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

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 

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!

Looking for Knowledge in All the Wrong Places

I always found it interesting when people talked about feeling their loneliest in the middle of New York City, surrounded by millions of people. It may seem like a leap, but that’s how I feel about finding reliable, reputable, easy to understand information on being healthy.

In today’s media-centric society, we have more information more easily available than ever before. Yet when it comes to healthy lifestyles, we may be at a low point in having accurate information that we can use to live healthier lives.

The popularity of social media has inflated the importance of just that….popularity.  It is more important to be popular than to be correct, accurate, intelligent, reasonable, balanced, and hundreds of other adjectives. Popularity -measured by numbers of clicks, likes and shares- is king.

That may be harmless when we are talking about videos of cats playing the piano and kangaroos jumping in the ocean, but when it comes to advice that directly impacts our health, popularity may be confusing us more than ever.

We have to be 100% vegan or we are killing ourselves. Statins are poison and should be avoided by everyone. Meat has been incorrectly vilified and we should all eat as much meat and bacon as possible. Low-fat is the only healthy diet. Ketogenic is the best diet for everyone. Cardio exercise is worthless and we all need to do heavy lifting. We need to do interval training every day for weight loss. Tumeric will solve all your problems. Vaccines are killing us and giving us autism.

I could go on and on. I’m getting disgusted just typing these.  But you can see how claims such as these from a popular voice, with thousands of shares and likes, could be taken as “truth” and as something that must be part of healthy living.

Fortunately, there are a smattering of popular voices that are also concerned with scientific evidence, reasonable approaches, and practical utility. I hope to be one of those voices. That was the goal behind creating my book, Your Best Health Ever: A Cardiologist’s Surprisingly Simple Guide to What Really Works (available on Amazon here).

My focus is the foundational principles of a healthy lifestyle, made very simple.

I present a balanced, scientifically accurate evaluation of lifestyle as medicine, and help build a sense of self-efficacy and “can do.” It’s meant to be a mix of science and practical tips for incorporating healthy habits into your life.

If my book and my message resonates with you, great. I am happy to be a voice to help. But do not stop there. Below is a list of other individuals with social media and web presence who are valuable sources of health advice. I do my best to summarize them to help you find the right ones for you.

 

The Physicians:

Mark Hyman, MD- @markhymanmd. One of the most well-known functional medicine doctors, head of Cleveland Clinic’s functional medicine program, and multiple times best-selling author. He is a proponent of eating fat as his book Eat Fat to Get Thin suggests. He is one of the more respected and reasonable voices at the intersection of traditional and functional medicine. He tailors posts to the general public with recipes and other concrete health suggestions, and he does an admirable job of combining scientific evidence with clinical experience.

 

John Mandrola, MD- @drjohnm John is an electrophysiologist (a sub-specialty within cardiology focusing on electrical problems of the heart) who is excellent at dissecting data and seeing multiple points of view. His posts can be on advanced topics and are usually geared towards physicians and less so to the general public.  He is still an outstanding example of a reasonable and intelligent voice who challenges the status quo when appropriate yet still acknowledges the benefits of agreeing with the masses.

 

Kevin Pho– @KevinMD. He is a primary care physician who is vocal regarding the challenges doctors face in providing high quality care and remaining engaged as physicians. He is a good resource for physicians to realize they are not the only ones facing these challenges, and he provides actionable advice to help with them. He may also be beneficial for patients to understand what MDs are going through, although most information may too technical for the public.

 

  Frank Lippman MD-@drfranklipman. He is a physician and functional medicine practitioner. He promotes basic, reasonable health and wellness advice. Sometimes his information is too general, but can still be helpful for general reminders about health and wellness. He avoids the extremes and controversial topics. Has a gentler approach to functional medicine than most.

 

Val Jones MD- @DrVal She runs Better Health LLC and provides intelligent and well balanced health information.

 

Tim Caufield- @cuafieldtim He is affectionately known as “The B.S, Detector.” He is very quick to call-out and engage anti-vaccine proponents, chiropractors, naturopaths, holistic practitioners, and of course Gweneth Paltrow for their lack of evidence.  His downfall is that he lumps groups together rather than recognizing a “few bad apples” can ruin the reputation of an entire profession. But if you have doubts about whether something legit, Tim likely has an opinion on the matter.

