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

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

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

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

What are your diet goals?

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

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

Do you want to lose weight?

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

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

Do you want to reduce your hunger?

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

Do you want to improve your focus?

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

Do you want to improve metabolic health?

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

Do you want to decrease your cardiovascular risk?

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

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

One last consideration

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

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

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

Thanks for reading,

Bret Scher, MD FACC

Does Eating Fat Make Us Fat?

Does eating fat make us fat? According to a new article in The New York Times, it just might. With a heavy emphasis on “might.”

The New York Times: Which kinds of foods make us fat? (Paywall)

The article is based on a trial published in Cell Metabolism over the summer, which concluded that feeding mice up to 80% calories from fat causes weight gain. The same was not seen with higher levels of carbs or sugar intake.

Does this end the debate on what make us fat? Does this prove Gary Taubes and all the low-carb pioneers wrong?

Of course not. For starters, this was a study of mice. So, if you have pet mice, then you should definitely pay attention.

The bigger question, however, is does this trial apply to humans? I would argue absolutely not.

Here is what they found. The mice that ate a higher percentage of fat calories ate more total calories and gained more weight. They also found changes in the mice brains with increased gene expression of serotonin, dopamine and opioid receptors — the so-called “reward” receptors. Simply put, that means the mice found the fat so pleasurable, they ate more calories than any of the other mice and they even increased their reward-signaling pathways to match the pleasure they were experiencing.

Here’s the crux of the problem. Humans do the opposite. That’s right. The exact opposite. A review of 23 randomized trials showed that low-carb, high-fat subjects lost more weight than low-fat subjects, plus trials show low-carb, high-fat subjects experienced less hunger and ate fewer calories than low-fat subjects.

What about the reward center upregulation? In humans, that clearly happens in response to sugar, not fat. Once again, the exact opposite of the findings in the mice study.

The biggest take home from this study, therefore, should be the cautionary tale of using a mice study to predict human behaviors. This is especially true when we already have human studies showing the opposite effect. Low-carb diets help us eat less and lose more weight, and sugar lights up our reward centers like a Christmas tree. We don’t need mice studies to tell us that.

Thanks for reading,
Bret Scher, MD FACC

Originally Posted on the Diet Doctor Blog

Low Carb and Intermittent Fasting Make Traveling a Breeze!

It's challenging enough to stick to your health, fitness, and dieting goals when you're at home. When you're traveling, it can be even harder. Nothing's worse than going on vacation only to be frustrated that you've gained back weight you worked so hard to lose.

Let's be honest. When you travel, it's harder to pay attention to what you're eating, when you're eating and how much you're eating. If you prepre ahead of time, however, you can make this much easier. Focusing on intermittent fasting, limiting your carbs, and keeping up some version of your exercise routine can put you on a path to success.

How Travel Disrupts Your Diet

We seem to be traveling more than ever. The U.S. Travel Association reports that spending on travel in the U.S. alone averages $2.8 billion per day. Per day! That's a lot of opportunity to fall off the wagon.

You're likely to be less physically active. While it may seem you're covering lots of ground rushing to the airport and flying (or driving) hundreds of miles, you're also spending most of that time sitting down. It's also common for travelers to abandon their usual workout routines.
There are snacks and junk food everywhere. It's tempting to grab snacks at the airport or to worry that you may not have a chance to eat for a while, so yo ugrab whatever is available. Most of these choices are high carb, high sugar distractions.
Your internal clock is disrupted. If you're traveling through time zones, your circadian rhythm is a mess and youo will find yourself craving more, with diminished self control.

But it's not hopeless! Here are some recommendations for counteracting these issues and staying healthy when you travel.

Limit Carbs When Traveling

We can debate all we want the merits of low fat vs low carb diets. Especially when the carbs are high quality, real food carbs. However, when you travel, lower quality carbs are often the biggest temptation. Simple carbs like sweets, foods made with white flour, and many packaged and processed foods are everywhere.

Bring healthy snacks with you. Instead of relying on food counters at the airport or filling up on junk food at rest stops on the highway, take the time to prepare some healthy meals. Prepare snacks that include superfoods such as almonds and other mixed nuts, salads with broccoli, kale hemp seeds and chia seeds, and perhaps some dark chocolate for a treat.
Do your own shopping and cooking. Just because you're on vacation doesn't mean you have to eat out every meal! Don't derpive yourself of trying some new restaurants, but remember you can still do some of your own cooking. Look for a hotel or Airbnb that lets you do at least a little cooking and that has a fridge. This gives you more control over your diet.
Research eating options ahead of time. Before you leave on your trip, identify hotels, restaurants, and eateries that offer healthy and low-carb options. Don't forget to find out when and where local farmer's markets are held. I find that is a fantastic way to check out the local scene and partake in healthy local food choices.
Drink water. Staying hydrated can help combat hunger, and it will keep you away from sodas, juices and other sugary distractions.

