I live in McAllen, Texas, where it’s difficult to find a doctor who’s knowledgeable on the benefits of a low-carb lifestyle. Because I battle a high A1C AND high cholesterol, I reached out to Dr. Scher for a consultation to monitor my blood work and develop a plan that will keep my heart healthy and my A1C in check. Before our video-consultation, he responded personally to every question I had via email. When I first reached out, I figured it would take at least a month or more to schedule our consultation, but to my surprise, it was planned just over a week from my initial email!

I like Dr. Scher’s commonsense approach to a healthy lifestyle. He came up with a very-easy-to-follow plan and agreed to review my bloodwork every 6-8 weeks to make sure I’m on the right track. Because of my family’s history, it’s comforting to know I have a cardiologist monitoring my health so that I can prevent a significant problem down the road.

Nicole Southwell

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

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

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

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

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

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

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

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

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

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

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

3.    Show them your results!

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

4.    Find a doctor who will listen

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

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

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

5.    Seek online Keto support

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

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

6.    Take control of your own healthcare journey

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

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

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

Thanks for reading.

Bret Scher, MD FACC

Founder, Boundless Health

www.LowCarbCardiologist.com

What do I mean by “misunderstood?” Look no further than the common misnomer of “good” or “bad” cholesterol.

Good and Bad Cholesterol

While it may be true that High-Density Lipoprotein (HDL) has potentially beneficial functions (reverse cholesterol transport), we have to remember there is no such thing as good and bad cholesterol. The cholesterol carried by HDL is the same as that carried by LDL. The only thing that makes it good or bad is if it ends up synthesizing our hormones or bile acids (good), or if it ends up in our vessel walls (bad).

If it’s true there is no such thing as good and bad cholesterol, why do we care about our HDL levels?

First, let’s start with the basics.

HDL is the smallest and most densely packed lipoprotein and has one or more ApoA protein on its surface. HDL can help lipids move around in circulation by accepting triglycerides or cholesterol from other particles, thus helping a VLDL turn into an LDL, or helping an LDL contain less cholesterol (turning a small dense LDL into a less densely packed LDL).

Like LDL, HDL transports cholesterol to the liver for recycling or excretion, or to the hormone producing cells like in the adrenals. Unlike LDL, HDL does not have the potential to get retained in the vascular wall and does not, therefore, contribute to plaque formation. In fact, functioning HDL can remove cholesterol from the vessel wall, thus putting it back into circulation and possibly removing it from the body.

Back to the question at hand.

Why should we care about HDL levels?

Early epidemiological trials showed that lower HDL levels were associated with a higher risk of cardiovascular disease and even death.  With such a strong association, the medical profession promoted elevated HDL levels as protective and low levels as something we need to avoid.

Since these were observational epidemiological studies, they do not prove that the low HDL caused the problems, only that HDL was associated with it. For instance, HDL is also known to be low in diabetes, metabolic syndrome and insulin resistance. It may, therefore, simply be a marker of underlying metabolic dysfunction that contributes to increased risk.  Yet, HDL’s function in reverse cholesterol transport, and its ability to remove cholesterol from vessel walls suggests a more direct impact on cardiovascular health.

It is also important to note that the Framingham data suggested that increased cardiovascular risk with elevated total cholesterol and LDL-C was lost in the presence of high HDL. In fact, very low levels of LDL combined with very low HDL levels had a much higher risk than markedly elevated LDL levels when combined with elevated HDL.

Thus, HDL proves to be a useful marker to help predict cardiovascular risk. For instance, one large meta-analysis showed that total cholesterol/HDL ratio was a much stronger predictor of cardiac mortality than total cholesterol alone.

In addition, the PURE study, an observational trial in over 135,000 subjects, showed that when considering lipid changes brought about by nutritional changes, ApoB/ApoA1 (essentially LDL-P/HDL-P ratio) is the best predictor of clinical outcomes.

Thus, HDL level is important in assessing cardiovascular risk.

Drugs Muddy the Picture

While HDL may be a good predictor of risk, raising it with drugs does not seem to confer added benefit.

For instance, cholesterol ester transferase protein inhibitors (CETP inhibitors) significantly reduced LDL by 20-30% and increased HDL 100-fold, yet showed either no clinical benefit or even worse, an increased risk of death.