 

The Vegetarian:

David Katz MD-@drdavidkatz Controversial for his history of self-promotion, but aside from that he provides a reasonable, intelligent, although heavily vegetarian biased, voice on nutrition and health. Frequently gets into twitter battles with Nina Teicholz, which provides an excellent point-counterpoint discussion of nutrition and quality of scientific evidence.

 

The Vegan:

Joel Kahn MD-@drjkahn He is an admirable mix of practicing cardiologist, businessman, author, and passionate individual. He is heavily biased toward Veganism, and practices what he preaches. He even has his own Vegan restaurant in Detroit. He is committed to promoting health and wellness, and it is noteworthy how strongly he believes in his message. He is very active contributing articles on multiple websites, and is always quick to weigh in on current issues. He also frequently engages in twitter debates with Nina Teicholz. Eventhough I don’t personally believe we all need to be vegan, I appreciate Dr. Kahn’s message and his style, and I highly recommend him as a vegan health resource.

 

The Alternative Practitioner:

Chris Kresser-@chriskresser  Of the non-MD functional medicine practitioners and Paleo proponents, he is the most reasonable, and the most detailed regarding science and research. He does not subscribe to the all-or-none approach to Paleo, and his level of thinking is deeper than most others.  If you read an article on fish oil and then read Chris’ article on the same, you will immediately see his added layer of thinking and analysis.

 

Comedic Relief:

@zdoggMD– Likely the most entertaining and humorous physician to follow. He may not be the best resource, but he certainly is the most entertaining.

 

Non-Physician Authors and Writers:

Gary Taubes-@garytaubes He is a journalist and author of The Case Against Sugar and Good Calories Bad Calories. He is not a medical professional, but he is a very good researcher and writer, and a vocal crusader against sugar and refined carbohydrates. The attacks against him would be the strength of evidence behind his claims, but overall he is a wealth of information and a vigilant proponent of health and the crusade against sugar.

 

Nina Teicholz-@bigfatsurprise Author of The Big Fat Surprise. Vocal proponent of saturated fat and one of the initial whistleblowers on the poor-quality science demonizing fat. She embraces controversy and can frequently be seen in twitter debates with Drs. Katz and Kahn listed above. That makes her always entertaining and informative, and a great source to help us see the “other side” of the low-fat trend that has been present for decades.

 

The Nutritional Movement:

The Whole 30: @whole30 Best-selling book promoting whole food nutrition and avoiding processed, refined foods. Great resource with recipes and inspirational links.

 

The Standard Medical Sites:

WebMD

NIH

MayoClinic

Everyday Health

These all seem to have a balanced and reasonable approach to standard medical advice.

 

New Generation:

@Greatist- The health website for millennials and Gen X.

 

Most Popular

 

Joseph Mercola DO-@mercola- He is one of the most popular and most active voices in the health and wellness sector. Many of his posts are reasonable and great resources. However, he also drifts to the extremes and overstates the strength of the evidence to suit his claims such as (Do Drug Companies Secretly Favor a World Flu Pandemic?” “Zinc Can Cure Diarrhea” and “Learn How Homeopathy Cured a Boy of Autism” not to mention calling shampoo, tampons and other daily use items a “poison.”  Of course, he sells healthy versions of them all on his website. There are multiple articles written calling him the most dangerous voice in health and wellness, and the FDA has reprimanded him on a number of occasions. Yet that doesn’t stop him from getting almost 2 million visitors to his site every month.  As far as the public is concerned, he is doing something very right.

 

Mehemet Oz, MD- He wins the award for most popular physician voice on multiple mediums- TV, website, social media etc. He reportedly reaches millions every day in over 100 countries. He has gotten into trouble in the past for episodes such as “Plant based magic weight loss cures,” “miracle appetite suppressants,” communicating with the dead to reduce stress, and others. Doctors have petitioned Columbia University to remove him from his faculty position due to his “egregious lack of integrity” and his promotion of “quack treatments.” Yet it is clear he has won the popularity game and has a voice millions yearn to hear. He could never have done that if he wasn’t helping people to some degree. From that aspect, we can all learn from him.

