148- Best Ways to Improve Your Heart Health w Dr. Bret Scher

Bryan Carroll: [00:00:15] Back in the 1960. An idea was brought forward that dietary fat is a problem with our heart issues and that we need to remove all fat from our diets. By the 1980s, the low fat diet became very mainstream with the support of governments, physicians, food industry, and popular health media.

But here we are today, nearly 60 years later. And guess what? The number one cause of death is in America. You guess it heart disease. So what happened was a whole diet idea, a total flop, and where we just part of some massive dietary experiment based on minimal scientific evidence that ended up producing a poor result, or is this just an indication that heart disease is much more complicated than just removing one important macronutrient from the human diet?

What's up everyone. I'm Bryan Carroll and I'm here to help people move more, eat well and be adventurous. And today I have cardiologist Dr. Bret Scher on the show with me. I'm very excited for this episode because Dr. Bret focuses more on preventative cardiology, meaning he tries to prevent the heart disease from happening in the first place.

You've heard me on previous episodes is talking about how we live in a very reactive society. And we typically don't take care of ourselves until we start to fall apart. So I'm really glad that we have docs who are focusing on prevention and trying to reach at-risk populations before it's too late. So let's dive into my conversation with Dr.

Bret, Dr. Bret Scher is board certified cardiologists and lipidologist, who is a medical [email protected] and also runs a preventive cardiology, telemedicine practice. He also has a passion for helping others prioritize their health and currently hosts the diet doctor podcast and author in a well-received book.

Your best health ever like cardiologists surprisingly simple guide to what really works. Thank you Bret for coming onto the show. Oh my pleasure, 

Dr. Bret Scher: [00:02:12] Bryan. Thanks for having me on today.

Bryan Carroll: [00:02:14] Of course. And I'm really excited to chat with you about heart health today. Because I think there's a lot of misconceptions around good ways to improve heart health.

We've been taught for. About 40 plus years now, at least some ways that might improve heart health. But as we're saying with numbers, that's not really working the way that we expected it to. But before we start talking about that, let's learn more about you. Let's dive into your background and what got you interested in cardiology.

Dr. Bret Scher: [00:02:42] Yeah, well, thanks for the opportunity. You know, it's funny how people pick their path in medical school and residency. And when I went into medical school, I was sort of set on becoming a sports medicine doctor. You know, I was, I was an athlete and I just loved everything about sports and athletics and medicine and the way the human body worked.

And that's what I went into into medicine thinking, but then I just had some great. Mentors in cardiology and I was just fascinated with the heart and heart disease and how heart disease was, was, and is the number one cause of death in America and in the world. And that really drew me to that just the, the degree of impact you could have on people.

And I mean, I thought there was something really fun about it. You know, you had the in-office work where you're seeing people for. Years and years, and following them for risk factors. And then you have the procedural work where you're sort of like a surgeon, but not really a surgeon and you're doing procedures.

And then you have sort of like the emergency medicine type atmosphere where there is acute heart attack. So you had a little bit of everything in terms of the way you work. So that drew me to it as well. And then as I got more involved in that, I really started to focus more on the prevention side of things, because that's just fits more with my passion for health and healthy lifestyle.

And as much as I thought, the procedures and everything were sort of, kind of cool and interesting and fun, I realized it'd be much better if we didn't have to use these. If people never got to needing these procedures in the first place, I really started to focus more on prevention at that point. And then fortunate for me.

As I was going through my practice as a cardiologist, I realized I wanted to have more of an impact that I was happy and having. So I opened a store, I guess you could call it a boutique wellness center called boundless health. And I opened it with a friend of mine who is a. A really amazing health coach.

But he was also really knowledgeable about low carbon keto diets. And that's not why I teamed up with him. But in, through working with him, he sort of really helped open my eyes to this whole world of, of low carb nutrition. That's not really talked about in medicine at all. In fact, it is talked very negatively in medicine and it really opened my eyes to the world of research that exists and how we can impact people.

So it helped me with my message. As a cardiologist, that what we're doing kind of doesn't work. You know, the standard teaching hasn't been working you know, heart disease has been the number one cause of death since I was in medical school and still is, and that's despite people smoking less and despite a statin medications, then despite better procedures, you would think with all those things, if that was the real problem, we would have eradicated our disease or would have dropped precipitously.

But it hasn't. So that's what part of this journey sort of this phase of my journey is to really say, well, what's wrong with the message we're giving and how can we help people more? And that's why I got into cardiology, right? I got into it to help people, to help people prevent heart disease, to help people live better lives.

And so that's taken me to where I am today.

Bryan Carroll: [00:05:43] I'm curious, are there very many cardiologists out there that focus primarily on the preventative side of it or do most cardiologists wish they were on that end more, but they ended up falling into the trap of people. Typically don't like to come in when they're.

You know, healthy and feeling fine because we don't assume that we need to go in. So when they're seeing people, it's usually already at a later stage where the preventative side has already kind of passed. 

