LCHF and “Healthy” Whole Grains: Do we Need Them?

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

Is LCHF Keto the right diet for you in the new year?

With New Year’s resolutions looming, many people are thinking about reinvigorating their health. In fact, 45% of people want to lose weight or get in shape as their New Year’s resolution.

The LCHF Keto diet has been quickly gaining momentum, and it is piquing a great deal of curiosity.

So, is this particular diet right for you? It may just be.

 

What are your diet goals?

Before selecting a diet, it’s important for you to define why you want to diet in the first place. Are your goals weight loss, general health, or a combination?

If you want to lose weight, reduce your hunger, enjoy your meals, and improve your metabolic health, then LCHF may be right for you.

 

Do you want to lose weight?

The primary reason most people go on a diet is to lose weight. As far as weight loss, low carb has you covered. Out of 60 studies comparing low carb to low fat diets, low carb had better weight loss in 30 and they were equal in 30. Low carb was inferior in exactly zero of these studies. That’s an impressive record, and definitely something to consider if weight loss is your primary goal.

But there is so much more to life and health than weight loss.

 

Do you want to reduce your hunger?

One main struggle in health and weight loss is how hungry we are and how much we need to think about food during the day. Studies show that following a LCHF diet reduces our hunger in the long-term. That means less worry about constant snacks, and less concern with needing to eat every few hours. In fact, LCHF works so well at curbing appetite that more people can practice time-restricted eating by compressing eating into a 6-8 hour window, which has indicated potential beneficial effects for longevity.

 

Do you want to improve your focus?

Food, especially the wrong food, can make us feel lethargic and unfocused. Many people report thinking more clearly and having better mental performance when on a low carb diet. The brain loves ketones, whereas carbs can cloud your thinking. Why not switch to low carb and see if your brain fog lifts?

 

Do you want to improve metabolic health?

A recent study showed that only 12% of Americans are metabolically healthy. Low carb diets are one of the fastest and best ways to improve metabolic health. Studies show it puts type 2 diabetes in remission, improves insulin resistance, reduces visceral fat, and improves overall metabolic health.

 

Do you want to decrease your cardiovascular risk?

Fat phobia is gone. Limiting carbs to real food veggies and eating plenty of healthy fats improves our cardiovascular risk profile. It reduces BP, reduces TG, increases HDL and improves the size and density of LDL, which all add up to a net improvement in cardiovascular health.

 

The main reason you should consider LCHF/Keto in the new year

You will love it!

No counting calories, no feeling hungry, no wild glucose swings and post meal crashes, no afternoon slump. With all of this research backing this diet, it’s definitely worth a try.

 

One last consideration

A note of caution, most people will do great. But not everyone reacts to this diet the same way, so you may want to consult a doctor experienced in low carb nutrition.

If you don’t already have a doctor to consult with or want to speak with one who specializes in Keto, I’m a professional who has extensive experience with LCHF diets and how they affect your health. If you’re just getting started, I recommend downloading my free LCHF/Keto starter tips e-book to get you on the right track:

 

 

 

If we can be of any additional service, please let us know!

Thanks for reading,

Bret Scher, MD FACC

A Guide to Keto-Friendly Meal Prep

 

Let's be honest. Changing our eating habits is hard. No matter how inspired and gung-ho we may feel when we first decide to go keto, inevitably, we will face temptations and frustrations. Whether you're brand new to the low carb or ketogenic diet or you've been following it for ages, adopting a meal prep habit can help traslate that initial enthusiasm into success. It can even save time and money along the way!

What is Meal Prep?

Meal prep is the practice of preparing a number of meals in advance, typically all at once on one day per week. I enjoy doing this on Sunday and trying to involve my kids as well! You can be flexible with this to fit your schedule. For instance, you can prepare and freeze an entire week of food, or make only certain meals or plan for only a few days at a time. 

Why Meal Prep?

It saves you time.

The more you prepare in advance, the less time you spend running to the grocery store, and my personal favorite, less day to day clean up! While yes, you prepare about the same amount of food, efficient meal prep typically relies on multitasking to significantly speed up the process.

It cuts your food bill, sometimes drastically.

Meal prep can save you a lot of money on food. How? Consider that the average U.S. consumer will dish out $5,400 on impulse purchases each year. Having a grocery list and sticking to it can dramatically decrease the likelihood that you will give into these types of impulse purchases. (anyone can make a list, but can you stick to the list? Seinfield reference anyone???) Also, preparing a week's worth of food at once makes it easier to buy in bulk, which is often more cost-effective. You'll also find it a lot easier to form your shopping list around sales when you're forced to plan in advance.

It helps you avoid impulse decisions about food.

