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.

 

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. 

 

The Number One Secret to Living Forever!

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

 

Metformin.

 

Maybe.

 

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

 

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

 

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

 

How Metformin Works

 

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

 

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

 

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

 

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

 

 

Why would this help us live longer?

 

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

 

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

 

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

 

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

 

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

 

What Else Has Shown Promise for Longevity?

 

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

 

Also, wear your seat belt.

 

Don’t text and drive.

 

Don’t drink and drive.

 

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

 

Caloric restriction

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

We Don’t Need Drugs

 

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

 

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

 

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

 

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

 

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

 

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

 

Then there is nutrition.

 

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

 

A few tricks to achieve that:

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

 

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

 

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

 

Live with a purpose.

 

Take care of yourself emotionally and physically.

 

Take care of others.

 

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

 

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com 

3 Simple Breathing Techniques You Can Practice Anywhere

It doesn’t always take a vacation to a private island or a lavish spa day to get some relaxation time in. There are simple, quick techniques you can learn and incorporate into your everyday schedule to help ease that nagging tension and anxiety you might feel, and they take only take 5 minutes or less! Any time you might feel overwhelmed by an upcoming deadline at work or stressed out just coping with everyday tasks, you can try out any of these three breathing techniques. Find a quiet space wherever you are (even at work!) and try one of these out to help you feel more relaxed and ready to tackle the rest of your day. 

Belly Breathing 

Also known as diaphragmatic breathing, this technique requires you to focus on expanding your stomach, rather than your chest, as you take in each deep breath. 

1. Preferably lying on your back, place one hand over your stomach and another over your chest. 

2. Breathe in slowly through your nose and through your stomach so that you feel your stomach rise against your hand as your abdomen fills with air. 

3. Exhale completely and as you exhale through your nose, feel your stomach deflate to its neutral position. 

4. Repeat this process for 5-10 minutes, focusing on the sensation of your stomach rising and falling with each breath. 

The 4-7-8 Method

This exercise helps you breathe more deeply while putting your mind into a meditative state as you focus on counting the seconds during each breath in and out. 

1. Sit in a comfortable position and start by slowly inhaling through your nose on a count of 4 seconds.

2. After the fourth second, hold your breath for a count of 7 seconds*

3. After 7 seconds, exhale your breath for a count of 8 seconds. Repeat this exercise 3-4 times. 

*If 7 seconds feels too long, lower the count to a number of seconds that feels more comfortable for you. 

Progressive Relaxation

Your entire body will take a role in this breathing exercise as you coordinate each breath with the tensing and relaxing of your toes and feet all the way up to your shoulders and head. 

1. Lying or sitting, start by tensing the muscles in your feet as you breathe in through your nose. Hold the breath for a moment as you experience what the tension feels like in your feet and toes. 

2. As you relax your feet, release your breath and exhale through your nose. Take another moment to appreciate the feeling of your feet no longer tensing and contracting. 

3. Continue the process throughout your whole body, including your legs, abdomen, arms, hands, shoulders, jaw and eyes. 

4. Finish the exercise by tensing the entire body as you take a final deep breath in, and as you release your breath make sure to focus on the sensation of each muscle returning to a relaxed state. 

Taking the time to breathe deeply not only helps remind your brain to calm down but it can help remind you to be mindful and present in the moment.  Just by taking 5 to 10 minutes out of your day to try any of these breathing techniques you’ll notice a difference in how you cope with your stress, negative thoughts and the tension you’re holding in your body. Give it a try and let us know which one works best for you! 

Coconuts are Driving Me Nuts!

How does this headline sound to you?

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

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

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

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

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

No.

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

No.

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

No way.

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

What Evidence?

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

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

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

Let’s look at it another way.

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

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

It is misleading to suggest one size fits all.

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

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

Both Sides Fail

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

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

No, we do not.

Can we prove saturated fat reduces our heart disease risk?

No.

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

No way. That’s crazy talk.

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

So, what can we conclude?

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

Nothing new was found for or against vegetable oils.

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

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

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

What Can We Do?

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

Don’t believe the hype.

Focus on real, minimally processed foods.

When it comes to cooking fats:

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

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

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

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com 

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

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

 

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

 

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

 

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

 

Subtleties of Science

 

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

 

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

 

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

 

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

 

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

 

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

 

The Three Keys

 

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

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

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

 

1-All Statin Trials Are Worthless

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

2-Statins Will Not Prolong Your life

 

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

 

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

 

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

 

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

 

3-Statins DO Reduce Your Heart Attack Risk

 

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

 

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

 

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

 

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

 

Better Than Statins

 

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

 

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

 

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

 

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

 

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

 

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

 

  • Maintain a physically active lifestyle.

 

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

 

  • Practice stress reduction techniques.

 

  • Don’t smoke.