Dr. Bret Scher: [00:06:14] Yeah. Yeah. That's a great question. I mean, there, there definitely is a a strong cohort of preventive cardiologists, people who are more focused on prevention.

But the caveat being, you know, like I said, when I was in training, there's something very exciting about the procedures and to take it one step further from a reimbursement standpoint, you know, what you get paid to do. You're going to earn more money by doing procedures and echocardiograms and stress tests and, and angiograms and stents than you are to sit and talk to somebody for an hour.

You know, that's not what our medical society and atmosphere. Prioritizes and rewards is the prevention. The, the really having meaningful conversations with people about how to change their lifestyle. That's not rewarded financially at least in our medical culture and that's something that needs to change.

So, so the answer is yes, there definitely is a fair number of preventive cardiologists. But I think there could be even more if medicine got his priorities straight and, and prioritized PR prevention, the way it should be. 

Bryan Carroll: [00:07:19] Now you mentioned that cardiovascular disease is I believe the number one killer in the States, as of right now, what.

Like, what, what does that equate to number wise? How many people each year are dying from a heart related issue? 

Dr. Bret Scher: [00:07:35] About 700,000 people per year, which is between one and three and one in four deaths. It's it's you know, probably about 20. Eight to 30% of all deaths are heart disease related deaths. So that's a lot, it's a big number and it's, it's the number one cause and has been for a very long time, but more than just the number of people dying.

I mean, if you look at the number of people who have heart disease or risk factors for heart disease, it's over half the American population. And that just speaks to sort of our unhealthy baseline when the average. Has a certain condition or is it high risk of developing a certain condition?

That's not a healthy place to be. It shows we're doing something wrong. And that's, you know, I like the analogy where if you're a teacher in a classroom and you have, you know, one kid is failing, okay. Maybe it's the kid, but if you're teaching in the classroom and over half the class is failing. You got to start looking at your teaching methods.

You can't blame it on half the class. And I think that's where we are now with over half the country in trouble from a cardiovascular standpoint, it's not the person's fault. It's the message. It's the teaching. It's the professionals that need to be a little more introspective and say, what are we doing wrong?

And how can we fix this? 

Bryan Carroll: [00:08:49] I'd say a really good way to look at it actually. And for a heart disease, how long does it take typically to develop these different types of conditions? Like obviously most of them probably don't happen overnight. So it takes some time. Is this over a couple of months? Is it years?

Is it decades? What leads up to these heart issues? 

Dr. Bret Scher: [00:09:10] Yeah, it's, it's it's decades. Most of the time, which is also makes it a challenge because. Yeah, it's hard to say, if you do this now, I can prove to you. You're going to lower your risk of heart disease or not have a heart attack. Right? If you, if someone has a heart attack at age 75, Maybe they would have had a heart attack at age 65 if they were still smoking or if they were still had type two diabetes or whatever, but, and if you can negate those things, they may still have a heart attack, but later than it was like, how do you prove that you can't and that's, you know, how do you.

How do you use that as an encouraging tool? You know, it's sort of hard to do so that that's part of the problem. When a disease process takes many years or even decades to manifest itself. It definitely makes it a challenge from a science standpoint and from a intervention and motivation standpoint.

But we certainly know what the, the main cardiovascular risk factors are. And we know how we can remedy those and improve those. The problem becomes when. Maybe the focus of rich whiskey, which risk factors are most important gets a little off track from what helps the majority of the people.

Hmm. Right. Does that make sense? Yeah, that's a little, those little cryptic, but basically what I'm getting at is when we focus too much on LDL at the risk of everything else and just to be blunt about it rather than to try and be cryptic about it. But, you know, LDL cholesterol certainly plays a role, but I think we've been, so hyper-focused on LDL at the expense of other risk factors.

And if you asked doctors or even. You know, healthcare administrators, they would say, Oh, sure, the risk factors are smoking and high blood pressure and type two diabetes and and visceral, adipose and hyperlipidemia. But when it comes to practice, the focus is so much on LDL in practice that the others, the other risk factors kind of get lip service, but not the attention they deserve.

Bryan Carroll: [00:11:05] Yeah. This it brings up an interesting question about Just testing in general. Like, should people be getting tests pretty regularly starting at a young age, like 20 or something so that they can see these changes as they progress through life? Or should they only be getting tested a lab test, whatever it is once they start noticing some symptoms start to arise.

Dr. Bret Scher: [00:11:27] Yeah. And I love the idea of people getting tested early because you want to have a baseline to compare things to so. You know, if you get a lipid test and you see your triglycerides and your HDL and you get a blood sugar and an insulin level in your fifties. You might be like, okay, you know, that's just the way I am.

You know, this is, this is not so bad, but if you compare that to what it was in your twenties and early thirties, you might say, wow, okay. And now I have a comparison and I'm actually not doing so well. Things have gone South and I need to turn it around. You know, our age is going to increase no matter what, but that doesn't mean our health has to decrease along with it.

