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!

Breakfast, Fasting and Our Health

“Breakfast is most important meal of day.”- Said in a thick eastern European accent by Colossus in the movie Deadpool. The statement has become so ingrained in our society that even a CGI created super hero quotes it as if it were fact.

 

What if I told you breakfast was the most important meal to skip each day? Would you dismiss the comment since it goes against everything you have heard up until now? Well, it turns out, it may be true. And the science backs it up.

 

Science Quality Matters…A Lot

 

First, where did the concept of breakfast being the most important meal come from? Would you believe cereal companies, and other food companies who have a vested interest in more people eating cereal? Yep. Bias and hidden motives over-rides scientific evidence once again.

 

This article in the Guardian is a good summary of how this came to be. Additionally, according to the book Three Squares: The Invention of the American Meal, Abigail Carroll proposes that breakfast used to be comprised mostly of leftovers. There were no “breakfast foods.” It was simply another meal, nothing unique.  But it did not take long for Kellogg’s to start promoting breakfast cereals, and suddenly it was expected that we eat specific “breakfast foods.”

 

What followed was a collection of media talent and poor science to elevate breakfast from just another meal, to “The Most Important Meal of the Day.” In fact, the claims were clear. If you skip breakfast you will have no energy, your metabolism will grind to a halt, and you will suffer from low blood sugar. You will gain weight and over-eat the rest of the day.

 

Unfortunately, these drastic clams were derived from poorly run observational studies. Obese people skip breakfast. Therefore, skipping breakfast must make you obese, right? Not so fast.

 

Could it have been obese people try to reduce calories and therefore skip breakfast?

 

In an observational trial, we can’t prove which theory is correct. All it tells us is that obese people skip breakfast. It tells us nothing about why, and what effect that may have on their health.

 

But cereal marketing firms will jump on that evidence and claim that skipping breakfast makes you obese. That’s scientific hogwash.

 

Better Quality Science

 

Fortunately, we now have randomized trials to investigate these claims. One study demonstrated that eating breakfast had no impact on resting metabolic rate, and another demonstrated that eating or skipping breakfast had no direct impact on weight loss.

 

Not all the science is faulty. The claim that missing meals can slow your metabolism is true, somewhat. It turns out that prolonged starvation of more than three days triggers a survival reflex resulting in a reduced resting metabolism. But that goes way beyond simply skipping breakfast. In fact, resting metabolic rate INCREASES in the first two days of a fast.  So if we are only skipping breakfast, it is clear that our metabolism is safe.

 

The Case for Intermittent Fasting (IF)

 

Nail in the coffin. We can now put away the baseless claims that we need breakfast. But that still doesn’t mean we should skip it, right?  Why would we want to skip breakfast?

 

I’m glad you asked……

 

One main reason to skip breakfast is that reducing our insulin and glucose levels allows our body to start breaking down fat stores. To make it sound technical, the concept of skipping breakfast is referred to as intermittent fasting, and it comes with numerous potential benefits.

 

In addition, some scientists believe intermittent fasting is the closest thing to the fountain of youth. It turns out that calorie restriction has increased survival in all sorts of animals, and shows promise for humans as well. But who wants to severely restrict their calories every day? In modern day society, that becomes nearly impossible.

 

Enter intermittent fasting. IF allows us to experience the physiological effects of calorie restriction without having a critically negative impact on our social existence.

 

Here is how it works. You set up an “eating window,” noon to 7pm, and a “fasting window,” 7pm to noon the next day. The key is that our bodies don’t enter a true fasting state until more than 10 hours after our last food intake. This is the point where our glucose and insulin levels are low enough to allow for lipolysis (the body breaking down fat stores for energy instead of using glucose circulating in the blood). In the above example, the fasting window is 17 hours, thus giving you 7 hours of fat breakdown. There are other versions of IF, but this is the one that I have seen works best for most people.

 

Food Quality Matters…A Lot

Now that I have made the case for trying intermittent fasting, I should be honest and tell you that intermittent fasting will not work for most of you.

 

Not until you improve the quality of what you eat.

 

If you eat mostly carbohydrates, simple sugars, and processed foods, then you don’t stand a chance. These foods cause rapid spikes and falls in glucose and insulin, throwing you into a cascade of hunger and cravings without a chance at extending the time between meals.

 

So, before you try IF, make sure you are eating nutrient dense, low sugar foods. Focus on lots of veggies, healthy fats (nuts, olive oil, avocados), appropriate proportions of animal fats and proteins, and a small amount of complex carbs. Once you do this, IF will be easily manageable.

