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

 

 

 

 

 

Cauliflower Mac & Cheese by Nourished Balance

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

Cauliflower Mac & Cheese 

Ingredients

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

Instructions

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

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

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. 

4 Fitness Apps To Try

Living a healthy lifestyle has many benefits, from taking fewer trips to your healthcare provider each year to managing stress and anxiety with ease. Luckily, getting on the path to your best health ever is right in the palm of your hand. Here are 4 fitness apps you should try today.

MapMyFitness

If someone asked you to choose your favorite workout style, could you choose just one? With MapMyFitness, you don’t have to. Choose from dozens of traditional workouts, like swimming, jumping rope, and weightlifting, to less traditional activities, like bowling, fishing, and horseback riding.

MapMyFitness also offers outdoor training routes near you, which are created and shared by other users. Simply search for a route based on the type of activity you want to do, make sure the app has a good GPS signal, and start your workout. If you’re a creature of habit, you also have the option to add private routes to your profile and do them again as often as you like.

Got a favorite way to exercise outdoors? There are several versions of the “MapMy” apps to choose from:

  • MapMyRun
  • MapMyHike
  • MapMyRide
  • MapMyWalk

All versions work the same way in terms of functionality, but each one provides map suggestions tailored to the default activity.

Charity Miles

Make your workouts meaningful with Charity Miles. Research shows that giving can be good for your mental health. Why not give your mind and body a boost by earning money for charity while you get fit?

All you have to do is pick a charity, select an activity, and start tracking your mileage using your smartphone’s GPS. There are more than 30 world-class charities to choose from, including the ASPCA, Habitat for Humanity, and Girls on the Run. Are you passionate about multiple causes? Charity Miles gives you the option to switch charities at any time.

A donation will be made for every mile you complete, and you can log miles through your choice of 5 outdoor and indoor activities. Once you tap to start tracking, the app lets you know who’s sponsoring your workout. Be sure to stop and save your miles when you’re done or your activity won’t count. (You can always tell the app to send you a reminder.)

Fitbit

Walking is a great way to boost your fitness level, lose weight, and feel healthier. It’s recommended that you get 10,000 steps a day, but how can you be sure you’re getting all those steps in? By tracking your daily steps with a wearable fitness device, like the Fitbit.

The Fitbit family of devices sync with the Fitbit app to give you a real-time look at your day. And you can track more than just exercise—the app allows you to log and monitor your sleep, weight, and food, which all adds up to a healthier and fitter you. Just choose the device that fits your goals, and then register it with the app.

Are you motivated by friendly competition? Get an extra dose of motivation by creating challenges among your Fitbit friends. Choose from fun options like Goal Day, Workweek Hustle, and Weekend Warrior. Or go on a virtual Adventure Race together and see who can reach the finish line first. The Fitbit app also features a community tab, where you can share your wins, join groups dedicated to your favorite healthy lifestyle topics, and connect with other Fitbitters.

MyFitnessPal

Keeping a food journal can help you build healthy eating habits—and what you consume is just as important as what you burn. Based on your fitness profile, MyFitnessPal will suggest a daily net calorie target to help you meet your nutrition and weight loss goals. As you fill up on foods and log your meals, the app will display your remaining calories. It will also show you the distribution of where those calories are coming from, be it fats, proteins, or carbohydrates.

Being mindful of what you eat and drink is a good practice for healthy living. As you create new journal entries, MyFitnessPal shares a snippet of nutrition advice to keep you aware of the healthy (or not so healthy) choices you’re making. For instance, if you decide to go out for an ice cream sundae, the app may alert you about the amount of sugar it contains, along with a reminder of your sugar goal for the day. Likewise, if you opt for a fruit cup, the app may tell you it has lots of Vitamin C.

You can also use the app to track your activity. Depending on how many calories you burned, the app automatically adjusts your net calorie needs for that day. Just sync your daily step counts and workouts from your smartphone or wearable fitness device to the app, and MyFitnessPal will figure out the rest. Another option is to manually log your cardio and strength workouts—the app will estimate your calories burned based on your current fitness profile.

Using an app is a great to get in shape and stay fit. Making small tweaks to your daily routine—like moving more and eating better—can go a long way in helping you live your best health ever. Try out one of these fitness apps today and let us know how it worked for you.

 

 

Activities for the Whole Family

Have you made the decision that YOU want to start living your best health ever? What about your family? It’s hard to get on track without the support of your loved ones and that’s why it can be necessary to make sure they’re on board for your lifestyle changes as well! It doesn’t have to be a tedious task for them or feel like a burden, it can be fun and a great way to spend more time together. So why not pack in the quality time while getting in a good workout and being active? Here are some perfect examples to get you started as you incorporate your family life into your journey to your best health ever. 


Go Hiking Together


As long as you do your research ahead of time you can find plenty of family friendly hikes where you live. Map out how long it will take you to get there, have some classic car games ready, plenty of water and snacks, and make a day out of it. Pack a healthy picnic to enjoy when you reach the top of your destination and enjoy a beautiful day outdoors while kicking up your heart rate. 


Try Out Fun Sports

You don’t need to be an athlete to play a friendly game of basketball or soccer. Try out a basketball game of HORSE or run around with a soccer ball at your nearest park. Tennis can also be a great game to get the whole family in on. Find your nearest court and grab a couple of rackets and balls. You’ll get some sun and burn off a ton of calories running back and forth on the court. If you’re not feeling so adventurous, just grab a frisbee and head to the beach. Before you know it you’ll be starting your own Ultimate Frisbee team!


