Blood pressure medications — friend or foe?

The medical world experienced yet another guideline update in 2018 telling doctors more medication is better. This guideline for treating hypertension was put out by the American College of Cardiology and the American Heart Association, and effectively lowered the definition of hypertension from 140/90 down to 130/80. The organizations also recommended drug treatment for all individuals with blood pressure greater than 140/90, regardless of underlying risk.

Unfortunately, this seems like a common scenario — medical guidelines recommend more aggressive medication use for minimal potential benefit despite potential harm. A new study published in the Journal of the American Medical Association (JAMA), suggests the blood pressure guidelines go too far for low risk individuals, and the risk of harm outweighs the potential benefits.

JAMA: Benefits and harms of antihypertensive treatment in low-risk patients with mild hypertension

The JAMA study was an extensive chart review of over 38,000 patients at low risk for heart disease who had stage two hypertension (blood pressure between 149/90 and 159/99) and were treated with blood pressure medications. Over an average follow-up time of almost six years, they found no reduction in the risk of cardiovascular disease events or risk of death with medication use. They did, however, find an increased risk for low blood pressure, fainting, and acute kidney injury among those treated with medications.

Based on these results, treating stage two hypertension in low risk patients tends to cause more harm than good.

What makes this study valuable is that it documents real world experience. Guidelines are frequently made from trials conducted with more aggressive follow-up and monitoring than is typical in usual care. That fuels the medical community’s perspective that drug interventions are the best course of care, which is why we need more studies like this one from Dr. Sheppard et. al. showing us how low risk patients probably do not benefit from drug therapy in real world scenarios.

Instead of reaching for drugs, we should continue to find the most effective lifestyle interventions to help lower blood pressure and reduce cardiovascular risk without a laundry list of side effects. Unless, of course, you consider losing weight, having more energy, and feeling great as side effects — those are the type of side effects (from low-carb eating) that we all can embrace!

Thanks for reading,
Bret Scher, MD FACC

 

Originally Posted on the Diet Doctor Blog 

High LDL cholesterol may protect against dementia – don’t tell the statin pushers!

Don’t tell the statin brigade, but elevated LDL cholesterol may actually help us as we age!

new study from China suggests that those with higher levels of LDL-C have a lower incidence of dementia. They evaluated 3,800 subjects with a mean age of 69 years, performing extensive neuropsychological and cognitive ability testing. They found that the diagnosis of dementia and cognitive impairment correlated with increasing age, decreasing education level, diagnosis of type 2 diabetes, and being an ApoE4 carrier. After controlling for all these factors, they also found that those in the highest tertile of LDL-C (>142 mg/dL or 3.7 mmol/L) had a 50% lower incidence of dementia than those in the lowest tertile (<110 mg/dL or 2.9 mmol/L).

Frontiers in Neurology: High low-density lipoprotein cholesterol inversely relates to dementia in community-dwelling older adults: The Shanghai aging study

These findings are consistent with a prior study (also observational) examining the Framingham Heart Study data that found lower risk of dementia in those over 85 years old with higher cholesterol levels.

In fairness, these studies were observational studies, so they do not prove higher LDL-C directly protected against dementia. We can hypothesize why higher levels of LDL-C are associated with lower incidence of dementia. It could be a marker of overall health or nutritional status, it could be that LDL-C directly improves the health of neurons and prevents brain atrophy, or it could be more related to lack of diabetes or ApoE4 status for which a study may not always completely control.

Even without proving causation, these studies are wonderful reminders that we can easily get caught up in one specific disease processes (i.e. cardiovascular disease) and forget about the rest of the patient. The old joke is that when the surgeon talks to the family after a complicated and risky coronary bypass surgery, he says, “The surgery was a great success. The grafts were perfect, and the anastomosis were flawless, some of the best I have ever done. I’m sorry the patient died, but the surgery was wonderful.”

This is a fictional over-exaggeration, but it makes my point.

Cholesterol’s effects on our health are far too intricate to simply label LDL-C as “bad” and leave it at that. Such oversimplifications harm our overall understanding and eventually harms our health.

Instead, we need to focus on the whole patient, not one specific outcome. Trials should focus on all-cause mortality and overall morbidity rather than one or two specific outcomes. It doesn’t do us much good to lower heart attack risk by 0.5% over five years if we are also increasing the risk of dementia, cancer or other complications.

Thanks for reading,
Bret Scher MD FACC

 

Originally Posted on the Diet Doctor Blog 

My Healthcare Apology

 

I owe you an apology. And not just you. I owe the whole country an apology. By being a part of our current healthcare system, I have been an implicit part of the demise of our country’s health.

 

Our healthcare policies and practices have failed us, and they continue to fail us. They have helped create two generations of overweight and obese individuals. They have allowed rampant increases in the number of people suffering with diabetes and insulin resistance, crippled by dementia, struggling with depression and autoimmune conditions, and the myriad of complications that come from our chronic diseases.

 

I am guilty too. I have been working within this system and did not stop it.  Sure, I can argue that I tried my best to ignore the misguided guidelines and policies, and I did what I felt was best for my patients. But I did not revolt. I did not demand that the system change. That makes me guilty.

