Does Weight Loss Depend on Calories or Hormones?

 

Why do people have such a hard time losing weight? Anyone who has tried it before knows the challenges. It frequently goes one of two ways:

  1. Initial success followed by a stall and eventual regaining of the weight leading to frustration and giving up.
  2. Difficulty changing habits enough to see a meaningful difference. Life seems to get in the way to prevent success.

 

Let’s be honest. There are numerous ways to lose weight. You can hardly go on the internet without seeing an ad for a magic weight loss solution or the one food you need to finally burn that belly fat.

 

As long as we are being honest, let’s also acknowledge that those don’t work. Ever.

 

The seemingly elusive weight loss holy grail would look like this:

  • We can easily maintain for years if not decades- it’s enjoyable!
  • Helps us maintain a healthy weight- losing mostly fat while preserving muscle
  • Helps improve our overall health, longevity and health span

Low Carb vs Low Fat Diets

 

If you have read some of my prior posts, you know where I am going with this. I think a low carb high fat (LCHF) lifestyle is likely the closest thing we have to the holy grail.

 

This isn’t just my opinion. As presented by DietDoctor.com, there have been 60 studies comparing LCHF vs low-fat diets for weight loss. The running score board shows 30 wins for LCHF, 30 ties, and exactly zero wins for the low-fat diet.

 

I’m the first to admit nutritional science is messy and we have to be careful with interpreting the data. But when there have been 60 studies and a low-fat diet has not been more beneficial in a single one, that speaks volumes.

 

This leads us to the next question:

 

Why is an LCHF diet better for weight loss?

 

Some would counter: Does it matter why? If we know it works, people enjoy the lifestyle and feel good on it, and we have evidence that it improves diabetes, metabolic syndrome and cardiovascular risk factors, then what more do we need to know?

 

This is where the science gets murky regarding two theories for weight loss

 

1.    Calories in/Calories out.

This theory states that weight loss is a simple equation. Take in fewer calories than you expend and you will lose weight. If you burn 2000 calories in a given day, then it doesn’t matter if you take in 1500 calories of bread, pasta, soda, cake, cookies, or vegetables and steak. You will lose weight. Period.

 

2.    Carbohydrate-Insulin Model.

This theory states that the hormonal response to calories is more important than the absolute number of calories. Simply put, insulin resistance and hyperinsulinemia prevent us from losing weight. Insulin’s “job” is to shuttle glucose into cells and prevents us from breaking down our fat stores, thus impairing weight loss attempts.  By following a LCHF diet, we can lower insulin levels, improve insulin resistance, and allow our body to break down fat stores and lose weight in a healthy and sustainable way. Absolute calories matter little in this theory.

 

Studies Around LCHF Diets

 

A series of trials funded by NUSI recently caused waves of controversy regarding the mechanism of LCHF diets and the carbohydrate-insulin hypothesis.

 

The Ketogenic Diet Study

 

The first study published in 2016 investigated 17 overweight men and their response to two diets. For the first 4-weeks they ate a “high-carbohydrate baseline diet,” followed by 4-weeks of an isocaloric ketogenic diet. Each week they spent two days in a metabolic ward where investigators measured everything they consumed along with their resting energy expenditure.

 

In theory, if our insulin response is the primary driver of weight loss, then our resting energy expenditure should increase on a ketogenic diet as a reflection of breaking down our natural fat stores for use as fuel.

 

Here are the basic highlights of the study:

  • Subjects lost weight on both the control diet and the ketogenic diet
  • Fat loss continued but slowed after transitioning from baseline to ketogenic diets
  • Resting energy expenditure increased on the ketogenic diet by about 100kcal/day.

 

Now comes the interesting part. How do we interpret these results? Resting energy expenditure went up on the ketogenic diet, suggesting the carbohydrate-insulin model works, right?

 

Not so fast. The lead author of the study, Kevin Hall, concluded that his study disproves the CIM, claiming that the resting energy expenditure change wasn’t high enough. As part of their research protocol, they estimated the dietary change should have resulted in a difference of between 300 and 600kcal per day. So even though the trial “worked,” it fell short of expectations.

 

Kind of like if Amazon predicted a 20% revenue increase for the quarter. When their increase is only 15%, their stock price falls, even though their revenue still went up!

 

To be honest, this is where I tune out.  Switching to a ketogenic diet lowered insulin and increased resting energy expenditure. What’s wrong with that? That sounds like a good result to me.

