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

 

 

 

My Healthcare Apology

 

I owe you an apology. And not just you. I owe the whole country an apology. By being a part of our current healthcare system, I have been an implicit part of the demise of our country’s health.

 

Our healthcare policies and practices have failed us, and they continue to fail us. They have helped create two generations of overweight and obese individuals. They have allowed rampant increases in the number of people suffering with diabetes and insulin resistance, crippled by dementia, struggling with depression and autoimmune conditions, and the myriad of complications that come from our chronic diseases.

 

I am guilty too. I have been working within this system and did not stop it.  Sure, I can argue that I tried my best to ignore the misguided guidelines and policies, and I did what I felt was best for my patients. But I did not revolt. I did not demand that the system change. That makes me guilty.

 

It boggles my mind that this situation came to be. It is almost as if all healthcare providers thought, “There is no way we can be responsible. Someone would have noticed and fixed it. We wouldn’t let a broken system continue to make us sicker and sicker. Not when our goal is health.”

 

It’s hard to imagine any other system where this could happen.

 

Picture this. You are hired to help a company improve the health of their business by increasing sales and improving the quality of their product. At least that is what your job description says. Your first day on the job, you sit in training all day to learn company policies and guidelines for marketing and product design.

 

After six months on the job, the company is in trouble. The product keeps falling apart, returns and complaints are at an all-time high, and the marketing is failing to increase demand. Yet, despite this, everyone is congratulated for sticking to the company policy and abiding by the guidelines. In fact, everyone gets a small mid-year bonus for doing such a great job.

 

Sounds ridiculous, right?

 

Yet, within the world of healthcare, we could argue that is exactly what is happening. Starting from governmental dietary guidelines, which the AHA and ADA faithfully echo, and continuing with our culture of using a pill for every problem, our healthcare industry has failed. At best it has failed to fix the obvious problems that faces us. At worst it has caused them.  

 

And I have been a part of it. For that I am sorry.

 

But there is good news on the horizon. Alternative approaches to healthcare continue to increase. Whether it’s from health coaches, naturopaths, functional medicine doctors, or open minded and forward-thinking MDs, we now have options.

 

The best options offer a hybrid approach that combines the knowledge of medications and acute care medicine, balanced with the desire to promote real health. It is through this framework where we can see the tide starting to change. And once that tide becomes a big enough wave, the mainstream healthcare system will have no choice but to take notice and reform. Then, and only then, can we hope to reverse the path we are on.

 

Then, and only then, can I be proud to be part of a healthcare system that truly helps people live happier and healthier lives.

 

Do you have experiences where the healthcare industry has failed you? Share your story in the comments below and let us know how we can help you.

 

I want to fix this problem and help you find the quality of health that our “health”care  industry cannot. Whether it is signing up for a one-on-one consult with me, listening to The Low Carb Cardiologist Podcast, reading my book Your Best Health Ever, or any other way I can help you understand the true essence of health and how to achieve it, please let me know.

 

Thanks for reading.

 

Bret Scher, MD FACC

Founder, Boundless Health

www.LowCarbCardiologist.com

What Does My Cholesterol Level Mean?

What Does My Cholesterol Level Mean?

 

Depending on how you look at it, cholesterol can be an incredibly simple topic, or an incredibly confusing one. Contemporary medicine teaches that cholesterol is “bad” and should be low.  That seems pretty simple, right? Get it tested, if it’s high start a drug to lower it. 

 

Times have changed. Now, cholesterol is much more complex, and we all need to be armed with knowledge before we sit down with our doctors to evaluate our cholesterol levels.

 

Here is my guide to you and your doctor for evaluating your cholesterol.

 

1. Understand the difference between Total Cholesterol (TC) and high density lipoprotein (HDL) and low density lipoprotein (LDL)

 

If you doctor is referring to your total cholesterol (TC) and is making decision based on your TC— Run, don’t walk. Run away and find another doctor. TC is comprised of low density lipoprotein (LDL), so-called “bad cholesterol” even though it isn’t bad. High density lipoprotein (HDL), so-called "good cholesterol", and remnant cholesterol (VLDL and IDL). Initial studies in the 1960s and 70s looked at TC and risk of cardiovascular disease (CVD) and found a weak association.  That was prior to when scientists learned how to measure LDL and HDL.

 

Studies then looked at the individual lipoproteins (i.e. LDL and HDL) and found the higher the LDL, in general, the higher the risk for CVD. And the higher the HDL< the lower the risk of CVD. So, while talking about TC was cutting edge in the 60s and 70s, it is woefully outdated today. That is why if your doctor is still evaluating and treating TC—Run!

 

2. Does Your Doctor Know Your TC to HDL and TG to HDL Ratios?

 

If your doctor does not know your ratios, this is another reason to run away and find another doctor (We are doing lots of running here, bonus exercise!) Studies in the early 2000s and more recently have shown that total cholesterol to HDL ratio (TC:HDL) and triglyceride to HDL ratio (TG:HDL) are BETTER predictors of cardiovascular risk than isolated LDL, TC or HDL.

 

By incorporating TG and HDL into the analysis, these ratios incorporate the impact of remnant cholesterol and track with insulin resistance, both strong predictors of CVD. These ratios are calculated from a standard lipid profile, so they do not require any special testing or special labs. They are widely available for everyone to see. So if your doctor is not using them to evaluate your lipids, it's time to find a new one.

 

3. Understanding a Familial hypercholesterolemia (FH) diagnosis

 

Familial hypercholesterolemia (FH) is a diagnosis that requires (wait for it…) a family history! As the name suggests, it is an inherited condition passed from generation to generation. All too often, doctors will see an LDL level over 190 and make the diagnosis of FH. If your doctor makes that diagnosis that based on level alone without a family history, run!

