New Hypertension Guidelines- Lifestyle over Drugs? Or another victory for Big Pharma?

Can half the population have a single disease?

 

First, we were told that half of all Americans have type II diabetes or pre-diabetes. Now we are told that almost 50% of Americans have hypertension (elevated blood pressure) too. Could it be true?

 

That depends who you ask.

 

The American Heart Association (AHA) published new hypertension guidelines during their annual meeting November 2017. These guidelines now classify those with a systolic blood pressure between 130-139 as having hypertension.  That increases the number of Americans with hypertension from 72 million adults to 103 million, a little over 46% of all adult Americans.

 

We should note, however, that the AHA does not have a monopoly on guidelines.

 

The American College of Physicians and the American Academy of Family Physicians still define hypertension as a systolic blood pressure (the top number) of 150 or greater for those over age 60. That means we have to take the new guidelines with a grain of salt (which may not raise your blood pressure). They are the recommendations of one specific organization, not a unanimously agreed-upon decree.

 

The AHA changed their guideline largely on the basis of one particular study, the SPRINT trial. This trial enrolled subjects over age 50 with hypertension and at least one other cardiac risk factor. They sought to determine if using drugs to treat to a blood pressure of less than 120 would be more beneficial than treating to a blood pressure less than 140.  In the end, they determined that it was.

 

After three years, treating subject’s blood pressure more aggressively (with an average of three drugs per subject) reduced the risk of cardiovascular events by 1.6%, a statistically significant difference. That means we need to treat 62 people for three years to prevent one cardiovascular event, pretty paltry evidence in the scheme of things.

 

This 1.6% reduction came at a potential cost. They found that the drugs caused dangerously low blood pressure in one out of every 100 people treated, fainting in one out of every 166 people treated, and significant kidney disease in one out of every 62 people.

 

So, even though the data were statistically significant, it appears that the clinical benefit may be much less impressive. But that isn’t even the biggest issue with the new guidelines.

 

The SPRINT trial was designed with meticulous follow up, something that usually don’t translate to the real world.

 

For example, in the SPRINT trial, researchers measured the blood pressure three times, not just once, and they did this only after the subject had been sitting quietly for at least five minutes.

 

Think about the last time you had your blood pressure measured in the doctor’s office. It was likely after you sprinted in from the parking lot after circling three times white knuckling the steering wheel looking for an open space. Or, it was after checking your watch for the tenth time wondering if they forgot about you since they were over 30-minutes late. You then are led into the room and they immediately take one blood pressure and chart it. Does that sound like we are comparing apples to apples?

 

No way.

 

Subjects in the study were also followed monthly for the first three months and then every three months after that. Is that how often your doctor sees you?

 

Unlikely.

 

Remember all those side effects that were found in the trial? That was with meticulous monitoring of patients and their blood pressure. What do you think will happen if the follow up turns into once or twice per year?

 

Medication-induced dizziness, falls, broken hips and kidney disease.

 

So, if your doctor wants to treat you for hypertension for a blood pressure of 130, insist that you measure your blood pressure at home, multiple times each day, for at least a full week before deciding you have a true “disease” that needs treatment. Blood pressure varies during the day, and we should not label you with a disease based on one measurement.

 

But wait. That STILL isn’t the biggest concern with the guidelines.

 

To their credit, the guidelines specify that those with blood pressure 130-139 should start with lifestyle intervention. Bravo. That is absolutely the way it should be.

 

Does that mean if your blood pressure is less than 130 you don’t need to worry about eating well, exercising, managing your stress and getting adequate restorative sleep? Hopefully we didn’t need to reclassify 30 million Americans as having a disease in order to start talking to them about healthy lifestyles. That should be the main focus of every visit for every patient, not just those who have the label of hypertension.

 

Also, remember the 2013 cholesterol guidelines? They specified that the low-risk group that was now labeled as having the disease of high cholesterol should “begin the conversation about statins.” That quickly turned into doctors grabbing their prescription pads and writing millions of statin prescriptions.

 

Even worse, it usually isn’t long before “quality” measurements and insurance reimbursements are attached to achieving the new goal of blood pressure less than 130. Once that happens, do you think your doctor will patiently work with you to fine tune your lifestyle over the course of months? Or will they reach for the drugs to get you to the target faster and simply check the box that they did it?

 

I love rhetorical questions.

 

That leads to the next issue. The guidelines state that if one fails lifestyle interventions, then drugs are indicated.

 

What does it mean when a patient “fails” lifestyle intervention? How long should that trial be? One month? Six months? And what is the lifestyle intervention? 150 minutes per week of cardio with no mention of resistance training or interval work? A low-fat, low-sodium diet, with no consideration that many people may respond better to a low-carb diet rather than a low-fat diet, and salt may have no impact on your blood pressure?

 

Picture this instead.

 

You bring your home blood pressure log into your doctor’s office. The average is consistently above 130. You have a detailed conversation about your risk for cardiovascular disease, and you agree to be more vigilant with your nutrition, physical activity, stress management and sleep.

 

But it doesn’t stop there. Together, you and your doctor decide what the best specific approach is for you. You then set an email follow up in one month and an office visit in 3 months to check in.

 

If you have not started to progress, you re-evaluate why. Does your nutrition need to change? Maybe you started with a low-fat diet but will actually respond better to a low carb diet. Maybe you are getting your 30 minutes of exercise but are sedentary the rest of the day. Maybe you are still hooked on Ambien and can’t get to sleep. Maybe you need a little more encouragement from a weekly email, or joining an online group, or competing with a friend over your Fitbit numbers.