 

Tips

 

  • Choose your IF days carefully. Make sure you will have control over the timing and food content of your first meal. You don’t want to get stuck eating “whatever is around” when you are hungry at 1pm after an 18hour fast. For best results, that first meal needs to be a healthy, nutrient dense meal low in simple carbohydrates and sugars.
  • Give it time! The first few times you experiment with IF, you may feel hungry and feel like you can’t survive. That feeling quickly passes with physical and psychological adaptation.
  • The initial psychological barrier to IF seems imposing. In reality, it’s simple to implement and stick to. Once you get over the initial hurdle in your mind, you will see.
  • Embrace the psychological benefits. IF allows you to know that you are in control of your feelings of hunger. You do not have to react to every small pang of hunger or food craving. You are in control, not the food.

 

 

So, Colossus should have said, in his thick Eastern European accent, “Breakfast is most important meal of day to skip. If you want.”

 

Don’t get me wrong.  A few days each week, I look forward to my big plate of leftover veggies, spinach and kale over two eggs and a sprinkle of grass-fed cheese. It’s a great way to start the day. And the other three-to-four days, I look forward to skipping breakfast, knowing that I am burning my fat stores, lowering my insulin and glucose levels, raising my HGH, and possibly taking one step closer to the fountain of youth.

 

Give it a try and see what it can do for you.

 

Thanks for reading.

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

Action item:

Pick a day this week when you have complete control over the timing of your lunch. Commit to practice IF that day. Stop eating at 7pm the night before, and don’t eat again until noon or 1 pm the next day. Make sure both of those meals are nutrient dense, veggie based meals with high quality fats and proteins. Expect to feel hungry, and remind yourself that you are in control of your hunger, not the other way around. You can do anything for 1-day. Then pick 2-days for the next week to try again. The more you do it, the more you adapt to it and reap the benefits.

Local Farmers- The New Frontier of Health

I’m convinced that to be the best physician possible, to be the ultimate health advocate for my clients, I need to be a coach, a personal trainer, a nutritionist, and a farmer.

 

That’s right. Our health may rely on farmers as much as on doctors. Farmers control how our vegetables are grown and how our animal protein sources are raised. It turns out, that’s a pretty big deal.

 

200 Decisions per day!

 

Every day we make over 200 food and drink related decisions. Decisions to put substances into our bodies that either augment our health, or substances that poison our health.  Considering that over 60% of the average American’s calories come from moderately or heavily processed food, the poison seems to be winning.

 

Instead, we need to focus on a real-foods, plant-based nutrition with a high proportion of healthy fats and, for many, appropriate proportions of high-quality animal protein. With these nutritional choices, we would see the incidence of diabetes, heart disease, strokes, dementia and other chronic diseases plummet.

 

Better Than Good

 

But what if we are already pretty health conscious with how we eat? What if we want to make sure the food we put in our bodies augments our health as much as possible?

 

For that, we need to look beyond the macro-nutrients. We need to look to the farms.

 

We have all heard the buzz words that we should eat local, organic produce. We should eat grass fed beef. Our eggs and chickens should be pasture raised. But does it really make a difference?

 

Yes, Yes and Yes!

 

Studies have shown that grass-fed meat has higher levels of vitamin A, vitamin E, Omega 3 fatty acids, and more beneficial saturated fats (such as CLA and stearic acid) compared to grain fed meat. In addition, wild fish have fewer dioxin contaminants compared to farmed fish, and greater benefit to harm ratios that farmed fish. Pasture-raised chicken produce meat and eggs with higher levels of vitamin E, omega-3 fatty acids, and vitamin A compared to cage-raised poultry.

 

When it comes to animal proteins, quality matters. A lot.  Not to mention the ethical considerations of how these animals are raised.

 

The industrialization of the food industry has done nothing to improve the quality of our food, and in fact, has done the opposite. To be fair, it has allowed some populations to enjoy animal protein at an affordable price, but it has gone too far. I’m not sure of the exact definition of “too far,” but all you need do is see the conditions at a CAFO (Concentrated Animal Feeding Operation) to know we have gone too far.

 

CAFO’s have overcrowded, inhumane conditions that lead to excessive methane production, concentrated waste that destroys the soil and contaminates the water runoff, and the end result is meat that has reduced nutritional value.

