Low Carb Denver 2019

They just keep getting better. These low carb conferences keep raising the bar, and they keep exceeding my expectations.

Low Carb Denver was no exception.

 

Robb Wolf on Low Carb Myths

 

The conference started out with Robb Wolf dispelling the unfounded myths that low carb is dangerous or associated with dying earlier. The quality of science that gets promoted in the media is nauseating, and Robb did a wonderful job highlighting that. (Plus, we had a fantastic podcast interview later that day, so stay tuned for that!)

 

Georgia Ede on the EAT Lancet Report

Next up was Georgia Ede, who destroyed the EAT Lancet report. By saying “destroyed,” I don’t mean she was malicious or attacking. Rather, Georgia was her usual incredibly analytical and science-based self. She showed how the report was based on faulty science, and how the recommendations weren’t even supported by the faulty data they used. It is mind boggling how this amounts to a well-funded PR campaign masquerading as science, and Georgia was masterful at demonstrating this fact.  Bonus- Georgia sat down for another action packed podcast interview. (You will love this one!)

 

Low Carb Practical Implications

From there, we got into practical implications such as how low carb might be an adjunctive treatment in cancer, how it can be safe in pregnancy, and Jason Fung showing how PCOS is essentially a disease of hyperinsulinemia. What’s the best treatment for hyperinsulinemia? Let’s say it together… LCHF! (and I had an amazing podcast interview with Jason as well!)

Then the controversy started.

 

LCHF Controversy

Kudos to the organizers for stirring things up with presentations followed by a civil debate between Dr. Dariush Mozafarrian and Gary Taubes.  It’s important to recognize intelligent opinions and scientific interpretation don’t always agree. This was a nicely highlighted in this section.

There are plenty of times when opinions and “data” against low carb are based on weak or nonexistent science. The discussion with Gary and Dariush showed the nuances of interpreting science, something I aim to continually help with!

 

Zoe Harcombe on Fiber

Fast forward to day two when Zoe Harcombe brought down the house with a riveting talk on how we don’t need fiber. None. Not at all. Zilch. If we eat tons of refined carbs, then fiber is helpful. If we don’t, then don’t worry about fiber! This was a great talk with perfectly placed “potty humor” as Zoe called it.

 

My Talk

Next came my favorite part of the conference. But then again I am biased. It was a 1-2-3 cholesterol punch with Dr. Paul Mason, myself, and Dr. Nadir Ali all discussing different aspects of cholesterol. The take home is that things are different with LCHF. The physiology changes and the existing cholesterol evidence does not reflect the specific subset who follow a healthy low carb diet. That much we know.

Yet, there is much we don’t know. These back-to-back-to-back talks helped highlight this.  That’s why I advise everyone following a LCHF lifestyle to see a practitioner experienced with LCHF. It doesn’t mean ignore cholesterol, but it does mean seeing it in a different light.

As if the first two days weren’t enough, day three kicked off with Dr. Eric Westman, followed by Dave Feldman sharing his amazing N=1 clinical data from the past year. Beware of coffee and high triglycerides!

 

The Diet Doctor on Long-Term LCHF Diets

Then came The Diet Doctor himself, Dr. Andreas Eenfeldt showing us how low carb diets do work in the long term. We just have to stick with them. This was a nice compliment to the earlier talk from Dr. David and Jen Unwin showing us how hope is a powerful force to maintain compliance and behavioral change.

 

LCHF and Sexual Health

And then we had a new topic for the LCHF meeting, sexual health. Perfectly delivered by stand-up comedian and low carb physician Dr. Priyanka Wali, her talk showed us how the number of problems LCHF helps continue to add up. That is why most of the time we are better off thinking of LCHF as an overall healthy lifestyle rather than a “treatment” for a specific disease.

LCHF Community

Despite all these amazing talks, however, the real star was the community. The interactions I had and witnessed between everyone, healthcare providers or not, showed the level of engagement, intelligence, and hope this community represents.

My personal highlight may have been having dinner with an ER doc, family practice doc, forage agronomist and ceramics teacher.  All of us with eclectic backgrounds, and all of us wanting to improve the health of the world (people and the environment).

