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The Number One Secret to Living Forever!

OK, maybe not forever, but pretty darn long. Here is the secret to the fountain of youth.

 

Metformin.

 

Maybe.

 

Metformin is a common medication used to treat diabetes and has also been shown to decrease the cellular aging process in mice and other animals. Now it has been approved for human studies to see if it increases our longevity as well. If not, then we will just have a bunch of young mice running around as we continue to age away.

 

The longevity community is full of excitement that this may be the one drug that pans out and makes a real difference. Not just for the high-profile Silicon Valley CEOs who want to live forever, but for masses of people. The hope is that it will drastically delay the onset of cancer, cardiovascular disease and neurodegenerative diseases. We have been down this road before  with resveratrol, so many are tempering their enthusiasm.

 

But this time may be different! Or so we hope.

 

How Metformin Works

 

Metformin helps us lower our glucose production, keep our insulin levels low, and helps our cells respond better to insulin.

 

It works by activating an enzyme called AMP Kinase, which decreases glucose production in the liver. The key point is that it lowers glucose levels without increasing insulin.

 

Insulin is a fat storage and potentially pro-inflammatory hormone. It is also associated with an increase in insulin-like growth factor-1 (IGF1), which has been implicated in cancer promotion over the long term. Safely minimizing insulin, therefore, should have direct health and longevity benefits. 

 

Metformin has other actions that directly improve muscle cell sensitivity to insulin. This means our bodies require less insulin to provide us with energy, thus ultimately reducing insulin resistance.  In addition, metformin can potentially alter the oxygenation of cells, providing the right balance of oxygen to stave off cellular aging.

 

 

Why would this help us live longer?

 

Lower blood glucose and insulin levels mean lower risk for diabetes, cardiovascular disease, and probably neurodegenerative diseases like Parkinson’s and Alzheimer’s. That certainly seems like a reasonable goal.

 

In addition, lower insulin and lower insulin growth factor 1 (IGF1) could mean less risk of developing cancer. In fact, studies have shown that those who take metformin have a lower incidence of most cancers. This does not prove that metformin itself reduces cancers, but it certainly makes for an interesting hypothesis that deserves further investigation.

 

And of course, anything that can slow down cellular aging could be of great benefit for longevity.

 

We have plenty of data to suggest metformin might be a fountain of youth.  Now, we eagerly await the results of the randomized, prospective, placebo controlled trial. The pinnacle of scientific evidence.

 

In the meantime, what can we do to help us extend our lives?

 

What Else Has Shown Promise for Longevity?

 

For starters, don’t smoke. No brainer there.

 

Also, wear your seat belt.

 

Don’t text and drive.

 

Don’t drink and drive.

 

It may sound like glib advice, but if you want the biggest return on your longevity investment, start there.

 

Caloric restriction

 

As the saying goes, caloric restriction may not make you live longer, but it certainly makes your life feel much longer. 

 

Calorie restriction has different definitions, but in general it means cutting your caloric intake by 30-50% or down to about 1500 kcal per day while avoiding malnourishment. If you have tried this, it can be a challenge to do and remain a social being in modern day society.

 

If living longer means being hungry and grumpy all the time and not being able to socialize, then no thanks. I will pass. As will most of the Silicon Valley elite.

 

But what can we learn from why long term caloric restriction works?

 

It turns out, caloric restriction improves insulin sensitivity, sound familiar? It also reduces our metabolic rate and reduces oxidative stress.

 

Calorie restriction also reduces the activity of a compound called mTorc1. The long name for this compound is mammalian target of rapamycin complex 1. The drug rapamycin has been around for decades as an antifungal and anti-cancer drug, but has now become the new kid on the longevity block. Some believe that the right dosing of rapamycin and/or inhibition of mtorc1 could reduce cellular aging and delay age related diseases.

 

Interestingly, AMP Kinase (the same mechanism stimulated by metformin) also inhibits mTorc1. When mechanisms combine, that gets scientists really excited. And when scientists get really excited, watch out.

 

So, in the end, we want to reduce glucose levels while also keeping insulin and IGF1 levels low. We want to reduce oxidative stress. And we probably want to reduce mTorc1.

 

Metformin can do this. Calorie restriction can do this. Rapamycin might be able to do this.

 

We Don’t Need Drugs

 

But guess what?  We Don’t Need Drugs to do all that!

 

If you are sleeping 4 hours per night, you are stressed out, you eat low quality- high carb fast food, and you sit on your arse all day, do you think metformin will help you live longer? Sorry Charlie.

 

If we have any interest in living longer and living better, we all have to start with the basic and critical elements called lifestyle.

 

Consistent, restorative sleep improves your cortisol levels, thus improving your glucose and insulin levels.

 

Managing your stress likewise reduces your cortisol and adrenaline spikes, again maintaining lower average glucose and insulin levels.

 

High intensity exercise and resistance training increases our mitochondrial activity, which increases glucose utilization, thus decreasing serum glucose and insulin levels.

 

Then there is nutrition.

 

This is a big one, and potentially the topic that is more variable from person to person. The key is to eat the minimum number of calories needed for nourishment, while still allowing you to enjoy your life and thrive. Specifically, we need to choose food that will keep our average blood glucose and insulin levels as low as possible.

 

A few tricks to achieve that:

  1. Avoid/limit added sugars. Hopefully this is obvious to everyone at this point.
  2. Avoid/limit processed simple carbohydrates (white flour, packaged snack foods etc.).
  3. Make low starch veggies (like green leafy veggies, cauliflower, zucchini etc.) the focus of the majority of your meals.
  4. Liberally add healthy fats (nuts, avocado, olives and olive oil).
  5. Don’t overdo it on the proteins. We only need 0.36- 0.5 grams of protein per pound of ideal body weight each day. So, if you weigh 180lbs., you only need 65-90gm of protein per day. If you are overweight and weigh 250lbs (but your ideal body weight is around 180 pounds), you still only need a maximum of 90gm of protein per day. So, don’t worry too much about getting enough protein. Instead, make sure you are not eating too much.