When you're busy, it's very easy to give into carb-laden fast food temptations. When you're drained after a long day of work, you may think, Whi has time of energy to make dinner? That can lead to less healthy take out choices. Meal prepping helps you avoid this kind of impulsive decision because you'll always have a healthy meal ready for you at home. Just walk in the door, heat it up and viola, dinner is served.

It can facilitate your keto diet.

Since staying in ketosis depends on a certain percentage of macros each day, a meal plan can be invaluable. By planning your meals in advance, you can be certain that you won't get to the end of the day and realize you've gone way over your carb allotment. Meal prep makes it even easier to stick to your meal plan because you can reuse the same base components in multiple meals, making the macro calculations much easier. You're also less likely to deviate from a meal plan when the food is already in your fridge, ready to eat.

 

How to Start Meal Prepping

Getting Started

As with any lifestyle change, when you first start out with meal prep, it's important that you start slowly so that you don't overwhelm yourself. You don't need to prepare an elaborate menu with a different entreé each night. Instead, try the following steps to get acclimated to the habit.

  1. Start by picking two keto-friendly protein options that use different cooking methods. For instance, if one requires the oven, pick something that you can prepare stovetop for the other recipe. You may also pick a side dish or two if you'd like.
  2. Buy enough ingredients to make at least 3 servings of each recipe. You might also consider buying some extra meat and vegetables that you can prepare early and use throughout the week for lunches (think salads and lettuce wraps).
  3. Set aside enough containers to hold your meals for the week. You'll likely want to pre-portion the meals to keep your macros consistent, so you'll need one container per individual meal (Tip: glass is much better than plastic).
  4. On your chosen meal prep day, Sunday in my house, prepare your recipes. Be sure to prep your ingredients all at once and find ways to complete multiple tasks simultaneously. While your chicken is in the oven, for instance, you can be steaming or stir-frying some veggies.
  5. Cook any extra meat and vegetables as well, if you chose to purchase some. A slow cooker can be extremely useful here to free up your other kitchen appliances for your main recipes.
  6. Once you've finished cooking, portion out the meals into their containers. Consider freezing half of the meals to prevent any issues with spoilage. Put the extras into larger containers to portion out as snacks or side dishes.

Refining Your Routine

Throughout the first week, pay attention to the following questions:

  • Did I prepare the right amount of food? If you don't eat all the meals, consider cutting back. If you run out early or don't feel like you've saved yourself any time, consider preparing extra next time.
  • Am I bored with these meal options? If so, next time try preparing slightly different variations on the same recipe or add another entreé entirely.
  • Did meal prepping benefit me this week? Think in any terms you want: time, money, healthy decisions, etc.

It will take some trial and error to determine how often to meal prep and how much to prepare each time. Experiment with different schedules and menus until you are completely satisfied with the answers to these questions.

Keto-Specific Meal Prep Tips

Making meal prep work for any diet is all about planning, and keto is no different. The key is to prepare foods that will help you comply with the diet.

Add variety.

One of the main objections to meal prepping is that people don't want to eat the same meal over and over throughout the week. People who aren't following keto will often use a different carb with each meal to change things up. This isn't possible when following keto, unless you use alternatives such as spiralized or riced vegetables. If variety is important to you, consider one of the following ideas that take less time than adding a whole extra recipe to your prep day.

  • Prepare the same marinade, sauce, or seasoning, but use it on different proteins.
  • Stir-fry different combinations of vegetables with the same sauce or spices.
  • Portion your protein, vegetables, or both into sections and season each differently before baking or frying.

Don't skimp on snacks.

Pre-portioning keto-friendly snacks during your meal prep time can help ensure that you always have healthy options to keep you from dipping into the office candy jar, or in my case, snacking on the muffins and doughnuts in the doctor's lounge (I know that's absurd, but that is what they serve in the hospital!).

Label your food containers.

You should always label your food containers with the dish and date it was prepared. It's also helpful if you're following keto to mark the net carbs and other relevant macros in case you end up mixing and matching your recipes you can still stay on point.

With these tips, you should be well on your way to an efficient and effective meal prep routine. Once you see how much easier it is to follow the ketogenic diet with meal prep, you'll never go back.

 

Is the Keto Diet Heart Healthy? 7 Reasons Why This Cardiologist Agrees

Is the Keto Diet Heart Healthy? 7 Reasons Why This Cardiologist Agrees

 

I am a board certified, card-carrying cardiologist, and I want my clients to eat more fat, more meat, more cheese, more eggs, more avocado, more, more, more.

 

For decades medical establishments have convinced us to eat low fat, higher carb diets. How has that worked for our health? Here’s a hint, we have record numbers of obesity, diabetes and dementia. Yet, as a cardiologist, that’s the party line I am supposed to support.

 

But I can’t. It’s just wrong, and I can’t support that line of thinking, not for a second.

 

Instead, I am a Low Carb Cardiologist. Here are the top Seven reasons why

 

 

1-  Reducing Insulin is Essential to Health and Weight Loss.