 

But it does not have to be this way. Cattle and the environment can have a symbiotic relationship. In fact, they did for generations before humans developed and industrialized the land and forced cattle into confined spaces. 

 

Ranchers have started to recreate the “good ‘ol days” of cattle by setting up migratory grazing, and cycling their cattle, chickens, and crops. The result is more nutrient dense meat, milk, chicken and eggs. It also leaves healthier soil, and results in a sequestration of carbon in the soil (as opposed to unopposed release of carbon in methane).

 

So, what can you do to help this process? First, eat grass-fed, locally sourced meat. Eat pasture raised chicken and eggs. Buy from your local butcher or even mail order meat from sustainable ranches. You will dramatically improve the nutrients you derive from your food and you will benefit the environment.

 

Won’t this be more expensive? That leads me to the second point.

 

Eat less meat.  Remember, the healthiest meals are vegetable-based. That means the main portion of the meal consists of veggies. In contrast, today most meals have vegetables as a small side dish if they are eaten at all. Some sources state that only 41% of all dinners contain a vegetable at all.  

 

What takes their place? Animal proteins and simple carbs/grains.  By refocusing on making our meals veggie-based, we can reduce the unneeded simple grains and sugars, reduce the quantity of animal proteins and INCREASE their quality. Think about it. You can eat less of a more nutrient dense animal protein source, you can get the same satisfaction, better nutrition, and you can manage to keep the cost fairly constant. That’s a win-win by any definition.

 

Eat your Veggies!

 

But what about the veggies? The news isn’t all rosy there either.

 

The National Academy of Sciences issued an alert that our veggies ‘aint what they used to be.

 

It appears that the nutritional value of vegetables has declined compared to the 1970s. For instance, the vitamin C content of sweet peppers declined by 30%, the vitamin A in apples dropped by 40%, and the calcium in broccoli has been cut in half. 

 

The most likely explanation for the nutrient decline is modern farming’s evolution to maximize yields and profits. To this end, the health and diversity of the soil has largely been ignored, resulting in undernourished soil feeding a larger number of crops. 

 

It doesn’t take a mathematician to see that there are fewer nutrients to go around.

 

The recommended daily allowance (RDA) is 5 servings of veggies per day with an optimal intake of 9 servings per day. But those are based on the “old” nutrient values for veggies. Assuming a 30% decline in nutrient value across the board, the optimal number of vegetable servings would go up to 12 per day.

 

Considering 87% of American adults don’t consume the current RDA for vegetables, it would be safe to assume an even lower number are getting adequate nutrition from vegetables. Something must change.

 

Re-Define a Meal

The first step is reframing how we see our meals. We need to make veggies the center of our meals. We need to start seeing veggies as fun, sexy, and enticing. That means exploring new veggies (How about tubers, chard, Romanesco, kohlrabi, or just multi-colored carrots?), and experimenting with new ways to prepare them.

 

By making veggies exciting, we can begin to make them the center of the meal. No longer is the chicken the main dish. Now it is a veggie medley with chicken and avocado on top. No longer is it miso salmon on a bed of white rice. Now it is a spinach salad with grilled salmon and an array of fresh veggies. Now that is a step towards health!

 

Know your Farmer

 

The second step, however, is where we all need to be a farmer, or at least know a farmer.

 

We don’t have to rely on produce that has been stripped of its nutrients by modern farming techniques. We don’t have to rely on mega-food corporations that are far more concerned with their stockholders than public health. Mega-food corporations have lost the public’s trust, and for good reason.  We shouldn’t have to eat carcinogens mixed with our spinach or our berries.

 

Granted, local farmers still need to make a profit, but they are not beholden to stock holders and large corporate greed. They can maintain their beliefs about the proper way to treat soil, the healthiest way to grow vegetables, and the most efficient way to support their community.

 

And don’t forget about the new generation of entrepreneurs. Folks like Kimbal Musk and Tobias Peggs with Square Roots. Not only are they growing fresh organic vegetables in Brooklyn in the middle of the winter, but they are teaching others how to do the same. Their use of hydroponics and vertical farming promises to revolutionize urban farming.

 

And the result? More fresh, healthy vegetables on our plates year-round.

