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!

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

 

Kidney Stones and Veggies- Which are Safe?

No good deed goes unpunished. I recently saw a young patient who had a severe coronary blockage requiring a stent. It was a true “Aha” moment and he dramatically improved his nutrition, lifestyle and stress management. He is one of my favorite patients (I’m probably not supposed to have favorites, but I’m human). Not just because of what a nice person he is, but because of his clear commitment to improving his health.

 

Gone were the processed foods and added sugars. They were quickly replaced by veggies, fish, healthy fats (including nuts and nut butters), and a clear focus on real foods. Not to mention his dediction to exercise and stress management. He re-examined his life, and revitalized his health.

 

Then it happened. Kidney stones. Ouch.

 

It turns out, some people absorb more oxalate from certain foods than others. Too much oxalate in your system can lead to calcium oxalate kidney stones (far and away the most common type of stone. Even though calcium is in the name, the oxalate is the more concerning component). Some of the biggest duetary offenders are spinach, beets and nuts.

 

As part of his real foods, veggie-based eating pattern he was consuming spinach and nuts every day. Ordinarily that would be fantastic! But not if you form oxalate stones. Oops.

 

The good news is, there are plenty of healthy veggie options that do not cause increased oxalate absorption. Some of the best greens for this are lacinto kale (also called dino kale), collard greens, and mustard greens.

 

Other low oxalate examples are broccoli, cauliflower, asparagus, Brussel sprouts

cabbage, zucchini, mushrooms, onions and peppers.

 

Last, taking more than 500mg of vitamin C has been implicated in increased oxalate production and should be limited.

 

Conclusion:

 

Don’t throw away your spinach or your almonds!

 

Most of us will do just fine eating spinach, nuts and taking vitamin C. However, for those few of us who are prone to forming calcium oxalate kidney stones, it makes sense to limit these foods and instead focus on the wealth of other healthy options listed above.

 

Do you have questions regarding your healthy lifestyles and your health? Let us know, info@DrBretScher.com

 

Thanks for reading

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

 

 

 

Can Eating Better Save 400,000 Heart Attack Deaths?

By now you have likely heard the news that poor nutritional choices cause almost half of all cardiovascular deaths. Wouldn’t it be amazing if by eating better 400,000 people would still be alive today? You bet it would.

 

While it’s no surprise that nutrition and heart health are directly related, causing half of all cardiovascular deaths is a dramatic finding that deserves further scrutiny.

 

The recent study, funded by the Bill and Melinda Gates Foundation, was presented at the 2017 annual AHA meeting. They retrospectively looked at years of observational data to correlate nutritional habits and the subsequent risk of dying. Instead of focusing only on the “bad” foods that people ate, they also looked at the “good” foods people did not eat. They concluded that Americans need to eat more nuts, vegetables and whole grains, and less salt and trans fats.

 

Yawn. That finding is hardly earth shattering as we have been hearing this for decades. Does this new study add anything to the current literature? I’m afraid not.

 

We have plenty of observational data suggesting the same.  In fact, another similar study published in JAMA at the same time provided more observational evidence that 318,000 out of 702,000 cardiovascular and diabetes related deaths are related to (in order of statistical strength), too much salt, not enough nuts and seeds, too much processed meats, not enough omega 3 rich seafood, not enough veggies or fruit and too many sugary beverages.

 

Bad Studies Yield Bad Data

 

Two studies with similar results. Does that sound conclusive? Not so fast. The problem is that all this data is observational, and therefore weak data. It can point out associations, but it cannot prove cause and effect (see chapter 2 in my book, Your Best Health Ever for a more detailed discussion).  What we need is a randomized, controlled trial investigating the question of nutrition and cardiac deaths, not more observational drivel (see my post on The Best Weight Loss Trial You Will Never See here)

 

As an example, processed food is high in salt. Fruits and veggies are low in salt. Can we say with certainty that the salt is the problem? Or is it the company it keeps, i.e. too much crackers, chips and baked goods instead of fruits and veggies? This study cannot determine between the two. Also, those who eat more veggies also tend to be more health conscious, more physically active, and have less dangerous habits (i.e. smoking). The opposite is true for those who eat more processed junk food. Again, observational studies cannot completely control for those variables (they can try, but statistics are imperfect for this).

 

Does this mean we need to throw out the study completely? Not necessarily. It raises important questions, even if it does not provide clear answers.

 

Instead, we should combine the findings with the higher quality, randomized trials to see what the science truly supports.

 

Good Studies Yield Good Data

 

The more conclusive studies are the randomized controlled trials. One such recent trial was the PREDIMED study (see more on this study and the Mediterranean diet here).  Briefly, this trial investigated a diet that included a “high intake of olive oil, fruits, nuts and vegetables; a moderate intake of fish and poultry; a low intake of dairy products, red meat, processed meats, and sweets; and wine in moderation with meals.” This pattern of eating significantly reduced the risk of cardiovascular disease when compared to low-fat diet.