 

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

 

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

 

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

Herb-Crusted Roasted Salmon with Roasted Broccoli Steaks

Here is another great recipe from our friends at Whole30. Give it a try for a delicious twist on salmon. But don't stop with just broccoli for the veggie. Add cauliflower, zucchini, and sweet potato for an even greater array of colors and flavors!

Ingredients
1/2 cup fresh basil leaves
1/2 cup fresh parsley leaves
6 tablespoons extra-virgin olive oil
1 tablespoon fresh lemon juice
1 teaspoon salt
1 teaspoon black pepper
1/2 teaspoon grated lemon zest
1/4 cup almond flour
2 salmon fillets (6 ounces each)
3 small heads broccoli with the stems attached (consider adding cauliflower, sweet potato and other veggies here!)
1/2 cup sliced almonds, toasted

Instructions
Preheat the oven to 400°F. Combine the basil, parsley, 4 tablespoons of the oil, lemon juice, ½ teaspoon of the salt, ½ teaspoon of the pepper, and the lemon zest in a blender or food processor. Cover and pulse until smooth. Pour the herb mixture into a bowl and stir in the almond flour.

Place the salmon fillets in a large roasting pan or on a rimmed baking sheet. Pack the herb mixture on the top of each fillet.

Trim the broccoli stems to about 3 inches below the florets. Slice the broccoli heads lengthwise into 1-inch-thick slabs (two or three slabs per head), cutting from the bottom of the stems through the crown to preserve the shape of the broccoli. Brush both sides of each broccoli slice with the remaining 2 tablespoons olive oil and sprinkle with the remaining ½ teaspoon salt and ½ teaspoon pepper. Arrange the broccoli in a single layer in the pan around the salmon.

Roast the broccoli and salmon for 25 minutes, until the salmon just barely starts to flake when pulled apart with a fork and the broccoli is lightly browned, turning the broccoli once halfway through roasting. Sprinkle the broccoli with the toasted almonds before serving.

Text excerpted from The Whole30 Cookbook © 2016 by Melissa Hartwig. 

Breakfast Smoothies

I have posted a few times about my quick, easy and delicious veggie eggs that I eat at least three days per week. As a response, many of you who aren’t big fans of eggs have reached out and asked for other options. First, I encourage you all to explore intermittent fasting at least two days per week. Another option is to turn to smoothies. Smoothies are a great way to get your greens and veggies, plus you can easily add healthy fats and proteins to start your day with balanced nutrition. Just don’t fall into the trap of the “easy” bagel, muffin or cereal! You can do better. Here is a link to a delicious Strawberry & Kale smoothie from Amy Krasner at Nourished Balance. It’s easy and very tasty. Give it a try!

http://www.nourishedbalance.com/recipes/breakfast/strawberry-kale-smoothie/

Are Gluten-Free Diets Killing Us?

Gluten has come full circle in the eyes of popular media. It was initially portrayed as the cause of all our health concerns. Eliminating it was the quickest path to feeling better and living healthier. After all, how else can we explain Tom Brady’s Super Bowl prowess????

 

Now, however, avoiding gluten has been implicated in increasing our risk of heart disease and causing a harmful disruption of our gut microbiome (the bacteria in our digestive tracts and plays an integral role in our health).

 

So, which should we believe?

 

As with most health topics in popular media, the key is in the details. But first, a quick primer on gluten and gluten sensitivity.

 

Gluten 101

 

Gluten is a protein found in wheat, barley and rye, and in foods made with those grains, like bread, cereal, cookies, crackers and pasta.

 

In people with the medical condition of celiac disease the body sees gluten as a foreign invader and is unable to properly absorb it. Gluten causes an autoimmune response against the lining of the intestines causing intestinal damage and decreased absorption of necessary nutrients.

 

Symptoms of celiac disease include abdominal pain, bloating, and rashes. It can also cause anemia, bone problems, and malnutrition. Your doctor can diagnose celiac disease with a blood test and a biopsy of your small intestine.

 

Without question, those with proven celiac disease must avoid gluten. Fortunately, it is a rare medical condition.

 

More commonly, people may be sensitive to gluten even though they don’t have celiac disease. They simply find that they feel much better when they avoid gluten-containing foods. They have more energy, less bloating, clearer skin, and have improved concentration and mental clarity.

 

This is not a medical diagnosis. There is no way to objectively prove if this is the case or not. This is a subjective feeling. Do you feel better while avoiding gluten or not? It’s that simple.

 

This is similar to numerous other food intolerances that abound. Some people feel better avoiding dairy. Some feel better avoiding meat. Some feel better avoiding legumes. Gluten is no different. It just gets more attention lately given its popularity among celebrities and weight loss pundits.

 

If you feel better avoiding gluten, then you should avoid it. After all, our bodies do not require gluten for good health.