Incorporate Fasting Into Your Trip

There are many health benefits to intermittent fasting. It can help you to lose weight and lower insulin, and there's even evidence that it contributes to longevity. But when it comes to travelling, the best part of IF is the convenience! If you're fasting, you don't have to worry about finding a healthy meal at the airport or on the plane. Stick with water and you are good to go!

If you are fasting, do it in a responsible and healthy way. If you're on any kind of medication, consult with a health professional before fasting. If you've never fasted, start slowly. Most people can do an 18:6 fast without too much discomfort. This means fasting for 18 hours and then eating for the next 6 hours. When you get comfortable with this, you can increase the duration of your fasts to 24, 48, or even 72 hours. If you want to try fasting on your next trip, it's a good idea to try some short fasts before you begin your journey.

Other Tips to Stay Healthy on the Road

Exercise regularly. Try to stay somewhere with a gym. Or a neighborhood that has a gym you can use. Even without this, you can schedule in a walk, jog or bike ride. If you're visiting tourist attractions, think of a walk or bike tour rather than a bus tour. Look into places where you can explore nature and get fresh air.
Get enough rest. Travel can also disrupt your sleep patterns. Lack of sleep is associated with anxiety, depression, hypertension, and many other health problems. If you're going to be traveling through time zones, start adjusting to the new time before you leave for your trip. When on your trip, be careful not to burn the candle at both ends. If you're getting up early for a long day of sightseeing (or business meetings), go to bed at a reasonable time.
Limit your intake of alcohol. It seems that alcoholic beverages are everywhere when you travel. Whether you're ordering a cocktail to help you relax on a long flight, downing tropical drinks on the beach, or sampling local craft breweries or wineries, the temptations are everywhere. Alcohol is high in calories and sugar. It can also disrupt your sleep patterns. If you do drink, limit it to one or two per day.
Don't stress out. Stress is never healthy and travel, even the kind that's supposed to be relaxing, can contribute to it. Avoid trying to fit in too many activities on your trip. Rushing around tends to make you reach for junk foods for quick comfort or energy. When planning your schedule, leave time for spontaneous exploration or just lounging around.

Watching your diet when traveling is important, especially if you frequently find yourself on the road. It's easy to slip into bad habits when traveling which means you have to start all over when you return home. It's better if you can stay consistent even when you're away from home. Limiting your carbs, fasting, and maintaining regular exercise and sleep routines all help you maintain optimum health when you travel.

Alcohol and Low Carb Diets: Can they Coexist?

Enjoying an alcoholic beverage or two is a normal part of daily life for many people. For some, any meal – other than breakfast – is not complete without some sort of alcoholic beverage, whether that's hard liquor, wine, or something more exotic. But did you know that what you drink can affect not only your health, but also your weight loss goals?

Is Alcohol Healthy?

Overall, it depends on the amount imbibed. Health centers, such as the Mayo Clinic, suggest that it's safe for women to drink one standard bottle of beer, one glass of wine, or 1.5 ounces of liquor every day. Men, on the other hand, can have twice that amount. Of course, these are just general guidelines. Large women may be able to drink more, while men with a slight build are generally better off having a bit less.

At this rate, alcohol can actually be healthy. Experts say that it can protect the heart, possibly reduce stroke risk, and surprisingly enough, it may reduce the risk of diabetes. That said, you shouldn't start drinking (if you don't already) just to get these benefits. And it isn't clear that the benfits are alcohol specific, they could be more lifestyle related or due to other factors. So tread carefully with the "benefits of alcohol."

When Alcohol Isn't Healthy

As almost everyone knows, alcohol is a toxin. The dose determines the poison. It certainly isn't healthy to have so much alcohol that you get drunk. It also isn't healthy to drink so much, or so often, that you develop an addiction to it. Alcoholism is well-known for causing problems with the liver, and it can be a contributing factor for cancer and other problems with the throat and stomach, as well. Not to mention how the addiction can ruin someone's life.

There are several other situations, some of which are surprising, that you should be aware of. Beer, for example, is the highest-carb form of alcohol – and therefore, the type that will wreck your low-carb eating plan the fastest. Clear hard liquor is better, but wine is the best in moderate amounts.

According to a recent WSJ article, consumers are learning of these differences and adjusting their buying habits to suit. Beer sales are on the decline, while spirits and wine are becoming more popular.

Alcohol and Your Diet

Alcohol has one other big negative: It can torpedo your low-carb diet. This is because typical drinks are high in calories and carbs. The body also metabolizes alcohol before anything else, so its punch can knock you out of ketosis for several hours or longer. While some people won't notice any ill effects from this, many do notice that their weight loss slows or stalls when they indulge.

Too much alcohol can also lower your inhibitions, and this means that you'll find it harder to stick to your diet. All of the high-calorie, high-carb foods that you'll have available at a party or in a restaurant will suddenly seem far more tempting than usual. For this reason, it is normally advised to either avoid alcohol altogether in such situations or keep intake to a very moderate level.