 

Dr. Oz and Dr. Mercola are two of many popular voices promoting a message of either distrust of modern medicine, or belief that miracle cures exist. This message resonates with millions. They both have credentials as experienced clinicians, and much of their advice is scientifically sound. The challenge comes in knowing when they cross the line and enter the potentially dangerous realm. That is why now more than ever, we need reasonable and responsible voices promoting health, wellness and prevention of chronic diseases.

 

 

Conclusion

 

So where can we turn for reputable, easy to understand information that will help us lead healthier lives? I encourage you to follow those on the above list whose style resonates with you, and I hope my book and website can fill that role as well. Just remember, everyone has a bias. Everyone. Every point has a counter point. Every story has more than one interpretation.

 

Look for balance, look for rational analysis, look for people who ask more question and don’t pretend to have all the answers. And please, remember to question every dramatic claim or headline you read. They rarely are as simple or impressive as authors would like you to believe.

 

Follow these principles, and you will ensure that you get the most accurate and reliable health information available. It may not always be the most popular or have the most likes, but hopefully it will be the most accurate and helpful. That’s more important than cats playing the piano, don’t you think?

 

 

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

 

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.

Is Alzheimer’s Disease Preventable?

Is Alzheimer’s Disease Type III Diabetes? And Can it be Prevented?

By Bret Scher, MD

 

Alzheimer’s disease is one of the most devastating conditions in our country, and you may have the power to prevent it.

 

There is nothing more empowering than knowing you have the ability to prevent a chronic disease. Especially when some view that chronic disease as worse than death. While not all factors that lead to chronic disease is controllable (e.g., genetics), there are some diseases that you can protect yourself against. And one of those might be Alzheimer’s disease.

 

Alzheimer’s disease—which is the sixth leading cause of death in the U.S.—is a devastating condition that impairs your memory and ability to think. It progresses over time, eventually condemning an otherwise functional body to a life completely dependent upon care from others. It changes the lives of not just those affected by the disease, but their loved ones and caregivers as well.

 

In 2015 alone, approximately 15 million caregivers provided an estimated 18 billion hours of unpaid care to the 5 million Americans who suffer from Alzheimer’s disease. But the cost to families and to society as a whole cannot be measured in just dollars and cents. The emotional toll can also be enormous. The negative effects on caregivers can be vast, including:
 

  • Psychological distress
  • Impaired health habits
  • Psychiatric illness
  • Physical illness

 

To make matters worse, the number of people diagnosed with Alzheimer’s dementia is only getting larger and is expected to triple as baby boomers reach the at-risk age of 65 and older.

 

Paradigm Shift in Understanding Alzheimer’s

Modern medicine has struggled to find effective treatments for those who suffer from Alzheimer’s. The most effective medicines may slow the symptoms by a few months, but the inevitable progression always happens in the end.

 

A new paradigm shift, however, offers promise for methods to prevent and treat Alzheimer’s disease. The paradigm shift is that Alzheimer’s may be Type III Diabetes.

 

To understand this relationship, it helps to understand the basics about diabetes, blood sugar, and insulin. Insulin’s job is to signal cells to take sugar out of the blood and convert the sugar into energy. When a person has diabetes, the cells no longer listen to insulin, so the body needs to produce more and more insulin to get the message across.

 

As the efficiency worsens, the body can’t keep up, the blood sugar rises and diabetes develops. This causes two main problems:
 

  • Insulin levels rise sky high. Since insulin is a fat storage and pro-inflammatory hormone, higher levels equate to deterioration of overall health.
     
  • Blood sugar levels increase to dangerous levels. This can eventually lead to heart disease, vascular disease, kidney disease, vision loss, neuropathy, and other serious conditions.

 

It turns out that brain cells can become resistant to insulin as well, thus drawing a connection between diabetes and Alzheimer’s. The theory is that increased insulin and increased sugar in the brain leads to damage of brain cells and eventual dementia.

