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Author: Bret Scher

Why I Ate My Wife’s Chocolate Chips. All of Them.

I didn’t sleep at all Saturday night.

 

 In college, that may have been an exciting statement full of fun and intrigue.

 

In medical school and residency, it was a badge of honor and usually involved clinical challenges and valuable experiences.

 

This past Saturday, it involved consoling my son as he kept throwing up. Changing his sheets, wiping his head with a damp towel, and most importantly, just letting him know I was there and that he would be OK. It is a rite of passage all parents go through, more than once.

 

On Sunday, he was much better and slowly getting back to his usual self. Me? I was hungry and craving carbs.

 

I also almost never crave carbs. I practice intermittent fasting, I eat a “veggie first diet” with healthy fats, appropriate portions of animal sources, some fruit and almost no refined carbs. Through years of this practice, I have been able to drastically diminish my sweet tooth and control my hunger and cravings

 

A Different Story

 

Sunday was a different story. I had the carb cravings and munchies all day. Instead of eggs, veggies, and avocado, I had fruit and granola for breakfast. But didn’t stop there. I still had this crazy craving so I added toast and a banana.

 

Later in the day the cravings really hit. Chocolate.

 

I was craving chocolate like you wouldn’t believe. Fortunately, my wife had some chocolate chips in the freezer. Let’s just say I need to make a run to replenish the supply before she sees what I have done. Without thinking, I polished off what was left in the bag.

 

How could this be? This was all so unlike me. What could have happened?

 

Sleep.

 

Or more importantly, lack of sleep.

 

Sleep and Our Hormones

 

Sleep is intimately involved with our hunger and our cravings. As a result, sleep is intimately involved with our weight gain, weight loss and our health. It effects not only our ability to make decisions, but also alters our hormones, our cravings and our feelings.

 

That’s powerful stuff!

 

It turns out that inadequate sleep affects our hormones ghrelin and leptin. They sound like comic book villains, but they are hormones that control our feelings of being hungry or feeling full. Ghrelin, the “hunger hormone,” signals to your body that you’re hungry and need to eat. Leptin has the opposite effect, and signals that you’re full and don’t need to eat. Research consistently shows that poor sleep spikes ghrelin and suppresses leptin levels.

 

The result? Poor sleep leaves you feeling hungrier than usual regardless of what you eat or how much you eat. You eat more and expend less energy. Bad combination.

 

Leptin and ghrelin load the gun, our lack of mental clarity pulls the trigger (it’s a terribly violent analogy, but it makes the point none the less).

 

When we are sleep deprived we don’t think with the same level of clarity and with the same emotional control. We tend to react impulsively when we feel hungry. Impulse decisions rarely end in a well-balanced meal of veggies with healthy fats and proteins. More often, the result is standing in front of the freezer, door open, eating your wife’s stash of chocolate chips.

 

Guilty as charged.

 

Ripple Effect

 

Guess what else I did (or more importantly, didn’t do) in my sleep-deprived state on Sunday.

 

I didn’t go to the gym as I had planned.

 

I didn’t get out for a hike or nature walk.

 

I drove to the grocery store instead of riding my bike.

 

I sat and watched a movie with my son rationalizing that he wanted me there so it was OK to plant myself on the couch for an hour and a half.

 

Sound familiar? When we are tired and run down from poor sleep, the rest of our healthy lifestyle decisions suffer. It is the classic ripple effect.

 

And poor sleep can cause it all.

 

The solution?

 

Sleep better.

 

“No kidding. We already knew that. Thanks for nothing doc!”

 

Ok. We all know we need more sleep. And there is a laundry list of sleep hygiene techniques that I review in more detail in my book and elsewhere.

 

But life happens. We can’t always prepare for the night of consoling our children. Or the night before a big presentation when we are too excited/nervous/scared (take your pick) to get to sleep. What do we do then?

 

Be mindful and be aware.

 

Mindful Power

 

In this case, knowledge truly is power. Simply being aware that our hormones will be off kilter and our decision making will be impaired gives us the power to control our day.