Drinking too late in the day can also keep you from getting a deep sleep. This interferes with your body's ability to repair itself, and therefore, can also interfere with an exercise program. Since both diet and exercise are generally recommended for weight loss, it's wise to stop drinking several hours before you intend to go to bed.

A Healthy Wine Alternative for Low-Carb Lovers

Dry Farm Wines has recognized that a glass of a typical wine isn't always healthy for everyone. Therefore, they have developed a line of wine that addresses the most common health concerns. Their wines are actually great for low-carb eating plans because they are sugar-free, contain less than 12.5 percent alcohol, and are explicitly made to be friendly to low-carb, keto, and paleo diets. This makes them an excellent alternative to the typical high-sugar, additive-filled wines found on the supermarket shelf.

These benefits aren't all that set Dry Farm Wines apart from others. They also lab-test every wine to make sure that it meets the company's strict purity and content standards. Dry Farm also makes sure not to add or remove anything from their product. Instead, the wines are produced so that they contain all of the good aspects right from the start, and so no unwanted ingredients need to be put in. As you might expect, the wines are also organic. They are sourced from small family farms, as well.

How Wine Can Affect Ketones

In a self-experiment of the type that makes the internet the great medium it is, Mark Moschel of Better Humans decided to fast for several days and measure his ketones vs. how he felt. He found that he was more energetic when he had more ketones in his system.

On the second run of the experiment, he added something new: He would have no food, but would have wine. He found that after one glass, his ketones and blood glucose still remained stable. However, after the second, his ketones dropped a bit and his glucose also rose moderately. Finally, after the third glass of a day, both stats continued their prior trends. It took until the middle of the next day for his levels to return to his usual norm.

As this shows, a single glass of wine can be enjoyed without interfering with ketosis or blood glucose, but more than that can lead to trouble on these fronts. But remember, this experiment was done with Dry Farm Wines. Other brands that aren't as meticulous to quality and low sugar may not have the same results.

Make Your Celebrations and Meals Healthier

Now, you don't have to worry about wrecking your diet, getting headaches, or any of the other negative side-effects of drinking moderate amounts of wine. With Dry Farm Wines, these pesky attributes are gone. You can host a party and raise your glass with no worries – and without looking unsociable. There'll be no more awkward moments caused by the need to turn down a beverage as long as the wine on the menu is from Dry Farm.

Despite all of the benefits of Dry Farm Wines, you will still need to partake in moderation as suggested by health experts. There is alcohol present, so stick to one or two glasses, and be sure to have them early enough in the day to allow for a good sleep that night.

To experience the flavor and healthiness of Dry Farm Wines for yourself, just click here. For a limited time, you can even add a bottle to your order for just one cent!

Leave us a comment if you have tried Dry Farm Wines, or if you know of similar products that are healthy, low-carb alcohol alternatives!

Does Fasted Cardio increase Fat Burning?

There is a lot of information out there around fasted cardio and fat burning. I’ve personally received a number of questions about whether or not fasted cardio increases fat burning, and I wanted to review the existing literature as well as add my thoughts.

Understanding Articles and Studies

I recently came by an article on Medium that reviewed recent studies about fasted cardio and concluded that fasted exercise does not reliably increase fat burning. Paradoxically, they did include a review of 27 studies that concluded “there was a significant increase in fat oxidation during a fasted state.” However, all the other studies reviewed concluded the opposite.

Their conclusion? “Fasted cardio does not work. At best it delivers results comparable to fed state exercise. At worst, it decreases intensity and performance, lowering total energy expenditure, and resulting in less overall fat loss. Fasted cardio seems to be more effort than it’s worth. It includes a lot of extra work without any added benefits.”

Is that true? Should we forget about exercising in a fasted state since it has no benefit?

No! The key is understanding who was investigated in those studies and if the results apply to you.

To their credit, they start the article by saying, “the body is a complex and dynamic system working on many variables. Simply exercising on an empty stomach may not be enough to increase fat loss.”

The Respiratory Quotient

That statement I can agree with. The body is complex and dynamic. In general, the body will use available glucose and glycogen first for energy. If those are in short supply, only then will the body change to fat burning. We can measure this by the respiratory quotient or RQ (see this video I did with Ken Nicodemus to learn more about cardiorespiratory testing and RQ).

If someone is eating a high carbohydrate diet, they are a requisite carbohydrate burner. Simply fasting for 12 hours is inadequate to turn them into a fat burner for a 60-minute exercise.

If, however, someone is following a healthy low carb lifestyle and has adapted to becoming a fat burner, then an overnight fast can greatly enhance the fat burning capacity of exercise.

The aforementioned studies, therefore, need to control for baseline diet and RQ, as that will greatly affect one’s ability to burn fat.

Duration of Exercise in a Fasted State

Also, duration of exercise matters. Longer exercise durations that deplete glycogen stores can help you transition to fat burning. This can be difficult, however if you have not cycled in and out of fat burning mode before as there is an adjustment period.