 

The Connection Between Alzheimer’s and Diabetes

 

Medical science is starting to explore the relationship between diabetes and dementia and is drawing a strong connection. One study, for instance, reviewed previous investigations of diabetes and dementia, accounting for over 2 million subjects. The study concluded that those with diabetes were 60 percent more likely to develop dementia.

 

While an association does not prove causation, it does raise an interesting potential link that deserves further exploration.

 

The next question is whether there is a reasonable explanation for why the two diseases might be related. And it turns out there is.

 

Another study demonstrated that individuals with type II diabetes are more likely to develop the same “brain tangles” that are seen in those affected with Alzheimer’s. It is thought that these tangles are directly responsible for the progressive cognitive decline. And they are present in both the brains of individuals with Alzheimer’s disease, and the brains of those with diabetes even in the absence of dementia.

 

How to Prevent Diabetes, and possibly Alzheimer’s

 

This emerging research could be discouraging news since the incidence of diabetes is on the rise, with an estimated increase from 285 million cases worldwide in 2010 to 439 million in 2030.  The result could be an equal surge in new Alzheimer’s cases.

 

Or it could be encouraging news, since type II diabetes is almost entirely preventable with healthy lifestyle habits. Presumably, these same habits may help prevent Alzheimer’s as well.

 

In fact, a 2001 study in NEJM suggested that 90 percent of type II diabetes cases could be prevented with:
 

  • Proper exercise
  • Healthy eating
  • Not smoking
  • Maintaining a healthy bodyweight

 

 Another study showed that a lifestyle program that included 150 minutes of weekly physical activity and a goal of 7 percent weight loss prevented diabetes better than the popular drug Metformin—an oral diabetes medicine that helps control blood-sugar levels.

 

Finally, a 2012 study followed 2,700 people over three years and found those who ate a diet higher in carbohydrates and sugars and lower in protein and fat were more likely to develop dementia.

 

This information shows that diabetes, and by extension Alzheimer’s disease, may be preventable by following a healthy lifestyle that includes these elements:
 

  • Exercise 150 minutes per week and remain physically active throughout the day
  • Maintain near ideal body weight
  • Eat a real-foods, vegetable-based diet with healthy fats
  • Avoid simple, refined carbohydrates
  • Avoid added sugars in food and drinks

 

A Healthy Lifestyle Is Necessary

 

Unfortunately, this is not hot-off-the-press news. These studies were published over 15 years ago, yet many people are still reluctant to adopt such healthy practices. In fact, one study of American adults found that only 2.7 percent of the subjects followed a truly healthy lifestyle.

 

The public shouldn’t need more inspiration to strive to be healthy, but knowing that Alzheimer’s disease and diabetes are likely preventable will hopefully be enough motivation to spark a revival for healthy lifestyles now and for decades to come.

 

Change doesn’t come easily, so start by making simple steps and find a support system that will help you adopt new ways of living.

 

Those in positions of influence (doctors, nurses, personal trainers, nutritionists, health coaches, chiropractors, and other medical professionals) need to actively educate society about the association between Alzheimer’s and diabetes.

 

If you fall into this category, it’s important to learn how to inspire individuals to adhere to healthy life habits, which may help prevent one of the most devastating conditions that touches the lives of tens of millions Americans every year.

 

Now that’s empowering.

 

Thanks for reading.

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

ACTION ITEM:

Make 1 meal this week a Vegetable Based meal. Don’t have chicken with a side of veggies, or salmon with rice and a couple veggies. Make the basis of the meal veggies and add 4-6 oz. of high quality animal protein.  Notice how it looks different, tastes different, and how you feel differently after you eat it. If you can do this, then you can increase it week after week until most of your meals are veggie-based. You will be amazed at how it improves your health and how you feel!

Breakfast, Fasting and Our Health

“Breakfast is most important meal of day.”- Said in a thick eastern European accent by Colossus in the movie Deadpool. The statement has become so ingrained in our society that even a CGI created super hero quotes it as if it were fact.