 

Once you have implemented all those lifestyle factors, then and only then should you even start to think about the effects of metformin, rapamycin, or other fountain of youth drugs. The future may be promising for a quick fix to slow the aging process. But one thing will hold true for ever:

 

The best way to live better and live longer is to make your life worth living.

 

Live with a purpose.

 

Take care of yourself emotionally and physically.

 

Take care of others.

 

And don’t forget to take care of the earth as well. Our health may just depend on it.

 

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com 

Coconuts are Driving Me Nuts!

How does this headline sound to you?

“Newsbreak! We have no new information about Coconut Oil, but we have a news alert that we still think all saturated fat is bad for everyone.”

That is the real story behind the headline “Coconut oil isn’t healthy. It’s never been healthy” that has grabbed the attention of millions.

The American Heart Association released a statement that, to summarize, says:

  1. Coconut Oil is a saturated fat.
  2. Saturated fat can raise LDL.
  3. High LDL has been associated with increased risk of heart disease.
  4. Therefore, coconut oil will increase your risk for heart disease

Is there any direct proof that coconut oil is dangerous to our health?

No.

Is there any new evidence directly linking saturated fat to heart disease?

No.

Can we say that because “A” is true above that “D” has to be true?

No way.

But that sure is an attention-grabbing headline to try to connect the dots.

What Evidence?

Don’t get me wrong. It’s not like the AHA is making this up out of thin air. They are basing their opinion on decades of science. Decades of poor quality science. But since that was all the science we had for years, you can see why they came to the conclusion.

LDL cholesterol is an important part of the puzzle when it comes to your health. But it is exactly that. One piece of a very complicated puzzle.

What else does saturated fat do? It raises of HDL. For many, the total cholesterol-to-HDL ratio remains the same.  Does that increase the risk of heart disease? There is no good data to support that claim, but likely not.

Let’s look at it another way.

Is an LDL of 150 dangerous? That depends. Are you overweight, sedentary, have a diagnosis of metabolic syndrome, eating a high inflammatory diet, and have a strong family history of heart disease? Then an LDL of 150 likely is dangerous. And you likely also have a low HDL, high triglyceride level (TG), high blood sugar etc.

On the other hand, do you eat real food, mostly vegetables with appropriate portions of animal fats? Do you exercise, manage your stress, and have few if any other cardiovascular risk factors? Are your HDL, TG and glucose levels near ideal? Then that same LDL of 150 is likely not as dangerous for you.

It is misleading to suggest one size fits all.

(For more details on the saturated fat debate, and why the data is not as clear as most seem to think, see our prior article on the topic here.

Unfortunately, the American Heart Association discounts the evidence that shows no association between saturated fat intake and cardiovascular disease.  They continue to promote industrial, processed oils over natural fats. Again, rooted in decades of science. Poor quality science.

Both Sides Fail

In essence, the attention-grabbing news flash is simply restating the AHA’s longstanding position. There is nothing new.

To be fair, however, do we have good evidence saying coconut oil is healthy?

No, we do not.

Can we prove saturated fat reduces our heart disease risk?

No.

Can we believe Dr. Axe when he claims that coconut oil has 20 proven health benefits (including curing UTIs, protecting the liver and preventing osteoporosis)?

No way. That’s crazy talk.

If we are going to question the poor-quality evidence against saturated fat, we certainly have to question the horribly inadequate evidence supporting views like Dr. Axe’s.

So, what can we conclude?

We can conclude that nothing new was found for or against coconut oil.

Nothing new was found for or against vegetable oils.

Saturated fats (and by extension coconut oil) are not inherently bad, especially if they are a component of a real-foods, vegetable-based, Mediterranean style of eating.

Vegetable oils are highly processed, pro-inflammatory, fake foods that have evidence both for and against their use.

It’s all so confusing! I know. Trust me, I know.

What Can We Do?

What is someone to do in this sea of contradictory news?

Don’t believe the hype.

Focus on real, minimally processed foods.

When it comes to cooking fats:

  1. Olive oil is the best for low heat.
  2. Avocado oil is the best for medium heat.
  3. Higher heat gets tricky due to concern over smoke points.

    1. First, ask yourself, why are you cooking or frying in high heat to begin with? Can you get the same result with lower heat?
    2. If it’s something you have to do, you can choose from coconut oil, butter, ghee, and vegetable oil. Make you decision based on taste, or even better, mix it up.

Action Item: Do you want to know how cooking oils affect you, as an individual? Get your labs done (at a minimum check LDL, HDL, TG, TC, hsCRP, glucose. For more advanced testing try WellnessFX or other ways to get advanced lipid testing). Then switch to 100% coconut oil as your cooking oil for a month and recheck your labs. Review your labs with someone who has an open mind and looks at more than just your LDL number. LDL does not exist in isolation, but is part of the whole picture.  Now you know how it affects you. Individualized medicine beats general guidelines any day.

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com 

The Three Most Important Things You Need to know About Statins!

Can you find a more polarizing topic than statins? One article says they are miracle drugs that should be given to everyone. Then you turn the page, and you read how they are poison and you should stay away from them no matter what.  How can one drug cause such differing views? And which should you believe?

 

The statin debate has intensified ever since the 2013 ACC/AHA cholesterol treatment guidelines increased the number of people without heart disease who “should” take a statin to 43 million Americans. That is for primary prevention, meaning the individual has never had a diagnosis of cardiovascular disease, never had a heart attack, and never had any type of a heart problem.

 

As you can imagine, this has been a windfall for the drug companies. But are we healthier and better off as a result? That is unknown.

 

The problem is understanding the bias of whoever is writing the story.

 

Subtleties of Science

 

But wait, you say. Won’t the science tell us if statins are good or not? Isn’t it an objective fact if they are good for us?

 

Not so fast. Beauty is in the eye of the beholder, and so is the application of science.