What’s the take home?

Be a fat burner at baseline. The better you burn fat at rest, the better you will burn it with exercise. If you follow a low carb lifestyle with time restricted eating and/or intermittent fasting, then you will train your body to burn fat. Exercising in a fasted state will enhance this capacity.

Hello fitness, good bye body fat.

Do you exercise in a fasted state? Let us know your experience and how it works for you!

Thanks for reading,

Bret Scher, MD FACC

www.LowCarbCardiologist.com

Does Weight Loss Depend on Calories or Hormones?

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

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

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

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

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

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

Low Carb vs Low Fat Diets

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

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

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

This leads us to the next question:

Why is an LCHF diet better for weight loss?

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

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

1. Calories in/Calories out.

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

2. Carbohydrate-Insulin Model.

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

Studies Around LCHF Diets

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

The Ketogenic Diet Study

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

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

Here are the basic highlights of the study:

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

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

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

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

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

The Healthy Low-Fat Diet Study

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

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

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

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

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

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

Dieting in the Real World

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

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

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

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

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

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

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

Thanks for reading

Bret Scher, MD FACC

www.LowCarbCardiologist.com

5 Reasons We All Should Fast, and 1 Reason Why We Shouldn’t

I wanted to write this article to address a question I hear often:

Do I need to Fast to Be Healthy?

In short, probably. But what exactly does that mean?

Thanks in large part to Dr. Jason Fung and others, intermittent fasting (IF) has emerged from the shadows of the health movement to now being discussed every day on social media, as if we have been doing it for decades.

And here’s the secret: We actually have been doing it for decades. In reality, it’s more like centuries.

Think of how we evolved. There wasn’t a convenience store, grocery store, restaurant, or fast food joint on every corner. We had to hunt and forage for our food. That took time and was sometimes unsuccessful. The natural result, therefore was periods of eating interspersed with periods of fasting.

Modern society is a far cry from that evolutionary period, as we now have a 24/7 eating cycle with late night taco runs, vending machines and snacks available at a moment’s notice, and misguided advice that we need to eat every two hours to stimulate our metabolism and lose weight (awful advice with no scientific backing, mostly promoted by snack food companies). We have plenty of reason to believe this constant eating cycle has contributed to our current obesity/diabetes/insulin resistance epidemic.

The good news is that we can reverse that trend. We can reverse it by bringing back fasts.

What exactly is fasting?

First we need to define what fasting means, and what time restricted eating means. Time Restricted Eating (TRE), means eating only in a specific time window, and not eating the rest of the day. For instance 18:6 means not eating for 18 hours straight, then eating over a 6-hour period. This can be 12:12, 16:8, 18:6 or even 22:2. They key is that you have an extended period of time each day when you are not consuming calories.

More extensive fasts, 24-72 hours or even longer, are really what we refer to when we say intermittent fasting. For this explanation, I will refer to extended fasts and TRE together as they have similar benefits. I will explore the differences and go into more scientific detail in a future post.

Here are the top 5 reasons we should all fast

1. Fasting is the most efficient way to lose weight.

Forget the fat burning foods, forget the cleanses and detoxes. Not eating is the key to losing weight. But do it intermittently. That’s why it’s called intermittent fasting. Chronic calorie restriction doesn’t work long term since it forces our bodies to reduce our resting metabolic rate (RMR), thus stalling weight loss and increasing frustration. Intermittent calorie restriction, on the other hand, allows for weight loss without changing our RMR, the key to healthy and successful long-term weight loss.

2. IF is a great way to lower insulin.

It just makes sense. If there is no food coming in, there is no need for insulin to rise. Insulin will stay at its low steady basal rate, and there will be no elevations or spikes. That keeps the area under the curve low, right where we want it. Low insulin means we can mobilize our fat stores, and possibly more importantly, it protects us from the harmful long-term effects of hyperinsulinemia.

3. Intermittent Fasting is the key to longevity.

The one consistent finding in longevity research, from single cell organisms up to primates, is that calorie restriction works. But as we have learned from chronic calorie restriction experiments in humans, it’s not so clear cut. First, its miserable and most people would rather die younger that live longer with chronic calorie restriction. Agree?

Second, our bodies adapt to chronic calorie restriction and thus make it difficult to maintain the health benefits. Intermittent calorie restriction, on the other hand, has the promise of all the longevity benefits without all the baggage that comes with it. The fountain of youth only helps if we like how it tastes.

4. It’s easy!

What’s easier than skipping breakfast? No planning, no shopping, no cooking, no cleaning. Simply walk out the door. In our hectic everyday lives, we should welcome anything that takes less time and makes our lives a little easier. Fasting does exactly that. Just make sure you bring a water bottle with you wherever you go, and maybe some sea salt to put in your water. Stay well hydrated and enjoy the simplicity.