 

So, the next time you want to be proactive about your health, you can go see your physician. Or you can go see your local farmer or rancher. They have as much, if not more to offer you for promoting your health and preventing chronic diseases.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

Action item:

 

Find the closest farmers market to you and go there! Find out when it is and plan your schedule accordingly. That is your time to go grocery shopping. Notice how the fresh fruit and vegetables looks and smell differently than in the grocery store. Talk to the local farmer. Ask if they use pesticides or other chemicals. Learn more about their farm and farming practices. Feel the sense of community and take pride that you are helping support local farmers and your health.

Take 2 Eggs and Call Me in the Morning

“Take Two Eggs and Call me in The Morning”

(For my easy to make veggie and eggs breakfast, see the video link here)

If I gave you this advice, how would you react? Would you think I was trying to harm you?

 

Or would you realize this is sound advice as part of a healthy nutritional strategy?

 

While the latter is true, most people likely fall into the first category. We can thank governmental and professional societal recommendations for that. For years eggs have been lumped into the “fat is bad” trend that ruled American nutritional standards.

 

Here is the truth. Eggs, including the yolks, can be an important component of a nutrient dense, vegetable based, real-foods style of eating that is beneficial to our overall health.

 

Mis-Guided Guidelines

 

As recently as 2000, the American Heart Association and American College of Cardiology guidelines recommended limiting dietary cholesterol intake to less than 300mg per day. Interestingly they followed that recommendation with the following quote: “There is no precise basis for selecting a target for dietary cholesterol intake.” Essentially they admit that they just made up the 300mg limit. That doesn’t appear to be the strongest of guidelines.

 

To be fair, they felt there was a legitimate concern.  Eating cholesterol could increase blood cholesterol levels, or so they thought. In addition, they pointed out that foods high in cholesterol are also high in saturated fat, and therefore should be avoided. In a way, dietary cholesterol was vilified because of the company it keeps. Of course, now we know the restrictions on saturated fat were also misguided (see the specific post here).

 

Fortunately, the ACC/AHA has come around and their most recent guidelines state “There is insufficient evidence to determine whether lowering dietary cholesterol reduces LDL-C.”

 

That has not kept cereal makers, bread and bagel companies, and others from continuing to promote eggs as dangerous to our health and something we need to avoid.

 

The interesting and often misleading intersection of health, food, and marketing rises again.

 

Setting the Record Straight

 

It turns out, there are numerous studies that all draw the same conclusion: For the general population, egg consumption is NOT associated with an increased risk of cardiovascular disease, and does not adversely affect our cholesterol levels. In fact, there is some evidence to suggest it is beneficial to our overall health.

 

A look back at the Physician’s Health Study of over 21,000 people found that eating up to 6 eggs per week had no association with an increased risk of heart attack or death.  Eating more than 7 eggs per week in diabetics may have had an association, but beyond that, there appeared to be no harmful link.

 

Analysis of both the Health Professionals study and the Nurses’ Health Study concluded that eating one egg per day had no significant impact of risk of heart disease or death.

 

A large meta-analysis of 17 trials and over 4 million person-years showed higher consumption of eggs was not associated with an increased risk of heart disease or stroke.

 

In aggregate, there is no evidence in the general population that egg consumption increases the risk of heart disease or death. While those with diabetes may be an exception, that requires further investigation.

 

Is There a Benefit?

 

Just because something isn’t bad for us doesn’t mean we should flock to it and make it part of our regular eating habits. But is there evidence that eggs may be good for us?

 

It turns out there is.

 

For starters, eggs are packed with vitamins and minerals that our bodies need. One large egg has

  • 78kcal
  • 6gm protein
  • 5gm fat (1.6 gm saturated fat, 2 gm monounsaturated fat)
  • Fat soluble vitamins: Vit A, D, E, and K2 (K2 is very difficult to get from other common nutritional sources)
  • Vitamins B-6 and B12
  • Calcium
  • Amino acid leucine
  • Choline
  • Selenium
  • Omega 3 fatty acids
  • And more…

 

If you just eat the whites, remember that the yolk has all the fat-soluble vitamins and 90% of the B vitamins, calcium, fatty acids and other nutrients (aside from the protein).

 

Packed with that many vitamins and minerals, it makes sense that eggs would be good for us.

 

One additional benefit is that they help fill us up. Compared to a bagel breakfast with the same total calories, an egg breakfast increased the feeling of being full and reduced how many calories subjects ate the rest of the day.

 

And remember the concern that eggs worsen our blood cholesterol levels? It turns out that couldn’t be further from the truth.

 

Eggs may minimally increase total cholesterol, but more importantly, they increase HDL and thus maintain the total cholesterol to HDL ratio, a more powerful predictor of heart disease risk than total cholesterol alone.