 

You may need an extra reminder, or you may have to try harder than usual, but staying in the present and being mindful of your decisions is the skill you need to counteract the effects of poor sleep.

 

Instead of acting rashly, take a breath. Step back, breathe and realize you did not sleep well. Remind yourself that poor sleep alters your hormones and your perceived needs. And realize that you can still control these feelings and cravings. When you are mindful, you are in control.

 

It turns out, studies show mindfulness also helps you sleep better. When compared to a group of individuals given sleep hygiene education, individuals who practiced regular mindful meditation slept more and felt more refreshed. So not only does being mindful help you get through your day with minimal damage, it also helps you get back on track.

 

Once again, that’s a pretty powerful effect. If that were a pill you better believe there would be a multi-million-dollar marketing campaign behind it.

 

But it isn’t a pill. It’s free for anyone to do. It’s a skill anyone can try and everyone can improve. Being mindful is like exercising a muscle. The more you practice it, the stronger it becomes. The stronger it becomes, the easier it is to use.

 

You won’t be perfect and it may not always be easy. But I promise you this. Practice being mindful, practice your breathing, and you will be better.

 

Action Item:

Start recording your sleep. Activity monitors like FitBit Alta HR, FitBit Charge, Garmin Vivosport, Mio Slice, the Apple watch and many others all record sleep duration. Or simply record it yourself with a pen and paper (old school). When you get less sleep than usual, make a concerted effort to control your surroundings more. Make a concerted effort to practice your mindfulness techniques more. Treat yourself with more compassion and more love.  And make sure you get to bed a little earlier that night to help break the cycle. You can do this. You just need to be aware.

 

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

 

 

 

Whole30 Mexican Salmon Cakes with Mango Relish

I am a big fan of Melissa Hartwig and her Whole30 program. First there is the general concept that how and why we eat are just as important as what we eat. Then there are her recipes. Some people feel it can get boring eating real foods, no added sugars or grains or processed food. Melissa's recipes show us that it is anything but boring. Try these Mexican Salmon Cakes with Mango Relish and you will drop the word boring from your vocabulary. I'm a spice wimp so I did it without the cayenne pepper and jalopenos, and I served it with sauted spinach and some leftover broccoli/carrots/cauliflower I had in the fridge. Deliscious!

What Does Your Utopia Look Like?

What does your Utopia look like? Have you ever stopped to think about it? How does health fit in to your utopia?

I bet in your ideal world, you feel light, fit, and move freely with no aches or pains. You have a positive frame of mind, you're happy and energetic.

When you see yourself in this utopia, what does the rest of your life look like? What kind of exercise do you do? What kind of work do you do and what does your commute look like? What kind of food you eat and where is the food come from? What do your relationships look like with those you love? 

Hopefully it feels good to allow yourself this moment of exploration and daydreaming. Hopefully this simple exercise can inspire you to change certain aspects in your life to help bring your utopia closer to reality.

My Utopia

Take a minute to come explore my utopia where health is first and foremost. 

In my utopia, we all live close enough to a farmer’s market or a hydroponic garden to get fresh fruits and vegetables year around. We walk or ride our bikes to the market and the fresh veggies and fruits make up over 50% of our meals.

 In my utopia packaged and processed foods and sweets don’t exist. Processed white flour does not exist. Concentrated fruit juice doesn’t exist. Sodas, energy drinks, and sports drinks won’t exist.

We will hydrate our bodies naturally with water, tea or freshly ground coffee beans. We won’t have refined and processed sugar to pour into our drinks.

 The sweetest foods and most concentrated sugars are berries, oranges and apples.

And we love it.

 

You Can’t Crave What Doesn’t Exist

Some may stop and think, what about my sweet cravings? Well, if it doesn’t exist, you can’t crave it. It won’t even be an option so you’ll quickly learn not to even think about it. The longer you go without it, eventually your body will stop craving it.

It’s amazing how quickly our taste buds can get used to less sugar, less sweet in our food and drinks.

Think about how people would eat differently, and as a result how the spectrum of disease in this country would change.

Think about how the generations of kids growing up in this culture will see food and health differently.

Looks pretty good, doesn’t it?