 

Are you getting advice from someone who believes prescribing more medicine is better? Or someone who believes a more natural lifestyle is better? 

 

Are you reading a report sponsored by the pharmaceutical company that paid for the research?

 

Or are you getting advice from a scientist who is more focused on statistical benefits, or someone who is more concerned with the potential benefit for the one individual they are taking care of at the moment?

 

It is a confusing sea of conflicting information, and you have to find which approach resonates more with your beliefs and your life.

 

The Three Keys

 

Regardless of who you are and your beliefs, I promised you the three most important things you need to know about statins. Here they are:

  1. All statin studies are worthless! That’s right. All statin studies that have been done to date are worthless and don’t apply to anyone who follows healthy lifestyle principles.
  2. Statins will not prolong your life. Not at all. Not for a single day.
  3. Statins DO reduce your heart attack risk, by about 0.7% over 5 years.

All of a sudden, statins don’t seem so powerful, do they? Let’s go deeper into these points to learn why.

 

1-All Statin Trials Are Worthless

When designing a trial, you have to decide what your control group is going to be. You have to show that the drug is better than something. The key is defining what that something is.

 

Therein lies the problem. In order to show beneficial effects, primary prevention statin trials need thousands of subjects, studied over years. That is very expensive to do. The vast majority of trials, therefore, rely on drug company funding.

 

Do you think they are going to fund a trial that makes it easier or harder to show a benefit? Of course, that was a rhetorical question.

 

Pharma companies don’t have an interest in your health and wellbeing. Their priority is to their stock holders and their bottom line. They are going to sponsor trials that are most likely going to benefit them.

 

How does this make the trials worthless? They compare statins to “usual care.” That means a brief, and ineffective attempt to educate people about healthy nutrition and physical activity.

 

In addition, the specific nutritional guidance that was used has always been a low-fat diet. As we now know, what does a low-fat diet usually include? Lots of sugars and simple carbohydrates. What does that diet do? Increase your risk of obesity, diabetes, inflammation, and eventually heart disease.

 

That’s setting the bar pretty low to show a benefit from statins. And that is exactly what the drug companies want.

 

What we need is a control group that is involved in a comprehensive lifestyle intervention program. A program that helps participants get regular physical activity. Helps them eat vegetable based, real food, low in added sugars and simple carbs, and high in natural healthy fats.

 

Since that is the way we should all be living, THAT is what the control group should be. I guarantee you, the results would be far different compared to the standard control groups used to date.

 

That is the trial the drug companies never want to see and will never fund. And that is why all statin trials to date are worthless.

 

If you can focus on proper lifestyle interventions, using healthy foods, physical activity and stress management as medicine, then we have no idea what effect, if any, statins would have. But I assure you it will be minimal if any benefit.

 

2-Statins Will Not Prolong Your life

 

You read that right. For people who have never had heart disease before, the multi-billion dollar drug won’t help you live longer. The overwhelming majority of primary prevention trials involving statins show no difference in overall mortality between those who took the drug and those who did not.

 

That surprises a lot of people. Statins are promoted as if they are wonder drugs that save lives left and right. That’s good marketing and good PR. Reality is far different.

 

If they don’t help you live longer, they must increase the quality of your life, right? Nope. In fact, 30-40% of people on statins will experience muscle aches and weakness causing them to exercise less and decreasing the overall quality of their lives.

 

So, if they don’t help us live longer, and they don’t increase the quality of our lives, why do we take them????

 

3-Statins DO Reduce Your Heart Attack Risk

 

If the news was all bad there wouldn’t be any debate about their use. But the truth is that statins do reduce the risk of heart attacks, and that is why in some cases it may be beneficial for you to take one.

 

But the big question is: How much do statins reduce your heart attack risk? The answer is not as much as you would think. Considering the recommendations keep getting more and more aggressive for statin therapy, you would think statins would be immensely powerful at reducing heart disease risk.

 

In reality, they reduce the risk of a heart attack by 0.7-1.5% over 5 years. That means you need to treat 66-140 people for 5 years to prevent one heart attack.  (as an aside, for people with pre-existing heart disease, so called secondary prevention, you need to treat approximately 40 people for 5 years to prevent 1 heart attack and 85 people to prevent 1 death)

 

When presented like that, it should certainly temper the enthusiasm for statin therapy. Again, it may still be the right choice for some people, but given the potential risks and side effects, I would hope for a much greater benefit.

 

Better Than Statins

 

A common response is that statins are “the best we have to offer” to reduce one’s risk of cardiovascular disease.  If you are talking about a drug manufactured in a laboratory, then that would be correct. But what else are options?

 

It turns out following a Mediterranean eating pattern with vegetables, fruit, fish, legumes, and lots of nuts, olive oil and avocados reduces the risk of cardiovascular events as well. For something as simple as nutritional choices the benefit must be much less than a statin, right?

 

That is what the drug companies would want you to believe. In reality, you need to “treat” 61 people with the Mediterranean diet for 5 years to reduce 1 cardiovascular event (a “combined endpoint” of stroke, heart attack or death).

 

To be fair, you cannot compare one trial to another as they have very different populations studied, and the outcome measures are different. So, it is not scientifically fair to say, “The Mediterranean diet has been proven to be more beneficial that statins.”  That would require a head-to-head trial. Unfortunately, that trial is unlikely to ever happen.

 

But it makes for an obvious answer when asked “If statins aren’t all that helpful, what else can I do to reduce my risk of cardiovascular disease?

 

  • Follow a real food, vegetable-based, Mediterranean style diet, low in sugar and high in healthy fats.

 

  • Maintain a physically active lifestyle.

 

  • Exercise with some form of moderate cardio exercise, resistance training and higher intensity interval exercises.

 

  • Practice stress reduction techniques.

 

  • Don’t smoke.

 

  • Manage your other risk factors such as diabetes and high blood pressure.

 

If you can follow these healthy lifestyle principles, you will be doing far more for your health than any pill you could take. And the best part? The only side effects are having more energy, feeling more empowered, and reducing your risk for chronic diseases.  Sounds like a good trade off to me!

