In today’s interview I get to speak with US board-certified cardiologist, Dr Bret Scher, about the effects of a low carb/Keto diet on heart health in the short and long-term.
Bret is very passionate about helping his patients avoid unnecessary and expensive heart treatments by focusing on prevention through a heart-healthy diet and other lifestyle changes.
In today’s interview we get a chance to talk about the different ways that the LCHF diet is beneficial to cardiovascular health. We also get a chance to bust some of the myths surrounding fat and cardiovascular disease.
If you know someone who is interested in trying out the LCHF/Keto diet, but is concerned about possible negative effects on the heart from adding healthy fat to their diet; this interview is for them.
I enjoyed this interview because Bret was very good at explaining all the factors that go in to maintaining a healthy heart.
After talking to Bret, I feel people should feel reassured that high fat diets aren’t harmful to cardiovascular health, contrary to what the conventional message has been from the medical profession for years.
Special thanks to Bret for joining me on the show. Enjoy the episode!
Show Notes with Timestamp Links
Highlights of what we talk about during the interview:
Click on one of the timestamp links in the brackets to jump to that point in the interview audio.[00:20] – Introducing Dr Bret Scher, a low-carb, US board certified cardiologist with additional training and certifications in personal training, fitness nutrition, behavioural modification and functional medicine. [01:18] – Bret shares his journey into the low carb, high fat (LCHF) world as a cardiologist. He explains how he was always interested in the prevention side of cardiology. Traditionally, this meant following a low-fat diet, but in practice the traditional wisdom wasn’t working. After seeing great results working with his friend Dustin – who was well versed in the keto diet as a health coach – he dug deeper into the keto/low carb science. [04:11] – A cardiologist has three thinking caps on. First is prevention (primary and secondary), secondly is the management of heart disease and tertiary is the hospital work. Bret explains that the reason cardiology falls short in terms of prevention is that it’s still a very drug- and procedural-focused treatment field. However, behavioural modifications and lifestyle are important in prevention of CV disease. [05:35] – Yes, keto and LCHF diets are preventative diets for heart disease. People’s fear of fat (saturated fat in particular) comes from Ancel Keys’ Seven Countries Study, and a lot of people inside the medical community still believe this as it’s what they were taught; it is hard to suddenly say the advice they were giving people was wrong. Bret urges people to look at Nina Teicholz’s and Zoe Harcombe’s work debunking the fat myth. [07:00] – Once we get past the initial fear of fat, we can see amazing benefits from the LCHF diets including weight loss, reduced inflammation, improved glucose, and insulin control (Top Tip: Listen to Dr Ben Bikman about insulin resistance). All these factors contribute to a reduced cardiovascular risk and we shouldn’t be focusing on cholesterol alone. Brett explains that because it is not clear that an increase in cholesterol causes any harm (in either the short or long term) if everything else is improving and you feel better, don’t panic. [10:51] – Bret explains how when interpreting blood tests results and LDL numbers on LCHF diets it is important to look at it in the context of everything else that is going on. Doctors often won’t be looking at the big picture i.e. is HDL high and triglycerides low? Is inflammation low? Are the insulin and glucose perfect? High LDL is only a concern if there are other concerning markers present but if all other markers are good, it is a completely different scenario. Bret’s advice to patients is to point all this out to your doctor so that they are looking at the whole picture. [13:34] – There are some things that have not been studied yet, including the use of statins on people eating LCHF diets. Bret explains how all statin studies that have been done are with people on low fat diets. This means we have zero evidence to say that there are any benefits in statin use for people following the LCHF diet. In fact, we know statins have the biggest impact in people who have high levels of inflammation. [14:49] – With keto gaining popularity in the US are there more people contacting Bret for consultations if they are seeing a rise in LDL? People contacting Bret through his online practice are often looking for another resource or a second opinion due to pressure from their doctor to take up statins. The advice Bret offers is not cut-and-dry; he looks