5. There are many ways to make fasting work for you.

There is more than one way to have a successful fast. As mentioned previously, 18:6 can work wonders for most people. For those who are more adventurous, a 72-hour water fast can have amazing results. And there is everything in between. Just follow the simple rules of staying hydrated, paying attention to how you feel, avoiding anything with calories, and even avoiding calorie-free sweeteners. The rest of the details can be individualized to fit your life and your goals.

The Top Reason Why You shouldn’t fast

Fasting can work wonders for most people, but it can also be dangerous for others. If you take medications for diabetes, hypertension or other medical conditions and you’re trying to fast on your own, don’t do it! Fasting can cause significant harm in these circumstances if not done with proper precaution. That doesn’t mean it can’t be done. In fact, it can still be incredibly beneficial. Just make sure you are working with an experienced clinician who can help coach you through it safely.

Here’s one last bonus tip.

Don’t give in to temptation once the fast is over.

How you break your fast can be just as important as how you fast.

Break the fast with a small low carb snack such as bone broth
Have your first meal an hour or two after your snack
Resist the urge to “reward” yourself with high carb foods or junk food. Your gastrointestinal system isn’t ready for that. Plus, why work so hard to keep insulin low if you are just going to spike it when you are done? Stick to your usual, healthy, high quality low-carb fare.
Resist the urge to increase your calorie intake to “make up” for the fast. If anything, the first 12 hours should have fewer calories than your usual eating pattern, slowly returning to normal (not supra-normal) over the next 24 hours.

Pretty easy, right? I am a big fan of simple, safe and effective. When done right, intermittent fasting hits all three criteria.

Is intermittent fasting right for you? It may just be.

If you are interested in Fasting, but are unsure where to start, or want to learn more of the benefits, my free Full Guide to Fasting E-Book is for you!

This E-Book discusses the benefits of fasting, an overview of different types of fasting, and a guide on how to fast correctly, so that you can see the best results.

Thanks for reading,

Bret Scher, MD FACC

Founder, Boundless Health

www.LowCarbCardiologist.com

How To Talk to Your Doctor About The LCHF and Keto Lifestyle

Are you interested in trying a Low Carb-High Fat/Ketogenic lifestyle? If so, great.

Are you looking to your doctor for support in this diet? If so, tread gently.

The medical community has engrained false beliefs that LCHF lifestyle is dangerous to your health. We can blame it on Ancel Keys. We can blame it on an over emphasis on LDL-C. We can blame it on Big Pharma. We can even blame it on the rain! Whatever the reason, you may not get a warm and receptive response from your physician.

But there is hope. Here are my top 6 Tips on How to Talk to Your Doctor About The LCHF/Keto Lifestyle.

1. First, ask for your doctor's opinion about LCHF

Doctors are people too. How would your spouse react if you said, “I’m no longer taking out the trash/doing the dishes/making dinner. It doesn’t work with my personal philosophy of house chores and we are going to change this. Now.” I hope you have a comfortable couch, cause that’s where you will be sleeping.

Picture instead, “Hi Honey. I was thinking that we may want to reassign some of our house chores to help things get done better and more efficiently without putting too much strain on either of us. What do you think about that? Do you have any thoughts how you would like to change things?” That sounds better, right?

The same approach applies to your doctor. Just don’t start by calling your doctor honey. That’s just awkward. Don’t say, “Hey Doc, I’m going LCHF and need you to order x, y and z blood tests on me now and again in 6 months, and help me get off my meds.” Instead, try a kinder, gentler approach. “Hi Doc. I was thinking of ways to be more proactive about my health. What I have done thus far has not worked as well as I have liked. I have heard a lot about LCHF as a way to lose weight, reduce insulin levels, improve blood glucose control, and feel better. I was thinking of trying it. What do you think about that?” You may not immediately get the answer you want (for instance, I am still taking out the trash every week), but you have opened the lines of communication in a much less confrontational way, which can set you up for success as we discuss other tips below.

2. Measure the effects of Keto on your body with a medical trial

If your doctor is hesitant about you trying LCHF/Keto, suggest a 3- or 6- month trial. Establish what you want to monitor (here's an eBook I created to help you get started: 10+Medical Tests to Follow on the LCHF Diet). Check what you would like to monitor at baseline and then at the 3-6-month mark. Emphasize you want to experiment to see how your body responds, and that you want his/her expertise in helping analyze the labs to help you progress safely.

Also, if you are on medications for blood pressure, blood sugar or lipids, you will want their guidance with these. Emphasize how you want him or her on your team to help you on your journey and temporary experiment. It is hard to resist when someone genuinely wants your help and thinks you can play a role in their improvement!

3. Show them your results!

Don’t gloat, don’t brag, but make sure you follow up with your doctor and tell them everything you feel and have measured. Do you have more energy? Less stiffness or inflammation? Are your pants fitting looser? And of course, follow up on all the labs to look at the whole picture. You will be surprised how often your doctor will then turn to you and ask you what you have been doing. If they have the time, they will likely say “Tell me more about that.” Yes! This is your opportunity to teach them the power of LCHF/Keto. Then, when the next patient comes around, they won’t be as resistant, and may even start to suggest it themselves. The patient becomes the teacher!