And there are things we can do. To improve our health, but we need that comparison. Otherwise we don't know how good it can be. We could just say like, all right. You know, it's okay. And that's another issue that I have with sort of modern medicine culture. It's almost like if, if you're in the pattern of checking the boxes and making sure you're billing appropriately and you know, your focuses on the reimbursement and making sure the notes are accurate, then it's the patient has type two diabetes or they don't.

You know, the patient has high blood pressure or they don't, it's a binary. Yes or no, rather than this continuum of, okay. You don't have type two diabetes now, but look, your insulin level has been creeping up. You're a waste of conference has been increasing. So we know on that trajectory. Maybe a few years from now, you're going to have type two diabetes and we know your risk is already increasing now because you're on that trajectory.

So it's, it seemed things from a different perspective to say, it's not binary, it's a continuum. And we need to act early on the continuum rather than waiting for somebody to get a diagnosis, to, to react. 

Bryan Carroll: [00:13:11] Now are there specific lab markers that you would like to see on just general lab work that would give you better indications of potential risk factors of heart disease?

Dr. Bret Scher: [00:13:22] Yeah, and I've, I've sort of alluded to some of them already, but one is when you're looking at the lipid profile, you don't just look at LDL. You look at HDL and triglycerides, even better. If you could get advanced lipid testing to get in, what's called an April B, which is a even better marker of your LDL.

And look at the size and density of your LDL particles. Look for inf inflammatory markers like CRP being the most common inflammatory marker, and then really focusing on metabolic health, which triglycerides are a big part of, but also what is your blood sugar and your insulin? Because blood sugar reacts much later than insulin reacts.

So you could have a normal blood sugar with an insulin level of five, and that's great. Well, you could have a normal blood sugar with an insulin level of 35, and that's a very different circumstance that you're going to want to react, or you weren't going to want to act proactively on. So you don't get to the point of the blood sugar becoming abnormal.

So I would love to see most people knowing their fasting insulin levels. In addition to their blood sugar and blood pressure being key, your waist circumference being another one, people focus so much on weight, but I think more important than weight is your waist or your waist to height ratio, even better.

If someone can get a body composition score, you know, like whether it's a DEXA scan or a bod pod or a hydrostatic weights, or some, some accurate measurement of your body composition. So you could follow that over time as well. You know, the, I, I love all those markers. I know they're not easy for everybody to get.

But if, if it's possible, I highly recommend people get that and follow them over time. Cause that's, that's really one of the biggest keys is how do you compare to your healthier self? How do you compare to your younger self? As well as how do you compare to other people? But we all have our own set points, right?

So just like we shouldn't be comparing ourselves to supermodels that we see on Instagram. You know, W instead we should be comparing ourselves to ourselves and what we can be in our, in our best state. 

Bryan Carroll: [00:15:22] Yeah, I'm curious for like the 20 and 30 year olds. If they hear this and they want to go get their baseline tests and they go to like their primary care physician.

I'm sure if they ask for a lot of these tests, either insurance probably won't cover it because they don't feel it's needed or maybe the primary care physician won't run all those types of tests. So are there certain ways to kind of play around the insurance system to either get insurance, to cover something like this, or just pay out of pocket?

Dr. Bret Scher: [00:15:51] Yeah, so getting insurance to cover, it's the tricky part. For sure. That is definitely a tricky part, but you know, if you have a family history of things, sometimes insurance will cover it. Your doctor would be more likely to order it. If you, if you have a specific reason, say, look, I'm thinking of doing X with my lifestyle.

I think, you know, of increasing my protein. I think, you know, of going low carb, I'm thinking of going vegan, whatever the case may be. And you say, I want to see how it affects my health markers. Then the doctor might be more likely. To order it as well, but nowadays there's a definite workaround. I mean, there are labs that you can get yourself that you don't need a doctor's order.

And there are a number of different companies that do it. You know, within the low carb world Dave Feldman and Chavonne [email protected] have started. And you have given people the ability to order their own labs at a discount. They have like a relationship with the labs where you can order your own labs and pay for your own labs and you get a discounted price to do it.

So there and there, I mean, that's just one that I happen to be familiar with, but there are many other opportunities like that where you can get your labs. And so I highly encourage people to do that and it may run a couple of hundred dollars. But if you're only doing it every few years when you're younger than then maybe that's worth it.

Bryan Carroll: [00:17:04] No. I'm also curious because a lot of people nowadays, they, where they have some sort of wearable, whether it's like an Apple watch or something right now, I have a Garmin watch on. So it's constantly checking my heart rate and all that type of stuff. Are we at a point with technology where we can glean any type of information from these wearables in regards to potential heart issues?

Or is that something that you see. Might be a potential for the future. 