 

Insulin is a hormone naturally secreted by the pancreas to help regulate blood sugar levels. Everything we eat (except possibly for 100% fat meals) causes insulin to rise. That is normal physiology. The problem occurs when our bodies become resistant to the effects of insulin, thus requiring our pancreas to make more and more and more insulin.

 

The problem? Insulin promotes fat storage, increase inflammation and oxidation, and can even help fuel the growth of cancer cells. Therefore, the healthiest approach is one which reduced the level of insulin to the lowest possible levels. As it happens, a Low-carb High-fat or ketogenic lifestyle (LCHF/Keto lifestyle) dramatically improves your body’s sensitivity to insulin, reduces the amount of insulin secreted, and it allows your body to naturally use your fat stores for what they are designed for: Break them down into energy! Once we see that we need to fight chronic elevations of insulin, it becomes obvious why a low-fat diet is harmful, and why a low carb diet is the true path to health.

 

2-    Eating Fat Improves Your Cholesterol!

Wait, what? Eating fat can improve my cholesterol? Sounds crazy, right? That goes against everything we have heard from the medical establishment. Notice I said “cholesterol.” I didn’t say the “bad” low density lipoprotein (LDL), I didn’t say the “good” high density lipoprotein (HDL), or any one specific type of cholesterol. We have over emphasized the solitary variable of LDL for too long. Total cholesterol to HDL ratio, Triglyceride to HDL ratio, lipoprotein size and density, insulin sensitivity, and other metabolic measures are more powerful predictors of cardiovascular health than just LDL.

Once again, we see that all these markers improve with a Low Carb High Fat (LCHF) lifestyle. The medical establishment needs to realize that we are more complicated than one lab value. The key is to look at the whole picture, and this picture dramatically improves with a LCHF lifestyle.

If you want to learn more about lipids and cholesterol, I recommend checking out my new dedicated cholesterol course: The Truth About Lipids.

 

3-    Higher HDL is Associated with a Lower Risk of Heart Disease.

HDL is your friend, but drugs are not. Observational evidence has consistently shown that higher HDL is associated with a lower risk of cardiovascular disease. However, our healthcare establishment does not prioritize HDL for one simple reason- Drugs that raise HDL don’t make you healthier. Trial after trial has failed to show any benefit from drugs that significantly increase HDL.

Instead, it’s the HDL-raising lifestyle that provides the benefit, not artificially increasing it with drugs. What’s the best lifestyle to naturally raise HDL? You guessed it. LCHF/Keto lifestyle. Add in some resistance training and you have your friendly HDL climbing the way it was meant to…Naturally.

 

4-    LCHF Leaves You Feeling Great, Leading to Healthier Decisions

 

What kind of health decisions do you make when you are fatigued, achy, and find it difficult to concentrate? That’s a rhetorical question, I already know the answer. When things look glum and we don’t feel well, it’s far too easy to sit on the couch or reach for the chips and cookies. Compare those decisions to those you make when you are well rested, energetic, and seeing the world more clearly. For most people, the better you feel, the better decisions you make.

Guess what? The majority of people who change to a LCHF lifestyle feel better! It may take a few days or weeks, but in general, they feel more in control of their health, more energetic, and they are able to make better health decisions. I admit this is difficult to prove in a scientific trial. That is why we all should become our own n=1 scientific trial. How do you feel and how are your health decisions after going to a LCHF lifestyle? What matters most is what works for you, not what works for hundreds of people who are kinda-sorta like you.

 

      5-    Keto helps you with fasting.

Eating better helps you not eat. People who eat a high carb diet eat a lot, don’t they? They are always grazing and snacking. Our bodies go through the roller coaster of blood sugar and insulin spikes, making it a challenge to go 24, 18, or even 6 hours without eating. This creates a constant, unwavering supply of insulin in our blood stream.

Why is this harmful? For one, it promotes fat storage and keeps us from using our fat as fuel. Secondly, chronically elevated insulin can predispose to heart disease, strokes, cancer, dementia and other devastating health conditions. When people change to Keto, however, they realize they do not need to eat nearly as much or as frequently. Avoiding the carbs and increasing the fats keeps us full longer, and our bodies quickly adapt to longer periods without eating. The result? We can use our fat stores for what they were designed- a source of fuel! It also allows our body to maintain lower insulin levels, and also allows our cells to take care of their health chores, referred to as Autophagy.

If you’re interested in Fasting and want to make sure you’re doing it correctly, download my free Full Guide to Fasting.

 

6-    LCHF Promotes Health Through Increased Autophagy.

Autopha-What? In medicine we like using fancy words to make us look smart. Autophagy is a big word to describe cellular housekeeping. When we have low enough intake of carbs and protein, or when we do intermittent fasts, our bodies can take care of their “to do” lists.  That list includes breaking down weak or damaged cells, recycling the good parts and discarding the rest, and slowing down the processes that can lead to abnormal cell growth (i.e. excess proteins in Alzheimer’s disease, abnormal cancer cells etc.).