4. Find a doctor who will listen

Our healthcare system is messy. No question. We don’t always have freedom to choose our own doctors. But that doesn’t mean it is impossible to change. Here is a hint: If your doctor isn’t open minded enough to try a self-directed experiment with you, what else are they close minded about? Maybe it is time for a change anyway.

It may not be easy to find a doctor with an open mind who takes your insurance, is geographically desirable, and who is accepting patients, but there are some tricks you can use. Look for a doctor who has been in practice more than seven years, but less than 20 years. In my experience, this is the critical “open minded” window. They have been in practice long enough to be confident in their own skills and are willing to stray from “what everyone else does.” On the other hand, they have not been in practice so long that “That’s the way I have always done it” becomes the reason for their care.

Look for doctors with interests in prevention, sports medicine, or integrative medicine. These suggest more interest in health and less interest in the standard “pill for every ill” medical practice. Lastly, people are developing lists of Keto-friendly doctors online. While these may be small at present, they are growing quickly and hopefully can help you find the right doctor for you.

5. Seek online Keto support

Numerous online sites exist to help you with you transition to a LCHF lifestyle. I have built my blog and Low Carb Cardiologist Podcast to provide information and support on those who are embarking on their healthy lifestyle journeys, with a lot of information about Keto and LCHF.

Some other sites I recommend are DietDoctor.com, 2KetoDudes podcast, and Ketovangelist podcast, to name a few.

6. Take control of your own healthcare journey

As nice as it is to have your physician on board with your health decisions, it is not always needed. As Brian Williamson from Ketovangelist said to me on his podcast, “If your doctor is more interested in your health than you are, then you are in trouble!” I agree with that sentiment, and I encourage everyone to be the driver in their own healthcare. You can still choose to try the LCHF lifestyle even without your doctor. Look for a reputable second opinion doc who is willing to help open lines of communication between you and your doc. That is one of the services I enjoy providing the most. Since I speak the same language, I can usually help someone start the conversation with their doctor.

In addition, online sites such as WellnessFx.com allow you to get your blood drawn and seek consultations with health care providers (Disclaimer: I am one of those providers and get paid for my services. Another disclaimer: I love doing it). If you go this route, I encourage you to then bring your results back to your doctor (See number 3 above). You can now become the teacher, young Jedi.

There you go. With these six simple tips and resources, you will be well on your way to safely adopting a Keto lifestyle. Doctors are people too. Just like everyone else, we like to be needed, we like to be helpful, and we don’t like being told what to do. I just need to remember that the next time my wife “needs” me to clean the toilet….

Thanks for reading.

Bret Scher, MD FACC

Founder, Boundless Health

www.LowCarbCardiologist.com

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

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

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

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

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

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

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

The problem? Insulin promotes fat storage, increase inflammation and oxidation, and can even help fuel the growth of cancer cells. Therefore, the healthiest approach is one which reduced the level of insulin to the lowest possible levels. As it happens, a Low-carb High-fat or ketogenic lifestyle (LCHF/Keto lifestyle) dramatically improves your body’s sensitivity to insulin, reduces the amount of insulin secreted, and it allows your body to naturally use your fat stores for what they are designed for: Break them down into energy! Once we see that we need to fight chronic elevations of insulin, it becomes obvious why a low-fat diet is harmful, and why a low carb diet is the true path to health.
Eating Fat Improves Your Cholesterol!
Wait, what? Eating fat can improve my cholesterol? Sounds crazy, right? That goes against everything we have heard from the medical establishment. Notice I said “cholesterol.” I didn’t say the “bad” low density lipoprotein (LDL), I didn’t say the “good” high density lipoprotein (HDL), or any one specific type of cholesterol. We have over emphasized the solitary variable of LDL for too long. Total cholesterol to HDL ratio, Triglyceride to HDL ratio, lipoprotein size and density, insulin sensitivity, and other metabolic measures are more powerful predictors of cardiovascular health than just LDL.

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

If you want to learn more about lipids and cholesterol, I recommend checking out my new dedicated cholesterol course: The Truth About Lipids.
Higher HDL is Associated with a Lower Risk of Heart Disease.
HDL is your friend, but drugs are not. Observational evidence has consistently shown that higher HDL is associated with a lower risk of cardiovascular disease. However, our healthcare establishment does not prioritize HDL for one simple reason- Drugs that raise HDL don’t make you healthier. Trial after trial has failed to show any benefit from drugs that significantly increase HDL.