 

Whole egg consumption, compared to an egg white substitute, improves the atherogenic lipid profile (that means it makes the cholesterol less dangerous).  

 

Eggs increase HDL, and can change the LDL from dense, more dangerous particles to large, less dense less dangerous particles.

 

None of this means that eggs have been proven to lower our risk of cardiovascular disease, but absence of proof does not equal proof of absence. In other words, since eggs haven't been proven to be harmful, and there are plausible reasons why they could be beneficial, we should welcome them as part of a vegetable-based, nutrient dense eating pattern.

Eggs Got a Bad Rap

 

So, in the end, it turns out that eggs got a bad rap.

 

They were innocent bystanders caught up in the marketing storm that followed poorly understood guidelines regarding dietary cholesterol intake.

 

Eggs can be an integral component of a nutrient dense, real-food way of eating.

 

They provide essential vitamins and minerals, they are filling and enjoyable, and they can improve our overall blood lipid profiles. While there is still some hesitation about individuals with diabetes consuming more than one egg per day, the rest of us can freely “Take two eggs and call me in the morning.”

 

Remember, however, the company they keep is still important. Instead of having two eggs with hash browns, pancakes and low-quality processed sausage at your local dirty spoon, try preparations like my simple eggs and veggie dish. It takes less than 5-minutes to make start to finish, it is delicious, and it is the perfect way to start your day. Here is the video link:

 

 

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

Action item:

Make it! You only need, eggs, avocado oil, a box of spinach, a sprig of kale, left-over veggies, celtic sea salt, and grass-fed cheese. It takes less than 5-minutes to make. And if you don’t have time to eat it, take it with you in a glass container. It even tastes great cold!

 

The Best Weight Loss Trial You Will Never See!

The Best Weight Loss Trial You Will Never See!

In my book, Your Best Health Ever: A Cardiologist’s Surprisingly Simple Guide to What Really Works, I make the point that we should be very careful with how we interpret nutrition, weight loss and health studies. Far too often we will read a decisive-sounding post about an observational trial. My favorite is the belief that eating animal products of any kind directly causes heart disease, but you can take your pick from hundreds of other examples. The bottom line is the same. Observational studies, ones that simply observe people in their normal activities rather than randomly assigning them to two different groups, cannot prove cause and effect. They can only point out associations, which may or not have a real causative relationship.

In the world of nutritional science, observational studies require someone to remember everything they ate, accurately document it in detail, and depends on the researchers to control for every possible variable. That’s a recipe for a poor study. In addition, there is no way to control for self-selection bias. My made-up example from the book is that an observational trial would likely show that people who eat at Whole Foods are healthier than people who eat at McDonalds. Seems straightforward. But it turns out, they are also likely to be more educated, in a higher socioeconomic class, exercise more, have more access to medical care, and hundreds of other differences that we cannot measure. In a nutshell, that is self-selection bias.

So, although it makes sense that Whole Foods is healthier, and we believe it to be true, an observational study cannot prove this. Only a randomized trial can hope to answer the question with scientific validity. Which leads me to the point of this article. When it comes to nutrition and lifestyle as medicine, there are two trials we need to see, but likely will never see.

APEVVV (Animal Protein Eaters Vs. Vegetarians and Vegans)

All good studies seem to need attractive acronyms. I did my best here.

Take 10,000 healthy individuals. Randomize them into one of three nutritional groups. All three groups will adhere to the following:

  • Every meal is at least 50% veggies with very limited processed foods and simple carbohydrates.
  • Encourage healthy fats with nuts, seeds, olive oil and avocados.
  • Strive for 10,000 steps per day plus 150 min of moderate exercise per week
  • Practice regular stress management and engage in healthy lifestyle courses

They will differ as follows:

  • 100% Vegan: No animal products at all are allowed.
  • Vegetarian: No meat is allowed, but eggs and dairy are allowed.
  • Meat Eaters: Every meal allows for 1-2 eggs, 4-6 ounces of animal protein (beef, chicken, fish, etc.), plus unflavored dairy, yogurt and cheese.

Follow them over 10 years to see who lives and who dies, who has heart attacks and strokes, and who enjoys their life more. Now that’s a trial that will tell us something! Do you see how this differs from observational trials? Since the subjects are randomized, we eliminate self-selection. They don’t get to choose which group they will be in.