 

It boggles my mind that this situation came to be. It is almost as if all healthcare providers thought, “There is no way we can be responsible. Someone would have noticed and fixed it. We wouldn’t let a broken system continue to make us sicker and sicker. Not when our goal is health.”

 

It’s hard to imagine any other system where this could happen.

 

Picture this. You are hired to help a company improve the health of their business by increasing sales and improving the quality of their product. At least that is what your job description says. Your first day on the job, you sit in training all day to learn company policies and guidelines for marketing and product design.

 

After six months on the job, the company is in trouble. The product keeps falling apart, returns and complaints are at an all-time high, and the marketing is failing to increase demand. Yet, despite this, everyone is congratulated for sticking to the company policy and abiding by the guidelines. In fact, everyone gets a small mid-year bonus for doing such a great job.

 

Sounds ridiculous, right?

 

Yet, within the world of healthcare, we could argue that is exactly what is happening. Starting from governmental dietary guidelines, which the AHA and ADA faithfully echo, and continuing with our culture of using a pill for every problem, our healthcare industry has failed. At best it has failed to fix the obvious problems that faces us. At worst it has caused them.  

 

And I have been a part of it. For that I am sorry.

 

But there is good news on the horizon. Alternative approaches to healthcare continue to increase. Whether it’s from health coaches, naturopaths, functional medicine doctors, or open minded and forward-thinking MDs, we now have options.

 

The best options offer a hybrid approach that combines the knowledge of medications and acute care medicine, balanced with the desire to promote real health. It is through this framework where we can see the tide starting to change. And once that tide becomes a big enough wave, the mainstream healthcare system will have no choice but to take notice and reform. Then, and only then, can we hope to reverse the path we are on.

 

Then, and only then, can I be proud to be part of a healthcare system that truly helps people live happier and healthier lives.

 

Do you have experiences where the healthcare industry has failed you? Share your story in the comments below and let us know how we can help you.

 

I want to fix this problem and help you find the quality of health that our “health”care  industry cannot. Whether it is signing up for a one-on-one consult with me, listening to The Low Carb Cardiologist Podcast, reading my book Your Best Health Ever, or any other way I can help you understand the true essence of health and how to achieve it, please let me know.

 

Thanks for reading.

 

Bret Scher, MD FACC

Founder, Boundless Health

www.LowCarbCardiologist.com

Forget Weight loss – Focus on Your Health First!

Each month, there are an estimated 4 million google searches about weight loss. 4 million!

 

On the one hand, that is an astounding number. On the other hand, considering more than one-third of U.S. Adults are obese with two-thirds overweight, along with alarming rates of growing obesity within our youth, suddenly 4 million searches seem just about right.

 

Of even greater concern, this growing obesity epidemic has coincided with increasing occurrences of heart disease, strokes, type 2 diabetes, and other chronic diseases.

 

It appears as if Google has yet to solve our obesity crisis. Why not?

 

One study suggests that Less than 3% of Americans are living a generally healthy lifestyle. Less than 3%! That means less then 3% of Americans are:

  • Performing moderate exercise for at least 150 minutes a week
  • Following a healthy diet as defined by the healthy eating index
  • Maintaining a body fat percentage of under 20 percent for men or 30 percent for women
  • Not smoking

 

It’s not lack of information that is most likely the issue. It’s the lack of attention to our behaviors and habits and our mindset regarding a healthy lifestyle.

 

We live in an impatient world that is addicted to convenience. We expect everything, from our food to our information, to be packed in a neat and convenient package for immediate consumption.

 

It is this attitude that has led many who are suffering from obesity to resort to weight loss drugs or dramatic interventions popularized by T.V. shows such as The Biggest Loser.

 

Unfortunately, neither of these options are making our society healthier.

 

Why?

 

Because weight loss by itself does not equate to better health. And because our health can’t be solved with convenience.

 

Weight loss drugs: Wrong Goal- Wrong Approach

 

Over the course of the last few years, weight loss drugs such as Qnexa, Contrave, & Lorcaserin have hit the market and have seemingly become the solution for many people’s weight loss problem.

 

But, if you dig deeper, these drugs are anything but a solution. Significant side effects, not to mention exorbitant costs, limit their efficacy.

 

Contrave (ranging from $55 to $200 depending on the plan) demonstrated 9% weight loss after 56-weeks with the most common side effect being nausea (did it work by making people feel sick so they ate less? One has to wonder).

 

Lorcaserin, also known as Belviq (starting at $213), also showed modest results. In its main study, only half of the subjects taking the drug lost more than 5% of their body weight. Once the drug was stopped, most regained the weight. The main side effect again was nausea, along with headache and dizziness. Are you seeing a pattern?

 

Lastly, a panel of FDA advisors recently voted against the approval of Qnexa. It showed a modest 5% weight loss and showed increased depression, trouble concentrating and suicidal thoughts. Hardly a path to health.

 

One of the biggest problems is that these drugs aren’t changing anyone’s behavior toward food. They aren’t changing habits or mindsets. Instead, they’re applying a band aid to the problem, creating a reliance on the drug, and ultimately helping the drug company shareholders more than your health.