Admittedly, long term outcome studies evaluating fasting or LCHF and cancer or dementia risk have not been done. But, on the flip side, drug trials to prevent the same are showing no benefit despite hundreds of millions of dollars invested. If you asked me (which you sort of did since you are reading my article), I’d vote for autophagy as a preventative strategy any day. It makes good physiologic sense, and it is so easy to achieve.

 

7-    With Keto You Will Enjoy Eating Again!

That’s right. A way of eating that helps you lose weight, helps you feel better, improves your health and is actually enjoyable! No fake processed soy products, no cardboard tasting rice cakes. True, it also means no more candy, processed snack foods, doughnuts and danishes. But once you swear them off for a few weeks, and you are eating all the eggs, avocados, nuts, fish, steak, cheese etc. that you want, you won’t miss those old crutches any more. Let the enjoyment begin!

I could go on, but since it seems people like “7 Reason” articles, I will leave it at that. 

 

Now you know the secret: Look at the whole picture. Look for a lifestyle, (not a diet) that helps you feel better, increases your enjoyment, and still benefits your overall health.

 

Is LCHF/Keto the right lifestyle for you? It just may be. To learn more about Low Carb and Keto, download this free E-Book:

 

Thanks for reading

 

Bret Scher, MD FACC

Founder, Boundless Health

www.LowCarbCardiologist.com

 

ADDENDUM!! Since I have published this article, there has been a windfall of media buzz around low carb diets increasing our risk of heart disease or diabetes. Let’s look at where that information came from.

1- A study force feeding mice excessive amounts of industrial omega 6 oils. You can guess what I have to say about that. The article was incredibly helpful, and I immediately stopped force feeding my pet mice industrial seed oils. Thanks goodness for that article. As for how it applies to humans eating real food that contain fat, there is zero correlation.

2- Epidemiological study suggesting those who ate low carb (40% calories from carbs, which by the way is NOT low carb) as measured by two food journals over 25 years had a higher risk of dying. Oh and by the way, at baseline they were heavier, more sedentary, smoked more, and ate fewer veggies. Yet somehow they concluded it must be the low carb diet that “caused” the harm. Once again, it may not be bad science, but it sure was awful interpretation of the science.

In light of those two studies and the hoopla surrounding them, has anything happened to change my mind about a LCHF/keto diet being beneficial for our overall health and our heart health?

Absolutely not.

We still need to individualize our care and our lifestyle for who we are and how our bodies respond. That is always the case regardless of our nutrition, our medications, our exercise etc. As long as we do that, then this cardiologist still believes that LCHF IS HEART HEALTHY!

If you liked this post, you’ll love my free E-Book on Low Carb/Keto Starter tips to help you get started on your LCHF path!

Thanks for reading.

Do Low Carb Ketogenic Diets Increase Your Risk of Dying?

Do Low Carb Ketogenic Diets Increase Your Risk of Dying?

 

Some people certainly want us to think so.

 

But as is often the case, the evidence doesn’t reliably support the dramatic claim.

 

Let’s face it. We all have biases. We all believe things strongly, and we look for evidence to support our position.  I have been guilty of that.

 

That is why those who state that ketogenic diets kill us may still be well meaning, even if they completely miss the point.

 

One frequently cited article to “prove” ketogenic diets kill us was published in the Annals of Internal Medicine in 2010

 

If we just read the abstract, the conclusion is clear. In a study of 129,000 subjects, those who scored the highest for an animal based low-carb diet had a 23% relative increased risk of all-cause mortality.

 

A plant based low-carb diet, on the other hand, seemed to be protective with a 20% decreased risk.

 

For many, an abstract is good enough evidence to sing from the rafters as if it were fact.

 

But that is not how science works. The details matter. They matter a lot. So, let’s look at the details before we condemn a ketogenic diet as a serial killer.

 

The analysis was based on a retrospective look at the Health Professional’s Study and the Nurse’s Health Study. Subjects filled out food questionnaires to estimate their nutrition intake over the past year, estimating their frequency of eating certain foods. Based on that frequency, they were given an animal low-carb diet “score,” and a vegetable low-carb diet “score”.

 

Let’s set aside the how horrible food questionnaires are for scientific validity. That’s the least of the study’s problems.

 

Looking at the baseline characteristics, we see all we need to know. Those who scored highest for animal low-carb diets also had the highest percentage of smokers, 30% vs 27% for women and 14% vs 9% for men (anyone else surprised there were more women smokers than men? I was). Is a 3-5% difference in smoking significant? You better believe it. Smoking is the single most dangerous thing we can do for our health. Considering the mortality difference was so small between the groups, a 5% smoking difference could absolutely account for it.