Dr. Bret Scher: [00:17:30] Yeah. Good question. So simple things like heart rate, not going to tell you a whole lot, usually things like heart rate variability are getting a little more nuanced and can give you a little more information. More advanced wearables like continuous glucose monitors are pretty awesome.

They can tell you a lot about how you respond to the meals that you're eating and how your blood sugar responds to sleep and exercise and all sorts of different things. Those aren't quite prime time without a prescription yet, but Apple is certainly hinting that they may be coming out with one soon, which would be pretty cool.

You know, the, I think the future of wearables is very bright and is going to be pretty amazing. What comes out in the near future, where it stands now. I think they can be helpful as motivating techniques. They can be helpful in certain circumstances for the most part for cardiovascular risks though.

They're not all that helpful right now. 

Bryan Carroll: [00:18:22] Hmm. Yep. That makes sense. I definitely see a future for wearables as well. I think there's a lot of potential in. Possibilities on the horizon with them. Yeah. 

Dr. Bret Scher: [00:18:32] But for, but for helping motivate you for a lifestyle, you know, to remind you, to get your steps in you know, to, to tell you, Hey, your heart rate, variability is a little bit off, you know, or your sleep was poor last night.

You know, to give you that kind of feedback to help you maybe change what you're doing for the day or what you're eating for the day, or just be aware of things, you know, like it should be common knowledge that when you sleep poorly, you're going to eat more. You're going to crave more. You're not going to be able to resist as much.

And, but if you knew going into your day, okay, I really had a poor night's sleep. You know, my aura ring, my Apple watch, whatever you're using. Shows me, I had a poor night's sleep. So that means, you know what, I better bring a healthy snack with me to work. Cause I know if I don't, I'm just going to start dipping into the candy jar because that's what I did.

You know, the past 10 times I had a bad night's sleep or whatever, you know, so being, being for a warrant is, is definitely being forearmed in that, in that circumstance. Now 

Bryan Carroll: [00:19:28] for decades, we have been living in a world that has been pushing a low fat diet. And we thought for a long time that that would fix heart disease.

And obviously it has not. So can you tell us kind of what was a big issue with low fat? Why did fat become the enemy in the first place? And then what are some different ways that you can work with heart issues via food? Without just taking all the fat out of your diet. 

Dr. Bret Scher: [00:19:58] Yes. This is obviously a huge topic and this is a lot of what I was kind of alluding to when I said it's not the teacher's fault, but maybe the message fault.

So when our message has been fat is bad, eat low fat for decades and decades, and we've seen no improvement in overall health. Or obesity or cardiovascular health from that standpoint, then, then we really have to question the message and you know, this is where you sort of get into the debate.

Well, is it the message or where people just not following the message? And from my standpoint, it doesn't matter because you need to give a message that people follow. You can be giving the absolute best advice for health that was tested in a lab, in a test tube, in a metabolic ward. But if people can't follow it in a real life situation, it does not matter.

It doesn't matter how good it works in a metabolic ward if people can't follow it in the real world. Because we are real people living in the real world with emotions and feelings and cravings, and, you know, we have to adjust for that. So, so that's a big part of, of what I think the problem with the advices, but the, the science that the low fat.

Recommendation is based on is various poor quality science. And that's the other problem. Cause you said, where does this recommendation come from? You know, everybody starts with ANSO keys to, to talk about where it came from and yeah. Is simple observation that in a very small subset of countries that people who ate more saturated fat.

Had higher cholesterol and had more heart disease. That is observational data that is very low quality data with tons of confounding variables with very poor data collection, with very small associations. And that type of quality data is not meant. To then support strong recommendations that we can say.

We clearly know the answer to, but even answer key is, is sort of outdated now, because since then we've had dozens and dozens of studies showing the same thing, but with the exact same methodology methodological flaws, because there's an, you can't get around this healthy user bias when you're, when the message is eat less saturated, fat, eat less meat.

You can clearly see in these studies, the people who are eating more meat already are eating more calories are overweight, are more likely to have. Diabetes are more likely to smoke and more likely to drink more alcohol and less likely to exercise and less likely to be educated. And eating meat didn't cause any of those things, it just happened to be the way they were and eating meat also didn't cause them to get heart disease or cancer or die young when they also have all these other unhealthy habits and unhealthy lifestyles and prioritize their health less.

So it's that low quality of evidence that then has been extrapolated to say, see, this shows saturated fat is bad. Meat is bad. But actually a diet doctor, I just published a couple articles. Based on recent studies. One was a study looking at meta analyses of fat intake, including saturated fat intake to say, okay, is there evidence to support that this is dangerous?

And the answer was clearly no. When you look at the men analysis and you look at the quality of the studies, there is no overall relationship to saturated fat and. Cancer stroke, heart disease. The same was said for red meat out of the pure study and analysis of the pure stay, which was over 170,000 people.