 

What else can we do if drugs aren’t the answer? Unfortunately, some have taken it even further to create a surgical form of bulimia. The AspireAssist is a pump that is surgically implanted into the stomach so that you can drain out what you just ate. The studies show that it can help you lose weight. No question about it. But what about your nutrition, vitamins, energy, and quality of life? Apparently, those are less important for some.

 

These weight loss drugs and surgeries are a direct contradiction to the development of healthy habits. Habits that create and maintain our health. It may not be easy to adopt these habits, but easy rarely leads to the best results.

 

Where can America learn the healthy habits that will produce results?

 

The biggest loser? It’s society that loses

 

The T.V. show The Biggest Loser has caught the attention and hearts of the American public for years. Watching men and women shed pounds along with witnessing the emotional hurdles they overcome is a powerful representation of overcoming health struggles.

 

But there’s a lot of the story that isn’t displayed on the television screen.

 

Contestants are losing weight and following strategies that aren’t kind to their metabolism and aren’t likely to succeed in the future. Astudy done on contestants from season 8 of the biggest loser found the majority regained most or all of the weight, and they showed a significant slowing of their resting metabolism. A slower metabolism makes it that much harder to keep the weight off. In essence, their own bodies were fighting against their efforts to lose weight.

 

Here’s a more sustainable alternative

 

If weight loss drugs and rapid weight loss programs aren’t the answer, then what is?

 

  1. Focus on your entire lifestyle, not just one part

 

We frequently hear about nutrition and exercise, but paying attention to factors such as sleep and stress levels will pay huge dividends with your health and weight loss as well.

 

When your body does not respond well to stress, the increased cortisol and adrenaline hormones sabotage your weight loss efforts, and negatively impact your overall health.

 

A regular mindfulness or meditation practice is the first step in correcting your body’s reaction to stress. Over time, your stress hormone response will diminish and your body will more efficiently lose weight and restore health.

 

The same applies to sleep. A poor night’s sleep is one of the best ways to sabotage our health or weight loss goals. It creates an imbalance in our leptin (I’m full hormone) and our Ghrelin (I’m hungry hormone), thus tricking our body into feeling hungry. That usually results in snacking on nutrient-poor, processed, high-carb foods. In short, a recipe for disaster.

 

  1. Commit to consistent activity

 

This doesn’t mean exhaustive boot camps or rigorous workouts for hours each day. Don’t get me wrong, those are great too. But they are not the only goal. Instead, focus on being active in your daily life.

 

In his book, Blue Zones, Dan Buettner identified the most common habits in societies where people live the longest. Guess what? They didn’t do triathlons or run marathons. Instead, they made regular physical activity a consistent part of their lifestyle.

 

If you can do that and still get your boot camp workouts done, fantastic! If not, don’t let perfect be the enemy of good. Develop the habits that will keep you moving. Start gardening, walk to do your errands, take the stairs. You have heard these before, now you just need to start doing them.

 

  1. Be okay with losing weight slowly

 

Slow and steady truly does win the race. Rapid, extreme weight loss disrupts our hormones and can create long-lasting metabolic changes that counteract our intentions in the future.

 

Focusing on healthy habits instead of weight loss ensures that your body does not react in a counterproductive way. Slow and steady is less likely to trigger deleterious hormonal and metabolic shifts within your body. And most importantly, slow and steady is more sustainable for the long term.

 

  1. Reframe your goal

 

If you want to lose 20, 50 or 100 pounds, this can be an overwhelming task.

 

To lessen the psychological toll of such a task, it’s better to break it up into mini goals and get small wins along the way.

 

Small victories can still have health benefits.  For example, 5% weight loss in obese individuals results in improved insulin sensitivity, an important factor for diabetes, heart disease, and dementia.

 

The small wins can add up to big wins, and the ultimate goal becomes less onerous and stressful.

 

Conclusion

 

If weight loss is your goal, stop and ask yourself why. Especially if you have considered weight loss drugs or intensive rapid weight loss programs. Take a moment to think about the difference between weight loss and health.

 

Being skinny but also stressed out and with a disturbed metabolism doesn’t sound like much of a victory.

 

Commit to healthy lifestyle habits, embrace them as part of who you are, and watch the weight steadily fall away. Slow and steady wins the race to your health.

Understanding Health Fads: Juice Cleanses

It’s hard to say when the juice cleanse craze began, but it’s definitely still here and probably not going anywhere soon. Whether it was the early 90s, or in the 2000’s when the internet started pouring out endless health tips, juice cleanses were deemed as the best way to “detox” and “lose weight fast”. Celebrities churn out endorsements for different juicing brands and you can even purchase pre-made juice cleanses sent right to your door step. The question is, are juice cleanses really a benefit to our health?

Let’s break down the two health claims that come from juicing and why they might not be so accurate…

Juice cleanses claim to act as a detox, a method to rid your body of toxins and reset itself to a healthier state. But what your body is actually detoxing from during a juice cleanse might be many of the essential nutrients we need for our body to properly function.

By only consuming fruit and vegetable juice we’re actually stripping out vital vitamins and minerals we need such as Vitamin D, E and B-12 that help power our metabolic functions, such as converting our food into glucose and energy.