 

There is a well-accepted scoring system, The Simon Broome Criteria, to help determine if someone has FH. This equation factors in age of diagnosis, absolute level of LDL, in addition to family history of early onset hyperlipidemia or early onset heart disease. It makes a big difference if you have FH or not. Don’t let your doctor label you as having FH without applying the full criteria. Just wait for the look on their face when you respond, “What was my Broome score? Did it confirm I have FH?” and hope you don't hear crickets.

 

4. What is Advance Lipid Testing?

 

Advance lipid testing may be helpful. And it may not. Advanced lipid testing can tell us the size, density, and inflammatory characteristics of our lipoproteins. This can help further risk stratify the potential danger of our lipids. For instance, small, dense LDL tend to correlate more strongly with CVD, whereas so-called pattern A LDL (the larger, less dense version) does not correlate as well.

 

Here is the interesting part. Those with high TG and low HDL almost uniformly have small dense LDL and increased inflammation. Conversely, those with low TGs and high HDL have Pattern A, larger less dense LDL. Are you starting to see a pattern? Low TG and high HDL=good. High TG and low HDL=bad.

 

Sometimes, however, there can be variation in this equation. Therefore, I usually suggest people get advanced lipid testing one time to see if their results correlate. If they do, then you can just follow your ratios to predict your advanced results. Why not get them all the time? They are frequently not covered by insurance and can be expensive.

 

5. Interpret your lipids in context

 

Lipids don’t exist in a vacuum. They exist in your body, so it's important to take into account what else is going on in your body. Insulin resistance and inflammation can directly affect your lipids and increase your risk in general. Hypertension, obesity, and family history of heart disease also play crucial roles in determining your risk.

 

Therefore, if your doctor checks only your lipids and bases decision on those labs alone—Run! Instead, you should get a hsCRP, Hgb A1c, fasting glucose, insulin and HOMA-IR, BP measurement, family history assessment, and complete history. This is the context in which your lipids should be evaluated. Not alone in a vacuum.

 

6. Why test a risk factor that may be related to CVD risk when you can test the disease itself?

 

Good question, right? To truly know what your lipids mean to you, you also need to know if you have evidence of CVD. Coronary artery calcium scores and Carotid Intima Media Thickness (CIMT) are two easy, relatively inexpensive tests, that you can get to show you whether or not you have current evidence of CVD. The presence or absence of disease significantly impacts the risk of lipid levels.

 

So, What Does Your Cholesterol mean to You? It depends.

 

It depends on many factors, and only by evaluating ALL of those factors can you truly know what impact your lipids may be having on our health. Anything short of this evaluation is an inadequate and antiquated approach to lipids.

 

Now you are forewarned and forearmed, and you can walk into your doctor’s office ready to ask the important questions and help guide the workup so that you can know what your cholesterol means to you.

 

Thanks for reading, and as always, please let us know If you have any comments or questions.

 

Bret Scher MD FACC

Founder, Boundless Health

www.LowCarbCardiologist.com

 

How To Talk to Your Doctor About The LCHF and Keto Lifestyle

Are you interested in trying a Low Carb-High Fat/Ketogenic lifestyle? If so, great.

 

Are you looking to your doctor for support in this diet? If so, tread gently.

 

The medical community has engrained false beliefs that LCHF lifestyle is dangerous to your health. We can blame it on Ancel Keys. We can blame it on an over emphasis on LDL-C. We can blame it on Big Pharma. We can even blame it on the rain!  Whatever the reason, you may not get a warm and receptive response from your physician.

 

But there is hope. Here are my top 6 Tips on How to Talk to Your Doctor About The LCHF/Keto Lifestyle.

 

 

1.    First, ask for your doctor's opinion about LCHF

Doctors are people too. How would your spouse react if you said, “I’m no longer taking out the trash/doing the dishes/making dinner. It doesn’t work with my personal philosophy of house chores and we are going to change this. Now.” I hope you have a comfortable couch, cause that’s where you will be sleeping.

 

Picture instead, “Hi Honey. I was thinking that we may want to reassign some of our house chores to help things get done better and more efficiently without putting too much strain on either of us. What do you think about that? Do you have any thoughts how you would like to change things?” That sounds better, right?

 

The same approach applies to your doctor. Just don’t start by calling your doctor honey. That’s just awkward. Don’t say, “Hey Doc, I’m going LCHF and need you to order x, y and z blood tests on me now and again in 6 months, and help me get off my meds.” Instead, try a kinder, gentler approach. “Hi Doc. I was thinking of ways to be more proactive about my health. What I have done thus far has not worked as well as I have liked. I have heard a lot about LCHF as a way to lose weight, reduce insulin levels, improve blood glucose control, and feel better. I was thinking of trying it. What do you think about that?” You may not immediately get the answer you want (for instance, I am still taking out the trash every week), but you have opened the lines of communication in a much less confrontational way, which can set you up for success as we discuss other tips below.

 

 

2.    Measure the effects of Keto on your body with a medical trial

If your doctor is hesitant about you trying LCHF/Keto, suggest a 3- or 6- month trial. Establish what you want to monitor (here's an eBook I created to help you get started: 10+Medical Tests to Follow on the LCHF Diet). Check what you would like to monitor at baseline and then at the 3-6-month mark. Emphasize you want to experiment to see how your body responds, and that you want his/her expertise in helping analyze the labs to help you progress safely.