 

 

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

 

Saturated Fat Kills! Or does it? Let the debate continue!

Dietary Saturated Fat Kills! Or does it? The Debate Rages On…..

 

A recent editorial publication in BMJ has once again stirred the raucous debate about dietary saturated fat. One subject with two completely opposing viewpoints, each one filled with ardent supporters who know in their hearts (pun intended) they are correct.

 

So……does dietary saturated fat directly cause heart disease, strokes and death? Or does it not?

 

Wait a second. This is science we’re talking about. Shouldn’t it be clear who is right? Shouldn’t the evidence prove one group right and the other wrong?

 

Nope.

 

Nutritional science is messy and rarely conclusive. That’s why we got into this mess in the first place.

 

Hooray for Debate

 

Before we get into the details, let’s all celebrate the debate itself. We should all be grateful that we can take part of an open and emotional debate among intelligent, successful and reputable individuals. Recent history has too many examples of some individuals trying to shut down debates in favor of declaring the “truth.” We all should know by now that isn’t going to fly.

 

Instead, we should celebrate every chance to debate the science and its impact on our lives. After all, we can still have free speech even if we can’t have free healthcare.

 

Bad Data

 

Here is the problem with nutritional science. It is really bad science.

 

Remember your science fair project as a kid? You were supposed to design an experiment that tested a hypothesis, controlled for one variable, and proved if that hypothesis was valid or not.

 

Nutritional science doesn’t work that way. Instead, most nutritional studies are observational studies. We observe how people live their lives, collect as much data as we can, and follow them to see who has heart attacks, who has diabetes, who lives and dies, etc. We can then see what habits each person had and try to draw statistical associations.

 

The problem is that this cannot prove anything. It can only suggest an association. When compared to your middle school science fair experiment, you can see the stark differences.

 

The observational study does not control any variables (they try to control for certain variables, but that is an impossible task especially since we can’t know all the variables for which we need to control), does not test a single hypothesis, and does not prove anything.

 

Why Does This Matter?

 

Here’s the problem. There are lots of studies that show an association between saturated fat intake (mostly animal products) and an increased risk of heart disease, strokes and death.

 

But here is the kicker. There are also lots of studies that show there is no association between saturated fat intake (mostly animal products) and an increased risk of heart disease, strokes and death.

 

Huh? How can that be?

 

There are many reasons why but here are the two big ones. 1- People are all different, and 2- Food is all different

 

People are Strange, I mean Unique

 

In the BMJ article, the authors propose that inflammation, not saturated fat, is the main cause of heart disease. There is definite sound evidence to support inflammation as a contributing causative factor in heart disease.

 

However, we need to acknowledge that inflammation is different in everyone. We are all unique. Our internal environments, from our degree of inflammation to our gut microbiome, are all different.

 

Therefore, how we respond to our external environment (i.e. the food we eat) is going to vary from person to person.

 

LDL cholesterol is a prime example. LDL is not inherently “evil.” Why would our bodies evolve to produce a substance whose job it is to kill us?

 

LDL is a necessary component in our cells, our brains and for making our hormones. We cannot live without it. Our internal environment, however, can alter LDL and turn it into an oxidized and inflamed structure that is more likely to cause heart disease. That may not be an inherent property of LDL, but rather, something our body’s environment does to LDL.

 

The same can be said of eating saturated fat. It is certainly plausible that introducing large quantities of saturated fat into an oxidized and inflamed environment can cause harm. But what if the individual exercises regularly, eats a veggie-first/real foods diet, practices mindfulness regularly, gets regular restorative sleep, and therefore has very low levels of inflammation and oxidation?  Chances are, the same amount of saturated fat in this individual is unlikely to cause damage (that’s my hypothesis, I haven’t don’t my science fair project on this yet).

 

Observational studies cannot tell the difference between these two types of people with different degrees of inflammation and oxidation. Instead, the trials try to reach a general conclusion that then is applied to everyone.

 

Does that sound like good science to you? I’d give it a C- in the middle school science fair (and that is being generous with extra points for their passion). Should we be making decisions about our health based on C- science?

 

We Don’t Eat Saturated Fat, We Eat Food!

 

Picture a big greasy burger on a huge bun, soaked in ketchup, with a side of fries and a coke. Observational studies call that a saturated fat eater.

 

Now picture a spinach and kale salad with beets, strawberries, walnuts, carrots and tomatoes topped with 4 ounces of grass fed steak. No fries. No coke. Observational studies also call this person a saturated fat eater.

 

I’ll say it once again. We don’t eat saturated fat. We eat food! It is crazy to think we can isolate one specific macronutrient and know all that it does. For starters, there multiple different types of saturated fat of highly variable quality with variable effects on our bodies.

 

Second, what we don’t eat (i.e. avoiding saturated fat) is just as important as what we do eat (instead, eating refined, processed, simple carbohydrates and sugar vs. veggies, fruit, nuts etc.). 

 

In the example above, the first person had a huge bun, fries and a coke. There wasn’t a veggie to be seen. Tough to pick just one villain in that so-called meal.

 

Don’t Throw It All Away

 

Don’t get me wrong. I am not about to suggest that we throw out all nutritional research. We still need it to guide future research and help us generate hypothesis.

 

I will suggest, however, that we need to be very careful about interpreting the research. Anyone who claims observational trials definitively prove anything must be seriously questioned.

 

And when they claim a “vast collection” of evidence, or an “overwhelmingly consistent conclusion” from the evidence, keep in mind that a vast collection of dog poop is still just a bunch a dog poop.

 

I respect and value ardent supporters on both side of the saturated fat aisle. But I also know that neither has the strength of evidence that their conviction conveys.

 

What Do We Do???

 

Be wary of anyone who claims they have the “answer” and the “conclusive” evidence. Try not to get caught up in all the debate if you don’t want. You can keep it simple and keep it healthy.