But one important thing about that study was it was a global multinational study. So people from all over the world, so that I think, I think that sort of diluted out that healthy user bias a little bit, which then. Overcame that and showed no association between red meat and all those risk factors.

And then there was even another one recently looking at saturated fat intake and progression of carotid intima-media thickness testing, or measurement an ultrasound measurement of subclinical atherosclerosis. And again, as soon as you control for. Age and gender there's absolutely no association between eating more saturated fat and having that cardiovascular risk.

So it really is time for us to reevaluate the evidence and we have. We have plenty of evidence over the past five decades saying that this line of education and this message does not work for the general population. And now we have science to show, Oh wait, maybe we were wrong about making this assumption of this association based on this poor quality data.

And instead we need to focus on other things. And so the other part of your question was how can you affect heart risk with diet? Well, you can absolutely affect blood sugar, insulin, blood pressure, triglycerides, HDL, body composition, visceral fat. We circumference all of those things are interrelated when it comes to cardiovascular risk and they all absolutely respond to nutrition.

Question is what nutrition, what dietary advice, and, you know, This is where it gets complicated because there isn't one dietary advice for all people. As much as I am a big fan of low carb, nutrition of higher protein, nutrition of higher fat nutrition. I also at the same time would say that it may not be right for everyone because you have to work with within everybody's context of their ethnicity, their, their history, their, their likes, their dislikes, the society, they live in their family structure.

You know, there are so many other things that play into. What are you going to be successful with eating? But the key is we have to find an enjoyable and sustainable. Nutritional pattern for every person. And I think for majority of people that will be a lower carb, higher protein, higher fat type of diet.

And it's been shown to work wonders for regulating blood sugar, for lowering insulin, for helping people lose weight, especially visceral adiposity in the central obesity for helping people improve their body composition and improving. There lipids from the standpoint of their triglycerides, the HDL, the size and density of the LDL.

I mean, it's just dah, dah, dah, dah. The list just keeps going on how this can be such a beneficial diet and people enjoy it. Right? You're not eating lettuce and things that tastes like cardboard and, and just limiting all the foods you like. You're, you're enjoying your foods. You're, you're eating your ribeye.

You're eating your. A chicken thighs with the skin on a you're having eggs and cheese, and you're having a ton of fibers above ground vegetables. But you're not having the pizza and the donuts and the danishes. And even the bagels in the, in the so-called healthy honey nut Cheerios cereals. And, you know, you're, you're avoiding those things.

And instead putting in the real nutrition, real foods, and it makes a huge difference for for the majority of people who try it. 

Bryan Carroll: [00:26:48] Yeah, I love that you brought up just all the, the information around medical studies and how they can be interpreted. And a lot of times it's based off a correlation and the correlation, not all the time is also causation.

It can give you some ideas on what to dig into deeper, but just because something's correlated doesn't mean that it is a cause. And actually people search on the internet correlation and causation charts. You can find some really weird ones, like I think like the number of bananas you eat in a day correlates to shark attacks in Florida or something crazy, stuff like that.

And it's like, just because you eat bananas, doesn't mean someone's going to get bit by a shark in Florida. 

Dr. Bret Scher: [00:27:32] And I saw one that was like, When Nicholas cage movies came out and the number of drownings that happen or something bizarre like that, and it was pretty well correlated and it was so, yeah, I mean, those are helpful to show you just, just how ridiculous it is that we're making such strong recommendations based on correlation instead of causation.

And the other thing is though people will say, well, look, there was never a randomized trial to show that smoking causes cancer. And that's true, but the, what you call the hazard ratio, or basically the strength of association of cancer and, and tobacco smoking in those observational studies was anywhere between like 15 and 30.

Compare that to the hazard ratios of, you know, red meat and heart disease or red meat and cancer. And it's like 1.1, 1.2. Compared to 30. Right? So that gives you an idea of like the difference that we're talking about here in terms of the, the importance in the and, and the amplitude of the effect that we're seeing.

Bryan Carroll: [00:28:33] And I think people want absolutes from medical studies, but they don't understand just how difficult that can be. Cause it's not like you're going to trap a bunch of humans in a very isolated environment for years and years, even the exact same way. And then testing that against another control.

That's also trapped in a very similar environment and come up with a result like that's so hard to do. 

Dr. Bret Scher: [00:28:57] It's hard, it's expensive. And, you know, studies like that exist. Doing studies on a limited number of people within a metabolic ward, but they're all two or three weeks long. So, what does that really tell us?

And it's also, you know, all the food is provided for them. So there are no external temptations. They're not dealing with having to cook and prepare meals. And most of them aren't even living their real lives when they're in the metabolic ward. So that can tell you a lot about physiology, but it tells you nothing about.

How people respond to the interventions you're recommending and how people will respond in real life to this type of nutrition pattern. So you know, there's, you need sort of both types of studies. You know, there's, there's benefit to those metabolic ward studies to learn the physiology. But from my standpoint, as a clinician and someone trying to reach, you know, as many millions of people as we can through diet doctor to help them radically transform their lives and their health.