And even though fruit and vegetable juices do contain many healthy vitamins such as Vitamin C, A & B, these vitamins need to work in conjunction with other foods to be best absorbed. Removing good fats from your diet prevents your body from processing those potentially healthy vitamins. In the end, you’re wasting your body's chance to absorb these great vitamins by restricting yourself to just vegetables and fruits and eliminating other valuable elements in your diet such as nuts, seeds and, yes even coconut oil (yes coconut oil can be part of a healthy eating pattern!)

Also, it’s important to note our body has its own detoxifying functions to keep you healthy and rid your system of anything it doesn't need. This is what your kidneys, liver and GI tract function as, organs that help rid our bodies of harmful substances. Keep those organs happy and healthy with a well-balanced eating pattern full of real foods and you should be fine functioning with just your own internal detox system!

The second biggest promise a juice cleanse offers is the opportunity to lose weight – fast. In a sense, this claim might actually be true because you are in fact reducing your daily calorie intake, sometimes to as low as just 1000 calories a day. However, if you're looking for a long-term weight loss solution, a juice cleanse will do anything but that for you.

The quick weight loss from a juice cleanse comes predominately from the loss of water weight because as your body is starved for calories it will turn to its stores of glycogen for energy and as your glycogen is depleted so is the water attached to it. So rather than any true fat loss being accomplished, your body is only losing the grams of water in the glycogen that it is burning to keep you functioning on the few calories you’re ingesting. Once you end the juice cleanse and return to your regular diet, your glycogen stores will quickly be replenished, along with the water attached to them, returning you to your initial weight.

If you really want to lose weight fast, you are better off with a fasting mimicking diet full of healthy fats and low carbohydrates. This helps you metabolize your own fat stores rather than burning through your stored glycogen. But even then, short term weight loss is not synonymous with health! In fact, it is usually quite the opposite.

In the end, a juice cleanse won’t deliver on either of its promises, and it will also lead to unpleasant side effects such as headaches, nausea and mood swings on top of faltering energy levels (usually from the lack of fiber and protein in your diet). As you can imagine, these side effects will only slow you down on your path to better health.

It might be appealing to consider a diet that promises to change your life in just 3-5 days, but with a juice cleanse not only is the change short lived, it’s not of considerable benefit to your overall health. To really make a lasting impact on your health, there are no short cuts. So don’t believe it when someone tries to sell you one.

Instead, make a long-term commitment to your health. Implement daily lifestyles that will help you feel better and be better. That involves smarter decisions around nutrition, exercise, mindfulness and more. To learn more and get practical tips on how to accomplish this, consider taking the first step to achieving your best health ever with the Boundless Health Program.

 

8 Ways to Instantly Improve Your Mood

Are you struggling to snap out of a funk? Whether you’re a little grumpy or you’re in an all around bad mood, you don’t have to spend the rest of your day wallowing. Need a few ideas for turning that frown upside down? Here are 8 ways you can instantly improve your mood.

1. Tidy Up Your Spaces

When your spaces are too cluttered, it can have an effect on your mental state. Juggling hectic schedules and constant deadlines means something else has to give, like organization. It’s easier to let things pile up around you when keeping a clutter free zone isn’t your priority. So start with just one thing you would like to tidy up, such as your office cubicle, the laundry room, or the trunk of your car. Set the kitchen timer for 30 minutes and focus on cleaning whatever you can for that amount of time. If you’ve got more time, rummage through your closets and then donate any clothes your family doesn’t wear. Or go through the pantry and donate any food that is no longer part of your healthy lifestyle!

2. Take a Nap

Maybe you just woke up on the wrong side of the bed. Or maybe you didn’t get enough deep, restful sleep (which is the more likely culprit of your bad mood). Feeling tired can make it that much harder to meet deadlines, be creative, or enjoy time with your family. Kick back for a 20-minute power nap to feel more refreshed and able to take on the rest of your day. Just keep in mind that naps are not a substitute for getting good quality sleep every night.

3. Write It Out

Is your mind’s playlist loaded with worries and stuck on repeat? A quick way to fix that broken record is to get all of those thoughts out of your head. Grab a notepad and organize a master to-do list, then break it down into smaller, more manageable lists. Kick start a project by doing 15 – 20 minutes of research, which can also get the creative ideas flowing. Or try journaling to put any worries or anxieties onto paper. Sometimes seeing them in writing can take a weight off your shoulders and leave you with more energy to take on the rest of the day.

4. Play a Word Game

If you love Scrabble, give Words with Friends a try. It’s a free virtual word game you can download to your smartphone and play to test your skills. Plus, feeling that Triple Word Score victory will definitely have you grinning ear to ear! You can work also in a little brain fitness. Just like your body, your mind needs a regular workout, too. Playing strategy games is an effective way to challenge your brain and keep it smart as you age.

5. Spend Time with Others

Are you communicating more and more by text, instant message, and email? Having real conversations can be a real mood booster. Meet a friend for coffee, or if you just can’t get away from your desk, call each other on Skype and switch on your web cameras for a virtual coffee chat. Go on a hike with your family and talk about what’s happening in each other’s lives. Or walk to a co-workers desk next time you have a question that can be answered with a quick chat.