 

Eat real food. Mostly vegetables and some fruits with healthy fats such as extra virgin olive oil, avocados, nuts and seeds. Add smaller portions of high quality animal sources and smaller portions of minimally processed whole grains and legumes.

 

If you enjoy the debate, by all means participate. It’s good for science. But here is the one and only thing I can say with absolute certainty.

 

I can’t prove anything that I recommended in this article.

 

There has never been a randomized study to prove my personal nutritional consensus. No one has done their middle school science fair project to prove my hypothesis.

 

Sometimes, we need to take a leap and say, “this makes sense.” We need to integrate all the evidence, combine it with clinical experience, and come up with our best solution.

 

That is why experts can be so passionate and so resolute in their position, and yet the positions can be so variable.

 

And that is why we need to find reliable voices we can trust. 

 

My voice? Keep it simple.

 

Eat real food. Mostly vegetables and some fruits with healthy fats such as extra virgin olive oil, avocados, nuts and seeds. Add smaller portions of high quality animal sources and smaller portions of minimally processed whole grains and legumes. Take away the stress, be mindful in your eating, and enjoy!

 

Action Item:

Identify a belief you hold to be true about nutrition. Something that is ingrained in your core that must be true. Saturated fat is a perfect example, but there are plenty others. Salt? Carbs? Juicing? Whatever you feel is undoubtedly healthy or unhealthy. Next, search online for the exact opposite position. Keep an open mind and explore what the opposing side says. This will hopefully help you understand the complexities and uncertain nature of nutritional science.

 

Then, get back to the basics and (say it with me now….) eat real food. Mostly vegetables and some fruits with healthy fats. Add smaller portions of high quality animal sources and smaller portions of minimally processed whole grains and legumes. Take away the stress, be mindful in your eating, and enjoy!

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

 

 

 

 

 

 

 

 

 

 

Should I salt My Food? Let’s Hear the Truth!

How guilty do you feel when you reach for the salt shaker? Do you look to make sure no one is watching as you quickly shake the little white granules on your food, salivating as you anticipate the bursting flavor that sodium brings? It may be time to stop feeling guilty. You can salt with impunity. At least most of you can.

 

For decades, nutritional guidelines have recommended consuming less that 2300mg of sodium per day. This was most recently perpetuated in the 2015 American dietary guidelines. Yet the evidence to support such a guideline for all Americans is lacking at best.

 

In reality, there is substantial evidence that sodium restriction for the average American does nothing to reduce one’s risk of heart attacks, strokes or death. So, why should we limit it?

 

Approximately 25% of the population is sensitive to salt and may have dramatic increases in blood pressure, increased fluid retention, and increased risk of cardiovascular complications. But that is 25% of the population. Not the entire population. Trying to devise a single guideline for everyone is destined to fail. And it did.

 

Before I get into the specifics of the evidence, here is the conclusion:

 

If you are not salt sensitive (you do not have difficult to control hypertension, you do not have salt sensitive congestive heart failure) then salt restriction is not going to benefit your health.

 

That doesn’t give you license to start eating salt laden processed junk food. No, no, no. But it does give you the freedom to add high quality, minimally processed salt (Celtic sea salt, Himalayan salt, Real Salt, etc.) to your vegetable based, minimally processed, real food diet. 

 

Salt away and experience the flavors that salt can bring.

 

How Did We Get Here?

 

The controversy around salt all started in 1997 when an early version of the DASH study was published in NEJM. This study showed that those with hypertension could reduce their blood pressure by 11/5mmHg by reducing their sodium intake. The less publicized part of the study, however, was that those without hypertension only reduced their BP by 3/2, hardly earth shattering.

 

The follow up DASH study, also in NEJM, followed only 400 people for 30-days. They concluded that those eating the standard American diet could reduce their systolic BP by 6mmHg by limiting sodium to 2300mg.day. Interestingly, those eating a diet higher in fruits and vegetables only reduced their BP by 2mmHg by reducing sodium. Again, a disparity was seen between those who were presumably salt sensitive and those who were not.

 

Notice that neither of these studies reported changes in heart attacks, strokes or death. It was just assumed that any reduction in BP, no matter how small, would automatically translate into improved health. That assumption lead to the guidelines committee recommending sodium restriction for all.

 

The Real Evidence

 

Since the original DASH study in 1997, we still have no randomized trials demonstrating reduced risk of heart attack, strokes or death by decreasing sodium intake.

 

In fact, we have plenty of evidence to the contrary.

 

One large meta-analysis showed no clear association between sodium reduction and cardiovascular complications.

 

Another study demonstrated that sodium restriction caused a cascade of deleterious effects including increased blood levels of renin, aldosterone, adrenaline, and noradrenaline. These are all hormones that lead to higher blood pressure over time.

 

Newer evidence suggests that excessive sodium intake (greater than 7 grams per day) and low sodium intake (less than 2500mg/day) could both lead to increased risk of heart attacks and death.

 

Lastly, recent trials suggest a more prominent response to sodium in those who already have hypertension and eat more than 5 grams/day (there was no report of increased cardiovascular risk). Interestingly, higher potassium consumption was associated with a decreased BP.

 

The Devil That We Know

 

The result? We have the wrong enemy.

 

I have seen countless of patients and clients who report to me, “I’m eating much better. I won’t touch salt anymore!” Salt became the devil we know, and we could feel much better about ourselves by avoiding it.

 

The problem is that it may lead us to ignore the other “evils” in our nutrition. The added sugar, the processed foods, the industrial trans-fats, the fake stuff. It takes too much energy to avoid everything. Our brains are wired to focus on one thing, get rid of it, and feel like we have succeeded.  Don’t make salt the one thing you focus on!

 

Quality Matters

 

What did we learn from all the above studies?

  1. There is no evidence supporting reducing sodium intake to less than 2300 mg/day in the general population
  2. Very high (>7g/d) and very low (<2.5g/d) sodium consumption could be potentially dangerous for most Americans
  3. Where you get you sodium matters!

