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Category: Blog

Meat and Homocysteine- Irrelevant or Dangerous?

Do we have to avoid meat if we have high homocysteine levels? Not really.

 

What our body does with homocysteine is more important than our food intake. I thought this was easier to explain in video form, so you can see my 4 minute explanation here:

The bottom line is we need to know our methylation status, make sure we have adequate levels of folate, B12 and B6, and make sure we have adequate choline (found in egg yolks).  If all those are perfect, and we still have elevated homocysteine, then we may want to experiment with a diet low in methionine to see if it makes a difference.

 

As always, however, we have to evaluate our overall health picture and not get too hung up on one blood marker. The more important questions to ask are how does homocysteine affect my overall health, and how will altering my supplements or diet change the big picture?

 

Hopefully this helps! Let me know if you have any comments or questions.

 

Thanks for reading (and watching!)

Bret Scher MD FACC

LCHF and “Healthy” Whole Grains: Do we Need Them?

Here it is again. The term “healthy” connected as a descriptor.

We see it all the time. Healthy Whole Grains. It reminds me of the common use of “fruits and vegetables,” as if they are one in the same.

Are whole grains, by definition, “healthy?”

For a full, in depth description, see the Whole Grains Guide on Diet Doctor, where I was the medical editor and reviewer.

For the quick answer, let’s leave it as a “maybe.”

If you choose to eat refined grains, white flour, processed snack foods, in essence the Standard American Diet, then switching to whole grains will almost certainly improve your health. And that is where the majority evidence in favor of whole grains stops. Compared to refined grains, they are great.

Who should eat whole grains?

If you are insulin sensitive, live in a society where you are physically active for most the day, eat fewer calories than most industrialized nations, and maintain a healthy body weight, then whole grains can be a healthy part of your diet. Observation of the Blue Zone countries demonstrate that whole grains can be part of a healthy lifestyle in that setting.

We cannot, however, extrapolate those findings above to apply to all Americans, Europeans, Asians etc. and say whole grains are by definition “healthy.”

Who should not eat whole grains?

If you are metabolically unhealthy with diabetes, metabolic syndrome or insulin resistance (estimated to be 88% of all Americans), then whole grains are anything but “healthy.” Borrow a continuous glucose monitor for a day and see how your blood glucose responds to whole grains. If you aren’t perfectly metabolically healthy, it isn’t pretty.

Instead, if you eat a whole-foods, low carb diet without grains and sugars, then whole grains have no necessary role and no association with health.

Enjoy the more detailed guide from DietDoctor.

Thanks for reading,

Bret Scher, MD FACC

Low Carb Denver 2019

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

Low Carb Denver was no exception.

 

Robb Wolf on Low Carb Myths

 

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

 

Georgia Ede on the EAT Lancet Report

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

 

Low Carb Practical Implications

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

Then the controversy started.

 

LCHF Controversy

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

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

 

Zoe Harcombe on Fiber

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

 

My Talk

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

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

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

 

The Diet Doctor on Long-Term LCHF Diets

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

 

LCHF and Sexual Health

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

LCHF Community

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

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

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

Thanks for reading!

Bret Scher, MD FACC

Low Carb Health and Fixing Our Broken Healthcare Experience Webinar

We had an incredible turnout for our Webinar, aimed to help you transform your health in 2019. As a result, we decided to create a blog post that includes the full webinar recording, as well as an overview of the learnings for those that were unable to attend.

Webinar Recording

Webinar Overview

Cardiovascular Disease Is the #1 Killer for Men and Women

  • 1/3 of all Americans die from Cardiovascular disease
  • Around 92 million Americans are living with CVD
  • Every 34 seconds someone suffers a heart attack
  • Annual health expenditure and lost productivity from CVD ~$330 billion

It’s been estimated that 50-80% of these are preventable! Unfortunately, our healthcare system and associated lifestyle guidelines have failed to prevent disease. We could say at best they have failed to prevent heart disease, obesity and diabetes. At worst they have been implicit in its prevalence. While this graph doesn’t show causation, it certainly shows the association of instituting national nutritional guidelines and the rise in diabetes.