 

Our bodies need proteins and fats, vitamins and minerals. There is no physiological need for gluten. If it makes you feel poorly, there is no need to eat it.

 

Gluten Coming Full Circle

 

Now, however, people are starting to question the safety of gluten-free diets based on recent research.

 

An article published in May in BMJ (British Medical Journal) suggested that avoiding gluten increased our risk of heart disease.  What followed was a social media and popular media storm of gluten-free backlash with the end result being confusion and frustration.

 

Who do we believe and what do we do now?

 

Take A Breath, Then Dive Deeper

 

First, take a breath. Remember that health claims, good or bad, are rarely as extreme as portrayed by the media.

 

Next, dive deeper. Understanding the implications of the study depends on understanding the details of the study. I know that not everyone has the time/desire/resources to dig deeper into the studies, so we did it for you.

 

This study was an observational study that followed healthcare workers without heart disease (at the time of enrollment) for 26 years. There was no specific intervention, the researchers simply collected data over time on who had heart attacks and who did not, and also collected data on what they ate. By going back and statistically crunching the data, they tried to find an association between the amount of gluten eaten and the risk of heart attacks.

 

Here is the main conclusion to the study. There was no significant difference in heart disease risk between those who ate the most gluten compared to those who ate the least. No significant difference.

 

Why all the news reports that it increased the risk of heart disease?

 

Statistical massaging of the data showed that those who ate the least amount of gluten and the least amount of whole grains did have a small increased risk of heart disease.

 

So, what was the problem? Was it the missing gluten? Or the missing whole grains? This study does not prove cause and effect. It does, however, suggest it was the lack of whole grains, not just the gluten, that was associated with a very small increased risk of heart disease.

 

How small?  There was a 15% relative risk increase. The absolute increase was not reported, but looking at the numbers it was around 0.1%. The difference was 1 person out of 1000. Hardly earth shattering.

 

Said another way, if the subjects avoided gluten containing cookies, crackers and processed bread and substituted gluten-free cookies, crackers and processed bread, they were not any healthier, and may have increased their heart disease risk by 0.1%.

 

Yawn. That type of analysis wouldn’t sell many papers or get many clicks. Thus, the media did not report it as such. Yet that is what the paper found.

 

Gut Bugs

 

What about gut microbiota? Can gluten-free diet hurt our gut bugs?

 

A 2010 study suggested eating a gluten-free diet harmed our gut microbiome. This one should be an easy one to explain.

 

What helps healthy gut microbes flourish? Fiber. Specifically, fermentable fiber.

 

The most common gluten substitute is rice flour. Rice flour has very little fiber, thus very little ability to feed the healthy gut bacteria.

 

The result? A relative overgrowth of the unhealthy gut bacteria. The bacteria that like high-sugar and low fiber foods flourish while the fiber-eating bacteria die off.

 

Wheat on the other hand, tends to have more fiber. Especially whole grain foods. So once again, it is likely that limiting whole grains in favor of low-fiber, processed foods is not helping our health, whether we are talking about our guts or our hearts (and by extension, likely our brains as well).

 

Gluten- Guilty or Not?

 

Is there anything inherently dangerous about eating gluten free?

 

No.

 

The key is what are you eating instead. If you are eating low fiber, processed gluten-free foods, then you are not doing yourself any favors.

 

But if you feel better avoiding gluten, and you are replacing it with real food, fresh veggies (both starchy and non-starchy), fruit, seeds and nuts, then chances are you will feel better and be healthier.

 

What if gluten doesn’t bother you? Then there is no real need to avoid it as long as you are eating whole grains, minimally processed versions of gluten, and avoiding the processed and refined junk.

 

It’s that simple Let’s not over complicate it.

 

Action Item: Take two weeks to see how you feel without eating gluten. Do you feel any better? More or less energy? Can you think or focus better? Do you have fewer aches and pains? Did your weight change? If not, then eat what you want (as long as you continue to follow a real food, vegetable first, low sugar and low processed food way of eating). If you do feel better without gluten, then stock up on the foods listed below. Avoid gluten, but also be careful not to add processed, low-fiber, gluten-free alternatives. Just because it is gluten free doesn’t mean it is good for you!

 

Whole grain gluten-free foods:

Amaranth, buckwheat, brown rice, millet, quinoa, oats. 

 

Other fiber containing foods:

Legumes such as beans, lentils and peas

Green leafy vegetables

Starchy vegetables such as yams, sweet potatoes, carrots and other root vegetables

Apples, pears and berries

Nuts and seeds

 

Thanks for reading.

 

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

www.DrBretScher.com

 

Bret Scher, MD FACC

Dr. Bret'sExclusive Wellness

Newsletters

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

Final Step

Where should we send your FREE

Exclusive Wellness

NEWSLETTERS

Dr Bret Scher