 

Since this was a randomized trial, there was no need to control for other healthy habits and self-selection bias. In addition, they didn’t measure surrogate outcomes like blood pressure, weight, or cholesterol. They measured the events we really care about- heart attack, stroke and death. In the end, a simple nutritional intervention reduced that risk.

 

This is an impressive study that tells us something conclusive about nutrition. I hope you can see the difference between this study and the throngs of poor-quality observational trials.

 

Do you see any similarities between the PREDIMED study and the recent observational trials?

 

Encourage nuts, veggies, and fish. Discourage processed meats and sweets.

 

In short, eat real food.

 

Can We Find A Common Ground?

 

After that, the science gets murky.

 

What about poultry? It was encouraged in the PREDIMED study and was not mentioned much in the recent observational trials. There doesn’t seem to be significant evidence to avoid it, and there may be reason to eat it. So be aware of your portion size and go for it.

 

What about salt? It wasn’t limited in the PREDIMED study. Some studies suggest increased risk with high sodium intake, and some studies suggest increased risk with low sodium intake. In the observational trials, it can be difficult to separate salt from processed foods, and therefore difficult to know if it is dangerous.

 

You may be thinking, if there is any question, why not just avoid it?  Is there a compelling reason to eat salt? You bet there is. Taste. Salt helps food taste better. If you are adding it to your cookies, white bread or potato chips, you aren’t doing yourself any favors. However, if you are adding a sprinkle of sea salt on your freshly steamed veggies or your roasted broccoli, then go for it. An observational study can’t tell the difference between those two circumstances, but trust me, your body can.

 

What about red meat? This is a big one. We don’t have any evidence that red meat reduces the risk of cardiovascular disease. However, all the evidence suggesting that red meat and animal protein increase the risk of cardiovascular disease is poor quality observational data. In addition, there is plenty of poor quality observational data that claims the exact opposite, that red meat does not increase the risk of cardiovascular disease. So again, we must ask, if there is controversy, should we just avoid it? Is there a compelling reason to eat meat? For some there is. Animal meat is the most efficient source of B-vitamins, iron and protein, it is filling and it tastes great.

 

Once again, the specifics matter. Are you eating a 16oz porterhouse steak with mashed potatoes? Or are you eating a fresh vegetable salad with 6-ounces of grass-fed steak on top? A study may not know the difference, but your body sure does.

 

Wrap It Up

 

Can improving what you eat reduce your risk of heart attacks and strokes? It sure can. The PREDIMED study showed that.

 

Do these new observational studies add anything new? That’s debatable.

 

We come back to the basics. Eat more real food. Eat more veggies and fruits. Eat less processed junk. Avoid manufactured trans fats. If you do that, you are doing 95% of the work (I made up 95%, but it seems right to me).

 

Spend all the time you want arguing about the remaining 5%. There is plenty of evidence to support your claim whether you are for or against salt, meat, eggs etc.

 

As for me, I am going to step out of the argument and go eat my spinach and kale salad with Brussel sprouts, cauliflower, squash, nuts and seeds, topped with olive oil and 4 oz. of wild salmon and a hard-boiled pasture raised egg. Heaven on earth. Bon Appetite.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com 

 

Action Item:

Look for ways to add veggies, nuts and seeds to your meals. Sprinkle pumpkin seeds on your oatmeal, eggs or salad. Ask for a double portion of veggies and half the protein when you go out to dinner. Watch our veggies and eggs video to see how easy it is to make a veggie-based breakfast. Focus on real food, veggies first. Try it today and see how easy and rewarding it can be!

Is Alzheimer’s Disease Preventable?

Is Alzheimer’s Disease Type III Diabetes? And Can it be Prevented?

By Bret Scher, MD

 

Alzheimer’s disease is one of the most devastating conditions in our country, and you may have the power to prevent it.

 

There is nothing more empowering than knowing you have the ability to prevent a chronic disease. Especially when some view that chronic disease as worse than death. While not all factors that lead to chronic disease is controllable (e.g., genetics), there are some diseases that you can protect yourself against. And one of those might be Alzheimer’s disease.

 

Alzheimer’s disease—which is the sixth leading cause of death in the U.S.—is a devastating condition that impairs your memory and ability to think. It progresses over time, eventually condemning an otherwise functional body to a life completely dependent upon care from others. It changes the lives of not just those affected by the disease, but their loved ones and caregivers as well.

 

In 2015 alone, approximately 15 million caregivers provided an estimated 18 billion hours of unpaid care to the 5 million Americans who suffer from Alzheimer’s disease. But the cost to families and to society as a whole cannot be measured in just dollars and cents. The emotional toll can also be enormous. The negative effects on caregivers can be vast, including:
 

  • Psychological distress
  • Impaired health habits
  • Psychiatric illness
  • Physical illness

 

To make matters worse, the number of people diagnosed with Alzheimer’s dementia is only getting larger and is expected to triple as baby boomers reach the at-risk age of 65 and older.