 

None of those issues should mean you “failed” lifestyle intervention. Instead, they should help you and your doctor fine tune your purposeful lifestyle prescription to find what will work for you.

 

In the end, could you have hypertension? You may. But that doesn’t mean you have a “drug deficiency.” It means it’s time to work together with your healthcare provider to get serious about your lifestyle. In a perfect world, that would already be happening for all of us. If it takes a new guideline to initiate that, so be it. Let’s applaud the guidelines for the attention it will bring to lifestyle interventions.

 

Doctors, just keep the prescription pad in the drawer please.

 

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?

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

 

 

 

 

 

Forget Weight loss – Focus on Your Health First!

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

 

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

 

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

 

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

 

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

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

 

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

 

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

 

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

 

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

 

Why?

 

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

 

Weight loss drugs: Wrong Goal- Wrong Approach

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

The biggest loser? It’s society that loses

 

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

 

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

 

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

 

Here’s a more sustainable alternative

 

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

 

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

 

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

 

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

 

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

 

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

 

  1. Commit to consistent activity

 

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

 

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

 

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

 

  1. Be okay with losing weight slowly

 

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

 

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

 

  1. Reframe your goal

 

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

 

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

 

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

 

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

 

Conclusion

 

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

 

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

 

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

Don’t Invite Me to Your Dinner Party

Don't invite me to your dinner party.

 

Seriously. Don’t do it.

 

If you do, you may feel like I am judging you. Like I am watching your every move, critiquing and grading you.

 

I am not, of course. I wouldn’t think of doing that. But that is how many people feel. Whether it's the third course of the meal when you're already full, or any talk of dessert after you just ate the delicious third course, I can sense the glance in my direction to see how I respond.

 

And don’t get me started on your third beer or third glass of wine or the amazing homemade Challah bread. You feel like I am watching and judging.

 

At first, I was a little disturbed by the perception. Can’t I just be another friend at your dinner party? Can’t you just see me as Bret, and not as Dr. Scher?

 

But now I realize it's a sign of success. Success that you are starting to get the message. Success that you are starting to realize all the unconscious decisions that go into preparing a meal and hosting a party, and you are starting to make them more conscious.

 

Recognizing the automatic lifestyle decisions and giving them serious thought is a tremendous improvement for our lifestyle and our health.

 

That doesn’t mean we cannot indulge on occasion. You can still serve dessert, even if I am at your dinner party. You can still prepare more food than anybody needs to eat, including the homemade Challah.

 

But now you can do it consciously. Not because it is what you always do, or what you think your guests expect. You can do it knowing that it is a special occasion, a rare splurge that you intend to enjoy with your friends (and me, if I am invited).

 

Remember it's not about being perfect. It's about being better every day, every week, every month, every year. So, go ahead and enjoy your life. Indulge on occasion. Just understand that your path to health is an everyday path. Be present, and be aware of your decisions. Strive to be better.

 

And please keep inviting me to your dinner parties. I promise to behave.

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com 

 

 

 

Fly Fishing as a Guide to Our Health

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

The first step is understanding why our patterns exist.

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

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

 

Sleep as if your health depends on it!

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

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

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

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

And more…

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

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

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

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

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

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

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

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

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

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

The Number One Secret to Living Forever!

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

 

Metformin.

 

Maybe.

 

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

 

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

 

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

 

How Metformin Works

 

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

 

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

 

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

 

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

 

 

Why would this help us live longer?

 

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

 

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

 

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

 

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

 

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

 

What Else Has Shown Promise for Longevity?

 

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

 

Also, wear your seat belt.

 

Don’t text and drive.

 

Don’t drink and drive.

 

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

 

Caloric restriction

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

We Don’t Need Drugs

 

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

 

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

 

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

 

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

 

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

 

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

 

Then there is nutrition.

 

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

 

A few tricks to achieve that:

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

 

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

 

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

 

Live with a purpose.

 

Take care of yourself emotionally and physically.

 

Take care of others.

 

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

 

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com 

Coconuts are Driving Me Nuts!

How does this headline sound to you?

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

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

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

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

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

No.

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

No.

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

No way.

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

What Evidence?

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

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

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

Let’s look at it another way.

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

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

It is misleading to suggest one size fits all.

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

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

Both Sides Fail

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

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

No, we do not.

Can we prove saturated fat reduces our heart disease risk?

No.

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

No way. That’s crazy talk.

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

So, what can we conclude?

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

Nothing new was found for or against vegetable oils.

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

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

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

What Can We Do?

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

Don’t believe the hype.

Focus on real, minimally processed foods.

When it comes to cooking fats:

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

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

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

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com 

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

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

 

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

 

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

 

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

 

Subtleties of Science

 

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

 

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

 

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

 

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

 

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

 

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

 

The Three Keys

 

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

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

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

 

1-All Statin Trials Are Worthless

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

2-Statins Will Not Prolong Your life

 

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

 

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

 

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

 

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

 

3-Statins DO Reduce Your Heart Attack Risk

 

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

 

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

 

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

 

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

 

Better Than Statins

 

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

 

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

 

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

 

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

 

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

 

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

 

  • Maintain a physically active lifestyle.

 

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

 

  • Practice stress reduction techniques.

 

  • Don’t smoke.

 

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

 

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

 

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

Bret Scher, MD FACC

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