Drugs Don’t Fix the Problem

  • 60% of Americans take at least 1 prescription drug
  • 15% take more than 5 drugs
  • Despite this, our overall health and life expectancy continue to decline

HEALTH IS NOT THE ABSENCE OF DISEASE!

In this webinar, we will discuss how to be your own best advocate, why low carb, high fat nutrition should be an option for everyone, and how lifestyle really is the best medicine.

3 Interventions to Improve your Healthcare Experience and Be Your Best Advocate

  1. Make sure your doc is working with accurate information! Lipids and blood pressure are two prime examples of when doctors make decisions based on limited and faulty information.
  2. Get your questions answered by writing them down ahead of time so you don’t forget anything and tell your doctor at the beginning of the appointment that you have some questions you’d like to ask at the end.
  3. Make sure you understand the purpose and benefit of each and every medication. Not some vague answer like “It will improve your cholesterol,” or “It will lower your blood pressure.” Rather, “what impact will it have on my longevity and quality of life?” Will I live longer? Will I feel better? What are the chances the drug will actually benefit me? These are the questions we need answered.

Why Low Carb, High Fat Nutrition Should be an Option for Everyone!

LCHF vs Low Fat Diets

LCHF Benefits

  • Decreased hunger, increased energy, mental clarity
  • Treats metabolic syndrome/insulin resistance
  • Better weight loss
  • Improves overall cardiovascular risk for most people

LCHF may not be the best for everyone, but it certainly should be an option for everyone. If you want tips that do work for everyone, follow these bonus tips for weight loss and overall health!

  • Don’t drink your calories – even “natural” drinks are full of unnecessary calories. Think about it this way, you would drink a glass of orange juice, but would you really sit down eat the 5 or so oranges it takes to make it? If not, why drink that same amount?
  • Get rid of “Food Delivery Systems” – Think about the big sandwiches or burritos we see everywhere in our culture. What is the food? The stuff in the middle! The meat, the cheese, the veggies. What is the unnecessary food delivery system? The bread, the tortilla, the outer layer that has a fraction of the nutrients and a multitude of the carbs!

Lifestyle Really is the Best Medicine!

Science says lifestyle, not drugs, reverse disease:

  • NEJM study reported findings on patients at highest genetic risk for heart attack, over 90% more likely to suffer heart attack. Those with healthy lifestyles had a 50% reduced risk with no drugs and no surgeries!
  • JACC study found 85% of all heart attacks could be prevented with greater attention to lifestyle.
  • A 2018 British Journal of Sports Medicine study found that increasing walking pace to “brisk” for those over 50 reduced all-cause mortality and cardiovascular mortality by 20-24%.

Why is it so hard?

We have all been told that in order to be healthy, we need to eat less, move more, and reduce fat in our diets. But if that is the case, why is it that only 12% of Americans are metabolically healthy, and only 3% of Americans follow a healthy lifestyle?

Because the simple Eat Less, Move More, Reduce Fat approach DOESN’T WORK!!!

I want to assure you that it’s not your fault, you’ve been given the wrong information.

“I was always told I simply didn’t have enough willpower to stick to a diet. I couldn’t understand why I was always hungry and craving foods. I figured it was all genetics. But working with Dr. Scher showed me there is a better lifestyle that I can stick with and still feel great and enjoy my life! Thanks Dr. Scher!”

  • E

Keys to Making Lifestyle Change Stick

  • Beware of one-size-fits-all nutrition and lifestyle claims
  • Individually tailored and flexible nutrition is the key.
  • When you eat is just as important as what you eat
  • Move your body more
  • Get Serious about your sleep
  • Don’t be afraid to test and adjust

A Word of Caution

Don’t try to Change Everything at one time.

Choose YOUR most important first step (nutrition, stress, fitness, etc.) and work on that until a new habit is created!

And remember, you don’t have to do it alone! Working with an expert who can help you on your health journey will increase your likelihood for long term success.

As you can see, this was a quick tour to highlight the main points in the webinar. To get the full benefit, I recommend watching the full recording to get all of the context and be able to see the Q&A session at the end.

If you want to get the full experience, here is that recording again:

If you’d like to see the date and content of our next webinar, or be notified when our next webinar will be, please visit our Webinar Page.