6. Pump Up The Jams

Turn up the tunes you loved as a teenager (hello, Duran Duran!) and dance like it’s 1985. Not only is it fun, but also moving freely to high-energy music can liberate you from your bad mood. That’s because like running, dancing releases feel-good endorphins that can curb stress and anxiety. Don’t want to dance alone? Join a social fitness class like Zumba or Jazzercise and follow along to the beat.

7. Doing Something Nice for Someone Else

Performing a random act of kindness can go a long way for making your day—and someone else’s. Next time you’re in line at the coffee shop, you could show a “pay it forward” act of kindness by buying the drink of the person behind you. Who doesn’t love a surprise freebie? You could also leave sticky notes on your kids’ bathroom mirror and start their day with an inspirational message. Or you could offer a simple gesture, like giving someone a smile as you pass by. Chances are, they’ll smile back! It’s win-win.

8. Move Your Body

Being physically active is a great way to reduce stress and anxiety. But you don’t have to squeeze in a midday workout to reap the mood-boosting benefits of exercise. Just going for a 10-minute stroll by yourself or with a walking partner can get you on the path to feeling happier—and help you work toward your daily goal of 10,000 steps. Is your day packed with meetings? See if there are any you don’t need to be physically present for; you may be able to call into the meeting during your walk and get some stimulating fresh air and vitamin D to boot.

Next time you’re in need of an instant mood boost, give one of these simple techniques a try. You might be surprised just how well it works!

 

 

Fly Fishing as a Guide to Our Health

I just had one of my best vacations in recent memory. Biking, hiking, and fly fishing my way through Bend, Oregon. The mountains, the rivers, the trails. It doesn’t get much better.

 

But I realized I can’t “turn off” completely and get away from my desire to help people improve their health and their lives. Nor do I want to.

 

My fishing guide and I had a 45-minute drive to the Crooked River northeast of Bend near Prineville, Oregon.  He is a great guy (and a phenomenal guide), and we immediately struck up a lively conversation. He is full of stories and tall tales of life as a fly fishing guide.

 

His tune changed, however, when I told him what I do. His response? “You can probably tell, I am not the healthiest guy around. I drink a little too much beer. Well, OK. A lot too much beer. I don't eat right. I'm active on the job but I’m not into exercise. I know I should be healthier. Do you have any advice to help me?” 

 

Where do I begin? I was at a loss at first where to start. I wanted to hear more stories about rainbow trout, nymphs, flies, and the “one that got away.” But since the conversation turned to health and I saw a chance to help, I knew this deserved a long discussion.

 

I could have told him to eat more veggies, get regular exercise, consume fewer empty calories, prioritize sleep more, and of course, Drink Less Beer.

 

Unfortunately, that wouldn’t have helped him at all. He knew all that. His problem was not one of poor advice or poor understanding of the unhealthy aspects of his lifestyle.

 

He didn’t need me to tell him what to do. Instead, he needed to understand why he does the things he currently does.

 

We all develop patterns and routines in our lives. Some become more entrenched than others. The key is making sure those routines are as healthy as possible.

 

For instance, we tend to have patterns of usual restaurants we go back to again and again. Whether it is a night with friends or loved ones, or a dinner business meeting, we likely have a handful of choices from which we choose.

 

Our job is to make sure those choices look more like True Food KitchenFlower Child, or Tender Greens and less like Olive Garden, the Chop House or other over-sauced, “under-vegetablized” establishments.

 

What about our post-dinner routine at home? Sitting on the couch, raiding the fridge for food our body does not need, and drinking one too many beers is an easy pattern to fall into.

 

Why not take a walk instead? Read a book in a room away from the kitchen. Meet friends for games that involve no or at most one beer.

 

The first step is understanding why our patterns exist.

 

My fishing guide drinks too much beer. He likes the taste. Ok, I say, but you can get the taste from one beer and savor it. That wasn’t it.

 

He likes the way it makes him feel, he likes the buzz. The buzz takes volume to get. One beer won’t cut it. We had to question, what else can give him similar joy? Did he need the buzz, or did he just need to feel good about something? 

 

It turns out, outside of fishing, his life was not very full. He had no nearby family, no real hobbies outside of fishing. He had plenty of friends, but they were all big drinkers and thus it was all too easy to drink on a regular basis.

 

I wasn’t going to help him by citing studies showing the dangers of being overweight, or the dangers of excessive alcohol consumption.

 

He needed to escape his routines and the company he keeps.

 

It’s remarkably difficult to tell someone you just met that they need to find their purpose in life. They need to like themselves more. And they need new friends, or at least to see current friends less. 

 

Thankfully before I overstepped my bounds, we reached the river and were well on our way of creating our own tall tales of rainbow trout, nymphs, flies, and the one that got away.

 

In the end, however, I was able to lay the groundwork for what will hopefully be a change in perspective regarding his life. It won’t happen overnight. It will take time, and it will take work. And it all starts with understanding why we do what we do.

 

Ask yourself that question. Question your assumptions and your routines. Find ways to alter them a little more towards health. We don’t have to be perfect. We just need to be better.

 

And we all need to get to the Crooked River to catch some fish. It’s simply beautiful.