It was a week’s worth of interactions packed into three days. And it leaves me hopeful for the future of science, the future of nutrition, and the future of health.

Thanks for reading!

Bret Scher, MD FACC

New Major Study: A Calorie Is Not A Calorie

Despite what the sugary beverage and processed snack food companies want us to believe, all calories are not created equal.

new study from Harvard shows that individuals following a low-carbohydrate (20% of total calories) diet burn between 209 and 278 more calories per day than those on a high-carbohydrate (60% of total calories) diet. So the type of calories we eat really does matter.

The New York Times: How a low-carb diet might help you maintain a healthy weight

This isn’t the first study to investigate this topic, but it is likely the best.

The current study was a meticulously controlled, randomized trial, lasting 20 weeks. Even more impressive, the study group provided all the food for participants, over 100,000 meals and snacks costing $12 million for the entire study! This eliminated an important variable in nutrition studies — did the subjects actually comply with the diet — and shows the power of philanthropy and partnerships in supporting high-quality science.

After a run-in period where all subjects lost the same amount of weight, participants were randomized to one of three diets: 20% carbs, 40% carb, or 60% carbs, with the protein remaining fixed at 20%. Importantly, calories were adjusted to stabilize weight and halt further weight loss, thus making it much more likely that any observed difference in calorie expenditure was not from weight loss, but rather from the types of food consumed.

After five months, those on the low-carb diet increased their resting energy expenditure by over 200 calories per day, whereas the high-carb group initially decreased their resting energy expenditure, exposing a clear difference between the groups. In addition, those who had the highest baseline insulin levels saw an even more impressive 308-calorie increase on the low-carb diet, suggesting a subset that may benefit even more from carbohydrate restriction.

Why is this important? It shows why the conventional wisdom to eat less, move more and count your calories is not the best path to weight loss. Numerous studies show better weight loss with low-carb diets compared to low-fat diets, and now studies like this one help us understand why.

Our bodies are not simple calorimeters keeping track of how much we eat and how much we burn. Instead, we have intricate hormonal responses to the types of food we eat. It’s time to accept this and get rid of the outdated calories in-calories, calories-out model, thus allowing for more effective and sustainable long-term weight loss.

Originally Posted on the Diet Doctor Blog 

How To Eat Low Carb On A Budget

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"I'd love to eat low-carb but I don't think I can afford it!" Have you thought this before? I know I have heard it before.

The benefits of a low carb diet are clear, but many people are put off because they think that a low carb diet has to be expensive. The truth is, eating low carb doesn't have to break the bank. You don't need to buy expensive foods or ingredients! In fact, you can eat delicious, healthy, and inexpensive meals every day. Read on to learn more about how to eat low carb without blowing your budget. 

Plan For Success

The most important part of eating low carb on a budget is the planning. Having a clear plan every week saves tons of time and effort. Start by browsing the weekly sale ad from your local grocery store to see what's on sale. From there, you can sketch out a meal plan for the week, based around those nutritious and tasty ingredients. You should be able to easily plan how much it will be for daily breakfast, lunch and dinner (or if you practice intermittent fasting, that's even easier!). Always plan to have a few extra snacks on hand, as this can help stop you from splurging on expensive, last minute treats.

If you have more than one local grocery store, compare prices. It may be worth the extra few miles of driving if you can save some serious money on food. If one store has free-range eggs on sale and the other has a sale on chicken, don't hesitate to stop for both.

One of the most helpful things you can do is put a few hours aside each week (maybe on the weekend) to map out your plan. During this time you can:

  • Plan out your grocery shopping.  After looking at your local store's weekly ad, write out a detailed list of everything you need to buy. Armed with a list, you'll be less likely to splurge once you get to the store.

  • Map out your meals for the week. Know what you'll be having for dinner each night of the week. Plan quick and easy meals for your busiest nights, and be sure that you know what you'll be packing for lunch during the weekdays. 

  • Prep foods you know you'll be using. You can pre-chop veggies, cook meat, and make soups or stews ahead of time. Keep pre-portioned meals in the fridge, so when you're hungry you already have a delicious low-carb meal on hand. Portion out snacks like nuts into containers or bags so you know you won't overindulge, and you'll always have something to grab when hunger strikes. When all your food is ready and on hand, you won't have any excuse to grab expensive takeout. 