I hope you enjoyed this recording, and that we will see you at the next live webinar!

 

Thanks for reading,

Bret Scher MD FACC

The Great Misunderstood High-Density Lipoprotein

What do I mean by “misunderstood?” Look no further than the common misnomer of “good” or “bad” cholesterol.

Good and Bad Cholesterol

While it may be true that High-Density Lipoprotein (HDL) has potentially beneficial functions (reverse cholesterol transport), we have to remember there is no such thing as good and bad cholesterol. The cholesterol carried by HDL is the same as that carried by LDL. The only thing that makes it good or bad is if it ends up synthesizing our hormones or bile acids (good), or if it ends up in our vessel walls (bad).

If it’s true there is no such thing as good and bad cholesterol, why do we care about our HDL levels?

First, let’s start with the basics.

HDL is the smallest and most densely packed lipoprotein and has one or more ApoA protein on its surface. HDL can help lipids move around in circulation by accepting triglycerides or cholesterol from other particles, thus helping a VLDL turn into an LDL, or helping an LDL contain less cholesterol (turning a small dense LDL into a less densely packed LDL).

Like LDL, HDL transports cholesterol to the liver for recycling or excretion, or to the hormone producing cells like in the adrenals. Unlike LDL, HDL does not have the potential to get retained in the vascular wall and does not, therefore, contribute to plaque formation. In fact, functioning HDL can remove cholesterol from the vessel wall, thus putting it back into circulation and possibly removing it from the body.

Back to the question at hand.

 

Why should we care about HDL levels?

Early epidemiological trials showed that lower HDL levels were associated with a higher risk of cardiovascular disease and even death.  With such a strong association, the medical profession promoted elevated HDL levels as protective and low levels as something we need to avoid.

Since these were observational epidemiological studies, they do not prove that the low HDL caused the problems, only that HDL was associated with it. For instance, HDL is also known to be low in diabetes, metabolic syndrome and insulin resistance. It may, therefore, simply be a marker of underlying metabolic dysfunction that contributes to increased risk.  Yet, HDL’s function in reverse cholesterol transport, and its ability to remove cholesterol from vessel walls suggests a more direct impact on cardiovascular health.

It is also important to note that the Framingham data suggested that increased cardiovascular risk with elevated total cholesterol and LDL-C was lost in the presence of high HDL. In fact, very low levels of LDL combined with very low HDL levels had a much higher risk than markedly elevated LDL levels when combined with elevated HDL.

Thus, HDL proves to be a useful marker to help predict cardiovascular risk. For instance, one large meta-analysis showed that total cholesterol/HDL ratio was a much stronger predictor of cardiac mortality than total cholesterol alone.

In addition, the PURE study, an observational trial in over 135,000 subjects, showed that when considering lipid changes brought about by nutritional changes, ApoB/ApoA1 (essentially LDL-P/HDL-P ratio) is the best predictor of clinical outcomes.

Thus, HDL level is important in assessing cardiovascular risk.

 

Drugs Muddy the Picture

While HDL may be a good predictor of risk, raising it with drugs does not seem to confer added benefit.

For instance, cholesterol ester transferase protein inhibitors (CETP inhibitors) significantly reduced LDL by 20-30% and increased HDL 100-fold, yet showed either no clinical benefit or even worse, an increased risk of death.

This was a shock to many in the lipid world as the notion of “good” and “bad” cholesterol would clearly predict lowering LDL and raising HDL would confer dramatic health benefits. So much so, that multiple pharmaceutical companies invested hundreds of millions of dollars developing these drugs only to abandon them when the trials showed no benefit.

Part of the issue is that not all HDL lipoproteins function the same. There are subsets of people with genetically determined markedly elevated HDL levels who have an increased risk of CVD. They may have plenty of cholesterol circulating in HDL particles, but the HDL particles are dysfunctional and therefore  do not effectively remove cholesterol from vessel walls or LDL and do not effectively transport it to the liver. Conversely, there are those with a specific genetic mutation called ApoA1 Milano who have very low HDL-C and lower cardiovascular risk.