 

The Healthy Low-Fat Diet Study

 

Which brings us to the second trial.  I wrote about this trial shortly after it was published, and will summarize it again here.

 

600 subjects were randomized to a “healthy low fat” or a “healthy low carb” diet (this was not a ketogenic diet as they ended up eating 130gram carbs per day). Both groups were advised to maximize veggies, minimize sugars and processed flour, minimize trans fats, and focus on nutrient dense whole food prepared mostly at home.

 

In the end, both groups lost the same amount of weight, and they saw no difference in genetics related to fat metabolism and insulin sensitivity. Does this also disprove the CIM and show restricting carbohydrates is of no value? Does it mean we can support drinking sodas and eating cookies as long as we keep our calories low?

 

This study compared a control diet is much healthier than what most Americans eat (remember, they still restricted sugars and flour and focused on home prepared nutrient dense meals), to a moderately low carb diet (not a very low carb ketogenic diet). In the end, it was not well formulated to answer the question of the CIM. But it does add to the ongoing score card of 30 wins for low carb, 30 ties, and zero wins for low fat.

 

Again, this is where I tune out of the debate.

 

I am a cardiologist. I care about what is going to help the client I am working with at that exact moment. These clients don’t live in metabolic wards where their meals are provided for them, and they don’t exist in study formats where they know they are under constant observation.

 

Dieting in the Real World

 

My clients live in the real world just like you. Thus, I care about what works in the real world.

 

In the real world, we cannot ignore human behavior and psychological responses to food. Robb Wolf’s book Wired to Eat is one of the best resources explaining the minefield we encounter on a daily basis, how carbohydrate rich foods stimulate our brain to crave more, how food companies purposely create foods we cannot resist, and how why we eat may be more important than what we eat.

 

In this environment, does your brain care if the carbohydrate-insulin model has scientific backing or not? No way. It just wants its reward centers triggered by the next chip/cookie/cracker.

 

Don’t get me wrong. How we interpret science is important.

 

As long as people feel calories in/calories out is the only answer, Coca Cola can keep promoting their sugar filled drinks and Nabisco can keep promoting their sugar filled snacks as part of a healthy diet, just so long as we exercise enough to burn the calories.

 

How has that worked for us so far? Just look at our obesity and diabetes epidemics to answer that question.

 

I strive to find a balance between the science and the practical question of what really works for most people.  Hunger, energy, mood, cravings and enjoyment are very powerful motivators. For that, I have found nothing more effective than an overall healthy lifestyle which incorporates a LCHF diet.

 

 

Thanks for reading

 

Bret Scher, MD FACC

www.LowCarbCardiologist.com

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

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

 

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

 

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

 

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

 

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

 

 

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

 

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

 

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

 

2-    Eating Fat Improves Your Cholesterol!

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

      5-    Keto helps you with fasting.

 

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

 

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

 

6-    LCHF Promotes Health Through Increased Autophagy.

 

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

 

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

 

7-    With Keto You Will Enjoy Eating Again!

 

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

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

 

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

 

Is LCHF/Keto the right lifestyle for you? It just may be. It is for me, The Low Carb Cardiologist, and it is for most of my patients and clients. Want to learn more about how LCHF lifestyle impacts your health? Visit us at www.LowCarbCardiologist.com

 

Thanks for reading

 

Bret Scher, MD FACC

Founder, Boundless Health

www.LowCarbCardiologist.com

 

 

My Journey to The Low Carb Cardiologist Podcast

My Journey to The Low Carb Cardiologist Podcast

 

Sometimes change is hard, and sometimes it just feels right.

 

Changing my podcast from The Boundless Health Podcast to The Low Carb Cardiologist Podcast was a little of both.

 

To be fair, this wasn’t exactly the biggest, most impactful decision I have made lately.  The perspective is not lost on me. It’s a podcast name, not heart surgery.

 

But it was meaningful for me personally, and it exemplifies the current atmosphere of health and nutrition, and that is why it is worth exploring with you.

 

I still remember when I started my podcast. I was so afraid that I wouldn’t get any guests, that I was simply happy anyone would agree to come on the show and talk to me! As soon as the interview started, I was so grateful they were there, I just wanted to support them and thank them for their time.

 

But that doesn’t do much for challenging them, or digging deep to determine fact from fiction, or deciphering reasonable recommendations from those that are…..well…..let’s just say not as reasonable. Luckily, my friend HD from HormonesDemystified.com was there to set me straight.