 

But it doesn’t stop there. The animal consuming men were less physically active and ate more trans-fats.  

 

This is a prime example of the “healthy user bias.” When the whole world says eating meat is bad for you (as they did in the 1980s), who do you think eats meat? You got it. Those who don’t care all that much about their health. Thus, the increase in smokers, increased unhealthy trans fats, and less physical activity.

 

And that is likely just the tip of the iceberg. What other unhealthy practices do they do more often that weren’t measured? We can’t analyze the data from what we didn’t measure.

 

Oh, and let’s not forget that the diets were nowhere close to being low carb ketogenic diets. The animal based low carb eaters consumed 163 grams of carbohydrates per day. 163 grams! I am not sure in what universe that is considered “low carb,” but I can assure you it isn’t in the actual low-carb community. For that, we need to eat at most 50 grams of carbs per day, and even less if we are already insulin resistant.

 

The paper then goes on to show the risk for all-cause mortality, cardiovascular mortality, and cancer mortality. But does it matter? When the data is as poor as this study’s, what can we really conclude?

 

We can conclude this: People who are unhealthy, who smoke, who follow a mixed diet of animal fat and moderate in carbohydrates, and who ignore society’s recommendations about their health have a worse outcome than those who are healthier and follow society’s health advice. Yawn. I think we have seen this movie before

 

So, before we condemn a ketogenic diet as being a silent killer, let’s make sure we are actually studying a ketogenic diet, and let’s make sure it is a level playing ground.

 

Does this mean ketogenic diets have been proven to be safe long term? No. Those studies have not been done. But……

 

Is losing weight, reducing inflammation, reversing diabetes and normalizing blood pressure, all while getting rid of medications likely to improve people’s long-term health? You better believe it.

 

Say hello to a real ketogenic diet.

 

Thanks for reading

 

Bret Scher, MD FACC

LowCarbCardiologist.com

Low-Carb No Better Than Low-Fat….Or is it?

The quest for the one study to finally answer all our nutritional questions continues. And likely will continue forever.

 

If you believe the hype, the recent JAMA study comparing a “healthy low fat” and “healthy low carb” diet on the effect of weight loss was the definitive answer we sought.  The only problem is that it wasn’t.

 

Their conclusion? Everyone lost the same amount of weight regardless of the diet, and genetics of insulin resistance didn’t matter. So, in the end, we can all stop worrying about low fat or low carb or insulin resistance and just eat well. Right?

 

I’m all for simple advice, and that is as simple as it gets. And it will work for many people. But from a scientific perspective, this study did not adequately address the questions it sought to answer. Let’s look under the hood…..

 

600 people without diabetes or heart disease and not on hypertension or lipid medicines were randomized to a “healthy low fat” or “healthy low carb” diet for 12 months.

 

Neither group was told to restrict calories (although both groups ended up eating 500 calories less per day on their own). They had extensive counseling and support with over 20 support sessions throughout the 12 months. These sessions included specifics about the diet and support for maintaining behavioral changes. (That’s a great goal for us all, but the reality of behavior change support looks far different. “Eat better, lose weight and come back in a year” is an all-to-familiar refrain).

 

Here is the kicker. Both diet groups were advised to maximize the veggies, minimize sugar and processed flour, minimize trans fats, and focus on nutrient dense whole foods prepared mostly at home.

 

I don’t care what the macros of the diet are. If we get people to do that, Bravo! That would be a vast improvement for the majority of this country. As a result, the “low fat” group reduced their carb intake from 241 grams per day at baseline down to 205-212 grams per day during the study, and undoubtedly improved the quality of their carbs. They were the low-fat group, and they reduced their carbs! Red flag #1.

 

On the other side, the low-carb group also started in the 240s per day, and reduced their carb intake to 96-132 grams per day during the trial. Red flag #2. This is not a true low carb diet. Low carb diets tend to have less than 50 grams of carbs (100 at the absolute most!), and ketogenic diets tend to have carbs <30grams per day.

 

So, let’s be clear about what was tested. The diet was a “lower than average but still not all that low” intake of carbohydrates, compared to a “lower than average but more moderate carb intake” diet.  

 

This is hardly the definitive once and for all answer about low fat vs low carb diets for which we had all hoped.

 

That doesn’t mean we have to throw out the results, however. We can still learn valuable information from the trial.

 

  1. Reduce junk, and focus on real foods and you will lose weight and improve your health. AMEN! Not a shocker, but always nice to be reminded of the simple things that work.
  2. Engage in a strong support system and you have a good shot of staying with a nutritional change for 12 months.
  3. The more you reduce your carbs, the more likely you are to raise your HDL and lower your TG.
  4. The more you lower your fat, the more likely you are to lower your LDL
  5. Following a mildly reduced carbohydrate intake may not significantly improve insulin resistance blood tests.
  6. There was still a huge variability within each group with some people losing a great deal of weight, and some not losing any. Looking at the averages does not help us decide what specific characteristics predicted success. But in this trial, it did not seem to be genetics.