 

Don’t Stop With Food

I’m not about to end my utopia there.  Let’s keep going. 

In my utopia, we all live within biking distance to our place of work. We live in communities with close social interactions and connections.

We move our bodies regularly during the day. Even if we sit behind a computer for work (after all I want my utopia to be somewhat realistic), it is EXPECTED of us to get up and walk every 30 minutes. We aren’t looked at strangely for constantly getting up and moving, and we don’t need to apologize for taking “movement breaks.”

Our work culture is such that we all glare at the one or two workers who continually grind away without getting up. We remind them, “Hey, it’s been 45 minutes already. Get up and start moving.”

In my utopia, when we walk into a building, the first thing we see is the stairwell. If we want to take the elevator, we need walk around to find it.

In my utopia, parking lots are empty. At least empty of cars. The bike racks are full.

In my utopia, it is perfectly acceptable to place a sign on your office door, “Please do not disturb. Meditating for ten minues. Namaste”

Fantasy or Reality?

Is this all fantasy? Could you see any of this being based in a reality we may one day achieve?

One by one, my goal is to convince people that we shouldn’t just dream of a life like this. We should take action and recreate our lives like this. One by one, we can affect the change we want.

This is my utopia for health. Health is my priority, for myself, my family and us all.

A utopia with different goals would look much different. What would one look like for working your way up the corporate ladder? For making as much money as possible so you can vacation first class in the Bahamas?

Those would obviously look much different.

Unfortunately, I have seen too many people create their perfect world at the expense of their health. The result? They may achieve their perceived goal, but when they end up too sick or too stressed to enjoy it, they realize their goal was misguided from the beginning.

My utopia reflects my priorities: Health and happiness. What are your priorities?

Action Item:

Visualize your utopia. Take ten minutes, sit in a quiet place where you will not be interrupted. Close your eyes and visualize your perfect work. Connect as many sense as you can, sight, sound, feel. Connect as many aspects of your life that you can, your nutrition, your exercise, your work environment, your friends and family, and as many as you can imagine. Shoot for the moon and come up with as many examples as you can. Let the feeling sink in and enjoy. Then open your eyes and pick one item to implement today to get you closer to that life.

 

Thanks for reading.

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

 

Rainbow Carrot and Brussels Sprout Salad with Pecans

Here is another one of our favorites from Dr. Hyman’s site. Rainbow carrotts, salad greens, cabbage, brussels sprouts, nuts and seeds. Yum! Great variety of colorful veggies and healthy fats. Delicious, nutritious and satisfying. Give it a try and let us know what you think.

Saturated Fat Kills! Or does it? Let the debate continue!

Dietary Saturated Fat Kills! Or does it? The Debate Rages On…..

 

A recent editorial publication in BMJ has once again stirred the raucous debate about dietary saturated fat. One subject with two completely opposing viewpoints, each one filled with ardent supporters who know in their hearts (pun intended) they are correct.

 

So……does dietary saturated fat directly cause heart disease, strokes and death? Or does it not?

 

Wait a second. This is science we’re talking about. Shouldn’t it be clear who is right? Shouldn’t the evidence prove one group right and the other wrong?

 

Nope.

 

Nutritional science is messy and rarely conclusive. That’s why we got into this mess in the first place.

 

Hooray for Debate

 

Before we get into the details, let’s all celebrate the debate itself. We should all be grateful that we can take part of an open and emotional debate among intelligent, successful and reputable individuals. Recent history has too many examples of some individuals trying to shut down debates in favor of declaring the “truth.” We all should know by now that isn’t going to fly.

 

Instead, we should celebrate every chance to debate the science and its impact on our lives. After all, we can still have free speech even if we can’t have free healthcare.

 

Bad Data

 

Here is the problem with nutritional science. It is really bad science.

 

Remember your science fair project as a kid? You were supposed to design an experiment that tested a hypothesis, controlled for one variable, and proved if that hypothesis was valid or not.

 

Nutritional science doesn’t work that way. Instead, most nutritional studies are observational studies. We observe how people live their lives, collect as much data as we can, and follow them to see who has heart attacks, who has diabetes, who lives and dies, etc. We can then see what habits each person had and try to draw statistical associations.