 

HD helped me focus on my relationship with my listeners, and helped me realize that my listeners were my primary responsibility. My job wasn’t to give my guests the best experience. My job was to give my listeners the best experience, and to give them the best information I could.

 

With a clearer mission, I set out to refine my role and my niche.

 

That is where nutritional and health science started to look more like religion to me.

 

When I interviewed a vegan, I got push back from my low carb supporters wondering how I could support his views. When I interviewed a meat proponent, those who appreciated my vegan interview were up in arms about my hypocrisy.  They felt as if I had misled them.

 

What I failed to get across was that my interviews were not about me! These interviews were supposed to tease out the nuances of my guests’ viewpoints, to help determine what is backed by science, what is backed by emotion, and what can we learn from it. Yet many listeners equated my guests’ opinions with my own, and thus were upset at me for supporting both a vegan and a meat advocate. They were left wondering what I stand for.

 

I understand this does not encapsulate everyone. But it does highlight the world in which we live. Far too many people hold so strongly to their nutritional and health beliefs that they cannot bear to listen to the “other side” or even consider an opposing view point. The importance of detail, nuance, and scientific integrity is far too easily lost in the emotion and vigor of belief. And that is a sad reality for the world of reason, debate and scientific “truth.”

 

Which brings me back to the name of my podcast. What do I stand for? Which side of the aisle do I sit?

 

I believe some people can be healthy as vegans. I believe some people can do well restricting their fat intake and focusing on calories.

 

I also believe that the vast majority of people cannot achieve their health goals limiting fat and counting calories.

 

The most generalizable and most effective intervention that I have seen in the past 20 years is without out a doubt the low-carb lifestyle. Thus, the change to The Low Carb Cardiologist Podcast. No confusion there. My guests and my listeners know where I stand.

 

But that doesn’t mean I am going to stop looking at differing views, or trying to find the common ground between healthy vegans, healthy carnivores, and everyone in between. I will continue to tease out the nuances behind endurance athletes, crossfitters, and power walkers.

 

We all need a reminder to look outside our field of view (me included!), to go outside our comfort zone, and to explore the “other side,” even if it is simply to help us feel stronger in our convictions. The exploration is part of the process.  

 

My promise is that I will continue to explore health from any and every angle that I think will help you, my listener, improve your health for a lifetime of Your Best Health Ever!

 

The name has changed, but the mission remains the same.

 

How can I help you on your health journey? Please visit me at www.LowCarbCardiologist.com  and let me know how I can best help you achieve your health goals, or feel free to provide feedback about what you would like to see from The Low Carb cardiologist in the future.

 

Thanks for reading!

 

Bret Scher, MD FACC

Founder, Boundless Health

www.LowCarbCardiologist.com

 

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

 

The War Against Wheat- Will Our Health Win?

The War Against Wheat

 

What’s at the base of your food pyramid? Is it whole grains? Have you ever stopped to ask why?

 

As we know, whole grains are the base of just about every “healthy” food pyramid. The American Heart Association recommends at least 3-5 servings of whole grains per day for optimal healthy nutrition. It’s simply accepted that whole grains are good for us.

 

So why are so many waging a war against whole grains?

 

Just look at the bestsellers on Amazon and you will find Wheat Belly, by Dr. William Davis, Grain Brain by Dr. David Perlmutter, plus a slew of books promoting low carb nutrition. Do they know something the AHA doesn’t?

 

It turns out, they just might.

 

It is time to start asking the questions, how do we know whole grains are healthy? What’s the evidence?

 

First, people living in Blue Zone communities (those where people routinely live the longest) eat vegetables fruits, nuts, seeds, legumes and whole grains. Since they routinely have better health than most other populations, that must mean whole grains are healthy, right?

 

Not so fast. People living in the Blue Zones also sleep 8 hours per night, they get regular physical activity, they have close social connections, they enjoy life and have a purpose for waking up every day, and they do not eat many sugars or processed junk food.  Plus, they eat vegetables, fruits, nuts, seeds and legumes.

 

How could we possibly say the whole grains themselves are what keeps them healthy? Are they healthy because of the whole grains? Or does the rest of their healthy activities outweigh the unhealthy effects of the whole grains?

 

Luckily, we have studies that tried to answer that question.

 

Studies looking at replacing white flour with whole grains consistently showed health improvements in those easting whole grains. Easy answer. Whole grains must be healthy.