Sign up For A 5k Walk Or Run 


See what’s coming up on active.com for the latest 5k Walks and Runs. These events are usually family friendly, a great way to build community and the perfect opportunity to get some steps in. Better yet, find one that is for a cause close to your heart and educate your family on why it means so much to you. You’ll feel the positive impact not just physically, but also get a mental boost for supporting a charity that you feel personally connected to. 


Start a Neighborhood Recreation League


Get your neighbors involved in your health journey by starting a friendly weeknight Kick-Ball league (or Ultimate Frisbee team!) with one side of the street against the other. You’ll create a greater sense of community within your neighborhood, meet new people and maybe even find your next babysitter. You can also do some research to see if your town already has social sports leagues set up and join an existing team with your family and friends. Weeknight games are a great way to break up your weekly routine and add some diversity to your exercise habits. 

Travel With Games

Keep a soccer ball or a frisbee in your trunk. Instead of waiting in the car in between errands or after school activities, get out of the car and throw the ball around. If you’re on your own, try jump roping wherever you are. You can burn as many as 200 calories in just one 10-minute jump-rope session. Or make sure to just get out of the car and walk around, as long as you’re moving you’re one step closer to achieving a healthier life!

Go For A Bike Ride

A great way to burn calories and explore your neighborhood, biking is a perfect outdoor activity. Whether you’re on a beach cruiser or a tandem bike, you’ll be enjoying the ride so much you won’t even mind the burn when you’re going up those hills. Make sure to strap on a helmet, ride with water and plan out a fun pit stop. Check out TrailLink to find safe, family-friendly trails in your city. 

Get Technology Involved 

Add an element of competition between family members and see who can get the most steps in the day. You can use the Health app on your phone or invest in a FitBit to track your steps. Set a goal of 10,000 or 20,000 steps a day and create incentives for whoever hits the goal first. For example, the winner doesn’t have to do dishes that night or gets to choose what movie you’ll see that weekend! 

Make sure your family and friends know about your commitment to your healthier lifestyle so they understand how important it is to you that you have their support. Rallying your community is a pivotal step towards achieving your best health ever and there are endless fun and active ways the whole family can join in on your journey. 

A Beginners Guide to HIIT 

Not sure what HIIT is or what it even stands for? This is the perfect place to start your education on a training program that has incredible benefits to your health and can add that diversity to your workout routine that you’ve been looking for.

High-Intensity Interval Training is defined by its bursts of high-intensity anaerobic exercise alternated with periods of low to moderate intensity exercise. The high-intensity portions of the workout will work your body to its max for anywhere between 30 seconds to 4 minutes, and the lower intensity periods that can last the same period of time will allow your body to recovery while you still remain active. This type of training has become increasingly popular in the fitness world due to its many health benefits, it’s shortened exercise time and it’s ability to be practiced anywhere, even from home.

So what exactly are the health benefits of HIIT? 

  • You burn a ton of calories, even after you’re done working out! Thanks to Excess Post-exercise Oxygen Consumption, your body is still using calories after a high-intensity workout to recover and restore itself from the effects of the exercise you just completed. This is also known as the “afterburn effect” and not only helps to burn additional calories hours after your workout but also helps to burn fat! 

     
  • Although this type of exercise might sound like a heart attack waiting to happen, it will actually benefit your cardiovascular system more than you think. Many people may be intimidated by the idea of going at 80% – 90% of their speed capacity on a treadmill but if you’re training properly you don’t need to worry that this will lead you to a heart attack, it will actually have the opposite effect! The intensity of the workout will help to increase the elasticity in your blood vessels and arteries, allowing for a better flow of blood and oxygen to the heart. So even though you might feel like your heart is about to pump out of your chest, it’s actually becoming stronger and healthier.
 
     
  • The more your practice HIIT the more you’ll increase your body’s rate that it can consume oxygen. Your body has a specific rate at which it can consume oxygen while you are physically active and in the high-intensity phases of a HIIT, your body is demanding to be filled with even more oxygen than it would during a lower paced cardio exercise. Each workout can increase the threshold of oxygen you take in, and with that extra oxygen your muscles will perform better and you’ll boost your stamina. 

     
  • We all have busy lives and would probably rather spend our extra time with our families or catching up with friends than putting in the hours at the gym. And that’s another reason why HIIT is so great – it doesn’t have to take up as much time as your other workouts! You can even get a great fat-burning session done in just 20 minutes by practicing the technique of high-intensity exercise bursts mixed in with moderate to low-intensity exercise bursts. 


     
  • HIIT tests both you both mentally and physically. When you’re in the high-intensity phase of the workout you are going faster and harder and pushing yourself beyond what you thought possible. Not only are you testing yourself physically, but you’re giving yourself that mental challenge of pushing back against thoughts that might tell you aren’t strong enough. Guess what though, you ARE and with HIIT you’ll learn you have more mental and physical endurance than you once thought. 

     
  • Diversity is key in your workout regime and high-intensity interval training can be practiced among a range of different exercises from cycling, swimming, running and weight-lifting. It’s easy to incorporate into your favorite workout and you can even try it from your own home.

Although it might sound intimidating, high-intensity interval training can be practiced by almost anyone, anywhere. It’s a great workout to incorporate into your routine 2-3 times a week and will help keep you motivated and energized. Try out an Orange Theory Fitness Class (they’re all about HIIT!) and let us know what you think. 

 

Bret Scher, MD FACC

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