Instead, it’s the HDL-raising lifestyle that provides the benefit, not artificially increasing it with drugs. What’s the best lifestyle to naturally raise HDL? You guessed it. LCHF/Keto lifestyle. Add in some resistance training and you have your friendly HDL climbing the way it was meant to…Naturally.
LCHF Leaves You Feeling Great, Leading to Healthier Decisions
What kind of health decisions do you make when you are fatigued, achy, and find it difficult to concentrate? That’s a rhetorical question, I already know the answer. When things look glum and we don’t feel well, it’s far too easy to sit on the couch or reach for the chips and cookies. Compare those decisions to those you make when you are well rested, energetic, and seeing the world more clearly. For most people, the better you feel, the better decisions you make.

Guess what? The majority of people who change to a LCHF lifestyle feel better! It may take a few days or weeks, but in general, they feel more in control of their health, more energetic, and they are able to make better health decisions. I admit this is difficult to prove in a scientific trial. That is why we all should become our own n=1 scientific trial. How do you feel and how are your health decisions after going to a LCHF lifestyle? What matters most is what works for you, not what works for hundreds of people who are kinda-sorta like you.
Keto helps you with fasting.
Eating better helps you not eat. People who eat a high carb diet eat a lot, don’t they? They are always grazing and snacking. Our bodies go through the roller coaster of blood sugar and insulin spikes, making it a challenge to go 24, 18, or even 6 hours without eating. This creates a constant, unwavering supply of insulin in our blood stream.

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

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

Admittedly, long term outcome studies evaluating fasting or LCHF and cancer or dementia risk have not been done. But, on the flip side, drug trials to prevent the same are showing no benefit despite hundreds of millions of dollars invested. If you asked me (which you sort of did since you are reading my article), I’d vote for autophagy as a preventative strategy any day. It makes good physiologic sense, and it is so easy to achieve.
With Keto You Will Enjoy Eating Again!
That’s right. A way of eating that helps you lose weight, helps you feel better, improves your health and is actually enjoyable! No fake processed soy products, no cardboard tasting rice cakes. True, it also means no more candy, processed snack foods, doughnuts and danishes. But once you swear them off for a few weeks, and you are eating all the eggs, avocados, nuts, fish, steak, cheese etc. that you want, you won’t miss those old crutches any more. Let the enjoyment begin!

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

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

Is LCHF/Keto the right lifestyle for you? It just may be. To learn more about Low Carb and Keto, download this free E-Book:

Thanks for reading,
Bret Scher, MD FACC
Founder, Boundless Health
www.LowCarbCardiologist.com

ADDENDUM!!

Since I have published this article, there has been a windfall of media buzz around low carb diets increasing our risk of heart disease or diabetes. Let’s look at where that information came from.

1- A study force feeding mice excessive amounts of industrial omega 6 oils. You can guess what I have to say about that. The article was incredibly helpful, and I immediately stopped force feeding my pet mice industrial seed oils. Thanks goodness for that article. As for how it applies to humans eating real food that contain fat, there is zero correlation.

2- Epidemiological study suggesting those who ate low carb (40% calories from carbs, which by the way is NOT low carb) as measured by two food journals over 25 years had a higher risk of dying. Oh and by the way, at baseline they were heavier, more sedentary, smoked more, and ate fewer veggies. Yet somehow they concluded it must be the low carb diet that “caused” the harm. Once again, it may not be bad science, but it sure was awful interpretation of the science.

In light of those two studies and the hoopla surrounding them, has anything happened to change my mind about a LCHF/keto diet being beneficial for our overall health and our heart health?

Absolutely not.

We still need to individualize our care and our lifestyle for who we are and how our bodies respond. That is always the case regardless of our nutrition, our medications, our exercise etc. As long as we do that, then this cardiologist still believes that LCHF IS HEART HEALTHY!

If you liked this post, you’ll love my free E-Book on Low Carb/Keto Starter tips to help you get started on your LCHF path!

Thanks for reading.

Low-Carb No Better Than Low-Fat….Or is it?

The quest for the one study to finally answer all our nutritional questions continues. And likely will continue forever.

If you believe the hype, the recent JAMA study comparing a “healthy low fat” and “healthy low carb” diet on the effect of weight loss was the definitive answer we sought. The only problem is that it wasn’t.

Their conclusion? Everyone lost the same amount of weight regardless of the diet, and genetics of insulin resistance didn’t matter. So, in the end, we can all stop worrying about low fat or low carb or insulin resistance and just eat well. Right?

I’m all for simple advice, and that is as simple as it gets. And it will work for many people. But from a scientific perspective, this study did not adequately address the questions it sought to answer. Let’s look under the hood…..

600 people without diabetes or heart disease and not on hypertension or lipid medicines were randomized to a “healthy low fat” or “healthy low carb” diet for 12 months.

Neither group was told to restrict calories (although both groups ended up eating 500 calories less per day on their own). They had extensive counseling and support with over 20 support sessions throughout the 12 months. These sessions included specifics about the diet and support for maintaining behavioral changes. (That’s a great goal for us all, but the reality of behavior change support looks far different. “Eat better, lose weight and come back in a year” is an all-to-familiar refrain).