I want to know the studies that show in a real life setting. How do people respond? Because that's what matters most to me, 

Bryan Carroll: [00:29:56] Now a lot of times, if you go to a cardiologist, they take a look at your cholesterol numbers. And then they, a lot of times you'll be recommended to avoid foods that are high in cholesterol.

Is there actually anything to indicate that you should avoid foods high in cholesterol? And does the majority of cholesterol in your body actually come from food? 

Dr. Bret Scher: [00:30:15] Yeah, that is a great point. And this is just one of those things that just won't die, but the cholesterol containing foods actually, I mean, in, in one of the dietary guidelines and the recommendations from the American heart association, they did say.

Cholesterol is no longer a nutrient of concern, which was huge for them to recommend them. But then so interesting. I wrote about this, a diet doctor, maybe, I don't know, a year or so ago, the American heart association came out with a scientific update on dietary cholesterol and they did a pretty good job going through how.

How eating dietary cholesterol doesn't significantly raise your cholesterol. And if it does, it likely raises your HDL and to a lesser extent, your LDL and how there's no proven association between eating dietary cholesterol and having heart attacks or strokes. And they kind of went through the science to show that dietary cholesterol really isn't a concern, but when their conclusion was so we recommend you eat low fat.

Healthy grains, lots of fruit, lots of vegetables. And they still stayed with their same recommendation of low cholesterol and low fat diet. Despite having gone through all the evidence of why that doesn't support it, which kind of blew my mind, but, but that's shows how the reluctance behind this. So the answer is for the overwhelming majority of people backed by science.

Eating cholesterol containing foods does not increase your risk of heart disease, strokes, dying young. And also, you know, it also brings up this whole concept. Anytime we talk about red meat, saturated fat dietary cholesterol, you know, we don't eat those things in isolation. We eat food, we eat meals, we eat recipes.

So are, you know, are you having your Your meat on a big plate of spaghetti with, you know, endless amount of garlic breadsticks, or you having it on a spinach salad with avocado and almonds and steak. On top of that with olive oil, for dressing, you know, in a, in a study, those both can be considered cholesterol containing foods, saturated fat containing foods.

But I guarantee you, your body is going to see those as very different meals, but a study may not see them as the same meal. So it's sort of a long-winded answer. I've seen dietary cholesterol should not be a concern. I mean, just look at, you know eggs have been studied more than any food in, in history, how it's say red meat and eggs.

And there, it's pretty clear. There's. There is no significant detrimental effect to eating eggs. And even if there is, even if you believe the studies that see there is it's such a minuscule tiny effect that for an individual, and it really means nothing. So and then, you know, from shell the shellfish perspective, that's another food that's sort of been maligned because of the cholesterol content.

I think those are some of the healthiest foods you can eat and I highly recommend them. So yeah, I don't, I don't think there's anything to support avoiding cholesterol containing foods. 

Bryan Carroll: [00:33:07] So if a cholesterol isn't as an important marker to pay attention to anymore, then what is the role of statins going forward?

Dr. Bret Scher: [00:33:15] Well, so now this is different cholesterol and food and cholesterol in our blood, two totally different things. And that's, that's the other problem by using the same word. It gets conflated. They get combined far too often. And I wish we called it something different when it was coming from food than when it was in your body.

So when it's in your body, again, I wouldn't even, I don't even like to talk about cholesterol because then people will focus about total cholesterol in your body. And that is, that is antiquated. Cause. Instead, we need to focus on LDL, HDL, triglycerides, and even better if we can even focus on the size and density and the inflammatory makeup of the LDL particles and HDL particles potentially.

So the role of statins then to get to your question is to lower LDL cholesterol. That's what sounds do they also have an anti-inflammatory effect? And they can have a plaque stabilizing effects. If you have a highly inflamed, what's called lipid Laden plaque in your artery, statins have been shown to sort of reduce that inflammation and reduce the chance of rupture of that plaque.

Now they're not the only intervention that can do it. They just happened to be the best studied because pharmaceutical companies have made billions of dollars off these drugs. So it's. You know, they're going to sponsor studies that that could potentially show their benefit. Whereas other things like nutrition and exercise and stress management and adequate sleep you know, those are not, I'm going to be studied as well because those are harder to make money off of for sure.

You're not going to have a big multi-billion dollar company sponsoring trials for those But so the role of statins, there's definitely a role of statins in secondary prevention. Meaning people have had heart attacks. People have had strokes, people have had documented severe vascular disease.

There, there could be a rule for statins as part of a comprehensive treatment. And I think that's the part that's missing because so much of medicine is I've got 10 minutes at most with the patient. And I know I have to check. The boxes to make sure I'm not penalized or to make sure my medical group is getting reimbursed or whatever the case may be, that statins are easy.