Simply measuring the HDL cholesterol content, therefore, may not accurately reflect its function. While we do not have easily available tests to measure HDL function, we can potentially use HDL particle assessment as well as the company it keeps (i.e. low triglycerides, larger less dense LDL particles) to better assess the potential benefits of HDL. Thus, if there is any concern about potentially dysfunctional HDL, I usually recommend advanced lipid testing to see the specific subtypes of HDL.

What can we conclude from all the HDL confusion?

Raising HDL with drugs does not reduce cardiovascular events, yet having a naturally low HDL is associated with increased risk.

The best answer, therefore, is to live a lifestyle that helps you have a “not low” HDL level. This means first and foremost avoiding the medical conditions associated with low HDL (i.e. insulin resistance, diabetes, and metabolic syndrome).

Textbooks predictably state the interventions to naturally raise HDL include exercise and moderate alcohol intake. Unfortunately, these have minimal effects. In fact, they pale in comparison to a low carb high fat lifestyle. In my 20+ years in the medical field, I have never seen an intervention as effective as LCHF in raising HDL, and the studies agree.

This brings us back to our question once again.

Why are HDL levels important?

HDL levels are important because it is a reflection of our underlying metabolic health and our lifestyle. A properly constructed LCHF lifestyle lowers triglycerides, raises HDL, and reduces the small dense LDL, among other benefits. Such a lifestyle likely reduces overall cardiovascular risk and will likely be shown to improve longevity and health span. While HDL may not be the main reason for this, we can’t ignore its role simply because it is more nuanced than “good” and “bad” cholesterol.

My advice, therefore, is to see the whole picture. Embrace the nuance. And make sure you get a thorough and proper evaluation of your cardiovascular risk.

If you are hungry for more, I created my Truth About Lipids program, a program focused on Cholesterol, to help break through the confusion and provide you with everything you need to thoroughly understand cholesterol and its impact on your health.

Learn more: Truth About Lipids Program

 

If you still have questions, you may want to consider a one-on-one health coaching consultation so you can get the individual attention you deserve  with a thorough assessment of your lifestyle and its impact on you as an individual.

Please comment below if you have any questions or comments that may help further the discussion.

Thanks for reading.

Bret Scher MD FACC

Low Carb USA Recap

This past weekend, I had the pleasure of attending the Low Carb USA Conference in West Palm Beach.

I was blown away by the amazing community of providers and participants. Everyone I came across was very engaged and hungry for knowledge. There was also a special day devoted to the Spanish speaking audience. I was impressed by their growth from previous conferences.

Low Carb Spanish-Speaking Leader Ignacio Cuaranta

One leader in the Spanish speaking community is Ignacio Cuaranta, who is also a leader promoting low carb for the prevention and treatment of mental disorders. A big take home from his keynote was that that problems with our brains are not that different from the problems with our body. Metabolic derangements affect both, and low carb nutrition appears to be very beneficial for both.  I was lucky enough to record a podcast with him, so look for that in the near future! I don’t want to give away all the spoilers but suffice it to say, he is seeing outstanding success with Low Carb and Intermittent Fasting in his practice.

 

Dr. Robert Cywes on Carbohydrate Addiction

The headliner of the meeting was Dr. Robert Cywes. He is a weight loss bariatric surgeon, and the most unique surgeon I have ever met. He doesn’t want to operate. He would rather cure people of their underlying carbohydrate addiction and help them heal themselves. He has a refreshing perspective focusing on the emotional and psychological aspects of weight gain and recognizes that food choices alone won’t help if these aspects aren’t also addressed.  I also recorded a podcast with him so stay tuned for that!

 

Dr. Will Cole Spoke About Vegetarian Keto

Dr. Will Cole presented his case for Keto-tarians, essentially vegetarian ketosis. One of the predominate theories is that when we are in ketosis, our bodies require much less protein that we otherwise would. That way we can focus more on the non-animal fats and worry less about getting our 20+% of calories from protein. It is an interesting theory that he has had success with and highlights that a ketogenic diet can take many forms and mean different things to different people.

 

Dr. Ryan Lowery on Ketosis Being Protein Sparing

Florida’s own Dr. Ryan Lowery from ASPI echoed Dr. Cole’s theory that something about being in ketosis appears to be protein sparing, thus we don’t have to eat as much for muscle growth or maintenance. He also shared his research in rats that suggests lifelong ketosis promotes longevity. And guess what? That’s right, I filmed a podcast with him as well! This one was packed with information and I know you will love it as much as I did.