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

Action Item: Find one routine per day and question it. Even something as simple as where you park your car. Or where you sit after dinner. Question one routine per day. Understand why you do what you do. Then see if you can reframe it in a healthier way. You don't have to be perfect. Just be a little better every day.

 

Sleep as if your health depends on it!

We all need more sleep, right? YAWN! We have said it or heard it hundreds of times. Get more sleep for better health. Yet despite the prevalence of the advice, there is a clear disconnect between hearing it and implementing it. For one, there is a positive stigma or bragging rights associated with “I only need 5 hours of sleep per night.” Secondly, our lives have become so busy, over scheduled, and over stressed, that it is easy to prioritize everything else before sleep. And lastly, even when we want to get more sleep, many of us are unable to do so for a variety of reasons that we will address.

As with many areas of health, the first step is educating ourselves about the importance of sleep. Only once we understand the real importance of sleep can we prioritize sleep adequately, thus committing to the sleep hygiene practices that help us achieve better health. Without education, the rest never follows.

The scientific literature is saturated with evidence that sleep is important for health. It would be overwhelming to try to summarize all the literature here, but here are some of the highlights. Poor sleep has been linked to:

  • Depression
  • Anxiety
  • Hypertension
  • Diabetes
  • Weight gain
  • Poor job performance
  • Poor athletic performance
  • Car Accidents
  • Coronary artery disease
  • Strokes

And more…

One of the most common associations is the connection between poor sleep and poor performance in life. What does that mean? It means not achieving your goals. Whether it is athletic performance, work performance, or improving your overall health, inadequate sleep dramatically reduces the chances of success.

Let’s look at one of the most frustrating failures of lack of sleep- inability to lose weight. Numerous studies have shown that poor sleep habits lead to increased hunger, increased snacking and poor nutritional choices. Not only is there a proven relationship, but there is also a biological reason for this. Ghrelin is a hormone in our body called the “hunger hormone.” It signals to your body that you are hungry and need to eat. Leptin has the opposite effect. It says to your body that you are full and don’t need to eat. When we do not get adequate sleep, our ghrelin levels spike and our leptin levels are inhibited. Thus we have a biological reason for feeling hungry and snacking more. Plus, since our mental clarity is reduced and our emotional control is inhibited by poor sleep, we tend to make impulse decisions in reaction to the feeling of hunger. Impulse decisions rarely end in preparing a well-balanced meal of veggies with high-quality fats and proteins. Instead, they may result in standing in front of the freezer eating the Ben and Jerry’s right from the carton with no end in sight. I’d be lying if I said I have never been there before. But I can also say that I will never be there again.

The next concept I want to address is our perception of how much sleep we need. Many people with inadequate sleep may feel like they are doing just fine. But a fascinating study published in the journal Sleep in 2003 showed that people who got no more than 6 hours of sleep for 10 days had a similar decline in cognitive function and physical reaction time as those who were completely deprived of sleep for 2 whole days. The amazing part, however, was that they had no idea how bad their performance was. They felt they were thinking clearly and performing well on all the required tests, and they did not feel tired. That makes it even more dangerous! To perform so poorly and not even realize it is a recipe for disaster. At least those who were deprived of sleep for two whole days knew they were exhausted, and they could change their lives accordingly. The same cannot be said for the group who got less than 6 hours of sleep per night. So it is clear that we frequently need more sleep than we realize.

Yet another incredible study was recently published looking at the sleep patterns of traditional hunter-gatherer tribes. Sleep problems were so rare in their cultures that the three tribes studied did not even have words for insomnia in their language.

The study showed that they averaged 7.5-8 hours in bed per night. In addition, they had an absolutely consistent sleep-wake schedule thus maintaining a stable diurnal rhythm. Couple that with their lack of distractions from computers and phones, and it is no wonder their society had no concept of sleep problems.

What about those who say “Sleep is a waste of time. It is unproductive time I could spend accomplishing things.” This couldn’t be further from the truth. “Restorative Sleep” is a combination of Stage 3 sleep and REM sleep. It is appropriately named because your body literally restores itself while you sleep. Learning, memory, and concentration are improved while you are in REM sleep, and your body is able to heal and restore physical energy when you are in Stage 3 sleep (deep sleep or delta wave sleep). Without adequate time spent in each stage of sleep, the body is not able to perform its essential “reboot” functions. Lack of sleep robs your body of these restorative functions. In addition, alcohol and sleep medications can disrupt the balance of sleep stages, thus resulting in less restorative sleep. Part of the importance of maintaining a steady sleep schedule is that it allows your body to cycle through the stages of sleep consistently, ensuring that you get adequate time in the deep and restorative stages.

Lastly, part of the problem is that even those who want to sleep more find they cannot. Insomnia is a growing problem in our society with prescriptions for sleeping medications increasing over 50% since 2008. As with many things in medicine, prescription drugs are simply Band-Aids. They treat the symptom without addressing the underlying cause. Sleeping medications come with their own risks of developing dependence, rebound insomnia, potential short-term memory loss, and distorting the stages of sleep so that the sleep you do get does not have the full restorative power of naturally achieved sleep.