 

What if I told you breakfast was the most important meal to skip each day? Would you dismiss the comment since it goes against everything you have heard up until now? Well, it turns out, it may be true. And the science backs it up.

 

Science Quality Matters…A Lot

 

First, where did the concept of breakfast being the most important meal come from? Would you believe cereal companies, and other food companies who have a vested interest in more people eating cereal? Yep. Bias and hidden motives over-rides scientific evidence once again.

 

This article in the Guardian is a good summary of how this came to be. Additionally, according to the book Three Squares: The Invention of the American Meal, Abigail Carroll proposes that breakfast used to be comprised mostly of leftovers. There were no “breakfast foods.” It was simply another meal, nothing unique.  But it did not take long for Kellogg’s to start promoting breakfast cereals, and suddenly it was expected that we eat specific “breakfast foods.”

 

What followed was a collection of media talent and poor science to elevate breakfast from just another meal, to “The Most Important Meal of the Day.” In fact, the claims were clear. If you skip breakfast you will have no energy, your metabolism will grind to a halt, and you will suffer from low blood sugar. You will gain weight and over-eat the rest of the day.

 

Unfortunately, these drastic clams were derived from poorly run observational studies. Obese people skip breakfast. Therefore, skipping breakfast must make you obese, right? Not so fast.

 

Could it have been obese people try to reduce calories and therefore skip breakfast?

 

In an observational trial, we can’t prove which theory is correct. All it tells us is that obese people skip breakfast. It tells us nothing about why, and what effect that may have on their health.

 

But cereal marketing firms will jump on that evidence and claim that skipping breakfast makes you obese. That’s scientific hogwash.

 

Better Quality Science

 

Fortunately, we now have randomized trials to investigate these claims. One study demonstrated that eating breakfast had no impact on resting metabolic rate, and another demonstrated that eating or skipping breakfast had no direct impact on weight loss.

 

Not all the science is faulty. The claim that missing meals can slow your metabolism is true, somewhat. It turns out that prolonged starvation of more than three days triggers a survival reflex resulting in a reduced resting metabolism. But that goes way beyond simply skipping breakfast. In fact, resting metabolic rate INCREASES in the first two days of a fast.  So if we are only skipping breakfast, it is clear that our metabolism is safe.

 

The Case for Intermittent Fasting (IF)

 

Nail in the coffin. We can now put away the baseless claims that we need breakfast. But that still doesn’t mean we should skip it, right?  Why would we want to skip breakfast?

 

I’m glad you asked……

 

One main reason to skip breakfast is that reducing our insulin and glucose levels allows our body to start breaking down fat stores. To make it sound technical, the concept of skipping breakfast is referred to as intermittent fasting, and it comes with numerous potential benefits.

 

In addition, some scientists believe intermittent fasting is the closest thing to the fountain of youth. It turns out that calorie restriction has increased survival in all sorts of animals, and shows promise for humans as well. But who wants to severely restrict their calories every day? In modern day society, that becomes nearly impossible.

 

Enter intermittent fasting. IF allows us to experience the physiological effects of calorie restriction without having a critically negative impact on our social existence.

 

Here is how it works. You set up an “eating window,” noon to 7pm, and a “fasting window,” 7pm to noon the next day. The key is that our bodies don’t enter a true fasting state until more than 10 hours after our last food intake. This is the point where our glucose and insulin levels are low enough to allow for lipolysis (the body breaking down fat stores for energy instead of using glucose circulating in the blood). In the above example, the fasting window is 17 hours, thus giving you 7 hours of fat breakdown. There are other versions of IF, but this is the one that I have seen works best for most people.

 

Food Quality Matters…A Lot

Now that I have made the case for trying intermittent fasting, I should be honest and tell you that intermittent fasting will not work for most of you.

 

Not until you improve the quality of what you eat.

 

If you eat mostly carbohydrates, simple sugars, and processed foods, then you don’t stand a chance. These foods cause rapid spikes and falls in glucose and insulin, throwing you into a cascade of hunger and cravings without a chance at extending the time between meals.