 

Number 3 deserves more attention. Where we get our sodium matters. If our sodium comes from processed junk food, high sugar or simple carb foods, then we aren’t doing ourselves any favors.

 

Also, why do you think increased potassium lead to reduced BP? First let’s look at potassium rich foods.

  • Avocado
  • Spinach
  • Sweet Potato
  • Acorn Squash
  • Wild salmon
  • Pomegranates
  • Citrus fruits
  • Bananas
  • White Beans

What do these foods have in common? They are real, unprocessed foods that come from nature.

 

Focusing on real, veggie-based foods is going to reduce your BP, and more importantly, lower your long-term risk of cardiovascular disease, diabetes, Alzheimer’s and other chronic diseases.

 

Don’t Make It Too Complicated

 

Remember, there is no one size fits all approach to nutrition. Guidelines that assume otherwise will likely fall short of being helpful. With that in mind, here are the 3 take home points regarding sodium consumption and your health.

 

  1. If you have poorly controlled hypertension or heart failure, then you may need to be careful with sodium intake
  2. If not, which applies to most the population, focus on real foods from nature. Have no hesitation adding real, minimally processed salt.
  3. Don’t get your sodium for processed junk food.

 

It’s that simple. Let’s not make it more complicated than it needs to be.

 

ACTION ITEM: Change the type of salt you use. Invest in Celtic Sea Salt, Himalayan Salt, Real Salt, or other minimally processed salt. Liberally enjoy this salt in your steamed, roasted, or sautéed veggies. Make sure you are limiting your processed food and junk food that contains refined salt (potato chips, pretzels, crackers etc.).  

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

Kidney Stones and Veggies- Which are Safe?

No good deed goes unpunished. I recently saw a young patient who had a severe coronary blockage requiring a stent. It was a true “Aha” moment and he dramatically improved his nutrition, lifestyle and stress management. He is one of my favorite patients (I’m probably not supposed to have favorites, but I’m human). Not just because of what a nice person he is, but because of his clear commitment to improving his health.

 

Gone were the processed foods and added sugars. They were quickly replaced by veggies, fish, healthy fats (including nuts and nut butters), and a clear focus on real foods. Not to mention his dediction to exercise and stress management. He re-examined his life, and revitalized his health.

 

Then it happened. Kidney stones. Ouch.

 

It turns out, some people absorb more oxalate from certain foods than others. Too much oxalate in your system can lead to calcium oxalate kidney stones (far and away the most common type of stone. Even though calcium is in the name, the oxalate is the more concerning component). Some of the biggest duetary offenders are spinach, beets and nuts.

 

As part of his real foods, veggie-based eating pattern he was consuming spinach and nuts every day. Ordinarily that would be fantastic! But not if you form oxalate stones. Oops.

 

The good news is, there are plenty of healthy veggie options that do not cause increased oxalate absorption. Some of the best greens for this are lacinto kale (also called dino kale), collard greens, and mustard greens.

 

Other low oxalate examples are broccoli, cauliflower, asparagus, Brussel sprouts

cabbage, zucchini, mushrooms, onions and peppers.

 

Last, taking more than 500mg of vitamin C has been implicated in increased oxalate production and should be limited.

 

Conclusion:

 

Don’t throw away your spinach or your almonds!

 

Most of us will do just fine eating spinach, nuts and taking vitamin C. However, for those few of us who are prone to forming calcium oxalate kidney stones, it makes sense to limit these foods and instead focus on the wealth of other healthy options listed above.

 

Do you have questions regarding your healthy lifestyles and your health? Let us know, info@DrBretScher.com

 

Thanks for reading

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

 

 

 

PCSK9 inhibitors- Hype or Hope?

Hot off the presses, just published today in NEJM. The new drug class PCSK9 inhibitors reduce heart attacks by 15%. Should we all rush out and start on one? Not so fast.

 

Initial studies demonstrated that Repatha (a PCSK9 inhibitor) dramatically reduced LDL cholesterol levels, but now we have evidence that they reduce the risk of heart attacks. Get ready for the barrage of commercials and ads for Repatha, and get ready for the experts to start proclaiming the benefits of this drug.

 

But as always, the truth may not live up to the hype.

 

For starters, the FOURIER trial focused on high risk patients who have already had heart attacks or strokes, and who were already on statins. This is called a secondary prevention trial. It is crucial to point out that it was not a primary prevention trial. The results do not apply to the millions of people with cardiovascular risk factors who have never had a heart attack or stroke (or peripheral vascular disease).

 

Second, the study did not show any difference in cardiovascular deaths. This is another important point as people frequently equate heart attacks with death. That is not the case. There was absolutely no difference in the risk of dying between the Repatha group and the placebo group.

 

Third, the reduction in heart attacks, although statistically significant, was small. Over 2.2 years, the risk of heart attacks was reduced by 1.2%. That means we need to treat 66 people for over 2 years to prevent 1 heart attack. Another way to look at it is that 65 people will not get the end benefit, and one will.

 

Last, the study was only 2.2 years long. The risk of side effects was similar between the two groups, suggesting that PCSK9 inhibitors don’t cause any adverse effects beyond statins. However, this is likely a big question mark regarding these drugs. These drugs drive the LDL lower than any other medication we have ever had. In this study, the average LDL for the Repatha group was 30. Our goal used to be 100, then 70, and now apparently 30. That’s quite a drop.

 

Is there reason to believe an LDL this low could be dangerous? You bet. LDL, although commonly known is the “bad” cholesterol, is vital for our health. We need it for neurologic and cognitive function. We need it for hormone production. We need it for cell membranes and for absorbing fat soluble vitamins.

 

Are you satisfied that the drug is harmless after this 2.2-year study? Neither am I. Stay tuned for the discovery of significant adverse effects over the next few years.

So far, I haven't even mentioned cost. If the drug was free, it would still be questionable if it was worth taking. But the drug is most certainly not free. In fact, it costs $14,000 per year.