 

Also, if you are on medications for blood pressure, blood sugar or lipids, you will want their guidance with these. Emphasize how you want him or her on your team to help you on your journey and temporary experiment. It is hard to resist when someone genuinely wants your help and thinks you can play a role in their improvement!

 

 

3.    Show them your results!

Don’t gloat, don’t brag, but make sure you follow up with your doctor and tell them everything you feel and have measured. Do you have more energy? Less stiffness or inflammation? Are your pants fitting looser? And of course, follow up on all the labs to look at the whole picture. You will be surprised how often your doctor will then turn to you and ask you what you have been doing. If they have the time, they will likely say “Tell me more about that.” Yes! This is your opportunity to teach them the power of LCHF/Keto. Then, when the next patient comes around, they won’t be as resistant, and may even start to suggest it themselves. The patient becomes the teacher!

 

 

4.    Find a doctor who will listen

Our healthcare system is messy. No question. We don’t always have freedom to choose our own doctors. But that doesn’t mean it is impossible to change. Here is a hint: If your doctor isn’t open minded enough to try a self-directed experiment with you, what else are they close minded about? Maybe it is time for a change anyway.

 

It may not be easy to find a doctor with an open mind who takes your insurance, is geographically desirable, and who is accepting patients, but there are some tricks you can use. Look for a doctor who has been in practice more than seven years, but less than 20 years. In my experience, this is the critical “open minded” window. They have been in practice long enough to be confident in their own skills and are willing to stray from “what everyone else does.” On the other hand, they have not been in practice so long that “That’s the way I have always done it” becomes the reason for their care.

 

Look for doctors with interests in prevention, sports medicine, or integrative medicine. These suggest more interest in health and less interest in the standard “pill for every ill” medical practice. Lastly, people are developing lists of Keto-friendly doctors online. While these may be small at present, they are growing quickly and hopefully can help you find the right doctor for you. 

 

 

5.    Seek online Keto support

Numerous online sites exist to help you with you transition to a LCHF lifestyle. I have built my blog and Low Carb Cardiologist Podcast to provide information and support on those who are embarking on their healthy lifestyle journeys, with a lot of information about Keto and LCHF.

 

Some other sites I recommend are DietDoctor.com, 2KetoDudes podcast, and Ketovangelist podcast, to name a few.

 

 

6.    Take control of your own healthcare journey

As nice as it is to have your physician on board with your health decisions, it is not always needed. As Brian Williamson from Ketovangelist said to me on his podcast, “If your doctor is more interested in your health than you are, then you are in trouble!” I agree with that sentiment, and I encourage everyone to be the driver in their own healthcare. You can still choose to try the LCHF lifestyle even without your doctor. Look for a reputable second opinion doc who is willing to help open lines of communication between you and your doc. That is one of the services I enjoy providing the most. Since I speak the same language, I can usually help someone start the conversation with their doctor.

 

In addition, online sites such as WellnessFx.com allow you to get your blood drawn and seek consultations with health care providers (Disclaimer: I am one of those providers and get paid for my services. Another disclaimer: I love doing it). If you go this route, I encourage you to then bring your results back to your doctor (See number 3 above). You can now become the teacher, young Jedi.

 

There you go. With these six simple tips and resources, you will be well on your way to safely adopting a Keto lifestyle. Doctors are people too. Just like everyone else, we like to be needed, we like to be helpful, and we don’t like being told what to do. I just need to remember that the next time my wife “needs” me to clean the toilet….

 

Thanks for reading.

 

Bret Scher, MD FACC

Founder, Boundless Health

www.LowCarbCardiologist.com

 

 

Is the Keto Diet Heart Healthy? 7 Reasons Why This Cardiologist Agrees

Is the Keto Diet Heart Healthy? 7 Reasons Why This Cardiologist Agrees

 

I am a board certified, card-carrying cardiologist, and I want my clients to eat more fat, more meat, more cheese, more eggs, more avocado, more, more, more.

 

For decades medical establishments have convinced us to eat low fat, higher carb diets. How has that worked for our health? Here’s a hint, we have record numbers of obesity, diabetes and dementia. Yet, as a cardiologist, that’s the party line I am supposed to support.

 

But I can’t. It’s just wrong, and I can’t support that line of thinking, not for a second.

 

Instead, I am a Low Carb Cardiologist. Here are the top Seven reasons why

 

 

              1-  Reducing Insulin is Essential to Health and Weight Loss.

 

Insulin is a hormone naturally secreted by the pancreas to help regulate blood sugar levels. Everything we eat (except possibly for 100% fat meals) causes insulin to rise. That is normal physiology. The problem occurs when our bodies become resistant to the effects of insulin, thus requiring our pancreas to make more and more and more insulin.

 

The problem? Insulin promotes fat storage, increase inflammation and oxidation, and can even help fuel the growth of cancer cells. Therefore, the healthiest approach is one which reduced the level of insulin to the lowest possible levels. As it happens, a Low-carb High-fat or ketogenic lifestyle (LCHF/Keto lifestyle) dramatically improves your body’s sensitivity to insulin, reduces the amount of insulin secreted, and it allows your body to naturally use your fat stores for what they are designed for: Break them down into energy! Once we see that we need to fight chronic elevations of insulin, it becomes obvious why a low-fat diet is harmful, and why a low carb diet is the true path to health.

 

2-    Eating Fat Improves Your Cholesterol!