 

The problem is that this cannot prove anything. It can only suggest an association. When compared to your middle school science fair experiment, you can see the stark differences.

 

The observational study does not control any variables (they try to control for certain variables, but that is an impossible task especially since we can’t know all the variables for which we need to control), does not test a single hypothesis, and does not prove anything.

 

Why Does This Matter?

 

Here’s the problem. There are lots of studies that show an association between saturated fat intake (mostly animal products) and an increased risk of heart disease, strokes and death.

 

But here is the kicker. There are also lots of studies that show there is no association between saturated fat intake (mostly animal products) and an increased risk of heart disease, strokes and death.

 

Huh? How can that be?

 

There are many reasons why but here are the two big ones. 1- People are all different, and 2- Food is all different

 

People are Strange, I mean Unique

 

In the BMJ article, the authors propose that inflammation, not saturated fat, is the main cause of heart disease. There is definite sound evidence to support inflammation as a contributing causative factor in heart disease.

 

However, we need to acknowledge that inflammation is different in everyone. We are all unique. Our internal environments, from our degree of inflammation to our gut microbiome, are all different.

 

Therefore, how we respond to our external environment (i.e. the food we eat) is going to vary from person to person.

 

LDL cholesterol is a prime example. LDL is not inherently “evil.” Why would our bodies evolve to produce a substance whose job it is to kill us?

 

LDL is a necessary component in our cells, our brains and for making our hormones. We cannot live without it. Our internal environment, however, can alter LDL and turn it into an oxidized and inflamed structure that is more likely to cause heart disease. That may not be an inherent property of LDL, but rather, something our body’s environment does to LDL.

 

The same can be said of eating saturated fat. It is certainly plausible that introducing large quantities of saturated fat into an oxidized and inflamed environment can cause harm. But what if the individual exercises regularly, eats a veggie-first/real foods diet, practices mindfulness regularly, gets regular restorative sleep, and therefore has very low levels of inflammation and oxidation?  Chances are, the same amount of saturated fat in this individual is unlikely to cause damage (that’s my hypothesis, I haven’t don’t my science fair project on this yet).

 

Observational studies cannot tell the difference between these two types of people with different degrees of inflammation and oxidation. Instead, the trials try to reach a general conclusion that then is applied to everyone.

 

Does that sound like good science to you? I’d give it a C- in the middle school science fair (and that is being generous with extra points for their passion). Should we be making decisions about our health based on C- science?

 

We Don’t Eat Saturated Fat, We Eat Food!

 

Picture a big greasy burger on a huge bun, soaked in ketchup, with a side of fries and a coke. Observational studies call that a saturated fat eater.

 

Now picture a spinach and kale salad with beets, strawberries, walnuts, carrots and tomatoes topped with 4 ounces of grass fed steak. No fries. No coke. Observational studies also call this person a saturated fat eater.

 

I’ll say it once again. We don’t eat saturated fat. We eat food! It is crazy to think we can isolate one specific macronutrient and know all that it does. For starters, there multiple different types of saturated fat of highly variable quality with variable effects on our bodies.

 

Second, what we don’t eat (i.e. avoiding saturated fat) is just as important as what we do eat (instead, eating refined, processed, simple carbohydrates and sugar vs. veggies, fruit, nuts etc.). 

 

In the example above, the first person had a huge bun, fries and a coke. There wasn’t a veggie to be seen. Tough to pick just one villain in that so-called meal.

 

Don’t Throw It All Away

 

Don’t get me wrong. I am not about to suggest that we throw out all nutritional research. We still need it to guide future research and help us generate hypothesis.

 

I will suggest, however, that we need to be very careful about interpreting the research. Anyone who claims observational trials definitively prove anything must be seriously questioned.

 

And when they claim a “vast collection” of evidence, or an “overwhelmingly consistent conclusion” from the evidence, keep in mind that a vast collection of dog poop is still just a bunch a dog poop.

 

I respect and value ardent supporters on both side of the saturated fat aisle. But I also know that neither has the strength of evidence that their conviction conveys.