In addition, since we measure hard-outcomes like heart attack, stroke and death, there is no debate about what the results mean clinically. We aren’t measuring “surrogate” endpoints like cholesterol, blood pressure, and other measures that may or may not be significant in this specific circumstance. Heart attacks, strokes and death are ALWAYS significant! 

Also, notice how weight loss is not mentioned anywhere. The focus is on health, not weight loss. They are most definitely not one in the same. The problem is that this trial will be very difficult and expensive to create. Without a drug company having a vested interest in the result, it will be difficult to find someone to pay for it, and therefore we are unlikely to see it in our lifetime. That’s even more of a problem with my second trial that we need to see.

HLVS (Healthy Lifestyle Vs. Statins)

If you have read my posts on statins, by now you are aware of the incredibly small benefits of statins in primary preventions (i.e. when used in people who have not had a heart attack).  In general, they do not reduce your risk of dying, and to save one person from a heart attack we need to treat anywhere from 60-140 people for five years. 

One of the most common arguments for starting a statin is, “It’s the best treatment we have for reducing your risk of heart attacks and strokes.” My response? Not so fast. If I change that to say “It’s the best prescription drug we have for reducing your risk of heart attacks and strokes” then maybe I would agree. 

What other treatments are better?

  • Nourish your body purposefully.
  • Move your body and exercise consistently.
  • Manage your stress.
  • Prioritize your sleep.
  • Maintain strong social connections.
  • Don’t smoke.
  • And other healthy lifestyle actions.

Can I scientifically prove that these healthy lifestyle habits are better than statins? Not yet. That is why we need the HLVS study. Start with 10,000 people who have never had a heart attack or stroke. Half of them get a statin and “usual medical care” from their doctor.

The other half enroll in a lifestyle management program focusing on the following habits:

  • Every meal is at least 50% veggies with very limited processed foods and simple carbohydrates.
  • Healthy fats such as nuts, seeds, olive oil and avocados are encouraged with most meals.
  • Appropriate proportion of animal proteins and animal products are allowed.
  • Participants will strive for 10,000 steps per day plus 150 min of moderate exercise per week.
  • Participants will practice regular stress management and mindfulness meditation.
  • Sleep hygiene is repeatedly reviewed with each participant.
  • Smoking cessation interventions are individually tailored to those who need it

They are followed for 10 years and we measure number of heart attacks, strokes and deaths. We also record subjective measures of happiness, depression and enjoyment of life. Then we will know. Are lifestyle interventions just as good as, if not better than, statins for primary prevention of cardiovascular disease?

I’m pretty sure I know what the answer will be. But alas, we will never see this trial either. Can you imagine if a drug company sponsored this trial and it showed the drug was inferior? Stock prices would plummet, and people will lose their jobs left and right. So, if we want to fund this trial, we better start our fundraising now (no bake sales or girl scout cookies please).

Conclusion

Does this mean we must disregard all nutritional and health science that isn’t a randomized prospective trial? That would mean throwing out most of our science. I don’t recommend that. Instead, we need to be vigilant about understanding the limits of the science and the limits to the catchy headlines. When we read a headline that “the Mediterranean diet has been proven to be better than statins,” we have to pause and think. We know that it may be intriguing, and we may want it to be true. However, until there is a head-to-head, randomized trial, we cannot prove that. Anyone who claims otherwise is inappropriately twisting the data.

What can we do instead?

In the absence of the trials that we need, we can continue to live our lives emphasizing healthy lifestyle habits. We can continue to demand a thorough and realistic explanation of the benefits and potential risks of prescription drugs. We can continue to seek out reliable and credible sources of information. And we can continue to talk about the need for better science. If we do this enough, we will transform ourselves for the better, and maybe, just maybe, we will change the world of nutritional and health science for generations to come.

Thanks for reading.

Bret Scher, MD FACC
Cardiologist, author, founder of Boundless Health
www.DrBretScher.com


Action Item:

Next time you hear a news story about a health study, take the time to look up the study and read it. Then you can decide, is this high-quality evidence? Does it apply to me? You may not understand everything, but the more you read, the more you will understand. And if you still have questions about it, ask me! I welcome your emails: info@drbretscher.com

Bret Scher, MD FACC

Dr. Bret'sExclusive Wellness

Newsletters

Receive valuable articles and tips to help
you achieve your best health ever!

Final Step

Where should we send your FREE

Exclusive Wellness

NEWSLETTERS

858-799-0980Dr Bret Scher