. In reality, it’s more like centuries.

 

Think of how we evolved. There wasn’t a convenience store, grocery store, restaurant, or fast food joint on every corner.  We had to hunt and forage for our food. That took time and was sometimes unsuccessful. The natural result, therefore was periods of eating interspersed with periods of fasting.

 

Modern society is a far cry from that evolutionary period, as we now have a 24/7 eating cycle with late night taco runs, vending machines and snacks available at a moment’s notice, and misguided advice that we need to eat every two hours to stimulate our metabolism and lose weight (awful advice with no scientific backing, mostly promoted by snack food companies).  We have plenty of reason to believe this constant eating cycle has contributed to our current obesity/diabetes/insulin resistance epidemic.

 

The good news is that we can reverse that trend. We can reverse it by bringing back fasts.

 

What exactly is fasting?

 

First we need to define what fasting means, and what time restricted eating means. Time Restricted Eating (TRE), means eating only in a specific time window, and not eating the rest of the day. For instance 18:6 means not eating for 18 hours straight, then eating over a 6-hour period. This can be 12:12, 16:8, 18:6 or even 22:2. They key is that you have an extended period of time each day when you are not consuming calories.

 

More extensive fasts, 24-72 hours or even longer, are really what we refer to when we say intermittent fasting. For this explanation, I will refer to extended fasts and TRE together as they have similar benefits. I will explore the differences and go into more scientific detail in a future post.

 

Here are the top 5 reasons we should all fast

 

1.    Fasting is the most efficient way to lose weight.

 

Forget the fat burning foods, forget the cleanses and detoxes. Not eating is the key to losing weight. But do it intermittently. That’s why it’s called intermittent fasting. Chronic calorie restriction doesn’t work long term since it forces our bodies to reduce our resting metabolic rate (RMR), thus stalling weight loss and increasing frustration. Intermittent calorie restriction, on the other hand, allows for weight loss without changing our RMR, the key to healthy and successful long-term weight loss.

 

2.    IF is a great way to lower insulin.

It just makes sense. If there is no food coming in, there is no need for insulin to rise. Insulin will stay at its low steady basal rate, and there will be no elevations or spikes. That keeps the area under the curve low, right where we want it. Low insulin means we can mobilize our fat stores, and possibly more importantly, it protects us from the harmful long-term effects of hyperinsulinemia.

 

3.    Intermittent Fasting is the key to longevity.

The one consistent finding in longevity research, from single cell organisms up to primates, is that calorie restriction works. But as we have learned from chronic calorie restriction experiments in humans, it’s not so clear cut. First, its miserable and most people would rather die younger that live longer with chronic calorie restriction. Agree?

 

Second, our bodies adapt to chronic calorie restriction and thus make it difficult to maintain the health benefits. Intermittent calorie restriction, on the other hand, has the promise of all the longevity benefits without all the baggage that comes with it. The fountain of youth only helps if we like how it tastes.

 

4.    It’s easy!

What’s easier than skipping breakfast? No planning, no shopping, no cooking, no cleaning. Simply walk out the door.  In our hectic everyday lives, we should welcome anything that takes less time and makes our lives a little easier. Fasting does exactly that. Just make sure you bring a water bottle with you wherever you go, and maybe some sea salt to put in your water. Stay well hydrated and enjoy the simplicity.

 

5.    There are many ways to make fasting work for you.

 There is more than one way to have a successful fast. As mentioned previously, 18:6 can work wonders for most people. For those who are more adventurous, a 72-hour water fast can have amazing results. And there is everything in between. Just follow the simple rules of staying hydrated, paying attention to how you feel, avoiding anything with calories, and even avoiding calorie-free sweeteners. The rest of the details can be individualized to fit your life and your goals.

 

The Top Reason Why You shouldn’t fast

 

Fasting can work wonders for most people, but it can also be dangerous for others. If you take medications for diabetes, hypertension or other medical conditions and you're trying to fast on your own, don’t do it! Fasting can cause significant harm in these circumstances if not done with proper precaution. That doesn’t mean it can’t be done. In fact, it can still be incredibly beneficial. Just make sure you are working with an experienced clinician who can help coach you through it safely.

 

Here’s one last bonus tip.

 

Don’t give in to temptation once the fast is over.

 

How you break your fast can be just as important as how you fast.

 

  1. Break the fast with a small low carb snack such as bone broth
  2. Have your first meal an hour or two after your snack
  3. Resist the urge to “reward” yourself with high carb foods or junk food. Your gastrointestinal system isn’t ready for that. Plus, why work so hard to keep insulin low if you are just going to spike it when you are done? Stick to your usual, healthy, high quality low-carb fare.
  4. Resist the urge to increase your calorie intake to “make up” for the fast. If anything, the first 12 hours should have fewer calories than your usual eating pattern, slowly returning to normal (not supra-normal) over the next 24 hours.

 

Pretty easy, right? I am a big fan of simple, safe and effective. When done right, intermittent fasting hits all three criteria.

 

Is intermittent fasting right for you? It may just be. Talk to your health care provider to find out more, or sign up for a one-on-one consultation with to me where we can explore the details of your health journey and come up with a detailed, individualized plan to help you reach Your Best Health Ever!

 

Thanks for reading,

Bret Scher, MD FACC

Founder, Boundless Health

www.LowCarbCardiologist.com

 

 

 

Bret Scher, MD FACC

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