Since we need to treat 66 people for 2.2 years to prevent one heart attack, that makes it $2.03million per heart attack saved. <Cough> That's a tough pill to swallow.

 

So why are so many experts going to promote it and extol its benefits? Most physicians believe that medicines are the path to health. The more we can alter our natural environment with drugs the better. Even minimal reductions in our risk are worth the minimal side effects from drugs. That seems to be a common bias in our healthcare system.

 

My bias is the exact opposite. We can achieve incredible benefits from purposeful lifestyle changes, and all without adverse effects! Drugs are largely unnecessary beyond that. Therefore, in my mind, any drug should have a dramatic benefit and a minimal long-term risk at an acceptable cost. After all, are you interested in lowering your heart attack risk for two-years? Or are you interested in lowering your risk over your lifetime?

 

Don’t get me wrong. There may still be a very limited role for PCSK9 inhibitors.

 

For very high-risk patients in whom you have tried everything (especially intensive lifestyle modifications) yet they are still likely to have another heart attack in the near future, then PCSK9 inhibitors could be a good option to reduce their heart attack risk by 0.6% per year, even though it won’t affect their risk of dying.

 

Beyond that, however, they have no proven benefit and no clear role in medical therapy. They are very expensive, and they are likely going to show significant long-term adverse effects when used for more than 2-years. Tread lightly with PCSK9 inhibitors. 

 

Action item:

When you read the headlines, and hear the news about the incredible benefits of PCSK9 inhibitors, please remember to put it all into context. Use this article as a guide to clarify where the trial has merits and where there are still unanswered questions. As always, if you have any questions, please do not hesitate to contact us at info@DrBretScher.com.

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

 

 

Can Eating Better Save 400,000 Heart Attack Deaths?

By now you have likely heard the news that poor nutritional choices cause almost half of all cardiovascular deaths. Wouldn’t it be amazing if by eating better 400,000 people would still be alive today? You bet it would.

 

While it’s no surprise that nutrition and heart health are directly related, causing half of all cardiovascular deaths is a dramatic finding that deserves further scrutiny.

 

The recent study, funded by the Bill and Melinda Gates Foundation, was presented at the 2017 annual AHA meeting. They retrospectively looked at years of observational data to correlate nutritional habits and the subsequent risk of dying. Instead of focusing only on the “bad” foods that people ate, they also looked at the “good” foods people did not eat. They concluded that Americans need to eat more nuts, vegetables and whole grains, and less salt and trans fats.

 

Yawn. That finding is hardly earth shattering as we have been hearing this for decades. Does this new study add anything to the current literature? I’m afraid not.

 

We have plenty of observational data suggesting the same.  In fact, another similar study published in JAMA at the same time provided more observational evidence that 318,000 out of 702,000 cardiovascular and diabetes related deaths are related to (in order of statistical strength), too much salt, not enough nuts and seeds, too much processed meats, not enough omega 3 rich seafood, not enough veggies or fruit and too many sugary beverages.

 

Bad Studies Yield Bad Data

 

Two studies with similar results. Does that sound conclusive? Not so fast. The problem is that all this data is observational, and therefore weak data. It can point out associations, but it cannot prove cause and effect (see chapter 2 in my book, Your Best Health Ever for a more detailed discussion).  What we need is a randomized, controlled trial investigating the question of nutrition and cardiac deaths, not more observational drivel (see my post on The Best Weight Loss Trial You Will Never See here)

 

As an example, processed food is high in salt. Fruits and veggies are low in salt. Can we say with certainty that the salt is the problem? Or is it the company it keeps, i.e. too much crackers, chips and baked goods instead of fruits and veggies? This study cannot determine between the two. Also, those who eat more veggies also tend to be more health conscious, more physically active, and have less dangerous habits (i.e. smoking). The opposite is true for those who eat more processed junk food. Again, observational studies cannot completely control for those variables (they can try, but statistics are imperfect for this).

 

Does this mean we need to throw out the study completely? Not necessarily. It raises important questions, even if it does not provide clear answers.

 

Instead, we should combine the findings with the higher quality, randomized trials to see what the science truly supports.

 

Good Studies Yield Good Data

 

The more conclusive studies are the randomized controlled trials. One such recent trial was the PREDIMED study (see more on this study and the Mediterranean diet here).  Briefly, this trial investigated a diet that included a “high intake of olive oil, fruits, nuts and vegetables; a moderate intake of fish and poultry; a low intake of dairy products, red meat, processed meats, and sweets; and wine in moderation with meals.” This pattern of eating significantly reduced the risk of cardiovascular disease when compared to low-fat diet.

 

Since this was a randomized trial, there was no need to control for other healthy habits and self-selection bias. In addition, they didn’t measure surrogate outcomes like blood pressure, weight, or cholesterol. They measured the events we really care about- heart attack, stroke and death. In the end, a simple nutritional intervention reduced that risk.

 

This is an impressive study that tells us something conclusive about nutrition. I hope you can see the difference between this study and the throngs of poor-quality observational trials.

 

Do you see any similarities between the PREDIMED study and the recent observational trials?

 

Encourage nuts, veggies, and fish. Discourage processed meats and sweets.

 

In short, eat real food.

 

Can We Find A Common Ground?

 

After that, the science gets murky.

 

What about poultry? It was encouraged in the PREDIMED study and was not mentioned much in the recent observational trials. There doesn’t seem to be significant evidence to avoid it, and there may be reason to eat it. So be aware of your portion size and go for it.

 

What about salt? It wasn’t limited in the PREDIMED study. Some studies suggest increased risk with high sodium intake, and some studies suggest increased risk with low sodium intake. In the observational trials, it can be difficult to separate salt from processed foods, and therefore difficult to know if it is dangerous.

 

You may be thinking, if there is any question, why not just avoid it?  Is there a compelling reason to eat salt? You bet there is. Taste. Salt helps food taste better. If you are adding it to your cookies, white bread or potato chips, you aren’t doing yourself any favors. However, if you are adding a sprinkle of sea salt on your freshly steamed veggies or your roasted broccoli, then go for it. An observational study can’t tell the difference between those two circumstances, but trust me, your body can.