 

The food was fantastic!

Did I mention the food? WOW, the food was incredible! Some of the best conference keto buffets I have seen. The leg of lamb with onions on Friday night along with the spinach salad, avocado, and fat-soaked veggies were just what this doctor ordered (pun intended!)

I was in Keto heaven.

 

Learning from the conference overall

As usual the team from Low Carb USA did an incredible job and the event went off without a hitch. It inspired me to take away lessons on how they put together a successful conference for hundreds of people and adapt it to our upcoming intimate and personalized Low Carb Beach Retreat in April.

At this retreat, we will combine the benefits of didactic teaching with small group discussions and development of individualized low carb programs.  Due to its small size spots are limited so reserve your spot today!

Is a Low Carb High Fat Diet Heart Healthy?

We hear the words Heart Healthy a lot, especially when it comes to our nutrition.

 

By now, you’re likely used to seeing cereals with the “heart healthy” moniker. Is it really heart healthy? We all too frequently refer to foods as “heart healthy”, or we say that our doctor gave our hearts a “healthy” checkup.  

 

It all sounds nice. But what does it mean? How do we define heart health?

 

How does LDL Cholesterol affect Heart Health?

 

Unfortunately, most of our current definitions center around LDL cholesterol concentration.  While LDL cholesterol plays a role in heart health, it by no means defines heart health in totality.

 

In fact, in many cases it is the least important factor.

 

Our healthcare system has simplified things too much, so as a result we focus on one bad guy, one demon to fight. In reality heart disease is caused, and made more likely to occur, by a constellation of contributing issues.

 

Elevated blood sugar, elevated insulin levels, inflammation, high blood pressure, poor nutrition, and yes, lipids all contribute to heart health.  It does us all an injustice to over simplify it to one single cause.

 

What food is heart healthy?

 

Our superficial definition of cardiac risk is how industrial seed oils containing polyunsaturated fatty acids (PUFAs) became known as “heart healthy.”

 

Studies show that they can lower LDL. But they can also increase inflammation and have no clinical benefit and even increase risk of dying. According to our simplified definitions, that doesn’t stop them from being defined as “heart healthy.”

 

 That’s right! Something that increases our risk of dying is still termed “heart healthy.”  How’s that for a backwards medical system?!

 

Same for blood sugar. If you have a diagnosis of Type 2 Diabetes (DM2) that is a risk for cardiovascular disease. If you don’t have the diagnosis, you are fine. That ignores the disease of insulin resistance that can predate diabetes for decades and increases the risk of heart disease and possibly even cancer and dementia.

 

Cereal can also be called “heart healthy” as they may minimally lower LDL. But is that a good thing if they contain grains that also worsen your insulin resistance and metabolic syndrome? I say definitely not.

 

Time has come to stop this basic, simplified evaluation and start looking at the whole picture.

 

How Low Carb High Fat Diets Improve Heart Health

 

Low carb high fat diets have been vilified as they can increase LDL. But the fact of the matter is that it does so only in a minority of people. The truth is that they can improve everything else!

 

These diets reduce blood pressure, reduce inflammation, improve HDL and triglycerides, and reverse diabetes and metabolic syndrome! Shouldn’t that be the definition of “heart healthy” we seek? Instead of focusing on one isolated marker, shouldn’t we define heart health by looking at the whole patient?

 

Only by opening our eyes and seeing the whole picture of heart healthy lifestyles can we truly make an impact on our cardiovascular risk and achieve the health we deserve.

 

Join me in demanding more. Demand better.

 

Thanks for reading,

Bret Scher, MD FACC

Is LCHF Keto the right diet for you in the new year?

With New Year’s resolutions looming, many people are thinking about reinvigorating their health. In fact, 45% of people want to lose weight or get in shape as their New Year’s resolution.

The LCHF Keto diet has been quickly gaining momentum, and it is piquing a great deal of curiosity.

So, is this particular diet right for you? It may just be.

 

What are your diet goals?