 

Wait, what? Eating fat can improve my cholesterol? Sounds crazy, right? That goes against everything we have heard from the medical establishment. Notice I said “cholesterol.” I didn’t say the "bad" low density lipoprotein (LDL), I didn’t say the "good" high density lipoprotein (HDL), or any one specific type of cholesterol. We have over emphasized the solitary variable of LDL for too long. Total cholesterol to HDL ratio, Triglyceride to HDL ratio, lipoprotein size and density, insulin sensitivity, and other metabolic measures are more powerful predictors of cardiovascular health than just LDL.

 

Once again, we see that all these markers improve with a Low Carb High Fat (LCHF) lifestyle. The medical establishment needs to realize that we are more complicated than one lab value. The key is to look at the whole picture, and this picture dramatically improves with a LCHF lifestyle.

 

3-    Higher HDL is Associated with a Lower Risk of Heart Disease.

 

HDL is your friend, but drugs are not. Observational evidence has consistently shown that higher HDL is associated with a lower risk of cardiovascular disease. However, our healthcare establishment does not prioritize HDL for one simple reason- Drugs that raise HDL don’t make you healthier. Trial after trial has failed to show any benefit from drugs that significantly increase HDL. 

 

Instead, it’s the HDL-raising lifestyle that provides the benefit, not artificially increasing it with drugs. What’s the best lifestyle to naturally raise HDL? You guessed it. LCHF/Keto lifestyle. Add in some resistance training and you have your friendly HDL climbing the way it was meant to…Naturally.

 

4-    LCHF Leaves You Feeling Great, Leading to Healthier Decisions

 

What kind of health decisions do you make when you are fatigued, achy, and find it difficult to concentrate? That’s a rhetorical question, I already know the answer. When things look glum and we don’t feel well, it's far too easy to sit on the couch or reach for the chips and cookies. Compare those decisions to those you make when you are well rested, energetic, and seeing the world more clearly. For most people, the better you feel, the better decisions you make.

 

Guess what? The majority of people who change to a LCHF lifestyle feel better! It may take a few days or weeks, but in general, they feel more in control of their health, more energetic, and they are able to make better health decisions. I admit this is difficult to prove in a scientific trial. That is why we all should become our own n=1 scientific trial. How do you feel and how are your health decisions after going to a LCHF lifestyle? What matters most is what works for you, not what works for hundreds of people who are kinda-sorta like you.

 

      5-    Keto helps you with fasting.

 

Eating better helps you not eat. People who eat a high carb diet eat a lot, don’t they? They are always grazing and snacking. Our bodies go through the roller coaster of blood sugar and insulin spikes, making it a challenge to go 24, 18, or even 6 hours without eating. This creates a constant, unwavering supply of insulin in our blood stream.

 

Why is this harmful? For one, it promotes fat storage and keeps us from using our fat as fuel. Secondly, chronically elevated insulin can predispose to heart disease, strokes, cancer, dementia and other devastating health conditions. When people change to Keto, however, they realize they do not need to eat nearly as much or as frequently. Avoiding the carbs and increasing the fats keeps us full longer, and our bodies quickly adapt to longer periods without eating. The result? We can use our fat stores for what they were designed- a source of fuel! It also allows our body to maintain lower insulin levels, and also allows our cells to take care of their health chores, referred to as…..

 

6-    LCHF Promotes Health Through Increased Autophagy.

 

Autopha-What? In medicine we like using fancy words to make us look smart. Autophagy is a big word to describe cellular housekeeping. When we have low enough intake of carbs and protein, or when we do intermittent fasts, our bodies can take care of their “to do” lists.  That list includes breaking down weak or damaged cells, recycling the good parts and discarding the rest, and slowing down the processes that can lead to abnormal cell growth (i.e. excess proteins in Alzheimer’s disease, abnormal cancer cells etc.).

 

Admittedly, long term outcome studies evaluating fasting or LCHF and cancer or dementia risk have not been done. But, on the flip side, drug trials to prevent the same are showing no benefit despite hundreds of millions of dollars invested. If you asked me (which you sort of did since you are reading my article), I’d vote for autophagy as a preventative strategy any day. It makes good physiologic sense, and it is so easy to achieve.

 

7-    With Keto You Will Enjoy Eating Again!

 

That’s right. A way of eating that helps you lose weight, helps you feel better, improves your health and is actually enjoyable! No fake processed soy products, no cardboard tasting rice cakes. True, it also means no more candy, processed snack foods, doughnuts and danishes. But once you swear them off for a few weeks, and you are eating all the eggs, avocados, nuts, fish, steak, cheese etc. that you want, you won’t miss those old crutches any more. Let the enjoyment begin!

I could go on, but since it seems people like “7 Reason” articles, I will leave it at that. 

 

Now you know the secret: Look at the whole picture. Look for a lifestyle, (not a diet) that helps you feel better, increases your enjoyment, and still benefits your overall health.

 

Is LCHF/Keto the right lifestyle for you? It just may be. It is for me, The Low Carb Cardiologist, and it is for most of my patients and clients. Want to learn more about how LCHF lifestyle impacts your health? Visit us at www.LowCarbCardiologist.com

 

Thanks for reading

 

Bret Scher, MD FACC

Founder, Boundless Health

www.LowCarbCardiologist.com

 

 

Top 4 Tips For Optimizing Melatonin and Sleep

Do you struggle to get consistent sleep? You are not alone.

 

An estimated 27% of Americans report having trouble sleeping most nights of the week, with an astounding 68% saying the same at least 1 night per week. That has led to 5% of all women and 3% of all men taking prescription sleeping pills at the cost of millions of dollars.

 

That pales in comparison the 10-20% of Americans spending multiple millions of dollars on non-prescription sleep supplements. Of those sleep aids, melatonin is likely the most common. But here’s the problem, melatonin is not a great on-demand sleep aid.