 

And the other take home? Testing moderate changes in diet are unlikely to show dramatic differences when both tested diets focus on real, nutrient dense, whole foods, limiting added sugar and processed flour.

 

If we want to test for a REAL difference, we need to go more “extreme.”

 

Doing this same study with a ketogenic diet would be very interesting.

 

Including people with diabetes and hypertension (more metabolically unhealthy, like so many in this country) would be very interesting.

 

Would that give us the once and for all answer which we crave?

 

Once again, probably not. But it may help us understand when to use the different tools we have in our nutritional tool box.

 

As was so nicely stated by The Diet Doctor, we now have an equal number of studies showing no difference between low fat and low carb diets as we do showing that low carb is better. We are still waiting for one to show low fat is better…….

 

The main takeaway, however, is that we don’t have to believe there is one diet for everyone. That is why we need an open mind, we need to be open to experimentation, and we need to treat individuals as…….individuals.

 

We can reverse type II diabetes with a ketogenic diet. Virta Health has shown us that.

 

Real food, relatively low-fat diets, when combined with healthy lifestyle practices can be associated with good healthspan. The Blue Zones observations have shown us that.

 

Our definitive trial may never come. But we don’t need it as long as we are willing to work with the n=1 experiment with each and every person we encounter. The starting point is easy. Just eat real food. Then be open to different avenues of specifics and see where the road goes.

 

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

Carbs Kill? Fat Heals? What does PURE Really Say?

Are you still confused about all the contradictory advice on fat and carbs? We have been told for decades that low-fat is best when it comes to our health.  Turns out, that was pretty bad advice.

 

We now have even more evidence showing that fat certainly isn’t “bad,” and it is probably beneficial for our health. Carbohydrates, on the other hand, are trending toward the “bad” side and may need to be reduced.

 

Confused? I don’t blame you. Read on for more info.

 

First my usual disclaimer.

 

We do not eat fats and carbs. We eat food. A wonderful combination of macro- and micronutrients, including fat and carbs. Whole grain bread, farro, quinoa can all be labeled as carbs. So too, can bleached white bread, French fries, Cheetos, and cookies. They are all carbs, but I guarantee you they are not all the same for your health.

 

Grass-fed steak, wild salmon, and avocado can all be labeled as fat and protein. So too, can deep fried chicken, processed lunch meats and others.  Do you see where I am going with this?

 

The Study

 

With that disclaimer in place, let’s talk about the new study released in the Lancet and presented at the European Society of cardiology Conference earlier this week. You may have already seen the headlines, “Low-fat Diet May Kill You!” “The Low-Fat, Low-Carb Question Has a New Answer.” And others. As usual, the truth is never as exciting as the headlines, but it is still worth exploring.


This trial followed over 135,000 subjects from 18 countries for over 7 years. Researchers recorded nutritional intake through standard questionnaires (which are subject to errors as I’ve mentioned before), and investigators followed the subjects, noting who died, who had heart attacks, strokes or heart failure.

 

The short answer is that the group with the highest intake of carbohydrates (77% of daily calories) had an increase in their risk of dying when compared to the group with the lowest intake of carbs (46%). Interestingly, their risk of dying from heart disease was not increased, but their overall risk of dying was increased.  This was mostly driven by cancer, respiratory diseases and dementia.

 

Intake of fat, on the other hand, was associated with a lower risk of dying. This held true for saturated fat, monounsaturated fat and poly unsaturated fat.  There was no significant change in the risk of cardiovascular disease, but again, total mortality was significantly improved.

 

What can we make of all this?

 

It is important to remember that this was an observational trial. It doesn’t prove anything. It shows a very interesting association, but there is no way to control for all the variables that could influence the outcome (as an aside, the same caveat applies to all the prior observational trials condemning saturated fat).

 

The subjects filled out a food intake questionnaire at the beginning of the study, but they were not followed over the seven years to see if their food intake changed. That can certainly introduce inconsistencies in the data.

 

Also, the study lacked many nutritional specifics. What kind of carbs were the subjects eating? Something tells me in the high carbohydrate group, it probably wasn’t sweet potatoes, buckwheat, quinoa, and amaranth. The higher the overall intake of carbs, the more likely their diet included poor quality carbs. Food quality matters.

 

Nonetheless, increasing carb intake seemed to go along with increasing risk of death. That association was clear. Conclusion #1, therefore, is to reduce our carb intake. My editorial is to reduce your low-quality carb intake, although that was not specifically studied.