Once you have made sleep a priority for your health, there are a number of specifics to consider. Here are some tips to incorporate into your life for better sleep:

  • Reduce exposure to screens and artificial light– they disrupt the circadian rhythm and fool your brain into not being tired. Avoid screens 60 min prior to sleep or if that is not possible, consider using blue blocker glasses which help filter out the blue light from your devices. You should also maintain a very dark room for sleeping. Use black out shades, cover your clocks (or if you need them keep them more than 3 feet away from your head), if you need light use low wattage yellow, orange or red lights, not standard white lights
  • Maintain a consistent schedule– this can be difficult for many, but going to bed and waking up at the same time every day has been scientifically shown to improve sleep performance and allow for consistent deep, restorative sleep
  • Meditation-A study comparing individuals engaging in a mindfulness meditation practice vs. those who were given general sleep hygiene education showed significant improvements in sleep quality as well as less depression and fatigue in the mindfulness group. This does not mean you need to meditate for an hour a day. Just 10 minutes of mindfulness meditation has proven results.
  • Avoid caffeine in the afternoon. Caffeine is a stimulant that can keep you from falling asleep. Even those who say caffeine has no effect on them have demonstrated reduced sleep performance than those who do not drink caffeine
  • Limit alcohol or any liquid for that matter. The more you drink, the more likely you are to wake up to urinate, thus giving your brain a chance to wake up and start spinning and reducing the chance of going back to sleep. Although alcohol may make you feel tired and help you “get to sleep,” it can dramatically alter the stages of sleep and prevent you from getting fully restorative sleep
  • Get outside and get light exposure during the day- This helps your circadian rhythm stay in sync with proper sleep-wake patterns. Studies in Hunter Gatherer societies have highlighted the importance of daytime light exposure. This may also help with your vitamin D levels, which are also linked, to better sleep performance.
  • Exercise during the day, but not within an hour before going to bed.
  • Keep your room cool, between 60-68 degrees
  • Bed is for sleeping and sex only, no TV books or phone use
  • Journaling to clear your mind before bed. This helps you get your thoughts out on paper so your mind is not ruminating on them and keeping you from falling asleep.
  • Low carb diet increases slow wave sleep, but fat can increase GERD, very individualized
  • Magnesium supplements (usually in the form of magnesium glycinate or malate) has been shown to help with falling and staying asleep
  • Melatonin is beneficial for short-term use when natural timing is disrupted, such as with travel or when your sleep cycle has been disrupted for other reasons. It is not meant to be used long term
  • Get checked for sleep apnea – This is a very common cause of poor sleep and now there are easily accessible home screening tests that can be ordered by your physician. Keep in mind that sleep apnea is more common in overweight people, as well as those who drink alcohol or take sedatives

The list is long, but hopefully, you will notice that most of these are actions that are easy to implement. Once we understand the importance of restorative sleep, and we prioritize sleep as a pillar of our health, then the above list becomes an easy “to do list” that will help you on your path to better sleep, better health, and a better life. 

4 Fitness Apps To Try

Living a healthy lifestyle has many benefits, from taking fewer trips to your healthcare provider each year to managing stress and anxiety with ease. Luckily, getting on the path to your best health ever is right in the palm of your hand. Here are 4 fitness apps you should try today.

MapMyFitness

If someone asked you to choose your favorite workout style, could you choose just one? With MapMyFitness, you don’t have to. Choose from dozens of traditional workouts, like swimming, jumping rope, and weightlifting, to less traditional activities, like bowling, fishing, and horseback riding.

MapMyFitness also offers outdoor training routes near you, which are created and shared by other users. Simply search for a route based on the type of activity you want to do, make sure the app has a good GPS signal, and start your workout. If you’re a creature of habit, you also have the option to add private routes to your profile and do them again as often as you like.

Got a favorite way to exercise outdoors? There are several versions of the “MapMy” apps to choose from:

  • MapMyRun
  • MapMyHike
  • MapMyRide
  • MapMyWalk

All versions work the same way in terms of functionality, but each one provides map suggestions tailored to the default activity.

Charity Miles

Make your workouts meaningful with Charity Miles. Research shows that giving can be good for your mental health. Why not give your mind and body a boost by earning money for charity while you get fit?

All you have to do is pick a charity, select an activity, and start tracking your mileage using your smartphone’s GPS. There are more than 30 world-class charities to choose from, including the ASPCA, Habitat for Humanity, and Girls on the Run. Are you passionate about multiple causes? Charity Miles gives you the option to switch charities at any time.

A donation will be made for every mile you complete, and you can log miles through your choice of 5 outdoor and indoor activities. Once you tap to start tracking, the app lets you know who’s sponsoring your workout. Be sure to stop and save your miles when you’re done or your activity won’t count. (You can always tell the app to send you a reminder.)

Fitbit

Walking is a great way to boost your fitness level, lose weight, and feel healthier. It’s recommended that you get 10,000 steps a day, but how can you be sure you’re getting all those steps in? By tracking your daily steps with a wearable fitness device, like the Fitbit.

The Fitbit family of devices sync with the Fitbit app to give you a real-time look at your day. And you can track more than just exercise—the app allows you to log and monitor your sleep, weight, and food, which all adds up to a healthier and fitter you. Just choose the device that fits your goals, and then register it with the app.