 

So, before you try IF, make sure you are eating nutrient dense, low sugar foods. Focus on lots of veggies, healthy fats (nuts, olive oil, avocados), appropriate proportions of animal fats and proteins, and a small amount of complex carbs. Once you do this, IF will be easily manageable.

 

Tips

 

  • Choose your IF days carefully. Make sure you will have control over the timing and food content of your first meal. You don’t want to get stuck eating “whatever is around” when you are hungry at 1pm after an 18hour fast. For best results, that first meal needs to be a healthy, nutrient dense meal low in simple carbohydrates and sugars.
  • Give it time! The first few times you experiment with IF, you may feel hungry and feel like you can’t survive. That feeling quickly passes with physical and psychological adaptation.
  • The initial psychological barrier to IF seems imposing. In reality, it’s simple to implement and stick to. Once you get over the initial hurdle in your mind, you will see.
  • Embrace the psychological benefits. IF allows you to know that you are in control of your feelings of hunger. You do not have to react to every small pang of hunger or food craving. You are in control, not the food.

 

 

So, Colossus should have said, in his thick Eastern European accent, “Breakfast is most important meal of day to skip. If you want.”

 

Don’t get me wrong.  A few days each week, I look forward to my big plate of leftover veggies, spinach and kale over two eggs and a sprinkle of grass-fed cheese. It’s a great way to start the day. And the other three-to-four days, I look forward to skipping breakfast, knowing that I am burning my fat stores, lowering my insulin and glucose levels, raising my HGH, and possibly taking one step closer to the fountain of youth.

 

Give it a try and see what it can do for you.

 

Thanks for reading.

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

Action item:

Pick a day this week when you have complete control over the timing of your lunch. Commit to practice IF that day. Stop eating at 7pm the night before, and don’t eat again until noon or 1 pm the next day. Make sure both of those meals are nutrient dense, veggie based meals with high quality fats and proteins. Expect to feel hungry, and remind yourself that you are in control of your hunger, not the other way around. You can do anything for 1-day. Then pick 2-days for the next week to try again. The more you do it, the more you adapt to it and reap the benefits.

Statins- What do We Really Know?

45 million Americans “should” take statins. Are you one of them?

 

 It may surprise you to find out that you might be. When your doctor plugs your information into a cardiac risk calculator, he or she may tell you that you should to take a statin.

 

You may not feel bad. You may not have many other cardiovascular risk factors. Yet you may be labelled with the “disease” of elevated cholesterol.

 

“New” Guidelines- Questionable Sources, Questionable Guidelines

 

Why are so many more previously healthy Americans now being treated for high cholesterol? We can thank the 2013 ACC/AHA guidelines, which increased the intensity with which physicians prescribe statins.

 

Interestingly, these were not based on any new data. Instead, they were based on new interpretations of old data, much of which has not been made available for third party reviewers. None the less, it is now recommended that physicians consider prescribing a statin to anyone with a 5% 10-year risk of cardiac disease (increased from a previous 20% risk).

 

To me it seems that a recommendation to dramatically increase the use of these drugs should save lives left and right and have almost no down side.  Unfortunately, that is not the case.

 

Don’t get me wrong. Statins are not useless. They can reduce the incidence of heart attacks and strokes. For someone who has never had a heart attack (referred to as primary prevention) we need to treat between 60 and 104 people for 5 years to prevent one heart attack without any significant difference in the risk of dying.

 

That’s a little underwhelming, is it not? That seems like a “shotgun” approach where you send a hundred bullets out knowing that one will hit the right person (in this case getting hit by a bullet is a good thing). It doesn’t have to be this way.

 

In addition, statins are not perfect drugs. For every 50 people treated over five years there will be one new case of diabetes. There will also be at least 10% risk of muscle aches and pains with potential damage to the mitochondria (the energy producing part of the cell), and may even be linked to onset of dementia and memory dysfunction.

 

A system that potentially harms more people than it helps doesn’t seem like a viable solution to me. We can do better.

 

Better Define Your Risk

 

The problem is that our medical culture emphasizes prescribing drugs more than further defining your risk, and more than exploring alternatives to reducing your risk.