 

What Do We Do???

 

Be wary of anyone who claims they have the “answer” and the “conclusive” evidence. Try not to get caught up in all the debate if you don’t want. You can keep it simple and keep it healthy.

 

Eat real food. Mostly vegetables and some fruits with healthy fats such as extra virgin olive oil, avocados, nuts and seeds. Add smaller portions of high quality animal sources and smaller portions of minimally processed whole grains and legumes.

 

If you enjoy the debate, by all means participate. It’s good for science. But here is the one and only thing I can say with absolute certainty.

 

I can’t prove anything that I recommended in this article.

 

There has never been a randomized study to prove my personal nutritional consensus. No one has done their middle school science fair project to prove my hypothesis.

 

Sometimes, we need to take a leap and say, “this makes sense.” We need to integrate all the evidence, combine it with clinical experience, and come up with our best solution.

 

That is why experts can be so passionate and so resolute in their position, and yet the positions can be so variable.

 

And that is why we need to find reliable voices we can trust. 

 

My voice? Keep it simple.

 

Eat real food. Mostly vegetables and some fruits with healthy fats such as extra virgin olive oil, avocados, nuts and seeds. Add smaller portions of high quality animal sources and smaller portions of minimally processed whole grains and legumes. Take away the stress, be mindful in your eating, and enjoy!

 

Action Item:

Identify a belief you hold to be true about nutrition. Something that is ingrained in your core that must be true. Saturated fat is a perfect example, but there are plenty others. Salt? Carbs? Juicing? Whatever you feel is undoubtedly healthy or unhealthy. Next, search online for the exact opposite position. Keep an open mind and explore what the opposing side says. This will hopefully help you understand the complexities and uncertain nature of nutritional science.

 

Then, get back to the basics and (say it with me now….) eat real food. Mostly vegetables and some fruits with healthy fats. Add smaller portions of high quality animal sources and smaller portions of minimally processed whole grains and legumes. Take away the stress, be mindful in your eating, and enjoy!

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

 

 

 

 

 

 

 

 

 

 

Should I salt My Food? Let’s Hear the Truth!

How guilty do you feel when you reach for the salt shaker? Do you look to make sure no one is watching as you quickly shake the little white granules on your food, salivating as you anticipate the bursting flavor that sodium brings? It may be time to stop feeling guilty. You can salt with impunity. At least most of you can.

 

For decades, nutritional guidelines have recommended consuming less that 2300mg of sodium per day. This was most recently perpetuated in the 2015 American dietary guidelines. Yet the evidence to support such a guideline for all Americans is lacking at best.

 

In reality, there is substantial evidence that sodium restriction for the average American does nothing to reduce one’s risk of heart attacks, strokes or death. So, why should we limit it?

 

Approximately 25% of the population is sensitive to salt and may have dramatic increases in blood pressure, increased fluid retention, and increased risk of cardiovascular complications. But that is 25% of the population. Not the entire population. Trying to devise a single guideline for everyone is destined to fail. And it did.

 

Before I get into the specifics of the evidence, here is the conclusion:

 

If you are not salt sensitive (you do not have difficult to control hypertension, you do not have salt sensitive congestive heart failure) then salt restriction is not going to benefit your health.

 

That doesn’t give you license to start eating salt laden processed junk food. No, no, no. But it does give you the freedom to add high quality, minimally processed salt (Celtic sea salt, Himalayan salt, Real Salt, etc.) to your vegetable based, minimally processed, real food diet. 

 

Salt away and experience the flavors that salt can bring.

 

How Did We Get Here?

 

The controversy around salt all started in 1997 when an early version of the DASH study was published in NEJM. This study showed that those with hypertension could reduce their blood pressure by 11/5mmHg by reducing their sodium intake. The less publicized part of the study, however, was that those without hypertension only reduced their BP by 3/2, hardly earth shattering.

 

The follow up DASH study, also in NEJM, followed only 400 people for 30-days. They concluded that those eating the standard American diet could reduce their systolic BP by 6mmHg by limiting sodium to 2300mg.day. Interestingly, those eating a diet higher in fruits and vegetables only reduced their BP by 2mmHg by reducing sodium. Again, a disparity was seen between those who were presumably salt sensitive and those who were not.