Are you motivated by friendly competition? Get an extra dose of motivation by creating challenges among your Fitbit friends. Choose from fun options like Goal Day, Workweek Hustle, and Weekend Warrior. Or go on a virtual Adventure Race together and see who can reach the finish line first. The Fitbit app also features a community tab, where you can share your wins, join groups dedicated to your favorite healthy lifestyle topics, and connect with other Fitbitters.

MyFitnessPal

Keeping a food journal can help you build healthy eating habits—and what you consume is just as important as what you burn. Based on your fitness profile, MyFitnessPal will suggest a daily net calorie target to help you meet your nutrition and weight loss goals. As you fill up on foods and log your meals, the app will display your remaining calories. It will also show you the distribution of where those calories are coming from, be it fats, proteins, or carbohydrates.

Being mindful of what you eat and drink is a good practice for healthy living. As you create new journal entries, MyFitnessPal shares a snippet of nutrition advice to keep you aware of the healthy (or not so healthy) choices you’re making. For instance, if you decide to go out for an ice cream sundae, the app may alert you about the amount of sugar it contains, along with a reminder of your sugar goal for the day. Likewise, if you opt for a fruit cup, the app may tell you it has lots of Vitamin C.

You can also use the app to track your activity. Depending on how many calories you burned, the app automatically adjusts your net calorie needs for that day. Just sync your daily step counts and workouts from your smartphone or wearable fitness device to the app, and MyFitnessPal will figure out the rest. Another option is to manually log your cardio and strength workouts—the app will estimate your calories burned based on your current fitness profile.

Using an app is a great to get in shape and stay fit. Making small tweaks to your daily routine—like moving more and eating better—can go a long way in helping you live your best health ever. Try out one of these fitness apps today and let us know how it worked for you.

 

 

Activities for the Whole Family

Have you made the decision that YOU want to start living your best health ever? What about your family? It’s hard to get on track without the support of your loved ones and that’s why it can be necessary to make sure they’re on board for your lifestyle changes as well! It doesn’t have to be a tedious task for them or feel like a burden, it can be fun and a great way to spend more time together. So why not pack in the quality time while getting in a good workout and being active? Here are some perfect examples to get you started as you incorporate your family life into your journey to your best health ever. 


Go Hiking Together


As long as you do your research ahead of time you can find plenty of family friendly hikes where you live. Map out how long it will take you to get there, have some classic car games ready, plenty of water and snacks, and make a day out of it. Pack a healthy picnic to enjoy when you reach the top of your destination and enjoy a beautiful day outdoors while kicking up your heart rate. 


Try Out Fun Sports

You don’t need to be an athlete to play a friendly game of basketball or soccer. Try out a basketball game of HORSE or run around with a soccer ball at your nearest park. Tennis can also be a great game to get the whole family in on. Find your nearest court and grab a couple of rackets and balls. You’ll get some sun and burn off a ton of calories running back and forth on the court. If you’re not feeling so adventurous, just grab a frisbee and head to the beach. Before you know it you’ll be starting your own Ultimate Frisbee team!


Sign up For A 5k Walk Or Run 


See what’s coming up on active.com for the latest 5k Walks and Runs. These events are usually family friendly, a great way to build community and the perfect opportunity to get some steps in. Better yet, find one that is for a cause close to your heart and educate your family on why it means so much to you. You’ll feel the positive impact not just physically, but also get a mental boost for supporting a charity that you feel personally connected to. 


Start a Neighborhood Recreation League


Get your neighbors involved in your health journey by starting a friendly weeknight Kick-Ball league (or Ultimate Frisbee team!) with one side of the street against the other. You’ll create a greater sense of community within your neighborhood, meet new people and maybe even find your next babysitter. You can also do some research to see if your town already has social sports leagues set up and join an existing team with your family and friends. Weeknight games are a great way to break up your weekly routine and add some diversity to your exercise habits. 

Travel With Games

Keep a soccer ball or a frisbee in your trunk. Instead of waiting in the car in between errands or after school activities, get out of the car and throw the ball around. If you’re on your own, try jump roping wherever you are. You can burn as many as 200 calories in just one 10-minute jump-rope session. Or make sure to just get out of the car and walk around, as long as you’re moving you’re one step closer to achieving a healthier life!

Go For A Bike Ride

A great way to burn calories and explore your neighborhood, biking is a perfect outdoor activity. Whether you’re on a beach cruiser or a tandem bike, you’ll be enjoying the ride so much you won’t even mind the burn when you’re going up those hills. Make sure to strap on a helmet, ride with water and plan out a fun pit stop. Check out TrailLink to find safe, family-friendly trails in your city. 

Get Technology Involved 

Add an element of competition between family members and see who can get the most steps in the day. You can use the Health app on your phone or invest in a FitBit to track your steps. Set a goal of 10,000 or 20,000 steps a day and create incentives for whoever hits the goal first. For example, the winner doesn’t have to do dishes that night or gets to choose what movie you’ll see that weekend! 

Make sure your family and friends know about your commitment to your healthier lifestyle so they understand how important it is to you that you have their support. Rallying your community is a pivotal step towards achieving your best health ever and there are endless fun and active ways the whole family can join in on your journey. 

Bret Scher, MD FACC

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