Here is the kicker. Both diet groups were advised to maximize the veggies, minimize sugar and processed flour, minimize trans fats, and focus on nutrient dense whole foods prepared mostly at home.

I don’t care what the macros of the diet are. If we get people to do that, Bravo! That would be a vast improvement for the majority of this country. As a result, the “low fat” group reduced their carb intake from 241 grams per day at baseline down to 205-212 grams per day during the study, and undoubtedly improved the quality of their carbs. They were the low-fat group, and they reduced their carbs! Red flag #1.

On the other side, the low-carb group also started in the 240s per day, and reduced their carb intake to 96-132 grams per day during the trial. Red flag #2. This is not a true low carb diet. Low carb diets tend to have less than 50 grams of carbs (100 at the absolute most!), and ketogenic diets tend to have carbs <30grams per day.

So, let’s be clear about what was tested. The diet was a “lower than average but still not all that low” intake of carbohydrates, compared to a “lower than average but more moderate carb intake” diet.

This is hardly the definitive once and for all answer about low fat vs low carb diets for which we had all hoped.

That doesn’t mean we have to throw out the results, however. We can still learn valuable information from the trial.

Reduce junk, and focus on real foods and you will lose weight and improve your health. AMEN! Not a shocker, but always nice to be reminded of the simple things that work.
Engage in a strong support system and you have a good shot of staying with a nutritional change for 12 months.
The more you reduce your carbs, the more likely you are to raise your HDL and lower your TG.
The more you lower your fat, the more likely you are to lower your LDL
Following a mildly reduced carbohydrate intake may not significantly improve insulin resistance blood tests.
There was still a huge variability within each group with some people losing a great deal of weight, and some not losing any. Looking at the averages does not help us decide what specific characteristics predicted success. But in this trial, it did not seem to be genetics.

And the other take home? Testing moderate changes in diet are unlikely to show dramatic differences when both tested diets focus on real, nutrient dense, whole foods, limiting added sugar and processed flour.

If we want to test for a REAL difference, we need to go more “extreme.”

Doing this same study with a ketogenic diet would be very interesting.

Including people with diabetes and hypertension (more metabolically unhealthy, like so many in this country) would be very interesting.

Would that give us the once and for all answer which we crave?

Once again, probably not. But it may help us understand when to use the different tools we have in our nutritional tool box.

As was so nicely stated by The Diet Doctor, we now have an equal number of studies showing no difference between low fat and low carb diets as we do showing that low carb is better. We are still waiting for one to show low fat is better…….

The main takeaway, however, is that we don’t have to believe there is one diet for everyone. That is why we need an open mind, we need to be open to experimentation, and we need to treat individuals as…….individuals.

We can reverse type II diabetes with a ketogenic diet. Virta Health has shown us that.

Real food, relatively low-fat diets, when combined with healthy lifestyle practices can be associated with good healthspan. The Blue Zones observations have shown us that.

Our definitive trial may never come. But we don’t need it as long as we are willing to work with the n=1 experiment with each and every person we encounter. The starting point is easy. Just eat real food. Then be open to different avenues of specifics and see where the road goes.

Thanks for reading.

Bret Scher, MD FACC

Cardiologist, author, founder of Boundless Health

What are your diet goals?

Do you want to lose weight?

Do you want to reduce your hunger?

Do you want to improve your focus?

Do you want to improve metabolic health?

Do you want to decrease your cardiovascular risk?

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

One last consideration

How Travel Disrupts Your Diet

Limit Carbs When Traveling

Incorporate Fasting Into Your Trip

Other Tips to Stay Healthy on the Road

Is Alcohol Healthy?

When Alcohol Isn't Healthy

Alcohol and Your Diet

A Healthy Wine Alternative for Low-Carb Lovers

How Wine Can Affect Ketones

Make Your Celebrations and Meals Healthier

Understanding Articles and Studies

The Respiratory Quotient

Duration of Exercise in a Fasted State

What’s the take home?

Low Carb vs Low Fat Diets

Why is an LCHF diet better for weight loss?

1. Calories in/Calories out.

2. Carbohydrate-Insulin Model.

Studies Around LCHF Diets

The Ketogenic Diet Study

The Healthy Low-Fat Diet Study

Dieting in the Real World

Do I need to Fast to Be Healthy?

What exactly is fasting?

Here are the top 5 reasons we should all fast

1. Fasting is the most efficient way to lose weight.

2. IF is a great way to lower insulin.

3. Intermittent Fasting is the key to longevity.

4. It’s easy!

5. There are many ways to make fasting work for you.

The Top Reason Why You shouldn’t fast

Don’t give in to temptation once the fast is over.

1. First, ask for your doctor's opinion about LCHF

2. Measure the effects of Keto on your body with a medical trial

3. Show them your results!

4. Find a doctor who will listen

5. Seek online Keto support

6. Take control of your own healthcare journey

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