 

Notice that neither of these studies reported changes in heart attacks, strokes or death. It was just assumed that any reduction in BP, no matter how small, would automatically translate into improved health. That assumption lead to the guidelines committee recommending sodium restriction for all.

 

The Real Evidence

 

Since the original DASH study in 1997, we still have no randomized trials demonstrating reduced risk of heart attack, strokes or death by decreasing sodium intake.

 

In fact, we have plenty of evidence to the contrary.

 

One large meta-analysis showed no clear association between sodium reduction and cardiovascular complications.

 

Another study demonstrated that sodium restriction caused a cascade of deleterious effects including increased blood levels of renin, aldosterone, adrenaline, and noradrenaline. These are all hormones that lead to higher blood pressure over time.

 

Newer evidence suggests that excessive sodium intake (greater than 7 grams per day) and low sodium intake (less than 2500mg/day) could both lead to increased risk of heart attacks and death.

 

Lastly, recent trials suggest a more prominent response to sodium in those who already have hypertension and eat more than 5 grams/day (there was no report of increased cardiovascular risk). Interestingly, higher potassium consumption was associated with a decreased BP.

 

The Devil That We Know

 

The result? We have the wrong enemy.

 

I have seen countless of patients and clients who report to me, “I’m eating much better. I won’t touch salt anymore!” Salt became the devil we know, and we could feel much better about ourselves by avoiding it.

 

The problem is that it may lead us to ignore the other “evils” in our nutrition. The added sugar, the processed foods, the industrial trans-fats, the fake stuff. It takes too much energy to avoid everything. Our brains are wired to focus on one thing, get rid of it, and feel like we have succeeded.  Don’t make salt the one thing you focus on!

 

Quality Matters

 

What did we learn from all the above studies?

  1. There is no evidence supporting reducing sodium intake to less than 2300 mg/day in the general population
  2. Very high (>7g/d) and very low (<2.5g/d) sodium consumption could be potentially dangerous for most Americans
  3. Where you get you sodium matters!

 

Number 3 deserves more attention. Where we get our sodium matters. If our sodium comes from processed junk food, high sugar or simple carb foods, then we aren’t doing ourselves any favors.

 

Also, why do you think increased potassium lead to reduced BP? First let’s look at potassium rich foods.

  • Avocado
  • Spinach
  • Sweet Potato
  • Acorn Squash
  • Wild salmon
  • Pomegranates
  • Citrus fruits
  • Bananas
  • White Beans

What do these foods have in common? They are real, unprocessed foods that come from nature.

 

Focusing on real, veggie-based foods is going to reduce your BP, and more importantly, lower your long-term risk of cardiovascular disease, diabetes, Alzheimer’s and other chronic diseases.

 

Don’t Make It Too Complicated

 

Remember, there is no one size fits all approach to nutrition. Guidelines that assume otherwise will likely fall short of being helpful. With that in mind, here are the 3 take home points regarding sodium consumption and your health.

 

  1. If you have poorly controlled hypertension or heart failure, then you may need to be careful with sodium intake
  2. If not, which applies to most the population, focus on real foods from nature. Have no hesitation adding real, minimally processed salt.
  3. Don’t get your sodium for processed junk food.

 

It’s that simple. Let’s not make it more complicated than it needs to be.

 

ACTION ITEM: Change the type of salt you use. Invest in Celtic Sea Salt, Himalayan Salt, Real Salt, or other minimally processed salt. Liberally enjoy this salt in your steamed, roasted, or sautéed veggies. Make sure you are limiting your processed food and junk food that contains refined salt (potato chips, pretzels, crackers etc.).  

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

Dessert- Who Needs it? Not Me and Not You!

I just had the most incredible family Passover Seder. We travelled to the east coast to see our cousins, and they treated us to a wonderful evening. We always have a fantastic time when we see them, which is not often enough.

 

Their company makes eating flattened cardboard (a.k.a matzah) almost worthwhile.