Right? You got to get someone to LDL down to the recommendation status or the easy way to do it, as opposed to focusing on the whole picture and saying, what can I do to maximally impact this person's health? And there is going to be lifestyle, lifestyle, lifestyle before reaching for the prescription pad, because while Statens may lower LDL.

They don't reduce your small dense LDL. They are not going to improve your metabolic health. In fact, they could worsen insulin resistance and promote you type two diabetes. But if you instead have a lifestyle program that someone can stick to. You could dramatically improve the size and density of their LDL.

You can improve their triglycerides, their HDL, you can improve their insulin resistance and their blood sugar. You're going to have such a much greater and broader impact by, by getting to the root cause and focusing on lifestyle rather than writing the prescription. So it doesn't mean statins should never be used, but it certainly means they're not the one and only treatment.

And anytime they're being used, it has to be used as a comprehensive lifestyle intervention program. 

Bryan Carroll: [00:36:32] All right. Let's do a, just a quick scenario. Give us a couple, maybe two different ways that someone can improve their lifestyle. If they are you know, someone that's very career-driven. They have an office type job.

They sit a lot during the day and they work really long hours. What are two lifestyle changes that someone like that could make. To improve their heart health. 

Dr. Bret Scher: [00:36:54] Yeah. That's a great question. I mean, moving your body is so important in, in some way, and generally that's not, you know, 20 minutes on the treadmill and then sit for 10 hours at work.

But if you can. If you can take breaks during the day and walk up and down the stairs, do some chair, squats, do some pushups just get up and walk around and move your body. One is great for your brain. People might say like, Oh, I can't take a break. I can't afford to spend the time to take a break.

But if you do overwhelmingly people say, Oh, I was so much more focused and so much more effective after taking that break. So doing some sort of physical break during the day on a regular basis, you know, five or six times a day. Is huge. You know, if I can use a personal example, I will frequently take breaks and just do like three minutes of yoga poses.

You know, it's not a big yoga session. It's just three minutes of yoga poses or I'll do you know a couple of minutes of like a, a brief core workout or, or just do some chair squats and some pushups. I have a pull up bar, you know, I do those things multiple times a day. Which I think is good for the body and good for the mind, especially if you can get outside and go for a walk to like, you know, lunch hour If you can avoid sitting at your desk, eating lunch while you continue to work, but instead, get outside, breathe some fresh air, get some sunshine, go for a walk.

It can just increase, increase your productivity and improve your health so much. So that that's one thing. I mean, I guess it's many things tied into one, but the main focus being is, is to move your body and take breaks. But the other thing is. We can really fall into poor nutrition habits at work because especially if we're working long hours because you know, what do people work bring to a workplace?

They, they usually bring junk, you know, they're going to bring donuts, they're going to have a candy ball or they're, you know, they're going to. Bring muffins that they cooked or whatever. And those are just going to be laying around the office. And if you're not prepared, if you don't have a snack prepared, if you haven't brought your meals if you usually go out for lunch, but you're so busy, you don't get a chance to go out for lunch that you're just grabbing whatever's there now.

Yeah. You know, meal deliveries have made that a little bit better, you know, with as things rise, they can just get a little expensive, but now you can sort of have any meal delivered to you at any time, which I think is pretty cool to help people in that circumstance, but preparing ahead of time and thinking ahead of time and, and, you know, don't get caught off guard by something that happens time and time again, which is mindless, snacking.

Bryan Carroll: [00:39:18] Perfect. Bret, thank you so much for, you know, talking through all of these different ways that we can improve heart health. My final question for you is what is your vision of what healthy looks like and what are three things you do daily to reach that vision? 

Dr. Bret Scher: [00:39:32] Yeah. So what does healthy look like? I mean, helping me focus so much on body health, but mind health is also so important and I think they are very related.

So for me, healthy, Is living a life that you enjoy living a life. That's not a struggle, living a life where you feel good. And of course, We were talking about health. It has to be tied in, into doing things that improve your metabolic health. So you may enjoy things and feel good doing things, but if it's destroying your anabolic health, then it's not worth it.

So finding that, that that mixture of a lifestyle that helps you feel good. And also improves your metabolic health. That is the key and the things that I, that I see for that are one, getting some form of regular exercise that you enjoy. You know I happen to be lucky that I love to exercise.

I know not everybody does, but getting some regular physical activity. And the other thing you know, is nutrition is so important. So really focusing on lowering carbs and finding a way to. Be happy and satiated with your meals so that you eat fewer calories without having to think about it and struggled to do it.

That's another big part of, of health and longterm, sustainable health, and then, you know, sleep and stress are so important. Really prioritizing ways to get enough sleep and to manage your chronic stress and, you know, to manage anger, stress, doesn't go away. You can't completely eliminate stress, but you can change how your body reacts to it.

And all those, all those things are interrelated. And they work together positively and they work together negatively. So really addressing all of those components are so important for long-term sustainable health. 

