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

Did you know changing the way you eat may be able to normalize your blood pressure completely? For many people it’s true. But what’s surprising is that it isn’t changing to the diet that most doctors and dieticians recommend.

The DASH diet, Dietary Approach to Stop Hypertension, has long been the “go-to” diet for reducing blood pressure. The DASH diet is a high carbohydrate, low fat diet that recommendseating plenty of fruits, veggies, whole grains, and limiting salt and saturated fat. And while that works for some people, many others can normalize their blood pressure with a nearly opposite approach.

A 2023 study published in The Annals of Family Medicine, demonstrated that a very low carbohydrate diet with no limitations on the amount of salt or the amount or type of fat eaten was better at lowering blood pressure compared to the DASH diet.

Many wonder how this could be, but the answer is pretty straightforward.

Poor metabolic health, from insulin resistance to type 2 diabetes, is a leading cause of high blood pressure. And low carb diets are one of the best lifestyle approaches for improving or even normalizing metabolic health. Therefore, it makes complete sense that a low carb diet would be highly effective at normalizing blood pressure.

Of course there are many other ways to improve blood pressure, such as quitting drugs, tobacco and alcohol, getting regular exercise, managing stress, etc. And these are very important. But since everyone has to eat, it is powerful to eat in a way that can normalize blood pressure.

Let’s explore four ways how low carb diets can help blood pressure.

1- Weight loss
Having overweight or obesity is a strong contributing factor to high blood pressure. And while low-carb eating isn’t the only way to lose weight, it tends to be as good as or even better than low fat eating for weight loss. Some publications even demonstrate weight loss on par with highly effective GLP1 weight loss drugs like Ozemipic and Wegovy.

2- improved metabolic health
As mentioned, metabolic dysfunction is a clear trigger for elevated blood pressure. And while low carb eating isn’t the only way to improve metabolic health, it is likely the most effective dietary pattern for improving metabolic health, and can even do so with or without weight loss.

3- Ketosis
If someone lowers their carbohydrate intake enough, they can enter a state of ketosis, a normal physiologic state where we burn primarily fat for energy instead of carbohydrates. When this occurs, our insulin levels drop to a normal level and we have a natural diuresis, meaning we eliminate sodium and water more than usual. This can help lower blood pressure above and beyond weight loss.

4- Avoiding processed foods
Most well formulated low carb diets avoid highly processed junk foods like potato chips, candy, doughnuts, etc. that can lead to high blood pressure. So, simply eliminating these foods can also contribute to lower blood pressure.

What about salt?

One of the big misconceptions about blood pressure is that we all need to lower our salt intake for better blood pressure. However, this appears to be a gross over-generalization. There’s a growing understanding that a minority of individuals have “salt sensitive” hypertension. This means that the majority are unlikely to affect their blood pressure by altering their salt intake.

Furthermore, where we get our salt likely makes a difference. For insurance, if someone is getting their salt from highly processed foods like chips, pretzels, etc, they are hit with an ultra-processed combination of salt, calories, carbs, and sugars that is bound to raise blood pressure.

But what if someone is eating whole foods like broccoli, cauliflower, steak, and avocado, and they add salt to that meal? Clinical experience suggests our bodies react much differently to this type of salt exposure, and people can dramatically lower their blood pressure despite adding salt to their diet.

Low Carb Eating Works

So while it may not be the right approach for everyone, it is increasingly clear that eating a well-formulated low carb diet is a safe and effective way to lower blood pressure. It’s time to include low carb diets as a first line treatment option for normalizing blood pressure.

Thanks for reading!

Bret Scher MD FACC

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

Here it is again. The term “healthy” connected as a descriptor.

We see it all the time. Healthy Whole Grains. It reminds me of the common use of “fruits and vegetables,” as if they are one in the same.

Are whole grains, by definition, “healthy?”

For a full, in depth description, see the Whole Grains Guide on Diet Doctor, where I was the medical editor and reviewer.

For the quick answer, let’s leave it as a “maybe.”

If you choose to eat refined grains, white flour, processed snack foods, in essence the Standard American Diet, then switching to whole grains will almost certainly improve your health. And that is where the majority evidence in favor of whole grains stops. Compared to refined grains, they are great.

Who should eat whole grains?

If you are insulin sensitive, live in a society where you are physically active for most the day, eat fewer calories than most industrialized nations, and maintain a healthy body weight, then whole grains can be a healthy part of your diet. Observation of the Blue Zone countries demonstrate that whole grains can be part of a healthy lifestyle in that setting.