 

I recently posted a Facebook video about the use of melatonin for sleep. If you like videos, you can watch it here. If you prefer blogs, then read on my friend!!

 

Seep aids like Ambien work within minutes, and therefore should be taken right when it is time to go to sleep. Many take melatonin the same way, right before it’s time to go to sleep. But melatonin doesn’t work that way.

 

Melatonin is a natural hormone in our brains that has a natural circadian rhythm, meaning it rises and falls during the day in concert with the light-dark cycle of the sun. Or at least that is how it is supposed to work. Thanks to Thomas Edison and Steve Jobs, melatonin doesn’t work that way for many of us.

 

Artificial light and especially blue light from our phones and computer screens fool our brains into thinking the sun is still out, and therefore, resetting our melatonin cycle.  Thus, the push for us to take melatonin supplements to help balance this us.

 

Instead of taking a melatonin supplements, however, we have much more success by getting our natural melatonin cycle back in sync with the sun. Here are my Top 4 Tips For Optimizing Melatonin and Sleep!

 

  1. Dim your lights EARLY, around 8pm. That doesn’t mean turn them off and live by candlelight (although that would work REALLY well). It does mean, however, that you should not have every light in the house on at full force until the moment you go to bed. You need to prepare your brain for bed, starting at least 2-hours before lights out. Get dimmers for your lights or turn off half the lights starting at 8pm. You might even save money on your electricity bill (bonus!).
  2. Dim your screens early as well. Most phones, tablets and computers now come with a screen dimming option. Most commonly I see people use this starting at 10pm. That’s better than nothing, but by then most of the damage has already been done.  I recommend dimming your screens at 8pm, along with the lights, and turn your screens off completely 1-2 hours before bed. Remember, you want your melatonin to start rising well before it’s time for lights out. Screen time prevents that from happening.
  3. Get plenty of light early in the day. This is the time to signal your brain that IT IS DAYTIME!!! Natural sunlight is best. Get outside and sun yourself for 20-minutes, go for a walk, eat breakfast outside, whatever you can do to get early sunlight. If that is too much of a logistical challenge, then this is when you want every light on in the house at full blast. Even house lights can tell your brain the sun is out and it’s time to get going.
  4. The best use for melatonin supplements is if you disrupt your sleep-wake cycle, such as travelling across a few time zones, or staying up a few nights in a row for work, kids or other reasons. In that case, melatonin supplements can help get your cycle back in rhythm. Just remember to take it an hour or two before you want to go to sleep, not at the moment you lie down in bed. If done right, you shouldn’t need melatonin for more than a couple days before your natural circadian rhythm is back in sync with your time zone.  Just keep I mind steps 1-3 above!

 

 

There you have it. My Top 4 Tips For Optimizing Melatonin and Sleep. For even more information, you can listen to my podcast with sleep expert Dr. Chris Winter, nicknamed The Sleep Whisperer,” or read my earlier blog on sleep. Do you have other tips that work for you, or other sleep challenges you need help with? Leave a comment below or contact us at www.LowCarbCardiologist.com.

 

Thanks for reading!

 

Bret Scher, MD FACC

Founder, Boundless Health

www.LowCarbCardiologist.com

 

 

 

Zero LDL vs Ketogenic Diet- Which Prevents Heart Disease?

Virta Health continues to revolutionize the treatment of diabetes. And they are doing it while taking drugs away!

 

They recently released their study of cardiovascular risk data which, no surprise to me, shows significant improvement in patients’ risk profile. This impressive lifestyle study contrasts sharply with the other side of the coin- promoting drugs to drive LDL to a near zero level in the hopes of helping patients. That’s the other study I read last week, and I was much less excited about it.

 

Two wildly different approaches with wildly different magnitude of benefit. Let’s dig deeper to learn more….

 

The Virta Health Study:

 

The Virta Health trial enrolled subjects with diabetes, mean age was 54 years old, and they were obese on average with a BMI 40.  After 1 year, they had the following results:

  • LDL particle number decreased by almost 5%,
  • Small LDL decreased by 20%,
  • Apo A1 increased by almost 10%,
  • TG decreased by 24%,
  • HDL increased by 18%,
  • TG/HDL radio decreased by almost 30%,  
  • Large VLDL particles decreased by 38%,
  • CRP decreased by almost 40%,
  • The 10-year calculated risk went down by 11% ,
  • No change in CIMT, and
  • LDL-C went up by 10%.

 

EVERYTHING IMPROVED! Except for a small increase in LDL-C.

 

The first question this study forces us to ask, therefore, is should we care about the LDL-C? That is the only marker that went “the wrong” way, increasing 10%. But that is in the face of the LDL-P decreasing, the size of the LDL improving, and dramatic improvements in HDL and TG. All things that are likely protective against CAD.

 

Going all the way back to Dr. Castulli and the Framingham data, we know that LDL-C is a very poor predictor of CVD in the setting on high HDL. We also know that markers such as LDL-P and non-HDL cholesterol are better predictors of CVD than LDL-C.

 

So, in short, the answer is no. We should not be concerned with a 10% increase in LDL-C in this setting.

 

The second question is this. Does this data show that one year on a ketogenic diet is BENEFICIAL for heart health?

 

The original assumption within the medical community was that a ketogenic diet would be harmful and lead us to our grave (as many docs still believe).

 

The times they are a changin.’

 

Based on this data, the question has changed significantly. We should no longer concern ourselves with wondering if a very low carbohydrate, ketogenic diet could be harmful. The data is overwhelming that it is not. Instead, we need to ask if this diet protects us from heart disease.