 

Again, not so fast. That only tells us that whole grains are healthier than processed white flour. That should not be a surprise. Said another way, they are less bad than white flour.

 

But are they healthy? Or are they necessary?

 

It turns out, grains are not necessary at all for health or for survival. You heard that right. Fats and proteins are considered essential nutrients. Our bodies cannot make all the fats and proteins we need, so we must eat them. That Is not the case for grains and carbs. Our bodies get all the fuel they need from converting fats and proteins to glucose or other fuel sources such as ketones.

 

OK. We have established that grains are not necessary. But do they add anything to a diet consisting only of fats and proteins?

 

Fiber. The whole grains that show the greatest health benefits, compared to white flour, are those with the highest fiber-to-carbohydrate ratio. That makes sense. Fiber is a key component to healthy eating, and whole grains can be a good source of fiber.

 

Lucky for us, we have a bounty of choices from where we can get our fiber. Vegetables, fruit, nuts, seeds and legumes are fantastic sources of fiber. If fiber is our goal, we once again see that grains are not necessary.

 

But are they harmful? Listening to William Davis, and reading his book Wheat Belly, will certainly convince you that they are.

 

For some, the answer is clear. If someone has celiac disease, or gluten sensitive enteropathy, the proteins in wheat cause an autoimmune reaction that attacks their intestinal lining. There is no question that they need to avoid wheat and grains.  

 

What if someone does not have celiac disease? Some are still sensitive to gluten or other elements of grains (some studies show it may be other components of grains called the FODMAPs instead of the gluten). Although there is no clear diagnostic test for this, we can subjectively test it very simply. Go for 30 days without wheat and grains and see if you feel better. Do you have more energy? Do you feel less bloated? Less achy? Do you sleep better? Do you think more clearly? If the answer is yes, then you too should avoid wheat and grains.

 

So far, this should be pretty intuitive.

 

But what if you do not feel any better off grains? Is there still a reason to avoid them?

 

At this point we need to better define our enemy. Is gluten inherently evil for everyone?

 

No.

 

Well then, are FODMAPS inherently evil for all?

 

No.

 

Is there something that is evil for all?

 

Maybe.

 

It’s true that we do not all need to avoid gluten. In fact, gluten-free foods may be far worse for our health than gluten containing whole grains. A recent study suggested that low fiber, gluten free foods increased heart disease risk compared to higher fiber whole grains. Again, this proves whole grains are less bad than something really bad. That makes sense.

 

But wheat, grains and flour are not comprised of only gluten. They are a mix of carbohydrates and other grain proteins.  And what do those carbohydrates do? Raise your blood glucose and insulin levels. “Healthy” whole grains have a glycemic index on par with a snickers bar!

 

Admittedly, glycemic index is not a perfect measure, but it is an accurate assessment of how quickly and strongly a food induces a glucose (and subsequently, an insulin) spike in your blood. For reference, white bread has a GI of 73, 100% Whole Grain Bread 51, Coca Cola 63, Snicker’s 51, oatmeal 55, cashews 22, broccoli 10, and cauliflower 10. Also for reference, spinach, salmon, beef, chicken and eggs have a GI of zero.

 

Do you see a pattern? Food that comes from wheat and grains, no matter how “Whole,” significantly raise our blood sugar and insulin. Real food, vegetables, meats, etc. do not.

 

Our bodies were never meant to eat grains or wheat. The agricultural revolution and production of wheat and grains has only existed for less than 0.1% of our evolution.

 

Some would argue that is enough for us to avoid them.

 

That’s not supported by evidence. But it does make sense (remember, this is an article on health, not about the economics of agricultural wheat production, government subsidies, worldwide famine or other issues outside larger than I care to tackle).

 

Again, the question comes back to, why are we eating them? Not because of physiological need. Not for health (as long as we can get fiber elsewhere).

 

We eat grains and wheat for taste, for convenience (since our society has evolved into a grain-centric society), and possibly for addiction (or at least a stimulated craving).

 

Health does not factor into the “Why.” If we believe Hippocrates who said, “Let food be thy medicine and medicine be thy food,” then our perspective of why we eat has to change. Everything we eat either helps our health, or hurts it. For that reason alone, I would argue that we should avoid wheat and most grains. I can’t defend it with solid research, but I can defend it with the often dangerous, “It makes sense.”

 

That’s enough for me. Is it for you?