Bryan Carroll: [00:41:12] Perfect. Well, people can find more about you at doc diet, doctor.com. You have your podcast there.

What else can people expect to find that dietdoctor.com?  

Dr. Bret Scher: [00:41:20] Yeah, so dietdoctor.com. We're the, we're the biggest number one website in the world for low carb and keto nutrition, but we're also focusing on just healthy weight loss and metabolic health in general. And helping people achieve that through various ways.

And we're, we keep coming out with more content. We have a ton of guides and videos and really just helpful content for people. And then we have meal plans, including a personalized meal plan, or we just answer a few questions about yourself and we have a an algorithm that will find the right meal plan for you in terms of your.

Here are your macros and your calories and what you like and what you don't like. And then we can, you can sort of change it as you go to get the recipes and the shopping list, and really just trying to make things as easy as possible for you to succeed in and healthy weight loss and metabolic health in general.

So people will find a lot of that at. At diet Dr. Com plus a huge video library that we have in courses that you can take, you know let's get moving course for people who are new to exercise a 10 week weight loss for good course, or a five week introductory to Quito course, we have all those different courses that you can learn from.

And then for clinicians, if anybody is whether a nutritionist or. A coach or a trainer or a doctor, we have a certified continuing medical education course. We have an intermittent fasting coaching course. We have so many different things that you can experience or how do you recommend that people go in and check that out at diet Dr.

Com and then, you know, for also more about me working with me as a patient low-carb cardiologist is a good place to start and their links to my book there as well. So hopefully there's enough information out there. And I know sometimes there, there can be information overload too. And people need a little, a little push or a little guidance in the right direction.

So hopefully we've got that covered as well. 

Bryan Carroll: [00:43:01] Perfect. Well, thank you so much, Bret, for coming on. We have decades of poor teachings that we need to reverse. So I'm glad that you have stepped up and are one of the cardiologists that's working on preventative care. And it's really good to see that you're, you know, trying to get ahead of the game with all that.

So thank you so much. Yeah, 

Dr. Bret Scher: [00:43:20] my pleasure, Bryan. Thanks for having me on. 

Bryan Carroll: [00:43:22] That was a really fun conversation with Dr. Bret. And like I said before, I am glad he was trying to educate people before they have heart issues that start to show up. So go check out his podcast [email protected] Next week I have Mario tell Mitch on the show.

Let's go learn who he is. I am here with Mario atomic. Hey Mario, what is one unique thing about you that most people don't know? 

Mario Tomic: [00:43:47] I'm a minimalist digital nomad, and I have been traveling for the last nine years. 

Bryan Carroll: [00:43:53] That's amazing. That sounds like a lot of fun. Except the last year has probably put a damper on that a little bit, a little bit.

Well, what will we be learning about in our interview together? 

Mario Tomic: [00:44:09] We're talking, getting lean building muscle. How to prepare yourself for the fitness journey, how to find a motivation and what are some of the key habits to implement in your life to be a healthy entrepreneur professional 

Bryan Carroll: [00:44:21] in what are your favorite foods or nutrients that you think everyone should get more of in their diet?

Mario Tomic: [00:44:28] I'd have to put on vegetables here because I wasn't a big fan of vegetables as I was growing up and add to acquired a taste and learn how to appreciate them and the bitterness and things like a rugala and some of the other stuff being creation close to Italy, I'd never really understood why people eat that stuff.

But then eventually when I. Growing up. And I saw the health benefits of some of the phytonutrients and anticancer and all the other stuff. I made it sort of my, my goal to incorporate vegetables with every single meal that I eat. So definitely would be vegetables, old colors. My favorite are red peppers, especially when I'm in a fat loss diet.

I find it very filling. So I just doubled on 

Bryan Carroll: [00:45:04] those in what are your top three health tips for anyone who wants to improve their overall wellness? 

Mario Tomic: [00:45:12] Good question. Number one would definitely be a resistance training. So do some form of resistance training. You have to do this for yourself in a sense that it's going to immediately be your Keystone habit.

That's going to get you to improve everything else, building more muscle, improve your metabolic health. And even if you don't get lose any weight, you're going to be a lot healthier just by doing more resistance training. Second one will be doing more walking. So I recommend between seven and 10,000 steps per day.

That's my thing. Highly recommended. So anytime you can just do a little bit more walking, you will immediately feel better. So without even me saying anything, and then the third one really start looking at, at it, your food intake from a perspective using an app like my fitness bell or, or one of the other apps to really start becoming aware of what exactly is going into your body.

How many calories are in certain foods? What foods are actually eating? I think most people are not aware of portion, sizes and calorie density. And this is going to really teach you some of the basic fundamental things that are gonna set you up for massive success down the line. And when it comes to getting lean, staying lean and all the other health.

Yeah, 

Bryan Carroll: [00:46:13] it was fun chatting with Mario about building muscle and different ways to lean out. So until then keep climbing to the peak of your health.