at the whole picture and does all the necessary tests before deciding on the best way forward. [16:41] – What are Bret’s thoughts on Dave Feldman’s cholesterol experiments and hyper-responders? Bret feels Dave has done amazing work in helping us understand cholesterol. Bret explains what his initial response was to seeing large cholesterol spikes and how Dave’s explanation behind the mechanism causing this kind of response makes a lot of sense. Taking this into consideration, maybe the rise in cholesterol is not as dangerous as it first seems. The bigger concern that needs to be addressed is when HDL goes down and triglycerides go up. [22:02] – So, is everything in the world in cardiology measured in terms of LDL? There is an over-focus on LDL as the primary marker of heart health; none of the biggest risk factors, such as smoking, diabetes, insulin resistance and inflammation do anything to the LDL. Bret explains that even though we shouldn’t eliminate it as a marker altogether, we must put it into context. [26:03] – To determine if you are heart healthy start with asking yourself “How am I living my life?”. Consider how you eat, how you move your body, how you sleep, and how you manage your stress. Secondly, look at metrics like belly fat and blood pressure. Then check your blood work by looking at the full metabolic picture including blood sugar, insulin levels, cholesterol, HDL, triglycerides and the ratios. In addition, tests measuring inflammation such as the high-sensitivity CRP and fibrinogen tests can also be helpful. Finally, Bret explains how one of the best tests to do is the coronary artery calcium score (CAC). [33:01] – Bret explains why we should consider doing the CAC test before starting the LCHF diet to get a baseline. Having calcium deposits does not preclude anyone from doing the LCHF diet, it just puts them at a higher risk for heart disease, regardless of the diet. In fact, a high carb diet may be riskier. What’s important is to make sure you have a good doctor monitoring and guiding you. [36:39] – Are there any people who the diet would not be suitable for? Simple answer is, no. Everyone can try it to see if it works for them. However, there are some caveats. Some people have unusual reactions e.g. people with both copies of APO4 allele or people with gut issues. In that case more experimentation is needed to find ways of adding more calories without losing out on the benefits of an LCHF diet. Bret emphasizes that everyone deserves to experiment and find out what works for them as an individual (n=1). [40:44] – We talk about how diabetics can benefit from the LCHF diet, but Bret stresses that in order to do so safely they need to be monitoring their response carefully. For diabetics, Virta health offers a great programme where doctors are closely monitoring people (listen to the Dr James McCarter interview for more info on how Virta health is helping people reverse their type 2 diabetes). [41:57] – How to know if we might have familial hypercholesteremia? Diagnostic criteria labelling anyone with LDL above 190 as having hypercholesteremia is not always accurate. Simon Broome criteria considering a variety of factors is more useful. Other than a genetic test, some factors we need to consider include: a family history of hypercholesteremia and premature coronary disease, a presence of nodules and age when diagnosed. It’s important to remember that if our cholesterol was normal before the LCHF diet we most likely don’t have familial hypercholesteremia. [45:16] – There are some instances where high cholesterol causes no problems and in fact people seem to live longer due to protective element of the high cholesterol. However, it can be difficult to determine if someone will have problems or not. [47:30] – It’s also good to remember that there are other methods we can use to lower LDL besides taking statins. Certain herbs and supplement or dietary interventions can also be effective. [48:00] – What are Bret’s favourite preventative treatment methods for heart disease, in addition to the LCHF diet? One is, intermittent fasting and time restricted eating. Two is regular physical activity. Three is regular sleep. The emphasis on lifestyle factors is crucial. [51:47] – This brings to mind the Roseto study from the book Outliers by Malcolm Gladwell. When people look at people’s behaviours in Blue Zones the focus is often on the diet, but there is so much more to it than that. Lifestyle and strong community ties also play a huge part in health and longevity. [54:25] – To follow Bret and find out more about him go to his website: lowcarbcardiologist.com, where you can find links to numerous resources including his podcast, videos, blog and social media.
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