 

They also know how to feed us. A beautiful salad, matzah ball soup, steamed green beans, butternut squash “rice,” salmon, roasted chicken…my mouth is watering all over again just thinking about it. It was delicious and plentiful.

 

When dinner concluded, we pushed ourselves away from the table nicely fed, likely fuller than we needed to be (these things can happen when we get distracted by great conversation and connecting with our loved ones). If the evening had ended here, we would all have been more than satisfied.

                     

Trust me when I say no one would have gone home hungry.

 

But then it happened.

 

They brought out dessert.

 

We figured this would happen and tried to plan in advance by bringing a beautiful fruit tray that we picked up from a local grocer. Everyone remarked how lovely it was. Then they would sample one or two pieces of fruit and immediately turn their attention to the not one, not two, but three cakes that were beautifully displayed next to it.

 

Why three? Excellent question. I’m not sure as to the answer, but I noticed that most people felt compelled to take a piece of each one.

 

I was immediately struck by the complete lack of necessity for the cakes.

 

Was anyone still hungry or lacking for calories? No way. Dinner was more than enough.

 

Were we lacking in conversation and socializing so we needed an excuse to extend the evening? No way. The kids were getting restless and the adults were starting to yawn as it was getting late in the evening. We had all had a wonderful time, but it was clear the end was drawing near.

 

Our well-meaning hosts provided the array of desserts because that is what people do.

 

That is our unconscious action and belief about what a dinner party should entail.

 

I am sure (or at least I hope) that if we logically think about the need for dessert, we would see that it is almost always unnecessary. When we act in an unconscious manner, however, we simply provide dessert because it is what we do and what we feel our guests expect.

 

It turns out, studies have shown that we make 200 food and beverage decisions every day. 200! When I first heard that my initial reaction was, “No way. It doesn’t feel like that many at all.” 

 

That is true. It doesn’t feel like we make 200 decisions because most of them are unconscious decisions. They are habit, routine, automatic. They are less decisions and more natural reactions.

 

Our health usually suffers from those decisions. On the one hand, we could say it isn’t really our fault. Society inundates us with unhealthy junk food.

 

A prime example was on our flight home from the east coast. It is a minor miracle to get any food on an airplane nowadays. Our flight attendants were happy to announce that they provided free snacks for the flight. They proudly walked down the aisle holding their trays full of packaged cookies, chips, fake cheese and crackers, and the healthiest option….pretzels.

 

It was no surprise that all the kids on the flight immediately wanted one or two of everything. I was struck, however, by how many adults wanted to partake in the junk fest as well.  Was it their fault? There were no other options available. What else could they have done?

 

Plan ahead. My wife is the master at plan ahead food. We had a Tupperware of carrots, almonds, cashews, sweet potato, broccoli and cauliflower. We even had PB&J for the kids.

 

What if you can’t pack ahead? Just say no. Nancy Regan would be proud of you. If you have read my posts on intermittent fasting, you understand the importance of knowing that we are in control of our hunger, not the other way around. Going without snacks on a four-hour flight should not be a major challenge in our lives.

 

The problem once again lies in our unconscious decisions. We don’t actively think about our nutrition and don’t plan ahead to provide healthy choices. Until society does it for us (which seems unlikely on a mass scale in the immediate future), it is up to us as individuals to make the unconscious become conscious.

 

It isn’t always easy to question the automatic decisions. Trust me, I wanted to discuss the dessert issue with our host. I chickened out. She was incredibly gracious and warm to welcome us into her home and provide a wonderful meal. The last thing I wanted to do was insult her or make her feel badly about her decisions.

 

So, I let it go. In a way, I am an enabler for the next time. I admit that it is not always an easy thing to point out to others.

 

But it is an important thing to do. Our health depends on us taking responsibility for what we put in our bodies, what we make available for us and others, and how we make our 200 food and drink decisions.

 

We can start by reframing how we make our own decisions, and then can help others see how they make theirs. One by one, we can make the unconscious become conscious. Then we can give our health the priority it deserves.