 

The current cardiac risk calculator uses:

  • Age
  • Gender
  • Race
  • Total cholesterol
  • HDL
  • Blood pressure or previous diagnosis of hypertension
  • Diagnosis of diabetes
  • Smoking status

 

Those are all reasonable initial risk factors to evaluate. But doesn’t it make sense that if we are using a drug that will only benefit one in 100, maybe we should try to further define those at high risk? To me that is a no-brainer.

 

For instance, one study showed that by measuring a coronary calcium score on statin eligible individuals, we could reclassify 50% of them so that they no longer “qualify” for statin treatment. We can avoid an enormous number of statin prescriptions with one simple test. A test that is readily available now. A test that has minimal risk (very low radiation dose, and a small chance of incidental findings), and is relatively low cost (about $100).

 

And we don’t have to stop there.

 

The Scripps Research Institute has developed an app to allow people to use their genetic information to better define their risks. This could potentially be used to define those who are not at high genetic risk for heart disease and therefore would likely not benefit from statin therapy.

 

Now we are starting to get somewhere. What if we could better define cardiac risk so that one in 5 people benefit from a statin, as opposed to the current 1 in 100? That is an admirable goal.

 

Even Better Than A Statin

 

Once we better define our risk, let’s not forget all the alternative to statins.

 

One recent study demonstrated that even those at the highest genetic risk for heart disease can cut their risk in half with healthy lifestyle habits (eating healthy, getting regular physical activity, not smoking and not being overweight). And that was the highest risk group! That’s likely just as good as, if not better than, a statin could do.

 

So why don’t we write prescriptions for intensive healthy lifestyle education programs instead of drugs?

 

Lifestyle changes are “harder.” Lifestyle changes take longer to see results. Lifestyle changes require more education, encouragement and follow up.

 

Do you know what else is associated with healthy lifestyle changes? Decreased risk of heart attack, strokes and death. Decreased risk of diabetes, high blood pressure and depression. And the only side effects are feeling better, having more energy, and being in control of your health.

 

That sounds like something that is well worth the extra work, the needed patience, and the more vigorous follow-up. Don’t you agree?

 

Start Asking Questions

 

So, what should you do if your doctor recommends a statin? Start asking questions. Lots of them.

  • How high is your calculated cardiovascular risk?
  • How much will a statin reduce that risk?
  • What else can be done to better define your risk (i.e. coronary calcium score)?
  • What else can be done to lower your risk (i.e. intensive lifestyle modifications)?

 

Ask yourself questions as well.

  • How can I improve my nutrition to focus on a vegetable based, real food, Mediterranean style eating that focuses on healthy fats and appropriate proportions of high quality animal products?
  • How can I improve my daily physical activities in addition to increasing my weekly exercise?
  • How can I improve my stress management and sleep habits?

 

Remember, the benefits of statins are small. Not zero, but small.

 

Also, remember that statins have not been directly compared to healthy lifestyle habits. We don’t know if they add anything to a comprehensive lifestyle modification program. In fact, I would wager that if you have healthy eating habits, you get regular physical activity, you exercise regularly, and you practice regular stress management, then statins will not reduce your cardiovascular risk at all.

 

It may seem like a bold prediction, but to me it seems obvious.

 

Unfortunately we will likely never see a head-to-head study between statins and healthy lifestyle interventions (I discuss the specifics of the study I would like to see in my prior blog post here).

 

We can do better than a drug

 

In the end, remember that we can do better than drugs. We can be in control of our health. We can achieve real health that is not dependent on blood tests or medications.

 

So, don’t blindly accept a prescription for a statin (or any drug for that matter) without further defining your risk, and without further exploring your alternatives. You and your health deserve at least that much.

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

Action Item:

If you are on a statin, or any drug for that matter, make sure you ask your doctor why you are on it, exactly what benefit you should expect, and what the potential short- and long-term side effects are. Also, ask what the alternatives are, specifically regarding your lifestyle and healthy habits. If you aren’t getting adequate answers, ask me! info@drbretscher.com. I welcome your emails. 

Bret Scher, MD FACC

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