Before selecting a diet, it’s important for you to define why you want to diet in the first place. Are your goals weight loss, general health, or a combination?

If you want to lose weight, reduce your hunger, enjoy your meals, and improve your metabolic health, then LCHF may be right for you.

 

Do you want to lose weight?

The primary reason most people go on a diet is to lose weight. As far as weight loss, low carb has you covered. Out of 60 studies comparing low carb to low fat diets, low carb had better weight loss in 30 and they were equal in 30. Low carb was inferior in exactly zero of these studies. That’s an impressive record, and definitely something to consider if weight loss is your primary goal.

But there is so much more to life and health than weight loss.

 

Do you want to reduce your hunger?

One main struggle in health and weight loss is how hungry we are and how much we need to think about food during the day. Studies show that following a LCHF diet reduces our hunger in the long-term. That means less worry about constant snacks, and less concern with needing to eat every few hours. In fact, LCHF works so well at curbing appetite that more people can practice time-restricted eating by compressing eating into a 6-8 hour window, which has indicated potential beneficial effects for longevity.

 

Do you want to improve your focus?

Food, especially the wrong food, can make us feel lethargic and unfocused. Many people report thinking more clearly and having better mental performance when on a low carb diet. The brain loves ketones, whereas carbs can cloud your thinking. Why not switch to low carb and see if your brain fog lifts?

 

Do you want to improve metabolic health?

A recent study showed that only 12% of Americans are metabolically healthy. Low carb diets are one of the fastest and best ways to improve metabolic health. Studies show it puts type 2 diabetes in remission, improves insulin resistance, reduces visceral fat, and improves overall metabolic health.

 

Do you want to decrease your cardiovascular risk?

Fat phobia is gone. Limiting carbs to real food veggies and eating plenty of healthy fats improves our cardiovascular risk profile. It reduces BP, reduces TG, increases HDL and improves the size and density of LDL, which all add up to a net improvement in cardiovascular health.

 

The main reason you should consider LCHF/Keto in the new year

You will love it!

No counting calories, no feeling hungry, no wild glucose swings and post meal crashes, no afternoon slump. With all of this research backing this diet, it’s definitely worth a try.

 

One last consideration

A note of caution, most people will do great. But not everyone reacts to this diet the same way, so you may want to consult a doctor experienced in low carb nutrition.

If you don’t already have a doctor to consult with or want to speak with one who specializes in Keto, I’m a professional who has extensive experience with LCHF diets and how they affect your health. If you’re just getting started, I recommend downloading my free LCHF/Keto starter tips e-book to get you on the right track:

 

 

 

If we can be of any additional service, please let us know!

Thanks for reading,

Bret Scher, MD FACC

Eating red meat increases TMAO levels. Should we care?

A new study published in the European Heart Journal says we should care about blood levels of a metabolite trimethylamine N-oxide (TMAO), but is that true?

NBC News: Study explains how red meat raises heart disease risk

For starters, this was a well run and controlled study. Researchers randomly assigned 133 subjects to one of three isocaloric diets with the only difference being the presence of red meat, white meat, or vegetarian protein. Similar to the study by Dr. Ludwig that we referenced earlier, a strength of this study was that the study team supplied all meals for the subjects. Therefore, there was no guessing about what the subjects ate or if they complied with the recommendations. That makes this a strong nutritional study.

Subjects stayed on each diet for four weeks and then had a washout period before transitioning to the next diet. The main take home is that eating red meat increases the blood level of TMAO, which declines after four weeks off the red meat diet. As described in the article:

a red meat diet raises systemic TMAO levels by three different mechanisms: (i) enhanced nutrient density of dietary TMA precursors; (ii) increased microbial TMA/TMAO production from carnitine, but not choline; and (iii) reduced renal TMAO excretion. Interestingly, discontinuation of dietary red meat reduced plasma TMAO within 4 weeks.

It is important to note in our era of frequent conflicts of interest, NBC news reported that the lead investigator for the study is “working on a drug that would lower TMAO levels.” While that in no way invalidates the findings, it does legitimately raise suspicion for their importance.

Interestingly, the study did not test eggs, another food reportedly linked to TMAO. They did, however, note that increased choline intake, the proposed “culprit” in eggs, had no impact on TMAO levels.