 

ACTION ITEM:

At your next dinner party, birthday party, or other social gathering, do not serve dessert. Simply don’t have it. Don’t apologize for not having it. Don’t make a big deal about it. Don’t even mention it. Just go about as usual as if nothing was different. Over the course of the next week, ask those who attended if they noticed anything different or if they felt anything was missing. You may be surprised about what you find!

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

Stevia- Sweetness for free, or same story different chemicals?

“I love your book but I have a big problem and a question for you.” Since this was coming from my favorite cousin, I knew she was obligated to say she loved the book. But she had a “big problem.” Was she about to attack a major premise? I braced for the question.

 

“Do I have to give up Stevia? I’m just not sure that I can.”

 

First off, I love this question. It is a very specific question. She can focus on this level of detail because she already eats predominately real foods, vegetables first with healthy fats, and with appropriate quantities of high quality animal sources. She already commits to regular exercise and physical activity and does her best with stress reduction and sleep.

 

Check. She gets the big picture. That’s 90% of my job when it comes to advising clients how to reframe their nutrition and lifestyle. The details may be harder to answer completely, but they are easier in the sense that the big picture is taken care of.

 

So, what about Stevia?

 

Stevia comes from the stevia plant, Stevia rebaudiana, and has naturally occurring glycosides which are extracted from the plant to concentrate the sweet flavor. Sounds great, right? It is a natural plant, what could be wrong?

 

It is the best of the sweeteners as it has no calories or absorbable carbohydrates.

 

It has been shown to have minimal effect of on glucose, a claim that artificial sweeteners cannot make. In fact, stevia proponents market it specifically for those with diabetes.  

 

Interestingly, stevia does increase insulin levels. Some promote this as a benefit. If it increases insulin without increasing glucose, then it could help treat hyperglycemia seen in diabetes. That assumes, however, that higher insulin levels are beneficial.

 

That is likely an incorrect assumption. Insulin is a pro-inflammatory fat storage hormone. Therefore, more insulin in the body can cause increased fat mass and increased inflammation. How much insulin is too much? That is very difficult to say. But it makes sense that we should all strive for optimal blood glucose control with the lowest possible amount of insulin in our bodies.

 

Stevia’s effect on insulin is small, especially when compared to sugar and artificial sweeteners, so it is unclear if this is “harmful” or not. As with most things, it is not a black or white answer. Shades of grey predominate.

 

In addition, some stevia products, such as Truvia, are highly processed versions of stevia that contain very little pure stevia extract. Remember, stevia has to survive on the store shelf, so manufacturers add chemical such as erythitriol or dextrose, plus added flavors.

 

Other versions, like Green leaf stevia, are less processed and more pure.

 

Stevia extract is much sweeter than sugar, so a little goes a long way.

 

Many have claimed even greater health benefits from stevia. However, claims for weight loss, cholesterol reduction, improved blood pressure, and even anti-cancer benefits are poorly researched and far from proven.

 

The Real Issue

 

The real problem with stevia is not with its chemical structure or its physiological effects on our blood sugar. The real problem is that Stevia reinforces our dependency on sweet tastes.

 

We can train our taste buds, for better or for worse. I see it time and time again. One sweetener becomes two, which then becomes three. Yet we don’t find the increased sweetener increasing the “sweetness.” That is because our taste buds adapt to the sweetness and require more.

 

As a society, sugar and sweet flavors have become an epidemic. We need to train our taste buds and our brains to not require sweeter and sweeter foods. That is where I see the big problem with stevia. It is too sweet and is a slippery slope to seeking sweetness in other aspects of our food and drink.

 

If you need a sweetener, and I encourage you to explore your definition of need, then stevia is likely your best choice.  If you can minimize the amount you use, even better. Remember, we can train our taste buds. We can require less sweet taste and can still enjoy our meals.

 

ACTION ITEM:

Go for a whole week without sugar or artificial sweeteners. That includes even the “natural” sugars like real maple syrup, honey and others. It’s just 7-days. You can do it. At the end of the week, if you feel the need to go back to your sugar or sugar substitute, cut it in half. You may find that your taste buds have adapted and half your usual amount is now just right.

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

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