 

Of course, we would need long term outcome data to show us that for certain. But in the absence of that, the most recent Virta Health data provides a strong vote of confidence that a very low carbohydrate ketogenic diet is likely cardioprotective.

 

That is my kind of medical science. Showing that lifestyle changes promote health.  Clean and simple.

 

The Drug Trials- PCSK9i

 

The Virta Health study contrasts sharply with another paper I read recently, one that claims it is safe and beneficial to lower LDL as low as possible, the so called “Zero LDL hypothesis.”

 

I have to admit, I started reading with a heavy contrary bias. I wanted to rip it apart and find all the shortcomings in the paper.  There were plenty, but I also have to admit that there are some very well thought out and well-argued points.

 

The general argument is that statins and PCSK9i are able to lower LDL to extremely low levels without documented significant adverse effects thus far. Therefore, there is no “floor” for how low we should drive down LDL.

 

Both statins and PCSK9i work by increasing the efficacy of LDL receptors, but they allow other compensatory mechanisms to remain functioning. For instance, the authors describe “back up” mechanisms for maintaining neuronal health, hormone synthesis, and even vitamin E transport (all of which are theoretical concerns with lowering LDL). They argue, since the back-up systems prevent adverse outcomes, and PCSK9i studies have gotten LDL down to 30, we can therefore safely drive LDL down to zero.

 

That’s a stretch that remains to be proven. However, the main question they fail to answer is this: Is worth the effort?

 

Once again, we see studies generating a tremendous amount of publicity and praise for underwhelming and conflicting results. Here’s what I mean:

 

The first big trial with PCSK9i was called the FOURIER trial. They enrolled patients with known cardiovascular disease and added PCSK9i or placebo to their current care. After 2 years, the PCSK9i drug reduced LDL by 60% to a median level of 30mg/dl (lower than any other major trial). The results? There was a small decrease in non-fatal heart attacks (1.2%), with absolutely no improvement in mortality. It did not save a single life.

 

The second trial that got even more attention was the Odessey trial. They enrolled individuals with a recent cardiac event and added PCSK9i or placebo to their standard care. After 2.8 years they lowered LDL by 61% to an average level of 53mg/dl.  Again, there was a very small 1.5% reduction in a combined primary endpoint. In reality, this is negligible clinically even though it is statistically significant.

 

Where the trials differed, however, was that Odessey showed a very small reduction in all-cause mortality of 0.6%., whereas Fourier did not.

 

But here is where it gets complicated. What the press and mainstream cardiology societies don’t tell us is that because of the way the trial was structured, this is not a truly significant finding. It had a weakly positive p value, but since cardiac mortality was not decreased, it invalidated the all-cause mortality. Don’t worry. I don’t completely understand this part either. But I’m told that’s how statistics work in this case.

 

In summary, despite lowering LDL cholesterol to levels lower than we have even seen before with drug therapy, the benefits were underwhelming. If LDL was the true cause of heart disease, there should have been breath takingly dramatic benefits. Yet, one trial showed no improvement in all-cause mortality. One may have shown an improvement, but the trial can’t really claim that.

 

Yet somehow the conclusion is that now we should drive LDL down to zero.  Where did that come from????

 

First Do No Harm

 

The belief that we should drive ldl to zero with drugs comes from the inherent bias in modern medicine: When it comes to drug therapy, “more is better,” and drugs are the best choice for treatment.

 

After all, the trials “proved” that the drugs were safe with no significant increase in adverse effects, right?  Not so fast. Lack of side effects at 2 years is not very reassuring for a drug people will be on for decades. There is plenty of concern about long term effects of near zero LDL levels, even if the authors postulate ways the body will compensate.  To counteract that concern, the benefits better be monumental.

 

After all, the medical oath is “First do no harm”.  Not “First assume there will be no harm”.

 

And more importantly, just because we can treat LDL to near zero, doesn’t mean we should. If we aren’t helping people live longer or live better, then what are we accomplishing?

 

Instead of talking about zero LDLs, we should be talking more about Virta Health. They showed the ability to reverse one of the most common chronic diseases we face with simple lifestyle interventions. And they did it while improving cardiovascular risk factors and getting people off of their medications. In my eyes, that deserves a ticker tape parade.

 

My take home message: Lifestyle beats drugs. Commit to lifestyle change and the argument about reducing your LDL to zero is a non-factor.  

 

What’s your take home message? Let us know your thoughts or if you have questions at www.LowCarbCardiologist.com

 

Thanks for reading

 

Bret Scher, MD FACC

Founder, Boundless Health

www.LowCarbCardiolgist.com

My Journey to The Low Carb Cardiologist Podcast

My Journey to The Low Carb Cardiologist Podcast

 

Sometimes change is hard, and sometimes it just feels right.

 

Changing my podcast from The Boundless Health Podcast to The Low Carb Cardiologist Podcast was a little of both.

 

To be fair, this wasn’t exactly the biggest, most impactful decision I have made lately.  The perspective is not lost on me. It’s a podcast name, not heart surgery.

 

But it was meaningful for me personally, and it exemplifies the current atmosphere of health and nutrition, and that is why it is worth exploring with you.

 

I still remember when I started my podcast. I was so afraid that I wouldn’t get any guests, that I was simply happy anyone would agree to come on the show and talk to me! As soon as the interview started, I was so grateful they were there, I just wanted to support them and thank them for their time.

 

But that doesn’t do much for challenging them, or digging deep to determine fact from fiction, or deciphering reasonable recommendations from those that are…..well…..let’s just say not as reasonable. Luckily, my friend HD from HormonesDemystified.com was there to set me straight.