 

Increasing fat intake, on the other hand, was associated with a reduced risk of death.  The group eating 35% fat had a better survival than the group eating 10% or 18%. Importantly, increasing fat intake was not associated with a lower risk of cardiovascular disease. But it wasn’t associated with a higher risk of cardiovascular disease either. It was neutral to heart disease, and beneficial to overall mortality.

 

Picture your doctor telling you a pill won’t change your risk of heart disease, but will reduce your risk of dying. And it’s only side effects are enjoying it as you ingest it, it gives you energy and nutrients, and helps you feel full. Sounds like a pretty good pill to me! Sign me up. Only in this case, it wasn’t a pill. It was dietary fat.

 

Conclusion #2, therefore, is to not fear the fat. Adding fat can be a benefit, especially if (again, my editorial) it is high quality and helps you reduce your carb and overall caloric intake.

 

There is Another

 

Based on most social media headlines, one may think that this was the only PURE study. It turns out, there was another one.

 

The other PURE study involved the same group of individuals, but it investigated overall fruit, vegetable and legume intake. The researchers found that three-to-four servings per day of fruit, vegetables and legumes was associated with the greatest decreased risk of death.

 

Interestingly, adding more was of no further benefit, but eating less was a lower benefit. This likely did not get the same media attention as the low fat study since the benefits of eating fruit, vegetables and legumes is much less controversial, and not surprising at all.

 

Should anything change from these studies?

 

Yes and no.

 

Real-foods like veggies, fruits, beans, legumes, nuts and seeds are a great place to start for most people. Hopefully we already knew that.

 

Fear of fat should get squashed. Fat is not inherently dangerous. Hopefully we already knew that as well.

 

Concern for too many carbs should be a hot button issue. Hopefully we already knew that also!

 

What may change for some people is further increasing the fat (up to 40+% of daily calories) and animal sources in your diet, and further limiting the carbohydrate sources (down to 40% of calories). Go ahead and add fish, meat, chicken, eggs, milk, olives, olive oil, avocados and avocado oil to your diet. Especially if your diet is based on veggies, fruits, beans, legumes, nuts and seeds. The evidence supports it.

 

Be careful of over-generalizing these results. Many details are missing, and observational trials cannot control for all the important variables. But since this is the best evidence we have, we still should take note.

 

Will this be enough to change national nutritional guidelines? That seems unlikely. Bureaucracy is much slower to move than individual recommendations. On an individual basis, not many people follow national guidelines anyway. But guidelines do impact governmental programs (i.e. school lunches, etc.), so my hope is that they will take note and start to change with the tide.

 

My advice?

 

Eat foods that make you happy. Eat foods that fit with your traditions. Just make sure you follow the concept of eating simply prepared, high-quality, real foods. Don’t over-do the carbs, and don’t underdo the fats. Start there and you are well on your way.

 

Interested in more information? Listen to my podcast, The Boundless Health Podcast here, read more of my blog here, learn about my book, Your Best Health Ever,  here, or The Boundless Health Membership Program here. My goal is to provide helpful information through multiple avenues to make sure you get what you need to live Your Best Health Ever!

 

Thanks for reading

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

 

 

 

 

Are Gluten-Free Diets Killing Us?

Gluten has come full circle in the eyes of popular media. It was initially portrayed as the cause of all our health concerns. Eliminating it was the quickest path to feeling better and living healthier. After all, how else can we explain Tom Brady’s Super Bowl prowess????

 

Now, however, avoiding gluten has been implicated in increasing our risk of heart disease and causing a harmful disruption of our gut microbiome (the bacteria in our digestive tracts and plays an integral role in our health).

 

So, which should we believe?

 

As with most health topics in popular media, the key is in the details. But first, a quick primer on gluten and gluten sensitivity.

 

Gluten 101

 

Gluten is a protein found in wheat, barley and rye, and in foods made with those grains, like bread, cereal, cookies, crackers and pasta.

 

In people with the medical condition of celiac disease the body sees gluten as a foreign invader and is unable to properly absorb it. Gluten causes an autoimmune response against the lining of the intestines causing intestinal damage and decreased absorption of necessary nutrients.

 

Symptoms of celiac disease include abdominal pain, bloating, and rashes. It can also cause anemia, bone problems, and malnutrition. Your doctor can diagnose celiac disease with a blood test and a biopsy of your small intestine.

 

Without question, those with proven celiac disease must avoid gluten. Fortunately, it is a rare medical condition.

 

More commonly, people may be sensitive to gluten even though they don’t have celiac disease. They simply find that they feel much better when they avoid gluten-containing foods. They have more energy, less bloating, clearer skin, and have improved concentration and mental clarity.

 

This is not a medical diagnosis. There is no way to objectively prove if this is the case or not. This is a subjective feeling. Do you feel better while avoiding gluten or not? It’s that simple.