Strategize Your Shopping

When you head to the grocery store, make sure you optimize your time and money. There are a few tricks to keep in mind to really stretch your grocery budget. First, make sure you head to the store with a list and don't stray from it. If you see something that you use a lot of on sale for a good deal, stock up and freeze it for later use. 

On a low-carb diet, you most likely don't even need to venture into the aisles of the store – you can just stick to the perimeter. That's where the most healthy, least processed foods are waiting. Fruits, veggies, meat, cheese, eggs and other staples are easily accessible, and you won't be tempting yourself with expensive, processed foods. 

Protein is Key

On a low-carb diet, your protein sources can be one of the more expensive items at the grocery store, but if you strategize your meat buying, you'll find that buying meat won't necessarily force you to go over budget. 

Often, it's cheaper to buy a whole chicken and portion it out yourself, instead of buying just chicken breasts, thighs, or legs. If you portion out a chicken by hand, you can also save the bones to make nourishing bone broth later. 

Also, try cuts of meat that you haven't necessarily considered before. For example, organ meat is much cheaper (and denser in nutrients) than muscle meat, but so many people are afraid to try it. Liver, onions, and bacon is a fantastic, healthy, and surprisingly tasty meal, and buying cow liver is much cheaper than buying steak.

Produce Power

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Fresh produce is an important staple in any healthy diet, and while some vegetables and fruits are high in carbs, sticking to lower carb avove the ground veggies will deliver nutrients that can help your body thrive. Look for seasonal veggies instead of buying expensive ones when they're out of season, and don't be afraid to go for frozen vegetables as well. They're just as healthy as their fresh counterpart, and you can be sure that you'll always have healthy veggies on hand in the freezer.

Also, keep in mind that convenience comes at a cost. Many stores have pre-cut veggies available, which makes dishes like stir-fry quick and easy, however, you pay for the prep work. If you set aside prep time every week, you won't need to spend the extra money on pre-shredded cabbage or pre-chopped broccoli.

Buying Smart

Sticking to a budget can be hard, but always buy the best quality that you can afford. Sure, free range chicken, grass fed beef, wild fish and organic produce is higher quality, but it can also be much more expensive, depending on where you shop. But you can always be sure that eating healthy, fresh food, even if it isn't organic, is much better for your body than pizza, soda, fast food, or other processed junk. So don't feel bad about buying the store brand canned salmon instead of the fresh fillets. Splurge on the good stuff when you can, and make the best possible choices when your budget is tight.

Another important thing to remember is to keep it as simple as you can. You don't need fancy cheese or expensive nuts to satisfy you. Grocery stores will upcharge trendy foods like kale because they know it will sell. Turnip greens, spinach, swiss chard, or collard greens are just as healthy, but can usually be found for much cheaper. A simple salad packed with superfoods makes a great meal and can be put together with affordable ingredients. Get familiar with all the different produce options, and how to cook them to make healthy and delicious side dishes. Be adventurous! 

Cooking healthy, delicious low carb meals for yourself and your family can be rewarding, and you'll add an impressive set of recipes to your repertoire. Herbs and spices don't add carbs to your meals and they can bring simple dishes to a whole new level. Buy herbs and spices in bulk, and they'll last you for months.

Final Thoughts

Maybe you've tried a low carb diet in the past without much success, or you got discouraged about how much you were spending. But the truth is, low carb is a healthy choice, and healthy choices are for everyone, not just the wealthy. If you spend some time planning out your meals weekly and get to know all the secrets of your grocery store, you'll find that eating low carb is easier and cheaper than you ever expected. It just takes a bit of strategy, and some creativity to kickstart your low carb lifestyle. 

 

Do Low Carb Ketogenic Diets Increase Your Risk of Dying?

Do Low Carb Ketogenic Diets Increase Your Risk of Dying?

 

Some people certainly want us to think so.

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

Say hello to a real ketogenic diet.

 

Thanks for reading

 

Bret Scher, MD FACC

LowCarbCardiologist.com

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

Bret Scher, MD FACC

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