 

HD helped me focus on my relationship with my listeners, and helped me realize that my listeners were my primary responsibility. My job wasn’t to give my guests the best experience. My job was to give my listeners the best experience, and to give them the best information I could.

 

With a clearer mission, I set out to refine my role and my niche.

 

That is where nutritional and health science started to look more like religion to me.

 

When I interviewed a vegan, I got push back from my low carb supporters wondering how I could support his views. When I interviewed a meat proponent, those who appreciated my vegan interview were up in arms about my hypocrisy.  They felt as if I had misled them.

 

What I failed to get across was that my interviews were not about me! These interviews were supposed to tease out the nuances of my guests’ viewpoints, to help determine what is backed by science, what is backed by emotion, and what can we learn from it. Yet many listeners equated my guests’ opinions with my own, and thus were upset at me for supporting both a vegan and a meat advocate. They were left wondering what I stand for.

 

I understand this does not encapsulate everyone. But it does highlight the world in which we live. Far too many people hold so strongly to their nutritional and health beliefs that they cannot bear to listen to the “other side” or even consider an opposing view point. The importance of detail, nuance, and scientific integrity is far too easily lost in the emotion and vigor of belief. And that is a sad reality for the world of reason, debate and scientific “truth.”

 

Which brings me back to the name of my podcast. What do I stand for? Which side of the aisle do I sit?

 

I believe some people can be healthy as vegans. I believe some people can do well restricting their fat intake and focusing on calories.

 

I also believe that the vast majority of people cannot achieve their health goals limiting fat and counting calories.

 

The most generalizable and most effective intervention that I have seen in the past 20 years is without out a doubt the low-carb lifestyle. Thus, the change to The Low Carb Cardiologist Podcast. No confusion there. My guests and my listeners know where I stand.

 

But that doesn’t mean I am going to stop looking at differing views, or trying to find the common ground between healthy vegans, healthy carnivores, and everyone in between. I will continue to tease out the nuances behind endurance athletes, crossfitters, and power walkers.

 

We all need a reminder to look outside our field of view (me included!), to go outside our comfort zone, and to explore the “other side,” even if it is simply to help us feel stronger in our convictions. The exploration is part of the process.  

 

My promise is that I will continue to explore health from any and every angle that I think will help you, my listener, improve your health for a lifetime of Your Best Health Ever!

 

The name has changed, but the mission remains the same.

 

How can I help you on your health journey? Please visit me at www.LowCarbCardiologist.com  and let me know how I can best help you achieve your health goals, or feel free to provide feedback about what you would like to see from The Low Carb cardiologist in the future.

 

Thanks for reading!

 

Bret Scher, MD FACC

Founder, Boundless Health

www.LowCarbCardiologist.com

 

Do Low Carb Ketogenic Diets Increase Your Risk of Dying?

Do Low Carb Ketogenic Diets Increase Your Risk of Dying?

 

Some people certainly want us to think so.

 

But as is often the case, the evidence doesn’t reliably support the dramatic claim.

 

Let’s face it. We all have biases. We all believe things strongly, and we look for evidence to support our position.  I have been guilty of that.

 

That is why those who state that ketogenic diets kill us may still be well meaning, even if they completely miss the point.

 

One frequently cited article to “prove” ketogenic diets kill us was published in the Annals of Internal Medicine in 2010

 

If we just read the abstract, the conclusion is clear. In a study of 129,000 subjects, those who scored the highest for an animal based low-carb diet had a 23% relative increased risk of all-cause mortality.

 

A plant based low-carb diet, on the other hand, seemed to be protective with a 20% decreased risk.

 

For many, an abstract is good enough evidence to sing from the rafters as if it were fact.

 

But that is not how science works. The details matter. They matter a lot. So, let’s look at the details before we condemn a ketogenic diet as a serial killer.

 

The analysis was based on a retrospective look at the Health Professional’s Study and the Nurse’s Health Study. Subjects filled out food questionnaires to estimate their nutrition intake over the past year, estimating their frequency of eating certain foods. Based on that frequency, they were given an animal low-carb diet “score,” and a vegetable low-carb diet “score”.

 

Let’s set aside the how horrible food questionnaires are for scientific validity. That’s the least of the study’s problems.

 

Looking at the baseline characteristics, we see all we need to know. Those who scored highest for animal low-carb diets also had the highest percentage of smokers, 30% vs 27% for women and 14% vs 9% for men (anyone else surprised there were more women smokers than men? I was). Is a 3-5% difference in smoking significant? You better believe it. Smoking is the single most dangerous thing we can do for our health. Considering the mortality difference was so small between the groups, a 5% smoking difference could absolutely account for it.

 

But it doesn’t stop there. The animal consuming men were less physically active and ate more trans-fats.  

 

This is a prime example of the “healthy user bias.” When the whole world says eating meat is bad for you (as they did in the 1980s), who do you think eats meat? You got it. Those who don’t care all that much about their health. Thus, the increase in smokers, increased unhealthy trans fats, and less physical activity.

 

And that is likely just the tip of the iceberg. What other unhealthy practices do they do more often that weren’t measured? We can’t analyze the data from what we didn’t measure.

 

Oh, and let’s not forget that the diets were nowhere close to being low carb ketogenic diets. The animal based low carb eaters consumed 163 grams of carbohydrates per day. 163 grams! I am not sure in what universe that is considered “low carb,” but I can assure you it isn’t in the actual low-carb community. For that, we need to eat at most 50 grams of carbs per day, and even less if we are already insulin resistant.