The study also did not investigate fish. Fish, traditionally promoted as “heart healthy,” has substantially higher concentrations of TMAO than meat or eggs. One thought, therefore, is that high TMAO levels are produced by gut bacteria rather than the food itself. Although this is an unproven hypothesis, it would also explain variability among subjects.

Now for the harder question. Does any of this data matter? For this study to be noteworthy, we have to accept the assumption that TMAO is a reliable and causative marker of heart disease.

The main NEJM study linking TMAO to an increased risk of cardiovascular disease is not as conclusive as many promote. First of all, only those at the upper quartile of TMAO level had a significant increase in cardiovascular disease risk. Lower elevations had no significant correlation.

Second, those with increased TMAO and cardiovascular disease risk also were more likely to have diabetes, hypertension and a prior heart attack; furthermore, they were older, and their inflammation markers, including myeloperoxidase, a measurement of LDL inflammation, were significantly higher. With so many confounding variables, it is impossible to say the TMAO had anything to do with the increased cardiovascular disease risk.

This study in JACC that saw a correlation with TMAO and complexity of coronary lesions, also found an increased incidence of diabetes, hypertension, older age in the high TMAO group.

Finally, this study found no association at all between TMAO levels and increased risk of cardiovascular disease.

Based on these mixed findings, the jury is still out, and we have plenty of reason to question the importance of elevated TMAO as an independent risk marker or causative factor of coronary disease.

Most importantly, however, since multiple studies continue to show no significant association between meat and egg consumption and increased heart attacks or mortality risk (references here, here, here, here and here) the weak surrogate markers don’t seem likely to matter much. Don’t get caught in the minutiae. Focus on a real-food diet that helps you feel better and improves the vast majority of your markers. And if you have elevated TMAO, the studies suggest you should also check your blood pressure, blood sugars, and inflammatory markers as they may also be elevated. In my opinion, until we have much more convincing data on TMAO, you are far better off targeting those more basic parameters than a blood test of questionable value.

Thanks for reading,
Bret Scher, MD FACC

 

Originally Posted on the Diet Doctor Blog 

Blood pressure medications — friend or foe?

The medical world experienced yet another guideline update in 2018 telling doctors more medication is better. This guideline for treating hypertension was put out by the American College of Cardiology and the American Heart Association, and effectively lowered the definition of hypertension from 140/90 down to 130/80. The organizations also recommended drug treatment for all individuals with blood pressure greater than 140/90, regardless of underlying risk.

Unfortunately, this seems like a common scenario — medical guidelines recommend more aggressive medication use for minimal potential benefit despite potential harm. A new study published in the Journal of the American Medical Association (JAMA), suggests the blood pressure guidelines go too far for low risk individuals, and the risk of harm outweighs the potential benefits.

JAMA: Benefits and harms of antihypertensive treatment in low-risk patients with mild hypertension

The JAMA study was an extensive chart review of over 38,000 patients at low risk for heart disease who had stage two hypertension (blood pressure between 149/90 and 159/99) and were treated with blood pressure medications. Over an average follow-up time of almost six years, they found no reduction in the risk of cardiovascular disease events or risk of death with medication use. They did, however, find an increased risk for low blood pressure, fainting, and acute kidney injury among those treated with medications.

Based on these results, treating stage two hypertension in low risk patients tends to cause more harm than good.

What makes this study valuable is that it documents real world experience. Guidelines are frequently made from trials conducted with more aggressive follow-up and monitoring than is typical in usual care. That fuels the medical community’s perspective that drug interventions are the best course of care, which is why we need more studies like this one from Dr. Sheppard et. al. showing us how low risk patients probably do not benefit from drug therapy in real world scenarios.

Instead of reaching for drugs, we should continue to find the most effective lifestyle interventions to help lower blood pressure and reduce cardiovascular risk without a laundry list of side effects. Unless, of course, you consider losing weight, having more energy, and feeling great as side effects — those are the type of side effects (from low-carb eating) that we all can embrace!

Thanks for reading,
Bret Scher, MD FACC

 

Originally Posted on the Diet Doctor Blog 

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Bret Scher, MD FACC

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