 

This is similar to numerous other food intolerances that abound. Some people feel better avoiding dairy. Some feel better avoiding meat. Some feel better avoiding legumes. Gluten is no different. It just gets more attention lately given its popularity among celebrities and weight loss pundits.

 

If you feel better avoiding gluten, then you should avoid it. After all, our bodies do not require gluten for good health.

 

Our bodies need proteins and fats, vitamins and minerals. There is no physiological need for gluten. If it makes you feel poorly, there is no need to eat it.

 

Gluten Coming Full Circle

 

Now, however, people are starting to question the safety of gluten-free diets based on recent research.

 

An article published in May in BMJ (British Medical Journal) suggested that avoiding gluten increased our risk of heart disease.  What followed was a social media and popular media storm of gluten-free backlash with the end result being confusion and frustration.

 

Who do we believe and what do we do now?

 

Take A Breath, Then Dive Deeper

 

First, take a breath. Remember that health claims, good or bad, are rarely as extreme as portrayed by the media.

 

Next, dive deeper. Understanding the implications of the study depends on understanding the details of the study. I know that not everyone has the time/desire/resources to dig deeper into the studies, so we did it for you.

 

This study was an observational study that followed healthcare workers without heart disease (at the time of enrollment) for 26 years. There was no specific intervention, the researchers simply collected data over time on who had heart attacks and who did not, and also collected data on what they ate. By going back and statistically crunching the data, they tried to find an association between the amount of gluten eaten and the risk of heart attacks.

 

Here is the main conclusion to the study. There was no significant difference in heart disease risk between those who ate the most gluten compared to those who ate the least. No significant difference.

 

Why all the news reports that it increased the risk of heart disease?

 

Statistical massaging of the data showed that those who ate the least amount of gluten and the least amount of whole grains did have a small increased risk of heart disease.

 

So, what was the problem? Was it the missing gluten? Or the missing whole grains? This study does not prove cause and effect. It does, however, suggest it was the lack of whole grains, not just the gluten, that was associated with a very small increased risk of heart disease.

 

How small?  There was a 15% relative risk increase. The absolute increase was not reported, but looking at the numbers it was around 0.1%. The difference was 1 person out of 1000. Hardly earth shattering.

 

Said another way, if the subjects avoided gluten containing cookies, crackers and processed bread and substituted gluten-free cookies, crackers and processed bread, they were not any healthier, and may have increased their heart disease risk by 0.1%.

 

Yawn. That type of analysis wouldn’t sell many papers or get many clicks. Thus, the media did not report it as such. Yet that is what the paper found.

 

Gut Bugs

 

What about gut microbiota? Can gluten-free diet hurt our gut bugs?

 

A 2010 study suggested eating a gluten-free diet harmed our gut microbiome. This one should be an easy one to explain.

 

What helps healthy gut microbes flourish? Fiber. Specifically, fermentable fiber.

 

The most common gluten substitute is rice flour. Rice flour has very little fiber, thus very little ability to feed the healthy gut bacteria.

 

The result? A relative overgrowth of the unhealthy gut bacteria. The bacteria that like high-sugar and low fiber foods flourish while the fiber-eating bacteria die off.

 

Wheat on the other hand, tends to have more fiber. Especially whole grain foods. So once again, it is likely that limiting whole grains in favor of low-fiber, processed foods is not helping our health, whether we are talking about our guts or our hearts (and by extension, likely our brains as well).

 

Gluten- Guilty or Not?

 

Is there anything inherently dangerous about eating gluten free?

 

No.

 

The key is what are you eating instead. If you are eating low fiber, processed gluten-free foods, then you are not doing yourself any favors.

 

But if you feel better avoiding gluten, and you are replacing it with real food, fresh veggies (both starchy and non-starchy), fruit, seeds and nuts, then chances are you will feel better and be healthier.

 

What if gluten doesn’t bother you? Then there is no real need to avoid it as long as you are eating whole grains, minimally processed versions of gluten, and avoiding the processed and refined junk.

 

It’s that simple Let’s not over complicate it.

 

Action Item: Take two weeks to see how you feel without eating gluten. Do you feel any better? More or less energy? Can you think or focus better? Do you have fewer aches and pains? Did your weight change? If not, then eat what you want (as long as you continue to follow a real food, vegetable first, low sugar and low processed food way of eating). If you do feel better without gluten, then stock up on the foods listed below. Avoid gluten, but also be careful not to add processed, low-fiber, gluten-free alternatives. Just because it is gluten free doesn’t mean it is good for you!

 

Whole grain gluten-free foods:

Amaranth, buckwheat, brown rice, millet, quinoa, oats. 

 

Other fiber containing foods:

Legumes such as beans, lentils and peas

Green leafy vegetables

Starchy vegetables such as yams, sweet potatoes, carrots and other root vegetables

Apples, pears and berries

Nuts and seeds

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

Bret Scher, MD FACC

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