Simple Salad Recipes

You don’t have to be a chef extraordinaire to put together a tasty and filling salad! You might need an easy go to lunch or something to complement your dinner but you’re overwhelmed by all the complicated recipes online. These simple salads are made up of only 5-6 ingredients and feature healthy options for salad dressings that you can make from your own kitchen. If you’ve got a busy schedule this week, try mixing together a larger batch of each salad, double the dressing recipe and set aside the dressing and salad mix in Tupperware to take with you on the go! 

Greek Salad 

Ingredients:

2 chopped heads of romaine lettuce
1/2 sliced purple onion
2 sliced roma tomatoes
1 sliced cucumber
1 cup sliced Kalamata olives
2 tbsp feta 

Greek Salad Dressing:

1/2 cup olive oil 
1/4 cup red wine vinegar
1/2 teaspoon Dijon mustard
1 minced garlic clove 
1 teaspoon dried oregano
1/2 teaspoon salt 
1/2 teaspoon pepper

Walnut & Strawberry Spinach Salad 

Ingredients:

2 handfuls of fresh spinach
1 cup sliced strawberries 
1/2 cup chopped walnuts 
1/4 cup crumbled goat cheese

Balsamic Vinaigrette Dressing:

1/2 cup olive oil
1/4 cup balsamic vinegar
1 tablespoon Dijon mustard
1/2 teaspoon salt
1/2 teaspoon pepper

Italian Mixed Greens Salad 

Ingredients:

2 handfuls of mixed greens 
1 cup halved cherry tomatoes 
1/2 cup sliced black olives 
1 cup garbanzo beans 
1/2 chopped purple onion

Italian Salad Dressing:

1/3 cup olive oil
1/3 cup white wine vinegar
1 teaspoon lemon juice
1 teaspoon honey
1 teaspoon dried oregano 
1 teaspoon dried parsley
1 teaspoon dried basil
1/2 teaspoon pepper

Also,  try adding your favorite protein to any of these salads and make sure to let us know which is your favorite! 

Photo Cred: Food Network, Cookie+Kate, WeightWatchers

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

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

 

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

 

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

 

First my usual disclaimer.

 

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

 

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

 

The Study

 

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


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

 

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

 

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

 

What can we make of all this?

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

There is Another

 

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

 

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

 

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

 

Should anything change from these studies?

 

Yes and no.

 

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

 

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

 

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

 

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

 

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

 

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

 

My advice?

 

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

 

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

 

Thanks for reading

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

 

 

 

 

How to Incorporate More Superfoods Into Your Nutrition

Achieving your best health ever a lot easier when you incorporate superfoods into your nutrition. But what are superfoods? Superfoods are considered nutritional powerhouses because they are low-calorie whole foods that pack loads of nutrients into every bite.

Ready to expand your palate? Not all superfoods are as exotic or hard to find as you think! Here are 6 everyday superfoods you should try, plus easy ways you can fit them into your healthy eating plan.

Almonds

Why it’s super: When it comes to weight loss, almonds and other nuts often get a bad rap for their high fat and calorie content. But almonds are a rich source of heart-healthy, unsaturated fats—just be sure to eat them in moderation. Not only are they nutritionally dense, almonds are a good source of fiber and protein, plus minerals, like iron, magnesium, and calcium.

How to enjoy it: Grab a small handful (about 100 calories) and pair them with a serving of dark chocolate for a delicious afternoon snack. Or try sprinkling slivered almonds over your salad for a crunchy alternative to croutons.

 

 


Kale

Why it’s super: Kale is a cruciferous vegetable that’s bursting with nutrients. In fact, kale is more nutrient-dense than nearly any of other whole food. It’s packed with antioxidants like carotenoids, flavonoids, and isothiocyanates, which may lessen the risk of certain cancers. It’s also a fantastic source of vitamin A for eye health, fiber for a healthy gut, and omega-3 fatty acids for blocking inflammation in the body.

How to enjoy it: Serve sautéed kale with caramelized onions as a side dish for dinner. Or liven up lunch by tossing raw kale into your salad. 

 

 

Apples

Why it’s super: Crunchy, delicious, and easy to munch on when you’re on the go. What’s not to love about apples? They’re chock-full of antioxidants and other health-promoting nutrients that help the body to fight inflammation and many chronic diseases. Eating the fruit whole, rather than juiced, can aid in blood sugar control and may lower the risk of developing type 2 diabetes. Plus, they contain soluble fiber, which promotes weight loss because the stomach will feel fuller for longer.