 

What about red meat? This is a big one. We don’t have any evidence that red meat reduces the risk of cardiovascular disease. However, all the evidence suggesting that red meat and animal protein increase the risk of cardiovascular disease is poor quality observational data. In addition, there is plenty of poor quality observational data that claims the exact opposite, that red meat does not increase the risk of cardiovascular disease. So again, we must ask, if there is controversy, should we just avoid it? Is there a compelling reason to eat meat? For some there is. Animal meat is the most efficient source of B-vitamins, iron and protein, it is filling and it tastes great.

 

Once again, the specifics matter. Are you eating a 16oz porterhouse steak with mashed potatoes? Or are you eating a fresh vegetable salad with 6-ounces of grass-fed steak on top? A study may not know the difference, but your body sure does.

 

Wrap It Up

 

Can improving what you eat reduce your risk of heart attacks and strokes? It sure can. The PREDIMED study showed that.

 

Do these new observational studies add anything new? That’s debatable.

 

We come back to the basics. Eat more real food. Eat more veggies and fruits. Eat less processed junk. Avoid manufactured trans fats. If you do that, you are doing 95% of the work (I made up 95%, but it seems right to me).

 

Spend all the time you want arguing about the remaining 5%. There is plenty of evidence to support your claim whether you are for or against salt, meat, eggs etc.

 

As for me, I am going to step out of the argument and go eat my spinach and kale salad with Brussel sprouts, cauliflower, squash, nuts and seeds, topped with olive oil and 4 oz. of wild salmon and a hard-boiled pasture raised egg. Heaven on earth. Bon Appetite.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com 

 

Action Item:

Look for ways to add veggies, nuts and seeds to your meals. Sprinkle pumpkin seeds on your oatmeal, eggs or salad. Ask for a double portion of veggies and half the protein when you go out to dinner. Watch our veggies and eggs video to see how easy it is to make a veggie-based breakfast. Focus on real food, veggies first. Try it today and see how easy and rewarding it can be!

How Many Pills Do We Need to be Healthy?

How many pills do you need to be healthy? To be healthy we would want to do the following:

  • Lose weight
  • Lower LDL
  • Raise HDL
  • Lower blood sugar
  • Lower insulin levels
  • Reduce inflammation
  • Reduce your risk of heart attack and stroke

 

To do all that you would need five or more prescription drugs. But is that what it means to be healthy?

 

Our traditional medical culture seems to be saying, “Yes!” That type of thinking is why prescription drug use continues to rise, with over 60% of American adults taking prescription drugs, and 15% taking five or more drugs.

 

Guess what. It doesn’t have to be this way. Not even close.

 

Here is the secret you can do that is better than taking 5 or more pills.

 

You can commit to healthy lifestyle habits.

 

Do that and you will lose weight in a healthy manner. You will lower your blood sugar and insulin levels. You will improve your cholesterol profile, reduce your inflammation and lower your risk for heart attack and stroke.

 

And you can do it all without side effects, unless of course you consider being happier, having more energy, and feeling better as side effects!

 

Sounds easy? It can be. It won’t always be easy, and it certainly isn’t easy to be perfect. But being better, and seeing every day as a new opportunity is well within our grasp.

 

The Science Supports Lifestyle First

 

A 2016 study in NEJM investigated four different trials comprising over 55,000 subjects. They concluded that even those with the highest genetic risk of cardiovascular disease can reduce their risk by almost 50% with healthy lifestyle habits, defined as eating healthy, getting regular physical activity, not bring obese, and not smoking.

 

In addition, A 2014 study showed that 80% of all first heart attacks are explained by 5 risk factors (smoking, waist circumference, healthy diet, regular physical activity, moderate alcohol consumption). It turns out, all five of those factors are within our control. We don’t need a pill to control them. We just need to commit ourselves to controlling them.

 

Putting it into practice

 

Despite this encouraging information, A study published in the Mayo Clinic Proceedings concluded that an only 2.7% of the Americans studied led a healthy lifestyle (defined as regular physical activity, healthy eating, not smoking, and having a recommended body fat level).

 

It should be no surprise, therefore, that heart disease remains the leading cause of death in men and women. There are approximately 900,000 heart attacks annually in the U.S., one every 42 seconds, with 365,000 people dying from a heart attack every year. Heart disease costs $207 billion annually in the U.S. alone. And for the first time since 1993, the life expectancy in the U.S. has started to decline.

 

The Health-Drug Disconnect

 

If more and more people are taking prescription drugs, yet our life expectancy is declining, how do we rationalize the disconnect?

 

I propose it is because we have lost sight of what first line medical therapy should be.

 

Statins come with a litany of side effects, and at best reduce your risk of heart attack by 3% over 5 years.

 

Drugs that raise HDL level can worsen your risk of dying (CETP inhibitors).

 

Diabetes drugs can increase insulin levels, increase weight, and create a medication dependency.

 

Weight loss drugs are rarely sustainable over the long run, and come with severe side effects.

 

Do any of those sound like good choices for first-line treatments? Not to me. And I hope not to you either.

 

Change What We Reach For

 

Instead of reaching for our prescription pads, physicians should be reaching for cookbooks, lists of farmer’s markets, different options for activity trackers, stress management apps, and other healthy lifestyle tools.

 

That is where true health begins. That is our best chance of achieving real health. Not health that is dependent on a medication, or health that is defined by a lab value.

 

For more information on how to improve your health with healthy lifestyle habits, read more about our book and instructional video series. They may just change your life.

 

Thanks for reading

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

Action item:

Take a look at Your Best Health Ever: A Cardiologists’ Surprisingly Simple Guide to what Really Works. You can buy it today on amazon (here is the link). It has all the information you need to prioritize healthy lifestyle practices over prescription drugs. Together, we can promote natural, long-lasting health that feels great.

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