 

The paper then goes on to show the risk for all-cause mortality, cardiovascular mortality, and cancer mortality. But does it matter? When the data is as poor as this study’s, what can we really conclude?

 

We can conclude this: People who are unhealthy, who smoke, who follow a mixed diet of animal fat and moderate in carbohydrates, and who ignore society’s recommendations about their health have a worse outcome than those who are healthier and follow society’s health advice. Yawn. I think we have seen this movie before

 

So, before we condemn a ketogenic diet as being a silent killer, let’s make sure we are actually studying a ketogenic diet, and let’s make sure it is a level playing ground.

 

Does this mean ketogenic diets have been proven to be safe long term? No. Those studies have not been done. But……

 

Is losing weight, reducing inflammation, reversing diabetes and normalizing blood pressure, all while getting rid of medications likely to improve people’s long-term health? You better believe it.

 

Say hello to a real ketogenic diet.

 

Thanks for reading

 

Bret Scher, MD FACC

LowCarbCardiologist.com

Low-Carb No Better Than Low-Fat….Or is it?

The quest for the one study to finally answer all our nutritional questions continues. And likely will continue forever.

 

If you believe the hype, the recent JAMA study comparing a “healthy low fat” and “healthy low carb” diet on the effect of weight loss was the definitive answer we sought.  The only problem is that it wasn’t.

 

Their conclusion? Everyone lost the same amount of weight regardless of the diet, and genetics of insulin resistance didn’t matter. So, in the end, we can all stop worrying about low fat or low carb or insulin resistance and just eat well. Right?

 

I’m all for simple advice, and that is as simple as it gets. And it will work for many people. But from a scientific perspective, this study did not adequately address the questions it sought to answer. Let’s look under the hood…..

 

600 people without diabetes or heart disease and not on hypertension or lipid medicines were randomized to a “healthy low fat” or “healthy low carb” diet for 12 months.

 

Neither group was told to restrict calories (although both groups ended up eating 500 calories less per day on their own). They had extensive counseling and support with over 20 support sessions throughout the 12 months. These sessions included specifics about the diet and support for maintaining behavioral changes. (That’s a great goal for us all, but the reality of behavior change support looks far different. “Eat better, lose weight and come back in a year” is an all-to-familiar refrain).

 

Here is the kicker. Both diet groups were advised to maximize the veggies, minimize sugar and processed flour, minimize trans fats, and focus on nutrient dense whole foods prepared mostly at home.

 

I don’t care what the macros of the diet are. If we get people to do that, Bravo! That would be a vast improvement for the majority of this country. As a result, the “low fat” group reduced their carb intake from 241 grams per day at baseline down to 205-212 grams per day during the study, and undoubtedly improved the quality of their carbs. They were the low-fat group, and they reduced their carbs! Red flag #1.

 

On the other side, the low-carb group also started in the 240s per day, and reduced their carb intake to 96-132 grams per day during the trial. Red flag #2. This is not a true low carb diet. Low carb diets tend to have less than 50 grams of carbs (100 at the absolute most!), and ketogenic diets tend to have carbs <30grams per day.

 

So, let’s be clear about what was tested. The diet was a “lower than average but still not all that low” intake of carbohydrates, compared to a “lower than average but more moderate carb intake” diet.  

 

This is hardly the definitive once and for all answer about low fat vs low carb diets for which we had all hoped.

 

That doesn’t mean we have to throw out the results, however. We can still learn valuable information from the trial.

 

  1. Reduce junk, and focus on real foods and you will lose weight and improve your health. AMEN! Not a shocker, but always nice to be reminded of the simple things that work.
  2. Engage in a strong support system and you have a good shot of staying with a nutritional change for 12 months.
  3. The more you reduce your carbs, the more likely you are to raise your HDL and lower your TG.
  4. The more you lower your fat, the more likely you are to lower your LDL
  5. Following a mildly reduced carbohydrate intake may not significantly improve insulin resistance blood tests.
  6. There was still a huge variability within each group with some people losing a great deal of weight, and some not losing any. Looking at the averages does not help us decide what specific characteristics predicted success. But in this trial, it did not seem to be genetics.

 

And the other take home? Testing moderate changes in diet are unlikely to show dramatic differences when both tested diets focus on real, nutrient dense, whole foods, limiting added sugar and processed flour.

 

If we want to test for a REAL difference, we need to go more “extreme.”

 

Doing this same study with a ketogenic diet would be very interesting.

 

Including people with diabetes and hypertension (more metabolically unhealthy, like so many in this country) would be very interesting.

 

Would that give us the once and for all answer which we crave?

 

Once again, probably not. But it may help us understand when to use the different tools we have in our nutritional tool box.

 

As was so nicely stated by The Diet Doctor, we now have an equal number of studies showing no difference between low fat and low carb diets as we do showing that low carb is better. We are still waiting for one to show low fat is better…….

 

The main takeaway, however, is that we don’t have to believe there is one diet for everyone. That is why we need an open mind, we need to be open to experimentation, and we need to treat individuals as…….individuals.

 

We can reverse type II diabetes with a ketogenic diet. Virta Health has shown us that.

 

Real food, relatively low-fat diets, when combined with healthy lifestyle practices can be associated with good healthspan. The Blue Zones observations have shown us that.

 

Our definitive trial may never come. But we don’t need it as long as we are willing to work with the n=1 experiment with each and every person we encounter. The starting point is easy. Just eat real food. Then be open to different avenues of specifics and see where the road goes.

 

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

Bret Scher, MD FACC

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