#80 Dr. Bret Scher – Low Carb Cardiologist

Meet Dr. Bret Scher

ABOUT DR. BRET SCHER

• I went to a preventive cardiology fellowship
• It was an Ornish style program
• We were deep into the vegetarian, low-fat nutrition training
• The nutritional part left a little to be desired, but at that time, that’s all I knew because that was what everybody was teaching
• And then, I got out of school thinking I was just going to reverse heart disease and prevent heart disease
• The impact was far from that and I quickly saw the revolving door of a very preventable disease of people just coming back time and time again, people not being able to hear the nutritional recommendations or even just those who did not adhere to them just not doing well enough with their health
• And, it really made me realize I wasn’t having the impact I wanted
• I needed to do something different
• And that’s when I opened up a little preventative boutique practice
• Fortunately, the health coach, that is a good friend of mine and who I was working with is deep into keto
• He kind of helped open my eyes
• I was skeptical at first, even though I knew I wanted to impact people more, I thought it was just more time, logistical health and more follow up with a higher touch
• All of that is important and I still believe that, but what I have learned is that, the message was wrong and I needed a new message
• The low-carb message and although it might not be for everybody, but it’s certainly right for a number of people, especially in our society with so many broken metabolisms
• I can’t ever look back, once I have seen the impact that this type of lifestyle can help people with
• The first and most important thing is how do you define cardiac health?
• There are number of ways to define it and the ultimate is preventing heart attacks, preventing strokes, preventing people from dying
• You can follow biomarkers, but here’s the thing, in medicine everybody likes to talk about LDL cholesterol level as the most important biomarker
• And the truth is, it is far from it
• You need to look at blood pressure, metabolic syndrome and the fat around your organs and waist
• You need to look at your blood sugar, insulin levels, inflammatory markers and when it come to your lipids, you need to know more than just LDL
• You need to know your LDL particle number, not the total concentration because that is a far better predictor
• And you need to put that into a context on what’s your HDL, triglycerides and the size and density of your cholesterol
• Those are all crucial aspects of your cardiovascular health
• If all we talk about is LDL, we are not scratching the surface from what your overall heart health really is
• And the people come to me because their doctors are just looking at their LDL and not really examining anything else
• What I have seen is dramatic changes in weight, abdominal circumference, triglycerides, HDL, size and density of the LDL, inflammatory markers, glucose, insulin and how people feel, people wanting more to be involved in their health, wanting to be more proactive
• When you think you are trying the right diet and lifestyle, and you are not making any progress, it’s incredibly disheartening
• Once you have seen that initial success and you start feeling better and start losing the weight, it’s addictive and you start wanting to do more
• That’s what I love to see
• Heart disease has been the number one killer for men and women for a decade
• Our society should have been all hands-on deck to prevent the number one killer or at least diminish the impact of the number one killer
• There has been impressive drugs or interventional procedures, but without the prevention side of things and with lifestyle, they have done nothing to lower the risk of cardiovascular disease
• This whole fallacy that fat is bad for our hearts is based on a house of cards. It is a flimsy evidence that never should have been used to make a level of recommendations
• When you are making recommendations for the entire population, you have to be absolutely certain
• And the quality of evidence that supports it was barely associative and suggestive – certainly not improving anything and really set our society down the path of chronic illness
• In the low-carb world, I see a lot of people completely dismissing statins and completely dismissing cholesterol, and I am not one to completely dismiss it
• I definitely evaluate and value other markers more
• But I still use statins in a responsible manner
• Because the last thing I want to do is to prescribe drugs that makes my patients stiff and achy so they stop exercising, that is not a great trade off
• I use them mostly in secondary prevention
• It comes down to what we are doing in our environmental exposure and how we live our lives is more far important than any drug that we out in our mouth
• Blood pressure medicines are completely optional in my mind because you can treat blood pressure with lifestyle
• The key is finding the right one and sticking to it
• With the right lifestyle you can get people off all those drugs and feeling better, living naturally and reversing all their chronic health conditions
• That’s power, that’s medicine and that’s the impact I wanted to have with people
• The test you can do on your calcium is a CAT scan
• It is a simple CAT scan. No IV needed, it takes about 10 seconds to do, it is relatively low radiation about the same as a mammogram
• It tells you if you have any calcium in the walls of the arteries in your heart
• The calcium scores are a wonderful marker as something to follow to see what’s happening with the lifestyle changes
• What calcium really is, is it’s response to cardiovascular injury
• It is very common to reduce the amount of calcium, but really, it does not matter
• Because the calcium itself does not hurt you. It’s just a marker of vascular injury
• What harms you is, if you develop plaque in the insides of your artery that ruptures and causes a heart attack
• So, the calcium score, it doesn’t matter if you reverse it, you just want to make sure that it’s not progressing
• The calcium score is more of an eye opener to show you what are your risks
• We do not know exactly why LDL goes up in the subset of people on a low-carb diet, but there’s a lot of theories and a lot of them is it’s actually beneficial
• And there are some studies that say it improves longevity and health in the elderly with a higher cholesterol
• The general concept of LDL is it’s a response to inflammation
• We need cholesterol in our body
• Without cholesterol we will die
• We need cholesterol in every cell membrane of our body, for our vitamin D, testosterone and for our neurons in our brain
• You would not want to live in a world without cholesterol

PERSONAL EXPERIENCE

• Around the same time that I was starting my preventive practice and working with the health coach, my second son was about a year old
• So, two young kids, stressful life and the weight was increasing
• I have always been athletic and thin, and I got up to 140 lbs.
• As I was learning about the low-carb and keto lifestyle, before I recommended it to my patients, I wanted to try it myself
• So, I did and I lost 8 lbs. without even trying and I started to feel better and have more energy
• For me, there is no turning back after that
• I was the guy who would make sure to set an alarm an hour and a half before my workout to eat something
• I felt like I had to eat something, a high-carb type of food
• And now, I workout fasted and I feel really good

ADVICE

• To get help because there are different ways to do keto and your body is going to respond differently
• You should be working with a coach, a doctor or with somebody with the experience and knowledge of  health markers to follow
• It is not a one-size fit all
• I definitely do daily time restricted eating
• I do fast once a month
• 2 or 3 days of fasting is good

FAVORITE KETO MEAL

• Steak, veggies and avocado
• I am not a true foodie
• I don’t like recipes because I like things simple
• I just like the combination of real food that is simply prepared

HOW CAN PEOPLE FIND YOU

• Website: lowcarbcardiologist.com
• I wrote a book called, Your Best Health Ever
• It is a lifestyle book
• It’s about educating you about what really works in lifestyle

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