 

Paradigm Shift in Understanding Alzheimer’s

Modern medicine has struggled to find effective treatments for those who suffer from Alzheimer’s. The most effective medicines may slow the symptoms by a few months, but the inevitable progression always happens in the end.

 

A new paradigm shift, however, offers promise for methods to prevent and treat Alzheimer’s disease. The paradigm shift is that Alzheimer’s may be Type III Diabetes.

 

To understand this relationship, it helps to understand the basics about diabetes, blood sugar, and insulin. Insulin’s job is to signal cells to take sugar out of the blood and convert the sugar into energy. When a person has diabetes, the cells no longer listen to insulin, so the body needs to produce more and more insulin to get the message across.

 

As the efficiency worsens, the body can’t keep up, the blood sugar rises and diabetes develops. This causes two main problems:
 

  • Insulin levels rise sky high. Since insulin is a fat storage and pro-inflammatory hormone, higher levels equate to deterioration of overall health.
     
  • Blood sugar levels increase to dangerous levels. This can eventually lead to heart disease, vascular disease, kidney disease, vision loss, neuropathy, and other serious conditions.

 

It turns out that brain cells can become resistant to insulin as well, thus drawing a connection between diabetes and Alzheimer’s. The theory is that increased insulin and increased sugar in the brain leads to damage of brain cells and eventual dementia.

 

The Connection Between Alzheimer’s and Diabetes

 

Medical science is starting to explore the relationship between diabetes and dementia and is drawing a strong connection. One study, for instance, reviewed previous investigations of diabetes and dementia, accounting for over 2 million subjects. The study concluded that those with diabetes were 60 percent more likely to develop dementia.

 

While an association does not prove causation, it does raise an interesting potential link that deserves further exploration.

 

The next question is whether there is a reasonable explanation for why the two diseases might be related. And it turns out there is.

 

Another study demonstrated that individuals with type II diabetes are more likely to develop the same “brain tangles” that are seen in those affected with Alzheimer’s. It is thought that these tangles are directly responsible for the progressive cognitive decline. And they are present in both the brains of individuals with Alzheimer’s disease, and the brains of those with diabetes even in the absence of dementia.

 

How to Prevent Diabetes, and possibly Alzheimer’s

 

This emerging research could be discouraging news since the incidence of diabetes is on the rise, with an estimated increase from 285 million cases worldwide in 2010 to 439 million in 2030.  The result could be an equal surge in new Alzheimer’s cases.

 

Or it could be encouraging news, since type II diabetes is almost entirely preventable with healthy lifestyle habits. Presumably, these same habits may help prevent Alzheimer’s as well.

 

In fact, a 2001 study in NEJM suggested that 90 percent of type II diabetes cases could be prevented with:
 

  • Proper exercise
  • Healthy eating
  • Not smoking
  • Maintaining a healthy bodyweight

 

 Another study showed that a lifestyle program that included 150 minutes of weekly physical activity and a goal of 7 percent weight loss prevented diabetes better than the popular drug Metformin—an oral diabetes medicine that helps control blood-sugar levels.

 

Finally, a 2012 study followed 2,700 people over three years and found those who ate a diet higher in carbohydrates and sugars and lower in protein and fat were more likely to develop dementia.

 

This information shows that diabetes, and by extension Alzheimer’s disease, may be preventable by following a healthy lifestyle that includes these elements:
 

  • Exercise 150 minutes per week and remain physically active throughout the day
  • Maintain near ideal body weight
  • Eat a real-foods, vegetable-based diet with healthy fats
  • Avoid simple, refined carbohydrates
  • Avoid added sugars in food and drinks

 

A Healthy Lifestyle Is Necessary

 

Unfortunately, this is not hot-off-the-press news. These studies were published over 15 years ago, yet many people are still reluctant to adopt such healthy practices. In fact, one study of American adults found that only 2.7 percent of the subjects followed a truly healthy lifestyle.

 

The public shouldn’t need more inspiration to strive to be healthy, but knowing that Alzheimer’s disease and diabetes are likely preventable will hopefully be enough motivation to spark a revival for healthy lifestyles now and for decades to come.

 

Change doesn’t come easily, so start by making simple steps and find a support system that will help you adopt new ways of living.

 

Those in positions of influence (doctors, nurses, personal trainers, nutritionists, health coaches, chiropractors, and other medical professionals) need to actively educate society about the association between Alzheimer’s and diabetes.

 

If you fall into this category, it’s important to learn how to inspire individuals to adhere to healthy life habits, which may help prevent one of the most devastating conditions that touches the lives of tens of millions Americans every year.

 

Now that’s empowering.

 

Thanks for reading.

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

ACTION ITEM:

Make 1 meal this week a Vegetable Based meal. Don’t have chicken with a side of veggies, or salmon with rice and a couple veggies. Make the basis of the meal veggies and add 4-6 oz. of high quality animal protein.  Notice how it looks different, tastes different, and how you feel differently after you eat it. If you can do this, then you can increase it week after week until most of your meals are veggie-based. You will be amazed at how it improves your health and how you feel!

Bret Scher, MD FACC

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