We cannot, however, extrapolate those findings above to apply to all Americans, Europeans, Asians etc. and say whole grains are by definition “healthy.”

Who should not eat whole grains?

If you are metabolically unhealthy with diabetes, metabolic syndrome or insulin resistance (estimated to be 88% of all Americans), then whole grains are anything but “healthy.” Borrow a continuous glucose monitor for a day and see how your blood glucose responds to whole grains. If you aren’t perfectly metabolically healthy, it isn’t pretty.

Instead, if you eat a whole-foods, low carb diet without grains and sugars, then whole grains have no necessary role and no association with health.

Enjoy the more detailed guide from DietDoctor.

Thanks for reading,

Bret Scher, MD FACC

There’s a common assumption in the medical and nutrition world that a low carb, high fat diet, like a ketogenic diet, will automatically increase one’s risk for heart disease. However, it’s crucial for us to realize that this assumption is inaccurate and not supported by data.

In fact, it’s been well documented that low carb diets can help someone reverse type 2 diabetes and improve metabolic health, changes that dramatically lower one’s cardiac risk. Research and clinical experience supports that a properly formulated low-carb diet can help someone improve, rather than worsen, their heart health.

But many may wonder, how can this be true when I’ve heard that eating fat is bad for us and bad for our hearts?

A big problem comes from assuming that our bodies react the same way to a diet high in carbs + fat as we do to a diet LOW in carbs and high in fat. The truth is that our bodies react dramatically differently to those two versions of a high-fat diet.

How It Works

You see, when we eat lots of carbs, our body uses the carbs as fuel first. Therefore, we won’t burn the fat for energy, and we end up storing it as adipose or fat stores. But when we eat a very low carb diet, our bodies prefer to burn the fat for energy, and therefore there is much less left over to store as body fat. This is dramatically different from a high carb diet!

Studies also demonstrate that people eating a low carb, high fat diet naturally reduce their calories, thus eating less and losing weight seemingly without trying. But those eating high fat and high carb diets tend to eat more calories and gain weight.

So you can see how we can’t just refer to a “high fat diet” as if it is one thing. It makes a big difference if it is also a high carb or low carb diet.

The Main Contributors

Let’s review the main contributors to heart disease, and see how a low carb, high fat diet impacts them.

1- Blood pressure
One study demonstrated a ketogenic diet lowers blood pressure better than the DASH diet, the diet previously felt to be the best for blood pressure management. And others have shown safe and effective blood pressure lowering when starting a low carb, high fat diet that is similar to a low-fat diet.

2- Type 2 Diabetes
Numerous studies demonstrate the efficacy of low carb diets for treating and even reversing type 2 diabetes. Since diabetes is a major contributor to heart disease, reversing it will significantly improve one’s heart health.

3- Inflammation
Ketogenic diets have been shown to reduce many markers of inflammation, including the commonly used CRP.

4- Triglycerides and HDL cholesterol
Having low triglycerides and normal to mildly elevated HDL cholesterol levels are predictive markers of better heart health, likely because they occur with good metabolic health. Numerous studies demonstrate that ketogenic diets reliably help lower triglycerides and raise HDL, thus improving overall cardiac risk.

5- LDL cholesterol
Many assume that high fat diets raise LDL cholesterol. But again, that is not the case. Multiple studies demonstrate no net change in LDL on a ketogenic diet compared to a low fat diet. In fact, one analysis of multiple studies found a net reduction in LDL particles for those following a ketogenic diet.

Important to Note

However, there is a subset of individuals who can see a dramatic rise in their LDL cholesterol when following a ketogenic diet. These so-called Lean Mass Hyper Responders, have unique physiology that predisposes them to an increase in LDL. But it’s important to realize that these individuals are the minority, not the majority. And there’s even emerging evidence suggesting that elevated LDL may not place these individuals at a higher risk, although with much still to learn.

In Summary

The data does not support the assumption that low carb, high fat diets increase heart disease risk. In fact, many studies demonstrate overall improvement in most, if not all, cardiac risk factors. We need to stop assuming all high fat diets are the same, and realize the unique heart health-improving impact of low carb/high fat diets.

If you would like to learn more about the misperception and misunderstanding about ketosis and heart disease risk, please see the video links listed here:

Does Keto Cause Heart Disease?

Debunking a study claiming low carb diets cause heart disease

Analysis of a study demonstrating lowering of cardiac risk with low
carb diets

Thanks for reading,

Bret Scher MD FACC