This was a shock to many in the lipid world as the notion of “good” and “bad” cholesterol would clearly predict lowering LDL and raising HDL would confer dramatic health benefits. So much so, that multiple pharmaceutical companies invested hundreds of millions of dollars developing these drugs only to abandon them when the trials showed no benefit.

Part of the issue is that not all HDL lipoproteins function the same. There are subsets of people with genetically determined markedly elevated HDL levels who have an increased risk of CVD. They may have plenty of cholesterol circulating in HDL particles, but the HDL particles are dysfunctional and therefore  do not effectively remove cholesterol from vessel walls or LDL and do not effectively transport it to the liver. Conversely, there are those with a specific genetic mutation called ApoA1 Milano who have very low HDL-C and lower cardiovascular risk.

Simply measuring the HDL cholesterol content, therefore, may not accurately reflect its function. While we do not have easily available tests to measure HDL function, we can potentially use HDL particle assessment as well as the company it keeps (i.e. low triglycerides, larger less dense LDL particles) to better assess the potential benefits of HDL. Thus, if there is any concern about potentially dysfunctional HDL, I usually recommend advanced lipid testing to see the specific subtypes of HDL.

What can we conclude from all the HDL confusion?

Raising HDL with drugs does not reduce cardiovascular events, yet having a naturally low HDL is associated with increased risk.

The best answer, therefore, is to live a lifestyle that helps you have a “not low” HDL level. This means first and foremost avoiding the medical conditions associated with low HDL (i.e. insulin resistance, diabetes, and metabolic syndrome).

Textbooks predictably state the interventions to naturally raise HDL include exercise and moderate alcohol intake. Unfortunately, these have minimal effects. In fact, they pale in comparison to a low carb high fat lifestyle. In my 20+ years in the medical field, I have never seen an intervention as effective as LCHF in raising HDL, and the studies agree.

This brings us back to our question once again.

Why are HDL levels important?

HDL levels are important because it is a reflection of our underlying metabolic health and our lifestyle. A properly constructed LCHF lifestyle lowers triglycerides, raises HDL, and reduces the small dense LDL, among other benefits. Such a lifestyle likely reduces overall cardiovascular risk and will likely be shown to improve longevity and health span. While HDL may not be the main reason for this, we can’t ignore its role simply because it is more nuanced than “good” and “bad” cholesterol.

My advice, therefore, is to see the whole picture. Embrace the nuance. And make sure you get a thorough and proper evaluation of your cardiovascular risk.

If you are hungry for more, I created my Truth About Lipids program, a program focused on Cholesterol, to help break through the confusion and provide you with everything you need to thoroughly understand cholesterol and its impact on your health.

Learn more: Truth About Lipids Program

If you still have questions, you may want to consider a one-on-one health coaching consultation so you can get the individual attention you deserve  with a thorough assessment of your lifestyle and its impact on you as an individual.

Please comment below if you have any questions or comments that may help further the discussion.

Thanks for reading.

Bret Scher MD FACC

Dr. Scher’s six-month program has been helping me make progress on my health journey. I started the program five months ago after I decided to get more serious about my health and reduce my coronary heart disease (CHD) risk by making healthy diet and lifestyle changes.

The program is not only providing me with excellent video and written content that helps me progressively realize my health goals with effective plans of action, but also individualized attention via email and with monthly video calls with Dr. Scher. I’m grateful for this individualized attention and for Dr. Scher’s insights and suggestions. His advice has honored my preference to continue following a low-carbohydrate lifestyle and has helped me select appropriate macronutrient targets such as daily intake of carbohydrates and protein based on my goals and his review of my medical history and lab test results.

Ken Carrillo
Chemical Engineer

I recently had a one-on-one Health Coaching Consultation with Dr. Bret Scher. I cannot adequately express the gratitude and respect I have for Dr. Scher. He took the time to consider all facets of my health and really listened to me and my concerns. He was not quick to insist I be on prescription medications, but rather he explored various avenues of suggested treatment/preventative measures I might consider taking…guiding, as opposed to dictating a plan of of action. The consultation was well worth my time and money! Loved his approach so much that my husband and I have decided to work with him long distance.

Jami Miltenberger
MS Counseling Psychology