How to enjoy it: Eat whole as a hand fruit or add apple chunks to your fruit cup for a savory snack. You can also pair apples and cheese as healthy party appetizers.

 

 

 


 

Garlic Cloves

Why it’s super: Garlic is often used to make prepared foods taste better, but it has also been used as a plant-based medicine for thousands of years. Garlic contains bioactive sulfur compounds that have the potential to fight certain cancers, such as those in the breast, stomach, or colon. It can also be used to treat metabolic diseases like diabetes and cardiovascular diseases like arteriosclerosis and hypertension.

How to enjoy it: Purée fresh or roasted garlic cloves and add them to homemade hummus dips, sauces, and soups!

 

 

Avocados

Why it’s super: Not only are avocados teeming with vitamins and minerals, they may help to boost the absorption of nutrients from other whole foods as well—meaning you get double the health benefits. Avocados are a good source of healthy fats that promote weight loss. And because avocados are a high-fiber fruit, they naturally increase good cholesterol levels (HDL) and lower bad cholesterol levels (LDL).

How to enjoy it: No matter how you take your eggs, add a few slices of avocado to your plate for a powerhouse breakfast. Or try substituting mayo on your sandwich for slices of creamy and buttery avocado. 

 

Dark Chocolate

Why it’s super: A nibble of dark chocolate a day may play an important role in helping the mind age well. That’s because dark chocolate is powered by cocoa flavanols, which promote healthy blood flow and the delivery of oxygen and nutrients to the brain. Better circulation also leads to improved cognitive function and can enhance learning, memory, and focus. And good circulation may lower the risk of stroke by encouraging the heart to maintain a healthy blood pressure.

How to enjoy it: As an occasional treat, a square or two of dark chocolate can be a tasty way to indulge a craving without the guilt. You can also mix dark chocolate cocoa powder with Greek yogurt for a high-protein snack that will fuel your body after a workout. 

 

 

 

Superfoods may be good for you, but the magic happens when you make them part of a well-balanced diet. Be sure to eat a variety of fruits, vegetables, whole grains, fats and proteins, and other foods to get all of the nutrients your body needs. How will you work more superfoods into your meals and snacks? Let the community know in the comments below!

 

 

Cauliflower Mac & Cheese by Nourished Balance

When you're first implementing healthier alternatives to your diet and nutrition, you can start to have some serious cravings for those go-to meals you used to make on a regular basis. This is especially true for those comfort foods we crave after a long day, like a big bowl of mac & cheese. This is why we love this recipe here at Boundless Health, it's the perfect healthy alternative to your classic mac & cheese that still satisfies your appetite for something cheesy and delicious. Thank you to Nourished Balance for our favorite "mac & cheese" recipe! 

Cauliflower Mac & Cheese 

Ingredients

  1. 5 cups cauliflower florets, cut into bite size pieces
  2. Sea salt and pepper to taste
  3. 1 cup coconut milk
  4. 1/2 cup chicken stock (or homemade broth)
  5. 2 Tbsp coconut flour
  6. 1 organic egg, beaten
  7. 2 Tbsps Nutritional yeast
  8. 2 cups organic mozzarella cheese

Instructions

  1. Preheat oven to 350. Grease a baking dish with unsalted butter
  2. Place cauliflower pieces in steamer basket, add a pinch of salt. Steam until al dente (not too soft, not too hard)
  3. Spread cauliflower pieces evenly at the bottom of the baking dish
  4. In a saute pan over medium heat, heat up the coconut milk- add a pinch of salt and pepper
  5. Add the broth and keep stirring- then add the coconut flour heat until simmering
  6. Take pan off the heat, add the egg and nutritional yeast to the sauce and stir with a fork until well incorporated
  7. The sauce will thicken- pour over the cauliflower. Add the cheese evenly and bake for 35-40 minutes.
  8. Turn the oven onto broil for 3-5 minutes to get a nice brown coloring on top.

And don't forget to eat mindfully so you truly enjoy each bite of this savory meal! 

Bret Scher, MD FACC

Dr. Bret'sExclusive Wellness

Newsletters

Receive valuable articles and tips to help
you achieve your best health ever!

Final Step

Where should we send your FREE

Exclusive Wellness

NEWSLETTERS

858-799-0980Dr Bret Scher